Law Exam multiple choice

Activities for pharmacists

(1) A pharmacist's primary responsibility is to ensure patients receive safe and appropriate medication therapy. (2) A pharmacist shall not delegate the following professional responsibilities: (a) Receipt of a verbal prescription other than refill authorization from a prescriber. (b) Consultation with the patient regarding the prescription, both prior to and after the prescription filling and/or regarding any information contained in a patient medication record system provided that this shall not prohibit pharmacy ancillary personnel from providing to the patient or the patient's health care giver certain information where no professional judgment is required such as dates of refills or prescription price information. (c) Consultation with the prescriber regarding the patient and the patient's prescription. (d) Extemporaneous compounding of the prescription, however, bulk compounding from a formula and IV admixture products prepared in accordance with chapter 246-871 WAC may be performed by a pharmacy technician when supervised by a pharmacist. (e) Interpretation of data in a patient medication record system. (f) Ultimate responsibility for all aspects of the completed prescription and assumption of the responsibility for the filled prescription, such as: Accuracy of drug, strength, labeling, proper container and other requirements. (g) Dispense prescriptions to patient with proper patient information as required by WAC 246-869-220. (h) Signing of the poison register and the Schedule V controlled substance registry book at the time of sale in accordance with RCW 69.38.030 and WAC 246-887-030 and any other item required by law, rule or regulation to be signed or initialed by a pharmacist. (i) Professional communications with physicians, dentists, nurses and other health care practitioners. (j) Decision to not dispense lawfully prescribed drugs or devices or to not distribute drugs and devices approved by the U.S. Food and Drug Administration for restricted distribution by pharmacies. (3) Utilizing personnel to assist the pharmacist. (a) The responsible pharmacist manager shall retain all professional and personal responsibility for any assisted tasks performed by personnel under his or her responsibility, as shall the pharmacy employing such personnel. The responsible pharmacist manager shall determine the extent to which personnel may be utilized to assist the pharmacist and shall assure that the pharmacist is fulfilling his or her supervisory and professional responsibilities. (b) This does not preclude delegation to an intern or extern. (4) It is considered unprofessional conduct for any person authorized to practice or assist in the practice of pharmacy to engage in any of the following: (a) Destroy unfilled lawful prescription; (b) Refuse to return unfilled lawful prescriptions; (c) Violate a patient's privacy; (d) Discriminate against patients or their agent in a manner prohibited by state or federal laws; and (e) Intimidate or harass a patient.

According to WAC 246-904-030: Pharmacist in charge, all of the following are responsibilities of the pharmacist in charge except

(1) To create and implement policy and procedures relating to: (a) Purchasing, ordering, storing, compounding, delivering, dispensing or administering of controlled substances or legend drugs. (b) Accuracy of inventory records, patient medical records as related to the administration of controlled substances and legend drugs, and any other records required to be kept by state and federal regulations. (c) Adequate security of legend drugs and controlled substances. (d) Controlling access to controlled substances and legend drugs. (2) To assure that the Washington state board of pharmacy is in possession of all current policies and procedures identified in subsection (1) of this section. (3) To execute all forms for the purchase and order of legend drugs and controlled substances. (4) To verify receipt of all legend drugs and controlled substances purchased and ordered by the health care facility.

A CDTA is considered valid and effective when

- Agreement between prescriber and pharmacist - Must be an ACTIVE prescriber and in their scope of practice - Must be within 2 years - Must contain list of diseases and drugs - Prescribing protocol- modification or initiation of therapy - Must be procedure, decision criteria, plans RPH follow to make therapeutic decisions - agreement document must be on file in PQAC and practicing location For multiple prescribers signing the CDTA: No new agreement At least one prescriber remains with full delegated authority. Adding/Subtracting pharmacists New agreement required → change in scope/delegation of prescriber if no other prescriber has that delegated authority. Expiration date of CDTA does not change with the addition/deletion of pharmacists. WAC 246-863-100(b): A time period not to exceed 2 years during which the written guideline/protocol will be in effect. WAC 246-863-100: Collaborative Drug Therapy Agreement Process A CDTA is permitted to include a single pharmacist or a group of pharmacists exercising prescriptive authority under the delegation of a practitioner authorized to prescribe. Authorizing prescriber determines needed number of pharmacists that can prescribe on his/her behalf. Authorizing prescriber determines scope of practice delegated and shall set any limitations of the prescribing that has been delegated. Upon filing the CDTA with the PQAC, each pharmacist will be assigned a unique CDTA identifier. A CDTA: Shall be continually updated to reflect all current pharmacist(s) covered by the agreement. Includes additions and deletions of pharmacist(s). Change in authorizing prescriber → new CDTA filed

