chapter reviews 1-9 PTCE Exam
OBRA 1990 retrospective drug review
"ongoing periodic examination of claims data and other records in order to identify patterns of fraud, abuse, gross overuse, or medically unnecessary care and implements corrective action when needed" also educational programming of state's drug use
ranking
A comparative technique of performance appraisal that involves the rank ordering of each individual from best to worst on each performance dimension
Index Nominum
A compilation of synonyms, formulas, and therapeutic classes of more than 7000 drugs and 28,000 proprietary preparations from 27 countries
reprocessing
-transferring medication from one unit-dose container to another unit-dose container is not permitted. -removing the blister card from the cardboard carrier and placing it in another cardboard carrier is permitted
1)Name of the patient, 2)address, 3)telephone number, 4)date of birth, 5)gender, 6)patients history
What should the pharmacist keep on record for a patient from the Omnibus Budget Reconciliation Act of 1990?
typewriter, pen, or indelible pencil
What writing utensils can be used to fill out a DEA Form 222?
Pharmaceutical Calculations
a clear concise, thorough introduction to pharmaceutical mathematics
paired comparison
a comparative method of performance appraisal whereby each person is directly compared with every other person
calibration
a comparison between measurements one of known magnitude or correctness made or set with one device and another measurement made in as similar a way as possible with a second device
360 evaluation
a comprehensive approach that uses self ratings, customer ratings, and other outside the workforce
Poisindex System
a computerized poison information system
tamper evident packaging
a container or individual carton of a sterile article intended for ophthalmic or otic use must be so sealed that the contents cannot be used without obvious destruction of the seal
direct compounding area(DCA)
a critical area within an ISO class 5 area
allowances
a deduction is given from the purchase price by the seller to the purchaser
policy
a definite course or method of action
80/20 report (velocity report)
a detailed summary of purchasing history based on the 80/20 rule, designating medications that account for 80% of the drug costs for that period of time
modem
a device that allows a computer to communicate over a network
ampule breaker(sterile compounding)
a device used to break the neck of an ampule
nebulizer
a device used to convert a liquid medication to a mist and deliver it to the lungs with the aid of deep inhalation
purchase invoice
a document that supports each credit purchase
liquid dosage forms
a dosage form composed of various solutions whose term relates to the type of liquid with which the medication is mixed
modified unit dose system
a drug distribution system that combines a unit dose medications, which are blister packaged onto a multiple-dose card instead of being placed in a box
negative pressure room
a room in which air flows into the room and away from adjacent rooms, which results in positive pressure in the room
positive pressure room
a room in which air flows out of or toward adjacent rooms, which results in a lower pressure in the room
Drug Information Fulltext
a searchable computer database combining two publications, the American Hospital Formulary Service Drug Information and the Handbook on Injectable Drugs
fee for service(managed care reimbursement)
a set fee is paid for each type of service that is performed and is paid at the time of service
heparin lock(sterile compounding)
a short piece of tubing attached to a needle or catheter when the tubing is filled with heparin to prevent potential clotting
single dose container
a single unit container for parenteral administration
unit dose container
a single unit container intended for administration other than parenteral
BIN (bank identification number)
a six digit number used to identify the company that will reimburse the pharmacy for the prescription being filled
lymph node
a small knob of tissue in the lymphatic system that filters lymph, trapping bacteria and other microorganisms that cause disease
ambulatory pumps(sterile compounding)
a small lightweight, portable pump worn by a patient that may be either therapy specific or used for multiple therapies
piggyback(sterile compounding)
a small volume solution added to an LVP
Clean area(sterile compounding)
a space where microbial containment is kept at a specific level or safety to ensure a certain level of cleanliness
aerosol
a spray in a pressurized container that contains a propellant an inert liquid or gas under pressure meant to carry the active ingredient to its location of application
syringe caps(Sterile compounding)
a sterile cap used to prevent contamination of syringes during the transportation out of the pharmacy
compounded sterile product (CSP)
a sterile drug, product that was prepared by compounding or underwent other handling or manipulation prior to administration
automated dispensing systems
a storage, dispensing, and charging system that is used to save time, improve inventory control tracking, and reduce medication errors
temporal lobe
A region of the cerebral cortex responsible for hearing and language.
occipital lobe
A region of the cerebral cortex that processes visual information
parietal lobe
A region of the cerebral cortex whose functions include processing information about touch.
graphic rating scale
A scale that lists a number of traits and a range of performance for each. The employee is then rated by identifying the score that best describes his or her level of performance for each trait.
dispersions
A solute dispersed through a dispersing vehicle
Textbook of Adverse Drug Reactions
A standard textbook on the subject
immune system
A system that protects the body from foreign substances and pathogenic organisms by producing the immune response
sifting
A technique to either blend or combine powders
controlled room temperature
A temperature maintained thermostatically that encompasses the usual and customary working environment of 20 degrees to 25 degrees C (68 degrees to 77 degrees F)
gel
A two-phase system containing an extremely fine solid particle that when mixed is difficult to distinguish between the two phases and is considered a semisolid form
United States Pharmacopeia
A voluntary non-profit organization that sets standards for the manufacture and distribution of drugs and related to products in the United States. These standards are directly referred to by federal and state laws.
creams
An emulsion of oil and water in approximately equal proportions
liniments
An emulsion or alcoholic or oleaginous solutions applied through rubbing
baker cells
An example of an automated counting and filling device. Each cell contains a particular medication. The desired quantity is entered, and the Baker cell counts the desired quantity for the pharmacist.
thymus
An immune organ located near the heart. The thymus is the site of T cell maturation and is larger in children and adolescents.
conjunctiva
Delicate membrane lining the eyelids and covering the eyeball
just in time ordering
a strategy of ordering a product just before it is used. this process minimizes tying up funds for long periods and reduces the cost associated with inventory management. Prevents overstock and out of stock conditions
pharmaceutical dosage forms and drug delivery systems
a superb survey of contemporary dosage forms and delivery systems
unit dose system
a system that provides a medication in its final "unit of use." Unit-dose packaging machines may be manual, semiautomatic, or automatic.
geometric dilution
a technique for mixing two powders of unequal size the smaller amount of powder is diluted in steps by additions of the larger amount of powder
solid waste
a term used to define all solid, liquid, and gaseous waste
media fill test
a test performed on compounded products to ensure no contamination has occurred during the preparation phase
uretha
a tube in which urine leaves the body
suspension
a two phase system in which sold particles are dispersed in a liquid vehicle, which may be oral, topical, or injectable.
Ignitable
Has a flashpoint less than 60 degrees C; examples include potassium permanganate, silver nitrate, and collodion
corrosivity
Has a pH less than 2 or greater than 12.5; includes glacial acetic acid and sodium hydroxide
Schedule 2 drugs
High potential for abuse and have medical use with severe restrictions
ISMP
Institute for Safe Medication Practices
Title I of HIPPA
Insurance reform. Protects health insurance coverage for workers and families when they change or lose their jobs
Error Prevention Strategies
TJC organizations implement safety standards to reduce medication errors in five distinct areas: -leadership process and accountability -competent and capable workforce -safe environment for staff and patients -clinical care for patients -improving quality and safety
multidose vial(sterile compounding)
a vial or container that can be used for more than one admixture that normally contains preservatives and contains a maximum dating of 28 days unless otherwise specified by manufacturer
single dose vial(sterile compounding)
a vial or container that can only be used once and does not contain a preservative
ante area(sterile compounding)
an area in which all preparations for IV admixtures are gathered, including labels, gowning, and drug materials
Buffer area(sterile compounding)
an area in which hoods are kept and IV preparations take place
ISO Class 7(class 10,000 area)
an area where are no more than 10,000 particles 0.5 micron or larger per cubic foot of air
ISO Class 5(class 100 area)
an area where there are no more than 10,000 particles 0.5 micron or larger per cubic foot of air
ISO Class 9(class 100,000 area)
an area where there are no more than 100,000 particles 0.5 micron or larger per cubic foot of air
USP Dictionary of USAN and International Drug Names
an authoritative guide to drug names, including chemical names, brand names, manufacturers, molecular formulas, therapeutic uses, and chemical structures
Goodman & Gilman's The Pharmacological Basis of Therapeutics
an authoritative text on pharmacology and therapeutics containing 67 articles by leading experts in the field. Provides information for pharmacists to help them answer clinical questions about how drugs work under different conditions in the body.
Understanding and Preventing Errors in Medication Orders and Prescription Writing
an education resource consisting of lecture materials, videotapes, and 35 mm slides describing medication errors that arise from poorly written orders and prescriptions, using examples of actual reports received through the USP Medication Errors Reporting Program
last in, last out
an inventory costing method that assumes that the costs of the latest units purchased are the first to be allocated to cost of goods sold
first in, first out
an inventory costing method that assumes the cost at the earliest purchase of goods is the first be recognized as the cost of the goods sold
average cost method
an inventory costing method that used the weighted average unit cost to allocate the costs of goods available for sale to inventory and cost of goods sold
periodic inventory system
an inventory system in which costs are allocated to ending inventories and cost of goods sold at the end of the period. Cost of goods is computed at the end of the period by subtracting the ending inventory from the cost of goods available for sale
douche
an irrigating or bathing solution
point of sale
an item is deducted from inventory as it is dispensed and in many situations is automatically reordered
PRN
an order that may be filled or administered when a patient requests it, but there may be limitations associated with it
workflow
an organized way of performing a task
pharmacy waste
any chemical product, vaccine, or allergenic whose intended use is for the diagnosis, cure, mitigation, treatment, or prevention of disease or injury in humans or other animals
drug allergies
any medication allergies the patient is known to possess.
New Drug Application (NDA)
application to the FDA for marketing approval -submitted after clinical studies are completed and the sponsor believes there are adequate data to support safety and effectiveness
Applied Therapeutics: The Clinical Use of Drugs
applied therapeutics
no
are partial fillings allowed after six months?
breakdown room
area where empty or used radiopharmaceuticals are returned and dismantled for reuse
proprietary name(brand name)
assigned by the drug manufacturer and is protected through a patent
Nonproprietary name(generic name)
assigned to a medication and contains a word stem
pyxis med station system
automated dispensing system supporting decentralized medication management. Bar code scanning ensures accurate medication dispensing, features to prevent loading of the wrong medication, and active alerts to provide an added safety precaution for high risk medications
Accusource monitoring system
automated total parenteral nutrition compounder with total nutrient admixture
informal channels
do not follow chain of command; allow for the transfer of information through networks and acquaintances
Resident monitoring form
documents behavior of a patient and any precipitating, factors, drug and nondrug intervention, outcomes, and adverse reactions
treatment administration record (TAR)
documents external treatments given to a patient in a hospital or a long term facility
Medication administration record (MAR)
documents medication administered to a patient. Includes drug, dose, route, frequency and timing of administration. Lists the patient's allergies and diagnoses. Used every time a drug is administered
safety data sheets
documents that provide information on a hazardous chemical and its characteristics
using vials with solutions(sterile compounding)
draw into syringe a volume of air equal to amount of volume being replace. Penetrate the vial without coring. Invert the vial upside down and pull back on the plunger to fill the syringe. Tap to bring air bubbles to the top of the syringe. Transfer the solution to the final container.
each drug assigned a 11 digit number to identify
drug listing act of 1972
confused drug names
drug names that look alike or sound alike that have resulted in medication errors and have been identified by reporting them through the ISMP-MERP
Drug-laboratory interactions
drugs tested in the lab
drug listing act of 1972
each drug is assigned a specific 11 digit number to identify it. This number as an NDC number. The first five digits are the manufacturer, the next four digits are the drug product, and the last two digits are the package size
ampules(sterile compounding)
elongated glass container in which the neck is broken off
group code
employer that contracted the insurance company for the policy
interoperability across documentation systems
enable authorized practitioners to capture, share, and report information from any system, whether paper or electronic
poison prevention packing act of 1970
enacted to reduce accidental poisoning in children. The act requires that most OTC and legend drugs be packaged in child-resistant containers.
pituitary gland
endocrine gland at the base of the brain
thyroid gland
endocrine gland that surrounds the trachea in the neck
omnibus budget reconciliation of 1987
established extensive revisions to medicare and Medicaid conditions of participation regarding long term care facilities and pharmacy -each resident's drug regimen must be free of unnecessary medications -antipsychotic drugs are not used unless the patient has a specific condition -patients requiring antipsychotic medication must be documented as having been diagnosed with a condition that warrants its use -patients requiring antipsychotics medication must receive gradual dose tapering. -residents are to be free of any significant medication errors -routine and emergency drugs must be provided to patients -long term care facilities must have the services of a consultant pharmacist -medications must be labeled according to accepted professional principles -medications must be stored in locked compartments at the proper temperature accounting both federal and state laws
Pancrelipase preparations
exceptions for child resistant containers #10
powdered anhydrous chloestyramine
exceptions for child resistant containers #11
powdered colestipol up to 5g per packet
exceptions for child resistant containers #12
prednisone tablets with no more than 105 mg per package
exceptions for child resistant containers #13
sodium fluoride tablets with no more than 264mg per package
exceptions for child resistant containers #14
sublingual and chewable isosorbide dinitrate in doses of 10mg or less
exceptions for child resistant containers #15
sublingual nitroglycerin tablets
exceptions for child resistant containers #16
drugs dispensed to institutionalized patients
exceptions for child resistant containers #4
betamethasone with no more than 12.6 mg per package
exceptions for child resistant containers #5
erythromycin ethylsuccinate tablets in packages containing no more than 16 g
exceptions for child resistant containers #6
mebendazole tablets with no more than 600 mg per package
exceptions for child resistant containers #7
methylprednisolone tablets with no more than 85 mg per package
exceptions for child resistant containers #8
oral contraceptions taken cyclically in the manufacturer's dispensing package
exceptions for child resistant containers #9
k-list waste
exhibits one or more of the following characteristics; corrosive, ignitable, reactive, or toxic; examples include veterinary pharmaceuticals and inorganic and organic chemicals
type B1 hoods(Sterile compounding)
expel most of the contaminated air through a duct to the outside atmosphere after it passes through a HEPS filter. The air is not recirculated within the hood or returned to the parenteral room atmosphere
sterile water for irrigation USP(sterile compounding)
has been sterilized but contains no antimicrobial agents; used as an irrigating solution
sterile water for injection USP (sterile compounding)
has been sterilized but has no antimicrobial agents; can be used in parenteral solutions
Orphan Dug Act of 1983
medications for treatment of diseases or conditions of which there are fewer than 200,000 cases in the world
computerization
method of processing, storing, and transferring prescriptions
cost containment
methods used include: -restrictive pharmacy networks -mail order and internet pharmacy -electronic claim submission -higher member copayments -tiered copayments -formulary management -prior authorization -competitive drug buying -benefit limitations -mandatory generic substitution
myocardium
middle layer of the heart
rejection code 1
missing or invalid BIN
rejection code 9
missing or invalid birth date
rejection code 7
missing or invalid cardholder ID number
rejection code 20
missing or invalid compound code
rejection code 15
missing or invalid date or service
rejection code 28
missing or invalid date prescription written
rejection code 19
missing or invalid days supply
rejection code 22
missing or invalid dispense as written/product selection code
rejection code 10
missing or invalid gender code
rejection code 6
missing or invalid group number
rejection code 29
missing or invalid number of refills authorized
rejection code 11
missing or invalid patient relationship code
rejection code 8
missing or invalid person code
rejection code 5
missing or invalid pharmacy number
rejection code 25
missing or invalid prescriber ID
rejection code 16
missing or invalid prescription/service reference number
rejection code 4
missing or invalid processor control number
rejection code 3
missing or invalid transaction code
rejection code 26
missing or invalid unit of measure
rejection code 2
missing or invalid version number
small volume parenterals(SVP)(Sterile compounding)
packaged products, containing a volume of 100mL or less, that are either directly administered to the patient or added to another parenteral
filter paper
paper used to filter a solution
parathyroid gland
parathyroid hormone
large volume parenterals(Sterile compounding)
parenterals with a volume greater than 100 mL
clinical care of patients(TJC)
patient's identification is verified before the administration of medications, treatments, and specific procedures
capitation(managed care reimbursement)
paying a fixed, prepaid fee per person to provide a range of health services; paid before the services are provided
scheduling
productivity reports can be used to show the peak times of the day when prescription processing is heaviest and when prescriptions are being picked up by customers.
