A pharmacist licensed in Illinois may fill or refill a valid prescription for Ambien which is on file in a pharmacy licensed in North Carolina.

True or False

A pharmacist licensed in Illinois may fill or refill a valid prescription for Ambien which is on file in a pharmacy licensed in North Carolina.

True, [Illinois Pharmacy Practice Act 225 ILCS 85/19(5)].

Nothing contained in this Act shall be construed to prohibit a pharmacist licensed in this State from filling or refilling a valid prescription for prescription drugs which is on file in a pharmacy licensed in any state and has been transferred from one pharmacy to another by any means, including by way of electronic data processing equipment upon the following conditions and exceptions:

(1). Prior to dispensing pursuant to any such prescription, the dispensing pharmacist shall:

(a). Advise the patient that the prescription on file at such other pharmacy must be canceled before he or she will be able to fill or refill it.

(b). Determine that the prescription is valid and on file at such other pharmacy and that such prescription may be filled or refilled, as requested, in accordance with the prescriber's intent expressed on such prescription.

(c). Notify the pharmacy where the prescription is on file that the prescription must be canceled.

(d). Record in writing the prescription order, the name of the pharmacy at which the prescription was on file, the prescription number, the name of the drug and the original amount dispensed, the date of original dispensing, and the number of remaining authorized refills.

(e). Obtain the consent of the prescriber to the refilling of the prescription when the prescription, in the professional judgment of the dispensing pharmacist, so requires.

When filling or refilling a valid prescription on file in another state, the dispensing pharmacist shall be required to follow all the requirements of Illinois law which apply to the dispensing of prescription drugs. If anything in Illinois law prevents the filling or refilling of the original prescription it shall be unlawful to dispense pursuant to this Section.

Prescriptions for drugs in Schedules III, IV, and V of the Illinois Controlled Substances Act may be transferred only once and may not be further transferred. However, pharmacies electronically sharing a real-time, online database may transfer up to the maximum refills permitted by the law and the prescriber's authorization.

It shall be unlawful for any distributor of a prescription drug to distribute a prescription drug without charge or for less than its fair market value to a patient by a pharmacist in response to a request written and signed by a medical practitioner which designates the quantity to be distributed.

True or False

It shall be unlawful for any distributor of a prescription drug to distribute a prescription drug without charge or for less than its fair market value to a patient by a pharmacist in response to a request written and signed by a medical practitioner which designates the quantity to be distributed.

False, [Illinois Pharmacy Practice Act 225 ILCS 85/24].

It shall be unlawful for any manufacturer or distributor of a prescription drug, or any person on behalf of such manufacturer or distributor, to distribute a prescription drug without charge or for less than its fair market value to any person directly or indirectly. Nothing in this Section shall be construed to PROHIBIT the distribution of a prescription drug:

(a). at a discount in accordance with the laws of the United States or the State of Illinois;

(b). to a person for use in an investigation conducted under Federal Food and Drug Administration regulations;

(c). to a patient by a pharmacist in response to a request written and signed by a medical practitioner which designates the quantity to be distributed;

(d). to a licensed medical practitioner in response to a request signed by the practitioner which designates the quantity to be distributed;

(e). to an agency of the federal government or to a state government or political subdivision for regulatory or enforcement purposes;

(f). in an emergency as determined by the laws of the United States or the State of Illinois; or

(g). to a bona fide charity authorized to possess and dispense prescription drugs.

Topic: Medication Error/Inattentional blindness/Tennessee Board of Pharmacy 2012 December News Letter

A pharmacist enters a prescription for methotrexate daily into the pharmacy computer.A dose warning appears on the screen. The pharmacist reads the warning, bypasses it, and dispenses the medication as entered. The patient receives an overdose of the medication and dies...

Topic: Medication Error/Inattentional blindness/Tennessee Board of Pharmacy 2012 December News Letter

A pharmacist enters a prescription for methotrexate daily into the pharmacy computer.A dose warning appears on the screen. The pharmacist reads the warning, bypasses it, and dispenses the medication as entered. The patient receives an overdose of the medication and dies.

This error, and many more, have happened because the person performing the task fails to see what should have been plainly visible, and later, they cannot explain the lapse. People involved in these errors have been labeled as careless and negligent. But these types of accidents are common – even with intelligent, vigilant, and attentive people. The cause is usually rooted in inattentional blindness.

Accidents happen when attention mistakenly filters away important information and the brain fills in the gaps with what is aptly referred to as a "grand illusion." Thus, in the example above, the brain of the pharmacist filtered out important information on the computer screen,and filled in the gaps with erroneous information that led him to believe he had read the warning appropriately.

Inattentional blindness is more likely to occur if part of your attention is diverted to secondary tasks, like answering the phone while entering prescriptions into the computer, or even thinking about your dinner plans while transcribing an order.

