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Test Bank for Pharmacy Technician Principles and Practice, 3rd Edition: Hopper

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ISBN-10 ‏ : ‎ 1437706711
ISBN-13 ‏ : ‎ 978-1437706710
Author: Hopper

With chapter-by-chapter review and practice, this easy-to-use workbook and lab manual helps you reinforce your understanding of key facts and concepts from Mosby’s Pharmacy Technician: Principles and Practice, 3^rd Edition. A wide variety of review questions, exercises, and activities help you study more effectively and learn to apply your knowledge for success on the job.

Table contents:

Who Will Benefit From This Book?
Why is This Book Important to the Profession?
Organization
Distinctive Features of this Edition
Drug Names and Pronunciations
Tech Notes
Tech Alerts
Mini Drug Monographs
Pharmacist’s Perspective
Technician’s Corner
New to This Edition
New Chapter! Chapter 14: Medication Safety and Error Prevention
Medical Terminology
Appendix A: Review for the PTCB, EXPCT, or PEBC Examination
Updated Pill Images
Additional Math Exercises
Overall Content Update
Learning Aids
Four-Color Design
Extensive Visual Aids
Chapter Objectives
Key Terms
Do You Remember These Key Points?
Ancillaries
For the Instructor
TEACH Instructor Resource
Instructor’s Resource.
TEACH Online Pharmacy Technician Program Guide.
Additional Instructor Ancillaries
For the Student
Ancillaries Available on the Evolve Companion Web Site
Student Workbook/Lab Manual
Acknowledgments
Reviewers
Contributors
Dedication
Section One General Pharmacy
CHAPTER 1 History of Medicine and Pharmacy
Objectives
Terms and Definitions
IMPORTANT PEOPLE
History of Medicine
Ancient Beliefs and Treatments
The Medical Staff
FIGURE 1-1 Medical staff.
Medicine in Its Infancy
Tech Note!
BOX 1-1
The Hippocratic Oath
Ancient Herbal Remedies
TABLE 1-1 Advancements in Medicine
Eighteenth- and Nineteenth-Century Medicine
North American Medicine
BOX 1-2
Example of Prescription Compound from The 1900s
Tech Note!
Opium and Alcohol
BOX 1-3
Typical Remedies of the 1800s in America
BOX 1-4
The Civil War
Tech Note!
Origin of Opium (Opiates)
Twentieth Century Medicine
Advancements in Drug Therapy and Vaccinations
BOX 1-5
Laudanum Recipe from The 1700s
TABLE 1-2 Examples of Important Vaccine Advancements in Medicine*
Old Remedies Making a Comeback?
History of Pharmacy
Early Pharmacists
Early Pharmacy in America
FIGURE 1-2 Medications were compounded by hand using a variety of compounds.
FIGURE 1-3 Large show globes (seen on top of shelf). An assortment of different mortars and pestles (seen on countertop).
Early Pharmacy Technicians
BOX 1-6
Famous Pharmacists
TABLE 1-3 Advancements in the Field of Pharmacy Technology
Changing Pharmacy
FIGURE 1-4 Pharmacy technician working in the pharmacy setting.
Trust in Pharmacists/Trust in Technicians
Technicians of the Twenty-First Century and Beyond
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites Referenced
For More Information on Topics Covered
CHAPTER 2 Pharmacy Federal Laws and Regulations
Objectives
Terms and Definitions
Introduction
FDA History
Early Activity of the FDA
Description of Laws
1906 Federal Food and Drugs Act
1914 Harrison Narcotics Act
1938 Food, Drug, and Cosmetic Act
1951 Durham-Humphrey Amendment
BOX 2-1
Well-Known Federal Laws
1962 Kefauver-Harris Amendments
1970 Comprehensive Drug Abuse Prevention and Control Act
1970 The Poison Prevention Packaging Act (PPPA)
1983 Orphan Drug Act
BOX 2-2
PPPA Guidelines (Exempt Drugs)*
1987 Prescription Drug Marketing Act
1990 Omnibus Budget Reconciliation Act (OBRA ’90)
1996 Health Insurance Portability and Accountability Act (HIPAA)
Patient Confidentiality
What Information Is Protected?
What Does This Mean for the Pharmacy?
How Is Information Protected via the Computer?
What Are the Rights of the Patient?
Examples of What You (the Technician) Cannot Do
BOX 2-3
Examples of Breaching Confidentiality
Examples of What Is Not Covered under HIPAA Patient Rights
Public Health Activities
Law Enforcement Purposes
Examples
2000 Drug Addiction Treatment Act (DATA 2000)
2003 Medicare Modernization Act (MMA)
2005 Combat Methamphetamine Epidemic Act
FIGURE 2-1 DEA poster on the misuse of pseudoephedrine.
BOX 2-4
Combat Methamphetamine Epidemic Act 2005
TABLE 2-1 Additional Pharmacy-Related Acts
Food and Drug Administration/Drug Enforcement Administration
1972 Drug Listing Act; National Drug Code (NDC)
FIGURE 2-2 Example of NDC label.
FDA Reporting Process and Adverse Reactions
Recalled Drugs
BOX 2-5
NDC Number Specifics
NDC 50580-449-05
FIGURE 2-3 FDA MedWatch form.
Controlled Substances
BOX 2-6
Sample Recall Notification
Recall—Firm Press Release
FIGURE 2-4 Codeine label showing C-II imprint.
TABLE 2-2 Typical Controlled Substances
Ratings of Scheduled (Controlled) Substances
Tamper-Proof Prescriptions
BOX 2-7
Tamper-Proof Features
FIGURE 2-5 Sample of tamper-proof prescription.
Registration Required for Maintaining Narcotics
Refilling Controlled Substances
Ordering Controlled Substances
FIGURE 2-6 Drug Enforcement Administration Form 222.
TABLE 2-3 Examples of State Regulations for C-II Refills and C-III to C-V Refills
Tech Note!
Record Keeping
FIGURE 2-7 A, Pharmacy log sheet. B, Nursing floor log sheet.
TABLE 2-4 Three Methods of Filing Controlled Substances and Legend Drugs
Narcotic Inventory
Reverse Distributor
Tech Note!
Filling, Refilling, and Transferring Prescriptions for Controlled Drugs
Original Filling of C-II through C-V
Emergency Filling of C-II
Refilling of C-II through C-V
Partial Filling of C-II through C-V
Transferring Controlled Drug Prescriptions C-II through C-V
Dispensing Without a Prescription
Lending or Transferring Schedule C-II through C-V Drugs to Another Pharmacy
Mailing Controlled Substances C-II through C-V
Monographs
1 Indications and Usage
2 Dosage and Administration
3 Dosage Forms and Strengths
4 Contraindications
5 Warnings and Precautions
6 Adverse Reactions
7 Drug Interactions
8 Use in Specific Populations
9 Drug Abuse and Dependence
10 Overdosage
11 Description
12 Clinical Pharmacology
13 Nonclinical Toxicology
14 Clinical Studies
15 References
16 How Supplied/Storage and Handling
17 Patient Counseling Information
Boxed Warning
FIGURE 2-8 Highlights of a drug monograph.
Medguides
Pregnancy Categories
BOX 2-8
(A) Special Warnings and Information
(B) Example of Drugs Requiring Boxed Warning
Prescription Regulation
Who Can Prescribe?
Who Can Receive a Prescription?
BOX 2-9
Pregnancy Categories
Category A
Category B
Category C
Category D
Category X
Tech Note!
Prescription Labels
BOX 2-10
Prescribing Authority
Special Labeling
Records and Labeling Requirements
FIGURE 2-9 A, Sample of information necessary on a physician’s prescription order. B, Sample of information on a medication label.
TABLE 2-5 Required Prescription Information*
Repackaging
Drug Enforcement Administration Verification
BOX 2-11
Drugs Requiring Additional Information
Tech Alert!
Non–Child-Resistant Caps
BOX 2-12
Drug Enforcement Administration Verification Process of Prescriber’s DEA Number
TABLE 2-6 Prescription Drugs That Can Be Packaged in Non–Child-Resistant Bottles
Special Prescribing Programs
Programs for Opioid Maintenance
Methadone Maintenance Treatment (MMT)
Suboxone and Subutex
Risk Management Programs for Prescription Drugs
iPledge Program under the FDA
Tech Alert!
Pharmacy Sites
Brick and Mortar and Mail-Order Pharmacies
Online Pharmacies (E-Pharmacy)
Occupational Safety and Health Administration
BOX 2-13
Common Safety and Health Topics
Material Safety Data Sheets (MSDS)
The Joint Commission
Legal Standards
State Laws
Liabilities
Tech Alert!
Pharmacy Employee Requirements: Request for Waiver
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Referenced Websites
CHAPTER 3 Pharmacy Ethics, Competencies, Associations, and Settings for Technicians
Objectives
Terms and Definitions
Introduction
Historical Data
Competencies
Current Qualifications
BOX 3-1
White Paper on Pharmacy Technicians 2002
Nondiscretionary Duties
BOX 3-2
Chapter References Citing Common Responsibilities and Competencies of A Pharmacy Technician
Basic Nondiscretionary Skills
Typing
Computers
Reports and Documentation
Ordering Supplies
BOX 3-3
Examples of Federal Laws Governing Pharmacy
Prescription Records
Patient Consultation (OBRA ’90)
Tech Note!
Inpatient Setting Requirements
Tech Note!
FIGURE 3-1 Room for preparing intravenous solutions for inpatients.
Community (Outpatient) Setting Requirements
FIGURE 3-2 Outpatient filling station.
Closed Door Pharmacy Requirements
FIGURE 3-3 Home health and long-term pharmacy industry setting.
Mail-Order Pharmacy and E-Pharmacy
Ethics and Communication in the Workplace
Professionalism
Morals Versus Ethics in the Workplace
Protocol
Communication
BOX 3-4
Pharmacy Technician Code of Ethics
Preamble
Principles
Listening Skills
FIGURE 3-4 Technician helping customer.
Body Language
Verbal Communications
Vocal: How You Sound
BOX 3-5
Example of Negative Body Language
How to Improve Your Vocal Communication Skills
Verbal: What You Say
First Way of Handling a Problem
Second Way of Handling the Same Problem
How to Improve Your Verbal Skills
Phone Etiquette
Written Communication
Confidentiality
Terminally Ill Patients
BOX 3-6
Example of Unacceptable Phone Etiquette
BOX 3-7
Example of Poor Written Communication Skills
Information That Should Be Obtained and Written Down in the Message:
BOX 3-8
Example of Breach of Confidentiality
Training Programs for the Pharmacy Technician Student
Different Levels of Pharmacy Technicians
BOX 3-9
ASHP Course Curriculum Requirements
National Certification for Technicians
BOX 3-10
Goals of PTCB and Exam Requirements
Goals
Eligibility Requirements to Take the Exam Include the Following:
Continuing Education
TABLE 3-1 Comparisons of National Certification Examinations
Tech Note!
Tech Alert!
Opportunities for Technicians
TABLE 3-2 Examples of Continuing Education Website Portals for Technicians
BOX 3-11
PTCB Qualifications and Common Duties of Certified Technicians
Job Duties
Knowledge, Skills, Training, and Education
Incentive Programs
The Professional Technician Associations
American Pharmacists Association (Apha)
American Society of Health-System Pharmacists (AShP)
TABLE 3-3 Organizations/Associations for Pharmacy Technicians*
American Association of Pharmacy Technicians (AAPT)
National Community Pharmacists Association (NCPA)
National Pharmacy Technician Association (NPTA)
BOX 3-12
Internet Sites for Jobs
The Job Search
The Resume
Professional Dress
Tech Note!
The Possibilities
BOX 3-13
Resume Help
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
CHAPTER 4 Conversions and Calculations Used by Pharmacy Technicians
Objectives
Terms and Definitions
Introduction
Tech Note!
History of Pharmacy
Roman Numerals
Rules for Determining Roman Numerals
EXAMPLE 4-1 Working with Roman Numerals
TABLE 4-1 Arabic and Roman Numerals
EXERCISE 4-1 Quick Check
International Time (Military Time)
FIGURE 4-1 Military clock versus traditional clock.
EXERCISE 4-2 Quick Check
Practice Quiz #1 (Roman Numerals and Time)
BOX 4-1
Time Conversions
Fill in the blanks:
Multiplication/Division
EXERCISE 4-3 Quick Check
TABLE 4-2 Multiplication Chart
Fractions, Decimals, Percentages, Ratios, and Proportions
Converting Fractions to Decimals
EXERCISE 4-4 Quick Check
Converting Fractions to Percentages
Converting Ratios to Percentages
Converting Decimals to Percentages
EXERCISE 4-5 Quick Check
Ratios/Proportions
EXAMPLE 4-2
EXAMPLE 4-3
Tech Note!
EXERCISE 4-6 Quick Check
Other Examples of Proportion Problems
EXAMPLE 4-4
EXAMPLE 4-5
EXAMPLE 4-6
Answer to question 1
Answer to question 2
Answer to question 3
Answer to question 4
EXAMPLE 4-7
Tech Note!
Example of Proportions in Compounding
Working with Word Problems
EXAMPLE 4-8
EXAMPLE 4-9
EXERCISE 4-7 Quick Check
Determine 1 Dose
TABLE 4-3 Metric Prefixes
Practice Quiz #2 (Decimals, Fractions, Percentages)
Convert the following percents to decimals
Convert the following fractions to percents
Metric System
Metric Measurements
Tech Alert!
EXERCISE 4-8 Quick Check
TABLE 4-4 Metric-Household Conversion Measurements
Household Measurements
EXAMPLE 4-10
EXAMPLE 4-11
EXAMPLE 4-12
Tech Note!
EXERCISE 4-9 Quick Check
Apothecary System
FIGURE 4-2 Oral cups show equivalent volumes between household to metric and household to apothecary units.
EXAMPLE 4-13
Using 65 mg/grain
EXAMPLE 4-14
Using 65 mg/grain
EXERCISE 4-10 Quick Check
Tech Note!
TABLE 4-5 Standard Weights and Volumes: Avoirdupois/Metric*
EXERCISE 4-11 Quick Check
Avoirdupois System
Avoirdupois Measurements
EXERCISE 4-12 Quick Check
Volumes
Weights
Practice Quiz #3
Important Differences among Systems
TABLE 4-6 Apothecary/Metric/Household Conversions
BOX 4-2
Time Schedule (Pharmacy Abbreviations)
FIGURE 4-3 Common devices used for measuring liquid medications.
Oral Syringes and Injections
Pediatric and Geriatric Dosing
EXAMPLE 4-15
EXAMPLE 4-16
Calculating the Proper Dose
EXERCISE 4-13 Quick Check
Tech Note!
Calculating Pediatric Dosage
EXAMPLE 4-17
EXERCISE 4-14 Quick Check
Tech Note!
Calculating Body Surface Area (BSA)
Other Methods of Calculating Pediatric Doses
Geriatric Patients
EXERCISE 4-15 Quick Check
Tech Note!
Drip Rates
Tech Note!
EXAMPLE 4-18 Calculating Drip Rates
EXERCISE 4-16 Quick Check
EXAMPLE 4-19 Determining Volume Based on Drop Factor (DF)
EXAMPLE 4-20
Tech Note!
Dilution
FIGURE 4-4 Large-volume IV drip with smaller piggyback attached to tubing on pump.
EXERCISE 4-17 Quick Check
Alligation
Tech Note!
EXERCISE 4-18 Quick Check
Practice Quiz #4
Do You Remember These Key Points?
Test Questions
Convert the following units into percentages
Convert the following fractions of grains into milligrams
Write the Arabic numbers in Roman numerals and the Roman numerals in Arabic numbers
Convert the following metric units into the units indicated to the right
Solve the following drug orders. Be sure to show your work. Use the following conversions
Technician’s Corner
Bibliography
CHAPTER 5 Dosage Forms, Routes of Administration and Drug Classifications, Drug Abbreviations, and Medical Terminology
Objectives
Terms and Definitions
TERMS AND ABBREVIATIONS
Introduction
Where Did Pharmacy Abbreviations Originate?
Do Not Use List
Dosing Instructions
TABLE 5-1 TJC Official “Do Not Use” List*
TABLE 5-2 ISMP Error-Prone Abbreviations, Symbols, and Dosage Designations
Classifications of Medications
TABLE 5-3 General Classifications of Medications
Different Types of Drug Sales
Dosage Forms
FIGURE 5-1 A, Unscored tablet. B, Scored tablet.
FIGURE 5-2 A, Plain tablets. B, Scored tablets. C, Enteric-coated tablets.
TABLE 5-4 25 Top Selling Generic Drugs with Multiple Dosage Forms
Tech Note!
Solids
Tablets/Caplets
Tech Note!
Capsules
Capsule Sizes
FIGURE 5-3 Different types of capsules.
FIGURE 5-4 Types of capsules. A, Capsules. B, Extended-release capsules.
FIGURE 5-5 Different sizes of capsules. Eight sizes are available; each holds a specific volume, and each holds a specific amount of medication. The size numbers are 5, 4, 3, 2, 1, 0, 00, 000—5 being the smallest and 000 being the largest.
Example of Caplets and Capsules
Lozenges/Troches
Example of Lozenges and Troches
Biomaterials
Implants
Transdermal Patches
FIGURE 5-6 A, Example of nitroglycerin ointment patch. B, Example of a transdermal patch.
Example of Topical patches
Tech Alert!
Liquids
Syrups
Example of Syrups
Elixirs
Example of Elixirs
Sprays
Example of Sprays
Inhalants and Aerosols
Example of Aerosol and Mdis
Tech Note!
Emulsions
FIGURE 5-7 A, Inhaler. B, Inhaler attached to an AeroChamber (also known as a spacer).
Example of Emulsions
Tech Note!
Suspensions
Example of Suspensions
Tech Note!
Enemas
Example of Enemas
Semisolids
Creams
Example of creams
Lotions
Example of Lotions
Ointments
Example of Ointments
Gels
Example of Gels
Pastes
Example of Pastes
Suppositories
Example of Suppositories
Powders
Example of Powders
Injectables
Example of Injectables
FIGURE 5-8 A, Medication in vials. B, Medication in ampules.
FIGURE 5-9 This type of vial is called Add-A-Vial or Mix-O-Vial. The advantage of this type of medication dosage form is its longer shelf life. 1, First remove the sterile cap. 2, The powder is below, and the sterile diluent is on top of the vial. The vial is divided by a rubber stopper in the middle. 3, Push the plunger down, forcing the stopper to fall into the bottom of the vial. This allows the diluent to mix with the powder. Shake well. Once dissolved, the medication is ready to be used.
FIGURE 5-10 On the left is a large-volume IV. On the right is an IV piggyback.
Routes of Administration
By Mouth, or Oral
Sublingual and Buccal Agents
TABLE 5-5 Common Abbreviations Used with Dosage Forms
FIGURE 5-11 A, Sublingual tablet placement. B, Buccal tablet placement.
Rapidly Disintegrating Oral Tablets
Rectal Agents
Topical Agents
Parenteral: Intravenous, Intravenous Piggyback, Intramuscular, and Subcutaneous Agents
Eye/Ear/Nose (ophthalmic, otic, nasal)
Inhalants
Injectable (Long-Acting)
Miscellaneous Routes
Other Considerations: Form and Function
Pharmacokinetics vs. Pharmacodynamics
Absorption
Distribution
FIGURE 5-12 Lock-and-key mechanism allowing absorption to take place in a cell. These common reactions take place naturally throughout the body. Only after the correct receptor makes a connection with the matching receptor site will the cell allow a reaction to take place. Medications often mimic this natural mechanism.
BOX 5-1
Ionization
Metabolism
Excretion/Elimination
Bioavailability
Half-Life
Bioequivalence
The Use of Excipients
Manufactured Products
TABLE 5-6 Description of Additives
TABLE 5-7 Description of Dosage Forms
TABLE 5-8 Examples of Storage Requirements
Packaging and Storage Requirements
Medical Terminology
TABLE 5-9 Abbreviations for Conditions or Body Systems
BOX 5-2
Overview of Word Parts of Medical Terminology
Rules
TABLE 5-10 Common Body System Word Segments
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Question
Bibliography
Websites
CHAPTER 6 Drug Information References
Objectives
Terms and Definitions
Introduction
Understanding the Correct Way to Reference
Tech Note!
BOX 6-1
Examples of Trade Drug Names That Indicate the Function of the Drug
Tech Note!
References Used in Pharmacy
Drug Facts and Comparisons
BOX 6-2
Examples of Similar Endings of Generic Drug Names
Physicians’ Desk Reference
TABLE 6-1 Sections in Drug Facts and Comparisons
TABLE 6-2 Sections of Physicians’ Desk Reference
Drug Topics Red Book
BOX 6-3
Example of Information in Drug Facts and Comparisons
Omeprazole
Looking Up Information Under Trade Name:
Looking Up Information Under Generic Name:
TABLE 6-3 Sections in Drug Topics Red Book
Approved Drug Products with Therapeutic Equivalence Evaluations: “Orange Book”
American Hospital Formulary Service Drug Information
United States Pharmacopeia–National Formulary (USP–NF)
TABLE 6-4 Abbreviations in Drug Topics Red Book
United States Pharmacists’ Pharmacopeia
Clinical Pharmacology and Other Gold Standard/Elsevier Products
Ident-A-Drug
FIGURE 6-1 Screen shot from Clinical Pharmacology showing a drug monograph.
Micromedex Healthcare Series
FIGURE 6-2 Screen shot from Clinical Pharmacology showing a pill using the Drug IDentifier.
Trissel’s Handbook on Injectable Drugs
American Drug Index
Goodman & Gilman’s the Pharmacological Basis of Therapeutics
Handbook of Nonprescription Drugs by Apha
Martindale’s The Complete Drug Reference
Remington’s Pharmaceutical Sciences: The Science and Practice of Pharmacy
Pediatric Dosage Handbook (Lexi-Comp)
Geriatric Dosage Handbook (Lexi-Comp)
TABLE 6-5 Main Attributes of Various References
Pocket-Sized Reference Books
Electronic Referencing
The Internet
Journals and Newsmagazines
TABLE 6-6 Online Websites and Databases
Additional Types of Information
TABLE 6-7 Types of Journals and Pharmacy Magazines Available
TABLE 6-8 Additional Reference Books That Technicians May Find Helpful in Understanding Various Aspects of Health Care
Tech Note!
Considerations When Choosing a Reference
BOX 6-4
Pharmacy Associations* that Provide Continuing Education and Information
Tech Note!
Do you Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 7 Prescription Processing
Objectives
Terms and Definitions
Introduction
Processing a Prescription: A Step-by-Step Approach
Receiving the Prescription
Tech Note!
Prescription Information
Community Pharmacy Setting
Institutional Setting
Tech Note!
FIGURE 7-1 Example of physician’s prescription.
BOX 7-1
Commonly Followed Rules for Taking Prescriptions
Call-in
Fax
Walk-in
E-Prescribing
The following are some benefits of using E-prescribing:
The following are some barriers for E-prescribing:
Tech Note!
Translation of an Order
BOX 7-2
Required Patient Information in a Community Setting
Patient Information:
Provider’s Information:
Prescription Information:
When to Ask for Help
Tech Note!
Tech Note!
Entering the Information into the Database
Community Setting
BOX 7-3
Required Patient Information in an Institutional Setting
Patient Information:
Prescriber Information:
Prescription Order Information:
Other Important Information, Usually Available from Medical Chart or Nursing Staff:
Institutional Setting
FIGURE 7-2 Technicians may enter information into the computer system in many pharmacy settings.
Filling the Prescription in a Community Setting
Tech Note!
1 Verifying the Prescription
FIGURE 7-3 Technicians filling prescriptions.
Tech Note!
2 Pulling the Correct Medication
Tech Note!
3 and 4 Counting and Filling the Medication
FIGURE 7-4 Pulling medication from the shelf.
5 Prescription Lids
6 Applying the Label
FIGURE 7-5 Technician counting and pouring tablets into medication vial.
TABLE 7-1 Exceptions for Safety Lids*
Tech Note!
7 Technician’s Initials
8 Auxiliary Labels
Tech Note!
9 and 10 Pharmacist’s Final Inspection
FIGURE 7-6 Applying an auxiliary label.
TABLE 7-2 Commonly Used Auxiliary Labels for Side Effects
Community Dispensing Systems
Filling Orders in an Institutional Setting
BOX 7-4
Advantages of a Computer Dispensing System
Computer Dispensing Systems
Inpatient Dispensing Systems
The 5 Rights of Medication SafetY
Pharmacist Consultations: When and Who Needs Them
Miscellaneous Orders
Community Setting
Daily Hard-Copy Printing (QUEUE)
FIGURE 7-7 Patient consultation.
Refills
Tech Note!
Zero Refill Reorders
Transfers
Refilling Automated Dispensing System (ADS) Machines
Tech Note!
Filing Prescriptions
TABLE 7-3 Filing Prescriptions
Early Fills
Medication Pickup
Billing Patients
Changing Trends
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
CHAPTER 8 Over-the-Counter Medications
Objectives
Terms and Definitions
Introduction
FIGURE 8-1 More than 100,000 OTC products exist from different combinations of only 1000 ingredients.
Three FDA Categories Concerning Classification of Over-the-Counter Drugs
TABLE 8-1 Common Over-the-Counter Brand Preparations
Food and Drug Administration Regulations
Purity
BOX 8-1
Types Of Product Additives
Potency
Bioavailability
Efficacy
Safety and Toxicity
BOX 8-2
Medications Measured in Units (Requires a Prescription)
How a Prescription Drug Becomes an Over-the-Counter Drug
BOX 8-3
Food and Drug Administration Phases of Over-the-Counter Drug Approval
TABLE 8-2 OTC Versus Rx Medications
Conditions Treated with Over-the-Counter Drugs
Analgesics and Antipyretics
TABLE 8-3 Common Types of Over-the-Counter Products*
Common Patient Information
Tech Note!
Tech Note!
