Fractions
1.
Before working with fractions, convert mixed numbers and whole numbers into improper fractions . A mixed number is a whole number with a fraction attached to it like this; 3 1/2.
This means three and one-half. An example of a whole number is 3. An improper fraction is a fraction with a numerator bigger than the denominator . A proper fraction has a numerator smaller than the denominator . The numerator is the top number in a fraction. The denominator is the bottom number in a fraction. The following example shows how to convert a mixed number into an improper fraction .
3 1 = 7
2 2
Multiply 3 by 2 . The result is 6 . Add 6 to 1 and the result is 7 . Therefore, the answer is
7
2
2.
All final answers involving fractions should be in lowest terms. Also, all improper fractions should be converted into a whole number or mixed number.
16 = 2 x 2 x 2 x 2 = 1
32 2 x 2 x 2 x 2 x 2 2
This is an example of how one can reduce a final answer involving fractions to lowest terms. As you can see,
2 x 2 x 2 x 2 is a set of prime numbers common to both the top and bottom. Prime numbers are numbers that are not divisible by any numbers other than 1 and itself. Examples of prime numbers are; 1, 2, 3, 5, 7, 11, etc. since 2 x 2 x 2 x
2 equals 16 , you divide both the top and bottom by 16 .
Therefore, the answer is 1
2
7 = 3 1
2 2
This is an example of how one can convert improper fractions into a whole number or mixed number . Divide 7 by
2 . The answer is 3 1
2
3.
When adding or subtracting fractions, convert all fractions in the problem so that they have a common denominator. Then, add or subtract the numerator.
1 + 5 = 6 + 10 = 16 = 1 1
2 6 12 12 12 3
First, convert all fractions in the problem so that they have a
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common denominator. Multiply both the numerator and denominator in 1/ 2 by 6 . Multiply both the numerator and denominator in 5/ 6 by 2 . This yields 6/ 12 + 10/ 12 . Adding the numerators yield 16/ 12 . Converting this improper fraction to a mixed number in lowest terms gives us the answer; 1 1/ 3 .
4.
When multiplying fractions , multiply numerators by numerators and denominators by denominators.
3 1 x 1 = 7 x 1 = 7 = 1 3
2 2 2 2 4 4
5.
When dividing fractions , invert the second fraction and treat it as a multiplication problem.
3 1
÷
1 = 7 x 2 = 14 = 7
2 2 2 1 2
Decimals
1.
A decimal is a fraction with a denominator of 10. Therefore, 7/10 = 0.7 = seven tenths,
7/100 = 0.07 = seven hundredths, and 7/1000 = 0.007 = seven thousandths.
2.
To convert a fraction to a decimal , just divide the numerator by the denominator.
Therefore 7/2 = 7 ÷ 2 = 3.5
3.
To do math problems with fractions and decimals , convert all numbers in the problem to either fractions or decimals.
Roman Numerals ss
I, i
V, v
X, x
L, l
C, c
D, d
M, m
1/2
1
5
10
50
100
500
1000
1.
When 2 letters are next to each other , if the value of the first letter is smaller, then the value of the first letter is subtracted from the value of the second letter. If the value of the first letter is larger or equal, then the value of the two letters is added. For example; IX = 9 but XI = 11.
2.
A letter may not be repeated more than 3 times . For example; XL = 40, but XXXX is incorrect.
2

3.
You can never subtract more than one numeral . For example; LXXX = 80, XC = 90, but
XXC is incorrect
Metric System
Equivalent Quantities
0.001 km
0.01 hm
0.1 dam
1 m
10 dm
100 cm
1000 mm
1,000,000 µm
1,000,000,000 nm
Type of
Measurement
Length
Volume
Volume
Weight
Prefix kilo hecto
Symbol k h deka da deci d centi c milli m micro
µ nano n
Metric
Name meter liter
Abbreviation m
L cubic meter m³ gram g
 When using the metric system , match an above prefix with a metric name or match a symbol for a prefix with an abbreviation of a metric name. For example; 1000 meters = 1 km, 1000 g = 1 kg. In other words, micro means 1/1,000,000, milli means 1/1000, centi means 1/100, and kilo means 1000.
Apothecary System
1.
Volume gallon quart pint fluidounce fluidrachm, fluidram gal, C qt pt, f , f , minim
3

1
2.
Weight
1
4
0
1
2
8
1
16
32
128
1
8
128
256
1024
60
480
7680
15360
61440 pound ounce drachm, dram lb
1
1
1
8
1 12 96
Avoirdupois System of Weight pound ounce oz
1
16 grain gr
437.5
7000 scruple grain gr
1 20
3
24
288
60
480
5760
Conversion
Note: 1 tsp = 5 mL and 1 f = 3.69 mL. However, in retail pharmacy, 1 f approximately equals to
1 tsp. In other words, you can use 1 f = 1 tsp for the purposes of writing a sig on a prescription label. However, you cannot use 1 f = 1 tsp as a conversion factor.
1.
Length
1 in
1 m
2.54 cm
39.37 in
2.
Volume
1
1 mL
1 f ,
1 tsp
1 tbsp
0.06 mL
16.23
3.69 mL
5 mL
15 mL
4

1 f ,
1 cup
1 pt, 0
1 gal, C
30 mL
8 f ,
473 mL
3785 mL
3.
Weight
1 gr
1 g
1 oz (avoir.)
1
1 (apoth.)
1 lb (avoir.)
1 kg
65 mg
15.4 gr
28.35 g
31.1 g
373.2 g
454 g
2.2 lb
4.
Water
1 mL 1 cc (cubic centimeter)
1 mL 20 drops from an official USP dropper
1 mL 1 g
1 f 455 gr
5.
Temperature
F temperature = (1 4/5 times number of degrees C) + 32
C temperature = 5/9 x (number of degrees F - 32)
View Fractions Lecture
Most pharmaceutical calculations can be solved with the simple three-step method.
1.
Write down all the variables.
Record all the variables that are known. Also, indicate the unknown variable that you are solving for.
2.
Choose the method used to solve the problem.
If the problem can be solved using a formula, then write down the formula. If the problem is a conversion, then write down the conversion factors and set up the equation. All the units should cancel out except for the unit
5

of the unknown variable in the numerator. If the problem is a proportion and ratio, then set up the equation. Proportion and ratio problems should have three known variables and one unknown variable.
3.
Solve the problem.
If it is a problem that can be solved with a mathematical formula, then plug the variables into the formula and solve it. Solve the problem to determine the unknown variable declared in the first step.
Make sure that the units that cancel each other out are the same type of units. For example, meters can cancel meters, but meters cannot cancel feet.





Problem - A medication order for a patient weighing 176 lb calls for 400 µg antibiotic per kg of body weight to be added to 400 mL of isotonic dextrose solution. If the drug is to be obtained from a solution containing 20 mg per 10 mL, how many milliliters should be added to the dextrose solution?
Known variables; 400 µg antibiotic dose/kg body weight, 176 lb body weight, 400 mL isotonic dextrose solution (this is not a useful variable, it was just thrown in to confuse you) ,
20 mg/10 mL antibiotic source
Unknown variable: X mL of antibiotic added to the dextrose solution.
Conversion factors; 1 kg/2.2 lb, 1 mg/1000 µg.
Solution:
176 lb x 1 kg x
400 µg x 1 mg x 10 mL = 16mL
2.2 lb 1 kg
1000 µg
20 mg
Make sure that the numerators on both sides of the equation have the same units. The denominators on both sides of the equation should also have the same units.


Problem - A pycnometer weighs 25.0 g. When filled with a liquid (S.G.=1.25) it weighs
55.0 g. How many ml of water will the pycnometer hold?
Specific Gravity & Density - In order to do this problem, you need to understand specific gravity and density. Density is the mass per unit volume of a substance. It is usually expressed as g per mL. Specific gravity is a ratio, expressed with decimals, of the weight of a
 substance to the weight of an equal volume of another substance (usually water) chosen as a standard. Both substances have to be at the same temperature or the temperature of both substances has to be known. Because the units cancel out when calculating the specific gravity, it is a dimensionless number. This means that it is a number without a unit.
Known variables; 55.0 g (weight of pycnometer and liquid) - 25.0 g (weight of pycnometer)
= 30.0 g (weight of liquid). Therefore, the known variables are; 30.0 g liquid weight, 1.25 g liquid/1 g water.


Unknown variable: X mL of water.
Proportion and ratio: - Since there are three known variables and one unknown variable, the proportion and ratio method is used.
 Solution:
30.0 g liquid = 1.25 g liquid
6

X g water 1.0 g water
30.0 g liquid x 1.0 g water = X g water
1.25 g liquid
The grams of liquid in the numerator and denominator cancel each other out.
X = 24.0 g water = 24.0 mL water
Since one g water = 1 ml of water, the answer is
24.0 mL of water.
 Problem - On a prescription balance having a sensitivity requirement of 0.012 g what is the
 smallest amount that can be weighed with a maximum potential error of not more than 10%.
 Known variables; 0.012 g Sensitivity Requirement, 10% Permissible Percentage of Error
 Unknown variable: X g Smallest Amount Weighable
Formula - In order for you to do this problem, you have to know the Percentage of error
 formula: (Sensitivity Requirement x 100%)/Permissible Percentage of Error = Smallest
Amount Weighable
Solution:
0.012 g x 100% = 0.12 g
10%
1.
Use The Three Step Method .
2.
Simplify ratios before performing calculations with them. First, reduce ratios to lowest terms. For example, reduce 25:5 to 5:1. Then, convert ratio strengths to a percentage strength expressed as a decimal. For example, 1:5 turns into 0.2.
3.
Use the formula: quantity x concentration = quantity x concentration
4.
Concentration may be expressed in w/v as g/mL (100% = 1.0 g/mL = 100 g/100 mL), v/v as mL/mL (100% = 1.0 mL/mL = 100 mL/100 mL), or w/v as mg/mL (100 mg% = 1.0 mg/mL = 100 mg/100 mL). w/v stands for weight in volume concentration and v/v stands for volume in volume concentration.
7



Problem: If 50 mL of sodium chloride solution (0.5% w/v) is diluted to a liter, convert the resulting concentration into ppm.
Known Variables; 50 mL of sodium chloride at 0.005 g/mL concentration, 1000 mL of diluted sodium chloride.
 Unknown Variables; X g/mL = concentration of 1000 mL diluted sodium chloride, Y ppm
= concentration of 1000 mL diluted sodium chloride.
 Formula: quantity x concentration = quantity x concentration
 Solution:
50 mL ( 0.005 ) = ( 1000 mL ) X
50 mL ( 0.005 ) = X
1000 mL
X = 0.00025
0.00025 = 0.00025 = 0.00025 ( 100,000 ) = 25
1 1 ( 100,000 ) 100,000
25 = Y
100,000 1,000,000
25 x 1,000,000 = Y
100,000
Y = 250 ppm ppm = parts per million. Therefore, Y is parts per million where Y/1,000,000.
The volume of water and alcohol contracts when they are mixed. In other words, 10 mL of water mixed with 10 mL of alcohol will equal less than 20 mL of mixture. Therefore, it is not possible to predict the volume of water needed to dilute alcohol to a specific mL/mL strength. However, you can "qs" a solution to the proper volume.
 Problem: A pipette is graduated in units of 10 mL from 0 to 100 mL. How would you prepare the following?
Rx Rose Oil
Alcohol qs
2.5 mL
90 mL
 Known Variables; 2.5 mL of rose oil, 20 mL is the minimum amount measurable in a 100 mL graduated pipette. For reasons of accuracy, you should never measure an amount less
 than 20% of the capacity of the graduate.
Explanation: 2.5 mL of rose oil cannot be measured directly as it is smaller than the smallest amount measurable by the graduate, 20 mL. Therefore, you have to measure 2.5 mL
8

of rose oil indirectly by measuring 20 mL of a diluted solution of rose oil. Therefore, the
 strength of this dilution is 1:8 rose oil:alcohol as 2.5 mL x 8 = or > 20 mL.
Unknown variable: rose oil to.
 Solution:
X = the volume of the alcohol & rose oil mixture to dilute 20 mL of
1 = 20 mL
8 X
8 ( 20 ) = X
1
X = 160 mL
Measure 20 mL of rose oil. Dilute to 160 mL with alcohol. Then measure 20 mL of this diluted solution and qs to 90 mL with alcohol.
The strength of a concentrated acid is expressed in units of w/w. However, the strength of a diluted acid is expressed in units of w/v. Therefore, you have to include the specific gravity of a concentrated acid in your calculations when computing the volume of concentrated acid needed to compound a specific quantity of diluted acid.
Formula: ( mL dil acid ) ( % w/v ) = ( mL conc. acid ) ( % w/w ) ( SG )



 Problem: You are requested to prepare 400 mL of phosphoric acid solution, 10% w/v. How many mL of a concentrated phosphoric acid solution (40% w/w, SG = 1.25) should be used?
 Known Variables; 400 mL dil phosphoric acid, 10% w/v dil phosphoric acid, 40% w/w conc. phosphoric acid, SG = 1.25.
Unknown Variable:
Formula:
Solution:
X mL conc. acid
( mL dil acid ) ( % w/v ) = ( mL conc. acid ) ( % w/w ) ( SG )
(400 mL)(0.1) = X mL (0.4)(1.25)
(400 mL)(0.1) = X
(0.4)(1.25)
X = 80 mL
The milliequivalent (mEq) measures the concentration of chemical activity of a solution. It takes into account the valence of the ions in solution. 1 mEq = mg of solute expressed as 1/1000 of its gram equivalent weight.
 Problem: A patient is to receive 0.2 mEq of NaCl per kg of body weight. If the patient weighs 154 lb, how many mL of isotonic saline should be used (M.W. NaCl = 58.5) ?
9





Known Variables; 154 lb patient, 0.2 mEq NaCl/kg body weight.
Unknown Variable: X mL = isotonic saline used.
Conversion Factors; 2.2 lb/kg, normal saline = 0.9 g/100 mL NaCl
Solution:
154 lb x 1 kg x 0.2 mEq = 14.0 mEq
2.2 lb 1 kg
NaCl molecular weight: 58.5
NaCl equivalent weight: 58.5 ÷
1 = 58.5
1 is the valence of Na+ or Cl-. In other words, Na+ or Cl- has a +1 or -1 charge.
Milliequivalent weight: 58.5 ÷ 1000 =
0.0585 g
0.0585 g = X
1 mEq 14.0 mEq
0.0585 g x 14.0 mEq = X
1 mEq
X = 0.819 g x 100 mL = 91.0 mL
0.9 g
10

Any dosage problem could be easily solved using Proportional Analysis . In order to set up the problem, you need to have the proper conversion factors. The most common conversion factors used to solve dosage problems are listed below.
Note: 1 tsp = 5 mL = 1 & 1/3 f . This would be the conversion factor used to solve a problem.
However, in retail pharmacy, you may use 1 tsp on the prescription label whenever a doctor writes 1 f on the prescription's sig.
Household Unit
Metric
Unit
20 drops from an official
USP dropper
1 mL
1 tsp
1 tbsp
5 mL
Apothecary
Unit
1 & 1/3 f
15 mL 4 f or 1/2 f
30 mL 1 f
1 kg 2.2 lb
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most pharmacy calculations will involve determining the cost of a particular drug. Most of the time, the calculation will be a proportion and ratio problem . The cost is the invoice dollar amount the pharmacy paid for an item.
1.
Write down all the variables. Write down all the known variables. Record the unknown variable that you are solving for.
2.
Set up the problem. Proportion and ratio problems have three known variables and one unknown variable. Keep this in mind when setting up the proportion and ratio problem.
Make sure that either 1.
each side of the equation has the same units in the numerator and denominator or 2.
both denominators have the same units and both numerators have the same units. Sometimes, you may have to solve a conversion problem in order to obtain one of the three known variables. If the problem is a conversion, then write down the conversion factors and set up the equation. All the units should cancel out except for the unit of the unknown variable in the numerator. Make sure that the units that cancel each other out are the same type of units. For example, meters cancel meters, but meters cannot cancel feet.
3.
Solve the problem. Solve the problem to determine the unknown variable declared in the first step.
 Example Problem - A prescription calls for 20 g of ephedrine. If 10 g of ephedrine cost
$9.00, what is the cost of the amount needed in the prescription?
 Known Variables; 20 g ephedrine in the prescription, 10 g ephedrine/$9.00
 Unknown Variable: X = Price in $ of 20 g of ephedrine.
 Solution:
$9.00 = X $
10 g 20 g
$9.00 x 20 g = X $
12

10 g
X = $18.00
- The dollar amount that a pharmacy receives for selling the product.
- Markup refers either to percent markup based on cost or percent markup based on price.
In retail pharmacy, markup usually refers to percent markup based on price.
 Price = Cost + Markup


Markup/Cost = % Markup on Cost
 Markup/Price = % Gross Margin
Price - (Cost of Goods Sold + Expenses) = Net Profit


Cost (1 + Markup on cost expressed as a decimal) = Price
 Price x %Discount = Discount
Price – Discount = Discounted Price
1.
Inventory - The sum of all the cost of goods waiting to be sold.
2.
Turnover - How often a particular item is sold during a specific period of time, usually one year.
3.
Expenses - Expenses or overhead in a pharmacy includes tech salaries, pharmacist salaries, utility bills, rent, etc.
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Alligation is a useful method to determine the ratio of different ingredients to use in a compound given the concentration of the ingredients and product.
In what proportion should alcohols of 35% and 5% strengths be mixed to make 10% alcohol?
1.
Set up and solve the problem as shown below.
2.
Take the difference between each ingredient concentration and the product concentration.
This will give the relative amount of each ingredient to use in making the compound. o 35% concentration ingredient - 10% concentration product = 25 parts 5% concentration alcohol. o 10% concentration product - 5% concentration ingredient = 5 parts 35% concentration alcohol.
3.
Reduce the ratio of the answer to lowest terms. 5 : 25 = 1 : 5 parts 35% alcohol : parts 5% alcohol
14

Controlled Substances
1.
The Controlled Substances Act of 1970 restricted the prescribing and dispensing of drugs with abuse potential. This law also regulates the manufacture, transport, and storage of all scheduled drugs (controlled substances). The Drug Enforcement Administration or DEA enforces it. The DEA is an organization within the Justice Department.
2.
The Controlled Substances Act divided certain drugs into 5 schedules (I, II, III, IV, and V) according to their level of abuse potential, addiction potential (tolerance potential), and medical acceptance. Schedule I drugs have no medical acceptance and have the highest abuse and addiction potential. Drugs with higher schedule numbers have lower abuse and addiction potential.
3.
Schedule I - heroin, PCP, LSD, marijuana.
4.
Schedule II - Dexedrine (dextroamphetamine), Ritalin (methylphenidate) , Desoxyn
(methamphetamine), oxycodone (Oxycontin, Oxy IR, Roxicodone), deodorized tincture of opium (DTO), Dolophine (methadone), Duragesic (fentanyl), morphine (Astramorph injection, Duramorph injection, MS Contin Oral, MSIR Oral, Roxanol Oral), oxycodone/aspirin (Percodan, Roxiprin), oxycodone/acetaminophen (Percocet, Roxicet
5/500, Tylox), Dilaudid (hydromorphone), cocaine, codeine, alfentanil, sufentanil, amobarbital, pentobarbital injection & capsule, secobarbital, belladonna and opium, levomethadyl acetate hydrochloride, levorphanol, and meperidine.
5.
Schedule III - Tylenol with Codeine (acetaminophen with codeine), aspirin and codeine,
Lortab ASA (hydrocodone and aspirin), hydrocodone and acetaminophen (Lorcet-HD,
Lorcet Plus, Lortab, Vicodin, Vicodin HP, Vicodin ES), Vicoprofen (hydrocodone and ibuprofen), paregoric (camphorated tincture of opium), fluoxymesterone, methyltestosterone, nandrolone, oxymetholone, testolactone, testosterone (Testoderm Transdermal System,
Depo-Testosterone Injection), butabarbital sodium, butalbital compound (Fioricet), Marinol
(dronabinol), pentobarbital suppository, thiopental.
6.
Schedule IV - Xanax (alprazolam), Stadol (butorphanol), Librium (chlordiazepoxide),
Klonopin (clonazepam), Valium (diazepam), Tenuate (diethylpropion), Ativan (lorazepam),
Versed (midazolam), Cylert (pemoline), pentazosine (Talwin, Talwin NX), phentermine
(Fastin, Adipex-P, Ionamin), Darvocet (propoxyphene), Darvocet N-100 (propoxyphene and acetaminophen), Restoril (temazepam), Halcion (triazolam), Ambien (zolipidem), chloral hydrate, clorazepate, estazolam, ethchlorvynol, flurazepam, halazepam, mephobarbital, meprobamate, methohexital, oxazepam, phenobarbital, quazepam.
7.
Schedule V - suspensions and elixirs of acetaminophen/codeine with 120 mg acetaminophen and 12 mg codeine per 5 ml of solution, diphenoxylate and atropine (Lomotil, Lonox), guaifenesin and codeine (Brontex Liquid, Brontex Tablet, Guaituss AC, Guaitussin with
Codeine, Robitussin A-C, Tussi-Organidin NR), buprenorphine.
8.
Verification of a DEA number - The first letter of the DEA number should be an A or B. The second letter of the DEA number should be the first letter of the doctor's last name. The sum of the 1st, 3rd, and 5th digits plus twice the sum of the 2nd, 4th, and 6th digits should yield a
15

number that has a last digit that matches the last digit of the DEA number. Therefore, if a valid DEA number of a physician is AB1212125, then the problem would be worked in the following manner;
9.
Requirements of Controlled Substance Prescriptions - All controlled substance prescriptions must have the patient's full street address, the doctor's DEA number, and must be signed by the prescriber. No phoned or faxed CII prescriptions are allowed. In Texas, a schedule II prescription must be on a triplicate CII form and the time limit on its validity is 7 days. For example, if a prescription was written on July 4th, then it could still be filled on July 11th, but not on July 12th. However, a CII prescription may be valid for 60 days (30 in Texas) if it says the words "terminally ill" or "LTCF patient" on it. No refills of CIIs are allowed.
Requirements for CIII-V prescriptions are less strict. For example, CIII-V prescriptions are allowed 5 refills and are valid for 6 months. Phoned and faxed prescriptions from the doctor's office are allowed on CIII-V prescriptions. Furthermore, refills are allowed and prescriptions do not have to be on a triplicate on CIII-V prescriptions.
10.
Documentation Requirements for Controlled Substances - Two separate inventories of CII and CIII-V must be kept in the pharmacy. An exact count of all CII is required. An estimate of CIII-V is allowed if the container contains less than 1001 tabs and is unopened.
Otherwise, an exact count is necessary. The pharmacist has to sign the inventory. Two separate invoice records for CII and CIII-V have to be kept in the pharmacy. The actual receipt date has to be recorded. In Texas, the receiving individual's initials also have to be on the invoice. In Texas, 3 separate prescription files have to be kept for CII, CIII-V, and dangerous drugs and other noncontrolled Rx's (OTC). However, federal rules allow for CII prescription hard copies to be kept either alone or with CIII-V prescriptions. If CII's are stolen , federal law requires the pharmacy to notify the DEA and the local police department.
11.
Storage of Controlled Substances - CII must be locked up. CIII-V may be stored openly on shelves within the pharmacy. CII and other controlled substances my alternately be dispersed throughout noncontrolled stock to deter theft. However, controlled substances cannot be all kept on one shelf.
12.
Ordering - DEA order form 222C is used to order CII medications. After the receipt of CII's the date of receipt and number of items received must be recorded on DEA form 222, according to DEA regulations.
Brand and Generic Names of the Most Popular Drugs
Generic drugs with an * beside them are unavailable. Generic drugs with a ? beside them are available but not therapeutically equivalent. Generic drugs without a * nor a ? beside it are therapeutically equivalent to the brand name drug. Therapeutically equivalent generics have the same active ingredient and the same therapeutic effects. All of the following medications are stored at room temperature except for Miacalcin nasal spray (calcitonin) and Phenergan suppositories
(promethazine). Miacalcin and Phenergan should be refrigerated at 2 to 8 deg C (36 to 46 deg F).
Room temperature is defined as 15 to 30 deg C (59 to 86 deg F).
16

Generic conj. estrogens / medroxyprogesterone*
Therapeutic Category estrogen & progestin combination norgestimate / ethinyl estradiol* oral contraceptive norgestimate / ethinyl estradiol* oral contraceptive desogestrel / ethinyl estradiol* oral contraceptive norgestrel / ethinyl estradiol* oral contraceptive levonorgestrel / ethinyl estradiol* oral contraceptive ethinyl estradiol / norethindrone* oral contraceptive estradiol estrogen derivative
Brand
Prempro tabs (0.625/2.5, 0.625/5 mg)
Ortho-Cyclen tabs
Ortho Tri-Cyclen tabs
Desogen tabs
Lo/Ovral tabs
Alesse tabs
Necon tabs estradiol conjugated estrogens* estrogen derivative estrogen derivative
Estrace tabs (0.5, 1, 2 mg)
Climara transdermal system (0.05,
0.1 mg/24h)
Premarin tabs (0.3, 0.625, 0.9, 1.25,
2.5 mg), vaginal cream, inj (25 mg) medroxyprogesterone levothyroxine? levothyroxine? levothyroxine? progestin thyroid product thyroid product thyroid product
Cycrin tabs (2.5, 5, 10 mg)
Synthroid tabs (25, 50, 75, 88, 100,
112, 125, 150, 175, 200, 300 mcg), pulv for inj 200, 500 mcg/vial
Levoxyl tabs (25, 50, 75, 88, 100,
112, 125, 150, 175, 200, 300 mcg)
Levothroid tabs (25, 50, 75, 88,
100, 112, 125, 150, 175, 200, 300 mcg), pulv for inj 200, 500 mcg/vial
Lipitor tabs (10, 20, 40 mg)
Zocor tabs (5, 10, 20, 40 mg) atorvastatin* simvastatin* pravastatin* gemfibrozil lovastatin* antilipemic agent antilipemic agent antilipemic agent antilipemic agent
Pravachol (10, 20, 40 mg)
Lopid tab 600 mg
Mevacor tabs (10, 20, 40 mg) omeprazole* antilipemic agent gastric acid secretion inhibitor
Prilosec caps (10, 20 mg) lansoprazole* famotidine* gastric acid secretion inhibitor antihistamine, H 2 blocker
(H 2 blockers usually prescribed to control stomach acid, not for allergies)
Prevacid caps (15, 30 mg)
Pepcid tabs (10, 20, 40 mg), po pulv susp (40mg/5ml), inj 10 mg/ml, pre-mix inj 20mg/50ml NS ranitidine tabs, effervescent tabs?, antihistamine, H 2 blocker Zantac tabs (150, 300 mg),
17

caps (150, 300 mg), syr?, granules? effervescent tabs 150 mg, caps (300 mg), syr 15 mg/ml, granules 150 mg, inj (1, 25 mg/ml) cimetidine caps, inj (90?, 120?,
180?, 240?, 360?, 480? mg/100mL, antihistamine, H 2 blocker
300 mg/2mL, 6 mg/mL), p.o. sol nizatidine*
Tagamet caps (200, 300, 400, 800 mg), inj (300 mg/2mL, 6 mg/mL), p.o. sol (300 mg/5mL) antihistamine, H 2 blocker Axid caps (150, 300 mg) hydrocodone / apap tabs (5/500 mg) propxyphene / apap tabs narcotic analgesic (& apap) narcotic analgesic (& apap)
Vicodin
Darvocet N-100 acetaminophen / codeine tabs
(15/300, 30/300, 60/300 mg codeine/apap), elix (120+12/5 mg apap+codeine/ml) narcotic analgesic (& apap) oxycodone / apap tabs (5/325 mg), caps (5/500 mg), sol (5+325/5 mg/ml)* narcotic analgesic (& apap) oxycodone* narcotic analgesic ibuprofen tabs 100 mg*, tabs (200,
300, 400, 600, 800 mg), chew tabs*, po susp, po gtts* tramadol* oxaprozin* naproxen tabs (200 mg*), (250,
375, 500 mg), po susp 125/5, delayed-release tabs (375*,500* mg), controlled-release tabs (375*,
500* mg) diclofenac / misoprostol* celecoxib* rofecoxib* albuterol tabs (2, 4 mg), extendedrelease tabs (4 mg*), syr (2/5 mg/ml), inh sol (0.083, 0.5 %) ipratropium
NSAID (non-steroidal anti-inflammatory drug) misc. analgesic
NSAID
NSAID
NSAID & prostaglandin
Tylenol with Codeine tabs (No 2, 3,
4), elix
Roxicet tabs and sol
Oxycontin tabs (20, 40 mg)
Motrin tabs (100, 200, 300, 400,
600, 800 mg), chew tabs (50, 100 mg), po susp (100/5 mg/ml), po gtts (40 mg/ml)
Ultram tabs (50 mg)
Daypro caplets (600 mg)
Aleve tabs (200 mg), Naprosyn tabs (250, 375, 500 mg), po susp
125/5, Anaprox tabs (250 mg),
Anaprox DS tabs (500 mg), EC-
Naprosyn delayed-release tabs
(375, 500 mg), Naprelan, controlled-release tabs (375, 500 mg)
Arthrotec tabs (50/200, 75/200 mg/mcg)
NSAID (cox-2 selective) Celebrex caps (100, 200 mg)
NSAID (cox-2 selective)
Vioxx tabs (12.5, 25 mg), po susp
(12.5/5, 25/5 mg/ml) beta 2 -adrenergic agonist, bronchodilator anticholinergic,
Proventil tabs (2, 4 mg), extendedrelease tabs (4 mg*), syr (2/5 mg/ml), aerosol, inh sol (0.083,0.5
%)
Atrovent inhalation aerosol, nasal
18

ipratropium / albuterol* calcitonin salmon* fluticasone* beclomethasone* triamcinolone aerosol* mometasone* diltiazem amlodipine* nifedipine? verapamil SR felodipine* diltiazem lisinopril* ramipril* lisinopril* quinapril* benazepril* enalapril* atenolol tabs, inj* metoprolol succinate* bronchodilator anticholinergic & beta 2adrenergic agonist bronchodilator hypercalcemia antidote
(usually prescribed for osteoporosis) inhaled corticosteroid inhaled corticosteroid spray, nebulizing sol
Combivent inhalation aerosol
Miacalcin nasal spray inhaled corticosteroid inhaled corticosteroid calcium channel blocker, antihypertensivee calcium channel blocker, antihypertensive calcium channel blocker, antihypertensive
Flonase nasal spray
Vancenase AQ DS nasal spray
Azmacort inhalation aerosol
Nasonex nasal spray
Cardizem CD sustained-release caps (120, 180, 240, 300 mg)
Norvasc tabs (2.5, 5, 10 mg)
Procardia XL sustained-release tabs
(30, 60, 90 mg) calcium channel blocker, antihypertensive calcium channel blocker, antihypertensive
Calan SR tabs (180, 240 mg)
Plendil extended release tabs (2.5,
5, 10 mg) calcium channel blocker, antihypertensive
Tiazac extended release caps (120,
180, 240, 300, 360 mg)
ACE (angiotensin converting enzyme) inhibitor, antihypertensive
Zestril tabs (2.5, 5, 10, 20, 40 mg)
ACE inhibitor, antihypertensive
ACE inhibitor, antihypertensive
ACE inhibitor, antihypertensive
ACE inhibitor, antihypertensive
Altace caps (1.25, 2.5, 5, 10 mg)
Prinivil tabs (2.5, 5, 10, 20, 40 mg)
Accupril tabs (5, 10, 20, 40 mg)
Lotensin tabs (5, 10, 20, 40 mg)
ACE inhibitor, antihypertensive beta-adrenergic blocker, antihypertensive beta-adrenergic blocker, antihypertensive
Vasotec tabs (2.5, 5, 10, 20 mg), inj
(1.25 mg/ml)
Tenormin tabs (25, 50, 100 mg), inj
5 mg/10ml
Toprol XL extended release tabs
(50, 100, 200 mg)
19

metoprolol tartrate
Beta-adrendergic blocker, antihypertensive
Lopressor propranolol LA, propranolol beta-adrenergic blocker, antihypertensive
Inderal LA sustained release caps
(60, 80, 120, 160 mg), Inderal tabs
(10, 20, 40, 60, 80 mg) valsartan* irbesartan* angiotensin II receptor antagonist, antihypertensive angiotensin II receptor antagonist, antihypertensive
Diovan caps (80, 160 mg)
Avapro tabs (75, 150 300 mg) digoxin tabs(0.124, 0.25, 0.5 mg), elix 0.05 mg/ml, inj 0.25 m/ml, ped cardiac glycoside, inj 0.1 mg/ml* triamterene / HCTZ doxazosin* furosemide losartan / HCTZ* antiarrhythmic potassium sparing & thiazide diuretic, antihypertensive
Lanoxin tabs (0.125, 0.25, 0.5 mg), elix 0.05 mg/ml, inj 0.25 mg/ml, ped inj 0.1 mg/ml
Dyazide caps (37.5/25 mg),
Maxzide tabs (37.5/25, 75/50 mg) alpha-adrenergic blocking agent, antihypertensive
Cardura tabs (1, 2, 4, 8 mg) loop diuretic, antihypertensive angiotensin II receptor antagonist & thiazide diuretic, antihypertensive
Lasix tabs (20, 40, 80 mg), po sol
(10 mg/ml), inj (10 mg/ml)
Hyzaar tabs (50/12.5, 100/25 mg) lisinopril / HCTZ isosorbide mononitrate S.A. nitroglycerin clonidine oral, clonidine tts* amlodipine / benazepril* hydrochlorothiazide (HCTZ) loratadine* loratadine* cetirizine*
ACE inhibitor & thiazide diuretic, antihypertensive
Zestoretic tabs (10/12.5, 20/12.5,
20/25 mg) nitrate, antianginal agent nitrate, antianginal
Imdur extended-release tabs (30,
60, 120 mg)
Nitrostat subl tabs (0.15, 0.3, 0.4,
0.6 mg) alpha 2 -adrenergic agonist, antihypertensive
Catapres Oral tabs (0.1, 0.2, 0.3 mg), Catapres TTS 1, 2, & 3 (0.1,
0.2, 0.3 mg/d) calcium channel blocker &
ACE inhibitor, Lotrel antihypertensive thiazide diuretic, antihypertensive
Microzide, Hydrodiuril non-sedating antihistamine Claritin tabs 10 mg, syr 1mg/ml non-sedating antihistamine Claritin Redi-Tabs subl tabs 10 mg non-sedating antihistamine
Zyrtec tabs (5, 10 mg), syr (5/5 mg/ml)
20

fexofenadine* fexofenadine / pseudoephedrine* amoxicillin chewtabs*, caps, po susp, pulv for po susp penicillin VK amoxicillin / clavulanate* non-sedating anithistamine
Allegra caps 60 mg, tabs (30, 60,
180 mg) non-sedating antihistamine Allegra-D extended-release tabs
& decongestant (60, 120 mg) penicillin antibiotic penicillin antibiotic
Trimox or Amoxil caps (250, 500 mg), po susp 125 mg/5ml, pulv for po susp 250/5 mg/ml, Amoxil chewtabs (125, 250 mg), ped gtts
50 mg/ml
Penicillin VK tabs (250, 500 mg), pulf for po sol 250/5 mg/ml penicillin antibiotic & beta-lactamase inhibitor
Augmentin tabs (250/125, 500/125,
875/125 mg), chewtabs
(125/131.25, 200/28.5, 250/62.5,
400/57 mg), pulv for po susp
(125+31.5/5, 200+28.5/5,
250+62.5/5, 400+57/5 mg/ml) ciprofloxacin* cephalexin trimethoprim / sulfamethoxazole nitrofurantoin mupirocin* neomycin / polymx / HC tobramycin / dexamethasone susp, oint* azithromycin* quinolone antibiotic cephalosporin antibiotic
Cipro tabs (100, 250, 500, 750 mg), susp (250/5, 500/5 mg/ml), opth sol
(3.5 mg/ml), inj (200, 400 mg), infusion (400, 200 mg)
Keflex caps (250, 500 mg), po susp
(125/5, 250/5 mg/ml), miscellaneous antibiotic & sulfonamide antibiotic
Bactrim tabs 80/400 mg, Bactrim
DS tabs160/800 mg, Bactrim pediatric po susp (40+200/5 mg/ml), Bactrim IV inj (80+400/5 mg/ml) miscellaneous antibiotic Macrobid caps 100 mg topical antibiotic antibiotics & corticosteroid antibiotic & corticosteroid, opthalmic macrolide antibiotic
Bactroban ung (15, 30 g),
Bactroban nasal ung 1 g neomycin / polymx / HC cream, otic sol, opthalmic susp, otic susp
Tobradex susp, oint azithromycin* clarithromycin macrolide antibiotic macrolide antibiotic
Z-pack
Zithromax pulv for inj 500mg, pulv for po susp (100/5, 200/5 mg/ml &
1 g), tabs (250, 600 mg)
Biaxin tabs (250, 500 mg), filmcoated extended release tabs (500
21

erythromycin sertraline* macrolide antibiotic antidepressant amitriptyline tabs, inj* fluoxetine citalopram* paroxetine* tricyclic antidepressant serotonin reuptake inhibitor, antidepressant serotonin reuptake inhibitor, antidepressant serotonin reuptake inhibitor, antidepressant venlafaxine* nefazodone* trazodone miscellaneous antidepressant miscellaneous antidepressant miscellaneous antidepressant oral hypoglycemic metformin* troglitazone* thiazolidinedione derivative, oral hypoglycemic glipizide XL extended-release tabs
(5, 10 mg)*, glipizide tabs (5, 10 mg) sulfonylurea, oral hypoglycemic glimepiride* glyburide sulfonylurea, oral hypoglycemic sulfonylurea, oral hypoglycemic warfarin clopidogrel* anticoagulant antiplatelet potassium chloride potassium chloride oral potassium oral potassium mg), granules for po susp (125/5,
250/5 mg/ml)
Ery-Tab tabs (250, 333, 500 mg)
Zoloft tabs (25, 50, 100 mg), po conc (20 mg/ml)
Elavil tabs (10, 25, 50, 75, 100, 150 mg), inj 10 mg/ml
Prozac caps (10, 20, 40 mg), tabs
10 mg, liq 20/5 mg/ml
Celexa liq 10/5 mg/ml, tab (20, 40,
60 mg)
Paxil po susp (10/5 mg/ml), tabs
(10, 20, 30, 40 mg), controlledrelease tabs (12.5, 25 mg)
Effexor XR extended-release caps
(37.5, 75, 150 mg)
Serzone tabs (50, 100, 150, 200,
250 mg)
Desyrel tabs (50, 100, 150, 300 mg)
Glucophage tabs (500, 625, 750,
850, 1000 mg)
Rezulin (withdrawn from market
3/21/2000)
Glucotrol XL extended-release tabs
(5, 10 mg), Glucotrol tabs (5, 10 mg)
Amaryl tabs (1, 2, 4 mg)
Diabeta & Micronase tabs (1.25,
2.5, 5 mg)
Coumadin tabs (1, 2, 2.5, 3, 4, 5, 6,
7.5, 10 mg) pulv for inj 2 mg
Plavix tabs 75 mg
K-Dur 10 mEq controlled-release tabs(750 mg), K-Dur 20 mEq (1500 mg)
Klor-Con 8 controlled-release tabs
(600 mg), Klor-Con 10 controlledrelease tabs (750 mg), Klor-Con pulv 20 mEq/pkt
22

prednisone corticosteroid
Deltasone tabs (2.5, 5, 10, 20, 50 mg) methylprednisolone tabs 2 mg*, (4,
8, 16, 24, 32 mg) corticosteroid zolipidem* alprazolam diazepam
Medrol tabs (2, 4, 8, 16, 24, 32 mg) hypnotic benzodiazepine, antianxiety
Ambien tabs (5, 10 mg)
Xanax tabs (0.25, 5, 1, 2 mg) benzodizepine, antianxiety Valium tabs (2, 5, 10 mg), inj 5 mg temazepam 7.5*, 15, 30mg lorazepam inj (2, 4 mg/ml*), tabs
(0.5, 1, 2 mg) alendronate* raloxifene* sidenafil citrate* divalproex* benzodiazepine, antianxiety benzodiazepine, antianxiety
Restoril 7.5, 15, 30mg
Ativan tabs (0.5, 1, 2 mg), inj (2, 4 mg/ml) biphosphate derivative, for osteoporosis
Fosamax tabs (5, 10, 40 mg) selective estrogen receptor modulator (SERM), for osteoporosis
Evista tabs (60 mg) phosphodiesterase (type 5) enzyme inhibitor, for erectile dysfunction (ED)
Viagra tabs (50, 100 mg) anticonvulsant
Depakote delayed-release tabs
(125, 250, 500 mg) Depakote
Sprinkle caps (125 mg) anticonvulsant Dilantin 30, 50, 100mg phenytoin 30*, 50*, 100 clotrimazole / betamethasone lotion*, cream antifungal & corticosteroid Lotrisone lotion terbinafine* promethazine 12.5*, 25?, 50? cyclobenzaprine carisoprodol olanzapine* montelukast* amphetamine mixed salts* tolterodine* tamoxifen* antifungal
Lamisil 1% cream, 1% gel, tabs
250 mg
H 1 blocker, antihistamine
(usually prescribed as an antiemetic)
Phenergan Suppository 12.5, 25,
50mg skeletal muscle relaxant Flexeril 10 mg tabs skeletal muscle relaxant Soma 350 mg tabs antipsychotic agent
Zyprexa tabs (2.5, 5, 7.5, 10, 15 mg) leukotriene receptor antagonist, for asthma amphetamine
Singulair tabs 10 mg, chewtabs (4,
5 mg)
Adderall tabs (10, 20 mg) anticholinergic estrogen receptor
Detrol tabs (1, 2 mg)
Nolvadex tabs (10, 20 mg)
23

antagonist, for breast cancer donepezil* brimonidine* folic acid cholinergic water soluble vitamin
Aricept tabs (5, 10 mg) alpha 2 -adrenergic agonist, opthlamic
Alphagan opthalmic sol
Folic Acid tabs (0.1, 0.4, 0.8, 1 mg), inj (5, 10 mg/ml) tamulosin* alpha-adrenergic blocker, for benign prostate hyperplasia (BPH) guaifenesin / phenylpropanolamine expectorant & decongestant allopurinol
NDC Number uricosuric, for gout
Flomax caps 0.4 mg
Contuss-XT syr
Zyloprim tabs (100, 300 mg)
 This is a number assigned all drugs by the manufacturer. The first 5 digits indicate the manufacturer. The next 4 digits indicate the drug's name, strength, and dosage form. The last
2 digits indicate the package size.
Prescription Drug Label
 All prescription drug labels have to have the name and address of the pharmacy, name of physician, name of patient, date filled, prescription number, directions for use, and cautionary statements.
Recalls
 Recalls are mostly voluntary on the part of the manufacturer. There are 3 classes of recalls;
1 . Strong probability of causing serious adverse effects or death, 2 . Temporary but reversible adverse effects or low probability of serious adverse effects. 3 . Unlikely to cause adverse effects. Manufacturers notify pharmacies of recalls in writing with the drug name and lot number.
Manufacturer Labelling


