RX test

Question 1

What is a prescription?

Answer 1

A written, verbal or electronic order from a licensed health care provider to a pharmacisy for a specific medication for a specific pt

Question 2

When does a drug require a prescription?

Answer 2

When it is considered potential harmful if not used under the supervision of a license practitioner

Question 3

How are scheduled drugs determined?

Answer 3

Scheduled drugs II-V are determined by the controlled substance Act. (Schedule I are not for medicinal purpose)

Question 4

What is a Dangerous Drug? Or a Legend drug?

Answer 4

A device or drug that is considered unsafe for self-medication, but is not in included in Scheduled I- V bears the ‘legend’ Caution: federal law prohibits from dispensing without prescription or ‘ RX only”

Any non-scheduled drug requiring a Rx – Antibiotic, antihypertensives etc

Question 5

Who regulates prescriptive authority?

Answer 5

Each state regulates prescriptive authority

Question 6

What is Off label and example of a med, also what NP must tell pt

Answer 6

Using a med for something outside its main purpose

Propranolol beta blocker but can be used ‘off label’ for performance anxiety

Pt must be aware that they are being prescribed a drug that is being used off label and be OK with this

Question 7

Who can NPs write Rx for?

Answer 7

Can only write prescriptions for patients who are established in your clinic

MDs can write Rxs for whomever

Question 8

Under state law all prescriptions should have what elements included?

Answer 8

Date of the prescription

Patient name, address and birthdate

Inscription (Rx) – name of drug (Rx) strength

Vehicle for drug – cap or tab, liquid susp or inhaler (pharmacist will assume pill form unless otherwise specified)

Quantity of the drug – number of pills, cc of liquid, gms of ointment

Transcription (Signature): dose, frequency, route of administration, duration of therapy, indications for medication

Intended use of the drug (unless practitioner feels indication is not in the best interest of the pt – EX- antidepressants for ‘mood’ or zovirax for ‘suppressive therapy’ or ‘tx dose’

Practitioner Name, Clinic contact info, collaborating MD

Must include license number /NPI (of both NP and MD)

• DEA ONLY if SCHEDULED DRUG

Question 9

Why is the date important on the Prescription?

Answer 9

Shows when the Rx was issued or written

Establishes the life of the Rx and validity of refills

Question 10

When do Legend drug Rxs expire?

Answer 10

ONE YEAR from date of Rx

Question 11

When do Controlled Drugs expire?

Answer 11

30 days from the time it is prescribed

Question 12

Specific exp dates for certain drugs, name one

Answer 12

Accutane only has 7 days, for pregnancy monitoring. Its X for pregnancy

Question 13

Why are Rxs dates sometimes modified?

Answer 13

Rxs can be written for 1 month or 3 months to encourage pt follow up

Question 14

How are patient weights used when determining dosage?

Answer 14

Pt weight is ALWAYS converted into Kgs

Question 15

Hoq mNY MEDICATIONS PER PRESCRIPTION?

Answer 15

Technically only supposed to have 1 med per prescription

Question 16

Should one write brand or generic names?

Answer 16

Generic names should typically be written
Only write brand name when

EX: birth control pill ..Sprinta (brand) but write ‘generis allowed’ or ‘substition allowed’ (so that pharmacists can substitute if needed)

Question 17

How should instructions for Rx be written

Answer 17

Write out in full English- avoid abbreviations

Provide clear, consice , specific direction

Avoid ‘take as directed’

Question 18

Risk Evaluation and Mitigation Strategy (REMS) drug that has it’s own rules for Rx expiration dates. REMS are addressed in the text when it’s pertinent for a drug (like Accutane). Knowing there are REMS drugs and what that means is what will be addressed in the text.

Drug Scheduling at DEA.gov would be the best resources for scheduled drugs. The correct term would be “schedule I” or “schedule II”, etc. Schedule I drugs are drugs like LSD, Ecstasy. Cannabis is also listed as schedule I. The DEA is always the best resource for this kind of information, but it is generally only schedule IV drugs that may be different between states.
egally in Texas, APRNs must work under the ‘supervision’ of a physician. Part of that supervision is having a collaborative prescriptive agreement. These restrictions are determined at the state level and is the reason we must advocate for full practice authority with our Texas legislators. The terms supervision and collaboration are often used interchangeably. I use the term collaboration because all health care providers should collaborate in their practice and the legalities of “supervision” rankles me. Collaboration is what describes my practice even thought the law says I am being supervised. It’s political.
There are situations when an APRN can prescribe some schedule II drugs in Texas, but these circumstances are limited.
Texas FAQ for APRNs prescribing Schedule II

Question 19

What is prescriptive authority?

Answer 19

the legal right to prescribe drugs

Question 20

What is full prescriptive authority?

Answer 20

The legal right to prescribe drugs independently and without limitation – Physician’s have this

Question 21

Who decides of the prescritptive authority of APRNs?

Answer 21

State laws- state board of nursing (for APRNs)

Question 22

What are some considerations with drug selection?

Answer 22

• Cost
• Guidelines
• Availability
• Interactions
• Side Effects
• Allergies
• Hepatic and Renal Function
• Need for monitoring
• Special Populations

Question 23

How are formularies for drugs selected?

Answer 23

selected by a panel of pharmacists and providers and may be subject to guidelines by (CMS) Centers for Medicare and Medicaid Services

Question 24

What is important about interactions of meds?

Answer 24

When adding a new med to a pts regimen important to check for interactions with all meds, OTC herbals etc that the pt is taking.

If low risk interaction is found, discuss risks w/ pt and document the conversation prior to prescribing.

Question 25

What is significant about Side Effects?

Answer 25

All drugs have side effects- some good, some bad, some fatal

Important to assess R/B ratio and discuss w/ pt

Also provide pt with list of more likely and important possible SEs and provide direction w/ how to respond…

Question 26

what is hepatic dosing or renal dosing?

Answer 26

special decreased doses d/t pt impaired renal or hepatic functioning.

sometimes alt drug substituted (EX morphine not good for renal impaired pts as has highly metabolized by the kidneys- better choice fentnyl)