free download pdf Mosby's pharmacy technician

Mosby's Pharmacy Technician
Principles and Practice
FIFTH EDITION
Karen Davis, AAHCA, BHS, CPhT

Accreditation Alliance Consulting Services
Pharmacy Tech Program Instructor
Society for the Education of Pharmacy Technicians (SEPhT)
Lyons, Georgia
Anthony Guerra, PharmD, RPh

Chair, Instructor
Pharmacy Technician Program
Des Moines Area Community College
Ankeny, Iowa
Table of Contents
Cover image
Title Page
Copyright
Reviewers
Preface
Who Will Benefit From This Book?
Why Is This Book Important to the Profession?
Organization
Distinctive Features
New Chapters in This Edition
Ancillaries
Part One Pharmacy Practice
Introduction
Chapter 1 History of Medicine and Pharmacy
Important People
History of Medicine
Do You Remember These Key Points?
Scenario Follow-Up
Review Questions
Technician's Corner
Bibliography
Websites Referenced
Chapter 2 Pharmacy Law, Ethics, and Regulatory Agencies

Review Questions
Technician's Corner
Bibliography
Websites Referenced
Chapter 3 Competencies, Associations, and Settings for Technicians

Scenario
Historical Data
Competencies
Scenario Checkup 3.1

National Certification for Technicians
Professionalism in the Workplace
The Future of Pharmacy Technicians Is Bright!
Scenario Follow-Up
Review Questions
Technician's Corner
Bibliography
Websites Referenced
Chapter 4 Communication and Role of the Technician With the

Customer/Patient
Scenario
Communication
Conclusion
Scenario Follow-Up
Review Questions
Technician's Corner
Bibliography
Websites Referenced
Chapter 5 Dosage Forms and Routes of Administration
Terms and Abbreviations
Scenario
Where Did Pharmacy Abbreviations Originate?
“Do Not Use” List
Dosing Instructions
Classifications of Medications
Classifications of Drug Sales
Dosage Forms
Routes of Administration
Other Considerations: Form and Function
The Use of Excipients
Manufactured Products
Packaging and Storage Requirements
Medical Terminology
Scenario Follow-up
Review Questions
Technician's Corner
Bibliography
Websites Referenced
Chapter 6 Conversions and Calculations

Scenario
History of Pharmacy Calculations
Roman Numerals
International Time (Military Time)
Temperature Conversion Between Fahrenheit and Celsius
Basic Math Skills
Measurement Systems
Calculations With Liquid Medication
Business Calculations
Scenario Follow-Up
Review Questions
Technician's Corner
Bibliography
Chapter 7 Drug Information References

Scenario
Researching a Drug
References Used in Pharmacy
Pocket-Sized Reference Books
Electronic Referencing
The Internet
Journals and Newsmagazines
Additional Types of Information
Considerations When Choosing a Reference
Scenario Follow-up
Review Questions
Technician's Corner
Bibliography
Websites Referenced
Chapter 8 Community Pharmacy Practice

Scenario
Role of the Pharmacy Technician
Prescription

Prescription Processing
Prescription Preparation
Other Pharmacy Technician Duties
Pharmacy Layout
Communication
Elderly Patients
Other Pharmacy Services
Review Questions
Technician's Corner
Bibliography
Websites Referenced
Chapter 9 Institutional Pharmacy Practice

Scenario
Types of Hospitals
Hospital Pharmacy Standards and Procedures
Pharmacy and Nursing Staff Relationship

Hospital Orders
Institutional Pharmacy Technicians
Scenario Follow Up
Review Questions
Technician's Corner
Bibliography
Websites Referenced
Chapter 10 Additional Pharmacy Practice Settings and Advanced

Roles for Technicians
Scenario
Advanced or Specialized Pharmacy Technician Opportunities
Scenario Follow Up
Review Questions
Technician's Corner
Bibliography
Websites Referenced
Chapter 11 Bulk Repackaging and Non-Sterile Compounding

Scenario
Bulk Repackaging
Non–Sterile Compounding
Packaging
Stability
Documentation
Safety
Compounding Professionalism
Regulatory and Quality Control
Veterinary Medications
Personnel Training
Compounding Calculations
Review Questions
Technician's Corner
Bibliography
Websites Referenced
Chapter 12 Aseptic Technique and Sterile Compounding
Scenario
Terminology Used in Pharmacy
Standard Precautions for a Health Care Worker
Supplies
Routes of Administration
Medication Delivery Systems
United States Pharmacopeia <797>
Aseptic Technique
Education and Training
Scenario Follow-Up
Review Questions
Technician's Corner
Bibliography
Websites Referenced
Chapter 13 Pharmacy Billing and Inventory Management

Scenario
Formulary and Drug Utilization
Generic Versus Trade Name Drugs
Types of Private and Group Medical Insurance Plans
Government-Managed Insurance Programs
Third-Party Billing
Other Methods of Payment
Inventory Management
Scenario Follow-Up
Review Questions
Technician's Corner
Bibliography
Websites Referenced
Chapter 14 Medication Safety and Error Prevention

Scenario
Overview
Five Rights of Medication Safety
What Constitutes an Error?
Types of Medication Errors

Responsibility for Errors
Where Errors Are Made
Why Errors Occur
Drug Interactions as a Source of Error
Errors in the Pharmacy
Errors Related to Patient Care
Age-Related Errors
Necessity of Reporting Errors
Common Pharmacy Technology
Patient Dose-Specific Orders
United States Pharmacopeia <797> Regulations
Medication Reconciliation
Quality Assurance Practices and Risk Management
Other Considerations
Training and Education
Conclusion
Scenario Follow-Up
Review Questions
Technician's Corner
References
Bibliography
Websites Referenced
Chapter 15 Pharmacy Operations Management and Workflow

Scenario
Overview
Community Pharmacy
Institutional Pharmacy
Improving Efficiency Techniques
Getting Started
Scenario Follow-Up
Review Questions
Technician's Corner
Bibliography
Website References
Part Two Pharmacology and Medications
Introduction
Chapter 16 Drug Classifications

Classifying Drugs
Generic Versus Brand Names
Drug Classifications by Drug Enforcement Agency (DEA) Schedules I, II, III,

