Comprehensive Pharmacy Practice Study Notes

Key Pharmacy Terminology and Vocabulary

• Administration: The process of giving or taking medication.

• Dosage Forms: Also known as routes of administration; describes the physical form in which medication will be delivered into the body.

• Absorption: Liquid or drug soaked up by something; specifically, the process of a drug being absorbed directly into the bloodstream.

• Adsorption: A physical phenomenon where a substance is attracted to and adheres to a surface (such as drug particles adhering to intravenous tubing).

• Suspend: To disperse particles evenly throughout a liquid, usually achieved by shaking suspensions.

• Infused: To instill, flow into, insert, or inject a solution.

• Render: To make, prepare, or transform into a specific form.

• Metabolized: The biological process by which the body breaks down medications, primarily occurring in the liver.

• Chest Pain Management: Chest pain is managed via sublingual administration (e.g., nitroglycerin / Nitrostat).

Sig Codes, Abbreviations, and Directives

• General Frequency and Timing Abbreviations:

  • q: every / each

  • h, hr, or °: hour

  • am: morning / in the morning

  • pm: evening / afternoon

  • hs: at bedtime / hour of sleep

  • qd or d: once daily / every day

  • qod: every other day

  • qwk: every week

  • qmo: every month / once a month

  • q4°: every 4 hours

  • q6h: every 6 hours / 4 times a day

  • bid: twice a day

  • tid or tds: three times a day

  • qid: four times a day

  • fid: five times daily

  • qam: every morning / each day before noon

  • qpm: every evening / night

  • ac: before meals

  • pc: after meals

  • STAT: immediately / at once

  • prn: as needed / when required

  • ud: as directed

• Routes and Delivery Abbreviations:

  • po: by mouth

  • npo: not by mouth / nothing by mouth

  • SL: sublingual (under the tongue)

  • buc or bu: buccal (cheek)

  • top: topical

  • TD: transdermal

  • PR or r: per rectum / rectally

  • PV: vaginally / per the vagina

  • NAS: nasal / nasally / administered through nose

  • OD: right eye (oculus dexter)

  • OS: left eye (oculus sinister)

  • OU: both eyes (oculus uterque)

  • AD: right ear (auris dextra)

  • AS: left ear (auris sinistra)

  • AU: both ears

  • INH: inhaled / inhalation

  • neb: nebulizer

  • NG / NGT: nasogastric tube

  • PEG: percutaneous endoscopic gastrostomy tube

  • NJ / NJT: nasojejunostomy / nasojejunal tube

  • IM: intramuscular

  • SQ, SC, or Subcut: subcutaneous

  • IV: intravenous

  • IVP: intravenous push

  • IVPB: intravenous piggyback

  • ID: intradermal

• Forms, Quantities, and Directives:

  • t: tablet

  • cap: capsule

  • ODT: orally disintegrated tablet

  • ung: ointment

  • crm: cream

  • elix: elixir liquid medication

  • sol: solution

  • sup: suppository

  • susp: suspension

  • syr: syrup

  • gtt or gtts: drop / drops

  • appl: applicator

  • aaa: apply to affected area

  • qs: quantity sufficient

  • daw: dispense as written

  • nr: no refill

  • c̄: with

  • s: without

  • sig: directions in using a prescription

  • aa: to affected area

  • Disp: dispense

  • No. or #: number

• Clinical Symptoms and Conditions Abbreviations:

  • n & v or n/v: nausea and vomiting

  • p: pain

  • prn f: as needed for fever

  • prn f/p: as needed for fever or pain

  • prn a: as needed for anxiety

  • apap: acetaminophen / Tylenol

  • ha: headache

  • Δ: change

  • HBP: high blood pressure

Visual Reference for Pharmacy Abbreviations

Roman Numerals and Measurement Conversions

• Roman Numerals in Pharmacy:

  • I or i: $1$ (one) — e.g., i c = 1 capsule, i t = 1 tablet, i gtt = 1 drop

  • V or v: $5$ (five)

  • X or x: $10$ (ten)

  • L: $50$ (fifty)

  • C: $100$ (one hundred)

  • D: $500$ (five hundred)

  • M: $1,000$ (one thousand)

