Answer Guide: Pharmacy Forensics, Legal and Ethical Practice Module Disclaimer: Please note these questions are not designed to be exact replicas of what you may receive on your written examination, they are however a useful tool to assist you in practicing the processes for multiple-choice questions and to identify area(s) of practice which may require further reading/study. To challenge yourself under exam conditions, use only the references which you intend to have available to you during the written exam (e.g. AMH, APF and other resources listed in the APC's Written examination candidate's guide) and consider setting a time limit for completion. Question 1 According to the Pharmacy Board of Australia s Guidelines for dispensing of medicines, which of the following is not a mandatory inclusion on a pharmacy-generated dispensed medication label? a) The brand and generic name of the medicine b) If dispensed for an animal, the owner s name and the kind of animal c) The date of dispensing or supply d) The fax number of the pharmacy or pharmacy department at which the script was dispensed e) A unique identifying code Answer = d Ref: PBA Guidelines for dispensing of medicines 7.1 and 7.2 Question 2 You decide to engage in advertising of your pharmacy services, and use the PBA Guidelines for advertising of regulated health services as a guide. Which of the following is a form of unacceptable advertising according to the Pharmacy Board of Australia? a) Advertising the gender of practitioners. b) Contact details of the office of the practitioner, including telephone numbers. c) The use of testimonials or purported testimonials. d) Non-enhanced photos or drawings of the practitioner or his or her office. e) A list of the practitioner s peer-reviewed publications. Answer = c Ref: PBA Guidelines for advertising of regulated health services 4 and 5
Question 3 In regards to the prescribing of controlled drugs, according to the Queensland Health (Drugs and Poisons) Regulation 1996, which of the following statements is INCORRECT? a) The prescriber s name, professional qualifications, and address, must appear on the front of a paper prescription or in an electronic prescription. b) The name, address, and date of birth of the patient for whom the controlled drug is prescribed. c) If the prescribed dose is more than the official dose of the controlled drug, a direction to dispense the higher dose that is underlined and initialled by the prescriber must be present on a paper prescription. d) If the prescriber intends for the controlled drug to be dispensed more than once, then a time that must elapse between each dispensing of the drug must be present. e) An electronic signature is not acceptable for electronically-generated controlled drug prescriptions, instead the prescriber must always physically sign the electronic prescription. Ref: Health (Drugs and Poisons) Regs 1996 QLD Part 4 Div 1, 79, page 73 Question 4 In regard to Emergency drug supply for prescribers (also known as Doctor Bag or Prescriber Bag ), which of the following statements is INCORRECT? a) The prescriber bag supply order form must be completed and signed in triplicate, with the pharmacist to keep all three copies of the order. b) The pharmaceutical benefits that are listed on the prescriber bag schedule are provided without charge to prescribers who then in turn can supply them free of charge to patients for emergency use. c) Prescribers may order the maximum quantity of an item provided they do not have the maximum quantity on hand. d) An authorised representative of the prescriber may sign for the receipt of the order form. e) Metoclopramide and prochlorperazine may not be ordered on the same prescriber bag order for one particular month. Answer = a Ref: Schedule of pharmaceutical benefits: http://www.pbs.gov.au/browse/doctorsbag
Question 5 Authorised Nurse Practitioner prescribing has been increasing since inception in September 2010. Which of the following statements regarding nurse practitioner prescribing is INCORRECT? a) The prescribing of PBS medicines by an authorised nurse practitioner is limited by their scope of practice, and state and territory prescribing rights. b) The Pharmaceutical Benefits Advisory Committee is responsible for making recommendations to the Minister for Health regarding medicines for prescribing by authorised nurse practitioners. c) Certain medications also have additional conditions for prescribing by authorised nurse practitioners, which are identified by the codes CTO or SCM. d) Regulation 24 does not apply for authorised nurse practitioners. e) Authorised nurse practitioner prescriptions may include repeats. Answer = d Ref: http://www.pbs.gov.au/browse/nurse Question 6 Regulation 24 a) Can be endorsed on a prescription written by an authorised optometrist prescriber. b) Can be endorsed on a prescription by a pharmacist to save the patient the hassle of revisiting the pharmacy to collect subsequent repeats. c) Refers to immediate supply necessary d) May be endorsed on a RPBS prescription under the words hardship conditions apply. e) Would not be appropriate for a scenario where the maximum PBS quantity is insufficient for the patient s treatment and returning to the pharmacy on a separate occasion would create hardship. Answer = d Ref: http://www.pbs.gov.au/info/healthpro/explanatorynotes/section1/section_1_2_explanatory_notes
