MPJE Prescription Dispensing Requirements 4 — Questions and Answers
Question 1: A pharmacist receives a prescription for a quantity of 120 tablets of alprazolam (Schedule IV). State law limits Schedule IV prescriptions to a 30-day supply. The prescriber wrote the quantity for a 60-day supply. What should the pharmacist do?
- Dispense the full 120 tablets because federal law supersedes state law on Schedule IV quantities
- Dispense only the quantity allowed under the more restrictive state law (Correct answer)
- Dispense 60 tablets and automatically schedule the remainder as a future pickup
- Refuse to fill the prescription without a new prescription from the prescriber
Correct answer: Dispense only the quantity allowed under the more restrictive state law
When federal and state laws conflict, pharmacists must follow the more restrictive law; since state law limits a 30-day supply, only that quantity should be dispensed.
Question 2: Under OBRA '90, pharmacists are required to offer counseling to Medicaid patients. Which statement best describes the scope of this requirement?
- Counseling must be offered verbally; written materials alone do not satisfy the requirement (Correct answer)
- Counseling may be provided by technicians trained in medication information
- Counseling must include the medication's cost compared to generic alternatives
- Counseling is only required for new prescriptions, not refills
Correct answer: Counseling must be offered verbally; written materials alone do not satisfy the requirement
OBRA '90 requires pharmacists to offer verbal counseling to Medicaid patients; merely providing written information does not fulfill the obligation.
Question 3: A prescription label for a dispensed medication must include directions for use. If the prescriber wrote 'use as directed,' how should the pharmacist handle the label?
- Print 'use as directed' on the label as written by the prescriber
- Obtain clarification from the prescriber and include specific directions on the label (Correct answer)
- Leave the directions blank and counsel the patient verbally
- Dispense only if the patient demonstrates knowledge of the directions
Correct answer: Obtain clarification from the prescriber and include specific directions on the label
Pharmacists should obtain specific directions from the prescriber so the label can include clear, unambiguous instructions for the patient's safety.
Question 4: Which of the following is correct regarding compounded preparations dispensed pursuant to a prescription?
- Compounded preparations must carry the same labeling as FDA-approved manufactured drugs
- Compounded preparations are exempt from all state Board of Pharmacy labeling requirements
- Compounded preparations must be labeled with the name and strength of the active ingredient(s), beyond use date, and pharmacist's name (Correct answer)
- Compounded preparations require an NDC number before dispensing
Correct answer: Compounded preparations must be labeled with the name and strength of the active ingredient(s), beyond use date, and pharmacist's name
Compounded prescriptions must be labeled with the active ingredient(s) and strength, the beyond-use date, and the dispensing pharmacist's or pharmacy's identifying information.
Question 5: A patient presents a prescription for Adderall (amphetamine/dextroamphetamine, Schedule II) dated today. The patient states the prescription is from out of state. What must the pharmacist verify?
- Out-of-state Schedule II prescriptions cannot be filled under any circumstances
- The prescription must meet federal requirements and, if the state permits, may be dispensed after verifying its legitimacy (Correct answer)
- Out-of-state Schedule II prescriptions are valid only at chain pharmacy locations in both states
- The prescriber must call the pharmacy directly before the out-of-state Schedule II prescription can be filled
Correct answer: The prescription must meet federal requirements and, if the state permits, may be dispensed after verifying its legitimacy
Out-of-state Schedule II prescriptions are valid if they meet federal and state requirements; the pharmacist must verify authenticity and prescriber legitimacy before dispensing.
Question 6: A pharmacist dispenses a 30-day supply of lisinopril and mistakenly gives the patient atenolol. The error is discovered after the patient has left. Which step is the MOST immediate priority?
- Document the error in the dispensing record and notify the prescriber at the next opportunity
- Contact the patient immediately to inform them of the error and provide guidance on next steps (Correct answer)
- Pull the remaining stock of atenolol to determine if additional errors occurred
- File a MedWatch report with the FDA before contacting the patient
Correct answer: Contact the patient immediately to inform them of the error and provide guidance on next steps
Patient safety requires immediately contacting the patient to disclose the dispensing error and provide guidance on what to do with the wrong medication.
Question 7: A pharmacist receives a written prescription for 'codeine sulfate 30 mg #30 – no refills.' Codeine is Schedule II in this state. How long is this prescription valid for dispensing?
- 6 months from the date written
- 12 months from the date written
- As determined by the pharmacist's professional judgment
- Validity depends on state law; many states limit Schedule II written prescriptions to a specific timeframe (e.g., 90 days) (Correct answer)
Correct answer: Validity depends on state law; many states limit Schedule II written prescriptions to a specific timeframe (e.g., 90 days)
Federal law does not specify an expiration date for Schedule II prescriptions, so state law governs; most states impose a validity period such as 90 days from the date written.
MPJE Prescription Dispensing Requirements 4
A pharmacist receives a prescription for a quantity of 120 tablets of alprazolam (Schedule IV).
State law limits Schedule IV prescriptions to a 30-day supply.
The prescriber wrote the quantity for a 60-day supply.
What should the pharmacist do?