MOSBY's Pharmacy Technician. Principles and Practice

Preface
List of Illustrations
List of Tables
Section One. Pharmacy Practice
1. History of medicine and pharmacy
Scenario
History of medicine
Ancient beliefs and treatments
The medical staff
The evolution of medicine
Scenario checkup 1.1
Eighteenth- and nineteenth-century medicine
Twentieth-century medicine
Advances in drug therapy and vaccinations
Are old remedies making a comeback?
History of pharmacy
Early pharmacists
Early pharmacy in America
Changing pharmacy requirements
Scenario checkup 1.2
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Technician’s corner
Bibliography
Websites referenced
2. Pharmacy law, ethics, and regulatory agencies
Scenario
US food and drug administration history
Early activity of the US food and drug administration
Description of laws
1906 Pure Food and Drug Act
1914 Harrison Narcotics Act
1938 Federal Food, Drug, and Cosmetic Act
1951 Durham-Humphrey Amendment
1962 Kefauver-Harris Amendments
1970 Comprehensive Drug Abuse Prevention and Control Act (also known as the Controlled Substances Act)
1970 Poison Prevention Packaging Act
1972 Drug Listing Act: National Drug Code
1983 Orphan Drug Act
1987 Prescription Drug Marketing Act
1990 Omnibus Budget Reconciliation Act
1996 Health Insurance Portability and Accountability Act
Scenario checkup 2.1
Patient confidentiality
Scenario checkup 2.2
Food and drug administration and drug enforcement administration
Controlled substances
Ratings of scheduled (controlled) substances
Scenario checkup 2.3
Drug monographs
1. Indications and usage
2. Dosage and administration
3. Dosage forms and strengths
4. Contraindications
5. Warnings and precautions
6. Adverse reactions
7. Drug interactions
8. Use in specific populations
9. Drug abuse and dependence
10. Overdosage
11. Description
12. Clinical pharmacology
13. Nonclinical toxicology
14. Clinical studies
15. References
16. How supplied/storage and handling
17. Patient counseling information
Boxed warning
MedGuides
Pregnancy categories
Prescription regulation
Who can prescribe?
Who can receive a prescription?
Prescription labels and prescription orders
Special labeling and record-keeping considerations
Veterinary medications
Repackaging
Drug enforcement administration verification
Child-resistant packaging
Special prescribing programs
Programs for opioid maintenance
Risk management programs for prescription drugs
Pharmacy sites
Brick-and-mortar and mail-order pharmacies
Occupational safety and health administration
Safety data sheets
The joint commission
Legal standards
State laws
Liabilities
Scenario checkup 2.4
Ethics and morals in the workplace
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Technician’s corner
Bibliography
Websites referenced
3. Competencies, associations, and settings for technicians
Scenario
Historical data
The pharmacy technician career
Competencies
State and national boards of pharmacy
Scenario checkup 3.1,
Nondiscretionary duties
Basic nondiscretionary skills
Inpatient setting requirements
Scenario checkup 3.2
Community (outpatient) setting requirements
Closed-door pharmacy requirements
Scenario checkup 3.3
Training programs for the pharmacy technician student
Different levels of pharmacy technicians
National certification for technicians
The national healthcareer association
Specialty certifications
Continuing education
Opportunities for technicians
Incentive programs
Professional technician associations
American pharmacists association
American society of health-system pharmacists
American Association of Pharmacy Technicians
National community pharmacists association
National pharmacy technician association
The society for the education of pharmacy technicians
Professionalism in the workplace
Professional dress
The resume
The job search
The future of pharmacy technicians is bright!
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Scenario follow-up
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Bibliography
Websites referenced
4. Communication and role of the technician with the customer/patient
Scenario
Communication
The communication cycle
Nonverbal communications
Verbal communication
Optimize your communication
Scenario checkup 4.1
Telephone etiquette
Virtual communication etiquette
Written communication skills
Communications with special patient groups
Scenario checkup 4.2
Communication with the health care team
Eliminating communication barriers
Conclusion
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Bibliography
Websites referenced
5. Dosage forms and routes of administration
Scenario
Where did pharmacy abbreviations originate?
