Pharmacy Technician Exam Prep PDF

LEARN i NG Exp RESS I An EBSCO Company COMPLETE TEST PREPARATION ► EFFECTIVE PRACTICE: Access to 3 full-length practice exams ► COMPREHENSIVE REVIEW: Thorough coverage of all tested topics on the ExCPT and PTCE: Science Math Medications...

LEARN i NG Exp RESS I An EBSCO Company COMPLETE TEST PREPARATION ► EFFECTIVE PRACTICE: Access to 3 full-length practice exams ► COMPREHENSIVE REVIEW: Thorough coverage of all tested topics on the ExCPT and PTCE: Science Math Medications & Dosages Ethics And more! ► ESSENTIAL INFORMATION: An in-depth look at the pharmacy technician career field  PHARMACY TECHNICIAN EXAM Third Edition PharmExam3E_00_FM_i-x.indd 3 4/6/17 10:55 AM  The content in this book has been reviewed and updated by the LearningExpress Team in 2020. Copyright © 2017 LearningExpress. All rights reserved under International and PanAmerican Copyright Conventions. Published in the United States by LearningExpress, New York. Cataloging-in-Publication Data is on fle with the Library of Congress. ISBN-13 978-1-61103-079-2 Printed in the United States of America 9876543 Third Edition PharmExam3E_00_FM_i-x.indd 4 4/6/17 10:55 AM  CONTENTS CONTRIBUTORS iv CHAPTER 1 Being a Pharmacy Technician 1 CHAPTER 2 Prescriptions and Abbreviations 5 CHAPTER 3 Pharmacy Law 21 CHAPTER 4 Dosage Forms and Routes of Administration 38 CHAPTER 5 Basic Anatomy and Physiology 61 CHAPTER 6 Pharmacology 77 CHAPTER 7 Basic Pharmacy Math 124 CHAPTER 8 Measuring Systems and Conversions 142 CHAPTER 9 Pharmacy Math Problem Solving 160 CHAPTER 10 Working in the Pharmacy Setting 188 CHAPTER 11 PTCE Practice Test 227 CHAPTER 12 ExCPT Practice Test 244 GLOSSARY 269 iii PharmExam3E_00_FM_i-x.indd 5 4/6/17 10:55 AM  CONTRIBUTORS Thomas Fridley, CPhT, is pursuing his doctor of pharmacy degree at Long Island University. He received his certification in 2004 from the Pharmacy Technician Certification Board. During his practice years, he was a pharmacy technician for Eckerd Pharmacy and the Regional Intern Program Manager for CVS. Currently, he is the Pharmacy Technology Program Chair at the Sanford-Brown Institute in Garden City—the first school in New York State to receive American Society of Health System Pharmacists accreditation for its technician program. Kristy Malacos is the Pharmacy and Purchasing Director at Magruder Hospital in Port Clinton, OH. She oversees both the inpatient and retail pharmacies, as well as the 340b program of the hospital. Kristy has been a certified pharmacy technician since 2009, and was previously the Pharmacy Technology Program Director at Sanford-Brown College. She holds her Master of Science degree in Biomedical Science from Kent State University, with a specialty in Pharmacology. Kristy has additional publications in the fields of sterile compounding, pharmacy technician exam review, and 340b. Joe Medina, CPhT, BS, is the former program director of two ASHP-accredited pharmacy technician programs at two community colleges in Colorado. He has worked in retail, in-patient hospital, and state psychiatric hos-pital pharmacy settings, and is well known as a national advocate for the pharmacy technician profession. Medina helped produce several textbooks and coauthored the Pharmacy Technician Workbook & Certification Review through Morton Publishing. With 15 years of experience as a pharmacy technician, and 20 years as a pharmacist, Medina is an advocate for the needs of pharmacy technicians and the important role they play for pharmacists, medical paraprofessionals, and the pharmacy community. iv PharmExam3E_00_FM_i-x.indd 9 4/6/17 10:55 AM  – CONTRIBUTORS – Michael Spencer, BA, PharmD, holds a degree in biochemistry from the University of California, Berkeley, and a doctor of pharmacy degree from the University of California, San Francisco. He has four decades of pharmacy practice experience in community, hospital, and research facilities, and more than two decades of experience teaching both pharmacists and pharmacy technicians. He is currently Director of Pharmacy Services at Memorial Medical Center in Modesto, CA, and Program Director for the Pharmacy Technician Career Training Program at Modesto Junior College. v PharmExam3E_00_FM_i-x.indd 10 4/6/17 10:55 AM  1 BEING A c h a p t e r PHARMACY TECHNICIAN CHAPTER OVERVIEW The pharmacy technician profession has been around for many years, but the role of the pharmacy technician has evolved tre- mendously. Pharmacy technicians fill prescriptions and medica- tion orders (which may include intravenous sterile compounds), and have many other responsibilities to help assist the pharma- cist with patient care. While on-the-job training was the past standard for many pharmacy technicians, a majority of states have now established requirements for education, certification or state-based registration. B eing a pharmacy technician offers an exciting opportunity to help others in the healthcare setting as one who not only assists the pharmacist, but also plays a vital role in the prescription and medication order process. Opportunities for advancement are many, as the individual pharmacy technician may see employment in not only the retail setting, but also in the hospital setting. Other avenues of specialization for pharmacy technicians include (but are not limited to): mail order, home healthcare, pharmaceutical companies, working as a pharmacy benefits manager (PBM), educational institutions, compounding pharmacies, veterinary pharmacies, and nuclear, chemotherapeutic, and specialty pharmacy settings. The duties of pharmacy technicians will vary depending on the pharmacy setting in which they work. Retail pharmacy technicians have more customer service interaction then hospital technicians—though some specialized roles within hospitals may have pharmacy technicians working more with patients. Other pharmacy technicians, such as mail order, home healthcare, and PBM, may not interact with patients directly, but may communicate over the phone with patients. Most functions involve filling prescriptions in the retail setting, or filling medication orders and making IV admixtures in the hospital setting. 