Pharmacology

Adverse Drug Reaction (ADR)

Is a negative consequence to a patient from taking a particular drug.

Product package insert (PPI)

Is sent to the pharmacy from the wholesaler, contained in the stock medication. The PPI is for the pharmacist and technician, not the patient.

radiopharmaceutical

Is working with radioactive isotopes, and is a specialized area of pharmacy practice; nuclear pharmacy. Specialized training and certification is required to work with these agents.

Apothecary system

One of the oldest systems of measurement, based on the weight system developed by the Romans. • Dram: approximately equal to 4mL • Scruple: roughly equivalent to 1.3 g

Social Causes of medication errors

Patients can contribute to medication errors through incorrect self-administration. Social causes of medication errors include failure to follow instructions because of cost or noncompliance, failure to take therapy as instructed, or misunderstanding of instructions. Patients can contribute to medication errors by: forgetting to take a dose or doses; taking too many doses; dosing at the wrong time; not getting a prescription filled or refilled; not following directions; terminating the drug regiment too soon. Social causes can result in adverse drug reaction, sub-therapeutics or even a toxic dose. Over 50% of patients on necessary long-term medications are no longer taking them after 1 yr. Noncompliance could result in a progression of a disease, lasting harm or death. Issues of noncompliance should be brought to the attention of the pharmacist. Social circumstances create the potential for medication errors.

Bioequivalent

Performs in the same manner as an already approved brand name drug.

What are other apothecary measurements?

Pint, quart, gallon, ounce, and pound

Phase 4 clinical trials

Postmarketing

Powders

Preparations in the form of fine particles. • Goody's headache powders

Prophylactic Agents

Prevents illness or disease from occurring. Prophylactic agents include: • Antiseptic and germicidal liquid chemicals for pre-operative hand washing procedures • Vaccines • Influenza; mumps; hepatitis • Pneumonia; rubella • Shingles; chicken pox • Tetanus; smallpox • Measles; poliomyelitis • Antibiotics

Step 6: Compound or fill prescription

Safety Practices for Accurate Compounding and Filling: calculation and substitution errors are frequent sources of medication errors in the pharmacy. Interruptions and distractions during filling or compounding can lead to medication errors. Equipment Maintenance: equipment used in compounding should be maintained, cleaned and calibrated on a regular basis. Auxiliary labels: serve as reminders of the most crucial aspects of proper medication administration.

Step 7: Obtain a Pharmacist review and approval

The pharmacist must be the one to review and approve a prescription. Responsibilities of the Pharmacist: the pharmacist is legally responsible for verifying the accuracy and appropriateness of the prescriptions filled. Pharmacist verify the quality and integrity of the end product; it is not very productive to have them verify each step in the process. Role of the Technician in Verification Process: practice checking the work of a colleague.

Burden of Proof

The plaintiff must provide sufficient evidence to prove his or her case

Step 3: Perform Drug Utilization Review and Resolve Medication issues

The potential for medication errors increases with the number of medications a patient takes. Drug Utilization Review (DUR): for every prescription; checks for multiple drug therapy, dosing ranges, existing allergies, pertinent medical diseases, and conditions. Dosing Ranges and Drug Interactions: a DUR should be performed by the pharmacist. Allergy-Related Alerts: a DUR will often prompt and allergy-related question that needs to be addressed by the pharmacist. Pharmacist Follow-up: the pharmacist must decide whether to counsel or contact the physician before filling a prescription.

Physical dependence

Taking a drug continuously so that when the medication is stopped, physical withdrawal symptoms occur.

Antibody

The part of the body's immune system that neutralizes antigens or foreign substances.

Registration

The process of being enrolled on a list created by the state board of pharmacy.

Microemulsions

Another type of colloidal dispersion; a liquid that is dispersed in another.

Compliance

adherence to a required set of standards, regulations, laws, and practices.

Enteric-coated tablet (ECT)

delay-release formulation.

Transdermal dosage form

designed to deliver a drug contained within a patch or disk to the bloodstream via absorption through the skin.

oral disintegrating tablet (ODT)

designed to melt in your mouth. ODT's are useful for pediatric and geriatric patients who may have difficulty swallowing or for patients with nausea.

Therapeutic effect

desired pharmacological action of a drug on the body

Pyrogens

fever-producing by-products of microbial metabolism.

Delayed-release (DR) formulations

have a special coating designed to delay absorption of the medication and to resist breakdown by acidic gastric fluids.

Storage of insulin

insulin must be protected against extreme temperatures. Open vials and pens can be stored at room temperature and discarded after one month. Unopened vials and pens should remain refrigerated.

Insulin Coverage for Insulin Supplies

insurance companies require a prescription for coverage of diabetic supplies.

Oral Syringe

measures and delivers oral liquid medications to pediatric patients. This type of syringe is a calibrated device consisting of a plunger and cannula, and is used without a needle to administer medications to the mouth. Oral syringes can be used to slowly administer liquid medications. Very small doses (less than 1 mL) can be administered with a tuberculin syringe (without a needle).

Biofeedback

mental exercise and relaxation to slow heartbeat, lower blood pressure, and reduce stomach problems.

Administration of Insulin

most commonly used medication that is administered subcutaneously is insulin.

IV route

one of the more common parenteral routes of drug and fluid administration. preferred route of administration in an emergency situation; rapid action to control and treat symptoms. IV medications can be administered via two routes: IV bolus and IV infusions.

Paraprofessional

one who is qualified and trained to assist a professional.

Magma

or milk like liquid, is an example of a dispersion containing ultrafine colloidal particles that remain distinct in a two-phase system.

Extract

potent dosage form derived from plant or animal sources which most or all of the solvent has evaporated to produce a powder, an ointment like form, or a solid.

Controlled-release (CR) formulations

one dose

Professional

someone with recognized expertise in a field who is expected to use his or her knowledge and skills to benefit others and to operate ethically with some autonomy.

Insulin Product Selection

syringe size, needle length and needle gauge. Insulin vials are 10mL with a concentration of 100 units per mL (containing 1,000 units of insulin); prefilled syringes contain 3mL.

Label design

tall man" or enhanced lettering, adding warning statements or other labeling changes to better differentiate products and dosages.

Licensure

the granting of a license by the state; usually renewable; often dependent on keeping current knowledge and skills. People become licensed through training and/or passing an exam. Pharmacists must license in each state to practice.

Ethics

the study of standards of conduct and moral judgment that outline the rights and wrongs of human conduct and character. A process for reflection and analysis.

