ExCpt Prep Study Guide

Schedules of Controlled Medications

What are exempt narcotics

(C-V) It means they DO NOT require a Rx for purchase. They require a purchaser to be approved by the pharmacist, 18 year old + and ID and sign a log book

Examples of Exempt Narcotics

Codeine Cough Syrup

Lomotil ( Diphenoxylate with atropine)

Refills on Scheduled Drugs:

How many refills are allowed for C-II

No Refills Allowed

Refills on Scheduled Drugs:

How many refills are allowed for

C-III, C-IV, C-V

5 refills within 6 months.

Limits of Pseudoephedrine (Sudafed)

• 3.6 grams per day

• 9 grams per 30 days

DEA #’s

Required by a prescriber to write Rx for CONTROLLED medications

A prescriber’s DEA # begins with…

A, B, or F

A MID-LEVEL Prescriber’s DEA # begins with the letter ….

M

Calculation for a DEA #

1 + 3 + 5 = 9

2 + 4 + 6 = 12 —→ *2 = 24

9 + 24 = 33

las digit should = final digit of the DEA #

How are hard (Paper) copies of Rx filed:

How are C-II Rx’s filed

Separately all by themselves

How are hard (Paper) copies of Rx filed:

How are C-III, C-IV, C-V filed

Are filed separately or by themselves

What else could

C-III, C-IV, C-V be filed with

can be filed with Non-Controlled Rx but must be marked with a Large Red C

How are Non-Controlled Rx’s filed

by themselves (unless C-III, C-IV, C-V are included)

DEA FORM 41

Used to document the destruction of controlled substances

DEA FORM 106

Used for reporting any theft or loss of controlled substances

DEA FORM 224

Used for a pharmacy to dispense controlled substances

DEA FORM 222

• Used to order C-II medication

• Also Used to transfer C-II from pharmacy to pharmacy

  • Triplicate Form

Where does each copy of the triplicate form DEA FORM 222 go

• Copy 1: Drug supplier

• Copy 2: Sent to DEA

• Copy 3: Kept by Pharmacy

What Drugs are safe for Pregnancy

Tylenol (APAP)

Sudafed

Insulin

What drugs aren’t safe for pregnancy

Isotretinoin

Finasteride

Dutasteride

Statins (ex. Lipitor)

NSAIDS

Tetracycline

Prescribers:

MD or DO

Doctors

Prescribers:

DPM

Foot Doctor (Podiatrist)

Prescribers:

DDS or DMD

Dentist

Prescribers:

DVM

Veterinarian

Prescribers:

NP

Nurse Practitioner (MID-LEVEL PRACTITIONER)

Prescribers:

OD

Eye Doctor (Optometrist) (MID- LEVEL PRACTITIONER)

Prescribers:

PA

Physician’s Assistant (MID-LEVEL PRACTITIONER)

Classes of Drug Recalls:

Recalls can be issued by…

FDA or Manufacturer

Recall issued b/c there is a strong chance of serious adverse effects or death

Class 1 Recall

Recall issued b/c there is a temporary (But reversible) chance of adverse effect or little chance of serious adverse effect

Class 2 Recall

Recall issued b/c of a problem not likely to cause adverse effects

Class 3 Recall

NDC # formatting

5 digits - 4 digits - 2 digits

00001-0001-01

The first 5 digits in NDC # indicated for

Identifies Labeler or Manufacturer

The middle digits in NDC # indicated for

referring to package strength and dosage form

The last digits in NDC # indicated for

Identifying package size QUANTITY

How is Insulin measured

Units

How is Insulin delivered

SC (subcutaneously)

What is Insulin indicated for

DM (diabetes Mellitus)

How long is a vial of insulin good for

28 days once it is first used

U- 100 Insulin

100 units of insulin in 1 mL = 100 units/mL

3 classic symptoms of DM (Diabetes Mellitus)

• polyphagia

• polydipsia

• polyuria

Health Care Organizations:

ISMP

Institute for Safe Medication Practices

Health Care Organizations:

ISMP Use

Educate HC (healthcare) workers & the public about medication practices

Health Care Organizations:

CDC

Centers for Disease Control and Prevention

Health Care Organizations:

EPA

Environmental Protection Agency

Health Care Organizations:

EPA use

Oversees the disposal of hazardous waste from facilities

Health Care Organizations:

OSHA

Occupational Safety and Health Administration

Health Care Organizations:

OSHA use

Ensures the health and safety of employees in the workplace

Health Care Organizations:

DEA

Drug Enforcement Administration

Health Care Organizations:

DEA use

• Handles all rules with Controlled (Scheduled) Medications, I-V

• Enforces the health and safety of employees in the workplace

Health Care Organizations:

