Understanding a Prescription: Quiz
A patient presents a new prescription for metoprolol 50 mg tablets, which the pharmacy technician recognizes as used for treating high blood pressure. The directions state "i po qd." Because the patient has never received this medication before, the technician should label the bottle with the directions:
"Take one tablet by mouth daily." (The sig "i po qd" translates as "take one tablet by mouth daily" or "take one tablet by mouth once daily." A technician should never add any extra information to the directions provided by the physician. In this case, though metoprolol is often used for high blood pressure, it can also be used for heart arrhythmias and other conditions. The addition of information may confuse or alarm the patient.)
What does BID mean when it appears on a prescription?
2 times daily BID, also written as bid, is an abbreviation for "2 times daily" or "twice a day" and refers to the number of drug doses a patient should take each day.
Which of the following statements is incorrect?
A pharmacy technician may accept a new prescription that was called in by a provider. Pharmacy technicians may not receive new prescriptions electronically, including by phone. Instead, such medication orders must be transcribed into hard copy by the pharmacist who can then ensure their accuracy. Once transcribed and approved, the pharmacy technician may then fill the prescription.
What is an NDC number?
An identification number that is assigned to each drug product. (NDC stands for National Drug Code. NDC numbers are unique product identifiers assigned to every drug product. They include three sets of numbers: the first relates to the manufacturer, the second relates to the drug itself, and the third relates to the package size.)
A prescription for Levoxyl reads 1 tablet PO daily ac. What does the abbreviation "ac" stand for?
Before meals The abbreviation "ac" stands for before meals, meaning the drug should be taken before the patient has eaten, or on an empty stomach, as this may affect the drug's absorption. A prescription for a drug that should be taken with food would include the abbreviation "pc," meaning after meals.
CPOE stands for:
Computerized Prescriber Order Entry. CPOE stands for Computerized Prescriber Order Entry. It is sometimes called Computerized Physician Order Entry, but that is not exactly correct. Other than physicians, nurse practitioners, physician assistants, pharmacists, and other health care professionals may use CPOE systems.
By federal law, a Schedule III medication is allowed how many refills within 6 months from the date the prescription was written?
Five refills are allowed. Five refills are allowed within 6 months for Schedule III and Schedule IV medications according to federal law. Individual states may set stricter standards, but Schedule III and IV medications may not be refilled more than five times within 6 months from the date the prescription was written. If a patient chooses not to get an entire fill, this partial fill will still count as one of the five allowed refills. Due to federal law, the patient will only receive five refills (full or partial) regardless of how many tablets are given at each fill.
Which of the following would not appear on a prescription?
Hospital ID number (A prescription is used in a retail pharmacy setting and thus would not include a hospital ID number. That information instead would be found on a medication order, or the equivalent to a prescription in an institutional setting. The medication order would also include more details about the patient such as all of the drugs prescribed by various providers within the hospital, the patient's room and bed number, and the patient's birth date and age.)
Translate the following sig: ii gtt OU tid x 10D.
Instill 2 drops into each eye three times daily for 10 days. The instructions in this sig can be broken down as follows: ii = 2gtt = dropsOU = each eyetid = 3 times daily10D = 10 days The best translation, therefore, is "Instill 2 drops into each eye three times daily for 10 days."
A hospital inpatient who requires medication on an as-needed basis would have which type of medication order for that particular drug?
PRN order A patient who only needs a particular drug on an as-needed basis would have a PRN order since PRN is the abbreviation for "as needed." This means the hospital staff would only give that patient a particular drug. Drugs that might fall into this category would include analgesics for pain.
Which of the following statements is most correct with regard to federal law?
Schedule II prescriptions must be handwritten or submitted as an electronic prescription, but all other controlled substance prescriptions may also be accepted by the pharmacy via telephone or fax. Effective June 1, 2010, the DEA has amended the law requiring all Schedule II prescriptions to be handwritten. Properly registered practitioners may now submit prescriptions to pharmacies for all controlled substances by electronic prescription if they desire. Prescriptions for the lower schedules may still be submitted through oral, fax, electronic prescription, or handwritten means. Handwritten prescriptions for Schedule II medications are still allowed, and this new ruling does not change any other controlled substance regulations. Some states and large pharmacy franchises may impose stricter laws prohibiting electronic filing of Schedule II or other scheduled prescriptions. In those instances, the stricter law is always followed.
When a patient brings in a new prescription to be filled, a pharmacy technician should ask the patient for the following information except the patient's:
Social Security number. It is always wise to ask for the patient's date of birth, address, or telephone number to verify the patient's identity. The pharmacy technician should also determine if the patient has any drug allergies to make sure that the new medication is safe to take and if the patient has prescription insurance. By asking these questions before the patient leaves the counter, the transaction will be conducted more smoothly and offer more benefits to the patient.
