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Chapter Review Answer Key
Chapter 6 Dispensing Medications in the Community Pharmacy
Checking Your Understanding
1. c
2. c
3. b
4. b
5. c
6. b
7. c
8. a
9. c
10. d
Thinking Like a Pharmacy Tech
1. Fred Figule
a. date, quantity, route, need to call prescriber
b. Prednisone 5 mg #12
c. none
d. Take five tablets orally in the morning on day 1, three tablets in the morning on day 2, two
tablets in the morning on day 3, and one tablet in the morning on days 4 and 5.
H.R. Rubbins
a. DEA#, patient’s address, quantity
b. Tylenol No. 4, 1 po q4-6h prn, no amount specified, need to call prescriber
c. none
d. Take one tablet orally every 4 to 6 hours as needed for pain.
Abby Gee
a. Rx number not recorded yet
b. Nexium 40 mg, one capsule po daily, #30
c. none, although DAW is specified
d. Take one capsule orally daily before eating.
2. Medication container labels should be filled out according to local practices.
a. Fred Figule
Demonis
Rx #673212
Take five tablets in the morning on day 1, three tablets on day 2, two tablets on day 3, and
one tablet on days 4 and 5
Prednisone 5 mg
01/01/XX
none
b. H.R. Rubbins
Jittern
Rx #431718
Take one tablet orally every 4 to 6 hours as needed for pain.
Tylenol #4
11/24/XX
none
© Paradigm Publishing, Inc.
c. Abby Gee
Jones
Rx #673214
Take one capsule orally daily before eating.
Nexium 40 mg
9/10/XX
3. a. date of birth and gender
b. sulfa and aspirin
c. arthritis, heart condition
d. Feldene, Isoptin, Nasalcrom OTC
e. yes, although many pharmacies will have him sign a separate waiver form
f. yes, his own name, Ted Frame
4. DEA number AY 1234563 is valid
(9 + 24 = 33); DEA number
AY 2749122 is not (7 + 36 = 43).
Communicating Clearly
1. Wear a nametag, a different colored lab coat or smock, and always refer the patient to the
pharmacist if the patient begins asking you questions you should not answer. Identify
yourself immediately if you feel the customer has misidentified you.
2. In case of a possible forged prescription, quietly and discreetly alert the pharmacist. Often,
you may want to delay filling the prescription until law enforcement authorities arrive. If the
customer leaves the pharmacy, then turn over the forged prescription to the police.
3. a. Our pharmacy does not have that medication in stock. “I’m sorry—we don’t have that
medication in stock. We will order it today, and it will be in tomorrow afternoon. May we
call you when it is received?” If the patient needs the medication that day, then offer to
call neighboring pharmacies to see whether they have the drug in stock.
b. We did not have a sufficient amount of medication to fill your prescription, so we
dispensed only a partial fill sufficient for the next few days until new stock is received.
“I’m sorry—we didn’t have sufficient stock to fully fill your medication. We provided
enough medication for the next 5 days. We will order your medication today, and you can
return for the remainder of the prescription any time after tomorrow afternoon.”
c. We could not fill your prescription as written; a PA was required. “Your physician must
call your insurance provider to get approval before this prescription can be billed to your
insurance. It often takes several days to get approval; your physician may want to change
the medication. We will call you when we’ve received approval from the physician’s
office or your insurance provider.”
d. We could not fill your prescription as written because a serious interaction may occur. “We
must contact your physician before releasing this prescription. There is a potential harmful
drug interaction that may cause harm to you. Your physician may choose to prescribe an
alternative medication that would be safer for you to take. We will call you when we hear
back from the physician’s office.”
Researching on the Web
1. Visit Walgreens.com.
a. The closest store to your zip code will vary depending on your location.
b. For $2.99, you can have one of these flavors added to Prelone syrup: apple, banana,
bubble gum, cherry, grape, grapeade, grape bubble gum, lemon, raspberry, sour apple, or
watermelon.
c. Following are common uses and side effects for Valtrex 500 mg caplets:
Common Uses: This medicine is an antiviral used in patients with normal immune
systems to treat herpes zoster infections (shingles) or to treat or suppress genital herpes.
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© Paradigm Publishing, Inc.
