CPJE EXAM-with 100% verified solutions 2024-2025, Exams of Nursing

Download CPJE EXAM-with 100% verified solutions 2024-2025 and more Exams Nursing in PDF only on Docsity! CPJE EXAM-with 100% verified solutions 2024-2025 Poison Prevention Packaging Act- place ORAL (only) Rx meds in child- resistant safety containers. What are the exceptions? - Nitroglycerin SL tab - Erythromycin ethylsuccinate granules for oral suspension - colestipol powder (Colestid- BAS) - oral contraceptives in manufacturer's memory-aid dispenser packages - Doctor or patient may request a non-complying container (keep documentation if that occurs) erythromycin oral counseling Base, PCE or stearate dosage forms should be taken on an empty stomach Ethylsuccinate (E.E.S. Granules) or delayed-release (Ery-Tab) admin without regard to meals--> May consider administering after food to decrease GI discomfort. DEA Form 222 Ordering of Schedule I & II C.S requires DEA Form 222 - keep record for 3 YEARs - Pharmacies can sell to other pharmacies or to prescribers with DEA 222 form (C I & II) --> can sell MAX 5% of their C.S dispensing (ie. can sell 1,000 to another pharmacy if dispense 20,000 C.Subs) - Valid for up to 60 days - The reverse distributor issues DEA Form 222 for C.S. II. Transfer of Schedule II C.S Schedule II C.S canNOT be transferred (DEA Form 222 is NOT used to transfer prescriptions) Filing of prescriptions Schedule III, IV, or V C.S prescriptions REQUIRE a 1-inch red 'C' on lower right corner if filed along with NON-scheduled prescriptions - does not apply for electronic filing systems - EXCEPTION: Schedule II C.S prescriptions MUST be filed separately Paper or electronic C.S prescription records must be kept for: - Federal: 2 years - CA: 3 years - When there's a conflict between a federal and a state statute, the federal statute outweighs the state statute or regulation, unless the state law is more stringent and, thus, mandates over the less stringent federal rule. Refill PRN (non-scheduled drugs) valid for 1 year from the date prescription was written CA Continuing Education Requirements - 30 hours CE/2 years - 2 of the 30 CE hours MUST be law & ethics from a course provided by the Board - retain CE certificates for 4 years - purchase invoices - hospital pharmacy chart order records for non-controlled drugs Time Limit Requirements in Keeping of Pharmacy Records: 4-years C.E certificates Time Limit Requirements in Keeping of Pharmacy Records: 6-years HIPAA Notice Records signed by the patients Time Limit Requirements in Keeping of Pharmacy Records: 7-years Hospital pharmacy chart order records for CONTROLLED substances Off-site Storage waiver - records for non-controlled subs must be kept in the pharmacy for at least 1 year & minimum 2 years if CS - a pharmacy that wishes to store prescription records off-site after these time limits, must have a WAIVER APPROVAL from the Board and records must be retrievable within 48 hours (2 business days) Automatic Refill Program - pt may enroll by written, online, or electronic informed consent to participate for ea/new Rx wherein there is a change in med, strength, dosage form or directions for use - keep patient's consent to enroll for 1 year - annual renewal + drug regimen review at the time of refill + notification (for ea/refill) to the patient that Rx is being refilled via program Pharmacy self-assessment survey - pharmacies, compounding pharmacies and wholesalers must complete self-assessments by July 1st of each odd-numbered year - completed assessments kept @ facility for 3 years - submitted to the Board ONLY if requested - ALSO, new self-assessment forms must be completed WITHIN 30-days whenever: a) new license is issued b) change in PIC or designated representative-in-charge c) change in facility address Pharmacist-In-Charge (PIC) - operates 2 pharmacies MAX (must be within 50 miles of one another) - responds to the pharmacy self-assessment surveys - canNOT serve concurrently as PIC and 'exemptee-in-charge' or 'representative-in-charge' for a wholesaler or veterinary food-animal drug retailer - Interim PICs can only be designated for MAX 120 days A single pharmacist may have the following ancillary personnel working at any time - 2 pharmacy interns - Retail: 1 pharmacy technician (2 for each additional pharmacist) --> if there are 3 Rphs = 5 techs - Inpatient: 2 pharmacy technicians - any reasonable number of clerks (typists) - Note: Interns may perform all the functions of a pharmacist under supervision (except for the FINAL verification) Pharmacy technician - must be registered with the CA BOP (background checks) - can obtain licensure after completion of a pharmacy tech certification program approved by the BOP - A pharmacy technician checking the work of other techs cannot be operational in every hospital or community pharmacy program; it may only occur in acute hospitals that have an ongoing clinical pharmacy program where pharmacists are in the patient care areas; the overall operations are the responsibility of the PIC Central Fill Pharmacy pharmacy that fills (with its own drug inventory) prescriptions submitted to another pharmacy - central filling pharmacy's address must be on the label Surgical Clinic vs. Multi-specialty Clinic - Surgical Clinics --> dispense 72-hours supply - Multispecialty Clinics--> no restrictions Prescriber's office & Emergency Room Prescriber may dispense a prescription drug (including C.S) only if: - drug regimen should start immediately (i.e ER) - no pharmacy available (ie hospital with < 100 beds) - records of drugs purchased (at wholesaler) and administered are kept - pharmacy must write a new Rx each time they receive a transfer (even if have Rx on record or it is a fax) - Rx can only be refilled within period of 1 year regardless of number of remaining refills Transfer of Rx refills between pharmacies: C.S. Schedule III, IV & V May ONLY be transferred ONCE - Except if pharmacies share a 'real-time, online database' i.e. pharmacy stores in the same chain --> may transfer up to the max refills permitted Transfer of Rx refills between pharmacies: C.S. Schedule II - canNOT be transferred!!!! (DEA Form 222 is NOT used to transfer Rxs) Transfer of prescription refills between pharmacies: The receiving pharmacist shall - reduce to writing - identify the prescription as 'transfer' - record the date of transfer, last & original fill - record the prescription