PTCB EXAM PREPARATION

DAW (Dispense as Written) codes

used by prescribers and pharmacies to tell payers whether a brand-name drug or its generic equivalent should be dispensed

indicating rules for product selection for that prescription

Codes range from 0 (no product selection indicated) to 9

DAW 0

No product selection indicated

No product selection is indicated; generic substitution is permitted by the prescriber

DAW 1

Substitution not allowed by provider

Substitution is not allowed by the prescriber / provider

often meaning the brand-name drug is medically necessary

DAW 2

Substitution allowed: patient requested product dispensed

Substitution is allowed, but the patient specifically requested the brand-name product dispensed

DAW 3

substitution allowed: pharmacist selected product dispensed

Substitution is allowed, but the pharmacist selected the brand-name product

brand is less expensive

DAW 4

substitution allowed: generic drug not in stock

Substitution is allowed, but the generic drug is not in stock

DAW 5

substitution allowed: brand drug dispensed as generic

Substitution is allowed, and the brand-name drug is dispensed as a generic

DAW 6

override

An all-purpose override code

DAW 7

substitution not allowed: brand drug mandated by law

Substitution is not allowed because the brand-name drug is mandated by law. 

DAW 8

Substitution allowed: generic drug not available in marketplace

Substitution is allowed, but the generic drug is not available in the marketplace. 

DAW 9

other

Schedule C-I

NO accepted medical use, HIGHEST abuse potential

Examples: Heroin, LSD, marijuana (federally), ecstasy

Schedule C-II

HIGH abuse potential, severe dependence risk

Examples: Morphine, oxycodone, fentanyl, Adderall, Ritalin, cocaine

Rules: No refills, written Rx required (EPCS allowed), emergency 72-hr supply only

Schedule C-III

MODERATE abuse potential

Examples: Tylenol with codeine, testosterone, anabolic steroids, ketamine

Rules: Max 5 refills in 6 months, can transfer once

Schedule C-IV

LOW abuse potential

Examples: Xanax, Ativan, Valium, Ambien, Tramadol

Rules: Max 5 refills in 6 months, can transfer once

Schedule C-V

LOWEST abuse potential

Examples: Lomotil, cough syrups with <200mg codeine/100mL

Rules: Max 5 refills in 6 months, can transfer once

DEA Form 222 / CSOS

Ordering Schedule II controlled substances

DEA Form 106

Reporting theft or significant loss of controlled substances

DEA Form 41

Disposal and destruction of controlled substances

Drug Recall Classifications: Class I

Most serious - reasonable probability of serious health consequences or DEATH

Drug Recall Classifications: Class II

Moderate - may cause temporary or medically reversible adverse effects

Drug Recall Classifications: Class III

Least serious - unlikely to cause adverse health consequences

PO

By mouth (oral)

Enteral route

SL

Sublingual (under tongue)

Enteral route

PR

Per rectum (rectal)

Enteral route

IV

Intravenous (into vein)

Parenteral route

IM

Intramuscular (into muscle)

Parenteral route

SubQ / SC

Subcutaneous (under skin)

Parenteral route

ID

Intradermal (into dermis)

Parenteral route

U or u

Unit

DO NOT USE

Write "unit"

IU

International unit

DO NOT USE

Write "international unit"

Q.D., QD, qd

Daily

DO NOT USE

Write "daily"

Q.O.D., QOD

Every other day

DO NOT USE

Write "every other day"

Trailing zero (5.0 mg)

5 milligrams

DO NOT USE

Write "5 mg"

No leading zero (.5 mg)

0.5 milligrams

DO NOT USE

Write "0.5 mg"

MS, MSO4, MgSO4

Morphine sulfate or Magnesium sulfate

DO NOT USE

Write full names

ac

before meals

pc

after meals

bid

twice daily

tid

three times daily

qid

four times daily

qhs

at bedtime

prn

as needed

stat

immediately

NPO

nothing by mouth

aa

of each

qs

quantity sufficient

ud / ut dict

as directed

disp

dispense

HIPAA

Patient Privacy

Protects Protected Health Information (PHI)

Requires patient consent for disclosure

Technicians must maintain strict confidentiality

OBRA '90

Requires pharmacist counseling for Medicaid patients

Mandates Drug Utilization Review (DUR)