“Do not use” list
Dosing instructions
Scenario checkup 5.1
Classifications of medications
Classifications of drug sales
Dosage forms
Solids
Liquids
Scenario checkup 5.2
Semisolids
Routes of administration
By mouth (oral)
Rectal agents
Topical agents
Parenteral: Intravenous, intravenous piggyback, intramuscular, and subcutaneous agents
Eye, ear, nose (ophthalmic, otic, nasal)
Scenario checkup 5.3
Inhalants
Injectables
Miscellaneous routes
Other considerations: Form and function
Pharmacokinetics and pharmacodynamics
Absorption
Distribution
Metabolism
Scenario checkup 5.4
Elimination
Bioavailability
Half-life
Bioequivalence
The use of excipients
Manufactured products
Packaging and storage requirements
Medical terminology
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Bibliography
Websites referenced
6. Conversions and calculations
Scenario
History of pharmacy calculations
Roman numerals
Rules for determining roman numerals
 Example 6.1 working with roman numerals
 Exercise 6.1 quick check
International time (military time)
 Exercise 6.2 quick check
Temperature conversion between fahrenheit and celsius
Fahrenheit to celsius
 Example 6.2
Celsius to fahrenheit
 Example 6.3
 Exercise 6.3 quick check
Basic math skills
Fractions, percentages, ratios, and proportions
 Exercise 6.4 quick check
 Practice quiz 6.1
 Exercise 6.5 quick check
Working with word problems
 Example 6.4 single-step ratio and proportion problem
Dimensional analysis
 Example 6.5 dimensional analysis
 Example 6.6 dimensional analysis
 Exercise 6.6 quick check
Measurement systems
Metric system
 Exercise 6.7 quick check
Household measurements
 Example 6.7
 Example 6.8
 Exercise 6.8 quick check
Apothecary system
 Example 6.9
 Example 6.10
 Exercise 6.9 quick check
Avoirdupois system
 Exercise 6.10 quick check
 Practice quiz 6.2
Important differences among systems
Calculations with liquid medication
 Example 6.11 single-step proportion problem
 Example 6.12 single-step proportion problem
 Example 6.13 multiple-step dimensional analysis problem
 Example 6.14 dimensional analysis
 Exercise 6.11 quick check
Calculating the proper dose using body weight
 Example 6.15
 Exercise 6.12 quick check
Calculating body surface area
 Exercise 6.13 quick check
Oral and injectable syringes
Pediatric and geriatric dosing
 Example 6.16
Calculations involving units and milliequivalents
 Example 6.17
 Example 6.18
 Example 6.19
 Exercise 6.14 quick check
 Scenario checkup 6.1
Subcutaneous injections
Intramuscular injections
Intravenous medications
 Example 6.20
 Exercise 6.15 quick check
 Example 6.21 calculating infusion rates and drip rates
 Example 6.22
 Exercise 6.16 quick check
Percentage and ratio strengths
 Example 6.23 using ratio and percentage
 Example 6.24
 Example 6.25 using dimensional analysis
 Exercise 6.17 quick check
Dilution
 Example 6.26
 Example 6.27
 Exercise 6.18 quick check
Total parenteral nutrition
 Example 6.28
 Example 6.29
Scenario checkup 6.2
Alligation alternate
 Example 6.30
 Exercise 6.19 quick check
 Practice quiz 6.3
Business calculations
Percentages of quantities
 Example 6.31
 Example 6.32
 Example 6.33
 Example 6.34
 Example 6.35
 Exercise 6.20 quick check
 Practice quiz 6.4
Scenario checkup 6.3
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Bibliography
7. Drug information references
Scenario
Researching a drug
References used in pharmacy
Drug facts and comparisons
Physicians’ desk reference
Drug topics red book
Approved drug products with therapeutic equivalence evaluations: The orange book
The purple book: A compendium of biological and biosimilar products
American hospital formulary service drug information
United states pharmacopoeia–national formulary
United states pharmacists’ pharmacopeia
Clinical pharmacology and other gold standard/elsevier products
Ident-A-Drug
Scenario checkup 7.1
Micromedex healthcare series
Trissel’s handbook on injectable drugs
American drug index
Goodman & gilman’s the pharmacological basis of therapeutics
Handbook of nonprescription drugs
Martindale: The complete drug reference
Remington’s pharmaceutical sciences: The science and practice of pharmacy
Pediatric and neonatal dosage handbook
Geriatric dosage handbook
Pocket-sized reference books
Scenario checkup 7.2
Electronic referencing
The internet
Journals and news magazines
Scenario checkup 7.3
Additional types of information
Considerations when choosing a reference
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Bibliography
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8. Community pharmacy practice
Scenario
Scenario checkup 8.1
Role of the pharmacy technician
Prescription
Prescription information
Prescriber information
Patient information
Date
Superscription
