Is there a limit on the quantity prescribed for a Schedule II, III, or V narcotic?32 A. Although some states and many insurance companies limit the quantity of controlled substances dispensed to a 30‐day supply or 120 doses, whichever is less, there are no specific federal limits to quantities of drugs dispensed by a prescription. Review the law in individual states. Remember the most restrictive clause will prevail, whether state or federal.
33 Q. Can a Schedule II narcotic (e.g., Percocet) be phoned into the pharmacy?
34 A. Yes, but only for emergency situations. Federal law requires the prescriber to follow up with a written prescription sent to the pharmacy within 72 hours, but different states have different time limits. No refills are allowed.
35 Q. What is the purpose of e‐prescribing?
36 A.In 2010, the DEA legalized e‐prescribing of controlled substances to reduce drug fraud and abuse. All nonnarcotic prescriptions can be e‐prescribed. New York has the I‐STOP law (Internet System for Tracking Over Prescribing) which requires all prescriptions to be sent to pharmacies through e‐prescribing. In addition, as of 2016, all prescribers have to monitor patient use of controlled substance prescriptions via the PDMP.According to the DEA, as of 1 June 2010, it is permissible to have e‐prescribing for controlled substances in all 50 states; however, not all states are using it. E‐prescribing software must meet the DEA requirements and have the required certifications before e‐prescribing is allowed. In addition, some state laws and regulations will require changes before controlled substance e‐prescribing will be fully legal. E‐prescribing helps to reduce medication errors associated with prescribing (https://decisionresourcesgroup.com/drg‐blog/health‐reform/states‐require‐e‐prescribing‐combat‐fraud‐abuse).
37 Q. Can a Schedule II prescription be faxed to the pharmacy?
38 A. According to the DEA, in order to expedite the filling of a prescription, a prescriber may transmit a Schedule II prescription to the pharmacy by fax, but the original prescription must be presented to the pharmacist before the drug can be dispensed. The faxed copy is just an alert to the pharmacist that the patient is on the way with an original prescription. Otherwise, a fax for a Schedule II drug is not accepted.
39 Q. In which situations can a faxed C‐II prescription serve as an original prescription?
40 A. A faxed C‐II prescription can serve as an original for patients in a long‐term care facility (LTCF), community‐based care, enrolled in hospice, or receiving home infusion/IV pain management therapy. The fax must be signed by the prescriber.
41 Q. Can a Schedule III–V prescription be faxed to the pharmacist?
42 A. It depends. According to federal law, Schedule III–V substances can be faxed but certain states do not allow faxing of prescriptions for any controlled substance. The most restrictive clause will prevail. So, if federal law allows faxing but state law does not, the state law will succeed. According to the DEA, Schedule III–V prescriptions can be communicated orally, in writing, or by fax to the pharmacist and may be refilled (not more than five times within six months) as written on the prescription or by call‐in.
43 Q. Are preprinted prescriptions for controlled substances allowed?
44 A. No.
45 Q. What are the more common Latin abbreviations used in prescription writing?
46 A. See Table 2.2. Table 2.2 Common Latin abbreviations used in dental prescription writingAbbreviationMeaningqevery hourqhsevery nightqdevery dayq8hevery 8 hoursbidtwice a daycapcapsuletidthree times a dayqidfour times a daystatimmediatelyacat meal timeshhourhsat bedtimeNRno refillspcafter mealspoorally (by mouth)prnas neededtabtablet
47 Q. What are the different measurement systems used in pharmacy and for writing prescriptions?
48 A. The metric system which bases calculations on the base of 10. There is a metric unit of weight (gram [g]) and a metric unit of volume (liter [L]). The apothecary system, which is becoming obsolete, uses old measures of weights and volumes such as grains (gr). This system is also confusing because the abbreviation “gr” can be mistaken for gram, which is abbreviated “g.” The avoirdupois system or household system of weights is used for ordinary commodities such as ounce, teaspoonful, and tablespoonful.
49 Q. What is a milligram (mg)?
50 A. A milligram (mg) is a unit (metric system) of mass equal to one thousandth of a gram. Thus, 1 gram (g) equals 1000 milligrams (mg). It is advised to write “g” instead of “gm” as an abbreviation for gram because “gm” can easily be misinterpreted as “mg.”
51 Q. What is a grain?
52 A. A grain (gr) is a unit of (apothecary) measurement of mass and 1 g = 64.79 mg = 0.06479 g. It is often confused with grams, which is abbreviated “g.”
53 Q. What does the term “parts per million” mean when expressing permissible exposure to fluorides?
54 A. Parts per million when referring to permissible exposure to fluorides means the number of grams (g) per million mL of solution. For example, one part per million (ppm) is interpreted as one gram per million mL of solution.
55 Q. What does a 1 : 100 solution mean?
56 A. In calculating the amount of a drug that must be administered, especially if it is in solution, there is specific information that is required to do the calculations. The concentration of the drug in solution is expressed as gm/mL, or as a percent or as a ratio such as 1 : 100, 1 : 1000 and so on. A percent solution means what percentage of a drug is in 100 mL of solution.For example: 1 : 100 means that there is 1 g of drug in 100 mL of solution (1 g/100 mL) = 0.01 g/mL = 10 mg/mL = 1%1 : 100 000 = 1 mg/100 mL = 0.01 mg/mL = 0.001%5% solution means that there is 5000 mg/100 mL or 50 mg/mL. A simple way to figure this out is just to move the decimal one place to the right of the percent.3% hydrogen peroxide means 3 g of hydrogen peroxide in 100 mL of solution or 3000 mg/100 mL or 30 mg/mL.
57 Q. What is a Black Box Warning regarding certain drugs?
58 A. A Black Box Warning (sometimes called a boxed warning) is a warning found on the package insert of a drug. It is given this name because there is a black border around the text of the warning. According to the FDA, a boxed warning is given to drugs that have a significant risk of serious or life‐threatening adverse reactions. Note that every Black Box Warning has the date that the warning was announced by the FDA. Not all drugs have a boxed warning. Examples of some drugs related to dentistry with boxed warnings include the following.March 2011: fluoroquinolone antibiotics including levofloxacin (Levaquin®) can exacerbate muscle weakness in persons with myasthenia gravis.January 2011: the FDA asked drug manufacturers to voluntarily limit the strength of acetaminophen in prescription drug products, which are predominantly combinations of acetaminophen and opioids. This action will limit the amount of acetaminophen in these products to 325 mg per tablet, capsule, or other dosage unit, making these products safer for patients.In addition, a Boxed Warning highlighting the potential for severe liver injury and a Warning highlighting the potential for allergic reactions (e.g., swelling of the face, mouth, and throat, difficulty breathing, itching, or rash) are being added to the label of all prescription drug products that contain acetaminophen. These actions will help to reduce the risk of severe liver injury and allergic reactions associated with acetaminophen.Note: over‐the‐counter (OTC) products containing acetaminophen
