Missouri Pharmacy Regulations and Requirements, Exams of Pharmacology

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MISSOURI MPJE

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MISSOURI MPJE EXAM TESTBANK

What bureau regulates controlled substance distribution in Missouri? -

CORRECT ANSWERS The Missouri Bureau of Narcotics and Dangerous

Drugs (BNDD) The Missouri Department of Health and Senior Services (DHSS) has regulatory

jurisdiction over pharmacies that are __________. - CORRECT ANSWERS

Located within the "licensed premises" of hospitals (except for Class-B hospital pharmacies). What additional services can pharmacists perform in Missouri if properly certified and

board notified if required? - CORRECT ANSWERS Administering

medication by prescription order Immunizing by protocol Medication therapy services T/F: After a name change, you must request a new license with updated name. -

CORRECT ANSWERS F

Address and employment changes must be reported to the board within __ days -

CORRECT ANSWERS 15

Name change requirements - CORRECT ANSWERS Written notice to the

board Legal documentation

Pharmacists must renew their license by - CORRECT ANSWERS October

31st of every even numbered year

How many CEs per renewal term for pharmacist licensure - CORRECT

ANSWERS 30

Proof of CE must be maintained in the licensee's records for - CORRECT

ANSWERS 2 renewal cyckes

Technology assisted- supervision requirements - CORRECT ANSWERS

Two-way communication by audio, completion of employer approved training and compliance kept for 2 years, 5-year audit trail of all activity.

Pharmacist prescriptive authority - CORRECT ANSWERS NRT

Naloxone, Naltrexone HIV PEP Emergency medication supply if unable to obtain refill authorizations

Pharmacists may accept a hard copy prescription where? - CORRECT

ANSWERS Only on pharmacy premises.

If a pharmacist can't accept a prescription off-site, can a tech? - CORRECT

ANSWERS No, but remote data sentry techs can enter data remotely if

following the law

What is a class I permit? - CORRECT ANSWERS A consultant pharmacy

permit

A Missouri pharmacy permit is not required for a pharmacist when - CORRECT

ANSWERS They are only providing consulting services

A pharmacist located in another state can perform pharmacy services if -

CORRECT ANSWERS They are a missouri licensed pharmacist or are

working for a missouri licensed pharmacy.

Can pharmacists perform lab testing? - CORRECT ANSWERS Yes, due

to absent statutory direction. However pharmacists can't "diagnose"

Prior to prescribing NRT, a pharmacist must... - CORRECT ANSWERS

Collect PMH Screen for high risk patients Prescribe based on clinical guidelines

Pharmacy records must be maintained for __ years - CORRECT ANSWERS

Patient medical records kept at the pharmacy must be produced immediately or within _____ after request from the BOP. Records not maintained at a pharmacy

must be produced within ___. - CORRECT ANSWERS 2 hours; 3

business days

What information must be collected when dispensing naltrexone - CORRECT

ANSWERS Pt name, dob, address, ph#

Date pt seen

PCP

Documentation of screening/testing PMH Name and dosage of drug Any recommended plan, follow-up, or referral

How many hours per week must a PIC be present? - CORRECT ANSWERS

There is no set amount of hours What are the requirements that must be met for a pharmacist to be PIC at more than

one pharmacy? - CORRECT ANSWERS The PIC must be present

enough to be regularly engaged with the operations of the pharmacy (subject to interpretation by the PIC and permit holder) In the event of a PIC leaving, the pharmacy should notify the board within ____. -

CORRECT ANSWERS 15 days

Describe inventory requirements for PIC changes - CORRECT ANSWERS

CII-CV inventory must be counted (including pseudoephedrine) immediately prior to or at time of PIC change. Outgoing and incoming PIC may conduct inventory together. In the event of a PIC change, what are the pharmacy's options involving continuing

its operations. - CORRECT ANSWERS Cease operations until new PIC is

appointed or appoint someone Interim Supervising Pharmacist for a period no longer than 30 days. Does an inventory need to take place when an Interim supervising pharmacist is

named? - CORRECT ANSWERS Yes, immediately, and retained for 2

years. An interim pharmacist may only serve for ___ days. After that if more time is needed,

the board must be notified by email or fax for extension (T/F). - CORRECT

ANSWERS 30; F, 30 days is the maximum allowable time. No extensions.

