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AND VERIFIED ANSWERS. A+ GRADE GUARANTEED. Responsibilities of a PIC at an institutional/alternative infusion practice site Dispensing, distribution, compounding, storage, and procurement of rx and non-rx drugs throughout the facility Policies and procedures of practice, pharmacist and tech responsibilities Participate in drug policy committees T/F: a pharmacist must be present in an institutional pharmacy True If no pharmacist is present, it must be kept closed and locked just like a community pharmacy In an institutional facility, the TN BoP requires original prescription orders to be retained for At least 2 years and must be readily retrievable Med carts refer to Drugs distributed from the pharmacy to other areas of the institution that are for individual patients and accessible by nursing staff Floor stock refers to medication cabinets, medication rooms, and nurses areas (outside the pharmacy) Can a pharmacist be on call 24/7 in an institutional pharmacy setting? Yes Policy and procedure for authorized personal to enter the pharmacy in an institutional setting when pharmacist not on duty MUST be accompanied by a security guard to remove the required drug/device Must record: date/time of removal, patient ID/location, name/strength/dosage form/quantity, and signatures of the authorized personnel and security guard Can dispense amount needed plus ONE additional dose until the pharmacy reopens Maintain records for 2 years An institutional facility involved in sterile product preparation must have a documented, ongoing quality assurance program that ensures the consistency in sterile product compounding Each day that a pharmacist or practice commits a violation is subject to Fines that range from $0-1,000 per violation per day to ARCOS Automated, comprehensive drug reporting system Monitors flow of DEA CS from point of manufacture through commercial distribution channels to point of sale/distribution at dispensing/retail level The controlled substance DISPENSED identifier in the CSMD is The NDC number of the controlled substance The DISPENSER identifier in CSMD is The DEA registration number of the dispenser The PRESCRIBER identifier in CSMD is The DEA registration number of the prescriber What is a healthcare practitioner extender in the TN CSMD? Any registered or licensed healthcare professional and up to TWO unlicensed persons designated by the prescriber or dispenser, who act as agents of the prescriber or dispenser (the prescriber/dispenser is responsible for all actions taken by the agents) Example of a healthcare practitioner extender A tech or intern that is enrolled under the pharmacist, but they must have their own log in credentials Who must have access to the TN CSMD? All prescribers with DEA numbers who prescribe in TN and all dispensers who provide direct care to patients for at least 15 days What are options for alternative identification of patients in the CSMD? Social security number Other - drivers license or telephone number receives, warehouses, or ships prescription drugs or devices for another entity, but doesn't own the drugs or devices (Pretty much just a site for extra storage) What are the storage requirements for controlled substances in an institutional pharmacy? Must be kept in the pharmacy in a locked cabinet or safe Can be in a room within a room and must have two locking mechanisms in place Donor definition a person, pharmacy, medical facility, drug manufacturer, wholesaler licensed by the TN BoP, prison or government entity who donates Rx drugs to a repository program most pharmacies are not registered for this Define an eligible individual who could accept a drug from a repository program An indigent person, an uninsured person, or underinsured person who meets all criteria Define an indigent person A person with an income that is below 600% of the federal poverty level, defined by the income guidelines published by the US DHHS What drugs cannot be collected via a drug donation or repository program? Controlled substances and REMS drugs Repository Pharmacy that has a license or permit in good standing with board and meets requirements of the program Requirements for a prescription drug to be donated to a repository program Must be unopened, have tamper resistant packaging, and can be in single dosage units What type of fee can/cannot be collected by a repository program? CAN'T charge or collect fees from eligible individuals CAN charge handling fee for each donated prescription drug or supply that is dispensed What is the in-person requirement according to the TN Abortion-Inducing Drug Risk Protocol Act? An abortion-inducing drug may be provided only by a qualified physician Mature Minor Doctrine prohibits a minor to consenting to vaccination HCP SHALL not provide a vaccine to a minor unless they first receive informed consent from a parent or legal guardian of the minor T/F: if a drug is misbranded its also adulterated in the state of Tennessee True What class of CII medications cannot be prescribed for the purpose of assisting a patient to gain or lose weight? (Tennessee Law) amphetamines/stimulants ex: methylphenidate, amphetamine, lisdexamfetamine Lisdexamfetamine has an FDA approved indication for Binge-eating What is the law in TN for dispensing a new script for a non-controlled substance from a deceased prescriber? Can be dispensed within 90 days of the date of which the practitioner passed How long does a patient have to get a refill of a non-controlled substance if the prescriber is deceased? 