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298 Cards in this Set
- Front
- Back
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pharmacology
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The study of drugs, their properties, uses, applications, and effects.
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herbal medicine
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People have used drugs derived from plants to treat illnesses and other physical conditions for thousands of years. The ancient Greeks used the bark of a white willow tree to relieve pain. The bark contained salicylic acid, the natural forerunner of the active ingredient in aspirin.
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cocaine
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The first effective local anesthetic.
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digitalis
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The drug of the foxglove plant which has been widely used in treating heart disease.
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quinine
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The first useful drug in the treatment of malaria, one of mankind's most deadly diseases. It was extracted from the bark of a Peruvian tree, the Cinchona.
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germ theory
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The theory that microorganisms cause food spoilage.
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polio vaccine
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The use of an injectable vaccine made from killed polio virus and an oral polio vaccine made from a weakened form of live polio virus was important to prevent the spread of this crippling and often fatal disease.
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insulin
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The hormone that lowers blood sugar in the treatment of diabetes-one of the great discoveries in medicine in the twentieth century.
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penicillin
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The first antibiotic.
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average life span
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This measure of health has increased by over twenty years in the United States in the Twentieth Century.
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synthetic drugs
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Drugs created by reformulating simpler chemicals into more complex ones, creating a new chemical not found in nature.
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Human Genome Project
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An attempt to map the entire DNA sequence in the human genome. This information will provide a better understanding of hereditary diseases and how to treat them.
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pharmacist education and training
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In the United States, an individual must graduate from an accredited college of pharmacy, pass a state licensing exam, and perform an internship working under a licensed pharmacist. Once licensed, the pharmacist must receive continuing education to maintain their license.
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cost control
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A significant trend in recent health care has been the effort to control the cost of prescription drugs, one aspect of which is the use of closed "formularies" that rely substantially on substituting generic drugs in place of more expensive brands.
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computerization
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Pharmacy computer systems put customer profiles, product, inventory, pricing, and other essential information within easy access. One result has been that pharmacies and pharmacists dispense more prescriptions and information than ever before.
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job responsibilities
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Pharmacy technicians perform essential tasks that do not require the pharmacist's skill or expertise. Specific responsibilities and tasks differ by setting and are described in writing by each employer through job descriptions, policy and procedure manuals, and other documents.
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supervision
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Pharmacy technicians work under the direct supervision of a licensed pharmacist who is legally responsible for their performance.
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pharmacist counseling
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Having technicians assist the pharmacist frees the pharmacist for activities which require a greater level of expertise, such as counseling with patients.
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scope of practice
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What individuals may and may not do in their jobs is often referred to as their "scope of practice."
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employment opportunities
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Like pharmacists, most pharmacy technicians are employed in community pharmacies and hospitals. However, they are also employed in clinics, home care, long term care, mail order prescription pharmacies, and various other settings.
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specialized jobs
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In various hospital and other environments, there are specialized technician jobs which require more advanced skills developed from additional education, training, and experience.
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trustworthiness
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Pharmacy technicians are entrusted with confidential patient information, dangerous substances, and perishable products.
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errors
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Drugs, whether prescription or over the counter, can be dangerous if misused, and mistakes by pharmacy technicians can be life-threatening.
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Health Insurance Portability and Accountability ACt (HIPAA)
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Pharmacy technicians are legally responsible for the privacy and security of protected health information (PHI).
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math skills
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Pharmacy technicians routinely perform mathematical calculations in filling prescriptions and other activites.
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terminology
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Pharmacy technicians must learn the specific pharmaceutical terminology that will be used on the job.
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teamwork
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Pharmacy technicians must be able to communicate, cooperate, and work effectively with others.
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standards
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There is no federal standard for pharmacy technician training or competency. However there are state and employer standards which must be met.
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certification
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A valuable career step for pharmacy technicians is getting certification by an appropriate organization or body. It verifies an individual's competence as a technician, and indicates a high level of knowledge and skill. In the United States, the Pharmacy Technician Certification Board (PTCB) provides technician national certification.
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Food and Drug Administration
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The leading enforcement agency at the federal level for regulations concerning drug products.
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Drug Enforcement Agency
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The agency which controls the distribution of drugs that may be easily abused.
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Food and Drug Act of 1906
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Prohibited interstate commerce in adulterated or misbranded food, drinks, and drugs. Government pre-approval of drugs is required.
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1938 Food, Drug and Cosmetic (FDC) Act
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In response to the fatal poisoning of 107 people, primarily children, by an untested sulfanilamide concoction, this comprehensive law requires new drugs be shown to be safe before marketing.
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1951 Durham-Humphrey Amendment
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This law defines what drugs require a prescription by a licensed practitioner and requires them to include this legend on the label: "Caution: Federal Law prohibits dispensing without a prescription."
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1962 Kefauver-Harris Amendments
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Requires drug manufacturers to provide proof of both safety and effectiveness before marketing the drug.
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1970 Poison Prevention Packaging Act
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Requires child-proof packaging on all controlled and most prescription drugs dispensed by pharmacies.
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1970 Controlled Substances Act (CSA)
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The CSA classifies drugs that may be easily abused and restricts their distribution. It is enforced by the Drug Enforcement Administration (DEA) within the Justice Department.
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1990 Omnibus Budget Reconciliation Act (OBRA)
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Among other things, this act required pharmacists to offer counseling to Medicaid patients regarding medications, effectively putting the common practice into law.
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1996 Health Insurance Portability and Accountability Act (HIPAA)
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Provided broad and stringent regulations to protect patients' privacy.
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placebos
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Inactive substances, not real medications, that are used to test the effectiveness of drugs.
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new drugs
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All new drugs, whether made domestically or imported, require FDA approval before they can be marketed in the United States.