Interactions between Aspirin and Other Agents
TABLE 8-4 Analgesics and Antipyretic Products
TABLE 8-5 Examples of Common and Important Interactions between Aspirin and Other Medications
Headache Products
Antiinflammatories
Common Patient Information
Tech Note!
Allergy and Cold Agents
Decongestants
TABLE 8-6 Headache Products
TABLE 8-7 Antiinflammatory Products
Common Patient Information
Antihistamines
Common Patient Information
Sleep Aids
TABLE 8-8 Decongestant Products
TABLE 8-9 Oral Antihistamine Products*
Common Patient Information
Cough Medicines
Common Patient Information
Sore Throat Products
TABLE 8-10 Antiinsomnia Products
TABLE 8-11 Cold and Cough Products
TABLE 8-12 Sore Throat Products
Common Patient Information
Tech Note!
Stomach Remedies/Antacids
Common Patient Information
Tech Note!
Intestinal Remedies
TABLE 8-13 Stomach Products/Antacids
Common Patient Information
Skin Remedies
Geriatric and Pediatric Considerations
TABLE 8-14 Intestinal Products
TABLE 8-15 Over-The-Counter Skin Products
TABLE 8-16 Common Agents Used to Treat a Variety of Conditions
TABLE 8-17 Effects Drugs Have on an Aging Body
Behind-the-Counter Drugs
Do You Remember These Key Points?
Review Questions
TABLE 8-18 Current BTC Medications
Multiple choice questions
True/False
Technician’s Corner
Reference
Bibliography
Websites
Websites
CHAPTER 9 Complementary and Alternative Medicine
Objectives
Terms and Definitions
Agents Covered In This Chapter
Introduction
What Is Alternative Medicine?
Overview of Eastern versus Western Medicine
Trends toward Alternatives
Organizations Related to Alternative Medicine
Maggot Therapy
TABLE 9-1 Twelve Alternative Treatments
TABLE 9-2 BTER Foundation Research Areas
Leech Therapy
Ancient Chinese Medicine
BOX 9-1
Ugly Medicine
Leeches
Maggots
Acupuncture
Acupressure
FIGURE 9-1 Acupuncture.
FIGURE 9-2 Acupressure points.
Additional Forms of Complementary and Alternative Medicine
Art Therapy
Ayurveda
Biofeedback
Chiropractic Therapy
FIGURE 9-3 Biofeedback. Example of electrode placement.
Pharmacist’s Perspective
Educate Yourself about Complementary and Alternative Medicine and Health
Herbal Medicine
TABLE 9-3 Examples of Herbal-Drug Interactions
Herbal Treatments
TABLE 9-4 Common Uses and Cautionary Notes for Herbals
FIGURE 9-4 Black cohosh.
FIGURE 9-5 Garlic.
FIGURE 9-6 Purple coneflower.
Herbal Preparations
TABLE 9-5 Herbal Preparations
Homeopathy
Tech Note!
The Placebo Effect
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites Referenced
CHAPTER 10 Hospital Pharmacy
Objectives
Terms and Definitions
Introduction
Types of Hospitals
Hospital Pharmacy Standards and Procedures
Policies and Procedures
TABLE 10-1 Example of Various Sizes and Types of Hospitals
Tech Note!
Hospital Protocol
Tech Note!
Hospital Standards
Hospital Orders
Flow of Orders
FIGURE 10-1 The flow of orders. As orders arrive, they are entered into the computer. If an order is unclear or if there is a question, the pharmacist contacts the physician.
FIGURE 10-2 Example of a physician’s order. Note the medical record number in place of a prescription number. Also, the patient’s room number and allergies should be listed (not shown).
FIGURE 10-3 Pneumatic tube system. A pneumatic tube system is used to transport orders to the pharmacy and medications to hospital floors.
Point of Entry (POE)
Computerized Physician Order Entry (CPOE)
Bar Code Point of Entry (BPOE)
Computerized Adverse Drug Event Monitoring (CADM)
Responsibilities of an Institutional Technician
Patient Cassette Drawers
TABLE 10-2 Common Job Descriptions
Preparing Unit Dose Medications
Unit Dose Liquids
Controlled Substances
Description
Duties
Daily IV Preparation Duties
Aseptic Technique
USP <797>
IV Tech
Description
Chemotherapy Preparation
Description
FIGURE 10-4 Airegard 301 (Horizontal Laminar Flowhood Clean Bench).
FIGURE 10-5 Vertical flow hood.
FIGURE 10-6 Proper placement of labels on parenteral solutions.
Tech Alert!
Labeling
Description
Tech Alert!
Inventory Control Technician
Description
Duties
Supplying Specialty Areas
BOX 10-1
Examples of Primary Units and Areas that Require Medication from Pharmacy
Tech Alert!
Nonclinical Areas Stocked by the Pharmacy
BOX 10-2
Examples of Hospital Codes*
Central Supply
TABLE 10-3 Commonly Used Crash Cart Medications and Their Classification
BOX 10-3
Special Departments Stocked by the Pharmacy
Glove Boxes
FIGURE 10-7 Labgard 437: Glove box for IV admixture.
Automated Dispensing Systems (ADSs)
Additional Areas of Pharmacy
Satellite Pharmacies
Description
Duties
Discharge Pharmacy
Description
Duties
Pharmacy and Nursing Staff Relationship
BOX 10-4
Ads Manufacturers
Tech Note!
Stat and ASAP Orders
Specialty Tasks
Investigational Drugs/Biological Therapies
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 11 Repackaging and Compounding
Objectives
Terms and Definitions
Introduction
Repackaging
Tech Note!
Repackaging Equipment
Repackaging Techniques
TABLE 11-1 Examples of Good Manufacturing Practice Guidelines
FIGURE 11-1 Sample of containers.
FIGURE 11-2 A sample blister pack container.
FIGURE 11-3 A technician is responsible for the proper preparation and labeling of all repackaged medications. A, The empty medication card is rotated under the hopper, where the medication is placed into the card. The medication card is then rotated to the heating element, where the seal is made to enclose each tablet. B, The technician uses a mirror to verify that each sheet is filled completely.
TABLE 11-2 Unit Dose Containers
Tech Note!
Documentation
Labeling and Checking Repackaged Medications
FIGURE 11-4 Sample of a unit dose log record.
TABLE 11-3 Example of Unit Dose Record Log Sheet Information*
TABLE 11-4 Examples of Manufacturer Abbreviation Codes
Tech Alert!
Storage and Stability
Expiration Dates Versus Beyond-Use Dating
Method 1
EXAMPLE 11-1 Expiration Dating (6-Month Version)
Method 2
EXAMPLE 11-2 Beyond-Use Dating (1-Year Version)
Tech Alert!
Compounding
History
Non–Sterile Compounding
BOX 11-1
Why Compound Medications?
Compounding Area
Equipment
Personal Protective Equipment
BOX 11-2
Examples of Dosage Forms that Can be Compounded
Topicals
Oral Liquids
Oral Solids
Suppositories
Measuring Devices
TABLE 11-5 Examples Of Compounding Equipment
Mixing Equipment
FIGURE 11-5 Graduated cylinders are used for liquid measurement.
TABLE 11-6 Types of Graduated Cylinders
FIGURE 11-6 Mortars and pestles are used to crush solids. Both glass and porcelain types are used in compounding.
TABLE 11-7 Types of Compounding Mixing Equipment
Weighing Equipment
FIGURE 11-7 A, Class A balance. B, Pharmaceutical weights. C, Analytical balance.
Additional Supplies
Mold Forms
Excipients
Taste
TABLE 11-8 Common Additives
TABLE 11-9 Common Flavor Additives for Taste*
Non–Sterile Compounding and Techniques
Personal Preparation
Weighing Techniques
BOX 11-3
Competencies
Tech Note!
Measuring Liquids
Preparing Solutions
BOX 11-4
Instructions for Using a Class a Balance
Solubility
Tech Note!
Reconstituting Premade Suspensions
FIGURE 11-8 The meniscus is the level at which liquids are measured and recorded. For accuracy always have the container at eye level when determining the volume.
Solids: Tablets, Capsules, and Lozenges
BOX 11-5
Solubility Characteristics
TABLE 11-10 Common Auxiliary Labels Placed on Medication Containers
Molded Tablets
Tablet Molds
Steps Necessary for Preparation of Molded Tablets
Compressed Tablets and Lozenges
BOX 11-6
Tablet Additives
Making a Tablet
Compounding Capsules
BOX 11-7
Calibrating the Mold
BOX 11-8
Compounding Procedure for Molded Tablets
Lozenges
TABLE 11-11 Capsule Sizes
Hard Lozenges
Soft Lozenges
Chewable Lozenges
Semisolids: Ointments, Sticks, and Suppositories
Medication Sticks
Filling Ointment Jars
Filling Ointment Tubes
Soft Sticks
BOX 11-9
Classifications of Ointment Bases
Formulations
Suppositories
Oleaginous Bases
Water-Soluble Bases
Glycerinated Gelatins
Preparing Suppositories
Using Molds
FIGURE 11-9 Suppository molds can be used as well as hand-rolled method. A, Suppository molds prepared in the pharmacy. B, Suppository packaging.
Using Hand-Rolling Method
Packaging Suppositories
Nasal Preparations: Ointments, Suspensions, Gels, and Solutions
Preparing Solution
Preparing Suspensions
Preparing Ointments
Preparing Gels
Tech Alert!
Packaging
TABLE 11-12 Types of Containers/Sealants and Dosage Forms They Contain
Tech Note!
Stability
Documentation
Safety
TABLE 11-13 USP <795> Guidelines
Sterile Compounding
BOX 11-10
Information Necessary on Compounding Log Sheet and Medication Label
Log Sheet Information
Medication Label Information
Ophthalmic Agents
Tech Note!
EXAMPLE 11-3
Cefazolin Super Eye Drops
Tech Alert!
Compounding Professionalism
Regulatory and Quality Control
Chemotherapeutic Agents
Veterinary Medications
BOX 11-11
Labeling Requirements for Animal Prescriptions
TABLE 11-14 Pet Dosage Forms and Flavorings
Compounding
Personnel Training
Compounding Calculations
Reducing or Enlarging Formulas
Determining Partial Dosage Units
Changing Stock Solutions
Mixing Products of Different Strengths
Performing Solubility Expressions
Converting Units to Weights
Do you Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites Referenced
CHAPTER 12 Aseptic Technique
Objectives
Terms and Definitions
Introduction
Terminology Used in Pharmacy
Standard Precautions of a Health Care Worker
BOX 12-1
Abbreviations and Descriptions of Pharmacy Stock
Types of Containers Used for Preparing Parenteral Medications; Description of Container and/or Contents
Common Types of Solutions Used/Ordered for Parenteral Agents
Routes of Administration for Parenteral Agents
Miscellaneous Terms Used Concerning Parenteral Medications
Supplies
Syringes
FIGURE 12-1 Anatomy of a syringe. As the syringe decreases in size, the calibrations (volume markers) become larger, allowing a more accurate dosage.
FIGURE 12-2 Two types of syringes. A, Regular tip syringe. The regular tip is held in place by pressure, as seen in the 1-mL syringe. B, The Luer-Lok syringe has spirals to secure the needle, as seen on a larger 3-mL syringe.
TABLE 12-1 Commonly Used Intravenous Room Supplies
Needles
FIGURE 12-3 Tubex holders are intended to be reused. They hold the disposable Tubex or Carpuject cartridges. Each cartridge is prelabeled with the medication name, strength, volume, and concentration. The pharmacy stocks holders and cartridges.
FIGURE 12-4 Needle sizes shown are (from top to bottom) 19, 20, 21, 23, and 25 gauge. Technicians may use a 19-gauge needle for small volumes such as 1 mL or less. Larger gauges (not shown) include 18 and 16 gauge for larger volumes.
Filters
Stock Levels
FIGURE 12-5 Anatomy of a needle.
FIGURE 12-6 A, Mini-spikes used in multidose vials. B, Filter needles. C, Filter sizes. D, Ampules and ampule breakers. E, Transfer needle. F, Syringe and caps.
Tech Note!
Routes of Administration (ROA)
Tech Note!
Medication Delivery Systems
Piggyback Containers
FIGURE 12-7 This gravity pump system intravenous piggyback setup shows a 100-mL Viaflex container (left) piggybacked to a large-volume 1-L IV (right).
Large- and Small-Volume Drips
Buretrol Systems
FIGURE 12-8 Volutrol drip systems are used mostly for pediatric patients. Nurses prepare these.
Tech Note!
Continuous Analgesic Delivery Systems
Patient-Controlled Analgesia (PCA) Syringe System
PCA Syringe Systems
Patient-Controlled Analgesia (PCA) Cassette System
FIGURE 12-9 A, Controlled analgesia device pump. B, Patient-controlled analgesia pump.
PCA Cassette Systems
Vials
Tech Note!
Aseptic Technique
FIGURE 12-10 ADD-Vantage system: To prepare IV, follow the three steps listed. 1, Remove the vial top. 2, Pull up flange, removing the seal on the intravenous bag. 3, Screw the vial into the port. Do not break the seal between vial and bag.
FIGURE 12-11 Proper hand washing technique.
FIGURE 12-12 Steps for proper sterile gloving. 1, Open glove packet. 2, Open glove cover without touching gloves. 3, Holding cuff of glove, pull glove over hand. 4, Slide gloved hand under the cuff of the second glove. Carefully pull on glove.
BOX 12-2
Personnel Preparation*
Tech Alert!
USP <797>
Risk Levels
TABLE 12-2 Terms/Abbreviations Used in Pharmacy
TABLE 12-3 USP <797> Risk Levels
Low Risk Level 1
Medium Risk Level 2
High Risk Level 3
Education and Training
FIGURE 12-13 Compounding evaluation checklist.
BOX 12-3
Media-Fill Tests
Tech Note
Requirements for Compounding
TABLE 12-4 USP Air Standards Based on 0.5-µm Particle Size
IV Environment
BOX 12-4
Environment Terminology
Storage and Stability
FIGURE 12-14 Clean room.
Hood Cleaning and Maintenance
Airflow
TABLE 12-5 Storage Risk Levels: Temperature Ranges and Expiration Dates of Compounded Medications
Cleaning and Maintaining Hoods
TABLE 12-6 HEPA Filtering System Standards
BOX 12-5
Daily Cleaning of Laminar Airflow Workbench
Hand Placement
FIGURE 12-15 The six-step process of using aseptic technique in the hood is as follows: (1) Using alcohol, wipe the tops of the vials and the ports on the intravenous bags from back to front (wipe around the vial and bag rather than over or behind). (2) Place the needle bevel side up and push it into the rubber stopper of the vial. Preload the syringe with the necessary amount of air to replace solution. (3) Invert the vial and syringe 180 degrees. Push in the air from the syringe and pull out the solution. (4) After removing the syringe from the vial, insert the needle into the intravenous bag and inject the medication using a steady hand. (5) After injecting the intravenous bag with the medication, immediately flip the bag over. This decreases the possibility of forgetting which bags have been injected and which ones have not. (6) Never recap the used needles; instead, discard each syringe in a sharps container along with the uncapped needle after use. Syringes cannot be reused when changing from one drug to another. This decreases the chance of drug-to-drug contamination.
BOX 12-6
Cleaning the Vertical Flow Hood
BOX 12-7
Cleaning the Biological Safety Cabinet
Disposal
Tech Note!
Spills
Tech Note!
Parenteral Antibiotics and Solutions
BOX 12-8
BSC Guidelines for Medication Preparation
TABLE 12-7 Example of Suggested Dosing Times, Solutions, and Appropriate Volumes for Antibiotics
Technique
Use of Ampules to Prepare Medications
Technique
FIGURE 12-16 Proper manipulation of ampule: Ampule sizes range from 1- to 50-mL glass containers. For larger ampules, an ampule breaker is suggested. For smaller ampules, follow these steps: (1) Tap top of ampule to empty top of container. (2) Using an alcohol swab, wipe the neck of the ampule and snap open (away from you). (3) Tilt the ampule at an angle (the solution will not spill) and withdraw needed amount of drug using a filter needle. (4) Replace the filter needle with a regular needle and inject into solution; however, if sending the syringe, remove the needle and cap the end of the syringe. (5) Label container and place in proper location for pharmacist’s inspection.
Hyperalimentation
Tech Note!
FIGURE 12-17 A total parenteral nutrition preparation connected to an infusion set.
Electrolytes and Additives
TABLE 12-8 Types of Parenteral Additives
FIGURE 12-18 Example of a total parenteral nutrition order.
Compatibility Considerations of Parenteral Medications
Tech Note!
Components of a Label for Intravenous Medication
TABLE 12-9 Additional Considerations for the Preparation of Drugs
FIGURE 12-19 Example of an intravenous medication label.
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 13 Pharmacy Stock and Billing
Objectives
Terms and Definitions
Types of Insurance
Introduction
Formulary and Drug Utilization
Pharmacist’s Perspective
Drug Utilization and Formulary Selection Process
Generic versus Trade Name Drugs
Third-Party Billing
Point of Sale (POS) Billing
Types of Insurance
Health Maintenance Organization (HMO)
TABLE 13-1 Types of Insurance Claims
What If Your Patient Has HMO Insurance?
Preferred Provider Organization (PPO)
What If Your Patient Has PPO Insurance?
Drug Discount Cards or Drug Coupon Cards
Government-Managed Insurance Programs
History of Medicare and Medicaid
FIGURE 13-1 Sample health insurance card.
BOX 13-1
Medicare Coverage Types
TABLE 13-2 Chronological Changes in Medicare/Medicaid Coverage
Tech Note!
Current Use of Medicare/Medicaid Insurance
Medicare
Medicare Part D
What If Your Patient Has Medicare Insurance?
BOX 13-2
Medigap Coverage
BOX 13-3
Various Supplies Covered by Medicare
FIGURE 13-2 Sample Medicare Part D card.
Medicaid
What If Your Patient Has Medicaid Insurance?
Workers’ Compensation
Tech Note!
Billing the Insurance Company
Prior Authorization
Tech Note!
TABLE 13-3 Minimum Information Required by Insurance Companies
Tech Note!
Patient Profiles
FIGURE 13-3 TAR form.
FIGURE 13-4 Computer patient profile using OmniLinkRx.
BOX 13-4
Information Contained on a Prescription Card
Processing Claims
Claim Problems
FIGURE 13-5 Universal claim form.
Tech Note!
Coverage Expiration Policy for Drugs
Limitation of Plan Exceeded
FIGURE 13-6 The arrow on the drug label shows the NDC code for this drug.
Tech Note!
Handling Non-formulary Drugs or Noncovered National Drug Codes
Filling a Prescription Too Soon
Non-Identification Match
Pharmacy Stock
Ordering Systems
Special Orders
Bar Coding
Automated Dispensing Systems (ADS)
Tech Note!
Manual Ordering
FIGURE 13-7 OmniRx.
New Stock
Tech Note!
Proper Storage
Returns
BOX 13-5
Receiving Stock
Drug Recalls
Damaged Stock
Expired Stock
BOX 13-6
Recall Notification
Automated Return Companies
Nonreturnable Drugs and Their Disposal
Tech Note!
Suppliers
Special Ordering Considerations
TABLE 13-4 Difference in Ordering from Manufacturers, Wholesalers, and Warehouse Repackaging Plants
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 14 Medication Safety and Error Prevention
Objectives
Terms and Definitions
Introduction
What Constitutes an Error?
TABLE 14-1 Common Hospital Pharmacy Errors (ASHP)
TABLE 14-2 MERP Error Categories
How Errors Occur
Scenario #1: Misinterpretation of Physician’s Orders
Scenario #2: Missed Dose
Scenario #3: Wrong Patient
Scenario #4: Adverse Effect
Scenario #5: Noncompliance
Where Errors Are Made
Why Errors Occur
BOX 14-1
Non–Health Care Settings
Recommendations from MERP
Example 1
Example 2
Look-Alike, Sound-Alike (LASA) Drugs
Look-Alike Drug Names/Tall Man Lettering
TABLE 14-3 Commonly Confused Drug Names
Drug Interactions as a Source of Error
Warfarin (Coumadin) Interactions
TABLE 14-4 Examples of Drug-Drug Interactions
Errors in the Pharmacy
TABLE 14-5 Example of Warfarin Interactions with Drugs, Supplements, and Foods
Documented Errors
Medication Errors That Involve Allergies
Parenteral Errors
Sustained Released (SR) Dosage Form Errors
Errors Related to Patient Care
Nosocomial Infections
Home Health Care Errors
Age-Related Errors
Medical Errors and the Elderly
Tech Alert!
Medical Errors and Pediatric Patients
How to Stop Errors from Occurring
A Pharmacist’s Daily Routine
Computerized Prescription Order Entry (CPOE)
FIGURE 14-1 WPL305 desktop bar code printer.
Reporting Errors
BOX 14-2
Organizations that Track Errors
Verbal Ordering Error Prevention
Parenteral Medication Error Prevention
Common Pharmacy Technology
Bar Coding
Robot Rx Machines
FIGURE 14-2 Robot Rx machine.
Automated Dispensing Systems (ADS)
Community Pharmacy ADS Machines
FIGURE 14-3 KL20.
Patient Dose-Specific Orders
USP <797> Regulations
Drug Labeling
FIGURE 14-4 SP 200 robotic prescription dispensing system.
Boxed Warnings
Training and Education
ASHP
Medication Reconciliation
Other Considerations
FIGURE 14-5 Sample reconciliation form.
Do You Remember These Key Points?
BOX 14-3
Methods to Avoid Errors in the Pharmacy
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Section Two Body Systems
CHAPTER 15 Endocrine System
Objectives
Terms and Definitions
COMMON DRUGS PRESCRIBED FOR HORMONAL CONDITIONS (NONINCLUSIVE LISTINGS)
MEDICAL TERMINOLOGY
Endocrine Anatomy
FIGURE 15-1 Endocrine anatomy.
TABLE 15-1 Endocrine Structures, Medical Terms, and Functions
Description of Hormones
Structure and Function of Hormones
FIGURE 15-2 Structures of a steroid and a protein molecule.
TABLE 15-2 Hormone Function
Mechanism of Action
Functions of the Endocrine Glands
Hypothalamus
Pineal Gland
Pituitary Gland
TABLE 15-3 Hormonal Production of Anterior and Posterior Pituitary Gland
Thyroid Gland
FIGURE 15-3 Thyroid and parathyroid glands.
Parathyroid Glands
Adrenal Glands
TABLE 15-4 Adrenal Hormones and Their Effects on the Body
FIGURE 15-4 Pancreas.
Pancreas
Ovaries
FIGURE 15-5 Ovaries.
FIGURE 15-6 Testes.
Testes
Conditions of the Endocrine System and Their Treatments
TABLE 15-5 Endocrine Conditions with Corresponding Glands and Hormones and Possible Treatments
Conditions of the Pituitary Gland and Hypothalamus and Their Treatments
Gigantism and Acromegaly
Prognosis
Non–Drug Treatment
Drug Treatment
Hypopituitarism
Prognosis
Non–Drug Treatment
Drug Treatment
Diabetes Insipidus
Prognosis
Non–Drug Treatment
Drug Treatment
Conditions of the Thyroid Gland and Their Treatment
Hyperthyroidism
Prognosis
Non–Drug Treatment
Drug Treatment
Hypothyroidism
Prognosis
Non–Drug Treatment
Drug Treatment
Conditions of the Parathyroid Glands and Their Treatment
Hyperparathyroidism
Prognosis
Non–Drug Treatment
Drug Treatment
Bone Metabolism Regulators
Bisphosphonates
Hypoparathyroidism
Prognosis
Non–Drug Treatment
Drug Treatment
Osteoporosis Management and Treatments
Osteoporosis
Prognosis
Non–Drug Treatments
Drug Treatments
Osteoporosis Prevention
Conditions of the Adrenal Glands and Their Treatment
Cushing’s Syndrome
Prognosis
Non–Drug Treatment
Drug Treatment
Addison’s Disease
Prognosis
Non–Drug Treatment
Drug Treatment
Mineralocorticoid
Glucocorticoids
Tech Note!
Adrenal Medulla
Endocrine Conditions of the Pancreas Gland and Their Treatments
Diabetes Mellitus
Type 1
Type 2
Gestational Diabetes Mellitus (GDM)
Other Specific Types
Prognosis
Non–Drug Treatment
Drug Treatments
Tech Alert!
FIGURE 15-7 A, Humulin R (fast-acting). B, Humulin L (intermediate-acting).
TABLE 15-6 Commonly Prescribed Insulins for Insulin-Dependent Diabetes Mellitus (All Are Given Subcutaneously)
TABLE 15-7 Antidiabetic Agents for Type 2 Diabetes Mellitus
TABLE 15-8 Combination Oral Agents
Combination Agents
Blood Glucose Meters
TABLE 15-9 Diagnostic Devices for Blood and Urine Analysis
Hormones Secreted by the Ovaries and Their Uses
TABLE 15-10 Examples of Alternate Routes of Administration of Estrogens
Conditions of the Testes and Their Treatment
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
CHAPTER 16 Nervous System
Objectives
Terms and Definitions
COMMON DRUGS USED FOR CONDITIONS INVOLVING THE CENTRAL NERVOUS SYSTEM
NERVOUS SYSTEM MEDICAL TERMINOLOGY
The Nervous System
FIGURE 16-1 The nervous system is analogous to a mainframe computer (central nervous system) that communicates with other computers further away (peripheral nervous system).
Tech Note!
The Neuron
TABLE 16-1 Neuronal Transmitters, Their Most Important Clinical Locations, and Some of Their Actions
FIGURE 16-2 The nervous system: Divisions include the somatic and autonomic branches. The somatic division sends and receives impulses to and from the muscles whereas the autonomic system regulates both sympathetic and parasympathetic systems.
Afferent (Sensory) Neurons
Efferent (Motor) Neurons
Tech Note!