Viscosity

the thickness and flow characteristics of fluids.

Bioavailability

the time it takes the generic drug to reach the bloodstream and exert a pharmacological effect on healthy volunteers, is one way that scientists demonstrate bioequivalence. Bioavailability includes how a drug is absorbed, metabolized, distributed or eliminated from the body.

Solvent

the vehicle that makes up the greater part of the solution.

Sustained-release (SR) formulations

two doses every 8-12 hours.

Medication Design

unique colors, shapes, or markings; the four middle numbers of the NDC are larger font or boldface type.

Rectal route of administration

used to deliver drugs into the rectum. proper storage and administration

Arabic

uses numbers, fractions and decimals.

Omission error

when a prescribed dose is not given.

Wrong time error

when any drug is given 30 minutes or more before or after it was prescribed; does not include prn (as needed) orders. Categories of medication errors can also be defined by what caused the failure of the desired result.

workplace ergonomics

work setting contributes to overall safety of the work environment.

Medication error

"any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer. Such events may be related to the professional practice, healthcare products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use." (The National Coordinating Council for Medication Error Reporting and Prevention)

What are the 3 most common causes of medication error?

(1) Assumption error: an essential piece of information cannot be verified. (2) Selection error: when two or more options exist and the wrong option is chosen. (3) Capture error: when focus on a task is diverted elsewhere.

What are the 5 R's?

1) Right Drug 2) Right Strength 3) Right Route 4) Right Time 5) Right Patient

What are the 3 steps of work practices?

1) information that needs to be obtained or checked 2) resources that can be used to verify information 3) potential medication errors that would result from a failure to obtain or check the necessary information using the appropriate resources

Syringe

A calibrated device used to accurately draw up, measure, and deliver medication to a patient through a needle. Common syringes include an insulin syringe, tuberculin syringe (cannula is the bore area inside the syringe) and hypodermic syringe.

Diagnostic Agent

A chemical containing radioactive isotopes that is used to diagnose or treat disease. Isotopes are forms of an element that contain the same number of protons but different number of neutrons. Unstable radioactive isotopes give off energy in the form of radiation. Isotopes can be used as tracers, helping pinpoint, diagnose and treat certain disorders. • Technetium (Tc) and iodine (I)

Psychological Dependence

A condition in which a patient takes a drug on a regular basis because it produces a sense of well-being. Patients can experience anxiety or withdrawal symptoms if they stop taking the drug.

Drug Tolerance

A condition in which the body adapts to a drug so that higher doses are needed to produce the same therapeutic effect achieved earlier with lower doses. Drug tolerance can lead to psychological, physical dependence, or drug addiction.

Ointment

A dosage form that is a water-in-oil (W/O) emulsion - a formulation that contains a small amount of water dispersed in oil.

Buccal route of administration

A drug absorbed by the blood vessels in the lining of the mouth. chewing differences between regular gum and nicotine gum

Synthesized drug

A drug created artificially in the laboratory but in imitation of a naturally occurring drug; epinephrine hydrochloride (EpiPen); digoxin, aspirin and quinine; many antibiotics.

Synthetic drugs

A drug that has been created from a series of chemical reactions to produce a specific pharmacological effect; phenobarbital, sulfa antibiotic.

Therapeutic agents

A drug that targets a specific need in the body. Maintaining health • Regulate metabolism; contribute to the maintenance of normal growth and function Relieving symptoms • Anti-inflammatory drugs; narcotics; diuretic (water pills) Combating illness • Antibiotics; antiviral medications; drugs for Alzheimer's disease Reversing disease processes • Medications that control depression, blood pressure and cholesterol

Antineoplastic Drugs

A drug used in cancer chemotherapy to destroy malignant tumor. Different antineoplastic drugs used in combination to slow the growth of cancer cells, at different phases.

Grain (gr)

A dry weight measure that is the most commonly encountered nonmetric unit.

Enema

A water-based solution administered rectally for cleansing or evacuating the bowel before a GI procedure.

Fluidextract

A liquid dosage form prepared by extraction from plant sources and commonly used in the formulation of syrups.

Liniment

A medicated topical preparation

Pharmacodynamic Agent

A medication that alters body functioning in a desired way. Pharmacodynamic agents can be used to relax muscles, dilate pupils, or change blood glucose levels. Caffeine is considered a pharmacodynamic agent.

Intravenous (IV) Infusions

A method for delivering a large amount of fluid and/or high concentration of medication directly into the bloodstream over a prolonged period and at a slow, steady rate. continuous amount of needed medication over a given period.

Colloid

A mixture having physical properties between those of a solution and a fine suspension. • Milk

Semisynthetic drugs

A natural drug that has been chemically modified in the laboratory to do one or more of the following actions: (1) improve the efficacy of the natural product (2) reduce its side effects (3) overcome developing bacterial resistance (4) broaden the spectrum of bacteria that can be treated

Phlebitis

A severe painful reaction at the injection site.

Plaster

A solid or semisolid that adheres to the body and contains backing material such as paper, cotton, linen, silk, moleskin, or plastic.

Irrigating solution

A solution for cleansing or bathing an area of the body, can be used both topically as well as instilled

Buccal

Absorbed in the cheek

Step 2: Enter prescription into the computer

Accurate Data Entry: the ability to accurately enter prescription information into a computer system can mean the difference between a patient receiving the correct medication, serious harm or death. Potential Dangers: does the form or formulation match the route of administration? Depo-Medrol: • Injectable • IM administration • Cloudy suspension (when reconstituted) Solu-Medrol: • Injectable • IV administration • Clear solution Teaspoons vs. Milliliters: use milliliters to minimize errors in order entry and labeling. Formulation Mix-Ups: morphine sulfate (20 mg/mL) and (10 mg/5 mL or 2 mg/mL); ointments vs. creams; solutions vs. suspensions; substituting a capsule for a tablet. Precautions with Scheduled Drugs: when entering certain Schedule II drugs. The information entered into the computer database should be checked against the original prescription.

FDA Amendments Act of 2007

Additional FDA authority over premarketing and postmarketing safety. Postmarketing studies and clinical trials, safety labeling changes, REMS. Required "side effects" statement that notifies patients to report ADEs. FDA pre-review direct to-consumer ads. FDA only makes recommendations about ad and may require change only if change addresses serious risks associated with drug use.

Spirit

Alcoholic or hydro alcoholic solution containing volatile, aromatic ingredients.

Tincture

Alcoholic or hydro alcoholic solution of extractions from plants.

