All questions
Question 1
A pharmacy technician spills a few drops of liquid nicotine from an e-cigarette refill bottle. After cleaning the spill with paper towels, the towels and used gloves must be disposed of in which type of container?
- A red sharps container
- A regular trash receptacle
- A black hazardous waste container (correct answer)
- A blue non-hazardous pharmaceutical waste container
Explanation: Nicotine is a P-listed, acutely hazardous waste. Any materials, including personal protective equipment (PPE) and cleaning supplies, that come into contact with a P-listed drug must be disposed of as hazardous waste in a designated black container.
Question 2
A technician is cleaning up a spill of powdered cyclophosphamide, a U-listed drug. The personal protective equipment (PPE) worn during the cleanup, such as the gown and gloves, must be disposed of in what manner?
- In a red biohazard bag for incineration.
- In the regular trash after being placed in a sealed plastic bag.
- In the black container for hazardous pharmaceutical waste. (correct answer)
- In the yellow container for trace chemotherapy waste.
Explanation: Materials used to clean up a spill of a hazardous drug, including the PPE, are considered grossly contaminated and must be disposed of as bulk hazardous waste. Therefore, they must be placed in the black RCRA hazardous waste container. The yellow container is for trace waste, not spill cleanup materials.
Question 3
While cleaning the pharmacy, a technician finds an expired bottle of multivitamins, a used lancet in a protective cap, and a sealed but expired epinephrine auto-injector. Which item requires disposal as P-listed hazardous waste?
- The expired bottle of multivitamins.
- The used lancet in its protective cap.
- The expired epinephrine auto-injector. (correct answer)
- None of the items are hazardous.
Explanation: Epinephrine is a P-listed drug, making the expired auto-injector a hazardous waste item requiring disposal in a black container. The multivitamins are non-hazardous (blue container). The used lancet is a sharp (red container).
Question 4
Which federal agency is primarily responsible for creating and enforcing regulations for the disposal of hazardous pharmaceutical waste under the Resource Conservation and Recovery Act (RCRA)?
- Food and Drug Administration (FDA)
- Drug Enforcement Administration (DEA)
- Environmental Protection Agency (EPA) (correct answer)
- Occupational Safety and Health Administration (OSHA)
Explanation: The Environmental Protection Agency (EPA) is the federal body that regulates the proper management and disposal of hazardous and non-hazardous solid waste in the United States under the authority of RCRA. The FDA regulates drug approval, the DEA regulates controlled substances, and OSHA regulates workplace safety.
Question 5
According to the Resource Conservation and Recovery Act (RCRA), which of the following medications is a P-listed hazardous waste that requires special handling for disposal?
- Warfarin (correct answer)
- Metformin
- Lisinopril
- Amoxicillin
Explanation: Warfarin is an anticoagulant that is designated as a P-listed drug by the Environmental Protection Agency (EPA). P-listed drugs are considered acutely hazardous, and any amount of residue makes the container or contaminated item hazardous waste. Metformin, lisinopril, and amoxicillin are not on the P or U lists and are considered non-hazardous pharmaceutical waste.
Question 6
Under federal guidelines for segregating pharmaceutical waste, which color container is specifically designated for the disposal of P-listed and U-listed hazardous drug waste?
- Yellow
- Black (correct answer)
- Red
- Blue
Explanation: Black containers are used for the disposal of hazardous pharmaceutical waste, which includes drugs on the EPA's P-list and U-list, as well as drugs exhibiting hazardous characteristics (e.g., ignitability). Yellow containers are for trace chemotherapy waste, red for sharps, and blue for non-hazardous pharmaceutical waste.
Question 7
A pharmacy is preparing to dispose of several expired drugs. All of the following require handling as P-listed hazardous waste EXCEPT:
- Nicotine gum
- Physostigmine injection
- Warfarin tablets
- Mitomycin injection (correct answer)
Explanation: Mitomycin is a chemotherapy drug that is classified as a U-listed hazardous waste, which is toxic. Nicotine, physostigmine, and warfarin are all examples of P-listed drugs, which are classified as acutely hazardous. While both U-list and P-list wastes are hazardous, it is important to know the distinction.
Question 8
A pharmacist administers an epinephrine injection from a vial, leaving the vial empty. According to RCRA regulations, how must this empty vial be disposed of?
- Placed in a regular trash can because it is empty.
- Placed in the red sharps container and handled as regular sharps waste.
- Placed in the black hazardous waste container. (correct answer)
- Rinsed three times and placed in the glass recycling bin.
Explanation: Epinephrine is a P-listed drug. Under RCRA, any container that held a P-listed drug is considered hazardous waste, even if it is empty. Therefore, the vial must be disposed of in the black container for hazardous waste.
Question 9
Which of the following items would be classified as U-listed hazardous waste under RCRA and must be disposed of in a black container?
- An expired bottle of amoxicillin tablets
- A syringe used to administer a flu vaccine
- An unopened box of cyclophosphamide for injection (correct answer)
- An empty vial that contained warfarin
Explanation: Cyclophosphamide is a chemotherapeutic agent classified as a U-listed hazardous waste due to its toxicity. Amoxicillin is non-hazardous. A flu vaccine syringe is a sharp but not hazardous waste. An empty warfarin vial is a P-listed hazardous waste.
Question 10
Some aerosol inhalers, even if the medication itself is not on a P- or U-list, must be disposed of as hazardous waste. What is the primary reason for this requirement?
