P2 Law Exam

What are the 5 licensed pharmacy types?

general, hospital, telepharmacy, limited-use, nonresident

what must each pharmacy maintain?

• adequate drug storage areas (sanitary and in accordance with labeling)

• references and drug information

• policies and procedures for operation & ensure drugs & patient records are secure, and maintian accountability and confidentiality

• equipment in accordance with manufactuer to meet pt needs

• drug storage and handling incompliance with USP Chapter 800 for hazardous drug handling

• pharmacist license certificate within view of public

each pharmacy must maintain _____ to ensure confidentiality of patient infromation and prevent theft even when drugs or records are stored outside the pharmacy

adequate security

where should pharmacy staff personal items be stored?

away from drug storage areas and monitored

what does pharmacy security include?

basic alarm system and video surveillance system

what should be maintained by an individual to maintain security of any electronic device/system that protects patient information?

authentication credentials

whent the pharmacist is absent from the facility, ______

the pharmacy department will be closed

in telepharmacy, pharmacist supervision of certified pharmacy tech must ensure what?

patient information is secure and confidential

pharmacist has real-time access to the system used or record processed

technician has real-time access to the pharmacist

pharmacies employ personnel who…

are licensed or registered

have documented training or education for activities within their practice

wear visible identification for public to see

what should be on the identification badge of pharmcy personnel?

first name, title

t/f an individual should provide care within their scope of practice that would be provided in a similar setting by a reasonable or prudent licensee or registrant with similar education

true

what groups of people is it appropriate to reveal patient information to? in all other groups you must maintain patient confidentiality.

patient

patient authorized representative

prescriber

licensed practitioner caring for the patient

licensed pharmacists

person duly authorized by law to receive information

what is protected as patient confidentiality? in other words, what is to be protected for the patient?

prescriptions

medical information

pharmacy service provided to the patient

when are case based situations you can share patient information?

patient gives consent

direction of the court

best interest of patient (emergency care)

what requirement must an applicant meet to qualify for a pharmacist license?

hold a current and unencumbered license in a state or territory of US

pass a board approved jurisprudence examination

What requirements must a new graduate (new licensee) meet?

• be a graduate of a school or college of pharmacy or of a department of pharmacy of a university recognized and approved by the board

• file proof of internship for a period of time

• pass board exam (NAPLEX, board approved jurisprudence examination)

t/f a pharmacist should publicly display the license to practice pharmacy and license renewal cetificate

true

except for the first renewal following licensure by examination, a pharmacist must complete ___ hours of CE since date of issuance or last renewal

30

what should CE be completed in?

pharmacists specific practice setting and provided by accredited CE provider

what must a pharmacist provide evidence of completion if they work with a minor or dependent?

identification and reporting of child abuse or dependent adult abuse

unless currently licensed as a pharmacist, an individual completing ________ should be registered as a pharmacist-intern

internship, fellowship, residency

what is the registration fee for a pharmacist-intern license

$30

when does the pharmacist-intern license expire

one year from graduation, completion of a residency or fellowship, withdrawal from a COP, or upon pharmacist licensure

credit for intership hours completed in Iowa are only granted for pharmacy practice experience completed under supervision of a preceptor during the period the ______ was registered

pharmacist-intern

how long are intership hours valid?

3 years from earlier date of graduation from COP or expiration of pharmacist-intern registration

how many hours should an internship include

1500

the 1500 hours to be completed by an intern should be done in what areas

community, hospital, institutional, clinical pharmacy practice setting

besides pharmacists and interns, who else must register with the board?

pharmacy technicians and pharmacy support persons

what must an individual register as if they are not certified as a technician, and when does this registration expire

technician trainee, one year after initial registration with one renewal under exceptional circumstances

what should a technician register as who holds an active certification and when does it expire

technician, expiring on the date that the technician’s national certification expires

who is responsible for the actions of pharmacist-intern, pharmacy technician, and pharmacy support person

pharmacist

the board establish a review committee and implement a program to monitor impaired pharmacy personnel which means….

• anyone who reports information about imparied pharmacy worker is immune from civil liability (employee or member of the board or a review committee member is presumed to have acted in good faith)

  • board may disclose that the license or registration is suspended, revoked, canceled, restricted, or retirde, or the person is limited in the practice of pharmacy

a crime must be reported to the board within how many days?

30 days of adjudication

what crime does not need to be reported to the board

minor traffic offense

Any disciplinary action in another state or federal jurisdiction will be reported to the board within ____ days of adjudication.