Transmucosal route of administration

Allows the drug to be absorbed through or across the "sieve-like" or permeable mucous membranes of the mouth, eyes, ears, nose, rectum, vagina and urethra. Transmucosal dosage forms include: tablets, gum, and lozenges (sublingual); ointments, solutions, suspensions, and sprays (eyes, ears, and nose); suppositories and solutions (rectum, urethra, and vagina).

National Drug Code (NDC) number

Appears on all drug stock labels and copies of duplicate prescription labels. The 10- to 11-character NDC number is made up of the following: - A four - or five-digit labeler code, identifying the manufacturer - A three - or four-digit product code, identifying the drug - A one - or two-digit package code, identifying package size and type The NDC number plays a vital role for pharmacy technicians in preventing avoidable medication errors.

Topical route of administration

Application of a drug directly to the surface of the skin; exert local effects; side effects are minimal.

Ocular route of administration

Application of a drug into the eye.

Dietary/nutritional supplements

Are regulated as foods; not regulated for safety and efficacy as are prescription and OTC products by the FDA.

Needle

Attached to the tip of a syringe and is used to either draw fluid into or push fluid out of the syringe; the larger the gauge the smaller the opening.

Step 1: Receive and Review Prescription

Basic Review of Prescription: Can you read and understand the prescription? Verbal Order Precautions: Clarify orders before entering into the computer system. Validity of Prescription: Is the prescription valid and legal? Detailed Review of Prescription: three basic types of information need to be reviewed: prescriber information, patient information, and medication information. Prescriber Information: sufficient to determine whether a licensed and qualified prescriber wrote the prescription. Patient Information: should include enough detail to ensure that unique individuals can be pinpointed. Medication Information: should include the drug name, strength, dose, dosage form, route of administration, refills or length of therapy, directions for use, and dosing schedule. Prescribing Errors: poor handwriting, nonstandard abbreviations, confusing look-alike and sound-alike drugs, and "as directed" instructions.

Embolism

Blockage of a vessel by a clot or foreign material brought to the site by the blood current.

Diseases that Disproportionately Affect Ethnic Minorities

Certain diseases are more common among specific ethnic groups.

Step 4: Generating prescription level

Check the printed label with the original prescription. Is the correct patient name on the label? Is the drug, dose, concentration and route identical to those indicated on the original prescription?

Addiction

Compulsive and uncontrollable use of controlled substances. Addicted patients will do anything to support their drug habit. Technicians must carefully review prescriptions for controlled substances.

Liquids

Consist of one or more active ingredient in a liquid vehicle such as a solution or suspension. Most liquids are commercially available as solutions (elixirs and syrups), suspensions or emulsions.

Generic Drug

Contains the same active ingredient as the brand name product and delivers the same amount of medication to the body in the same way and in the same amount of time

Reliance on Self-Care

Cultures with a history of poverty have developed a strong reliance on self-care.

Alphabet of release formulations

DR, CR, CD, XR, SR, XT, and XL.

Inhalation

Delivery of drugs into the lungs, where a patient breathes it in through the mouth. Examples: Metered dose inhalers (MDI), dry powder inhalers, and nebulizers • Systemic absorption is possible. • Allows for direct treatment to lung tissues. • Proper inhalation technique is required for adequate drug delivery and activity.

Electronic medication administration record (eMAR)

Documents administration of a medication electronically rather than on paper.

Phase 2 and 3 clinical trials

Drugs are tested on humans having the condition or disease the drug is supposed to treat

Physiological Causes of medication errors

Each patient has a unique response to medication. Each person is genetically unique; the speed at which a medication is eliminated from the body varies greatly. Even if a patient lacks a certain enzyme that helps remove a drug from the body, resulting in serious harm, the result is considered a medication error. Technicians must pay special attention to computer software alerts. Age-related decrease in kidney function is a physiological cause. Many medications rely on kidney function to eliminate drugs from the body. If the dose of a drug is not lowered, the drug could build up to toxic levels, causing a medication error.

Risk evaluation and and mitigation strategy

Ensure that the benefits outweighed the risks of their drugs.

Prescription drugs

Formerly known as a legend drug, can only be dispensed upon receipt of a prescription from a licensed healthcare professional in a state. All prescription drugs are labeled "Rx only." Prescription drugs are available as brand name or generic.

Franchise Pharmacies

Franchise pharmacy - combines characteristics of an independent with a chain pharmacy. Franchisors are granted exclusive use of company name and rights to market and sell company products. Franchise pharmacies attempt to provide personalized health care. Franchise operation - Medicine Shoppe International (MSI) is the largest franchisor of independent community pharmacies in the U.S. A franchise pharmacies typically has one pharmacist (owner) and one technician.

Gram (g)

Gram is used for measuring: 1) the amount of medication in a solid dosage form, 2) the amount of solid medication in a solution, and 3) express the weight of an object or person.

Effervescent salts

Granules or coarse powders containing one or more medicinal agents, as well as some combination of sodium bicarbonate with citric acid, tartaric acid or sodium bisphosphate. • Alka-Seltzer

Destructive Agents

Has a - cidal action; it kills bacteria, fungi, viruses - normal and abnormal cancer cells. • Radioactive iodine

Informed consent

Is a document that must be signed by each research subject, that states, in easily understandable terms, the purpose and risk of the research.

hospice care

Is a form of home healthcare.

Reliance on Herbalists and Healers:

Healers have a presence in indigenous and folk cultures.

What are some medication errors?

Incorrect drug, strength, or dose Confusion over look-alike and sound-alike drugs Incorrect route of drug administration Calculation or preparation errors Misuse of medical equipment Errors in prescribing, transcribing, dispensing, or monitoring medications.

Independent Pharmacies

Independent pharmacy - a community pharmacy owned and usually operated by one pharmacist or group of pharmacists. The owner makes decisions regarding practice of pharmacy, with more time and attention spent on customer service. Some independent pharmacies have developed into compounding pharmacies - specializing in the preparation of nonsterile (sometimes sterile) preparations not commercially available.

Phase 1 Clinical Studies

Initial study or trial of new drugs in humans • Small number of healthy volunteers (20-100) • Gather sufficient data concerning the drug's actions and potential side effects

Occupational Safety and Health Administration (OSHA)

Its primary mission is to ensure the safety and health of America's workers through a variety of resources. OSHA uses its resources to stimulate management commitment and employee participation.

Paste

Like an ointment that contains more solid materials, creating a dense consistency.

Skilled Care Facilities (SCF)

Limited to patients requiring more round-the-clock care.

