Pharmaceutical Agents: Prescriptive Authority, Formulary, and Recordkeeping
What this domain covers
This domain tests Connecticut optometrists' authority to use and prescribe pharmaceutical agents, the limits of the formulary, and the prescription records that must support the decision.
Core rules
- Scope of authority. TPA authority covers pharmaceutical agents for diagnosis and treatment of conditions of the eye and its adnexa. It does not authorize treating systemic disease or performing surgery.
- Formulary. The statute and DPH regulations define which categories of agents may be used. Diagnostic agents include topical anesthetics and mydriatics; therapeutic agents include anti-infectives, anti-inflammatory agents, and glaucoma medications as permitted. Controlled substances require separate registration and compliance.
- Prescription requirements. A prescription must be patient-specific and include the drug, strength, dosage form, quantity, directions, refills, date, prescriber identification, and any required DEA number. Pre-signed blank prescriptions are not permitted.
- Recordkeeping. Document the indication, findings, allergy history, drug and dose, instructions, follow-up plan, and any adverse response. For controlled substances, check the Connecticut Prescription Monitoring Program as required and document the check.
- Referral and co-management. If the condition requires surgery, hospitalization, or systemic workup beyond scope, refer and document.
Worked example
An optometrist diagnoses preseptal cellulitis in an adult without orbital signs. The optometrist prescribes an oral antibiotic, documents the absence of proptosis, pain with eye movement, and vision loss, and schedules a 48-hour follow-up. That is within therapeutic authority if the drug is on the formulary. If the same patient has orbital signs, the optometrist should arrange urgent ophthalmology or emergency evaluation rather than simply adding a second oral drug.
Traps that cost marks
- Prescribing for a systemic infection because the eye is "connected" to the body.
- Using a drug that is not on the Connecticut formulary.
- Omitting the indication or follow-up plan from the record.
- Forgetting PMP checks and DEA requirements when a controlled substance is prescribed.
- Relying on a verbal order with no written prescription or chart entry.