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95 Cards in this Set

  • Front
  • Back
What's the schedule?

Amobarbital (Amytal/Tuinal)
Schedule II
What's the schedule?

Amphetamine (Dexedrine, Adderall, Obetrol)
Schedule II
What's the schedule?

Glutethimide (Doriden, Dorimide)
Schedule II
What's the schedule?

Hydromorphone (Dilaudid)
Schedule II
What's the schedule?

Oxycodone (512s, 602s)
Schedule II
What's the schedule?

Butalbital (Fiorinal)
Schedule III
What's the schedule?

Hydrocodone product containing less than 15 mg/du
(Lorcet, Lortab, Vicodin, Vicoprofen, Tussionex, Norco)
Schedule III
What's the schedule?

Alprazolam (Xanax, Xannies as one of my customers refered to them)
Schedule IV
What's the schedule?

Clonazepam (Klonopin)
Schedule IV
What's the schedule?

Diazepam (Valium)
Schedule IV
What's the schedule?

Lorazepam (Ativan)
Schedule IV
What's the schedule?

Zolpedim (Ambien)
Schedule IV
All commercial packaging for controlled substances must have __________ packaging
taper-proof (allows you to see if the contents have been messed with)
What's a dispenser?
The pharmacist
Is a pharmacist an individual practitioner?
Not in Title 21! Individual pracitioners are physcians, dentists, vets, or anyone else who can prescribe controlled substances.
Is an institutional practitioner a pharmacy?
Not in Title 21! It's a hospital
Nurse midwives, nurse practitioners, physician assistants are all categorized as what in Title 21?
Mid-level practitioners
What does a reverse distributor do?
Returns or destroys unwanted, outdated, or unusable drugs from a DEA registrant (aka a pharmacy)
Freight forwarding facility is what?
A warehouse that stores controlled substances for less than 24 hours.
A central fill pharmacy can only fill prescriptions for a retail pharmacy if (2 situations)
1.) Both have the same owner
2.) Both have a contractual relationship = have a signed contract
Does each pharmacy on a hospital floor have to have its own DEA number?
NO! There is only 1 DEA number . . .the hospital's.
Name 4 places that don't need DEA numbers
1.) Freight forwarding facility

2.) Administrative buildings in a drug manufacturing plant

3.) Doctor satellite offices where controlled substance prescriptions are written, but no controlled substances are dispenses (so no office stock)

4.) Warehouses that store controlled substances for longer than 24 hours (so long as no distribution takes place.)

5.) Rush Limbaugh's radio station (j/k)
Do all CVS stores have the same DEA number?
NO! Each store in a chain has to have different DEA numbers.
Why don't pharmacist get their own DEA numbers?
The store or hospital's DEA covers us. Hosptials have to come up with individual codes based off their DEA number for everyone that works with controlled substances, such as adding a number or letter or both after their DEA number such as:
AC1111119-007
Are physcians allowed to dispense controlled substances directly to paitents without writting a prescription and going through a pharmacy?
YES!!! The controlled substance is taken from office stock.
What needs to appear on the label of each controlled substance?
The symbol that designates what controlled class it is a member of (C-II, C-III, etc.) If this symbol doesn't appear, the product is misbranded!
Can a doctor write a prescription in order to get controlled substances with the purpose of giving it out to his patients? (office stock)
NO! He can give controlled substances directly his patients, but he can't obtain the controlled substances with a written prescription.
An eye doctor writes a prescription for Percocet. Is this a legit prescription?
Not according to Title 21 because eye doctors don't prescribe Controlled substances in their line of work. Plus, I don't think the eye has pain receptors, though I could be wrong.
Are post-dated prescriptions allowed? (dating a prescription written on Monday for next Tuesday)
NO! (Hahahaha . . .lots of docs do this anyway to prevent their junkie patients from getting their controlled substances too soon)
Can pencils be used to write prescriptions?
Only if the pencil isn't erasable. Pen and electronic are the way to go.
A doctor needs to write the medical need of the patient for the prescription for which drug?
gamma-hydroxybutyric acid
Can a doctor phone in a prescription for Adderall?
NO! Written prescriptions are required to fill Control II substances. (exception: emergency fills)
OH NO!!! Jamie is having a sickle cell crisis and is in a lot of pain. She can't afford to go to the ER and her doctor's office is closed (it's Saturday night). She is in need of some serious C-II action. Luckily, Drug Rite is open 24 hours. The doctor calls in a prescription for a C-II medication. How much meds can Drug Rite dispense?
Only a 72 hours supply
OH NO!!! Jamie is having a sickle cell crisis and is in a lot of pain. She can't afford to go to the ER and her doctor's office is closed (it's Saturday night). She is in need of some serious C-II action. Luckily, Drug Rite is open 24 hours. The doctor calls in a prescription for a C-II medication.