How should a prescriber write "take one tablet by mouth daily" on a physician's order sheet in a healthcare system setting?
Take one tablet by mouth daily. (The Joint Commission requires certain dangerous and confusing abbreviations to be avoided in a hospital setting. Among the abbreviations with restricted usage is "i po qd," which can be misinterpreted as "take one tablet by mouth four times daily" instead of "take one tablet by mouth daily." Though other medication safety organizations like the Institute for Safe Medication Practices (ISMP) offer guidelines for safe use of abbreviations, these are not currently enforced for outpatient prescriptions.)
A prescription for Diflucan includes the code DAW Code 1. What does this mean?
The pharmacy may not substitute a generic drug for Diflucan. (The code DAW Code 1 means that the prescriber intends that no substitution is allowed. DAW is an abbreviation for "dispense as written." If a prescriber enters this abbreviation, or in some states signs his or her name above the signature line that states "dispense as written," this indicates to the pharmacy that a generic form of a drug should not be substituted. Another way to indicate this is to write "brand medically necessary" on the prescription. Note that many insurance companies will only authorize payment for generic versions of drugs, so be sure to communicate this information to the patient or refer them to the pharmacist or back to their provider if they have questions or concerns.)
When filling a prescription, the pharmacy technician notices that the NDC of the medication in stock does not match the NDC on the prescription label. The drug and strength in stock is exactly the same as what the prescriber ordered. How should the pharmacy technician proceed?
The pharmacy technician should modify the order in the computer with the NDC of the drug in stock, print a new label, and then proceed to fill the order. The National Drug Code (NDC) is very important in many respects in the prescription filling process. Filling by NDC is a safety measure to ensure you are filling a prescription with the correct medication. Many software programs recognize the special imprints and colors of products of a certain NDC and will print that information out for the patient on the label. If a different product is issued, this may cause confusion for the patient. In addition, there are laws and third-party billing issues restricting the filling of a prescription with a product that has a different NDC number. Though many generic companies make the same drug and strength, it is important to select the product with the NDC that the pharmacy has in stock.
A medication order that requires a medication to be given to a patient in regular intervals around the clock is called:
a standing order. A standing order is a medication order for a patient that requires the medication to be given at certain times around the clock. A standing order is sometimes referred to as a scheduled order because it is always given at scheduled times. A STAT order is used when a medication is urgently needed, and a PRN order is used for medication that is only given on an "as-needed" basis.
A physician's order form in a hospital setting contains:
all of the prescriber's orders, including medication, lab, procedures, and dietary orders. (The medication orders in an inpatient hospital setting appear on a physician's order form. These orders include the medications as well as orders for labs, tests, dietary restrictions, activities, and other pertinent patient information. These order forms contain much information which the pharmacy and other departments of the hospital use to give the patient the best care possible. Physician's order forms can also be found in an electronic format in some facilities.)
Common oral pain medication on a busy surgical unit of a hospital is usually dispensed to a patient from:
an automated unit dose dispensing cabinet or floor stock. (Most hospitals have automated unit dose dispensing cabinets throughout the hospital, from which nurses may dispense the most common medications without the need to contact the pharmacy for each dose. Each unit will have a different combination of stock items depending on the unit.)
In a healthcare system setting when patient medications are dispensed in 24-hour increments and kept in individual patient drawers on each unit, this medication filling system is called:
cart fill. When medications are filled in patient drawers for a 24-hour period in a health-system pharmacy, this process is typically known as cart fill. Due to the high number of patient drawers, they are usually kept on carts which are used to exchange the drawers with those on the unit that need to be replenished. Pharmacy technicians usually fill and exchange the drawers, but in larger facilities, robotic cart fill systems are sometimes employed.
Electronic prescribing, or e-prescribing, refers to:
computer-to-computer transmission of prescription information using certified software between prescribers, pharmacies, and pharmacy benefits managers. (By the strictest definition, e-prescribing refers only to the computer-to-computer exchange of prescription information using certified software in which prescribers, pharmacies, and pharmacy benefits managers are all registered.)
When reviewing a refill request for an oral contraceptive phoned in by a patient, the pharmacist notes that the patient is out of refills. The pharmacist will:
contact the prescriber directly to obtain a refill authorization. If a prescription has not changed in strength or dosage, a pharmacist may contact a prescriber's office directly to request a refill authorization for a patient. In some states, this may be done by the pharmacy technician, but if the prescription has changed in any way, some states then require the refill authorization to be made by the pharmacist. Pharmacy technicians must be well informed of the pharmacy laws of the states in which they work.
