Medical prescription

Preface Welcome to one of the fastest growing ? elds in medical care—the pharmacy technician. The rapid growth in the ? eld of pharmaceutical therapeutics has created opportunities for a variety of well-trained technical personnel: physician’s assistants, medical assistants, nursing assistants, and pharmacy technicians. The position of pharmacy technician has expanded from a simple assistant position to one of great responsibility in patient care.

The pharmacy technician is now responsible for a variety of duties in the pharmacy—legal record-keeping, dispensing of prescriptions, proper inventory, storage, and maintenance of drugs, to name a few. In addition, the technician plays a role in patient care by assisting the pharmacist in evaluating the various aspects of patient care. The growing demand for these trained technical personnel is due, in large part, to the rapidly expanding area of drug research and drug discovery.

The pharmacist simply does not have enough time to keep up with recent advances in drug therapy and new dosage delivery systems, counseling patients and physicians, and other duties such as drug dispensing and ordering, and the record-keeping that is required by law. The CPhT Examination The growing need for well-quali? ed technicians to perform sophisticated duties has created the requirement for a standardized examination to ensure that the technicians working within a pharmacy uphold an acceptable level of knowledge and integrity.

Thus, a national examination for the certi? cation of pharmacy technicians has been created to replace state certi? cation examinations. There are two certi? ed examinations available for technicians today. The Pharmacy Certi? cation Training Board (PCTB), and the Institute for the Certi? cation of Pharmacy Technicians (ICPT) offer these exams. Since the PCTB exam was ? rst implemented in 1994, the test material has become increasingly more dif? cult, which re? ects the changing duties of the technician. The ICPT exam was developed in 2005.

With the growing number of drugs available and the increasing number of patients that require medical care, the technician is now required to know an extensive amount of pharmacology in order to monitor for possible drug interaction or other harmful effects of the prescribed drug regimen on the patient. ix x Preface Both exams are offered with continual registration windows and on-line testing. They must be proctored, so they are offered throughout the country at licensed testing centers. Why This Book? The high standards and increasing dif?

culty of this examination have created a need for a text that, in addition to being useful for the student of pharmacy technology, will address the main features of the examination and provide information, a comprehensive review, and a basis for understanding the concepts addressed in the examination.

The third edition of Pharmacy Technician Certi? cation Exam Review was written to ? ll this need. This text was designed for a twofold purpose: to function as a review for technicians familiar with the material and to serve as a learning tool both for students of pharmacy technology and for technicians who have been trained to perform a limited number of duties (such as within a retail pharmacy).

These technicians must now become familiar with more sophisticated concepts, such as pharmacology and advanced pharmaceutical calculations, in order to become certi? ed. The text is written in conversational style to facilitate understanding of dif? cult concepts among many levels of readers. Foremost in the text is an examination of the routine procedures in the pharmacy: accepting prescriptions, creating patient pro? les, processing and ? lling prescriptions, and maintaining inventory.

This portion of the text covers procedures in both the retail and institutional pharmacy settings, and provides comparisons between them. Special care has been taken to discuss not only the procedures themselves but the reasoning behind the procedures—why are they done in a particular way? This approach is not only necessary to understand work within a pharmacy but is critical to doing well on the certi? cation examination. A large block of chapters dealing with pharmaceutical calculations has also been provided, which covers a variety of types of calculations that will appear on the examination.

These have been presented in a simple, easy-to- understand manner and are designed to take the fear out of math. Topics include not only simple dosage conversions but also intravenous calculations, pediatric dosages, compounding, and commercial calculations. An entire chapter is included consisting only of math problems, with answers and worked-out solutions. Organization of the text This exam review guide is organized in the best possible presentation to maximize student learning and comprehension of the scope of the pharmacy technician profession. It consists of three sections, four parts that contains 38 chapters.

Preface xi The textbook opens with Section I: Assisting the Pharmacist in Serving Patients, which is broken down into the following parts: Part A: Filling the Medication Order introduces the learner to working within a professional setting and the responsibilities that are required to accurately set-up patient pro? les and proper procedures in processing medication orders, including handling and storing medications. Part B: Pharmaceutical Calculations prepares the learner by providing complete coverage of necessary mathematical concepts and formulas that are crucial for success on the national exam.

