1. Ch 19: Introduction to Pharmacy Math
Roman Numerals
Fractions
Decimals
Rounding Numbers ©

2. Roman Numeral Symbols
ss = one-half I = one V = five X = ten L = fifty C = one hundred D = 500 hundred M = one thousand ©

3. Roman Numerals
Often used in prescription orders
Three Cardinal Rules:
#1 If a symbol follows another symbol of equal or greater value, the two symbols are added together
#2 If a symbol follows another symbol of lower value, the lower value is subtracted from the higher value
#3 First perform any necessary subtraction, then add the resulting values together to get the final answer ©

4. Roman Numerals
IX = ? 9 ©

5. Roman Numerals
XXX = ? 30 ©

6. Roman Numerals
XCII = ? 92 ©

7. Fractions A numerical representation of pieces of a whole
Bottom number is the denominator
tells us how many total pieces there are
Top number is the numerator
tells us how many pieces of the whole we have ©

8. Fractions
Fractions with a numerator that is smaller than the denominator are called “proper fractions”
Fractions with a numerator that is larger than the denominator are called “improper fractions”
For our purposes we won’t worry about reducing improper fractions ©

9. Addition and Subtraction of Fractions
Must have a common denominator
Then just add or subtract the numerators ©

10. Fractions
1/3 + 3/9 = ?
6/9 ©

11. Fractions
9/30 + 4/10 = ?
21/30 ©

12. Fractions
12/14 – 3/7 = ?
6/14 ©

13. Multiplication of Fractions
Simply multiply the two numerators and the two denominators
Do NOT need a common denominator ©

14. Fractions
2/6 x 5/7 = ?
10/42 ©

15. Fractions
3/9 x 2/4 = ? 6/36 ©

16. Division of Fractions The order of the fractions is important
The second fraction is the divisor
the divisor is what we are dividing by
Invert the divisor and then multiply the fractions ©

17. Fractions
1/8 divided by 5/6 = ?
6/40 ©

18. Fractions
6/3 divided by 7/8 = ?
48/21 ©

19. Decimals Three general rules when working with decimals
#1 Never leave a decimal point “uncovered”
too easy to misread and make a mistake
#2 Unless working with money, Never add zeros to the right of the decimal point
the end signifies the accuracy of the number
#3 The answer you get can be only as accurate as the least accurate number used in the calculation ©

20. Rounding Numbers
If the number following the place you are rounding to is 5 or higher, you round up
If the number following the place you are rounding to is 4 or lower, you round down ©

21. Try some rounding
to tenths to hundredths to thousandths 9.998 ©

22. Ch 14: Requirements of the Drug Order
Retail  the PRESCRIPTION
Hospital  the Hospital Drug Order ©

23. Methods of Transmitting a Retail Prescription
May Use Four Methods:
Written
Telephoned
Faxed
E-scribe ©

24. Written Prescriptions
Non-Controlled Drugs
May be written
Must be signed by prescriber
Schedule III thru IV Drugs
Schedule II Drugs ©

25. Telephoned Prescriptions
Non-Controlled Drugs
May be telephoned
May be called in by the prescriber’s agent
Schedule III thru IV Drugs
Schedule II Drugs
ONLY allowed under emergency situations
VERY RARE
**ALL TELEPHONED PRESCRIPTIONS MUST BE REDUCED TO WRITING IMMEDIATELY** ©

26. Faxed Prescriptions Non-Controlled Drugs Schedule III thru IV Drugs
May be faxed
Must be signed by prescriber or electronic signature
Schedule III thru IV Drugs
Schedule II Drugs
May be faxed ONLY UNDER THREE SPECIAL SITUATIONS ©

27. Situations That Allow for the Faxing of Schedule II Prescriptions
Compounding of a narcotic for direct administration by a parenteral route
Residents of a long term care facility
Patients enrolled in a hospice program ©

28. E-Scribed prescriptions
Requires special software for the prescriber and pharmacy
Generates an electronic signature for the provider
Four main components of the e-prescribe system:
The prescriber
The transaction hub
The pharmacy benefit manager (PBM) if the patient has prescription insurance
The pharmacy ©

29. E-Scribed Prescriptions
Non-Controlled Drugs
May be e-scribed
Must be electronically signed by the prescriber
Schedule III thru IV Drugs
Schedule II Drugs
May be e-scribed ONLY WITH SPECIAL SOFTWARE ©

30. REMEMBER! We are studying FEDERAL LAW in this class
The laws of your state may forbid some methods of transmission, and your instructor will point out the differences
For the purposes of the certification examinations and our examinations, remember the FEDERAL requirements ©

31. Anatomy of the Prescription©

32. Requirements of Tamper Resistance©

33. Required Information on the Prescription
Prescriber’s name, address, DEA number
Patient’s name, address
Date prescription was written
Drug name, strength, dosage form, & Quantity
Instructions for use
Refill information
Doctor’s signature (in ink) ©

34. Optional Information on the Prescription
Refill information
Diagnosis
“Dispense as written” information
Prescriber’s numbers
Special instructions for preparation ©

35. Controlled Substance Prescriptions
Should have written out quantity and/or date according to state law
ie.) THIRTY, not 30
Patient’s full name and address
Prescriber’s full name and address
Prescriber’s DEA number ©

