Lecture 11: TPP + Drug Scheduling Flashcards Preview

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Flashcards in Lecture 11: TPP + Drug Scheduling Deck (43)
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1

what is the purpose of the Alberta Triplicate Prescription Program?

◦ TPP Alberta has been monitoring the use of prescription drugs prone to misuse and abuse since 1986.
◦ When prescribing and dispensing data meet certain criteria, they alert physicians and others involved in
the care of the patient. We provide resources to address these issues.

2

Which drugs are monitored by the
Alberta TPP?

What are Type 1 Drugs

Type 1 Drugs (secure prescription required)
◦ Buprenorphine
◦ Codeine (oral liquid)
◦ Fentanyl
◦ Hydrocodone
◦ Hydromorphone
◦ Meperidine
◦ Methadone
◦ Morphine
◦ Methylphenidate (Biphentin® and Concerta® do not require a TPP)
◦ Oxycodone
◦ Others

3

Which drugs are monitored by the
Alberta TPP?

What are Type 2 Drugs

Type 2 Drugs (secure prescription not required)
◦ Benzodiazepines
◦ Buprenorphine/Naloxone
◦ Codeine
◦ Methylphenidate
◦ Tramadol

Netcare ID of patient with Type 2 drug monitored
Zopiclone on PDL Type 2 sometimes needs it

4

where do the copies of TPP forms go?
time limit?

Using TPP Alberta’s secure 2‐part form for Type 1 TPP drugs
◦ Two copies, top copy to pharmacist, second
stays with prescriber
◦ Prescriptions must be brought into a pharmacy
within 72 hours
◦ A separate form for each triplicate drug is required
◦ Prescriber must provide indication

5

who are the TPP program participants? (7)

To prescribe any TPP medication, prescribers must register with the program. The program requires the use of a two part prescription (triplicate form) for all Type 1 and veterinary practice prescriptions. TPP also relies on Alberta Netcare’s Pharmaceutical Information Network (PIN) as a data source
◦ Alberta College of Pharmacists (ACP)
◦ Alberta Dental Association and College (ADA+C)
◦ Alberta Veterinary Medical Association (ABVMA)
◦ College of Physicians and Surgeons of Alberta (CPSA)
◦ Yukon Medical Council
◦ College and Association of Registered Nurses of Alberta (CARNA)
◦ College of Podiatric Physicians of Alberta

Program participants need to be registered with a college to get a number and get a pad

6

Describe the diff TPP medication types

Type 1 medications – require a prescriber to register with the TPP and use a triplicate prescription pad when prescribing these drugs
◦ Pharmacist must be presented with the top copy of the TPP form for Type 1 medications and for all
veterinary use medications (see TPP medication list)

Type 2 medications – are monitored electronically but do not require a prescriber to register or
use a triplicate prescription pad

Veterinary Practice Specific medications – triplicate required for all TPP medications (i.e. for all Type 1 medications, Type 2 medications and additional listed drugs)

7

what does the prescriber need to fill out for TPP prescription?'
what is already preprinted on the pad?

◦ Health Care # (blank for an animal)
◦ Date
◦ Patient Name
◦ If pet (owners name will be in brackets behind pet’s name)
◦ Patient Address
◦ Patient DOB (or animal DOB)
◦ Drug Name and Strength
◦ Quantity (Numeric and Alpha) - so can't add another number behind last digit
◦ Refills not allowed. Part‐fills may be indicated.
◦ Indication
◦ Directions
◦ Signature - Only prescriber can sign the pad

Preprinted
◦ Dr. Name and Address (prescribers are not allowed to share pads)
◦ Triplicate Rx Number (this is NOT the prescriber id)
◦ Two copies of the form = 1 triplicate
◦ Prescriber’s copy is kept in the patient’s chart

8

Mitte: 90 caps
Patient requires a prescription for Biphentin® 10 mg capsules. They take it as 1 capsule daily. They need a 3 month supply.

what example is this of?

No refills

Patient gets all 90 caps at once

9

Mitte: 30 caps, 2 refills (refill every 28 days)
Patient requires a prescription for Biphentin® 10 mg capsules. They take it as 1 capsule daily. They need a 3 month supply.

what example is this of?

Refills with interval

Patient gets 30 caps, next refill of 30 can be obtained in 28 days.

10

Mitte: 90 caps (release 30 caps every 28 days)
Patient requires a prescription for Biphentin® 10 mg capsules. They take it as 1 capsule daily. They need a 3 month supply.

what example is this of?

