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Under a final rule (PDF) published in the Federal Register, the pain reliever tramadol is now classified as a Schedule IV controlled substance (CS).

Starting August 18, 2014, Drug Enforcement Administration (DEA) will require manufacturers to print the “C-IV” designation on all labels that contain 2- [(dimethylamino)methyl]-1-(3-methoxyphenyl)cyclohexanol (tramadol), including its salts, isomers, and salts of isomers.

The agency notes that every “DEA registrant who possesses any quantity of tramadol on the effective date of this final rule must take an inventory of all stocks of tramadol on hand as of August 18, 2014, pursuant to 21 U.S.C. 827 and 958, and in accordance with 21 CFR 1304.03,1304.04, and 1304.11 (a) and (d).” In addition, all “prescriptions for tramadol or products containing tramadol must comply with 21 U.S.C. 829, and be issued in accordance with 21 CFR part 1306 and subpart C of 21 CFR part 1311 as of August 18, 2014.”

National Association of State Controlled Substances Authorities notes (PDF) that several states have already classified tramadol as a CS. To “provide a reasonable time for registrants to comply with the handling requirements” for a Schedule IV CS, DEA established the effective date of the final rule as 45 days from the date of publication.


Under a final rule (PDF) published in the Federal Register, the pain reliever tramadol is now classified as a Schedule IV controlled substance (CS).

Starting August 18, 2014, Drug Enforcement Administration (DEA) will require manufacturers to print the “C-IV” designation on all labels that contain 2- [(dimethylamino)methyl]-1-(3-methoxyphenyl)cyclohexanol (tramadol), including its salts, isomers, and salts of isomers.

The agency notes that every “DEA registrant who possesses any quantity of tramadol on the effective date of this final rule must take an inventory of all stocks of tramadol on hand as of August 18, 2014, pursuant to 21 U.S.C. 827 and 958, and in accordance with 21 CFR 1304.03,1304.04, and 1304.11 (a) and (d).” In addition, all “prescriptions for tramadol or products containing tramadol must comply with 21 U.S.C. 829, and be issued in accordance with 21 CFR part 1306 and subpart C of 21 CFR part 1311 as of August 18, 2014.”

National Association of State Controlled Substances Authorities notes (PDF) that several states have already classified tramadol as a CS. To “provide a reasonable time for registrants to comply with the handling requirements” for a Schedule IV CS, DEA established the effective date of the final rule as 45 days from the date of publication.


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A patient with severe anxiety and depression shall avoid which of the following antidepressants?

a. Mirtazapine
b. Bupropion
c. Paroxetine
d. Fluvoxamine
e. Duloxetine

Answer:


A patient with severe anxiety and depression shall avoid which of the following antidepressants?

a. Mirtazapine
b. Bupropion
c. Paroxetine
d. Fluvoxamine
e. Duloxetine

Answer: (b), Bupropion. Bupropion hydrochloride (Wellbutrin) is an antidepressant of the aminoketone class. It is supplied for oral administration as 75-mg (yellow-gold) and 100-mg (red) film-coated tablets. It is indicated for the treatment of major depressive disorder (MDD).

The recommended starting dose is 200 mg per day, given as 100 mg twice daily. After 3 days of dosing, the dose may be increased to 300 mg per day, given as 100 mg 3 times daily, with at least 6 hours between successive doses. Dosing above 300 mg per day may be accomplished using the 75-or 100-mg tablets.

A maximum of 450 mg per day, given in divided doses of not more than 150 mg each, may be considered for patients who show no clinical improvement after several weeks of treatment at 300 mg per day. Administer the 100-mg tablet 4 times daily to not exceed the limit of 150 mg in a single dose.

To minimize the risk of seizure, increase the dose gradually. Increases in dose should not exceed 100 mg per day in a 3-day period. Due to its CNS stimulation property, it shall be avoided in patients suffering from severe anxiety. In such patients, instead Bupropion, one can use Mirtazapine or Paroxetine for its sedative effects.