The manufacturer stock label should contain the following elements; brand name, generic name, active ingredient & strength, type of dispensing container required, storage requirements, lot number, expiration date, "warning: may be habit forming" (if applicable),
"caution: federal law prohibits dispensing without prescription" (legend statement), package quantity, CII-CIV (controlled substance mark, if applicable), dosage form (tablet, injection, cream, etc), manufacturer's name and address.
In addition to the manufacturer's stock container labelling, prescription drugs should also have additional labelling or a package insert. This should include information on
24

pharmacology, indications, contraindications, warnings, precautions, adverse reactions, potential for drug abuse and dependence, dosage, and packaging.
Cardiology - study of the heart.
1.
anti arrhythmic - drug used to treat an abnormal cardiac rhythm (Greek; anti - against, rhythmos - rhythym)
2.
anti anginal - dilates coronary arteries to oxygenate the myocardium, thereby relieving symptoms of angina pectoris
3.
arter io sclerosis - hardening of the arteries
4.
brady cardia - slow heart condition.
5.
card io my o pathy - disease of the heart muscle
6.
diastolic - blood pressure when heart is relaxed. Blood pressure is expressed as sytolic/diastolic
7.
hyper tension - high blood pressure
8.
hypo tension - low blood pressure
9.
phleb itis - inflamed vein
10.
systolic - blood pressure when heart is contracted
11.
tachy cardia - fast heart condition
Dermatology - study of the skin.
1.
derma titis - skin inflammation
25

2.
erythro derma - red skin
3.
lac tation - secreting milk
4.
mast ectomy - breast removal
5.
sub cutane ous - pertaining to under the skin
6.
trans derm al - pertaining to through the skin
Endocrinology - study of the endocrine system. the endocrine system secretes substances into the blood or lymph that affects another part of the body.
1.
anti lip emic agent - drug used to treat high cholesterol (Greek; anti - against, lipos - fat, haima - blood)
2.
diabetes mellitis - a condition of hyperglycemia that is either classified as type I or type II
3.
end o crine - pertaining to glands that secrete into the body
4.
hyper glyc emia - high blood sugar
5.
hyper lipid emia - high blood lipids
6.
hyper thyroid ism - high thyroid condition
7.
hypo glyc emia - low blood sugar
8.
hypo thyroid ism - low thyroid condition
9.
somat ic - pertaining to the body
10.
thyroid - gland in the neck that produces thyroxin and other thyroid hormones. removal of this gland causes hypothyroidism, a disease characterized by low metabolism.
11.
type I diabetes - insulin dependent diabetes mellitis (IDDM). needs insulin. usually juvenile onset.
12.
type II diabetes - non-insulin dependent diabetes mellitis (NIDDM). usually no need for insulin. usually maturity onset.
Gastroenterology - study of the gastrointestinal (GI) tract. the GI tract includes; bile duct, gall bladder, small intesting, large intesting, and stomach.
1.
an orexia - no appetite
2.
anti emetic - drug that treats nausea and vomiting (Greek; anti - against, emesis - vomiting)
3.
a phagia - not able to swallow
4.
col itis - inflammation of the colon
5.
dia rrhea - liquid discharge of bowel movement
6.
duoden al - pertaining to the duodenum
7.
peptic ulcer - a loss of the mucous membrane in any part of the digestive system that is exposed to gastric juices containing acid and pepsin. this causes circular lesions that are usually located in the stomach or duodenum.
8.
gastr o enter itis - stomach & intestinal inflammation , usually causing discomfort in the abdominal area
9.
gastr itis - stomach inflammation
10.
hemat emesis - vomiting blood
11.
hepat itis - liver inflammation
12.
hepat oma - liver tumor
13.
hyper acidity - too much acid . this term is often used to describe a condition where the stomach produces an excess of acid. hyper acidity may be a cause or contributing cause of peptic ulcers.
Gynecology - study of feminine health, including the female reproductive system.
26

1.
a men orrhea - no menstrual discharges
2.
dys men orrhea - difficult or painful menstrual discharges
3.
end o metri o sis - an abnormal growth in the uterus
4.
estrogen - female reproductive hormones
5.
gynec ology - study of women 's reproductive organs
6.
mast itis - breast inflammation
7.
progesterone - female reproductive hormone
8.
vagin itis - vaginal inflammation
Immunology - study of how the immune sytem reacts to antigens.
1.
aden o pathy - disease where lymphatic gland is enlarged
2.
AIDS - acquired immunodeficiency syndrome. when HIV is no longer dormant and the patient experiences a severe shortage of T-lymphocytes.
3.
hemat oma - a lump or tumor of clotted blood resultant of internal bleeding
4.
hemo philia - a hereditary bleeding disorder where the blood doesn't clot due to a missing clotting factor
5.
HIV - human immunodeficiency virus. deadly viral sexually transmitted disease that causes a severe decrease in immune function mainly caused by the decrease in T-lyphocytes, a type of white blood cell
6.
leuk emia - a malignant abnormal growth of new tissue of blood forming tissues that causes a diseased proliferation of immature white blood cells or leukocyte precursors
7.
lymph oma - lymph tissue tumor
8.
thym oma - thymus tumor
Neurology - study of the nervous system.
1.
anti convulsant - drug that reduces epileptic and other convulsive seizures (Greek: anti - against, Latin: convellere - to shake)
2.
encephal itis - brain inflammation
3.
mening itis - infection or inflammation of the membranes covering the brain and spinal cord.
4.
neur algia - nerve pain
5.
neur oma - nerve tumor
Ophthalmology - study of the eye.
1.
ambly opia - a decrease or dulling in vision
2.
blephar itis - eyelid inflammation
3.
blephar optosis - upper eyelid dropping
4.
conjunct ivitis - conjunctiva inflammation
5.
cornea - transparent outer part of the eye
6.
glaucoma - elevated pressure within the eye due to obstruction of the outflow of aqueous humor
7.
retina - consists of the optic nerve, rods, and cones. rods and cones actually detect light and colors, respectively. optic nerve sends visual signals to the brain.
8.
retino pathy - a disease of the retina caused by non-inflammatory changes in the blood vessels of the retina . the most common cause retinopathy leading to blindness is diabetes. diabetics should have regular eye exams.
27

Osteology - study of bone.
1.
arthr algia - joint pain
2.
arthr itis - joint inflammation . there's osteoarthritis and rheumatoid arthritis.
3.
carp al tunnel syndrome - extreme hand and wrist pain caused by compression of the median nerve between the carpal ligament and other structures within the carpal tunnel
4.
osteo arthr itis - degenerative joint disease
5.
oste o carcin oma - cancerous bone tumor
6.
osteo por osis - condition of porous bones . this often happens to post-menopausal women and patients on long-term steroid therapy. this can often lead to lower back pain and a deformed posture.
7.
rheumatoid arthr itis - autoimmune disorder where the joints progressively degenerate
Otology - study of ears.
 ot itis - ear inflammation , usually caused by an infection
Pulmonology - study of lungs.
1.
a pnea - no breathing
2.
bronch itis - bronchial inflammation
3.
broncho dilator - drugs that widen the airways of the lungs (Greek: bronchos , Latin: dilatare )
4.
cyan o sis - blue skin condition caused by shortage of oxygen
5.
dys pnea - difficult breathing , shortness of breath
6.
hyp ox ia - condition of low oxygen
7.
laryng itis - larynx inflammation
8.
para nasal - around the nose
9.
pector algia - chest pain
10.
pneum o nia - a condition of acute inflammation of the lungs , usually caused by pneumococci bacteria
11.
pulmon ary - pertaining to the lungs
12.
sinus itis - inflammation of the sinuses
Mens' Health
1.
a sperm ia - medical condition where the man produces no sperm
2.
erectile dysfunction (male) - penis has a difficult or impossible time attaining or maintaining an erection. also known as ED.
3.
prostat itis - prostate inflammation that may cause urine to be obstructed in a man
Sports Medicine
1.
fibr o my algia - chronic muscle fiber pain
2.
my o plasty - muscle repair
3.
sprain - pain, swelling, and discoloration of a joint caused by injury to the tendons, muscles, or ligaments around a joint
4.
strain - excessive physical effort causing a muscular injury
5.
tendin itis - tendon inflammation
28

Urology - study of the urinary tract in both sexes and study of the male genital tract.
1.
anticholinergic - blocks acetylcholine receptors to relax smooth muscles in the bladder, bronchi, and intestine. some anticholinergic drugs are used to treat an overactive bladder. may cause dry mouth, urinary retention, and blurry vision (relaxes the iris sphincter).
2.
an uria - no urine
3.
cyst itis - bladder inflammation
4.
nephr itis - kidney inflammation
5.
poly uria - a lot of urine
6.
ur emia - toxic blood caused by kidney failure
Abbreviations aa. - of each a.c. - before meals ad - up to a.d. - right ear ad lib. - at pleasure, freely
AIDS - acquired immunodeficiency syndrome a.m. - morning
AMI - acute myocardial infarction amp. - ampul
ANS - autonomic nervous system aq. - water a.s. - left ear
ASA - aspirin
ATC - around the clock a.u. - each ear b.i.d. - two times a day
BM - bowel movement
BP - blood pressure
BS - blood sugar
BSA - body surface area c. - with
CA - cancer cap. - capsule cc. or cc - cubic centimeter
CHF - congestive heart failure comp. - compound
COPD - chronic obstructive pulmonary disease
CV - cardiovascular
CVA - cerebrovascular accident (stroke)
DI - diabetes insipidus dil. dilute ml. - milliliter mOsm or mOsmol - milliosmoles
MS morphine sulfate noct. - night non rep. or N.R. - do not repeat
NPO - nothing by mouth
N.S. or NS - normal saline = 0.9% NaCl
½ NS - ½ strength NS = 0.45% NaCl
NTG - nitroglycerin
O. - pint o.d. - right eye oint. - ointment o.l. - left eye o.s. - left eye o.u. - each eye o 2 - both eyes p.c. - after meals p.m. - afternoon; evening p.o. - by mouth p.r.n. - when required
PUD - peptic ulcer disease pulv. - powder q.d. - every day q.h. - every hour q.i.d. - four times a day q.o.d. - every other day q.s. - a sufficient quantity q.s. ad - a sufficient quantity q wk - every week
R, rect - rectal
RBC - red blood cell
29

disc or D.C. - discontinue disp. - dispense div. divide
DOB - date of birth
DW - distilled water
DX - diagnosis
D5W - dextrose 5% in water
ECG or EKG - electrocardiogram elix. - elixir e.m.p. - as directed et - and ex aq. - in water ext - extract fl or fld - fluid ft. - make g. or Gm. or g - gram
GERD - gastroesophageal reflux disease
GI - gastrointestinal gr. or gr - grain gtt. - drop
H - hypodermic h. or hr. - hour
HA - headache
HBP - high blood pressure
HC - hydrocortisone
HDL - high density lipoprotein
HI - infectious hepatitis
HIV - human immunodeficiency virus h.s. - at bedtime
HT - hypertension
IC - intracardiac
ID - intradermal
IH - infectious hepatitis
IM intramuscular inj. -injection
IO, I/O - fluid intake and output
IT - intrathecal
IV - intravenous
IVP - intravenous push
IVPB - intravenous piggy back
M² or M² - square meter mcg - microgram mEq - milliequivalent mg. or mg - milligram
MI - myocardial infarction
R.L. or R/L - Ringer's Lactate s. - without
Sig. - write on label
SL - sublingual
SOB - shortness of breath sol. - solution s.o.s. - if there is need ss. - one-half stat. - immediately subc or subq or s.c. - subcutaneously sup. - suppository susp. - suspension syr. - syrup
T - temperature tab. - tablet tal. - such tal. dos. - such doses
TB - tuberculosis tbsp. - tablespoonful t.i.d. - three times a day tinct - tincture t.i.w. - three times a week top - topically
TPN - total parenteral nutrition tr. - tincture tsp. - teaspoonful
U or u - unit u.d. - as directed ung. - ointment
URI - upper respiratory infection
USP - United States Pharmacopeia
UTI - urinary tract infection
VD - venereal disease
WBC - white blood cell count or white blood cell
WT - weight
XX - female sex chromosome
XY - male sex chromosome
Key Terms and Concepts
30

1.
prescription - an order for the preparation and administration of medication or a medical treatment. Authorized prescribers are MD, DDS, DVM, or DO. In Texas, RN and PA may also prescribe. In other states, RPh may prescribe,depending on state law. Prescriptions may be phoned in, faxed, or written. In some states, prescriptions may even be sent by computer.
Prescriptions are usually outpatient orders. Prescriptions and medication orders are always written in black ink, never pencil.
2.
medication order - just like prescriptions, except it is for an institiutional setting
3.
brand name - trade or proprietary drug names protected by trademark
4.
generic name - chemical or nonproprietary drug names not protected by trademark
5.
compound Rx - a prescription that must be prepared according to the directions and ingredients outlined on the prescription.
Components of a Prescription
A. Dr. A. B. Normal
229 El Camino Dr
Beverly Hills, CA 90210
Ph: 210-552-0136
D. DEA# AN1218088
E. Date: 7/4/2000
B. Name: Eddie Manimal
Address: 18 Scream St, Bevery Hills, CA 90210
Rx
C. Amoxicillin 500mg #30
F. Sig: ipotid
G. Refill: 0
_______________________ _ A.B. Normal _ I.
_____
H. Product Selection Permitted H. Dispense as Written
Use separate form for each controlled substance prescription.
Theft, unauthorized possession and/or use of this form including alterations or forgery, are crimes punishable by law.




 A. Prescriber information - name, title, address, and telephone number
 B. Name and address of patient - other information such as birthday or weight is optional but sometimes important
 C. Inscription - name, strength, and quantity. Strength may be omitted if there is only one strength commercially available or if the prescription is for a medical device. The quantity may be omitted if it can be implied from the sig.
 D. DEA registration number of prescriber - mandatory on all controlled substance prescriptions
E. Date the prescription was written
F. Sig - instructions on how to use the medication to be printed on the Rx label
G. Refills authorized

H. Brand or Generic Designation - A doctor's signature on top of "Dispense as written" means to only give the brand name medication. However, a signature on top of "Product selection permitted" means that it is O.K. to dispense either the brand or generic medication as indicated by the patient's preference.
I. Signature of Prescriber - not necessary on oral prescriptions
Medication Orders
31

 medication orders are instructions to the nursing staff for medical care that may include drug therapy. They are the same as prescriptions exept for the following points;
1.
Patient Information - medication orders typically include the patient's birthday, room
#, I.D. #, indication for medication use, and allergies
2.
Date and time the medication order was written. Actual administration times are noted and signed by nurses.
3.
If it is an oral medication order , then the name or initial of the recipient (RN or RPh) should be on the medication order.
4.
Orders may be revised to reflect therapy changes.
5.
Instructions for administering the medication should include route of administration, dosage and dosing schedule, duration of therapy, and any other information that a caregiver would need to administer the medication.
Community Pharmacy Prescription Labels
The above prescription should result in the prescription label below;
A. Bob's Guns & Drugs 972-123-4208
18 Danger St
Bobstown, TX 75287 B.
RPh: TK
C. Rx #888 D. Date filled: 7/4/2000
E. Eddie Manimal
18 Scream St
Bevery Hills, CA 90210
F. Take 1 capsule by mouth three times a day.
G. 30 Amoxicillin 500mg capsules PFIZER
I. Dr. A. B. Normal
J. Refill 2 times by 7/24/02
H. Caution: State and federal law prohibits transfer of this drug to any person other than patient for whom prescribed.


 A. Name, address, and phone number of the pharmacy
 B.
Pharmacist’s initials
 C.
Prescription and/or transaction number


D.
Date the prescription was filled
 E.
Patient's name and address
F.
Sig or instructions on how to use the medication
 G.
The quantity, drug name, strength, dosage form, and manufacturer of the medication
H.
I.
Legally mandated statement for all prescriptions
Doctor's name
 J.
Number of refills remaining and the last date that you can get the refills.
Institutional Pharmacy Prescription Labels
1.
Unit dose medications should have the following information on the labelling; drug name & strength, lot number, expiration date, directions for administration (if needed), and auxiliary labels (if needed). This is often already put on the packaging by the manufacturer.
2.
Multi-dose medications should have the same information as unit dose medications plus the following information; patient's name & room number, drug quantity, and directions for administration.
3.
Sterile products have the same labelling requirements as multi-dose medications.
32

Auxiliary Labels
Auxiliary labels provide additional information on the prescription bottle. CII-V prescriptions must state on the bottle, "Caution: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed." This is often added on the bottle as an auxilliary label. Also, if generics are dispensed, the bottle has to say that the generic was substituted for the brand prescribed. This statement is also often added on the bottle as an auxiliary label. Other auxiliary labels include; "Take with food", "May cause drowsiness", "Do not drink alcohol", and "Do not take with aspirin", etc.
Receiving Prescriptions
 Prescriptions or medication orders are received by written means or by fax. In an institutional setting, medication orders may also be transmitted via an in-house computer system or a pneumatic tube system. Verbal prescriptions, medication orders, and changes to them may only be received by a pharmacist or supervised intern. In an institutional setting, a nurse can also receive a medication order.
Receiving Prescription Refill and Transfer Requests


Accepting Refill Requests - The technician should try to acquire the following information from the person requesting the refill. At the very least, try to get items 1 to 3. That way, if the patient gives you an invalid prescription number, you can still look up the proper prescription number in the computer. Also, if there are any other problems, you can contact the patient.
1.
Patient name, birthday and phone number
2.
Prescription number
3.
Drug nume, strength, and quantity
4.
Prescriber information
5.
Reimbursement mechanisms/third-party-payer information
Contacting Prescribers For Medication Order/Prescription Clarifications or Refills - The following information should be given to the prescriber or representative thereof when requesting authorization for prescriptions & medication orders that have expired.
1.
Pharmacy's name, phone number, and fax number
2.
Patient's name, birthday
3.
Drug name, strengh, quantity
4.
Last fill date
5.
Sig or instructions for medication administration
6.
Statement that this is a refill authorization request or the question regarding the prescription if it is a clarification
Assessing Prescriptions & Medication Orders
1.
Clarity - Make sure that the prescription or medication order is clearly written and complete.
2.
Authenticity - Make sure that the prescription is not a forgery.
3.
Legality - Be certain that everything is in compliance with the law.
4.
Reimbursement Eligibility - Check to see if the drug is covered by the insurance plan. Is the patient covered by the presented insurance plan? Is the patient's insurance plan honored by your pharmacy?
Work Flow
33

1.
In community pharmacies, the technician usually receives the patient's prescription, collects all pertinent patient information (everything outlined in "components of a prescription", patient's phone number, sex, allergies, other drugs the paient is taking, birthday, insurance information, and whether or not they want child safety caps), and types the prescription in the computer. Check with the patient if generics are O.K. Check to see if a CII is in stock before typing it in the computer. Consult with a pharmacist if any judgement or counseling is needed. This includes the recommendation of OTC medicines. Although OTC prescriptions do not have to be typed in the computer (except for insurance purposes), the pharmacist should still counsel the patient. Alert the pharmacist if there are any potential forgeries. Alert the pharmacist if the prescription is more than a week old. In Texas, CII Rx's are valid for 7 days counting from the day after the prescription was written. CIII-V are valid for 6 months for 5 refills. However, special conditions may apply, so consult with your pharmacist .
2.
The computer then processes the prescription and simultaneously bills the insurance company online. Then, the computer prints a prescription label. Alert the pharmacist if there is a possible drug interaction pointed out by the computer.
3.
The prescription may then be prepared by a technician . Some computer systems may print out the proper auxilliary labels automatically. At the pharmacist's discretion, a technician may label the bottle. FDA regulations require patient package inserts (PPI) to be provided to all patients of the following medications; oral contraceptives, estrogenic drugs, progesteronal drugs, isotretinoin, intrauterine devices (IUD), and isoproterenol inhalation drugs. PPI are often provided by the manufacturer of the drug. Also, the computer may print out patient drug information on all new prescriptions.
4.
The pharmacist checks the prescription.
5.
The technician hands the patient his/her medication, rings up the sale, and has the patient sign the insurance log.
6.
The pharmacist then counsels the patient. All patients receiving new prescriptions have to be counselled.
34

Routes
Route buccal
Definition oral administration of drug, usually a tablet, to be dissolved between the cheek and the teeth or gums
Abbreviation epi dural inhalation parenteral administration just outside the dura mater oral administration of medication breathed in to supply medication to the lungs intra arterial parenteral administration inside the arteries intra cardiac parenteral administration inside the heart intra dermal parenteral administration inside the top skin layer intra muscular parenteral administration inside the muscle intra nasal administration inside the nose , absorbed through nasal mucosa
(cellular lining of nose) intra peritoneal parenteral administration inside the peritoneum (area enclosed by membrane in abdomen) intra thecal parenteral administration to cerebrospinal fluid inside the theca of the spinal canal
IC
IT intra venous parenteral administration inside the vein nasal administration inside the nose , absorbed through nasal mucosa
(cellular lining of the nose) ophthalmic topical administration to the eye oral by mouth
IV o.u., o.d., o.s. p.o.
35

otic parenteral rectal sub cutaneous sub lingual topical trans vaginal urethra l dermal topical administration to the external ear canal any route other than oral, sublingual, or rectal. usually administration with needles administration to the rectum (last 12 cm of large intestine next to anus), usually refers to suppositories, solutions, and ointments. parenteral administration just
(epidermis & dermis) oral administration under the under the tongue cutaneous tissue
,usually tablets a.u., a.d., a.s.
R, rect surface delivery of medicine through dermis (skin). usually refers to transdermal patches. delivery of medicine into the urethra (urinary canal). usually refers to suppositories. top delivery of medicine to the vagina . usually suppositories, ointments, creams, aerosol foams, IUD, tablets, or contraceptive sponge. subc, subq, s.c.
SL
Formulations
Formulation Definition aerosol nebulized particles suspended in gas or air. usually refers to MDIs
(metered dose inhalers) for inhalation therapy. capsule cream drops gelatin casing that contains medicine. usually for p.o. therapy. semisolid emulsions containing medicine. usually for topical therapy. solutions and suspensions in a dropper bottle containing medicine. usually for topical therapy.
Abbreviation cap. gtt. elixir emulsion enema extract gel sweetened solution of ethanol and water containing medicine. usually for p.o. therapy. elix. dispersions containing coarse particles 10-50 µm in size. usually a liquid in an immiscible vehicle. usually for subcutaneous administration. rectally administered solutions. animal or vegetable drugs removed from raw materials with solvents which are evaporated. fine dispersions containing particles 0.5 to 10 µm in size. usually for topical therapy. ext granule implant agglomerates of smaller particles. surgically implanted drug delivery formulations. injection sterile, pyrogen-free, parenteral solutions. lotion lozenge suspension of solid materials in an aqueous vehicle. usually for topical therapy. medicine in a disk shaped solid dosage form usually flavored and meant inj.
36

ointment paste patch pellet for slow p.o. release of medication for a localized effect. mixture of drug substances in an ointment base. usually for topical therapy. like an ointment, except is is thicker as it has a higher proportion of solids. usually for topical therapy. usually refers to a transdermal drug delivery system that delivers drugs through the skin for a systemic effect. a solid dosage form meant to be surgically implanted for slow release of medication over an extended period of time. ung. powder solution suspension a drug dissolved in an aqueous vehicle that doesn't fall in another pharmaceutical formulation category. solutions do not settle like suspensions. may be p.o., rectal, opthalmic, intranasal, intravenous, intramuscular, intradermal, dermal, subcutaneous, as well as vaginal. suppository a solid dosage form that releases drugs into a body orifice (vagina, urethra, rectum) a coarse dispersion containing particles 10-50µm in size. suspensions settle and may need to be shaken before administration. may be p.o., opthalmic, intranasal, intravenous, intramuscular, intradermal, or subcutaneous. syrup a mixture of finely divided drugs and/or chemicals in dry form. may be used internally as well as topically. tablet tincture viscous sucrose solution of medication. ususally p.o. solid dosage form of medicine prepared with pharmaceutical adjuncts. may be vaginal , sublingual, or p.o. a solution containing a concentrated medicinal extract from a plant or animal source. pulv. sol. sup. susp. syr. tab. tr., tinct
37

1.
Additive - the drug that is added to the parenteral solution.
2.
Admixture - the parenteral solution after mixing with an additive.
3.
Aeseptic Technique - proper use of sterile technique to make IV admixtures that keeps sterile things sterile.
4.
Biological Safety Hood - used in the preparation of hazardous drugs in order to prevent contamination of the environment and personnel. This is often used in the preparation of chemotherapeutic agents.
5.
Class 100 Environment - sterile air with no particles bigger than 5 µm and no more than
100 particles per cubic foot bigger than 0.5 µm in size.
6.
Coring - when poking a needle through something causes the needle to punch out a small circular piece of particulate matter.
7.
Flow Rate - administration rate of the solution to the patient.
8.
Gauge - a number that measures the width of the needle. the larger the gauge, the narrower the needle. smaller gauge needles (large lumen) are necessary for viscous solutions, but may cause coring.
9.
Laminar Air Flow sterile class 100 air flowing in parallel sheets at 90 ft/min. this prevents non-sterile air containing particulates from the room from entering the laminar flow hood.
10.
Laminar Flow Hood - device that makes a sterile class 100 environment for the preparation of parenteral solutions. laminar flow hoods have to be certified at least annually. this is verified by the Joint Commission on Accreditation of Healthcare Organizations.
11.
LVP - large volume parenterals are bags or bottles of larger volumes of parenteral solutions.
12.
Milliequivalent - a chemical unit that measures the chemical activity of an electrolyte. this unit of measurement includes the total number of ionic charges in a solution. it includes the valences of the ions.
13.
Needle - the 2 main parts of a needle are the shaft and hub. the gauge is a number that represents the needle's thickness. the smaller the gauge, the wider the needle. the larger the gauge, the thinner the needle. in other words, the larger the gauge, the smaller the diameter of the shaft.
14.
Parenteral Nutrition - hypertonic solutions of amino acids, fats, dextrose, vitamins, electrolytes, and trace elements. when mixing, dextrose and fats cannot be run together. this is because dextrose will break the fat emulsion. the order has to be FAD (fat, amino acid, dextrose) or DAF (dextrose, amino acid, fat).
15.
Parenteral Solution Requirements - injections and infusions have to be sterile, free of visible particulates, pyrogen-free, stable at time of injection or infusion, approximately pH
7.4, and usually isotonic.
38

16.
Percentage Concentration - percentage concentration by weight is mg of active drug ingredient per 100 mg of drug preparation. percentage concentration by volume is ml of active drug ingredient per 100 ml of drug preparation.
17.
Peritoneal Dialysis Solutions - patients without functioning kidneys use this to filter out toxic wastes and electolytes via osmosis through the peritoneum or cavity between the abdominal lining and internal organs. this solution is hypertonic so that it will not put water into the circulatory system.
18.
Personal Protective Equipment - face shields, respirators, gowns, latex gloves, and chemical splash goggles used in chemotherapy preparation.
19.
Piggy Back - medium sized volumes of 50-100 ml bags infused into the administration set of
LVPs.
20.
Pump - infusion pumps, syringe pumps, and ambulatory pumps administer parenteral solutions and control their rate of administration. A unique type of pump, the PCA (patient controlled administration) pump is commonly used for administration of narcotic analgesics in hospitals.
21.
Sharps Container - a special container used to dispose of hazardous waste, specifically sharp objects.
22.
Spill Kit - a spill kit should be used after spilling cytotoxic and hazardous drugs such as chemotherapy agents. examples of chemotherapy agents are; etoposide, Taxol (paclitaxel), cyclophosphamide, methotrexate, doxorubicin, vincristine, vinblastine, and cysplatin.
23.
SVP - small volume parenteral are ampules or vials of smaller volumes of parenteral solutions.
24.
Syringe - the 2 basic parts of a syringe are the barrel and plunger. syringe volume is measured by holding the syringe upright and making sure that there is no air in the syringe. if there are any air bubbles in the syringe, just tap it lightly to make any air bubbles rise to the top. the volume is read from the edge of the plunger's stopper. generally, the proper syringe size is one size bigger than what is needed. syringes are generally 120 ml or less in size.
Luer-Lok syringes should be used with cytotoxic agents.
25.
Syringe Filter - a filter used to remove particulate contaminants from a solution. To ensure complete sterilization, a 0.22 micron or smaller pore filter is required.
Laminar Flow Hood (left)
Air flows into the hood through a prefilter that removes gross particulates. Then, the air moves through a HEPA (high energy particulate air) filter which creates a sterile class 100 environment.
Any HEPA filter should be left running continuously. The air then flows over the work space as laminar air flow. This constant flow of air over the work space pushes particulate contaminants out of the work space introduced by people or work materials.
Biological Safety Hood (not shown)
This differs from the laminar flow hood because after the air moves through the HEPA filter, the air is directed downward through the work area. The air exits the work area by going back into the unit through vents on the edges of the work surface. Most of the air is recirculated while a minor portion of the air is passed through a secondary HEPA filter and vented into the room. Recirculating most of the air and filtering the air before venting it into the
39

room prevents contamination of the surrounding room and people in the room. The biological safety hood is commonly used in the preparation of hazardous materials such as chemotherapeutic agents.
Hand Washing
1.
Prepare means to dry hands.
2.
Get warm water running.
3.
Remove jewelry.
4.
Get hands and arms wet.
5.
Lather up with antiseptic soap such as Hibiclens.
6.
Scrub soap under finger nails by rubbing them with the palm of the other hand.
7.
Scrub from finger tips to elbows. Do step 6 & 7 for 2 minutes.
8.
Rinse from fingertips to elbows.
9.
Pat dry with a lint free paper towel.
10.
Use towel to turn off water if necessary.
11.
After hands are washed, avoid touching any nonsterile item.
Proper Attire