Low workload causes boredom and reduces the mental attention given to tasks, as does carrying out highly practiced tasks, such as counting out medication. We spend a large majority of our waking life functioning with the equivalent of an automatic pilot, with occasional conscious checks to ensure tasks are being carried out properly. This makes us particularly prone to inattentional blindness.

Which of the following agencies analyzes medication errors, near misses, and potentially hazardous conditions as reported by pharmacists and other practitioners?

a. ASHP
b. ACPE
c. ISMP
d. DRG

Answer:

Which of the following agencies analyzes medication errors, near misses, and potentially hazardous conditions as reported by pharmacists and other practitioners?

a. ASHP
b. ACPE
c. ISMP
d. DRG

 Answer: (c). ISMP (Institute for Safe Medication Practices) is an independent nonprofit agency that analyzes medication errors, near misses, and potentially hazardous conditions as reported by pharmacists and other practitioners.

ISMP then makes appropriate contacts with companies and regulators, gathers expert opinion about prevention measures, and publishes its recommendations.

To assist pharmacists in the process of minimizing the occurrence of medication errors, many state boards of pharmacy are contemplating or already requiring community pharmacies to have a continuous quality improvement program in place.

Many of these state’s regulations include the requirement of root cause analysis (RCA) in the case of sentinel events.

The Joint Commission defines a sentinel event as an “unexpected occurrence involving death or serious physical or psychological injury or risk thereof,” and recommends completing an RCA for all sentinel events for health care organizations in which they accredit.

It is anticipated that RCA for sentinel events may be required as part of an accreditation program for community/ambulatory pharmacies.

Researchers tested three types of inquiry about the patient’s understanding:

1. Yes-No
2. Tell Back-Directive
3. Tell Back-Collaborative

Researchers tested three types of inquiry about the patient’s understanding:

1. Yes-No
2. Tell Back-Directive
3. Tell Back-Collaborative

The Yes-No approach asked closed-ended questions to assess patient understanding. (Example: “I’ve given you a lot of information. Do you understand?”)

The Tell Back-Directive method used open-ended questions that were physician-centered and paternalistic in that it was clear authority and control still remained with the physician. (Example: “It’s really important that you do this exactly the way I explained. What do you understand?”)

The Tell Back-Collaborative approach used openended questions that were patient centered, making it clear that power and responsibility were shared between the health care provider and patient. (Example: I imagine you are really worried about your blood pressure. I’ve given you a lot of information. It would be helpful to me to hear your understanding about your clot and its treatment.)

Patients showed a significant preference for the Tell Back-Collaborative inquiry over other tested approaches. Because of the potential for embarrassment if patient misunderstandings are exposed, one might anticipate health care providers’ reluctance to put patients “on the spot” with open-ended questions.

But a collaborative approach to Tell Back allows the patient to save face for misunderstandings by acknowledging the large amount of information being provided. Patients might also view the request for Tell Back as evidence of the health care provider’s care and concern for them personally, or evidence of the provider’s attention to detail and competence.

So, when counseling patients about their medications, instead of asking “Do you have any questions?” or “Do you understand?” ask them to restate their understanding of the information you provided in their own words within a shame-free, blame-free environment.

Pharmacists, pharmacy interns and pharmacy technicians may transfer a prescription containing a Schedule II controlled substance with any other drug that is a non-scheduled prescription drug to another prescription form under Tennessee Pharmacy Practice Act.

True or False

Pharmacists, pharmacy interns and pharmacy technicians may transfer a prescription containing a Schedule II controlled substance with any other drug that is a non-scheduled prescription drug to another prescription form under Tennessee Pharmacy Practice Act.

True, [Tennessee Pharmacy Practice Act of 1996 63-10-215].

(a). Pharmacists, pharmacy interns and pharmacy technicians may transfer a prescription containing a Schedule Il controlled substance with any other drug that is a non-scheduled prescription drug to another prescription form under Tennessee Pharmacy Practice Act.

(b). The transfer authorized in subsection (a) may be accomplished by scanning, photocopying or transcribing, by hand or other means, and shall include all information regarding each drug or supply being transferred.

(c). The prescription generated in a pharmacy by the transfer process shall not be required to be on tamper-resistant prescription paper.

(d). The prescription generated in a pharmacy utilizing the transfer process shall be recognized as a valid, legal prescription order and shall serve as the original prescription for recordkeeping and other purposes.

Which of the following sign(s) and symptom(s) is/are commonly reported with kidney failure?

I. Vomiting and diarrhea
II. Anemia
III. Nocturnal urination

Which of the following sign(s) and symptom(s) is/are commonly reported with kidney failure?

I. Vomiting and diarrhea
II. Anemia
III. Nocturnal urination

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

Answer: (d), All.