30

you should report what to the board of pharmacy within 30 days regarding individual licensee or registration changes?

address

email

phone #

pharmacy of employment

name

what is the purpose of the iowa pharmacy practice act

promote, preserve, and protect the public health, safety and welfare through effective regulation of practice of pharmacy and licensing of pharmacy personnel engaged in sale, delivery, and distribution of prescription drugs

what must be evaluated to determine is a licensee or registrant violated appropriate standard of care

• performance is expressly prohibited by provision of chapter 155

• performance of act is expressly prohibited by a rule adopted in the board in the IAC

• performance of the act is consistent with the education, traning, and experience of a licensee or registrant

  • performance is within accepted standard of care that would be provided in a similar setting by a reasonable and prudent licensee or registrant with similar education, training, and experience

under the standing order for naloxone, when should a pharmacist dispense naloxone?

individual is at risk of opioid related overdose or a person in a position to assist an individual at risk of opioid related overdose

a pharmacist should dispense naloxone only after completing what?

eligibility assessment and training and education to recipient

under the naloxone statewide protocol, how old must a recipient of naloxone be?

18

under the statewide protocol, nicotine replacement tobacco cessation products can be ordered and dispensed to who?

18+

a pharmacist can adminster what vaccines to those 6 months +

influenza + vaccine related to public health emergency

a pharmacist can adminster what vaccines to those 11+

final two doses of HPV

a pharmacist can adminster what vaccines to those 18+

immunizations recommended by CDC for vaccine schedule

immunization recommended by CDC for travel

immunization for COVID

what can pharmacists intiate CLIA-waived point of care testing when indicated and dispence abx for?

group A strep pharyngitis infection

what can pharmacists intiate CLIA-waived point of care testing when indicated and dispence antivirals for?

influenza

A _____ can assist in the administration of immunizations and vaccinations and the utilization of statewide protocols, pursuant to a pharmacist’s order and consistent with the practice of the profession of a registered nurse, without obtaining a registration from the board (of pharmacy).

registered nurse

A pharmacist or pharmacy may engage in collaborative pharmacy practice under a______ with one or more practitioners who are authorized to independently prescribe to provide patient care and drug therapy management services to one or more patients.

collaborative pharmacy practice agreement

how often should a collaborative practice agreement be reviewed

every 2 years

a pharmacist can delegate ___ to pharmacy technicians and ___ to pharmacy support persons

technical functions, nontechnical functions

a pharmacist can delegate functions to technicans and support persons only if they can what

oversee functions performed

a pharmacist can delegate ____ to the pharmacy intern in accordance with the education and training

any task

when is the pharmacists phycial presence not required regarding delegation?

• remotely supervising pharmacy personal operating in a licensed telepharmacy site

  • utilizing automated dispensing system that utilizes quality control assurance plan

the pharmacists verification of a prescription drug is not required when a certified pharmacy technician is in a _____

technican product verification program

whether a technican is in product verifivation program or telepharmacy, pharmacist should still use a _____ to ensure accuracy for dispensing

quality control assurance plan

______ and _____ remain in the responsibility of the pharmacist

accuracy, completeness

what must be included in a noncontrolled substance for a hospital patient or carefacility or correctional facility?

patient name

drug name, strength, dose

instructions for use

date of authoirization

prescriber name and signature

for hospitalized/institutionalized patients, a ____ will review entry of a new medication order compelled by a nonpharmacist prior to ___ of the med

pharmacist, adminstration

prescriptions are valid when

• issues for legitamate medical purpose

• by a prescriber acting in usual course of professional practice

  • to a patient within established prescriber/patient relationship

every prescription shall be transmitted ___ as a ____ by a prescriber unless exempt

electronically, electronic prescription

t/f a pharmacist that receives a written, oral, or fax prescription must verify the prescription is subject to exception

false

what is to be required on a prescription

date of issue

name and address of patient

name, strength, and qty of drug

directions for use of the drug, medicine or device prescribed

name, address, and written or electronic signature of the prescriber issuing the prescription

federal drug enforcement administration number

if a prescription is transmitted by prescribers agent, what should the prescription include

agents name and title

an electronic, faxed, and oral prescription should serve as the original signed prescription and prescriber should not provide a patient with a ______

signed written prescription

Regardless of the means of transmission, a prescriber shall provide ____ of a prescription upon request of the pharmacy.

verbal verification

when does a prescription lose its validity

prescriber/patient relationship is broken and the prescriber is no longer available to treat the patient or oversee the patient’s use of the medication

Upon a prescrber/patient relationship being broken, the pharmacist will cancel the prescription and any remaining refills but may exercise ____ to ensure sufficient patient access to continued treatment until the patient can reasonably obtain the service of another prescriber.

prudent judgment in individual circumstances

when can a pharmacist refill a patients prescription when in the pharamacist’s judgement, the patient may experience harm due to lapse in therapy (excluding controls)

unable to obtain a repsonse from a prescriber after reasonable attempts

a pharmacist should performa drug utilization review for all prescription to identify….