Liter (L)

Liter is used for measuring the volume of liquid medications as well as liquids for oral and parenteral solutions. • 1 L = 1000 cc (cubic centimeters) • 1 cc = 1 mL (milliliter)

Mistrust of Western Medical Practice

Many minority groups do not always accept Western medical practice.

Scope and impact of medication errors

Medication errors are the more common medical errors. From hospital studies, medication-related error deaths are approximately 7,000 per year. Drug errors caused an estimated 400,000 preventable errors in the hospital with twice as many in nursing homes. Medication errors in a community pharmacy are estimated at 1.7% of all prescriptions dispensed; 4 out of 250 prescriptions contains an error of some type. Pharmacy technician's need to be on constant lookout for possible errors and adopt safety-oriented practices when working with patients.

Meter (m)

Meter is used for measuring distance, area, and volume and has limited application in pharmacy practice.

Step 8: Store completed prescription

Proper Storage Conditions: medication integrity, and being able to ensure that is an important part of medication safety. Organizational Systems: order and organization can help keep patient's medications together and separate from other patients.

Step 5: Retrieve Medication

Safety Practices for Accurate Drug Selection: use NDC numbers, drug names and other information supplied by the manufacturer to secure the correct drug. NDC Numbers: use the NDC number to cross-check a medication because each NDC number is specific. Heparin Safeguards: several serious medication errors have occurred when the wrong concentration of heparin was administered. Look-Alike and Sound-Alike Labels: can lead to medication errors and possible adverse drug reactions; Troppi vs. Scarf. Product line extension - using a brand name to sell various combinations of active ingredients with different indications.

Local effect

Site of action is a specific area or tissue.

Gender and Sexuality Concerns

Some people prefer speaking to a pharmacist or technician of the same gender when discussing personal medical issues.

Controlled substances

Some prescription drugs are classified as controlled substances by the Controlled Substances Act of 1970. Drugs are organized into five schedules or classes according to their potential for abuse and addiction.

Sublingual route of administration

Sub meaning "under" and lingua meaning "tongue"; the tablet is placed under the tongue, where it is rapidly absorbed by blood vessels. storage requirements; nitroglycerin.

Insulin Vials

Syringes sizes 0.3mL, 0.5mL, 1mL; size is determined by dose of insulin; insulin vials should never be shaken.

Capsules

The active ingredient of a capsule is in the form of a granular powder (liquid gel) enclosed by a gelatin shell. The body and cap may be sealed to prevent tampering. Diluent - pharmacologically inert filler used in capsules. Some capsule formulations are designed to provide better absorption of drugs, with less side effects. Some medications that come in capsule form are substitutable with a tablet, others are not.

Otic route of administration

The application of a drug into the ear canal. • Eardrops can never be used in the eye, but eyedrops can be used in the ear. store at room temperature;

Conjunctival route of administration

The application of a drug to the conjunctival mucosa.

active ingredient

The biochemically active component of the drug that exerts the desired therapeutic effect

Dispersion

The medication is simply dispersed or distributed throughout the vehicle, creating an incomplete mixture of solid and liquid.

Suspension

The state of a substance when its solid particles are mixed with but undissolved in a liquid. Suspensions contain inactive ingredients such as colorings, flavorings and coatings. Some suspensions are commercially available, others come in the form of powders that must be reconstituted prior to dispensing.

Bactericidal

These agents kill rather than inhibit bacteria that are sensitive to these drugs. • Penicillin

Abbreviated New Drug Application (ANDA)

These drug applications are termed "abbreviated" because they generally are not required to include preclinical (animal) and clinical (human) data to establish safety and effectiveness.

Subutex and Suboxone

These medications are prescribed to treat opioid dependence. Certified physicians DEA number starts with an "x." The goals of this program are to mitigate the risks of accidental overdose, misuse, and abuse and to inform patients of serious risks.

Tikosyn

This antiarrhythmic drug can cause serious and sometimes fatal arrhythmias. The REMS program was developed to establish dispensing and administering protocols. Only physicians and pharmacies that have been enrolled, educated and certified in the program can prescribe and dispense.

Transmucosal Immediate-Release Fentanyl (TIRF)

This program is designed to mitigate the risk of misuse, abuse, addiction, overdose or severe complications due to various medication errors involving fentanyl. Prescribers, pharmacies and wholesalers must complete an education program, enrolling them and certifying them to participate in this program.

iPLEDGE program

This program was designed for two reasons: - To prevent fetal exposure to the drug isotretinoin - To inform and educate all healthcare providers and patients on drug risks and how to use this medication safely

Influence of Religion on Medical Care

Traditions and customs can impact healthcare practices.

Homeopathic Medications

Use of subclinical doses of natural extracts or alcohol tinctures to stimulate the body's own immune system to overcome the specifically targeted symptom. Homeopathy is derived from the Greek root words homos - "similar" and pathos - "suffering or disease." Homeopathic medications use was popular in the early 19th century and remains popular in parts of Europe. "Natural treatments" is another designation of homeopathic medications; minimal risk of side effects.

ID route

Used for diagnostic and allergy skin testing, local anesthesia, and various diagnostic tests and immunizations. ID injections are given into the capillary-rich skin layer just below the epidermis.

IM route

Used to administer antibiotics, narcotics, medications for migraine headache and vaccines. offers a more convenient way to deliver injectable medications; slower onset than IV administration; duration of action is much longer, making it more practical for use outside of a hospital setting; unpredictable rate of absorption. IM injection doesn't work as fast as an IV injection infusion, but the pharmacological effect will last longer.

Step 9: Deliver medication to patient

Verification of Patient Identity: how can you as a technician verify that the right prescription is being given to the right patient? Explanation of Medication to Patient: double-check the number of medications the patient expects; encourage the patient to ask questions. "Show-and-Tell" Technique with Patient: what advantages are there to the "show-and-tell" technique? ISMP's "Tell-Back" System: "tell-back" approach uses patient-centered, open-ended questions to determine patient understanding. Nursing Unit Delivery of Medication: adding the caregiver to the medication delivery process add an additional person to confirm the accuracy and appropriateness of the medication. The technician is in the best position to discover potential errors. Communication and cooperation with nurses, physicians, and other members of the health care team safeguards the patient's well-being.

Elixir

a clear, sweetened, flavored solution containing water and ethanol.

Drug delivery system

a design feature of a dosage form that modifies the release of a drug by one or more pharmacokinetic parameters of the drug.

Notice of privacy practices

a document that is often times signed by the patient that they understand a pharmacy's privacy statement.

