ExCPT Study Guide

Pharmacy Technician Duties

1. Answer phone and handle questions that do not require a pharmacist's expertise or judgement

2. receive written prescriptions or telephoned refill requests

3. Gather information needed to prepare prescriptions

4. Record information needed before prescriptions can be dispensed

5. Enter data into the pharmacy's computer system

6. notify the pharmacist of patient or prescriber questions, as well as medication warnings or interactions

7. Help the pharmacist prepare prescriptions by counting, pouring, labeling, or pricing medications

8. Keep pharmacy supplies stocked

9. place completed prescriptions in the pick up area

10. order and stock medications

11. prepare insurance claims and verify payments

12. help patients find otc meds and stock otc department

13. complete purchase transactions and log them when necessary

14. perform housekeeping duties

What a tech cannot do

1. receive oral prescriptions, refill authorizations, or changes to prescriptions

2. consult with prescribers about prescriptions

3. provide confidential patient information to other health professionals or insurance companies

4. checking medications before dispensing them.

5. consult with patients about medication use and other health issues

6. recommending otc medications

intake area

1. where patients leave prescriptions. keep clean and uncluttered. Scan rx in a timely manner to prevent delays

processing area

data entry occurs here. Keep free from distraction. also houses counting equipment.

processed rx area

completed prescriptions are stored until pick up

out window-

where patients pick up completed prescriptions. cash register is used. nearby counseling area.

other areas

administration area, clean room for sterile compounding, otc area, and consultation room

Pharmacy Security

1. pharmacy doors should always be closed. Unauthorized persons should not have access

2. Non pharmacy personnel should not be allowed to enter unless designated and approved to work in that area.

3. pharmacy should be locked any time a pharmacist is not on duty.

Receiving Staff Responsible for-

1. verify name, address, DOB as well as quantity of orders received

2. shipments must be inspected for damage and observations noted

3. products requiring special care, such as temperature conditions should be given priority

4. shipments should be inspected to ensure they exactly match the details written on the purchase order.

5. invoice should be signed and dated by whoever receives the shipment

6. expiration dates must be checked to ensure that they are compliant with pharmacy standards.

7. Any product on back order should be brought to the pharmacist's or management's attention to prevent any possible outages

Stocking Medications- Pay attention to

1. Expiration of new products

2. products inspected and anything unusual reported to pharmacist

3. report prescription patterns to members responsible for ordering/purchasing

4. stock should be examined for damaged or recalled products

5. as stock bottles are placed into inventory, label information should be noted.

Identifying expired products-

techs are responsible for checking dates prior to dispensing to determine whether the entire rx is likely to be used by the pt prior to expiration date.

Controlled Substances Act-

1970. Regulates manufacture, importation, possession, use, and distribution of substances with abuse potential. Created five federal schedules of controlled substances. Scheduling determined by DEA. Techs responsible for knowing federal and state rules.

Schedule 1

High potential for abuse

no accepted medical use in US

unsafe for use under medical supervision

LSD and Heroin

Schedule 2

Have current accepted medical use in US

high potential for abuse or physical/psychological dependence

morphine, methamphetamine, secobarbital

Schedule 3

Have abuse potential less than C1-2

Moderate or low physical dependence

May lead to high psychological dependence

morphine/opium combo products, central nervous system stimulants and depressants

Schedule 4

low potential for abuse

limited risk for dependence

compound/mixture containing limited amount of controlled substance with noncontrolled active ingredients (cough suppressants)

difenoxin and dephenoxylate preparations

Form 222

used when ordering controls

pen and paper

middle copy forwarded to DEA

record quantity, date received

How long must invoiced for controls be kept?

7 years

How often must inventory of controls be taken?

2 weeks at a minimum

How often must inventory of regular drugs be taken?

monthly

The records of which Schedule drugs must be kept separate?

C2

How many times can c3-4 meds be refilled?

Up to five times in 6 months if authorized

How many times can a c2 be refilled

it cannot be refilled

if the entire quantity is not available, how long do you have to dispense the entirety of a c2 prescription?

72 hours, otherwise the rx is considered to be expired

True/False, in an emergency, a c2 rx can be taken by phone

True. Must say Emergency on rx. Must be followed by written rx. Prescriber has 7 days to follow with a written prescription. Some states require written rx within 24 hours.

Information required in c2 books

1. dispensing date

2. name of product

3. quantity

4. name, signature, and address of purchaser

5. pharmacist signature

Methamphetamine Precursor Control Act

Customers required to show ID

Must have: name, address, date/time, quantity

Daily limit for Sudafed

3.6gm

Monthly limit for Sudafed

9gm

DEA numbers

First letter will be A,B,M,F

Second usually first letter of prescriber last name

Four steps to Check DEA numbers

add the first, third, and fifth digit

add the second, fourth, and sixth digit and multiply by two

add the result of the first two steps

the last digit of the calculation should be the same as the seventh digit

Generic Substitution

substituting a lower cost generic when brand name is prescribed. Often mandated by third party.

What determines whether or not you can substitute a generic for brand?

Prescriber will either check "may substitute" or "DAW(dispense as written)"

HIPAA

Health Insurance Portability and Accountability Act

1996

Privacy is important

OBRA 90

federal law requiring pharmacists to keep records of all medications used by medicaid patients. Pharmacists required to counsel all medicaid patients. Generally interpreted to include all patients.

Consumer Product Safety Commission

requires child-resistant packaging on any substance that might cause serious injury to children.