When inputting a new prescription, the pharmacy technician notices a warning on the screen. The pharmacy technician should:
either alert the pharmacist before processing or print the warning and place with the labels so the pharmacist will see it when checking the prescription. A warning on the screen is presented when the computer has detected a possible allergy, drug-drug interaction, or therapeutic duplication. The warnings range in degree of severity, so the pharmacy technician should consult the pharmacist immediately before proceeding or print out the warning for the pharmacist to analyze before dispensing. The pharmacist must use his or her best judgment to determine if it is safe to fill the drug for the patient. A pharmacy technician is not allowed to make these decisions.
Adjudication in pharmacy practice is the act of:
electronically submitting prescription information to a third-party for approval and billing. Adjudication, or online adjudication, is the electronic submission of prescription information to a third-party payer or pharmacy benefits manager for the approval and correct billing for a prescription.
Prescriptions are considered valid:
for only one year after being written. According to federal law, prescriptions are considered valid for only one year after being written by a prescriber. Individual state laws may allow exceptions to this rule, and prescriptions for controlled substances in Schedules II-IV are excluded from this rule and are usually valid for six months, or even less.
Medications in an inpatient hospital setting are dispensed in all of the following ways except
in patient-specific amber pill bottles. (Medications in a hospital or health-system pharmacy are purchased or repackaged in unit-dose packaging for patient use. Commonly dispensed medications are kept on the medical units in automated dispensing cabinets for easy nursing access, but those medications that are not in the cabinets are issued on demand or in 24-hour increments and kept in secure patient medication drawers on the nursing units.)
All of the following pharmacies can fill prescriptions except:
inpatient pharmacies. (Prescriptions are medication orders traditionally written on prescription blanks for presentation to ambulatory (community) and mail order pharmacies. Inpatient hospital pharmacies use physician order sheets for medication orders.)
If a prescription for Zestril should be taken by the patient once a day, the prescription should read:
once daily. The abbreviations o.d. or OD were formally used by health care providers to mean "once daily," but are now on the Institute for Safe Medical Practices' (ISMP) "Recommended" Do Not Use List because they can easily be mistaken for the abbreviation for "right eye" (OD = oculus dexter) and this confusion could cause medication errors. Pharmacy technicians should become familiar with both the ISMP's and the Joint Commission's Do Not Use lists to ensure the safety of the patients they are serving.
The second letter included in the DEA number correlates to the:
prescriber's last name. The DEA number is issued to a health care provider by the Drug Enforcement Agency if that prescriber is allowed to dispense controlled substances to patients. It is a nine-digit number that begins with two letters, followed by seven numbers. The first letter is generally A, B, or C and relates to the prescriber's status. The second letter correlates to the prescriber's last name.
What is the abbreviation for every week?
qw The abbreviation for every week is qw, with "q" meaning every and "w" meaning week. QAM is the abbreviation for "every morning"; qd stands for "every day"; and qod stands for "every other day."
A pharmacy technician must:
refer a patient to the pharmacist for all counseling on prescription drugs. A pharmacy technician must refer patients to the pharmacist for counseling on all prescription or nonprescription (OTC) drugs. While pharmacy technicians should be knowledgeable about drugs and drug interactions, it is beyond their scope of practice to counsel patients. Pharmacists are also required to offer patients counseling on all new prescription drugs. It is then the right of the patient to refuse counseling.
A medication order is considered "verified" once it has been:
reviewed and approved by the pharmacist. A medication order is considered "verified" once it has been reviewed and approved by the pharmacist. It is beyond the scope of practice for the pharmacy technician to verify a medication order. However, the pharmacy technician may prescreen a medication order for completeness before handing it off to the pharmacist. This is called an unverified order.
medication order is considered "verified" once it has been:
reviewed and approved by the pharmacist. A medication order is considered "verified" once it has been reviewed and approved by the pharmacist. It is beyond the scope of practice for the pharmacy technician to verify a medication order. However, the pharmacy technician may prescreen a medication order for completeness before handing it off to the pharmacist. This is called an unverified order.
A pharmacy technician has just received a call from a prescriber's office that wishes to authorize refills on a patient's medication. The pharmacy is located in a state that allows technicians to contact prescribers to obtain refill authorization. The best action is to:
write down all the pertinent information regarding the patient, the prescription, and refills, then read back and confirm with the prescriber's office that the information is correct before ending the call. Some, but not all, states allow a technician to take refill authorizations from a prescriber's office. It is important to take down all the information necessary, such as patient's name and date of birth, drug and strength, directions, any refills, and the prescriber's name and representative to whom you are speaking. Always read back and confirm all the information with the office before ending the call. Some states may forbid refill authorization by pharmacy technicians, so the technician must check all applicable laws before taking action.
