Foundations Final Exam

Which drugs Rx expires 6 months after written date? 

• schedule II

• schedule III-V

rx expiration

Which drugs Rx expires 1 year after written date?

• Schedule VI

rx expiration

Which schedule drugs has NO refills ever?

• Schedule II

refills

In VA, what are the two options for prescribers to do for writing maintenance C2 prescriptions and sending them in at one time?

• 3 prescriptions for 1 month supplies

• 1 prescription of a 3 month supply

What is the legal limit of months prescribers can write a C2 for?

• 3 months (90 days)

Which schedule drugs can have 5 refills in 6 months? 

• Schedule III-V

refills 

Which schedule drugs can have PRN or unlimited refills?

• Schedule VI

refills

What are PRN refills usually written as in community pharmacy?

• 99 refills

What are the address requirements for schedule II drugs? 

• patient address must be written on hardcopy of Rx

What are the address requirements for schedule III-V drugs?

• patient address required on hardcopy of Rx

What are the address requirements for schedule VI drugs? 

• no patient address required

Which schedule drugs can be phoned in?

• Schedule III-V

• Schedule VI

phoned in

Which schedule drugs can NOT be phoned in?

• Schedule II

phoned in

Which schedule drugs require DEA number? 

• schedule II - written on hardcopy

• schedule III-V - written on harcopy

DEA

Which schedule drugs do not require DEA number?

• Schedule VI

DEA

What are two examples of Schedule II drugs?

• Percocet (oxycodone/acetaminophen)

• Oxycodone

What are 2 examples of Schedule III-V drugs?

• Ambien (Zolpidem)

• Ativan (lorazepam)

What are some examples of Schedule VI drugs?

• Everything else from our top 300 list

What is the only exception for allowing a phoned in C2?

• an emergency

• only in the case where the Board of Pharmacy enlists a state of emergency

What is the 1st letter of a DEA number? 

• type of physician the prescriber is

• NP, PA, MD, DO

What is the 2nd letter of the DEA number?

• initial of the prescriber’s last name

What is the math behind the 7 numbers in a DEA number?

• add 1st, 3rd, and 5th together

• add 2nd, 4th, and 6th then multiply by 2

• add those values together

• the 7th (LAST) number of the DEA should be the last digit of the calculated number from the last bullet

What can be edited on a prescription after having an oral consultation with a prescriber? 

• drug quantity

• drug strength

• date written

• dosage form

• can add or edit directions

Ex. of adjusting drug quantity after consultation:

• Rx should be dispensing 30 tabs

Ex. of editing drug strength after consultation:

• changing eliquis 5 mg to 2.5 mg

Ex. of editing the date written after consultation:

• adding it was written yesterday (dr. forgot to write it down)

Ex. of editing dosage form after consultation:

• should be a topical metronidazole, not a metronidazole suspension

What can NEVER be edited on a prescription?

• Drug type/identity

• prescriber’s signature

What does the pharmacy require in order to change a drug identity or a prescriber’s signature? 

• a whole new prescription

If an C2 Rx is an orally created emergency, what are the appropriate filling guidelines if a partial must be done?

• 72 hours to fill the rest in an emergency

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If a pharmacy is out of stock of C2, or it doesn’t have enough to fill it all, what are the appropriate filling guidelines if a partial must be done? 

• 72 hours to fill the rest of the Rx if they are out of/low on stock

If a patient is requesting a partial fill of their C2 prescription and they are OUTPATIENT (community), what are the filling guidelines?

• 30 days to fill the rest of the script

If a patient is requesting a partial fill of their C2 prescription and they are INPATIENT (long term care), what are the filling guidelines?

• 60 days to fill the rest of the script

Where must C2 drugs be stored? 

• completely separate from other drugs, in a SAFE

If a patient is unknown to a pharmacy, what is required at the counter when picking up a C2 and how long must that info be stored at the pharmacy?

• valid photo ID with proof of address (driver’s license, Gov. ID)

• 1 month after pick up

What is the deal with schedule 1 drugs?

• NO accepted medical use

• unable to prescribe at all

• highly abusive

• Ex. Heroin, LSD, quaaludes

What is a PMP?

• Prescription Monitoring Program: perpetual log of all controlled Rx’s given to a patient

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What does a PMP do?

• prevents diversion of medications

• ensures compliance with the use of controlled substances

What is a DEA form 222 for?

• ordering C2 medications

What is a DEA form 224 for?

• for initial registration (new provider)

What is a DEA form 224a for?

• for DEA renewal (every 36 months)

What are the two pieces that make up a capsule shell? 

• cap and body

What are the sizes of a capsule, starting from smallest to the largest?

• 5 (smallest) → 000 (largest)

What are the 3 components of a capsule:

• capsule shell (cap and body)

• active ingredient (API) → this weight is the dose of the drug

• excipient (the filler)

How much more do we prepare for capsules in order to incorporate room for error? 

• 10% more than what is required to fill the prescription

• this is only for non-solutions and non-suspensions (solid dosage forms)

What you required to have on the compounding log?

• Name/strength/dosage form of the drug

• All ingredients

• Quantities of ingredients

• Manufacturer

• Lot # and expiration date

• Use of ingredient in the prescription (API or vehicle)

• ***solubility is only if you are making a solution***

How is sufficient quantity written on a compounding log?