• overutilization or underutilization

• therapeutic duplication

• drug-disease CI

• DDI

• incorrect drug dose or duration

• drug -allergy interactions

• clincial abuse-misuse

• drug-prescriber CI

what information from the patient should be obtained to complete a drug utilization review

list of prescription and nonprescription med

allergies

disease states

when can a pharmacist not provide a therapetic substitution to a patient

dispense as written indicated on the prescription

how many months after a prescription for a non controlled drug can it no longer be filled, and how many time can it be refilled in that time

18 months, 12 times

t/f a pharmacist cannot refill a prescription drug order without prescriber authorization in accordance with the appropriate standard of care and pursuant to rules established by the board

false - you can

a pharmacist can dispense additional qtys of a drug (not controlled) as long as they…

• do not exceed a 90 day supply

• does not exceed number of total dosage units on the og script and any refills

t/f pharmacists can fill scripts authorized by out of state practioners who would be authorized to prescribe if they were practicing in iowa

true

who is authorized to transfer a prescription

pharmacist, certified tech, and pharmacy intern

when are noncontrolled transfers appropriate?

number of transfers does not exceed the number of originally authoirzed refills and the original presription is still valid

how many times can schedule 3, 4, and 5 drugs be transferred?

once

who can transfer controlled presriptions?

pharmacist and intern

for noncontrols and controls, pharamcies that share a ____ can transfer up to maximum number of refills

real time online database

a pharmacist can add a flavoring agent to a prescription not to exceed ___ % of total volume of drug

5

when flavoring agents are added, a ___ is assigned and documentation of ___ and __ are added to script record

BUD, flavoring agent, volume used

pharmacies should use a continuous quality improvement program to prevent medication errors are include:

• incorrect drug & strength or dose form

• drug received by wrong patient

• inadequate or incorrect packaging, labeling or directions

  • error that results in or has the potential to result in serious patient harm

what is required on a label for a prescription dispensed for an ambulatory patient

• patient

• prescriber

• pharmacy name, address, and phone

• product name, strength, dose, qty

• instructions for use

• dispense date

• unique serial number

• manufacturer name of NDC

  • BUD

what is required for the labeling of a med for institutional patient

patient name

drug name, strength, and dose form

to prevent accidental poisonings, manufacturers must create containers that ___ % children under 5 cannot open but ___ % adults can

80, 90

drugs can only be dispensed ____ time(s) in a child resistant container because continued use compromises container

one

what are exceptions to the rule that drugs can only be dispensed once in a child resistant container

glass bottles or threaded plastic with new safety cap

when can drugs be dispenses in containers that are not child resistant

prescriber or patient requests

what should the request inlcude to dispense meds in non child resistant containters

• can be oral but should be documented (ideally signed)

• patients may make a “blanket” non-safety cap request which should be in writing & with periodic check ins

  • prescribers cannot

• manufacturers may manufacture one side of OTC for elderly or handicapped in noncompliant package

if a manufactuer makes a package that is noncomplant for elderly and handicapped, what must the labeling include

this package for households without young children

t/f institutionalized patients may have non child resistant containers if adminstered by institution employees

true

what are product specific examples of non child resistant containers

• SL nitroglycerin (do not want to delay opening if having MI)

• aerosols for inhalation (inhalers)

  • oral contraception (packaging to aid in memory)

except for institutionalized patients, a ____ or ___ must counsel the patient or caregiver on matters that enhance drug therapy

pharmacist, intern

t/f an offer to counsel does not satisfy the requirement of counseling on new meds

true

each pharmacy should have an area for counseling that prevents access to _____but ensures confidentialtiy and privacy

prescription drugs

if oral counseling is not practicable, the pharmacist can use an alternative method for providing education materials. what does non practicable not include?

staffing issues, prescription volume, manner of dispensing (mail, courier)

a patients ___ of counseling should be documented by pharmacist

refusal

prescription drugs should be ordered from ___

iowa licensed distributors