Workbook To The Manual For Pharmacy Technicians, 2nd Edition

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American Society of Health-System Pharmacists, 4500 East-West Highway, suite

900, Bethesda, MD 20814, attention: Special Publishing.
The information presented herein reflects the opinions of the contributors and
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Because of ongoing research and improvements in technology, the information and
its applications contained in this text are constantly evolving and are subject to the
professional judgment and interpretation of the practitioner due to the uniqueness
of a clinical situation. The editors and ASHP have made reasonable efforts to
ensure the accuracy and appropriateness of the information presented in this
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information contained in this document and specifically disclaims any liability to any
party for the accuracy and/or completeness of the material or for any damages
arising out of the use or non-use of any of the information contained in this
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Vice President, Publishing: Daniel Cobaugh

Editorial Project Manager, Special Publishing: Ruth Bloom
Production Manager: Johnna Hershey
Cover & Page Design: David Wade
Composition: Carol Barrer
© 2019, American Society of Health-System Pharmacists, Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any

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permission from the American Society of Health-System Pharmacists.
ASHP is a service mark of the American Society of Health-System Pharmacists,

Inc.; registered in the U.S. Patent and Trademark Office.
ISBN: 978-1-58528-619-5
10 9 8 7 6 5 4 3 2 1
Contents
Preface
Part I: Setting Your Goals and Objectives

1. How to Be a Great Student: Strategies for Effective Learning
Part II: Introduction to Pharmacy

2. The World of Pharmacy and Pharmacy Technicians
3. Pharmacy Law, Regulations, and Standards
4. Community, Ambulatory Care, and Home Care Pharmacy Practice
5. Hospital and Specialty Pharmacy Practice
Part III: Science Knowledge and Skills

6. The Human Body: Structure and Function
7. Drug Classifications and Pharmacologic Actions
8. Drugs and the Body: Basic Biopharmaceutics, Pharmacokinetics, and
Pharmacodynamics
9. Medication Dosage Forms and Routes of Administration
Part IV: Practice Basics

10. Communication and Teamwork
11. Processing Medication Orders and Prescriptions
12. Pharmacy Calculations
13. Nonsterile Compounding and Repackaging
14. Aseptic Technique, Sterile Compounding, and IV Admixture Programs
15. Medication Safety
Part V: Business Applications

16. Pharmacy Informatics and Technology
17. Pharmaceutical Supply Chain Management
18. Billing and Reimbursement
Part VI: Getting Started

19. In the Real World
Answers
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Index
Preface
I have had the distinct honor of authoring the Workbook for

the Manual for Pharmacy Technicians, 2nd edition. Having
worked in various technician and pharmacist roles in
community pharmacy, hospital pharmacy, and regulatory
compliance, I deeply respect the value of trained and
experienced technicians. Both the pharmacists and the
technicians have increasingly expanded roles and technician
education is needed now, more than ever! As the program
director for an ASHP/ACPE-accredited technician training
program, I recognize and appreciate the value of resources
to train technicians including the Manual for Pharmacy
Technicians, 5th edition.
In this Workbook, I have designed exercises to help
students master the concepts and skills discussed in the
Manual. Both the Manual and this Workbook have been
expanded to cover all areas of the current certification exam
offered by the Pharmacy Technician Certification Board
(PTCB) and includes educational standards of the 2019
ASHP/ACPE Accreditation Standard for Pharmacy Technician
Programs.
By asking students to apply their knowledge, the
exercises in the Workbook reinforce key points and allow for
targeted assessment. Chapters in the Workbook
complement those in the Manual, so that instructors and
students can easily work between both books. Each chapter
includes a wide range of exercises such as multiple choice,
true/false, fill in the blank, concept and key term matching,
short answer, and activity questions. I recommend using this
book alongside the Manual to enhance learning.
Once you have learned the basics with the help of the
Manual and the Workbook, the Pharmacy Technician
Certification Review and Practice Exam, 4th edition, will be
helpful for those studying for certification.
I hope you find this Workbook a valuable resource for
pharmacy technicians and educators.
Denise M. Frank, RPh
May 2019
PART ONE
Setting Your Goals and
Objectives
1. How to Be a Great Student: Strategies for

Effective Learning
QUESTIONS CH 1
HOW TO BE A GREAT
STUDENT: STRATEGIES FOR
EFFECTIVE LEARNING
Learning Outcomes
After completing this chapter, you will be able to

■ List key strategies for effective learning.
■ Differentiate between intrinsic and extrinsic motivation.
■ Apply the principles of emotional intelligence.
■ List characteristics of individuals with high levels of grit.
■ Differentiate between fixed and growth mindset.
■ Develop time management strategies that can help when
learning.
■ Identify strategies for self-advocacy.
MULTIPLE CHOICE
______1. Which of the following strategies will

NOT help a student become a better learner?
a. Eliminating distracters.
b. Using time management strategies.
c. Asking questions.
d. Adopting a fixed mindset.
______2. Which of the following is NOT a component of grit?

a. Showing interest or passion in the work and
study.
b. Allocating equal amounts of time to study the
easy and the hard concepts.
c. Viewing learning as a way to achieve your goal
or purpose.
d. Persevering in the face of adversity.
______3. Which of the following is a way you can use

creative scheduling to help with time
management?
a. Avoid scheduling time for personal needs.
b. Prioritize items in the order to be completed,
not by easiest first.
c. Schedule less time than you think you will
need.
d. Change the deadline to a later date in your
calendar.
______4. You have a patient at the counter who has been
waiting 15 minutes for his prescription to be filled
and appears to be impatient and angry. You just
found out the medication he was prescribed is not
covered by his insurance. Which of the following
would be the best way to help this patient,
recognizing that he doesn’t feel well and just
spent an hour at the doctor’s office so he wants to
get his medication and go home.
a. Let him know immediately that his insurance
will not cover the medication and ask if he
would like the pharmacy to contact the
prescriber to get it changed to a covered
medication.
b. Tell him you must call the doctor and that he
needs to sit down in the waiting area until you
hear back.
c. Tell him the medication is not covered and
hand the prescription back to him, telling him
he’ll have to go back to the doctor’s office and
get a new prescription for a medication that is
covered.
______5. Which of the following is a time management

strategy?
a. Respond to emails immediately.
b. Do easier tasks first, without regard to the
order in which they are due.
c. Prioritize projects to work on the ones due first,
ahead of the other projects.
d. Do whole projects at once; breaking them up
into smaller tasks takes longer.
______6. When being trained on a new task:
a. Don’t ask questions during training; ask other
coworkers afterward to explain.
b. Don’t bother trying to understand why you are
doing the task as long as you know the steps to
perform it.
c. Take notes during training and ask questions if
something is unclear to you.
d. Don’t concern yourself with asking questions if
you have been paying attention; asking
questions will make you look stupid.
MATCHING
A. Intrinsic motivation
B. Extrinsic motivation
C. Growth mindset
D. Fixed mindset
______1. “I am bad at math.”
______2. “I can master this chapter if I study harder.”
______3. “I want to graduate at the top of my class.”
______4. “I’m not smart enough to understand this no

matter how hard I study!”
______5. “I’m going to ask the instructor for more

information on this topic.”
______6. “Now that I know which items I made mistakes on,
I can work on them.”
______7. “I really want to help people be healthier.”
______8. “I need to learn this well enough to pass the

exam.”
______9. “I didn’t pass the quiz; I’ll never understand this.”
______10. “I want to learn as much as I can about taking care

of my patients.”
TRUE OR FALSE
______1. People with more extrinsic motivation tend to

outperform those who have intrinsic motivation in
the long run.
______2. A growth mindset is more beneficial to learning,

resilience, and work relationships.
______3. Feeling good about helping patients is an example

of extrinsic motivation.
______4. Having good emotional intelligence skills has been

shown to improve grades and performance in
nursing and medical school students.
______5. Higher emotional intelligence quotient (EQ) scores

are linked to increases in salary.
______6. Self-advocacy is finding the answers to your

questions on your own.
SHORT ANSWER
Kim forgot her lunch. When she looked in the break room
cupboard, she found some chips but the bag was not
labeled with anyone’s name. Food in the break room that is
not marked is considered available for anyone. Still, Kim
asked the others in the break room if the chips belonged to
them and no one claimed them, so she ate them. You came
in for the second shift and when you went on break, you
discovered your chips were gone. You got mad when you
found out that Kim had eaten them and yelled at her. Kim
was hurt and explained the chips were unmarked and said
she had asked around and no one claimed them.
1. What is the best way to handle this relationship?
2. What are some strategies you could have used to control

your immediate emotional response (self-management)?
CROSSWORD PUZZLE
Across:
1. Self-__________: The ability to accurately identify
emotions while they are happening to you.
6. The belief that aptitude is not changeable is called a
__________ __________ (2 words).
7. The way individuals see and interact with the world
around them is called their __________.
8. Perseverance and passion for long-term goals is called:
__________.
9. __________ awareness is the ability to recognize and
understand the emotions of those around you.
10. __________ motivation is based on a reward system.
11. __________ mindset is the belief that outcomes can be
influenced by how much effort is applied to a task.
Down:
2. __________ management is the ability to have healthy
relationships with those around you.
3. The ability of an individual to understand and manage
the emotions of oneself and others is emotional
__________.
4. Self-__________ is the ability to control your emotions.
5. __________ motivation is based on a sense of fulfillment
or satisfaction from the task.
PART TWO
Introduction to Pharmacy
2. The World of Pharmacy and Pharmacy

Technicians
3. Pharmacy Law, Regulations, and
Standards
4. Community, Ambulatory Care, and Home
Care Pharmacy Practice
5. Hospital and Specialty Pharmacy Practice
QUESTIONS CH 2
THE WORLD OF PHARMACY AND PHARMACY
TECHNICIANS
Learning Outcomes

■ Compare and contrast the responsibilities of pharmacy technicians and pharmacists.
■ Describe the differences between licensure, certification, and registration.
■ Outline advantages of formal training for pharmacy technicians.
■ Describe differences between the ambulatory and institutional pharmacy practice
settings.
■ List specific examples of ambulatory and institutional pharmacy practice settings.
■ Describe at least six characteristics of a professional.
■ List five tasks that pharmacy technicians perform in various pharmacy settings.
■ Identify five ethical principles that pharmacy technicians follow as they perform their
duties.
■ Define medication therapy management.
■ Explain why the use of outpatient pharmacy and medical services is increasing.
MULTIPLE CHOICE
______1. Which of the following may be performed by a pharmacist but NOT a technician?
a. Enter patient information into the computer profile.
b. Answer questions about medication side effects from a patient.
c. Compound sterile intravenous (IV) preparations in a hospital.
d. Receive and put away drug orders from a wholesaler.
a. Packaging or repackaging medications.
b. Giving advice on the appropriate over-the-counter (OTC) medication to take for
a headache.
c. Preparing prescriptions to be dispensed.
d. Filling unit-dose carts for a nursing home.
a. Perform inventory functions, such as ordering prescription stock and
maintaining appropriate levels of inventory on the shelves.
b. Enter new prescriptions in the computer to be filled.
c. Perform patient counseling on a new medication for the patient.
d. Fill automated dispensing cabinets (ADCs).
a. Answering clinical questions about a medication from a prescriber.
b. Billing patient prescription medications to the patient insurance plan.
c. Performing non-clinical technical tasks.
d. Compounding a prescription oral suspension from tablets for a child.
______5. Which of the following is true regarding ASHP/Accreditation Council for Pharmacy
Education (ACPE)-accredited technician training programs?
a. All states require technicians to have completed an ASHP/ACPE-accredited
technician training program before being allowed to register and work as a
pharmacy technician.
b. You are not permitted to take a national certification exam (Pharmacy
Technician Certification Exam [PTCE] or Exam for the Certification of Pharmacy
Technicians [ExCPT]) unless you have successfully completed an ASHP/ACPE-
accredited technician training program.
c. An ASHP/ACPE-accredited technician training program must meet the
minimum standards and requirements to provide consistent formal training of
technicians.
d. You must take and pass a national certification exam (PTCE or ExCPT) to
successfully complete an ASHP/ACPE-accredited technician training program.
______6. Which of the following is true regarding national technician certification?

a. All states require technicians to have successfully passed a national
certification exam (PTCE or ExCPT) as a requirement to become registered
with the State Board of Pharmacy and practice as a pharmacy technician.
b. Anyone can take the certification exam without having any formal or on-the-
job training or experience as long as you have a high school diploma or
graduate equivalency diploma (GED).
c. You may not be eligible to take the certification exam if you have a criminal
history or Board of Pharmacy disciplinary record.
d. You don’t need to be registered with the Board of Pharmacy to practice as a
technician if you are certified.
______7. Which of the following is true?

a. Technician certification is good only for the state in which you took the exam.
b. You can practice as a pharmacy technician in any state as long as you have a
valid registration in at least one state; there is no need to get a separate
registration in each state.
c. If you have taken and passed the technician certification exam, you do not
need to meet the educational requirements of the state in which you are
registering to practice as a technician.
d. Continuing education-specific requirements vary between states and between
the two certification programs’ renewal requirements.
______8. Which of the following is true regarding registering with the State Board of
Pharmacy to practice as a pharmacy technician?
a. All states require technicians to be nationally certified within 1 year of initial
registration.
b. Every state has its own requirements for registration as a pharmacy technician
and requirements vary state-to-state.
c. Every state requires completion of an ASHP/ACPE-accredited technician
training program within 1 year of initial registration.
d. All states require you to register as either a community pharmacy technician
or a hospital pharmacy technician.
______9. The Pharmacy Technician Code of Ethics:

a. Is a legal document enforced by the State Boards of Pharmacy.
b. Contains a set of 20 principles that apply to all pharmacy technicians.
c. Are principles based on the moral obligations that guide the pharmacy
profession.
d. Applies only to technicians who work directly with patients.
______10. Which of the following is true regarding technician responsibilities?

a. The technician performs the technical functions and does not perform any
function that involves critical thinking or problem-solving skills.
b. Technicians with advanced knowledge and skills may check other technicians’
work and administer medications and immunizations.
c. Automated dispensing technology will replace the need for technicians as
automation does not fail and needs no one to oversee the functions
performed.
d. Technicians are ultimately and legally responsible for their own performance
and work even when under the supervision of a pharmacist.
______11. Medication therapy management (MTM) includes all of the following except:
a. Assessment of a pharmacy’s inventory
b. Formulation of a medication treatment plan
c. Initiation or modification of medication therapy
d. Monitoring of a patient’s response to therapy
______12. In all states, pharmacists are licensed by:

a. North American Pharmacist Licensure Examination (NAPLEX)
b. State Board of Pharmacy
c. National Association of Boards of Pharmacy (NABP)
d. ASHP/ACPE
______13. ASHP’s 10 characteristics of a professional include the following except:

a. Knowledge and skills of the profession
b. Commitment to self-improvement of skills and knowledge
c. Accountability for his or her work
d. Ability to defend medication errors
______14. As the demand for cost-effective healthcare increases, pharmacy technicians with
well-developed critical thinking skills may find themselves assuming
responsibilities previously performed by pharmacists, such as:
a. Managerial duties
b. Patient education
c. Pharmacokinetic studies
d. Drug utilization review
MATCHING I
A. Ambulatory care pharmacy
B. Institutional pharmacy
______1. Community pharmacy
______2. Chain pharmacy
______3. Independent pharmacy
______4. Pharmacy located in a nursing home
______5. Hospital pharmacy
______6. Clinic outpatient pharmacy

______7. Inpatient pharmacy
______8. Typically, little or no patient contact
______9. Typically, frequent patient contact
MATCHING II
A. PTCE
B. ExCPT
______1. 110-minute, 90 question test (80 scored questions, 10 unscored questions)
______2. 130-minute, 120 question test (100 scored and 20 unscored)
______3. Administered by National Healthcareer Association (NHA)
______4. Administered by Pharmacy Technician Certification Board (PTCB)
______5. Certification renewal every 2 years includes 20 hours of CE with at least 1 hour in
pharmacy law.
______6. Certification renewal every 2 years includes 20 hours of technician-specific CE

with at least 1 hour in pharmacy law and 1 hour in medication safety.
______7. Covers nine knowledge domains
______8. Covers four knowledge areas
TRUE OR FALSE
______1. A technician may reconstitute an oral antibiotic suspension for a patient

prescription.
______2. A technician may gather allergy and disease state information from a patient and
enter it into the profile.
______3. Technicians may contact an insurance company to investigate and resolve a

rejected claim.
______4. Technicians are not allowed to weigh out the ingredients to make a compounded
prescription.
______5. Technicians may check for expiration dates and fill in nursing station floor stock.
______6. A technician may answer prescriber requests for dosing information of a

medication.
______7. A technician may perform a controlled substance inventory.
______8. A technician may perform all the tasks of a pharmacist but must be supervised by
the pharmacist.
______9. Technicians only need to be professional in settings where they interact with
patients.
ALPHABET SOUP
Fill in the full name of the acronyms below.
1. AAPT: ________________
2. ACPE: ________________
3. ADC: ________________
4. APhA: ________________
5. ASHP: ________________
6. CCP: ________________
7. CE: ________________
8. CPhT: ________________
9. ExCPT: ________________
10. GED: ________________
11. IV: ________________
12. JCPP: ________________
13. MTM: ________________
14. NABP: ________________
15. NDC: ________________
16. NHA: ________________
17. NPTA: ________________
18. PBM: ________________
19. PTCB: ________________
20. PTCE: ________________
21. RPh: ________________
22. TPN: ________________
SHORT ANSWER
1. Discuss the benefits of enrolling in an ASHP/ACPE-accredited technician training
program versus only receiving on-the-job training at your work site.
2. What is the top priority for both pharmacists and pharmacy technicians?
3. You observe another technician talking with a friend at the counter. The other technician
is talking about a specific patient and their unusual medical problem. Discuss this
behavior and what options you have in response to this observation.
4. Discuss the ways in which you will fulfill the ethical principle of maintaining competency
and enhancing your professional knowledge and expertise.
INTERNET RESEARCH
Go to ASHP’s website and access the pharmacy technician page at
www.ashp.org/technicians. Explore the page and links.
1. Look at the Pharmacy Technician Forum. What is the mission?
2. What is listed under Meetings and Involvement Opportunities?

CROSSWORD PUZZLE
Across:
2. A pharmacist who is licensed in a state to practice pharmacy is identified by what
initials after their name?
5. The state agency of pharmacists and public members appointed to protect and
promote the safety and health of the citizens by regulating the profession of pharmacy.
6. To keep up certification, technicians must recertify every 2 years by completing at least
20 hours of continuing __________.
7. The process where a governmental agency gives permission to an individual to work in
a specific occupation. The individual must show that they have the necessary
knowledge and skills to protect public health, safety, and welfare as they work in that
occupation.
8. The process of making a list or being added to an existing list.
9. The process of granting a designation that indicates qualifications in a subject or an
area and by which an organization or institution obtains, verifies, and assesses an
individual’s qualifications to provide patient care services.
10. A voluntary process where a non-governmental agency or association recognizes an
individual person who has met specific qualifications and has achieved a certain level
of knowledge, skill, or experience.
Down:
1. Pharmacist degree
3. Recognition by an outside organization that an institution or program meets
established criteria.
4. A technician that has achieved national certification is identified by what initials after
their name?
QUESTIONS CH 3
PHARMACY LAW, REGULATIONS, AND
STANDARDS
Learning Outcomes

■ Understand how the practice of pharmacy is regulated by federal/state laws and
regulations and the role of State Boards of Pharmacy.
■ Discuss state pharmacy laws and regulations that govern pharmacy technicians,
including permitted functions and the requirements for pharmacy technician
registration or licensure.
■ Discuss the laws that regulate controlled substances, special requirements for pharmacy
ordering and dispensing controlled substances, and the role of state prescription
monitoring programs.
■ Describe the restrictions on the sales of products containing pseudoephedrine and
ephedrine.
■ Describe the U.S. Food and Drug Administration’s approval process for drugs and the
differences between brand name and generic drugs.
■ Discuss generic drug substitution and the means for prescribers to indicate if
substitution is not authorized.
■ Discuss the difference between prescription drug inserts for prescribers and for patients.
■ Discuss patient privacy in the pharmacy and the federal law that governs privacy of
protected health information.
MULTIPLE CHOICE
______1. The federal agency that administers and enforces federal laws for controlled
substances and illegal substances such as narcotics and other dangerous drugs is
the:
a. U.S. Food and Drug Administration (FDA)
b. Drug Enforcement Administration (DEA)
c. New Drug Application (NDA)
d. National Association of Boards of Pharmacy (NABP)
______2. The NABP:

a. Enforces state laws in each state.
b. Administers the national licensing exam for technicians.
c. Is an organization whose members include State Boards of Pharmacy.
d. Is part of the FDA.
______3. Pharmacy technician registration or licensure in a state generally includes the

following EXCEPT:
a. Minimum age qualification
b. High school graduation or graduate equivalency diploma (GED)
c. Completion of formal or on-the-job training
d. Requirement for liability insurance
______4. The biennial inventory required by the DEA is the inventory of all controlled
substances on hand to be conducted:
a. Twice yearly
b. Annually
c. Every 2 years
d. Every 3 years
______5. The federal law that established health information privacy is called:
a. Protected Health Information Act
b. Health Insurance Portability and Accountability Act
c. OBRA 90
d. Prescription Drug Marketing Act
______6. The federal law regulating controlled substances is:

a. Drug Enforcement Administration (DEA) Act
b. Combat Methamphetamine Epidemic Act
c. Controlled Substances Act
d. Food and Drug Act
______7. Which of the following are NOT required to be registered with the DEA?
a. Physicians who prescribe controlled substances.
b. Nurse practitioners who prescribe controlled substances.
c. Pharmacists who dispense controlled substances.
d. Drug wholesalers that buy and sell controlled substances.
______8. Prescription monitoring programs are programs that collect, review, and analyze:
a. Information from pharmacies about controlled substance prescriptions
dispensed in the state.
b. Information from physicians about controlled substances prescribed in the
state.
c. Information from wholesalers about controlled substances purchased in the
state.
d. Information from insurance companies about controlled substance
prescriptions dispensed in the state.
______9. If state and federal laws or regulations differ:

a. The state law has precedence.
b. The federal law has precedence.
c. The less strict of the two laws may be followed.
d. Both laws must be followed, including the more stringent law.
______10. Adhering to ethical principles means:

a. “Doing the right thing”
b. Complying with laws and regulations
c. Maintaining competency
d. Respecting patient privacy and confidentiality
e. All of the above
______11. State pharmacy laws are:

a. Enacted by state legislatures through the legislative process
b. The same as rules and regulations
c. Issued and enforced by the NABP
d. All of the above
______12. The State Boards of Pharmacy have regulatory authority over all the following
EXCEPT:
a. Licensing of pharmacies and pharmacists
b. Registering or licensing of pharmacy technicians
c. Reimbursement rates for prescriptions filled under an insurance plan
d. Disciplinary actions against pharmacies, pharmacists, and pharmacy
technicians for violations of pharmacy laws and regulations
______13. Pharmacy technicians may:

a. Provide patient counseling under the supervision of a pharmacist.
b. Provide counseling if they are fluent in the patient’s language.
c. Not counsel patients as technicians are not authorized to counsel.
d. Provide patient counseling under the supervision of a licensed pharmacy
resident.
______14. Pharmacy technicians may:

a. Provide patient counseling only if they are registered and nationally certified
and the pharmacist is not immediately available.
b. Provide patient counseling only if the patient is informed and authorizes the
technician to do so.
c. Provide patient counseling only for refilled prescriptions and only if they are
nationally certified.
d. Offer counseling to the patient by asking if they would like to speak with the
pharmacist.
______15. A Schedule II prescription, according to federal law:

a. May be refilled only once every 30 days.
b. Must be filled within 30 days of being written.
c. With prescriber authorization, may be refilled up to 5 times within 6 months.
d. Is not refillable; a new prescription is needed for each fill.
______16. Federal law allows Schedule III prescriptions, with prescriber authorization, to be
refilled:
a. For as many refills as authorized within 6 months.
b. For a maximum of 5 refills within 6 months.
c. Only 1 time within 6 months.
d. Never. A new prescription is required each time unless it’s for a hospice
patient.
______17. Federal law allows Schedule IV prescriptions, with prescriber authorization, to be

refilled:
a. Up to 5 times within 6 months of the prescription being issued (written).
b. Up to 5 times within 6 months of the first fill of the prescription.
c. For as many times as authorized within 6 months of the original fill.
d. Never. A new prescription is required for each fill.
______18. Federal law allows Schedule V prescriptions, with prescriber authorization, to be

refilled:
a. For as many refills as authorized within 6 months.
b. For as many refills as authorized up to a year from the issue date (date
written).
c. For a maximum of 5 refills within 6 months.
d. Only 1 time within 6 months.
______19. When dispensing a prescription for any controlled substance, the prescription vial
given to the patient must:
a. Have a red “C” with the Roman numeral inside the “C,” indicating the
schedule of the controlled substance dispensed.
b. Have a caution statement indicating that federal law prohibits the transfer of
this drug to any person other than the patient for whom it was prescribed.
c. Have a statement that the controlled substance is a prescription drug (such as
“Rx Only”).
d. Contain contact information for the nearest DEA office to report if the
prescription is lost or stolen.
______20. Written controlled substance prescriptions must include which of the following:
a. The patient’s name and date of birth.
b. Patient allergies or “NKA” indicating “No Known Allergies.”
c. The prescriber’s name, address, and DEA number.
d. Must be dated with the date the prescriber wants the prescription to be filled.
______21. According to federal law, a written prescription from a prescriber for a Schedule II
controlled substance must include:
a. A red “C” at least 1 inch tall stamped in the upper right-hand corner.
b. The name and address of the pharmacy that the prescription must be filled
from as authorized by the prescriber.
c. The actual date the prescription was written (issued) even if it won’t be filled
until a later date.
d. The prescriber’s name, address, and NPI or National Provider Identifier number.
______22. Which of the following is true regarding the transfer of controlled substance
prescriptions from one independent pharmacy to another for filling?
a. Schedule III controlled substance prescriptions with valid refills remaining may
be transferred 1 time only.
b. Prescriptions for Schedule II controlled substances that were partially filled
may have the remainder of the original prescription transferred to another
pharmacy.
c. A prescription for a controlled substance that was transferred to another
pharmacy must be filled by that pharmacy within 72 hours.
d. Schedule V controlled substance prescriptions with valid refills may be
transferred a maximum of 5 times in 6 months.
______23. Which of the following is true regarding controlled substance records in a

pharmacy?
a. Records must be kept for at least 5 years according to federal law.
b. You must keep records of controlled substance inventories and prescription
records, but not invoices.
c. You are only required to keep controlled substance prescription dispensing
records (prescriptions) until it’s reported to the state prescription monitoring
program database.
d. Invoices for Schedule II controlled substances received must be kept
separately from invoices for Schedule III-V controlled substances.
______24. The Combat Methamphetamine Epidemic Act:

a. Prohibits filling prescriptions for the precursor’s ephedrine and
pseudoephedrine.
b. Requires a log to be kept of all sales of ephedrine and pseudoephedrine that
contains purchaser information, quantity of product purchased, and date and
time of purchase.
c. Sets federal limits on the maximum amounts of ephedrine that may be
purchased within any 1-week (7 day) period.
d. Allows for the purchase of double the maximum quantity of ephedrine or
pseudoephedrine if a parent is purchasing for themselves and a minor child.
______25. Federal requirements for over-the-counter (OTC) sales of pseudoephedrine include

all of the following EXCEPT:
a. Products must be kept locked up or behind the counter to prohibit public
access.
b. Customers are limited to a daily limit of 3.6 grams of pseudoephedrine
hydrochloride.
c. Customers are limited to a maximum of two commercial packages containing
pseudoephedrine per day.
d. Customers may purchase a maximum of 9 grams of pseudoephedrine
hydrochloride in any 30-day period.
______26. Prescriptions for controlled substances must be for a legitimate medical purpose
in the normal course of the prescriber’s professional practice. Which of the
following may NOT be legitimate?
a. A dentist prescribes acetaminophen with codeine for a patient who had dental
surgery.
b. A podiatrist prescribes methylphenidate for the son of a patient.
c. An ophthalmologist prescribes oxycodone for a patient after eye surgery.
d. A nurse practitioner prescribes lorazepam for anxiety in a nursing home
patient.
______27. All of the following are true EXCEPT:

a. Patient package inserts, when required by the FDA for that medication, must
be provided with each and every fill and refill of that prescription.
b. MedGuides, when required by the FDA for that medication, must be provided
with each and every fill and refill of that prescription.
c. All prescription drugs must have a package insert supplied to the pharmacy. A
copy of this package insert is required to be provided to the patient on the first
fill of a new prescription.
d. Labeling on OTC products includes a “Drug Facts” section that lists the active
ingredients, uses, warnings, and directions for use.
______28. Which of the following is true regarding brand name and generic drugs?
a. Generic drugs only need to show they have the same amount of the same
ingredient to be considered “equivalent” in the Orange Book.
b. Generic drugs are required to look the exact same as the brand name drug
(size, shape, color, etc.) except for the markings.
c. Generic drugs may only be manufactured by the same company that makes
the brand name drug.
d. Patients may request that only the brand name of the medication be
dispensed even if the prescriber authorizes generic substitution.
______29. Which of the following is true about new, brand name drugs?
a. The drug company must submit an ANDA (abbreviated new drug application)
to the FDA for approval of a new drug for use in the United States.
b. The company will have patent and exclusivity protection for a short period of
time (2-3 years) to allow the company to market the drug without
competition.
c. The FDA only evaluates the results of trials in animals and humans to
determine if the new drug is safe and effective before approval.
d. The FDA reviews safety and efficacy, if the benefits of the new drug outweigh
the risks, labeling, and manufacturing methods before approving a new drug.
______30. Which of the following is true regarding generic drugs?

a. Generic drug manufacturers must repeat all of the original research that was
made for the brand name drug.
b. The first generic equivalent of a brand name drug that gets approved gets an
average of 5 years of patent and exclusivity before subsequent generic
equivalents for the same drug are approved.
c. Not only do generic drugs have to prove they contain the same amount of the
active ingredient as the brand name drug, they also have to prove
bioequivalence.
d. Once a generic equivalent for a brand name drug is approved, pharmacists are
required to switch all prescriptions for the brand name drug to the generic,
even if the patient still wants the brand name.
______31. The following statements are true about biological products EXCEPT:
a. The original biological product approved by the FDA for use in the United
States is referred to as the “reference product.”
b. A biological product approved by the FDA that is similar to the reference
product is referred to as a “biosimilar” product.
c. All biosimilar products may be substituted for the reference products in the
same way a generic drug is substituted for a brand name product.
d. Only biosimilar products that have been approved as “interchangeable” may
be considered for substitution for the reference product.
MATCHING
A. 1906 Food and Drugs Act

B. 1930 FDA
C. 1938 Food, Drug, and Cosmetic Act (FDCA)
D. 1951 Durham-Humphrey Amendment
E. 1962 Kefauver-Harris Drug Amendments
F. 1982 Tamper-Resistant Packaging Regulations
G. 1984 Hatch-Waxman Act
H. 1988 Prescription Drug Marketing Act
I. 1997 Food and Drug Administration Modernization Act
J. 2005 Combat Methamphetamine Epidemic Act
______1. Allowed FDA to approve generic versions of brand name drugs without repeating
research to prove safety and efficacy; allowed brand name drugs to apply for up
to 5 years of additional patent protection for new drugs.
______2. Defines the type of drugs that cannot be used safely without medical supervision
and limits the sale to prescription only by medical professionals.
______3. Designed to eliminate diversion of products from legitimate channels of

distribution and requires wholesalers to be licensed.
______4. Expands scope of agency activities and moves agency to the Department of
Health and Human Services.
______5. U.S. Food and Drug Administration is named.
______6. Limits retail sale of OTC products that contain ephedrine, pseudoephedrine, and
phenylpropanolamine, which can be used to manufacture methamphetamine.
______7. Makes it a crime to tamper with packaged products and requires tamper-proof
packaging.
______8. Outlaws states from buying and selling food, drinks, and drugs that have been
mislabeled and tainted.
______9. Requires manufacturers to prove that their drugs are effective prior to marketing.
______10. Requires new drugs to be proven safe prior to marketing; starts a new system of
drug regulation.
TRUE OR FALSE
______1. “Legend” drugs are controlled substances that are marked with a “C” on the
labeling.
______2. All Schedule V controlled substances may be sold OTC without a prescription.
______3. Drugs with a label that says “Rx Only” may only be dispensed by prescription (not
over-the-counter).
______4. Protected health information (PHI) includes the medications the patient is taking.
______5. Federal laws always take precedence over state laws.
______6. The more stringent law or rule must be followed whether it is state or federal.
______7. The FDA is responsible for enforcing state regulations.
______8. NABP is responsible for enforcing federal regulations.
______9. Prescribers may not authorize refills on prescriptions for any controlled
substances.
______10. Pharmacies can fill prescriptions for controlled substances in Schedules I–V.
______11. Methadone is an example of a Schedule I controlled substance.
______12. Hydrocodone with acetaminophen is an example of a Schedule II controlled

substance.
______13. Lorazepam has a high potential for abuse.
______14. Diphenoxylate with atropine is an example of a Schedule IV controlled substance.
______15. Methylphenidate is an example of a Schedule III controlled substance.
______16. Meperidine has a moderate potential for abuse or dependence.
______17. Phenobarbital has a low potential for abuse and limited risk of dependence.
______18. There are six schedules of controlled substances (I–VI).
______19. Some controlled substances are “exempt narcotics” and may be dispensed or sold
by a pharmacist without a prescription.
______20. Pharmacies that ship prescriptions to patients in other states are only required to
be licensed in their home state (the state in which they are located).
______21. Generic medications may be substituted for brand name medications prescribed
if they are bioequivalent (according to the Orange Book) and the prescriber and
patient approve.
______22. You are not required to dispense prescription drugs in child-resistant packaging
unless you ask the patient if they have small children in the house and document
this in their profile.
______23. Only prescription drugs are required to be in child-resistant packaging, not OTC
products.
______24. Significant losses of controlled substances are reported to the DEA on a form DEA-
222.
ALPHABET SOUP
1. AAPT: ________________
2. ANDA: ________________
3. CMEA: ________________
4. DAW: ________________
5. DEA: ________________
6. DHHS: ________________
7. DNS: ________________
8. FDA: ________________
9. FDCA: ________________
10. HIPAA: ________________
11. NASCSA: ________________
12. NDA: ________________
13. NDC: ________________
14. OBRA90: ________________
15. OTC: ________________
16. PHI: ________________
17. PPA: ________________
18. PPI: ________________
SHORT ANSWER
1. When working in a community pharmacy, you must protect patient privacy for protected
health information. How do you do this?
INTERNET RESEARCH
When you are presented with a written prescription for a controlled substance, then:
1. What are the characteristics you would look for that may indicate the prescription is
forged? See https://www.deadiversion.usdoj.gov/pubs/brochures/pharmguide.htm
2. What other information is in this Guide?
QUESTIONS CH 4
COMMUNITY, AMBULATORY CARE, AND
HOME CARE PHARMACY PRACTICE
Learning Outcomes

■ Describe the history of community and ambulatory care pharmacy practices.
■ Describe the differences among the various types of practice sites in community and
ambulatory care pharmacy practice.
■ Describe the importance of the pharmacy technician’s role in communicating with
patients in the community and ambulatory care pharmacy settings.
■ Explain the various steps and responsibilities involved in filling a prescription.
■ Identify the trends in community and ambulatory care pharmacy practices.
■ Describe the pharmacy technician’s evolving role in community and ambulatory care
pharmacy practices.
■ Identify the historical reasons for establishing home care services and the growth of the
home care industry.
■ Cite the seven goals of home care therapy.
■ Identify the members of the home care team and describe their primary roles in the
home care process.
■ Identify the most common diseases or conditions treated with home care services.
■ Identify the top drug classes used in home infusion therapy. List one or two parameters
for these drugs that affect how they are used in the home environment.
■ Compare the advantages and disadvantages of the types of infusion systems available
for use in a patient’s home.
■ List the labeling requirements for sterile products used in a patient’s home.
■ Outline the important factors to consider when determining expiration dates for sterile
products used in the home care setting.
MULTIPLE CHOICE
______1. An ambulatory pharmacy is a pharmacy that:

a. Only serves hospitalized patients.
b. Travels to neighborhoods to provide services.
c. Only serves patients who walk in or who have medications mailed to them.
d. Only serves patients who need their medications compounded.
______2. A community pharmacy:

a. May be an independent or a chain pharmacy.
b. Is always located inside a clinic or hospital building.
c. Sends all filled prescriptions to patients by mail or common carrier.
d. Typically fills prescriptions only for nursing homes and assisted living facilities.
______3. A chain pharmacy:

a. Is not allowed to compound prescriptions for patients.
b. Must be open 24 hours a day, 7 days a week.
c. Only carries generic prescription and over-the-counter (OTC) products.
d. May be a stand-alone pharmacy or inside a grocery store or mass-merchant.
______4. A community pharmacy:

a. Is not allowed to mail prescriptions to patients within 20 miles of the
pharmacy.
b. Only serves patients who are in an institution such as a hospital or nursing
home.
c. Typically serves both cash-paying patients and those with a third-party
insurance.
d. Is required to have a drive-through window for easier patient access.
______5. A managed care pharmacy operated by an HMO:

a. Is not required to provide patient counseling for new prescriptions filled.
b. May fill prescriptions for walk-in patients and send out prescriptions by mail.
c. Does not fill any acute-care prescriptions, only maintenance prescriptions for
chronic diseases.
d. Is not allowed to compound any prescriptions for patients.
______6. A mail order pharmacy:

a. Is not allowed to fill prescriptions for controlled substances.
b. Must have a pharmacist available to answer patient questions about their
medications.
c. May send prescriptions to patients in other states as long as it has a license in
the state in which they are located.
d. Is exempt from keeping patient profiles and performing drug utilization review
(DUR) because they do not fill any new prescriptions—only refills for
maintenance medication for patients.
______7. A clinic pharmacy:

a. Fills prescriptions for both hospital inpatients and outpatients.
b. Is only allowed to fill prescriptions written by prescribers at that facility.
c. Is required to be open 24 hours a day, 7 days a week to take care of
emergency room patients’ prescriptions.
d. May fill prescriptions for walk-in patients, and prescriptions to be mailed or
delivered to patients’ homes.
______8. Which of the following is true regarding ambulatory care and community
pharmacies?
a. The number of prescriptions filled at ambulatory and community pharmacies
is decreasing due to the increased use of managed care and mail order
pharmacies.
b. The need for pharmacy technicians in ambulatory care and community
pharmacies is decreasing due to the increased use of automation in these
settings.
c. The need for pharmacy technicians is increasing in ambulatory care and
community pharmacy settings due to increases in pharmacist clinical tasks
and changes in the pharmacists’ role.
d. The number of prescriptions filled at ambulatory and community pharmacies
is decreasing due to the decrease in the numbers of infants and children
because more people are having smaller families and delaying starting
families.
______9. Part of this legislation requires a prospective utilization review of a Medicaid

patient’s medication profile to screen for problems.
a. Durham-Humphrey Amendment
b. Food, Drug, and Cosmetic Act
c. Omnibus Budget Reconciliation Act
d. Health Insurance Portability and Accountability Act
______10. The legislation that was the beginning of drug regulation and the designation of a
drug by a manufacturer to be available only by prescriptions is the:
______11. In 1951, this legislation defined two categories of drugs: legend drugs and OTC.
The authorization from a physician for a legend drug became known as a
“prescription.”
______12. The legislation that protects individuals’ private health information is the:
______13. OBRA-90 requires pharmacists to perform the following functions when filling
prescriptions for Medicaid patients, EXCEPT:
a. Keep records for each patient that includes all the drugs the patient is taking.
b. Keep all protected health information (PHI) confidential.
c. Talk to patients and answer their questions about their prescriptions.
d. Review the patient’s medication profile to screen for problems or issues.
______14. Home care pharmacies provide the following EXCEPT:

a. Intravenous (IV) infusion services in the patient’s home
b. Primarily oral, solid, or injectable drugs
c. Only IV infusion to patients in a nursing home
d. High-technology drug administration services
______15. Pharmacy technician responsibilities in ambulatory care and community

pharmacies include the following EXCEPT:
a. Entering prescriptions in to the computer system.
b. Performing DUR on prescriptions to be filled and dispensed.
c. Resolving third-party payer billing issues.
d. Handling controlled substances.
______16. Pharmacy technician responsibilities in ambulatory care and community

pharmacies include the following EXCEPT:
a. Entering new patient profile data into the computer, including allergies and
other medications taken.
b. Performing nonsterile compounding of prescriptions.
c. Offering counseling to patients when they are picking up filled prescriptions.
d. Informing patients about the common side effects of their medication.
______17. Technician responsibilities in a community pharmacy may include all of the

following EXCEPT:
a. Managing inventory, including handling special orders.
b. Maintaining pharmacy records.
c. Handling and appropriately recording sales of pseudoephedrine products.
d. Answering patient requests for information on dosing of OTC medications.
______18. When communicating with patients, it is important for a technician to be all of
the following, EXCEPT:
a. Patient
b. Caring
c. Professional
d. Impersonal
______19. When a patient is bringing a prescription to you for the first time, which of the
following information is not required?
a. Correct spelling of name
b. Address and phone number(s)
c. Marital status
d. Date of birth
______20. Which of the following is true regarding third-party payers?

a. Third-party payers continually negotiate higher reimbursement rates for
community pharmacies.
b. Pharmacies have been able to increase staffing and offer services such as
delivery services due to revenue increases from third-party payers.
c. Most prescriptions filled today are covered in full or in part by a third-party
payer.
d. Third-party payers have no influence over what drugs physicians prescribe
because they do not restrict coverage or vary patient copays for different
drugs.
______21. Examples of sources of third-party payers include:

a. Government employers
b. Government programs such as Medicaid
c. Private insurance companies
d. All of the above
______22. Which of the following is NOT TRUE regarding labeling of prescriptions being
filled?
a. Ensure that the prescription label does not cover up the lot and expiration
date on the manufacturer’s package, if labeling the package.
b. If there are multiple packages, such as dispensing three inhalers, each
package must be labeled.
c. If the prescription is for #100 tablets and the drug comes in a #100 tablet
bottle, you may simply label the bottle if it is child-resistant.
d. If the manufacturer’s stock bottle does not have a child-resistant cap, you do
not need to dispense with a child-resistant cap.
______23. The steps a pharmacy technician takes when filling and labeling a prescription for
30 tablets to be dispensed includes the following EXCEPT:
a. Selecting the correct medication and strength.
b. Counting out the correct quantity to be dispensed.
c. Putting the tablets into a vial and applying the prescription label.
d. Performing the final verification check before dispensing to the patient.
______24. The following are ways to ensure the correct product was selected to fill a
prescription EXCEPT:
a. Manually checking the name of the medication, strength, and dosage form
against the prescription being filled.
b. Checking the national drug code (NDC) number of the stock bottle against the
NDC number on the label generated to be filled.
c. Weighing a tablet or capsule and comparing the weight to the known weight
of the correct tablet or capsule.
d. Barcode scanning the stock bottle and the computer-generated prescription
label to be filled to ensure they match.
______25. When using automated counting devices or robotics, which of the following is
NOT TRUE?
a. The technology may partially or fully automate the counting and labeling
process.
b. Robotic systems interface with computer systems and can quickly and
accurately fill large numbers of prescriptions.
c. Counting devices using optic sensors are always equipped with barcode
scanners to improve accuracy.
d. The technology requires appropriate cleaning and maintenance to perform
correctly.
______26. Which of the following is NOT required when dispensing a prescription to a

patient at the cash register?
a. New patients must be given a copy of the pharmacy’s patient privacy policy.
b. If it is a new prescription, patient counseling must be provided (or the offer for
patient counseling made).
c. The technician must ensure that the correct medication is given out for the
correct patient by comparing at least two identifiers before completing the
transaction (such as patient name and date of birth, address, or phone
number).
d. The technician may only give the prescription medication to the actual patient
when completing the transaction and not to another family member or
caregiver.
______27. Risk Evaluation and Mitigation Strategy (REMS) drugs that require specific
conditions for prescribing and dispensing include the following EXCEPT:
a. alosetron (Lotronex)
b. thalidomide (Thalomid)
c. isotretinoin creams and gels (Retin-A)
d. clozapine (Clozaril, Fazaclo)
______28. REMS drugs that require specific conditions for prescribing and dispensing
include the following EXCEPT:
a. isotretinoin oral (Amnesteem, Claravis, Sotret)
b. clonazepam (Klonopin)
c. alosetron (Lotronex)
d. thalidomide (Thalomid)
______29. The REMS program for prescribing and dispensing isotretinoin oral products is
called:
a. PPL
b. iPledge
c. TIRF-REMS
d. MedGuide
______30. Disease state management is:

a. A service that all pharmacies are required to provide for patients with
diabetes.
b. A patient care service that pharmacists provide with assistance from
technicians who may collect and manage the data and records for monitoring
patients.
c. A service that requires the pharmacist to be board-certified to provide to
Medicare patients.
d. A service covered in whole or in part by a third-party payer.
______31. Health screenings and wellness programs:

a. Are patient-specific comprehensive monitoring programs offered by
pharmacies.
b. Typically include short educational sessions and taking simple measurements
and are always free of charge to patients.
c. May have some screening tests and data collection performed by technicians.
d. Are always provided by an outside agency hired by the pharmacy to perform
the services at the pharmacy location.
______32. Which is NOT TRUE regarding immunizations?

a. Immunizations are typically administered to patients in a pharmacy by
pharmacy technicians.
b. There are several different immunizations that may be administered in a
pharmacy including influenza (flu) vaccine, shingles, and pneumonia.
c. Immunizations are allowed to be administered to adults by pharmacists with
appropriate training in all the states.
d. Technicians assist in immunization of patients by registering patients,
maintaining vaccine inventory, preparing doses, and keeping records.
______33. Patients receiving home infusion services:

a. Often require intensive medical care in addition to the home infusion services.
b. Are increasing in numbers as administration of long-term IV therapy in the
home is proven to be safe and effective.
c. Are using low-tech equipment that requires frequent professional visits to
ensure proper functioning.
d. Typically pay out of pocket because home services are more expensive than
keeping patients in the hospital.
______34. Home infusion services include providing therapy with specialty drugs. Specialty
drugs include the following types of drugs EXCEPT:
a. Expensive biologic drugs.
b. Drugs only available through a limited distribution network.
c. Drugs that do not need special handling for storage or administration.
d. The drug must be infused or injected.
______35. Which of the following is true regarding cephalosporin antibiotics used for home
infusion?
a. Cephalosporins have a short stability of only 5 days so they must be delivered
twice weekly.
b. The infusion time for most cephalosporins must be 1 hour or more to prevent
pain and irritation of the veins.
c. The duration of therapy when being used for cellulitis is typically over 4–6
weeks.
d. Ceftriaxone is an often-used cephalosporin because it can be administered
once daily.
______36. Which of the following is true regarding the penicillin antibiotics used for home
infusion?
a. Penicillins are commonly used because they can be dosed once daily.
b. Once mixed, penicillins are typically stable for 14 days when refrigerated.
c. A central venous catheter is often used for administering penicillins because
they are irritating to the veins and may cause phlebitis.
d. Penicillins are a common antibiotic used for septic arthritis, cellulitis, and
Aspergillus infections.
______37. Which of the following is true regarding the vancomycin used for home infusion?
a. To avoid “red man syndrome,” vancomycin should be rapidly infused over 5-10
minutes.
b. Vancomycin is irritating to the veins and is best given through a central
catheter for home infusion.
c. Individualized dosing of vancomycin is accomplished by using the results of
primarily peak blood levels and pharmacokinetics.
d. Peripheral catheters are never used for administering vancomycin.
______38. Home infusion therapy with the antifungal amphotericin B:

a. May be used for immunocompromised patients who develop serious bacterial
infections.
b. Have few side effects or reactions in many patients.
c. Is always given using an infusion pump.
d. May require premedication with oral acetaminophen and diphenhydramine.
______39. Total parenteral nutrition is:

a. IV nutrition that is used to provide a patient with all the fluid and essential
nutrients needed when oral nutrition is difficult or impossible.
b. Must always be infused continuously (24 hours a day), requiring patients to
remain home-bound.
c. Compatible with other IV medications so any other medications the patient
may need may be added to the total parenteral nutrition (TPN) bag.
d. Used a majority of the time in elderly patients who have lost weight.
______40. Some of the ingredients in parenteral nutrition are only stable for 24 hours. These
ingredients:
a. Include items such as insulin and heparin.
b. Must be added by the nurse on a home visit prior to infusion of the TPN.
c. Are typically supplied in ampules for patient convenience.
d. Are administered separately, and just prior to, starting the infusion of the TPN.
______41. The label on a home care medication for infusion includes all of the following
EXCEPT:
a. Directions for use, including the rate and frequency of administration.
b. A beyond-use date (BUD) based on stability and sterility data.
c. The patient’s name, the prescriber’s name, and a prescription number.
d. The prescriber’s address and DEA number if the infusion is a controlled
substance.
______42. Which of the following statements is NOT TRUE regarding tunneled central
venous catheters?
a. A Hickman catheter is an example of a tunneled central venous catheter.
b. They are inserted in a peripheral vein and threaded through the vein until
reaching the entrance to the right atrium of the heart.
c. They can have single, double, or triple lumens.
d. To prevent clots, heparin is used to “lock” each lumen daily.
______43. Common complications in using catheters for infusions of admixtures include the
following EXCEPT:
a. Venous thrombosis
b. Peripheral neuropathy
c. Dislodgement or incorrect positioning
d. Phlebitis at the insertion site or along the vein
______44. Common complications in using catheters for infusions of admixtures include the
following EXCEPT:
a. Occlusion of the catheter
b. Incorrect positioning
c. Choking or throat irritation
d. Infection or cellulitis
MATCHING I
Select the role that typically corresponds best to the descriptions below.
A. Intake coordinator
B. Case manager
C. Physician
D. Nursing
E. Pharmacist
F. Pharmacy technician
G. Reimbursement specialist
H. Patient service representative
______1. Coordinates billing and collection for services and interfaces between the patient,
the home infusion service, and the third-party payer.
______2. Compounding, preparing, and labeling medications; picking and packaging

supplies to send to home infusion patients; and maintaining the compounding
room.
______3. Monitoring patient laboratory data, performing pharmacokinetic dosing of certain

medications, and the acquisition, compounding and dispensing of the home
infusion medications.
______4. Works to manage the cost of medical care for the patient, including the location
of the therapy (whether in the hospital or receive infusions at home). Usually an
RN or MSW.
______5. Also known as an admissions representative, gathers the information and

documentation needed to provide home infusion services including insurance
information.
______6. The person ultimately responsible for the care of the patient and is the leader of
the team.
______7. Is the primary patient educator, performs home visits, and is responsible for the
maintenance of IV catheters, scheduling and performing blood work, and
assessing the condition of the patient including any psychosocial issues the
patient is facing.
______8. This person is responsible for controlling the patient’s inventory of supplies,
screening for any problems, contacting the patient weekly or routinely, and
coordinating pick-up of supplies and equipment when therapy is completed.
MATCHING II
Match the type of infusion system to the descriptions below. Items may be used more than
once.
A. Minibag infusion via gravity system
B. Syringe infusion via syringe device
C. Syringe infusion via IV push method
D. Elastomeric balloon pumps
E. Ambulatory electronic infusion pumps
F. Smart pumps
______1. Are available to administer single or multiple types of therapies. Small and
lightweight, the device can infuse out of a variety of standard and proprietary IV
containers.
______2. Cost-effective delivery system because no pump is needed. Manual connections

increase the risk for contamination. Tubing with a built-in flow regulator may be
used.
______3. ICU Medical, Inc. ESP60™ and the RMS Medical Products Freedom60® are
examples of this type of device.
______4. Cost effective and easy to do. Administration is directly into the patient’s IV
catheter.
______5. Devices that are equipped with error prevention software including dose
calculators, limits, and remote communication capabilities.
______6. Examples of these systems include Easypump,® Dosi-Fuser,® and Homepump C-

Series®.
______7. Contains a reservoir made of stretchy membranes inside a soft shell. May be filled
manually or with an automated filling pump.
______8. Easy-to-prepare, small-volume fluids. May be electronically or mechanically

driven. Compact design.
______9. CADD,® WalkMed,® and the Curlin 6000 CMS Series™ are examples of this type of
system.
MATCHING III
A. Peripheral catheters
B. Tunneled central venous catheters

C. Subcutaneous access ports
D. Peripherally inserted central catheter
______1. Broviac and Hickman are examples of this type.
______2. Also known as a PICC.
______3. Surgically inserted into a central venous site and threaded through the vein to the
entrance of the right atrium of the heart.
______4. Access to this device is with a Huber needle through skin and septum.
______5. An example of this type is the Groshong® with a pressure-sensitive, distal tip slit
valve.
______6. Also known as “long-line” catheters.
______7. Port-a-Cath® and Infusaport® are examples of this type.
______8. These can be inserted at bedside in the hospital or at home by a nurse.
______9. Per-Q-Cath Midline® and PowerGlide Midline Catheter® are examples of this type.
______10. These are inserted through a vein in the arm and threaded through until the tip is
resting in the superior vena cava of the heart.
______11. Usually placed in a large vein of the upper arm, the basilic or cephalic vein.
______12. Placement is confirmed by x-ray before infusing hypertonic solutions such as

TPNs.
______13. These are placed under the skin in the chest wall by a surgeon.
______14. Commonly ¾ to 1 inch in length, and the midline catheters are 6 inches in length.
______15. The catheter is tunneled under the skin to establish a barrier between the skin
exit and the vascular entrance sites.
ORDERING
Put the following tasks in the sequence in which they are typically performed.
A. The prescription information is entered into the computer.
B. The prescription is filled and labeled.
C. A patient presents a new prescription to be filled.
D. A final check is performed on the filled prescription by the pharmacist.
E. The pharmacist counsels the patient when the prescription is dispensed.
F. The prescription is billed to the third-party payer, and any issues are resolved.
1. ______
2. ______
3. ______
4. ______
5. ______
6. ______
TRUE OR FALSE
______1. The dispensing fee is the portion of the prescription cost that the patient is
responsible for paying.
______2. An adverse drug reaction is a bothersome or unwanted effect that results from
the use of a drug, unrelated to the intended effect of the drug.
______3. A generic drug is one that is covered by a patent and is, therefore, only available
from a single manufacturer.
______4. The Health Insurance Portability and Accountability Act (HIPAA) is legislation
enacted by states to establish guidelines for the pharmacist to perform a drug
utilization review prior to dispensing a prescription.
______5. An ambulatory patient is one who is primarily bedridden but can get around
using a wheelchair and who receives care in a hospital setting.
______6. DUR must be performed before the prescription is dispensed to the patient.
______7. Mixing two creams together and making an oral suspension from a medication
only available as tablets are examples of compounding.
______8. All prescriptions must be checked for accuracy by a pharmacist before dispensing
so accuracy by the technician filling the prescription is unimportant.
______9. Technicians are allowed to give patients advice about OTC products and dietary
supplement use and dosing if they are nationally certified.
______10. A legend drug is one that, based on safety and potential for addiction, requires
authorization from an authorized prescriber before a pharmacist can prepare and
dispense the product.
______11. Pouring a liquid from the manufacturer’s original packaging into a smaller bottle
for dispensing is an example of compounding.
______12. The foundation of medication therapy management by pharmacists is the proper

handling, compounding, and preparation of the drug product by technicians.
______13. Resolving third-party payer issues is a complicated task usually handled by

pharmacists.
______14. The use of both isotretinoin and thalidomide is restricted because both
medications can cause serious birth defects.
______15. A pharmacist generally completes special training or becomes certified to provide
specific disease state management.
______16. One of the goals of home healthcare is to decrease healthcare costs.
______17. Home healthcare allows patients to receive treatment without being hospitalized.
______18. Patients receiving home infusion services experience a longer time to return to
work or normal activities compared to patients hospitalized for infusion services.
______19. Patients are more comfortable recuperating at home, and the risk of hospital-
associated complications such as infections is decreased for patients receiving
home care.
______20. The majority of medications used in home infusions are cancer chemotherapy
drugs.
______21. You must always use normal saline and not dextrose to flush catheters used for
amphotericin B.
______22. Patients receiving parenteral nutrition require intensive monitoring, including

laboratory work and weight.
______23. The administration of IV medications that are incompatible with a TPN infusion
may be given through a central catheter that has two lumens—one used for the
TPN and the other for other medications.
______24. Enteral nutrition is the electrolyte and nutrient solutions administered to patients
directly into a vein.
______25. Chemotherapy agents are never administered to patients in the home setting.
______26. Many patients on chemotherapy experience a drop in white blood cells that
requires the addition of colony-stimulating factor therapy to their regimen.
______27. Growth hormone, interferons, and monoclonal antibodies are examples of

biologic response modifiers.
______28. Antibiotics are made of proteins and if shaken, the potency may be reduced.
______29. Biotech drugs such as filgrastim and erythropoietin are produced through genetic
engineering.
______30. Intrathecal administration of a pain medication is injecting the medication into

the fluid around the brain and spinal cord.
______31. Most home care orders for IV narcotics are for hydromorphone.
______32. It’s extremely important to prime tubing to remove any air before providing an
elastomeric balloon device to a patient.
______33. “Pharmaceutical Compounding—Sterile Preparations” is the name of the USP