Inscription
Subscription
Scenario checkup 8.2
Signatura (signa or sig)
Prescription processing
Intake
Data input
Drug utilization evaluation
Scanning the prescription
Prescription labeling
Auxiliary labels
Patient product information
Scenario checkup 8.3
Prescription preparation
Scanning the manufacturer’s bottle
Packaging the prescription
Checking the prescription
Filing prescriptions
Prescription payment
Scenario checkup 8.4
Other pharmacy technician duties
Prescription refilling
Requesting prescription refill authorization
Transferring a prescription
Scenario checkup 8.5
Pharmacy layout
Prescription intake window
Pharmacy bench
Pharmacy stock area
Nonsterile compounding area
Sterile compounding area
Pharmacy order check-in area
Reconstitution area
Repackaging area
Pharmacy records
Patient bins
Prescription pick-up window
Consultation area
Drive-through window
Scenario checkup 8.6
Communication
Interacting with the pharmacist
Interacting with the patient
Elderly patients
Customer service
Scenario checkup 8.7
Other pharmacy services
Immunizations
Medication therapy management
Synchronization of medications
Durable and nondurable supplies and equipment
Long-term care services
Wellness and disease prevention
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Bibliography
Websites referenced
9. Institutional pharmacy practice
Scenario
Types of hospitals
Hospital pharmacy settings
Hospital pharmacy standards and procedures
Policies and standard operating procedures
Hospital protocol
Pharmacy and nursing staff relationship
Regulatory agencies
Scenario checkup 9.1
Hospital orders
Flow of orders
Point-of-entry systems
Institutional pharmacy technicians
Specialty tasks
Scenario checkup 9.2
Patient cassette drawers and/or pyxis machines
Automated dispensing systems
Unit dose medications
Controlled substances
Scenario checkup 9.3
Intravenous preparations
Nonhazardous intravenous preparation
Scenario checkup 9.4
Labeling
Scenario checkup 9.5
Central supply
The future of the US health care system
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Bibliography
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10. Additional pharmacy practice settings and advanced roles for technicians
Scenario
Advanced or specialized pharmacy technician opportunities
Inventory and purchasing agent
Medication reconciliation technician
Prior approval or investigational drug coordinator
Managed care pharmacy technician
Scenario checkup 10.1
Pharmacy technician educator or trainer
Pharmaceutical sales representative
Nuclear pharmacy technician
Scenario checkup 10.2
Remote/telepharmacy technician
Pharmacy informatics
Lead pharmacy technician
Medication adherence or compliance technician
Future opportunities for the pharmacy technician
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11. Bulk repackaging and nonsterile compounding
Scenario
Bulk repackaging
Bulk repackaging equipment
Bulk repackaging techniques
Documentation
Scenario checkup 11.1
Labeling and checking bulk repackaged medications
Storage and stability
Expiration dates and beyond-use dating
 Example 11.1: beyond-use dating
Scenario checkup 11.2
Long-term care packaging
Nonsterile compounding
History
Use of nonsterile compounding
Determining beyond-use dating for nonsterile compounds
Compounding area
Equipment
Additional supplies
Personal preparation
Measuring liquids
Preparing solutions
Reconstituting premade suspensions
Solids: Tablets, capsules, and lozenges
 Example 11.2: hard lozenge formula
 Example 11.3: soft lozenge formula
 Example 11.4: chewable lozenge formula
Semisolids
 Example 11.5: soft opaque stick formulation
 Example 11.6: soft clear stick formulation
 Example 11.7: Hard stick formulation
Scenario checkup 11.3
Nasal preparations: Ointments, suspensions, gels, and solutions
Packaging
Stability
Documentation
Scenario checkup 11.4
Safety
Compounding professionalism
Regulatory and quality control
Veterinary medications
Personnel training
Compounding calculations
 Example 11.8: Increasing a formulation’s quantity
 Example 11.9: Reducing (decreasing) a formulation’s quantity
 Example 11.10: Reducing a formulation’s quantity
 Example 11.11: Determining partial dosage units
 Example 11.12: Changing stock solutions
 Example 11.13: Mixing products of different strengths
 Example 11.14: Performing solubility expressions
 Example 11.15: Converting units to weights
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12. Aseptic technique and sterile compounding
Scenario
Terminology used in pharmacy
Standard precautions for a health care worker
Scenario checkup 12.1
Supplies
Syringes
Needles
Filters
Stock levels
Routes of administration
Medication delivery systems
Piggyback containers
Continuous analgesic delivery systems
