ExCPT Pharmacy Tech Exam

Pharmacists duties are

clinical

Where will a medication with the prescription sig code "ii gtts os tid" be used?

Left eye

Room Temperature

20-25 degrees C

Refrigerator Temperature

1.7-7.8 degrees C

Freezer Temperature

-15+ degrees C

Celsius & Fahrenheit Conversion

5F=9C+160

What is the expiration date for insulin in the fridge? Outside the fridge?

Manufacturer's date; 28 days

Disposal of Controlled Substances

1. Remove med from inventory

2. Complete DEA-41 form

3. Dipose

*2 witnesses on required to dispose

Medication Recall on Class I

strong chance of serious adverse effects or death

Medication Recall on Class II

temporary (but reversible) chance of adverse effect or little chance of serious adverse effect

Medication Recall on Class III

problem that's not likely to cause any adverse effects

A vial of insulin is removed from the refrigerator to compound an IV bag on April 1. When should the vial be discarded if stored at room temp?

April 29

USP 800

hazardous medications

P-listed Meds

Acutely hazardous; empty containers are considered hazardous

Epinephrine, Nicotine, Warfarin are

P-listed meds

D-listed Meds

toxic, ignitable, corrosive, or reactive; potential to get into drinking water

Benzoyl Alcohol, Albuterol Inhalers, Silver Sulfadiazine are

D-listed meds

U-listed Meds

toxic; usually chemo

Cyclophosphamide, Mercury, Mitomycin are

U-listed Meds

What are statutes and who passes them?

Statutes are enacted laws and legislatures pass them.

What happens if there are federal and state laws covering the same things?

The more stringent law takes precedence.

What is a PPI?

Product Package Insert; prescribing info for prescribers and dispensers

MedWatch

Reporting program for adverse reactions to medications

CSA

Controlled Substances Act of 1970

DEA

Drug Enforcement Agency

HIPAA

Health Insurance Portability & Accountability Act of 1996

What is the name of the principle that requires pharmacy professionals to disclose only the info other parties require about a patient?

Minimum Necessary Standard

How often must employers of pharmacy staff provide training about HIPAA's privacy and security rules?

Annually

OBRA

Omnibus Budget Reconciliation Act of 1990; requires pharmacists to keep records for all medications that medicaid recipients use and to offer counseling

Can technicians offer advice? Can they read info from the label or the medication guide?

No, yes

What is a legend statement?

The "Rx Only" or "Caution: Federal Law prohibits dispensing without a prescription"

What does an NDC consist of?

1st 4-5: Manufacturer

2nd 3-4: Name, Strength, Dosage

Last 2: Package Size

How many numbers does an NDC contain for billing? What happens if there aren't that many?

11; zeros are added to the appropriate area

What is the general rule for how much of a prescription a patient must use before health insurance will cover a refill?

75%

Poison Prevention Packaging Act of 1970

Requires child-resistant packaging on any substance that could cause serious injury to children

What must be dispensed in its original, unopened containers?

Sublingual Nitroglycerin and Sublingual/Chewable Isosorbide

When should sharps containers be sealed and replaced?

After they are 75% full

PMPs

Prescription Monitoring Programs; track controlled prescription medications dispensed w/i the state

When reviewing the quantity requested on a prescription for a controlled substance, what might be a sign of forgery?

An unusually large quantity

What do patient profiles contain?

Demographics, medication/prescription history, medication allergies, conditions/diseases, 3rd party info

Controlled Substances Act of 1970

categorized drugs identified as controlled substances into 5 groups/schedules

Schedule I Drugs

Highly addictive and completely illegal

Schedule II Drugs

High potential for abuse; morphine, oxycodone, hydrocodone, meth, etc.

Schedule III Drugs

Moderate-low potential for dependence; acetaminophen w/ codeine, testosterone, anabolic steroids, etc.

Schedule IV Drugs

Low potential for abuse; Diazepam, Zolpidem, Clonazepam, etc.

Schedule V Drugs

Contain limited quantities of some narcotics; pregablin, guaifenesin w/ codeine, etc.

Steps to Determine DEA #

1. Add 1st, 3rd, 5th digits

2. Add 2nd, 4th, 6th and multiply by 2

3. Add results of steps 1 and 2

4. Check that last digit of the summed is same as last digit of the DEA #

CII Refills

None allowed

CIII & CIV Refills

5 times w/i 6 months after date of pres. issue

CV

5 times w/i 6 months

When did the DEA give prescribers the option to write electronic prescriptions for controlled substances?

