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Pharmacy Technician

Chapter Three

What elements should a prescription contain? *Patient name + DOB *Address *Date of Rx *Rx med and dose *Info about disp. generic alternatives *Directions for use, method, and frequency of administration *Amount disp. *# of refills *DEA number *Prescriber's name, address, and contact info
What should the technician do when filling a prescription? Verify insurance info and ask about other meds the patient is taking, including OTC meds and herbal supplements, and confirm any allergies
In case of a partial fill, how many days' worth are usually dispensed until the full amount is available? 3-5
If a pharmacy does not have the entire Rx amount in stock for a C-II drug and the patient wants whatever is in stock, what are the requirements? The patient is required to get a new Rx from the prescriber in order to get the rest of their Rx
Directions for oral medications *Take *Give *Dissolve *Swallow
Directions for external/topical medications *Apply *Rub
Directions for suppositories *Insert
Directions for ophthalmic/otic medications *Instill *Place
Directions for nasal/bronchial medications *Instill *Place
AD Right ear
AS Left ear
AU Both ears or each ear
IEN In each nostril
IM Intramuscular
IV Intravenous
IVPB Intravenous piggy back
IOC Locally
OD Right eye
OS Left eye
OU Both eyes
PO By mouth; orally
PR Per rectum or rectally
SC, SQ, or SUBQ Subcutaneous
SL Sublingual
TOP Topically
UD or UT DICT As directed
VAG Vaginally
AMP Ampule
CAP Capsule
CR Cream
EL or ELIX Elixir
EXPECT Expectorant
FL Fluid
LIQ Liquid
LOT Lotion
PULV Powder
SOL Solution
SUPP Suppository
SUSP Suspension
SYR Syrup
TAB Tablet
TINC Tincture
UNG or OINT Ointment
AC Before food/ meals
AM Morning
AD LIB As needed, freely
ASAP As soon as possible
ATC Around the Clock
BID Twice a day
W/ With
H, HR Hour
HS Bedtime
NOC Night
NV Nausea/vomiting
PC After food/ meals
PC and HS After meals and at bedtime
PM Afternoon, evening
PRN As needed
Q Every
Q4H Every four hours
QH Every hour
QHS Every hour at bedtime
QID Four times a day
W/O Without
STAT Immediately
TID Three times a day
UD or UT DICT As directed
U (unit) Can be misinterpreted as the numvers 0 and 4, the abbreviation cc
IU (international unit) Can be misinterpreted as the number 10, the abbreviation IV
QD (daily) Can be misinterpreted as QID and QOD
QOD (Every other day) Can be misinterpreted as QID and QD
Training zeros on decimals Can be misinterpreted through missed decimal point
Lack of leading zeros or decimals Can be misinterpreted through missed decimal points
The symbol "@" Can be misinterpreted as the number 2
What is the first step in medication profiling? Create or update the patient profile
What should a patient's profile include? *Demographic information *Medication history *Allergies *Chronic diseases and conditions
How should a technician identify patients as to avoid errors? *DOB *Gender *Address *Other patient numbers
What should be done in the case of a system alert? *Technician should not override the alert *Notify the pharmacist
What patient information must a technician have to file a claim? *Member ID # and/ or ss # *Group number *Plan code *Insurance info such as BIN/PCN
What will happen once a prescription is submitted in a claim? *Patient eligibility is determined *Whether or not the patient's plan will cover the prescription is determined *Quantity allowed is determined *Amount of payment the pharmacy received is verified
If there was a rejection or issue with a claim, what must be done? Contact the third-party toll-free number for assistance
What should a technician do if an Rx has a "DAW" note on it? *Dispense as written, no generic or substitutes *Include the appropriate DAW code when submitting a claim.
DAW code 0: No product selection indicated- what does it mean? Used when product selection is not an issue, for example, dispensing a brand product when only the brand product is available.