1 PharmExam3E_01_1-4.indd 1 4/6/17 11:29 AM  –BEING A PHARMACY TECHNICIAN– In a retail pharmacy, the pharmacy technician The PTCE consists of 90 multiple-choice receives and enters prescriptions to be filled, fills the questions, of which 80 are scored and 10 are order, and (after pharmacist verification) delivers the experimental items that are unscored and prescription to the patient. Retail pharmacy unidentified. The time limit for this computer-based technicians are also often involved in resolving exam is 110 minutes, and an unofficial result is insurance issues, such as prior authorizations or other displayed immediately following exam completion. rejections. In many states, pharmacy technicians can To sit for the PTCE, you must complete a PTCB- now take verbal prescriptions over the phone such as recognized education or training program or have a refill authorizations. minimum of 500 hours equivalent work experience. In the hospital setting, medications are dis- pensed as individually prepackaged unit medications DOMAIN % OF EXAM called unit doses. Pharmacy technicians may deliver CONTENT these to individual nursing units or stock automated Medications 40 dispensing cabinets (ADCs) for floor stock dispens- Federal Requirements 12.5 ing. The hospital setting also offers pharmacy techni- Patient Safety and 25.25 cians the opportunity to compound sterile IVs and Quality Reassurance chemotherapy products for patients. A pharmacist Order Entry and Processing 21.25 enters the medication orders, or they are entered The ExCPT consists of 120 questions, of directly into the system through computerized physi- which 100 are scored and 20 are not. The cian order entry (CPOE) and verified by a pharmacist. ExCPT is also multiple-choice and computer- All orders filled by the pharmacy technician are based, and the time limit for this exam is 130 checked by a pharmacist before administration to minutes. To sit for the ExCPT, a candidate must patients. have completed a pharmacy technician training All of these disciplines will be discussed in later program or employer-based training program. chapters. The employer-based program must either be recognized by the Board of Pharmacy in the state of application, or have been verified by the Education and Certification candidate’s employer that sufficient technical skills have been obtained to adequately perform Many states are now requiring pharmacy techni- duties of an entry-level pharmacy technician. cians to be certified. Currently, there are two regula- Military training for pharmacy services also tory national organizations that offer national fulfills training requirements. certification: the Pharmacy Technician Certification The content of the ExCPT is divided into Board (PTCB), which offers the Pharmacy Techni- four domains with a varying number of items on cian Certification Exam (PTCE); and the National the exam from each domain: Overview and Laws, Healthcare Association (NHA), which offers the 25; Drugs and Drug Therapy, 15; Dispensing Exam for the Certification of Pharmacy Technicians Process, 45; Medication Safety and Quality (ExCPT). Check the requirements of your state and Assurance 15. your employer to determine which regulatory orga- For specific information on each exam, go to nization you should choose for your certification. the following links: Passing either national exam will certify you, and allows you to wear the letters CPhT (certified phar- PTCB: www.ptcb.org macy technician). NHA: https://www.nhanow.com/certifications/ pharmacy-technician 2 PharmExam3E_01_1-4.indd 2 4/6/17 11:29 AM  –BEING A PHARMACY TECHNICIAN– For specifcs of what your state requires, check The National Pharmacy Technician with your state board of pharmacy, as changes do Association (NPTA) is the largest professional occur rapidly in this feld. organization established for pharmacy technicians. Many pharmacy technicians from a variety of National Association of Boards of Pharmacy or settings comprise NPTA, and therefore make it a NABP: https://nabp.pharmacy/ diverse source of support and resources to members. Certification requires pharmacy technicians to In addition to pharmacy technician specific complete 20 hours of continuing education (CE) every organizations, there are several pharmacy two years to maintain their national certification. For organizations that pharmacy technicians can join both the ExCPT and PTCB certifications, one hour and be an active member. The American Society of must be in pharmacy law, and one hour must be in Health-System Pharmacists (ASHP) is a professional patient safety. Continuing education is an important organization that includes pharmacists, technicians, way for pharmacy technicians to stay current with and student pharmacists who practice in hospital or new pharmacy trends, important new standards of ambulatory care settings. ASHP has divisions within practice, and any other industry-wide news that may each state that pharmacy technicians can join for be relevant to pharmacy technician practice. CE is local support. offered by a number of sources, including websites Time to Begin that offer pharmacy technician–specific CE, colleges, pharmacy employers, phar-macy magazines, journals, The pharmacy technician field is an exciting or associations. career avenue for one interested in helping patients, whether in a retail, hospital, or specialized setting. You work side by side with fellow technicians and Pharmacy other health professionals to not only enhance the Technician Associations quality of lives of the customers and patients you serve, but in some cases, to save lives as well. In this After becoming a pharmacy technician you career, you are given the opportunity to continue to may consider joining a professional organ- learn as you develop your skills and advance to ization, whether it is a pharmacists’ association other pharmacy settings. For some, this will be that has a specific pharmacy technician unit, or your calling for life—and for others, this may be a a national organization that is specifically for stepping stone to another health profession, as some and about pharmacy technicians. These assoc- continue onward to get their Doctor of Pharmacy iations are helpful for networking with degree and become pharmacists. fellow pharmacy technicians, developing friend- With this in mind, you have decided to ships with others in your vocation, and finding job pursue becoming a pharmacy technician; and you opportunities. have most likely purchased this review book to learn The American Association of Pharmacy as much as you can to help you pass one of the Technicians (AAPT), the firstpharmacy technician national exams. This book will allow you that association, and was established in 1979. opportunity, but you must put effort into the AAPT supports pharmacy technicians through learning process. This is your first step on your way education, meetings, and as an active voice in to being recognized as a certified pharmacy pharmacy technician regulation. technician! 