A tech notices that his pharmacy owner has been selling large quantities of controlled drugs to the  doctor office down the street. He estimates that the sales of controlled drugs represent about 25% of the store's monthly drug volume. Is this permissible under California Law?

1. Sales of controlled substances to other pharmacies or prescribers is acceptable if it is kept under 25% of the total of the controlled substance sales per year.
2. Sales of controlled substances to other pharmacies or prescribers is acceptable if it is kept under 20% of the total of the controlled substance sales per year.
3. Sales of controlled substances to other pharmacies or prescribers is acceptable if it is kept under 5% of the total of the controlled substance sales per year.
4. Pharmacies are not allowed to sell controlled substances to prescriber's offices.
5. Pharmacies are not allowed to sell any drugs, controlled or non-controlled, to prescriber's offices.

Answer: C. Remember the 5% rule, the sale of C.S must not exceed 5% of the total C.S. the pharmacy dispenses.

 

 

The Caring Corner is a local skilled nursing facility for patients recovering from orthopedic surgery. It is equipped with an automated drug dispensing cabinet. According to California Law, the use of the ADC in a skilled nursing or transitional care must abide by the following regulations:

1. A pharmacist must have reviewed all medication orders and the patient's profile prior to drugs being removed for any patient.
2. The stocking of the automated drug delivery system must be done by a pharmacist.
3. If a pharmacist is not available, the medical director of the facility may fill the cabinet.
4. A and B only.
5. All of the above

Answer: D.

 

A pharmacist has just assumed Pharmacist In Charge position at where he works. He is planning to assign a staff pharmacist to conduct drug inventories. How often should the controlled substance inventory be taken? (Select the minimum required-)

1. The controlled substances inventory is completed twice a year.
2. The controlled substances inventory is completed annually.
3. The controlled substances inventory is completed biennially (every two years).
4. The controlled substances inventory must be taken when every new controlled drugs are received by the wholesaler.

Answer: C. If diversion is suspected, a change in PIC, or a newly scheduled C.S., the inventory can be taken sooner.

 

A 52 year old male with type 2 DM that is poorly managed with oral meds. His doctor recently started him on insulin. After administering his insulin, the patient would throw away the syringe and needle in his kitchen trash can. The patient claims he does not have money to purchase a sharp container. The patient lives alone and is free of any infectious diseases. Which of the following sharps disposal methods are acceptable?

1. Advise the patient to clip off the needle tip, collect the tips in a puncture-proof container, and discard the plastic syringes in the trash.
2. Advise patient to secure the needle and syringes in a cardboard milk carton or plastic bag before disposing in a trashcan.
3. Advise the patient to place used needles/syringes in a sturdy plastic container, such as a detergent bottle, before disposing in a trashcan.
4. Return used needles/syringes to the state DEA office.

Answer: C. The plastic container should be leak-resistant, puncture resistant, and properly labeled before disposing into a trashcan. A tight-fitting, puncture-proof lid should be used so that no sharps can come out. Do not recommend glass, which can break. Generally, pharmacists do not recommend clipping off the needle tip, but in select patients (no disease transmission risk, dexterity concerns) this is an acceptable option.

 

When a pharmacy compounds medications, it must come from reliable suppliers to ensure that the ingredients are not adulterated or mislabeled. The board requires each of the following to ensure quality ingredients except:

1. Use FDA licensed manufacturers, CA Department of Public Health-FDA licensed drug repackagers, or CA licensed pharmacies and wholesalers.
2. If receiving material from an out of state pharmacy or wholesaler, they should be licensed in California.
3. If chemicals are purchased from another country, the pharmacy should obtain a certificate issued by the FDA authorizing shipment of the product into the US and a certificate of analysis printed in English.
4. Any pharmacy that purchases, trades sells or transfers drugs to an entity not licensed by the board will be fined.
5. All of the above are accurate.

Answer: E. All these are common practice of compounding pharmacy to ensure safety.

 

Which of the following statements concerning therapeutic interchange are correct?

