Like this study set? Create a free account to save it.

Sign up for an account

Already have a Quizlet account? .

Create an account

Factors Affecting Drug Stability

-dosage form
-ingredients used in a compound
-material of the container
-order and method of preparation

Physical Incompatibilities

-occur from changes in solubility -> change in color or precipitation
-change in pH of solution, use of buffers, type of solvent used create problems

Chemical Incompatibilities

-incompatibility may not be noticeable
-changes in pH/chemical decomposition may occur
-presence of light cause deterioration of ingredients
-IV medications are normally prepared using D5W except ampicillin, ampicillin-sulbactam, erythromycin, lactobionate, imipenem-cilastatin, & oxacillin which must be mixed with normal saline

Therapeutic Incompatibilities

-mixing together of 2 or more ingredients -> change in therapeutic response of the drugs

Procedures to Prepare Intravenous Admixtures

-flow hood on >30 min
-wear protective clothing
-clean laminar flow hood with 70% isopropyl alcohol or other disinfectant, pole to hang IV bags, sides of hood moving from back to front, bottom of hood moving side to side from back to front
-collect supplies. check expiration dates & bags for leaks. use presterilized needles, syringes, & filters
-position supplies in the hood
-sterilize puncture surfaces with alcohol wipe
-prevent coring by placing vial on flat surface, insert needle into rubber closure at 45-60 degree angle. Use downward pressure on needle & move needle to 90 degree angle

Using Vials With Solutions

-draw into syringe volume of air equal to amount of volume being replaced
-penetrate vial without coring
-invert vial upside down & fill syringe
-tap to bring air bubbles to top of syringe
-transfer solution to final container

Vial With Lyophilized Powder

-determine correct volume of diluent & withdraw it
-transfer diluent into vial with powder
-remove more air from vial than amount of diluent injected. Whirl vial until powder dissolves
-use new syringe & needle, proceed as if using a vial with solution

Using Ampules

-score neck of ampule with fine file if not already done so
-hold it upright & tap. wipe neck with alcohol swab
-wrap gauze around neck & gently snap neck
-insert & use filter needle to withdraw
-hold ampule downward at 20-degree angle & withdraw solution with filter syringe
-exchange old filter needle with new one & transfer solution into final container

Procedures To Prepare Chemotherapy Drugs

-same procedures as IV, with a few exceptions
-require vertical laminar airflow hood (smaller)
-special chemotherapy clothing is worn
-hands in vertical flow hood should not be over top of any needle, vial, or IV bag

Preparing Parenteral Antineoplastics

-safety cabinet work surface covered with plastic-backed absorbent paper (disposed of in biohazard container)
-personnel wear surgical gloves & closed-front surgical gown with knit cuffs
-reconstituted vials vented to reduce possibility of spraying/spillage
-sterile alcohol pledget wrapped around needle & vial top during withdrawal of solution
-external surfaces of syringes & IV bags (bottles) wipe clean of contamination
-when use ampules: wrap neck with sterile alcohol pledget to protect fingers
-syringes & IV bottles properly identified & dated (caution labels needed)
-safety cabinet wiped down with 70% alcohol on completion of compounding
-contaminated needles & syringes placed in sharps container. Disposable gowns, gloves, masks, head & shoe covers placed in red biohazard bags
-wash hands
-dispose of remaining antineoplastic agents according to regulations

Procedures To Prepare Total Parenteral Nutrition Solutions

-TPN: 50% dextrose, 10% amino acids, 20% fat
-aseptic technique require: TPN infused into right atrium of heart
-TPN compounders: include multichannel pump for amino acids, dextrose, fats, & other additives that connect to personal computer. Computer assists calculations & drives pump
-micro compounding pump used for electrolytes & other additives
-PPN (peripheral parental nutrition): 25% dextrose, 10% amino acids, 10% fat, short-term therapy
-TPN & PPN premixed from manufacturer but electrolytes, vitamins, & medications added to nutrients at pharmacy

Compounding Techniques

-Method 1: amino acids & dextrose mixed first. Add fat emulsion & then additives
-Method 2: amino acids added to fat emulsion. Add dextrose then additives
-Method 3: dextrose, amino acids, & fat emulsion added simultaneously while swirling & mixing. Add additives last

