Compounding Flashcards
1
Q
A powder containment hood that has HEPA filtered air, negative air pressure, and an exhaust system is called a:
a. Compounding aseptic isolator
b. Buffered compounding box
c. Secondary engineering control
d. Laminar airflow workbench
e. Containment ventilated enclosure
A
e
-A powder containment hood is a box designed to contain powder while preparing a non-sterile compounded product. It doesn’t have ISO-rated air.
-A containment ventilated enclosure is a specific type of powder containment hood that has additional features, such as negative air pressure and an external exhaust, which makes it USP 800 compliant for compounding with non-sterile hazardous drug powders.
2
Q
Carmustine vials must be stored at 2C to 8C (36F to 46F). Where can the carmustine vials be stored?
a. At room temp, on a dedicated shelf that only contains antineoplastic drugs. The shelf is located in a negative pressure segregated compounding area.
b. In a dedicated fridge that only contains hazardous drugs. The fridge is located in the anteroom.
c. In a dedicated fridge that only contains antineoplastic drugs. The fridge is located in the negative pressure buffer room.
d. In a dedicated freezer that only contains hazardous drugs. The freezer is located in the anteroom.
e. In a dedicated freezer that only contains hazardous drugs. The freezer is located in the negative pressure buffer room.
A
c
-Refrigerated antineoplastics must be stored in a dedicated fridge in a negative pressure area with at least 12 ACPH (e.g., storage room, buffer room, or containment segregated compounding area).
-The anteroom is a positive pressure room.
3
Q
Another name for the buffer room is:
a. Anteroom
b. Segregated compounding area
c. Primary engineering control
d. Secondary engineering control
e. Direct compounding area
A
d
4
Q
A pharmacy technician spilled cyclophosphamide solution on his gloves and gown while compounding. He feels the drug seeping under his gloves and his eye begin to burn. Which of the following should the technician do first?
a. Cleanse the skin with 2% sodium hydrochlorite
b. Remove the gloves and gown that have the drug on them
c. Flood the affected eye at an eyewash station for at least 5 minutes
d. Document the exposure in the employee’s record
e. Contact the hospital’s infection control team
A
b
-The first 10-15 seconds after an exposure are critical.
-The 1st priority is to get the drug off of the person ASAP.
-If the exposure involves a gown or gloves, the garb should be immediately removed and the skin washed with soap and water.
-For eye exposure, flood the affected eye/s at an eyewash station for at least 15 minutes.
-Once the exposure has been properly dealt with, the incident should be documented in the employee’s record.
5
Q
Which organization publishes the List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings?
a. United States Pharmacopeia (USP)
b. National Institute for Occupational Safety and Health (NIOSH)
c. American Society of Health-System Pharmacists (ASHP)
d. Occupational Safety and Health Administration (OSHA)
e. United States Environmental Protection Agency (EPA)
A
b
6
Q
A specialty oncology pharmacy has several rooms in the compounding suite. In one room, a technician is preparing a blinatumomab IV admixture for infusion. In another room, a technician is crushing mercaptopurine tablets to compound a 50 mg/mL PO suspension. Which USP standards apply to both of these activities?
a. USP 795
b. USP 797
c. USP 800
d. USP 1
e. USP 71
A
c
-USP 800 sets the standards for the safe handling of hazardous drugs.
-USP 800 applies to both non-sterile hazardous drugs (mercaptopurine PO solution) and sterile hazardous drugs (blinatumomab IV infusion).
7
Q
After an eye exposure to a drug or chemical, what is the minimum # of minutes that the eye/s should be flushed out in the eyewash station?
a. 5
b. 10
c. 15
d. 20
e. 30
A
c
8
Q
During a 12-hour work shift preparing IV chemo (assuming no breaks), what is the minimum # of times that the gloves will need to be changed during the shift after donning the 1st pair?
a. 23
b. 18
c. 11
d. 5
e. 3
A
a
While compounding hazardous drugs, gloves should be changed every 30 minutes and additional times if torn, punctured, or contaminated. After donning the initial pair, the gloves need to be changed 23 more times within the 12-hour shift.
9
Q
The technician is cleaning the cleanroom suite prior to leaving for the day. Place the following in the correct order for cleaning and disinfection.
a. Clean the ceiling of the PEC
b. Clean the sides of the PEC, including the grill over the HEPA filter
c. Clean the counters and floors in the SEC
d. Clean the ante-area
e. Clean the work surface (bottom) of the PEC
A
a-b-e-c-d
10
Q
What PPE should be worn when preparing tretinoin PO suspension in a containment primary engineering control located within a sterile C-SEC?
a. N95 respirator
b. 2 pairs of shoe covers
c. 2 pairs of ASTM D6978 (chemo-related) gloves
d. Disposable chemo gown
e. Earplugs/guards
A
b, c, d
-PPE needed when compounding in a BSC or CACI should include gowns, face masks, eye protection, hair covers, shoe covers or dedicated shoes, and double gloving with sterile chemo-type gloves.
-An N95 respirator is only required when working outside of a control device (e.g., BSC/CACI)
11
Q
After the pharmacy technician has finished preparing a tretinoin PO suspension, what color waste bin should the technician use to throw away the disposable mortar and pestle?
a. Red
b. Blue
c. Black
d. Yellow
e. Grey
A
d
-Black - bulk HD waste
> Any containers (drug vials, IV bags) that contain a clearly
visible amount of HD and any supplies that were used to
administer HDs or to clean up HD spills
-Yellow - trace HD waste
> Empty syringes, IV bags, used PPE, including gowns, gloves,
and shoe covers
> The mortar and pestle that was used to compound the PO
suspension would contain trace amounts of tretinoin,
indicating that it should be disposed of in a yellow waste
container
-Red - infectious waste, including IV tubing an used culture dishes
12
Q
What is an appropriate method to efficiently count all the capsules needed to prepare a tretinoin suspension?
a. Use an automated pill counting machine
b. Use a dedicated tray and spatula
c. Count the capsules aloud
d. Use a robotic dispensing system
e. Use an automated pouch packing machine
A
b
-When equipment is “dedicated” for use with HDs, it’s not used to handle non-hazardous drugs
-HD tabs and caps can’t be put into automated counting or packaging machines because they can leave powder residue and contaminate other drugs
13
Q
Master Formulation Record
Tretinoin 10 mg/mL PO Suspension
Ingredients & Quantity:
-Tretinoin, 10 mg capsules - 1 g
-Butylated hydroxyanisole - 0.02 g
-Edetate disodium dehydrate - 0.1 g
-Soybean oil, qs ad - 100 mL
Storage: Stable for 30 days at room temp
Auxiliary Labels: Shake well; protect from light
If today is January 1, 2022, what beyond-use-date should be written on the label of the tretinoin PO suspension?
a. July 1, 2022
b. January 15, 2022
c. January 31, 2022
d. February 15, 2022
e. January 4, 2022
A
c
14
Q
Master Formulation Record
Tretinoin 10 mg/mL PO Suspension
Ingredients & Quantity:
-Tretinoin, 10 mg capsules - 1 g
-Butylated hydroxyanisole - 0.02 g
-Edetate disodium dehydrate - 0.1 g
-Soybean oil, qs ad - 100 mL
Storage: Stable for 30 days at room temp
Auxiliary Labels: Shake well; protect from light
In addition to the auxiliary labels listed in the master formula, what other auxiliary label should be added to the bottle of tretinoin PO suspension?