Nerve Transmission
FIGURE 16-3 Neuron: Impulses travel down the axon into the nerve terminal, where they are released into the synaptic space between each neuron. Impulses then are transmitted to the following neuron via the dendrites, which extend out of the cell body. The spaces between segments of the myelin sheath are known as the nodes of Ranvier.
FIGURE 16-4 The afferent and efferent nerves and the areas innervated by the sympathetic and parasympathetic systems. Preganglionic and postganglionic nerves that make up the cell bodies and axon are shown.
Central Nervous System
Brain
FIGURE 16-5 Neuronal impulse transfer cycle.
FIGURE 16-6 Lobes of the brain, cerebellum, and brainstem, which are all part of the central nervous system.
FIGURE 16-7 Cranial nerves.
Cranial Nerves
Spinal Cord
TABLE 16-2 Primary Functions of Cranial Nerves
FIGURE 16-8 Segments of the spinal cord.
Blood-Brain Barrier
Tech Note!
Peripheral Nervous System (PNS)
TABLE 16-3 Permeability of the Blood-Brain Barrier
FIGURE 16-9 Lock-and-key mechanism: As the knee is tapped, impulses are sent to and from the brain. The neurotransmitters affect specific receptors that are interpreted. The reaction sent via neurotransmitters is to jerk the knee.
Tech Note!
Autonomic System
Sympathetic System
Tech Note!
Parasympathetic System
Somatic System
TABLE 16-4 Major Organ Response When Sympathetic System Is Activated
TABLE 16-5 Response of the Body Systems to Parasympathetic Stimulation
Tech Note!
Neurotransmitters
Main Neurotransmitters
Tech Note!
TABLE 16-6 α- and β-Receptors and Their Effects on the Body Systems
Adrenergic Agents and Adrenergic Blockers
Sympathomimetics or Adrenergic Agents
Tech Note!
Cholinergic Agents and Cholinergic Blockers
Conditions of the Nervous System and Their Treatments
BOX 16-1
Conditions/Diseases Affecting the Nervous System and Websites for Additional Information
Disorders and Stroke
Government Institutes
General Nervous System Disorders
Skeletal Muscle Pain
Central-Acting Medications
Smooth Skeletal Muscle Relaxants
Direct-Acting Agents
Muscle Relaxants with Analgesics/Antiinflammatories
Specific Conditions Affecting the Peripheral Nervous System
Bell’s Palsy
Prognosis
Non–Drug Treatment
Drug Treatment
Myasthenia Gravis (MG)
Prognosis
Non–Drug Treatment
Drug Treatments
Cholinergic Agents
Disorders of the Brain and/or Spinal Cord
Stroke
Prognosis
Non–Drug Treatment
Drug Treatment
Anticoagulant
Antiplatelet
Tech Note!
Migraine Headache
Prognosis
Non–Drug Treatment
TABLE 16-7 Types of Migraines
Drug Treatments
TABLE 16-8 Migraine Medications
Pharmacist’s Perspective
What’s New in Headache Management?
Epilepsy
Prognosis
BOX 16-2
Types of Seizures
Partial Seizures
Generalized Seizures
Non–Drug Treatment
Drug Treatments
TABLE 16-9 Agents Used for Treatment of Epilepsy
Examples of Anticonvulsants
Hydantoin Anticonvulsants
Succinimide Anticonvulsant
Tech Note!
Barbiturates (Controlled Substances)
Benzodiazepines (Controlled Substances)
Alzheimer’s Disease
Prognosis
Non–Drug Treatment
Drug Treatment
BOX 16-3
Stages Associated with Alzheimer’s Disease
Cholinesterase Inhibitors
Tech Note!
Multiple Sclerosis (MS)
FIGURE 16-10 Multiple sclerosis lesions in the brain and brainstem.
Prognosis
Non–Drug Treatment
Drug Treatment
ABRC Agents
Interferons
Antispasmodic Medication
Central-Acting Smooth Muscle Relaxant; Antispasmodic
Parkinson’s Disease
Prognosis
Non–Drug Treatment
FIGURE 16-11 Symptoms and signs of Parkinson’s disease.
Drug Treatment
TABLE 16-10 Medications Used to Treat Parkinson’s Disease
Examples of Anti-Parkinsonism Drugs
Selective MAO-B Inhibitor
Anticholinergics Prolong the Effects of Dopamine by Inhibiting the Reuptake Mechanism
Dopamine Agonists
Amyotrophic Lateral Sclerosis (ALS)
Prognosis
Non–Drug Treatment
Drug Treatment
Dystonia
Prognosis
Non–Drug Treatment
Drug Treatment
Tech Note!
Tourette’s Syndrome (TS)
BOX 16-4
Medications Used to Treat Dystonia
Agents That Reduce Levels of Acetylcholine
Dopamine-Stimulating Agents
Agents That Regulate GABA
Miscellaneous Agents Used for the Following Symptoms:
Insomnia
Spasms
Pain
Prognosis
Non–Drug Treatment
Drug Treatment
TABLE 16-11 Medications Used for Treatment of Tourette’s Tics
Butyrophenone
Miscellaneous Muscle Agents
Neuromuscular Blockers
BOX 16-5
Classification of Neuromuscular Blockers
Short-Acting (Effective 20-26 min)
Intermediate-Acting
Long-Acting (Effective 75-100 min)
BOX 16-6
Medications Used for Conscious Sedation
Possible Combinations for Adults
Possible Combinations for Children
Conscious Sedation
Tech Alert!
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites Referenced
CHAPTER 17 Psychopharmacology
Objectives
Terms and Definitions
COMMON DRUGS USED FOR PSYCHOTHERAPEUTIC CONDITIONS
PSYCHOPHARMACOLOGY TERMINOLOGY
TABLE 17-1 Types of Mental Disorders
TABLE 17-2 Mental Health Websites
Emotional Health
Psychiatric Disorders
Non–Drug Treatments
Tech Note!
General Psychiatric Disorders
Depression
Prognosis
Non–Drug Treatment
Drug Treatments
Antidepressants
Selective Serotonin Reuptake Inhibitors
Selective Serotonin Reuptake Inhibitors (SSRIs)
Serotonin Norepinephrine Reuptake Inhibitors
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
Tricyclic Antidepressants
Tricyclic Antidepressants
TABLE 17-3 Examples of Foods That Contain Tyramine
Monoamine Oxidase Inhibitors (MAOIs)
Monoamine Oxidase Inhibitors (MAOIs)
Additional Antidepressants
Other Antidepressants
Anxiety Disorders
Prognosis
Non–Drug Treatments
Drug Treatments
TABLE 17-4 Examples of Types of Phobias
TABLE 17-5 Types of Obsessive-Compulsive Personality Disorders
Antianxiety Medications
Bipolar Disorder
Prognosis
Non–Drug Treatment
Drug Treatment
Antimanics
Schizophrenia
Prognosis
Non–Drug Treatments
Drug Treatments
TABLE 17-6 Common Agents Used to Treat Schizophrenia
Typical Antipsychotics
Phenothiazines
Atypical Antipsychotics
Atypical Antipsychotics
TABLE 17-7 Types and Description of Insomnia
Other Conditions
Insomnia
Prognosis
Non–Drug Treatment
Drug Treatment
TABLE 17-8 Common (Adult Dosages) Over-the-Counter Medications Indicated For Insomnia
Tech Note!
Benzodiazepines.
Benzodiazepine Hypnotics
Non-benzodiazepines.
Non-Benzodiazepine Hypnotics
Barbiturates.
Side Effects
TABLE 17-9 Common Barbiturates
Barbiturates
Attention Deficit/Hyperactivity Disorder (ADHD)
Prognosis
Non–Drug Treatment
Drug Treatment
TABLE 17-10 Agents Used to Treat ADD/ADHD. (Most products are for use in children >6 yr.; some extended-release products not acceptable for young children)
Medications and the Elderly
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 18 Respiratory System
Objectives
Terms and Definitions
COMMON DRUGS USED FOR RESPIRATORY CONDITIONS
FIGURE 18-1 Diagram of respiratory system.
RESPIRATORY TERMINOLOGY
Structure and Function of the Respiratory System
Tech Note!
Upper Respiratory System
Lower Respiratory System
FIGURE 18-2 Bronchial tree.
Respiration
Exchange of Gases
FIGURE 18-3 Exchange of oxygen and carbon dioxide.
Tech Note!
Breathing
Tech Note!
Sneezing
Disorders/Conditions of the Respiratory System
Upper Respiratory System
TABLE 18-1 Types of Breathing Dysfunction
TABLE 18-2 Conditions of the Upper Respiratory System
Common Cold
Prognosis
Non–Drug Treatment
Drug Treatment
Relief of Sore Throat
Local Anesthetics for Throat Pain
BOX 18-1
Examples of Conditions that May be Affected by OTC Medications
TABLE 18-3 Combination Agents Sold OTC for Symptoms of Colds, Hay Fever, Allergies, Flu, and Respiratory Tract Infections
Antitussives (Reduce Coughing)
Narcotic Antitussive/Expectorant
Expectorants (Promote Coughing)
Expectorant (OTC)
Nasal Decongestants (Sympathomimetics)
Decongestants (OTC)
Laryngitis
Prognosis
Non–Drug Treatment
Drug Treatment
Influenza
Prognosis
Non–Drug Treatment
FIGURE 18-4 Influenza.
Drug Treatment
H1N1 (Swine Flu)
Prognosis
Non–Drug Treatment
BOX 18-2
Vaccinations (Prevention Guidelines)
Drug Treatment
Rhinitis
Prognosis
Non–Drug Treatments
Drug Treatments
Rx Nasal Corticosteroids
Allergies
Prognosis
Non–Drug Treatment
Drug Treatments
OTC Antihistamines
Nonsedating Rx Antihistamines
TABLE 18-4 Agents Used for the Treatment of Allergies
Nonsedating OTC Antihistamines
Low-Sedating OTC Antihistamines
Lower Respiratory System
TABLE 18-5 Conditions of the Lower Respiratory System
Tech Note!
Pneumonia
Prognosis
Non–Drug Treatment
Drug Treatment
Bacterial Vaccines
Viral Vaccines
Asthma
Prognosis
Non–Drug Treatments
Drug Treatments
Corticosteroids
FIGURE 18-5 Asthma obstruction.
FIGURE 18-6 A, Proper use of an inhaler. B, Inhaler with spacer (e.g., AeroChamber).
Long-Acting Bronchodilators
Combination: Long-Acting Bronchodilator/Steroid Inhaler
Leukotriene Receptor Antagonists (Leukotriene Inhibitors)
Mast Cell Stabilizers
Medications for Acute Asthma Attacks
Tech Note!
Chronic Obstructive Pulmonary Disease (COPD)
BOX 18-3
Lung Diseases That Can Lead to COPD
Prognosis
Non–Drug Treatment
Drug Treatment
Corticosteroid/Long-Acting Bronchodilator Combinations
Methylxanthine Bronchodilators
Anticholinergics
Tuberculosis
Prognosis
FIGURE 18-7 Positive result of a tuberculosis test.
Non–Drug Treatment
Drug Treatment
Antituberculosis Agents
TABLE 18-6 Examples of Tuberculosis Regimens
Emergency Disorders of the Lungs
FIGURE 18-8 Pneumothorax.
Mucolytics
Mucolytic
Tech Alert!
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 19 Visual and Auditory Systems
Objectives
Terms and Definitions: Eye
Terms and Definitions: Ear
COMMON DRUGS USED FOR CONDITIONS OF THE EYE
The Eyes (Ophthalmic System)
MEDICAL TERMS AND CONDITIONS OF THE EYE
Anatomy of the Eye
FIGURE 19-1 Anatomy of the eye.
FIGURE 19-2 Eye muscles and direction of movement. Superior rectus rotates upward and inward; inferior rectus rotates downward and inward; medial rectus rotates inward; lateral rectus rotates outward; superior oblique rotates downward and outward; inferior oblique rotates upward and outward.
Tech Note!
Vision
Conditions That Affect the Eye
Common Conditions
Allergies
BOX 19-1
Abbreviations
Terms
Abbreviations That Should NOT Be Used*
Prognosis
Non–Drug Treatment
Drug Treatments
TABLE 19-1 Ophthalmic Decongestants, Antihistamines, and Mast Cell Stabilizers*
Antiallergy Agents
Inflammation Caused by Infection or Injury
Corticosteroids
Antiinflammatory, Corticosteroids
BOX 19-2
Main Treatments for Inflammation and Infection
Nonsteroidal Antiinflammatory Drugs (NSAIDs)
Conjunctivitis
Prognosis
Non–Drug Treatment
Drug Treatment
Antiinfective Agents
Ophthalmic Sulfonamides
TABLE 19-2 Antiinfective Combination Ophthalmics
Aminoglycosides
TABLE 19-3 Viral/Nonviral Conjunctivitis
Macrolides
Antifungals
Tech Note!
Antivirals
Cataracts
TABLE 19-4 Types of Cataracts
Prognosis
Non–Drug Treatment
Drug Treatment
TABLE 19-5 Commonly Used Agents for the Treatment of Glaucoma
Anticholinergics
Cholinergics—Miotics
Glaucoma
Prognosis
Non–Drug Treatment
Drug Treatment
BOX 19-3
Types of Glaucoma*
Primary (Includes Angle-Closure or Open-Angle Conditions)
Secondary
Congenital
Beta-Adrenergic Blockers
Carbonic Anhydrase Inhibitors
Carbonic Anhydrase Inhibitor—Oral
Miotics
Cholinergics—Miotics
Sympathomimetics
Prostaglandin Agonists
Tech Note!
Blindness
Prognosis
Non–Drug Treatment
TABLE 19-6 Causes of Blindness
BOX 19-4
Proper Use of Eye Drops
Drug Treatment
Miscellaneous Ophthalmic Agents
The Ears (Auditory System)
COMMON DRUGS USED FOR CONDITIONS OF THE EAR
MEDICAL TERMS AND CONDITIONS OF THE EAR
TABLE 19-7 Artificial Tear Products
FIGURE 19-3 Anatomy of the ear.
Anatomy of the Ear
External Ear
Middle Ear
Inner Ear
Tech Note!
Conditions Affecting the Ear
FIGURE 19-4 Anatomy of the inner ear.
BOX 19-5
Three Main Areas of the Inner Ear and Their Functions
Cochlea
Vestibule
Semicircular Canals
TABLE 19-8 Hearing Conditions
TABLE 19-9 Ear Preparations*
TABLE 19-10 Major Ingredients in Otic Preparations
TABLE 19-11 Combination Otics
Deafness
Prognosis
Non–Drug Treatment
Drug Treatment
Otitis Media
Prognosis
Non–Drug Treatment
Drug Treatment
Oral Antibiotics (Systemic)
Otic Antibiotics
Cerumen Buildup
Prognosis
Non–Drug Treatment
Drug Treatment
Ototoxicity
TABLE 19-12 Medications That Cause Ototoxicity or Tinnitus
Prognosis
Non–Drug Treatment
Drug Treatment
Steroid and Antibiotic Combination
Miscellaneous Otic Preparation
Tech Note!
Miscellaneous Otic Preparations
Tech Alert!
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 20 Integumentary System
Objectives
Terms and Definitions
COMMON DRUGS USED FOR SKIN CONDITIONS
MEDICAL TERMS AND CONDITIONS OF THE SKIN
Skin Anatomy
Hair and Nails
FIGURE 20-1 Skin anatomy.
Glands
Conditions Affecting the Skin, Hair, and Glands
FIGURE 20-2 Nail anatomy.
FIGURE 20-3 Glands of the skin.
Noninfectious Skin Conditions
Acne Vulgaris
FIGURE 20-4 Acne.
Prognosis
Non–Drug Treatment
TABLE 20-1 Topical Acne Treatments
Drug Treatments
Sunburn
TABLE 20-2 Skin Protection Factor Guide Coverage of Sunscreen*
Prognosis
Non–Drug Treatments
Choosing a Sunscreen
Drug Treatments
TABLE 20-3 Choosing a Sunscreen*
Urticaria
Prognosis
Non–Drug Treatment
Drug Treatment
TABLE 20-4 Examples of Topical Antiinflammatory Products
Skin Cancer
Prognosis
Non–Drug Treatment
Drug Treatment
FIGURE 20-5 Types of skin cancer: A, Squamous cell; B, Basal cell; C, Malignant melanoma.
BOX 20-1
Detection of Possible Skin Cancer
A—Asymmetry
B—Border
C—Color
D—Difference
BOX 20-2
Cancer Treatments
Surgery
Medication
Stasis Dermatitis and Ulcers
FIGURE 20-6 Ulceration.
TABLE 20-5 Examples of Topical Antibacterial Products
Prognosis
Non–Drug Treatment
Drug Treatment
Psoriasis
Prognosis
FIGURE 20-7 Psoriasis.
Non–Drug Treatment
Drug Treatment
TABLE 20-6 Agents Used to Treat Psoriasis (Most Are Rx)
Corticosteroids
Immunomodulators
Vitamin D Analog
Burns
Prognosis
BOX 20-3
Burn Degrees
FIGURE 20-8 Third-degree burn.
Non–Drug Treatment
Drug Treatment
Canker Sores
Prognosis
Non–Drug Treatment
Drug Treatment
TABLE 20-7 Canker Sore Treatments
Infectious Inflammatory Skin Conditions
Warts
Prognosis
FIGURE 20-9 A, HPV (common warts). B, Genital warts, male. C, Genital warts, female.
TABLE 20-8 Over-the-Counter (OTC) Products to Treat Common Warts
Non–Drug Treatment
Drug Treatment
Genital Warts
Tech Note!
Athlete’s Foot
Prognosis
Non–Drug Treatment
FIGURE 20-10 A, Tina capitis (head). B, Tina pedis (athlete’s foot).
Drug Treatment
TABLE 20-9 Antifungal Products to Treat Athlete’s Foot
Herpes
Prognosis
FIGURE 20-11 Herpes simplex.
Non–Drug Treatment
Drug Treatment
TABLE 20-10 Herpes Medications
Impetigo
Prognosis
Non–Drug Treatment
Drug Treatment
Conditions of the Hair
Lice
FIGURE 20-12 A, Head louse. B, Crab lice.
Prognosis
Non–Drug Treatment
Drug Treatment
Conditions of the Nail
Acute Paronychia and Onychomycosis
Prognosis
Non–Drug Treatment
Drug Treatment
BOX 20-4
Nail Conditions
Tech Note!
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Bibliography
Websites
CHAPTER 21 Gastrointestinal System
Objectives
Terms and Definitions
COMMON DRUGS FOR THE GASTROINTESTINAL SYSTEM
GASTROINTESTINAL MEDICAL TERMINOLOGY
Form and Function of the Gastrointestinal System
Anatomy of the Gastrointestinal System
FIGURE 21-1 Anatomy of the gastrointestinal system (including mouth, pharynx, esophagus, stomach, and intestines).
FIGURE 21-2 Major glands of the mouth.
Ingestion
Tech Note!
FIGURE 21-3 pH scale ranges from 1 (the most acidic) to 14 (the most basic). Normal human blood is pH 7.4, approximately the midpoint of the range.
Absorption
FIGURE 21-4 Intestinal tract (including duodenum, jejunum, and ileum).
TABLE 21-1 Foods and Enzymes That Digest Them
Excretion
Auxiliary Organ Functions
Conditions Affecting the Gastrointestinal System
TABLE 21-2 Conditions of the Upper/Lower GI System
Mouth and Throat Conditions
Tech Note!
Stomach Conditions
Tech Note!
GERD
TABLE 21-3 Gastrointestinal Conditions
TABLE 21-4 Over-the-Counter Antacid Agents (Single Ingredient)
Prognosis
Non–Drug Treatments
Drug Treatments
Antacids
Tech Note!
Histamine2-Antagonists
TABLE 21-5 Over-the-Counter Combination Antacids
Proton Pump Inhibitors (PPIs)
Tech Note!
Peptic Ulcer Disease (PUD)
Prognosis
Non–Drug Treatment
Drug Treatments
Intestinal Conditions
TABLE 21-6 Diagnostic Tests to Confirm Helicobacter pylori
TABLE 21-7 Helicobacter pylori Regimens
Diarrhea
Prognosis
Non–Drug Treatments
Drug Treatments
BOX 21-1
Bowel Problems
Constipation
Prognosis
Non–Drug Treatments
Drug Treatments
Tech Note!
Bulk-Forming Laxatives
TABLE 21-8 Laxatives
Emollient Laxatives (Stool Softeners)
Stimulant Laxatives
Hyperosmolar Laxatives
Selective Chloride Channel Activators
Flatulence
Prognosis
Non–Drug Treatment
Drug Treatment
Antiflatulence Medications
TABLE 21-9 Over-the-Counter Combination Antacid-Antiflatulence Agents
Irritable Bowel Syndrome (IBS)
Prognosis
Non–Drug Treatment
Drug Treatment
Antispasmodics
Serotonin
Crohn’s Disease
Prognosis
Non–Drug Treatment
Drug Treatment
Biological Agents
Ulcerative Colitis
Prognosis
Non–Drug Treatment
Drug Treatment
Antiinflammatory
Emesis
Prognosis
Non–Drug Treatments
BOX 21-2
Variations of Emesis
Drug Treatments
Antidopaminergics
Phenothiazines
Miscellaneous Antiemetics
Serotonin Receptor Antagonists (5-HT3-Antagonists)
Antihistamines/Anticholinergics
Miscellaneous Conditions
Poisoning
TABLE 21-10 Antidotes
BOX 21-3
Poisonous Snakes and Spiders
Types of Snakes
Types of Spiders
Prognosis
Non–Drug Treatment
Drug Treatment
Lavage
Ipecac Syrup
Tech Alert!
Activated Charcoal
Tech Alert!
General Information
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 22 Urinary System
Objectives
Terms and Definitions
COMMON DRUGS FOR THE URINARY SYSTEM
URINARY MEDICAL TERMINOLOGY
Anatomy
Function of the Kidneys
FIGURE 22-1 Anatomy of urinary tract and nephrons.
Nephron Function
FIGURE 22-2 Anatomy of the kidney.
FIGURE 22-3 Nephron anatomy.
Tech Note!
Tubular Reabsorption
FIGURE 22-4 Tubular reabsorption and secretion.
Tubular Secretion
FIGURE 22-5 Also known as an osmotic gradient, the smaller water molecules gravitate toward the highly concentrated sodium ions.
The Importance of Electrolytes
Conditions Affecting the Urinary System
Common Conditions
Renal Failure
TABLE 22-1 Conditions Affecting the Urinary System
TABLE 22-2 End-Stage Renal Disease Symptoms*
Prognosis
Non–Drug Treatment
FIGURE 22-6 Two types of dialysis.
Drug Treatment
Iron Supplement
Red Blood Cell Stimulators
Phosphorus Binding Agents
Agent to Reduce Risk of Renal Osteodystrophy (Weak Bones)
Edema
BOX 22-1
Some Causes of Edema
FIGURE 22-7 Pitting edema.
Prognosis
Non–Drug Treatment
Drug Treatment
Thiazides and Thiazide-like Agents
Tech Alert!
Loop Diuretics
Potassium-Sparing Agents
TABLE 22-3 Combination Diuretics (Potassium-Sparing)
Potassium-Sparing Diuretics
Carbonic Anhydrase Inhibitors
Carbonic Anhydrase Inhibitor
Osmotic Diuretics
Tech Alert!
Kidney Stones
Prognosis
Non–Drug Treatment
FIGURE 22-8 Common locations of kidney stones.
TABLE 22-4 Kidney Stones: Characteristics and Treatments
Drug Treatments
Urinary Tract Infection (UTI)
Prognosis
Non–Drug Treatment
Drug Treatment
Antiinfective Antibiotic
Tech Note!
Uti Antibiotic
TABLE 22-5 Treatments for Urinary Tract Infections* (Based on Oral Adult Dosages Unless Otherwise Indicated)
Cephalosporin Antibiotic
Prostatitis
Prognosis
Non–Drug Treatment
Drug Treatment
Incontinence
TABLE 22-6 Drugs Commonly Used to Treat Bacterial Prostatitis
TABLE 22-7 Types of Urinary Incontinence
Prognosis
Non–Drug Treatment
Drug Treatment
Anticholinergic
Tech Alert!
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Question
Bibliography
Websites
CHAPTER 23 Cardiovascular System
Objectives
Terms and Definitions
EXAMPLES OF CARDIOVASCULAR AGENTS
MEDICAL TERMINOLOGY OF THE CARDIOVASCULAR SYSTEM
Anatomy of the Heart
FIGURE 23-1 Anatomy of the heart.
FIGURE 23-2 Blood oxygenation.
Oxygenation
Cardiac Conduction System
The Cardiac Cycle
Conditions Affecting the Heart
FIGURE 23-3 Circulation of blood through the body.
Common Conditions
Hypertension
BOX 23-1
Common Conditions and Definitions
TABLE 23-1 Drug Classifications
Prognosis
Non–Drug Treatment
TABLE 23-2 Classifications of Combination Drugs
BOX 23-2
Examples of Conditions that Can Lead to Hypertension
Common Conditions or Factors That May Increase Risk for Hypertension
Risk Factors for Essential Hypertension
Drug Treatment
BOX 23-3
Classification of Blood Pressure Measurements
BOX 23-4
Approaches to Controlling High Blood Pressure
TABLE 23-3 Examples of Combination Drugs
Hypotension
Prognosis
Non–Drug Treatment
BOX 23-5
Types of Hypotension
BOX 23-6
Causes of Hypotension
Drug Treatment
Hyperlipidemia
Prognosis
Non–Drug Treatment
Drug Treatment
BOX 23-7
U.S. Guidelines for Cholesterol Measurements
Antihyperlipidemics
Bile Acid Sequestrants
HMG-CoA Reductase Inhibitors (“Statins”)
Fibric Acid Antihyperlipidemic
Cholesterol Absorption Inhibitor
Miscellaneous Antihyperlipidemic
Transient Ischemic Attacks (TIAs) and Strokes
Prognosis
Non–Drug Treatment
Drug Treatment
Calcium Channel Blocker
Tech Alert!