IV, V
Review Questions
Technician's Corner
Bibliography
Chapter 17 Therapeutic Agents for the Nervous System

The Nervous System
Central Nervous System
Peripheral Nervous System
Conditions of the Nervous System and Their Treatments
Review Questions
Technician's Corner
Bibliography
Chapter 18 Therapeutic Agents for the Endocrine System

Anatomy of the Endocrine System
Description of Hormones and Glands
Functions of the Endocrine Glands
Conditions of the Endocrine System and Their Treatments
Review Questions
Technician's Corner
Bibliography
Chapter 19 Therapeutic Agents for the Musculoskeletal System

Anatomy and Physiology of the Skeletal System
Anatomy and Physiology of Skeletal Muscle
Common Conditions Affecting the Musculoskeletal System
Other Select Medication Classes That Affect the Musculoskeletal System
Review Questions
Technician's Corner
Bibliography
Chapter 20 Therapeutic Agents for the Cardiovascular System

Anatomy of the Heart and Vasculature System
Regulation of the Heart and Vasculature
Common Medication Classes Used to Treat Cardiac Conditions
Conditions Affecting the Cardiovascular System
Review Questions
Technician's Corner
Bibliography
Chapter 21 Therapeutic Agents for the Respiratory System

Structure and Function of the Respiratory System
Disorders and Conditions of the Respiratory System
Review Questions
Technician's Corner
Bibliography
Chapter 22 Therapeutic Agents for the Gastrointestinal System

Form and Role of the Gastrointestinal System
Anatomy and Physiology of the Gastrointestinal System
Conditions Affecting the Gastrointestinal System
Review Questions
Technician's Corner
Bibliography
Chapter 23 Therapeutic Agents for the Renal System

Anatomy and Physiology of the Renal and Urological Systems
Conditions Affecting the Renal and Urological Systems
Review Questions
Technician's Corner
Bibliography
Chapter 24 Therapeutic Agents for the Reproductive System

Female Reproductive System
Conditions Affecting the Female Reproductive System
Male Reproductive System
Conditions Affecting the Male Reproductive System
Sexually Transmitted Diseases
Review Questions
Technician's Corner
Bibliography
Chapter 25 Therapeutic Agents for the Immune System

Anatomy and Physiology of the Immune System
Autoimmune Disorders
Transplant Rejection
Immunizations
Review Questions
Technician's Corner
Bibliography
Chapter 26 Therapeutic Agents for Eyes, Ears, Nose, and Throat

The Eyes (Ophthalmic System)
Conditions That Affect the Eye
The Ears (Auditory System)

Nose and Sinuses
The Throat
Review Questions
Technician's Corner
Bibliography
Chapter 27 Therapeutic Agents for the Dermatological System

Anatomy and Physiology of the Dermatological System
Common Conditions Affecting the Dermatological System
Review Questions
Technician's Corner
Bibliography
Chapter 28 Therapeutic Agents for the Hematological System

Anatomy and Physiology of the Hematological System
Conditions Affecting the Hematological System
Review Questions
Technician's Corner
Bibliography
Chapter 29 Over-the-Counter Medications

Food and Drug Administration Regulations
How a Prescription Drug Becomes an Over-the-Counter Drug
Common Routes of Administration for Over-the-Counter Drugs
Considerations for Special Populations
Restricted Over-the-Counter Products
Urinary Incontinence (Overactive Bladder)
Review Questions
Technician's Corner
Bibliography
Chapter 30 Complementary and Alternative Medicine

What Is Complementary and Alternative Medicine?
Types of Complementary and Alternative Medicine
Review Questions
Technician's Corner
Bibliography
Appendix A Review for the Pharmacy Technician Certification Board

Examination
Answer Key
Appendix B Top 200 Prescription Drugs

Appendix C Top Herbal Remedies
Glossary
A
W
X
Index
Copyright
3251 Riverport Lane

St. Louis, Missouri 63043
MOSBY'S PHARMACY TECHNICIAN: PRINCIPLES AND

PRACTICE, FIFTH EDITION ISBN: 978-0-323-44356-2
Copyright © 2019 by Elsevier, Inc. All rights reserved.
Previous editions copyrighted 2016, 2012, 2007, and 2004 by Elsevier,

Inc.
No part of this publication may be reproduced or transmitted in any

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can be found at our website: www.elsevier.com/permissions.
Notices
Knowledge and best practice in this field are constantly changing.
As new research and experience broaden our understanding,
changes in research methods, professional practices, or medical
treatment may become necessary.
Practitioners and researchers must always rely on their own
experience and knowledge in evaluating and using any information,
methods, compounds, or experiments described herein. In using
such information or methods they should be mindful of their own
safety and the safety of others, including parties for whom they have
a professional responsibility.
With respect to any drug or pharmaceutical products identified,
readers are advised to check the most current information provided
(i) on procedures featured or (ii) by the manufacturer of each
product to be administered, to verify the recommended dose or
formula, the method and duration of administration, and
contraindications. It is the responsibility of practitioners, relying on
their own experience and knowledge of their patients, to make
diagnoses, to determine dosages and the best treatment for each
individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the
authors, contributors, or editors, assume any liability for any injury
and/or damage to persons or property as a matter of products
liability, negligence or otherwise, or from any use or operation of
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material herein.
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Publishing Director: Kristin Wilhelm

Senior Content Development Manager: Ellen Wurm-Cutter
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Designer: Renée Duenow
Printed in Canada
Last digit is the print number: 9 8 7 6 5 4 3 2 1

