Within the electronic supervision environment, the data entry can be performed by the pharmacy student or pharmacy technician being electronically supervised.

True or False

Within the electronic supervision environment, the data entry can be performed by the pharmacy student or pharmacy technician being electronically supervised.

True or False

Answer: True, [Kansas Pharmacy Practice Act Article 22 Sec. 68-22-5(c)].
 
(a). A pharmacy student or pharmacy technician may enter the pharmacy without a pharmacist present for purposes of turning on the data, video, or audio links and determining if a pharmacist is available for electronic supervision.
 
(b). Electronic supervision shall not be permitted if an interruption occurs in any of the data, video, or audio links. Whenever an interruption in any of the data, video, or audio links occurs, no medication order shall be filled or dispensed using electronic supervision.
 
(c). Data entry may be performed by the electronically supervising pharmacist or the pharmacy student or pharmacy technician being electronically supervised. Each entry performed by an electronically supervised pharmacy student or pharmacy technician shall be verified by the electronically supervising pharmacist before the drug leaves the pharmacy.
 
(d). All medication orders processed by a pharmacy student or a pharmacy technician being electronically supervised shall be capable of being displayed on a computer terminal at both the location of the electronically supervising pharmacist and the medical care facility's pharmacy.
 
(e). The quality of the image viewed by the pharmacist shall be sufficient for the pharmacist to be able to determine the accuracy of the work of the pharmacy student or pharmacy technician.

The Kansas Pharmacy Board is authorized to provide data in the prescription monitoring program to the:
 
I. An individual who requests the individual's own prescription monitoring information.
 
II. Designated representatives from the department of health and environment regarding authorized Medicaid program recipients.
 
III. Persons authorized to prescribe or dispense scheduled substances and drugs of concern, for the purpose of providing medical or pharmaceutical care for their patients.
 
a. I only
b. I and II only
c. II and III only
d. All

The Kansas Pharmacy Board is authorized to provide data in the prescription monitoring program to the:
 
I. An individual who requests the individual's own prescription monitoring information.
 
II. Designated representatives from the department of health and environment regarding authorized Medicaid program recipients.
 
III. Persons authorized to prescribe or dispense scheduled substances and drugs of concern, for the purpose of providing medical or pharmaceutical care for their patients.
 
a. I only
b. I and II only
c. II and III only
d. All

Answer: (d) All, [Kansas Pharmacy Practice Act Article 16 Chapter 65 Sec. 65-1685(c)].
 
The board is hereby authorized to provide data in the prescription monitoring program to the following persons:
 
(1). Persons authorized to prescribe or dispense scheduled substances and drugs of concern, for the purpose of providing medical or pharmaceutical care for their patients;
 
(2). an individual who requests the individual's own prescription monitoring information in accordance with procedures established by the board;
 
(3). designated representatives from the professional licensing, certification or regulatory agencies charged with administrative oversight of those persons engaged in prescribing or dispensing of scheduled substances and drugs of concern;
 
(4). local, state and federal law enforcement or prosecutorial officials engaged in the administration, investigation or enforcement of the laws governing scheduled substances and drugs of concern subject to the requirements in K.S.A. 22-2502 and amendments thereto;
 
(5). designated representatives from the department of health and environment regarding authorized Medicaid program recipients;
 
(6). persons authorized by a grand jury subpoena, inquisition subpoena or court order in a criminal action;
 
(7). personnel of the prescription monitoring program advisory committee for the purpose of operation of the program;
 
(8). personnel of the board for purposes of administration and enforcement of this act or the uniform controlled substances act, K.S.A. 65-4101 et seq., and amendments thereto.
 
(9). persons authorized to prescribe or dispense scheduled substances and drugs of concern, when an individual is obtaining prescriptions in a manner that appears to be misuse, abuse or diversion of scheduled substances or drugs of concern; and
 
(10). medical examiners, coroners or other persons authorized under law to investigate or determine causes of death.

If in the pharmacist’s professional judgment oral counseling is not practicable, the pharmacist may use alternative forms of patient information. “Not practicable” includes patient variables such as:
 
I. the patient’s or caregiver’s hearing impairment
 
II. high prescription volume
 
III. inadequate staffing
 
a. I only
b. I and II only
c. II and III only
d. All

If in the pharmacist’s professional judgment oral counseling is not practicable, the pharmacist may use alternative forms of patient information. “Not practicable” includes patient variables such as:
 
I. the patient’s or caregiver’s hearing impairment
 
II. high prescription volume
 
III. inadequate staffing
 
a. I only
b. I and II only
c. II and III only
d. All

Answer: I only.
 
If in the pharmacist’s professional judgment oral counseling is not practicable, the pharmacist may use alternative forms of patient information. “Not practicable” refers to patient variables including, but not limited to,
 
a. the absence of the patient or patient’s caregiver,
 
b. the patient’s or caregiver’s hearing impairment, or a language barrier.
 
“Not practicable” does NOT include pharmacy variables such as inadequate staffing, technology failure, or high prescription volume.
 
