Law Review part 2 Flashcards
What happens if cant pass the board exams after 4 tries?
Have to take 16 semester unites required
If a PA, NP etc prescribes soemthing, who’s name has to go on the label of the bottle?
can be the name of the physician or the the PA, NP etc
ratio of pharmacist to techs? what is it for clerks?
the first pharmacist can have just 1 tech, any additional pharmacist adds two more techs. No limit for number of techs
Who can call in a prescription into the pharmacy?
a person working under the physician can call in a prescripition. Pharmacist has to do their best to make sure its legitimate.
Can any person call in a schedule II phone prescription?
No, only a physician can call in a schedule II as long as its an emergency.
Can all prescriptions be sent electronically to pharmacist?
All can be sent as e-prescriptions except schedule II drugs. Schedule II must be on security prescription blank.
what does a pharmacist do when he or she receives a valid phone prescription of e-prescription?
Must commit the prescription onto a prescription blank, sign and date
Can a pharmacist fill out of state RXs?
Yes but there are different rules for out of state scheduled medications
Can a pharmacist in california fill an out of state prescription for schedule III, IV, V?
Yes under certain conditions. If written, must be on a scheduled security form for III, IV, V. They can also be called in and then RPH must write a hard copy
Can you fill an out of state schedule II med?
NO,
what expiration date should you put on the bottle of a prescription?
the date of the manufacturer expiration or 1 year from the dispense date, which ever is earlier.
what is the expiration date of a compounded non-sterile product?
6 months from the date it was compounded, unless one of the ingredients expires before that
what is the expiration of an extemporaneous preparation of a unit dose drug packaging
1 year or MFG expiration date whichever is earlier
if a doctor writes PRN refills, for how long can you refill the medication?
Up to a year, then need to call doctor to get authorization again. CANNOT refill controlled substances as PRN
can a pharmacist dispense less than what was prescribed by the doctor?
yes can give less than whats on the prescription
Can I refuse to fill a prescription?
yes, as long as the pharmacist has made arrangements with the pharmacy about what RXs they dont want to fill. When they get the prescription, they must do their best to make sure the patient gets the med filled in a reasonable time at another pharmacy
if a medicine is not in stock, what does the pharmacist have to do?
- tell the pt immediately and arrange so that they get the med in a timely manner
- You can transfer it to another pharmacy that has the medication
- Can return the rx to the patient, and refer them to a pharmacy that has the RX
Based on california law, can a medicine be used off - label?
Only in two situations 1. It is for a life-threatening condition 2. Its for chronic or disabling condition
can a pharmacist write false information on the bottle of a label?
Generally no, unless there are two situations 1. As part of an investigational program approved by the FDA 2. when presciber is scared that the pt will become addicted to a med so the prescriber gives a placebo ( the pharmacist still puts the name of the active drug on the label)
Can emergency rooms dispense medications directly to patients?
Generally NO, unless certain conditions are met 1. hospital outpatient is closed or RPH not available. 2. ER must keep of the dispensing 3. Staff must believe no pharmacy nearby is open 4. Amount dispensed is the amount necessary to not interrupt therapy MAX 72 hour supply
Can a doctor prescribe a dispense a medication directly?
yes as long as 1. its is labeled correctly and intended to be given in the office. Doctor needs to keep a record .2. NP, PA, RPH can give med to patient prepackaged 3. Samples can be given by doctor as long as they are in the MFG package and the patient doesnt pay any money for them.
Do all medications need to child resistant?
Generally Yes, unless 1. They are topical application meds 2. If the patient requests its (recommended that pt submits this in writing, but not required
Maximum hours pharmacist can work?
108 hours within the span of 2 weeks ( 9 hours a day for 6 days). If you work more than 40 hours per week, you deserve overtime pay. > 8 hours = X 1.5 and > 12hours/day X 2 pay . There are some exceptions to this MAX 1. 2/3 employees vote for a diff max 2. Bargaining agreement 3. In emergencies to protect life 4. Pharmacist has a second job
Can a pharmacist leave for their break for lunch or other breaks?
