Download - Pocket Guide for Pharmacy Technicians
Pocket Guide for Pharmacy
Technicians Second Edition
Jahangir MD, MPH, CPhT Professor and Former Director Allied Health Sciences,
including the Pharmacy Technician Program Everest University Melbourne, Florida
CENGAGE Learning-
Australia • Brazil • Japan • Korea • Mexico • Singapore • Spain • United Kingdom • United States
Contents
Preface xxiii
Acknowledgments xxix
About the Author xxxiii
SECTION 1 Introduction 1
The Foundation of Pharmaceutical Care 3 Educational 3
Educational Technician 4
Certification Examination for the Pharmacy Technician 5
Continuing Education 6
Job Opportunities 7
Places of Employment 8
Code of Ethics 9
Pertinent Websites
v i CONTENTS
Drug Regulation and Control Pure Food and Drug Act of
Harrison Narcotics Tax Act of 1914 15
Federal Food, Drug, and Cosmetic Act (FDCA) 15
Durham-Humphrey Amendment of
Kefauver-Harris Amendment of 1963 17
Controlled Substances Act (CSA) of 1970 18
Poison Prevention Packaging Act (PPPA) 22
Occupational Safety and Health Act (OSHA) of 1970 23
Drug Listing Act of 1972 24
Medical Device Amendment of 1976 24
Drug Regulation Reform Act of 1978 25
Orphan of 1983 25
Drug Price Competition and Patent Term Restoration Act of 1984 25
Prescription Drug Marketing Act of 1987 26
FDA Safe Medical Devices Act of 1990 26
Anabolic Steroids Control Act of 1990 26
Omnibus Budget Reconciliation Act of 1990 (OBRA '90) 27
Dietary Supplement Health and Education Act of 1994 28
Health Insurance Portability and Accountability Act 28
CONTENTS vii
FDA Modernization Act of 1997 29
Medicare Prescription Drug, Improvement, and Modernization Act of 2003 30
The Combat Methamphetamine Epidemic Act 2005 30
Food and Drug Administration Amendments 2007 31
Secure and Responsible Drug Disposal Act of2010 31
Patient Protection and Affordable Care Act 2010 32
New Drug Approval 32
Law and the Pharmacy Technician 33
Pertinent Websites 33
Pharmaceutical Terminology and Abbreviations 35 Medical and Pharmacy Abbreviations 35
Medication Errors 41
ISMP's List of Error-Prone Abbreviations, Symbols, and Dose Designations 45
Arabic and Roman Numerals on Prescriptions 57
Drug Names 57
Pertinent Websites 58
Pharmacy Calculations 59 Arabic Numbers and Roman Numerals 59
Rules for Using Roman Numerals 60
viii CONTENTS
The Metric System 62
Basic Units of the Metric System 62
The Household System 63
The Apothecary System 64
International Units 65
Fractions 66 Types of Fractions 67 Reducing Fractions to Lowest Terms 69 Adding Fractions 70 Subtracting Fractions 71 Multiplying Fractions 72 Dividing Fractions 72
Decimals 73 Adding Decimals 73 Subtracting Decimals 75 Multiplying Decimals 76 Dividing Decimals 76
Percents, Ratios, and Proportions 77 Percents 78 Ratios 78 Proportions 79
Calculation of Oral Drug Dosages 80 Ratio and Proportion Method 81 Formula Method 82
Calculation of Parenteral Dosages 83 Calculation of Dosages 83 Insulin Dosages 84 Heparin Dosages 85 Intravenous Calculations 86 Drop Factor 88 Calculation of Intravenous Flow Rates 89 Manually Calculating Drop Rates 90
Pediatric Dosage Calculations 92 Youngs Rule 92
CONTENTS
Clark's Rule 93 Rule 94
Calculate Dosage Based on Body Surface Area (BSA) 94
Alligation Alternate 96
Prescriptions 99 The Prescription Order Form 99
Prescription Blanks 99 Hospital Medication Orders 99
Parts of the Prescription 101
Processing the Prescription Order 102 Receiving 102 Reading and Checking 103 Numbering and Dating 104 Labeling 104 Preparing 106 Packaging 106 Rechecking 107 Delivering 108 Counseling 108 Recording and Filing 108 Pricing 108
Prescription Refilling 109
Controlled Substance Prescriptions
Dosage Forms and Routes of Drug Administration Drug Forms 112
Solid Drugs 113 Semisolid Drugs Liquid Drugs 113 Gases
CONTENTS
Basic Equipment for Parenteral Administration
Medication Containers Topical Route Transdermal Patches 119 Sublingual Administration 120 Buccal Administration 120 Inhalation Administration 121 Ophthalmic Administration 121 Otic Administration 123 Nasal Administration Vaginal Administration 125 Rectal Administration 125
SECTION II Community and Institutional Pharmacy 127