Angina Pectoris
Prognosis
Non–Drug Treatment
Drug Treatment
Nitrates
FIGURE 23-4 Nitroglycerin sublingual tablet prescription.
TABLE 23-4 Common Nitrate Agents
Tech Note!
Tech Note!
Myocardial Infarction (MI)
Prognosis
Non–Drug Treatment
Drug Treatment
Arrhythmia
Prognosis
Non–Drug Treatment
Drug Treatment
Drug Action
Tech Note!
Antiarrhythmics
Congestive Heart Failure (CHF)
Prognosis
Non–Drug Treatment
Drug Treatment
Cardiac Glycoside
Tech Note!
Diuretics Used for Congestive Heart Failure–Related Edema
Thiazide and Thiazide-Like Diuretics
Loop Diuretics
BOX 23-8
Classification of Diuretic Agents
Loop Diuretics
Potassium-Sparing Diuretics
Potassium-Sparing Diuretic
Carbonic Anhydrase Inhibitors
Carbonic Anhydrase Inhibitor
Coronary Artery Disease (CAD)
Prognosis
Non–Drug Treatment
Drug Treatment
Tech Note!
Thrombosis
Prognosis
Non–Drug Treatment
Drug Treatment
BOX 23-9
American Heart Association Guidelines to Prevent Heart Disease
TABLE 23-5 Examples of Types of Embolisms
Anticoagulants
TABLE 23-6 Examples of Anticoagulants
BOX 23-10
Heparin Concentrations
Generic Name: Heparin Sodium
Trade Name: Heplok
Low-Molecular-Weight Heparins (LMWHs)
Tech Note!
Anticoagulants
Antiplatelet Agents
Thrombolytics
BOX 23-11
Enoxaparin (Lovenox)
Prefilled Injection (PFS)
Types of Medications Used for Heart Conditions
Angiotensin-Converting Enzyme Agents (Ace Inhibitors)
Tech Note!
ACE inhibitors (ACEIs)
TABLE 23-7 Oral Antiplatelet Agents
TABLE 23-8 Examples of Thrombolytics
Angiotensin II Receptor Antagonists (Also Known As Angiotensin Receptor Blockers)
Angiotensin II Receptor Antagonists
Beta-Blocking Agents
Beta-Blocking Agents
Calcium Channel Blockers
Calcium Channel Blockers
Tech Alert!
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 24 Reproductive System
Objectives
Terms and Definitions
EXAMPLES OF REPRODUCTIVE SYSTEM DRUGS
TABLE 24-1 Hormone Functions
MEDICAL TERMINOLOGY OF THE REPRODUCTIVE SYSTEM
Male Reproductive System
FIGURE 24-1 Male reproductive system.
FIGURE 24-2 Function of testes in response to hormone stimulation.
Conditions Affecting the Male Reproductive System
TABLE 24-2 Conditions Affecting the Male Reproductive System
Common Conditions
Erectile Dysfunction (ED)
TABLE 24-3 Causes of Erectile Dysfunction
Prognosis
Non–Drug Treatments
Drug Treatments
Benign Prostatic Hypertrophy (Benign Prostatic Hyperplasia or BPH)
Prognosis
Non–Drug Treatment
TABLE 24-4 Medications for Erectile Dysfunction
Drug Treatment
Androgen Hormone Inhibitors
Alpha-Adrenergic Blockers
Prostate Cancer
FIGURE 24-3 Prostate cancer.
BOX 24-1
Stages of Prostate Cancer
TABLE 24-5 Prostate Cancer Treatments
Prognosis
Non–Drug Treatment
Drug Treatment
Male Hypogonadism
Prognosis
Non–Drug Treatment
Drug Treatment
Androgens
Female Reproductive System
FIGURE 24-4 Female reproductive system.
Conditions Affecting the Female Reproductive System
Hormonal Treatments
FIGURE 24-5 Function of ovaries in response to hormone stimulation.
Common Conditions
Female Hypogonadism
Prognosis
Non–Drug Treatments
Drug Treatments
Pelvic Inflammatory Disease (PID)
Prognosis
TABLE 24-6 PID Treatments
Non–Drug Treatments
Drug Treatments
Menopause
Prognosis
Non–Drug Treatments
Drug Treatments
Estrogen Preparations
Infertility
Prognosis
Non–Drug Treatment
Drug Treatment
Ovulation Stimulants
TABLE 24-7 Infertility Treatments
Luteinizing Hormone and Follicle-Stimulating Hormone Stimulants
Ergot Alkaloid
Progestins
Menstrual Disorders
Prophylaxis Medications
Oral Contraceptives (OCs)
FIGURE 24-6 Common contraceptives, including barrier and medicinal methods: condoms, diaphragm, oral contraceptives, and parenteral contraceptives.
BOX 24-2
Menstrual Disorders
Tech Note!
Long-Acting Contraceptive
Intrauterine Progesterone Contraception
Tech Note!
Other Contraceptives
Tech Note!
TABLE 24-8 Contraceptive Methods: Risks, Complications, and Failure
Sexually Transmitted Diseases (STDs)
Tech Alert!
Do You Remember These Key Points?
TABLE 24-9 Sexually Transmitted Disease Organisms and Various Drug Therapies
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
Section Three Classification of Drugs
CHAPTER 25 Antiinfectives
Objectives
Terms and Definitions
EXAMPLES OF ANTIINFECTIVES
TERMINOLOGY RELATED TO ANTIINFECTIVES
History of Antibiotics
The Discovery of Penicillin
Gram Stain
Modern Antibiotics
FIGURE 25-1 A Petri dish is prepared with nutrient-rich agar. This nutrient feeds the bacteria that are placed on the plate. The Penicillium colony can be seen with an area of clearance where the bacteria cannot grow. This occurs because the Penicillium colony inhibits the bacterial growth.
Types of Infections and Their Treatments
Sexually Transmitted Diseases
Gastrointestinal Infections
FIGURE 25-2 Helicobacter pylori, a bacterium that causes infection of the stomach.
TABLE 25-1 Types of Microorganisms and Parasites
TABLE 25-2 Common Sexually Transmitted Diseases and Treatments
Respiratory Infections
Nosocomial Infections
Multidrug-Resistant Organisms (MDROs)
BOX 25-1
MDROs
TABLE 25-3 Potentially Fatal “Superbugs”
Methicillin-Resistant Staphylococcus aureus (MRSA)
Vancomycin-Resistant Staphylococcus aureus (VRSA)
Multidrug-Resistant S. pneumoniae (MDRSP)
Gram-Negative Resistant Bacilli (GNRB)
Vancomycin-Resistant Enterococcus (VRE)
The Centers For Disease Control And Prevention (CDC)
Infections of the Skin
Infections of the Nose and Mouth
BOX 25-2
Nationally Notifiable Infectious Diseases 2010
Centers for Disease Control
Infections of the Eyes and Ears
Antibiotic Treatments
Tech Note!
Penicillin
FIGURE 25-3 Tinea pedis, a fungal infection that causes athlete’s foot.
TABLE 25-4 Otic and Ophthalmic Antiinfectives, Examples
Antibacterial, Penicillins
TABLE 25-5 Examples of Bacterial Morphology, Areas Affected, Treatment, and Conditions
Tech Note!
Cephalosporins
Mycobacterium and Mycobacterial Treatment
TABLE 25-6 Antibiotics Other Than Penicillins and Cephalosporins
Tech Note!
Aminoglycosides
TABLE 25-7 Antituberculin Agents
Drug-Resistant and Miscellaneous Antibiotics
TABLE 25-8 Antibiotics for Resistant Microorganisms
Antifungals
Candida Infections
TABLE 25-9 Fungal Infections and Their Treatments
FIGURE 25-4 Types of tinea infections. A, Tinea cruris. B, Tinea capitis. C, Tinea corporis.
BOX 25-3
Parasitic Organisms and Their Description
Tinea Infections
Parasites
TABLE 25-10 Protozoan Infections and Their Treatments
Protozoa
Helminths (Worms)
TABLE 25-11 Helminthic Infestations and Their Treatments
Parasitic Treatments
Malaria
TABLE 25-12 Anthelmintic Drug Actions and Common Dosage
Antivirals
BOX 25-4
Antiviral Mechanisms of Action
TABLE 25-13 Antiviral and Antiretroviral Agents
HIV/AIDS
Tech Note!
Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NRTIs)
Non-Nucleoside Reverse Transcriptase Inhibitors
Protease Inhibitors (PIs)
Tech Note!
Colds/Flu
Miscellaneous Viral Conditions
Human Papillomavirus (HPV)
Herpes Viruses
BOX 25-5
Types of Human Herpes Viruses
Herpes Simplex
Herpes Zoster (Shingles)
Varicella Zoster Chickenpox
Tech Alert!
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Use
Agents
Bibliography
Websites
CHAPTER 26 Antiinflammatories and Antihistamines
Objectives
Terms and Definitions
COMMON ANTIINFLAMMATORY AGENTS
The Inflammatory Response
TABLE 26-1 Immune Cell Responses in Injury
TABLE 26-2 Types of Inflammatory Conditions
ANTIINFLAMMATORY AND ANTIHISTAMINE TERMINOLOGY
The Body’s Natural Response
Glucocorticoids (Steroids)
Adrenal Effects of Steroid Agents
FIGURE 26-1 Prednisone-tapered prescription.
Corticosteroids
BOX 26-1
Corticosteroid Dosage Forms and Uses
TABLE 26-3 Examples of Corticosteroidal Agents and Dosage Forms
Corticosteroids
Inflammatory Pain
FIGURE 26-2 Pain route.
Tech Note!
Pain and Inflammation Medications
Aspirin
TABLE 26-4 Various Strengths of Aspirin Available
Tech Note!
Nonsteroidal Antiinflammatory Drugs (NSAIDs)
TABLE 26-5 Nonsteroidal Antiinflammatory Drugs, Cyclooxygenase-2 Inhibitors, and Similar Agents*
Cyclooxygenase-2 Inhibitors
Cox-2 Inhibitors
Controlled Analgesics
Inflammatory Conditions
Common Conditions
Osteoarthritis
Prognosis
Non–Drug Treatment
FIGURE 26-3 Severe osteoarthritis.
Drug Treatment
Rheumatoid Arthritis (RA)
FIGURE 26-4 Severe rheumatoid arthritis.
Prognosis
Non–Drug Treatment
Drug Treatment
Biological Response Modifiers
Disease-Modifying Antirheumatic Drugs
Allergies
FIGURE 26-5 Asthma: airways become obstructed by mucus and edema, causing dyspnea.
Allergic Conditions and Their Treatments
FIGURE 26-6 Events that take place in an allergic reaction, from the first exposure to an antigen to the allergic response.
BOX 26-2
Types of Antigens
BOX 26-3
Allergic Conditions
Allergic Rhinitis
Symptoms of Allergic Rhinitis
Contact Dermatitis
Symptoms of Contact Dermatitis
Atopic Dermatitis
Symptoms of Atopic Dermatitis
Drug Allergies
Symptoms of Drug Allergies
Food Allergies
Symptoms of Food Allergies
Antihistamines and Combination Drugs
TABLE 26-6 Ophthalmics for Allergic Inflammation (Mast Cell Stabilizers)
TABLE 26-7 Examples of Oral Antihistamines
TABLE 26-8 Oral Combination Antihistamine/Decongestant OTC Agents
Drug Interactions
Antihistamines
TABLE 26-9 Nasal OTC Decongestant Agents
TABLE 26-10 Intranasal Prescription Steroids
TABLE 26-11 Ophthalmic Steroidal Prescription Agents
TABLE 26-12 Topical Steroidal Treatment
Commonly Used Antihistamines
Common Nasal Corticosteroids
Tech Alert!
Anaphylaxis
Tech Alert!
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 27 Vitamins and Minerals
Objectives
Terms and Definitions
VITAMINS
MINERALS
History of Regulation of Vitamin and Mineral Supplements
BOX 27-1
Food and Drug Administration Regulatory Requirements for Dietary Supplements and Nonregulated Items
Regulatory Requirements:
The Manufacturers Must Also State on All Containers:
Vitamins
Tech Alert!
Fat-Soluble Vitamins (A, D, E, and K)
TABLE 27-1 Drug Interactions of Fat-Soluble Vitamins
TABLE 27-2 DRI Values for Fat-Soluble Vitamins
Vitamin A
Sources of Vitamin A
Hypervitaminosis A
Vitamin D
Sources of Vitamin D
Deficiency of Vitamin D
FIGURE 27-1 Rickets.
Hypervitaminosis D
Drug Interactions
Vitamin E
Sources of Vitamin E
Deficiency of Vitamin E
Hypervitaminosis E
Drug Interactions
Vitamin K (Phytonadione)
Sources of Vitamin K
Deficiency of Vitamin K
Water-Soluble Vitamins (B and C)
TABLE 27-3 DRI Values for Water-Soluble Vitamins
B Vitamins
Sources of B Vitamins
TABLE 27-4 Water-Soluble Vitamins: Overdose and Drug Interactions
TABLE 27-5 B Vitamins: Sources, Function, and Deficiency States
Deficiencies of B Vitamins
Vitamin B1 (Coenzyme)
Deficiency of Vitamin B1
Drug Interactions with Vitamin B1
Vitamin B2 (Coenzyme)
Deficiency of Vitamin B2
Tech Note!
Vitamin B3 (Coenzyme)
Deficiency of Vitamin B3
Tech Note!
Vitamin B5 (Coenzyme)
Deficiency of Vitamin B5
Vitamin B6 (Coenzyme)
Deficiency of Vitamin B6
Drug Interactions with Vitamin B6
Vitamin B7 (Biotin)
Deficiency of Vitamin B7
Vitamin B9 (Coenzyme)
Deficiency of Vitamin B9
Interactions with Vitamin B9
Vitamin B12 (Coenzyme)
Deficiency of Vitamin B12
Tech Note!
Vitamin C
Deficiency of Vitamin C
Antioxidants
Minerals
Zinc
TABLE 27-6 Common Minerals and Trace Elements, Their Actions, and Deficiencies
Drug Interactions
iron
TABLE 27-7 DRI Values for Minerals and Trace Elements
TABLE 27-8 Mineral Sources
TABLE 27-9 Iron Sources
TABLE 27-10 DRI for Elemental Iron
Iron Deficiency
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 28 Vaccines
Objectives
Terms and Definitions
TYPES OF VACCINES
SYSTEMIC IMMUNOSUPPRESSIVE AGENTS (EXCLUDES CORTICOSTEROIDS)
Lymphatic System
Thymus
Tonsils
Spleen
Types of Immune Cells
FIGURE 28-1 Overview of the major lymphatic organs within the body.
Immunizations
TABLE 28-1 Major Immune Response Cells
BOX 28-1
Brief Overview of All Immune Cells
Types of Immunity
Active Immunity
Passive Immunity
Tech Note!
How Vaccines are Prepared
Viral Vaccines
Bacterial Vaccines
Miscellaneous Vaccines
TABLE 28-2 Common Viral Vaccines, Diseases Treated, and Route of Administration
TABLE 28-3 Common Toxoids and Route of Administration
Development of Vaccines
BOX 28-2
Three Types of Less Common Vaccines and Their Specific Characteristics
Antiidiotypic Vaccines
Subunit Vaccines
Acellular and Conjugated Vaccines
TABLE 28-4 Vaccines That Prevent Diseases
TABLE 28-5 Childhood Immunization Schedule
Childhood Immunization
National Childhood Vaccine Injury Act of 1986
Tech Note!
Autism and Vaccines
Diphtheria, Pertussis, and Tetanus Infections and Vaccines
Vaccines for Diphtheria, Pertussis, and Tetanus Infections
Polio
Vaccine for Polio
Measles, Mumps, and Rubella
FIGURE 28-2 A, Measles. Symptoms include rash, consisting of both papules and macules, that spreads over the body and lasts 3 to 5 days. B, Mumps. Glands become swollen, causing pain when chewing or drinking liquids. Symptoms last approximately 24 hours. C, Rubella. Lymph nodes enlarge, and a fine red rash occurs. Symptoms last approximately 2 to 3 days.
Vaccine for Measles, Mumps, and Rubella
Chickenpox
Vaccine for Chickenpox
FIGURE 28-3 Chickenpox. Rash begins with macules, which turn into severe papules. Symptoms can last from a few days to 2 weeks.
Herpes Zoster
Hepatitis Infections and Vaccines
Hepatitis A Virus (HAV)
Vaccine
Hepatitis B Virus (HBV)
BOX 28-3
Hepatitis Infections with No Available Vaccines
Vaccine
Active Treatment
Hepatitis C Virus (HCV)
Vaccine
Active Treatment
Hepatitis D Virus (HDV)
Vaccine
Other Viruses and Vaccines
Human Papillomavirus
Vaccine
Pneumonia
Vaccine
Haemophilus influenzae Type B
Vaccine
Influenza
Vaccines
Swine Flu (H1N1)
Vaccine
Passive ImmunitY
Travel Medicine and Immunizations
Antitoxins and Antivenins
Tech Note!
Storage of Vaccines
TABLE 28-6 Types of Vaccines
Tech Note!
Immune Therapies
Special Situations for Vaccination—Pregnancy
TABLE 28-7 Examples of Biological/Immune Therapies
Tech Alert!
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 29 Oncology Agents
Objectives
Terms and Definitions
CHEMOTHERAPEUTIC AGENTS
CONTROLLED OPIOID ANALGESICS COMMONLY USED FOR CANCER PAIN
What Is Cancer?
MEDICAL TERMINOLOGY
FIGURE 29-1 Metastasis of cancer. Diagram shows how lung cancer may metastasize to other areas of the body.
What Causes Cancer?
Types of Cancer
TABLE 29-1 Types of Cancer
BOX 29-1
Types of Cancer and Where They occur
FIGURE 29-2 Lymph node sites where Hodgkin’s disease can strike.
FIGURE 29-3 Kaposi’s sarcoma.
FIGURE 29-4 Malignant mesothelioma.
BOX 29-2
Characteristics of Cancer Growth and Treatment
Diagnosis of Cancer
Treatments for Cancer
Surgery
TABLE 29-2 Combination Therapies for Cancer
Tech Note!
Radiation
Side Effects of Radiation Therapy
FIGURE 29-5 Radiation dermatitis from exposure to radiation treatment for cancer.
BOX 29-3
Forms of Treatment
Radioactive Isotopes
Chemotherapy
TABLE 29-3 Common Types of Chemotherapeutic Agents
TABLE 29-4 Routes of Administration of Chemotherapeutic Agents
Targeted Therapy
Agents Used in the Treatment of Neoplastic Diseases
Antimetabolite Agents
Antibiotics
Mitotic Inhibitors
FIGURE 29-6 Mitosis.
Alkylating Agents
Nitrogen Mustards
Nitrosoureas
Other Antineoplastic Agents
Tech Note!
Side Effects of Chemotherapy and BiologicAL Treatments
TABLE 29-5 Other Cancer Treatment Agents
Adjunctive Agents
Erythropoietin
Filgrastim
TABLE 29-6 Treatment of Chemotherapy Side Effects
Cytoprotective Agents
Other Types of Treatment
Chemoradiotherapy (CRT)
Radiopharmaceuticals
BOX 29-4
Examples of Radiopharmaceuticals and Their Use
Biological Therapy
Tech Note!
Hyperthermia
Photodynamic Therapy
Complementary and Alternative Medicine
Pain ControL
Cancer Survival Rates
Tech Alert!
TABLE 29-7 Estimated Deaths Attributable to Cancer for 2009
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
Section Four Basic Sciences for the Pharmacy Technician
CHAPTER 30 Microbiology
Objectives
Terms and Definitions
EXAMPLES OF ORGANISMS AND DISEASES THEY CAUSE
Charles Darwin (Evolution)
The Golden Age of Microbiology
Louis Pasteur
FIGURE 30-1 The golden age of microbiology.
Classifications of Organisms (Taxonomy)
TABLE 30-1 Kingdoms, Cell Characteristics, and Examples
Robert Whittaker (The Five Kingdoms)
Plantae
Plant Cell Structure
FIGURE 30-2 Major components of a plant cell.
Animalia
FIGURE 30-3 Cell composition of an animal cell.
Animal: Eukaryotic Cell Structure
TABLE 30-2 Characteristics and Structure of an Animal (Eukaryotic) Cell
Protista
FIGURE 30-4 Three forms of locomotion in protozoa.
How Parasites Are Transmitted
FIGURE 30-5 Life cycle of Plasmodium vivax.
TABLE 30-3 Parasitic Diseases Contracted by Human Beings
Fungi
Tech Note!
FIGURE 30-6 The budding process of replication of yeast cells. Yeast multiplies asexually by budding or sprouting a new cell that then breaks away from the mother cell.
FIGURE 30-7 Morphology of prokaryotic organisms. Pictures 1 to 6 show the various morphologies or shapes of microbes. The most common shapes include the following: 1, coccus; 2, bacilli; 3, spirilla; 4, vibrios. Picture 5 shows cocci microbes that are found in sets of two, called diplococci or diplobacilli. Those microbes found in strips are shown in picture 6: streptococci or streptobacilli. Picture 7 shows staphylococci and staphylobacilli, which are found in clusters.
Monera
Characteristics and Structure of Prokaryotes
Brief History of Antibiotics
Structure of the Bacterial Cell Wall
Exterior of Bacterial Cell Walls
Antibiotic Spectrum and Resistance
FIGURE 30-8 Bacterial cell walls.
Tech Note!
Human Diseases and Conditions
Diseases Caused by Organisms within the Plantae Kingdom
TABLE 30-4 Classes of Microorganisms within the Kingdom Monera
TABLE 30-5 Commonly Caused Bacterial Conditions
BOX 30-1
Examples of Common Plants that Can Cause Harm to Humans and Animals
Tech Alert!
Diseases Caused by Organisms within the AnimalIA Kingdom
FIGURE 30-9 Poison oak infection.
Diseases Caused by Organisms within the ProTISTA Kingdom
FIGURE 30-10 Brown recluse spider bite.
Diseases Caused by Organisms within the Monera Kingdom
FIGURE 30-11 Rocky Mountain spotted fever.
Diseases Caused by Fungus
BOX 30-2
Conditions Caused by Fungi
Viruses
Classification of Viruses
Morphology and Characteristics of Viruses
FIGURE 30-12 Viral composition. A, Unenveloped (capsomeres). B, Enveloped virus. C, Bacteriophage.
FIGURE 30-13 Human immunodeficiency virus replication. Diagram of the replication process of viruses. Each component is made independently inside the host cell. All materials are made from the host cell. Once the parts are made, they are assembled.
Analysis of Virions
FIGURE 30-14 Determination of antibody formation: antibody test using bacteriophages. This proves whether a person has formed antibodies against a certain antigen. A, A sample of blood (containing an antibody, O) is placed in a beaker. Two components are added to this beaker: a complement (color when bound to antigen and antibody) and the antigen (A) to the antibody. B, The result would be that O and A bind, resulting in a color that makes this test positive. C, A sample of blood (with no antibody) is placed in a beaker. The two components are then added to the beaker. The result in this case is negative because there is no antibody present to complete the color change. Thus the blood has no previous contact with that specific antigen.
Diseases Caused by Viruses
TABLE 30-6 Well-Known Viral Diseases
How Viral Infections are Stopped
Using Viruses to Fight Disease
FIGURE 30-15 The four ways to stop viral infections.
BOX 30-3
Methods of Viral Inhibition
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 31 Chemistry
Objectives
Terms and Definitions
Parts of an Atom
Tech Note!
FIGURE 31-1 Electron orbit.
FIGURE 31-2 Periodic table of elements. The elements K, Na, Cl, Mg, Se, and Cu are highlighted.
Tech Note!
Molecules
Enzyme Activators and Inhibitors
FIGURE 31-3 Carbon, represented by the letter C. Below the element is the atomic number. Above is the atomic weight.
FIGURE 31-4 Water molecule formation. Water is one of the most important compounds on earth. Water composes approximately 65% to 75% of all living cells.
TABLE 31-1 Chemical Charges of Compounds
Tech Note!
Metabolism: Anabolism and Catabolism
Electrolyte and Mineral Replacement
Hyperalimentation Example: Electrolytes in Clinical Practice
Chemistry in Clinical Practice: Drug and Food Chemical Reactions
Acid-Base Reactions
TABLE 31-2 Interactions between Ions and Medications
Tech Note!
Amino Acids
FIGURE 31-5 Amino acid structure.
FIGURE 31-6 Essential amino acids for human life. They are the basis for proteins that are responsible for normal body functions.
Tech Note!
Conclusion
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Back Matter
Appendix A Review for the PTCB Examination
Answer Key
Appendix B 200 Top Selling Trade Name Drugs for 2009
APPENDIX C Top 30 Herbal Remedies
Glossary
Abbreviations
Common Disease States/Conditions
Drug and Solution Abbreviations
Measurements
Drug Dose Intervals, Forms, and Instructions
Organizations
Pharmacy Chemical Abbreviations and Terms
Medical Terms/Abbreviations
Medical Personnel Titles
Miscellaneous
Reference Book Abbreviations
Math Review for Pharmacy Technicians
Proportions
Method 1: Cross Multiply and Divide
Method 2: Means and Extremes
Questions
Percents
Rules
Questions
Metric, Household, and Apothecary Conversions
Metric System
Weight (gram)
Volume (liter)
Household System
Weight
Volume
Apothecary System
Weight
Volume
Questions
Units
Questions
Milliequivalents
Questions
Pediatric Dosages
Example 1
Example 2
Questions
Concentration/Dilution
Three Hints to Prevent Errors in Solving Dilution Problems
Questions
Alligation
Questions
Drip Flow Rates
Questions
Temperature Conversions
Questions
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
What Information Is Protected?