Chapter <800>.
______34. Pharmacies that compound prescription products for specific patients are
considered 503B Outsourcing Pharmacies.
______35. Storing a sterile-compounded infusion under refrigeration will inhibit microbial
growth.
______36. A sterile-compounded drug product can change or deteriorate due to drug

adsorption to the product container.
______37. IV admixtures requiring refrigeration do not need to be transported in coolers as

long as they are double-bagged.
______38. Gloves must be worn when nurses are performing blood draws in home care
patients.
______39. Home care patients may dispose of hazardous medical waste and sharps in the
regular trash.
______40. Supplies needed by home infusion patients include alcohol pads, gloves, a sharps
container, medical waste bags, and tubing.
FILL IN THE BLANK

1. Medication therapy management (MTM) essentially encourages the establishment of
the __________ as the manager of a patient’s drug therapy.
2. __________ pharmacies are those where companies own a large number of pharmacies
that all use the same name and logo and carry similarly branded OTC products.
3. The restricted-use drug used to treat patients with schizophrenia, __________, can cause
a serious drop in white blood cells, so careful monitoring of these levels must be done
regularly based on the patient’s condition and medical history.
4. The FDA requires some drugs to be dispensed with __________, which help patients
avoid serious adverse events, inform them about known serious side effects, and
provide directions for use to promote adherence to the treatment.
5. A product’s __________ can be used as a double check for technicians to make sure the
correct drug product has been selected for filling.
6. Two organizations that provide guidance and standards for sterile compounding are
__________ and __________.
7. The USP General Chapter <800> provides the standards for handling __________ drugs.
SHORT ANSWER
1. List three newer practice trends pharmacies are using to serve their patients while also
generating revenue. How would pharmacy technicians assist with these trends?
2. Discuss the risk category levels in the preparation of IV admixtures according to ASHP
guidelines.
CROSSWORD PUZZLE
Across:
2. Pharmacy __________ manager: a third-party payer (insurance payer) that is responsible
for processing and paying for prescription medications and services.
5. Universal __________ is treating all patients as if they were potentially infectious to
prevent employees from exposure to human blood or other potentially infectious
material.
8. A __________ pharmacy is an ambulatory pharmacy located in a clinic or medical center
to serve outpatients’ needs.
9. An ambulatory care pharmacy that is owned and operated as part of a managed care
system such as a health maintenance organization (HMO) is called a __________
__________ (two words) pharmacy.
11. A __________ name drug is a drug that is covered by a patent and is available only from
a single manufacturer.
13. A __________ pharmacy is generally a stand-alone pharmacy in a community that
provides medication services to ambulatory patients.
15. Drug __________ are the effects caused by the combined actions of two or more drugs
used simultaneously.
16. An __________ drug reaction is a bothersome or unwanted effect that results from the
use of a drug, unrelated to the intended effect of the drug.
18. The portion of the cost of a prescription that the patient is responsible for paying, when
a part of the cost is covered by a third-party payer, is called the patient __________.
19. Risk Evaluation and __________ Strategy is a safety strategy developed by a
pharmaceutical company, which is used to ensure that patients are able to obtain and
safely use a medication known to have a serious potential risk.
20. The federal legislation enacted to establish guidelines for the protection of patients’
private health information is called __________.
21. The money that is collected by a pharmacy from a third-party payer to cover partial cost
or the entire cost of a patient’s prescription is the __________.
22. A __________ pharmacy is a pharmacy that is part of a large number of corporately-
owned pharmacies that use the same name and carry similarly branded OTC products.
Down:
1. An __________ pharmacy is a community pharmacy or small group of pharmacies in a
limited geographic area that are owned by a single individual or a small number of
individuals.
3. The leaking of IV solutions into areas outside of the vein, resulting in potentially severe
tissue damage, is called __________.
4. A __________ drug is a drug that is no longer covered by a patent and is generally
available from multiple manufacturers, usually resulting in a significant reduction in
cost.
6. __________ drugs are those that are available for purchase without a prescription.
7. A list of drugs and their tiers that a third-party payer will cover is called their __________.
10. An __________ care pharmacy is a pharmacy generally located within, or in close
proximity to a clinic, hospital, or medical center that provides medication services to
ambulatory patients.
12. The written or verbal authorization, by an authorized prescriber, for the use of a
particular pharmaceutical agent for an individual patient is called a __________.
14. A __________ __________ (two words) payer is an entity other than the patient that is
involved in paying partial cost or the entire cost of a patient’s prescriptions.
17. The act of a pharmacist educating a patient regarding the proper use of a prescribed
drug at the time of dispensing is called patient __________.
19. A __________ order pharmacy functions like a warehouse, with pharmacists and
technicians who dispense prescriptions that are mailed to patients.
QUESTIONS CH 5
HOSPITAL AND SPECIALTY PHARMACY
PRACTICE
Learning Outcomes

■ Describe the differences between centralized and decentralized pharmacy services.
■ List the steps required to dispense a medication in the hospital.
■ Explain how a medication is added to formulary.
■ List the components of the medication management process.
■ Describe nontraditional roles of pharmacy technicians in the hospital setting.
■ List characteristics that may qualify a medication as a specialty therapy.
MULTIPLE CHOICE
______1. Historically, hospital pharmacy services were:

a. Primarily involved with drug distribution.
b. Performed from a central pharmacy, usually in the basement.
c. Provided medications in bulk containers to nursing units.
d. All of the above.
______2. Which of the following is a typical aspect of a hospital pharmacy?

a. Contracts directly with pharmacy benefit managers.
b. Has frequent face-to-face patient contact.
c. Operates with a closed formulary of medications.
d. Stores all medications within the pharmacy.
______3. The following are aspects of a hospital pharmacy EXCEPT:

a. Pharmacists have access to patient’s medical records and laboratory results.
b. It operates with an open formulary.
c. Pharmacists have frequent face-to-face interactions with nurses, physicians,
and other healthcare professionals.
d. Sterile compounds IV medications and chemotherapy.
______4. Which of the following is TRUE regarding hospital pharmacy services?

a. The use of automation and technology has improved efficiency but has led to a
decrease in patient safety.
b. Pharmacy services only include procuring, preparing, and dispensing
medications from a central location.
c. Clinical management of patients has become a more important focus of
pharmacists in a hospital setting.
d. The opportunities for technicians in a hospital setting are decreasing due to
advances in technology and outsourcing pharmacy services.
______5. Which of the following is true regarding healthcare institution management?

a. The Board of Directors typically reports to the CEO.
b. The CFO reports to the CEO.
c. The Director of Pharmacy reports directly to the CEO.
d. Technicians are not allowed to assume management or supervisory positions
in the pharmacy department.
______6. Typically, in hospital organizations:

a. The Board of Directors reports to the COO.
b. The CEO reports to the COO.
c. The CFO reports to the Board of Directors.
d. The COO reports to the CEO.
______7. Decentralized pharmacy services:

a. Replace the need for a centralized pharmacy.
b. Require fewer resources such as personnel and inventory.
c. Provide a shorter time to deliver medications.
d. Are different from satellite pharmacies.
______8. Technician responsibilities in a central pharmacy include all of the following

except:
a. Preparing IV antibiotics.
b. Preparing IV chemotherapeutic agents.
c. Performing functions related to quality control and quality improvement.
d. Monitoring and evaluating patient response to medications.
______9. One disadvantage of decentralized pharmacies is that:

a. They require additional resources.
b. They do not have as many filling stations as the central pharmacy.
c. They are often located in the basement.
d. The pharmacist has fewer opportunities to discuss the plan of care, answer
drug information questions, and make appropriate drug therapy
recommendations.
______10. Pharmacy technicians are accustomed to helping pharmacists in all of the

following areas except:
a. Collecting routine clinical data.
b. Providing patient education.
c. Tracking medication errors.
d. Taking on management tasks.
______11. Hospital clinical pharmacy services include the following EXCEPT:

a. Ensuring all patient-specific problems requiring drug therapy are met.
b. Ensuring the selected medication is appropriate for the indication.
c. Determining if the patient’s insurance information is up-to-date.
d. Educating patients and other healthcare providers regarding the use of
medications.
______12. Hospital clinical pharmacy services include ensuring the following EXCEPT:
a. Appropriate duration of hospitalization
b. Correct dose and duration of therapy
c. Potential drug interactions are checked
d. Monitoring effects of the medication through laboratory results (e.g., serum
drug levels, culture and sensitivity results, serum creatinine levels)
______13. Hospital clinical pharmacy services include ensuring the following EXCEPT:
a. Double checking appropriate dosage form and administration technique are
used.
b. Monitoring potential adverse effects of the medication.
c. Attending patient care rounds with physicians and other healthcare providers.
d. Confirming appropriate diagnosis was made by physician.
______14. Which of the following is NOT performed by a pharmacist while attending medical
emergencies or codes?
a. Remove medications from emergency cart or “crash” cart.
b. Prepare medications for administration.
c. Provide guidance for drug therapy selection and dosing.
d. Ensure all medications used are covered by the patient’s insurance.
______15. Technicians assist with clinical pharmacy services by performing all of the
following EXCEPT:
a. Collecting clinical data.
b. Providing clinical advice to prescribers.
c. Tracking medication errors.
d. Gathering information for medication reconciliation.
______16. Drug distribution service includes the following EXCEPT:

a. Participating in medical rounds with physicians.
b. Processing prescription orders from physicians.
c. Receiving and storing medications appropriately to protect product integrity.
d. Compounding intravenous (IV) medications for patients.
______17. The following criteria are considered by the P&T Committee when deciding which
medications will be included in the hospital formulary EXCEPT:
a. Potential for errors and abuse
b. Medication cost
c. Use and effectiveness of the medication
d. Incentives the drug company offers the physicians
______18. Which of the following is true regarding hospital formularies?

a. Physicians are not allowed to request that certain medications be added to the
hospital formulary.
b. The hospital will have a procedure for the temporary use of a non-formulary
drug.
c. If a new drug is used for the same indication as an existing drug on the
formulary, it is automatically added to the formulary.
d. Discharged patients are required to continue the formulary drug used in the
hospital.
______19. Which of the following is NOT TRUE regarding drug shortages?

a. A shortage may occur because of increased demand such as an epidemic.
b. Pharmacy technicians do not have a role in managing drug shortages in a
hospital.
c. A shortage may occur because of decreased supply, such as a manufacturing
issue.
d. The recall of a manufacturer’s products due to quality issues may cause a
temporary shortage.
______20. Drug storage includes the following EXCEPT:

a. Medications must be stored according to the temperature and humidity
requirements from the manufacturer.
b. Appropriate storage is required to ensure stability and potency of medications.
c. Only the medications stored in the pharmacy are required to be inspected for
medications that are expired or past their beyond-use date.
d. Pharmacy technicians routinely perform inspections of drug products in
storage to ensure expired products are removed from active stock.
______21. Which of the following is true regarding storage and documentation of controlled
substances?
a. Drug diversion is when a controlled substance medication is administered to
the wrong patient.
b. Unlike the general population, fewer than 1% of healthcare professionals will
misuse alcohol or drugs so diversion in the hospital is unlikely.
c. Pharmacy technicians are prohibited from handling controlled substances or
performing documentation or recordkeeping.
d. Technicians that suspect a co-worker or other healthcare professional of
diversion should follow the hospital policy and report the suspicion
immediately.
______22. Storage of hazardous drugs as defined by NIOSH include the following EXCEPT:
a. Hazardous drugs must be stored in the appropriate environment depending on
the level of risk.
b. Some hazardous drugs must be stored in an externally vented negative
pressure room.
c. Gloves are not necessary when technicians are handling hazardous drugs.
d. Hazardous drugs require special handling and disposal.
______23. CPOE stands for:

a. Computerized prescription order entry
b. Computerized pharmacy order entry
c. Computerized physician order entry
d. Computerized prescriptive order entry
______24. Which of the following is NOT TRUE regarding the review of a physician order
before dispensing the medication to the patient?
a. The pharmacist reviews the order to ensure it’s the appropriate medication for
the patient and the condition and screens for allergies or drug interactions.
b. If the medication order is unclear or is missing information, the pharmacist
will clarify with the prescriber before releasing the medication for
administration to the patient.
c. If an order is written when the pharmacy is closed (the pharmacy is not open
24/7), the nurse administers the first dose(s) before the order is verified by the
pharmacist the next morning.
d. Orders received after hours may be remotely verified by a pharmacist at a 24-
hour hospital pharmacy and then the medication is released for patient
administration.
______25. Medications for patients in the hospital:

a. Are purchased and dispensed from bulk vials because it is cost-effective.
b. Are purchased in unit-of-use or unit dose packaging because they are less
expensive.
c. Have barcodes that are scanned to improve accuracy and safety in the
dispensing and administration process.
d. Are all kept within the hospital central pharmacy.
______26. Which of the following is true regarding sterile compounding in a hospital

pharmacy?
a. Most IVs compounded in the pharmacy have extended dating, which allows for
making large batches.
b. The hospital pharmacy may outsource the compounding of IVs and total
parenteral nutrition (TPN) because it is cost effective with savings on labor and
equipment.
c. Technicians in hospitals are not allowed to prepare complex sterile
compounded TPNs.
d. It is not necessary to include the route of administration on the label if the
medication is dispensed in an IV bag.
______27. Which of the following is TRUE regarding automated dispensing devices?

a. Securing the cabinet in the patient care area is not required if it is within sight
of the nursing station.
b. The dispensing device system is able to track when a medication is accessed,
but not how many units were removed.
c. There is no need to utilize barcodes if the medication is retrieved from an
automated dispensing device.
d. The device is able to report discrepancies in access and if a medication is
expired or needs to be restocked.
______28. Which of the following is TRUE regarding the use of medication carts for hospital
patient maintenance medications?
a. The cart drawers are arranged alphabetically by the name of the drug that is
in the drawer.
b. Each patient drawer is filled with medications from a fill list printed from the
patient files.
c. Filled patient drawers may be checked by a pharmacist or a technician, but
technicians are not as accurate.
d. Cassettes or carts are prohibited from being filled by automation or robotics.
______29. Medication-use evaluation (MUE) is commonly performed for the following types
of drugs EXCEPT:
a. Drugs that are used with high frequency
b. Expensive drugs
c. High-risk drugs
d. Generic drugs to compare to the brand
______30. Which of the following is TRUE regarding transitions of care?

a. Medication reconciliation includes only information from the patient’s primary
care provider and the hospital.
b. Technicians may be involved in collecting medication regimen information on
admission to the hospital, and they may also be involved in the discharge
medication process.
c. About 50% of serious medical errors involve miscommunication during the
hand-off between medical providers.
d. Transitions of care only occurs when a patient moves from home to a nursing
home and then to the hospital (from less care to more intensive care).
______31. Before a study is approved to be conducted in the hospital, a study protocol is

developed, reviewed, and approved by:
a. The Joint Commission (TJC)
b. The P&T Committee
c. The Institutional Review Board (IRB)
d. The U.S. Food and Drug Administration (FDA)
______32. Specialty medications:

a. Are required to be administered in a hospital setting.
b. Defined only by their high cost.
c. Frequently require clinical patient monitoring.
d. Are not covered by insurance plans.
______33. Technicians assist in providing specialty medications to patients by:

a. Facilitating appropriate delivery to the patient, clinic, or other healthcare
setting.
b. Performing benefits investigations and medication assistance programs.
c. Ensuring the appropriate storage of specialty drugs to protect product
integrity.
______34. Examples of diseases treated with specialty medications includes the following
EXCEPT:
a. Rheumatoid arthritis
b. HIV/AIDS
c. Bronchitis
d. Infertility
ORDERING
List the following items in the order in which they occur.
A. The medication order is reviewed and verified by a pharmacist.
B. The medication is administered, and the administration is documented in the MAR.
C. Medications are procured and appropriately stocked in the automated medication

dispensing device or in the pharmacy.
D. If the medication is not available in the automated medication dispensing device, the
order is filled by a technician in the pharmacy and verified by the pharmacists before
delivery to the patient’s nurse.
E. The patient is monitored to ensure response to therapy and to watch for adverse events.
F. The medication is released in the automated medication dispensing device and

retrieved by a nurse for administration to the patient.
G. Prescriber issues medication order.
H. Medication order is processed and added to the patient’s medication profile.
1. ______
2. ______
3. ______
4. ______
5. ______
6. ______
7. ______
8. ______
TRUE OR FALSE
______1. The method, using communication technology, in which a pharmacist remotely

oversees aspects of pharmacy operations or provides patient care services, is
called “telepharmacy.”
______2. The hospital formulary is the list of approved medications that are stocked and
used for hospital patients.
______3. Hospital pharmacies order stock from the wholesaler when a medication order is
received by the pharmacy in order to have the medication for the patient the next
day.
______4. The P&T Committee is responsible for ordering all medications from the
wholesaler to stock in the pharmacy.
______5. Barcoding on medications may reduce medication errors.
______6. Inventory systems may be set up to automatically order medication stock when
levels are low.
______7. Pharmacy technicians may be assigned to management or lead responsibilities.
______8. The advantage of centralized services is that a pharmacist also has more
opportunities to discuss the plan of care, answer drug information questions, and
make appropriate drug therapy recommendations with other healthcare
providers.
______9. An example of an ad hoc committee is the P&T Committee.
______10. Pharmacists have the responsibility to operate and maintain automated drug
distribution systems because pharmacists are licensed.
______11. Every hospital pharmacy is required by TJC to maintain a policy and procedure
manual.
______12. Studies have shown that technicians are more accurate at checking medication
carts than pharmacists.
______13. All medication storage areas in the hospital are assigned to be inspected at least
monthly by pharmacy technicians.
______14. When prescribers enter the order electronically, it is not necessary for a
pharmacist to review the order for appropriateness.
______15. Refilling emergency crash carts does not require a check to ensure the correct
items were replaced.
______16. Medications do not need to be checked visually before administering to a patient

if a barcode-assisted medication administration system is used.
______17. Monitoring patients for the effects of the medications may include both adverse
effects and positive outcomes.
______18. Medications with a narrow therapeutic index may have blood levels in patients
monitored.
______19. MUE is a process to identify areas for improvement and implement needed
changes in the process.
______20. Investigational drugs may be stored with the hospital pharmacy regular drug
stock if they are marked “investigational use only.”
______21. Hospitals are accredited by the FDA, and this accreditation includes pharmacy
services.
______22. Specialty pharmaceuticals require closer supervision because they are more
complex to administer, store, and manage.
FILL IN THE BLANK

1. The __________ is an approved list of medications that are routinely stocked in the
hospital pharmacy to treat the types of patients the hospital typically serves.
2. A pharmacy satellite is an example of a __________ pharmacy service.
3. Every hospital pharmacy is required by TJC to maintain a __________ __________
__________ manual. (3 words)
4. When a drug is administered to the patient, the dose is documented as given in the
patient’s __________.
5. The standing committee called the __________ establishes a hospital formulary based on
criteria such as indications for use, effectiveness, drug interactions, potential for errors
and abuse, adverse effects, and cost.
6. Hospitals that typically only have a few drugs in a specific class of medications operate
with a __________ formulary, which means that the list of available drugs is limited.
7. The __________ department is responsible for the appropriate inspection of all
medication storage areas to ensure that medications have not expired.
8. Baxa Exactamix® is an example of an __________ compounder.
9. The Pyxis Medstation® and OmniCell® are examples of __________ medication

dispensing systems.
SHORT ANSWER
1. Describe the elements on a medication label intended for patient administration.
2. What is the purpose of MUEs?
3. What is the difference between quality improvement and quality control?

CROSSWORD PUZZLE
Across:
1. A __________ pharmaceutical is a high-cost medication, requires special handling or
monitoring, and/or is used to treat rare diseases.
4. The system that begins when the pharmacy receives the medication and ends when
the medication is administered to the patient is called the drug __________ system.
5. The services that are provided to support clinical trials involving medications are called
__________ drug services.
8. A __________ pharmacy is located in or near a patient care area and provides distribution
and clinical services to the patients in that patient care area.
9. When pharmacy services are provided at or near patient care areas, and are often
supported by a central pharmacy, the services are __________.
10. Medication __________ is the process to create the most accurate list of all medications
the patient is currently taking, with the goal of providing the correct medications to the
patient at all transition points within the hospital.
11. The Pharmacy and __________ Committee is the group of providers that oversee drug
therapy in a healthcare system with the goal of providing safe, effective, and cost-
effective medications to patients.
Down:
2. The services provided by a pharmacist that are focused on patient care, including that
medications are appropriate for the diagnosis, and are safe as well as cost effective are
called __________ pharmacy services.
3. __________ pharmacy services are pharmacy services that are provided from a single
location in the hospital.
4. Drug __________ is when a prescription medication is taken out of the legal channel of
distribution or use.
6. An __________ medication dispensing device is a secure device containing medications
that are electronically tracked, inventoried, and dispensed.
7. __________ medications are those that are carcinogenic; are teratogenic; have
reproductive toxicity; have organ toxicity at low doses; or that are genotoxic.
PART THREE
Science Knowledge and
Skills
6. The Human Body: Structure and Function

7. Drug Classifications and Pharmacologic
Actions
8. Drugs and the Body: Basic
Biopharmaceutics, Pharmacokinetics, and
Pharmacodynamics
9. Medication Dosage Forms and Routes of
Administration
QUESTIONS CH 6
THE HUMAN BODY: STRUCTURE AND
FUNCTION
Learning Outcomes

■ Identify the major structures of each of the body systems presented.
■ Describe the major functions of each of the body systems presented.
■ Describe common diseases and disorders that can develop when something goes wrong
in a body system.
■ Recognize the role of drug therapy in the common diseases and disorders of the body
systems.
MULTIPLE CHOICE
______1. The two major parts to the nervous system are the:
a. Central nervous system and the peripheral nervous system
b. Afferent system and the efferent system
c. Sympathetic system and the parasympathetic system
d. Skeletal muscle and the smooth muscle
______2. All of the following are diseases of the nervous system except:
a. Seizure disorders
b. Anxiety disorders
c. Hypertension
d. Myasthenia gravis
______3. The cardiovascular system is comprised of the:

a. Heart, lymphatic system, and blood vessels
b. Heart, blood vessels, and blood
c. Heart, spinal cord, and lymphatic system
d. Heart, autonomic nervous system, and kidneys
______4. The middle layer of the heart is called the:

a. Pericardium
b. Endocardium
c. Myocardium
d. Atrium
______5. The right and left sides of the heart are separated into two functional pumps,
which do the following:
a. The right atria and the left ventricle pump blood into the lungs.
b. The right atria and the right ventricle pump blood into the lungs.
c. The left atria and left ventricle pump blood into the lungs.
d. The left atria and the right ventricle pump blood into the lungs.
______6. The heart also has a conduction system of nerve pathways that respond to
messages from the:
a. Somatic nervous system
b. Afferent division
c. Peripheral nervous system
d. Autonomic nervous system
______7. This disease is caused when the blood vessels that supply the heart with oxygen
become narrowed as the result of atherosclerosis:
a. Venous thromboembolism
b. Hypertension
c. Coronary artery disease
d. Heart failure
______8. Uncontrolled hypertension may lead to all of the following EXCEPT:

a. Kidney damage
b. Retinal damage
c. Anemia
d. Stroke
______9. The respiratory system is responsible for gas exchange, which:

a. Allows oxygen to be taken to cells in the body and carbon dioxide to be
removed from the same cells.
b. Allows carbon dioxide to be taken to cells in the body and oxygen to be
removed from the same cells.
c. Occurs at two levels: at the lungs between the alveoli and the bronchi, and at
the cellular level between blood and the tissues.
d. Occurs at two levels: at the lungs between the trachea and the blood, and at
the cellular level between blood and the tissues.
______10. Asthma may be caused by an allergic response to the following EXCEPT:

a. Exercise
b. Sunlight
c. Cold air
d. Smoke
______11. Which of the following is TRUE regarding muscles?

a. There are more than 800 muscles in the body.
b. All muscles are attached to bones by tendons.
c. Muscle fibers are made up of thick and thin elongated filaments.
d. Skeletal muscle is under voluntary control through the autonomic nervous
system.
______12. The following are all types of muscle EXCEPT:

a. Skeletal muscle
b. Cardiac muscle
c. Smooth muscle
d. Pulmonary muscle
______13. Risk factors for osteoporosis include the following EXCEPT:

a. Being female (especially after menopause)
b. A family history of osteoporosis or broken bones
c. Cushing’s syndrome
d. High levels of vitamin D
______14. The outermost layer of the kidney is called the:

a. Medulla
b. Renal pelvis
c. Cortex
d. Nephron
______15. The endocrine system works to do all of the following EXCEPT:

a. Maintain the body’s normal internal balance (homeostasis).
b. Regulate growth and development.
c. Produce, use, and store energy.
d. Control glands around the eye that produce tears.
______16. Which of the following is TRUE regarding the endocrine system?

a. Hormones have a targeted effect on a single bodily function.
b. Disturbances in the endocrine system may occur from damage to the gland.
c. Decreased production of hormones is treated by giving hormone production
inhibitors.
d. Hormones are taken up by the red blood cells and transported throughout the
body.
______17. The following are true regarding melatonin EXCEPT:

a. Melatonin is produced by the pituitary gland.
b. Melatonin is a hormone that affects more than one organ system.
c. It causes sleep in response to darkness.
d. It is used to set the body’s “time clock.”
______18. Autoimmune diseases:

a. Are caused when the body develops an allergy to itself.
b. Causes IgE molecules to attach to mast cells in the lungs, skin, and tongue.
c. Can develop into full-blown acquired immunodeficiency disease after several
years.
d. Can cause a broad range of illnesses in humans.
______19. The eyes are enclosed by three layers. The outermost layer is the:
a. Sclera/cornea
b. Vitreous humor
c. Choroid/ciliary body/iris
d. Retina
______20. The part of the ear that detects changes in position and movement of the head
and is responsible for maintaining balance and equilibrium is called the:
a. Tympanic membrane
b. Organ of Corti
c. Auditory canal
d. Vestibular apparatus
______21. Treatment for eczema includes all of the following except:

a. Lubricants
b. Topical anti-inflammatory creams
c. Antihistamines
d. Antiseptics
______22. The female hormones, which are responsible for the development of secondary
sex characteristics when an individual reaches puberty and to prepare for
pregnancy, are:
a. Estrogen and testosterone
b. Progesterone and cortisone
c. Estrogen and dihydrotestosterone
d. Estrogen and progesterone
______23. Erectile dysfunction may be caused by:

a. Diabetes
b. Medication
c. Atherosclerosis
d. All of the above
______24. The following are part of the immune system EXCEPT:

a. Leukocytes
b. Lymph nodes
c. Bone marrow
d. Thyroid gland
______25. The following are major lymphoid organs EXCEPT:

a. Pancreas
b. Appendix
c. Spleen
d. Tonsils
______26. Which of the following is TRUE regarding inflammation?

a. Only injuries cause inflammation redness, heat, and pain.
b. Inflammation is a response to cells with a distinctive “self” marker.
c. A goal of inflammation is to begin the process of tissue healing and repair.
d. Inflammation is an adaptive immune response targeting a specific invader.
______27. Which of the following is TRUE regarding the gastrointestinal (GI) tract?
a. The GI tract runs through the body from the mouth to the anus and is about
60 feet long.
b. The trachea is a muscular tube that connects the mouth to the stomach.
c. The small intestine is nearly 10 feet long with its inner wall covered with villi.
d. The large intestine is where almost all the nutrients from food are absorbed
into the body.
______28. Common diseases and disorders of the GI tract include the following EXCEPT:
a. Constipation and diarrhea
b. Crohn’s disease and irritable bowel syndrome
c. Ulcers and gastroesophageal reflux disease (GERD)
d. Bladder infections and colitis
______29. In most cases, the formation of kidney stones is unknown but may be precipitated
by all of the following EXCEPT:
a. Urinary tract infections
b. Gout
c. Living in a hot climate
d. Drinking an excess of water
______30. Symptoms of an overactive bladder include the following EXCEPT:

a. Sudden urge to urinate
b. Inability to fully empty the bladder
c. Leakage of urine
d. Urinating frequently
______31. The skin receptors that respond to pain and damage to tissue are called:
a. Mechanoreceptors
b. Proprioceptors
c. Nociceptors
d. Chemoreceptors
______32. Swimmer’s ear:

a. Is also known as otitis media.
b. Is an inflammation of the inner ear causing dizziness.
c. Is commonly caused by excessive moisture leading to an infection.
d. Has symptoms including fever and may lead to perforation of the eardrum.
______33. Contact dermatitis is treated with the following EXCEPT:

a. Topical antihistamines
b. Anti-inflammatory agents
c. Antiseptics
d. Barrier creams
______34. Common women’s health issues include the following EXCEPT:
a. Impotence
b. Infertility
c. Endometriosis
d. Polycystic ovarian syndrome
MATCHING I
Match the following to the correct definition. Items may be used more than once.
A. Central nervous system
B. Peripheral nervous system
C. Afferent division
D. Sensory stimuli
E. Visceral stimuli
F. Efferent division
G. Autonomic nervous system
H. Somatic nervous system
I. Motor neurons
J. Sympathetic nervous system
K. Parasympathetic nervous system
______1. A division that carries information from the brain to organs and tissues.
______2. Also known as the adrenergic system.
______3. Also known as the cholinergic system.
______4. Comprised of the brain and the spinal cord.
______5. Divided into the afferent and efferent divisions.
______6. Divided into the autonomic and somatic nervous systems.
______7. Functions when the body is at rest (as opposed to under stress).
______8. Information from the environment such as temperature.
______9. Information on the status of internal organs such as heart rate.
______10. Network of nerves outside the spinal cord.
______11. Signals are transmitted by these to skeletal muscles.
______12. This division carries sensory information to the brain.

______13. This system is divided into the sympathetic and parasympathetic systems.
______14. Transmits signals to organs such as the heart under automatic control of the
brain.
______15. Transmits signals to skeletal muscles under voluntary control.
______16. Works when the body is under stress—fight or flight response.
MATCHING II
Imbalances of the following neurotransmitters are associated with which of the diseases
listed below? Items may be used more than once.
A. GABA and acetylcholine
B. dopamine and acetylcholine
C. acetylcholine
D. serotonin and norepinephrine
E. dopamine
F. norepinephrine and dopamine
______1. Alzheimer’s disease
______2. Attention deficit hyperactivity disorder
______3. Depression
______4. Mood disorders
______5. Myasthenia gravis
______6. Parkinson’s disease
______7. Psychotic disorders
______8. Schizophrenia
______9. Seizure disorders
ORDERING
Put the following in order of blood flow starting with the oxygenated blood from the lungs
(pulmonary capillaries).
A. aorta
B. left atrium
C. left ventricle
D. pulmonary arteries
E. pulmonary capillaries
F. pulmonary veins
G. right atrium
H. right ventricle
I. systemic arteries
J. systemic capillaries
K. systemic veins
L. vena cava
1. ______
2. ______
3. ______
4. ______
5. ______
6. ______
7. ______
8. ______
9. ______
10. ______
11. ______
12. ______
TRUE OR FALSE
______1. Multiple sclerosis is caused by an imbalance of acetylcholine.
______2. Pain that involves the nerves is called “neuropathic” pain.
______3. The ability of the central and peripheral nervous systems to communicate with
and regulate the function of organs in the body is possible through the release of
neurotransmitters.
______4. Alzheimer’s disease is a condition where the myelin sheath is broken down,
causing lesions on the nerves, problems with speech, difficulty swallowing, and
muscle weakness.
______5. The two most common mood disorders are anxiety and attention deficit
hyperactivity disorder (ADHD).
______6. Acute pain typically lasts for months to years and may be accompanied by other
symptoms such as sleep problems, lack of appetite, and depression.
______7. Common symptoms of schizophrenia include hallucinations and delusions.
______8. ADHD causes feelings of powerlessness with excessive worrying.
______9. The pulmonary vein carries oxygenated blood from the lungs.
______10. The white blood cells (leukocytes) are responsible for transporting oxygen to, and
carbon dioxide away from, the cells of body tissues.
______11. Veins deliver blood to the heart, and arteries take blood away from the heart.
______12. When the electrical activity of the heart is abnormal, a condition known as
anemia develops.
______13. The cause of a stroke can be a blood clot or a blood vessel that has ruptured.
______14. Strokes, also known as cerebrovascular accidents (CVAs), occur when there is an
acute decrease or stoppage of blood flow to a part of the brain.
______15. Hypertension is a condition where a person is unable to cope with stressful

events.
______16. Skeletal muscle is the primary muscle found in the internal organs of the body:
stomach, intestines, glands, and blood vessels.
______17. Coronary artery disease can lead to a myocardial infarction or arrhythmia.
______18. Expiration is breathing “in,” and inspiration is breathing “out.”
______19. Osteoarthritis is an inflammatory disease of the joints believed to be an

autoimmune disease whereby the body produces specific proteins called
antibodies, which cause inflammation of a special membrane around the joints.
______20. Generally, problems within the endocrine system are due to one of two things:
either too little or too much of a hormone is produced.
______21. The organs of the immune system are connected with one another and with other
organs of the body by a network of lymphatic vessels similar to blood vessels.
______22. The ultimate goal of inflammation is to bring more help from the immune system
to destroy the invaders, remove the dead cells, and begin the process of tissue
healing and repair.
______23. Drugs called antiarrhythmics are commonly used to treat and prevent allergies.
______24. The pulmonary system terminates in single-layered cell structures called

bronchioles, where the exchange of gases takes place between the lungs and the
blood.
______25. Chronic obstructive pulmonary disease (COPD) includes two conditions known as
emphysema and asthma.
______26. Congestive heart failure (CHF) can be cured with lifestyle changes.
______27. Tachycardia is when the heart beats too fast.
______28. Only cardiac muscle exhibits pacemaker activity, the ability to initiate electrical
signals.
______29. Lower respiratory infections are those that occur in the oropharynx and larynx.
______30. Actin and myosin are responsible for making a muscle contract and relax.
______31. An individual suffering from hyperthyroidism can be treated with thyroid

hormone replacement.
______32. Diabetes insipidus is treated with insulin.
______33. Chronic renal failure can be cured with medication.
______34. Human immunodeficiency virus/acquired immune deficiency syndrome

(HIV/AIDS) is an airborne virus that spreads from sneezing or coughing.
______35. Glaucoma is a leading cause of blindness.
FILL IN THE BLANK

1. __________ is the study of body structure.
2. The heart is located in the center of the __________ cavity between the lungs and behind
the __________.
3. The skeleton is made up of __________ bones, each of which varies in size and shape.
4. The study of the collective functions and processes of the body systems is known as
__________.
5. The heart is separated into __________ chambers.
6. A portion of a clot that formed in a vein that travels to the lung is called a __________
__________. (two words)
7. __________ muscle is the primary muscle found in the internal organs of the body:
stomach, intestines, glands, and blood vessels.
8. When the heart beats too slowly, it’s called __________.
9. __________ is a disease of the lungs characterized by inflammation of the bronchioles,
increased mucus secretion, and abnormal contractions of the smooth muscles in the
bronchioles, which leads to the narrowing of the airway passages.
10. __________ is a condition that affects the bones, where the structure of the bone
changes from a dense and heavy structure to a thinner and lighter one because of a
loss of proteins and minerals such as calcium and phosphate.
11. Type __________ diabetes (previously known as juvenile diabetes) is characterized by a
lack of insulin production from the pancreas.
12. Type __________ diabetes is the most common type of diabetes, and it is characterized
as either decreased production of insulin or an abnormal sensitivity of the tissues to the
insulin that is present.
13. The body’s complex defense system, called the __________ system, provides constant
protection against invasion by foreign substances or organisms.
14. When the outermost layer of the eye and the inner eyelids become inflamed, the
condition called __________ occurs, commonly referred to as pink eye. It can be caused
by an allergic reaction or infection by a virus or bacteria.
15. The respiratory system regulates blood pH, and hyperventilation may cause respiratory
__________.
16. A __________ is an injury to a muscle or tendon.
17. An injury to a ligament is called a __________.
18. The condition of inflammation of the epidermis, causing patches of red, dry, or crusty
flaking areas that itch, is called __________.
19. HIV-AIDS, genital herpes, hepatitis C, human papillomavirus (HPV), genital warts,
chlamydia, gonorrhea, syphilis, trichomoniasis, and pelvic inflammatory disease are all
examples of __________.
20. In some men, especially those greater than 60 years of age, the prostate gland expands
so much that it presses against the urethra, causing bladder problems such as frequent
urination, a weak stream of urine, and urgency or leaking of urine. This condition is
called __________.
SHORT ANSWER
1. Describe the important functions of the kidneys.
2. Describe what triggers heart muscle contractions and heart rhythms, including the
systems involved.
CROSSWORD PUZZLE
Across:
3. A substance capable of causing the production of an antibody.
5. Waves of involuntary muscular contractions in the digestive tract. In the stomach, this
motion mixes food with gastric juices, turning it into a thin liquid called chyme.
6. The mental process of becoming aware of or recognizing an object or idea.
8. The study of how living organisms function normally, including such processes as
nutrition, movement, and reproduction.
9. Unhealthy function in an individual body system or an organ due to a disease.
10. An instrument for measuring blood pressure.
14. A structure on the surface of a cell (or inside a cell) that selectively receives and binds a
specific substance.
16. A state of unresponsiveness to a specific antigen or group of antigens to which a person
is normally responsive.
17. Reproductive organs; testes in the male, and ovaries in the female.
18. The process whereby ingested food is broken up into smaller molecules by chemical or
mechanical means.
Down:
1. To form and give off.
2. Occurs when the heart muscle is relaxed, and the chambers are filling with blood; the
pressure is at the lowest point in a normal heart.
3. A misdirected immune response that happens when the body attacks itself.
4. Occurs when the heart muscle is contracting and ejecting blood from the chambers of
the heart; the pressure is at the highest point in a normal heart.
7. These glands have no ducts; their secretions are absorbed directly into the blood. (two
words)
11. The hydrogen ion concentration in a solution/fluid.
12. A chemical substance produced in the body that controls and regulates the activity of
certain cells or organs.
13. The study of body structure.
15. The internal secretion of substances into the systemic circulation (bloodstream).
QUESTIONS CH 7
DRUG CLASSIFICATIONS AND
PHARMACOLOGIC ACTIONS
Learning Outcomes

■ Identify the common drug names for each classification.
■ Describe the important actions and/or therapeutic uses for the major classes of drugs.
■ Describe the most common or most serious adverse effects for the major classes of
drugs.
■ List special precautions for the major classes of drugs.
MULTIPLE CHOICE
______1. Antiepileptic drugs:

a. Are sometimes used for migraine prevention.
b. Are not used for seizures in patients who do not have epilepsy.
c. Are only used as monotherapy and not used in combination with other drugs.
d. Have relatively few adverse effects, so monitoring is not required.
______2. Which of the following is TRUE regarding the FDA-approved Medication Guide for
antiepileptic drugs?
a. MedGuides are required to be provided with new prescriptions but not refills.
b. If the patient is under 16 years old, the MedGuide is required to be given to a
parent or guardian.
c. The MedGuide includes a warning about the increased risk of suicidal
thoughts or behavior.
d. MedGuides are provided to prescribers to inform them to monitor patients for
unusual changes in mood or behavior.
______3. The goals for treatment of Parkinson’s disease (PD) include:

a. Complete remission of the disease (cure).
b. Keep the disease from progressing.
c. Maintain function and quality of life.
d. Decrease acetylcholine and decrease dopamine levels.
______4. Drug therapy for Parkinson’s disease is focused on:

a. Decreasing acetylcholine and increasing dopamine.
b. Increasing acetylcholine and decreasing dopamine.
c. Increasing acetylcholine and increasing dopamine.
d. Decreasing acetylcholine and decreasing dopamine.
______5. Alzheimer’s disease signs and symptoms include:

a. Uncontrollable tremors
b. High fever and rash
c. Memory impairment and behavioral changes
d. Muscle spasms and weakness
______6. Which of the following statements about multiple sclerosis (MS) is FALSE?
a. It is a progressive neurological disorder affecting the brain and the spinal cord.
b. Its onset is generally between the ages of 18 and 45 and often affects women
more than men.
c. In MS, the myelin sheath that covers neurons degenerates, causing a
disruption of nerve transmission.
d. Symptoms may include memory loss and confusion.
______7. Goals of headache therapy include all of the following EXCEPT:

a. Ability to maintain normal activities.
b. Provide quick relief of headache pain.
c. Reduce frequency of attacks.
d. Maximize the amount of medications needed.
______8. Neuropathic pain:

a. Is treated with opioid analgesics as first-line agents.
b. May be due to lack of stimulation of the nerve fibers.
c. May be due to nerve damage in the central or peripheral nervous system.
d. Is only treated with topical agents (creams or patches).
______9. First-line therapy of attention deficit hyperactivity disorder (ADHD) would include:
a. Atomoxetine
b. Bupropion
c. Venlafaxine
d. Methylphenidate
______10. The goal of treatment for hyperlipidemia is to:

a. Reduce low-density lipoprotein (LDL) levels and reduce high-density
lipoprotein (HDL) levels.
b. Reduce LDL levels and increase HDL levels.
c. Increase LDL levels and increase HDL levels.
d. Increase LDL levels and reduce HDL levels.
______11. Which of the following is FALSE about diuretics?

a. Thiazide diuretics are well tolerated by patients.
b. Blood glucose control in patients with diabetes may be altered by thiazide
diuretics.
c. Patients who are taking thiazide diuretics may be more sensitive to sun.
d. Thiazide diuretics are only used as monotherapy.
______12. Which is TRUE about angiotensin-converting enzyme (ACE) inhibitors?

a. ACE inhibitors may increase the incidence of kidney disease in diabetic
patients.
b. ACE inhibitors may increase survival in patients with heart failure.
c. ACE inhibitors have a “–sartan” ending on the generic name.
d. ACE inhibitors can lower both LDL and very low density lipoprotein (VLDL)
levels.
______13. Calcium channel blockers are used for:

a. Osteoporosis
b. Heart rhythm disturbances
c. Leg edema
d. Prevention of clot formation
______14. Which of the following is not a nitrate medication used for the treatment of
angina?
a. Isosorbide dinitrate tablets
b. Nitrofurantoin capsules
c. Nitroglycerin ointment
d. Nitroglycerin spray
______15. Which of the following medications is NOT a type of bronchodilator?

a. Beta2-agonists
b. Anticholinergics
c. Acetylcholine blockers
d. Methylxanthines
______16. Which of the following is a long-acting bronchodilator?

a. Montelukast
b. Levalbuterol
c. Salmeterol
d. Budesonide
______17. Which of the following is TRUE regarding inhaled corticosteroids?

a. They are to be avoided in children due to reports that they affect growth.
b. A fungus of the throat and mouth called “thrush” is a common side effect.
c. They are only used in combination products that include a bronchodilator.
d. They are primarily used for acute attacks to dilate airways, increasing air flow.
______18. Expectorants are controversial because:

a. They may not be used in combination with other medications.
b. They are very expensive compared to other remedies.
c. They are only approved for use in children.
d. There is little scientific evidence to show that they decrease the thickness of
phlegm.
______19. Which of the following is TRUE regarding nonsteroidal anti-inflammatory drugs

(NSAIDs)?
a. Only some of the NSAIDs may cause serious bleeding and ulcers in the
stomach.
b. NSAIDs can cure some inflammatory diseases such as bursitis and gout.
c. NSAIDs have antipyretic properties.
d. They are often inhaled in combination with bronchodilators to treat
inflammation of the airways.
______20. Which of the following is TRUE regarding muscle relaxers?
a. Cyclobenzaprine is superior to other muscle relaxers in efficacy.
b. Medications used as muscle relaxers do not cause psychological or physical
dependence.
c. Relatively few muscle relaxers cause sedation.
d. Diazepam, baclofen, and dantrolene are used for muscle spasticity.
______21. Due to the subjective nature of pain, the standard assessment of pain is
determined:
a. By the observation of the patient’s facial expressions.
b. By speaking to the patient’s spouse or caregiver.
c. By using a pain scale where the patient rates their own pain.
d. By evaluating the frequency of requests for medication to treat pain.
______22. Insulin:
a. Is the mainstay of treatment for many patients with diabetes insipidus.
b. May be given by subcutaneous or intravenous (IV) injection or by inhalation.
c. Requires a prescription.
d. Varieties all have the same onset of action but may differ in the length of time
(after the injection) that the effects last.
______23. The following is an antithyroid drug:

a. Propantheline
b. Propylthiouracil
c. Liothyronine
d. Pyridoxine
______24. Which of the following statements about antihistamines is NOT true?

a. Antihistamines reduce or prevent symptoms of allergic rhinitis.
b. Antihistamines are often included in cold products because of their drying
effects on mucosal secretions.
c. Antihistamines have been shown to effectively shorten the duration of the
common cold.
d. Newer antihistamines show less sedation than the older ones.
______25. Intranasal corticosteroids are:

a. Used for rhinitis and other allergic or inflammatory conditions of the nose.
b. Very effective agents due to immediate benefit.
c. Used frequently during the day due to the short duration of action.
d. Are effective when used “as needed.”
______26. The histamine-2 receptor antagonists (H2 antagonists):

a. Are the same as the proton pump inhibitors.
b. Block the same histamine receptor as the antihistamines used for allergic
conditions.
c. Are available for the oral route only and are available over the counter (OTC)
and by prescription.
d. May be used in drug regimens directed at eradicating H. pylori.
______27. Agents to treat inflammatory bowel disease (IBD) include the following EXCEPT:
a. Aminosalicylates
b. Immunosuppressive agents
c. Monoclonal antibodies
d. Aminoglycosides
______28. A common ophthalmic disease is:

a. Conjunctivitis
b. Otitis media
c. Osteoporosis
d. Endometriosis
______29. Which medication is commonly used both as an antiepileptic medication and for
the treatment of neuropathic pain?
a. amitriptyline (Elavil)
b. pramipexole (Mirapex)
c. lacosamide (Vimpat)
d. gabapentin (Neurontin)
______30. Which of the following drugs is used in the treatment of Parkinson disease?
a. chlorpromazine
b. diazepam
c. levodopa/carbidopa
d. lithium
______31. The medication fluoxetine may be used to treat:

a. Allergic reactions
b. Insomnia
c. Obsessive compulsive disorder
d. Hypertension
______32. Which of the following is classified as an HMGCoA reductase inhibitor?

a. atorvastatin
b. fenofibrate
c. ezetimibe
d. gemfibrozil
______33. Which of the following medications is considered a preventive medication for
migraine headaches when taken on a daily basis?
a. dihydroergotamine
b. sumatriptan
c. butalbital, acetaminophen, caffeine
d. propranolol
______34. Which antihypertensive medication can cause a dry cough?

a. lisinopril
b. metoprolol succinate
c. hydrochlorothiazide
d. pravastatin
______35. Which of the following medications can cause a blue-gray discoloration of the skin
as a side effect?
a. flecainide
b. vancomycin
c. amiodarone
d. diltiazem
______36. Which of the following statements regarding opioid analgesic medications is

FALSE?
a. Opioid medications are useful for the suppression of cough.
b. Opioid analgesics act on receptors located in the brainstem, spinal cord, and
limbic system of the brain to help control pain.
c. Opioid medications can cause respiratory depression.
d. Opioid medications have anti-inflammatory properties.
______37. Which insulin is a long-acting insulin that can be given once a day?
a. Insulin lispro
b. Insulin glargine
c. Regular insulin
d. NPH insulin
______38. Which anti-infective can be affected by dairy products?

a. fluconazole
b. acyclovir
c. clindamycin
d. tetracycline
______39. Which of the following medications is used as a first-line treatment for ADHD?
a. Adderall XR
b. Ativan
c. Paxil CR
d. Strattera
______40. Consuming spinach can affect the levels of which medication?

a. pravastatin
b. losartan
c. warfarin
d. budesonide
______41. A patient with osteoarthritis may use celecoxib (Celebrex). Which

pharmacological class does celecoxib belong to?
a. COX-2 inhibitors
b. Opioids
c. Selective serotonin reuptake inhibitors (SSRIs)
d. Monoclonal antibody
______42. Which of the following agents may be used to treat an asthma attack?
a. montelukast
b. mometasone
c. fluticasone
d. albuterol
______43. Which of the following is a BENEFIT of using metformin (Glucophage) in patients

with diabetes?
a. It may cause weight loss.
b. It may cause gastrointestinal (GI) side effects.
c. It may cause hypoglycemia (low blood sugar).
d. It may be used in patients with renal problems.
______44. Which of the following conditions is not treated with oral contraceptives?
a. Endometriosis
b. Acne vulgaris
c. Polycystic ovary syndrome
d. Gallbladder disease
______45. Which medication may be affected by the consumption of grapefruit?

a. atorvastatin
b. amoxicillin
c. enoxaparin
d. sumatriptan
______46. Nucleoside reverse transcriptase inhibitors and protease inhibitors are used to
treat which condition?
a. Cancer
b. Human immunodeficiency virus/ acquired immune deficiency syndrome
(HIV/AIDS)
c. Cardiac arrhythmias
d. Irritable bowel disease
______47. Which of the following is a BENEFIT of using a combination of chemotherapy

agents?
a. Combination therapy usually leads to lower response rates.
b. Combination therapy usually leads to a shorter period of remission compared
to therapy with a single agent.
c. Combination therapy often allows for lower doses of each medication, which
may decrease the incidence and severity of toxicity.
d. Combination therapy with lower doses of each medication is often less
expensive than single therapy.
______48. Which of the following medications is considered an oral Factor Xa inhibitor?

a. argatroban
b. fondaparinux
c. apixaban
d. dabigatran
MATCHING I
Match the following vitamins with their synonyms:
A. Vitamin A
B. Vitamin E
C. Vitamin B1
D. Vitamin B2
E. Vitamin B3
F. Vitamin B5
G. Vitamin B6
H. Vitamin B12
______1. Cyanocobalamin
______2. Niacin
______3. Pantothenic acid
______4. Pyridoxine
______5. Retinol
______6. Riboflavin
______7. Thiamine
______8. Tocopherol
MATCHING II
Match the drugs to the affected system, type, or action below (may be used more than
once).
A. Nervous system
B. Cardiovascular system
C. Respiratory system
D. Musculoskeletal system
E. Endocrine system
F. Gastrointestinal system
G. Urinary system
H. Anti-infectives
I. Hematologic system
J. Oncology/chemotherapy
K. Topical (eyes, ears, skin)
L. Nutritional or dietary supplement
______1. alteplase
______2. amlodipine
______3. anastrozole
______4. atazanavir
______5. atorvastatin
______6. bisacodyl
______7. carbamazepine
______8. carbamide peroxide/glycerin drops
______9. cefuroxime
______10. cetirizine
______11. cisplatin
______12. cyanocobalamin
______13. cyclophosphamide
______14. dabigatran
______15. desonide
______16. dextroamphetamine
______17. digoxin
______18. diphenoxylate with atropine
______19. donepezil
______20. Echinacea
______21. empagliflozin
______22. enoxaparin
______23. famotidine
______24. fluconazole
______25. fosphenytoin
______26. glatiramer acetate
______27. glipizide
______28. glucosamine
______29. imatinib
______30. insulin detemir
______31. levalbuterol
______32. levetiracetam
______33. levothyroxine
______34. lorazepam
______35. mesalamine
______36. methimazole
______37. methocarbamol
______38. methotrexate
______39. metoprolol tartrate
______40. ofloxacin
______41. ondansetron
______42. oseltamivir
______43. oxybutynin
______44. pantoprazole
______45. potassium chloride
______46. ramipril
______47. ropinirole
______48. salmeterol
______49. selegiline
______50. sertraline
______51. sumatriptan
______52. tetrahydrozoline
______53. tolterodine
______54. travoprost
______55. valsartan
TRUE OR FALSE
______1. Only some drugs have adverse effects.
______2. All drugs are toxic when more than the recommended dose is taken.
______3. The decision to use a drug therapy is made after weighing the benefits of the
drug against the risks involved with its use.
______4. Antiepileptic agents should not be discontinued abruptly.
______5. There may be differences in the bioavailability (extent of absorption) of the

antiepileptic generics versus brand name drugs, so patients should be closely
monitored when switching between products.
______6. Phenytoin IV must only be mixed in dextrose. If phenytoin is mixed with normal
saline, a precipitate will form.
______7. The most common agents used in MS patients are those to prevent relapses and
disease progression, and they have become known as the ABC therapy (i.e.,
Avonex, Betaseron, Copaxone).
______8. The most common side effects of interferon use for multiple sclerosis (MS) are
fever, chills, and muscle aches for 24 hours after injection.
______9. The most common class of medications used for the treatment of migraines is
narcotics.
______10. Antidepressant medications are often used in the treatment of neuropathic pain.
______11. The drugs used in the treatment of mood disorders work by altering the
neurotransmitters at the nerve junctions in the brain such as norepinephrine,
epinephrine, serotonin, and dopamine.
______12. Monoamine oxidase inhibitors are thought to be effective and safe

antidepressants because they have few drug or food interactions.
______13. Neuropathic pain may be due to nerve damage in the central or peripheral
nervous system.
______14. Drugs used for anxiety (anxiolytics) include SSRIs, benzodiazepines, serotonin–
norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and
buspirone (Buspar).
______15. One type of psychosis includes hallucinations and delusions.
______16. Benzodiazepines, when used long-term for anxiety, do not cause withdrawal
symptoms when stopped.
______17. Buspirone is effective when used on an “as needed” basis for anxiety.
______18. Omega-3 fatty acids, commonly found in fish oil, have been shown to reduce
triglyceride levels in patients with hypertriglyceridemia.
______19. The HMG-CoA reductase inhibitors are also known as “statins.”
______20. Loop diuretics are less potent diuretics and have fewer effects on electrolytes
such as sodium, potassium, chloride, calcium, and magnesium than the
thiazides.
______21. ACE inhibitors may slow or prevent the development of kidney disease in diabetic
patients and increase survival, alleviate symptoms, and decrease hospitalization
in patients with heart failure.
______22. ACE inhibitors have a –olol ending on the name.
______23. Steroid asthma inhalers are meant to treat an acute attack (i.e., “quick relief”).
______24. Patients with hypertension, heart disease, overactive thyroid, diabetes mellitus, or
an enlarged prostate gland should use caution if taking decongestants.
______25. Adequate calcium intake is essential for the prevention and treatment of
osteoporosis.
______26. All NSAIDs can cause serious bleeding and ulcers in the stomach.
______27. All muscle relaxants cause sedation.
______28. Opioid analgesics control pain, reduce inflammation, lower fever, and suppress
cough and diarrhea.
______29. Insulin can be given only by subcutaneous or IV injection.