type A hoods(sterile compounding)
recirculate a portion of the air (after it first passes through a HEPA filter) within the hood and exhaust a portion of this air back into the parenteral room
The International Pharmacopeia
recommended production methods and specifications for drugs
pulverization by intervention
reducing the size of a particle in a solid with the aid of an additional material
self pay
some patients are responsible for the full price of their prescriptions, In these situations, the patients may pay with cash, check, credit or debit card
nasal cavities
space between the cranium and the roof of the mouth
transfer needles(sterile compounding)
specially designed needles that look like two needles attached together at the hub that are used to transfer sterile solutions from one vial directly into another without the use of a syringe
disease states on health conditions
specific medications can have an adverse effect on a disease state or condition
Competent and capable workforce(TJC)
staff has documented credentials, accurate job descriptions, and training in their employee files
microcomputers or personal computers (PC's)
stand alone systems that run software programs and manage data accessed from a larger source. PC's include a monitor, central processing unit (CPU), and printer. Used in the pharmacy for quality assurance, drug information, drug utilization evaluations, adverse drug reporting, nonformulary drug use, and workload statistics
mission statement
states the purpose and goals of an organization
bacteriostatic water for injection USP(sterile compounding)
sterile water with antimicrobial agents that can used for injection
storage and disposable area
storage area for radioactive waste
gallbladder
stores and concentrates bile
epididymis
stores sperm
bladder
stores urine
pharmacology
study of drugs
DAW 5
substitution allowed; brand drug dispensed in generic
DAW 8
substitution allowed; generic band is not available in market place
DAW 4
substitution allowed; generic drug not in stock
DAW 2
substitution allowed; patient requested product dispensed
DAW 3
substitution allowed; pharmacist selected product dispensed
DAW 1
substitution not allowed by provider
DAW 7
substitution not allowed; brand name drug mandated by law
overhead
sum of all expenses
software applications
support pharmacy practices and user desired tasks
multiskilling
team members are trained in skills to perform more than one job
self managing teams
teams that are empowered to make decisions about planning, doing, and evaluating their daily work
State-Specific Prescription Transfer Regulations
technicians must be familiar with their state laws regarding the transfer of prescriptions between pharmacies. -transferring a prescription can only occur between two licensed pharmacies and the pharmacy processing the original prescription must record the following information in the patient profile: date of prescription transfer; the name, telephone number, and address of the pharmacy receiving the transferred prescription; the name of the pharmacist receiving the transferred prescription; and the number of refills remaining. Void must be written of the original hard copy of the prescription -the receiving pharmacy must indicate transfer on the front of the prescription, the date it was received from the other pharmacy, the name of the pharmacist; the name, address, and telephone of the pharmacy; the original date of the original prescription; and the number of refills remaining -a pharmacy technician may fax a copy of a prescription to another pharmacy under the supervision of a pharmacist
aseptic techniques(sterile compounding)
techniques used in the preparation of both hazardous and nonhazardous materials -used to prevent the introduction of microbes or unwanted debris that may cause a serious infection to occur -includes hand hygiene and wearing personal protective equipment
credit terms
terms that specify the amount of cash discount and the time period during which it is offered. They indicate the length of time in which the purchaser is expected to pay the full invoice price. An example include 2/10 where a 2 % discount can be taken off the invoice price less any returns or allowances if the invoice is paid within 10 days of the invoice date
Diencephalon
thalamus and hypothalamus
low risk level 1(sterile compounding)
uses a class 100 laminar flow hood; sterile ingredients or devices; only syringe transfer used for measuring or mixing; no more than three products; batch doses have preservatives; ampule extraction requires filter needles; manually prepared total parenteral nutrition with only three ingredients
Schedule 5 drugs
• Lower abuse potential than schedule 4 drugs • Accepted medical uses • Limited physical or psychological dependence
Physician's Desk Reference
two supplements published twice a year, this standard reference work contains information from package inserts for more than 4000 prescription drugs, as well as information on 250 drug manufacturers
authentication and accountability
uniquely identify persons, devices, and systems that create or generate information and that take responsibility for the information's accuracy and timeliness; require that all information be attributable to a source and require review of documents before authentication
applicator bottles
used for applying liquid medications to a wound or skin surface
wide mouth bottles
used for both powders or large quantities of tablets, capsules, and viscous liquids that cannot be poured readily from narrow-necked containers
hinged-lid or slide boxes
used for dispensing suppositories and powders
prescription bottles
used for liquids of low visocity
compounding slab
used for mixing compounds
glass
used for mixing liquids and semisolid forms
dropper bottles
used for ophthalmic, nasal, otic, or oral liquids to be administered by drop
filter straws(sterile compounding)
used for pulling medications from ampules
round vials
used for solid dosage forms such as tablets or capsules
porcelain
used in blending of powders
maximum allowable cost (MAC)
used in calculating the reimbursement formula to generic medications. MAC + dispensing fee. The MAC is determined by a managed care organization
hard rubber spatula
used in the compounding of ingredients that react with metal
type B3 hoods(sterile compounding)
used recycled air within the hood. All exhaust air is discharged to be the outside atmosphere. A type A hood may be converted to a type B3 hood.
70% isopropyl alcohol(sterile compounding)
used to clean laminar air hood surfaces
alcohol pads(sterile compounding)
used to clean the ports on an IV bag, the rubber stopper of a vial, or an area of the skin before an injection
ointment jars and collapsible tubes
used to dispense semisolid dosage forms
funnels
used to filter or pour liquids
graduates
used to measure liquids
pipettes
used to measure volumes less than 1.5 mL
mortar and pestle
used to mix up ingredients
forceps
used to pick up prescription weights and are used to ensure that oil is not deposited on the weight which would affect it
filters(sterile compounding)
used to remove particulate material and microorganisms from solution; they can be attached to the end of a syringe, the end of the administration kit, or the end of the needle
glass stirring rods
used to stir solutions and suspensions
Accrediting Council of Pharmacy Education
What does the ACPE stand for?
National Association of Boards of Pharmacy
What does the NABP stand for?
the manufacturer
What does the first five digits of the NDC stand for?
the drug product
What does the four digits of the NDC stand for?
the package size
What does the last two digits of the NDC stand for?
the pharmacy has to notify the DEA diversion office, police, and submit a DEA Form 106
What happens when theft occurs at a pharmacy?
Must be dated, signed, and stamped with a red C
What has to be on a receipt, invoice, or packing slip for Schedule III, IV, V drugs?
The Drug Price Competition and Patent Term Restoration
What is the Hatch-Waxman Act of 1984 also called?
10 items
What is the maximum items that can be written on a DEA Form 222?
the physican's last name
What is the second letter in the DEA number?
A, B, F, M
What letters are used in a DEA number?
comminution
act of reducing a substance to small, fine particles
Category F
(Error, Harm) An error occurred that may have contributed to or resulted in temporary harm to the patient and required initial or prolonged hospitalization
category A
(No error) Circumstances or events that have the capacity to cause error
category I
(error, death) an error occurred that may have contributed or resulted to patient's death
category E
(error, harm) an error occurred that may have contributed to or resulted in temporary harm to patient and patient required intervention
category G
(error, harm) error occurred that may contributed to or resulted in temporary or permanent harm to patient
category H
(error, harm) error occurred that may have contributed to or resulted harm to patient and required hospitalization to sustain life
category B
(error, no harm) error occurred but did not reach patient
category D
(error, no harm) error reach patient, did not cause harm but needed monitoring or intervention to prove no harm resulted
category C
(error, no harm) error reach the patient but did not cause harm
memory
(random access memory (RAM)) provides the computer with a temporary workspace
medicaid
- a federal program that is based on income and other circumstances -each state determines its own eligibility rules, services provided, and copays -eligibility is determined on a month by month basis -in most situations. Medicaid covers physician visits, emergency care, hospital care, vaccinations. prescription drugs, vision, hearing, long term care, and preventive care for children
advantages of automation
- reduction in medication errors - increased speed in medication processing - manage and track inventory
beyond use date
-6 months or 1/4 of the maunfacturer's expiration date -maximum of 1 year as long as drug does not exceed the safety margin of the drug manufacturer
medications that should not be crushed
-Accutane -Actonel -Adalat CC -Allegra D -Ambien CR -Augmentin XR -Avodart -Calan SR -Cardizem CD, LA, XL -Cymbalta -Depakote -Detrol LA -Ecotrin -EES 400 -Effexor XR -Evista -Flomax -Glucophage XR -Indera LA -Isotretinoin -Janumet XR -K-Dur -Lithobid -MS contin -Nexium -Nitrostat -Paxil CR -Prilosec -Ritalin LA, SR -Seroquel XR -Tessalon Perles -Wellbutrin
Fusion Mold Procedure for Preparing Suppositories
-Active ingredients are dispersed or dissolved in a melted base -Weigh quantities of base and active ingredients -Melt the suppository base at a low temperature and dissolve the drug in it -The base is poured and overfilled into a special suppository mold (metal, plastic, or rubber) and is left to harden -Excess material is removed from the top of the mold
measuring liquids procedures
-Choose properly sized gradates such that quantity measured is not less than 20% of the total volume of graduate -Pour liquid down the center of the graduate slowly and watch the level of liquid rise to desired volume -Allow time for all liquid to fall in graduate before taking measurement -Measure level of liquid at eye level and make observation at the bottom of meniscus -Pour liquid into the container and allow for liquid to be completely drained from the graduate
ISMP pharmacy regulations
-DO NOT CRUSH list -black box warnings -community pharmacy medication safety tools and resources -error prone abbreviation list -guideline for preventing medication errors in therapy -confused drug name list -list of high alert medications -list of products with drug name suffixes -patient controlled analgesia -standard concentration of neonatal drug infusion -tall man lettering
FDA Adverse Event Reporting System regulations
-Database that contains information on adverse event and medication error reports that have been submitted by the FDA -supports the FDA's postmarketing safety surveillance program for drug and therapeutic biologic products -information received is used to identify possible safety concerns for a marketed product -health care professionals and consumers may voluntarily report adverse events and medication errors -drug manufacturer's must receive an adverse drug event report must submit the information to the FDA
required prescriber information
-name of physician and prescriber -office address of physician -DEA number for controlled substance -NPI number -State license
tracking medication errors
-FDA MedWatch is a voluntary program that allows the reporting adverse health events and medical problems -ISMP oversees the MERP -The FAERS is a database that contains information regarding both adverse events and medication error reports submitted to the FDA -Institute of Medicine(IOM) -TJC -National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) -United States Pharmacopeia (USP): MedMarx is a national, internet accessible database used by hospitals and health care systems to track and trend adverse drug reactions and medication errors -The FDA and Centers for Disease Control and Prevention (CDC) Vaccine Adverse Event Reporting System is a postmarketing safety surveillance program that collects information about adverse events that occur after the administration of US licensed vaccines
Drug Shortages
-FDA attempts to reduce the number of medication shortages from occurring because of manufacturing, supply issues, and medication being discontinued by drug manufacturer's. -FDA tries to find alternative sources for a specific product from other drug manufacturer's. -Drug manufacturer's are not required to provide information regarding drug shortages, but many do so
Food, Drug, and Cosmetic Act of 1938 (FDCA 1938)
-Food and Drug Administration (FDA) created as a result of fatal poisonings from untested drugs. -Required all drug applications to be filed with FDA, and that drugs be proven safe before marketing.
technology and the health insurance portability and accountability act
-HIPPA requires that identifiable or protected health information (PHI) be held confidentially -allows patients to have better access to their medical records -prescriber order entry complements technology with HIPAA -patient information is portable and allows information stored on the internet to be moved between systems
torsion balance procedures
-Leave the balance in a draft-free area -If the balance has a level bubble, make sure the bubble is inside the bull's eye and make adjustments using the leveling feet -Place a weighing boat or a single piece of paper on the pan -When the balance has determined the final weight, press the tare bar to compensate for the weighing boat -As ingredients are added or removed, the digital display will show the weight
Vaccine Adverse Reporting System regulations
-National vaccine safety and surveillance administered by the FDA -collects and analyzes data from adverse events after vaccination -reports may be generated by health care providers, vaccine manufacturer's vaccine recipients and state immunization programs Health care providers are required: -any event that is listed by the vaccine manufacturer as a contraindication to subsequent doses of the vaccine -any events listed in the reportable events table that occurs within the specified time period after vaccination
procedure for preparing nonaqueous solution
-Prepare by dissolving in alcohol-soluble ingredients in alcohol and water-soluble ingredients -Add the alcohol portion to the aqueous portion and stir
preparing total parenteral nutrition
-TPN normally contains 50% dextrose, 10% amino acids, and 20% fat. -aseptic technique is required because TPN is infused into the right atrium of the heart -TPN compounders have been developed that include a multichannel pump for the amino acids, dextrose, fats, and other additives that is connected to a personal computer. The computer assists in the calculations and drives the pump. Micro compounding pumps are used for the electrolytes and other additives. -TPN and peripheral parental nutrition (PPN) are premixed from the manufacturer, but electrolytes, vitamins, and medications may be added to the nutrients at the pharmacy
Standard Concentrations of Neonatal Drug Infusions
-The ISMP and the Vermont Oxford Network(VON) are working to standardize the concentrations of typical neonatal infusions -reduce medication error risk when critically ill neonates are transferred from one facility to another -stimulate development of standardized infusion device drug libraries -provide the demand necessary for all manufacturers to offer commercially prepared standard solutions
punch method procedure for capsules
-Triturate ingredients to the same particle size -Mix using geometric dilution -Calculate enough ingredients for several extra capsules -Place powder on the ointment slab, where the depth of powder is approximately half the length of the capsule body -Hold the capsule vertically and punch the open end into the powder until capsule is filled -Place the cap on the capsule and weigh it using an empty capsule as a counterweight. Add or remove ingredient as needed -Place completed capsules in either a glass or plastic vial and store in a dry place to prevent them from absorbing moisture or becoming dry
Procedures for preparing ointments and creams
-Weight quantities of each ingredient and place them either on an ointment slab or parchment paper -Prepare by using geometric dilution and two spatulas to mix the ingredients -Transfer the final product into an ointment jar using a spatula -Remove air pockets from the ointment by using a spatula -Spread evenly in the container
formulary usage in managed care
-a list of medications approved for use or reimbursement under a prescription plan -each managed care organization determines its own formulary to be used -used to control prescription costs
mail order pharmacy network
-a mail order pharmacy owned and operated by a managed care organization -members obtain their filled prescriptions through the mail; in some situations; members may be eligible to obtain prescriptions from a community pharmacy
patient package insert requirements
-a patient package insert is an informational leaflet written for the benefits and risks of medications. -description -clinical pharmacology -indications and usage -contraindications -warnings -precautions -adverse reactions -drug abuse and dependence -overdosage -dosage and administration -how supplied -date of the most recent revision of the labeling a pharmacy is required to provide patient package inserts to all patients receiving metered dose inhalers, oral contraceptives, estrogen, progesterone, and isotretinoin
private plans
-a private plan is one in which the patient obtains a prescription drug card from a pharmacy benefits manager -private plans are extremely expensive for individuals to purchase
Institutional Review Board
A board, committee, or other group designated by an institution to approve biomedical research in accordance with the FDA
variable copayment
-a variable or different payment based on the type of drug being dispensed -examples of classifications used include generic drug, preferred brand name drug, nonpreferred brand name drug, and lifestyle drug -variable copayments encourage use of generic and formulary drugs -provides a greater access to drugs for the member but makes them responsible for higher copays -lowers the cost of prescription drug benefit to the employer and shifts more of the drug cost to the members
standard operating procedures
-access to buffer area is restricted to qualified personnel -cartoned supplies are decontaminated by using a spray disinfectant -supplies that are not used frequently are stored in anteroom -carts used in bringing supplies from the store room cannot be rolled past the anteroom -supplies must be disinfected and brought into the buffer room -nonessential supplies that shed particles should be taken into the buffer area -traffic in and out of the buffer are is minimized -individuals entering buffer area should not wear other garments, cosmetics, jewelry, or piercings -proper attire should be worn into the anteroom -hands and forearms should be washed with soap and water for at least 30 seconds -antiseptic hand cleansing must be performed before sterile gloves are donned -no food, drink, or chewing gum is permitted in buffer or anteroom -at the beginning of the compounding session and whenever anything is spilled, the area is cleaned with USP-purified water followed by a disinfecting agent with a nonlint wipe -a blower must be on at least 30 minutes before working in the area -supplies in the direct compounding area (DCA), an area within the ISO Class 5 where critical sites are exposed to unidirectional HEPA filtered air, are disinfected with 70% isopropyl alcohol -supplies are arranged neatly in the DCA area -procedures are performed to reduce touch contamination; gloves are disinfected with 70% isopropyl alcohol -all rubber stoppers of vials, bottles, and ampule necks should be wiped with 70% isopropyl alcohol for at least 10 seconds before preparing CSP
computerized physician order entry attributes and functions
-access to the system is simple when the application sign on and sign off are accomplished through a combination of passwords, biometrics, or other devices. Biometrics use technologies that measure and analyze human body characteristics, such as DNA, fingerprints, eye retinas, and irises, voice patterns, facial patterns, and hand measurements, for authentication purposes -access to the needed decision support system is available from any patient care setting, pharmacy, physician's office, or home -mobility is maintained through a combination of mobile and stationary devices that are readily available and located at various point of care locations based on the work flow of a specific patient care area -navigation is from a main screen with direct links to screens designed for patient data review, ordering, and information directory. Moving forward and back to the main screen is clear and simple -patient data to support the ordering process are readily available electronically. Decision support includes allergies, height, weight, current medications, laboratory values, radiology results, and medical problems -the maximum amount of relevant information is available on each screen -system responses are fast, and there is virtually no down time
The Joint Commission services
-accredits ambulatory health care, behavioral health care, critical access hospitals, home care, hospital laboratory services, and long term facilities -certification for disease-specific care, palliative care, and home care staffing -addresses health care-associtated infections, infection control, and patient safety concerns to include medication errors
Accrediting Council of Pharmacy Education guidelines
-accredits professional degree programs in pharmacy and providers of continuing pharmacy education -ensures and advances the quality of continuing pharmacy education -provides continuing education through knowledge based, application-based, and pharmacy-based activities -establishes standards for pharmacy continuing education
accountability and record keeping
-accurate drug accountability records demonstrate that the study drug was dispensed or administered according to protocol; dispensing records and kept for the sponsor -check expiration dates and graduated dosing regimens -support the validity of the study data and conclusions from those data -document the handling of the study drug from receipt to dispensing to return or disposal
classes and categories of high alert medications
-adrenergic agonists, intravenous (epinephrine, phenylephrine, and norepinephrine) -adrenergic antagonist (propranolol, metoprolol, and labetolol) -anesthetic agents, general, inhaled, and IV (Propofol, and ketamine) -antiarrhythmics, IV (lidocaine, amiodarone,) -antithrombotic agents -anticoagulants (warfarin, low molecular weight heparin, IV unfractionated heparin) -Factor Xa inhibitors -direct thrombin inhibitors (argatroban, bivalirudin, dabigatran, lepirudin) -thrombolytics (alteplase, reteplase, tennecteplase) -glycoprotein IIb/IIIa (eptifibatide) -cardioplegic solutions -chemotherapeutic agents, parenteral and oral -dextrose, hypertonic, 20% or greater -epidural or intrathecal medications -hypoglycemics, oral -inotropic agents, IV -Insulin, subcutaneous -liposomal forms of drugs (liposomal, amphotericin, B desoxycholate) -moderate sedation agents, IV (dexmedetomidine, midazolam) -moderate sedation agents, oral for children (chloral hydrate) -narcotics/opiods -IV -Transdermal -oral (lipid concentrates, immediate, and sustained release formulations) -neuromuscular blocking agents (succinylcholine, rocuronium, vecuronium) -parenteral nutritional agents -radiocontrast agents, IV -sterile water for injection, inhalation, and irrigation (excluding pouring bottles) or containers of 100 mL or more -sodium chloride for injection, hypertonic, greater than 0.9% concentration
American Society of Health-System Pharmacists guidelines
-advocate for the practice of pharmacy to various organizations like, TJC, federal and state regulatory agencies -provide continuing education -develops official professional policies in the form of policy positions and guidance documents in order to establish best practices -establishes regulations and standards for pharmacy technician programs to include curriculum and clinical expectations -accredits pharmacy technician training programs -developed the pharmacy technician initiative
disposition
-after the study has been completed, the leftover drugs are returned to the sponsor -obtain medication reconciliation instructions in writing from the sponsor -in rate situations, approved drugs may be dispensed to patients for compassionate use
specific pharmacy infection control processes
-all injectable drugs and other sterile products must be compounded under laminar flow hoods -laminar flow hoods must be recertified every 6 months by an independent contractor -routine maintenance of the laminar flow hoods includes cleaning all work surfaces and prefilters -inspection records must be kept on file within the pharmacy department
pharmacy security
-all pharmacies are required to have workable alarm service when the pharmacy is closed. -closed-circuit televisions and hold-up alarm buttons may be installed in pharmacies, but such installation is at the discretion of the institution -each facility will have established policies and procedures to ensure the safety of staff, customers, and property -facilities may provide lockers for employee's belonging in a secure area -keys may be required to be signed out from a secure location to gain access to a pharmacy -motion detectors must be installed and in working condition -only licensed pharmacists may dispense a prescription and supervise pharmacy technicians -security requirements that restrict access to medications to authorized personnel only are in place because of legal and institutional standards and standards of practice -touch pads and scannable means of identification may be used for employees to gain access to a particular area
Ways Pharmacy Technicians can reduce Errors
-always question illegible handwriting -question ambiguous orders -question the prescription order that uses abbreviations you are not familiar with or that are uncommon -do a mental check on dosage appropriateness -keep you work area free of clutter -always keep the prescription and the label together during the filling process -check the drug three times: when removing the medication bottle from the shelf, after placing the medication in the bottle, and before returning medication bottle to the shelf -make sure the label is always compared with the original prescription by at least two people. If an error occurs at this stage, the refills may be filled incorrectly as well. -observe and report pertinent OTC purchases -triple check your work -verify your own data entry before processing
drug approval process
-an investigational drug is one that is under study, but does not have the permission from the FDA to be legally marketed and sold in the United States -clinical research is conducted by pharmaceutical and bio-tech companies, as well as federal agencies such as the National Institutes of Health and the National Cancer Institute, cooperative research groups such as the Southwest Oncology Group and Eastern Cooperative Oncology Group, and individual investigators -preclinical studies are performed on animals to help establish boundaries of safety when human testing begins. An Investigational New Drug Application is submitted to request permission to begin human testing
inappropriate medication usage in elderly
-anticholinergic: first generation antihistamines such as chlorpheniramine, hydroxyzine, diphenhydramine, and cyproheptadine should be avoided because it may cause confusion, constipation, and dry mouth -benzodiazepines such as lorazepam causes drowsiness -nonbenzodiazepine sedatives such as zolpidem causes drowsiness -androgens methyltestosterone may cause cardiac problems -estrogens with or without progestins may cause carcinogenic effects -insulin a higher risk of hypoglycemia may occur -sulfonylureas glyburide may cause hypoglycemia -nonsteroidal anti-inflammatory drugs ibuprofen and naproxen increase the possibility of gastrointestinal bleeding -skeletal muscle relaxants carisoprodol and cyclobenzaprine have anticholingeric effects -oral decongestants pseudoephrine lead to central nervous system stimulation -the pharmacist needs to be notified when warnings appear for elderly patients who may be prescribed these medications. The pharmacist will contact the prescriber to determine whether an alternative treatment might be more appropriate for the patient
Medicaid tamper resistant prescription act
-applies to all handwritten prescriptions for covered outpatient drugs; drugs that are transmitted from the prescriber to the pharmacy verbally, by fax, or through e-prescribing are not affected by this legislation -enforced whenever Medicaid pays any portion of the cost of a prescription -a tamper resistant prescription pad must include all of the following three characteristics: -one or more industry recognized features designed to prevent unauthorized copying of a completed or blank prescription form -one or more industry recognized features designed to prevent the erasure of modification of information written on the prescription pad by the prescriber -one or more industry recognized features designed to prevent the use of counterfeit prescription forms if a pharmacy receives a prescription and there are questions regarding whether the prescription meets the requirements of the act, the pharmacy staff may contact the prescriber's office for verification. The pharmacy may accept a faxed prescription from the physician's office until it has obtained tamper resistant prescription pads. A pharmacy may fill the prescription as a emergency prescription as long as the pharmacy receives documentation from the prescriber's office in 72 hours. A prescription may be transferred from the original pharmacy to another pharmacy by fax or telephone. The second pharmacy does not need to have direct confirmation of the original prescription from the physician.