  • ss: $\\frac{1}{2}$ (half) — e.g., ss t = $\\frac{1}{2}$ tablet

  • ii: $2$ (two) — e.g., ii c, ii t, ii gtts

  • iii: $3$ (three) — e.g., iii c, iii t, iii gtts

• Measurement Equivalents and Conversions:

  • $1\\,\\text{tsp} = 5\\,\\text{mL}$

  • $1\\,\\text{tbsp} = 15\\,\\text{mL} = 3\\,\\text{tsp}$

  • $1\\,\\text{oz} = 30\\,\\text{mL} = 6\\,\\text{tsp} = 2\\,\\text{tbsp}$

  • $1\\,\\text{c} = 8\\,\\text{oz} = 240\\,\\text{mL}$

  • $1\\,\\text{pt} = 16\\,\\text{oz} = 480\\,\\text{mL}$

  • $1\\,\\text{qt} = 32\\,\\text{oz} = 960\\,\\text{mL}$

  • $1\\,\\text{gal} = 128\\,\\text{oz} = 3,840\\,\\text{mL}$

  • cc: cubic centimeter ($1\\,\\text{cc} = 1\\,\\text{mL}$)

  • g or gm: gram(s)

  • gr: grain

  • mEq: milliequivalent

  • mg: milligram

  • mL or mLs: milliliter(s)

  • Drop Calibration Equivalents:

  • $15\\,\\text{gtts/mL} = 15\\,\\text{drops per } 1\\,\\text{mL}$ (suspension / shake)

  • $20\\,\\text{gtts/mL} = 20\\,\\text{drops per } 1\\,\\text{mL}$ (solution)

  • All liquid volumetric measurements must be converted to milliliters ($\\text{mL}$) because calibrated measuring cups provided to patients are marked in $\\text{mL}$.

Rules for Prescription Interpretation and Decoding

• 5 Core Components of a Decoded Prescription:

  1. Action (verb)

  2. Amount to be taken (quantity)

  3. Route by which it is taken

  4. Frequency

  5. Duration (if necessary)

• Formatting Rules for Sig Translation:

  • Write out all numbers in explicit word form, except for duration times and milliliter ($\\text{mL}$) values.

  • Always convert household volumetric measures (teaspoon, tablespoon, ounce) into milliliters ($\\text{mL}$).

• Standard Action Verbs by Delivery Route:

  • By mouth = TAKE (tablets, capsules, liquids)

  • Vaginally or Rectally = INSERT (tablets, suppositories)

  • Sublingual = PLACE UNDER THE TONGUE

  • Ear drops or Eye drops = INSTILL

  • Suppository = UNWRAP THEN INSERT

  • Shots / Injections = INJECT

  • Topical = APPLY

Sig Code Translation Practice Examples

• i tab po qid pc: Take one tablet by mouth four times daily after meals.

• iss tsp po tid prn cough: Take 7.5 mL ($1\\frac{1}{2}$ teaspoonful) by mouth three times daily as needed for cough. (Calculated as $1.5 \\times 5\\,\\text{mL} = 7.5\\,\\text{mL}$).

• iiii gtts ad q4h x 5d: Instill four drops in right ear every four hours for 5 days.

• i sup pr q4h prn nausea: Unwrap then insert one suppository rectally every four hours as needed for nausea.

• i cap po tid ac + hs: Take one capsule by mouth three times daily before meals and at bedtime.

• i tab sl prn chest pain: Take one tablet under the tongue as needed for chest pain.

• i tab po qod: Take one tablet by mouth every other day.

• ii stat, then i tab po qid x 10d: Take two tablets immediately, then take one tablet by mouth four times daily for 10 days.

• i gtt ou bid x 7d: Instill one drop in both eyes twice daily for seven days.

• i appl vag qhs: Insert one applicatorful vaginally every night at bedtime.

• ii gtts os tid x 14d: Instill two drops in left eye three times a day for 14 days.

• ss appl pv qhs: Insert half an applicatorful vaginally every night at bedtime.

• i tab po qmo: Take one tablet by mouth every month.

• ii STAT, then npo until 8am: Take two tablets immediately, then nothing by mouth until 8am.

