Section 1
Preview this deck
C2
Front
| 5 | 0 | ||
| 4 | 0 | ||
| 3 | 0 | ||
| 2 | 0 | ||
| 1 | 0 |
Active users
0
All-time users
0
Favorites
0
Last updated
6 years ago
Date created
Mar 1, 2020
Cards (114)
Section 1
(50 cards)
C2
opiates & some stimulants oxycodone, hydrocodone, morphine, fentanyl cocaine, amphetamines, methylphenidate
Dangerous Drug
FFD&C says: Rx only or the drug may be dispensed only with a prescription * any drug that contains a schedule 5 controlled substance and exempt (Robitussin AC) * OTC insulin Keep dangerous drugs out of self-service areas
C4
benzos, tramadol
Ohio State Board of Pharmacy
goal: protect public 9 members appointed by the governor 8 Rph, 1 public member >60 yo 4 year term, max of 2 terms
BOP Charges on license
felony or gross immorality, dishonesty or unprofessional conduct, addicted/abusing alcohol or drugs, misdemeanor related to or committed in the practice of pharmacy, willfully violating, conspiring to violate, attempting to violate or aiding and abetting the violation of any of the provisions (catch all) permitting anyone other than the RPh or intern to practice pharmacy, knowingly lending the RPh or intern's name to an illegal practitioner or having connection with an illegal practitioner of pharmacy , dividing or agreeing to divide remuneration made in the practice of pharmacy with other individuals violated the terms of a consult agreement, committed fraud, misrepresentation, or deception in applying for or securing a license
C3
Depo Testosterone, products containing not more than 90mg of codeine/dosage unit tylenol with codeine, buprenorphine
dispense
final association of a drug with a patient for which the prescription from a prescriber and the professional judgement of and the interpreting, preparing, compounding, labeling, and packaging a specific drug * when the pharmacist has given the final approval * only a pharmacist may dispense * prescribers may personally furnish their own patients with medication ( samples) * nurses can administer, not dispense
depo-teststerone
C3
C5
cough preps with not more than 200mg of codeine/100mL or 100g Robitussin AC, Phenergan with Codeine
Emergency Stock
the drugs required to meet immediate needs to save or sustain life in an emergency (crash carts)
methamphetamine (desoxyn)
C2
What Can Interns Do?
Under the direct supervision of the RPh: sell CV controlled substances receive new oral prescriptions transfer of non-controlled substances request refill authorizations for all dangerous drugs contact prescriber for clarification as long as no professional judgement is required counsel patients immunize compound send/receive E-scripts between pharmacies accessing the same database dispense naloxone perform diagnostic lab tests stock automated dispensing cabinet & floor stock
Buprenorphine (Suboxone)
C3
Wholesale Distributor of dangerous drugs
any sale that the purpose of the purchaser is to resell - not patient specific
Certified Roles that registered/trainee can't do!