Patient-controlled analgesia syringe system
Patient-controlled analgesia cassette system
United States Pharmacopeia <797>
History of united states pharmacopeia <797>
Sections of United States Pharmacopeia <797>
Categories of CSPs levels
Requirements for compounding
Intravenous environment
Primary engineering controls
Aseptic technique
Hand placement
Use of ampules to prepare medications
Scenario checkup 12.2
Vials
Scenario checkup 12.3
Parenteral antibiotics and solutions
Hyperalimentation
Scenario checkup 12.4
Electrolytes and additives
Compatibility considerations of parenteral medications
Components of a label for intravenous medication
Disposal
Chemotherapeutic agents
Spills
Scenario checkup 12.5
Education and training
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13. Pharmacy billing and inventory management
Scenario
Formulary and drug utilization
Generic versus trade name drugs
Types of private and group medical insurance plans
Health maintenance organization
Scenario checkup 13.1
Preferred provider organization
Government-managed insurance programs
History of medicare and medicaid
Current use of medicare and medicaid insurance
Medicare
Scenario checkup 13.2
Medicaid
Other government medical insurance plans: TRICARE and CHAMPVA
Workers’ compensation
Third-party billing
Point of sale billing
Prior authorization
Scenario checkup 13.3
Patient profiles
Processing claims
Claim problems
Coverage expiration policy for drugs
Limitation of plan exceeded
Handling nonformulary drugs or noncovered national drug codes
Filling a prescription too soon
Nonidentification match
Scenario checkup 13.4
Resubmitting rejected claims
Plan limitations
Other methods of payment
Self-pay
Drug discount cards or drug coupon cards
Private plans
Health savings account and flexible spending account
Inventory management
Pharmacy stock
Inventory control technician
Ordering process
Special orders
Bar coding
Automated dispensing systems
Manual ordering
New stock
Proper storage
Returns
Suppliers
Special considerations
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14. Medication safety and error prevention
Scenario
Overview
Five rights of medication safety
What constitutes an error?
Types of medication errors
Scenario 1: Misinterpretation of physician’s orders
Scenario 2: Missed dose
Scenario 3: Wrong patient
Scenario 4: Adverse effect
Scenario 5: Noncompliance
Responsibility for errors
Case study 1
Case study 2
Case study 3
Where errors are made
Why errors occur
Stress
Distraction
Multitasking
Look-alike, sound-alike drugs
Scenario checkup 14.1
Risk evaluation and mitigation strategies
Look-alike drug names and tall man lettering
Drug labeling
Excessive workload
Drug interactions as a source of error
Warfarin interactions
Errors in the pharmacy
Errors related to patient care
Health care–associated infections
Home health care errors
Age-related errors
Medication errors and the elderly
Medical errors and pediatric patients
Scenario checkup 14.2
Medication errors that involve allergies
Parenteral errors
Sustained-released dosage form errors
Necessity of reporting errors
Pharmacist’s daily routine
Computerized prescription order entry
Reporting errors
Strategies for reducing errors
Common pharmacy technology
Bar codes
Scenario checkup 14.3
Robot-Rx machines
Hospital pharmacy automated dispensing system machines
Community pharmacy automated dispensing systems
Patient dose-specific orders
United states pharmacopeia <797> regulations
Medication reconciliation
Quality assurance practices and risk management
Risk management
Other considerations
Training and education
Conclusion
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References
Bibliography
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15. Pharmacy operations management and workflow
Scenario
Overview
Community pharmacy
Case study 1
Case study 2
Case study 3
Case study 4
Institutional pharmacy
Case study 5
Improving efficiency techniques
Getting started
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Section Two. Pharmacology and Medications
16. Drug classifications
Classifying drugs
Brand versus generic versus chemical names
Tall man lettering in brand and generic medications versus the use of generic prefixes, suffixes, and infixes
The tall man letters can be identical to the generic name stem
The tall man letters can be different from the generic name stem
Tall man letters intentionally appear in brand names, but generic name stems do not
Medication characteristics
Drug trials
Four phases of drug testing
Anatomy, physiology, pharmacology, pharmacodynamics, and pharmacokinetics
Pharmacokinetics: ADME
Pharmacodynamics
Drugs and receptors
Agonists and antagonists
Therapeutic index