______30. Oral hypoglycemic agents are used to lower blood sugar in Type 1 diabetes.
______31. Diseases of the thyroid gland include hypothyroidism (underproduction of thyroid

hormone) and hyperthyroidism (overproduction of thyroid hormone).
______32. Antihistamines often cause excitation, but a paradoxical reaction of drowsiness

rather than excitation is sometimes seen in children and the elderly.
______33. Diseases on or near the surface of the eye are most often treated with oral
medications.
______34. Because the antacid aluminum hydroxide commonly causes constipation and the
antacid magnesium hydroxide commonly causes diarrhea, these antacids are
combined to try to avoid either constipation or diarrhea.
______35. When treating nausea and vomiting, OTC medications are generally used first
before moving to prescription medications.
______36. Inflammatory bowel disease is usually controlled by the use of a single agent.
______37. Eye drops may have systemic effects.
______38. Many ophthalmic vasoconstrictors, or “decongestants,” are OTC and commonly

used to reduce redness in the eyes from minor irritations and may be used
indefinitely.
______39. Topical ear treatments are commonly used for conditions involving the middle or
inner ear.
______40. Oral contraceptives are used to prevent pregnancy, reduce the risk of stroke, and
alleviate symptoms of gallbladder disease.
______41. A woman is considered to have infertility problems after attempting to conceive

for over 3 years without success.
______42. Benign prostatic hypertrophy (BPH) is a non-cancerous enlargement of the

prostate gland that develops in older men and women.
______43. The severity, site, and source of infection; characteristics of the antibiotic; and
characteristics of the patient are all considered when an antibiotic is selected.
______44. Penicillin allergies are estimated to occur in 5 to 8% of the population and can be
fatal.
______45. Patients who are allergic to penicillin should not take the macrolides.
______46. Fluoroquinolones may be used for treatment of urinary tract infections,

respiratory infections, and gastrointestinal infections and as single-dose therapy
for some sexually transmitted diseases.
______47. Vancomycin is given intravenously or orally for the treatment of systemic

infections.
______48. There are published guidelines for the prevention and treatment of tuberculosis
(TB) to be used when no drug resistance is found or expected.
______49. Isoniazid used for TB infections may cause orange coloring in urine, sweat, and
tears.
______50. Herpes simplex virus causes the very painful symptoms of shingles and the
potentially serious cases of chicken pox in people with weakened immune
systems (e.g., children with leukemia).
______51. Anti-HIV antivirals have been developed that may be effectively used as
monotherapy.
______52. Liposomal amphotericin B formulations are less toxic to the kidneys and cause
fewer infusion-related adverse events when compared with conventional
amphotericin.
______53. Fluoroquinolones have a black box warning regarding potential serious side
effects.
______54. Colony-stimulating factors are used to increase red blood cells.
______55. OTC herbal formulations and vitamins are safe to use because they are natural
and have no interactions with prescription drugs.
______56. Because anticoagulants slow clot formation, the main concern with anticoagulant
therapy is excessive bleeding.
______57. Monoclonal antibody agents are only used for cancer and osteoarthritis.
______58. Fatigue and fruity breath are symptoms of ketoacidosis, which can lead to coma
or death.
______59. Treatment with an antibiotic that is started before culture and test results are
obtained is called “empiric” therapy.
______60. Fluconazole is an antifungal that is only available in IV form.
______61. Petit mal seizures are also known as tonic-clonic seizures.
______62. Akathisia means “restlessness” and is an extrapyramidal symptom.
______63. Tardive dyskinesia includes involuntary movements of the limbs, tongue

protrusion, rapid eye blinking, and lip smacking.
FILL IN THE BLANK

1. A neurotransmitter that can increase blood pressure and heart rate, and can also cause
vasoconstriction is __________.
2. __________ hypotension is a decrease in blood pressure upon standing.
3. A __________ is a chemical or drug that causes widening of the bronchi in the lungs for
easier airflow.
4. A __________ hemorrhage is a condition in which blood collects underneath the
membrane that covers the brain.
5. __________ is a decrease in platelets as well as red and white blood cells.
6. A decrease in the ability to inhale and exhale is called __________ __________. (2 words)
7. __________ is a dramatic decrease in white blood cells.
8. An __________ is a drug that when attached to a receptor produces an action.
9. __________ symptoms are a group of effects that include restlessness, muscle
contractions, and involuntary movements of the limbs, tongue protrusion, rapid eye
blinking, and lip smacking.
10. A narrowing of the bronchi in the lungs causing less airflow into the lungs is called
__________.
11. __________ is a neurotransmitter found in the brain and intestines that is responsible for
controlling mood and gastric secretions, and can also cause vasoconstriction.
12. __________ is a neurotransmitter in the brain that is responsible for movement and
speech.
13. A __________ is any substance that, when introduced into the body, alters the body’s
function.
14. __________ is a neurotransmitter that is released at the ends of nerve fibers in the
nervous system and transmits nerve impulse across other nerves or muscles.
15. __________ __________ (2 words) is a reaction that can occur from excessive levels of this
neurotransmitter in the body. The effects may include agitation, confusion, tremor,
seizures, fever, coma, and death.
16. A seizure characterized by jerking or twitching movements of the body is called a
__________ __________ seizure.
17. The general name for a substance that transmits nerve impulses from one nerve cell to
another is __________.
18. An __________ substance is used to prevent the spread of cells into surrounding tissue.
19. A swelling or fluid accumulation in the lower limbs is called __________ __________. (2
words)
20. __________ is the widening of the bronchi in the lungs to increase the amount of airflow
into the lungs.
21. An agent that blocks the action of the parasympathetic nerves is an __________.
22. An __________ therapy is added on to another therapy to assist or maximize therapy.
23. An agent that slows or blocks the action of a chemical reaction or an enzyme is an
__________.
24. An antibody that is cloned or genetically produced from a specific hybrid cell is called a
__________ __________. (2 words)
25. __________ is an increase in the diameter of a blood vessel to allow more blood flow
through the vessel.
26. Damage of nerves other than the brain and the spinal cord, such as in the feet, is called
__________ __________. (2 words)
27. When high blood sugar levels cause an excess of ketones in the body, it is called
__________.
28. Fixed beliefs that are false are called __________.
29. Hearing or seeing things that are not real is called having __________.
30. Immunity transferred to an individual artificially such as administering an immune
globulin is called __________ immunity.
31. __________ is inflammation of the heart muscle.
32. An irregular heart rhythm is called an __________.
33. Joint pain is called __________.
34. Immunity that is formed from the exposure to a disease or from a vaccine is __________
immunity.
35. __________ is the loss or impairment of normal motor function.
36. Low blood pressure is called __________.
37. __________ is muscle pain.
38. One therapy or sole therapy is called __________.
39. __________ seizures usually occur during childhood, last 5 to 10 seconds, and are
characterized by staring spells or excessive blinking.
40. Sensitivity to one substance that predisposes an individual to sensitivity to other
substances that are related in chemical structure is called __________ sensitivity.
41. Inflammation of the nasal lining is called __________.
42. __________ is slowed movement.
43. The suppression of white blood cell and platelet production from the bone marrow is
called __________.
44. To cough up or spit is to __________.
45. Treatment that is started based on experience without any cause identified is called
__________ therapy.
46. Weakness is called __________.
47. __________ __________ (2 words) is a condition of repetitive seizures with little or no
interruption between them.
48. The most common class of medications used for the treatment of migraines is the
serotonin 5-HT1 receptor agonists, or the __________.
49. __________ pain may be due to the persistent stimulation of nerve fibers or nerve
damage in the central or peripheral nervous system.
50. Many medications’ package inserts now contain a __________ __________ __________ (3
words), which is a strong warning about the medication that needs to be considered
carefully prior to prescribing the medication to a patient.
51. __________ antidepressants were the most widely used antidepressants for many years
and have the recognizable stem of “–triptyline.”
52. __________ disorder, also called manic-depressive disorder, is characterized by extreme
mood swings.
53. A mental disorder in which a person’s capacity to recognize reality is distorted is called
__________.
54. Memory loss, also called __________, is an adverse effect of some medications but is
desirable when these drugs are used for sedation during painful medical procedures.
55. The __________ decrease blood pressure by decreasing the blood volume.
56. The __________ are the most commonly prescribed medicines for treating angina
pectoris.
57. __________ are commonly used to suppress inflammation and the immune response,
which is useful in a wide spectrum of diseases, including asthma, allergic reactions,
lupus, ulcerative colitis, psoriasis, rheumatoid arthritis, bursitis, and organ
transplantation.
58. __________ is a disease that affects both women and men characterized by a loss of
bone, resulting in misshapen bone such as curvature of the backbone seen in the
elderly, or in easily broken bones.
59. Gentamicin, tobramycin, and amikacin belong to the drug class of __________
antibiotics.
60. A reaction referred to as Red Man Syndrome may occur if the drug __________ is given
too rapidly.
61. Cold sores and fever blisters are caused by the __________ __________ (2 words) virus.
62. __________ is the most commonly used oral anticoagulant.
63. Vitamin __________ may be given to reverse the effects of warfarin.
64. The primary mineral found inside cells is __________ and its imbalance adversely affects
cellular metabolism and nerve and muscle function.
SHORT ANSWER
1. Identify the common drug names, important actions and/or therapeutic uses, most
common or most serious adverse effects, and special precautions for drugs used to treat
diabetes mellitus.
common or most serious adverse effects, and special precautions for sedatives and
hypnotic drugs.
QUESTIONS CH 8
DRUGS AND THE BODY
BASIC BIOPHARMACEUTICS, PHARMACOKINETICS, AND
PHARMACODYNAMICS
Learning Outcomes

■ Define the study of biopharmaceutics.
■ List and describe the four major processes that make up the study of pharmacokinetics.
■ Describe factors that can alter the absorption of a medication.
■ Describe how medications are distributed within the body, including factors that affect
medication distribution in the body.
■ List and describe the two most common types of drug interactions.
■ Define pharmacodynamics.
■ Describe how medications are eliminated from the body, including factors (e.g., disease
states) that can increase or decrease elimination of a medication.
■ Define pharmacogenomics.
■ Describe the steps that must occur before a medication can exert its effect on the body.
■ Describe potential problems that can occur when a product formulation is disrupted or
when absorption, distribution, metabolism, or elimination is altered, and how these
alterations can affect the pharmacodynamics of a medication.
MULTIPLE CHOICE
______1. Pharmacokinetics is the study of the movement of a drug through the body
through the phases referred to as ADME. The phases are:
a. Administration, duration, metabolism, excretion
b. Absorption, disintegration, metabolism, elimination
c. Administration, dissolution, metabolism, excretion
d. Absorption, distribution, metabolism, excretion
______2. Which of the following is TRUE regarding bioavailability?

a. Drugs that undergo first-pass metabolism have close to 100% bioavailability.
b. Sublingual nitroglycerin has a higher bioavailability than oral capsules.
c. Intravenous (IV) medications typically have a lower bioavailability than oral
solutions.
d. The dose for IV administration of a medication is typically the same as the oral
dose because they have a similar bioavailability.
______3. Which of the following is subject to first-pass metabolism?

a. A sublingual tablet
b. A nasal inhalation spray
c. An oral suspension
d. A rectal suppository
______4. Examples of antibiotic medications, which are frequently monitored by measuring

the levels of the medication in the bloodstream, include the following EXCEPT:
a. Gentamicin
b. Tobramycin
c. Neomycin
d. Vancomycin
______5. Which of the following is TRUE regarding drug distribution in the body?
a. Medications absorbed in the bloodstream travel only to the site of action
where it exerts an effect and then is eliminated.
b. All medications are bound to blood proteins where it becomes activated.
c. Only the amount of drug that is free can leave the bloodstream to exert a
pharmacological effect.
d. The main protein in blood that binds medications is globulin.
______6. Pharmacokinetics is defined as the study of:

a. The manufacture of medications for effective delivery into the body.
b. The movement of a drug through the body.
c. The relationship between the concentration of a drug in the body and the
response or outcome observed or measured in a patient.
d. The way a person’s genetic makeup can impact drug levels and therapeutic
effects.
______7. Medications given intravenously are administered directly into the vein; therefore:
a. The medications are 100% bioavailable.
b. The dose is the same as medications given orally.
c. The dose given by IV must be much higher than doses given orally.
d. The medications are subject to first-pass metabolism.
______8. Metabolism:
a. Occurs only in the liver.
b. May occur in the small intestines.
c. Only occurs when the medication is a prodrug.
d. Is necessary for all medication in order to be excreted.
______9. The most common location of drug excretion in the body is the:
a. Liver
b. Kidneys
c. Intestines
d. Lungs
______10. Once a solid oral dose of medication has disintegrated, what is the next process it
must undergo to exert a pharmacologic effect?
a. Distribution
b. Dissolution
c. Elimination
d. Metabolism
______11. First-pass metabolism occurs in which of the following organs?

a. Pancreas and gallbladder
b. Kidneys and biliary tract
c. Liver and small intestine
d. Heart and lungs
______12. Medications are most commonly excreted by the:

a. Pancreas and gallbladder
b. Kidneys and biliary tract
c. Liver and small intestine
d. Heart and lungs
______13. Metabolism is accomplished by protein substances called:

a. Albumin
b. Enzymes
c. Prodrugs
d. Inducers
______14. Which of the following processes is most impaired in the presence of kidney
disease?
a. Disintegration
b. Distribution
c. Metabolism
d. Elimination
______15. Administering a drug by which of the following routes will likely result in the
greatest bioavailability?
a. Intravenous
b. Oral solution
c. Intramuscular depot injection
d. Oral suspension
______16. If a patient has liver disease and is taking a medication that is metabolized by the
liver to an inactive form before elimination, which of the following may result?
a. Drug accumulation and toxicity
b. Impaired drug absorption and low blood levels
c. Impaired metabolism and high blood levels
d. No change in pharmacodynamics
______17. An enzyme inhibitor may decrease the:

a. Metabolism of other medications
b. Absorption of other medications
c. Distribution of other medications
d. Bioavailability of other medications
______18. A patient is currently taking warfarin to prevent blood clots. Which of the
following may block the blood-thinning effects of warfarin?
a. Taking calcium or drinking milk along with the dose.
b. Drinking grapefruit juice.
c. Eating a large amount of kale.
d. Drinking red wine or eating aged cheese.
______19. A patient is taking the MAO inhibitor selegiline. Which of the following will cause
a reaction that may severely increase blood pressure?
______20. A patient is taking ciprofloxacin for an infection. Which of the following may
decrease the blood levels of the antibiotic?
c. Eating bananas and oranges.
______21. A patient with hyperlipidemia is taking simvastatin. Which of the following, along
with the simvastatin, may cause muscle aches and liver abnormalities?
d. Eating bananas and oranges
______22. A patient is taking captopril for her blood pressure. Which of the following, when
taken with the captopril, may greatly increase potassium levels?
c. Eating bananas and oranges.
______23. Drug binding to a is required to produce a clinical effect.

a. Enzyme
b. Receptor
c. Organ or tissue
d. Blood protein
______24. Medications must be used carefully:

a. In elderly patients because of increased metabolism of medications in the
liver.
b. In children by accurately determining the child’s age to determine a
proportionate dose.
c. In pregnant patients because drugs may be cleared through the kidneys faster
than normal.
d. When dosing topical medications because more drug is absorbed in elderly
patients than in younger patients.
MATCHING
Match the following terms to the descriptions below.
A. Absorption
B. Bioavailability
C. Biopharmaceutics
D. Clearance
E. Cytochrome P450 (CYP)
F. Disintegration
G. Dissolution
H. Distribution
I. Drug interaction
J. Elimination
K. Excretion
L. First-pass metabolism
M. Half-life
N. Loading dose
O. Metabolism
P. Metabolite
Q. Pharmacodynamics
R. Pharmacogenomics
S. Pharmacokinetics
T. Therapeutic level
U. Volume of distribution
______1. A breakdown product of a medication that has undergone metabolism.
______2. A group of enzymes that metabolize drugs.
______3. A larger first dose given to quickly achieve a high drug concentration in the body.
______4. The amount of medication that enters the bloodstream, or systemic circulation.
______5. The blood level at which most patients receive a medication’s desired effect with
minimal side effects.
______6. The breakdown of medication from its original solid formulation.
______7. The breakdown of medication in the body.
______8. The dissolving of medication into solution, usually in the stomach and intestinal
tract.
______9. The extent of a medication’s outreach to various tissues and spaces throughout
the body.
______10. The impact of a drug or food product on the amount or activity of another drug in
the body.
______11. The irreversible removal of a drug or metabolite from a body fluid.
______12. The metabolism of orally ingested medications by the liver and small intestine
before they reach the main bloodstream.
______13. The percentage of an administered dose of a medication that reaches the

bloodstream.
______14. The removal of a drug from the body, mainly in the urine or feces.
______15. The study of how a person’s genetic makeup can impact the pharmacokinetics
and pharmacodynamics of a drug.
______16. The study of the manufacture of medications for effective delivery into the body.
______17. The study of the movement of a drug through the body during absorption,
distribution, metabolism, and excretion.
______18. The study of the relationship between the concentration of a drug in the body and
the response or outcome in a patient.
______19. The time that it takes for 50% of a drug to be eliminated from the body.
______20. The total removal of the drug via metabolism and/or excretion from the
bloodstream per unit of time.
______21. The travel of the medication from the bloodstream to the target tissues to other
tissues.
TRUE OR FALSE
______1. Disintegration is the dissolving of medication into solution, usually in the stomach
and intestinal tract.
______2. Oral tablets must first undergo dissolution and then disintegration before the
medication can be absorbed.
______3. Some product formulations are disintegrated and dissolved more slowly than
others, which may affect the rate of onset of therapeutic effect.
______4. Medications given by IV have a slower onset of action because they must pass
through the liver first.
______5. Some injected medications dissolve slowly from the site of injection over a period
of time.
______6. Metabolites may be active or inactive.
______7. Some medications that are administered intravenously are metabolized (broken
down) before they reach the main bloodstream, which is referred to as first-pass
metabolism.
______8. The medication bound to blood proteins is active and exerts its pharmacologic
effect while it is bound to the protein.
______9. The therapeutic level for medications is the level at which most patients receive
the desired effect with minimal side effects.
______10. In general, medications with a large volume of distribution will have a lower blood
concentration, whereas medications with a small volume of distribution will have
a higher blood concentration.
______11. If a medication is widely distributed throughout the body and the prescriber
wants the medication to start working quickly, sometimes a loading dose of the
medication will be given to more quickly achieve a higher drug concentration in
the body.
______12. Most medications require a loading dose.
______13. Most drug metabolism occurs in the kidneys and biliary tract, although significant
metabolism can occur in the small intestine.
______14. The most common enzymes that metabolize drugs belong to a family of enzymes
called the cytochrome P450 (CYP) system.
______15. A “pro-drug” is where a drug is administered in an inactive form, which is

metabolized or converted to the active component.
______16. In pharmacokinetics, clearance refers to the amount of medication that enters the
bloodstream or systemic circulation.
______17. Drug binding to a blood cell is required to produce a clinical effect.
______18. Medications do not cross into breast milk so there is no need to alter therapy for
patients who are breast feeding.
FILL IN THE BLANK

1. __________ is the study of the manufacture of medications for effective delivery into the
body.
2. __________ is the main protein that binds medications in the blood.
3. In pharmacokinetics, the __________ of medication is the breakdown of medication in
the body.
4. A __________-__________ interaction is defined as the impact of a drug on the amount or
activity of another drug in the body.
5. The most common way to detect the presence of kidney disease is to measure blood
levels of __________, a substance that is normally produced in muscles and is cleared
from the body by the kidneys.
6. Common tests to detect __________ disease include measuring for alanine
aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, and albumin.
7. Medications that augment or enhance a signal normally communicated in a cell are
called __________.
8. The half-life of a medication is the time it takes for __________ of a drug to be eliminated
from the body.
9. An obese patient will have __________ concentration of a drug in the bloodstream than a
petite person when given the same dose.
10. __________ is the testing of a patient’s genetics to determine specific characteristics
such as enzyme systems that can predict how the patient will respond to some drugs or
have side effects from others.
11. Medications that block the transmission of a signal normally communicated in a cell are
called __________.
SHORT ANSWER
1. List the common formulations and routes of administration for medications.
2. Discuss why one formulation or route of administration would be used over another.
3. Describe why it is valuable for a pharmacy technician to become familiar with the basic
principles of biopharmaceutics, pharmacokinetics, and pharmacodynamics.
QUESTIONS CH 9
MEDICATION DOSAGE FORMS AND ROUTES
OF ADMINISTRATION
Learning Outcomes

■ Explain why medications are often available in more than one dosage form.
■ List three advantages of liquid medication dosage forms.
■ List three disadvantages of solid medication dosage forms.
■ Outline characteristics of solutions, emulsions, and suspensions.
■ Describe two situations in which an ointment may be preferred over a cream.
■ Explain the differences in use among solid medication dosage forms such as tablets,
capsules, lozenges, powders, and granules.
■ List six routes of administration by which drugs may enter or be applied to the body.
■ Identify special considerations for five routes of administration.
■ List five parenteral routes of administration.
■ Distinguish among sublingual, subgingival, and buccal routes.
MULTIPLE CHOICE
______1. A patch that delivers medication through the skin where it is absorbed by the
bloodstream and travels to the site of action has what type of effect?
a. Local
b. Remote
c. Systemic
d. Holistic
______2. Besides water, common vehicles for liquid dosage forms include the following
EXCEPT:
a. Alcohol
b. Glycerin
c. Mineral oil
d. Acetone
______3. Oral solutions:

a. Must be shaken before each use to ensure the medication is uniformly
dispersed.
b. Are absorbed more quickly than other oral dosage forms.
c. Will have suspended particles, which may make the solution cloudy.
d. Are those made only with water and a sweetener.
______4. Which is TRUE regarding syrups?

a. Their sweet taste completely disguises the unpleasant taste of any
medication.
b. Syrups contain medication suspended in a thick sugar vehicle.
c. Syrups may be plain sugar and water or may have added flavorings.
d. Because syrups are thick, they should not be used by a patient with a sore
throat.
______5. Medicated irrigants are used in the following EXCEPT:

a. To flush out debris from the eyes.
b. In the urinary bladder for treatment.
c. To cleanse open wounds.
d. Transdermally to administer medication.
______6. Which of the following dosage forms may be used for medications to be ingested
orally?
a. Collodions
b. Emulsions
c. Lotions
d. Ointments
______7. Which of the following is TRUE when considering medications used in pediatric
patients?
a. There is no concern about the alcohol content in elixirs given to infants
because it is such a small amount.
b. Children absorb much less medication through their skin so there is no
concern about systemic effects of medications applied topically.
c. It is better to use a tablet or capsule form of a medication rather than a liquid
in children to ensure the entire dose is administered.
d. A flavored oral solution or suspension is preferred for use in children to make
unpleasant-tasting medications more palatable.
______8. Glycerin:
a. Is used alone as a vehicle and not mixed with water or alcohol.
b. Solutions are typically very thin and watery.
c. Is used in oral, topical, and parenteral formulations.
d. Is added to oral formulations to slow the release of the medication.
______9. Solid medication dosage forms allow for delivery of medications by the following
routes EXCEPT:
a. Orally
b. Intravenously
c. Rectally
d. Vaginally
______10. Enteric-coated tablets:

a. Dissolve immediately in the stomach.
b. Are the same as film-coated tablets.
c. Should not be cut or crushed.
d. Are used for medications that should not dissolve in the intestine.
______11. Film-coated or sugar-coated tablets:

a. Protect the medication from exposure to air and humidity.
b. Protect the stomach lining by not dissolving until they reach the intestines.
c. Are harder to swallow than uncoated tablets.
d. Do not mask the smell of medications.
______12. Medications in effervescent tablet form:

a. Are swallowed whole and followed with a full (8 oz) glass of water.
b. Are slower acting than uncoated tablets once ingested.
c. Are only used in prescription formulations of medications.
d. Are absorbed quickly as the tablet is placed in liquid to dissolve before
ingesting.
______13. Caplets:
a. Are solid, capsule-shaped tablets.
b. Are always enteric coated for easier swallowing.
c. Are also known as lozenges or troches.
d. Should not ever be cut or crushed.
______14. Hard gelatin capsules:

a. Come in sizes with 000 being the smallest up to a 5, which is the largest.
b. Should never be cut, crushed, or opened.
c. Are only used for medications taken by mouth and swallowed.
d. Are not the same as caplets.
______15. Lozenges:
a. Are also known as troches.
b. Are only used for medications delivered to the mouth and throat.
c. Are placed in the mouth where they are chewed up and then swallowed.
d. Are only used for sore throat treatments.
______16. Which of the following is TRUE regarding suppositories?

a. They should never be refrigerated, or they will be too hard to melt when
inserted.
b. Should be coated with petroleum jelly (Vaseline) just prior to insertion to make
insertion easier.
c. Medications delivered in suppository form may be for local or systemic effects.
d. Suppositories are only used by inserting into the anus.
______17. Creams:
a. Are heavier than ointments and leave a residue on the skin.
b. Can be freely interchanged with the ointment form of the same medication
depending on the patient’s preference.
c. Soften the skin and may or may not contain medication.
d. Are not used for any OTC products.
______18. Types of solutions used to cleanse, wash, treat, or disinfect parts of the body or
body cavities include the following EXCEPT:
a. Wash or irrigant
b. Douche or enema
c. Spray
d. Syrup
______19. Enemas:
a. Are only used rectally.
b. Are only used to empty the large bowel prior to surgery.
c. Are commonly used to cleanse inside the vagina.
d. Are used primarily to deodorize and refresh.
______20. Which of the following is NOT TRUE regarding alcoholic solutions?

a. Also known as spirits or essences.
b. Contain volatile substances.
c. Some are used as flavoring agents.
d. Are only used as a vehicle for oral administration of medication.
______21. You have a patient with a prescription for 300 mg of a medication. The medication
comes in 500-mg tablets, an oral liquid, and a 200-mg suppository. Which of the
following options would be the most appropriate?
a. Fill for the 500-mg tablets and instruct the patient to crush the tablets and
take a little more than half the powder as the 300-mg dose.
b. Fill for the oral liquid and instruct the patient in how to measure the correct
volume that would contain 300 mg of the medication.
c. Fill for the suppositories and instruct the patient to cut some of the
suppositories in half length-wise and administer one whole and one half of a
suppository to get the 300-mg dose.
d. Give the prescription back to the patient and tell them the medication isn’t
available in 300 mg and they must return to the prescriber and get a
prescription for a different dose.
______22. Which of the following dosage forms would NOT be appropriate for a patient who
is unable to swallow solid food and is on a liquid diet?
a. Transdermal patch
b. Effervescent tablet
c. Alcoholic or hydroalcoholic elixir
d. Coated capsule
______23. Which of the following is TRUE regarding emulsions?

a. Emulsions are never given by the intravenous (IV) route.
b. Oil-in-water emulsions spread more evenly on skin than water-in-oil emulsions.
c. Oil-in-water emulsions wash off with water and do not feel greasy.
d. Unpleasant oily medications are formulated into water-in-oil emulsions to
mask the taste.
______24. Which of the following is NOT TRUE regarding gels?

a. Gels are commonly used for oral administration.
b. Some gels are formulated for topical administration of medications.
c. Gels are not used rectally or vaginally administered medications.
d. Gels have smaller-sized suspended particles than magmas or milks.
______25. Which of the following is TRUE?

a. There is less chance of contamination by bacteria in the bloodstream when
administering an IV medication than if the medication was administered
orally.
b. The effects of an intravenously administered drug may be more easily reversed
if too high a dose is given.
c. The IV form of a medication is generally less expensive and is more convenient
to administer than an oral liquid.
d. A drug given by IV is available to act faster than an orally administered
medication when used to treat serious conditions.
______26. A pharmacy technician reviews a prescription for 500 mg of an antibiotic to be

administered intravenously. This medication will be administered:
a. Into a vein
b. Into a ventricle of the heart
c. Into the urinary bladder
d. Under the skin
______27. Drugs that are to be administered through the mouth and swallowed are given by
the route.
a. Buccal
b. Sublingual
c. Oral
d. Transdermal
______28. Oral tablets contain ingredients in addition to the medication. These additional
ingredients may include any of the following EXCEPT:
a. Diluents and binders
b. Desiccants
c. Lubricants and colorants
d. Disintegrators
______29. Which of the following dosage forms is NOT required to be shaken before use?
a. Elixirs
b. Gels
c. Emulsions
d. Lotions
______30. Which of the following routes of administration refers to the administration of a

drug to the inside of the eye?
a. Intrapleural
b. Intravitreous
c. Intravenous
d. Intravesicular
MATCHING
A. Oral
B. Buccal
C. Sublingual
D. Subgingival
E. Enteral
F. Parenteral
G. Intra-arterial
H. Intra-articular
I. Intracardiac
J. Intradermal
K. Intrathecal
L. Intravenous
M. Intraventricular
N. Intravesicular
O. Intravitreal
P. Subcutaneous
Q. Intranasal
R. Ophthalmic
S. Otic
T. Percutaneous
U. Rectal
V. Topical
W. Transdermal
______1. Applied to skin or mucous membranes
______2. By way of the intestine
______3. Bypassing the gastrointestinal tract
______4. Immediately under the skin
______5. Inside the cheek

______6. Into a joint
______7. Into a vein
______8. Into an artery
______9. Into the ear
______10. Injected in the eye
______11. Applied to the eye
______12. Into the heart muscle
______13. Into the nose
______14. Into the space around the spinal cord
______15. Into the top layers of the skin
______16. Into the urinary bladder
______17. Into the ventricles, or cavities, of the brain
______18. Through the anus
______19. Through the mouth
______20. Through the skin
______21. Delivery across the skin
______22. Under the gums
______23. Under the tongue
TRUE OR FALSE
______1. Capsules are easier to administer to children because they are less messy than
syrups.
______2. A medication that does not dissolve well in water may be dispensed as an
aqueous solution.
______3. For a systemic effect to take place, absorption of the medication must occur.
______4. Liquid medications are always solutions.
______5. All liquid medications may be made palatable by adding flavors and sweetening
agents.
______6. Aqueous solutions can be injected into the bloodstream.
______7. Solid medication dosage forms are usually faster-acting than liquid medication
dosage forms.
______8. Medications may be absorbed into the bloodstream as very small particles
suspended in an aqueous vehicle.
______9. Like gargles, mouthwashes should be swallowed.
______10. Simple syrup contains sucrose, flavoring, and water.
______11. The only uses for enemas are to relieve severe constipation or to clean the large
bowel before surgery.
______12. Elixirs and spirits are examples of hydroalcoholic solutions.
______13. Elixirs should be avoided by alcoholics.
______14. Tablets that are enteric coated should not be crushed, chewed, or cut.
______15. Suppositories may treat local conditions in the immediate area of administration
or may exert systemic effects elsewhere.
______16. If it seems necessary to crush, chew, or cut an extended-release product, an

immediate-release formulation of the same drug should be used instead.
______17. Continuous infusions may be given by IV push.
______18. Medications given by the intramuscular (IM) route act just as quickly as
medications given intravenously.
______19. Subcutaneous (sub-Q) injections may be solutions or suspensions.
______20. The same volumes of medications may be administered by the IV, IM, or sub-Q
route.
______21. Medications formulated for IV administration may also be safely given intra-
arterially.
______22. Intrapleural means into the abdominal cavity.
______23. Intravesicular means into the heart ventricles.
______24. Transdermal or percutaneous administration of medication delivers drugs through

the skin.
______25. Rectal administration of medications may be in the form of solids, liquids,

suspensions, or aerosol foams.
______26. Medications administered vaginally only have local effects.
FILL IN THE BLANK

1. A __________ effect refers to an action of a medication that takes place at the area of
contact.
2. A __________ effect is the result of an action of a medication that affects the whole body
or takes place at a location distant from the medication’s initial point of contact.
3. __________ are mixtures of two liquids that normally do not mix.
4. A __________ is a solution held in the throat, and the patient gurgles air through the
solution then spits it out.
5. __________ tablets contain ingredients that bubble and release the active drug when
placed in a liquid.
6. When powders are wetted, allowed to dry, and ground into coarse pieces, the resulting
medication dosage form is called a __________.
7. __________ are mixtures of fine particles of an undissolved solid spread throughout a
liquid.
8. An oral __________ is used by swishing around in the mouth and then spitting out.
9. __________ are thick, viscous, gummy liquids composed of water that contains the
sticky, pulpy parts of vegetables.
10. __________ tablets are placed inside the pouch of the cheek and stick to the inside lining
of the cheek.
11. The oral route is abbreviated as __________.
12. __________ routes of administration bypass the gastrointestinal tract.
ALPHABET SOUP
For each of the abbreviations for medication dosage forms that slowly release a drug over a
period of time (below), indicate their meaning.
1. CD: ________________
2. CR: ________________
3. CRT: ________________
4. ER: ________________
5. LA: ________________
6. SA: ________________
7. SR: ________________
8. TD: ________________
9. TR: ________________
10. XL: ________________
11. XR: ________________
SHORT ANSWER
1. What are the advantages and disadvantages of liquid medications versus other dosage
forms?
2. Discuss the advantages and disadvantages of extended-release products.
3. Discuss the different technologies used to make a medication in an extended-release

form.
CROSSWORD PUZZLE
Across:
2. An emulsion in which small oil droplets (internal phase) are scattered throughout water
(external, continuous phase). (3 words)
4. A clear, sweet, flavored water-and-alcohol (hydroalcoholic) mixture to be taken by
mouth.
6. Administered into the abdominal cavity.
9. A patch that contains medication, which is absorbed through the skin into the
bloodstream, is called a __________ patch.
13. A fine powder or solution of a drug sprayed as a mist through the mouth into the
respiratory tract.
14. An emulsion in which small water droplets (internal phase) are spread throughout an
oil (external, continuous phase). (3 words)
16. A liquid solution that uses purified water as the vehicle for a medication is an __________
solution.
19. Administered into the sac that surrounds the lungs.
21. Very fine liquid or solid particles of medication suspended in a gas, packaged under
pressure, and shaken before use. The medication is released from the container as a
spray.
23. A liquid solution that uses a fluid other than water as the vehicle for medication is a
__________ solution.
24. A mixture of two liquids that normally do not mix, in which one liquid is broken into
small droplets (the internal phase) and evenly scattered throughout the other (the
external or continuous phase).
Down:
1. A semisolid solution that contains a high amount of liquid, usually water.
3. Injected directly into a large muscle, such as the upper arm, thigh, or buttock, and
absorbed from the muscle into the bloodstream.
5. A solution used to wash or cleanse part of the body such as the eyes, the urinary
bladder, open wounds, or scraped skin.
6. Administered into the uterus.
7. Administered through, or across, a mucous membrane.
8. Administered into the windpipe.
10. A water-based solution that is placed into a body cavity or against a part of the body
(e.g., the vagina) to clean or disinfect.
11. A solution that is pushed into the rectum to empty the lower intestinal tract or to treat
diseases of that area; often given to relieve severe constipation or to clean the large
bowel before surgery.
12. Administering a medication into the windpipe.
15. A concentrated preparation of material removed from dried plant or animal tissue by
soaking it in a liquid, which is then evaporated and leaves behind the parts that have
medical action; examples include extracts, tinctures, and fluid extracts.
17. A mixture of fine particles of an undissolved solid spread throughout a liquid or
sometimes a gas.
18. An evenly blended mixture of dissolved medication in a liquid vehicle.
20. A hard, disk-shaped solid medication dosage form that is held in the mouth and sucked
to release medication into the mouth.
22. A semisolid medication dosage form, applied to the skin or mucous membranes, which
lubricates and softens or is used as a vehicle for medication.
PART FOUR
Practice Basics
10. Communication and Teamwork

11. Processing Medication Orders and
Prescriptions
12. Pharmacy Calculations
13. Nonsterile Compounding and Repackaging
14. Aseptic Technique, Sterile Compounding,
and IV Admixture Programs
15. Medication Safety
QUESTIONS CH 10
COMMUNICATION AND TEAMWORK
Learning Outcomes

■ Describe the purpose of various types of communications that occur within pharmacy
practice settings, including the role of the pharmacy technician.
■ Distinguish between questions that a technician may answer and those that only a
pharmacist should answer.
■ List the basic elements of verbal and nonverbal communications.
■ Given a specific patient encounter scenario, compare and contrast effective and
ineffective communication skills.
■ Describe how to vary communication techniques to improve success when working with
special patient populations.
■ Describe the types of behaviors that pharmacy technicians should demonstrate to
promote effective working relationships with other healthcare team members.
MULTIPLE CHOICE
______1. A pharmacy technician is defined as:

a. An individual working in a pharmacy who can assist the pharmacist with all
tasks.
b. An individual working in a pharmacy who, under the supervision of a licensed
pharmacist, assists in pharmacy activities that do not require the professional
judgment of a pharmacist.
c. An individual working in a pharmacy who, under the supervision of a licensed
pharmacist, meets with patients and answers questions about medications.
d. An individual working in a pharmacy who operates the cash register and
answers the phone.
______2. It is important that pharmacy technicians develop good communication skills

because in the technician role, they communicate:
a. With patients when gathering information for the patient profile or answering
questions about the status of their prescriptions
b. When they engage in activities related to medication distribution and
inventory control
c. When participating in pharmacy practice management and administration
roles
d. All of the above
______3. Which of the following is NOT TRUE regarding pharmacists?

a. The pharmacist is responsible for ensuring the medication will not harm the
patient.
b. The pharmacist should communicate with patients in a manner that expresses
and demonstrates a caring attitude.
c. A goal of pharmacists is creating supportive conditions under which patients
can be encouraged to be successful through communication.
d. Pharmacy practice is stressful, and the pharmacist is not expected to always
remain in control of their feelings and emotions.
______4. If your patient is being negative and somewhat disrespectful, the most
appropriate way to handle the communication is:
a. By matching their attitude, because it will make them more comfortable if you
are communicating in the same way.
b. By remaining calm and courteous and determine what it is you can do to help
the patient, realizing they already don’t feel well and may have other things
on their mind.
c. By letting the patient know that they are acting inappropriately and ask them
to leave.
d. By using body language to communicate your disapproval of the patient’s
attitude—don’t smile and remain silent until they apologize.
______5. Which of the following is NOT TRUE regarding communication with patients?
a. Patients need to feel care and understanding and not feel like they are being
treated as objects.
b. Misinterpretation or misunderstandings can occur when underlying issues are
present.
c. Body language is an important part of communication.
d. Your personal grooming and hygiene do not play a role in effective
communication.
______6. To build a strong relationship with your patients,

a. Show an active interest in a patient’s concerns by interrupting them
frequently to engage in dialogue.
b. Empathize with your patient by making statements such as “I know exactly
how you feel,” even if that situation has not happened to you.
c. Always maintain a personal physical distance of at least 4 feet to show
respect.
d. Pay attention to body language and emotional signals and anticipate your
patient’s needs.
______7. Patients’ health-related personal issues that may affect communication include
which of the following?
a. Financial worries about the expense of treatment
b. Denial, fear, or grief regarding the diagnosis or disease
c. Social support availability
d. All of the above
______8. Which of the following is NOT TRUE regarding communication with patients?
a. A pharmacist counseling a patient includes verifying the patient understands
how the medication should be taken to prevent harm and achieve therapeutic
goals.
b. Pharmacists and pharmacy technicians need to communicate with patients in
a manner that expresses and demonstrates a caring attitude.
c. High-quality service is provided when better understanding of patient needs
and patient feelings are achieved.
d. The first person that a new patient—presenting a prescription to be filled at
the pharmacy counter—meets (and the first impression) is always the
pharmacist.
______9. Unprofessional behavior includes the following EXCEPT:

a. Engaging in a personal phone call that causes an inappropriate wait for the
patient.
b. Greeting a new patient by his or her first name instead of more formally
without first asking permission.
c. Acknowledging a patient when they arrive and letting them know you will be
with them shortly and then finishing your call with a clinic.
d. Sharing religious or ethnic jokes or comments when the patient has shared the
same first.
______10. Which of the following statements about professional appearance is NOT TRUE?
a. Wearing a professional identification badge is important.
b. Any type of clothing may be worn if the clothing is clean, free of stains, and
pressed. (Clothing must also be socially appropriate and adhere to the dress
code of the pharmacy.)
c. Hair needs to be appropriately groomed.
d. Personal hygiene must be observed.
______11. Which of the following is NOT TRUE regarding appropriate behavior?

a. Political comments that may be overheard by patients should be avoided
unless you know your patients share your same viewpoint.
b. Seemingly innocent comments about religion or ethnicity may cause offense
and are never acceptable.
c. Using mobile phones to access social media or make personal calls or texts is
discouraged, as this can distract the technician and contribute to errors by
decreasing concentration.
d. Inappropriate expressions such as lack of eye contact, eye rolling, and
grimacing, can undermine effective communication.
______12. Which of the following is NOT TRUE regarding communication?

a. When the goal of communication is clear, it can help shape the response and,
ultimately, the outcome of an encounter.
b. The pharmacy technician does not have control over circumstances facing a
patient.
c. The pharmacy technician does not have control over their response to a
patient.
d. The priority should be the well-being of the patient.
______13. Which of the following is TRUE regarding communication?

a. Personal physical distance from the patient when communicating is important.
b. Physical contact during communication is always welcome and is a sign of
caring.
c. Incorrect written communication is easily fixed and will not lead to any
significant consequences.
d. When communicating with other health professionals, it is acceptable and
expected that the interactions are less formal, such as using first names.
______14. How the patient hears and interprets the information or message:
a. Relies entirely on the words you say.
b. May be affected by body language and your vocal tone.
c. Is not affected by any preconceived attitudes or opinions if they are not
expressed verbally.
d. Is the same whether or not the patient perceives you care about them.
______15. The recipient’s response or reaction to your message:
a. Will be conveyed entirely verbally.
b. Should be used to determine if the message was understood and interpreted
correctly.
c. Will be delivered entirely by their nonverbal body language.
d. Is unimportant as long as the message you said was clear and correct.
______16. Strong communication skills help to:

a. Avoid misunderstandings.
b. Avoid interpersonal conflicts.
c. Ensure patient safety.
______17. Miscommunications in pharmacies could result in problems with:

a. Inventory control
b. Licensure maintenance
c. Employment
d. All of the above
e. None of the above.
______18. The goal of effective communication is to:

a. Ensure that the recipient party hears the same message, both in content and
intent, as the deliverer and that the intended result of that message is
achieved.
b. Ensure that the deliverer conveys to the recipient the required HIPAA
information.
c. Ensure that the recipient party understands the medication informational
sheets.
d. Ensure that the deliverer speaks the same language as the recipient.
______19. Patients may display confrontational behavior due to:

a. Financial worries
b. Grief
c. Terminal illness
d. All of the above
e. None of the above
______20. Because pharmacists are human beings just as patients are, pharmacists:
a. May express their anger to patients due to stressful work.
b. May expect to be viewed as objects just as patients are.
c. Can struggle with their personal lives and may share this with patients.
d. Must manage personal feelings while recognizing and considering the feelings
of their patients.
______21. Interpersonal communication involves a complex array of processes focused on:
a. Transmitting, receiving, and processing information
b. Talking, listening, and writing with others
c. E-mailing, tweeting, and blogging
d. Listening, hearing, and analyzing information
______22. Which of the following is an open-ended question?

a. “Do you want to talk to the pharmacist?”
b. “What allergies do you have?”
c. “You want a 90-day supply, right?”
d. “Will you wait for this?”
______23. Which of the following is a closed-ended question?

a. “Which health insurance do you have?”
b. “Would you like a month’s supply?”
c. “Which OTC products are you taking?”
d. “What’s the best phone number to reach you?”
______24. It’s a busy day in the community pharmacy, and you are waiting on a patient at
the counter who is picking up a new prescription. You are required to offer the
opportunity to be counseled by the pharmacist. The patient is in a hurry, you have
several customers waiting behind this patient, and the pharmacist is very busy,
on the phone with a prescriber and checking prescriptions. Which of the following
is the best way to communicate this to the patient?
a. Knowing that the patient is in a hurry, you say “You don’t want to wait for the
pharmacist to counsel you about this prescription, do you? She’s very busy,
and it might be a while.”
b. You simply ask, “Do you want a pharmacist to talk to you about this
prescription?”
c. You tell the patient to call back and ask for the pharmacist if they have any
questions.
d. Knowing that this is a new prescription for this patient, and that the
pharmacist has important information to review with the patient regarding the
medication and administration, you let the patient know that the pharmacist
will be able to talk to them about this prescription in a few minutes and
encourage them to wait.
______25. You have a patient whose first language is Spanish. You print the prescription
label and the drug information sheets in Spanish. This:
a. Ensures that the directions and drug information will be easily read and
understood.
b. Helps the patient appropriately use the medication and prevent medication
errors only if the patient can read that language.
c. Adequately addresses concerns about health literacy issues.
d. Eliminates the need for verbal medication counseling.
______26. Which of the following strategies or behaviors is NOT used to improve teamwork?
a. Hold yourself and other team members to the same standards.
b. Recognize the contributions of all team members.
c. Revisit discussions and decisions again and again after finalized.
d. Put the team goals ahead of your own interests and goals.
______27. You have an angry patient at the counter saying the pharmacy is incompetent,
there wouldn’t be this problem if he went to another pharmacy, and we should fill
his prescription now and let him be on his way. You show understanding and
caring and find out that the prescription is not ready because it is not covered by
his insurance plan. Which of the following would be the best way to handle this
patient?
a. Give him his prescription back and tell him to take it to another pharmacy; you
just want him out of the pharmacy as quickly as possible.
b. Tell him that the medication is not covered by his insurance and he will have
to go back to his physician and get a prescription for an alternative
medication; there’s nothing you can do.
c. Let the patient know that you must call the insurance company to get a prior
authorization to get the medication covered, or you must call the physician for
a new prescription.
d. Explain that either a prior authorization would need to be obtained to cover
the medication or that a prescription for a covered medication would need to
be obtained. Then ask the patient if he would like you to contact the insurance
company and his physician for him.
______28. Which of the following is NOT TRUE regarding working with patients?
a. Caregivers for terminal patients experience many of the same emotions as the
patient, and it is important to express support, care, respect, and
understanding to them as well.
b. Millennials are the fastest-growing population group and account for the
highest percentage of medication use requiring the most in-depth medication
management.
c. Elderly patients pose challenging communication issues including issues due
to changes in memory, attention span, vision, hearing, and mobility.
d. The consequences of poor communication in individuals with low health
literacy include poor health outcomes.
______29. It may be hard to identify patients with low general literacy (e.g., reading and
comprehension difficulties). Which of the following is TRUE regarding patients
with low literacy?
a. “Red flags” that may indicate the patient has low literacy include issues with
medication adherence, asking questions contained in patient information
handouts, and bringing family members or friends to fill out paperwork.
b. Verbal communication must include plain, nonmedical, and nontechnical
language.
c. Speak slowly, spend additional time, and use visual images to improve the
patient’s understanding.
______30. When communicating with patients with mental health illnesses,

a. It is not any more challenging than working with your other patients.
b. It’s easier if you ask closed-ended questions to determine their level of
understanding of health-related issues.
c. Genuine interest and concern should be exhibited using patient-centered
communication strategies.
d. Stereotyping mental health patients helps in developing appropriate
communication strategies given their specific type of mental illness.
MATCHING
The following statements should be matched with the type of response they represent.
A. Judgmental response
B. Advice-giving response
C. Quizzing response
D. Placating response
______1. “Oh, you shouldn’t worry so much about the length of time. Just shop around for a
while until it is ready, and try not to get yourself so worked up.”
______2. “You need to talk to the other patients who are waiting here. They will tell you
that we know more about medicine and the prescription-filling process than you
do.”
______3. “Think back to when you have picked up medication at other pharmacies. I don’t
believe that you have gotten it as quickly as we are going to give it to you.”
______4. “You seem to be the only one concerned about our ability to provide you with the
correct medication quickly. All our other patients really love us, and they don’t
seem to care about the wait.”
______5. “This medication is really not that expensive. I have seen much higher costs.”
______6. “You think this is expensive? Have you priced the cost of college lately?”
______7. “If you really think about it, most Americans waste more money in 1 month than
the cost of this medication.”
______8. “You really have no right to question our prices. I am sure that you have had to
make a living too.”
TRUE OR FALSE
______1. Effective communication strategies can help to prevent medication errors and
improve the quality of patient care.
______2. Developing effective communication skills will strengthen professional
relationships.
______3. If you are having a bad day, it is not very important to maintain a pleasant
attitude because your patients don’t always have a pleasant attitude—we’re all
human!
______4. When the goals of communication are clear, they help to shape the responses and
ultimately the outcomes of the encounters.
______5. Empathy is feeling sorry for the other person.
______6. Patient-centered care focuses on the patient’s role and responsibility in health-
related behaviors.
______7. Body movements or mannerisms can indicate one’s feelings or psychological

state of mind.
______8. Having strong communication skills helps avoid misunderstandings but does not
help avoid interpersonal conflicts.
______9. Communication is not as important for pharmacy technicians because they do not
typically interact with others when performing their daily job responsibilities.
______10. It is important for pharmacy technicians to develop effective communication skills

to strengthen professional relationships.
______11. Pharmacists and pharmacy technicians help ensure optimal and safe use of
medications.
______12. Effective communication with customers, patients, coworkers, and other health
professionals is only necessary when talking face-to-face.
______13. Communication occurs in many ways in a pharmacy including face-to-face,

telephone, email, and fax.
______14. Communication misunderstandings are easily remedied and rarely lead to any
serious consequences.
______15. Effective communication includes listening.
______16. One of the most important things to remember about verbal communication is
that “once it has been said, it can be taken back” because you can always explain
why you said what you said.
______17. When communicating using e-mail or social media, it is acceptable to use all
upper-case letters because this makes the message clearer.
______18. Aggressive behavior, in which an individual displays an overbearing or

intimidating attitude, can result in conflict and create a combative atmosphere
and a perception of disrespect.
______19. Open-ended questions are questions that can be answered with a simple “yes” or
“no.”
______20. Body language, tone of voice, and preconceived attitudes or opinions can all
interfere with the original message and result in a new, distorted message that
the receiver hears. This distorted message can sometimes be very different than
the intended message.
______21. Older patients generally have low general and health literacy skills.
______22. Sensitivity to cultural differences is not necessary because to be fair, everyone

should receive the same treatment.
______23. There is no excuse for patients to be hostile.
______24. Regardless of outward behaviors, patients need to feel that care and
understanding is being extended to them.
______25. If a patient has graduated from high school or college, it is reasonable to assume
that he or she has high health literacy.
______26. Use of e-mail, website portals, and even social media are becoming popular
methods for patients to communicate with their healthcare providers.
FILL IN THE BLANK

1. The statement, “You seem to be the only one concerned about our ability to provide you
with the correct medication quickly. All our other patients really love us, and they don’t
seem to care about the wait,” is considered a __________ response.
2. “Do you have any allergies to medications?” is considered a __________-ended question
3. The federal law that prohibits the disclosure of protected health information (PHI) to
anyone without the patient’s permission or outside of the process of providing patient
care is called __________.
4. When individuals collaborate or cooperate to accomplish a common goal, they are
demonstrating __________.
5. The ability of an individual to read and understand healthcare information is referred to
as __________ __________ skills. (2 words)
6. __________ patients are the fastest growing population group and account for the
highest percentage of medication use (both prescription and over-the-counter).
7. Rolling your eyes is a form of __________ communication.
8. When one displays __________, in which an individual is able to identify with and
understand another individual’s feelings or difficulties, a caring and trusting
relationship may be established.
9. An important part of communication is __________, where a technician can observe any
nonverbal communication, better understand the patient’s perceptions, and sense the
patient’s emotions.
SHORT ANSWER
1. Describe a situation in a pharmacy where a pharmacy technician would interact with a
patient. In this patient encounter scenario, compare and contrast effective and
ineffective communication skills using your knowledge of all forms of communication
(e.g., verbal, nonverbal).
2. Discuss the four types of responses that should be avoided and how these responses
might be perceived negatively by the patient, producing an undesirable outcome.
3. Teamwork is important in pharmacy. Disrespectful behavior of coworkers may result in

lack of teamwork, poor morale, resignations, and may even contribute to errors. Discuss
disrespectful behaviors in the workplace, including how they should be handled.
CROSSWORD PUZZLE
Across:
1. The reaction of a receiver on receiving a message.
7. __________ behavior is when an individual does not take an active role or lets others
make decisions.
9. Body movements or mannerisms that can be interpreted as conveying one’s feelings or
psychological state of mind. (2 words)
10. The exchange of messages by using means other than speaking to convey attitudes,
beliefs, and emotions is called __________ communication.
12. The act of giving full attention to the person conveying information.
16. Information, a point of view, or an idea that is being communicated.
17. __________ behavior is when an individual displays an overbearing or intimidating
attitude.
18. __________ communication is the transcribing information to paper or other medium for
transmission, such as email.
19. __________ __________ (2 words) questions can be answered by a simple “yes” or “no.”
Down:
2. An individual that is receiving medical or health treatment.
3. The responsible provision of drug therapy for the purpose of achieving outcomes that
improve a patient’s quality of life, which focuses on the patient’s role and responsibility
in his or her medication-taking and health-related behaviors. (2 words)
4. The individual who conveys a message to a receiver.
5. When an individual displays a confident attitude and expression of ideas and opinions,
it is called __________ behavior.
6. The transfer of information, knowledge, facts, wishes, or emotions from one source to
another.
8. The ability to read, understand, and act on healthcare information to make appropriate
decisions and follow instructions for treatment. (2 words)
11. A spoken message conveyed from a sender to a recipient is __________ communication.
13. The recipient of a message.
14. __________ __________ (2 words) questions require a response other than a simple “yes”
or “no”—designed to obtain as much information from an individual as possible.
15. A sharing of or identification with another person’s feelings or state of mind; the ability
to view feelings from the patient’s perspective, communicating acceptance or
understanding.
QUESTIONS CH 11
PROCESSING MEDICATION ORDERS AND
PRESCRIPTIONS
Learning Outcomes

■ Identify the components of a complete prescription or medication order.
■ Prioritize prescriptions and medication orders based on specific criteria.
■ Describe the necessary steps in processing a prescription or medication order.
■ List the information that is typically contained in a patient profile.
■ Identify the information that is necessary to make a medication label complete.
MULTIPLE CHOICE
______1. Medication orders should be prioritized on the basis of many factors, including
those below, EXCEPT:
a. The time the medication is needed
b. By the order in which the medication order was received (i.e., first in, first out)
c. The seriousness of the condition that is being treated
d. The urgency of the other medication orders waiting to be processed
______2. Steps involved in processing an order include:

a. Comparing the order against the patient’s existing medication profile.
b. Ordering the medication from the wholesaler.
c. Selecting, preparing, or compounding medication.
d. Scanning the medication barcode on administration.
______3. You receive a medication order with a sticker at the top bearing the patient’s
name and identification number. A method to verify that orders are marked with
the correct patient name is to:
a. Check to see that the order makes sense for the patient by comparing the
order against the patient profile.
b. Double-checking the patient’s date of birth.
c. Double-checking the patient’s medical record number.
d. Double-checking the patient’s room and bed number.
______4. Many computer systems offer alerts for:

a. Drug interactions
b. Therapeutic duplications
c. Drug allergies
d. Over or under the recommended dose
e. All of the above
f. None of the above
______5. Standardized schedules of drug administration are usually based on:

a. Physician orders
b. Pharmacy hours of operation
c. Nursing break times
d. The institution’s standard medication administration times
______6. You have received a medication order for 100 mg twice daily for a patient. The
usual dose for this medication is 10 mg. Which of the following is an appropriate
action to take?
a. Fill for the 10-mg tablets with the directions to take 10 tablets (100 mg) twice
daily.
b. Fill for the liquid form of the medication because 10 tablets would be difficult
to take, and calculate the volume needed for a 100-mg dose twice daily.
c. Compound the medication, making 100-mg capsules to be taken twice daily.
d. Bring the unusual dose to the attention of the pharmacist for clarification as it
may be an error.
______7. When multiple dosage forms of the drug are available, considerations in selecting
a dosage form may include:
a. Whether or not a patient can swallow tablets
b. Whether the patient would prefer to take a liquid medication
c. If the patient is unable to swallow and a rectal suppository would be preferred
d. All of the above
e. None of the above
______8. Many institutions have developed protocols in which the pharmacist is requested
to dose and monitor certain medications. Examples of pharmacist protocols
include:
a. Blood pressure medication dosing and monitoring
b. COPD medications dosing and monitoring
c. Aminoglycoside dosing and monitoring
d. PRN pain medication dosing and monitoring
______9. There are state-by-state variations regarding:

a. Who may receive a telephone order from a prescriber
b. If facsimile transmission is permitted for controlled substances
c. If e-prescribing is required
d. All of the above
______10. Which of the following pieces of information are required on both an outpatient
prescription and an inpatient medication order?
a. Patient’s address
b. Prescriber’s address and telephone number
c. Patient’s date of birth
d. Patient’s name
______11. Which of the following medications is often required urgently in a hospital

setting?
a. Docusate
b. Acetaminophen
c. Naloxone
d. Estrogen
______12. A thorough review of a well-kept patient profile in an outpatient pharmacy will
generally allow the technician to identify all of the following except:
a. Existing orders for the same medication
b. Allergies that may indicate that the medication should not be used
c. A disability, such as blindness, which requires special attention
d. Hair color and eye color
______13. Common screening options during a pharmacy- or nursing-operated

computerized order entry process in a hospital include all the following EXCEPT:
a. Insurance coverage
b. Therapeutic duplication
c. Dose range checking
d. Drug interactions with existing orders
______14. Which of the following statements about prescription labeling is NOT TRUE?
a. Some prescriptions require labeling beyond what will fit on the label itself.
b. Auxiliary labels are often used to clarify or elaborate on directions for use.
c. When you are dispensing two bottles of a medication, you only need to label
one bottle.
d. Most states have specific requirements about what information must be
included in prescription labeling.
______15. Which of the following best incorporates all recommended components of label
directions for outpatient use?
a. Take 1 tablet by mouth every 12 hours.
b. Take 1 tablet three times daily.
c. Take 1 tablet by mouth two times daily for 10 days.
d. Take 1 tablet by mouth every 4 hours as needed for pain for 3 days.
______16. Which of the following is NOT required on an outpatient prescription label for a
controlled substance?
a. Patient’s name
b. Prescriber’s name and DEA number
c. Prescription number and date filled
d. An expiration date or beyond-use date
______17. Information required in the patient profile for a patient at the outpatient
pharmacy includes the following EXCEPT:
a. Address and telephone number
b. Third-party insurance billing information
c. Allergies and diagnoses
d. Height and weight
______18. Which of the following is TRUE of hospital pharmacy dispensing automation?

a. Dispensing automation is only used as a decentralized system at the point of
care.
b. Decentralized automation is superior to centralized automation.
c. Both centralized and decentralized automation make dispensing more
efficient.
d. Institutions that use dispensing automation use it in a centralized setting OR a
decentralized setting but not both.
______19. When a filling label seems to indicate an error, which of the following would be an
appropriate initial action for the technician?
a. Alert the pharmacist that an error has been made.
b. Check the label against the original order to determine if an error was made.
c. Call the physician to clarify the order.
d. Fill the prescription to the best of your ability, and then clarify it with the
pharmacist.
______20. Which of the following is NOT TRUE regarding potential forged prescriptions in an
outpatient pharmacy?
a. Forged prescriptions may be paper prescriptions or phoned in.
b. A common forged prescription will have the quantity erased and rewritten or
altered.
c. Forged prescriptions may look legitimate because they are written on printed
prescription pads stolen from a prescriber.
d. A technician presented with a prescription that appears to be forged should
immediately call the police.
MATCHING
Indicate whether the information below is required in these locations (items may have
more than one answer):
A. Inpatient MAR
B. Outpatient prescription label
C. Neither
______1. Patient’s name
______2. Patient’s account number
______3. Patient’s birth date
______4. Patient’s allergies
______5. Brand drug name
______6. Route of administration
______7. Dosage form

______8. Dose/strength
______9. Frequency and duration of administration (if duration is pertinent; may be open-
ended)
______10. Indication for use of the medication
______11. Other instructions for the person administering the medication, such as whether
it should be given with food or on an empty stomach
______12. Prescriber’s name/signature and credentials
______13. Date the order was written
______14. Time the order was written
______15. Sex
______16. Height and weight
______17. Laboratory values, such as serum creatinine
______18. Room and bed number
______19. Quantity to be dispensed
______20. Number of refills to be allowed
______21. Substitution authority or refusal
______22. DEA number for controlled medications
ORDERING
Put the following steps in the correct order.
A. Compare the order to the patient profile in detail (e.g., appropriateness, allergies,
duplications).
B. Ensure the information is entered in the patient MAR (may be generated automatically).
C. Enter any comments, including physician special instructions.
D. Enter or select the medication, including dosage strength and dosage form.
E. Fill and label the medication.
F. Identify the correct patient record in the computer system.
G. Medication is dispensed for administration to the patient.
H. Perform a final check of the labeled medication.
I. Perform a review of the order for clarity and completeness.
J. Prioritize the order.