number from the sending pharmacy - write name and address of the transferring pharmacy and name of the pharmacist making transfer - note the # of refills remaining - for C.S: record the DEA # of both the forwarding pharmacy and licensed prescriber Transfer of prescription refills between pharmacies: The transferring pharmacist shall - mark 'void' across the face of the transferred prescription - record date of the transfer - note the pharmacist receiving the information on the Rx - record name and address of the receiving pharmacy (and DEA # if controled) - indicate number of refills transferred Filling Rx - pharmacist can refuse to fill a Rx based on religious, moral, or ethical concerns (but pharmacy must arrange a written policy with alternative measures to provide the drug to the pt without delays) - if the pharmacy runs out of stock, pharmacist must be proactive and arrange for drug to be delivered to pt, transfer the Rx to another pharmacy, or refer pt to a pharmacy that stocks the drug - pharmacist shall not deviate from filling Rx as it is written (i.e dispensing a reduced amount) unless prescriber is contacted to authorize the change - Rx may be written and filled for 'off-label' use if medical need (chronic/disabling/life-threatening condition) - real name of pt must be used on Rx --> can't use fictitious names for celebrities - if formal Rx blank is not available, plain piece of paper may be used to prescribe NON-C.S if all the info required is written Only a pharmacist (or intern pharmacist) can: - transfer refills between pharmacies: pharmacist must be involved at both transmitting & receiving telephone transfers - request & receive a new Rx over the phone - receive a modification of an existing order over the phone - validate the info on a prescription --> NOTE: intern can fill a Rx but the supervising RPh's initials must be on the label as the FINAL check Pharmacy technicians & clerks/typists can: - call the doctor for refills (request and receive) - process a prescription that has not changed Oral (phone calls) prescribing (CS schedule III-V ONLY...unless emergency for CII) - any employee at MDO can call pharmacy for Rx - proof of identity required from anyone picking up Rx that was orally transmitted/faxed - Pharmacist/intern must: 1) reduce the oral Rx to writing (blank Rx pads) -- MDs address, license, federal registry # & address of pt may be omitted if on file 2) record name of person transmitting the Rx + MDs name 3) sign and date 4) if fax was sent from ANOTHER pharmacy = must reduce faxed Rx to hard copy + sign & date + record name of person transmitting Rx - retain this hard copy Rx for 3 years Faxed prescriptions (allowed for CIII-CV) - if MDO faxes the Rx: fax serves as the official written Rx (no need to rewrite it) - if fax is sent from another pharmacy: fax is to be treated as a TELEPHONE order and a new Rx shall be created NEW Rx required if: - change in drug, strength, directions for use, prescriber - Rx is > 1 year old - CIII-IV limit is 5 refills or 120 days limit - NO refills allowed for CII Dispensing workflow 1) review pt's med profile 2): oral consult 3) dispense: oral med? (child-resistant safety container) 4) file Rx: a- nonscheduled drugs & CIII-CV (mark with red C)--> regular files b- schedule CII --> exclusive file Dispensing workflow: TRANSFER from another pharmacy (FAX & ORAL) - nonscheduled drugs (take ALL remaining refills) - CIII-CV: only ONE transfer allowed - CII: can NOT be transfrred ** MUST reduce to writing, prepare a new Rx (use blank Rx pads) Dispensing workflow: order sent from MDO - if ORAL: reduce to writing, prepare new Rx with blank Rx pads (oral CII ONLY allowed in EMERGENCY & MUST be called in by the PRESCRIBER) - if FAX: a) non-scheduled drug = faxed Rx serves as official Rx (no need to call MDO) b) if controlled substance = CS security prescriptions print VOID when faxed (CII canNOT be faxed except in EMERGENCY) --> must validate Rx -- > reduce to writing on blank Rx pads Dispensing workflow: ELECTRONIC order sent from MDO OR ELECTRONIC TRANSFER from another pharmacy 1. retain electronically 2. Electronic Filing System EMERGENCY refill - until Rx can be reached: a) nonscheduled drug = full refill b) CIII-CV = reasonable quantity - if CII: PRESCRIBER gives order (call/fax/non-secure form)--> write down a temporary Rx "Authorization for Emergency Dispensing" & receive security form Rx WITHIN 7 DAYS Patient Consultation - whenever any NEW PRESCRIPTION is dispensed or where there is a modification of an existing Rx (new drug/dosage form/strength/instruction), at least an ORAL consultation must be provided by the (intern) pharmacist (ALL pt care settings). - Also: 1) whenever the pt requests it 2) whenever pharmacist deems it necessary Patient Consultation session shall include: 1. directions for use and storage 2. importance of adherence 3. precautions and side effects ** consultation MUST BE ORAL ** if pt cannot understand english or hearing-impaired, RPh must make good faith effort to consult. (Document inability to provide consultation. Provide written material & upon request, dispenser shall provide translated directions for use. the ONLY 2 exceptions where a pharmacist doesn't have to provide an oral consultation are: 1. When the prescription has been previously filled as written 2. When the pt refuses ** it is NOT mandatory to document a consultation ** enforced: Board inspectors will observe Other notes on CONSULTATION - Must a pharmacist consult a pt who is being discharged with medications? "Yes". However, consultation can be given to a family member or to/by a RN or MD. Does not apply if the pt is only given the prescription (no meds), since the consultation will occur at the time the drug is dispensed. - consultation is NOT required for INPATIENT meds (progress of hospitalized pt is being monitored) Consultation provided by the intern pharmacist MUST be within hearing distance Who is authorized to prescribe AND furnish drugs? - Physicians (including Doctor of Osteopathic Med- D.O., psychiatrists, ophthalmologists..) NOT Doctor of Chiropractic Med or psychologists - dentists (DDS) - podiatrists (w/o physician-directed protocol) - veterinarians - TPA-certified Optometrists e.g. license = OPT-12345-T TPA (ONLY EYE DRUGS-- including ORAL & TOPICAL drugs but ONLY eye-related disorders = anti-allergy/anti-inflammatory, steroids, oral/topical glaucoma