Wear lint-free clothing.
One may also wear barrier clothing such as coveralls, hair cover, shoe cover, or mask.
Follow facility or manufacturer's instructions for wearing barrier clothing.
One may also wear sterile gloves. Sterile gloves should be worn when preparing hazardous drugs such as chemotherapeutic agents.
Rules to Follow When Working With Sterile Hoods
 Clean the hood with isopropyl alcohol daily and before every set of preparations. Wipe from back to front using side-to-side motions. Let the sterile hood sit with the HEPA filter on for at least 30 minutes before you start working in the hood. This will allow enough time for the sanitizing agent to work.
 Clean the room daily with antiseptic solution.
 Do not cough, sneeze, nor talk into the hood.
 Make sure there is no breeze from doors, windows, and vents disrupting the laminar air flow.
Close all doors and windows.
 Laminar air mixes with outside air near the edge of the hood. Make sure all work is performed at least 6 inches inside the hood.
 Do not shadow. Shadowing is when you block the flow of laminar air to a surface that is supposed to be sterile.
Vocabulary
1.
Balances - balances should be put in areas of low moisture and situated on flat, nonvibrating surfaces away from currents of moving air such as vents, windows, and doors. The performance of the balances
40

should be checked and documented monthly. In Texas, the performance of a pharmacy's Class A balance is checked periodically by the Texas State Board of Pharmacy. o Class A Torsion Balance - pharmacies must have at least a class A balance. Class A balances can o measure 120 mg with a 5% error or less.
Electronic Balance - many pharmacies also have an electronic balance. electronic balances can be extremely accurate and easy to use.
2.
Capsules - solid or liquid drugs encased in a hard gelatin shell. there are 2 techniques used in filling capsules; hand filling and machine filling. o Sizes - 000, 00, 0, 1, 2, 3, 4, and 5. The smaller number, the larger the volume. 000 indicates the largest capsules while 5 indicates the smallest capsules. o Hand filling - also called the punch method. while wearing gloves or using a capsule to hold another capsule, the compounder will punch (with a slight twist) half of a capsule into a line of powder with a width 1/3 the length of the capsule. the proper weight of a few capsules made using this method is verified on a balance. if this method is verified correct, then all of the other capsules are made in the same manner (with the same amount of resistance on the last punch) as the verified capsules. All capsules are completed by capping with the other half. If the drug powder is not adhesive enough to use this method, then use a spatula to guide the drug powder into the capsule or use a mortar and pestle to reduce the particle size of the drug powder. o Machine filling - using a machine to make capsules. machines can make 50 to 100 capsules at one time. the empty capsule halves are oriented with the open end facing up and flush with the working surface of the machine. the powder is then evenly spread into the capsules with a spatula or by tapping. pegs may also be used to tamp the powder into the capsules more tightly. The capsule halves are then joined.
3.
Compounding - the preparation, mixing, assembling, packaging, and/or labeling of a drug or device as the result of a practitioner’s prescription drug order or initiative based on the practitioner/patient/pharmacist relationship in the course of professional practice, or for the purpose of, or as an incident to, research, teaching, or chemical analysis and not for sale or dispensing. Extemporaneous compounding is for a specific patient. Bulk compounding includes the preparation of drugs or devices in anticipation of prescription drug orders based on routine, regularly observed prescribing patterns.
Compounds done in anticipation of prescription drug orders should have the following elements; o Stability Documentation - documentation of the criteria used to determine the stability for the o anticipated shelf life must be maintained with the non-sterile compounding record. the pharmacist's professional judgement of the shelf life should be based on criteria such as; physical and chemical properties of active ingredients; use of preservatives and/or stabilizing agents; dosage form; storage conditions; and scientific, laboratory, or reference data.
Labelling - labelling that contains the name and strength of the compounded medication or list of the active ingredients and strengths; facility's lot number; "use by" date as determined by the pharmacist using appropriate documented criteria as outlined above; and quantity or amount in the container.
4.
Elixir - A solution made of alcohol, water, and the drug. The alcohol is used as a solvent to dissolve the drug. Other ingredients such as glycerin, sorbitol, and propylene glycol may also be included. This is also known as a hydroalcoholic solution.
5.
Emulsion - Emulsions have 3 components; dispersed phase (internal discontinuous phase), dispersion medium (external continuous phase), and emulsifying agent . An emulsion is a mixture of two immiscible liquids. Immiscible liquids cannot dissolve into each other. One immiscible liquid, the dispersed phase, is dispersed as 0.1 to 10µ globules throughout the dispersion medium. Emulsifying agents are used to stabilize an emulsion. Common emuslifiers include; acacia, glyceryl monostearate, methocel 15 cps, various PEG 400s, parmagel b, potassium oleate, sodium lauryl sulfate, sodium oleate, Span 20 - 85, tragacanth, triethanolamine oleate, and Tween 20 - 85. Oil in water emulsions generally contain more than
45% water by weight. Water in oil emulsions generally contain less than 45% water by weight.
6.
Measuring Equipment - volumetric glassware is used to measure volume. Erlenmeyer flasks, beakers, and prescription bottles are not volumetric glassware. use the smallest container that can measure the volume. do not use a container to measure a volume of liquid that is below 20% of the capacity of the container due to lower accuracy.
41

o Graduated cylinder - cylindrical glassware open at the top that is graduated for measurement of o o liquids. always measure a liquid at the meniscus or the bottom of the curve formed by the liquid's surface in a graduate.
Syringe - measures smaller volumes (0.3 mL - 120 mL). generally more accurate than a graduated cylinder. measurements are taken at the edge where the rubber stopper, syringe, and liquid to be measured meet.
Dropper - generally not used for measurments in compounding. generally used for measurements in patient dosage containers. usually holds a volume of about 1 mL. usually not graduated and thus must be calibrated before use in measuring. droppers are not considered volumetric glassware. o Micropipette - measures smallest volumes (10 µL - 10 mL). generally more accurate than a syringe.
7.
Mortar and Pestle - may be made of ceramic, melamine plastic, wedgewood, or glass. there is even an electric mortar and pestle that can mix ointments, creams, gels, or suspensions in the dispensing container. wedgewood and ceramic are generally used to triturate or grind larger particles into a powder. glass and melamine plastic are generally used to mix liquids and semisolids.
Using a Class A Torsion Balance
There are many different types of balances. The procedures for using each type may vary slightly. There are triple beam balances, electronic balances, and class
A torsion balances.
1.
Arrest the balance and place two clean weighing boats or weighing papers on each side of the balance.
2.
Release the arresting knob and adjust the zero point of the balance.
3.
With the balance arrested, place the object to be weighed on one of the weighing boats or weighing papers.
4.
With the balance arrested, place/adjust the weights on the other weighing boat or paper.
5.
Release the arresting knob. If both sides are balanced, then the amount of weights on one side of the balance indicates the weight of the object to be determined on the other side of the balance.
6.
Steps 4 & 5 may be repeated until both sides are balanced.
7.
Clean the weighing pan & surfaces, shut the lid, and arrest the balance before storage.
Compounding Suspensions & Syrups
1.
Wet the drug compound with a minimum of wetting agent. The wetting agent for hydrophyllic (water soluble) substances is water. Wetting agents for hydrophobic substances (not water soluble) are alcohol and glycerin. Triturate or grind into smaller particles in a mortar and pestle.
2.
Add a suspending agent such as Tragacanth (05-2.0%), Acacia (0.5-2.0%), Colloidal Silicon Dioxide (1.5-
3.5%), Sodium Carboxymethylcellulose (0.5- 1.5%), Methylcellulose (0.5-5.0%), or Carbomer Resins
(0.5-5.0%). Higher concentrations of a suspending agent will cause the formation of a gelatinous suspension.
42

3.
Add a vehicle such as Simple Syrup (50-100%), Cherry Syrup (50- 100%), Ora-Sweet® (20- 100%), Ora-
Sweet SF® (50- 100%), Ora-Plus® (20- 100%), Sorbitol (5-10%), or Glycerin (2-10%).
4.
Add a preservative such as Methylparaben (0.025-0.20%), Propylparaben (0.01-0.02%), Sorbic Acid
(0.05-0.2%), or Sodium Benzoate (0.05-0.1%). Parabens dissolve slowly and may require a small amount of boiling water to speed up the dissolution process. Be sure to cool off the solution of paraben in water before adding it to the drug product.
5.
Apply a refridgerate sticker on the bottle if necessary. Apply a shake well sticker on the bottle.
Compounding Ointments and Creams


Manual methods - Pill tile & spatula, mortar & pestle, or ointment pad & spatula are all valid methods to make ointments and creams. However, an ointment pad may tear and the ointment pad method also doesn't reduce particle size. The other two manual methods can decrease particle size as well as mix the components of the topical dosage form together. Levigation is a method used to decrease particle size to make a topical dosage form feel less gritty. The drug is ground into a paste in a mortar & pestle or pill tile
& spatula using a small amount of nonsolvent. Geometric dilution is a method used to manually mix the ingredients of a topical dosage form. The smaller quantity ingredient is diluted by mixing it with small portions of the larger quantity ingredient. This is repeated until the two ingredients are fully mixed.
Mechanical methods - Ointment mill, electric mortar and pestle, and various mixing apparatus may be used to mix the components of a topical dosage form together. The ointment mill can reduce particle size as well as mix. The electric mortar and pestle can mix the product in the dispensing container. This is not only convenient, but reduces loss of drug product in the compounding process. However, this method cannot reduce particle size. Various mixing apparatus can also be used. However, mixing apparatus also cannot reduce particle size.
Compounding Suppositories
There are three methods of preparing suppositories; compression molding, hand molding, and fusion molding.
Compression molding mixes the drug and suppository base at room temperature and compresses it into a mold.
Fusion molding mixes the drug and heated liquified suppository base which is poured into a mold. Hand molding involves mixing the drug and cocoa butter shavings with a pill tile & spatula or mortar & pestle. The mixture is then manually formed into suppositories.
1.
Prepare the Mold - If necessary, spray the mold with a small amount of lubricant such as vegetable oil.
2.
Prepare the Base - Make shavings of the cocoa butter mold if compression molding is going to be utilized. If fusion molding is used, melt the cocoa butter at 34 - 35°C. If fusion molding is used with PEG
(polyethylene glycol), melt the PEG at 60°C.
3.
Prepare the Drug - It is preferable to use pure dry powdered drug. If particle size of the drug is large, levigate the drug (see compounding ointments and creams).
4.
Pour the Mold - If using the fusion method, continuously pour the melted suppository base containing the drug into a room temperature mold.
5.
Remove from Mold - Cool for 30 min at room temperature, then cool for 30 min in the refridgerator.
Trim any excess suppository sticking out of the mold. Open the mold and wrap the suppository in foil.
43

Reconstituting Dry Powders
1.
Measure the amount of solvent
(usually water) to add by reading the meniscus . Due to intermolecular forces, water forms a “U” shape when measured in a glass graduate.
You measure a volume of water by reading the mL marking at the bottom of the “U”. The bottom of the
“U” is the meniscus.
2.
Add half of the solvent.
3.
Shake until suspension/solution is uniform.
4.
Add other half of the solvent.
5.
Shake until suspension/solution is uniform.
 Mechanism of Action - Drugs can be either agonists or antagonists. Agonists are drugs that activate or facilitate the activation of receptors that either speed up or slow down a specific cellular function. Antagonists are drugs that inhibit the activation of a specific receptor. The
 receptor is either blocked or the agonist is destroyed.
ADME - ADME stands for absorption, distribution, metabolism, and excretion. Absorption , is when a drug enters the blood. Distribution is the spread of the drug throughout the body after absorption. Metabolism describes the chemical changes that the body performs on the drug. Most drug metabolism happens in the liver. Excretion is the process that the body uses to get rid of drugs and toxins. Most excretion is performed by the kidneys.
A patient's age can affect the pharmacological response to a medication.
 Neonates & Infants - Neonates may be up to 28 days old. Infants are between 28 days old to
12 months old. The system of distribution, metabolism, and excretion are immature.
Metabolism and excretion are not as efficient as in adults.
44

 Children & Adolescents - Children are between 12 months old and 12 years old.
Adolescents are between 12 years old and 18 years old. Children & adolescents have faster
 drug metabolism than adults.
 Adults - Adults are between 18 years old and 65 years old.
Geriatrics - Geriatrics are over 65 years old. Geriatrics experience slower absorption, distribution, and excretion.


Adverse Effects - Undesired effects of medicine.
 Side Effects - Adverse effects of medicines that are present at the usual therapeutic dose.
Allergy - A hyper immune response to a medication. The patient may get rashes or an anaphylactic reaction where the airways swell shut. An anaphylactic reaction is a severe adverse reaction after prior administration of the drug. In case of anaphylactic shock, treatment with a bronchodilator, epinephrine, and/or antihistamine may be necessary. Cross sensitivity is when a patient who is allergic to one drug is also allergic to another chemically similar drug.
A drug interaction is a pharmacological or clinical response to the administration of a drug combination, different from that anticipated from the known effects of the known agents when given alone. There are 2 different types of drug interactions; pharmacokinetic and pharmacodynamic.


Pharmacokinetic - The action of one drug upon another which results in the changing of the drug's ADME.
Pharmacodynamic - The interaction of two drugs which results in an antagonistic, additive, or synergistic pharmacological effect, which is not due to changes in ADME.
Drug
Coumadin (warfarin) interacts with Aspirin
(NSAID)
Type of Interaction
Coumadin (warfarin) interacts with macrolide antibiotics such as erythromycin (Ery-Tab) and clarithromycin (Biaxin).
Azithromycin (Z-Pack or
Zithromax) is O.K.
Macrolide antibiotics enhance anticoagulation effects. The only macrolide antibiotic that is O.K. to take with warfarin is azithromycin.
Pharmacodynamic interaction, increased anticoagulation (bleeding) risk, especially gastric (stomach) bleeding, possible fatal homorrhage
(bleeding)
Viagra (sildenafil citrate) interacts with Nitroglycerin
(or various nitrates)
AlOH or MgOH (ex.
Maalox) interacts with tetracycline (Sumycin)
Pharmacodynamic interaction, decreased blood pressure, possible fatal hypotensive event
Pharmacokinetic interaction, decreased absorption of tetracycline due to chelation of tetracycline.
45

Flagyl (metronidazole) interacts with Alcohol
Codeine interacts with
Alcohol erythromycin interacts with
Orap (pimozide) or Seldane
(terfenadine) or Propulsid
(cisapride) cimetidine (Tagamet) interacts with theophylline
Chelation is when the Maalox sticks to and coats the tetracycline, causing it not to be absorbed
Pharmacodynamic interaction, disulfiram-like interaction with flushing and nausea
Pharmacodynamic interaction, increased drowsiness they may or may not ask this interaction since Propulsid and
Seldane were both taken off the market.
Pharmacokinetic interaction, cimetidine causes decreased hepatic
(liver) metabolism of theophylline.
Increases theophylline level.
Lanoxin (digoxin) interacts with hydrochlorothizide
(Dyazide) or Lasix
(furosemide)
Coumadin (warfarin) interacts with vitamin K (in green leafy vegetables)
Pharmacodynamic interaction, increased excretion of K & Mg. This changes heart function to cause arrhythmias.
Pharmacodynamic drug-food antagonism, replaces vitamin K loss caused by warfarin. This decreases the drug's efficacy.
MAO inhibitors such as
Nardil (phenelzine) and
Parnate (tranylcypromine) interact with tyramine rich foods (cheese, chocolate, wine), methylphenidate, and pseudoephedrine.
Tyramine, methylphenidate, and pseudoephedrine cause norepinephrine to be released. Since MAO inhibitors increase the amount of stored epinephrine available to be released from adrenergic neurons, this causes a rapid increase in norepinephrine levels, which may cause a hypertensive crisis. This is an example of a pharmacodynamic drug-food and drug-drug interaction, respectively.
Nardil (phenelzine) and
Parnate (tranylcypromine) interact with SSRI's (Prozac,
Paxil, Zoloft), venlafaxine, trazodone, TCA's
(amitriptyline), and dextromethorphan.
The pharmacodynamic interaction caused by the additive effect of both medicines increases the serotonin level. This may cause a fatal hypertensive crisis.
46




Legally Required References - Pharmacies that carry hazardous chemicals are required by
OSHA to carry MSDS (material safety data sheets) for every hazardous chemical that the pharmacy carries. The manufacturer of the chemical can provide you with a copy of the chemical's MSDS. Many state boards of pharmacy also require certain texts to be present in a pharmacy. For example, in Texas, a current copy of the law has to be kept. This includes
Texas Pharmacy Act and Rules, Texas Dangerous Drug Act and Rules, Texas Controlled
Substances Act and Rules, and Federal Controlled Act and Rules (or official publication describing the requirements of the Federal Controlled Substances Act and rules). Also, in
Texas, at least one of each category of texts has to be kept in the pharmacy; Patient
Information (ex. USPDI), Drug Interactions (ex. Drug Interactions), and General Information
(ex. Facts and Comparisons).
Types of References - There are three types of references; primary, secondary, and tertiary.
Primary references are professional journals such as JAMA (Journal of the American
Medical Association) containing articles of original research. Secondary references are abstracts and/or indexes of primary sources of information. An example is Medline . Tertiary references are textbooks and reference books such as the Drug Information Handbook.
Examples of References
Drug Information
Handbook
Drug Topics Red
Book
Facts and
Comparisons
Handbook of
Medical Diagnosis and Treatment
Handbook of
Nonprescription
Drugs
Journal of the
American
Pharmaceutical
Association
Martindale: The
Extra
Pharmacopoeia
A good portable drug information reference
Complete Guide to Rx and
OTC pricing. It lists the drugs'
NDC numbers.
A complete drug reference updated monthly
A good reference for diagnosis and determination of treatment
An excellent reference for
OTC products
A good journal for pharmacists with CE in it
A good reference for drugs from other countries
Medline
Pocket Medical
Dictionary
The Review of
The best secondary reference for medical research.
A good reference for looking up big words
A complete reference for
47

Natural Products herbal medicine and other food supplements updated monthly
Rx List: Top 200
Drugs
Spanish-English
Dictionary
This is a list of the top 200 drugs by brand and generic names. Also, some basic chemical information and foreign drug names are available on this website.
A must if you work in certain areas of the Southwest
Today's Technician
The journal for pharmacy technicians with CE in it.
48




DAW - This stands for dispense as written. When a doctor writes this on the prescription or signs his/her name on top of this phrase, then the pharmacy has to fill the Rx with the brand name medication. However, if the pharmacist calls the doctor to authorize the generic, then you may fill the Rx with the generic.
MAC - This is the maximum allowable cost of the drug that the insurer will allow the pharmacy to bill it for. Sometimes, this cost is the cost of the generic. Since generics are a lot cheaper than the brand name medication, dispensing the brand in this case will result in a loss for the pharmacy.
Third Party - The third party payer is an insurer that pays for at least part of the price of medicine for patients.
 Medicaid - A federally funded, state administered medical insurance program for low income individuals. Each state decides eligibility and services rendered. With regard to prescription coverage, medicaid programs have formularies that list all covered medication in the plan. Since generics are cheaper, medicaid programs usually favor generics. Any drug not on the formulary will require prior authorization from medicaid before the drug can be reimbursed.
 Medicare - A federally funded medical insurance program for seniors over age 65, the disabled, and those with kidney failure. Medicare consists of 2 parts; part A and part B. Part
A covers medical, surgical, and psychiatric hospital care. Part B is a voluntary program

 where the members pay a premium.
Patient Assistance Programs - Pharmaceutical companies often have programs where they pay for indigent patients' medications. This usually requires that the prescriber submit a form to the manufacturer for prior approval.
Workman's Compensation - A federal program that outlines compensations for employees injured on the job. The state bureau of workman's compensation or the employer (if the employer is self-insured) may be billed for workman's compensation claims.
Private insurance plans often either require generics or favor generics with a lower copay. Often, there is a copay that the patient has to pay for prescriptions or a deductible. A deductible is an amount that the patient has to pay before the insurer will pay for medicines the rest of the year. The insured is often given a prescription insurance card that verifies coverage and displays online adjudication information. This is the information that you need to type into a computer for online payment by the insurance company.
49



HMO - Medical costs are covered inside the network of providers, but not outside.
POS - A patient sees a primary care physician in a network. Costs outside the network of providers are only partially covered.
 PPO - Medical costs are only partially covered outside the network of preferred providers.
The primary care physician doesn't have to be a member of the network.
Often, you will get the following reject messages when billing insurance companies online. If the claim is valid, then you may have to call the insurance company's help desk to get an override code.
Retransmitting the claim with the appropriate override code may get the claim to go through.
 NDC Not Covered - Drug prescribed is not on the formulary. Insurance will not pay for the drug. However, if the doctor requests a prior authorization, the insurance may pay for it.
Otherwise, call the insurance help desk to see which alternate medication is covered.
 Patient Not Covered - The patient's insurance carrier may have changed. If the patient is covered, you need to call the new insurance company's help desk or get the new insurance card.
 Prescriber Not Covered - The doctor is not on the insurance company's network of covered
 providers.
Refill Too Soon - Most insurance plans will only allow the patient to have a refill only after
 the patient has consumed all or almost all of his/her supply of medicine. If the patient needs an early refill because he/she is going on a vacation, then you may call the insurance help desk for an override code so that the submitted claim may be accepted.
System Down - The insurance carrier's computer system may be temporarily down and therefore unable to accept online claims. Just wait awhile and re-submit the claim.
 Determine What Drugs to Order
The desired stock level and reorder points are usually maintained by a computer. However, the desired stock level and reorder points are periodically adjusted by a person based on expected inventory turnover rate, whether or not the drug is a brand or generic, and the cost
50

 of the medicine. Drugs with a higher inventory turnover rate have a higher desired stock level and reorder point. Cheaper cost drugs such as generics also have a higher desired stock level and reorder point. This is to ensure an ample inventory of more frequently used drugs.
What to Know Before Ordering
Be sure to know the name of the drug, name of the manufacturer, dosage form, type of packaging (quantity per package, unit dose or bulk packaging), and number of units. Identify where you are going to order the drug from based on known availability, cost, and time to delivery. If possible, orders for medication are through a company owned warehouse or a coop wholesale buying club. These are often the lowest cost providers. Drug wholesalers are next in line and other pharmacies are the last choice when placing an order due to high cost.
Orders are rarely placed through the manufacturer.
 Placing the Order
Most ordering systems are computerized. An order report is generated by a pc and a person will check this for accuracy, revise it if necessary, confirm it, and send it. A printed copy of the items ordered should be kept. Sometimes, a handheld computer is used to place an order.
In this system, a running "want list" of drugs that need to be ordered is kept. This "want list" will usually also have the quantity desired and the item's order number. If the item is a special order placed for a specific person, this person's name and phone number should be recorded in the "want list". That way, if the person forgets to pick up a special order item, someone from the pharmacy could call him/her and remind this person to pick up their

 medication. The item's order number and quantity are entered in the handheld computer to place the order.
Confirming the Order
After the order is sent, your supplier should send you an electronic confirmation of the order items that you are going to receive and a "shorts" list of items that are shorted which you will not receive. Items may be shorted due to the item being temporarily out-of-stock, backordered, or discontinuation of manufacture. A shorted item may have to be ordered from a different supplier.
Receiving Orders
Received orders should be reconciled for correctness. The printed copy of the drugs ordered list or the "want list" is used to reconcile with the actual order received and the invoice accompanying this order. Make sure that the name of the drug, name of the manufacturer, dosage form, type of packaging (quantity per package, unit dose or bulk packaging), and number of units received in the order are correct. The supplier should be notified of an incorrectly filled order. The pharmacist should be the one to check in and document the receipt of a controlled substance order.
 Special Situations
Items that are designated by MSDS (material safety data sheets) as hazardous materials are shipped under special protocol by the USPS, Fed Ex, or UPS. The FAA may not allow some hazardous materials to be shipped by air due to possible safety risks. These items deemed hazardous by the FAA are shipped via land courier.
As mentioned previously, the desired stock level and reorder points are periodically adjusted by a person based on expected inventory turnover rate, whether or not the drug is a brand or generic, and the cost of the medicine. In many pharmacies, especially in large intitutions, there is a formulary that determines what drugs are going to be kept in stock. A goal of any formulary system should be to rationally manage the cost of drug therapy. An open formulary allows a pharmacy to stock any medicine that has been prescribed for. A closed formulary only allows the pharmacy to stock certain
51

medications. A physician must gain permission under protocol to prescribe a drug that is not in the formulary. Only then can the pharmacy in such an institution stock a non-formulary drug. The formulary is usually determined by the P & T (pharmacy and therapeutics) committee.


Repackaging and Bulk Compounding
Repacks and compounds should have the following documented in the inventory records;
1.
Date of compound or repack.
2.
Drug name, dosage form, strength, and quantity.
3.
Lot #
4.
Initials of tech and Rph.
5.
Anything else required by the Q & A (quality and assurance) policies of the pharmacy
Controlled Substances
1.
Biennial Inventory - The Federal Controlled Substances Act requires at least a biennial inventory. State laws may be stricter. For example, in Texas, all community
(class A) and institutional (class C) pharmacies are required to take an annual inventory.
2.
Count - Exact count is required on CII's. For CIII-CV, estimates are allowed unless the bottle holds more than 1000 tablets or capsules and the container has been opened.
3.
Requirements - Name, address and DEA number of pharmacy; Date and time
(opening or closing of business) inventory taken; Signed by pharmacist taking inventory; Maintained on file in the pharmacy at least 2 years; List of CII's separate from inventory of CIII-V substances.
Drugs in stock - commercial containers
1.
Name of drug
2.
Dosage form
3.
Number of units or volume
4.
Number of containers
Drugs in stock compounding or awaiting disposal (destruction or return for credit).
5.
Name of drug
6.
Total quantity
7.
Reason for being maintained
Newly scheduled drugs inventoried on the day of scheduling.
4.
Receipts - For CIIs, document date and number of containers received on copy 3 of
DEA order form (DEA 222C). In Texas, TSBP rules require the initials of the receiving individual as well. For CIII-CV, the supplier's invoice indicates receipt of drugs.
1.
Place actual date of receipt on invoice. TSBP rules also require the initials of the receiving individual.
2.
Place DEA number of supplier on invoice (if omitted by supplier).
52

3.
Identify CS's by underlining in red ink or asterisk if not otherwise identified by supplier.
4.
Files of receipts; Keep a sparate file for CII's. CIII-CV invoices may be kept with commercial invoices.
 Storage - Frozen items should be kept at -20 to -10 deg C (-4 to 14 deg F), refridgerated items should be maintained at 2 to 8 deg C (36 to 46 deg F), room temperature items are stored at 15 to 30 deg C (59 to 86 deg F), and warm storage is defined as 30 to 40 deg C (86 to 104 deg F). Common reconstituted antibiotics that have to be refridgerated are Augmentin
(amoxicillin/clavulanate), Keflex (cephalexin), and Cefzil (cefprozil). Other common drugs that have to be stored under refridgerated conditions in the pharmacy are Miacalcin
(calcitonin), Phenergan sup. (promethazine sup.), Xalatan (latanoprost), and insulin
(Humalog, Humulin, etc.). Common reconstituted antibiotics that are stored at room temperature are Amoxil (amoxicillin), Biaxin (clarithromycin), and Zithromax
(azithromycin). Items should be rotated on the shelves. The older items should be placed in the front (earlier expiration date) so that they would be used first. The newer items should be
 placed in the back (longer expiration date). This is known as stock rotation . Damaged, returns, recalls, disposals, and expired drugs should be clearly marked and stored separate from other stock. Besides storage in the pharmacy, drugs may be stored in point of use stations . These are stations or carts of medicine that are usually stocked with unit-dose packaging. This facilitates administration of medication in large institutions. All withdrawals and restocks are recorded as if it were dispensed from the central pharmacy. Inventory records may be instantly updated as stations may have a computer on the facility's network.
Packaging - Unit dose packaging contains just one dose of medication per package. Each unit dose package contains the name of the drug, its strength, and the expiration date.
Examples of unit dose packaging are ampules, unit dose vials, a blister pack containing a suppository, and a blister pack containing a tablet.
Products that have to be removed from inventory;



Expired and Discontinued Drugs - If a bottle of medicine will expire before a patient will be finished using it, then another bottle should be used. If an investigational drug is discontinued by the doctor, the leftover drug should be returned to the people responsible for investigational drugs.
Drugs with a low turnover rate - Turnover rate is the speed with which an item in the inventory is used up.
Recalled Products - If a patient is already in possession of a recalled product, the patient should be notified. If the patient used the product, then the patient's doctor should be notified. Usually, the manufacturer will also offer a refund or exchange for the recalled product.
53

Task
Obtain medical info and profiles from patients
Accept refill requests from patients
Maintenance of pharmacy e.g. cleaning, removal of expired drugs from shelves, restocking supplies, etc.
Order, check in, and shelve RX/OTC drugs
Accept refill authorization from prescribers
Call prescribers for refill authorization
Pull medication from stock for purpose of dispensing
Count & pour medication into RX vials/bottles
Acknowledge and fix computer "Check RX" messages
Affix the prescription label to RX vial/bottle
Affix auxillary labels to RX vials/bottles
Reconstitute solid preparations into liquids
Enter prescription data into the computer
Enter refill numbers into the computer
OK or reject Rxs from Phone Doctor queue
Count & pour schedule II medication
Clerk Technician R.Ph.
Y Y Y
Y Y Y
Y Y Y
Y Y
N Y
N Y
N Y
N Y
N Y
N Y
N Y
N Y
N Y
N Y
N Y
N N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
54

Override "DUR" messages without consulting RPh
Counsel patients on RX or OTC medication therapy
Interpret patient profiles for drug utilization review
Discuss patient profiles with prescriber offices
Provide drug information or medical advice
Make judgmental decisions on drug therapy
Receive new telephoned RXs from prescribers
Transfer RXs between pharmacies
Supervise other pharmacy staff
N N
N N
N N
N N
N N
N N
N N
N N
N N
*Please note that Tennessee does allow pharmacy technicians to receive new telephoned RXs from prescribers under the supervising pharmacist's permission. However, the PTCB exam is a national exam. For the purposes of the exam, pharmacy technicians and clerks are not allowed to receive new telephoned RXs from prescribers.
Pharmacies need a pharmacy license and a certificate of registration with the DEA. In Texas, pharmacies also have to have a certificate of registration with the DPS. Pharmacists have to have a pharmacist license. Furthermore, if a pharmacist is also a preceptor, a pharmacist should also have a preceptor certificate. Pharmacy technician certification requirements vary from state to state. In
Texas, pharmacy technicians have to be nationally certified by January 1, 2001 or they will be classified either as a clerk or technician in training. The training period of 1 year is a grace period that will allow technicians to get certified. All technicians will have to be certified by January 1,
2002 or they will be classified as clerks. Other licenses and certificates may be necessary in specific practice environments.
 Trash - Needles and ampules should be disposed of in sharps containers. Vials, syringes, and bags should be disposed of in biohazard bags. Overwraps, caps, and prep pads should be disposed of in regular trash.
 Chemical Burns
CAUTION: If the chemical is a powder, brush off as much as possible with a clean cloth before flushing with water.
1.
Flush the skin with large amounts of cold water for 15 minutes. Use a shower or hose for large body areas.
2.
Remove contaminated clothing while continuing to flush the skin with water.
3.
Cover the burned area with a sterile cloth.
4.
Seek medical attention immediately.
5.
You may have to provide care for shock.
6.
Tie a cloth in place with a bandage. Never tie a bandage to the neck, use tape.
 Exposure of the eye to chemicals
Flood the eye with water immediately, using your fingers to keep the eye open as wide as possible. Put your eye under a faucet or pour water from a clean container gently and continuously for at least fifteen minutes. Roll the eyeball around as much as possible. Do not
55
Y
Y
Y
Y
Y
Y
Y
Y
Y

 use an eye cup and do not bandage the eye. After these steps have been taken, seek medical attention immediately.
Needlestick injury
Encourage the wound to bleed but without pressing directly on to the wound. Wash the wound thoroughly with soap and water. Seek medical attention immediately.


Prescription filling area should be kept clean. A separate counting tray should be kept for filling penicillin and sulfa drug prescriptions as many people are severely allergic to sulfa drugs. If there isn't a spare counting tray, then wipe the counting tray with a wet-nap (a small cloth containing alcohol) before filling the next prescription.
Follow your pharmacy's quality assurance procedures for cleaning and maintenance of equipment. Equipment should be kept sanitary and maintained regularly to ensure proper, safe function and accurate calibration. A documented record of equipment sanitation, maintenance, and inspection should be kept. HEPA filters should be certified every 6 months. Prefilters for laminar flow hoods should be checked every 30 days. Class A balances should be calibrated regularly. For example, all pharmacies in Texas have to have a class A balance. This balance is inspected annually by the Texas State Board of Pharmacy. This balance inspection is also documented with a sticker on the balance.
 Patient Confidentiality
A patient's medical information is confidential. You may share this information with other health professionals such as doctors and other pharmacists. You may also share this information with the patient's designated agent, the State Board of Pharmacy, law enforcement officials investigating a violation of the Controlled Substances Act, or an official in charge of licensing practitioners in the due course of his/her duty. However, you may not share it with anybody else such as insurance companies and employers. You may only share confidential patient information with insurance companies after a patient authorizes it.
 FDA Medwatch Program
A program run by the FDA where health care professionals report serious adverse drug events to the FDA so that the FDA may act on this information. Reports could alternately be made indirectly to the FDA by reporting to the manufacturer which will then make a report to the FDA. Serious adverse drug events have the following patient outcomes; death, lifethreatening, hospitalization (initial or prolonged), disability, congenital anomaly, or requires intervention to prevent permanent impairment or damage.
 Computers
The pharmacy computer system used should restrict access to particular features and/or records to those who know specific passwords. The computer should also have a data backup feature. The most important feature of pharmacy computer system maintenance is the use of a daily backup tape. The system should have the data backed-up on a regular periodic basis.
This is preferably done daily. Furthermore, any electronic data should have the ability to make a hard copy on demand for State Board of Pharmacy officials. Finally, the computer records should be complete and contain all information that is required by law on a manual data system.
56

1.
ss f makes how many mL?
A.
60 mL
B.
30 mL
C.
15 mL
D.
2 mL
2.
14.18g makes how many oz?
A.
0.5000
B.
2.000
C.
402.0
D.
0.4559
3.
Iss oz makes how many g?
A.
0.053
B.
15
C.
0.18
D.
43
4.
2 1/3 cc makes how many f ?
A.
0.14
B.
13
C.
70
D.
0.078
5.
If you use 32.5mg of a 9 ½ gr container of hydrocortisone, how many grains of hydrocortisone do you have left?
A.
9
B.
7.5
C.
18
D.
32
6.
5 degrees Celsius is equal to how many degrees Fahrnheit?
A.
41
B.
35
C.
–15
D.
15
7.
If you add ¼ gr of hydrocortisone to 1 1/8 gr of talcum, how many gr of product do you have?
A.
1 3/8
B.
3 1/8
C.
1 1/16
D.
1 2/12
8.
What is 7/8 divided by 3?
A.
7/24
B.
7/16
C.
4/16
D.
8/24
57

9.
What is 0.08 expressed as a fraction?
A.
4/5
B.
2/25
C.
1/5
D.
4/25
10.
What is 28 expressed as a roman numeral?
A.
XXVIII
B.
XXIIX
C.
IIXXX
D.
XXXVIIX
1.
A medication order for a patient weighing 176 lb calls for 400 µg antibiotic per kg of body weight to be added to 400 mL of isotonic dextrose solution. If the drug is to be obtained from a solution containing 5 mg per 10 mL, how many milliliters should be added to the dextrose solution?
A.
128 mL
B.
32 mL
C.
64 mL
D.
2 mL
2.
A pycnometer weighs 25.0 g. When filled with a liquid (S.G.=1.25) it weighs 85.0 g. How many ml of water will the pycnometer hold?
A.
24 mL
B.
48 mL
C.
12 mL
D.
22 mL
3.
On a prescription balance having a sensitivity requirement of 0.018 g what is the smallest amount that can be weighed with a maximum potential error of not more than 10%.
A.
0.18 g
B.
1.8 g
C.
18 g
D.
0.0018 g
4.
How many ml are left in a 800 ml bottle of elixir after a pharmacist dispenses a prescription with direction; 2 tablespoonfuls qid for 3 days followed by 3 teaspoonfuls tid for 5 days?
A.
215
B.
305
C.
140
D.
455
5. If the dispensing dropper calibrates 20 drops per mL, how many mg of atropine sulfate should be used in compounding the following prescription?
58

Sol. Atroping Sulfate 50 mL
Each 4 drops = 1/2000 gr
Sig. 4 drops in each feeding
A.
8.125 mg
B.
33 mg
C.
130 mg
D.
0.004 mg
6. From the following formula, calculate the quantity of cold cream in g required to make 2 lb of the ointment.
Vioform Powder 0.2g
Hydrocortisone Powder 0.6g
Cold Cream ad 20.0g
A.
873 g
B.
909 g
C.
87.3 g
D.
90.9 g
7. A sunscreen lotion contains 5 g of methyl salicylate (specific gravity = 1.05) per 100 mL. How many grams of methyl salicylate should be used in preparing 1 gallon of the lotion?
A.
180 g
B.
189 g
C.
1890 g
D.
1800 g
8. How many fluid ounces remain in a bottle containing 2 pints of medication when f iss, f iv, and f xiiss have been used to fill three prescriptions?
A.
3.5 fluid ounces
B.
16 fluid ounces
C.
17.5 fluid ounces
D.
35 fluid ounces
9. How many 25 mcg doses of levothyroxin can be obtained from 0.6 g of the drug?
A.
240,000 doses
B.
24,000 doses
C.
2,400 doses
D.
240 doses
10. How many grains of zinc oxide would be present in vi of the following ointment?
Rx ZnO
Starch
80 g
50 g
59

Kaolin
Petrolatum
270 g
800 g
Ft. Ung.
Sig. Apply Nocte.
A.
0.25 gr
B.
25 gr
C.
8 gr
D.
80 gr
1. How much water should be added to 50 mL of a 1:20 stock solution of a chemical such that 10 mL diluted to a liter gives 1:10,000?
A. 200 mL
B. 250 mL
C. 10 mL
D. 20 mL
2. How many mL of 1:500 stock solution of KCl should be used in compounding 30 mL of a 0.2%
KCl solution?
A. 30 mL
B. 60 mL
C. 15 mL
D. 300 mL
3. How many mL of a 1:50 solution of sodium chloride are required to make 2.5 L of a 1:5000 solution?
A. 25 mL
B. 250 mL
C. 500 mL
D. 125 mL
4. How many mL of 85% (v/v) alcohol and how much water should be used in compounding the following prescription?
Rx Citric Acid 2.0 g
Alcohol 60% 40 mL
Sig. Drink.
60

A.
28 mL
B.
57 mL
C.
5.7 mL
D.
2.8 mL
5. You are requested to prepare 300 mL of sulfuric acid solution, 20% w/v. How many mL of a concentrated sulfuric acid solution (80% w/w; SG = 1.8) should be used?
A.
42 mL
B.
167 mL
C.
75 mL
D.
1200 mL
6. You are presented with a vial containing 40 mL of magnesium sulfate injection. If the injection contains 40% MgSo4*7H2O, How many mEq of magnesium are present in each mL of solution:
The M.W. of MgSO4*7H2O is 246. M.W. of MgSO4 is 120. Atomic weight of magnesium is 24.
A.
3.25 mEq
B.
400 mEq
C.
130 mEq
D.
13.225 mEq
7. How many mEq of Na+ ion are present in 200 mL of isotonic saline? (At. Wt. of Na+ = 23 and
Cl- = 35.5).
A.
30.8 mEq
B.
78.3 mEq
C.
155 mEq
D.
308 mEq
8. Convert 100 mg % into a ratio strength.
A.
1 to 1
B.
1 to 10
C.
1 to 100
D.
1 to 1000
9. Convert 2 mg/mL to ppm.
A.
20 ppm
B.
200 ppm
C.
2,000 ppm
D.
20,000 ppm
10. Convert 1:10,000 into mcg/mL.
A.
10 mcg per mL
B.
100 mcg per mL
C.
1,000 mcg per mL
D.
10,000 mcg per mL
1. An infusion containing 50 mg of antibiotic in 30 mL of sterile water for injection is added to 450 mL of isotonic saline. If the infusion is injected over an 8 hour period and the dropper for the venoclysis set delivers 20 drops/mL, calculate the flow rate in drops per minute.
A.
20 drops per minute
B.
2.08 drops per minute
C.
20.8 drops per minute
D.
2 drops per minute
61

2. Manuel is 10 months old. He was prescribed amoxicillin 30 mg/kg/day, given three times a day.
Manuel weighs 25 lbs. Amoxicillin has a concentration of 250 mg/5 mL. How many teaspoons are in each dose?
A.
quarter teaspoonful
B.
half teaspoonful
C.
one teaspoonful
D.
two teaspoonful
3. If 500 mL of a parenteral fluid is to be infused over a 6 hour period using an infusion set which delivers 25 drops per milliliter, what should be the rate of flow in drops per minute?
A.
34.7 drops per minute
B.
208 drops per minute
C.
347 drops per minute
D.
20.8 drops per minute
4. How many mL of digoxin injection 0.1 mg/mL would be in a 150 mcg dose?
A.
0.67 mL
B.
6.7 mL
C.
1.5 mL
D.
15 mL
5. A pharmacist sells vitamin tablets at $3.50 thereby realizing a markup of 40% on the cost.
Calculate the cost of the tablets.
A.
2 dollars 50 cents
B.
40 cents
C.
3 dollars 10 cents
D.
25 cents
6. What would be the selling price of a bottle of cough syrup if it costs $2.40 a bottle and the gross profit based on the selling price is 25%?
A.
3 dollars 20 cents
B.
31 dollars 25 cents
C.
32 dollars
D.
3 dollars 13 cents
7. A prescription calls for 20 g of epinephrine bitartrate. If 10 g of epinephrine bitartrate cost $9.00, what is the cost of the amount needed in the prescription?
A. 4 dollars 50 cents
B. 45 dollars
C. 18 dollars
D. 1 dollar 80 cents
8. A drug costs $25 and sells for $30. What is the percent markup based on cost?
A.
25 percent
B.
20 percent
C.
10 percent
D.
5 percent
9. How many grams of petrolatum must be mixed with 16 g of 30% zinc oxide ointment in order to prepare a 5% zinc oxide ointment?
A.
80 g
B.
112 g
62

