Pharmacy Technician

1. Pharmacy Technician Math Module

2. Calculate the Dosage Ashia is a pharmacy technician at a local hospital. She works part time to support her family and provide health insurance coverage for her family. She prefers to work evenings when her husband can assist her by watching their two children. Hi, my name is Ashia; I am a pharmacy technician.

3. Focus The focus of this math strand is for you to be able to figure out the amount of medication, in the proper form, to fill a prescription ordered by a doctor. In this math strand, you will be learning and reviewing the following math skills: 1) Applying medical abbreviations to math solutions2) Using a formula to calculate dosage3) Adding4) Multiplying5) Dividing6) Sorting necessary and unnecessary information to solve a word problem7) Noting key math words or phrases to solve math problems such as simplify an expression and per as in 5 milligrams per milliliter8) Reading drug labels9) Applying the standard formulas used in health care

4. Calculating Dosage On the evening shift,Ashiasupports the nursing staff at the hospital by calculating medical dosages and providing the medicine in measured doses to the nursing staff. To do this, Ashia relies on some basic knowledge about medications.

5. Calculating Dosage The dose is located directly after the name of the medication. This is the individual dose that the doctor is ordering. The total medication order covers a certain period of time such as: take for 7 days, take for 10 days, or take daily. Look at the doctor’s prescriptions and consider the following questions: Phone 360-293-9999 DEA# 23476512 Angela Truong, MD Pediatrician Pt. name Thi Tran Age12 Date May 1, 2008 Address: 234 7th Avenue, Anacortes, WA 98221 RX Ceclor 10 mL bid X 10 d Refill _0_ _X_Generic and/orequivalent allowed Physician’s Signature Angela Truong Anacortes Pediatric Medical Office 23453 Mall Blvd. Anacortes, WA 98221

6. Questions 1) What is the drug name on the prescription? Click Here 2) What is the individual drug dosage? Click Here 3) How many times a day is this medication to be given? Click Here Ceclor 10 milliliters twice a day For 10 days

7. Listen Listen and read along as Aisha defines medical order and prescription. Did you know that a medical order or medication order is a drug order written in a hospital, nursing home, or recovery center for a patient? A prescription is a drug order that is written in an office or clinic or for a client or patient being discharged. Licensed medical personnel like physicians, nurse practitioners, and other certified practitioners are allowed under state law to write medical orders and prescriptions.

8. Task One: Reading the Doctor’s Prescription A doctor writes a prescription or drug orders for patients. Again, a prescription is a written medication order for a patient leaving a medical facility. A medical order is used in a hospital or care facility. For example, a patient in the hospital may have a change in medication or need to have an increase or decrease in the amount of medication. Both of these medical prescriptions follow a similar format and include the essential information that the pharmacy technician or other licensed health care workers will use to fill the order. Please note that the paper forms of prescriptions and medical orders do not all look the same; however, the information is the same. This information may be in a different location on the form.

9. Stop! Safety Alert: A pharmacy technician may fill the drug order and work under the supervision of the pharmacist. The pharmacist will check and verify the accuracy of each filled prescription before handing it to the patient or client.

10. Format Look at the general format of a prescription. Do you ever look carefully at your prescription before you hand it to the pharmacist or pharmacy technician to fill? You should so that you know what medicine you are getting and the amount. You can also ask the pharmacist questions about what the doctor has prescribed. The job of a pharmacy technician requires careful reading. You need to read the prescription carefully to understand the medication ordered and then compare this drug order to the supply available on the pharmacy shelves. _Phone_#_________ -DEA# 123456878 Thelma Cook, MD 2332 Medical Way Renton, WA 98056 Pt. Name: ______________________ Age:__________ Address:______________________________________ RX: ___________________________________________________________________ Refill: _____________ __________Generic and/or equivalent allowed ___________________________________Date______ Physician’s Signature

11. Format As a pharmacy technician, you need to read the prescription carefully; otherwise, you may not select the correct medicine to fill the bottle. This is especially true because many medications have similar names and often times a particular medication comes in several forms. The form of medication must match the route, or way, that the medication will be taken. For example, an elixir is a liquid and easily swallowed by a young child. An older adult may take the medication in tablet or capsule form. As a patient, you should check the number and type of medicine you get from the pharmacy to make sure that it matches what the doctor ordered.

