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1. Prior to Omnibus Budget Reconciliation Act of 1990 (OBRA-90) what was the status of patient education and the identification and detection of problems with drug therapy by pharmacists?

A. There was a clear expectation that pharmacists would consistently provide this level of service to all patients B. The law required this in community practice but not in institutional practice C. Pharmacists often accepted these responsibilities as a service to their patients D. This was considered unethical conduct for a pharmacist

2. From the perspective of 20 years later, how should OBRA-90 be viewed?

A. It is a disaster for patients and pharmacists B. It is a disaster for patients, but a value for pharmacists C. It is a disaster for pharmacists, but a value for patients D. It must be viewed as a success

3. For what additional professional expansion has OBRA-90 set the stage?

A. Generic substitution B. Medication Therapy Management C. Contemporaneous compounding D. Tech check tech

4. OBRA-90 was perhaps the most significant piece of federal legislation affecting pharmacy since which earlier law?

A. The Durham-Humphrey Amendment B. The Kefauver-Harris Act C. OBRA-87 D. The Drug Price Competition/Patent Term Restoration Act

5. OBRA-90 establishes a condition of participation in what program?

A. Medication Therapy Management B. Managed care pharmacy C. Medicare D. Medicaid

6. Under the OBRA-90 program, with what laws must pharmacists comply?

A. U.S. Food and Drug Administration (FDA) regulations B. Drug Enforcement Administration (DEA) regulations C. State laws D. Federal Trade Commission (FTC) regulations

7. Pharmacists have become recognized as having a responsibility to assure the appropriateness of medications prescribed for patients. What is this role called?

A. Gatekeeper B. Drug police C. Intervention D. Managed care

8. Approval of a new drug means that the drug has been determined to be more beneficial than detrimental for whom?

A. The population as a whole B. Each and every patient C. Patients who are compliant with directions for use D. Patients who read the MedGuide

9. One approach to drug therapy is defined as “the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life.” What is this approach called?

A. Professionalism B. Dedication C. Pharmaceutical Care D. Pharmacy quality commitment

10. In what way has OBRA-90 systematized the practice of pharmacy?

A. It anticipates bad outcomes and promotes good outcomes B. It imposes severe penalties for noncompliance C. It requires extensive technician training D. It weeds out the “bad apples” from the profession

11. What was the deadline for states to adopt expanded standards of pharmacy practice under the mandate of OBRA-90?

A. 1990 B. 1991 C. 1992 D. 1993

12. What agency promulgated the initial rules for OBRA-90 compliance?

A. Health Care Financing Administration (HCFA) B. FDA C. DEA D. Agency for Healthcare Research and Quality (AHRQ)

13. OBRA-90 reverses a trend of paternalism in drug regulation. Under OBRA-90, who has the ultimate responsibility for the outcomes of drug therapy?

A. Patients B. Prescribers C. Pharmaceutical manufacturers D. FDA

14. What section of OBRA-90 is most directly relevant to pharmacy practice?

A. Rebates B. Demonstration projects C. Drug Use Review (DUR) D. Medication Therapy Management

15. At what point does the DUR cycle end?

A. After one revolution B. When problems have been solved C. When the most pressing departures from standards have been addressed D. It never ends

16. Under the OBRA-90 program, there are allowable deviations from criteria. What is this called?

A. Flexibility B. Standards C. Professional judgment D. Professional discretion

17. Which of the following is listed in OBRA-90 as a potential problem for which pharmacists should screen prescriptions?

A. Unnecessary expense B. Poor reputation of prescriber C. Incorrect drug dosage D. Noncompliance with drug therapy

18. Under the OBRA-90 program, as administered by the states, who may do actual patient counseling?

A. Any person to whom the pharmacist delegates this responsibility B. A clerk or a technician or a pharmacist C. A technician or a pharmacist D. Only a pharmacist

19. OBRA-90 requires that pharmacists make a reasonable effort to obtain, record, and maintain at least certain pieces of information. What is listed in OBRA-90 as one of these pieces of information?

A. Patient disease state B. Patient's end of life care preference C. Patient's willingness to receive generic drugs D. Patient's willingness to use mail-order pharmacy

20. What have many people considered to be the “Achilles' heel” of OBRA-90?

A. Low compensation for pharmacists B. Physician opposition C. The patient's right to waive counseling D. Time constraints in pharmacy