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clinical tests
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Tests on proposed new drugs (investigational drugs) are "controlled" by comparing the effect of a proposed drug on one group of patients with the effect of a different treatment on other patients.
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blind tests
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Patients in a trial are always "blind" to the treatment, i.e, they are not told which control group they are in. In a "double-blind" test, neither the patients nor the physicians know what the medication is.
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patent protection
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A patent for a new drug gives its manufacturer an exclusive right to market the drug for a specific period of time under a brand name. A drug patent is in effect for 17 years from the date of the drug's discovery. The Hatch-Waxman Act of 1984 provided for up to five year extensions of patent protection to the patent holders to make up for time lost while products went through the FDA approval process.
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generics
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Once a patent for a brand drug expires, other manufacturers may copy the drug and release it under its pharmaceutical or "generic" name.
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labels and product labeling
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All drugs are required to have clear and accurate information for all labels, inserts, packaging, and so on, but there are different information requirements for various categories of drugs.
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prescription drug labels
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The minimum requirements on prescription labels for most drugs are as follows: name and address of dispenser, prescription serial number, date of prescription or filling, name of prescriber, name of patient, directions for use, and cautionary statements.
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NDC (National Drug Code) number
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The number assigned by the manufacturer. Each NDC number has three parts or sets of numbers: The first set indicated the manufacturer; the next set indicates the medication, its strength, and dosage form; the last set indicates the package size.
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controlled substances
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A drug which has the potential to be abused and for which distribution is controlled by one of five "schedules."
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control classifications
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Manufacturers must clearly label controlled drugs with their control classification.
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DEA number/formula
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The number all prescribers of controlled substances are assigned and which must be used on all controlled drug prescriptions. It has two letters followed by seven single-digit numbers, e.g., AB1234563. The formula for checking a DEA number on a prescription form is: if the sum of the first, third, and fifth digits is added to twice the sum of the second, fourth, and sixth digits, the total should be a number whose last digit is the same as the last digit of the DEA number.
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risks of approved drugs
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There is always the risk that an approved drug may produce adverse side effects when used on a larger population.
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recalls
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Recalls are, with a few exceptions, voluntary on the part of the manufacturer. There are three classes of recalls: 1.) where there is a strong likelihood that the product will cause serious adverse effects of death; 2.) where a product may cause temporary but reversible adverse effects, or in which there is little likelihood of serious adverse effects; 3.) where a product is not likely to cause adverse effects.
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state regulation
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State boards of pharmacy are responsible for licensing all prescribers and dispensers and administering regulations for the practice of pharmacy in the state.
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liability
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Legal liability means you can be prosecuted for misconduct.
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negligence
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Failing to do something that should or must be done.
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prescription
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A written order from a practitioner for the preparation and administration of a medicine or a device. Medical doctors (MD), dentists (DDS), veterinarians (DVM), and doctors of osteopathy (DO) are the primary practitioners allowed to write prescriptions. IN some states, nurse practitioners, physicians assistants, and/or pharmacists are also allowed limited rights to prescribe medications.
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medication orders
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Used in institutional settings instead of a prescription form.
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technician responsibilities
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In community pharmacies, this generally includes receiving the prescription, collecting patient data, entering it into a computerized prescription system, and filling orders.
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pharmacist role
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Does all consulting with patients, handles Schedule II prescriptions, and checks all filled orders before dispensing.
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prescription verification
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It is necessary to check with the pharmacist on potential forgeries, on prescriptions that are more than a few days old, or on prescriptions that in any way appear questionable.
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online billing
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A prescription is interpreted and confirmed by the prescription system. If third party billing is involved, this is done online simultaneously.
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preparation
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Once the prescription and third-party billing is confirmed, the label and receipt are printed and the prescription is prepared.
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label
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The general purpose of the prescription label is to provide information to the patient regarding the dispensed medication and how to take it. Additionally, the label includes information about the pharmacy, the patient, the prescriber, and the prescription or transaction number assigned to the prescription.
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signa
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Directions for use. Since the patient is expected to self-administer the medication, these must be clear and easily understood by the patient.
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pharmacist check
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If a prescription has been prepared by a technician, there is a final check by the pharmacist to make sure that it is correct.
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institutional settings
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There are different requirements for institutional prescriptions since nursing staff generally administer medications to patients. Rules for institutional pharmacy prescription labels vary by institution but often do not contain much more than the name, strength, manufacturer, expiration date, and dosage form of the medication.
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OTC prescriptions
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Prescriptions may be written for over-the-counter (OTC) medications.
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judgement questions
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Technicians must request the advice of the pharmacist whenever judgement is required.
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auxiliary labels
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Many computerized prescription systems will automatically indicate which auxiliary labels to use with each drug.
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controlled substance labels
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Schedules II, III, and IV substances must carry an auxiliary label stating: "Caution: Federal law prohibits the transfer of this drug to any person other than the patient for whom it prescribed."
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formulations
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Drugs are contained in products called formulations. There are many drug formulations and many different routes to administer them.
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route of administration
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Routes are classified as enteral parenteral. Enteral refers to anything involving the tract from the mouth to the rectum. There are three enteral routes: oral, sublingual, and rectal. Any route other than oral, sublingual, and rectal is considered a parenteral administration route. Oral administration is the most frequently used route of administration.
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local and systemic effects
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A local effect occurs when the drug activity is at the site of administration (e.g., eyes, ears, nose, skin). A systemic effect occurs when the drug is introduced into the circulatory system.
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oral administration
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The stomach has a pH around 1-2. Certain drugs cannot be taken orally because they are degraded or destroyed by stomach acid and intestinal enzymes. Drugs administered by liquid dosage forms generally reach the circulatory system faster than drugs formulated in solid dosage forms.