Combat Methamphetamine Epidemic Act

Pseudoephedrine sales limits: 3.6g per day, 9g per month

Must be behind counter, requires ID and logbook

PTCB Certification Requirements

Requires PTCB-recognized education program OR 500 hours work experience

Recertification every 2 years with 20 CE hours

Technician Scope of Practice

CAN do: Counting tablets, labeling, inventory, data entry

CANNOT do: Counseling, DUR, clinical judgments, therapeutic substitutions

Must refer to pharmacist: Drug interactions, OTC recommendations, adverse events

Insurance Card Information 

BIN (Bank Identification Number): 6-digit number identifying insurance processor

PCN (Processor Control Number): Identifies specific benefit plan or network

Group Number: Identifies employer or plan group

Member ID: Unique identifier for insured person

Person Code: 01=Cardholder, 02=Spouse, 03+=Dependents

Government Insurance Programs

Medicare Part D: Prescription drug coverage for age 65+, disabilities, ESRD

Medicaid: State/federal program for low-income individuals

TRICARE: Military health coverage, Workers' Comp: Work-related injuries

Common Rejection Codes - MUST KNOW

Refill Too Soon: Patient requesting refill before allowed

Prior Authorization Required: Insurance requires approval before covering

Non-Formulary Drug: Medication not on insurance formulary

Patient Not Found/Invalid ID: Insurance information incorrect

DAW Codes - Dispense as Written

DAW 0: No product selection indicated (generic OK)

DAW 1: Substitution not allowed by prescriber (brand medically necessary)

DAW 2: Substitution allowed, patient requests brand

Orange Book Therapeutic Equivalence

A-Rated Drugs: Therapeutically equivalent to reference drug, can be substituted

AB Rating: Most important - meets bioequivalence standards, substitutable

B-Rated Drugs: NOT therapeutically equivalent, cannot be automatically substituted

Inventory Management - Key Concepts

FEFO (First Expired, First Out): Preferred method, dispense medications closest to expiration first

Turnover Rate = Total Sales ÷ Average Inventory (typical pharmacy: 10-12 times/year)

Par Level System: Min = reorder point, Max = stock up to this level

Perpetual Inventory: Required for C-II, continuous tracking of every receipt and dispensing

FDA Recall Classes

Class I: Serious harm or death likely

Class II: Temporary or reversible harm possible

Class III: Unlikely to cause harm

The Five Rights - CRITICAL FOUNDATION

Right Patient: Verify name (first AND last), date of birth, two identifiers

Right Drug: Verify medication name (brand AND generic), check LASA medications

Right Dose: Verify strength matches prescription, calculate correctly

Right Route: Verify route of administration, ensure dosage form matches route

Right Time: Verify frequency and timing, ensure patient understands when to take

High-Alert Medications - MUST MEMORIZE

Anticoagulants: Heparin, warfarin, enoxaparin, DOACs (risk: bleeding)

Insulin: All forms (risk: hypoglycemia or hyperglycemia)

Opioid Analgesics: Morphine, hydromorphone, fentanyl (risk: respiratory depression)

Chemotherapy: Methotrexate, vincristine (risk: severe toxicity)

Concentrated Electrolytes: KCl, NaCl >0.9%, MgSO4 (risk: cardiac arrest)

Look-Alike/Sound-Alike (LASA) Medications - CRITICAL

Celebrex (celecoxib) / Celexa (citalopram) / Cerebyx (fosphenytoin)

hydrALAZINE / hydrOXYzine

predniSONE / prednisoLONE

glipiZIDE / glyBURIDE

vinBLAStine / vinCRIStine (chemotherapy - FATAL if confused)

Tall Man Lettering

Capitalize dissimilar portions to highlight differences

Narrow Therapeutic Index (NTI) Medications

Small difference between therapeutic dose and toxic dose

Common NTI drugs: Warfarin, Digoxin, Phenytoin, Lithium, Theophylline

Levothyroxine, Carbamazepine, Cyclosporine, Tacrolimus

Leading and Trailing Zeros - CRITICAL

Trailing Zero (NEVER USE): Wrong: 5.0 mg → Risk: Read as 50 mg (10x overdose)

Leading Zero (ALWAYS USE): Right: 0.5 mg (Wrong: .5 mg → Risk: Read as 5 mg)

TJC 'Do Not Use' Abbreviations

U or u → Write 'unit'

IU → Write 'international unit'

QD, qd → Write 'daily'

QOD, qod → Write 'every other day'

MS, MSO4, MgSO4 → Write full drug names

REMS Programs 

iPLEDGE (Isotretinoin): Birth defects risk, requires monthly enrollment, pregnancy tests

Clozapine REMS: Agranulocytosis risk, regular blood monitoring required

TIRF REMS: Fentanyl products for breakthrough cancer pain

Drug Interactions - Key Types

Grapefruit Juice: Inhibits CYP3A4, increases levels of statins, calcium channel blockers