K. Receive a prescription medication order.
L. Schedule administration times.
1. ______
2. ______
3. ______
4. ______
5. ______
6. ______
7. ______
8. ______
9. ______
10. ______
11. ______
12. ______
TRUE OR FALSE
______1. Medication orders may be delivered to the hospital pharmacy via physical handoff
or pneumatic tube.
______2. The prescriber may fax prescriptions to the outpatient pharmacy.
______3. The patient may scan or fax prescriptions to the outpatient pharmacy.
______4. Medication orders for inpatients may be faxed or scanned to the pharmacy.
______5. Nurses and other healthcare providers record the times and dates of drug
administration to a patient in a medication administration record. These records
may be hard-copy (paper) or electronic.
______6. If information is missing from a medication order or an order is unclear, most

clarifications may be handled by the pharmacy technician.
______7. An order for phenylephrine, a medication used intravenously to maintain blood

pressure in critically ill patients, would usually receive priority over an order for
an orally administered vitamin.
______8. Medications ordered for the initial treatment of pain, fever, or nausea and
vomiting are generally high priority because of the desire to relieve the patient’s
discomfort.
______9. A patient’s account number never changes, but medical record numbers change
every time a patient is admitted to an institution.
______10. Prescribers should order drug products by brand name instead of generic name.
______11. Default time schedules may differ on some specialized nursing units.
______12. The last step in the order-entry process is generally an acceptance (also called
verification or validation) function in which the pharmacist verifies that the order
is correctly entered for the right patient and is clinically appropriate.
______13. If an inpatient is taking his medications brought in from home, there is no need to
enter these medications into the computer system since the patient will not be
charged for the medications.
______14. With CPOE, it is not necessary for a pharmacist to review and verify the order
before the medication is dispensed because the physician has entered the order.
______15. In all states, when a prescriber signs his or her name over the DAW signature line,
the medication must be dispensed by the outpatient pharmacy as written.
______16. In the outpatient setting, prescriptions are always filled in the order in which the
pharmacy receives them (i.e., first in, first out).
______17. As long as the correct drug is selected regarding medication name and strength,
it is not necessary to match the NDC number with the product dispensed,
especially when generic products are used.
______18. Unlike inpatient pharmacies, there are no formulary issues in the outpatient
setting.
______19. A patient’s medical record number or patient-specific account number are both
examples of a patient’s identification number.
______20. Any pharmacy technician who has worked in a pharmacy for a minimum of 2
years may receive a telephone prescription from a physician’s office.
______21. Generally, the first step when a prescription is received is a review of the
prescription for completeness and accuracy, and the second is to prioritize the
prescription in relation to the other work to be done.
______22. When searching for a medication name in a pharmacy computer system search
screen, typing fewer letters will result in a shorter list and is therefore less likely
to result in a mispicked item.
______23. Any suspicious prescription should be brought to the attention of the pharmacist
because it may be a forgery.
______24. Many hospitals have default times of the day associated with common dosing
frequencies.
______25. Patient identification is a significant concern in an outpatient pharmacy, because

the technician needs to make sure that medications are delivered to the correct
patient.
______26. An outpatient pharmacy generally has a single formulary that is used for all
patients, regardless of the third-party payer.
______27. Barcoding technology completely eliminates the chance of errors with regard to
medication administration.
______28. Special instructions for nurses may be included on a hospital medication label.
______29. In the outpatient setting, appropriate medication administration times must be

discussed with the patient or caregiver to ensure optimal benefit.
______30. In the case of an outpatient prescription with complex directions that won’t fit on
the label (e.g., “ii tid for 3 days, i tid for 3 days, i bid for 3 days, i qd for 3 days,
then dc”), it is acceptable to use the Latin abbreviations on the label as long as
they are explained to the patient.
______31. Inpatient pharmacies may become less efficient by implementing decentralized

dispensing automation, because filling functions are replaced by batch runs.
FILL IN THE BLANK

1. Electronic storage cabinets that secure and dispense medications near the point of care
are an example of __________ dispensing technology.
2. Typically, the term __________ __________ (2 words) refers to a physician’s written,
electronic, telephone, or verbal request for a medication in an inpatient setting.
3. The term __________ refers to a medication order on a prescription blank that is
transmitted in writing, via oral communication, or by electronic means to be filled in an
outpatient or ambulatory care setting.
4. Medication orders may be entered directly into the computer system by the prescriber,
which is commonly referred to as computer physician order entry, or __________.
5. The __________ is the part of the patient’s medical record in which the caregiver
(generally the nurse) documents when medications ordered for a patient are
administered.
6. The drug buspirone written as “busPIRone” is an example of a safety precaution
utilizing __________ __________ __________. (3 words)
7. Drug distribution devices placed in patient care areas are part of a __________
automation system.
8. Robotics is an example of automated dispensing products that are located in a
__________ location.
9. Robotics or carousel systems use __________ to identify medications accurately during
filling.
10. Most prescriptions are now electronically filed with a third-party payer at the time they
are entered into the pharmacy information system; this is called electronic claims
__________.
11. A label affixed to a drug product that alerts users to special handling or administration
concern is called an __________ label.
12. A __________ is a shorthand name for a drug product that facilitates faster computer
data entry.
ALPHABET SOUP
1. CPOE: ________________
2. MAR: ________________
3. eMAR: ________________
4. STAT: ________________
5. ASAP: ________________
6. QA: ________________
7. DAW: ________________
8. DNS: ________________
9. NDC: ________________
10. DEA: ________________
SHORT ANSWER
1. Identify the components of a complete inpatient prescription or medication order.
2. List the information that is typically contained in a patient profile of an inpatient.
3. Describe the process of medication administration and inventory management using a

decentralized automated dispensing model.
QUESTIONS CH 12
PHARMACY CALCULATIONS
Learning Outcomes

■ Explain why it is important to follow a standardized approach when using math in
pharmacy.
■ Convert between fractions, decimals, and percentages.
■ Convert between different systems of measurement.
■ Perform and check key pharmacy calculations, including the calculations needed to
interpret prescriptions and those involving patient-specific information.
MULTIPLE CHOICE
______1. When adding fractions, the three steps in the correct order are:
a. Reduce to the simplest fractions or mixed numbers, add numerators and
denominators, and express answer as a fraction and simplify.
b. Convert to common denominators, add the numerators, and reduce to the
simplest fractions or mixed numbers.
c. Convert to common numerators, add denominators, and reduce to the
simplest fractions.
d. Add numerators and then add denominators, express answer as a fraction, and
simplify.
______2. When multiplying fractions, the steps in the correct order are:
a. Convert to common denominators, multiply the numerators, express answer
as a fraction, and simplify.
b. Multiply the denominators, multiply the numerators, express answer as a
fraction, and simplify.
c. Convert to common numerators, multiply the denominators, express answer
as a fraction, and simplify.
d. Convert to common denominators, multiply numerators and denominators,
express answer as a fraction, and simplify.
______3. When subtracting fractions, the steps in the correct order are:
a. Reduce to the simplest fractions or mixed numbers, subtract numerators and
denominators, express answer as a fraction, and simplify.
b. Convert to common numerators, subtract the denominators, and reduce to the
simplest fractions.
c. Convert to common denominators, subtract the numerators, and reduce to the
d. Subtract the numerators, subtract the denominators, express answer as a
______4. When dividing fractions, the steps in the correct order are:
a. Convert to common denominators, divide the numerators, express answer as a
b. Invert the divisor, divide the denominators, divide the numerators, express
answer as a fraction, and simplify.
c. Invert the divisor, multiply the denominators, multiply the numerators, express
d. Convert to common denominators, divide numerators and denominators,
express answer as a fraction, and simplify.
______5. Percentage means per:

a. Each
b. 10
c. 100
d. 1000
______6. To convert a percentage to a number, move the decimal point:

a. One space to the left (5% = 0.5)
b. Two spaces to the left (0.1% = 0.001)
c. One space to the right (3% = 30)
d. Two spaces to the right (1% = 100)
______7. Which of the following is NOT TRUE regarding solving proportions?

a. Two ratios with the same units can be combined to create a proportion, or
statement of equality between the ratios.
b. If the units don’t match, the calculation may result in under-or over-dosing
your patient.
c. Write the units next to each number when solving and check that the units are
lined up correctly, with units in the first ratio’s numerator matching the
second ratio’s denominator.
d. You must convert mismatched units to matching units before solving.
______8. The standard units used in healthcare are:

a. Meter (distance), liter (mass), gram (volume)
b. Meter (distance), millimeter (mass), gram (volume)
c. Centimeter (distance), microgram (volume), milliliter (mass)
d. Meter (distance), liter (volume), gram (mass)
______9. One dram is used to represent:

a. 5 mL
b. 1 tablespoonful
c. 1.5 teaspoonful
d. 1 oz.
______10. Which of the following statements about BSA values is NOT TRUE?
a. BSA values are frequently used to calculate doses of chemotherapeutic
agents.
b. There is one formula that is used to calculate BSA.
c. Hospital computer systems will usually calculate the BSA value.
d. It is helpful to understand how the calculation is performed.
______11. When calculating days’ supply for an ophthalmic solution, assume 1 mL equals
drops.
a. 10
b. 15
c. 20
d. 25
______12. When mixtures are created by adding a solid to a liquid, the percentage strength
is measured in:
a. Weight in volume (w/v) or grams of drug per 1 mL of mixture
b. Volume in weight (v/w) or liters of drug per 100 grams of mixture
c. Weight in volume (w/v) or grams of drug per 100 mL of mixture
d. Volume in weight (v/w) or milliliters of drug per 10 grams of mixture
______13. The concentrations of very weak solutions are sometimes expressed as ratio
strengths. Ratio strengths are usually expressed as 1:something, where the units
are:
a. mg per L
b. g per 100 mL
c. g per L
d. g per mL
ORDERING I
Put the following in order from low to high:
C, I, L, M, V, X
1. ______
2. ______
3. ______
4. ______
5. ______
6. ______
ORDERING II
Put the following liquid measures in order from least to most.
12 oz.
15 mL
1 teaspoon
0.5 L
1 pint
2.5 L
1/2 gallon
1 mL
2 tablespoons
1 quart
6 oz.
1/2 cup
1. ______
2. ______
3. ______
4. ______
5. ______
6. ______
7. ______
8. ______
9. ______
10. ______
11. ______
12. ______
TRUE OR FALSE
______1. Fractions may lead to medication errors if the “/” is misread as a “1.”
______2. You should always indicate a trailing “0” to ensure the dosage is clear (e.g., 5.0).
______3. Numbers to the right of the decimal point represent whole numbers, and
numbers to the left of the decimal point represent quantities less than one.
______4. With respect to rounding, pharmacy numbers must be measurable and practical.
______5. The symbol μ has been used as an abbreviation for micro, but this is an unsafe
symbol because it can be confused with an “m.”
______6. You should always indicate a leading “0” before a decimal quantity for safety.
______7. The avoirdupois system is a Spanish system of mass that includes grams and
liters.
______8. Ideal body weight (IBW) is an estimate of how much a patient should weigh,
based on his or her height and gender, and is expressed as pounds.
______9. Body mass index (BMI) is a measure of body fat based on height and weight, and
is commonly used in medication calculations.
______10. Specific gravity is the ratio of the weight of the compound to the weight of the
same amount of water.
______11. Specific gravity is expressed in grams.

______12. In pharmacy calculations, specific gravity and density are used interchangeably.
______13. When calculating concentration percentages of medications, if the product does

not contain active ingredient, its concentration is 0%; if the product is pure active
ingredient, its concentration is 100%.
______14. Some pharmacy mixtures are created by adding two solids together. When this
occurs, the percentage strength is measured in weight in weight (w/w) or grams
of drug/10 grams of mixture.
______15. When the desired concentration of a product is not readily available, but
concentrations above and below the desired concentration are available, the
dilution method will help to determine how many parts of each strength should
be mixed together to prepare the desired strength.
______16. The apothecary system of measurement was originally developed in Greece for
use by physicians and pharmacists, and it used measurements such as the grain
and the dram.
______17. A percentage shows the relationship between two items.
SOLVE
1. Convert Roman numerals to Arabic:

a. MMCX
b. LXIV
c. CXVI
d. XVIII
e. CXXI
2. Convert Arabic numerals to Roman:

a. 57
b. 183
c. 14
d. 2306
e. 1305
3. Simplify these fractions:
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
4. Add these fractions:

a.
b.
c.
d.
e.
5. Subtract these fractions:

a.
b.
c.
d.
e.
6. Multiply these fractions:

a.
b.
c.
d.
e.
7. Divide these fractions:

a.
b.
c.
d.
e.
8. Convert these fractions to decimals (round to the nearest 1000th):

a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
9. Convert these percentages to decimals:

a. 45%
b. 2%
c. 0.01%
d. 4.35%
e. 62.5%
f. 0.9%
g. 0.45%
h. 5%
i. 98.5%
j. 0.003%
k. 0.83%
10. Ibuprofen suspension comes in 100-mg/5-mL strength. Solve the following:

a. How many mg are in 12.5 mL?
b. How many mL will you need for a dose of 150 mg?
c. How many mL is needed for a dose for a 15-kg child if the dose is 5 mg/kg?
d. How many mL is needed for a dose for a 22-lb. child if the dose is 10 mg/kg?
11. Amoxicillin suspension is available in 250 mg/ 5 mL. The prescription is written for 40
mg/kg/day divided to be given every 12 hours. Solve the following:
a. What is the total daily dose in mg for this 44-lb. child?
b. How many mL of suspension will this child need every 12 hours?
c. What is the amount of suspension you will need to prepare if this child is to take
amoxicillin for 10 days?
12. Convert the following:

a. 0.5 g into mg
b. 125 mcg into mg
c. 27.5 lbs. into kg
d. 75 kg into lbs.
e. 8 oz. into mL
f. 120 mL into teaspoons
g. 2 tablespoons into mL
h. 8°C into °F
i. 77°F into °C
j. 3:00 p.m. into 24-hour clock time
k. 2000 24-hour clock time into 12-hour clock time
13. Solve the following:

a. If 500 mg orally is given three times daily for 10 days, how many 250-mg tablets are
needed?
b. Insulin glargine is available as 100 units/mL in 3-mL pens. How long will one pen
last if the patient is using 30 units/day?
c. How many doses are in a 4-oz. bottle if a patient is taking 1 teaspoonful every
6 hours?
d. Hydroxyzine HCl injection comes in 50 mg/ 2 mL. How many 25-mg doses are in a
10-mL vial?
e. How many days will a 5-mL bottle of eye drops last using 1 drop in each eye twice
daily?
f. Ranitidine oral solution comes in 15 mg/mL. How many mL will be needed for a 30-
day supply dosing 150 mg twice daily?
g. How many mg of epinephrine are in 20 mL of 1:10,000 solution?
h. How many grams of dextrose are in a 500-mL bag of D5W?
i. How many grams of sodium chloride are in a 500-mL bag of normal saline?
j. How many mL of gentamicin 40 mg/mL will you need for a dose of 120 mg?
k. Potassium Chloride Oral Solution 20% contains 40 mEq of potassium chloride/15
mL. How many grams of potassium chloride are in 15 mL?
14. DEA numbers consist of 2 letters, 6 numbers, PLUS a check digit at the end. Check the
following DEA numbers, and indicate if the number is “valid” or “invalid.”
a. BW5031656
b. AR4365213
c. ME5152354
d. MM1024657
e. BA3518529
15. Calculate the following using alligation:
a. Prepare 500 mL of 7.5% dextrose solution. You have on hand 5% dextrose solution
and 50% dextrose solution. How much of each solution will you need?
b. Prepare 120 g of 25% urea cream. You have on hand 20% and 40%. How much of
each will you need?
16. Calculate the following regarding flow rates:

a. How many mL per minute will a patient receive if a 1000-mL bag of solution is
infused over 3 hours?
b. If you are infusing a solution at a rate of 4 mL/min, how long will it take to infuse a
500-mL bag?
c. A 220-lb. patient is to receive dopamine at 2 mcg/kg/min. You have a 250-mL bag of
D5W containing 400 mg of dopamine. What flow rate in mL/hour is needed?
17. Determine the BSA for a male patient who is 6′3″ and weighs 200 pounds.
18. Calculate the following patients’ IBW and determine if they are over or under their IBW:
a. Male, 6′3″, 200 lbs. IBW
b. Male, 5′10″, 150 lbs. IBW
c. Female, 5′3″, 160 lbs. IBW
d. Female, 5′0″, 145 lbs. IBW
SHORT ANSWER
1. Discuss BMI, IBW, and BSA.
CROSSWORD PUZZLE
Across:
2. The bottom number of a fraction, representing the total number of parts.
4. A French system of mass that includes ounces and pounds; the system of mass most
commonly utilized in the United States is called __________ the system.
6. __________ numerals are represented as 1, 2, 3, etc.
8. An estimate of how much a patient should weigh based on his or her height and
gender; expressed in kg. (3 words)
12. In the hospital setting, this term describes the way medications are packaged
individually. (3 words)
14. Numbers represented as I, V, X, etc. are called __________ numerals.
15. A part of a whole number, used to express quantities less than one or quantities
between two whole numbers.
16. Relating to or denoting a system of numbers and arithmetic based on the number ten,
tenth parts, and powers of ten.
17. The amount of medication dispensed for a specified time period.
18. The top number of a fraction, representing the number of parts present.
19. A ratio expressed as 1:something, where the units are g per mL, is called the ratio
__________.
Down:
1. The most widely used and accepted system of measurement in the world, which is
based on multiples of 10, is called the __________ system.
3. A combination of two ratios with the same units; a statement of equality between two
ratios.
5. A representation of the relationship between two items.
7. The total surface area of the body, taking the patient’s weight and height into account
and expressed in m2. (3 words)
9. A way to help determine how many parts of each strength should be mixed together to
prepare the desired strength is called the __________ method.
10. A system of measurement commonly used in cooking including the teaspoon, the
tablespoon, and the cup is called the __________ system.
11. A system of measurement originally developed in Greece for use by physicians and
pharmacists but now largely replaced by the metric system is called the __________
system.
13. A measure of body fat based on height and weight, used to determine if a patient is
underweight, of normal weight, overweight, or obese. (3 words)
QUESTIONS CH 13
NONSTERILE COMPOUNDING AND
REPACKAGING
Learning Outcomes

■ Define compounding.
■ Describe the steps involved in the nonsterile compounding process.
■ Describe the equipment commonly used when compounding nonsterile preparations.
■ Identify the types of nonsterile preparations commonly compounded.
■ Explain the concept of and reasons for repackaging medications.
■ Explain the importance of record keeping for compounding and repackaging.
MULTIPLE CHOICE
______1. Compounding is often associated with several specialty practice areas, including:
a. Veterinary medicine
b. Dermatology
c. Hormone replacement therapy
d. All of the above
______2. Which of the following is TRUE regarding nonsterile compounding?

a. Nonsterile compounding requires a separate pharmacy license.
b. An estimated 1-3% of all prescriptions filled in community pharmacies are
compounded.
c. Compounding is frequently performed because it is cheaper than using a
commercially available product.
d. Compounding is the same as manufacturing and must meet the same
standards.
______3. Which of the following is NOT TRUE regarding the compounding environment?
a. Must have adequate space for the orderly placement and storage of
equipment and support materials.
b. Must have carpet or cushioned mats to prevent fatigue.
c. Must have controlled temperature and lighting.
d. Must be kept clean to prevent cross contamination.
______4. Examples of container choices for compounded preparations to maximize stability

should take into consideration the following, EXCEPT:
a. If the container is translucent so you can see the quantity remaining
b. Whether the medication is light sensitive
c. If the medication binds to the container
d. If the container is tight closing to protect from moisture and humidity
______5. Things to consider for determining beyond-use dates include whether:

a. The medication is aqueous or nonaqueous
b. A technician or a pharmacist compounded the mixture
c. The medication is comprised of legend medications
d. If the medication is a controlled substance
______6. Each step of the compounding process should be documented in order to:
a. Allow another individual to subsequently reproduce the same formulation.
b. Accurately calculate charges for billing.
c. Look for ways to improve efficiency.
d. Use the documentation instead of performing a final verification before
dispensing.
______7. Which of the following is TRUE regarding safety?

a. As long as you’re wearing gloves, you do not need to refer to the Safety Data
Sheets (SDS) for the ingredients.
b. Using garb such as gloves, facemask, and head covering is only necessary to
protect the product from contamination.
c. You only need a clean lab coat and gloves if you are compounding a hazardous
drug.
d. SDS must be readily available to all employees in the pharmacy.
______8. The compounding record is the log of an actual compounded preparation or batch
being prepared and includes the following, EXCEPT:
a. Manufacturer and lot numbers of the active and inactive ingredients used
b. The date of preparation and an internal identification number
c. The name of the pharmacist in charge at the time the preparation was
compounded
d. The names of the individuals who prepared, performed in-process checks, and
performed the final verification of the preparation
______9. Common nonsterile preparations compounded in a pharmacy include the

following, EXCEPT:
a. Creams and ointments
b. Oral solutions and suspensions
c. Powders and granules
d. Suppositories
______10. When using a graduate, it is recommended:

a. To use glass graduates rather than plastic graduates.
b. To use conicals rather than cylinders.
c. To use the smallest one that will hold the volume to be measured.
d. To always measure the liquid twice to ensure accuracy.
______11. Regarding levigation agents,

a. Mineral oil is always used because of its versatility.
b. Glycerin is always used because it has no effect on the final product.
c. Compatibility in the final preparation is considered in the selection.
d. Any moisturizing substance may be used, since only a small amount is
needed.
______12. The main task of an ointment mill is to:

a. Blend the various ingredients.
b. Fill ointment tubes efficiently.
c. Keep the compounding area clean.
d. Reduce particle size in preparations.
______13. Which statement is FALSE regarding beyond-use dates (BUDs) for a compounded
preparation?
a. A BUD is calculated from the date the preparation is compounded.
b. A BUD is the same as an expiration date.
c. A BUD is to be included on all compounded preparations.
d. A BUD is the date after which a compounded preparation is not to be used.
______14. Examples of nonsterile compounded preparations include all the following,

EXCEPT:
a. Analgesic suppository
b. Antibiotic ophthalmic suspension
c. Antibiotic otic suspension
d. Hormone vaginal cream
______15. Which statement is TRUE regarding inactive ingredients?

a. Preservatives are considered an active ingredient.
b. Excipients are also known as therapeutic ingredients.
c. Sweeteners are an example of an inactive ingredient.
d. Inactive ingredients cause a pharmacological response.
______16. Which statement is TRUE regarding repackaging records?

a. Repackaging records are only kept for inventory purposes.
b. Repackaging records are used instead of final verification by visual inspection.
c. Repackaging records are useful for quality-control purposes.
d. Repackaging records may be destroyed once the medication supply has been
dispensed.
______17. Which of the following is NOT TRUE regarding compounding suppositories?

a. The base is first melted, and then the active ingredient is added.
b. There are a variety of suppository molds available in different sizes.
c. Once poured into the mold, the suppositories are put immediately into the
refrigerator or freezer to harden.
d. Suppositories must be formulated to remain solid at room temperature and
melt at body temperature.
______18. Which of the following is TRUE regarding lozenges and troches?

a. Medications in lozenges and troches are released when the patient chews
them.
b. After the base is melted, the rest of the active and inactive ingredients are
added.
c. Lozenges and troches are hard, small, medicated squares.
d. Once the compounded mixture is poured in the mold, it is immediately
refrigerated or put in the freezer to harden.
______19. A disadvantage to using repackaged medications is:
a. It’s more inefficient to use unit-dose packages than simply pouring the
medication out of a bulk bottle.
b. Unit-dose packaging is less safe because the printing on the packages is
small, and this increases errors in administration.
c. The cost of repacking in-house, which includes equipment, supplies, and labor.
d. Unit-of-use packaging makes inventory control more difficult due to the
increased number of medications to be kept as floor stock.
______20. Which of the following is NOT TRUE regarding repacking equipment?

a. Equipment used may be manual, semi-automated, or automated.
b. There are more repacking systems for liquid medications than for oral solids.
c. Blister packs or pouches are used for tablets and capsules.
d. Semi-automated systems for repacking liquids typically use either a
volumetric or peristaltic pump.
MATCHING I
Identify the following as being a sterile or a nonsterile compound.
A. Sterile compound
B. Nonsterile compound
______1. Eye drops
______2. Nasal allergy spray
______3. Ear drops
______4. Antibiotic cream
______5. Wound irrigation solution
______6. Oral suspension made from tablets
______7. IV antibiotic
______8. Capsules
______9. Lozenges
______10. Suppositories
______11. Eye ointment
______12. Nebulizer solution
MATCHING II
Match the inactive ingredients to their purpose.
A. Suspending agent
B. Sweetener
C. Preservative
______1. Acacia
______2. Acesulfame potassium
______3. Alcohol
______4. Aspartame
______5. Benzalkonium chloride
______6. Carbomer
______7. Carboxymethylcellulose sodium
______8. Carrageen
______9. Cellulose
______10. Glycerin
______11. Methylparaben
______12. Potassium sorbate
______13. Saccharin
______14. Sorbitol
______15. Sucrose
______16. Xanthan gum
ORDERING
A. Compound the preparation.
B. Document/complete the compounding record.
C. Assemble equipment, materials, ingredients, and packaging needed, and garb

appropriately.
D. Calculate the amount of each ingredient needed for the preparation.
E. Label the final preparation appropriately.
F. Properly clean and store all equipment used in compounding the preparation.
G. Retrieve the master formula and start a compounding record.
1. ______
2. ______
3. ______
4. ______
5. ______
6. ______
7. ______
TRUE OR FALSE
______1. When pharmacies compound both sterile and nonsterile preparations, the
compounding area for sterile preparations is also used for compounding
nonsterile preparations.
______2. If a patient needs a drug that has been withdrawn from the market by the FDA,
the patient should ask a compounding pharmacy to order the ingredients and
compound the medication.
______3. Preparations should contain at least 90%, but not more than 110%, of the labeled
active ingredient, unless more restrictive guidelines apply.
______4. To be as efficient as possible, several similar preparations may be compounded at

one time in the compounding area if the compounding personnel are
experienced.
______5. Patient counseling is not required for compounded medications.
______6. Because they do not cause pharmacologic activity, inactive ingredients are not a
necessary part of the product, and the specific chemicals used as excipients do
not need to be named in the formula.
______7. Once a class A torsion balance is calibrated, it does not need to be recalibrated as
long as it remains on a stable and solid surface.
______8. The bottom of the meniscus should be read at counter level.
______9. Wedgewood mortars are preferable when mixing liquids or preparing solutions,
suspensions, or lotions, adding flavoring oils and coloring.
______10. An ointment slab or ointment paper may be used for preparing and mixing
creams and ointments.
______11. Numerous capsule sizes and colors are available for human and veterinary use.
Sizes of capsules for humans range from No. 000 to No. 5. No. 000 is the smallest,
and No. 5 is the largest.
______12. Extemporaneous repackaging is also known as “just-in-time” packaging.
______13. End-product testing is performed for all repackaging processes.

______14. Peristaltic pumps need less recalibrating than volumetric pumps and are more
accurate and reliable for delivering fluid volumes of less than 10 mL.
______15. A compounding method of incorporating a solid into an ointment by adding an

agent to the powder to form a paste, which is then incorporated into the
ointment, is called trituration.
______16. A non-reusable container designed to hold a quantity of drug to be administered

as a single dose is called a prescription vial.
______17. An ingredient that is necessary to prepare the formulation but is not intended to
cause a pharmacologic response is called an active ingredient.
______18. Compounding equipment used to measure the volume of liquid ingredients is

generally referred to as torsion or electronic.
______19. Compounding technique used to ensure the uniform mixing when there is a wide
discrepancy in amounts of individual ingredients is called geometric dilution.
______20. Compounds prepared in a pharmacy using strict aseptic technique including

preparations such as injections, ophthalmic solutions, and irrigation solutions are
called sterile compounds.
______21. The ingredient in the compounded preparation that is responsible for the
therapeutic or pharmaceutical action of the medication is called an excipient.
______22. The act of mixing powders or crushing tablets using a mortar and pestle until a
state of fine, evenly-sized particles is achieved is called geometric dilution.
______23. The active pharmaceutical ingredients used in compounding must meet purity
and safety standards such as USP, NF, or FCC (Food Chemicals Codex).
______24. When commercially manufactured products are used (e.g., tablets) in

compounding, the excipients must be taken into account for compatibility when
assessing the formula.
______25. Unit-dose packaging is not the same as single-unit packaging.
FILL IN THE BLANK

1. The United States Pharmacopeia (USP) offers guidelines and an enforceable set of
standards describing procedures and requirements for compounding in Chapter
__________ (Pharmaceutical Compounding–Nonsterile Preparations).
2. __________ is defined in USP-NF as “the extent to which a preparation retains, within
specified limits, and throughout its period of storage and use, the same properties and
characteristics that it possessed at the time of compounding.”
3. Solutions contain one or more ingredients and are made from a solid that __________ in
the liquid.
4. The __________ date is the date after which a preparation is not to be used and is
calculated from the date it was compounded.
5. It is important for suspensions to be __________ before use.
6. Each step of the compounding process should be documented. USP General Chapter
<795> requires pharmacies to maintain a formulation record, also known as the
__________ __________, (2 words) and a compounding record for each compounded
preparation.
7. The __________ is the natural curvature of the surface of the liquid, and it is lower in the
middle than at the edges.
8. Mixing powders or crushing tablets by moving the pestle in a circular motion in the
mortar until a state of fine, evenly-sized particles is achieved is termed __________.
9. The __________ is a unique three-segment number that is used to identify a specific drug
product.
10. __________ are the steps in the repackaging process that are crucial to ensuring a high-
quality package.
SHORT ANSWER
1. Discuss the considerations when choosing a mortar and pestle for compounding a
mixture.
2. Discuss beyond-use dating and labeling requirements for repackaged medications.

CROSSWORD PUZZLE
Across:
2. Pumps that allow the user to preset a volume to be dispensed into a container based on
the drawback setting are called __________ pumps.
3. Usually takes place in a pharmacy and includes the preparation, mixing, packaging,
and labeling of a small quantity of a drug based on a practitioner’s prescription or
medication order for a specific patient.
8. An individual record (like a recipe) for a preparation. It includes a listing of the
ingredients, compounding equipment, and instructions for preparing the compound
and is called the __________ __________ record. (2 words)
9. __________ packages, often called “bubble packs,” are composed of a plastic bubble that
forms a cavity for the medication. The package is then sealed with a backing material.
13. The natural curvature of the surface of the liquid, lower in the middle than at the
edges.
14. Ingredient in the compounded preparation that is responsible for the therapeutic or
pharmacologic action of the preparation is called the __________ ingredient.
15. A __________ __________ (2 words) package is a non-reusable container designed to hold
a quantity of drug to be administered as a single dose.
19. __________ __________ __________ (3 words) packaging is characterized by a vial, an
envelope, or a plastic bag containing several doses of the same medication.
20. A compounding method of incorporating a solid (i.e., powder) into an ointment. A small
amount of an agent is added to the powder to form a paste, which is then incorporated
into the ointment.
21. An __________ ingredient is an ingredient that is necessary to prepare the formulation
but is not intended to cause a pharmacologic response.
22. The extent to which a preparation retains, within specified limits and throughout its
period of storage and use, the same properties and characteristics that it possessed at
the time of compounding.
23. __________ pumps are pumps with a series of roller wheels that press against tubing to
force a volume of liquid down the length of the tubing.
24. The log of an actual compounded preparation that was prepared is called the __________
__________. (2 words)
Down:
1. Glass or plastic cylinders and conicals used to measure the volume of liquid
ingredients.
4. __________ __________ (2 words) is the preparation of a medication individualized for a
specific patient that requires the mixing of ingredients in a pharmacy and is based on a
prescription or drug order.
5. Compounding technique where the preparer starts with the smallest ingredient
amount and mixes it with an equal amount (estimated by sight) of the next smallest
ingredient amount and continues adding and doubling the size until all ingredients are
integrated. (2 words)
6. __________ repackaging is the repackaging quantities of medications that will be used
within a short period of time.
7. The act of mixing powders or crushing tablets using a mortar and pestle until a state of
fine, evenly-sized particles is achieved.
9. The periodic repackaging of large quantities of medications in unit-dose or single-unit
packages. (2 words)
10. The steps in the repackaging process where certain steps and processes are double-
checked are called __________ __________ (2 words), and they are crucial to ensuring a
high-quality package.
11. A date that is given to a compounded preparation or repackaged medication, noting
when it should no longer be used by the patient. (3 words)
12. Occurs in licensed facility and includes the production, conversion, and/or processing of
a drug in bulk quantities without a prescription or medication order.
16. __________ compounds are prepared in a pharmacy using strict aseptic technique.
17. The compounding log for a batch, usually filed by lot number. (2 words)
18. __________ compounds are prepared in a pharmacy and do not require strict aseptic
technique.
QUESTIONS CH 14
ASEPTIC TECHNIQUE, STERILE
COMPOUNDING, AND IV ADMIXTURE
PROGRAMS
Learning Outcomes

■ Define and explain key elements of USP General Chapters <797> and <800>.
■ Explain how proper aseptic technique improves patient safety.
■ Outline the equipment and devices needed for compounding sterile products.
■ Describe how sterile compounding is impacted by infection control processes, including
use of proper gowning and use of personal protective equipment.
■ Describe the difference between stability and sterility and how they both affect beyond-
use dating.
■ Differentiate between the handling requirements for nonhazardous and hazardous
medications.
■ Document the sterile compounding process appropriately.
■ Describe the components and benefits of having a formal intravenous admixture
program.
MULTIPLE CHOICE
______1. IV administration of medications is beneficial because:

a. There is a delayed onset of action.
b. Patients who are unconscious can be medicated.
c. An allergic reaction to IV medications is less severe.
d. There is less chance of infection when giving IV medications.
______2. Infection from IV administration of medications may be due to contamination

during:
a. Preparation
b. Administration
c. Improper storage
d. All of the above
______3. The concentration of heparin used in heparin locks is usually:

a. 1 unit/mL or 10 units/mL
b. 10 units/mL or 100 units/mL
c. 100 units/mL or 1000 units/mL
d. 1000 units/mL or 10,000 units/mL
______4. The final filter constitutes the entire back portion of the hood’s work area, and
this filter is called a:
a. High-efficiency particulate air or HEPA filter
b. Horizontal exhaust pressure area or HEPA filter
c. Hazardous elimination processing activator or HEPA filter
d. Laminar airflow filter (LAFF)
______5. It is advisable to work with objects at least __________ inches from the sides and
front edge of the hood without blocking air vents, so that unobstructed airflow is
maintained between the HEPA filter and sterile objects.
a. 4
b. 6
c. 8
d. 10
______6. When a LAFW has been turned off and is turned back on, it should be allowed to
run for a minimum of __________ minutes before it is used to blow the nonsterile
air out of the LAFW work area.
a. 10
b. 15
c. 30
d. 60
______7. Before use, all interior working surfaces of the laminar flow workbench should be
cleaned with sterile __________% isopropyl alcohol or other appropriate
disinfecting agent and a clean, lint-free cloth.
a. 50
b. 70
c. 90
d. 99
______8. The side walls of the hood should be cleaned in a(n):

a. Side-to-side direction, starting at the HEPA and working toward the outer edge
of the hood
b. Side-to-side direction, starting at the outer edge and working toward the HEPA
filter in the hood
c. Up-and-down direction, starting at outer edge and working toward the HEPA
filter in the hood
d. Up-and-down direction, starting at the HEPA and working toward the outer
edge of the hood
______9. Parenteral drug solutions should:

a. Contain pyrogens.
b. All be sterility tested before administration.
c. Be free of particulate matter.
d. All be stored at room temperature.
______10. The space between the HEPA filter and the sterile product being prepared is
referred to as the:
a. Hot spot
b. Backwash zone
c. Zone of turbulence
d. Critical area
______11. All manipulations inside a LAFW should be performed at least __________ inches
inside the front sill of the hood to prevent __________.
a. 2; backwash
b. 6; backwash
c. 10; contamination
d. 12; turbulence
______12. Before working in the LAFW that has been unplugged,

a. The hood should be operated for at least 15 minutes.
b. You only need to clean off the deck if the LAFW was off for less than an hour.
c. You must perform a full clean of the interior surfaces of the hood.
d. The interior surfaces should be wiped with sterile 70% isopropyl alcohol.
e. You only need appropriate garb and glove as the hood is in a sterile room.
______13. Items inside a LAFW should be placed away from other objects and the walls of
the hood to prevent:
a. Zones of turbulence
b. Accidentally knocking them over
c. Windows of contamination
d. Laminar airflow
______14. To ensure sterility of a new needle,

a. The user should make sure the package was intact and not damaged.
b. Wipe the needle with 70% isopropyl alcohol to disinfect it.
c. Apply additional silicone so the needle self-sterilizes on insertion into a vial.
d. Only touch the needle while wearing gloves.
______15. To prevent core formation when entering a vial diaphragm:

a. The needle should be inserted straight into the vial diaphragm, so the bevel
tip enters first and then the rest of the bevel.
b. The smallest needle that will accommodate the product being drawn up
should be used.
c. Needles should be inserted quickly before a core is formed.
d. The needle should be inserted with the bevel tip first, then pressing downward
and toward the bevel so the bevel tip and heel enter at the same point.
______16. Ampules differ from vials in that they:

a. Are closed systems.
b. Require the use of a filter needle.
c. Can be used for both solutions and suspensions.
d. Are typically plastic where vials can be plastic or glass.
______17. Labels for IV products:

a. May be labeled with the patient’s room and bed number in lieu of their name.
b. Are not required to show the flow rate if it’s hooked up to a programmed smart
pump.
c. Are only required to contain the patient’s name and the medication name.
d. Should be in a format that is consistent and easily understood.
______18. Preservatives in parenteral products:

a. Kill organisms and therefore eliminate the need for aseptic technique and
LAFWs.
b. Are in every parenteral product as they are nontoxic and do not react with
medications.
c. Are present in multidose vials of medications.
d. Should be used in epidural dosage forms to ensure sterility.
______19. Which of the following is an IV system that uses a threaded drug vial screwed into
a corresponding receptacle on an IV bag?
a. Drug-o-matic
b. Luer-lock system
c. Add-Vantage ®
d. LVP
______20. Chronic contact with cytotoxic drugs has the potential to cause:
a. A latex allergy
b. A positive test for tuberculosis
c. An electrolyte imbalance
d. Possible impaired fertility or cancer
______21. Protective apparel for those preparing cytotoxic or hazardous injections in a BSC
includes:
a. A solid front gown with two pairs of chemo-certified gloves
b. A full face-piece self-contained respirator with hood
c. An elastomeric full mask respirator
d. A “bunny suit” full protective coverall with a hood
______22. After a cytotoxic agent is prepared in the pharmacy, delivery:

a. Should be done immediately so it is at the nursing station ready to administer
at a later time.
b. May be done by anyone in the pharmacy as long as they are wearing
chemotherapy gloves.
c. Should be expedited with systems, such as pneumatic tubes, to minimize
personnel handing the cytotoxic medication.
d. Includes the transporter being trained in handling hazardous drugs,
containing spill management.
______23. Contents of a Chemo Spill Kit should include the following EXCEPT:
a. Gloves and mask
b. Goggles
c. A blood draw kit to use on personnel who may have been exposed
d. A disposable gown
______24. An example of an electrolyte added to a TPN solution to meet metabolic needs

and correct deficiencies in a patient is:
a. Amino acids
b. Potassium chloride
c. Vitamin D
d. Lipid emulsions
______25. What is the difference between a 3-in-1 and a 2-in-1 TPN?

a. 2-in-1 is lipids and electrolytes
b. 3-in-1 TPNs are premade
c. Lipids are included in a 3-in-1 TPN
d. 3-in-1 is protein, electrolytes, and dextrose
______26. After leaving the nonhazardous compounding area, all PPE must be discarded and
not used again except for:
a. Masks
b. Gowns
c. Hair nets
d. Shoe covers
______27. TPN solutions are typically given through a

a. Central IV line
b. Hand vein
c. Piggyback system
d. Syringe
______28. Which PPE item would be specifically worn in a negative pressure environment?
a. Gown
b. Sterile gloves
c. Chemo gloves
d. Shoe covers
______29. When donning sterile chemo gloves, how should the cuffs be placed?
a. The first pair must be under the cuff of the chemo gown.
b. Both pairs must be under the cuff of the chemo gown.
c. Both pairs must be over the cuff of the chemo gown.
d. Cuffs should be at the edge of the gown and not overlapping.
______30. End-product evaluation by the pharmacist includes the following EXCEPT:

a. Container and closure integrity (leaks)
b. Particulate matter
c. Temperature
d. Color and cloudiness
______31. Which of the following is NOT TRUE regarding process validation?

a. It is a method for evaluating the aseptic technique of personnel.
b. It includes media-fill testing where normal processes are performed using
growth media instead of medications and then incubated to detect any
contamination.
c. It includes gloved-fingertip testing to test both garbing and aseptic technique.
d. It is only required when microbial contamination of sterile compounded
preparations is detected.
MATCHING
Match the ingredients of a TPN to the correct general class; some general classes will be
used more than once.
A. Carbohydrate
B. Electrolyte
C. Lipid
D. Protein
E. Vitamin
F. Trace element
______1. 10% fat emulsion
______2. Calcium gluconate
______3. MVI
______4. Sodium chloride
______5. Amino acids
______6. Biotin
______7. Copper
______8. Dextrose
______9. Folic acid
______10. Iodine
______11. Magnesium sulfate
______12. Phytonadione
______13. Potassium phosphate
______14. Selenium
______15. Thiamine
______16. Pyridoxine
______17. Zinc
TRUE OR FALSE
______1. Particulate matter in IVs may include microscopic glass fragments, hair, lint, or
cotton fibers.
______2. Phlebitis is an irritation of the vein, which may be caused by too fast a rate of
administration.
______3. USP Chapter <795> defines practice standards regarding the preparation of
sterile compounds.
______4. A clean room that contains a BSC for hazardous compounding should be a
negative pressure environment.
______5. It is permissible to touch any part of the syringe while making sterile products as
long as you are wearing sterile gloves and are working inside a hood.
______6. Prior to compounding a product for parenteral administration, one should gather
the supplies anticipated for the entire shift and place them in the LAFW.
______7. A clean room that contains only LAFW should be a positive pressure environment.
______8. IVs may be administered to patients at home by their families rather than by
nurses.
______9. When drugs are injected directly into the body, the body’s barriers to infection are
bypassed.
______10. Drug incompatibilities may involve other drugs, containers, or solutions.
______11. Extravasation is a very minor problem, seldom causing any complications.
______12. When an IV solution is sterilized, pyrogens are removed.
______13. Nothing should be permitted to come in contact with the HEPA filter.
______14. Only those objects essential to product preparation should be placed in the LAFW
such as paper, pens, and labels.
______15. Jewelry may be worn on the hands or wrists when working in the LAFW as long as
appropriate clean room attire completely covers all exposures.
______16. Rings can be worn when working in the LAFW if they are entirely smooth and
cleaned with sterile 70% isopropyl alcohol.
______17. Every entry into a sterile product area should include full washing and garbing,
even if you just stepped out for a moment.
______18. If you are only entering the buffer room to check a technician’s work, you only
need to don shoe covers, hair cover, and gown.
______19. Due to their toxicity, solutions with preservatives should not be used for epidural
or intrathecal dosage forms and should only be used with caution in pediatric or
neonatal preparations.
______20. To withdraw the solution from an ampule, a needle with a 5-micron filter in the
hub should be used for both withdrawing contents and expelling contents.
______21. All hazardous drugs should be identified by distinctive labels, indicating that the
product requires special handling.
______22. Precipitation may occur if the wrong sequence or concentrations of electrolytes

are added to an IV bag.
______23. Heparin locks are used to maintain catheter access to a vein without having to
run a continuous drip to keep the vein patent or unobstructed.
______24. LAFWs should be tested and certified by qualified personnel every 12 months,
whenever the hood is moved, or if filter damage is suspected.
______25. All IV admixture programs should have a quality assurance program to ensure
that products and services are of desired quality.
______26. Hazardous drugs as well as contaminated and trace-contaminated garb and

cleaning materials may be disposed of in the regular trash as long as the bags are
sealed before being removed from the negative pressure hazardous room.
______27. All areas where hazardous drugs are stored should be marked clearly as
containing HDs. Access to these areas should be limited to authorized personnel
who have been trained in handling HDs.
______28. Cleaning requirements of HD compounding areas includes four steps:

deactivation, decontamination, cleaning with a detergent, and being sanitized
with sterile 70% isopropyl alcohol.
FILL IN THE BLANK

1. A type of catheter that offers some of the benefits of both central and peripheral
catheters and is threaded through the venous system and its tip ends near the heart is
called a __________ catheter.
2. It is called __________ when the IV catheter punctures and exits the vein under the skin,
causing drugs to infuse or infiltrate into the tissue.
3. __________ are the by-products or remnants of bacteria, and they can cause reactions
(e.g., fever, chills) if injected in large enough amounts.
4. __________ is irritation of the vein, and it may be caused by the IV catheter, the drug
itself due to its chemical properties or its concentration, the location of the IV site, the
rate of administration, or the presence of particulate matter.
5. Another term for a small volume parenteral IV is __________.
6. Two commonly used permanent catheters are the __________ and the __________.
7. The term __________ __________ (2 words) is used to refer to pumps designed to alert the
user to an infusion setting that does not match a facility’s drug administration
guidelines, where the medication’s infusion parameters (e.g., dose, dosing unit
[mcg/kg/min, units/hr, etc.], rate, concentration) can be safely chosen with notification
for doses that fall outside the recommended range .
8. A device for medication infusion that is similar in concept to a water balloon inside a
plastic bottle where the balloon is filled with drug solution—and the pressure of the
container forces it through the tubing, eliminating the need for a separate pump—is
called a(n) __________.
9. __________ technique is a means of manipulating sterile products without compromising
their sterility.
10. Sterile products should be prepared in ISO Class __________ PEC located in an ISO Class
__________ buffer room.
11. The __________ catheter is more complicated and riskier to insert and maintain but has
fewer restrictions with respect to concentration of drug, rate of administration, and
time the venous access can remain in place.
12. In __________ LAFWs, HEPA-filtered air emerges from the top and passes downward
through the work area.
13. __________ are single-dose containers composed entirely of glass and, once broken (i.e.,
opened), become open-system containers.
14. You should refer to USP Chapter __________, “Pharmaceutical Compounding—Sterile
Preparations,” for a full description of recommendations and regulations regarding IV
admixture programs.
15. You should refer to USP Chapter __________ and the __________ List of Antineoplastics
and Other Hazardous Drugs for the standards and requirements of handling hazardous
drugs.
ALPHABET SOUP
What do the following acronyms stand for?
1. ACPH: ________________
2. ASHP: ________________
3. BSC: ________________
4. BUD: ________________
5. CACI: ________________
6. CAI: ________________
7. CSP: ________________
8. CSTD: ________________
9. DCA: ________________
10. FDA: ________________
11. GI: ________________
12. HD: ________________
13. HEPA: ________________
14. IM: ________________

15. IPA: ________________
16. ISO: ________________
17. IT: ________________
18. IV: ________________
19. LAFW: ________________
20. LOD: ________________
21. LVP: ________________
22. MDV: ________________
23. NIOSH: ________________
24. OSHA: ________________
25. PEC: ________________
26. PICC: ________________
27. PPE: ________________
28. PPN: ________________
29. SDV: ________________
30. SEC: ________________
31. SVP: ________________
32. TNA: ________________
33. TPN: ________________
34. USP: ________________
SHORT ANSWER
1. Discuss the risks involved with IV therapy.
2. Explain automated TPN compounding.
3. Explain the differences in the types of PECs commonly used in a hospital pharmacy.
4. How does the pharmacy additionally prepare HDs in order to limit potential exposure to
HDs on administration?
5. What is a spill kit, and how is it used?
CROSSWORD PUZZLE
Across:
2. The creation of a medication under the supervision of a pharmacist, to meet a
physician’s order. This process is completed in the pharmacy setting for medications
not available in a commercial formulation and is called pharmacy __________.
7. Garb worn to protect a compounder from hazardous materials, or to prevent shedding
of human particulates. (3 words)
8. The technique and procedures designed to prevent contamination of drugs, packaging,
equipment, or supplies by microorganisms during sterile drug preparation is called
__________ technique.
9. The date after which a compounded sterile product should no longer be stored or
transported to a patient.
11. Unidirectional clean air direct from a high efficiency particulate air filter in the PEC.
12. A work area (hood) where parenteral products are compounded with filtered air
continuously sweeping the work area inside the hood to prevent the entry of
contaminated room air is called a workbench. (2 words)
14. A pharmacy preparation made using aseptic technique to maintain the sterility is called
a __________ __________ __________. (3 words)
15. Pressurized rooms with filtered air, such as ante rooms or buffer rooms, are called
__________ engineering controls.
16. Introducing particulate matter in the form of a plastic or rubber plug into a sterile fluid
through the process of penetrating the outer seal of a vial or bag with a needle.
Down:
1. A vertical laminar airflow workbench (LAFW) used for the preparation of hazardous
medications that confines airflow within the hood. (3 words)
3. Workstations that maintain an ISO 5 environment through the use of filters and
unidirectional airflow are called __________ engineering controls.
4. A __________ product is free from viable microorganisms.
5. A filter that removes 99.97% of all air particles 0.3 micrometers or larger is called a
__________ filter.
6. Also known as hyperalimentation, refers to the IV administration of nutrition needed to
sustain life. (abbreviation)
9. An International Organization for Standardization (ISO) 7 room in which a primary
engineering control resides. (2 words)
10. A vial transfer system that prevents hazardous drugs from being vented or exposed to
the environment during compounding is called a __________ __________ transfer device.
(2 words)
13. A room with a minimum of 20 air changes per hour adjacent to the buffer room, which
contains a line of demarcation and is where gowning activities take place.
QUESTIONS CH 15
MEDICATION SAFETY
Learning Outcomes

■ List 10 different types or categories of medication errors.
■ Identify causes or factors that contribute to medication errors.
■ List five “high-alert” medications.
■ Describe 10 medication error prevention strategies.
■ Define culture of safety.
■ Describe the possible consequences of actual medication errors.
■ Explain the steps to be taken when an error has been identified.
■ Identify the four steps in the PDSA cycle.
MULTIPLE CHOICE
______1. A culture of safety includes the following EXCEPT:

a. An environment where personnel feel comfortable questioning co-workers if
something doesn’t seem right.
b. A philosophy that encourages reporting of all errors directly to the State Board
of Pharmacy to ensure appropriate disciplinary action is taken.
c. An environment that encourages reporting of errors without fear of
punishment.
d. A philosophy where all pharmacy staff work together to develop systems to
improve patient safety.
______2. The following are examples of compliance errors EXCEPT:

a. A patient whose medication is to be taken twice daily takes both doses
together first thing in the morning.
b. A patient is to take a blood pressure medication every day and only takes it
sporadically.
c. A patient takes two tablets at a time instead of one tablet to make the
medication work faster.
d. A nurse fails to give the evening dose to a patient in the hospital.
______3. An example of a monitoring error is:

a. A patient taking a blood pressure medication daily, neglecting to take a blood
pressure reading.
b. A patient on a sliding scale of insulin, neglecting to take a blood glucose
reading prior to administering insulin.
c. A patient taking an antibiotic for acne who doesn’t refill the medication on
time, missing a couple of doses.
d. A patient who receives a refill for a 30-day supply when it was written for a 90-
day supply.
______4. Paying attention to detail is critical in busy, constantly changing work

environments and when completing complex tasks. Using the STAR safety tool
may be helpful in such situations. STAR stands for:
a. Stop–think–assess–redo
b. Start–train–act–revise
c. Stop–think–act–review
d. Slow down–think–assess–review
______5. Wrong administration technique errors include the following EXCEPT:

a. An IM injection mistakenly labeled as an IV medication.
b. An oral antibiotic suspension applied to a rash.
c. A unit dose oral medication injected IV by a nurse.
d. A vaginal suppository inserted rectally.
______6. Wrong dosage form errors include the following EXCEPT:

a. An otic solution used instead of an otic suspension.
b. Simvastatin tablets dispensed instead of lovastatin tablets.
c. Amoxicillin capsules dispensed instead of amoxicillin chewable tablets.
d. Betamethasone topical solution dispensed instead of betamethasone topical
lotion.
______7. Medication error rate comparisons are challenging because of:

a. The different definition and reporting techniques used.
b. Medication errors being common.
c. Differences in hospitals’ census.
d. Medication errors only occurring in the pharmacy.
______8. The Harvard medical practice study, which analyzed the incidence of adverse
events in hospitalized patients, found what percentage of those adverse events
were related to drug complications?
a. Less than 1%
b. 9%
c. 19%
d. 39%
______9. An evaluation of causes of prescribing errors in hospitals found the majority of

potentially serious prescribing errors were made because of:
a. Lack of knowledge about new drugs and procedures
b. Lack of up-to-date references at site of prescribing
c. Performance lapses or failure to follow established procedures
d. Increased performance of CPOE
______10. Which of the following is TRUE regarding medication errors?