accepting new verbal prescription orders for non-controlled drugs from a prescriber * stock automated drugs (pyxis) * accept verbal refill for dangerous drugs (no controls) as long as there are no changes * send/receive copies of non-controls (transfers) * contacting a prescriber for clarification as long as no professional judgement is required
methadone
C2
tramadol
C4
Benzphetamine (Didrex)
C3
CE Requirements
40 hours (4.0 CEUs) every 2 years from september 15th specialty certification may be used as 36 hours requires: 0.2 CEU of Jurisprudence (law) & 0.2 CEUs of Med/Pt safety all must have NABP e-Profile CE from CME or CLE is not accepted
Tech Trainee
must be in educatin/training to be a registered tech pass board approved exam within 12 months RPh's/interns whose license has been denied, revoked, suspended, or restricted may not apply
fentanyl
C2
definition: direct supervision
a pharmacist shall be physically present in the pharmacy or in the area where the practice of pharmacy is occurring & provide personal review and approval of all professional activities
Methylphenidate (Ritalin)
C2
methaqualone
C1
Contingency Stock
the drugs required to meet the therapeutic needs of the patients when an RPh is unavailable (floor stock; pyxis)
Responsible Person
Every pharmacist must have a responsible person- a RPh * ensures adequate safeguards * is physically present a sufficient amount of time must take controlled substance physical inventory when change in responsible person * must notify board within 10 days of changing of responsible person
ketamine
C3
benzos
C4
Technicians
>18yo, high school diploma, "good moral character", not bee convicted of to any felony, pass exam by 75% within 12 months, must be "registered", not issued a physical license an RPh may only supervise up to 3 tech trainees at a time
Summary Suspension
the board may suspend a license by using a telephone conference call to review allegations and take a vote if the issue can't wait for a hearing * addiction or any situation that the pharmacist actions would be an immediate threat to the public
Unprofessional Conduct
advertising or displaying signs that promote dangerous drugs to the public in a manner that is false or misleading * selling drugs without an Rx * knowingly dispensing meds under false/forged prescriptions * knowingly failing to maintain complete and accurate records of all drugs received or dispensed * get any remuneration by fraud, misrepresentation or deception
C1
illegal/illicit drugs, lacks medicinal use Heroin, Marijuana, LSD
Registered
10 hours of CE every 2 years including 2 hrs of law and 2 hrs of Patient/Med Safety
meperidine
C2
Terminal Distributor of dangerous drugs
engaged in the sale of dangerous drugs at retail, or any person who has possession, custody, or control of dangerous drugs for any purpose other than for that person's own use and consumption * required to purchase and store dangerous drugs to sell at retail to patients
phendimetrazine
C3
amphetamine
C2
License Expiration Date
September 15th of each odd # year (every 2 years) $250
Ezogabine
C5
Administrative Disciplinary Actions
after a hearing: revoke, suspend, limit, place on probation, refuse to grant or renew license, impose fine or forfeiture
Phenergan with Codeine
C5
Controlled Substance
categorized by medicinal use + addiction/abuse potential * the lower the #, the greater the addiction/abuse potential
Techs Application
$50 application fee Q2 years, on EVEN years
Patient Counseling
Rph or designee shall personally offer counseling with every Rx (new and refill) for every patient * personally offer verbally, if not present written, refusal should be documented *counseling is documented with a positive ID (signature)
Prescriber Definition
licensed health professional authorized to prescribe drugs in the course of the individual's professional practice Not a chiropractor! Full prescribing rights: MD & DO limited: MLP Certificate to Prescribe #s no longer required- PAs now must include "Rx" at the end of the license # APN's need only their APN license #
hydromorphone
C2
peyote
C1
Practice of Pharmacy **
providing pharmacist care requiring specialized knowledge, judgement, and skill * interpreting prescriptions * dispensing drugs and devices * compounding * counseling * DUR * drug regimen reviews * advising on drug therapy * immunizing
oxycodone
C2
Robitussin AC
C5
Section 2
(50 cards)
DUR OARRS
before dispensing any controls, at a minimum, the RPh must request & review an OARRS report covering at least one year and/or bordering state's report if: * a pt adds a different or new drug to their therapy that they were not on previously * OARRS has not been ran in >12 months * a prescriber or patient is outside the pharmacy's usual geographic area * RPh suspects Dr shopping: more than one prescriber in the last 3 months (unless docs are in same location) * pt has signs of potential abuse/diversion
Oral/Verbal Rx's
orally transmitted by the prescriber/agent to the pharmacist, recording device, or intern * must document full name of the agent on the prescription * positive ID of the pharmacist and intern responsible for the oral prescription must be documented C2 Rx's cannot be phoned in unless emergency
emergency supply of a C2
