Exam 3 Flashcards
BIG four
Vet
physician
dentist
podiatrist
What date do pharmacy interns have to renew their license by?
Sept 30 (every year)
What date do pharmacists and pharmacy technicians have to renew their license by?
June 30 (every 2 years, even numbered years)
requirements to be pharmacy techs
-18+
-graduated high school or GED
-committed no crime that will have a direct bearing on your ability to practice
3 ways for pharm techs to get licensed
- PTCB exam
- employer training
- competency based training
requirements to become a pharmacist
-18+
-committed no crime that will have a direct bearing on your ability to practice
-graduated from an accredited ACPE COP or foreign equivalent
-satisfactorily completed a board of pharmacy intern program
active pharmacist definition
- pay fees
- compliant with CE requirements
inactive pharmacist definition
- pays fees
- does not complete CE requirements
CE requirements for pharmacists per biennium
total hours: 30
what are the dates of the CE biennium period
January 1st, 2024 - December 31st, 2025
what are the dates of the licensure biennium period
July 1st, 2024 - June 30th, 2026
CE can/cannot roll over to the next years
cannot
Why are the licensure and CE months offset by 6 months?
so you can catchup on CE
30 total CE hours required
1. 4/5 must be ______ ______
2. 1/2 must be ______ ______
3. no more than 1/5 can be what type?
pharmacy practice
ACPE approved
business, management, or computer courses
an unlicensed person is what two things?
- does not hold license, permit, etc.
- not HIPAA trained
for a pharmacist to get licensed in Indiana, what are the requirements?
- 1500 hours of practical experience
- submit an application as required by the board, which is required to take the licensure exam, then must take and pass the licensure exams in english (NAPLEX and MPJE)
T/F: if you fail one of the exams, you must reapply to take it again
True
Max number of attempts to take MPJE and NAPLEX
5
If you fail more than twice, what must you do to take it again?
appear before the board to receive written permission
If the physical requirements are not met for a pharmacy as determined by the board, who will they notify and how long do they have to fix it?
the qualifying pharmacist, 30 days
how often do pharmacy permits expire and is it on odd or even numbered years?
every 2 years, odd number years
3 categories of pharmacies in Indiana
category 1: open to general public
category 2: inpatient drug orders and outpatient from institution under a prescription
category 3: not open to general public
category 1 may offer drugs or devices to:
- a long term care facility
- a health facility
- an assisted living facility
to be eligible for a pharmacy permit, a pharmacy must:
- be stationary (unless registered otherwise)
- be sufficiently secure and able to detect entry when pharmacy is closed
- be well lighted and ventilated and otherwise cleanly
- be equipped with sink and running hot and cold water, proper sewage, and refrigeration
- Be of sufficient size to allow for the practice of pharmacy
- have other equipment as required by the board to operate in compliance with state and federal law
When opening a pharmacy, a person must include what on application?
- name and occupation of the persons requesting the permit
- the location of the pharmacy
- any other information the board requires
transferring prescriptions: upon request of a patient, a pharmacy SHALL transfer to another pharmacy a prescription for a patient (including C-II), that the pharmacy has received but not filled, unless:
- prohibited in writing by the prescriber
- prohibited by federal law
This transfer must be requested by the patient, be the initial fill of the prescription, be done electronically and be communicated between two pharmacists. For any C-III, C-IV, or C-V, all refills are transferred with script
when can pharm techs transfer a prescription?
when delegated to do so by a pharmacist (includes verbal transfer)
*except controlled substances, these must be pharmacist to pharmacist transfers
For controls: written, faxed, and phone prescriptions cannot be transferred until
it has been filled once
*electronic do not have to be filled first
30 to 90 days supply requirements
- cannot be controlled substance
- prescriber does not indicate anywhere on the prescription that the quantity cannot be changed
- the patient has completed an initial 30 day supply of that therapy
- patient has to request more than 30 day supply
- prescription + included refills must contain enough for 90 day supply
when can the pharmacist change the quantity of the medication prescribed?