Below is the list of antidepressants and their special effects:
 

  1. SSRI or SSNRI: May cause reduced libido and arousal, erectile dysfunction, and delayed or absent orgasm.

  2. Bupropion: Minimum weight gain. Contraindicated to use in patients suffering from anxiety and seizure.

  3. Mirtazapine: Strong antihistamine and sedation properties.

  4. Duloxetine: Useful in patients suffering from depression with fibromyalgia or diabetic neuropathic pain.


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An advanced pharmacist intern under the Nebraska Law may supervise another pharmacist intern or a pharmacy technician.

Answer: True or False


An advanced pharmacist intern under the Nebraska Law may supervise another pharmacist intern or a pharmacy technician.

Answer: True or False

Answer: False, [Nebraska Administrative Code Title 172 Chapter 128 Section 128-015.03]. A pharmacist intern must NOT supervise another pharmacist intern or a pharmacy technician.


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Under the Nebraska State Pharmacy Law, a prescription, chart order, or refill authorization issued by a prescriber may be communicated to a pharmacist or a pharmacist intern by an employee of the prescriber.

Answer: True or False


Under the Nebraska State Pharmacy Law, a prescription, chart order, or refill authorization issued by a prescriber may be communicated to a pharmacist or a pharmacist intern by an employee of the prescriber.

Answer: True or False

Answer: True, [Nebraska Administrative Code Title 172 Chapter 128 Section 128-014.05]. A prescription, chart order, or refill authorization issued by a prescriber may be communicated to a pharmacist or a pharmacist intern by an employee or agent of the prescriber.


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A hard copy of an electronic data prescription drug order for any Schedule II controlled substance that is given directly to the patient shall NOT be REQUIRED on security paper approved by the board.

True or False


A hard copy of an electronic data prescription drug order for any Schedule II controlled substance that is given directly to the patient shall NOT be REQUIRED on security paper approved by the board.

Answer: False, [Pharmacy Practice Act of Georgia 26-4-80.1(c)].

If a hard copy of an electronic data prescription drug order for any Schedule II controlled substance is given directly to the patient, the manually signed hard copy prescription drug order must be on security paper approved by the board.


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A pharmacy technician may NOT perform which of the following tasks?

I. Accept an original prescription drug order by telephone.
II. Perform patient counseling.
III. Sign any federally-required controlled substance or inventory form.

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

Answer:


A pharmacy technician may NOT perform which of the following tasks?

I. Accept an original prescription drug order by telephone.
II. Perform patient counseling.
III. Sign any federally-required controlled substance or inventory form.

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

Answer: All listed tasks cannot be performed by a pharmacy technician. The pharmacist in charge or the retail drug outlet shall determine the duties of pharmacy technicians based upon the needs of the drug outlet.

At time of employment the pharmacist in charge shall provide the technician with a description of the tasks that the technician may perform.

Pharmacy technicians are limited to performing tasks in the preparation of prescription legend drugs and nonjudgmental support services.

Permissible duties include the dispensing of drugs under the direct supervision of a pharmacist. Pharmacy technicians may also have access to a facsimile machine or computer used to receive original prescription drug orders via facsimile.

A pharmacy technician may not perform any of the following tasks:

A. Accept an original prescription drug order by telephone;

B. Clinically evaluate a patient profile relative to drugs that have or will be dispensed;

C. Perform patient counseling or suggesting over-the-counter or prescription products to a patient;

D. Make decisions that require the education and professional training of a pharmacist; or

E. Sign any federally-required controlled substance or inventory form.


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Under Maine State Pharmacy law, a physician's assistant or registered nurse who writes a prescription while working under the control or supervision of a physician shall print or type the name of the physician under whom the assistant or nurse works on the prescription blank.

True or false


Under Maine State Pharmacy law, a physician's assistant or registered nurse who writes a prescription while working under the control or supervision of a physician shall print or type the name of the physician under whom the assistant or nurse works on the prescription blank.

Answer: True,[Title 32 Professions and Occupations, Chapter 117, Subchapter 9, Section 13786].

Any practitioner who writes a prescription upon a prescription blank of a hospital or clinic shall sign that practitioner's name and cause that name to be printed, stamped or typed on the blank.

