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PHAR 112 > Drug Distribution by Prescription > Flashcards

Drug Distribution by Prescription Flashcards

1
Q

What are some examples of narcotics?

A

Buprenorphine
Cocaine
Codeine
Fentanyl
diphenoxylate/atropine (Lomotil)
* hydromorphone (Dilaudid, Hydromorph
Contin)
* hydrocodone
* methadone
* morphine (MS Contin, Statex, Kadian)
* nabilone
* oxycodone (OxyNeo)
* tramadol

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2
Q

What is the criteria for verbal prescription narcotics?

A

contain a narcotic and two or more non-
narcotic drugs in a therapeutic dose;

  • are not intended for parenteral use; and
  • do not contain diacetylmorphine (heroin), hydrocodone, methadone, oxycodone or pentazocine.
  • Examples include:
    Codeine/butalbital/caffeine/acetylsalicylic
    acid (Fiorinal C1/4 & C1/2)

Codeine/guaifenesin/pheniramine
(Robitussin AC)

Codeine/caffeine/acetaminphen (Tylenol
#2 & #3)

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3
Q

What is the criteria for low-dose codeine preparations?

A

Low-dose Codeine Preparations contain:
* codeine up to 8 mg/ solid dosage form, or
not more than 20 mg/30 mL of liquid, and
* 2 or 3 active non-narcotic ingredients.

  • Examples include:
    Codeine/caffeine/acetaminphen (Tylenol
    #1)

Codeine/doxylamine/acetaminophen
(Mersyndol)

Codeine/methocarbamol/acetaminophen
(Robaxacet-8)

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4
Q

Can normal narcotics be verbally transmitted?

A

No (but an exemption is in place rn)

Written prescription signed and dated by a
practitioner.

The pharmacist must verify the signature of
the practitioner if it is not known to them.

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5
Q

What types of narcotics can be verbally prescribed?

A

Verbal Prescription Narcotic:
May be prescribed verbally. Pharmacist
must create a written record of the verbal
prescription.

The pharmacist must take reasonable
precautions to determine the person calling is a
practitioner.

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6
Q

What are some rules for pharmacists regarding low-dose codeine products?

A

Low-dose Codeine Preparations:
No prescription required for a low-dose codeine
preparation. However, if a prescription is
provided, all prescription-related requirements
for narcotics apply.

Pharmacist may only sell a low-dose codeine
preparation if they have reasonable grounds to
believe the preparation is to be used for
recognized medical or dental purposes.

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7
Q

What are the labelling requirements for narcotics?

A

Class A Opioids (see Opioids List – Part A):
When dispensing to patients, must be
accompanied by a warning sticker and patient
information handout as specified by Health
Canada.

Low-dose Codeine Preparations: The inner and
outer label must caution that the preparation
contains codeine and should not be
administered to children except on the advice
of a physician, dentist or nurse practitioner.

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8
Q

Are refills for narcotics permitted?

A

Not permitted.

However, a narcotic prescription may be part-
filled. A part-fill is the dispensing of a quantity
of drug which is less than the total amount of
the drug specified by a practitioner when the
prescription was originally written or issued.

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9
Q

Are transfers of narcotics permitted?

A

Not permitted (but an exemption is in place rn for transfers between pharmacists)

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10
Q

What are the requirements for a information on a prescription for narcotics?

A

Patient’s date of birth;
* Patient’s address;
* Patient’s health services number;
* Practitioner’s name and address; and
* Total quantity of drug prescribed, both
numerically and in written form (both forms not
required if Rx is by electronic transmission).

No refills permitted. A smaller portion of a total
quantity may be dispensed at specified intervals

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11
Q

What are some Part 1 Controlled Drugs?

A

Part I includes:
* amphetamine salts (Adderall)
* dextroamphetamine (Dexedrine)
* lisdexamfetamine (Vyvanse)
* methylphenidate (Biphentin, Concerta,
Ritalin)

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12
Q

What are some Part 2 Controlled Drugs?

A

Part II includes:
* butalbital/acetylsalicylic acid/caffeine
(Fiorinal, Tecnal)
* phenobarbital

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13
Q

What is the only Part 3 Controlled Drug?

A

Part III includes:
* testosterone

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14
Q

Are verbal prescriptions of controlled drugs permitted?

A

Written and verbal prescriptions are permitted (No federal requirements)

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15
Q

Are refills for Controlled Drugs permitted?

A

Permitted for written prescriptions of controlled
drugs listed in Part I.

Permitted for written and verbal prescriptions
of controlled drugs listed in Part II and III.

