PEBC Pharmacy Practice Management Flashcards

A pharmacy manager discovers that a pharmacist has been consistently dispensing a Schedule I controlled substance under a standing order signed by a physician who retired 14 months ago. Under NAPRA Model Standards and provincial legislation, which action takes HIGHEST priority before contacting the College?

Answer: Notify Health Canada's Office of Controlled Substances and preserve all dispensing records without alteration

Dispensing a Schedule I controlled substance under an invalid (post-retirement) prescription constitutes a federal offence under the Controlled Drugs and Substances Act. The legal obligation to notify Health Canada's Office of Controlled Substances and preserve all unaltered records takes precedence over internal disciplinary measures or stock quarantine, as federal regulatory authority supersedes provincial College jurisdiction for Schedule I substances. Altering the record chain or suspending the pharmacist first could be construed as obstruction.

A community pharmacy receives a fax prescription for a compounded preparation containing 0.1% tacrolimus in a lipid-based vehicle for a pediatric patient with refractory atopic dermatitis. The preparation is not commercially available in Canada. Which combination of NAPRA's Non-Sterile Compounding Standards conditions must be met before dispensing?

Answer: A documented therapeutic rationale, a beyond-use date supported by stability data or literature, and a risk assessment classifying the preparation as Category 2 or higher

Under NAPRA's 2018 Non-Sterile Compounding Standards, a pharmacy must document a clear therapeutic rationale demonstrating commercial unavailability or unsuitability, establish a beyond-use date (BUD) based on stability references or published data, and classify the preparation by risk category to determine appropriate environmental and process controls. Tacrolimus topical falls under Category 2 due to its immunosuppressant nature and skin-penetration profile. A TPD exemption number is not required for extemporaneous compounding for a specific patient, and ISO 5 clean rooms are sterile-compounding requirements.

During a medication reconciliation process on hospital admission, a pharmacist identifies that a patient's home medication list includes warfarin 5 mg daily, but the admitting physician ordered warfarin 2.5 mg daily citing 'renal dosing.' The patient's eGFR is 62 mL/min/1.73m². Which pharmacist action BEST reflects evidence-based practice and professional responsibility?

Answer: Intervene immediately: warfarin does not require renal dose adjustment at eGFR 62, so the home dose should be verified with the anticoagulation clinic and reconciled back to 5 mg pending INR review

Warfarin is NOT renally dosed; its metabolism is hepatic (CYP2C9) and the rationale of 'renal dosing' at eGFR 62 is pharmacologically incorrect. The correct action is to identify the prescribing error, verify the patient's established dose with their anticoagulation clinic or previous INR records, and communicate the discrepancy to the physician with a recommendation to restore the home dose—pending INR assessment. Simply holding the drug or accepting an erroneous rationale without intervention fails the pharmacist's duty to optimize medication therapy and prevent harm.

A pharmacy owner is developing a Continuous Quality Improvement (CQI) program following a near-miss dispensing error involving look-alike/sound-alike (LASA) drugs. Under ISMP Canada guidelines, which program element has the STRONGEST evidence for reducing LASA errors at the point of dispensing?

Answer: Implementation of Tall Man Lettering on shelf labels combined with physical separation of LASA pairs and barcode verification at final check

ISMP Canada's evidence base identifies Tall Man Lettering (TML), physical separation of LASA pairs, and barcode verification as a combined system-level intervention with the strongest evidence for reducing LASA dispensing errors. Education-only interventions (option A) are consistently shown to be insufficient as standalone measures. Double-check policies (option C) have mixed evidence and can create complacency ('automation bias in reverse'). ADCs (option D) reduce certain error types but are expensive, not universally applicable, and photo-recognition technology is not a validated standard for community pharmacies under current ISMP Canada guidelines.

A pharmacy benefit manager (PBM) contract requires that a pharmacy achieve a Medication Adherence Score above 80% for three chronic disease classes (diabetes, hypertension, renin-angiotensin system agents) to avoid a 2% DIR fee clawback. A patient with Type 2 diabetes has a PDC of 0.71 for metformin. The patient reports they skip doses intentionally due to GI side effects. What is the pharmacist's MOST appropriate sequence of interventions?

Answer: Assess adherence barriers (GI intolerance), recommend dose titration or extended-release formulation with physician collaboration, then optimize refill synchronization to improve PDC meaningfully

The pharmacist's primary obligation is patient-centred care, not metric optimization. The correct sequence addresses the root cause (GI intolerance): assess severity and timing, then collaboratively recommend metformin extended-release (which significantly reduces GI side effects), adjust dosing titration, and synchronize refills—all of which genuinely improve adherence and outcomes. Dispensing a 90-day supply without addressing the barrier is a metric-gaming tactic that constitutes an ethical breach and does not improve the patient's health. Recommending an SGLT-2 inhibitor without ruling out a simpler fix (XR formulation) is premature. Referral alone without pharmacist-level intervention is an abdication of the expanded scope.

During a routine narcotic inventory reconciliation, a pharmacy technician discovers a discrepancy: 28 tablets of hydromorphone 2 mg are unaccounted for over a 6-week period. The log shows all entries were made by the same pharmacist on night shifts. No signs of tampering are visible on vials. Under federal CDSA regulations and NAPRA professional standards, what is the CORRECT order of required actions?

Answer: Conduct a full internal audit to confirm the discrepancy, then simultaneously notify Health Canada's Office of Controlled Substances and the provincial College, and preserve all records without alteration

Under Section 30 of the Narcotic Control Regulations, a confirmed loss or theft of a narcotic must be reported to the Office of Controlled Substances (Health Canada) and the appropriate provincial regulatory authority. Crucially, both must be notified — not one before the other. Records must be preserved unaltered to maintain evidentiary integrity. Suspending the pharmacist or involving police are legitimate steps, but they do not precede mandatory federal regulatory notification. A re-count to verify is appropriate before formal reporting only if the discrepancy is unconfirmed, but 6 weeks of consistent logging by a single pharmacist constitutes a sufficiently documented discrepancy requiring immediate dual notification.