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1: Assisting the Pharmacist in Serving Patients

Receiving Prescriptions and Medication Orders A prescription is an order for the preparation and administration of a drug or nondrug remedy issued by licensed medical practitioner who is authorized to do so. Prescriptions may be presented in written form, via telephone, fax, or computer. Usually in outpatient and ambulatory pharmacy. o A prescription must have the following components: Patients name, age, address, and telephone number Prescription date Name of product, either as generic or trade Strength of product. Can be voided if the drug only has 1 strength or only 1 compound ratio Dosage form. Can be voided if the drug only has 1 dosage form Quantity of medication Direction for preparation and Direction for patient (route of administration and dose schedule) Direction for labeling and refills Prescribers name, address, telephone number, DEA number, and signature A medication order is a written order for the preparation of medication issued by licensed medical practitioner. Usually in inpatient and hospital. Medication order labeled STAT should be attended immediately, then ASAP. PRN means the drug should be used on as needed basis. Standing order are drugs that do no require new order. o A medication order must have the following components Patients name, DOB, room number, identification number, indication of use, and allergies Time and Date of the order Name of the product, either as generic or trade Strength of product. Can be voided if the drug only has 1 strength only 1 compound ratio Dosage form. Can be voided if the drug only has 1 form Prescriber information. Signatures are usually not required if the order is received verbally. In this case, the name or initial of the recipient has to be on the medication order Direction for preparation and for administration Duration of therapy and other instruction for administration Receiving Prescription and Medication order o New order in written form Ambulatory/outpatient Prescription maybe presented to the pharmacy by the patient or patients representative. If the state law permits it, it can also be delivered via fax Institutional/inpatient Medication order maybe presented to the pharmacy by doctors, nurses, healthcare professionals, or messenger. It can also be transmitted via computer or pneumatic tube system. o New order in electronic form are processed as the written form o Only licensed pharmacist or nurses can accept new order via telephone. Receiving Prescription refill and transfer request o Accepting refill request electronically (telephone, fax, and computer) The refill request must have patients name, phone number, prescription number, drug name, strength, and quantity, prescriber information, and reimbursement information o Contacting prescriber for clarification and authorization When contacting the prescriber, the information that needs to be given are pharmacys name and number, patients name, drug name, strength, and quantity, date of last refill, prescription direction, and the concern that needs to be addressed. o Transferring and accepting transfers of prescription or medication order

When transferring or accepting prescription, the information that needs to be present are pharmacys name and phone number, patients name and phone number, drug name, strength, quantity, and instruction, date of original prescription, date of last refill, physicians name and phone number, name of individual receiving or transferring prescription, and original Rx number. Federal law stipulates that controlled substances may be transferred only once. State board of pharmacy prefers to allow transfer of prescription to happen once, and a pharmacy technician may fax a prescription to another pharmacy. Assessing prescription and medication orders o Assessing prescription and medication order for accuracy and completeness is crucial. The following criteria must be confirmed before fulfilling the order Patient information: includes name, age, address, and known allergies. For medication orders in the hospital, the order requires name, DOB, room number, identification number, allergies, indications, and other relevant patient information such as diagnosis. Drug and product availability: Verify the product name, strength, dosage form are consistent with the commercially available product. Authenticity: Assess whether the prescription or medication order is legitimate such as signature. Legality: Assess whether the prescription or medication order is compliant with federal and state regulations. Reimbursement eligibility: Determined whether the patients insurance cover the drug that is being prescribed and is eligible for reimbursement. Assist the patient in choosing the best payment assistant plan if multiple are available. Patient Information/Profile System Under the supervision of pharmacist, CPhT may obtain patient information to build profile that includes crucial patient information such as drug use for references and updates on conditions. This requires the CPhT to have adequate communication skills to interview the patient. These information includes: o Patient information: name, DOB, address, phone number, and insurance information. For institutional setting, the information are name, DOB, address, height and weight, identification number, room number, and primary physician. o Diagnosis and desired therapeutic outcome o Medication use: includes medication history and current medication use (including nonprescription). Refill information should also be included o Allergies and Adverse reaction to drugs and other substances o Medication history o Psychosocial history o Patient characteristics: includes impairment and sociological characteristics o Socioeconomic history and insurance information o Patient outcome: blood pressure, glucose level, and blood lipid analysis After obtaining patient information, CPhT may be responsible to enter the information into the system. It can either be a new profile or an update of an existing profile o Some of the common updates are patient information, diagnosis, medication use, allergies, adverse effect, insurance, medication duplication, and drug interaction. Processing Prescriptions and Medication Orders Entering prescription and medication order information in profile: Crucial process in having accurate drug dispensing. It will also change the drug inventory record, create entry into the want book, and generate a prescription label. In order to ensure accurate input, the following steps must be followed o Verify the patients name or identification number. If the patient already has a profile, then verify the prescription with the existing record. If not, then create a new profile. o Compare the new prescribed order with the existing order to check for duplication and potential problems. If problems are discovered, notify the pharmacist. o Enter the date, drug name, dosage form, quantity, direction, and number of refills o Enter prescriber information and the initials of the technician