180 days from the date of death for a non-controlled drug How does Tennessee law differ from Federal law in refills of C III-V after a prescriber dies? TN says that patients have 90 days from the date of death to refill a C-III-V substance; however, the federal law says the DEA number becomes invalid when the prescriber dies, so we must follow the more strict law Interchange Dispensing of 1 manufacturer of a drug for a different manufacturer for which the patient is currently receiving (brand for diff brand, brand subbed for generic, generic subbed for a brand, generic subbed for diff generic) -advise the patient of associated risk using opioids during pregnancy -counsel on appropriate/effective BC -offer info about availability of BC What are the identification requirements for dispensing controlled substances in Tennessee? Prior to dispensing an Rx for any CII-IV opioid, benzo, zolpidem, barbiturate, or carisoprodol for >7 day supply, the patient must show a valid government ID or private/public insurance card What are some exceptions to being ID'd for controlled substances? The person is personally known by the pharmacist, tech, or intern Pharmacist can use professional judgement if the patient is a minor or homeless and does not have an ID Buprenorphine monotherapy is allowed to be dispensed when Patient is pregnant, breast feeding, or has a documented allergy to naloxone The only providers in Tennessee who can prescribe buprenorphine mono products for the treatment of addiction include MD or DO Cannot be a PA or NP Buprenorphine brand names used for treatment of PAIN Belbuca and Butrans Buprenorphine brand names used for treatment of ADDICTION Subutex and Suboxone Handwritten prescription orders in the state of TN must include: 1) name of prescriber 2) name and strength of drug 3) quantity 4) instructions for use 5) month and day the prescription was issued In Tennessee, any prescription for a C-II-V controlled substance issued by a prescriber must be issued as An electronic prescription (still needed on electronic rx) What is the policy regarding health professional self-prescribing in the state of Tennessee? self-treatment allowed only in emergencies (controlled substances prohibited even in emergencies) This is a policy, not a LAW.. so it's not enforceable.. Who is authorized to prescribe in the state of Tennessee? NP, nurse midwife, clinical nurse specialist, nurse anesthetist (if issued certificate of fitness) Tennessee has how many different controlled substance schedules? 7 Who is able to schedule drugs in Tennessee? Commissioner of Mental Health and Substance Abuse Services upon agreement of the Commissioner of Health Schedule VI substances (Tennessee) -Marijuana -Tetrahydrocannabinols (THC) -Synthetic equivalents of the substances contained din the plant or resinous extractive of cannabis sp. Cannabis oil may contain how much THC and still be considered legal in the state of Tennessee? < 0.9% Butyl nitrate schedule C-VII A person must be how old to purchase, possess, or sell kratom 21 years old Dextromethorphan may not be sold to a person under what age 18 years old Dextromethorphan may be placed where in the store? Anywhere, there is no designated area 2) must be at least 18 y/o 3) must report purchase to national precursor log exchange (NPLEx) 4) NPLEx must generate a stop sale alert if the seller/purchaser is violating quantity limits Xylazine limitations in Tennessee It is illegal to possess, manufacture, deliver, or sell this substance that is structurally similar to clonidine, due to it's use in illicit drug production Xylazine can be legally issued by A veterinarian 5 A's that should be discussed and documented by the prescriber at each visit according to the TN Chronic Pain Guidelines -analgesia -ADLs -adverse side effects -aberrant drug-taking behaviors -affects According to TN Chronic Pain Guidelines, PCPs are encouraged to treat patients requiring less than how many MME/day? <120 According to the TN Chronic Pain Guidelines, a pain medicine specialist should be consulted ifa patient requires how many MME/day Over 120 Screening tools that can be used to assess risk of abuse ORT SOAPP-R If a patient will be requiring chronic opioid therapy, how often do they need to do a urine drug screening? At onset of treatment and twice yearly thereafter How often should the CSMD be checked? At least twice yearly, but its preferred at every fill T/F: According to TN Chronic Pain Guidelines, telemedicine can be used to prescribe chronic opioid treatment False 