This part is concluded by a practice math exam that tests the learner’s knowledge of all mathematical concepts and principles that were introduced in this section of the textbook. Part C: Pharmacology provides an introduction to the importance of pharmacology and the role of the technician. This part of the textbook follows a chapter format that groups together pharmacology medications according to the types of disease that needs to be treated or by body system. The learner’s knowledge is tested with a practice pharmacology review test to ensure complete understanding and industry knowledge. Part D: Pharmacy Law covers in?

uential and mandatory state and federal regulations, governing bodies and provides the learner with a foundation of understanding about the laws and ethics surrounding the practice of pharmacy. Section II: Maintaining Medication and Inventory Control System expands upon the role of the pharmacy technician in controlling inventory and the upkeep of medications within the pharmacy stock. Section III: Administration and Management of Pharmacy Practice delves deeper into the technologies that are an integral part of a functioning pharmacy and the importance of accurate communication between patients, pharmacists, and pharmacy technicians.

The usefulness of this textbook is enhanced with several appendices, including an updated Too 200 Frequently Prescribed Drugs and Their Uses, Abbreviations list, and a sample exam that will help learners assess their comprehension of core concepts. There is also a corresponding appendix that provides answers for all of the chapter activities. Features Each chapter includes a variety of learning aids designed to help the learner further a basic understanding of key concepts. Each chapter begins with a Quick Study that condenses the chapter content into a learner friendly outline of what will be covered in the chapter.

This will help learners focus their study and use time ef? ciently. Another important feature that enhances this textbook is Notes, which are found throughout each chapter in the left hand margin. They succinctly draw out the most important concepts presented within the content of the chapter. A Physiology Review is included in chapters where a refresher in physiology is in? uential to understanding chapter subject matter. xii Preface Concluding each chapter are Chapter Review Questions that assist the learner in retaining and directly applying the material presented in the chapters for preparation of the national exam.

Detailed solutions and answers, which will help the learner understand the thought processes that are crucial to understanding and correctly answering the questions on the examination, are given in Appendix E. New to the third edition New material added in this revision includes: • updated chapters on pharmacy practice and law offers the learner the most current industry standards and practices according to state and federal guidelines, including current HIPPA regulations. updated chapters on pharmacy math enhances a challenging core learning area.

New and updated problems are presented in each chapter as well as corresponding solutions. back of book CD with randomized practice exams provides learners with an unlimited amount of practice exams and mimics the national examination for as close as the actual experience as possible. updated and expanded section on pharmacology with new market medications and substantial updates to medications included in the second edition when applicable. This section covers not only the principles of pharmacology, drug dosage, and dosage forms, but also the mechanism of action of drugs, adverse effects, and potential drug interactions.

• • • Extensively updated chapters: Section I: Assisting the Pharmacist in Serving Patients • Part A: Filling the Medication Order; Chapters 1–6: These chapters have been updated to re? ect new guidelines for labeling and dispensing drugs based on state and federal laws. The chapter review sections of chapters 1–5 have been expanded to 10 questions. Part B: Pharmaceutical Calculations; Chapters 7–20: Typographical errors have been corrected, updated examples have been added, and the chapter review sections of chapters 7–18 now have a minimum of 10 questions. Chapter 20 is a 60-question math test for further practice.

All the review questions in Part B, including the math test, have the solutions worked out in addition to providing the correct answers (Appendix E). Part C: Pharmacology; Chapters 21–31: These chapters have been greatly re-worked to include new drug products and dosage forms in each of the drug classes represented. The chapter review sections of chapters 21–30 now have a minimum of 10 questions. Chapter 31 is a pharmacology exam that includes 50 questions. • • Preface xiii • Part D: Pharmacy Law; Chapters 32–34: These chapters have been updated to re? ect the changing state and federal regulations, including HIPAA.

Each chapter review section has been expanded to a minimum of 10 questions. Section II: Maintaining Medication and Inventory Control Systems • Chapter review questions have been updated for chapters 35–36. Section III: Administration and Management of Pharmacy Practice • • Chapter 37 has been updated to re? ect the newer computer technologies now available in pharmacy. Chapter 38 has an updated chapter review with more questions. Appendices: • • • Appendix A: The Top 200 list has been revised to re? ect the current dispensing trends.

