RXPREP chapter 8: controlled substances part 3 Flashcards
Who can prescribe CS?
physician
dentist
podiatrist
veterinarian
midlevel practitioner
or other practitioner who is authorized to prescribe, registered with the DEA or exempt from DEA registration, an under the hospital’s registraiton
What are common mid-level practitioners?
certified nurse midwives
certified registered nurse anesthetists
NP
Optometrists
PA
Rph
The DEA number starts with two…
two letters
The first letter of the DEA identifies…
the type of practitioner or institution
the second letter of the DEA identifies the…
prescribers last name
the two letters of a dea number are followed by
7 numbers (the last number is the check digit)
if a practitioner is authorized to prescribe narcotics for opioid addition treatment, the practitioner will receive what number
DATA 2000 waiver unique identification number (UIN)
same as the DEA number but the first letter is X (replaces the FIRST letter)
For a DEA number, A/B/F/G represents…
Hospital, clinic, practitioner, teaching institution, pharmacy
for a DEA number, M represents
mid level practitioner
P/R represents in a DEA number
manufacturer, distributor, researcher, analytical lab, importer, exporter, reverse distributor, narcotic treatment program
Step 1 of determining a DEA number is valid
add the 1st, 3rd, and 5th digits together
Step 2 of determining a DEA number is valid
add the 2nd, 4th, 6th digits tgoether
Step 3 of determining a DEA number is valid
multiply the result of step 2 by 2
Step 4 of determining a DEA number is valid
add the results of step one and step three together. the last digit of this sum should match the last digit of the prescriber’s DEA number. (this is the check digit)
the PDMP is regulated by
specified state-wide administrative, regulatory or law enforcement agency. NOT THE DEA
most commonly collected in real time, daily or every 72 hours or weekly
CS prescriptions must include
patient full name and address
prescriber full name and address
drug name, strength, dosage form, quantity, and directions for use
# of refills authorized
signed and dated by the prescriber the date it is issued to patient
if an MLP is prescribing under a physician directed protocol who signs?
the MLP
orders written for direct administration to patients in facilities such as clinics and hospitals are not considered prescription, they are referent o as
medication orders or chart orders
pharmacists can receive prescriptions for what schedule drugs verbally?
III-V
the pharmacist must immediately reduce the prescription to writing
don’t need prescriber’s signature
oral prescriptions for schedule II drugs are not valid except in what type of situations
emergent
faxed prescriptions are acceptable for schedule what drugs
III-V
as long as they contain all required elements and the prescriber has SGINED
generally, faxed prescriptions for schedule II drugs CANNOT serve as the original prescription
t/f
true
the schedule II drug cannot be dispensed to the patient until the pharmacy receive the written prescription
a faxed prescription can serve as the original copy for a schedule II drug in what three scenarios?
- a drug compounded for administration to pa tint by parenteral, IV, IM, subQ, or intraspinal route
- a prescription for a resident of a LTCF
- a prescription for a patient enrolled in a hospice program
in 2010, the DEA released final rules that permit electronic prescription for controlled substances for schedule…
II-V drugs
prescribers and pharmacies must use what type of software for electronic prescriptions for CS?
DEA-approved software
two factor authentication method to sign and transmit EPCS
The credentials that are permitted for DEA-sanctioned validation include two of the following:
something you know (password or response to a question)
something you have (hard token)
something you are (iris, fingerprint scan)
OR
can use a digital certificate
when a prescription is received electronically, federal law requries that the prescription and all required annotations must be stored electronically for at least __ years
2
for all CS, there are three items that cannot be changed:
patient name
drug
dr signature
despite schedule II drugs having the highest abuse potential of all drugs, there is no expiration date or quantity limit set by federal law for schedule II presriptions
t/f?
true
but no refills
what are the three circumstances in which a schedule II prescription may be partially filled
1) if the pharmacy cannot supply full quantity (remaining portion must be filled in 72 hours; after this time, a new prescription is required - rph notifies dr)
2) under the 2016 CARA, pharmacists can partially fill schedule II drugs at the request of the PATIENT or prescriber, can only be dispensed up to 30 days from the date the prescription was issued
3) patients residing in a LTCH or patients with a terminal illness/hospice (must document this on prescription, partial fills can be dispsended up to 60 days from the date the rx was issued
the pharmacy does not have sufficient stock fo the drug.. deadline to fill remaining balance
72 hours after first partial filling
partial fills - request by the patient or the practitioner who wrote the CII rx; deadline to fill remaining balance
within 30 days after issue date
partial fills- terminally ill or LTCF residents; deadline to fill remaining balance
within 60 days after issue date
for each partial fill, the pharmacist must document what on the back of the prescription?