unit dose packaging procedures (equipment)
-appropriate design should allow cleaning to prevent cross-contamination -equipment and utensils should be cleaned, maintained, and sanitized at appropriate times
health information standards
-are necessary to ensure the interchange of electronic information within the health care community -pharmacies need standards to communicate electronically with hospitals, physician offices, laboratories, radiology, patients, and caregivers. In addition, it is necessary to communicate for billing, reimbursing, dispensing, and providing clinical functions
National Association of Boards of Pharmacy guidelines
-assists the BOP's in developing, implementing, and enforcing uniform standards for protecting the public health -addressed standards for electronic prescribing, overprescribing controlled substances, pharmacy technician education, and prescription monitoring programs
Medication Distribution
-automation used to regulate and track controlled substances -bar-coded labels used as part of automation to reduce errors. supposedly improves quality of patient care -computerized dispensing systems, TJC requiring unit-dose dispensing and pharmacy based IV additive programs -robotics used to scan unit dose medications and to fill patient medications -scanning patient identification bracelets -internal and external medications must be separated -medications must be checked perodically according to institutions policies and procedures -medications that are out of date need to be separated from other medications -recall medications need to be separated from usable medications
ways pharmacists can decrease errors
-avoid using abbreviations that have more than one meaning and verify the meaning of these abbreviations with the prescriber -check prescription in a timely manner -document all clarifications on orders -encourage OTC and herbal remedy documentation -initial checked prescriptions -use the ISMP Medication Error Reporting Form to inform manufacturers of errors caused by commercial packaging and labeling -visually check the product in the bottle -educate patients to always verify their insulin purchases
NCPDP standards for electronic prescribing process
-batch transaction standard -billing unit standard -financial information reporting standard -formulary and benefit standard -Medicaid subrogation -member enrollment standard -payment reconciliation repayment tape format -pharmacy identification cards -post adjudication standard -prescription transfer standard -telecommunication standard -universal claim form -medication history standard
unit dose packaging procedures (blister pack components)
-blister: holds the medication -lidding stock: material that seals the blister
telepharmacy
-brings pharmacy care to patients when its not responsible to bring the patient to the pharmacy setting -video conferencing is used to provide real time counseling -cost effective method to provide pharmacy services
drug adherence
-calculate how many days the prescriptions should last -if the patient is seeking a refill early or the prescription is lasting longer than it should, the pharmacy technician should bring this to the attention of the pharmacist. If the directions have changed a new prescription should be issued from the physician. -the pharmacist should empathetically determine the reason for noncompliance
responsibility of compounding personnel
-compounding personnel must be adequately skilled, educated, instructed, and trained -ingredients must have their correct identity, quality, and purity -opened or partially used packages must be properly stored under restricted access conditions -water containing CSP that are nonsterile during any phase of compounding must be sterilized within 6 hours after completing preparation -measuring, mixing, sterilizing, and purifying devices are clean, appropriately accurate, and effective for their use -packaging selected CSP is appropriate to preserve the sterility and strength until BUD -compounding environment maintains sterility or presterilization purity -labels on CSP's list the names and amounts or concentrations of active ingredients -labeling of injections list the names and amounts or concentrations of all ingredients -before dispensing or administering CSP's the clearness of the solution is visually confirmed -BUD's are assigned based on testing and obtaining information from reliable literature sources -procedures for measuring, mixing, diluting, sterilizing, packaging, and labeling conform to quality established for the CSP.
community pharmacy network
-consists of both chains and independent pharmacies -may be either open or closed network
Durham-Humphrey Amendment of 1951
-created a distinction between "OTC" and "Legend Drugs" -required legend drugs to carry the statement: "Caution: Federal law prohibits dispensing without a prescription." -legend drugs requires a prescription, but an OTC drug does not. Prescription medications require the supervision of a physician -allows verbal prescriptions over the phone -allows refills to be called from a physician's office
repackaging log
-date of repackaging -name of drug -drug strength -dosage form -drug manufacturer -lot number -drug manufacturer's expiration date -beyond use dat assigned by pharmacy -quantity repackaged -pharmacy tech's initials -pharmacist's initials -repacking log must be maintained
repacking log requirements
-date of repacking -name of drug -dosage form -drug manufacturer -manufacturer's expiration date and lot number -pharmacy lot number -expiration date assigned by the pharmacy -quantity of drug repackaged -pharmacy technician's initials
required prescription information
-date prescription was written -patient name -patient's home address, number, street, city, stat, and zip code -inscription -name of medication -strength -dosage form -quantity to be dispensed -instructions to the pharmacist -physician's signature
unit dose log record
-date unit dose was prepared -drug -medication strength -dosage form -quantity prepared -drug manufacturer -drug manufacturer lot number -manufacturer's expiration date -pharmacy assigned beyond use date -pharmacy lot number -pharmacy technician's initials -pharmacist's initials
required prescription label information
-date when prescription was filled -serial number of prescription -name and address of pharmacy -name of patient -name of prescribing physician -all directions for use of prescription -generic or brand name of prescription -name of drug manufacturer -quantity of drug -expiration date of prescription -initials of licensed pharmacist -number of refills allowed
medication error reporting and prevention recommendations for verbal orders
-describe limitations or prohibitions on use of verbal orders -provide a mechanism to ensure validity/authenticity of the prescriber -list the elements required for inclusion in a complete verbal order -describe situations in which verbal order may be used -list and define the individuals who may send and receive verbal orders
medication error reporting and prevention recommendations
-develop written policies and procedures for persons who administer medications -provide training to personnel who are responsible for medication management -ensure that controlled medications are stored properly to prevent theft and diversion -encourage personnel to report medication errors to appropriate drug error reporting programs -when a medication error occurs, evaluate possible causes to improve the facility's system for drug management and to prevent future errors
drug benefit limitations
-dollar limit: a maximum amount that can be spent one time on a prescription -spending or prescription cap: the maximum amount that can be spent per period of time, normally yearly -maximum number of prescriptions that can be dispensed to a member over a period of time, normally monthly -time limits for a prescription to include refills, which is normally 1 year for noncontrolled prescriptions
receiving
-drug shipment record accompanies study drug -inventory, store, and record shipment upon arrival -ensure shipping records match shipment exactly -note any differences in quantity received, lot numbers, and labeling errors -record, quantity and lot number required
Quality Assurance Practices Pharmacy Staff Guidelines
-each organization maintains a policies and procedure manual, which is to be adhered to at all times -policies are written rules of an organization that ensure all employees follow them -procedures are processes that employees are to follow when performing a particular task to ensure consistency throughout the organization
pons
A brain structure that relays information from the cerebellum to the rest of the brain
electronic health care records
-electronic records of patient health information generated by one or more encounters in any care delivery setting -recorded in a digital, interoperable standard -included in this information are patient demographics, progress notes, problems, medications, vital signs, medical history, immunizations, laboratory data radiology reports, and advanced directives -The EHR automates and streamlines the clinician's workflow -the EHR has the ability to generate a complete record of a clinical patient encounter as well as supporting other care related activities directly or indirectly via interface, including evidence based decision support, quality management, and outcomes reporting
electronic prescribing
-eliminates illegible prescriptions -uses clinical decision support to reduce preventative error -improves communication between patient and clinician -improves communication through prescribing chain -increase access to patient and reference information -improve work efficiency
State Board of Pharmacy regulations
-ensure the specific standards are met for the licensing of pharmacists, permits are issued for pharmacies and pharmacy technicians meet specific requirements -discipline pharmacies, pharmacists, and pharmacy technicians for egregious conduct -require prescription error reporting
specific high alert medications
-epoprostenol (flolan), IV -magnesium sulfate injection -methotrexate, oral, non oncologic use -opium tincture -oxytocin, IV -nitroprusside sodium for injection -potassium chloride for injection concentrate -potassium phosphates injection -promethazine, IV -vasopressin, IV or intravenous
ISMP errors list
-errors in the prescribing, transcribing, dispensing, administering, and monitoring of medications and vaccines -wrong drug, wrong strength, or wrong dose errors -wrong patient errors -confusion over look-alike, sound-alike drugs or similar packaging -wrong route of administration errors -calculation of preparation errors -misuse of medical equipment
Physical environment
-every pharmacy must have running cold and hot water. A mild detergent used to clean instruments in extermporaneous compounding; 70% isopropyl alcohol should be used to clean countertops -traffic needs to be controlled -buffer room needs to be at least a class 100,000 clean room but can have a 10,000 clean room -fire extinguishers must be certified every year. -first-aid kits need to be checked
TJC recommendations to prevent patient harm when implementing health information technology
-examine workflow process and procedures for risks and inefficiencies; resolve them before implementation -during the introduction of new technology, monitor for problems and address issues promptly -establish a training program for individuals who will be working with technology. The training should occur before implementation. -develop and communicate policies outlining who will be responsible for implementation, use, oversight, and safety review. -before taking technology live, ensure all standardized order sets and guidelines are developed, tested, and approved by the pharmacy and therapeutics committee -develop a system that eases potential harmful computerized physician order entry(CPOE) drug orders by requiring pharmacy review and sign off on orders that are created outside the usual guidelines. Use P&T committee oversight and approval for all electronic order sets -provide an environment that protects staff involved in data entry when using technology
pharmacy benefit management company
-focuses on the pharmacy services provided under a health care plan contracts with an insurer to provide prescription drugs to members usually through community pharmacies
FDA oversees what?
