NH MPJE cheat sheet

Practice of pharmacy in NH is defined by statute to include dispensing, compounding, interpreting prescriptions, drug utilization review, patient counseling, and administering drugs and vaccines; the definition sets the outer boundary of licensed activity.

A pharmacist license requires graduation from an ACPE-accredited program (or equivalent), passage of NAPLEX and MPJE, and a specified number of internship hours; NH also requires a jurisprudence (law) exam component for licensure.

Pharmacy technician registration in NH is handled by the Board; technicians work under direct pharmacist supervision, and the pharmacist-in-charge is responsible for documenting training and competency.

Pharmacy interns must be enrolled in or graduates of an accredited program and register with the Board; interns may perform pharmacist activities only under direct preceptor supervision, and the preceptor is accountable for the intern's acts.

A pharmacy permit is issued per physical location; a change of location, ownership, or name requires notification or a new permit, and the permit is not transferable between owners or addresses.

Nonresident pharmacies that ship into NH must register with the Board and comply with NH labeling, counseling, and recordkeeping requirements; they designate a pharmacist-in-charge responsible for NH compliance.

Licenses and registrations must be renewed on the Board's cycle; practicing on a lapsed license is unlicensed practice and grounds for discipline, and continuing education hours must be completed before renewal.

The pharmacist-in-charge is responsible for overall compliance: staffing, security, recordkeeping, sanitation, and ensuring that only licensed or registered personnel perform pharmacy functions.

A prescription must contain the patient's name and address, drug name, strength, dosage form, quantity, directions, prescriber's name and address, prescriber's DEA number for controlled substances, and date of issuance.

Refills are limited by the prescriber's authorization and by controlled substance schedules: Schedule II cannot be refilled; Schedule III and IV may be refilled up to 5 times within 6 months of issuance.

Prescription transfers between pharmacies are permitted for noncontrolled and Schedule III-V prescriptions; Schedule II prescriptions cannot be transferred for refill, though a one-time transfer of an unfilled Schedule II may be allowed under federal rules.

Substitution of a therapeutically equivalent generic is permitted unless the prescriber writes 'dispense as written' or the patient refuses; the dispensed product and its manufacturer must be recorded and the patient informed of the substitution.

Labels must include pharmacy name and address, prescription number, date, patient name, directions, drug name and strength, quantity, prescriber, and required auxiliary and cautionary statements; controlled substances carry the federal transfer warning.

Patient counseling must be offered on every new prescription and on refills when requested; counseling covers directions, storage, interactions, side effects, and what to do about missed doses.

Prescriptions may be transmitted orally, by fax, or electronically; oral orders must be reduced to writing and include the same elements as a written prescription, with the receiving pharmacist's identity recorded.

Expired drugs must be removed from active stock and quarantined; dispensing an expired or misbranded product is a dispensing error and a violation of pharmacy law.

Federal CSA schedules: Schedule I has no accepted medical use; Schedule II has high abuse potential with severe dependence; Schedule III-V have decreasing abuse potential and accepted medical use.

Schedule II prescriptions require a written, electronic, or emergency oral order; emergency oral orders must be followed by a written prescription within 7 days, and partial fills are limited to a 30-day supply unless the patient is in a long-term care facility or terminally ill.

Schedule III-V prescriptions expire 6 months from the date issued and may be refilled no more than 5 times; the prescriber may authorize additional refills only by issuing a new prescription.

A DEA registration is required for each registered location; registrants must maintain a biennial inventory, keep records of receipt and distribution, and store controlled substances securely.

Controlled substance records must be kept for at least 2 years and be readily retrievable; Schedule II records must be kept separately from other records, and inventories must be exact counts for Schedule II and estimated counts for III-V.

Loss or theft of controlled substances must be reported to DEA in writing within one business day of discovery, and to the NH Board; significant losses require a Form 106 and an internal investigation.

NH's prescription monitoring program requires dispensers to report controlled substance dispensing to the state database, and pharmacists must review the PMP before dispensing certain controlled substances per state requirements.