3 PharmExam3E_01_1-4.indd 3 4/6/17 11:29 AM  blank page PharmExam3E_01_1-4.indd 4 4/6/17 11:29 AM  2 PRESCRIPTIONS c h a p t e r AND ABBREVIATIONS CHAPTER OVERVIEW The legal form a physician must complete to be filled at a licensed pharmacy is called a prescription (retail pharmacy) or medication order (hospital). Prescriptions and medication orders must be correct and verified, and have specific rules governing the dispensing and refilling. This chapter will cover the different aspects of prescriptions and medication orders, as well as the abbreviations that are vital for pharmacy technicians to understand when reading each type of order and solving cal- culations in the process. KEY TERMS prescription DAW policy and procedures manual auxiliary label controlled drugs “Rx Only” abbreviations NDC number patient package insert references medication guide 5 PharmExam3E_04_41-54.indd 41 4/6/17 11:33 AM  –PRESCRIPTIONS AND ABBREVIATIONS– The Prescription Written Parts of the Prescription Every prescription order received should contain the A prescription is a lawful order for a specifc medication following information: to be flled at a licensed pharmacy. This order is gener- ally written by a licensed physician—but depending n prescriber’s name, address, and phone number on individual state laws, it can also be written by other n name of the patient for whom the prescription health professionals (with restrictions), such as dentists, was written veterinarians, physician assistants, and certifed nurse n date the prescription was written practitioners. Prescriptions can be hand written or sent n Inscription—medication ordered, including by fax, computer, or phone. All handed-in or faxed pre- name, strength, dosage form, and quantity scription orders must have the physician’s signature. If n Signa (sig)—directions for use the physician is unable to call in a prescription order, a n Subscription—instructions to the pharmacist, representative of the physician, such as a nurse, may call such as number of reflls permitted, or whether a in the order. Federal law mandates that only pharmacists generic drug is permitted to replace a brand- may receive phoned-in prescription orders. name drug (if not, the prescription will say DAW, The role of the pharmacy technician in accepting or dispense as written) prescriptions from a patient begins with understanding n prescriber’s Drug Enforcement Administration the proper procedures involved. Procedures are gener- (DEA) number, if this is a controlled medication ally stated in the pharmacy policy and procedures order manual and should be reviewed in the beginning of n physician’s signature one’s employment in a particular pharmacy setting. Here’s an example of a completed prescription: Dr. Irene Cortiz-Colella 366 Holly Lane, Denver, CO 80219 (303) 111-1111 Patient ___Joe Medina_____________________________ Date November 3, 2020 Address ___560 Benzodiazepine Avenue ______________________________________________ Rx Zoloft 100 mg #60 Sig: i po qd x 60 days for depression Dr. Irene Cortiz-Colella__ M.D. DAW: ____ Reflls __6____ DEA REG. No. ________________________ 6 PharmExam3E_04_41-54.indd 42 4/6/17 11:33 AM  –PRESCRIPTIONS AND ABBREVIATIONS– Processing a Prescription or costly. The following methods can help reduce the chance of making an error when entering and pro- When processing a prescription, it is important to cessing a prescription. follow all steps carefully, as this is the frst place where a mistake or oversight can occur. The same steps, in n When pulling up a patient profile to begin enter- the same order, should be performed each time a pre- ing a prescription, make sure the entire last name is scription is submitted by a patient. spelled out and the first letter of the first name is entered. When this is done, it will pull up a list of n Check the prescription to ensure it is valid. This patients in the computer with that last name and includes having a patient name, date, medication the same first letter of the first name. You can name, and quantity. choose the correct patient by verifying their date of n Verify the name. Ensure that the name on the birth. n Verify insurance information. This is done when prescription resembles the name the patient gives you. Some pharmacies require that the patient the patient presents a new insurance card. Search show a legal picture ID to authenticate the name for the prescriber the same way a patient is found. If on the prescription. the wrong provider’s name is put on the n Record the date of birth. This is for insurance prescription, there is potential for an insurance processing purposes, as well as to differentiate audit or pharmacist oversight. n Providers can also be determined utilizing the between patients with the same name. n Record the address. This is required to fll all con- National Provider Identifier (NPI). This is a unique trolled schedule II through V drugs, according to identifier for all covered health care providers, the Controlled Substance Act, but also helps to which includes prescribers and pharmacies. keep your patient profle up-to-date in the event n Enter the name of the medication to be dis- the pharmacy needs to contact the patient. pensed. This can be done by National Drug Care n Record the phone number. This allows the phar- (NDC) number or drug name. NDC is a stan- macy to contact the patient directly to provide dardized method used by all manufacturers to customer service. identify each individual drug by a sequence of n Verify any patient allergies. This allows the phar- numbers. All NDCs consist of 11 digits which macy to ensure that the medication about to be appear like this: 12345-6789-10. The first five dispensed will not harm the patient. It is also indicate the manufacturer, the next four indicate used to monitor future prescriptions to which the drug and strength, and the last two indicate a patient may be allergic. package size. n Record the insurance information. This is used n Enter the quantity to be dispensed. This may have for billing purposes so that a patient does not to be adjusted because of insurance payer limita- have to pay full retail price for a medication. tions. Many insurance companies only cover 30 days’ worth of medication at a retail pharmacy. Enter directions for use in the computer. It is very Entering Prescriptions important for a pharmacy technician to interpret the prescription and not assume or guess. If the Entering prescription information is another area pharmacy technician interprets the prescription where an error can occur. These are usually billing or incorrectly, it will be typed and appear on the label patient profle errors, but they may still be dangerous as such. If the pharmacist misses this mistake and dispenses it to a patient, then the patient may take an incorrect dosage and could possibly be harmed. 