Pharmacy Tech Review

CMI

Consumer medication information must be dispensed with every fill of a prescription

Room temperature

68 degrees to 77 degrees

Refrigerated temperature

36 degrees to 46 degrees

Relative humidity

Humidity less than 65%

PDMP

Prescription drug monitoring program

E-FORCSE

Florida’s PDMP

NIOSH

National Institute for Occupational Safety and Health

Finasteride & Tretinoin

2 drugs from NIOSH hazardous drug list in Ro’s inventory

Premium

Prescription drug plans are usually set up with a monthly premium, which the patient pays to participate in the prescription drug plan

Deductible

Prescription drug plans may have an annual Deductible, where the patient must pay full price for their prescriptions until a specific dollar amount is met

Co-pay

Typically a flat amount, such as $10

Co-insurance

Typically a percentage of the drug cost, such as 25%

Medicaid

Federal and state program for low income families, seniors, and individuals with mental or physical disabilities

“Original” Medicare A & B

Federally funded program designed for people of any income who are age 65 and older, as well as some individuals under age 65 with certain disabilities or other special circumstances

Medicare Part D

Added onto “Original” Medicare to cover prescription drugs

Analytical balance

Must have at least 4 decimal places of readability or more

Correct order of steps to use an analytical balance

1. Visually inspect balance

2. Ensure all bubble levels indicate level surface

3. Place empty container on scale

4. Tare to zero

5. Add ingredient to be weighed into container

Volumetric devices provide accurate volume measures

Graduated cylinder, graduated pipet, syringe, calibrated dropper.

When pouring liquid from measuring device, how long to drain for low-viscosity fluids to drain?

Allow 15 seconds to drain

When pouring liquid from the measuring device, how long for viscous liquids (syrups, glycerin, propylene glycol, mineral oil) to drain?

Allow 60 seconds or more to drain

Benefits of compounded drug products

1. Help a patient who needs a medication to be made without a certain dye in the commercial product they are allergic to

2. Help an elderly patient who cannot swallow a pill and needs medicine in a liquid form that is not available in a commercial product

3. Help a child who needs a drug in a strength that is lower than what can be achieved using the commercially available product

USP

United States Pharmacopeia is an organization that sets standards for compounding, such as General Ch. 795 Nonsterile Compounding, General Ch. 797 Sterile Compounding, and General Ch. 800 Hazardous Drugs

Nonsterile compounded preparations

Creams, Tablets, Troches, Oral liquids

Sterile compounded preparations

Injections, ophthalmic preparations, implants

Important factors for communicating

1. Smile and introduce your name and title

2. Maintain eye contact

3. Speak clearly, using a normal tone, at a moderate pace

4. Use the teach-back method to make sure patients understand

Open ended question

Ask questions that cannot be answered with a ‘yes’, ‘no’, or other short answers

Empathy

Use empathy to indicate to patients that you are able to see things from their point of view

Medical jargon

Avoid medical jargon when communicating with patients

Openness

Use openness to consider new views and possibilities, while putting aside prejudices, biases, preconceptions, and assumptions

Non-verbal communication

Your body language and other aspects of non-verbal communications can tell people a lot about how well you are listening to them

Pharmacy employees must wash their hands with soap and water during what times?

1. Before performing pharmacy activities

2. Before returning from a work break

3. After using the bathroom

4. Anytime the hands become soiled

Work surfaces and equipment

Must be cleaned and sanitized daily

Pharmacist rely on techs for what?

Critical tasks, including quality, patient care, and inventory

Quality

Everyone’s responsibility in the pharmacy, including pharmacists and techs

HIPAA

Health Insurance Portability and Accountability Act

PHI

HIPAA defines protected health information and establishes standards for protecting this information through privacy and security measures. It also ensures patients have certain rights related to how that information is maintained, shared, and accessed

FDCA

Federal Food, Drug, and Cosmetic Act required new drugs to be tested for safety before marketing. Results would be submitted to FDA in a new drug application (NDA). Law also required that drugs have adequate labeling for safe use

DEA

Drug Enforcement Administration regulates the use of controlled substances / chemicals to ensure adequate/uninterrupted supply for legitimate use while preventing diversion & misuse

Regulations

Written by agencies (such as the Board of Pharmacy), which are authorized by law to clarify how a law will be implemented. Regulations also known as rules and have the force of law

Corresponding Responsibility

Pharmacist have responsibility to prevent the filing of forged or altered prescription or one that was not issued in the usual course of medical practice by a doctor

Signs of illegitimate prescription

1. Prescriber writes significantly more prescriptions compared to other practitioners

2. Patient presents prescriptions written in the names of other people

3. Number of people appear simultaneously all bearing similar prescriptions from the same physician

4. Prescriber writes prescriptions for antagonistic drugs, such as depressants and stimulants, at the same time

DEA requires that controlled prescription records to be maintained in a particular matter. What is it?

