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Questions and Answers
What is the maximum number of refills allowed for a CIII prescription?
Which of the following information cannot be changed on a CII prescription?
How long is a CV prescription valid for refills as authorized by the prescriber?
What does the first letter of a DEA number indicate?
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Under what condition is a pharmacist permitted to substitute a generic drug for a brand name product?
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What role does a pharmacist serve when increasing awareness of immunization benefits?
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What does the term 'gaps in coverage' refer to in the context of immunizations?
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Which of the following protocols may be required for a pharmacist to administer immunizations?
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How can pharmacists facilitate immunization services in their facilities?
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What must pharmacists provide about immunizations according to Quality Standards?
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What is the purpose of the Vaccine Information Statement (VIS)?
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What additional information should pharmacists provide to patients during immunization discussions?
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Why is it important for pharmacists to provide culturally appropriate information?
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What is the minimum age required to purchase a non-prescription CV medication?
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What is the maximum quantity of non-prescription CV medication that can be purchased every 48 hours?
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Where should sales of non-prescription CV medications be recorded?
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What is a key component of evidence-based medicine?
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Which factor contributes to the difficulty in finding relevant medical information?
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What percentage of adults discussing drugs with their doctors learned about them through direct-to-consumer advertising?
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How frequently does research information double in volume?
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What is a suggested strategy for efficiently identifying quality medical information?
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Which component is NOT part of a drug therapy problem?
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Which of the following best describes a drug therapy problem related to adherence?
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What is one common cause of unnecessary drug therapy?
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Which scenario represents a need for additional drug therapy?
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Which drug therapy problem is associated with the drug being unsafe for the patient?
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What can lead to ineffective drug therapy?
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A dosage that is too low may require what adjustment?
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What is a common reason for patients not adhering to their medication regimen?
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Which of the following describes the impact of a drug interaction?
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Which role of pharmacists is least likely associated with immunizations?
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Which of the following is a valid method for transmitting prescriptions to a pharmacy?
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What is the maximum number of handwritten prescriptions that can be written on a single prescription document?
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What is required on a written prescription for a controlled substance?
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How long is a CII prescription valid for after being written?
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True or False: A prescriber is required to indicate the total number of drugs on each paper prescription.
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When a patient's address is missing on a controlled substance prescription, what can a pharmacist do?
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What format must the quantity for controlled substances be listed in?
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For non-controlled legend drugs, how long are prescriptions valid?
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Study Notes
Prescription Orders
- Outpatient prescriptions are for medications or devices to be dispensed from a pharmacy for use outside of a hospital or other institutional setting.
- Prescriptions can be transmitted to the pharmacy by writing, faxing, electronically, or phoning in.
- Handwritten prescriptions: up to 4 prescriptions can be written on one document.
- Computer-generated prescriptions: up to 6 prescriptions can be written on one document.
- Controlled and non-controlled prescriptions can be written on the same prescription document.
- A prescriber must indicate the total number of drugs on each paper prescription.
- Required components of a written prescription:
- Date and signature of the prescriber
- Full name of the patient
- Prescriber's printed name and address
- Drug name and strength
- Quantity prescribed
- Directions for use
- Number of refills authorized
- Required components for a controlled substance prescription:
- DEA number and professional designation
- Quantity in both writing and numerical terms
- No refills for Schedule II drugs
- Patient's address
- Required components for a controlled substance for an animal:
- Species of the animal
- Full name and address of the animal's owner
- If a patient's address is missing on a script for a controlled substance, a pharmacist is allowed to enter it based on Michigan Law.
- Prescription validity periods:
- Schedule II: must be filled within 90 days of the date written
- Schedule III and IV: maximum of 6 months from the date written
- Schedule V and Non-controlled legend drugs: valid for up to a year from the date written
- Quantities for controlled substances should be listed in both alphabetic and numeric formats.
- Legend drugs are identified on the original container by "Caution: Federal Law prohibits dispensing without a prescription" or "RX Only".
- Controlled substances are identified by the Roman numerals (CII, CIII, CIV, and CV) that designate their schedule. This is found on the front of the drug container, on the package insert, and in information sources like Facts and Comparisons.
- A prescription without a refill status is considered to have zero refills.
- A Schedule III or IV prescription can be refilled no more than 5 times.
- PRN refills (as needed):
- Schedule II: none
- Schedule III and IV: 5 times or 6 months
- Schedule V and Non-controlled: may be filled at appropriate intervals authorized by the prescriber for one year.
DEA Policy
- DEA policy regarding information that can be changed on a Schedule II prescription after contacting the prescribing practitioner:
- Patient's address
- Drug strength
- Drug quantity
- Directions for use
- Dosage form
- DEA policy regarding information that CANNOT be changed on a Schedule II prescription:
- Patient's name
- Controlled substance prescribed (except for generic substitutions permitted by state law)
- Prescriber's signature
- All practitioners who prescribe controlled substances must have a DEA number.
- The first letter of a DEA number is:
- A/B/F/M: Hospital/clinic/practitioner/teaching institution/pharmacy
- M: Mid-level practitioner (NP/PA/OD/ET, etc.)