Question 7 Alprazolam is included in which of the following schedules? a) Schedule 2 b) Schedule 3 c) Schedule 4 d) Schedule 7 e) Schedule 8 Ref: SUSMP amendment February 01, 2014 Question 8 Which of the following is CORRECT regarding the preparing of general PBS prescriptions? a) A prescriber can write more than one PBS prescription for the same pharmaceutical benefit for the same person on the same day. b) Back dating is permitted on PBS prescriptions. c) Optometrists may prescribe up to three pharmaceutical benefits on a single PBS prescription. d) If an item is restricted, and the use for the patient is different from the use specified in the restriction, the item still may be prescribed, but the prescriber should cross out the text PBS/RPBS and endorse the prescription with non-pbs. e) A PBS prescriber may prescribe a narcotic drug for him/herself, provided it is an authorised quantity and a phone approval number is obtained. Answer = d Ref: http://www.pbs.gov.au/info/healthpro/explanatorynotes/section1/section_1_2_explanatory_notes#preparing-general-pbs-prescriptions
Question 9 The Federal Government has developed the Close The Gap (CTG) program to improve the capability of the PBS to better meet the needs of Aboriginal and Torres Strait Islander people. Which of the following statements regarding Close The Gap is INCORRECT? a) Mupirocin 2% nasal ointment 3g is a listed authorised item for nasal colonisation with Staphylococcus aureus in an Aboriginal or Torres Strait Islander person. b) Ketoconazole 2% cream 30g is a listed authorised item for treatment of a fungal or yeast infection in an Aboriginal or Torres Strait Islander person. c) Prescribers belonging to general practices that participate in the Indigenous Health Incentive under the Practice Incentive Program may prescribe CTG PBS prescriptions. d) The annotation that appears on the original CTG prescription (eg CTG82K) will correspond to all future repeats (if authorised) of that original prescription. e) An approved pharmacist must undertake a specialised CTG-training course in order to dispense CTG prescriptions. Ref: http://www.pbs.gov.au/info/healthpro/explanatorynotes/section1/section_1_2_explanatory_notes#preparing-general-pbs-prescriptions and http://www.health.gov.au/internet/ctg/publishing.nsf/content/pharmacy-staff-resourcebooklet-measure-booklet#3 Question 10 The Pharmacy Board of Australia publishes the Code of conduct for registered health practitioners. Which of the following scenarios would not be considered as maintaining a high level of professional competence and conduct? a) Ensuring that you maintain adequate knowledge and skills to provide safe and effective care. b) Considering the balance of benefit and harm in all clinical management decisions. c) Providing treatment options based on the best available information. d) Consulting and taking advice from colleagues when advised. e) Taking steps to alleviate the symptoms and distress of patients only when a cure is possible. Ref: PBA code of conduct for registered health care professionals pg 3 (part 2.2) Symptoms should be alleviated regardless if a cure if possible or not at that point in time.
Question 11 What is the length of time a Controlled Drug (S8) script is valid for from the date it is prescribed? a) 1 month b) 3 months c) 6 months d) 9 months e) 12 months Answer = c Prescribing has been nationally standardised to reflect new expiries for S8 drugs to 6 months. Previously, in QLD, a S8 prescription was valid for 12 months. Question 12 An out of town patient, unknown to your pharmacy, presents with a prescription for Oxycontin CR 40mg 28 bd nil rpts. It is 8.30pm on a Friday night, and the patient is in some discomfort after travelling all day. Upon checking the forensics of the prescription you notice that the prescriber has not signed the prescription or handwritten the quantity and strength of the medication. There is no answer when you try contacting the prescriber. What is the most appropriate legal course of action in this scenario? a) Recognising that the patient is in discomfort and not wanting to interrupt continuity of care, it is best to dispense the prescription and supply the full amount as is and contact the prescriber on Monday, when you will ask for a new prescription. b) Recognising that the patient is in discomfort and not wanting to interrupt continuity of care, it is best to dispense the prescription and supply 14 tablets and contact the prescriber on Monday, when you will ask for a new prescription, and then supply the remainder of the prescription. c) Recognising that the patient is in discomfort and not wanting to interrupt continuity of care, it is best to dispense an emergency supply of the medication, giving 3 days worth (i.e. 6 tablets), and contact the prescriber on Monday to organise a legal prescription. d) Apologise to the patient and explain the situation that you are in, and recommend a paracetamol and codeine OTC preparation, and advise him to seek a local prescriber in the morning. e) Explain the illegalities of the script and sympathise with the position this leaves the patient in, whilst locating a prescriber willing to produce a legal script, which may involve sending the patient to an after-hours surgery, or hospital setting. Reasoning: Legally, the bottom answer is the most appropriate response. Due to the nature of the item being prescribed and the lack of history, the pharmacist has no option but to seek outside advice from after hours prescribers. Given the strength of Oxycontin required, OTC pain options would be inappropriate.