Warfarin + Vitamin K foods: Need consistent intake of leafy greens

St. John's Wort: CYP450 inducer, decreases effectiveness of birth control, warfarin

Tetracycline + Dairy: Calcium binds antibiotics, take 2 hours before/after dairy

Medication Error Reporting

MedWatch (FDA): Report adverse drug events, product quality problems, errors

ISMP: Institute for Safe Medication Practices, confidential error reporting

Near Miss: Error caught before reaching patient, important to report for learning

Root Cause Analysis (RCA): Systematic investigation to identify underlying causes

Types of Medication Orders - CRITICAL

STAT: Immediate, one-time dose for emergencies

ASAP: High priority, within 30-60 minutes

Routine/Scheduled: Ongoing therapy at regular times

PRN: As needed, must specify indication and frequency limits

Standing Orders: Pre-approved protocols, Verbal Orders: Must be signed within 24-48 hours

Unit Dose System - Key Advantages

Reduces medication errors (pre-measured, labeled doses)

Decreases waste (unused medications can be returned)

Improves inventory control and billing accuracy

Cart filling: 24-hour supply most common, 72-hour for weekends

Automated Dispensing Cabinets (ADC) - Know This

Common systems: Pyxis (BD), Omnicell, AccuDose

Open Access: No restrictions (non-controlled, low-risk items)

Profile Access: Links to patient profiles (most common for routine meds)

Controlled Access: Highest security for narcotics (may require two-person sign-off)

IV Therapy - Classifications

Large Volume Parenterals (LVP): ≥100 mL (examples: 1000 mL NS, 500 mL D5W)

Small Volume Parenterals (SVP): <100 mL (examples: 50 mL piggyback)

IVPB (IV Piggyback): Secondary bag, infused over 30 min-2 hours

IV Push: Direct injection, 1-5 minutes; IV Bolus: Rapid administration

IV Flow Rate Formula - MEMORIZE

Flow Rate (mL/hr) = Total Volume (mL) ÷ Time (hours)

TPN (Total Parenteral Nutrition)

Complete nutrition delivered IV for patients who cannot eat

Components: Amino acids (protein), Dextrose (carbohydrate), Lipids (fat), Electrolytes, Vitamins, Trace elements

Must be refrigerated, infused via central line, 24-hour hang time maximum

Beyond-Use Dating for Repackaged Meds - BUD - EXTREMELY HIGH-YIELD

Repackaged solid oral dosage forms BUD = SHORTER of:

25% of time remaining until manufacturer expiration OR 6 months

Can NEVER exceed 6 months, even if 25% is greater

Required Label Info for Repackaged Medications

Drug name, strength, dosage form, beyond-use date

Lot number, quantity, storage requirements, manufacturer name

Compounding Equipment - Know These

Class III Prescription Balance: Minimum weighable quantity 120 mg, sensitivity 6 mg

Electronic Balance: More accurate (0.001 g or 1 mg sensitivity)

Mortar & Pestle: Glass (liquids, oily), Wedgwood/Porcelain (powders)

Graduated cylinders for measuring liquids (more accurate than beakers)

Key Compounding Techniques

Trituration: Reducing particle size by grinding in mortar and pestle

Levigation: Reducing particle size using a liquid (levigating agent)

Geometric Dilution: Mix small amount with equal amount, double each time

Spatulation: Mixing semisolids with spatula on ointment slab

Aliquot Method: Used when amount needed is below minimum weighable quantity

Beyond-Use Dating for Compounded Preparations - CRITICAL

Water-containing formulations: 14 days refrigerated (high contamination risk)

Non-aqueous solids/semi-solids: 25% of remaining time OR 6 months (shorter)

All other formulations: 30 days

ISO Classifications - International Organization for Standardization - MUST MEMORIZE

ISO Class 5: Cleanest, where compounding occurs (DCA - Direct Compounding Area)

ISO Class 7 (Buffer Area/Clean Room): Where PEC is located, minimum 30 air changes/hour

ISO Class 8 (Anteroom): Hand hygiene and garbing area, minimum 20 air changes/hour

Primary Engineering Controls (PECs)

Laminar Airflow Workbench (LAFW): Horizontal or vertical flow, for non-hazardous drugs

Biological Safety Cabinet (BSC): Negative pressure, for hazardous drugs

Compounding Aseptic Isolator (CAI): Closed system, non-hazardous

Compounding Aseptic Containment Isolator (CACI): For hazardous drugs

HEPA Filters - Key Facts

99.97% efficient at removing particles ≥0.3 microns

Work at least 6 inches inside hood, never block airflow between HEPA filter and critical site