- If the prescribed # or package size is not commercially available
- the change in quantity is related to change is dosage form
- change in quantity reflects the intended day supply
Cannot do this with controls, compounded drugs or biologics
what a pharmacist can prescribe
- nebulizer
- inhalation spacer
- BG testing supplies
- supplies for medical devices
- syringes
- pen needles
- NS or sterile water for irrigation
- hormonal contraceptives*
epinephrine and glucagon are not things we can prescribe
a pharmacy cannot dispense epinephrine or glucagon if it expires when?
within 12 months from the date dispensed, unless the patient consents to a shorter expiration date
can a pharmacist substitute a therapeutic equivalent for epinephrine?
yes (this is not a brand to generic substitution)
pharmacists may administer 12 vaccines under protocol approved by a physician, list these
- flu
- shingles
- pneumonia
- Tdap
- HPV
- meningitis
- MMR
- Varicella
- Hep A
- Hep B
- Hib
- COVID
a pharmacist administering immunizations under protocol must:
- notify the physician who authorized the immunization and PCP
- not administer immunizations to anyone under age 11, and not for pneumonia under age 50
- must receive consent from the patient, or if under 18, the parent or legal gaurdian
within how many days must a new owner of a pharmacy submit an application to the board of pharmacy to transfer ownership ?
10 days
old permit must be returned to BOP in 10 days
A pharmacist may not supervise more than __ pharmacy interns, pharmacy technicians or pharmacy technicians in training at any time
8
no more than __ of the __ individuals that a pharmacist supervises may be techs in training
3; 8
a pharmacy can only be open without a pharmacist if:
-they obtain approval from the board
-they securely lock all legend drugs and other merchandise which can only be dispensed by the pharmacist
-they prominently display a 20” x 30” sign stating: Prescription Department Closed, No pharmacist on Duty
-only a pharmacist has access to the secured area
temporary and permanent pharmacy closure:
-if a pharmacy will be closed for __ days or more, the permit holder must notify the board of the closure and secure drugs as directed by the board
5
when can a pharmacist refill a prescription?
can be done by a pharmacist without written, electronically transmitted, or oral authorization of a licensed practitioner (normally needed) IF (must meet all criteria):
- the pharmacist made every reasonable effort to obtain authorization to refill from the prescriber (reasonable effort)
- the pharmacist believes that failure to provide a refill would be detrimental to the patient’s health (detrimental to pt health)
- the original prescription authorized refill, but not all refills were dispensed or the prescription is expired (not all refills used/Rx expired)
- the prescription was originally filled at the pharmacy where the request for refill is received, or at an affiliate sharing a real-time, online database (refilling at OG pharmacy or sharing real time, online database)
I realized theres 10 of these so I’m not writing them all
cabinet definition
medical storage device for dispensing drugs
consultant pharmacist definition
pharmacist who practices pharmacy at a LTCF or other residence other than as a supplying pharmacist
consulting definition
provision of nonsupply related cognitive services
emergency drugs definition
drugs that are required to meet immediate therapeutic patient needs, and are not available from another source in sufficient time to prevent risk of harm to patients
pharmacist in charge definition
pharmacist who directs the activities of the institutional pharmacy
quality related event definition
inappropriate provision of pharmaceutical services which may result in an adverse health incident
reversible condition definition
condition that requires intervention to resolve in a reasonable time
sentinel event definition
unexpected occurrance involving a serious adverse effect
temporary condition definition
condition that resolves in a reasonable time without intervention
pharmacist in charge duties
- establish and carry out a performance improvement program
- develop a policies and procedures manual to allow safe and effective practice
- develop policies and procedures that specify duties to be performed by pharmacy techs
absence of a pharmacist -cabinet access
-all drugs in the cabinet must be properly labeled and prepackaged, in amounts sufficient for a maximum of 24 hours of use
-when drugs are used from the cabinet, they must be tied to a physician’s order or accountability record
-drugs in cabinets must be reviewed by a pharmacist upon return to duty, not more than 24 hours later
-policies and procedures must be established to implement this section
___ supervisory nurse in any shift may have access to the pharmacy may remove drugs. that nurse must record what on a suitable form (and leave the form in the pharmacy, apparently) ?