Reviewers
Technical Reviewer
Ashlee Mattingly PharmD
Abilities Lab Pharmacist and Technician Training Coordinator
Department of Pharmacy Practice and Science
University of Maryland School of Pharmacy
Baltimore, Maryland
Reviewers
Katrina Brasuell BS, CPhT, TR Ph
Vernon College Pharmacy Technician Coordinator/Instructor
Pharmacy Technician Department
Vernon College
Wichita Falls, Texas
Gwyn Collier CPhT, MCPhT, MBA
Pharmacy Technician Program Coordinator
National American University
Independence, Missouri
Amanda Daniels BS, CPhT
Pharmacy Technology Clinical Coordinator/Instructor
Department of Pharmacy Technology
Atlanta Technical College
Atlanta, Georgia
Lindsay R. Elcure CLS, CPhT
Secondary Health Science Educator
Department of Health Science
Clear Creek High School
League City, Texas
Adam R. Hasty BS, CPhT
Program Director/Instructor
Tennessee College of Applied Technology, Murfreesboro
Murfreesboro, Tennessee
Sasha Kahiga CPhT, MAEd
Pharmacy Technology Program Director
Allied Health Division Chair
School of Health Sciences/Allied Health
Lanier Technical College
Oakwood, Georgia
Wendy Lubin BS, CPhT
Clinical Coordinator for the Pharmacy Technician Program
Department of Allied Health
Front Range Community College
Westminster, Colorado
Bradley Merryfield
Curriculum Development & Program Advisor
Academics & Program Director
Canadian College of Health Science & Technology
Windsor, Ontario, Canada
Elina Pierce CPhT, MSP
Program Director, Senior Certified Pharmacy Technician
Pharmacy Technician Training Program
Southeast Community College
Lincoln, Nebraska
Sandra A. Plaza CBCS, RMA
Medical Assistant/Medical Coder/Biller Instructor
Health Sciences Department
Osceola Business School
Celebration, Florida
Alecia Ann Powell-Crowe CPhT
Instructor
Health Department
University of Arkansas–Fort Smith
Petra Allied Health
Fort Smith, Arkansas
Denise J. Propes CPhT
Pharmacy Technician Coordinator
Research Pharmacy (Investigational Drug Service)
University of Michigan Hospital–Michigan Medicine
Ann Arbor, Michigan
Zenia Ridley BS, CPhT-RPhT
Pharmacy Technician Instructor
Career and Technical Educator
Clear Brook High School
Friendswood, Texas
Meera K. Shah PharmD, AAHIVP
Clinical Pharmacist
Ambulatory Pharmacy–Hepatology and Infectious Disease
University of Kansas Health Systems
Kansas City, Kansas
Karen Shaw RPhT, CPhT
Director of Pharmacy Technician Program
Pharmacy Technician Department
Saint Louis College of Health Careers County Campus
Fenton, Missouri
Dawnna Sileo CPhT
Instructor
Allied Health
Penn Foster Career School
Scranton, Pennsylvania
Lisa Soares MHRM, BSTM, CPhT
Pharmacy Technician Program Director/Instructor
Introduction to Healthcare Instructor
Pharmacy Technology
Allied Health
Southern Crescent Technical College
Griffin, Georgia
Bobbi Jane Steelman BS Ed, MA Ed, CPhT
Director of Education/Pharmacy Technician Program Director
Academics
Daymar College
Bowling Green, Kentucky
Kimberly L. Taron BS Ed, CPhT, RPhT
Director/Master Instructor
Pharmacy Technology
Tennessee College of Applied Technology–Memphis
Memphis, Tennessee
Preface
You are about to embark on an exciting journey into one of today's
fastest-growing fields in health care. Whether you end up working in
a hospital pharmacy, community pharmacy, mail-order pharmacy,
Internet pharmacy, or another location, the knowledge you will gain
from this textbook and its supplements will prepare you well for your
new career. The authors and publisher have made every effort to
equip you with all the background knowledge and tools you need to
succeed on the job. Mosby's Pharmacy Technician: Principles and Practice
was designed as a fundamental yet comprehensive resource that
represents the very latest information available for preparing
pharmacy technician students for today's challenging job
environment.
Who Will Benefit From This Book?