Garbing Order - MUST KNOW EXACT SEQUENCE

In Anteroom (ISO Class 8):

1. Remove personal items (jewelry, cosmetics, outer garments)

2. Don shoe covers

3. Don head/hair cover (bouffant) - cover ALL hair

4. Don face mask (cover nose and mouth)

5. Perform hand hygiene (30 seconds minimum)

In Buffer Area (ISO Class 7):

6. Don non-shedding gown (cuffs tucked into gloves)

7. Don sterile gloves (extend over gown cuffs, sanitize with 70% IPA)

Critical Sites - Never Touch

Any surface that contacts sterile product

Examples: Needle hub/shaft, syringe tip, vial stopper (after cleaning), ampule neck, IV ports

Vials vs. Ampules

Single-Dose Vial (SDV): No preservatives, use within 1 hour once punctured

Multi-Dose Vial (MDV): Has preservatives, BUD 28 days after opening

Ampules: Use filter needle to withdraw (filters glass), must change to regular needle before injecting

Beyond-Use Dating for Sterile Preparations

Room temp 12, 30, 24 (hours)

Refrigerated 24 hr, 9 days, 3 days

Frozen: all 45 days

Category 1: Simple transfer (1-2 ingredients) | Category 2: Multiple ingredients | Category 3: Non-sterile ingredients

Category 1 (Low Risk) - 12 hours - 24 hours - 45 days

Category 2 (Medium Risk) - 30 hours - 9 days - 45 days

Category 3 (High Risk) - 24 hours - 3 days - 45 days

Hazardous Drugs (USP <800>)

Must use BSC or CACI (negative pressure)

Two pairs of chemotherapy gloves (change outer gloves every 30 minutes)

Chemotherapy gown, face shield/goggles, all materials disposed as hazardous waste

Cleaning - Sterile 70% Isopropyl Alcohol (IPA)

Clean PEC daily: sides (back to front), back wall (top to bottom), work surface

Allow to air dry completely (minimum 10-second contact time)

Sanitize gloved hands before compounding, every 30 minutes, after touching non-sterile surfaces

Roman Numerals - Essential for Reading Prescriptions

Basic values: I=1, V=5, X=10, L=50, C=100, D=500, M=1000, ss=½

Subtractive notation: IV=4, IX=9, XL=40, XC=90

Read left to right, subtract when smaller value behind larger

Metric System Conversions - MEMORIZE THESE

Weight:

1 kg = 1,000 g 

1 g = 1,000 mg 

1 mg = 1,000 mcg

Volume:

1 L = 1,000 mL

Household Conversions - Common on PTCB

1 tsp = 5 mL

1 tbsp = 15 mL = 3 tsp

1 fl oz = 30 mL = 2 tbsp

1 cup = 8 fl oz = 240 mL

Critical Calculation Methods

Ratio & Proportion: Most common method! Set up: Known ratio = Unknown ratio, then cross multiply

Days Supply Formula: Total Quantity Dispensed ÷ Quantity Per Day

Dosage Calculation: (Dose Ordered ÷ Dose Available) × Quantity = Amount to Give

Dilution Formula: C1 × V1 = C2 × V2

Percent Strength: w/v = grams per 100 mL

Primary References - Official Standards

USP-NF: Official drug compendium, includes USP <797> for sterile compounding

Package Inserts: FDA-approved manufacturer information

SDS (Safety Data Sheets): Hazardous material handling information

Tertiary References - Quick Access Resources

Drug Facts and Comparisons: Comprehensive drug comparison guide

AHFS Drug Information: Evidence-based monographs

Lexi-Comp: Electronic drug database for interactions and dosing

Prescription Components - ALL Required

Prescriber info: Name, address, phone, DEA number (for controls), signature, date

Patient info: Full name, address, date of birth

Rx symbol (℞): Means "take thou" from Latin recipe

Inscription: Drug name, strength, dosage form

Subscription: Quantity to dispense

Signa (Sig): Patient directions for use

Refills: Number authorized by prescriber

DAW Codes - Know These for Order Entry

DAW 0: Generic substitution permitted

DAW 1: Prescriber requires brand name (no substitution)

DAW 2: Patient requests brand name

Prescription Processing Workflow - 8 Steps

1. Receive and Review → 2. Enter/Input → 3. DUR (Drug Utilization Review)

4. Fill/Prepare → 5. Label → 6. Final Check (Pharmacist)

7. Counseling → 8. Dispense