Procedures To Prepare Reconstituted Injectable and Noninjectable Medications

-reconstitution: mixing liquid & powder to form a suspension/solution
-measure solute & solvent (distilled water) to be used
-add solute to solvent in small portions & mix
-check precipitation for solutions or changes in color
-add new expiration date & affix a "shake well" auxiliary label

Procedures To Prepare Radiopharmaceuticals

-may be diagnostic/therapeutic; oral/IV/inhaled
-individual must wear meter indicating radioactive levels to which individual is exposed
-quality-control tests perform to ensure radiopharmaceutical is sterile, pyrogen-free, & pure
-proper handling of isotopes during preparation & disposal
-radiopharmaceuticals: prepare in vertical flow hood, strict packaging requirements (special shipping containers)
-safety principles of time, distance, & shielding
-special training completed if one is to work in a nuclear pharmacy

Procedures To Prepare Oral Dosage Forms

-Unit dose: provides medication in "final unit of use" form. Contained in small packet (made of thermal paper & foil laminate; other side of poly film material)
-machines are manually, semiautomatically, or automatically loaded
-single-drop machine: 60 packages/min
-double-drop machine: 120 packages/min
-machine drops drug into package, seals, & prints medication info in one operation

Procedures To Compound Sterile Noninjectable Products

Factors considered in preparing ophthalmic products:
-sterilzation: by autoclave, filtration, gas, radiation
-clarity: free from foreign particle (filtration)
-stability: affected by chemical nature of drug, pH, method of preparation, solution additives, & packaging
-Buffer & pH: should be formulated at 7.4 pH but rarely occurs. pH chosen should be optimum for stability
-Tonicity: osmotic pressure exerted by salts. Isotonic solution have tonicity = NaCl 0.9%
-Viscosity: agents used to prolong contact time in eye & enhance drug absorption & activity

Procedures To Compound Nonsterile Products

-blending: combing 2 substances
-comminution: reduce substance to small, fine particles
-geometric dilution: mixing 2 ingredients of unequal quantities (begins with smallest quantity & adds equal quantity of ingredient with larger amount)
-emulsifier: stabilizing agent in emulsions
-flocculating agent: electrolytes used in preparations of suspensions
-levigation: trituration of powder drug with solvent (drug is insoluble)
-mucilage: wet, slimy liquid formed as initial step in wet gum method
-pulverization by intervention: reduce particle size in solid with aid of additional material
-sifting: blend or combine powders
-thickening agent: ingredient used in preparation of a suspension to increase viscosity
-trituration: rubbing, grinding, pulverizing powder to create fine particles
-tumbling: combine powders in bag & shake

Weighing Procedures

-unlock balance, make sure it's level, relock
-place weighing paper on
-unlock scale & ensure it's balanced
-place weights on right-hand pans using forcep
-place material on left-hand pans
-release beam by unlocking balance
-lock balance before adding/removing additional powder
-unlock to check for equilibrium
-close lid & have pharmacist verity weight
-remove ingredient & remove weight with forceps

Measuring Using a Torsion Balance

-leave balance in draft-free area
-make sure bubble is inside bull's-eye & adjust using leveling feet
-place weighing boat/paper on pan
-press tare bar to compensate for weighing boat
-add ingredients

Procedure For Measuring Liquids

-choose proper size graduate (quantity to measure not <20% of total volume of graduate)
-pour liquid into graduate
-measure level of liquid at eye level & observe bottom of meniscus
-pour liquid into container

Procedure For Filling Capsules

-triturate ingredients to same particle size, mix using geometric dilution
-calculate enough for several extra capsules
-place powder on ointment slab where depth of powder is 1/2 length of capsule body
-hold capsule vertically & punch the open end into powder until it's filled
-place cap on capsule & weigh using empty capsule as counterweight
-add/remove ingredients as needed

-remove exact # of capsules from box
-wear finger cots to protect fingers
-roll capsules on clean towel to remove traces of drug
-place completed capsules in glass/plastic vial
-store in dry place


-contains 2 immiscible liquids; 1 dispersed throughout another & aided by stabilizing agent
-may be oil-in-water (O/W) or water-in-oil (W/O)
-Ex: continental, wet gum, & beaker method

Continental Method (Dry Gum Method)

-primary emulsion: 4 parts oil, 2 parts water, 1 part gum (emusifier-acacia)
-with Wedgwood or porcelain mortar, gum & oil levigate
-water added & trituration continues
-additional ingredients added up to initial volume with external phase

