RXPREP chapter 8: controlled substances part 3

Question 1

Who can prescribe CS?

Answer 1

physician

dentist

podiatrist

veterinarian

midlevel practitioner

or other practitioner who is authorized to prescribe, registered with the DEA or exempt from DEA registration, an under the hospital’s registraiton

Question 2

What are common mid-level practitioners?

Answer 2

certified nurse midwives

certified registered nurse anesthetists

NP

Optometrists

PA

Rph

Question 3

The DEA number starts with two…

Answer 3

two letters

Question 4

The first letter of the DEA identifies…

Answer 4

the type of practitioner or institution

Question 5

the second letter of the DEA identifies the…

Answer 5

prescribers last name

Question 6

the two letters of a dea number are followed by

Answer 6

7 numbers (the last number is the check digit)

Question 7

if a practitioner is authorized to prescribe narcotics for opioid addition treatment, the practitioner will receive what number

Answer 7

DATA 2000 waiver unique identification number (UIN)

same as the DEA number but the first letter is X (replaces the FIRST letter)

Question 8

For a DEA number, A/B/F/G represents…

Answer 8

Hospital, clinic, practitioner, teaching institution, pharmacy

Question 9

for a DEA number, M represents

Answer 9

mid level practitioner

Question 10

P/R represents in a DEA number

Answer 10

manufacturer, distributor, researcher, analytical lab, importer, exporter, reverse distributor, narcotic treatment program

Question 11

Step 1 of determining a DEA number is valid

Answer 11

add the 1st, 3rd, and 5th digits together

Question 12

Step 2 of determining a DEA number is valid

Answer 12

add the 2nd, 4th, 6th digits tgoether

Question 13

Step 3 of determining a DEA number is valid

Answer 13

multiply the result of step 2 by 2

Question 14

Step 4 of determining a DEA number is valid

Answer 14

add the results of step one and step three together. the last digit of this sum should match the last digit of the prescriber’s DEA number. (this is the check digit)

Question 15

the PDMP is regulated by

Answer 15

specified state-wide administrative, regulatory or law enforcement agency. NOT THE DEA

most commonly collected in real time, daily or every 72 hours or weekly

Question 16

CS prescriptions must include

Answer 16

patient full name and address
prescriber full name and address
drug name, strength, dosage form, quantity, and directions for use
# of refills authorized

signed and dated by the prescriber the date it is issued to patient

Question 17

if an MLP is prescribing under a physician directed protocol who signs?

Answer 17

the MLP

Question 18

orders written for direct administration to patients in facilities such as clinics and hospitals are not considered prescription, they are referent o as

Answer 18

medication orders or chart orders

Question 19

pharmacists can receive prescriptions for what schedule drugs verbally?

Answer 19

III-V

the pharmacist must immediately reduce the prescription to writing
don’t need prescriber’s signature

Question 20

oral prescriptions for schedule II drugs are not valid except in what type of situations

Answer 20

emergent

Question 21

faxed prescriptions are acceptable for schedule what drugs

Answer 21

III-V

as long as they contain all required elements and the prescriber has SGINED

Question 22

generally, faxed prescriptions for schedule II drugs CANNOT serve as the original prescription

t/f

Answer 22

true

the schedule II drug cannot be dispensed to the patient until the pharmacy receive the written prescription

Question 23

a faxed prescription can serve as the original copy for a schedule II drug in what three scenarios?

Answer 23

• a drug compounded for administration to pa tint by parenteral, IV, IM, subQ, or intraspinal route
• a prescription for a resident of a LTCF
• a prescription for a patient enrolled in a hospice program

Question 24

in 2010, the DEA released final rules that permit electronic prescription for controlled substances for schedule…

Answer 24

II-V drugs

Question 25

prescribers and pharmacies must use what type of software for electronic prescriptions for CS?

Answer 25

DEA-approved software two factor authentication method to sign and transmit EPCS

Question 26

The credentials that are permitted for DEA-sanctioned validation include two of the following:

Answer 26

something you know (password or response to a question) something you have (hard token) something you are (iris, fingerprint scan) OR can use a digital certificate

Question 27

when a prescription is received electronically, federal law requries that the prescription and all required annotations must be stored electronically for at least __ years

Answer 27

2

Question 28

for all CS, there are three items that cannot be changed:

Answer 28

patient name drug dr signature

Question 29

despite schedule II drugs having the highest abuse potential of all drugs, there is no expiration date or quantity limit set by federal law for schedule II presriptions t/f?

Answer 29

true but no refills

Question 30

what are the three circumstances in which a schedule II prescription may be partially filled

Answer 30

1) if the pharmacy cannot supply full quantity (remaining portion must be filled in 72 hours; after this time, a new prescription is required - rph notifies dr) 2) under the 2016 CARA, pharmacists can partially fill schedule II drugs at the request of the PATIENT or prescriber, can only be dispensed up to 30 days from the date the prescription was issued 3) patients residing in a LTCH or patients with a terminal illness/hospice (must document this on prescription, partial fills can be dispsended up to 60 days from the date the rx was issued

Question 31

the pharmacy does not have sufficient stock fo the drug.. deadline to fill remaining balance

Answer 31

72 hours after first partial filling

Question 32

partial fills - request by the patient or the practitioner who wrote the CII rx; deadline to fill remaining balance

Answer 32

within 30 days after issue date

Question 33

partial fills- terminally ill or LTCF residents; deadline to fill remaining balance

Answer 33

within 60 days after issue date

Question 34

for each partial fill, the pharmacist must document what on the back of the prescription?