• vi tab po qd x 2d, then v tab qd x 2d, then iv tab qd x 1d, then iii tab qd x 2d, then stop: Take six tablets by mouth everyday for 2 days, then five tablets everyday for 2 days, then four tablets everyday for 1 day, then three tablets everyday for 2 days, then stop. Total dosage calculation: $(6 \\times 2) + (5 \\times 2) + (4 \\times 1) + (3 \\times 2) = 12 + 10 + 4 + 6 = 32\\,\\text{tablets}$.

• i tab po qd pc: Take one tablet by mouth everyday after a meal.

• iiss tsp po q6h prn congestion: Take 12.5 mL ($2\\frac{1}{2}$ teaspoonfuls) by mouth every six hours as needed for congestion. (Calculated as $2.5 \\times 5\\,\\text{mL} = 12.5\\,\\text{mL}$).

• iii gtts AD q8h x 10d: Instill three drops in right ear every eight hours for 10 days.

• i supp pr ud prn constipation: Unwrap then insert one suppository rectally as directed as needed for constipation.

• ii cap po bid ac + hs: Take two capsules by mouth twice a day before meals and at bedtime.

• ss tab SL prn chest pain: Place half a tablet under the tongue as needed for chest pain.

Enteral and Parenteral Routes of Administration

• Enteral Route:

  • Defined as routes in which medications pass through the gastrointestinal (GI) tract.

  • Medications are absorbed into the bloodstream and metabolized by the liver.

  • Includes oral (PO), nasogastric (NGT), nasojejunal (NJT), percutaneous endoscopic gastrostomy (PEG), and rectal (PR) routes.

• Parenteral Route:

  • Defined as routes in which medications do not travel through or pass through the gastrointestinal tract or liver before entering the bloodstream (administered outside of the body).

  • Includes injections, topical applications, and inhalation routes. In standard pharmacy practice, parenteral specifically refers to injections.

  • Injectable Preparations:

  • Epidural: Injected into the dura mater (epidural space) surrounding the spinal cord.

  • Intravenous (IV): Injected directly into the vein, providing immediate absorption. Subcategories include IV push (IVP), IV piggyback (IVPB), and continuous IV infusion or drip.

  • Intramuscular (IM): Injected directly into muscle tissue (e.g., deltoid muscle of the arm, buttocks). Commonly used for antibiotics and vaccines.

  • Subcutaneous (SQ/SC/Subcut): Injected into the fatty tissue layer under the skin (e.g., insulin).

  • Intradermal (ID): Injected into the top layer of skin at a slight angle (e.g., tuberculin skin tests, allergy testing).

  • Intracardiac: Injected directly into the heart muscle.

  • Intraocular: Injected within the eye.

  • Intrathecal: Injected into the fluid-filled space surrounding the spinal cord.

  • Intra-articular: Injected directly into joint cavities.

Comprehensive Overview of Oral and Non-Oral Dosage Forms

• Oral Solid Dosage Forms:

  • Tablets: Formed by combining active drug with inert fillers and compressing the mixture into a hard pellet. Available in standard immediate release, slow release, controlled release, enteric-coated, film-coated, sublingual, and chewable formulations.

  • Sublingual: Designed to dissolve under the tongue for rapid absorption (e.g., nitroglycerin / Nitrostat used for acute chest pain / heart attack patients).

  • Buccal: Placed between the cheek and gum tissue.

  • Caplet: An oval-shaped tablet engineered for easier swallowing.

  • Chewables: Solid oral dosage forms intended to be chewed by the patient prior to swallowing rather than swallowed whole.

  • Capsules: Active drug contained within a cylindrically shaped shell (including hard or soft gelatin capsules) that dissolves and breaks open in the GI tract to release the drug.

• Types of Medication Release Formulations:

  • LA: Long acting

  • SA: Sustained action

  • SR: Sustained release

  • CR: Controlled release

  • XR: Extended release

  • XL: Extra long

  • TR: Timed release

  • Immediate Release: Drug is absorbed shortly after ingestion (approximately 30 minutes).

  • Controlled Release: Releases drug consistently over an extended timeframe (8 to 24 hours).