Community or Retail Pharmacy 129 Duties of the Pharmacy Technician in the Community Pharmacy 129
Prescription Processing 130 Record Keeping 130 Pricing 131 Answering Phone Calls 131 Using Computer Applications in the Control
Use 132 Accountability 133 Maintaining Privacy 133 Communication Skills 133 Teamwork Purchasing 134 Inventory Control 134
CONTENTS x i
Billing Records 135 Repackaging Products 135 Preventing Drug Errors 136 Safe Methods of Working 137
Organization of the Retail Pharmacy 138 Customer Service Area 138 Customer Pickup 138 Cash Register 139 Storage Cabinets for Controlled
Substances 139 Refrigerator 139 Storage of Completed Prescriptions 139 Computer Systems 140 Equipment for Filing, Labeling, and
Packaging 140 Pharmacy Sink 141 Storage for Stock Medications 141 Consultation Area 142
Hospital or Institutional Pharmacy 143 Hospital Pharmacy 143
Support Services 144 Product Services 144 Clinical Services 144 Educational Services 145
Organization of the Hospital Pharmacy 145
The Roles and Duties of Pharmacy Technicians in Hospitals 146
Medication Orders Types of Medication Orders 149
xii CONTENTS
Medication Dispensing Systems 150 The Floor Stock System The Unit-Dose System
Purchasing Systems Purchasing 152
Group Purchasing 152 Forms of Purchasing
Order Processing 153
Storage of Medications 153 The Shelf Life of Medications Medications Needing Refrigeration Automation Quality Control 155 Compounding Medications 155
Inventory Management 155
Inventory Turnover Rate 156
Safety 156
The Policy and Procedure Manual Regulatory Agencies That Oversee Hospital Pharmacy 157
The Joint Commission 158 CMS 158 State Board of Pharmacy Department of Public Health
Advanced Pharmacy 161 Mail-Order Pharmacy
Advantages 162 Disadvantages 162 Staff Members 163 The Role of Pharmacy Technicians
CONTENTS
Internet Pharmacy 164 Advantages 165 Disadvantages 166 Staff Members 166 The Role of Pharmacy Technicians 167 Verified Internet Pharmacy Practice Sites
167
Home Infusion Pharmacy 168 Advantages 169 Disadvantages 169 Staff Members 169 The Role of Pharmacy Technicians
Hospice Pharmacy Advantages Disadvantages 172 Staff Members 172 The Role of Pharmacy Technicians
Nuclear Pharmacy Radioactive Drugs 173 Inventory 175 Pharmacy Design 175 Equipment and Supplies Advantages Disadvantages 179 Staff Members 180 The Role of Pharmacy Technicians 180
Long-Term Care Pharmacy 180 Drug Distribution Systems 181 Emergency Medication Supply Advantages 182 Disadvantages 183 Staff Members 183 The Role of Pharmacy Technicians 183
Pertinent Websites 183
CONTENTS
Nonsterile Compounding 185 Equipment 186
Balances 187 Counter Balances 189 Weights 189 Spatulas 189 Compounding Slabs 190 Hot Plates 191 Mortars 191 Pestles 191 Beakers 193 Tongs 193 Heat Guns 194 Graduates 194 Pipettes 196
Compounded Preparations 197
Compounding Processes 197
Compounding Records and Documents 198
Commonly Compounded Products 199 Compounding Solutions 199 Compounding Suspensions 200 Compounding Suppositories 204 Compounding Capsules 208 Compounding Tablets 210 Compounding Powders Compounding Transdermal or Topical Dosage
Form Drugs
Repackaging 217 Unit-of-Use Packaging 218 Single-Unit Packaging 218 Single-Dose Packaging 218 Automated Systems 218
CONTENTS xv
Sterile Compounding 219 Issues Related to Sterile Compounding 219
Role of the Pharmacy Technician in Sterile Compounding 220
Types of Sterile Formulations 222
Equipment for Sterile Compounding 223
Laminar Airflow Hoods 224
Cleaning Laminar Airflow Hoods 228
Large-Volume Parenteral Solutions 230
Small-Volume Parenteral Solutions 233
Factors Affecting Parenteral Products 234 Basic Considerations for Sterile Compounding 235
Uses for Sterile Compounding 236
Aseptic Technique 236 Hand Washing 236 Clean Room 238
Sterile Compounding of Solutions 240 Procedure for Compounding Solutions
Compounding and Drug-Preparation Errors 241
Compounding a Total Parenteral Nutrition (TPN) Product 242
Packaging 243
Labeling 244
Storage 244
Quality Control and Quality Assurance 244
Roles of the Pharmacy Technician in Sterile Compounding 245
United States Pharmacopeia (USP) Chapter <797> 246
CONTENTS
