Lesson 3 - Other Practice Settings Assignments Answer Key

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1 Lesson 3 - Other Practice Settings Assignments Answer Key Assignments 1 - Case Study Review the Case Study on page 413 of the Pharmacy Technician Practice and Procedures textbook. Then answer the following question. What should Andrew know before he goes on his first interview? Answer: Andrew should look at the requirements for each position that have been posted for each job. He should become familiar with the knowledge base required for each position and compare it to what he has learned from his classes. Andrew may wish to look at the skills that he has developed through his classes, externship, and previous work experience. Assignments 2 - At Your Service Review the At Your Service scenario on page 413 of the Pharmacy Technician Practice and Procedures textbook. Then answer the following question. Andrew informs Mary Ellen of the situation and she would like to know how she is able to obtain a 90-day supply. What should Andrew tell her? Answer: Andrew should ask the customer if her insurance plan has a mail-order pharmacy to use. If her plan does, he should inform her that she can receive a 30-day supply from the retail pharmacy today if she needs the medication immediately. If she does obtain a 30-day supply from the pharmacy, recommend that she explain to her physician that she needs a new prescription written as a 90-day supply to be mailed to her mail-order pharmacy. If she does not have the prescription filled the same retail pharmacy, she can mail the prescription to her mail-order pharmacy. Assignments 3 - Critical Thinking 1. How would you explain to a current pharmacy customer the advantages of mail-order pharmacy? Possible answer: Let them know it is more convenient as they would not have to leave their home to pick up their medication. A mail-order pharmacy has the advantage of providing a cost savings to the patient, which enables the patient to purchase a larger quantity of medication in terms of day s supply compared to a community pharmacy. Mail-order pharmacies are open year round 24 hours a day, 7 days a week and a Pharmacist is always available to talk to. The patient would also receive electronic notification reminders to refill their prescriptions. 2. Why do managed-care organizations need to use a formulary system? Possible answer: In order to manage costs. It is used to promote high-quality medical care that is affordable to patients. 3. Will the need for long-term care facilities increase or decrease in the future? Why? Possible answer: The need for long-term care facilities will increase in the future because of the growing aged population. These facilities meet all the needs of disabled individuals

2 that require greater care. Some are also federally funded making them more easily accessible for the lower income patient. Assignments 4 - HIPAA Scenario Gale Johnson of Austin, Texas, received a package from her mail-order pharmacy. She was expecting her maintenance prescription for legend drug glyburide. Instead, she received a box for a natural hormone replacement therapy (vaginal skin cream) with a label for a patient named Gail Johnston. The packaging label had Gale Johnson s correct name and address but the prescription container had the incorrect name and wrong medication. If this medication had been shipped to Gail Johnston of Houston, Texas, then it would have gone to the right patient. Discussion Questions 1. What HIPAA laws were broken, if any? 2. What is the ethical thing for the patient to do? 3. What should the pharmacist or director of pharmacy do? 4. What other ethical questions does this raise? Answers: After medications are placed in dispensing containers by pharmacy technicians and checked by pharmacists, mail-order pharmacies packaging label the majority of labeled prescription containers in shipment boxes by automation. However, some items, such as liquid, syrups, delicate glass items, special compounded items, and controlled substances, our hand-packed and labeled for shipment by technicians were the personnel. In this case, the technician for a pharmacist placed the medication for the patient with a similar name in a shipment box, but placed the wrong address label on it. It is also possible that a technician scrolled to the wrong patient name and selected it, thereby generating a label with the wrong patient address for this particular prescription medication. Either way, HIPAA confidentiality laws are broken. Assignments 5 - Internet Activities 1. Go to to determine what type of products can be purchased. Can prescriptions be refilled? Are OTCs available? If so, what type? Is a VIPPS pharmacy? Possible answer: At CVS online they provide optical and photo service as well as carry a wide variety of products online. Some examples of items for purchase include: Vitamins Baby & infant care items Beauty supplies Diet & Nutrition supplies Household items Personal Care items Sexual Health items Skin Care Products