a. “Contains Peanut Oil”
b. “Chemo - Dispose of Properly”
c. “Take on Empty Stomach”
d. “May Cause Discoloration of the Urine”
e. “Keep in the Refrigerator”
A
b
15
Q
What ISO air rating is required for a compounding aseptic isolator?
a. 4
b. 5
c. 6
d. 7
e. 8
A
b
-Primary engineering control (PEC, called the sterile hood, or isolator, if using a glove box): ISO 5
-Secondary engineering control (SEC, called the buffer room or buffer area) and Anteroom, if it opens into a negative pressure SEC (same ISO # as the SEC): ISO 7
-Anteroom, if it opens into a positive pressure SEC: ISO 8
16
Q
Which compounding area can have unclassified (I.e., room) air?
a. Anteroom
b. Buffer room
c. Containment aseptic isolator
d. Segregated compounding area
e. Containment secondary engineering control
A
d
A segregated compounding area (SCA) is a designated area in the pharmacy, such as a corner in the regular pharmacy space, where an isolator (glove box) is located. The air in the SCA is unclassified with no minimum ISO air requirements.
17
Q
Which of the following is used for disinfection while performing sanitization?
a. Sodium hypochlorite
b. Peroxide
c. Ammonia
d. 70% isopropyl alcohol
e. Sodium thiosulfate
A
d
Sanitization process:
1. Deactivation and decontamination - 2% bleach (sodium hypochlorite) or peroxide) –> reduces HD toxicity, then removes HD residues
2. Cleaning - germicidal detergent, such as Quat, Ammonium, Phenolics –> removes dirt and microbial contamination
3. Disinfection - sterile 70% isopropyl alcohol (IPA) –> inhibits or destroys microorganisms (required step in sterile compounding)
18
Q
A nurse will be administering an PO chemo drug through the pt’s feeding tube. The nurse will need to crush the tablet at the pt’s bedside. What precaution must the nurse take when crushing the tablet?
a. Wear a reusable chemo gown
b. Use a chemo pin
c. Wear one pair of sterile, powdered gloves
d. Use a plastic bag to crush the tablet
e. Wear one pair of shoe covers
A
d
19
Q
What temp range should be maintained for refrigerators and freezers?
A
Fridge: 2-8 celsius
Freezer: -25 to -10 celsius; if freezer also contains vaccines, the temp should be maintained at -50 to -15 celsius
20
Q
Laminar airflow in a sterile compounding hood describes airflow that is:
a. Bidirectional
b. Unidirectional
c. Turbulent
d. Recirculated
e. Ionized
A
b
21
Q
What is the purpose of using a closed-system transfer device (CSTD)?
a. Reduces waste from hazardous drug compounding
b. Saves pharmacy costs associated with hazardous drug compounding
c. Increases the speed of drug delivery to various nursing units in the hospital
d. Protects staff from hazardous drug fumes and particles
e. Provides adequate mixing of a chemo drug with the diluent
A
d
A CSTD is a drug transfer device that prevents the escape of hazardous drug fumes and particles that could endanger personnel during manipulation, such as compounding or drug administration.
22
Q
What is the most common source of contamination in a sterile compounding environment?
a. Compounding personnel
b. Defective HEPA filters
c. Inadequate room air pressurization
d. Lack of an external exhaust
e. Excessive humidity
A
a
Most contamination to compounded sterile products comes from the compounding staff, largely from inadequate hand hygiene and garbing.
23
Q
Rank the following steps of garbing for sterile compounding in the correct order.
a. Don gloves
b. Clean hands with an alcohol-based surgical hand scrub
c. Perform hand hygiene with soap and water
d. Don shoe covers, hair covers, and face mask
e. Don gown
A
d - c - e - b - a
24
Q
Which of the following can be used to prepare hazardous drugs?
a. Class II biological safety cabinet
b. Horizontal laminar airflow workbench
c. Compounding aseptic isolator
d. Compounding aseptic containment isolator
e. Positive-pressure airflow workbench
A
a, d
25
During a 12-hour work shift preparing IV chemo (assuming no breaks), what is the minimum # of gowns that will be needed for the entire shift assuming that no additional manufacturer info is available?
a. 1
b. 2
c. 3
d. 4
e. 5
d
Gowns must be changed per the manufacturer's schedule. If no info is provided, gowns should be changed every 2-3 hours and immediately after a spill or splash. Since the shift is 12 hours, and the gown must be changed at least every 3 hours, a minimum of 4 gowns will be needed during the shift.
26
Master Formulation Record
Herceptin (Trastuzumab) IV Admixture
Ingredients - Quantity:
-Herceptin lyophilized powder, multidose vial - 420 mg
-Bacteriostatic Water for Injection, USP - 20 mL
-0.9% Sodium Chloride Injection, USP - 250 mL
Storage: The solution of Herceptin for infusion diluted in polyvinylchloride or polyethylene bags containing 0.9% NaCl Injection, USP, should be stored at 2C-8C (36F-46F) for no more than 24 hours prior to use. Don't freeze.
Quality control procedure: Visually inspect for any abnormal particulate matter or color.
The technician has finished preparing all the Herceptin IV admixtures and will be leaving the compounding area. The compounding area has a buffer room and an anteroom. Where and when should the technician throw away his garb?
a. The garb should be thrown away in the bulk chemo waste bin before leaving the buffer.
b. The chemo gown and outer shoe covers should be thrown away in the bulk chemo waste bin before leaving the buffer room.
c. Both pairs of chemo gloves should be thrown away in the trace chemo waste bin before leaving the anteroom.
d. The chemo gown and outer shoe covers should be thrown away in the trace chemo waste bin before leaving the buffer room.
e. All the garb should be thrown away in the bulk chemo waste bin before leaving the anteroom.
d
-The outer chemo gloves worn during compounding are discarded in a yellow trace chemo waste bin located insidde the C-PEC.
-The chemo gown and outer shoe covers must be taken off before exiting the buffer room and in the yellow trace chemo waste bin.
-The rest of the garb is removed when leaving the anteroom.
27
A technician will be cleaning underneath the work surface of a biological safety cabinet used for compounding chemo. According to USP 800, which respirator is appropriate for this activity?
a. N90 respirator
b. N95 respirator
c. Surgical face mask
d. Powered air-purifying respirator
e. Elastomeric half-mask
d
An N95 respirator is sufficient for most hazardous drug compounding. Additional respiratory protection is needed in situations with direct hazardous drug exposure, such as cleaning underneath the work surface of a C-PEC. When there's risk of respiratory exposure, either a respirator mask with an attached gas canister or a powered air-purifying respirator (PAPR) should be worn.
