pharmacy tech tech stuff (copy)

Medication storage factors — Temperature, humidity, and light affect medication stability

Why proper medication storage matters — Maintains drug integrity and effectiveness

Where to find storage requirements — Package label, package insert, or manufacturer

Room temperature range (Celsius) — 20°C to 25°C

Room temperature range (Fahrenheit) — 68°F to 77°F

Refrigerator temperature range (Celsius) — 1.7°C to 7.8°C

Refrigerator temperature range (Fahrenheit) — 35°F to 46°F

Freezer temperature — −15°C (5°F) or lower

How often pharmacy staff check temperatures — Twice daily

Formula to convert Celsius to Fahrenheit — F = (9/5 × C) + 32

Formula to convert Fahrenheit to Celsius — C = (F − 32) × 5/9

20°C in Fahrenheit — 68°F

86°F in Celsius — 30°C

25°C in Fahrenheit — 77°F

10°C in Fahrenheit — 50°F

2°C in Fahrenheit — 35.6°F

68°F in Celsius — 20°C

104°F in Celsius — 40°C

32°F in Celsius — 0°C

First step if medication is stored incorrectly — Move to proper storage immediately

Second step if medication is stored incorrectly — Assess impact on drug efficacy

Third step if medication is stored incorrectly — Notify pharmacist

Fourth step if medication is stored incorrectly — Review storage protocols with staff

Fifth step if medication is stored incorrectly — Inspect storage areas regularly

Nitroglycerin storage requirement — Must be kept in original amber bottle

Why nitroglycerin stays in original bottle — Sensitive to light and humidity

Medications that require refrigeration (examples) — Latanoprost, insulin, vaginal rings, promethazine suppositories

Antibiotic powders before reconstitution — Stored at room temperature

Antibiotic powders after reconstitution — May require refrigeration

🧠 Extra (Test-style cards)

Which medication must stay in original container? — Nitroglycerin

Why are amber bottles used? — Protect from light

Communication in pharmacy — A soft skill requiring adaptability, respect, and cultural awareness

External customers — Patients and caregivers

Internal customers — Staff and healthcare professionals

Adaptability in communication — Adjusting communication style based on the audience

How to communicate with healthcare professionals — Use medical terminology

How to communicate with patients — Use plain language and avoid complex terms

Why plain language is important — Improves understanding and patient engagement

Respect in healthcare — Treating all patients with dignity regardless of background

Examples of patient diversity — Age, race, religion, gender identity, sexual orientation, medical condition

How to show respect to patients — Active listening, empathy, involving them in decisions

Why mutual respect matters in pharmacy — Improves teamwork, work culture, and job satisfaction

Professional communication tip — Limit medical terminology when speaking to patients

Cultural sensitivity — Awareness and respect for different cultural beliefs

Why cultural sensitivity matters — Helps provide culturally competent care

When cultural sensitivity is important — Birth control, hormone therapy, emergency contraceptives

How to demonstrate cultural sensitivity — Avoid judgment and respect differences

Clinical empathy — Understanding and sharing patient feelings while staying professional

How to show clinical empathy — Active listening, acknowledging emotions, showing compassion

Why clinical empathy matters — Builds trust and improves patient satisfaction

Example of empathy in pharmacy — Listening to patient concerns and asking respectful questions

Who answers clinical questions — Pharmacist

🧠 Test-style cards

Best example of cultural awareness in pharmacy — Tailoring communication about birth control respectfully

What is NOT respectful behavior — Ignoring patient concerns or pronouns

What is unethical behavior in pharmacy communication — Dismissing patient concerns based on personal beliefs

Controlled Substances Act (CSA) — Federal law regulating controlled substances

Who enforces CSA — Drug Enforcement Administration (DEA)

DEA Form 222 purpose — Used to order C-II medications

DEA Form 222 format — Triplicate paper form

Who signs DEA Form 222 — Pharmacist or power of attorney

Where copies of Form 222 go — Supplier, DEA, pharmacy

How long Form 222 is valid — 60 days

How long Form 222 must be kept — 2 years

CSOS (Controlled Substance Ordering System) — Electronic system to order C-II medications

Advantage of CSOS — Faster ordering with electronic signature

Which schedules require Form 222 — C-II only

Which schedules do NOT require Form 222 — C-III to C-V

DEA Form 41 purpose — Disposal of controlled substances

When Form 41 is used — Expired, damaged, or unused meds

How controlled substances can be disposed — Manufacturer, wholesaler, reverse distributor

DEA Form 106 purpose — Report theft or loss of controlled substances

Who is responsible for reporting theft — Pharmacist

Technician role in theft situations — Gather inventory/count information

Controlled substance inventory requirement — Every 2 years

How long inventory records must be kept — 2 years

C-II inventory requirement — Exact count required

C-III to C-V inventory requirement — May estimate

Perpetual inventory log — Ongoing record of controlled substances

Who updates perpetual inventory — Technician

Who verifies perpetual inventory — Pharmacist

C-II prescription filing requirement — Must be filed separately

C-III to C-V filing options — With non-controlled (with red “C”) or separate file

Controlled substance lending between pharmacies — Allowed under specific rules

Requirement for lending controlled substances — Both pharmacies must be DEA registered

Form used for lending controlled substances — DEA Form 222

Max amount that can be lent — 5% of annual supply

Example of 5% rule — 1,000 tablets → max 50 tablets can be lent

How to verify prescriber legitimacy — Check DEA number

What to do if prescription seems fraudulent — Notify pharmacist immediately

🧠 Test-style cards

How can C-II meds be ordered? — Electronically (CSOS) or paper (Form 222)

Can C-II meds be ordered by phone or fax? — No

🚨 HIGH-YIELD (you NEED these for your test)

• Form 222 = Order C-II

• Form 41 = Dispose

• Form 106 = Theft/Loss

• C-II = Exact count + separate file

• Inventory = Every 2 years

• Max transfer = 5%

INPATIENT PHARMACY & PRESCRIPTION VERIFICATION

Inpatient pharmacy — Pharmacy within a hospital or health system

Key difference in inpatient setting — DEA number not required on prescription

Why DEA number isn’t required inpatient — Hospital keeps prescriber DEA numbers on file

Do inpatient pharmacies follow CSA laws? — Yes, most laws still apply

📋 CONTROLLED SUBSTANCE PRESCRIPTION REQUIREMENTS

Basic prescription components — Drug name, strength, dosage form, route, directions, quantity

Additional CSA-required components — Patient info, prescriber info, DEA number, date, refills, signature

Patient information required — Full name and full street address

Prescriber information required — Name, address, phone number, DEA number

Exception (inpatient) — DEA number not required on prescription

Prescription must include date — Date issued by prescriber

Prescription must include refills — Number of refills authorized

Prescription must include signature — Prescriber’s signature

🚨 FRAUD & PRESCRIPTION SAFETY

Why controlled substance prescriptions are high risk — High abuse potential

Examples of fraudulent prescriptions —

• Stolen prescription pads

• Fake prescriber names

• Invalid DEA numbers

• Altered phone numbers

First step if prescription seems fraudulent — Notify pharmacist immediately

Technician’s role in verification — Check required components before processing

🧠 TEST-STYLE CARDS

What is NOT required on inpatient controlled prescriptions? — DEA number

What should you do if a prescription looks altered or fake? — Tell the pharmacist

Who is on the front line for receiving prescriptions? — Pharmacy technician

🚨 HIGH-YIELD (MEMORIZE THIS)

• Inpatient = No DEA number on Rx

• Always check:

  • Patient info

  • Prescriber info

  • Date

  • Refills

  • Signature

• Suspicious Rx = STOP + tell pharmacist immediately

MEDICATION INDICATIONS (Quizlet Set)

Medication indication — The disease or condition a drug is approved to treat

Labeled indication — FDA-approved use of a medication

Off-label use — Using a medication for a condition not FDA-approved

Is off-label use allowed? — Yes, if prescriber believes it benefits patient

Who approves medication indications — FDA

💊 COMMON MEDICATIONS (HIGH-YIELD)

Haloperidol (Haldol) — Schizophrenia

Insulin glargine (Lantus, Toujeo) — Type 1 & Type 2 diabetes

Levothyroxine (Synthroid) — Hypothyroidism

Hydrochlorothiazide (Microzide) — Hypertension, edema

Lithium (Lithobid) — Bipolar disorder

Lorazepam (Ativan) — Anxiety

Metformin (Glucophage) — Type 2 diabetes

Memantine (Namenda) — Alzheimer’s disease

Methylphenidate (Ritalin) — ADHD, narcolepsy

Montelukast (Singulair) — Asthma, allergies

Ondansetron (Zofran) — Nausea, vomiting

Omeprazole (Prilosec) — GERD, ulcers

Pioglitazone (Actos) — Type 2 diabetes

Pregabalin (Lyrica) — Nerve pain, fibromyalgia

Quetiapine (Seroquel) — Bipolar, schizophrenia, depression

Metoprolol (Lopressor) — Hypertension, angina

Rosuvastatin (Crestor) — High cholesterol

Sertraline (Zoloft) — Depression, anxiety disorders

Sildenafil (Viagra) — Erectile dysfunction, pulmonary HTN

Bactrim (SMX/TMP) — Bacterial infections

Tamsulosin (Flomax) — BPH (prostate)

Tramadol (Ultram) — Pain

Valsartan (Diovan) — Hypertension, heart failure

Acyclovir (Zovirax) — Herpes infections

Hydrocodone/APAP (Norco) — Pain

Allopurinol (Zyloprim) — Gout

Alprazolam (Xanax) — Anxiety

Amitriptyline (Elavil) — Depression

Amlodipine (Norvasc) — Hypertension

Amoxicillin (Amoxil) — Bacterial infections

Aripiprazole (Abilify) — Bipolar, schizophrenia

Atorvastatin (Lipitor) — High cholesterol

Azithromycin (Zithromax) — Bacterial infections

Lisinopril (Zestril) — Hypertension, heart failure

Bupropion (Wellbutrin) — Depression, smoking cessation

Cephalexin (Keflex) — Bacterial infections

Ciprofloxacin (Cipro) — Bacterial infections

Citalopram (Celexa) — Depression

Albuterol (ProAir) — Asthma

Clopidogrel (Plavix) — Stroke, heart attack prevention

Cyclobenzaprine (Flexeril) — Muscle spasms

Diazepam (Valium) — Anxiety, seizures

Donepezil (Aricept) — Alzheimer’s

Duloxetine (Cymbalta) — Depression, nerve pain

Enoxaparin (Lovenox) — Blood clots (DVT)

Escitalopram (Lexapro) — Depression, anxiety

Eszopiclone (Lunesta) — Insomnia

Advair (fluticasone/salmeterol) — Asthma, COPD

🧠 HIGH-YIELD MATCHES (EXAM FAVORITES)

