CphT Rx Study     Last updated on 2010     1     29, a full moon day;

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Global CphT

phT calculation no. 58:

For treating glaucoma, topical carbonic anhydrase inhibitors are available such as Dorzolamide Hydrochloride 2% ophthalmic solution aka Trusopt vs. Brinzolamide 1% ophthalmic suspension aka Azopt:

(a) "SHAKE WELL prior to use" is not necessary by Dorzolamide 2%
(b) Dorzolamide 2% provides lower incidence of blur-vision than Brinzolamide 1%
(c) In common, suspension requires "SHAKE WELL" before use
(d) All of the above

Answer: All of the above;


phT calculation no. 34:

Common interactions are adverse drug reaction, drug diet interaction, drug drug interaction, ... ; Concerning drug diet interaction, CphT should inform to patient that while taking iron the patient should also take
(a) water (b) orange juice (c) milk (d) soda

Drug diet interaction of iron and orange juice causes efficient bioavailability;

Answer: orange juice;


phT calculation no. 33:

Common interactions are adverse drug reaction, drug diet interaction, drug drug interaction, ... ; Concerning drug diet interaction, CphT should inform to patient that while taking tetracycline the patient should not drink
(a) water (b) orange juice (c) milk (d) soda

Drug diet interaction of milk and tetracycline causes deficient bioavailability;

Answer: milk;


phT calculation no. 32:

Drug's dose can be administered by % AND rate. So, within the time period, the drug reaches into body's circulation systematically, aka
(a) antibody (b) bioavailability (b) generic equivalence (c) systematic therapy

Actual drug inside of body's circulation [because of absorption "input", because of drug-drug reactions [IFF reaction exists, actual drug is lesser than the drug's dose], because of excretion "output such as urine, ... ", ... ]; aka bioavailability;

Answer: bioavailability;


phT calculation no. 31:

KCl and NaCl are:
(a) electrolytic agent (b) electrolytic capacitor IFF blocks light (c) cardiovascular electrode (d) kinetic energy

Even though other choices are relatively true ... ;

Answer: electrolytic agent;

phT calculation no. 30:

Generic name amoxicillin's drug-classification is:
(a) anti-diabetic (b) anti-infective (c) electrolytic (d) psychotropic

Drug can be either brand OR generic. Classifications of common drugs are:
analgesic [pain management],
anesthetic [insensitive],
anti-diabetic [diabetes],
anti-infective [against infection aka anti-biotic],
anti-neoplastic [cancer, chemo*],
cardiovascular [heart related],
dermatological [skin related],
electrolytic [energy related electrolyte cells are KCl, NaCl, ...],
gastrointestinal [GI, stomach & intestine],
musculoskeletal [muscle & bone],
psychotropic [mental health],
respiratory [inhale/exhale, lung],
... ;

Answer: anti-infective aka anti-biotic;


phT calculation no. 27:

Cytotoxic drug is
(a) antibiotic (b) antihypertensive (c) antidiarrheal (d) antineoplastic;

Drug names and classes such as chemical, generic, trade aka brand name, classes such as antibiotic, antihypertensive, antineoplastic [cancer chemotherapy drug, cytotoxic drug, ... ], cardiovascular aka CV, depressant vs. stimulant, narcotic vs. analgesic, psychotherapeutic [mental health], ... ;


Answer: antineoplastic;


phT calculation no. 41:

anti-neoplastic drug might cause another cancer, by its adverse drug reaction, aka
(a) Idiosyncrasy effect (b) GI effect (c) CNS effect (d) carcinogenicity effect

Answer: carcinogenicity;


phT calculation no. 42:

Before dispensing drugs, e.g. amino-glycoside + gentamicin + ibuprofen may cause
(a) Nephro-toxicity effect (b) Allergy effect (c) GI effect (d) Hyper-sensitivity effect,
so patient should be informed adverse drug reaction info;


Answer: Nephro-toxicity;


phT calculation no. 43:

After taking a drug, patient becomes sleepy, aka adverse drug reaction's
(a) Allergy effect (b) CNS effect (c) Hypersensitivity effect (d) Nephro-toxicity effect

Answer: CNS;


phT calculation no. 44:

Vomiting, diarrhea, constipation, ... , aka adverse drug reaction's
(a) Nephro-toxicity effect (b) Carcinogenicity effect (c) Hepato-toxicity effect (d) GI effect

Answer: GI;


phT calculation no. 45:

Unexpected drug reaction can occur because drug is taken at 1st time, aka
(a) CNS effect (b) Idiosyncrasy effect (c) Hyper-sensitivity effect (d) Allergy effect

Answer: Idiosyncrasy;


phT calculation no. 50:

Hepatic necrosis means
(a) dead tissue
(b) excessive bleeding
(c) stop bleeding
(d) obstruction in kidney
which is caused by overdose of acetaminophen, aspirin, chlorpromazine, halothane, ... , aka hepato-toxicity;

Answer: dead tissue;


phT calculation no. 28:

Concerning ANS vs. CNS, autonomic nervous system is classification to
(a) central (b) peripheral (c) hyper (d) hypo

Classification system such as adrenergic vs. cholinergic, agonist vs. antagonist, ANS vs. CNS, anti*, blocker, *lytic, mimetic, neurotransmitter, parasympathetic, sympathetic, ... ;


Answer: peripheral if compare to CNS;


phT calculation no. 16:

Rx is Respiradone 5mg #120 sig: 2 po bid;
CphT dispenses mental health drug for how many days?
(a) 120 days (b) 60 days (c) 24 days (d) 30 days

1st, 5mg is 5mg tablet ["tab" was not written in Rx, because in common, Respiradone 5mg is in tablet form]; # is quantity, so 120 tablets; 2 po is 2 tablets by mouth; bid is 2 times a day;

2nd, 2 po is 5mg x 2 = 10mg dose; 2 times a day x 2 po is 4 tables per day; so, 120 / 4 = 30 days;

3rd, CphT dispenses 120 tablets; and labels:

"sig" is derived from Latin language "signa", which means "to write", so CphT writes "Take 2 tablets orally twice a day until gone";

CphT would apply warning label such as MEDICATION SHOULD BE TAKEN WITH PLENTY OF WATER;

CphT would apply warning label such as AVOID DIRECT EXPOSURE TO SUN.


phT calculation no. 17:

Rx is Respiradone 5mg #120 po qd;
CphT dispenses senior[age>70yr] mental health drug for how many days?
(a) 120 days (b) 60 days (c) 24 days (d) 30 days

1st, 5mg is 5mg tablet ["tab" was not written in Rx, because in common, Respiradone 5mg is in tablet form]; # is quantity, so 120 tablets; po is route by mouth; qd is each day;

2nd, 5mg dose; 1 time a day x po is 1 table per day; so, 120 / 1 = 120 days;

3rd, CphT dispenses 120 tablets; CphT would label "Every day, take 1 tablet orally with plenty of water".





Types of pharmacy are chain pharmacy, food store with pharmacy, independent pharmacy, mass merchandiser, ... ; Requirements of pharmacy are consultation area, equipment, refrigerator, Rx area for counting/pouring, permits [IFF sole entrepreneurship aka "be your own pharmacy", must submit blue print to pharmacy.ca.gov to get approval], sink, storage, ... ; Out patient pharmacies are home-infusion [some pharmacies service to patient at home via home visit nurses], long term care, mail order, ... ; Radio isotope [so many different isotopes exist] pharmacy, and nuclear pharmacy are called radio pharmacy;

Customer service such as telephone etiquette and conversational skills, to be so, be nice and courteous, listen carefully because some people talk fast, some people talk slow; Avoid liability, to do so, knowledge based phone calls should refer to pharmacists [because CphT does lower level policy, CphT earns less money, so avoid liabilities ... ];

Prescription process such as address, DOB, patient info, Pt. name, telephone number, ... ; Ask allergy info of patient; Process insurance info; Enter info into computer such as DAW, drug/strength/quantity, initials including CphT AND Pharmacist, MD(DEA #) [no need to enter MD's name; MD's DEA number only is required], NDC, refills, sig., ... ; Insurance info such as group #, person code (01 spouse, 02 dependent), Pt ID #, ... ; Enter safety info such as allergy, drug-drug interaction; In common, after entering data to process, computer's AI program will run to check automatically ... ;




phT calculation no. 18:

DAW aka Dispense As Written, which has been checked in prescription. What does it mean?

(a) brand name must be dispensed as written;

(b) generic name must be dispensed as written;

(c) substitute generic to be DAW2;

(d) substitute generic to be DAW1;

There is either DAW1 or DAW2, accordance with insurance companies' rule and regulation. Sometimes, government pays DAW1 only, sometimes insurance companies pay DAW2 only, sometimes vice versa ... ; In bubble economy, common people do not notice that the value of ZERO 00, 000, 00000, ... ; CphT must not substitute; Since, DAW has been checked/marked/written, so brand name must be dispensed as written.


DAW, MAC, Rejection, ... , are online adjudication; CphT enters data to do prescription process, sometimes computer prompts rejection due to DAW, sometimes due to MAC, ... ; e.g. MAC, Maximum Allowable Cost is $100, on the other hand bill becomes $150, notice that insurance company will pay MAC only, so pharmacy might lose $$.

Financial issue such as 3rd party programs [including private company, medicare/medical by State, work compensation, ... ], co-pay, deductible, online adjudication, paper process [e.g. universal claim form UCF, CMS-1500 form, CMS 10114 form, CPT codes, ... ], ... ;

Preparation such as auxiliary labels, counting and pouring, safety caps, ... ; All drugs CphT dispense must be finally checked by pharmacist [CphT does not know medical knowledge well enough like pharmacist; liability legal issue]; Patient's pick-up such as cash register record, payment record, signature logs, ... ;

Inventory control such as outdates [in common, 30 days ahead checking on expiration date of drug, not only by computer system, but also in person aka "ground stock checking" ], ordering, receiving, stickers, ... ; Ordering/Receiving process including automatic order, manual order, MSDS [data sheet for any hazard, any toxic], shipping, receiving, credit-by-returns [stock list of return to get credit from wholesaler; concerning credit, some wholesalers do, some wholesales don't ], stocking & storing, ... ; Holding cost can be high up, if not JIT, because JIT does time based rate;

i = i - 1, so reorder point can be either RP or CRP at breaking point, e.g. RP aka re-order point has been set to 10 at dispensing-rate of 2 per day, notice that pharmacy might re-order 60 for another 30 days at RP = 10; CRP, critical re-order point because dispensing-rate unusually high, for example: RP = 10 AND day < 20; Dispensing system machine: some holds 50 medications, max machine hold 400 medications; Well known automatic dispensing machines are omnicell, pyxis, robot, ... ; Therefore, RP is like a marking line at stock market, RP is pre-determine; RP is JIT rate by availability; Concerning ordering, manual vs. automatic, manual fill form, auto re-barcode with quantity; POS point of sales, prompted by computer system which can track inventory; Availability opposes to out-of-stock e.g. active ingredient not available, problem in real time treatments, ... ; Concerning drug, turnover-rate down IFF high ordering, turnover-rate up IFF low ordering; In common, hospital orders drug 2 times a day to wholesaler, wholesaler receives drugs from manufactures, and then wholesaler supplies to hospital;

CphT has many responsibilities and be member of healthcare teams, such as in-patient pharmacies, compounding, IV rooms [clean sterile rooms for making IV, e.g. US797],  narcotic storage aka narcotic vault, order entry area, satellite pharmacies, unit dose filling areas, ... ;

Hospital pharmacy such as formulary vs. non-formulary concerning therapeutic interchange, in common, hospitals deploy formulary only, so dose AND secret quality of drug are pre-set [in formulary, medication that are approved to use] for higher productivity and also higher quality health care; Unit dose systems such as cart-exchanged, manufactured, repackaged/pre-pack, robots, U/D cassette AND cart system [very labor intensive], ... ;

Communication such as fax/scan of chart order, PIS, Pharmacy Information System [PIS may vary depending on computer systems among companies], pneumatic [pronounce "nu-mer-tic", cash/drug/document/... can be sent 1 way to main control room via tubes] tube system, telephone, ... ;

Medical records such as everything goes into the chart including code, doctor orders, legal documents, pharm. info, ... ; Microfilm old documents, and then shed-it-out for recycling ... ;

Medication order such as chart orders [e.g. prn, stat, ... ], inventory control, ordering process i.e. PIS system's medication process, medical admin. record aka MAR, missing dose [ nurses' complaints], preprinted "standing" orders, ... ;

Agencies such as California State Board of Pharmacy; CDPH, California Dept. of Public Health Services; CMS, Center for Medicare Services; DEA including State & Federal; NPSE; TJC, The Joint Commission; policy; procedure; Therefore, in order to be accredited, agencies' requirements are essential; Think of "Warfarin" to keep INR between 2 ~ 3 because IF <2 will clog, IF >3 will internal bleed, when special cases are involved, and then educate medical professionals, nurses, patients, physicians, ... computer AI programmer also ... ;


phT calculation no. 22:

Drugs which are NOT TO USE in United States for protecting higher abuse potential, by DEA is:

(a) Schedule IV (b) Schedule III (c) Schedule II (d) Schedule I;


Currently, Schedule I is not accepted by DEA for medical use in USA. e.g. Benzethidine.


phT calculation no. 25:

Among Drug Recall I, Drug Recall II, Drug Recall III, Drug Recall IV, which Drug Recall involves CphT, doctor, manager, patient, pharmacist, ... due to serious harmful, due to unacceptable drug potential:
(a) class 1 recall (b) class 2 recall (c) class 3 recall (d) class 4 recall;

Answer: Drug Recall I aka class 1 recall;


phT calculation no. 23:

One of the HIPAA requirements is that:

(a) privacy rules must be observed for PHI;

(b) privacy rules must be accordance with CphT;

(c) privacy rules must be consulted by pharmacist;

(d) privacy rules must be offered by pharmacy;


Answer: HIPAA requires privacy rules must be observed for PHI.


phT calculation no. 24:

NDC's 1st 5 digits number identifies:

(a) license's number;

(b) Rx's number;

(c) manufacturer's number;

(d) pharmacy's number;

In NDC, National Drug Code, the first five digits number identifies manufacturer.

Remark: last digits are for packaging;