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oral formulations
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Oral formulations contain various ingredients besides the active drug. These inactive ingredients include binders, lubricants, fillers, diluents, and disintegrants.
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gastrointestinal action
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The disintegration and dissolution of tablets, capsules, and powders generally begins in the stomach, but will continue to occur when the stomach empties into the intestine. Modified-release formulations extend dissolution over a period of hours and provide a longer duration of effect compared to plain tablets. Enteric coated tablets prevent the tablet from disintegrating until it reaches the higher pHs of the intestine.
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sublingual administration
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These tablets are placed under the tongue. They are generally fast dissolving uncoated tablets which contain highly water soluble drugs. When the drug is released from the tablet, it is quickly absorbed into the circulatory system since the membranes lining the mouth are very thin and there is a rich blood supply to the mouth.
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rectal administration
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Rectal administration may be used to achieve a variety of systemic effects, including asthma control, antinausea, anti-motion sickness, and anti-infective. However, absorption from rectal administration is erratic and unpredictable. The most common rectal administration forms are suppositories, solutions, and ointments.
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parenteral administration
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Parenteral routes are often preferred when oral administration causes drug degradation or when a rapid drug response is desired, as in an emergency situation. The parenteral routes requiring a needle are intravenous, intramuscular, intradermal, and subcutaneous. These solutions must be sterile (bacteria-free), have an appropriate pH, and be limited in volume.
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intravenous formulations
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Intravenous dosage forms are administered directly into a vein (and the blood supply). Most solutions are aqueous (water based), but they also have glycols, alcohols, or other non-aqueous solvents in them.
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IV emulsions
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Fat emulsions and TPN emulsions are used to provide triglycerides, fatty acids, and calories for patients who cannot absorb them from the gastrointestinal tract.
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infusion
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Infusion is the gradual intravenous injection of a volume of fluid into a patient.
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intravenous sites
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Several sites on the body are used to intravenously administered drugs: the veins of the antecubital area (in front of the elbow), the back of the hand, and some of the larger veins in the foot. On some occasions, a vein must be exposed by a surgical cut.
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intramuscular injections
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The principal sites of injection are the gluteal maximus (buttocks), deltoid (upper arm), and vastus lateralis (thigh) muscles. Intramuscular injections generally reult in lower but longer lasting blood concentrations than with intravenous administration.
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subcutaneous injections
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Injection sites include the back of the upper arm, the front of the thigh, the lower portion of the abdomen and the upper back. The subcutaneous (SC, SQ) route can be used for both short term and very long term therapies. Insulin is the most important drug routinely administered by this route.
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intradermal injections
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Intradermal injections involve small volumes that are injected into the top layer of skin. The usual site for intradermal injections is the anterior surface of the forearm.
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ophthalmic formulations
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Every ophthalmic product must be manufactured to be sterile in its final container. A major problem of ophthalmic administration is the immediate loss of a dose by natural spillage from the eye.
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intranasal formulations
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Intranasal formulations are primarily used for their decongestant activity on the nasal mucosa, the cellular lining of the nose. The drugs that are typically used are decongestants, antihistamines, and corticosteroids. Nasal administration often causes amounts of the drug to be swallowed, in some cases this may lead to a systemic effect.
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inhalation formulations
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Inhalation dosage forms are intended to deliver drugs to the pulmonary system (lungs). Most of the inhalation dosage forms are aerosols that depend on the power of compressed or liquefied gas to expel the drug from the container. Gaseous or volatile anesthetics are the most important drugs administered via this route. Other drugs administered affect lung function, act as bronchodilators, or treat allergic symptoms. Examples of drugs administered by this route are adrenocorticoid steroids (beclomethasone), bronchodilators (epinephrine, isoproterenol, metaproterenol, albuterol), and antiallergics (cromolyn sodium).
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dermal formulations
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Most dermal dosage forms are used for local (topical) effects on or within the skins. Dermal formulations are used to treat minor skin infections, itching, burns, diaper rash, insect stings and bites, athlete's foot, corns, calluses, warts, dandruff, acne, psoriasis, and eczema. The major disadvantage of this route of administration is that the amount of drug that can be absorbed will be limited to about 2mg/day.
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vaginal administration
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Formulations for this route of administration are: solutions, powders for solutions, ointments, creams, aerosol foams, suppositories, tablets, and IUDs. Vaginal administration leads to variable absorption since the vagina is a physiologically and anatomically dynamic organ with pH and absorption characteristics changing over time. Another disadvantage of this route is that administration of a formulation during menstruation could predispose the patient to Toxic Shock Syndrome.
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parenteral solutions
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There are two types of products: large volume parenteral (LVP) solutions and small volume parenteral (SVP) solutions. LVP solutions are typically bags or bottles containing larger volumes of intravenous solutions. SVP solutions are generally contained in ampules or vials.
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properties
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Solutions for injection or infusion must be sterile, free of visible particulate material, pyrogen-free, stable for their intended use, have a pH around 7.4, and in most (but not all) cases isotonic.
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flow rate
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The rate at which the solution is administered to the patient.
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piggybacks
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Small volumes of fluid (usually 50-100 ml) infused into the administration set of an LVP solution.
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pumps
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Infusion pumps, syringe pumps, and ambulatory pumps are devices used to administer LVP solutions and control flow rates. Administration sets are threaded through infusion pumps, and the pumps control the gravity flow. Infusion pumps have made the infusion process much more accurate and easier to administer and have been a major factor in the growth of home infusion.
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admixtures
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When a drug is added to a parenteral solution, the drug is referred to as the additive, and the final mixture is referred to as the admixture.