Alternative forms of patient information may include written information leaflets, pictogram labels, video programs, or information generated by electronic data processing equipment.
 
When used in place of oral counseling, alternative forms of patient information shall advise the patient or caregiver that the pharmacist may be contacted for consultation in person at the pharmacy by toll-free telephone or collect telephone call.
 
A combination of oral counseling and alternative forms of counseling is encouraged.

During the temporary absence of the pharmacist, only the pharmacist in charge designated pharmacy technicians or pharmacy support persons may be present in the prescription department to perform technical or nontechnical functions.

True or False

During the temporary absence of the pharmacist, only the pharmacist in charge designated pharmacy technicians or pharmacy support persons may be present in the prescription department to perform technical or nontechnical functions.

True or False

Answer: True, [Title 657 Iowa Administrative Code Chapter 6 Section 6.7(2)].
 
In the temporary absence of the pharmacist, only the pharmacist in charge may designate pharmacy technicians or pharmacy support persons who may be present in the prescription department to perform technical or nontechnical functions, respectively, designated by the pharmacist in charge.
 
Activities identified in subrule 6.7(3) may not be performed during such temporary absence of the pharmacist. A temporary absence is an absence of short duration not to exceed two hours.

The board may impose the following disciplinary sanctions if it found that the pharmacist is practicing pharmacy without a current license:
 
I. Revocation of a registration, a permit, or a license issued by the board.
 
II. Suspension of a registration, a permit, or a license issued by the board until further order of the board or for a specified period.
 
III. Nonrenewal of a registration, a permit, or a license issued by the board.

a. I only
b. III only
c. I and II only
d. II and III only
e. All

The board may impose the following disciplinary sanctions if it found that the pharmacist is practicing pharmacy without a current license:
 
I. Revocation of a registration, a permit, or a license issued by the board.
 
II. Suspension of a registration, a permit, or a license issued by the board until further order of the board or for a specified period.
 
III. Nonrenewal of a registration, a permit, or a license issued by the board.

a. I only
b. III only
c. I and II only
d. II and III only
e. All

Answer (e) All, [Title 657 Iowa Administrative Code Chapter 36 Section 36.1(2) And Chapter 2 Section 2.11(2)].
 
If a license is not renewed before its expiration date, the license is delinquent and the licensee may not practice pharmacy in the state of Iowa until the licensee reactivates the delinquent license.
 
Reactivation of a delinquent license shall include submission of a completed application and appropriate fees and may include requirements relating to the reactivation of an inactive license pursuant to subrule 2.13(2).
 
A pharmacist who continues to practice pharmacy in Iowa without a current license may be subject to disciplinary sanctions pursuant to the provisions of 657—subrule 36.1(2).
 
657—subrule 36.1(2):
 
a. Revocation of a registration, a permit, or a license issued by the board.
 
b. Suspension of a registration, a permit, or a license issued by the board until further order of the board or for a specified period.
 
c. Nonrenewal of a registration, a permit, or a license issued by the board.
 
d. Prohibit permanently, until further order of the board, or for a specified period, the engaging in specified procedures, methods or acts.
 
e. Probation.

f. Require a pharmacist or a pharmacist-intern to complete additional education or training.
 
g. Require a pharmacist to successfully complete any reexamination for licensure.
 
h. Order a pharmacist, pharmacist-intern, pharmacy technician, or pharmacy support person to undergo a physical or mental examination.
 
i. Impose civil penalties not to exceed $25,000.
 
j. Issue citation and warning.
 
k. Such other sanctions allowed by law as may be appropriate.

Oxygen is a drug and therefore requires prescribing in all but emergency situations. In the emergency situation oxygen prescription is not required.

Before oxygen therapy is prescribed there are guidelines or criteria that must be met. These criteria involve a blood test. (These blood test criteria must also be met for Medicare and other insurers to pay for the oxygen costs.) Medical experts produced the criteria. They establish what the levels of oxygen in the blood must be for oxygen therapy to be needed.

Oxygen is a drug and therefore requires prescribing in all but emergency situations. In the emergency situation oxygen prescription is not required.

Before oxygen therapy is prescribed there are guidelines or criteria that must be met. These criteria involve a blood test. (These blood test criteria must also be met for Medicare and other insurers to pay for the oxygen costs.) Medical experts produced the criteria. They establish what the levels of oxygen in the blood must be for oxygen therapy to be needed.
 
These guidelines describe three conditions that require the use of oxygen therapy:

1. PaO2 is less than or equal to 55 mmHg. Or hemoglobin oxygen saturation (SaO2) measured by pulse oximeter is less than or equal to 88 percent when breathing room air at rest.
 
2. PaO2 of 56-59 mmHg. Or if the hemoglobin oxygen saturation (SaO2) is equal to or greater than 89 percent when linked to specific conditions. These may include Cor Pulmonale, congestive heart failure or erythrocytosis. (With a hematocrit of greater than 56 percent.) (Erythrocytosis means there are more red cells in the blood than normal. Hematocrit measures the percentage of cells in a sample of blood.)
 