-foods, drugs, medical devices, vaccines, blood, biologics. veterinary, cosmetics, radiation-emitting products, and tobacco -polices on biotechnology and provides information on dietary supplements, bioterrorism, drug preparedness, and our natural disaster response during emergencies -provides information on recent drug approvals and drug shortages and provides drug safety information -establishes clinical trials, submission of drug applications, and the required labeling of medications -issues warning letters to the public regarding specific medications and conducts post market surveillance programs for newly approved medications
labeling
-generic name of the drug -strength -dosage form -manufacturer's name and lot number -expiration date after repackaging
health savings accounts
-health savings accounts (HSA) are financial accounts established by an individual or family to pay for qualified medical expenses -US federal regulations require citizens to have a minimum deductible on their health insurance from all sources to make tax deductible contributions to their HSA's -HSA's combine the benefits of both traditional and roth 401(k) and IRA's for medical expenses taxpayers receive 100% income tax deduction on annual contributions, they may withdraw HSA funds tax free to reimburse themselves for qualified medical expenses, and they may defer taking such reimbursements indefinitely without penalties -HSA limits; 3250 for individuals and 6450 for family coverage
American Pharmacists Association guidelines
-improve medication use and advance patient care -advocates for the practice of pharmacy regardless of the setting -provides informational resources for both pharmacists and pharmacy technicians -provides continuing education through home study, live activities, and certificate training
benefit potential of health information technology
-improved patient care -increased efficiency and productivity -improved communication and health care delivery -improvement in reimbursement processes -will be able to track the effectiveness of treatment options and quality of care
working conditions
-improving work flow -improving lighting -establishing the maximum number of prescriptions a pharmacist may fill during a shift -limiting the number of hours a pharmacist or technician may work in a given pay period addressed by BOP -states established a maximum number of pharmacy technicians a pharmacist can supervise
Needle Recapping
-never recap with both hands or point at the body -use one handed scoop technique -do not remove needles from disposable syringes by hand -do not bend, break, or manipulate needle by hand
causes of medication errors
-noise -stress -multitasking -similar medication labels -medication labels that are difficult to read
pharmacy technicians regulations
-obtain a high school diploma or GED -become certified with either the PTCB or NHA -obtain certification every two years and take 20 hours in education one with law
Thalidomide
-indicated for multiple myeloma, and certain conditions must adhered to by a patient. Cannot be taken by a pregnant woman do severe birth defects. The program System for Thalidomide Education and Prescription Safety (STEPS) was approved by the FDA to make sure pregnant women do not take thalidomide. Patients that do take Thalidomide have to see a doctor every month and to take about their condition and possible side effects. A prescription can be up to a 28 day supply of medication with no refills. The patient must have the prescription filled within 28 days. Blood cannot be donated from a patient taking this medication. -A woman must use two acceptable birth controls for 4 weeks before taking thalidomide and 4 weeks after treatment. -A woman must have a negative pregnancy test within 24 hours before beginning thalidomide
patient education
-instruct the patient on use, handling, storing, and returning study drug -inform the patient that his or her drug intake is being measured -inform the patient of consequences of missed doses of varied timing -warn the patient against sharing the study drug -provide a list of prohibited medications or supplements or other potential interactions -return empty bottles
high incidence of medication errors
-insulin -morphine -potassium chloride -albuterol -heparin -vancomycin -cefazolin -acetaminophen -warfarin -furosemide
plan limitations
-intended to control drug use and reduce drug costs -method of determining plan savings
storage (read only memory (ROM))
-investigational drugs are secured in area with limited access and must be kept separate from other medications -must have a backup power source -daily log of temperature must be maintained -storage of study drugs under appropriate conditions of temperature, humidity, and light so the identity, strength, quality, and purity of the study drugs are not affected -site is responsible for investigational medications being safely stored, controlled, administered, and destroyed -acceptable storage conditions, temperature, storage times, and reconstitution requirements should be determined by the sponsor of all investigational products -packaging of study drugs to prevent contamination and deterioration during transport and storage
fraudulent prescriptions
-legitimate prescription pads are stolen from physician's offices, and prescriptions are written for fictitious patients -drug abusers may alter the physician's prescription to obtain larger quantities of medications -drug abusers may have prescription pads from legitimate physicians printed with a different callback number that is answered by an accomplice to verify the prescription -a drug abuser will call in a prescription and give his or her own telephone number as a callback number -computers may be used to create prescriptions for nonexistent physicians or to copy legitimate physician's prescriptions
pharmacy customer service principles
-maintain a positive attitude toward customer -be friendly -obtain as much information as possible from customer -do not interrupt -provide accurate information -understand customer's condition -develop a professional relationship with customer -preserve patient confidentiality -demonstrate compassion -avoid conflict
unit dose packaging procedures (packing)
-manually -automatic
minimizing pharmacy waste
-maximize use of open chemotherapy vials -label drugs for home use -prime and flush intravenous lines with saline solution -examine size of containers relative to use -replace prepackaged unit-dose liquids with patient specific oral syringes -eliminate generation of controlled substances that are also hazardous waste -use hard plastic buckets for delivery of chemotherapeutic drugs to hospital floors -monitor dating of emergency syringes -review inventory control to minimize outdates
prescription limitations
-maximum amount of medication that may be dispensed at one time -normally expressed as day's supply, which is 30 days for community pharmacies and 90 days for mail order supplies
preparing radiopharmaceuticals
-may be diagnostic or therapeutic; they may be oral, IV, or inhaled -the individual must wear a meter indicating the radioactive levels to which the individual is exposed -quality control tests are preformed to ensure the radiopharmaceutical is sterile, pyrogen free and pure -proper handling of isotopes during preparation and disposal must be ensured -have strict packaging requirements including the use of special shipping containers -safety principles of time, distance, and shielding are observed -special training must be completed if one is to work in a nuclear pharmacy
procedure for preparing a liquid drug in a liquid vehicle
-measure quantities for each liquid in a graduated cylinder -add drug to vehicle slowly then shake and stir
hospital automatic processing of medication orders
-med order entered into hospital computer that gives order to pharmacy, pharmacist reviews and verify order -RN retrieves med from point-of-use automated med station -pharm tech fills inventory as med supply falls below periodic automatic replacement (PAR) levels
compliance
-most have reasonable assurance that majority of study drug was actually taken by subject -usually will require at least 80% compliance to be considered evaluable
pharmacists regulations
-must be high school graduates and have graduated from an accredited school of pharmacy with BS or a pharm D -meet state requirements for licensure, including externship requirements, passing a pharmacy board examination, and continuing education -can take licensure to other states -people from other countries can become a pharmacists
Compounding of Sterile Products personnel training
-must be trained using video and professional publications -course work must include both didactic and clinical content -must pass written and media-fill tests
required medication order label information
-name and location of patient -trade or generic name of drug -strength of drug -quantity of drug for outpatient prescription labels -expiration date of medication -lot number of medication
prepackaged medications
-name of medication -drug manufacturer's name -dosage form -strength of drug -beyond use date -lot number of medication
components of a label for intravenous medication
-name of pharmacy -patient's name -date the medication was filled -ingredients with quantity of each in IV -total quantity of IV -directions for usage -infusion rate -any special notes -expiration date -must be initialed by the technician who prepared it -licensed pharmacist's initials
risks of health information technology
-patient safety risks have been identified during implementation of health information technology if implementation is not carefully planned and followed -medication errors involved mislabeled bar codes and unclear computer screens -adverse events may occur because of strain on health care personnel if workflow becomes complicated -patient safety becomes a concern if systems ate not updated consistently of if data are incomplete or inconsistent -alert fatigue occurs when excessive drug safety alerts occur
prescription refill information
-patient's name -patient contact information -patient's date of birth -patient's home telephone number -prescription number -name of medication, strength, dosage form, and quantity
causes of errors (identified by MedMarx)
-performance deficit -procedure or protocol not followed -transcription inaccurate or omitted -improper documentation -incorrect computer entry -knowledge deficit -communication -written order -incorrect drug distribution center -handwriting illegible or unclear
environmental quality and control
-personnel requirements -cleaning and disinfecting the compounding area -personnel cleansing and garbing: -donning of dedicated shoe covers -head and facial covers -face masks -nonshedding gown -sterile powder free gloves -personnel training and competency: -training must be documented before the individual compounds a sterile preparation -personnel must complete didactic training, pass written competence assessments, and undergo skills assessment and a media fill test
sterile product prescription labeling
-pharmacy name -patient name -date of filling -ingredients -total volume -directions for use -infusion rate -beyond use date
in house network
-pharmacy owned by an HMO -normally located in the HMO facility -provides pharmacy services only for members of the network
physician dispensing network
-physicians dispense medications form their offices
expired medications
-policies are established by each pharmacy regarding the process of pulling medications that expire within a given period -a system must be in place in all practices of pharmacy to check for expired medications. Expired medications must be kept away from in-date medications -both pharmacists and pharmacy technicians must be familiar with the institution's policy regarding outdated medications -medication should never be dispensed if it has passed its expiration date or will expire before the patient is able to complete the current course of therapy. Multidose containers cannot be redispensed to another patient; unit dose medications can be redispensed to other patients -contracts with wholesalers and manufacturers will determine if products may be returned for partial or full credit. Proper inventory management skills may eliminate the necessity of returns of the manufacturer if a product is being properly rotated -cytotoxic medications are destroyed with biohazardous waste goods -reconstituted or compounded drugs are not returnable to the manufacturer. Other examples of nonreturnable items include partially used bottles of medications -Controlled substances can be returned only by institutions having a DEA number. Long term facilities cannot return controlled substances because they do not have a DEA number -The DEA must be notified at least 2 weeks before the destruction of controlled substances through the issue of form 41 for expired controlled substances
Preferred Provider Organizations
-preferred provider organizations(PPOs) provide health care services to members at a discounted fee for service -nonexclusive contract with network of providers -members pay a copay at time of service -often members have a yearly deductible to meet before insurance coverage begins -insurance pays a percentage of medical bills -members may select a non-PPO provider, but member must pay the difference between the discounted fee and regular fee -the percentage paid by the insurance is lower if services are provided by an out-of-network provider -no referral is required for specialist services
required medication order information
-prescriber's information, including physician's name, DEA number and hospital assigned ID -date of order -patient information, including room number, bed number, and ID number assigned to patient -name, strength, dosage form of medication -administration timing -duration of therapy prescriber's signature
forged prescriptions
-prescription looks to good; the prescriber's handwriting is too legible -quantities, directions, or dosages differ from usual medical usage -the prescription does not comply with the acceptable standard abbreviations or appears to be textbook presentation -the prescription appears to be photocopied -directions are written in full with no abbreviations -prescriptions are written in different colored ink, different pens, or different handwriting -zeroes are added to the quantities
Prescriptions and Medication Orders
-prescriptions and medication orders must contain specific information from the prescriber to valid -prescriptions and medication orders are valid only for a given period of time depending on federal and state regulations -e-prescribing is encouraged in lieu of writing, telephoning, or faxing prescriptions to the pharmacy
procedure for preparing an emulsion using the wet gum method
-primary emulsion is formed by triturating one part gum and two parts water to form a mucilage -add four parts oil and triturate slowly -add additional ingredients
storage of unit-dose medications
-products should be rotated to ensure first-in, first-out process -temperature should not exceed 25 C -the final product should be examined for instability caused by changes in color or odor
medication assistance programs
-programs established by drug manufacturers and various other organizations to provide medications to qualified patients who are unable to afford their medications
prescription drug marketing act of 1987
-prohibits the reimportation of a drug into the united stated by anyone except the manufacturer -forbids the sale or distribution of samples to anyone other than those licensed to prescribe them -requires them the following label to appear on all medications to be administered to animals
Exclusive Point of Service
-the exclusive point of service (EPOS) is a hybrid of PPO in which the PPO does not make payment to providers outside of network
infection control
-proper hand washing -containment and disposal of waste -hand-washing technique and personal hygiene -infection surveillance, prevention, and control for the pharmacy -irrigation solution preparation -microbial monitoring of laminar flow hoods -preparation of sterile parenteral nutrition products -proper use of laminar hoods -reporting of unsanitary conditions and practices -requirements for assessing sterile technique of personnel and frequency assessed -routine cleaning of pharmacy facilities -shelf life of all sterile items in storage -storage of sterile medication products -testing for microbial contamination of hospital-prepared sterile products -traffic control of sterile medication preparation areas -use of single-dose and multidose containers
purpose of inventory management
-provides an adequate stock of pharmaceuticals and supplies -reduces unexpected stock outs and temporary shortages, which may affect patient care -reduces carrying cost (financial investment) in drug products -minimizes costs associated with placing orders to the wholesaler -minimizes time spent on purchasing functions -minimizes capital charge on average inventory -minimizes shrinkage, breakage, and obsolescence of inventory -reduces purchasing dollars spent by selecting products based on organizational formulary requirements, bioequivalence, and cost
medicare prescription drug improvement and modernization act of 2003
-provides for a voluntary prescription drug benefit to medicare beneficiaries -adds preventive medical benefits to senior citizens -lowers the reimbursement rates for medicare payment for durable medical equipment -created a national competitive bidding program for durable medical equipment in 2007 -changed the way medicare pays for outpatient part B drugs -allowed for a voluntary medicare approved discount card program, begun in june 2004 -medicare part D prescription plan allows beneficiaries to enroll in either regional or national based insurance plans -provided for medication therapy management (MTM)
hazardous drugs regulations
-recognize sources of exposure to hazardous drugs, which include procedures, and materials that come into contact -prepare in an are that is intended for that purpose and is restricted to authorized individuals only -are prepared inside a ventilated cabinet that is designed to protect employee and others from exposure -wear to pairs of powder free disposable chemotherapy gloves with the outer glove covering the cuff -avoid skin contact using a disposable gown made of polyethylene coated polypropylene material gowns need to be worn once -use syringes and IV sets with Luer-Lok fittings for preparing and administering -waste and contaminated materials separately from other trash -clean and decontaminate work areas before each activity and at the end of each shift -clean up small spills immediately using safety precautions and PPE
preparing reconstituted injectable and noninjectable medications
-reconstitution is the process of mixing a liquid and powder to form a suspension or solution -solvent is the larger part of the solution -solute is the agent or ingredient used with solvent -solution is the solvent plus the solute -measure the solute and solvent(distilled water) to be used -add the solute to the solvent in small portions; mix thoroughly -check precipitation for solutions or changes in color -add a new expiration date and time of day to product bottle and affix a shake well auxiliary label
MERP Information Guidelines
-report the medication error -understand the medication error -provide additional knowledge of the problem -evaluate data that have been collected -develop educational tools
pharmacy waste disposition
-select vendor to handle the waste -options include segregation of waste, or managing all drug waste as hazardous -if a pharmacy waste is considered hazardous; use hazardous waste labels to identify it -keep containers covered when not in use -limit quantity and allow for 3 days to remove waste when limit is reached
unit dose packaging procedures (material used)
-should not be reactive, additive, or absorptive
investigational drug accountability record
-sign out all study drug at time of dispensing; best practice is to double check on drug assignment and have two individuals initial -fill out dispensing information completely -never scratch out, white out, or alter any entry on the Drug Accountability Record (DAR); instead line through entry with a single line, date, and initial. The original entry needs to be readable; write in the correct entry -write entry on DAR at time of dispensing. Do not wait until later. Enter data into each column; do not leave bank -all entries should be neat and readable -use the subject's initials consistently -do no make any entry below the last line of the form -all entries must be written completely
single and multiple dose containers
-single dose containers must be used within 1 hour of being opened -multiple dose containers have a BUD of 28 days
coupons
-some drug manufacturers provide coupons for specific drug products to physicians. The physician distributes these coupons to patients when they receive new prescriptions -the coupon is for the original filling of a new prescription -the pharmacy bills the drug manufacturer electronically for the value of the coupon -the value of the coupon is deducted from what the patient is responsible for paying -in situations when a patient has a third party prescription plan, the value of the coupon is deducted from the cost of the prescription being billed to the insurance provider
child resistant containers
-the consumer product safety commission requires drug manufacturer's to place prescription drugs in child resistant containers if the original package is intended to go directly from the pharmacist to the patient -all legend drugs intended for oral used must be dispensed by the pharmacist to the patient having safety closures unless the prescribing physician or patient requests otherwise. If a patient requests a non-child resistant container, the prescription may be dispensed in a non child resistant container, but the patient must sign the back of the prescription indicating he or she has requested a non child resistant container -select medications such as oral contraceptives and select cardiovascular medications such as nitroglycerin, are exempted from child resistant packaging -drugs that are used or dispensed to inpatient institutions such as hospitals nursing homes and extended stay facilities are not required to be in child resistant containers
electronic personal health record
-the electronic personal health record (ePHR) originates and is controlled by health care providers -can be generated by physicians, patients, hospitals, and pharmacies -controlled by the patient or legal proxy and is presented to the health care provider when and where the patient needs care -can be used by pharmacies in providing medication therapy management
procedures to prepare intravenous admixtures(sterile compounding)
-the flow hood should be on for at least 30 minutes -wear PPE -clean the laminar flow hood with 70% isopropyl alcohol or another suitable or another suitable disinfectant. Then clean the pole to hang IV bags, the sides of the hood by moving from the back to the front, and finally the bottom of the hood by moving side to side from the back to the front -collect supplies; check expiration dates and bags for leaks. Remove dust coverings before placing supplies in the hood. Use presterilized needles, syringes, and filters -position supplies in hood -sterilize puncture surfaces with an alcohol wipe -prevent coring by placing the vial on a flat surface and insert the needle into the rubber closure at a 45 to 60 degree angle. Use downward pressure on the needle and move the needle to a 90 degree angle
e prescribing
-the paperless computer to computer transfer of prescription data among prescribers, pharmacies, and payers -connects health providers, patients, and agencies in real time and can include medication history, and messages regarding new prescriptions, prescription changes or cancellations, refill requests, and other prescription information -demonstrates efficiency with time savings, reduces medication errors, decreases pharmacy costs, improves prescriber and pharmacy administrative efficiency, eliminates handwriting interpretation errors, reduces phone calls between pharmacists and physicians, reduces data entry, creates electronic records, and speeds up refill requests -a disadvantage of e prescribing is the transaction fee the pharmacy incurs -e prescribing tools can include software programs as well as hardware such as personal computers, handheld and wireless devices, and touch screens -e prescribing is one of the integral steps to achieving broad use of electronic health records (EHR's) -will reduce prescription errors in a variety of health care settings
Food and Drug Administration Product Recalls
-the pharmacy is notified by FDA, drug manufacturer, wholesaler. Notification may occur either by mail or fax -complete list of all medications recalls is found on FDA's website -the pharmacy determines if the recalled medication is currently in stock -the pharmacy contacts patients who may have received the medication. If customer has the medication it should be returned to the pharmacy for a refund and substitution in place -recalled medication is returned to the manufacturer for credit -the pharmacy technician should reorder medication that has been recalled; notify the physician of the recalled medication; and inquire if the physican wishes to change the medication order, especially if product may not be available for a long period
Recalled Medication Processes
-the pharmacy is notified by the manufacturer or wholesaler by e-mail, mail, or fax of the reason of the recall. Information contained in a recall notice include the drug manufacturer's name, drug name, strength, package size, lot number, and expiration date -the pharmacy determines if the recalled medication is currently in stock -the pharmacy contacts patients who may have received the medication. If a customer has the recalled product, the medication should be returned to the pharmacy for refund or substitution -the pharmacy follows disposition directions from the drug manufacturer -recalled medication is returned to manufacturer for credit -medication that has been recalled is reordered. Notify the physician of the recalled medication; inquire if the physician wishes to change the medication order, especially if the product may not be available for a long period
point of care
-the place where the pharmacist and patient attempt to address, identify, resolve, and prevent drug related problems -may be either stationary or mobile in nature. A desktop computer is an example of a stationary system. mobile systems include personal digital assistants (PDA's), notebook or tablet computers, and computers on wheels (COW's)
computerized physician order entry
-the portion of a clinical information system that enables a patient's care provider to enter an order for a medication, clinical laboratory or radiology test, or procedure directly into the computer -the system transmits the order to the appropriate department or individuals so that it can be carried out -the most advanced implementations of such systems also provide real time clinical decision support such as dosage and alternative medication suggestions, duplicate therapy warnings, and drug to drug and drug to allergy interaction checking
continental method(dry gum)
-the primary emulsion is formed from four parts oil, two parts water, and one part gum -using a wedgwood or porcelain mortar, the gym and oil are levigated -water is added and the trituration continues -after the primary emulsion is formed, additional ingredients may be added and are added up to the initial volume with external phase
preparing parenteral antineoplastics
-the safety cabinet work surface should be covered with a plastic backed absorbent paper, which is disposed of in a hazardous container after use -personnel should wear approved gloves for chemotherapy products that are double gloved and a closed front surgical gown with knit cuffs that is specially designed for handling chemotherapeutic agents. Contaminated gloves or outer gloves should be removed and replaced. If the skin comes in contract with antineoplastics, the area should be washed with soap and water -reconstituted vials should be vented to reduce the possibility of spraying and spillage -a sterile alcohol pledget should be wrapped around the needle and vial top during withdrawal of solution -external surfaces of syringes and iv bags should be wiped clean of contamination -when using ampules, wrap the neck of the ampule with a sterile alcohol pledget to protect one's fingers from being cut by the glass -syringes and iv bottles should be properly identified and dated. Cautionary labels should be affixed to the outer bag of the containers -the safety cabinet should be wiped down with 70% isopropyl alcohol on completion of compounding -contaminated needles, syringes, and hazardous waste should be placed in a sharp container. Disposable gowns, gloves, masks, and head and shoe covers should be placed in red hazardous bags. -wash hands -dispose of remaining antineoplastic agents according to federal and state regulations
procedure for preparing solutions
-the solid drug to be suspended is weighed and levigated in mortar and pestle with either alcohol or glycerin -a portion of the vehicle is added to mortar and is mixed with the levigated drug until a uniform consistency occurs -this portion of the drug is placed in the final container -the mortar and pestle are rinsed with the balance of the vehicle, and the suspension is added up to the final volume with the vehicle being used -shake well label
unit dose labeling
-trade or generic name of drug -drug manufacturer -strength of drug -beyond use date -lot number of medication -a unit dose log must be maintained
infection control processes
-universal precautions apply to all individuals in an institution who may come in contact with blood, other body fluids, or body substances -gloves must be worn when there is a possibility the individual may come in contact with these substances -hands must be washed after removing the latex gloves -specially trained individuals must be notified for cleanup or removal of contaminated waste -contaminated materials such as syringes, needles, swabs, and catheters must be placed in red plastic containers labeled for disposal or biohazardous materials -a first aid kit must be maintained and adequately stocked for use if an individual does come in contact with contaminated waste or body fluids. Items to be contained in the first aid kit include adhesive bandages, alcohol. antiseptic or disinfectant, bleach, disposable latex gloves, disposable towels, medical tape, sterile gauze, and plastic bags for contaminated waste disposal -employees should not use patient restrooms; they should only use employee restrooms -medication refrigerators and freezers may only hold medications; they should not be used in the storage of food or drinks -eating is prohibited in any drug preparation or patient care areas
ways pharmacies can reduce errors
-use electronic prescribing -automate and bar code all fill procedures -encourage physicians to use common terminology and abbreviations -maintain a safe work area -provide adequate computer applications and hardware. Use the metric system. A leading zero should always be present in decimal values less than 1. -provide adequate storage areas -maintain accurate and up to date patient profiles to include OTC, nutritional, and herbal supplements -make sure prescriptions and orders include the correctly spelled drug name, strength, appropriate dosing, quantity or duration of therapy, dosage form, and route. Missing information should be obtained from the prescriber -never used error-prone abbreviations in internal communications, telephone and verbal prescriptions, computer generated labels, labels for storage bins, and medication administration records -use both brand and generic names on a drug label -configure computer selection screens to prevent look alike drug names from appearing consecutively -scan the original prescription -scan the prescription label and the UPC code found on the bulk medication bottle -keep dangerous or high alert medications in a separate storage area of the pharmacy -know the common look alike and sound alike drugs and keep them stored in different areas of the pharmacy so that they will not be easily mistaken
receiving processes
-verify incoming merchandise against packing slip or invoice -hazardous substances must be handled by trained personnel wearing personnel protective equipment -any inventory appearing to be damaged or out of date should be noted on the packing slip and the vendor contacted immediately -any merchandise requiring special storage, such as refrigeration, should promptly be verified and placed in proper conditions to avoid damage or loss or potency -sign and date invoice or package slip -forward documentation to accounts payable -place merchandise on shelf and rotate product by placing product with shortest dating in front and longest dating behind it. -retain appropriate paperwork in the pharmacy as outlined in controlled substances act occupation safety and health administration requirements or the institutions polices and procedures manuals
procedure for preparing emulsions using the beaker method
-water-soluble and oil-solute ingredients are mixed in separate containers -heat both phases to 70 degrees C and remove from heat -add the internal phase to the external phase -the final product is cooled to room temperature but is continually stirred
Compression Mold Procedure for Preparing Suppositories
-weigh quantities or base and active ingredient -mix the suppository base and drug ingredients -force the mixture into a special compression mold
procedure for dissolving a sold drug in a liquid vehicle
-weigh the solid and measure the solvent -triturate drug if needed and dissolve in solvent -if needed heat gently stir or shake gently
patient consultation
1)ask patient or person picking up the prescription if they question for the pharmacist 2)pharmacy techs do not have permission to counsel patients
Interpreting the prescriptions
1)identify the name, strength, dosage form, and quantity of the medication to be dispensed 2)identify the route of administration 3)identify the frequency of administration 4)determine if a generic drug may be dispensed 5)identify the number of refills permitted by the prescriber 6)ask pharmacist for clarification
Entering information into computer system
1)information required is prompted 2)quantities are expressed in metric units 3)input the correct dispense as written 4)calculate a day's supply of medication 5)third party adjudication: submitting prescription for payment by third party drug insurance provider. 6)drug utilization evaluation
Filling the Prescription
1)verify all prescriptions information has been entered properly 2)pull medication from shelf and check prescription label against the NDC number found in the bulk container; scan the UPC code on the bottle to ensure the correct medication was selected 3)measure or count the medication 4)select an appropriately sized container and pour medication into container 5)place an appropriately sized child resistance on top of container 6)place labels on the container 7)print auxiliary labels to prescription container 8)place completed prescription container on top of the original prescription 9)pharmacist checks the completed prescription
Manufacturer Drug Labeling
1. Name and place of business of manufacturer, packer, or distributor. 2. National Drug Code number. 3. Adequate directions for use. 4. No misleading statements. 5. Statement of ingredients. 6. Prominence of required label statements. 7. Spanish-language version of certain required statements. 8. Expiration date. 9. Manufacturer lot or control numbers. 10. Declaration of presence of FD&C Yellow No. 5 or No. 6 in certain drugs for human use 11. Declaration of presence of phenylalanine as a component of aspartame in OTC and prescription drugs. 12. Prescription drugs containing sulfites, required warning statements. 13. Labeling for systemic antibacterial drug products. 14. Bar code label requirements. Exceptions or alternatives to labeling requirements for human drug products held by the Strategic National Stockpile.
