Order Entry and Process (21.25%) Flashcards
What are functions of key compounding equipment?
Balance: Used to WEIGH INGREDS. Class A electronic or torsion require for all compounding.
Mortar & Pestle: Used to REDUCE PARTICLE SIZE AND/OR MIX INGREDS.
Graduated cylinder: Used to MEASURE LIQUIDS, has graduated markings, measure at MENISCUS.
Ointment paper: Used to PREP SEMI-SOLID DOSAGE FORMS
What is in The Compounding Record?
Should be maintained and logged EACH TIME a compound is prepared, and must include:
• Name, strength, dosage form of the preparation
* Master formulation record reference
• Name, quantity, source, lot number and expiration date for all ingredients (active & inactive)
• Total quant compounded
• NAME(S) OF PHARMA TECH OR PHARMACIST who compounded the product and/or performed quality control
• Name of the pharmacist verify the compound
• Date of the compound
• Assigned control or prescription number and BUD
• Duplicate label as described in the Master Formulation Record
• Results of quality control procedures
• Documentation of any other details of product, quality issues, or reports of adverse drug events
What are the (3) Categories of Compounding per USP General Chapter 795
1) SIMPLE: Making a preparation that has a USP MONOGRAPH, APPEARS IN A PEER REVIEW JOURNAL, OR PER MANUF LABELING that contains specific info on ingredients, quants, processes, stability and BUD
2) MODERATE: Make a prep that requires SPECIAL CALCULATIONS or procedures to determine quants of components, or making a prep that lacks stability data
3) COMPLEX: Make a prep that requires SPECIAL TRAINING, environment, facilities, equip, facilities, equipment, and proceds to ensure approp therapeutic outcomes
What are different Liquids, how to prepare?
1) Solutions:
* Generally prepared from combo of COMPATIBLE SOLUTIONS or other ingreds that mix homogen into a vehicle. MAY REQUIRE HEAT to dissolve particles. Eg is prep of simple syrup – sugar is dissolve into distill water by heat and stirring.
2) Suspensions
* INSOLUBLE SOLID DOSAGE forms (tabs, powders, granules, etc.) can be compounded into a suspension
* Solid substance is LEVIGATED IN A MORTAR AND PESTLE, wetted to form a paste, transfer from the mortar by combine w/small amounts of suspension vehicle until all remnants of paste are empty into compound container.
* Suspensions, which contain water, have BUD no later than 14 days from reconstitution
3) Emulsions
o MIX OF OIL, WATER and emulsifying agent
o Generally reqs the use of special blending or homogenizing equip.
4) Ointments
o Made by incorporate other ingreds/dosage forms into a base
o Can be done in mortar and pestle, or more commonly with a spatula on ointment slab or paper
5) Creams
o Made by separate ingreds into “lipid” and “aqueous” categories, heat them separately above their melting points, then mix toget continuous as they cool
6) Gels/Jellies
o Involve incorporate into “gelling agent”, typically by either heating ingreds or alter their pH
What are different Solids, how to prepare?
1) Capsules
* Can be prepped by hand or w/special capsule-packaging equipment
2) Tablets
* Require packaging/compressing equip to prep the molded dosage form.
* Can also be used for lozenges, troches, other molded dosage forms
3) Suppositories: Can be compounded using 1 of 2 methods:
* Molding: ingreds are incorp into a melted base and pour into a suppository mold to cool
* Hand-rolling & shaping; ingreds are incorporate into semi-solid base, and hand molded or rolled into suppository shape
Prescription should include what?
