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Controlled Substances CII

When taking the exam it’s important to read each question carefully and concentrate on which law, general concept or principle the question is testing.  

When a drug name is given in the question identify if it is OTC, prescription only or a controlled substance. Use that information to determine which laws apply and how they apply to the question at hand.

Always remember, state law may be stricter and if so STATE LAW APPLIES.

Link to Teachable Courses and Study Guides
Drugs with a high potential for abuse
Potential to lead to severe psychological or physical dependence
Dangerous
hydromorphone (Dilaudid) fentanyl (Sublimaze, Duragesic)hydrocodoneamobarbital
methadone (Dolophine)morphineamphetamine (Dexedrine, Adderall)glutethimide
meperidine (Demerol)opiummethamphetamine (Desoxyn)pentobarbital 
oxycodone (OxyContin, Percocetcodeinemethylphenidate (Ritalin)secobarbital
CII Controlled Substances

Barbiturates

Amobarbital (Amytal), pentobarbital (Nembutal) and secobarbital (Seconal) are CIIs.

Phenobarbital (Luminal) is a CIV.

Hydrocodone

Hydrocodone was reclassified to CII in 2014.

CII Prescription Requirements: Valid Types of Prescriptions

Written signed prescription

Erx

Oral (ONLY in emergency)

Fax (ONLY if home infusion, long term care facility, hospice)

CII Prescriptions: What Can be Changed?

Patient address (can also obtain from patient)

Drug strength

Dosage form

Drug quantity

Directions

CII Prescriptions: What Cannot be Changed?

Patient’s Name

Controlled substance prescribed

Prescriber’s Signature

⬆️ Any of the above items would require a new prescription.

CII Prescriptions: Partial Filling

No refills are allowed on CII prescriptions

Partial may be dispensed: 

*If it is not prohibited by State laws*

The partial fill is requested by the patient or the practitioner who wrote the prescription.

The total quantity dispensed in all partial fillings does not exceed the total quantity prescribed.

Within 30 days of the date on which the prescription was written 

Exception: Terminal patients may get a partial dispense and prescription is void 60 days after written

Partial dispense prescription documentation:

Date of partial fill

Quantity dispensed

Remaining quantity

Dispensing pharmacist

Check out the detailed information in our guided course and downloadable study guides on Teachable!!

Link to Teachable Courses and Study Guides

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Pharmacy – How Do We Fix Our Profession?

So, I had something else planned for the blog today.  With the recent coverage, I thought this would be an excellent time to bring up our profession.  

https://www.nbcnews.com/health/health-care/overworked-understaffed-pharmacists-say-industry-crisis-puts-patient-safety-risk-n1261151

As a whole.  

Where we are.  

Where we are headed.  

How we can fix our profession to best serve our patients and use our skills to the highest of our abilities.  

I have been in pharmacy for 10+ years and it has changed SIGNIFICANTLY during that period, not necessarily for the good of our profession or our patients.  

Some of us may work in areas that don’t feel impacted and I would encourage us to link together and support our colleagues who are struggling to take care of the patients they are devoted to in the way they wish they could.  I would encourage us to stand with our colleagues who can’t get away for a bathroom break, who don’t get a meal break, who aren’t allowed a stool to sit on, who aren’t able to take the time to counsel a patient who could benefit, who aren’t able to have a simple conversation with a recent widower who feels lonely to make them feel connected for the day, who are struggling to meet metrics that aren’t designed to serve our patients or other healthcare providers, who see the local Chik-Fil-A staffed better than their pharmacy, who feel like they are doing 5+ things at a time and struggling to do them well because of the constant interruptions.  We see you.

How can we improve this? How can we put healthcare and patients first again?  How can we better support other healthcare providers and the healthcare system as a whole? I don’t have the answers, but I think it’s time we start the discussion and continue it until we have some resolution. 

Thoughts.

Obtain provider status to be able to give patients access to and to allow us to bill for the valuable, expert care we are able to provide.

Provide medication therapy management through primary care, specialty services and/or local pharmacies.

Get involved in collaborative practice agreements in states that allow and work to expand in other states. Some ideas for collaborative practices:

            Anticoagulation

            Diabetes

            Hypertension

            Hyperlipidemia

            Pain Management

            Heart Failure

            Asthma/COPD

            Smoking Cessation

            Travel Vaccinations

Improved billing and financial margins for filling prescriptions.  Profit to pharmacies.