intravenous solutions used
1/4 NS; one fourth normal saline(0.225% sodium chloride) 1/2 NS: one half normal saline(0.45% sodium chloride) D10W: 10% dextrose in water D5NS: 5% dextrose in normal saline (0.9% solution) D5W: dextrose in water LRS: Lactated Ringer solution NS: normal saline solution (0.9%) SW: sterile water
additions, antagonism, potentiation, and synergism
4 drug to drug interactions
solid dosage forms
A dosage form that can be contained in various packages and when administered enterally can be given orally, rectally, or sublingually
spray
A dosage form that consists of a container with a valve assembly that, when activated, will emit a dispersion of liquid, solid, or gaseous material.
capsules
A drug contained in a shell or gelantin that dissolves in 10 to 20 minutes
critical incident diary
A method of performance appraisal that records incidents of unusual success or failure in a given performance aspect
esophagus
A muscular tube that connects the mouth to the stomach.
hypothalamus
A neural structure lying below the thalamus; it directs several maintenance activities (eating, drinking, body temperature), helps govern the endocrine system via the pituitary gland, and is linked to emotion and reward.
adrenal gland
A pair of endocrine glands that sit just above the kidneys and secrete hormones that help arouse the body in times of stress.
Behaviorally Anchored Rating Scale (BARS)
A performance evaluation technique that relates an employee's performance to specific job-related incidents.
Freezer
A place in which the temperature is maintained thermostatically between -25 degrees and -10 degrees C (-13 degrees and 14 degrees F)
Dry place
A place that does not exceed 40% average relative humidity at controlled room temperature
trituration
A process of rubbing, grinding, or pulverizing a powder to create fine particles
quality control
A process that evaluates output relative to a standard and takes corrective action when output doesn't meet standards
Cold
A refrigerator is a cold place in which the temperature is maintained thermostatically between 2 degrees and 8 degrees C. (36 degrees and 46 degrees F)
spirits
Alcoholic or hydroalcoholic solutions containing volatile aromatic ingredients
anhydrous ointments
Absorb water but are insoluble in water and are not water washable
large intestine
Absorbs water and forms feces
category A
Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).
deteriorated drug error
Administration of a drug that has expired or for which the physical or chemical dosage form integrity has been compromised
wrong time error
Administration of medication outside a predfined time interval from its scheduled administration time (this interval should be established by each individual health care facility)
improper dose error
Administration to the patient of a dose that is greater than or less than the amount ordered by the prescriber or administration of duplicate doses to the patient (i.e. one or more dosage units in addition to those that were ordered)
wrong dosage form error
Administration to the patient of a drug product in a different dosage form than ordered by the prescriber
unauthorized drug error
Administration to the patient of medication not authorized by a legitimate prescriber for the patient
Title II of HIPPA
Administrative simplification. Establishes electronic transaction and Code Set Standards: requires health information privacy
add each sums together and the last digit of the total number is the seventh number of the DEA number
After each set of numbers what do you do next?
NCPA
America's Pharmacist
AACP
American Journal of Pharmaceutical Education
AJHP
American Journey of Health Systems of Pharmacy
organizations recommendations for parenteral medication error prevention
American Society of Health System Pharmacists, Institute of Safe Medication Practices, The Joint Commission, Infusion Nurses Society, and National Patient Safety Foundation -standardize product concentrations, patient care procedures, and equipment -develop toolkits and other resource material to enhance adoption of recommendations -improve mechanisms for communicating in a timely manner specific information about medication errors that can reduce the likelihood of the event from occurring again
pyxis
An automated dispensing system often used in hospitals
category B
Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.
category C
Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
other medication error
Any medication error that does not fall into any of the other predefined categories
Excessive heat
Any temperature above 40 degrees C (104 degrees F)
Warm
Any temperature between 30 degrees and 40 degrees C (86 degrees and 104 degrees F)
Cool
Any temperature between 8 degrees and 15 degrees C (46 and 59 F)
syrups
Aqueous solutions containing sucrose or sucrose substitutes
yes
Are physicians required to have a DEA number?
yes
Are schedule III, IV, V drugs electronic prescriptions permitted?
order entry area
Area where prescription orders for radiopharmaceuticals are entered
cerebellum
Balance and coordination
pharmaceutical weights
Brass weights are available in both metric and apothecary systems. The weights should never be touched by the hand; they should be stored in a clean state and should be calibrated once per year.
digestive system
Breaks down food into absorbable units that enter the blood for distribution to body cells.
respiratory system
Brings oxygen into the body. Gets rid of carbon dioxide.
By individual who is registered under the DEA
By individual who is registered under the DEA Who can sign the DEA Form 222?
yes
Can Schedule III, IV, and V be called talked over the phone?
No
Can schedule II drugs have refills?
t cells
Cells created in the thymus that produce substances that attack infected cells in the body.
Chemical incompatibilities
Chemical reaction occurs between one or more of the ingredients. Incompatibilities may not be noticeable. Changes in pH or chemical decomposition may occur. The presence of light may cause deterioration of the ingredients.
iris
Colored part of the eye
United States Pharmacopeial Convention
Combined compendium of monographs setting official national standards for drug substances and dosage forms and standards for pharmaceutical ingredients
drug facts and comparisons, St Louis
Comprehensive source of information about 16,000 prescription and 60000 OTC drugs contains monographs about individual drugs and groups of related drugs: product listings in table format providing information on dosage forms and strength, distributor names, costs, package sizes, product identification codes, flavors, colors and distribution status; and information on therapeutic uses, interactions, and adverse reactions. The publication includes an index of manufacturers and distributors and controlled substance regulations
Drug Approval Process Phase III
Conducted in larger patients in groups for which the medication is ultimately intended -comparison is between new treatment and standard therapy or placebo -medication is used in the manner in which it will be used after approval -may take 2 to 5 years to complete
brain stem
Connects the brain and spinal cord
pastes
Contain more solid materials than ointments
retina
Contains sensory receptors that process visual information and sends it to the brain
chemical name
Determined by chemical structure of the drug entity
small intestine
Digestive organ where most chemical digestion and absorption of food takes place
yes
Do pharmacy's that dispense control substances have to be registered with the DEA?
implants or pellets
Dosage forms that are placed under the skin through injection and are effective for a long period of time
Comprehensive Drug Abuse Prevention and Control Act of 1970
Drug Enforcement Agency (DEA) was created and placed under the supervision of the Department of Justice. Controlled substances are placed in one of five schedules based on a potential for abuse and accepted medical use in the United States
Wrong drug-preparation error
Drug product incorrectly formulated or manipulated before administration
urinary system
Eliminates nitrogenous wastes from the body. Regulates water, electrolyte and acid-base balance of the blood.
Anabolic Steroid Control Act of 1990
Enacted harsher penalties for the abuse of anabolic steroids and their misuse by athletes
cervix
Entrance to the uterus
Beyond Use Dating
Established by the repackager or the compounder. It is used when a pharmacy either repackages a medication or compounds a product.
Omnibus Budget Reconciliation Act of 1987
Established extensive revisions to Medicare and Medicaid Conditions of Participation regarding long-term care facilities and pharmacy. -the name and description of the medication -the route, dosage form, dosage, route of administration, and duration of drug therapy -special directions and precautions for preparation, administration, and use by patient -common severe side effects or interactions and therapeutic contraindications that may be encountered, including their avoidance, and the action required if they occur -techniques for self monitoring of the drug therapy -proper storage -prescription refill information and action to be taken in the event of a missed dose
Pharmacist Services Technical Advisory Coalition (PSTAC)
Established to improve the coding infrastructure for pharmacy billing and to secure a place for pharmacy in the electronic data interchange(EDI). Has established Health Insurance Portability and Accountability Act (HIPAA) compliant Current Procedural Terminology (CPT) billing codes for pharmacists when performing Medication Therapy Management (MTM) services consists of seven pharmacy organizations: 1) the American College of Clinical Pharmacy 2)Academy of Managed Care Pharmacy 3)American Pharmacists Association 4)American Society of Consultant Pharmacists 5)American Society of Health System Pharmacists 6)National Association of Chain Drug Stores 7)National Pharmacist Association
single time dispensing of product in noncompliant container as order by prescriber
Exceptions for child resistant containers #1
single time of product in noncompliant container as requested by patient or customer in a signed statement
Exceptions for child resistant containers #2
elderly and warning saying packing for households with young children
Exceptions for child resistant containers #3
monitoring error
Failure to review a prescribed regimen for appropriateness and detection of problems, or failure to use appropriate clinical or laboratory data for adequate assessment of patient response to prescribed therapy
Food and Drug Administration
Federal agency formed in 1913 that approves all foods and drugs for sale in the US.
category X
Fetal abnormalities have been reported, and positive evidence of fetal risk in humans is available from animal and/or human studies. These drugs are not to be used in pregnant women.
salivary glands
Glands of the mouth that produce saliva, a digestive secretion
endocrine system
Glands secrete hormones that regulate processes such as growth, reproduction, and nutrient use (metabolism) by body cells.
GMP's
Good Manufacturing Practices
effervescent salts
Granules or powders; when dissolved in water; they effervesce and release carbon dioxide
2 years
How long are receipts, invoices, and packing slips for schedule III, IV, V drugs kept in a pharmacy?
2 years
How long does a pharmacy have to hold onto defective forms?
1
How many DEA Form 41 can a retail pharmacy submit per year?
60 days
How many days is a DEA Form 222 valid for?
7 days
How many days must a pharmacy be able to receive an emergency prescription?
one item per line
How many items can be written per line on the DEA Form 222?
Every 3 years
How often does a pharmacy have to renew their registration with the DEA?
pharmacy abbreviations
ISMP created a list of abbreviations
Institute of safety medication practices and the national medication errors reporting program
ISMP-MERP stands for?
Institute of safety medication practices and the national vaccine errors reporting program
ISMP-VERP stands for?
72 hours
If a patient gets a partial filling, how many hours can they wait to receive the rest?
Health Insurance Portability and Accountability Act (HIPAA) of 1996
Improve portability and continuity of health coverage in the group and individual markers, combat waste, fraud, and abuse in health insurance and health care delivery, promote the use of medical savings accounts, improve access to long term care services and coverage, and simplify the administration of health insurance
Point of Service Plans
In a point of service plan (POS), members may choose an HMO or PPO for services -PCP directs the medical care -member may see out of network providers -higher cost for out of network providers higher premiums
compliance error
Inappropriate patient behavior regarding adherence to a prescribed medication regimen
wrong administration technique error
Inappropriate procedure or improper technique in the administration of a drug
The Pediatric Drug Handbook
Information on drugs, dosage forms, and administration for pediatric patients
Goldfrank's Toxicologic Emergencies
Information on treating toxicologic emergencies
oleaginous ointments
Insoluble in water, do not contain or absorb water, and are not water washable
the second, fourth, and sixth
What numbers do you have to add up in the DEA number and multiply by 2?
APhA
Journal of American Pharmacists Association; Pharmacy Today
CRS
Journal of Controlled Release
AMCP
Journal of Managed Care Pharmacy
Misbranding
Labeling of a product that is false or misleading
aorta
Largest artery in the body
Schedule 3 drugs
Less potential for abuse and currently accepted medical use
American Society of Health System Pharmacists Guidelines on Quality Assurance for Pharmacy-Prepared Products
Level 1: products to be stored at room temperature and administered completely within 28 hours after being prepared; unpreserved products that are prepared for more than one patient that contain preservatives and products prepared by closed system aseptic transfer of nonpyrogenic, sterile finished products -single patient admixtures -sterile ophthalmic -syringes without preservatives -batch-prefilled syringes with preservatives Level 2: products administered more than 28 hours after preparation and stored at room temperature, products that are batch prepared with no preservatives for more than one patient, and products compounded by various manipulations of sterile ingredients using close-system aseptic transfer from licensed manufacturers -batch-reconstituted antibiotics without preservatives -batch-prefilled syringes without preservatives -total parenteral nutrition solutions mixed with automatic compounding devices Level 3: products with compounded from nonsterile components, containers, or equipment before they are terminally sterilized. -autoclaved IV solutions -TPN solutions made from dry amino acids or sterilized final filtration -morphine injections made from powders or tablets
generic substitution
Providing a generic medication in place of the brand medication that was written for by the provider.
lungs
Main organs of the respiratory system
Resource Conservation and Recovery Act
Management of non-hazardous and hazardous solid waste including landfills and storage tanks. Set minimal standards for all waste disposal facilities and for hazardous wastes.
1 year version
Maximum of 1 year of the drug life as long as it does not exceed the expiration date assigned by the drug manufacturer
online adjudication
Method of billing insurance companies and ensuring payment for services
faxes
Method of transmitting prescriptions and medication orders from a physician's office to a pharmacy
personal digital assistants
Method of transmitting prescriptions to a pharmacy
spatulation
Mixing powders using a spatula in a mortar, an ointment slab, or a plastic bag; it is a process used when ingredients may liquefy on mixing; there is no reduction in particle size
stainless steel spatula
Most commonly used because of its flexibility and ability to remove materials from a mortar
biennial inventory of narcotics
Must be maintained in the pharmacy
change of pharmacist in charge inventory
Must be maintained in the pharmacy
Patient Profile
OBRA-90 requires that patient profile be maintained for every patient regardless of the pharmacy setting. A patient profile may be either a hard copy or a computerized list of a patient's prescriptions and other information. A patient profile identifies the patient by name, social security number, birth date, and gender. Provides billing information like insurance.
