Texas MPJE: Dr. C's Review Chapter 3

True or False: Dangerous drugs do not include prescription medical devices

False - medical devices and drugs that are not controlled substances

True or False: a designated agent does not have prescriptive authority and cannot authorize prescriptions

True - they are allowed to communicate a prescription to a pharmacist

*practitioners must designate in writing each agent authorized to verbally communicate scripts, and a pharmacist may request a list of these agents from the practitioner

True or False: a practitioner can authorize a licensed vocational nurse to serve as a designated agent to call in prescriptions for NPs and PAs

True

*DAs may be a licensed nurse, PA, pharmacist, or any other individual the practitioner designates

Independent Prescriptive Authority - these practitioners can independently prescribe under their own license

1. Physicians (MD, DO)

2. Dentists (DDS, DMD)

3. Podiatrists (DPM)

4. Veterinarians (DVM)

5. Optometrists (OD) - therapeutic optometrists and optometric glaucoma specialists

Dependent Prescriptive Authority

1. Physician Assistant (PAs)

2. Advanced Practice Registered Nurses (APRN)

True or False: the Texas definition of "practitioner" includes persons licensed in other states, Canada, and Mexico in a health-care field who can legally prescribe dangerous drugs under Texas law.

True

*this means that a pharmacist can fill a prescription (written, verbal, or electronic) for a dangerous drug from a physician, dentist, podiatrist, veterinarian, or optometrist from another; for Canadian and Mexican practitioners, the scripts must be written

For a pharmacist to fill a prescription for a dangerous drug from a Canadian or Mexican practitioner, the prescription must be what?

Written (not electronic or verbal)

True or False: pharmacists can fill prescriptions for controlled substances from out-of-state APRNs and PAs

False - only dangerous drugs (written, verbal, electronic)

In Texas, what is required on written (paper) prescriptions for dangerous drugs from all types of authorized prescribers?

manual signature or electronic replica of manual signature printed on secured paper required

True or False: Texas physicians, dentists, veterinarians, and podiatrists can all authorize dangerous drug prescriptions via electronic, written, facsimile, and oral methods.

True

True or False: name of the designated agent is required on written (paper) Rxs for dangerous drugs, if applicable.

False - not required on written Rxs; required on electronic, facsimile, and oral

*statement indicating Rx has been "faxed" required for faxed Rxs

On what drug order format for a dangerous drug prescription written by an APRN or PA must have the delegating physician information and DEA number?

Oral (verbal/telephonic) Rxs

*DP's DEA number is only required on oral Rxs, but the DP's info is required on all Rx drug order formats for dangerous drugs (electronic, written, facsimile, oral)

What types of prescribers may not authorize a dangerous drug prescription via verbal/telephonic methods?

1. Canadian or Mexican physician, dentist, veterinarian, or podiatrist

2. Physician-delegated Texas pharmacist performing drug therapy management (DTM)

What are the requirements for a DTM RPh authorizing dangerous drug prescriptions via electronic, written, or facsimile methods?

1. RPh practices at federally qualified health center (FQHC), hospital, hospital-based clinic, or academic healthcare institution

2. delegating physician information required

*signature required on written and facsimile Rxs; not electronic

On what drug order format for a dangerous drug prescription authorized by a DTM RPh must have their signature?

written and facsimile Rxs (not electronic)

What must be on all authorized prescriptions from a Texas Therapeutic Optometrist (T)?

License number plus "T" designation

*topical & oral drugs for health conditions of the eye, excluding glaucoma

True or False: Authorized Texas Advanced Practice Registered Nurses (APRNs) and Physician Assistants (PAs) can both authorize dangerous drug prescriptions via electronic, written, facsimile, and oral methods.

True

True or False: Physician-Delegated Texas Pharmacist Performing Drug Therapy Management (DTM) can authorize dangerous drug prescriptions via electronic, written, facsimile, and oral methods.

False - cannot authorize oral Rxs

True or False: Texas Therapeutic Optometrists (Ts) can authorize dangerous drug prescriptions via electronic, written, facsimile, and oral methods.

True

*topical & oral drugs for health conditions of the eye, excluding glaucoma

True or False: Texas Therapeutic Optometrist - Optometric Glaucoma Specialists (TGs) can authorize dangerous drug prescriptions via electronic, written, facsimile, and oral methods.

True

True or False: Out-of-State NPs and PAs can authorize dangerous drug prescriptions via electronic, written, facsimile, and oral methods.