Tamsulosin (Flomax) — BPH

Enoxaparin (Lovenox) — DVT

Cyclobenzaprine (Flexeril) — Muscle spasm

Lisinopril (Zestril) — Hypertension

Rosuvastatin (Crestor) — Hyperlipidemia

🧬 BIOSIMILARS (TESTABLE)

Biosimilar — Similar version of a biologic drug

Interchangeable biosimilar — Can be substituted without new prescription

Key rule — Only interchangeable biosimilars can be substituted

Purple Book — Lists biologics, biosimilars, and interchangeability

🚨 HIGH-YIELD (YOU NEED THIS FOR YOUR SCORE)

Focus on:

• Diabetes → Metformin, Insulin

• BP → Lisinopril, Amlodipine

• Cholesterol → Atorvastatin, Rosuvastatin

• Mental health → Sertraline, Xanax

• Pain → Tramadol, Norco

• Infections → Amoxicillin, Azithromycin

BEHIND-THE-COUNTER (BTC) MEDICATIONS

Behind-the-counter (BTC) medications — OTC drugs kept behind the pharmacy counter due to legal restrictions

Why BTC medications are restricted — Potential for misuse or safety concerns

Examples of BTC categories — Pseudoephedrine products, codeine cough meds, insulin

Pseudoephedrine (Sudafed) — Nasal and sinus congestion

Fexofenadine + pseudoephedrine (Allegra-D) — Seasonal allergies

Loratadine + pseudoephedrine (Claritin-D) — Cold and allergy symptoms

Codeine + guaifenesin (Cheratussin AC) — Cough

Codeine + promethazine — Cough

Insulin regular (Humulin R) — Diabetes

Insulin isophane NPH (Novolin N) — Diabetes

Insulin 70/30 (Humulin 70/30) — Diabetes

🧠 TEST-STYLE CARDS

Which BTC medications treat diabetes? — Insulin (Humulin R, Novolin N, 70/30)

Which ingredient makes products BTC for congestion meds? — Pseudoephedrine

Are all insulin products BTC? — No

What type of drug is insulin glargine-yfgn? — Prescription (legend drug)

Why is insulin glargine NOT BTC? — It is a biologic

🚨 HIGH-YIELD (EXAM FOCUS)

• BTC = Behind the counter, NOT fully OTC

• Pseudoephedrine = BTC (big test topic)

• Insulin (some types) = BTC

• Biologics = ALWAYS prescription

📚 MEDICATION CLASSIFICATIONS (Quizlet Set)

Medication classification — Grouping drugs by action, use, or body system

Why classifications matter — Helps understand drug effects, uses, and patient impact

⚙ CLASSIFICATION TYPES

Classification by mechanism of action — How the drug works in the body

Classification by therapeutic indication — What condition the drug treats

Classification by body system — Which system the drug affects

💡 EXAMPLES OF CLASSIFICATION

Metoprolol classification (mechanism) — Beta-blocker

Metoprolol classification (use) — Antihypertensive

Metoprolol body system — Cardiovascular

⚠ IMPORTANT CONCEPTS

Therapeutic equivalence — Drugs have same effect, safety, and bioavailability

Are same-class drugs always interchangeable? — No

Reference for therapeutic equivalence — Orange Book

🔟 TOP 10 PRESCRIBED DRUGS (HIGH-YIELD)

Lisinopril (Zestril) — ACE inhibitor, BP

Levothyroxine (Synthroid) — Thyroid hormone

Atorvastatin (Lipitor) — Statin, cholesterol

Metformin (Glucophage) — Diabetes

Simvastatin (Zocor) — Statin

Omeprazole (Prilosec) — Proton pump inhibitor (acid reducer)

Amlodipine (Norvasc) — Calcium channel blocker

Metoprolol (Lopressor) — Beta-blocker

Hydrocodone/APAP (Norco) — Opioid pain reliever

Albuterol (ProAir) — Bronchodilator

🧪 CLASSIFICATIONS BY ACTION (EXAMPLES)

ACE inhibitor — BP (Captopril)

Beta-blocker — Lowers heart rate/BP (Metoprolol)

Statin — Lowers cholesterol (Simvastatin)

SSRI — Antidepressant (Fluoxetine)

Benzodiazepine — Anxiety (Clonazepam)

Macrolide — Antibiotic (Azithromycin)

Cephalosporin — Antibiotic (Cephalexin)

Proton pump inhibitor (PPI) — Acid reducer (Pantoprazole)

H2 blocker — Acid reducer (Famotidine)

Beta-2 agonist — Bronchodilator (Albuterol)

🧍 CLASSIFICATIONS BY BODY SYSTEM

Cardiovascular system — Heart/blood vessels (Digoxin)

Endocrine system — Hormones (Insulin)

Gastrointestinal system — Stomach/intestines (Sucralfate)

Hematologic system — Blood (Enoxaparin)

Immune system — Immune response (Oseltamivir)

Nervous system — Brain/spinal cord (Donepezil)

Musculoskeletal system — Bones/muscles (Indomethacin)

Urinary system — Kidneys/bladder (Tamsulosin)

Respiratory system — Lungs (Salmeterol)

Reproductive system — Hormonal organs (Leuprolide)

🧬 BIOLOGICS & BIOSIMILARS

Biologic drug — Made from living organisms

Example biologic — Insulin glargine

Biosimilar — Similar version of a biologic

Reference product — Original biologic

Naming of biosimilars — Ends with 4 random letters

Interchangeable biosimilar — Can be substituted without new prescription

Where to check biosimilars — Purple Book

Key rule — Must be interchangeable AND allowed by state law

🧠 TEST-STYLE CARDS

Is insulin glargine OTC or prescription? — Prescription

What body system does insulin affect? — Endocrine

What is insulin’s therapeutic use? — Antidiabetic

🚨 HIGH-YIELD (EXAM BOOST)

Focus on:

• BP meds → ACE inhibitors, beta-blockers, CCBs

• Cholesterol meds → Statins

• Mental health meds → SSRIs, benzos

• Asthma meds → Beta-2 agonists

• Acid meds → PPIs + H2 blockers

📚 SIDE EFFECTS & ADVERSE REACTIONS

Side effect — Unintended, expected effect at normal dose

Can side effects be positive? — Yes

Example of positive side effect — Sildenafil helping erectile dysfunction

Adverse reaction — Undesirable, harmful, often more severe effect

Severity of adverse reactions — Can be dangerous or life-threatening

Example of adverse reaction — Severe allergic reaction to sulfa drugs

Do side effects and adverse reactions occur at normal doses? — Yes

Key difference (side effect vs adverse reaction) — Side effects = expected; adverse reactions = harmful

How to decide if medication should continue — Weigh benefit vs harm

When medication may continue — If side effects are mild and benefits outweigh risks

💊 COMMON MEDICATIONS (SIDE EFFECTS vs ADVERSE REACTIONS)

Acetaminophen (Tylenol) — Rash → Hepatotoxicity (liver damage)

Baclofen (Lioresal) — Drowsiness, nausea → CNS/withdrawal effects

Clindamycin (Cleocin) — Nausea → C. difficile infection

Diclofenac (Lofena) — Edema, nausea → None listed

Hydroxychloroquine (Plaquenil) — Rash, fatigue → Heart, retinal, neuro effects

Lisinopril (Zestril) — Dizziness, hypotension → Kidney injury, angioedema

Morphine (Duramorph) — Nausea, rash → Respiratory depression, constipation

Nitroglycerin (Nitrostat) — Headache, dizziness → None listed

Phenytoin (Dilantin) — Rash, nausea → Blood disorders, liver toxicity

Amlodipine (Norvasc) — Nausea, fatigue → Peripheral edema

🧠 TEST-STYLE MATCHES (VERY IMPORTANT)

Acetaminophen → Hepatotoxicity

Clindamycin → C. difficile infection

Lisinopril → Acute kidney injury

Phenytoin → Blood dyscrasias

Amlodipine → Peripheral edema

🚨 HIGH-YIELD (MEMORIZE THESE)

• Tylenol → Liver damage

• Clindamycin → C. diff

• Lisinopril → Angioedema + kidney issues

• Morphine → Respiratory depression

• Amlodipine → Edema (swelling)

⚡ QUICK MEMORY TRICKS

• “C for Clinda → C. diff”

• “Tylenol → Toxic liver”

• “ACE (lisinopril) → Angioedema”

• “Morphine → breathing slows”

📚 CONTRAINDICATIONS & INTERACTIONS

Contraindication — Situation where a medication should NOT be used due to risk

Medication interaction — When drugs/food affect how a medication works

⚠ TYPES OF CONTRAINDICATIONS

Relative contraindication — Use with caution (risk is higher but possible)

Absolute contraindication — NEVER use under any circumstances

💡 EXAMPLES (HIGH-YIELD)

Aspirin + warfarin — Relative contraindication (↑ bleeding risk)

Simvastatin + diltiazem (high dose) — Absolute contraindication

Isotretinoin + pregnancy — Absolute contraindication 🚨

Pseudoephedrine + hypertension — Relative contraindication

👩‍⚕ TECHNICIAN ROLE

What to do with interaction alerts — Notify pharmacist

When pharmacist review is critical — New prescriptions or multiple meds

⚙ TYPES OF MEDICATION INTERACTIONS

1. Absorption

Absorption interaction — Affects how drug is absorbed (GI tract)

Example — Omeprazole ↓ absorption of posaconazole

2. Distribution

Distribution interaction — Changes protein binding in blood

Example — Valproic acid ↑ warfarin levels → ↑ bleeding

3. Metabolism

Metabolism interaction — Alters liver enzyme activity

Example — Amiodarone ↑ warfarin levels → ↑ INR

4. Excretion

Excretion interaction — Affects kidney elimination

Example — Aspirin ↓ excretion of methotrexate → toxicity

5. Pharmacodynamic

Pharmacodynamic interaction — Drugs have similar effects

Example — Opioids + benzodiazepines → respiratory depression 🚨

🧠 KEY TERMS

Metabolite — Byproduct after drug is processed by body

🧠 TEST-STYLE CARDS

Which interactions affect kidney elimination? — Excretion

Which interactions involve liver enzymes? — Metabolism

Which interactions involve protein binding? — Distribution

Which interactions occur in GI tract? — Absorption

🚨 HIGH-YIELD (MEMORIZE THIS)

• Opioids + benzos = breathing stops (BIG TEST ONE)

• Warfarin = lots of interactions (bleeding risk)

• Isotretinoin = NEVER in pregnancy

• Methotrexate + aspirin = toxicity

• Simvastatin + diltiazem = NO

⚡ QUICK MEMORY TRICK

ADME = interactions

• A → Absorption (gut)