What complies with both employee duties and employee rights and duties

- cooperate with OSHA inspection

Employee rights and duties

- non-discrimination/retaliation -report hazardous conditions to a supervisor -report hazardous conditions to OSHA, if employers do not fix them - follow the employer's safety and health rules and wear or use all required gear and equipment -cooperate with OSHA inspectors -Although employees have duty to comply with the law, although there are no fines or sanctions for disobedient employees

intellectual properties

- suppliers, customer list -

As a new pharmacist you join a CDTA that has been in effect for 18 months. Now that you are part of that CDTA, it expires

-2 years of prescriptive authority granted by practitioner (with written guideline or protocol indicating approval) -expiration date of CDTA does not change with addition or deletion of pharmacists -Expires in 6 months (since it has been in effect for 18 months already; 6 months remaining)

Ex of discrimination law

-Federal +Title 7 for 15<x employees +Age discrimination +equal pay act +americans with disabilities act +genetic information notification act +civil right laws -State +Law against discrimination (WLAD) include sexual preference and 8<x employees +Seattle Human Rights Ordinance

Employer duties

-General duty clause -specific standards -cooperate with OSHA inspections -Recordkeeping including ee access

Cal, a 45 year-old male is brought to the hospital by ambulance after skydiving accident near Issaquah. Cal is not married but he has twin 16 year-old daughters. Cal's parents still live on 1516543 Pharmacy Laws & Ethics Midterm 3 - Question Stems & Instructions Page 2 Tiger Mountain as does Cal's older brother who is a physician. Cal has been meaning to make his brother his durable power of attorney for health care but he hasn't completed the paperwork yet. When Cal is unconscious after his accident, who has priority for giving informed consent for Cal?

-Twin 16 yr old daughters not "competent" -Cal older brother is not officially made his durable power of attorney - Oder of priority Legal guardian> durable power of attorney for health care> spouse/state-registered partner> adult children> parents> adult brothers and sisters Answer: parents

For a prescription for life-ending drugs to be valid under the Washington State Death with Dignity Act, which of the following is necessary?

-WA resident - verified by 2 physicians to be mentally stable - patient make request w/o coercion and requests must be 15 days apart - patient was informed of other options - 48 hours between written request and writing of RX - request signed by 2 witnesses

For a prescription for life-ending drugs to be valid under the Washington State Death with Dignity Act, which of the following is necessary?

-WA resident -mentally competent, verified by 2 physicians -Less than or equal to 6 months left to live, verified by 2 physicians -patient makes requests without coercion, verified by 2 physicians -minimum 15 day waiting period from first oral request to second oral request -patient must be informed of other options -may change mind at any time -minimum 48 hours waiting period between written request and writing of RX -written request signed by at least 2 witnesses -patient may change their mind at any time RCW 70.245.04-- Attending must contact pharmacist, inform pharmacist of Rx, and deliver Rx personally by mail or fax Drugs can't be dispensed by mail or courier- can dispense to patient, attending MD, identified agent of patient

Ex of employee protections

-Wage and Hour law -Worker's Comp -Health and safety

4 types of Workplace laws

-labor management relations -discrimination law -employee protections -Common Law

Title 7

-main source of protection from discrimination -protect on basis of race, color, sex, national origin, religion -cover hiring, firing, wages, terms and condition of employment -enforced by EEOC-equal employment opportunity commission -might have 180 or 300days (criminal cases) to report

Americans with Disabilities Act (ADA)

-prohibit discrimination against americans with disabilities - Def: actual impairment, record of an impairment, or perception of having an impairment- must be otherwise qualified - employer has a DUTY TO ACCOMMODATE unless undue hardship or direct threat -covers drugs and alcoholic in rehabs but not current users -cover HIV -doesn't cover drug testing -individual (employee) must advise of disability and seek accommodation - orally, need not be written - say I need help with a medical condition

Ex of Common Law

-wrongful discharge -intellectual property -employment contract

How should a prescription with the SIG "I po sid" for an animal patient be interpreted?

1 PO once daily

GINA: genetic information notification act- employee screening and genetics

ER with 15 or more employees are barred from base hiring and other employment decisions on genetic information -cannot increase or deny coverage based on genetic testing

Genetic information

Information about -individual's genetic tests -genetic tests of family members of such individuals -manifestation of a disease or disorder in family members of such individual

According to WAC 246-904-030: Pharmacist in charge, all of the following are responsibilities of the pharmacist in charge except

It shall be the responsibility of the pharmacist in charge: (1) To create and implement policy and procedures relating to: (a) Purchasing, ordering, storing, compounding, delivering, dispensing or administering of controlled substances or legend drugs. (b) Accuracy of inventory records, patient medical records as related to the administration of controlled substances and legend drugs, and any other records required to be kept by state and federal regulations. (c) Adequate security of legend drugs and controlled substances. (d) Controlling access to controlled substances and legend drugs. (2) To assure that the Washington state board of pharmacy is in possession of all current policies and procedures identified in subsection (1) of this section. (3) To execute all forms for the purchase and order of legend drugs and controlled substances. (4) To verify receipt of all legend drugs and controlled substances purchased and ordered by the health care facility.

