Drug Information and Interactions

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• Spring 2009 – DEA sanctions LTC Pharmacies; likely to trigger onerous new prescribing requirements for everyone.  In recent weeks, federal Drug Enforcement Administration (DEA) agents have conducted inspections in several long-term care (LTC) pharmacies in Ohio.  The agents are focusing on several areas of concern including: 
  

1. dispensing CII, III, IV and V drugs based upon a chart order faxed by the facility to the pharmacy.  DEA does not consider a chart order to meet the legal requirements of a valid prescription order  under 42 CFR 1306.21.  DEA also does not recognize the LTC nurse as the agent of the prescriber.
2. dispensing III, IV and V drugs upon the oral orders of the LTC nurse, after the nurse has received the order from the physician.  Again, the DEA does not recognize the LTC nurse as the agent of the prescriber.
3. using the exception for emergency orders for non-emergencies, including situations where the need for the drug could have been anticipated by the prescriber/pharmacy failed to obtain timely a new \ prescription.
4. drugs dispensed from a e-box without a valid prescription. 

The American Society of Consulting Pharmacists published a Q&A bulletin describing the DEA’s rules for prescribing in the LTC setting.  These differ vastly from common industry practice.  Read the Q&A here.   ECP’s management company, Geriatric Practice Management is developing a e-fax solution for scheduled drugs that should be both compliant and less onerous than managing paper faxes.  This should be ready by mid June 2009.

• Effects of Common Drugs on PT/INR values - This handy pamphlet provides qualitative descriptions of the effect of commonly used pharmaceuticals on PT/INR values. It can help clinicians better understand possible underlying causes contributing to changes in these laboratory values. The pamphlet was originally produced by Medical Review of North Carolina, Inc. under a contract with the Centers for Medicare & Medicaid Services (CMS), formerly HCFA.


• Excerpts from the CMS State Operations Manual F329. The three following tables are excerpted from Appendix PP of the State Operations Manual
  CMS List of Unnecessary Medications a modification of the Beers List
  
Anticholinergic Drugs
Common Medication-Medication Interactions



• 2002 Beers List (update) – Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

  Results of a US Consensus Panel of Experts – Link to Archives of Internal Medicine article updating a list of medications with potential adverse effects in older adults.  This list is employed by Nursing Home Surveyors as a screening tool.  While some of these medications are appropriate to use in a LTC setting, clinicians should take extra steps to document the reason for use of a listed medication:

  2002 Beers List