o Enter insurance information and other information required by the pharmacy Selecting appropriate products: prescription should be filled from the original order. CPhT should also decide the manufacturing source of the product to be dispensed. A generic maybe filled from the preferred manufacturer of the pharmacy over other generic manufacturer. For brand name drugs in the hospital, the formulary authorizes the pharmacy to fill the prescription with generic equivalent when available. If a generic is not available, the prescription may be filled with brand name product. For brand name drugs in the ambulatory pharmacy, usually generic s preferred by the pharmacy. The insurance also has a list of drugs that are covered for individual patient. If the patient insists on having brand name, then the patient has to pay the difference. After deciding the medication, it should be removed by the inventory. CPhT should also calibrate the equipment that is needed to prepare the medication. Preparing and Dispensing Medication to Fill Prescriptions and Medication Orders o Dispensing finished dosage form: measure and count the finished dosage form according to the original prescription o Calculation: Perform pharmaceutical calculation to desired concentration and strength o Compounding: follow the original prescription for formula and instruction to compound the medication in need. o When a mixture might react with metal, a plastic spatula is used. o Record keeping: The information on how the prescription was prepared should be updated in the patients profile. The dispensing of controlled substances should be documented on dosage form and compounded preparation. It should also include the date when the drug was removed from inventory, amount of drug removed, how it was used, patients information, and dispensers information. Preparing Intravenous Admixture and Sterile Products o Sterile/Aseptic Method: compounding intravenous solution and other solution that comes in direct contact with the patients tissues require sterile preparation. Different pharmacies have different policies regard to aseptic regulation. Some requires the use of laminar airflow hood, which passes air through HEPA filter twice to create a working area with constant flow of sterile air. Proper attire such as gown, gloves, facemask, and cap must be worn when preparing sterile solution. Technician should also wash hands using chlorhexidine or other disinfectant. When preparing the work area for sterile preparation, the laminar airflow hood should be turned on 30 minutes prior to working. The working surface must wipe down with either ethanol or isopropanol and leave the surface wet to kill any remaining bacteria or microorganisms. When preparing injectable medication, the injection site of the container should also be wiped down with alcohol. Be careful not to touch any sterile material with other surface. o Compounding Sterile Preparation: When preparing injectable from sterile powder, sterile USP solution is added into the vial. The vial is then shaken and left on the hood surface to allow every particle to dissolve. The container and syringes that is used to dilute or withdraw one medication should never be used to withdraw or dilute another medication to prevent cross-contamination. When preparing antineoplastic drugs (chemotherapeutic agent), technician should work in a vertical laminar airflow hood to prevent from inhaling the toxic fume. For enteral products, most of the products are manufactured in such a way that is ready to use. Technician should check for formulation that requires compounding. o Trituration is the process of rubbing, grinding, or pulverizing a powder to create fine particles. Deaggregation is the breaking up of granules or aggregates into fine particles in aqueous fluid o Packaging preparation: For prescriptions, most preparation are packaged and dispensed in a container that protects the drug from light. For medication order, it can either be unit-dose or multi-dose packaging (which can be single day supply or multi-day supply). The packaging of sterile product has to be aseptically sealed and dispensed. Some preparation must be filtered before dispensing. o Labeling: For prescription, it must include name and address of pharmacy, date filled, Rx number, drug name, strength, quantity, direction of use, patients name, prescribers name, expiration date, number of refills, lot number, pharmacists initials, auxiliary information, and other information required by state law such as controlled substance label. For unit-dose medication order, it must include drug name and strength, lot number, expiration date, direction for use (for IV only), and auxiliary information. For multi-dose medication order, it should have patients name and room number, drug name, strength, quantity,