Physical incompatibilities
Occur from changes in solubility, which may result in changes in color or the formation of a precipitate. A change in the pH of a solution, the use of buffers, and the type of solvent used may create problems
Drug Approval Process Phase II
Performed in 100 to 300 patients who have the disease or condition to be treated -often involves hospitalized patients for close monitoring -preliminary evaluation of safety and efficacy; may focus on dose response and dosing schedule
Combat Methamphetamine Epidemic Act of 2005
Placed ephedrine, pseudoephedrine, and phenylpropanolamine in scheduled listed chemical products -products containing ephedrine, pseudoephedrine, and phenylpropanolamine are subject to sales restrictions, storage requirements, and record keeping requirements -the act specifies a 3.6g/day base product sales limit, a 9g/30 day base product purchase limit a blaster package requirement, and mail order restrictions -logbook have been implemented and required following products by name, quantity sold, names and addresses of purchasers, and date and time of sales
tablets
Prepared either by compressing or by molding. The dosage form is accurate, compact, portable and easy to administer.
Class II (Drug Recall)
Probability exists that use of the product will cause adverse health events that are temporary or medically reversible
Medication Administration Record (MAR)
Provides documentation that a drug has actually been dispensed in a hospital or long-term care facility
the first, third and fifth
What numbers do you have to add up in the DEA number?
quality control area
Quality assurance tests are performed before delivery
activity measures
Rating system based on evaluator's observation and rating
right atrium
Receives deoxygenated blood from the body
midbrain
Region between the hindbrain and the forebrain; it is important for hearing and sight.
pancreas
Regulates the level of sugar in the blood
class A balance
Required in all pharmacies; 6 mg sensitivity
poison log
Requires name and address of purchaser (must be at least 18 years of age), name of product and date sold, intended use, seller's signature, and price of product
exempt narcotic log
Requires the name and address of purchaser (Must be at least 18 years of age), name of product and date sold, seller's signature and price of the product. The pharmacist must be present for any transaction involving "exempt narcotics"
weighing
Scales must be tared before being used for each weighing and be inspected once a year by the state department of taxation
digital balance
Sensitive to a tenth of a milligram and are used to replace class A balances
Buffer and pH
Should be formulated at a pH of 7.4, but this rarely occurs. The pH chosen should be optimum for stability.
yes and three times
Should you always double count narcotics and how many times should a medication be checked?
lozenges, troches, or pastilles
Solid dosage forms with flavoring that dissolve in the mouth
United States Pharmacopeia <797>
Sterile Compounding
sc (hypodermis)
Stores fat that insulates the body
therapeutic substitution
Substituting a therapeutic alternative for the prescribed drug product.
Basic Concepts in Pharmacology: A Student's Survival Guide
Survey of basic pharmacologic concepts for students
Clozaril (Clozapine) Programs
The Clozaril National Registry (CNR) was developed in response to an FDA mandate to ensure the safety of patients treated with Clozaril, which has dangerous side effects. The program has 800 numbers for internal clients, consumers, and health care professionals to call for information, education. and patient enrollment. The Clozaril Administration Registry Enrollment (CARE) is a secured internet application that facilitates the reporting of white blood cells values and absolute neutrophil counts of patients taking brand Clozaril to the CNR. CARE is designed to safeguard patient information, protect patients' privacy, and assists physician's and pharmacists with effective monitoring facilities. Prescribers and pharmacies must be registered before they can treat patients with Clozaril.
ASCP
The Consultant Pharmacist
bar code scanners
The FDA requires that bar codes be placed on all human drugs and biological agents, which will result in an improvement in both patient and medication safety. The potential for errors will be greatly reduced because the right patient will be receiving the right drug and dose at the right time through the right route
Over The Counter Packing Labeling
The FDA requires the following on all OTC packages. 1)Drug's name and place of business of manufacturer, packer, or distributor of drugs and devices. 2)national drug code number 3)active ingredient 4)established name of a drug 5)inactive ingredients 6)content requirements 7)purpose or purposes 8)use or uses 9)warning or warnings 10)directions 11)questions
MedWatch Program
The FDA's Safety Information and Adverse Event Reporting Program -Provides an Online Voluntary Reporting Form to report serious adverse events for human medical products, including potential and actual product use errors -not used to report vaccine events -provides safety alerts for human medical products that include drugs, biologics, medical devices, special nutritionals, and cosmetics
do not crush list
The ISMP has established a list of medications that should never be crushed before administration -slow release dosage form -extended release dosage form -enteric coated dosage form -may irritate the mucous membrane -rate of absorption may be increased -coating of tablet may release the drug over a period of time -taste -skin irritant -liquid filled -sublingual dosage form -film coated dosage form -effervescent tablet -teratogenic effect -local anesthesia of the oral mucosa
TJC
The Joint Commission
standards development organizations
The National Council for Prescription Drug Programs (NCPDP) is the only standards development organization that focuses on pharmacy services. The NCPDP works to develop and maintain standards for each step in the prescribing process. The NCPDP has established e-prescribing standards known as SCRIPT.
Drug Utilization Evaluation (DUE)
The Omnibus Budget Reconciliation Act of 1990 requires that all pharmacists perform a drug utilization evaluation during the processing of prescriptions. The DUE will alert the pharmacist of any potential drug interactions or contraindication a patient may experience while taking a prescribed medication
cornea
The clear tissue that covers the front of the eye
American Hospital Formulary Service Drug Information
The complete text of roughly 1400 monographs covering about 50,000 commercially available and experimental drugs, including information on uses, interactions, pharmacokinetics, dosage and administration
6 month version
The date assigned will be a maximum of 6 months or one fourth of the time to the manufacturer's expiration date
BUD(sterile compounding)
The date or time a drug or material can no longer be used; the drug is ineffective after this date
omission error
The failure to administer an ordered dose to a patient before the next scheduled dose, if any
sweat glands
The glands that secrete sweat, located in the dermal layer of the skin.
cerebral cortex
The intricate fabric of interconnected neural cells covering the cerebral hemispheres; the body's ultimate control and information-processing center.
frontal lobe
The lobe at the front of the brain associated with movement, speech, and impulsive behavior.
Quality Assurance
The maintenance of a desired level of quality in a service or product
Room temperature
The temperature prevailing in a working area
Dietary Supplement Health and Education Act of 1994
The manufacturers of supplements are allowed to make claims with regard to general health promotion but not disease claims. Requirements: 1) Be labeled as a dietary supplement 2)Have labeling that identifies all ingredients by name 3)Have labeling that lists the quantity of each ingredient 4)Have packaging that identifies the plant and plant part from which ingredient is derived 5)Comply with any standards set by an official compendium 6)Meet the quality, purity, and compositional specification 7)Have good manufacturing practices followed by the manufacturer
Therapeutic incompatibilities
The mixing together of two or more ingredients, resulting in a change in the therapeutic response of the drugs.
Institute for Safe Medications
The organization provides impartial, timely, and accurate medication safety information.
performance appraisal
The process of observing and evaluating an employee's performance, recording the assessment, and providing feedback.
Drug Reconciliation
The process of verifying with patients the medications they are currently taking
Class I (Drug Recall)
There is a reasonable probability that used of the product will cause or lead to serious adverse health effects or death
category D
There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Pure Food and Drug Act of 1906
This law forbade the manufacture or transport or sale of mislabeled or adulterated food or drugs and poisonous patent medicines and gave the government broad powers to ensure the safety and efficacy of drugs in order to abolish the "patent" drug trade. It paved the way for the eventual creation of the Food and Drug Administration (FDA) still in existence as the FDA.
Omnibus Budget Reconciliation Act of 1990
This legislation required PROs to report actions taken against physicians to state medical boards and licensing agencies
Controlled cold temperature
This temperature is defined as the temperature maintained themostatically between 2 degrees and 8 degrees Celsius (36 degrees Farenheit and 46 degrees Farenheit) that may experienced during storage, shipping and distribution
Hatch-Waxman Act of 1984
To provide up to five year extensions of patent protection to the paten holders to make up for time lost while products went through the FDA approval process
NPTA
Today's Technician
Levigation
Trituration of a powder drug with a solvent in which the drug is insoluble with the solvent
Safety Data Sheets
What does SDS stand for?
non sterile compounding
United States Pharmacopeia <795>
USP-NF
United States Pharmacopeia and National Formulary
Class III (Drug Recall)
Use of product will probably not cause an adverse health event
Use of Sharp Containers
Used disposable syringes are placed in a sharp containers (red container)
wedgewood
Used in the trituration of crystals, granules, and powders
Dispense as Written
Used to ensure the pharmacy is properly reimbursed by a third party provider for a prescription being dispensed
sink with hot and cold running water
Used to wash equipment and hands
DEA Form 222
What DEA Form do you have to use to order schedule II medications?
DEA Form 224
What DEA Form does a pharmacy have to submit in order to register?
DEA Form 106
What DEA Form does a pharmacy use for theft?
blanket authorization
What do hospitals have that is similar to a DEA Form 41
State Board of Pharmacy
What does BOP's stand for?
National Drug Code
What does NDC stand for?
every year by the Department of Taxation
When should pharmacy balances be recertifed?
in a secure location in a pharmacy
Where do unused DEA 222 forms be kept?
Protection from freezing
Where, in addition to the risk of breakage of the container, freezing medications can lose strength or potency, or to destructive alteration of its characteristics. The container label bears an appropriate instruction to protect the article from freezing
resource conservation and recovery act
a US law that provides, in broad terms, the general guidelines for the waste management program envisioned by congress -hazardous waste is a waste with properties that make it dangerous or potentially harmful to human health or the environment. RCRA has two categories: -listed wastes, which appear on one of the four hazardous waste lists established by environmental protection agency (EPA). -F list(non-specific wastes) -K-list(source specific waste) P-list and U-list(discarded commercial chemical products) characteristics of waste include: -ignitability, corrosivity, reactivity, and toxicity
lower of cost or market basis
a basis whereby inventory is slated at the lower of cost or market (current replacement cost)
purchase discount
a cash discount claimed by a buyer for prompt payment of a balance due
p and u list waste
a chemical substance that is the commercially pure grade, a technical grade, or a formulation in which the chemical is the sole active ingredient. P-list Examples: warfarin(>0.3%), phentermine, nicotine, physostigmine, epinephrine, and nitroglycerine. U-list examples: mitomycin, chloral hydrate, chlorambucil, lindane, melphalan, mercury, phenol, reserpine, selenium sulfide, and warfarin(<0.3%) treat like hazardous waste -drugs with more than one active ingredient -all chemotherapy agents -drugs with low LD50's -endocrine disruptors -all drugs on the P and U lists
facsimile prescriptions
a faxed prescription for schedule III, IV and V drug may serve as the original prescription. exceptions: -a narcotic schedule II substance that is to be compounded for direct administration to a patient by parenteral, IV, intramuscular, subcutaneous, or intraspinal infusion -a schedule II substance for a resident of a long term facility -a practitioner prescribing a schedule II narcotic substance for a patient in hospice care, as certified by medicare under title XVIII or licensed by the state, may transmit prescription to the dispensing pharmacy by fax regardless of whether the patient resides in a hospice facility or other care setting. The practitioner's agent may also transmit the prescription to the pharmacy. The practitioner will note on the prescription that is for a hospice patient.
depth filter(sterile compounding)
a filter that works by trapping particles as a solution moves through the channel
blood-brain barrier
a filtering mechanism of the capillaries that carry blood to the brain and spinal cord tissue, blocking the passage of certain substances.
purchase order
a form that is used to order drugs and supplies from a wholesaler. -name and address of the institution -shipping address -date the order was placed -vendor's name and address -purchase order number -ordering department's name and location -expected date of delivery -shipping terms -account name or billing designation -description of items ordered -quantity of items ordered -unit price -extended price -total price of the order -buyer's name and phone number
pharmacy provider networks
a group of health care providers linked through a contract to provide health care service to its members
drip chamber(sterile compounding)
a hollow chamber where drops of an IV solution accumulate that prevent air bubbles from entering the tubing
restricted formulary
a hybrid of both open and closed formularities
lotion
a liquid for topical application that contains insoluble solids or liquids
isotonic
a liquid or osmolarity of another substance where there is no loss or gain of water by the cell. The dilution of an isotonic solution may affect the composition of solution. Ophthalmic solutions are considered isotonic.
repacking log
a log contains documentation required for repacking medication and must be signed by the pharmacist
Training Manual for Intravenous Admixture Personnel
a manual for training people to create parenteral preparations
ASAP
a medication order that does not have priority of a STAT order but needs to be processed as soon as possible
STAT
a medication order that should be filled within 15 minutes of receiving it in a hospital
forced distribution
a method of performance appraisal that uses a small number of performance categories, like, very good, good, adequate, and very poor and forces a certain proportion of people into each
needle adapter(sterile compounding)
a needle or catheter may be attached to it
patient counseling
a pharmacy technician may ask patients if they any questions about their medications, but it is the pharmacist's responsibility, not a pharmacy technician's, to counsel a patient. Information that is not considered to be counseling: -name of medication -dosage form -dosage -route of administration Information that is considered counseling: -duration of therapy -action to be taken if a dose is missed -common or severe side effects -interactions and contraindications of the medication -self monitoring of medication -proper storage of medication -special directions of use
deductible
a predetermined amount of money that must be spent on prescriptions before copayment begins not all prescription drug plans have deductibles
fixed copayment
a predetermined fixed or predetermined dollar amount per prescription filled
percentage copayment
a predetermined fixed percentage of the cost of the prescription filled
Complaints
a process is in place to handle all oral and written complaints
returned goods
a process is in place to handle all returned medications. Returned unit dose medications should be credited to the patient's account. The returned unit dose medications may be redispensed because they are in unit dose packages
depreciation
a process of allocating to expense the cost of a plant asset over its useful life in a rational and systematic manner. It is not a process of asset valuation. Takes into account the cost the use for repair, service life, and vulnerability to obsolescence and the salvage value. Can be computed by the straight-line, declining balance, or units-of-activity method
Management by Objectives (MBO)
a process of joint goal setting between a supervisor and a subordinate
inventory turnover rate
a ratio that measures the number of times on average the inventory sold during the period; computed by dividing cost of goods sold by the average inventory during the period
sales discount
a reduction given by a seller for prompt payment of a credit sale
Handbook of Nonprescription Drugs
a reference work on OTC medications
compliance report
a report summarizing all items that were not purchased on bid
spike(sterile compounding)
a rigid, sharpened plastic piece that is inserted into the IV bag
Receiving the Prescription
a)method of receipt 1) walk in 2) call in 3)e-prescribing 4)fax b)patient profile: provides health history. It is to be completed the first a prescription is filled in a pharmacy and updated with new prescriptions and refills. 1) name, age, sex, race, occupation, address, weight 2)medical history to include surgeries 3)medication history to include current prescriptions, otc medications, vitamins, and herbal supplements 4)drug and food allergies 5)adverse drug effects c)prescription information: 1)patient information: includes patient's name, home address, office telephone, national provider identifier number, and drug enforcement administration
error prone abbreviation list
abbreviations that have caused a high number of medication errors. Reported to the ISMP through the ISMP Nationals Medication Errors Reporting Program.
isotretinoin safety and risks management act of 2004
acutance is a powerful medication for acne. The medication has been found to cause severe birth defects; induce spontaneous abortions; and produce adverse psychiatric effects, including depression, psychosis, suicidal ideation, suicide attempts, and suicide. -mandatory registry of all patients, practitioners, and pharmacists -education of all practitioners and pharmacists regarding the risks associated with the drug, including birth defects and mental health risks -a requirement that Accutane and its generic form are prescribed only for severe recalcitrant nodular acne, the medical condition for which Accutane was approved, that is unresponsive, to conventional therapy, including antibiotics. Accutane and its generic are often prescribed for mild acne or without other medications being tried first -monthly education of patients, both male and female, regarding the need to avoid pregnancy, as well as completion of a survey to warn the patient of the adverse side effects. Patient
leadership process and accountability(TJC)
addresses the leadership, structure of an organization, individual accountability, policies and procedures, and the management of daily operations
prostate gland
adds a chemical fluid to the semen
clamps(sterile compounding)
adjusts the rate and shutting down of the flow of the IV; they include slide clamps, screw clamps, and roller clamps
stability
affected by chemical nature of the drug substance, pH, method of preparation, solution additives, and packages
visocity
agents are used to prolong contact time in the eye and enhance drug absorption and activity
tinctures
alcoholic or hydroalcoholic solutions of either pure chemical substances or of plant extractives
high risk level 3 (sterile compounding)
all low or medium risk plus sterile products compounded from nonsterile ingredients; use of nonsterile device before terminal sterilization; sterile ingredients, components, or devices exposed to air quality; class 100 hood or partially used and not adequately preserved
medium risk level 2(sterile compounding)
all low risk plus no broad spectrum antibiotic present even over a predetermined number of days; complex aseptic technique manipulations; multiple doses in one container for multiple patients or multiple doses for one patient
open formulary
all pharmaceutical products carried
nonsterile compounded products
all recipe information is copied and shows the step by step process. The following information is documented: date prepared, name of ingredients, lot number and expiration date of each ingredient, amount or weight of each ingredient, dosage form of each ingredient. pharmacy lot number assigned, technician's initials, pharmacist's initials, date dispensed, patient's name, and medical record number. This information must be maintained for minimum of 2 years.
