Chapter 6

1. Chapter 6 Dispensing Medications in the Community Pharmacy Edited by Dr. Ryan Lambert-Bellacov

2. COMMUNITY PHARMACY OPERATIONS • Technician Duties Related to Dispensing Over-the-Counter Drugs and Diet Supplements:In the community pharmacy, a pharmacy technician assumes a number of responsibilities related to both OTC and legend drugs, which depend on state laws and regulations. Edited by Dr. Ryan Lambert-Bellacov

3. COMMUNITY PHARMACY OPERATIONS • Technician Duties Related to Dispensing Prescription Drugs:A technician can take written prescriptions from walk-in customers but cannot take new prescriptions by telephone and reduce them to writing. Edited by Dr. Ryan Lambert-Bellacov

4. Figure 6.5

5. Community Pharmacy Dispensing Issues Safety Note! • Pharmacy technicians should not counsel patients about OTC products without the approval of the pharmacist. Edited by Dr. Ryan Lambert-Bellacov

6. GUIDELINES FOR RECEIVING AND REVIEWING PRESCRIPTIONS • Checking for Patient Allergies:The parts of a prescription include • prescriber information, • the date, • patient information, • the symbol Rx, • the inscription, • the subscription, • additional instructions, • and the signature.

7. GUIDELINES FOR RECEIVING AND REVIEWING PRESCRIPTIONS • Receiving a Controlled-Drug Prescription:Prescriptions for controlled substances require special record-keeping procedures. Pharmacy technicians should be sure to follow any labeling requirements as determined under state and federal law. Edited by Dr. Ryan Lambert-Bellacov

8. Critical Path of a Prescription 1. The patient drops off the prescription. Edited by Dr. Ryan Lambert-Bellacov Table 6.1

9. Critical Path of a Prescription 2. The pharmacy technician checks the prescription to make certain it is complete and authentic; then he or she verifies that the patient is in the pharmacy database. If the patient is not in the pharmacy database, the technician obtains necessary demographic, insurance, and allergy information from the patient and enters the information into the computer. Table 6.1

10. Critical Path of a Prescription 3. The pharmacy technician enters the prescription into the computer, bills the insurance company or the patient, and generates the medication label. Edited by Dr. Ryan Lambert-Bellacov Table 6.1

11. Critical Path of a Prescription 4. The pharmacy technician asks the pharmacist to check the drug use review (DUR) or drug interaction warning screen when required. Edited by Dr. Ryan Lambert-Bellacov Table 6.1

12. Critical Path of a Prescription 5. The pharmacy technician selects the appropriate medication and verifies the National Drug Code (NDC) number on the computer-generated medication label. Edited by Dr. Ryan Lambert-Bellacov Table 6.1

13. Critical Path of a Prescription 6. The pharmacy technician prepares the medication(s) (e.g., the prescribed number of tablets is counted or the liquid measured). Edited by Dr. Ryan Lambert-Bellacov Table 6.1

14. Critical Path of a Prescription 7. The pharmacy technician packages the medication in the appropriate container. Edited by Dr. Ryan Lambert-Bellacov Table 6.1

15. Critical Path of a Prescription 8. The pharmacy technician labels the prescription container with the computer-generated medication label. In some states the law requires the pharmacist to affix the label to the container. Table 6.1

16. Critical Path of a Prescription 9. The pharmacy technician prepares the filled prescription for the pharmacist to check. Table 6.1

17. Critical Path of a Prescription 10. The pharmacist checks the prescription(s) and may initial it. Edited by Dr. Ryan Lambert-Bellacov Table 6.1

18. Critical Path of a Prescription 11. The pharmacy technician bags the approved prescription for patient sale and attaches an information sheet about the prescription, including indications, interactions, and possible side effects. Edited by Dr. Ryan Lambert-Bellacov Table 6.1

19. Critical Path of a Prescription 12. The pharmacy technician returns the bulk product container to the shelf. Edited by Dr. Ryan Lambert-Bellacov Table 6.1

20. Critical Path of a Prescription 13. The pharmacy technician delivers the packaged prescription to the cash register area for patient pickup and pharmacist counseling. Edited by Dr. Ryan Lambert-Bellacov Table 6.1

21. Figure 6.1

22. Community Pharmacy Dispensing Issues Safety Note! • Show all questionably authentic prescriptions to the pharmacist. Edited by Dr. Ryan Lambert-Bellacov

23. Discussion • Discuss how you would handle a prescription for a controlled substance that you suspect is forged. Edited by Dr. Ryan Lambert-Bellacov

24. PATIENT PROFILE • Creating New Profiles:The pharmacy technician is often responsible for entering the new prescription order and creating or updating the computerized patient profile. Edited by Dr. Ryan Lambert-Bellacov

25. Figure 6.2

26. Figure 6.3

27. MEDICATION SELECTION AND PREPARATION • Preparing Oral Dose Forms:Oral drug products are available in many different dose forms, and each dose form has its own dispensing requirements.

28. Figure 6.4

29. MEDICATION SELECTION AND PREPARATION • Dispensing Prepackaged Drugs:Filling a prescription often involves simply retrieving from stock a drug with the right name, manufacturer, and strength.

30. MEDICATION SELECTION AND PREPARATION • Dispensing Schedule V Over-the-Counter Drugs:Some Schedule V controlled substances may be dispensed without a prescription under specific conditions.

31. MEDICATION SELECTION AND PREPARATION • Dispensing Drugs That Contain Ephedra:Many states have passed legislation restricting the access and sale of products containing ephedra and pseudoephedrine. • manufacture of methamphetamine Edited by Dr. Ryan Lambert-Bellacov

32. 2006 law • A retrievable record of all purchases identifying the name and address of each party to be kept for two years. • Required verification of proof of identity of all purchasers • Required protection and disclosure methods in the collection of personal information • Reports to the Attorney General of any suspicious payments or disappearances of the regulated products • Required training of employees with regard to the requirements of the CMEA; Retailer must self-certify as to training and compliance Edited by Dr. Ryan Lambert-Bellacov

33. 2006 law • Non-liquid dose form of regulated product may only be sold in unit dose blister packs • Regulated products are to be stored behind the counter or in a locked cabinet in such a way as to restrict public access • Daily sales of regulated products not to exceed 3.6 grams without regard to the number of transactions • 30 day (not monthly) sales limit not to exceed 7.5 grams if sold by mail-order or "mobile retail vendor" • 30 day purchase limit not to exceed 9 grams of pseudoephedrine base in regulated products Edited by Dr. Ryan Lambert-Bellacov

34. MEDICATION SELECTION AND PREPARATION • Choosing Containers:A wide variety of amber vial sizes are available and selecting the proper vial size is a skill that will be learned quickly Edited by Dr. Ryan Lambert-Bellacov

35. Discussion • It can be frustrating for a customer have difficulty identifying the pharmacist and to not understand the different roles of the pharmacist and the pharmacy technician. What types of things could you do as a pharmacy technician to help the customers?

36. LABEL PREPARATION • Contents of a label:Medication container labels must contain many different elements, including a unique prescription number, the name of the patient, directions for use, and the name and strength of the medication. (next two examples) Edited by Dr. Ryan Lambert-Bellacov

37. Figure 6.6

38. FINAL CHECK OF THE PRESCRIPTION • Final Checking:The pharmacist is responsible for the final check of the original prescription, the patient profile, the drug and drug quantity used, and the accuracy of the medication label.

39. Community Pharmacy Dispensing Issues Safety Note! • The technician should become aware and thoroughly familiar with the appropriate state’s regulations concerning scheduled drugs.