direction, lot number, expiration date, and auxiliary label. Sterile products are labeled like multi-dose medication order. Verifying Dispensing and Labeling Accuracy: technician should perform intermediate checks through out the process of dispensing and labeling by comparing the original order, label, patient profile, and drug selected. A supervising pharmacist must verify the order before dispensing. The label should be checked with original order by at least 2 people. Delivering medication: The medication should be stored in the designated area before dispensing to the patient. Emulsion should not be stored in the freezer or in area with excess heat. It should not be refrigerated either. When giving the prescribed drug to the patient, offer patient pharmacist consultation. In an institutional setting, medication is either placed in the unit-dose care or delivered to the patient-care unit. For mailing order, medication has to be packaged and shipped to the patient. Drug company courier usually delivers drug order. Determining Charges and Obtaining Compensation: Charges for medication are determined by individual pharmacy policy. Technician should contact third-party payer (insurance) to verify coverage and also for approval to dispense non-formulary drug. When obtaining compensation, first step is to determine the copayment of the patient. Then contact specific insurance company if the patient has benefit coverage plan. Technician should also identify and resolve problems with rejected claims. Providing Supplemental information: technician should ask patient if pharmacist consultation is needed. Several prescriptions should also have PPIs (Patient package insert) with the medication when dispensing. These medications are: Oral contraceptives Products containing estrogenic drugs Products containing presentational drugs Isotretinoin (Accutane) Intrauterine devices Isoproterenol inhalation products There are several regulations regarding to the dispensing of controlled substance. A controlled substance usage form monitors receipt, administration, and disposal of controlled substance, incoming nurse must witness counts, and a separate form is used to account for the amount of controlled substance the patient is taking. Pyxis system is an automated point-of-use storage system for making floor stock items available to nursing staff

Section 2: Maintaining Medication and Inventory Control Systems

Medication Distribution and Inventory Control Systems Ordering Pharmaceuticals, durable medical equipment, devices, and supplies o Identifying products to be ordered: technician should determine the products to order depends on the inventory-purchasing procedures of each pharmacy. Technician should consider inventory turnover rate (the number of times a product is purchased, sold, and replaced during an accounting period), manufacturing source, and price. o Entering Information on products to be ordered: For pharmaceuticals, it should include drug name (generic or trade), manufacturer, strength and dosage form, type of packaging, quantity, and number of units. For equipment, it should include name and manufacturer, strength or size, quantity, number of unit, and other required information. o Identifying Appropriate source: each pharmacy has its own preferred source such as wholesale drug distributors, manufacturers, and other pharmacist. Technician should be knowledgeable about when will the product arrive and order from source where products can be delivered quickly. In an emergency where a product cannot be obtained from preferred source, pharmacy may borrow product from other pharmacy. Receiving goods: technician should verify the received order and make sure the original purchase order, invoice received, and the products received in the order are consistent. Technician should also check drug

name and manufacturer, strength and dosage form, appropriateness of packaging, quantity, and number of units. Pharmacist should document receipt of controlled substance. Placing and removing pharmaceuticals, durable medical equipment, devices, and supplies from inventory: products should be placed in the inventory under proper condition and subject to stock rotation (put the one that expire the soonest in front). Products should be removed when it expires, slow moving, and recalled. The physical inventory of prescription drugs is checked every 5 years.