• D → Distribution (blood/proteins)

• M → Metabolism (liver)

• E → Excretion (kidneys)

 PRESCRIPTION FULFILLMENT & OBRA (Quizlet Set)

👩‍⚕ PRESCRIBERS & AUTHORITY

Prescriptive authority — Legal ability to write prescriptions

Who can prescribe (examples) — Physicians, dentists, NPs, PAs, optometrists

Are prescriber rules the same everywhere? — No (state-specific)

What to do if prescriber seems inappropriate — Check with pharmacist

📋 PRESCRIPTION COMPONENTS (HIGH-YIELD)

Required prescriber info — Name, address, phone

When is DEA number required? — Controlled substances only

Required patient info — Name, address, DOB

Required prescription details —

• Drug name

• Strength

• Dosage form

• Route

• Dose

• Quantity

• Refills

Sig (Signa) — Directions for patient use

Prescription must include — Prescriber signature + date

🚨 FRAUD RED FLAGS

Suspicious prescription signs —

• Multiple ink colors

• Very neat handwriting

• Large quantities (over 30-day supply)

• Unusual formatting

✏ ABBREVIATIONS (SAFETY)

“Do Not Use” abbreviation lists come from —

• The Joint Commission

• ISMP

Examples of unsafe abbreviations —

• HS (confusing)

• D/C (discontinue or discharge)

• TIW (unclear frequency)

✅ FIVE RIGHTS OF MEDICATION

Core Five Rights —

• Right patient

• Right drug

• Right dose

• Right route

• Right time

Additional Rights —

• Right technique

• Right documentation

🏛 OBRA (VERY IMPORTANT)

OBRA (1990) — Federal law for pharmacy practice

What OBRA requires —

• Patient profiles

• Drug utilization review (DUR)

• Offer counseling

Who can counsel patients? — Pharmacist ONLY

Technician role under OBRA —

• Gather patient info

• Assist workflow

• Refer questions to pharmacist

🔍 DRUG UTILIZATION REVIEW (DUR)

DUR definition — Review of prescribing, dispensing, and patient use

What DUR checks —

• Interactions

• Allergies

• Duplicate therapy

• Dosing

🏥 INPATIENT FULFILLMENT

Inpatient prescriptions — Called medication orders

Where orders are entered — Computer system (CPOE)

Extra inpatient info — Room number, hospital ID

Formulary — List of meds hospital keeps

Automatic substitution — Switching to formulary drug

🔁 REFILL REVIEW (QUICK RECAP)

Non-controlled Rx validity — 12 months

Early refill rule — ~75% used before insurance pays

🧠 TEST-STYLE CARDS

Who regulates prescribers? — State boards

Who can counsel patients? — Pharmacist

What law requires patient profiles? — OBRA

What checks interactions/allergies? — DUR

Are DEA numbers needed for all prescriptions? — No (only controlled)

🚨 FINAL HIGH-YIELD (MEMORIZE)

• OBRA = profiles + counseling + DUR

• Only pharmacist = counseling

• DEA = controlled only

• Five Rights = core safety

• ISMP + Joint Commission = abbreviation safety

📚 PATIENT GUIDANCE & LABELING (Quizlet Set)

📄 PATIENT EDUCATION MATERIALS

Medication Guide — FDA-required handout for high-risk meds

When medication guides are required —

• Prevent serious adverse events

• Inform patient decisions

• Ensure proper use

Common meds needing guides —

• NSAIDs

• Antidepressants

• ADHD meds

• Insomnia meds

• Isotretinoin

Patient Package Insert (PPI) — Detailed manufacturer info about medication

PPI includes — Use, side effects, dosing, storage, warnings

Consumer Information Sheet — General patient-friendly medication info

🏷 PRESCRIPTION LABEL REQUIREMENTS

Must include —

• Pharmacy name/address/phone

• Rx number

• Patient name

• Prescriber name

• Drug name/strength/form

• Directions

• Refills

• Expiration date

• Federal legend

Federal legend — “Caution: Federal law prohibits transfer…”

💊 PACKAGING & DISPENSING

Amber vials purpose — Protect from light

Counting tray cleaning — Use isopropyl alcohol

When to clean tray — After penicillin or sulfa drugs

Childproof packaging law — Poison Prevention Packaging Act

Are blister packs childproof? — No

🏥 TYPES OF PACKAGING

Prescription vials — Tablets/capsules

Ointment jars — Creams/ointments

Dropper bottles — Liquids (eyes/ears)

Blister packs (punch cards) — Unit doses

🧾 UNIT DOSE & REPACKAGING

Unit-dose system — Single-dose packaging (hospitals)

Punch cards — Used for long-term care patients

Repackaging requirements —

• Product identification

• Environmental protection

• Proper handling

• Usability

🔐 REMS & ETASU (VERY HIGH-YIELD)

REMS — FDA safety program for high-risk drugs

Purpose of REMS — Ensure benefits outweigh risks

ETASU — Required safety actions before dispensing

Examples of REMS requirements —

• Lab monitoring

• Pregnancy tests

• Registration

💊 MED TYPES

Legend drug — Prescription only

OTC drug — No prescription needed

BTC drug — Behind-the-counter

🔢 NDC (CRITICAL)

NDC definition — Unique drug identifier

3 parts of NDC —

1. Manufacturer

2. Drug/strength/form

3. Package size

NDC importance — Prevents medication errors

Barcode rule — Must match label and stock bottle

🚨 MEDICATION SAFETY

How to prevent errors —

• Match NDC

• Use barcode scanning

• Double-check meds

Look-alike/sound-alike drugs — Major error risk

⚠ FORGERY RED FLAGS

• Different ink colors

• Messy vs neat handwriting

• Large quantities

• Photocopied Rx

If suspicious Rx — Notify pharmacist

🧮 CALCULATIONS (MUST KNOW)

Quantity Formula

Quantity = dose × frequency × days

Days Supply

Days supply = quantity ÷ daily dose

tsp to mL

1 tsp = 5 mL

BSA Dosing

Dose = mg/m² × BSA

💧 DILUTION FORMULA

SV × SP = DV × DP

Diluent needed = DV – SV

⚖ RATIO

Ratio — Relationship between two values (mg/mL)

💰 BUSINESS CALCULATIONS

Gross profit — Selling price − cost

Markup % — (Profit ÷ cost) × 100

🧠 TEST-STYLE CARDS

What law requires childproof containers? — Poison Prevention Packaging Act

What ensures high-risk drug safety? — REMS

What must match when filling meds? — NDC/barcode

Who can counsel patients? — Pharmacist

What is 1 tsp in mL? — 5 mL

🚨 FINAL HIGH-YIELD (MEMORIZE THIS)

• REMS = high-risk drug safety

• NDC = drug identity

• 1 tsp = 5 mL

• Qty = dose × freq × days

• OBRA = counseling + profiles

• Fraud = weird prescriptions

Nonsterile Compounding

USP <795> — Standard that regulates nonsterile compounding 

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What USP <795> covers — Compounding area design, cleaning, training, hygiene, garbing, beyond-use dates, and documentation 

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Gloves in nonsterile compounding — Required 

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Why nonsterile compounding still requires cleanliness — Products are not sterile, but contamination must still be minimized 

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Compounding area location — Away from routine dispensing, counseling, and high-traffic areas 

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How often nonsterile compounding area is cleaned — Daily and after each use 

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Scale must be tared — Before use to ensure accurate weighing 

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Nonsterile Compounding Equipment

Class A balance — Weighs smaller amounts 

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Electronic balance — Weighs larger amounts 

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Brass weights — Used to calibrate balances and should not be touched with ungloved hands 

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Spatula — Used to mix or transfer ingredients 

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Weighing paper/boat — Holds ingredients and protects balance surface 

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Mortar — Bowl/container used for mixing or grinding 

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Pestle — Tool used to grind or mix in mortar 

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Ointment slab — Glass surface used for mixing powders, liquids, and creams 

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Hot plate — Used to heat or melt ingredients 

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Most accurate graduated cylinder — Cylindrical graduated cylinder 

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How to read liquid level — At the bottom of the meniscus 

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Syringe purpose in compounding — Transfers liquid ingredients 

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Molds — Shape troches, suppositories, and tablets 

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📚 SIG CODES & ABBREVIATIONS

Routes of Administration

PO — By mouth/orally 

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IV — Intravenous 

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TOP — Topically 

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VAG — Vaginally 

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EN — Each nostril 

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UD / UT — As directed 

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Dosage Forms

CAP — Capsule 

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TAB — Tablet 

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LIQ — Liquid 

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SUSP — Suspension 

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SUPP — Suppository 

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UNG / OINT — Ointment 

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SOL — Solution 

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SYR — Syrup 

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LOT — Lotion 

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Frequency Abbreviations

BID — Twice daily 

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Q4H — Every 4 hours 

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Q6H — Every 6 hours 

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QHS — Every night at bedtime 

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PC, HS — After meals and at bedtime 

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AM — Morning 

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PM — Afternoon/evening 

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ASAP — As soon as possible 

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STAT — Immediately/at once 

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W/ — With 

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W/O — Without 

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Abbreviations to Avoid

U — Avoid; may be misread as 0, 4, or cc 

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IU — Avoid; may be misread as IV or 10 

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QD — Avoid; may be misread as QID or QOD 

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QOD — Avoid; may be misread as QD or QID 

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Trailing zero — Avoid because decimal point may be missed 

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No leading zero — Avoid because decimal point may be missed 

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📚 ELECTRONIC ALERTS & SAFETY

Computer system checks for — Allergies, interactions, duplicate therapies, contraindications, early refills, and over/underuse 

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Who handles simple alerts like refill too soon — Technician may handle 

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Who must handle DUR/DDI/allergy alerts — Pharmacist 

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DUR alert — Review for dosage problems, age issues, sex contraindications, or utilization problems 

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PMP — State-run program tracking controlled substance prescribing and dispensing 

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Pre-adjudication alerts — Problems found before claim is processed 

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Examples of pre-adjudication alerts — Invalid NDC, incorrect package size, missing days’ supply, invalid prescriber 

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Post-adjudication alerts — Messages after claim is processed by insurance 

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📚 DISPENSING & DAW CODES

First step in dispensing process — Create or update patient profile 

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Use how many identifiers to choose correct patient — At least two identifiers 

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Examples of patient identifiers — DOB, middle initial, address, patient number 

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DAW codes — Codes indicating substitution or brand/generic selection status 

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DAW 0 — No product selection indicated; generic allowed 

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DAW 1 — Substitution not allowed by prescriber 

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DAW 2 — Patient requested brand 

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DAW 3 — Pharmacist selected brand/product dispensed 

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DAW 4 — Generic not in stock 

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AB rating — FDA rating showing generic is therapeutically equivalent and substitutable 