Spray

a dosage form that consists of a container having a valve assembly unit, when activated, emits a fine dispersion of liquid.

Wrong dose error

a dose is either above or below the correct dose, more than 5%.

Target drug delivery systems

a drug is "carried" by a liposome, and released at a targeted organ site; increasing availability in the near future.

Caplet

a hybrid of a capsule and tablet; shaped like a tablet, coated like a capsule.

Solution

a liquid in which the active ingredients are completely dissolved in a liquid vehicle. Solutions can be classified as aqueous (water-based), alcoholic (alcohol-based), or hydro alcoholic (water-based and alcohol-based).

Root Cause Analysis

a logical and systematic process used to help identify what, how and why something happened in order to prevent it from happening again.

Colloid

a mixture with physical properties that fall between a solution and a fine suspension.

Certification

a nongovernmental association grants recognition to an individual who has met certain predetermined qualifications; seldom mandatory in order to practice legally. Certification is preferred or even required for employment in many areas. Certification can be required for employment or is encouraged within the first year of employment.

Extra dose error

a patient receives more doses than prescribed.

Insulin Pens

a portable device in which the prescribed dose of medication is "dialed up" to administer insulin.

Patient-controlled analgesia (PCA) infusion device

a programmable machine that delivers a small amount of painkillers upon patient demand.

Matrix-controlled release formulations

a reservoir-controlled release utilizing an osmotic pressure principle or an ion exchange resin. • OxyContin (matrix-controlled release) • Tussionex (ion exchange resin)

Tablets

a solid dosage form produced by compression. Tablets contain one or more active ingredient along with inert or inactive ingredients (excipients). Tablets are available in a variety of shapes, sizes, surface markings and coatings.

aromatic waters

a solution of water containing oils or other substitutes that have a pungent, and usually pleasing smell.

Parenteral Solution

a sterile or microbial-free solution (w/ or w/o medication) that is administered via a hollow needle or catheter inserted through one or more layers of skin. Parenteral comes from the Greek roots para meaning "beside" and enteron meaning "intestine." This route bypasses - or goes "beside" rather than through - the alimentary canal or GI tract.

Subcutaneous route

administer medications below the skin into the subcutaneous tissue. injections typically administered on the outside of the upper arm, top of the thigh, or lower portion of each side of the abdomen.

IV bolus injection

administration of a drug all at once.

Injection

administration of a parenteral medication into the bloodstream, muscle or skin.

Extended-release (XL) formulations

allow a reduced frequency of dosing as compared with immediate-release medications.

Dimensional analysis

also known as "calculation by cancellation." Drug calculations have units of measure or "dimensions" attached to them. The dimensional analysis method is based on the principle that any number can be multiplied by one without changing its value.

Syrup

an aqueous solution thickened with a large amount of sugar - sucrose - or sugar substitute. Syrups can contain additional flavors, colors or aromatics. Most pediatric formulations are syrups or elixirs.

Cultural Sensitivity

an awareness, knowledge of, and respect for cultural beliefs that differ from your own. Patients, no matter what their situation, should not be treated differently from anyone else.

Suppository

an example of a semisolid dosage form that is created from an inactive ingredient and formulated to melt at body temperature and release an active drug.

Cream

an oil-in-water (O/W) emulsion - a small amount of oil dispersed in water.

Sentinel event

an unexpected occurrence involving death, serious physical or psychological injury, or the potential for such occurrences to happen.

Lotion

another O/W emulsion for topical application.

Emulsion

another type of dispersion; a mixture of two immiscible or unblendable substances. Emulsions contain an emulsifying agent that renders the emulsion stable and less prone to separate.

Intrauterine device (IUD)

another way to prevent conception via a drug delivery device.

medical errors

any circumstance, action, inaction, or decision related to health care that contributes to an unintended health result.

Pharmaceutically equivalent drug products

are formulated to contain the same amount of active ingredient in the same dosage form in order to meet the same standards. Characteristics like shape, scoring configuration, release mechanisms, packaging, etc. can be different.

Compression tablets

are the most inexpensive and common dosage form. • Acetaminophen (Tylenol)

Military time

based on a 24-hour clock, with midnight considered time 0000. • 0000 Midnight • 0600 6 AM • 1200 Noon • 1800 6 PM The first two digits are the time in hours, the second two digits are the time in minutes. No AM or PM are used, reducing confusion - fewer medication errors.

household system

based on the apothecary system and was established to help patients take their medications at home. Common units of measure: • Ounce • Pound • Drop • Teaspoon • Tablespoon • Cup • Hogshead - obsolete in pharmacy (1 hogshead = 238.480942 liters) • Jigger - obsolete in pharmacy (1 shot = 44.3602943 mL)

Pharmaceutical alternative drug products

contain the same active therapeutic ingredient but contain different salts or are available in different dosage forms. Approval must be obtained before a substitution occurs when involving different salts and dosage forms. Drugs are considered to be therapeutic equivalents only if they are pharmaceutical equivalents and if they can be expected to have the same clinical effect and safety profile.

Chewable tablets

contains a base that is flavored and/or colored. It is designed to be chewed (masticated) and absorbed quickly for slightly faster onset.

Dropper

contains a small squeezable bulb at one end and a hollow glass or plastic tube with a tapering point.

film-coated tablet (FCT)

contains a thin outer layer of a polymer that can either be soluble or insoluble. Film coating are colored for an attractive appearance; taste-masking benefits can be lost if crushed.

sugar coated tablets (SCT)

contains an outside layer of sugar that protects the medication and improves appearance and flavor. Sugar coating makes tablets larger and heavier thus more difficult to swallow.

Gel

contains solid particles in a liquid, but the particles are fine or ultrafine. • Jelly - a gel that contains a higher portion of water in combination with a drub substance and a thickening agent. • Glycerogelatin - a topical preparation made with gelatin, glycerin, water, and medicinal substances.

Credential

documented piece of evidence of one's qualifications. Pharmacy technician credentials may include licensure and/or certification.

Wrong dosage from error

dose formulation given is not the accepted interpretation of the doctors order.

Irrigating Solutions

douche, is often reconstituted from a powder and introduced into the vaginal cavity for local cleansing.

Phase 4 Clinical Studies

drug approved for market • Continued testing to collect information about its effects in various populations and to identify any side effects associated with long-term use

Vaginal

drug delivery by inserting and applying medication into the vagina. • Few vaginal products are intended for systemic absorption. • Dosage forms include creams, gels, solutions, suppositories, ointments, and tablets.