Can go to the restroom, can take regularly schedules breaks, yes for meals
These rules apply: Pharmacist must believe that meds and devices will be safe 2. Techs and clerks cannot give a prescription drug to a patient if it was not previously cleared by pharmacist, if it is not a refill , if a consultation is required . MAX 30 min break that doesnt have to be in the pharmacy
how often to renew pharmacist license?
every 2 years
How long does it take so that you cannot renew your pharmacist license after expires?
3 years after it expires, you cannot renew it any more , then the pharmacist has to take the board exam again if they want their license back. you cant renew also if you dont pay your child support or you default on your government student loans
Can a celebrity change their name on their prescription to hide their identity?
No , by law the need to use their legal name
whats the purpose of the quality assurance program
to document medication errors so you can prevent future errors. They have policies and procedures of how to deal with errors and who needs to be notified of the error (patient and doctor)
by law, what is required for a new prescription consultation ?
- how to use the medication
- importance of complying with instructions on the label
- how to store the medication
- sever adverse events or DDIs expected
What if a patient has a bad reaction to an immunization? who covers the cost?
The mfg covers the adverse effects or allergic reactions. make sure pharmacist insurance also covers immunizations
whats the difference between the quality assurance record of an error VS and incident report of an error
QA: mainly maintained in the pharmacy to learn from previous mistakes, no names are necessary and they are not discoverable IR: for the pharmacy insurance company, names must be stated, and they are discoverable which means can be used in arbitrations, civil actions, or other proceedings
Can a pharmacist refill a medication when no refills left and cannot get a hold of the prescriber?
its up to the pharmacists for all med and schedule 3, 4, 5 . If you decide to give a refill, give enough to not interrupt therapy or until you know you can contact the prescriber. Cannot give a full refill for a scheduled medication
if a prescriber calls in an emergency Scheduled II med, when do they have to provide the RX in security form?
they have 7 days to give the security form, otherwise the pharmacist has to report it within 6 days
what do you write on a refill that you self-authorize (on the back)?
date
amount of drug given
reason for continuing refill
initials
All oral contraception couseling (EMERGENCY)
- ask if they are allergic to any component?
- Make sure that the timing is right (max 120 hours for effectiveness)
- Give a fact sheet
- Need to document that EC was given to patient in their medication profile
Requirement for a valid prescription
- handwritten signature and date signed (by hand)
- Name and address of patient
- Drug name, quantitiy, SIG
- Date issued (if controlled subtance must be in handwriting of prescriber)
- Name address, tel # of prescriber
- License classification of presciber, fed reg #
- Optional (condition prescribed for)
What do you require on the label for the drug name if it is a generic?
Required you to put the MFG name along with the drug name
whats required on a prescription label?
- Pharmacy name, address, rx #, and date issued
- Pt name
- Prescriber name
- Drug name, strength, quantity, expiration, color, shape, ID code
- RPH signature not legally required unless an Intern or tech filled it! :D
which types of meds dont have the standard expiration date for meds?
Antibiotics
certain eye/nose drops
insulin
compounded products
information on record required for refills
date it was dispensed initials of dispensing pharmacist quantity dispensed (if different) MFG if generic Name of person who authorized the refill and quantity
What is required on the medication profile for a patient ?
- pt name, address, phone #, DOB, Gender, allergies
- Drug name, strength, dosage form, route, quantity, SIG
- Prescriber name, appro license #, DEA #, drug dispensed, prescription #
Can you fax any prescription to a pharmacy?
Yes prescriber can fax but cannot fax any schedulled II prescriptions
can pharmacies fax each other prescriptions?
Yes except schedule 2 meds. The fax is considered a transfer, so it needs to be written down as a transfer on a prescription blank by the pharmacist.
what information is required for a transfer on a prescription blank?
Last dispensed date
Original dispensed dated
Refills remaining
RX #
date transferred and who transferred it
Is there a maximum number of times that meds could be transferred between pharmacies?
There is no limit for non scheduled drugs (each time they are transferred, need to write a new prescription, even if a previous one already existed)
For schedule 3,4,5 can only be transferred once
Sched 2 CANNOT be transferred
What info needs to be recorded on a prescription that was transferred to the pharmacy?