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syringes
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Syringes come in sizes ranging from 1 to 60 ml. As a rule, a syringe size is used that is one size larger than the volume to be measured. The volume of solution in a syringe is measured to the edge of the plunger's stopper while the syringe is held upright and all air has been removed from the syringe.
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needle sizes
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Needle sizes are indicated by length and gauge. The higher the gauge number, the smaller is the lumen (the hollow bore of the needle shaft). Large needles may be needed with highly viscous solutions but are more likely to cause coring.
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filters
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Often used to remove contaminating particles from solutions. Depth filters and membrane filters are the two basic groups.
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laminar flow hood
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Establishes and maintains an ultraclean work area for the preparation of IV admixtures.
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aseptic techniques
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Maintain the sterility of all sterile items and are used in preparing IV admixtures.
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biological safety cabinets
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Used in the preparation of hazardous drugs. They protect both personnel and the environment from contamination.
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total parenteral nutrition solutions
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These are complex admixtures composed of dextrose, fat, protein, electrolytes, vitamins, and trace elements. They are hypertonic solutions. Most of the volume of TPN solutions is made up of macronutrients: amino acid solution (a source of protein) and a dextrose solution (a source of carbohydrate calories). Several electrolytes, trace elements, and multiple vitamins (together referred to as micronutrients) may be added to the base solution to meet individual patient requirements. Common electrolyte additives include sodium chloride (or acetate), potassium chloride (or acetate), calcium gluconate, magnesium sulfate, and sodium (or potassium) phosphate. Multiple vitamin preparations containing both water-soluble and fat-soluble vitamins are usually added on a daily basis. A trace element product containing zinc, copper, manganese, selenium, and chromium may be added.
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IV fat emulsions
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Intravenous fat (lipid) emulsion is required as a source of essential fatty acids. It is also used as a concentrated source of calories. Fat provides nine calories per gram, compared to 3.4 calories per gram provided by dextrose. Intravenous fat emulsion may be admixed into the parenteral nutrition solution with amino acids and dextrose, or piggybacked into the administration line.
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peritoneal dialysis solutions
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Used by patients who do not have functioning kidneys to remove toxic substances, excess body waste, and serum electrolytes through osmosis. The solution is administered directly into the peritoneal cavity (the cavity between the abdominal lining and the internal organs) to remove toxic substances, excess body waste, and serum electrolytes through osmosis. These solutions are hypertonic to blood so the water will not move into the circulatory system.
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extemporaneous compounding
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The on-demand preparation of a drug product according to a physician's prescription, formula, or recipe.
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accuracy and stability
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The supervising pharmacist must determine that a product can be accurately compounded and will be stable for its expected use. Accuracy is then essential in all weighings, measurements, and other activities in the compounding process.
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class A balances
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Can weigh as little as 120 mg of material with a 5% error. Always use the balance on a level surface and in a draft-free area. Always arrest the balance before adding or removing weight from either pan, or storing.
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electronic or analytical balances
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Highly sensitive balances that can weigh quantities smaller than 120 mg with acceptable accuracy.
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weighing papers or boats
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Should always be placed on the balance pans before any weighing is done. Balances must be readjusted after a new weighing paper or boat has been placed on each pan. Weighing papers taken from the same box can vary in weight by as much as 65 mg.
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mortar and pestle
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Made of three types of materials: glass, wedgewood; and porcelain. Wedgewood and porcelain mortars are used to grind crystals and large particles into fine powders. Glass mortars and pestles are preferable for mixing liquids and semi solid dosage forms.
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volumetric glassware
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For weighing liquid drugs, solvents, or additives. Includes graduates, flasks, pipets and syringes. Erlenmeyer flasks, beakers, and prescription bottles, regardless of markings, are not volumetric glassware.
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small volumes
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Always use the smallest device (graduate, pipet, syringe) that will accommodate the desired volume of liquid.
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graduated cylinders
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Cylindrical graduates are preferred over cone shaped because they are more accurate. When selecting a graduate, always choose the smallest graduate capable of containing the volume to be measured. Avoid measurements of volumes that are below 20 percent of the capacity of the graduate because the accuracy is unacceptable.
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disposable syringe
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Used to measure small volumes. Measurements made with syringes are more accurate and precise than those made with cylindrical graduates. Measure volumes to the edge of the syringe stopper.
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meniscus
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The curved surface of a volume of liquid. When reading a volume of a liquid against a graduation mark, hold the graduate so the meniscus is at eye level and read the mark at the bottom of the meniscus.
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medicine droppers
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Used to deliver small liquid doses, but must first be calibrated.
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trituration
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The fine grinding of a powder.
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levigation
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The trituration of a powdered drug with a solvent in which the drug is insoluble to reduce the particle size of the drug.
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geometric dilution
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A technique for mixing two powders of unequal size. The smaller amount of powder is diluted in steps by addition of the larger amount of powder.
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solvents
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Water is the most common solvent, but ethanol, glycerin, propylene glycol, or a variety of syrups may be used.
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sensitivity
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The amount of weight that will move the balance pointer one division mark.
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nonaqueous solutions
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Solutions that contain solvents other than water.
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syrup
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A concentrated or nearly saturated solution of sucrose in water. Syrups containing flavoring agents are known as flavoring syrups (e.g. Cherry Syrup, Acacia Syrup, etc.).
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thickening agents
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Reduce the settling (sedimentation rate) of a suspension.
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suspensions
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A "two-phase" compound consisting of a finely divided solid dispersed in a liquid. Most solid drugs are levigated in a mortar to reduce the particle size as much as possible before adding to the vehicle. Common levigating agents are alcohol and glycerin.
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flocculating agents
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Electrolytes that carry an electrical charge and enhance particle "dispersibility" in a solution.
