Mini 
You must know abbreviations and sig codes to start off, and of course your brand and generics and their classifications also their treatments. Also how to calculate medication day supply. You also need to know your conversions, very important when it comes to math it will surely help you in the exam. All the links on the very top page of the site comes to an advantage when it comes towards the exam or even working in a pharmacy in so many levels. Here is a short study guide for the PTCB exam . For more information about the PTCB exam visit www.ptcb.org
Remember:Make sure you read the questions carefully , concentrate on what the question is asking because sometimes the question includes info that we don't need, because it wants to get you confuse so don't let that get in your way, really read what it's asking for. Study retail and hospital setting for sure.
**Book Recommendations: I used this book for the exam here is a link to see a preview of the questions, it will give you an idea of the exam
http://www.pharmacyexam.com/RGPTE_sample3.cfm
**Also this book was helpful from all the books I've used....to get the book go to www.techlectures.com
Narcotics
>To order CII DEA form 222 must be completed
>To destroy narcotics DEA form 41 must be completed
>Theft of narcotics DEA form 106 must be completed (notify DEA and police)
>To renew registration for pharmacy DEA form 224 must be completed (renewal is every 3 years)
>To register as a new pharmacy DEA form 224 must be completed as well
>Narcotics prescriptions are good for 6 months only , regular medications are good for 1 year.
>No refills permitted with CII (need new prescription if want refill), up to 5 refills for CIII - CV narcotics
>Transfer to another pharmacy for CII is not permitted, CIII - CV only permitted only once
>CII must be filed separate from other prescriptions, CIII - CV can be filed with non narcotics prescriptions
>Narcotics should not be stocked with regular medications it should be locked in a cabinet
>The partial supply on DEA 222 order should be filled within 60 days from the order date
>CII partial filling should be done within 72 hours
>Doctor must send written prescription within 7 days from authorize emergency prescription for narcotics
NDC (national drug code) has 10 digits with 3 segments
Ex) Daytime cold/flu relief
NDC # 49560-3412-6 OR 45689-123-10
* First segment (49560) (45689) represents the Manufacture
* Second segment (3412) (123) represents the Product
* Third segment (6) (10) represents the Package Size
Aseptic Technique
Aseptic Technique= Is a procedure used to eliminate drug contamination with microbes or particles
**Here is a helpful website that shows you the scrub, gown, glove procedures
http://www.brooksidepress.org/Products/Scrub_Gown_and_Glove_Procedures/lesson_1_Section_1.htm
OSHA (occupational safety and health administration)= They make guidelines for health issues, to inspect the working area
JCAHO (Joint Commission on Accreditation of Healthcare Organizations)= Is an inspection done every 3 years/ 2x a year that will last a 2 day period. only in hospitals.
Horizontal flow hood: Used for many types of parenterals med preparations or sterile product mixtures. HEPA (high efficiency particulate air) is a special filter that traps all particles larger than 0.2 microns. Outside air flows into the back of hood, through the HEPA and out toward the opening. Stay 6 inches away side to side. Clean with 70% isopropyl alcohol from back to front, side to side hand motions. Note: working less than 6 inches, the laminar flow hood begins to mix with the outside air and contamination is more likely possible.
Vertical flow hood: Used for chemotherapeutic agents because of the direction of the air flow and the specifications of hood. Air comes in HEPA and then towards workspace area. Has a glass shield in front where technician is standing.
Material Safety Data Sheet: How to clean spill hazards drugs
Sterile= No living organism present
Free of pyrogens (micro-0rganisms)= Products of microbial metabolism. If micro-organisms are in the IV bag it can cause the patient to have fever and the chills.
**No jewelry, hair tied back, hands and up to elbows washed with antimicrobial soap, hood must run for 30min before using, all materials wiped down with alcohol, use gloves and gown by the proper procedure.**
**USE PAPER TOWEL RATHER THAN A CLOTH WHEN DRYING HANDS TO AVOID CONTAMINATION**
**FLOW HOODS SHOULD BE TURNED ON LEAST 30 MINUTES BEFORE USING**
Types Of IV's
LVP (large volume parenterals): Also known as infusion. Its a large amount of fluid that is administered over a prolonged period of time. Carries 250ml up to 1000ml of sterile solution. Nitroglycerin, lidocaine, potassium, dopamine, aminophylline are example of drugs that are used as LVP. Mainly used to provide electrolyte replacement.
