Pharmacy Technician Exam, DAW Codes, Study Guide

Sublingual tablets

Must be dissolved under the tongue; held under the tongue until completely dissolved. This method is used for rapid action.

Outside Vendors

"Cardinals". Red totes. Delivers Mon-Fri. Can enter orders up to 8PM for next day delivery. Order days are Sun-Thurs 5-12 Totes upon delivery.

Cholesterol

-A soft, waxy substance in the body, which is vital to many functions, but having too much in the blood can lead to serious health conditions such as coronary heart disease, stroke, and heart attack -The body produces a certain amount in the liver but the rest comes from dietary sources such as meat, fish, butter, whole milk, eggs and cheese

Glycerinated gelatin

-A suppository base -Base that can be mixed with water, often for vaginal and rectal uses.

Cocoa butter

-A suppository base -Fat soluble -Melts at body temperature, often for rectal suppositories

Polyethylene Glycol Derivatives

-A suppository base -Water-soluble -Suitable for vaginal and rectal uses

Hypertension

-An abnormal increase in arterial pressure above (140/90) -Primary (essential) hypertension: when cause is unknown -Secondary hypertension: due to kidney disease, overactive adrenal glands, or other disorders -If untreated, can lead to blood vessel damage, heart attack/heart failure, kidney failure -Risk factors: family history, stress, obesity, smoking, diabetes, high blood lipid (fat) levels -Blood pressure is affected by several factors, including the volume of blood, the size of the blood vessels and how much they resist blood flow (how flexible or "hardened"), and strength of cardiac output

Lot Numbers

-An identification number assigned to a particular quantity or lot of material from a single manufacturer. -Can typically be found on the outside of packaging. -Enables tracing of the constituent parts or ingredients as well as labor and equipment records involved in the manufacturing of a product. This enables manufacturers and other entities to perform quality control checks, calculate expiration dates, and issue corrections or recall information to subsets of their production output. -Gives consumers an identifier that they can use in contacting the manufacturer and researching the production of goods received.

DEA Numbers

-Any prescriber who writes prescriptions for controlled substances must have a DEA number. ---Prescribers are assigned DEA numbers made up of two letters and seven numbers. -The first letter of a DEA number is always A, B, F or M. -The second letter is the first letter of the prescriber's last name at the time of the DEA number application.

System Initiated Cycle Counts

-Appears automatically in the RF unit when AIMRx detects a discrepancy between your actual BOH and BOH in AIMR -If AIMRx thought you had 25 tablets of Lisinopril 10, but you were able to fill a prescription for 30, this type of cycle count will generate -Must be completed daily, first thing in the morning, to maintain BOH -When you scan an item as OOS, but the system thinks you have some on hand, it will create a system generate cycle count so you have to complete the cycle count to correct BOH

Offer to counsel

-Ask patients if they would like to speak to a Pharmacist about their prescriptions -When the patient speaks to the Pharmacist. he/she can get answers to questions about medical interactions, side-effects, OTC recommendations, and other medical issues -In the State of Maryland, pharmacists are required to offer to discuss issues pertaining to the prescription being filled

Suppository

-Bullet-shaped dosage form to be inserted into a body orifice. They contain medication for local effect where inserted. They keep their shape at room temperature, but melt or dissolve when inserted. Most common sites for insertion are the rectum, vagina, and urethra. -Solid drug forms of various weights, sizes, and shapes. -Should be stored in a cool, dry place

Return to stock

-Daily function performed by pharmacy teams. -By executing this procedure, store teams can return unclaimed prescriptions back into inventory for use when filling future prescriptions. -Properly executing the RTS process allows store teams to manage their inventory and maintain the highest levels of patient safety. -After the RTS process is performed, RxConnect will maintain a log of RTS balances for products within amber vials. -During the production process, you will be prompted to use the RTS product, minimizing expired product and non-saleable returns.

NDC numbers

-Every prescription bottle and Rx Only label is required to carry a National Drug Code (NDC) number, which labels the product. -Made up of three sets of digits. 1. The first set of numbers identifies the drug manufacturer 2. The second set identifies the product 3. The third set of numbers identifies the size of the package.