Drug interactions
Other drug effects
Therapeutic agents for the nervous system (Chapter 17)
Therapeutic agents for the endocrine system (Chapter 18)
Therapeutic agents for the musculoskeletal system (Chapter 19)
Therapeutic agents for the cardiovascular system (Chapter 20)
Therapeutic agents for the respiratory system (Chapter 21)
Therapeutic agents for the gastrointestinal system (Chapter 22)
Therapeutic agents for the renal system (Chapter 23)
Therapeutic agents for the reproductive system (Chapter 24)
Therapeutic agents for the immune system (Chapter 25)
Therapeutic agents for eyes, ears, nose, and throat (Chapter 26)
Therapeutic agents for the dermatologic system (Chapter 27)
Therapeutic agents for the hematologic system (Chapter 28)
Drug classifications by drug enforcement administration schedules I, II, III, IV, and V
Schedule I
Schedule II
Schedule III
Schedule IV
Schedule V
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17. Therapeutic agents for the nervous system
Nervous system introduction
Neurons
Nerve transmission
Central nervous system
Brain
Spinal cord
Cranial nerves
Peripheral nervous system
Autonomic system
Somatic system
Conditions of the nervous system and their treatments
Diseases and conditions of the peripheral nervous system
Diseases and conditions of the central nervous system
Other conditions associated with the nervous system
Schizophrenia
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18. Therapeutic agents for the endocrine system
Anatomy of the endocrine system
Description of hormones and glands
Structure and function of hormones
Mechanism of action
Functions of the endocrine glands
Hypothalamus
Pituitary gland
Pineal gland
Thyroid gland
Parathyroid glands
Adrenal glands
Pancreas
Ovaries
Testes
Conditions of the endocrine system and their treatments
Conditions of the pituitary gland and hypothalamus and their treatments
Conditions of the thyroid gland and their treatment
Conditions of the parathyroid glands and their treatment
Conditions of the adrenal glands and their treatment
Endocrine conditions of the pancreas and their treatments
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19. Therapeutic agents for the musculoskeletal system
Anatomy and physiology of the skeletal system
Anatomy and physiology of skeletal muscle
Common conditions affecting the musculoskeletal system
Osteoarthritis
Osteoporosis
Gout
Other select medication classes that affect the musculoskeletal system
Skeletal muscle relaxants
Neuromuscular blockers
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20. Therapeutic agents for the cardiovascular system
Anatomy of the heart and vasculature system
Oxygenation
Cardiac conduction system
Regulation of the heart and vasculature
Common medication classes used to treat cardiac conditions
Angiotensin-converting enzyme inhibitors
Angiotensin II receptor antagonists
Entresto
Renin inhibitors
Beta-blockers
Calcium channel blockers
Conditions affecting the cardiovascular system
Common conditions
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21. Therapeutic agents for the respiratory system
Structure and function of the respiratory system
Upper respiratory system
Lower respiratory system
Respiration
Gas exchange
Disorders and conditions of the respiratory system
Conditions of the upper respiratory system
Conditions of the lower respiratory system
Lung cancer
Cystic fibrosis
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22. Therapeutic agents for the gastrointestinal system
Form and role of the gastrointestinal system
Anatomy and physiology of the gastrointestinal system
Ingestion
Absorption
Excretion
Auxiliary organs
Conditions affecting the gastrointestinal system
Conditions mainly associated with the stomach
Conditions mainly associated with the intestines
Miscellaneous conditions of the gastrointestinal system
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23. Therapeutic agents for the renal system
Anatomy and physiology of the renal and urologic systems
Function of the kidneys
Nephron function
Importance of electrolytes
Conditions affecting the renal and urologic systems
Common conditions associated with the renal and urologic systems
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24. Therapeutic agents for the reproductive system
Female reproductive system
Conditions affecting the female reproductive system
Common conditions
Male reproductive system
Conditions affecting the male reproductive system
Common conditions
Sexually transmitted diseases
Hepatitis C
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25. Therapeutic agents for the immune system
Anatomy and physiology of the immune system
Bone marrow
Thymus
Spleen
Cells and mediators of the immune system