Pharmacy technicians are increasingly called on to perform duties
traditionally fulfilled by pharmacists. This development has occurred
because federal regulations now require pharmacists to spend more
time with patients providing patient education. As the number of
pharmacy technicians in the United States and Canada continues to
grow, the need to outline a scope of practice for the pharmacy
technician profession has become more urgent. Mosby's Pharmacy
Technician: Principles and Practice provides students with solid
coverage of the information they need to be successful, while also
giving the instructor the tools required to present the information
effectively and easily.
Why Is This Book Important to the
Profession?
This textbook maps directly to the Pharmacy Technician Certification
Examination (PTCE) and to the American Society of Health-System
Pharmacists (ASHP) Curriculum. The Pharmacy Technician
Certification Board (PTCB) set forth its blueprint for the PTCE, and
the blueprint was implemented in exams administered to candidates
who applied for certification on or after November 1, 2013. The
blueprint divides the information into nine Knowledge Domains and
Areas: Pharmacy for Technicians, Pharmacy Law and Regulations,
Sterile and Non–Sterile Compounding, Medication Safety, Pharmacy
Quality Assurance, Medication Order Entry and Fill Process,
Pharmacy Inventory Management, Pharmacy Billing and
Reimbursement, and Pharmacy Information System Usage and
Application. ASHP's current Model Curriculum, finalized and
approved in April 2013, provides details on how to meet the goals
defined in the ASHP Accreditation Standard for Pharmacy Technician
Education and Training Programs. It includes objectives and
instructional objectives for each of the goals, in addition to examples
of learning activities for each portion of the program, including the
didactic, simulated (laboratory), and experiential program
components. In total, the ASHP Model Curriculum has 45 goals, each
with its own objectives. The goals are categorized into sections:
Personal/Interpersonal Knowledge and Skills; Foundational
Professional Knowledge and Skills; Processing and Handling of
Medications and Medication Orders; Sterile and Non–Sterile
Compounding; Procurement, Billing, Reimbursement, and Inventory
Management; Patient and Medication Safety; Technology and
Informatics; Regulatory Issues; and Quality Assurance. The criteria
defined in the PTCB Blueprint (the foundation of the PTCE) and the
ASHP Model Curriculum are designed to help pharmacy technicians
work more effectively with pharmacists, provide greater patient care
and services, and create a minimum standard of knowledge across all
50 states in the United States and the provinces throughout Canada, to
help employers determine a knowledge base for employment.
Organization
For this edition, Mosby's Pharmacy Technician: Principles and Practice,
has been completely reworked to relate to the PTCB Blueprint (the
foundation of the PTCE) and ASHP Model Curriculum. This textbook
remains a reliable and understandable resource, written specifically
for the pharmacy technician student and for technicians already on
the job, including those preparing for the certification examinations.
The writing style, content, and organization guide today's pharmacy
technician student to a better understanding of anatomy and
physiology, diseases, and, most important, the drugs and agents used
to treat those diseases. The textbook is divided into two parts,
Pharmacy Practice and Pharmacology and Medications, and includes
three appendices and a glossary.
Part One, Pharmacy Practice, provides an in-depth overview of
pharmacy practice as it relates to pharmacy technicians. Highlights of
Part One include the history of medicine and pharmacy; law and
ethics (and regulatory agencies); competencies, associations, and
settings for pharmacy technicians; communication; dosage forms (and
routes of administration); conversions and calculations; drug
information references; community pharmacy practice (including
prescription interpretation); institutional pharmacy practice
(including long-term care and medication order interpretation);
additional pharmacy practice settings (including managed care, mail-
order pharmacy, and pharmaceutical industry); bulk repackaging and
non–sterile compounding; aseptic technique and sterile compounding;
pharmacy stock and billing; medication safety and error prevention;
and pharmacy operations management. This part gives the pharmacy
technician student a full, comprehensive look at the vast world of
pharmacy practice today.
Part Two, Pharmacology and Medications, provides an overview
of each body system and the medications used to treat common
conditions that afflict these systems. Highlights of Part Two include
drug classifications; therapeutic agents for all the body systems (i.e.,
nervous; endocrine; musculoskeletal; cardiovascular; respiratory;
gastrointestinal; renal; reproductive; immune; eyes, ears, nose, and
throat; dermatological; and hematological), in addition to over-the-
counter (OTC) medications. It also covers the emerging world of
complementary and alternative medicine (CAM). Unique to this part
are detailed discussions of anatomy and physiology and photographs
of a number of drugs used to treat various conditions of each body
system.
Three appendices are included in this edition. Appendix A, Review
for the Pharmacy Technician Certification Board (PTCB) Examination,
presents 90 review questions that are directly indicative of the type of
questions on actual PTCB examinations. This review is designed to
help students assess their knowledge and readiness to sit for the
examination. Appendix B, Top 200 Prescription Drugs, lists the 200
most commonly prescribed legend drugs, their classifications, and the
indications for their use. Appendix C, Top 30 Herbal Remedies, lists
some of the more popular herbal remedies and their commonly
reported uses. The Glossary contains all key terms and definitions
listed in the textbook.
Distinctive Features
Learning Objectives
The organizational format of this textbook facilitates the learning
process by providing students and educators with detailed learning
objectives that address the cognitive knowledge required to master
each chapter's content. These learning objectives are listed at the
beginning of each chapter, giving both students and instructors
definitive evaluation tools to use as each chapter's content is covered.
Key Terms
Key terms are identified and defined at the beginning of each chapter,
providing students with a valuable terminology overview for the
chapter. These key terms are included in the Glossary at the back of
the book and are provided in flashcard form on the Evolve site to
allow students to test their knowledge of the chapter's terms and
definitions.
Scenario
In Part One (Pharmacy Practice), pharmacy technician scenarios are
provided at the beginning of each chapter, and scenario checkups
appear throughout the chapter. These scenarios provide practical
applications for pharmacy technician students and allow them to
“connect” with their future beyond the classroom. The scenarios in the
chapters often involve authentic pharmacy technicians sharing their
fears, likes, hopes, and aspirations, providing a “real-world” feel to
the book and inspiration for the student.
Tech Notes
Helpful pharmacy technician notes are interspersed throughout the
chapters, providing interesting historical facts, drug cautions, hints,
and safety information. These notes enhance students' acquisition of
the practical information they will need to know in a pharmacy
setting.
Tech Alerts
Tech Alert boxes highlight important information the pharmacy
technician needs to remember when in the pharmacy. In many
instances the Tech Alert functions as a medication safety reminder or
presents proper drug names.
Technician Profile
In Part One (Pharmacy Practice), technician profiles are shared to help
pharmacy technician students “connect” with their future beyond the
classroom. These profiles provide insight into life after graduation and
often show students the different types of jobs and responsibilities
they may take on once they enter the real-life profession of pharmacy
technician.
Mini Drug Monographs

Drug monographs with pill photographs are provided in Part Two
(Pharmacology and Medications), where each body system is
discussed. In addition to a photograph of the drug, these monographs
include the drug class, generic and trade names, indication, route of
administration, common adult dosage, mechanism of action, side
effects, and any required auxiliary labels. The monographs provide
students with quick, easy-to-understand information about specific
drugs. All pill photo images used in the Mini Drug Monographs are
provided by Clinical Pharmacology powered by ClinicalKey, ©
Elsevier.

These chapter summaries are placed at the end of every chapter to
recap the highlights and most important topics covered in the chapter.
These brief summaries of each chapter's key points can serve as a
study tool, reminding students of the subject areas they may need to
review before taking an examination on the chapter's content.
Review Questions
Multiple-choice review questions are included at the end of every
chapter (and also, in interactive form, on the Evolve site). This section
provides students with a unique review tool as they prepare both for
classroom examinations and for certification examinations, once
they're ready to begin their professional lives as pharmacy
technicians. Just as the key points serve as a study tool and chapter
summary, these review questions give students a chance to quiz
themselves on the chapter content, assess their knowledge of
important chapter topics, and evaluate which topics need follow-up
review.
Technician's Corner
The Technician's Corner, which appears at the end of every chapter,
provides critical thinking questions to help students prepare for on-
the-job experiences.
New Chapters in This Edition

Chapter on Pharmacy Operations Management
Chapter 15, Pharmacy Operations Management, discusses workflow and
pharmacy management in different practice settings. Technicians are
an integral part of the efficiency, safety, and quality of the services
provided for patients. General layout and descriptions of different
pharmacy settings are discussed, along with the roles that technicians
and pharmacists play in each of the areas. Error prevention and
increasing productivity through teamwork within the pharmacy team,
as well as with other disciplines, are described and aligned with
techniques to increase efficiency and provide better error prevention.
Chapter on Drug Classifications