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📚 MEDICATION SAFETY & QUALITY ASSURANCE

Medication error — Preventable event that may cause inappropriate medication use or patient harm 

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Just culture — Safety culture focused on learning and system improvement, not automatic blame 

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Human error — Unintentional failure; not a behavioral choice 

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At-risk behavior — Unsafe choice made because risk seems insignificant or justified 

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Reckless behavior — Conscious disregard of substantial risk 

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Two patient identifiers — Standard safety practice when receiving and dispensing prescriptions 

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Document patient weights in — Kilograms, not pounds 

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Never do with unclear prescription — Never make assumptions; clarify with pharmacist/prescriber 

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Controlled substances counting best practice — Count at least twice 

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🚨 HIGH-YIELD CARDS

USP standard for nonsterile compounding — USP <795> 

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Most accurate graduated cylinder — Cylindrical 

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1 tsp — 5 mL

QHS — Every night at bedtime 

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TOP — Topically 

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QD / QOD / U — Abbreviations to avoid 

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DAW 0 — Generic allowed 

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DAW 1 — Brand medically required by prescriber 

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Use two identifiers — Prevents wrong-patient errors 

Payment & Insurance

Tiered copays — Different copay amounts based on a drug’s insurance tier 

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Tier 1 medications — Usually generics and lowest cost to patient 

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Coordination of benefits (COB) — Ensures insurance claims are not paid more than once 

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Primary insurance — Insurance billed first 

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Medicaid rule — Medicaid is payer of last resort 

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Adjudication — Electronic processing of a claim to insurance for approval/payment 

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Carrier/insurer — Insurance company 

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Processor — Company hired to process claims 

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Claim — Request for reimbursement sent to insurer 

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Copay/coinsurance — Patient’s share of the cost 

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Deductible — Amount patient pays before insurance starts covering costs 

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Days’ supply — Number of days the dispensed medication should last 

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If a $100 claim returns a $100 patient pay in February — Most likely deductible has not been met yet 

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If claim says “Product/Service Not Covered. Xarelto preferred.” — Contact prescriber/pharmacist to request covered alternative 

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Refills & On-Hold Prescriptions

On-hold prescription — Prescription entered in profile but not yet filled 

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Auto-fill — Automatic refill service for ongoing medications 

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First refill check — Make sure refills are still available 

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If no refills remain — Prescriber must authorize refills or send new prescription 

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When a new prescription is required instead of refill authorization — When directions/change to therapy are different from original prescription 

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Prescription Validity

Non-controlled prescription validity — Usually valid for 1 year 

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C-III to C-V validity — Usually valid for 6 months and up to 5 refills 

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C-II refill rule — No refills; new written prescription needed each time 

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Early, Emergency, and Partial Refills

Most insurance plans allow refill how early? — Up to 7 days early 

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Refill-too-soon message — Insurance denial when refill is requested too early 

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Problem queue — Where prescriptions with processing issues go instead of filling queue 

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Why a patient may need an early refill — Travel, lost meds, or taking medication differently than prescribed 

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Emergency refill — Short-term supply pharmacist may provide until refill authorization is received 

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Typical emergency refill amount — Usually 2 to 3 days of medication 

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Partial fill — Pharmacy dispenses only part of prescription due to limited stock 

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Typical partial fill amount — Usually 3- to 5-day supply 

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If C-II is partially filled because stock is short — Remaining amount is void; patient needs new prescription for the rest 

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Dispensing Process

First step in dispensing — Create or update patient profile 

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How many identifiers should be used to select correct patient — Two identifiers 

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Examples of identifiers — DOB, middle initial, address, patient number 

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Patient profile should include updated — Demographics, allergies, meds, medical conditions, insurance 

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Prescription Input Steps

Step 1 — Enter date prescription was written 

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Step 2 — Enter NDC or medication name/strength and select correct product 

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Step 3 — Select correct DAW code 

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Step 4 — Enter quantity ordered 

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Step 5 — Enter number of refills 

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Step 6 — Enter directions for use 

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Step 7 — Select correct prescriber and address 

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Step 8 — Enter correct days’ supply 

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Step 9 — Enter method of receipt (e-script, fax, written, phone, transfer, etc.) 

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Step 10 — Select billing option 

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Step 11 — Process the entry 

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DAW Codes

DAW — Dispense as written code used for substitution decisions 

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DAW 0 — No product selection indicated; generic allowed 

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DAW 1 — Substitution not allowed by prescriber 

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DAW 2 — Patient requested brand product 

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DAW 3 — Pharmacist selected product dispensed 

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DAW 4 — Generic not in stock 

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DAW 5 — Brand dispensed as generic 

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DAW 6 — Override 

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DAW 7 — Brand mandated by law 

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DAW 8 — Generic not available in marketplace 

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DAW 9 — Other 

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Most common DAW code — DAW 0 

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AB rating — FDA rating showing generic is therapeutically equivalent and substitutable 

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If prescriber wants brand only — Use DAW 1 

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If patient wants brand — Use DAW 2 

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Correct DAW for John Q. Smith’s ciprofloxacin transfer — DAW 0 

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High-yield cards

Non-controlled Rx valid for — 1 year 

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C-III to C-V refills — Up to 5 refills in 6 months 

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C-II refills — None 

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Most insurers allow refill this many days early — 7 days 

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Medicaid billing order — Bill last 

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DAW 0 — Generic allowed 

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DAW 1 — Brand required by prescriber 

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DAW 2 — Brand requested by patient 

Core Concepts

Q: What does the Drug Enforcement Administration require under the Controlled Substances Act (CSA)?
A: Anyone who manufactures, distributes, prescribes, researches, imports, exports, or dispenses controlled substances must register with the DEA.

Q: What is a DEA registration number?
A: A unique identifier issued to prescribers, pharmacies, and manufacturers handling controlled substances.

Q: What must accompany all prescriptions for controlled substances?
A: A valid DEA registration number.

Q: What should a pharmacy technician verify when receiving a controlled substance prescription?
A: That the prescriber’s DEA number is valid.

DEA Number Structure

Q: How many characters are in a DEA number?
A: Two letters + seven digits (total of 9 characters).

Q: What does the first letter of a DEA number represent?
A: The type of registrant (e.g., A, B, F, M, X).

Q: What does the second letter of a DEA number represent?
A: The first letter of the registrant’s last name (with some exceptions).

Q: What is the check digit in a DEA number?
A: The last digit, used to verify validity via a math calculation.

DEA Number Validation Steps

Q: What is the first step in validating a DEA number?
A: Add the 1st, 3rd, and 5th digits.

Q: What is the second step in validating a DEA number?
A: Add the 2nd, 4th, and 6th digits and multiply the sum by 2.

Q: What is the third step in DEA validation?
A: Add the results from steps 1 and 2.

Q: What is the final step in DEA validation?
A: Confirm the last digit of the total matches the DEA number’s last digit.

Example / Application

Q: DEA number: AS4967432 — What is the sum of the 1st, 3rd, and 5th digits?
A: 4 + 6 + 4 = 14

Q: DEA number: AS4967432 — What is the result of doubling the sum of the 2nd, 4th, and 6th digits?
A: (9 + 7 + 3 = 19) → 19 × 2 = 38

Q: DEA number: AS4967432 — What is the final sum used for validation?
A: 14 + 38 = 52

Q: DEA number: AS4967432 — Is it valid? Why?
A: Yes, because the last digit (2) matches the last digit of the total (52).

Extra Details / Edge Cases

Q: Can the second letter of a DEA number ever not match the prescriber’s last name?
A: Yes, for example if the prescriber changes their last name but keeps the original DEA number.

Q: Who must obtain a DEA registration number besides prescribers?
A: Pharmacies and manufacturers that handle controlled substances.

Manufacturer Packaging (FDA Requirements)

Q: What agency regulates prescription medication packaging labels?
A: The Food and Drug Administration

Q: What are prescription medications also called?
A: Legend drugs

Q: What must appear on manufacturer prescription labels regarding active ingredients?
A: Established (generic) name and quantity of each active ingredient

Q: When can a brand name be used on manufacturer labels?
A: When the drug is still under patent

Q: What is the “federal legend”?
A: “Rx only” or “Caution: Federal law prohibits dispensing without a prescription”

Q: What must be included about dosing on manufacturer labels?
A: Statement of usual dosage

Q: What information is provided about administration?
A: Route of administration

Q: When must inactive ingredients be listed?
A: When the route is not oral

Q: What is a lot number?
A: A number identifying a specific batch of medication

Q: What is the purpose of an expiration date?
A: Indicates last date drug is guaranteed safe and effective

Q: What must be included about the manufacturer?
A: Name and place of business

Q: What special marking appears on controlled substances?
A: “C” + Roman numeral schedule (e.g., C-II)

Q: What must labels include about storage?
A: Storage requirements (e.g., room temperature)

OTC Label Requirements

Q: What must OTC labels include about ingredients?
A: Active and inactive ingredients

Q: What usage info is required on OTC labels?
A: Indications (uses) and directions

Q: What safety info must OTC labels include?
A: Warnings and cautions

Q: What business info is required on OTC labels?
A: Manufacturer/distributor name and address

National Drug Code (NDC)

Q: What law requires the NDC?
A: Drug Listing Act of 1972

Q: What does the NDC identify?
A: Labeler, product, and package size

Q: What does the first segment of the NDC represent?
A: Labeler (manufacturer)

Q: What does the second segment of the NDC represent?
A: Drug (name and strength)

Q: What does the third segment of the NDC represent?
A: Package size

Q: Why is the NDC important in pharmacy practice?
A: Insurance billing and correct drug selection

Q: What act helps track counterfeit drugs using barcodes?
A: Drug Supply Chain Security Act (DSCSA)

Bioequivalence & Orange Book

Q: What does bioequivalence mean?
A: Generic and brand drugs have the same therapeutic effect

Q: Why are generics commonly dispensed?
A: They are cheaper

Q: What reference is used to determine bioequivalence?
A: Approved Drug Products with Therapeutic Equivalence Evaluations

Q: Who is responsible for ensuring bioequivalence?
A: The pharmacist

Prescription Label Requirements (ISMP)

Q: What organization provides basic prescription label requirements?
A: Institute for Safe Medication Practices

Q: What patient info must be on a prescription label?
A: Patient name

Q: What prescriber info must be included?
A: Prescriber name

Q: What pharmacy info must be included?
A: Name, address, phone number

Q: What dispensing info must be included?
A: Date filled and prescription number

Q: What medication details must appear on the label?
A: Name, strength, dosage form, quantity, manufacturer, directions

Q: What additional label elements may be required?
A: Auxiliary labels

Child-Resistant Packaging (PPPA)

Q: What law requires child-resistant packaging?
A: Poison Prevention Packaging Act of 1970