SVP (small volume parenterals): Carries 50ml to 250ml. It is used as a vehicle for medications such as IVPB (intravenous piggyback), ampules, syringes, vials for antibiotics
IVPB: Has secondary line with an running primary line. It is used to deliver medications.
TPN (total parenteral nutrition): An admixture that contains nutrition such as amino acids, electrolytes, dextrose, MVI (multivitamins). Techs need to be correct when calculating TPN's because it contains so many ingredients.
***Amino acids should be added last when preparing TPN's due to stability problems***
***Lipid is generally added last to prevent fatal errors in 3 in 1 TPN mixture***
IV Push or IV Bolus: Injection of a small amount of drug that is used with a needle or syringe.
Alligations (tic tac toe)
How much 1% boric acid solution, and 5% boric acid solution are needed to make 30ml of 3% boric acid solution?
5% I I 2% <2% / 4% x 30ml = 15ml>
_____I_______I_____
I 3% I 4%
_____I_______I_____
1% I I 2% <2% / 4% x 30ml = 15ml>
*The desired % goes in the middle (3%), the higher % goes to the left top corner (5%), the lower % goes to the left bottom corner.
*Now 3% - 1%= 2% (the 2% goes on the right top corner) / Now 3% - 5%= 2% (the other 2% goes to the right bottom corner)
*You add both 2%'s ------- 2 plus 2= 4% (the 4% goes in the right middle box)
*Now you do math as I shown on the very top page next to the tic tac toe.
*To know if your problem was correct, simply add both final ml's and it will equal to the milliliter given in the problem
15ml + 15ml = 30ml
Intravenous Flowrates
FORMULA: V(volume)
T(time) X C (calibration or drop factor) = FR (rate of flow rate in gtts / min or ml per hr)
Note: At times you may be required to convert [hours to minutes][minutes to hours][hours to seconds]
Hrs to Min : Multiply by 60
Min to Hrs: Divide by 60
Hours to Sec: Multiply by 60 twice Ex) 8hrs [8 x 60 x 60= 28800 sec ] why multiply 60 twice? Because there are 60 minutes in a hour and 60 seconds in a minute.
EX) Hespan 500ml is ordered to be infused over 3 hours. The drop factor is 15 gtt/ml. How many drops per minute should be given to infuse the total amount of Hespan over 3 hours?
500ml
180 minutes ([3hrs x 60] to convert hr to min) X 15 gtt/ml = 41.6 >> 42 gtt/min
Pediatric Dosages
Clark's Rule: Ibs
150 X adult dose
Ex) A child weighs 14 pounds with an adult dose of 100mg, what would be the final pediatric dose?
14
150 X 100mg = 9.3mg
[Formula used for newborns & young infants]
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Young's Rule: age in yrs
age + 12 X adult dose
Ex) A 6 year old child is given adult dose 6mg, what is the final pediatric dose that should be given?
6yrs
6yrs + 12 X 6mg = 2mg
[Formula used for older children]
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Fried's Rule: months
150 X adult dose
Ex) The adult dose of an antihistamine is 40mg for a child of 20 months, what is the final pediatric dose that should be given?
20months
150 X 40mg = 5.3mg
[Formula used for toddlers]
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Formula : Body surface area of child
173 X adult dose
Ex) If the adult dose of drug is 250mg, what would be the dose of drug for a child who has a body surface area of 55m2?
55m2
173 X 250 = 79.47 mg
Extra Math (important)
Type of Solutions below >
D5W-[DEXTROSE 5% IN WATER]
D10W-[DEXTROSE 10% IN WATER]
NS-[0.9% NaCL (SODIUM CHLORIDE)]
1/2NS-[0.45% NaCL]
1/3NS-[0.33% NaCL]
1/4NS-[0.2% NaCL]
D5NS-[DEXTROSE 5%, 0.9 NaCL]
D5 1/2NS-[DEXTROSE 5%, 0.45% NaCL]
D5 1/4NS-[DEXTROSE 5%, 0.2% NaCL]
LR (LACTATED RINGERS)-[NA,K,CA,CAL,LACTATE (ELECTROLYTES)]
D5LR-[DEXTROSE 5%, LACTATED RINGER]
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**How many grams of NaCL are in 100ml of NS solution?
First off NaCL is = to 0.9% / Second anything that is a % is always over 100
0.9 = 100
X = 100ml 0.9 x 100ml = 90 / 100 = 0.9 grams
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**How much sodium chloride(in grams) is there in a 500ml infusion of sodium chloride 1.8% w/v?