DAW Numbers

-Indicates the prescriber's instruction regarding substitution of generic equivalents or order to dispense the specific prescribed medication. -Tells insurance companies why we chose this drug and how much they should pay us for that claim; critical when billing prescriptions to Third Party Payers

Type 1 Diabetes

-Insulin-dependent diabetes mellitus (IDDM) -Usually occurs before age 30 -Pancreas doesn't produce enough insulin -Insulin is usually used

Antibiotics

-Medications used for treating many types of infections -Effective if a bacterium causes an infection, but they will have no effect if symptoms are caused by a virus -Treat infection by destroying or suppressing microorganisms; goal is to suppress the organism enough so that the body's own defenses can eliminate it -Anti-infective drugs derived from natural sources

Diabetes Mellitus

-Metabolic disorder that affects the way our body handles energy you get from eating food -A disorder of carbohydrate metabolism involving insulin deficiency or inefficient use of insulin -All causes of this disorder lead to hyperglycemia (high blood glucose). Excess insulin causes hypoglycemia (low blood glucose) -People with this disorder either do not produce insulin or cannot use the insulin that they have -Patients may feel extremely tired and are often thirsty or hungry because their body doesn't have enough fuel to function -Since cells cannot absorb glucose, it begins to build up in your blood. Too much sugar in your blood will begin to cause damage to your blood vessels and organs, leading to very serious complications -Strongly affected by daily stress, exercise, diet, and infections -Left untreated it can lead to ketoacidosis and diabetic coma -Treatment includes diet, exercise, and if necessary oral hypoglycemic agents or insulin to control blood glucose levels

The 3 common suppository bases

1. Cocoa butter 2. Polyethylene glycol derivatives 3. Glycerinated gelatin

Compounds

-Mixture of two or more ingredients that are not readily available -A prescription for a compound includes more than one ingredient, 1 dispensed quantity, and 1 set of instructions

Ophthalmic Administration

-Mucous membrane route of drug administration -Drops and ointments instilled into the eye -Generally are absorbed slowly and have a local effect -Ophthalmic preparations must be sterile, to prevent infections and isotonic to prevent burning -Examples include antibiotics, antivirals, decongestants, artificial tears, topical anesthetics

Otic Route

-Mucous membrane route of drug administration -Sterile medicated solution into the ear -Very low dosages are needed, and it must be indicated by manufacturer for otic use -In children under 3, the earlobe is gently pulled down and back; in adults is is pulled up and out -Patients should lie on his/her side for 5 min. after administration to coat the ear canal -This route is contraindicated in a patient with a perforated eardrum

Type 2 Diabetes

-Non-insulin dependent diabetes mellitus (NIDDM) -Usually occurs after age 40 -Controlled by diet, exercise, oral anti-diabetics and insulin when necessary -Accounts for about 90% of diabetics. Includes gestational diabetes

Special dosing considerations for pediatric populations

-Pediatric populations often get adult sicknesses; however they may not be able to take the same medication that an adult can -This is largely due to their smaller size, which can also mean decreased kidney and liver function -Giving adult size doses of medications to pediatric patients can quickly result in toxic levels. -Important to remember: -To note the child's age, and if necessary, their weight, as most pediatric doses are determined using these -To remember that a child is usually unable to swallow tablets -Most pediatric medications are available as flavored or chewable tablets

Asthma triggers

-Pet dander -Dust mites -Cockroaches -Molds -Pollens -Respiratory infections -Exercise -Stress -certain Foods -Certain drugs -Tobacco smoke -Other pollutants

Special dosing considerations for geriatric populations

-The elderly may require special dosing for many reasons: -Older people are often on many different medications at the same time - this increases the risk of interactions. Certain drugs that cause confusion or blurred vision should be avoided because they can result in falls and fractures. -Age-related changes can also affect the levels of drug in the body. the elderly have less water in their bodies, and decreased muscle mass. -They also have slower movement through the stomach and intestines -Most importantly, many have reduced liver or kidney function, and are less able to metabolize drugs -Other issues to consider are the person's ability to take their medications: poor memory or eyesight may be a problem, some may have trouble opening the bottle or holding a pill, some pills may be too large for them to swallow

