Section 1: Question 29, Answer Explanation is changed.

Carisoprodol (Soma) is a schedule II controlled drug under Louisiana Pharmacy Law.

Section 1: Question 24, Answer Explanation is changed.

The Michigan board of pharmacy is created in the department and shall consist of the following 11 voting members who shall meet the requirements of (part 161): 6 pharmacists, 5 public members. 4 public members and 1 pharmacy technician.

Following information is updated under Michigan State Pharmacy Law:

A prescriber can NOT prescribe a controlled and non-controlled substance on the same prescription form.

The following questions are affected in our quiz.

1. Section 1. Question 25

2. Section 3. Question 19

Section 2: Question 6, The entire question about "clinical thermometer" is replaced with a new question.

Section 2: Question 22, The entire question about "radiopharmaceuticals reference books" is replaced with a new question.

Section 3: Question 28, The entire question is replaced with a new question.

Section 4: Question 29, The explanation of the answer is changed.

For each pharmacist, dispensing prescriber, or veterinarian who does not have the capacity to forward the information by using electronic submission, the information shall be mailed or delivered to a location specified by the department or the department’s contractor at least twice monthly by the first calendar day and the 15th calendar day of the month following the month in which the prescription was dispensed.

The pharmacist, pharmacy, dispensing prescriber, or veterinarian may choose 2 different dates to report each month provided they are within 2 days of the first calendar day and the 15th calendar day of each month and they include all controlled substances dispensed since the previous transmission or report.

For each pharmacist, pharmacy, dispensing prescriber, or veterinarian who does not have the capacity to forward the information as specified in R 338.3162b, the information shall be mailed or delivered to a location specified by the department or the department’s contractor not later than 7 calendar days after the date that the controlled substance has been dispensed, and shall include the data for all controlled substances dispensed since the previous transmission or report.

Section 5: Question 30, The choice of the answer and explanation of the answer are changed.

Answer explanation is changed from:

OD (Optometrists): Schedule III to V controlled substances.

TO

OD (Optometrists): Schedule III to V controlled substances. Prescribe Schedule II Hydrocodone Products only.

Question choices are changed from:

I. Physicians assistant
II. Nurse practitioner
III.OptometristsEuthanasia Technicians

Section 4: Question 22, Answer Explanation and Answer choice are changed.

True False, [http://www.michigan.gov/lara/0,4601,7-154-35299_63294_27529_27548-66827--,00.html].

Every Pharmacist who is renewing his/her license should retain records documenting the completion of continuing education. All continuing education completion certificates or proof of attendance records must be kept for up to 1 year beyond the licensure period. If the license is good for 2 years, save your proofs for 3 years .

Section 1: Answer 21 Explanation is changed.

True, [Illinois Controlled Substances Act - Section 3100.400(a)].A pharmacist may fill a Schedule II controlled substance prescription upon a written or electronic prescription that conforms with the requirements of Section 311.5 or 312 of the Act, respectively. No triplicate or special prescription form is required for CII.

Section 2: Question 19, Answer choice(a) is changed from "The Department of Health" To "The Department of Financial and Professional Regulation ". 

I. The Department of Health The Department of Financial and Professional Regulation
II. The DEA
III. The State Board of Pharmacy

Section 2: Question 30, Answer choice(c) is changed from "Vicodin" To "Provigil". 

a. Ambien
b. Duragesic
c. Vicodin Provigil
d. Tylenol No. 3

Section 3: Question 16, Entire Question Is Changed.

Which of the following drugs is/are classified as Schedule III controlled drug(s)?

I. Fiorinal
II. Fioricet
III. Codeine

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

Answer:Both Fiorinal and Fioricet are classified as Schedule III drugs, [Illinois Controlled Substances Act - 720 ILCS 570 Section 208(3)(3.3) and section 811(g) (3) (A) of the Controlled Substances Act].

Illinois Regulation:

*Please Note: Under the Illinois State Pharmacy Law, Fioricet and Fiorinal are classified as Schedule III controlled drugs.

Illinois Controlled Substances Act - 720 ILCS 570 Section 208: Any substance which contains any quantity of a derivative of barbituric acid, or any salt thereof Butalbital.

Section 5: Question 4, Entire Question Is Changed.

