K1. Adaptations

Question 1

What is the def of an ADAPTATION (3)?

Answer 1

1) changing the dose, formulation, or regimen/frequency of an Rx

2) RENEWING for continuity of care; or

3) making a THERAPEUTIC SUB within the SAME therapeutic CLASS for an Rx.

Question 2

What are the criteria Rph’s must meet when ADAPTING an Rx?

Answer 2

a) must be COMPETENT (therapeutics)
b) must have sufficient info (i.e. SCHOLARE, medical hx)
c) Rx must be: ORIGINAL, CURRENT, AUTHENTIC AND VALID (note can include transferred prescriptions as long as they’re ORIGINALS).
d) adapting must be APPROPRIATE
e) must get informed consent from pt or pt’s rep.
f) DOCUMENTATION must include:
- pt info (PHN)
- pharmacist info, signature*, and name of pharmacy.
- ORIGINAL rx info, including prescriber’s name, and contact info;
- a DESCRIPTION of the adaption and relevant Rx details (i.e. switched to what drug and what strength ).
- the RATIONALE for adapting, the assessment, pt hx, instructions fiven to pt and F/U plan (basically, must include full DAP note with monitoring and f/u).

g) NOTIFICATION of other original prescriber within 24 hrs of dispensing (unless it’s a formulation change, or brand to generic switch).

Question 2

What are the 3 conditions under which an Rph can change the dose/regimen of an Rx?

Answer 2

a) if the STRENGHT of the drug is NOT COMMERCIALLY AVAILABLE;

b) if the pt’s AGE, WEIGHT, OR ORGAN FXN requires a change in dose or regimen; or

c) if the change in dose/regimen would otherwise benefit the pt (I.E. IEASA -> if dose too high, dose subtherapeutic, to improve adherence (ie. switching metformin from 2g daily to 1g BID to dcr GI upset).

Question 2

***Can an Rph continue adapting a REFILL of the original Rx that they already adapted once before?

Answer 2

NO!! Rx’s can only be ADAPTED ONCE. for Further adaptations, must contact prescriber to get a new rx or VPO.

However, refills can continue being refilled as the ADAPTED rx was written.

Question 2

When would you change the FORMULATION of an Rx?

Answer 2

For adherence reasons (i.e. swallowing, a child etc)

Question 3

Can an Rph ADAPT an Rx DOSE, QUANTITTY, FORMULATION OR REGIMEN if the info provided is INCOMPLETE (i.e. unsure of indication, sig incomplete or regimen is unusual)?

Answer 3

YES, Rph can make an informed decision to ADAPT an incomplete Rx IF INTENDED TRX can be determined by speaking to the pt and reviewing pt’s record (i.e. medical hx shows they clearly have GAS-> can switch to appropriate dose).

eg//

Amnox 500mg (is missing frequency)
–> could change to 500 mg TID x 10 days if confirmed with pt they were using for CAP.

Question 4

Renewal for Continuity of Care:

What does it mean to renew an Rx fo rhte purpose of continuity of care?

Answer 4

means there has been NO Rx changes IN THE PAST 6 MOS (AT MINIMUM) and condition is STABLE.

Question 5

How LONG can an Rph RENEW an Rx for?

Answer 5

Technically, for any appropriate period as long as it does not exceed the EXPIRY OF THE ORIGINAL RX.
[however, it’s usually not more than 3 mos so they can go back to their provider for checkups, but can be case by case]

Question 6

Can Rph’s RENEW NARCOTICS AND CONTROLLED SUBSTANCES?

Answer 6

NO!!! (w/o covid exemption)

• Currently with covid exemptions technically they can (expires Sep 2026).

Question 7

Therapeutic Drug Sub:

What is considered a “therapeutic sub”?

Answer 7

A switch within the SAME THERAPEUTIC CLASS.

Question 8

What can Rph’s NOT ADAPT? (6)

KNOW

Answer 8

i) CONTROLLED SUBSTANCES (I.E. narcotics, controlled substances, benzos and targeted substances)
ii) Chemo agents
iii) a PREVIOUSLY ADAPTED RX (included previous Rph initiated renewals)
iv) If Rx says DO NOT ADAPT on it
v) an Rx from a VET
vi) an emergency supply for continuity of care.