Receiver writes “Transfered” and sender writes “void”
record: date of transfer, name and address of receiving pharmacy, federal registration # of receiving pharmacy, number of refills left
Do patients need a prescriptions for syringes and needles?
YES, unless
- the pharmacist knows that the patient has gotten them previously there and is using them for legitimate purposes
- part of a program to stop HIV or HEP C
- Will be used on animals
What maximum for number of syringes or needles sold to a person without a prescription?
10 max for a person 18 or older
What is considered a state of emergency to give meds without a prescription?
Earthquake, flood, mudslide, bomb, nuclear attack, terrorism
must be declared a state of emergency by the government
what meds can be given to patients in a state of emergency?
meds known to be normally given to the patient
must keep records: pt name, address, drug name , strength and quantity
must notify physician ASAP
Can you get a prescription through email?
yes as long as it has the right information for a prescription. Make sure that it is legitimate such as Prescriber name, identity, address, license classification, fed registration # , entry date, receipt date and date of dispensing etc
Can you repackage a previous?
Yes, as long as you label the new bottle with a normal prescription label
By law, when are you required to give a consultation?
- Any changes in dosage for
- any changes in dosage strength
- It is a new prescription
- if the patient requests it
- if the pharmacist deems it necessary
what must you do if you cannot communicate with patient that speaks another language?
Must make a good faith effort to talk to patient and contact someone who does speak the language
document inability to provide consultation and reason why could not provide consultation
Is a consultation for a mail/delivery pharmacy?
No, but need to have a written notice of right to receive consultation with a number to call that is 24 hours like an 800 number or the pharmacy phone number is ok TOO
When are you not required to give a price quote over the phone?
- when it is a controlled substance
- request by a competitor
- a request from out of state
When an auxilary label required on a bottle?
- if the med can cause drowsiness
- if it can affect vision
- if in combination with ETOH can cause drowsiness or other harmful effect
- any med packs
drugs that require a drowsiness warning
muscle relaxants analgesics that cause CNS depression antipsychotics antidepresssants antihistamines motion sicknesss meds antipruritics anticonvulsants antinausea antihypertensives with cns depressive effects anticholinergics disulfirma like reactions
What contraceptives require the Package insert to be included with med?
Any OC that contains estrogen! if no estrogen, dont require package insert
which medications require the MED guide
Amiodarone Antidepressants Advair/Symbicort Fentayl Insulin Isotretinoin mefloquine NSAIDS Emsam (selegiline) pimecrolimus/ tacrolimus warfarin teriperitide
what is the BBW for fluoroquinolones?
Tendinitis and tendon rupture
what is the BBW for antidepresants?
suicidal ideation for 18 - 24 yo especially in the first or second month after beginning
BBW for sodium phosphate preparations
could lead to kidney damage
can you substitute a brand for their generic?
generally yes as long a the chemical ingredient, strength, quantity and dosage form are identical.
MUST inform patient that you substituted the product in order to save them money
MUST type the mfg name next to the generic name on the label
can you change the dosage form of a prescription?
Yes from capsule to tab to oral liquid or vice versa, as long as the strength and duration of effect are equivalent. UNLESS, prescriber says no substitution is allowed. In written form for DO NOT SUBSTITUTE must write initials right next to that part
can a pharmacist store and dispense samples of meds?
Only in emergencies like drug supply shortages so generally no. prescribers, people under prescribers, hospital pharmacies under a protocol can though
what is the maximum pseudoephedrine that can be sold
must be 18 or older with state and federal ID
3.9 grams in one day or 9 g in a month
a 60mg or two 30mg do not require logging in the book
what is required in the ephedrine, pseudofed, phenylpropanolamine LOG BOOk
Name, strength, quantity
address , date of sale
signature
what is considered compounding according to FDA?
no relation with patient and prescription
exact generic products made that are FDA approved
high volume filling in anticipation of prescriptions
can a pharmacist compound medications for a doctor?