meds, oral antiHM, oral ABX, topical antivirals, PO acyclovir, codeine/hydrocodone combined w/nonsched analgesic. can Rx CS if have DEA#)--> can NOT Rx SQ, IV, or IM drugs who is NOT authorized to PRESCRIBE, but CAN FURNISH (pursuant to a MD-developed protocol)? - Nurse Practitioners (NP or CNP) - Physician Assistants (PA) - Certified Nurse-Midwives (CNM)--> Rx must be related to prenatal care *** all are bound to a physician protocol; may administer or provide meds, transmit a Rx, and furnish controlled substances (CII-CV) if registered with DEA --> all mid-level practitioners DEA#: M + first initial of last name EXCEPTION: - Naturopathic Doctors (ND) NDF-123 --> ONLY allowed to Rx epinephrine for anaphylaxis & hormones (i.e. Armour Thyroid), can furnish non/scheduled CS III-V ONLY if bound to physician protocol & has DEA#, can NOT furnish CII Physician-directed protocol NP/ PA/ CNM/ ND signs the prescription but the order contains the name, address, and phone # of the authorizing prescriber, as well as the stamped name and license # of the NP/ PA/ CNM/ ND. (Pharmacy label may only include the name of the NP/ PA/ CNM/ ND). Physician-directed protocol: Controlled Substances All prescriptions for any scheduled C.S. must be written on a California security prescription form issued specifically to the prescriber or NP/ PA/ CNM/ ND. Rxs for STI a PA/ NP/ CNM may write a prescription for an antibiotic to treat a sexually transmitted Chlamydia infection for the examined pt as well as for the pt's partner (who does not need to be examined). The pharmacist filling the prescription will place on the label the full name of the examined patient and the word "partner". Physical Therapist (PT) NOT authorized licensed prescribers but can order drugs or devices specifically to perform their service. I.e. electroneuro-myographic needle electrodes or hypodermic needles for placing wire electrodes for kinesiological electromyographic testing --> The pharmacist must keep a record w/ date of the transaction, name + address of the PT, and name + quantity of the drug/ device provided. PHARMACISTS - pursuant to a prescriber-directed protocol: RPhs have the same opportunities as PAs, NPs, CNMs, and NDs in writing prescriptions for drugs, along with being able to register with the DEA for the furnishing of CII-CV C.S. if authorized to do so according to a prescriber's protocol, and be the sole signature on the prescription - advanced practice pharmacist --> in order to become adv practice pharm: complete residency + BCPS certification HIPAA (Health Insurance Portability and Accountability Act) Each person who receives a prescription from your pharmacy must be provided a "Notice Statement" explaining how the pharmacy's information about them will be used. If the person does not wish to sign a statement that they have received this "Notice Statement", the pharmacy need only document that the patient received it, and did not choose to sign it. This still allows the pharmacy to continue filling the person's prescriptions. this type of consent or "authorization to disclose patient's health information" is NOT REQUIRED. Otherwise, patient care activities, such as searching for potential drug interactions or coverage verification and filling a prescription, would be delayed. In any case, the patient must still receive notice of how his/her health care information will be used or disclosed. HIPAA: Circumstances that allow the release of medical information w/o a patient's consent request is made by court or law enforcement agency/BOP/arbitration hearing or a coroner in the course of an investigation The CONSENT = HIPAA written notice provided to the pt. A HIPAA Notice Record signed by the pt must be kept in the pharmacy records for at least 6 years. The consent includes: 8. dispense STD therapy w/o indiv name if Rx includes "expedited partner therapy = EPT" 9. initiate/furnish HIV PEP & PrEP (req prior training) --> PrEP: 30-60 DS max + (-) HIV test + no symptoms + no CIs + mandatory counseling --> PEP: exposure w/in previous 72 hours +/- testing & mandatory counseling & notify PCP 10. Furnish w/o doctor's prescription (RPh completed prior training, notify pt's PCP w/in 14 days): a) Emergency oral contraceptives b) Hormonal contraceptives (12-month supply); pt completes health questionnaire & BP test, keep copy of self-screening tool for > 3 years c) NRT d) Travel meds (not requiring a diagnosis) e) Naloxone (Narcan) --> a, b, e = provide pt with FACTSHEET Pharmacist's Scope of Practice (ADVANCED PRACTICE PHARMACIST) 1. performs pt assessments 2. order & interpret drug-therapy related tests 3. participate in eval & management of dz/health conditions in collab w/other providers 4. initiate, adjust, or d/c drug tx beyond health care facilities in collab w/pts PCP Intern Pharmacist 1. may perform all functions of a pharmacist ONLY at the discretion/supervision of a RPh 2. can provide emergency contraception, skin punctures, & validate prescriptions (supervising RPh initials the label) 3. all Rx re/filled by an intern must be checked for accuracy & the label must be initialed by the RPh 4. only a RPh or intern may sign for the receipt of Rx meds delivered by the wholesaler to the pharmacy EMERGENCY (ORAL) contraception: by physician's PRESCRIPTION - Ullipristal (Ella): take 1 tab (30 mg) ASAP & within 120 hours (5 days) of unprotected sex - may Rx emergency OC for pt < 18 yo - RPh is not allowed to charge admin fee of $10, nor needs special training for dispensing EMERGENCY (ORAL) contraception: by RPh pursuant to the CA State Protocol or by a physician-directed PROTOCOL 1. RPh has completed training program on EC 2. pt provided w/FACT SHEET (indications, admin, need for medical f/u) 3. protocol indicates #tabs/dose 4. RPh will document each EC supply dispensed 5. RPh will document provision of EC in pt's profile 6. NO prior exam by MD is required 7. pharmacy may charge admin fee (max $10) 8. RPh may provide EC to pts < 18 yo --> includes Ella & levonorgestrel, NOT Paragard (inserted at MDO) EMERGENCY (ORAL) contraception: by unrestricted OTC sale (OTC Oral Plan B) a) Plan B Next Choice: 2 tab levonorgestrel 0.75 mg q12h x 2 doses b) Plan B One-Step: 1 tab levonorgestrel (1.5 mg) --> take either within 72 hrs (3 days) of unprotected sex - available on shelf w/o age restriction - may purchase for future need - no consultation required - physician can write