Permitted Uses and Disclosures
Workforce Training and Management
Data Safeguards
Documentation and Record Retention
Civil Money Penalties
Criminal Penalties
What Does This Mean to You and Other Pharmacy Personnel?
Scenarios
Student Case Scenarios
200 Top Selling Trade Name Drugs for 2009

Who Will Benefit From This Book?
Why is This Book Important to the Profession?
Organization
Distinctive Features of this Edition
Drug Names and Pronunciations
Tech Notes
Tech Alerts
Mini Drug Monographs
Pharmacist’s Perspective
Technician’s Corner
New to This Edition
New Chapter! Chapter 14: Medication Safety and Error Prevention
Medical Terminology
Appendix A: Review for the PTCB, EXPCT, or PEBC Examination
Updated Pill Images
Additional Math Exercises
Overall Content Update
Learning Aids
Four-Color Design
Extensive Visual Aids
Chapter Objectives
Key Terms
Do You Remember These Key Points?
Ancillaries
For the Instructor
TEACH Instructor Resource
Instructor’s Resource.
TEACH Online Pharmacy Technician Program Guide.
Additional Instructor Ancillaries
For the Student
Ancillaries Available on the Evolve Companion Web Site
Student Workbook/Lab Manual
Acknowledgments
Reviewers
Contributors
Dedication
Section One General Pharmacy
CHAPTER 1 History of Medicine and Pharmacy
Objectives
Terms and Definitions
IMPORTANT PEOPLE
History of Medicine
Ancient Beliefs and Treatments
The Medical Staff
FIGURE 1-1 Medical staff.
Medicine in Its Infancy
Tech Note!
BOX 1-1
The Hippocratic Oath
Ancient Herbal Remedies
TABLE 1-1 Advancements in Medicine
Eighteenth- and Nineteenth-Century Medicine
North American Medicine
BOX 1-2
Example of Prescription Compound from The 1900s
Tech Note!
Opium and Alcohol
BOX 1-3
Typical Remedies of the 1800s in America
BOX 1-4
The Civil War
Tech Note!
Origin of Opium (Opiates)
Twentieth Century Medicine
Advancements in Drug Therapy and Vaccinations
BOX 1-5
Laudanum Recipe from The 1700s
TABLE 1-2 Examples of Important Vaccine Advancements in Medicine*
Old Remedies Making a Comeback?
History of Pharmacy
Early Pharmacists
Early Pharmacy in America
FIGURE 1-2 Medications were compounded by hand using a variety of compounds.
FIGURE 1-3 Large show globes (seen on top of shelf). An assortment of different mortars and pestles (seen on countertop).
Early Pharmacy Technicians
BOX 1-6
Famous Pharmacists
TABLE 1-3 Advancements in the Field of Pharmacy Technology
Changing Pharmacy
FIGURE 1-4 Pharmacy technician working in the pharmacy setting.
Trust in Pharmacists/Trust in Technicians
Technicians of the Twenty-First Century and Beyond
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites Referenced
For More Information on Topics Covered
CHAPTER 2 Pharmacy Federal Laws and Regulations
Objectives
Terms and Definitions
Introduction
FDA History
Early Activity of the FDA
Description of Laws
1906 Federal Food and Drugs Act
1914 Harrison Narcotics Act
1938 Food, Drug, and Cosmetic Act
1951 Durham-Humphrey Amendment
BOX 2-1
Well-Known Federal Laws
1962 Kefauver-Harris Amendments
1970 Comprehensive Drug Abuse Prevention and Control Act
1970 The Poison Prevention Packaging Act (PPPA)
1983 Orphan Drug Act
BOX 2-2
PPPA Guidelines (Exempt Drugs)*
1987 Prescription Drug Marketing Act
1990 Omnibus Budget Reconciliation Act (OBRA ’90)
1996 Health Insurance Portability and Accountability Act (HIPAA)
Patient Confidentiality
What Information Is Protected?
What Does This Mean for the Pharmacy?
How Is Information Protected via the Computer?
What Are the Rights of the Patient?
Examples of What You (the Technician) Cannot Do
BOX 2-3
Examples of Breaching Confidentiality
Examples of What Is Not Covered under HIPAA Patient Rights
Public Health Activities
Law Enforcement Purposes
Examples
2000 Drug Addiction Treatment Act (DATA 2000)
2003 Medicare Modernization Act (MMA)
2005 Combat Methamphetamine Epidemic Act
FIGURE 2-1 DEA poster on the misuse of pseudoephedrine.
BOX 2-4
Combat Methamphetamine Epidemic Act 2005
TABLE 2-1 Additional Pharmacy-Related Acts
Food and Drug Administration/Drug Enforcement Administration
1972 Drug Listing Act; National Drug Code (NDC)
FIGURE 2-2 Example of NDC label.
FDA Reporting Process and Adverse Reactions
Recalled Drugs
BOX 2-5
NDC Number Specifics
NDC 50580-449-05
FIGURE 2-3 FDA MedWatch form.
Controlled Substances
BOX 2-6
Sample Recall Notification
Recall—Firm Press Release
FIGURE 2-4 Codeine label showing C-II imprint.
TABLE 2-2 Typical Controlled Substances
Ratings of Scheduled (Controlled) Substances
Tamper-Proof Prescriptions
BOX 2-7
Tamper-Proof Features
FIGURE 2-5 Sample of tamper-proof prescription.
Registration Required for Maintaining Narcotics
Refilling Controlled Substances
Ordering Controlled Substances
FIGURE 2-6 Drug Enforcement Administration Form 222.
TABLE 2-3 Examples of State Regulations for C-II Refills and C-III to C-V Refills
Tech Note!
Record Keeping
FIGURE 2-7 A, Pharmacy log sheet. B, Nursing floor log sheet.
TABLE 2-4 Three Methods of Filing Controlled Substances and Legend Drugs
Narcotic Inventory
Reverse Distributor
Tech Note!
Filling, Refilling, and Transferring Prescriptions for Controlled Drugs
Original Filling of C-II through C-V
Emergency Filling of C-II
Refilling of C-II through C-V
Partial Filling of C-II through C-V
Transferring Controlled Drug Prescriptions C-II through C-V
Dispensing Without a Prescription
Lending or Transferring Schedule C-II through C-V Drugs to Another Pharmacy
Mailing Controlled Substances C-II through C-V
Monographs
1 Indications and Usage
2 Dosage and Administration
3 Dosage Forms and Strengths
4 Contraindications
5 Warnings and Precautions
6 Adverse Reactions
7 Drug Interactions
8 Use in Specific Populations
9 Drug Abuse and Dependence
10 Overdosage
11 Description
12 Clinical Pharmacology
13 Nonclinical Toxicology
14 Clinical Studies
15 References
16 How Supplied/Storage and Handling
17 Patient Counseling Information
Boxed Warning
FIGURE 2-8 Highlights of a drug monograph.
Medguides
Pregnancy Categories
BOX 2-8
(A) Special Warnings and Information
(B) Example of Drugs Requiring Boxed Warning
Prescription Regulation
Who Can Prescribe?
Who Can Receive a Prescription?
BOX 2-9
Pregnancy Categories
Category A
Category B
Category C
Category D
Category X
Tech Note!
Prescription Labels
BOX 2-10
Prescribing Authority
Special Labeling
Records and Labeling Requirements
FIGURE 2-9 A, Sample of information necessary on a physician’s prescription order. B, Sample of information on a medication label.
TABLE 2-5 Required Prescription Information*
Repackaging
Drug Enforcement Administration Verification
BOX 2-11
Drugs Requiring Additional Information
Tech Alert!
Non–Child-Resistant Caps
BOX 2-12
Drug Enforcement Administration Verification Process of Prescriber’s DEA Number
TABLE 2-6 Prescription Drugs That Can Be Packaged in Non–Child-Resistant Bottles
Special Prescribing Programs
Programs for Opioid Maintenance
Methadone Maintenance Treatment (MMT)
Suboxone and Subutex
Risk Management Programs for Prescription Drugs
iPledge Program under the FDA
Tech Alert!
Pharmacy Sites
Brick and Mortar and Mail-Order Pharmacies
Online Pharmacies (E-Pharmacy)
Occupational Safety and Health Administration
BOX 2-13
Common Safety and Health Topics
Material Safety Data Sheets (MSDS)
The Joint Commission
Legal Standards
State Laws
Liabilities
Tech Alert!
Pharmacy Employee Requirements: Request for Waiver
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Referenced Websites
CHAPTER 3 Pharmacy Ethics, Competencies, Associations, and Settings for Technicians
Objectives
Terms and Definitions
Introduction
Historical Data
Competencies
Current Qualifications
BOX 3-1
White Paper on Pharmacy Technicians 2002
Nondiscretionary Duties
BOX 3-2
Chapter References Citing Common Responsibilities and Competencies of A Pharmacy Technician
Basic Nondiscretionary Skills
Typing
Computers
Reports and Documentation
Ordering Supplies
BOX 3-3
Examples of Federal Laws Governing Pharmacy
Prescription Records
Patient Consultation (OBRA ’90)
Tech Note!
Inpatient Setting Requirements
Tech Note!
FIGURE 3-1 Room for preparing intravenous solutions for inpatients.
Community (Outpatient) Setting Requirements
FIGURE 3-2 Outpatient filling station.
Closed Door Pharmacy Requirements
FIGURE 3-3 Home health and long-term pharmacy industry setting.
Mail-Order Pharmacy and E-Pharmacy
Ethics and Communication in the Workplace
Professionalism
Morals Versus Ethics in the Workplace
Protocol
Communication
BOX 3-4
Pharmacy Technician Code of Ethics
Preamble
Principles
Listening Skills
FIGURE 3-4 Technician helping customer.
Body Language
Verbal Communications
Vocal: How You Sound
BOX 3-5
Example of Negative Body Language
How to Improve Your Vocal Communication Skills
Verbal: What You Say
First Way of Handling a Problem
Second Way of Handling the Same Problem
How to Improve Your Verbal Skills
Phone Etiquette
Written Communication
Confidentiality
Terminally Ill Patients
BOX 3-6
Example of Unacceptable Phone Etiquette
BOX 3-7
Example of Poor Written Communication Skills
Information That Should Be Obtained and Written Down in the Message:
BOX 3-8
Example of Breach of Confidentiality
Training Programs for the Pharmacy Technician Student
Different Levels of Pharmacy Technicians
BOX 3-9
ASHP Course Curriculum Requirements
National Certification for Technicians
BOX 3-10
Goals of PTCB and Exam Requirements
Goals
Eligibility Requirements to Take the Exam Include the Following:
Continuing Education
TABLE 3-1 Comparisons of National Certification Examinations
Tech Note!
Tech Alert!
Opportunities for Technicians
TABLE 3-2 Examples of Continuing Education Website Portals for Technicians
BOX 3-11
PTCB Qualifications and Common Duties of Certified Technicians
Job Duties
Knowledge, Skills, Training, and Education
Incentive Programs
The Professional Technician Associations
American Pharmacists Association (Apha)
American Society of Health-System Pharmacists (AShP)
TABLE 3-3 Organizations/Associations for Pharmacy Technicians*
American Association of Pharmacy Technicians (AAPT)
National Community Pharmacists Association (NCPA)
National Pharmacy Technician Association (NPTA)
BOX 3-12
Internet Sites for Jobs
The Job Search
The Resume
Professional Dress
Tech Note!
The Possibilities
BOX 3-13
Resume Help
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
CHAPTER 4 Conversions and Calculations Used by Pharmacy Technicians
Objectives
Terms and Definitions
Introduction
Tech Note!
History of Pharmacy
Roman Numerals
Rules for Determining Roman Numerals
EXAMPLE 4-1 Working with Roman Numerals
TABLE 4-1 Arabic and Roman Numerals
EXERCISE 4-1 Quick Check
International Time (Military Time)
FIGURE 4-1 Military clock versus traditional clock.
EXERCISE 4-2 Quick Check
Practice Quiz #1 (Roman Numerals and Time)
BOX 4-1
Time Conversions
Fill in the blanks:
Multiplication/Division
EXERCISE 4-3 Quick Check
TABLE 4-2 Multiplication Chart
Fractions, Decimals, Percentages, Ratios, and Proportions
Converting Fractions to Decimals
EXERCISE 4-4 Quick Check
Converting Fractions to Percentages
Converting Ratios to Percentages
Converting Decimals to Percentages
EXERCISE 4-5 Quick Check
Ratios/Proportions
EXAMPLE 4-2
EXAMPLE 4-3
Tech Note!
EXERCISE 4-6 Quick Check
Other Examples of Proportion Problems
EXAMPLE 4-4
EXAMPLE 4-5
EXAMPLE 4-6
Answer to question 1
Answer to question 2
Answer to question 3
Answer to question 4
EXAMPLE 4-7
Tech Note!
Example of Proportions in Compounding
Working with Word Problems
EXAMPLE 4-8
EXAMPLE 4-9
EXERCISE 4-7 Quick Check
Determine 1 Dose
TABLE 4-3 Metric Prefixes
Practice Quiz #2 (Decimals, Fractions, Percentages)
Convert the following percents to decimals
Convert the following fractions to percents
Metric System
Metric Measurements
Tech Alert!
EXERCISE 4-8 Quick Check
TABLE 4-4 Metric-Household Conversion Measurements
Household Measurements
EXAMPLE 4-10
EXAMPLE 4-11
EXAMPLE 4-12
Tech Note!
EXERCISE 4-9 Quick Check
Apothecary System
FIGURE 4-2 Oral cups show equivalent volumes between household to metric and household to apothecary units.
EXAMPLE 4-13
Using 65 mg/grain
EXAMPLE 4-14
Using 65 mg/grain
EXERCISE 4-10 Quick Check
Tech Note!
TABLE 4-5 Standard Weights and Volumes: Avoirdupois/Metric*
EXERCISE 4-11 Quick Check
Avoirdupois System
Avoirdupois Measurements
EXERCISE 4-12 Quick Check
Volumes
Weights
Practice Quiz #3
Important Differences among Systems
TABLE 4-6 Apothecary/Metric/Household Conversions
BOX 4-2
Time Schedule (Pharmacy Abbreviations)
FIGURE 4-3 Common devices used for measuring liquid medications.
Oral Syringes and Injections
Pediatric and Geriatric Dosing
EXAMPLE 4-15
EXAMPLE 4-16
Calculating the Proper Dose
EXERCISE 4-13 Quick Check
Tech Note!
Calculating Pediatric Dosage
EXAMPLE 4-17
EXERCISE 4-14 Quick Check
Tech Note!
Calculating Body Surface Area (BSA)
Other Methods of Calculating Pediatric Doses
Geriatric Patients
EXERCISE 4-15 Quick Check
Tech Note!
Drip Rates
Tech Note!
EXAMPLE 4-18 Calculating Drip Rates
EXERCISE 4-16 Quick Check
EXAMPLE 4-19 Determining Volume Based on Drop Factor (DF)
EXAMPLE 4-20
Tech Note!
Dilution
FIGURE 4-4 Large-volume IV drip with smaller piggyback attached to tubing on pump.
EXERCISE 4-17 Quick Check
Alligation
Tech Note!
EXERCISE 4-18 Quick Check
Practice Quiz #4
Do You Remember These Key Points?
Test Questions
Convert the following units into percentages
Convert the following fractions of grains into milligrams
Write the Arabic numbers in Roman numerals and the Roman numerals in Arabic numbers
Convert the following metric units into the units indicated to the right
Solve the following drug orders. Be sure to show your work. Use the following conversions
Technician’s Corner
Bibliography
CHAPTER 5 Dosage Forms, Routes of Administration and Drug Classifications, Drug Abbreviations, and Medical Terminology
Objectives
Terms and Definitions
TERMS AND ABBREVIATIONS
Introduction
Where Did Pharmacy Abbreviations Originate?
Do Not Use List
Dosing Instructions
TABLE 5-1 TJC Official “Do Not Use” List*
TABLE 5-2 ISMP Error-Prone Abbreviations, Symbols, and Dosage Designations
Classifications of Medications
TABLE 5-3 General Classifications of Medications
Different Types of Drug Sales
Dosage Forms
FIGURE 5-1 A, Unscored tablet. B, Scored tablet.
FIGURE 5-2 A, Plain tablets. B, Scored tablets. C, Enteric-coated tablets.
TABLE 5-4 25 Top Selling Generic Drugs with Multiple Dosage Forms
Tech Note!
Solids
Tablets/Caplets
Tech Note!
Capsules
Capsule Sizes
FIGURE 5-3 Different types of capsules.
FIGURE 5-4 Types of capsules. A, Capsules. B, Extended-release capsules.
FIGURE 5-5 Different sizes of capsules. Eight sizes are available; each holds a specific volume, and each holds a specific amount of medication. The size numbers are 5, 4, 3, 2, 1, 0, 00, 000—5 being the smallest and 000 being the largest.
Example of Caplets and Capsules
Lozenges/Troches
Example of Lozenges and Troches
Biomaterials
Implants
Transdermal Patches
FIGURE 5-6 A, Example of nitroglycerin ointment patch. B, Example of a transdermal patch.
Example of Topical patches
Tech Alert!
Liquids
Syrups
Example of Syrups
Elixirs
Example of Elixirs
Sprays
Example of Sprays
Inhalants and Aerosols
Example of Aerosol and Mdis
Tech Note!
Emulsions
FIGURE 5-7 A, Inhaler. B, Inhaler attached to an AeroChamber (also known as a spacer).
Example of Emulsions
Tech Note!
Suspensions
Example of Suspensions
Tech Note!
Enemas
Example of Enemas
Semisolids
Creams
Example of creams
Lotions
Example of Lotions
Ointments
Example of Ointments
Gels
Example of Gels
Pastes
Example of Pastes
Suppositories
Example of Suppositories
Powders
Example of Powders
Injectables
Example of Injectables
FIGURE 5-8 A, Medication in vials. B, Medication in ampules.
FIGURE 5-9 This type of vial is called Add-A-Vial or Mix-O-Vial. The advantage of this type of medication dosage form is its longer shelf life. 1, First remove the sterile cap. 2, The powder is below, and the sterile diluent is on top of the vial. The vial is divided by a rubber stopper in the middle. 3, Push the plunger down, forcing the stopper to fall into the bottom of the vial. This allows the diluent to mix with the powder. Shake well. Once dissolved, the medication is ready to be used.
FIGURE 5-10 On the left is a large-volume IV. On the right is an IV piggyback.
Routes of Administration
By Mouth, or Oral
Sublingual and Buccal Agents
TABLE 5-5 Common Abbreviations Used with Dosage Forms
FIGURE 5-11 A, Sublingual tablet placement. B, Buccal tablet placement.
Rapidly Disintegrating Oral Tablets
Rectal Agents
Topical Agents
Parenteral: Intravenous, Intravenous Piggyback, Intramuscular, and Subcutaneous Agents
Eye/Ear/Nose (ophthalmic, otic, nasal)
Inhalants
Injectable (Long-Acting)
Miscellaneous Routes
Other Considerations: Form and Function
Pharmacokinetics vs. Pharmacodynamics
Absorption
Distribution
FIGURE 5-12 Lock-and-key mechanism allowing absorption to take place in a cell. These common reactions take place naturally throughout the body. Only after the correct receptor makes a connection with the matching receptor site will the cell allow a reaction to take place. Medications often mimic this natural mechanism.
BOX 5-1
Ionization
Metabolism
Excretion/Elimination
Bioavailability
Half-Life
Bioequivalence
The Use of Excipients
Manufactured Products
TABLE 5-6 Description of Additives
TABLE 5-7 Description of Dosage Forms
TABLE 5-8 Examples of Storage Requirements
Packaging and Storage Requirements
Medical Terminology
TABLE 5-9 Abbreviations for Conditions or Body Systems
BOX 5-2
Overview of Word Parts of Medical Terminology
Rules
TABLE 5-10 Common Body System Word Segments
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Question
Bibliography
Websites
CHAPTER 6 Drug Information References
Objectives
Terms and Definitions
Introduction
Understanding the Correct Way to Reference
Tech Note!
BOX 6-1
Examples of Trade Drug Names That Indicate the Function of the Drug
Tech Note!
References Used in Pharmacy
Drug Facts and Comparisons
BOX 6-2
Examples of Similar Endings of Generic Drug Names
Physicians’ Desk Reference
TABLE 6-1 Sections in Drug Facts and Comparisons
TABLE 6-2 Sections of Physicians’ Desk Reference
Drug Topics Red Book
BOX 6-3
Example of Information in Drug Facts and Comparisons
Omeprazole
Looking Up Information Under Trade Name:
Looking Up Information Under Generic Name:
TABLE 6-3 Sections in Drug Topics Red Book
Approved Drug Products with Therapeutic Equivalence Evaluations: “Orange Book”
American Hospital Formulary Service Drug Information
United States Pharmacopeia–National Formulary (USP–NF)
TABLE 6-4 Abbreviations in Drug Topics Red Book
United States Pharmacists’ Pharmacopeia
Clinical Pharmacology and Other Gold Standard/Elsevier Products
Ident-A-Drug
FIGURE 6-1 Screen shot from Clinical Pharmacology showing a drug monograph.
Micromedex Healthcare Series
FIGURE 6-2 Screen shot from Clinical Pharmacology showing a pill using the Drug IDentifier.
Trissel’s Handbook on Injectable Drugs
American Drug Index
Goodman & Gilman’s the Pharmacological Basis of Therapeutics
Handbook of Nonprescription Drugs by Apha
Martindale’s The Complete Drug Reference
Remington’s Pharmaceutical Sciences: The Science and Practice of Pharmacy
Pediatric Dosage Handbook (Lexi-Comp)
Geriatric Dosage Handbook (Lexi-Comp)
TABLE 6-5 Main Attributes of Various References
Pocket-Sized Reference Books
Electronic Referencing
The Internet
Journals and Newsmagazines
TABLE 6-6 Online Websites and Databases
Additional Types of Information
TABLE 6-7 Types of Journals and Pharmacy Magazines Available
TABLE 6-8 Additional Reference Books That Technicians May Find Helpful in Understanding Various Aspects of Health Care
Tech Note!
Considerations When Choosing a Reference
BOX 6-4
Pharmacy Associations* that Provide Continuing Education and Information
Tech Note!
Do you Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 7 Prescription Processing
Objectives
Terms and Definitions
Introduction
Processing a Prescription: A Step-by-Step Approach
Receiving the Prescription
Tech Note!
Prescription Information
Community Pharmacy Setting
Institutional Setting
Tech Note!
FIGURE 7-1 Example of physician’s prescription.
BOX 7-1
Commonly Followed Rules for Taking Prescriptions
Call-in
Fax
Walk-in
E-Prescribing
The following are some benefits of using E-prescribing:
The following are some barriers for E-prescribing:
Tech Note!
Translation of an Order
BOX 7-2
Required Patient Information in a Community Setting
Patient Information:
Provider’s Information:
Prescription Information:
When to Ask for Help
Tech Note!
Tech Note!
Entering the Information into the Database
Community Setting
BOX 7-3
Required Patient Information in an Institutional Setting
Patient Information:
Prescriber Information:
Prescription Order Information:
Other Important Information, Usually Available from Medical Chart or Nursing Staff:
Institutional Setting
FIGURE 7-2 Technicians may enter information into the computer system in many pharmacy settings.
Filling the Prescription in a Community Setting
Tech Note!
1 Verifying the Prescription
FIGURE 7-3 Technicians filling prescriptions.
Tech Note!
2 Pulling the Correct Medication
Tech Note!
3 and 4 Counting and Filling the Medication
FIGURE 7-4 Pulling medication from the shelf.
5 Prescription Lids
6 Applying the Label
FIGURE 7-5 Technician counting and pouring tablets into medication vial.
TABLE 7-1 Exceptions for Safety Lids*
Tech Note!
7 Technician’s Initials
8 Auxiliary Labels
Tech Note!
9 and 10 Pharmacist’s Final Inspection
FIGURE 7-6 Applying an auxiliary label.
TABLE 7-2 Commonly Used Auxiliary Labels for Side Effects
Community Dispensing Systems
Filling Orders in an Institutional Setting
BOX 7-4
Advantages of a Computer Dispensing System
Computer Dispensing Systems
Inpatient Dispensing Systems
The 5 Rights of Medication SafetY
Pharmacist Consultations: When and Who Needs Them
Miscellaneous Orders
Community Setting
Daily Hard-Copy Printing (QUEUE)
FIGURE 7-7 Patient consultation.
Refills
Tech Note!
Zero Refill Reorders
Transfers
Refilling Automated Dispensing System (ADS) Machines
Tech Note!
Filing Prescriptions
TABLE 7-3 Filing Prescriptions
Early Fills
Medication Pickup
Billing Patients
Changing Trends
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
CHAPTER 8 Over-the-Counter Medications
Objectives
Terms and Definitions
Introduction
FIGURE 8-1 More than 100,000 OTC products exist from different combinations of only 1000 ingredients.
Three FDA Categories Concerning Classification of Over-the-Counter Drugs
TABLE 8-1 Common Over-the-Counter Brand Preparations
Food and Drug Administration Regulations
Purity
BOX 8-1
Types Of Product Additives
Potency
Bioavailability
Efficacy
Safety and Toxicity
BOX 8-2
Medications Measured in Units (Requires a Prescription)
How a Prescription Drug Becomes an Over-the-Counter Drug
BOX 8-3
Food and Drug Administration Phases of Over-the-Counter Drug Approval
TABLE 8-2 OTC Versus Rx Medications
Conditions Treated with Over-the-Counter Drugs
Analgesics and Antipyretics
TABLE 8-3 Common Types of Over-the-Counter Products*
Common Patient Information
Tech Note!
Tech Note!
Interactions between Aspirin and Other Agents
TABLE 8-4 Analgesics and Antipyretic Products
TABLE 8-5 Examples of Common and Important Interactions between Aspirin and Other Medications
Headache Products
Antiinflammatories
Common Patient Information
Tech Note!