Chapter 16, Drug Classification, provides an introductory overview of
the prescription drug classifications you will find in the following
chapters. Often pharmacology seems overwhelming because it is (1) a
new language and (2) has so many drug names.
This Part Two introductory chapter will introduce you to the rules
of the pharmacology language to make it easier to understand. This
chapter will also provide shortcuts to help you learn more drugs more
quickly. For example, knowing that the ending –cillin indicates a
penicillin antibiotic helps you learn the many drugs in the penicillin
class instead of having to learn them individually.
Knowing why we classify drugs as we do and how we group them
will make the chapters that follow much easier to absorb and help you
better succeed on quizzes and tests.
Ancillaries
Considering the broad range of students, instructors, programs, and
institutions for which this textbook was designed, an extensive
package of supplements has been designed to complement this fifth
edition of Mosby's Pharmacy Technician: Principles and Practice. Each of
these comprehensive supplements has been thoughtfully developed
with the shared goals of students and instructors in mind; that is, to
produce students who are well equipped for a career in pharmacy and
well prepared to earn their certification. All of these supplements and
their inventive features (with the exception of the Workbook/Lab
Manual) can be found on the Evolve site
(http://evolve.elsevier.com/Mosby/pharmtech). They include the following
materials.
For the Instructor

TEACH Instructor Resource
TEACH for Mosby's Pharmacy Technician is designed to help the
pharmacy technician instructor prepare for class by reducing
preparation time, providing new and innovative ideas to promote
student learning, and helping to make full use of the rich array of
resources available. This completely revised manual includes:
• Detailed Lesson Plans that map to the chapter

objectives (as well as the PTCE [Pharmacy
Technician Certification Examination] and ASHP
Model Curriculum)
• PowerPoint presentations
• Answer Keys for the Chapter Review Questions
as well as Workbook/Lab Manual exercises
Additional Instructor Ancillaries
• ASHP Curriculum
• Image Collection
• ExamView Test Bank
• Competency Skills Checklists
For the Student

Ancillaries Available on the Evolve Site
• Review Questions
• Clinical Pharmacology drug database access
• Appendices from the textbook
Student Workbook/Lab Manual

The student Workbook/Lab Manual is a unique blend of a traditional
workbook combined with lab exercises that enhance the student's
ability to perform in class. This valuable product includes:
• Exercises to reinforce key concepts taught in this

textbook
• Skill Check-off Sheets to correspond to textbook
procedures
• Opportunities for students to reflect critically on
topics as they develop critical thinking and
decision-making skills
• Complete lab activities that will relate to practice
PA R T O N E
Pharmacy Practice
OUTLINE
Introduction
Chapter 1 History of Medicine and Pharmacy
Chapter 2 Pharmacy Law, Ethics, and Regulatory Agencies
Chapter 3 Competencies, Associations, and Settings for
Technicians
Chapter 4 Communication and Role of the Technician With
the Customer/Patient
Chapter 5 Dosage Forms and Routes of Administration
Chapter 6 Conversions and Calculations
Chapter 7 Drug Information References
Chapter 8 Community Pharmacy Practice
Chapter 9 Institutional Pharmacy Practice
Chapter 10 Additional Pharmacy Practice Settings and
Advanced Roles for Technicians
Chapter 11 Bulk Repackaging and Non-Sterile
Compounding
Chapter 12 Aseptic Technique and Sterile Compounding
Chapter 13 Pharmacy Billing and Inventory Management
Chapter 14 Medication Safety and Error Prevention
Chapter 15 Pharmacy Operations Management and
Workflow
Introduction
1 History of Medicine and Pharmacy, 2
2 Pharmacy Law, Ethics, and Regulatory Agencies, 17
3 Competencies, Associations, and Settings for Technicians, 56
4 Communication and Role of the Technician With the
Customer/Patient, 83
5 Dosage Forms and Routes of Administration, 94
6 Conversions and Calculations, 126
7 Drug Information References, 153
8 Community Pharmacy Practice, 168
9 Institutional Pharmacy Practice, 196
10 Additional Pharmacy Practice Settings and Advanced Roles
for Technicians, 220
11 Bulk Repackaging and Non-Sterile Compounding, 229
12 Aseptic Technique and Sterile Compounding, 263
13 Pharmacy Billing and Inventory Management, 297
14 Medication Safety and Error Prevention, 326
15 Pharmacy Operations Management and Workflow, 351
CHAPTER 1
History of Medicine and

Pharmacy
Karen Davis
OBJECTIVES
1. Discuss the following related to the history of medicine: (a) discuss

ancient beliefs of illness and medicine from 440 BC through AD
1600; (b) list common ancient treatments that prevailed in Western
civilization; (c) describe eighteenth- and nineteenth-century
medicine and identify influences that major wars had on medicine;
(d) describe the wide use of opium and the problems surrounding
opium use, and differentiate between opiates and opioids.
2. Discuss advances in drug therapy and vaccinations.
3. Discuss the following related to the history of pharmacy: (a) identify
the role that early pharmacists played in society; (b) describe how
the first pharmacies began in the United States; (c) describe the
first technicians in pharmacy; (d) list major ways pharmacy has
changed over the past 100 years; (e) list important current trends in
pharmacy in relation to pharmacy technicians.
TERMS AND DEFINITIONS

