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