Controlled substance form
allow a nursing staff to verify controlled substances at each change of shift. Monitors the receipt, administration, and disposal of a controlled substance
auditability
allow users to examine basic information elements, such as data fields, audit access, and disclosure of PHI; alert users of errors, inappropriate changes, potential and security breaches; and promote use of performance metrics
dumb terminals
allows a number of users to access patient information
roll clamp(sterile compounding)
allows for variable flow rates
Medicare Advantage (Part C)
allows participants in Medicare Part A and B to obtain coverage through an HMO or PPO that provides additional services at a higher cost
purchase from drug manufacturers
allows pharmacies to purchase in bulk, resulting in a savings for the company. Wholesalers may not always stock specific medications because of storage conditions, expense, or low demand
Method 1 (compounding techniques for total parenteral nutrition solution and requires aseptic techniques)
amino acids and dextrose are mixed first. Fat emulsion is added next followed by the additives
Method 2 (compounding for total parenteral nutrition solution and requires aseptic techniques)
amino acids are added to the fat emulsion. Dextrose is added next followed by the additives.
blending
an act of combining two substances
specific identification method
an actual physical flow costing method in which items still in inventory are specifically costed to arrive at the total cost of the ending inventory
improving quality and safety(TJC)
an adverse reporting system must be in place, and the system must be analyzed
critical site
an area exposed to air or touch, such as, vial, needle, or ampule
Drug Interaction Facts, St Louis
available as a hardbound book or loose leaf book that is updated quarterly, provides comprehensive information on potential interactions that can be reviewed by drug class, generic drug name, or trade name. Provides information on drug to drug and drug to food interactions
weighted average unit cost
average cost that is weighted by the number of units purchased at each unit cost
community care
cost of medication plus a dispensing fee for dispensing, monitoring, and record keeping
inventory that is taken every two years after initial inventory is taken
biennial inventory
vagina
birth canal
processor
brains of the workstation
bronchial tree
branched airways that lead from the trachea to the microscopic air sacs called alveoli
cross training
bringing together persons with different expertise to work on a common task
administration sets(sterile compounding)
disposable sterile tubing that connects the IV solution to the injection site
Medicare Part A
covers inpatient hospital care, skilled nursing facilities, hospice, and home health care. There is no cost if the patient worked for 10 years in a medicare covered employer
sterilization
can be accomplished by autoclave, filtration, gas, or radiation
renal artery
carries blood to the kidney
cillia
catch particles
elixir
clear, sweetened, flavored hydroalcoholic solution containing water and alcohol that may or may not be medicated
documentation
coding systems are used in the documentation of drug related problems and interventions
blended unit-dose system
combine a unit dose system with a non unit-dose system. May be a multiple-medication package or a modular cassette. A multiple medication package has all the medication, which is administered at the same time. A modular cassette is a combination cassette or drawer exchange system
addition
combined effects of two drugs
blended unit dose system
combines a unit dose system with a non unit dose system.
tumbling
combing powders in a bag and shaking it
hardware
components are controlled by software
syringes needles(sterile compounding)
components include a hub, shaft, bevel, lumen, and point
syringe(sterile compounding)
components include, a plunger, plunger flange, barrel and tip
needles(sterile compounding)
composed of a hub and a shaft and are designated by two numbers(gauge and length). The gauge measures the diameter of the needle bore; the larger the gauge the smaller the bore. The length of the needle is measured in inches
low risk (compounded sterile product microbial contamination risk levels)
compounded with an ISO Class 5 or better air environment. The compounding involves the transfer, measuring, and mixing of not more than three packages of sterile products. There cannot be more than two ingredients entered into one sterile container. Sterile needles and syringes must be used to open disinfected ampules or vials. The time from compounding and administering the CSP cannot exceed 48 hours at controlled room temperature
compounding area
compounding or dispensing area
Patient Drug Facts: Professionals Guide to Patient Drug Facts
comprehensive guide to patient counseling about drugs, available in loose leaf format for verbal patient counseling in PC format for creation of patient handouts
backup and archiving procedures for stored data and documentation
computer systems must be backed up at regularly scheduled times to prevent loss of data if the system goes down for any reason
interfaces
connections between two or more computer systems
Pharynx
connects mouth to esophagus
membrane filters(sterile compounding)
consist of small pores that retain particles that are larger than the pores. Membrane filters may be placed between syringe and needle before a medication is introduced into an LVP or a small volume parenteral (SVP)
software
consists of instructions that tell the computer hardware how to operate
minibags(sterile compounding)
contain volumes between 50mL and 100mL
toxicity
contains a regulated substance at a concentration above the limit; examples include zinc and selenium
virtual groups
converse and operate with members linked together electronically by computers
confidentially and security
demonstrate adherence to related legislation, regulations, guidelines, and policies through out the documentation process; alert users to potential confidentiality and security
single use container
designed to hold a quantity of drug product intended for administration as a single dose
nose
detects smell and a drainage system
vials with lyophilized powder(sterilized compounding)
determine the correct volume of diluent and withdraw it. Transfer the diluent into a vial containing the powder. Remove more air from vial than amount of diluent injected. Whirl the vial until the powder is dissolved. Use a new syringe and needle and proceed as is using a vial with solution
Drug Approval Process Phase I
determines the appropriate dose range with regard to safety and toxicity -conducted with a small number of healthy individuals (20 to 80 people) -nine to 18 months in length
catheters(sterile compounding)
devices that are inserted into veins for direct access to the vascular system that may be either peripheral venous or central venous catheters
Method 3 (compounding for total parenteral nutrition solution and requires aseptic techniques)
dextrose, amino acids, and fat emulsions are added simultaneously while swirling and mixing. Additives are incorporated last. TPN examples: -potassium chloride(KCl) -potassium phosphate(KPO3) -calcium gluconate (Ca gluconate) -magnesium sulfate(MgSO4) -sodium phosphate(NaPO4) -sodium chloride(NaCl) -multivitamin(MVI) -multiple trace elements(MTE) -zinc(Zn)
vitamins, glucosamine-chondroitin, fish oil, and coenzyme q
dietary supplements that can affect the effects of warfarin?
drug-dietary interactions
dietary supplements with possible interaction with drugs
drug-disease interactions
diseases interacting with drugs
Investigational New Drug
dispensed for controlled study only, which is sponsored by a drug manufacturer, institution, or agency. The FDA may allows dispensing of a particular drug for a particular situation when all other methods of treatment have been exhausted. The pharmacy and therapeutic committee asks the pharmacy to maintain administrative control over the clinical investigation. -distribution and control of investigational drugs, which includes drug procurement, storage, inventory management, packaging, labeling, distribution, and disposition -clinical services, such as patient education, staff in-service training, and monitoring and reporting of adverse drug reactions -research activities, such as participation in the preparation or review of research proposals and protocols and assisting in data collection and research -clinical study management; writing accountability reports to the drug sponsor
SCRIPT standards
facilities the transfer of prescription data among pharmacies, prescribers, intermediaries, and payers. The current standard supports messages regarding new prescriptions, prescription changes, refill requests, prescription fill status notification, prescription cancellation, medication history and transactions for long term care environments. Enhancements have been added for drug use or utilization review alerts, standardized signatures(instructions), allergies and diagnosis information. Future improvements may include laboratory values, patient drug profiles, prescription transfers, and formulary inquiries.
expiration date of repackaged drugs
federal law mandates the expiration date cannot exceed 6 months and cannot exceed 25% of the remaining time on the manufacturer's original expiration date on the bulk of the container
medicare
federal program to provide health care for elderly adults, persons with disabilities, and patients with end stage renal disease
ovaries
female gonads
final filters(sterile compounding)
filter used before a solution enters a patient's body
nephrons
filtering units of the kidney that remove wastes from the blood and produce urine
spleen
filters blood
powders
finely ground substances that can be administered internally or externally
packaging area
finished product is packaged for delivery
male and female adapters(sterile compounders)
fit a syringe on each end and are used in the mixing of the two contents
inventory management
focuses on the procurement, drug storage and inventory control, repackaging, and label considerations, distribution systems, and recapture and disposal of used and unused pharmaceutical products
pharmacy informatics
focuses on the use of information technology and drug information to maximize medication usage with patients. Hospital, long term care, and retail pharmacies use technology for prescription management and billing while also providing computer based education to patients and tracking medical compliance. Through the electronic communication of medication data, clinicians send prescription orders to pharmacies through secure channels. Medication orders are verified with other patient records, prepared, and dispensed with higher quality, thus avoiding undue risks and negative interactions. With database interconnectivity to insurance companies, medication orders are validated against formulary data and contracts to ensure proper usage and payment. Plays an important role in reducing errors and increasing medication treatment outcomes.
formal channels
follow the chain of command or hierarchy or an organization
customer service
follow up survey with customers
FDA indication
for a very specific disease or cause of a specific disease -sponsor must label (with package insert)only for the specific indication -limits what the sponsor can "promote" the drug for
centralized pharmacy
found in the central pharmacy that is used to improve manual unit dose cart fill process. A disadvantage is its inability to handle all dosage forms
decentralized pharmacy
found in the patient care areas of a hospital to eliminate or reduce management issues that include narcotic diversion and poor record keeping. Advantages of this system include the ability to dispense and return medications, document medication waste, and produce reports
clarity
free from foreign particles, which can be accomplished through filtration
FOB (free on board) destination
freight term indicating that the goods are placed free on board at the buyer's place of business and the seller pays the freight cost; goods belong to the seller while in transit
FOB shipping point
freight term indicating that the goods are placed free on board the carrier by the seller; the buyer pays the freight cost; goods belong to the buyer while in transit
requires special equipment
fume box, glove box, dose calibrator, Geiger-muller counter, dosimeter, lead lined refrigerator and freezer, lead lined storage boxes, autoclave, heating equipment, testing equipment. centrifuge, lead barrier shield, stainless steel sink, shower, and respirator
inhalants
gases, vapors, solutions, or suspensions intended to be inhaled either orally or intranasally
beakers
glass or plastic and used to estimate and mix solutions
vials(sterile compounding)
glass or plastic containers with rubber stoppers. Single dose vials do not contain a preservative, but multidose vials do.
consigned goods
goods held for sale by one party (the consignee), although ownership of the goods is retained by another party
operating system
govern basic operation of the hardware
plasters
medicated or nonmedicated preparations that adhere to the skin by a backing material
managed care providers
health maintenance organizations -goal of health maintenance organizations(HMO's) is to keep patients healthy -proactive health care instead of reactive health care -based on capitation reimbursement system -provides a predictable cost of payment for services -healthcare providers work directly for the HMO -little flexibility in selection of providers -primary care physician(PCP) directs all medical car for the member -provides coverage for routine inpatient and outpatient care -small copays -usually no deductibles -low premiums
heat method
heat must be controlled
using ampules(sterile compounding)
hold the ampule upright and tap it to ensure all the liquid is in the bottom of the ampule. Wipe the neck of the ampule with alcohol swab. Wrap gauze around the neck and gently snap the neck away from the individual. Inspect and use a filter needle or filter straw to withdraw. Hold the ampule downward at a 20 degree angle and withdraw the solution with a filter syringe
Graduates TC
hold the desire volume but when transferred a residual remains making the amount measured inaccurate
30 minutes
how long can a laminar hood run for before being used?
5 months
how many refills can a patient have in six months of the date the prescription was authorized?
completeness
identify the minimum set of information required to complete the incident, observation, or intent; provide the means to ensure all recorded information meets legal, regulatory, institutional policy or other requirements
hermetic container
impervious air or gas
prescription monitoring programs
in 2005, the federal national all schedules prescription electronic reporting act was introduced. The act established an electronic system for practitioner monitoring of the dispensing of controlled substances in schedule II, III, IV. The act would have required specific information to be reported, such as a patient identifier, drug dispensed, and quantity dispensed, as well at the prescriber and the dispenser. The act was never enacted but states have either this or similar legislation
Medication Reporting and Documentation
incident reports are used to report accidents and events involving employees, individuals, visitor injury, property damage, and occupational illiness
safe environment for staff and patients(TJC)
includes a safe work environment, adherence to infection control practices, and handling of hazardous waste
procurement considerations (order and receiving process)
includes drug selection, source selection, cost analysis, group purchasing, prime vendor, relationships, purchasing procedures, record keeping, and receiving control -drug selection includes a cost analysis which examines the perceived benefit versus the cost of the medication -source selection is deciding whether a generic or brand name drug is to be purchased. It examines the therapeutic equivalency of the products -cost analysis is an examination of acquisition and storage costs and the costs associated with time required to prepare or package a drug -group purchasing organizations allow hospitals to purchase medications at a lower cost based on volume. These organizations negotiate prices but do not make purchases for an institution. The ability to purchase contract items is known as a "bid" or "contract compliance." -a primary or prime vendor is one source, a wholesaler from which as many products as possible are purchased. When choosing a primary vendor, one should consider the following: delivery rate or items, 24 hour emergency service, computer system for ordering drugs from the vendor, electronic order entry devices, bar-coded shelf labels, competitive pricing, purchasing history reports, pricing updates, return policy, and drug recalls -purchasing procedures include negotiating discounts and establishing payment schedules, terms of payment, prepayment policies, nonperformance penalties, and returned and damaged good practices. -records must be maintained to meet government regulations, standards of practice requirements, accreditation standards, policies, and management information requirements. Records may include purchase orders that authorize the purchase of a product. -receiving procedures include shipments, invoices, and purchase orders that must be reconciled by item. Quantity and strength of each item must be checked, prices on invoice should correspond to price that has been negotiated, and discrepancies must be addressed promptly with the pharmacist and vendor,
infectious waste
includes, blood, blood products, and bodily fluids, infectious sharps waste, and laboratory waste.
prescribing error
incorrect drug selection, dose, dosage form, quantity, route, concentration, or instructions of use of a drug product ordered or authorized by physician
subscriber (cardholder) name
individual who purchased the policy
Pediatric Drug Formulations
information on formulation and compounding of drugs for pediatric patients
complete and accurate inventory of all controlled substances
initial inventory
drug recall
initiated by either the drug manufacturer and the FDA -common causes include drug package mislabeling, drug contamination, lack of potency, or a lack of good manufacturer practices
endocardium
inner lining of the heart
endometrium
inner lining of the uterus
Immediate CSP
intended only for emergency or immediate patient administration of CSP
efficiency
inventory turnover rates, reduction in prescription errors per shift, compliance reports from vendors. average waiting time per prescription
Medigap (Medicare Supplement Policy)
is an additional policy that covers the gaps in the original medicare program
water for injection USP (sterile compounding)
is not sterile and cannot be used in aseptic compounding of sterile products
types of computer input devices
keyboard, mouse, trackball, microphone for voice recognition, touch screen, light pen
stomach
large muscular sac that continues the mechanical and chemical digestion of food
mainframe
large, expensive, and powerful computer used to process large quantities of data
reactivity
liable to explode, react violently, or release toxic gases when in contact with water; an example nitroglycerin
closed formulary
limited number of products of each drug classification covered
Physician order sheet (POS)
list of all of the physician's orders for a patient, including both drug and nondrug orders.
master formula sheet
lists the ingredients and their quantities and the procedures to follow in the preparation
thymus gland
located in the mediastinal cavity anterior to and above the heart; secretes thymosin
unit dose packaging procedures (facility)
low relative humidity and controlled room temperature
Adulteration
lowered quality and safety of a product caused by adding inferior ingredients that may be toxic
ambulatory pharmacy computer functions
maintains a pharmacy database that contains: 1)drug file a)abbreviations b)brand and generic name c)price structure 2)physician file a)phone number b)address c)drug enforcement administration number d) national provider identifier (NPI) 3)clinical monitoring a)drug drug interactions b)drug food interactions c)drug disease interactions d)drug laboratory test interactions e)dose range checking 4)payer and insurance information permits a pharmacy computer to interface with other systems: 1) patient information: a)demographic information b)allergies, weight, height, diagnosis c)insurance 2)prescription processing a)patient selection (1)Name (2)patient number (3)room number (4)prescription number b)prescription information (1)medication name, dose, route, frequency, duration, and expiration date (2)quantity of medication and refills if allowed (3)comments and special instructions (4)patient education material (5)receipts c)verification d)label generation e)price inquiry 3)pharmacist verification of orders entered by technicians 1)generate reports: used to evaluate and improve workflow 2)examples of reports generated a)nonformulary drug use b)drug usage patterns c)drug costs d)productivity e)workload f)pharmacist interventions 3)distribution reports, such as narcotic use records 4)financial reports to include billing information 5)workload data (productivity data) 6)file maintenance
testes
male gonads
ID
may be either numeric or alphanumeric
copays
may be identified on the card but not required
days in inventory
measure of the average number of days the inventory is held; calculated as 365 divided by inventory turnover rate
medium risk (compounded sterile product microbial contamination risk levels)
multiple individual or small doses of sterile products are combined to prepare a CSP that will be administered to multiple patients or to one patient on multiple occasions to complete. The time period from the completion of the compounding and administration cannot exceed 30 hours at controlled room temperature
multiple dose container
multiple unit container for parenteral administration
repackaged medications
must be maintained on a log with the following information: date, drug, dosage form, manufacturer, manufacturer's lot number, manufacturer's expiration date, pharmacy lot number, pharmacy expiration date, technician, and pharmacist. The information must be readily retreiveable
without heat method
must use a container that is twice the size of the final volume. The syrup needs to be shaken or stirred
filter needles(sterile compounding)
needles that include a filter that prevents glass from entering the final solution when one draws from an ampule
DAW 0
no product selection indicated
purified water USP(sterile compounding)
not intended for parenteral administration; used in the reconstitution of oral products
Drug-Nutrient Interactions
nutrition affecting drugs
creation of OSHA and SDS
occupational safety and health act of 1970
sebaceous glands
oil glands in the skin
ointment
oil of 80 percent with water 20 percent with high viscosity that is intended for external application to the skin or mucous membranes.
prescription hard copy
on the back of the hard copy of the prescription is a copy label with the initials of the pharmacist or technician who filled the prescription. Prescriptions are filed numerically. Electronic backup copies are made at the end of the day. They must be maintained for a minimum of 2 years
potentiation
one drug increases or prolongs the effect of another drug
antagonism
one drug works against the action of another drug
emulsion
one liquid is dispersed in another liquid; may be oil in water
unit of use container
one that contains a specific quantity of a drug product that is intended to be dispensed as such without further modification except for appropriate labeling
over the counter recommendations
only a pharmacist may recommend an over the counter medication to patient after evaluating the patient's symptoms and other medications the patient is taking. When a pharmacist recommends an OTC medication to a patient, he or she is making a professional judgement that is in the realm of pharmacist's practice. Pharmacy technician's are not permitted to make professional judgement's.