DAW code 1: Substitution not allowed by the prescriber- what does it mean? Used when the prescriber specifically instructs to dispense the medication as written
DAW code 2: Substitution allowed- what does it mean? Used when generic is allowable, but the patient specifies the brand
DAW code 3: Substitution allowed- pharmacist selected- what does it mean? Used when the generic is allowable, but the pharmacist dispensed the brand
DAW code 4: Subsitution allowed- generic not in stock- what does it mean? Used when the pharmacy does not have the generic product available, and the brand is dispensed
DAW code 5: Substitution allowed- brand dispensed as generic- what does it mean? Used when the pharmacist is using a brand product in place of a generic
DAW code 6: Override- what does it mean? Used by claims processors
DAW code 7: Subsitution not allowed- what does it mean? Used when the prescription allows for a generic, but law or regulation specifies that the brand be dispensed
DAW code 8: Substitution allowed- generic not available- what does it mean? Used when the generic product is not available in the market
DAW code 9: Other- what does it mean? Used when a medication is not currently in use
Informational leaflets Used when the computer flags with a certain medication and they should be included with the patient's prescription
To prepare a medication in an outpatient setting, what tools does a technician need? *Counting tray *Spatula *Clean and appropriate sized bottle *Appropriate lid *Label for counted medication
What is an ISO Class 5? Glove box workbench for preparing medications
What is an ISO Class 8? An entire clean room to prepare medications in
How long should hoods run prior to use? 30 minutes at least
What should the technician do in the case of preparing medications in an ISO Class 5 workbench? Place manipulated items into the antechamber for 15 minutes prior to placing them into the hood
Proper aseptic technique for using a glove box. Wear gloves and place arms through glove box
Proper PPE for using an ISO Class 8 *Shoe booties *Shower cap *Face mask *Gown *Gloves (OF COURSE SCRUB HANDS)
Proper use of ISO Class 8 *Place all items into an antechamber before manipulation *Clean the hood with at least 70% alcohol before + after each use *Keep needles + syringes in sterile wrapping until use *Work at least 6 in. in the hood for sterility *Calculate before begining
Technician responsibilities within preparation area for compounding pharmacies *Clean all equipment (ointment slabs, spatulas, containers, compounding instructions, and logs) *Calibrating and maintaining the scales *Keeping records
What is Hydroxyzine commonly confused with? Hydralazine
What is Humalog commonly confused with? Humulin
What is Metformin commonly confused with? Metronidazole
What is Oxycontin commonly confused with? Oxycodone
What is Lorazepam commonly confused with? Alprazolam
What is Heparin commonly confused with? Hespan
What is Topamax commonly confused with? Toprol XL
What is Zantac commonly confused with? Xanax
What is Amicar commonly confused with? Omacor
What is Cardura commonly confused with? Coumadin
What is Tramadol commonly confused with? Trazodone
What is Zestril commonly confused with? Zetia
What is Zocor commonly confused with? Zyrtec
What is the safest distribution system in a hospital setting? Unit-dose; they provide checks and balances for preventing errors, improving drug control, decreasing cost, ensuring more accurate billing, and reducing inventory.
In case of an error, what should the technician do? *Document errors according to their facility's policy *Communicate the error to patient according to facility's policy
What information should prescription product labels contain? *Pharmacy name, address, and phone # *Patient's name *Disp. date *Directions for use *Rx # *Prescriber's name *Medication name, strength, and dosage (SOME states may require exp. date)
Who performs the final check before dispensing the medications? Pharmacist only
How to avoid errors when patients pick their prescriptions up? Use information such as address or DOB
When if the best time to offer the pharmacist's counseling services to the patient? At Rx pick-up
What are the three measurement systems used in the pharmacy? *Apothecary *Metric *Avoirdupois
What is the metric system? Measures weight and volume in increments of ten and uses decimals rather than fractions. Weight is measured ni grams, kilograms, and micrograms. Volume is measured in liters or milliliters
1 gram (gm) is equal to how many milligrams (mg)? 1,000
1,000 milligrams (mg) are equal to how many micrograms (mcg)? 1,000,000
1,000,000 micrograms (mcg) are equal to how many grams (gm)? 1
1 kilogram (kg) is equal to how many grams (gm)? 1,000
1 liter (l) is equal to how many milliliters (mL)? 1,000
What is the apothecary system? Rarely used; The standard unit for weight is gran (gr):Volume is measured in drams (z)- abbreviation is "fl dr."
