Abbreviations
Calculations
Calc II
Compounding
Controlled Substances
Dispensing
Insurance
Law
Medications
Prescriptions
Safety
100
OD = ___ AS = ___
OU = ___ PRN = ___
GTT = ___ mL = ___
tsp = ____ T = ___
PO = ____ PR = ___
BID = ___ TID = ___
AC = ____ QD = ___
Right eye | Left ear
Both eyes | As needed
Drop | milliliter
teaspoon | Tablespoon
by mouth | per rectal
twice daily | three times daily
Before meals | every day
100
1 tsp = _____ mL 1 tbsp = ____ mL
1 fl oz = ____ mL 1 kg = ______ lbs
°C to °F = _________
°F to °C = _________
5 mL | 15 mL
30 mL | 2.2 lbs
C to F = (°C x 9/5) + 32
F to C = (°F -32) x 5/9
100
Methods to calculate pediatric doses:
- most common = ________________
- weight based formula = __________
- age based formula = _____________
- can also use = __________________
most common = weight based dosing (mg/kg)
weight based form = Clark's
age based form = Young's
can also use = BSA
100
Which USP chapters correlate to the following topics?
1. hazardous drugs
2. sterile compounding
3. non-sterile compounding
1. <800>
2. <797>
3. <795>
100
DEA form:
41 is used for _____
106 is used for ____
222 is used for ____
224 is used for ____
41 = destroying, discarding, significant spillage, etc
106 = reporting left or loss
222 = ordering C I/II or TRNFR C-II btw pharmacies
224 = new registrants (getting a DEA #)
100
Room Temp = ____ °F
Refrigeration Temp = _____ °F
Freezer Temp = _____ °F
RT = 68-77 °F
Fridge = 35-46°F
Freezer = 5°F
100
What's the term for the out of pocket amount the patient has to pay before insurance starts covering costs?
Deductible
100
What law required all medications to have an NDC?
What do the 3 sections of an NDC tell us?
Drug Listing Act
1st section: manufacturer
2nd section: drug name, strength, dosage form
3rd section: package size
100
Drugs are mainly absorbed in the _________ into the blood. Then they travel to and are metabolized by the ______.
small intestine, liver
100
What does the "origin code" for a Rx tell us?
What would be the origin code for the following Rx images?
1. 
2. 
3. 
Manner in which we received the Rx...where it originated
1. Written
2. Electronic
3. Verbal (taken by RPh)
100
Which organization's primary function/goal is to prevent medication errors?
Institute for Safe Medication Practices (ISMP)
200
APAP = ___ NSAID = ___
ASA = ___ HCTZ = ___
SSRI = ___ CCB = ___
ACEi = ___ ARB =
Acetaminophen | Non-Steroidal Anti-Inflamm Drugs
Aspirin | Hydrochlorothiazide
Select. Seroton. Reuptake Inhib | Ca Chan. Blockers
ACE inhibitors | Angiotensin Receptor Blocker
200
Calculate the days supply:
Take 3 tabs po BID #48
8 days
200
A pharmacy sells a Rx for $56.15. The total cost of the Rx was $32.50. What is the gross profit?
$23.65
200
What's the difference between a BUD and an expiration date?
Which one is usually in years vs days/months? and why?
Expiration dates used on commercially manufactured products (years)
BUD's used on compounds (days/months)
Why - typically no preservatives in compounds
200
What extra piece of prescriber information is required to be on a controlled substance Rx?
DEA number
200
Dispensing medications is run on a FIFO system.
What does that stand for?
What does it mean?
First in, first out
Products with a shorter expiration dates are in the front to use first
200
What are the names of the Medicare Part plans and what do they do?
A- ?
B- ?
C- ?
D- ?
A = hospital insurance
- helps cover inpatient hospital, SNF, hospice
B = medical insurance
- HCPs costs, medical equip, preven. services
C = medicare advantage
- bundled "all in one" instead of Med A and B
D = prescription drug coverage
- helps cover Rx drug costs
200
Which law required childproof packaging on all controlled and most prescription drugs dispensed to patients?
What does childproofing mean?
What is 1 exception to this law?
Must be sufficiently resistant that at least 80% of children < 5yo CAN'T open it, and that it’s resistant enough that at least 90% of adults CAN open it within 5 min.
Nitroglycerin SL tabs
200
Dosage forms (tabs/caps/suspensions/solutions etc) are made up of the active drug and _________.
These include binders, lubricants, fillers, diluents, preservatives, stabilizers, disintegrants that help the drug do what it needs to do
inactive ingredients or "excipients"
200
Are we able to substitute a brand name medication to its generic if the prescriber indicates DAW 0?
What about DAW 1?
What does DAW 2 mean?