Appendix B: The commonly used abbreviations has been updated to re? ect the currently accepted abbreviations used in the medical ? eld today. Appendix C: This pretest has been updated. Obsolete questions have been removed and newer questions have been added. The answer key has been adjusted to re? ect the new exam. Appendix D: This sample exam has been reformatted to re? ect the PTCB exam.

The questions have been reduced to 90 questions to match the current PTCB format. Appendix E: The solution choices for each of the chapter review sections were changed from a numeric format (1, 2, 3, 4) to an alpha format (A, B, C, D) for better clarity.

The solutions have been updated to re? ect the new questions and the math questions have the problems worked-out for further student learning. • • Also Available Book only • • Pharmacy Technician Certi? cation Exam Review (1111321159) Practice Exam Software to accompany Pharmacy Technician Certi? cation Exam Review (1111535744) CD only About the Author The author of Pharmacy Technician Certi? cation Exam Review third edition, Dr. Lorraine C. Zentz, is a certi? ed pharmacy technician with a bachelor’s xiv Preface degree in biology and minor in chemistry.

She also holds her master’s degree in curriculum and instruction as well as her doctorate degree in adult education. She has authored, and currently instructs, her own pharmacy techniciantraining program offered through Cengage Learning’s Ed2Go division, and has also authored a math textbook. She has presented continuing education at the NPTA annual convention and many programs locally in her home state of Colorado. Acknowledgements The author wishes to thank the reviewers and editors for their invaluable input.

The author would also like to thank her husband for providing the time and much needed support, which made the production of this text possible. About the CPhT Examination Structure of the Examination The PTCB examination consists of 90 questions. It is a timed test, which lasts for two hours. This means that you must pace yourself in answering the questions.

There are three general areas in which competency will be assessed: 1. Assisting the pharmacist in serving patients. This section includes a discussion of the day-to-day procedures in pharmacy practice, such as: • • • interpretation of the prescription order; preparation and use of the patient pro?le; and the dispensing, labeling, storage, and delivery of medications.

Also included are discussions on the various aspects of preparing a dosage form for administration, such as: • • • • • • pharmaceutical calculations, including: dosage conversions intravenous medications preparation of IV admixtures administration of drug dose per time commercial calculations Computation of markup and selling price is also covered in this section, along with a thorough discussion of pharmacology.

This will prepare the technician for assisting the pharmacist in the evaluation of proper prescribing procedures, identifying possible drug interactions and therapeutic duplications, and evaluation of the treatment regimen to assure that the patient has received a prescription for the correct drug in the correct dosage for his or her needs. The questions pertaining to assisting the pharmacist will make up 66% of the exam. Both hospital and retail settings will be discussed, and the student will be expected to know the differences in procedures between the different practice settings.

xv xvi About the CPhT Examination The questions following the chapter material will require you to think about why things are done a certain way (with responsibility comes challenge). EXAMPLE Why is certain information required to be placed onto the prescription order and patient pro? le? Why do we have the patient pro? le at all? Why do we use aseptic technique when preparing intravenous medications? This book will train you to think about the reasoning behind procedures as you answer the questions. 2. Maintaining medication and inventory control system.

This portion addresses the proper way to store medication and drug products in the pharmacy; procedures for ordering and inventory of drugs, drug products, and devices; drug prepackaging and distribution; and unit dose distribution, labeling, and mandatory record-keeping. These questions will make up 22% of the exam. 3. Administration of and management of pharmacy practice. This section addresses safety concerns, cleanliness, infection control, pharmacy law, communications, and automation (e. g. , computers). These questions make up 12% of the exam. The ICPT examination consists of 110 questions. It is a timed test, which last two hours.