Under Illinois, what changes may a pharmacist make to a prescription written for a controlled substance in schedule II after verbally consulting with a practitioner?

I. The name of the controlled substance
II. The dosage form of the drug
III. The quantity prescribed

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

Answer:II and III only, [Illinois Controlled Substances Act Section 3100.400(c)].

Changes in a Prescription:

1). A pharmacist may NOT change the following components of a prescription for a Schedule II controlled substance:

A). Date written, or add the date;
B). Name of the patient;
C). Name of the prescriber, or add a signature; and
D). Name of the drug.

2). Any other components of a prescription for a Schedule II controlled substance may be changed after consultation with the prescriber.

 Section 5: Question 14, Answer choice is changed from "False" To "True". The explanation is also changed.

True, [Illinois Controlled Substances Act - Section 3100.390(c)].

a). All prescriptions for controlled substances shall be dated as of, and signed on, the day when issued and shall bear the full name and address of the patient, the drug name, strength, dosage form, quantity prescribed, directions for use, and the name, address and DEA registration number of the practitioner.

b). A practitioner may sign a paper prescription in the same manner as he or she would sign a check or legal document (e.g., J.H. Smith or John H. Smith). When an oral order is not permitted, paper prescriptions shall be written with ink or printed and shall be manually signed by the practitioner.

A computer-generated prescription that is printed out or faxed by the practitioner must be manually signed.

c). A prescription may be prepared by the secretary or agent for the signature of a practitioner, but the prescribing practitioner is responsible in case the prescription does not conform in all essential respects to the Act and this Part.

A corresponding liability rests upon the pharmacist, including a pharmacist employed by a central fill pharmacy, who fills a prescription not prepared in the form required by this Part. Neither a pharmacist nor a pharmacy technician may act as an agent for a practitioner.

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.

Section 2: Answer 27 is changed from "False" To "True". 

False, True, [Alabama Administrative Code 680-x-2-.19 (2),(3)]]. 

All pharmacists engaged in compounding and dispensing of parenteral solutions, including cytoxic agents, shall register annually (not biennially) biennially with the Alabama State Board of Pharmacy which shall expire on December 31 of even-numbered years.

Pharmacists, who have not successfully completed a certifying course for parenteral pharmacists that have been approved by the Board, will not be registered as parenteral pharmacists with the Board until they have completed said certifying course.

Programs submitted for certification shall be a minimum of five (5) contact hours, including didactic and hands-on experience. All programs certified by the Board shall require a written exam as a part of the training.

Section 3: Question 2, Answer choice(a) is changed from "DEA registraton" To "PQRCC certificate". 

a. DEA registration PQRCC certificate
b. QACSC certificate
c. A physician's aggrement
d. ACC certificate

Section 1: Answer 2 is changed from "False" To "True". 

False, True, [New York State Laws and Regulations 63.6(a)(7) AND http://www.op.nysed.gov/prof/pharm/pharmelectrans.htm#cs]. 

Amendments to Title 10 NYCRR Part 80 Rules and Regulations on Controlled Substances have been adopted and became effective as final regulations on March 27, 2013. The amendments authorize a practitioner to issue an electronic prescription for controlled substances (EPCS) in Schedules II through V and allow a pharmacy to accept, annotate, dispense and electronically archive such prescriptions. 

The practitioner and pharmacy must use a certified software application that is consistent with all federal security requirements to process electronic prescriptions for controlled substances.

As of March 27, 2014 all prescriptions (including prescriptions for controlled substances) issued in New York State must be electronically transmitted, with certain limited exceptions. 

Section 5: Question 19 and Answer 19 are changed. Schedule II controlled Prescription Change...
What changes may a pharmacist make to a prescription written for a controlled substance in schedule II after verbally consulting with a practitioner?

I. The dosage form of the drug
II. The quantity prescribed
III. “Do not fill until” date.

a. I only
b. I and II only
c. II and III only
d. None of the above.

I and II only, [http://www.nh.gov/pharmacy/documents/cii-changes-nh-bop.pdf].

The Board of New Hampshire Pharmacy feels that hardship trickles down to the patient when a schedule II prescription order needs to be adjusted. At the January 2012 Board of Pharmacy meeting, a consensus was reached to develop a policy statement clarifying this issue for pharmacists.

