CPJE II, II & III
Choose the correct statement/s concerning the Power of Attorney to Sign a DEA Form 222:
- A pharmacy may authorize persons to obtain and execute DEA Forms 222 by granting a power of attorney to each person - The power of attorney must be signed by the same person who signed the most recent application for DEA registration.
Celeste is a pharmacist who does not believe in providing emergency contraception (EC). She wished to gain a job near her home and she did not share this belief with her employer during the job interview. Celeste was hired at a pharmacy that provides EC. A female patient came into the pharmacy to request EC. The only pharmacist available was Celeste, who told the woman that EC was not available. Celeste chose not to refer the woman anywhere else nor did she call another pharmacist to provide telephone consultation. The patient missed the "window" to prevent pregnancy, and became pregnant. Choose the correct statement/s:
- Celeste has the right not to work in a facility that violates her personal beliefs - The employer has a right not to hire Celeste if she will not dispense certain medications that the store carries - Celeste had an obligation to inform the employer of her objection to EC during the job interview
A pharmacist is preparing a chemotherapy infusion. The pharmacist must, according to California law, place the following label on the bag:
- Cytotoxic--Dispose of Properly - Chemotherapy-Dispose of Properly
A patient had a prescription for alprazolam filled at a pharmacy near her house. She found that Scuzzy Pharmacy a block down is offering a $10 gift card for each transferred prescription. She asked the pharmacist at Scuzzy's to call and have the prescription transferred. What is required of the pharmacy that initially filled the prescription?
- If the prescription is transferred, the hard copy of the prescription should be pulled, and the word "VOID" should be written on the face - The name of the pharmacy to which the prescription is transferred is written on the back of the voided prescription and all other information is recorded as required
When is a patient profile reviewed by the pharmacist?
- It is reviewed each time a new drug is dispensed - It is reviewed each time a refill is dispensed
An independent pharmacy operates in a town with a lot of senior citizens. The pharmacist-owner wishes to compete with the large chain down the street. He has decided to offer "free delivery" for prescriptions. Choose the correct response:
- Prescriptions may be delivered to patient's homes - Prescriptions may be delivered to patient's work locations - The pharmacy must include written information about the drug/s and provide a phone number that the patient can call if they have any questions
Which of the following methods are acceptable means of documenting the identity of the pharmacist who reviewed the prescription bottle prior to dispensing?
- The pharmacist who reviewed the bottle can initial the bottle's label - The pharmacist can record their identity to the prescription record in the pharmacy computer system, if the record of the reviewer cannot be altered and is immediately retrievable in the pharmacy
The California Board of Pharmacy protects and promotes the health and safety of Californians by pursuing the highest quality of pharmacist's care and the appropriate use of pharmaceuticals through education, communication, licensing, legislation, regulation, and enforcement. Which of the following statements concerning the Board of Pharmacy are correct?
- There is one Executive Officer, who is a paid employee of the Board - The Board has 13 members, 11 of whom are appointed by the Governor - Seven of the Board Members are pharmacists, who work in a variety of practice settings - Pharmacy Inspectors work for the Board and inspect pharmacies to make sure they are Board-compliant
A person can be employed as a Pharmacy Technician if the following requirements are met:
- They have received an A.A. degree and are licensed with the board - They have taken a Pharm Tech training program and are licensed with the board - They are eligible to take the pharmacist board exam.
When a pharmacy compounds medications, it must use "reliable suppliers" in order to ensure that the ingredients have the specified content and are free from contaminants. The board recommends or requires each of the following to ensure quality ingredients:
- Use FDA licensed manufacturers, CA Department of Public Health-FDA licensed drug repackagers, or CA licensed pharmacies and wholesalers - If receiving material from an out of state pharmacy or wholesaler, they should be licensed in California - 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 - Any pharmacy that purchases, trades sells or transfers drugs to an entity not licensed by the board will be fined, per transaction.
Pseudoephedrine (PSE) is located behind pharmacy counters as part of the "Combat Meth Act" under the Patriot Act to crack down on the methamphetamine epidemic. Sales of PSE are limited to the following amounts:
120 of the 30 mg tablets, or 3.6 grams, and a maximum of 300 tablets per 30 day period.