Under Washington law, if a pharmacist chooses to participate in the Death with Dignity Act and dispense such drugs under a valid prescription, the pharmacist may NOT dispense the drugs to which of the following

MAY dispense to -patient -attending MD -expressly identified agent of patient -can't be dispensed by mail or courier

Jimmy, a minor, lives in Republic, Washington, learns that he must be AT LEAST _______ years old to consent to treatment for genital herpes. His sister Jane may be ________ years old to consent to an abortion.

Minors -14 years to consent treatment of STD w/o parental consent -13 years for outpatient chemical dependency -13 years for inpatient/outpatient mental health -any age for reproductive health, birth control, abortion For Jimmy- at least 14 years of age For Jane- at any age

Can a pharmacist delegate the receipt of a verbal new prescription from a prescriber?

No WAC 246-863-095 Receipt of a verbal prescription other than refill authorization from a prescriber.

If you don't know the dosing for an animal, can you use weight based human dosing instead?

No use suitable veterinary reference

When compounding a medication for a pet, which common compounding ingredient should be avoided due to toxicity concerns for the animal?

No xylitol for pets and gabapentin feline - APAP because no UGT canine - Ivermectin if species susceptible to P-gp knockout (MDR-1 gene deletion; MDR codes for P-gp) Never recommend NSAIDs without approval of veterinarian

Chart format: Mark ALL who may complete the following activities in a pharmacy. (Choose from pharmacist, pharmacy technician, and pharmacy assistant, intern, PIC)

Pharm intern: no rules guiding when an intern can do which functions WAC 246-858-040 "the pharmacy intern shall engage in the practice of pharmacy...under the direct and personal supervision of a certified preceptor or a licensed pharmacist..."

Chart format: Mark ALL who may complete the following activities in a pharmacy. (Choose from pharmacist, pharmacy technician, and pharmacy assistant, intern, PIC)

Pharm tech: RCW 18.64.030 "...manipulative nondiscretionary functions associated with the practice of pharmacy..." WAC 246-901-020 "entry of a new medication order into the pharmacy computer system and retrieval of a drug product to fill a prescription are tasks reserved to the pharmacist and pharmacy technician"

A pharmacist can delegate which of the following:

Pharmacist CANNOT delegate -Receipt of a verbal prescription (refill authorization is allowed) -Consultation with the patient regarding their Rx -Consultation with the prescriber regarding the patient/patient's Rx -Extemporaneous compounding (bulk compounding from formula allowed) -interpretation of data in patient medication record system -responsibility for all aspects of completed Rx -Dispensing Rx to patient with proper information -Any documentation that must be signed by the pharmacist -Professional consultation with any health care provider -Decision not to dispense

Who is ultimately in charge of REMS registration?

Pharmacist in charge

[probably chart format] Who are the necessary parties for an effective CDTA and what are their roles?

Physicians- -in active practice -authority granted must be in prescribers scope of practice -statement of what type of prescriptive authority the pharmacist is authorized to make Pharmacist- initiate or modify drug therapy based on approval granted by practitioner authorized to prescribe, with a written guideline or protocol PQAC

Chart format: Mark ALL who may complete the following activities in a pharmacy. (Choose from pharmacist, pharmacy technician, and pharmacy assistant, intern, PIC)

RCW 18.64.030 "...duties including but not limited to, typing of prescription labels, filing, refiling, bookkeeping, pricing, stocking, delivering, nonprofessional phone inquiries, and documentation of third party reimbursements..." WAC 246-091-070 Pharmacy assistants may: prepackage and label drugs for subsequent use in prescription dispensing operations count, pour, and label for individual prescriptions

Which of the following CANNOT be delegated to a pharmacist intern?

Rules for Pharmacy Interns (WAC 246-858-040) The pharmacy intern shall engage in the practice of pharmacy only while the intern is under the direct and personal supervision of a certified preceptor or a licensed pharmacist designated by the preceptor to supervise that intern during the preceptor's absence from the site. No rules: Guiding when an intern can do which functions (i.e. which year in school P1-P4) or Specific intern training requirements

Laws governing safety in the workplace can be found in

State Law - Worker's compensation - WISHA (Washington Industrial Safety and Health Act) - Section 18 Plan under OSHA (occupational safety & health admin) Federal Law -OSHA-occupational safety and health admin.