Q: What percentage of children must be unable to open child-resistant containers?
A: 80% of children under 5

Q: What percentage of adults must be able to open them?
A: 90% within 5 minutes

Q: Who enforces the PPPA?
A: Consumer Product Safety Commission

Q: Can patients request non-child-resistant packaging?
A: Yes, but they must sign a waiver

Q: What must be added if a non-childproof cap is used?
A: A warning label

Exceptions to Child-Resistant Packaging

Q: What is a key exception requiring original container dispensing?
A: Nitroglycerin sublingual tablets

Q: Name other exceptions to child-resistant packaging.
A:

• Methylprednisolone dose packs

• Pancrelipase

• Cholestyramine powder

• Unit-dose potassium

• Inpatient unit-dose meds

Exam-Style Question

Q: What does the NDC NOT include?
A: Expiration date and lot number

Q: Which law requires most prescriptions (e.g., amoxicillin) to be child-resistant?
A: Poison Prevention Packaging Act (PPPA)

Product Verification Basics

Q: Who is responsible for final product verification before dispensing?
A: The pharmacist

Q: What is the goal of prescription verification?
A: Ensure accuracy, safety, and legality before dispensing

Q: What role does a pharmacy technician play in verification?
A: Assists by reviewing prescriptions for completeness, accuracy, and safety

Q: What specific elements do technicians check during verification?
A: Patient info, dosage, drug interactions, allergies, labeling, and packaging

Q: Why is pharmacy workflow design important?
A: It reduces errors and ensures every prescription is properly verified

Community Pharmacy Workflow

Intake Area

Q: What happens in the intake (drop-off) area?
A: Patients drop off prescriptions and provide information

Q: Why is the intake area important?
A: It creates the first impression and prevents delays by catching missing info early

Processing Area

Q: What occurs in the processing area?
A: Data entry and prescription filling

Q: Why should the processing area be distraction-free?
A: To ensure accurate data entry and reduce errors

Q: How are prescriptions organized in processing?
A: Separate bins/totes for each prescription

Q: What equipment is found in the processing area?
A: Counting tools, scales, labels, compounding supplies, calculators

Pharmacist Verification Area

Q: What happens in the pharmacist verification area?
A: Final check of prescriptions before dispensing

Processed Prescriptions (Will Call)

Q: What is the “will call” area?
A: Storage for completed prescriptions waiting for pickup

Q: How are prescriptions organized in will call?
A: Alphabetically by patient last name

Out Window (Pickup Area)

Q: What happens at the out window?
A: Patient pickup and payment

Q: What system prevents unverified prescriptions from being sold?
A: Point-of-sale system alerts

Q: What must be done if insurance is added at pickup?
A: Reprocess claim, print new label, and pharmacist must reverify

Q: How are patients verified at pickup?
A: Two identifiers (e.g., name + DOB)

Consultation Area

Q: What is the purpose of the consultation area?
A: Private counseling by the pharmacist

Institutional Pharmacy Workflow

Q: What must occur before medications are released in institutional settings?
A: Pharmacist verification of medication orders

Q: What should technicians look for before releasing meds?
A: Pharmacist’s initials or signature

Q: How should verified vs. unverified meds be handled?
A: Kept separate

Technician Check Technician (TCT)

Q: What is TCT?
A: Certified techs checking other techs’ work (limited tasks)

Q: Where is TCT commonly allowed?
A: Automated dispensing refills and unit-dose batching

Institutional Layout Areas

Main Dispensary

Q: What happens in the main dispensary?
A: Pharmacists review and verify medication orders

Pullout Shelves / Carousel

Q: What is stored here?
A: Prepackaged, unit-dose medications

Ward Boxes

Q: What are ward boxes?
A: Containers used to organize meds for hospital units

Q: What happens before meds go into ward boxes?
A: Final pharmacist verification

Bulk Storage

Q: What is stored in bulk medication shelves?
A: Large stock for filling and compounding

Refrigeration Area

Q: What is stored in the fridge?
A: Temperature-sensitive medications

Medication-Filling Robot

Q: What does a pharmacy robot do?
A: Automates filling and packaging of medications

Aseptic Suite

Q: What is prepared in the aseptic suite?
A: Sterile IV medications

Q: Who verifies IV preparations?
A: Pharmacist

Unpacking Area

Q: What happens in the unpacking area?
A: Deliveries are checked and stocked

Workflow Order (Community – Test Favorite)

Q: What is the correct order of workflow in a community pharmacy?
A: Intake → Processing → Filling → Pharmacist Verification → Will Call → Pickup

Key Exam Traps

Q: Can a prescription be sold before pharmacist verification?
A: No

Q: What happens if a prescription is changed after processing (e.g., insurance)?
A: It must be reverified by the pharmacist

General Concepts

Q: What is the route of administration?
A: How a medication is delivered into the body for absorption and distribution

Parenteral Routes (Injection)

Q: What does “parenteral” mean?
A: Administration by injection using a needle

Q: What are the main parenteral routes?
A: IV, IM, subcutaneous, intradermal

Q: What is a major advantage of parenteral administration?
A: Rapid absorption and onset of action

Q: What are disadvantages of parenteral administration?
A: Pain, infection risk, higher cost

IV (Intravenous)

Q: Where are IV medications administered?
A: Into large veins (arms, hands, or central lines)

Q: What is unique about IV administration?
A: Fastest onset; can be given as push or infusion

IM (Intramuscular)

Q: Where are IM injections given?
A: Deltoid, vastus lateralis, ventrogluteal, dorsogluteal muscles

Q: How does IM absorption compare to IV?
A: Slower than IV

Q: What common outpatient meds use IM?
A: Vaccines

Subcutaneous (SubQ)

Q: Where are subcutaneous injections given?
A: Under the skin

Q: What are advantages of subcutaneous injections?
A: Can be self-administered, less painful, smaller needle

Q: How does absorption compare to IM?
A: Slower than IM

Intradermal

Q: Where are intradermal injections given?
A: Top layer of skin

Q: What are intradermal injections commonly used for?
A: Allergy and tuberculosis testing

Other Parenteral Routes (Recognition)

Q: Name less common parenteral routes.
A: Intrathecal, intra-articular, intraperitoneal, intravitreal, intracardiac, intra-arterial

Enteral Routes (GI Tract)

Q: What does enteral administration mean?
A: Medication delivered through the gastrointestinal tract

Q: What is the most common enteral route?
A: Oral (by mouth)

Q: What dosage forms are oral?
A: Tablets, capsules, solutions, suspensions

Feeding Tubes

Q: What is a nasogastric (NG) tube?
A: Tube from nose to stomach

Q: What is a PEG tube?
A: Tube placed directly into the stomach through the skin

Buccal vs Sublingual

Q: Where is buccal administration?
A: Between cheek and gum

Q: Where is sublingual administration?
A: Under the tongue

Q: How are buccal and sublingual drugs absorbed?
A: Through mucous membranes (not GI tract)

Other Routes (Non-Parenteral, Non-Enteral)

Transdermal

Q: What is transdermal administration?
A: Drug delivered through skin via patch into bloodstream

Topical

Q: What is topical administration?
A: Applied to skin for local effect (creams, ointments, lotions)

Inhalation

Q: What is inhalation route?
A: Medication delivered to lungs via inhaler or gas

Q: Is inhalation typically local or systemic?
A: Usually local (lungs)

Matching / Exam Traps

Q: Match: IV → ?
A: Veins

Q: Match: IM → ?
A: Muscle

Q: Match: Subcutaneous → ?
A: Under skin

Q: Match: Intradermal → ?
A: Top layer of skin

Q: Match: Oral → ?
A: Mouth

Q: Match: Buccal → ?
A: Cheek/gum

Q: Match: Sublingual → ?
A: Under tongue

Medication Naming

Q: What are the three types of medication names?
A: Chemical, generic, and brand (trade)

Q: What does a chemical name describe?
A: The drug’s chemical structure

Q: What is the generic name?
A: The nonproprietary name assigned by manufacturers and the Food and Drug Administration

Q: What is a brand (trade) name?
A: A proprietary name registered by a manufacturer

Q: How are generic vs. brand names typically written?
A: Generic = lowercase; Brand = capitalized

Examples of Names

Q: What are the three names for Tylenol?
A: Chemical: 4’-hydroxyacetanilide; Generic: acetaminophen; Brand: Tylenol

Q: What is the generic name for Advil and Motrin?
A: Ibuprofen

Q: Can one generic drug have multiple brand names?
A: Yes

Patents & Generics

Q: How long do drug patents typically last?
A: 17–20 years

Q: When can generic drugs be produced?
A: After the patent expires

Q: Why are generics usually preferred?
A: Lower cost and same effectiveness

Equivalence Concepts

Q: What is pharmaceutical equivalence?
A: Same active ingredient, strength, dosage form, and route

Q: What is therapeutic equivalence?
A: Same rate and extent of absorption

Q: Who ensures generics meet quality standards?
A: Food and Drug Administration

Medication Effects & Safety

Q: What is a side effect?
A: An unintended effect (positive or negative)

Q: What is an adverse reaction?
A: A harmful or serious negative effect

Q: What is a contraindication?
A: A reason a drug should NOT be used

Compounding

Q: What is compounding?
A: Custom preparation of medications not commercially available

Q: What is nonsterile compounding used for?
A: Non-injectable medications

Q: What is sterile compounding used for?
A: Injectable (parenteral) medications

Vaccines

Q: What is the purpose of vaccines?
A: Stimulate the immune system to protect against pathogens

Common Drug Flashcards (HIGH-YIELD)

Q: Carvedilol → Brand? Use?
A: Coreg → Hypertension, heart failure

Q: Clindamycin → Brand? Use?
A: Cleocin → Bacterial infection

Q: Clonidine → Brand? Use?
A: Catapres → Hypertension, ADHD

Q: Enalapril → Brand? Use?
A: Vasotec → Hypertension, heart failure

Q: Fenofibrate → Brand? Use?
A: Tricor → Hyperlipidemia

Q: Fentanyl → Brand? Use?
A: Duragesic → Pain

Q: Fluconazole → Brand? Use?
A: Diflucan → Fungal infection

Q: Glipizide → Brand? Use?
A: Glucotrol → Type 2 diabetes

Q: Latanoprost → Brand? Use?
A: Xalatan → Glaucoma

Q: Losartan → Brand? Use?
A: Cozaar → Hypertension

Q: Meloxicam → Brand? Use?
A: Mobic → Pain, arthritis

Q: Pantoprazole → Brand? Use?
A: Protonix → GERD

Q: Paroxetine → Brand? Use?
A: Paxil → Anxiety, depression, OCD

Q: Pravastatin → Brand? Use?
A: Pravachol → Hyperlipidemia

Q: Propranolol → Brand? Use?
A: Inderal → HTN, migraines, arrhythmias

Q: Sitagliptin → Brand? Use?
A: Januvia → Type 2 diabetes

Q: Spironolactone → Brand? Use?
A: Aldactone → Heart failure, HTN

Q: Sumatriptan → Brand? Use?
A: Imitrex → Migraine

Q: Vancomycin → Brand? Use?
A: Vancocin → Bacterial infection

Q: Venlafaxine → Brand? Use?
A: Effexor → Anxiety, depression

Exam Tips (High Yield)