3 Prescriptions can be refilled. And OTC medications are available as well. They have a variety of Herbals, Minerals, Multivitamins, Supplements and Vitamins from A to Z available for purchase. CVS is a VIPPS pharmacy. 2. Go to a managed care pharmacy website such as and find out what type of services it offers. Possible answer: They offer services such as ordering prescriptions, helping you understand your plan and benefits, they find ways for you to save on prescriptions and they teach you about different medications. You can learn what medications may interact with one another or what might be better to take in a certain situation. There is also support by a Pharmacist when needed. They also have mail-order forms which can be accessed right from the site and printed out. Assignments 6 - Apply Your Knowledge 1. In most situations, managed-care organizations will reimburse a retail pharmacy only for a 30-day supply of a medication. How would you handle a patient who presents you with a prescription for a 90-day supply of medication and three refills? What would you say to the patient if he or she questions receiving only a 30-day supply? Possible answer: Let the patient know that their insurance company only covers for a 30- day supply at a time, unless they have mail-order coverage and then they could order a 90-day supply from a mail-order pharmacy. If they need the medication right away tell them to take the 30 day supply and then submit the remaining prescription to a mailorder pharmacy so they could be provided with the 90 day supply for the remainder of the refills. 2. Which type of pharmacy practice interests you the most and why? Possible answer: Working in a mail-order pharmacy as it s an organized type of system. Mail-Order pharmacy offers a lot of varied tasks and is very structured. This would be a great start to entering the Pharmacy Technician field as you are dealing with basic medications no parenteral meds etc. so you can get familiar with different aspects of the basic tasks before moving on to something a little more in depth. 3. What special skills are necessary for a pharmacy technician to practice in a home infusion pharmacy? Possible answer: They must be able to prepare an IV solution and must possess excellent aseptic technique. They must have experience with computerized pharmacy systems and using both IV manual and automated equipment. They must have knowledge of medical terminology, pharmaceutical dosage forms, and nomenclature. They need to be familiar with pharmacy calculations involving dosages, dilutions, flow rates, and meq and they need to know and understand the pharmacology of medications being used. They also have to have knowledge on the following topics: Knowledge of both federal and state pharmacy laws affecting home infusion (i.e., OBRA-90, FDA Safe Medical Device Act of 1990, usage of Category II medications in home infusion patients). Comprehension of OSHA requirements involving home infusion pharmacy. Knowledge of TJC regulations affecting home infusion pharmacy.

4 Knowledge of proper documentation and record-keeping requirements for home infusion pharmacy. 4. Identify 5 long-term care facilities in your community and find out who provides medications for their patients. Answer: Answers will vary depending on location. 5. Are technical or interpersonal skills more important for someone who is working for a pharmacy manufacturer? Why? Possible answer: If you are working in the sales and marketing departments of the manufacturer than definitely interpersonal skills are important. You have to be able to present the drug in such a way that the clients will want to stock and sell it. This is how the pharmacy manufacturers stay in business without their sales and marketing team they cannot promote their drugs in order to justify the cost of making them. 6. Identify and list 6 medications found in an emergency box or crash cart in a long-term care facility. Why would these medications be needed? Possible answer: Analgesics relieve pain + Inflammation, i.e. Tylenol Antibiotics - for treatment of infection i.e. quinolones, penicillin Anticoagulants to prevent blood clots & strokes, i.e. Coumadin, Heparin Anticonvulsants used in the treatment of epileptic seizures and can also aid in severe mood changes, i.e. Depakote, Depakene Hyperglycemic agents Controls high blood sugars, i.e. Humulin, Novolog Hypoglycemic agents Treatment of low blood sugars, i.e. Dextrose 7. Identify the roles of all the practitioners in preparing home infusion medications. Possible answer: A pharmacy technician working in an infusion environment orders and maintains appropriate stock levels of IV drugs and supplies in compliance to contracts. He/she assists with the proper accounting and transfer of IV pharmaceuticals to infusion therapy and oncology cost centers. A technician works cooperatively to identify the special needs or changing demands in drugs and medical supplies. The technician maintains appropriate logs and cleaning records of biomedical (pumps) equipment and arranges for preventative maintenance and inspects and maintains the necessary records as required by the FDA Safe Medical Devices Act of The technician may assist in various quality assurance procedures including the laminar flow hood cleaning, repairs, and inspection to include biological laboratory testing. He or she may be accountable for maintaining the cleanliness of the admixture machinery and keeping the IV room properly stocked with supplies. The pharmacy technician may arrange the packing, shipping, and delivery or the pickup of home infusion products, and coordinates the efficient operation of the IV admixture service. He or she may be asked to take part in the aseptic training of new pharmacy trainees. A home infusion pharmacy is responsible for the proper preparation, storage, and distribution of medication and supplies. It is the responsibility of the pharmacist to ensure that stability, compatibility, and safety of injectable medications are maintained.