  • Special Precaution: Controlled-release and extended-release formulations CANNOT be crushed, as destroying the formulation matrix can cause rapid drug release and severe toxic reactions.

• Oral Liquid and Dissolving Dosage Forms:

  • Effervescent Tablets: Formulated to break apart upon contact with liquids such as water or juice, effervescing to release carbon dioxide and dissolve into a solution (e.g., Alka-Seltzer).

  • Enteric-Coated Tablets: Coated with a specialized polymer barrier that resists dissolution in the acidic environment of the stomach, allowing the tablet to pass intact into the small intestine.

  • Oral Disintegrating Tablets (ODT): Engineered to dissolve rapidly on top of the tongue without requiring water or chewing (e.g., Zofran ODT, ajin).

  • Films / Oral Dissolving Strips: Thin sheets composed of water-soluble polymers that release medication rapidly by dissolving or adhering to the oral mucosa within seconds when placed in the mouth (e.g., breath strips).

  • Oral Solutions: Clear liquid preparations in which active ingredients are completely dissolved in a liquid medium.

  • Oral Suspensions: Heterogeneous liquid mixtures containing un-dissolved drug particles suspended in a liquid medium. Suspensions must be shaken thoroughly prior to each dose to ensure uniform particle dispersion.

  • Syrups: Concentrated aqueous solutions containing high concentrations of sucrose or sugar to sweeten medication and improve palatability.

  • Elixirs: Sweetened hydro-alcoholic solutions containing between 5% and 40% alcohol, utilized for active ingredients that are insoluble in water alone.

  • Tinctures: Medicinal alcoholic or hydro-alcoholic solutions containing alcohol concentrations ranging from 17% up to 80%.

  • Emulsions: Two-phase liquid preparations composed of one liquid dispersed as tiny droplets throughout a second immiscible liquid (e.g., oil-in-water or water-in-oil), stabilized using an emulsifier to improve solubility and mask taste.

  • Oral Powders: Dry formulation powders intended to be dissolved in fruit juice or distilled water prior to administration (e.g., reconstituted oral antibiotics, probiotic packets).

  • Lozenge & Troche: Solid dosage forms designed to dissolve slowly in the mouth, delivering localized therapeutic effects in the mouth or throat (e.g., cough drops).

• Topical, Inhalation, and Rectal Dosage Forms:

  • Transdermal Patch: Medicated adhesive patch applied directly to intact skin to deliver precise doses into systemic circulation. Application sites must be rotated regularly (e.g., OTC Nicotine patches, prescription Fentanyl patches).

  • Topical Dosage Forms: Applied directly to skin surfaces or mucous membranes (nasal cavity, mouth).

  • Inhalation Dosage Forms: Delivered directly into the respiratory tract via the mouth or nose using inhalers or nebulizers to treat respiratory conditions (e.g., asthma, COPD); gaseous anesthetics are also administered via inhalation.

  • Rectal Suppositories: Solid or semi-solid bullet-shaped forms designed to melt at normal body temperature following rectal insertion to release medication.

  • Enemas: Rectal liquid formulations where medication is dissolved or suspended in solution and infused into the rectum.

Pharmacy Calculations: Dosage and Supply Calculations

• Section 1: Direct Multiplication ($\\text{Dose} \\times \\text{Frequency} \\times \\text{Duration}$)

  • Rx 1: Amoxicillin 500mg

  • Directions: Take 1 capsule by mouth three times daily for 10 days.

  • Calculation: $1 \\times 3 \\times 10 = 30$

  • Total Capsules: $30$

  • Rx 2: Metformin 1000mg

  • Directions: Take 1 tablet by mouth twice daily with meals for 1-month supply (30 days).

  • Calculation: $1 \\times 2 \\times 30 = 60$

  • Total Tablets: $60$

  • Rx 3: Atorvastatin 40mg

  • Directions: Take 1 tablet by mouth every evening at bedtime for 3-month supply ($30 \\times 3 = 90\\,\\text{days}$).

  • Calculation: $1 \\times 1 \\times 90 = 90$

  • Total Tablets: $90$

  • Rx 4: Carvedilol 6.25mg

  • Directions: Take $\\frac{1}{2}$ tablet by mouth twice daily for 1-month supply (30 days).