Q: Why might a brand be used instead of a generic?
A: Prescriber or patient preference

Q: Why do insurance companies prefer generics?
A: Lower cost

Core Concepts

Q: Do all medications have the potential to cause side effects or adverse reactions?
A: Yes

Q: What is a side effect?
A: An unintended, expected effect (can be positive or negative) at normal doses

Q: What is an adverse reaction?
A: A harmful, unintended, and often more severe effect at normal doses

Q: What is the key difference between side effects and adverse reactions?
A: Side effects may be mild/expected; adverse reactions are more serious and harmful

Positive vs Negative Side Effects

Q: Can side effects be beneficial?
A: Yes

Q: What drug is a classic example of a positive side effect discovery?
A: Sildenafil

Q: What was sildenafil originally intended to treat?
A: Pulmonary arterial hypertension

Q: What positive side effect led to its new use?
A: Erectile dysfunction

Clinical Decision Concept

Q: When might a patient continue a medication despite side effects?
A: When benefits outweigh risks and effects are mild

High-Yield Drug Flashcards

Acetaminophen

Q: Acetaminophen → common side effect?
A: Rash

Q: Acetaminophen → serious adverse reaction?
A: Hepatotoxicity (liver damage)

Baclofen

Q: Baclofen → common side effects?
A: Dizziness, drowsiness, nausea, vomiting

Q: Baclofen → adverse reactions?
A: CNS effects, withdrawal effects

Clindamycin

Q: Clindamycin → common side effects?
A: Itching, nausea, vomiting

Q: Clindamycin → serious adverse reaction?
A: C. difficile infection

Diclofenac

Q: Diclofenac → common side effects?
A: Edema, nausea

Q: Diclofenac → major adverse reaction?
A: None listed (important exam trick)

Hydroxychloroquine

Q: Hydroxychloroquine → side effects?
A: Rash, abdominal pain, fatigue, dizziness

Q: Hydroxychloroquine → serious adverse reactions?
A: Retinal toxicity, cardiomyopathy, QT prolongation

Lisinopril

Q: Lisinopril → common side effects?
A: Hypotension, dizziness, GI issues

Q: Lisinopril → serious adverse reactions?
A: Angioedema, acute kidney injury, hyperkalemia

Morphine

Q: Morphine → common side effects?
A: Nausea, hypotension, rash

Q: Morphine → serious adverse reactions?
A: Respiratory depression, neurotoxicity, constipation

Nitroglycerin

Q: Nitroglycerin → common side effects?
A: Headache, hypotension, dizziness

Q: Nitroglycerin → major adverse reaction?
A: None listed

Phenytoin

Q: Phenytoin → common side effects?
A: Rash, nausea, constipation

Q: Phenytoin → serious adverse reactions?
A: Blood dyscrasias, hepatotoxicity, CNS effects

Amlodipine

Q: Amlodipine → common side effects?
A: Rash, fatigue, nausea

Q: Amlodipine → serious adverse reaction?
A: Peripheral edema

Matching (Exam Style)

Q: Blood dyscrasias → ?
A: Phenytoin

Q: Hepatotoxicity → ?
A: Acetaminophen

Q: C. difficile infection → ?
A: Clindamycin

Q: Acute kidney injury → ?
A: Lisinopril

Q: Peripheral edema → ?
A: Amlodipine

Exam Tips (High Yield)

Q: Are side effects and adverse reactions always different in real practice?
A: Often used interchangeably, but exams distinguish them

Q: At what doses do side effects and adverse reactions occur?
A: Normal therapeutic doses

Core Concepts (Sig & Directions)

Q: What does “Sig” mean on a prescription?
A: Directions for use

Q: What key elements are included in the Sig?
A: Route, dosage, frequency (and sometimes duration & indication)

Q: Why is interpreting the Sig important?
A: Ensures safe and effective medication use

Q: What should a technician do if unsure about a Sig?
A: Ask the pharmacist

Q: Should technicians add missing information to a Sig?
A: No

Routes of Administration (Sig Codes)

Q: PO
A: By mouth

Q: IV
A: Intravenous

Q: TOP
A: Topically

Q: VAG
A: Vaginally

Q: EN
A: Each nostril

Q: UD / UT
A: As directed

Q: IVPB
A: Intravenous piggyback

Q: LOC
A: Locally

Dosage Forms

Q: TAB
A: Tablet

Q: CAP
A: Capsule

Q: LIQ
A: Liquid

Q: SUSP
A: Suspension

Q: SUPP
A: Suppository

Q: UNG / OINT
A: Ointment

Q: SOL
A: Solution

Q: SYR
A: Syrup

Frequency Abbreviations (HIGH-YIELD)

Q: Q
A: Every

Q: Q4H
A: Every 4 hours

Q: BID
A: Twice daily

Q: AM
A: Morning

Q: PM
A: Evening

Q: QHS
A: Every night at bedtime

Q: PC
A: After meals

Q: HS
A: At bedtime

Q: ASAP
A: As soon as possible

Q: STAT
A: Immediately

Q: ATC
A: Around the clock

Q: AD LIB
A: As often as desired

Q: W/
A: With

Q: W/O
A: Without

Abbreviations to AVOID (VERY TESTED)

Q: Why are some abbreviations unsafe?
A: They can be misinterpreted and cause medication errors

Q: Which organization lists “Do Not Use” abbreviations?
A: The Joint Commission

Q: Why is “U” (unit) dangerous?
A: Can be mistaken for 0, 4, or cc

Q: Why is “IU” dangerous?
A: Can be mistaken for IV or 10

Q: Why is “QD” dangerous?
A: Can be mistaken for QID or QOD

Q: Why is “QOD” dangerous?
A: Can be mistaken for QD or QID

Q: What decimal errors should be avoided?
A: Trailing zeros and missing leading zeros

Translation Practice (Exam Style)

Q: Sig: 1 TAB Q4H
A: Take 1 tablet every 4 hours

Q: Sig: Apply 1 application TOP in AM and QHS
A: Apply topically in the morning and at bedtime

Q: Sig: Insert 1 TAB VAG QHS
A: Insert 1 tablet vaginally at bedtime

Tricky / Must-Know Concepts

Q: Why might a Sig need clarification?
A: If directions are ambiguous or unclear

Q: Example: “2 tabs PC HS” — what’s the issue?
A: Could mean multiple interpretations → must clarify with prescriber

Matching (Exam Practice)

Q: UD → ?
A: As directed

Q: TOP → ?
A: Topically

Q: VAG → ?
A: Vaginally

Q: IV → ?
A: Intravenous

Q: EN → ?
A: Each nostril

Big Picture Tip

Q: What is the #1 rule when interpreting Sig codes?
A: Never guess—clarify anything unclear

Core Concepts

Q: What is a patient profile?
A: A record in the pharmacy system containing patient information for safe medication use

Q: Why is an accurate patient profile important?
A: Prevents overdoses, underdoses, allergies, and drug interactions

Q: Who typically updates patient profiles?
A: Pharmacy technicians

Contact Information

Q: What basic contact info is required in a patient profile?
A: Name, address, phone number

Q: Why is phone number important?
A: To contact patients about prescriptions

Q: What additional contact details may be included?
A: Phone type (mobile/home/work) and contact preference (call/text)

Patient-Specific Information

Q: What demographic information is required?
A: Date of birth, weight, sex assigned at birth

Q: Why is weight important?
A: Helps determine correct dosing

Q: What must be documented about allergies?
A: Drug, food, and contact allergies + reactions

Medical History

Q: What diagnoses should be included in a patient profile?
A: Known medical conditions

Q: What should be included in medication history?
A:

• Current medications

• Dosage & directions

• Quantity

• Date dispensed

Q: What non-prescription items must be included?
A: OTC meds, vitamins, herbal supplements

Q: What lifestyle factors should be documented?
A: Tobacco and cannabis use

Preferences & Insurance

Q: What patient preferences may be documented?
A:

• Generic substitution preference

• Child-resistant cap preference

Q: What insurance info is required?
A:

• Insurance company

• BIN

• ID number

• PCN

• Rx group

• Person code

Q: Why is insurance info important?
A: Needed for claim submission and billing

Drug Safety (VERY HIGH-YIELD)

Q: What are drug-drug interactions (DDIs)?
A: When one drug affects another

Q: Why is a complete medication list important?
A: To detect DDIs

Q: What is a contraindication?
A: A reason NOT to use a medication

Drug Utilization Review (DUR)

Q: What is a DUR?
A: Software check for unsafe or inappropriate medication use

Q: What should a technician do if a DUR alert appears?
A: Notify the pharmacist

Real-World / Exam Scenario

Q: What should be updated if a patient moves?
A: Address, phone number, and any other changed info

Q: What is a good follow-up question at drop-off?
A: “Are you taking any other medications?”

Q: Why ask about other pharmacies?
A: Patients may get meds elsewhere → risk of interactions

Exam Traps (Important)

Q: Can DDIs be checked without a full medication list?
A: No

Q: What happens if insurance info is missing?
A: Claim cannot be processed

Q: Who makes the final decision on medication safety?
A: Pharmacist

Core Concept

Q: Why is proper medication labeling important?
A: Ensures safe and correct use of medication

Q: How are most prescription labels created?
A: Computer-generated

Required Prescription Label Information (VERY HIGH-YIELD)

Q: What pharmacy information must be on the label?
A: Pharmacy name, address, and phone number

Q: What patient information is required on the label?
A: Patient name

Q: What prescription identification is required?
A: Prescription number

Q: What date must be included on the label?
A: Date dispensed

Q: What medication instructions must be included?
A: Directions for use (Sig)

Q: What medication details must be on the label?
A: Name, strength, and dosage form

Q: What refill information must be included?
A: Number of refills

Q: What prescriber information is required?
A: Prescriber’s name

Sometimes Required (State-Specific)

Q: What expiration info may be required?
A: Expiration date

Q: What pharmacist info may be required?
A: Pharmacist’s name or initials

Federal Requirement (VERY TESTED)

Q: What is the federal legend for prescription labels?
A: “Caution: Federal law prohibits transfer of this medication to any person other than for whom it was prescribed.”