A pharmacist has developed safe use guidelines for sodium chloride infusion. Each of the following represents reasonable safety recommendations that could be included on the protocol for sodium chloride solution EXCEPT the following:
A peripheral line is preferred for administration of hypertonic saline. IT IS NOT ADMINISTERED VIA A PERIPHERAL LINE, CENTRAL LINE ONLY
Choose the correct statement concerning quality assurance programs in pharmacies in California:
All pharmacies must have a quality assurance program that documents medication errors.
Each of the following medications should have the auxiliary label "Take on an Empty Stomach" and "Take with a Full Glass of Water"
Bactrim, VFEND, Boniva, Alendronate
What controlled category is Cheracol cough syrup?
CV
A physician has written an order for cefoxitin IV for a skin cellulitis infection, pathogen unknown. The patient has recently received chemotherapy. An IV agent is preferred due to mucositis and nausea. Cefoxitin 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 a reasonable substitution for this drug?
Cefoxitin is a second-generation agent. For this type of infection, it may be reasonable to use a first-generation agent, however none presented in the question are available IV and switching second to first generation may not be authorized in the protocol. The correct answer is cefuroxime
Which of the following represents the most reasonable method to help pharmacists avoid dispensing the wrong drug to a patient in a community setting:
Check a second patient identifier in addition to the patient's name, such as the home address or date of birth.
A pharmacy gets a transfer call from a pharmacist who has retired and shut his store. The pharmacist has the records stored in his home, and is calling the pharmacy at the request of the patient, who is an old friend. The medication is for enalapril 10 mg, take once daily in the morning. The patient has a blood pressure today (recorded in your store) of 144/88 mmHg. What action should the pharmacist take who is receiving the prescription?
Contact the Board of Pharmacy. A prescription cannot be transferred from a store that is no longer in business. Anytime you are questioning the legality of an action, or know that the action is not according to board policies, contact the board. That is why they are there.
An IV piggyback of vancomycin in D5W is prepared specifically for Mr. Banks in Room 403, cardiac care unit. It is expected to be stable at room temperature for seven days and is sent to the floor at 0800. At 1100 the same day Mr. Banks expired. The medication had not yet been administered. It was sent back to the pharmacy. Can it be sent to another patient during the same day?
If the medication has been delivered to the patient, it can be re-used. Although it was "compounded" for that specific patient, there is little risk of contamination as the patient has not handled the drug. This is only if the drug continues to be stable, with proper storage and duration checked by the pharmacist prior to re-labeling. Otherwise the following is required for any compounded product. When a pharmacy compounds a product for an individual patient the following must be in the compounding record: The formula (the recipe, or the prescription) written in the compounding log, with the date compounded, the identity of the preparer who compounded, the identity of the pharmacist who checked it documented, the quantity of each component, the manufacturer and lot number of each component, the equipment used, the expiration date and the quantity or amount that was compounded--all of this must be in the pharmacy record prior to the drug leaving the pharmacy. Any compounded product requires a "master formula" in place at the pharmacy that is used to check the preparation.
On January 15, 2013 a pharmacist received a prescription for Concerta 36 mg, take one tablet by mouth every day in the morning, #30. The pharmacist filled a medication bottle with 30 tablets of the medicine right away since the patient was waiting. The manufacturer's bottle had an expiration date of 8/2015. What expiration date should the pharmacist put on the bottle?
January 14, 2014 WHY ONE YEAR?
A physician has written an order for Avinza. The patient cannot swallow tablets or capsules, and has her medicine crushed or put into a small amount of soft food. She is in pain, rated at 6-7 and needs to receive pain medication quickly. Avinza 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 the most reasonable substitution for this drug?
