Pharm Tech Module 2

Minimum Necessary Standard

principle that requires pharmacy professionals to disclose only the information other parties require about a patient

How often must employers of pharmacy staff provide training about HIPAA’s privacy and security rules?

annually

Prescription

a legal document that conveys a prescriber’s medication treatment plan to a pharmacist

Inpatient

acquires care in a health care facility

Outpatient

acquires medication from a retail or other pharmacy

Omnibus Budget Reconciliation Act of 1990 (OBRA ‘90)

• federal law that increases pharmacists’ professional responsibilities in two ways

  • requires pharmacists to keep records (patient profiles) for all medications that Medicaid recipients use

  • requires pharmacists to offer counseling to all Medicaid recipients about the correct use of their medications

• now applies to all patients

Prospective

prior to dispensing drug utilization reviews (DUR)

retrospective

periodic drug utilization reviews (DUR)

Controlled Substances Act (CSA) 1970

regulates the manufacture, importation, possession, use, and distribution of medications and substances that have the potential for abuse

Drug Enforcement Agency (DEA)

• classifies controlled substances

• enforces CSA provisions

• regulates the sale and use of specific medications

Health Insurance Portability and Accountability Act (HIPAA) 1996

primary federal law that directs pharmacy professionals in handling patients’ protected health information (PHI)

• guards against any misuse or disclosure of patients’ PHI

National Provider Identifier (NPI)

unique 10-digit number for that pharmacy used on all HIPAA addressed transactions

Prescription mandatory

• patient’s name, address, and date of birth

• date the prescriber wrote the prescription

• medication information (name, strength, dosage form, route, dose, frequency, amount to dispense, number of refills, and permission for generic substitution

• sig code or directions for the patient

• prescriber’s signature, address, telephone number, and DEA number

Prescription Medication Labels

• brand or trade name

• generic name

• the medication’s strength

• legend statement

• storage requirements

• the package’s quantity

• dosage form

• manufacturer’s name

• controlled substance mark

• lot number

• expiration date

National Drug Code (NDC number)

• The first 4 digits identify the manufacturer

• The next 3 or 4 digits identify the name, strength, and dosage form

• The last two digits identify the package size

Basic Medication Label requirements

• name and address of the dispenser

• prescription’s serial or identification number

• date the pharmacy filled the medication

• name of the prescriber, plus any of the following that appeared on the prescription

  • patient’s name

  • directions for use

  • cautionary statements (take with food, shake well, can cause drowsiness)

OTC Medication Label requirements

• medication’s name

• name and address of the manufacturer or distributor

• list of all active and inactive ingredients

• amount of the product

• adequate warnings

• directions for use

Occupational Safety and Health Administration (OSHA)

helps ensure safe and healthful working conditions by setting and enforcing standards and by providing training, outreach, education, and assistance for all workers.

Health care fraud

the deliberate attempt to accrue illicit gain from a health care benefit program

• patients using someone else’s health insurance carb

• forging or altering prescriptions

• stealing and attempting to fill someone else’s prescription

• selling prescription medications

When reviewing the quantity requested on a prescription for a controlled substance, what might be a sign of a forgery?

an unusually large quantity

Patient Profile information

• demographics (name, address, telephone numbers, date of birth, gender)

• medication or prescription history

• medication allergies

• chronic conditions or diseases

• third-party information

Paper Record of new and refill prescription information

• serial number

• dispensing date

• patient’s name

• prescriber’s name

• medication name, strength, and dosage form

• quantity dispensed

• initials or identification code of the pharmacist and/or technician

Daily printout information

• patient’s address

• prescriber’s address

• prescriber’s DEA number (if the prescription is for a controlled substance

• quantity prescribed (if different from quantity dispensed

• date of issue

• total number of refills dispensed to date

Schedule I (C-I)

drugs that have a high potential for abuse and have no generally accepted medical uses

• illegal

• providers do not prescribe them

• pharmacies do not stock or dispense them

• heroin, mescaline, peyote, and lysergic acid diethylamide (LSD)

Schedule II (C-II)

medications that have a high potential for abuse, are dangerous, and can lead to psychological and physical dependence

• morphine, methadone, oxycodone, hydromorphone, hydrocodone, fentanyl, levorphanol, meperidine, methylphenidate, secobarbital, and methamphetamine

Schedule III (C=III)

medications that have a moderate to low potential for physical and psychological dependence

• ketamine, acetaminophen with codeine, butabarbital, dronabinol, thiopental, anabolic steroids, and testosterone

Schedule IV (C-IV)

medications that have a low potential for abuse and dependence

• phenobarbital, chloral hydrate, diazepam, zolpidem, eszopiclone, alprazolam, chlordiazepoxide, pentazocine, temazepam, triazolam, and clonazepam

Schedule V (C-V)

medications that contain limited quantities of some narcotics, usually for antidiarrheal, antitussive, and analgesic purposes.

