Rhode Island Multistate Pharmacy Jurisprudence (MPJE) Practice Exam

Can Canadian pharmacies perform therapeutic substitution without prescriber approval?

1. Yes, under all circumstances

2. No, not without approval from prescriber

3. Yes, if the patient is informed

4. Yes, if it is for generic drugs

The correct answer is: No, not without approval from prescriber

Therapeutic substitution refers to the practice of replacing a prescribed medication with a different drug that has a similar therapeutic effect but may differ in formulation or active ingredients. In Canada, the regulations surrounding therapeutic substitution are quite stringent to ensure patient safety and maintain the integrity of the prescriber-patient relationship. Under Canadian pharmacy law, therapeutic substitution cannot occur without the explicit approval of the prescriber. This requirement is in place to ensure that the healthcare provider who understands the patient's specific medical history and treatment needs is involved in the decision-making process. By requiring prescriber approval, regulations help maintain continuity of care and safeguard against potential adverse effects that could arise from switching medications without professional oversight. While some jurisdictions may allow for certain levels of substitution under specific circumstances—like informing the patient or substituting within a class of drugs—such practices still typically require communication and, ultimately, consent from the prescriber. Therefore, the necessity for prescriber approval is a critical factor that reinforces the collaborative nature of healthcare, where pharmacists and physicians work together to optimize patient outcomes.