a. Medication errors occur almost exclusively in the pharmacy.
b. CPOE has greatly increased prescribing errors.
c. It’s relatively easy to gather data on error rates.
d. Pharmacy technicians need to be aware of all types of errors and may notice
errors that the pharmacist missed.
______11. The list of specific categories of medication errors:

a. Makes it mandatory to classify errors.
b. Defines each possibility clearly so that every error can fall into one of the
categories.
c. Helps to classify errors, but some errors may fit in several of the categories.
d. Has only made reporting errors more difficult.
______12. The following are unauthorized drug errors EXCEPT:

a. A medication for one patient was given mistakenly to another patient.
b. A nurse gave a medication without a prescriber order.
c. Patients “share” prescriptions at home.
d. Administration of a medication occurs outside established administration
time.
______13. Wrong drug preparation errors include all of the following EXCEPT:
a. Reconstituting a clindamycin oral suspension with an incorrect volume of
water.
b. Not activating an ADD-Vantage ® IV admixture bag.
c. Using bacteriostatic saline instead of sterile water to reconstitute a lyophilized
powder for injection.
d. Accidently storing a compounded antibiotic IV at room temperature instead of
in the refrigerator overnight.
______14. When patients read about or experience an adverse drug event, they may:
a. Hesitate to seek medical help for fear of not receiving quality care.
b. Tell everyone they know and switch pharmacies or physicians.
c. Seek nonconventional treatments from outside the medical community.
______15. When a prescription is filled with a wrong strength of a medication because of

illegible handwriting, it should be classified as:
a. Wrong dosage form error
b. Improper dose error
c. CPOE data entry error
d. Prescribing error
______16. Which of the following actions might increase the likelihood of a medication
error?
a. Reading the drug label carefully when selecting the drug from the shelf.
b. Having a nurse phone in a prescription order that was communicated verbally
by the doctor.
c. Reviewing recent medication errors at a pharmacy staff meeting.
d. Asking another pharmacy technician to double-check a calculation.
______17. The term high-alert medication is defined as a medication that:

a. Is involved in more mistakes than others.
b. Is a specialty drug that is expensive, so mistakes are costly.
c. Has a high risk of causing patient harm if used in error.
d. Is a narrow therapeutic drug that must be monitored.
______18. Which of the following error prevention strategies might be useful in

distinguishing between two drug products available in similar packaging (e.g.,
similar size, color, and labeling)?
a. Store the drugs in separate locations in the pharmacy.
b. Use barcode scanning technology to verify selection of the correct product.
c. Put the medications on an “alert” list and train staff to be extra diligent when
filling prescriptions for either product.
d. All the above.
______19. A patient calls in to refill her maintenance medication for blood pressure. As you
are processing the request, you notice that the patient received a 30-day supply
only 10 days ago. What should you do?
a. Inform the pharmacist of the request for an early refill.
b. Not fill the prescription because it’s early.
c. Write a reminder note to refill the prescription at a later date.
d. Refill the prescription as requested but charge the patient cash because it’s
too soon to bill through the insurance.
______20. Which of the following is NOT a patient safety concern when a drug product is in
short supply?
a. The replacement or substitute product is available in a different concentration
than what is routinely used.
b. Alternative products may be much more expensive than the product that is in
short supply.
c. Alternative products are not as efficacious or have a less desirable adverse
effect profile compared to the unavailable product.
d. The pharmacy may not be made aware of a drug shortage in a timely manner,
resulting in stock outs of critical medications.
______21. As a technician undergoing on-the-job training, you are falling behind in putting
away the drug shipment that arrived earlier this morning, so you quickly put stock
on the shelves. In your haste, you fail to realize that one of the medications
requires refrigeration. Failure to refrigerate a product could lead to which of the
following medication errors?
a. Deteriorated drug error
b. Improper dose error
c. Compliance error
d. Monitoring error
______22. Which of the following will NOT put you at risk for a calculation error?
a. Not verifying that the final answer is reasonable.
b. Using a larger package size.
c. Using an inaccurate conversion or neglecting to convert.
d. Misplacing the decimal point.
______23. Which of the following is LEAST likely to lead to a wrong dose error?
a. 125 mcg
b. .125 g
c. 100 U
d. 10.0 units
______24. You have a prescription written for a child that indicates: patient name, age 6,
amoxicillin 1.5 PO BID dispense 120. Which of the following additional pieces of
information are needed to ensure no errors?
a. Clarification if the age is 6 months or 6 years.
b. The concentration of the amoxicillin (what strength is needed).
c. An indication of the dosage form—is this a suspension? Chewable tablets?
______25. It’s 8 am and you are asked to prepare the following sterile compounds for the 10
am delivery. To save time, you prepare them simultaneously. Which of the
following reasons increase the risk of making an error?
Pat Johnson cefazolin 0.5 g IVPB every 8 hours
Pat Peterson cefazolin 1 g IVPB every 8 hours
Jerome Peterson ceftazidime 1 g IVPB every 8 hours
a. The drug names and patient names are similar.
b. Two different doses of the same medication are needed.
c. You are in a hurry.
______26. A prescriber calls the pharmacy with a new prescription. The pharmacist writes
down the prescription and then reads it back to the prescriber. The prescriber
confirms that the prescription was communicated correctly by saying, “That’s
correct.” The safety strategy being used in this scenario is called:
a. S-T-A-R
b. Clarifying questions
c. 3-Way Repeat Back
d. P-D-S-A
______27. Which of the following statements is TRUE regarding the practice of color-coding
drug product packaging and its relationship to medication errors?
a. Color coding the vial caps to match the color of the solution when
reconstituted would decrease the likelihood of medication errors.
b. Color coding, in general, is an unsafe practice as it may lead to relying on the
color instead of reading the name and strength on the vial.
c. Developing a color-coding scheme unique to a specific manufacturer would
decrease the likelihood of a medication error.
d. Color coding saves time when stocking or restocking medications because you
know to place the medications with the same color-coded cap in the same
bins on the shelf.
______28. Which would NOT be considered a contributing factor(s) to medication errors?

a. Performing maintenance on the tablet counting machine only when it is not
performing correctly.
b. Failing to read current pharmacy literature about new drug products.
c. Stocking a substitute different strength of a drug that’s been on backorder.
d. Always using leading zeros before a decimal.
______29. Why are published medication error rates probably underestimated?

a. Only errors that result in patient injury are reported.
b. Some errors go undetected.
c. Only pharmacies report errors.
d. No reported errors resulted in disciplinary action.
______30. The purpose of TALL man lettering in drug names is to:

a. Identify the high-risk drugs with a narrow therapeutic index.
b. Highlight the generic name of a drug.
c. Distinguish between two drugs with similar-looking or -sounding names.
d. Identify medications associated with serious side effects.
______31. A patient comes into the pharmacy stating that he has a “sinus headache.” He
asks the pharmacy technician to assist in selecting a medication. What should the
technician do?
a. Show the patient the OTC sinus and allergy section, and tell him to pick one
out.
b. Ask the patient more questions to determine if a sinus medication or a pain
medication would be more appropriate.
c. Refer the patient to the pharmacist for assistance.
d. Tell the patient to contact his doctor for a recommendation.
______32. A technician compounding an IV preparation of calcium gluconate and D5W

notices the calcium gluconate injection looks slightly cloudy before preparing the
IV bag. What should the technician do to prevent a medication error?
a. Nothing; calcium gluconate solution is always cloudy.
b. Place the calcium gluconate vial in warm water for 15 minutes.
c. Return the vial of calcium gluconate back to the shelf and use another vial
that looks clear.
d. Inform the pharmacist that the calcium gluconate vials look cloudy and
inspect all the calcium gluconate vials in stock.
______33. The pharmacy receives a prescription for triamcinolone cream 0.1%, but there is
none in stock. Instead, the prescription is filled with triamcinolone lotion 0.1%.
Which of the following statements is TRUE regarding this scenario based on the
information provided?
a. A wrong dose error occurred.
b. No error occurred because both products contain the same drug and strength
—triamcinolone 0.1%.
c. The products are not interchangeable, and the prescriber should have been
contacted to obtain an order for an alternative product.
d. According to the NCC MERP index for categorizing medication errors, this
event would be considered Category D (i.e., reached the patient and required
monitoring).
______34. A pharmacy technician notices two different size tablets mixed together in the
metformin 500-mg tablet bin in the automated counting machine. The filling log
indicates that the machine was refilled the day before and the lot number is
different than the previous refill. What should the technician do?
a. Remove the tablets that look different and discard them.
b. Nothing—assume the manufacturer has changed the look of the tablets.
c. Inform the pharmacist of the situation immediately.
d. Nothing—the refill of the machine was double checked by the pharmacist.
______35. Which of the following medications have been identified as high-alert

medications by ISMP?
a. Insulin, methotrexate (oral), fentanyl, heparin
b. Enoxaparin, warfarin, opioids, epinephrine injection
c. Metformin, chemotherapeutic agents, promethazine IV, antipsychotics
d. Heparin, enalapril, isotretinoin, potassium chloride injection
______36. Which of the following is NOT an error prevention strategy that can be used to
avoid entering an order/prescription on the wrong patient?
a. Verify the correct spelling of the patient’s name on a handwritten prescription.
b. Use a minimum of two distinct identifiers such as patient’s full name and date
of birth to confirm correct patient selection in the computer.
c. Confirm patient’s address associated with name selection prior to entering
order.
d. Always enter the patient by their preferred nickname.
______37. Which of the following describes the four steps of the PDSA cycle?
a. Plan–direct–study–act
b. Predict–demonstrate–secure–apply
c. Plan–do–study–act
d. Process–demonstrate–secure–apply
MATCHING
A. Prescribing error
B. Omission error
C. Wrong time error
D. Unauthorized drug error
E. Improper dose error

F. Wrong dosage form error
G. Wrong drug preparation error
H. Wrong administration technique error
I. Deteriorated drug error
J. Monitoring error
K. Compliance error
L. Infusion pump-related errors
M. Barcode technology-related errors
N. Errors related to drug shortages
O. Computer prescriber order entry errors
P. Automated dispensing cabinet (ADC) errors
Q. Patient education errors
R. Transitions of care errors
S. No error
Note that many errors may be classified under more than one category, or that one error
leads to a second error being performed.
______1. A patient IV infusion was running at half the volume per hour than was
programmed in the pump.
______2. A patient was unable to receive an infusion because the IV solution was on
backorder due to a shortage.
______3. A physician ordering hydroxyzine hydrochloride tablets instead selected

hydroxyzine pamoate capsules, which was one line down on the screen.
______4. A prescriber entered a medication order via CPOE that he wanted to be given
twice daily, but he sent it through with the default administration frequency of
three times daily.
______5. A unit-dose medication has a smudged barcode that will not scan, but the nurse
administers it anyway.
______6. An inpatient was given the hospital formulary statin, lovastatin, while in the
hospital. Upon discharge to the assisted living facility, the physician prescribed
lovastatin. The patient filled the prescription and took it along with the
simvastatin the patient was taking before admission to the hospital.
______7. At St. Francis Hospital, all medications must be given within 1 hour of the
assigned administration time. Nurse Peterson gave Bob his 0900 medication at
0830.
______8. Fred was supposed to get 13 units of insulin for a blood glucose reading of 160–
170. His BG was 169. He received 12 units of insulin.
______9. George was having stomach problems, so his neighbor shared his prescription PPI
medication because it worked so well for him.
______10. Greta was mixing up a bottle of Cleocin Pediatric. She was supposed to add 75
mL of water to make a total of 100 mL of solution. She only added 60 mL of
water, so she changed the total quantity to 80 mL and changed the directions to
make sure the patient got the correct dose.
______11. Justine forgot to take her vitamin D on Tuesday.
______12. Mr. Jones took her antibiotic for 6 days until she felt better, although she was
supposed to take the medication for 10 days.
______13. Nurse Jerome was supposed to give Frank 100 mg of atenolol each day as long as
his blood pressure was greater than 160/100. His blood pressure has been over
160/100 every day for 3 weeks, so he skipped taking the blood pressure reading
today and gave him his medication anyway.
______14. The 10 mg/mL strength of an injection that is on formulary is on backorder, and

the pharmacy supply was depleted. The medication was still available in 20
mg/mL and was substituted for the lower strength. Several patients received
twice the ordered dose because of inattention to the strength change.
______15. The ADC was incorrectly calibrated and was releasing two doses of a medication
instead of a single dose ordered.
______16. The barcode on the stock bottle for a medication shows up on the computer as a
different strength than the label on the stock bottle.
______17. The expiration date on the bottle of naproxen 500 mg was 7-19. The patient
received a prescription of naproxen 500 g #20 1 tab bid on 7-3-19.
______18. The incorrect strength of a medication was loaded into the ADC.
______19. The label with the barcode placed on the drug cartridge in the automated
counting machine does not match the drug label for the medication in that
cartridge.
______20. The pharmacist advised a patient that a specific herbal product was safe to take
along with a blood thinner, but the herbal product also acted to thin the blood
and the patient experienced significant bruising.
______21. The pharmacist neglected to inform the patient that the antibiotic prescribed
must be taken with food. The patient took the antibiotic on an empty stomach,
experienced distress, and stopped taking it.
______22. The physician prescribed ciprofloxacin for a 7-year-old child. The pharmacist
called the physician and reminded him that this class of drugs should be avoided
in children.
______23. The physician’s directions were for Boric Acid Capsules 500 mg q day. The nurse
gave the patient this dose by mouth. The intended route was vaginal.
______24. Two infusion pumps were programmed for different infusion rates and
inadvertently switched for the patients they were intended.
TRUE OR FALSE
______1. Some of the errors as defined in the ASHP guidelines apply primarily to patients
in healthcare facilities and do not apply to other settings such as home
healthcare, clinic, and physician office settings or outpatient pharmacy practice
settings.
______2. There have been numerous and thorough studies of medication errors in
hospitals.
______3. Errors occurring earlier in the medication-use process (i.e., in the prescribing
phase) are less likely to be detected and corrected than those occurring later in
the process (i.e., in administration).
______4. Using abbreviations that have been published in reputable medical journals is
acceptable because only widely accepted abbreviations are used in publications.
______5. Printing or typing prescriptions in all caps is a good way to increase readability
and reduce errors.
______6. A slip occurs when an action is not completed as part of a routine task, whereas a
lapse occurs when a step is forgotten.
______7. A good general rule to follow is to question any dose that requires less than ½ or
more than 2 of the dosage unit (e.g., tablet, capsule, teaspoonful).
______8. The recipient of a verbal or telephone order should immediately repeat the order
to the prescriber and then immediately write down the order to ensure clarity.
______9. Omission errors are less likely to result in negative outcomes than improper dose
errors because the patient is not receiving a harmful dose.
______10. Experienced pharmacy technicians are less likely than technicians-in-training to

make calculation errors.
______11. Medication safety is the freedom from accidental or preventable injury related to
the medication-use process.
______12. A medication error is defined as “an error made by a pharmacist or pharmacy

technician at any time during the dispensing process.”
______13. The pharmacist should clarify ambiguous doses before the technician processes
the order.
______14. A pharmacy technician supervisor notices several technicians making the same
calculation error. At the next staff meeting, the supervisor discusses the errors
anonymously and demonstrates how to perform the calculations correctly. This
practice can help to prevent medication errors.
______15. The purpose of a national medication error reporting program is to share

experiences with errors made by specific personnel so they will get extra scrutiny
of their work if they change jobs to prevent future medication errors.
______16. Read the label at least three times to help prevent medication errors: when you
remove it from the shelf, as it is being prepared, and as the finished product is set
aside for the pharmacist to check.
______17. The abbreviation “qid” is considered unsafe by the NCC MERP.
______18. The correct way to write Coumadin ½ mg using decimals is “Coumadin.5 mg.”
______19. The correct way to abbreviate microgram is μg.
______20. A compliance error is when a patient does not follow their dosing regimen.
______21. It’s not a medication error if there was no patient harm.
FILL IN THE BLANK

1. The term medication __________ is used to describe adverse drug reactions (i.e.,
unintended responses to drugs used at normal doses), adverse drug events (i.e., an
injury from a medicine or lack of an intended medicine), and medication errors (i.e.,
errors related to the medication-use process that may or may not result in adverse drug
outcomes).
2. A __________ error occurs at the time a prescriber orders a drug for a specific patient.
Errors can include the selection of an incorrect drug, dose, dosage form, route of
administration, length of therapy, or number of doses.
3. Failure to administer an ordered dose to a patient in a hospital, long-term care facility,
or other facility before the next scheduled dose is considered an __________ error.
4. An institution may determine that administering medications within a specified time of
the scheduled time is acceptable, so that medications administered outside this
window would be considered __________ __________ errors. (2 words)
5. An __________ __________ (2 words) error might occur if a medication for one patient was
given mistakenly to another patient or if a nurse gave a medication without a prescriber
order.
6. __________ __________ (2 words) errors occur when a patient is given a dose that is
greater or less than the prescribed dose.
7. Doses administered or dispensed in a different form than ordered by the prescriber
(e.g., capsules instead of chewable tablets) are classified as __________ __________
__________ errors. (3 words)
8. Medications not stored as required to maintain potency (e.g., left out of the refrigerator
for several days) are considered __________ __________ errors. (2 words)
9. Drugs that require reconstitution (i.e., adding liquid to dissolve a powdered drug),
dilution, or special actions prior to dispensing or administration are subject to
__________ __________ __________ errors. (3 words)
10. Doses that are given to a patient using an inappropriate procedure, such as injecting an
IM medication by the IV route, are categorized as __________ __________ __________ errors.
(3 words)
11. Medications that are dispensed or administered beyond their expiration date are
considered to be __________ __________ errors. (2 words)
12. __________ errors result from inadequate drug therapy review.
13. Medication errors are committed by patients when they fail to follow or adhere to a
prescribed drug regimen; this is referred to as a __________ error.
ALPHABET SOUP
1. ADC: ________________
2. ASHP: ________________
3. CMS: ________________
4. CPOE: ________________
5. FDA: ________________
6. FMEA: ________________
7. ISMP: ________________
8. ISMP MERP: ________________
9. NCC MERP: ________________
10. PDSA: ________________
11. RCA: ________________
12. STAR: ________________
SHORT ANSWER
1. Discuss how workplace issues may affect medication errors.
2. Explain the purpose and procedures for FMEA.
3. What is the purpose of root cause analysis, and when and how would you proceed with
one?
4. Calculation errors can lead to serious events. Discuss the errors that are common with
calculations and what technicians can do to help reduce the possibility of calculation
errors.
PART FIVE
Business Applications
16. Pharmacy Informatics and Technology

17. Pharmaceutical Supply Chain Management
18. Billing and Reimbursement
QUESTIONS CH 16
PHARMACY INFORMATICS AND
TECHNOLOGY
Learning Outcomes

■ Describe the use of current technology in the healthcare environment to ensure the
safety and accuracy of medication dispensing.
■ Explain how medical information systems are used in pharmacy practice activities.
■ Explain the type of data pharmacy information systems collect, transmit, and store.
■ Explain the impact on quality of decision making of valid, reliable, and consistent data
entered into medical information systems.
■ Describe proficiency with word processing, spreadsheets, and databases.
■ Describe skills in using the Internet, e-mail, and electronic medication information
databases.
■ Explain currently emerging technologies that may impact the practice of pharmacy.
■ Describe the ability to use technologies including barcoding and automated dispensing
technology, and unit dose packaging and reporting.
MULTIPLE CHOICE
______1. Which of the following is NOT TRUE regarding pharmacy technicians?

a. Pharmacy technicians require basic computer skills and in pharmacy-related
computer applications.
b. There are opportunities for technicians in managing automated technology.
c. There are opportunities for pharmacists but not technicians in informatics and
medication-use technologies.
d. Technicians are accepting new roles in supporting the hardware and software
that are changing the way pharmacy is practiced.
______2. Basic computer skills include the following EXCEPT:

a. Using a keyboard and a mouse.
b. Opening folders on a computer desktop and printing documents.
c. Starting up and powering down a computer.
d. Setting up computer interoperability.
______3. Pharmacy informatics:

a. Is the access of medication information in a database to provide to patients.
b. Is solely focused on the medications filled by the pharmacy and documented
in the patient profile.
c. Focuses on medication-related data within and across the healthcare system
in the delivery of optimal medication-related patient care and health
outcomes.
d. Includes only gathering and storing data.
______4. The EHR:

a. May include information from external data sources such as MTM notes,
patient device data (e.g., glucose monitors), and PDMP data.
b. Contains all the patient’s medical information from clinic visits, laboratory
results, hospital stays, and medications prescribed for the last 2 years.
c. Does not need or require pharmacist or technician participation in building,
reviewing, or validating the build or functionality of medication orders, clinical
decision support, or medication-related guidelines.
d. Does not include provider progress notes and may or may not include patient
laboratory data.
______5. The “meaningful use” program is a set of objectives to incentivize providers and
hospitals to implement:
a. PDMP programs
b. Qualified EHR systems
c. DSCSA standards
d. NCPDP transactions
______6. The use of clinical decision support alerts offers guidance to providers in making
the best choice, but when they “alert” too frequently, they cause:
a. The provider to bypass the system
b. A decrease in patient positive health outcomes
c. Alert fatigue
d. Automatic overrides
______7. Which of the following is TRUE regarding medication orders and CPOE?
a. All medication orders are routed through CPOE, including complex orders such
as chemotherapy and TPNs.
b. Only a relative few hospitals have implemented CPOE.
c. CPOE and eRx minimizes the dispensing step of the medication-use process.
d. If technicians transcribe written orders into the pharmacy information system,
they will have to be verified by a pharmacist.
______8. What identifier is usually incorporated into the barcode of a medication that the
nurse will administer with a BCMA system?
a. CUI
b. Lot number and expiration date
c. CDS
d. NDC
______9. Orders entered via CPOE:

a. Are routed directly to the automated counting equipment to fill the
medication order.
b. Allow for the immediate release of the medication from the ADC on the
nursing station.
c. Generate prescription labels in the pharmacy for pharmacy technicians to
retrieve and fill.
d. Must be verified by a pharmacist before the medication may be dispensed.
______10. The use of IV workflow software products incorporate the following technologies
except for:
a. Image capture (photo)
b. RFID
c. Barcode scanning
d. Gravimetrics
______11. Pharmacy robots consist of the following types EXCEPT:

a. IV/Chemotherapy
b. Delivery
c. Dispensing
d. Inventory control
______12. SureScripts is a national network that connects all of the following entities
EXCEPT:
a. Clinicians and hospitals
b. Veterinary hospitals and clinics
c. Pharmacies and PBMs
d. Technology vendors
______13. E-prescribing:
a. Uses NCPDP-developed SCRIPT standard for e-Rx.
b. Allows for the exchange of information only between prescribers and
pharmacies.
c. Increases the chance of errors because information must be transcribed at the
pharmacy.
d. Is safe and secure for both controlled and noncontrolled substance
prescriptions without the need for additional authentication.
______14. The following are true regarding telepharmacy EXCEPT:

a. Enables remote supervision by a pharmacist of a technician at a location
where a pharmacist is not present.
b. Is an example of the wider phenomenon of telemedicine.
c. Allows pharmacists to interact with patients via audio/visual communication
systems from a remote location.
d. Allows technicians to remotely check and verify other technicians’ work.
MATCHING
Match the following terms to their descriptions.
A. Bidirectional interface
B. Integration
C. Interface
D. Interoperability
E. RxNorm
F. Semantic interoperability
G. SNOMED
H. SureScripts
I. Syntactic interoperability
J. Telepharmacy
K. Unidirectional interface
______1. A boundary across which two independent systems meet and act on or
communicate with each other.
______2. A dictionary of standard codes for diseases and symptoms. The use of these codes
helps to standardize the data captured in the EHR to allow for billing, research,
and search ability in the EHR.
______3. A dictionary of standard codes or identifiers for medications. The use of these
codes helps to standardize the data captured in the EHR to allow for billing,
research, and search ability in the EHR.
______4. The exchange of information back and forth between applications, keeping both
applications in synchronization.
______5. The sending of messages to a device or application, but no messages go back to

the sending application.
______6. The ability of two or more systems to exchange data in a meaningful fashion
without human prompting, for diverse systems to work compatibly.
______7. The nationwide network of providers, pharmacies, PBMs, and others to facilitate
electronic prescribing.
______8. The seamless interaction of various applications from a single vendor that forms a
larger and more complex system.
______9. The supervision of technicians and provision of pharmacist care to patients at a

remote location.
______10. The use of a standard messaging format of the information, such as allergy
information or laboratory data.
______11. The use of both the structuring of the data exchange and the codification of the
data to ensure the receiving information technology system can interpret the
data.
TRUE OR FALSE
______1. Besides the pharmacy computer programs, basic programs a technician may use
include word processing, spreadsheets, databases, and email.
______2. The use of stand-alone computer systems in hospital pharmacies is growing.
______3. The EHR is a longitudinal electronic record of patient health information

generated by one or more encounters in any care delivery setting.
______4. Technology downtime may be planned or unplanned.
______5. An integrated system connects several systems together, but you still must log
into each system separately with an ID and password.
______6. Medication orders entered by CPOE are first routed to the pharmacist for
verification before the order is released to be filled and dispensed.
______7. Incorporating a CDS with the CPOE results in a decrease in safety.

______8. CPOE has limitations for complex orders, and these may still be generated on
paper such as chemotherapy or TPN orders.
______9. Barcodes can be linear or 2-dimensional.
______10. If a barcode will not scan in the BCMA system, the nursing staff should alert the
pharmacy.
______11. Pharmacy technicians are the key staff interacting with ACDs on a daily basis
including replenishment, inventory control par levels, and removal of expired
medications.
______12. IV workflow technology is not allowed for the compounding of chemotherapy

agents.
______13. Specialized software applications are available to assist with investigational drug
service management, unit-dose preparation and labeling, parenteral nutrition
ordering, and stewardship documentation and tracking.
______14. Pharmacy departments are required to retrieve data from the EHR or other
applications to make financial, efficiency, and operational decisions.
______15. Transaction and data requests that are part of the SCRIPT standard includes the
capability for a pharmacy to transmit a prescription transfer to another pharmacy.
______16. A pharmacist would access PDMP data to determine if a TPN formulation was
within acceptable limits of electrolytes.
______17. The incorporation of MTM tools should be part of the PMS or interfaced with the
PMS to facilitate documentation and billing.
______18. Telepharmacy allows for remote supervision of technicians who conduct

dispensing activities or CSP production.
ALPHABET SOUP
1. ADC: ________________
2. ADS: ________________
3. ADT: ________________
4. ANSI: ________________
5. BCMA: ________________
6. CDA: ________________
7. CDS (or CDSS): ________________
8. CPOE: ________________
9. CSP: ________________
10. DEA: ________________

11. DSCSA: ________________
12. EHR: ________________
13. eMAR: ________________
14. EMR: ________________
15. EPCS: ________________
16. eRx: ________________
17. HICS: ________________
18. HIT: ________________
19. HIMSS: ________________
20. HIPAA: ________________
21. HITECH: ________________
22. HL7: ________________
23. ISMP: ________________
24. ISO: ________________
25. IV: ________________
26. MTM: ________________
27. NABP: ________________
28. NAMSDL: ________________
29. NCPDP: ________________
30. ONC: ________________
31. OSI: ________________
32. PBM: ________________
33. PDMP: ________________
34. PIS: ________________
35. PMS: ________________
36. PTI: ________________
37. RFID: ________________
38. ROI: ________________
39. SDO: ________________

40. SNOMED: ________________
41. UPC: ________________
42. WG: ________________
SHORT ANSWER
1. List the five rights of clinical decision support.
2. Discuss the technician’s role in pharmacy informatics as well as the knowledge, skills,
and abilities required.
3. Discuss technology downtime planning, including strategies for continued operations

during downtime.
CROSSWORD PUZZLE
Across:
1. A clinical information system that allows clinicians to record patient-specific orders
(e.g., tests, treatments, management plans) for communication to other patient care
team members and to other information systems is called __________ physician (or
provider/prescriber) order entry.
4. The application of information processing involving both computer hardware and
software that deals with the storage, retrieval, sharing, and use of healthcare
information, data, and knowledge for communication and decision making including
the electronic health record, the personal health record, computerized provider order
entry, and clinical decision support is called __________ __________ __________. (3 words)
8. An integral discipline within the clinical informatics domain, centered on the effective
management and delivery of medication-related data, information, and knowledge
across systems that support the medication-use process is called __________ __________.
(2 words)
9. The application of biomedical informatics methods and techniques, including
information technology, to deliver healthcare services is called __________ __________. (2
words)
11. The act of bringing together smaller components into a single system that functions as
one.
12. The principal federal entity charged with coordination of nationwide efforts to
implement and use the most advanced health information technology and the
electronic exchange of health information is called the Office of the __________
__________ (2 words) for Health Information Technology.
15. The fields of clinical informatics and public health informatics, including both applied
research and practice, is collectively called __________ __________. (2 words)
17. The __________ __________ (2 words) process is one of the most complex and risky
processes in the hospital. It involves a large number of caregivers in widely diverse
areas and includes history taking, ordering and transcribing, medication procurement,
pharmacy management, administration manage-ment, and quality assurance.
18. Computer tools or applications to assist clinicians in clinical decisions by providing
evidence-based knowledge in the context of patient-specific data are called a
__________ __________ support system. (2 words)
19. An ANSI-accredited, all-volunteer, not-for-profit organization involved in development of
international healthcare standards is called __________ __________ __________
International. (3 words)
21. A digital version of the paper charts in a healthcare organization that contains the
medical and treatment history of the patients within this organization is called an
__________ __________ __________. (3 words)
23. __________ is a normalized naming system for clinical drugs that links its names to
many of the drug vocabularies commonly used in pharmacy management and drug
interaction software to mediate messages between systems not using the same
software and vocabulary.
24. A commonly observed condition among clinicians overwhelmed with large numbers of
clinically insignificant alerts, thus causing them to “tune out” and potentially miss an
important drug-drug or drug allergy alert. (2 words)
25. A type of computer technology whereby physicians use handheld or personal computer
devices to review drug and formulary coverage and to transmit prescriptions to a
printer or a local pharmacy is called __________ prescribing.
26. A user interface that organizes and presents information in a way that is easy to read
and is likely to be interactive.
28. A secure online website that gives patients convenient 24-hour access to personal
health information from anywhere with an Internet connection.
29. A collection of data in machine-readable format organized so it can be retrieved or
processed automatically by computer.
30. A field of information science concerned with the management of data and information
used to diagnose, treat, cure, and prevent disease through the application of computers
and computer technologies is called __________ __________. (2 words)
Down:
2. Software that enables many disparate systems to pass information back and forth using
a set of defined standards is called an interface __________.
3. A Health Level Seven XML-based document markup standard for the electronic
exchange model for clinical documents (e.g., discharge summaries, progress notes) is
called the clinical __________ __________. (2 words)
5. A computerized record of the total health of the patient—going beyond standard
clinical data collected in the provider’s office and inclusive of a broader view on a
patient’s care is called an __________ __________ __________. (3 words)
6. The actions (operations), capabilities, and usefulness of something such as a software
application.
7. A tiered set of objectives related to the American Recovery and Reinvestment Act
Medicare and Medicaid EHR incentive programs. These __________ __________ (2 words)
criteria must be met by eligible professionals and hospitals if they are to collect
financial rewards for the implementation of qualified, certified EHRs to achieve health
and efficiency goals.
10. The ability of health information systems to work together within and across
organizational boundaries in order to advance the effective delivery of healthcare for
individuals and communities.
13. This organization, the __________, creates and promotes the transfer of data related to
medications, supplies, and services within the healthcare system through the
development of standards and industry guidance.
14. A person that uses technology tools to support the management of information within
an organization.
16. A control system to make sure that patients are receiving the correct medications at
the correct time by electronically validating and documenting medications is called a
__________ __________ administration system. (can be used as 1 word but is usually 2
words)
20. The series of activities in step form that is necessary to complete a task.
22. A boundary across which two independent systems meet and act on or communicate
with each other.
24. A system of computerized drug storage devices or cabinets is called an __________
dispensing system.
27. The acronym for a global, cause-based, not-for-profit organization focused on better
health through information technology. It leads efforts to optimize health engagements
and care outcomes using information technology.
QUESTIONS CH 17
PHARMACEUTICAL SUPPLY CHAIN
MANAGEMENT
Learning Outcomes

■ Describe the formulary system and its application in a purchasing and inventory system.
■ Execute lending and borrowing pharmaceutical transactions between pharmacies.
■ Apply the proper principles and processes when receiving and storing pharmaceuticals.
■ Discuss the process for managing medication inventory.
■ Demonstrate an understanding of pharmaceutical products that require special
handling.
■ Identify products that require special handling.
■ Complete the appropriate processes in the management of pharmaceutical recalls and
the disposal of pharmaceutical products.
MULTIPLE CHOICE
______1. Inventory management and control:

a. Is not critical in hospital pharmacies because the drug products are
inexpensive, so having excess on hand does not impact the pharmacy
financially.
b. Is necessary because running out of a needed medication will impact patient
treatment.
c. Is typically a manual system with visual assessments of product quantities to
determine the quantity to order.
d. Is not critical because medications can be ordered for the next day’s delivery,
so no need to keep stock on hand.
______2. The first set of digits in the national drug code identifies the:
a. Package type and size
b. Product code, denoting the formulation, dosage form, and strength
c. Dosage form
d. Specific drug manufacturer or labeler of the product
______3. A hospital P&T Committee is generally comprised of:

a. Nurses, pharmacists, and risk managers
b. Administrators, purchasing agents, and pharmacists
c. Physicians, pharmacists, nurses, and administrators
d. Pharmacists, pharmacy technicians, and purchasing agents
______4. The members of the P&T Committee collaborate to choose medications for the
formulary that are the:
a. Safest
b. Most effective
c. Least costly
d. All of the above
______5. A hospital formulary is generally formatted to inform users of the following:

a. Product dosage form, strength, and availability
b. The appropriate therapeutic uses of medications
c. Actual or relative cost of the medication
d. All of the above
______6. An advantage of a wholesaler arrangement is that wholesalers:

a. Agree to deliver 70-75% of the items on schedule and offer a 24-hour/7-day-
per-week emergency service.
b. Provide the pharmacy with electronic order entry/receiving devices, a
computer system for ordering, storage shelving and bins, and barcoded shelf
stickers.
c. Offer a highly competitive discount (minus 10-15%) below product
cost/contract pricing and competitive alternate contract pricing.
d. Allow for drugs to be received shortly before use and is a highly efficient and
cost-effective approach to purchasing and inventory management.
______7. Technicians should pay close attention to these three main issues of product
similarity:
a. Similar tablet color, therapeutic class, manufacturer
b. Similar package inserts, expiration dates, control schedules
c. Similar drug names, package sizes, label format
d. Similar capsule sizes, cap colors, costs
______8. When receiving pharmaceuticals, it is important to:

a. Verify that the products shipped match the products listed on the packing slip
or invoice.
b. Detect if there are missing or damaged products.
c. Detect if items were shipped that were not ordered such as a mispick from the
warehouse.
______9. Traditional inventory management and handling practices do not work well with
medication samples because:
a. Medication samples are not ordered or dispensed by the pharmacy.
b. Samples are provided to physicians by the drug manufacturer on request and
are free of charge.
c. Samples may not be medications on the formulary.
______10. The most common reason that drugs are returned to the manufacturer is because
they:
a. Expired
b. Were ordered in error
c. Were damaged in shipment
d. Were shipped in error
______11. Which of the following is NOT TRUE regarding expired products?

a. Expired controlled substances may not be disposed of by the pharmacy
without filing the appropriate forms and obtaining permission from the DEA.
b. Compounded nonhazardous drugs may be sent back to the manufacturer or
wholesaler when expired.
c. Expired medications, including controlled substances, may be sent to a duly
licensed reverse distributor for destruction.
d. Expired investigational drugs should be returned to the manufacturer or
sponsor of an investigational drug study according to the instructions they
provide.
______12. A report following a multiple-month study of environmental impact of

pharmaceutical waste indicates that trace amounts of pharmaceuticals are
present in the drinking water of 24 major U.S. metropolitan cities nationwide due
to:
a. Human excretion
b. Routine waste disposal of medication by consumers
c. Routine waste disposal of medication by pharmacies
d. All of the above
______13. Recalls initiated by manufacturers and distributors:

a. Are more efficient and effective in ensuring timely consumer protection than
an FDA-initiated court action or seizure of the product.
b. Are phoned to pharmacies by the manufacturer of the product or by drug
wholesalers.
c. Include a phone number for pharmacies to call to find out the class of recall,
the reason for recall, the name of the recalled product, the manufacturer, all
affected lot numbers of the product, and response required.
d. Typically, do not include instructions on the extent of action required in
contacting affected patients. This information must be retrieved from the FDA
website.
______14. Which of the following is NOT TRUE regarding hazardous waste in the pharmacy?
a. Hazardous waste is regulated by the EPA and the state’s hazardous waste
regulatory agency.
b. Many medications are considered hazardous waste such as nicotine products,
warfarin, epinephrine, and hazardous drugs.
c. Pharmacies may dispose of all hazardous waste and hazardous drugs in the
red biohazard bags or sharps containers.
d. Full compliance to the hazardous waste handling and disposal is essential to
avoid state and/or federal sanctions.
______15. Which of the following is TRUE regarding inventory?

a. Inventory turnover is a way of measuring the productivity of a pharmacy’s
inventory use and the use of invested capital.
b. It is not necessary to perform a physical inventory at about the same time
each year in order to get meaningful, comparable results.
c. Low inventory turnover is a sign of efficiency.
d. High inventory turnover rates indicate that the pharmacy inventory
management processes are inefficient.
______16. Which of the following is NOT TRUE regarding pharmacy inventory management
systems?
a. Using an order book or want list is the simplest system but is the most fallible.
b. Par-level systems are also called min/max systems and rely on a
predetermined order quantity and order point.
c. There are also statistical models of inventory control called the Pareto/ABC
analysis and the economic order quantity model.
d. Automated or computerized systems of inventory control are less efficient
than simply ordering products by hand.
MATCHING
Match the following actual recalls with the correct class used for their recalls.
A. Class I: The most serious of recalls; ongoing product use may result in serious health
threat or death.
B. Class II: Moderate severity concern; ongoing product use may pose serious adverse
events or irreversible consequences.
C. Class III: Lowest severity concern; ongoing product use unlikely to cause adverse health
threat; however, a marginal chance of injury may exist, so the product is being recalled.
______1. PRODUCT M.V.I. ADULT (Multi-Vitamin Infusion), 10 mL UNIT VIAL
REASON: Subpotent (Multiple Ingredient Drug): The discolored top chamber

solution does not meet the visual appearance specification. This discoloration
potentially impacts the potency of the Biotin and Folic Acid contained in the top
chamber.
______2. PRODUCT Fentanyl Transdermal System 75 mcg/hr, 5 systems per box
REASON: Incorrect NDC barcode label on the outer carton; barcode is indicated
for the 100 mcg/hr strength instead of the 75 mcg/hr strength. The immediate
package label is correct.
______3. PRODUCT ALLOPURINOL Tablets, USP, 100 mg, 30 Tablets
REASON: Labeling: Correct Labeled Product Mispack; 100-mg bottles packed in

shipping boxes labeled as 300 mg.
______4. PRODUCT Propofol Injectable Emulsion 1%, 200 mg/20 mL (10 mg/mL), 20-mL
vials
REASON: Lack of Sterility Assurance; the product was manufactured on

equipment found to be contaminated with microbiological organisms.
______5. PRODUCT Isosorbide Mononitrate, 60 mg
REASON: The products may contain oversized tablets.
______6. PRODUCT Nikki Haskell’s StarCaps Diet System Dietary Supplement Capsules
REASON: Unapproved new drug; the dietary supplement lots contain the
undeclared drug ingredient Bumetanide, a prescription diuretic.
______7. PRODUCT Liothyronine Sodium Tablets, USP 5 mcg
REASON: The recall is being conducted due to a stability failure at the 12-month
time point; the assay value of this lot was found to be subpotent.
______8. PRODUCT IBUDONE (hydrocodone bitartrate and ibuprofen tablets), 5 mg/ 200
mg
REASON: Subpotent (Multiple Ingredient Drug); below specification for the assay
at the room temperature 3-month stability time-point for Ibuprofen and
Hydrocodone Bitartrate.
______9. PRODUCT Honey Lemon Soothing Cough Drops (Menthol) 9.1 mg, individually
twist wrapped drops
REASON: Subpotent (Single Ingredient Drug); cough drops are out of

specification for menthol.
______10. PRODUCT Ondansetron in 5% Dextrose Injection, 32 mg/50 mL (0.64 mg/mL),

Single-Dose Premix Bag
REASON: Non-Sterility; this product is being recalled because a white feathery

substance found floating inside the IV bag was identified as mold.
______11. RIPPED TABS TR tablets, Anabolic Amplifier Proprietary Blend
REASON: Marketed Without an Approved NDA/ANDA; 62 products marketed as

dietary supplements have been found to contain steroid or steroid-like
substances, making them unapproved new drugs.
______12. PRODUCT Sertraline Tablets, 50 mg bottles of 90
REASON: Incorrect medication guides shipped with product.
TRUE OR FALSE
______1. Inventory control systems are used in hospital pharmacies but not in community
(outpatient) pharmacies.
______2. A hospital formulary is developed and maintained by a committee of medical and

allied health staff called the Pharmacy and Therapeutics (P&T) Committee.
______3. Formularies are not a concern in retail pharmacy.
______4. When a request for use of products is not on the official hospital formulary, the
pharmacist must refuse the request and offer a comparable or therapeutically
equivalent product.
______5. Independent community pharmacies typically do not become members of a GPO.
______6. In a hospital, use of a nonformulary drug is strictly prohibited.
______7. Purchasing contracts can involve sole-source or multisource products. Sole-source

branded products are available from only one manufacturer, whereas multisource
generic products are available from numerous manufacturers.
______8. A GPO guarantees the price of pharmaceuticals over the established contract
period, which is usually 3–6 months.
______9. It is important that the pharmacy technician documents any off-contract
purchases resulting from manufacturers’ inability to supply a given product that
the pharmacy is buying on contract, which may require the pharmacy to buy or
substitute a competing product that is not on contract at a higher cost.
______10. For most pharmacies, the advantages of direct ordering outweigh the
disadvantages.
______11. Some drugs can only be purchased directly from the manufacturers.
______12. Borrowing or lending drugs between pharmacies is not allowed due to federal
restrictions.
______13. In a reliable and efficient receiving system, the personnel responsible for ordering
should be the same as the receiving personnel.
______14. Just as checking the product label carefully is important when a prescription or
medication order is filled, taking the same care when receiving pharmaceuticals
and accurately placing them in their storage location are essential for prevention
of medication errors.
______15. Research on tall man lettering has failed to demonstrate effectiveness in

distinguishing similarities and preventing look-alike, sound-alike drug mix-ups.
______16. If a hospital uses a BCMA system, it is critical that each barcode on items new to
the facility be scanned at the time that each product is received to ensure that
the barcode is in the BCMA system. This does not apply to products that have
been received before from the same manufacturer.
______17. Schedule III, IV, and V controlled substances are generally obtained in a manner
identical to that for Schedule II substances.
______18. The difficult logistical and control factors of medication samples have led many
organizations to adopt policies that simply disallow medication samples.
______19. When receiving the drug order, you should process products requiring cold or
frozen storage first.
______20. The refrigerator (used for storing pharmaceuticals) temperature should be kept
between 2° to 8°C.
______21. Pharmaceuticals should be stored within the appropriate temperature and

humidity range indicated by the manufacturer on the product packaging, or, if
specifics are not on the package, stored within the appropriate USP temperature
ranges.
______22. As long as the pharmacy has a thermostat and feels at a comfortable

temperature, and the refrigerator feels cold, there is no need to monitor the
actual temperatures.
______23. USP controlled room temperature range is 68° to 77°F.
______24. Store in a “dry place” means that once the bulk medication container has been
opened, it must be stored in a place that does not exceed 40% relative humidity.
______25. Radiopharmaceuticals are radioactive and potentially dangerous to humans and
the environment and require special preparation and handling (typically in a
nuclear pharmacy).
______26. If you receive a drug recall notice and you have no affected product in stock, you
may discard the notice.
______27. A recall for a drug may require you to contact any patients who have or may have
received the affected lots, or simply involve returning any pharmacy stock of the
recalled product.
______28. If there is a drug shortage and you need to obtain the drug from a source other
than your primary wholesaler, it is important to ensure the source is reliable to
avoid purchasing products that may be counterfeit.
______29. If your hospital is a covered entity under section 340B of the Public Health Service
Act, your pharmacy will be able to buy all medications at a substantial discount
for all your patients.
______30. Specialty drugs include drugs that are very expensive, are restricted distribution
products, used for complex conditions, require special handling, and require
therapeutic monitoring (REMS).
FILL IN THE BLANK

1. There is an FDA database that utilizes a unique identification number, called the
__________, to identify drug products that are intended for human consumption or use.
2. Most hospitals and healthcare systems develop a list of medications that may be
prescribed for patients in the institution or healthcare system, called a __________.
3. Most health-system pharmacies are members of a __________ __________ __________ (3
words), which contracts with manufacturers to purchase pharmaceuticals at discounted
prices, in return for a guaranteed minimum purchase volume.
4. __________ purchasing from a manufacturer involves the execution of a purchase order
(PO) from the pharmacy to the manufacturer of the drug.
5. The __________ (also known as distributor) usually operates a large-scale warehouse in
various geographic regions and exists to help bring pharmaceutical products closer to
the market.
6. When a health-system pharmacy agrees to purchase most (e.g., 90-95%) of its
pharmaceuticals from a single wholesale company, a __________ vendor arrangement is
established, and, customarily, a contract between the pharmacy and the drug
wholesaler is developed.
7. The process of receiving medications; putting them in their proper location; and
placing products that will expire earlier in the front of the shelf or bin, and the newly
acquired products (with longer shelf lives) behind packages that will expire before
them is a common practice known as __________ __________. (2 words)
8. The convention of labeling pharmaceuticals with mixed-case labeling, also known as
__________ __________ __________ (3 words), is an important tactic employed in the
interest of calling attention to similarities in drug names.
9. When an order is received and checked in, the product’s expiration dates should be
checked to ensure that it meets the department’s minimum expiration date
requirement, which is commonly a minimum shelf life of __________ __________ (2 words)
remaining before they expire.
10. When controlled substances are inventoried and tracked continuously, this type of
inventory method is referred to as a __________ inventory process.
11. Regulations specific to Schedule II controlled substances require a DEA form __________
to be completed to initiate procurement of these products if the pharmacy does not
order by CSOS.
12. A simple means of calculating total inventory __________ in a given period is to divide
the total purchases in that period by the value of physical inventory taken at a
reasonable single point in time.
ALPHABET SOUP
1. ANDA: ________________
2. ASHP: ________________
3. AWP: ________________
4. BCMA: ________________
5. CMS: ________________
6. CSOS: ________________
7. DEA: ________________
8. DOT: ________________
9. DQSA: ________________
10. DRLS: ________________
11. EHR: ________________
12. EOQ: ________________
13. EPA: ________________
14. FDA: ________________
15. FIFO: ________________
16. FY: ________________
17. GMP: ________________
18. GPO: ________________
19. HD: ________________

20. IMPACT: ________________
21. IOM: ________________
22. IRB: ________________
23. IV: ________________
24. LASA: ________________
25. LDDs: ________________
26. MSDS: ________________
27. NDA: ________________
28. NDC: ________________
29. NIOSH: ________________
30. P&T: ________________
31. PBM: ________________
32. PO: ________________
33. PPE: ________________
34. RCRA: ________________
35. RDDS: ________________
36. REMS: ________________
37. USP: ________________
38. WHO: ________________
SHORT ANSWER
1. Discuss the special processes required for ordering, receiving, and storing controlled
substances. Where would you look to find more information?
2. Explain the considerations when receiving and storing hazardous drugs and USP
Chapter <800>.
3. Investigational drugs require special ordering, inventorying, and handling procedures.

Discuss.
QUESTIONS CH 18
BILLING AND REIMBURSEMENT
Learning Outcomes

■ Explain the basic principles of pharmacy billing and reimbursement.
■ Define common pricing benchmarks.
■ List various payers of pharmaceuticals and pharmacy services.
■ Describe the differences in reimbursement processes dependent on payers and patient
care settings.
■ Describe the categories of information that are needed to submit a third-party claim for
a prescription or medication order.
■ Use knowledge of third-party insurance billing procedures to identify a reason for a
rejected claim.
MULTIPLE CHOICE
______1. The pharmacy business:

a. Is a hybrid business offering both goods and services.
b. Is mostly a cash business, with less than half the prescriptions filled being
billed to a third-party plan.
c. Includes one standard methodology for billing and reimbursement from third-
party plans
d. Relies on prospective payments in a community pharmacy practice.
______2. Third-party reimbursement is:

a. Copay paid by the patient minus the acquisition cost of the drug
b. Selling price of the product minus the actual cost of the product
c. Ingredient cost plus dispensing fee minus copay
d. Amount paid by the patient minus acquisition cost of drug
______3. Which of the following is NOT TRUE regarding the AWP?

a. AWP stands for the average wholesale price.
b. AWP information is available from Medi-Span and First Databank.
c. Third-party reimbursement relies exclusively on the AWP to determine the cost
of the medication.
d. The AWP is usually set at 20-25% above the wholesale acquisition cost.
______4. Benchmark prices include the following EXCEPT:

a. AMP
b. WAC
c. AWP
d. MME
______5. Which of the following is NOT TRUE regarding the WAC?

a. It’s the wholesale acquisition cost set by each manufacturer.
b. It represents the list price at which the manufacturer sells the drug to the
wholesaler.
c. If WAC is used as the basis for reimbursement, it is usually expressed as the
WAC minus a small percentage (e.g., 2 or 3%).
d. WAC, along with AWP, do not represent what is actually paid for a drug and
are falling out of use as benchmark prices.
______6. The exact methodology that is used to bill and reimburse for drugs varies based
on several factors, including the following:
a. The practice setting in which the drug is dispensed.
b. The type of drug that is being dispensed (e.g., single-source brand products
vs. multisource generic products).
c. The third-party who is paying for the drugs.
______7. Overhead costs often include various expenses such as:

a. Rent and utilities
b. Personnel costs (i.e., salaries for pharmacists and technicians)
c. Equipment (e.g., computers, fax, printer)
d. Supplies (e.g., labels, vials)
e. All of the above
______8. PBMs and their sponsors do the following EXCEPT:

a. Develop formularies.
b. Negotiate discounts or rebates with pharmaceutical companies.
c. Charge different copays for different tier drugs with the highest copay for
generic medications.
d. Keep track of all prescriptions dispensed under the benefit.
______9. To optimize clinical and economic performance, a PBM uses the following
strategies EXCEPT:
a. Prior authorization
b. Step therapy
c. Quantity limits
d. Progressive copays for subsequent fills
______10. Medicare is the federal health program for:

a. The elderly and the disabled
b. People with end-stage renal disease
c. People with amyotrophic lateral sclerosis (ALS)
d. All of the above
______11. Medicare part B pays for:

a. Hospital stays
b. Medically necessary supplies
c. All prescription drugs
d. 100% of part B covered items
______12. Individuals with part B coverage are responsible for the:

a. Premium
b. Deductible
c. Copayment
d. All of the above
______13. Part A coverage is:

a. Pre-paid through payroll taxes.
b. Optional medical insurance for outpatient physician and hospital services,
medical equipment, prosthetics, orthotics, and supplies.
c. The Medicare Advantage Plan, which combines parts B and C coverage.
d. A federal prescription drug program that is paid for by the Centers for
Medicare & Medicaid Services (CMS).
______14. During the coverage gap, the beneficiary:

a. Pays no costs for prescriptions.
b. Pays 10% of the cost of prescriptions.
c. Pays 75% of the cost of prescriptions.
d. Must pay all costs for prescriptions.
______15. is the largest public payer of prescription drug benefits.

a. Medicaid
b. Medicare
c. CVS Health
d. Department of Defense
______16. The Low-Income Subsidy (LIS) is:

a. A fixed amount the individual pays out of pocket at the beginning of the year
before the part D plan begins to pay.
b. Extra Help to pay for Medicare hospital and clinic coverage.
c. A period of reduced coverage once the initial coverage limit is reached.
d. Extra Help, which means the eligible person does not pay premiums or
deductibles and has reduced or no copays for prescription drugs.
______17. Mr. Johnson comes into your pharmacy with a prescription for furosemide 20-mg
tablets, Sig: take one tablet twice daily, Quantity #100. When you enter the
information into the pharmacy system, you get a message saying, “Maximum
days’ supply = 30.” You should:
a. Dispense 100 tablets as a 30-day supply.
b. Dispense 60 tablets as a 30-day supply, and document the change in quantity
on the face of the prescription.
c. Not dispense the prescription. Ask Mrs. Jackson to obtain a new prescription
for 60 tablets.
d. Dispense 100 tablets and submit the claim as a 50-day supply.
______18. Mrs. Johnson is enrolled in a Medicare part D plan. She does not qualify for Extra
Help. Every month, she has four prescriptions filled for copayments totaling $100.
This month, the pharmacy system shows that the copayments total $350. What
happened?
a. She is most likely in the donut hole (i.e., coverage gap) of her Medicare part D
plan and must pay the ($350) “out-of-pocket cost” until she reaches
Catastrophic Coverage.
b. The drugs are no longer covered. She should ask her physician to obtain prior
approvals for the prescriptions.
c. She should switch to another Medicare part D plan immediately.
d. Obviously, there is an error in the pharmacy system; she should only owe
$100.
______19. A new patient who is a Medicare beneficiary comes into your pharmacy with a
prescription. She does not have her Medicare card with her. What should you do?
a. Have her go home and get her card.
b. Call the clinic and get a copy of her card.
c. Check the Medicare website (www.medicare.gov) to determine the name of
her plan.
d. Perform an E1 transaction on the pharmacy system to determine her part D
eligibility information.
______20. A customer comes into your pharmacy with a prescription ID card for a new
Medicare part D plan. She has a prescription for Tylenol #3 tablets # 360, Sig:
take one or two tablets every 6 hours as needed for chronic pain. She has been
taking the Tylenol #3 for many years. When you enter the information in the
pharmacy system, you get a message saying “MME limit exceeded.” What should
you do?
a. Figure out the maximum number of tablets you can fill before exceeding the
MME limit and fill for that amount.
b. Fill the prescription anyway and charge the normal copayment.
c. Contact the part D plan as a quantity override may be allowed/required.
d. Advise the customer to have the physician prescribe a non-opioid pain
medication.
______21. Mrs. Patel comes into your pharmacy with a new prescription for Aricept and a
prescription ID card for a Medicare part D plan. You enter the information into the
pharmacy system and get a message that states, “prior authorization required.”
You tell Mrs. Patel that:
a. She should switch to a different Medicare part D plan.
b. She may be entitled to a 30-day supply of medication while her physician
completes the paperwork for a prior authorization.
c. She needs to pay cash for the prescription.
d. She cannot get the prescription filled until a prior authorization is obtained.
MATCHING I
Part A
Part B
Part C
Part D
______1. Prescription drug coverage

______2. Hospital insurance
______3. Medical insurance
______4. Medicare Advantage Plans
MATCHING II
Match the listed DAW codes (0–9) with the correct description.
0
1
2
3
4
5
6
7
8
9
______1. Brand-Name Drug Mandated by Law: substitution not allowed
______2. Brand Name Dispensed at Generic Price: substitution allowed
______3. Override
______4. Generic not in stock: substitution allowed
______5. Patient DAW: substitution allowed; patient requested product dispensed
______6. Physician DAW: substitution not allowed by provider
______7. Generic or Single-Source Brand: no product selection
______8. Other
______9. Pharmacist-Selected Brand Name: substitution allowed; pharmacist-selected

product
______10. Generic not available: substitution allowed
TRUE OR FALSE
______1. Typically, the reimbursement formula for a generic product is the same as that for
a brand product.
______2. Some third-party payers may pay a higher dispensing fee for generic drugs or
formulary products as an incentive to encourage utilization of preferred products.
______3. In the IPAP model, pharmacies typically receive payment for medications that
have already been dispensed.
______4. Medicare part B, which covers outpatient physician and hospital services, clinical
laboratory services, and durable medical equipment, prosthetics, orthotics, and
supplies (DMEPOS), is automatic medical insurance for those 65 and older.
______5. Medicare part D is a federal prescription drug program that is paid for by the
Centers for Medicare & Medicaid Services (CMS) and by individual premiums.
______6. A patient’s copay may be a percentage or fixed fee.
______7. Because drug formularies for Medicare part D are the same from plan to plan,
beneficiaries need not worry about which plan they select as their prescription
drugs are covered.
______8. CMS requires that all Medicare prescription drug plans cover at least six drugs in
each of the ten therapeutic categories.
______9. If a beneficiary has a prescription for a drug that requires prior authorization from
the part D plan, the prescribing physician needs to obtain prior authorization for
the drug before the claim can be paid.
______10. All part D claims must contain a National Provider Identifier (NPI) for the
prescriber or may substitute the provider’s DEA number.
______11. Medicaid is another term for Medicare.
______12. As of April 1, 2008, all Medicaid prescriptions must be electronically prescribed or

written/printed on “tamper-resistant” paper.
______13. By law, Medicaid recipients may not be denied services based on their inability to
pay the assigned cost sharing.
______14. Benzodiazepines are required to be covered by Medicare part D plans but must
have a quantity limit.
______15. You submit a claim for a medication with the diagnosis code provided by the
physician. You get a reject that indicates the medication is not covered for that
diagnosis code, and it lists the codes for which the medication IS covered. It’s
okay to change the code to one that is covered.
FILL IN THE BLANK

1. In simple accounting terms, __________ represents the inflow of funds.
2. __________ payment typically includes all costs associated with treating a particular
condition, including medications.
3. Insurance companies or pharmacy benefit managers are considered __________
__________ payers. (2 words)
4. The __________ is the cost-sharing amount paid by the patient or customer.
5. The amount paid for a prescription by a cash paying customer is called the __________
__________ __________ price. (3 words)
6. __________ was created in the 1960s and was the first generally accepted standard
pricing benchmark.
7. Many drug companies offer certain free drugs through __________ __________ __________
to low-income patients who lack prescription drug coverage and meet certain criteria.
(3 words)
8. __________ __________ __________ are organizations that administer pharmacy benefits for
private or public third-party payers, also known as plan sponsors. (3 words)
9. The __________ is the cornerstone of any PBM activity. It is a specific list of drugs that is
included with a given pharmacy benefit.
10. For Medicare part A claims, __________ is the basis for reimbursement.
11. Medicaid recipients who also qualify for Medicare are known as __________ __________. (2
words)
ALPHABET SOUP
1. ACA: ________________
2. AMP: ________________
3. APC: ________________
4. ASP: ________________
5. AWP: ________________
6. BIN: ________________
7. CMS: ________________
8. CPT: ________________
9. DAW: ________________
10. DEA: ________________
11. DME MAC: ________________
12. DMEPOS: ________________
13. DRG: ________________
14. DSH: ________________
15. FPL: ________________
16. FQHC: ________________
17. FUL: ________________
18. HCPCS: ________________
19. HMO: ________________
20. ICD-10: ________________

21. IEP: ________________
22. IHS: ________________
23. IPAP: ________________
24. LIS: ________________
25. MAC: ________________
26. MAPD: ________________
27. MSP: ________________
28. NCPDP: ________________
29. NDC: ________________
30. NPI: ________________
31. OPPS: ________________
32. PAP: ________________
33. PBM: ________________
34. PCMA: ________________
35. PCN: ________________
36. PPO: ________________
37. PPS: ________________
38. SEP: ________________
39. SSI: ________________
40. VA: ________________
41. WAC: ________________
SHORT ANSWER
1. Explain step therapy.
2. Discuss the steps in processing third-party prescriptions, possible rejections that may
occur, and possible solutions to the rejections.
3. Explain the difference between prospective and retrospective payment.