June 1, 2010

Combat Methamphetamine Epidemic Act of 2005

Regulates sales of OTC products containing ephedrine, pseudophedrine, and phenylpropanolamine (meth precursors)

*SALES CAN'T EXCEED 3.6 g/day & 9 g/month

*NON-LIQUID MUST BE IN 2-UNIT BLISTER P'S

DEA Form-222

ordering/transferring CII drugs

How is a DEA Form-222 filled out by the pharmacist? Where do the copies go?

In triplicate; 1st=supplier, 2nd=DEA, 3rd=Pharmacy

What is the name of the system allowing for online ordering of CII's?

Controlled Substance Ordering System (CSOS)

DEA Form-41

used for disposal of controlled substance

DEA Form-106

used to report loss/theft of controlled substances

What are dosage forms?

various formulations in which medications are available (solids, semisolids, solutions)

Sublingual

Under the tongue

Buccal

between the cheek and gums

LA, SA, SR, CR, ER, TR

long-acting

sustained action

sustained release

controlled release

extended release

time release

Enteral

through GI

Parenteral

outside GI tract

Otic Route

inside the ears

Side Effect

expected

Adverse Effect

undesirable, sometimes dangerous

Contraindications

diseases, disorders, conditions making it unsafe or harmful for patients to take a certain med

What are common signs of instability in a medication?

1. Discoloration

2. Separation

3. Uncharacteristic Odor

4. Texture Changes

5. Visible Contaminants

6. Precipitation

Visible vs. Invisible Incompatabilities

Visible: apparent; gas, odor, hazy happens when mixed

Invisible: no apparent incompatibility, but could be causing ineffectiveness/degradation in one another when mixed

Vaccine Schedules

1. Birth-18 years

2. Adult

What steps should be taken if a prescription is illegible?

Ask the pharmacist if they can decipher. If not, contact the prescriber.

DAW

Dispense as Written

How long is an Rx for noncontrolled medication valid?

1 year from written date

BIN

Processor Bank Identification Number

6 digit number assigned used for electronic routing of prescriptions

PCN

Processor Control Number

secondary identifier used in routing prescriptions

DUR

Drug Utilization Reviews

alerts prescribers of inappropriate/unapproved med usage

Rx Group Number

identifies the plan a member falls under

Person Code

identifies which household member is receiving services

Who is a third-party program comprised of?

Patient, pharmacy, and insurance/government program

Where are claims processed?

Computer

Who standardizes rejection messages?

National Council for Prescription Drug Programs (NCPDP)

Prior Authorization

process some health insurance companies use to determine whether they will cover a procedure, med, service

What are tiered copayments?

different copays for medications in different tiers

What is a formulary?

an Rx that is on a list of meds covered by a health care benefit plan

What is coordination of benefits?

practice of ensuring that insurance claims are not paid multiple times

**When using COB, make sure that insurances are in proper billing order

How does Medicare or Medicaid work with COB?

They are always billed last

What is DME?

Durable Medical Equipment

equipment providing therapeutic benefits to a patient in need due to conditions/illnesses

What are requirements for billing Medicare part B?

paper claims

What are requirements for filling medical supplies (non diabetic related) under Medicare Part B?

1. The filling pharmacy must be accredited appropriately

2. Prescriber's orders must state the reason for the product to be dispensed on the Rx, also may require additional paperwork

Adjudication

process of transmitting Rx electronically to insurance for approval/billing

Processor

company hired by insurer to process claims

What does the sig include?

Route of administration

Dosage

Frequency

What are some common medications that should be dispensed in original packaging?

1. Nitroglycerin Sublingual Tabs

2. Pradaxa/Dabigatran

3. Azithromycin (Z-Pak)

4. Methylprenisolone

5. Accutane

6. Anything needing reconstituted

Teratogenic

an agent that can cause malformation of an embryo

Common Examples: finasteride, dutasteride

REMS

Risk Evaluation and Mitigation Strategies

ensure benefits of medications outweigh the risk associated (ex. pregnancy tests & birth control on accutane)

Elements to Assure Safe Use (ETASU)

required medical interventions or actions that health care proff. execute prior to dispensing

USP <800>

guidelines for identification and handling of hazardous materials

*include facility design, garbing, cleansing, and administering

Auxiliary Labels

a label added to dispensed medication to provide supplementary info regarding safety of administration, use, and storage

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