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daynuhmay
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act that prohibited adulteration and misbranding of foods & drugs
Pure Food & Drug Act
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FDCA
Federal Food, Drug, and Cosmetic Act
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prompted by deaths from sulfanilamide elixer
FDCA
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states that new drugs must be proven to be SAFE
FDCA
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established Rx and OTC drug classes
Durham-Humphrey Amendments
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authorized verbal/call-in prescriptions & refills
Durham-Humphrey Amendments
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prompted by thalidomide disaster
Kefauver-Harris Amendments
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stated that drugs must be proven to be EFFECTIVE
Kefauver-Harris Amendments
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established Good Manufacturing Practices (GMP)
Kefauver-Harris Amendments
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required informed consent of research subjects in investigational drug trials
Kefauver-Harris Amendments
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created incentives for pharma companies to create drugs for rare conditions
Orphan Drug Act
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stated that prescription labels must contain "Rx only"
FDA Modernization Act
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establishes the offenses of "adulteration" and "misbranding"
FDCA
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3 functions of the FDA
- 1) rulemaking
- 2) issue guidance documents
- 3) incorporate advice from standing advisory committees of outside experts
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FDCA prohibited acts (3)
- 1) receipt & delivery of adulterated/misbranded drugs
- 2) counterfeiting dugs
- 3) altering labeling
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FDA enforcement of the FDCA (4)
- 1) injunction
- 2) criminal proceedings
- 3) drug seizure
- 4) warning letter
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general penalties of FDCA offenses
fines ($1000-$1M), prison
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what does the FDCA *NOT* require on Rx label?
drug name
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document required to be issued to patient every time they fill for certain high risk drugs
MedGuide
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required in labeling when use of a drug may lead to death or serious injury
black box warning
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Pregnancy Warning: X
DO NOT TAKE if pregnant
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Pregnancy Warning: C
inadequate info to prove unsafe/contraindicated during pregnancy
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Phase I of NDA Process
detect adverse effects
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Phase II of NDA process
determine efficacy
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Phase III of NDA process
determine safety & efficacy on large scale
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which phases are informed consents required?
all 3
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gives FDA authority to require procedures ranging from MedGuides to limiting the drug to specified settings for dispensing
Risk Evaluation & Mitigation Strategy (REMS)
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designed to detect early signs of a drug's risk
- Sentinel Initiative
- established by FDA Amendments Act
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3 requirements generic manufacturers must demonstrate under the DPC and PTRA
- 1) same active generic ingredient
- 2) bioequivalence
- 3) acceptable manufacturing & control
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review process that approves drugs on the basis therapeutic category and conformance to a monograph
OTC drug review
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review process that approves drugs o a drug by drug basis
prescription drug review
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products derived from living organisms
biologics
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Class I drug
causes serious adverse effects or death
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Class II drug
product causes temporary adverse effects on health
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Class III drug
product not likely to cause adverse effects on health
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Rx insulin
anything that is NOT Novolin or Humulin
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Def'n of a drug (3)
- 1) recognized in the U.S. Pharmacopeia, Homeopathic Pharmacopeia, or National Formulary
- 2) intended for diagnosis, treatment, or prevention of disease
- 3) articles other than food intended to affect structure/fcn
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evidence a product is a drug (3)
- 1) labeling
- 2) advertising
- 3) nature of product
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Special Food Categories (2)
- 1) legal
- 2) publicly conceived
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legal (special food) categories (2)
- 1) special dietary foods (ex: gluten free)
- 2) medical foods (ex: infant formulas)
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Dietary Supplement Health and Education Act (DSHEA)
- -DS more food than drug
- -DS does not req premarket approval
- -only safety tested (NOT effectiveness)
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DSHEA only permits DS manufacturers to make health claims if.. (2)
- 1) FDA approves claim
- 2) by significant scientific agreement test
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may be made when claim does not meet the "significant scientific agreement test"
qualified health claim
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by FDCA definition, excludes articles that achieve their purpose through chemical action and metabolism
- device
- ex: IUD, drug eluting stent
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Does a DS firm have to provide the FDA with safety and efficacy info prior to product marketing?
NO
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FD&C Act defines a drug by its
intended use
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primary purpose of DSHEA
product safety
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2 major government agencies regulating drug advertising and promotion
- 1) FDA
- 2) Federal Trade Commission (FTC)
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type of advertising the FDA regulates
Rx drugs
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type of advertising the FTC regulates
OTC drugs
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reminder advertising
- brand/drug labeled materials (pens, clocks, etc)
- exempt from FDCA required labeling
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requirements of a "true statement" (3)
- 1) not misleading
- 2) presents fair balance
- 3) reveals material facts
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brochures, booklets, mailings, bulletins, calendars, etc dist'd to health care professionals by a manufacturer
labeling
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PhRMA Code on Interactions with Healthcare Professionals
- bans entertainment & recreational activities separate from or in conjunction with educational programming
- companies should not provide meals
- items that do not advance education should be be provided
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regulates deceptive ads
FTC under FTC Act
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Durham-Humphrey Amendments (3)
- 1) distinguishes Rx from OTC
- 2) allows verbal Rx & refills
- 3) specifies min info Rx label must contain
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beyond-use date
expiration date that is 1 year from dispensing (even if original packing exp date is later)
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3 methods to switch Rx drug to OTC
- 1) Supplemental New Drug Application (SNDA)
- 2) petition
- 3) adding/amending OTC drug monograph (affects all products in class)
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who has the authority to determine who may prescribe independently or in collaborative practice?
the state
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whether a pharmacist has a right to refuse to dispense prescriptions s/he has a moral or religious objection towards
conscientious objection
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products contain same active ingredients and are identical in strength/dosage form
pharmaceutical equivalence
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under the FDCA, is off-label prescribing and dispensing legal?
YES
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less than a 2-fold difference between median lethal dose and median effective dose
narrow therapeutic index (NTI)
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Prescription Drug Marketing Act
- requires state licensing of wholesalers
- regulates how drugs are marketed/distributed by wholesalers
- **prohibits community pharmacies from receiving samples**
- prevents hospitals from reselling drugs to community pharmacies
- requires pedigree
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prohibits community pharmacies from receiving samples
Prescription Drug Marketing Act
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