28
A pharmacist will be checking a batch of IV admixtures inside of the buffer room. The director of pharmacy notices that the pharmacist is wearing makeup. What is the most appropriate action for the director of pharmacy to take?
a. Skin foundation is acceptable to wear, but eye makeup must be removed.
b. Since the pharmacist isn't preparing the IV admixtures herself, it's acceptable to wear makeup.
c. The pharmacist must remove her makeup before entering the anteroom.
d. It's acceptable for the pharmacist to wear makeup as long as she wears a face mask.
e. It's acceptable for the pharmacist to wear makeup as long as she stays 10 feet away from the hood.
c
29
Which approach is NOT acceptable for delivering chemo infusions to the pt's bedside?
a. Delivery to the nurse by a technician
b. Delivery to the nurse by a pharmacist intern
c. Delivery through the pneumatic tube system
d. Delivery by a pharmacist
e. The nurse picking up the infusion at the pharmacy
c
Pneumatic tube systems can't be used to transport any liquid hazardous drugs or any antineoplastics because of the potential for breakage and contamination.
30
A pharmacist intern will be reconstituting ifosfamide powder with sterile water for injection and further diluting it with normal saline. 2 pairs of each of the following garb are required for this activity:
a. Shoe covers
b. Chemo gowns
c. Head covers
d. Chemo gloves
e. Face masks
a, d
31
A technician spills a PO rinse containing misoprostol while compounding. Which resource will provide the technician with detailed info on the steps required to manage the exposure?
a. The Compounding Log
b. USP 797
c. The SDS
d. The NIOSH List
e. The Orange Book
c
32
What color waste bin should be used for disposal of a partial vial of ifosfamide remaining after preparation of the admixture?
a. Red
b. Blue
c. Black
d. Yellow
e. White
c
Bulk antineoplastic waste includes unused or partially empty IV bags, syringes, or vials.
33
The technician will be using a syringe and needle to withdraw a ifosfamide solution from the vial. This compounding activity should be performed in the cleanest air, which is:
a. The first air that's coming out from the back of the horizontal laminar airflow hood
b. The first air that's coming out from the top of the vertical airflow biological safety cabinet
c. The first air that's flowing into the biological safety cabinet from the buffer room
d. The first air that's within the first 6 inches from the front of the laminar airflow hood
e. The first air that's recycled through the redundant HEPA filters of the biological safety cabinet
b
Vertical airflow biological safety cabinets are used to compound hazardous sterile drugs. The HEPA filter is located at the top of a BSC, which is where the direct compounding area containing the cleanest air (or first air) is located.
34
A dr ordered 1200 mg/m2/day of ifosfamide for a pt with a BSA of 1.6 m2. How much of the solution should the technician withdraw from the vial and what syringe size should be used of a ifosfamide IV solution with a concentration of 3 g/60 mL?
a. Use a 35 mL syringe to withdraw 24 mL of solution
b. Use a 30 mL syringe to withdraw 24 mL of solution
c. Use a 5 mL syringe to withdraw 3.8 mL of solution
d. Use a 50 mL syringe to withdraw 38.4 mL of solution
e. Use a 60 mL syringe to withdraw 3.8 mL of solution
d
35
Ifosfamide is prepared in a biological safety cabinet with an ISO 7 buffer room and anteroom.
Ingredients - Quantity:
-Ifosfamide IV solution - 3 g/60 mL
-D5W - 100 mL
What is the risk level of this preparation?
a. Low risk
b. Medium risk
c. High risk
d. Low risk with 12-hr BUD
e. Immediate use
a
-Low risk - uses 1-3 components (including the diluent) that are supplied as sterile from the manufacturer
-Medium risk - more than 3 sterile components are needed (including the diluent)
36
Which testing parameter is compliant with USP 797 for a hospital compounding low- and medium-risk sterile products?
a. Air sampling weekly
b. Surface sampling daily
c. Air pressure monthly
d. Gloved fingertip testing every 6 months
e. Temperature daily
e
-Air sampling - at least every 6 months
-Surface sampling - periodically
-Air pressure - each shift (preferably) or daily (minimum)
-Humidity - daily
-Gloved fingertip testing - annually
37
Which of the following drugs would be eligible for an Assessment of Risk?
a. MTX tabs that are split in half
b. Hydroxyurea powder used to prepare a PO solution
c. Carboplatin IV solution that's added to a bag of normal saline
d. Intact tamoxifen tabs which are packed into unit-dose packages
e. Carmustine powder whish is reconstituted with dehydrated alcohol
d
-A pharmacy can conduct an AoR that permits modification of the USP 800 requirements for HDs with lower risk by developing a plan to limit staff exposure.
-Activities that don't require manipulation, such as counting and packaging, can be covered under an AoR.
-If manipulation is required, the full USP 800 requirements must be followed.
38
The pharmacist-in-charge performs wipe sampling of the surfaces inside the class II biological safety cabinet every 6 months. What is the pharmacist checking for?
a. Hazardous drug residue
b. Bacterial endotoxins
c. Proper aseptic technique of the compounding staff
d. Contamination of the compounding staff's hands
e. Sodium hypochlorite residue
a
Wipe sampling of all compounding surfaces should be performed initially and at least every 6 months to ensure hazardous residue is contained. If contamination is present, the source must be identified, and a plan implemented to contain it.
39
Which of the following drugs would be found on the NIOSH list?
a. Bleomycin
b. Nystatin
c. Tacrolimus
d. Medroxyprogesterone
e. Isotretinoin
a, c, d, e
40
The pharmacist intern is reconstituting a 1 g vial of ceftazidime with 10 mL of sterile water for injection. The reconstituted solution will be added to a bag of normal saline for IV administration. The primary engineering control used to compound this IV admixture should have:
a. Positive pressure air
b. Unclassified air
c. At least ISO 5 air quality
d. At least ISO 7 air quality
e. Horizontal laminar airflow
a, c, e
41
Which of the following is an acceptable alternative to an external exhaust when compounding non-sterile hazardous drugs?
a. Redundant HEPA filters
b. An internal exhaust
c. Charcoal filters
d. Ionization of the contaminant air
e. Recirculating air vents
a
42
A hazardous drug spill kit should contain each of the following items EXCEPT:
a. Protective gown and latex gloves
b. N95 respirator mask plus goggles with side shields
c. Chemo pads to absorb hazardous liquid
d. Hazardous drug spill report exposure form to document exposure
e. Broom and dustpan to get spill waste into HD waste bag
e
43
Which of the following garb can be retained in the anteroom for reuse on the same shift when making non-hazardous compounded sterile products?
a. Shoe covers
b. Hair cover
c. Gloves
d. Gown
e. Face mask
d
44
The hospital routinely prepares antibiotic IV admixtures and total parenteral nutrition with only sterile ingredients. How often do the compounding pharmacy technicians need to pass the media-fill test to evaluate their aseptic technique?
a. Every 14 days
b. Twice a year
c. Yearly
d. Every other year
e. Quarterly
c
45
Non-sterile compounding that requires specialized training, facilities, equipment, or procedures is considered what category of compounding?
a. Simple
b. Moderate
c. Complex
d. Low-risk
e. Medium-risk
c
Compounding transdermal patches or ER tablets are examples of complex compounding.
46
What is the max recommended temp (in degrees Celsius) inside the secondary engineering control (SEC)?
a. 15
b. 20
c. 18
d. 30
e. 45
b
47
The pharmacist is compounding cyclophosphamide PO suspension. What type of gloves should the technician wear?
a. Gloves are optional for oral preparations
b. One pair of sterile gloves
c. One pair of ASTM-rated gloves
d. Two pairs of ASTM-rated gloves
e. Two pairs of powdered sterile gloves
d
According to USP 800, two pairs of ASTM-rated (chemo) gloves should be worn when manipulating all hazardous drugs.