- The canister contains a propellant that makes it an ignitable hazardous waste. (correct answer)
- The medication residue in the canister is considered acutely toxic.
- All inhaled medications are automatically classified as biohazardous.
- The plastic actuator is not recyclable and contaminates landfills.
Explanation: Many aerosol canisters contain propellants that are flammable. Under RCRA, this makes the entire unit an ignitable hazardous waste (D001 characteristic) and requires it to be disposed of in a black hazardous waste container, regardless of the medication inside.
Question 11
A pharmacy has an expired stock bottle of oxycodone, a C-II controlled substance. For disposal purposes under RCRA, this medication is typically classified as:
- P-listed acutely hazardous waste.
- U-listed toxic waste.
- ignitable hazardous waste.
- non-hazardous pharmaceutical waste. (correct answer)
Explanation: While oxycodone is a highly regulated controlled substance by the DEA, it is not listed as a P- or U-list hazardous waste by the EPA, nor does it typically exhibit hazardous characteristics. Therefore, under RCRA, it is considered non-hazardous. Its disposal must follow strict DEA rules for controlled substances, which are separate from EPA hazardous waste rules.
Question 12
The EPA's P-list of hazardous wastes includes drugs that are specifically classified as:
- acutely toxic. (correct answer)
- corrosive.
- ignitable.
- carcinogenic.
Explanation: P-listed wastes are commercial chemical products that are designated as acutely hazardous by the EPA. This means they can be fatal to humans in low doses. Corrosive and ignitable are characteristics of hazardous waste (D-list), while carcinogenic drugs are typically found on the U-list.
Question 13
Which of the following items represents bulk chemotherapy hazardous waste and must be disposed of in a black RCRA container?
- A pair of gloves worn while compounding fluorouracil.
- A vial of methotrexate that is more than 3% full by weight of its original volume. (correct answer)
- An empty syringe that once contained a chemotherapy drug.
- An IV administration set used to infuse a chemotherapy drug.
Explanation: The "3% rule" is a standard used to differentiate between bulk and trace chemotherapy waste. Any container with more than 3% of its original volume remaining is considered bulk hazardous waste and must be placed in a black container. The other items are considered trace chemotherapy waste and would be placed in a yellow container.
Question 14
A patient returns a partially used physostigmine ophthalmic solution to the pharmacy take-back program. The pharmacy must manage this returned medication as:
- biohazardous waste in a red bag.
- non-hazardous waste in a blue container.
- P-listed hazardous waste in a black container. (correct answer)
- regular trash, since it was returned by a patient.
Explanation: Physostigmine is a P-listed, acutely hazardous drug. Once a pharmacy takes possession of it with the intent to discard it, it must be managed as hazardous waste according to RCRA regulations, regardless of its source. It must be segregated into a black container.
Question 15
U-listed pharmaceutical wastes, which include many antineoplastic agents, are designated as hazardous primarily because they possess which characteristic?
- They are acutely toxic in very small doses.
- They are ignitable or reactive with other chemicals.
- They are toxic, carcinogenic, mutagenic, or teratogenic. (correct answer)
- They are also regulated as controlled substances by the DEA.
Explanation: U-listed wastes are discarded commercial chemical products that are designated as hazardous because they are toxic. This toxicity can manifest as being carcinogenic (causing cancer), mutagenic (damaging DNA), or teratogenic (causing birth defects). Acutely toxic drugs are on the P-list.
Question 16
A full, sealed manufacturer's stock bottle of warfarin tablets has expired and is designated for disposal. What is the correct procedure for this item?
- It can be returned to the manufacturer for credit, so it is not waste.
- It must be segregated and managed as RCRA hazardous waste. (correct answer)
- It should be disposed of in a sewer with a witness per hospital policy.
- It can be sent to the reverse distributor with non-hazardous drugs.
Explanation: Once the decision is made to discard a medication, it becomes waste. Because warfarin is a P-listed drug, the full bottle is considered hazardous waste under RCRA. It must be properly segregated (into a black bin) and sent for disposal via a licensed hazardous waste hauler, which may be a reverse distributor that is also permitted to handle hazardous waste.
Question 17
A technician is sorting expired medications for disposal. Which of the following items is considered non-hazardous pharmaceutical waste and should be placed in a blue disposal container?
- An expired nicotine patch
- An unopened vial of cyclophosphamide
- A stock bottle of expired atorvastatin tablets (correct answer)
- A partially used epinephrine auto-injector
Explanation: Atorvastatin is not classified as hazardous waste under RCRA. Therefore, it should be disposed of in a blue container for non-hazardous pharmaceuticals. Nicotine and epinephrine are P-listed hazardous wastes, and cyclophosphamide is a U-listed hazardous waste, all of which require disposal in a black container.
Question 18
An IV bag that once contained cisplatin and is now empty, along with the tubing used to administer it, is considered trace chemotherapy waste. These items should be disposed of in a:
- black container for bulk hazardous waste.
- yellow container for trace chemotherapy waste. (correct answer)
- red container for standard sharps.
- blue container for non-hazardous waste.
Explanation: Items such as gowns, gloves, empty vials, IV bags, and tubing that are contaminated with small amounts of chemotherapy drugs are considered trace chemotherapy waste. These items must be segregated and placed in a designated yellow waste container.