miscellaneous pharm tech

community pharmacy equipment

bar code scanner, robotic vial filler, automated pill counter

institutional pharmacy equipment

laminar flow hood, tallest, kitcheck

capsule

meds in which active ingredient is enveloped in a hard or soft gelatin shell

lozenges (troches)

hard, sugary, candy-like dosage form

ointment

small amount of water in a large, oily base

creams

small amount of oil in a water base

lotion

small amount of oil in a water base; thinner than creams

suppositories

med contained in an inactive base that will melt once inserted into the body

elixir

dissolved med in water and ethanol

syrups

sugar-based solution

extract

powder derived from an animal or plant after solvent is evaporated

tincture

alcoholic or hydroalcoholic liquid that contains plant extract

spirit

alcoholic or hydro alcoholic liquid w volatile, aromatic ingredients

suspension

drug does not dissolve in the base, leaving small solid particles floating; may need to be reconstituted or mixed w water before dispensing; shake before dispensing

enema

used to deliver med rectally to bypass GI tract

intrathecal

med to be injected around or in the spinal cord

warfarin drug interactions

NSAIDs, antibiotics, fish oil, coenzyme 10, garlic supplements, ginko blob, vitamin K

warfarin side effects

excessive bruising/bleeding

NSAIDs drug interactions

lithium or methotrexate —> causes toxicity

warfarin —> risk of bleeding

HMG-CoA reductase inhibitors interactions

grapefruit inhibits metabolism leading to muscle damage

benzodiazepines + hydrocodone drug interaction

respiratory depression

clopidrogel + PPIs drug interaction

reduce effectiveness of clopidrogel

antibiotics drug interaction

anticoagulants —> inc risk of bleeding; reduce effectiveness of birth control

SSRIs or SNRIs + MAOIs interaction

cause serotonin syndrome

digoxin + diuretics interaction

inc risk of digoxin toxicity

lithium drug interactions

alcohol, NSAIDs, methotrexate

therapeutic index

comparison of the amt of a drug that causes the desired effect vs the amt that causes toxicity

narrow therapeutic index

when the window between positive effect and toxic effect is small

ISMP high alert meds

Institute for Safe Medication Practices; list o high alert meds based on practice setting

drug allergy

immune system mistakenly identifies a med as a harmful invader and overreacts to it

side effects

predictable reaction to a medication; related to how the med works

prescription reqs

patient name, patient phone num, patient DOB, administration route, physicians office name, address, phone num, physicians signature, sig (directions for use), date written, med name, strength, quantity, dose, and dosage form, refill info

origin codes

how the prescription was produced and delivered

origin code —> 1

written; typed and printed or handwritten

origin code —> 2

phone; a prescriber phones in a prescription to a pharmacist

origin code —> 3

electronic; prescriber sends an electronic transmission of prescription thru software package

origin code —> 4

faxed; pharmacy must retain transmission info for records

DAW code —> 0

generic substitution permitted; pharmacy can dispense generic in place of brand meds when available

DAW code —> 1

brand name medically necessary; prescriber mandates pharmacy dispenses brand name med

DAW code —> 2

patient requests brand name

controlled substances act (CSA) of 1970

establishes the DEA and forms drug schedules

drug schedule

based on accepted medical use in treatment in US and likelihood of causing dependence

addiction

disorder characterized by compulsive drug use; repeated use alters brain functions

drug abuse

habitual taking of addictive substances

tolerance

when a patient’s run to a drug is progressively reduced, require an increased dose to achieve the desired effect

withdrawal

onset of symptoms resulting from discontinued use of a substance

psychological dependence

dependency of the mind to continue the same pattern of behavior

physical dependence

awareness of withdrawal symptoms such as seizures, sweating, and tremors when use of a substance is discontinued

C-I medications

no accepted medical use

C-II medications

high dependence factor; no refills; no transferring from one pharmacy to another; expire 6 months after they are written

C-III medications

moderate dependence factor; can be prescribed 5 refills; can be transferred from pharmacy to pharmacy ONCE; expire 6 months after they are written

C-IV medications

less dependence factor; can be prescribed 5 refills; can be transferred from pharmacy to pharmacy ONCE; expire 6 months after they are written