immediate administration of the control is necessary and no appropriate alternative tx is available and it is not reasonably possible for the prescriber to provide a written Rx to be presented to the person dispensing the controlled substance prior to the dispensing * in case of an emergency, a RPh can dispense a C2 upon receiving oral authorization from a prescriber if: quantity prescribed & dispensed is limited to emergency period, Rx is immediately reduced to writing by the RPh, and if the RPh is not known to the pharmacist, a reasonable effort is taken to determine the Rx came from a legitimate prescriber * within 7 days, the prescriber shall provide the RPh a written Rx for the ER med which the RPh will attach to the verbal Rx * if the prescriber doesn't get you the Rx: notify the DEA and call the BOP * Rx is expired/prescriber is unavailable * RPh to use professional judgement: pt has chronic medical condition where left untreated could endanger the life of the pt or failure to dispense drug to pt could result in harm to the health of the patient
issuance of a prescription
a prescription must be issued for a legitimate medical purpose by a prescriber acting in the usual course of their professional practice RPh has a corresponding responsibility to see that this is true (identify fake Rxs) if the person knowingly dispensed a fake prescription, the prescriber and dispenser will be penalized
dihydrocodeine/asa/caffeine
C3
emergency supply C2 verbal order
within 7 days,need hardcopy partial fill due to pharmacy shortage: must complete fill within 72 hours
morphine sulfate
C2
butorphanol
C4
Minimum Standards of a Pharmacy
library with access to laws and references, poison control phone #, necessary equipment, drugs & prescription containers, well lighted & ventilated, clean & sanitary adequate physical security, posted pharmacy hours, appropriately staffed to operate in a safe & effective manner, staff must have name tag including job title
exemptions to opiate regulations
does not apply to vets, does not apply to chornic pain/addiction * prescribers may vary from regs, but must document in medical record why
OARRS
Ohio's PMP * required for OUTPATIENT * submitted daily for all controlled substances, gabapentin & naltrexone * prescribers: submit for controls & gaba that they personally furnish * Wholesalers also report controls + gaba sold to a terminal distributor * only keeps for 2 years
opiate max day supply for acute pain
adults with initial cute pain: max 7 days minors with initial acute pain: max 5 days with written consent from guardian all pts, max acute pain to a daily MED of 30 ( not a hard stop- exercise corresponding responsibility to ensure legitimacy, do what is in the best interest of the patient)
drugs for office use
not prescriptions!
E-prescriptions
if prescriber's software & pharmacist's software is certified by DEA * Rx must be printed out in ahrd copy (unless system proves positive ID and is approved by the Board) *
opioids for minors
must have informed consent completed by prescriber limited to 5 day supply for acute pain exempt: hospital situation RPh has corresponding responsibility
codeine
C3
OARRS errors
if error identified, only the dispensing pharmacist can resolve by resubmitting
Med Synch
may dispense in a way that varies from original Rx a <30 day supply goal: compliance *ensures pay should provide for med sych * cannot be a C2 , opiate or benzo
hydromorphone
C2
max quantity/max day supply on a single Rx
90 days for opiate chronic pain * 7 days for acute, 5 days for minor opiate acute pain * 90 day max total supply on multiple C2 Rx written on same day (do not fill until- only 3)
ICD-10 codes
prescriber must include ICD 10 code on all controls including the first 4 digits of the code if not reported: RPh may indicate "NC" (no code), if no code, you can still fill!
Change/added on a C2
after consulting prescriber, anything except: name of patient, drug or prescriber * must talk to prescriber to change/add
tapentadol
C2
partial fill of C2
document on back of Rx: date dispensed, quantity dispensed, remaining quantity authorized to be dispensed, Rx number of partial dispensing if different, manual initials of dispensing pharmacist
tramadol
C4
expiration of C2
6 months for non-opiate must fill within 14 days for opiate
Security
effective & approved controls & procedures to deter and detect theft and diversion board should be notified of any new facilities or changes in operation before being utilized/implemented * personal supervision by a pharmacist of the dangerous drugs at all times to deter and detect * physical/electronic security when pharmacist isn't present
Prescription Processing
Rx may only be filled for the first time within 6 months from the date issued * opiates must be filled within 14 days * Dangerous drugs and CV prescriptions can only be refilled for one year from date of issuance * 6 months for C3-4 no refills on C2 * all Rxs must have # of times or a period of time for which the Rx can be refilled (NO PRN)
Rx requirements:
dated on the day it is issued * full name, # & address of prescriber drug name, strength, quantity * explicit directions # of refills/time period for refills * can't be coded so that it can only be dispensed by certain pharmacies
What can an RPh change on a prescription?