Yes, DAW 0 = generic substitutable
DAW 1 = no, fill as prescribed
DAW 2 = brand dispensed per pt request
200
What are the 3 classifications of FDA drug recalls and what do they mean?
Class I - strong likelikehood to cause adverse effects
Class II - may cause temporary but reversible AE's
Class III - unlikely to cause adverse health effects
300
Cardi = ___ Oste = ___
Gast = ___ Derma = __
Glyc = ___ My = ___
Heart | Bone
Stomach | Skin
Sugar | Muscle
300
Calculate the quantity needed:
2.5 tabs BID x30 days
150 tabs
300
A specialty medication's wholesale cost is $14.50. The pharmacy adds a 15% markup for specialty medications. What will the patient pay for the medication?
$16.68
300
What is it called when we use processes to prevent contamination from things like bacteria and fungi by using PPE, appropriate compounding practices, hand hygeine, etc. called?
Aseptic technique
300
How long does a prescriber have to send in a Rx after giving the pharmacy an emergency verbal C-II Rx?
7 days
300
What is scanned when packaging medications to ensure we're dispensing the correct product?
NDC
300
What does the BIN # do?
BIN # is assigned to a third party, tells us where the claims goes
300
How many phases of clinical trial are there?
Describe them.
Phase 1: 20-100pts, focus on safety
Phase 2: hundreds pts, safety + effectiveness
Phase 3: thousands pts, safety, dosage, and effectiv.
300
Name the routes.
Which routes need longest needle? shortest?
1. IV
2. IM
3. SQ/SC
4. ID
IV/IM = longest, ID/SC = shortest
300
What are common auxiliary labels for the following:
- NSAIDs
- Antibiotics
- Levothyroxine
- Suspensions
NSAIDs = take with food
Abx = take until gone
Levothyroxine = take on an empty stomach (OES)
susp = shake well
300
What's the purpose of Tall Man Lettering?
Name 1 SALAD combo.
Safety - to point out "differences" in common SALAD's
1. Bupropion/buspirone
2. presnidone/prednisolone
3. hydralazine/hydroxyzine
400
HTN = __ DM = __
CAD = __ CVA = __
GERD = __ BPH = __
UTI = __ N/V = __
HA = __ PRNP = __
Hypertension | diabetes mellitus
Coronary artery disease | cerebrovascular accident
Gastroesoph. Reflux Dis. | Benign Prost. Hyperplas.
Urinary Tract Infection | Nausea and Vomiting
Headache | As Needed for Pain
400
Calculate the days supply:
Take 1 tab BID x10 days, then increase to 1 tab QID
Disp # 120
35 days
400
A 115 lb patient is prescribed Vancomycin 10 mg/kg/day.
- How many mg will the patient receive over 3 days?
- In grams?
1568.1 mg
1.57 g
400
What types of formulations are the following? Which one(s) do we need to ensure has a "shake well" auxiliary sticker on?
A - suspension: drug particles dispersed in a soln
B - emulsion: 2 liquids that don't mix
- emulsifying agent to help
C - solution: solute (drug) in a solvent (liquid)
- Aqueous solns use water as solvent
- nonaqueous solns:
- hydroalcoholic: water + alcohol
- alcoholic: only alcohol
400
How many refills are allowed on:
C-II Rx's?
C III-V Rx's?
Zero
5 refills max within 6 months
400
What are some examples of medications we would keep in the manufacturer's packaging?
- If the packaging protects the medication from light, mositure, etc, (Nitroglycerin SL tabs, dabigatran)
- Reconstituted meds
- hazardous materials (most)
400
What does person code 03 mean?
dependent; usually a child
400
Which law distinguished this as a legend drug as well as requiring the manufacturer to include "Rx only" on the stock label?
400
Describe local vs systemic effect.
Describe first-pass metabolism.
Local - drug activity stays at site of administration..eyes, ears, nose, skin
Systemic - introduced to circulatory system, carreid by blood to where it needs to go
FPM: Some drugs are significantly degraded by liver metabolism as they pass from GI tract to the liver, before it reaches main circulation
400
Rules for Label diections
1. Start with a ___________
2. Indicate _______________
3. Don't use ______________
4. Use familiar ____________
1. verb
2. ROA
3. abbreviations
4. words
400
What are a couple of ways to helps patients increase adherence?
Pill boxes, calendars
RPh counseling, etc.
500
FDA = _____ DEA= _____
BOP = _____ CMS = ____
Food and Drug Admin. | Drug Enforcement Agency
Board of Pharm. | Cntr for Medicare & Medicaid Serv
500
How many grams of dextrose are in a 750 mL IV bag of D5W?
37.5 g
500
A 1 L bag of NS is to be infused over 3 hrs, what’s the flow rate in mL/min? Round to nearest whole number.