- Med office info and contact info
- Date of prescription
- Patient Info: Full name, address, date of birth (DOB)
- Drug name, brand or generic
- Dosage form and strength
- “Sig” (instructions): Dose, route, frequency, +/- duration
- Quant of medication to be dispense
- Refill count
- Prescriber signature
- DEA NUMBER require for CONTROLLED substances
Commonly used abbrev for ADMIN ROUTES
AAA AD: AS: AU: OD: OS: OU: ID: IV: SC(Sub-Q; SQ): IM: InH: PO: PR: SL:
AAA: Apply to Affected Area AD: Right Ear AS: Left Ear AU: Both Ears OD: Right eye OS: Left eye OU: both eyes ID: Intradermal (shallowest shot, right under top layer of skin) IV: Intravenous (shot in vein) SC(Sub-Q; SQ): Subcutaneously (shot below dermis, above muscle) IM: Intramuscular (shot in muscle) InH: Inhalation PO: Orally PR: Rectally SL: Sublingually – dissolve under tongue
Commonly used abbrev for AMOUNTS
cc: g: gr: gtt: L: lb: mcg: mL: oz: qty: Q.S. tbsp
cc: cubic centimeter
g: grams
gr: grain
gtt: drop
L: liter
lb: pound
mcg: microgram
mL: milliliter
oz: ounce
qty: quantity
Q.S. A SUFFICIENT QUANTITY
tbsp: tablespoon
Commonly used abbrev for FREQUENCY OR TIMING
AM AC ATC BID h or hr HS PC PM PRN Q QID STAT TID
AM morning AC Before meals ATC around the clock BID twice daily h or hr Hour HS at bedtime PC after meals PM evening PRN as needed (for) Q every… QID four times daily STAT immediately TID 3 times daily
Other Commonly used abbrevs
BP c DAW IR K, KCI ODT s SOB supp. tab u.d. w/ w/o
BP Blood pressure c with DAW dispense as written IR immediate release K, KCI Potassium, Potassium chloride ODT orally disintegrating tablet s without SOB shortness of breath supp. Suppository tab tablet u.d. as directed w/ with w/o without
What are the modes of receive prescription in community pharmacy?
- e-prescribe: Becoming predominant, reduce transcription errors. Prescribers incentivized.
- Hard copy: Still common, patients bring in.
- Fax: Still used
- Tele order: Still done
What’s included in 1st time patient profile?
- Demos: Full name, sex, date of birth, address, height, weight
- Insurance Info
- Medication allergies/intolerances
- Medical conditions
- ACTIVE PREGNANCY, BREASTFEED, PLANS TO BECOME PREGNANT
- All current medications, including OTC, dietary, supps
- Pertinent details of prior medication therapy
What are key things deserve scrutiny w/prescription?
a. Unusual doses, quantities, refills
b. Non-local providers
c. Unfamiliar signatures
d. Signs of alteration
e. Incorrect DEA #
With new prescribe, systems file initial claim against patient’s insurance. This may trigger DUR. What are some common issues?
o Prior authorizs that are require before insurance will pay, may need phone calls or fax.
o Refill too soon rejections (maybe override for emergencies or lost meds – may be sign of abuse)
o Interaction warnings – if patient has medical or pharma claims for drugs/health condits that conflict.
o Non-formulary – some drugs may not be cover by insure – pharmacist may need to recco another one.
What are the modes of receive “medication orders” in healthcare institution?
- Computerized Physician Order Entry (CPOE)
- Paper Chart Orders
- Telephone Order
Standardized Nomenclature institutes
- Nomenclat for frequencies should be standardize w/in institute as well, e.g. “BID” to mean 9am-5pm, “every 12 hours” to mean at 9am, 9pm, etc.
Some standard nomenclat
o STAT: Within 15 minutes
o Urgent: Within 1 hour
o Routine: To be admined at next standard time
What is order of math operations?
Order of Math Operations: PEMDAS
- P: Solve anything in parentheses first
- E: Exponents next
- MD: Multiply/Divide
- AS: Add/Subtract
What do the following stand for?
mcg mg g gr kg
mcL
mL
dL
L
mm
cm
m
Weight
Microgram (mcg) = 0.000001 gram Milligram (mg) = 0.001 gram Gram (g) Grain (gr) = 65 milligrams Kilogram (kg) = 1000 grams
Volume Microliter (mcL) = 0.000001 liter Milliliter (mL) = 0.001 liter Deciliter (dL) = 0.1 liter Liter (L)
Length
Millimeter (mm) = 0.001 meter
Centimeter (cm) = 0.01 meter
Meter (m)
How many lbs/kg and kg/lb?
How many grams (g) per oz?
How many grains per g?
Weight 1 lb = 454g 2.2 lbs = 1kg 1 oz = 28.5g 1 grain (gr) = 0.065 gram; 15 grains = 1 gram
Converting Fahrenheit to Celsius and Celsius to Fahrenheit?
