Lecture 15 Flashcards
(22 cards)
Sale
“Sale” means every sale and includes the following:
1. Manufacturing, processing, transporting, handling,
packing, or any other production, preparation, or repackaging.
2. Exposure, offer, or any other proffer.
3. Holding, storing, or any other possession.
4. Dispensing, giving, delivering, or any other supplying.
5. Applying, administering, or any other using.”
What can be described as a sale?
Placing a legend drug outside the pharmacy in a publicly accessible area
Administering a medication to a patient
Transporting a drug from one pharmacy to another
The big four prescribers
Physicians
Dentists
Podiatrists
Veterinarians
As long as they are licensed appropriately, working within their scope, and following the applicable laws of the state in which they are licensed
Advanced Practice Registered Nurses
APRNS are:
Nurse Practitioners
Certified Nurse Midwives
Clinical Nurse Specialists
They must work under the following types of supervising practitioners:
- Physicians
- Podiatrists
- Dentists
APRN Prescribing
Apply for prescribing authority with the state
Have a collaborative practice agreement on file with the Indiana state board of nursing, which outlines the agreement between the APRN
and the supervising practitioner
APRNs are limited to prescribing within the scope and practice specialty of the supervising practitioner, and may be further limited according to the terms of the collaborative practice agreement
APRNs can prescribe controlled substances, so long as they have a DEA number and an Indiana Controlled Substance Registration (CSR)
APRNs can practice independently from their supervising practitioner
When prescribing, the APRN must sign their own name, their credentials, and provide their board-assigned ID
In Indiana, prescriptions written by APRNs from any state are honored, so long as the prescription is legally written from the APRN’s state of licensure
Physician Assistants
PA’s work in a similar way as APRNs, but with more limitations
They must work with a supervising physician (no other practitioner)
Must be directly supervised by a physician in person
- in the same location, or via electronic method, with the physician immediately available via telecommunications
Physician Assistant Prescribing
More limited than APRNs
Can only prescribe things directly delegated by collaborative practice agreement on file with the medical licensing board of Indiana
Cannot prescribe ophthalmic devices under any circumstance, and cannot prescribe or administer general anesthesia or deep sedation
Physician assistants can prescribe controlled substances, so long as they have a DEA number and an Indiana Controlled Substance Registration (CSR)
When prescribing, the physician assistant must sign their own name, list their credentials as awarded by the National Commission on Certification of Physician Assistants (NCCPA), and provide their state
license number
In Indiana, prescriptions written by physician assistants from any state are honored, so long as the prescription is legally written from the physician assistant’s state of licensure
Optometrists
Mid-level practitioners
Can prescribe independently without a supervising practitioner but may only do so according to formulary
Optometrist formulary titers
- Independent Prescribing
- Dependent prescribing by notification: must notify the patient’s PCP before prescribing
- Dependent prescribing by consult: must call and consult with patient’s PCP before prescribing a listed medication
Optometrists Prescribing Formulary
a. The formulary of legend drugs…is any legend drug for the treatment of the eye or associated
structures of the eye.
b) All formulary drugs may be independently prescribed by an optometrist.
c) Controlled substances as defined in IC 35-48-1 are prohibited from use by an optometrist.
However, Indiana code says “An optometrist who:
1. holds a license under this article;
2. meets the requirements of this chapter for certification to administer, dispense, or prescribe a
legend drug; and
3. maintains a controlled substance registration under IC 35-48-3; may prescribe Tramadol (Ultram).”
When there is a direct conflict follow INDIANA CODE
When there is a direct conflict follow INDIANA CODE
Optometrists Prescribing
Unlike APRNS and PAs, optometrists must be licensed in the state of Indiana in order for a valid prescription
You may NOT fill a prescription written by an optometrist who is not licensed in INDIANA
Pharmacists are Independent Prescribers
IC 25-26-13-31: Pharmacist can prescribe any of the following devices or supplies:
Inhalation spacer
Nebulizer
Supplies for medical devices
Normal saline and sterile water for irrigation
Diabetes blood sugar testing supplies
Pen Needles
Syringes for medication use
IC 25-26-25: Hormonal Contraceptives, which we will touch on in a future lecture.
Pharmacists: Statewide Standing Orders
Pharmacists may also have authority granted through a statewide standing order
Auto-Injectable Epinephrine
Vaccines
Naloxone
Tobacco Cessation
These standing orders must be renewed every year and can be terminated by the State Health Commissioner at any time.
Pharmacists: Protocols
Pharmacists may also act as prescriber under a collaborative practice agreements, also referred to as protocols in law
Outside of a hospital, pharmacists may enter a protocol with:
- a physician
- An APRN
- A physician assistant
so long as the protocol is signed by a physician and applies to a single patient or group of patients, as specified by the physician
Pharmacist Prescribing
Like optometrists, pharmacists operating under these prescribing authorities must be licensed in Indiana for another pharmacist to fill one of these prescriptions.
You may not fill a prescription written by a pharmacist who is not licensed in Indiana
Other Midlevel Practitioners
In other states, some other midlevel providers (naturopaths, dietitians, chiropractors, etc.) are granted prescribing authority.
These are not recognized providers in Indiana
You may not fill a prescription written by one of these midlevel providers, even if they are a recognized provider in that state with prescribing authority
Indiana Code Citation
IC T-A-C-S
Indiana Administrative Code
T IAC A-C-S
IC 25-1-9-2 Practitioner
unlimited license, certificate, registration, permit
limited/probationary license, certificate, registration, permit
temporary license, certificate, registration, permit
intern permit
inactive license
IC 16-42-19-5 Practitioner
physician licensed
veterinarian licensed in Indiana
dentist licensed in Indiana
podiatrist licensed in Indiana
optometrist licensed in Indiana & certified
APRN meeting requirements
PA licensed who is delegated prescriptive authority
IC 16-42-44-4.5 Practitioner
physician licensed
dentist licensed in Indiana
podiatrist licensed in Indiana
optometrist licensed in Indiana & certified
APRN licensed & granted authority to prescribe legend drugs
NO VETERINARIAN OR PA