C.
3.2 g
D.
32 g
10. How many grams of coal tar should be added to 400 g of 10% coal tar ointment to prepare an ointment containing 25% coal tar?
A. 80 g
B. 2000 g
C. 200 g
D. 112 g
1. When will a drug expire if the stock bottle states that the expiration date is 7/2000?
A.
midnight 7-31-2000
B.
midnight 6-30-2000
C.
noon 7-1-2000
D.
noon 8-1-2000
2. A drug was recalled because some patients died from liver failure while on the medication. What type of recall was it?
A.
class 1
B.
class 2
C.
class 3
D.
class 4
3. Which of the following is not a mandatory component of a prescription label?
A.
pharmacy name
B.
expiration date
C.
physician name
63

D.
date filled
4. The 1st 5 digits of a NDC number represents?
A.
manufacturer
B.
drug name
C.
drug strength
D.
package size
5. How do therapeutically equivalent generics compare to brand name medication?
A.
same active ingredient and different therapeutic effects
B.
different active ingredient and same therapeutic effects
C.
same active ingredient and same therapeutic effects
D.
different active ingredient and different therapeutic effects
6. Which of the following is not a NSAID?
A.
oxaprozin
B.
diclofenac
C.
Motrin
D.
pentazosine
7. Which law created the DEA?
A.
1938 Food - Drug and Cosmetic Act. FDC
B.
1970 Controlled Substances Act. CSA
C.
Omnibus Budget Reconciliation Act. OBRA
D.
1997 FDA Modernization Act
8. CII prescription records are required to be kept for how many years by the DEA?
A.
2
B.
3
C.
4
D.
5
9. A doctor's DEA number is AB1212125. Is this a valid DEA number?
A.
no - this is an intern
B.
yes - this number validates
C.
no - this number doesn't validate
D.
no - this doctor is an optometrist
10. Which of the following is not a CII?
A.
amphetamine
B.
oxycodone
C.
oxycodone with acetaminophen
D.
pentazosine
1. IV gtt. a.d. q.h. prn. otitis means?
A.
Instill 6 drops in right ear every hour when required for ear inflammation.
B.
Instill 4 drops in right ear every hour when required for eye inflammation.
C.
Instill 4 drops up to every hour when required for ear inflammation.
D.
Instill 4 drops in right ear every hour when required for ear inflammation.
2. dil. VI O D5W c. I O NS p.r.n. hypotension means?
64

A.
Dilute 6 pint dextrose 5 percent in water with 1 pint normal saline when required for low blood pressure.
B.
Dilute 6 fluidounce dextrose 5 percent in water with 1 fluidounce normal saline when required for low blood pressure.
C.
Dilute 6 pint dextrose 5 percent in water with 1 pint normal saline when required for high blood pressure.
D.
Dilute 6 pint dextrose 5 percent in water with 1 pint normal saline in the evening for low blood pressure.
3. inj. s.c. t.i.d. for type I diabetes and high BS means?
A.
Inject subcutaneously three times a day for type I diabetes and high blood sugar.
B.
Inject subcutaneously two times a day for type I diabetes and high blood sugar.
C.
Inject subcutaneously three times a day for type I diabetes and high blood pressure.
D.
Inject intravenously three times a day for type I diabetes and high blood sugar.
4. I gtt. o.s. q4h x 5d means?
A.
Instill 1 drop into left eye every 4 hours for 5 days.
B.
Instill 1 dropperful into left eye every 4 hours for 5 days.
C.
Instill 1 drop into left ear every 4 hours for 5 days.
D.
Instill 1 drop into left eye four times a day for 5 days.
5. I tab. p.o. q.d. for pneumonitis means?
A.
Take 1 tablet by mouth every day for kidney infection.
B.
Take 1 tablet by mouth four times daily for inflammation of the lungs.
C.
Take 1 tablet by mouth every day for inflammation of the lungs.
D.
Insert 1 tablet rectally every day for inflammation of the rectum.
6. I sup. p.r. q.i.d. p.r.n. for nausea means?
A.
Insert 1 suppository rectally 4 times daily as needed for nausea.
B.
Insert 1 suppository rectally 5 times daily as needed for nausea.
C.
Take 1 tablet by mouth 4 times daily as needed for nausea.
D.
Take 1 tablet by mouth 5 times daily as needed for nausea.
7. I tab. sl q 5 min. p.r.n. pectoralgia means?
A.
Take 1 tablet sublingually every 5 minutes as needed for chest pain.
B.
Dissolve 1 tablet in the rectum slowly for 5 minutes for chest pain.
C.
Take 1 tablet by mouth and slowly chew for 5 minutes for chest pain.
D.
Take 1 tablet sublingually every 5 minutes as needed for muscle pain.
8. 1 puff p.o. q.i.d. p.r.n. sob means?
A.
1 puff by mouth 4 times daily as needed for shortness of breath.
B.
1 puff by mouth daily as needed for shortness of breath.
C.
1 inhalation in each nostril every day as needed for depression.
D.
1 inhalation in each nostril four times daily for shortness of breath.
9. Apply ung. top b.i.d. p.r.n. erythroderma means?
A.
Apply ointment topically twice daily as needed for red skin.
B.
Apply cream topically twice daily as needed for red skin.
C.
Apply ointment on breasts twice daily as needed for red skin.
D.
Apply ointment topically twice daily as needed for dry skin.
10. Instill 1 spray into each nare bid for allergy means?
A.
Instill one spray into each ear twice daily for allergy.
B.
Instill one spray into each nostril daily for allergy.
C.
Instill one spray into each nostril daily for allergy.
D.
Instill one spray into each nostril twice daily for allergy.
65

The next 4 questions are based on the following prescription.
Dr. A. B. Normal
229 El Camino Dr
Beverly Hills, CA 90210
Ph: 210-552-0136
Date: 7/4/2000
Name: Eddie Manimal
Address: 18 Scream St, Bevery Hills, CA 90210
Rx
Norco #30
Sig: i po tid prn pain
Refill: prn
_______________________ _ A.B. Normal _________
Product Selection Permitted Dispense as Written
Use separate form for each controlled substance prescription.
Theft, unauthorized possession and/or use of this form including alterations or forgery, are crimes punishable by law.
1. What is missing from this prescription?
A.
The doctor's DPS number.
B.
The doctor's state license number.
C.
The medicine's strength.
D.
The doctor's DEA number.
2. How many refills does this prescription have?
A.
1
B.
6
C.
5
D.
prn
3. This prescription should last how many days?
A.
Less than 10 days.
B.
Less than 9 days.
C.
10 or more days.
D.
11 or more days.
4. A patient wants the generic. Can you give the patient generic?
A.
No - the doctor signed it dispensed as written.
B.
No - no generic is available.
C.
Yes - if the patient wants generic, then it is O.K.
D.
Yes - if the pharmacist calls the doctor to have it changed.
5. Which of the following are not characteristics of a medication order?
A.
The time of each order is indicated. Nurses sign and note time of actual order carried.
B.
The order may be revised if the patient's therapy changes.
C.
Allergies are recorded.
D.
Since orders are frequently changed - pencil is used.
6. Which one of the following is not a characteristic of institutional multi-dose medication labelling?
A.
Patient's name and room number.
66

B.
Drug quantity.
C.
Directions for administration.
D.
Patient's allergies.
7. If generic hydrocodone/apap is dispensed instead of the brand name Norco, which one of the following is not a proper auxilliary label?
A.
Patient's name.
B.
May cause drowsiness.
C.
Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed.
D.
Generic substituted for brand prescribed.
8. Which one of the following may not receive a verbal medication order in an institutional setting?
A. Nurse
E.
Pharmacist
F.
Supervised pharmacist intern
G.
Pharmacy technician
9. Which of the following do you not have to provide to a medical office when requesting a refill?
A. Patient's name
B. Doctor's name
C. Last fill date
H.
Patient's allergies
10. Which one of the following does not require a patient package insert?
A. Prempro
B. Ortho-Cyclen
C. Desogen
E.
Vicodin
1. I gtt. o.u. b.i.d. indicates what route of administration?
A. oral
B. ophthalmic
C. otic
E.
drops
2. Which route of administration is least likely to cause pain?
A. intramuscular
B. intradermal
C. intravenous
E.
sublingual
3. Which of the following terms do not describe sublingual nitroglycerin tablets?
A. tab.
B. systemic
C. SL
D. parenteral
4. Which of the following is not used vaginally?
A.
Vagistat cream
B.
Vagifem tablet
C.
Fleets enema
D.
Estradiol cream
67

5. Use subq as directed refers to which route of administration?
A. transdermal
B. subcutaneous
C. topical
D. urethral
6. Apply ung. top refers to which dosage form?
A. cream
B. lotion
C. powder
E.
ointment
7. III gtt. elix. t.i.d. p.r.n. refers to which medication?
A. Tylenol elixir
B. Robitussin syrup
C. Valium tablet
D. Carafate suspension
8. Which route of administration is Bactroban gel supposed to be used in?
A. sublingual
B. oral
C. subcutaneous
D. dermal
9. MDIs supply medication to which organ?
A. lungs
B. arteries
C. veins
D. skin
10. I sup. q.d. cannot refer to which dosage route?
A. vaginal
B. rectal
C. oral
D. urethral
1. What is a HEPA filter? a.
Device that filters toxins in patients without a liver b.
High efficiency particulate air filter c.
High efficiency parenteral filter d.
HEPA is the name of the company that manufactures in-line filters
2. What can PCA pumps administer? a.
Blood plasma b.
TPN c.
Cytotoxic agents d.
Morphine
3. What do you use to prep and clean a laminar flow hood?
A.
Isopropyl alcohol
B.
Distilled water
68

C.
Hydrogen peroxide
D.
Extra strength napkins
4. Which of the following steps is unnecessary when washing your hands?
A.
Remove jewelry
B.
Shave all body hair on surfaces that will enter the laminar flow hood
C.
Scrub from finger tips to elbows for 2 minutes
D.
Pat dry with a lint free paper towel
5. What should you dispose used ampules in?
A.
Sharps container
B.
Trash can
C.
Sealed cardboard box
D.
Red biological hazard trash bag
6. What is the proper order to mix TPN ingredients?
A.
Fat - dextrose - amino acids
B.
Amino acids - fat – dextrose
C.
Dextrose - fat - amino acids
D.
Fat - amino acid – dextrose
7. Which article of clothing should not be worn when preparing parenterals?
A.
Hair cover
B.
Gloves
C.
Scrubs
D.
Cardigan
8. What are Biological Safety Hoods used to prepare?
A.
TPN
B.
NS
C.
D5W
D.
Cancer Chemotherapy Agents
9. A laminar flow hood produces laminar air. What is laminar air flow?
A.
Sterile class 100 air moving in parallel sheets at 90 ft per min
B.
Air found in a laminar flow hood just after the prefilter
C.
Air that has been sprayed with a antiseptic solution
D.
Pure oxygen
10. What is shadowing?
A.
When laminar air flow to a surface that needs to be kept sterile is interrupted
B.
Watching someone else prepare an IV before you prepare one for the first time
C.
When somebody watches you make an IV for process validation
D.
When someone puts his head into the laminar flow hood while preparing a parenteral solution
69

1. What is not a requirement for compounds done in anticipation of prescription drug orders?
A.
Labelling that identifies the facilitys lot number
B.
Stability documentation
C.
There is a routine and regular prescribing pattern for the compound.
D.
The patient must pay for the compound in advance.
2. Which number indicates the largest capsule?
A.
000
B.
00
C.
0
D.
5
3. What is another name for an elixir?
A.
emulsion
B.
suspension
C.
hydroalcoholic solution
D.
tablet
4. Which of the following is not a necessary component of an emulsion?
A.
continuous phase
B.
dispersed phase
C.
emulsifier
D.
alcohol
5. Which of the following would you use to measure 15mL of water?
A.
100mL graduated cylinder
B.
20mL syringe
C.
dropper
D.
micropipette
6. Which of the following is not a proper use of a mortar and pestle?
A.
levigation
B.
trituration
C.
mixing
D.
compression molding
7. Which of the following is an improper way to use a balance?
A.
Clean weighing pans and surfaces after usage.
B.
Always use clean weighing papers or weighing boats.
C.
Adjust the zero point of the balance with weighing papers or weighing boats in place before weighing objects.
D.
Put drug powder to be weighed directly on the weighing pans.
8. Which of the following is not a possible component of a syrup?
A.
glycerin
B.
sorbitol
C.
cocoa butter
70

D.
methylparaben
9. Which of the following is not a method to make ointments and creams?
A.
levigation
B.
geometric dilution
C.
electric mortar and pestle
D.
compression molding
10. Which of the following is not a possible component of suppositories?
A.
PEG
B.
cocoa butter
C.
tragacanth
D.
vegetable oil
1. The A in ADME stands for?
A.
addition
B.
absorption
C.
attrition
D.
absolution
2. Naloxone is often used for treatment of morphine toxicity. This is because naloxone displaces morphine from opiate receptors. The pharmacological effect of morphine is caused when morphine binds to opiate receptors. What is naloxone?
A.
opiate agonist
B.
opiate antagonist
C.
morphine agonist
D.
morphine co-agonist
3. A geriatric or senior citizen is over how many years of age?
A.
50
B.
60
C.
65
D.
70
4. Maria is a neonate. Which of the following medications is appropriate for her?
A.
Vicodin Tablets
B.
Tylenol Capsules
C.
Ritalin Tablets
D.
Tylenol Syrup
5. A severe adverse reaction after prior administration of a drug is?
A.
anaphylactic reaction
B.
drug misadventure
C.
habitual reaction
D.
anxiety reation
6. Manuel takes 1 to 2 Vicodin every 6 hours as needed for pain. This is the usual dose of Vicodin, but he is experiencing drowsiness. What is Manuel experiencing?
A.
Adverse Effect
B.
Side Effect
C.
Allergy
71

D.
Drug Misadventure
7. You notice that a patient has a bottle of aspirin in his shopping basket as he is picking up his
Coumadin prescription. What should you do?
A.
Counsel the patient not to take aspirin and Coumadin together.
B.
Bring the potential drug interaction to the attention of the pharmacist.
C.
Tell the patient to be careful of potential bleeding.
D.
Ring up the sale and tell the patient to have a nice day.
8. Which of the following is not a potential drug interaction?
A.
Viagra and nitroglycerin
B.
Maalox and tetracycline
C.
Premarin and Tylenol
D.
metronidazole and alcohol
9. La Tapia Pharmacy carries hydrochloric acid for compounding purposes. What reference does
OSHA require this pharmacy to carry?
A.
USPDI
B.
Facts and Comparisons
C.
Federal Controlled Substances Act and rules
D.
MSDS
10. What is an example of a primary reference?
A.
Drug Information Handbook
B.
Facts and Comparisons
C.
Journal of the American Pharmaceutical Association
D.
Medline
1. The doctor indicated DAW on the prescription. Which of the following drugs can you not dispense without calling the doctor's office?
A.
amoxicillin
B.
Amoxil
C.
Motrin
D.
Cardizem CD
2. What is MAC?
A.
a large batch of compounds
B.
minimum allowable cost
C.
maximum allowable cost
D.
a prepaid drug order
3. Juan was injured on the job. Which third party payer do you bill?
A.
PCS
B.
United
C.
Medicare
D.
Workmans Compensation
4. Medicare
A.
is a federally funded and state administered program for low income individuals.
B.
is a federal program for seniors over 65.
C.
has an open formulary.
D.
is all of the above.
5. The HMO paid 80% of a $100 claim while the patient paid $20. What is this $20 called?
72

A.
prepay
B.
postpay
C.
deductible
D.
copay
6. A patient has to pay at least $1000 per year out-of-pocket before the third party payer will pay for medications the rest of the year. What is this $1000 called?
A.
copay
B.
deductible
C.
prepay
D.
postpay
7. A patient wants to see a doctor outside of the third party payer's network of doctors. In which type of private insurance plan is this not possible?
A.
HMO
B.
POS
C.
PPO
D.
SOL
8. A valid online insurance claim has been rejected by the third party payer. What should you do?
A.
Call their help desk and ask for an override code.
B.
Call the NDC and ask for the BIN code.
C.
Call the SOL and ask for the POS code.
D.
Tell the patient he or she has to pay cash.
9. You got a system down reject. What should you do?
A.
Call the help desk.
B.
Call the doctor.
C.
Call the pharmacist.
D.
Resubmit the claim later.
10. You got a refill too soon reject because the patient is going on vacation soon. What should you do?
A.
Call the doctor for another prescription.
B.
Call the pharmacist for help.
C.
Call the insurance company help desk to get the vacation override code.
D.
Wait a couple of minutes and resubmit the claim.
1. Which of the following drugs doesn't have to be refridgerated?
A.
Humalog
B.
Miacalcin
C.
promethazine suppositories
D.
Anusol HC suppositories
2. Which of the following is the lowest cost pharmaceutical supplier?
A.
retail pharmacy
B.
drug wholesaler
C.
hospital
D.
your company wherehouse
73

3. Under the current protocols, only generics are formulary drugs at Bethesda hospital. Which of the following drugs can be prescribed at this institution?
A.
Desogen
B.
Miacalcin nasal spray
C.
hydrocodone and acetaminophen 5-500 mg
D.
Darvocet N-100
4. Which of the following may be stored with commercial invoices of legend drugs?
A.
CII invoices
B.
CIII invoices
C.
Copy 3 of DEA order form 222C
D.
Copy 1 of DEA order form 222C
5. What is a "want list"?
A.
A list of drugs to be returned.
B.
A list of unsolved insurance problems.
C.
A list of ingredients to be used in a compound.
D.
A list of drugs to be ordered.
6. What is considered room temperature with regard to storage of pharmaceuticals?
A.
30 to 40 deg C
B.
15 to 30 deg C
C.
2 to 8 deg C
D.
-20 to -10 deg C
7. Which of the following is an improper place to store an aspirin tablet?
A.
point of use station
B.
medicine cart
C.
shelf
D.
refridgerator
8. Which of the following doesn't have to be on the packaging of a unit dose ampule of morphine?
A.
medicine name
B.
strength
C.
expiration date
D.
price
9. Which of the following drugs do not have to be returned to the manufacturer?
A.
expensive drug
B.
expired drug
C.
recalled drug
D.
drug with low turnover rate
10. The speed at which an item in inventory is used up is?
A.
turnover rate
B.
fast
C.
slow
D.
usage rate
74

1. Which of the following jobs can a pharmacy technician do?
A.
Receive new telephoned RXs from prescribers
B.
Override DUR messages without consulting Rph
C.
Counsel patients on OTC medication therapy
D.
Affix the prescription label to RX vial or bottle
2. Which of the following jobs can a pharmacy clerk do?
A.
Obtain medical info and profiles from patients
B.
Call prescribers for refill authorization
C.
Count and pour medication into RX vials and bottles
D.
Accept refill authorization from prescribers
3. Juan is a pharmacist preceptor at Bob's Guns and Drugs. Which of the following is not a required license or certificate at this pharmacy?
A.
Pharmacy license
B.
DEA registration certificate
C.
preceptor certificate
D.
FDA registration certificate
4. You need to throw away a used needle. Which container do you discard it in?
A.
biohazard bag
B.
black plastic trash bag
C.
recyling trash can
D.
sharps container
5. You accidentally splashed some chemicals in your eye. What should you do?
A.
Put a couple drops of lubricant eye drops in your eye.
B.
Use an eye wash.
C.
Wash the eye with soap and water.
D.
Shut the eye really hard to induce tear production.
6. Which of the following should be certified every six months?
A.
HEPA filter
B.
mortar and pestle
C.
graduated cylinder
D.
pharmacy technician national certification
7. With which of the following can you not share information on a patient?
A.
HMO
B.
Doctor
C.
Pharmacist
D.
State Board of Pharmacy
8. Serious adverse drug events are reported to what agency?
A.
DEA
B.
DPS
C.
FDA
D.
HMO
9. Which of the following can a pharmacy clerk not do?
A.
Accept refill requests from patients
B.
Maintenance of pharmacy such as cleaning - removal of expired drugs from shelves - restocking supplies - etc.
C.
Order - check in - and shelve RX and OTC drugs
D.
Affix auxillary labels to RX vials and bottles
75

10. Which of the following can a pharmacy technician not do?
A.
Enter refill numbers in the computer
B.
Reconstitute solid preparations into liquids
C.
Pull medication from stock for purpose of dispensing
D.
Transfer RXs between pharmacies
1.
ss f = 1 f x 30 ml = 30 ml = 15 ml
2 1 f 2
2.
14.18
g x 1 oz = 14.18
oz = 1 oz = 0.5
oz
28.35
g 28.35 2
76

3.
4.
5.
Iss oz = 1.5
oz x 28.35
g = 43 g
1 oz
2 1 cc = 7 cc x 1 ml x 1 f = 7 f = 0.078 f
3 3 1 cc 30 ml 90
First, convert both numbers to fractions with a common denominator and the same unit.
32.5
mg x _1 gr = 32.5
gr = 1 gr
65 mg 65 2
91 gr = 19 gr
2 2
Then, solve the problem.
19 gr - 1 gr = 18 gr = 9 gr
2 2 2
6.
7.
First, determine which formula you are going to use.
F temp = (9 * C temp ) + 32
5
Then, plug in the numbers to solve the equation.
( 9 *
5°C
) + 32 = ( 45°C ) + 32 =
9°C
+ 32 =
41°F
5 5
First, determine the common denominator. Compute the prime numbers that comprise both denominators.
4 = 2 * 2
77

8 = 2 * 2 * 2
In order to get both denominators to equal each other, you clearly have to multiply 4 by 2 .
2 * 2 * 2 = 8
Therefore,
1 * 2 = 2
4 2 8
Then, add the numbers.
2 + 1 1 = 1 3
8 8 8
8 .
7
÷
3 = 7 x 1 = 7
8 1 8 3 24
9 .
0.08 = __8 = 2 x 2 x 2 = 2
100 2 x 2 x 5 x 5 25
10.
28 is XXVIII in roman numerals.
1.
 Problem - A medication order for a patient weighing 176 lb calls for 400 µg antibiotic per kg of body weight to be added to 400 mL of isotonic dextrose solution. If the drug is to be obtained from a solution containing 5 mg per 10 mL, how many milliliters should be added to the dextrose solution?
 Known variables; 400 µg antibiotic dose/kg body weight, 176 lb body weight, 400 mL isotonic dextrose solution (this is not a useful variable, it was just thrown in to confuse you) ,
5 mg/10 mL antibiotic source
 Unknown variable: X mL of antibiotic added to the dextrose solution.
 Conversion factors; 1 kg/2.2 lb, 1 mg/1000 µg.
 Solution:
176 lb x 1 kg x 400 µg x 1 mg x 10 mL = 64 mL
78

2.2 lb 1 kg
1000 µg
5 mg
2.
 Problem - A pycnometer weighs 25.0 g. When filled with a liquid (S.G.=1.25) it weighs
85.0 g. How many ml of water will the pycnometer hold?
 Specific Gravity & Density - In order to do this problem, you need to understand specific gravity and density. Density is the mass per unit volume of a substance. It is usually expressed as g per mL. Specific gravity is a ratio, expressed with decimals, of the weight of a substance to the weight of an equal volume of another substance (usually water) chosen as a
 standard. Both substances have to be at the same temperature or the temperature of both substances has to be known. Because the units cancel out when calculating the specific gravity, it is a dimensionless number. This means that it is a number without a unit.
Known variables; 85.0 g (weight of pycnometer and liquid) - 25.0 g (weight of liquid =
60.0 g (weight of liquid). Therefore, the known variables are; 60.0 g liquid weight, 1.25 g
 liquid/1 g water.
 Unknown variable: X mL of water.
Proportion and ratio: - Since there are three known variables and one unknown variable, the proportion and ratio method is used.
 Solution:
60.0 g liquid = 1.25 g liquid
X g water 1.0 g water
60.0 g liquid x 1.0 g water = X g water
1.25 g liquid
The grams of liquid in the numerator and denominator cancel each other out.
X = 48.0 g water = 48.0 mL water
Since one g water = 1 ml of water, the anwer is
48.0 mL of water.
3.
1.
Problem - On a prescription balance having a sensitivity requirement of 0.018 g what is the smallest amount that can be weighed with a maximum potential error of not more than 10%.
79

2.
Known variables; 0.018 g Sensitivity Requirement, 10% Permissible Percentage of Error
3.
Unknown variable: X g Smallest Amount Weighable
4.
Formula - In order for you to do this problem, you have to know the Percentage of error formula: (Sensitivity Requirement x 100%)/Permissible Percentage of Error = Smallest
Amount Weighable
5.
Solution:
0.018 g x 100% = 0.18 g
10%
4.
 Problem - How many ml are left in a 800 ml bottle of elixir after a pharmacist dispenses a prescription with direction; 2 tablespoonfuls qid for 3 days followed by 3 teaspoonfuls tid for
5 days?
 Known Variables - First 3 days; 2 tbsp, 4 times a day, 3 days. Next 5 days; 3 tbsp, 3 times a
 day, 5 days. 800 mL bottle.
 Unknown Variable: X mL left
Conversion Factors; 15 mL/1 tbsp, 5 mL/1 tsp.
 Solution:
15 mL x 2 tbsp x 4 times x 3 days = 360 mL
1 tbsp time day
5 mL x 3 tsp x 3 times x 5 days = 225 mL
1 tsp time day
360 mL + 225 mL = 585 mL
800 mL - 585 mL = 215 mL
5.





Problem - If the dispensing dropper calibrates 20 drops per mL, how many mg of atropine sulfate should be used in compounding the following prescription?
Known Variables; 1/2000 gr = 0.0005 gr = 4 drops, 20 drops/mL, 50 mL atropine sulfate, 4 drops/feeding was just thrown in to confuse you
Unknown Variable: X mg of atropine sulfate
Conversion Factor: 65 mg/gr
Solution:
65 mg x 0.0005 gr x 20 gtts x 50 mL = 8.125 mg
1 gr 4 gtts 1 mL
80

6.
 Problem - From the following formula, calculate the quantity of cold cream in g required to make 2 lb of the ointment.
Vioform Powder
Hydrocortisone Powder
Cold Cream ad
0.2g
0.6g
20.0g

Known Variables; 2 lb ointment, 0.2 g vioform powder, 0.6 g hydrocortisone powder, ad
20.0 g cold cream.

Conversion Factor: 1000 g/2.2 lb

Unknown Variable: X g cold cream.

Solution:
2 lb ointment x 1000 g = 909 g ointment
2.2 lb
0.2 g vioform powder = Y g vioform powder
20.0 g cold cream 909 g ointment
0.2 g x 909 g = Y g
20.0 g
Y = 9.09 g vioform powder
0.6 g hydrocortisone powder = Z g hydrocortisone powder
20.0 g cold cream 909 g ointment
0.6 g x 909 g = Z g
20.0 g
Z = 27.27 g hydrocortisone powder
909 g ointment - 9.09 g - 27.27 g = 873 g cold cream
7.
 Problem - A sunscreen lotion contains 5 g of methyl salicylate (specific gravity = 1.05) per
100 mL. How many grams of methyl salicylate should be used in preparing 1 gallon of the lotion?
 Known Variables; 5 g methyl salicylate/100 mL sunscreen lotion, 1 gallon sunscreen lotion,
1.05 methyl salicylate specific gravity (not a useful variable, just thrown in to confuse you).
 Conversion Factor: 3785 mL = 1 gallon
 Unknown Variable: X g of methyl salicylate
81

 Solution:
5 g methyl salicylate = X g methyl salicylate
100 mL sunscreen 3785 mL sunscreen
5 g x 3785 mL = X g
100 mL
X = 189 g methyl salicylate
8.
 Problem - How many fluid ounces remain in a bottle containing 2 pints of medication when
 f iss, f iv, and f xiiss have been used to fill 3 Rx’s?
Known Variables; 2 pints medication and prescriptions using 1.5 fluidounce, 4 fluidrams, and 12.5 fluidounce, respectively.
 Conversion Factors; 16 fluidounce/1 pint, 1 fluidounce/8 fluidram.
 Unknown Variable: X fluidounce medication left
 Solution:
2 pint x 16 fluidounce = 32 fluidounce
1 pint
4 fluidram x 1 fluidounce = 0.5 fluidounce
8 fluidram
32 fluidounce - 1.5 - 0.5
- 12.5 = 17.5 fluidounce
9.
 Problem - How many 25 mcg doses of levothyroxin can be obtained from 0.6 g of the drug?
 Known Variables; 25 mcg dose of levothyroxin, 0.6 g of levothyroxin.
 Conversion Factor: 1 mcg/0.000001 g
 Unknown Variable: number of doses of levothyroxin
 Solution:
0.6 g x 1 mcg = 600,000 mcg
0.000001 g
600,000 mcg = 24,000 doses
25 mcg
10.
 Problem - How many grains of zinc oxide would be present in vi of the following ointment?
82

Rx
Ft. Ung.
Sig. Apply Nocte.
ZnO
Starch
Kaolin
Petrolatum
80 g
50 g
270 g
800 g
 Known Variables; 80 g ZnO, 50 g starch, 270 g Kaolin, 800 g Petrolatum, 6 ointment.



Conversion Factor:
Unknown Variable:
Solution:
20 gr/1
X gr ZnO in 6 ointment
80 g + 50 g + 270 g + 800 g = 1200 g ointment
6 x 20 gr = 120 gr
1
80 g = X gr
1200 g 120 gr
80 g x 120 gr = X gr
1200 g
X = 8 gr zinc oxide
1.



 Problem - How much water should be added to 50 mL of a 1:20 stock solution of a chemical
 such that 10 mL diluted to a liter gives 1:10,000?
Known variables; Solution A; 50 mL, 1:20 = 5% = 0.05 concentration.
Solution B; 1:10000 g/mL concentration, 1 L = 1000 mL.
Unknown variables;
Formula:
Solution:
Solution C; concentration and volume unknown.
quantity x concentration = quantity x concentration
83

50 mL x 0.05
= quantity Cq x concentration Cc
X g = 1 g
1000 mL 10,000 mL
1 g x 1000 mL = X
10,000 mL
X = 0.10 g
0.10 g = Y
10 mL 100 mL
Y = 1 g
Cc = 1 g = 0.01
100 mL
50 mL x 0.05 = Cq x 0.01
50 mL x 0.05 = Cq
0.01
Cq = 250 mL
250 mL - 50 mL = 200 mL
2.
 Problem - How many mL of 1:500 stock solution of KCl should be used in compounding 30 mL of a 0.2% KCl solution?
 Known variables; Stock Solution: 1:500 g/mL = 1/500 g/mL = 0.002 g/mL.
Compound; 30 mL, 0.2% concentration = 0.2/100 g/mL = 0.002 g/mL.
 Unknown variable: X mL of stock solution used.
 Formula: - quantity x concentration = quantity x concentration
 Solution:
84

30 mL x 0.002 g/mL = X mL x 0.002 g/mL
30 mL x 0.002 g/mL = X
0.002 g/mL
X = 30 mL
Therefore, the stock solution is used and no compounding has to be done.
3.
1.
Problem: How many mL of a 1:50 solution of sodium chloride are required to make 2.5 L of a 1:5000 solution?
2.
Known variables; 1:50 concentration NaCl , 2.5 L of 1:5000 concentration NaCl.
3.
Unknown variable: X mL of 1:50 concentration NaCl.
4.
Formula: quantity x concentration = quantity x concentration
5.
Solution:
1:50 = 1 ÷ 50 = 0.02
1:5000 = 1 ÷ 5000 = 0.0002
2.5 L = 2.5 L x 1000 mL/L = 2500 mL
X ( 0.02
) = ( 2500 mL ) ( 0.0002
)
2500 mL x 0.0002
= X
0.02
X = 25 mL
4.
 Problem - How many mL of 85% (v/v) alcohol and how much water should be used in compounding the following prescription?
Rx Citric Acid 2.0 g
Alcohol 60% 40 mL
Sig. Drink.
85

 Known Variables; 40 mL of 60% alcohol. 85% alcohol.
 Unknown Variable: X mL of 85% alcohol.
 Formula: quantity x concentration = quantity x concentration
 Solution:
85% = 85 ÷ 100 = 0.85
60% = 60 ÷ 100 = 0.60
X mL ( 0.85
) = (40 mL) ( 0.60
)
(40 mL) ( 0.60
) = X
0.85
X = 28 mL
Measure 28 mL of 85% alcohol and q.s. to 40 mL with water to make 40 mL of 60% alcohol.
5.





Problem - You are requested to prepare 300 mL of sulfuric acid solution, 20% w/v. How many mL of a concentrated sulfuric acid solution (80% w/w; SG = 1.8) should be used?
Known Variables; % w/v of dil acid = 20%, mL dil acid = 300 mL, % w/w of conc acid =
80%, SG of conc acid = 1.8.
Unknown Variable: X = mL conc acid
Formula: ( mL dil acid ) ( % w/v ) = ( mL conc acid ) ( % w/w ) ( SG )
Solution:
(300 mL) (20%) = X (80%) (1.8)
(300 mL) (20%) = X
(80%) (1.8)
X = 42 mL
6.
 Problem: You are presented with a vial containing 40 mL of magnesium sulfate injection. If the injection contains 40% MgSo4*7H2O, How many mEq of magnesium are present in each mL of solution: The M.W. of MgSO4*7H2O is 246. M.W. of MgSO4 is 120. Atomic
 weight of magnesium is 24.
Known Variables; M.W. of MgSo4*7H2O = 246 g, valence = 2 (Mg has a +2 charge and
SO4 has a -2 charge), 1 mL of 40% MgSO4*7H2O.
 Unknown Variables; X = g/mL of MgSO4*7H2O, Y = mEq in 1 mL of 40%
MgSO4*7H2O.
 Solution:
86

40% MgSO4*7H2O = 40 g/100 mL
M.W. = 246 equivalent weight = 246 ÷ 2 = 123 milliequivalent weight = 0.123 g
40 g = X
100 mL 1 mL
40 g x 1 mL = X
100 mL
X = 0.4 g
Y = 1 mEq
0.4 g 0.123 g
1 mEq x 0.4 g = Y
0.123 g
Y = 3.25 mEq
7.


 Problem: How many mEq of Na+ ion are present in 200 mL of isotonic saline? (At. Wt. of
Na+ = 23 and Cl- = 35.5).
 Known Variable: 200 mL isotonic saline.
 Constants; Isotonic saline has a concentration of 0.9 g/100 mL, At. Wt. of Na+ = 23, M.W. of NaCl = 58.5.
Unknown Variables; X = g NaCl, Y = g Na+, Z = mEq Na+
Solution:
0.9 g = X g NaCl
87

100 mL 200 mL
0.9 g x 200 mL = X
100 mL
X = 1.80 g NaCl
Y g Na+ = 23 g Na+
1.80 g NaCl 58.5 g NaCl
23 g Na+ x 1.80 g NaCl = Y
58.5 g NaCl
Y = 0.708 g Na+
Na+ At.Wt. = 23
Na+ equivalent weight = 23 ÷
1
1 is the valence of Na+. In other words, Na+ has a
+1 charge.
Na+ milliequivalent weight = 23 ÷ 1000 =
0.023 g
1 mEq = Z mEq
0.023 g Na+ 0.708 g Na+
1 mEq x 0.708 g Na+ = Z
0.023 g Na+
Z = 30.8 mEq
8.


Problem: Convert 100 mg % into a ratio strength.
 Known Variable: 100 mg % = 100 mg/100 mL
Conversion Factor: 1 g = 1000 mg
 Unknown Variable: ratio strength of 100 mg %
 Solution:
100 mg x 1 g = 0.1 g
1000 mg
88

100 mg = 0.1 g x 10 = 1 g
100 mL 100 mL x 10 1000 mL
1:1000 ratio strength
9.
 Problem: Convert 2 mg/mL to ppm.
 Known Variable: 2 mg/mL Conversion Factor: 1 g/1000 mg
 Unknown Variable: Y = ppm
 Solution:
2 mg x 1 g = 0.002 g
1000 mg
2 mg = 0.002 g mL mL
0.002 g = X g
1 mL 1,000,000 mL
0.002 g x 1,000,000 mL = X
1 mL
X = 2000 ppm
10.
 Problem: Convert 1:10,000 into mcg/mL.
 Known Variable: 1:10,000 concentration Conversion Factor: 1,000,000 mcg/1 g
 Unknown Variable: X = mcg/mL
 Solution:
1 g = X g
10,000 mL 1 mL
1 g x 1 mL = X
10,000 mL
X = 0.0001 g x 1,000,000 mcg = 100 mcg/mL
mL 1g
1.
89

2.