Over the counter drugs (OTC)

drug that can be purchased without a prescription. OTC drugs must be recognized as safe and effective by the FDA when labeled directions on the container are followed. Most OTC drugs are indicated for short-term therapy (7 days) and self-limited conditions. Some OTC drugs can be used long-term with physician approval. Many OTC drugs were once prescription drugs approved by the FDA after expiration of the manufacturer's patent. OTC drugs must have adequate labeling, written in easily understood terms, to assist the customer in proper usage, assuming no contact with a pharmacist or typed directions from a physician. Labels must contain "Drug Facts" box listing active ingredients, purposes, use of the product, warnings and directions for age-appropriate dosing. Drug labels must also have an expiration date as well as a list of inactive ingredients. Some OTC drugs and supplies are sold "behind the counter."

Therapeutic uses

effects last 24 hours to 1 week.

Phase 2 Clinical Studies

evaluate the effectiveness and safety of a drug for a given indication or disease state • Small number of patients • Well controlled and closely monitored by FDA

Dietary Supplements

exerts weak pharmacological effects on the body similar to drugs. Dietary supplements can cause side effects, adverse reactions, and drug interactions. Dietary supplements are considered "food supplements" that maintain health. Consumers should not exceed the recommended daily dose or "serving size." The FDA can only regulate dietary supplements when patient safety concerns exist. Technicians need to gather information from patients about their use of herbs or other dietary supplements.

black box warning

is a warning statement on the PPI indicating the possibility of serious or even life-threatening adverse reaction.The black box warning is indicated by a thick black border, surrounding the statement. This box is required by the FDA and is based on post surveillance studies. Data is collected via voluntarily submitting reports from pharmacists and physicians. Manufacturers must submit all reports to the FDA for further review and investigation

Body surface area (BSA)

is an expression of a patient's weight and height used to calculate patient-specific dosages.

multiple compression tablet (MCT)

is made by multiple compression cycles and is a tablet on top of a tablet or a tablet within a tablet.

Alligation

is used when the two quantities needed to prepare the desired concentrations are both relatively large. Alligation alternate method is the calculation used to determine proportions of available products needed to prepare the desired concentration.

Confidentiality

keeping privileged information about a customer from being disclosed without his or her consent.

Phase 3 Clinical Studies

larger clinical trials • Better assess the benefits and risks of the investigational drug on patients

Institute for Safe Medication Practices (ISMP)

nonprofit healthcare agency whose membership is composed of physicians, pharmacists, and nurses. ISMP mission statement: "to understand the causes of medication errors and to provide time-critical error reduction strategies to the healthcare community, policy makers and the public."

Roman

numerals are expressed in either lowercase or capital letters. Most frequently used Roman numerals in pharmacy are I, V, and X, which represent 1, 5, and 10. Lowercase roman numerals i, ii, and iii are occasionally used. Example: "aspirin gr vi" means "six grains of aspirin"

Human failure

occurs at an individual level.

Organizational error

occurs because of deficiency in organizational rules, policies or procedures.

Avoirdupois system

originated in France and is considered the "everyday" system of measurement in the United States. Common units of measure: • Feet • Miles • Grains - shared with the apothecary system • Pounds - shared with the apothecary system • Ounces - shared with the apothecary system

Technical failure

results from equipment problems.

Intranasal route of administration

the application of a drug into the passages of the nasal cavity. used for relief of nasal congestion or prevention of allergy symptoms

Inhalation route of administration

the application of a drug through inhalation into the lungs, typically through the mouth.

Urethral route of administration

the application of a drug within the urethra.

Vaginal route of administration

the application of any drug within the vagina. use medication for prescribed time period;

Osmotic pressure system

the drug is delivered to the body by slowly being "pushed out" into the bloodstream.

Wax matrix systems

the drug is embedded in a polymer matrix, release takes place by partitioning of the drug into the polymer matrix and surrounding medium.

Solute

the ingredient dissolved in a solution.

Parenteral routes of administration

the injection of any drug or fluid into the bloodstream, muscle, or skin.

metric system

the legal standard of measure for pharmaceutical measurements and calculations in the U.S. Based on decimal notation, units are described as multiples of ten (0.001, 0.01, 0.1, 1, 10, 100, 1000). Contains clear correlations among units of measurement of length, volume, and weight. The modern metric system makes use of the standardized units of the Système International (SI). To convert from one metric unit to another, simply move the decimal point. Moving the decimal to the left converts to larger units; moving the decimal to the right converts to smaller units. To prevent misreading of numbers less than one (1), a zero (0) is placed before the decimal; this is known as the leading zero.

Spacer device

the medication is released into a "storage chamber" where it can be more easily inhaled by the patient. The patient should be sure to rinse their mouth after administration of an MDI to prevent an oral fungal infection.

specific gravity

the ratio of the weight of a substance to the weight of an equal volume of water, the standard, when both are at the same temperature. 1 mL, volume of water = 1 g, weight of water Specific gravity of water = 1 Specific gravity = weight of a substance / weight of an equal volume of water

Bar coding technology

the scanned bar code is compared against the verified prescription information.

Powder volume (pv)

the space occupied by a freeze-dried medication in a sterile vial; equal to the difference between the final volume (fv) and the volume of the diluting ingredient, or the diluent volume (dv). Powder volume = final volume - diluent volume • pv = fv - dv

Viscous

thick solutions; solutions that have particles floating in them often have a specific gravity higher than 1. Solutions that contain volatile chemicals (or evaporate quickly), such as alcohol, often have a specific gravity lower than 1.

Medication Errors Reporting Program (ISMP MERP)

this program is designed to allow healthcare professionals to report medication errors directly.

Administration

transdermal patches should be applied to a relatively hair-free area; localized heat speeds up the movement from the patch into the body.

Lozenge

troche, solid dosage form containing active ingredients and flavorings, that are dissolved in the mouth.

Celsius temperature scale

• 0° C as the freezing point • 100° C as the boiling point °C = (°F - 32°) ÷ 1.8 5 x °F = 9 x °C + 160 (alternative method)

Fahrenheit temperature scale

• 32° F when water freezes • 212° F when water boils °F = (1.8 x °C) + 32° 5 x °F = 9 x °C + 160 (alternative method)

Aerosol and MDI's

• Aerosol - a spray in a pressurized metered-dose container that contains a propellant • Metered-dose inhaler (MDI) - a handheld, propellant-driven device, an MDI provides a specific measured amount of medication with compressed gas.