Section 3: Processing and Handling of Specific Drug Categories

Processing and Handling Commercially Available Chemotherapeutic Medication Chemotherapeutic agents are used to target cancer cells that are most likely metastasized. The drug will be distributed throughout the body to target cancer cells. There are several type of chemotherapeutic agents depends on its property and mechanism: o Cytotoxic Agents: used to kill or arrest the growth of abnormal cancer cells. Most of these drugs interfere with the cells ability to grow or multiply. The most commonly used cytotoxic agents are Capecitabline (Xeloda) Chlorambucil (Leukeran) Cisplatin (Platinol) Cyclophosphamide (Cytoxan) Daunorubicin (Cerubidine) Doxorubicin (Adriamycin) Etoposide (VePesid) Flurouracil (Efudex) Meclorethamine (Mustargen) Melphalan (Alkeran) Mercaptopurine (Purinethol) Methotrexate (Trexall) Adverse Effect of cytotoxic agents: cytotoxic agents cannot differentiate healthy cells from cancerous ones; therefore the drug will kill all surrounding cells. The most commonly killed cells are blood cells, hair cells, and gastrointestinal lining. These will show up as hair loss, nausea, vomiting, blood cell changes, and organ damage. Cytotoxic agents may be carcinogenetic (cancer causing), teratogenic (birth defects causing), and mutagenic (genetic mutation causing). o Hormonal therapy: used to add, block, or remove hormone that stimulate the growth of cancer cells. There are several types of hormonal therapeutic agents for different type of hormonal induced cancer. Selective Estrogen Receptor Modulators (SERMS) chemically resemble estrogen and binds to estrogen receptor. This prevents estrogen from binding to the site. Tamoxifen (Nolvadex) is the most common drug. Aromatase inhibitors block aromatase, which is the source of estrogen in many organs. The most common drugs are Anastrozole (Arimidex), Exemestane (Aromasin), Formestane (Lenatron), and Letrozole(Femara). Selective Estrogen Receptor Downregulators (SERDS) blocks estrogen in all tissues in the body. Fulvestrant (Faslodex) is the most common drug. Progestins are used to treat advanced breast cancer when tamoxifen fails. Megestrol (Megace) is the most common drug. Luteinizing Hormone-Releasing Hormone agonist (LHRH) agonist prevents testicles from producing testosterone. Most common drugs are Goserelin (Zoladex) and Leuprolide (Lupron). Antiandrogens blocks remaining male hormone after orchiectomy or after testicle production seized. This medication blocks hormone produced by adrenal gland. Most common drugs are Bicalutamide (Casodex) and Flutamide (Eulexin). Adverse effect of estrogen blocking agents includes hot flashes, bleeding and discharge, visual disturbance, and blood clots. Testosterone blocking agents may cause nausea, constipation, decreased appetite, dizziness, insomnia, gynecomastia, impotence, and decreased sex drive. Processing and Handling of Chemotherapeutic Agents: pregnant or lactating women, male or female staff that wants to conceive child, personnel with medical condition, and personnel that do not meet competency requirement are exempt from handling chemotherapeutic agents. Handling of chemotherapeutic drugs commercially available in finished dosage form: Oral cytotoxic agents are just as dangerous as injectable chemotherapeutic agents. There are several route of exposure, such as