5 grains (gr) is equal to how many milligrams (mg)? 325
1 Dram (z) is equal to how many milliliters (mL)? 5
What is the avoirdupois system? Most often used in commerce by manufacturers and suppliers: weight is based on the 16 ounce pound: Weight is measured in ounces and pounds: volume is measured in cups, pints, quarts, gallons, and teaspoons and tablespoons (use dosing spoons + cups)
1 pound (lb) is equal to how many ounces (oz)? 16
1 tablespoon (tbsp or t) is equal to how many teaspoons (tsp)? 3
3 teaspoons (tsp) is equal to how many milliliters (mL)? 15
15 milliliters (mL) are equal to how many tablespoons (tbsp or t)? 1
1 fluid ounce (fl oz) is equal to how many milliliters (mL)? 30
How to set up ratios and proportions (used when trying to find the relationship between two quantities. 1. Cross multiply and divide 2. Get all like-values on the same side (gm=mL) 3. Work the product out with PEMDAS
How to do percentage preparations (Weight to volume) Number of grams (gm) in 100 milliliters (mL)
How to do percentage preparations (Weight to weight) Number of grams (gm) in 100 grams (gm)
How to do percentage preparations (Volume to volume) Number of milliliters (mL) in 100 milliliters (mL)
How are flow rates measured? Milliliters per hour, milliliters per minute, an drop per minute
How to calculate D5W 1,000 mL with 40 mEq K over 8 hr (flow rate) 1.1,000 mL must be given over 8 hr -1,000mL/8hr=125 mL/1 hr --2.1 mL/min *(If milliliter per minute is needed, divide the mL/hr by 60)
Fahrenheit to Celsius (F-32) x 5/9= C
Celsius to Fahrenheit (Cx 9/5) + 32= F
When should a technician verify drug dosages? *When the dosages appear out of normal limits *When dosing for young or older adult patients
Since dosage equations are X mg/kg of body weight, how would you convert pounds (lb) to kilograms (kg) for a 120 lb patient? 1 kg/ 2.2 lb= kg/120 lb -Mlutiply both sides by 120 to get *(120) X 1 kg/ 2.2= X kg -Perform calculation *54.54 kg= X kg
What is the formula of the dosing of a child? Weight of Child (lb)/150 X adult dose= approximate child's dose
Lanoxin 0.125 mg q am -- how many to dispense? 30 (allow up to 34)
Augmentin 1 tsp tid x 14 days -- how much to dispense? 210 mL
Alprazolam 0.5 mg; 1/2 tab hs x 3 weeks 11
What are punch cards/ blister packs? Typically individualized for the patient. This provides accountability for dosing and minimizes the opportunity for giving a patient the wrong medication
What are unit-dose packages? Individually packaged to control drug distribution
What must the process of repackaging bulk medications into units of individual use, or smaller packages include? *Product ID *Environmental exposure *Handling *Usability
What are additional guidelines for repackaging medications? *Use clean area w/good space that is isolated *Repackage 1 med @ a time *Follow procedure close *Label w/med name, strength, lot number, + exp. date *Ingredients + labels *Always check w/pharmacist *Maintain equip. *Keep records for @ least 1 yr
What are compliance aids and what are some examples? Assist patient with taking their medications more consistently and effectively; Dosage spoons, pill cutters, droppers, oral syringes, dosing planners or pill organizers, watches/ reminders
What is USP 797? Sets forth suggested guidelines that health care organizations may adopt. Even in a community pharm., techs may prepare sterile ophthalmic products. Be aware of regulations in this setting as well.
What is a sterile product? A product containing no pyrogens, which are bacteria or other substances that could potentially cause infection
What are parenteral products? Products that are administered directly into the body. They are administered subcutaneously (SQ), intramuscularly (IM), or intravenously (IV). Most common is IV fluids
What is the personal preparation step to aseptic technique? Remove all jewelry and outer garments, wash hands thoroughly with water and antibacterial soap. Cosmetics are banned (including nail polish). Donning gowns, masks, gloves, and show covers.
What is the preparation of work surfaces step to aseptic technique? Disinfect the work surface from the back to the front. USP 797 specifies cleaning hoods a minimum of every shift, before each batch prep, every 30 minutes during continuous compounding, or any time contamination is suspected. Disinfect counters daily
What is the quality assurance step to aseptic technique? Test and validate compounding practices through the testing of products compounded in the sterile environment. This is done minimally on an annual basis, or more frequently if required.
