Texas MPJE Practice Questions

It is only required in Texas for Schedule II controlled substances in Class C (institutional) or Class F (Freestanding Emergency Medical Care Facilities) pharmacies to be kept in locked storage. For all other drugs and locations, controlled substances may be kept either in a secure cabinet that is locked or dispersed throughout the non-controlled stock.

Texas law requires that the purchaser of a product containing ephedrine, pseudoephedrine, or phenylpropanolamine be at least 16 years old.

A pharmacist may dispense a generic equivalent if the product costs less than the brand name prescribed, the patient does not refuse the substitution, and the prescriber has not prohibited substitution with a dispensing directive. For electronic prescriptions, a prescriber may prohibit substitution by specifying “brand necessary” or “brand medically necessary.” On a written prescription, this text must be written on the prescription (no check boxes or signature line indicators permitted). A dispensing directive may also be given over the phone.

The Schedule V opium limit under Texas law is 50 mg/100 mL, which is half the concentration permitted under federal law (100 mg/100 mL). Any product containing more than 50 mg/100 mL is considered a Schedule III controlled substance.

Schedule III–V controlled substances may be partially filled with no maximum number of fills as long as the total amount dispensed does not exceed the total number of dosage units initially authorized, and all partial fills are dispensed within six months of the initial prescription. Partial fills should not be treated as refills, which are limited to five in a six month period.

Schedule II controlled substance prescriptions may be faxed in Texas if a practitioner is prescribing a narcotic for a patient undergoing home infusion/IV pain therapy, any controlled substance for a patient in a long-term care facility, or a narcotic for a patient in hospice care. If a Schedule II prescription is faxed in one of these cases, it must be a fax of the Texas Official Prescription Form. For other situations, faxed Schedule II prescriptions are generally not valid. A Schedule II controlled substance prescription may be given over the phone in emergency situations, however, the quantity prescribed and dispensed must be limited to the amount needed to treat during the emergency period. Electronic prescriptions for Schedule II medications are permitted if all DEA requirements are met and the prescription is transmitted directly from the prescriber’s computer to the pharmacy’s computer, and there is no quantity limit on a single controlled substance prescription.

While there is no federal law limiting refills on Schedule V controlled substances, the Texas Controlled Substances Act limits refills to 5 refills or 6 months, whichever comes first.

Patients must be counseled by a pharmacist on all new prescriptions (Answer E is incorrect) unless counseling is refused, in which case the prescription may be dispensed without counseling (Answer B is incorrect). Technicians may not question or screen patients in an effort to limit interaction with the pharmacist (Answer A is incorrect). Counseling is required on new prescriptions (including dosage changes), but is not necessary if the patient is picking up a refill of a prescription they have filled at the pharmacy within the past year (Answer C is incorrect). If a patient refuses counseling on a new prescription, documentation of this must be made (Answer D is correct).

The pharmacist-in-charge is responsible for the education and training of pharmacy technicians.

Federal practitioners such as officials of the US Armed Forces, Public Health Service, or Bureau of Prisons are not required to register with the DEA. However, Schedule II prescriptions written by these practitioners may only be filled on the military base or at the facility where the prescriber practices. To fill a Schedule II prescription outside of these facilities, it must be written on a Texas official prescription form, and TSBP only issues these forms to DEA registered practitioners. A Schedule III–V prescription written by a federal practitioner who is not registered with the DEA may be filled off base or outside of the practice location.

The pharmacist-in-charge is required to have policies and procedures in place for handling prescription drug recalls. Recalled drugs must be removed from inventory within 24 hours of the recall notification.

Class G pharmacies are facilities established for the primary purpose of processing prescriptions and medication orders on behalf of another pharmacy, healthcare provider, or payor. They do not possess, store, or dispense medications. A freestanding facility providing emergency care to patients (Freestanding Emergency Medical Care Facility) requires a Class F pharmacy license.

There are many opportunities for obtaining CE credit that are offered in addition to ACPE-accredited courses. A complete list may be found in TSBP Rule 295.8.

A license can be reinstated upon successful completion of requirements set by the TSBP after 12 months.

TSBP requires that all invoices for controlled substances be initialed by the receiving pharmacist except in Class C-ASC (Ambulatory Surgical Centers) and Class F (Freestanding Emergency Medical Facility) pharmacies. At these locations, the person receiving, who does not have to be a pharmacist, must sign the invoice.

Pharmacy personnel preparing sterile preparations must pass an initial written and media-fill test of aseptic technique. After the initial test, personnel must be tested every 12 months for low- and medium-risk level compounding, and every 6 months for high-risk level compounding.