date of partial filling
amount dispensed
amount remaining
name of dispensing rph
if an electronic record keeping system is used, the following information must be maintained and be updated in real time when a partial fill is dispensed
original rx number date of issue drug name, dose, formulation, strength and quantity quantity authorized patients name prescriber name address of LTCF, hospital, or patients home list of partial fills dispensed
what type of pharmacy are prohibited from preparing emergency fills for schedule II Drugs under any circumstance
central fills
what is the criteria for dispensing pursuant to an oral schedule II prescription
dispense the minimum necessary amount
prescriber must provide the original prescription within SEVEN DAYS of oral authorization (original can be written or electronic; can be mailed; authorization for emergency dispensing and date of oral prescription must be on the front of the rx)
pharmacist must attach the written prescription to the emergency oral prescription
if the original prescription is not received within 7 days, the pharmacist must report the breach to the local DEA office
according to federal law, prescriptions for non-scheduled and schedule V drugs do not expire; when do schedule III-IV drugs expire?
6 months from the issue date
what is the refill limit for schedule III and IV
5 refills (6 months expiration)
schedule V and non-scheduled drugs never expire, and have no refill limit; schedule II drugs never expire
what is the emergency fill day supply
only 72 hours
record keeping requirements for schedule III-V refills - pharmacist must write what on the back the rx
dispensing rph intials
date dispensed
quantity dispensed
schedule III-V prescriptions are only allowed ___ transfer(s) that must be communicated directly between two licensed pharmacists
1
some states allow interns or CPHT
the only exception is if the pharmacies share a rel time online database of the prescription record keeping system
records kept for 2 years
The transferring pharmacy must do what steps when transferring CS
void on front of original hard copy
write the receding pharmacy’s information on the back
pharmacy name business address DEA# name of transferring rph name of receiving pharmacist date of transfer
the receiving pharmacy must do what steps when receiving CS
reduce the prescription to writing and write transfer on the face of the rx
date the original prescription was issued
original number of refills
date it was first dispensed
number of refills remaining
transferring pharmacy name, address, DEA# and prescription#
name of transferring rph
pharmacy’s name, address, DEA#, and prescription number from which the prescription was originally filled if different
can you transfer a CII?
only if its electronic
federal law requires this caution statement on all schedules except for
“CAUTION: federal law prohibits the transfer of this drug to any person other than the person for whom it was prescribed”
V
each controlled substance prescription disposed must include what items on the container
date of initial fill date of current fill (if it is a refill) pharmacy name and address prescription serial # name of patient name of prescriber directions for use cautionary statements
the federal limit on the amount of drug that can be dispensed every TWO days:
240mL (8oz) or 48 units of any CS containing _____
120mL (4oz) or 24 units of any other CS…
opium
- only the pharmacist can dispense a non-prescription CS to patient who must be at least 18
what must the rph record after dis-sending a non-prescription CS
patient name and address
drug name and quantity
date of purchase
pharmacist name or initials
what methadone tablet is only FDA approved for treating opiod addition
40mg soluble tablet
the lower doses are indicated for the treatment of pain and opioid dependence
to operate as an opioid treatment program, clinics must register with the DEA using what form
363
additionally, practitioner must obtain approval and certification by the center for substance abuse treatment (CSAT)
for the first 90 days (days 1-90), the patient can receive up to ___ take home dose per week
one
second 90 days (91-180) the patient can receive up to ___ take home doses per week
2
third 90 days (181-270) the patient can receive up to ___ take home doses per week
3
treatment beyond 270 days and less than one year can receive a maximum of how many day supply of take home medication
6 dat supply
after one year, can receive a max of ___ supply
2 week
after two years, can receive a max of ___ supply of take home medication; but monthly visits
1 month
DATA 2000 waiver; physicians can treat up to how many patients in the first year and then the potential eligibility to treat how many after the first year
30; 100
CARA expanded DATA 2000 and allowed who to prescribe buprenorphine for a 5 year period
NP and PAs
SUPPORT granted NPs and PAs permanent prescribing authority of buprenorphine for opioid addition.
true
also inlaced qualified clinical nurse specialists, CNAs and certified nurse midwives; eligible to treat up to 100 patients at a time in the first year; 275 patients after the first year
What is the indication of Butrans
pain management
what is the indication of probuphine, sublocade, Suboxone
opioid addition