Rx for Plan B oral EC and must be treated as such Patient's Drug Profile - must be easily retrievable & kept at the pharmacy for > 1 year after AFTER last entry - pharmacy does NOT need to keep med profile on every pt that comes in to have Rx filled --> ONLY if the pt is expected to come back (i.e. Rx has refills) - whereas counseling is mandatory for every new or modified Rx Pt drug profile should contain the following - pts contact info, DOB, gender - all drugs dispensed (strength, dosage form, route, quantity, directions for use) - prescriber's name, license #, DEA # - date when drug was first dispensed/refilled - Rx# for ea/Rx - name/initials of dispensing RPh - brand name or distributor's name if generic - allergies, current/past meds, medical conditions - date dispensed - initials of dispensing pharmacist - brand name or manufacturer's name if generic Prescription label - Name of the Prescriber (or PA, NP, CNM, ND or RPh pursuant to a prescriber's written protocol)--> original Rx contains the name of authorizing provider (NOT req on the label) - pharmacy's name & address - Rx# - pts name - Drug name & strength - fill date (date of issue) - manufacturer - directions for use - description of the drug (color + shape + imprint) - quantity dispensed - expiration date - NOT REQ: initials of filling pharmacist & # refills remaining (already recorded in sys) EXCEPT if Rx was filled by tech/intern, then supervising RPh's initials must be on label as final check - lot #s only req when pharmacy compounds a product - translation/interpretive servies may be req for pts w/limited or no english proficiency - generics: label MUST list generic name + statement 'generic for X' w/brand name inserted (except if brand name is no longer used) Scheduled Controlled Substances - a prescriber MUST use the security prescription form for ordering all CII- CV for pts - Rx for CII-CV can be filled up to 6 months from the date it is written Errors for CII-CV - if there is an error/ omission on the Rx (ie wrong dose), the RPh can CONTACT PRESCRIBER & CORRECT the error on the Rx by NOTING DATE & PRESCRIBER contacted (do NOT FILL Rx until PRESCRIBER was CONTACTED) - EXCEPTION for CII only: If the prescriber did NOT SIGN or DATE the Rx in their OWN HANDWRITING, the Rx HAS to be RETURNED for rectification. --> date does NOT have to be handwritten when the Rx forms are generated by a computerized sys from a HOSPITAL or HEALTH CARE FACILITY. Schedule controlled substances: frequency of PRN use Unlike with NON-scheduled, the prescriber needs to SPECIFY the FREQUENCY for a C.S. to ensure pt is not overusing it (or passing the 5 refills, 120-day supply in a 6 month period for CIII & IV) I.e. "Take 1 tab PRN" --> "Take 1 tab q4h PRN" CURES (Controlled Substance Utilization, Review, and Evaluation System) - CURES = database of CII-CV C.S Rx dispensed in CA created to reduce drug abuse & diversion - access to CURES is limited to licensed prescribers & pharmacists STRICTLY for pts in their DIRECT care; and regulatory Board staff & law enforcement personnel for investigation purposes - Who: HCP authorized to prescribe, order, admin, or furnish C.S. (Dentists, MDs, NDs, optometrists, DOs, PAs, podiatrists, CNMs (furnishing), NPs (furnishing), & RPhs - How often: must CONSULT CURES before prescribing CII- CV C.S. for the FIRST time & at least q6 months thereafter if C.S. remains in pt's tx plan - pharmacists are NOT req to check CURES before dispensing but they must upload dispensing data w/in 24 hrs - REPORTING to CURES MUST be done within ONE BUSINESS DAY C.S. Quarterly Inventory Reconciliation: req by CA BOP - Applies to all C.S. or only CII? --> QUARTERLY inventory reconciliation report req ONLY to CII --> however, every pharmacy MUST perform periodic inventory of ALL C.S. - How to count: accurate PHYSICAL count (not estimate) of ALL quantities of CIIs - locations: includes satellite locations, does NOT include ADS used in inpatient hospital pharmacy - frequency: A) CA = every THREE (3) MONTHS (quarterly) for ALL CIIs B) Federal law = ALL C.S. must be inventoried AT LEAST EVERY 2 YEARS ** When a drug has been RE-classified as a controlled substance (must inventory the SAME DAY it is re-classified) ** when the pharmacy first opens for business ** ALL records MUST be KEPT FOR THREE (3) YEARS CIV Tapentadol Nucynta CII - opioid analgesic + inhibits NE reuptake - not recommended with CrCl <30 mL/min *less GI side effects* AVOID alcohol with ER - increased exposure *seizures* Cocaine topical analgesic - CII Controlled substances security form rules CII Rx must be written on a SECURITY FORM exclusively, EXCEPT: 1) Emergency phone-in/fax (must be done by provider & security form rec'd < 7 days) 2) regular Rxs for terminally ill pts --> MD must write "11159.2 exemption" or if this exact language is not used, the RPh must be aware of the pt's terminal illness & RETURN the Rx to the MD to correct w/in 72 HOURS. 3) declared local, state, or federal emergency: "11159.3 exemption" 4) licensed health care facilities/clinics/ hospitals --> May generate C.S. Rx forms w/clinic & designated prescriber info preprinted (may NOT include the MD who actually wrote the Rx nor the six quantity check-off boxes) C.S. rules - CII Rx must be kept in exclusive CII file (separated from non-controlled & CIII-CV) - Remember: RPh should check CURES before dispensing - ALL CII records must be kept separate, including: C-II prescriptions, invoices, DEA order forms 222, and inventory records PARTIAL FILL of CII is ALLOWED when: (goal: reduce unused/unwanted C.S) 1. pharmacy doesn't have sufficient stock (RPh will order the drug and fill the balance < 72 hours of the first partial filling. If can't be filled < 72 hours, the prescriber will have to issue a new Rx) 2. when requested by pt or prescriber (no partial fill can be dispensed > 30 days from the date of the Rx) 3. When pt is "terminally ill" in hospice/long-term care facility (Rx may be partially filled multiple times until full amount), no partial fill can be dispensed > 60 days from the date of the Rx --> ONLY for CII: prescriber may use a regular Rx blank (non-security) for terminally ill pts; "exemption 11159.2" printed/written on Rx--> if not written, you can still fill it if know terminal status of pt, but MUST RETURN Rx to prescriber for correction < 72 hours *** Exemption 11159.2 does NOT apply for phone/fax Rx bc purpose is