True

*delegating physician information required

*includes U.S. territories (Puerto Rico, U.S. Virgin Islands, American Samoa, Guam, Northern Mariana Islands)

True or False: Out-of-State physicians, dentists, veterinarians, and podiatrists can all authorize dangerous drug prescriptions via electronic, written, facsimile, and oral methods.

True

*includes U.S. territories (Puerto Rico, U.S. Virgin Islands, American Samoa, Guam, Northern Mariana Islands)

True or False: Canadian or Mexican physicians, dentists, veterinarians, and podiatrists can all authorize dangerous drug prescriptions via electronic, written, facsimile, and oral methods.

False - only written Rxs; no electronic, facsimile, or oral Rxs

What must be on all authorized prescriptions from a Texas Therapeutic Optometrist - Optometric Glaucoma Specialists (TGs)?

License number plus "TG" designation

If a Therapeutic Optometrist (T) wants to treat glaucoma, what must they do?

must obtain (TG) certification

*Ts and TGs may both prescribe topical & oral drugs for health conditions of the eye, but only TGs may treat glaucoma

True or False: Texas physicians, dentists, veterinarians, and podiatrists can all authorize controlled substance (CII-V) prescriptions via electronic, written, facsimile, and oral methods.

True

*Oral CII Rxs are only for emergency situation; otherwise, a written prescription must be used if exempted from EPCS

In Texas, what is required on written (paper) and facsimile (faxed) prescriptions for controlled substances (CII-V) from all types of authorized prescribers?

manual signature on written Rxs and facsimile of manually signed written Rxs

*for CII Rxs, manual signature and facsimile of a manually signed written Rx must be written on a TSBP "Official Form"

True or False: name of the designated agent is required on written (paper) Rxs for controlled substances (CII-V), if applicable.

False - not required on written Rxs; required on EPCS, facsimile, and oral Rxs.

*statement indicating Rx has been "faxed" required for faxed Rxs

True or False: a pharmacist who receives a controlled substance prescription in a manner other than electronically is not required to verify that the prescription is exempt from the requirements for electronic transmission.

True

*a pharmacist may dispense a controlled substance pursuant to an otherwise valid written, oral or telephonically communicated prescription consistent with the requirements in the Texas and Federal Controlled Substances Acts

True or False: Canadian or Mexican practitioners can authorize controlled substance (CII-V) prescriptions via electronic, written, facsimile, and oral methods.

False - no controlled substance Rxs are ever authorized

True or False: Out-of-State NPs and PAs can authorize controlled substance (CII-V) prescriptions via electronic, written, facsimile, and oral methods.

False - no controlled substance Rxs are ever authorized

True or False: Physician-delegated Texas Pharmacists performing Drug Therapy Management (DTM) can authorize controlled substance (CII-V) prescriptions via electronic, written, facsimile, and oral methods.

False - no controlled substance Rxs are ever authorized

*DTM RPh may orally communicate new Rx as designed agent of the prescribing DTM-delegating physician

True or False: Texas Therapeutic Optometrists (Ts) and Optometric Glaucoma Specialists (TGs) can authorize CII prescriptions via electronic, written, facsimile, and oral methods.

False - no CII Rxs are ever authorized

True or False: Out-of-State physicians, dentists, veterinarians, and podiatrists can all authorize controlled substance (CII-V) prescriptions via electronic, written, facsimile, and oral methods.

False - this statement is true for CIII-Vs; not allowed for CIIs unless pharmacy has plan approved by TSBP

*CII oral Rxs are only for emergency situations; otherwise a written prescription must be used if exempted from EPCS

If an APRN or PA authorizes a CII-V prescription, what must be on the prescription?

Delegating physician information and DEA number

If a T or TG authorizes a CIII-V prescription via electronic, written, facsimile, or oral methods, the script is limited to one ___ day supply with ____ refills.

one 3-day supply with no refills

On what drug order format for a CIII-V prescription authorized by an APRN or PA must be limited to a period not to exceed 90 days?

EPCS, written, facsimile (not stated under oral Rxs)

*physician or other practitioner with full independent prescriptive authority can legally prescribe more than a 90-day supply except for opioids for acute pain

True or False: all practitioners' prescriptive authority is limited to their area of practice

False - physician practitioners can legally prescribe to treat any disease or illness

Whose rules state that inappropriate prescribing by physicians includes prescribing dangerous drugs or controlled substances for oneself, family members, or others in which there is a close personal relationship?