Problem - Manuel is 10 months old. He was prescribed amoxicillin 30 mg/kg/day, given three times a day. Manuel weighs 25 lbs. Amoxicillin has a concentration of 250 mg/5 mL.
How many teaspoons are in each dose?
Known variables; 30 mg/kg/d dose, given 3 times/d, 25 lb infant, 250 mg/5 mL concentration of amoxicillin.
Unknown variable: X teaspoons of amoxicillin per dose
Conversion factors; 1 kg/2.2 lbs, 1 tsp/5 mL
Solution:
30 mg x 1 kg x 25 lbs = 341 mg per day
kg 2.2 lbs
341 mg ÷ 3 = 114 mg per dose
Since 341 mg of amoxicillin is the daily dose, you have to divide 341 mg by 3 to get the mg per dose since amoxicillin is dosed 3 times a day.
114 mg x 5 mL x 1 tsp = 0.456 tsp per dose
250 mg 5 mL
Since it is very difficult for the patient to measure
0.456 tsp, we approximate the dose to be 1/2 teaspoon.
3.
 Problem - An infusion containing 50 mg of antibiotic in 30 mL of sterile water for injection is added to 450 mL of isotonic saline. If the infusion is injected over an 8 hour period and the dropper for the venoclysis set delivers 20 drops/mL, calculate the flow rate in drops per minute.
 Known variables; 450 mL isotonic saline, 30 mL sterile water for injection , 8 hr, 20
 gtts/mL.
 Unknown variable: X gtts/min
Conversion factor: 1 hr/60 min
 Solution:
450 mL + 30 mL = 480 mL
480 mL x 1 hr x 20 gtts = 20 gtts/min
8 hr 60 min mL
1.
Problem: If 500 mL of a parenteral fluid is to be infused over a 6 hour period using an infusion set which delivers 25 drops per milliliter, what should be the rate of flow in drops per minute?
90

2.
Known variables; 500 mL/6 hr, 25 gtts/mL
3.
Unknown variable: X gtts/min
4.
Conversion factor: 1 hr/60 min
5.
Solution:
500 mL x 25 gtts x 1 hr = 34.7 gtts/min
6 hrs mL 60 min
4.
 Problem: How many mL of digoxin injection 0.1 mg/mL would be in a 150 mcg dose?
 Known Variables; 0.1 mg/mL, 150 mcg dose
 Unknown Variable: X mL of dose
 Conversion Factor: 1 mg/1000 mcg
 Solution:
150 mcg x 1 mg = 0.150 mg
1000 mcg
0.1 mg = 0.150 mg
mL X mL
X = 1.5 mL
5.
 Problem: A pharmacist sells vitamin tablets at $3.50 thereby realizing a markup of 40% on the cost. Calculate the cost of the tablets.
 Known Variables; 40% markup, $3.50 price
 Unknown Variable: $X cost
 Formula: Cost (1 + markup on cost expressed as a decimal) = price
 Solution:
40% markup on cost = 0.4
X (1 + 0.4
) = $3.50
$3.50 = X
(1 + 0.4
)
X = $2.50 cost
91

6.
 Problem: What would be the selling price of a bottle of cough syrup if it costs $2.40 a bottle
 and the gross profit based on the selling price is 25%?
 Known Variables; 25% gross profit based on selling price, $2.40 cost.
Unknown Variable: $X price
 Formula: price (1 - gross profit based on price as a decimal) = cost
 Solution:
25% gross profit based on price = 0.25
X (1 0.25
) = $2.40
$2.40 = X
(1 - 0.25
)
X = $3.20 price
7.




Problem: A prescription calls for 20 g of epinephrine bitartrate. If 10 g of epinephrine bitartrate cost $9.00, what is the cost of the amount needed in the prescription?
Known Variables; $9/10 g epinephrine, 20 g epinephrine
Unknown Variable: $X epinephrine cost
Solution:
X = $9
20 g 10 g
( 20 g x $9) = X
10 g
X = $18 cost
8.


 Problem: A drug costs $25 and sells for $30. What is the percent markup based on cost?
 Known Variables: $25 cost, $30 price
 Unknown Variable: X% markup based on cost
Formula: markup/cost = % markup on cost
Solution:
$30 price - $25 cost = $5 markup
$5 = 0.2 = 20% markup on cost
92

$25
9.


 Problem: How many grams of petrolatum must be mixed with 16 g of 30% zinc oxide ointment in order to prepare a 5% zinc oxide ointment?
 Known Variable: 16 g 30% zinc oxide ointment (ingredient) , 0% zinc oxide ointment or petrolatum ointment base (ingredient) , 5% zinc oxide ointment (product)
Unknown Variable: X g 0% zinc oxide ointment or petrolatum ointment base
Solution:
1. Take the difference between the concentration of the ingredients and the product.
30% - 5% = 25 parts petrolatum ointment base
5% - 0% = 5 parts 30% zinc oxide ointment
This yields a ratio of 5 : 25 parts 30% zinc oxide ointment to petrolatum ointment base .
2. Reduce this ratio to 1 : 5 as both 5 and 25 are divisible by 5.
3. Use a proportion to solve the problem.
16 g = X g
1 part 5 parts
16 g x 5 parts = X
93

1 part
X = 80 g petrolatum ointment base
10.
 Problem: How many grams of coal tar should be added to 400 g of 10% coal tar ointment to prepare an ointment containing 25% coal tar?
 Known Variables; 100% pure coal tar (ingredient) , 400 g of 10% coal tar ointment
(ingredient) , 25% coal tar ointment (product) .
 Unknown Variable: X g 100% pure coal tar
 Solution:
1. Take the difference between the concentration of the ingredients and the product.
100% - 25% = 75 parts 10% coal tar ointment
25% - 10% = 15 parts 100% pure coal tar
This yields a ratio of 15 : 75 parts 100% pure coal tar to 10% coal tar ointment .
2. Reduce this ratio to 1 : 5 as both 15 and 75 are divisible by 15.
3. Use a proportion to solve the problem.
400 g = X g
5 parts 1 part
400 g x 1 part = X
5 parts
X = 80 g coal tar
94

1. The expiration month marked on a stock bottle indicates the expiration date to be after the last day of that month.
2. There are 3 classes of recalls. 1. Strong probability of causing serious adverse effects or death. 2.
Temporary but reversible adverse effects or low probability of serious adverse effects. 3. Unlikely to cause adverse effects.
3. All prescription drug labels have to have the name and address of the pharmacy - name of physician - name of patient - date filled - prescription number - directions for use and cautionary statements.
4. The first 5 digits indicate the manufacturer. The next 4 digits indicate the drug name - strength and dosage form. The last 2 digits indicate the package size.
5. Therapeutically equivalent generics have to have the same active ingredients and the same therapeutic effects
6. Pentazosine or Talwin is a narcotic analgesic. Oxaprozin - diclofenac and Motrin are NSAIDS.
7. FDC requires new drugs to prove safe before marketing. OBRA required pharmacists to counsel
Medicaid patients. FDA Modernization Act changed legend requirement to -Rx only- by Feb 2003.
The CSA established the DEA.
8. The DEA - DPS - and TSBP require prescription records be kept for 2 yrs. Medicaid and
Medicare for 3 yrs. However - criminal statute of limitations is 5 yrs - so better keep records for 5 yrs.
9. The sum of the 1st - 3rd and 5th digits is added to twice the sum of the 2nd - 4th - and 6th digits.
The last digit of the result should be the same as the last digit of the DEA number.
10. Pentazosine is a C IV. amphetamine - oxycodone and oxycodone with acetaminophen are CIIs.
1. IV gtt. a.d. q.h. prn. otitis means Instill 4 drops in right ear every hour when required for ear inflammation. If you are confused about roman numerals - then read the Pharmaceutical
Calculations - Basic Concepts Lesson.
2. dil. VI O D5W c. I O NS p.r.n. hypotension means Dilute 6 pint dextrose 5 percent in water with
1 pint normal saline when required for low blood pressure. If you are confused about the apothecary system of measurement - then read the Pharmaceutical Calculations - Basic Concepts Lesson.
3. inj. s.c. t.i.d. for type I diabetes and high BS means Inject subcutaneously three times a day for type I diabetes and high blood sugar.
4. I gtt. o.s. q4h x 5d means Instill 1 drop into left eye every 4 hours for 5 days.
95

5.I tab. p.o. q.d. for pneumonitis means Take 1 tablet by mouth every day for inflammation of the lungs.
6. I sup. p.r. q.i.d. p.r.n. for nausea means Insert 1 suppository rectally 4 times daily as needed for nausea.
7. I tab. sl q 5 min. p.r.n. pectoralgia means Take 1 tablet sublingually every 5 minutes as needed for chest pain.
8. 1 puff p.o. q.i.d. p.r.n. sob means 1 puff by mouth 4 times daily as needed for shortness of breath.
9. Apply ung. top b.i.d. p.r.n. erythroderma means apply ointment topically twice daily as needed for red skin.
10. Instill 1 spray into each nare bid for allergy means instill one spray into each nostril twice daily for allergy.
1. The doctors DEA number is required on all controlled substance prescriptions. Since there is only
1 strength for Norco - the strength is not required on the prescription.
2. CIII-V prescriptions are valid for 6 months and may be filled a total of 6 times. This means that the patient gets 5 refills.
3. 30 tablets taken three times daily is a 10 day supply. Therefore - the prescription should last 10 or more days.
4. The prescription was signed dispense as written. Therefore - the pharmacist has to call the doctor to change the prescription. New prescriptions and changes to prescriptions on the phone should always be handled by the pharmacist.
5. Medication orders are always written in black ink.
6. The patients allergies is not a characteristic of intitutional multi-dose medication labelling.
7. The patients name should go on the main prescription label - not the auxilliary label.
8. Only pharmacists - supervised pharmacy interns and nurses may receive medication orders in an institutional setting.
9. You do not have to provide the patients allergies when requesting a refill from a medical office.
10. Vicodin does not require a patient package insert. Only oral contraceptives - estrogenic drugs - progesteronal drugs - isotretinoin - IUDs and isoproterenol inhalation drugs require a patient package insert.
96

1. o.u. indicates an opthalmic route of administration.
2. Intramuscular - intradermal - and intravenous routes of administration are all parenteral. These routes all use needles and cause pain. Sublingual means under the tongue.
3. Parenteral means by any route other than oral - sublingual - or rectal.
4. Suppositories - ointments - creams - aerosol foams - IUD - tablets - and contraceptive sponges are used vaginally. However - enemas are used rectally.
5. Subq means subcutaneous.
6. Ung. means ointment.
7. Elix. means elixir.
8. Gels are usually administered topically. Dermal means topically on the skin.
9. MDI means metered dose inhaler. An inhaler supplies medication to the lungs usually as an aerosol.
10. Suppositories can be administered vaginally - rectally - or via the urethra. However - suppositories could not be administered orally.
1. A HEPA filter is a high efficiency particulate air filter that filters particulates over 0.5 microns.
2. Patient Controlled Analgesia or PCA pumps are for patient controlled on demand administration of narcotics.
3. Isopropyl alcohol is the standard antiseptic used to clean laminar flow hoods.
4. It is not necessary to shave your hands and arms when washing your hands.
5. One should always dispose sharp objects such as a used ampule in a sharps container.
6. Proper order of mixing TPN ingredients is... fat - amino acids - dextrose or dextrose - amino acids
- fat. This is because mixing fat and dextrose back-to-back will cause the dextrose to break the fat emulsion.
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7. A cardigan may lint. Lint-free clothing must be worn while preparing parenterals.
8. Biological Safety Hoods are used to prepare hazardous drugs such as cytotoxic cancer chemotherapy agents.
9. Laminar air is sterile class 100 air moving in parallel sheets at 90 ft per min.
10. Shadowing is when laminar air flow to a surface that needs to be kept sterile is interrupted. This causes such a surface to become non-sterile.
1. It is not required by law that a patient must pay for a compound in advance. However - compounds done in advance must be properly labelled - the stability must be documented - and there must be a pattern of prescriptions for the compound.
2. Sizes include 000 - 00 - 0 - 1 - 2 - 3 - 4 - and 5. The smaller number - the larger the volume. 000 indicates the largest capsules while 5 indicates the smallest capsules.
3. Hydroalcoholic solution is another name for elixir.
4. The three components of an emulsion are dispersed phase or internal discontinuous phase - dipersion medium or external continuous phase - and emulsifying agent.
5. 15mL of water is best measured with a 20mL syringe. A 100mL graduated cylinder is too big as the 15mL to be measured is smaller than 20 percent of its capacity. This will result in erroneous measurements. Droppers and micropipettes are too small.
6. Compression molding is not a proper use of a mortar and pestle. Compression molding is a technique used to make suppositories. Levigation - trituration - and mixing are all proper uses of a mortar and pestle.
7. Putting drug powder to be weighed directly on the weighing pan without weighing papers or weighing boats will dirty the weighing pans - lose drug to porous surfaces - and may scratch the weighing pan.
8. Cocoa butter is not a possible component of a syrup. It is a possible component of suppositories.
9. Compression molding is not a method to make ointments and creams. It is a method used to make suppositories.
10. Tragacanth is not a possible component of suppositories. It is a suspending agent used in making suspensions.
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1. ADME is an acronym for absorption - distribution - metabolism - and excretion.
2. Morphine causes its pharmacological effect by binding opiate receptors. Morphine is an opiate agonist. Naloxone blocks these receptors to block the pharmacological effect of morphine. Naloxone is an opiate antagonist.
3. A geriatric or senior citizen is over 65 years of age.
4. Neonates are up to 28 days old. Neonates cannot swallow tablets or capsules. The only appropriate medicine in the group would be Tylenol Syrup.
5. A severe adverse reaction after prior administration of a drug is an anaphylactic reaction.
6. A side effect is an adverse effect that is present at the usual therapeutic dose.
7. There is a drug interaction between aspirin and Coumadin that may cause hemorrhage. However - only a pharmacist can legally counsel patients.
8. There is no potential drug interaction between Premarin and Tylenol.
9. OSHA requires pharmacies that carry hazardous chemicals to carry MSDS or material safety data sheets for every hazardous chemical that the pharmacy carries.
10. Primary references are professional journal articles such as those found in the Journal of the
American Pharmaceutical Association.
1. DAW means dispense as written. This means that the pharmacist should give the patient the brand name medication instead of the generic. Amoxicillin is the generic for Amoxil. Motrin and
Cardizem CD are also brand name medications.
2. MAC stands for maximum allowable cost. This is the maximum cost for a particular drug that the pharmacy is allowed to bill the insurance company for.
3. Workmans Compensation is a federal program that outlines the compensation for employees injured on the job.
4. Medicare is a federally funded medical insurance program for seniors over age 65 - the disabled - and those with kidney failure.
5. After the third party payer pays its share of the claim - the remaining sum that the patient pays for medication is called the copay.
6. A deductible is an amount that the patient has to pay before the insurer will pay for medicines the rest of the year.
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7. In an HMO - medical costs are covered inside the network of providers - but not outside.
8. If a valid claim is rejected - calling the help desk may get you an override code that will allow the claim to go through.
9. A system down reject simply means that the insurance company computer is temporarily down.
Just resubmit the claim later.
10. If you get a refill too soon reject because a patient is going on a vacation - call the insurance company help desk for a vacation override code.
1. Humalog - Miacalcin nasal spray - promethazine suppositories - and Xalatan eye drops should all be stored in the refridgerator. However - Anusol HC suppositories can be stored at room temperature.
2. In order from highest to lowest cost pharmaceutical supplier. Another pharmacy - drug wholesaler
- co-op buying club or your company wherehouse - manufacturer. There is very little sales from the manufacturer to the pharmacy as manufacturers usually only deal in large volume sales to wholesalers.
3. Since only generics are on the formulary - only generic Vicodin or hydrocodone and acetaminophen 5-500 mg can be used.
4. CII invoices and copy 3 of DEA order form 222C has to be filed separately from CIII-V invoices.
CIII-V invoices may be filed with commercial invoices of legend drugs.
5. A want list is a list of drugs to be ordered.
6. 15 to 30 deg C is room temperature with regard to storage of pharmaceuticals.
7. If you store an aspirin tablet in the refridgerator at 2 to 8 deg C - condensation will form on the aspirin tablet. This will wet the tablet and compromise its integrity.
8. All unit dose packaging has to have the medicine name - strength - and expiration date on it.
However - the price of medicines do not have to be on unit dose packaging.
9. All expires - discontinues - recalls - and drugs with a low turnover rate have to be returned.
10. The turnover rate if the speed at which an item in inventory is used up.
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1. A pharmacy technician can affix the prescription label to RX vial or bottle. All of the other jobs mentioned can only be done by a pharmacist.
2. A pharmacy clerk can obtain medical info and profiles from patients. All of the other jobs are for technicians or pharmacists.
3. Pharmacies are not required to be registered with the FDA. A pharmacy needs to have a pharmacy license and DEA registration. Also - all preceptors have to be certified.
4. Any sharp objects should always be discarded in a sharps container.
5. If you get harmful chemicals in your eye - immediately put your eye into a stream of clean water such as a faucet - eye wash - or container of clean water for at least 15 minutes.
6. The HEPA filter in a laminar flow hood should be certified every six months.
7. Unless the patient gives you permission to do so - you cannot share confidential patient information with an insurance company or HMO.
8. Serious adverse drug events are reported to the FDA.
9. Only pharmacists and technicians are allowed to affix auxillary labels to RX vials and bottles.
10. Pharmacy technicians are not allowed to transfer RXs between pharmacies.
Since the first day of our education, we’ve been fed the paradigm that we can only comprehend one word at a time. As a result, studying large volumes of info can prove to be quite a monumental task.
However, new educational research shows that it is possible to mentally photograph an entire page at a time. Notice I did not say that you could read an entire page at a time. You could comprehend an entire page at once by using the underutilized subconscious portion of your brain. Research shows that most people only use less than 10% of their brain. Therefore, you can learn to become 10 times smarter just by tapping into the underutilized parts of your mind. You might be surprised to find that tapping into the underutilized subconscious will allow you to make better grades while decreasing your study time.
Clearly state your goal for each study session. Studying without a goal is like driving a car without knowing your destination. Your brain needs a mental destination for each study session.
Relax your body while keeping your mind alert. Do whatever is necessary to get into “the zone”. If your household is noisy and full of distractions (phone, kids, spouse), then go to a quiet place such as your local library. I invite you to remember when you were a kid, what place/thing made you feel
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peaceful and safe? As you experience that again, you might be surprised to find yourself… totally relaxed. I also find that some soft music with a subsequent face washing helps me relax.
Doing so will allow you to judge which areas are worth studying in more detail and which areas you don’t need to go over as you already know them. This is a real time-saver. Read the titles, headings, and keywords. Examples of keywords are words in bold or italics.
I invite you to imagine yourself, tomorrow, remembering and understanding everything that you’re about to study today. Open a book and make a mental photograph of each page with your subconscious. Look at both pages of the open book at the same time. Notice the four corners of the book. Be aware of the white space between the lines of text. Flip the pages at a steady rhythm while consciously controlling each breath at a steady deep breathing rhythm. This will occupy your conscious mind while freeing your subconscious mind to photograph every page in seconds.
Afterward, I invite you to smile and tell yourself, “I release this information for my mind and body to process.” Go to bed and sleep.
The next day, take a quiz to test your knowledge of the material that you photographed the night before. Doing so starts the activation process. Activation is the process of making mental links between your subconscious photographs to your conscious awareness. If you do not know the answer to a quiz question, let your subconscious guide to where you feel like you can find the answer in the text. Read just the short passages that contain the answer. Then, quickly go over the book, allowing your subconscious to guide you to what you feel like are the important parts of the book. Read only the important parts. Just keep the passages that you read short. Notice the key words, headings, titles, and passages that contain the main idea. Passages that contain the main idea are usually the first and last paragraphs in a chapter. The first and last sentences of each paragraph are also more likely to be main ideas. Make your own diagrams of key concepts and memorize them. Get together in a study group to discuss the topic (go to class).
Quickly read the book. Slow down when the material gets complicated.
When memorizing groups of drugs, don’t memorize each one individually. That will take forever.
Just lump drugs with the same endings together. For example, don’t memorize the properties of penicillin, amoxicillin, and ticarcillin separately. Just memorize that all *cillins have certain properties.
Also, it’s sometimes helpful to make humorous or silly phrases to help you memorize stuff. For example, suppose you have trouble remembering that the three *cillins on a formulary are penicillin, amoxicillin, and ticarcillin. You could make a nonsensical phrase like Pen ny and Am y can be tic kled with cil ia.
If you have a very long commute to work or school, make an audio cassette with information that you want to memorize and listen to it while you drive to work or school. Don’t buy ready-made audio tapes. Making the tape is part of the educational process.
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You may also make flash cards to help you memorize information. Don’t be lazy and buy some ready-made flash cards. Making the flash cards is part of the educational process.
Repeat steps 1 through 5 for each lesson. Be sure to allow at least 2 days to study each lesson.
For further information on better study techniques, read The Memory Book by Harry Lorayne et. al. and Photoreading by Paul R. Scheele.
General Exam Info
140 multiple-choice questions (125 actual + 15 experimental questions) with 3 hours to do it
This is a national exam, so you don’t have to memorize any state-specific information
When doing practice problems, allow yourself an average of 1 minute per question
Eat a good breakfast and get a good night’s sleep before the exam.
Use a calculator that you’re familiar with
Scaled Score: 300-900 points, 650 points is passing (No percentage score equals a passing score)
More difficult exams are worth more points and easier exams are worth less points
There is no penalty for guessing. The exam is 30% math.
Strategy
There are a limited number of types of math questions that they can ask you. The answers to math questions are always clear. In other words, 1 + 1 will always equal 2. In contrast, there are much more drug questions that they can ask you.
Drug Facts and Comparisons is over 3000 pages long. Sometimes, the non-math questions can be unfair or unclear.
Therefore, you should aim to get all of the math questions correct because it is possible to get all the math questions correct.
No one pharmacy technician book or program can have all the info that will be on the exam. However, I’ve included in this book all the math info and most of the non-math info. You are given all of the info necessary to pass the exam.
Preparing for the PTCB exam is not very difficult, but it is very time consuming. Please be prepared to study at least 4 hours a day for 8 weeks. When studying the practice exam questions, please do not memorize the questions. Due to copyright laws, the questions are completely different from the actual exam questions. However, the practice exam questions will cover the same topics. So, do study the topics that the sample exam questions cover. For example, if
(hypothetically) the real exam asks, “Which of the following drugs are macrolide antibiotics,” the practice question will ask, “Name the medication that is not a cephalosporin antibiotic.” Furthermore, the answer choices will be different. In response to this question, you should memorize all the drugs in each therapeutic category. You should not study the practice exam question itself. Instead, make sure that you memorize all the tables, everything in boldface print, everything in color, and all items printed in italics.
Hint: Answer the questions yourself by covering the provided answers. After you do it yourself, check your answer against the provided answer.
DEA number verification
Q: A prescription has the following as Dr. Donald’s DEA #. Is this DEA # valid?
AP 1626575
A: No, this DEA number is not valid.
Q: Why is this number not valid?
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A: The second letter should be the first letter of the doctor’s last name. The sum of the 1 st , 3 rd , and 5 th digits plus twice the sum of the 2 nd , 4 th , and 6 th digits should yield a number with the last digit that is the same as the last digit of the DEA number.
Ex; 1+2+5=8
6+6+7=19, 19x2=38.
8+38=46. Therefore, a valid DEA number would have a 6 as the last digit.
Drug Interactions
Make sure that you study the drug interactions in the pharmacology unit really well.
Q: Patient takes Bufferin, Viagra, metronidazole, Biaxin, and warfarin. Which ones interact?
A: Bufferin and warfarin.
> Be careful as they may not say aspirin but Bufferin,
> They may not say hydrochlorothiazide, but instead say Dyazide.
> They may not say hydrocodone, but instead say Vicodin.
> You get the picture.
There are whole books written on drug interactions, but the drug interactions in the pharmacology unit are the most likely to be asked on the exam.
Drug Chart
Memorize the drug chart in the drug regulation unit; brand, generic, use, storage temperature, therapeutic category, and dosage form. Also, memorize the storage temperatures in the Inventory Management unit.
Additional Info
Also, specific gravity in the "Proportional Analysis" section will probably not be emphasized on the exam. It is only in the book for completeness.
A large portion of the exam is about retail pharmacy. There may also be a lot of hospital pharmacy questions. However, compounding pharmacy will not be emphasized. There might be 1 or 2 questions, but don’t expect it to be heavily tested. There may only be just a few questions on parenterals.
Be sure to study the drug regulation unit really well as controlled substances, the most popular drug list, and math are the 3 most emphasized topics.
Any unit bigger than kilo and smaller than micro will not be tested with regard to the Metric System.
Be sure to know everything on the Basic Concepts unit. Be sure to memorize the temperature conversion formulas.
Although it is unfair, the exam may ask questions with generic names
of unavailable generics. For example, the exam may ask about sildenafil
(Viagra brand), but sildenafil is not a commercially available generic (yet). Only the brand Viagra is commercially available.
Pharmacy terminology will be used in the questions and answers everywhere on the exam, but there shouldn't be many questions that ask what is the definition of something.
Q: In all states are techs not able to take new Rx's from doctors over
the phone?
A: Technicians are not allowed to take new Rx's from doctors over the phone. Some techs do it, but you're not supposed to.
Q: Judy is a clerk. Can Judy take a transfer Rx from another pharmacy?
A: No
Q: Max is a certified technician (CPhT), can Max do it?
A: No, pharmacy technicians are not supposed to take a transfer from another pharmacy.
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You can take refills from doctor's offices, but not new Rx's and transfers. The exception is an electronic transfer within the same pharmacy chain. A pharmacy technician can electronically transfer (with a computer & modem) a prescription within the same pharmacy chain.
Q: Can a clerk accept a refill authorization from a doctor?
A: No
Q: How about a technician?
A: Yes
Q: But as a tech you are allowed to take refills from a doctor?
A: Check out the Pharmacy Administration Unit for duties of a tech, clerk and pharmacist. Yes, you're allowed as a tech to take refills from a doctor, but just not New Rx's.
Some students confuse refills with new prescriptions. If the doctor’s office calls back on a pharmacy’s refill request, but the prescription was changed, then it is considered a new prescription, not a refill. For example, the sig. or drug dose was changed.
Some students confuse refills with transfers. Transfers involve transferring a prescription between two pharmacies.
Refills involve a doctor’s office calling back on a pharmacy’s refill request.
OTC Review
Cough, Cold, and Allergy Products
Antihistamines; Benadryl (diphenhydramine), Tavist (clemastine fumarate), Chlortrimeton (chlorpheniramine maleate),
Chlortrimeton-D (chlorpheniramine maleate & pseudoephedrine) chlorpheniramine maleate is an antihistmine while pseudoephedrine is a decongestant, Tavist-D (clemastine fumarate & pseudoephedrine) pseudoephedrine is a decongestant while clemastine fumarate is an antihistamine.
Decongestants; Pseudafed (pseudoephedrine), phenylpropanolamine or PPA (all OTC PPA products were taken off the market by the FDA)
Cough Suppresants; dextromethorphan or DM (Delsym has DM and Robitussin DM which has DM and guaifenesin),
Robitussin DM (guaifenesin & dextromethorphan) dextromethorphan is a cough suppressant while guaifenesin is an expectorant.
Expectorant: guaifenesin (Robitussin)
Nasal Saline: Ayr, Ocean
Intranasal Decongestant (nose spray or drops): nephazoline (Privine), oxymetazoline (Afrin)
Hint: High blood pressure, glaucoma, and BPH (benign prostatic hyperplasia or enlarged prostate) are contraindicated with OTC decongestant usage. Therefore, if you are asked an interaction question, if the patient is on blood pressure medication (metoprolol, hydrochlorothiazide, etc.), then a systemic OTC decongestant such as PPA or pseudoephedrine may not be a wise choice.
Internal Analgesics/Antipyretics
ASA aka acetyl salicylic acid aka aspirin; Anacin, Ascriptin, Aspergum, Bayer, Bufferin, Ecotrin, Empirin. acetaminophen; Panadol, Tempra, Tylenol ibuprofen; Advil, Motrin. ketoprofen; Orudis. naproxen; Aleve.
Hint: OTC NSAIDs (non-steroidal anti-inflammatory drugs) are ASA, ibuprofen, ketoprofen, and naproxen.
Acetaminophen is not an NSAID. Generally, you don’t want to take 2 NSAIDS at the same time. You also don’t want to
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take a NSAID with a blood thinner such as Coumadin (warfarin) as it could potentially cause hemorrhaging or severe bleeding.
There are a lot more OTC drugs, but these are the ones that are most likely to be tested. Cough/cold remedies and pain meds comprise the lion’s share of OTC pharmacy sales.
1. I ss oz makes how many g?
I is a roman numeral for 1. ss is a roman numeral for 1/2. Therefore,
Iss = 1 & 1/2 or 1.5
1 oz = 28.35 g Therefore, you set up the following equation;
1.5 oz x 28.35 g/1 oz = 43 g
The units of oz cancels each other out to yield an answer in g.
2. 2 & 1/3 cc makes how many fluidounces?
Any time you're dealing with a fraction, you always want to change the mixed number to just a simple fraction. Therefore, 2 1/3 = 7/3. You multiply the denominator
3, by the number 2. This yields 6. 6 plus the numerator of the mixed number gives 7. Hence, 7/3.
7/3 cc x 1 ml/1 cc x 1 fluidounce/30 ml = 7/90 fluidounce.
The units cancelled to give an answer in the unit fluidounce.
1 ml/1 cc and 1 fluidounce/30 ml are conversion factors.
Then, you divide 7 by 90 to give the answer in decimal format, 0.078 fluidounce.
Roman Numerals
Q: How many tablets are XC tablets?
A: 90
It important that you understand roman numerals because many sig's (Rx instructions) will be written with roman numerals.
English vs Metric System of Measurement
Q: Could you explain No. 1 & 2?
1. ss fluidounce makes how many ml? ss is a roman numeral for 1/2 or 0.5. conversion factor 1 fluidounce/30 ml or 1 fluidounce = 30 ml
Therefore, 0.5 fluidounce x 30 ml/1 fluidounce = 15 ml
Units of fluidounce cancel each other out to yield answer in ml
2. 14.18 g makes how many oz?
Conversion factor: 1 oz = 28.35 g
Hence, 14.18 g x 1 oz/28.35 g = 14.18/28.35 oz units of g cancel out to yield answer in oz.
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Reduce the fraction to yield the final answer.
14.18/28.35 oz = 1/2 oz = 0.5 oz
Q: How many fluidounces are in a quart?
A: 32
A lot of questions will require that you be able to read english measures. You will have to convert english to metric and vice versa, too.
Q: If you have a iii fluidounce container of Amoxil and the patient takes i tablespoon tid, how many days will the container of Amoxil last?
Hint: 1 fluidounce = 30 mL
Hint: 1 tablespoon = 15 mL
A: 2 days
This is an example of a typical question that will require you know roman numerals, metric, and english system. Let's go over how we do this problem:
1 fluidounce = 30 ml. Therefore, 3 fluidounce = 90 mL.
You get 90 mL from the conversion factor. A conversion factor is an equivalent that you use to convert between different units. For example;
1 fluidounce = 30 mL is a conversion factor. You use this to convert
3 fluidounces to 90 mL;
3 fluidounce x 30 mL/1 fluidounce = 90 mL
1 tablespoon = 15 mL. (Conversion Factor)
1 tablespoon three times a day is 3 tablespoons a day. Therefore, 3 x 15 =45 mL per day.
Since the container has 90 mL, 90 mL x 1 day/45 mL = 2 days
Therefore, it will last 2 days.
Q: A man weighs 210 lb. The dose of a drug is 15 mg/kg. What dose in mg will the man need?
Hint: 2.2 lb = 1 kg
Hint: Convert lb to kg for the man.
Hint: Then, multiply kg weight of the man with 15 mg/kg.
A: 1432 mg dose
Let's go over how we did this.
Conversion factor for this problem is 1 kg/2.2 lb or 1 kg = 2.2 lb
210 lb x 1 kg/2.2 lb = 94.45 kg
The units of lb cancelled each other out to yield an answer in kg.
95.45 kg x 15 mg/kg drug X = 1431.75 mg drug X.
Therefore, a 210 lb man needs to take 1432 mg drug X.
You can also work the problem another way;
210 lb x 1 kg/2.2 lb x 15 mg/kg = 1432 mg
In other words,
210 lb multiplied by 1 kg/2.2 lb multiplied by 15 mg/kg = 1432 mg
The units cancel each other out to yield an answer in mg.
210 lb x 1 kg/2.2 lb = 95.45 kg
You can look at this math a different way: multiplying by 1 kg/2.2 lb is the same as dividing by 2.2 lb. multiplying is the same as dividing by the inverse of the fraction.
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Q: A 145 lb woman needs to take 25 mg/kg of drug Y. How many mg of drug Y does she need?
A: 1648 mg
Let’s see how we got that answer:
145 lb x 1 kg/2.2 lb = 65.9 kg
65.9 kg x 25 mg/kg = 1648 mg
We can also work this problem another way;
145 lb x 1 kg/2.2 lb x 25 mg/kg = 1648 mg
Hints:
Please memorize the temperature conversion formulas in the Basic Concepts of Pharmaceutical
Calculations unit.
All units bigger than kilo and smaller than micro will also not be on the exam.
Metric Suffixes; g = suffix for metric unit of weight m = suffix for metric unit of length
L = suffix for metric unit of volume m³ = suffix for metric unit of volume
Metric Prefixes;
1,000 g = 1 k g
100 g = 1 h g
10 g = 1 da g
1g = 1g
0.1
g = 1 d g
0.01 = 1 c g
0.001 g = 1 m g
0.000001 g = 1
 g
0.001 k g = 1 g
0.01 h g = 1 g
0.1 da g = 1 g
1 g = 1 g
1 g = 10 d g
1 g = 100 c g
1 g = 1,000 m g
1 g = 1,000,000
 g
Make sure you have everything else in the Basic Concepts of Pharmaceutical Calculations unit memorized. Make flash cards. It will help.
For your vocabulary words, make a tape and play it in your car on your commute to work/school if you have a long drive to work/school.
Converting Numbers to Decimals
Q: 1 2/3 = ?
A: 1.66
Q: ssC = ?
Hint: C = 100 in roman numerals
Hint: ss = 0.5 in roman numerals
Hint: You subtract the first smaller roman numeral from the second larger roman numeral. 100-0.5
= ?
A: 99.5
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Converting Numbers to Percents
Q: 1/6 = ?
A: 16.7%
Let's see how we did that.
1 ÷ 6 = 0.167
Hence, 16.7% is the answer.
You divide the numerator by the denominator, then you multiply the resultant decimal by 100 or move the decimal 2 places to the right.
Reading Rx’s
Q: If a compound needs Metronidazole 125 mg tid x 10 days, and only 0.5 g tablets are on hand, how many tablets will it take to fill the Rx?
Hint: 125 mg x 3 x 10 = total mg metronidazole needed.
Hint: 0.5 g x 1000 mg/1 g = mg of metronidazole per tablet.
Hint: total mg metronidazole x 1 tablet/ mg of metronidazole in each tablet = ?
A: 7.5 tablets
Let’s see how we did this problem:
125 mg x 3 x 10 = 3750 mg metronidazole needed.
0.5 g x 1000 mg/1 g = 500 mg of metronidazole per tablet.
3750 mg total metronidazole needed x 1 tablet/500 mg of metronidazole per tablet = 7.5 tablets
This can be written another way:
3750 mg metronidazole total / 500 mg metronidazole per tablet = 7.5 tablets
Remember, there's always more than one way to do a math problem.
Just use the method you're most comfortable with.
O.K. Let's go over this again.
125 mg of metronidazole is needed tid ( 3 times a day) for 10 days.
This is expressed numerically as;
125 mg x 3 x 10 = 3750 mg metronidazole total needed for the compound.
If there are 0.5 g of metronidazole in each tablet, you know you have to convert g to mg as the above expression is in mg.
Also, there are 1000 mg in a g.
This is expressed numerically as 1000 mg/1 g
Therefore, to convert g to mg:
0.5 g x 1000 mg/1 g = 500 mg
The units of g cancel each other out to yield an answer in mg
3750 mg total metronidazole x 1 tablet / 500 mg = 7.5 tablets. This is how many metronidazole tablets needed to be crushed to make the compounded drug product.
Additional Help & Hints
HINT: 1 teaspoon = 5 mL, 1 fluidram = 3.69 mL,
However, in retail pharmacy, 1 fluidram approximately equals to 1 teaspoon.
Therefore, 1 fluidram tid can be labelled 1 teaspoonful three times a day. It should
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not be labelled 3.69 mL three times a day. Furthermore, you should not use 1 fluidram
= 1 teaspoon as a conversion factor as this is only an approximation for the purposes of typing up patient dosing instructions on a prescription label in retail pharmacy.
Proportional Analysis
When solving a math problem, do not try to tackle the problem all at once. Break it down into smaller parts and solve it little by little. Use the
Three Step Method
1. Write down all the variables. What do you know?
2. Figure out exactly what you are solving for. What do you not know?
3. Decide which method to use to solve the problem. For example, if the
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problem is an alligation, set up the problem as an alligation. If it is a proportion, set up an equation.
If it is a conversion, write the conversion factor(s). If the problem can be solved with a formula, write down the formula to be used.
Conversions are when you have a number in X units (for example, mL) and you need to convert this into Y units (for example, L).
Formula problems are like if you have X, Y, but not Z. However, if you use an equation (for example, X + Y = Z), you can use this equation to find out what Z is.
Proportions are when you have X/Y = A/B. You basically have 3 knowns and 1 unknown. You solve for the unknown.
Using the proper method, solve the problem to determine the unknown variable declared in the first step.
HINT: about 90% of all math problems on the exam are either proportion problems or conversions.
There may be a few alligation problems and formula problems, but not many. Most are either proportions or conversions.
Quiz
1. A medication order for a patient weighing 176 lb calls for 400 µg antibiotic per kg of body weight to be added to 400 mL of isotonic dextrose solution.
If the drug is to be obtained from a solution containing 5 mg per 10 mL, how many milliliters should be added to the dextrose solution?
O.K. You break down the problem and the unknown is mL of drug to be added to the dextrose solution. You know the drug is given in 400 micrograms per kg of body weight, but the man is listed as 176 lb. Therefore, you need the conversion factor for conversion between lb and kg. The drug is 5 mg per 10 mL, but the dose is listed as 400 micrograms per kg.
Therefore, you need the conversion factor for conversion between micrograms and milligrams.
Hence, you can set up the problem like so with the forementioned conversion factors:
176 lb x 1 kg/2.2 lb x 400
 g/1 kg x 1 mg/1000
 g x 10 mL/5 mg = 64 mL
1 kg/2.2 lb is the conversion factor for lb and kg. 1 mg/1000
 g is the conversion factor for mg and
 g. All the units cancel out except for mL in the answer.
Therefore, the answer is 64 mL
111

