| (a) An optometric glaucoma specialist may administer
and prescribe any drug authorized by the Texas Optometry Act, §351.358
and §351.3581, in addition to those drugs that may be administered
and prescribed by a therapeutic optometrist.
(b) The requirements of §280.5 of this chapter
(relating to Prescription and Diagnostic Drugs for Therapeutic Optometry
and the statutes cited in the rule apply to the optometric glaucoma
specialist's prescription orders, the administration of drugs in the
optometric office and the labeling of drugs supplied to patients.
The requirements for a prescription order for a Controlled Substance
are listed in subsection (f) of this section.
(c) An optometric glaucoma specialist may administer
and prescribe appropriate medications in accordance with the Texas
Optometry Act Section 351.3581, in addition to those drugs authorized
by §280.5 of this chapter:
(1) appropriate oral and topical pharmaceutical agents
used for diagnosing and treating visual defects, abnormal conditions,
or diseases of the human vision system, including the eye and adnexa;
(2) appropriate medication by parenteral means and
purpose pursuant to Section 351.3581 of the Texas Optometry Act, and
(3) antiglaucoma drugs.
(d) An optometric glaucoma specialist may inject appropriate
medications to treat a patient who has an anaphylactic reaction in
order to counteract the anaphylaxis. The optometric glaucoma specialist
shall immediately refer the patient to a physician.
(e) An optometric glaucoma specialist may independently
administer oral carbonic anhydrase inhibitors for emergency purposes
only and shall immediately refer the patient to an ophthalmologist.
(f) Controlled Substances.
(1) The following paragraphs apply to an optometric
glaucoma specialist possessing, administering or prescribing a Schedule
III, IV or V analgesic Controlled Substance. The paragraphs also apply
to an optometric glaucoma specialist who has obtained the registrations
necessary to possess, administer or prescribe a Schedule III, IV or
V Controlled Substance.
(2) An optometric glaucoma specialist must possess
a current Controlled Substances Registration from the United States
Drug Enforcement Administration (DEA) in order to procure, possess,
administer or prescribe a Schedule III, IV or V analgesic Controlled
Substance. A licensee applying for or possessing a Controlled Substances
Registration must observe all requirements of the Texas Controlled
Substances Act, the Health and Safety Code, Chapter 481, and applicable
federal law.
(3) All prescriptions for a Schedule III, IV or V Controlled
Substance shall contain the following information (Licensees telephoning
or communicating the prescription orally to a pharmacist shall supply
the information in this subsection to the pharmacist, except for the
signature of the optometric glaucoma specialist.):
(A) date of issuance;
(B) name, address and date of birth of the patient
for whom the controlled substance is prescribed;
(C) name, strength and quantity (written as both a
number and as a word) of the controlled substance prescribed;
(D) direction for use of the controlled substance;
(E) intended use of the controlled substance prescribed
unless the optometric glaucoma specialist determines the furnishing
of this information is not in the best interest of the patient;
(F) printed or stamped name, address and business telephone
number of the optometric glaucoma specialist;
(G) written signature of the prescribing optometric
glaucoma specialist;
(H) complete license number of the prescribing optometric
glaucoma specialist; and
(I) DEA registration number.
(4) An optometric glaucoma specialist shall maintain
a complete and accurate record of purchases (to include samples received
from pharmaceutical manufacturer representatives) and administrations
of Schedule III, IV or V analgesic Controlled Substances.
(5) The record keeping listed in this section shall
be subject to inspection at all times by the Texas Department of Public
Safety, the U.S. Drug Enforcement Administration and the Texas Optometry
Board, and any officer or employee of the governmental agencies shall
have the right to inspect and copy records, reports and other documents,
and inspect security controls, inventory and premises where Schedule
III, IV and V analgesic controlled substances are possessed or administered.
(6) Minimum security controls shall be established
to include, but not limited to:
(A) establishing adequate security to prevent unauthorized
access and diversion of the controlled substance;
(B) during the course of business activities, not allowing
any individual access to the storage area for controlled substances
except those authorized by the optometric glaucoma specialist;
(C) storing the controlled substance in a securely
locked, substantially constructed cabinet or security cabinet which
shall meet the requirements under the DPS Drug Rules; and
(D) not employ in any manner an individual that would
have access to controlled substances who has had a federal or state
application for controlled substances denied or revoked, or has been
convicted of a felony offense under any state or federal law relating
to controlled substances or been convicted of any other felony, or
has been a licensee of a health regulatory agency whose license has
been revoked, canceled or suspended.
(7) Failure of the optometric glaucoma specialist to
maintain strict security and proper accountability of controlled substance
shall be deemed to be a violation of the Texas Optometry Act, §351.501
and §351.551.
(g) Prescribing a Controlled Substances Schedule III,
IV or V analgesic.
(1) If permitted by the generally accepted standard
of care, an optometric glaucoma specialist may prescribe a Schedule
III, IV or V analgesic if the following minimum requirements have
been met:
(A) Evaluation of the patient.
(i) An optometric glaucoma specialist is responsible
for obtaining a medical history and a physical examination that includes
a problem-focused exam specific to the chief presenting complaint
of the patient.
(ii) Should the optometric glaucoma specialist prescribe
a Schedule III, IV or V analgesic, the medical record shall document
the medical history and physical examination, including:
(I) the nature and intensity of the presenting pain;
(II) current and past treatments for the presenting
pain;
(III) underlying or coexisting diseases and conditions;
(IV) any history and potential for substance abuse
or diversion; and
(V) the presence of one or more recognized medical
indications for the use of a dangerous or scheduled drug.
(B) Prior to prescribing a Schedule III, IV or V analgesic,
an optometric glaucoma specialist must review the prescription data
and history related to the patient, if any, contained in the Prescription
Drug Monitoring Program set out in §§481.075, 481.076, and
481.0761 of the Texas Health and Safety Code, unless:
(i) the patient has been diagnosed with cancer or the
patient is receiving hospice care and the optometric glaucoma specialist
clearly notes in the prescription record that the patient was diagnosed
with cancer or is receiving hospice care, as applicable; or
(ii) the optometric glaucoma specialist makes a good
faith attempt to comply but is unable to access the information under §481.076(a)(5)
of the Texas Health and Safety Code because of circumstances outside
the control of the prescriber or dispenser.
(C) Informed consent. It is the responsibility of the
optometric glaucoma specialist to discuss the risks and benefits of
the use of a Schedule III, IV or V analgesic with the patient, persons
designated by the patient, or with the patient's surrogate or guardian
if the patient is without medical decision-making capacity. This discussion
must be documented by a contemporaneous notation included in the medical
records. Discussion of risks and benefits must include an explanation
of the:
(i) diagnosis;
(ii) treatment plan;
(iii) anticipated therapeutic results, including the
realistic expectations for sustained pain relief and improved functioning
and possibilities for lack of pain relief;
(iv) therapies in addition to or instead of drug therapy,
including physical therapy or psychological techniques;
(v) potential side effects and how to manage them;
(vi) adverse effects, including the potential for dependence,
addiction, tolerance and withdrawal; and
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