7 PharmExam3E_04_41-54.indd 43 4/6/17 11:33 AM  –PRESCRIPTIONS AND ABBREVIATIONS– n Enter day supply. This is the quantity divided by both the bottle and the label. If they do not, the how many times a day the medication is used. label must be changed. The pharmacy technician For example, 90 tabs/TID = 30 days. must always process exactly what is being flled. n Enter the number of reflls. The pharmacy techni- This ensures that the stock indicated in the com- cian must include the exact number of reflls on puter matches what is contained on the shelves. the prescription according to law. Note: n Place the medication in a vial, then attach the n For controlled drugs, CII cannot have reflls. label. Select the appropriate size vial based on n CIII to CV may have up to fve reflls maxi- quantity dispensed. Make sure the correct cap is mum, and the prescription is good for up to chosen—either safety or easy-off (if the patient six months from the date written. has a signed wavier on fle). n For noncontrolled drugs, the maximum num- ber of reflls is 11, and the prescription is good Prescription Drug Orders for one year from the date written. Each state has laws that regulate the prescribers of n Enter the expiration date. This must come directly medications. Each practitioner must be state licensed from the stock bottle. If the wrong expiration and if prescribing narcotics, registered with the DEA date is entered, the patient could potentially as well. In some states, nurse practitioners, physician take expired medication. assistants, and even pharmacists can prescribe medi- n Process through the patient’s insurance. This is cations. If a prescription is for a controlled substance, the last step and the step where the pharmacy it must include all of the information that a regular receives authorization to dispense a drug. prescription includes, as well as an address for the patient and a DEA number given to the prescriber to write for controlled schedule drugs. The prescription Counting, Measuring, must also be hand-signed, not stamped. Pouring, and Labeling Prescription Refills Counting, measuring, pouring, and labeling may The reflling of an individual prescription is up to the seem like simple tasks, but they have great importance physician writing the order, but there are some legal within the pharmacy. This must also be done in spe- guidelines that must be met depending on if the drug cifc steps in order to prevent errors or to allow phar- is a controlled substance or not. macy staff to catch any errors that have been made The Controlled Substances Act (CSA), lists con- while processing. trolled drugs into fve classes, or schedules. Schedule I substances have the highest abuse potential, while n Verify that the name on the label matches the schedule V have the least. Under this law, refll of a prescription. If the names do not match, then prescription and how long it is good for once written the label is wrong and must be fxed before is dependent on its schedule. the pharmacy technician can continue. n Verify that the drug on the label matches the pre- n If a prescription is a controlled drug according to scription. Both the drug and the medication schedule II of the Controlled Substances Act, the strength on the label must match the prescription cannot be reflled. prescription. n If a prescription is a controlled drug and found in n Count the quantity from the stock bottle, as indi- schedule III through schedule V, the prescription cated on the label. Make sure the NDCs match on may have up to fve reflls maximum. The 8 PharmExam3E_04_41-54.indd 44 4/6/17 11:33 AM  –PRESCRIPTIONS AND ABBREVIATIONS– prescription is also valid for six months from the date of issue. Correct DEA Number? n If a prescription is a noncontrolled drug, the pre- First letter will always be A, B, F, or M. scription may have up to 11 reflls maximum. The prescription is also valid for 12 months from the Second letter will always be the frst letter date of issue. of the prescriber’s last name. A mathematical calculation exists which ensures Prescription Validity (ExCPT) that the DEA number is correct: One role of the pharmacy technician is to verify a prescription is legal and valid. In the retail setting, n Add the frst, third, and ffth numbers to get this problem does arise and can frequently be diff- your frst answer. cult to spot. Forgeries can be as simple as replacing a n Add the second, fourth, and sixth numbers, quantity or as complex as writing a false prescription then multiply your total by two to get your entirely. second answer. n Add your frst answer with your second Passed in April of 2008, the Tamper Resistant answer. The last digit of this sum will be the Prescription Act is a federal law requiring Medicaid same as the last digit of the DEA number. physicians to write their prescriptions on prescrip- Example: Dr. Hodson DEA No: AH1234563 tion pads that are easily recognized as legitimate. All Medicaid prescriptions must be written on tamper- 1) 1 + 3 + 5 = 9 resistant prescription pads in order to be eligible for 2) 2 + 4 + 6 = 12 × 2 = 24 pharmacy reimbursement. These pads are made of paper that makes it diffcult to copy completed or 3) 9 + 24 = 33 AH1234563 blank individual prescriptions, and to erase or mod- ify information on a prescription. Prescription Interpretation Another way to prevent fraud is to know how to Understanding the components of a prescription is interpret a verifable Drug Enforcement Administra- essential. This allows the pharmacy technician to put tion (DEA) number on each controlled prescription the necessary (and correct) information into the ordered. If a DEA number is incorrect, this could be computer. indicative of a fake prescription. The Controlled Sub- Upon receipt of a prescription, the pharmacy stance Act also indicates the need for a physician to technician should be able to interpret the prescription have a DEA number to write a prescription for any fully and notice any missing information that may be controlled substance. The DEA number consists of necessary to process the prescription order properly. two letters. The frst letter can be either A, B, F, or M. The pharmacy technician may complete some missing The second letter will be the frst l etter of the pre- information, but the pharmacist must add any miss- scriber’s last name followed by seven numbers. The ing information that requires professional or clinical pharmacy technician can easily identify a correct judgment. DEA number by following these steps: 9 PharmExam3E_04_41-54.indd 45 4/6/17 11:33 AM  –PRESCRIPTIONS AND ABBREVIATIONS– DAW Codes Who Can Prescribe Medications? DAW codes are used to indicate the instructions In order for a provider to prescribe a controlled regarding generic substitution or if the prescribed substance, he or she must have registered with the medication