How many days does the doctor have to send a written prescription over to Drug Rite?
7 days according to Title 21, but only 72 hours in PA. Every state has stricter rules for this than the federal rule.
OH NO!!! Jamie is having a sickle cell crisis and is in a lot of pain. She can't afford to go to the ER and her doctor's office is closed (it's Saturday night). She is in need of some serious C-II action. Luckily, Drug Rite is open 24 hours. The doctor calls in a prescription for a C-II medication.

What must the doctor write on the prescription?
"Authorized for Emergency Dispensing" and the date of the oral order.
The doctor sends over the written prescription that authorizes the emergency oral prescription. What does the pharmacist do with it?
Attach the oral prescription (written by the pharmacist) to the written prescription (written by the doctor)
Can a central fill pharmacy fill a emergency C-II order?
NO! Central fill pharmacies are forbidden from filling C-IIs without a written prescription
There are some cases where a fexed prescription for a CII can serve as the "real" prescription (the actual written prescription from the doc isn't needed) Name 3 situations where this can occur.
1.) The schedule II drug is to be compounded for the direct administration to a patient by IV, IM, SQ, or intraspinal administration.

2.) The Schedule II drug is for a LTCF patient

3.) The Schedule II drug is for a patient who's in hospice care (financed by Medicare or a state program)
Mr. Sleazy calls in for a refill on his Endocet prescription. What do you tell him?
Refills are not allowed for Schedule II substaces. And laugh at him.
Uh-Oh. The script calls for 100 Dilaudid and you only have 20 and the guy really needs it. Now what?
Dispense a 72 hour supply to the patient and order the drug. You now have 72 hours to get the rest of the order to the patient. If you don't get the drug in within 72 hours or if the patient waits 5 days to return to get the rest, you need to get a new script from the doctor.
There's 2 cases where a prescription can be continually partialed until the quantity written for either runs out or the script becomes older than 60 days. Name the 2 situations
The patient is in a LTCF (write "LTCF patient" on the script)

The patient is terminally ill (write "terminally ill on the script)
Hospitals are exempt from the labeling rules for C-IIs that retail pharmacys have to follow under certain conditions. Name 'em.
1.) The drugs are not in the possession of the patient prior to administration (i.e. the bottle is kept in the nursing station/medication drawer and not on the patient's bedstand)

2.) Not more than a 7 days supply of the C-II is given to the patient

3.) The C-II is controlled properly


2.)
You just faxed over a C-II prescription to a central fill pharmacy. What do you write on the original prescription?
"Central Fill" plus the name, address, DEA number, the date, and the name of the pharmacy who transmitted the order to the central fill pharmacy. Keep Rx for 2 years
You just recieved the filled order of the C-II from the central fill pharmacy. What do you write down?
The date you got it, the method of delievery, and the name of the retail employee who accepted the order.
On the central fill side, what gets written on all faxed over prescriptions?
The name, address, and DEA number of the retail pharmacy, the date you received the Rx, the date you filled the Rx, and the name of the pharmacist who sent you the order. Also write down the date the Rx was delivered back to the retai store and the method of delivery.
A doctor has 3 options for sending a Rx for a C-III, C-IV, or C-V to a pharmacy. Name 'em
1.) Written Rx