12. Think About It! What information is included on the prescription? Why do you think that this information is important to the pharmacist? Advance to the next screen for the answers.

13. Answers The prescription contains: a) The patient’s or client’s full nameb) The datec) The drug name d) The doctor’s order for dosage amount (how much medication)e) The administration route (by mouth, IV, injection)f) The frequency with which the patient is to take the medicationg) The duration, the number of days that the patient is to take the medicationh) The quantity or amount that the pharmacist is to dispense. i) A check off or box allowing a substitutej) The physician’s signaturek) The physician’s DEA number (United States Drug Enforcement Agency registration number) if the medication is a controlled substance such as morphine or codeine

14. Answers The medical community requires that all prescriptions contain certain information. This is to avoid making medical errors. Again, the information is not required to be in the same format or placed in the same area on the prescription form. Thus, there is no single form for medical orders and prescriptions.

15. Contents of a Prescription Here are the eleven items of a prescription: a) The patient’s or client’s full nameb) The datec) The drug name d) The doctor’s order for dosage amount (how much medication)e) The administration route (by mouth, IV, injection)f) The frequency with which the patient is to take the medicationg) The duration, the number of days that the patient is to take the medicationh) The quantity or amount that the pharmacist is to dispense. i) A check off or box allowing a substitutej) The physician’s signaturek) The physician’s DEA number (United States Drug Enforcement Agency registration number) if the medication is a controlled substance such as morphine or codeine

16. Example Can you locate all eleven parts of the prescription? Phone 425-235-9999 DEA# 123456878 Thelma Cook, MD Pt. name Bruce BrownAge50Date April 29, 2008 Address: 12347 NE 2nd Street, Seattle, WA 98432 RX Darvon 1 g tab. p.o.q4 h.for 3 days Refill _0_ ___Generic and/or equivalent allowed Physician’s Signature ________________Thelma Cook Sweet Meadow Medical Office 546 North Street Seattle, WA 98045

17. Practice Print, and fill in the chart with the information from the prescription:

18. Answers

19. Practice Practice locating the eleven parts of the medical order or prescription. Complete your chart, and then compare it with the answers on the next screen. Phone 360-456-9999 DEA# 44567823 Buck Sawyer, MD Pediatrician Pt. name Sammie Smith Age12 Date May 1, 2008 Address: 546 4th Avenue, Everett, WA 99876 RX Loratidine 5 mg tabletsqd X 5 d Refill 1_ _X_Generic and/or equivalent allowed Physician’s Signature ________________Buck Sawyer Everett Pediatric Medical Office 23453 Mall Blvd. Everett, WA 99876

20. Answers

21. Practice Read the prescription and then complete the chart below, complete your chart, and then compare it with the answers on the next screen. Phone 206-777-9999 DEA# 98072653 Yu Thi Nguyen, MD Gerontology Pt. name Ethyl BonkerAge98 Date May 5, 2008 Address: 234 Madison Ave E., Seattle, 98021 RX acetaminophen 650 mg. tablets po. q 4h x 5 d Refill _2_ _ _Generic and/or equivalent allowed Physician’s Signature ________________NguyenYuThi Capitol Hill Senior Medical Center, 3000 Broadway N., Seattle, WA 98045

22. Answers

23. Practice Read the prescription and then complete the chart below, complete your chart, and then compare it with the answers on the next screen. Phone 206-333-8888 DEA# 34455667 Pt. nameMohamed SomaAge 32 Address: 23234 Ballard Ave E., Seattle, 98567 RX Pencillin-G 2 million U IM qid X 7 d Refill _0_ _ _Generic and/or equivalent allowed Physician’s SignatureAretha Arnold, MDDate May 2, 2008 Aretha Arnold, MD Infection Specialist North Central Medical Center, 23 Antioch Way N., Seattle, WA 98655

24. Answers

25. Tablets scored tablet Listen and read along as Aisha discusses scored tablets. Did you know that only tablets that are scored may be split in half? What is a scored tablet? A tablet that is scored has a cut where it may be divided. It is important to know that the only scored tablets are divided along the score line to ensure an even distribution of medication. Enteric-coated tablets, those tablets with a special coating over the medicine, are not divided because they are coated with a special substance that allows them to dissolve in the intestines instead of the stomach. Dividing a tablet also impacts its absorption. Capsules (two-part soft tablets) and suppositories (medicine capsules inserted into the rectum) are never divided because the medicine needs to remain coated when it enters the body and even distribution of medication may be a problem

26. Practice Match the terms,Click Here to see the correct answers 1. C 2. D 3. E 4. B 5. A

27. Think About It! Why do some drugs come in different forms? How do you know what form it comes in? Advance to the next screen for the answers.