Apothecary Latin term for pharmacist; also, a place where drugs are
sold
Bloodletting The practice of draining blood; believed to release illness
Caduceus Often confused as the symbol of the medical field; it is a
staff with two entwined snakes and two wings at the top
Dogma A principle or set of principles laid down by an authority as
incontrovertibly true
Hippocratic oath An oath taken by physicians concerning the ethics
and practice of medicine
Inpatient pharmacies Pharmacies in a hospital or institutional setting
Laudanum A mixture of opium and alcohol used to treat dozens of
illnesses through the 1800s
Leeches A type of segmented worm with suckers that attaches to the
skin of a host and engorges itself on the host's blood
Maggots Fly larvae that feed on dead tissue; used in medicine to clean
wounds not responding to routine antibiotics
Medicine The science and art dealing with the maintenance of health
and the prevention, alleviation, or cure of disease
Opioid Any agent that binds to opioid receptors
Opium An analgesic that is made from the poppy plant
Pharmacist Person who dispenses drugs and counsels patients on
medication use and any interactions it may have with food or
other drugs
Pharmacy A place where drugs are sold
Pharmacy clerk Person who assists the pharmacist at the front
counter of the pharmacy; the person who accepts payment for
medications
Pharmacy technician Person who assists a pharmacist by filling
prescriptions and performing other nondiscretionary tasks
Pharmacy Technician Certification Board (PTCB) Issues a national
exam for pharmacy technicians
Shaman A person who holds a high place of honor in a tribe as a
healer and spiritual mediator
Staff of Asclepius The symbol of the medical profession; it is a
wingless staff with one snake wrapped around it
Trephining A practice of making an opening in the head to allow
disease to leave the body
This chapter is revised from a version contributed by Bobbi Steelman
for the previous edition of this work.
Important People
Aristotle Greek scientist, philosopher
Asclepius Greek god of healing and medicine
Bacon, Roger English scientist responsible for scientific methods
Crick, Francis Co-discoverer of the molecular structure of DNA, the double helix
Domagk, Developed sulfonamides and synthetic antibiotics
Gerhard
Fleming, Discovered penicillin, the first antibiotic
Alexander
Galen, Greek physician
Claudius
Hippocrates Greek physician and philosopher, considered to be the father of medicine
Mendel, Gregor Scientist and monk, known as the father of genetics
Nightingale, Nurse who was responsible for improving the unsanitary conditions at a British base
Florence hospital during the Crimean War, reducing the death count
Paracelsus Swiss physician, philosopher, and scientist
Pasteur, Louis French scientist, discovered several vaccines and invented pasteurization
Watson, James Co-discoverer of the molecular structure of DNA, the double helix
History of Medicine
Scenario
Kelly is a new pharmacy technician student at a local career college.

She begins her course of study by learning about the history of
pharmacy. Why is this an important part of Kelly's education?
Ancient Beliefs and Treatments

Medicine has been practiced for thousands of years. Archaeological
discoveries have unearthed civilizations that have documented the
use of minerals, animals, and plant parts to heal the sick. Certain
remedies, such as the use of herbs, have been used consistently
throughout history. For example, herbs have been used for centuries
for minor ailments such as intestinal problems, arthritis, and gout.
Many ancient treatments for illness were based on the dreams or
visions of the believers. A dogma, such as gods being able to both
cause and cure illnesses, is based on a set of principles (eg, religious or
ideological doctrines) proposed by authoritarians. These principles are
based on writings from respected spiritual authorities rather than
scientific evidence. One belief about healing the sick was that severe
illness was caused by evil spirits. To rid a person of an evil spirit, a cut
was made into the skull to give the spirit a portal through which to
leave. This type of treatment was called trephining and often was
performed by a tribal shaman (a spiritual person in a tribe who cares
for the spiritual, medicinal, and physical health of the tribe). Tribal
shamans were believed to have the gift of being able to communicate
with spirits. Other shamans believed that they were connected with a
special spirit who helped them render the evil spirits harmless
through the use of prayer, herbs, or potions. Shamans were prevalent
throughout societies in ancient times. Some still exist in various
societies throughout the world. In North America, various Eskimo
and Native American tribes held shamans in high esteem. However,
many popular beliefs of the past have mostly disappeared.
The Medical Staff

The staff of Asclepius is the formal symbol of medicine and is
associated with Asclepius, the Greek god associated with healing. The
staff of Asclepius is a wingless walking stick with a single serpent
wrapped around it. Because snakes shed their skin, the snake was
believed to signify renewal of youth. The caduceus is often mistakenly
used as a symbol of medicine. The caduceus is the staff of Hermes, a
Greek god; the staff represented magic and had two serpents wrapped
around it, usually with two wings at the top (Fig. 1.1). For example, in
1902 the US Army erroneously adopted the caduceus as an emblem of
the Medical Corps, leading to its mistaken use as a symbol of
medicine. Although many organizations still use the caduceus to
represent medicine, the true staff of Asclepius has been adopted as a
symbol by authoritative health organizations, such as the World
Health Organization and the American Medical Association.
FIGURE 1.1 A, Caduceus. B, Army Medical Corp emblem.
The Evolution of Medicine

The early path of medicine was not a smooth road. Throughout the
ages, many plagues killed thousands of people. The existence of
microbes, unseen by the eye, was not known to be responsible for
many of the diseases that caused death and despair. Despite advances
made through early history, most remedies for physical ailments
tended to be extreme. Other ancient remedies have been used for
hundreds of years. Prevalent thoughts included the belief that
sickness was an entity within the body that needed a means to leave
the body. Another widely held belief was that spirits were responsible
for illness. In many cultures, the most common form of treatment,
prayer, has remained the only way to cure illness.
Hippocrates (460–357 BC), born on the small island of Cos near
Greece, was a third-generation physician. He taught at a school of
medicine on Cos, which was one of the first medical schools
established. He believed in the prevailing concept of that era: life
consisted of a balance of four elements that were linked to the
qualities of good health. These four qualities were wet, dry, hot, and
cold. In addition, he believed that illness resulted from an imbalance
of the four humors of the body system: blood, phlegm, yellow bile,
and black bile. These four humors were linked to the four basic
elements: blood is air, phlegm is water, yellow bile is fire, and black
bile is earth. Methods used to treat imbalance of the humors included
bloodletting and natural laxatives.
Hippocrates was responsible for many advances in the world of
medicine. Some of his observations included the effects of food,
climate, and other influences on illness. He was one of the first
physicians to record his patients' medical illnesses. This new way of
viewing the causes of illnesses eventually led to the belief that
sickness originated from something other than the supernatural.
Hippocrates believed that the spirit of the patient was just as
important as the condition being treated, and he promoted kindness
to the sick. He also believed in letting nature do the healing and
promoted resting and eating light foods. He taught that doctors
needed to rebalance the four humors. Most of his teachings have been
documented in a collection of books called the Corpus Hippocraticum.
Although many of the writings are now believed to be from different
authors, they still reflect the teachings of Hippocrates.
Today's medical schools still use the Hippocratic oath as part of
their graduation ceremony. Box 1.1 presents the revised version of the
Hippocratic oath used today. The Hippocratic oath outlines the
physician's responsibility to the patient. Hippocrates practiced what
he preached with respect to exercise, rest, diet, and overall moderation
in lifestyle. Various records have documented his death as occurring
in 377 BC, whereas others record his death as having occurred in 357
BC. Because of the advances he promoted in the world of medicine, it
is not surprising that Hippocrates is known as the father of medicine.
Before the existence of Hippocrates and other innovative scientists,
people believed that they were at the mercy of the gods or
supernatural forces.
Box 1.1
The Hippocratic Oath*
I swear to fulfill, to the best of my ability and judgment, this