must be dispensed. Many insurance DEA. This includes physician (either osteopathic or companies will require usage of generic medications, medical doctor), podiatrist, dentist, veterinarian, or or a prior authorization if DAW is requested. mid-level practitioner (physician assistant or nurse practitioner). Additionally, for a prescription to be Below are DAW codes indicated on a prescription valid, it must be prescribed for a medical purpose in and submitted during insurance adjudication for the field of practice. For example, a dentist could not approval. write a prescription for tramadol for back pain. Below are the credentials for each class of No selection indicated (substitution allowed) prescribers. Substitution not allowed by prescriber Patient requested brand only be dispensed Medical Doctor MD Pharmacist selected brand be dispensed Doctor of Osteopathy DO Generic product not in stock Podiatrist Dentist DPM Brand dispensed but priced as generic (Surgeon) Dentist DDS Physician Assistant DMD Override Nurse Practitioner PA Substitution not allowed-brand drug Veterinarian CNP required by law aa DVM Generic product not available Other 10 PharmExam3E_04_41-54.indd 44 4/6/17 11:33 AM  –PRESCRIPTIONS AND ABBREVIATIONS– Prescription Directions otic for the ear In most cases, the directions (sig means “take thou”) ou* each eye are written in shorthand, or an abbreviated form, that p after allows directions to be written easily. Directions gen- erally include how and when to take the medication pc after meals ordered. pm evening The pharmacy technician should have knowl- po by mouth edge of the abbreviations in prescription orders. This pr in rectum is the only way a pharmacy technician will be able to prn as needed correctly input directions into the computer and pv in vagina ensure the correct directions will be on the pharmacy q every label when the medication is dispensed. qd* every day or daily The following is the list of abbreviations you should know not only for the national exam, but q4h every four hours when working in the pharmacy setting as well: qid four times a day qod* every other day Commonly Used Abbreviations qs quantity sufficient or to make ac before meals qsad add quantity to make ad* right ear specific volume am morning s without as* left ear ss* one-half ASAP as soon as possible sig directions au* both ears sl under the tongue bid twice a day stat at once or now c with supp suppository cc* cubic centimeter tid three times a day (same as mL or milliliter) ud as directed d day DAW dispense as written *The drugs with a * denote those found in the Institute for Safe dc* discontinue Medical Practices (ISMP) Error-Prone Abbreviations, Symbols, and Dose List. Though these may still be seen in practice today, gtt drop they should be avoided, as they can be confused with other similar- h or hr hour looking abbreviations, leading to a potential medication error. hs* at bedtime From the list of abbreviations, we are able to cre- i one ate sentences to give directions. ii two iii three Example: ii gtts ou qid ud iv four Translation: Instill two drops into each eye, four od* right eye times a day as directed. opth ophthalmic (for the eye) os* left eye 11 PharmExam3E_04_41-54.indd 46 4/6/17 11:33 AM  –PRESCRIPTIONS AND ABBREVIATIONS– Prescription Misinterpretation counsel a patient. This job is reserved for the pharma- Human error can lead to misinterpretation of pre- cist, but a technician may ask the patient if there are scriptions. This is especially true with the names of any questions. If the patient would like to speak to a medications and the prescribing directions. To avoid pharmacist, they can be directed to the counseling problems, an understanding of abbreviations is vital area of the pharmacy so that questions and concerns for the pharmacy technician, as is conveying these may be discreetly addressed. directions in an easy-to-understand format, so In addition to the possible counseling, patients patients can understand completely how to take the may fnd some questions answered by reading the medication. patient package insert found with their prescription. This includes all the basic information about the drug, including the trade and generic names (if the brand Example: 1 pr qd prn name is dispensed), the indication of the drug and its Translation: Insert one rectally daily as needed. mechanism of action, any contraindications or warn- ings, dosage forms and routes of administration, basic Now let’s make it easier to understand for the cus- dosage instructions and dosing times, and possible tomer: adverse effects. The FDA requires this leafet be dis- pensed with every prescription. As an additional information source, some Remove foil and insert 1 suppository into rec- patients may receive medications that are accompa- tum once a day as needed. nied by a medication guide. This is a handout given with specifc drugs or drug classes that addresses or In some cases, the prescription directions may be highlights issues with their use. The FDA requires diffcult to interpret. If there’s any question as far as medication guides to accompany certain drugs in the validity of information on a prescription, the order for patients to use that drug safely and effec- pharmacist should be notifed. In most cases, the tively. A medication guide will give information pharmacist will be able to correct the issue or, if neces- regarding possible side effects, risks involved in taking sary, call the physician for clarifcation. the medication, ways to avoid possible adverse effects The medication information itself is as vital as from the drug, and other additional information. the directions for the medication’s use. The correct Antidepressants and non-steroidal anti-inflammatory interpretation of the prescription, including strength drugs (NSAIDs) are examples of drug classes requir- and quantity, is important. Misinterpretation does ing medication guides when being dispensed. occur, involving thousands of drugs, because of poor physician handwriting and drug names that sound the Prescription Transfer same phonetically. An understanding of trade and Federal law states only a pharmacist can accept a pre- generic drug names is necessary to interpret a pre- scription transferred from one pharmacy to another. scription correctly. State laws differ as to whether the original prescription Patients should also be offered a consultation is canceled when a transfer is made. Federal law man- from the pharmacist to ensure proper understanding dates that all prescription transfers must be handwrit- of the prescription label. If there are any questions ten on a new prescription form (hard copy) by the about the prescription, the pharmacist should be