The inflammatory response
Autoimmune disorders
Transplant rejection
Immunizations
Vaccine types
Storage of vaccines
Antitoxins and antivenins
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26. Therapeutic agents for eyes, ears, nose, and throat
The eyes (ophthalmic system)
Anatomy and physiology of the eye
Vision
Conditions that affect the eye
Common conditions
The ears (auditory system)
Anatomy and physiology of the ear
Common conditions affecting the ear
Nose and sinuses
Anatomy and physiology of the nose and sinuses
Common conditions affecting the nose and sinuses
The throat
Common conditions affecting the throat
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27. Therapeutic agents for the dermatologic system
Anatomy and physiology of the dermatologic system
Skin
Hair and nails
Glands
Common conditions affecting the dermatologic system
Dermatologic conditions affecting the skin
Common dermatologic conditions affecting the scalp and hair
Common dermatologic conditions affecting the nails
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28. Therapeutic agents for the hematologic system
Anatomy and physiology of the hematologic system
Major components of blood
Conditions affecting the hematologic system
Common conditions
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29. Over-the-counter medications
US food and drug administration regulations
How a prescription drug becomes an over-the-counter drug
Patient perceptions and safety of OTC medications and herbal supplements
Common routes of administration for over-the-counter drugs
Over-the-counter pain relievers and antipyretics
Over-the-counter allergy treatments
Over-the-counter products to treat cough and cold symptoms
Over-the-counter products for insomnia
Gastroesophageal reflux disease and indigestion
Over-the-counter products for nausea and vomiting
Over-the-counter agents for other gastrointestinal conditions
Miscellaneous over-the-counter products for skin-related conditions
Considerations for special populations
Restricted over-the-counter products
Urinary incontinence (overactive bladder)
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30. Complementary and alternative medicine
What is complementary and alternative medicine?
FDA regulation of dietary supplements
Medical food
Types of complementary and alternative medicine
Natural products
Mind and body medicine
Manipulative and body-based practices
Other complementary and alternative medicine practices
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Appendix A: Top 200 prescription drugs
Appendix B: Top herbal remedies
Glossary
Index

Get everything you need to prepare for a successful career as a pharmacy technician in one easy-to-read textbook! Useful from day one through graduation, Mosby's Pharmacy Technician: Principles and Practice, 7th Edition, includes comprehensive information on pharmacy practice, anatomy and physiology, math calculation, and pharmacology. Built from the ground up to map directly to American Society for Health-System Pharmacists (ASHP) accreditation competencies and to the accepted certification exams, this approachable text covers everything from processing and handling of medications and medication orders to patient safety, quality assurance, and regulation and compliance. It also features a rich art program with equipment close-ups, clinical procedures and processes, and body system illustrations that bring the content to life and visually reinforce your understanding of key concepts. With its clear writing, expert insight, and engaging study tools, this text will help you develop a solid foundation in the pharmacy content you need to pass the board examination and launch a successful and rewarding career.

• NEW! Content covers the latest information on telehealth, virtual patient communication, infection protection, and medications.
• EXPANDED! Additional information addresses non-sterile and sterile compounding and foundational math calculations.
• Comprehensive coverage of pharmacy practice, A&P, and pharmacology support classroom success and board exam preparation.
• Built from the ground up to map to the latest ASHP accreditation standards and competencies.
• Step-by-step illustrated procedures offer rationales for key skills and competencies.
• Study practice includes review questions at the end of each chapter, exam-review appendix with sample questions, and review questions online.
• Real-world problem-solving is emphasized in scenario boxes throughout the text.
• Mini drug monographs provide essential drug information summaries and photos for commonly prescribed medications.
• Tech Notes and Tech Alerts offer practical tips for on-the-job accuracy and efficiency.