• diphenoxylate with atropine, pregabalin, lacosamide, guaifenesin with codeine, kaolin and pectin with belladonna

In which controlled substance schedule is the commonly prescribed sleep aid zolpidem?

Schedule IV (C-IV)

DEA Number

• valid DEA numbers consist of 2 letters and 7 digits

  • 1st letter = code identifies the type of registrant

  • 2nd letter - first letter of the registrant’s last name

Verifying a DEA number

• add the first, third, and fifth digits of the DEA number

• add the second, fourth, and sixth digits and multiply the sum by 2

• add together the results

• check that the last digit of the sum is the same as the last digit of the DEA number

CSA required prescription components

• patient’s full name and street address

• prescriber’s name, address, telephone number, and DEA registry number

• date the prescriber issued the prescription, number of refills (no refills for C-II medications)

• prescriber’s signature

Schedule II (C-II) refills

• refills not allowed on a C-II prescription

Schedule III (C-III) and IV (C-IV) refills

• refilling allowed 5 times within 6 months after the date of issue

• can transfer to another pharmacy but only once

Schedule V (C-V)

• some are prescription only while some are OTC (over the counter)

• refills allowed 5 times in 6 months

C-I substance

lysergic acid diethylamide (LSD)

C-I substance

marijuana

C-I substance

heroin

C-I substance

peyote

C-II substance

fentanyl

C-II substance

methadone

C-II substance

methylphenidate

C-II substance

hydrocodone with acetaminophen

C-III substance

acetaminophen with codeine

C-III substance

ketamine

C-III substance

butabarbital

C-III substance

thiopental

C-IV substance

zolpidem

C-IV substance

diazepam

C-IV substance

clonazepam

C-IV substance

pentazocine

C-V substance

pregabalin

C-V substance

kaolin and pectin with belladonna

C-V substance

diphenoxylate with atropine

C-V substance

guaifenesin with codeine

Combat Methamphetamine Epidemic Act of 2005

a federal law that regulates retail sales of OTC products that contain ephedrine, pseudoephedrine, or phenylpropanolamine

• can be used to make methamphetamine

Besides presenting a written prescription, what other information must appear on a prescription for a controlled substance like morphine?

the prescriber’s DEA number

How long will the pharmacy have to keep the prescription a patient brings for a C-II drug on file?

2 years

A patient presents a pharmacy technician with a prescription for zolpidem (Ambien) that the prescriber wrote 6 weeks ago. What should the technician do?

Process the prescription for the pharmacy to fill

A pharmacy technician should recognize that which of the following information is mandatory for controlled substance prescriptions and unnecessary for noncontrolled substance prescriptions?

the prescriber’s DEA number

Which of the following processes should a pharmacy technician use to file prescription hard copies for controlled substances?

file controlled substance prescriptions separately from legend prescriptions

According to HIPAA guidelines, which documents should a pharmacy technician have a new patient sign?

acknowledgement of notice of privacy practices

A pharmacy technician is filling prescriptions for storage according to federal regulations. What is the minimum amount of time prescriptions for controlled substances be retained?

2 years

A pharmacy technician should recognize that anabolic steroids are included in which of the following controlled substance schedules?

Schedule III

Which of the following sublingual medications is an exception to mandate for child-resistant caps on prescription medication containers?

nitroglycerin

Which of the following organizations enforces guidelines concerning medication quality standards?

Food and Drug Administration (FDA)

According to HIPAA guidelines, which of the following patient information is considered protected health information (PHI)

email address

According to the DEA, how often should a pharmacy technician conduct an inventory check for controlled substances?

Every 2 years

A pharmacy technician receives a handwritten prescription from a patient. The technician should verify that the prescription contains which of the following information?

quantity of the medication

A pharmacy technician should recognize that exempt narcotics are included in which of the following controlled substance schedules?

Schedule V

A pharmacy technician should recognize that which of the following laws requires medication manufactures to place a label stating, “Caution: Federal law prohibits dispensing without a prescription” on medication stock bottles?

Durham-Humphrey Amendment

A pharmacy technician should identify that which of the following organizations issues a pharmacy’s National Provider Identifier (NPI)

Centers for Medicare and Medicaid Services (CMS)

A pharmacy technician is required to include a patient package insert (PPI) when filling a prescription for which of the following types of medication?

Contraceptives