Allergy and Cold Agents
Decongestants
TABLE 8-6 Headache Products
TABLE 8-7 Antiinflammatory Products
Common Patient Information
Antihistamines
Common Patient Information
Sleep Aids
TABLE 8-8 Decongestant Products
TABLE 8-9 Oral Antihistamine Products*
Common Patient Information
Cough Medicines
Common Patient Information
Sore Throat Products
TABLE 8-10 Antiinsomnia Products
TABLE 8-11 Cold and Cough Products
TABLE 8-12 Sore Throat Products
Common Patient Information
Tech Note!
Stomach Remedies/Antacids
Common Patient Information
Tech Note!
Intestinal Remedies
TABLE 8-13 Stomach Products/Antacids
Common Patient Information
Skin Remedies
Geriatric and Pediatric Considerations
TABLE 8-14 Intestinal Products
TABLE 8-15 Over-The-Counter Skin Products
TABLE 8-16 Common Agents Used to Treat a Variety of Conditions
TABLE 8-17 Effects Drugs Have on an Aging Body
Behind-the-Counter Drugs
Do You Remember These Key Points?
Review Questions
TABLE 8-18 Current BTC Medications
Multiple choice questions
True/False
Technician’s Corner
Reference
Bibliography
Websites
Websites
CHAPTER 9 Complementary and Alternative Medicine
Objectives
Terms and Definitions
Agents Covered In This Chapter
Introduction
What Is Alternative Medicine?
Overview of Eastern versus Western Medicine
Trends toward Alternatives
Organizations Related to Alternative Medicine
Maggot Therapy
TABLE 9-1 Twelve Alternative Treatments
TABLE 9-2 BTER Foundation Research Areas
Leech Therapy
Ancient Chinese Medicine
BOX 9-1
Ugly Medicine
Leeches
Maggots
Acupuncture
Acupressure
FIGURE 9-1 Acupuncture.
FIGURE 9-2 Acupressure points.
Additional Forms of Complementary and Alternative Medicine
Art Therapy
Ayurveda
Biofeedback
Chiropractic Therapy
FIGURE 9-3 Biofeedback. Example of electrode placement.
Pharmacist’s Perspective
Educate Yourself about Complementary and Alternative Medicine and Health
Herbal Medicine
TABLE 9-3 Examples of Herbal-Drug Interactions
Herbal Treatments
TABLE 9-4 Common Uses and Cautionary Notes for Herbals
FIGURE 9-4 Black cohosh.
FIGURE 9-5 Garlic.
FIGURE 9-6 Purple coneflower.
Herbal Preparations
TABLE 9-5 Herbal Preparations
Homeopathy
Tech Note!
The Placebo Effect
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites Referenced
CHAPTER 10 Hospital Pharmacy
Objectives
Terms and Definitions
Introduction
Types of Hospitals
Hospital Pharmacy Standards and Procedures
Policies and Procedures
TABLE 10-1 Example of Various Sizes and Types of Hospitals
Tech Note!
Hospital Protocol
Tech Note!
Hospital Standards
Hospital Orders
Flow of Orders
FIGURE 10-1 The flow of orders. As orders arrive, they are entered into the computer. If an order is unclear or if there is a question, the pharmacist contacts the physician.
FIGURE 10-2 Example of a physician’s order. Note the medical record number in place of a prescription number. Also, the patient’s room number and allergies should be listed (not shown).
FIGURE 10-3 Pneumatic tube system. A pneumatic tube system is used to transport orders to the pharmacy and medications to hospital floors.
Point of Entry (POE)
Computerized Physician Order Entry (CPOE)
Bar Code Point of Entry (BPOE)
Computerized Adverse Drug Event Monitoring (CADM)
Responsibilities of an Institutional Technician
Patient Cassette Drawers
TABLE 10-2 Common Job Descriptions
Preparing Unit Dose Medications
Unit Dose Liquids
Controlled Substances
Description
Duties
Daily IV Preparation Duties
Aseptic Technique
USP <797>
IV Tech
Description
Chemotherapy Preparation
Description
FIGURE 10-4 Airegard 301 (Horizontal Laminar Flowhood Clean Bench).
FIGURE 10-5 Vertical flow hood.
FIGURE 10-6 Proper placement of labels on parenteral solutions.
Tech Alert!
Labeling
Description
Tech Alert!
Inventory Control Technician
Description
Duties
Supplying Specialty Areas
BOX 10-1
Examples of Primary Units and Areas that Require Medication from Pharmacy
Tech Alert!
Nonclinical Areas Stocked by the Pharmacy
BOX 10-2
Examples of Hospital Codes*
Central Supply
TABLE 10-3 Commonly Used Crash Cart Medications and Their Classification
BOX 10-3
Special Departments Stocked by the Pharmacy
Glove Boxes
FIGURE 10-7 Labgard 437: Glove box for IV admixture.
Automated Dispensing Systems (ADSs)
Additional Areas of Pharmacy
Satellite Pharmacies
Description
Duties
Discharge Pharmacy
Description
Duties
Pharmacy and Nursing Staff Relationship
BOX 10-4
Ads Manufacturers
Tech Note!
Stat and ASAP Orders
Specialty Tasks
Investigational Drugs/Biological Therapies
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 11 Repackaging and Compounding
Objectives
Terms and Definitions
Introduction
Repackaging
Tech Note!
Repackaging Equipment
Repackaging Techniques
TABLE 11-1 Examples of Good Manufacturing Practice Guidelines
FIGURE 11-1 Sample of containers.
FIGURE 11-2 A sample blister pack container.
FIGURE 11-3 A technician is responsible for the proper preparation and labeling of all repackaged medications. A, The empty medication card is rotated under the hopper, where the medication is placed into the card. The medication card is then rotated to the heating element, where the seal is made to enclose each tablet. B, The technician uses a mirror to verify that each sheet is filled completely.
TABLE 11-2 Unit Dose Containers
Tech Note!
Documentation
Labeling and Checking Repackaged Medications
FIGURE 11-4 Sample of a unit dose log record.
TABLE 11-3 Example of Unit Dose Record Log Sheet Information*
TABLE 11-4 Examples of Manufacturer Abbreviation Codes
Tech Alert!
Storage and Stability
Expiration Dates Versus Beyond-Use Dating
Method 1
EXAMPLE 11-1 Expiration Dating (6-Month Version)
Method 2
EXAMPLE 11-2 Beyond-Use Dating (1-Year Version)
Tech Alert!
Compounding
History
Non–Sterile Compounding
BOX 11-1
Why Compound Medications?
Compounding Area
Equipment
Personal Protective Equipment
BOX 11-2
Examples of Dosage Forms that Can be Compounded
Topicals
Oral Liquids
Oral Solids
Suppositories
Measuring Devices
TABLE 11-5 Examples Of Compounding Equipment
Mixing Equipment
FIGURE 11-5 Graduated cylinders are used for liquid measurement.
TABLE 11-6 Types of Graduated Cylinders
FIGURE 11-6 Mortars and pestles are used to crush solids. Both glass and porcelain types are used in compounding.
TABLE 11-7 Types of Compounding Mixing Equipment
Weighing Equipment
FIGURE 11-7 A, Class A balance. B, Pharmaceutical weights. C, Analytical balance.
Additional Supplies
Mold Forms
Excipients
Taste
TABLE 11-8 Common Additives
TABLE 11-9 Common Flavor Additives for Taste*
Non–Sterile Compounding and Techniques
Personal Preparation
Weighing Techniques
BOX 11-3
Competencies
Tech Note!
Measuring Liquids
Preparing Solutions
BOX 11-4
Instructions for Using a Class a Balance
Solubility
Tech Note!
Reconstituting Premade Suspensions
FIGURE 11-8 The meniscus is the level at which liquids are measured and recorded. For accuracy always have the container at eye level when determining the volume.
Solids: Tablets, Capsules, and Lozenges
BOX 11-5
Solubility Characteristics
TABLE 11-10 Common Auxiliary Labels Placed on Medication Containers
Molded Tablets
Tablet Molds
Steps Necessary for Preparation of Molded Tablets
Compressed Tablets and Lozenges
BOX 11-6
Tablet Additives
Making a Tablet
Compounding Capsules
BOX 11-7
Calibrating the Mold
BOX 11-8
Compounding Procedure for Molded Tablets
Lozenges
TABLE 11-11 Capsule Sizes
Hard Lozenges
Soft Lozenges
Chewable Lozenges
Semisolids: Ointments, Sticks, and Suppositories
Medication Sticks
Filling Ointment Jars
Filling Ointment Tubes
Soft Sticks
BOX 11-9
Classifications of Ointment Bases
Formulations
Suppositories
Oleaginous Bases
Water-Soluble Bases
Glycerinated Gelatins
Preparing Suppositories
Using Molds
FIGURE 11-9 Suppository molds can be used as well as hand-rolled method. A, Suppository molds prepared in the pharmacy. B, Suppository packaging.
Using Hand-Rolling Method
Packaging Suppositories
Nasal Preparations: Ointments, Suspensions, Gels, and Solutions
Preparing Solution
Preparing Suspensions
Preparing Ointments
Preparing Gels
Tech Alert!
Packaging
TABLE 11-12 Types of Containers/Sealants and Dosage Forms They Contain
Tech Note!
Stability
Documentation
Safety
TABLE 11-13 USP <795> Guidelines
Sterile Compounding
BOX 11-10
Information Necessary on Compounding Log Sheet and Medication Label
Log Sheet Information
Medication Label Information
Ophthalmic Agents
Tech Note!
EXAMPLE 11-3
Cefazolin Super Eye Drops
Tech Alert!
Compounding Professionalism
Regulatory and Quality Control
Chemotherapeutic Agents
Veterinary Medications
BOX 11-11
Labeling Requirements for Animal Prescriptions
TABLE 11-14 Pet Dosage Forms and Flavorings
Compounding
Personnel Training
Compounding Calculations
Reducing or Enlarging Formulas
Determining Partial Dosage Units
Changing Stock Solutions
Mixing Products of Different Strengths
Performing Solubility Expressions
Converting Units to Weights
Do you Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites Referenced
CHAPTER 12 Aseptic Technique
Objectives
Terms and Definitions
Introduction
Terminology Used in Pharmacy
Standard Precautions of a Health Care Worker
BOX 12-1
Abbreviations and Descriptions of Pharmacy Stock
Types of Containers Used for Preparing Parenteral Medications; Description of Container and/or Contents
Common Types of Solutions Used/Ordered for Parenteral Agents
Routes of Administration for Parenteral Agents
Miscellaneous Terms Used Concerning Parenteral Medications
Supplies
Syringes
FIGURE 12-1 Anatomy of a syringe. As the syringe decreases in size, the calibrations (volume markers) become larger, allowing a more accurate dosage.
FIGURE 12-2 Two types of syringes. A, Regular tip syringe. The regular tip is held in place by pressure, as seen in the 1-mL syringe. B, The Luer-Lok syringe has spirals to secure the needle, as seen on a larger 3-mL syringe.
TABLE 12-1 Commonly Used Intravenous Room Supplies
Needles
FIGURE 12-3 Tubex holders are intended to be reused. They hold the disposable Tubex or Carpuject cartridges. Each cartridge is prelabeled with the medication name, strength, volume, and concentration. The pharmacy stocks holders and cartridges.
FIGURE 12-4 Needle sizes shown are (from top to bottom) 19, 20, 21, 23, and 25 gauge. Technicians may use a 19-gauge needle for small volumes such as 1 mL or less. Larger gauges (not shown) include 18 and 16 gauge for larger volumes.
Filters
Stock Levels
FIGURE 12-5 Anatomy of a needle.
FIGURE 12-6 A, Mini-spikes used in multidose vials. B, Filter needles. C, Filter sizes. D, Ampules and ampule breakers. E, Transfer needle. F, Syringe and caps.
Tech Note!
Routes of Administration (ROA)
Tech Note!
Medication Delivery Systems
Piggyback Containers
FIGURE 12-7 This gravity pump system intravenous piggyback setup shows a 100-mL Viaflex container (left) piggybacked to a large-volume 1-L IV (right).
Large- and Small-Volume Drips
Buretrol Systems
FIGURE 12-8 Volutrol drip systems are used mostly for pediatric patients. Nurses prepare these.
Tech Note!
Continuous Analgesic Delivery Systems
Patient-Controlled Analgesia (PCA) Syringe System
PCA Syringe Systems
Patient-Controlled Analgesia (PCA) Cassette System
FIGURE 12-9 A, Controlled analgesia device pump. B, Patient-controlled analgesia pump.
PCA Cassette Systems
Vials
Tech Note!
Aseptic Technique
FIGURE 12-10 ADD-Vantage system: To prepare IV, follow the three steps listed. 1, Remove the vial top. 2, Pull up flange, removing the seal on the intravenous bag. 3, Screw the vial into the port. Do not break the seal between vial and bag.
FIGURE 12-11 Proper hand washing technique.
FIGURE 12-12 Steps for proper sterile gloving. 1, Open glove packet. 2, Open glove cover without touching gloves. 3, Holding cuff of glove, pull glove over hand. 4, Slide gloved hand under the cuff of the second glove. Carefully pull on glove.
BOX 12-2
Personnel Preparation*
Tech Alert!
USP <797>
Risk Levels
TABLE 12-2 Terms/Abbreviations Used in Pharmacy
TABLE 12-3 USP <797> Risk Levels
Low Risk Level 1
Medium Risk Level 2
High Risk Level 3
Education and Training
FIGURE 12-13 Compounding evaluation checklist.
BOX 12-3
Media-Fill Tests
Tech Note
Requirements for Compounding
TABLE 12-4 USP Air Standards Based on 0.5-µm Particle Size
IV Environment
BOX 12-4
Environment Terminology
Storage and Stability
FIGURE 12-14 Clean room.
Hood Cleaning and Maintenance
Airflow
TABLE 12-5 Storage Risk Levels: Temperature Ranges and Expiration Dates of Compounded Medications
Cleaning and Maintaining Hoods
TABLE 12-6 HEPA Filtering System Standards
BOX 12-5
Daily Cleaning of Laminar Airflow Workbench
Hand Placement
FIGURE 12-15 The six-step process of using aseptic technique in the hood is as follows: (1) Using alcohol, wipe the tops of the vials and the ports on the intravenous bags from back to front (wipe around the vial and bag rather than over or behind). (2) Place the needle bevel side up and push it into the rubber stopper of the vial. Preload the syringe with the necessary amount of air to replace solution. (3) Invert the vial and syringe 180 degrees. Push in the air from the syringe and pull out the solution. (4) After removing the syringe from the vial, insert the needle into the intravenous bag and inject the medication using a steady hand. (5) After injecting the intravenous bag with the medication, immediately flip the bag over. This decreases the possibility of forgetting which bags have been injected and which ones have not. (6) Never recap the used needles; instead, discard each syringe in a sharps container along with the uncapped needle after use. Syringes cannot be reused when changing from one drug to another. This decreases the chance of drug-to-drug contamination.
BOX 12-6
Cleaning the Vertical Flow Hood
BOX 12-7
Cleaning the Biological Safety Cabinet
Disposal
Tech Note!
Spills
Tech Note!
Parenteral Antibiotics and Solutions
BOX 12-8
BSC Guidelines for Medication Preparation
TABLE 12-7 Example of Suggested Dosing Times, Solutions, and Appropriate Volumes for Antibiotics
Technique
Use of Ampules to Prepare Medications
Technique
FIGURE 12-16 Proper manipulation of ampule: Ampule sizes range from 1- to 50-mL glass containers. For larger ampules, an ampule breaker is suggested. For smaller ampules, follow these steps: (1) Tap top of ampule to empty top of container. (2) Using an alcohol swab, wipe the neck of the ampule and snap open (away from you). (3) Tilt the ampule at an angle (the solution will not spill) and withdraw needed amount of drug using a filter needle. (4) Replace the filter needle with a regular needle and inject into solution; however, if sending the syringe, remove the needle and cap the end of the syringe. (5) Label container and place in proper location for pharmacist’s inspection.
Hyperalimentation
Tech Note!
FIGURE 12-17 A total parenteral nutrition preparation connected to an infusion set.
Electrolytes and Additives
TABLE 12-8 Types of Parenteral Additives
FIGURE 12-18 Example of a total parenteral nutrition order.
Compatibility Considerations of Parenteral Medications
Tech Note!
Components of a Label for Intravenous Medication
TABLE 12-9 Additional Considerations for the Preparation of Drugs
FIGURE 12-19 Example of an intravenous medication label.
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 13 Pharmacy Stock and Billing
Objectives
Terms and Definitions
Types of Insurance
Introduction
Formulary and Drug Utilization
Pharmacist’s Perspective
Drug Utilization and Formulary Selection Process
Generic versus Trade Name Drugs
Third-Party Billing
Point of Sale (POS) Billing
Types of Insurance
Health Maintenance Organization (HMO)
TABLE 13-1 Types of Insurance Claims
What If Your Patient Has HMO Insurance?
Preferred Provider Organization (PPO)
What If Your Patient Has PPO Insurance?
Drug Discount Cards or Drug Coupon Cards
Government-Managed Insurance Programs
History of Medicare and Medicaid
FIGURE 13-1 Sample health insurance card.
BOX 13-1
Medicare Coverage Types
TABLE 13-2 Chronological Changes in Medicare/Medicaid Coverage
Tech Note!
Current Use of Medicare/Medicaid Insurance
Medicare
Medicare Part D
What If Your Patient Has Medicare Insurance?
BOX 13-2
Medigap Coverage
BOX 13-3
Various Supplies Covered by Medicare
FIGURE 13-2 Sample Medicare Part D card.
Medicaid
What If Your Patient Has Medicaid Insurance?
Workers’ Compensation
Tech Note!
Billing the Insurance Company
Prior Authorization
Tech Note!
TABLE 13-3 Minimum Information Required by Insurance Companies
Tech Note!
Patient Profiles
FIGURE 13-3 TAR form.
FIGURE 13-4 Computer patient profile using OmniLinkRx.
BOX 13-4
Information Contained on a Prescription Card
Processing Claims
Claim Problems
FIGURE 13-5 Universal claim form.
Tech Note!
Coverage Expiration Policy for Drugs
Limitation of Plan Exceeded
FIGURE 13-6 The arrow on the drug label shows the NDC code for this drug.
Tech Note!
Handling Non-formulary Drugs or Noncovered National Drug Codes
Filling a Prescription Too Soon
Non-Identification Match
Pharmacy Stock
Ordering Systems
Special Orders
Bar Coding
Automated Dispensing Systems (ADS)
Tech Note!
Manual Ordering
FIGURE 13-7 OmniRx.
New Stock
Tech Note!
Proper Storage
Returns
BOX 13-5
Receiving Stock
Drug Recalls
Damaged Stock
Expired Stock
BOX 13-6
Recall Notification
Automated Return Companies
Nonreturnable Drugs and Their Disposal
Tech Note!
Suppliers
Special Ordering Considerations
TABLE 13-4 Difference in Ordering from Manufacturers, Wholesalers, and Warehouse Repackaging Plants
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 14 Medication Safety and Error Prevention
Objectives
Terms and Definitions
Introduction
What Constitutes an Error?
TABLE 14-1 Common Hospital Pharmacy Errors (ASHP)
TABLE 14-2 MERP Error Categories
How Errors Occur
Scenario #1: Misinterpretation of Physician’s Orders
Scenario #2: Missed Dose
Scenario #3: Wrong Patient
Scenario #4: Adverse Effect
Scenario #5: Noncompliance
Where Errors Are Made
Why Errors Occur
BOX 14-1
Non–Health Care Settings
Recommendations from MERP
Example 1
Example 2
Look-Alike, Sound-Alike (LASA) Drugs
Look-Alike Drug Names/Tall Man Lettering
TABLE 14-3 Commonly Confused Drug Names
Drug Interactions as a Source of Error
Warfarin (Coumadin) Interactions
TABLE 14-4 Examples of Drug-Drug Interactions
Errors in the Pharmacy
TABLE 14-5 Example of Warfarin Interactions with Drugs, Supplements, and Foods
Documented Errors
Medication Errors That Involve Allergies
Parenteral Errors
Sustained Released (SR) Dosage Form Errors
Errors Related to Patient Care
Nosocomial Infections
Home Health Care Errors
Age-Related Errors
Medical Errors and the Elderly
Tech Alert!
Medical Errors and Pediatric Patients
How to Stop Errors from Occurring
A Pharmacist’s Daily Routine
Computerized Prescription Order Entry (CPOE)
FIGURE 14-1 WPL305 desktop bar code printer.
Reporting Errors
BOX 14-2
Organizations that Track Errors
Verbal Ordering Error Prevention
Parenteral Medication Error Prevention
Common Pharmacy Technology
Bar Coding
Robot Rx Machines
FIGURE 14-2 Robot Rx machine.
Automated Dispensing Systems (ADS)
Community Pharmacy ADS Machines
FIGURE 14-3 KL20.
Patient Dose-Specific Orders
USP <797> Regulations
Drug Labeling
FIGURE 14-4 SP 200 robotic prescription dispensing system.
Boxed Warnings
Training and Education
ASHP
Medication Reconciliation
Other Considerations
FIGURE 14-5 Sample reconciliation form.
Do You Remember These Key Points?
BOX 14-3
Methods to Avoid Errors in the Pharmacy
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Section Two Body Systems
CHAPTER 15 Endocrine System
Objectives
Terms and Definitions
COMMON DRUGS PRESCRIBED FOR HORMONAL CONDITIONS (NONINCLUSIVE LISTINGS)
MEDICAL TERMINOLOGY
Endocrine Anatomy
FIGURE 15-1 Endocrine anatomy.
TABLE 15-1 Endocrine Structures, Medical Terms, and Functions
Description of Hormones
Structure and Function of Hormones
FIGURE 15-2 Structures of a steroid and a protein molecule.
TABLE 15-2 Hormone Function
Mechanism of Action
Functions of the Endocrine Glands
Hypothalamus
Pineal Gland
Pituitary Gland
TABLE 15-3 Hormonal Production of Anterior and Posterior Pituitary Gland
Thyroid Gland
FIGURE 15-3 Thyroid and parathyroid glands.
Parathyroid Glands
Adrenal Glands
TABLE 15-4 Adrenal Hormones and Their Effects on the Body
FIGURE 15-4 Pancreas.
Pancreas
Ovaries
FIGURE 15-5 Ovaries.
FIGURE 15-6 Testes.
Testes
Conditions of the Endocrine System and Their Treatments
TABLE 15-5 Endocrine Conditions with Corresponding Glands and Hormones and Possible Treatments
Conditions of the Pituitary Gland and Hypothalamus and Their Treatments
Gigantism and Acromegaly
Prognosis
Non–Drug Treatment
Drug Treatment
Hypopituitarism
Prognosis
Non–Drug Treatment
Drug Treatment
Diabetes Insipidus
Prognosis
Non–Drug Treatment
Drug Treatment
Conditions of the Thyroid Gland and Their Treatment
Hyperthyroidism
Prognosis
Non–Drug Treatment
Drug Treatment
Hypothyroidism
Prognosis
Non–Drug Treatment
Drug Treatment
Conditions of the Parathyroid Glands and Their Treatment
Hyperparathyroidism
Prognosis
Non–Drug Treatment
Drug Treatment
Bone Metabolism Regulators
Bisphosphonates
Hypoparathyroidism
Prognosis
Non–Drug Treatment
Drug Treatment
Osteoporosis Management and Treatments
Osteoporosis
Prognosis
Non–Drug Treatments
Drug Treatments
Osteoporosis Prevention
Conditions of the Adrenal Glands and Their Treatment
Cushing’s Syndrome
Prognosis
Non–Drug Treatment
Drug Treatment
Addison’s Disease
Prognosis
Non–Drug Treatment
Drug Treatment
Mineralocorticoid
Glucocorticoids
Tech Note!
Adrenal Medulla
Endocrine Conditions of the Pancreas Gland and Their Treatments
Diabetes Mellitus
Type 1
Type 2
Gestational Diabetes Mellitus (GDM)
Other Specific Types
Prognosis
Non–Drug Treatment
Drug Treatments
Tech Alert!
FIGURE 15-7 A, Humulin R (fast-acting). B, Humulin L (intermediate-acting).
TABLE 15-6 Commonly Prescribed Insulins for Insulin-Dependent Diabetes Mellitus (All Are Given Subcutaneously)
TABLE 15-7 Antidiabetic Agents for Type 2 Diabetes Mellitus
TABLE 15-8 Combination Oral Agents
Combination Agents
Blood Glucose Meters
TABLE 15-9 Diagnostic Devices for Blood and Urine Analysis
Hormones Secreted by the Ovaries and Their Uses
TABLE 15-10 Examples of Alternate Routes of Administration of Estrogens
Conditions of the Testes and Their Treatment
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
CHAPTER 16 Nervous System
Objectives
Terms and Definitions
COMMON DRUGS USED FOR CONDITIONS INVOLVING THE CENTRAL NERVOUS SYSTEM
NERVOUS SYSTEM MEDICAL TERMINOLOGY
The Nervous System
FIGURE 16-1 The nervous system is analogous to a mainframe computer (central nervous system) that communicates with other computers further away (peripheral nervous system).
Tech Note!
The Neuron
TABLE 16-1 Neuronal Transmitters, Their Most Important Clinical Locations, and Some of Their Actions
FIGURE 16-2 The nervous system: Divisions include the somatic and autonomic branches. The somatic division sends and receives impulses to and from the muscles whereas the autonomic system regulates both sympathetic and parasympathetic systems.
Afferent (Sensory) Neurons
Efferent (Motor) Neurons
Tech Note!
Nerve Transmission
FIGURE 16-3 Neuron: Impulses travel down the axon into the nerve terminal, where they are released into the synaptic space between each neuron. Impulses then are transmitted to the following neuron via the dendrites, which extend out of the cell body. The spaces between segments of the myelin sheath are known as the nodes of Ranvier.
FIGURE 16-4 The afferent and efferent nerves and the areas innervated by the sympathetic and parasympathetic systems. Preganglionic and postganglionic nerves that make up the cell bodies and axon are shown.