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ointments and creams
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Ointments are simple mixtures of a drug(s) in an ointment base. A cream is a semi-solid emulsion. Oleaginous (oil based) bases generally release substances slowly and unpredictably. Water miscible or aqueous bases tend to release drugs more rapidly.
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emulsion
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An unstable system consisting of at least two immiscible (unmixable) liquids, one that is dispersed as small droplets throughout the other, and a stabilizing agents.
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oil-in-water (o/w)
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An emulsion of oils, petroleum hydrocarbons, and/or waxes with water, where the aqueous phase is generally in excess of 45% of the total weight of the emulsion.
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water-in-oil (w/o)
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When water or aqueous solutions are dispersed in an oleaginous (oil based) medium, with the aqueous phase constituting less than 45% of the total weight.
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emulsifiers
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Emulsifiers provide a protective barrier around the dispersed droplets that stabilize the emulsion. Commonly used emulsifiers include: tragacanth, sodium lauryl sulfate, sodium dioctyl sulfosuccinate, and polymers known as the Spans and Tweens.
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suppository bases
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There are three classes that are based on their composition and physical properties: oleaginous bases, water soluble or miscible bases, and hydrophilic bases.
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polyethylene glycols (PEGs)
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Popular water soluble bases that are chemically stable, non-irritating, miscible with water and mucous secretions, and can be formulated by molding or compression in a wide range of hardnesses and melting points.
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fusion molding
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A method in which the drug is dispersed or dissolved in a melted suppository base. The fusion method can be used with all types of suppositories and must be used with most of them.
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compression molding
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A method of preparing suppositories by mixing the suppository base and the drug ingredients and forcing the mixture into a special compression mold.
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capsules
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When filling, the smallest capsule capable of containing the final volume is used since patients often have difficulty swallowing large capsules.
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objective of drug therapy
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To deliver the right drug, in the right concentration, to the right site of action at the right time to produce the desired effect.
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receptors
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When a drug produces an effect, it is interacting on a molecular level with cell material that is called a receptor. Receptor activation is responsible for most of the pharmacological responses in the body.
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site of action
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Only those drugs able to bind chemically to the receptors in a particular site of action can produce effects in that site. This is why specific cells only respond to certain drugs.
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agonists
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Drugs that activate receptors and produce a response that may either accelerate or slow normal cell processes.
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antagonists
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Drugs that bind to receptors but do not activate them. They prevent other drugs or substances from interacting with receptors.
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dose-response curve
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Specific doses of a drug is given to various subjects and the effect or response is measured in terms of dose and effect.
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blood concentrations
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The primary way to monitor a drug's concentration in the body and its related effect is to determine its blood concentrations.
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minimum effective concentration (MEC)
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When there is enough drug at the site of action to produce a response.
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minimum toxic concentration (MTC)
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An upper blood concentration limit beyond which there are undesired or toxic effects.
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therapeutic window
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The range between the minimum effective concentration and the minimum toxic concentration is called the therapeutic window. When concentrations are in this range, most patients receive the maximum benefit from their drug therapy with a minimum of risk.
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ADME
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Blood concentrations are the result of four simultaneously acting processes: absorption, distribution, metabolism, and excretion.
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disposition
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Another term for ADME
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elimination
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Metabolism and excretion combined.
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passive diffusion
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Besides the four ADME processes, a critical factor of drug concentration and effect is how drugs move through biological membranes. Most drugs penetrate biological membranes by passive diffusion.
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hydrophobic drugs
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Lipid (fat) soluble drugs that penetrate the lipoidal (fat-like) cell membrane better than hydrophilic drugs.
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hydrophilic drugs
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Drugs that are attracted to water.
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aqueous pores
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Openings in cell membranes that allow entry of water and water soluble drugs.
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absorption
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The transfer of drug into the blood from an administered drug product is called absorption.
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gastric emptying
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Most drugs are given orally and absorbed into the blood from the small intestine. One of the primary factors affecting oral drug absorption is the gastric emptying time.
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distribution
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The movement of a drug within the body once the drug has reached the blood.
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selective action
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Drug action that is selective to certain tissues or organs, due both to the specific nature of receptor action as well as to various factors that can affect distribution.
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protein binding
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Many drugs bind to proteins in blood plasma to form a complex that is too large to penetrate cell openings. So the drug remains inactive.
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metabolism
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The body's process of transforming drugs. The primary site of drug metabolism in the body is the liver. Enzymes produced by the liver interact with drugs and transform them into metabolites.
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enzyme
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A complex protein that causes chemical reactions in other substances.
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metabolite
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The transformed drug.
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enzyme induction
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The increase in enzyme activity that results in greater metabolism of drugs.
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enzyme inhibition
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The decrease in enzyme activity that results in reduced metabolism of drugs.
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first-pass metabolism
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When a drug is substantially degraded or destroyed by the liver's enzymes before it reaches the circulatory system, an important factor with orally administered drugs.
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enterohepatic cycling
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The transfer of drugs and their metabolites from the liver to the bile in the gall bladder and then into the intestine.
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excretion
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The process of excreting drugs and metabolites, primarily performed by the kidney through the urine.
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glomerular filtration
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The blood filtering process of the kidneys. As plasma water moves through the nephron, waste substances (including drugs and metabolites) are secreted into the fluid, with urine as the end result.
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bioavailability
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The amount of a drug that is available to the site of action and the rate at which it is available is called the bioavailability of the drug.
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bioequivalents
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Bioequivalent drug products are pharmaceutical equivalents or alternatives which have essentially the same rate and extent of absorption when administered at the same dose of the active ingredient under similar conditions.
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pharmaceutical equivalents
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Pharmaceutical equivalents are drug products that contain identical amounts of the same active ingredients in the same dosage form, but may contain different inactive ingredients.