This section applies to any physician's assistant or registered nurse who writes a prescription while working under the control or supervision of a physician.

In case of the physician's assistant or registered nurse, the name of the physician under whom the assistant or nurse works shall be printed, stamped or typed on the blank.


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A prescription for a Schedule II drug written by an out-of-state practitioner on a prescription blank that does not comply with the requirements for a security prescription blank, as defined in the Department of Public Safety rule, shall NOT be filled by a pharmacist.

Answer: True or False


A prescription for a Schedule II drug written by an out-of-state practitioner on a prescription blank that does not comply with the requirements for a security prescription blank, as defined in the Department of Public Safety rule, shall NOT be filled by a pharmacist.

Answer: False, [Title 32 Maine Pharmacy Act Chapter 117 Sec. 13786-A,(2),(A),(B)].

A prescription for a Schedule II drug written by an out-of-state practitioner on a prescription blank that does not comply with the requirements for a security prescription blank, as defined in the Department of Public Safety rule, may be filled by a pharmacist only if:

A. The pharmacist receives and makes a record of oral confirmation of the validity of the prescription from the out-of-state practitioner or the practitioner's agent and the pharmacist makes a reasonable effort to determine that the oral confirmation came from the practitioner or the practitioner's agent, which may include a telephone call to the practitioner's telephone number listed in a telephone directory or other directory, or other good faith efforts to confirm the identity of the person giving the oral confirmation; and

B. The pharmacist demands, inspects and records a valid photographic identification from any person presenting a prescription or receiving a filled prescription unless:

(1). The person is the patient for whom the prescription is written;

(2). The person's identity is personally known to the pharmacist; and

(3). The pharmacist confirms by reviewing the pharmacy records that the pharmacist has previously demanded, inspected and recorded a valid photographic identification from the person.


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Controlled Substances on Maryland List - But Not on DEA List of Controlled Substances

1-(1-phenylcyclohexyl) piperidine C-II
Butalbital, Acetaminophen, caffeine (Fioricet)  C-III (Non-controlled DEA) 
Chlorotestosterone C-III
Dihydrotestosterone C-III
Methandrostenolone C-III
Stanolone C-III
Mazindol C-III (DEA C-IV)
Pentazocine C-III (DEA C-IV)
Dihydrocodeinone < or = 15mg per dosage unit C-III
Opium < or = 100mg per 100Gm or 100ml
or not more than 5mg per dosage unit C-III

Citation: http://dhmh.maryland.gov/laboratories/drugcont/docs/Supplemental%20CDS%20List%20-%20Maryland.pdf


Controlled Substances on Maryland List - But Not on DEA List of Controlled Substances

1-(1-phenylcyclohexyl) piperidine C-II
Butalbital, Acetaminophen, caffeine (Fioricet)  C-III (Non-controlled DEA) 
Chlorotestosterone C-III
Dihydrotestosterone C-III
Methandrostenolone C-III
Stanolone C-III
Mazindol C-III (DEA C-IV)
Pentazocine C-III (DEA C-IV)
Dihydrocodeinone < or = 15mg per dosage unit C-III
Opium < or = 100mg per 100Gm or 100ml
or not more than 5mg per dosage unit C-III

Citation: http://dhmh.maryland.gov/laboratories/drugcont/docs/Supplemental%20CDS%20List%20-%20Maryland.pdf


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In Georgia, a prescription for Fioricet can be refilled how many times?

a. Cannot be refilled
b. 5 times
c. As Needed within 1-year
d. Maximum 10 times.


In Georgia, a prescription for Fioricet can be refilled how many times?

a. Cannot be refilled
b. 5 times
c. As Needed within 1-year
d. Maximum 10 times.

Answer: 5 times, [http://www.nascsa.org/stateprofiles/georgia.htm].

Normally for most states Fioricet is a non-controlled substance whereas Fiorinal is a controlled substance. However, in Georgia, all Butalbitals, including those in combination with acetaminophen, are classified as Schedule III controlled substance.

Therefore, the prescription for Fioricet in Georgia can be filled maximum 5 times within a 6-month period.




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