through inhaling crushed and split tablets, powders, and liquids. It can also be from absorption through skin or eye contact and also through contaminated food and drinks. o Protective apparel must be worn when handling therapeutic agent. Gloves without powder are preferred to prevent absorption of cytotoxic agent. Gloves should be changed frequently to avoid exposure. Gowns, masks, eye protectors, and caps should be worn. Preparation of cytotoxic drug should be in a biological safety cabinet. The cabinet sustains a sterile vertical airflow and provides shield to protect the operator. The preparation area must be a restricted area where only authorized personnel can enter. Apparel must not leave the preparation area and should be disposed according to regulation. Receiving, handling, and dispensing cytotoxic drugs: gloves and other protective apparel should be worn when receiving cytotoxic agents. Cytotoxic drug should be separated from other drugs. Designated counting tray and spatula should be used exclusively for cytotoxic drug. Waste should be disposed in a puncture-proof container that is labeled cytotoxic waste. Collecting and Communicating Data on Investigational Drugs Investigational drugs are drugs used in clinical studies but not yet approved by FDA. The handling of investigational drug is different from other drugs due to several aspects like toxicity and stability. Since the drug is still used in studies, technicians should keep detailed record on the preparation and administration of the drug. Such record includes date and time, packing slip, storage, and labels. Technicians are responsible in assisting in the development of detailed procedure for preparation, dispensing and distribution of investigational drugs. They are also responsible for reconciling each investigational drug order with corresponding protocol and study subject, communicate with study monitors, and contact coordinators when drugs are returned unused. Collecting and Communicating Data on Restricted Drug Distribution Programs Restricted drugs are rarely used by small amount of patients due to limited therapeutic options and serious side effects. These drugs often have strict regulation and registration requirements. o Thalidomide (Thalomid) is approved for treatment of skin manifestation related to erythema nodosum leprosum. Thalidomide is tertogenic. S.T.E.P. is a program developed by Celgene Corporation that requires product labeling that includes information about risk and a boxed warning to highlight side effects and risk. Registration of all prescribers, patients, pharmacist, and pharmacies who prescribe, receive, and dispense thalidomide is also required. Patients are required to take pregnancy tests and use highly effective birth control method to prevent pregnancy. Only 28-day supply is provided and no telephone prescription and automatic refills. o Isotretinoin (Accutane, Amnesteem, Claravis, Sotret) is approved to treat severe, disfiguring acne. It also has tetratogenic property. System to Manage Accutane Related Teratogenicity (SMART) program includes self-certification program of physicians who plan to prescribe Isotretinoin, patient agreement, FDA-approved medication guide. Under this program, no more than 30-day supply may be dispensed, a yellow sticker must be present on the prescription, the prescription must be written within 7 days. o Clozapine (Clozaril) is used to treat severe schizophrenia. It has serious side effect such as agranulocytosis, seizures, myocarditis, and other cardiovascular and respiratory effects. Patient must be prescribed with IVAX Pharmaceuticals Clozapine Patient Registration or Clozaril National Registry. Patient needs to have a current WBC count and only 1-2 week supply may be dispensed. o Alosetron (Lotronex) is used to treat women with severe, diarrhea-prominent irritable bowel syndrome. It causes ischemic colitis and maybe death. A program called Prescribing Program for LOTRONEX requires enrollment and self-certification of doctors, consent form, written prescription, sticker on the prescription, and guide. o Other restricted drug includes: Bosentan (Tracleer), Dofetilide (Tikosyn), and Gefitinib (Iressa).

Section 4: Participating in the Administration and Management of Pharmacy Practice

Operations Coordinating communications throughout the practice site

o Phone calls may be addressed directly or routed to appropriate recipient by the technician. Technicians may also be responsible in accepting, communicating, and transmitting messages to and from individuals and also routing faxes, processing prescriptions, and routing other written communications. Technicians may also participate in meetings regarding the performance and improvement of service. o Technicians may be implementing and monitoring policies for environmental safety such as sanitation management, hazardous waste handling, and infection control. These practices may include cleaning, sanitizing, maintaining, calibrating and recording equipment. o Computer system may be made to process prescriptions, inventory, track controlled substances, update drug price, workload and productivity tracking, drug utilization, and billing. It can also be used to dispense medication. o Fire extinguisher must be checked biannually o Records of biennial inventory of narcotics, change of pharmacist-in-charge inventory, and controlled substance invoices should be kept in the pharmacy. Related Drug Laws and Regulations Medicare Drug, Improvement and Modernization Act of 2003: provide senior citizens with improved outpatient drug coverage. It also adds preventative medicine to the prescription drug benefits of Medicare recipients, allowing voluntary discount drug benefit card. Poison Prevention Packaging Act: To prevent accidental opening and consuming of hazardous substance by minors. There are several exceptions such as nitroglycerine and oral contraceptives that do not need to be dispensed in child resistance package. Single time dispensing of a product noncompliant in container as ordered by prescriber and single time or blanket dispensing of a product noncompliant in container as requested and signed by the patient as well as drug dispensed in institutional setting are also exceptions Health Insurance Portability and Accountability Act (HIPAA): protect he privacy rights of patients and secure health insurance coverage for individuals and families when they change or lose their jobs. It also prohibits healthcare professionals to disclose information regarding a patients medical care without authorization. Pure Food and Drug Act of 1906: The manufacture, transport, or sale of misbranded or adulterated food or medications are illegal. The law required that food and medication to be labeled clearly and with all content listed. o Misbranding is defined as false or misleading in any particular manner when labeling the product. Drug packaging must be clearly labeled with name of the medication and also the name and address of manufacturer. The risk of habit forming, adverse effect, and interaction must also be stated. These labels must be clear and easy to understand. o Adulteration is defined of any putrid or decomposed substance in the product. Preparing drugs under unsanitary condition, contain unsafe additive or poisonous substance is also adulteration. Adulteration also includes making erroneous claims to strength, quality, or purity of the medication and any attempt to conceal hazardous ingredients. Harrison Narcotic Act: regulates and taxes the production, import, and distribution of opiate medications. Food, Drug, and Cosmetic Act of 1938: Created the FDA and give it the authority to oversee the sale and safety of food, drugs, and cosmetics. It also requires that a medication must obtain premarketing approval from the government Durham-Humphrey Act of 1951: An amendment to the Food, Drug and Cosmetic Act of 1938 which divided medications into 2 categories: legend drugs (prescription only) and non-legend drug (OTC). This act also allowed physician to call in new prescription and refills via telephone. Kefauver-Harris Amendment: An amendment to the Food, Drug and Cosmetic Act that requires drug manufacturer to prove that a drug is both safe and effective before FDA would approve it. It also requires the disclosure of any adverse effect and register with FDA for inspection every 2 years. Comprehensive Drug Abuse Prevention and Control Act of 1970: Creation of DEA and give DEA the power to regulate the sale and use of controlled substances. Controlled substances are defined as medications that have potential for abuse and habit-forming.

