IMM 18: MTM in CP III – Rx Adaptation Flashcards
What are the principles that must be met when adapting a prescription? (8)
- individual competence
- sufficient information about health status
- prescription – is current Rx authentic and valid
- sufficient information about any previous adaptations
- appropriateness
- informed consent
- documentation
- notification of other health professionals
What are the three types of activities permissible when adapting a prescription?
- changing dose, regimen, or formulation of a prescription
- renewing prescription for continuity of care
- making therapeutic drug substitution within the same therapeutic class for the prescription
When can a pharmacist change the dose and/or regimen?
- strength of the drug is not commercially available – ie. RX written for Naproxen 400mg (commercially available as 250mg, 375mg, 500mg)
- patient’s age, weight, or kidney/liver function requires a change of dose and/or regimen – ie. RX written for Cephalexin 500mg QID for patient with reduced kidney function (GFR = 48mL/min) → change to Cephalexin 500mg TID
- change in dose and/or regimen would otherwise benefit the patient – ie. reducing dose to decrease risk of adverse effects
When can a pharmacist change the formulation or regimen?
change improves the ability of the patient to effectively take the medication
- ie. betamethasone 0.1% cream prescribed for eczema, but patient’s skin is also dry and scaly, and would benefit from a more moisturizing formulation adapt RX to ointment
- ie. prescription for Diclofenac 25mg three times daily, but patient only remembers to take morning dose – adapt RX to Diclofenac SR 75mg once daily
When can a pharmacist change the dose, formulation or regimen for a narcotic, controlled drug, or targeted substance?
as long as the quantity dispensed does not exceed the stated amount authorized in the prescription, and if:
- the strength of the drug is not commercially available
- in the case of a change in dose and/or regimen – client’s age, weight or kidney or liver function requires the change, or the change would otherwise benefit the client
- in the case of a change in formulation and/or regimen, the change would improve the ability of the client to effectively take the drug
ie. RX written for M-Eslon 10mg qHS x 30 capsules can be adapted to M-Eslon 5mg BID x 60 capsules (does not exceed the stated amount authorized in the prescription
Can pharmacists adapt a prescription if Rx information is incomplete?
yes – may change the dose, quantity, formulation or regimen of a prescription if the information provided is incomplete or ambiguous, but the intended treatment can be determined through:
- consultation with client
- review of client records – local profile, PharmaNet record
Can pharmacists adapt a prescription for a narcotic, controlled drug, or targeted substance if Rx information is incomplete?
yes – as long as the quantity dispensed does not exceed the stated amount authorized in the prescription
- but the intended treatment can be determined through consultation with client, and review of client records
When can pharmacists renew prescriptions for continuity of care?
- no clinically significant change to the prescription for a minimum of 3-6 months – to be assessed at the time of each renewal by reference to accepted clinical practice applicable to the condition being treated
- the condition being treated is stable
How long can pharmacists renew prescriptions for continuity of care?
may renew a prescription for an appropriate time period as long as it does not exceed the expiry date of the prescription
- prescriptions are valid up to 2 years from the date they were written
How long can pharmacists renew prescriptions for a narcotic, controlled drug, or target substance for continuity of care?
for a time period that does not exceed the same duration as prescribed or 30 days, whichever is greater– if permitted under a section 56 exemption to the Controlled Drugs and Substances Act
When can pharmacists make therapeutic drug substitutions within the same therapeutic class for prescriptions?
must be satisfied that the dose and dosing regimen of new drug have an equivalent therapeutic effect as the prescribed drug
When making therapeutic drug substitutions, what must pharmacists ensure of for the new drug?
new drug is approved for the intended indication by Health Canada, or evidence supports using the drug for the intended indication (ie. it is considered a best practice, or is accepted clinical practice in peer-reviewed clinical literature or clinical practice guidelines)
Can pharmacists make a therapeutic drug substitution for a narcotic, controlled drug, or targeted substance?
no
What are some drugs in the NSAIDs class?
(for pain and inflammation)
- ibuprofen
- naproxen
- diclofenac
- indomethacin
- ketorolac
- celecoxib
- meloxicam
What are some drugs in the HMG-CoA reductase inhibitors (statins) class?
(for high cholesterol)
- rosuvastatin
- atorvastatin
- simvastatin
- pravastatin
- lovastatin
- fluvastatin