2. It is not likely that there will be a specific gravity problem on the exam.
3. On a prescription balance with a sensitivity requirement of 0.018 g what is the smallest amount that can be weighed with a maximum potential error of not more than 10%?
This is just simply a formula problem. If you know the formula, just plug in the variables to solve for the answer.
Sensitivity Requirement = SR
Permissible Percentage of Error = PPE
Smallest Amount Weighable = SAW
(SR x 100%)/PPE = SAW
Therefore, if you have a balance with a sensitivity of 0.018 g, any amount smaller than 0.018 g will not budge the balance. This also means that any measurement of weight can be implied as being + or - 0.018 g. For example, if something is measured to be 8 g, it is implied as being 8.018 g to 7.982 g. Therefore, if you cannot tolerate a margin of error of more than
10%, then you'd figure out the smallest amount weighable by using this formula.
(0.018 g x 100 %)/10% = 0.18 g
Therefore, any amount smaller than 0.18 g weighed on this balance will have a margin of error that is bigger than 10%.
4. This is a proportion problem.
A sunscreen lotion contains 5 g of methyl salicylate (specific gravity
= 1.05) per100 mL. How many grams of methyl salicylate should be used in preparing
1 gallon of the lotion?
There are 5 g of methyl salicylate per 100 mL of sunscreen lotion. This is the concentration. Therefore, for every 100 mL of sunscreen lotion, there is 5 g of methyl salicylate in it. So, if there are 200 mL of lotion, there would be 10 g of methyl salicylate in it... The amount of methyl salicylate in the lotion is proportional to the amount of lotion there is.
Therefore, you'd set up a proportion equation.
Since the concentration is in 5 g/100 mL, but the amount of lotion is in gallons instead of mL, you have to convert gallons to mL. The conversion factor for gallon to mL is 1 gallon = 3785 mL.
5 g/100 mL = X g/3785 mL
Solving for X gives 189 g of methyl salicylate as the answer.
How many grains of zinc oxide would be present in vi scruples of the following ointment?
Rx
ZnO
80 gr
Starch
112

50 gr
Kaolin
270 gr
Petrolatum
800 gr
Ft. Ung.
Sig. Apply
Nocte.
Since zinc oxide is given in grains, you also want to convert scruples to grains. This is because you want the numerator and denominator to be the same units.
6 scruples x 20 grains/1 scruple = 120 grains
Therefore, there are X grains of zinc oxide per 120 grains of ointment.
80 + 50 + 270 + 800 g = 1200 g ointment.
Therefore, the proportion problem will be set-up as:
80 g zinc oxide/1200 g ointment = X grains zinc oxide/120 grains ointment
X = 8 grains zinc oxide
Dilution & Concentration
1. Use the three step method: determine the known and unknown variables. Choose the method used to solve the problem and set-up the problem. Solve the math problem.
2. Simplify all ratios to simplify the calculations. Reduce ratios to lowest terms. Convert ratio strengths to a percentage strength expressed as a decimal. For example, 2:10 = 1:5 = 0.2
3. Use the formula quantity A x concentration A = quantity B x concentration B
4. Remember, concentration may be expressed as weight in volume:
20% = 20 g/100 mL = 0.2 g/mL
As mentioned previously, watch out for mg % versus %.
20 mg% = 20 mg/100 mL = 0.2 mg/mL vs.
20 % = 20 g/100 mL = 0.2 g/mL
Concentration can also be expressed as volume in volume:
30% = 30 mL/100 mL = 0.3 mL/mL
Furthermore, concentration may be expressed as weight in weight:
10% = 10 g/100 g = 0.1 g/g ex #1: If 25 mL of a KCl solution ( 2% w/v ) is diluted to 250 mL, what is the resultant concentration?
Known: 25 mL of 2% w/v, 250 mL (of X% w/v)
Unknown: X% of w/v
2% = 2 g/100 mL = 0.02 g/mL concentration A x quantity A = concentration B x quantity B
0.02 g/mL x 25 mL = X g/mL x 250 mL
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solving for X gives: ( 0.02 g/mL x 25 mL ) / 250 mL = X g/mL
X = 0.002 = 0.2 % = 0.2 g/100 mL w/v ex #2: If 25 mL of a KCl solution ( 1% w/v ) is diluted to a liter, convert the resulting concentration to ppm.
25 mL x 0.01 = 1000 mL x A
0.25/1000 = 0.00025 = A
0.00025 = 25/100,000
25/100,000 = B/1,000,000
B = ( 25 x 1,000,000 )/100,000
B = 250 ppm
Hints: There probably won't be any math problems that involve making dilute acids from concentrated acids that requires knowledge of specific gravity. Specific gravity is not a concept that is emphasized on the exam. Also, if you’ve taken chemistry, you’ll know that if you add 10mL of water and 10mL of alcohol, the volume will be less than 20mL due to intermolecular forces. For our purposes, 10mL + 10mL will always equal 20mL. However, they might ask one or two milliequivalent questions.
Milliequivalents
Ex #1: You have a solution containing 6 mEq/mL of calcium chloride (CaCl2.2H20).
Determine the concentration in g/mL.
1.
Determine the valence – The valence of a molecule is the total positive OR negative charge of the molecule.
All ionic solutes have a valence. Common pharmaceutical solutes are sulfate(
SO4-- ) and Sodium ( Na+ ). The Na+ ion has a valence of positive 1. The
Sulfate ion has a valence of negative 2. By definition, NS or normal saline has a concentration of 0.9% NaCl. 1/2NS has a concentration of 0.45% NaCl.
Ca++ has a charge of +2, while Cl2 has a charge of –2. Cl- has a charge of –
1, but there are 2 chlorines expressed in each Cl2. Therefore, the valence of
CaCl2.2H20 is just 2, since valence is the positive OR negative charge of the molecule. Furthermore, the 2 water (H20) molecules hydrating the CaCl2 doesn’t affect the calculation of the valence of CaCl2.2H20.
2.
Determine the formula weight – This will usually be given to you on your exam.
The atomic weight of; Ca++ = 40, Cl- = 45.5, H2O = 18.
Therefore, the formula weight of CaCl2.2H20;
Ca + (2 x Cl ) + (2 x H20) = formula weight of CaCl2.2H20
40 + (2 x 35.5) + (2 x 18 ) = 147
3.
equivalent weight = formula weight/valence
147/2 = 73.5 g
4.
milliequivalent weight = equivalent weight/1000
73.5 g/1000 = 0.0735 g = 73.5 mg
This is the weight per milliequivalent of CaCl2.2H20
5.
conversion method;
0.0735 g/mEq x 6 mEq/mL = 0.441 g/mL
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Ex #2: You have a solution containing 4 mEq/mL of potassium chloride (KCl).
Determine the concentration in mg/mL.
1.
Determine the valence
KCl consists of K+ and Cl-. KCl has a charge of positive or negative one.
Therefore, the valence is 1.
2.
Determine the formula weight.
K+ = 39, Cl- = 35.5
39 + 35.5 = 74.5
3.
equivalent weight = formula weight/valence
74.5/1 = 74.5 g
4.
milliequivalent weight = equivalent weight/1000
74.5 g/1000 = 0.0745 g = 74.5 mg/mEq
5.
conversion method;
74.5 mg/mEq x 4 mEq/mL = 298 mg/mL
Working with Multiplying and Dividing Fractions
1.
Convert mixed numbers and whole numbers into improper fractions ex. 3 & 1/4 is a mixed number. This is the same as 13/4, an improper fraction. You multiply 4, the denominator, with 3. This yields 12. 12 plus 1 is
13. Therefore,
3 & 1/4 = 13/4
6 is a whole number. This is the same as 6/1. Any whole number is the number itself divided by 1.
6 = 6/1
2.
When multiplying fractions, multiply numerators by numerators and denominators by denominators. ex. 13/4 x 6/1 = 78/4 multiply the numerators 13 by 6 to get 78. multiply the denominators
4 by 1 to get 4.
3.
When dividing fractions, multiply numerators by denominators and denominators by numerators.
In other words, invert the second fraction and treat it as a multiplication problem. ex. 13/4  6/1 = 13/4 x 1/6 = 13/24
4.
Reduce the fraction answer to lowest terms. ex. 78/4 = 39/2
In the denominator of 78/4, the 4 is composed of two prime numbers, 2 x 2.
The numerator is also divisible by 2. Hence,
(39 x 2) / (2 x 2)
The 2 in the numerator and denominator cancel each other out. This leaves
39/2.
5. Present the answer as a mixed number or whole number. ex. 39/2 = 19 & 1/2
This is done by dividing the numerator by the denominator.
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39  2 = 19 & 1/2
O.K. Let's move on to the
Dosage Unit.
Very Important: 1 tsp = 5 mL = 1 & 1/3 fluidram
This is the correct conversion factor.
However, in retail pharmacy, you approximate 1 fluidram = 1 teaspoonful. This is used in final answers and in reading sigs. However, this is not to be used as a conversion factor.
This is a favorite source of trick questions.
Ex; sig. 1 fluidram po tid
This can be typed 1 teaspoonful by mouth three times a day.
If you do a math problem that has as a Final Answer, 2 fluidram as the dosage. You can type out the dosage as 2 teaspoonfuls on the label.
However, do not use this as a conversion factor. You cannot use 1 tsp/1 fluidram or 1 tsp = 1 fluidram as a conversion factor to convert teaspoons to fluidrams and vice versa. For example, if a compound needs 1 fluidram of hydrocodone syrup to be mixed with 30 mL of Tylenol elixir, then, you must mix
3.69 mL of hydrocodone syrup with 30 mL of Tylenol.
Example Problems
1. How many drops (gtts) would be prescribed in each dose of a liquid medicine if 3/4 fluid ounce contained 75 doses? The dispensing dropper has been calibrated to deliver 30 drops per milliliter of solution.
0.75 fluid ounce/75 dose x 30 mL/1 fluid ounce x 30 gtts/1 mL = 9 gtts
2. How many milliliters of medicine should be dispensed to a patient if he is directed to take 2 tablespoons t.i.d. for 8 days, 2 teaspoonfuls q.i.d. for 4 days, and finally one teaspoonful b.i.d. for 6 days?
2 tbsp/dose x 15 ml/tbsp x 3 doses/day x 8 days = 720 ml
2 tsp/dose x 5 ml/tsp x 4 doses/day x 4 days = 160 ml
1 tsp/dose x 5 ml/tsp x 2 doses/day x 6 days = 60 ml
720 ml + 160 ml + 60 ml = 940 ml of medicine
3. The usual initial dose of chlorambucil is 125  g/kg of body weight once a day. How many milligrams should be administered to a person weighing 154 lb?
125  g/kg x 1 kg/2.2 lb x 154 lb x 1 mg/1000  g = 8.75 mg
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AWP is the average wholesale price.
> What is a 30% mark-up on an item that has a cost of $2.30?
> Markup on cost = cost x percentage markup
> percentage markup is 30%. This is the same as 0.3

Therefore, markup on cost = $2.30 x 0.3 = $0.69

Markup on cost = $0.69
Also, Price = Cost + Markup
Price = $2.30 + $0.69
Price = $2.99
Often times, you would receive a wholesale order. The pharmacist will tell you what markup % to use. Based on a certain markup % and the cost of the drugs, you would be expected to put the drug’s price on the bottle. This is often true of over-the-counter (OTC) drugs.
> Let's try another one
> You purchased 3 g of tetracycline powder for $2 per g. What is a
20% markup on the 3 g of tetracycline?

3 g x $2/g = $6 cost

20% = 0.2
 cost x % markup = markup

$6 cost x 0.2 = $1.20 markup
Given $6 cost and $1.20 Markup, what is the Price?
Price = Cost + Markup
Price = $6 + $1.20
Price = $7.20
> An item with a $2.99 sale price was marked up from cost $0.69. What is the
percent markup?
> Ready for the answer?> It's 30%. Let me explain.
> The concept of markup on cost is this: you purchase something at
a certain COST and add a MARKUP to arrive at the sale PRICE.
> Therefore: price = cost + markup
> If an item sold for $2.99 and you know the markup is $0.69, then
you plug in the formula:
> $2.99 = cost + $0.69
117

 solving for cost:
 cost = $2.99 - $0.69 = $2.30
> markup/cost = % markup on cost
> $0.69 markup/$2.30 cost = 0.3 = 30%
> Hence, the markup on cost is 30%
> Let's try another problem.
> An item is selling for $8. The markup on cost was $2. What is the
percentage markup on cost?
> ready for the answer?

Price = cost + markup

$8 = cost + $2
 cost = $8 – $2 = $6
 markup/cost = % markup on cost

$2 markup/$6 cost = 0.33 = 33% markup on cost
> Let's go over discounts.
> A bottle of vitamin B has a sale price of $3. We discount it 30%.
What is the discounted price?

Discounting 30% off the price: Price x %discount = $discount

$3 x 0.3 = $0.90 discount

Price – discount = discounted price

$3 - $0.90 = discounted price
 discounted price = $2.10
> O.K. let's go over percent gross profit.
> markup/cost = % markup on cost
> markup/price = percent gross profit
> Let's do an example problem.
> A bottle of aspirin sells for $30. You want to make a 20% gross
profit on it. What is the markup?
> ready for the answer?
> markup/price = % gross profit
> markup/$30 price = 0.20
> remember, 20% = 0.20
> solving for markup...
> markup = 0.20 x $30 = $6
> O.K. gross profit doesn't take into account the expenses or
overhead involved in running a pharmacy.
> gross profit only takes into account the cost of the drugs sold.
> Therefore, we have net profit.
> Net profit takes into account the cost of the drugs sold AND the
expenses involved in running a pharmacy.

Hence, the formula:
 Net Profit = price - (cost of goods sold + expenses)
> Let's try one more example problem.
> You have a bottle of coumadin costing $0.20 per tablet. The price is $2 for a bottle of 5. You want to make $0.30 per bottle, net. What were your expenses?
> Setting up the problem:
> Net Profit = price - (cost + expenses)
> Net Profit = $0.30, Price = $2, and we still need the cost to solve
118

for expenses.
> cost is $0.20/tablet x 5 tablets = $1 for a bottle of 5 tablets
> $0.30 net profit = $2 price - ($1 cost + expenses)

Solving for expenses...

$0.30 = $2 - $1 – expenses
 expenses = $2 - $1 - $0.30
 expenses = $0.70
You need to know the following formulas to solve commercial calculations in pharmacy;
Price = Cost + Markup
Markup/Cost = %Markup on Cost
Cost x %Markup on Cost = Markup
Markup/Price = %Gross Margin
Price – (Cost of Goods Sold + Expenses) = Net Profit
Price x %Discount = Discount
Price – Discount = Discounted PricePrice = (1 + %Markup on Cost) Cost
Hint: Do these problems without looking at the answers first. Then, look at the answers and their explanations to see if you got it correct.
You use the alligation method when you are mixing 2 ingredients of different concentrations to get a solution of yet another concentration.
Q: How many grams of petrolatum must be mixed with 8 g of 35% zinc oxide ointment in order to prepare a 10% zinc oxide ointment?
A:
1.
X = parts of higher concentration ingredient
119

2.
Y = parts of lower concentration ingredient
3.
X = concentration of product – concentration of weaker ingredient
4.
Y = concentration of stronger ingredient – concentration of product
5.
X/Y = ratio of parts of higher concentration ingredient to parts of lower concentration ingredient
X = 10% - 0% = 10 parts
Y = 35% - 10% = 25 parts
Another way to compute the ratio X/Y = 10/25 parts is to use the alligation grid;
0% 25 parts
10%
35% 10 parts
Proportion Problem
X/Y = 10 parts/25 parts = 8 g/Y
Solving for Y
Y = (25 * 8)/10 = 20 g of petrolatum
Remember: petrolatum just by itself is 0% zinc ointment.
Q: How many grams of coal tar should be added to 300 g of 20% coal tar ointment to prepare an ointment containing 30% of coal tar?
A:
Remember: coal tar just by itself is 100% coal tar with no ointment base at all.
Alligation Grid;
20% 70 parts
30%
100% 10 parts
X = 30% - 20% = 10 parts
Y = 100% - 30% = 70 parts
Proportion Problem
X/Y = 10/70 = X/300 g
Solving for X
X = (10 * 300)/70 = 43 g of coal tar
Q: How much 0.01% steroid cream and 0.025% cream are needed to prepare 60 g of 0.015% steroid cream?
A:
1.
Set up the problem to find the relative number of parts of X, Y, and product.
2.
X = concentration of product – concentration of weaker ingredient
3.
Therefore: X = 0.015% - 0.01% = 0.005 parts stronger concentration ingredient
4.
Y = concentration of stronger ingredient – concentration of product
120

5.
Therefore: Y = 0.025% - 0.015% = 0.010 parts of weaker concentration ingredient
6.
X parts + Y parts = total number of parts in product
7.
0.005 parts X + 0.010 parts Y = 0.015 parts total product
Alligation Grid;
0.01% 0.010 parts
0.015%
0.025% 0.005 parts
1.
Set up a proportion to solve for X, the stronger concentration ingredient.
2.
A proportion is defined as: part/whole = part/whole or X/Y = X/Y or Y/X = Y/X
3.
X/whole = 0.005/0.015 = X/60 g total product
4.
X = (60 * 0.005)/0.015 = 20 g stronger concentration ingredient
1.
Set up a proportion to solve for Y, the weaker concentration ingredient
2.
Y/whole = 0.010/0.015 = Y/60 g total product
3.
Solving for Y: Y = (60 * 0.010)/0.015 g = 40 g weaker concentration ingredient
1.
Check your answer.
2.
part + part = whole
3.
20 g stronger conc ingredient + 40 g weaker conc ingredient = 60 g product.
4.
Therefore, the answer is correct since the answer is 60 g, as expected.
Try to solve the following problems by yourself before you look up the answers below;

How many mL of ampicillin would be needed to provide a 20,000 mcg dose from a vial containing 0.2 g/10 mL?

How many mL per hour would be required to infuse a drug dose of 10 mcg/kg/min to a man weighing 180 lb if the drug is delivered by a bag containing 300 mg/250 mL?
1.
Q: How many mL of ampicillin would be needed to provide a 20,000 mcg dose from a vial containing 0.2 g/10 mL?
A: Known; 0.2 g/10 mL concentration, 20,000 mcg dose
Unknown: mL of ampicillin
The proportion equation for this problem is:
10 mL/0.2 g = Y mL/X g
121

Since the dose weight is given in mcg, you need to convert this to g in order to plug the dose weight into this equation because the units in the denominator on both sides of the equation has to be the same. Therefore, you have to set-up another proportion equation to solve for the dose weight in g.
X g/20,000 mcg = 1 g/1,000,000 mcg
Multiplying both sides by 20,000 mcg, we solve for X.
(20,000 mcg * X g)/20,000 mcg = (1 g * 20,000 mcg)/1,000,000 mcg
Solving for X, we get:
X = 0.02 g
Now, we go back to the first proportion equation to get:
10 mL/0.2g = Y mL/0.02 g
Multiplying both sides by 0.02 g we get:
(0.02 g * 10 mL)/0.2 g = (0.02 g * Y mL)/0.02 g
Solving for Y, we get:
Y = 1 mL
We can also use an alternative one-step method to solve this problem:
10 mL/0.2 g * 1 g/1,000,000 mcg * 20,000 mcg = 1 mL
The first method is easier to understand but takes longer to solve a math problem. Either method is O.K. to use. Just use the method that you are most comfortable with.
2.
Q: How many mL per hour would be required to infuse a drug dose of 10 mcg/kg/min to a man weighing 180 lb if the drug is delivered by a bag containing 300 mg/250 mL?
A: Knowns; dose is 10 mcg/kg every minute or 10 mcg/(kg*min), 180 lb man, 300 mg/250 mL drug concentration, 1 kg/2.2 lb, 1,000 mg/1 mcg, 1 hr/60 min
Unknown: dose in mL per hour or mL/hour
Therefore, you’d have to arrange a conversion problem by flip-flopping the numerators and denominators to get the units to cancel each other out to leave mL on top and hour on the bottom. Also, since you have the known dose given in mcg/(kg*min), but the size of the man is given in lb, you also need the conversion factor 1 kg = 2.2 lb or 1 kg/2.2 lb in this conversion. Furthermore, since you have known dose in mcg/(kg*min), you also need the conversion factor 1 mg/1000 mcg since the concentration is given in mg. Finally, you need the conversion factor of 60 min/1 hr because the answer should be in mL/hr but the known dose is given in mcg/(kg*min). In the following set-up, you have to flip-flop 300 mg/250 mL to 250 mL/300 mg:
180lb * 1kg/2.2lb * 10mcg/(kg*min) * 1mg/1000mcg * 60min/hr * 250mL/300mg = 40.9 mL/hr
Test Taking Hints
Similar Answers
Those writers of standardized tests often try to hide the correct answer of a question by offering similar potential answer choices.
For example:
122

Which of the following is another name for cyanocobalamin?
A.
vit B12
B.
vit B6
C.
niacin
D.
levothyroxine
If you have no idea which one is the correct answer, you can use process of elimination to weed out the incorrect answers for an educated guess. You know that the answer is either vit B12 or vit B6 because they’re trying to hide the correct answer with a similar sounding wrong answer. They’re hoping that if you remember that cyanocobalamin is vit B, but you’re unsure which B vitamin it is, then you might pick the wrong answer. However, this can be to your advantage if you have no idea what the answer is because, knowing what you know now, you’ve narrowed the answer choice down to a 50/50 chance. Cool, huh?
BTW, the answer is A. B12.
Another example:
A prescription reads: i gtt OD tid. This medicine is supposed to be administered in the
A.
mouth
B.
left eye
C.
right eye
D.
both ears
You know that the answer has to be one of the “eyes” because they’re trying to hide the real correct answer with similar sounding incorrect answers. You’ve just eliminated two definite incorrect answers without having a clue what the answer is!
BTW, the answer is C. right eye.
Ignore the Extra Stuff
Make sure that you know how to IGNORE extra info meant to trip you up. Often times, those testmakers try to put extra info into a math problem, hoping that you'll include that useless number in your calculations, thereby doing it WRONG! You can avoid this by... defining your knowns and unknown. Calm down and carefully set-up your problem.
For example:
A prescription order specifies potassium chloride 30 mEq PO bid. What volume of KCl elixir containing 80 mEq/30 mL will be required to deliver a single dose?
HINT: the extra info to IGNORE is PO bid. This is because they're asking for the volume of a
SINGLE dose. Some people will mistakenly multiply everything by two and miss the problem.
This is a simple proportion problem.
Knowns; 30 mEq of KCl per dose, 80 mEq/30 mL concentration
Unknown: volume of KCl in mL = X
123

30 mL/80 mEq = X/30 mEq multiply both sides by 30 mEq to solve for X:
(30 mL * 30 mEq)/80 mEq = (30 mEq * X)/30 mEq
X = (30 mL * 30 mEq)/80 mEq
X = 11.25 mL
Herbal Medicine
1.
St. John’s Wort – mild antidepressant
2.
Kava Kava – skeletal muscle relaxant
3.
Garlic – decreases cholesterol level
4.
Milk Thistle – hepatoprotectant (protects the liver)
5.
Ginseng – aerobic endurance
6.
Ginkgo – increases circulation to the brain. Improves memory.
7.
Ginger – increases appetite and decreases nausea & vomiting.
8.
Echinacea – immune booster.
9.
Valerian – sleep aid
10.
Cranberry – treats urinary tract infections
11.
Melatonin – sleep aid (not an herb)
12.
Glucosamine/Chondroitin – heals arthritic joints (not an herb)
13.
Saw Palmetto – for benign prostate hyperplasia (BPH)
14.
Bilberry – improves microcirculation. Improves vision and varicose veins.
15.
Evening Primrose Oil – claimed anti-inflammatory and antioxidant good for diabetic neuropathy, eczema,
PMS, and rheumatoid arthritis
16.
Feverfew – migraine prophylactic
P.T.
O.T.
M.S.W.
R.D.
M.D.
P.A.
D.O.
O.D.
D.D.S.
D.V.M.
P.A.
Institutional Pharmacy
Hospital Staff
Practitioners who can prescribe*
Optometrists cannot prescribe, but therapeutic optometrists can prescribe drugs that aren’t scheduled.
R.N.
R.T.
L.P.N.
Registered Nurse
Respiratory Therapist
Licensed Practical Nurse
Pharm.D.
R.Ph.
C.Ph.T
Doctor of Pharmacy
Registered Pharmacist
Certified Pharmacy
Physical Therapist
Occupational Therapist
Master’s of Social Work
Registered Dietitian
Technician
Medical Doctor*
Physician’s Assistant*
Doctor of Osteopathic Medicine*
Doctor of Optometry*
Doctor of Dentistry*
Doctor of Veterinary Medicine*
Physician’s Assistant*
124

N.P. Nurse Practitioner*
Unit Dose
There is one dose of medication in each drug package. Commonly, a plastic blister pack machine is used to make the unit dose packaging. For example, in a plastic blister pack system, there is one dose in each blister bubble. If the proper dose is one capsule, then there is just one capsule in the bubble. If the proper dose is one tablet, then there is just one tablet in each blister bubble. Other methods to make package medication as unit doses are; ampule for injection, foil blister pack for tablets, foil cup for oral liquids, packet of powder, paper packaging for tablets, syringe for injection, tube of ointment, and vial for injection.
1.
Technicians pre-pack bulk pharmaceuticals into unit dose packaging. In larger institutions, a password protected automated system is used to pre-pack oral solid dosage forms such as tablets and capsules. Unit dose packaging can also be done manually. In either case, strict institutional policies and procedures are followed.
Each package is labeled with; dosage form, expiration date, lot number, name of drug, strength, and other information as required by the institution.
The unit dose label may contain a bar code for purposes of inventory control, drug identification, and documentation.
2.
Technicians then fill the medication carts with the medication that patients need for the next 24 hour period.
Each cart contains many individual trays for each patient. Each tray is labeled with a patient’s name and room number. In some institutions, a cart-filling robot is used to automate this process. A pharmacist checks the medication cart.
3.
The filled medication cart is wheeled out to the nursing stations. Used carts from the previous 24 hour period are retrieved. Unused medication in the retrieved carts is credited to the patient.
4.
Throughout the day, the contents of a patient’s tray may change due to medication being administered, drugs being discontinued from the patient’s treatment regimen, and drugs being added to the patient’s treatment regimen. A computer system is usually used to keep track of such changes. Many such computer systems also use bar codes to help track inventory, identify drugs, and for purposes of documentation.
Floor Stock
Medication kept in the nursing station that doesn’t have to be labeled with patient-specific information.
Another type of cart that can be used in an institution is a crash cart or code cart . The trays in this cart are not patient specific. Crash carts contain medications that are typically used in medical emergencies on the floor. Each cart contains sealed trays. Once the seal is broken, the cart cannot be reused. The items used in the cart are charged to the patient.
After the cart is filled, the pharmacist checks it. Then, the cart is resealed before wheeling it out to the floor again.
Large volume parenterals are too bulky to be kept in the patient’s tray. Therefore, they are usually kept as floor stock in the refrigerator or other designated place in the nursing station. Examples of large volume parenterals are large bottles and bags of medication to be administered intravenously.
Hospital Pharmacy Organizational Systems
In a centralized pharmacy system, all pharmacy duties occur at the inpatient pharmacy . In a decentralized pharmacy system, pharmacy duties are managed at many designated places in the hospital. In a decentralized pharmacy system, there are subordinate pharmacies called satellite pharmacies that manage pharmacy activities outside the central pharmacy . An outpatient pharmacy is also known as an ambulatory pharmacy . It is a pharmacy in a hospital that treats patients who have either checked out of the hospital or are being seen by doctors in the hospital’s outpatient clinic.
In a large organization such as a hospital, having a good communication system is crucial. The phone system is used for voice communication. A fax machine is used for written communication. In order to exchange written communication and medication, a pneumatic tube system may be used. In a pneumatic tube system , the item to be sent to another location is put in a capsule and it is whisked away to its destination in a transport tube with compressed air. Such systems are also used in drive-thru pharmacies.
Rules and Regulations
The Policy and Procedure Manual is a document required in a pharmacy by law. This document contains all the rules and regulations of the pharmacy. It also contains step-by-step instructions on how to do many job tasks expected of the pharmacy technician. All pharmacy employees should have read and understood the policy and procedure manual.
DPH – Department of Public Health. The DPH inspects hospitals to ensure legal compliance.
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HCFA - Health Care Financing Administration. Medicaid requires approval by HCFA in order to be eligible for reimbursement.
JCAHO – The Joint Commission on Accreditation of Healthcare Organizations. Medicare and many insurance providers require that hospitals be accredited by the JCAHO in order to be eligible for reimbursement.
State Board of Pharmacy – Oversees the registration of pharmacists. Also oversees the registration of pharmacy technicians, where applicable.
Long Term Care Facilities
Long term care facilities such as nursing homes have pharmacists who perform two types of duties. These duties are consultant pharmacist and distributive pharmacist. A consultant pharmacist performs DURs (drug use reviews) for each patient in the nursing home. The pharmacist reviews each patient’s medical record for drug interactions and optimal drug use. In so doing, the pharmacist helps the health care team there create and maintain a pharmaceutical plan for every patient or resident of the facility. Usually, a retail pharmacist who works at an off-site pharmacy will take care of the distributive tasks and makes sure that patients get the correct medication as ordered by the patients’ physicians.
The prescriptions are filled and delivered to the long term care facility.
Medication carts in long term care facilities may only be refilled weekly. Also, they may use crash carts, just like hospitals. Furthermore, point-of-use automated systems might be used to dispense medication. In such a system, a doctor sends a medication order by computer to a central pharmacy. The pharmacy then communicates the order to the nursing station at the point-of-use. As soon as the nursing station receives this confirmation, the medication may be dispensed.
This is gaining popularity as some medication cannot wait a week to be dispensed.
The Medication Order
In a community pharmacy, the medication order is the filled prescription blank. In an institutional pharmacy, the medication order is a carbon-copied document that has a lot more information. The prescriber keeps one of the copies of the medication order and sends the other copy to the pharmacy or nursing station to be filled. In a community pharmacy, Schedule II controlled substances might require a special state-printed triplicate prescription to be used
(depending on state law). In a hospital, only the doctor’s medication order is necessary. However, the delivering technician and the head nurse receiving the CII medication should document with a signature the transfer of such substances from the pharmacy to the nursing station. A medication order should contain the following information;
Prescriber information (name and title), patient’s full name, patient’s birth date, patient’s room number, date & time an order was initiated, drug name, drug strength, and dose instructions. There are 3 types of medication orders that include standing order, PRN order, and STAT order. A standing order provides for patient dosing at regular intervals. A PRN order provides for patient dosing on an as needed basis. A STAT order provides for patient dosing immediately.
Please note that in addition to the list of medical practitioners who can prescribe, in an institutional setting, pharmacists and nurses could also write medication orders as long as the institution allows it and the supervising physician cosigns it.
After receiving the prescription order, the order entry may be done by a pharmacy technician, clerk, nurse, pharmacist, or physician. However, only a pharmacist can check orders in the computer and verify medication before it is sent to the nursing stations.
Nurses then document the carrying out of these prescription orders by filling out the MAR or medical administration record. The MAR may either be computerized or paper-based. The MAR gives a more detailed schedule of drug administration. The MAR records the dispensing/administration time and contains the signature of the person dispensing/administering the medication. The drug ordered, dose, dosage route, frequency of dose, and drug allergies are all recorded in the MAR . In addition, the MAR may contain the following information, whenever appropriate; diagnosis, height, laboratory tests, weight, and other confidential information about the patient (name, birth date, room number).
Guessing Techniques
Similar Answers
The writers of the PTCB exam always try to hide the correct answer by putting similar sounding wrong answers in the answer choices to confuse you. Therefore, if you have no idea what the correct answer is, just guess amongst the similar sounding answer choices. For example;
126

1.
Which of the following is cyanocobalamin?
A.
vitamin B12
B.
vitamin B6
C.
Warfarin
D.
Taxol
Let’s pretend that you don’t have any idea what the correct answer is. If you just guess randomly, you have a 25% chance of getting the answer correct. However, notice how answer choices “A” and “B” sound similar. By choosing one of these answer choices, you’ve increased your probability of getting the answer to 50%. The correct answer, by the way, is “A”.
Matching Grammar
The correct answer choice has to match the grammar of the question in a complete-the-sentence type question. For example;
2.
An example of a practitioner that can prescribe is a
A.
o ccupational therapist
B.
o ptician
C.
a nalyst
D.
p hysician’s assistant
Let’s suppose you don’t have any idea what the answer to this question is. Notice that answer choices “A”, “B” and “C” all grammatically require the word “an” to precede it. This is because all three of these answer choices begin with a vowel. However, the word preceding them is “a”. Answer choice “D” is physician’s assistant. This begins with a consonant which requires the word “a” to precede it. Since answer choice “D” requires the word “a” to precede it, the correct answer choice is “D”.
Matching Tone
If the question uses big words that sound difficult, then the answer is probably going to match the tone of the question by also using big words that sound difficult. Likewise, if the question sounds easy, then the answer should sound easy.
For example;
3.
An example of a beta-lactam antibiotic is;
A.
ticarcillin
B.
aspirin
C.
Vitamin B
D.
Vitamin C
The question sounds difficult. Therefore the most difficult sounding answer has the biggest probability of being correct.
Therefore, the correct answer is ticarcillin.
Regional Information
Please note that the regional information below will not be on your exam. The PTCB exam is a national exam.
Therefore, the exam will not have any state-specific questions.
For Texas Students
Please note that there is a new CII prescription form in addition to the triplicate forms currently in use. These are not triplicate forms but they are still government issued standard forms. They are green and issued by the DPS. These new
CII forms contain all the info that was present on the old triplicate forms. These DPS single copy prescription forms for schedule II drugs have the following identifying information;

Prescription control number - Preprinted by DPS or contractor and unique to individual prescriptions

VOID pantograph - A copied prescription is voided

Heat sensitive 'thumb print' - Disappears and reveals the word 'SAFE' when rubbed or heated

Watermark - gray-scale DPS seal in the middle of the prescription
In New York, the triplicate prescriptions are also being phased out. The new single copy prescription forms are to be used for CII drugs and benzodiazepines. Such prescriptions expire after 30 days in New York.
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Pediatric Dosing
Young’s Rule
Age of Child in Years x Adult Dose = Child’s Dose
Age of Child + 12 yrs
Clark’s Rule
Weight of Child in lb x Adult Dose = Child’s Dose
150 lb
The Successful Job Interview
Dress for Success
Wear office clothes. Make sure that you have immaculate grooming from your head to your toes. In less than 30 seconds, people pass the following judgments on you based on your 1 st impression;
1.
Your status in society
2.
Your level of education
3.
Your attractiveness
Remember, you don’t get a 2 nd chance to make your first impression. Make sure to dress accordingly.
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1.
Wear a matching business outfit that fits well. Make sure this includes a jacket.
2.
Wear long sleeves.
3.
Wear hosiery (women). Wear socks (men).
4.
Wear a dress watch. You must be on time to your interview.
5.
Wear a smile, stand up straight and take a deep breath to relax. Confidence will win people over.
6.
Groom properly. Make sure that you’ve taken a shower, cut your nails, shaved (men), and properly styled your hair before the interview.
Body Language
1.
Do not cross arms.
2.
Do not sit with legs open.
3.
Always look at the person that you’re talking to.
4.
Do not shake legs, tap fingers or exhibit other nervous habits.
Research Before the Interview
1.
Talk with ex-employees. Ex-employees will tell you everything about the company, both good and bad.
2.
Go take an incognito look at the pharmacy in the afternoon between 5-6PM. Do the employees look unreasonably busy? Ask what the wait time for a prescription is. If you are quoted more than 60 minutes, they may be extremely busy.
3.
Talk with some current employees. A current employee can tell you more about the company’s current policies and procedures.
Questions to Ask
1.
Who pays for uniforms, disability insurance, liability insurance, CE, travel to CE, lodging and meals for CE?
2.
What is the pay? Is there a yearly review of performance/pay?
3.
On what days are the pharmacy closed for holidays?
4.
How many paid days off per year do you get? This means vacation, personal, and sick days.
5.
Ask if there’s an employer matched 401k-retirement plan.
Most Commonly Asked Questions
1.
Do you have any experience?
2.
Are you certified?
3.
Can you provide a reference from your last employer?
4.
What special qualities or talents do you have?
5.
How do you perform under deadline pressure?
6.
Describe how you handled a major crisis at work.
The Resume
Remember, the purpose of a resume is to sell yourself. It is an advertisement that should create ample interest for an interview. 1, 2, 3 creates interest while 4, 5, 6, & 7 informs more. Be concise and to the point. Try your best to fit it all on 1 page. Keep in mind that most resumes are “read” in 10-20 seconds. Make sure that there are neither spelling nor grammar mistakes. Remember, you are not “just a housewife”. You are in charge of cost control, you manage people, motivate people, etc.
1.
The objective – be clear
2.
The Summary or Summary of Qualifications – focuses on important stuff that you offer
3.
Skills and Accomplishments – the summary in more detail
4.
Experience
5.
Education
6.
Awards (optional)
7.
Professional Affiliations (optional)
8.
Comments From Supervisors (optional)
9.
Personal Interests (optional)
10.
References or “References Available Upon Request”
The Follow-Up
Always follow-up an interview with a telephone call a week later. Call to “touch base” with them. This shows that you’re serious about wanting to join their company.
129

Practice Exam I
Please do these problems on your own before studying the answers at the bottom. Pace yourself and do these 125 problems in 125 minutes.
1.
90

F =
A.
32

C
B.
194

C
C.
104

C
D.
18

C
2.
30

C =
A.
86

F
B.
49

F
C.
1

F
D.
-15

F
3.
TPN Order for a 500 mL bag:
Aminosyn
Dextrose
Additives
5%
20%
25 mEq KCl
5 mL MVI
What you have:
8% Aminosyn 500 mL
60% Dextrose
5 mL MVI
500 mL
2.5 mEq/mL KCl 5 mL
130