1. It is acceptable to change levofloxacin IV to PO in an inpatient setting (depending on the severity of infection and patient status, such as ability to take oral medications) because the doses are not equivalent, and IV medications are preferred for hospitalized patients.
2. It is acceptable to change linezolid IV to linezolid PO in an inpatient setting (depending on the severity of infection and patient status, such as ability to take oral medications) because the doses are not equivalent, and IV medications are preferred for hospitalized patients.
3. Therapeutic interchange involves collaboration between pharmacists and physicians or it will not be successful; after all, the pharmacist is changing what the physician ordered.
4. A, B and C.

Answer: D.

 

A pharmacist will initiate an automatic intravenous to oral conversion program at his hospital. He is designing a protocol that includes patient criteria that would meet the requirements. Which of the following conditions would prohibit a conversion from IV to oral medication?

1. Current sepsis or bacteremia
2. NPO status
3. Not in a critical care unit
4. Having a functional GI tract
5. A and B

Answer: E.  Prior to surgery patients will be NPO, and with some medical conditions.

 

A physician has written an order for Sonata, for a 72-year old female. Sonata is not on the hospital's formulary. The pharmacist will substitute the drug, according to the hospital's therapeutic interchange protocol. Which of the following medications are acceptable substitutions for this drug?

1. Zolpidem
2. Ambien CR
3. Temazepam
4. Dalmane, due to higher efficacy in elderly
5. Halcion, due to higher efficacy in elderly

Answer: A. Chose a drug that is from the same drug class. If you do have to choose a BZD for use in an elderly patient, the LOT agents are preferred. Halcion (triazolam) has a high-risk of daytime anxiety and is contraindicated with 3A4 inhibitors. Dalmane (flurazepam) has a long half life, lasts a long time and will put the patient at risk for fall.  Lorazepam and temazepam (L and T) are used for sleep, and oxazepam and lorazepam (O and L) are used for anxiety.

 

A physician has written an order for Neosporin ointment, which is not on the hospital's formulary. The pharmacist will substitute the drug, according to the hospital's therapeutic interchange protocol. Which of the following medications are acceptable substitutions for this drug?

1. Bacitracin and polymixin
2. A&D Ointment
3. Hydrocortisone 0.5%
4. Aldara
5. Silver saladene.

Answer: A. Neosporin (or triple antibiotic ointment) contains neosporin, bacitracin and polymixin. 

 

A physician has written an order for Micafungin (Mycamine) to treat a bloodstream candidiasis infection. Mycamine is not on the hospital's formulary. The pharmacist will substitute the drug, according to the hospital's therapeutic interchange protocol. Which of the following medications is an acceptable substitution for this drug?

1. Cancidas
2. Zosyn
3. Rocephin
4. Mucinex
5. Merrem

Answer: A The Echinocandins include: Capsofungin (Cancidas), Anidulafungin (Eraxis) 

 

The label of a compounded drug product must contain the following information except:

1. The generic names of the principle active ingredients.
2. Everything contained in a normal prescription label.
3. The container or receipt must contain a statement that the product has been compounded by the pharmacy. The active ingredient identifier number, such as a lot number.
4. The name and designation (RPh, MD, DO, etc.) of the person who wrote the formula.

Answer: D

 

Only pharmacies that are county-owned or  contract with the county may dispense medication donated to a drug repository and distribution program. Choose the correct statement about pharmacy  dispensing donated drugs:

1. The pharmacist cannot charge more than $1 per prescription for drugs that have been donated for low-income patients.
2. Controlled substances are permitted as part of a free drug distribution program; all controlled drug dispensing requirements apply.
3. The pharmacist cannot charge more than $5 per prescription for drugs that have been donated for low-income patients.
4. The medication that has been donated for the distribution program can be stored with the other medications; donated medications do not need to be separated from other drug stock.
5. The pharmacy that is distributing donated drugs to low-income patients must establish eligibility requirements, in policies and procedure document, for which medically indigent patients who may participate in the program.

Answer: E. C.Ss are not permitted in donated (free) drug program. The medications must be on a formulary. The patients (who are indigent, or very low income) cannot be charged. The donated drugs are kept separate from the rest of the inventory.

