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APh - advanced practice pharmacist can do: - ANSWER--perform patient assessments -order and interpret drug therapy - related tests in coordination with the patient's PCP or with the diagnosing prescriber -Refer patients to other healthcare providers -Participate in the evaluation and management of diseases and health conditions in collaboration with other healthcare providers -initiate, adjust, and discontinue drug therapy based on protocols with prescriber. if its a CONTROLLED substance, APh must be registered with DEA (drug enforcement adminisration) To be a APh (advanced practice pharmacist), you need 2 of 3: - ANSWER--earn certificate in a relevant area of practice: ambulatory care, critical care, oncology pharmacy or pharmacotherapy -complete residency program -have provided clinical services for patients for 1 year (and at least 1,500 hours) under CPA or protocol with physician, APh, pharmacists in collab drug therapy management, or within a health system can Intern have pharmacy key? - ANSWER-no pharm: intern ratio - ANSWER-1 : 2
CPJE Exam with Complete Solutions.
t/f: intern can only act like a tech when pharmacist is gone - ANSWER-true what is needed for intern registration? - ANSWER--enrolled in pharmacy school that is ACPE-accredited or recognized by BOP -graduate of school of pharmacy (same as above) -graduate of foreign pharmacy school who has obtained a certification from NABP's foreign pharmacy graduate examination committee (FPGEC). this is obtained after passing english competency test (TOEFL) and the foreign pharmacy graduate equivalency examination (FPGEE). pharm : tech ratio - ANSWER-outpatient: 2(# of pharm) - 1 inpatient: 1: to be a tech, you need: - ANSWER--high school graduate -GED certificate equivalent -meets one of requirements: --obtain associate's degre in pharmacy technology --completed a course of training specified by the BOP --graduated from a school of pharacy recognized by the BOP --completed a board-approved certification program accredited by the national commission for certifying agencies. This includes both pharm tech certification board (PTCB) and the national healthcareer association (NHA) programs
RPh can furnish - ANSWER--emergency contraception, self- administered hormonal contraception -travel medicine -rountine immunization for 3+ years old -naloxone -rx nicotine replacement products -C-2 to C- 5 can docs write controlled meds to themselves? - ANSWER-no, only noncontrolle meds can be self written can docs write for controlled meds for family members? - ANSWER- Yes, only if there is a -valid physician/patient relationship -legitimate medical purpose -good faith exam if doc dies, and pt needs a refill, can you refill it? - ANSWER-yes, -valid until all refills are gone. -controlled, valid for no more than 6 months -1 year for non-controlled meds can a pharmacist fill an rx from another country? - ANSWER-no
which U.S. territories can you fill for? - ANSWER--district of columbia -Puerto Rico -Virgin Islands
- Guam -American Samoa Rx MUST have following info: - ANSWER--name of the pt -address of pt -name and qty of drug -direction of use -date of issue -prescriber info: name, address, phone #, license classification, DEA (if controlled med) prescriber's signature -*condition or purpose of drug, if requested by pt Rx for vet requirements: - ANSWER-same info +kind of animal +name and address of owner Rx info is kept for - ANSWER-3 years t/f pharm has to put name or initials on every rx - ANSWER-true, -or they can electronic document they verified it
if misspelled a drug name on non-controlled, the pharmacist can fix it after calling the doc. true or false? - ANSWER-true refill for C-3 to C-4 limits: refills months D/S - ANSWER--4 months (120 d/s) -5 refills -6 months refill limit for C-V? - ANSWER-none, but expire in 6 months what is the max fill for PRN fills if fill is 30 d/s for non-control? - ANSWER-11 refills what is the max fill for PRN fills if fill is 90 d/s for non-control? - ANSWER-3 refills is PRN fill okay for controlled meds? - ANSWER-NO limit for emergency supply for non-controlled and C-3 to C5 drugs?
- ANSWER-non-controlled - no limit C-3 to C-5: reasonable amount
when is it okay to convert 30 d/s to 90 d/s without doctor notice?