Part-fill (interval indicated)

Interval: Patient gets 30 capsules, next refill of 30 can be obtained in 28 days.

11

when can the pharmacist no longer accept a TPP (time)?

Must receive within 3 days of prescribing
◦ Day 1 is considered the date the prescription is written (cannot be honoured after midnight of the 3rd day). At their discretion, pharmacists may call the prescriber to obtain approval to use an expired prescription written on a TPP form. The authorization
should be documented on both copies.

12

what must the pharmacist add to the TPP opnce received?
what must they get to patient to do?

◦ Date filled or logged (write deferred if not filled and send the TPP after it has been logged)
◦ Assigned Rx Number
◦ DIN
◦ Quantity
◦ If triplicate prescribed for 90 tablets but only filled 30 tablets must write 30/90.
◦ Pharmacy License #
◦ Pharmacist Signature and License #

◦ Must have patient or agent: Sign the prescription upon PICK UP of drug
- signs at bottom to confirm they have received the prescription (or animal's owner signs)
- do not get the pt to sign in advance

◦ Pharmacist makes a photocopy of the triplicate and
mails it to the College of Physicians and Surgeons
only if the triplicate is for a compound, vet
medication or Yukon Triplicate (Yukon jurisdiction like ours)
◦ You still need to meet the Narcotic Regulations - Narcotic sales

13

Can the same form be used for several TPP meds?

No. A separate form is required for each TPP medication. Different strengths of the same medication
may be ordered on one form only if the orders are legible, and clearly indicate the prescribed
dosage and quantity

14

Can TPPs be faxed?

If the prescriber has used a label to note patient demographics, ensure that this information appears on both the CPSA and PHARMACY copies

Faxing TPP forms directly from the prescriber’s office is acceptable
◦ The prescriber destroys the original copy of the TPP form or marks it “VOID” and must never give it to
the patient
- if faxed, you must make a copy for the patient to sign, then the signed copy can be photocopied (on permanent quality paper) and sent to the College of Physicians & Surgeons

Changes or notes added to the TPP form should be added to the back of the form. If note is made on the PHARMACY COPY, it should also be added to the back of the CPSA copy that is returned.

15

Triplicate Prescription for Veterinarians

how is the program diff for Vets?

Many times the veterinarian will dispense the product from within their practice to the patient

Veterinary Specific medications ‐ In addition to those on the CPSA website ABVMA requires that the following drugs must be written on a TPP form:
◦ All Barbiturate preparations
◦ All codeine‐containing preparations
◦ Benzodiazepines and all other targeted substances listed in Regulation under the Controlled Drugs and Substances Act
◦ Tramadol
◦ Anabolic Steroids

Veterinarians do not require a methadone exemption to prescribe buprenorphine.

16

what products cannot be dispensed from a vet clinc?

ABVMA policy requires that there will be no dispensing of the following products from a veterinary clinic, even if prescribed on a TPP form
◦ Ketamine
◦ Euthanasia Solutions
◦ Sodium Pentobarbital
◦ General Anaesthetics (ex: Propofol, Halothane, Isoflurane)
◦ Alpha ‐2 ‐Agonists

17

what changes to the TPP Program due to
COVID have been made?

◦ The TPP Program remains active and prescribers and pharmacists should continue to adhere to the polices outlined in the TPP Alberta Guide.
◦ The temporary exemptions from Health Canada mean prescriptions for type 1 TPP medications that are sent by verbal order from physicians and other prescribers, or written by pharmacists will not require a secure TPP form.
◦ Verbal prescriptions bring the risk of errors and diversion, pharmacists should take any steps
necessary to authenticate the source of the verbal prescriptions, while physicians should be prepared to provide identifiers such as their license number.
◦ For all other circumstances, physicians and other prescribers should make every effort to
provide a secure form whenever possible, to prevent diversion and protect the public.

18

what to do for out of province prescriptions written on a normal Rx pad?

for any out‐of‐province prescriptions, pharmacists should contact the appropriate regulatory body in
the prescription’s province of origin as regulations vary by jurisdiction and profession.

Can fill for out of province patients but need to document and validate

19

Can pharmacists fill a TPP from another province?

If the prescriber is authorized to write the prescription in their province of employment, then you may fill it. Which medications various health professionals are permitted to prescribe varies by province. To confirm prescription validity, check with the prescriber’s college in their province of employment.

20

Are pharmacies required to send TPPs that come from other provinces somewhere?