Central Nervous System
Brain
FIGURE 16-5 Neuronal impulse transfer cycle.
FIGURE 16-6 Lobes of the brain, cerebellum, and brainstem, which are all part of the central nervous system.
FIGURE 16-7 Cranial nerves.
Cranial Nerves
Spinal Cord
TABLE 16-2 Primary Functions of Cranial Nerves
FIGURE 16-8 Segments of the spinal cord.
Blood-Brain Barrier
Tech Note!
Peripheral Nervous System (PNS)
TABLE 16-3 Permeability of the Blood-Brain Barrier
FIGURE 16-9 Lock-and-key mechanism: As the knee is tapped, impulses are sent to and from the brain. The neurotransmitters affect specific receptors that are interpreted. The reaction sent via neurotransmitters is to jerk the knee.
Tech Note!
Autonomic System
Sympathetic System
Tech Note!
Parasympathetic System
Somatic System
TABLE 16-4 Major Organ Response When Sympathetic System Is Activated
TABLE 16-5 Response of the Body Systems to Parasympathetic Stimulation
Tech Note!
Neurotransmitters
Main Neurotransmitters
Tech Note!
TABLE 16-6 α- and β-Receptors and Their Effects on the Body Systems
Adrenergic Agents and Adrenergic Blockers
Sympathomimetics or Adrenergic Agents
Tech Note!
Cholinergic Agents and Cholinergic Blockers
Conditions of the Nervous System and Their Treatments
BOX 16-1
Conditions/Diseases Affecting the Nervous System and Websites for Additional Information
Disorders and Stroke
Government Institutes
General Nervous System Disorders
Skeletal Muscle Pain
Central-Acting Medications
Smooth Skeletal Muscle Relaxants
Direct-Acting Agents
Muscle Relaxants with Analgesics/Antiinflammatories
Specific Conditions Affecting the Peripheral Nervous System
Bell’s Palsy
Prognosis
Non–Drug Treatment
Drug Treatment
Myasthenia Gravis (MG)
Prognosis
Non–Drug Treatment
Drug Treatments
Cholinergic Agents
Disorders of the Brain and/or Spinal Cord
Stroke
Prognosis
Non–Drug Treatment
Drug Treatment
Anticoagulant
Antiplatelet
Tech Note!
Migraine Headache
Prognosis
Non–Drug Treatment
TABLE 16-7 Types of Migraines
Drug Treatments
TABLE 16-8 Migraine Medications
Pharmacist’s Perspective
What’s New in Headache Management?
Epilepsy
Prognosis
BOX 16-2
Types of Seizures
Partial Seizures
Generalized Seizures
Non–Drug Treatment
Drug Treatments
TABLE 16-9 Agents Used for Treatment of Epilepsy
Examples of Anticonvulsants
Hydantoin Anticonvulsants
Succinimide Anticonvulsant
Tech Note!
Barbiturates (Controlled Substances)
Benzodiazepines (Controlled Substances)
Alzheimer’s Disease
Prognosis
Non–Drug Treatment
Drug Treatment
BOX 16-3
Stages Associated with Alzheimer’s Disease
Cholinesterase Inhibitors
Tech Note!
Multiple Sclerosis (MS)
FIGURE 16-10 Multiple sclerosis lesions in the brain and brainstem.
Prognosis
Non–Drug Treatment
Drug Treatment
ABRC Agents
Interferons
Antispasmodic Medication
Central-Acting Smooth Muscle Relaxant; Antispasmodic
Parkinson’s Disease
Prognosis
Non–Drug Treatment
FIGURE 16-11 Symptoms and signs of Parkinson’s disease.
Drug Treatment
TABLE 16-10 Medications Used to Treat Parkinson’s Disease
Examples of Anti-Parkinsonism Drugs
Selective MAO-B Inhibitor
Anticholinergics Prolong the Effects of Dopamine by Inhibiting the Reuptake Mechanism
Dopamine Agonists
Amyotrophic Lateral Sclerosis (ALS)
Prognosis
Non–Drug Treatment
Drug Treatment
Dystonia
Prognosis
Non–Drug Treatment
Drug Treatment
Tech Note!
Tourette’s Syndrome (TS)
BOX 16-4
Medications Used to Treat Dystonia
Agents That Reduce Levels of Acetylcholine
Dopamine-Stimulating Agents
Agents That Regulate GABA
Miscellaneous Agents Used for the Following Symptoms:
Insomnia
Spasms
Pain
Prognosis
Non–Drug Treatment
Drug Treatment
TABLE 16-11 Medications Used for Treatment of Tourette’s Tics
Butyrophenone
Miscellaneous Muscle Agents
Neuromuscular Blockers
BOX 16-5
Classification of Neuromuscular Blockers
Short-Acting (Effective 20-26 min)
Intermediate-Acting
Long-Acting (Effective 75-100 min)
BOX 16-6
Medications Used for Conscious Sedation
Possible Combinations for Adults
Possible Combinations for Children
Conscious Sedation
Tech Alert!
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites Referenced
CHAPTER 17 Psychopharmacology
Objectives
Terms and Definitions
COMMON DRUGS USED FOR PSYCHOTHERAPEUTIC CONDITIONS
PSYCHOPHARMACOLOGY TERMINOLOGY
TABLE 17-1 Types of Mental Disorders
TABLE 17-2 Mental Health Websites
Emotional Health
Psychiatric Disorders
Non–Drug Treatments
Tech Note!
General Psychiatric Disorders
Depression
Prognosis
Non–Drug Treatment
Drug Treatments
Antidepressants
Selective Serotonin Reuptake Inhibitors
Selective Serotonin Reuptake Inhibitors (SSRIs)
Serotonin Norepinephrine Reuptake Inhibitors
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
Tricyclic Antidepressants
Tricyclic Antidepressants
TABLE 17-3 Examples of Foods That Contain Tyramine
Monoamine Oxidase Inhibitors (MAOIs)
Monoamine Oxidase Inhibitors (MAOIs)
Additional Antidepressants
Other Antidepressants
Anxiety Disorders
Prognosis
Non–Drug Treatments
Drug Treatments
TABLE 17-4 Examples of Types of Phobias
TABLE 17-5 Types of Obsessive-Compulsive Personality Disorders
Antianxiety Medications
Bipolar Disorder
Prognosis
Non–Drug Treatment
Drug Treatment
Antimanics
Schizophrenia
Prognosis
Non–Drug Treatments
Drug Treatments
TABLE 17-6 Common Agents Used to Treat Schizophrenia
Typical Antipsychotics
Phenothiazines
Atypical Antipsychotics
Atypical Antipsychotics
TABLE 17-7 Types and Description of Insomnia
Other Conditions
Insomnia
Prognosis
Non–Drug Treatment
Drug Treatment
TABLE 17-8 Common (Adult Dosages) Over-the-Counter Medications Indicated For Insomnia
Tech Note!
Benzodiazepines.
Benzodiazepine Hypnotics
Non-benzodiazepines.
Non-Benzodiazepine Hypnotics
Barbiturates.
Side Effects
TABLE 17-9 Common Barbiturates
Barbiturates
Attention Deficit/Hyperactivity Disorder (ADHD)
Prognosis
Non–Drug Treatment
Drug Treatment
TABLE 17-10 Agents Used to Treat ADD/ADHD. (Most products are for use in children >6 yr.; some extended-release products not acceptable for young children)
Medications and the Elderly
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 18 Respiratory System
Objectives
Terms and Definitions
COMMON DRUGS USED FOR RESPIRATORY CONDITIONS
FIGURE 18-1 Diagram of respiratory system.
RESPIRATORY TERMINOLOGY
Structure and Function of the Respiratory System
Tech Note!
Upper Respiratory System
Lower Respiratory System
FIGURE 18-2 Bronchial tree.
Respiration
Exchange of Gases
FIGURE 18-3 Exchange of oxygen and carbon dioxide.
Tech Note!
Breathing
Tech Note!
Sneezing
Disorders/Conditions of the Respiratory System
Upper Respiratory System
TABLE 18-1 Types of Breathing Dysfunction
TABLE 18-2 Conditions of the Upper Respiratory System
Common Cold
Prognosis
Non–Drug Treatment
Drug Treatment
Relief of Sore Throat
Local Anesthetics for Throat Pain
BOX 18-1
Examples of Conditions that May be Affected by OTC Medications
TABLE 18-3 Combination Agents Sold OTC for Symptoms of Colds, Hay Fever, Allergies, Flu, and Respiratory Tract Infections
Antitussives (Reduce Coughing)
Narcotic Antitussive/Expectorant
Expectorants (Promote Coughing)
Expectorant (OTC)
Nasal Decongestants (Sympathomimetics)
Decongestants (OTC)
Laryngitis
Prognosis
Non–Drug Treatment
Drug Treatment
Influenza
Prognosis
Non–Drug Treatment
FIGURE 18-4 Influenza.
Drug Treatment
H1N1 (Swine Flu)
Prognosis
Non–Drug Treatment
BOX 18-2
Vaccinations (Prevention Guidelines)
Drug Treatment
Rhinitis
Prognosis
Non–Drug Treatments
Drug Treatments
Rx Nasal Corticosteroids
Allergies
Prognosis
Non–Drug Treatment
Drug Treatments
OTC Antihistamines
Nonsedating Rx Antihistamines
TABLE 18-4 Agents Used for the Treatment of Allergies
Nonsedating OTC Antihistamines
Low-Sedating OTC Antihistamines
Lower Respiratory System
TABLE 18-5 Conditions of the Lower Respiratory System
Tech Note!
Pneumonia
Prognosis
Non–Drug Treatment
Drug Treatment
Bacterial Vaccines
Viral Vaccines
Asthma
Prognosis
Non–Drug Treatments
Drug Treatments
Corticosteroids
FIGURE 18-5 Asthma obstruction.
FIGURE 18-6 A, Proper use of an inhaler. B, Inhaler with spacer (e.g., AeroChamber).
Long-Acting Bronchodilators
Combination: Long-Acting Bronchodilator/Steroid Inhaler
Leukotriene Receptor Antagonists (Leukotriene Inhibitors)
Mast Cell Stabilizers
Medications for Acute Asthma Attacks
Tech Note!
Chronic Obstructive Pulmonary Disease (COPD)
BOX 18-3
Lung Diseases That Can Lead to COPD
Prognosis
Non–Drug Treatment
Drug Treatment
Corticosteroid/Long-Acting Bronchodilator Combinations
Methylxanthine Bronchodilators
Anticholinergics
Tuberculosis
Prognosis
FIGURE 18-7 Positive result of a tuberculosis test.
Non–Drug Treatment
Drug Treatment
Antituberculosis Agents
TABLE 18-6 Examples of Tuberculosis Regimens
Emergency Disorders of the Lungs
FIGURE 18-8 Pneumothorax.
Mucolytics
Mucolytic
Tech Alert!
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 19 Visual and Auditory Systems
Objectives
Terms and Definitions: Eye
Terms and Definitions: Ear
COMMON DRUGS USED FOR CONDITIONS OF THE EYE
The Eyes (Ophthalmic System)
MEDICAL TERMS AND CONDITIONS OF THE EYE
Anatomy of the Eye
FIGURE 19-1 Anatomy of the eye.
FIGURE 19-2 Eye muscles and direction of movement. Superior rectus rotates upward and inward; inferior rectus rotates downward and inward; medial rectus rotates inward; lateral rectus rotates outward; superior oblique rotates downward and outward; inferior oblique rotates upward and outward.
Tech Note!
Vision
Conditions That Affect the Eye
Common Conditions
Allergies
BOX 19-1
Abbreviations
Terms
Abbreviations That Should NOT Be Used*
Prognosis
Non–Drug Treatment
Drug Treatments
TABLE 19-1 Ophthalmic Decongestants, Antihistamines, and Mast Cell Stabilizers*
Antiallergy Agents
Inflammation Caused by Infection or Injury
Corticosteroids
Antiinflammatory, Corticosteroids
BOX 19-2
Main Treatments for Inflammation and Infection
Nonsteroidal Antiinflammatory Drugs (NSAIDs)
Conjunctivitis
Prognosis
Non–Drug Treatment
Drug Treatment
Antiinfective Agents
Ophthalmic Sulfonamides
TABLE 19-2 Antiinfective Combination Ophthalmics
Aminoglycosides
TABLE 19-3 Viral/Nonviral Conjunctivitis
Macrolides
Antifungals
Tech Note!
Antivirals
Cataracts
TABLE 19-4 Types of Cataracts
Prognosis
Non–Drug Treatment
Drug Treatment
TABLE 19-5 Commonly Used Agents for the Treatment of Glaucoma
Anticholinergics
Cholinergics—Miotics
Glaucoma
Prognosis
Non–Drug Treatment
Drug Treatment
BOX 19-3
Types of Glaucoma*
Primary (Includes Angle-Closure or Open-Angle Conditions)
Secondary
Congenital
Beta-Adrenergic Blockers
Carbonic Anhydrase Inhibitors
Carbonic Anhydrase Inhibitor—Oral
Miotics
Cholinergics—Miotics
Sympathomimetics
Prostaglandin Agonists
Tech Note!
Blindness
Prognosis
Non–Drug Treatment
TABLE 19-6 Causes of Blindness
BOX 19-4
Proper Use of Eye Drops
Drug Treatment
Miscellaneous Ophthalmic Agents
The Ears (Auditory System)
COMMON DRUGS USED FOR CONDITIONS OF THE EAR
MEDICAL TERMS AND CONDITIONS OF THE EAR
TABLE 19-7 Artificial Tear Products
FIGURE 19-3 Anatomy of the ear.
Anatomy of the Ear
External Ear
Middle Ear
Inner Ear
Tech Note!
Conditions Affecting the Ear
FIGURE 19-4 Anatomy of the inner ear.
BOX 19-5
Three Main Areas of the Inner Ear and Their Functions
Cochlea
Vestibule
Semicircular Canals
TABLE 19-8 Hearing Conditions
TABLE 19-9 Ear Preparations*
TABLE 19-10 Major Ingredients in Otic Preparations
TABLE 19-11 Combination Otics
Deafness
Prognosis
Non–Drug Treatment
Drug Treatment
Otitis Media
Prognosis
Non–Drug Treatment
Drug Treatment
Oral Antibiotics (Systemic)
Otic Antibiotics
Cerumen Buildup
Prognosis
Non–Drug Treatment
Drug Treatment
Ototoxicity
TABLE 19-12 Medications That Cause Ototoxicity or Tinnitus
Prognosis
Non–Drug Treatment
Drug Treatment
Steroid and Antibiotic Combination
Miscellaneous Otic Preparation
Tech Note!
Miscellaneous Otic Preparations
Tech Alert!
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 20 Integumentary System
Objectives
Terms and Definitions
COMMON DRUGS USED FOR SKIN CONDITIONS
MEDICAL TERMS AND CONDITIONS OF THE SKIN
Skin Anatomy
Hair and Nails
FIGURE 20-1 Skin anatomy.
Glands
Conditions Affecting the Skin, Hair, and Glands
FIGURE 20-2 Nail anatomy.
FIGURE 20-3 Glands of the skin.
Noninfectious Skin Conditions
Acne Vulgaris
FIGURE 20-4 Acne.
Prognosis
Non–Drug Treatment
TABLE 20-1 Topical Acne Treatments
Drug Treatments
Sunburn
TABLE 20-2 Skin Protection Factor Guide Coverage of Sunscreen*
Prognosis
Non–Drug Treatments
Choosing a Sunscreen
Drug Treatments
TABLE 20-3 Choosing a Sunscreen*
Urticaria
Prognosis
Non–Drug Treatment
Drug Treatment
TABLE 20-4 Examples of Topical Antiinflammatory Products
Skin Cancer
Prognosis
Non–Drug Treatment
Drug Treatment
FIGURE 20-5 Types of skin cancer: A, Squamous cell; B, Basal cell; C, Malignant melanoma.
BOX 20-1
Detection of Possible Skin Cancer
A—Asymmetry
B—Border
C—Color
D—Difference
BOX 20-2
Cancer Treatments
Surgery
Medication
Stasis Dermatitis and Ulcers
FIGURE 20-6 Ulceration.
TABLE 20-5 Examples of Topical Antibacterial Products
Prognosis
Non–Drug Treatment
Drug Treatment
Psoriasis
Prognosis
FIGURE 20-7 Psoriasis.
Non–Drug Treatment
Drug Treatment
TABLE 20-6 Agents Used to Treat Psoriasis (Most Are Rx)
Corticosteroids
Immunomodulators
Vitamin D Analog
Burns
Prognosis
BOX 20-3
Burn Degrees
FIGURE 20-8 Third-degree burn.
Non–Drug Treatment
Drug Treatment
Canker Sores
Prognosis
Non–Drug Treatment
Drug Treatment
TABLE 20-7 Canker Sore Treatments
Infectious Inflammatory Skin Conditions
Warts
Prognosis
FIGURE 20-9 A, HPV (common warts). B, Genital warts, male. C, Genital warts, female.
TABLE 20-8 Over-the-Counter (OTC) Products to Treat Common Warts
Non–Drug Treatment
Drug Treatment
Genital Warts
Tech Note!
Athlete’s Foot
Prognosis
Non–Drug Treatment
FIGURE 20-10 A, Tina capitis (head). B, Tina pedis (athlete’s foot).
Drug Treatment
TABLE 20-9 Antifungal Products to Treat Athlete’s Foot
Herpes
Prognosis
FIGURE 20-11 Herpes simplex.
Non–Drug Treatment
Drug Treatment
TABLE 20-10 Herpes Medications
Impetigo
Prognosis
Non–Drug Treatment
Drug Treatment
Conditions of the Hair
Lice
FIGURE 20-12 A, Head louse. B, Crab lice.
Prognosis
Non–Drug Treatment
Drug Treatment
Conditions of the Nail
Acute Paronychia and Onychomycosis
Prognosis
Non–Drug Treatment
Drug Treatment
BOX 20-4
Nail Conditions
Tech Note!
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Bibliography
Websites
CHAPTER 21 Gastrointestinal System
Objectives
Terms and Definitions
COMMON DRUGS FOR THE GASTROINTESTINAL SYSTEM
GASTROINTESTINAL MEDICAL TERMINOLOGY
Form and Function of the Gastrointestinal System
Anatomy of the Gastrointestinal System
FIGURE 21-1 Anatomy of the gastrointestinal system (including mouth, pharynx, esophagus, stomach, and intestines).
FIGURE 21-2 Major glands of the mouth.
Ingestion
Tech Note!
FIGURE 21-3 pH scale ranges from 1 (the most acidic) to 14 (the most basic). Normal human blood is pH 7.4, approximately the midpoint of the range.
Absorption
FIGURE 21-4 Intestinal tract (including duodenum, jejunum, and ileum).
TABLE 21-1 Foods and Enzymes That Digest Them
Excretion
Auxiliary Organ Functions
Conditions Affecting the Gastrointestinal System
TABLE 21-2 Conditions of the Upper/Lower GI System
Mouth and Throat Conditions
Tech Note!
Stomach Conditions
Tech Note!
GERD
TABLE 21-3 Gastrointestinal Conditions
TABLE 21-4 Over-the-Counter Antacid Agents (Single Ingredient)
Prognosis
Non–Drug Treatments
Drug Treatments
Antacids
Tech Note!
Histamine2-Antagonists
TABLE 21-5 Over-the-Counter Combination Antacids
Proton Pump Inhibitors (PPIs)
Tech Note!
Peptic Ulcer Disease (PUD)
Prognosis
Non–Drug Treatment
Drug Treatments
Intestinal Conditions
TABLE 21-6 Diagnostic Tests to Confirm Helicobacter pylori
TABLE 21-7 Helicobacter pylori Regimens
Diarrhea
Prognosis
Non–Drug Treatments
Drug Treatments
BOX 21-1
Bowel Problems
Constipation
Prognosis
Non–Drug Treatments
Drug Treatments
Tech Note!
Bulk-Forming Laxatives
TABLE 21-8 Laxatives
Emollient Laxatives (Stool Softeners)
Stimulant Laxatives
Hyperosmolar Laxatives
Selective Chloride Channel Activators
Flatulence
Prognosis
Non–Drug Treatment
Drug Treatment
Antiflatulence Medications
TABLE 21-9 Over-the-Counter Combination Antacid-Antiflatulence Agents
Irritable Bowel Syndrome (IBS)
Prognosis
Non–Drug Treatment
Drug Treatment
Antispasmodics
Serotonin
Crohn’s Disease
Prognosis
Non–Drug Treatment
Drug Treatment
Biological Agents
Ulcerative Colitis
Prognosis
Non–Drug Treatment
Drug Treatment
Antiinflammatory
Emesis
Prognosis
Non–Drug Treatments
BOX 21-2
Variations of Emesis
Drug Treatments
Antidopaminergics
Phenothiazines
Miscellaneous Antiemetics
Serotonin Receptor Antagonists (5-HT3-Antagonists)
Antihistamines/Anticholinergics
Miscellaneous Conditions
Poisoning
TABLE 21-10 Antidotes
BOX 21-3
Poisonous Snakes and Spiders
Types of Snakes
Types of Spiders
Prognosis
Non–Drug Treatment
Drug Treatment
Lavage
Ipecac Syrup
Tech Alert!
Activated Charcoal
Tech Alert!
General Information
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 22 Urinary System
Objectives
Terms and Definitions
COMMON DRUGS FOR THE URINARY SYSTEM
URINARY MEDICAL TERMINOLOGY
Anatomy
Function of the Kidneys
FIGURE 22-1 Anatomy of urinary tract and nephrons.
Nephron Function
FIGURE 22-2 Anatomy of the kidney.
FIGURE 22-3 Nephron anatomy.
Tech Note!
Tubular Reabsorption
FIGURE 22-4 Tubular reabsorption and secretion.
Tubular Secretion
FIGURE 22-5 Also known as an osmotic gradient, the smaller water molecules gravitate toward the highly concentrated sodium ions.
The Importance of Electrolytes
Conditions Affecting the Urinary System
Common Conditions
Renal Failure
TABLE 22-1 Conditions Affecting the Urinary System
TABLE 22-2 End-Stage Renal Disease Symptoms*
Prognosis
Non–Drug Treatment
FIGURE 22-6 Two types of dialysis.
Drug Treatment
Iron Supplement
Red Blood Cell Stimulators
Phosphorus Binding Agents
Agent to Reduce Risk of Renal Osteodystrophy (Weak Bones)
Edema
BOX 22-1
Some Causes of Edema
FIGURE 22-7 Pitting edema.
Prognosis
Non–Drug Treatment
Drug Treatment
Thiazides and Thiazide-like Agents
Tech Alert!
Loop Diuretics
Potassium-Sparing Agents
TABLE 22-3 Combination Diuretics (Potassium-Sparing)
Potassium-Sparing Diuretics
Carbonic Anhydrase Inhibitors
Carbonic Anhydrase Inhibitor
Osmotic Diuretics
Tech Alert!
Kidney Stones
Prognosis
Non–Drug Treatment
FIGURE 22-8 Common locations of kidney stones.
TABLE 22-4 Kidney Stones: Characteristics and Treatments
Drug Treatments
Urinary Tract Infection (UTI)
Prognosis
Non–Drug Treatment
Drug Treatment
Antiinfective Antibiotic
Tech Note!
Uti Antibiotic
TABLE 22-5 Treatments for Urinary Tract Infections* (Based on Oral Adult Dosages Unless Otherwise Indicated)
Cephalosporin Antibiotic
Prostatitis
Prognosis
Non–Drug Treatment
Drug Treatment
Incontinence
TABLE 22-6 Drugs Commonly Used to Treat Bacterial Prostatitis
TABLE 22-7 Types of Urinary Incontinence
Prognosis
Non–Drug Treatment
Drug Treatment
Anticholinergic
Tech Alert!
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Question
Bibliography
Websites
CHAPTER 23 Cardiovascular System
Objectives
Terms and Definitions
EXAMPLES OF CARDIOVASCULAR AGENTS
MEDICAL TERMINOLOGY OF THE CARDIOVASCULAR SYSTEM
Anatomy of the Heart
FIGURE 23-1 Anatomy of the heart.
FIGURE 23-2 Blood oxygenation.
Oxygenation
Cardiac Conduction System
The Cardiac Cycle
Conditions Affecting the Heart
FIGURE 23-3 Circulation of blood through the body.
Common Conditions
Hypertension
BOX 23-1
Common Conditions and Definitions
TABLE 23-1 Drug Classifications
Prognosis
Non–Drug Treatment
TABLE 23-2 Classifications of Combination Drugs
BOX 23-2
Examples of Conditions that Can Lead to Hypertension
Common Conditions or Factors That May Increase Risk for Hypertension
Risk Factors for Essential Hypertension
Drug Treatment
BOX 23-3
Classification of Blood Pressure Measurements
BOX 23-4
Approaches to Controlling High Blood Pressure
TABLE 23-3 Examples of Combination Drugs
Hypotension
Prognosis
Non–Drug Treatment
BOX 23-5
Types of Hypotension
BOX 23-6
Causes of Hypotension
Drug Treatment
Hyperlipidemia
Prognosis
Non–Drug Treatment
Drug Treatment
BOX 23-7
U.S. Guidelines for Cholesterol Measurements
Antihyperlipidemics
Bile Acid Sequestrants
HMG-CoA Reductase Inhibitors (“Statins”)
Fibric Acid Antihyperlipidemic
Cholesterol Absorption Inhibitor
Miscellaneous Antihyperlipidemic
Transient Ischemic Attacks (TIAs) and Strokes
Prognosis
Non–Drug Treatment
Drug Treatment
Calcium Channel Blocker
Tech Alert!
Angina Pectoris
Prognosis
Non–Drug Treatment
Drug Treatment
Nitrates
FIGURE 23-4 Nitroglycerin sublingual tablet prescription.
TABLE 23-4 Common Nitrate Agents
Tech Note!