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pharmaceutical alternatives
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Pharmaceutical alternatives are drug products that contain the identical active ingredients, but not necessarily in the same amount or dosage form.
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therapeutic equivalent
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Pharmaceutical equivalents that produce the same effects in patients.
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therapeutic alternative
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Drugs that have different active ingredients but produce similar therapeutic effects.
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human variability
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Differences in age, weight, genetics, and gender are among the significant factors that influence the differences in medication responses among people.
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age
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Drug distribution, metabolism, and excretion are quite different in the neonate and infant than in adults because their organ systems are not fully developed. Children metabolize certain drugs more rapidly than adults. The elderly typically consume more drugs than other age groups. They also experience physiological changes that significantly affect drug action.
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pregnancy
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A number of physiological changes that occur in women in the latter stages of pregnancy tend to reduce the rate of absorption.
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genetics
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Genetic differences can cause differences in the types and amounts of proteins produced in the body, which can result in differences in drug action.
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pharmacogenetics
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A new field of study that defines the hereditary basis of individual differences.
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weight
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Weight adjustments may be needed for individuals whose weight is more than 50% higher than the average adult weight. Weight adjustments are also made for children, or unusually small, emaciated, or obese adult patients.
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allergic reactions
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Almost any drug, in almost any dose, can produce an allergic or hypersensitive reaction in a patient. Anaphylactic shock is a potentially fatal hypersensitivity reaction.
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common adverse reactions
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Anorexia, nausea, vomiting, constipation, and diarrhea are among the most common adverse reactions to drugs.
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teratogenicity
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The ability of a substance to cause abnormal fetal development when given to pregnant women.
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drug-drug interactions
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These can result in either increases or decreases in therapeutic effects or adverse effects.
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additive effects
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Occur when two drugs with similar pharmacological actions are taken, e.g., alcohol and a sedative together produce increased sedation.
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synergism or potentiation
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Occurs when two drugs with different sites or mechanisms of action produce greater effects when taken together than either does when taken alone, e.g., acetaminophen and codeine together produce increased analgesia.
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inhibition
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When a drug blocks the activity of metabolic enzymes in the liver.
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displacement
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Displacement of one drug from protein binding sites by a second drug increases the effects of the displaced drug. Decreased intestinal absorption can occur when orally taken drugs combine to produce nonabsorbable compounds, e.g.. when magnesium hydroxide and oral tetracycline bind.
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enzyme induction
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Caused when drugs activate metabolizing enzymes in the liver, increasing the metabolism of other drugs affected by the same enzymes.
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increased excretion
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Some drugs raise urinary pH, lessening renal reabsorption, e.g., sodium bicarbonate rases pH and will cause increased elimination of phenobarbital.
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drug-diet interactions
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The physical presence of food in the gastrointestinal tract can alter absorption by interacting chemically (e.g., certain medications and tetracycline); improving the water-solubility of some drugs by increasing bile secretion; affecting the performance of the dosage form (e.g., altering the release characteristics of polymer-coated tablets); altering gastric emptying; altering intestinal movement; altering liver blood flow. Some foods contain substances that react with certain drugs, e.g., foods containing tyramine can react with monoamine oxidase (MAO) inhibitors.
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disease states
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The disposition and effect of some drugs can be influenced by the presence of diseases other than the one for which a drug is used. Hepatic, cardiovascular, renal, and endocrine disease all increase the variability in drug response. For example, decreased blood flow from cardiovascular disorders can delay or cause erratic drug absorption.
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primary literature
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Information based directly on contemporary research.
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secondary literature
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Primarily general reference works based upon primary literature sources.
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tertiary literature
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Condensed and compact information based on primary literature.
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abstracting services
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Services that summarize information from various primary sources for quick reference.
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Material Safety Data Sheets (MSDSs)
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OSHA required information for handling hazardous chemicals.
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state regulations
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Many states have laws or State Board of Pharmacy rules and regulations that require pharmacies to maintain specific professional literature references.
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Drug Facts and Comparisons (DFC)
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A preferred reference for comprehensive and timely drug information, containing information about prescription and OTC products.
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Martindale
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"The Extra Pharmacopoeia," the best source of information on drugs in clinical use internationally.
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Physician's Desk Reference
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An annual publication intended for physicians that provides prescription information on major pharmaceutical products.
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American Hospital Formulary Service
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The authority for drug information questions. It groups drug monographs by therapeutic use.
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USP DI
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Provides comprehensive and clinically relevant information on drugs in current use.
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Handbook on Injectable Drugs
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A collection of monographs on commercially available parenteral drugs that include concentration, stability, dosage, and compatibility information.
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Merck Index
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An encyclopedic source of chemical substance data, contains monographs referenced by trade, code, chemical, investigational and abbreviated drug names.
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American Drug Index
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An exhaustive list of drug products and contains trade and generic drug names, phonetic pronunciations, indications, manufacturers and schedule information in a dictionary format.
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Drug Topics Red Book
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The pharmacist's guides to products and prices, providing annual price lists of drug products including manufacturer, package size, strength and wholesale and retail prices.
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"Orange Book"
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The common name for the FDA's Approved Drug Products publication.
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Internet
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A "supernetwork" of many networks from around the world all connected to each other by telephone lines, and all using a common "language."
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URLs (uniform resource locators)
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The specific addresses of Web sites you want to visit.
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personal digital assistants (PDAs)
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Small hand-held computers that pharmacists can use for drug information.
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inventory goals
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Good inventory management ensures that drugs which are likely to be needed are both on hand and usable-that is, not expired, damaged, contaminated, or otherwise unfit for use.
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open formulary
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One that allows purchase of any medication that is prescribed.
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closed formulary
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A limited list of approved medications.