to allow CII to be WRITTEN on reg form for terminally ill pt --> NOTE: all other info REQ (handwritten DATE & SIGN & reporting to CURES) ** NOTE: pharmacy must RETAIN original Rx for 3 YEARS & notate on the Rx or ea/partial fill (include DATE, QUANTITY, INITIALS of RPh) DEA Form 222: ONLY for CI & CII * CIII-V may be handled by invoicing normal records Form 222 triplicate format DOJ's order form used by DEA registrants to purchase, return or sell C.S. schedules I & II. DEA registrants: Pharmacies, MDO, wholesalers, manufacturers (CLINICS can NOT purchase CI & II). Reverse Distributor (CII) - to return CII, must order DEA Form 222 1) submit online return req w/waste company 2) waste company issues form 222 to pharmacy for indicated drugs - any indiv w/granted power of attorney (POA) can place order (doesnt have to be RPh) - DEA Form 222 valid for up to 60 days avoid < 14 days of MAOI BZDs CIV - including Librium (chlordiazepoxide) Z- drugs - Zaleplon (Sonata) - Zolpidem (Ambien) - Eszopiclone (Lunesta) Fintepla Fenfluramine oral solution CIV Antiepileptic, Dravet syndrome seizures Also previously used for weight loss (higher doses w/d from market) BBW: Valvular heart dz & PAH (REMS drug) - medguide Provigil Nuvigil Modafinil & Armodafinil CIV (narcolepsy, Shift work sleep disorder, OSA) Lomotil diphenoxylate/atropine C-V - CI: C. diff colitis, risk of resp/CNS dep (avoid in < 6 yo for tab) - AE: anticholinergic d.t. atropine Lyrica Pregabalin - CV Vimpat Lacosamide (PO/IV) C-V 150 - 200 mg BID IV:PO = 1:1 - CARDIOTOXIC- PROLONG PR interval--> INC risk of arrhythmia!!!! (monitor ECG), risk of DRESS, SEVERE skin RASH CIII-CV Rx rules - if written on NON-security Rx form, tx like ORAL/FAXED Rx & use pharmacy's pads but CONTACT prescriber to verify legitimacy Out-of-state Rx: - "RPh may furnish a drug pursuant to a written or oral order from an out- of-state prescriber" --> use the CA security Rx form or perform a phone-in or fax transfer (NOT acceptable for CII). − Ensure legitimacy by calling the prescriber! - A Rx for a CS issued by a prescriber in another state may be dispensed by a CA pharmacy, if the Rx conforms with the req for CS Rxs in the state in which the CS was prescribed (CII-V). CIII & CIV refills may be refilled up to 5 times within 6 mo period from date the Rx is written - Total REFILLS not to exceed 120 day supply (4 months of 30-DS each) per Rx (all refills added together) --> if refills extend tx > 120 days, need new Rx i.e. #100 Dalmane 30mg cap w/5 refills, 1 cap at bedtime (CIV) --> can only be refilled ONCE (100-day supply) i.e. 30 tab w 5 refills. Take 1 tab q4hrs --> Represent 4-6 tab daily, so 30 tab = 5-7 day supply, and 5 refills= 25-35 day supply (ok) ** IF Rx for CIII or CIV DESIGNATED as "REFILLABLE as NEEDED" = fill ONLY ONE TIME ** CV refill limits 4. pharmacy may decline to provide the med/device if it is not covered by your insurance or if you are unable to pay for it Publicity of services & drug prices - allowed but canNOT be false, misleading - may advertise name of provider, languages spoken, insurance type - special compounding of products - NOT req to post prices but MUST be available upon request (max 3 req/6 mo) - may charge a fee if >/= 5 Rx prices req - no prices of C.S in response to PHONE req & NO prices for out-of-state req Auxillary drug warning labels: REQ BY LAW 1. Caution: Federal Law prohibits the transfer of this drug to any person other than the pt for whom it was Rx for CII-CIV (optional for CV/non- scheduled) 2. may affect VISION 3. STORE IN A COOL, DRY PLACE for multiple-drug package (pt med pak, 1 mo-supply containers) 4. may impair pt's ability to operate vehicle/vessel or pose substantial risk when drug combo w/alcohol 5. May cause DROWSINESS -when taken alone OR in combo w/alcohol. Operation of a motor vehicle should be avoided while taking this med i.e. muscle relaxants (Amrix, Fexmid) i.e. antipsychotics & antidepressants w/CNS dep effects i.e. CII-CV w/CNS dep effects i.e. Anti-HM, motion sickness, antipruritics, antiemetics, anticonvulsants, anti-HTN w/CNS dep effects i.e. Anticholinergics & drugs that impair vision ** drugs w/harmful effects when combo w/alcohol: - disulfiram, SU for T2D, metronidazole (disulfiram-rxn) - MAOI - nitrates Patient Package Insert (PPI) - Federal/FDA req inform pt of drug benefits & risks - some drugs REQ BY LAW to have PPI given EVERY TIME DRUG IS DISPENSED = ORAL CONTRACEPTIVES & ESTROGEN Medication Guides - Req for drugs with serious AE - Federal/FDA req patient drug info sheets to help avoid serious AE give EVERY TIME DRUG IS DISPENSED (if req MedGuide, it MUST be provided w/NEW & REFILL Rx whether or not contains BBW) - abacavir (Ziagen), Epzicom, acitretin (retinoid for psoriasis), Alosetron (Lotronex), amiodarone & Multaq, Remicade, isotretinoin, mefloquine, lindane lotion & shampoo (head lice, crab lice), interferon/peginterferon, nevirapine (NNRTI, Viramune), ribavirin (HCV), selegiline (Emsam patch), tacrolimus, tamoxifen, warfarin, PTU, colchicine - PPI - bisphosphonates - NSAIDs - opioids - BZDs - stimulants (includ atomoxetine, provigil, nuvigil) - bowel prep kits (PEG) - antidepressants - antipsychotics (incld lithium) - DIABETIC Agents (TZDs, insulin, GLP-1RA, SGLT-2i, DPP4, Soliqua - lixisenatide + glargine) - Z drugs (+ Belsomra) - COPD inhalers (symbicort, breo ellipta, anoro ellipta, serevent diskus, stiolto) - anticoags - FQ ABX - anticonvulsants - testosterone - antiemetics (Reglan, Transderm- Scop) - addiction meds (Vivitrol, suboxone) BBW Some med guides contain BBW - FQ: tendinitis/tendon rupture, peripheral neuropathy, & CNS - Avandia, Actos: CHF - Antidepressants: suicidality - Warfarin: bleeding Permits & Licences - pharmacy permit must be granted by BOP (1 permit/ pharmacy) & renewed annually - TEMP permit may be issued for 180 DAYS upon transfer of ownership - SEPARATE permit granted by DEA req for pharmacy to BUY & DISPENSE C.S. - Separate, annual BOP-issued sterile compounding license: nuclear pharmacy (RA drugs compounding), sterile injectable compounding, ophthalmic products compounding, inhalation products compounding ** Compounding pharmacies REQ to report to BOP ANY RECALL notice within 12 HOURS Compounding licenses issuable by the BOP 1. 503A Pharmacy License: pt & Rx-specific compounding, CA law allows: - anticipatory compounding "in limited quantities" based on Rx history - contract compounding is SOLELY PT-SPECIFIC and NOT anticipatory - centralized hospital packaging (cmpd unit dose drugs for admin to inpatients) 2. 