Download some drugs. - LaGuardia Community College Pharmacy

Pharmacy Technician Certification
Exam : Knowledge statements and
Study Guide
 The following are thesis and topics covered in class but
are commonly easily forgotten for the test
 Information in this powerpoint presentation was
gathered from previous exams and some other test
material by me
 Used the information here to supplement the
knowledge you gained in class
Medications that require special
handling
 Nitroglycerin, Nitroprusside, Paclitaxel, and Fat
Emulsions and amiodarone require IV infusion set that
don’t have PVC or DHEP plasterizer.
 Nitroprusside is light sensitive and the IV bag and IV
set should be cover with a light opaque medium
 Pradaxa (Dabigatran) is a anticoagulant used in place
of warfarin for many condition. FDA in 2011 requires
that the pharmacist dispense drug in the orginal
container and the bottle be dated 60 days after
opening
Medications that require
refrigeration storage
Generic (Brand)
Indication
Interferon 1B (Betaseron) IV vials
Multiple Sclerosis
Erthyromycin/Benozyl Peroxide
(Benzamycin ) Gel
Acne
Alprostadil (Caverject) Vials
Erectile Dysfunction
Estradiol/norethinedrone Patchs
(Combipatch)
Contraception
Desmopressin (DDAVP) IV vials
Diabetes insipidus
Etanercept (Embrel) vial kits
Various Autoimmune diseases
Erythropoetin (Procrit, Epogen)
RBC disorders
Generic (brand)
Indications
Human Insulins
Diabetes Mellitus
Human Growth Hormone (Humatrope) Dwarfism, short stature in children
Lopinavir/Ritonovir (Kaletra oral sol)
HIV infection
Saquinavir (Fortovase) capsules
HIV infection
Salmon Calcitonin (Miacalcin) nasal
sypray
Osteoporosis
Octreotide (Sandostatin)
Various endocrine disorders
Erthyromcyin Ethyl Succinate oral soln
(EES oral solution)
Bacterial infections
Ribavirin/Interferon (Rebetron)
HBV infections
Etoposide (Vepeside) capsules
Cancer
Chlorambucil (Leukeran) tablets
Cancer
Teriparatide (Forteo)
Bone osteoporosis
Medication that must be Frozen for
storage
Generic (Brand)
Indication
MMR (measles, mumps and Rubella)
vaccination
Varivax (Varicella Zoster vaccine)
vaccination
Most refrigerated medications should be refrigerated
by the patient while taking at home. The most notable
exception are insulin products, they may be keep at
room temperature by the patient and they must be
dated with a 28 day expiration from date vials are open
Medication that cause
photosensitivity in Patients
 It’s the responsibility of the pharmacist to advise patients using these drugs to
wear protect clothing when in the day sunlight and using these drugs
 This reaction does not always happen but when it does may cause a severe sun
burn type reaction
Generic
Brand
Doxycycline and other
Tetracycline drugs
Various
Sulfonamide drugs
Various
Retinoids
Accutane and others
Sulfonylureas (Glipizide)
Glucotrol
Diuretics (Furosemide and
HCTZ)
Lasix and Hydrodiuril
Dapsone
Various
Outdated Medication Warning
 Remember that expired tetracycline products are
unsafe.
