Controlled Substances: Scheduling, Prescribing, Dispensing, Inventory, Reporting
Controlled substance questions are the highest-yield area. Know the five federal schedules and the criteria distinguishing them (abuse potential, accepted medical use, dependence liability). Texas adopts the federal schedules and may add state scheduling actions. Prescribing and dispensing rules differ sharply by schedule: Schedule II generally requires written or qualifying electronic prescriptions with no refills; Schedules III–V allow limited refills within a defined window. Federal rules impose specific requirements for electronic prescriptions for controlled substances, partial fills, and emergency oral Schedule II orders that must be followed by a written prescription.
Inventory and reporting duties are heavily tested: initial and biennial inventories (exact counts for Schedule II, estimated counts for III–V), records of receipt and distribution, and reporting of theft or significant loss to DEA and state authorities. The PMP (prescription monitoring program) requires dispensing reporting and, in Texas, checking before dispensing opioids, benzodiazepines, barbiturates, and carisoprodol under specified conditions. Texas also regulates Schedule II prescriptions with supply limits and requires specific documentation.
Traps: mixing refill rules across schedules; forgetting the emergency oral Schedule II follow-up requirement; confusing inventory count precision by schedule; and overlooking PMP check obligations. Questions often hinge on a single schedule-specific detail.
Rule of thumb: identify the schedule first, then apply the rule set. Worked example: an oral emergency Schedule II order - the pharmacist may dispense only the quantity needed for the emergency, and the prescriber must provide a written prescription within the required follow-up period or further dispensing is barred.