503B Outsourcing Facility License: NON-pt-specific batch cmpding - must meet cGMPS & be registered w/FDA, may NOT wholesale products - can also dispense pt-specific Rxs in CA Drug Substitutions: when a Rx is written using... 1. EITHER Brand name or generic --> RPh can dispense either brand or generic --> IMPORTANT: if substituted by generic, must have the SAME active chemical ingredients (identical salt) --> in order to substitute generic equiv to brand, REQ TO ASK THE PT (do NOT need to contact the prescriber) & include Brand name on label - DOSAGE FORM CAN BE CHANGED (strength, duration of effect MUST BE EQUIV); i.e. to improve pts compliance w/tx, RPh may dispense diff form W/O CONTACTING PRESCRIBER (Caps --> tab; tab --> oral liq) ** CAUTION: CREAM vs. OINTMENT = DIFF RATE OF DELIVERY!!!! Drug Substitution NOT allowed if Prescriber writes for BRAND name and: 1. States orally/in writing that drug substitution is NOT allowed (DAW) 2. Checks 'Do NOT substitute' (& initials if hard copy vs. no initials req if electronic) --> pharmacist canNOT dispense generic equiv drug Naloxone Furnishing RPh can furnish naloxone w/o Rx pursuant to state protocol - req 1-hr CE prior (all forms naloxone, IM, Nasal spray Narcan, injectable) - furnished to pts using opioids or in contact w/others using opioids (street or pain meds) - pt counseling canNOT be waived (provide Fact Sheet) - keep records on furnishing naloxone for > 3 YEARS Hypodermic needles & syringes physicians & RPhs are authorized to furnish needles & syringes for human use to ADULTS > 18 yo W/O RX or PERMIT - anyone OVER 18 YO allowed to obtain needles/syringes for personal use w/o Rx or license (NO limit of quantity purchased) - pharmacies that sell syringes w/o Rx MUST: provide safe disposal of needles/syringes (sell sharps containers or mail-back sharps containers), provide on-site sharps collection/ disposal (can take-back used syringes only if in sharps container), provide info for drug abuse tx & HCV/HIV testing NON-Rx diabetes test device pharmacy must maintain records of NON-Rx diabetes devices/test strips dispensed for > 3 YEARS Veterinary Drugs Require Rx - pharmacy req BOP-issued veterinary food-animal drug permit for dispensing (annual renewal) Thermometers mercury fever thermometers REQUIRE PRESCRIPTION SAMPLE Rx drugs ** NO person may sell, purchase or trade any drug sample a) prescriber: may dispense samples to pt w/o usual labeling if samples are: in packages prepared by manufacturer & NOT paid for by pt b) hospital pharmacy: prescriber will AUTHORIZE in writing to a distrib that samples are to be supplied to pharmacy & health care entity may transfer samples to pharmacy if regular supples shortage - compounding aseptic isolators (CAI) & compounding aseptic containment isolators (CACI) = Restricted Access Barrier Systems & MUST be placed in cleanroom to get Category 2 BUD Compounding Areas & Air Quality: what is a cleanroom suite according to USP 797? ** consists of at LEAST 2 ROOMS = anteroom & buffer room (A--> B) 1. anteroom: area w/min ISO Class 8 air quality, adjacent to cleanroom, for hand hygiene (has a sink), garbing, & staging of components 2. Buffer area: min ISO Class 7 air quality 3. Primary Engineering Control (PEC): device that provides min ISO Class 5 HEPA-FILTERED air for STERILE COMPOUNDING ** STERILE COMPOUNDING: EACH ISO area shall be certified at least EVERY 6 MONTHS & cert records kept for > 3 YEARS Compounding Room Pressure 1. non-hazardous compounding: POSITIVE PRESSURE 2. HAZARDOUS (ie chemo): NEGATIVE PRESSURE USP Compounding STDs & BUD 1. USP 800: hazardous drugs 2. USP 797: sterile drugs 3. USP 795: non-sterile drugs 4. USP 825: RADIO-pharmaceuticals ** BUD: date/time after which a compounded sterile product (CSP) OR non-sterile (NSCP) can longer be stored or used ** Exp date: stability of product as prepared by manufacturer vs. BUD is the last date/time that product can be safely used after it has been altered for pt use USP 795: Non-sterile compounding - oral (solid/liq), rectal, vaginal, topical, nasal, otic 1. non-preserved aqueous = 14 days 2. preserved aqueous = 35 days 3. non-aqueous = 90 days 4. solid dosage form = 180 days (6 mo) Temp: - fridge = 2-8C - freezer = (-)10-(-)25C - room temp (CRT) = 20-25C USP 797: Sterile compounding - injection, irrigation, ophthalmic, inhalation, live organ baths, implants 1. category 1: prepared in unclassified Segregated Compounding Area (SCA), shorter BUD: a) </= 12 hrs at CRT b) </= 24 hrs in 2-8C 2. Category 2: cleanroom suits, longer BUDs immediate use CSP BUD immediate use: must be prepared w/no more than 3 sterile products & admin req to begin w/in FOUR (4) HOURS following start of prep --> does NOT address admin time Drug Compounding: Recordkeeping keep for at LEAST 3 YEARS: - Master formula document - compounding log - Quality Assurance records/ Certification records/staff training records Labeling of Compounded Drug prep includes: a) Name of compounding pharmacy & dispensing pharmacy (if diff) b) name of API (brand or generic) c) strength, volume/wt of final prep d) lot # e) BUD ** IF STERILE: a) telephone # of pharmacy (not req if admin to inpatients w/in hospital) b) instructions for storage, handling, admin - Tri-pak: 500 mg daily x 3 days Baxdela Delafloxacin - 300 mg IV Q12H - 450 mg PO Q12H - SSTI - active against MRSA (ONLY FQ used if MRSA suspected) Doryx Doxycycline (also Vibramycin) - 100 mg Q12H PO/IV - IV:PO = 1:1, no renal dose adj - MUST PROTECT from light - take WITH food & remain upright for > 30 mins Nuzyra Omadacycline - tetracycline - CAP & skin infxns Xerava Eravacycline - IV - complicated intra-abd infxns Vibativ Telavancin - MEDGUIDE - BBW: fetal risk, pregnancy test prior to initiating - QT prolongation concern Betapace Sotalol - Class III antiarrhythmic, non selective BB - PO dose: 80 mg PO BID - IV dose: 75 mg IV infusion over 5 hours BID --> max dose of 150 mg IV BID if req & QTc < 500 msec - monitor QTc (avoid > 500 msec) Adcirca Tadalafil for PAH - 40 mg daily Cialis: Tadalafil for ED or BHD - dose for ED: a) PRN = 10-20 mg PO > 30 mins prior to sex b) daily dosing = 2.5-5 mg daily (~same time daily, w/o regard to sex timing) - dose for BPH= 5 mg once daily (can be used w/Proscar, rec tx duration < 26 wks)** do NOT combo