Glucose

-The food you eat get broken down into this -A type of sugar -Absorbed into the blood stream, and with the help of insulin, a hormone produced by your pancreas, enters your cells where it is used as energy

Extemporaneous prescription compounding

-The preparation, mixing, assembling, packaging, and labeling of a drug product, based on a prescription order from a licensed practitioner, for an individual patient. Includes: -Preparation of oral liquids, topical preparations and suppositories -Conversion of one dose or dosage form into another -Preparation of select dosage forms from bulk chemicals -Preparation of intravenous admixtures, parenteral nutrition solutions, and pediatric dosage forms from adults dosage forms -Preparation of radioactive isotopes -Preparation of cassettes, syringes and other devices for home administration

Symptoms of Asthma

-Wheezing -Shortness of breath -Breathlessness -Chest tightness -Airway gets inflamed, clogged with mucus and fluid and bronchioles constrict -Can be allergic, brought on by exercise, or a respiratory tract infection

Insulin

-Without insulin, your cells are unable to absorb the glucose from the bloodstream and cannot get the energy that they need -Made by the pancreas normally -Must be given by injection, since it is destroyed by digestive juices -Excess insulin may result in dangerous symptoms of hypoglycemia, which include hunger, nervousness/shakiness, perspiration, dizziness, sleepiness, confusion, or difficulty speaking -Are classified as short-acting (6-16 hr), intermediate-acting (18-24 hr), and long-acting (36 hr) -Most diabetics need a combination of short- and long-acting insulin

Tasks at Pick-up

1. Immediately acknowledge all customers even if you cannot serve them right away. This ensures customers feel welcome and important. 2. Use the pharmacy register to search for the patient by name and date of birth. Ask the patient to verify their birthday (month and day) and enter it into the pharmacy register. If only 1 patient returns from the search, the Patient Match screen will not display. 3. Continue to verify the address using the Patient Basket screen. If more than 1 result appears, select the patient 4. Use the pharmacy register to review the patient's prescriptions that are in process and confirm the prescriptions for pick-up prior to obtaining them from the Waiting Bin. 5. Gather the customer's prescription(s). Check the Waiting Bin first. Prescriptions recently verified will be highlighted green for easier script location. Check the area where recently verified scripts are located. The prescription status for refrigerated items displays as WB-F to indicate that the prescription is stored in the fridge. 6. Once you have the prescription(s), verify the information on the prescription label(s) match the patient information in the pharmacy register. This step ensures that the patient gets the correct medication at Pick-up. 7. You will be prompted by the pharmacy register to communicate key messages to the customer (for example, Action Notes or ReadyFill enrollment). You may also be prompted to update patient contact information. 8. As a final step, you will assist customers in signing their electronic signature. The Electronic Signature Log records acknowledgement from the person "receiving the medication" and captures electronic signatures for Consultation, Third Party, Safety Cap, and Privacy Notice as determined by the prescription and state laws. Follow the register prompts to assist customers in signing their electronic signature. 9. To complete the sale, first ask the customer for his or her ExtraCare Card. Use the In-Store, Drive-Thru, and Home Delivery buttons on the Prescription Basket screen. Select a button and continue the transaction. Then, process the prescription through the register along with any other merchandise the customer may be purchasing. When accepting a personal check for the customer's order, ask the customer to print his or her state and driver's license number on the check as verification. 10. When prompted by the pharmacy register, guide the customer over to Consultation, and notify the Pharmacist that counseling is required. 11. Complete the transaction and thank the customer by name while making eye contact. 10. When you do not have customers to help, you will need to catch up on other tasks. Some of those tasks involve moving completed prescriptions from the Green Zone / Verified Area to the Waiting Bins and maintaining the Waiting Bins.