Fahrenheit to Celsius: (Temp F -32) * 5/9 (.556). e.g. 72F -32 * 5/9 = 22.2C
Celsius to Fahrenheit: TempC * 9/5 (.556) +32, e.g. 10C * 9/5 +32 = 50F
What do the drug concentration percentages represent?
a) W/W
b) W/V
c) V/V
w/w (weight in weight): GRAMS OF DRUG PER 100 GRAMS of the drug product
w/v (weight in volume): GRAMS OF DRUG PER 100 MILLILITERS of the drug product
v/v (volume in volume): MILLILITERS OF DRUG PER 100 MILLILITERS of the drug product
Pharmacy Calculation Practice
1) Review examples in Tech Scholar notes;
2) Look at Barrons 148-162 examples.
3) Find others
Who is leading authority to set standards for product safety and purity?
United States Pharmacopeial Convention.
For drugs to be marketed in the United States, they must conform to USP-NF standards. The USP-NF is the United States Pharmacopeia and National Formulary, which is published by the United States Pharmacopeia.
How many drops (ggts) per ml? How many ml per tsp? How many ml per tbsp? How many mL per fluid oz? How many mL per cup? How many mL per pint?
How many cups per pint?
How many pints per quart?
Haw many pints per gallon? quarts per gallon?
20 drops per mL. 1 teaspoon (tsp) = 5ml 1 tablespoon (Tbsp) = 15mL 1 fluid ounce (fl oz) = 30 mL 1 cup = 237.5 mL 1 pint = 475 mL
2 cups = 1 pint
2 pints = 1 quart
8 pints = 1 gallon / 4 quarts = 1 gallon
Active pharmaceutical ingredient (API) vs. Inactive ingredient (excipient)?
- Active pharmaceutical ingredient (API): The SUBSTANCE used in compounding of drug product that will DISPLAY PHARMACOLOGIC ACTIVITY TO TREAT, MITIGATE, CURE, PREVENT or diagnose disease.
- Inactive ingredient (excipient): Substances required to compound a dosage form that are NOT INTENDED to exert a pharmacologic effect.
What is Non-Sterile Compounding?
Any Oral, transdermal (route of administration wherein active ingredients are delivered across the skin), vaginal, rectal med preps using strict QC.
USP 795 provides guidelines and procedures for Non-Sterile Compounding.
Geometric dilution?
Mix DIFFERENT QUANTITIES OF 2+ INGREDS to create mixture.
- Small quant ingred is first, mix w/equal part of diluent.
- Diluent then mix with rest.
Levigate?
*Levigate: Grinds a powder by INCORPORATE A LIQUID.
What is Meniscus?
*Meniscus: (IF) CONCAVE in shape, measurement should be done at “BOTTOM” OF MENISCUS.
Triturate?
To reduce particle size by GRINDING IN THE MORTAR AND PESTLE.
Spatulation?
Use spatula to mix ingreds in plastic bag, on ointment paper, etc.
What do following prefixes mean? Hyper Hypo Semi Tachy
Hyper - Over, above: Hypertension
Hypo - Below: Hypotension (low blood pressure, faint)
Semi - Half
Tachy - Fast, Tachycardia (rapid heart beat)
Reconstitution?
Process of mixing powder with diluents PRIOR to administration.
Oral devices?
Oral cups: For teaspoons, tablespoons, milliliters. >5mL
Oral droppers: Eyes, Ears, occasional mouth. <5mL
Calibrate spoon: Hollowed spoon, <5mL
Oral syringe: Most common, come in 1, 3, 5, 10 mL
Injectable syringes
Syringe: Plunger/Barrel/Tip
Needle: Hub/Shaft/Bevel/Lumen(opening)
Needle length from 3/8” to 3.5”
13 (largest size lumen) to 32 (smallest size lumen)
1-60mL capacity
U-100 Insulin how many units/mL?
U-500 Insulin how many units/mL?
U-100 insulin has 100 units per mL
u-500 insulin has 500 units per mL
What is NS, and what is % concentration?
Sodium Chloride 0.9% Injection is used to replace lost body fluids and salts (=Saline).
Child doses - Clark and Young rules
Young’s Rule:
Adult Dose X (Age ÷ (Age+12)) = Child’s Dose
Clark’s Rule:
Adult Dose X (Weight ÷ 150 LBs) = Childs Dose
LBs, NOT KGs