100 = 1.8% (remember a % is always 100)
500ml = X 500 x 1.8 = 900 / 100 = 9 grams
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**Concentration And Dilution**
Ex) A tech has been given 100ml of 10% acetic acid sol. The pharmacist asked the tech to dilute the solution to 500ml with sterile water and to label the solution. What % should appear on the label?
FORMULA: C1 X V1 DIVIDE C2 OR V2
' '
' '
(CONCENTRATION % PER 100) (VOLUME/ML)
10% (C1) X 100ML (V1) DIVIDE 500ML (V2) = 2% IS YOUR ANSWER
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Fahrenheit to Celsius temp Celsius to Fahrenheit temp
FORMULA: 5/9 (F - 32) FORMULA: 32 + 1.8C
Ex) 46 Fahrenheit for oral polio Ex) 7.8 Celsius
5/9 (46 - 32) 7.8 x 1.8 = 14.04
5/9 (14) 14.04 + 32 = 46.04 Fahrenheit
14 / 9 x 5 = 7.7 >> 7.8 Celsius NOTE: 1.8C IS THE SAME AS 9/5, BUT USING 1.8 TO
CALCULATE IS SO MUCH EASIER
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**If 30 tablets cost $43.00, then how much would 15 tablets cost?
30 tabs = $43.00
15 tabs = X 15 x 43.00 / 30 = $21.50
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**How much of a 1:1000 stock solution would you use to make 500ml of a 1:4000?
(1:4000) ---------- 1g = 4000ml
ratio X = 500ml 1 x 500 / 4000 = 0.125 g
(1:1000) --------- 1g = 1000ml
ratio 0.125g = X 0.125 x 1000 / 1 = 125 ml
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**How many Liters are in 2,010 milliliters? Hint: use the ratio and proportion method
(first off there is 1,000 ml in 1 liter) 1L = 1,000 ml
X = 2,010 ml 1 x 2010 / 1000 = 2.01 L
Common Refridgerated Medications
Famotidine, Insulin (rDNA origin) injection, Insulin glargine (rDNA origin) cartridge or vial, 70% insulin as part protamine suspension / 30% insulin as part injection vial, Lente human insulin zinc suspension, Insulin lispro vial, NPH human insulin isophane suspension, Regular human insulin injection, Erythromycin ethylsuccinate oral suspension, Epoetin alfa multidose and single dose, Conjugated estrogens injection, Xalantan, Penicillin G benzathine injection suspension. ------So much more
Common Pharmacy Laws
1906 Federal Food and Drug Act: Have accurate drug labels
1914 Harrison Narcotic Act: People could no longer obtain opium without a Rx, became harder to get
1938 Food,Drug and Cosmetic Act: Required drug companies to include package inserts and directions to consumers regarding use of package inserts on drugs. All narcotics were required to be labeled "WARNING"- provided legal status for FDA.
1951 Durham-Humphrey Amendment: Added more instructions for drug companies and required label "CAUTION". certain drugs require a doctor order and supervision. Made initial distinction between legend drugs (prescription medications) and non legend drugs (OTC medications).
1962 Kefauver- Harris Amendment: In Europe people took thalidomide helping them to sleep, pregnancy women gave birth to children with severe birth defects/ absence of limbs. Thalidomide was removed from the united states. This law was to ensure safety and effectiveness of all new drugs.
1970 Comprehensive Drug Abuse prevention and Control Act: DEA was formed to enforce laws concerning controlled substances and their distribution. A narcotic schedule was introduced
The Poison Prevention Act of 1970: Most medications require child resistance caps. (sublingual medications do not require those special caps)
1983 Orphan Drug Act: Allowed drug companies to have a lengthy time requirements of testing a new drug and the costs accomplied them to provide a medication to a person who had a rare disease. Back then they spent millions of money and years to treat a disease that affected a small portion of population.
1987 Prescription Drug Marketing Act: OTC drugs were sold for the use in animals without restrictions. Labels must require "CAUTION". Now vetenarians must write prescriptions to buy special drugs for your pet.
1990 Anabolic Steroids Control Act: Stiffen regulation on the abuse problems on anabolic steroids and their misuse by athletes.
1990 Omnibus Budget Reconciliation Act (OBRA'90): Passed by US congress, deals with specifically with practicing pharmacists. Deals with the specific reimbursements for medications that affected the pharmacies. Must counsel patients with new prescription. If they do not counsel the board of pharmacy(BOP) can fine pharmacy or pharmacist.