w/alpha-1 antag for BPH Stendra Avanafil - ED - dose: 50-200 mg PO > 15 mins before sex (with or w/o food) Minipress Prazosin - alpha-1 blocker - HTN: 1mg BID or TID (other alpha-1 blockers QHS), Max 20mg/day - PTSD: 1-2mg QHS; Max 15mg/day - BPH: use not recommend at this time Cardura, Cardura XL (OROS) Doxazosin - HTN: 1-2mg IR PO daily; may titrate Q1-2w; Max 16mg - BPH: a) 1-2mg IR PO daily; may titrate Q1-2w; Max 8mg b) 4mg ER PO daily w/ breakfast; may titrate Q3-4w; Max 8mg --> start ALL alpha-blockers (Hytrin, Cardura) @ 1 mg QHS & titrate --> SIG ORTHOSTASIS --> IFIS: intra-op floppy iris syn w/alpha blockers Hytrin Aloprim Allopurinol (IV) Zyloprim = Allopurinol (PO) - X.O inhib for gout maintenance * UA target; < 6 mg/dL - inc risk of SEVERE skin rash (SJS) with HLA-B*5801 --> DISCONTINUE at FIRST SIGN OF RASH * AVOID w/azathioprine & 6-MP d.t. inc toxic buildup of immunosupp (myelosuppression) Aggrastat Tirofiban - GP IIB/IIIa receptor antagonist - (ACS) typically includes oral antiplatelet therapy (eg, aspirin plus a P2Y12 inhibitor) and an IV anticoagulant (eg, bivalirudin or heparin). A glycoprotein (GP) IIb/IIIa inhibitor is not routinely used due to limited benefit on ischemic outcomes and more bleeding complications. However, use may be considered in high risk patients when percutaneous coronary intervention (PCI) is planned Romazicon flumazenil - benzodiazepine overdose antidote Amerge naratriptan - serotonin receptor AGONIST - acute tx of migraine - 2.5 mg x1, may repeat after ≥4 hours (max: 5 mg/ 24 hours) - Cerebrovascular & CV event risk (triptans CI in uncontrolled HTN, CAD- h/o MI, h/o stroke/TIA, prinzmetal's angina, WPW syndrome) Aptivus Tipranavir - Protease inhibitor (HIV) - SULFA drug - BBW: hepatotoxicity, ICH - 500 mg PO BID w/ ritonavir 200mg PO BID w/ FOOD - SE: diarrhea, rash, Inc CPK, hepatoxic, ICH Lexiva Fosamprenavir - protease inhibitor (HIV) - SULFA drug Saphris asenapine SL - SL tab - SGA antipsychotic - no food or drink 10 min after dose (bioavial dec w/food) - Schizo or bipolar: 5-10mg PO BID; max 20mg/day SE: Somnolence, tongue/mouth numbness; EPS, QTc prolongation Secuado: daily asenapine patch (only for SCHIZO) Remember FGA (EPS); SGA (metabolic) Humira Adalimumab - SQ injection into abdomen/thigh - Crohn's disease/UC, plaque psoriasis, rheumatoid arthritis - TNF inhibitor - remove from fridge 30 mins before use, RT 14 days max, protect from light - Medguide - BBW: serious infections (including TB reactiv, invasive fungal infxns), malignancy - SE: inj site rxn, increase CPK, URI, positive ANA titer, CAUSE HF (all TNF inhib) Rowasa mesalamine - rectal suspension (enema) - 5-aminosalicylic acid (SALICYLATE) - enema: 4g qHS - do NOT use if susp is dark brown Saw Palmetto Clotrimazole - fungal infection - tinea cruris/pedis/corporis: apply topically to AA BID for ~ 1-4 weeks Camila, Errin, Heather, Lyza Norethindrone - Progestin Only Pill (POP) - may be started at any time postpartum in breastfeeding patients Cleocin clindamycin - For Suspension/IV: DO NOT refrigerate - no renal dose adj - IV: NEVER administer undiluted as a bolus (admin by IV intermittent infusion over 30-60 min) What lab/test do you check on a person on Diprivan? Propofol - Monitor: ABGs, LFTs, BP, RR, HR, TG (if longer than 2 days), S&S of pancreatitis, K+, fever infection/sepsis, sedation - inc TG --> may lead to PANCREATITIS - Rare: PRIS (propofol related infusion syndrome) = metabolic acidosis, HYPERkalemia, lipemia, rhabdo, Hepatotox, brachy/tachycardia, inc QRS, HF, hypotension Absorica, Amnesteen, Myorisan, Claravis, Zenatane Isotretinoin - REMS: IPledge program, females must be on 2 forms of BC (pharmacy, pt, prescriber registered) --> AVOID preg 1 mo prior/post (2 neg preg test prior to start & MONTHLY preg test) --> 1 mo Rx at a time (fill < 7 days) - Absorica: Take w/OUT meals & with full glass of liquid - Others Brands: Take WITH FOOD + liq ** can NOT be transferred to another pharmacy (cannot buy, borrow, transfer to another pharmacy) ** AE: dry skin/lips/eyes, eye irritation, psych issues (depression), arthralgia, inc cholesterol & TG, photosensitivity - d/c after total cumulative dose: 120-150 mg/kg Disposal of meds - Trash bins: Maintenance IV Fluid = Sewer system/sink (NS, NS+bicarb, KCl, LR, Controlled substance) - Blue Container: Non-Hazardous (non labled) (non haz spill cleanup) - Red Container: NON-hazardous Sharps (Epi pen, Syringe w/needles, Vaccine sys, Controlled syringes) - Black Bins: Hazardous Rx Waste (label/identified): NO CONTROLLED substance, NO SHARPS, Vials full/partial, creams/oint/lotions; Nicotine; Solid dosage medication (tab/caps), IV med Drips bags, Inhalers, coumadin/warfarin, IV with blood backup - Yellow bin: Trace HAZARDOUS waste (i.e. empty SYRINGES used to make CHEMO), used PPE Sulfa Protease inhibitors DTF = PAL darunavir tipranavir fosamprenavir Prezista/Prezcobix Aptivus Lexiva Sulfa Carbonic anhydrase inhibitor BAD = ADT Brinzolamide Acetazolamide Dorzolamide Azopt Diamox Trusopt Corvert Ibutilide - Class III antiarrythmic - IV only Sulfa drugs DTF = PAL DTA = ADB Omeprazole, esomeprazole: 20-40 mg Rabeprazole: 20 mg Lansoprazole: 15-30 mg Colesevalam Cholestyramine Colestipol Welchol Questran, Prevalite Colestid - AE: COnstipation - dec LDL but may inc TG - take w/food & water - dec abs of ADEK Norvir Ritonavir - protease inhibitor - Take ritonavir with food (ALL FORMULATIONS, tab/cap/oral solution) Lamisil AT (topical) or Lamisil (PO) ** KNOW BOTH TOPICAL & PO dosing Terbinafine **TOPICAL DOC** MOST effective OTC tinea pedis/cruris/corporis: - Apply 1-2 inch beyond rash, once daily for 2-4 weeks (even if appears healed) - tinea cruris/corporis: once daily for 1 week - tinea pedis: daily-BID for 2 weeks - onychomycosis (PO, Rx ONLY): 250mg once daily for x 6 weeks (fingernail) or x 12 weeks (toenail) --> monitor HEPATOTOXICITY --> other option= Sporanox (200 mg daily)- less fav d.t. inc HF, QT prolong, hepatotox & DDI Lotrimin AF Miconazole - OTC - antifungal - powder, spray Clotrimazole - OTC - antifungal - Cream, ointment, solution: BID for ~ 1-4 weeks Lotrimin Ultra Butenafine - OTC cream - Topical Antifungal Tinactin Tolnaftate - OTC cream, powder, spray - Anti-fungal Undecylenic acid (Toelieva) - OTC antifungal - Tinea pedis/tinea corporis: 4 weeks. - Tinea cruris (spray only): 2 weeks. Lotrisone ** clotrimazole/betamethasone - Rx cream/lotion for