Tech Note!
Myocardial Infarction (MI)
Prognosis
Non–Drug Treatment
Drug Treatment
Arrhythmia
Prognosis
Non–Drug Treatment
Drug Treatment
Drug Action
Tech Note!
Antiarrhythmics
Congestive Heart Failure (CHF)
Prognosis
Non–Drug Treatment
Drug Treatment
Cardiac Glycoside
Tech Note!
Diuretics Used for Congestive Heart Failure–Related Edema
Thiazide and Thiazide-Like Diuretics
Loop Diuretics
BOX 23-8
Classification of Diuretic Agents
Loop Diuretics
Potassium-Sparing Diuretics
Potassium-Sparing Diuretic
Carbonic Anhydrase Inhibitors
Carbonic Anhydrase Inhibitor
Coronary Artery Disease (CAD)
Prognosis
Non–Drug Treatment
Drug Treatment
Tech Note!
Thrombosis
Prognosis
Non–Drug Treatment
Drug Treatment
BOX 23-9
American Heart Association Guidelines to Prevent Heart Disease
TABLE 23-5 Examples of Types of Embolisms
Anticoagulants
TABLE 23-6 Examples of Anticoagulants
BOX 23-10
Heparin Concentrations
Generic Name: Heparin Sodium
Trade Name: Heplok
Low-Molecular-Weight Heparins (LMWHs)
Tech Note!
Anticoagulants
Antiplatelet Agents
Thrombolytics
BOX 23-11
Enoxaparin (Lovenox)
Prefilled Injection (PFS)
Types of Medications Used for Heart Conditions
Angiotensin-Converting Enzyme Agents (Ace Inhibitors)
Tech Note!
ACE inhibitors (ACEIs)
TABLE 23-7 Oral Antiplatelet Agents
TABLE 23-8 Examples of Thrombolytics
Angiotensin II Receptor Antagonists (Also Known As Angiotensin Receptor Blockers)
Angiotensin II Receptor Antagonists
Beta-Blocking Agents
Beta-Blocking Agents
Calcium Channel Blockers
Calcium Channel Blockers
Tech Alert!
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 24 Reproductive System
Objectives
Terms and Definitions
EXAMPLES OF REPRODUCTIVE SYSTEM DRUGS
TABLE 24-1 Hormone Functions
MEDICAL TERMINOLOGY OF THE REPRODUCTIVE SYSTEM
Male Reproductive System
FIGURE 24-1 Male reproductive system.
FIGURE 24-2 Function of testes in response to hormone stimulation.
Conditions Affecting the Male Reproductive System
TABLE 24-2 Conditions Affecting the Male Reproductive System
Common Conditions
Erectile Dysfunction (ED)
TABLE 24-3 Causes of Erectile Dysfunction
Prognosis
Non–Drug Treatments
Drug Treatments
Benign Prostatic Hypertrophy (Benign Prostatic Hyperplasia or BPH)
Prognosis
Non–Drug Treatment
TABLE 24-4 Medications for Erectile Dysfunction
Drug Treatment
Androgen Hormone Inhibitors
Alpha-Adrenergic Blockers
Prostate Cancer
FIGURE 24-3 Prostate cancer.
BOX 24-1
Stages of Prostate Cancer
TABLE 24-5 Prostate Cancer Treatments
Prognosis
Non–Drug Treatment
Drug Treatment
Male Hypogonadism
Prognosis
Non–Drug Treatment
Drug Treatment
Androgens
Female Reproductive System
FIGURE 24-4 Female reproductive system.
Conditions Affecting the Female Reproductive System
Hormonal Treatments
FIGURE 24-5 Function of ovaries in response to hormone stimulation.
Common Conditions
Female Hypogonadism
Prognosis
Non–Drug Treatments
Drug Treatments
Pelvic Inflammatory Disease (PID)
Prognosis
TABLE 24-6 PID Treatments
Non–Drug Treatments
Drug Treatments
Menopause
Prognosis
Non–Drug Treatments
Drug Treatments
Estrogen Preparations
Infertility
Prognosis
Non–Drug Treatment
Drug Treatment
Ovulation Stimulants
TABLE 24-7 Infertility Treatments
Luteinizing Hormone and Follicle-Stimulating Hormone Stimulants
Ergot Alkaloid
Progestins
Menstrual Disorders
Prophylaxis Medications
Oral Contraceptives (OCs)
FIGURE 24-6 Common contraceptives, including barrier and medicinal methods: condoms, diaphragm, oral contraceptives, and parenteral contraceptives.
BOX 24-2
Menstrual Disorders
Tech Note!
Long-Acting Contraceptive
Intrauterine Progesterone Contraception
Tech Note!
Other Contraceptives
Tech Note!
TABLE 24-8 Contraceptive Methods: Risks, Complications, and Failure
Sexually Transmitted Diseases (STDs)
Tech Alert!
Do You Remember These Key Points?
TABLE 24-9 Sexually Transmitted Disease Organisms and Various Drug Therapies
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
Section Three Classification of Drugs
CHAPTER 25 Antiinfectives
Objectives
Terms and Definitions
EXAMPLES OF ANTIINFECTIVES
TERMINOLOGY RELATED TO ANTIINFECTIVES
History of Antibiotics
The Discovery of Penicillin
Gram Stain
Modern Antibiotics
FIGURE 25-1 A Petri dish is prepared with nutrient-rich agar. This nutrient feeds the bacteria that are placed on the plate. The Penicillium colony can be seen with an area of clearance where the bacteria cannot grow. This occurs because the Penicillium colony inhibits the bacterial growth.
Types of Infections and Their Treatments
Sexually Transmitted Diseases
Gastrointestinal Infections
FIGURE 25-2 Helicobacter pylori, a bacterium that causes infection of the stomach.
TABLE 25-1 Types of Microorganisms and Parasites
TABLE 25-2 Common Sexually Transmitted Diseases and Treatments
Respiratory Infections
Nosocomial Infections
Multidrug-Resistant Organisms (MDROs)
BOX 25-1
MDROs
TABLE 25-3 Potentially Fatal “Superbugs”
Methicillin-Resistant Staphylococcus aureus (MRSA)
Vancomycin-Resistant Staphylococcus aureus (VRSA)
Multidrug-Resistant S. pneumoniae (MDRSP)
Gram-Negative Resistant Bacilli (GNRB)
Vancomycin-Resistant Enterococcus (VRE)
The Centers For Disease Control And Prevention (CDC)
Infections of the Skin
Infections of the Nose and Mouth
BOX 25-2
Nationally Notifiable Infectious Diseases 2010
Centers for Disease Control
Infections of the Eyes and Ears
Antibiotic Treatments
Tech Note!
Penicillin
FIGURE 25-3 Tinea pedis, a fungal infection that causes athlete’s foot.
TABLE 25-4 Otic and Ophthalmic Antiinfectives, Examples
Antibacterial, Penicillins
TABLE 25-5 Examples of Bacterial Morphology, Areas Affected, Treatment, and Conditions
Tech Note!
Cephalosporins
Mycobacterium and Mycobacterial Treatment
TABLE 25-6 Antibiotics Other Than Penicillins and Cephalosporins
Tech Note!
Aminoglycosides
TABLE 25-7 Antituberculin Agents
Drug-Resistant and Miscellaneous Antibiotics
TABLE 25-8 Antibiotics for Resistant Microorganisms
Antifungals
Candida Infections
TABLE 25-9 Fungal Infections and Their Treatments
FIGURE 25-4 Types of tinea infections. A, Tinea cruris. B, Tinea capitis. C, Tinea corporis.
BOX 25-3
Parasitic Organisms and Their Description
Tinea Infections
Parasites
TABLE 25-10 Protozoan Infections and Their Treatments
Protozoa
Helminths (Worms)
TABLE 25-11 Helminthic Infestations and Their Treatments
Parasitic Treatments
Malaria
TABLE 25-12 Anthelmintic Drug Actions and Common Dosage
Antivirals
BOX 25-4
Antiviral Mechanisms of Action
TABLE 25-13 Antiviral and Antiretroviral Agents
HIV/AIDS
Tech Note!
Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NRTIs)
Non-Nucleoside Reverse Transcriptase Inhibitors
Protease Inhibitors (PIs)
Tech Note!
Colds/Flu
Miscellaneous Viral Conditions
Human Papillomavirus (HPV)
Herpes Viruses
BOX 25-5
Types of Human Herpes Viruses
Herpes Simplex
Herpes Zoster (Shingles)
Varicella Zoster Chickenpox
Tech Alert!
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Use
Agents
Bibliography
Websites
CHAPTER 26 Antiinflammatories and Antihistamines
Objectives
Terms and Definitions
COMMON ANTIINFLAMMATORY AGENTS
The Inflammatory Response
TABLE 26-1 Immune Cell Responses in Injury
TABLE 26-2 Types of Inflammatory Conditions
ANTIINFLAMMATORY AND ANTIHISTAMINE TERMINOLOGY
The Body’s Natural Response
Glucocorticoids (Steroids)
Adrenal Effects of Steroid Agents
FIGURE 26-1 Prednisone-tapered prescription.
Corticosteroids
BOX 26-1
Corticosteroid Dosage Forms and Uses
TABLE 26-3 Examples of Corticosteroidal Agents and Dosage Forms
Corticosteroids
Inflammatory Pain
FIGURE 26-2 Pain route.
Tech Note!
Pain and Inflammation Medications
Aspirin
TABLE 26-4 Various Strengths of Aspirin Available
Tech Note!
Nonsteroidal Antiinflammatory Drugs (NSAIDs)
TABLE 26-5 Nonsteroidal Antiinflammatory Drugs, Cyclooxygenase-2 Inhibitors, and Similar Agents*
Cyclooxygenase-2 Inhibitors
Cox-2 Inhibitors
Controlled Analgesics
Inflammatory Conditions
Common Conditions
Osteoarthritis
Prognosis
Non–Drug Treatment
FIGURE 26-3 Severe osteoarthritis.
Drug Treatment
Rheumatoid Arthritis (RA)
FIGURE 26-4 Severe rheumatoid arthritis.
Prognosis
Non–Drug Treatment
Drug Treatment
Biological Response Modifiers
Disease-Modifying Antirheumatic Drugs
Allergies
FIGURE 26-5 Asthma: airways become obstructed by mucus and edema, causing dyspnea.
Allergic Conditions and Their Treatments
FIGURE 26-6 Events that take place in an allergic reaction, from the first exposure to an antigen to the allergic response.
BOX 26-2
Types of Antigens
BOX 26-3
Allergic Conditions
Allergic Rhinitis
Symptoms of Allergic Rhinitis
Contact Dermatitis
Symptoms of Contact Dermatitis
Atopic Dermatitis
Symptoms of Atopic Dermatitis
Drug Allergies
Symptoms of Drug Allergies
Food Allergies
Symptoms of Food Allergies
Antihistamines and Combination Drugs
TABLE 26-6 Ophthalmics for Allergic Inflammation (Mast Cell Stabilizers)
TABLE 26-7 Examples of Oral Antihistamines
TABLE 26-8 Oral Combination Antihistamine/Decongestant OTC Agents
Drug Interactions
Antihistamines
TABLE 26-9 Nasal OTC Decongestant Agents
TABLE 26-10 Intranasal Prescription Steroids
TABLE 26-11 Ophthalmic Steroidal Prescription Agents
TABLE 26-12 Topical Steroidal Treatment
Commonly Used Antihistamines
Common Nasal Corticosteroids
Tech Alert!
Anaphylaxis
Tech Alert!
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 27 Vitamins and Minerals
Objectives
Terms and Definitions
VITAMINS
MINERALS
History of Regulation of Vitamin and Mineral Supplements
BOX 27-1
Food and Drug Administration Regulatory Requirements for Dietary Supplements and Nonregulated Items
Regulatory Requirements:
The Manufacturers Must Also State on All Containers:
Vitamins
Tech Alert!
Fat-Soluble Vitamins (A, D, E, and K)
TABLE 27-1 Drug Interactions of Fat-Soluble Vitamins
TABLE 27-2 DRI Values for Fat-Soluble Vitamins
Vitamin A
Sources of Vitamin A
Hypervitaminosis A
Vitamin D
Sources of Vitamin D
Deficiency of Vitamin D
FIGURE 27-1 Rickets.
Hypervitaminosis D
Drug Interactions
Vitamin E
Sources of Vitamin E
Deficiency of Vitamin E
Hypervitaminosis E
Drug Interactions
Vitamin K (Phytonadione)
Sources of Vitamin K
Deficiency of Vitamin K
Water-Soluble Vitamins (B and C)
TABLE 27-3 DRI Values for Water-Soluble Vitamins
B Vitamins
Sources of B Vitamins
TABLE 27-4 Water-Soluble Vitamins: Overdose and Drug Interactions
TABLE 27-5 B Vitamins: Sources, Function, and Deficiency States
Deficiencies of B Vitamins
Vitamin B1 (Coenzyme)
Deficiency of Vitamin B1
Drug Interactions with Vitamin B1
Vitamin B2 (Coenzyme)
Deficiency of Vitamin B2
Tech Note!
Vitamin B3 (Coenzyme)
Deficiency of Vitamin B3
Tech Note!
Vitamin B5 (Coenzyme)
Deficiency of Vitamin B5
Vitamin B6 (Coenzyme)
Deficiency of Vitamin B6
Drug Interactions with Vitamin B6
Vitamin B7 (Biotin)
Deficiency of Vitamin B7
Vitamin B9 (Coenzyme)
Deficiency of Vitamin B9
Interactions with Vitamin B9
Vitamin B12 (Coenzyme)
Deficiency of Vitamin B12
Tech Note!
Vitamin C
Deficiency of Vitamin C
Antioxidants
Minerals
Zinc
TABLE 27-6 Common Minerals and Trace Elements, Their Actions, and Deficiencies
Drug Interactions
iron
TABLE 27-7 DRI Values for Minerals and Trace Elements
TABLE 27-8 Mineral Sources
TABLE 27-9 Iron Sources
TABLE 27-10 DRI for Elemental Iron
Iron Deficiency
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 28 Vaccines
Objectives
Terms and Definitions
TYPES OF VACCINES
SYSTEMIC IMMUNOSUPPRESSIVE AGENTS (EXCLUDES CORTICOSTEROIDS)
Lymphatic System
Thymus
Tonsils
Spleen
Types of Immune Cells
FIGURE 28-1 Overview of the major lymphatic organs within the body.
Immunizations
TABLE 28-1 Major Immune Response Cells
BOX 28-1
Brief Overview of All Immune Cells
Types of Immunity
Active Immunity
Passive Immunity
Tech Note!
How Vaccines are Prepared
Viral Vaccines
Bacterial Vaccines
Miscellaneous Vaccines
TABLE 28-2 Common Viral Vaccines, Diseases Treated, and Route of Administration
TABLE 28-3 Common Toxoids and Route of Administration
Development of Vaccines
BOX 28-2
Three Types of Less Common Vaccines and Their Specific Characteristics
Antiidiotypic Vaccines
Subunit Vaccines
Acellular and Conjugated Vaccines
TABLE 28-4 Vaccines That Prevent Diseases
TABLE 28-5 Childhood Immunization Schedule
Childhood Immunization
National Childhood Vaccine Injury Act of 1986
Tech Note!
Autism and Vaccines
Diphtheria, Pertussis, and Tetanus Infections and Vaccines
Vaccines for Diphtheria, Pertussis, and Tetanus Infections
Polio
Vaccine for Polio
Measles, Mumps, and Rubella
FIGURE 28-2 A, Measles. Symptoms include rash, consisting of both papules and macules, that spreads over the body and lasts 3 to 5 days. B, Mumps. Glands become swollen, causing pain when chewing or drinking liquids. Symptoms last approximately 24 hours. C, Rubella. Lymph nodes enlarge, and a fine red rash occurs. Symptoms last approximately 2 to 3 days.
Vaccine for Measles, Mumps, and Rubella
Chickenpox
Vaccine for Chickenpox
FIGURE 28-3 Chickenpox. Rash begins with macules, which turn into severe papules. Symptoms can last from a few days to 2 weeks.
Herpes Zoster
Hepatitis Infections and Vaccines
Hepatitis A Virus (HAV)
Vaccine
Hepatitis B Virus (HBV)
BOX 28-3
Hepatitis Infections with No Available Vaccines
Vaccine
Active Treatment
Hepatitis C Virus (HCV)
Vaccine
Active Treatment
Hepatitis D Virus (HDV)
Vaccine
Other Viruses and Vaccines
Human Papillomavirus
Vaccine
Pneumonia
Vaccine
Haemophilus influenzae Type B
Vaccine
Influenza
Vaccines
Swine Flu (H1N1)
Vaccine
Passive ImmunitY
Travel Medicine and Immunizations
Antitoxins and Antivenins
Tech Note!
Storage of Vaccines
TABLE 28-6 Types of Vaccines
Tech Note!
Immune Therapies
Special Situations for Vaccination—Pregnancy
TABLE 28-7 Examples of Biological/Immune Therapies
Tech Alert!
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 29 Oncology Agents
Objectives
Terms and Definitions
CHEMOTHERAPEUTIC AGENTS
CONTROLLED OPIOID ANALGESICS COMMONLY USED FOR CANCER PAIN
What Is Cancer?
MEDICAL TERMINOLOGY
FIGURE 29-1 Metastasis of cancer. Diagram shows how lung cancer may metastasize to other areas of the body.
What Causes Cancer?
Types of Cancer
TABLE 29-1 Types of Cancer
BOX 29-1
Types of Cancer and Where They occur
FIGURE 29-2 Lymph node sites where Hodgkin’s disease can strike.
FIGURE 29-3 Kaposi’s sarcoma.
FIGURE 29-4 Malignant mesothelioma.
BOX 29-2
Characteristics of Cancer Growth and Treatment
Diagnosis of Cancer
Treatments for Cancer
Surgery
TABLE 29-2 Combination Therapies for Cancer
Tech Note!
Radiation
Side Effects of Radiation Therapy
FIGURE 29-5 Radiation dermatitis from exposure to radiation treatment for cancer.
BOX 29-3
Forms of Treatment
Radioactive Isotopes
Chemotherapy
TABLE 29-3 Common Types of Chemotherapeutic Agents
TABLE 29-4 Routes of Administration of Chemotherapeutic Agents
Targeted Therapy
Agents Used in the Treatment of Neoplastic Diseases
Antimetabolite Agents
Antibiotics
Mitotic Inhibitors
FIGURE 29-6 Mitosis.
Alkylating Agents
Nitrogen Mustards
Nitrosoureas
Other Antineoplastic Agents
Tech Note!
Side Effects of Chemotherapy and BiologicAL Treatments
TABLE 29-5 Other Cancer Treatment Agents
Adjunctive Agents
Erythropoietin
Filgrastim
TABLE 29-6 Treatment of Chemotherapy Side Effects
Cytoprotective Agents
Other Types of Treatment
Chemoradiotherapy (CRT)
Radiopharmaceuticals
BOX 29-4
Examples of Radiopharmaceuticals and Their Use
Biological Therapy
Tech Note!
Hyperthermia
Photodynamic Therapy
Complementary and Alternative Medicine
Pain ControL
Cancer Survival Rates
Tech Alert!
TABLE 29-7 Estimated Deaths Attributable to Cancer for 2009
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
Section Four Basic Sciences for the Pharmacy Technician
CHAPTER 30 Microbiology
Objectives
Terms and Definitions
EXAMPLES OF ORGANISMS AND DISEASES THEY CAUSE
Charles Darwin (Evolution)
The Golden Age of Microbiology
Louis Pasteur
FIGURE 30-1 The golden age of microbiology.
Classifications of Organisms (Taxonomy)
TABLE 30-1 Kingdoms, Cell Characteristics, and Examples
Robert Whittaker (The Five Kingdoms)
Plantae
Plant Cell Structure
FIGURE 30-2 Major components of a plant cell.
Animalia
FIGURE 30-3 Cell composition of an animal cell.
Animal: Eukaryotic Cell Structure
TABLE 30-2 Characteristics and Structure of an Animal (Eukaryotic) Cell
Protista
FIGURE 30-4 Three forms of locomotion in protozoa.
How Parasites Are Transmitted
FIGURE 30-5 Life cycle of Plasmodium vivax.
TABLE 30-3 Parasitic Diseases Contracted by Human Beings
Fungi
Tech Note!
FIGURE 30-6 The budding process of replication of yeast cells. Yeast multiplies asexually by budding or sprouting a new cell that then breaks away from the mother cell.
FIGURE 30-7 Morphology of prokaryotic organisms. Pictures 1 to 6 show the various morphologies or shapes of microbes. The most common shapes include the following: 1, coccus; 2, bacilli; 3, spirilla; 4, vibrios. Picture 5 shows cocci microbes that are found in sets of two, called diplococci or diplobacilli. Those microbes found in strips are shown in picture 6: streptococci or streptobacilli. Picture 7 shows staphylococci and staphylobacilli, which are found in clusters.
Monera
Characteristics and Structure of Prokaryotes
Brief History of Antibiotics
Structure of the Bacterial Cell Wall
Exterior of Bacterial Cell Walls
Antibiotic Spectrum and Resistance
FIGURE 30-8 Bacterial cell walls.
Tech Note!
Human Diseases and Conditions
Diseases Caused by Organisms within the Plantae Kingdom
TABLE 30-4 Classes of Microorganisms within the Kingdom Monera
TABLE 30-5 Commonly Caused Bacterial Conditions
BOX 30-1
Examples of Common Plants that Can Cause Harm to Humans and Animals
Tech Alert!
Diseases Caused by Organisms within the AnimalIA Kingdom
FIGURE 30-9 Poison oak infection.
Diseases Caused by Organisms within the ProTISTA Kingdom
FIGURE 30-10 Brown recluse spider bite.
Diseases Caused by Organisms within the Monera Kingdom
FIGURE 30-11 Rocky Mountain spotted fever.
Diseases Caused by Fungus
BOX 30-2
Conditions Caused by Fungi
Viruses
Classification of Viruses
Morphology and Characteristics of Viruses
FIGURE 30-12 Viral composition. A, Unenveloped (capsomeres). B, Enveloped virus. C, Bacteriophage.
FIGURE 30-13 Human immunodeficiency virus replication. Diagram of the replication process of viruses. Each component is made independently inside the host cell. All materials are made from the host cell. Once the parts are made, they are assembled.
Analysis of Virions
FIGURE 30-14 Determination of antibody formation: antibody test using bacteriophages. This proves whether a person has formed antibodies against a certain antigen. A, A sample of blood (containing an antibody, O) is placed in a beaker. Two components are added to this beaker: a complement (color when bound to antigen and antibody) and the antigen (A) to the antibody. B, The result would be that O and A bind, resulting in a color that makes this test positive. C, A sample of blood (with no antibody) is placed in a beaker. The two components are then added to the beaker. The result in this case is negative because there is no antibody present to complete the color change. Thus the blood has no previous contact with that specific antigen.
Diseases Caused by Viruses
TABLE 30-6 Well-Known Viral Diseases
How Viral Infections are Stopped
Using Viruses to Fight Disease
FIGURE 30-15 The four ways to stop viral infections.
BOX 30-3
Methods of Viral Inhibition
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Websites
CHAPTER 31 Chemistry
Objectives
Terms and Definitions
Parts of an Atom
Tech Note!
FIGURE 31-1 Electron orbit.
FIGURE 31-2 Periodic table of elements. The elements K, Na, Cl, Mg, Se, and Cu are highlighted.
Tech Note!
Molecules
Enzyme Activators and Inhibitors
FIGURE 31-3 Carbon, represented by the letter C. Below the element is the atomic number. Above is the atomic weight.
FIGURE 31-4 Water molecule formation. Water is one of the most important compounds on earth. Water composes approximately 65% to 75% of all living cells.
TABLE 31-1 Chemical Charges of Compounds
Tech Note!
Metabolism: Anabolism and Catabolism
Electrolyte and Mineral Replacement
Hyperalimentation Example: Electrolytes in Clinical Practice
Chemistry in Clinical Practice: Drug and Food Chemical Reactions
Acid-Base Reactions
TABLE 31-2 Interactions between Ions and Medications
Tech Note!
Amino Acids
FIGURE 31-5 Amino acid structure.
FIGURE 31-6 Essential amino acids for human life. They are the basis for proteins that are responsible for normal body functions.
Tech Note!
Conclusion
Do You Remember These Key Points?
Review Questions
Multiple choice questions
True/False
Technician’s Corner
Bibliography
Back Matter
Appendix A Review for the PTCB Examination
Answer Key
Appendix B 200 Top Selling Trade Name Drugs for 2009
APPENDIX C Top 30 Herbal Remedies
Glossary
Abbreviations
Common Disease States/Conditions
Drug and Solution Abbreviations
Measurements
Drug Dose Intervals, Forms, and Instructions
Organizations
Pharmacy Chemical Abbreviations and Terms
Medical Terms/Abbreviations
Medical Personnel Titles
Miscellaneous
Reference Book Abbreviations
Math Review for Pharmacy Technicians
Proportions
Method 1: Cross Multiply and Divide
Method 2: Means and Extremes
Questions
Percents
Rules
Questions
Metric, Household, and Apothecary Conversions
Metric System
Weight (gram)
Volume (liter)
Household System
Weight
Volume
Apothecary System
Weight
Volume
Questions
Units
Questions
Milliequivalents
Questions
Pediatric Dosages
Example 1
Example 2
Questions
Concentration/Dilution
Three Hints to Prevent Errors in Solving Dilution Problems
Questions
Alligation
Questions
Drip Flow Rates
Questions
Temperature Conversions
Questions
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
What Information Is Protected?
Permitted Uses and Disclosures
Workforce Training and Management
Data Safeguards
Documentation and Record Retention
Civil Money Penalties
Criminal Penalties
What Does This Mean to You and Other Pharmacy Personnel?
Scenarios
Student Case Scenarios
200 Top Selling Trade Name Drugs for 2009

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