Comprehensive Final Exam Review and Pharmacy Technician Certification Study Guide

End of Course Logistics and Administrative Requirements

• Mandatory Class Survey:     * There is a mandatory final survey located at the bottom of the modules for Year 17 (next week).     * This survey link is distinct from the standard course evaluations sent at the end of the semester.     * Submissions go directly to the CSI workforce director.     * Access is via a link provided in the course module that leads to a QR code for scanning.     * The survey is completely anonymous; the instructor cannot see individual responses.     * CSI requires a high volume of input for these surveys, hence the mandatory status.

• Access to Course Materials:     * Once final grades are submitted, students will lose all access to the Canvas course and materials.     * Students are strongly advised to download and save all desired materials, including the EXCPT registration instructions, before the course closes.

• Final Grades and Eligibility:     * A minimum grade of $70\%$ is required in the class to be eligible to sit for the EXCPT exam.     * The instructor will notify students via message when final grades have been posted.

EXCPT Certification Exam Registration and Preparation

• Registration Process:     * Crucial Requirement: Students must not sign up for the EXCPT exam until final grades are officially posted.     * Registering early results in the instructor denying the application because eligibility (the $70\%$ threshold) hasn't been confirmed.     * Students must follow the provided instruction document specifically to ensure that CSI pays for the exam and the student is not charged directly.

• Exam Coverage and Timeline:     * CSI covers the cost for exactly one attempt at the EXCPT exam.     * Any retake attempts must be paid for by the student out of pocket.     * Eligibility for CSI to pay for the exam lasts for up to one year after passing the class.

• Study Resources on NHA Website:     * 2023 Test Plan: Breaks down the exact number of questions per category and lists specific learning objectives.     * NHA Store: Provides access to optional, paid study materials including practice tests and study guides.     * Practice Tests: Usually include two different exams. Each version can typically be taken up to three times. These are highly recommended for understanding NHA question wording.

Final Exam Structure and Guidelines

• Timing and Availability:     * The exam opens on Monday, May 4.     * The deadline for submission is Sunday, May 10, at $11:59\,PM$.

• Format and Content:     * The exam consists of $50$ questions and is worth a total of $100$ points.     * There are no bonus questions or extra credit opportunities.     * Students are granted one attempt and a time limit of $2$ hours ($120\,minutes$).     * The test is "closed-note"; students are asked to refrain from using textbooks, Google, or personal notes to gauge their actual retention.

• Question Types:     * Calculations: There are $10$ calculation questions ($20\%$ of the exam). These include one example of every calculation type covered: day supply, IV flow rates, compounding, and financial math (calculating gross/net profit using average wholesale cost).     * Brand/Generic Matching: One question is a matching exercise for brand and generic names based on the Top 200 drug list.     * Multiple Choice: All other questions follow the standard multiple-choice format.

• Grading Policy:     * The instructor reviews questions after the exam to see if any should be dropped.     * The instructor typically rounds up borderline grades (e.g., $69\%$, $79\%$, or $89\%$) to the next highest letter grade.

Regulatory and Legal Requirements

• Prescription Validity Limits:     * Schedule II (C-II): Valid for only $90\,days$ from the date written. They cannot be refilled and cannot be transferred between pharmacies.     * Schedule III - V (C-III to C-V): Valid for $6\,months$ (or $180\,days$) from the date written. They can have up to $5$ refills and may be transferred between pharmacies exactly one time.     * Legend Drugs (Non-Controlled): Generally valid for $1\,year$ ($12\,months$) from the date written.

• Packaging Requirements:     * Nitroglycerin: Must never have a child-safety cap. It must be dispensed in an easy-open container because it is a life-saving medication for chest pain and heart attack prevention; fast access is critical.     * Controlled Substances: Medications like Norco (hydrocodone/acetaminophen) should always have child-safety caps to prevent pediatric overdose.

• Combat Methamphetamine Epidemic Act (CMEA):     * Restricts the sale of pseudoephedrine to combat illicit methamphetamine manufacturing.     * The daily purchase limit for pseudoephedrine is $3.6\,g$.

• DEA Forms and Systems:     * Technicians must be familiar with specific DEA forms (e.g., for ordering, returns, or reporting theft).     * VAERS (Vaccine Adverse Event Reporting System): Mandatory reporting system for any side effects resulting from vaccines.     * MedWatch: The FDA's reporting system for adverse effects related to medications.