5 mL/min
500
Describe the steps of garbing
1. remove unnecessary items (jewelry, etc)
2. Shoe covers, hair bonnet/beard cover, and face mask
3. hand hygiene
4. Gown
5. Gloves
500
How long is a Rx valid for once written?
- regular Rx
- C III-V Rx
- C II Rx
1 year
6 months
1 year (no refills)
500
What is an automated dispensing system?
What's a benefit of one?
“Cabinet” that holds prepackaged meds for fast administration
Benefit: less wait time and decreases errors
500
Describe the following formularies:
- open
- closed
- tiered
Open - typically cover all drugs/NDCs, but cost more since most flexibility
Closed - covers certain drugs/NDCs, but lower cost
Tiered - different categories
- Tier 1: cheaper, generics, preferred drugs
- Tier 5: most expensive, brand name, higher copay
500
__________ established strict controls on OTC sales of Sudafed, ephedrine, and phenylpropanolamine.
1. What is the generic name for Sudafed?
2. What are the federal and state daily limits? Monthly limits?
1. pseudoephedrine
2. Daily limit = 3.6g
Federal monthly limit = 9g
IN monthly limit = 7.2g
500
What type of dosage forms were created to help PO drugs avoid significant degradation of first-pass metabolism?
Which ones bypass it altogether?
Modified Release dosage forms. Ex: ER/XR/CR/XL/EC
Bypass = injection (IV, IM, SQ), SL, buccal, rectal, topical, inhalation, etc.
500
How many years does federal law require pharmacies have to keep records for controlled substances including order forms and prescriptions?
2 years
500
Which of the following are "error-prone" abbreviations?
1. QD, BID, TID, QOD
2. U, mL, fl oz, IU
3. qhs, qam, qpm
4. OD, AD, OS, AS, OU, AU
1. QD and QOD
2. U and IU
3. qHS
4. All
600
IV = ____
IM = ____
SC = ____
ID = ____
INH = ____
intravenous
intramuscular
subcutaneous
subcutaneous
intradermal
inhalation
600
Calculate the total mL needed to fill the Rx:
ii tsp po BID x5 days
100 mL
600
How many grams of triamcinolone 3% and 8% are needed to make 30 grams of a 6% triamcinolone preparation?
3% strength = 12 g
8% strength = 18 g
600
How long does a LAFW need to run before sterile compounding can begin?
How often do PEC's need recertified?
How often does a work surface in a PEC need cleaned?
30 minutes
6 months
Daily
600
Give 1 example of a medication in each schedule
I -
II -
III -
IV -
V -
I - heroin, LSD, peyote
II - opioids, Amphetamines, Cocaine, Demerol
III - Tylenol #3, Testosterone, anabolic steroids
IV - benzodiazepines, Ambien, phenobarb, tramadol
V - Lyrica, Lomotil, Cough syrup w/ codeine
600
Put the following steps in order for community pharmacy dispensing:
1. Bill pt's insurance Receive a Rx
2. Print label + fill Rx
3. Pull up patient profile or create new one (obtain ins info, allergies, etc)
4. Receive a Rx
5. Offer pt counseling
6. Dispense Rx to the patient
7. RPh final verifies Rx
1. Receive a Rx
2. Pull up pt profile or create new one (obtain pt demographics, ins info, allergies, etc)
3. Bill pt's insurance
4. Print label + fill Rx
5. RPh final verifies Rx
6. Dispense Rx to the patient
7. Offer pt counseling
600
What does COB stand for?
what does it entail?
Coordination of Benefits
One insurance will be primary, billed first. Others (if any) will be secondary, billed for the remaining cost
Medicaid usually always billed last
600
A ____ gives manufacturers exclusive market rights to a new drug (~20 yrs from filing, ~10 yrs once reaches market) -- called a ______ drug at this point.
Once it expires, other manufacturers can copy the drug and release it under its _______ name. These manufacturers don't do any safety testing, but must show that their copy is ____ equivalent and ___ equivalent.
The ____ Book shows generic drug evaluations
Which Act offers patent extensions to original manufacturers as well as faster market entry for copied drugs once patents expire?
patent; brand name
generic; pharmaceutically and therapeutically
Orange
- A rated = equivalent
Hatch-Waxman Act
600
Which 2 PEC's can be used to compound hazardous drugs?
Biological Safety Cabinet
Compounding Aseptic Containment Isolator
600
What are some requirements for Rx labels?
Pharmacy name, address, phone #
Pt name + address
Prescriber name + address
Fill date
Rx #
Drug name, strength, and dosage form
Directions + qty
etc.
600
Which types of medications are thrown away in
P waste:
U waste:
P - "acutely' hazardous, warfarin, nicotine, etc.
U - most chemo drugs including cyclophosphamide