48
Which environmental parameter is matched correctly with its minimum monitoring frequency?
a. Air sampling; weekly
b. Air pressure; daily
c. Surface sampling; daily
d. Air pressure; weekly
e. Air sampling; annually
b
-Air sampling - at least every 6 months
-Surface sampling - periodically
-Air pressure - each shift (preferably) or daily (minimum)
-Humidity - daily
-Gloved fingertip testing - annually
49
Which of the following statements are correct regarding the operation of a horizontal laminar airflow workbench?
a. If power is interrupted, the hood can be used immediately for compounding.
b. The hood must be operating continuously during compounding activity.
c. The hood can be turned off for a max of 8 hours.
d. If the hood is turned off, it must be on for at least 30 minutes before it can be used for compounding.
e. The hood must be turned off any time it's not being used for compounding activity.
b, d
50
A pharmacy only prepares low-risk and medium-risk CSPs. If today's date is January 22, 2022, which of the following personnel needs to perform the gloved fingertip test within the next month?
Date of Last Gloved Fingertip Test:
Angie - July 30, 2021
Jennifer - August 15, 2021
Karen - February 10, 2021
Pamela - March 20, 2021
Stephanie - December 1, 2021
a. Angie
b. Jennifer
c. Karen
d. Pamela
e. Stephanie
c
The gloved fingertip test is required at initial training and then annually for personnel who compound low- and medium-risk CSPs.
51
A pharmacy only prepares low-risk and medium-risk CSPs. If today's date is January 22, 2022, which of the following personnel needs to perform the gloved fingertip test within the next month?
Date of Last Gloved Fingertip Test:
Angie - July 30, 2021
Jennifer - August 15, 2021
Karen - February 10, 2021
Pamela - March 20, 2021
Stephanie - December 1, 2021
a. Angie
b. Jennifer
c. Karen
d. Pamela
e. Stephanie
c
The gloved fingertip test is required at initial training and then annually for personnel who compound low- and medium-risk CSPs.
52
A drug wholesaler delivers a plastic tote containing chemo drugs to the pharmacy. Upon opening the tote, the technician discovers that the drugs aren't wrapped in plastic. What PPE should the technician wear when unpacking this tote?
a. Two pairs of shoe covers
b. N95 respirator
c. Goggles
d. Surgical face mask
e. Elastomeric half-mask with a multi-gas cartridge and P100-filter
e
Should be used when unpacking HDs not wrapped in plastic until an assessment of the packaging ensures that no breakage or spillage occurred during transport.
53
USP requires periodic testing of the surfaces involved in sterile compounding. Which of the following statement/s concerning testing is/are accurate?
a. Testing should occur at the end of the day
b. Surfaces regularly exposed to staff should be tested
c. At least one surface sample must be taken from each 5, 7, and 8 area
d. Action must be taken if any colony-forming units (CFUs) are identified
e. Tryptic soy agar (TSA) is used as the growth medium
a, b, c, e
Action must be taken once > CFUs are identified in the ISO 5 area, > 5 CFUs in the ISO 7 area, or > 100 CFUs in an ISO 8 area
54
Which of the following best describes the minimum space requirements to compound amoxicillin suppositories?
a. A designated workspace, separate from dispensing areas, that contains unclassified (room) air.
b. A segregated compounding area with a primary engineering control and external exhaust.
c. A containment secondary engineering control with a containment primary engineering control.
d. An anteroom, a buffer room, and a primary engineering control with external exhausts.
e. Any dedicated workspace with ISO 7 negative pressure air and redundant HEPA filters.
a
-Amoxicillin suppositories are non-sterile and non-hazardous
-A primary engineering control, secondary engineering control, ISO-rated air and/or special exhaust, and filtering systems are not required.
55
What type of drugs are most likely prepared in a class II biological safety cabinet with a containment segregated compounding area and negative pressure air?
a. Sterile, non-hazardous drugs
b. Non-sterile, hazardous drugs
c. Non-sterile, non-hazardous drugs
d. Sterile, hazardous drugs
e. Sterile drugs (both non-hazardous and hazardous)
d
56
A technician is making a topical cream by mixing equal parts of 2% hydrocortisone cream and Aquaphor without any available stability data. What category of non-sterile compounding is this considered?
a. Simple
b. Moderate
c. Complex
d. Low-risk
e. Medium-risk
b
-Simple - requires following instructions
-Moderate - involves specialized calculation or procedures, or making a preparation that has no stability data
-Complex - requires specialized training, equipment, facilities, or procedures
57
What is the minimum # of air changes per hour (ACPH) required in spaces used for non-sterile hazardous drug compounding?
a. 5
b. 12
c. 20
d. 30
e. 45
b
In the sterile HD space, there must be at least 30 ACPH.
58
Which of the following is the correct order of steps to be taken for daily sanitization of sterile hazardous compounding areas?
a. Deactivation, desensitization, disinfection, stabilization
b. Decontamination, disinfection, cleaning, deactivation
c. Deactivation, decontamination, cleaning, disinfection
d. Disinfection, sanitization, cleaning
c
59
What is the minimum ISO air requirement for an anteroom that opens into a negative-pressure buffer area?
a. ISO 5
b. ISO 6
c. ISO 7
d. ISO 8
e. ISO 9
c
60
If a compounded sterile product is prepared in a compounding aseptic isolator that's located in a segregated compounding area, what is the max BUD that can be assigned?
a. 1 hour
b. 6 hours
c. 12 hours
d. 24 hours
e. 36 hours
c
61
The media fill test is used to determine if a pharmacist or a pharmacy technician is preparing compounded sterile products (CSPs) that are free from contamination. What is the name of the growth medium utilized?
a. Sodium hypochlorite broth (SHB)
b. Whey protein isolate (WPI)
c. Soy protein isolate (SPI)
d. Lactose and xylitol (LAX)
e. Tryptic soy broth (TSB)
e
62
How often should a laminar airflow workbench be cleaned when making compounded sterile products (CSPs)?
a. Before each shift
b. Twice a day
c. Before and after each batch of CSPs
d. Every 2 hours of continuous compounding
e. Every 30 min of continuous compounding
a, c, e
Should also be cleaned after spills and any time contamination is suspected.
63
Which of the following is recommended when compounding to contain hazardous drugs and prevent spills?
a. Redundant HEPA filters
b. Tryptic soy agar
c. 70% IPA
d. Closed-system transfer device
e. Powered air-purifying respirator
d
Used to keep hazardous drugs contained inside the device to prevent spills and are recommended when compounding hazardous drugs
64
Which of the following is a primary engineering control (PEC)?
a. Anteroom
b. Buffer area
c. Segregated compounding area
d. Compounding aseptic isolator
e. Closed-system transfer device
d
A CAI is a type of PEC used to compound non-hazardous sterile products.
-A laminar airflow workbench is also a PEC for non-hazardous sterile products.
65
Master Formulation Record
Bi-est 2.5 mg/g (80:20) Cream
Qty made: 100 g
Ingredients:
Estriol, micronized powder 0.2 g
Estradiol, micronized powder 0.05 g
Glycerin liquid 5 mL
Dermabase 100 g QS
Instructions:
1. Weigh all ingredients
2. Dissolve the estriol and estradiol powder with glycerin liquid using a spatula to form a smooth slurry
3. Using geometric dilution, gradually add the base cream
4. QS to final weight with base cream
5. Examine final product
Storage: Room temp
What is the purpose of glycerin in the master formulation record above?
a. Thickener
b. Emulsifier
c. Lubricant
d. Levitating agent
e. Antioxidant
d
It's used to wet the estrogen to help grind down the powders.
