- 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?
Answer: Placed in the black hazardous waste container.
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.
- A patient returns a partially used physostigmine ophthalmic solution to the pharmacy take-back program. The pharmacy must manage this returned medication as:
Answer: P-listed hazardous waste in a black container.
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.
- 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?
Answer: Warfarin
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.
- 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?
Answer: Black
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.
- 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?
Answer: A black hazardous waste container
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.
- Which of the following items represents bulk chemotherapy hazardous waste and must be disposed of in a black RCRA container?
Answer: A vial of methotrexate that is more than 3% full by weight of its original volume.
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.
- 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?
Answer: In the black container for hazardous pharmaceutical waste.
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.
- 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?
Answer: A stock bottle of expired atorvastatin tablets
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.
- 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?
Answer: The expired epinephrine auto-injector.
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).
- 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)?
Answer: Environmental Protection Agency (EPA)
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.
- Which of the following items would be classified as U-listed hazardous waste under RCRA and must be disposed of in a black container?
Answer: An unopened box of cyclophosphamide for injection
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.
- U-listed pharmaceutical wastes, which include many antineoplastic agents, are designated as hazardous primarily because they possess which characteristic?
Answer: They are toxic, carcinogenic, mutagenic, or teratogenic.
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.
- 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?
Answer: The canister contains a propellant that makes it an ignitable hazardous waste.
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.
- 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:
Answer: yellow container for trace chemotherapy waste.
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.
- 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?
Answer: It must be segregated and managed as RCRA hazardous waste.
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.
- The EPA's P-list of hazardous wastes includes drugs that are specifically classified as:
Answer: acutely toxic.
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.
- 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:
Answer: non-hazardous pharmaceutical waste.
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.
- A pharmacy is preparing to dispose of several expired drugs. All of the following require handling as P-listed hazardous waste EXCEPT:
Answer: Mitomycin injection
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.