- ANSWER--if non-controlled, nonpsychiatric drug -pt completed an initial 30 d/s
- total qty dispensed does not exceed the amount authorized on rx -pharm notifies the doc of the increase in # of d/s dispensed when can pharm not change 30 d/s to 90 d/s - ANSWER--in oral or handwriting: "no change in qty" -30 d/s is medically necessary is indicated Who can do transfer? - ANSWER-Pharmacists and Interns how many times can non-controlled be transferred? - ANSWER-as man times as there are refills remaining Transfer info needed: - ANSWER--ID of pharm or intern -Name pharm, pharm store # or address, -original date -last dispensing date -# of refills and date originally authorized -# of refills transferred labeling requirement for rx container MUST have: - ANSWER--drug name -direction for use
tacrolimus should use HOURS or time of day? - ANSWER-use hours, but normally for other drugs use time of the day like afternoon Translation should be - ANSWER-on label or on supplemental document. which drugs have "impair a person's ability to operate a vehicle or vessel" - ANSWER--muscle relaxants -antipsychotic drugs -antidepressants -antihistamines, motion sickness agents, antipruritics, antinauseants, anticonvulsants, HTN meds, -controlled substances with CNS depressant effect -anticholinergic agents meds don't take with alcohol - ANSWER--disulfiram -monoamine oxidase inhibitors -nitrates -cycloserine -antidiabetic agents (insulin and sulfonylureas) due to hypoglycemia t/f: C-R packaging requirements do not apply if the drug is given directly by a healthcare provider to an institutionalized patient - ANSWER-true
t/f: non-compliant container must carry a warning that it is not recommended for use in household with children - ANSWER-True prospective DUR *** - ANSWER--happen prior dispense -looks at --duplication --dosing --treatment duration --CI --Interaction --allergies --signs of abuse or diversion retrospective DUR *** - ANSWER--look after dispensed. -required by OBRA -checked by hospital or insurance company how long does pharmacy keep med profile of pt? - ANSWER-1 year from the dat when last rx was filled what are 3 things pharmacy can give patient? - ANSWER--consumer medication informatinon - CMI -patient package insert - PPI -medguides PPI and medguide is FDA approved
FDA uses REMS requirements to make sure that risks are known and managed adequately. FOUR PARTS: - ANSWER-1. Communication plans
- Implementation systems
- Elements to assure safe use (ETASU)
- Medguides REM drugs: - ANSWER--thalidomide: birth defects -isotretinoin: birth defects -clozapine: neutropenia -Qsymia: birth defects -morphine deriatives: abuse and resp. depression -Saxenda: medullary thyroid carcinoma, acute pancreatitis -Addyi: hypotension and syncope due to interaction of alcohol when do you have to counsel? - ANSWER-1. rx drug never been dispensed
- refill has diff dosage form, strength, or new written rx
- pt request counseling
- when pharmacist feels counseling is necessary what MUST be in consultation? - ANSWER-1. directions for use
- storage
- importance of compliance with directions
- precautions and relevant warnings, (SE)
who can make offer to counsel? - ANSWER-intern and pharmacist if rx is mailed, there must be - ANSWER-a written notice that pharmacist is available with phone # to call, if pt has questions if pt need translation, then it can be provided by: - ANSWER--staff -third party service by telephone are pharmacist require to give consultation inpatient? - ANSWER-no. only when discharge counseling what is purpose of "Notice to Consumers"? - ANSWER-let consumer know they have rights: -receive counseling -ask questions -easy to read type and interpretive services are available **must be in public view alternative ways for Notice to consumers? - ANSWER--poster -small legal size paper printed out -written receipt (mail-order or closed-door pharmacies) -powerpoint presentation on videoscreen *can be in different languages
T/F: rx can be picked up by family or friends unless pharm has reason to believe pt don't want to - ANSWER-true if pt had a HIPAA violation, who can they report to? - ANSWER- department of health and human services (DHHS) when is privacy notice given to the patient in pharmacy? - ANSWER- first day that service was provided what if pt doesn't sign privacy notice? - ANSWER-pharmacy needs to document pt did not sign. it has to be on a diff signature that doesn't connect to other signatures. where is privacy notice has to be? - ANSWER-prominent location within pharmacy and on pharmacy website patients must be able to inspect their medical records within or making a written request and receive copies within
- ANSWER- days 15 days med can't be sub if - ANSWER--doc oral, write, elec it do not sub -check off box do not sub -initials do not sub
can a pharmacist switch a tablet to a suspension if they are equal dose? - ANSWER-yes. they can switch formulation. there are exceptions where they cannot when can pharmacist not change formulation? - ANSWER--long actining to short acting. vice versa -combo drugs to single drugs original brand of biologic is called? - ANSWER-reference product biosimilar is a - ANSWER-biological product that is highly similar structure and function to the reference product ans has no significant difference in safety and effectiveness. when can biosimilar product be interchangeable? - ANSWER- biosimilar must prove that it would have the same clinical effect as the reference product in any given patient which book list the reference products, biosimilar products and interachangeable products? - ANSWER-purple book t/f the dispensed biosimilar product cannot cost more than the prescribed biological product and sub should be notified to the pt - ANSWER-true when biosimilar is dispensed, the pharmacist or someone they designate must - ANSWER-make an entry into the electronic
if the ADDS is used to store and dispense schedule drugs, - ANSWER-a DEA-registered pharmacy must manage the cabinet if ADDS is in a skilled or intermediate care facility, what is required? - ANSWER--pharmacy and nursing facility develop P&P to ensure drugs are being stored and dispensed properly -pharmacist reviews each med order and pt profile before drug is removed from ADDS. -override to use med before pharm can review order is only for emergency -when cabinet is stocked in the facility, the stocking is done by pharmacist -if ADDS use removable pockets, drawer, then it can be done outside the facility (at the pharmacy) and delivered back to the facility. It has to be transported in a TAMPER-EVIDENT container and restocked by Pharmacist, INTERN, or TECH. drugs that are in the ADDS has to be labeled with what requirements:
- ANSWER--name of drug -strength -dosage form -manufacturer -manufacturer's lot number -experation date
pharmacies that remotely operate an ADDS must register the ADDS witht the board within of installing the device and as part of license renewal - ANSWER-1. 30 days
- annually who do not need to register the ADDS separately with the board? - ANSWER-Hospitals that operate ADDS within their own facility repackaging should be done with CGMP and labeled with: - ANSWER- -name of drug -strength -dosage form -manufacturer name -manufacturer lot # -expiration date -qty per repackaged unit **instructions for handling or storage can drugs that were previously dispensed be repackaged? - ANSWER- yes, if patient requests it. this is usually for blister packs or pill card what is on label for blister packs? - ANSWER--all info required for rx label -name and address of pharmacy that initially dispensed drugs to pt