Occupational Health and Safety Act of 1970: Creation of OSHA within the department of labor. The purpose of OSHA is to regulate the workplace and ensure a safe and healthy work environment for all employees. OSHA also sets standard for workplace condition. OSHA regulates the exposure to hazardous materials, air quality, and worker protection. OSHA also require a facility receiving hazardous substances also receives MSDS (material safety data sheet). Drug Listing Act of 1972: This creates the national drug code, which assigns each drug with a unique 11digit code. First give identify the manufacturer, next four refers to the product itself, and the final two identify the specific package size. Orphan Drug Act of 1983: To encourage pharmaceutical companies to pursue treatments for rare diseases by providing tax and licensing incentives. Drug Price Competition and Patent-Restoration Act of 1984: Also known as Hatch-Waxman Act, it establishes the modern generic drug system. Prescription Drug Marketing Act of 1987: Establish legal safeguards regarding the sales and distribution of prescription drugs. The goal is to discourage the sale and distribution of counterfeit or expired prescription drugs. Anabolic Steroids Control Act of 1990: Creates harsher penalties for athletes abusing anabolic steroids. FDA Safe Medical Devices Act of 1990: To regulate the distribution and use of medical devices. It requires the provider to report adverse effects that result from the use of medical device to the manufacturer. It also sets policies for maintaining and tracking medical devices. Americans with Disabilities Act of 1990: The ADA prevents discrimination against an individual based on disability. It requires the employer to make reasonable accommodations. Omnibus Budget Reconciliation Act of 1990: changed reimbursement limits and mandated drug utilization evaluation, pharmacy patient consultation, and educational outreach programs. OBRA gave states permission to create Drug Utilization Review (DUR) boards to manage state specific drug purchasing and formulary decisions for state purchased health care such as Medicaid programs, injured workers programs, and state employee benefits. Resource Conservation and Recovery Act: Established laws regarding the disposal of hazardous waste and solid waste. This includes medical waste and controlled substances. FDA Modernization Act: Enacted to improve patient access to new pharmaceuticals and medical devices. It streamlines and shortens the process of brining a new drug or medical device to market. Dietary Supplement Health and Education Act of 1994: Defines the meaning of dietary supplement which must contain at least one of the following: vitamin, mineral, herb, botanical, or amino acid. Dietary supplements must comply with standards for quality, purity, and safety. Combat Methamphetamine Epidemic Act: Regulates the sale of medication containing ephedrine, pseudoephedrine, or phenylpropanolamine. After being nationally certified, technician should take 20 units of pharmacy related continuing education every 2 years Related Agencies Bureau of Alcohol, Tobacco, and Firearms is responsible for regulating the sale of tax-free alcohol used by pharmacies and hospitals Center for Medicare and Medicaid Service regulates all Medicare and Medicaid services including reimbursement. Low-income families are not under the supervision of Medicare but Medicaid. Drug Enforcement Agency is responsible for enforcing all laws pertaining to controlled substances Environmental Protection Agency is responsible for regulating the disposal of all hazardous waste Food and Drug Administration is responsible for the regulation of the manufacturing and sale of all drugs and medical device. It also monitors the safety and efficacy of all pharmaceutical products. A drug has 3 human testing phases before FDA approval. Although FDA does have the power of calling drug recalls, usually FDA would request the manufacturer to call for a recall before enforcing its authority. When a drug is recalled, it is being referred to as its NDC and lot number. Institutional Review Boards oversees all biomedical research within the institution

