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
