EXAM 3 lecture 19

Question 1

Pharmacy permit expirations

Answer 1

Pharmacy Permits expire every two years on December 31st of odd-numbered years, renewal is similar to the pharmacist renewal process.

Question 2

Category I Pharmacies

Answer 2

They provide drugs or devices to outpatients under a prescription
A Category I pharmacy may offer drugs or devices to:

• A long term care facility
• A health facility
• An assisted living facility

Question 3

Category II Pharmacies

Answer 3

They provide pharmaceutical care to inpatients under a drug order
A Category II pharmacy may offer drugs or devices to specific individuals pursuant to a prescription:

• an employee, student, volunteer of hospital/health system
• a retiree in a benefit program
• an independent contractor
• a member of hospital board
• a member of hospital staff

Any dependents above

Question 4

Physical requirement of the pharmacy

Answer 4

• be stationary
• be sufficiently secure (detect and deter entry when pharmacy is closed)
• be well lit and ventilated
• be equipped with a sink with hot and cold running water, a proper sewage outlet, and refrigeration
• be sufficient size to allow for practice
• have equipment required by board to operate with state and federal law

Question 5

Pharmacy Permit Application

Answer 5

Application form requirements:

• Name and occupation of persons requesting the permit
• The location of the pharmacy
• Any other information the board requires

Permit ensures adequate staffing

After an application is approved, but before pharmacy opens – it must submit to an inspection by board representative

Question 6

Pharmacist Supervision

Answer 6

Requires reasonable and vocal distance of the pharmacist

May not supervise more than:

• 8 interns, techs or techs-in-training at once
• no more than 3 of 8 may be techs in training

Question 7

A category I or category III pharmacy may request to be open to the general public without a pharmacist on duty if:

Answer 7

• They obtain approval from the board
• They securely lock all legend drugs and other merchandise which can only be dispensed by the pharmacist
• They prominently display a 20” x 30” sign stating: Prescription Department Closed, No Pharmacist on Duty
• Only a pharmacist has access to the secured area

Question 8

You cannot practice pharmacy without a pharmacist license, and without a pharmacy permit

Answer 8

• Inappropriate display of either of these items, or practice without these appropriate licensure and permit, is grounds for a violation
• You can’t even use words in a title which might cause the public to believe that pharmacy is being practiced (pharmacy, pharmacist, apothecary, drugs, etc.).

Question 9

Transfer of pharmacy ownership

Answer 9

• Within 10 days of the change of ownership of a pharmacy, an application must be submitted to transfer the ownership
• If the new owner moves the pharmacy, an application for a permit for the new location must be filed.

Question 10

Temporary & Permanent Pharmacy Closure

Answer 10

If a pharmacy will be closed for 5 days or more, the permit holder must notify the board of the closure and secure drugs as directed by the board

Question 11

Transferring Prescriptions

Answer 11

• Upon request of a patient, a pharmacy shall transfer to another pharmacy a prescription for a patient (including C-II), that the pharmacy has received but not filled unless prohibited by law or writing prescriber
• A prescription for a patient may be transferred electronically or by fax if pharmacies don’t share a common data base
• A technician may transfer a prescription, including a verbal transfer, as delegated by the pharmacist

Question 12

Electronic Controlled Substance Transfers

Answer 12

Electronic prescriptions may be transferred to another pharmacy, even if they have never been filled. This applies to all schedules, and is allowed if:

• Allowed by state law
• Prescription was electronically prescribed
• If communicated between two licensed pharmacists
• If the prescription is maintained in an electronic format

Question 13

Non-electronic Controlled Substance Transfers

Answer 13

Any non-electronic transfers are limited to C-III, C-IV, and C-V prescriptions

• These prescriptions must have been filled at least once before being eligible to be transferred.

Question 14

Original Prescription Maintenance

Answer 14

All original prescriptions shall be organized, maintained and accessible at the pharmacy for at least two years.

They must be available for inspection to any member of the board or agent of the board.

Question 15

A prescription may not be refilled:

Answer 15

without written, electronically transmitted, or oral authorization of a licensed practitioner

Question 16

A prescription may be refilled by a pharmacist without written, electronically transmitted, or oral authorization of a licensed practitioner if the following conditions are met:

Answer 16

• RPh made reasonable effort to obtain authorization
• RPh believes failure would be detrimental to the patient’s health
• The original prescription authorized refills, but it is expired
• Rx was originally filled at pharmacy where the request was received
• Rx is prescribed for continuous use
• RPh documents the info like time dates to contact prescriber
• RPh notifies the original prescriber by next business day
• Max 1 RPh-initiated refill for a single Rx every 6 months
• Drug is not CS

IF prescriber writes “No emergeny refill” this cannot occur

Question 17

A pharmacist may dispense up to a 90-day supply of a medication for a patient if:

Answer 17

• The patient requests a supply of more than 30 days
• The prescription is not a controlled substance
• The prescriber does not indicate on the prescription that the quantity of the prescription may not be changed
• The patient has completed an initial 30-day supply of the drug therapy
• The prescription and included refills allow the pharmacist to dispense at least a 90-day supply of the medication.

Question 18

Prescription Validity

Answer 18

A prescription is valid for not more than 1 year after the original date of issue

A pharmacist may not knowingly dispense a prescription after the demise of the prescriber, unless the pharmacist judges it to be in the best interest of the patient’s health.

Question 19

A medication may not be resold, reused, or redistributed after being returned to the pharmacy unless the medication:

the pharmacist may use their professional judgement

Answer 19

• Was dispensed to an individual residing in an institutional facility, a hospice program, or a county jail or department of correction facility
• Was properly stored and securely maintained
• Is returned unopened and was dispensed either in the manufacturer’s original container, or in a multiple dose blister container or unit dose package supplied by the dispenser
• Was dispensed by the same pharmacy that is accepting the return
• Is not expired
• Is not a controlled substance

Question 20

A pharmacist, acting in good faith, exercising reasonable care, and obtaining patient consent may

Answer 20

change the quantity of medication prescribed if:
- The prescribed quantity is incorrect package size

• The change quantity is related to a change in dosage form
• The change quantity reflects the intended day supply

Change the dosage form of the prescription if in the best interest of the patient
Complete missing info on a prescription if there is sufficient evidence to support the change
Extend a maintenance drug for the limited quantity necessary to coordinate a patient’s refills in a medication synchronization program

Question 21

A pharmacist may not dispense epinephrine or glucagon to a person unless

Answer 21

The product has an expiration date of not less than 12 months from the date dispensed

Question 22

A pharmacist may substitute a therapeutic alternative for epinephrine products to a patient.

Answer 22

TRUE

*Note that this is not generic substitution, this is changing to a different chemical
structure in the same therapeutic class with the same expected therapeutic
effects and adverse reactions

Question 23

Pharmacists may also dispense epinephrine pursuant to a standing order, so
long as…

Answer 23

the individual has completed a training and can administer the drug to
patients experiencing anaphylaxis

Question 24

A pharmacist administering an immunization must:

Answer 24

• Notify the physician who authorized the immunization
• Not administer immunization to anyone under 11, and not for pneumonia under age 50
• Must receive consent from the patient, or if <18 their parent/guardian

Question 24

A pharmacist may admin immunization according to a protocol approved by a physician for

Answer 24

Influenza Shings Pneumonia TDap HPV Meningitis MMR Varicella HEPA + B Hib COVID