f Medication Errors 249 Occurrence of Medication Errors 249
Prescribing Errors 251
Dispensing Errors 252
Administering Errors 253
The Patient's Role in Medication Errors 254
Avoiding Medication Errors 256
Medication Error Reporting 258 FDA Program 258 USP's Medication Error Reporting
Program 259 Minimizing Liability 259
Negligence and Malpractice Penalties 260
Computer Systems in the Pharmacy 263 Components of a Computer System 263
Computer System Databases 264 Patient and Customer Profiles 265 Prescriber Profiles 265 Drug Databases 265 Pricing Databases 266 Billing Databases 266 Payer Databases 266
Management 267
Computer System Functions 268 Management Functions 268 Labeling 268 Bar Codes 268
Technology and H1PAA 269 Documentation 270
Automation and Robotics 271
CONTENTS x
Pharmacy Operation 273 The Role of the Pharmacy Manager 273
Profitability of the Pharmacy Practice 274 Cost 274 Overhead 275 Markup 276 Discount 276 Inventory Control 277 Inventory Systems 278 Perpetual Inventory 278 Point Sale 278
Inventory Turnover Rates 279
Automated Work Systems 280
Ordering 281
Purchasing Procedures 282
Pricing 282
Average Wholesale Price 282
Repackaging 283
Disposal of Drugs 284
Accounting 286 Billing 286 Invoices 286
Receiving 287
Bar Coding 287
Returning Products 288
Drug Recalls 288
Record Keeping 291
Billing and Health Insurance 293
293
xviii CONTENTS
Coding System 296
Understanding Insurance Policies 298
Types of Health Insurance 298
Insurance Health Plans 299 Blue Cross And Blue Shield 299
Government Plans 299 TRICARE 299 CHAMPVA 300 Workers' Compensation 300 Medicare 301 Medicaid 307
Insurance Forms 307 Forms 308
Pharmacist Care Claim Forms 309
Fraud 310
SECTION III Drug Classifications and Pharmacologic Actions 313
Biopharmaceutics 315 Biopharmaceutics 315
Bioavailability Pharmacokinetics 316 Pharmacodynamics 321 Toxicology 326
. Human Response to Drug Activity 327 Factors Influencing the Effects of Drugs 327
Age 328
CONTENTS x ix
Weight 329 Gender 330 Genetics 330 Psychological Factors 331 Disease States 331 Pregnancy 331 Adverse Drug Reactions Drug Interactions 334 Drug-Diet Interactions 335
Drug Effects and Drug Classifications 337 Central Nervous System 337
Sedatives, Hypnotics, and Antianxiety Drugs 338
Anticonvulsants 340 Anti-Parkinson's Drugs 344 Antidepressants 346 Antipsychotics 350 Narcotic Analgesics 354 Anesthetics 356
Endocrine System 360 Drugs to Control Thyroid
Diseases 360 Drugs to Control Diabetes 362 Oral Contraceptives 368
Cardiovascular System 372 Antiangina Drug Therapy 372 Drugs to Treat Hypertension 375 Antiarrhythmics 381 Heart Failure and Drug Therapy 385 Antihyperlipidemic Drugs 386 Anticoagulant Drugs 389
CONTENTS
Musculoskeletal System Skeletal Muscle Relaxants Analgesics, Antipyretics, and
Inflammatory Drugs 395
Immune System 398 Chain of Infection 399 Beta-Lactam Antibiotics 401 Penicillins 401 Cephalosporins 404
406 Sulfonamides 408 Tetracyclines 410 Aminoglycosides 412 Fluoroquinolones 414 Miscellaneous Antibacterial Agents 415 Antiviral Drugs 417 Highly Active Antiretroviral Therapy
(HAART) 423 Antifungals 424
Respiratory System 426
Antitubercular Drugs 433
Antineoplastic Drugs 433
Sensory System 439 Topical Medications 439 Drugs Used for Skin Diseases 439
Ophalmic Medications 444 Otic Drugs 449
Digestive System 449 Nutritional Products 450 Vitamins 450 Minerals 452
APPENDICES
APPENDIX A Professional Organizations 455
CONTENTS x x i
APPENDIX B Federal Regulatory Agencies 461
APPENDIX C State Boards of Pharmacy 465
APPENDIX D Converting Measurements 477
APPENDIX E Medical Symbols and
Abbreviations 483
APPENDIX F The Most Common Poisonous Substances and their Antidotes 485
APPENDIX G The 100 Most Commonly
Prescribed Drugs in 2010 487
APPENDIX H Controlled Substances in the
United States and Canada 495
APPENDIX I Pregnancy Categories:
FDA Assigned 503
Interactions 505
APPENDIX K Drugs That Should Not Be
Crushed 519
APPENDIX L Pharmaceutical Companies 523
APPENDIX M Common Sound-Alike Drug
Names 529
APPENDIX N Nomogram 541
APPENDIX O Drug Identification Guide 543
P Professional Journals 551
APPENDIX Q Top 200 Drugs by Prescriptions Dispensed 553
Glossary 571
Index 583