This means you must pace yourself in answering the questions. The competency will be assessed in three general areas: 1. Regulations and technician duties. This section will include an overview of technician duties and general information, including: • • • • • • • • • • • • • • • Roles of pharmacists and technicians Functions a technician may perform Prescription work ? ow Security Inventory control Stocking medications Expired products Controlled substances, including: Drug schedules Re? lls, ? ling and transfers Procedure for schedule V sales Control Substance Act DEA numbers Other laws and regulations, including: Federal laws

About the CPhT Examination xvii • • • • • Generics substitutions Roles of government agencie Prescribing authority Manufacturer drug package labeling OTC labeling The questions pertaining to the regulations and technician duties will make up 25% of the exam. 2. Drugs and drug therapy. This section will include the following: • • • • • • • • • • Drug classi? cation Major drug classes Dosage forms OTC products NDC numbers Frequently prescribed medications, including: Brand and generic names Pharmacology and classi? cations Indications Adverse drug reactions and contraindications

The questions pertaining to drugs and drug therapy will make up 23% of the exam. 3. Dispensing process. This section will include the following: • • • • • • • • • • • • • • • • Prescription information Valid prescription information Telephone/fax prescriptions Re? ll requirements Patient information Common abbreviations Preparing/dispensing prescriptions, including: Avoiding errors Checking prescriptions Automated dispensing systems Procedures for data entry Labeling properly Use of patient records Packaging and storage Managed care prescriptions Calculations, including:

xviii About the CPhT Examination • • • • • • • • • • • • • • • • • Conversions Calculating prescription ingredients Calculating quantity to be dispensed Calculating daily doses Compounding calculations IV calculations Business calculations Sterile products, unit dose and repackaging, including: Drug distribution systems Repackaging medications Compliance aids Aseptic technique and laminar ? ow hoods Chemotherapy Routes of administration for parenteral products Types of sterile products Procedures for maintaining sterile environments Accurate compounding and labeling of sterile products

The questions in this section will make up approximately 52% of the exam. Taking the Examination You should read the booklet that came with your application carefully. It contains a lot of useful information, such as what you should bring to the exam. You should also be aware that the actual examination will not simply test on memorized information. Questions and problems will require the student to think and synthesize information. It is also helpful if you know how to take the test (see below). NOTE When using this text to prepare for the exam, bear in mind that the certi?

Cation examination is now a national examination, and, since laws vary from state to state, information that may be considered correct for the examination may not be exactly the same as what you have learned in practice. Answering Questions on the Examination Since the test is in multiple-choice format, you must know how to take multiple-choice tests. You will not know all of the information; however, you can use what you do know to choose the correct answer. About the CPhT Examination xix Take the time to look at the question.

Perhaps a question asks which of the following drugs is a diuretic. The potential answers are: streptomycin, penicillin, tobramycin, and mannitol. You panic because you have no clue. Instead, you should look carefully at the answers, bearing in mind that only one is correct. Everyone (hopefully) knows that penicillin is an antibiotic. Scratch that one. Two of the answers end in the same thing: streptomycin and tobramycin: It is likely (but not necessarily a given fact) that they do similar things. The only one that is left is mannitol, which happens to be the right answer.

NOTE If you take the time to look at the question and all of the answers given, and think your way through the problem using the knowledge that you do have, it is time well spent. More wrong answers are made on exams because students get nervous and change their initial (correct) answer to another (incorrect) answer. Read the question. Another thing that you must be sure to do is read the question carefully. Ask yourself “What is the question asking? ” Then, if you can, answer the question in your head before looking at the answers provided. If you do not, the answers will confuse you.

A standard way of making up multiple-choice tests is to ask a question and then think of all the ways a student could interpret the question, or the mistakes that could easily be made, and then make the incorrect answers from that. It is not that the exam is unfair; the questions are simply testing your knowledge, which includes the ability to distinguish ? ne points. So always answer the question ? rst in your head, and then look for your answer in the choices given. Don’t panic. Do not let the questions or answers intimidate you. Let’s say you are answering a math problem. You come up with an answer and ?

nd it in the list, but the other answers are the same as yours, except for a zero or decimal place. If you did the calculation correctly, your answer is correct. Do not second-guess yourself. More wrong answers are made on exams because students get nervous and change their initial (correct) answer to another (in- correct) answer. You have prepared for this exam—act like it! Have con? dence in what you can do. Scoring. This exam, like many standardized exams, does not have one passing score. The passing score is different for each exam, because the people who make up the questions assign a dif?