Symptoms of kidney failure include:

(a). High levels of urea in the blood, which can result in:

1. Vomiting and/or diarrhea, which may lead to dehydration
2. Nausea
3. Weight loss
4. Nocturnal urination
5. More frequent urination, or in greater amounts than usual, with pale urine
6. Less frequent urination, or in smaller amounts than usual, with dark coloured urine
7. Blood in the urine
8. Pressure, or difficulty urinating
9. Unusual amounts of urination, usually in large quantities

(b). Muscle cramps (caused by low levels of calcium which can be associated with hyperphosphatemia)

(c). A build up of potassium in the blood that diseased kidneys cannot filter out (called hyperkalemia) may cause:

1.Abnormal heart rhythms
2. Muscle paralysis

(d). Failure of kidneys to remove excess fluid may cause:

1. Swelling of the legs, ankles, feet, face and/or hands
2. Shortness of breath due to extra fluid on the lungs (may also be caused by anemia)

(e) Healthy kidneys produce the hormone erythropoietin that stimulates the bone marrow to make oxygen-carrying red blood cells. As the kidneys fail, they produce less erythropoietin, resulting in decreased production of red blood cells to replace the natural breakdown of old red blood cells. As a result, the blood carries less hemoglobin, a condition known as anemia. This can result in:

1. Feeling tired and/or weak
2. Memory problems
3. Difficulty concentrating
4. Dizziness
5. Low blood pressure

In Tennessee, an Institutional Pharmacy setting, a prescription order that is ordered and administered before the pharmacist’s review; such order shall be reviewed by a pharmacist no later than 72 hours.

True or False

In Tennessee, an Institutional Pharmacy setting, a prescription order that is ordered and administered before the pharmacist’s review; such order shall be reviewed by a pharmacist no later than 72 hours.

False, [Rules of the Tennessee Board of Pharmacy 1140-4-.04].

A pharmacist shall review all prescription orders before the drug is first dispensed. In the event that medications available in the institutional facility are ordered and administered before the pharmacist’s review, the order shall be reviewed by a pharmacist in a timely manner (No time limit such as within 72 hours).

The pharmacist shall have access to the patient’s medical record.

The original order must be maintained in a readily retrievable manner according to the pharmacy practice site policy for at least two (2) years from the date of its issuance.

Which of the following pharmacies may perform a prospective drug review in a Centralized Processing System?

Which of the following pharmacies may perform a prospective drug review in a Centralized Processing System?

a. Central Processing Pharmacy
b. Central Fill Pharmacy
c. Dispensing Pharmacy
d. Intake Pharmacy

Answer: (a). Central Processing Pharmacy, [New Jersey Administrative Code 13:39 4.19].

The four component functions of handling a prescription in centralized processing system are intake, processing, fulfillment and dispensing.

Central prescription handling entails two or more licensed pharmacies sharing responsibility for performing the four component functions of handling a prescription.

The following pharmacies may engage in central prescription handling: an intake or originating pharmacy; a central processing pharmacy; a central fill pharmacy; and a dispensing pharmacy.

The four component functions of handling a prescription shall be performed by the following pharmacies:

1). An intake or originating pharmacy, which is a pharmacy that received the patient's or prescribing practitioner's request to fill or refill a prescription.

1A). A central processing pharmacy or a central fill pharmacy may be considered the intake or originating pharmacy if the prescription was transmitted by the prescribing practitioner directly to the centralized pharmacy or if the patient requested the refill from that pharmacy;

2). A central processing pharmacy, which is a pharmacy that engages in prescription review by performing functions that may include, but are not limited to, data entry, prospective drug review, refill authorizations, interventions, patient counseling, claims submission, claims resolution and adjudication;

3). A central fill pharmacy, which is a pharmacy engaging in central prescription handling by filling and/or refilling prescriptions, which includes the preparation and packaging of the medication; and

4). A dispensing pharmacy, which is a pharmacy that receives the processed prescription and/or the filled or refilled prescription for dispensing to the patient or to the patient's authorized representative and that offers patient counseling regarding the dispensed medication.

Hyperchloremic acidosis results from excessive loss of which of the following?

Hyperchloremic acidosis results from excessive loss of which of the following?

a. Water
b. Sodium bicarbonate
c. Lactic acid
d. Potassium

Answer: Sodium bicarbonate

Metabolic acidosis occurs when the body produces too much acid, or when the kidneys are not removing enough acid from the body.

There are several types of metabolic acidosis:

Diabetic acidosis (also called diabetic ketoacidosis and DKA) develops when substances known as ketone bodies, which are acidic, build up during uncontrolled type 1 diabetesHyperchloremic acidosis results from excessive loss of sodium bicarbonate from the body, as can happen with severe diarrhea.

Lactic acidosis is a buildup of lactic acid. It can be caused by:
Alcohol
Cancer
Exercising for a very long time
Liver failure
Low blood sugar (hypoglycemia)
Medications such as salicylates
Prolonged lack of oxygen from shock, heart failure, or severe anemia
Seizures

Other causes of metabolic acidosis include:

Kidney disease (distal tubular acidosis and proximal renal tubular acidosis), Poisoning by aspirin, ethylene glycol (found in antifreeze), or methanol Severe dehydration.