pupil
opening in the center of the iris
primary care provider
optional depending on the plan
DAW 9
other
epicardium
outer layer of the heart
Drug-Over-The-Counter Drug Interactions
over the counter medications that can increase or decrease the effects of prescription drugs
net profit
overall cost x desired percent profit
DAW 6
override
left atrium
receives oxygenated blood from the lungs
long term care
per diem reimbursement that is based on prior medication costs of the facility. Formulary control, is important. Regulatory agencies have developed lists of medications they have deemed unnecessary based on excessive adverse affects or poor outcomes obtained
multiple unit container
permits withdrawal of successive portions of the contents without changing the strength, quality, or purity of the remaining portion
inventory that shows controlled substances received by the facility, suppled to other locations, returned to the pharmacy, and dispensed to patients
perpetual inventory
Billing information
person responsible for payment of prescription, whether it is the patient of a third party provider. The third party provider information includes a group number and subscriber identifier and the individual's relationship to the cardholder
AAPS
pharmaceutical research
ordering
physicians initiate the process of studying investigational drugs -obtain approval for any study of investigational review board (IRB) -interactive voice response system (IVRS) call in electronic menu that allows for screening, randomization, environment, and assignment of the subject study drug. A PIN (personal identification number) and password are provided for tracking purposes. Provides confirmatory fax. Allows for reorder of drug supply. -complete the investigational Drug Data Form and return it to the pharmacy -provide the pharmacy with a copy of the signed consent form -instruct the manufacturer to supply the pharmacy with all pharmacologic and stability data. -make arrangements for the transfer of the drug to the pharmacy. -arrange for the pharmacy in maintain a minimum level of the medication
glycine paper
placed under substances to be weighed
flexible bag(sterile compounding)
plastic container that may hold volumes ranging from 50 to 3000 mL
unit dose packaging procedures (personnel)
possess the education and training to perform the necessary functions
Drug Approval Process IV
postmarketing evaluation
national council for prescription drug programs rejection codes
prescription claims that are rejected will have at least one rejection code. The pharmacist or pharmacy technician must correct the prescription claim before resubmitting it to the managed care provider.
plan code
prescription provider
medications patient is taking
prescription, OTC, or complementary and alternative medications; this information is used to prevent drug-drug interactions
productivity
prescriptions filled per pharmacist per hour, absenteeism and tardiness reports through payroll
electronic prescriptions for controlled substance
prescriptions for controlled substances in schedule II, III, IV, V may be transmitted electronically from a physician's office to a pharmacy
extract
process by which active ingredients are removed from their source through the applications of solvents
procedures
process of accomplishing a task to ensure efficiency and consistency
formulary exception process
process that allows the right to use select nonformulary and formulary medication to be dispensed
formulary override
process that requires the physician to request approval to prescribe a nonformulary medication and to document the reason the medication
prior authorization
process to obtain authorization to use select nonformulary drugs that requires the physician to request and document the reason why the medication is needed -brand name medications that have a generic available -expensive medications -medicines with age limits such as retin-a -drugs used for cosmetic purposes such as propecia -medications such as Cialis and Viagra prescribed for non life threatening medical conditions -drugs not usually covered by the insurance company but said to be medically necessary by the physician -medicines that are usually covered by the insurance company but are being used at a higher dose than normal
b cells
produce antibodies
mammary glands
produce milk
ovary
produces eggs
reproductive system
produces offspring
lacrimal gland
produces tears
accuracy
promote accuracy throughout information capture and report generation and during transfer among systems
integumentary system
protects against environmental hazards; helps control body temperature
tight container
protects the contents from contamination by liquids, solids, or vapor
well closed container
protects the contents from other solids and from loss of the article under normal conditions
light resistant container
protects the contents from the effects of light caused by the contents of the container
auxiliary label
provide additional information such as special instructions, warnings, or storage conditions. to the patient. -do not drink alcohol -may cause drowsiness -take with food or milk -avoid sunshine -take on an empty stomach -shake well -refrigerate
Laminar hood qualifications
provide an ISO class 5 clean environment worked surfaces need to be cleaned with 70% isopropyl alcohol prefilter and HEPA filter need to maintain particles greater than 3 microns cannot enter the sterile area HEPA filter is monitored by introducing aerosolized emery 3004 into the plenum of the laminar flow hood No more than 0.01% upstream concentration may be detected downstream from the HEPA filter automated compounding and repackaging equipment must be calibrated before each use
unique patient identification
provide unique identification of each patient when recording or accessing information
King Guide to Parenteral Admixtures
provides 350 monographs on compatibility and stability information critical to determining the advisability of preparing admixtures of drugs for parenteral administration
Medication delivery record
provides accountability for medication distribution between the pharmacy and hospital or long term care facility. It lists the medication found a particular delivery for a patient
Medicare Part B
provides for physician services, outpatient care, and some physical and occupational therapy; requires an extra monthly payment
Medicare Part D
provides for prescription medications, biologicals, insulin, vaccines, and select medical supplies. All medications are not covered under medicare part D
Handbook on Injectable Drugs with Supplement
provides information on stability and compatibility of injectable drug products, including formulations, concentrations, and pH values
pyxis anesthesia system
provides visibility to medication inventory and utilization to help pharmacy ensure anesthesia providers can access the needed medication for patients. The system has biometric access system and a variety of a drawer types, including a new controlled access drawer for larger high risk medications
right ventricle
pumps blood to the lungs
left ventricle
pumps oxygenated blood to the body
cost
purchase price + cost to dispense
discounted price
purchase price - discount
discount
purchase price x discount rate
net purchases
purchases less purchase returns and allowances and purchase discounts
average wholesale price (AWP)
refers to the average price that wholesalers sell a medication. The AWP is not regulated by the government and does not take into account discounts based on volume. Managed care reimbursement may be calculated by using the following equation: AWP-% Discount + dispensing fee
tonicity
refers to the osmotic pressure exerted by the salts. An isotonic solution should have tonicity equal to that of sodium chloride 0.9%
infusion pumps(sterile compounding)
regulate the flow of medication into a patient
Federal Privacy Act of 1974
regulates what personal information the federal government can collect about private individuals and how information can be used
pharmacy reimbursement from managed care
reimbursement formula= ingredient cost + dispensing fee, where the dispensing fee may be either a predetermined dollar amount or a predetermined percent
thalamus
relays messages between lower brain centers and cerebral cortex
type B2 hoods(sterile compounding)
remove all of the contaminated air to the outside atmosphere after it passes through a HEPA filter. This air is not recirculated within the hood or returned to the parenteral room atmosphere
timeliness
require health care documentation during or immediately after the event in memory
retrievability
require use of standardized titles, formats, templates, macros, terminology, abbreviations, and coding; enable authorized data searches, indexing, and mining
ophthalmic system
responsible for providing an individual with vision
cubic system
restricts access to only one medication at a time during the removal process. The system helps reduce the risk of nurses selecting a medication from the wrong pocket.
a physician order entry system
results in a reduction of medical errors by having complete and accurate information, accurate dose calculation, and appropriate clinical decision support
Approved Drug Products with Therapeutic Equivalence Evaluations
revised annually, with monthly updates, this source lists drug products approved for use in the United States. Also known as the Orange Book.
dermis
second layer of skin
pineal gland
secretes melatonin
loop of henle
section of the nephron tubule that conserves water and minimizes the volume of urine
exempt narcotics
select cough and antidiarrheal prescription items can be purchased by an individual if permitted by state law -the quantity dispensed must be in the original manufacturer's container and must not exceed the quantity established by law -the purchaser must be at least 18 years of age and must complete the Exempt Narcotic Book with the following information: date purchased, name of purchaser, address of purchaser, name of product, and quantity purchased, price of transaction, and pharmacist's signature -there is a limit of one container in a 48 hour period
profit
selling price - overall cost
mark up
selling price - purchase price
gross profit
selling price- purchase price
alveous
site of gas
pellets
small cylinders that are implanted subcutaneously for continuous absorption
minicomputers
smaller scaled mainframes used by several people in an organization through the use of local area network (LAN)
orbit
socket that contains the eye
suppositories
solid dosage forms to be inserted in body orifices such as the rectum vagina and uretha
enema
solution administered rectally for either cleansing or drug administration
aromatic waters
solutions of water-containing oils that have a smell and are volatile
transferring of controlled substance prescriptions
the DEA allows transfer of the original prescription information for schedule III, IV, V, controlled substances for the purpose of refill dispensing between pharmacies on a one time basis. If pharmacies share a real time online database, however, then the prescription may be transferred up to the maximum number of refills permitted by state law. requirements: 1) the transfer is communicated directly between two licensed pharmacists and the transferring pharmacist is responsible a)the word void must be written on the face of the invalidated prescription b)on the reverse side of the invalidated prescription must be written the name, address, and DEA number of the pharmacy to which the prescription was transferred and the name of the pharmacist receiving the prescription information c)the date of the transfer and name of the pharmacist transferring the prescription must be recorded 2)the receiving pharmacist is responsible: a) transfer, must be written on the face of a transferred prescription: b)the following information must be recorded: 1)date of issuance of the original prescription 2)original number of refills authorized on the original prescription 3)date of the original dispensing 4)number of valid refills remaining and dates and locations of previous refills 5)pharmacy's name, address, and DEA registration number and prescription number from which the prescription was transferred 6)name of the pharmacist who transferred the prescription 7)pharmacist's name, address, and DEA registration number and prescription number from which the prescription was originally filled 3)the original and transferred prescription must be maintained for a period of 2 years from the date of the last refill
guidelines for timely administration of medications
the ISMP developed guidelines for the administration of medications in an acute car facility where medications are to be administered to the patient either 30 minutes before or 30 minutes after the schedule time. scheduled medications do not include: -STAT and NOW doses -first doses and loading doses -one time doses -specifically timed doses -on call medications -time sequenced or concomitant medications -medications administered at specific times to ensure accurate drug levels -PRN medications -investigational drugs -time critical scheduled medications are those for which early or delayed administration of maintenance doses of greater than 30 minutes before or after the schedule time may cause harm or result in suboptimal therapy or pharmacologic effect. -nontime critical scheduled medications are medications where early or delayed administration within a specific range of either 1 or 2 hours should not cause harm or result in suboptimal therapy or pharmacological effect
inventory maintenance
the ISMP has identified specific high alert drug classifications and medications that may cause potential harm to patients if taken inappropriately. These drug classifications and medications should be either identified in some manner or stored away from the other medications to eliminate possible errors. The pharmacy should have a method in place to identify short dated medications. In addition, the pharmacy should not be left in their original home in the pharmacy because of the possibility of being dispensed accidentally to the patient. Finally, the pharmacy should identify a place to store recalled medications until they are returned to the drug manufacturer
radioactive materials
the U.S. Department of Transportation (DOT) regulates the shipment of hazardous materials under the Hazardous Materials Transportation Act of 1994. Radioactive materials are considered hazardous materials. The DOT has set regulations regarding packaging, labeling, and transporting of radioactive materials -the shipping containers for transporting radioactive material must be able to maintain the integrity of the product during shipping. The container must be specifically labeled based on the activity of the radioactive material: radioactive white I, radioactive yellow II, and radioactive yellow III -the container must have a caution radioactive label with the name of the nucleotide, the quantity, the date, and the time -shipping papers must be inside the shipping container and include the following information: name of nucleotide, quantity, form, label category, emergency response telephone number, information regarding emergency personnel, and pharmacy name. The driver carries a copy of the shipping papers. -a placard must be on the vehicle if it is carrying radioactive yellow III material. Shipped material must be braced inside the transportation vehicle.
pharmacokinetics
the absorption, distribution, metabolism, and elimination of a drug in a living system
PAR (periodic automatic replacement) value
the amount of drug that is automatically reordered. When a drug falls below a predetermined quantity it is automatically reordered.
channel richness
the capacity of a channel to convey information effectively. list of most effective to least -face to face -telephone -e-mail -written memos -letters -posted notices -bulletins
ambulatory care parenteral therapy
the centers for medicare and Medicaid services has created a list of health insurance continuation program codes for drug in this setting. Reimbursable costs are also included. Other fees include a professional fee component and a facility fee
Remington The Science and Practice of Pharmacology
the compounding bible of the pharmacy profession
medulla oblongata
the continuation of the spinal cord within the skull, forming the lowest part of the brainstem and containing control centers for the heart and lungs.
what is on a DEA Form 41?
the controlled substance's name, strength, and quantity, the date of destruction, the method of destruction, and the witnesses
current replacement cost
the current cost to replace an inventory item
rectum
the final section of the large intestine, terminating at the anus.
issuer
the health insurance company who issued the card
Schedule 1 drugs
the highest potential for abuse; no accepted medical use
optic nerve
the nerve that carries neural impulses from the eye to the brain
nervous system
the network of nerve cells and fibers that transmits nerve impulses between parts of the body.
On a receipt for a schedule II drug what must be on the DEA Form 222?
the number of packages and dated and signed by a pharmacist
cost of goods available for sale
the sum of the beginning merchandise inventory and the cost of goods purchased
cost of goods purchased
the sum of the net purchases and freight charges associated with a product
cost of goods sold
the total cost of merchandise sold during the period, determined by subtracting ending inventory from the cost of goods available for sale
lens
the transparent structure behind the pupil that changes shape to help focus images on the retina
cognitive services
these services include prescriptive authority by the pharmacist, administration of medications by the pharmacist, patient assessment, and treatment, pharmacist intervention with prescribers and other health care providers, patient education, and patient reassessment and monitoring. Reimbursement is based on prior years' data
American Drug Index, St Louis
this standard reference work contains more than 20,000 entries on drugs and drug products, including alphabetically listed drug names, cross indexing,, phonetic pronunciations, brand names, manufacturers, generic or chemical names, composition and strength, pharmaceutical forms available, package size, use, and common abbreviations. It also contains a listing of orphan drugs.
Epidermis
top layer of skin
collodion
topical dosage form that contains pyroxylin and is dissolved in alcohol and ether
TQM
total quality management
pyxis CII safe
tracks and monitors the replenishment of controlled substance and inventory within a hospitals
inferior vena cava
transports blood from the lower portion of the body to the heart
superior vena cava
transports blood from the upper portion of the body to the heart
mobile robots
travel through a hospital to various nursing units deliver medication
urethra
tube leading from the urinary bladder to the outside of the body
ureter
tube that carries urine from the kidney to the urinary bladder
fallopian tubes
tubes which carry eggs from the ovaries to the uterus and which provides the place where fertilization occurs
counter balance (bulk balance)
two pan balance used to weigh quantities up to 5 kg with a sensitivity of 100 mg
high level (compounding sterile product microbial contamination risk levels)
uses nonsterile ingredients not intended for sterile routes of administration. If the air quality is less that International Organization for Standardization (ISO). Class 5 for 1 hour or longer: 1) sterile contents of commercially manufacturing products 2)CSP's that lack effective antimicrobial preservatives 3)sterile surfaces of devices and containers for the preparation, transfer, sterilization, and packaging of CSP
preparing chemotherapy medications
uses the same aseptic techniques used in preparing IV solutions except for the following: -requires a vertical laminar airflow hood, which is smaller than a horizontal laminar flow hood -special clothing is needed to be worn -the hands in a vertical flow hood should not be over the top of any needle, vial, or IV bag
larynx
voice box
Graduates TD
volume delivered is the exact amount desired
hazardous waste
waste that is dangerous or potentially harmful to human health or the environment -regulated under the Resource Conservation Recovery Act (RCRA) -appears on one or four hazardous waste lists (F,K,P, or U) or exhibits at least one or four characteristics (ignitable, reactive, toxic, or acutely hazardous)
ISMP-MERP and ISMP-VERP
what are ISMP two error-reporting programs?
Central Nervous System (CNS) and Peripheral Nervous System(PNS)
what are the two nervous systems in the body?
conical and cylindrical
what are two types of graduates?
American Society of Health-System Pharmacists
what does ASHSP stand for?
Bank Identification Number
what does BIN stand for?
The FDA Adverse Event Reporting System
what does FAERS stand for?
Institutional Pharmacy and Therapeutics Committee
what does IP&TC stand for?
Personnel Protective Equipment
what does PPE stand for?
The Vaccine Adverse Reporting System
what does VAER stand for?
American Pharmacists Association
what does the APhA stand for?
vitamin k
what drug nutrient interaction can affect warfarin?
tetracycline, ciprofloxacin, etidronate, phenytoin, norfloxacin, zidovudine, levothyroxine, and didanosine
what drugs are affected by taking food with them?
Ketoconazole, nitrofurantoin, and griseofulvin
what drugs can be taken with a fatty meal to improve success?
calcium channel blockers, estrogens, cyclosporine, midazolam, and triazolam
what drugs decrease in effect due to grapefruit juice?
spinach and romaine lettuce
what foods are high in vitamin k?
a from that is incomplete, illegible, shows signs of alteration, erasure, or change
what is a defective form?
must be separated from normal business records
what is readily retrievable?
every year
when should pharmacy weights be recalibrated?
mouth
where the digestive tract starts?
Sclera
white part of the eye
The American Pharmacists Association
who was the code of ethics published by?
purchase from wholesaler
wholesalers stock medications from all manufacturers, Pharmacies are able to purchase when they need a product rather than far in advance. Wholesalers may provide special services to the pharmacy, such as emergency deliveries, automated ordering systems, or automated purchasing systems
trachea
windpipe
uterus
womb
What ways can Schedule III, IV, V be ordered?
written, faxed, or verbal
Kefauver-Harris Amendment of 1962
• Also known as the "Drug Efficacy Amendment". • requires all medications in the united states to be pure, safe, and effective -established procedures for both drug applications and investigational drugs -drug manufacturers are required to be responsible for good manufacturing practices
Schedule 4 drugs
• Lower abuse potential than schedule 3 drugs • Accepted medical uses • Limited physical or psychological dependence
