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Questions and Answers
Which of the following methods can be used to transmit an outpatient prescription to the pharmacy?
What must always be indicated on a prescription for a controlled substance?
Which of the following is NOT a required component of a written prescription?
What is the validity period for a CII prescription from the date it is written?
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What additional information is required for a controlled substance prescription for an animal?
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What happens if a patient's address is missing on a controlled substance prescription in Michigan?
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How must the quantities for controlled substances be listed on a prescription?
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What must be included on a medication label if the prescriber indicates "do not label"?
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Which of the following is a requirement for labeling prescriptions in Michigan regarding generic substitutions?
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What statement must be included on labels for controlled substances?
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Which of the following items is NOT a legend label requirement based on federal law?
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What information should be included on a prescription receipt for a drug with no brand name?
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Which types of prescriptions require separate filing in Michigan?
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What is a required legend label item for all prescriptions that are filled?
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When is a CIII prescription required to have a warning statement included on its label?
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How many states allow pharmacists to administer immunizations?
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What is a primary role of a pharmacist as an educator regarding immunizations?
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What do 'gaps in coverage' refer to in the context of immunizations?
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Which of the following describes how a pharmacist can act as a facilitator of immunizations?
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What documents or agreements may be required before a pharmacist can administer immunizations?
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According to Quality Standards for Pharmacy-Based Immunization, what must pharmacists provide while informing patients?
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Which action is reinforced by Standards 3 and 4 before a pharmacist administers an immunization?
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What is essential for pharmacists to provide when discussing immunizations with patients?
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What is the primary definition of a drug therapy problem?
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Which of the following is NOT one of the components of a drug therapy problem?
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What is a common cause of unnecessary drug therapy?
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Which problem is associated with a drug that is not producing the desired response?
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Which of the following reasons most likely leads to patients not adhering to their drug therapy?
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Which of the following is a common cause of a dosage being too low?
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Which type of drug therapy problem encompasses the risk of adverse drug reactions?
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What is the correct term for when additional drug therapy is needed for a medical condition?
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Which of the following is a potential cause for a drug being classified as ineffective?
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Which is a potential issue with patient adherence to medication?
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What is the first step in the systematic approach?
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Which type of resource is considered a tertiary resource?
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What is a potential disadvantage of providing a verbal response?
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Why is obtaining clarifying information important in the systematic approach?
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In the evaluation of information, which factor should NOT be considered?
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What is the main purpose of following up after providing a recommendation?
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Which statement is a con of a written response?
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What aspect of communication should be anticipated during the response phase?
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Study Notes
Prescription Orders
- Outpatient prescriptions are written for medication to be dispensed from a pharmacy for use outside of a hospital, extended care facility, or other similar setting.
- They can be transmitted to the pharmacy via written, faxed, electronic, or phoned in orders.
- Handwritten prescriptions can include up to four prescriptions on one sheet, computer-generated prescriptions can include up to six.
- Controlled and non-controlled prescriptions can be written on the same document.
- A prescriber needs to indicate the total number of drugs on each paper prescription.
- Required components for a written prescription include the date and signature of the prescriber, the patient's full name, the prescriber's printed name and address, the drug name and strength, the quantity prescribed, the directions for use, and the number of refills authorized.
- Required components for a controlled substance prescription include a DEA number and professional designation of the prescriber, the quantity in both written and numerical terms, the patient's address, and ALWAYS ZERO REFILLS FOR CII'S.
- Required components for a controlled substance prescription for an animal include the species of animal and the name and address of the animal's owner.
- Under Michigan law, pharmacists are allowed to enter a patient's address on a controlled substance prescription if the address is missing.
- CII prescriptions must be filled within 90 days of the date written.
- CIII prescriptions can be filled no more than 6 months from the date written.
- CIV prescriptions can be filled no more than 6 months from the date written.
- CV prescriptions are valid for up to a year from the date written.
- Non-controlled legend drugs are valid for up to a year from the date written.
- Prescription quantities for controlled substances should be listed in both alpha and numeric format.
- Dispensing as Written (DAW) should be noted when either the prescriber writes it or states it verbally.
Prescription Labeling Requirements
- Federal law requires legend labels to include the name and address of the pharmacy (best practices include the phone number with area code), the prescription number, the date the prescription was filled or refilled, the name of the prescriber, the name of the patient, and the directions for use as indicated by the prescriber.
- Michigan's additional legend label requirements include the name and strength of the medication unless the prescriber indicates "do not label," the quantity dispensed (if applicable), a notification when generic substitution occurs (including the name of the brand prescribed and the generic name of the drug dispensed), the name of the manufacturer or supplier, the statement "discard this medication one year after the date it is dispensed" or the actual expiration date, and if the medication expires in less than one year, the actual expiration date.
- For non-brand name medications, the name of the manufacturer or supplier should be included on the prescription receipt.
- Labels for CII, CIII, and CIV prescriptions should include the statement "Caution: Federal Law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed."
Prescription Files
- Michigan requires three prescription files to be kept: 1) CII prescriptions, 2) CIII, CIV, and CV prescriptions, and 3) a file for all other prescriptions (noncontrolled).
Prescription Labeling for Non-prescription CV Medications
- When a person dispenses or sells a non-prescription CV medication, the label must include the following:
- "Caution: Federal law prohibits the dispensing of this drug without a prescription."
- The statement "Keep out of the reach of children."
Systematic Approach to Drug Information Requests
- The systematic approach for responding to drug information requests helps to ensure that the response is accurate, complete, and relevant to the question asked.