Adequate staffing to allow time for MTM, collaborative practice, vaccine clinics, and counseling.

Adequate staffing to handle the volume of incoming phone calls.

Adequate staffing to run a drive thru lane.

Adequate staffing or dedicated pharmacy hours that allow for meal breaks and bathroom breaks.

Time to connect to patients.

Time to follow up on patient specific inquiries and insurance issues to reduce or prevent escalations BEFORE they happen.  

Fair wages for support staff, technicians and pharmacists.

Incentives for continuing education, certifications, and participation in local, state and national pharmacy organizations to keep staff engaged and knowledgeable.

Recruit, train and hire leaders in pharmacy that are PHARMACISTS.  

Patient safety support and action from the state Boards of Pharmacy and pharmacy organizations.

Bye bye metrics.  Remove metrics. They don’t belong in healthcare.

“At the end of the day, at the end of the week, at the end of my life, I want to be able to say that I contributed more than I criticized.”

-Brene Brown
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Study Tips for the MPJE

Do not waste time memorizing law citations.

The test will not refer to specific laws by citation.  Examples: Chapter 10.32.22, Regulations 10.34.22.01-.08 or Public Health Law Section 2164.  Instead, focus on learning the law material and how to apply it. 

Focus on well-established laws and regulations.

The test is not likely to ask or score questions related to recent changes in the law. The test is also not going to ask about temporary or recent exceptions such as the current COVID-19 exceptions in place.  

When a drug name is given in the question identify if it is OTC, prescription only or a controlled substance.  

Identify the regulations that may apply to the drug based on how it is classified and identify the general concept or principle the question is asking about.  Think about the question in a straightforward manner. Questions are not written to trick.

Make sure to review how state and federal laws may differ in the particular state. 

When there is a difference between federal and state laws and regulations, the strictest applies.  Some specific areas to review and compare are controlled substance schedules, methamphetamine purchase limitations and regulations related to controlled substance prescriptions such as valid types of prescriptions, refill limitations, and expiration dates.  Additionally, mid-level authority, technician ratios and authority, board licensing and renewals, collaborative practice agreements, immunizations, prescription monitoring programs, etc. vary from state to state.

Set aside a specific time to study.

It can be really easy to have good intentions of studying without ever making it happen. Plan and set aside time to study for the scheduled test date.  Add it to a digital calendar or planner if needed.  Once plans are in writing, it is easier to stick to those plans.  Try to make sure your plans don’t interfere with work, family or other obligations.  Have a regular study space that is comfortable and conducive to studying. 

Don’t try to cram all at once.  

It can be best to space studying out into more shorter sessions than one long binge session.  If you are fighting heavy eyelids, it is really hard to study! Try not to procrastinate or find excuses not to study.  There will always be other tasks to complete, material that is boring or difficult, however it’s important to stick to set study plans if at all possible. It can be best to plan for a 5-minute break every 30 to 40 minutes for longer study sessions.  If possible, take a walk around the block, grab a snack or complete a short physical task during break periods.

Eliminate ALL the distractions.  

It feels like there are SO many distractions these days.  Technology can be a big one.  Try to reduce notifications, background noises and access to mindless internet scrolling.  Find a quiet place away from family or roommates if possible.  Make sure to have good lighting, a comfortable temperature, and uncluttered workspace.

Organize notes or study material.

Group similar topics or information together.  Break it up into sections.  Look up and research any words or topics that aren’t understood to make sure notes are complete and accurate.  Re-write or re-organize information if it’s presented in a way that doesn’t work well for your learning style.  Color code, create charts, create tables or other graphics that help with learning if necessary.  Or purchase a study guide or course that does this for you – that’s what we do!!

Link to the Prepared Pharmacist Study Guides and Courses on Teachable

Create a specific goal for your study session.  

Organize material that needs to be studied.  Have a goal of getting through a set number of sections, chapters or subject material.    

Mark or highlight study material you will need to revisit.  

If there is a topic that is particularly difficult, or the bulk of the test material, make sure to spend more time revisiting that material.  Be able to find it easily and review it just prior to your test time.