Chapter Review Answer Keys, Chapter 6
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This medicine may be used in combination with safe sex practices in patients with genital
herpes to help reduce the risk of spreading the condition to others. This medicine may also
be used for cold sores (herpes simplex) or other conditions as determined by your doctor.
Possible Side Effects: Side effects that may occur while taking this medicine include
nausea, vomiting, dizziness, diarrhea, or headache. If they continue or are bothersome,
check with your doctor. Contact your doctor immediately if you experience symptoms of a
kidney problems (such as a change in the amount of urine, lower back pain), fever,
weakness, speech problems, seizures, yellowing of the skin or eyes, bloody or dark urine,
pale skin, or pinpoint bruises. An allergic reaction to this medicine is unlikely, but seek
immediate medical attention if it occurs. Symptoms of an allergic reaction include rash,
itching, swelling, severe dizziness, or trouble breathing. If you notice other effects not
listed above, contact your doctor, nurse, or pharmacist.
d. Body mass index will vary by individual.
2. Visit www.dea.gov.
a. “Facts and Stats” of drug abuse vary by year and state.
b. Following is information concerning drug abuse involving common cough syrups sold in
the pharmacy:
At dangerously high-level doses Dextromethorphan (DM) is dissociative, like PCP and
ketamine. Since the 1950s it has been used primarily as a safe and effective cough
suppressant ingredient found in OTC medicines. When taken according to directions,
products containing DM produce few side effects and have a long history of safety and
effectiveness. But these days, some teens are abusing this medicine and causing serious
damage to their bodies. They think because it’s usually found in over-the-counter
medicines that it must be harmless, just an easy and safe way to get high. But it’s not.
Taken in recreational doses, which far exceed recommended doses, DM can cause serious
damage; at high enough doses, DM alone can suppress the central nervous system. If that
happens your brain can stop telling your lungs to breathe. Some drugs that people take to
get the DM high also include other ingredients which can interact in your body and have
dangerous consequences. And remember, extremely high doses of DM can induce a
hallucinatory state which can lead to “accidents” that result in death. Even more serious
when abused, over-the-counter medications that contain detroxmethorphan often contain
antihistamine and decongestant ingredients as well, and high doses of these mixtures can
seriously increase the harmful effects. Cough medicine is also sometimes abused with
other drugs, including alcohol, which can cause other dangerous effects on the mind.
Chapter Review Answer Key
Chapter 7 The Business of Community Pharmacy
Checking Your Understanding
1. a
2. b
3. c
4. a
5. b
6. c
7. c
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© Paradigm Publishing, Inc.
Chapter Review Answer Keys, Chapter 6
Page 3
8. c
9. a
10. a
Thinking Like a Pharmacy Tech
1. The patient must be identified in the database by name, date of birth, and/or phone number.
The prescription information is reviewed and entered into that patient’s profile, where it is
reviewed by the pharmacist. A label is printed; the proper stock bottle with the correct NDC
number is retrieved; the correct amount of medication is counted; the label is affixed to the
medication container; and the original prescription, medication vial, and drug are verified by
the pharmacist. To adjudicate the claim, the technician must get the following information
from the insurance card: insurance plan ID, BIN, PCN, patient ID number, and group
number.
2. a. $4.85
b. $3.90 markup; $19.50 selling price
c. 24% markup
d. $425
e. $4.25
f. Smith’s Pharmacy, $2.74; Jones’s Pharmacy, $8.94
g. $67.12 profit
h. Eucerin: 7 jars; ampicillin: 2100 caps; eye drops: 20 bottles; Nystatin: 600 mL; saline: 525
mL
3. a. ProAir MDI #1 (200 inhalations per MDI)
Sig: 2 sprays q6 h prn wheezing
Answer: 200 inhalations in MDI/8 sprays per day = 25 days supply
b. Fluticasone Nasal Spray #1
(120 sprays per canister)
Sig: 2 sprays in each nostril daily for allergies
Answer: 120 sprays in each canister/2 sprays in each nostril per day = 30 days supply
c. Gentamicin ophthalmic solution
7.5 mL
Sig: 2 gtts in each eye qid for 7 days
Answer: 20 gtt/mL solution × 7.5 mL bottle = total of 150 gtt
150 gtt/bottle ÷ 16 gtt/day = 9+ days
d. Keflex 250 mg/5 mL 150 mL
Sig: ¾ tsp po tid for 10 days
Answer: ¾ tsp = 3.75 mL × 3 times daily = 10.25 mL/day
10.25 mL per day × 10 days requires 102.5 mL total
150 mL is enough for 14 days, so some medication will need to be discarded (a 100 mL
bottle is not quite enough medication to fill the prescription).