culty rating to each question, and the average dif? culty rating for all of the questions on a particular exam determines the passing score. Thus, the passing score for an exam given in one session will not be the same as another, as the examinations will vary in dif? culty. Bear this in mind, and if the questions seem to be extremely dif? cult, don’t despair. This may mean that the passing score is lower as well. Don’t panic—attack the exam logically. xx About the CPhT Examination Preparing for the Examination First, take the “pretest” to determine which sections of the book to review ?

rst. There is a Quick Study guide at the beginning of each chapter for quick review. Study this ? rst, then read through the chapters for approaches to thinking and important details. Then, as you continue to go through the book, practice doing the problems in each section, even if they seem too easy or too hard. The answers are explained for you, so use these to channel your thinking about how to approach the questions in a certain way. Ask yourself questions about the material, and see if you can come up with the answers either on your own or from the text material.

Ask yourself why! Finally, take the practice test. Taking the Practice Test When you take the practice test, you should sit in a room with conditions that may not be the best for you. The examination center may not be as warm or as cool as you like, and there will be many other people there who will be making at least a small amount of noise (excessive erasing, drumming ? ngers or tapping feet, clearing throats, heavy breathing, etc. ). Practice concentrating under the worst conditions—anyone can concentrate in a climate-controlled, comfortable, quiet room!

If you can do well under the worst conditions, you will do even better if the conditions are most favorable for you. If possible, have some others next to you when taking the practice test. These exams are often in close quarters. Finally, grade the exam, using the answer key. Determine which questions you missed and why. Study those parts again. Now you will have prepared for many things that can come your way (one can never be prepared for everything—that’s where the thinking part comes in). You are ready to take the exam. Before the Examination—Helpful Hints.

Get a good night’s sleep before the exam. Know where the exam is to be held, exactly how to get there, and where to park. Make a dry run, in order to ? nd out how much time it will take you to get there, park, and get to the examination room—then add an extra few minutes. This way, when the test day arrives, you will arrive on time with a minimum of frustration. Get adequate nutrition before the exam. Remember, the brain runs on glucose. If you do not feed it, it will not work. So, on the morning of the exam, be sure to eat a good breakfast, even if you are not hungry.

This is more important than you might think! Avoid drinking a lot of coffee; substitute juices instead. You may wish to bring a sweater, in case the examination room is cold. You have prepared, so you should not be nervous. If you are, try looking over the section outlines in the book or notes that you have taken for yourself. If it all looks too familiar, you should be ready. Good luck! S E C T I O N I Assisting the Pharmacist in Serving Patients THIS SECTION of the book reviews the content in the ? rst functional area as tested in the ICPT or PTCB exam.

This comprises 52% (ICPT), and 66% (PTCB) of the examination questions. Due to the length of this section, it will be broken down into four parts: Part A. Filling the Medication Order Part B. Pharmaceutical Calculations Part C. Pharmacology Part D. Pharmacy Law 1 P A R T A Filling the Medication Order Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Receiving the Medication Order Processing the Medication Order Preparation and Utilization of the Patient Pro? le Handling Medications Proper Storage and Delivery of Drug Products Receiving Payment for Goods and Services.

3 C H A P T E R 1 Receiving the Medication Order Quick Study I. The retail medication order A. Information required to be present on the prescription at the time of acceptance— written in ink or typed on the prescription form • The patient’s full name • The date of issue of the prescription: Prescriptions are typically valid for one year, depending on state regulations, with the exception of prescriptions for controlled substances (Schedules II–V), which are valid for three days to six months depending on the drug, state of issue, and the classi?

cation (II–V) • The name and title of the prescriber • The Drug Enforcement Agency (DEA) number assigned to the prescriber (this information is required for controlled substances only, and may be added by pharmacy personnel) • The name of the drug prescribed (generic or brand name) • The strength and dosage form of the drug prescribed (see exceptions) • The quantity of drug to be dispensed • The instructions for dosage (SIG) • The signature of the prescriber, in ink • Authorization to dispense a generic substitution: required for substitution of proprietary label only.

When “dispense as written” (DAW) or “brand name medically necessary” designation is present, there is to be no substitution of any kind, including the substitution of another proprietary label. • Re? ll information: must be clearly written in the appropriate blank on the form (or the number of re? lls circled). A re? ll authorization may be made to extend 4 Chapter 1: Receiving the Medication Order 5.