Special Labeling Situations

Q: Do medications in original packaging still need a pharmacy label?
A: Yes

Q: What must be avoided when placing labels on original packaging?
A: Covering important manufacturer instructions

Q: Example of packaging where label placement matters?
A: Methylprednisolone dose packs

Exam Sorting (COMMON QUESTION)

Required on Prescription Label

Q: Patient name → Required?
A: Yes

Q: Federal legend → Required?
A: Yes

Q: Prescriber name → Required?
A: Yes

Q: Date dispensed → Required?
A: Yes

Q: Quantity dispensed → Required?
A: Yes

Q: Prescription number → Required?
A: Yes

NOT Required on Prescription Label

Q: Patient date of birth → Required?
A: No

Q: Patient gender → Required?
A: No

Q: Prescriber phone number → Required?
A: No

Q: Medication manufacturer → Required?
A: No

Quick Memory Trick

Q: What are the “must-have” categories on a prescription label?
A:

• Patient

• Drug

• Directions

• Prescriber

• Pharmacy

• Prescription details

Days’ Supply – Core Concept

Q: What is days’ supply?
A: The number of days a prescription will last based on dose and quantity

Q: What is the formula for days’ supply?
A:
Total quantity ÷ (dose per day)

Q: Why is days’ supply important?
A: Insurance billing and controlled substance monitoring (Drug Enforcement Administration compliance)

Step Method (MEMORIZE THIS)

Q: How do you calculate days’ supply?
A:

1. Find dose per day

2. Multiply dose × frequency

3. Divide total quantity by daily dose

Sig Translation Essentials

Q: BID = ?
A: 2 times daily

Q: TID = ?
A: 3 times daily

Q: QID = ?
A: 4 times daily

Q: Q4H = ?
A: Every 4 hours = 6 times daily

Q: Q6H = ?
A: Every 6 hours = 4 times daily

Days’ Supply Practice Logic

Q: 2 tabs TID = how many per day?
A: 6 tablets/day

Q: 1 spray each nostril BID = how many doses/day?
A: 4 sprays/day (2 nostrils × 2 times/day)

Q: Why do inhaler questions use MAX dose?
A: To avoid underestimating use (exam trick)

Key Exam Tricks

Q: When given a range (1–2 tabs), what dose is used?
A: Maximum dose

Q: When frequency is a range (q4–6h), what is used?
A: Most frequent dosing (worst case)

Weight Conversions

Q: 1 kg = ? lb
A: 2.2 lb

Q: lb → kg formula
A: lb ÷ 2.2

Weight-Based Dosing Formula

Q: What is mg/kg dosing?
A: Medication dose per kilogram of body weight

Q: Weight-based dosing steps?
A:

1. Convert lb → kg

2. Multiply kg × mg/kg dose

3. Divide if multiple doses/day

Weight Example Logic

Q: 167 lb → kg ≈ ?
A: 75.9 kg

Q: 126 lb → kg ≈ ?
A: 57.3 kg

Key Pattern Recognition

Q: If dose is mg/kg/day, what does that mean?
A: Total daily dose is calculated from weight

Q: If dose is divided (e.g., TID), what happens?
A: Divide total daily dose by number of doses

Example Outcomes (MEMORY ANCHORS)

Q: 220 lb, 15 mg/kg/day → total daily dose?
A: 1,500 mg/day

Q: 180 lb, 25 mg/kg/day TID → per dose?
A: 682 mg per dose

Exam Strategy (VERY IMPORTANT)

Q: What is the #1 mistake in days’ supply questions?
A: Not converting frequency correctly (Q4H, Q6H)

Q: What is the #1 mistake in weight dosing?
A: Forgetting to convert lb → kg

Q: What is always true in calculations questions?
A: Units must match before calculating

DEA Registration

Flashcard 1
Q: Who must register with the DEA under the CSA?
A: Anyone who manufactures, distributes, prescribes, researches, imports, exports, or dispenses controlled substances.

Flashcard 2
Q: What is a DEA registration number used for?
A: It identifies registrants authorized to handle controlled substances and must appear on controlled substance prescriptions.

Flashcard 3
Q: What is the format of a DEA number?
A: 2 letters followed by 7 digits (last digit is a check digit).

Flashcard 4
Q: What do the first and second letters of a DEA number represent?
A: First letter = registrant type (A, B, F, M, X). Second letter = first letter of prescriber’s last name (with exceptions).

Flashcard 5
Q: How do you verify a DEA number?
A:

1. Add 1st, 3rd, 5th digits

2. Add 2nd, 4th, 6th digits ×2

3. Add results

4. Last digit must match DEA number check digit

📦 Packaging & Labeling

Flashcard 6
Q: Where do prescription drugs arrive from suppliers?
A: In manufacturer packaging or stock bottles.

Flashcard 7
Q: What must FDA manufacturer packaging labels include?
A: Active ingredients, dosage info, federal legend, route, expiration, lot number, storage info, manufacturer info, NDC, and warnings.

Flashcard 8
Q: What does “Rx only” indicate?
A: The medication requires a prescription under federal law.

Flashcard 9
Q: What is a lot number?
A: A batch identifier used for tracking medications.

🧾 National Drug Code (NDC)

Flashcard 10
Q: What does the NDC identify?
A: Labeler, product, and package size.

Flashcard 11
Q: Why is the NDC important?
A: Insurance billing, dispensing accuracy, and drug tracking.

Flashcard 12
Q: What law created the NDC system?
A: Drug Listing Act of 1972 (FDA).

💉 Bioequivalence

Flashcard 13
Q: What is bioequivalence?
A: Generic and brand drugs that have the same rate and extent of absorption.

Flashcard 14
Q: What is pharmaceutical equivalence?
A: Same active ingredient, strength, dosage form, and route.

Flashcard 15
Q: What is the Orange Book?
A: FDA reference for therapeutic equivalence of drugs.

📋 Prescription Labels

Flashcard 16
Q: What must be on a pharmacy prescription label?
A: Pharmacy info, patient name, drug info, directions, prescriber name, Rx number, refills, expiration, dispense date.

Flashcard 17
Q: What is the federal caution statement on labels?
A: “Caution: Federal law prohibits transfer of this medication…”

👶 Child-Resistant Packaging

Flashcard 18
Q: What law requires child-resistant packaging?
A: Poison Prevention Packaging Act (PPPA) of 1970.

Flashcard 19
Q: What percentage of children must NOT be able to open child-resistant packaging?
A: 80% of children under 5.

Flashcard 20
Q: What percentage of adults must be able to open it within 5 minutes?
A: At least 90%.

Flashcard 21
Q: What are exceptions to child-resistant packaging?
A: Nitroglycerin SL tablets and some specific dosage forms (e.g., Medrol Dosepak, potassium unit-dose).

🏪 Pharmacy Layout

Flashcard 22
Q: What happens in the intake area?
A: Prescriptions are dropped off and initial patient interaction occurs.

Flashcard 23
Q: What happens in the processing area?
A: Data entry, labeling, filling, and preparation occur.

Flashcard 24
Q: What happens in the pharmacist verification area?
A: Pharmacist performs final check before dispensing.

Flashcard 25
Q: What is the “will-call” area?
A: The area where verified prescriptions wait for pickup.

🏥 Institutional Pharmacy Workflow

Flashcard 26
Q: What is the main dispensary?
A: Where pharmacists verify medication orders in hospitals.

Flashcard 27
Q: What is the aseptic suite used for?
A: Sterile IV compounding.

💉 Routes of Administration

Flashcard 28
Q: What are parenteral routes?
A: IV, IM, SC, intradermal.

Flashcard 29
Q: What is enteral administration?
A: Oral, NG/OG tube, PEG tube, sublingual, buccal.

Flashcard 30
Q: What is transdermal?
A: Medication absorbed through skin via patch.

⚠ Side Effects vs Adverse Reactions

Flashcard 31
Q: What is a side effect?
A: Expected, often mild or unintended outcome at normal dose.

Flashcard 32
Q: What is an adverse reaction?
A: Severe, harmful, or dangerous medication effect.

🧪 Sig Codes

Flashcard 33
Q: What does “Sig” mean?
A: Directions for use (route, dose, frequency).

Flashcard 34
Q: What does BID mean?
A: Twice daily.

Flashcard 35
Q: What does QID mean?
A: Four times daily.

Flashcard 36
Q: What does Q4H mean?
A: Every 4 hours.

Flashcard 37
Q: What does PRN mean?
A: As needed.

Flashcard 38
Q: What does UD/UT mean?
A: As directed.

⚠ Abbreviations to Avoid

Flashcard 39
Q: Why should “U” be avoided?
A: Can be misread as 0, 4, or CC.

Flashcard 40
Q: Why is QD avoided?
A: Can be confused with QID or QOD.

Flashcard 41
Q: Why are trailing zeros dangerous?
A: They can cause overdose errors (e.g., 1.0 mistaken as 10).

👤 Patient Profiles

Flashcard 42
Q: Why are patient profiles important?
A: Prevent overdoses, interactions, and allergies.

Flashcard 43
Q: What must be included in a patient profile?
A: Name, DOB, allergies, medications, insurance, contact info.

Flashcard 44
Q: What is BIN in insurance?
A: Six-digit number used to process pharmacy claims.

💊 Medication Labeling

Flashcard 45
Q: What must a prescription label include?
A: Patient name, drug name, directions, pharmacy info, Rx number, prescriber, refills.

📊 Calculations

Flashcard 46
Q: Days’ supply formula?
A: Total quantity ÷ daily dose.

Flashcard 47
Q: Convert lbs to kg?
A: lb ÷ 2.2 = kg

📈 Percent Calculations

Flashcard 48
Q: Percent means what?
A: Per 100.

Flashcard 49
Q: Convert decimal to percent?
A: Multiply by 100.

Flashcard 50
Q: Convert percent to decimal?
A: Divide by 100.

Work Environment & Quality Assurance

Flashcard 1
Q: Why is pharmacy workflow designed in one direction?
A: To improve efficiency, accuracy, and reduce medication errors.

Flashcard 2
Q: What environmental factors help reduce pharmacy errors?
A: Lighting, noise control, workload management, reduced clutter, proper staffing, and minimized interruptions.

Flashcard 3
Q: What is CQI in pharmacy?
A: Continuous Quality Improvement—processes used to improve safety and reduce errors.

🧽 Cleaning & Organization

Flashcard 4
Q: When should pharmacy work areas be cleaned?
A: At the beginning, during, and end of each shift.

Flashcard 5
Q: What is used to clean counting trays?
A: 70% isopropyl alcohol.

Flashcard 6
Q: When must counting trays be cleaned?
A: Beginning of shift, during shift, end of shift, and after counting penicillins or sulfa drugs.

⚠ Allergy Safety (VERY TESTED)

Flashcard 7
Q: Why are penicillins and sulfonamides handled carefully?
A: They commonly cause allergic reactions and cross-contamination must be avoided.