66
Master Formulation Record
Bi-est 2.5 mg/g (80:20) Cream
Qty made: 100 g
Ingredients:
Estriol, micronized powder 0.2 g
Estradiol, micronized powder 0.05 g
Glycerin liquid 5 mL
Dermabase 100 g QS
Instructions:
1. Weigh all ingredients
2. Dissolve the estriol and estradiol powder with glycerin liquid using a spatula to form a smooth slurry
3. Using geometric dilution, gradually add the base cream
4. QS to final weight with base cream
5. Examine final product
Storage: Room temp
After the technician is finished compounding the Bi-Est cream, where should the technician document what was done?
a. Master formula
b. Package insert
c. Medication guide
d. Compounding log/record
e. Patient's profile
d
67
Rank the following steps for preparing capsules using the punch method in correct order.
a. Mix all the ingredients together using geometric dilution.
b. When the base is filled, fit the cap over the base.
c. Take the base of the capsule and "punch down" into the pile of powder.
d. Triturate the dry ingredients.
e. Smooth the powder to a height that's 1/3 of the length of the capsule.
d - a - e - c - b
68
A pharmacy technician is preparing amiodarone 150 mg in 100 mL D5W for IV infusion. After swabbing the rubber stopper of the amiodarone vial with alcohol, what is the correct order of the steps he should take to correctly remove the drug from the vial?
a. Inject the air into the vial.
b. Invert the vial and needle; withdraw the desired volume of amiodarone.
c. While pushing the needle through the stopper, reposition the needle to a 90-degree angle.
d. Pull back the syringe plunger to draw up the volume of air that's equal to the desired volume of amiodarone.
e. Position the needle at a 45-degree angle on the vial with the bevel up.
d - e - c - a - b
69
What is the purpose of simethicone?
a. Lubricant
b. Preservative
c. Anti-foaming agent
d. Coloring agent
e. Emollient
c
Anti-foaming agents are used to reduce the production of form or gas.
70
What is the purpose of benzoic acid?
a. Preservative
b. Levitating agent
c. Sweetener
d. Humectant
e. Emollient
a
71
What is the purpose of sucralose?
a. Lubricant
b. Wetting agent
c. Anti-foaming agent
d. Surfactant
e. Sweetener
e
Sucralose is a non-caloric, artificial sweetener used to increase the palatability of compounded PO formulations.
72
What is the purpose of xanthan gum?
a. Thickening agent
b. Buffer
c. Coating
d. Disintegrant
e. Antioxidant
a
Thickening agents increase the viscosity of a substance and can provide stability to the mixture.
73
300 mL lansoprazole 3 mg/mL suspension
What is the percentage strength (% w/v) of the prepared lansoprazole suspension?
a. 0.003%
b. 0.03%
c. 0.3%
d. 3%
e. 33%
c
3 mg/mL = x mg/100 mL
x = 300 mg = 0.3 g = 0.3%
74
300 mL lansoprazole 3 mg/mL suspension
The pharmacist will label the suspension using ratio strength. Which of the following provides the correct approximate ratio strength for the label?
a. 1:643 lansoprazole suspension
b. 1:533 lansoprazole suspension
c. 1:333 lansoprazole suspension
d. 1:53 lansoprazole suspension
e. 1:33 lansoprazole suspension
c
Percentage strength: 0.3%
0.3 g/100 mL = 1/x
x = 333
75
Which of the following can be used for sterility testing of high-risk compounded sterile products (CSPs)?
a. Tryptic soy broth
b. Fluid thioglycollate medium
c. Bacterial endotoxin test
d. Media-fill test
e. Bubble-point test
a, b, c
Certain high-risk CSPs and CSPs intended for use beyond the recommended BUD must have sterility testing.
76
A pharmacist makes an amiodarone infusion during a code blue in an uncluttered area in the ED. What BUD should be assigned to the infusion?
a. 1 hour
b. 12 hours
c. 24 hours
d. 30 hours
e. 48 hours
a
-Since this CSP is prepared outside of an ISO 5 environment, the risk level is considered immediate-use, and the BUD is 1 hour.
-The immediate-use provision is intended only for those situations where there's a need for emergency or immediate pt administration of a CSP where the delay from the preparation of the CSP under low-risk conditions would put the pt at serious risk of harm.
77
Which of the following is NOT correct regarding an immediate-use CSP?
a. Administration must occur within 1hour of product preparation
b. Compounding must take place in an ISO 5 environment
c. Preparation may take play in an ED or ambulance
d. Intended for use in situations where waiting for sterile preparation could lead to pt harm
e. Preparations can't be refrigerated or frozen to extend the BUD
b
78
A technician is preparing a non-sterile compound with atropine. The master formula instructs the technician to triturate the atropine. What should the technician do?
a. Incorporate the atropine into a cream
b. Mix the atropine with a liquid
c. Melt the atropine down to a liquid
d. Grind the atropine into smaller, finer particles
e. Mix the atropine with another powder for bulk
d
Trituration is a general term that means to mix thoroughly. In pharmacy, it's commonly associated with grinding tabs with a mortar and pestle until a fine powder is achieved.
79
Which of the following is correct regarding osmolarity in IV forms?
a. The osmolarity of CSPs should be hypertonic to human blood
b. Solutions with high osmolarity should be administered through a central line
c. Hypotonic solutions will cause water to move out of RBCs
d. Hypertonic saline is often located on nursing units for emergent use
e. Hypertonic solutions will cause water to move into RBCs
b
80
A pharmacist has received an order to compound 200 mg progesterone suppositories. She will use a white, amorphous low density progesterone powder that aerosolizes easily.
The master formulation record includes the following ingredients:
-Theobroma oil
-Progesterone powder
-Sodium lauryl sulfate
What is the purpose of the theobroma oil in the formula above?
a. Suppository base
b. Active pharmaceutical ingredient (API)
c. Surfactant
d. Anti-foaming agent
e. Preservative
a
Theobroma oil (cocoa butter) can be used for suppository bases but often newer bases are selected because theobroma oil melts easily.
81
A pharmacist has received an order to compound 200 mg progesterone suppositories. She will use a white, amorphous low density progesterone powder that aerosolizes easily.
The master formulation record includes the following ingredients:
-Theobroma oil
-Progesterone powder
-Sodium lauryl sulfate
In the formula above, what is the purpose of the sodium lauryl sulfate?
a. Suppository base
b. Active pharmaceutical ingredient
c. Surfactant, charge neutralizer
d. Lubricant, stability agent
e. Preservative
c
82
A pharmacist is compounding a hard lozenge for sore throat relief. Which of the following would be an appropriate base for the lozenge?
a. Sucrose
b. PEG
c. Gelatin
d. Acacia
e. Cocoa butter
a
A base of sucrose or syrup (sugars) can be used to prepare hard lozenges.