Pharmacies must keep 2 separate files, 1 for schedule II, and 1 for schedule III, IV, V

How to order schedule II substances?

Must be ordered using a DEA single-sheet Form 222

What is the unlawful amount of pseudoephedrine a person may purchase?

3.6 grams per day or more than 9 grams during a 30-day period

Florida Board of Pharmacy

Responsible for making and enforcing regulations that govern pharmacy practice in Florida. Is composed of pharmacists and consumer (non-healthcare provider) members

Pharmacy technician cannot do any of the following

1. Receive new non written prescriptions or receive any change in the medication, strength, or directions of an existing prescription

2. Interpret a prescription or medication order for therapeutic acceptability and appropriateness

3. Conduct final verification of dosage and directions

4. Engage in prospective drug review

5. Monitor prescription usage

6. Override clinical alerts without first notifying the pharmacist

7. Transfer a prescription

8. Prepare a copy of a prescription or read a prescription to any person for purposes of providing reference concerning treatment of the person or animal for whom the prescription was written

9. Engage in patient counseling

10. Receive therapy or blood product procedures in a permitted nuclear pharmacy

11. Engage in any other act that requires the exercise of a pharmacist’s professional judgement

In Florida, how many techs can a pharmacist supervise?

No more than 12

Legend Drugs

Prescription drugs that are not considered controlled substances. May be refilled up to the quantity prescribed, within one year of date the prescription was written

Schedule I drugs

Controlled substances with no currently accepted medical use and a high potential for abuse. EX: heroin, LSD

Schedule II drugs

Controlled substances with high potential for abuse, with use potentially leading to severe psychological or physical dependence. EX: oxycodone, fentanyl, adderall. Not allowed to be refilled

Schedule III drugs

Controlled substances with moderate to low potential for physical and psychological dependence. EX: Tylenol with codeine, testosterone

Schedule IV drugs

Controlled substances with low potential for abuse and low risk of dependence. EX: Xanax, Valium, ambien, soma, tramadol

Schedule V drugs

Controlled substances with lower potential for abuse than IV and consist of preparations containing limited quantities of certain narcotics. EX: Robitussin AC, lyrica

Refill for schedule III, IV, V drugs

May not be refilled more than 5 times or more than 6 months after the date the prescription was written

Tablet

Oral solid dosage form containing a drug substance

Capsule

Oral solid dosage form consisting of gelatin or other gelling agent which a drug substance is enclosed

Solution

Homogeneous mixture of 2 or more components, typically prepared by dissolving a solute in a solvent

Suspension

Dispersion of an insoluble solid material (typically the drug) that does not fully dissolve in the solvent to any appreciable extent but remains as solid particles that are distributed throughout the solvent

Emulsion

Composed of 2 immiscible liquids that form 2 separate phases, wherein the small globules of 1 liquid are dispersed uniformly within the other liquid

Oral route

Deliver drugs to the gastrointestinal tract through swallowing. Convenient, cost effective, most common used route

Sublingual route

Deliver drugs under the tongue and has benefit of bypassing the first-pass effect

Transdermal or topical route

Deliver drugs through the skin

Otic route

Deliver drugs into the ear

Ophthalmic route

Deliver drugs into the eye

Nasal route

Deliver drugs by absorption through the nasal mucosa which can result in either local or systemic therapeutic effects

Pulmonary route

Deliver drugs rapidly across the large surface area of the lungs

Parenteral route

Deliver drugs as an injection through the skin

Rectal route

Deliver drugs through the rectum and has the benefit of bypassing the first-pass effect

Vaginal route

Deliver drugs through the vagina. Benefit of bypassing first-pass effect and can be ideal for drugs such as hormones

Best practices for preventing medication errors

1. Avoid using error prone abbreviations. EX: qd, hs

2. Always use leading zeros, never trailing zeros

3. Separate look-alike, sound-alike drugs

4. Use tall man lettering (TML)

High alert drugs

Require extra safety precautions. An error is more likely to cause severe harm or death to the patient than making a similar error with a drug that is not considered “high alert”

List of high alert drugs

Chemotherapy (cyclophosphamide), insulin (humalog), methotrexate (used for rheumatoid arthritis), opiates (oxycodone, opium tincture), injectable electrolytes (potassium chloride), sedatives (midazolam), paralytics (rocuronium)