4. Discuss the programs available for those without insurance.
CROSSWORD PUZZLE
Across:
1. Represents the inflow of funds.
5. A type of insurance in which the insured pays a share of the payment made against a
claim.
10. The maximum of federal matching funds that the federal government will pay to state
Medicaid programs for eligible generic and multisource drugs is called the federal
__________ __________. (2 words)
11. Requires the prescriber to receive preapproval from the PBM in order for the drug to be
covered by the benefit. (2 words)
12. The amount paid for the services related to dispensing a prescription. (2 words)
15. A specific list of drugs that are approved to be covered by a given prescription drug
plan.
16. It is a period of reduced coverage that typically occurs once the individual’s total
prescription drug spending for the year reaches the initial coverage limit. (2 words)
18. A system of health insurance in which the insurer agrees to pay for the cost of covered
services after care has been given on a fee-for-service basis is called __________
insurance. It usually defines the maximum amounts covered and may require the
insured to pay upfront for services and submit a claim for reimbursement.
19. The amount to be paid for drugs is predetermined based on the treated condition; it is
called a __________ payment. It typically includes all costs associated with treating a
particular condition, including medications.
20. A standardized set of medical codes that identifies procedures, equipment, and
supplies for claim submission purposes. (acronym)
21. A method of payment in which providers bill and are paid separately for each patient
encounter or service they provide. (3 words)
22. A predetermined amount that insured individuals pay at the time of service, such as a
prescription or doctor visit, each time they use the insurance benefit.
23. The amount of insurance costs that the insured individual, plan member, or beneficiary
shares. (2 words)
Down:
2. Total revenue minus total expenses. (2 words)
3. Sales price minus cost.
4. A fixed amount that must be paid each year by the individual before the insurance
starts to pay.
6. A group of pharmacies, physicians, hospitals, or other providers who participate in a
certain managed care plan.
7. Reimbursement given after the drugs are dispensed is called a __________ payment and
is based on a predetermined formula that is specified in a contract between the
pharmacy and the third-party payer.
8. The determination of the insurer’s payment after the member’s insurance benefits are
applied to a prescription claim.
9. An organization (either private or public) that reimburses a pharmacy or patient for
products and/or services. (3 words)
13. The amount the individual pays to belong to a health plan, often paid monthly.
14. The costs incurred above product cost including rent, utilities, personnel, equipment,
supplies, and advertising. (2 words)
17. Requiring the use of a recognized first-line drug before a more complex or expensive
second-line drug is used. (2 words)
PART SIX
Getting Started
19. In the Real World

QUESTIONS CH 19
IN THE REAL WORLD
Learning Outcomes

■ Identify potential requirements for registration as a
pharmacy technician.
■ Outline the key components of a resume and a cover
letter.
■ List characteristics to consider when choosing a job.
■ Outline the steps of the job application process.
■ Identify strategies for a successful job interview.
■ Define mission statement and vision and identify their
value to a professional’s career.
■ Differentiate between a mentor and a sponsor.
■ Outline the steps of continuing professional
development.
■ List benefits of joining and actively participating in
professional pharmacy and pharmacy technician
organizations.
■ Describe how the role of the pharmacy technician has
expanded in recent years.
MULTIPLE CHOICE
______1. Which of the following is TRUE regarding

registration as a pharmacy technician?
a. The requirements for education and
certification vary from state to state.
b. You do not need to register with the state if you
are already certified.
c. You can use completion of an accredited
technician training program in lieu of
certification.
d. You only need to register in one state, then you
may practice as a technician in any state.
______2. Certification requires:

a. You are at least 16 years old.
b. That you have successfully completed an
ASHP/ACPE-accredited training program.
c. That you take and pass either the PTCE or the
ExCPT exam.
d. That you are already registered with the State
Board of Pharmacy as a technician.
______3. Which of the following is TRUE regarding

continuing education?
a. PTCB certification requires 20 hours of CE every
2 years and ExCPT requires 15 hours of CE
every 2 years.
b. You may be required to take CE to maintain
your state pharmacy technician registration.
c. You can get CE credits by submitting proof if
you are employed as a pharmacy technician.
d. PTCB and ExCPT both require 2 hours of CE in
pharmacy law and 1 hour of CE in patient
safety.
______4. Which of the following items is NOT TRUE

regarding your resume?
a. It should include a list of the places you
previously worked from the oldest to the most
recent position.
b. The list of skills in your resume may include
experience with specific computer systems or
hardware, fluency in another language, and
leadership skills.
c. The education list should include your high
school diploma and college degrees, if
applicable.
d. If applicable and relevant, list your volunteer
experiences and involvement with professional
organizations.
______5. Which of the following is NOT TRUE regarding a

cover letter?
a. Your cover letter should include an opening
paragraph that briefly describes who you are
and why you are applying for the job.
b. Ideally a cover letter should be no more than 1
page.
c. Note in the closing paragraph any materials
you are attaching or sending, thank the reader,
and list the best way to contact you.
d. Once you have a cover letter developed, you
can use the same letter for all your job
applications.
______6. Which of the following should be considered when

deciding which job to apply for?
a. Location and length of commute
b. Salary and benefits, flexibility of hours
c. The kind of setting such as community,
hospital, etc.
d. All of the above
______7. Which of the following is TRUE regarding job

interviews?
a. Research the business or institution ahead of
time and compile a list of questions regarding
explanations for any bad reviews you came
across.
b. Compile a list of answers to behavioral
questions you may be asked such as how you
have handled a difficult situation, what are
your strengths and weaknesses, etc.
c. It is not so important to dress up for your
interview as it is to be well groomed with clean
and pressed clothing.
d. Be assertive and take control of the interview; it
shows initiative.
______8. It is predicted that there will be a 9% increase in
the demand for pharmacy technicians from 2014–
2024 due to many factors, including which of the
following?
a. Increased growth in the young adults with
children population with an increased demand
for prescription medications.
b. As the pharmacy profession evolves, it is
creating a need for pharmacy technicians in
expanded roles.
c. A decrease in the number of people who have
health insurance who then do not access
preventative care so are much sicker, requiring
more medications.
d. The rising cost of medications, leaving many
patients unable to afford their prescription
medications, causing a need for technicians to
help them with patient assistance programs.
TRUE OR FALSE
______1. Every state requires PTCB or ExCPT certification

before a pharmacy technician can be licensed.
______2. Continuing education is the same as continuing

professional development (CPD).
______3. A resume is the same as a curriculum vitae.
______4. Include your email address in the header of your

resume. If you don’t have a professional sounding
email address, create one.
______5. It is NOT acceptable to list the derivative of your
name on your resume (such as Rob, or Jen). It
must be your full, legal name.
______6. There are four stages in the CPD process.
______7. More institutions have developed interdisciplinary

teams for a variety of healthcare professionals to
work collaboratively, which gives pharmacy
technicians the opportunity to work with nurses,
physicians, social workers, and others.
FILL IN THE BLANK

1. A __________ is a more experienced person who shares
experience, knowledge, and advice.
2. A __________ describes what you want to accomplish in
the future.
3. A person who has someone advocating on their behalf to
higher positions is called a __________.
4. A __________ __________ (2 words) is focused on how you
will achieve what you want to accomplish in your future.
5. A __________ may be informal or a formal program and is
especially helpful for new employees at a business or
institution.
6. A __________ is a person who is in a position of power or
influence who has access to individuals in higher level
positions and advocates for another.
7. A less experienced person who receives advice and
learns from a more experienced person is called a
__________.
8. A relationship where a person with power or influence
advocates for another to higher level positions is called a
__________.
SHORT ANSWER
1. Define and describe the differences between continuing
education and CPD.
2. List the benefits of joining and participating in a

professional organization.
CROSSWORD PUZZLE
Across:
1. Mandatory education that an individual must complete
to maintain their licensure or registration is called
__________ education.
3. A person providing counseling or guidance.
6. The step in CPD where you determine your educational
and development needs.
7. A strategy of how the individual or institution will
achieve the vision. (2 words)
9. A list of your education, work experience, credentials,
and accomplishments that is submitted to a potential
employer when you are applying for a job.
12. A statement identifying what an individual or an
institution wants to accomplish.
14. The act of providing assistance to a new employee to
help them increase their technical skills, knowledge, or
emotional well-being.
16. The step in CPD where you reflect whether an activity
was successful in meeting a development need.
17. The step in CPD where you create a portfolio of learning
experiences.
18. A voluntary comprehensive plan designed to identify
areas for future improvement, plan an action course to
improve those areas, and record progress is called
continuing __________ development.
20. A benefit of belonging to a professional organization
where you meet and interact with others
Down:
1. Similar to a resume but containing additional
information such as research publications,
presentations, and teaching experience. (2 words)
2. A voluntary process where a nongovernmental entity
recognizes an individual person who has met specific
qualifications and has achieved a certain level of
knowledge, skill, or experience.
4. The recipient of counseling or guidance.
5. The step in CPD where you identify formal and informal
activities to meet development needs.
8. This is when a professional organization meets with
legislators on behalf of the profession.
9. Required by a state in order to practice as a pharmacy
technician.
10. A document that is usually sent with a resume when
applying for a job. (2 words)
11. The person being promoted or advocated for.
13. The person doing the promoting or advocating.
15. The act of promoting or advocating for an employee to
high-level institution leadership to help that employee’s
career advance.
19. The step in CPD where you perform formal and informal
activities to meet development needs.
ANSWERS
ANSWERS CH 1
HOW TO BE A GREAT STUDENT:
STRATEGIES FOR EFFECTIVE
LEARNING
MULTIPLE CHOICE
1. d. Adopting a fixed mindset.
2. b. Allocating equal amounts of time to study the easy and

the hard concepts.
3. b. Prioritize items in the order to be completed, not by

easiest first.
4. a. Let him know immediately that his insurance will not

cover the medication and ask if he would like the
pharmacy to contact the prescriber to get it changed to a
covered medication. Note: All three answers could
happen, but this is the best answer because it lets him
know what is going on with his prescription, why, and
how you can help him.
5. c. Prioritize projects to work on the ones due first, ahead of

the other projects.
6. c. Take notes during training and ask questions if something

is unclear to you.
MATCHING
1. D
2. C
3. B
4. D
5. C
6. C
7. A
8. B
9. D
10. A
TRUE OR FALSE
1. F People with intrinsic motivation outperform those with

extrinsic motivation in the long run.
2. T
3. F Intrinsic motivation
4. T
5. T
6. F Self-advocacy is being your own advocate including

asking questions, being proactive in training, and asking
for help when needed.
SHORT ANSWER
1. What is the best way to handle this relationship?
You are mad, and Kim is hurt. Now that you know that you
forgot to label the chips, you realize you are at fault. The best
way to handle this is to talk to Kim directly. Discuss, calmly,
the fact that Kim had no way of knowing the chips were yours
because you neglected to mark them with your name as is the
break-room policy. Apologize for yelling at her.
2. What are some strategies you could have used to control your
immediate emotional response (self-management)?
First, follow the break-room policy to label food you do not

want to share with your name! When you discovered someone
had eaten the chips, remain calm and investigate. When you
found out it was Kim, calmly ask her why she ate the chips.
(Count to 10 first if you are having trouble controlling your
emotions!) When she explained she did not know they were
yours and she even asked around, you should have realized
that it was your fault for not labeling them with your name.
You would have no reason to be mad at this point. By reacting
first before knowing all the facts, you were not in control of
your emotions and needlessly hurt a coworker.
CROSSWORD PUZZLE
ANSWERS CH 2
THE WORLD OF PHARMACY AND PHARMACY
TECHNICIANS
MULTIPLE CHOICE
1. b. Answer questions about medication side effects from a patient.
2. b. Giving advice on the appropriate OTC medication to take for a headache.
3. c. Perform patient counseling on a new medication for the patient.
4. a. Answering clinical questions about a medication from a prescriber.
5. c. An ASHP/ACPE-accredited technician training program must meet the minimum

standards and requirements to provide consistent formal training of technicians.
6. c. You may not be eligible to take the certification exam if you have a criminal history
or Board of Pharmacy disciplinary record.
7. d. Continuing education-specific requirements vary between states and between the

two certification programs’ renewal requirements.
8. b. Every state has its own requirements for registration as a pharmacy technician and
requirements vary state-to-state.
9. c. Are principles based on the moral obligations that guide the pharmacy profession.
10. b. Technicians with advanced knowledge and skills may check other technicians’ work
and administer medications and immunizations.
11. a. Assessment of a pharmacy’s inventory
12. b. State Board of Pharmacy
13. d. Ability to defend medication errors

14. a. Managerial duties
MATCHING I
1. A
2. A
3. A
4. B
5. B
6. A
7. B
8. B
9. A
MATCHING II
1. A
2. B
3. B
4. A
5. B
6. A
7. A
8. B
TRUE OR FALSE
1. T
2. T
3. T
4. F Technicians often perform compounding, which includes weighing out ingredients.
5. T
6. F This is a clinical function to be performed only by a pharmacist.
7. T
8. F Technicians may perform technical tasks, but only pharmacists may perform clinical
tasks.
9. F Technicians should be professional in all work settings.
ALPHABET SOUP
1. AAPT: American Association of Pharmacy Technicians
2. ACPE: Accreditation Council for Pharmacy Education
3. ADC: Automated dispensing cabinet
4. APhA: American Pharmacists Association
5. ASHP: American Society of Health-System Pharmacists
6. CCP: Council on Credentialing in Pharmacy
7. CE: Continuing education
8. CPhT: Certified Pharmacy Technician
9. ExCPT: Exam for the Certification of Pharmacy Technicians
10. GED: Graduate equivalency diploma
11. IV: Intravenous
12. JCPP: Joint Commission of Pharmacy Practitioners
13. MTM: Medication therapy management
14. NABP: National Association of Boards of Pharmacy
15. NDC: National drug code
16. NHA: National Healthcareer Association
17. NPTA: National Pharmacy Technician Association
18. PBM: Pharmacy benefits manager
19. PTCB: Pharmacy Technician Certification Board
20. PTCE: Pharmacy Technician Certification Examination
21. RPh: Registered pharmacist
22. TPN: Total parenteral nutrition

SHORT ANSWER
1. Discuss the benefits of enrolling in an ASHP/ACPE-accredited technician training

program versus only receiving on-the-job training at your work site.
An accredited program is a program that meets certain standards for educating

pharmacy technicians across different types of practice. The accredited program will
offer broad-based and consistent education and experience. An on-the-job training
course will focus only on the specific type of practice (a retail drugstore, for example)
and not include information that would apply to other sites (such as a hospital inpatient
pharmacy). This will be less valuable if you want to be considered for another position
at another pharmacy or different type of pharmacy practice.
2. What is the top priority for both pharmacists and pharmacy technicians?
Patient safety—the right dose of the right drug given to the right patient by the right
route at the right time.
3. You observe another technician talking with a friend at the counter. The other
technician is talking about a specific patient and their unusual medical problem.
Discuss this behavior and what options you have in response to this observation.
The other technician is clearly violating patient privacy in relaying personal and
confidential health information to another person that is not part of the healthcare
team. This is unprofessional and highly unethical (and may be illegal). You could talk to
the technician and ask if he or she realized this behavior is unethical and
unprofessional. But this is an issue that should be reported to the pharmacist on duty.
4. Discuss the ways in which you will fulfill the ethical principle of maintaining
competency and enhancing your professional knowledge and expertise.
Become certified and maintain the certification, including obtaining pharmacy

technician continuing education. Ask about training in more advanced skills for more
advanced roles within your organization. Belong to pharmacy organizations and
participate in programs and education at meetings and events. Seek out additional
education about specific subjects in pharmacy that interest you.
INTERNET RESEARCH
1. The ASHP Pharmacy Technician Forum serves as the collective voice for pharmacy
technicians by supporting their advancement, professionalization, and engagement
within ASHP.
2. Midyear Clinical Meeting, Section Advisory Group: Advancing Pharmacy Practice with
Technicians, Summer Meetings, etc.
CROSSWORD PUZZLE
ANSWERS CH 3
PHARMACY LAW, REGULATIONS, AND
STANDARDS
MULTIPLE CHOICE
1. b. DEA
2. c. Is an organization whose members include State Boards of Pharmacy.
3. d. Requirement for liability insurance
4. c. Every 2 years
5. b. Health Insurance Portability and Accountability Act
6. c. Controlled Substances Act
7. c. Pharmacists who dispense controlled substances. (Pharmacies are registered, not

the pharmacists.)
8. a. Information from pharmacies about controlled substance prescriptions dispensed in

the state.
9. d. Both laws must be followed, including the more stringent law.
10. e. All of the above
11. a. Enacted by state legislatures through the legislative process.
12. c. Reimbursement rates for prescriptions filled under an insurance plan
13. c. Not counsel patients as technicians are not authorized to counsel.
14. d. Offer counseling to the patient by asking if they would like to speak with the
pharmacist.
15. d. Is not refillable; a new prescription is needed for each fill.
16. b. For a maximum of 5 refills within 6 months.
17. a. Up to 5 times within 6 months of the prescription being issued (written).
18. a. For as many refills as authorized within 6 months.
19. b. Have a caution statement indicating that federal law prohibits the transfer of this
drug to any person other than the patient for whom it was prescribed.
20. c. The prescriber’s name, address, and DEA number.
21. c. The actual date the prescription was written (issued) even if it won’t be filled until a
later date.
22. a. Schedule III controlled substance prescriptions with valid refills remaining may be
transferred 1 time only.
23. d. Invoices for Schedule II controlled substances received must be kept separately
from invoices for Schedule III-V controlled substances.
24. b. Requires a log to be kept of all sales of ephedrine and pseudoephedrine that
contains purchaser information, quantity of product purchased, and date and time
of purchase.
25. c. Customers are limited to a maximum of two commercial packages containing

pseudoephedrine per day.
26. b. A podiatrist prescribes methylphenidate for the son of a patient.
27. c. All prescription drugs must have a package insert supplied to the pharmacy. A copy
of this package insert is required to be provided to the patient on the first fill of a
new prescription.
28. d. Patients may request that only the brand name of the medication be dispensed
even if the prescriber authorizes generic substitution.
29. d. The FDA reviews safety and efficacy, if the benefits of the new drug outweigh the
risks, labeling, and manufacturing methods before approving a new drug.
30. c. Not only do generic drugs have to prove they contain the same amount of the
active ingredient as the brand name drug, they also have to prove bioequivalence.
31. c. All biosimilar products may be substituted for the reference products in the same
way a generic drug is substituted for a brand name product.
MATCHING
1. G. 1984 Hatch-Waxman Act
2. D. 1951 Durham-Humphrey Amendment
3. H. 1988 Prescription Drug Marketing Act

4. I. 1997 Food and Drug Administration Modernization Act
5. B. 1930 FDA
6. J. 2005 Combat Methamphetamine Epidemic Act
7. F. 1982 Tamper-Resistant Packaging Regulations
8. A. 1906 Food and Drugs Act
9. E. 1962 Kefauver-Harris Drug Amendments
10. C. 1938 Food, Drug, and Cosmetic Act (FDCA)
TRUE OR FALSE
1. F Legend drugs have an “Rx” on the labeling; only controlled substances have a “C.”
2. F Some may, but others are prescription only such as diphenoxylate with atropine.
3. T
4. T
5. F The most stringent law takes precedence whether it’s the state law or the federal
law.
6. T
7. F The State Board of Pharmacy enforces state regulations. The FDA enforces federal.
8. F NABP is a nonprofit organization whose members are Boards of Pharmacy, but it is

not—itself—a government agency.
9. F Refills may not be authorized for Schedule II controlled substance prescriptions.
10. F Schedule I controlled substances include illicit and illegal substances like heroin
and may not be carried in a pharmacy to be filled by prescription.
11. F Schedule II
12. T
13. F Schedule IV with a moderate potential for abuse.
14. F Schedule V
15. F Schedule II
16. F High potential for abuse
17. T
18. F There are five schedules, I–V.
19. T
20. F Pharmacies must obtain a nonresident pharmacy license in the states into which
they ship prescriptions to patients.
21. T
22. F You must dispense in child-resistant packaging unless the medication is specifically
exempt, or the patient or prescriber requests easy-open lids.
23. F Both prescription and OTC packaging for medications and other products are
required to be child-resistant.
24. F DEA form 106
ALPHABET SOUP
1. AAPT: American Association of Pharmacy Technicians
2. ANDA: Abbreviated new drug application
3. CMEA: Combat Methamphetamine Epidemic Act
4. DAW: Dispense as written
5. DEA: Drug Enforcement Administration
6. DHHS: Department of Health and Human Services (also known as DHS)
7. DNS: Do not substitute
8. FDA: U.S. Food and Drug Administration
9. FDCA: Food, Drug, and Cosmetic Act
10. HIPAA: Health Insurance Portability and Accountability Act
11. NASCSA: National Association of State Controlled Substance Authorities
12. NDA: New drug application
14. OBRA90: Omnibus Budget Reconciliation Act of 1990
15. OTC: Over-the-counter
16. PHI: Protected health information
17. PPA: Phenylpropanolamine
18. PPI: Patient package insert
SHORT ANSWER
1. When working in a community pharmacy, you must protect patient privacy for
protected health information. How do you do this?
All paper to be discarded that has patient information on it is shredded. Paper, receipts,
labels, or labeled prescriptions are not in view of customers waiting at the counter.
Speaking softly to patients and waiting on only one patient at a time (having others
wait a few steps away while you are with a patient) also protects privacy. Being careful
of your volume and mindful of what other patients, customers, and non-pharmacy
employees can overhear when you are talking to other pharmacists or technicians also
helps, or when you are on the phone with a patient or health professional. Being
mindful of what can be overheard when a patient is in the drive-through is important.
INTERNET RESEARCH
1. Characteristics of Forged Prescriptions

• Prescription looks “too good”; the prescriber’s handwriting is too legible.
• Quantities, directions, or dosages differ from usual medical usage.
• Prescription does not comply with the acceptable standard abbreviations or appear
to be textbook presentations.
• Prescription appears to be photocopied.
• Directions written in full, with no abbreviations.
• Prescription written in different color inks or written in different handwriting.
2. Responsibilities in dispensing controlled substance prescriptions, types of fraudulent

prescriptions, criteria that may indicate the prescription is not for a legitimate medical
purpose, and prevention techniques.
ANSWERS CH 4
COMMUNITY, AMBULATORY CARE, AND
HOME CARE PHARMACY PRACTICE
MULTIPLE CHOICE
1. c. Only serves patients who walk in or who have medications mailed to them.
2. a. May be an independent or a chain pharmacy.
3. d. May be a stand-alone pharmacy or inside a grocery store or mass-merchant.
4. c. Typically serves both cash-paying patients and those with a third-party insurance.
5. b. May fill prescriptions for walk-in patients and send out prescriptions by mail.
6. b. Must have a pharmacist available to answer patient questions about their

medications.
7. d. May fill prescriptions for walk-in patients, and prescriptions to be mailed or

delivered to patient’s homes.
8. c. The need for pharmacy technicians is increasing in ambulatory care and

community pharmacy settings due to increases in pharmacist clinical tasks and
changes in the pharmacists’ role.
9. c. Omnibus Budget Reconciliation Act
10. b. Food, Drug, and Cosmetic Act
11. a. Durham-Humphrey Amendment
12. d. Health Insurance Portability and Accountability Act
13. b. Keep all protected health information (PHI) confidential.

14. b. Primarily oral, solid, or injectable drugs
15. b. Performing DUR on prescriptions to be filled and dispensed.
16. d. Informing patients about the common side effects of their medication.
17. d. Answering patient requests for information on dosing of OTC medications.
18. d. Impersonal
19. c. Marital status
20. c. Most prescriptions filled today are covered in full or in part by a third-party payer.
21. d. All of the above
22. d. If the manufacturer’s stock bottle does not have a child-resistant cap, you do not
need to dispense with a child-resistant cap.
23. d. Performing the final verification check before dispensing to the patient.
24. c. Weighing a tablet or capsule and comparing the weight to the known weight of the
correct tablet or capsule.
25. c. Counting devices using optic sensors are always equipped with barcode scanners to
improve accuracy.
26. d. The technician may only give the prescription medication to the actual patient
when completing the transaction and not to another family member or caregiver.
27. c. isotretinoin creams and gels (Retin-A)
28. b. clonazepam (Klonopin)
29. b. iPledge
30. b. A patient care service that pharmacists provide with assistance from technicians
who may collect and manage the data and records for monitoring patients.
31. c. May have some screening tests and data collection performed by technicians.
32. a. Immunizations are typically administered to patients in a pharmacy by pharmacy

technicians.
33. b. Are increasing in numbers as administration of long-term IV therapy in the home is

proven to be safe and effective.
34. c. Drugs that do not need special handling for storage or administration.
35. d. Ceftriaxone is an often-used cephalosporin because it can be administered once

daily.
36. c. A central venous catheter is often used for administering penicillins because they
are irritating to the veins and may cause phlebitis.
37. b. Vancomycin is irritating to the veins and is best given through a central catheter for
home infusion.
38. c. Is always given using an infusion pump.
39. a. IV nutrition that is used to provide a patient with all the fluid and essential
nutrients needed when oral nutrition is difficult or impossible.
40. a. Include items such as insulin and heparin.
41. d. The prescriber’s address and DEA number if the infusion is a controlled substance.
42. b. They are inserted in a peripheral vein and threaded through the vein until reaching
the entrance to the right atrium of the heart.
43. b. Peripheral neuropathy
44. c. Choking or throat irritation
MATCHING I
1. G. Reimbursement specialist
2. F. Pharmacy technician
3. E. Pharmacist
4. B. Case manager
5. A. Intake coordinator
6. C. Physician
7. D. Nursing
8. H. Patient service representative
MATCHING II
1. E. Ambulatory electronic infusion pumps
2. A. Minibag infusion via gravity system
3. B. Syringe infusion via syringe device
4. C. Syringe infusion via IV push method
5. F. Smart pumps
6. D. Elastomeric balloon pumps
7. D. Elastomeric balloon pumps
8. B. Syringe infusion via syringe device
9. E. Ambulatory electronic infusion pumps

MATCHING III
1. B. Tunneled central venous catheters
2. D. Peripherally inserted central catheter
4. C. Subcutaneous access ports
9. A. Peripheral catheters
ORDERING
1. C. A patient presents a new prescription to be filled.
2. A. The prescription information is entered into the computer.
3. F. The prescription is billed to the third-party payer, and any issues are resolved.
4. B. The prescription is filled and labeled.
5. D. A final check is performed on the filled prescription by the pharmacist.
6. E. The pharmacist counsels the patient when the prescription is dispensed.
TRUE OR FALSE
1. F The patient responsibility is the copayment.
2. T
3. F Brand name drugs have patents; generic medications are available once the patent
protection expires.
4. F HIPAA requires protection of confidential health information.
5. F An ambulatory patient is one that is not primarily bedridden but is able to move
around on their own. It is also a reference to patients receiving care outside of a
hospital.
6. T
7. T
8. F Accuracy is important at every step. Increasing the errors that reach the pharmacist
to catch will lead to some of the errors not being detected.
9. F Clinical tasks are limited to pharmacists only.
10. T
11. F This is simply repackaging—the medication itself was not altered in any way.
12. F MTM is the clinical management of medication therapies, not the handling,
compounding, and dispensing of the drug product itself.
13. F Technicians
14. T
15. T
16. T
17. T
18. F Shorter time
19. T
20. F Antibiotics
21. F Saline will cause a precipitate to form; dextrose is used instead.
22. T
23. T
24. F Parenteral nutrition is through a vein, and enteral is through the GI system.
25. F Chemotherapy agents are given in the home setting.
26. T
27. T
28. F Biological response modifiers are proteins and should not be shaken.
29. T
30. T
31. F Morphine
32. T
33. F “Pharmaceutical Compounding—Sterile Preparations” is the name of the USP

Chapter <797>; USP Chapter <800> is Hazardous Drugs.
34. F Pharmacies that only compound pursuant to a patient-specific prescription are

503A.
35. T
36. T
37. F Refrigerated medications should be shipped in coolers to maintain drug integrity.
38. T
39. F Hazardous medical waste and sharps have specific waste disposal requirements.
40. T
FILL IN THE BLANK
1. Pharmacist
2. Chain
3. Clozapine
4. MedGuides
5. NDC number
6. ASHP and USP
7. Hazardous
SHORT ANSWER
1. List three newer practice trends pharmacies are using to serve their patients while also
generating revenue. How would pharmacy technicians assist with these trends?
Technicians might assist with disease state management and health screenings by
arranging appointments and making sure the pharmacist has up-to-date information
about patients. Technicians may draw up immunizations and assist with record
keeping. Technicians may compound medications under the supervision of a
pharmacist.
2. Discuss the risk category levels in the preparation of IV admixtures according to ASHP
guidelines.
In the ASHP guidelines, sterile products are grouped into three levels of danger to the
patient, based on potential risk of microbial contamination. These levels increase from
least (level 1) to greatest (level 3) potential risk, and they have different quality
assurance recommendations for product integrity and patient safety. The greater the
chance of contamination or the greater the risk of microbial growth in the product, the
more careful providers should be to safeguard the sterility of the IV admixture. Most
products used for home care patients are medium risk (ASHP risk level 2).
CROSSWORD PUZZLE
ANSWERS CH 5
HOSPITAL AND SPECIALTY PHARMACY
PRACTICE
MULTIPLE CHOICE
2. c. Operates with a closed formulary of medications.
3. b. It operates with an open formulary.
4. c. Clinical management of patients has become a more important focus of

pharmacists in a hospital setting.
5. b. The CFO reports to the CEO.
6. d. The COO reports to the CEO.
7. c. Provide a shorter time to deliver medications.
8. d. Monitoring and evaluating patient response to medications.
9. a. They require additional resources.
10. b. Providing patient education.
11. c. Determining if the patient’s insurance information is up-to-date.
12. a. Appropriate duration of hospitalization
13. d. Confirming appropriate diagnosis was made by physician.
14. d. Ensuring all medications used are covered by the patient’s insurance.
15. b. Providing clinical advice to prescribers.

16. a. Participating in medical rounds with physicians.
17. d. Incentives the drug company offers the physicians
18. b. The hospital will have a procedure for the temporary use of a non-formulary drug.
19. b. Pharmacy technicians do not have a role in managing drug shortages in a hospital.
20. c. Only the medications stored in the pharmacy are required to be inspected for
medications that are expired or past their beyond-use date.
21. d. Technicians that suspect a co-worker or other healthcare professional of diversion

should follow the hospital policy and report the suspicion immediately.
22. c. Gloves are not necessary when technicians are handling hazardous drugs.
23. c. Computerized physician order entry
24. c. If an order is written when the pharmacy is closed (the pharmacy is not open 24/7),
the nurse administers the first dose(s) before the order is verified by the pharmacist
the next morning.
25. c. Have barcodes that are scanned to improve accuracy and safety in the dispensing
and administration process.
26. b. The hospital pharmacy may outsource the compounding of IVs and TPNs because it
is cost effective with savings on labor and equipment.
27. d. The device is able to report discrepancies in access and if a medication is expired or
needs to be restocked.
28. b. Each patient drawer is filled with medications from a fill list printed from the
patient files.
29. d. Generic drugs to compare to the brand
30. b. Technicians may be involved in collecting medication regimen information on

admission to the hospital, and they may also be involved in the discharge
medication process.
31. c. The Institutional Review Board (IRB)
32. c. Frequently require clinical patient monitoring.
34. c. Bronchitis
ORDERING
1. C. Medications are procured and appropriately stocked in the automated medication

dispensing device or in the pharmacy.
2. G. Prescriber issues medication order.

3. A. The medication order is reviewed and verified by a pharmacist.
4. H. Medication order is processed and added to the patient’s medication profile.
5. F. The medication is released in the automated medication dispensing device and

retrieved by a nurse for administration to the patient.
6. D. If the medication is not available in the automated medication dispensing device,

the order is filled by a technician in the pharmacy and verified by the pharmacists
before delivery to the patient’s nurse.
7. B. The medication is administered, and the administration is documented in the MAR.
8. E. The patient is monitored to ensure response to therapy and to watch for adverse
events.
TRUE OR FALSE
1. T
2. T
3. F Inventory is ordered and kept on hand so it is available immediately when a

medication order is received for a patient.
4. F The P&T Committee sets the formulary, but the pharmacy is responsible for
obtaining and stocking the medications.
5. T
6. T
7. T
8. F These are advantages of a decentralized service.
9. F The P&T Committee is a standing committee, not ad hoc.
10. F The operation and maintenance of automated distribution systems is a technical

responsibility assigned to pharmacy technicians. It is not required that a
pharmacist perform these activities.
11. T
12. T
13. T
14. F All medication orders, regardless of the origin or form, are reviewed by a
pharmacist.
15. F A double-check is performed manually or with technology (barcode scans). It is

important that the medications are correct and in the proper place for easy and
accurate retrieval during a code.
Medications should be visually checked for expiration date, any damage, and to ensu
16. F medication is correct (because barcode systems can fail if the barcode is
smudged or damaged, or the wrong barcode sticker was applied).
17. T
18. T
19. T
20. F Investigational medications must be stored in a separate section of the pharmacy

with limited access.
21. F The FDA is not an accreditation organization. Hospitals are accredited by TJC.
22. T
FILL IN THE BLANK
1. Formulary
2. Decentralized
3. Policy and procedure
4. Medication administration record or MAR
5. Pharmacy and Therapeutics (P&T) Committee
6. Closed
7. Pharmacy
8. Automated
9. Automated
SHORT ANSWER
1. Describe the elements on a medication label intended for patient administration.
The major requirements for proper labeling include patient’s name, patient’s location in
the hospital, medication name, dose, route of administration, expiration date, and any
special directions or cautionary instructions for storage or administration.
2. What is the purpose of MUEs?
An MUE is commonly performed with medications that fall into one or more categories
identified by the hospital, including high-use drugs, high-cost drugs, and high-risk
drugs. Data are collected to evaluate the appropriate use of these drugs, including
appropriate indications, dose, route, and clinical response. After the MUE data are
collected on a predefined number of patients, the results are tabulated and presented
to the appropriate healthcare providers and committees. Depending on the results,
appropriate recommendations and actions are taken. For example, if the data show
many patients are receiving doses too high based on the indication and renal function,
recommendations and actions may be provided that include education and training to
healthcare providers on the appropriate dosing criteria for this medication. Another
action may be to give the pharmacist authority to automatically change the dose based
on approved criteria by the P&T Committee. No matter what technique or data source is
used to evaluate the process, the primary goal is to identify areas for improvement and
implement strategies or needed changes in the process to improve the medication
management system.
3. What is the difference between quality improvement and quality control?
Quality improvement (QI) is a formal or systematic approach to analyzing the

performance of a system or process. Quality control (QC) is a process of checks and
balances (or procedures) that are followed during the manufacturing of a product or
provision of a service to ensure that the end-products or services meet or exceed
specified standards (e.g., zero errors, zero problems).
CROSSWORD PUZZLE
ANSWERS CH 6
THE HUMAN BODY: STRUCTURE AND
FUNCTION
MULTIPLE CHOICE
1. a. Central nervous system and the peripheral nervous system
2. c. Hypertension
3. b. Heart, blood vessels, and blood
4. c. Myocardium
5. b. The right atria and the right ventricle pump blood into the lungs.
6. d. Autonomic nervous system
7. c. Coronary artery disease
8. c. Anemia
9. a. Allows oxygen to be taken to cells in the body and carbon dioxide to be removed
from the same cells.
10. b. Sunlight
11. c. Muscle fibers are made up of thick and thin elongated filaments.
12. d. Pulmonary muscle
13. d. High levels of vitamin D
14. c. Cortex
15. d. Control glands around the eye that produce tears.

16. b. Disturbances in the endocrine system may occur from damage to the gland.
17. a. Melatonin is produced by the pituitary gland.
18. d. Can cause a broad range of illnesses in humans.
19. a. Sclera/cornea
20. d. Vestibular apparatus
21. d. Antiseptics
22. d. Estrogen and progesterone
24. d. Thyroid gland
25. a. Pancreas
26. c. A goal of inflammation is to begin the process of tissue healing and repair.
27. c. The small intestine is nearly 10 feet long with its inner wall covered with villi.
28. d. Bladder infections and colitis
29. d. Drinking an excess of water
30. b. Inability to fully empty the bladder
31. c. Nociceptors
32. c. Is commonly caused by excessive moisture leading to an infection.
33. c. Antiseptics
34. a. Impotence
MATCHING I
1. F. Efferent division
2. J. Sympathetic nervous system
3. K. Parasympathetic nervous system
4. A. Central nervous system
5. B. Peripheral nervous system
6. F. Efferent division
7. K. Parasympathetic nervous system
8. D. Sensory stimuli
9. E. Efferent division
10. B. Peripheral nervous system
11. I. Motor neurons
12. C. Afferent division
13. G. Autonomic nervous system
14. G. Autonomic nervous system
15. H. Somatic nervous system
16. J. Sympathetic nervous system
MATCHING II
1. C. acetylcholine
2. F. norepinephrine and dopamine
3. D. serotonin and norepinephrine
4. D. serotonin and norepinephrine
5. C. acetylcholine
6. B. dopamine and acetylcholine
7. E. dopamine
8. E. dopamine
9. A. GABA and acetylcholine
ORDERING
1. E. pulmonary capillaries
2. F. pulmonary veins
3. B. left atrium
4. C. left ventricle
5. A. aorta
6. I. systemic arteries
7. J. systemic capillaries
8. K. systemic veins
9. L. vena cava
10. G. right atrium
11. H. right ventricle
12. D. pulmonary arteries
TRUE OR FALSE
1. F MS is caused by a breakdown in the myelin sheath.
2. T
3. T
4. F Alzheimer’s is a degenerative neurological disorder in which brain tissue shrinks

and nerve cells are lost.
5. F Depression and bipolar disorder
6. F Acute pain is short-lived. Chronic pain lasts for months.
7. T
8. F ADHD is hyperactivity and difficulty staying focused.
9. T
10. F Red blood cells
11. T
12. F Arrythmia
13. T
14. T
15. F Anxiety disorder
16. F Smooth muscle
17. T
18. F “In” is inspiration, and “out” is expiration.
19. F The description is of rheumatoid arthritis.
20. T
21. T
22. T
23. F Antihistamines
24. F At the terminal end of the bronchioles are the alveolar sacs, where gas exchange
takes place.
25. F Includes emphysema and chronic obstructive bronchitis.
26. F Treatment is not curative, but it is chronic. Lifestyle changes are aimed at lessening
symptoms and preventing further damage.
27. T
28. F Smooth and cardiac muscles have their own ability to initiate electrical signals.
29. F Lower respiratory infections are of the lower airways and lungs.
30. T
31. F Hypothyroidism is treated with thyroid hormone replacement.
32. F Diabetes mellitus is treated with insulin.
33. F Chronic renal failure requires dialysis or a kidney transplant to cure.
34. F HIV/AIDS is spread by blood-to-blood and sexual contact.
35. T
FILL IN THE BLANK
1. Anatomy
2. Thoracic or chest; sternum or breast bone
3. 206
4. Physiology
5. Four
6. Pulmonary embolism
7. Smooth
8. Bradycardia
9. Asthma
10. Osteoporosis
11. Type 1
12. Type 2
13. Immune
14. Conjunctivitis
15. Alkalosis
16. Strain
17. Sprain
18. Eczema
19. Sexually transmitted diseases or STDs
20. Benign prostatic hyperplasia or BPH
SHORT ANSWER
1. Describe the important functions of the kidneys.
The kidneys perform many important functions. One such function is to filter the blood
as it passes through the nephrons and remove waste products (e.g., products from
protein breakdown), while reabsorbing important substances (e.g., glucose, protein),
and returning them to the circulation for use by the cells of the body. In the process of
filtering the blood, urine is formed. The kidney also plays a critical role in regulating the
volume of the plasma, and therefore the blood volume, which affects blood pressure.
Another function is regulating the concentration of certain electrolytes (e.g., chemicals
such as sodium, potassium, bicarbonate) in the blood plasma, which are important for
maintaining proper functioning of cells throughout the body.
2. Describe what triggers heart muscle contractions and heart rhythms, including the
systems involved.
The heart contains specialized cells, called pacemaker cells, which generate electrical
signals that trigger contraction of the heart and set the heart rhythm. In addition, the
rate and force with which the heart pumps blood is regulated by the two divisions of
the autonomic nervous system: the sympathetic and parasympathetic divisions. The
sympathetic division increases the heart rate and the force with which the heart
contracts. In contrast, the parasympathetic division slows the heart rate.
CROSSWORD PUZZLE
ANSWERS CH 7
DRUG CLASSIFICATIONS AND
PHARMACOLOGIC ACTIONS
MULTIPLE CHOICE
1. a. Are sometimes used for migraine prevention.
2. c. The MedGuide includes a warning about the increased risk of suicidal thoughts or
behavior.
3. c. Maintain function and quality of life.
4. a. Decreasing acetylcholine and increasing dopamine.
5. c. Memory impairment and behavioral changes
6. d. Symptoms may include memory loss and confusion.
7. d. Maximize the amount of medications needed.
8. c. May be due to nerve damage in the central or peripheral nervous system.
9. d. Methylphenidate
10. b. Reduce LDL levels and increase HDL levels.
11. d. Thiazide diuretics are only used as monotherapy.
12. b. ACE inhibitors may increase survival in patients with heart failure.
13. b. Heart rhythm disturbances
14. b. Nitrofurantoin capsules
15. c. Acetylcholine blockers

16. c. Salmeterol
17. b. A fungus of the throat and mouth called “thrush” is a common side effect.
18. d. There is little scientific evidence to show that they decrease the thickness of
phlegm.
19. c. NSAIDs have antipyretic properties.
20. d. Diazepam, baclofen, and dantrolene are used for muscle spasticity.
21. c. By using a pain scale where the patient rates their own pain.
22. b. May be given by subcutaneous or IV injection or by inhalation.
23. b. Propylthiouracil
24. c. Antihistamines have been shown to effectively shorten the duration of the common
cold.
25. a. Used for rhinitis and other allergic or inflammatory conditions of the nose.
26. d. May be used in drug regimens directed at eradicating H. pylori.
27. d. Aminoglycosides
28. a. Conjunctivitis
29. d. gabapentin (Neurontin)
30. c. levodopa/carbidopa
31. c. Obsessive compulsive disorder
32. a. atorvastatin
33. d. propranolol
34. a. lisinopril
35. c. amiodarone
36. d. Opioid medications have anti-inflammatory properties.
37. b. Insulin glargine
38. d. tetracycline
39. a. Adderall XR
40. c. warfarin
41. a. COX-2 inhibitors
42. d. albuterol
43. a. It may cause weight loss.

44. d. Gallbladder disease
45. a. atorvastatin
46. b. HIV/AIDS
47. c. Combination therapy often allows for lower doses of each medication, which may
decrease the incidence and severity of toxicity.
48. c. apixaban
MATCHING I
1. H. Vitamin B12
2. E. Vitamin B3
3. F. Vitamin B5
4. G. Vitamin B6
5. A. Vitamin A
6. D. Vitamin B2
7. C. Vitamin B1
8. B. Vitamin E
MATCHING II
1. I. alteplase, a thrombolytic—hematologic system
2. B. amlodipine, antihypertensive agent—cardiovascular system
3. J. anastrozole, an aromatase inhibitor chemotherapy agent—oncology/chemotherapy
4. H. atazanavir, an antiretroviral used for HIV—anti-infectives
5. B. atorvastatin, a cholesterol-lowering agent—cardiovascular system
6. F. bisacodyl, used for constipation—gastrointestinal system
7. A. carbamazepine, used for tonic-clonic seizures—nervous system
8. K. carbamide peroxide/glycerin drops, used to soften ear wax—topical (eyes, ears,

skin)
9. H. cefuroxime, a cephalosporin antibiotic—anti-infectives
10. C. cetirizine, antihistamine for allergies—respiratory system
11. J. cisplatin, a heavy metal chemotherapy agent—oncology/chemotherapy

12. L. cyanocobalamin, Vitamin B12—nutritional or dietary supplement
13. J. cyclophosphamide, an alkylating agent used for chemotherapy—

oncology/chemotherapy
14. I. dabigatran, a direct thrombin inhibitor anticoagulant—hematologic system
15. K. desonide, used topically to treat skin inflammation and itch—topical (eyes, ears,
skin)
16. A. dextroamphetamine, used for ADHD—nervous system
17. B. digoxin, for heart failure—cardiovascular system
18. F. diphenoxylate with atropine, used for diarrhea—gastrointestinal system
19. A. donepezil, used for Alzheimer disease—nervous system
20. L. Echinacea, herbal supplement—nutritional or dietary supplement
21. E. empagliflozin, used for diabetes mellitus—endocrine system
22. I. enoxaparin, a low molecular weight heparin anticoagulant—hematologic system
23. F. famotidine, H2 antagonist to reduce stomach acid—gastrointestinal system
24. H. fluconazole, an antifungal agent—anti-infectives
25. A. fosphenytoin, used for status epilepticus—nervous system
26. A. glatiramer acetate, used for patients with relapsing MS—nervous system
27. E. glipizide, used for diabetes mellitus—endocrine system
28. L. glucosamine, a supplement often used for joint pain or arthritis—nutritional or

dietary supplement
29. J. imatinib, a kinase inhibitor chemotherapy agent—oncology/chemotherapy
30. E. insulin detemir, used for diabetes mellitus—endocrine system
31. C. levalbuterol, a short-acting bronchodilator—respiratory system
32. A. levetiracetam, used as an adjunct for partial onset, myoclonic and tonic-clonic
seizures—nervous system
33. E. levothyroxine, used for hypothyroidism—endocrine system
34. A. lorazepam, used for anxiety, seizures—nervous system
35. F. mesalamine, used for inflammatory bowel disease—gastrointestinal system
36. E. methimazole used for hyperthyroidism—endocrine system
37. D. methocarbamol, muscle relaxer—musculoskeletal system
38. J. methotrexate, an antimetabolite chemotherapy agent—oncology/chemotherapy