- The second letter of a DEA number is the first letter of the registrant's last name.
- When a generic drug is substituted for a brand name, the prescription label must include both the brand name prescribed and the generic name dispensed.
- A pharmacist is not permitted to substitute a generic drug for a brand name product if the patient has a "Do Not Substitute" order on their prescription.
- The prescription label must include:
- The date
- The pharmacist's name
- The name and address of the place of practice where the medication was dispensed.
- A person must be at least 18 years of age to purchase a non-prescription Schedule V medication.
- The maximum quantity of a non-prescription Schedule V medication that can be purchased every 48 hours is 4 ounces.
- The sale of a non-prescription Schedule V medication must be recorded in an exempt narcotic book.
Evidence-Based Medicine
- Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.
- Individual clinical expertise is integrated with the best available external clinical evidence from systematic research.
- Clinical expertise, the best available external clinical evidence, and patient values are combined to make the best decision.
- Factors that make looking for information difficult:
- Information explosion
- Too many sources of information
- Increase in the number and sophistication of drugs/medical interventions
- Traditional resources are often inadequate
- Readily available search tools
- More knowledgeable patients
- Daily need for valid information
- Systematic approach: a structured method for searching literature to achieve the best possible outcomes from drug therapy.
Drug Therapy Problems
- Drug therapy problem: an undesirable event experienced by a patient that involves or is suspected to involve drug therapy, and which interferes with achieving the desired goals of therapy.
- Components of a drug therapy problem:
- 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 exists or is suspected to exist between the undesirable patient event and the drug therapy
- Types of drug therapy problems:
- Unnecessary drug therapy: Indication
- Needs additional drug therapy: Effectiveness
- Ineffective drug: Effectiveness
- Dosage too low: Effectiveness
- Adverse drug reaction: Safety
- Dosage too high: Safety
- Adherence (noncompliance): Adherence
Drug Therapy Problem Categories
-
Unnecessary drug therapy:
- Common causes:
- Duplicate therapy
- No medical indication at the time
- Nondrug therapy is more appropriate
- Addiction/recreational drug use
- Treating an avoidable adverse reaction
- Common causes:
-
Needs additional drug therapy:
- Common causes:
- Preventative therapy required to reduce the risk of developing a new condition
- Untreated condition
- Synergistic therapy
- Common causes:
-
Ineffective drug:
- Common causes:
- More effective drug available
- The condition is refractory to the drug
- The dosage form is inappropriate
- Contraindication is present
- The drug is not indicated for the condition
- Common causes:
-
Dosage too low:
- Common causes:
- Dosage too low
- Ineffective dose
- Needs additional monitoring
- Frequency is inappropriate
- Incorrect administration
- Drug interaction
- Incorrect storage
- Duration is inappropriate
- Common causes:
-
Adverse drug reaction:
- Common causes:
- Adverse drug reaction
- Undesirable effect
- Unsafe drug for the patient
- Drug interaction causing an undesirable effect
- Incorrect administration
- Allergic reaction
- Dosage increase/decrease too fast
- Common causes:
-
Dosage too high:
- Common causes:
- Dosage too high resulting in toxicity
- Needs additional monitoring
- Frequency is too short
- Duration is too long
- Drug interaction
- Common causes:
-
Adherence (noncompliance):
- Common causes:
- Patient does not understand the instructions
- The patient cannot afford the drug
- The patient prefers not to take the drug
- The patient forgets to take the drug
- The drug product is unavailable
- The patient cannot swallow or administer the drug
- Common causes:
Vaccines
- Pharmacist roles related to immunizations:
- Educator
- Facilitator
- Immunizer
- All 50 states allow pharmacists to administer immunizations.
- A pharmacist can serve as an educator by increasing awareness of the personal and public health benefits of immunization.
- Gaps in coverage: a period during which a patient lacks health insurance coverage of drugs and healthcare services.
- Pharmacists should routinely monitor a patient's immunization status and identify any gaps in coverage.
- A pharmacist can serve as a facilitator by hosting others who immunize in their pharmacy or facility. This can be done by hosting a nurse-run immunization clinic, referring patients to other health care providers, or collaborating with local health departments to refer patients to community immunization programs.
- Pharmacists may provide immunizations under a protocol, collaborative-practice agreement, standing order, or individual prescription.
- Quality Standards for Pharmacy-Based Immunization:
- Standard 1:
- The patient must be provided with information about the risks and benefits of immunization.
- The vaccine information statement developed by the CDC must be given to the patient.
- The pharmacist must discuss questions and concerns the patient may have about the vaccine.
- The patient must be informed about the importance of receiving other preventive medical services and the benefits of having a medical home.
- The pharmacist must provide culturally and linguistically appropriate information at an easily understood reading level.
- Standard 3 and 4:
- The patient must obtain informed consent to the immunization and must provide a medical history to the pharmacist prior to receiving an immunization.
- Standard 1:
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Description
This quiz covers the essential components and regulations surrounding outpatient prescriptions. Participants will learn about the different types of prescriptions, required information, and how prescriptions can be transmitted to pharmacies. Test your knowledge on the critical aspects of prescribing medication.