83
Which of the following statements are correct regarding the preparation of ointments?
a. Glycerin can be used as a wetting agent to better incorporate the drug into the delivery vehicle.
b. Cooling the preparation with ice can help speed the process and make the product more consistent.
c. Ointments are composed of less water than creams.
d. If using heat, melt the ingredient with the highest melting point first, then add the others by decreasing melting points.
e. Ointments are packaged in pumps and tubes.
a, c, d
-Cooling shouldn't be sped up with ice or cold water, as it alters the consistency of the final product.
-Ointments are too thick to package in pumps.
84
Place the following steps for making an ointment in the correct order.
a. Place the mixture into a plastic ointment jar.
b. Affix the prescription and auxiliary label to the container.
c. Levigate the active pharmaceutical ingredient on an ointment slab.
d. Gradually add in the ointment base using geometric dilution.
e. Measure and weight out all ingredients.
e - c - d - a - b
85
The pharmacy technician would like to prepare an emulsion using the Continental gum method (AKA the dry gum method). Place the steps that the technician will need to take in the correct order.
a. Levigate the gum with oil.
b. Homogenize the emulsion.
c. Add water all at once.
d. Add other ingredients and water sufficient to make the final volume.
e. Triturate until a cracking sound is heard and the mixture looks creamy white.
a - c - e - d - b
86
A multi-dose vial of ondansetron is being used to prepare doses for multiple pts at the same time. The doses are prepared in an ISO 5 laminar airflow workbench, which is located in an ISO 7 cleanroom with an ISO 8 anteroom. According to USP 797, what BUD should be assigned to these IV admixtures if stored at room temp?
a. 1 hour
b. 12 hours
c. 24 hours
d. 30 hours
e. 48 hours
d
Batch preparation requires multiple entries into the same vial, which increases the risk of contamination. Batching is considered medium-risk compounding, and the BUD for medium-risk CSPs stored at room temp is 30 hours.
87
Which CSP risk level does NOT match the corresponding category of preparations?
a. Low-risk: 1-3 sterile components
b. High-risk: Non-sterile ingredients or equipment
c. Medium-risk: Batch preparation
d. Medium-risk: < 3 sterile components
e. Immediate-use: Prepared outside of a cleanroom for use within 1 hour
d
88
Which of the following compounded preparations can be safely sterilized using an autoclave?
a. Gentamicin
b. Protamine zinc insulin
c. Insulin glargine
d. Human chorionic gonadotropin injection
e. Levothyroxine injection
a
Steam sterilization (with moist heat) is done in an autoclave. Heat denatures the proteins of microorganisms (which is lethal), but it can also destroy other protein-based drugs, such as insulin and hormones (human gonadotropin, levothyroxine).
89
Select the reagent that is used with a bacterial endotoxin test (BET):
a. BET
b. USB
c. TSB
d. LAL
e. FTM
d
Limulus Amebocyte Lysate (LAL) reagent is used with the BET to test for pyrogens.
90
Cefepime 500 mg in NS is being prepared in a compounding aseptic isolator (CAI) located in a segregated compounding area. The admixture is prepared on 9/13/2021 at 0100. What BUD should be assigned if the final preparation will be stored at room temp?
a. 9/13/2021, 0200
b. 9/13/2021, 1300
c. 9/14/2021, 0100
d. 9/14/2021, 0700
e. 9/15/2021, 0100
b
Low- or medium-risk sterile preparations made in a compounding aseptic isolator (glovebox) located in a segregated compounding area (outside of an ISO 7 buffer room) have a BUD of 12 hours at room temp or refrigerated.
91
The technician has finished compounding a doxycycline IV admixture. Which of the following must be included on the label?
a. Name and concentration of ingredients
b. Manufacturer's expiration date of the individual ingredients
c. Route of administration
d. Storage information
e. Appropriate auxiliary labels
a, c, d, e
A BUD must be on the label
92
A compounding pharmacist receives an Rx for thirty 60 mcg levothyroxine (T4) capsules. How many 150 mcg tablets will he need to compound this Rx?
12
30 x 60 caps = 1800 mcg needed
1800 mcg / 150 mcg per cap = 12 caps needed
93
A pharmacist needs to prepare a 4% hydrocortisone ointment to treat a rash on a pt's forearms and to protect the skin from dying.
The master formulation includes these ingredients:
Hydrocortisone powder
Mineral oil
Petrolatum
Dimethicone
The mineral oil will be added to the hydrocortisone powder before mixing it with the base. What is the purpose of the mineral oil?
a. Humectant
b. Wetting agent
c. Disintegrant
d. Preservative
e. Buffer
b
Hydrocortisone will need to be wetted with mineral oil (wetting agent) and stirred into a thick paste before being put into the delivery vehicle.
94
A pharmacist needs to prepare a 4% hydrocortisone ointment to treat a rash on a pt's forearms and to protect the skin from dying.
The master formulation includes these ingredients:
Hydrocortisone powder
Mineral oil
Petrolatum
Dimethicone
The compound is being prepared on January 1st. The earliest expiration date of any ingredients is December 30th of that same year. What is the BUD of the hydrocortisone ointment (assuming all are within the same year)?
a. January 15th
b. January 30th
c. April 1st
d. July 1st
e. December 30th
d
The BUD of non-sterile, nonaqueous formulations is up to 6 months from the preparation date. If any of the ingredients expire before 6 months, the earlier expiration date should be used.
95
A pharmacist needs to prepare a 4% hydrocortisone ointment to treat a rash on a pt's forearms and to protect the skin from dying.
The master formulation includes these ingredients:
Hydrocortisone powder
Mineral oil
Petrolatum
Dimethicone
Place the following steps for making the hydrocortisone ointment in the correct order.
a. Add a small amount of mineral oil to the powder.
b. Levigate the powder using an ointment slab and spatula.
c. Place the powder on an ointment slab.
d. Add petrolatum using geometric dilution.
e. Weigh the hydrocortisone powder.
e - c - a - b - d
96
A pharmacist needs to prepare a 4% hydrocortisone ointment to treat a rash on a pt's forearms and to protect the skin from dying.
The master formulation includes these ingredients:
Hydrocortisone powder
Mineral oil
Petrolatum
Dimethicone
The pharmacist has prepared 60 g of the 4% hydrocortisone ointment and is concerned that the strength is too strong for the pt's thin, cracked skin. How much petrolatum should be added to reduce the strength to 2.4%?
a. 15 g
b. 20 g
c. 40 g
d. 55 g
e. 60 g
c
(60 g)(4%) = (x)(2.4%)
x = 100 g
100 - 60 = 40 g
97
A pharmacist needs to prepare a 4% hydrocortisone ointment to treat a rash on a pt's forearms and to protect the skin from dying.