36. Medicare Part B Requirements
Cannot be telephoned prescription / order
Patient’s full name and address
Prescriber’s full name, address, and NPI number
The disease code the order is meant to treat
The exact product name (trade name if applicable)
The exact directions for use (NOT “as directed”)
Must have written out date and quantity
Prescriber must sign and date the rx next to signature ©

37. Veterinary Prescriptions
Must have name of pet and species
Must have owner’s name and full address ©

38. Restricted Drug Programs
Created due to special risks associated with certain medications
Involves targeted education and approval process
IPLEDGE
- Isotretinoin causes birth defects
Clozapine Registry
- Clozapine can cause life threatening blood changes
Thalidomid REMS
- Thalidomide can cause severe birth defects ©

39. Ch 15: Interpreting the Prescription
Never guess at anything you’re not sure of!
Abbreviations
Directions for use (the sig)
Calculating the amount to dispense
Written Date and the time limits it imposes
Number Limitations
Generic Substitution ©

40. Know these Abbreviations?
qam every morning hs at bedtime qD every day ©

41. BID twice daily QID four times daily TID three times daily qOD every other day ©

42. q8hr every 8 hours ac before meals pc after meals prn as needed ©

43. gtt drop ud as directed OD right eye OS left eye ©

44. OU both eyes AD right ear AS left ear AU both ears ©

45. Let’s Try Some Sigs
1TID 1 three times daily 2 po TID ac 2 by mouth 3 times daily before meals 2gtt OU qid Instill 2 drops in both eyes 4 times daily ©

46. How many do we give?
1 TID x 10days 30 2 qOD x 30 days 4ml BID x 1 week 56ml ©

47. The Prescription Date
The federal laws do not put a limit on Schedule 2 or legend drugs!
Schedule 3 thru 5 are only good for 6 months from the date the prescription is written ©

48. Number of Refills Legend drugs- no limit
Schedule 3 thru 5 – 5 Refills max
Schedule 2- no refills allowed ©

49. Partial filling of Schedule 2’s
The only time you may have 2 separate fillings from one Schedule 2 prescription is if you do not have enough medication in stock to fill it completely the first time
You only have 72 hours to provide the remaining balance or the remainder is void ©

50. Review
A schedule 3 prescription is good for ____ months and _____ refills
6 months / 5 refills
A schedule 2 prescription is good for ____ months and _____ refills
no federal limit / NO refills
A non-controlled prescription is good for _____ months and _____refills
no federal limit / no federal limit ©

51. Ch 16: Patient Information on the Hospital Drug Order
The patient’s name
The patient’s age
The patient’s location
The hospital billing number ©

52. Medication Information on the Hospital Drug Order
Drug name
Strength
Dosage form
Route of administration
Exact times of administration ©

53. Prescriber Information on the Hospital Drug Order
Practitioner’s name & title
NO DEA NUMBER IS NECESSARY FOR CONTROLLED SUBSTANCE ORDERS……….why? ©

54. Review & Comparison Prescription Hospital Order Address DEA number
Exact quantity
Refill information
Less precise sig
Hospital Order
Room number
NO DEA number
Hospital policy determines length of supply
Exact times
Billing number ©

55. The Hospital Drug Order
Prescriber electronically enters into system
Sent to the pharmacist
Pharmacist reviews and releases order
Order becomes active and available for administration ©

56. The Hospital Formulary
Simply stated, a formulary is a list of the medications a pharmacy normally stocks
Limited list based on factors such as drug cost, effectiveness, frequency of need, storage requirements and adverse effects
Dictated by the “Pharmacy & Therapeutics” Committee
Creates a list of needed medications without stocking unnecessary or duplicate drugs ©

57. Distribution in the Hospital
In-patient pharmacy
Out-patient pharmacy
IV room
Floor stock
Emergency carts & trays
Automated dispensing units
REMEMBER- No matter where the drugs are stored in the hospital, they are the PHARMACY’S responsibility! ©

58. Ch 17: Medication Order Entry
Components of the computer
Importance of scheduled backups
Methods of order entry into the pharmacy computer
Manual entry
Internet transmission (e-scribe)
Fax transmission
Telephone entry system
Automated refills
Prescription process on the computer
entry and verification ©

59. Medication Order Entry
Study the steps of prescription entry in Chapter 17
Always take a moment and review what you have entered into the computer BEFORE you hit the key to accept the information ©

60. Ch 18: The Patient Records
Retail  Patient Profile
Hospital  Patient Chart
Many differences you need to know
© 2013

61. RETAIL PROFILE PATIENT CHART Name Home Address Third Party Information
Diagnosis
Allergy Information
Date of Birth
Concurrent Medications
Previous Rxs filled
Refill Information
PATIENT CHART
Name
Room / Location
Billing Number
Diagnosis
Allergy Information
Date of Birth
Height & Weight
Lab & Radiology Reports
24hr observation notes
Nursing Care Plan
Dr notes & orders
Hx of drug or alcohol abuse
Hx of previous hospital visit
Physical or mental handicap
Physical therapy plan
Dietary Information
© 2013

62. Abbreviations Found on the Chart
Abbreviations commonly found in the hospital
are listed in Chapter 18
MEMORIZE the abbreviations!!
© 2013

63. Questions? ©