Texas Medical Board

True or False: Texas Medical Board does not permit prescribing of controlled substances to oneself, family members, or others in which there is a close personal relationship

False - permitted to meet immediate needs which is defined as no more than a 72-hour supply

True or False: there is no such thing as a prescription for office use

True

*if prescribers wish to purchase dangerous drugs or controlled substances for their office use, they should order the drugs from a manufacturer, wholesaler, or pharmacy using an invoice or DEA Form 222 for CIIs

What happens to prescriptions with refills when the prescriber retires or dies?

TSBP and Texas Medical Board have agreed by policy that it is acceptable for a pharmacist to provide a 30-day supply of a dangerous drug and inform the patient that they need to find a new practitioner.

*if it is a CIII-V, TSBP recommends using the emergency refill rules to provide a 72-hour supply

Nurses of Home and Community Support Agencies may purchase, store, or transport what drugs in a portable sealed container without being in violation of the Texas Dangerous Drug Act?

1. Sterile water and saline for injection and irrigation

2. Hepatitis B vaccine

3. Influenza vaccine

4. Tuberculin purified protein derivative for TB testing

5. No more than 5 dosage units of:

- Heparin sodium lock flush - 10 units/mL or 100 units/mL

- Epinephrine 1:1000

- Diphenhydramine 50 mg/mL

- Methylprednisolone 125 mg/2mL

- Naloxone 1 mg/mL in 2 mL vial

- Promethazine 25 mg/mL

- Glucagon injection 1 mg/mL

- Furosemide 10 mg/mL

- Lidocaine 2.5% and Prilocaine 2.5% in a 5 gm tube

- Lidocaine solution 1% in a 2 mL vial

Opioid antagonists may be dispensed under a valid prescription, including a prescription issued by a standing order, to whom?

1. a person at risk of experiencing an opioid-related drug overdose

2. a family member, friend, or other person in a position to assist a person at risk of experiencing an opioid-related drug overdose

*many chain pharmacies have standing orders that cover all their pharmacies in Texas; Texas Pharmacy Association has a standing order that members can access after they complete training

A pharmacist who dispenses or does not dispense an opioid antagonist under a valid prescription is not subject to any criminal or civil liability or any professional disciplinary action for what?

1. dispensing or failing to dispense the opioid antagonist

2. if the pharmacist chooses to dispense an opioid antagonist, any outcome resulting from the eventual administration of the opioid antagonist

Texas Health and Safety Code Chapter 488 prohibits OTC sales of products containing ___________________ to customers under 18 years of age.

Dextromethorphan

*does not apply to products dispensed pursuant to a valid prescription

Mid-level practitioners (APRNs and PAs) may prescribe under a ___________________ with a supervising physician that identifies the locations and types or categories or drugs that may be prescribed.

Prescriptive Authority Agreement

True or False: in a hospital, LTCF, freestanding clinic, or other medical practice owned or operated by a hospital or LTCF, prescriptive authority may be delegated to APRNs and PAs through a facility protocol.

False - only hospital and LTCFs; freestanding clinics or other medical practices owned or operated by a hospital or LTCF are not considered facility-based practices

For prescriptions for a child less than ___ years of age, the APRN/PA must consult with the delegating physician, and the consultation must be noted in the patient's chart.

2 years of age

A physician may not supervise more than ____ APRNs or PAs, except in medically underserved areas or in a facility based practice in a hospital or LTCF.

7 APRNs or PAs

Written prescriptions must contain what of the supervising physician as well as the APRN or PA?

their names, addresses, telephone numbers, and identifying (DEA) numbers

True or False: the prescription label has to contain the name of the APRN/PA and the name of the supervising physician

False - label is only required to list the prescribing APRN/PA

Prescribing of CIIs by APRNs and PAs is not generally permitted except when?

in a hospital-based practice under policies approved by the medical staff

- patients must be admitted to the hospital for an intended length of stay of 24 hours or greater, be receiving care in the ED, or have a terminal illness and be under hospice care

APRN/PAs must be registered with _______ as a mid-level practitioner

DEA

True or False: prescriptions from out-of-state APRNs or PAs for controlled substances are valid in Texas if they are registered with the DEA and have prescriptive authority for controlled substances in the state where they are licensed.

False - not valid

Cocaine Eye Drops for Diagnostic Purposes

Therapeutic optometrists and optometric glaucoma specialists may possess and administer (but not dispense) no greater than a 10% solution of cocaine eye drops in a prepackaged liquid form (solution cannot be compounded); must have a DEA registration to possess/store eye drops; cannot store more than 2 vials