25 mEq NaCl 2 mEq/mL NaCl 10 mL
Given this TPN order, how much KCl do you need to prepare this?
A.
0.1 mL
B.
10 mL
C.
75 mL
D.
7.5 mL
4.
Given the TPN order above, how much Dextrose do you need?
A.
167 mL
B.
0.04 mL
C.
10 mL
D.
20 mL
5.
Given the TPN order above, how much NaCl do you need?
A.
12.5 mL
B.
25 mL
C.
37.5 mL
D.
50 mL
6.
pt IIss =
A.
6.4 fluidounce
B.
11 fluidounce
C.
40 fluidounce
D.
24 fluidounce
7.
Which of the following is not an inhaler used by asthmatics?
A.
albuterol
B.
Azmacort
C.
Flonase
D.
Combivent
8.
Which of the following is the proprietary name of an antibiotic?
A.
Cephalexin
B.
Celexa
C.
Keflex
D.
Ciprofloxacin
9.
Which of the following cannot be administered to the patient at room temperature?
A.
Amoxil
B.
Biaxin
C.
Zithromax
D.
Mannitol
10.
A prescription is prepared by a pharmacy technician. Which of the following is not the next step?
A.
The pharmacist checks the prescription
B.
The technician hands the patient his/her prescription
C.
The pharmacist counsels the patient
D.
The technician asks the patient to fill out a patient information form
11.
A patient who is on warfarin gets ready to pay for a bottle of Bayer aspirin. What should you do?
A.
Ring up the sale
B.
Warfarin and aspirin causes bleeding when taken together. Warn the patient.
C.
Tell the pharmacist.
D.
Tell the patient to exchange it for a bottle of Ecotrin aspirin.
12.
A 250 mL bag of NS runs at 30 gtt/min with an infusion pump delivering 12 gtt/mL. How long will the infusion last?
A.
100 min
B.
50 hours
C.
360 min
D.
1 hour
13.
500 mL of saline is dripping through an infusion pump at 20 gtt/mL. The infusion will last 6 hours. The infusion rate will be
A.
28 gtt/min
B.
166 gtt/min
C.
56 gtt/min
D.
83 gtt/min
14.
Which of the following is not true? Parenterals must be made
131

A.
in a sterile hood
B.
using aseptic technique
C.
in a class 100 environment
D.
quickly
15.
Which of the following describes an ophthalmic medication?
A.
I gtt au tid
B.
I gtt as tid
C.
III gtt ou tid
D.
IV gtt ad tid
16.
A prescription of Vicodin might carry which auxiliary label?
A.
do not drink alcohol
B.
may cause sleeplessness
C.
take on an empty stomach
D.
for rectal use only
17.
Which of the following is not a parenteral dosage form?
A.
SL
B.
IC
C.
IT
D.
IV
18.
Which of the following cannot be for topical use?
A.
pulv.
B.
sol.
C.
sup.
D.
ung.
19.
Which of the following drugs should be packaged in a dark, light resistant container?
A.
nitroglycerin
B.
amoxicillin
C.
cephalexin
D.
normal saline
20.
Which of the following is not true?
A.
Pharmacy computers should be password secured.
B.
Use of pharmacy computers means that you can do away with card copy records.
C.
The system should be backed up on a regular basis.
D.
You should be able to make a hard copy for the State Board of Pharmacy on demand.
21.
Which of the following is not an example of a pharmacodynamic additive drug interaction?
A.
Vicodin & Tylenol
B.
Aspirin & ibuprofen
C.
Synthroid & Levothroid
D.
Maalox & Sumycin
22.
“IV gtt as qid prn pain” means
A.
4 drops 4 times daily in the left ear as needed for pain.
B.
6 drops 4 times daily in the left ear as needed for pain.
C.
4 drops daily in left ear as needed for pain.
D.
4 drops 4 times daily in left eye as needed for pain.
23.
Which of the following is not used to measure liquids for compounding?
A.
graduated cylinder
B.
syringe
C.
dropper
D.
micropipette
24.
Which of the following is not a narcotic analgesic?
A.
Vicodin
B.
Darvocet N-100
C.
oxycodone
D.
Diovan
25.
“disp. CCC tab.” Means?
132

A.
dispense 700 tablets
B.
dispense 300 tablets
C.
dispose 700 tablets
D.
dispose 300 tablets
26.
Amoxicillin is given to a child at 20-50 mg/kg/day divided into 3 daily doses. Amoxicillin is available in 125 mg/5 mL suspension. What is the dose for a 20 lb child?
A.
5 mL
B.
10 mL
C.
15 mL
D.
20 mL
27.
Archie took 5 mL of a 15% concentration drug. The drug dose is:
A.
300 g
B.
75 g
C.
0.75 g
D.
100 mg
28.
Investigational drug X-131 is 0.15% in concentration. It is given ii gtts ad tid. Each drop is 0.05 mL. What is the total daily dose?
A.
0.45 mg
B.
0.9 mg
C.
45 mg
D.
90 mg
29.
“Ft. 3 g hydrocortisone pulv. in 150 g of cream.” What is the percentage of hydrocortisone?
A.
1%
B.
2%
C.
3%
D.
4%
30.
“Sig. 1 tbsp p.o. q8h x 5 d” How much medicine should be dispensed?
A.
57 mL
B.
113 mL
C.
225 mL
D.
450 mL
31.
A dosage form where the drug is dissolved in a solvent is known as?
A.
solution
B.
suspension
C.
emulsion
D.
tablet
32.
Which of the following is not an example of good pharmacy practice when working with parenterals?
A.
Wear lint-free clothing
B.
Opening windows and doors to ensure adequate air circulation
C.
Prepare parenterals in a sterile hood
D.
Remove jewelry
33.
After compounding a sterile preparation, what do you do with the sharp needles and broken ampules?
A.
Put them in a sharps container
B.
Put them in s red trash bag
C.
Seal them in a cardboard box and throw them out in the regular trash
D.
Incinerate them
34.
“Sig. I tbsp tid x 4d” How much medicine was prescribed?
A.
180 mL
B.
45 mL
C.
60 mL
D.
12 mL
35.
Which of the following dosage forms is the most bioavailable?
A.
tablet
B.
cream
C.
ointment
133

D.
iv
36.
Which of these drugs is not available commercially?
A.
ibuprofen 800 mg tablet
B.
Prozac 20 mg capsule
C.
Ambien 5 mg/5 mL
D.
Aricept 5 mg tablet
37.
Ecstacy is a drug with the highest abuse and addiction potential with no medical acceptance. What is it classified as by the DEA?
A.
Schedule I
B.
Schedule II
C.
Schedule III
D.
Schedule IV
38.
Which of the following is not an antihistamine?
A.
Claritin
B.
Zyrtec
C.
Allegra
D.
Celexa
39.
Which drug is not a liquid?
A.
Tussionex syr.
B.
Imitrex inj.
C.
Xalatan gtt.
D.
Hydrocortisone pulv.
40.
Which of the following is not available as a liquid?
A.
sildenafil
B.
hydrocodone
C.
Xalatan
D.
Phenergan
41.
You have some bulk powder of amoxicillin 250 mg/5 mL. Given “Sig. 1 tsp tid 7d,” how many mL of water do you need if you ignore the volume of the powder itself?
A.
95 mL
B.
105 mL
C.
315 mL
D.
100 mL
42.
A patient in a nursing home needs all meds given in unit doses. Given “Sig. 1000 mg tid” for Augmentin 500 mg, what is the unit dose?
A.
1 tablet
B.
2 tablets
C.
3 tablets
D.
4 tablets
43.
Which of the following can a pharmacy technician not do?
A.
Take a new Rx from a doctor
B.
Count tablets
C.
Label a prescription bottle
D.
Type into a computer
44.
Which of the following doesn’t have to be cleaned with a spill kit if you spill it?
A.
Platinol
B.
Taxol
C.
cetirizine
D.
cyclophosphamide
45.
Given Keflex 250mg/5mL, “Sig. 1tsp qid 10d,” how much medicine should you dispense?
A.
100 mL
134

B.
200 mL
C.
300 mL
D.
400 mL
46.
Investigational drug X-269 is given a minute dose of 120 mcg IV. You have a stock bottle of 1:3000 concentration bottle. What is the dosage volume?
A.
0.36 mL
B.
3.6 mL
C.
36 mL
D.
1 mL
47.
The patient does not need a concurrent prescription of K-Dur with which of the following medications?
A.
hydrochlorothiazide
B.
Lasix
C.
fluoxetine
D.
furosemide
48.
Investigational drug XS-268 is available as 2 g of meds in a 500 mL bag of NS. The dose rate is 100 mg/hr and the equipment is calibrated to 20 gtts/mL. What is the flow rate?
A.
498 gtt/min
B.
49 gtt/min
C.
5 gtt/min
D.
8 gtt/min
49.
What would you not expect to find in John’s patient profile?
A.
His name
B.
His address
C.
His medications
D.
His credit card number
50.
Which of the following is not an ACE inhibitor antihypertensive?
A.
Altace
B.
Prinivil
C.
Accupril
D.
Coumadin
51.
Which of the following is not a schedule III drug?
A.
Duragesic
B.
Vicodin
C.
Lortab
D.
Vicoprofen
52.
In which of the following products do you not have to include a package insert?
A.
Estrace
B.
Ortho TriCylen
C.
Prempro
D.
Propranolol
53.
Which of the following is not contraindicated for Coumadin therapy?
A.
vitamin K
B.
green leafy vegetables
C.
aspirin
D.
Vicodin
54.
Which drug is Nardil most compatible with?
A.
dextromethorphan
B.
guaifenesin
C.
pseudoephedrine
D.
dextroamphetamine
55.
Which of the following is an example of pharmacodynamic food-drug antagonism?
A.
warfarin & green leafy vegetables
B.
Viagra & nitroglycerin
135

C.
Flomax & tomatoes
D.
Coumadin & aspirin
56.
Given “Ft. 25 g hydrocortisone in 1 kg Curel,” what is the concentration of hydrocortisone?
A.
1%
B.
2%
C.
2.5%
D.
5%
57.
2L of D5W is administered at 25mL/hr. After 4 hrs, how many g of dextrose has the patient received?
A.
10,000 g
B.
500 g
C.
100 g
D.
5 g
58.
How many units of regular insulin are in 50 mL of a 500 U/mL solution?
A.
25,000 U
B.
2,500 U
C.
100 U
D.
10 U
59.
Given regular insulin 500 U/mL dosed at 25 U/hr administered with a drip set that administers 20 gtts/mL, what is the flow rate in gtt/hr?
A.
500 gtt/hr
B.
400 gtt/hr
C.
1 gtt/hr
D.
5 gtt/hr
60.
Given the above flow rate, how much insulin do you need for 20 hours of administration?
A.
20 mL
B.
10 mL
C.
5 mL
D.
1 mL
61.
Which drug is not usually used to treat type II diabetes?
A.
Micronase
B.
Diabeta
C.
Gyburide
D.
Insulin
62.
Which drug should you dispense with protective gloves and clothing?
A.
vincristine
B.
butorphanol
C.
methylphenidate
D.
tocopherol
63.
Which of the following is contraindicated in a person with asthma?
A.
atenolol
B.
butorphanol
C.
Stadol
D.
mannitol
64.
Which of the following is estrogen available as a vaginal cream?
A.
Climara
B.
Premarin
C.
Desogen
D.
Alesse
65.
Which drug doesn’t treat hypertension?
A.
hydrochlorothiazide
B.
Zestril
C.
hydrocodone
D.
Zestoretic
66.
Which of the following is a sublingual tablet dispensed in a brown, light resistant container?
A.
Nitrostat
136

B.
Imdur
C.
Aricept
D.
Evista
67.
Which of the following is not available as a reconstitutable powder antibiotic?
A.
Amoxil
B.
Augmentin
C.
Claforan
D.
Ceftin
68.
Which drug is not available commercially?
A.
Vicodin tablets
B.
Viagra syrup
C.
Hycodan syrup
D.
Valium injection
69.
Which of the following is not an example of volumetric glassware approved for making compounds?
A.
syringe
B.
graduated cylinder
C.
micropipette
D.
dosage cup
70.
Given 30 g of 0.1% hydrocortisone cream, you have to compound a 1% hydrocortisone cream. How much
2.5% hydrocortisone cream would you have to use?
A.
0.045 g
B.
45 g
C.
20 g
D.
18 g
71.
Rx Levoxyl 150 mcg, sig. qd, disp. #90. Your pharmacy only has 0.075 mg levoxyl in stock. How many tablets do you dispense?
A.
30
B.
60
C.
90
D.
180
72.
200

L of U100 insulin contains how many units of insulin?
A.
10 U
B.
20 U
C.
100 U
D.
200 U
73.
Investigational drug X-365 has a dose of 250 mg for a 150 lb patient. It comes in a 10% concentration suspension. The amount of X-365 given in a single dose is?
A.
0.025 mL
B.
0.1 mL
C.
2.5 mL
D.
5 mL
74.
Which of the following is not an NSAID?
A.
Motrin
B.
ketoprofen
C.
acetaminophen
D.
naproxen
75.
Which of the following drugs may cause bradycardia?
A.
atenolol
B.
acetaminophen
C.
Xalatan opth gtts
D.
tocopherol
76.
Which of the following is not an antihypertensive?
A.
metoprolol
137

B.
Inderal
C.
Diovan
D.
Tocopherol
77.
You have a 250 mL bag of D5NS that has precipitated. There’s flakes of white stuff in it. What should you do?
A.
discard it, it’s contaminated
B.
heat it to redissolve the precipitate
C.
shake it to redissolve the precipitate
D.
inject glycerin in it to suspend the precipitate
78.
Given “sig: 1 gtt ou tid prn”, what is the proper auxillary label to affix to the bottle?
A.
do not drive may cause drowsiness
B.
take with food
C.
for the eye
D.
for the ear
79.
Which of the following should not be stored in the refridgerator at 2-8

C?
A.
phenergan supp
B.
Miacalcin NS
C.
Reconstituted Augmentin
D.
Mannitol
80.
The drugs stocked by a pharmacy based on cost and efficacy factors is the __. This can either be an open __ or a closed __. An open __ allows the pharmacy to stock any drug that is prescribed while a closed __ only allows a pharmacy to stock drugs specified on the __. What goes in the blank?
A.
formula
B.
list
C.
formulary
D.
quantity
81.
Generic multivitamins cost $90 per case. One case holds 25 bottles. The markup on cost is 200%. The price per bottle is:
A.
$10.80
B.
$90
C.
$180
D.
$270
82.
What if these were prescription prenatal vitamins with a $2 dispensing fee per prescription bottle? What is the price per bottle?
A.
$12.80
B.
$8.80
C.
$92.00
D.
$272.00
83.
A regular accounting of the quantity of medication in stock is the
A.
inventory
B.
formulary
C.
rotation
D.
want list
84.
You have to order 2 bottles of Ritalin. What form do you use?
A.
DPS form 222
B.
DEA form 222C
C.
Invoice
D.
Inventory
85.
Which of the following is not a valid DEA number for Dr. Brown?
A.
AB3646152
B.
AB5626152
C.
BA5626152
D.
AB3828158
86.
Drug X was recalled due to severe liver damage leading to possible death. What type of drug recall is this?
A.
Class 1
B.
Class 2
C.
Class 3
D.
Class 4
138

87.
Which of the following is not information required on a drug prescription label?
A.
patient name
B.
prescription number
C.
date prescription was filled
D.
color and shape of pills
88.
Your pharmacy was robbed! All of your OxyContin is gone. Who do you report this to?
A.
DEA & police department
B.
DEA & FDA
C.
DEA & USDA
D.
FDA & USDA
89.
Harry’s was prescribed 15 mg/kg of drug X, sig. i tid x 10d. Harry weighs 185 lb. What is the dose?
A.
2775 mg
B.
1261 mg
C.
11.2 mg
D.
5.6 mg
90.
The above medicine is available as a 250 mg/mL suspension. What is amount of the dose?
A.
1 tsp
B.
2 tsp
C.
1 tbsp
D.
2 tbsp
91.
You are to dispense a 120 mL bottle of Zyrtec. Given sig. 2 tsp qd, what is the day supply on this?
A.
6 days
B.
12 days
C.
24 days
D.
48 days
92.
Which of the following is a Schedule II Controlled Substance?
A.
Marinol
B.
Talwin
C.
Duragesic
D.
Marijuana
93.
Which of the following is the minimum distance that you must work within the laminar flow hood?
A.
2 inches
B.
5 inches
C.
6 inches
D.
10 inches
94.
Which of the following drugs have the lowest abuse potential?
A.
Schedule I
B.
Schedule II
C.
Schedule III
D.
Schedule IV
95.
You have a prescription for Keflex 25 mg qid for 7 days. You have Keflex 125mg/5mL in 100 mL bottles.
How many mL do you need to fill the Rx?
A.
14 mL
B.
28 mL
C.
44 mL
D.
17,500 mL
96.
Which of the following is not an antihistamine?
A.
diphenhydramine
B.
Allegra
C.
Claritin
D.
indomethacin
97.
How many 25 mg NaCl tablets are need to make 500 mL of NS?
A.
180 tablets
B.
90 tablets
C.
45 tablets
D.
5 tablets
139

98.
Which of the following combinations are not potentially deadly?
A.
warfarin & aspirin
B.
Viagra & Nitrostat
C.
dextromethorphan & allopurinol
D.
Coumadin & erythromycin
99.
Which of Justice Department organizations enforces the Controlled Substances Act of 1970?
A.
DEA
B.
CIA
C.
DIA
D.
State Board of Pharmacy
100.
You read iv gtts au tid. What do you type on the label?
A.
Instill 6 drops into both ears 3 times a day.
B.
Instill 4 drops into both ears 3 times a day.
C.
Instill 4 drops into left ear 3 times a day.
D.
Instill 4 drops into both eyes 3 times a day.
101.
Which bottle size should you use to dispense 240 mL of Tussionex?
A.
4 ounces
B.
6 ounces
C.
8 ounces
D.
24 ounces
102.
The 4 digits in the middle of the NDC number represents?
A.
manufacturer
B.
drug
C.
quantity
D.
expiration date
103.
What does “product selection permitted” mean on a prescription?
A.
You may not use generics.
B.
You may use another drug in the same class
C.
You may use an AB rated generic
D.
You bill for the generic price but dispense with the brand
104.
What is 25 mg expressed in grains?
A.
1625 gr
B.
1.6 gr
C.
0.76 gr
D.
0.38 gr
105.
Material Safety Data Sheets (MSDS)
A.
are required by OSHA for pharmacies that carry hazardous chemicals.
B.
are lists of antidotes provided by the poison control center.
C.
are first aid procedures.
D.
are none of the above.
106.
How many grams of dextrose is in 200 mL of D5W?
A.
5 g
B.
10 g
C.
15 g
D.
20 g
107.
500 mL of an IV has to be infused over 8 hours. What is the infusion rate in mL/min?
A.
8 mL/min
B.
4 mL/min
C.
1 mL/min
D.
16 mL/min
108.
Which of the following is not a skeletal muscle relaxant?
140

A.
carisoprodol
B.
Skelaxin
C.
cyclobenzaprine
D.
Ultram
109.
Which of the following is false regarding class A torsion balances?
A.
They can weigh objects lighter than 120 mg.
B.
They have 2 weighing pans.
C.
They are analog.
D.
All pharmacies are required to have one.
110.
Which drug comes in a patch?
A.
alprazolam
B.
Duragesic
C.
mefloquine
D.
Lindane
111.
Which capsule size is the biggest?
A.
d
B.
c
C.
000
D.
5
112.
To what volume do you q.s. a 5 g vial to attain a concentration of 200 mg/mL?
A.
1000 mL
B.
5000 mL
C.
0.025 mL
D.
25 mL
113.
Which document do you use to order CII’s?
A.
DEA222C
B.
DEA120
C.
invoice records
D.
want sheet
114.
Most drugs are excreted by the
A.
liver
B.
kidney
C.
nares
D.
oidos
115.
A man weighs 220 lbs. He is to be given a 20 mg/kg dose of a drug. What dose should he receive?
A.
9680 mg
B.
24.2 mg
C.
2000 mg
D.
5 mg
116.
The cost of 80 g of butt cream costs $25. If the markup is 33%, what is the price?
A.
$8.25
B.
$16.75
C.
$33.00
D.
$33.25
117.
Hypertension is
A.
high blood pressure
B.
low blood pressure
C.
slow heart condition
D.
fast heart condition
118.
According to the following sig, how many capsules should be dispensed? i bid, i qd x 4 days.
141

A.
6
B.
5
C.
4
D.
3
119.
Dr. Addison orders the nurse to give Manny 5 mg/kg of Claforan tid. Manny weighs 165 lbs. How much
Claforan would the nurse need to dose Manny for 1 day?
A.
1125 mg
B.
112,500 mg
C.
2250 mg
D.
225 mg
120.
What auxiliary label should you use for the following sig: i-ii gtts ou tid.
A.
for the eye
B.
for the ear
C.
for rectal use only
D.
take with food
121.
Sterile parenteral solutions are made in a
A.
class 100 environment
B.
fume hood
C.
SVP
D.
LVP
122.
00555-2676-02 represents;
A.
Drug Enforcement Agency number
B.
Uniform Product Code
C.
National Drug Code
D.
Mnemonic code
123.
You received an order of Norco. Which document proves that you received this?
A.
DEA form 222C
B.
Invoice
C.
DUR
D. CII inventory book
124.
If your state requires pharmacies to take an annual inventory of your controlled substance stock, but federal law only requires a biennial inventory, which law do you follow?
A.
Municipal regulations
B.
State law
C.
Federal law
D.
International law
125.
Arnold develops hives when he takes Penicillin. Arnold also develops hives when he takes Amoxil. This means that Arnold has a/an _____ to Amoxil. Which of the following does not belong?
A.
An adverse reaction
B.
A cross-sensitivity reaction
C.
An allergic reaction
D.
Drug-drug interaction
Answers to Practice Exam I
1.
A
C temperature = 5/9 x (number of degrees F - 32)
C temperature = 5/9 x (90 – 32)
142

C temperature = 32

C
2.
A
F temperature = (1 4/5 times number of degrees C) + 32
F temperature = (1 4/5 x 30) + 32
F temperature = 86

F
3.
B
1 mL/2.5 mEq = A mL/25 mEq
A mL = (1 mL x 25 mEq) / 2.5 mEq
A mL = 10 mL
4.
A
20% = 0.20, 60% = 0.60, to convert % to decimals, just move the decimal to the left two places
0.20 x 500 mL = 0.6 x A mL
A mL = 167 mL
5.
A
1 mL/2 mEq = A mL/25 mEq
A mL = (1 mL x 25 mEq) / 2 mEq
A mL = 12.5 mL
6.
C pt IIss = 2.5 pt
16 fluidounce/1 pt = A fluidounce/2.5 pt
A fluidounce = (16 fluidounce x 2.5 pt) / 1 pt
A fluidounce = 40 fluidounce
7.
C
Flonase is a nasal inhaler used for prevention of nasal allergies.
8.
C
Keflex is the brand (proprietary) name. Cephalexin and ciprofloxacin are generic names. Celexa is not even an antibiotic.
9.
D
Mannitol has to be warmed in a hot water bath or autoclave to melt the crystals. It is then cooled to body temperature for injection. Please note that you will come across questions that ask for info that you didn’t study. Relax, answer the question quickly and move on to avoid wasting time.
10.
D
Asking for patient information is the first step in a retail pharmacy’s work flow.
11.
C
There is a drug interaction that causes serious bleeding if warfarin and aspirin are taken together. However, technicians are not allowed to counsel patients. Only pharmacists are supposed to counsel patients.
12.
A
250 mL x 12 gtt/mL x 1 min/30 gtt = 100 min
13.
A
500 mL/6 hrs x 20 gtt/mL x 1 hr/60 min = 28 gtt/min
14.
D
Parenterals do not have to be made quickly. They have to be made using aseptic technique in a sterile hood that provides a class 100 environment.
15.
C ou means both eyes. Ophthalmic medications are for the eyes.
16.
A
Vicodin shouldn’t be taken with alcohol or Tylenol due to hepatotoxicity (all of these are harsh on the liver).
Vicodin also causes sleepiness. It is a tablet for oral use and it should always be taken with food as it can cause nausea.
17.
A
SL means sublingual (under the tongue)
18.
C sup means suppository (deposit in vagina, urethra, or rectum).
19.
A
Nitroglycerin should be stored in a dark, light resistant container as it degrades in light.
20.
B
You have to have hard copy records and computer records in a pharmacy.
143

21.
D
Maalox inhibits Sumycin absorption by chelating (coating) the Sumyicin. This is a pharmacokinetic drug interaction.
22.
A
“IV gtt as qid prn pain” means 4 drops in the left ear 4 times daily as needed for pain.
23.
C
A dropper is generally not used to measure liquids for compounding. It is not graduated glassware, so it is usually only used as for patient dosing.
24.
D
Diovan is an angiotensin II receptor antagonist, antihypertensive.
25.
B
“disp. CCC tab.” Means dispense 300 tablets.
26.
A
20 lb x 50 mg/(kg x day) x 1 kg/2.2 lb x 1 day/3 doses = 152 mg/dose
This is closest to 125 mg. Since the concentration of amoxicillin is 125 mg/5 mL, the dose should be 5 mL.
27.
C
15% = 15 g/100 mL
5 mL x 15 g/100 mL = 0.75 g
28.
A
0.15% = 0.15 g
0.15 g/100 mL x 6 gtts/day x 0.05 mL/1 gtt x 1000 mg/1 g = 0.45 mg
29.
B
HC is hydrocortisone
% = A g/100 g
3 g HC/150 g cream = A g/100 g
A g = (3 g x 100 g) / 150 g
Ag = 2%
30.
C
1 tbsp = 15 mL
15 mL/dose x 3 doses/day x 5 days = 225 mL
31.
A
A solution is when a drug is completely dissolved in a liquid.
32.
B
Breezes from open windows and doors will disrupt laminar air flow
33.
A
You dispose of sharp hazardous waste in a sharps container.
34.
A
15 mL x 3 x 4 = 180 mL
35.
D
Bioavailability is the fraction of drug delivered by a dosage form into a patient. Therefore, iv is the most bioavailable since 100% of the drug is injected into the patient. Tablets are not 100% bioavailable since stomach acids may dissolve much of the medicine. Creams and ointments may not be 100% absorbed as some may be left on the surface of the skin.
36.
C
Ambien 5 mg/5 mL is not a commercially available drug product
37.
A
Schedule I drugs have the highest abuse and addiction potential with no medical acceptance.
38.
D
Celexa is not an antihistamine. It is an antidepressant.
39.
D
Hydrocortisone powder is not liquid.
40.
A
Sildenafil or Viagra is not available as a liquid. Although this is unfair, they may require you to know generic names of drugs that are unavailable commercially as a generic.
41.
B
5 mL x 3 x 7 = 105 mL
42.
B
2 tablets
144

43.
A
A pharmacy technician cannot take a new prescription from a doctor. Only a pharmacist can do so.
44.
C
Cetirizine is the only drug that is not a toxic antineoplastic drug. Therefore, you don’t need a spill kit to clean it up if you spill it.
45.
B
5 mL x 4 x 10 = 200 mL
46.
A
120 mcg = 0.000120 g
A mL/0.000120 g = 3000 mL/1 g
A mL = (3000 mL x 0.000120 g) / 1 g
A mL = 0.36 mL
47.
C
Hydrochlorothiazide and Lasix (furosemide) may cause hypokalemia (low potassium). Prozac (fluoxetine) doesn’t. Therefore, K-Dur (a potassium supplement) is not needed with Prozac therapy.
48.
D
500 mL/2 g x 1 g/1000 mg x 100 mg/hr x 20 gtt/mL x 1 hr/60 min = 8 gtt/min
49.
D
A patient profile should contain; patient’s name, address, phone, allergies, birthday, drug name & dose, medical conditions, child proof top preference, and insurance information. Anything else is not expected.
50.
D
Coumadin is an anticoagulant. Altace, Prinivil, Accupril are all ACE inhibitor antihypertensives.
51.
A
Duragesic is a schedule II drug. Vicodin, Lortab, and Vicoprofen are schedule III drugs.
52.
D
Only oral contraceptives, estrogenic drugs, progesteronal drugs, isotretinoin, IUDs and isoproterenol inhalation drugs require a patient package insert.
53.
D
Vicodin is O.K. to take with Coumadin. Vitamin K, green leafy vegetables, and aspirin may all change the
Coumadin therapy.
54.
B
Nardil is most compatible with guaifenesin. All the other drugs might cause a drug interaction.
55.
A
Green leafy vegetables replace the vitamin K lost by warfarin. This causes the warfarin to be less effective.
56.
C
% is g/100 g and 1000 g = 1 kg
25 g/1000 g = A/100 g
A = (25 g x 100 g) / 1000 g
A = 2.5%
57.
D
5g/100mL x 25mL/hr x 4hr = 5g
58.
A
50 mL x 500 U/mL = 25,000 U
59.
C
1 mL/500U x 25 U/hr x 20 gtt/mL = 1 gtt/hr
60.
D
20 hr x 1 gtt/hr x 1 mL/20 gtt = 1 mL
61.
D
Type II diabetes is usually not treated with insulin. This is also known as non-insulin dependent diabetes or maturity onset diabetes.
62.
A
Vincristine is an antineoplastic drug that is toxic.
63.
A
Atenolol is a beta blocker drug. Beta blockers are contraindicated in asthmatic patients as they can exacerbate the asthma.
64.
B
Premarin is available as tabs (0.3, 0.625, 0.9, 1.25, 2.5 mg), vaginal cream, and injection (25 mg).
145

65.
C
Hydrocodone is a narcotic opiate pain reliever. It is not usually used to treat hypertension.
66.
A
Nitrostat is a sublingual tablet dispensed in a brown, light resistant container.
67.
C
Claforan is an injectable antibiotic.
68.
B
Viagra is not available commercially as a syrup.
69.
D
A dosage cup is not volumetric glassware used for making compounds. Dosing droppers, spoons, and cups are all not accurate enough to be used for compounding purposes. They are only meant for patient dose measurements.
70.
D
This is an alligation problem. Take the difference between the concentration of each ingredient and the product;
2.5% conc ingredient - 1% conc product = 1.5 parts of 0.1% conc ingredient
1% conc product – 0.1% conc ingredient = 0.9 part of 2.5% conc ingredient
Now that you have 2 ratios that are proportional to each other and 3 known & 1 unknown variable, you can use the ratio & proportion method to solve this problem;
1.5 parts/30 g of 0.1% conc ingredient= 0.9 parts/A g of 2.5% conc ingredient
(30 g x 0.9 parts) / 1.5 parts = A g
A g = 18 g of 2.5% conc ingredient
71.
D
0.075 mg x 1000 mcg/1 mg = 75 mcg
Since 75 mcg is ½ of 150 mcg, you’d have to double up on 75 mcg tablets. Therefore, you’d have to dispense twice the number of tablets; 2 x 90 tablets = 180 tablets
72.
B
U100 insulin contains 100 U of insulin per mL. 1000

L = 1 mL.
100 U/1000

L = ? U/200

L
? U = 20 U insulin
73.
C
A 10% solution is equal to 10 g/100 mL in concentration. 1 g = 1000 mg.
100 mL/10 g x 1 g/1000 mg x 250 mg = 2.5 mL
74.
C
Acetaminophen is not a NSAID. It is just generic Tylenol. An NSAID is a non-steroidal anti-inflammatory drug.
75.
A
Atenolol is a beta blocker. Beta blocker drugs can slow the heart. Bradycardia means a slow pulse.
76.
D
Tocopherol is not an anithypertensive. It is vitamin E.
77.
A
The solution is contaminated and/or expired if it has precipitated. IV solutions should not have precipitates in them.
78.
C
“ou” means in each eye. Therefore, you would use the auxillary label that reads “for the eye”.
79.
D
Mannitol should not be stored in the refridgerator. It has to be kept warm at 30-40

C.
80.
C
The list of medications that a pharmacy stocks based on cost and efficacy factors is a formulary.
81.
A
200% = 200/100 = 2
Markup/Cost = % Markup on Cost
Markup/$90 = 2
Markup = 2 x $90
Markup = $180
146

Price = Cost + Markup
Price = $90 + $180
Price = $270
This is the price per case. Since there are 25 bottles in the case, you divide by 25 to get the price per bottle:
$270/25 = $10.80 per bottle
Alternately, you could do this as a conversion problem;
$270/case x 1 case/25 bottles = $10.80/bottle
82.
A
$90/case x 1 case/25 bottles = $3.60/bottle cost
Cost + (cost x % markup as a decimal) + dispensing fee = prescription price
$3.60 + ($3.60 x 2) + $2 = prescription price prescription price = $12.80
83.
A
A regular accounting of the quantity of medication in stock is the inventory.
84.
B
All CII (schedule II) controlled substances have to be ordered with a DEA form 222C.
85.
C
In a valid DEA number, the second letter of the DEA number is the first letter of the doctor’s last name.
86.
A
Class 1 drug recalls have a strong probability of causing serious adverse effects or death.
87.
D
The color and shape of the pills are not info required to be on a prescription label.
88.
A
DEA & local police department should be notified if any CII’s are stolen. This is federal law.
89.
B
15 mg/kg x 1 kg/2.2 lb x 185 lb
1261 mg
90.
A
1261 mg x 1 mL/250 mg x 1 tsp/5 mL = 1 tsp
91.
B
120 mL x 1 tsp/5 mL x 1 day/2 tsp = 12 days
92.
C
Duragesic is a CII.
93.
C
You must work at least 6 inches inside a laminar flow hood.
94.
D
The higher the number, the lower the abuse potential. CI has no legitimate medicinal use and has the highest abuse potential. CII has the highest abuse potential of medicinal drugs. CV are controlled substances with the lowest abuse potential.
95.
B
Knowns; 25 mg/dose, 4 doses/day, 7days, 5 mL/125 mg
Unknown: ? mL
Conversion: 5 mL/125 mg x 25 mg/dose x 4 doses/day x 7 days = ?
Answer: 28 mL
Note: Be careful, they always throw extra useless info in to confuse you. Carefully setting up the problem like I did above will help you ignore the useless info. The info that the medication comes in 100 mL bottles is useless. Also, in a conversion problem, you want to arrange all your knowns in such a way that all the units cancel each other out except for the unit of the answer, mL.
96.
D
Indomethacin is not an antihistamine. It is a NSAID.
97.
A
Knowns; 1 tab/25 mg, 1000 mg/1 g, 0.9 g/100 mL, 500mL
Unknown: ? tablets
Conversion: 1 tab/25 mg x 1000 mg/1 g x 0.9 g/100 mL x 500 mL = ?
Answer: 180 tablets
147

You have to know the definition of NS = 0.9 g NaCl/100 mL water = 0.9% NaCl
98.
C
Only dextromethorphan with allopurinol is not a potentially deadly drug interaction.
99.
A
The DEA, a branch of the Justice Department, enforces the Controlled Substances Act of 1970.
100.
B iv gtt au tid means instill 4 drops in both ears 3 times daily.
101.
C
Knowns; 240 mL, 1 ounce/30 mL
Unknown: ? ounces
Conversion: 240 mL x 1 ounce/30 mL = ? ounces
Answer: 8 ounces
102.
B
The middle 4 digits represent the drug, the first 5 digits represents the manufacturer, and the last 2 digits represent the quantity.
103.
C
“product selection permitted” means that you may use an AB rated generic.
104.
D
Knowns; 25 mg, 1 gr/65 mg
Unknown: ? gr
Conversion: 25 mg x 1 gr/65 mg = ? gr
Answer: 0.38 grains
105.
A
MSDS are required by OSHA for pharmacies that carry hazardous chemicals.
106.
B
Knowns; 5 g/100 mL, 200 mL
Unknown: ? g dextrose
Conversion: 5 g/100 mL x 200 mL = ?
Answer: 10 g dextrose
Note: You have to know that D5W is dextrose 5% = 5 g/100 mL.
107.
C
Knowns; 500 mL/8 hrs, 1 hr/60 min
Unknown: ? mL/min
Conversion: 500 mL/8 hrs x 1 hr/60 min = 1 mL/min
108.
D
Ultram is not a skeletal muscle relaxant. It is an analgesic.
109.
A
Class A torsion balances have a minimum amount weighable of 120 mg.
110.
B
The dosage form of Duragesic is a patch.
111.
C
000 is the largest available capsule size. The larger the number, the smaller the capsule size. The following capsules are listed in order of decreasing size; 000, 00, 0, 1, 2, 3, 4, and 5.
112.
D
25 mL
Knowns; 5 g, 1000 mg/1 g, 1 mL/200 mg
Unknown: ? mL
Conversion: 5 g x 1000 mg/g x 1 mL/200 mg = ? mL
Answer: 25 mL
113.
A
The DEA222C is the document used to order CII’s.
114.
B
Most drugs are excreted by the kidney. Remember ADME or absorption (gastrointestinal if drug is given orally), distribution (circulatory), metabolism (mostly liver), excretion (mostly kidney).
115.
C
2000 mg
Knowns; 220 lb, 1 kg/2.2 lb, 20 mg/kg
148

Unknown: ? mg
Conversion: 220 lb x 1 kg/2.2 lb x 20 mg/kg = ? mg
Answer: 2000 mg
116.
D
Knowns; % Markup on Cost = 33% = 0.33, Cost = $25
Unknown: Markup, Price
Formulas; Markup/Cost = % Markup on Cost
Price = Cost + Markup
This is a 2 part problem. First you have to find out how much the markup is.
Markup/Cost = % Markup on Cost
Markup/$25 = 0.33
Markup = 0.33 x $25
Markup = $8.25
Then, you have to figure out what the price is.
Price = Cost + Markup
Price = $25 + $8.25
Price = $33.25
117.
A
Hypertension is high blood pressure.
118.
A
6 capsules should be dispensed according to the following sig: i bid, i qd x 4 days.
119.
A
Knowns; 5 mg/(kg x dose), 1 kg/2.2 lb, 165 lbs, 3 doses/day, 1 day
Unknown: ? mg
Conversion: 5 mg/(kg x dose) x 1 kg/2.2 lbs x 165 lbs x 3 doses/day x 1 day = ? mg
Answer = 1125 mg
120.
A ou means both eyes.
121.
A
Sterile parenteral solutions are made in a class 100 environment.
122.
C
National Drug Code
123.
B
Invoice
124.
B
State Law. The stricter state law always holds precedence over the less strict federal law.
125.
D
Drug-drug interaction
149

Practice Exam II
1.
Which of the following should be stored at room temperature (15-30

C)?
A.
promethazine suppositories
B.
insulin (Humulin, Humalog, etc)
C.
reconstituted Cefzil
D.
Phenergan tablets
2.
You bought a bottle of vitamin C for $8.00. Your markup is 30%. What is the price?
A.
$5.60
B.
$10.40
C.
$4
D.
$12
3.
Given, “iss tsp tid 10d,” how many mL should you dispense?
A.
75mL
B.
150mL
C.
180mL
D.
225mL
4.
0.25g/mL w/v = __ %
A.
25
B.
50
C.
75
D.
None of the above
5.
1:100 w/v = __ g/mL
A.
0.01
B.
10
C.
100
D.
1,000
6.
2 mg% w/v = __ mg/mL
A.
0.02
B.
2
C.
200
D.
None of the above
150