- The steps include:
- Classify the issue/request: This involves identifying the WHO asking the question and the WHAT TYPE of question being asked.
- Obtain clarifying information: This step clarifies whether the request is general or patient-specific and identifies what other relevant information is needed.
- Conduct a systematic search: This step involves determining the most appropriate sources to use, including tertiary resources (drug information handbooks), secondary resources (PubMed, OVID, Google Scholar), and primary sources (journals or articles).
- Evaluate and apply the information: This involves evaluating whether the information is relevant and sufficient to answer the question, considering factors such as the indication, age group, etc., to determine whether the information found applies to the specific situation asked.
- Communicate the response: This step involves gathering the information found, formulating a response, restating the request, stating the response/providing a recommendation, describing the data sources used, stating any limitations, anticipating further questions, and addressing ethical considerations and liability.
- Follow-up: The follow-up step involves checking in with the individual to see if the recommendation was accepted/implemented to assist in achieving the best possible therapeutic outcomes for patients.
Verbal vs. Written Responses
- Verbal responses help to engage the individual and provide clarification, but can lead to forgotten or inaccurately communicated information.
- Written responses provide a permanent record of the information shared and can improve the understanding of complex issues or legal implications, however, they are time-consuming and do not allow for dialogue.
Drug Therapy Problems
- A drug therapy problem is any undesirable event experienced by a patient that involves, or is suspected to involve, drug therapy that interferes with achieving the desired goals of therapy and requires professional judgment to resolve.
- The three components of a drug therapy problem are:
- an undesirable event or risk of an event experienced by the patient
- the drug therapy (products and/or dosage regimen) associated with the problem
- the relationship that is suspected or known between the undesirable patient event and drug therapy
- The seven types of drug therapy problems are:
- Unnecessary Drug Therapy: The patient does not have a clinical indication for the drug. (INDICATION)
- Needs Additional Drug Therapy: Additional drug therapy is required to treat or prevent a patient's medical condition. (EFFECTIVENESS)
- Ineffective Drug: The drug product is not effective at producing the desired response. (EFFECTIVENESS)
- Dosage Too Low: The dosage is too low to produce the desired response. (EFFECTIVENESS)
- Adverse Drug Reaction: The drug is causing an adverse reaction. (SAFETY)
- Dosage Too High: The dosage is too high, resulting in undesirable effects. (SAFETY)
- Adherence (Noncompliance): The patient is not able or willing to take the drug as intended. (ADHERENCE)
Causes of Drug Therapy Problems
- Unnecessary Drug Therapy: common causes include duplicate therapy, no medical indication, nondrug therapy more appropriate, addiction/recreational drug use, and the treatment of avoidable adverse reaction.
- Needs Additional Drug Therapy: common causes include preventative therapy required, an untreated condition, or synergistic therapy.
- Ineffective Drug: common causes include a more effective drug available, refractory condition, inappropriate dosage form, contraindication present, and the drug product not being indicated for the condition.
- Dosage Too Low: Common causes include too low of a dosage, ineffective dose, the need for additional monitoring, inappropriate frequency, incorrect drug administration, drug interactions, incorrect drug storage, and inappropriate duration.
- Adverse Drug Reaction: Common causes include adverse drug reactions, undesirable drug effects, an unsafe drug for the patient, drug interactions causing undesirable effects, incorrect drug administration, allergic reactions, and too fast of a dose increase or decrease.
- Dosage Too High: Common causes include a dosage leading to toxicity, the need for additional monitoring, too short of the recommended dosage frequency, too long of a duration, and drug interactions.
- Adherence (Noncompliance): Common causes include the patient not understanding instructions, the patient not being able to afford the medication, the patient's preference not to take the drug, the patient forgetting to take the medication, the drug product being unavailable, and the patient being unable to swallow or administer the drug.
Pharmacist Roles in Immunizations
- Pharmacists play three important roles regarding immunizations: Educator, Facilitator, and Immunizer.
- All 50 states allow pharmacists to administer immunizations.
- Pharmacists can be educators related to immunizations by increasing awareness of the personal and public health benefits of immunization.
- "Gaps in Coverage" refers to periods when a patient lacks health insurance coverage of drugs and healthcare services, including immunizations.
- Pharmacists can be facilitators related to immunizations by hosting others to provide immunizations within their facility, referring patients to other healthcare providers, or collaborating with local health departments to refer patients to community immunization programs.
- Pharmacists can immunize patients under a protocol, collaborative-practice agreement, standing order, or individual prescription based on state-level scope of practice laws and regulations.
- Liability related to these approaches is dependent on the state-based scope of practice laws and regulations.
Quality Standards for Pharmacy-Based Immunization
- Standard 1: Requires the pharmacist to provide information about the risks and benefits of immunization to include the vaccine information statement developed by the CDC.
- Standard 1: Requires the pharmacist to discuss questions and concerns that patients may have about the vaccine.
- Standard 1: Encourages the pharmacist to inform patients about the importance of receiving other preventive services and the benefits of having a medical home.
- Standard 1: Requires the pharmacist to provide culturally and linguistically appropriate information at a reading level that is easily understood by patients.
- Standards 3 and 4: Reinforce the need to obtain consent and assess contraindications for an immunization prior to administering the vaccine.
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Description
This quiz covers the essential components and regulations for writing outpatient prescriptions. It includes details on different methods of transmission and specific requirements for controlled substances. Test your knowledge on the correct practices involved in prescribing medications.
