1. General Prescriptions
Henderson

2. 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

3. 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.

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

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

6. 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 

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

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

13. 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

14. 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.

15. 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

16. 5 rights of medications RIGHT MEDICATIONS (NDC check) RIGHT PATIENT
RIGHT DOSE
RIGHT ROUTE
RIGHT TIME

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

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

19. 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

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

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

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

23. 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

24. 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

25. 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