Free PTCE Exam Flashcards

Brand name: manufacturer's proprietary name (Tylenol). Generic name: official nonproprietary name (acetaminophen). Generics are bioequivalent to brand, typically cheaper. DAW (Dispense As Written) means brand only.

Grouping drugs by similar characteristics. Examples: Antihypertensives (lower BP), Antibiotics (fight bacteria), Analgesics (pain relief), Anticoagulants (prevent clots). Know common suffixes: -olol (beta blockers), -pril (ACE inhibitors).

DEA classifications: Schedule I (no medical use, high abuse—heroin), II (high abuse potential—oxycodone, Adderall), III (moderate—Tylenol with codeine), IV (low—benzodiazepines), V (lowest—cough syrup with codeine).

Using capital letters to distinguish look-alike drug names. Examples: hydrOXYzine vs hydrALAZINE, predniSONE vs prednisoLONE. Prevents medication errors. FDA's Name Differentiation Project recommends it for certain drug pairs and asks manufacturers to adopt it voluntarily.

Drugs where small dose changes cause significant effects. Examples: warfarin, digoxin, lithium, phenytoin, theophylline. Require careful monitoring. Generic substitution may need prescriber approval.

Drugs with heightened risk of causing harm. Include: insulin, opioids, anticoagulants, chemotherapy, concentrated electrolytes (KCl). Require independent double-checks and special storage/handling.

10-character identifier for prescribers. Format: 2 letters + 7 digits. First letter indicates type (A/B/F = physician, M = mid-level). Check digit formula: add 1st, 3rd, 5th digits + (2 × sum of 2nd, 4th, 6th). Last digit matches.

Required for ordering Schedule I and II controlled substances. Since October 30, 2021 it is a single-sheet paper form: the purchaser keeps a copy and sends the original to the supplier, who keeps it. Can be replaced by electronic ordering through CSOS.

Initial inventory required when opening. Biennial (every 2 years) inventory required. Schedule II: exact count. Schedules III-V: an opened container may be estimated unless it holds more than 1,000 tablets or capsules (then exact count). Keep records 2 years minimum.

Schedule III-V: refill information may be transferred one time between pharmacies; pharmacies sharing a real-time online database may transfer up to the maximum refills (21 CFR 1306.25). Schedule II: no refills to transfer, but an unfilled electronic Schedule II-V prescription may be transferred once between retail pharmacies for initial dispensing (21 CFR 1306.08(e)). Transfers are pharmacist to pharmacist; document both pharmacists and both pharmacies.

Federal: no time limit for filling a Schedule II prescription, but the pharmacist must confirm it is still needed (state law may set one). Schedules III and IV: no more than 5 refills, within 6 months of the date issued, whichever comes first. Many states set their own limits. Check state law.

Health Insurance Portability and Accountability Act. Protects patients' protected health information (PHI). Requires safeguards for PHI and the minimum necessary use and disclosure.

The '5 Rights' (expanded to 9): Right patient, drug, dose, route, time, documentation, reason, response, and right to refuse. Verify at each step.

When one drug affects another's action. Types: Synergistic (enhanced effect), Antagonistic (reduced effect), Additive (combined effect). Example: Warfarin + aspirin = increased bleeding risk. Check interactions before dispensing.

Former FDA categories: A (safe), B (animal studies safe), C (risk unclear), D (evidence of risk), X (contraindicated). Now replaced by narrative labeling describing risks. Still appear on older drug references.

FDA's strongest warning, bordered in black on labeling. Indicates serious or life-threatening risks. Examples: Fluoroquinolones (tendon rupture), SSRIs in youth (suicidal thoughts), Opioids (addiction/overdose).

FDA-required safety program for high-risk drugs. May include: medication guides, patient registries, prescriber certification, dispensing restrictions. Examples: isotretinoin (iPLEDGE), opioid analgesics. FDA removed the clozapine REMS effective June 13, 2025.

Medications with similar names or packaging that can be confused. Examples: Celebrex/Celexa, metformin/metronidazole, Zyrtec/Zyprexa. Prevention: Tall Man lettering, separate storage, barcode verification.

1 kg = 1000 g = 1,000,000 mg. 1 L = 1000 mL. 1 g = 1000 mg = 1,000,000 mcg. Weight: 1 kg = 2.2 lb. Volume: 1 tsp = 5 mL, 1 tbsp = 15 mL, 1 oz = 30 mL.

Formula: Total quantity dispensed ÷ Daily dose. Example: 90 tablets, take 1 tablet TID (3x daily). Days supply = 90 ÷ 3 = 30 days. Important for insurance billing and refill timing.

Formula for diluting solutions. C1 × V1 = C2 × V2. Example: Dilute 70% alcohol to 30%. How much 70% needed for 500 mL of 30%? 70 × V1 = 30 × 500, V1 = 214 mL of 70%, add water to 500 mL.

Calculating how to mix two different strengths to get desired concentration. Draw tic-tac-toe grid. Higher strength top left, lower bottom left, desired middle. Subtract diagonally. Ratio of parts needed.

Formula: Dose = Weight (kg) × mg/kg/day. Convert pounds to kg first (÷ 2.2). Example: Patient 154 lb, dose 5 mg/kg/day. Weight = 70 kg. Daily dose = 70 × 5 = 350 mg/day.

Formula: (Volume × Drop factor) ÷ Time (min) = drops/min. Or Volume ÷ Time (hours) = mL/hr. Example: 1000 mL over 8 hours = 125 mL/hr. Drop factor is drops/mL (commonly 10, 15, 20, or 60).