3. Some individuals do not qualify for oxygen therapy while at rest. But they may require oxygen while walking, exercising or during sleep. Oxygen therapy is needed in these cases when the hemoglobin oxygen saturation (SaO2) falls to less than or equal to 88 percent. Also, for the costs of oxygen to be covered by insurance there must be proof that the oxygen therapy used during exercise or sleep improves the individual's hypoxemia.
 
A physician must write a prescription for oxygen therapy prior to delivery. The prescription will indicate the flow rate, how much oxygen you need per minute -- referred to as liters per minute (LPM) -- and when you need to use oxygen.

Also necessary is Diagnosis, portability (if needed), and length of need. Some people use oxygen therapy only while sleeping, others only while exercising, and still others need oxygen continuously.

Your physician will order a blood test or oximetry test that will indicate what your oxygen level is and help determine what your needs are. A written prescription is required prior to delivery.

Certain insurance polices may pay for all your oxygen, but payment is based on laboratory results, diagnosis, and other information. The information listed below will help you to determine insurance coverage.
 
Medicare – In addition to a prescription, Medicare requires a Certificate of Medical Necessity (CMN) to be filled out by your physician. CMN Oxygen requirements are as follows:
 
1.      Length of need.
2.      Diagnosis, a respiratory ailment showing the need for oxygen.
3.      Oxygen Blood Gas to be 56-59 or below, or Oxygen Saturation level to be 89 or below.
4.      How the test was taken, room air, during exercise, or while sleeping.
5.      The testing facility where blood gasses or oximetry was performed.
6.      Portability if needed.
7.      Liter flow prescribed.
8.      Physicians Signature.
9.      Date.

Updated hypertension recommendations from panel members previously appointed to the Eight Joint National Committee (JNC 8) raised blood pressure goals in adults age 60 and older to less than 150/90 mm Hg, with patients younger than 60 years old (including those with chronic kidney disease and diabetes) having a target of less than 140/90 mm Hg. In nonblack individuals, initial treatment should include a thiazide-type diuretic, calcium channel blocker (CCB), ACE inhibitor, or angiotensin receptor blocker (ARB). Treatment should start with a thiazide-type diuretic or CCB in black patients, including those with diabetes.

Updated hypertension recommendations from panel members previously appointed to the Eight Joint National Committee (JNC 8) raised blood pressure goals in adults age 60 and older to less than 150/90 mm Hg, with patients younger than 60 years old (including those with chronic kidney disease and diabetes) having a target of less than 140/90 mm Hg. In nonblack individuals, initial treatment should include a thiazide-type diuretic, calcium channel blocker (CCB), ACE inhibitor, or angiotensin receptor blocker (ARB). Treatment should start with a thiazide-type diuretic or CCB in black patients, including those with diabetes.

For I.V light sensitive drugs, Amber Bags offer a fast, cost effective solution. They effectively filter out ___% of the rays in the ultraviolet spectrum, providing the required safety.

For I.V light sensitive drugs, Amber Bags offer a fast, cost effective solution. They effectively filter out ___% of the rays in the ultraviolet spectrum, providing the required safety.

Answer: 96.7%. Ultraviolet light can cause oxidation, hydrolysis and loss of potency to sensitive meds in solution. This loss can be greatly minimised by protecting from light. Amber glass protection is expensive, foil wrapping is cumbersome and time consuming. Amber Bags offer a fast, cost effective solution. They effectively filter out 96.7% of the rays in the ultraviolet spectrum, providing the required safety.

Which of the following is commonly known as “Z-Drug”?

a. Omeprazole
b. Olanzapine
c. Zolpidem
d. Nizatidine
e. Doxylamine

Which of the following is commonly known as “Z-Drug”?

a. Omeprazole
b. Olanzapine
c. Zolpidem
d. Nizatidine
e. Doxylamine

Answer: (c) The Z-drugs, which include Eszopiclone (Lunesta), Zolpidem (Ambien), and Zaleplon (Sonata), are benzodiazepine receptor agonists.  That means they work in a similar way to the benzodiazepine drugs inside the brain.  They are GABA agonists meaning they somewhat mimic the action of gamma-Aminobutyric acid, the inhibitory neurotransmitter and thereby induce sleepiness.
 
These drugs are sometimes referred to as non-benzodiazepine hypnotics or just non-benzodiazepines.  That's a dumb name, if you ask us.  Too unspecific and vague, especially if you are not in the context of sleep medicine. 

Further, even within sleep medicine, there are compounds that are non-benzodiazepine hypnotics that would not be considered part of this class: antihistamines and Ramelteon, for instance.

One problem is that the chemists don't have a category that these drugs all fall into which is narrow enough to signify what medical practitioners are talking about.  These drugs are in the categories pyrazolopyrimidines, imidazopyridines or cyclopyrrones, but they are not all in the same category.
Therefore, we prefer the term Z-drugs.  The generic names for these drugs all contain the letter Z, and it is as good a name as any.