tinea with inflammation/itching - other Rx cream/foam: Ketoconazole (Extina) Isopto Carpine; Vuity Pilocarpine - miotic agent - stimulates cholinergic receptors of eye causing miosis, and lowering intraocular pressure Compro prochlorperazine - indication: N/V (VERY HIGH POTENCY TOPICAL STEROID) - lotion/shampoo/spray (Clobex) - cream/ointment (Temovate) - Foam (Olux) --> other high potency steroids: - Fluocinonide 0.1% cream (Vanos) ** - Betamethasone 0.05% ointment (Diprolene) -- reg Diprolene cuz it kno - Halobetasol 0.05% lotion (Ultravate) HIGH POTENCY TOPICAL STEROID (not VERY high) - Fluocinonide 0.05% (Lidex) oint ** - Betamethasone 0.05% cream (Diprolene AF) ** - Mometasone 0.1% oint (Elocon) ** medium potency topical steroids - Mometasone 0.1% cream ** (Elocon) - Triamcinolone 0.1% cream * (Triderm), Spray (Kenalog*) Low/mild potency topical steroids Desonide lotion (DesOwen), gel (Desonate), cream (Tridesilon), Foam (Verdeso) Hydrocortisone butyroate 0.1% Fluocinonide 0.01% oil LOWEST potency topical steroid Hydrocortisone: - cream 0.5%, 1% (Cortaid, Cortisone, Cortizone-10**), 2.5% (MiCort-HC) - lotion 1%, 2% - ointment 0.5%, 1%, 2.5% Caduet Amlodipine + Atorvastatin - Hypertension, dyslipidemia, angina, documented coronary artery disease, primary and secondary prevention of cardiovascular disease Rhythmol SR propafenone Tudorza Pressair Aclidinium LAMA for COPD -DPI Viramune XR Nevirapine NNRTI for HIV ** BBW: hepatotoxicity, SKIN reactions Perforomist Formoterol - LABA * medguide - Remove unit-dose vial from foil pouch IMMEDIATELY before use - Discard any unused medication immediately Brexafemme Ibrexafungerp - vaginal candida infection: 150 mg PO BID (AM/PM) Discontinue antithrombotics prior to elective surgery - Clopidogrel & Ticagrelor: 5 days - Prasugrel: 7 days - LMWH (Enoxaparin, Dalteparin): 24 hours - Heparin: 4-6 hours - Warfarin: 5 days (bridge w/LMWH or UFH in pts w/mech valves, AF, VTE @ high risk for thrombois)-- pts at low risk do NOT req bridge (restart ~12- 24 hrs post surgery when hemostasis achieved) - Apixaban: 24-48 hours (dep on bleed risk) - Edoxaban & Rivaroxaban: 24 hours - BBW: serious behavior & psych rxns (hostility, irritability, homicidal ideation) who can sign DEA form 222 and CSOS 1. person granted power of attorney 2. the person who signed DEA form 224 * CSOS: alt to DEA form 222, can order sch I-V substances electronically which registrants must use DEA form 224 to register w/the DEA? 1. hospitals/clinics/teaching institutions (NOT methadone/OTP clinics) 2. retail pharmacies 3. prescribers/mid-level practitioners 4. researchers ** NOTE: OTP- clinics registered w/DEA Form 363 (can disp & admin methadone but NOT prescribe it - cannot provide Rx for disp at retail pharmacy--> visit OTP daily to receive supervised dose & pts can receive take-home supply if deemed eligible ** methadone 40 mg sol tab = ONLY FDA-approved for tx opioid addiction triplicate DEA form 222 copies 1. copy 1- brown (retained by supplier) 2. copy 2- green (sent to DEA by supplier) 3. copy 3- blue (kept by the receiver who initiated the 222) * as of oct 2021, triplicate DEA form no longer in use.... Purchasing of Schedule III-V drugs - CSOS - purchase order form 11159.2 Exemption (YOU) Exception means CII can be written on normal Rx pads for people with terminal illness 11159.3 exemption (WE) declared state of emergency - During local, state, or federal emergency, RPh may fill Rx for a C.S. that does not meet the CS security form requirements, if the Rx: 1. Indicates that the pt is affected by a declared emergency with "11159.3 exemption" or a similar statement. 2. Is written & dispensed w/in the first 2 weeks of the notice issued by the BOP partial fill for CIII-CV - record in the same manner as a fill - must dispense remaining amount within 6 months ALL controlled substances Rx (CII-CV) expire 6 months after the issue date (date it was written) Eluxadoline Viberzi C-IV - Mu opioid receptor agonist for IBS-D expiration date of a prescription either manufacturer's exp date on stock bottle/container or 1 year (for non-compounded, solid oral products) End of Life /Aid-in dying - must be > 18 yo - pt must be able to take/admin med to themselves - must have a terminal illness w/less than 6 months projected life - pharmacist may refuse to prescribe - drugs: secubarbital or pentobarbital - may cause N/V--> instruct pt to take antiemetic an hour before barbiturate Prescription bottle font > 12-point, san serif font vaccinations at a pharmacy - both the intern and supervising pharmacist MUST maintain current Immunization certification AND BLS certification - pharmacist may admin epi inj to tx severe allergic rxn - MD-directed protocol ONLY req for non-routine vax "short stability BACtrim F L I P" what are the diff patches used for? Exelon = AD & PD Neupro = PD & RLS Emsam = MDD only (Zelapar = ODT used for PD) --> REMOVE ALL patches prior to MRI EXCEPT EXELON Antipsychotics & metabolic syndrome high met syn C-PORQ clozapine paliperidone olanzapine risperidone quetiapine (BEST in PD d.t. LEAST EPS) & preferred in cardiac pts (less QT prolong) LAAZ Lurasidone asenapine aripiprazole ziprasidone Flagyl pediatric dose metronidazole Oral: 15-50 mg/kg/day in divided doses TID IV: 20-40 mg/kg/day in divided doses TID-QID Warfarin DDI SUPER IMPORTANT: (TP-FLAMES) Tamoxifen Paroxetine Fluconazole Levofloxacin Amiodarone (dec warf by 30-50%) Metronidazole Erythromycin (macrolides in gen) SMX/TMP - 2C9 inducers: carbamazepine, rifampin, St. John's - 2C9 inhib: amiodarone, fluconazole, metronidazole, bactrim inc bleed risk w/o inc INR: NSAIDs, antiplt, other AC, SSRIs, SNRIs & 5 G's - high doses of fish oil, VitE Pediatric cough and cold avoid in these age groups < 18 yo: - TussiCaps, Tussionex - codeine preps (Promethazine VC, G Tussin AC, Virtussin A/C, Tuzistra, Tuxarin)--> all c&c codeine are C-V EXCEPT Tuzistra & Tuxarin C-III - ASA < 6 yo - Benadryl - Budesonide (Rhinocort) < 4 yo: OTC C&C (package labeling) --> can use Ocean's Spray < 2 yo: - PROMETHAZINE - topical menthol & camphor (Vicks Vaporub) labeling: - D (decongestant= PE, PSE) - DM (dextromethorphan) - AC (with codeine) Xofluza Baloxavir - influenza post-exp ppx & tx dose: 40-80 kg: 40 mg PO X1 > 80 kg: 80 mg PO X1 Relenza and Tamiflu influenza post-exp ppx & tx Relenza (zanamavir): tx: 10 mg inh BID x 5 days ppx: 10 mg inh daily x 10 days Tamiflu (oseltamivir)