Flashcard 8
Q: What suffix often indicates penicillin drugs?
A: -cillin

Flashcard 9
Q: What prefix often indicates sulfa drugs?
A: sulfa-

Flashcard 10
Q: What percentage of penicillin-allergic patients may also react to cephalosporins?
A: About 10%

Flashcard 11
Q: Why should automated counting machines be avoided for penicillins and sulfa drugs?
A: To prevent cross-contamination.

💊 Sulfonamide (Sulfa) Drugs

Flashcard 12
Q: What is co-trimoxazole (Bactrim)?
A: A sulfonamide antibiotic combination (trimethoprim + sulfamethoxazole).

Flashcard 13
Q: What is sulfamethoxazole/trimethoprim used for?
A: Bacterial infections.

Flashcard 14
Q: Name a sulfonamide anti-inflammatory drug.
A: Sulfasalazine (Azulfidine).

🏥 Hospital Compounding Safety

Flashcard 15
Q: When must nonsterile compounding areas be cleaned?
A: Before and after each compound is prepared.

Flashcard 16
Q: Why is cleaning nonsterile compounding important?
A: To prevent chemical contamination and patient injury (e.g., burns).

🧪 Clean Room (Sterile Compounding)

Flashcard 17
Q: What is a clean room used for?
A: Sterile compounding of IV medications.

Flashcard 18
Q: What must be used for clean room cleaning supplies?
A: Dedicated, room-specific cleaning materials only.

Flashcard 19
Q: What cleaning agents are used in sterile areas?
A: Sterile 70% isopropyl alcohol, water, bleach, approved agents, lint-free cloths.

🧼 Clean Room Cleaning Schedule

Flashcard 20
Q: How often are laminar airflow hoods cleaned?
A: Beginning of shift, every 30 minutes during batching, and after spills.

Flashcard 21
Q: How often are floors cleaned in a clean room?
A: Daily.

Flashcard 22
Q: How often are storage bins cleaned?
A: Monthly.

Flashcard 23
Q: How often are ceilings and walls cleaned?
A: Monthly.

⚠ Safety Takeaways

Flashcard 24
Q: What is the main purpose of pharmacy cleaning protocols?
A: Prevent contamination, infection, and medication errors.

Flashcard 25
Q: What is a key risk if cleaning is not done properly in compounding areas?
A: Patient harm from contamination or chemical exposure.

Unit Dose & Packaging Systems

Flashcard 1
Q: What is unit dosing?
A: Repackaging medications into single-use doses for hospitals or institutions.

Flashcard 2
Q: Where are unit dose systems commonly used?
A: Inpatient hospital settings.

Flashcard 3
Q: What is a punch card or blister pack used for?
A: Organizing patient medications by dose/time to improve adherence.

Flashcard 4
Q: What is a major benefit of blister packs/punch cards?
A: Improved medication adherence and reduced medication errors.

Flashcard 5
Q: How long is a typical punch card supply?
A: Usually a 30-day supply.

🏥 Unit Dose Labeling & Safety

Flashcard 6
Q: What must unit-dose repackaged medications include on the label?
A: Drug name, strength, lot number, manufacturer, expiration date, and other key info.

Flashcard 7
Q: Why is unit-dose labeling important?
A: Ensures accurate identification and prevents medication errors.

Flashcard 8
Q: Why is patient name NOT included on hospital unit-dose packaging?
A: To protect patient confidentiality (PHI).

📦 Repackaging Principles

Flashcard 9
Q: Why is repackaging done in pharmacy systems?
A: To improve safety, usability, and inventory control.

Flashcard 10
Q: What is the first rule of repackaging?
A: Repackage one medication at a time.

Flashcard 11
Q: Why should only one medication be repackaged at a time?
A: To prevent medication mix-ups and errors.

Flashcard 12
Q: What environmental protection must packaging provide?
A: Protection from light, air, moisture, heat, and contamination.

🧾 Repackaging Requirements

Flashcard 13
Q: What must always be verified before repackaging?
A: Medication name, strength, and label accuracy.

Flashcard 14
Q: What must be documented in repackaging?
A: Lot number, expiration date, manufacturer, and batch records.

Flashcard 15
Q: Who must approve repackaging?
A: A pharmacist.

Flashcard 16
Q: Why is batch documentation important?
A: For tracking, safety, and recall purposes.

🧠 Adherence Aids

Flashcard 17
Q: What is a pill organizer used for?
A: Helping patients manage daily medication schedules.

Flashcard 18
Q: What is a pill cutter used for?
A: Splitting tablets into accurate doses (e.g., ½ tablet).

Flashcard 19
Q: What is an oral syringe used for?
A: Measuring accurate liquid medication doses.

Flashcard 20
Q: What is a dosage spoon used for?
A: Measuring liquid medications more accurately than household spoons.

📋 Documentation & Logs

Flashcard 21
Q: Where is unit-dose repackaging documented?
A: Compounding log.

Flashcard 22
Q: What does NOT require punch card documentation like compounding does?
A: Punch cards are treated like standard dispensing (like prescription bottles).

⚠ Safety & Accuracy Concepts

Flashcard 23
Q: What is the biggest safety risk in repackaging?
A: Medication mix-ups or contamination.

Flashcard 24
Q: What is a key principle of safe repackaging workflow?
A: Clean workspace, one drug at a time, and strict labeling.

🧪 Exam Style Takeaways

Flashcard 25
Q: Why are blister packs helpful in long-term care?
A: They organize doses by time and reduce administration errors.

Flashcard 26
Q: What is the role of unit dosing in hospitals?
A: Provides ready-to-administer single doses to reduce errors and waste.

Sterile/Nonsterile Compounding – Challenge Answers

1. Latex allergy + only latex gloves available

Correct answer: D. Release the technician from sterile compounding duties

Because:

• Latex exposure = immediate safety risk (hypersensitivity reaction risk)

• No acceptable workaround if only latex gloves are available

• You remove the technician from exposure tasks, not continue work

2. Order of PPE donning (correct sequence)

Correct order:

1. Shoe covers

2. Bouffant cap

3. Beard cover (if applicable)

4. Mask

5. Aseptic handwashing

6. Gown

7. Sterile powder-free gloves

Key idea:

• “Clean from bottom to top”

• “Hand hygiene happens before sterile gloves”

3. Minimum handwashing time

Correct answer: A. 30 seconds

• Aseptic handwashing minimum = 30 seconds

• Longer is fine, but not required minimum

4. Correct location for doffing PPE

Correct answer: B. Anteroom

Why:

• Prevents contamination of clean room and buffer room

• PPE removal must occur outside sterile environment zones

5. PPE required before compounding (select all that apply)

Correct answers: A, C, D, F

• A. Bouffant cap ✔

• C. Sterile gloves ✔

• D. Shoe covers ✔

• F. Barrier gown ✔

Not allowed / irrelevant:

• B. Artificial nails ❌ (contamination risk)

• E. Cologne/perfume ❌ (particulate contamination risk)

Sterile Compounding Key Concepts (high-yield summary)

Clean room rules:

• HEPA filter = produces first air (sterile airflow)

• No cardboard near hood (particulate risk)

• Only necessary items in hood area

Critical sites (must not be touched):

• Syringe tip

• Needle hub

• Vial septum

• IV bag ports

Ampules:

• Always single-use

• Use filter needle (prevents glass contamination)

Nonsterile Compounding Case

1. BUD vs 30-day supply

Correct answer: C. Label the final product with a 30-day expiration date

Rule:

• Always choose the shorter expiration date

• Patient safety overrides product BUD

2. Wrong patient label on blister pack

Correct answer: C. Correct the label and notify the pharmacist

Why:

• Medication labeling error = serious safety + legal issue

• Must correct AND escalate (documentation required)

Big Exam Patterns to Remember

• PPE errors → almost always “remove from exposure / correct order”

• Sterile compounding → contamination prevention > speed

• Labeling errors → always correct + notify pharmacist

• Expiration rules → always shortest date wins

1. Diluent (Base Solution) Selection — KEY RULES

What a diluent is:

A diluent is the fluid used to:

• Reconstitute powders

• Dilute IV medications

• Carry drugs in solution (base fluid like IV bag)

Common examples:

• 0.9% Sodium Chloride (Normal Saline)

• D5W (5% Dextrose in Water)

Critical Exam Rule

👉 Always use the correct diluent based on:

• Drug compatibility (package insert)

• Patient condition (tonicity needs)

Classic Example (VERY TESTED)

• Daptomycin
  ❌ NOT compatible with dextrose (D5W)
  ✔ Must be mixed with normal saline (0.9% NaCl)

👉 This is a high-yield safety rule:

Two “RIGHTS” of compounding (exam phrase)

1. Right medication

2. Right diluent

2. Tonicity (why diluent matters)

Clinical logic

• IV choice depends on patient needs:

  • Dehydration → isotonic

  • Brain swelling risk → careful with hypotonic

3. Sterile Product Labeling (VERY TESTED)

Required label elements:

• Patient name + MRN

• Room number (hospital setting)

• Drug name + strength

• IV base solution (diluent)

• Infusion rate

Labeling rules:

• Do NOT cover:

  • Syringe markings

  • IV bag volume lines

  • Drug visibility

• Label must:

  • Be flat

  • Be readable without moving container

  • Not interfere with inspection

Why this matters:

• Nurses must verify dose visually

• Errors often happen from blocked or unreadable labels

4. Aseptic Technique Flow (Simplified Exam Order)

Correct concept:

You alternate between:

• PPE donning

• Hand hygiene steps

Key sequence idea:

1. Shoe covers

2. Bouffant cap

3. Beard cover (if needed)

4. Mask

5. Hand hygiene (ASEPTIC handwashing)

6. Gown

7. Alcohol hand rub again

8. Sterile gloves

Critical test concept:

• Hand hygiene happens multiple times

• Gloves are ALWAYS last

5. Sterile Compounding Safety Concepts

HEPA filter + First Air

• HEPA filter produces sterile airflow

• “First air” = cleanest air zone

• Never block airflow inside hood

Critical sites (NEVER TOUCH):

• Syringe tip

• Needle hub

• Vial septum

• IV ports

Ampules:

• Glass containers → risk of glass shards

• Always use:

  • Filter needle or filter straw

• Always:

  • Single-use only

6. Compounding Error Rules (High-Yield)

If something is wrong:

• Label error → fix + notify pharmacist

• Calculation error → must verify before compounding

• Contamination → stop immediately

7. One-line exam memory shortcuts

• Diluent = “drug must be compatible with fluid”

• Daptomycin = “saline only”

• Label = “never block visibility”

• HEPA = “cleanest air”

• Gloves = “last step”

• Ampule = “filter needle required”