Health Insurance Portability and Accountability Act of 1996 (HIPAA): Bill deals with patients rights to continue health insurance even when changing employers. Computer systems have a signature line for patient to except given personal information about them. Patient information should be confidential.
Drug listing Act: All drugs need NDC number.
Common Reference Books
Facts and Comparisons (F&C)= Bible of pharmacy. Created for quick and accurate reference and drug comparison. Answers most questions for pharmacists.
Physicians Desk Reference (PDR)= Very popular book, publication for more than 50 years. has package inserts description, chemical structure, study results, addresses and numbers, brand/generic, classifications, FDA approved drugs, etc.
Drug Topics Red Book= Longest published. has drug costs. information about drugs that should not be crushed, sugar-free/ alcohol-free drugs, pharmacy calculations, etc.
Mosby's Drug Consult= Includes drug monographs.
Orange Book= FDA approved drugs, therapeutic and bioequivalence of drugs.
American Hospital Formulary Service Drug Information (AHFS DI)= Used mainly in hospitals. lists approved formulary drugs, their uses, adverse reactions, and other patient information.
United States Pharmacopoeia Drug Information (USP DI)= Drug information, helps pharmacists in advising patient about their medication. Covers both state and federal requirements such as how the drug must be stored, etc.
Ident-A-Drug= Lists both tablet and capsule identifications by codes, colors, shapes, or if tablet is scored. The book provides the manufactures, generic/brand, strengths, use of drug. this book comes in handy when a patient does not know what they taking.
The Injectable Drug Handbook= Mostly used in hospital. gives various agents given parenterally.
Common Drug to Drug Interactions
(Warfarin & Aspirin), (Halcion & ketoconazole), (Tetracycline & Ferrous sulfate & Aluminum hydroxide), (Phenytoin & Tagamet), (Inderal & Tagamet), (Rifampin & Oral contraceptives), (Quinidine & Calan), (Lidocaine & Tagamet), (Heparin & Aspirin), (Clozapine & Tegretol), (Digoxin & Verapamil), (Catapress & Inderal)
*Drug interactions checker: http://www.drugs.com/drug_interactions.php
Inventory
Initial Inventory: Is a complete and accurate inventory of all narcotics before opening pharmacy.
Biennial Inventory: Exact count of CII, estimated count for CIII - CV narcotics.
Perpetual Inventory: Shows narcotics receive by facility, supplied to other locations, returned to any pharmacy, and dispensed to patient, shows actual number of units of drug at any given moment.
POS (point of sale): Every time a medication is being dispensed at the cash register it is electronically recorded in the computer which lets the pharmacy know a certain medication is almost out of stock.
Reorder Point: Is the inventory level at which it is appropriate to replenish stock.
Periodic System: Analysis can be made of fast moving medications versus slow moving medications, this type of inventory can be used with stock control cards to keep records on how many units have been used and how many to order.
Stock Rotation: Important inventory because it encourages to use the medications before they expire and helps prevent the use of expired medications.
AWP (average wholesale price): How do you calculate AWP? Here is an example
Ex) What price do we charge a patient if the AWP for 1000 tablets is $48.50 and we want to give 30 tablets plus a 6% markup with a $4 fee.
1000 tablets = $48.50
30 tablets = X 30 x 48.50 = 1455/1000 = 1.455 ------- $1.46 for 30 tablets
$1.46 x 0.06 (convert 6%--- 6/100=0.06) = 0.0876 -----0.09
$1.46 plus 0.09 plus $4.00(fee) = $5.55 in total
Expiration Date : Very important to look out for drugs that are going to expire soon. Usually medications are taken off the shelves when they are about 3 months before their expiration date. An expiration date will be the last day of the month. Example Metformin expiration date is 03/11. This means the expiration date is March 31, 2011.
3 Classes Of Drug Recall
1. Strong probability of causing serious adverse effects or death
2. Temporary but reversible adverse effects or low probability of serious adverse effects
3. Unlikely to cause adverse effects
Pregnancy Categories
A: No risk in fetus in the first 3 months nor later
B: No risk for women and animal fetus
C: Studies using animal fetus shown harmful effect, caution is advised
D: Clear evidence to harm fetus
X: Clear evidence that causes abnormalities in fetus
DEA Verification
AY1234892 (First letter is always A or B / Second letter is the letter of the doctor last name)
First step: add 1,3,8= 12
Second step: add 2,4,9= 15 then multiply by 2 = 30
Third step: add two sums together 12 and 30= 42
Last digit must match last DEA number, so in this case DEA is valid