How far into the hood should you work and why? 6 inches at least; air closest to the filter is the cleanest
How to prepare for compounding Arrange all of the necessary products during the process
Why do you review orders before compounding? To determine the necessary supplies, such as syringes, needles, and alcohol swabs
What not to touch when compounding Needle or tip of syringe
What do you clean the top of the vial with prior to drawing the solution? Alcohol swab
How to draw up solution 1. Uncap the needle 2. Pull the plunger to the desired volume 3. Insert needle into vial at 45 degree angle 4. Inject air into vial and withdraw the desired amount 5. Insert amount withdrawn into desired location
What to do when mixing more than one product Check for chemical and physical incompatibilities and always check final product for clarity and any particulate matter
What should be on the label of a sterile prescription? *Pharmacy name, address, and phone number *Patient name *Rx date *Prescriber name *Date compounded *Med name and all additives, including diluents and volume *DIrections *Pharmacist and technician ID *Directions *Expiration date/time
What is the temperature in Fahrenheit for 28 degrees Celsius? 82.4
Interpret the following sig; " 1 T PO Q4H PRN NV UTD) Take one tablet by mouth every four hours as needed for nausea and vomiting as directed
Which agency establishes the guidelines for IV admixture technique? USP 797
How much does child weigh in kilograms if he weighs 17 lb? 7.727
How long must a laminar flow hood run before using? 30 minutes
How far should objects be in the laminar flow hood in order to be in compliance? 6 inches
Adulterated drugs Drugs that differ in strength, quality, or purity from the official drug standards
Aliquot Calculations required when the quantity of drug required for a compound is less than the minimum amount that can be weighed on a Class A prescription balance
Anteroom A room where hand washing, gowning, and gloving take place, and where supplies are sanitized before taking into the clean room
Asepsis The complete absence of microbes
Aseptic conditions Conditions in which there is a complete absence of living pathogenic organisms
Aseptic techniques Procedure for mixing sterile compounded products with a complete absence of viable microorganisms
Average inventory A figure calculated by adding the beginning inventory and ending inventory for the desired period of time
Average wholesale price The calculated national average price that a retail pharmacy might pay for a given package size of a drug
Barrier isolator A sealed laminar flow hood that is supplied with air through a HEP filter, maintaining an ISO Class 5 environment
Bio hazard A hazardous biological agent that presents a risk to the health of humans exposed
Biological safety cabinet (BSC) A ventilated cabinet designed to protect the worker, the product, and the environment with a downward HEPA-filtered airflow and exhaust
Bolus dose A large, initial dose given to bring the blood level of a drug up to therapeutic level
Calibrate Testing the accuracy of a balance by comparing it with known weights
Chemo spill kit A kit that contains PPE and equipment for cleaning up a hazardous spill
Cleanroom An enclosed room with smooth walls, floors, and ceiling that are resistant to damage from sanitizing agents
Coring Piece of rubber cored out from the rubber bung that enters the solution causing particulate matter contamination
Dispersion Uniform distribution of each ingredient in a powder mixture
Displacement Uses the density factor to determine the amount of base that is needed to compound a given quantity of product when the density factor is more or less than one
Extemporaneous compound A medication compounded in the pharmacy pursuant to a prescriber's order for a given patient
Fluid (total fluid volume) The total amount of fluid that a patient needs to receive from the TPN to satisfy daily fluid requirements
Geometric dilution The process of mixing two solid chemicals together by taking equal pats of each in small amounts, mixing thoroughly, and continuing to add small, equal parts
Good manufacturing practices (GMP) Regulations that set minimum standards to follow by the manufacturing industry for human and veterinarian drugs
Hospital protocols Policies established by a hospital to standardize procedures in different departments
Intra-arterial administration An injection into an artery
Intra-articular administration An injection into a joint
Intracardiac administration An injection directly into the heart
Intradermal injection An injection between the layers of the skin
Intramuscular (IM) administration An injection into a large muscle
Intraperitoneal administrations An injection into the abdominal cavity
Intrapleural administration An injection into the pleural sac surrounding the lungs
Intravenous administration An injection or infusion into a vein
Intravenous medication A medication prepared under aseptic conditions and injected or infused into the veins of a patient
ISO Class 5 International Organization for Standardization Class 5 environment, in which a maximum of 100 particles 0.5 microns in size, will be present for every cubic foot of air space
ISO Class 8 International Organization for Standardization Class 8 cleanroom environment, in which a maximum of 100,000 particles, 0.5 microns in size, will be present for every cubic foot of air
IV admixure Process of preparing intravenous fluids using aseptic technique
Laminar air flow (LAF) workbench A workbench that meets the ISO Class 5 standard
Laminar flow hood A workbench that provides an environment of air filtered through a high-efficiency particulate air filter to facilitate aseptic work conditions
Large-volume parenteral (LVP) A single-dose injection containing more than 100 mL of solution for intravenous use
Medication error A preventable event that may cause or lead to inappropriate medication use or patient harm
Parenteral dosage forms Injectable doses of medications delivered subcutaneously, intramuscularly, or intravenously
Pharmaceutical elegance A term used to describe a compounded formulation that is expertly made and packaged to present a pleasuring appearance
Pipettes Thin, hollow tubes used for volumetric measuring
Quality assurance A set formula to analyze and improve pharmacy procedures to provide excellent pharmaceutical care to patients
Reconstitution Purified water or an appropriate liquid is added to a powder to produce a solution on suspension for oral administration
Small-volume parenteral (SVP) A single-dose injection containing 100 mL or less of solution for intravenous use; also called a mini-bag or piggyback
Solute A chemical dissolved in a liquid
Solvent A liquid used to dissolve a solute
Stability The amount of time a drug or compound retains its potency
United States Pharmacopeia (USP) The official listing of drugs and the quality standards they must meet
USP Chapter 797 Guidelines established to provide the standards involved in IV admixture
Created by: Martinafulgieri



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