noti- pharmacist receiving the transfer, with other essential fed. Remember, a pharmacy technician must never information. Although a transfer must be completed 12 PharmExam3E_04_41-54.indd 47 4/6/17 11:33 AM  –PRESCRIPTIONS AND ABBREVIATIONS– by a pharmacist, the pharmacy technician may enter tion label, as well as the expiration date and number the prescription into the pharmacy computer system of reflls. For federal purposes, all of the information after the order has been transcribed. in the prescription label should be included. The Prescription Label What Is an NDC Number? Finished prescription labels derived from the com- puter should contain the following information: The NDC number is the National Drug Code number which should appear on every prescrip- n pharmacy name, address, and telephone number tion bottle, as well as the “Rx Only” label. The n prescription or Rx number number is similar to our Social Security Number n patient’s name (SSN) in that it identifes the product in the con- n dispensing date tainer. It comes in three sets of digits of which each set has its own meaning. n medication name, strength, dosage form, and quantity Example: 00000–0000–00 n directions for use The frst set of 5 numbers indicates the manufac- n prescriber’s name turer. n expiration date The second set of 4 numbers indicates the drug n number of reflls allowed product. n necessary auxiliary labels, including “Rx Only” The fnal set of 2 numbers indicates the package n National Drug Code (NDC) number size. Sample Prescription label Norma’s Rx Auxiliary and OTC Labels (ExCPT) 1524 South Euphoria Lane Denver, CO 80054 Auxiliary labels are used to provide additional 000-305-9988 infor-mation about the proper use of a drug that is Rx 116039430 11/03/2020 jm not included in the directions. These labels are Joe Medina Dr. Irene Cortiz-Colella colorful and easy to see so patients are alerted to special information regarding routes of Take 1 tablet by mouth twice a day for depression. administration, dosing instructions, and possible Zoloft (Sertraline HCl) 100 mg #60 side effects. NDC No. 0049-4960-50 May cause drowsiness Refills left: 4 Rx exp: 11/3/2021 Avoid sunlight For the Eye Some states differ as to whether both the trade name and generic name must appear on the prescrip- 13 PharmExam3E_04_41-54.indd 48 4/6/17 11:33 AM  –PRESCRIPTIONS AND ABBREVIATIONS – The FDA requires OTC drug labels to contain specific information in an easy-to-read format so patients can select or compare OTC medications and follow dosage guidelines. The following information is required: Active ingredients, including the amount in each dosage unit Purpose of each active ingredient Indications or uses for the product Specific warnings, including when the product should not be used under any circumstances, and when it is appropriate to consult with a doctor or pharmacist. This includes side effects and contraindications Dosage instructions Inactive ingredients, important information to help consumers avoid ingredients that may cause an allergic reaction. The labels for all OTC medications have the same format as well, with the required information in a font size large enough to be read easily. 14 PharmExam3E_04_41-54.indd 44 4/6/17 11:33 AM  –PRESCRIPTIONS AND ABBREVIATIONS– Pharmacy Drug Recalls n Class III recall: A situation in which use of or exposure is not likely to cause adverse health FDA drug recalls may occur if a manufactured legend consequences (prescription) drug product appears to have serious problems associated with it. Drug recalls are issued in three different classes which indicate the severity of Reference Books Found the recall: in the Pharmacy Setting n Class I recall: A situation in which there is a rea- The pharmacy should have reference books that sonable probability that the use of or exposure allow a health professional, including the pharmacy will cause serious adverse health consequences or technician, to look up specifc information as needed. death The following is a chart of the most commonly used n Class II recall: A situation in which use of or reference sources found in the pharmacy setting, and exposure may cause temporary or medically what kinds of information are offered in each. reversible adverse health consequences; or where Although many reference texts can now be found the probability of serious adverse health conse- online, some are still in book form. quences is remote REFERENCE INFORMATION PROVIDED OTHER USEFUL INFORMATION United States drug standards required in the pharmacy setting Pharmacopeia USP—Drug Information or USP-DI (3 volumes) Volume I information for the health professional Volume II advice for the patient written in easy-to-understand language Volume III approved drug products and legal requirements Remington’s information for compounding contains physical characteristics of different Pharmaceutical purposes drugs and recipes Facts and Comparisons drug information is the most updated reference source Physician’s Desk Refer- information about drugs, mainly limited information, as the book is dependent ence or PDR inserts from drug manufacturers on which drug inserts are included American Drug Index brief information about all trade if more information needed, go to Facts and and generic drugs available Comparisons Handbook of Over-the- information on all OTC drugs on includes not only active ingredients, but also Counter Drugs the market inactive ingredients Handbook of Injectable information about IV solutions and includes charts that indicate compatibility of Drugs drug-drug compatibilities drugs and IV solutions Redbook information concerning the for insurance or third-party pricing average wholesale pricing of prescriptions The Orange Book listing of therapeutic identifies drug products that are equivalencies of drugs therapeutically equivalent 15 PharmExam3E_04_41-54.indd 49 4/6/17 11:33 AM  –PRESCRIPTIONS AND ABBREVIATIONS– Drug Expiration Date Practice Questions A drug’s expiration date is the time frame for which a 1. Interpret the following directions: drug is “effective,” according to the manufacturer. i cap po qid × 10d Many times, the expiration date of a product will be indicated by month and year. The actual expiration a. Take one capsule by mouth four times a day date, though, is the last day of the month and year for ten days. indicated. a. Take one capsule by mouth three times a day for ten days. Example: A 12/2020 expiration date on a. Take one capsule by mouth twice a day for the bottle really means 12/31/2020 is the ten days. actual expiration date. a. Take one capsule by mouth once a day for ten days. To ensure products do not expire while in the pharmacy setting, it is important to rotate stock 2. Interpret the following directions: accordingly by placing drugs that are to expire sooner ii tab po tid × 7d. in front of drugs that are to expire later. This can easily be done when replenishing medications on a daily a. Take two tablets by mouth four times a day basis. for seven days. b. Take two tablets by mouth three times a day for seven days. c. Take two tablets by mouth twice a day for seven days. d. Take two tablets by mouth once a day for seven days. 3. Interpret the following directions: i pr hs a. Take one as needed at bedtime. b. Insert one in rectum before bedtime. c. Insert one in rectum at bedtime. d. Insert one in rectum after bedtime. 