- TPP forms should be sent to their provincial TPP, usually at the College of Physicians and Surgeons of the province that the prescription originated.
- British Columbia no longer requires the return of TPP forms.
- Saskatchewan has changed its triplicate program to no longer include specially printed triplicate prescription forms. Send photocopies of TPPs from Saskatchewan physicians to: College of Physicians and Surgeons of Saskatchewan

21

How often should TPP forms be sent to the TPP centre?

TPP forms should be sent daily if the volume of TPP prescriptions is high; however, a weekly schedule is acceptable. By regularly submitting copies of the TPP forms, prescribers can get up-to-date information on patients, and the monthly reports can flag potential abusers.

22

If a medication normally requiring a TPP form is purchased by one pharmacy for another for emergency use only, does it require another TPP form?

No. However, an order for emergency use, signed by the pharmacist receiving the medication, must be provided to the pharmacy selling the medication (refer to narcotic regulations).

23

If a palliative care patient cannot sign for a TPP drug, who can?

An agent of the patient can sign. If one is not available, the pharmacist can sign with an explanation of the circumstances, e.g., patient incapable of signing.

24

Drug Scheduling

Name 4 federal schedules

• F&D Regulations (PDL)
• Part G
• Narcotic Regulations
• B/TS Regulations

25

Drug Scheduling

Name 2 provincial scheduling bodies

• NAPRA
• ACP (exemptions)

26

How does federal correspond vs provincial schedules?

PDL for humans and namals - Sch 1 (A1)
- Some vaccines (excluding influenza vaccine)

N, C1, C2, C3, CP, T/C (Own Class)

NPD/EC - Schedule 2 (A2)
• Insulin, dimenhydrinate, epinephrine – Epipen, influenza vaccine, oral vaccine (cholera)

Schedule 3 (A3)
• Dimenhydrinate

Unscheduled (NPD)
• Acetaminophen, TUMS®

27

Define the following abbreviations
TC?
C1, C2, C3?
CP
N?
N1TPP, C1TPP, VPNTPP?
A1, A2, A3?
U?

TC for schedule of Benzodiazepines and other Targeted Substances
• C1 for part I to schedule G of F&D regulations of CDS Act
• C2 for part II to schedule G of F&D regulations of CDS Act
• C3 for part III to schedule G of F&D regulations of CDS Act
• CP for drug preparations to schedule G regulations of CDS Act
• N for schedule I (and narcotic regulation schedule) to CDS Act
• "TPP" after above descriptions if on Triplicate Rx Program (N1TPP, C1TPP, VPNTPP)
• A1 for schedule 1 additions to Alberta Pharmacy & Drug Act
• A2 for schedule 2 additions to Alberta Pharmacy & Drug Act
• A3 for schedule 3 additions to Alberta Pharmacy & Drug Act
• U for unscheduled products

28

who is responsible for market authorization?

who determines “where” (location in the pharmacy vs. convenience store) the product may be sold?

Health Canada is responsible for market authorization
NAPRA determines “where” (location in the pharmacy vs. convenience store) the product may be sold.

NAPRA – National Association of Pharmacy Regulatory
Authorities
• NAPRA’s members, the pharmacy regulatory authorities
throughout Canada, are the bodies with the responsibility
to determine the conditions of sale of drug products.
• NDSAC – National Drug Scheduling Advisory Committee
• Makes drug scheduling recommendations to NAPRA.

29

describe the 4 schedules

what principle is scheduling based on?

In general, the National Drug Schedules capture drugs that have been authorized for sale and classified as non-prescription by Health Canada

• Schedule I drugs require a prescription for sale.
• Schedule II drugs require professional intervention from the pharmacist (e.g. patient assessment and patient consultation) prior to sale.
• ACP SOPs: Pharmacist must conduct and document an assessment prior to sale
• Schedule III drugs must be sold in a licensed pharmacy, but can be sold from the self- selection area of the pharmacy. Pharmacist must be available for consultation.
• Unscheduled drugs can be sold without professional supervision, from any retail
outlet.

Cascading principle: Do many questions need to be ask, risk of harm, F/U?
If less strict drop to Sch 2 then Sch 3

30

what is the schedule for cholera vaccine?
what about other vaccines?

Cholera vaccine
- injected = Sch 1
- oral, inactivated = Sch 2

Vaccines
- part of a routine immunization program in most/all provinces and territories = Sch 2
- others not part of the program = Sch 1