Micronized powders and non-aerosolized inhalers

• Breath-activated powder for inhalation to avoid propellants • Administers a higher concentration of drug as a micronized powder into the lungs

Sterile solutions and Nebulizers

• Nebulizer - atomizing machine that delivers medication as a mist

Volatile medications and Vaporizers

• Used to deliver moisture to the air for relief of cold systems

Phase 1 clinical trials

1st tried on healthy human subjects

Antibiotic

A chemical substance that kills or inhibits the growth of bacteria.

nuclear pharmacy

A highly specialized practice compounding and dispensing sterile radioactive pharmaceuticals for diagnostic or therapeutic uses. It is staffed by pharmacists and technicians with advanced training and certification in radiation safety. Pharmacy personnel must always wear badges that monitor radiation exposure.

Iron Lung

A noninvasive negative-pressure ventilator, was used to treat severe symptoms by artificially maintaining respiration during acute polio infection until the patient could breath independently; lasting about 2 weeks.

Vaccinations

A substance introduced into the body to produce immunity to disease.

What is a drug?

A substance taken into or applied to the body for the purpose of altering the body's biochemical functions and thus its physiological processes.

Parental routes of administration

Administered by injection; administered elsewhere in the body than the mouth and alimentary canal.

Medication Error

An event in which a patient is harmed by a medication in some way that could have been prevented. The mistake could be made by the prescriber, the pharmacy, or during administration. A technician's job is crucial to ensuring good patient care

Oral (Personal or PO)

By mouth. The most convenient and cost-effective means of delivering a medication to a patient. Examples: Tablets, Capsules, and Liquid forms

Chain Pharmacies

Chain pharmacy - national or regional, found in department stores, grocery stores, or typical corner drugstore. Chain pharmacies are typically located in metropolitan areas with heavy use of technicians and automation. A chain pharmacy is owned by a corporation, administrative decisions made at the corporate level. Some chains have established walk-in clinics; specialty pharmacies, or specialty services.

Home healthcare

Delivery of medical, nursing, and pharmacy services to patients who remain at home. Home healthcare systems are expected to grow as our population ages.

Pregnancy categorization

Developed to assess safety during pregnancy; determining potential benefits and risks involved when a woman takes a medication while pregnant. Some drugs are considered safe during pregnancy because they do not significantly cross through the placenta and enter the bloodstream of the developing fetus.

What are some of the drugs that are used today?

Dietary supplements - vitamins, minerals, and herbs Homeopathic remedies Over-the-counter (OTC) Prescription

Orally Dissolving Tablet (ODT)

Dissolving quickly on the tongue

Transdermal

Drug delivery through the skin over time. Patches can be applied and left in place for a period of time (hours to days).

Major Drug Classes

Drugs that are used the same way are put into a particular class

Four D's of Negligence

Duty: responsibility Dereliction: failure to act Direct cause: sequence of events, produces injuries Damages: injuries caused by defendant

Ayurveda

East Indian medicine that involves spiritual and whole-body well-being, employing change in diet and lifestyle.

Inert ingredients

Has little or no physiological effect on the body Examples: preservatives and flavorings; needed to stabilize the tablet, capsule, or liquid formulation; provide raw material for many topical creams and ointments; ensure sterility of injectable products; assist in the masking of unpleasant oral medications.

Schedule 1 drugs

Illegal substances or only available for research or experimental purposes

intravenous (IV)

Injections given directly into a vein A small catheter is inserted and left in a vein when repeated or continuous infusion is needed.

Acupunture

Insertion of needles at specific points on the body to unblock energy channels.

Institutional pharmacies

Institutional pharmacy - a pharmacy associated with any organized healthcare system. Hospital pharmacy is the most common example of an institutional pharmacy. Other examples include: long-term care facilities, home healthcare systems, managed-care organizations, and nuclear pharmacies. Responsibilities: order entry; prepare medications and IV's; education; policy and procedures; counseling patients

Mail order pharmacies

Mail-order pharmacies - one of the fastest-growing types of pharmacies. A centralized operation using extensive automation and technicians to dispense and mail large volumes of prescriptions every day.

Managed care pharmacist responsibilities

May work closely with primary-care physicians to better control chronic disease; may be more involved in monitoring and adjusting drug therapy for patients with chronic diseases.

Schedule 2 - 5

Medications that can be legally dispensed with certain restrictions

Over-the-counter (OTC)

Medications that can be used and purchased without prescription

Controlled substances

Medications that have been categorized by the Drug Enforcement Agency (DEA) to have the potential for abuse and dependence

Community pharmacies

Most pharmacists and technicians work in community pharmacies, also called retail pharmacies. Most community pharmacies are divided into restricted prescription area and front-end merchandise. Responsibilities: nonsterile and sterile compounding; dispense and send medications in special packaging; business person and entrepreneur; hires and supervises employees.

Sources of drugs

Natural Synthetic - created artificially Synthesized - created artificially but in imitation of naturally occurring substances Semisynthetic - containing both natural and synthetic components Biogenetically engineered drugs are a major source of new drug development in the 21st century.

Chiropractic therapy

Non-drug modalities; manipulation to achieve better body alignment and health.

Eastern Medicine

Older type of medicine that used herbs and alternative therapies and recognizes a person's spiritual being and balance.

legend/prescription drugs

Only available by prescription and are dispensed from the pharmacy upon receipt of a valid prescription from a prescriber.

Home healthcare pharmacies

Provide IV and oral medications and must often be available 24/7. Responsibilities: prepares IV's and medications for home use for patients of all ages.

Health Maintance Organization (HMO)

Provides health insurance for medical and pharmacy services using a managed-care model. The HMO philosophy is based on the idea that keeping patients of all ages healthy, decreases hospitalization and ER visits, lowering the costs to the healthcare system. Most HMO's are centralized primary-care clinics serving adult, pediatric and OB/GYN patients, offering pharmacy, X-ray, and laboratory services on-site. HMO's, like hospitals, have an approved formulary (drug list). HMO pharmacies and responsibilities of the technician are similar to community pharmacies. Effective use of technicians allows pharmacists to provide more time counseling patients, resulting in lower costs and fewer medication errors.

Extended care facilities (ECF)

Provides services to older adults or disable residents who can no longer provide activities of daily living (ADL)

Tort

Refers to personal injuries; wrongs that one citizen commits against another. Example: broken contract, negligence, malpractice, slander (using spoken words to speak falsely of another), libel (using written words to falsely represent another), assault (threatening another with bodily harm), and battery (causing bodily harm to another).

