Wk 1: Principles of Prescribing

Question 1

Prescriber is responsible to consider the following when prescribing:

Answer 1

Does pt need the drug?
Education
Financial concerns
Individual variations in response
Pregnancy / nursing concerns
Obtain THOROUGH history

Question 2

FDA created in 1906, required _______, and only prescribing meds listed in ___________

Answer 2

accurate labeling, and only prescribing USP or National Formulary

Question 3

Durham Humphrey Amendment ________

Answer 3

1951: Mandated the Provider-Patient relationship for prescription drugs

Question 4

Kefauver-Harris Amendment _________

Answer 4

1962: Drugs must be safe and effective, ADEs must be reported

Question 5

Prescription is a method of communication to the pharmacist for a specific ______, specific ______, specific _______, and ________.

Answer 5

Method of communication to a pharmacist, for a specific medication, specific patient, specific time, instructions on how to use it

Question 6

Controlled substances require a ________ for prescribing

Answer 6

DEA number

Question 7

FDA site for reporting adverse drug events

Answer 7

Medwatch

Question 8

Factors that cause confusion / error in prescription handoff include:

Answer 8

Large number of drugs
Numerous forms
Similar sounding names
Varying dosing regimens and usage

Question 9

Percentage of prescriptions not filled, per Annals of Medicine, most commonly for these types of meds

Answer 9

31%, dermatology, GI, BP meds

Question 10

Increased likelihood to fill Rx

Answer 10

Older adult
No copay
Frequent provider interaction

Question 11

Eight components of a prescription:

Answer 11

Date
Pt Name / Address / DOB
Rx Name / Strength / Dosage form
Signa (instructions on how to take it)
Dispensing information (how much to dispense)
Renewal information (Refills)
Prescriber name / info

Question 12

DEA: Controlled substances cannot be dispensed beyond ____ from date prescribed

Answer 12

6 months

Question 13

Schedule II substances can be prescribed ______

Answer 13

1 month at a time with NO refills

Question 14

St Johns Wort is metabolized by CYP___ and may compete for metabolism of ________ leading to ______.

Answer 14

CYP3A4; alprazolam; worsening fatigue

Question 15

Esomeprazole increases ______, and can decrease _______ of _______

Answer 15

gastric pH; absorption of ketoconazole, iron pills, vit b12

Question 16

________ abbreviations should not be used on prescriptions

Answer 16

Latin

Question 17

Teaspoon = ____ mL; Tablespoon = ______mL; Ounce = _____ mL; Ounce = ______ g

Answer 17

Teaspoon = 5mL; Tablespoon = 15mL; Ounce = 30mL; Ounce = 28.35g

Question 18

Controlled substances have refill limits per ______ and _______

Answer 18

Schedule and state law

Question 19

All Controlled Substances require ________

Answer 19

DEA Number

Question 20

Schedule ___ require FULL signature

Answer 20

Schedule II

Question 21

Controlled Substances Act of 1970 provides a ____________

Answer 21

Legal framework for controlled substances

Question 22

Drug abuse potential defined by…

Answer 22

Pharmacologic properties
chemical structure
CNS effects

Question 23

Narcotic is a ______ term to denote controlled substance

Answer 23

Legal

Question 24

Controlled Substance Scheduling criteria is based on

Answer 24

Dependence liability
Potential for abuse
Approved clinical use

Question 25

Schedule I drugs:

Answer 25

No therapeutic value, high potential for abuse | APPLICATION TO DEA REQUIRED

Question 26

Schedule II drugs:

Answer 26

Medical use, but high potential for abuse Includes Cocaine Must be WRITTEN prescription on paper (can be done by phone in emergencies but must have written Rx in 72 hours) 30 days max / 100 dosage units max 3-5 day supply sometimes NO REFILLS

Question 27

Schedule III drugs:

Answer 27

``` Medical use, less potential for abuse Anabolic steroids Testosterone/estrogen Buprenorphine Paregoric REFILL OK 5 REFILLS in 6 MONTHS ```

Question 28

Schedule IV drugs:

Answer 28

``` Medical use, less potential for abuse Benzodiazepines Barbiturates Sleep aids (Ambien) REFILL OK 5 REFILLS in 6 MONTHS ```

Question 29

Schedule V drugs:

Answer 29

No Prescription required; 18 years old with ID required Pregabalin / Lyrica

Question 30

Product Package Insert (PPI or PI) written by _____ and provides _______.

Answer 30

Product Package Insert (PPI or PI) Provides FDA approved safety & efficacy information Written by drug manufacturer Includes BLACK BOX WARNING

Question 31

The international drug directory is called __________

Answer 31

Index Nominum and Martindale

Question 32

Natural Product Resources include:

Answer 32

Natural Medicines Comprehensive Database* The Review of Natural Products Natural Standard* PDR for Herbal Medicines* Complete German Commission E Monographs * Electronic options available Pharmacist’s Letter herbal supplement

Question 33

Prescribers typically give a _______ supply if on stable therapy

Answer 33

12 month

Question 34

4 "S" rule for prescribing

Answer 34

Smart (Always ask about pregnancy possibility) Safe (clear) Sensible Secure