• qs ad

How is capsule product verification done in compounding? 

• tare empty capsules

• compare their weights to filled capsules

How do we clean the tables when compounding? 

• 1st - peroxide

• 2nd - IPA (isopropyl alcohol)

What are the 4 reasons to compound a prescription?

• improve taste for medication adherence

• allergies/intolerances form manufactured products

• drug shortages

• reducing the “pill burden” by combining drugs together

How do you fill a capsule?

• punch the capsule into the powder, rotate it slightly as it enters the powder, it will help pack the mixture into the capsule

What are the two uses for Tamiflu?

• treatment

• Prophylaxis - prevention of disease

When do you give Tamiflu as a treatment?

• there is a positive flu test

When do you give Tamiflu as a prophylaxis?

• there is a negative flu test

Why is it important to pay attention to what Tamiflu is being used as (treatment or prophylaxis)? 

• both have different directions/dosages to follow

What are the “reference materials” for Tamiflu that you have to write on the prescription?

• Tamiflu Package insert

If a Tamiflu prescription is not legally correct, then add these elements:

• strength/dose of prescription (15mg/mL)

• Quantity dispensed in mLs

• SIG: “give in mLs”

• reference materials: tamiflu package insert

• Pharmacist signature for the edits on the script

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What are the two main reasons for emergency compounding? 

• FDA shortages

• Natural disasters

When Tamiflu is refrigerated, what is the BUD?

• 35 days

When Tamiflu is kept at room temperature, what is the BUD?

• 5 days

What are the different formulas that can be used in Magic Mouthwash?

• diphenhydramine (Benadryl)

• corticosteroids

• lidocaine

• antacids (Maalox/Mintox)

• tetracyclines

• Nystatin

What is diphenhydramine (Benadryl) used for in magic mouthwash?

• local pain relief/analgesic

What are coricosteroids used for in magic mouthwash?

• inflammation

What is lidocaine used for in magic mouthwash?

• topical pain relief

What are antacids (Maalox/Mintox) used for in magic mouthwash?

• to coat ulcers in mouth

• used as a vehicle

What are tetracyclines used for magic mouthwash?

• to reduce healing times (not really used anymore due to teeth discoloration)

What is Nystatin used for in magic mouthwash? 

• an antifungal for oral thrush

What do you need to calibrate if you decide not to use your graduated cylinder to measure everything in the compound?

• Amber vials

What do you have to add to the SIG for Magic Mouthwash? 

• Swish and Spit

When compounding for children and pets, what should be written in the SIG?

• “Give (patient name)”

What are two good characteristics of a suspending vehicle?

• viscous enough to maintain the drug particles in suspention

• fluid enough to be poured into and out of a container

What should all suspensions have on their amber vials as an aux label?

• “shake well”

What are you required to wear/garb/PPE for compounding?

• gloves (changed between each compound)

• gowns (changed after every shift)

• hairnet and mask as needed

Why is BUD for aqueous vehicles shorter than non-aqueous vehicles?

• they are very susceptible to chemical degradation

What is the definition of a suspension?

• liquid preparations that consist of solid particles dispersed throughout a liquid phase in which the particles are not soluble

What are the characteristics of a suspension?

• prepared from small/fine uniform particles

• uniform dispersion in liquid vehicle

• slow sedimentation rate

• ease of re-dispersion - readily when shaken

• pours easy

What is the definition of Solutions?

• liquid preparations containing one or more drug substances molecularly dispersed in a suitable solvent or mixture of mutually miscible solvents

What are the characteristics of a solution? 

• syrups or elixirs

• small particles

• water soluble API - syrup or simple solution vehicle

• Oil API - emulsion vehicle preferred

What is the accepted medical use of a CI?

• NONE, research only

Is there accepted medical use for CIIs?

• Yes, restricted though

Is there accepted medical use for CIII-CVI?

• Yes

What is the level of potential abuse for CI-CII?

• HIGH

What is the level of potential abuse for CIII?

• moderate to low

What is the level of abuse for CIV-V?

• low

What is the level of abuse for CVI? 

• No known abuse potential

What is the dependence potential for CI-CII?

• Severe psychological/physical dependence

What is the dependence potential for CIII?

• moderate/low physical dependence

• high psychological dependence

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What is the dependence potential for CIV-V? 

• limited

W

What is the dependence potential for CVI?

• no known dependence potential

what are the two parts of a syringe?

• flatter “bottom”

• tippy top

What part of the syringe do you look at at to read it? 

• flatter bottom end

What is required on the hardcopy of a pet’s prescription?

• owner’s full name and address

Where is the owner’s name vs. the pet’s name on a pet’s prescription label? 

• Owner’s name, First (ANIMAL-type) Last for the patient name

• Sig: Give (PET NAME)…

What will a PMP pull for a pet’s prescription?

• the owner’s name

What drug is toxic to cats? 

• Metronidazole benzoate

What tastes are cats opposed to? 

• no sweet things

What are dogs sensitive to?

• smell

What diet are cats on?

• strict carnivore

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What diet are dogs on?

• carnivore

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What diet are horses on?

• herbivore/constant grazer