In order to facilitate patient care, the pharmacist can make certain changes to a valid schedule II prescription, only after consulting with the prescriber. After contacting the prescriber and documenting the changes, the pharmacist can change the:

1. Patient’s address;
2. Drug strength;
3. Drug quantity;
4. Directions for use;
5. Dosage form.

The prescription can then be filled with the documented changes, and the prescribing practitioner does not need to send a new hard copy. The pharmacist and prescriber should document the date of the conversation and the changes to the prescription as a record of the conversation.

In certain cases, the Board ruled that some changes challenge the necessity of the original prescription and would require a new prescription from the prescribing practitioner. Therefore, the pharmacist is never permitted to change the:

1. Patient’s name;
2. Controlled substance(s) prescribed;
3. Prescriber’s signature;
4. “Do not fill until” date.

In these cases the pharmacist must receive a new hardcopy of the prescription reflecting the changes. This policy statement is set forth to expedite the process of correcting minor changes to a schedule II prescription, and to optimize patient care.

Section 1: Answer 4 is changed.

I and II only, All, [New Jersey Administrative Code 13:39-7.9(a) and (b)].

Section 1: Explanation 29 is changed.

Hydrocodone and isoquinoline alkaloid, Hydrocodone combination product (Tussionex, Tussend, Lortab, Vicodin, Hycodan, Anexsia) are now added to Schedule II controlled substances.

Section 2: Explanation 4 is changed.

Hydrocodone and isoquinoline alkaloid, Hydrocodone combination product (Tussionex, Tussend, Lortab, Vicodin, Hycodan, Anexsia) are REMOVED from Schedule III controlled substances.

Section 2: Question 16 is replaced.

Bill's father comes to your pharmacy and asks for the medication records of his son who is a minor. The pharmacist gives him the medication records of his son. The pharmacist was in accordance with the state pharmacy law.

Section 2: Explanation 16 is replaced. True. According to HIPAA, a healthcare provider cannot disclose medication records or the history of patients without prior approval of patients or otherwise permitted by the law. The only exception under this law is when the patient is designated a minor by the court [Public Law 104-191].

Question 16: A prescription for Codeine may be issued by a physician who is licensed to practice medicine and registered in Maine. A registered pharmacist in Massachusetts may fill such prescription.

Explanation 16: True, [M.G.L Chapter 94C, Section 18(d1/2)].

A prescription for a narcotic substance contained in Schedule II of section 3 may also be issued by a physician who is licensed to practice medicine and registered in Maine or in a state contiguous with the commonwealth wherein such physician resides or practices, if required, and registered under federal law to write prescriptions.

A registered pharmacist filling a prescription under this subsection shall determine, in accordance with professional standards and personal judgment, that such prescription is authentic and valid and shall verify the prescription by telephonic or other means.

A pharmacist shall not fill a prescription for which verification cannot be obtained.

A pharmacist shall not be liable for refusing to fill a prescription for which verification cannot be obtained provided that documented good faith efforts were made to determine the authenticity and validity of such prescription.

This subsection shall only apply to authorizations for the filling of prescriptions within the commonwealth, issued within the preceding 5 days.

In the case of a prescription for a Schedule II substance filled pursuant to this subsection, a pharmacist shall, within 30 days after filling such prescription, deliver to the department a copy of each such Schedule II prescription; provided, however, that such copy shall not include the name and address of the patient for whom the prescription was issued; and provided further, that such copy and the information contained therein shall not be a public record.

Nothing in this section shall authorize a mail-order pharmacy.

Section 2: Question 20 is changed.

An oral prescription for Vicodin Tylenol No.3 must be mailed to dispensing pharmacy by an authorized prescriber within:

Drug Enforcement Administration (DEA) has published its final rule rescheduling hydrocodone combination products from Schedule III to Schedule II in the Federal Register. The change imposes Schedule II regulatory controls and sanctions on anyone handling hydrocodone combination products, effective October 6, 2014.

DEA first published the proposed rules in March 2014, in response to a Food and Drug Administration recommendation.

DEA received almost 600 public comments regarding the proposed rules after they were published, with a small majority of the commenters supporting the change, a DEA press release notes.