MPJE - NJ Flashcards

Practitioners who can prescribe (5)

Certified Nurse Midwives

Physician’s Assistants

• PA lists their own DEA # on CS prescriptions

Optometrists

• prescribe for the eye-related scope of practice

• can prescribe C3 to C5 & Non-CS; + hydrocodone (C-II)

• “27TO” = topical only; “27OM” = oral + topical meds

Advanced Practice Nurses

• all CS’s; joint protocol with collaborating physician

• own DEA # for CS scripts

• + include collaborating MD’s license number on all prescriptions issued by APN

Dentists

• all CS’s can be prescribed; but within scope of practice

Others:

- veternarians - for animals only of courses

- specialty docs: GI/podiatrists/ophthamologist

Who may NOT write prescriptions in NJ

ambulance services

certified chiropractors

doctors of oriental medicine

euthanasia technicians

homeopathic physicians

medical psychologists

naturopathic physicians

animal shelters may administer CII narcotics + dispense/procure Sodium Pentobarbital

NJBOP application

registration application fee

penalties

may request hearing

may grant waivers

failure to complete application within 1 year of initial application date —> ?

Pharmacy Intern vs Pharmacy Extern + internship/externship hours

Continuation Education Credits

What conditions (7) / scenarios can you prescribe amphetamines & sympathomimetic amines?

1. To tx the following conditions:

• Narcolepsy

• Idiopathic CNS Hypersomnia

• ADHD

• Drug-induced brain dysfunction

• Epilepsy

• Refractory depression

• Senile apathetic behavior

2. For immediate use in a hospital for acute conditions such as depression associated with illness or surgery.

3. For the differential diagnostic psychiatric evaluation of depression.

4. For the clinical investigation of the effects of such drugs or compounds (prior application and Board approval is required)

*C-II: Adderall, Amphetamine, Desoxyn, Dexedrine, Dextroamphetamine, Methamphetamine, Methylphenidate and Ritalin

1. The sending pharmacy invalidates the prescription on file as of the date the prescription is transferred and records on the back of the invalidated prescription order or in the electronic system the following:

• That the prescription has been transferred and the date of transfer;

• The name and address of the pharmacy or store identifies to which the prescription was transferred;

• The name or personal identifier of the pharmacist, intern or extern to whom the prescription was transferred; and

• The initials or personal identifier of the pharmacist, intern, or extern issuing the transferred prescription order;

2. The receiving pharmacy, upon receiving such prescription directly from another pharmacy, records the following:

• The name, address and original prescription number of the pharmacy from which the prescription was transferred;

• The name or personal identifier of the sending pharmacist, intern or extern ;

• All information constituting a prescription order, as well as the following:

  • Date of issuance of original prescription;

  • (2) Original number of refills authorized on original prescription;

  • (3) Number of valid refills remaining; and

  • (4) Date the prescription was last filled; and

3. The receiving pharmacist, intern, extern or technician informs the patient or caregiver that the original prescription has been cancelled at the sending pharmacy.

N.J.A.C. 13:39-7.12 Labeling (p.119-120)

a). The dispense container for any product shall bear a permanently affixed label with at least the following information:

1. The pharmacy name and address

2. The pharmacy telephone number

3. The brand name or generic name and if generic, the brand name and the name of the generic in the following form, with the generic name and brand name inserted as appropriate: “ Generic for ————-”;

4. The strength of medication, where applicable

5. The quantity dispensed

6. The date upon which prescription medication is dispensed

7. A CDS cautionary label where applicable

8. The patient name

9. The practitioner’s name;

10. The prescription number

11. Directions for use

12. The phrase “use by” followed by product’s use by date if not in manufacturer original packaging

    • “Use by date” (NJ rule) means the earlier of one year from the date of dispensing or the expiration date on the manufacturer container.

13. For substituted biological products, the information required in N.J.A.C. 13:39-7.23(d).

b) The patient name, brand or generic name of medication, and the directions for use shall appear in large type, in a different color, or in bolded type, in comparison to the other information required to appear on the label of the dispensed container pursuant to (a) above.

c). In addition to above, the dispensed container shall have auxiliary labeling as recommended by manufacturer.

d). When in a pharmacist’s judgment, cautionary message or directions to the patient are necessary, either for clarification or proper administration, storage or use, the pharmacist may add the directions or cautionary messages in addition to these given by the practitioner on the Rx.

Note: no longer requires dispensing pharmacist’s initials.

e) In addition to the requirements set forth in this section, when a pharmacist dispenses a prescription for an opioid medication, the pharmacist shall affix, to the container, a warning label or sticker such that the label or sticker shall:

1. Contain the warning, "Opioid Risk of Addiction and Overdose." Punctuation and layout of the warning may be determined by the permitted pharmacy.

2. The warning label or sticker must be:

   • Red, orange, or yellow in color;

   • ii. Written in black color text;

   • iii. Printed with a font size of at least 10- point font that is print- or block based (that is, not cursive) such that the font and lettering shall be easily and clearly readable; and

   • iv. Placed on the side, not the bottom, of the bottle or box that contains the prescription label, or on the cap of the bottle.

For animals the NJBOP recommends the following be added to the “name” information on each label: The name of the animal, (its species), and the owner’s last name ( i.e., “Tabatha (feline) Smith). The Board also recommends the following be recorded on the prescription, and/or the patient profile for the animal: animal’s date of birth if known, otherwise “January 1” plus the estimated year of birth; owner’s name and owner’s address.

Requirements for Drug Disbursement - Written Orders

• RPh - review original drug orders (or direct copy or electronic facsimile) prior to dispensing initial dose

• If no instructions for end of order use automatic stop order procedure.

• Can only use abbreviations or symbols if included on an approved standard list

• When appropriate, the pharmacist shall make necessary entries into the patient medical record relative to drug use in accordance with health care facility policies and, where applicable, pursuant to regulations of the Department of Health and Senior Services and/or Centers for Medicare and Medicaid Services.

Requirements for Drug Disbursement - Oral Orders

• Only accept oral orders from prescribers; reduce to writing

• C-II —> only in bona fide emergency situations

• PO orders = countersigned by prescriber

• dispense any remaining medication to patient upon discharge in a multiple dose container (ie., inhalers, multiple dose injectable like insulin, topical preparations, drops, ointments)

  • provided that the RPh:

    1. Labels the medication for outpatient use according to requirements set forth in N.J.A.C. 13:39-7.12;

    2. Counsels the patient prior to discharge pursuant to N.J.A.C. 13:39-7.21

    3. Discharge orders should contain the attending physician’s authorizations to release the remaining medication.

Return of Rx Medications

• If correctly dispensed to a patient →may be accepted for return by pharmacist; but shall not be placed in stock for reuse or resale

  • except: In a healthcare facility unit dose medication stored in a medication room or secure area with the control number intact may be reused

• If incorrectly dispensed to a patient → accepted for return by pharmacist and shall not be placed back in stock for reuse/resale

• Rx prepared for pt but not yet dispensed/abandoned → may be placed back in stock for resuse/resale within 2 weeks provided that:

  • professional judgment of the pharmacist, the prescription medication is eligible for re-dispensing

    • within the original time frame established for the medication’s stability and expiration

    • not be placed in manufacturers’ stock containers of different lot numbers and/or with different expiration dates

    • Manufacturers’ stock containers shall not be over-filled

    • p. 44/83

Sterile-compounding: Risk Levels (3)

Low-risk:

Medium-risk:

High-risk:

DEA 222

DEA 224

DEA 224a

DEA 41 - disposal of CS must be witnessed/signed by 2nd person (nurse/pharmacist/physician)