What are the three situations where a faxed C-II can be used as the Original Rx?
- C-II injectable
- C-II for LTCF
- C-II for hospice
Are C-III, IV, V prescriptions allow to be kept as the original prescription?
- Yes, these can be used as the original
What are the Electronic Prescription transfer requirements?
- Can be transfered, even if they havent been filled
- C-III, IV, V can only be transfer after filled ONCE
- C-II CANNOT be transfered
What is important to understand about pharmacies that share a real time database and transfering?
- Transfer up to max refills; can continue transfering until refills are out
Like Payless and Kroger
What is some of the information that you must have for a transfering prescription?
- OG date issued [not if electronic]
- OG refills [not if electronic]
- OG date dispened
- # of vaild refills, dates, locations
- Pharmacy name, address, DEA #, Rx # [transfered & OG filled]
- Pharmacist Name
Controls NEED to be fill once before tranfering
Non-Controls do not have a cap of transferings
What is detoxification and Maintenacne?
- Detox: Narcotic Drug in decreasing doses to get to drug-free state
- Maintain: On stable dose of Narcotic for 180 days
Narcotic: Drugs that contain opium or opiates
Should a prescription be used for detoxification and/or maintainance?
- NO, unless the Rx is C-III, IV, V & approved by FDA FOR maintiance or detox
What is the first exception [about NTP/OTP] to maintenacne and detoxification?
- Dr. registered with NTP/OTP; this allows Dr. to administer or dispense, NOT PRESCRIBE for maintain/detox
Normallly called methadone clinics
What is the second exception [offices] to maintenance and detoxifications?
- Dr. can NOT PRESCRIBE from office with a 3 day supply to start maintain/detox
- ONE-AND-DONE
What is the third exception [hospitalized] to maintenacne and detoxification?
- Patient MUST due to an outside of substance use disorder; i.e: heart attack, accident, etc
- Pharmacist can deliver controls to Dr. Office; Rx CANNOT say Office Use
What is the final exception [DEA Approval] for maintenance and detoxification?
- Use C-III, IV, V that are APPROVED by DEA for maintenacne and detox
- ONLY buprenorphine/naloxone used for Opioid Use Disorder
What is the two ways that pharmacies are able distribute to other registrants?
- Other registrant WANTS to dispense to patient [needs DEA registration to dispense & pharmacy records distribution]
- Sending drugs to Reverse Distributor [Reverse sends 222 to pharmacy]
What are the four ways to dispose of controlled substances?
- On-site destruciton
- Reverse Distributors
- Sending back to distributor
- Local DEA office (ONLY done by practioners)
What DEA forms should be used for destructions and what should be on it?
- DEA Form 41
- NEEDS: Registrant info, Inventory Info, Method of Destruction, Witnesses
What is the DEA Form that is used for Theft or Significant Loss?
- DEA Form 106
MUST Report within 45 days of discovery
After a thief, do you need to report it?
- Yes; doesnt matter if it was 5000 units or 1 unit
After losses, do you need to report it?
- ONLY significant losses; which vary for each registration type
What are the six things to determine if a loss is significant?
- Actual quantity lost [based on type of business]
- Specfic control lost
- Loss assoicated with access
- Patterns of loss over time [Random]
- Controlls are candidates
- Local Trands
Practice Question 1
A prescriber can prescribe methadone for the maintenance of a substance used disorder to a patient previously enrolled in a narcotic treatment program?
a. True
b. False
- b. False
Practice Question 2
A patient is admitted to the hospital after a MVA. They’re currently enrolled in a narcotic treatment program for herion additcion and are on a stable methadone dose for maintenance. The resident overseeing the patient is frantic because the hospital lacks an OTP or NTP prescriber. They come to you asking how to switch the patient to suboxone because they know that works for maintenance too. What is the most reasonable respsonse?
a. Can maintain the patient on current methadone dose from the NTP, no issue present.
b. Cannot maintain the patient in the hospital with any product
c. Can switch the patient to suboxone in a 40mg methadone to 8mg buprenorphine ratio without consultation with the NTP provider
d. Can maintain the patient on methadone if a nurse goes to get the dose from the NTP clinic every day
e. Cannot maintain the patient in the hospital without the NTP having privileges. Must talk to hospital administration
- a. Can maintain the patient on current methadone dose from the NTP, no issue present.
Practice Questoin 3
Select all of the following forms that must be used when destorying ketamine products
a. 41
b. 106
c. 222
d. 224
e 363
- a. 41
Practice Question 4
Which of the following is true about controlled substance transfers?
a. Can be completed by a technician or pharmact
b. Adderall prescription can only be transferred if they were partially filled first
c. Can only be transferred one time between pharmacies with a shared database
d. Alprazolam prescriptions can only be transderred if they’ve never been filled and are on hold at the pharmacy
e. Tramadol prescription can only be transferred if the prescription is in date with refills reminaing
- e. Tramadol prescription can only be transferred if the prescription is in date with refills reminaing
Practice Question 5
Based on their schedule, select all of the following products that can always be faxed to the pharmacy and the fax used as the original
a. Codeine
b. Codeine/Acetaminophen
c. Codeine/Guaifenesin
d. Diazepam
e. Ketamine
- B, C, D, E
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Reading 118
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Reading 228
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Reading 330
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Reading 430
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Reading 532
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Reading 626
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Reading 737
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Reading 818
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Reading 921
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Reading 1033
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Reading 1118
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Reading 1228
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Reading 1323
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Reading 1419
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Reading 1531
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Reading 1628
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Reading 17/18 (IC 25-26)61
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Reading 19/20 (IAC)55
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Reading 21 (IC, IAC 2, IAC 4, IAC 5, IAC 7, Hormonal Contraceptive Prescribing)12