Tasks at Production

1.Acquire the Prescription label (print batch) 2.Obtain the Medication (retrieve stock bottles) 3.Perform Accuracy scan (initiate accuracy scan and scan all bottles) 4.Place product on the production safety zone 5.Choose container 6.Count, pour, and dispense medication immediately 7.Prepare for final verification

How many seconds do we have to acknowledge a customer at drive-thru?

20 seconds.

HIPAA

A privacy act that helps maintain privacy and security of the PHI of patients.

Care Check Plus Program

A program that targets certain prescriptions as they are processed through our computer. Educates the patients on their medication, condition, and may give them coupons for over the counter medications related to their prescription.

AIMRx

Advanced Inventory Management for the Pharmacy. The report we use for the CVS Warehouse.

Bacterial infections

An infection caused by bacteria

BOH

Balance on hand; quantity of an item, or family of items in your store

BOO

Balance on order; the quantity of an order that AIMRx is planning to order; an accurate BOH drives an accurate BOO

DAW 5

Brand Drug Dispensed as Generic

DAW 7

Brand Drug Mandated by Law

Asthma

Chronic inflammation of the airways of the respiratory system

Drug Naming

Common for each drug to be known by up to three names: chemical, generic, and trade

What you must do before placing an order

Complete all Rx Return to Stock (because you might have it) Processed overstock, damaged, or outdated items (because it may look like you have more than you actually do) Straighten and face the pharmacy (things may be there but misplaced).

Out of Stock Scans

Completed every Saturday (the day before order day). Done to verify what we actually have in stock and what we don't.

Medicaid

Copy of either $1.10, $2.20, or $3.30 (depending on patient income). Covers ONLY generic medication. MUST BE A HARD COPY PRESCRIPTION. NJ- Dark Blue card with silver line. ID # starts with 7's. CONDER CODE in place of BIN #. State program for financial assistance One card per person Only works in issuing state Prefers generic and usually covers OTC.

Medicare Part B

Covers durable medical supplies and Diabetic supplies. SOME asthma medication. HARD COPY ONLY. Needs a diagnostic code with specific directions.

Drop Off

Critical piece of the prescription fulfillment process. The customer's first interaction with the pharmacy. Input prescriptions, edit/run insurance, manage OT, make service calls to patients when necessary.

What you must do to ensure an accurate order

Cycle counts, Label Maintenance, Out of Stock Scans, and Review Reports must be performed consistently and accurately.

What form does a pharmacist use to order narcotics?

DEA 222 Forms

Quantity Dispensed ---------------------- Dosage x Frequency

Determining the Day Supply

Dosage x Frequency x Day Supply

Determining the Quantity Dispensed.

Mandatory Orders

Done Sun-Thurs.

Voluntary Orders

Done at any time.

Store Initiated Cycle Counts

Done on any item you observe to have unusually high or low inventory; done after system initiated cycle counts so as to not duplicate your efforts

DUR Rejects

Drug Utilization Review. An authorized, structured ongoing review of prescribing, dispensing, and use of medication. Encompasses a drug review against predetermined criteria that results in change to drug therapy when these criteria are not met. Rejects we get from insurance for many different reasons, such as a medication being refilled too soon, too high of a dosage, wrong amount of days or quantity of medication.

Green Trash Bags

Empty amber viles, prescription bottles, and boxes.

DEA Form 106

Federal regulations require that registrants notify the DEA Field Division Office in their area, in writing, of the theft or significant loss of any controlled substance within one business day of discovery of such loss or theft. The registrant shall also complete and submit to the Field Division Office in their area, DEA Form 106, "Report of Theft or Loss of Controlled Substances" regarding the theft or loss.

Production

Fills prescriptions to keep the process flowing and ensure medications are filled when promised.

Partial- do we accept a full copayment?

For partial fills, we do not accept a full copayment until the full medication is available for the patient.

DAW 8

Generic Drug Not Available in Marketplace

DAW 4

Generic Drug Not in Stock

Trade name

Given by the manufacturer for marketing purposes, usually protected by copyright

Partial Fill

Given to a patient while they were waiting for the remainder of the prescription to be available.