39. B. metoprolol tartrate, antihypertensive agent and antiarrhythmic—cardiovascular
system
40. H. ofloxacin, a fluoroquinolone antibiotic—anti-infectives
41. F. ondansetron, antiemetic agent—gastrointestinal system
42. H. oseltamivir, an antiviral agent—anti-infectives
43. G. oxybutynin, used to treat overactive bladder—urinary system
44. F. pantoprazole, proton-pump inhibitor to prevent production of stomach acid—

gastrointestinal system
45. L. potassium chloride, a mineral—nutritional or dietary supplement
46. B. ramipril, antihypertensive agent—cardiovascular system
47. A. ropinirole, used for Parkinson disease—nervous system
48. C. salmeterol, a long-acting bronchodilator—respiratory system
49. A. selegiline, used for Parkinson disease —nervous system
50. A. sertraline, SSRI used for depression—nervous system
51. A. sumatriptan, used for migraine headaches—nervous system
52. K. tetrahydrozoline, used as a vasoconstrictor in eye drops—topical (eyes, ears, skin)
53. G. tolterodine, used to treat overactive bladder—urinary system
54. K. travoprost, prostaglandin analog used in the eyes—topical (eyes, ears, skin)
55. B. valsartan, antihypertensive agent—cardiovascular system
TRUE OR FALSE
1. F All drugs have adverse effects.
2. F Many are toxic, not all.
3. T
4. T
5. T
6. F Phenytoin in dextrose will cause a precipitate and should not be used.
7. T
8. T
9. F Triptans
10. T
11. T
12. F Monoamine oxidase inhibitors have many severe food and drug interactions.
13. T
14. T
15. T Schizophrenia
16. F
17. F Must be taken on a scheduled basis to be effective.
18. T
19. T
20. F Loop diuretics are more potent.
21. T
22. F “-pril”
23. F Bronchodilators
24. T
25. T
26. T
27. T
28. F Not anti-inflammatory or antipyretic.
29. F Also available by inhalation.
30. F Used in Type 2.
31. T
32. F Often cause drowsiness; the paradoxical effect is excitation.
33. F Topical
34. T
35. T
36. F Multiple agents
37. T
38. F 72 hours
39. F External
40. F Not used for stroke or gallbladder disease.
41. F Over 1 year
42. F Only men have a prostate.
43. T
44. T
45. F Macrolides do not cross-react with penicillins.
46. T
47. F Not effective orally for systemic infections.
48. F Guidelines are for TB that shows no drug resistance.
49. F Rifampin
50. F Herpes zoster
51. F Used in combination therapy.
52. T
53. T
54. F White blood cells
55. F There are many side effects and interactions.
56. T
57. F Also, inflammatory bowel disease, arthritis, MS, psoriasis, and more.
58. T
59. T
60. F Also available in an oral tablet.
61. F Absence seizures
62. T
63. T
FILL IN THE BLANK
1. Norepinephrine
2. Orthostatic or postural
3. Bronchodilator
4. Subarachnoid
5. Pancytopenia
6. Respiratory depression
7. Agranulocytosis
8. Agonist
9. Extrapyramidal
10. Bronchoconstriction
11. Serotonin
12. Dopamine
13. Drug
14. Acetylcholine
15. Serotonin syndrome
16. Tonic-clonic
17. Neurotransmitter
18. Antiproliferative
19. Peripheral edema
20. Bronchodilation
21. Anticholinergic
22. Adjunct or adjunctive
23. Inhibitor
24. Monoclonal antibody
25. Vasodilation
26. Peripheral neuropathy
27. Ketoacidosis
28. Delusions
29. Hallucinations
30. Passive
31. Myocarditis
32. Arrhythmia
33. Arthralgia
34. Active
35. Akinesia
36. Hypotension
37. Myalgia
38. Monotherapy
39. Absence or petit mal
40. Cross
41. Rhinitis
42. Bradykinesia
43. Myelosuppression
44. Expectorate
45. Empiric
46. Asthenia
47. Status epilepticus
48. Triptans
49. Neuropathic
50. Black box warning
51. Tricyclic
52. Bipolar
53. Psychosis
54. Amnesia
55. Diuretics
56. Nitrates
57. Corticosteroids
58. Osteoporosis
59. Aminoglycoside
60. Vancomycin
61. Herpes simplex
62. Warfarin or Coumadin
63. K
64. Potassium
SHORT ANSWER
common or most serious adverse effects, and special precautions for drugs used to treat
diabetes mellitus.
See pages 222-226 in the Manual for Pharmacy Technicians, 5th edition (Drugs That
Affect the Endocrine System).
common or most serious adverse effects, and special precautions for sedatives and
hypnotic drugs.
See pages 148–152 in the Manual for Pharmacy Technicians, 5th edition (The Nervous
System).
ANSWERS CH 8
DRUGS AND THE BODY
BASIC BIOPHARMACEUTICS, PHARMACOKINETICS, AND
PHARMACODYNAMICS
MULTIPLE CHOICE
1. d. Absorption, distribution, metabolism, excretion
2. b. Sublingual nitroglycerin has a higher bioavailability than oral capsules.
3. c. An oral suspension
4. c. Neomycin
5. c. Only the amount of drug that is free can leave the bloodstream to exert a
pharmacological effect.
6. b. The movement of a drug through the body.
7. a. The medications are 100% bioavailable.
8. b. May occur in the small intestines.
9. b. Kidneys
10. b. Dissolution
11. c. Liver and small intestine
12. b. Kidneys and biliary tract
13. b. Enzymes
14. d. Elimination
15. a. Intravenous
16. c. Impaired metabolism and high blood levels
17. a. Metabolism of other medications
18. c. Eating a large amount of kale.
19. d. Drinking red wine or eating aged cheese.
20. a. Taking calcium or drinking milk along with the dose.
21. b. Drinking grapefruit juice.
22. c. Eating bananas and oranges.
23. b. Receptor
24. c. In pregnant patients because drugs may be cleared through the kidneys faster than
normal.
MATCHING
1. P. Metabolite
2. E. Cytochrome P450 (CYP)
3. N. Loading dose
4. A. Absorption
5. T. Therapeutic level
6. F. Disintegration
7. O. Metabolism
8. G. Dissolution
9. U. Volume of distribution
10. I. Drug interaction
11. K. Excretion
12. L. First-pass metabolism
13. B. Bioavailability
14. J. Elimination
15. R. Pharmacogenomics
16. C. Biopharmaceutics
17. S. Pharmacokinetics
18. Q. Pharmacodynamics
19. M. Half-life
20. D. Clearance
21. H. Distribution
TRUE OR FALSE
1. F Dissolution
2. F Must disintegrate first.
3. T
4. F IV-administered medications are placed directly in the bloodstream.
5. T Intramuscular (IM) depot injections are an example.
6. T
7. F IV drugs are delivered directly to the veins and do not experience first-pass
metabolism.
8. F The medication must be free (unbound to the protein) to be effective.
9. T
10. T
11. T
12. F Not most
13. F Liver and small intestine
14. T
15. T
16. F Absorption
17. F Receptor
18. F Many drugs cross into breast milk.
FILL IN THE BLANK
1. Biopharmaceutics
2. Albumin
3. Metabolism
4. Drug-drug
5. Creatinine
6. Liver
7. Agonists
8. 50%
9. Lower
10. Pharmacogenomics
11. Antagonists
SHORT ANSWER
1. List the common formulations and routes of administration for medications.
Common formulations include tablets, capsules, solutions, suspensions, suppositories,

transdermal patches, creams, nasal sprays, and aerosolized medications.
Routes of administration include oral, intraocular (in the eye), rectal, sublingual (under
the tongue), buccal (cheek), topical, transdermal (through the skin), injectable, and
inhaled.
2. Discuss why one formulation or route of administration would be used over another.
Choosing one over the other may simply be a matter of preference or convenience. For
example, the analgesic acetaminophen is available in many different dosage forms
including tablets, capsules, caplets, suspensions, and suppositories. For small children,
administration by suspension or suppository will likely be easier than a tablet. In other
cases, different formulations and routes of administration are used because they can
influence the rate, duration, or even extent of drug effect. Therefore, using the correct
or optimal formulation is important and often has a bearing on the clinical effect of the
medication.
3. Describe why it is valuable for a pharmacy technician to become familiar with the basic
principles of biopharmaceutics, pharmacokinetics, and pharmacodynamics.
A pharmacy technician must become familiar with the basic principles of these
important areas to appreciate their contribution to the clinical effects, drug
interactions, and toxicity of medications. When the technician is asked if a medication
can be crushed, he or she will know why this seemingly simple question is a very
important one with potentially problematic consequences if wrong directions are given.
When the computer system alerts the technician to a drug interaction between an
enzyme inducer and another medication, he or she will have a basic understanding of
the mechanism of the interaction. Knowledge about loading doses will help the
technician understand why there might be two doses given in a short period of time for
the same drug. Knowledge of differences in dosing in special populations will help the
technician assist in recognizing when doses make sense and when they should be
questioned.
ANSWERS CH 9
MEDICATION DOSAGE FORMS AND ROUTES
OF ADMINISTRATION
MULTIPLE CHOICE
1. c. Systemic
2. d. Acetone
3. b. Are absorbed more quickly than other oral dosage forms.
4. c. Syrups may be plain sugar and water or may have added flavorings.
5. d. Transdermally to administer medication.
6. b. Emulsions
7. d. A flavored oral solution or suspension is preferred in children to make unpleasant-

tasting medications more palatable.
8. c. Is used in oral, topical, and parenteral formulations.
9. b. Intravenously
10. c. Should not be cut or crushed.
11. a. Protect the medication from exposure to air and humidity.
12. d. Are absorbed quickly as the tablet is placed in liquid to dissolve before ingesting.
13. a. Are solid, capsule-shaped tablets.
14. d. Are not the same as caplets.
15. b. Are only used for medications delivered to the mouth and throat.
16. c. Medications delivered in suppository form may be for local or systemic effects.
17. c. Soften the skin and may or may not contain medication.
18. d. Syrup
19. a. Are only used rectally.
20. d. Are only used as a vehicle for oral administration of medication.
21. b. Fill for the oral liquid and instruct the patient in how to measure the correct volume
that would contain 300 mg of the medication.
22. d. Coated capsule
23. c. Oil-in-water emulsions wash off with water and do not feel greasy.
24. c. Gels are not used rectally or vaginally administered medications.
25. d. A drug given by IV is available to act faster than an orally administered medication
when used to treat serious conditions.
26. a. Into a vein
27. c. Oral
28. b. Desiccants
29. a. Elixirs
30. b. Intravitreous
MATCHING
1. V. Topical
2. E. Enteral
3. F. Parenteral
4. P. Subcutaneous
5. B. Buccal
6. H. Intra-articular
7. L. Intravenous
8. G. Intra-arterial
9. S. Otic
10. O. Intravitreal
11. R. Ophthalmic
12. I. Intracardiac
13. Q. Intranasal
14. K. Intrathecal
15. J. Intradermal
16. N. Intravesicular
17. M. Intraventricular
18. U. Rectal
19. A. Oral
20. T. Percutaneous
21. W. Transdermal
22. D. Subgingival
23. C. Sublingual
TRUE OR FALSE
1. F Liquid dosage forms are easier for children to take.
2. F It may be made into an aqueous suspension OR a nonaqueous or hydroalcoholic

solution.
3. T
4. F May also be suspensions.
5. F Even with sweeteners, some medications remain unpleasant to the taste.
6. T
7. F Liquids do not have to disintegrate first.
8. F Particles must dissolve first.
9. F Should not be swallowed.
10. F Only sucrose and water
11. F Also used to treat diseases in that area.
12. T
13. T
14. T
15. T
16. T
17. F Boluses are given by IV push.
18. F IM is faster than oral but slower than IV.
19. T
20. F Relatively small amounts may be administered IM or sub-Q, and larger amounts
may be administered IV.
21. F Intra-arterial administration is a greater risk and only medications specifically

formulated for intra-arterial use are administered.
22. F Into the sacs (pleura) around the lungs
23. F Urinary bladder
24. T
25. T
26. F Systemic medications may also be administered vaginally.
FILL IN THE BLANK
1. Local
2. Systemic
3. Emulsions
4. Gargle
5. Effervescent
6. Granule
7. Suspensions
8. Rinse
9. Mucilages
10. Buccal
11. PO
12. Parenteral
ALPHABET SOUP
1. CD: controlled-diffusion
2. CR: controlled-release or continuous-release
3. CRT: controlled-release tablet
4. ER: extended-release
5. LA: long-acting
6. SA: sustained-action
7. SR: sustained-release or slow-release
8. TD: time-delay
9. TR: time-release
10. XL: extra-long
11. XR: extended-release
SHORT ANSWER
1. What are the advantages and disadvantages of liquid medications versus other dosage
forms?
Advantages:
a. Oral liquid medication dosage forms are usually faster-acting than solid medication
dosage forms.
b. Patients who have difficulty swallowing may find oral liquid medications easier to
take than medications in solid dosage forms.
c. Liquids have more dosage flexibility than some other dosage forms because liquid
is usually dispensed in bulk containers rather than individual dosage units.
d. Liquid medications may be used where solid medication dosage forms are not
practical (e.g., eye or ear drops).
Disadvantages:
a. Liquid medication dosage forms often have shorter expiration times than other
dosage forms.
b. Many drugs have an unpleasant taste when the medicine is chewed or dissolved,
and drug particles come in contact with the taste buds of the tongue. Sweeteners
and added flavors are used to make these liquid medications taste better. Even so,
the taste of some liquid medications remains disagreeable. In contrast, tablets and
capsules are often coated and can be swallowed quickly to avoid contact with the
taste buds.
c. Patients sometimes find liquid medications inconvenient because they can spill,
require careful measuring before taking, or have special storage or handling
requirements such as refrigeration or shaking before use.
2. Discuss the advantages and disadvantages of extended-release products.
Advantages:
a. They deliver medication in a slow, controlled, and steady way so the patient
absorbs the same amount of medication throughout a particular time period.
b. The chance of drug side effects is reduced because the medication is delivered in
smaller amounts over a long period of time, rather than all at once.
c. Patients may take the medication less frequently, perhaps only once or twice a day,
or even as infrequently as once a week, once a month, or even longer.
d. Patients are more likely to take their medications properly and are less likely to
experience side effects, if they can take them less often.
e. The daily medication cost to patients may be decreased. Although extended-
release products may be more expensive on a per-dose basis, the total daily cost
may be less because the patient takes fewer doses overall.
Disadvantages:
a. There may be a delay between the time the patient takes the medication and the
time it takes effect. Extended-release products are not helpful in situations where
an immediate effect is required.
b. If a patient experiences a side effect, it may take time for the effect to go away
because some of the medication may remain in the body for a while.
c. Most extended-release products cannot be cut, crushed, or chewed. This may limit
the situations in which the product may be used.
d. The medication may be more expensive than an immediate-release product.
3. Discuss the different technologies used to make a medication in an extended-release

form.
Beads—many small, different-sized beads of medication with different thicknesses of a

coating material are put in a hard gelatin capsule, suspended in a liquid vehicle,
compressed into a tablet, or put into a soft gelatin shell. In the stomach, the small
beads are let loose and dissolve and release medication at varying rates over a period
of time.
Matrix—a portion of the medication is treated and made into special granules. These
granules are combined with an untreated portion of the medication and made into a
tablet or capsule. The untreated drug granules immediately release the drug in the
stomach, while the treated ones slowly wear away to provide a prolonged effect.
Layers—one layer of medication dissolves immediately, and the remaining layer(s)

dissolves more slowly and gradually releases the drug.
Plastic or wax matrix core covered by a controlled-release layer—drug is

released into the body as it slowly trickles out of the matrix. The matrix does not
dissolve and passes through the digestive tract and is excreted in the feces. The
leftover matrix is inactive and is sometimes called a ghost tablet.
Osmotic pump—uses the principle of osmosis, the flow of fluids from areas with a
high amount of a substance to areas with a low amount. The osmotic pump consists of
a special membrane that surrounds a core of medication. As fluid in the stomach
passes through the membrane, the core inside swells and pushes medication out of a
small hole drilled in the membrane.
CROSSWORD PUZZLE
ANSWERS CH 10
COMMUNICATION AND TEAMWORK
MULTIPLE CHOICE
1. b. An individual working in a pharmacy who, under the supervision of a licensed

pharmacist, assists in pharmacy activities that do not require the professional
judgment of a pharmacist.
3. d. Pharmacy practice is stressful, and the pharmacist is not expected to always remain
in control of their feelings and emotions.
4. b. By remaining calm and courteous and determine what it is you can do to help the
patient, realizing they already don’t feel well and may have other things on their
mind.
5. d. Your personal grooming and hygiene do not play a role in effective communication.
6. d. Pay attention to body language and emotional signals and anticipate your patient’s
needs.
8. d. The first person a new patient—presenting a prescription to be filled at the

pharmacy counter—meets (and the first impression) is always the pharmacist.
9. c. Acknowledging a patient when they arrive and letting them know you will be with
them shortly and then finishing your call with a clinic.
10. b. Any type of clothing may be worn if the clothing is clean, free of stains, and
pressed. (Clothing must also be socially appropriate and adhere to the dress code
of the pharmacy.)
11. a. Political comments that may be overheard by patients should be avoided unless
you know your patients share your same viewpoint.
12. c. The pharmacy technician does not have control over their response to a patient.
13. a. Personal physical distance from the patient when communicating is important.
14. b. May be affected by body language and your vocal tone.
15. b. Should be used to determine if the message was understood and interpreted
correctly.
18. a. Ensure that the recipient party hears the same message, both in content and
intent, as the deliverer and that the intended result of that message is achieved.
20. d. Must manage personal feelings while recognizing and considering the feelings of
their patients.
21. a. Transmitting, receiving, and processing information
22. b. “What allergies do you have?”
23. b. “Would you like a month’s supply?”
24. d. Knowing that this is a new prescription for this patient, and that the pharmacist has
important information to review with the patient regarding the medication and
administration, you let the patient know that the pharmacist will be able to talk to
them about this prescription in a few minutes and encourage them to wait.
25. b. Helps the patient appropriately use the medication and prevent medication errors
only if the patient can read that language It cannot be assumed that a patient who
speaks another language will possess the necessary level of general literacy in that
language to read and fully understand the label instructions. If a patient is literate
in the target language, this can help them understand the printed directions on the
label, but even this does not eliminate the need to use other methods of counseling
and verification of understanding.
26. c. Revisit discussions and decisions again and again after finalized.
27. d. Explain that either a prior authorization would need to be obtained to cover the
medication or that a prescription for a covered medication would need to be
obtained. Then ask the patient if he would like you to contact the insurance
company and his physician for him. (This is the best answer because you have
explained the details of the situation and given the patient the choice. By asking if
the patient would like you to take the extra steps to help him, you are conveying
that you care about the patient and are willing to help obtain the needed
medication or alternative.) (Answers a and b do not take care of the patient; answer
c is true, but it implies that you have to do extra work, and if it is said curtly, would
imply you are unhappy about it.)
Millennials are the fastest-growing population group and account for the highest
28. b. percentage of medication use requiring the most in-depth medication
management.
30. c. Genuine interest and concern should be exhibited using patient-centered

communication strategies.
MATCHING
1. D. Placating response
2. B. Advice-giving response
3. C. Quizzing response
4. A. Judgmental response
5. D. Placating response
6. C. Quizzing response
7. B. Advice-giving response
8. A. Judgmental response
TRUE OR FALSE
1. T
2. T
3. F Pharmacists and technicians need to keep their personal emotions to themselves.
4. T
5. F Empathy is when an individual can identify with and understand another person’s
feelings or difficulties.
6. T
7. T
8. F Does both.
9. F Technicians must interact with many individuals—coworkers, patients, healthcare

professionals, and others.
10. T
11. T
12. F Effective communication is important regardless of the type of interaction or the
media used.
13. T
14. F Once it has been said, a message can’t be taken back. And if you don’t realize there
is a miscommunication or misunderstanding, it could lead to very serious health
consequences for your patient if it involves appropriately taking a needed
medication, for example.
15. T When you convey a message, the receiver must listen to understand the message.
When the receiver responds, the sender must listen to ensure the original message
was conveyed and understood correctly.
16. F One of the most important things to remember about verbal communication is that
“Once it has been said, it can’t be taken back.”
17. F Internet “etiquette” also dictates that e-mail and business-related messages not be
composed of all uppercase letters, to prevent the perception of “shouting” or
“scolding.”
18. T
19. F Close-ended questions are questions that can be answered with a simple “yes” or
“no.”
20. T
21. F Old age should not be confused with low general and health literacy skills. Assess
all patients with regard to hearing, understanding, and general health literacy
skills.
22. F Sensitivity to the cultural differences in patient populations is necessary to help

ensure effective communication.
23. F Patients are often coping with a number of personal issues and serious health
conditions and concerns. Some patients are better able to cope with these
challenges than others.
24. T
25. F Literacy is not always correlated with a high health literacy. Patients can achieve a
very high education level but can still have a hard time understanding healthcare
terminology and their plan of care. For example, if you do not understand baseball,
you will have difficulty understanding an article about baseball because the article
assumes you know the terminology, slang, acronyms, and rules of the game.
26. T
FILL IN THE BLANK
1. Judgmental
2. Closed
3. HIPAA
4. Teamwork
5. Health literacy
6. Older or elderly
7. Nonverbal
8. Empathy
9. Listening
SHORT ANSWER
1. Describe a situation in a pharmacy where a pharmacy technician would interact with a

patient. In this patient encounter scenario, compare and contrast effective and
ineffective communication skills using your knowledge of all forms of communication
(e.g., verbal, nonverbal).
Many scenarios may be described in answer to this question. Important points include:
a. Professionalism
b. Care and respect
c. Assertive behavior
d. Active listening skills
e. Empathy
f. Appropriate body language
g. Appropriate physical distance and contact
2. Discuss the four types of responses that should be avoided and how these responses
might be perceived negatively by the patient, producing an undesirable outcome.
A judgmental response to a situation could be viewed as devaluing the patient’s

concern, as in: “You seem to be the only one concerned about our ability to provide you
with the correct medication quickly. All our other patients really love us, and they don’t
seem to care about the wait.”
An advice-giving response to a situation could be viewed as evidence that the

technician thinks that the patient doesn’t understand or hasn’t thought through the
comments; it might consist of the following statement: “You need to talk to the other
patients who are waiting here. They will tell you that we know more about medicine
and the prescription-filling process than you do.”
A quizzing response to a situation could be viewed as evidence that the technician

thinks the patient is confused or wrong; for example: “Think back to when you have
picked up medication at other pharmacies. I don’t believe that you have gotten it as
quickly as we are going to give it to you.”
A placating response to a situation above could be viewed as condescending, for

example: “Oh, you shouldn’t worry so much about the length of time. Just shop around
for a while until it is ready, and try not to get yourself so worked up.”
3. Teamwork is important in pharmacy. Disrespectful behavior of coworkers may result in

lack of teamwork, poor morale, resignations, and may even contribute to errors. Discuss
disrespectful behaviors in the workplace, including how they should be handled.
Examples of disrespectful behavior may include disruptive, demeaning, intimidating,

passive-aggressive behavior, passive disrespect, or dismissive comments to others. It
may also involve bullying, threats, or physical/verbal abuse.
If you find yourself in a stressful situation that is causing you to feel intense emotions,
try to separate the message from the emotions and use calming techniques, such as
counting to 10. Always think before you speak and seek help from others if you feel like
you cannot control your impulses. Many organizations have employee assistance
programs that can offer guidance on how to control emotions. If you see or experience
this type of behavior from others, you should talk to the pharmacist or appropriate
supervisory personnel. If the behavior is not addressed, it will likely continue to occur.
Some organizations have anonymous reporting mechanisms available for those who do
not feel comfortable giving their name when speaking up. It is important to be aware of
how to handle this type of behavior so that you can help yourself, your co-workers, and
patients who may be the victims of this behavior.
CROSSWORD PUZZLE
ANSWERS CH 11
PROCESSING MEDICATION ORDERS AND
PRESCRIPTIONS
MULTIPLE CHOICE
1. b. By the order in which the medication order was received (i.e., first in, first out)
2. a. Comparing the order against the patient’s existing medication profile.
3. a. Check to see that the order makes sense for the patient by comparing the order
against the patient profile. (If an incorrect sticker is applied to an order, it will
contain the wrong patient name as well as the wrong account number and the
wrong medical record number.)
5. d. The institution’s standard medication administration times
6. d. Bring the unusual dose to the attention of the pharmacist for clarification as it may
be an error.
8. c. Aminoglycoside dosing and monitoring
10. d. Patient’s name
11. c. Naloxone
12. d. Hair color and eye color
13. a. Insurance coverage

14. c. When you are dispensing two bottles of a medication, you only need to label one
bottle.
15. d. Take 1 tablet by mouth every 4 hours as needed for pain for 3 days.
16. b. Prescriber’s name and DEA number
17. d. Height and weight
18. c. Both centralized and decentralized automation make dispensing more efficient.
19. b. Check the label against the original order to determine if an error was made.
20. d. A technician presented with a prescription that appears to be forged should

immediately call the police.
MATCHING
1. A, B. Inpatient MAR, Outpatient prescription label
2. A. Inpatient MAR
3. A. Inpatient MAR
4. A. Inpatient MAR
5. B. Outpatient prescription label
10. C. Neither
12. C. Neither
13. A. Inpatient MAR
14. C. Neither
17. C. Neither

21. C. Neither
22. C. Neither
ORDERING
1. K. Receive a prescription medication order.
2. I. Perform a review of the order for clarity and completeness.
3. J. Prioritize the order.
4. F. Identify the correct patient record in the computer system.
5. A. Compare the order to the patient profile in detail (e.g., appropriateness, allergies,
duplications).
6. D. Enter or select the medication, including dosage strength and dosage form.
7. L. Schedule administration times.
8. C. Enter any comments, including physician special instructions.
9. B. Ensure the information is entered in the patient MAR (may be generated

automatically).
10. E. Fill and label the medication.
11. H. Perform a final check of the labeled medication.
12. G. Medication is dispensed for administration to the patient.
TRUE OR FALSE
1. T
2. T
3. F The hard copy prescription given to the patient must be presented at the pharmacy.
It may not be faxed in by the patient. (This is to prevent the prescription from being
faxed to and filled by multiple pharmacies. A prescriber may fax a prescription
directly to a pharmacy instead of giving a hard copy to the patient.)
4. T
5. T
6. F Most clarifications must involve the pharmacist.
7. T
8. T
9. F A patient’s medical record number never changes, but account numbers change
every time a patient is admitted to an institution.
10. F It is recommended that prescribers order drug products by generic name instead of
brand name.
11. T
12. T
13. F It is important for the medications to show up on the MAR/eMAR and in the patient
profile so that all caregivers are aware the patient is receiving the medication.
There is also a legal record that the doses were administered, so these medications
must be entered into the computer system.
14. F With CPOE, a pharmacist still reviews and verifies the order before the medication
is dispensed.
15. F Depending on state law, signatures may or may not be valid. Some states do not
accept preprinted prescription blanks, and the prescriber must write “DAW.”
16. F Some common-sense judgment does apply in the outpatient setting. For example,
regardless of the order in which they were presented, prescriptions for customers
who are waiting are generally filled before prescriptions to be mailed the next day.
17. F It is necessary to match the NDC number with the product dispensed both from a
safety standpoint (i.e., a double check) and to ensure accurate billing is performed
(i.e., billing for the actual product dispensed).
18. F Although the pharmacy is not restricted from ordering any medication, outpatient
dispensing will be restricted by the patient’s third-party payer’s formulary of
covered medications.
19. T A patient’s identification number is a unique code number that identifies a specific
patient.
20. F State laws vary in their requirements for telephone prescriptions, particularly when
controlled substances are involved. In many states, only a pharmacist is allowed to
receive telephone prescriptions.
21. T
22. F Entering fewer letters into a search field will often result in a longer list of
selections, thereby increasing the chance for picking the wrong item. Using four or
more letters is optimal.
23. T
24. T
25. T
26. F An outpatient pharmacy generally does not have a single formulary, as a hospital
pharmacy might, but must conform to the various formularies of all the different
third-party payers its customers use.
27. F No identification system is completely free from potential error. Patient
identification is one of the most important steps in the order processing sequence.
28. T
29. T
30. F Latin abbreviations should never be used on labeling for home use. Although
patients may fully understand the directions when they leave the pharmacy, they
may forget by the time they get home. If detailed instructions do not fit on the
prescription label itself, it would be appropriate to give the patient a separate piece
of paper with instructions written in plain English.
31. F Replacing more filling functions with batch runs takes less time and is more
efficient.
FILL IN THE BLANK
1. Automated
2. Medication order
3. Prescription
4. CPOE
5. MAR or eMAR
6. Tall man lettering
7. Decentralized
8. Central
9. Barcodes
10. Adjudication
11. Auxiliary
12. Mnemonic
ALPHABET SOUP
1. CPOE: Computer physician order entry
2. MAR: Medication administration record
3. eMAR: Electronic medication administration record
4. STAT: Immediately (from statim)
5. ASAP: As soon as possible

6. QA: Quality assurance
8. DNS: Do not substitute
SHORT ANSWER
1. Identify the components of a complete inpatient prescription or medication order.

a. Patient name, hospital identification number, and room/bed location
b. Generic drug name (It is recommended that generic drug names be used, and
many institutions have policies to this effect.)
c. Brand drug name (if a specific product is required)
d. Route of administration (with some orders, the site of administration should also be
specified)
e. Dose/strength and dosage form
f. Frequency and duration of administration (if duration is pertinent; may be open-
ended)
g. Rate and time of administration, if applicable
h. Indication for use of the medication
i. Other instructions for the person administering the medication, such as whether it
should be given with food or on an empty stomach
j. Prescriber’s name/signature and credentials (Some hospitals require a printed
name, physician number, or pager number in addition to the signature, to assist
with identification.)
k. Signature and credentials of person writing the order, if other than prescriber
l. Date and time of the order
2. List the information that is typically contained in a patient profile of an inpatient.

a. Patient’s name and identification numbers
b. Date of birth or age
c. Sex
d. Height and weight
e. Laboratory values such as serum creatinine
f. Admitting and secondary diagnoses (e.g., pregnancy, lactation status)
g. Room and bed number
h. Names of admitting and consulting physicians
i. Allergies
j. Medication history (e.g., current and discontinued medications; medication from a
previous admission, if applicable)
k. Special considerations (e.g., foreign language, disability)
l. Clinical comments (e.g., therapeutic monitoring, counseling notes)
3. Describe the process of medication administration and inventory management using a

decentralized automated dispensing model.
a. An order is received in the pharmacy and is entered into the pharmacy computer
system.
b. Once an order entry is completed, a computer interface sends the information to
the automation device, effectively “releasing” the medication for use for a specific
patient.
c. The nurse goes to the machine and keys in the patient’s name and the drug name,
and the appropriate location in the device “unlocks” so that the medication can be
removed.
d. For continuing medications (e.g., a tid medication), the nurse goes back to the
device at designated times (e.g., standard administration times) throughout the
day and removes the medication for administration to the patient.
e. When it is time to restock the machine, the technician prints a batch restock report
that is filled by a technician and then checked by a pharmacist. The technician then
makes a delivery to each unit and restocks the medications into the machines.
Some devices allow for barcode verification of the medication to ensure that the
correct medication goes to the correct bin.
ANSWERS CH 12
PHARMACY CALCULATIONS
MULTIPLE CHOICE
1. b. Convert to common denominators, add the numerators, and reduce to the simplest
fractions or mixed numbers.
2. b. Multiply the denominators, multiply the numerators, express answer as a fraction,

and simplify.
3. c. Convert to common denominators, subtract the numerators, and reduce to the

4. c. Invert the divisor, multiply the denominators, multiply the numerators, express
5. c. 100
6. b. Two spaces to the left (0.1% = 0.001)
7. c. Write the units next to each number when solving and check that the units are
lined up correctly, with units in the first ratio’s numerator matching the second
ratio’s denominator.
8. d. Meter (distance), liter (volume), gram (mass)
9. a. 5 mL
10. b. There is one formula that is used to calculate BSA.
11. c. 20
12. c. Weight in volume (w/v) or grams of drug per 100 mL of mixture
13. d. g per mL
ORDERING I
1. I
2. V
3. X
4. L
5. C
6. M
ORDERING II
1. 1 mL
2. 1 teaspoon
3. 15 mL
4. 2 tablespoons
5. 1/2 cup
6. 6 oz.
7. 12 oz.
8. 1 pint
9. 0.5 L
10. 1 quart
11. 1/2 gallon
12. 2.5 L
TRUE OR FALSE
1. T
2. F Decimals with a trailing zero may be misinterpreted; “5.0” may be read as “50.”
3. F Numbers to the left of the decimal point represent whole numbers, and numbers to
the right of the decimal point represent quantities less than one.
4. T
5. T
Without a leading “0,” a decimal quantity may be misinterpreted. For example, “.5” c
6. T read as a “5.”
7. F This is a French system that includes ounces and pounds.
8. F IBW is expressed as kg.
9. F The BMI is generally not used in medication calculations, but it may be mentioned
in the pharmacy and in the literature.
10. T
11. F Generally, units do not appear with specific gravity as it is a ratio.
12. T
13. T
14. F The percentage strength is measured in weight in weight (w/w) or grams of

drug/100 grams of mixture.
15. F Alligation
16. T
17. F Ratio
SOLVE
1. Convert Roman numerals to Arabic:

a. 2110
b. 64
c. 116
d. 18
e. 121
2. Convert Arabic numerals to Roman:

a. LVII
b. CLXXXIII
c. XIV
d. MMCCCVI
e. MCCCV
3. Simplify these fractions:

a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
4. Add these fractions:

a.
b.
c.
d.
e.
5. Subtract these fractions:
a.
b.
c.
d.
e.
6. Multiply these fractions:

a.
b.
c.
d.
e.
7. Divide these fractions:

a.
b.
c. 6
d.
e.
8. Convert these fractions to decimals (round to the nearest 1000th):

a. 0.125
b. 0.75
c. 0.938
d. 0.417
e. 2.333
f. 3.8
g. 1.214
h. 6.875
i. 3.063
j. 0.833
k. 2.25
9. Convert these percentages to decimals:

a. 45% = 0.45
b. 0.02
c. 0.0001
d. 0.0435
e. 0.625
f. 009
g. 0.0045
h. 0.05
i. 0.985
j. 0.00003
k. 0.0083
10. Ibuprofen suspension comes in 100 mg/5 mL strength. Solve the following:
a. 250 mg
b. 7.5 mL
c. 3.75 mL
d. 5 mL
11. Amoxicillin suspension is available in 250 mg/5 mL. The prescription is written for 40
mg/kg/day divided to be given every 12 hours. Solve the following:
a. 800 mg
b. 8 mL
c. 160 mL
12. Convert the following:

a. 500 mg
b. 0.125 mg
c. 12.5 kg
d. 165 lbs.
e. 240 mL
f. 24 teaspoons
g. 30 mL
h. 46.4°F
i. 25°C
j. 1500
k. 8:00 p.m.
13. Solve the following:

a. 60
b. 10 days
c. 24 doses
d. 10 doses
e. 25 days
f. 600 mL
g. 2 mg
h. 25 g
i. 4.5 g
j. 3 mL
k. 3g
14. DEA numbers consist of 2 letters, 6 numbers, PLUS a check digit at the end. Check the
following DEA numbers, and indicate if the number is “valid” or “invalid.”
a. (5+3+6) + 2(0+1+5) = 14 + 12 = 26. Check digit 6 = 6 VALID
b. (4+6+2) + 2(3+5+1) = 12 + 18 = 30. Check digit 0 ≠ 3 INVALID
c. (5+5+3) + 2(1+2+5) = 13 + 16 = 29. Check digit 9 ≠ 4 INVALID
d. (1+2+6) =2(0+4+5) = 9 + 18 = 27. Check digit 7 = 7 VALID
e. (3+1+5) +2(5+8+2) = 9 + 30 = 39. Check digit 9 = 9 VALID
15. Calculate the following using alligation:

a. 472.2 mL of the 5% solution and 27.8 mL of the 50% solution.
b. 90 g of the 20% cream and 30 g of the 40% cream
16. Calculate the following regarding flow rates:

a. 5.6 mL
b. 2 hours and 5 minutes
c. 7.5 mL/hr
17. Convert height to cm and weight to kg and multiply together. Then divide by 3600.
Take the square root of this number to get the BSA in m2. BSA = 2.19 m2.
18. Calculate the following patients’ IBW and determine if they are over or under their IBW:
a. 84.5 kg, over
b. 73 kg, under
c. 52.4 kg, over
d. 68.5 kg, under
SHORT ANSWER
1. Discuss BMI, IBW, and BSA.
Body mass index (BMI) is a measure of body fat based on height and weight. This value
is used to determine if a patient is underweight, of normal weight, overweight, or
obese. The BMI is not generally used in medication calculations, but it may be
mentioned in the pharmacy and in the literature.
Ideal body weight (IBW) is an estimate of how much a patient should weigh, based on
his or her height and gender. IBW is expressed as kg.
Body surface area (BSA) is a value that takes the patient’s weight and height into
account and is expressed as m2. BSA values are frequently used to calculate doses of
chemotherapeutic agents. Several similar equations are used such as the Mosteller
formula.
CROSSWORD PUZZLE
ANSWERS CH 13
NONSTERILE COMPOUNDING AND
REPACKAGING
MULTIPLE CHOICE
2. b. An estimated 1-3% of all prescriptions filled in community pharmacies are

compounded.
3. b. Must have carpet or cushioned mats to prevent fatigue.
4. a. If the container is translucent so you can see the quantity remaining
5. a. The medication is aqueous or nonaqueous.
6. a. Allow another individual to subsequently reproduce the same formulation.
7. d. SDS must be readily available to all employees in the pharmacy.
8. c. The name of the pharmacist in charge at the time the preparation was
compounded
9. c. Powders and granules
10. c. To use the smallest one that will hold the volume to be measured.
11. c. Compatibility in the final preparation is considered in the selection.
12. d. Reduce particle size in preparations.
13. b. A BUD is the same as an expiration date.
14. b. Antibiotic ophthalmic suspension

15. c. Sweeteners are an example of an inactive ingredient.
16. c. Repackaging records are useful for quality-control purposes.
17. c. Once poured into the mold, the suppositories are put immediately into the
refrigerator or freezer to harden.
18. b. After the base is melted, the rest of the active and inactive ingredients are added.
19. c. The cost of repacking in-house, which includes equipment, supplies, and labor.
20. b. There are more repacking systems for liquid medications than for oral solids.
MATCHING I
1. A. Sterile compound
2. B. Nonsterile compound
MATCHING II
1. A. Suspending agent
2. B. Sweetener
3. C. Preservative
4. B. Sweetener
5. C. Preservative
7. A Suspending agent
10. C. Preservative
11. C. Preservative
12. C. Preservative
13. B. Sweetener
14. B. Sweetener
15. B. Sweetener
ORDERING
1. G. Retrieve the master formula and start a compounding record.
2. D. Calculate the amount of each ingredient needed for the preparation.
3. C. Assemble equipment, materials, ingredients, and packaging needed, and garb

appropriately.
4. A. Compound the preparation.
5. B. Document/complete the compounding record.
6. E. Label the final preparation appropriately.
7. F. Properly clean and store all equipment used in compounding the preparation.
TRUE OR FALSE
1. F In these pharmacies, the compounding area for sterile preparations is separate and
distinct from the area used for compounding nonsterile preparations.
2. F Any drug that is withdrawn from the market by the FDA should not be used.
3. T
4. F Only one preparation should be compounded at one time in the compounding area
to avoid errors and cross-contamination.
5. F Patient counseling is important with all medications, including compounded

formulations. The patient should be counseled by the pharmacist on the correct
use, storage, beyond-use date, and evidence of instability in the compounded
medication.
6. F Inactive ingredients are a necessary part of the product, and the specific chemicals
used as excipients must be named in the formula.
7. F The balance must be maintained and calibrated regularly.
8. F The bottom of the meniscus should be read at eye level.
9. F It is preferable to use glass mortars when mixing liquids, preparing solutions,

suspensions, or lotions as well as when adding flavoring oils and coloring.
10. T
11. F No. 000 is the largest, and No. 5 is the smallest.
12. T
13. F End-product testing is not generally performed for basic repackaging processes.
14. F Volumetric pumps need less recalibrating than peristaltic pumps and are more
accurate and reliable for delivering fluid volumes of less than 10 mL.
15. F Levigation
16. F Unit-dose package
17. F Inactive or inert ingredient
18. F Graduates and conicals. Torsion and electronic refer to scales and balances used to
measure the weight of a substance.
19. T
20. T
21. F Active ingredient. An excipient is an inactive ingredient.
22. F Trituration
23. T
24. T
25. T
FILL IN THE BLANK
1. 795
2. Stability
3. Dissolves
4. Beyond-use
5. Shaken
6. Master formula
7. Meniscus
8. Trituration
9. NDC or national drug code
10. Checkpoints
SHORT ANSWER
1. Discuss the considerations when choosing a mortar and pestle for compounding a
mixture.
Mortars and pestles are used to crush, grind, and blend various medicinal ingredients.
Trituration is achieved by moving the pestle in a circular motion in the mortar. Mortars
are available in a variety of materials such as glass, porcelain, and Wedgewood.
• Glass mortars are preferable when mixing liquids or preparing solutions,
suspensions, or lotions. Glass mortars are also non-staining and, therefore, should be
used when adding flavoring oils and coloring.
• Wedgewood mortars have a rough interior surface and are ideal for intense grinding
and trituration to reduce particle size. Wedgewood mortars stain easily and are
porous; therefore, extra care must be taken when cleaning Wedgewood to ensure
that all particles are removed to avoid cross-contamination.
• Porcelain mortars are also very durable and are often used for blending powders and
reducing particle size. Porcelain mortars have a glazed interior surface that is less
porous than Wedgewood.
2. Discuss beyond-use dating and labeling requirements for repackaged medications.
Labeling is the responsibility of the dispenser who should take into account the nature
of the drug repackaged, the characteristics of the containers, and the storage
conditions to which the medication may be subjected in order to determine a beyond-
use date for the label. USP offers standards for determining an appropriate beyond-use
date in the absence of published stability data, “For nonsterile solid and liquid dosage
forms that are packaged in single-unit and unit-dose containers, the beyond-use date
shall be 1 year from the date packaged or the expiration date on the manufacturer’s
container, whichever is earlier.” Considerable technical advances have occurred in the
area of labeling, partly as a result of using computers in institutional practice. In
particular, personal computers have greatly improved the quality and efficiency of the
label production process.
Current federal labeling requirements are described in the ASHP Technical Assistance
Bulletin on Single-Unit and Unit-Dose Packages of Drugs. The technical bulletin states
that the nonproprietary name (generic name), proprietary name (brand name) if
appropriate, dosage form, strength, amount delivered in package, notes (e.g., storage
conditions, preparation, administration instructions), beyond-use date, and control
number or lot number should appear on the package. Inclusion of a barcode on
repackaged items is highly recommended and is necessary to facilitate bedside
barcode scanning in hospitals. Most computerized packaging machines include the
ability to include a barcode to identify the medication in the package. Some labels are
applied manually to the finished product. Newer semi-automated and automated
repackaging machines have printers built in so the label can be printed on the package
prior to the dosage form being inserted.
CROSSWORD PUZZLE
ANSWERS CH 14
ASEPTIC TECHNIQUE, STERILE
COMPOUNDING, AND IV ADMIXTURE
PROGRAMS
MULTIPLE CHOICE
1. b. Patients who are unconscious can be medicated.
3. b. 10 units/mL or 100 units/mL
4. a. High-efficiency particulate air or HEPA filter
5. b. 6
6. c. 30
7. b. 70
8. d. Up-and-down direction, starting at the HEPA and working toward the outer edge of
the hood
9. c. Be free of particulate matter.
10. d. Critical area
11. b. 6; backwash
12. c. You must perform a full clean of the interior surfaces of the hood.
13. a. Zones of turbulence
14. a. The user should make sure the package was intact and not damaged.
15. d. The needle should be inserted with the bevel tip first, then pressing downward and to
the bevel so the bevel tip and heel enter at the same point.
16. b. Require the use of a filter needle.
17. d. Should be in a format that is consistent and easily understood.
18. c. Are present in multidose vials of medications.
19. c. Add-Vantage ®
20. d. Possible impaired fertility or cancer
21. a. A solid front gown with two pairs of chemo-certified gloves
22. d. Includes the transporter being trained in handling hazardous drugs, containing spill
management.
23. c. A blood draw kit to use on personnel who may have been exposed
24. b. Potassium chloride
25. c. Lipids are included in a 3-in-1 TPN
26. b. Gowns
27. a. Central IV line
28. c. Chemo gloves
29. a. The first pair must be under the cuff of the chemo gown.
30. c. Temperature
31. d. It is only required when microbial contamination of sterile compounded

preparations is detected.
MATCHING
1. C. Lipid
2. B. Electrolyte
3. E. Vitamin
4. B. Electrolyte
5. D. Protein
6. E. Vitamin
7. F. Trace element
8. A. Carbohydrate
9. E. Vitamin
10. F. Trace element
11. B. Electrolyte
12. E. Vitamin
13. B. Electrolyte
15. E. Vitamin
16. E. Vitamin
TRUE OR FALSE
1. T
2. T
3. F <797>
4. T
5. F It is never okay to touch the needle, tip, or the interior of the plunger.
6. F Only gather the supplies for one compounded preparation at a time to put in the
hood. Additional items will obstruct laminar airflow, compromising sterility, and
there is a greater chance of error.
7. T
8. T
9. T
10. T
11. F Extravasation and infiltration can be painful and usually require that the IV be
restarted in a different location, and some drugs such as certain chemotherapy
agents may cause severe tissue damage if they infiltrate the tissue. Although there
are medications to alleviate some of the effects of the drug and hot and cold
compresses to arrest progression, sometimes the tissue damage can be so severe
that it requires surgery or even loss of the limb.
12. F A pyrogen can be present even after a solution has been sterilized.
13. T
14. F Only those objects essential to product preparation should be placed in the LAFW.
Do not put paper, pens, labels, or trays into the hood.
15. F Jewelry should not be worn on the hands or wrists when working in the LAFW since
it may introduce bacteria or particles into the clean work area or compromise the
glove barrier.
16. F No jewelry should be worn.
17. T
18. F ANY entry into the buffer room requires full washing and garbing.
19. T
20. F To withdraw the solution, either use a filter needle and change to a regular needle
before expelling the contents or start with a regular needle and change to a filter
needle before expelling the contents. Either way, the filter needle must not be used
for both withdrawing from the ampule or expelling from the syringe; doing so
would nullify the filtering effect. Usually, the medication is withdrawn from the
ampule with a regular needle, and then the needle is changed to a filter needle
before pushing the drug out of the syringe.
21. T
22. T
23. T
24. F Every 6 months
25. T
26. F Hazardous waste may NOT be disposed of as regular trash and should only be
disposed of in hazardous containers located within the negative pressure clean
room and other areas where hazardous drugs are handled. There are different
colored bins for contaminated and trace-contaminated waste. Regular trash should
not be placed in hazardous waste containers.
27. T
28. T
FILL IN THE BLANK
1. PICC
2. Extravasation
3. Pyrogens
4. Phlebitis
5. Piggyback
6. Hickman®; Broviac®
7. Smart pump
8. Elastomeric infusion device or EID

9. Aseptic
10. 5; 7
11. Central
12. Vertical
13. Ampules
14. <797>
15. <800>; NIOSH
ALPHABET SOUP
1. ACPH: Air changes per hour
3. BSC: Biological safety cabinet
4. BUD: Beyond-use date
5. CACI: Compounding aseptic containment isolator
6. CAI: Compounding aseptic isolator
7. CSP: Compounded sterile preparation
8. CSTD: Closed-system transfer device
9. DCA: Direct compounding area
11. GI: Gastrointestinal
12. HD: Hazardous drug
13. HEPA: High-efficiency particulate air (filter)
14. IM: Intramuscular
15. IPA: Isopropyl alcohol
16. ISO: International Organization for Standardization
17. IT: Intrathecal
18. IV: Intravenous
19. LAFW: Laminar airflow workbench
20. LOD: Line of demarcation

21. LVP: Large-volume parenteral
22. MDV: Multidose vial
23. NIOSH: National Institute for Occupational Safety and Health
24. OSHA: Occupational Safety and Health Administration
25. PEC: Primary engineering control
26. PICC: Peripherally inserted central catheter
27. PPE: Personal protective equipment
28. PPN: Peripheral parenteral nutrition
29. SDV: Single-dose vial
30. SEC: Secondary engineering control
31. SVP: Small-volume parenteral
32. TNA: Total nutrient admixture
33. TPN: Total parenteral nutrition
34. USP: United States Pharmacopeia
SHORT ANSWER
1. Discuss the risks involved with IV therapy.
Infection can result if a product contaminated with microorganisms or pathogens is

infused into a patient. Human touch contamination (e.g., improper product handling)
continues to be the most common source of IV-related contamination.
Air embolus is caused if air is infused into the patient from the IV line. In adults, it takes
15 to 20 mL of air given quickly to result in harm. Infants and pediatric patients are
adversely affected by much lower amounts of air. Air-eliminating filters are available on
some IV sets, which also stop air bubbles and add another measure of safety.
Bleeding may be caused by intravenous therapy. When the IV catheter is removed,

bleeding may occur around the catheter site. Also, if the patient has a condition that
results in prolonged bleeding time or if he or she is receiving an anticoagulant
medication, extra care and caution should be used, especially when removing the
catheter.
When a patient has an allergic reaction to a substance given parenterally, the reaction
is usually more severe than if the same substance was given by another route because
substances given parenterally cannot be retrieved like substances given by other
routes. The patient should be monitored closely if given a drug intravenously that has
caused allergic reactions in a large number of patients. If the likelihood of an allergic
reaction is especially high, a test dose (e.g., a small amount of the drug)—often
referred to as a challenge—may be given to see how the patient reacts before
administering the full dose of the medication if there is no alternative therapy allowing
for risk mitigation.
Incompatibilities can exist among some drugs that are incompatible with other drugs,
containers, or solutions. If an incompatibility exists, the drug may precipitate, be
inactivated, or adhere to the container. These outcomes are undesirable and may be
difficult to detect with the naked eye. A visual inspection of the final product should
always be performed to observe any cloudiness, coring, or signs of irregularity.
Solutions with known or detectable incompatibilities should not be administered to
patients.
Extravasation occurs when the IV catheter punctures and exits the vein under the skin,
causing drugs to infuse or infiltrate into the tissue. Extravasation may happen when the
catheter is being inserted or after it is in place, if the extremity with the IV catheter is
moved or flexed too much. Using a stiff arm board to prevent excessive movement near
the catheter site may help to maintain regular flow and prevent extravasation and
infiltration. Extravasation and infiltration can be painful and usually require that the IV
be restarted in a different location. Some drugs such as certain chemotherapy agents
may cause severe tissue damage if they infiltrate the tissue. Although there are
medications to alleviate some of the effects of the drug and hot and cold compresses to
arrest progression, sometimes the tissue damage can be so severe that it requires
surgery or even loss of the limb.
Particulate matter refers to unwanted particles present in parenteral products.

Particulate matter that is injected into the bloodstream can cause adverse effects to the
patient. Some examples of particulate matter are microscopic glass fragments, hair,
lint or cotton fibers, cardboard fragments, undissolved drug particles, and fragments of
rubber stoppers (i.e., cores). Improvements in manufacturing processes have greatly
reduced the presence of particulates in commercially available products. Similar care
must be taken in the pharmacy so that particulate matter is not introduced into
products. When using glass ampules, for example, inline filters are required to prevent
glass fragments from entering the compounded sterile product. All products should be
visually inspected for particulate matter before dispensing. Additionally, some
institutions may use inline filters to help minimize the amount of particulate that
reaches the patient, especially in situations where medications need to be prepared in
emergency situations outside the controlled environment of a pharmacy.
Pyrogens, the by-products or remnants of bacteria, can cause reactions (e.g., fever,
chills) if injected in large enough amounts. Since a pyrogen can be present even after a
solution has been sterilized, great care must be taken to ensure that these substances
are not present in quantities that would harm the patient via filtration when
appropriate. If the pyrogen is smaller than the filter being used, however, it may be
introduced into the bloodstream.
Phlebitis, or irritation of the vein, may be caused by the IV catheter, the drug being
administered (e.g., due to its chemical properties or its concentration), the location of
the IV site, a fast rate of administration, or the presence of particulate matter. The
patient usually feels pain or discomfort along the path of the vein, which is often
severe. Red streaking may also occur.
If phlebitis is caused by a particular drug, it may be helpful to further dilute the drug,
give it more slowly, or give it via an IV catheter placed in a larger vein with a higher,
faster moving volume of blood.
2. Explain automated TPN compounding.

There are two primary versions of TPN compounders available. One version provides a
separate compounder for the base solutions and the electrolytes, while the other
version uses one compounder to infuse all the compounded ingredients (e.g., bases,
electrolytes). In the former, three primary pieces of equipment are used, sometimes
together and sometimes individually. An automated compounder prepares the base
components dextrose, amino acids, and possibly fat emulsion and water; a second
automated compounder adds most or all of the additives or other components; and a
computer with software maintains the orders for the ingredients and controls the two
compounders. The base compounder uses special tubing that can withstand the
pumping action of the machine in allocating large volumes of solutions. It accounts for
the specific gravity of the solutions used and actually weighs the amount pumped into
the final container. Some compounders also weigh the original container from which
solutions are pumped. It stops pumping when the selected amount has been added.
The base compounder can be used with the computer, or it can be used alone. When
the base compounder is used alone, the operator enters the desired volume and
specific gravity of the base solution components. The device weighs the correct
amounts as described above. In the latter, the compounder provides both the base
solutions and additives.
The additives compounder also uses special tubing that delivers exact amounts of the
solutions in very small quantities. It weighs the solutions to ensure proper volumes and
flushes the line between injections to avoid incompatibility problems. The additives
compounder must be used with the computer and cannot be programmed alone.
The computer software controls the system and offers many safeguards:
• It performs many of the calculations that would otherwise be done by hand and
prone to human error.
• It allows the user to enter maximum safe quantities for different components.
• It alerts the user to potential entry errors and inappropriate orders.
Alarms are available to detect free-flowing ingredients and air bubbles in the line. The
final products are subsequently checked by comparing the anticipated weight of the
product against the actual weight of the product. Variances of more than +/– 3% are
not accepted.
The accuracy provided by the automated compounders is not a substitute for checks
and balances in ensuring accuracy and quality of the product. Checks and balances
must be built into each step of the TPN ordering, preparation, and administration
process. Calculations should be verified and double-checked, and solutions and their
ingredients should be checked and double-checked, regardless of the system used. The
many additives that go into a TPN solution make it complicated with respect to
compatibility and stability. For example, certain concentrations of electrolytes (e.g.,
calcium, phosphate) will precipitate when put together and warrant that all solutions
be inspected carefully before they are dispensed. For this reason, software programs
are designed to analyze key components of the order for potential incompatibilities.
Admixture references should also be used before a solution is mixed.
Automated compounders are used inside the LAFW and must be cleaned daily
according to the manufacturer’s instructions. These systems require routine
maintenance and calibration to ensure accurate compounding. To minimize the
potential for errors, the compounders should be observed during operation. Quality
control procedures may be implemented to verify final contents of the product. These
systems are occasionally used for compounding other solutions. Great care should be
taken to avoid compounding errors.
3. Explain the differences in the types of PECs commonly used in a hospital pharmacy.
Horizontal LAFW is when LAFWs sweep filtered air from the back of the hood to the
front. Horizontal flow workbenches use an electric blower to draw contaminated room
air through a prefilter. The prefilter, which is similar to a furnace filter, only removes
gross contaminants and should be cleaned or replaced on a regular basis. The
prefiltered air is then pressurized to ensure that a consistent distribution of airflow is
presented to the final filtering apparatus. The final filter is a HEPA filter that constitutes
the entire back portion of the hood’s work area. This filter eliminates most particles and
airborne microorganisms, which are usually 0.5 microns or larger. Most horizontal
LAFWs are configured as large rectangular boxes with an opening in the front. The back
of the opening is where the HEPA filter resides. Air forced through the HEPA filter blows
horizontally at the user through small holes in the HEPA cover. Often a diffuser screen is
used to ensure that consistent laminar air is present throughout the compounding area.
Inside the opening, there is a horizontal work surface as well as features such as rails
and hooks on which to hang compounding components.
Vertical LAFWs with a vertical flow of filtered air are also available. In vertical LAFWs,
HEPA-filtered air emerges from the top of the hood and passes downward through the
work area.
Because exposure to hazardous drugs (HDs) may be harmful to the compounder, they
should only be prepared in vertical LAFWs to minimize the risk of exposure to airborne
drug particulates. If a horizontal LAFW were used to prepare HDs, airflow would push
HD residue directly at the compounder. Vertical LAFW airflow, on the other hand,
pushes drug residue down and out of the compounding area. The types of vertical
LAFW used for the preparation of HDs confine airflow within the hood and are referred
to as biological safety cabinets (BSCs). A BSC is a type of vertical LAFW that is designed
to protect workers from exposure as well as to help maintain product sterility during
preparation. The front air barrier of the BSC protects the handler from contact with HD
dusts and aerosols that are generated in the work zone. Room air is pulled into the
front intake grill and filtered through a HEPA filter. The air then passes vertically (i.e.,
downward) through the work zone. The air that has passed through the work zone goes
through front intake and rear exhaust grilles, passes through a separate HEPA filter, and
is re-circulated through the work zone or exhausted to the outside. Placing objects on
or near the front intake or rear exhaust grilles may obstruct the airflow and reduce the
effectiveness of the cabinet.
4. How does the pharmacy additionally prepare HDs in order to limit potential exposure to
HDs on administration?
While compounding the HD in the BSC located in the negative pressure buffer room, it
is best practice to attach a CSTD or attach and prime the IV tubing to administer the
drug to the patient. Priming the IV tubing means that fluid from the IV bag has been
allowed to flow the entire length of tubing and the roller clamp applied so that no
leakage occurs. This procedure should be performed prior to injecting the HD into the
IV bag and limits contamination once the patient’s caregivers receive and administer it.
Wipe the IV bag and tube set with a decontaminating agent prior to them leaving the
BSC.
Place the IV with CSTD attached, or the bag and tubing into a sealable bag, so any
hazardous contamination is contained within and any possible leakage will be
contained before removing from the hazardous compounding area and delivering to
the area where it will be administered.
5. What is a spill kit, and how is it used?
In the event of a HD spill, you should use a spill kit, and the cleanup should follow
established procedures. It is essential that you know the spill kit storage location and
how to use the spill kit prior to requiring its use. Spill kits contain all the materials
needed to clean up HD spills and protect healthcare workers and patients.
Spill kits contain:

• Protective gear, eye protection, a respirator, utility and latex gloves, a disposable
gown or coveralls, and shoe covers.
They also contain the equipment needed to clean up the spill:

• A disposable scoop; a puncture- and leak-resistant plastic container for disposing of
glass fragments; absorbent spill pads; gauze and disposable toweling; absorbent
powder; and sealable, thick plastic waste disposal bags. Hazardous waste must be
stored in leak-resistant containers until it is disposed of in accordance with
government and institution policy.
In the event of a spill:

• Put up a warning sign to alert other people in the area of the hazard. Put on all of
the protective equipment, including two pairs of gloves. Put broken glass in the
puncture- and leak-resistant plastic container. Absorb liquids with disposable towels
or spill pads. Remove powders with dampened towels or gauze. Rinse the
contaminated surface with water, wash it with detergent, and then rinse it again.
Start at the outside of the spill and work toward the center. Place all the
contaminated materials in sealable, plastic disposal bags.
In all cases, it is important that the circumstances and the handling of the spill be
documented in writing, including completion of an incident report, and kept on file.
CROSSWORD PUZZLE
ANSWERS CH 15
MEDICATION SAFETY
MULTIPLE CHOICE
1. b. A philosophy that encourages reporting of all errors directly to the State Board of
Pharmacy to ensure appropriate disciplinary action is taken.
2. d. A nurse fails to give the evening dose to a patient in the hospital.
3. b. A patient on a sliding scale of insulin, neglecting to take a blood glucose reading

prior to administering insulin.
4. c. Stop–think–act–review
5. a. An IM injection mistakenly labeled as an IV medication.
6. b. Simvastatin tablets dispensed instead of lovastatin tablets.
7. a. The different definition and reporting techniques used.
8. c. 19%
9. c. Performance lapses or failure to follow established procedures
10. d. Pharmacy technicians need to be aware of all types of errors and may notice errors
that the pharmacist missed.
11. c. Helps to classify errors, but some errors may fit in several of the categories.
12. d. Administration of a medication occurs outside established administration time.
13. d. Accidently storing a compounded antibiotic IV at room temperature instead of in

the refrigerator overnight.