C-V medications

slight dependence factor; can be prescribed 5 refills; can be transferred from pharmacy to pharmacy ONCE; expire 6 months after they are written

NCLM (non-controlled legend medications)

all other prescription medications

OTC

non-prescription med; may be prescribed up to a year’s worth of refills; can be transferred pharmacy to pharmacy for an unlimited amount of times; expire one year after the date they are written

sig

shorthand notation of directions written by providers

adjudication

submission and subsequent response of a claim to an insurance company

manufacturer’s label

includes med’s brand name, generic name, strength, quantity, manufacturer, lot number, expiration date, NDC code

prescription label

includes med name, strength, quantity, directions, patient’s name, prescriber’s name, prescription #, expiration date, refills remaining, pharmacy name, pharmacy phone #

accuracy scanners

commonly used to verify that the correct med is used to fill prescriptions

automatic med counters

used to streamline the dispensing process by eliminating the need to count meds by hand

counting trays

used to count prescriptions for dispensing

safety caps

all prescriptions should be dispensed with child-proof safety caps by default except nitroglycerin and non-oral dosage forms

auxiliary labels

provide info to patient about how to take meds

look-alike sound-alike meds

meds with similar looks or sounds; use tall-man lettering to avoid confusion

counseling

involves pharmacist talking to patients to ensure they feel comfortable taking their meds

reference manuals

used to fill a prescription for a patient or med you aren’t used to

medicare

funded by tax dollars; provides healthcare services for elderly (65+), disabled individuals, or those with end stage renal disease

medicare part A (“hospital insurance”)

covers inpatient (pt is formally admitted to stay in the hospital) and hospital costs

medicare part B (“medical insurance”)

covers outpatient services (pt does not need to stay in hospital to receive care)

medicare part C (“medicare advantage plan”)

alt way to receive benefits

medicare part D (“prescription insurance”)

covers prescription meds

doughnut hole

when spending exceeds a certain amount, medicare requires that patients pay a higher % for meds

catastrophic coverage

medicare drops the % paid for meds after reaching a certain amount

medicaid

funded by federal and state dollars; insurance for low-income, pregnant, elderly, and disabled individuals and children

tricare

funded by federal dollars; provides healthcare service to active and retired armed forces and fam members

non-profits

federal funding provided to non-profit hospitals and research institutes

formulary

list of drugs that are preferred for any given plan; designed by physicians, pharmacists, and administrators

open formulary

allows patients any covered med within formulary; largest # of covered meds

preferred formulary

entices patients to use preferred meds by offering lower prices in a three-tier system

three-tier system

provides generic med at a low cost, preferred brand meds at slightly higher cost, and non-preferred meds at substantially higher cost

closed formulary

does not cover any drug not listed on the formulary; commonly seen w restrictive HMOs like Medicaid

quantity limit

place strict guidelines on how many dosage units can be dispensed in a specific day supply

step therapy

when the formulary only allows for the med prescribed to be covered if the patient has alr taken other (less expensive) meds first

prior authorization

provider answers qs abt a patient’s condition and based on the info provided, a med may or may not be covered

copay

the amount due from the customer for a claim

benefit

the amount paid by the insurance for a claim

deductible

the amount the customer must pay, per plan year, to receive any benefit from insurance

premium

the amount the customer must pay monthly to have insurance

average wholesale price (AWP)

the average price paid by pharmacy to buy a drug from the wholesaler; typically much higher than the actual cost paid

maximum allowable cost (MAC)

the max the PBM will pay for a generic med

drug utilization review (DUR)

software checks for drug interactions, age alerts for pediatric meds, over/underutilization of meds, therapeutic duplication

specific gravity

ratio of a liquid’s density at a certain temp compared to the density of water at that temp; no units

ratio strength

compares 2 ingredients in a mixture

percentage strength

compares 2 ingredients in a mixture

daily dose

total dose a patient will take in a day; dose x frequency

day supply

how long a prescription should last a patient; insurance companies use it to determine how often to pay for meds; total quantity / daily dose

quantity sufficient

total quantity for prescription; day supply x daily dose

Clark’s Rule

child’s dose (mg) = [weight of child (lbs) x adult dose (mg)] / 150 (lbs)

Young’s Rule

child’s dose (mg) = [child’s age (yrs) x adult does (mg)] / [child’s age + 12 (yrs)]