28. Answers Drugs come in different forms because there are many different kinds of patients. For example, babies do not swallow tablets so there are injections, liquids, and suppositories. Adults can swallow tablets and capsules. Also, different administration routes have different absorption rates, or the medicine form determines how quickly it will become effective. For example, a tablet takes longer to work in the body than an injection. An injection goes into blood stream quicker. A tablet must be absorbed through the stomach and that takes time. Read the prescription or medical order. Note that g or mg or mcg is a dry weight and so these are tablets, capsules or suppositories. Milliliters and units (a special unit of measure used in medicine) are volume or liquid measures, which could be elixirs or injections.

29. Task Two: Understanding the Parts of the Dosage Formula The dosage formula has four parts. We use this formula to translate a doctor’s order so that a pharmacy technician can calculate an individual dose for a patient.

30. Think About It! Why would a formula assist a pharmacy technician to calculate a drug dosage?Click Here Do you think that a formula can help sort out the parts of a word problem? Click Here Yes, because the quantities represented in the formula go in the same place in the math equation. Pharmacy technicians learn how to read the prescriptions and substitute the information into the dosage formula. A formula is an agreed upon method of calculating dosages in the same way so that the dosages are equivalent (or equal).

31. Dosage Formula Let’s look at the parts of the dosage formula.

32. Dosage Formula Let’s look more closely at the parts of the dosage formula.

33. Dosage Formula Another part of the prescription to know about is the medical terms used to detail the doctor’s order. To calculate an individual drug dosage, we use a formula. Patients have individual dosages and daily doses. The formula is used to calculate an individual or one time dose. The daily dose has to do with the frequency of a dose. qd = every day every 8 hours bid = twice a day at hs = hour of sleep tid= three times a day prn = as needed qid = four times daily

34. Dosage Formula Note that time does not play a role in calculating the individual dose. The factors are the doctor’s order for an amount of drug, the form of the medication available in the pharmacy, and the form of the medication (tablet, capsule, mL).

35. Units of Measure Aisha is often asked to describe how much a gram, milligram, and a microgram weigh. She shows the clients this chart to show the relationship among these common metric units of measure.

36. Stop! In the metric system, the answers will be either whole numbers or decimals. No fractions are used in the metric system. For example: 2.75 grams or 1.2 milliliters or 0.5 micrograms. Also, any decimal number that is not greater than 1 has a 0 in front. So the correct form is 0.8 mL instead of .8 mL.

37. Units of Measure

38. Practice Practice matching the medication forms. Click Here 1. G2. H3. I4. J5. F6. A7. C8. K9. L10. D11. B12. E

39. Practice Use the formula to practice substituting the information from the prescription into the formula. ddhh x q = individual drug dose

40. Stop! Safety Alert: The quantity is important to know because it leads the pharmacy technician to the correct form or unit of measure for a specific drug. In other words, if the quantity (q) is a tablet, the individual dose will be in tablets. If the quantity is in milliliters, the pharmacy technician knows that the medication is in liquid form. Including the quantity in the formula, helps ensure proper form of the medication. Young children would take medication in a liquid form while adults may take a tablet or capsule.