7.
22% v/v = __ mL/mL
A.
0.22
B.
22
C.
2200
D.
None of the above
8.
50 ppm = __ g/mL
A.
0.00005
B.
0.005
C.
0.5
D.
None of the above
9.
You have a 120mL bottle of promethazine syrup. Each dose is 1 tsp. How many doses does this bottle contain?
A.
24 doses
B.
33 doses
C.
120 doses
D.
None of the above
10.
A hydrocortisone suppository contains 2% hydrocortisone. How much hydrocortisone is in a 2.5g suppository?
A.
0.05g
B.
5g
C.
125g
D.
None of the above
11.
You are using a glass graduate to measure 50 mL of water to reconstitute an antibiotic. How do you measure this?
A.
Where the mark touches the water
B.
Where the mark touches the top of the water
C.
Where the meniscus is
D.
None of the above
12.
Given, “sig: 0.1g tid x 10d,” How many 25mg tablets do you need?
A.
12
B.
120
C.
300
D.
None of the above
13.
Sandy weighs 70 lbs. She is to receive 2.5 mg/kg of Amoxil. Amoxil comes in 250mg/5mL concentration.
What is the dose in mL?
A.
1.6mL
B.
3.5mL
C.
3.69mL
D.
5mL
14.
A patient is to be dosed 2 mg of a drug. You have a 1:500 solution. The dose is
A.
1mL
B.
2mL
C.
10mL
D.
None of the above
15.
Which of the following is an example of volumetric glassware proper for measurement of pharmaceutical compounding ingredients?
A.
teaspoon
B.
tablespoon
C.
dropper
D.
graduated cylinder
16.
A 500 mL bag of NS is administered over 2 hours. The infusion set says that the drop factor is 20gtt/mL. The flow rate in gtt/min is?
A.
83gtt/min
B.
166gtt/min
C.
5,000gtt/min
D.
10,000gtt/min
17.
How many mEq of Na are in 1L of NS? M.W. of Na+ = 23 and M.W. of Cl- = 35.
A.
0.155 mEq
B.
15.5 mEq
151

C.
155 mEq
D.
15,517 mEq
18.
What can you do when working with antineoplastic drugs in a biological safety hood?
A.
Open the windows
B.
Gently rub your eyes
C.
Wear gloves
D.
Scratch an itch on your nostril
19.
Which of the following is not a typical characteristic of a pharmacy computer system?
A.
Backup data
B.
Password protected
C.
Identifies possible drug interactions
D.
Voicemail
20.
Which of the following tasks is a pharmacy technician not allowed to do?
A.
Tell a patient not to take nitrate drugs with Viagra
B.
Take refill approvals over the phone
C.
Make electronic transfers of prescriptions between pharmacies in the same chain with a computer.
D.
Type a prescription into the computer.
21.
Which of the following is not an antidepressant?
A.
St. John’s Wort
B.
fluoxetine
C.
Zoloft
D.
Ambien
22.
Which of the following drugs are not used to lower cholesterol?
A.
atorvastatin
B.
simvastatin
C.
gemfibrozil
D.
Lotrel
23.
Which of the following drug combinations represent a major drug-drug interaction?
A.
Viagra & Nitrostat
B.
Coumadin & acetaminophen
C.
acetaminophen & theophylline
D.
albuterol & Amoxil
24.
Which of the following is not a sulfonylurea drug?
A.
Glucotrol XL
B.
Amaryl
C.
Diabeta
D.
Gleevec
25.
Given, “sig: i gr tid 10d,” how many mg of drug should you dispense?
A.
3 mg
B.
30 mg
C.
195 mg
D.
1950 mg
26.
On a prescription balance having a sensitivity requirement of 0.02g, what is the smallest amount that can be weighed with a maximum potential error of not more than 10%?
A.
0.002g
B.
0.2g
C.
2g
D.
None of the above
27.
10g of hydrocortisone powder can make how many g of a 2.5% hydrocortisone cream?
A.
25g
B.
400g
C.
1,000g
D.
2,500g
28.
You dilute a 500mL bag of D5W to a 2.5% concentration. What is the volume?
A.
25mL
B.
250mL
C.
1,000mL
D.
None of the above
152

29.
Which of the following is a valid DEA number for Dr. Corduroy?
A.
BB7256791
B.
BC7256792
C.
CB7256791
D. BC7256793
30.
Your pharmacy was robbed. The Oxycontin is missing. What are you legally required to do?
A.
Call the local police department.
B.
Call the DEA.
C.
Call the regional pharmacy manager.
D.
A and B
31.
Which of the following is the generic of Calan?
A.
verapamil
B.
felodipine
C.
diltiazem
D.
lisinopril
32.
Which of the following is not an oral contraceptive?
A.
Ortho-Cyclen
B.
Desogen
C.
Alesse
D.
Estrace
33.
Which of the following is not a Beta-Blocker?
A.
atenolol
B.
metoprolol
C.
Inderal
D.
tramadol
34.
Which of the following is not an antihypertensive?
A.
Zestril
B.
Altace
C.
Plendil
D.
Flexeril
35.
Which of the following is not available as a nasal spray?
A.
Miacalcin
B.
Flonase
C.
Alphagan
D.
Vancenase
36.
Which of the following cannot be stored at room temperature?
A.
Phenergan tablets
B.
Vitamin B injection
C.
Normal Saline
D.
mannitol
37.
Which of the following is not legally necessary on a prescription drug label?
A.
Address of pharmacy
B.
Name of doctor
C.
Date filled
D.
Expiration date of the medication
38.
What information does the manufacturer have to give the pharmacy in order to notify the pharmacy of a drug recall?
A.
drug name
B.
lot number
C.
expiration date of the drug
D.
A and B
39.
Which of the following has to be on the manufacturer’s stock labeling but does not have to be on the prescription drug label?
A.
Lot number
B.
Patient name
C.
Doctor’s name
D.
Drug name
40.
Which of the following means low blood sugar?
A.
Hypothyroidism
153

B.
Hypoglycemia
C.
Hyperglycemia
D.
Hyperthyroidism
41.
Which statement is required by law?
A.
Caution: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed.
B.
Take with food.
C.
May cause drowsiness.
D.
Do not drink alcohol.
42.
Which drug is not legally required to have a PPI or patient package insert?
A.
Ortho Tri-Cyclen
B.
Prempro
C.
IUD
D.
Albuterol inhaler
43.
Which of the following is not a parenteral dosage form?
A.
Intrathecal
B.
IV
C.
Intramuscular
D.
Sublingual
44.
Which of the following is not available as a sup?
A.
allopurinol
B.
promethazine
C.
acetaminophen
D.
glycerin
45.
Which of the following is not a SVP?
A.
500mL IV bag of NS
B.
1mL ampule of morphine
C.
2mL vial of digoxin
D.
10mL vial of insulin
46.
Where would you dispose of used needles?
A.
Sharps container
B.
Red trash bag
C.
Black trash bag
D.
None of the above
47.
Which of the following does not have to be cleaned up with a Spill Kit?
A.
Taxol
B.
Cyclophosphamide
C.
Cysplatin
D.
Hydrodiuril
48.
Which of the following is not an example of aseptic technique?
A.
Hand washing
B.
Wearing sterile gloves
C.
Not coughing, sneezing, nor talking into the hood
D.
Opening the window to allow fresh air in
49.
Which is the smallest capsule?
A.
1
B.
2
C.
3
D.
4
50.
Which of the following is not used as a suppository base?
A.
cocoa butter
B.
PEG
C.
Methylcellulose
D.
Polyethylene Glycol
51.
What is a neonate?
A.
An unborn fetus
154

B.
A premature baby
C.
Up to 28 days old
D.
28 days to 1 year old
52.
Which organ is most active in excreting toxins and drugs?
A.
Liver
B.
Kidneys
C.
Heart
D.
Stomach
53.
Mrs. Doodie is allergic to codeine. To which of the following medication may Mrs. Doodie have a cross sensitivity to?
A.
Ocycontin
B.
Tylenol
C.
Acetaminophen
D.
Vioxx
54.
If your pharmacy has hazardous chemicals, what reference is required by OSHA?
A.
Drug Information Handbook
B.
Drug Topics
C.
MSDS
D.
Journal of the American Pharmaceutical Association
55.
Which of the following doesn’t cover any medical costs outside the network of providers?
A.
PPO
B.
HMO
C.
POS
D.
None of the above
56.
Which formulary style allows a pharmacy to stock any medication that has been prescribed?
A.
Closed formulary
B.
Open formulary
C.
Big formulary
D.
Small formulary
57.
Federal law requires that you take a controlled substance inventory at least…
A.
Annually
B.
Biannually
C.
Monthly
D.
None of the above
58.
Which of the following can a pharmacy technician not do?
A.
Take refill approvals
B.
Request refills
C.
Electronically transfer prescriptions between pharmacies in the same chain with a computer modem
D.
Transfer prescriptions and take new prescriptions over the phone
59.
A used vial of medication should be disposed of in a
A.
Sharps container
B.
Biohazard bag
C.
Regular trash
D.
None of the above
60.
Which of the following is not required by law to operate a pharmacy?
A.
Pharmacy license
B.
Pharmacist license
C.
DEA registration
D.
APhA registration
61.
After getting a chemical burn or needlestick injury, you provide first aid. What do you do after first aid has already been administered?
A.
Eat a meal
B.
Go home and rest
C.
Seek medical attention immediately
D.
Bandage the area
62.
Serious adverse drug events should be reported to the
A.
FDA Medwatch program
B.
DEA
155

C.
FBI
D.
AphA
63.
Which organ metabolizes most drugs?
A.
Stomach
B.
Heart
C.
Liver
D.
Kidney
64.
When a doctor writes DAW on the prescription, what does this mean?
A.
Dispense as written – only dispense the brand name drug
B.
Dispense antibiotics with water – reconstitute all antibiotics before dispensing
C.
This designates the drug as being addictive.
D.
None of the above.
65.
The middle set of digits of an NDC number indicates
A.
The manufacturer
B.
The drug
C.
The package size
D.
The expiration date
66.
iss in Roman numerals is
A.
0.5
B.
1.5
C.
5
D.
15
67.
A TPN order calls for 2.5% aminosyn in a 1L TPN bag. You have a 500mL bag of 10% aminosyn in stock.
How do you prepare the TPN order?
A.
Dilute 250mL of 10% aminosyn to 1,000mL
B.
Dilute 25mL of 10% aminosyn to 1,000mL
C.
Dilute 500mL of 10% aminosyn to 1L
D.
Dilute 50mL of 10% aminosyn to 1L
68.
A TPN order calls for 20mEq of NaCl. You have a 50mL container of 5.4 mEq/mL NaCl stock solution. How do you prepare the TPN order?
A.
Put 3.7mL of the 5.4 mEq/mL NaCl stock solution in the TPN
B.
Put 108 mL of the 5.4 mEq/mL NaCl stock solution in the TPN
C.
Put 13.5 mL of the 5.4 mEq/mL NaCl stock solution in the TPN
D.
Put 11 mL of the 5.4 mEq/mL NaCl stock solution in the TPN
69.
For which of the following medications is a prescription not necessary?
A.
DEA
B.
UPC
C.
OTC
D.
RX only
70.
All pharmacies are required to have this reference.
A.
USP
B.
DEA
C.
OSHA
D.
UPS
71.
Which tool do you use to triturate?
A.
Placebo
B.
WD-40
C.
Mortar & Pestle
D.
Class A Torsion Balance
72.
8 fluid ounces is
A.
128mL
B.
12.8mL
C.
240mL
D.
24.0mL
156

73.
1 avoirdupois lb is equal to how many gr?
A.
16gr
B.
437.5gr
C.
7,000gr
D.
None of the above
74.
What does D5W mean?
A.
Dextrose 5% in water
B.
Doctors needed in hospital wing 5
C.
Dispense as written
D.
None of the above
75.
How much 5% acetic acid is needed if you mix it with 13% acetic acid to make 2000 mL of 10% acetic acid?
A.
250 mL
B.
500 mL
C.
750 mL
D.
1000 mL
76.
What is 10

C = ?
A.
25

F
B.
37.56

F
C.
50

F
D.
233.52

F
77.
What is 10

F = ?
A.
-10

C
B.
-12.2

C
C.
-39.6

C
D.
-50

C
78.
What is the brand name of nortriptyline?
A.
Pamelor
B.
Depo-Provera
C.
Aldactone
D.
Tegretol
79.
What is the generic of Tegretol?
A.
sildenafil
B.
ramipril
C.
temazepam
D.
carbamazepine
80.
The doctor told Mr. Brownstone to take some Anaprox for his headache. What generic can Mr. Brownstone take instead?
A.
naproxen sodium
B.
naproxen
C.
tramadol
D.
ibuprofen
81.
Arnie takes Warfarin, Percodan, Roxiprin, and Percocet. Which drug(s) interact with Warfarin to cause possibly fatal bleeding?
A.
Percodan
B.
Roxiprin
C.
Percocet
D.
A and B
82.
Delila has a fungal infection. Which drug is used for that?
A.
fluconazole
B.
miconazole
C.
astemizole
D.
A and B
83.
Juju takes Tylenol No. 2. What generic can be substituted for that?
A.
APAP/codeine 300/15 mg tablets
157

B.
APAP/codeine 300/30 mg tablets
C.
APAP/codeine 400/60 mg tablets
D.
APAP/codeine 120/12 mg per 5 mL
84.
Ms Isis was prescribed 500 mg of Amoxil t.i.d. As a pharmacy technician, what should you do?
A.
Call the pharmacist. Amoxicillin should be given 250mg t.i.d.
B.
Fill the prescription
C.
Call the doctor to clarify the dose.
D.
Ask the patient if the dose is correct.
85.
Which of the following should only be kept in a brown glass bottle?
A.
Nitrostat
B.
NaCl
C.
KCl
D.
Amoxil
86.
Which of the following can be used as an antidepressant?
A.
St. John’s Wort
B.
Kava Kava
C.
Garlic
D.
Milk Thistle
87.
You have a 120g tube of hydrocortisone cream 2.5% How much hydrocortisone is in this cream?
A.
3 g
B.
6 g
C.
9 g
D.
12 g
88.
A patient asks you, a pharmacy technician, what he is taking Amoxil for. What do you do?
A.
Tell the patient that Amoxil is an antibiotic.
B.
Tell the patient that Amoxil is an antihypertensive.
C.
Tell the patient that Amoxil is for her sore throat.
D.
Ask the pharmacist to consult the patient.
89.
Jimmy the pharmacist filled out the DEA order form 222 incorrectly. What should he do?
A.
Cross out the mistake and initial it.
B.
Throw the form away and start over.
C.
File away the incorrectly filled form and start over with a fresh one.
D.
Consult with Iggy the pharmacist.
90.
Which person can write a prescription?
A.
N.P.
B.
Optician
C.
Psychologist
D.
Chiropractor
91.
Where are crash carts located after leaving the pharmacy?
A.
There is one by each patient’s bed. Each cart is labeled with the patient’s name.
B.
There should be some crash carts on the floor at the nursing stations.
C.
They are dispensed to patients on an outpatient basis.
D.
They are destroyed.
92.
What information do unit packaging not have to be labeled with?
A.
expiration date
B.
lot number
C.
dosage form
D.
quantity of doses in each package
93.
Which of the following is kept as floor stock?
A.
unit dose packages of Tylenol
B.
large volume parenteral bag of normal saline
C.
30 mL foil cup of milk of magnesia
D.
ampule of promethazine
94.
Which of the following would an outpatient pharmacy not typically dispense?
A.
methohexital
B.
Tylenol No. 3
C.
APAP
D.
ASA
158

95.
What type of pharmacy would typically use a pneumatic tube system?
A.
hospital
B.
retail pharmacy with no drive-thru
C.
consulting
D.
nuclear
96.
Which of the following is a text required by law in the pharmacy?
A.
Drug Topics
B.
National Association of Chain Drug Stores
C.
Policy and Procedure Manual
D.
Today’s Technician
97.
Which of the following oversees the registration of pharmacists?
A.
State Board of Pharmacy
B.
JCAHO
C.
HCFA
D.
DPH
98.
What pharmacist would typically visit a nursing home periodically to perform DURs?
A.
consultant pharmacist
B.
distributive pharmacist
C.
nuclear pharmacist
D.
retail pharmacist
99.
Which of the following does a MAR not typically contain?
A.
drug ordered
B.
dose
C.
dosage route
D.
patient’s credit rating
100.
Dr. Levy orders morphine to be administered STAT. When should the nurse administer it?
A.
immediately
B.
every morning at breakfast
C.
every evening before dinner
D.
as needed
101.
Amoxicillin costs $9.95 per bottle of 100 capsules. The sig on your prescription reads; i tid x 10d. Your standard markup is 50%. What would the selling price for the prescription be?
A.
$4.48
B.
$2.99
C.
$1.49
D.
14.93
102.
Arnold takes weighs 170 lbs. The doctor wants to prescribe Amoxil 2 mg/kg tid x 10d. Amoxil comes in
250mg/5mL. What is the dose?
A.
3.09mL
B.
6.18mL
C.
9.27mL
D.
12.36mL
103.
Which of the following is on the MAR but not retail pharmacy prescriptions?
A.
Doctor’s signature
B.
Drug name, dose, and strength
C.
Patient’s name
D.
Dosage schedule
104.
Which of the following doesn’t have to be on a prescription?
A.
Drug allergies
B.
Patient name
C.
Drug name, dose, and strength
D.
Practitioner’s signature
105.
Which of the following jobs can a pharmacy technician do?
A.
accept new prescriptions over the phone
B.
accept new prescriptions electronically
159

C.
transfer prescriptions between pharmacies electronically
D.
authorize refills
106.
Which of the following is not found on a patient profile?
A.
Patient’s telephone number
B.
Patient’s insurance information
C.
Patient’s medications
D.
Expiration date of patient’s medications
107.
A patient returns to the pharmacy complaining of a codeine allergy. What should you do?
A.
Tell him to take a Benadryl.
B.
Enter opiate allergy in his patient profile.
C.
Notify the pharmacist to counsel the patient.
D.
Do both A and B.
108.
Which of the following is not a therapeutic duplication?
A.
Vicodin and Tylenol
B.
Vicoprofen and Motrin
C.
Tyelnol No. 3 and APAP
D.
Vicodin and ibuprofen
109.
Which drug listed below is a solid dosage form?
A.
Phenergan syrup.
B.
Betagan ophthalmic drops.
C.
Hyrdocortisone cream.
D.
Nystatin powder.
110.
The sig for Cipro otic drops says, “i gtt au tid”. What would the prescription label say?
A.
1 drop by mouth three times daily.
B.
Instill one drop in both ears three times a day.
C.
Take 1 drop in both ears three times daily.
D.
Instill one drop in both eyes three times a day.
111.
Which of the following doesn’t have to be stored in the refrigerator at 2 to 8 
C (36 to 46

F)?
A.
Promethazine syrup
B.
Miacalcin nasal spray
C.
Humalog insulin
D.
Promethazine suppository
112.
Which of the following is not a proper auxiliary label for Vicodin?
A.
Take with food
B.
May cause drowsiness
C.
For the eye
D.
Both A and B
113.
Which of the following are not required on the prescription label?
A.
Date the prescription was written
B.
Expiration date
C.
Date the medication was dispensed
D.
A and B
114.
Which of the following is not important when preparing parenterals?
A.
Do not talk.
B.
Work at least 6 inches inside the hood.
C.
Notifying the parents
D.
Wash hands properly before preparing the parenteral.
115.
Which of the following does not have to be refrigerated?
A.
Reconstituted Augmentin
B.
Dry-powdered Cefzil
C.
Miacalcin nasal spray
D.
Phenergan suppositories
116.
Which of the following drugs is the most stable?
A.
Coal tar
B.
Dry-powdered Augmentin
C.
Reconstituted Augmentin
D.
A radiopharmaceutical with a half-life of 10 minutes
160

117.
Which of the following is not a third-party payer?
A.
Insurance company
B.
Medicare
C.
Medicaid
D.
Patient
118.
You work in a hospital with a closed formulary. A doctor prescribes Viagra. Viagra is not on the formulary.
Can you order this drug and dispense it?
A.
No, you can only stock formulary drugs in a closed formulary facility.
B.
Yes, you can stock non-formulary drugs.
C.
Automatically substitute with the generic.
D.
No, you cannot stock the non-formulary drug unless the doctor gains permission under protocol.
119.
Who/What determines what an institution’s formulary is?
A.
The insurance companies
B.
The CEO of the company
C.
The P & T Committee
D.
The head doctor
120.
A patient takes Vicodin. Which of the following drugs represent a therapeutic duplication when taken concurrently with Vicodin?
A.
Tylenol
B.
Ibuprofen
C.
Ascorbic acid
D.
ASA
121.
When a pharmacy needs to order Duragesic patches,
A.
The P.I.C. (pharmacist-in-charge) needs to order it.
B.
Duragesic is ordered with DEA form 222C.
C.
The technician may order it by filling out DEA form 222C
D.
A and B
122.
When a drug manufacturer notifies your pharmacy of a drug recall, what do you do?
A.
Alert the affected patients.
B.
Alert the prescribing doctors.
C.
Remove the medication with the appropriate lot numbers from the inventory.
D.
All of the above.
123.
10 patients died from manufacturing impurities in a lot of Viagra. The lot of Viagra is recalled. What class of recall is this?
A.
Class I
B.
Class II
C.
Class III
D.
Class IV
124.
A child is 4 years old and weighs 45 lbs. The adult dose of a medication is 250mg. Using Young’s Rule, what is the dose?
A.
62.5 mg
B.
57.7 mg
C.
83.3 mg
D.
75.0 mg
125.
A child is 4 year old and weighs 45 lbs. The adult dose of a medication is 250mg. Using Clark’s Rule, what is the dose?
A.
62.5 mg
B.
57.7 mg
C.
83.3 mg
D.
75.0 mg
161

Answers to Practice Exam II
1.
D
Phenergan tablets can be stored at room temperature.
2.
B
Markup/Cost = % Markup
Markup/$8.00 = 0.30
Markup = $2.40
Cost + Markup = Price
$8.00 + $2.40 = Price
Price = $10.40
3.
D
1.5tsp/dose x 5mL/tsp x 3dose/day x 10days = 225mL
4.
A
162

0.25g/1mL = Xg/100mL
X = 25g
Since w/v % is g/100mL, 0.25g/mL = 25%
5.
A
1g/100mL = Xg/1mL
X = 0.01g/mL
6.
A
2mg/100mL = Xmg/1mL
X = 0.02mg
7.
A
22% = 22mL/100mL
22mL/100mL = XmL/1mL
X = 0.22mL/mL
8.
A ppm = parts per million
50g/1,000,000mL = Xg/1mL
X = 0.00005g/mL
9.
A
120mL x 1tsp/5mL x 1dose/1tsp = 24 doses
10.
A
2g/100g = Xg/2.5g
X = 0.05g
11.
C
You measure fluids by where the mark indicates the meniscus. When water is measured in a glass container, it forms a
“u” shape. This is due to intermolecular attraction between the water and the glass. You measure the liquid by where the bottom of the “u” is indicated by the mark on the glass graduate. Therefore, if the corresponding mark says “50mL,” then you are measuring 50mL.
12.
B
Tablet/25mg x 0.1g/dose x 1000mg/1g x 3doses/day x 10days = 120tablets
13.
A
70lbs x 1kg/2.2lbs x 2.5mg/kg x 5mL/250mg = 1.6mL
14.
A
2mg x 1g/1000mg x 500mL/1g = 1mL
15.
D
A graduated cylinder is an example of volumetric glassware for the measurement of pharmaceutical compounding ingredients. Teaspoon, tablespoon, and dropper are examples of devices the patient uses to measure medication dosages.
These are not accurate means to measure compounding ingredients. Acceptable volumetric glassware are; graduated cylinder, syringe, and micropipette.
16.
A
500mL/2hrs x 1hr/60min x 20gtt/1mL = 83gtt/min
17.
C
0.9g/100mL x 1000mL x 1mEq/0.058g = 155mEq
The definition of NS or normal saline is 0.9g/100mL or 0.9% sodium chloride.
The definition of 1/2NS or ½ concentration normal saline is 0.45g/100mL or 0.45% sodium chloride.
18.
C
You are supposed to wear gloves when working with antineoplastic drugs. You cannot open the windows (lets in drafts and contaminants). You also cannot scratch your eyes or nose as that my place the toxic drugs on your eyes or nose.
19.
D
All pharmacy computer systems should have a data backup system, password protected access, and identification of possible drug interactions. Voicemail is not typical.
20.
A
A pharmacy technician is not allowed to counsel a patient. That is the pharmacist’s job.
21.
D
Ambien is not an antidepressant. Ambien is a hypnotic (sleep aid).
22.
D
Lotrel is not used to lower cholesterol. It is a combination drug; amlodipine (calcium channel blocker) & benazepril
(ACE inhibitor). This is an antihypertensive drug used to lower blood pressure.
23.
A
163

Viagra & Nitrostat is a potentially fatal drug interaction. Viagra cannot be taken with any nitrates.
24.
D
Gleevec is not a sulfonylurea drug used as a hypoglycemic drug for diabetics. Gleevec is a cancer drug.
25.
D
1gr/dose x 3doses/day x 65mg/1gr x 10days = 1950mg
26.
B
(Sensitivity Requirement x 100%)/Permissible % of Error = Smallest Amount Weighable
(0.02g x 100)/10 = 0.2g
27.
B
10g/X = 2.5g/100g
X = 400g
28.
C
VolA x ConcA = VolB x ConcB
500mL x 0.05 = VolB x 0.025
VolB = 1,000mL
Note: 5% = 0.05 To convert a % to a decimal number, just move the decimal 2 places to the left.
29.
D
The first letter of a DEA number has to be either an “A” or “B”.
The second letter of a DEA number has to be the first letter of the doctor’s last name.
StepA: 7 + 5 + 7 = 19
StepB: 2 + 6 + 9 + 17
StepC: StepB x 2 = 17 x 2 = 34
StepD: StepC + StepA = 34 + 19 = 53
The last digit of StepD should be the last digit of the DEA number.
30.
D
If any Schedule II drugs are stolen, you are required by federal law to notify the police and DEA.
31.
A
Verapamil is the generic of Calan.
32.
D
Estrace is not an oral contraceptive. It is an estrogen derivative.
33.
D
Tramadol is not a Beta-Blocker. It is the generic of Ultram.
34.
D
Flexeril is not an antihypertensive. It is used as a skeletal muscle relaxant.
35.
C
Alphagan is an ophthalmic solution. It is not available as a nasal spray.
36.
D
Mannitol has to be stored warm at 30-40

C (86-104

F).
37.
D
The expiration date of the medication is not legally necessary on the prescription drug label.
38.
D
The drug manufacturer has to notify the pharmacy of a drug recall in writing by naming the recalled drug’s name and lot number.
39.
A
The lot number has to be on the manufacturer’s stock labeling but does not have to be on the prescription drug label. The manufacturer’s stock label is the label on the big bottle (ex. 100 tablets) that the pharmacy buys from the wholesaler.
After the pharmacist puts 10 of those tablets into a smaller bottle for the patient, the patient’s bottle has a prescription drug label.
40.
B
Hypoglycemia means low blood sugar.
41.
A
“Caution: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed” is a statement required by law to be on all patients’ prescription bottles.
42.
D
Albuterol inhalers are not legally required to have a PPI. Only the following require a PPI; oral contraceptives, estrogenic drugs, progesteronal drugs, isotretinoin, intrauterine devices (IUD), and isoproterenol inhalation drugs.
43.
D
164

Sublingual is not a parenteral dosage form. Parenteral dosage form includes any route other than oral, sublingual, or rectal. It is usually administration with needles.
44.
A
Allopurinol is not available as a suppository (sup.).
45.
A
A 500mL IV bag of NS is considered a LVP or large volume parenteral.
46.
A
Sharp objects are disposed of in a sharps container.
47.
D
Hydrodiuril is a diuretic. You only have to use a spill kit to clean up spills of cytotoxic and hazardous drugs such as chemotherapy agents.
48.
D
Opening the window will create drafts that destroy laminar airflow. Also, this will let in particulates that destroy the class 100 environment.
49.
D
The smaller the number, the larger the capsule.
50.
C
Methylcellulose is not used as a suppository base.
51.
C
The definition of a neonate is a child up to 28 days old.
52.
B
Your kidneys are most active in excreting toxins and drugs.
53.
A
Oxycontin and codeine are both narcotic analgesics. Therefore, if a patient is allergic to one, the patient may be allergic to both. This is called cross sensitivity.
54.
C
If a pharmacy carries hazardous chemicals, OSHA requires that the pharmacy has a MSDS or material safety data sheet for every hazardous chemical in the pharmacy.
55.
B
HMO’s do not cover any medical costs outside the network of providers.
56.
B
An open formulary allows a pharmacy to stock any medication that has been prescribed.
57.
B
Federal law requires that the pharmacy takes a controlled substance inventory at least biannually. State laws may be stricter than this, though.
58.
D
Only a pharmacist can take new prescriptions and transfer prescriptions over the phone.
59.
B
Used vials, syringes, and bags that held drugs should be disposed of in biohazard bags.
60.
D
APhA registration is not required by law to operate a pharmacy. The AphA stands for American Pharmacist Association.
61.
C
After administering first aid, you should always seek immediate medical attention following a needlestick injury or chemical burn.
62.
A
Serious adverse drug events should be reported to the FDA Medwatch program.
63.
C
The liver metabolized most drugs.
64.
A
DAW – means dispense as written or only dispense the brand name drug.
65.
B
The middle set of NDC number indicates the drug.
66.
B iss in Roman numerals is 1.5
67.
A
0.025 x 1,000mL = 0.1 x XmL
X = 250mL
165

You ignore the number 500mL in the calculations because you are not diluting the whole 500mL bag. You are diluting only 250mL of the 10% aminosyn stock solution to 1,000mL of the 2.5% aminosyn TPN.
68.
A
1mL/5.4mEq x 20mEq = 3.7mL
69.
C
OTC or “over the counter” drugs do not require a prescription.
70.
A
All pharmacies are required by law to carry a USP.
71.
C
You triturate or grind drugs into smaller particles with a mortar & pestle.
72.
C
8 fluid ounce x 30mL/1 fluid ounce = 240mL
73.
C
7,000 gr is the same as 1 avoirdupois lb.
74.
A
D5W means dextrose 5% in water.
75.
C
Alligation Problem:
5% 3 parts of 5% concentration ingredient
10% concentration product
13% 5 parts of 13% concentration ingredient
To get 3 parts, you take the difference between the 13% concentration ingredient and the 10% concentration product.
13% - 10% = 3 parts
To get 5 parts, you take the difference between the 10% concentration product and the 5% concentration ingredient.
10% - 5% = 5 parts
3 parts of 5% + 5 parts of 13% = 8 parts 10%
? mL of 5% + ? mL of 13% = 2000 mL of 10%
Therefore, you can set-up a ratio and proportion equation;
2000mL of 10%/8 parts = ?mL of 5%/3 parts
? mL = (2000 mL x 3 parts)/8 parts
Answer: 750 mL
76.
C
(9/5 x

C) + 32 =

F
(9/5 x 10

C) + 32 = 50

F
77.
B
5/9 x (

F – 32) =

C
5/9 x (10

F – 32) = -12.2

C
78.
A
Pamelor is the generic of nortriptyline.
79.
D
Carbamazepine is the generic of Tegretol.
80.
A
Naproxen sodium is the generic of Anaprox.
81.
D
Percodan and Roxiprin both contain aspirin that could lead to fatal bleeding when taken with Warfarin.
82.
D
Fluconazole and miconazole are both antifungal medications.
83.
A
Tylenol No. 2 contains 300mg of APAP (acetaminophen) and 15mg of codeine. Tylenol No. 3 contains 300mg of APAP and 30mg of codeine. Tylenol No. 4 contains 300mg APAP and 60mg codeine.
166

84.
B
Amoxil 500 mg t.i.d. is the usual and customary dose for Amoxil.
85.
A
Nitrostat should be kept in a brown glass bottle.
86.
A
St. John’s wort can be used as an antidepressant.
87.
A
Knowns; 2.5g hydrocortisone/100g cream = 2.5% hydrocortisone cream, 120g hydrocortisone cream
Unknown: ? g hydrocortisone
2.5 g hydrocortisone + 100 g cream = 102.5 g of 2.5% hydrocortisone cream.
2.5g hyrocortisone/102.5g hydrocortisone cream = ?g hydrocortisone/120 g hydrocortisone cream.
(2.5g HC x 120 g HC cre) / 102.5 g HC cre = ? g HC
Answer: 2.93 g hydrocortisone.
88.
D
Only a pharmacist can counsel a patient.
89.
C
Some drug wholesalers will not process a DEA 222 that has been altered in any way. Since each DEA 222 is numerically sequenced, you shouldn’t throw it away. You should file the altered form and start over with a fresh form.
90.
A
Opticians, psychologists, and chiropractors are not legally authorized to write prescriptions for medication.
91.
B
After being filled in the pharmacy, sealed crash carts are wheeled out to the nursing stations.
92.
D
Unit packaging do not have to be labeled with the quantity of doses in each package because unit dose packages only have one dose per package.
93.
B
Large volume parenteral bags are too big to be kept in the patient’s medication cart. They are usually kept as floor stock.
94.
A
Methohexital is a general anesthesia agent. It is not usually dispensed in an outpatient pharmacy. APAP is acetaminophen and ASA is aspirin.
95.
A
A hospital pharmacy would typically use a pneumatic tube system.
96.
C
All pharmacies have to have a copy of their own Policy and Procedure Manual.
97.
A
The State Board of Pharmacy oversees the registration of pharmacists.
98.
A
A consultant pharmacist would periodically visit a nursing home to perform DURs.
99.
D
A patient’s MAR would usually not contain the patient’s credit rating.
100.
A
STAT means to administer the medication immediately.
101.
A
First, figure out the cost of each amoxicillin capsule;
$9.95/100 capsules x 1 capsule = $0.0995
Then, figure out how many capsules you need in the Rx; itid x 10d means 1 capsule three times daily for 10 days. We need 30 capsules to fill the prescription.
Then, figure out the cost of 30 capsules;
30 capsules x $0.0995/capsule = $2.985
Finally, figure the price;
50% = 0.50 markup/cost = % markup on cost markup/$2.985 = 0.50 markup = 0.50 x $2.985 markup = $1.4925
167

price = cost + markup price = $2.985 + $1.4925 price = $4.48
102.
A
Remember, the question asks for the amount of medication in one dose. Therefore, the fact that Arnold takes his medication 3 times daily is irrelevant.
Knowns; 170 lbs, 1 kg/2.2 lbs, 2 mg/kg, 250 mg/5 mL
Unknown: ? mL
Conversion:
5mL/250mg x 2mg/kg x 1kg/2.2lbs x 170lbs = ? mL in each dose
Answer: 3.09mL
103.
D
The dosage schedule isn’t on retail pharmacy prescriptions, but it is on the MAR.
104.
A
Drug allergies don’t have to be on a prescription.
105.
C
A pharmacy technician may transfer prescriptions between pharmacies electronically.
106.
D
The expiration date of the patient’s medications is not normally in the patient’s profile.
107.
C
The pharmacist should be contacted any time clinical judgement and/or counseling are required.
108.
D
Therapeutic duplication is an example of a drug interaction where you take the same drug twice. An inadvertent overdose may be possible. Vicodin has Tylenol in it. Therefore, if you take The two together, you may get an overdose of Tylenol. Likewise, Vicoprofen has Motrin in it. Tylenol No. 3 has APAP in it. APAP is just an abbreviation for acetaminophen or Tylenol. However, Vicodin is O.K. with ibuprofen because Vicodin doesn’t contain ibuprofen.
109.
D
Nystatin powder is a solid dosage form.
110.
B
“i gtt au tid” means “Instill 1 drop in both ears three times a day”.
111.
A
Promethazine syrup doesn’t have to be stored in the refrigerator.
112.
C
Vicodin is a tablet. Tablets cannot be used in the eye.
113.
D
The date the prescription was written and the expiration date are not required information on the prescription label.
114.
C
Parenterals have nothing to do with your parents. A parenteral is a dosage form of medicine that enters your body via a route other than your alimentary tract. The medication enters your body via the intravenous, intramuscular, or subcutaneous route.
115.
B
Cefzil doesn’t have to be refrigerated until after it has been reconstituted.
116.
A
A radiopharmaceutical with a half-life of 10 minutes will be almost completely gone in 50 minutes. Reconstituted
Augmentin is good for 7 days when refrigerated. Dry-powdered Augmentin is good for 2 years at room temperature.
Coal tar has been unchanged since almost the time of the dinosaurs. It will probably be stable for thousands of years. A drug’s stability is determined by the length of time it can remain relatively unchanged and retain its potency. Therefore, coal tar is the most stable pharmaceutical of all the choices.
117.
D
Examples of third-party payers are medicare, medicaid, and insurance companies.
118.
D
In a closed formulary, you can only stock non-formulary drugs if the doctor gains permission under protocol. Otherwise, you cannot stock non-formulary drugs.
119.
C
The P & T Committee or Pharmacy & Therapeutics Committee determines an institution’s formulary.
120.
A
168

Vicodin already contains APAP. Another name for APAP is acetaminophen or Tylenol. Therefore, if the patient takes
Tylenol with Vicodin, he is experiencing a possible drug interaction called a therapeutic duplication. The patient may be taking too much Tylenol by taking Vicodin and Tylenol together.
121.
D
The pharmacist-in-charge needs to order Duragesic patches by filling out DEA form 222C.
122.
D
In the event of a drug recall, you need to alert the patients, alert the doctors, and remove the medication with the appropriate lot numbers from the inventory.
123.
A
Class I recalls indicate a strong probability of causing serious adverse effects or death .
124.
A
Young’s Rule
Age of Child in Years x Adult Dose = Child’s Dose
Age of Child + 12 yrs
4 yrs . x 250 mg = 62.5 mg
4 yrs + 12 yrs
125.
D
Clark’s Rule
Weight of Child in lb x Adult Dose = Child’s Dose
150 lb
45 lb . x 250 mg = 75 mg
150 lb
169