Order Entry and Processing (4.1 & 4.2)

Define this:

An identification number assigned to a particular quantity or lot of material from a single manufacturer. Can typically be found on the outside of packaging

Lot Number

Define this:

A preparation of a medication for topical use that contains a water base

Cream

Define this:

A preparation of a medication for topical use that contains an oil base.

Ointment

Define this:

Medications made in a clean environment that's not completely free from all microorganisms. This type of compounding is for drugs to be taken orally or topically

Non-sterile compounding

Define this:

A medication is a drug that is specifically mixed and prepared for you, based on a prescription from your doctor. Similar to when you bake a cake, creating compound medications involves mixing one or more active ingredients, each at a specified amount.

Compounded

Define this:

Medications include the production of solutions, suspensions, ointments, creams, powders, suppositories, capsules, and tablets.

Non-sterile products

Define this:

A mixture of two or more liquids that are normally immiscible (unmixable or unblendable) owing to liquid-liquid phase separation.

Emulsion

Define this:

The colloidal dispersion of one liquid in another liquid

Emulsion

Define this:

A mixtures of drugs and a waxy medium designed to melt at body temperature after being inserted into the anus or vagina

Suppositories

Define this:

A waxy capsules that are inserted deep into the vagina, where they melt and release a spermicide

Suppositories

Define this:

The placement of a solution into the rectum and colon to empty the lower intestine through bowel activity

Enema

Define this:

The introduction of fluid into the rectum and lower colon

Enema

Define this:

1.Not sterile, gloves, privacy, warmed solution as ordered, adult 750-1000 ml

2. Assess for abdominal distention, bowel sounds

*3.Left side, sim's position (follow natural curve of colon), insert lubricated tip, adult 3-4 inches

4.Open clamp and allow to flow slowly, raise to appropriate height, can cause cramping if flow rate too rapid

5.If order, "enemas until clear", repeat until fluid passed is clear, up to 3 total

Enema administration

Define this:

Drug packaging is the material that surrounds the pharmaceutical product

Primary Drug Packaging

Define this:

A drug packaging provide additional external protection.

Secondary and Tertiary Packaging

How do you calculate day supply?

1. Using a conversion factor of 20 drops per milliliter, calculate the days' supply by dividing the total number of drops dispensed by the number of drops required for each day's dose.

   For example, consider an ophthalmic product to be dosed one drop in each eye twice daily and dispensed in a 2.5 milliliter bottle

Define this:

Commonly used as unit-dose packaging for pharmaceutical tablets, capsules or lozenges

Blister Packs

How are pharmacy doses calculated?

How are pharmacy doses calculated?

A basic formula, solving for x, guides us in the setting up of an equation: D/H x Q = x, or Desired dose (amount) = ordered Dose amount/amount on Hand x Quantity.

Define this:

Drug dosage system that provides prepackaged, prelabeled, individual medications that are ready for immediate use by the patient

Unit Dose

Define this:

A package containing a single dose of a medication

unit-dose packaging

unit-dose packaging

The packaging of products from bulk containers into single dose containers

diabetic supply

Most diabetic supply DME providers sell a wide variety of diabetic testing supplies and brands (i.e., blood sugar/glucose meters, batteries, test strips, lancing devices, lancets, and alcohol swabs), as well as Continuous Glucose Monitor Systems, insulin pumps and pump supplies

Define this:

Attaches to the inhaler. It holds the cloud of medicine in the chamber long enough for you to inhale it in one or two slow, deep breaths. Prevents coughing

A spacer or valved-holding chamber (VHC

Define this:

• Only meant to be used by mouth.

• Usually amber or orange in color, except when a patient needs a dose larger than 10mls.

• Clear syringes usually are used to inject medicines into the body (through an IV or injected in a muscle (IM) or just under the skin (sub-Q))

Oral syringes

Define this:

This number identifies YOUR prescription . Numbers are assigned in the order they are filled at the pharmacy. When calling in for a refill, providing this number can make for easy identification by pharmacy staff.

RX Number

How do you read a pharmacy prescription?

Patient's name and another identifier, usually date of birth. Medication and strength, amount to be taken, route by which it is to be taken, and frequency. Amount to be given at the pharmacy and number of refills. Signature and physician identifiers like NPI or DEA numbers

Define this:

Scroll down to read all.

1 / 7. Drug Facts You Should Know.

2 / 7. Active Ingredient and Purpose. Find this info at the top of the label on over-the-counter meds.

3 / 7. Uses.

4 / 7. Warnings.

5 / 7. Directions.

6 / 7. Other Information.

7 / 7. Inactive Ingredients

Reading Drug Labels

How do you get an 11 digit NDC number?

Taking it to Eleven: How to Convert 10-Digit NDC Numbers

For a 10 digit NDC in the 4-4-2 format, add a 0 in the 1st position.

For a 10 digit NDC in the 5-3-2 format, add a 0 in the 6th position.

For a 10 digit NDC in the 5-4-1 format, add a 0 in the 10th position.

Are all NDC codes 11 digits?