16 PharmExam3E_04_41-54.indd 50 4/6/17 11:33 AM  –PRESCRIPTIONS AND ABBREVIATIONS– 4. How many tablets need to be dispensed for the 8. Of the following reference sources, which one following directions: deals with the term incompatibility? a. Facts and Comparisons sig: vi tab po tid × 2d; iv po bid × 2d; b. PDR iii po qd × 2d; i po qd × 2d then dc c. Handbook of Injectable Drugs a. 28 tablets d. Remington’s Pharmaceutical Sciences b. 36 tablets c. 48 tablets 9. Of the following reference sources, which one d. 60 tablets involves manufacturer drug inserts? a. Facts and Comparisons Using the following information to answer questions b. PDR 5 and 6: c. Handbook of Injectable Drugs d. Remington’s Pharmaceutical Sciences Percocet® #30 sig: i – ii po qid ud prn pain 10. Based on the following directions, which Cortisporin® drops are you going to use? 5. Interpret the directions above. a. Take one by mouth as needed for pain. sig: ii gtts ou bid × 10d b. Take one to two by mouth as needed for a. Cortisporin® Otic drops pain. b. Cortisporin® Ophthalmic drops c. Take one to two by mouth four times a day c. Both drops can be used. as needed for pain. d. The directions have nothing to do with d. Take one to two by mouth four times a day drops. as directed as needed for pain. 11. What does the third set of numbers describe in 6. If Percocet® is a schedule II drug, what is the the NDC number? maximum number of reflls allowed for this a. the manufacturer prescription? b. the product a. 0 c. the package size b. 1 d. the classifcation of drug c. 5 d. 11 12. What does DAW mean? a. to fll a prescription for quantity asked for 7. Of the following drug recalls, which one is the b. to fll a prescription for drug asked for most serious, indicating that a patient may be c. The prescription order must be delivered. harmed? d. It is allowable to substitute a generic version a. class I of this drug. b. class II c. class III d. class IV 17 PharmExam3E_04_41-54.indd 51 4/6/17 11:33 AM  –PRESCRIPTIONS AND ABBREVIATIONS– Using the following information, answer questions 13, 16. What would the true expiration date be for a 14, and 15: drug that has 04/2020 as the expiration date imprinted on the manufacturer’s container? amoxicillin 150 mg 11/03/2020 a. 3/31/2020 sig: i po tid × 10d b. 4/01/2020 Dr. Irene Ortiz c. 4/30/2020 Reflls ____ DAW __ d. 5/01/2020 13. How many capsules are needed to fll this pre- 17. Interpret the following directions: scription order? a. 10 capsules ii po q12h pc prn indigestion. b. 20 capsules a. Take two by mouth every 12 hours as needed. c. 30 capsules b. Take two by mouth every 12 hours as needed d. 40 capsules for indigestion. c. Take two by mouth every 12 hours before 14. How many reflls did this prescriber authorize meals as needed for indigestion. for the amoxicillin? d. Take two by mouth every 12 hours after a. 0 meals as needed for indigestion. b. 1 c. 5 18. If one teaspoonful (tsp) is equal to 5 mL in vol- d. 11 ume, what is the total volume needed to fill this 15. How long is this prescription valid to be flled prescription or last the full 30 days? at a licensed pharmacy? sig: 1/2 tsp po bid × 30d a. ten days a. 50 mL b. three months b. 100 mL c. six months c. 150 mL d. one year d. 200 mL 19. Which of the following is a false statement? a. Being human causes misinterpretation of prescriptions sometimes. b. The medication being prescribed is as vital as the directions for the medication’s use. c. Always assume directions can be easily understood by a customer or patient. d. If a prescription order indicates DAW, this means it should be dispensed as written. 18 PharmExam3E_04_41-54.indd 52 4/6/17 11:33 AM  –PRESCRIPTIONS AND ABBREVIATIONS– 20. Which of the following is most likely to be a Answers and Explanations correct DEA number for a Dr. Robert Plick? a. AR4637810 1. a. Take one capsule by mouth four times a day b. AR4637816 for ten days. Remember: qd is once a day, bid c. AP4637810 is twice a day, tid is three times a day and qid d. BP4637813 is four times a day. 2. b. Take two tablets by mouth three times a day 21. For the following NDC number, what would for seven days. the frst set of numbers be indicative of? 3. c. Insert one in rectum at bedtime. Hs means NDC: 50111-0648-03 always at bedtime and not before or after. Pr means “pertaining to the rectum,” but for a. the product easy to understand directions, “in rectum” b. the manufacturer would apply. c. the package size 4. d. The total is 60 tabs. If we break it down in d. the generic name days: on day one, we would dispense 18 tabs; on day two, 18 tabs; on day three, eight tabs; on day four, eight tabs; on day fve, three tabs; on day six, three tabs; on day seven, one tab; and on day eight, one tab. If we add these tabs, it would come to 60 tablets total. 5. d. Take one to two by mouth four times a day as directed, as needed for pain. 6. a. The maximum number of reflls for a CII drug is 0; for schedule III to V, it is 5 reflls; for noncontrolled drugs, the maximum refll amount would be 11. 7. a. A class I drug recall would be the most seri- ous, meaning it may cause harm to a patient. Class II is less serious, as harm to a patient is remotely possible, but highly unlikely. In class III, there is no harm expected for the patient, as the product does not meet FDA guidelines. 8. c. Handbook of Injectable Drugs is used to look for compatibility or incompatibility of injectable drugs or solutions. Facts and Comparisons is a reference source for drug therapy, as is the PDR. Remington’s Pharma- ceutical Sciences is a book that deals with questions involving compounding. 19 PharmExam3E_04_41-54.indd 53 4/6/17 11:33 AM  –PRESCRIPTIONS AND ABBREVIATIONS– 9. b. The PDR is a source for drug information 17. d. Take two by mouth every 12 hours after but is limited as it contains only drug meals as needed for indigestion. inserts from drug manufacturers. 