Answer 34

date of partial filling amount dispensed amount remaining name of dispensing rph

Question 35

if an electronic record keeping system is used, the following information must be maintained and be updated in real time when a partial fill is dispensed

Answer 35

``` original rx number date of issue drug name, dose, formulation, strength and quantity quantity authorized patients name prescriber name address of LTCF, hospital, or patients home list of partial fills dispensed ```

Question 36

what type of pharmacy are prohibited from preparing emergency fills for schedule II Drugs under any circumstance

Answer 36

central fills

Question 37

what is the criteria for dispensing pursuant to an oral schedule II prescription

Answer 37

dispense the minimum necessary amount prescriber must provide the original prescription within SEVEN DAYS of oral authorization (original can be written or electronic; can be mailed; authorization for emergency dispensing and date of oral prescription must be on the front of the rx) pharmacist must attach the written prescription to the emergency oral prescription if the original prescription is not received within 7 days, the pharmacist must report the breach to the local DEA office

Question 38

according to federal law, prescriptions for non-scheduled and schedule V drugs do not expire; when do schedule III-IV drugs expire?

Answer 38

6 months from the issue date

Question 39

what is the refill limit for schedule III and IV

Answer 39

5 refills (6 months expiration) schedule V and non-scheduled drugs never expire, and have no refill limit; schedule II drugs never expire

Question 40

what is the emergency fill day supply

Answer 40

only 72 hours

Question 41

record keeping requirements for schedule III-V refills - pharmacist must write what on the back the rx

Answer 41

dispensing rph intials date dispensed quantity dispensed

Question 42

schedule III-V prescriptions are only allowed ___ transfer(s) that must be communicated directly between two licensed pharmacists

Answer 42

1 some states allow interns or CPHT the only exception is if the pharmacies share a rel time online database of the prescription record keeping system records kept for 2 years

Question 43

The transferring pharmacy must do what steps when transferring CS

Answer 43

void on front of original hard copy write the receding pharmacy's information on the back ``` pharmacy name business address DEA# name of transferring rph name of receiving pharmacist date of transfer ```

Question 44

the receiving pharmacy must do what steps when receiving CS

Answer 44

reduce the prescription to writing and write transfer on the face of the rx date the original prescription was issued original number of refills date it was first dispensed number of refills remaining transferring pharmacy name, address, DEA# and prescription# name of transferring rph pharmacy's name, address, DEA#, and prescription number from which the prescription was originally filled if different

Question 45

can you transfer a CII?

Answer 45

only if its electronic

Question 46

federal law requires this caution statement on all schedules except for "CAUTION: federal law prohibits the transfer of this drug to any person other than the person for whom it was prescribed"

Answer 46

V

Question 47

each controlled substance prescription disposed must include what items on the container

Answer 47

``` date of initial fill date of current fill (if it is a refill) pharmacy name and address prescription serial # name of patient name of prescriber directions for use cautionary statements ```

Question 48

the federal limit on the amount of drug that can be dispensed every TWO days: 240mL (8oz) or 48 units of any CS containing _____ 120mL (4oz) or 24 units of any other CS...

Answer 48

opium - only the pharmacist can dispense a non-prescription CS to patient who must be at least 18

Question 49

what must the rph record after dis-sending a non-prescription CS

Answer 49

patient name and address drug name and quantity date of purchase pharmacist name or initials

Question 50

what methadone tablet is only FDA approved for treating opiod addition

Answer 50

40mg soluble tablet the lower doses are indicated for the treatment of pain and opioid dependence

Question 51

to operate as an opioid treatment program, clinics must register with the DEA using what form

Answer 51

363 additionally, practitioner must obtain approval and certification by the center for substance abuse treatment (CSAT)

Question 52

for the first 90 days (days 1-90), the patient can receive up to ___ take home dose per week

Answer 52

one

Question 53

second 90 days (91-180) the patient can receive up to ___ take home doses per week

Answer 53

2

Question 54

third 90 days (181-270) the patient can receive up to ___ take home doses per week

Answer 54

3

Question 55

treatment beyond 270 days and less than one year can receive a maximum of how many day supply of take home medication

Answer 55

6 dat supply

Question 56

after one year, can receive a max of ___ supply

Answer 56

2 week

Question 57

after two years, can receive a max of ___ supply of take home medication; but monthly visits

Answer 57

1 month

Question 58

DATA 2000 waiver; physicians can treat up to how many patients in the first year and then the potential eligibility to treat how many after the first year

Answer 58

30; 100

Question 59

CARA expanded DATA 2000 and allowed who to prescribe buprenorphine for a 5 year period

Answer 59

NP and PAs

Question 60

SUPPORT granted NPs and PAs permanent prescribing authority of buprenorphine for opioid addition.

Answer 60

true also inlaced qualified clinical nurse specialists, CNAs and certified nurse midwives; eligible to treat up to 100 patients at a time in the first year; 275 patients after the first year

Question 61

What is the indication of Butrans

Answer 61

pain management

Question 62

what is the indication of probuphine, sublocade, Suboxone

Answer 62

opioid addition