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wholesalers
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More than three-quarters of pharmaceutical manufacturers' sales are directly to drug wholesalers, who in turn resell their inventory to hospitals, pharmacies, and other pharmaceutical dispensers. They are government-licensed and regulated.
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Schedule II substances
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Must be stocked separately in a secure place and require a special order form for reordering. Their stock must be continually monitored and documented.
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perpetual inventory
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A system that maintains a continuous record of every item in inventory so that it always shows the stock on hand.
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spoilage
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Inappropriate storage conditions or expired products automatically determine that a product is spoiled since in either case the chemical compounds in the drug product may have degraded.
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turnover
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The rate at which inventory is used.
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point of sale (POS) system
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A system in which the item is deducted from inventory as it is sold or dispensed.
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drug reorder points
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Maximum and minimum inventory levels for each drug.
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hard copy
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Important reports (especially purchase orders) should be regularly printed out and filed as hard copy both for convenience and as a backup record-keeping system.
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computer maintenance
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Factors that can damage computer systems are temperature, dust, moisture, movement, vibrations, and power surges.
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data back-up
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Pharmacy computer files must be regularly backed-up or copied to an appropriate storage media.
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order entry device
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In a computerized inventory system, a hand-held device to generate orders.
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online ordering
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In an online ordering system, if an order can be filled as ordered, a message from the supplier will automatically confirm the order to the ordering system. The system automatically assigns to each order a purchase order number for identification.
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Material Safety Data Sheets
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Instructions for hazardous substances such as chemotherapeutic agents that indicate when special handling and shipping is required.
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controlled substance shipping
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These substances are shipped separately and checked in by a pharmacist. A special order form must be used for Schedule II substances.
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stock bottles
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The bulk containers in which most medications are received from the supplier.
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storage
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Drugs must be stored according to manufacturer's specifications. Most drugs are kept in a fairly constant room temperature of 59-86 degrees F. The temperature of refrigeration should generally be 36-46 degrees F.
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freshness
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Medications should be organized in a way that will dispense the oldest items first.
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dispensing units
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In hospitals and other setting, medications are stocked in dispensing units throughout the facility that may be called supply stations or med-stations.
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third party programs
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Another party besides the patient or the pharmacy that pays for some or all of the cost of medication: essentially, an insurer.
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pharmacy benefit manager (PBM)
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A company that administers drug benefit programs for insurance companies, HMOs, and self-insured employers.
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co-insurance
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Essentially between the insurer and the insured to share costs.
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co-pay
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The portion of the cost of prescriptions that patients with third party insurance must pay.
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deductible
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A set amount that must be paid by the patient for each benefit period before the insurer will cover additional expenses.
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maximum allowable cost (MAC)
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The amount paid by the insurer is not equal to the retail price normally charged, but is determined by a formula described in a contract between the insurer and the pharmacy. There is a maximum allowable cost (MAC) per tablet or other dispensing unit that an insurer or PBM will pay for a given product.
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usual and customary (U&C)
|
The MAC is often determined by survey of the usual and customary (U&C) prices for a prescription within a given geographic are. This is also referred to as the UCR (usual, customary, and reasonable) price for the prescription.
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prescription drug benefit card
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Cards that contain necessary billing information for pharmacies, including the patient's identification number, group number, and co-pay amount.
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HMO (health maintenance organization)
|
Health care networks that usually do not cover expenses incurred outside the network and often require generic substitution.
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POS (point of service)
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Health care network where the patient's primary care physician must be a member and costs outside the network may be partially reimbursed.
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PPO (preferred provider organization)
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Health care network that reimburses expenses outside the network at a lower rate than inside the network and usually requires generic substitution.
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workers' compensation
|
Compensation for employees accidentally injured on-the-job.
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Medicare
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National health insurance for people over the age of 65, disabled people under the age of 65, and people with kidney failure.
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Medicaid
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A federal-state program for the needy.
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online adjudication
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Most prescriptions claims are now filed electronically by online claim submission and online adjudication of claims. In online adjudication, the technician uses the computer to determine the exact coverage for each prescription with the appropriate third party.
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dispense as written (DAW)
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When brand name drugs are dispensed, numbers corresponding to the reason for submitting the claim with brand name drugs are entered in a DAW (dispense as written) indicator field in the prescription system.
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patient identification number
|
The number assigned to the patient by the insurer that is indicated on the drug benefit card. If it does not match the code for the patient in the insurer's computer (with the same sex and other information) a claim may be rejected.
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age limitations
|
Many prescription drug plans have age limitations for children or dependents of the cardholder.
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refills
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Most third party plans require that most of the medication has been taken before the plan will cover a refill of the same medication.
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maintenance medications
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Many managed care health programs require mail order pharmacies to fill prescriptions for maintenance medications.
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rejected claims
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When a claim is rejected, the pharmacy technician can telephone the insurance plan's pharacy help desk to determine if the patient is eligible for coverage.
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community pharmacy
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The pharmacy practice that provides prescription services to the public. In addition to prescription drugs, community pharmacies sell over-the-counter medications as well as other health and beauty products. In the United States, more than half of all prescription drugs are dispensed by community pharmacies. There are about 60,000 community pharmacies.
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counseling
|
The role of the community pharmacist in counseling and educating patients has been steadily increasing. In the United States, the 1990 Omnibus Budget and Reconciliation Act (OBRA) required community pharmacists to offer counseling to Medicaid patients regarding medications. Many states have expanded this requirement to apply to all customers.
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regulation
|
Community pharmacies are most closely regulated at the state level. In addition to the many regulations on prescribers and prescriptions, states regulations include such things as the ratio of pharmacists to technicians, scope of practice, record keeping, equipment, and work areas.