Communicating Clearly
1. a. Covers basic health and hospitalization and may or may not cover prescriptions.
b. Part A/B is available to older adults and disabled individuals to cover major medical
expenses. Part D is a federal benefit that currently covers outpatient prescription
medications.
c. Available to the financially disadvantaged, families with small children, and disabled
individuals. Qualifications, funding, and requirements vary by state. Coverage is usually
major medical and prescriptions.
d. Amount that a patient must pay before the insurance considers paying a claim. It may be a
large amount at the beginning of the year, or it may be a per incident coverage.
e. Flat fee that a patient must pay out-of-pocket at each time of service (i.e., physician visits,
Pharmacy Practice for Technicians, Fourth Edition
© Paradigm Publishing, Inc.
Chapter Review Answer Keys, Chapter 6
Page 4
prescriptions).
f. A percentage-based payment that a patient must pay out-of-pocket for a service (i.e.,
physician visits, prescriptions).
g. List of brand name medications for which an insurance company will pay more benefits
than for brand name medications not on the preferred list (but less benefits than if a
generic drug were prescribed).
h. Pharmacy benefits manager who administers the prescription drug benefit for several
insurance companies.
i. Normal amount that would be charged to a cash-paying customer.
j. Dual co-pay is a lower cost for a generic and a higher cost for a brand name medication; a
tiered co-pay includes escalating co-pays for generic, preferred, and nonpreferred brands.
k. A prior approval or authorization is a process by which your physician must call your
insurance to determine if insurance will cover prescribed medication or an alternative
(usually lower-cost) drug prescribed.
2. Diabetic Tussin and other similar products are often stocked in the diabetic supplies section
of the pharmacy. Selecting a sugar-free liquid cold or cough product is important for a child
who is diabetic. The manufacturer must include all information on the OTC product label that
is necessary for the safe and effective use of the product by the consumer, in language that is
both understandable and readable. Such information should include dosage and frequency of
administration for different age groups, as well as precautions, warnings, and expiration
dates.
3. Several glucometers are on the market, including some store-brand versions. Features such as
portability, amount of blood, time to get results, memory, connectivity to a computer, as well
as cost, differ greatly. Most glucometer purchases offer rebates that cover a majority of the
cost. The major cost is the disposable test strips, which can cost (without insurance) over
$100 per month! Test strips for store-brand monitors often save the patient 40 to 50% of the
cost compared to brand name strips.
Researching on the Web
1. These companies are examples of wholesalers that supply and sell drugs and medical
supplies to pharmacies.
They also can provide other services, such as pharmaceutical repackaging, retail
merchandising, private label products, customized reports, physical inventory, bar-code
ordering, receiving, inventory, desktop ordering software, online ordering, and new product
placement. See whether students prefer one wholesaler over the other, and their reason, based
on their Internet research.
2. Contact numbers, local/regional news, and seizures of drugs vary by state. Hydrocodone was
considered a Schedule II drug in 1971. It is used as a cough suppressant and narcotic for
moderate to severe pain. It is currently listed as a Schedule III drug (not kept in the safe,
refills allowed), but it may be reclassifed by the FDA to Schedule II status in the future. More
than 500 million legal prescriptions have been written for this narcotic in the past five years.
Most prescriptions are written for chronic, long-term pain.
3. There are 20.8 million children and adults in the U.S. with diabetes—and nearly one third of
them (or 6.2 million people) do not know it! Take this test to see if you are at risk for having
or developing type 2 diabetes. Diabetes is more common in African Americans, Latinos,
Native Americans, Asian Americans, and Pacific Islanders. If you are a member of one of
these ethnic groups, then you need to pay special attention to this test. To find out whether
you are at risk for type 2 diabetes, answer the following questions as they apply to you and
then click the “Calculate” button to run the test and view your score. Encourage patients with
a family history or who are at risk to visit the Web site and take the test. Give the test to
family members who may be at risk—you may save a life!
Pharmacy Practice for Technicians, Fourth Edition
© Paradigm Publishing, Inc.