add/change pt address (when verified) *add/change everything except: name of patient, drug/prescriber (C2: verify with prescriber; C3-5: verify with prescriber or prescriber's agent) may change days supply, ICD-10 code, or DAW when verified
Opiate regulation updates
days supply must be indicatedon all controlled substances + gabapentin * 90 day max supply applies for non-acute pain opiate rx's also * no qty/days supply limits for non-opiate controlled substance Rx's
buprenorphine
C3
Positive ID
method of identifying an individual who prescribes, dispenses, or administers a dangerous drug *manual or electronic signature, initials 2 factor authentication: something you know, have, and are (password, physical card, fingerprint) username and password alone are not positive IDs
C2 must fill
Opiate: 14 days non-opiate: 6 months
press pause score + pain management agreement
MED 80
narx
narcotics, sedatives, stimulants
What can the RPh change on an Rx without verification
non-controls: dosage form, drug strength, quantity, directions for use as long as: drug is generically equivalent, rx is for human, and DAW is not written *cannot substitute between long-acting & short-acting forms of a drug without verification * all changes should be documented on Rx or in profile AND communicated to patient OR prescriber * cannot make changes to: patient's name, name of drug, name of prescriber
Opiates refill/fill date
max 90 day supply for opiates for chronic pain * must fill within 14 days of issuance for all opiates (day 1 starts on date of issuance) * for "do not fill until" rx's must fill within 14 days but applies to the do not fill date, not the issuance date
fentanyl
C2
Preprinted Rx for Hospice Pts
no preprinted C2s, can manually add & sign for C2s * may have multiple orders on one form
Refills
only one year for dangerous drugs (non-C) and C5 all Rx: PRN not valid No refills for C2 C3/C4: no more than 5x in 6 mo period from date of issuance (exception: partial fill--> DEA total quantity rule) partial fill: pharmacy shortage: must get them the remaining amount within 72 hours
Prescription Monitoring Program (PMP)
OARRS * tool for prescribers and pharmacists to identify and prevent prescription drug abuse, misuse, or addiction * tool for law enforcement to investigate prescription drug abuse
Prescription Format
cannot have more than 3 non-C per form * if preprinted with multiple drug names/strength combos: can't be controls and only one prescription order selected/form * for controls: only one Rx, quantity numerically &alphabetically
MED 120
board certified pain medicine physician
Faxing
C3,4,5 can be faxed no e-faxes (electronic--> pharmacy prints it) hardcopy faxed Rx's must have wet signature C2: cannot be faxed unless: resident of long term care facility, hospice pt, compounded sterile product
meperidine (demerol)
C2
OARRS access
pharmacist, pharmacist delegates (under own login, must have separate OARRS accounts for each preceptor), HC professional, prescriber delegates, licensing board, law enforcement, individual
Processing a Prescription
ensure pt info is profiled, DUR, label drug, ensure pt is given offer to counsel, Rx is filed correctly
emergency supply of dangerous drugs (not C2)
can be dispensed up to a 30 day supply if the pt has been on consistent drug therapy as documented by pharmacy records (must have record on profile) * if package size is >30 days, just dispense smallest package available * can only be provided once per year/pt * must notify prescriber within 72 hours C3-5 limited to 72 hour supply!
Prescription Definition
written, electronic, or oral order for drugs or combos/mixtures of drugs to be used by a patient/animal, issued by a licensed health professional authorized to prescribe drugs
Section 3
(14 cards)