Pharmacy Skills II Final Exam Review

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medicare part A

hospital care, hospice care, and health care

medicare part B

doctor visits, injections, medical equipment, chem, and diabetes supply

medicare part C

Advantage plan - parts A and B combined

medicare part D

pays for prescription drug coverage → outpatient RX drugs

medicare qualifiers

• > 65 years old

• those with disabilities

• end-stage renal disease

primary provider for those with both medicare and medicaid

medicaid qualifiers

low income population

• parents with children

• elderly

• disabled

insurance card components

RXBIN: bank (carrier) identification

RXPCN: processor control number secondary identity for routing

RXGRP: group/business number identifier insured by same company

RXID: individual number specific to patient

insurance drug formulary tiers for insurance co-pay

tier I: preferred generics (cheapest)

tier II: generics

tier III: preferred brands

tier IV: non-preferred brands

tier V: speciality (most expensive)

Article 137

New York State Pharmacy Law

• defines requirements of being an intern/pharmacist

• defines pharmacy practice

• outlines dispensing requirements

pharmacist NYS non-patient executions…

1. HIV post-exposure 7 day

2. insulin + related supplies

3. order/admin covid/flu vaccines

4. admin injectable meds for emergency anaphylaxis

5. self-admin hormonal contraceptives

   1. questionnaire, fact sheet, notify PCP 72 hours, can refuse to dispense

continuing education credit reqs.

45 hours of CE per 3 years

• 23 must be live

• 3 on med errors

• 3 on pharmaceutical compounding

article 28 ratios (hospitals and nursing homes)

no more than 2 registered pharm techs per 1 pharmacist (2:1)

no more than 4 unlicensed personnel per 1 pharmacist (4:1)

no more than 4 individuals per 1 pharmacist

→ 2 regi techs + 2 unlicensed = 4:1

→ 1 regi techs + 3 unlicensced = 4:1

dispensing error medication error category

occurs within the pharmacy while processing RX filling

• wrong drug, wrong strength, wrong quantity, wrong directions

• wrong dosage form

• wrong prescriber

• omission of info on lablel

non-dispensing error mediation error category

happen before or after processing of RX

• ineffective/inappropriate prescribing

• over/under dosing

• incorrect admin of drug

• insurance issues (?)

The Drug Enforcement Agency (DEA): Federal Enforcement Roles

• process/maintain registration for those legally allowed to posses/prescribe controls

• Investigate complaints of diversion

those registered with DEA: physicians, dentists, nurse practitioners, PA’s, midwives, vets, hospitals, and pharmacies

FORM 224: DEA registration form for pharmacy controls

validating DEA number

• add 1 + 3 + 5 digits

• add (2 + 4 + 6)x2

• add a + b = last digit = last number of DEA

schedule I drugs

no medicinal value, highest risk of abuse

• phencyclidine (PCP)

• ecstasy

• heroin

• LSD

• THC/cannabis

• depressants: methaqualone, rohypnol roofers

schedule II drugs

medicinal value, high potential for abuse

→ no refills of CII drugs

narcotics: morphine, codeine, fent, hydrocodone, oxy cocaine, amphetamine

→ RX’s must be filled within 30 days

emergency oral order for CII drugs

• prescribers must send a written “cover” prescription within 7 days (3 days in NYS)

  authorizing the emergency CII RX

• NYS: 3 day cover, 5 day max supply for emergency CII oral

schedule III drugs

moderate physical dependence, high psychological dependence

→ up to 5 refills in 6 months for CIII

what can pharmacists NEVER ADD to a controlled RX?

• patient name

• practitioner signature

• date written

• drug name

• quantity

what can pharmacists NEVER CHANGE to a controlled RX?

• patient name

• practitioner signature

• date written

• drug name

NYS prescribing initial acute pain

prescribers cannot prescribe CS for more than 7 days intially for CII, CIII, or CIV drugs

• acute paint treatment

NYS registered pharmacies patient education reqs

1. pamphlet for each controlled substance

2. dangers of misuse

3. addiction resources

4. proper disposal

NYS Benzodiazepine Prescribing

Benzo’s are treated as a schedule II in NYS

• up to 30 day supply

• NO refills allowed

NYS Benzo Exception Codes for more than 30 day supply

A - panic disorder (anxiety)

B - ADHD (behavioral)

C - chronic debilitating neuro disorder (chronic)

D - pain relief for chronic/incurable disease (dying)

E - narcolepsy (sleeeeeep)

F - hormone deficiency, metastatic breast cancer, anemia, angiodema (female)

NYS: oral orders for CII’s in NYS

• limited to 5-day supply for CII’s and Benzos

• Oral Order RX may be phoned in

  • endorsed with 3 day Cover letter (72 hours)

• partial fills are not allowed

7 Day Rule NYS

no prescription shall be filed until all but 7 day supply is exhausted

EX: 30 day supply begins on March 1st…

• Month 1st + (#supply - 1) = date the refill is due

• March 1st + 29 days = March 30th day for refill due

• March 30th - 7 = March 23rd → patient can get refill on 23rd

ESAP:syringes and needle dispensing

non-controlled dispensing

• RX expires 2 years

• no limit to amount of syringes that can be purchased

• must be 18 years or older to buy

• safety insert must be provided

Pharmacies: not required to take back used needles

Hospitals: ARE required to take back used needles

I-STOP/PMP

monitoring of controlled drug database

• prescribers ARE REQUIRED to check the PMP before prescribing: CII, CIII, and CIV

• pharmacists can check but are not required to check

co-pay

out of pocket expense → responsibility of the patient

deductible

amount set by the insurance company that a patient must pay before coverage kicks in

who is involved in enactment of LAWS that govern pharmacy practice?

1. governor

2. assembly and senate

3. higher education committee

who is in charge of the REGULATIONS that govern practice of pharmacy? (NYS specific)

• NYS board of pharmacy

• NYS education department

supervising pharmacist roles:

1. management of pharmacy

2. ensuring all laws and regulations are being followed

3. working at the pharmacy at least 30 hours a week

when would a NYS prescriber be able to issue a paper RX?

• prescriber is a vet

• RX will be filled OUTSIDE of NY

• the prescriber has a waiver

when are pharmacist’s PERMITTED to take-back a controlled mdeication?

• drug recall

• dispensing error occured

• participant is apart of an investigational drug study

when does a pharmacy/prescriber in NYS have to submit info about dispensing data of a controlled substance?

24 hours to submit the dispensing data to The BNE

1 quart

946 mL, 2 pints, 32 oz

1 pint

473 mL, 16 oz

1 pound

454 g

1 teaspoon

5 mL

weighable quants

1252 mg → 1250 mg

1252 mg → 1.25 g

1 ounce

30 mL

1 kg to lbs conversion

1 kg x 2.2 = pounds

1 gallon

3785 mL, 128 oz, 4 quarts