PEBC Pharmacy Practice Management Flashcards

A pharmacist receives a faxed prescription for hydromorphone 8 mg tablets, 120 tablets, with instructions to dispense in two separate fills of 60 tablets each. The prescriber is a licensed Ontario physician. Under the NAPRA Model Standards and CDSA, which of the following actions is MOST appropriate?

Answer: Dispense the first 60 tablets immediately and flag the file for the second fill at the prescriber's specified interval

Under the CDSA, a faxed prescription for a narcotic such as hydromorphone is legally valid in most provinces when originating directly from the prescriber's office. A prescriber may legitimately specify partial fills for controlled substances to manage supply and reduce diversion risk. The pharmacist must honour the split-fill instructions as written, dispensing only the first fill and retaining the prescription for the remainder. Dispensing the full quantity at once overrides a clinically and legally significant prescriber directive and raises diversion concerns.

A pharmacy technician certified by the PEBC independently verifies a final product check on a non-sterile compound prepared by another technician. The pharmacist is on duty but occupied with a patient counseling session. Under which condition does this practice model remain compliant with NAPRA's Professional Practice Policy?

Answer: The pharmacy's operational policies designate this activity as within the certified technician's authorized scope, and the pharmacist maintains overall professional accountability

NAPRA's PPP on pharmacy technicians allows regulated technicians to perform final product checks on defined categories of non-sterile preparations — but only when explicitly authorized within the pharmacy's written policies and procedures, and when a pharmacist retains overall professional accountability for the practice site. Technician certification alone is insufficient; the enabling policy framework and pharmacist oversight must both be in place. The activity is not categorically prohibited, nor does it automatically require a second pharmacist.

A pharmacy manager discovers that 15 units of morphine sulfate 10 mg/mL injectable have been recorded as wasted over the past month with only one witness signature per entry, rather than the two required by the provincial college. No diversion is suspected. What is the MOST appropriate immediate course of action?

Answer: Document the discrepancy in the narcotic register, conduct an internal investigation, and self-report the record-keeping breach to the provincial regulatory authority

Record-keeping deficiencies involving controlled substances are regulatory violations independent of whether actual diversion occurred. The pharmacist manager must document the breach, conduct an internal review to establish whether all product is accounted for, and proactively self-report to the provincial college. Retroactive signature collection is not permissible — entries in a narcotic register must reflect contemporaneous, accurate records, and altering them after the fact compounds the breach. Health Canada reporting under CDSA is triggered by loss or theft, not documentation gaps alone.

Under the federal Food and Drugs Act, a pharmacist dispenses a Schedule F drug using a telephone order from a nurse practitioner practicing in a province that authorizes NPs to prescribe Schedule F medications. Two days later, the pharmacist learns the NP's provincial prescribing authority had been suspended the day before the call. Which statement BEST describes the pharmacist's liability exposure?

Answer: The pharmacist acted in good faith on information available at the time; liability is mitigated provided there was no reasonable way to verify the suspension before dispensing

Canadian pharmacy law does not impose a strict duty on pharmacists to verify prescriber registration status prior to every dispense — it requires reasonable professional judgment. Acting in good faith on a verbal order from an identified regulated health professional, with no prior indication of suspension, significantly mitigates the pharmacist's liability. However, mitigation is not complete immunity; documentation of the order, identity confirmation steps taken, and the absence of red flags are all material to any professional review. Strict liability and full college absorption are both legally inaccurate standards.

A pharmacist is offered a fee-per-prescription arrangement by a long-term care facility to serve as its consulting pharmacist. The contract would require the pharmacist to review all residents' medication profiles monthly. Under NAPRA's ethical framework and most provincial college standards, what is the PRIMARY concern with this remuneration model?

Answer: The fee-per-prescription structure creates a financial incentive to maximize dispensing volume rather than optimize therapy, compromising professional independence

A fee-per-prescription model in a consulting role creates a structural conflict of interest: the pharmacist's income increases with the number of prescriptions dispensed, incentivizing over-prescribing or failure to recommend deprescribing even when clinically appropriate. NAPRA's ethical framework requires pharmacists to act in the patient's best interest free from conflicts that could compromise clinical judgment. An appropriate fee model for consulting services would be time-based or flat-fee per review. The concern exists regardless of whether the pharmacist also owns the dispensing pharmacy.

A pharmacist in a province with mandatory medication reconciliation standards receives a patient being discharged from hospital. The discharge prescription omits a chronic antihypertensive the patient was taking pre-admission. The hospital discharge summary notes the medication was 'held peri-operatively.' The patient states they feel fine and wants only the new prescriptions filled. What is the pharmacist's MOST defensible action?

Answer: Complete a medication reconciliation, contact the discharging prescriber to clarify whether the antihypertensive should be resumed, and document the clinical consultation before dispensing

Medication reconciliation at care transitions is a professional and, in many provinces, regulatory obligation. An omitted chronic antihypertensive at discharge is a clinically significant discrepancy — it may reflect intentional discontinuation, an oversight, or a planned restart with no instruction provided. The pharmacist cannot simply restart from an old prescription (prescribing authority) nor ignore the gap (professional duty). The required action is to perform reconciliation, contact the prescriber to resolve the discrepancy, document the interaction, and then dispense based on the clarified therapeutic plan. Patient preference to skip does not override the pharmacist's professional duty to resolve a potentially dangerous omission.