 Expired tetracycline products can cause Fanconi’s
syndrome, a disorder of the kidney that can produce
dangerous electrolyte abnormalities in patients
 When in doubt, discard these medications
Processing Rx orders
 No federal law states that a technician can not receive a
phoned in Rx; however some state prohibit this for phoned
in new prescriptions
 DAW codes helps insurance companies determine
reimbursements for drugs
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DAW code are universal for all payers
DAW 0 means generic product
DAW 1 means MD wants brand
There are actually up to 8 codes, the DAW 5 code means
pharmacist selects brand but is willing to accept generic
reimbursement
 One of the most important elements on the dispensed
product label is the initials of the pharmacist
 All new patients to your pharmacy it is important to give
them a copy of the HIPPA notice of privacy practices and to
document that the patient received it; same holds true for
doctor’s offices
 Medicare Modernization Act of 2003 established the MTM,
Medication therapy management
 Intent was to reduce health care costs due to poor use of
medication by patients
 Pharmacists to help discover these problems and fix them
 Allows for billing of insurance for these services by
submitting CPT codes
 Insurance company use CPT code for billing (Current
procedural terminology)
Assisting the pharmacist with
Insurance issues
 Medicare
 Government insurance for those over 65
 Patients young that 65 with certain disabilities
 Any age patient with end stage renal disease
 Part A=hospital
 Part B= office
 Part C= Medicare advantage
 Part D= Rx drug coverage
 Part D was signed into law in 2003
 Provide Rx coverage to seniors
 Premium depends on plan
 All plans have coverage up to $2,830/year after which the patient covers all the
cost of the drug
 After the patients reaches $4,550 in cost, Plan D kicks in a catastrophic Rx
coverage where it pays 100% of the cost
 This gap is called the “donuthole”
 Affordable Care Act of 2010 (Obamacare)
 Provides financial relief to needy patients that fall into the
“donuthole”
 One time $250 rebate in 2010
 50% reduction in cost of some drugs. The savings are counted
towards the donuthole
 7% discount on other drugs in the Part D
 Medigap Insurance
 Some patients have medicare and medicare supplemental
private insurance plans as secondary insurance
 Medicare is the primary insurance, always bill medicare first
for any pharmacy related service; if medicare does not pick up
all the cost then charge the balance to the secondary
insurance
Medicaid
 Government health insurance for needy people,
pregnant women, teenagers, individuals who are
legally blind
 State splits the cost with the federal government
 After a pharmacy submits a claim, we are paid at the
MAC (maximum allowable cost) which is based on
U&C’s (usual and customary costs publish by the drug
companies)
Other government programs
 Worker’s Compensation
 A worker injured on the job and that requires
prescription medications will have no copay for drugs
 Pharmacy files paperwork with employer to the state
and federal governments
 TRICARE is the health insurance plan that services
uniformed armed services men and women
 CHAMPVA (civilian health and medical program of
the veteran administration) is insurance for
permanently disable veterans and their family
members
Adjudication Denial Codes
 When a pharmacy claim is rejected it could be because of
 Refill too soon
 Expired coverage
 Prescribed quantity exceed limits of insurance plan
 The most annoying are
 NDC not covered which means that insurance will not pay for
the drug who selected to fill the Rx; fix is to try another
generic with a different NDC
 Prescriber not covered: patient’s MD is not a part of the
insurance network; patient need to change MD or pay for
drug.
 US FDA publishes the Orange Book
 Orange Book publishes ratings data on drug therapeutic
equivalence between drugs
 For drugs to be consider therapeutically equivalent, they
must have a rate of AB or better
 Drugs that have B ratings are not therapeutically
equivalent and substitution between them is not
permitted
FDA restricted drugs
 Some drugs have strong side effects such that the FDA
mandate special rules in the marketing of these drugs
 Prior to 2007,FDA restricted drug program was called
RiskMAP, risk mitigation action plans
 After 2007 the new standards are called REMS, risk
mitigation evaluation and mitigation strategies
 For some drugs the REMS involves distributing PPI
with each script (Oral Contraceptives, Hormone
products (Estradiol), Accutane, and Inhaler products);
others involve drug manufacturer to set up registries of
patients, prescribers and pharmacies
REMS Special programs
Drug
REMS
Special requirements
Fentanyl Transmucosal Systems
(Actiq)
Transmucosal Immediate Release
Fentanyl (TIRF) REMS
Registration of wholesalers and
pharmacies to dispense products
Accutane (Isotrenoin)
I Pledge REMS
Patient and Prescribers must be
enrolled, Female patients must
have a negative pregnancy test
and use two forms of birth
control, Pharmacies must
enrolled to order
Avandia products
Rosiglitazone Medicines Access
Program
Prescibers/patients must enroll
and only specialty pharmacies
stock it
Clozapine
Clozaril National Registry
Prescribers and patients must be
enrolled; must provide ANC and
WBC count to pharmacy,
pharmacy must enroll to order
Procrit and Epogen and Aranesp
APPRISE REMS
Prescribers must enrolled in
program, patient must sign form
to understand the risks
Alosetron (Lotronex)
PPL (Prescribing program for
lotronex)
Prescribers must enroll, patients
must sign form, pharmacy to
dispense with PPL sticker on RX
Paperwork requirements
 If pharmacy wants to file a claim to Medicare for
pharmacy services and/or durable medical equipment
(DME) must use paper claim form, CMS 1500
 DEA 222 for ordering CII drugs must be attached to
invoice and filed for 2 years (Federal law). ALL
controll substance invoices are saved for 2 years
 All outpatient prescriptions for controlls must be
saved for 2 years, after the date of last filling
Rotation of Pharmacy stock
 Rotate medications with the longer expiration behind
those with the earliest medications on the shelf
 With controlled substances, Federal law says if you
group controlled substances together you must keep
them in a locked area (like a locked cabinet). If you
don’t want to lock the drugs, you must scatter the
drugs among your regular stock. Lock or scatter-your
choice
Commercially Prepared dehydrated
powder medications for oral use
 Products: Amoxicillin, Augmentin, Clindamycin,
Zithromycin, and may other antibiotics
 Once mixing these antibiotics with water: a 14 day
expiration is used under refrigeration
 Exceptions: Augmentin (amoxicillin/clavulunate
potassium) and Biaxin (clarithromycin) are both 10 days
 Remember these, very common
Radiopharmaceuticals
 Nuclear pharmacy provides radiopharmaceutical for use of
imaging, and therapy of cancer
 Examples: Indium 111 capromab for prostate cancer
imaging, Iodine 131 for thyroid cancer, and strontium 89 for
metastatic cancer bone pain
 In general preparation requires use of a BSC cabinet of type
3. This BSC is completely enclosed, often called “glove box”
BSC.