Proper billing of a National Drug Code (NDC) requires an 11-digit number in a 5-4-2 format

Can controlled substances be returned to the pharmacy?

DEA to patients: Don't return unused controlled substance prescription medications to pharmacy.

Typically, pharmacies have two methods for returning expired drugs

Mail-in or in-person consultation. With a mail-in service, the pharmacy removes the expired drugs from the shelves every few weeks, inventories them online and ships them to the returns company themselves

Define this;

The process of moving unsold saleable inventory within the pharmaceutical supply chain or removing unsaleable inventory from the supply chain in a safe, secure and reliable manner.

Reverse distribution

Define this:

• Return stock to the wholesaler that has been ordered in excess or is moving slowly off of the shelves.

• Monitor the pharmacy's shelves for products that are not being used or were previously special ordered for a patient who discontinued treatment with the specific product if a package has not been opened or damaged and does not expire for at least 12 months, a wholesaler can accept the product for return.

• Wholesalers should be contacted to request a return approval before sending the medication back.

Overstock Return

Define this:

• A product sent from the wholesaler may arrive at the pharmacy in a damaged condition.

• If it is noticed before dispensing to the patient, the pharmacy should contact the wholesaler to seek replacement of any damaged products.

• The wholesaler generally must send an approval code or return form before they will accept return of a damaged product.

• If a patient receives a product and discovers that it is damaged after its attempted use, the patient may generally bring it back to the pharmacy for replacement. The pharmacy can give the patient a replacement item from its stock, then contact the drug manufacturer to seek replacement of the damaged product.

• After completing the necessary paperwork, the manufacturer will send a replacement item to the pharmacy to replace the item the pharmacy gave out to the patient. The manufacturer may or may not request the pharmacy to ship back the damaged item.

Damaged products

Define this:

• In the community pharmacy setting, there are several types of machines available to assist with the filling of prescriptions.

• The pharmacy technician is responsible for refilling the machine's cells with medication. Errors are common when refilling this type of automatic dispensing machine, so it is very important to ensure the correct medication is poured into the correct cell, and a pharmacist should check each medication before the technician refills.

Automatic dispensing

Define this concepts when ordering and managing inventory:

• When managing inventory, it is important to consider. This term refers to the time it takes to use up a particular product in the pharmacy's inventory. Technicians should focus on ensuring there is enough stock of medications.

Turnover Rate

Define this concepts when ordering and managing inventory:

• After a set amount of time, the chemical structures of medications may change to decrease the potency of medication or change it into an entirely different product.

• It is important for the pharmacy technician to consider when ordering medications.

  For example, epinephrine has a relatively short expiration date, generally no longer than a year after its receipt at the pharmacy. The pharmacy technician should ensure that the pharmacy does not ever order more epinephrine than it could reasonably use before it expires, because if it cannot all be used before it expires, it can result in a potential loss of profit.

Expiration Dates

Define this concepts when ordering and managing inventory:

• Certain medications can be affected by several different external factors. These include issues with manufacturing, recalls, decreased availability of raw materials, and higher demand than usual.

• Should be kept in consideration when ordering medications, and pharmacy technicians should be prepared to consider alternative options and communicate this information to patients, caregivers, nurses and hospital staff when specific medications are unavailable.

Availability

What container is used to safely dispose of all items considered dangerous and sharp, such as: needles, syringes, and broken glass?

Red Container

The size of a needle is determined by its/

Gauge. Higher gauge the smaller the opening

Define this:

Hollow portion of the needle where fluid moves

Lumen

Define this:

Slanted opening of the needle

Bevel

Define this:

length of the needle

Shaft

Define this:

End point that will attach to the syringe

Hub

Define this:

A container that is sealed containing medication either in liquid or powder form.

• can be made from plastic or glass

• has a hard plastic cap that is removed by the technician prior to puncture

• can be either single-dose or multiple-dose

Vial

How many days does a Vial stay functional?

28 days

Define this:

A sealed container made from glass that has an elongated neck. • must be broken prior to use

• Contains no preservatives—single use only

Opening an ampule

Ampule

Define this:

• Make sure the medication is at the body (gently tap the head if necessary).

• Swab 70% IPA around the neck.

• Snap the neck away from you using gentle but firm pressure.

Opening an ampule

Define this:

A needle used to withdraw fluid from an ampule; has a built-in filter to remove any glass particles that may have fallen into the medication

Filter Needle

• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Sterile and Nonsterile Compounding

LARGE VOLUME PARENTERAL

SMALL VOLUME PARENTERAL

IV SOLUTIONS

An IV infusion of greater than 250 mL (most commonly given as 500 mL or 1000 mL). • used for electrolyte replacement and hydration • given as a continuous infusion or IV drip

A CSP given usually as an IVPB over a short period of time. • less than 250 mL (usually 150, 100, 50, or 25 mL) • examples: antibiotics, antifungals, antiviral medications

0.9% Sodium Chloride (NaCl) Normal Saline (NS) 0.45% Sodium Chloride (NaCl) 0.45% Normal Saline (1/2 NS) Lactated Ringer's LR Dextrose 5% in Water D W5 Dextrose 10% in Water D W10 Sterile Water for Injection SWFI 5% Dextrose in 0.9% Sodium Chloride D NS 5 5% Dextrose in 0.45% Sodium Chloride D 1/2NS