To whom must a pharmacy manager report his/her termination of employment?

State board of pharmacy WAC 246-863-060 Licensed Pharmacists and employers

Which of the following is FALSE concerning animal compounding?

True: - xylitol is toxic to pets and must be avoided (this is true for gabapentin) - published "recipes" are available but not tested for stability and absorption - pharmacist can prepare: chewable tabs, topical paste (for cats to lick), topical gel (to apply to the inside of the outer ear). For get, isolate pet for at least an hour - cats: cod liver oil, fish, chicken, avoid sweet flavors - dogs: sweet, meat, almost anything -federal extra-label drug use regulation to permit compounding from FDA approved drugs when a vet believe there is a need to alter approved drug to medicate non-food animal w/ diagnosed medical condition -Must be established Vet-Client-Patient relationship (VCPR) - no duplication of existing products. Cost is not a reason for compounding from bulk ingredients - Not legal for vet to dispense med previously compounded by a pharmacy to leave the vet practice with client. - Using compounded drug in food animal is reserved if there is no other choice in treating animals' medical condition and safe use of the animal for human food purposes when animal discontinues of the drug

Which diagnostic element is required for invoking Washington's Death with Dignity Act

WA resident -Mentally competent, verified by 2 physicians -Patient must have equal or less than 6 months to live, verified by 2 physicians - Make requests, without coercion by 2 physicians informed of other decisions

In Washington State to be a preceptor a pharmacist must be in practice for one year, to be a pharmacist in charge a pharmacist must only be licensed.

WAC 246-904-030 ...The pharmacist in charge must be licensed to practice pharmacy in the state of Washington... WAC 246-858-060 (2) The pharmacist preceptor must have completed 12 months as a licensed pharmacist engaged in the practice of pharmacy as defined in RCW 18.64.011

Chart format: Mark ALL who may complete the following activities in a pharmacy. (Choose from pharmacist, pharmacy technician, and pharmacy assistant, intern, PIC)

WAC 246-904-030 It shall be the responsibility of the pharmacist in charge: (1) To create and implement policy and procedures relating to: (a) Purchasing, ordering, storing, compounding, delivering, dispensing or administering of controlled substances or legend drugs. (b) Accuracy of inventory records, patient medical records as related to the administration of controlled substances and legend drugs, and any other records required to be kept by state and federal regulations. (c) Adequate security of legend drugs and controlled substances. (d) Controlling access to controlled substances and legend drugs. (2) To assure that the Washington state board of pharmacy is in possession of all current policies and procedures identified in subsection (1) of this section. (3) To execute all forms for the purchase and order of legend drugs and controlled substances. (4) To verify receipt of all legend drugs and controlled substances purchased and ordered by the health care facility

general duty clause

applies to cover situations where no specific standards applies

beneficence

do good, duty to help other

non-malificence

do no harm principle of doubt intent nature of action can't be intrinsically wrong agent intends good effect not bad effect, even though foreseen bad effect must not be the means of the good effect good effect must outweigh the bad permitted

An employee technician working for a large pharmacy chain asks for "reasonable accommodation" for a medical problem.

don't need to say "reasonable accommodation" can say "I need help with a medical condition" need only inform of disability; that triggers duty to accommodate need not be a written request, can be oral

justice

fairness, equality, including access and rationing

clinical issue

medical indication, patient preference, quality of life, contextual features

specific standards

must cite employers under specific standard rather than general duty if standard exists

virtue

right action, motive, agent's character focus on virtue in the conduct of your profession, including compassion, discernment, trustworthiness, and integrity

autonomy

self determination, individual control

Collaborative drug therapy agreements usually encompass which of the following elements

statement identifying practitioner authorized to prescribed and the pharmacist party to the agreement -practitioner must be in active practice -authority granted must be in prescriber's scope of practice -it must be between a physician and a pharmacist statement of what type of prescriptive authority decisions the pharmacist is authorized to make -types of disease states, drugs, drug categories -type of prescriptive authority (modification, initiation, dc of drug therapy) authorized -general statement of the procedures, decision criteria, or plan the rph will follow when making therapeutic decision Collaborative drug therapy agreements usually encompass the following essential elements: -a collaborative practice environment, in which physicians and pharmacists are willing to share responsibility for the patient -direct communication with patients; and access to the patient's medical records, including history, assessments, and laboratory and procedure results. -specify the pharmacist's knowledge, skills, and abilities -All activities be documented!

Ex of Labor management relations

union

issue of law

what we have to do