1 nurse
- name and strength of drug
- amount
- date and time
- signature of nurse
- a copy of the order
for any emergency drugs, pharmacy policy and procedures must assure the:
-availability
-control
-security
of emergency drug carts, kits, or boxes in the pharmacy and patient care areas
a nurse removing drugs from an emergency kit must document:
name of pt
name of drug
strength of drug
quantity removed
date and time of removal
institutional drug labeling requirements:
all drugs, other than unit-of-use packages, dispensed by an institutional pharmacy must be labeled with:
- pt ID
- drug name
- strength, if applicable
- route of admin
- quantity
- pharmacists initials
- location of pt within the institution (room/bed #)
unit-of-use packages in an institutional setting must have on their label at least:
- drug name
- strength, if applicable
- control number (LOT) and/or expiration date
describe the situation(s) in which a patient may self administer drugs at an institutional facility
if specifically authorized by the treating or ordering physician and:
1. the patient’s knowledge of self-admin has been evaluated, or:
2. the patient has received training in the proper manner of self-admin by a pharmacist or according to hospital policy AND:
3. there is no risk of harm to the patient
where can pharmacy staff store drugs that a patient has brought in to the institution themselves?
pharmacy may not touch these drugs
pt can use own medications if:
- they can maintain it at bedside or under control of nursing personnel if special storage needed
AND - the nurses in charge of that pts care witness the admin and maintain records of medication use
required reference material for institutional pharmacy
- the handbook on injectable drugs
- the king’s guide to parenteral admixtures
OR - another board approved printed or electronic database with similar guidance to the above publications
if a pharmacy is preparing hazardous drugs, they must have a copy of what?
OSHA requirements for handling hazardous drugs
What is monitored in INSPECT?
ephedrine*
pseudoephedrine*
controlled substances
gabapentin (controlled in IN)
*prescription only, OTC not monitored in INSPECT
3 APRN types
certified nurse midwives
nurse practitioner
clinical nurse specialist
what PA’s cannot prescribe
ophthalmic devices
general anesthesia or deep sedation (cannot prescribe or administer)
limits for prescription ephedrine and pseudoephedrine
none
limits for OTC ephedrine and pseudoephedrine
max of 3.6g in one day
max of 7.2g in one 30 day period
max of 61.2g in one 365 day period
*must be 18+
ephedrine and pseudoephedrine sales log requirements
-kept for 2 years and include:
1. name and address of purchaser
2. ID presented
3. government entity issuing the ID
4. ID number
5. product purchased, including grams of the product and date and time of the transaction
limits for dispensing a C-V without a prescription
not more than 8oz or 48 doses of a substance containing opium or 4oz or 24 doses of any other C-V
main requirement for (rx or not rx) controlled substance labels
must have “federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed”
age you can buy C-V without prescription
18+
age you can buy syringes/needles without prescription
no restrictions
non prescription C-V, needles and syringes must be recorded in bound book and include:
- name and address of purchaser
- name and quantity of product purchased
- date of each purchase
- name or initials of the pharmacist dispensing the product
does a pharmacy intern need pt consent to admin a vaccine
yes, must identify themselves as intern and receive consent from pt
pharmacists may independently prescribe and dispense hormonal contraceptives to pt ___ years old or older. This includes:
18
1. hormonal contraceptive patches
2. self-admin hormonal contraceptives
for pharmacist to independently prescribe hormonal contraceptives, they must:
- complete training
- self-screening to pt
- refer to PCP
- advise they meet with PCP and provide written record of the product
- if RPh works at site with APRN, physician, or PA, suggest pt see one of them
- Rx may not be for more than 6 months
name the 6 sanctions and define them
revocation: license taken away permanently
suspension: license taken away temporarily
probation: can practice but with limits or additional requirements
letter of reprimand: written expression of disapproval
censure: verbal expression of disapproval
Fine: up to $1,000 for each violation
all prescribers are required to transmit controlled substances electronically except which 2
vet
med resident
a prescription for an opioid may not be written for greater than 7 days if:
-if the pt less than 18
-if the medication being prescribed is the first time for this pt by this provider
-same as above for animal for vets
exemptions for the 7 day opioid limit
-cancer
-palliative care
-medication assisted treatment for SUD
-a condition exempt by the medical licensing board
cannot substitute brand for generic if prescription written by a ____
vet
can community pharmacies have drug samples
no, none at any time