Yes as long as you give a reasonable quantity: enough that is enough for the doctor to use within the expiration date (180 days max)
What is the max amount of drug a doctor can give directly to a patient?
max 72 hour supply
compounded med is administered at the doctors office
What must you record on meds that will be used of the future after you have compounded them?
date of preparation lot # expiration of each ingredient expiration of furnished products max 180 days signature of RPH raw material quantity MFG units made and package size
what is the schedule of benzodiazepines?
IV
what is the schedule of buprenorphine
V
what is the schedule of any schedule II med that is in combo with a non stimulant ?
III (except vicodin)
what is the schedule of steroid like combinations?
Schedule III
what is the schedule of alfentail?
II
what is the schedule of Z drugs?
IV
what is the schedule of meperidine
II
what is the schedule of methadone
II
what is the schedule of morphine, apomorphine, hydromorphone, oxymorphone,
II
what is the schedule of phenobarbital?
IV
what is the schedule of carisoprodol - soma
IV
what is the schedule of codeine, dihydrocodeine, oxycodone,
II
what is the schedule of fentanyl, sufentanyl
II
what is the schedule of amphetamines
II
What is the CURES program and what is the purpose?
Purpose is to mitigate abuse of scheduled medications
it is a program in which you report all prescriptions of Schedule 2,3,4 medications every week
How often do you need to report medications to the CURES program?
every week
what quantities need to be reported to CURES?
for scheduled IV only if its a supply greater than 48 hours
for schedule 2 and 3 only if greater than 48 hour supply report weekly , otherwise report monthly
what is the only exception of when a schedule II prescription is not required to be on a security form?
for a terminally ill patient with the 11159.2 exemption
what happens if a controlled substances prescription is missing the signature and date by hand of the prescriber?
Must return the prescription and have the prescriber sign by hand
what happens if there is an error on a scheduled medication on 3, 4, 5?
the pharmacist can call the prescriber and document the correction on the prescription like a typical prescription
what is the expiration of a scheduled II prescription?
6 months
what is the expiration of a prescription for a terminally ill patient?
60 days
filing scheduled 2, 3, 4, 5 prescriptions with other prescriptions
Schedule 2 need to separate from other prescriptions
3,4,5 can be filed separately or if they are with the general prescriptions, must stamp them with a red C
Can you phone in prescriptions for scheduled meds?
Yes for 3,4, 5 but NO for schedule 2. Schedule 2 only in emergency situations
What do you do if you get an emergency schedule II prescription?
write it down on a blank prescription form and then destroy that form once you receive the replacement prescription from the doctor
MUST write “authorized for emergency dispensing”
when must you receive the replacement security prescription for an emergency Schedule 2 prescription? what if you dont?
7 days and you must notify the dea in 144 hours (6 days) after not receiving the security form
for how long do you need to keep a record of an incident where you dont receive the schedule 2 security form?
for 3 years. Write name of prescriber, name drug , strength,quantity,
date and method that DEA / bureau of narcotic enforcement was contacted
name of person contacted at the DEA
can a pharmacist store and dispense samples of meds?
Only in emergencies like drug supply shortages so generally no. prescribers, people under prescribers, hospital pharmacies under a protocol can though
what is the maximum pseudoephedrine that can be sold
must be 18 or older with state and federal ID
3.9 grams in one day or 9 g in a month
a 60mg or two 30mg do not require logging in the book
what is required in the ephedrine, pseudofed, phenylpropanolamine LOG BOOk
Name, strength, quantity
address , date of sale
signature
can a pharmacist store and dispense samples of meds?
Only in emergencies like drug supply shortages so generally no. prescribers, people under prescribers, hospital pharmacies under a protocol can though
what is the maximum pseudoephedrine that can be sold
must be 18 or older with state and federal ID
3.9 grams in one day or 9 g in a month
a 60mg or two 30mg do not require logging in the book
what is required in the ephedrine, pseudofed, phenylpropanolamine LOG BOOk
Name, strength, quantity
address , date of sale
signature
can a pharmacist store and dispense samples of meds?