Pharmacy permits may be owned by sole proprietors or LLP/LLCs. When must you

receive a new permit? How long are they good for? - CORRECT ANSWERS

A new permit must be made anytime change of ownership occurs, even in the event of naming a new business partner. They are good for the life of that ownership. CVS is a publicly traded company that owns pharmacies across missouri. They have a new large shareholder of 10%. Does the board of pharmacy need to be notified of

ownership change? - CORRECT ANSWERS No. Pharmacies owned by

corporations are owned by the corporation, not the shareholders.

How does missouri handle label requirements for patient use off-site for class b

pharmacies? - CORRECT ANSWERS Medications may not be given to

patients to use off-site unless they are initiated onsite and continued offsite by an external or implanted medical delivery devices programmed by a healthcare professional. Under federal law, a missouri pharmacy must enroll as a drug distributor with the DEA if controlled substances exceed __% of drugs dispensed during the previous

calendar year, - CORRECT ANSWERS 5

When is tech check tech allowed and not allowed. - CORRECT ANSWERS

It is allowed when authenticating product selection. It is not allowed when verifying final preparation (such as with a compound).

What is a class E pharmacy - CORRECT ANSWERS Nuclear Pharmacy

What is a Class J permit? - CORRECT ANSWERS A permit that allows

two or more pharmacies to provide pharmacy functions on behalf of one another (remote data entry, verification)

What is a Class-L pharmacy? - CORRECT ANSWERS Veterinarian

pharmacy

Does a pharmacist need to be on site at a class L pharmacy? - CORRECT

ANSWERS No provided that the PIC does monthly reviews of activities and

records of pharmacy operations and that controlled substances are not being dispensed. Dispensing errors at type L pharmacies must be reported to the PIC within -

CORRECT ANSWERS 24 hours

Class M pharmacies are? - CORRECT ANSWERS Pharmacies for

bleeding disorders (dispense clotting factors).

Prepackaged drugs have an expiration date of... - CORRECT ANSWERS

12 months or the manufacturers expiration, whichever is sooner.

What are the labelling requirements? - CORRECT ANSWERS Date,

unique number, Pt name, Prescriber name, Directions, name and address of pharmacy, name and dosage of drug, manufacturer (if generic). Blood clotting factor concentrates must be delivered within __ days for established patients and __ days for new patients. If it is an emergency, established patients

must be provided products within ____. - CORRECT ANSWERS 2; 3; 12

hours

How can class M pharmacies offer counseling? - CORRECT ANSWERS

By providing a toll free number each time a rx is dispensed.

Established patient definition... - CORRECT ANSWERS A patient that has

been dispensed to more than 3 times in a calendar year

What is class Q pharmacy? - CORRECT ANSWERS Charitable pharmacy

Define a charitable pharmacy - CORRECT ANSWERS Pharmacy that

provides services to indigent people that have been screened and approved by a charitable organization and deemed not to have sufficient funds to obtain needed medications.

How can a class Q pharmacy obtain medications? - CORRECT ANSWERS

Must be donated by a pharmacy, distributor, healthcare entity, or provider, in its original sealed package.

Class R pharmacy definition... - CORRECT ANSWERS Remote

dispensing pharmacy

Class R pharmacies must be supervised by - CORRECT ANSWERS

Continuous audio and video To be eligible for licensure, a class R pharmacy must be __ miles away and

supervised by... - CORRECT ANSWERS 10; A missouri licensed

pharmacy Class R pharmacies can participate in Class ,, or __ functions under their class

R permis - CORRECT ANSWERS A B C

Supervising pharmacies of a class R pharmacy can be no more than __ miles away

unless otherwise approved by the board. - CORRECT ANSWERS 50

How much experience must a tech have before working at a class R pharmacy?

Must they be certified? - CORRECT ANSWERS 1 year. Yes.