Kadian is a morphine long-acting formulation that can be sprinkled in a small amount of applesauce. It is a reasonable substitute. If she cannot swallow easily, the fentanyl patch may be a good option to try, but takes 12 hours or more to begin to have effect, and longer still to provide reasonable pain relief. The question stated the patient is in pain now. If an injection was available as an option, that woud be the most reasonable choice at the present time. Roxanol and morphine sulfate extended-release could be fatal if crushed.
A pharmacist in Westminster, California receives a prescription for Serax on a prescription written by a doctor in Arizona. The physician is a legitimate prescriber with the Arizona Medical Board and has a valid DEA number that authorizes him to write for controlled drugs. It is not on a California security prescription form. Can the pharmacist fill the prescription?
No, because it is not on a California security prescription form.
Select the person/s allowed to complete the board's self-assessment forms
PIC
The actress Brittney Spears was hospitalized at the UCLA Medical Center's psychiatric hospital. Employees were terminated for viewing her medical records. Choose the correct statement concerning this privacy violation under the Health Portability and Accountability Act (HIPAA):
Personal Health Information (PHI) should be kept to the minimum needed, and does NOT include date of birth, date of death, state and zip code. (MANY people are born on the same day,or live in the same zip code--these are not "patient specific.") PHI DOES include information that can be used to identify a specific person, such as medical record number, account number (used for billing), email address, photos or images, device identification numbers, fingerprints, phone numbers, social security numbers, vehicle ID numbers, and relative information. Important for pharmacy: PHI includes the medication labels; these contain patient identifying information. Labels must be shredded.
A pharmacist has just assumed Pharmacist In Charge responsibilities for his store. He is planning to assign a staff pharmacist to conduct drug inventories. The staff pharmacist conducts the controlled drug inventory and files the record with the other inventory records in a file folder called "Drug Inventories." Choose the correct statement:
Pharmacies are required to keep all C II records separate, including C II prescriptions, invoices, DEA order forms 222, and inventory records.
A pharmacist is working with the information technology department to program safety warnings into the computerized prescriber order entry (CPOE) software. He has written safety alerts for certain high-risk drugs. Each of the following are reasonable safety alerts EXCEPT for the following:
Procrit orders: do not order iron supplementation with erythropoetin orders. Erythropoetin orders should not be administered without adequate iron stores since increases in red blood cells exhaust iron stores rapidly.
A pharmacist fills in at his uncle's pharmacy where the prescription labels are typed on an old electric typewriter. He notices that his uncle has been selling rather large quantities of controlled drugs to the upstairs medical office. He takes a quick look and estimates that the sales of controlled drugs to these prescribers represents about 20% of his uncle's monthly drug volume. Is this permissible under California Law?
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.
Which of the following products will require the pharmacist to affix an auxiliary label that says "Shake Well Before Using"?
Suspensions, most asthma inhalers, nasal steroid sprays (not OTC nasal liquid sprays?)
Pseudoephedrine (PSE) is located behind pharmacy counters as part of the "Combat Meth Act" under the Patriot Act to crack down on the methamphetamine epidemic. In order to sell the PSE the staff must check valid identification. Each of the following statements is correct EXCEPT:
The customer does not have to sign the logbook if the pharmacy can automatically scan the magnetic code on the driver's license or state-issued ID card. THIS IS WRONG. MUST SIGN LOGBOOK
A Hospital uses a Pyxis machine for many of the unit-dose medications dispensed to inpatients. Most, but not all, of the medications are available in unit-dose packaging. There are a couple of medications that the pharmacy packages themselves into unit-dose packaging. Which of the following information is required on the package labeling?
The name of drug, strength and dosage form, manufacturer and manufacturer's lot number, the NDC number, and expiration date.
On February 1, 2013 a pharmacist pulls a new, unopened bottle of Zyban 150 mg off the shelf. The bottle has an expiration date of November, 2013. It contains #60 tablets. The pharmacist is refilling a prescription for a patient who uses Zyban 150 mg one tablet twice daily. He decides to put the pharmacy label over the label on the manufacturer's bottle. What expiration date should the pharmacist place on the label?