Chapter Review Answer Keys, Chapter 6
Page 5
Chapter Review Answer Key
Chapter 8 Nonsterile Pharmaceutical Compounding
Checking Your Understanding
1. b
2. d
3. b
4. d
5. b
6. d
7. c
8. d
9. b
10. c
Thinking Like a Pharmacy Tech
1. This is a lab activity that includes measuring and filling capsules with a “pumpkin pie spice”
compound. The powder should be uniform in color, although individual colors may still be
noticed on close investigation. Capsules should be filled, but not packed, with powder. The
student may practice weighing the capsules if time allows.
2. No way exists to check the amount of the individual components once they have been mixed
together and dispensed to the patient. The pharmacist should check your calculations and
your weights or printouts if available. In addition, no one other than the pharmacist conducts
an inspection of the product. Proper technique (i.e., GCP) must be strictly followed by the
technician.
3. The percentage of error will be 3% and is calculated as follows: 80 g × 0.03 = 2.4 g.
Therefore your range is the following: 80 g – 2.4 g = 77.6 g; 80 g + 2.4 g = 82.4 g or 77.6 g
to 82.4 g
4. a. 60 mL
b. 120 mL
c. 240 mL
d. 500 mL
e. 1000 mL
f. 1000 mL
5. First, determine the difference between the two measurements to determine the amount of
error:
453 mg – 438 mg = 15 mg
Second, use the percentage of error equation to determine the percentage of error of the
measurement: (amount of error/quantity desired) × 100% =
(15 mg/453 mg) × 100% = 3.3% (The original scale was undermeasuring.)
6. To be consistent with USP 795 guidelines, the beyond-use dating for a nonaqueous
suspension of Magic Mouthwash is 6 months, or 25% of the remaining time of the ingredient
with the shortest expiration date. Because lidocaine 2% viscous has an expiration date of
12/10, the beyond-use dating of the nonsterile compound is 3 months, or 25% of the 12
months until the expiration of the lidocaine.
Pharmacy Practice for Technicians, Fourth Edition
© Paradigm Publishing, Inc.
Chapter Review Answer Keys, Chapter 6
Page 6
Communicating Clearly
1. a. levigate: a powder is mixed with an inert substance
b. punch method: empty gelatin capsules are punched into a layer of powder like a “cookie
cutter”
c. triturate: grinding or reducing particles in size
d. spatulation: using a spatula to blend ingredients together
e. diluent: an ingredient is added to the active ingredient to make it less concentrated
f. tumbling: a method to mix powders together in a closed container
g. solute: the substance dissolved in the solution (usually the active ingredient)
h. solvent: the substance that dissolves the solute (usually an inert ingredient)
i. geometric dilution: adding small portions of a potent ingredient together in several stages
to ensure uniform mixing
j. comminution: reducing particle size
2. Answers vary, but the technician’s explanation may include the fact that the physical time to
prepare the prescription may be 60 minutes or longer. This time is required because special
weighing techniques, equipment, and procedures must be used to ensure accuracy. In a
community pharmacy setting the pharmacist often requires a day to compound a prescription.
As a courtesy, the pharmacy should contact the patient by telephone when the medication is
ready to be picked up.
Researching on the Web
1. Answers vary widely. This is a wonderful site, with explicit instructions on how to perform
many compounding duties. This Web site has several years of review articles in PDF form
available to the student and instructor, including many recipes for compounding practice in
the laboratory for a variety of organ disorders.
2. The mission of PCAB is:
–to serve the public good by serving pharmacy, patients, and prescribers
–to organize and carry out a comprehensive program of voluntary accreditation in the
practice of pharmacy compounding
–to promote, develop, and maintain principles, policies, and standards for the practice of
pharmacy compounding in the public interest and to apply these in the accreditation of
pharmacies that offer pharmacy compounding to improve the quality and safety of pharmacy
compounding provided to the general public
–to offer to the public and prescribers a way to identify the pharmacies that satisfy
accreditation criteria on the practice of pharmacy compounding and to educate the public on
the importance of pharmacy compounding
3. Answers vary by state. If the answer is not in the state board of pharmacy laws and
regulations, then ask a compounding pharmacist what the standard of care is for pharmacy
technician involvement in this practice in your state.
Pharmacy Practice for Technicians, Fourth Edition
© Paradigm Publishing, Inc.
Chapter Review Answer Keys, Chapter 6
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