Pharmacist Practice Flashcards
Who has corresponding liability for patient provider relationship?
Pharmacist
Prescriber can prescribe CS for self/family only in emergency (true/false)
true
Can you fill out of state CS Rx?
Yes-but must meet VA requirements
Rules for PA to prescribe CS
-become approved by board of medicine to prescribe under collaborating physician OR podiatrist
-Rx must have name of collaborating physician
Rules for APRN/NP to prescribe CS
Option 1: become authorized with board of nursing and medicine for autonomous practice to prescribe
Option 2: collaborative practice agreement with physician
*need either DEA number for CS or if legend need Rx authority #
Can TPA-certified optometrists prescribe CS?
Yes-can prescribe oral analgesics. CII-only hydrocodone
Can dentists prescribe CS?
Yes-must be in scope
What needs to be on legend Rx?
-signature (or e signature)
-patient first/last name
-patient address (prescriber or pharmacist)
-only 1 Rx per blank
Can legend drugs be filled without authorized refills?
Yes-if prescriber unavailable and patient’s health is in danger. However, cannot happen after 12 dates from Rx written.
What are exceptions to eRx for CII?
Can be faxed for LTCF, hospice, home infusion. If it is faxed outside of these examples, pharmacist must obtain original Rx prior to dispensing
How long can CII be filled from date of issuance?
6 months
Can CIIs be transferred?
Partial fill, no. Unfilled that was issued electronically can be transferred.
Acute pain opioid Rx limit
-7 days; must be short acting
-Exception: clearly documented in medical record why they need longer
-must document why it’s greater than 50 MME per day
Surgical procedure opioid Rx limit
14 days
How long do you have to do partial CII fill due to lack of supply?
72 hours
CII partial fill timeline
30 days from issuance. 60 days for LTCF
Items needed for CII Rx
PharmD can add:
patient address
DEA
dosage form
strength
directions
quantity
date
PharmD cannot add:
signature
drug
How long does a provider have to provide hard copy Rx for emergency CII verbal orders?
7 days
Can multiple CII Rxs be issued on same day for same pt/drug?
Yes-90 day supply. Can put earliest fill date on Rx. Issue date must be accurate though!
RN can authorize refills for what type of drugs?
Non CS if no changes
CIII-V refills?
5 refills and cannot be filled after 6 months from issuance. Can be faxed.
When can pharmacists administer drugs under standing state protocol?
-standing protocol (naloxone, epinephrine, contraception, prenatals, PrEP, PEP, dietary fluoride supplements, PPD)
-hormonal contraception: preventative care, well woman visits, STI risk, pap smear importance
-CLIA waiver: therapy for COVID, flu, Strep A, UTI
-vaccines-anything on CDC on immunization schedule
-collaborative practice with provider
When must counseling be offered?
New scripts. If declined, must be documented.
Can a retail pharmacy accepted dispensed drugs?
No! Exception: drug donation site registered, charitable clinics, prison pharmacies
Can drug be returned to stock in retail if not dispensed?
Yes-expiration date cannot exceed 1 year
When must naloxone be prescribed for acute pain?
-If prescribing >/= 120 MME per day. Must also document why in EMR
-risk factors for OD
-substance misuse
-concomitant benzos
What can TPA optometrist prescribe?
Must be on TPA formulary
-analgesics hydrocodone/APAP, oral analgesics
-other drugs to treat eye conditions
-topicals
-IM epi for emergencies
What must a patient fill out prior to pharmacist prescribed contraception?
Assessment - US medical eligibility criteria for contraception use
What can techs not do that pharmacists/interns can do?
-receive oral rx
-prospective drug review
-counseling
-communicate w prescriber about anything other than than refill auth
-verify (can interns do though??)
What can techs not do that pharmacists/interns can do?
-receive oral rx
-prospective drug review
-counseling
-communicate w prescriber about anything other than than refill auth
-verify (can interns do though??)
What type of oral Rx can techs accept?
Under nuclear pharmD can accept diagnostic, non patient specific radiopharm rx
Can CIII-V be renewed orally?
Yes-must be transcribed to written by pharmacist.
What acronym is used to depict bioequivalence?
AB (NO NUMBERS AFTER)
What do numbers after AB represent?
If same number then they are bioequiv (AB1 and AB1).
What book determines bioequivalence?
Orange Book
Who besides patient can pick up CS?
-anyone with proof of identity provided (unless know to pharmacist)
-if it isn’t the patient, we take a photocopy of ID –> keep record for 1 month
A pharmacist can have registration to dispense CS suspended or revoked for misdemeanor relating to CS. True or false
False-would have to be felony
When does accuracy of on hold Rx need to be confirmed?
Upon time of data entry by pharmacist; pharmD dispensing it at a later date must do prospective drug review
Can you return an on hold Rx to patient?
Yes but then must delete entry from system
What legend drugs are exceptions to emergency fill law?
psychotherapeutic agents, anxiolytics, sedatives, or hypnotics
What can be accepted at drug donation site?
Legend drugs, in sealed manufacturer containers, individual dose/unit dose packaging, don’t expire in less than 90 days
Max CE required from activating inactive license?
60 hrs (15 hrs per year)
How many years can pharm license be inactive for you to have to retake VA law?
5 years
Also must perform 160 hrs of intern work if you can’t prove you were practicing in a different state
What out of state products cannot be dispensed to a pharmacy or equipment supplier?
Hypodermic needles
oxygen
medical devices
drugs for operation/cleaning of medical equipment
solutions for PD
sterile water
saline irrigation
they must register as medical equipment supplier and if happening out of state then non resident medical supplier
If an out of state pharmacy is shipping, mailing, or delivering drugs to VA residents-what must they do?
register as a non-resident pharmacy
A pharmacy can provide compounded drugs to an office for office use. True or false
False-must be non compounded.
-if CS cannot exceed 5% of total dosage units dispensed annually
Pharmacists may dispense from Rx written “For office use only”
False-this is outside patient provider relationship. Instead pharmacist must create invoice with:
-date of transfer
-name/address of physician
-name/address of pharmacy
-kind/quantity drugs
If physician wants CII for office use what form must they use?
222
Procedures for collecting eligible donated drugs
-pharmD or CPhT must receive/screen the drugs
-donor form (give pt a copy), don’t need to have if directly from facility
-cannot charge a fee!!
What does BC mean in terms of bioequivalence?
NOT bioequivalent-often times of a different formulation (i.e. extended release)
What can AB2 be subbed for?
Only other AB2! AB = bioequivalence and can be subbed for any other product that matches it # wise
A pharmacist is required to verify that a written CS Rx meets one of the requirements. True or false
False!
If a pharmacy delivers medications, how do they offer counseling?
Prescription in tamper resistant bag with Medi-Span Patient leaflet and a written offer for counseling with a toll free number
What is pharmacists responsibility to notifying PCPs when partaking in initiating treatment?
Notify them IF you get consent from patient
Can a nurse authorize refills? Give original verbal orders?
-refills-90 days only IF legend, no change to dose/strength/drug and protocol. RN must document in chart
-new Rx-must take down name of ‘authorized agent’. If CIII-V, you need a whole signed agreement. If emergency CII rx must be provider