The pharmacist should put the expiration date of November 30, 2013
Only pharmacies that are county-owned or that contract with the county may dispense medication donated to a drug repository and distribution program. The pharmacy that dispenses donated drugs must meet the following requirements (choose the correct statement):
The pharmacy that is distributing donated drugs to low-income patients must establish eligibility requirements, in a policies and procedure document, for which medically indigent patients who may participate in the program. Controlled substances are not permitted in this type of 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.
Choose the correct statement concerning the label on a medicine bottle dispensed by a refill pharmacy:
The refill prescription label must show the name and address of the refilling and/or the originating pharmacy.
Mehdi just took over the pharmacist-in-charge duties at a new pharmacy. He continues to act as pharmacist-in-charge at his previous store location, which is located in the same city but is 67 miles away from the new pharmacy. Choose the correct statement:
This is not permissible; if PIC is in charge of two pharmacies, they must be within 50 driving miles of each other.
A physician has written an order for Treximet, 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 reasonable substitutions for this drug?
Treximet contains naproxen and sumatriptan; some patients get better migraine relief with an NSAID and triptan combination, and others are fine with either one alone, or from the use of other agents--do not assume combination therapy is necessarily better to treat migraine.
A 73 year-old female patient takes lorazepam 1 mg four times daily. She lives in a small town with few prescribers. Her doctor is away on a fishing trip and did not leave a phone number for another doctor for his patients to call in emergencies. The doctor will return to the office in three days. The patient has ran out of the lorazepam. Can the pharmacist refill the lorazepam prescription?
Yes, the pharmacist should fill the lorazepam since failure to fill it would likely have significant adverse effects on the patient's well-being.
A pharmacist has a patient who has the following chronic medications filled at her store: Amaryl 4 mg Q daily, metformin 1000 mg XR two tablets with the evening meal, 80 mg EC ASA Q daily and Altace 10 mg Q daily. Can the pharmacist dispense syringes to this patient?
Yes, up to 30 syringes can now be dispensed to anyone, without a prescription, in order to reduce the spread of infectious disease; if she had a prescription for insulin or other drug that requires a syringe, the pharmacist could dispense more than 30 (such as a box of 100).
A patient uses the following medications daily: Insulin glargine 22 units QHS, metformin 1000 mg XR two tablets with the evening meal, 80 mg EC ASA Q daily and Altace 10 mg Q daily. Can the pharmacist dispense syringes to this patient?
Yes. No prescription is required and there is no need to sign a logbook.
A physician has written an order for Zebeta, which is not on the hospital's formulary. The patient has hypertension, with blood pressure typically ranging from 135-147/82-88 mmHg outpatient, and 148/86 inpatient currently. The pharmacist will substitute the drug, according to the hospital's therapeutic interchange protocol. Which of the following medications are reasonable substitutions for this drug and could be acceptably "interchanged" if included on the interchange protocol?
Zebeta contains bisoprolol, a beta-one selective beta blocker. Atenolol is falling out of use for initial treatment of hypertension, and if used, should be given twice daily (it does not last long enough to be used once daily). The best option is metoprolol extended-release. Beta blockers will no longer be used first line for hypertension in the new guidelines, however if you were to change the class of drugs you would need the prescriber to concur.
A physician has written an order for Timentin, 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 reasonable substitutions for this drug?
Zosyn
Mycamine
micafungin
A pharmacist receives a prescription from an optometrist for Vigamox eye drops. Which of the following license numbers would be permissible to designate an optometrist with the authority to write for this medication?
optometrists who are allowed to prescribe will have a T after their license number
Aceon
perindopril
Mike Jones, RPh owns an independent pharmacy in Walnut Creek, California that has a large front end business with a soda fountain and gift shop. Mike is the sole pharmacist. Mike needs to have a surgical procedure and has hired a relief pharmacist to cover his store. He will not be present when the relief pharmacist arrives. He leaves the key in a sealed envelope in a tamper-proof container with the store manager to hand to the relief pharmacist when she arrives. The store manager has been instructed not to open the envelope since it contains a key to the pharmacy area. It has been signed across the back of the envelope by the pharmacist. Is it permissible to hand the key over in this manner?
yes