41. Task Let’s put Aisha’s task together and see the medication vial and the prescription and learn how they are the tools of the pharmacy technician. Rx: Doctor Sheila Smith orders 30 mg of Augmentin for his patient. Ashia, a pharmacy technician, looks at the drug label and discovers that the medicine is supplied in 60 milligrams per tablet. RX30 mg Augmentin Dr. Sheila Smith 4/6/08 60 mg

42. Practice Practice setting up the problems. Do not work the problems yet. (d) 30 mg x (q) 1 tablet = drug dose(h) 60 mg 1) Order: 500 mg Supply on hand: 250 mg per tablet x = drug dose Click Here 2) Order: 1000 mg Supply on hand: 2000 mg per scored tablet x = drug dose Click Here (d) 500mg x (q)1 tablet = drug dose (h) 250mg (d) 1000mg x (q)1 tablet = drug dose (h) 2000mg

43. Practice 3) Order: 1 gSupply on hand: 12. gr per capsule x = drug dose Click Here 4) Order: 50 mg Supply on hand: 25mg per 5 mL x = drug dose Click Here 5) Order: 500 mg Supply on hand: 125mg per caplet x = drug dose Click Here (d) 1gr x (q)1 capsule= drug dose (h) ½ gr (d) 50mg x (q) 5mL= drug dose (h) 25mg (d) 500mg x (q) 1 caplet= drug dose (h) 125mg

44. Task Three: Calculating the Dosage Formula To calculate a doctor’s drug order (how much medication is needed for an individual dose), we use a formula. Review: Remember that the fraction bar means to divide.

45. Methods There are two ways to look at calculating this formula. Method 1: Multiply d (doctor’s order) times q (format of the medicine on hand) then divide the result by h (supply on hand). The doctor orders 250 mg of a medication. Aisha has the medication in 125 mg per capsule in her pharmacy’s supplies. 250mg125mg x 1 capsule = _________ a) 250 x 1 = 250 b)250 ÷ 125 = 2 Thus, the answer is 2 capsules, but it is a bad habit to get into,  if it wasn’t a 1 in the quantity you’d get an incorrect answer.

46. Methods Method 2: Divide d (the doctor’s order, the numerator, or top number) by h (the supply on hand, the denominator, or bottom number) then multiply by q (the format of the medicine on hand). The doctor orders 250 mg of a medication. Aisha has the medication in 125 mg per capsule in her pharmacy’s supplies. 250mg125mg x 1 capsule = _________ a) 250÷125 = 2 b) 2 x 1 =2 Thus, the answer is 2 capsules.

47. Simplify One of the things to consider is the possibility of simplifying the expression before multiplying or dividing. For example, Aisha filled this prescription earlier in the day. The doctor order 100 milligrams of a medication. The drug was available in 25 milligrams per 5 milliliters. 100mg 25mg x 5 milliliters = _________ 100mg 100mg 25mg x 5  milliliters = 5 mg x 1milliliters = 100 5 = 20 Thus, the answer is 20. Notice since 5 divides evenly into 25, Aisha simplifies the expression before multiplying or dividing.

48. Practice Practice simplifying expressions to be ready to work with Aisha. 1) 25mg 100 mg x 20 milliliters = Click Here 2) 5mg 32mg x 8 milliliters = Click Here 3) 500mg 50 mg x 2 milliliters = Click Here 4) 75mg 5mg x 20 milliliters = Click Here 5) 25mg 100mg x 5 milliliters = Click Here 6) 5mg 100mg x 20 milliliters = Click Here 5 mL 1.25 mL 20 mL 300mL 1.25 mL 31 mL

49. Practice Aisha needs to fill the following drug orders for the evening shift nurses. Assist her in the set up and the solutions of each medical order. 1) Ampillicin 500 mg p.o. qid X 5 d. Dosage available: 250 mg capsules. Click Here  ______________ x __________ = ____________ 2) Ordered Clondine 0.4 mg p.o. bid X 3 d. Dosage available: 0.1 mg tablets. Click Here  ______________ x __________ = ____________ 2 capsules 4 tablets

50. Practice 3) Prescribed: Tigan 200 mg IM q 8 h x 4 d for nausea. On hand: Single use vials 100mg/1mL. Click Here  ______________ x __________ = ____________ 4) Give: Digoxin elixir 150 mcg stat p.o. Dosage available: 50 mcg/mL. Click Here  ______________ x __________ = ____________ 5) Ordered: Codeine sulfate 60 mg p.o. q 4 h until further notice. Dosage available: 30 mg tablets. Click Here  ______________ x __________ = ____________ 2 milliliters or 2 mL 3 milliliters or 3 mL 2 tablets