covenant:
I will respect the hard-won scientific gains of those physicians
in whose steps I walk, and gladly share such knowledge as is
mine with those who are to follow.
I will apply, for the benefit of the sick, all measures which are
required, avoiding those twin traps of overtreatment and
therapeutic nihilism.
I will remember that there is art to medicine as well as science,
and that warmth, sympathy, and understanding may
outweigh the surgeon's knife or the chemist's drug.
I will not be ashamed to say “I know not,” nor will I fail to call
in my colleague when the skills of another are needed for a
patient's recovery.
I will respect the privacy of my patients, for their problems are
not disclosed to me that the world may know. Most especially
must I tread with care in matters of life and death. If it is
given me to save a life, all thanks. But it may also be within
my power to take a life; this awesome responsibility must be
faced with great humbleness and awareness of my own
frailty. Above all, I must not play at God.
I will remember that I do not treat a fever, chart a cancerous
growth, but a sick human being, whose illness may affect the
person's family and economic stability. My responsibility
includes these related problems, if I am to care adequately for
the sick.
I will prevent disease whenever I can, for prevention is
preferable to cure.
I will remember that I remain a member of society, with special
obligations to all my fellow human beings, those sound of
mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected
while I live and remembered with affection thereafter. May I
always act so as to preserve the finest traditions of my calling
and may I long experience the joy of healing those who seek
my help.
*Writtenin 1964 by Louis Lasagna, Academic Dean of the School of Medicine at

Tufts University, and used in many medical schools today.
Source: http://ethics.ucsd.edu/journal/2006/readings/Hippocratic_Oath_Modern_Version.pdf.
Tech Note!
The origin of the term “black humor” stems from the belief that too
much of the black bile humor resulted in a person showing signs of
melancholy.
Later in history, the Greek philosopher and scientist Aristotle (384–

322 BC) was responsible for many advances in the areas of biology
and medicine. His main area of interest was biology and the study
and classification of various organisms. He classified human beings as
animals. Because the Grecian belief system in those times did not
allow dissection of the dead, he described much of human anatomy
from observations he made from dissections of other animals. This
included in-depth descriptions of the brain, heart, lungs, and blood
vessels.
Claudius Galen (129–210) began to study medicine at the age of 16.
He attended medical schools in Greece and the famous Alexandria
School of Medicine in Egypt. He later resided in Rome and was the
personal physician of the Roman imperial family. Although he was
born nearly 600 years after Hippocrates, he followed many of the
same beliefs, such as eating a balanced diet, exercising, and practicing
good hygiene. He contributed greatly to the study of medicine,
writing more than 100 books on topics such as physiology, anatomy,
pathology, diagnosis, and pharmacology. Many of his books were
used in medical schools for 1500 years. He proved that blood flowed
through arteries rather than air.
Philosopher and alchemist Roger Bacon (1214–1294) further refined
and explained the importance of experimental methods, which
focused on observation, hypothesis, experimentation, and verification.
During Bacon's time, most explanations were based on tradition, not
fact. He preferred to rely on mathematics and measurement to prove
his theories. He is considered an important contributor to what is now
known as the scientific method.
Paracelsus (1493–1541), a Swiss physician and alchemist, believed
that it was important to treat illness with one medication at a time. At
the end of the Middle Ages, it was a common practice to give multiple
remedies or large quantities of agents that had not been tested
previously. Through experimentation and documentation of the
effectiveness and dosage of each individual agent, Paracelsus was able
to produce many medications. He introduced one of the most popular
tonics of that time—laudanum, which was used to deaden pain. Table
1.1 lists major figures and their influences throughout medical history.
TABLE 1.1
Advances in Medicine
Name Year Medical Advance