B. C. D. E. F. the original prescription, but a new prescription must be written. This is the responsibility of the pharmacist in most states. • Instructions for preparation of the drug, if applicable: If preparation of the drug is required, detailed instructions must be given; otherwise it is considered extemporaneous compounding and must be done by the pharmacist.

Information to be added to the prescription form at the time of acceptance • The address and telephone number of the patient: used to identify the patient and assist in medication recalls • Age or date of birth of the patient: used to identify the patient and to verify that the dose prescribed is appropriate • Allergies and concurrent medications: used to prevent potential allergic reactions, drug interactions, adverse effects, and therapeutic duplications (information is found in patient pro? le)

• The insurance coverage of the patient may also be noted Authentication and clari? cation of the prescription order • Veri? cation of medication and the amount prescribed • Signature veri? cation • Veri? cation of DEA number Accepting prescriptions for controlled substances • Prescriptions for drugs classi? ed under Schedule II • Some states require that all information be present on triplicate form: No writing on the form is allowed.

• Prescriptions for controlled substances expire quickly—based on state regulations, those for Schedule II drugs may expire within a few days in some states or up to six months in other states, and those for drugs falling under Schedules III–IV may be valid for six months following the date the prescription was written.

Receiving prescriptions by electronic means (telephone, fax machine, modem, or e-mail) • May be accepted by licensed practitioner (i. e. , pharmacist, intern, nurse) only • Must be immediately transcribed onto a “hard copy” Accepting re? ll requests: A re? ll request by a patient can be accepted by the technician. Changes in amount or form of the drug dispensed can only be made by the pharmacist. II. The institutional medication order and MAR A.

The hospital medication order may include: • More detail than the retail prescription • Patient location, billing number, diagnosis, height, weight, diet, and medical tests • Directions for use of medications and/or instructions for compounding • The times of initiation and discontinuation of drug therapy are speci? ed 6 Section I: Assisting the Pharmacist in Serving Patients B. Structure and use of the MAR • The MAR is prepared in the pharmacy from the medication order. • Medications are administered by work schedule, according to the 24-hour clock.

• The MAR serves as a legal record of drug administration for administrative and billing purposes. C. Filling the medication order • Calculation of the amount of drug required per dose (unit dose) • Preparation of the correct amount of drug in the correct vehicle for delivery • Preparation and placement of the appropriate label • Placement of the prepared daily doses into an appropriately labeled cassette for placement into the medication cart • Preparation of the MAR from the medication order D. Preparation of unit dose medications III.

Comparison of medication orders in retail and institutional settings • • • • • Differences in amount of detail presented: instructions, dosing schedules, etc. More detailed identifying information is presented on the hospital order: This helps ensure the administration of drugs to the proper patient. More information is present on the hospital order (e. g. , laboratory tests, diet). DEA numbers of individual prescribers are not required. Special documentation for controlled substance prescription is not required on the hospital order.

The Retail Medication Order The retail medication order (prescription) may be communicated to the pharmacy by several means—it may be presented by the patient or communicated by telephone, fax, or e-mail. Schedule II Drugs have speci? c criteria for presenting a prescription. The Written Prescription Order At the retail pharmacy window, the medication order (prescription order) is received written on a form that is normally preprinted with certain information. If the required information is not preprinted, it may be written in or typed on the form.

The prescription order must be completed in ink or typed to avoid possible alteration, and it must contain speci? c information when it is received in the pharmacy. If the prescription is incomplete or illegible, it cannot be ? lled, and the patient should be referred back to the prescriber or to the pharmacist. Chapter 1: Receiving the Medication Order 7 Required Information on the Prescription Order Information on the upper portion of the prescription form must include the following (see Figure 1-1): The date the prescription was written helps to determine if the prescription may be ? lled.

• • The patient’s full name: This is required for positive identi? cation. The date of issue of the prescription: The date of writing helps to determine if the prescription may be ? lled. It should be noted that the laws regarding prescription ? lling do vary from state to state. However, since the certi? cation exam is based on federal laws, the normal rule of thumb to remember is this: Prescriptions are valid only for one year after being written with the exception of prescriptions for controlled substances (Schedule II–Schedule V), which are valid for six months or less.

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