5 8. What are the advantages and disadvantages of managed care? Possible answer: The advantages of managed care are that the organizations both insure and provide health care services. While a disadvantage is it could be costly for those not receiving federal funding from either Medicare or Medicaid. 9. Which type of co-payment (fixed or percentage) is best for the customer? For the pharmacy? Answer: A managed care pharmacy collects a copayment fee from the patient and bills the remainder of the cost to the insurer. This copayment may be in the form of a fixed or percentage copayment. A fixed copayment is a predetermined fee for either a brand or generic drug. A percentage copayment is based upon predetermined percentage of the reimbursement formula. The percentage copayment is an incentive for the patient to request a generic medication. In some situations the patient is charged a higher copayment if a non-formulary lifestyle medication is dispensed. If a patient requests a brand name medication when the physician has approved the use of a generic drug, the patient maybe charged copayment for what is associated with a brand name drug. A fixed co-payment would be better for the patient so that could get a brand name drug if they chose to without worrying about the additional costs. For the Pharmacy I would think the fixed payment would be better as well than they know exactly what is being charged for a drug regardless of whether generic or brand. 10. Who benefits from a drug formulary the patient, the pharmacy, or the PBM? Why? Possible answer: The use of a drug formulary benefits all of these as it helps control costs for all concerned. For the Pharmacy if they find a certain drug is not covered under a patient s drug plan the formulary can help them find one that might be and have the doctor prescribe it instead, keeping their customers happy and making the medication more affordable. The patient saves because they are not forced to take a medication that may be prescribed but is not covered under their drug benefit if there is a suitable replacement on the drug formulary that is covered. And it helps the PBM manage the prescription drug benefit. Assignments 7 - Practice Your Knowledge Goal - To identify skills that are necessary for a pharmacy technician to be successful in a longterm pharmacy. Assignment Visit and identify the various career opportunities available for pharmacy technicians. What is the role of the pharmacy technician in each of these positions? Do you possess the necessary skills and knowledge to work in a long-term care pharmacy? If not, what areas should you focus on? Answer: Answers will vary depending on available positions.

6 Assignment 8 - Pharm Facts Research 1. Use Drug Facts and Comparisons or the PDR to complete the following table. Answers: Brand Name Advair Generic Name Salmeterol, Fluticasone Propionate Therapeutic Classification Beta2- agonist/corticosteroid Ambien Zolpidem Tartrate Imidazopyridine hypnotic Augmentin Clavulanate Potassium, Amoxicillin Aminopenicillin/beta lactamase inhibitor Avonex Interferon beta-1a Biological response modifier Dosage Forms Metered Dose Inhaler, Disk Tablets Tablet: extended release, scored Injection Biaxin Clarithromycin Macrolide Suspension, Tab, Ext-Rel. Tab. Combivir Zidovudine, Lamivudine Nucleoside reverse transcriptase inhibitor Cordarone Amiodarone HCl Class III antiarrhythmic List Two Indications of the Medication Asthma, COPD Insomnia, Other sleep problems Pneumonia, Acute bacterial sinusitis Multiple sclerosis, decrease frequency of exacerbations Tonsilitis, Sinusitis List Three Adverse Effects of the Medication Upper respiratory Tract Infection, bronchitis, cough Drowsiness, Dizziness, Headaches Diarrhea, loose stools, nausea Headache, Dizziness, Nausea Diarrhea, Rash, Headache Tablet HIV. Hepatitis Myopathy, Headache, Fever Tablet Detrol LA Tolterodine Tartrate Muscarinic antagonist ER Capsule, Tablet Dilantin Phenytoin Sodium Hydantoin Capsules, Infatabs, Susp. Ventricular fibrillation, Ventricular tachycardia Overactive bladder, Urination leakage Grand mal seizures, Temporal lobe seizures Duragesic Fentanyl Opioid analgesic Patch Chronic pain, Cancer Efudex Fluorouracil Antimetabolite Cream, Solution Focalin Dexmethylphenidate HCl Sympathomimetic amine Multiple actinic, Solar keratoses Fatigue, Constipation, tremor Dry mouth, Dizziness, Headache Slurred speech, Confusion, Dizziness Constipation, Headache, Abdominal Pain Burning, Crusting, Irritation Tablet ADD, ADHD Abdominal pain, Fever,