Pharmacology and Drug Information (Top 200)

• Key Brand-Generic Pairings & Salt Forms:     * Metoprolol Succinate: Toprol XL (Extended Release).     * Metoprolol Tartrate: Lopressor (Immediate Release).     * Escitalopram: Lexapro.     * Citalopram: Celexa.     * Fluoxetine: Prozac.     * Bupropion: Wellbutrin.     * Amlodipine: Norvasc (Legend drug).     * Lisinopril: Zestril or Prinivil (Legend drug).     * Hydroxyzine: Vistaril (Often confused with Zestril).     * Losartan: Cozaar.     * Metformin: Glucophage (Type 2 Diabetes).     * Metronidazole: Flagyl (Antibiotic).     * Warfarin: Coumadin or Jantoven (Blood thinner).     * Clopidogrel: Plavix.     * Rivaroxaban: Xarelto.     * Levothyroxine: Thyroid agent used for hypothyroidism.     * Methimazole: Used for hyperthyroidism to bring thyroid levels down.     * Oseltamivir: Tamiflu (Antiviral for influenza).     * Hydrocodone/APAP: Norco (C-II).     * Oxycodone/APAP: Percocet (C-II).

Pharmacy Calculations and Units

• Standard Conversions:     * $1\,oz = 30\,mL$     * $1\,tbsp = 15\,mL$     * $1\,tsp = 5\,mL$     * $2.2\,lb = 1\,kg$

• Day Supply Calculation for Variable Dosing:     * Always calculate based on the maximum possible dose a patient can take per day.     * Example: "Take 1 to 2 tablets every 6 to 8 hours."     * Maximum dose: $2\,tablets$ every $6\,hours$.     * Calculation: $24\,hours / 6\,hours = 4\,doses/day$. $4 \times 2\,tablets = 8\,tablets/day$.

• Pharmacy Math Concepts:     * Day supply for nebulizer boxes: Treat similarly to insulin/liquid calculations.     * Financial math: Calculating net/gross profit on a prescription.

Clinical and Institutional Pharmacy Practice

• Scope of Practice:     * Pharmacy technicians can perform almost all tasks a pharmacist can EXCEPT counseling.     * Technicians cannot provide advice on side effects, drug interactions, or recommend OTC/prescription products.

• USP Chapters:     * USP 795: Standards for Non-sterile Compounding.     * USP 797: Standards for Sterile Compounding.     * USP 800: Standards for Hazardous Drugs.

• Sterile Compounding:     * First Air: Never block the path of "first air" coming from the HEPA filter in a sterile hood.     * Ampules: Always use a filter needle when drawing medication from a broken glass ampule to prevent glass shards from entering the syringe.     * Needle Gauges: The larger the gauge number, the smaller the needle diameter (e.g., $30\,gauge$ is a small needle; $18\,gauge$ is a large needle).

• Drug Recalls:     * Class I: Most serious; likely to cause significant harm or death.     * Class II: May cause temporary or reversible harm.     * Class III: Unlikely to cause harm; often related to minor contaminants or labeling issues.

• Routes of Administration:     * Ophthalmic (Eye) vs. Otic (Ear): Eye drops can be used in the ears (as the ears do not require the specific pH or sterility of the eye). However, ear drops can never be used in the eyes due to differences in pH and sterility requirements.     * Suppositories: Administered vaginally or rectally.

Sig Code Abbreviations and Medical Terminology

• Common Codes:     * GTT: Drop.     * O: Ocular (Eyes).         * OU: Both eyes.         * OD: Right eye.         * OS: Left eye.     * A: Auditory (Ears).         * AU: Both ears.         * AD: Right ear.         * AS: Left ear.     * BID: Twice a day.     * AC: Before meals (Instructor mnemonic: "Anticorps" as in "around" or "before").     * PC: After meals (Instructor mnemonic: "Post course").

• Definitions:     * Neuralgia: Severe nerve pain.

Questions & Discussion

• Question (Calculator): Can I take my calculator with me into the exam hall?     * Response: The instructor believes the NHA does not restrict the type of calculator. Additionally, the computerized EXCPT exam should have an on-screen calculator available if a physical one is forgotten. However, this is not $100\%$ confirmed regarding specific restrictions.

• Question (Testing Center): Do I have to contact the CSI testing center before my exam?     * Response: No. When you register for the EXCPT, you select your preferred testing location, and the NHA system automatically sends a notification to that center.

• Question (Drug List): Are the top 200 drugs enough for the exam?     * Response: Yes, if you know the common brand and generic names for the top 200. The exam won't have all 200 drugs, but knowing standard ones like Lisinopril, Omeprazole, and statins will ensure success on matching questions.

• Question (Insulin Math): Is math regarding insulin important for the exam?     * Response: While there may not be a specific insulin question, there is a question calculating the day supply for nebulizer boxes, which uses the same logical process as insulin calculations found in the same lecture material in the course.