18. c. The directions imply what the total volume 10. b. The directions imply that the drops are to will be if we insert our volume and multiply. be placed in each eye, so you would use the In this case, you are told that 1 tsp is equal to ophthalmic drops—the otic drops would 5 mL. If this is the case, then 0.5 tsp would be for the ear. be equal to 2.5 mL, or one-half of 5 mL. 11. c. The third set of digits of the NDC number is To solve: (2.5 mL)(2 times a day)(10 days) the package size. The frst set would be the = 150 mL. manufacturer, and the second set of digits 19. c. You should never assume that directions can would identify the product itself. be understood easily by the customer or 12. b. DAW, or dispense as written, specifcally asks patient. That is one reason that counseling the pharmacy to fll the medication as pre- customers/patients is so important. scribed or ordered. A change can be made 20. d. The frst letter of a DEA number is either A only if the pharmacist were to get approval or B, and the second letter is the frst letter from the physician to do so. of the physician’s last name. The mathemati- 13. c. The directions “one capsule by mouth three cal steps involve adding the frst, third, and times a day for ten days” will tell you how ffth set of digits to get a total, then add the many capsules you need if you simply follow second, fourth, and sixth set of digits to get the directions and multiply: (1 cap) × a total, which you will multiply by 2. Then (3 days) × (10 days) = 30 capsules. simply add your two totals, and the last 14. a. Because there is nothing completed next to number of your new total is the last digit the reflls line, the prescriber has not indi- of the DEA number. cated she would like this reflled for the 21. b. The NDC number consists of three sets of patient, so this would be 0 reflls. digits. The frst set of digits is indicative of 15. d. Since this drug is noncontrolled, the pre- the manufacturer. The second set of digits scription is good for one year. would be what the drug product is, and 16. c. The true expiration date given on a manu- the third set would be indicative of the facturer’s container, when written in the package size. month/year format, is always the last day of the month in the year shown. In this case, that’s 4/30/2020. 20 PharmExam3E_04_41-54.indd 54 4/6/17 11:33 AM  3 c h a p t e r PHARMACY LAW CHAPTER OVERVIEW The practice of pharmacy is one of the most heavily regulated professions in the United States. Although a basic understand- ing of pharmacology is the center of a technician’s education, knowledge of both state and federal law is required to practice effectively in this profession. This chapter will help you under- stand the concepts of some of the more important laws that may appear on the national exams, which, more importantly, you will need to understand when working in the pharmacy. The most common pharmacy reference books will also be discussed. KEY TERMS adulteration law board of pharmacy (BOP) legend drug case law legislative law civil law Material Safety Data Sheets (MSDS) code of ethics MedWatch common law misbranding contract law National Association of the Boards of Pharmacy criminal law (NABP) Drug Enforcement Administration (DEA) protected health information (PHI) ethics orphan drug Food and Drug Administration (FDA) state board of pharmacy 21 PharmExam3E_05_55-72.indd 55 4/6/17 11:34 AM  –PHARMACY LAW– The need to understand the specific laws Ethics governing the pharmacy profession cannot be overstated. There are situations in which a In the workplace, ethics are a system of moral pharmacy technician will make a decision that values given to a vocation or profession to follow. As involves a law in some respect. As mentioned in a pharmacy technician, it is imperative that you Chapter 2, there are state and federal laws which all follow the ethical standards of pharmacy practice. technicians need to understand. Since states do It is important to remember that professional differ, we will simply discuss federal law on which behavior and moral character are just as important the national exam is based. Be sure to check with in pharmacy as knowledge of medications. the pharmacy board of your own state to learn more about the specific laws that will affect your job. Pharmacy Technician Code of Ethics The American Association of Pharmacy Laws are the principles and regulations established Technicians (AAPT) developed a code of ethics in a community by a governing body and applicable for pharmacy technicians. These ethics guide the to its people, whether in the form of legislation or technician in relationships with patients, healthcare policies recognized and enforced by judicial professionals, and society. The principles of the decision. Laws also provide resolution to conflicts pharmacy technician code of ethics include the between two parties. In pharmacy, the goal is to following: protect the health and welfare of the patients, while also protecting the practitioners from individuals n A pharmacy technician’s frst consideration is to who would defraud a pharmacy to obtain ensure the health and safety of the patient and to medication. Laws must evolve to meet the changes use knowledge and skills to the best of his/her or challenges that are presented in the community. ability in serving patients. n A pharmacy technician supports and promotes honesty and integrity in the profession, which State and Federal Law includes a duty to observe the law, maintain the highest moral and ethical conduct at all times, State and federal courts are not necessarily indepen- and uphold the ethical principles of the dent of each other. Many state and federal laws profession. interact, creating overlap between the courts. n A pharmacy technician assists and supports the The difference is that federal courts handle cases pharmacists in the safe, effcacious, and cost- that violate the laws that Congress has enacted. effective distribution of health services and States have the authority to enact laws in areas healthcare resources. where Congress has already acted, assuming the n A pharmacy technician respects and values the laws do not conflict with the federal versions. The abilities of pharmacists, colleagues, and other federal law will always supersede the state, unless the healthcare professionals. state law is stricter than the federal version. In these n A pharmacy technician maintains competency in cases, the state law will prevail. An example is the his/her practice, and continually enhances his/her classification of Valium®. According to the Drug professional knowledge and expertise. Enforcement Administration (DEA), Valium® n A pharmacy technician respects and supports the (diazepam) is a class IV controlled substance; but patient’s individuality, dignity, and in the state of New York, it is treated as a class II and confdentiality.