Medicare

Government insurance for those 65 and older or those who are permanently disabled.

Low BOH

If your BOH is low, an order will be needed so that it meets the amount of drugs your store needs for the patients.

Where are CII (Narcotic) medications stored?

In the safe, which only pharmacists have access to.

CVS Code of Conduct

Intended to help resolve ethics and compliance issues by providing the information, tools, and resources necessary to make good decisions.

What medication is associated with iPledge?

Isotretinonin, which is sold under the trade names "Roaccutane", "Claravis", "Absorica", "Amnesteem", "Myorisan", "Sotret", or "Zenatane". This program is intended to prevent the use of the drug during pregnancy due to the high risk of birth defects.

Gel

Jelly-like substance for topical medication. Some gels have a high alcohol content that can sting if applied to broken skin

Non-formulary list vs Formulary list

List of what medications are covered (formulary) and are not covered (non-formulary) with insurance. Every insurance has its own formulary list with different tiers, or levels of costs. The higher the tier, the more expensive the medication.

DAW 0

No Product Selection Indicated

Generic (non-proprietary) Name

Official name of the drug; this is simpler and more informative than the chemical name, not copyright protected and is meant to avoid confusion

Semisolids

Often used for topical applications; they are soft and pliable

Compounding Ointments, Creams, Pastes, and Gels

Ointments, creams, pastes, and gels are semisolid dosage forms for topical application. Ointments are oily. Creams are generally oil-in-water or water-in-oil emulsions and pastes have a high content of solids. Gels are suspensions of either inorganic or organic particles interpenetrated by a liquid These forms may act only on the surface of the skin for a local effect or can release a medication that can penetrate into the skin. They may also release medication to be absorbed systemically. Drugs in powder or crystal form are often ordered to be mixed into ointment or cream bases (salicylic acid, hydrocortisone)

DAW 9

Other

DAW 6

Override

Blue Trash Bags

PHI (Personal Health Information) and PII (Personally Identifiable Information)- name, address, DOB, social security number, prescription number, and any medical information

DAW 2

Patient Requested That Brand Product Be Dispensed

PHI

Personal Health Information

PII

Personally Identifiable Information

Foods that don't contain cholesterol

Plant-based foods such as fruit, vegetables, and grains

Medicare Part D

Prescription insurance. Most commonly used insurance at CVS.

Clear Bags

Regular garbage.

Otic

Relating to the ear.

Opthalmic

Relating to the eye

Drive-Thru

Responsible for both Drop Off and Pick Up tasks.

Chemical Name

Scientific identification, based on the chemical, plant, or animal of origin

Cream

Semisolid that is usually white, non-greasy and water-based. Applied externally or by applicator intravaginally

Ointment

Semisolid, greasy medication for external application, usually by rubbing. Some medications in ointment form are anti-inflammatory drugs, topical anesthetics and antibiotics

Pick Up

Serve customers picking up their prescription(s) in the pharmacy.

DAW 1

Substitution Not Allowed by Prescriber

TIL

Target inventory level; the inventory level necessary to create value for your company and value for the patient's of your store; the amount of drugs your store has to reach because of patient needs; if BOH is below a certain number, an order will be needed so that it meets the TIL

Anti-hypertensive drugs are used....

To lower the blood pressure toward "normal" with minimal side effects and prevent or reverse organ damage.

2 Type of Cardinal Orders

Voluntary and Mandatory.

Pharmacies must create and maintain up-to-date patient files. Records should include...

− Full name − Date of birth − Gender − Home address and phone number(s) − Drug allergies and reactions − Disease/medical conditions − Insurance infirmation − Pharmacist comments and notes − Drug profile (other OTC or prescription medication he or she is taking) − Safety cap preference

What a patient profile must include

− Full name − Date of birth − Gender − Mailing address and phone number(s) − Drug allergies and reactions − Disease/medical conditions − Insurance − Pharmacist comments and notes − Drug profile