Abbreviations for directions. Common: QD (daily), BID (twice daily), TID (three times), QID (four times), PRN (as needed), AC (before meals), PC (after meals), HS (at bedtime), PO (by mouth).

Dispense As Written codes for insurance. DAW 0: no preference. DAW 1: prescriber requests brand. DAW 2: patient requests brand. DAW 3-9: various substitution scenarios. Affects reimbursement.

Insurance requirement for approval before dispensing certain medications. Usually for expensive or restricted drugs. Pharmacy submits clinical information. Can take 24-72 hours. Patient may pay cash while waiting.

National Drug Code: 10-digit identifier for medications. Format: 4-4-2, 5-3-2, or 5-4-1. First segment: labeler. Second: product. Third: package size. Used for billing, inventory, and verification.

Legal requirements: Patient name, prescriber name/address/phone, drug name/strength/quantity, directions, date written, prescriber signature. Controlled substances also need DEA number and may require patient address.

Electronic Prescription for Controlled Substances. Requires: certified software, identity proofing, two-factor authentication. Reduces fraud and errors. SCRIPT standard used.

Standards for non-sterile compounding. Covers potency, stability, packaging, labeling, quality control. Requires: trained personnel, appropriate equipment, written procedures, proper documentation, beyond-use dating.

Standards for sterile compounding. The 2022 revision replaced the low-, medium- and high-risk levels with Category 1, 2 and 3 CSPs, set mainly by the conditions where they are made and how long they may be used. Requires classified rooms or a segregated compounding area, a primary engineering control, garbing, and environmental monitoring.

Standards for handling hazardous drugs (HD). Covers receiving, storage, compounding, dispensing, administration, disposal. Requires: negative pressure room, closed system devices, special PPE, medical surveillance.

Date after which compounded preparation should not be used. Different from manufacturer expiration. Non-sterile (USP <795>, 2022): 14 days refrigerated for nonpreserved aqueous, 35 days preserved aqueous, 90 days nonaqueous oral liquids, 180 days other nonaqueous. Sterile (USP <797>, 2022): set by CSP category and storage; Category 1 is no more than 12 hours at room temperature or 24 hours refrigerated.

Provides an ISO Class 5 work area for sterile compounding. Horizontal: HEPA-filtered air flows from the back toward the operator. Vertical: air flows down onto the work surface. Sterile hazardous-drug compounding uses a containment PEC (C-PEC) such as a BSC or CACI (USP <800>). ASHP guidance: work at least 6 inches inside the front edge and never block first air.

Practices maintaining sterility during compounding. Includes: proper garbing (shoe covers, gown, gloves, mask, cap), hand washing, hood cleaning, never blocking airflow, checking for particles/leaks, proper syringe technique.

Lot number: manufacturer's batch identifier for recalls. Expiration: last date product can be dispensed/used. Check monthly. First In First Out (FIFO): dispense oldest stock first. Never dispense expired products.

Class I: Serious adverse effects or death possible. Immediate removal. Class II: Temporary or reversible effects. Class III: Not likely to cause harm. All require documentation and notification.

Verify order against invoice. Check quantities, lot numbers, expiration dates, drug integrity. Controlled substances require DEA 222 (C-II) or electronic CSOS. Refrigerated items: verify cold chain maintained.

Returning unclaimed prescriptions to inventory. Typically after 10-14 days. Must verify integrity, proper storage, not expired. Controlled substances have specific procedures. Document and reverse billing.

Strategies: barcode scanning, independent double-checks, Tall Man lettering, separate LASA drugs, automated dispensing, patient counseling. Report errors through incident reports. Focus on system improvements, not blame.

Method to identify underlying cause of errors. Asks 'why' repeatedly until root cause found. Focuses on systems/processes, not individuals. Goal: implement changes to prevent recurrence.

Copay: fixed amount per prescription. Deductible: amount patient pays before insurance kicks in. Coinsurance: percentage patient pays (e.g., 20%). Understanding helps explain costs to patients.

Process when patient has multiple insurance plans. Primary insurance billed first, secondary covers remainder. Birthday rule for dependents: parent with earlier birthday in year is primary.

Common insurance rejections: 75 (prior auth required), 76 (plan limits exceeded), 79 (refill too soon), 88 (DUR reject—drug interaction). Each requires different resolution. Check patient profile and contact insurance.

Lower cholesterol by inhibiting HMG-CoA reductase. Examples: atorvastatin (Lipitor), simvastatin (Zocor), rosuvastatin (Crestor). Monitor liver function. Avoid grapefruit (some statins).

Lower blood pressure by blocking angiotensin-converting enzyme. Examples: lisinopril, enalapril, benazepril. Side effects: dry cough, hyperkalemia. Contraindicated in pregnancy. Avoid with ARBs.

Lower BP and heart rate by blocking beta receptors. Examples: metoprolol, atenolol, carvedilol. Avoid abrupt discontinuation. Can mask hypoglycemia symptoms. Use caution in asthma.

Reduce stomach acid by blocking proton pumps. Examples: omeprazole (Prilosec), pantoprazole (Protonix), esomeprazole (Nexium). Take 30-60 min before meals. Long-term use: B12 deficiency, bone fracture risk.

Antidepressants that increase serotonin. Examples: sertraline (Zoloft), fluoxetine (Prozac), escitalopram (Lexapro). Take 4-6 weeks for full effect. Black box warning for suicidal thoughts in youth. Serotonin syndrome risk with other serotonergic drugs.