Employer training of class R techs must occur when? - CORRECT

ANSWERS Initially then annually.

Pharmacists supervising a class R pharmacy must be employed by and located at -

CORRECT ANSWERS The supervising pharmacy

Clsas R pharmacies must be staffed at least - CORRECT ANSWERS 8

hours per month

No record less than __ years old may be stored off-site - CORRECT

ANSWERS 2

Individuals/entities acquiring more than __% must notify the board within __ dyas -

CORRECT ANSWERS 25; 30

Dispensing errors that reached the patient must be reported within __ days of

discovery - CORRECT ANSWERS 10

Pharmacy remodeling must be reported to the board within __ days - CORRECT

ANSWERS 30

Recall of a compounded preparation must be reported to the board and _______

within __ days - CORRECT ANSWERS The prescriber; 3

Theft or diversion from a controlled substance waste container must be reported

within __ days - CORRECT ANSWERS 14

If a chiropractor has prescriptive authority in another state, can the script be filled at

a missouri pharmacy? - CORRECT ANSWERS Yes.

A candian licensed physician writes a prescription brought to a missouri pharmacy.

Can it be filled? - CORRECT ANSWERS No

Dentists, podiatrists, veterinarians, and optometrists may prescribe control/non-

control substances. T/F - CORRECT ANSWERS T. As long as it is within

their scope.

What can a prescriber self-prescribe? - CORRECT ANSWERS Non-

controlled substances and controlled substances only in emergency situations?

Can a prescriber prescribe for family members? - CORRECT ANSWERS

Yes, as long as they keep the same record as they would for a patient A retired physician wishes to prescribe an antibiotic for a grandson. Can he? -

CORRECT ANSWERS If his license is valid and active or inactive

(granted inactive status by the board of healing arts) he may prescribe non-control substances for himself or immediate family members.

When is security paper required for a prescription? - CORRECT ANSWERS

If it is electronically signed

What can't be changed on a prescription for a control substance? - CORRECT

ANSWERS Patient name, drug name, prescriber name, or the prescriber

signature

How may control substance changes be communicated? - CORRECT

ANSWERS Electronically, fax, email, mail, or verbally (if the prescribe has a

waiver from mandated electronic prescribing). If a patient present a prescription written by a deceased prescriber, may it be filled? -

CORRECT ANSWERS Yes, but refills must be dispensed using

professional judgement.

Electronic signatures are valid for what prescriptions? - CORRECT

ANSWERS All non-controlled substances whether faxed, written, etc.

E-prescribed controlled substances (not faxed CS)

Manual signatures are valid for what prescriptions? - CORRECT ANSWERS

All scripts except e-prescribed CS

Can a prescriber use a stamp for signing prescriptions? - CORRECT

ANSWERS No

Controlled substance expiration - CORRECT ANSWERS C2 - C4 = 6

months

What are the quantity limits for C2 - CORRECT ANSWERS 30 days and

no refills. 90 days with documented medical reason ____________ control substances may be written for a quantity of 90 days without

medical reason - CORRECT ANSWERS C3- 5

How many refills can be on a C5 prescription? - CORRECT ANSWERS

As many as the prescriber wants

C5 expiration - CORRECT ANSWERS 1 year

A patient has a script for Norco 5-325 #30 1t PO q6h PRN acute pain. This patient recently filled a prescription for this medication 3 months prior. Can this prescription

be filled assuming it is an otherwise valid script? - CORRECT ANSWERS

Yes, but not for the quantity prescribed. Only 7 days supply may be dispensed, as long the patient has seen the prescriber for a consultation. Who is exempt from 7 day supply opioid limits with control substances? -

CORRECT ANSWERS Cancer, palliative care, LTC, buprenorphine for

In telemedicine, the prescriber must have a license where? - CORRECT

ANSWERS Where the provider is and where the patient is.