7 Imuran Azathioprine Purine antagonist antimetabolite Lexapro Escitalopram Oxalate Selective serotonin reuptake inhibitor Lovenox Enoxaparin Sodium Low molecular weight heparin Lupron Leuprolide Acetate Synthetic gonadotropinreleasing hormone analog Maxalt- MLT Tablet Solution, Tablet Injection, Syringe Injection Rizatriptan Benzoate 5-HT1B/1D agonist Tablet, Disintegratin g Tab. Renal homotransplantati on, Rheumatoid Arthritis Anxiety, Depression Deep Vein Thrombosis, Pulmonary embolism Prostatic Cancer, Endometriosis Migraine, Pain OxyContin Oxycodone HCl Opioid analgesic CR Tablet Pain from Arthritis, Cancer Procrit Epoetin Alfa Erythropoiesis stimulator Protonix Pantoprazole Proton pump Sodium inhibitor Strattera Atomoxetine HCl Selective norepinephrine reuptake inhibitor Injection, Injection, Susp., Tabletdelayed release Tegretol Carbamazepine Carboxamide Susp, Tablet, Chew-Tab, ER Tab Wellbutrin Bupropion HCl Aminoketone Tablet, SR tab, Xopenex Levalbuterol Tartrate Beta2-agonist Anemia, Iron & Blood transfusions GERD, Heartburn Nausea Malignancy, Infections, Hematologic toxicities Insomnia, Fatigue, Diarrhea Hemorrhage, Anemia, Fever Headache, Hot flashes, General pain Dry mouth, Nausea, Dizziness Constipation, Dizziness, Dry mouth Cough, Rash, Headache Headache, Diarrhea, Abdominal pain Capsule ADHD, ADD Abdominal pain, Headache, Dry mouth Metered Dose Inhaler Seizures, Nerve pain Depression, Smoke cessation Bronchitis, Asthma Dizziness, Drowsiness, Liver dysfunction Dry mouth, Excessive sweating, Blurred vision Vomiting, Dizziness, Pain

8 2. For each drug from the table choose which types of pharmacies (from the list below) that may stock these drugs for their patients. Retail Pharmacy = RP Hospital Pharmacy = HP Long-Term Care Pharmacy = LTCP Mail-Order Pharmacy = MOP Federal Pharmacy = FP Answers: Advair = All pharmacies Ambien = HP, RP, LTCP Augmentin = HP, RP, FP Avonex = HP, RP, LTCP Biaxin = HP, RP Combivir = HP, RP, LTCP Cordarone = HP, LTCP Detrol LA = All pharmacies Dilantin = HP, LTCP Duragesic = HP, LTCP, RP Efudex = RP, MOP, LTCP Focalin = RP Imuran = HP, RP Lexapro = HP, RP, FP Lovenox = HP, LTCP Lupron = HP, LTCP Maxalt-MLT = HP, RP, FP OxyContin = HP, RP, LTCP Procrit = HP, LTCP Protonix = All pharmacies Strattera = RP Tegretol = HP, RP, FP, LTCP Wellbutrin = HP, RP, FP Xopenex = RP, MOP, FP Assignment 9 - Calculation Corner A physician orders 50 ml of D10W that contains ampicillin 1.25 million units. The IV is to be infused over 30 minutes. How many units of ampicillin will the patient have received after 15 minutes? Answer: This problem can be solved using proportions. Step 1: Set up a proportion 1.25 million units = X units 30 minutes 15 minutes Step 2: Cross-multiply (1.25 million units) (15 minutes) = (30 minutes) (X units)

9 Step 3: Divide both sides of the equation by 30 minutes: (1.25 million units) (15 minutes) = (30 minutes) (X units) 30 minutes 30 minutes Step 4: X= 625,000 units