  • Calculation: $0.5 \\times 2 \\times 30 = 30$

  • Total Tablets: $30$

  • Rx 5: Clindamycin 150mg

  • Directions: Take 2 capsules by mouth four times daily for 7 days.

  • Calculation: $2 \\times 4 \\times 7 = 56$

  • Total Capsules: $56$

• Section 2: Hourly Intervals and Calendar Schedules

  • Formula: Convert hourly directions into daily frequency ($24\\,\\text{hours} \\div X\\,\\text{hours}$) before multiplying.

  • Rx 6: Cephalexin 500mg

  • Directions: Take 1 capsule by mouth every 6 hours for 7 days.

  • Daily Frequency: $24 \\div 6 = 4\\,\\text{times/day}$

  • Calculation: $1 \\times 4 \\times 7 = 28$

  • Total Capsules: $28$

  • Rx 7: Ciprofloxacin 250mg

  • Directions: Take 1 tablet by mouth every 12 hours for 5 days.

  • Daily Frequency: $24 \\div 12 = 2\\,\\text{times/day}$

  • Calculation: $1 \\times 2 \\times 5 = 10$

  • Total Tablets: $10$

  • Rx 8: Nitrofurantoin 100mg

  • Directions: Take 1 capsule by mouth every 8 hours for 7 days.

  • Daily Frequency: $24 \\div 8 = 3\\,\\text{times/day}$

  • Calculation: $1 \\times 3 \\times 7 = 21$

  • Total Capsules: $21$

  • Rx 9: Gabapentin 300mg

  • Directions: Take 1 capsule by mouth three times daily and 2 capsules at bedtime for 1-month supply (30 days).

  • Daytime Calculation: $1 \\times 3 \\times 30 = 90\\,\\text{capsules}$

  • Bedtime Calculation: $2 \\times 1 \\times 30 = 60\\,\\text{capsules}$

  • Total Capsules: $90 + 60 = 150$

  • Rx 10: Warfarin 5mg

  • Directions: Take 1 tablet by mouth on Mondays and Fridays, and $\\frac{1}{2}$ tablet on all other days of the week. Dispense a 4-week supply (28 days).

  • Mondays & Fridays ($2\\,\\text{days/week} \\times 4\\,\\text{weeks} = 8\\,\\text{days}$): $8 \\times 1 = 8\\,\\text{tablets}$

  • Other Days ($5\\,\\text{days/week} \\times 4\\,\\text{weeks} = 20\\,\\text{days}$): $20 \\times 0.5 = 10\\,\\text{tablets}$

  • Total Tablets: $8 + 10 = 18$

• Section 3: PRN Ranges & Maximum Potential Use Calculations

  • Rule: Always calculate based on worst-case scenario (maximum potential dose and maximum frequency).

  • Rx 11: Ibuprofen 600mg

  • Directions: Take 1 tablet by mouth every 4 to 6 hours as needed for severe pain for 10 days.

  • Max Frequency: Every 4 hours ($24 \\div 4 = 6\\,\\text{times/day}$

  • Calculation: $1 \\times 6 \\times 10 = 60$

  • Total Tablets: $60$

  • Rx 12: Tramadol 50mg

  • Directions: Take 1 to 2 tablets by mouth every 6 hours as needed for back spasms. Dispense a 1-month supply (30 days).

  • Max Dose: $2\\,\\text{tablets}$; Max Frequency: Every 6 hours ($24 \\div 6 = 4\\,\\text{times/day}$

  • Daily Maximum: $2 \\times 4 = 8\\,\\text{tablets/day}$

  • Calculation: $8 \\times 30 = 240$

  • Total Tablets: $240$

  • Rx 13: Acetaminophen/Codeine 300/30mg (Tylenol #3)

  • Directions: Take 1 or 2 tablets by mouth every 4 hours as needed for pain for 5 days.

  • Max Dose: $2\\,\\text{tablets}$; Max Frequency: Every 4 hours ($24 \\div 4 = 6\\,\\text{times/day}$

  • Daily Maximum: $2 \\times 6 = 12\\,\\text{tablets/day}$

  • Calculation: $12 \\times 5 = 60$

  • Total Tablets: $60$

  • Rx 14: Zofran 4mg ODT

  • Directions: Dissolve 1 tablet under the tongue every 8 hours as needed for nausea for 5 days.