Wet Gum Method

-primary emulsion: formed by triturating 1 part gum & 2 parts water to form mucilage
-slowly add 4 parts oil & triturate slowly
-add additional ingredients

Beaker Method

-water-soluble & oil-solute ingredients mixed in separate containers
-both heated to 70 degrees C, removed heat
-internal phase added to external phase
-final product cooled to room temp. but continually sirred


-prepared through trituration & geometric dilution

Liquid Drug In Liquid Vehicle

-measure quantities of each liquid
-add drug to vehicle slowly
-shake & stir

Solid Drug In Liquid Vehicle

-weigh solid & measure solvent
-consider solubility of drug & solvent
-may need to heat gently, stir, or shake

Nonaqueous Solutions

-contain solvents other than water; include elixirs, tinctures, spirits, fluid extracts, glycerates, collodions, liniments, & oleaginous solutions
-dissolving alcohol-soluble ingredients in alcohol & & water-soluble ingredients in water
-add alcohol portion to aqueous portion & stir


-may be oleaginous, water soluble, hydrophilic
-compression mold: mix suppository base & drug ingredients. Force mixture into special mold
-fusion mold: active ingredients dispersed or dissolved in melted base. Suppository base melted at low temp. & drug dissolve in it. Base poured & overfilled into special mold (metal, plastic, or rubber) & left to harder. Excess material removed from top of mold


-solid drug to be suspended is weighed & levigated in mortar & pestle with alcohol or glycerin
-portion of vehicle added to mortar & mixed with levigated drug until uniform consistency occurs -> placed in final container
-mortar & pestle rinsed with balance of vehicle & suspension is added up to final volume with vehicle being used
-"shake well" label affixed to container
-flocculating & thickening agents may be used


-Heat Method: heat needs to be controlled, works fastest but not all ingredients can be used with heat
-Without Heat Method: must use container that's twice the size of final volume. syrup needs to be shaken/stirred

Procedures To Prepare Ready-To-Dispense Multidose Packages

Preparing Ointments:
-prepared on ointment slab
-weigh quantities of each ingredient
-use geometric dilution & 2 spatulas to mix
-transfer final product into ointment jar by spatula
-remove air pockets of ointment by spatula
-ointment bases chosen based on their characteristics to deliver a drug

Aseptic Techniques For Technicians

-no jewelry worn in hood (includes artificial nails)
-long hair tied back
-hands washed after entering IV area & before entering laminar flow hood
-hands, wrists, & arms to elbow wash with antimicrobial soap & hot water for 30-90 seconds
-gloves can be worn but wash down with 70% isopropyl alcohol after being put on
-surface of hood washed down with 70% isopropyl alcohol
-hood run 30< before medications placed in
-all vials & ports wiped down with alcohol, not sprayed
-hands or any object within hood cannot block airflow at any time
-work 6< inches into horizontal hood; keep pens & other objects out
-all needles, syringes, vials, & other by-products must be disposed of in proper receptacles
-no sneezing, talking, or coughing can be directed toward airflow in laminar flow hood

Universal Precautions

-apply to all individuals in any institution who may come in contact with blood, body fluids or substances
-latex gloves must be worn
-hands must be washed after removing gloves
-blood-soaked or contaminated materials disposed in wastebasket lined with plastic bag
-specially trained individuals must be notified for cleanup or removal of contaminated waste
-first-aid kit must maintained & adequately stocked for use if individual comes in contact with contaminated waste or body fluids.
-First-aid kit: adhesive bandages, alcohol, antiseptic or disinfectant, bleach, disposable latex gloves & towels, medical tape, sterile gauze, plastic bags for waste disposal

Requirements For Handling Hazardous Products and Disposing Of Hazardous Waste

-sharps containers for used syringes, needles, ampules, & vials. Needles should be clipped or snapped
-biohazard containers: other refuse like gloves, gowns, masks, shoe & head coverings, any clothing or linens that come in contact with body fluids

Documentation Requirements For Controlled Substances, Investigational Drugs, and Hazardous Wastes

-DEA Form 224: register a pharmacy with DEA to be able to stock controlled substances
-DEA Form 222: to order Schedule II drugs
-DEA Form 41: to destroy outdated or unused controlled substances
-DEA Form 106: to report theft of controlled substances
-power of attorney: authorizes a pharmacist to order Schedule II durgs

Pharmacy-Related Software For Documenting The Dispensing Of Prescriptions Or Medication Orders