Joint Commission on Accreditation of Healthcare Organization is a private sector organization that assures the quality of healthcare and patient safety. It sets standards for healthcare organizations and evaluates on regular basis. Under JCAHO, unit-dose system is preferred over floor stock inventories, internal and external products must be kept in separate location in pharmacy, dispensing of professional samples to patient is discouraged, and IV admixture are prepared using aseptic technic and laminar flow hood. National Association of the Boards of Pharmacy assists member boards and jurisdiction in developing, implementing, and enforcing uniform standards for the purpose of protecting public health. It has no regulatory role. State Boards of Pharmacy is the regulatory agency that sets and enforces all the regulation in the state. In terms of Board of Pharmacy, a pharmacy must have an alarm system; have certain minimum amount of counter space, and a safe for Schedule 2 medications. The Department of Taxation evaluates pharmacy scales and balances on yearly basis

Pharmacy Math Calculations and Conversions

Roman Numerals: SS (1/2), I (1), V (5), X (10), L (50), C (100), D (500), M (1000). When roman numerals are repeated, the value repeated (XX=20), no numeral may repeat more than three times. When a smaller numeral is placed before a larger one, it is subtracted from the larger number. When a smaller numeral is placed after a larger one, it is added onto the larger number. V, L, and D are never subtracted. When subtracting, only subtract one numeral. Use I before V and X, X before L and C, and C before D and M. Metric System Measurement: The primary units used in pharmacy are meter (length), liter (volume), and gram (weight). The prefixes change the property of the unit. Kilo means 1000 of basic unit, milli- is 1/1000 of basic unit, and micro- is 1/1000000 of basic unit. Rounded-off conversion: 1 gram (g) 15.4 grain (gr) 1 gallon (gal) 4 quarts (qt) 1 grain (gr) 65 milligram (mg) 1 quart (qt) 2 pints (pt) 1 pound (lb) 454 gram (g) 1 inch (in) 2.54 centimeter (cm) 1 kilogram (kg) 2.2 pound (lb) Degrees F 32+9/5 C 1 ounce (oz) 28.4 gram (g) Degrees C 5/9 (F -32) 1 pound (lb) 16 ounce (oz) 1 teaspoon (tsp.) 5 milliliter (ml) 1 fluid ounce (fl. oz) 30 milliliter (ml) 1 tablespoon (tbsp.) 15 milliliter (ml) 1 pint (pt) 16 fluid ounce (fl. oz) 1 fluid ounce (fl. oz) 30 milliliter (ml) Flow Rate: flow rate calculations are normally used for intravenous solutions and can be done by multiple ratio and proportion. It can be done by ( )( ) = . 60 Body surface area: often use to determine the drug dosage for children. This can be determined by using a nomogram. To use a nomogram, draw a dot on the side indicating the patients height and a dot on the side indicating the patients weight. Use a straightedge and draw a line connecting the two dots, the value intersected by the line will be the body surface area. Concentration and Dilutions: Weight-in-weight (w/w) is used when both the components and the final product are solid. It is determined by (weight of component/weight of final product). Volume-in-volume (v/v) is used when both the components and the final product are liquid. It is determined by (volume of component/volume of final product). Weight-in-volume (w/v) is used when the final product is liquid and the components are solids. It can be determined by (weight of component/final volume of solution) Dilution: To dilute a solution from a higher concentration to a lower concentration, the final volume of the diluted solution can be calculated by (old volume)(old concentration) = (new volume)(new concentration) Alligation Method: used for making dilutions when the diluent is zero percent or higher. The final product will have the concentration between the 2 solutions.