Only in emergencies like drug supply shortages so generally no. prescribers, people under prescribers, hospital pharmacies under a protocol can though
what is the maximum pseudoephedrine that can be sold
must be 18 or older with state and federal ID
3.9 grams in one day or 9 g in a month
a 60mg or two 30mg do not require logging in the book
what is required in the ephedrine, pseudofed, phenylpropanolamine LOG BOOk
Name, strength, quantity
address , date of sale
signature
what must they write on the prescription for the 11159.2 rule?
11159.2 exemption . If there is an error must send it back within 72 hours, cant call to correct. Must have the necessary information fora prescription, and a signature and date
what is considered terminally ill?
incurable and irreversible disease in which patient will die
treat symptoms of pain, do not cure
what if patient requests to get a smaller amount of a schedule 2 meds?
yes patient can get a smaller amount of med, but pharmacist needs to notify the doctor that pt go smaller amount . Patient can get the remaining amount later
what happens if can only fill a partial amount of a schedule II medication because there is no more in stock?
pharmacy must fill the remaining within 72 hours, but if cant within that time, need to contact prescriber for a new prescription on a security form
Refrigerate azithromycin (z max)
NO
Refrigerate Augmentin?
YES
Refrigerate Biaxin - Clarithromycin?
NO cuz bitter taste and thickens gels
Refrigerate cefaclor?
YES
Refrigerate Clindamycin (cleocin) ?
NO can thicken and crystalize
Refrigerate cefpodoxime?
YES
Refrigerate Voriconazole VFEND?
NO
Refrigerate cefuroxime?
YES
Refrigerate Cefdinir?
NO
Refrigerate Cephalexin?
YES
Refrigerate cipro ?
NO
Refrigerate erythromycin ethylsuccinate/ sulfisoxazole?
YES
Refrigerate doxycycline ? vibramycin
NO
Refrigerate penicillin VK?
YES
Refrigerate amoxicillin ?
YES for improved taste
Refrigerate fluconazole ?
NO
Refrigerate levaquin ?
NO
Refrigerate linezolid ?
NO
Refrigerate SMX/TMP?
NO
what are the refill limits of shedule 2 meds
NO REFILLS
what are the refill limits of schedule 3, 4, BUT NOT 5
max 5 refills within 6 months
max 120 day supply
can you give an emergency supply of schedule 3, 4, 5 meds when you cannot contact the prescriber?
Yes, but only the ammount sufficient until you can contact the prescriber again Ie a 72 hour supply max
Can you fill an out of state prescription for a schedule 2 med?
only if the prescriber is a CA licensed prescriber and they submit the RX in a CA security form. OTherwise, pretty much no
Can you fill an out of state prescription for schedule 2 that is for mail order?
yes as long as you fulfill the requirements of the state that you are exporting the medicine to
Can you fill an out of state prescription for schedule 3, 4, 5
yes as long as the prescriptions are on security blanks. They could also phone in the prescription , or transfer it in electronically
prescriber needs a legit DEA license, Its a good idea to call the prescriber back to verify it.
How to verify a Valid DEA number
add the odd numbers
add the even numbers and multiply it by 2
add the first two answers and make sure the last number of the answer is the same was the last number of the DEA number
Can you have controlled substances in a multiple check off list?
yes as long as they are in security form
how often do you need to take inventory of controlled substances? Do you need exact numbers
every 2 years, For schedule 2 you need exact numbers. For 3, 4, 5 you need estimates unless the vial has more than 1000 units, then you need exact
what form do you use to get rid of controlled substances
DEA 41
what will the board be inspecting at your pharmacy?
every prescription is complete
have necessary equipment
no outdated or damaged prdocutcs, no dirty medications
every patient is counseled on a new medication
patients have a medications profile
have all lonaed, bought and sold meds logged : date, med name, strengths
only pharmacist or intern take oral prescriptions
the Ratios are correct 1:2: 1 or 2 : 4 : 3 pharmacist: intern: tech
how do you find out if a substances is controlled?
Federally: FDA website or Epocrates
California: google it http://www.leginfo.ca.gov/cgi-bin/displaycode?section=hsc&group=11001-12000&file=11053-11058