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customer service
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A major area of importance in the community pharmacy, since technicians constantly interact with patients as customers. It is important to always respond to customers in a positive and courteous way.
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interpersonal skills
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Skills involving relationships between people. Good inter-personal skills are based on techniques such as looking the other person in the eye, listening carefully, etc.
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telephone use
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Telephone calls must be answered in a pleasant and courteous manner, following a standard format that should be indicated by the store manager or pharmacist.
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refills
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When processing a refill prescription, it is necessary to check that there are refills available. In the case of a patient requesting an early refill of a controlled substance, involve the pharmacist right away.
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drug interactions
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Whenever the prescription system flags drug interactions and allergy conflicts, alert the pharmacist so that he or she can evaluate the significance of the flag.
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safety caps
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All dispensed prescription vials and bottles must have a safety cap or child resistant cap, unless the patient requests an easy-open or non-child resistant cap.
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auxiliary labels
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Auxiliary labels identify important usage information, including specific warnings or alerts on: administration, proper storage, possible side effects, and potential food and drug interactions.
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final check by pharmacist
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As a final step of the prescription preparation process, the final product and all paperwork, including the original prescription, is organized for the pharmacist's final check.
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signature log
|
Customer signatures in a log are required for Medicaid and most third party insurer or HMO prescriptions, along with Schedule V controlled substances, poisons, and certain other prescriptions (depending on the state).
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mark-up
|
The amount of the retailer's sale price minus their purchase price. It is calculated by multiplying the retailer's purchase price by the mark-up percentage. For example, a 30% mark-up on an item purchased for $2.30 is $0.69 (2.30 x 0.3), so the sale price would be $2.99.
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OTC products
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Drug products that do not require a prescription, but are not without risks. Therefore, the technician should not recommend them to pharmacy customers.
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shelf stickers
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Stickers for OTC drugs and other products that can be scanned for inventory identification.
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unit price
|
The price of a single unit of a product, such as for one ounce of a liquid of cold remedy.
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stock
|
Managing stock is often a technician responsibility and includes ordering, receiving, storing, and placing products on shelves.
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Disease State Management
|
Consultation services targeted toward improved therapy of a chronic disease that may be billed to a patient's major medical insurance.
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around-the-clock care
|
Hospitals provide care around the clock. Standard shifts are 7am to 3:30pm; 3:00pm to 11:30pm; and 11:00pm to 7:00am.
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patient care units
|
Patient rooms are divided into groups called nursing units or patient care units, with patients having similar problems often located on the same unit.
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nurse's station
|
The work station for medical personnel on a nursing unit is called the nurse's station. Various items required for care of patients are stored there, including patient medications.
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ancillary areas
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Areas such as the emergency room that also use medications and are serviced by the pharmacy department.
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centralized pharmacy
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A system in which all pharmacy activities are conducted from one location within the hospital; the inpatient pharmacy.
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decentralized pharmacy
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A system in which there are several pharmacy areas (called satellites) located throughout the hospital, each performing a specific function.
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investigational drug service
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A specialized pharmacy subsection that deals solely with clinical drug trials. These drug studies require a great deal of paperwork and special documentation of all doses of medication taken by patients. Technicians frequently assist the pharmacist with this documentation and in preparing individual patient medication supplies.
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pharmacist supervision
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Pharmacy technicians in hospitals work under the direct supervision of a pharmacist. Only a pharmacist may verify orders in the computer system and check medications being sent to the nursing floors.
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formulary
|
A list of drugs stocked at the hospital which have been selected based on therapeutic factors as well as cost.
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closed-formulary
|
A closed formulary means that a hospital carries only formulary medications and physicians must order from this list.
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non-formulary
|
Drugs not on the formulary list.
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patient drug profiles
|
Computer generated drug profiles are prepared daily for each patient.
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patient medication trays
|
The amount of medications for a 24 hour period are placed in patient trays that are loaded into medication carts.
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unit doses
|
The amount of drug required for one dose, called a unit dose.
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unit dose labels
|
Unit dose labels contain bar codes for identification and control. Items are scanned into the dispensing and inventory system at various stages up to dispensing. This reduces the chances of medication errors and improves documentation and inventory control.
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pre-packing
|
Technicians often "pre-pack" medications that have been supplied in bulk into unit doses. Machines that automate this process are generally used for pre-packing oral solid medications.
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medication order form
|
In the hospital, all drugs ordered for a patient are written on a medication order form and not a prescription blank as in a community pharmacy. Physicians write medication orders for hospital patients, though both nurses and pharmacists may also write orders if they are directly instructed to do so by a doctor. In addition, physician's assistants and nurse practitioners may sometimes write orders, depending upon the institution.
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medication administration record
|
Nurses record and track medication orders on a patient specific form called the medication administration record (MAR).
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physician order entry
|
A computer system that allows the physician to enter the medication order directly into the hospital computer system.
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controlled substances
|
A primary area of concern for inventory control is narcotics, or controlled substances, which require an exact record of the location of every item to the exact tablet or unit.
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code carts
|
Locked carts filled with emergency medications. All patient areas are required to have code carts.
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IV admixtures
|
A large portion of the medication used in the hospital is administered intravenously. Pharmacy technicians prepare I.V. admixtures, including small and large volume parenterals, enteral nutrition therapy, and chemotherapy.
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policy and procedures manual
|
A manual containing information about every aspect of the job from dress code to disciplinary actions and step by step directions on how to perform various tasks that will be required of technicians. All departments within the hospital are required by regulating agencies to maintain this.
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JCAHO
|
The Joint Commission on Accreditation of Healthcare Organizations, the accreditation agency for healthcare organizations. Organizations undergo a JCAHO survey every 3 years.
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automated dispensing machine
|
Automated units which dispense medications at the point of use.
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