A prescriber's DEA number must be verified on controlled substance prescriptions; pharmacists have a corresponding responsibility not to fill prescriptions that lack a legitimate medical purpose.

The pharmacy must have a designated prescription area with a sink, adequate lighting, temperature control, and security; the area must be locked when a pharmacist is not on duty.

Drugs must be stored under conditions specified by the manufacturer; refrigerated items require a monitored thermometer, and temperature logs must be maintained and retained.

Records must be retained for the period required by NH law and DEA (generally 2 years for controlled substances); records must be readily retrievable for inspection by the Board or DEA.

Automated dispensing systems and pharmacy automation must be validated, have documented policies, and remain under pharmacist oversight; the pharmacist is responsible for the accuracy of the system's output.

Sterile compounding must follow USP <797> standards: cleanroom classification, environmental monitoring, personnel training, and media fill and gloved fingertip testing.

Nonsterile compounding follows USP <795> standards: master formulation records, compounding records, ingredient verification, and beyond-use dating based on stability and preservative content.

Hazardous drugs must be handled per USP <800>: negative pressure rooms, closed system transfer devices, personal protective equipment, and documented spill procedures.

Pharmacies must have a written quality assurance program that includes error detection, documentation, and periodic review, and must report dispensing errors as required by the Board.

A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm; errors should be documented and reviewed regardless of whether harm occurred.

Quality improvement uses a continuous cycle: identify errors, analyze root causes, implement changes, and monitor outcomes; documentation of the cycle is required for accreditation and Board review.

Adverse drug events and serious outcomes must be reported to the appropriate authority; the pharmacy must maintain an internal log of errors and near misses.

Look-alike/sound-alike drug names, high-alert medications, and pediatric dosing are priority targets for error prevention; independent double checks are required for high-alert drugs.

The pharmacist must perform a prospective drug utilization review before dispensing to screen for interactions, duplications, contraindications, and dosing errors.

Patient counseling and written information are core error-prevention tools; the pharmacist must confirm patient understanding and document refusal of counseling.

Continuous quality improvement programs must be reviewed at least annually by the pharmacist-in-charge; findings and corrective actions must be documented and available to the Board.

Grounds for discipline include unprofessional conduct, practicing beyond scope, dispensing errors that endanger patients, fraud, and practicing while impaired.

The Board may impose sanctions ranging from reprimand and fines to suspension or revocation of license, and may require additional training or supervised practice.

Due process requires notice of charges, an opportunity to respond, and a hearing before the Board; decisions are subject to appeal under the state administrative procedure act.

Impaired practice is handled through a diversion or monitoring program; self-reporting and participation may mitigate discipline, while failure to report an impaired colleague may itself be a violation.

Unprofessional conduct includes falsifying records, dispensing without a valid prescription, and failing to maintain patient confidentiality.

The Board may conduct inspections and investigations; refusal to cooperate with an investigation is a separate violation.

Disciplinary actions are reported to national databases (e.g., NPDB) and may affect licensure in other states.

Pharmacists may administer vaccines and certain medications under a protocol or standing order; NH allows pharmacist immunization authority with documented training and reporting to the state immunization registry.

Collaborative practice agreements allow pharmacists to manage drug therapy under a written agreement with a prescriber; the agreement must specify scope, protocols, and communication requirements.

Pharmacists have authority to dispense naloxone and other emergency medications under standing orders; they must provide counseling and document the dispensation.

The pharmacist must review the prescription monitoring program before dispensing controlled substances as required by state law, and must document the review.

Emergency and public health authority allows pharmacists to dispense and administer medications during declared emergencies under the direction of public health officials.

Scope of practice includes drug utilization review, patient counseling, and therapeutic interchange under protocol; activities outside the defined scope require additional credentialing.

Pharmacists must report suspected prescription fraud, forged prescriptions, and impaired prescribers to the appropriate authority.