Define this:

A CSP given usually as an IVPB over a short period of time. • less than 250 mL (usually 150, 100, 50, or 25 mL) • examples: antibiotics, antifungals, antiviral medications

Define this:

0.9% Sodium Chloride (NaCl) Normal Saline (NS)

0.45% Sodium Chloride (NaCl)

0.45% Normal Saline (1/2 NS) Lactated Ringer's LR Dextrose (5% in Water D W5 Dextrose 10% in Water D W10 Sterile Water for Injection SWFI 5% Dextrose in 0.9% Sodium Chloride D NS 5 5% Dextrose in 0.45% Sodium Chloride D 1/2NS

IV Solutions

• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Sterile and Nonsterile Compounding

DILUENT

CORING TOTAL

PARENTERAL NUTRITION (TPN)

A liquid used to reconstitute a powder medication before it is injected into a patient or another IV solution. Common diluents: • sterile water • normal saline

The accidental introduction of small pieces of rubber from the top of a vial into the solution of medication; if this occurs, must discard vial.

An IV solution that provides nutrients for patients who are unable to eat or cannot get the nutrition they need through eating orally. Composed of: • sterile water (hydration) • dextrose (sugar and carbs) • amino acids (protein building blocks) • lipids (fatty acids) • electrolytes and other additives (vitamins and minerals) • medications that a patient may need

COMPOUNDING LOG

CLASS III PRESCRIPTION BALANCE

PHARMACEUTICAL WEIGHTS

Used to record all entries of each compounded prescription so a reference can be available and easily accessible. Lists the following information: • date of compound • Rx number • names of specific ingredients used, along with: • expiration date • lot number • manufacturer • NDC number • amount weighed or measured • name of compound • procedures detailing how compound was prepared • name of preparer and pharmacist checking

A two-pan balance that has a capacity of 15 to 120 grams. • can be used to weigh small amounts in the range of +/- 5 mg • used with pharmaceutical weights • Weighing paper is placed on pans to prohibit contact of medication with the balance. • Weighing boat can be used to weigh a larger quantity of a chemical

Weights used for calibration of class III prescription balance and for weighing ingredients. • must be handled with forceps to avoid the transfer of any oils or dirt from the hands

DIGITAL BALANCE

GRADUATED CYLINDER

BEAKER

Uses one pan and a digital or analytical readout for weighing ingredients. • easier to use than a class III balance and more accurate

A glass or plastic tool used for measuring liquid volumes. • range in size from 5 mL to more than 1,000 mL • For highest degree of accuracy, always choose the smallest size that can measure the volume desired (e.g., choose a 100 mL cylinder to measure 95 mL—don't choose a 250 mL cylinder).

Can also be used to measure larger volumes of liquid, but less accurate than a graduated cylinde

MENISCUS

MORTAR AND PESTLE

OINTMENT SLAB

Curve at the upper surface of a liquid caused by surface tension. • The liquid at the bottom of the meniscus should be measured at eye level

Used in nonsterile compounding to grind substances. Mortar—bowl-shaped item Pestle—used for crushing or grinding substances

A flat surface used for mixing compounds such as creams, ointments, pastes, or gels. • Usually made from ground glass, so it is nonabsorbent.

GEOMETRIC DILUTION

TRITURATION

LEVIGATION

A method that ensures equal distribution of ingredients: • First, mix the ingredient in the smallest amount with an equal amount of the next ingredient in quantity. • Mix these thoroughly, then add another amount equal to that which is now in the mortar and mix again. • Continue this process, increasing in quantity until all ingredients are mixed evenly.

Grinding tablets or other substances into a fine powder.

A levigating agent is added to a triturated powder slowly to make a paste. Examples of levigating agents: • mineral oil • castor oil • vegetable oil • glycerin

SPATULATION

PUNCH METHOD

CAPSULE SIZES

Combining substances using a spatula.

A method for hand-filling capsules. • The powder to be filled is placed on a surface, and the capsule is punched into the powder repeatedly until full.

Sizes range from 5 (smallest) to 000 (largest).

Define this:

A method used to make the environment, the worker, and the patient as germ-free as possible

aseptic technique

Define this:

Torsion balance that is required by law to be available in every pharmacy

- Has a sensitivity requirement of 6 mg can be accurately weigh a minimum of 120 mg up to 155g

Class A balance

Define this:

A technique for mixing two powders of unequal quantity

geometric dilution

Define this:

USP 797

sterile compounding

Define this:

USP 795

Non-sterile compounding

Define this:

CPS

compounded sterile preperations

Define this:

Environment for the preparation of sterile products where air originating from the back of the hood moves forward across the hood and into the room. Should be turned on for 30 minutes before use.

Horizontal laminar flow hood

In horizontal laminar flow hoods, air blows

toward the operator

Define this:

Should be used for all chemotherapeutic agents and can also be used to mix non-chemotherapeutic agents

Vertical airflow hood