2.) Phoned-in Rx

3.) Faxed Rx
If the Rx is phoned-in, should the pharmacist ever sign the physcian's name?
NEVER!!!
How many maximum refills can Rush Limbaugh get for his Ambien?
5!
Controlled substance Rx are only good for _________ months after the date they are written on
6 months
Hospital pharmacies are exempt from the labeling rules for Controls III, IV and V if certain conditions are followed. What are they?
1.) Not more than a 34 day supply or 100 dosage forms (whichever is less) is dispensed at 1 time to the hospitalized patient (compared to a 7 day supply for C-IIs)

2.) The controlled substance isn't in the possession of the hospitalized patient prior to administration

Blah Blah Blah, something abour record keeping.
How many times can a C-III, IV, or V be transferred between Happy Harry stores?
5 (each refill can be transferred to a different store because all Happy Harry's are linked through an electronic database.)
Mr. Sleazy wants to transfer his Norco back to Rite Aid because "you shorted him 4 tablets." Can you do this?
NO! Controlled substances can only be transferred once between different chains.
Ms. Hess hates your store and wants to get all her prescriptions transferred to Heavenly Drugs. What information does the pharmacist at Heavenly Drugs need to write on the form?
1.) Date the original prescription was written

2.) Original number of refills written by the Dr.

3.) Date the patient originally picked up the prescription (the last filled refill)

4.) Number of refills remaining on the prescription

5.) Pharmacy's name, address, DEA registration number and prescription number from the old retail pharmacy

6.) Pharmacist's name
The original and transferred prescription must be maintained for how long after being filled?
2 years.
Codeine is kept behind the counter in New Jersey. Who can fill the 8 oz bottle of codeine-containing product for the customer?
Only the pharmacist although the cashier can ring him up.
Harry Potter is 17 years old. Can he buy a CIII, CIV, or CV substance without a prescription (where sold)?
NO!. You need to be 18 to buy a controlled substance without a prescription.
Dispensing controlled substances without prescriptions (behind the counter where allowed by law)

What's the max amount of liquid containing opium you can buy in a 48 hour period?
240 ml (8 oz)
Dispensing controlled substances without prescriptions (behind the counter where allowed by law)

How much liquid can you buy without a prescription that doesn't contain opium and is a controlled substance?
120 mL (4 oz)
Dispensing controlled substances without prescriptions (behind the counter where allowed by law)

How many opium-containing pills are you buy without a prescription?
48 dosage units
Dispensing controlled substances without prescriptions (behind the counter where allowed by law)

How many non-opium containing pills are you buy without a prescription that's a controlled substance?
24 dosage units.
Can Central Fill pharmacies fill C-III, C-IV, and C-V substances without a prescription?
NO! Only retail pharmacies can (where permitted)
There's an additional piece of information that's needed by Central Fill pharmacies when dispensing non-CII controls for a retail pharmacy. What is it?
The number of refills dispensed and the number of refill remaining on the prescription.
Do Schedule I have an accepted medical purpose?
NO!
Name the drugs we have to know that can be dispensed in convetional packaging
SL nitroglycerin

SL and chewable isosorbide tablets

Bethamethasone tablets in manufacturer's packaging (less than 12.6 mg)

Methylprednisone (less than 84 mg)

