General Prescriptions Henderson

Product Selection Drug Substitutions Bioavailability must be the same Cannot indication DAW (Dispense as Written) Patient agrees with the substitution Drug is equal or less value to the brand name and savings are passed on to the patient or third party. Bioavailability must be the same

Product Selection The FDA reviews generic products to make certain they are equivalent in composition prior to being available for use. Orange Book- contains two-letter codes assigned to therapeutic equivalences of generics. A rated drugs are considered therapeutically equivalent and therefore suitable for substitution where permitted by the prescriber.

Formularies A document or listing of committee approved pharmaceuticals and therapeutics in stock. Used in institutional facilities. Preferred products

Bar Code Medication Administration (BCMA) Designed to prevent medication errors. Improve quality and safety of medication administration Improve accuracy and errors Generate records

Assisting the pharmacist in preparing medications Measuring/counting Conical- easy to handle, has a wide mouth Cylindrical- more accurate to measure the meniscus Perform necessary calculations Should be verified by a pharmacist Calculate twice, compound once 

Compounding Mixing/assembling drugs for professional practice. Who benefits from compounding? Why would you compound? Remington’s Pharmaceutical Sciences: A reference book to look up formulas.

Compounding BUD Reconstituted with water (ABX) 14 days when stored at controlled cold temps. Component- any ingredient used in compounding of a drug preparation (active and non-active ingredients) Compounder- professional authorized by appropriate jurisdiction to perform compounding. Vehicle: a component used for internal or external use that is used as a carrier/diluent for active ingredients.

Hazardous Drug Any drug identified by one the following 6 criteria: 1. Carcinogenicity: an agent directly involved in causing cancer 2. Teratogenicity: an agent that can disturb the development of the embryo or fetus. 3. Organ Toxicity 4. Genotoxicity: having a destructive effect on a cell's genetic material (DNA, RNA) affecting its integrity 5. Reproductive Toxicity 6. New drugs mimicking existing hazardous drugs in structure or toxicity.

Types of Compounding Extemporaneous: on the spot compounding for one specific patient. Bulk: Preparing and packaging for more than one patient. Most include lot numbers and expiration dates of ingredients. Documentation of procedure on prescription/medication order.

Definitions Desiccation- the act or process of desiccating or the state of being or becoming desiccated.  This is the complete or nearly complete deprivation of moisture or of water not chemically combined. Colation- (straining) the process of separating a solid from a fluid by pouring the mixture on a cloth which will permit the fluid to pass through, but will retain the solid. Distillation- the process that involves a change of state - from liquid to vapor and back to liquid. Filtration- the process of separating liquids from solids with the purpose of obtaining optically transparent liquids. Levigation- the process of producing a smooth dispersion of a drug with a spatula. Trituration- the grinding of tablets into a fine powder in a porcelain mortar. Stability- the ability for medication to maintain chemical and physical integrity over time.

Miscellaneous Capsules Vary in size, 5 being the smallest and 000 being the largest Controlled room temperature is defined as 15-30 degrees centigrade or 59-86 degrees Fahrenheit Refrigeration is defined as 2-8 degrees centigrade or 46-59 degrees Fahrenheit.

Weighing Class A balance Class B balance 6mg sensitivity Accurately weighs between 120mg and 15gm Class B balance 30mg sensitivity Accurately weighs between 650mg and 120gm

Process for Weighing Paper is placed on each pan Balance or “tare” or “zero” Desired weight is placed on the right tray (weights) Substance is placed on the left tray and measured until balanced.

Controlled substances Require strict inventory control Documentation of receipt- commercial invoice Documentation of distribution- Narcotic inventory record DEA 222: used to purchase DEA 106: used to report theft

5 rights of medications RIGHT MEDICATIONS (NDC check) RIGHT PATIENT RIGHT DOSE RIGHT ROUTE RIGHT TIME

Three check points Retrieving bottle from stock Counting from the bottle Returning the bottle to stock

Medication Errors It happens… What leads to medication errors? Not rotating stock Preparing multiple prescriptions at one time Going too fast Misinterpreting abbreviations

Misinterpreting Abbreviations HS-Half Strength hs-At Bedtime D/C- Discontinue DC-Discharge IU- International Unit IV- Intravenous Q.D.- Every Day Q.I.D.-Four times a day Q1D- Once Daily Q.I.D.- Four times a day ss-1/2 SS- Sliding Scale SSRI- Sliding Scale Regular Insulin SSRI- Selective Serotonin Reuptake Inhibitor Q.O.D.-Every other day Q.I.D-Four Times a Day UD-As Directed UD- Unit Dose O.D.-Once Daily OD- Right Eye

Results of medication errors Increased risk of serious adverse effects Worsening of disease signs or symptoms Death

Quality Control A process of checks and balances Hold meetings Have open communication Make changes

Package inserts Required every time the following meds is dispensed Oral contraceptives Estrogens Progesterones Isotretinoin IUDs Albuterol

Filling a prescription in a pharmacy: Drop Off Greet the customer with a smile Verify patient information Name Date of birth Address Phone number Allergies Prescription medications, vitamins, herbals, disease states Verify insurance information Enter patient information Enter Doctor information Enter prescription information Medication Strength Quantity prescribed Sig Day supply Insurance adjudication Drug interaction review Print label

Filling a prescription: Filling station Compare written prescription from prescriber to prescription label to verify information was entered correctly Pull appropriate medication from pharmacy shelf Check the ndc on medication bottle with ndc on label Scan prescription label and medication bottle to ensure they match Count medication on counting tray or pour into counting machine Label the prescription vial Auxiliary labels Verification station Pharmacists check prescription by comparing written prescription to label for accuracy Pharmacist reviews prescription for interactions with any of the medications patient is currently taking Technician must leave medication stock bottle with prescription bottle for the pharmacist to check

Filling a prescription- pick up station Bag prescription Verify patients name and date of birth when the patient picks up medication Verify if patient needs counseling by the pharmacist Scan prescription to ring up Have patient sign for prescription Collect co-payment from patient Give change if applicable Thank the patient