Natural sources of drugs

Some drugs are naturally occurring biological products made or taken from single-celled organisms, plants, animals, minerals, and humans. Penicillin and insulin are modern-day drugs from natural sources. Other examples: antibiotic streptomycin; digitalis; opium (derivatives morphine & codeine); quinine & colchincine; acetylsalicylic acid (aspirin); USP thyroid; salts of minerals (iron & potassium); milk of magnesia; human growth hormone (somatotropin).

Food and Drug Administration (FDA)

The FDA has the responsibility and authority to enforce the law, but has no legal authority over the practice of pharmacy in each state. The FDA has the ability to create and enforce regulations; requiring all manufacturers to file applications for investigational studies and approval of new drugs, etc. The FDA enforces packaging, labeling, advertising, and marketing guidelines for medications. The FDA has been known to ask manufacturers to cancel advertising campaigns, or present a new campaign to clear up any misconceptions. OTC (Over the Counter) marketed medications undergo the same level of scrutiny by the FDA. DrThe FDA also is responsible for the publishing of specific reference material, Approved Drug Products with Therapeutic Equivalence Evaluations (FDA Orange Book).

Liscensure

The process by which the state board grants permission to an individual to engage in a given occupation upon finding that the applicant has obtained the minimum degree of necessary competency to safeguard the public.

Reasonable doubt

The standard of proof in a case involving crime against local, state, or federal government.

Pathophysiology

The study of abnormal body processes or disease

Pharmacodynamics

The study of drugs and their receptors on the molecular level

Pharmacokinetics

The study of how drugs are absorbed into the bloodstream (absorption), circulated to tissues throughout the body (distribution), inactivated (metabolized), and eliminated (metabolism and excretion). Pharmacokinetic processes affect a drug's effectiveness, dosing schedule, and usePhara

Pharmaceutics

The study of how drugs are introduced into the body

Pharmacotherapeutics

The study of how drugs are used in clinical practice for individual patients. Determining what will be most beneficial and appropriate for use for an individual patient

Pharmacology

The study of how drugs from various sources work inside the body for their intended purposes

Physiology

The study of normal body function

Western medicine

Traditional medicine; treatments generally recognized and accepted; relies on the scientific method

Homeopathy

Treating an ailment with a substance, that can cause an effect similar to the ailment itself.

Therapeutic classes

Use on a particular body system

Chinese Medicine

Uses Eastern medical philosophies.

Plaintiff

a person who brings a case against another in a court of law.

Defendent

an individual or group being sued or charged with a crime

Dermal

applied topically to the skin; creams, lotions, gels, ointments, powders, solutions, and pastes. • For the treatment of local infections, wounds, sunburns, and rashes. • Systemic absorption is possible if applied to large areas, in large quantities.

Acupressure

applies pressure to those points to enhance energy flow.

Otic

delivery of medication into the external ear canal. • Eardrops are instilled into the ear canal, but the eardrum prevents systemic absorption. • Dosage forms include solutions and suspensions.

Ophthalmic

drug delivery topically to the eye; eyedrops and eye ointments. • Limited systemic absorption, but is possible with solutions and ointments.

Intranasal

drug products sprayed into the nose; available in a liquid dosage form, delivering the drug to the nasal mucosa. • Intended for local activity, though some are formulated for systemic absorption. • Patients should not forcefully sniff to assist the spray to enter the nose. • Doing so will cause the drug too far back into the sinuses and down the throat, missing the intended site of administration.

Rectal

drugs inserted via the rectum and allowed to melt or dissolve in place - allows for systemic absorption through the mucosal lining. Local treatment for hemorrhoids. Dosage forms include suppositories and enemas.

teratogenic

drugs that can cause birth defects or malformations in a developing fetus; degree of teratogenicity may depend on the stage of development.

Systemic effect

effects the body as a whole.

Intramuscular (IM)

given directly into a muscle. Example: Deltoid (Upper arm) and the Gluteus medius (Buttocks)

Systemic Routes of Administration

how the drug gets into or onto the body.

Dosage form

how the drug is delivered.

Intrathecal (IT)

injections given into the spinal column between vertebrae; Epidural - injections given via a small catheter to deliver a drug directly into the spinal column over time; both are administered exclusively by anesthesiologists or anesthetists.

Intradermal (ID)

injections given just underneath the top layer of skin (epidermis); used for tuberculosis (TB) skin tests (PPD), local anesthesia, and allergy skin testing.

Subcutaneous (SQ or SC or Subq)

injections into the fatty tissue under the dermal layer of the skin about the muscular tissue. Example: Abdomen, upper thigh, back of upper arm

Peripheral IV Line

inserted into a vein in the arm, wrist, or hand; small amounts of fluid; time infused is a few days or less.

Central IV Line

inserted into one of the larger veins in the upper chest area near the clavicle (collarbone); inserted surgically; used when large volumes of fluid must be given; repeated infusions; time is longer than a few days.

Implants

inserted just below the skin to release a drug slowly over time (months to years). Long-term treatments, like birth control, work best for this route.

Solutions

liquids with dissolved substances

Suspensions

liquids with particulate matter - must be shaken. Onset of action with most oral dosage forms is around a half an hour after swallowing.

Topical routes of administration

not for the intent of systemic absorption; limited to local absorption. Not limited to application on the skin. Lungs, eyes, and vagina, are some ways that are considered topical administrations.

Drug Enforcement Administration (DEA)

primarily responsible for enforcing the laws regarding both legal and illegal addictive substances. Inspections of all medical facilities, including pharmacies is a function of the DEA. The DEA works closely with state agencies responsible for physical inspections and local investigations. The DEA has established an audit trail to track the flow of narcotics from manufacturer to warehouse to pharmacy to patient.

Generic drug name

the manufacturer who first develops the drug assigns the name, and it is then listed in the U.S. Pharmacopeia

Excretion

the process by which drug molecules are removed from the bloodstream; primarily involving the bloodstream.

Absorbtion

the process by which drugs enter the bloodstream

Distribution

the process by which drugs move around in the bloodstream and reach other tissues of the body.

Metabolism

the process in the body by which drugs are converted to other biochemical compounds, and then excreted through metabolic pathways.

Hospital Pharmacies

¼ of all pharmacists work in a hospital setting. Hospital pharmacists and technicians prepare, or supervise preparation of, unit-dose, IV, and extensive floor stock medications. Many technicians in the hospital work in a "clean room" environment. To work in a "clean room" requires education, training, and certification.