Question 13 With regard to dispensing an owing prescription, which of the following scenarios represents BEST PRACTICE? a) You are too busy to take the medical practitioner s phone call, so you ask the dispensary technician to transcribe the details on your behalf. b) You dispense a faxed prescription for methotrexate for a patient who you do not have any dispensing history, but as the script appears legal, you do not need to orally confirm the prescriber s intentions. c) A patient is prescribed a 5 day course of Augmentin Duo Ft (amoxycilin 875mg + clavulanic acid 125mg) for an uncomplicated UTI but is still showing symptoms, so you issue an owing supply for a further 5 day. d) After a faxed prescription is received for Atorvastatin 40mg for a patient with previous dispensing history, you confirm the prescription orally with the prescriber and ask for the original paper prescription to be sent to the pharmacy within 7 days. e) You dispense from an illegible faxed prescription as you are almost certain that the item prescribed matches the selected patient s dispensing history. Answer = d Ref: PBS what pharmacists need to know factsheet (if any confusion exists from option B any item with a complicated regimen or small TI should be confirmed with the prescriber, particularly in the case of no dispensing history). Question 14 When looking to confirm if a particular S3 poison is allowed to be advertised, where will this information be found? a) SUSMP, Appendix A b) SUSMP, Appendix H c) SUSMP, Appendix K d) National Health Act 1953, Section 91. e) National Health Act 1953, Section 97. Answer = b Ref: SUSMP http://www.comlaw.gov.au/details/f2013l01607
Question 15 The following statement refers to which poisons schedule? Substances with a low potential for causing harm, the extent of which can be reduced through the use of appropriate packaging with simple warnings and safety directions on the label a) Schedule 2 b) Schedule 3 c) Schedule 5 d) Schedule 7 e) Schedule 9 Answer = c Ref: SUSMP definitions of schedule Question 16 A prescriber wants to set up a staged supply program for their patient with your pharmacy and asks for your help. The patient is to receive 10 tablets of dexamphetamine 5mg every 2 days. With regards to staged supply, which of the following statements is CORRECT? a) Patients who are dosed via a staged supply agreement should not be offered a private consultation area to discuss how supply works as this will create suspicion from other patients in-store. b) A staged supply service may be initiated by the prescriber, the pharmacist, the patient/agent or another healthcare professional involved in the care of the patient. c) Dexamphetamine is subject to abuse and is therefore not recommended for staged supply. d) Dexamphetamine is subject to abuse and therefore a staged supply interval of anything longer than 24 hours is inappropriate. e) A service fee is a mandatory component of delivering a stage supply service in community pharmacy. Answer = b Ref: Stage Supply Professional Guidelines https://www.psa.org.au/download/practiceguidelines/staged-supply-guideline.pdf
Question 17 When considering the professional practice guidelines concerning Dose Administration Aids (DAAs), which of the following statements is INCORRECT? a) A patient brings in dispensed medication from a recent hospital visit, which you decide to reuse in future DAAs after you have been satisfied of the source and storage conditions of the medicines. b) Hygroscopic medications should not be removed from original packing before inserted into a DAA. c) All staff involved in the packing of DAAs should have appropriate training, which is documented in their training file. d) The patient should understand the benefits of the DAA service and instructions and procedures behind their use before being provided with the service. e) It is acceptable to leave an uncompleted DAA unsealed whilst the staff member responsible for packing answers the phone. Ref: http://www.psa.org.au/download/community-pharmacy-agreements/dose-administrationaids/professional-practice-standard-7.pdf Question 18 Under the Fair Work Act 2009, pharmacist can issue absence from work certificates. What is the maximum number of sick days a pharmacist can issue a certificate for? a) 1 b) 2 c) 3 d) 7 e) Pharmacists can no longer issue absence from work certificates Answer = b Ref: https://www.psa.org.au/guidelines/issuing-certificates-for-absence-from-work
Question 19 Paracetamol 500mg suppositories (pack size 24) belong to which schedule? a) Unscheduled b) Schedule 2 c) Schedule 3 d) Schedule 4 e) Schedule 8 Answer = b REF = SUSMP Question 20 In regards to the Highly Specialised Drugs (HSD) program, which of the following statements is INCORRECT? a) Only an accredited prescriber of medication for the treatment of HIV or AIDS who is approved by the State or Territory they practice in is authorised to prescribe such treatments. b) PBS HSD prescribed in public hospitals can only be dispensed and claimed by an approved public hospital using PBS online. c) Complex Authority Required HSD prescribed in public hospitals can only be dispensed and claimed for by a public hospital. d) All HSD prescribed in private hospitals can be dispensed and claimed for by a community pharmacy. e) HSD medications are eligible to count towards a patient s safety net. Answer = c REF = http://www.medicareaustralia.gov.au/provider/pbs/highly-specialised-drugs/