 Distance and speed principle is followed, aseptic technique
is performed fast and with tongs (for distance) to minimize
exposure to pharmacy personnel
Storage
 Federal law defines the following:
 Room temperature= 59-86 F or 15-30 C
 Refrigeratored temperature= 36-46 F or 2-8 C
 Freezer temperature= below 32 F or 0 C
Extemperaneous Compounding
 Pharmacy makes a unique product dose form for a specific
patient, i.e acetaminophen 2% cream
 USP 795 (not 797) says that expiration dating for these
products should not exceed 25% of the time remaining
among the manufacturer drug product or six months into
the future which ever is earliest
 Any product where water is add to a solid dosage form is
given 14 days under refrigeration unless published data
state otherwise
 Gelatin capsules come in sizes from 000 to 13.
 00o is the largest size
 13 is the smallest size
Prepacking and Unit dose systems
 Helps in inventory management in hospitals
 Prepacked and unit dose blister cards by law are
permitted to be return to inventory upon return
 Expiration dating are one of two systems
 50% of the expiration date on the manufacturer drug or 1
year whichever is sooner (my hospital uses this)
 USP 795 guideline: 25% or six months whichever is
sooner
Combat Methamphetamine Act of
2005
 Products containing ephedrine or pseudoephedrine
 Pseudoephedrine products include: Pseudofed, formally in
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DayQuil and Nyquil
Used to make illegal crystal meth or “ice” on the street
Currently ephedrine based diet pills (uses outside allergy,
asthma, and traditional chinese use) are banned by the FDA
(since 2006).
Aside these, all these products are kept behind the counter in the
pharmacy.
A log book must be keep
ID is required to be verified by the pharmacist
No more than 3.6 grams/day for any one person
No more than 9 grams/month for any one person
Medications that should not be
prepacked (unit dose)
 The standard unit dose prepackage machine as a mechanical dial that
rotates between metal plates that are heated to high temperatures.
Oral dose forms are placed on the dial and the metal plates seal the
blister pack material around the medication with heat
 Some medications should not be prepacked with a standard machine
because the machine will become contaminated with dust particles
from these drugs
 At times a dedicated machine can be used for some of these drugs
 Common highly allergic potential drugs include:
 Penicillins, Cephalosporins, sulfa drugs
 Moisture Sensitive medications
 Pyridostigmine (Mestinon)
 Prasugrel (Effluent)
 Emtriva
 Most orally melting tablets : Risperdal M
 Capsules
 Most gelatin capsules will melt when exposed to heat
 Ritonovir
 Omega 3 Fatty Acids capsules
 Chemotherapy drugs and Teratogenic drugs
 Chlorambucil (Leukeran)
 Cyclophosphamide (Cytotaxan)
 Cyclosporin (Gengraf)
 Bosentan (Tracleer): Pregnancy category X
 In general, always inquire about the pregnancy rating and the cytotoxic
potential of drugs before you are asked to prepack anything. (especially
if you are a woman of childbearing potential)
 For a more complete listing visit:
 http://www.ashp.org/s_ashp/docs/files/MedNO_unit-
dosedpackage.pdf