FDA

Food and Drug Administration

Health Care Organizations:

FDA Use

• Approval of new medications

• Inspects & regulates new medications

• Issues drug recalls

• Reviews New generic equivalents and therapeutic indications for existing medications

• QSR’s - Quality System Regulations

  • regulate the labeling marketing and manufacturing of products under FDA

QSR’s - Quality System Regulations

regulate the labeling marketing and manufacturing of products under the FDA

Health Care Organizations:

HIPPA

Health Insurance Portability and Accountability Act

Health Care Organizations:

HIPPA

• Contains PHI (protected health information)

• PHI - DOB, diagnosis, medications, etc

Disclose _______ amount of PHI needed to complete the task

MINIMUM

Insurance/Third Party

Tiered Co-payment

• Tier 1 - Generic Medications

• Tier 2 - Preferred brand medications

• Tier 3 - non-preferred brand medicaitons

Insurance/Third Party

Premium

Amount paid- usu per month, as the cost of the insurance

Insurance/Third Party

Coinsurance

Insurer and patient agree to share costs - usually a percentage agreement

Insurance/Third Party

Deductible

Amount the patient must pay before the insurance will start covering health care costs

Insurance/Third Party

Copay

Amount the patient pays for each Rx. Insurance pays part, patient pays part

Insurance/Third Party

Adjudication

When we bill the Rx online - our computer interfaces with the PBM computer to tell us the price to change the patient

Insurance/Third Party

MAC

equals maximum allowable cost the maximum amount that the insurance company ( or their party payer) will pay for a Rx medication on behalf of a patient

Insurance/Third Party

Member ID number

ID # unique to the primary insurance holder

Insurance/Third Party

PCN #

Secondary identifier used in routing claims

Insurance/Third Party

Person Code

Identifies which household member is receiving services

Insurance/Third Party

Rx group #

Identifies the plan a member falls under

Insurance/Third Party

BIN #

The # that tells the computer who to send the claim to for processing

Inventory:

When you receive a shipment of medication be sure to _________ the purchase order

Reconcile (compare)

Inventory:

FIFO

First in, First out

Inventory:

ROP/ROQ

reorder point / reorder quantity

Inventory:

PAR

periodic automatic replacement

Inventory:

Where is medication that is pulled from inventory kept until it can be destroyed or disposed of

In a designated space away from meds that are used so they aren’t mistaken as usable

Inventory:

How often should inventory be checked and inspected

Daily

Inventory:

How many months before the med expires should it be MARKED

6 months

Inventory:

How many months before the med expires should it be pulled from inventory

3 months

Inventory:

What is the minimum and Maximum bottles allowed on the shelf

Minimum = 3

Maximum = 10

Storage Temperature:

What is Room Temperature

(68-77 F)

(20-25 C)

Storage Temperature:

What is Refrigerator Temperature

(35-46 F)

(1.7-7.8 C)

Storage Temperature:

What is Freezer Temperature

(5 F)

(-15 C)

Medicare:

Part A

Covers hospital stays, hospice, skilled nursing facilities, home health care

Medicare

Part B

Covers DME (wheelchairs, walkers, oxygen tanks etc.) and glucose test strips, lancets, glucose meters

Medicare

Part C

Covers managed care

Medicare

Part D

Covers Rx drugs, insulin, vaccines & biologicals

References:

Red Book

Provides comprehensive drug information, including pricing and product identification.

References:

Orange Book

Lists FDA-approved drug products and their therapeutic equivalence.

References:

USP-NF

A compendium of official standards for drugs, food ingredients, and dietary supplements.

References:

The Handbook on Injectable Drugs

A reference guide for the preparation, stability, and compatibility of injectable drugs.

References:

SDS

Provides detailed information on the safe handling, storage, and hazards of chemicals.

Suspensions & Emulsions always need to be ….

Shaken

An ELIXIR is a liquid that contains ….

Alcohol

Elixirs, extracts, tinctures, all contain

Alcohol within all of them

UNG

ointment

Buccal Tablets

Placed in the cheek

SL (sublingual) tablets

Put under the tongue

Capsule 000

Largest size capsules

Capsule 5

Smallest size capsule

Federal Drug Laws:

The Durham-Humphrey Amendment of 1951

It created a distinction between “OTC and Legend Rx Drugs” and allowed for refills

Federal Drug Laws:

The Kefauver-Harris Amendment of 1962

Drugs need to be safe and effective

Federal Drug Laws

Controlled Substances Act (CSA) / Comprehensive Drug Abuse and Prevention Act of 1970

This created the DEA and controlled substances and the C-I,C-II,C-III,C-IV,C-V levels