William Harvey 1628 Writes first book on blood circulation through the heart
James Lind 1747 Discovers that citrus fruits prevent scurvy
Rene Laennec 1816 Invents stethoscope
James Blundell 1818 Performs first blood transfusion
Crawford W. Long 1842 Uses ether as a general anesthetic
Joseph Lister 1867 Publishes Antiseptic Principle of the Practice of Surgery
Louis Pasteur 1870s Establishes germ theory of disease
Wilhelm Roentgen 1895 Discovers x-rays
Ronald Ross 1897 Demonstrates that malaria is transmitted by mosquitoes
Felix Hoffman 1899 Develops aspirin
Karl Landsteiner 1901 First describes ABO, B, AB, and O blood groups
Sir Frederick Gowland 1906 Suggests existence of vitamins and concludes they are essential to
Hopkins health
Dr. Paul Dudley White 1913 One of the first cardiologists; pioneers use of electrocardiograph
Edward Mellanby 1921 Discovers that lack of vitamin D causes rickets
1922 First uses insulin to treat diabetes
Sir Alexander Fleming 1928 Discovers penicillin*
Gerhard Domagk 1932 Discovers sulfonamides
Dr. John H. Gibbon, Jr. 1935 Successfully uses heart-lung machine (on cat) to continue circulating
blood while patient was in surgery
Selman A. Waksman 1943 Discovers streptomycin
Paul Zoll 1952 Develops first cardiac pacemaker
James Watson, Francis Crick 1953 Describe double-helical structure of DNA
Dr. Joseph E. Murray 1954 Performs first kidney transplant
Dr. Luc Montagnier, Dr. 1983 Discover the human immunodeficiency virus (HIV), the virus that
Anthony Galo causes acquired immunodeficiency syndrome (AIDS)
James Thomson 2007 Scientists discover how to use human skin cells to create embryonic
stem cells; study was performed in laboratory at University of
Wisconsin
Laurent Lantieri 2008 Performed the first full face transplant
Deborah Persaud 2013 First baby cured of HIV in the United States
Researchers at 2013 Produced first kidney grown in vitro in the United States
Massachusetts General
Hospital in Boston
*Although discovered in 1928, it was not isolated and used as an antibiotic until
1938.
Ancient Herbal Remedies
Over the millennia, some prevalent treatments consisted of multiple
mixtures of plants, roots, and other concoctions. Digestion of the type
of plant that resembled the organ affected by disease also was
believed to cure illnesses. For example, those with liver problems
ingested a plant called liverwort (named because the leaves were
shaped like a liver). Other popular treatments included using garlic
for inflammation of the bronchial tubes, wine and pepper for various
stomach ailments, onions for worms, and tiger fat for joint pain. It was
difficult to detect which, if any, of the ingredients administered
actually worked, because many concoctions contained a multitude of
ingredients. As strange as many of these archaic remedies seem, there
were many people who were “cured” because of their strong belief in
the treatment given or their belief in the person treating them.
Throughout history, popular religious beliefs revolved around the
idea that evil spirits were the cause of illness in a person who had
sinned. This belief may have persisted partly because no one had the
slightest idea about germs or genetics. Many times, through trial and
error (error sometimes causing death), certain treatments were found
to be fairly effective.
Anytime new theories are proposed, they can be met with some
skepticism and disbelief. Eventually, medicine and science discovered
methods to answer this need for corroboration, leading to modern
approaches and effective treatments for disease. A new hypothesis
should be treated as a possible answer that has not been disproved. As
new sciences emerge and new methods are devised to test hypotheses,
the results can lead to medical advances. This was especially evident
throughout the golden age of microbiology.
Kelly is assigned to create a poster board showing the advances of

medicine throughout ancient history. What should she focus on when
creating her poster? What important pieces of information from
ancient history relate to today's pharmacy practice that Kelly could
show on her poster?
Eighteenth- and Nineteenth-Century Medicine

From the time of Galen, it was widely believed that the four humors
could be rebalanced through the use of cathartics to clean out the
bowels; diuretics to lessen the imbalance of body fluids; emetics to
empty the stomach; and bloodletting to lessen body fluids, heart rate,
and temperature. Physicians brought this theory to America, where
such techniques were widely used, especially bloodletting.
Bloodletting had its origins in Egypt more than 3000 years ago and
later spread into all areas of Europe through the Middle Ages. Just as
trephination of the skull was believed to release evil spirits,
bloodletting was thought to be an effective way of lessening excess
body fluids that were believed to cause illness. Artifacts such as sharp
bones, sharks' teeth, thorns, and sharpened sticks were believed to be
the earliest instruments used in bloodletting. During the 19th century,
some even used bloodletting as preventive medicine to ensure good
health. A well-known victim of bloodletting in America during the
18th century was George Washington, who suffered from an infection
and died of complications from bloodletting. At that time, it was
wrongly believed that the body contained 12 quarts of blood;
however, it contains only 6 quarts, and President Washington was
bled of 4 quarts over a 24-hour period.
One bloodletting treatment involved using leeches. These blood-
sucking worms were gathered, stored, and used to remove blood from
patients. The leech has the ability to latch onto the skin with sharp,
teeth-like appendages and engorge itself to nearly twice its size on a
person's blood. Leeches also emit a natural anticoagulant, hirudin,
that allows the blood to flow freely. Leeches were used in specific
places, such as the vagina to treat menorrhea. Once the leeches were
finished eating, they would normally detach themselves; if not, they
were encouraged to detach with the use of salt. Bleeding would
continue until it was necessary to manually stop the flow of blood
with bandages.

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Mosby's Pharmacy Technician

Principles and Practice

Karen Davis, AAHCA, BHS, CPhT

Anthony Guerra, PharmD, RPh

Why Is This Book Important to the Profession?

New Chapters in This Edition

Part One Pharmacy Practice

Do You Remember These Key Points?

Chapter 2 Pharmacy Law, Ethics, and Regulatory Agencies

Chapter 3 Competencies, Associations, and Settings for Technicians

Scenario Checkup 3.1

Scenario Checkup 3.2

Scenario Checkup 3.3

Professionalism in the Workplace

The Future of Pharmacy Technicians Is Bright!

Do You Remember These Key Points?

Chapter 4 Communication and Role of the Technician With the

Scenario Checkup 4.1

Scenario Checkup 4.2

Do You Remember These Key Points?

Where Did Pharmacy Abbreviations Originate?

“Do Not Use” List

Scenario Checkup 5.1

Classifications of Drug Sales

Scenario Checkup 5.2

Scenario Checkup 5.3

Other Considerations: Form and Function

Scenario Checkup 5.4

The Use of Excipients

Packaging and Storage Requirements

Do You Remember These Key Points?

Chapter 6 Conversions and Calculations

History of Pharmacy Calculations

International Time (Military Time)

Temperature Conversion Between Fahrenheit and Celsius

Basic Math Skills

Calculations With Liquid Medication

Scenario Checkup 6.1

Scenario Checkup 6.2

Scenario Checkup 6.3

Do You Remember These Key Points?

Chapter 7 Drug Information References

References Used in Pharmacy

Scenario Checkup 7.1

Pocket-Sized Reference Books

Scenario Checkup 7.2

Journals and Newsmagazines

Scenario Checkup 7.3

Additional Types of Information

Considerations When Choosing a Reference

Do You Remember These Key Points?

Chapter 8 Community Pharmacy Practice

Scenario Checkup 8.1

Role of the Pharmacy Technician

Scenario Checkup 8.2

Scenario Checkup 8.3

Scenario Checkup 8.4

Other Pharmacy Technician Duties

Scenario Checkup 8.5

Scenario Checkup 8.6

Scenario Checkup 8.7

Other Pharmacy Services

Do You Remember These Key Points?

Chapter 9 Institutional Pharmacy Practice

free download pdf Mosby's pharmacy technician

free download pdf Mosby's pharmacy technician