Can a hospital allow a telemedicine doctor to use their DEA license number? -

CORRECT ANSWERS Yes

Which providers can purchase, administer, or dispense controlled substances? -

CORRECT ANSWERS Physicians and mid-levels if they have a CPA

C2 refill/quantity limits for APRNs - CORRECT ANSWERS Hydrocodone

products only Limited to a 5 day or 120 hour supply

C2 refill/quantity limits for PAs - CORRECT ANSWERS Hydrocodone

products only Limited to a 5 day or 120 hour supply

C3 opiate srefill/quantity limits for PAs - CORRECT ANSWERS Limited to

a 5 day 120 hour supply Prescription valid for 6 months No refills

C3 opiates refill/quantity limits for APRNs - CORRECT ANSWERS Limited

to a 5 day 120 hour supply Prescription valid for 6 months No refills

C3 non-opiates refill/quantity limits for APRNs - CORRECT ANSWERS

Full authority to prescribe 90 - day quantity limits Prescription valid for 6 months

C3 non-opiates refill/quantity limits for PAs - CORRECT ANSWERS

Limited to a 5 day 120 hour supply Prescription valid for 6 months No refills

C4 and C5 refill/quantity limits for APRNs - CORRECT ANSWERS 90 day

limit supply c4 scripts valid for 6 months c5 scripts valid for 12 months

C4 and C5 refill/quantity limits for PAs - CORRECT ANSWERS 90 day

limit supply c4 scripts valid for 6 months c5 scripts valid for 12 months

Buprenorphine refill/quantity limits for PAs and APRNs - CORRECT

ANSWERS 30 day supply limit

X-DEA number What are the limits for a c2 rx written by an out of state midlevel practitioner -

CORRECT ANSWERS Expiration: 6 months

Refills: none Supply limits:

• MO pt: 30 days, or 90 if documented medical reason
• Non-mo pt: as allowed in home state What are the limits for a c3 rx written by an out of state midlevel practitioner -

CORRECT ANSWERS Expiration: 6 months

Refills: as allowed in home state Supply limit:

• MO pt: 90 days
• non-MO pt: as allowed by home state What are the limits for a c4-5 rx written by an out of state midlevel practitioner -

CORRECT ANSWERS Expiration: c4 = 6 months, c5 = 12 months

Refills: as allowed in home state Supply limit:

• MO pt: 90 day supply
• non-MO pt: as allowed in home state T/F: Remote data entry must be monitored via real-time communication -

CORRECT ANSWERS T

Documentation of remote data training must be kept for __ years - CORRECT

ANSWERS 2

Describe image requirements for electronic final verification? - CORRECT

ANSWERS Image of medication must be the actual med in the actual bottle

(final product) What type of medication cannot solely be electronically verified by a pharmacist

(although technology may be used to assist)? - CORRECT ANSWERS

Compounded medications System validation (auto-verify) records of validation/revalidation must be kept... -

CORRECT ANSWERS 2 years

What allowances do techs/interns have with technology-assisted verification? -

CORRECT ANSWERS They may do the final verification of non-controlled

If a pharmacist wants to split a tablet, what are the requirements? - CORRECT

ANSWERS Literature says it is ok to do so

Prescriber has approved of any change Patient has been counseled

The beyond use date of a med pak is - CORRECT ANSWERS 90 days

If a med pak is returned, what is the new BUD? - CORRECT ANSWERS It

is the original 90 days that it was given.

Can removed meds from a med pak be returned to stock? - CORRECT

ANSWERS No

Who can receive meds sealed in a med pak that has been returned? What about

LTC facilities? - CORRECT ANSWERS Only the patient that they were

initially packaged for. They cannot be distributed if they were previously comingled with other medications. Meds from an LTC facility may be reused unless they are multi-med pak or controlled substance.

Who may issue a blanket easy off top request? - CORRECT ANSWERS

Only the patient

Can a prescriber request easy off tops for a patient? - CORRECT

ANSWERS Yes, but only on each designated prescription. They cannot do a

blanket request.