  • Max Frequency: Every 8 hours ($24 \\div 8 = 3\\,\\text{times/day}$

  • Calculation: $1 \\times 3 \\times 5 = 15$

  • Total Tablets: $15$

  • Rx 15: Meloxicam 15mg

  • Directions: Take 1 to 2 tablets by mouth daily as needed for arthritis flare-ups. Max 2 tablets per 24 hours. Dispense a 1-month supply (30 days).

  • Max Daily Dose: $2\\,\\text{tablets/day}$

  • Calculation: $2 \\times 30 = 60$

  • Total Tablets: $60$

• Section 4: Tapers and Stock Strength Matching

  • Rx 16: Prednisone 10mg

  • Directions: Take 40mg daily for 2 days, 30mg daily for 2 days, 20mg daily for 2 days, 10mg daily for 2 days, then stop.

  • Tablet breakdown (10mg stock): 40mg = 4 tabs/day; 30mg = 3 tabs/day; 20mg = 2 tabs/day; 10mg = 1 tab/day

  • Calculation: $(4 \\times 2) + (3 \\times 2) + (2 \\times 2) + (1 \\times 2) = 8 + 6 + 4 + 2 = 20$

  • Total Tablets: $20$

  • Rx 17: Docusate Sodium (Stock on hand: 100mg capsules)

  • Directions: Take 200mg by mouth twice daily for 14 days.

  • Capsules per dose: $200\\,\\text{mg} \\div 100\\,\\text{mg} = 2\\,\\text{capsules}$

  • Daily Capsules: $2 \\times 2 = 4\\,\\text{capsules/day}$

  • Calculation: $4 \\times 14 = 56$

  • Total Capsules: $56$

  • Rx 18: Dexamethasone 4mg

  • Directions: Take $1\\frac{1}{2}$ tablets twice a day for 3 days, 1 tablet twice a day for 3 days, $\\frac{1}{2}$ tablet daily for 3 days, then stop.

  • Phase 1 ($1.5 \\times 2 \\times 3$): $9\\,\\text{tablets}$

  • Phase 2 ($1 \\times 2 \\times 3$): $6\\,\\text{tablets}$

  • Phase 3 ($0.5 \\times 1 \\times 3$): $1.5\\,\\text{tablets}$

  • Calculation: $9 + 6 + 1.5 = 16.5$

  • Total Tablets: $17$ (dispensed as 17 whole tablets)

  • Rx 19: Synthroid (Stock on hand: 50 mcg tablets)

  • Directions: Take 0.1 mg by mouth every morning. Dispense a 3-month supply ($30 \\times 3 = 90\\,\\text{days}$).

  • Unit Conversion ($1\\,\\text{mg} = 1000\\,\\text{mcg}$): $0.1\\,\\text{mg} \\times 1000 = 100\\,\\text{mcg/day}$

  • Tablets per day: $100\\,\\text{mcg} \\div 50\\,\\text{mcg} = 2\\,\\text{tablets/day}$

  • Calculation: $2 \\times 90 = 180$

  • Total Tablets: $180$

  • Rx 20: Methylprednisolone 4mg (Taper Schedule)

  • Directions: Take 24mg on Day 1, 20mg on Day 2, 16mg on Day 3, 12mg on Day 4, 8mg on Day 5, and 4mg on Day 6, then stop.

  • Tablets calculation per day ($4\\,\\text{mg}$ stock tablets):

    • Day 1: $24 \\div 4 = 6\\,\\text{tablets}$

    • Day 2: $20 \\div 4 = 5\\,\\text{tablets}$

    • Day 3: $16 \\div 4 = 4\\,\\text{tablets}$

    • Day 4: $12 \\div 4 = 3\\,\\text{tablets}$

    • Day 5: $8 \\div 4 = 2\\,\\text{tablets}$

    • Day 6: $4 \\div 4 = 1\\,\\text{tablet}$

  • Calculation: $6 + 5 + 4 + 3 + 2 + 1 = 21$

  • Total Tablets: $21$