Tic-tac-toe Method for allegation: subtract value diagonally and obtain the absolute value of the answer. Concentration of Solution A Desire Concentration of Final Concentration of Solution B Number of Solution A needed Number of parts of Solution B needed

Commercial Calculations: Cost: total paid for an item or items received as noted on an invoice Selling price: 100% of the amount received for the sale of an item Markup: the difference between the cost and the selling price Percent Markup: the percent of (selling price cost)/cost Percent gross profit: markup/selling price Overhead: the cost of operation, utility, taxes, insurance, and technician salary Net profit: selling price (cost of goods + overhead)

Other Resources, Abbreviations, and Miscellaneous

The United States Pharmacists Pharmacopeia is a comprehensive compilation of information on compounding products and ingredients and their safety as well as products used to treat specific medical conditions. Also included are the most recent sterile preparation guidelines for USP, the most common non-formulary agents. It also includes regulation regarding labeling on medication The medication delivery record documents the receipt of medication on a nursing floor from the pharmacy. Records are checked against records in the pharmacy. PACU is known as post-anesthesia care unit, SICU is surgical intensive care unit, PEDS is pediatric unit, and PICU is pediatric intensive care unit. The Drug Topics and Red Book contains information pertaining to average and wholesale drug costs and prices The PAR value is the periodic automatic replacement value, which is the amount of drug that is automatically reordered. A point of sale is characterized by a network of providers under contract by the insurer, patients are required to choose a primary care physician and required to obtain a referral for service outside the network. It also involves deducting the item from inventory as it is dispensed A nebulizer generates very fine particles of liquid in a gas and is used in providing inhalation therapy. Peak flow meter is used to measure and manage asthma. A normal volume of urine in the bladder is around 250-300 mL Bells Palsy is characterized by paralysis of facial nerves, usually on one side A postprandial hypotension is sudden drop in blood pressure after eating. Neurally mediated hypotension is drop in blood pressure after standing up for a long time. Orthostatic hypotension is a drop in blood pressure after standing up quickly from sitting position. Its size, host, genetic makeup characterizes a virus, and whether it is enveloped or naked. Ulesfia, Ovide, and Kwell are prescription treatment for lice. Nix, Tegrin LF, and Pronto are OTC lice treatment. A nosocomial infection is acquired while in the hospital or other healthcare facility. It has the potential of being fatal.

Novolog is a fast acting insulin used in emergency situation such as diabetic coma Transdermal product provides systemic therapy, delivers controlled dose of medication, and result in improved patient compliance A onychomycosis is a fungal infection of the nail IR stands for immediate release, TR is time-release, XR is extended release, and CR is continuous release A lozenge or troche is a medication that dissolves slowly in the mouth, such as Cepacol (cetylpyridinium chloride-lozenge) Parts of a needle include hub, hilt, shaft, bevel, lumen, and point. A gravity infusion system is a stationary infusion system, which uses a minibag that is regulated by the patient. An ISO class 9 is an area in which there are no more than 100,000 particles 0.5 microns or larger per cubic food of air. Class 7 is no more than 10000 particles and class 5 is no more than 100. The onset of insulin is (from fastest to slowest) NPH, Lente, Ultra-Lente A drug patent last 20 years and starts from the initial filing date DAW is dispense as written When indicating eyes or ear, D indicates right side while S indicates left side A Laminar Airflow Hood should produce a ISO 5 class environment A monograph is a detailed document pertaining to a specific drug, more commonly known as package inserts The last in, first out method of costing inventory assumes that the costs of the latest units purchased are the first to be allocated to cost of goods sold. The first in, first out method of costing inventory assumes the cost at the earliest purchase of goods is the first to be recognized as the cost of the goods sold.