Refills for all controlled drugs must include:
* Number of times that it may be refilled
(“PRN” is not valid for refills); and
* the dates for refills, or the intervals between
refills.

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16
Q

Are transfers of controlled drugs permitted?

A

Not permitted (but an exemption is in place rn for transfers between pharmacists)

17
Q

What are some special prescription storage tecniques used for controlled drugs?

A

Purchase records for controlled drugs listed
in Part I must be maintained in a book,
register or other record exclusively for
controlled drugs.

Purchase records for Part II
and III may be maintained in a different
manner. (See Health Canada references in
Resources section below.)

18
Q

What are some benzodiazipines?

A

usually end with -pam

alprazolam (Xanax)
* bromazepam
* chlordiazepoxide (Librium)
* clobazam
* clonazepam (Rivotril)
* diazepam (Valium)
* lorazepam (Ativan)
* midazolam
* oxazepam
* temazepam (Restoril)
* triazolam

but excluding:
* clozapine (Clozaril)
* flunitrazepam (Rohypnol)
* olanzapine (Zyprexa)

19
Q

What is the only example of a targeted substance that is otherwise associated with benzodiazipines?

A

Zolpiderm

20
Q

Can prescriptions for benzodiazepines and other targeted substances be prescribed verbally?

A

Written prescription signed and dated, or
verbal prescription from practitioner. (Both are fine)

Verbal Prescription Requirements:
Pharmacist must create a written record of the
verbal prescription showing:
* Patient’s name and address;
* Date;
* Name of the drug;
* Quantity and strength per unit of the drug;
* Pharmacist’s name;
* Practitioner’s name;
* Directions for use;
* Number of refills and interval if specified.

21
Q

What are some of the labelling requirements in benzodiazepines and other targeted substances?

A

Name and address of pharmacy;
* Dispense date and prescription number;
* Patient’s name;
* Practitioner’s name;
* Name of drug;
* Quantity and strength per unit of the drug;
* Directions for use.

22
Q

Are refills of benzodiazepines and other targted substances permitted?

A

Permitted for written and verbal
prescriptions.
* Specific number of refills must be specified
(“PRN” is not valid for refills).
* If interval for refill is specified, must only refill
when interval has elapsed.
* Valid if less than one year has elapsed since
the date the prescription was issued.

23
Q

How many times can benzodiazepines and other targeted substances be transferred between pharmacies?

A
  • May be transferred only once.
  • Written or verbally between pharmacists.
  • Written transfers - must obtain a copy of the
    written prescription or written record of a
    verbal prescription.
  • Verbal transfers - must record same
    information as required for Verbal
    Prescriptions.
24
Q

While waiting for a transfer prescription for benzodiazepines or other targeted subtances, the pharmacist must transmit the following information:

A

Transferring pharmacist must record:
o Date of transfer;
o Name of receiving pharmacist;
o Name and address of receiving
pharmacy;
o Refills remaining.

25
Q

What information should a pharmacist acquire when receiving a verbal prescription for benzodiazepines and other targeted substances?

A

Receiving pharmacist must record:
o Name and address of the transferring
pharmacist;
o Refills remaining and interval if
applicable;
o Date of last refill.

26
Q

What are some examples of prescription drug list (PDL)?

A
  • amlodipine
  • baclofen
  • candesartan
  • furosemide
  • gabapentin
  • metformin
  • metoprolol
  • oxybutynin
  • pantoprazole
  • pregabalin
  • ramipril
  • ranitidine
  • rabeprazole
  • rosuvastatin
  • salbutamol
27
Q

Can PDL drugs be prescribed verbally?

A

Written or verbal prescription from practitioner are fine, do whatever is comfortable

28
Q

How do transfers between equipment affect occur in PDL drugs?

A

Written or verbally, between pharmacists or
pharmacy technicians.
* Written transfers - must obtain a copy of the
written prescription or written record of a
verbal prescription.
* Verbal transfers - must record same
information as required for Verbal
Prescriptions.

29
Q

What information should the receiving pharmacist obtain in transfers?

A

Receiving pharmacist / pharmacy
technician must record:
o Name and address of transferring
pharmacist / pharmacy technician;
o Refills remaining;
o Date of last refill;

30
Q

What information should the transferring pharmacist obtain when processing a transfer request?

A
  • Transferring pharmacist / pharmacy
    technician must record:
    o Date of transfer.
31
Q

Can PDL drugs have refills?

A

Refills are permitted. PDL drugs do not need to
meet part-fill requirements of the PRP. See
Regulatory Update here.

PHAR 112 (2 decks)

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