What is proper storage and expiration of drugs returned to stock - CORRECT

ANSWERS Must be stored in the containers that they were initially filled in

(not to the stock bottle), expire 1 year from dispensing or manuf expiration (whichever is sooner). Drugs may also be returned to an automated filling system, but the expiration of all meds in that pocket must be updated. Drugs returned from the patient because the wrong medication was filled must

be________________. - CORRECT ANSWERS Destroyed

What medications may be prescribed to a school? - CORRECT ANSWERS

Epi-pens and asthma medication A prescription written to Cass County Parks and Rec for epi-pen by John Doe NP is

sent to the pharmacy. Is this valid? - CORRECT ANSWERS No, only

physicians may write a prescription for a school or other entity for epi pens or albuterol A class __ permit is required for pharmacies that do sterile compounding. -

CORRECT ANSWERS H

When can a compound be used in an office? - CORRECT ANSWERS If a

valid prescription for a compound has been written for the patient it is to be used on (not for office use), or if it is for a veterinarians office. Can a pharmacy compound a stock supply? If so what are the limits? -

CORRECT ANSWERS Yes. There must be a valid prescription to

dispense and an established relationship must exist between the pharmacy, patient, and prescriber. 1 year supply of topicals and 3 month supply of a batched product.

Compounds not picked up by the patient must be.... - CORRECT ANSWERS

Batched and returned to stock

For what level of compound do you need shoe covers - CORRECT

ANSWERS risk level 2 and 3

How often do media fill tests need to be completed? - CORRECT ANSWERS

q 6 months for level 3 compounds annually for level 1 and 2 Hospitals may accept the media fill test from another facility in an emergency. After

__ days, an initial skills assessment must be completed. - CORRECT

ANSWERS 45

Frequency of cleaning PEC - CORRECT ANSWERS Daily and frequently

throughout the day with a germicidal followed by alcohol.

Counters and work surface frequency of cleaning - CORRECT ANSWERS

daily

Floors frequency of cleaning - CORRECT ANSWERS daily

ceilings and walls frequency of cleaning - CORRECT ANSWERS monthly

Storage shelving/supply bin cleaning frequency - CORRECT ANSWERS

monthly

How often do air samples need collected - CORRECT ANSWERS every 6

months

If air or surface sampling is over the acceptable limit, then what? - CORRECT

ANSWERS The pharmacy must cease compounding activities, or continue to

compound as long as they use a germicidal and sporicidal. Resampling is required.

To administer vaccines off-site, what is required? - CORRECT ANSWERS

The signed protocol must indicate that information. Prescription must be obtained or created within __ after an immunization under

protocol. - CORRECT ANSWERS 72 hours

VAERS events must be reported within how long - CORRECT ANSWERS

30 days

ShowMeVax data must be reported within - CORRECT ANSWERS 14

days

Medication Therapy Service (MTS) certificate is required to - CORRECT

ANSWERS Change or modify therapy pursuant to a protocol signed by a state

licensed physician

Can a pharmacist change controlled substances through a MTS? - CORRECT

ANSWERS No

Changes made through MTS must be communicated to who, and within what time

period? - CORRECT ANSWERS The physicians office or designee within

24 hours. __ hours of CE specifically in MTS must be obtained each renewal period for MTS

certificate holders - CORRECT ANSWERS 6

What records must be maintained for 5 years? - CORRECT ANSWERS -

Rx's

• remote data entry
• technology-assisted supervision

What records must be maintained for 8 years? - CORRECT ANSWERS -

MTS protocols

• immunization protocols

What records must be maintained for 7 years? - CORRECT ANSWERS

MTS patient records What actions/breaches must be reported to the board within 7 days? -

CORRECT ANSWERS Breaches of security in data (at a non dispensing

location) Breach of security at a class R pharmacy

What actions/breaches must be reported to the board within 15 days? -

CORRECT ANSWERS Any final disciplinary action against a pharmacy

worker Final adverse action or license surrender of a pharmacy Out of business notification Change of employment location Change of PIC

What events must be reported to the board within 10 days? - CORRECT

ANSWERS Dispensing error that reaches the patient

Change of partner in an LLC OR LLP Missouri MPJE

How old must someone be to be a pharm tech?

At least minimum legal working age

Where must certificates of board registration be displayed?

Conspicuously in the pharmacy