15. d. Prescribing error
16. b. Having a nurse phone in a prescription order that was communicated verbally by
the doctor.
17. c. Has a high risk of causing patient harm if used in error.
18. d. All the above
19. a. Inform the pharmacist of the request for an early refill.
20. b. Alternative products may be much more expensive than the product that is in short
supply.
21. a. Deteriorated drug error
22. b. Using a larger package size.
23. a. 125 mcg
26. c. 3-Way Repeat Back
27. b. Color coding, in general, is an unsafe practice as it may lead to relying on the color
instead of reading the name and strength on the vial.
28. d. Always using leading zeros before a decimal.
29. b. Some errors go undetected.
30. c. Distinguish between two drugs with similar-looking or -sounding names.
31. c. Refer the patient to the pharmacist for assistance.
32. d. Inform the pharmacist that the calcium gluconate vials look cloudy and inspect all
the calcium gluconate vials in stock.
33. c. The products are not interchangeable, and the prescriber should have been
contacted to obtain an order for an alternative product.
34. c. Inform the pharmacist of the situation immediately.
35. a. Insulin, methotrexate (oral), fentanyl, and heparin
36. d. Always enter the patient by their preferred nickname.
37. c. Plan–do–study–act
MATCHING
Note that many errors may be classified under more than one category, or that one error
leads to a second error being performed.
1. L
2. N leading to B
3. O leading to A/G
4. O leading to A
5. M
6. R
7. S
8. E
9. D
10. G
11. B or K
12. K
13. J
14. N leading to E
15. P
16. M
17. S. Note that when the expiration date is expressed as only a month and year, the
medication will expire on the last day of the month indicated.
18. P
19. M
20. Q
21. Q
22. A
23. A causing H
24. L
TRUE OR FALSE
1. F Actually, these same definitions can be applied to home healthcare, clinic, and
physician office settings as well as the outpatient pharmacy practice settings.
2. F Few studies provide a complete and thorough evaluation of errors within the entire
medication-use process.
3. F It has been observed that errors occurring earlier in the medication-use process
(i.e., in the prescribing phase) are more likely to be detected and corrected than
those occurring later in the process (i.e., in administration).
4. F Authors frequently make up abbreviations for disease states or drug

names/combinations to avoid having to write out lengthy terms numerous times.
This practice is acceptable when writing an article for publication, provided the full
term is spelled out the first time the abbreviation is used. It is not an acceptable
practice for writing medication orders or prescription labels.
5. F Computer-generated and typewritten labels reduce medication errors by making

the medication labels easier to read for both healthcare personnel and patients.
The use of upper- and lowercase lettering (as opposed to all uppercase) also
improves readability.
6. T
7. T
8. F The recipient of a verbal or telephone order should immediately write down the
order and read it back to the prescriber to ensure clarity.
9. F Omission errors can be just as dangerous as wrong dose errors, because the
medical treatment for which the drug is prescribed has been withheld and a missed
dose can result in patient harm.
10. F The number of years of pharmacy experience does not correlate with frequency of
calculation errors.
11. T
12. F A medication error can occur any time during the medication use process—drug
product selection, storage, prescribing, transcription, preparing, dispensing,
administration, monitoring, transitions of care—and can be made by anyone
involved in the medication-use process, including physicians, nurses, pharmacy
staff, patients, or their caregivers.
13. T
14. T
15. F The purpose is to share experiences among healthcare personnel so patient safety
can be improved. It also can contribute to educational efforts to prevent future
medication errors.
16. T
17. F QD and qod are considered unsafe, but qid is not.
18. F The correct way to write Coumadin ½ mg using decimals is “Coumadin 0.5 mg.”
19. F The correct way to abbreviate microgram is mcg.
20. T
21. F An error is an error even if it doesn’t reach the patient. The error is more serious if
patient harm occurs.
FILL IN THE BLANK
1. Misadventure
2. Prescribing
3. Omission
4. Wrong time
5. Unauthorized drug
6. Improper dose
7. Wrong dosage form
8. Deteriorated drug
9. Wrong drug preparation
10. Wrong administration technique
11. Deteriorated drug
12. Monitored
13. Compliance
ALPHABET SOUP
3. CMS: Centers for Medicare & Medicaid Services
4. CPOE: Computerized prescriber order entry
6. FMEA: Failure mode and effects analysis
7. ISMP: Institute for Safe Medication Practices
8. ISMP MERP: Institute for Safe Medication Practices Medication Errors Reporting Program
9. NCC MERP: National Coordinating Council for Medication Error Reporting and
Prevention
10. PDSA: Plan–do–study–act
11. RCA: Root cause analysis
12. STAR: Stop–think–act–review

SHORT ANSWER
1. Discuss how workplace issues may affect medication errors.
Factors within the workplace can contribute to medication errors. Inadequate lighting,
poorly designed work spaces, and inefficient workflow can make it difficult to perform
assigned duties accurately. Cluttered work spaces and stock areas can increase the risk
of picking up the wrong drug. The many distractions and interruptions, including phone
calls, in a busy pharmacy can cause loss of concentration. Many modern pharmacies
rely on specialized equipment and computers to assist in filling prescriptions. Improper
maintenance of this equipment can result in unacceptable performance or may
necessitate the use of older, unfamiliar, or cumbersome manual systems when the
equipment breaks down. For example, failure to properly maintain a balance can result
in an inaccurate measure of medication components for a compounded prescription
and ultimately a wrong dose error. Routine maintenance schedules should be followed
to prevent equipment malfunction. Technicians should be trained on the use and
maintenance of such equipment. Operating manuals should be available in the
pharmacy for troubleshooting when a problem occurs. Scheduling of staff members
and the frequency of rotating shifts have been shown to correlate with error rates.
Other factors, such as staffing levels and amount of supervision, are also work
environment issues to consider.
The frequency with which drug products are changed because of changes in
purchasing contracts may lead to unfamiliarity with products among the staff.
Significant changes should be communicated to the staff, and product labels should be
read carefully. Untrained, inadequately trained, or inexperienced personnel may be
unfamiliar with drug names, doses, or use of agents, which limits their ability to
recognize inappropriate orders and circumstances. New technological advances make
keeping up with drug use difficult, even for experienced healthcare practitioners. The
important thing is for technicians to recognize their limits and work within them just as
nurses, pharmacists, and physicians are trained to do.
Relying on memory instead of checking references (e.g., dilution charts, maximum

dosage ranges) or performing complicated calculations without a double-check stage
can result in errors. It is a technician’s responsibility to help prevent medication errors
by questioning unusual or unfamiliar orders. When abnormal or unfamiliar situations
arise, it is always best to consult references and others before making a decision or
taking action. Being aware of a potential error and not knowing what to do about it,
thinking that someone else will catch it, or feeling intimidated by a pharmacist or
supervisor increases the chances that an actual error will take place. The lack of
knowledge of medication errors and how to avoid them also contributes to medication
errors. Not being familiar with common errors or medications most frequently involved
in errors might cause one to think that medication errors are infrequent. The
medication errors most frequently reported to the USP in 2002 involved albuterol,
insulin, morphine, potassium chloride, heparin, and warfarin. Of these six medications,
all but albuterol were most frequently involved in errors that were associated with
patient harm or death.
2. Explain the purpose and procedures for FMEA.
Sometimes the systems that people work within present numerous opportunities for
errors. Failure mode and effects analysis (FMEA), also called failure mode effect and
criticality analysis (FMECA), is a systematic evaluation of a process or system used to
predict the opportunity for and severity of errors at various steps in the process. FMEA
focuses on finding flaws within a system that create opportunities for individuals to
make errors. It evaluates the “how” and “why” of an error instead of the “who.”
The first step in evaluating a system or process using FMEA is to describe in detail the
individual steps involved in the overall process from start to finish. Use of a flow
diagram is helpful to create a visual representation of the process. The next step is to
list the potential opportunities for failure at each stage. Then, the effects of these
failures on the process and their root causes are described. The severity, likelihood of
occurrence, and probability of actually identifying the failure are then estimated. The
criticality index is determined by multiplying these three estimates. Steps that have the
highest criticality index should be addressed first because improvements in these areas
have the greatest potential for reducing the risk for error.
After making changes to the process, FMEA should be performed again to determine
the effectiveness of these changes. An acute care hospital in California used the FMEA
system to reduce IV pump-related medication errors. One year after implementation of
several error reduction strategies identified during the FMEA, pump-related medication
errors had decreased significantly.
3. What is the purpose of root cause analysis, and when and how would you proceed with
one?
Once an error has occurred, it is important to thoroughly examine the error to learn why
it occurred and how such an error can be avoided in the future. A root cause analysis
(RCA) is a process that examines the contributing factors regarding why and how an
error (or near miss) occurred. There are usually several factors that led to the error. A
root cause analysis consists of five steps:
a. Establish a team of appropriate personnel to conduct the root cause analysis. This
team may include pharmacists, technicians, nurses, prescribers, risk management
representatives, or other allied health personnel. The team should seek
management support and establish meeting times and locations.
b. Describe the event in detail. As much information as possible about the event
should be obtained, and the people directly involved in the event should be
interviewed. The description of the event is then revised to include any new
findings.
c. Diagram the steps that led up to the error to help determine the root cause. The
steps should be described in chronological order and thoroughly examined for
inconsistencies or weaknesses. Based on this information, propose a summary of
causes.
d. Develop a specific action plan to address the identified causes of the error. Some of
the action plans might be implemented immediately, whereas others may be more
long term.
e. Develop outcome measures in order to determine if the action plan is effective. The
outcome measures should evaluate whether the actions taken actually prevent
similar errors.
4. Calculation errors can lead to serious events. Discuss the errors that are common with
calculations and what technicians can do to help reduce the possibility of calculation
errors.
Reports show that numerous medication errors are caused by errors in mathematical
calculations. Miscalculation of doses can lead to serious patient harm or even death.
Calculation errors are made by prescribers, pharmacists checking doses for
appropriateness or calculating doses, technicians compounding products, and nurses
preparing or administering doses. Even with the use of calculators and computers,
healthcare personnel frequently make calculation errors. The pediatric population is
particularly at risk for calculation errors. It is not uncommon for pediatric doses to be
determined by the patient’s weight, requiring an interim step to calculate the final
dose. Many drugs are not available in pediatric formulations, so adult formulations
must be diluted or manipulated multiple times to get the appropriate dose. Personnel
with many years of experience are just as likely to make mathematical errors as
inexperienced personnel.
Calculation errors are often made by using the wrong concentration of stock solutions,
misplacing a decimal point, or using wrong conversions. Personnel also neglect to
double-check their work or rely on their memory instead of looking up a conversion. In
some cases, they fail to ask themselves, “Does the answer seem reasonable?”
Another way to decrease the risk of a calculation error is to ask a pharmacist or another
technician to double check the calculation prior to preparing the product. The
calculation should be performed independently and should be compared with the
original answer. This system is an effective way to prevent calculation errors.
Misplacing a decimal point by one place results in errors tenfold greater than or less
than intended. For drugs with a narrow therapeutic range (e.g., digoxin, phenytoin,
warfarin, gentamicin), the consequences can be significant. Decimal point errors can
occur as a result of a miscalculation, and also when writing orders or instructions.
Failure to write a leading zero in front of a number less than one (e.g.,.1 mg instead of
0.1 mg) can result in the number being read as a whole number (e.g., 1 mg). Writing
unnecessary trailing zeros can also be confusing (e.g., 10.0 mg instead of 10 mg, which
could be misinterpreted as 100 mg). Medication order sheets with lines can sometimes
cause a decimal point to be overlooked on the copy that is sent to the pharmacy.
Medication orders that are received via fax should be reviewed carefully since artifact
(e.g., insignificant markings on the page) might cause the order to be misinterpreted.
When writing numbers, a leading zero should always be used with a decimal point for
numbers less than one (e.g., 0.1 mg, not.1 mg), and a decimal point and trailing zero
should never be used for whole numbers (e.g., 10 mg, not 10.0 mg). Technicians must
be aware of the potential for decimal point errors due to misplaced or missing decimal
points when interpreting orders, and questionable orders should be brought to the
attention of the pharmacist.
ANSWERS CH 16
PHARMACY INFORMATICS AND
TECHNOLOGY
MULTIPLE CHOICE
1. c. There are opportunities for pharmacists but not technicians in informatics and
medication-use technologies.
2. d. Setting up computer interoperability.
3. c. Focuses on medication-related data within and across the healthcare system in the
delivery of optimal medication-related patient care and health outcomes.
4. a. May include information from external data sources such as MTM notes, patient
device data (e.g., glucose monitors), and PDMP data.
5. b. Qualified EHR systems
6. c. Alert fatigue
7. d. If technicians transcribe written orders into the pharmacy information system, they
will have to be verified by a pharmacist.
8. d. NDC
9. d. Must be verified by a pharmacist before the medication may be dispensed.
10. b. RFID
11. d. Inventory control
12. b. Veterinary hospitals and clinics
13. a. Uses NCPDP-developed SCRIPT standard for e-Rx.

14. d. Allows technicians to remotely check and verify other technicians’ work.
MATCHING
1. C. Interface
2. G. SNOMED
3. E. RxNorm
4. A. Bidirectional interface
5. K. Unidirectional interface
6. D. Interoperability
7. H. SureScripts
8. B. Integration
9. J. Telepharmacy
10. I. Syntactic interoperability
11. F. Semantic interoperability
TRUE OR FALSE
1. T
2. F Stand-alone systems were prevalent in the early days of computerization but are
becoming obsolete.
3. T
4. T
5. F An integrated system allows for the seamless access of the connected systems.
6. T
7. F The CDS is a process for enhancing health-related decisions and actions with
pertinent, organized clinical knowledge and patient information to improve health
and healthcare delivery.
8. T
9. T
10. T
11. T
12. F The technology addresses the workflow and documentation and is not limited to or
from specific medications to be compounded.
13. T
14. T
15. F Pharmacies do not connect with other pharmacies but do connect with providers
and facilities.
16. F PDMP database contains information on controlled substance prescriptions filled for
specific patients.
17. T
18. T
ALPHABET SOUP
2. ADS: Automated dispensing system
3. ADT: Admission, discharge, transfer
4. ANSI: American National Standards Institute
5. BCMA: Barcode medication administration
6. CDA: Clinical document architecture
7. CDS (or CDSS): Clinical decision support system
8. CPOE: Computerized physician (provider or prescriber) order entry
9. CSP: Compounded sterile preparation
11. DSCSA: Drug Supply Chain Security Act
12. EHR: Electronic health record
13. eMAR: Electronic medication administration record
14. EMR: Electronic medical record
15. EPCS: Electronic prescribing of controlled substances
16. eRx: Electronic prescription
17. HICS: Hospital incident command center
18. HIT: Health information technology
19. HIMSS: Healthcare Information and Management Systems Society

20. HIPAA: Health Insurance Portability and Accountability Act
21. HITECH: Health Information Technology for Economic and Clinical Health Act
22. HL7: Health Level Seven International
23. ISMP: Institute for Safe Medication Practices
24. ISO: International Standards Organization
25. IV: Intravenous
26. MTM: Medication therapy management
27. NABP: National Association of Boards of Pharmacy
28. NAMSDL: National Alliance for Model State Drug Laws
29. NCPDP: National Council for Prescription Drug Programs
30. ONC: Office of the National Coordinator for Health Information Technology
31. OSI: Open systems interconnection
33. PDMP: Prescription drug monitoring program
34. PIS: Pharmacy information system
35. PMS: Pharmacy management system
36. PTI: Pharmacy technician informaticist
37. RFID: Radio-frequency identification
38. ROI: Return on investment
39. SDO: Standards development organization
40. SNOMED: Systemized nomenclature of medicine
41. UPC: Universal product code
42. WG: Workgroup
SHORT ANSWER
1. List the five rights of clinical decision support.
The right information to the right people through the right channels in the right
formats at the right times.
2. Discuss the technician’s role in pharmacy informatics as well as the knowledge, skills,
and abilities required.
The need for pharmacy technicians in advanced informatics roles is required to support
the complex needs of technology-enhanced medication-use process. Pharmacy
technicians involved in informatics need to possess a variety of skills to be successful.
The PTI will need to exhibit his or her skills in the following areas: automation and
technology, systems management, management of projects, end-user training and
education, policy and governance, customer service, charge integrity, and reporting.
Many PTIs acquire their skills by on-the-job training with long-term employment
through other specialized technician roles within an institution. PTIs interested in
informatics and technology often have excellent knowledge of the medication-use
process but require further training on the technology-associated skills and knowledge.
There are some training resources available on the Internet that a technician can
review. Because many opportunities for pharmacy technicians pertain to a specific
technology, the vendor frequently offers training. Bachelor’s and Master’s level degrees
with a focus in health informatics can be completed. Certifications are offered that are
information technology-focused and could benefit the PTI in other areas of the hospital.
Some of these certifications are company and application specific (e.g., CompTIA,
Cisco, Microsoft, VMware). Becoming certified in a specific application can add to the
PTI’s credibility, marketability, and informatics development.
3. Discuss technology downtime planning, including strategies for continued operations

during downtime.
Power outage—no computers or applications available. Strategies include paper orders

and forms, alternate communication methods, uninterruptible power supplies for
critical equipment, emergency power supply available, ADCs inoperable—plan for
emergency medications, and medication labeling needs to be addressed.
Internet down—no web-based or web-hosted applications including billing and

adjudication, no access to on-line references or formularies, and no access to the
wholesaler will affect communications. Strategies include having a backup of
applications, printed formulary and wholesaler reports, and manual process for
adjudication.
Intranet down—no access to hospital-based resources. Strategies include having paper

or electronic backups of important resources.
Interface failure—messages will not process to interfaced applications and technology.

Strategies include manual entry of data to applications and set ADCs to override
EHR failure (e.g., no orders or documentation; systems unavailable including CPOE,

eMAR, and BCMA; integrated pharmacy system and eRx)—strategies include using
paper for all orders and documentation as well as developing a plan for documentation
required to be entered into the EHR when the system becomes operable again.
Prolonged downtime will require a plan for future pharmacy batch work.
CROSSWORD PUZZLE
ANSWERS CH 17
PHARMACEUTICAL SUPPLY CHAIN
MANAGEMENT
MULTIPLE CHOICE
1. b. Is necessary because running out of a needed medication will impact patient

treatment.
2. d. Specific drug manufacturer or labeler of the product
3. c. Physicians, pharmacists, nurses, and administrators
6. d. Allow for drugs to be received shortly before use and is a highly efficient and cost-
effective approach to purchasing and inventory management.
7. c. Similar drug names, package sizes, label format
10. a. Expired
11. b. Compounded nonhazardous drugs may be sent back to the manufacturer or

wholesaler when expired.
13. a. Are more efficient and effective in ensuring timely consumer protection than an
FDA-initiated court action or seizure of the product.
Pharmacies may dispose of all hazardous waste and hazardous drugs in the red bioha
14. c. bags or sharps containers.
15. a. Inventory turnover is a way of measuring the productivity of a pharmacy’s inventory

use and the use of invested capital.
16. d. Automated or computerized systems of inventory control are less efficient than
simply ordering products by hand.
MATCHING
Match the following actual recalls with the correct class used for their recalls.
A. Class I: The most serious of recalls; ongoing product use may result in serious health
threat or death.
B. Class II: Moderate severity concern; ongoing product use may pose serious adverse
events or irreversible consequences.
C. Class III: Lowest severity concern; ongoing product use unlikely to cause adverse
health threat; however, a marginal chance of injury may exist, so the product is being
recalled.
1. B. Class II
2. C. Class III
3. C. Class III
4. B. Class II
5. A. Class I
6. A. Class I
7. B. Class II
8. B. Class II
9. C. Class III
10. A. Class I
11. A. Class I
12. C. Class III
TRUE OR FALSE
1. F Inventory control and management applies to all types of pharmacy settings

including decentralized, centralized, home infusion, and ambulatory care pharmacy
operations.
2. T
3. F Because PBMs and insurance companies use formularies, retail pharmacies need to
understand them and assist patients and physicians to maximize savings while
maintaining high standards of healthcare.
4. F The pharmacy’s non-formulary procedure may or may not restrict the use of various
dosage forms of a given chemical entity, so pharmacy technicians need to
understand the policy in place at their specific institutions.
5. F Hospitals, independent community pharmacies, and other retail chain pharmacies

typically become members of a GPO to leverage buying power and take advantage
of the lower prices that manufacturers offer to the GPOs.
6. F The hospital will have a process to evaluate non-formulary drug requests and may
approve the use if it is justified.
7. T
8. F A GPO guarantees the price of pharmaceuticals over the established contract

period, which may be 1 year or more.
9. T
10. F For most pharmacies, the disadvantages of direct ordering outweigh the
advantages.
11. T
12. F Borrowing or lending drugs between pharmacies is usually restricted to emergency

situations and limited to authorized staff.
13. F Some pharmacies create processes whereby the person receiving pharmaceuticals
is different from the person ordering them. This process is especially important for
controlled substances, because it effectively establishes a check in the system to
minimize potential drug diversion opportunities.
14. T
15. F Research on tall man lettering has demonstrated effectiveness in distinguishing

similarities and preventing look-alike, sound-alike drug mix-ups.
16. F All items should be scanned, both new and regular. This applies even if the product
has been received before from the same manufacturer. Some barcodes contain lot
and expiration date information, which could change with each manufacturer’s
batch production.
17. F Schedule III, IV, and V controlled substances are generally obtained in a manner
identical to that for noncontrolled substances.
18. T
19. T
20. T
21. T
22. F Temperature and humidity should be monitored in drug storage areas and
temperature monitored in the refrigerator(s) and freezer(s) used to store
medications.
23. T
24. T
25. T
26. F If none of the recalled products is in stock, a note indicating none in stock is written
on the recall notice and filed in a recall log to document that the recall was
properly addressed.
27. T This depends on the level of recall and instructions from the manufacturer
regarding actions to take.
28. T
29. F The program requires drug manufacturers to discount certain medications provided
to eligible, vulnerable patient populations as outpatients.
30. T
FILL IN THE BLANK
1. NDC or NDC number
2. Formulary
3. Group purchasing organization or GPO
4. Direct
5. Wholesaler
6. Prime or primary
7. Stock rotation or FIFO—first-in, first-out
8. Tall man lettering
9. 6 months
10. Perpetual
11. 222
12. Turns
ALPHABET SOUP
1. ANDA: Abbreviated New Drug Application

3. AWP: Average wholesale price
4. BCMA: Barcode medication administration
6. CSOS: Controlled Substances Ordering System
8. DOT: Department of Transportation
9. DQSA: Drug Quality and Security Act
10. DRLS: Drug Registration and Listing System
11. EHR: Electronic health record
12. EOQ: Economic order quantity
13. EPA: Environmental Protection Agency
15. FIFO: First-in, first-out
16. FY: Fiscal year
17. GMP: Good manufacturing practice
18. GPO: Group purchasing organization
19. HD: Hazardous drug
20. IMPACT: International Medicinal Products Anti-Counterfeiting Taskforce
21. IOM: Institute of Medicine
22. IRB: Institutional Review Board
23. IV: Intravenous
24. LASA: Look-alike/sound-alike
25. LDDs: Limited distribution drugs
26. MSDS: Materials safety data sheet
27. NDA: New Drug Application
29. NIOSH: National Institute for Occupational Safety and Health
30. P&T: Pharmacy and Therapeutics (Committee)

32. PO: Purchase order
33. PPE: Personal protective equipment
34. RCRA: Resource Conservation and Recovery Act
35. RDDS: Restricted Drug Distribution System
36. REMS: Risk Evaluation and Mitigation Strategy
37. USP: United States Pharmacopeia
38. WHO: World Health Organization
SHORT ANSWER
1. Discuss the special processes required for ordering, receiving, and storing controlled
substances. Where would you look to find more information?
Controlled substances have specific ordering, receiving, storage, dispensing, inventory,

record-keeping, return, waste, and disposal requirements established under the law.
The Pharmacist’s Manual: An Informational Outline of the Controlled Substances Act of
1970 and the ASHP Technical Assistance Bulletin on Institutional Use of Controlled
Substances provide detailed information on the specific handling requirements for
controlled substances.
It is critical for pharmacy technicians to know two principles regarding controlled

substances:
• Ordering and receiving Schedule II controlled substances can be accomplished by
utilizing a CSOS system and the Schedule II controlled substances will arrive as with
regular orders, or, if the pharmacy does not utilize CSOS, ordering will require
special order forms and additional time (1-3 days).
• Controlled substances are inventoried and tracked continuously in a hospital
pharmacy. Community pharmacies may only continuously track Schedule II
controlled substances. This type of inventory method is referred to as a perpetual
inventory process, whereby each dose or packaged unit such as a tablet, vial, or
milliliter of fluid volume is accounted for at all times.
In some pharmacies, pharmacy technicians work with pharmacists to manage

inventory and order, dispense, and store controlled substances.
Controlled substances require additional processing when ordering, receiving,

dispensing, storing, and inventorying occurs. These procedures are required by Drug
Enforcement Administration (DEA) regulations and, in many cases, the State Board of
Pharmacy. These regulations create the chain of accountability in the interest of
minimizing drug diversion, illicit drug use, and public safety. State and federal
regulations vary regarding length of storage requirements for purchase orders, invoices,
and dispensing records. It is best to check both sets of regulations and comply with the
stricter requirements. Regulations specific to Schedule II controlled substances for
those pharmacies not ordering through CSOS require DEA form 222 to be completed to
initiate procurement of these products. Form 222 is a triplicate, handwritten form, and
each copy has a specific intent, as specified by the DEA. On receipt of DEA Schedule II
products, the pharmacy must separately file the appropriate copy of form 222, along
with the supplier’s copy of the invoice and packing slip accompanying each shipment.
Alternatively, the pharmacy can be registered with the DEA to place Schedule II orders
online through the wholesaler’s electronic process. A perpetual inventory of Schedule II
products is maintained by the pharmacy, so an exact accounting should be performed
whenever a product is added or removed from the inventory.
Schedule III, IV, and V controlled substances are generally obtained in a manner
identical to that for other noncontrolled substances. However, the receipt and storage
requirements of these products may depend on state regulation or on the specific
employer’s policy. For example, state regulation may require a pharmacy to file
separately the receipts of all controlled substances ordered during a particular year and
to maintain them in a readily retrievable manner for inspection. Some pharmacies may
require all controlled substances inventories to be shelved separately from other legend
drugs, whereas others may store them together.
2. Explain the considerations when receiving and storing hazardous drugs and USP
Chapter <800>.
Despite numerous medical publications and known risks, prior to the recent publication
of USP Chapter <800> there was no enforceable standard to mitigate the risks
resulting from HD exposure in the healthcare setting. The intent of USP Chapter <800>
is to protect all workers, patients, and the general public who may enter facilities where
HDs are prepared for administration. This includes but is not limited to pharmacists,
pharmacy technicians, nurses, physicians, and other practitioners such as physician
assistants, home care workers, and veterinarians.
According to provisions of Chapter <800>, workers who come in contact with HDs must
receive appropriate HD training and be assessed for competency regularly. The
development of Chapter <800> was in response to numerous reports of adverse effects
occurring in healthcare personnel as a result of their occupational exposure to HDs.
HDs are categorized into one of three types: antineoplastic, non-antineoplastic, and
reproductive risk only. The facility will develop a list of hazardous drugs handled by the
pharmacy and perform an assessment of risk. This is an important part of compliance
with Chapter <800>, and it incorporates the type of HD, its dosage form, the relative
risk of human exposure, as well as packaging and dosage form manipulation
requirements.1
Because of the risks inherent in human exposure to HDs, care and precaution must be
exercised in the receipt, handling, and storage of these products. The distributor
generally ships HDs separately and apart from other products (e.g., in their own
container). Special care should be exercised when opening and unpacking totes
containing these products. In addition to spill management, it is also necessary to wear
personal protective equipment (PPE) when handling these shipments. HD containers
must be properly wiped down, physically segregated from other drugs, and stored in a
negative pressure room whenever the assessment of risk deems a particular item to be
high risk.
Although the distributor takes appropriate measures to pack and pad the items
properly inside totes, it is still possible for damage to occur. Pharmacy technicians
should be familiar with the organization’s HD spill management protocol. Most
hospitals or other entities that handle HDs will have an HD spill kit on hand to be used
in the management and cleanup of an accidental spill. All personnel who may be
required to assist with spill cleanup must be properly trained, including the use of PPE
and NIOSH-certified respirators.
3. Investigational drugs require special ordering, inventorying, and handling procedures.

Discuss.
Generally, the use of investigational drugs is categorized into two distinct areas:
• In a formal protocol approved by the institution
• For a single patient on a one-time basis that has been authorized by the
manufacturer and the FDA
In both cases, the physician may be responsible for the ordering, and the pharmacy
staff handles the inventory management of the investigational drug.
Some pharmacies associated with academic centers or institutions conducting clinical

research may have a pharmacist—principally dedicated to pharmaceutical research
activities—manage the formally organized investigational drug services. In these cases,
the investigational drug service pharmacist may be responsible for the ordering,
dispensing, and inventory management of investigational drugs according to the
research protocol.
Reference
1. The United States Pharmacopeial Convention (USP). USP general chapter <800>
hazardous drugs—handling in healthcare settings. http://www.usp.org/usp-chapter-
800-download (accessed 2018 Feb 18).
ANSWERS CH 18
BILLING AND REIMBURSEMENT
MULTIPLE CHOICE
1. a. Is a hybrid business offering both goods and services.
2. c. Ingredient cost plus dispensing fee minus copay
3. c. Third-party reimbursement relies exclusively on the AWP to determine the cost of

the medication.
4. d. MME
5. c. If WAC is used as the basis for reimbursement, it is usually expressed as the WAC
minus a small percentage (e.g., 2 or 3%).
8. c. Charge different copays for different tier drugs with the highest copay for generic
medications.
9. d. Progressive copays for subsequent fills
11. b. Medically necessary supplies
13. a. Pre-paid through payroll taxes.
14. d. Must pay all costs for prescriptions.
15. b. Medicare
16. d. Extra Help, which means the eligible person does not pay premiums or deductibles
and has reduced or no copays for prescription drugs.
17. b. Dispense 60 tablets as a 30-day supply, and document the change in quantity on
the face of the prescription.
18. a. She is most likely in the donut hole (i.e., coverage gap) of her Medicare part D plan
and must pay the ($350) “out-of-pocket cost” until she reaches Catastrophic
Coverage.
19. d. Perform an E1 transaction on the pharmacy system to determine her part D

eligibility information.
20. c. Contact the part D plan as a quantity override may be allowed/required.
21. b. She may be entitled to a 30-day supply of medication while her physician
completes the paperwork for a prior authorization.
MATCHING I
1. Part D
2. Part A
3. Part B
4. Part C
MATCHING II
1. 7
2. 5
3. 6
4. 4
5. 2
6. 1
7. 0
8. 9
9. 3
10. 8
TRUE OR FALSE
Typically, the reimbursement formula for a generic product is different than that for a
1. F
product.
2. T
3. F In the IPAP model, pharmacies typically receive “replacement” product for

medications that have already been dispensed.
4. F Medicare part B is optional medical insurance for outpatient physician and hospital
services, clinical laboratory services, and durable medical equipment, prosthetics,
orthotics, and supplies (DMEPOS).
5. T
6. T
7. F Formularies vary from plan to plan, so beneficiaries must be careful when choosing
a Medicare prescription drug plan to ensure that their prescription drugs are
covered.
8. F CMS requires that all Medicare prescription drug plans cover at least two drugs in
each of the six therapeutic categories.
9. T
10. F All part D claims must contain a National Provider Identifier (NPI) for the prescriber.
11. F Medicaid is a medical and long-term care program that is jointly funded by the
federal and state governments. Medicaid covers three main groups of low-income
Americans: parents and children, the elderly, and the disabled.
12. T
13. T
14. F There are some classes of drugs that are not covered at all by Medicare part D: over-
the-counter drugs, benzodiazepines, barbiturates, drugs for weight loss or weight
gain, and drugs for erectile dysfunction. Some part D plans may cover some of
these drugs as an added benefit, but they are not required by CMS to do so.
15. F Some medications, like certain inhalers, are covered for asthma or COPD but NOT
for acute bronchitis. If the patient has acute bronchitis, switching the code to
asthma to get the medication covered may be considered fraudulent.
FILL IN THE BLANK
1. Revenue
2. Prospective
3. Third-party
4. Copayment or copay
5. Usual and customary

6. Average wholesale price or AWP
7. Patient assistance programs or PAP
8. Pharmacy benefit managers or PBMs
9. Formulary
10. Diagnosis-related group or DRG
11. Dual eligible
ALPHABET SOUP
1. ACA: Affordable Care Act
2. AMP: Average manufacturer price
3. APC: Ambulatory payment classification
4. ASP: Average sales price
5. AWP: Average wholesale price
6. BIN: Bank identification number
8. CPT: Current procedural terminology (code)
11. DME MAC: Durable Medical Equipment Medicare Administrative Contractors
12. DMEPOS: Durable medical equipment, prosthetics, orthotics, and supplies
13. DRG: Diagnosis-related group
14. DSH: Disproportionate share hospital
15. FPL: Federal poverty limits
16. FQHC: Federally qualified health center
17. FUL: Federal upper limit
18. HCPCS: Healthcare Common Procedure Coding System
19. HMO: Health maintenance organization
20. ICD-10: International Classification of Diseases, 10th revision
21. IEP: Initial enrollment period

22. IHS: Indian Health Service
23. IPAP: Institutional patient assistance program
24. LIS: Low-income subsidy
25. MAC: Maximum allowable cost
26. MAPD: Medicare Advantage Prescription Drug (plan)
27. MSP: Medical savings program
28. NCPDP: National Council of Prescription Drug Program
30. NPI: National Provider Identification (number)
31. OPPS: Outpatient prospective payment system
32. PAP: Patient assistance program
33. PBM: Pharmacy benefit manager
34. PCMA: Pharmaceutical Care Management Association
35. PCN: Processor control number
36. PPO: Preferred provider organization
37. PPS: Prospective payment system
38. SEP: Special enrollment period
39. SSI: Supplemental security income
40. VA: Veterans Administration
41. WAC: Wholesale acquisition cost
SHORT ANSWER
1. Explain step therapy.
Step therapy requires use of a recognized first-line drug before a more complex or
expensive second-line drug is used. Beneficiaries must try and fail with the first-line
drug before a second-line drug can be covered by the benefit. For example, the PBM
might require use of a generic antibiotic before newer, more complex, broad-spectrum
antibiotics are prescribed.
2. Discuss the steps in processing third-party prescriptions, possible rejections that may
occur, and possible solutions to the rejections.
Patients with a prescription drug benefit should have a prescription identification (ID)
card. The information on the prescription ID card is necessary in order to submit a claim
to the PBM. The card identifies the PBM or drug benefit provider. It shows a telephone
number for the PBM customer service department. The employer may be identified
(Your Company, Inc.), followed by the Member Name (Jane Doe) and Member ID Number
(12345678). If the beneficiary is different from the plan member, such as a dependent
child, the Participant’s Name may be listed. Finally, the BIN # (000012) is the bank
identification number, which is also needed to submit the claim. It references the
claims processor or PBM. Once the technician enters information in the pharmacy
computer from the prescription ID card and the prescription, the PBM either accepts or
rejects the claim.
If the claim is rejected, the PBM responds with a message, commonly known as a
rejection code. Such codes are standard across all prescription benefit plans and may
include “Missing or Invalid Patient ID,” “Prior authorization required,” “Pharmacy not
contracted with plan on date of service,” “Refill too soon,” or “Missing or invalid
quantity prescribed.” The technician must assess the meaning of the rejection code
and respond accordingly. The resolution may be simple, such as checking the patient ID
and making sure it was entered correctly. Or the pharmacist or physician may need to
take further action (e.g., obtaining prior authorization) for the claim to be processed. If
the issue can’t be resolved or if the rejection code is unclear, the technician may need
to call the PBM customer service, which is usually listed on the prescription ID card.
3. Explain the difference between prospective and retrospective payment.
Prospective payment typically includes all costs associated with treating a condition,
including medications. With prospective payment systems, pharmacies are challenged
to deliver drugs at or below the predetermined rate in order to ensure that drug costs
are covered.
In community pharmacy practice, the most common type of payment method is

retrospective or fee for service. In the retrospective payment model, drugs are
dispensed, and later reimbursed, according to a predetermined formula that is
specified in a contract between the pharmacy and the third-party payer, such as the
insurance company or pharmacy benefit manager.
4. Discuss the programs available for those without insurance.
Many drug companies offer certain free drugs through patient assistance programs
(PAPs) to low-income patients who lack prescription drug coverage and meet certain
criteria. The criteria for PAPs are widely variable and are determined by individual drug
companies. In most cases, the products that are available free to the patient are
proprietary drugs, and the patient is required to complete an application that
determines eligibility. On approval, the drug company delivers a specified quantity of
the drug (usually a 30- to 90-day supply) to a licensed pharmacist or physician on the
patient’s behalf. Some companies also offer bulk replacement or institutional patient
assistance programs (IPAPs). In the IPAP model, medications are provided to an
institution (e.g., pharmacy, clinic) rather than to the individual patient. The institution
has the obligation of verifying that each patient who receives medications meets the
established criteria. In the IPAP model, pharmacies typically receive “replacement”
product for medications that have already been dispensed.
Pharmacy technicians can play an important role in helping pharmacists identify and
enroll eligible patients in PAPs. RX for Success Copay foundations or independent
charity PAPs are other resources that can be used to help patients who can’t afford to
pay for prescriptions or copays.
CROSSWORD PUZZLE
ANSWERS CH 19
IN THE REAL WORLD
MULTIPLE CHOICE
1. a. The requirements for education and certification vary

from state to state.
2. c. That you take and pass either the PTCE or the ExCPT
exam.
3. b. You may be required to take CE to maintain your state

pharmacy technician registration.
4. a. It should include a list of the places you previously

worked from the oldest to the most recent position.
5. d. Once you have a cover letter developed, you can use

the same letter for all your job applications.
7. b. Compile a list of answers to behavioral questions you

may be asked such as how you have handled a difficult
situation, what are your strengths and weaknesses, etc.
8. b. As the pharmacy profession evolves, it is creating a

need for pharmacy technicians in expanded roles.
TRUE OR FALSE
1. F Although many states require that pharmacy

technicians attain certification prior to licensure, not
every state does. It is important to check each state’s
requirements for licensure.
2. F CE is required education hours for licensure and

certification where CPD is a process for maintaining
lifelong competency in a profession.
3. F Although they contain much of the same information, a

CV will also include information about grants, awards,
research publications, presentations, and teaching
experience.
4. T
5. F It is acceptable in the header to list the name you

prefer to be called.
6. F There are five stages: reflect, plan, act, evaluate, and

record.
7. T
FILL IN THE BLANK

1. Mentor
2. Vision
3. Sponsee
4. Mission statement
5. Mentorship
6. Sponsor
7. Mentee
8. Sponsorship
SHORT ANSWER
1. Define and describe the differences between continuing

education and CPD.
• Continuing education is mandatory education that an
individual must complete to maintain their licensure or
registration. Moreover, certified technicians have CE
requirements to maintain their certification. One of the
exciting things about the profession of pharmacy is that
it is constantly changing. New drugs are approved, new
treatment guidelines are published, and new technology
is created and implemented. Maintaining CE
requirements helps ensure that all healthcare workers,
including pharmacy technicians, stay up-to-date. Some
states may also have additional requirements, such as
getting CE for pharmacy law. Consequences of failing to
keep up with the CE requirements can vary from mild
(e.g., having to pay a late fee) to severe (e.g., inability to
renew license). There are various ways that pharmacy
technicians can obtain CE including attending live
seminars, completing home study modules, or taking
pharmacy-related coursework. Some employers offer CE
on the job free of charge. It is the pharmacy technician’s
responsibility to know his or her state’s requirements
and complete them by the deadline. When selecting CE
programs, it is important to choose topics in areas that
you need development in as well as those you have an
interest in to reinforce knowledge and further
understanding.
• Continuing professional development or CPD is a
voluntary comprehensive plan designed to identify areas
for future improvement, plan an action course to
improve those areas, and record progress. CPD has been
proposed as a framework for approaching the need to
maintain life-long competency. Although CPD is not
required by State Boards of Pharmacy, it is used by
some healthcare professionals to help design a plan to
ensure that their knowledge and skills are up-to-date.
There are five stages involved in the CPD process:
■ Reflect—the individual reflects on the type of
education he or she needs to have to practice
effectively and safely in their work environment. This
may require consultation with supervisors to validate
areas of need.
■ Plan—after noting the educational needs, the next
stage is identifying activities to help meet those
opportunities for development. This could include CE
presentations, but it might also include other, less
formal activities such as reviewing a new
policy/procedure with a boss or co-worker, shadowing
a colleague, or finding opportunities to practice
certain skills.
■ Act—the individual completes the activities identified
in the “plan” stage of the process.
■ Evaluate—once completing the learning activity,
time should be spent reflecting on whether that
activity was successful in meeting the educational
need. This evaluation process can be performed by
the individual, a co-worker, or a supervisor. This will
help the practitioner determine if further steps are
necessary to meet the identified educational need.
■ Record—finally, efforts should be recorded. CPD
proponents typically recommend creating a portfolio,
where learners can record the learning experiences.
This serves as a record of their CPD journey.
2. List the benefits of joining and participating in a

professional organization.
• CE—many organizations offer free or low-cost CE.
• Advocacy—professional associations advocate for the
profession at the state and national level.
• Networking—professional organizations give you the
chance to meet and interact with others in your
profession for information, insight, and support.
• Tools and resources—many organizations have
members-only resources and learning and practice
tools.
• Online communities—members can participate to ask
questions and share ideas.
CROSSWORD PUZZLE
INDEX
A
abbreviated new drug application (ANDA), 22
abbreviations for medication dosage forms, 98, 264
acronyms. See alphabet soup
ADME (absorption, distribution, metabolism, and excretion), 84
administration technique error, 156
admixtures, infusions of, 34, 39, 230
adverse drug reaction, 36, 157
advice-giving response, 272
air embolus, 300
allergic reaction, 300
allergy and disease state information, 13
alphabet soup
aseptic technique, sterile compounding, and IV admixture programs, 150–151,
299
billing and reimbursement, 195–196, 330–331
medication dosage forms and routes of administration, 98, 264
medication safety, 163, 308
pharmaceutical supply chain management, 186, 323
pharmacy and pharmacy technician, 13, 216
pharmacy informatics and technology, 173–174, 316
pharmacy law, regulations, and standards, 25, 222–223
processing medications orders and prescriptions, 122, 279
Alzheimer’s disease, 63, 70, 76
ambulatory patient, 37
ambulatory pharmacy, 12, 28, 29
amphotericin B, 33–34, 37
ampules, 146
angiotensin-converting enzyme (ACE) inhibitors, 71
antiepileptic drugs, 70, 73
antihistamines, 72
antithyroid drugs, 72
297–304
ASHP/ACPE-accredited technician training program, 14, 215, 216
ASHP Technical Assistance Bulletin on Institutional Use of Controlled
Substances, 323–334
ASHP Technical Assistance Bulletin on Single-Unit and Unit-Dose Packages of
Drugs, 293
attention deficit hyperactivity disorder (ADHD), 71, 74
automated compounding, 301–302
automated counting devices, 31
automated dispensing devices, 48, 118
automated dispensing model, decentralized, 280
average wholesale price (AWP), 190
B
barcode medication administration (BCMA), 171
beads, 264
benchmark prices, 190
beyond-use-dates (BUDs), 134, 135, 293
biennial inventory, 18
billing and reimbursement, 189–198, 329–333
bioavailability, 84, 85
biological products, 23
biopharmaceutics, 83
biotech drugs, 38
bleeding, IV therapy and, 300
body mass index (BMI), 286
body surface area (BSA), 286
bronchodilator, 71
C
calcium channel blockers, 71
calculation errors, 311–312
caplets, 93
capsules, 93
captopril, 86
catheters, 34, 36, 228
ceftriaxone, 33, 228
celecoxib (Celebrex), 74
cephalosporin antibiotics, 33
chain pharmacy, 28
chemotherapy, 75
child-resistant packaging, 24
ciprofloxacin, 86
Class I recall, 182, 321
Class II recall, 182, 321
Class III recall, 182, 321
clinical decision support rights, 316
clinic pharmacy, 29
clonazepam (Klonopin), 32, 227
color-coding drug product packaging, 159–160
Combat Methamphetamine Epidemic Act, 21, 23
communication and teamwork, 103–113, 269–273
community, ambulatory care, and home care pharmacy practice, 27–41, 227–231
community pharmacy, 28, 29, 223
compliance error, 156
compounded prescriptions, 13, 215
compounding
automated, 301–302
nonsterile, 133
sterile, 47, 143
total parenteral nutrition, 301–302
computerized physician order entry (CPOE), 47, 171
continuing education (CE), 202, 337–338
continuing professional development (CPD), 337–338
controlled substances
ordering, receiving, and storing, 323–324
prescriptions for, 20–21, 23, 25
storage and documentation of, 46–47
corticosteroids, 71–72, 73
creams, 93–94
credentialing, 15, 217
crossword puzzle
304
billing and reimbursement, 197–198, 333
communication and teamwork, 112–113, 273
community, ambulatory care, and home care pharmacy practice, 40–41, 231
hospital and specialty pharmacy practice, 52–53, 238
human body, 66–67, 244
learning strategies, 6, 212
medication dosage forms and routes of administration, 98–99, 265
nonsterile compounding and repackaging, 140–141
pharmacy and pharmacy technician, 15–16, 217
pharmacy calculations, 130–131, 287
pharmacy technicians in the real world, 205–206, 339
cytotoxic agents, 146
D
decentralized pharmacies, 44–45
diphenoxylate, 24, 222
disease state management, 32, 37
dispensing fee, 36
diuretics, 71
dosage form error, 156
dosing information, 13
drug classifications and pharmacologic actions, 69–82, 247–252
drug distribution service, 46
Drug Enforcement Administration (DEA), 18, 221, 324
drug excretion, 85
drug shortages, 46
drug storage, 46
drug utilization review (DUR), 37
E
electronic health record (EHR), 170, 317
emotional intelligence, 5, 211
emulsions, 94
enteral nutrition, 37
ephedrine, 221
e-prescribing, 171
erythropoietin, 38
ethical principles, 19
ExCPT exam, 12
expectorants, 72
extended-release products, 263–264
extravasation, 300
extrinsic motivation, 5, 6, 211, 212
F
failure and mode effects analysis (FMEA), 310–311
filgrastim, 38
fill in the blank
299
biopharmaceutics, pharmacokinetics, pharmacodynamics, 89, 256
communication and teamwork, 111, 271
community, ambulatory care, and home care pharmacy practice, 39, 230
drug classifications and pharmacologic actions, 80–82, 251
hospital and specialty pharmacy practice, 51, 237
human body, 65, 243
medication dosage forms and routes of administration, 97, 262
medication safety, 165, 309
nonsterile compounding and repackaging, 140
pharmaceutical supply chain management, 185–186, 323
pharmacy technicians in the real world, 204, 337
first-pass metabolism, 84, 85
fixed mindset, 5, 6, 211, 212
fluoxetine, 73
Food and Drug Administration (FDA), 18, 221
forged prescriptions, 25, 118, 223
G
gels, 94
generic drugs, 22, 24, 36, 221–222
glycerin, 92–93
grit, 6, 212
growth mindset, 5, 6, 211, 212
H
hazardous drugs (HDs), 302
receiving and storing, 324–325
spills of, 303
healthcare institution management, 44
Health Insurance Portability and Accountability Act (HIPAA), 18, 29, 37, 221
health screenings, 32
heart contractions/heart rhythms, 243
high-alert medication, 158, 161
histamine-2 receptor antagonists (H2 antagonists), 72
home care pharmacy, 30
home infusion services, 33–34, 37
horizontal LAFW, 302
hospital and specialty pharmacy practice, 43–53, 235–238
hospital clinical pharmacy services, 45
hospital formulary, 46, 49, 180
human body, structure and function, 57–67, 241–244
hydrocodone, 24
hyperlipidemia, 71
I
ideal body weight (IBW), 286
immunizations, 32–33
incompatibilities, 300
infection, IV therapy and, 300
infusions of admixtures, 34, 39, 230
infusion systems, 35–36
institutional patient assistance programs (IPAPs), 332
institutional pharmacy, 12
insulin, 72, 74
internet research
pharmacy law, regulations, and standards, 25, 223
pharmacy technician, 14, 217
intrinsic motivation, 5, 6, 211, 212
inventory, biennial, 18
inventory management and control, 180, 182, 280
isotretinoin, 32, 37, 227
IV admixture programs, 143, 144
IV therapy risks, 300–301
J
job application/hiring process, 202, 203
judgmental response, 271–272
K
kidneys, 243
L
labeling
home care medication, 34
IV products, 146
medication, 51, 237
prescription, 31, 117, 118, 277
laminar airflow workbench (LAFW), 144, 145, 302
layers, of extended-release form, 264
learning strategies, 3–6, 211–212
“legend” drugs, 23, 29, 37, 222
levigation agents, 135
liquid medications, 263
lorazepam, 24
Low-Income Subsidy (LIS), 191
lozenges, 93, 136
M
mail order pharmacy, 28–29
managed care pharmacy, 28
matching
aseptic technique, sterile compounding, and IV admixture programs, 148, 297
billing and reimbursement, 193, 329
biopharmaceutics, pharmacokinetics, pharmacodynamics, 87–88, 255
communication and teamwork, 109, 270
human body, 61–62, 241–242
medication dosage forms and routes of administration, 95–96, 261–262
medication safety, 162–163, 308
pharmacy informatics and technology, 172, 315
processing medications orders and prescriptions, 118–119, 277
matrix, 264
“meaningful use” program, 170
MedGuides, 22, 70
Medicaid patient’s medication profile, 29
Medicare part B, 191
Medicare part D, 192, 193
medication carts, 48
medication dosage forms and routes of administration, 91–99, 261–265
medication error rate, 156
medication safety, 155–165, 307–312
medication therapy management (MTM), 39
medication-use evaluation (MUE), 48, 50, 51, 237
meperidine, 24
metformin (Glucophage), 74
methadone, 24
methylphenidate, 24, 221
monitoring error, 156
mortar and pestle, 293
multiple choice
297
biopharmaceutics, pharmacokinetics, pharmacodynamics, 84–86, 255
community, ambulatory care, and home care pharmacy practice, 28–34, 227–
228
drug classifications and pharmacologic actions, 70–75, 247
hospital and specialty pharmacy practice, 44–49, 235–238
human body, 58–61, 241
medication safety, 156–161, 307
pharmacy law, regulations, and standards, 18–23, 221–222
pharmacy technicians in the real world, 202–203, 337
processing medications orders and prescriptions, 116–118, 277
multiple sclerosis (MS), 70
muscle relaxers, 72
N
National Association of Boards of Pharmacy (NABP), 18, 24, 222
National drug code (NDC), 31, 180
neuropathic pain, 70–71, 73
nitrates, 71
nonsterile compounding and repackaging, 133–142, 291–294
nonsteroidal anti-inflammatory drugs (NSAIDs), 72
nucleoside reverse transcriptase inhibitors, 75
O
OBRA-90, 30
opioids, 74
oral Factor Xa inhibitor, 75
oral solutions, 92
Orange Book, 22, 24
ordering
human body, 63, 242
osmotic pump, 264
over-the-counter (OTC) drugs, 29
P
pain, assessment of, 72
Parkinson’s disease treatment, 70, 73
particulate matter, 300
patient assistance programs (PAPs), 332
patient counseling, 19
patient package inserts, 22, 221
patient privacy, 18, 24, 25, 29, 37, 221, 223
patient profile, 280
penicillin antibiotics, 33
pharmaceutical supply chain management, 179–187, 321–325
pharmacodynamics, 83
pharmacokinetics, 84
pharmacy, 11–16, 215–217
ambulatory, 12, 28, 29
chain, 28
clinic, 29
community, 28, 29, 223
decentralized, 44–45
home care, 30
institutional, 12
mail order, 28–29
managed care, 28
telepharmacy, 172
pharmacy benefit managers (PBMs), 191–192
pharmacy calculations, 123–131, 283–287
pharmacy informatics and technology, 169–175, 315–318
pharmacy law, regulations, and standards, 17–25
pharmacy satellite, 51
pharmacy technician, 10–12
ambulatory care and community pharmacies and, 30
biopharmaceutics, pharmacokinetics, and pharmacodynamics, 256–257
certification, 10–11, 12, 15, 202, 215, 216
certification renewal, 12, 15
Code of Ethics, 11
continuing education, 202, 337–338
continuing professional development, 337–338
defined, 104
duties, 10, 13
duties in hospital clinical pharmacy, 45
registration, 17, 24, 202
responsibilities, 11
role in pharmacy informatics, 316–317
Pharmacy Technician Certification Board (PTCB), 12
Pharmacy Technician Certification Exam (PTCE), 12
Pharmacy Technician Forum, 14, 217
phenobarbital, 24
phlebitis, 301
placating response, 272
prescription identification card, 331
prescription monitoring programs, 18–19
priming IV tubing, 302–303
processing medications orders and prescriptions, 115–122, 277–280
professional organization benefits, 338
prospective payment, 332
Protected health information (PHI), 24, 25
pseudoephedrine, 21, 221
pyrogens, 300–301
Q
quality control, 51, 237
quality improvement, 51, 237
quizzing response, 272
R
real world, pharmacy technician in the, 201–206, 337–339
recalls, 181–183
relationship management, 5, 211, 212
repackaging, 136, 293
retrospective payment, 332
Risk Evaluation and Mitigation Strategy (REMS) drugs, 32
root cause analysis, 311
routes of administration, 91, 92, 256
S
Safety Data Sheet (SDS), 134
Schedule I prescription, 24, 222
Schedule II drugs, 324
prescription for, 19, 20, 21, 221, 222
Schedule III drugs, 324
prescription for, 20, 221
Schedule IV drugs, 324
prescription for, 20, 221, 222
Schedule V drugs, 324
prescription for, 20, 23, 221, 222
selegiline, 86
self-advocacy, 5, 211
self-management, 5, 6, 211
short answer
aseptic technique, sterile compounding, and IV admixture programs, 151, 300–
303
billing and reimbursement, 196, 331–332
biopharmaceutics, pharmacokinetics, pharmacodynamics, 89, 256–257
communication and teamwork, 111, 271–272
drug classifications and pharmacologic actions, 82, 252
human body, 65, 243
medication dosage forms and routes of administration, 98, 263–264
medication safety, 165, 309–312
pharmaceutical supply chain management, 187, 323–325
pharmacy and pharmacy technician, 14, 216–217
pharmacy calculations, 130, 286
pharmacy informatics and technology, 174, 316–317
pharmacy technicians in the real world, 204, 337–338
simvastatin, 86
social awareness, 6, 212
solve, pharmacy calculations, 127–129, 284–286
specialty medications, 48–49
spill kit, 146, 303, 325
standard units, 125
STAR safety tool, 156
State Boards of Pharmacy, 70,22617, 19, 222, 324
step therapy, 331
sterile compounding, 47, 143
study protocol, 48
substance inventory, 13
suppositories, 93
compounding, 136
SureScripts, 171
syrups, 92
T
teamwork, 103, 111, 272
technology downtime planning, 317
telepharmacy, 172
thalidomide, 37
third-party payers, 30–31, 37
third-party reimbursement, 190
time management, 4, 211
total parenteral nutrition (TPN), 34, 37, 147
automated compounding of, 301–302
transitions of care, 48
trituration, 293
troches, 136
true or false
298
billing and reimbursement, 194, 329–330
biopharmaceutics, pharmacokinetics, pharmacodynamics, 88, 255–256
hospital and specialty pharmacy practice, 49–50, 236
human body, 63–64, 242–243
medication safety, 164–165, 308–309
pharmaceutical supply chain management, 183–185, 321–322
pharmacy and pharmacy technician, 13, 215–216
pharmacy calculations, 126–127, 283–284
pharmacy informatics and technology, 173, 315–316
pharmacy law, regulations, and standards, 23–24, 222
pharmacy technicians in the real world, 203, 337
processing medication orders and prescriptions, 119–121, 278–279
tunneled central venous catheters, 34
U
universal precautions, 40
USP Chapter <800>, 324–325
V
vancomycin, 33, 228
vertical LAFW, 302
vitamins, 75
W
warfarin, 86
wellness programs, 32
wholesale acquisition cost (WAC), 190
workplace issues affecting medication errors, 309–310

Workbook To The Manual For Pharmacy Technicians, 2nd Edition

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Workbook To The Manual For Pharmacy Technicians, 2nd Edition

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Any correspondence regarding this publication should be sent to the publisher,

American Society of Health-System Pharmacists, 4500 East-West Highway, suite

Vice President, Publishing: Daniel Cobaugh

© 2019, American Society of Health-System Pharmacists, Inc. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any

ASHP is a service mark of the American Society of Health-System Pharmacists,

Part I: Setting Your Goals and Objectives

Part II: Introduction to Pharmacy

Part III: Science Knowledge and Skills

Part IV: Practice Basics

Part V: Business Applications

Part VI: Getting Started

I have had the distinct honor of authoring the Workbook for

1. How to Be a Great Student: Strategies for

After completing this chapter, you will be able to

______1. Which of the following strategies will

______2. Which of the following is NOT a component of grit?

______3. Which of the following is a way you can use

______5. Which of the following is a time management

______1. “I am bad at math.”

______2. “I can master this chapter if I study harder.”

______3. “I want to graduate at the top of my class.”

______4. “I’m not smart enough to understand this no

______5. “I’m going to ask the instructor for more

______7. “I really want to help people be healthier.”

______8. “I need to learn this well enough to pass the

______9. “I didn’t pass the quiz; I’ll never understand this.”

______10. “I want to learn as much as I can about taking care

______1. People with more extrinsic motivation tend to

______2. A growth mindset is more beneﬁcial to learning,

______3. Feeling good about helping patients is an example

______4. Having good emotional intelligence skills has been

______5. Higher emotional intelligence quotient (EQ) scores

______6. Self-advocacy is ﬁnding the answers to your

2. What are some strategies you could have used to control

2. The World of Pharmacy and Pharmacy

After completing this chapter, you will be able to

______6. Which of the following is true regarding national technician certiﬁcation?

______7. Which of the following is true?

______9. The Pharmacy Technician Code of Ethics:

______10. Which of the following is true regarding technician responsibilities?

______12. In all states, pharmacists are licensed by:

______13. ASHP’s 10 characteristics of a professional include the following except:

A. Ambulatory care pharmacy

______1. Community pharmacy

______2. Chain pharmacy

______3. Independent pharmacy

______4. Pharmacy located in a nursing home

______5. Hospital pharmacy

______6. Clinic outpatient pharmacy

______8. Typically, little or no patient contact

______9. Typically, frequent patient contact

______1. 110-minute, 90 question test (80 scored questions, 10 unscored questions)

______2. 130-minute, 120 question test (100 scored and 20 unscored)

______3. Administered by National Healthcareer Association (NHA)

______4. Administered by Pharmacy Technician Certiﬁcation Board (PTCB)

______6. Certiﬁcation renewal every 2 years includes 20 hours of technician-speciﬁc CE

______7. Covers nine knowledge domains

______8. Covers four knowledge areas

______1. A technician may reconstitute an oral antibiotic suspension for a patient

______3. Technicians may contact an insurance company to investigate and resolve a

______6. A technician may answer prescriber requests for dosing information of a

______7. A technician may perform a controlled substance inventory.