PEBC PEBC Pharmacy Practice Management 5 — Questions and Answers
Question 1: A pharmacist receives a fax prescription for a Schedule I controlled substance. Under CDSA regulations, the pharmacist should:
- Dispense the medication immediately, as fax prescriptions are fully equivalent to written originals for all drugs
- Refuse to fill the prescription because narcotics cannot be dispensed on a fax
- Contact the prescriber to verbally confirm then treat the fax as an emergency verbal order
- Accept the fax for documentation and dispense only after receiving the original signed prescription (Correct answer)
Correct answer: Accept the fax for documentation and dispense only after receiving the original signed prescription
For Schedule I narcotics, the CDSA requires an original signed prescription; a fax may be used to begin preparation, but the original must be received before dispensing or shortly after in an emergency.
Question 2: Which of the following best describes a pharmacy's duty under 'duty to warn' in the context of drug interactions?
- Pharmacists must only warn patients about interactions listed in the provincial formulary
- Pharmacists must proactively counsel patients about clinically significant drug interactions identified during dispensing (Correct answer)
- Warning patients about drug interactions is the exclusive responsibility of the prescribing physician
- Duty to warn applies only when the patient specifically requests drug interaction information
Correct answer: Pharmacists must proactively counsel patients about clinically significant drug interactions identified during dispensing
Pharmacists have a professional and legal duty to counsel patients about clinically significant interactions discovered during the medication review process, regardless of whether the patient asks.
Question 3: A pharmacy is closing permanently. Regarding Schedule I narcotic inventory, the pharmacist must:
- Donate remaining narcotics to a local hospital without documentation
- Return all narcotics to the wholesaler or transfer to another licensed dealer with proper documentation (Correct answer)
- Destroy all narcotics on-site without notification to any authority
- Retain narcotics until the provincial authority responds to a written notice
Correct answer: Return all narcotics to the wholesaler or transfer to another licensed dealer with proper documentation
Upon closure, narcotic inventory must be transferred to another licensed dealer or returned to the wholesaler, with all transfers fully documented per CDSA requirements.
Question 4: When calculating the break-even point for a pharmacy's compounding service, which formula is correct?
- Break-even units = Fixed Costs ÷ (Selling Price per Unit + Variable Cost per Unit)
- Break-even units = Fixed Costs ÷ (Selling Price per Unit − Variable Cost per Unit) (Correct answer)
- Break-even units = Variable Costs ÷ Selling Price per Unit
- Break-even units = Total Revenue ÷ Fixed Costs
Correct answer: Break-even units = Fixed Costs ÷ (Selling Price per Unit − Variable Cost per Unit)
The break-even formula divides total fixed costs by the contribution margin (selling price minus variable cost per unit).
Question 5: A new pharmacy employee refuses to dispense emergency contraception on moral grounds. How should the designated manager handle this situation in most Canadian provinces?
- Immediately terminate the employee for refusing a professional duty
- Allow the refusal with no further action since freedom of conscience is absolute
- Ensure a seamless referral process so the patient receives timely care without burden (Correct answer)
- Place a permanent note in the employee's file and require supervisor approval for all dispensing
Correct answer: Ensure a seamless referral process so the patient receives timely care without burden
Most provincial regulatory colleges permit conscientious objection but require that the pharmacist or pharmacy ensure patients are referred promptly so access to care is not compromised.
Question 6: Under provincial pharmacy legislation, which situation would MOST likely require a pharmacist to initiate an adapted prescription?
- A patient requests a brand-name drug instead of the generic dispensed
- A prescription for metformin 500 mg is received but the pharmacy only stocks 1000 mg tablets (Correct answer)
- A patient wants a 90-day supply but the prescriber wrote for 30 days
- A prescriber uses a non-standard abbreviation on a handwritten prescription
Correct answer: A prescription for metformin 500 mg is received but the pharmacy only stocks 1000 mg tablets
When the prescribed strength is unavailable and a therapeutically equivalent strength exists, the pharmacist may adapt the prescription (e.g., adjust quantity and directions) under provincial adaptation authorities.
Question 7: A pharmacy's dispensing software flags a potential QTc-prolonging interaction between two medications a patient is already stabilized on under specialist supervision. The MOST appropriate action is to:
- Override the alert without documentation because the patient is already stabilized
- Refuse to dispense both medications until a new specialist consultation is arranged
- Document the clinical rationale for proceeding, counsel the patient, and consider notifying the prescriber (Correct answer)
- Automatically substitute one medication with a non-QTc-prolonging alternative
Correct answer: Document the clinical rationale for proceeding, counsel the patient, and consider notifying the prescriber
When a patient is stable under specialist oversight, the pharmacist should document the decision rationale, ensure patient awareness of monitoring signs, and communicate with the prescriber as appropriate rather than unilaterally refusing or substituting.
PEBC PEBC Pharmacy Practice Management 5
A pharmacist receives a fax prescription for a Schedule I controlled substance.
Under CDSA regulations, the pharmacist should: