- Lisinopril class & use
- ACE inhibitor — treats hypertension and heart failure. Watch for dry cough and hyperkalemia; contraindicated in pregnancy.
- Metoprolol class & use
- Beta-blocker (cardioselective, beta-1) — hypertension, angina, heart failure, post-MI. Slows heart rate.
- Amlodipine class & use
- Dihydropyridine calcium channel blocker — hypertension and angina. Common side effect: peripheral (ankle) edema.
- Atorvastatin class & use
- HMG-CoA reductase inhibitor (statin) — lowers LDL cholesterol. Take at any time of day; monitor for muscle pain (myopathy).
- Metformin class & use
- Biguanide — first-line for type 2 diabetes. Lowers hepatic glucose output; hold before contrast dye (lactic acidosis risk).
- Omeprazole class & use
- Proton pump inhibitor (PPI) — GERD, peptic ulcers. Take 30–60 minutes before the first meal.
- Levothyroxine use
- Synthetic T4 thyroid hormone — treats hypothyroidism. Take on an empty stomach; narrow therapeutic index.
- Albuterol class & use
- Short-acting beta-2 agonist (SABA) — rescue inhaler for acute bronchospasm/asthma. Fast onset.
- Warfarin antidote
- Vitamin K (phytonadione). Warfarin is an anticoagulant monitored by INR (target usually 2–3).
- Heparin antidote
- Protamine sulfate. Heparin is monitored by aPTT.
- Opioid overdose antidote
- Naloxone (Narcan) — an opioid antagonist that reverses respiratory depression.
- Acetaminophen overdose antidote
- N-acetylcysteine (NAC, Acetadote/Mucomyst).
- Benzodiazepine overdose antidote
- Flumazenil.
- Insulin onset: rapid-acting
- Lispro, aspart, glulisine — onset ~15 minutes. Give right before a meal.
- Insulin: long-acting (basal)
- Glargine (Lantus) and detemir (Levemir) — no pronounced peak, ~24-hour duration.
- Lasix (furosemide) class
- Loop diuretic — edema and hypertension. Can cause hypokalemia (low potassium).
- Spironolactone class
- Potassium-sparing diuretic / aldosterone antagonist. Risk of hyperkalemia.
- Hydrochlorothiazide (HCTZ) class
- Thiazide diuretic — first-line for hypertension. Can cause hypokalemia and raise glucose/uric acid.
- Losartan class & use
- Angiotensin II receptor blocker (ARB) — hypertension. Alternative when ACE inhibitors cause cough.
- Clopidogrel (Plavix) class
- Antiplatelet (P2Y12 inhibitor) — prevents clots after stents and in ACS.
- Apixaban (Eliquis) class
- Direct oral anticoagulant (factor Xa inhibitor) — atrial fibrillation, DVT/PE. No routine INR monitoring.
- Amoxicillin class
- Penicillin (beta-lactam) antibiotic. Augmentin = amoxicillin + clavulanate.
- Azithromycin (Z-Pak) class
- Macrolide antibiotic. Common 5-day Z-Pak regimen for respiratory infections.
- Ciprofloxacin class & warning
- Fluoroquinolone antibiotic. Boxed warning: tendon rupture; avoid with antacids/dairy (chelation).
- Doxycycline class & caution
- Tetracycline antibiotic. Avoid in pregnancy and young children (tooth staining); photosensitivity.
- Sulfamethoxazole/trimethoprim
- Bactrim — a sulfonamide combination antibiotic for UTIs and MRSA. Sulfa allergy caution.
- Gabapentin use
- Anticonvulsant also used for neuropathic pain. Now a controlled substance in some states.
- Sertraline (Zoloft) class
- SSRI antidepressant. Used for depression and anxiety; takes weeks for full effect.
- Fluoxetine (Prozac) class
- SSRI antidepressant with a long half-life.
- Duloxetine (Cymbalta) class
- SNRI — depression, anxiety, and neuropathic pain.
- Alprazolam (Xanax) class & schedule
- Benzodiazepine, Schedule IV controlled substance — anxiety. Risk of dependence.
- Zolpidem (Ambien) class
- Non-benzodiazepine 'Z-drug' hypnotic for insomnia. Schedule IV.
- Hydrocodone/acetaminophen schedule
- Norco/Vicodin — Schedule II opioid combination.
- Oxycodone schedule
- Schedule II opioid analgesic (OxyContin = extended release).
- Prednisone class
- Oral corticosteroid — anti-inflammatory/immunosuppressant. Taper to stop; take with food.
- Montelukast (Singulair) class
- Leukotriene receptor antagonist — asthma maintenance and allergic rhinitis.
- Tamsulosin (Flomax) use
- Alpha-1 blocker — benign prostatic hyperplasia (BPH). Can cause orthostatic hypotension.
- Sildenafil (Viagra) class
- Phosphodiesterase-5 (PDE5) inhibitor — erectile dysfunction. Never combine with nitrates.
- Allopurinol use
- Xanthine oxidase inhibitor — lowers uric acid to prevent gout (not for an acute attack).
- Digoxin use & caution
- Cardiac glycoside — heart failure and atrial fibrillation. Narrow therapeutic index; toxicity worsened by low potassium.
- Phenytoin (Dilantin) use
- Antiepileptic — seizures. Narrow therapeutic index; monitor levels.
- Carbamazepine genetic test
- HLA-B*1502 testing before use in at-risk patients (severe skin reactions/SJS).
- Lithium caution
- Mood stabilizer for bipolar disorder. Narrow therapeutic index; monitor levels, sodium, and hydration.
- Metronidazole (Flagyl) warning
- Antibiotic/antiprotozoal — avoid alcohol (disulfiram-like reaction).
- Tramadol class & schedule
- Centrally acting opioid analgesic, Schedule IV. Seizure and serotonin syndrome risk.
- Pregabalin (Lyrica) schedule
- Schedule V — neuropathic pain, fibromyalgia, seizures.
- Methotrexate use & schedule note
- DMARD/antimetabolite — rheumatoid arthritis and cancer. Often dosed WEEKLY (a daily error is fatal); give folic acid.
- Levodopa/carbidopa use
- Parkinson disease — replaces dopamine; carbidopa prevents peripheral breakdown.
- Epinephrine (EpiPen) use
- Treats anaphylaxis — give intramuscularly in the outer thigh.
- Ondansetron (Zofran) class
- 5-HT3 antagonist antiemetic — prevents nausea/vomiting.
- Diphenhydramine (Benadryl) class
- First-generation (sedating) antihistamine.
- Loratadine/cetirizine class
- Second-generation (non-/less-sedating) antihistamines for allergies.
- Pantoprazole class
- Proton pump inhibitor (PPI) — GERD; available IV in hospitals.
- Ranitidine status
- An H2 blocker (Zantac) withdrawn from the U.S. market over NDMA impurity; famotidine is the H2-blocker alternative.
- Warfarin drug interactions
- Many — including antibiotics, NSAIDs, and vitamin-K-rich foods. Monitored by INR.
- Insulin storage
- Unopened: refrigerate. Opened/in-use: usually room temperature for ~28 days (check the product). Never freeze.
- Nitroglycerin SL storage & use
- Sublingual tablet for angina — store in original amber glass, away from light/heat; may repeat every 5 minutes ×3.
- Beta-blocker suffix
- Generic names ending in '-olol' (metoprolol, atenolol, propranolol).
- ACE inhibitor suffix
- Generic names ending in '-pril' (lisinopril, enalapril, ramipril).
- ARB suffix
- Generic names ending in '-sartan' (losartan, valsartan, olmesartan).
- Statin suffix
- Generic names ending in '-statin' (atorvastatin, simvastatin, rosuvastatin).
- PPI suffix
- Generic names ending in '-prazole' (omeprazole, pantoprazole, esomeprazole).
- Triptan suffix & use
- '-triptan' (sumatriptan) — abortive treatment of migraine.
- Benzodiazepine suffix
- Often end in '-pam' or '-lam' (lorazepam, diazepam, alprazolam).
- Aminoglycoside suffix
- Antibiotics ending in '-micin/-mycin' such as gentamicin; monitor for nephro-/ototoxicity.
- Calcium channel blocker (dihydropyridine) suffix
- '-dipine' (amlodipine, nifedipine).
- Brand: Lipitor
- Generic atorvastatin (a statin).
- Brand: Synthroid
- Generic levothyroxine.
- Brand: Glucophage
- Generic metformin.
- Brand: Coumadin
- Generic warfarin.
- Brand: Prilosec
- Generic omeprazole.
- Brand: Norvasc
- Generic amlodipine.
- Brand: Zestril/Prinivil
- Generic lisinopril.
- Brand: Ventolin/ProAir
- Generic albuterol.
- Brand: Lasix
- Generic furosemide.
- Brand: Neurontin
- Generic gabapentin.
- Brand: Lopressor/Toprol XL
- Generic metoprolol (tartrate / succinate XL).
- Brand: Cozaar
- Generic losartan.
- Brand: Crestor
- Generic rosuvastatin.
- Brand: Eliquis
- Generic apixaban.
- Brand: Xarelto
- Generic rivaroxaban (factor Xa inhibitor).
- Brand: Januvia
- Generic sitagliptin (a DPP-4 inhibitor).
- Brand: Ozempic
- Generic semaglutide (a GLP-1 receptor agonist).
- Brand: Humira
- Generic adalimumab (a TNF-inhibitor biologic).
- DPP-4 inhibitor suffix
- '-gliptin' (sitagliptin, saxagliptin) — type 2 diabetes.
- GLP-1 agonist suffix
- '-glutide/-tide' (semaglutide, liraglutide, dulaglutide) — type 2 diabetes and weight loss.
- SGLT2 inhibitor suffix
- '-gliflozin' (empagliflozin, dapagliflozin) — diabetes and heart/kidney benefit.
- Monoclonal antibody suffix
- '-mab' (adalimumab, infliximab) — biologic agents.
- Proton pump inhibitors take when?
- 30–60 minutes before the first meal of the day.
- Bisphosphonate (alendronate) directions
- Take on an empty stomach with a full glass of water; stay upright 30 minutes (esophageal irritation).
- What is a high-alert medication?
- A drug that carries a heightened risk of significant patient harm if used in error — e.g. insulin, heparin, opioids, chemotherapy.
- Tetracycline / fluoroquinolone food caution
- Avoid taking with dairy, antacids, or iron — these cations chelate the drug and reduce absorption.
- Route abbreviation: PO
- By mouth (orally).
- Route abbreviation: IV / IM / SubQ
- IV = intravenous; IM = intramuscular; SubQ/SC = subcutaneous.
- Route abbreviation: SL / PR
- SL = sublingual (under the tongue); PR = per rectum.
- Frequency: QD / BID / TID / QID
- Once, twice, three times, four times daily. (QD/QOD are on the ISMP do-not-use list — write 'daily'.)
- Frequency: QH / Q4H / PRN
- QH = every hour; Q4H = every 4 hours; PRN = as needed.
- Timing: AC / PC / HS
- AC = before meals; PC = after meals; HS = at bedtime.
- Abbreviation: gtt / ung / supp
- gtt = drop(s); ung = ointment; supp = suppository.
- Abbreviation: stat / NPO
- stat = immediately; NPO = nothing by mouth.
- Sig: 'i tab PO BID'
- Take one tablet by mouth twice a day.
- Sig: 'ii gtts OU QID'
- Instill two drops in both eyes four times a day. (OD = right eye, OS = left eye, OU = both eyes.)
- ISMP do-not-use: 'U'
- Write out 'unit' — 'U' can be misread as 0, 4, or cc, causing overdose (especially insulin).
- ISMP do-not-use: trailing zero
- Never write 1.0 mg (can be read as 10). Do use a leading zero: 0.5 mg, never .5 mg.
- ISMP do-not-use: 'MS / MSO4 / MgSO4'
- Ambiguous (morphine vs magnesium sulfate). Write the full drug name.
- Tall man lettering
- Mixed-case lettering to distinguish look-alike names, e.g. predniSONE vs prednisoLONE, hydrOXYzine vs hydrALAZINE.
- What is an NDC number?
- National Drug Code — a 10- or 11-digit number identifying the labeler, product, and package size of a drug.
- What are 'the five rights' of medication?
- Right patient, right drug, right dose, right route, right time.
- What is a 'near miss'?
- An error caught and corrected before it reaches the patient.
- What is a sentinel event?
- An unexpected occurrence involving death or serious physical/psychological injury, requiring immediate investigation.
- What is root cause analysis (RCA)?
- A retrospective process that identifies the underlying cause(s) of an error to prevent recurrence.
- What is FMEA?
- Failure Mode and Effects Analysis — a PROACTIVE method that anticipates how a process could fail before harm occurs.
- What is a black box warning?
- The FDA's strongest warning, on the label, alerting to serious or life-threatening risks.
- What is medication reconciliation?
- Comparing a patient's current medication list against new orders at care transitions to avoid errors and omissions.
- What is therapeutic duplication?
- Two drugs from the same class (or with the same effect) prescribed together, raising overdose/side-effect risk.
- LASA drugs
- Look-Alike/Sound-Alike medications (e.g. hydralazine/hydroxyzine) — a leading source of errors; use tall man lettering and barcodes.
- What is a DUR / DUE?
- Drug Utilization Review — a check (often automated) for interactions, duplications, dose problems, and allergies during processing.
- What is an auxiliary label?
- A supplemental warning/instruction label on a dispensed prescription (e.g. 'Take with food', 'May cause drowsiness').
- What is prior authorization?
- Insurer approval required before a drug is covered; the pharmacy/prescriber submits clinical justification.
- What is an ISMP?
- Institute for Safe Medication Practices — a nonprofit that publishes high-alert and confused-name lists and error-prevention guidance.
- USP <797>
- Standard for sterile compounding (preventing contamination of injectables, IVs).
- USP <800>
- Standard for safe handling of HAZARDOUS drugs to protect workers and the environment.
- USP <795>
- Standard for NON-sterile compounding (oral, topical preparations).
- Laminar airflow hood: clean-to-dirty
- Work at least 6 inches inside; never block (shadow) airflow between the HEPA filter and the sterile object.
- Horizontal vs vertical flow hood
- Horizontal LAFW protects the PRODUCT (non-hazardous sterile). Vertical/BSC protects the WORKER (hazardous drugs).
- PPE for hazardous drugs
- Chemo-rated gloves (often double), gown, and respiratory/eye protection per USP <800>; compound in a containment device.
- Sharps disposal rule
- Never recap needles by hand; drop them point-first into a puncture-proof sharps container (OSHA).
- What is a recall: Class I / II / III?
- Class I = reasonable probability of serious harm or death; Class II = temporary/reversible harm; Class III = unlikely to cause harm.
- What is a barcode (BCMA) scan for?
- Verifying the right drug/dose at dispensing and bedside to prevent the wrong-drug error.
- What does a pharmacy tech do for an allergy alert?
- Stop and flag it for the pharmacist — the technician does not override clinical alerts.
- Controlled Substances Act: schedules
- Five schedules (I–V) by abuse potential. Schedule I has no accepted medical use; II–V do, with decreasing abuse potential.
- Schedule I examples
- No accepted U.S. medical use, high abuse: heroin, LSD, ecstasy, (federally) marijuana.
- Schedule II examples & refills
- High abuse, accepted use: oxycodone, fentanyl, morphine, Adderall. NO refills allowed.
- Schedule III–V refills
- May be refilled up to 5 times within 6 months of the original date.
- Schedule III / IV / V examples
- III: ketamine, anabolic steroids, Tylenol #3. IV: alprazolam, lorazepam, tramadol. V: low-dose codeine cough syrups, pregabalin.
- DEA Form 222
- Used to order/transfer SCHEDULE II controlled substances (or the electronic CSOS equivalent).
- DEA Form 41
- Used to record the DESTRUCTION of controlled substances.
- DEA Form 106
- Used to report the THEFT or significant LOSS of controlled substances.
- DEA Form 224
- Application for a pharmacy to register (and dispense) controlled substances.
- DEA number check digit
- Add 1st+3rd+5th digits, then (2nd+4th+6th)×2; the last digit of that sum must equal the 7th (check) digit.
- DEA number first letter
- Identifies registrant type (e.g. A/B/F = hospital/pharmacy/practitioner; M = mid-level); the 2nd letter = first letter of the last name.
- Controlled substance inventory frequency
- A complete inventory at least every 2 years; an initial inventory when first handling controlled substances.
- Schedule II record-keeping
- Must be kept SEPARATE from other records; many states require perpetual inventory for CII.
- Pseudoephedrine limits (CMEA)
- Combat Methamphetamine Epidemic Act: max 3.6 g/day and 9 g/30 days per purchaser; kept behind the counter with a logbook and ID.
- PPPA (1970)
- Poison Prevention Packaging Act — requires child-resistant packaging for most oral prescription drugs (patient may waive).
- FDCA (1938)
- Federal Food, Drug, and Cosmetic Act — required drugs to be proven SAFE before marketing; created the FDA's authority.
- Kefauver-Harris Amendment (1962)
- Required drugs to be proven EFFECTIVE (not just safe) — prompted by the thalidomide tragedy.
- Durham-Humphrey Amendment (1951)
- Created the legend (Rx-only) vs OTC distinction and the 'Rx only' label.
- HIPAA
- Health Insurance Portability and Accountability Act — protects patients' protected health information (PHI).
- OBRA-90
- Omnibus Budget Reconciliation Act of 1990 — requires DUR and an offer to counsel patients on new prescriptions.
- Controlled Substances Act (1970)
- Created the DEA scheduling system (I–V) for drugs with abuse potential.
- DSCSA (part of DQSA)
- Drug Supply Chain Security Act — tracks drugs through the supply chain to keep counterfeits out (drug pedigree/track-and-trace).
- Ryan Haight Act
- Requires an in-person (or qualifying telehealth) evaluation before prescribing controlled substances online.
- Anabolic Steroid Control Act (1990)
- Added anabolic steroids to Schedule III of the Controlled Substances Act.
- REMS
- Risk Evaluation and Mitigation Strategy — an FDA safety program for certain high-risk drugs (e.g. isotretinoin/iPLEDGE, clozapine).
- MedWatch
- The FDA program for voluntarily reporting adverse events and product problems.
- VAERS
- Vaccine Adverse Event Reporting System (CDC/FDA) — reporting adverse events after vaccination.
- Adulterated vs misbranded
- Adulterated = the product is contaminated/impure or improperly made. Misbranded = the labeling is false or misleading.
- Who issues DEA registrations?
- The Drug Enforcement Administration (DEA) — part of the Department of Justice.
- Who approves drugs / oversees labeling?
- The Food and Drug Administration (FDA).
- C-II emergency oral order rule
- Allowed in a genuine emergency for the amount needed; a written/e-prescription must follow within 7 days.
- Transfer of controlled Rx (III–V)
- Generally a one-time transfer of remaining refills (shared real-time databases may allow more); CII cannot be refilled or transferred.
- What must be on a controlled Rx?
- Patient name/address, drug, strength, quantity, directions, date, prescriber name/address and DEA number, and signature.
- Drug recall: who initiates?
- The manufacturer (often at the FDA's request); the pharmacy quarantines affected stock and notifies patients as directed.
- Reverse distributor
- A DEA-registered company that processes the return/destruction of expired or unwanted controlled substances.
- Days' supply: 30 tablets, take 1 BID
- Take 2 per day → 30 ÷ 2 = 15 days' supply.
- Days' supply for eye drops
- Use ~20 drops per mL; divide total drops by drops used per day. (Account for both eyes and doses per day.)
- Days' supply for an inhaler
- Total actuations (puffs) ÷ puffs used per day. (Albuterol HFA = 200 actuations.)
- Days' supply for insulin
- Total units in the vial/pen(s) ÷ units used per day. (A 10 mL U-100 vial = 1000 units.)
- What is compounding?
- Preparing a customized medication by combining/altering ingredients for an individual patient when a commercial product won't work.
- Trituration
- Reducing a substance to a fine powder by grinding, often with a mortar and pestle.
- Geometric dilution
- Mixing a small amount of potent drug with an equal amount of diluent, then doubling repeatedly — ensures uniform distribution.
- Levigation
- Adding a small amount of liquid (levigating agent) to a powder to make a smooth paste and reduce particle size.
- Reconstitution
- Adding a specified volume of diluent (often sterile water) to a powdered drug to make a solution/suspension just before dispensing.
- Beyond-use date (BUD)
- The date after which a compounded or repackaged product should not be used — based on USP, not the manufacturer's expiration date.
- Expiration date vs BUD
- Expiration = manufacturer's date on the original container. BUD = assigned to compounded/repackaged products (usually shorter).
- Unit-dose vs bulk
- Unit-dose = a single packaged dose (common in hospitals). Bulk/multi-dose = larger stock containers.
- What is a formulary?
- An approved list of medications (often with preferred/tiered choices) a health plan or facility will cover or stock.
- Therapeutic substitution
- Dispensing a different drug in the same class than prescribed — requires prescriber/protocol approval (unlike generic substitution).
- Generic substitution
- Dispensing an AB-rated generic for the brand; allowed unless 'dispense as written' (DAW) is specified.
- DAW 1 vs DAW 0
- DAW 0 = substitution allowed (no restriction). DAW 1 = prescriber requires brand ('dispense as written').
- What is adjudication?
- The real-time electronic claim process where the insurer approves the prescription and returns the patient's copay.
- BIN / PCN
- Insurance routing numbers on the card: BIN (Bank Identification Number) and PCN (Processor Control Number) direct the claim.
- What is a copay?
- The fixed amount a patient pays for a covered prescription; the plan pays the rest.
- Rejected claim: 'refill too soon'
- The plan won't pay because too much supply remains; the patient may wait or pay cash.
- NDC mismatch / wrong NDC
- A claim or dispense error where the billed NDC doesn't match the product dispensed — correct before dispensing.
- What is a 340B program?
- A federal drug-pricing program that lets eligible safety-net providers buy outpatient drugs at reduced prices.
- DUR rejection at point of sale
- An online edit flags an interaction/duplication/early refill; the technician routes it to the pharmacist to resolve.
- Order entry: what does the tech verify first?
- That the prescription is complete and valid — patient info, drug, strength, quantity, directions, prescriber, and date.
- Why split a tablet?
- Cost or dose flexibility — but only scored/film-coated immediate-release tablets; never split extended-release or enteric-coated.
- Roman numeral: V, X, L, C
- V = 5, X = 10, L = 50, C = 100. (I = 1.)
- Sig: 'gr' unit
- Grain — an apothecary unit; 1 grain ≈ 65 mg (often rounded to 60 mg).
- Conversion: 1 kg / 1 lb
- 1 kg = 2.2 lb; 1 lb = 16 oz. Convert pounds to kg by dividing by 2.2.
- Conversion: 1 tsp / 1 tbsp
- 1 teaspoon = 5 mL; 1 tablespoon = 15 mL.
- Conversion: 1 fluid ounce / 1 pint
- 1 fl oz = 30 mL; 1 pint = 480 mL; 1 gallon = 3840 mL.
- Conversion: 1 inch / 1 mL
- 1 inch = 2.54 cm. 1 mL = 1 cc.
- Percent strength meaning
- % w/v = grams of drug per 100 mL; % w/w = grams per 100 g; % v/v = mL per 100 mL.
- Ratio strength 1:1000
- 1 gram of drug in 1000 mL (or g) → 1 mg/mL. (Epinephrine 1:1000 = 1 mg/mL.)
- Alligation use
- Calculates how to mix two strengths (high and low) to make a desired in-between concentration.
- Flow rate (mL/hr) basics
- mL/hr = total volume ÷ infusion time (hours). Drops/min = (volume × drop factor) ÷ time in minutes.
- Dimensional analysis
- A calculation method that cancels units step by step to reach the desired unit — reduces dosing errors.
- Body surface area (BSA) dosing
- Used mainly for chemotherapy — dose per square meter (mg/m²); BSA from height and weight.
- Specific gravity
- The ratio of a substance's weight to the weight of an equal volume of water; water = 1. Used to convert weight and volume.
- Storage: refrigerator range
- About 2–8 °C (36–46 °F).
- Storage: controlled room temperature
- About 20–25 °C (68–77 °F).
- Storage: freezer range
- About −25 to −10 °C (−13 to 14 °F).
- What is repackaging?
- Moving a drug from a bulk container into unit-dose or smaller packages — assign a BUD and label fully.
- What is a PAR level?
- Periodic Automatic Replenishment level — the minimum stock that triggers reordering for inventory control.
- FEFO inventory rule
- First Expired, First Out — stock the shortest-dated product to be used first to minimize waste.
- What is an automated dispensing cabinet (ADC)?
- A computerized cabinet (e.g. Pyxis/Omnicell) that stores and tracks medications on nursing units.
- Atrial fibrillation on EKG
- Irregularly irregular rhythm — relevant because warfarin/DOACs and rate-control drugs are prescribed for it.
- Warfarin monitoring lab
- INR (international normalized ratio); therapeutic range usually 2–3.
- Drug for hypothyroidism vs hyperthyroidism
- Hypothyroid → levothyroxine (replace). Hyperthyroid → methimazole/PTU (suppress).
- Aspirin low-dose use
- 81 mg daily as an antiplatelet to reduce heart-attack/stroke risk in selected patients.
- NSAID examples & caution
- Ibuprofen, naproxen — anti-inflammatory; GI bleeding and kidney risk, especially with anticoagulants.
- Acetaminophen max daily dose
- Generally no more than 4 g (4000 mg) per day in healthy adults; less with liver disease/alcohol use.
- Antibiotic that needs level monitoring
- Vancomycin and aminoglycosides (gentamicin) — monitor trough levels for efficacy and toxicity.
- Insulin sliding scale
- Dosing insulin based on measured blood glucose — a high-alert process; double-check the units.
- Anticoagulant vs antiplatelet
- Anticoagulants (warfarin, heparin, DOACs) target clotting factors; antiplatelets (aspirin, clopidogrel) stop platelets clumping.
- Suffix '-cycline'
- Tetracycline antibiotics (doxycycline, minocycline).
- Suffix '-floxacin'
- Fluoroquinolone antibiotics (ciprofloxacin, levofloxacin).
- Suffix '-cillin'
- Penicillin antibiotics (amoxicillin, ampicillin).
- Suffix '-azole' (antifungal)
- Azole antifungals (fluconazole, ketoconazole).
- Suffix '-vir'
- Antiviral agents (acyclovir, oseltamivir, tenofovir).
- Drug for acute gout attack
- NSAIDs, colchicine, or corticosteroids — NOT allopurinol (which is for long-term prevention).
- Levothyroxine narrow therapeutic index
- Small dose changes matter; keep patients on the same manufacturer/product when possible.
- Common opioid side effects
- Constipation (does not improve with time), sedation, respiratory depression, nausea.
- Statin time of administration
- Short-acting statins (simvastatin) work best in the evening; long-acting (atorvastatin, rosuvastatin) any time.
- Why give folic acid with methotrexate?
- To reduce methotrexate's side effects (mucositis, GI upset); methotrexate is a folate antagonist.
- MAOI dietary caution
- Avoid tyramine-rich foods (aged cheese, cured meats) — hypertensive crisis risk.
- Serotonin syndrome
- Excess serotonin (e.g. SSRI + tramadol/triptan) — agitation, fever, tremor, rapid heart rate.
- Beers Criteria
- A list of potentially inappropriate medications in older adults (e.g. avoiding certain sedatives/anticholinergics).
- Counseling: who may counsel?
- Only the pharmacist may counsel on a new prescription; the technician facilitates the offer (OBRA-90).
- What does a technician NOT do?
- Counsel patients clinically, make therapeutic decisions, perform the final verification, or override clinical alerts.
- Two patient identifiers
- Verify at least two identifiers (e.g. full name and date of birth) before dispensing — never the room number.
- Hand hygiene importance
- The single most effective measure to prevent the spread of infection in the pharmacy/healthcare setting.
- Hazardous drug spill kit
- Used to contain and clean a hazardous-drug spill per USP <800>; includes PPE, absorbent pads, and disposal bags.
- Quarantine of recalled stock
- Physically separate recalled/expired drugs from usable stock and label clearly to prevent dispensing.
- What is a P&T committee?
- Pharmacy and Therapeutics committee — decides the formulary and medication-use policy in a hospital/health plan.
- Smart pump
- An IV infusion pump with a dose-error-reduction software library to catch programming errors.
- Independent double check
- A second qualified person independently verifies a high-alert preparation (e.g. insulin, chemo, pediatric doses).
- What is diversion?
- Theft or redirection of (usually controlled) medications for non-medical use; prevented by counts, audits, and ADC tracking.
- Perpetual inventory
- A running, real-time count of certain drugs (often CII) updated with each transaction.
- Who counsels on OTC vs Rx?
- The pharmacist provides clinical counseling; technicians may direct customers and answer non-clinical questions.
- Vaccine handling (cold chain)
- Maintain required temperatures throughout storage/transport; log fridge/freezer temps and report excursions.
- Look-alike packaging risk
- Similar vials/boxes cause selection errors — separate storage, barcodes, and alerts reduce the risk.
- What is an MAR?
- Medication Administration Record — documents each dose given to an inpatient.
- What is e-prescribing (eRx)?
- Electronic transmission of a prescription from prescriber to pharmacy; EPCS covers controlled substances.
- What is a drug monograph?
- A standardized reference summarizing a drug's uses, dosing, interactions, and warnings.
- Leading vs trailing zero (recap)
- Use a leading zero (0.5 mg). Never use a trailing zero (write 5 mg, not 5.0 mg) — prevents 10-fold errors.
- C-V purchase without Rx
- Some Schedule V products may be sold without a prescription where state law allows, with ID and a logbook.
- Partial fill of CII
- Permitted under federal rules; the remainder is generally supplied within 30 days of the written date.
- Recordkeeping retention
- Pharmacy records (including controlled-substance records) are generally kept at least 2 years (states may require longer).
- Tamper-resistant Rx pad
- Required for many written prescriptions (especially Medicaid) to deter forgery.
- PDMP
- Prescription Drug Monitoring Program — a state database tracking controlled-substance dispensing to curb misuse.
- What is a wholesaler's role?
- A licensed distributor that supplies drugs to pharmacies; the DSCSA tracks products through them.
- EpiPen storage
- Room temperature, protected from light; do not refrigerate. Inspect that the solution is clear.
- Suspension vs solution
- A suspension has undissolved particles (shake well); a solution is fully dissolved (clear).
- Enteric coating purpose
- Protects the drug from stomach acid (or the stomach from the drug); do not crush — it bypasses the stomach.
- Extended-release (ER/XR/SR) caution
- Do not crush or split — it releases the full dose at once (overdose risk).
- Buccal vs sublingual
- Buccal = dissolved between cheek and gum; sublingual = under the tongue. Both bypass first-pass metabolism.
- Transdermal patch
- Delivers drug through the skin over time (e.g. fentanyl, nicotine); rotate sites and remove the old patch.
- Bioavailability
- The fraction of a dose that reaches systemic circulation; IV = 100%; oral is reduced by first-pass metabolism.
- First-pass effect
- Oral drugs are metabolized by the liver before reaching circulation, lowering the amount that takes effect.
- Half-life (t½)
- The time for the drug concentration to fall by half; ~4–5 half-lives to reach steady state or clear the drug.
- Contraindication
- A condition under which a drug should NOT be used (e.g. ACE inhibitors in pregnancy).
- Indication
- The FDA-approved condition a drug is used to treat.
- Adverse drug reaction (ADR)
- An unwanted, harmful response to a drug at normal doses; report serious ones via MedWatch.
- Prophylaxis
- Use of a medication to PREVENT a condition (e.g. propranolol for migraine prophylaxis).
- Synergistic interaction
- Two drugs together produce a greater effect than the sum of each alone.
- Loading dose vs maintenance dose
- A loading dose rapidly reaches therapeutic level; a maintenance dose keeps it there.
- OTC vs legend drug
- OTC = available without a prescription; legend (Rx-only) requires a prescription (Durham-Humphrey).
- Behind-the-counter (BTC)
- OTC products kept behind the counter requiring a sale interaction (e.g. pseudoephedrine).
- Compounding vs manufacturing
- Compounding is patient-specific; manufacturing makes large commercial batches (FDA-regulated differently).
- 503A vs 503B facility
- 503A = traditional patient-specific compounding pharmacy; 503B = an FDA-registered outsourcing facility making larger batches.
- What is titration?
- Gradually adjusting a dose up or down to reach the best effect with the fewest side effects.
- Therapeutic index
- The ratio between a drug's effective and toxic dose; a NARROW index (warfarin, digoxin, lithium) needs monitoring.
- Pharmacokinetics (ADME)
- What the body does to a drug: Absorption, Distribution, Metabolism, Excretion.
- Pharmacodynamics
- What the drug does to the body — its mechanism and effect at the site of action.
- Agonist vs antagonist
- An agonist activates a receptor (produces a response); an antagonist blocks it (e.g. naloxone blocks opioid receptors).