Nitro is an exception

FDA

responsible for approval of drugs deemed safe and effective for human use. Testing phases are required

State Boards of Pharmacy

regulate safe practices and requiring registration for those practicing pharmacy.

Determine scope of practice for techs

Inspections to determine compliance.

Standard Setting Organizations

Joint Commission

National Commission for Quality Assurance (NCQA)

United States Pharmacopeia (USP)

Manufacturer Drug Package Labeling must have

1. brand or trade name

2. generic name

3. medication's strength (amount of active ingred)

4. legend statement- (rx only)

5. storage requirements

6. package quantity

7. dosage form

8. Manufacturer's name

9. controlled substance mark

10. lot number

11. expiration date

12. NDC

First five digits of NDC indicate

Manufacturer

Second four digits of NDC indicate

name, strength, dosage form

Last two digits of NDC indicate

package size

Common use of Analgesic

treatment of mild to moderate pain

Generic Analgesics

acetaminophen

acetylsalicylic acid

acetaminophen/hydrocodone combo

acetaminophen/oxycodone combo

Brand Name Analgesics

Tylenol

Aspirin

Vicodin

Percocet

Common use of Antibiotics

treatment of bacterial infections

Generic Antibiotics

amoxicillin

azithromycin

ciprofloxacin

clarithromycin

levofloxacin

Brand name Antiobiotics

Amoxil

Zithromax

Cipro

Biaxin XL

Levaquin

Anticoagulant common use

prevent/inhibit clotting of blood

Anticoagulant generics

Enoxaparin sodium

Heparin Sodium

Warfarin Sodium

Anticoagulant Brand Names

Lovenox

Heparin

Coumadin

Anticonvulsant Common Use

treatment of seizures

Anticonvulsant generics

Clonazepam

Phenobarbital Sodium

Gabapentin

Phenytoin Sodium

Anticonvulsant Brand Names

Klonopin

Dilantin

Neurontin

Dilantin

Common interactions: Blood thinners

interact with other meds or foods to increase bleeding or increase the medication effectiveness. Diet can be a factor in the effectiveness of warfarin

Common interactions: Heart Meds

other drugs can affect metabolism of these meds

small changes can result in significant effects which can cause toxicity or lack of efficiency

Common interactions: Antibiotics

rashes and diarrhea are the most common

can cause photosensitivity

can alter metabolism of other medications

Common interactions: Diuretics

changes in serum potassium and sodium levels directly associated with these medications can cause serious side effects

Common Interactions: Herbal Products

Can affect potency of prescribed medications and should be noted in patients profile.

Capsules

gelatin containers filled with medications. Considered easier to swallow.

Tablets

solid dosage forms

vary greatly in size, color, shape, weight, etc

Sometimes scored to facilitate breaking

sometimes coated to delay absorption

Buccal Tablets

placed in buccal pouch between cheek and gums to dissolve

Sublingual Tablets

placed under tongue and dissolve rapidly

Chewable Tablets

chew before swallowing, only those marked as chewable should be chewed

Effervescent Tablets

mixtures of acids and sodium bicarbonate plus active ingredients. Should not be chewed or swallowed. Should be dissolved in water.

Enteric-coated tablets

coated to prevent dissolving in stomach. Move to small intestine.

Toches and lozenges

held in the mouth while they dissolve. Keep medication in contact with mouth and throat.

pills

originally made from powdered raw materials mixed with sticky liquid

LA

long acting

SA

Sustained Action

SR

Sustained-Release

CR

Controlled- Release

XR/XL

Extended-Release

TR

Timed-Release

Solutions

solid ingredients are dissolved in liquid (usually water)

Suspension

medication particles are suspended in liquid. Medication is not dissolved. In order to help the medication stay suspended, an agent is added to make the preparation thick. Can settle. Need to be shaken.

Reconstitution of Powders to liquids

adding a specific amount of distilled water. Deteriorate rapidly as liquids. Generally effective for 10-14 days. need to be refrigerated.

Elixirs

clear

hydroalcoholic (water/alcohol)

orally used

often contain flavoring substances

Fluid extracts and tinctures

alcoholic or hydroalcoholic solutions of volatile substances

contain enough alcohol to necessitate tight containers to prevent evaporation

Syrups

concentrated solutions of sugar in water with active ingredients. May contain alcohol

Emulsions

mixtures of oil and water. Separate over time. Must be shaken.

Ointments

greasy preparations

petroleum jelly base

good for areas that need protection

leave heavy coatings

cream

water/oil/other substances

not as much protection as ointments

more appealing (less greasy/absorbed by skin)

Lotions

like creams, but more liquid

applied easier over larger areas

liniments

mixtures of various substances in oil, alcoholic solutions of soap, or emulsions intended for external application.

often used with heat-producing products

gels

semi-solid suspensions of very small particles

usually water based

collodions

liquids that dry as flexible films on skin

wart/corn/callus removers

transdermal patches

stick to skin with adhesives, long lasting

12 hours to several days

nitro for angina or estrogens for hormone replacement

suppositories

cylindrical, egg, or pear shaped

some for insertion into rectum or vagina.

local effects or to be absorbed

vaginal tablets

inserted into vagina

remind patients to remove wrapper

otic

for the ear

usually in dropper bottles

opthalmic

for the eyes

must be sterile

Aerosols

sprayable products using pressurized gas and valve systems

commonly used for skin application or inhalation into lungs or nasal passages

Chewing Gum

absorbed through mucus membranes

nicotine gum

Parenteral Medications

sterile preparations injected with syringes

insulin