-software customized to meet requirements of pharmacy
-outpatient dispensing software used to reduce errors, increase productivity, & perform inventory management
-impatient dispensing software: used to reduce staff, accessible to medical staff & regulates controlled substances, must interface with various computer systems in hospital.
-Hospitals use robotics possess capability of scanning unit-dose labels & filling patients' orders

Customer Service Principles

-customer satisfaction is the goal of customer service
-pharmacist called to handle any difficult situation
-technician listen carefully, make eye contact, repeat what customer had said, use positive language to emphasize what can be done rather the opposite.
-If using phone, maintain a pleasant & courteous manner, state name of pharmacy, his/her name, adhere to standard procedures est. by pharmacy, refer any questions requiring pharmacist's judgement to the pharmacist

Communication Techniques

-empathetic responses to customer
-nonverbal communication
-phone skills
-verbal communication
-writing skills

Patient Confidentiality Requirements

-HIPAA requires any personally identifiable info be protected as being confidential
-patients allowed to access & request copies of their medical records & entitled to complete discussion of health care options from health care provider (can request confidentiality)
-health care provides & organizations must provide written statement that states how medical info will be handled
-every organization must have a written privacy procedure

Cash-Handling Procedures

-technician may be required to ring into cash register Rx & other purchases
-should accept & count payment within sight of patient
-etc... common sense

Average Wholesale Price (AWP) Applications

-form or reimbursement: AWP plus/minus percentage plus dispensing fee
-most commonly used & encourages pharmacy to dispense generic medications bc percentage of return is greater for generic than brand-name


-actual acquisition cost
-price pharmacy actually paid for medication after receiving any discounts
-may be used instead of AWP


-maximum allowable cost
-maximun price insurance company will pay for generic medication

Capitation Fee

-reimbursement system
-pharmacy receives fixed payment each month per patient, regardless of # of Rx filled or cost of Rx filled
-commonly used by health maintenance organizations (HMOs)


-set amount that must be paid by patient for each benefit period before insurance will cover additional expenses

Per Diem

-predetermined amount of money paid to an individual/institution for daily service


-fixed: patient pays fixed/set dollar amount
-percentage: fixed percentage of total cost of Rx
-variable: different dollar amount charged based on type of drug dispensed; could be for lifestyle drug, nonformulary drug, or medication with DAW2 code
-DAW2 code: indicates prescriber has authorized use of generic medication but patient has requested brand-name medication

Health Maintenance Organization (HMOs)

-purpose: keep patient healthy, control costs by mandating generic usage
-composed of network of providers employed by HMO or signed contracts with HMO
-expenses not covered outside network unless referral has been made

Preferred Provider Organization

-network of providers contracted by insurer that offers most flexibility to patient
-costs outside network may be partially reimbursed
-do not require physician within network to make referrals

Point Of Sale

-network of providers under contract by insurer
-patients required to choose a primary care physician & obtain referral from primary care physician for services outside network


-federally funded program for individuals 65<, disabled individuals <65, & patients with kidney failure


-federally funded program administered by states
-states determined eligibility & services rendered
-Rx drug formularies used, not all drugs covered

Patient Assistance Programs

-special programs offered by pharmaceutical manufacturers for patients with specific needs who may be unable to afford their medication

Worker's Compensation

-federal & state laws require compensation for patients who have been accidentally injured on the job
-Rx for medications from injury are billed to state bureau of workers' compensation or employer

Legal Requirements For Pharmacist Counseling Of Patient or Patient's Representative

-offer to counsel must be made for every patient
-counseling: name & description of medication, dosage form, route of administration, duration of drug therapy, action take if dosage missed, common side effects, interactions & contraindications, self-monitoring for drug therapy, Rx refill info, proper storage, & special directions

Please allow access to your computer’s microphone to use Voice Recording.

Having trouble? Click here for help.

We can’t access your microphone!

Click the icon above to update your browser permissions and try again


Reload the page to try again!


Press Cmd-0 to reset your zoom

Press Ctrl-0 to reset your zoom

It looks like your browser might be zoomed in or out. Your browser needs to be zoomed to a normal size to record audio.

Please upgrade Flash or install Chrome
to use Voice Recording.

For more help, see our troubleshooting page.

Your microphone is muted

For help fixing this issue, see this FAQ.

Star this term

You can study starred terms together

Voice Recording