 

AB is a 36 year old female being treated at the local pain management clinic for chronic pain due to a knee injury back in 2014. She is considered a “frequent flyer” by the healthcare team. The physician suspects that the patient is using drugs prescribed outside of the Center and not abiding by her pain management contract. Select the correct statements regarding the Controlled Substance Utilization Review and Evaluation System (CURES) reports:   

1.  CURES data is submitted by prescribers and pharmacists on a monthly basis. 
2.  Physicians and pharmacists can run reports on a patient’s scheduled drug use. 
3. CURES submissions include all C II, III,  IV and V drugs. 
4. CURES can be used as a valuable tool to detect illicit drug use.

Answer: B. CURES data is submitted weekly for C II-IV drugs. The purpose is to keep track of the controlled drugs patients are receiving. However, any illicit drug use will not be on the CURES report.

 

A pharmacy gets a transfer call from a friend who is a retired pharmacist and recently closed his store. The pharmacist keeps the records in his home, and is calling the pharmacy at the request of the patient.. The medication is for lisinopril 10 mg,  once daily in the morning. The patient has a blood pressure today (recorded in your store) of 150/88 mmHg. What action should the pharmacist take who is receiving the prescription?

1. Contact the board of pharmacy.
2. Contact the pharmacist and tell him to bring in the prescription in person; the record cannot be transmitted over the phone as the pharmacy sending the prescription is no longer in business.
3. Tell the patient to report the pharmacist (from the previous store) to the prescriber.
4. Tell the patient they no longer need blood pressure medication.
5. None of the above.

Answer: A. A prescription cannot be transferred from a store that is no longer in business. Anytime a pharmacist is doubting the legality of an action, or if they know that the action is not compliant to board policies, the Board should be contacted.

 

Pharmacist Provider Status legislation, is made into California law in the fall of 2013. The legislation expands the ability of all pharmacists to perform the following duties:   

I) Furnish NuvaRing pursuant to a statewide protocol. 

II) Administer injectable biologic therapies when ordered by a prescriber. 

III) Independently initiate and administer Engerix-B to a 6 month old infant if certain training, certification, recordkeeping, and reporting requirements are met. 

IV) Perform patient assessments.

1. I and II
2. II and III
3. III and IV
4. I and IV
5. I and III

Answer: A. Under SB 493, pharmacists can perform patient assessments, can order and interpret laboratory tests to monitor patient progress, can adjust a patient's prescription when necessary and medically appropriate and can discontinue medications that are duplicative, unnecessary, or life-threatening to a patient. Patient assessments can be made by Advanced Practice Pharmacists.

 

A man comes into the pharmacy buying syringes and needles to administer NPH insulin to his dog. His dog has elevated blood glucose and the veterinarian has recommended the insulin. The man is a regular customer of the pharmacy, he often shops and picks up his medication refills at the store. Which of the following statements are correct? 

I) The pharmacist or veterinarian can provide needles and syringes to the pet owner for animal use.

II) The man can purchase the insulin from the pharmacy without a prescription. 

III) This type of insulin requires a prescription.

1. I only
2. II only
3. I and II
4. II and III
5. I, II, and III

Answer: C. Syr can be provided to person Rph knows need (insulin users or for animal). A MD or pharmD can furnish unlimited syringes, for 18 yo+, to prevent spread of STD.

 

Who is allowed to have a key to the secured pharmacy area?

1. Licensed pharmacists
2. Licensed interns
3. Store managers
4. A and C

Answer: A

 

KT is a 17-year-old female patient who comes into the pharmacy asking for “empty syringes.” She does not have a prescription and is not a patient at this pharmacy. The pharmacist notices track marks on the patient’s arms. Can the pharmacist sell syringes to this patient?

1. Yes, this is permitted to reduce the risk of infectious disease spread
2. Yes, but there is a limit of 10 syringes
3. Yes, but there is a limit of 30 syringes
4. Yes, but there is a limit of 100 syringes
5. No

Answer: E. The patient must be 18 years or older to purchase syringes without known human, animal or industrial use. The patient is too young to receive syringes without a prescription and should be referred to a free service at the local public health agency. As of  2015 there is no longer a limit on the number of syringes can be dispensed for disease prevention purposes.

 

AB is a 37-year-old female who comes into the local pharmacy asking for a refill on the Lyrica she has been taking for the past several years. The pharmacist realizes that the prescriber, Dr. Thomas Green, is now deceased. The patient has four refills remaining. Can the pharmacist fill the Lyrica?