The master formulation includes these ingredients:
Hydrocortisone powder
Mineral oil
Petrolatum
Dimethicone
The pharmacist doesn't have enough petrolatum to use for the above preparation. The pharmacist will prepare 60 grams of the 2.4% by combining the 4% hydrocortisone ointment with a 1.5% hydrocortisone ointment the pharmacy has in stock. How many grams of each ointment will be required?
a. 21.6 g 4%, 38.4 g 1.5%
b. 22.4 g 4%, 37.6 g 1.5%
c. 24.4 g 4%, 35.6 g 1.5%
d. 26.4 g 4%, 33.6 g 1.5%
e. 26.6 g 4%, 33.4 g 1.5%
a
Alligation:
1. 4% - 2.4% = 1.6 parts of 1.5% and 2.4% - 1.5% = 0.9 parts of 4%
2. 0.9 + 1.6 = 2.5 parts of 2.4%
3. (60 g) / (2.5 parts) = 24 g per part
4. (0.9 parts 16%) x (24 g / 1 part) = 21.6 g of 4%
5. (1.6 parts 1.5%) x (24 g / 1 part) = 38.4 g of 1.5%
98
What does "PLO" stand for in "PLO gel"?
a. Potassium lecithin organogel
b. Palmitate lecithin organogel
c. Poloxamer lipophilic organogel
d. Pluronic lecithin organogel
e. Pluronic liquid organogel
d
Pluronic lecithin organogel (PLO) gel is a transdermal vehicle used by compounding pharmacists to administer medications through the skin.
99
Master Formulation Record:
Lidocaine, Benzocaine, & Tetracaine Gel
Purpose: Topical anesthetic/analgesic for superficial surgical procedures and laser therapy
Ingredients & Quantity:
Lidocaine - 10 g
Benzocaine - 20 g
Tetracaine - 4 g
Butylhydroxytoluene - 0.1 g
Polysorbate 80 (Tween 80) - q.s.
Organic phase - 13 mL
Aqueous phase - 52 mL
When the lidocaine, benzocaine, and tetracaine powders are combined, the mixture has a lower melting point than the individual drugs. What type of mixture is this?
a. Hygroscopic
b. Deliquescent
c. Efflorescent
d. Eutectic
e. Effervescent
d
When the melting point is lower, the drug will penetrate the skin more efficiently.
100
D/t a nationwide shortage of sodium bicarbonate injection, a pharmacist is looking at the possibility of using non-sterile sodium bicarbonate powder to compound sterile IV sodium bicarbonate. What BUD should be on the label if the final preparation will be stored at room temp?
a. 1 hour
b. 30 hours
c. 9 days
d. 24 hours
e. 3 days
d
High-risk sterile compounding uses non-sterile ingredients or equipment. The BUD for a high-risk CSP stored at room temp is 24 hours.
101
A pharmacist is preparing to compound the following prescription:
Digoxin Liq. 0.1 mg/mL
Disp. 20 mL
Sig: 10 mcg per kg PO daily
The pharmacist will make the elixir by using crushed digoxin tabs for a 27-month-old child weighing 40 lbs. Each digoxin tab contains 250 mcg of digoxin. How many digoxin tabs will be needed to compound this Rx?
8
0.1 mg / mL = x / 20 mL
2 mg = 2000 mcg
2000 mcg / 250 mcg = 8 tabs
102
A technician is compounding IV clindamycin using non-sterile clindamycin hydrochloride powder as an ingredient. According to USP, what is an appropriate BUD if the final preparation will be stored in the fridge?
a. 12 hours
b. 24 hours
c. 3 days
d. 9 days
e. 45 days
c
The CSP is considered high-risk.
103
The pharmacy receives an Rx for 80 g of 2.5% hydrocortisone cream. D/t a medication shortage, the pharmacist must compound this with the 5% and 1% hydrocortisone creams in stock. How many grams of the 5% cream will be used to compound this Rx?
30
104
A technician is compounding a minoxidil 5% and finasteride 0.1% topical liquid with the following ingredients:
Minoxidil
Finasteride
Propylene glycol
Ethanol 95%
Purified water
What technique should he use when mixing ingredients to ensure that all the ingredients are uniformly distributed in the final preparation?
a. Levigation
b. Pulverization
c. Geometric dilution
d. Trituration
e. Comminution
c
105
During sterile compounding, which of the following requires the use of a filter needle or filter straw?
a. ADD-Vantage systems
b. Small volume parenterals
c. Glass ampules
d. Vials
e. Syringes
c
106
A pharmacy technician is compounding cefazolin 2 g in 50 mL of D5W for IV infusion. How should the pharmacist verify that the correct volume of ingredients was used in the preparation?
a. Direct visualization of the syringe immediately after compounding
b. Syringe pull-forward method
c. Direct visualization of the syringe before compounding
d. Written documentation by the technician
e. Syringe pull-back method
c
107
A prescription reads as follows: Prepare lidocaine HCL 3% w/v; qs with pure water to 150 mL. How many grams of lidocaine are needed to compound this Rx?
4.5
3 g / 100 mL = x / 150 mL
x = 4.5 g
108
Which document provides directions on how to make a calamine-zinc oxide ointment?
a. Compounding record
b. MedGuide
c. Master formula
d. Package insert
e. Patient package insert
c
109
A pharmacist wishes to measure 7.5 mL of glycerin. Which measuring device would be preferable?
a. 10 mL syringe
b. 8 mL volumetric pipette
c. 3 mL Mohr pipette
d. 10 mL graduated cylinder
e. Tablespoon
a
Syringes are best for measuring viscous (thick) liquids, such as glycerin and mineral oil
110
What is the purpose of Ora-Plus when used to prepare a PO suspension?
a. Adds flavor to compounds with poor palatability
b. Facilitates drug absorption in the small intestine
c. Maintains the pH of the suspension within a narrow range
d. Keeps drug particles suspended and prevents settling
e. Prevents preparations from becoming dry and brittle
d
111
Which of the following are correct statements about sieves?
a. Another name is a sifter
b. It's used to grind an ointment between rollers to homogenize
c. A common use is to prevent contamination in sterile compounding
d. The functionality is similar to a coffee grinder
e. The purpose is to ensure a uniform particle size
a, e
After a powder has been ground fine, it's sifted in a sieve to ensure a uniform particle size.
112
Which of the following represents reasonable methods to limit oxidative damage?
a. Reduce the drug concentration in solution
b. Temperature control with refrigeration
c. Maintain pH with a buffer
d. Use chelators to bind metal ions
e. Use a desiccant to absorb moisture
b, c, d
Oxidation is catalyzed by heat, light, and metal ions. To control oxidation, it's important that changes in temperature and pH be carefully controlled.
113
A compounding pharmacist is considering using poloxamer gel in his pharmacy. Which of the following statements concerning poloxamer gel is INCORRECT?
a. It's a liquid when stored cold and forms a gel when stored at room temp.
b. It has both a hydrophobic and a hydrophilic component.
c. It's commonly used for compounding transdermal products.
d. It's thermoreversible.
e. It's a liquid at room temp and forms a gel when cold.
e
114
A pharmacist will prepare a 2% testosterone ointment in white petrolatum from a compounding kit.
The compounding kit contains:
12 mL Testosterone Solution (100 mg/mL)
48 g White Petrolatum
What is the purpose of the petrolatum in the compounding kit above?
a. Thickening agent
b. Levigating agent
c. Adsorbent
d. Emollient
e. Antioxidant
d
An emollient is a product that softens and soothes the skin. White petrolatum is an occlusive emollient that will provide a barrier to water loss from the skin and act as a vehicle for topical drug delivery of the testosterone.