Birth control

Prednisone (less than 105 mg)
What must bear what's known as "The 7 Point Label"?
All OTC products
A doctor requests that Mrs. Eldery's Norvasc be dispensed with a non-safety cap (that's non-childproof for all of you who don't work for CVS). Should the pharmacist also put a non-safety cap on Mrs. Eldery's Lipitor?
Not unless Mrs. Elderly requests that all her meds have non-safety caps. If no such request exists, the pharmacist must put a safety cap (childproof cap) on the Lipitor.
Out of 100 children, 15% of children are able to get into Medication A. Out of 100 seniors, 20% are able to get into the medication. Is Medication A compliant?
NO! While less than 20% of children could get into the medication, which makes it child-resistant, 20% of seniors aren't able to assess the medication. If only 10% of the seniors weren't able to get into the medication, then Medication A would be considered to be in compliant packing.
When does unit dose packaging fail to be compliant?
If a child is able to open more than 8 individual units or the number of units representing a toxic amount (whichever is less).
Can you get Ipecac syrup without a prescription?
YES!
Which drugs require that you hand out Patient Package Inserts?
Estrogen-containing birth control and asthma medication require that the package insert be dispensed each time.
If the PPI isn't given to the patient, the drug is ___________.
Misbranded
If the patient is hospitalized and is given a medication that requires a PPI, what are the guidelines?
The patient needs to receive the PPI on the first dose and every 30 days that the patient is hospitalized.
A patient wants to get his Ibuprofen 800 mg prescription refilled, but there are no refills left on the container, should you direct your patient to take 4 of the 200 mg?
There's no law to prevent this, but the FDA's position is that the prescription should be refilled only as authorized by the prescriber.
Is the NDC required on the labels of comercial containers?
No. It's requested, but not requried.
Can you give a patient a package insert if he/she requests it?
Absolutely
A customer walks into your store and requests a sample of insulin (this really happened in my store) What do you tell him?
The law does not allow pharmacists to dispense drug samples to patients. Only practitioners licensed to prescribe such drugs may be provided samples from companies.
Dr. Nifty likes your pharmacy and wants you to receive, store and handle his drug samples. Is this allowed?
Yes, BUT Dr. Nifty has to be a licensed practitioner and must submit a document telling the FDA about your relationship.
Narcs-R-Us pharmacy has run out of Percocet! (The horror!) Can your pharmacy loan them some to tide them over during this temporary shortage?
Yes, because the law will not consider such a transaction to be "whoesale distribution." (but why would you want to?)
Adulterated or Misbranded?

The drug has decomposed
Adulterated
Adulterated or Misbranded?

The container that holds the drug contains poison
Adulterated
Adulterated or Misbranded?

The drug wasn't made in a manufacturing plant that uses Good Manufacturing Practices
Adulterated
Adulterated or Misbranded?

The drug is labeled as 99.9% iron, but is actually 14% iron.
Adulterated
Adulterated or Misbranded?

The drug is supposed to be 10 mg, but it's really 8.7 mg
Adulterated
Adulterated or Misbranded?

Red Yeast Rice contains trace amount of lovastatin
Adulterated
Adulterated or Misbranded?

The label is missing information required by name (name, address of manufacturer, etc.)
Misbranded
Adulterated or Misbranded?

The label doesn't contain adequate instructions for use
Misbranded
Adulterated or Misbranded?

The fake Viagra from China that appears in the Viagra container is _________
Misbranded
Adulterated or Misbranded?

Sweettarts are in a contained that labeled as aspirin
Misbranded
Adulterated or Misbranded?

A patient has no refills on his Fiorinal, but what the heck, you give it to him anyway.
Misbranded
Adulterated or Misbranded?

Eli-Lilly forgot to put "Rx only" on their new Prozac containers
Misbranded
Mr. Forgetful is out of Coreg pills and his bottle says "no refils." It's Sunday and the doctor is on the golf course without his cell phone. What does the law allow you to do?
Dispense an emergency 72 hour supply of the medication.
Who is exempt from all the rules involving GMP when compounding medications?
1.) Retail pharmacies

2.) IV rooms in hospitals
What's the maximum amount of Ipecac you can buy OTC?
1 oz (30 ml)
All Ipecac syrup containers must bear this warning in red lettering
"For emergency use to cause vomiting in poisoning. Before using call physician, the Poison Control Center, or hospital emergency room immediately for advice."
Ipecac syrup must also contain another warning. What is it?
Keep out of reach of children.

Do not use in an unconscious person

General guidelines: If it burnt going down the throat, don't use Ipecac syrup to bring it up.