1. Yes, but no longer than 6 months from the date the prescription was written.
2. No, the prescription is no longer valid once the prescriber is deceased.
3. Yes, but no longer than 12 months from the date the prescription was written.
4. No, because the drug the patient requires is scheduled.
5. Yes, it is acceptable since there is a new physician at the practice.

Answer: A. The pharmacist should encourage the patient to look for a new prescriber as soon as possible and not to wait until the prescription is expired or the refills are exhausted.

 

A patient on a medical unit was administered methylprednisolone 20 mg IV Q12H for an asthma exacerbation.  Which of the following were likely caused by the steroid injection?   

1. Hyperglycemia 
2. Insomnia 

III. Leukopenia 

1. Low blood pressure
2. I and II
3. II and III
4. I, II and III
5. I, II and IV
6. I, III and IV

Answer: On your own to find out.

 

Prescriptions for the following drugs would need to be reported to the Controlled Substance Utilization Review and Evaluation System (CURES) online database:   

I) Lyrica 

II) Vyvanse 

III) Suboxone 

IV) Provigil

1. I, II, and IV
2. II, III, and IV
3. II and IV
4. I and IV
5. EII and III

Answer: B. Lyrica is schedule V, and does not need to be reported to CURES.

 

When dispensing non-prescription needles and syringes for disease prevention purposes, the pharmacist must provide the following information:   

I) How to access treatment for drug abuse. 

II) How to access services for testing and treatment for HIV and hepatitis C. 

III) Information on safe sexual practice.

1. I only
2. II only
3. I and II
4. II and III
5. I, II, and III

Answer: C. The pharmacy must also provide information on how to safely dispose of sharps waste.

 

Each of the following statements concerning the Board of Pharmacy are correct except:

1. There is one executive officer, who is a paid employee of the Board.
2. The Board has 13 members, 11 of whom are appointed by the governor.
3. Board members receive continuing education credits for attending board meetings. Pharmacists (outside of the Board) who attend a full day do not receive CE, but this is considered good practice.
4. Pharmacy inspectors work for the Board and inspect pharmacies to make sure they are board-compliant.
5. Seven of the board members are pharmacists.

Answer:  C. CE hours may be earned by pharmacists who is not a board member, board members are not eligible  to receive this CE credit. A pharmacist may acquire 6 CE hours once a year by attending one full day of the Board's meetings.

 

Naturopathic doctors (NDs) can write for scheduled III-V under protocol, and can write for natural and synthetic hormones and for epinephrine independently if they have received proper training. A pharmacist received a prescription for Armour Thyroid written by a naturopathic doctor. The pharmacist will check the license number to see if this ND can write for this drug. Of the license numbers below, which one is acceptable for an ND to issue prescriptions for this drug?

1. N500
2. ND695
3. NDF371
4. NDX346
5. NDC346

Answer: C. For a naturopathic doctor to write a prescription, the letters NDF will precede the license number.

 

Amiodarone is a class III antiarrhythmic. All of the following are boxed warnings with the use of amiodarone EXCEPT:

1. Exacerbation of arrhythmias
2. Pulmonary toxicity
3.  Liver toxicity
4. Renal Toxicity

Answer: C. Many organ toxicities can occur except renal.

 

which class of HIV medications has the most significant risk for lactic acidosis?

1. Protease inhibitors
2. Nucleoside/tide reverse transcriptase inhibitors (NRTI)
3. Non-nucleoside reverse transcriptase inhibitors (NNRI)
4. CCR5 Antagonists
5. Fusion Inhibitors

Answer:  B. although this is rare and is more likely with the presence of co-morbid conditions. If lactic acidosis happens the fatality is high.

 

Which statements concerning vancomycin monitoring are correct?

1. A patient who has a diabetic foot infection that has gone into the bone and is MRSA-positive will require a vancomycin trough level of 15-20 mcg/mL.
2. A patient who has MRSA bacteremia will require a vancomycin trough level of 15-20 mcg/mL.
3. III. A patient with septic arthritis who is receiving vancomycin and ceftriaxone will require a vancomycin trough level of 10-15 mcg/mL.
4. If intravenous vancomycin cannot be tolerated, oral vancomycin is an acceptable option for systemic infections if not moderate or severe

Answer: Your chance to practice. 

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