115
A pharmacist prepares caramelized onions to use in omelets. She slices some yellow onions and places them into a wide pan to permit water to easily evaporate while the onions slowly cook. After ~20 minutes of cooking, the sliced onions have shrunk down to a smaller amount of brown, caramelized onions because much of the water in the onions has been lost. What is the chemical process that is central to this desirable effect?
a. Decarboxylation
b. Oxidation
c. Epimerization
d. Suzuki couplings
e. O-demethylation
b
The sugar is caramelized in a series of reactions, which begins when the alcohol functional group in the sugar is oxidized. An alcohol is a hydroxy functional group (-OH) bound to a carbon. The water is removed when the steam evaporates. The sugar is broken down by a series of other reactions.
116
The pharmacy receives an Rx for Gleevec 600 mg PO once daily. Which of the following statements is true regarding counting the Gleevec tablets?
a. Counting the Gleevec tablets must be done in a negative pressure room.
b. The equipment used to count Gleevec tablets should be sanitized after use.
c. Counting the Gleevec tablets must be done in a biological safety cabinet.
d. Gleevec can be counted in an automated pill counter if the pill counter is used for HDs only.
e. PPE should include a face shield when counting the tablets.
b
117
Compounding ingredients should be obtained from a reputable source. Which of the following provide guidance for ensuring high-quality ingredients are obtained?
a. NIOSH and USP-NF
b. FCC and USP-NF
c. ACIP and NIOSH
d. FTC and USP-NF
e. IDSA and FCC
b
The Food Chemicals Codex (FCC) and USP National Formulary (USP-NF) are reputable sources that provide info to assist compounding pharmacies in finding ingredients that are pure and safe.
118
Which of the following can also be referred to as a levigating agent?
a. Buffer
b. Foaming agent
c. Surfactant
d. Wetting agent
e. Hydrophilic solvent
d
Levigating/wetting agents are types of surfactants used to reduce surface tension between a solid and a liquid.
119
Which of the following is a type of surfactant that reduces the surface tension between a solid and a liquid?
a. Emulsifier
b. Foaming agent
c. Disintegrant
d. Lubricant
e. Wetting agent
e
120
A pharmacist will prepare an oil-in-water emulsion and can select from the available stock surfactants:
Surfactants & HLB:
Tween 80 - 10.5
Span 80 - 1.3
Jojoba oil - 6.5
Glycerol monostearate - 3.8
Cottonseed oil - 6
Which surfactant should be chosen to prepare the emulsion from the available stock surfactants?
a. Tween 80
b. Span 80
c. Jojoba oil
d. Glycerol monostearate
e. Cottonseed oil
a
-Oil-in-water: Surfactants with the highest HLB # (or an HLB # > 10) should be used
-Water-in-oil: Surfactants with the lowest HLB # (or an HLB # < 10) should be used
121
Which type of water used in compounding is matched correctly with its most common usage?
a. Sterile: Reconstitution of PO suspensions
b. Distilled: Preparation of a bladder irrigation
c. Tap: Non-sterile compounding preparations
d. Potable: Hand washing and initial equipment cleaning
e. Distilled: Reconstitution of sterile preparations
d
-Sterile - used for preparation and reconstitution of sterile drugs
-Distilled - used for reconstitution to prepare PO suspensions and in non-sterile preparations
122
A pharmacy technician is compounding a progesterone PO suspension. After weighing and measuring out the ingredients, she will levigate the progesterone powder with glycerin to form a thick paste. What type of mortar and pestle should she select to perform this step?
a. Bamboo
b. Wedgewood
c. Porcelain
d. Glass
e. Stainless steel
d
-Glass - used for mixing liquids, such as suspensions and solutions, and for mixing compounds that are oily or can stain
-Wedgewood - have a rough surface, and are preferred for grinding dry crystals and hard powders
-Porcelain - have a smooth surface, and are preferred for blending powders and pulverizing gummy consistencies
123
Which of the following are ointments?
a. Aquabase
b. Aquaphor
c. Acacia
d. Span
e. Petrolatum
f. Polybase
g. Tween
a, b, e, f
124
A pharmacist will be compounding an electrolyte rehydration solution by mixing dextrose, sodium chloride, and potassium citrate powders. The powders are already uniform in particle size and only need to be blended. Which mortar and pestle should be used?
a. Bamboo
b. Wedgewood
c. Porcelain
d. Glass
e. Stainless steel
c
-Glass - used for mixing liquids, such as suspensions and solutions, and for mixing compounds that are oily or can stain
-Wedgewood - have a rough surface, and are preferred for grinding dry crystals and hard powders
-Porcelain - have a smooth surface, and are preferred for blending powders and pulverizing gummy consistencies
125
What is the purpose of an ointment mill?
a. Weigh ingredients
b. Thoroughly homogenize ingredients
c. Mold the final compounded preparation
d. Determine the pH of the preparation
e. Measure ingredients
b
126
Soribitol has many uses in drug delivery. Which of the following are practical uses for sorbitol?
a. Sweetener
b. Preservative
c. Plasticizer for gelatin capsules
d. Improve tolerability in pts with IBS
e. Lubricant
a, c
Sorbitol can be used as both a sweetener and a plasticizer for gelatin capsules. It can cause GI distress, including cramping, which may be particularly bothersome to pts with IBS.
127
What is the purpose of a homogenizer?
a. Weight ingredients
b. Thoroughly mix ingredients
c. Mold the final compounded product
d. Reduce the particle size of powders
e. Fill capsules
b
-Also called an electric mortar and pestle
128
Which of the following pieces of equipment is not commonly used when performing non-sterile compounding?
a. Graduated cylinder
b. Mortar and pestle
c. Horizontal laminar airflow hood
d. Pipette
e. Class III torsion balance
c
Hoods are used for sterile compounding.
129
A compounding pharmacy specializes in hormone replacement therapy and will be preparing progesterone troches with the following ingredients:
Progesterone Troches:
Polyethylene glycol 1450
Progesterone, micronized powder
Aspartame
Mint extract
Green food color
What is the purpose of aspartame in the ingredients list?
a. Preservative
b. Humectant
c. Sweetener
d. Coating
e. Glidant
c
130
Which statement is correct regarding the HLB number?
a. A lipid-soluble surfactant has an HLB number > 10
b. A surfactant with a low HLB number will be used for an oil-in-waster (o/w) emulsion
c. The HLB scale ranges from 0-10
d. Surfactants with a high HLB number are water-soluble
e. An HLB value of 6 indicates the surfactant is water-soluble
d
131
Select the agents used as thickeners:
a. Alginic acid, polacrilin potassium
b. Lanolin, Aquaphor, Aquabase
c. Acacia, agar, gelatin
d. Span, Myrj, Tween
e. Sorbitol, glycerin, phenylalanine
c
These are common thickeners used in non-sterile compounding.
132
A pharmacist is preparing a water-in-oil emulsion and needs to select the most lipophilic surfactant available in the pharmacy. Which available surfactant should be selected?
a. Polyoxyethylene sorbitan trioleate (HLB = 11)
b. Span 60 (HLB = 4.7)
c. Tween 60 (HLB = 14.9)
d. Sorbitan tristearate (HLB = 2.1)
e. Glyceryl monostearate (HLB = 3.8)
d
A lower HLB number indicates a more lipophilic surfactant.
133
Which of the following reduces the surface tension between two liquids?
a. Disintegrant
b. Suspending agent
c. Levigating agent
d. Emulsifier
e. Lubricant
d
-Suspending agent - added to suspensions to help keep the solid particles from settling
-Levigating agent - make particles smaller; glycerin or mineral oil
