1Medications35%
More than a third of the exam. For each common drug, be able to give the generic name, a brand name, the class and what it treats, and then what follows from the class: typical side effects, notable interactions, and who should not take it. Add the practical tasks at the end of the domain: dosage forms and routes, how long a reconstituted or opened product stays usable, and what has to be refrigerated, kept from light or locked up.
- 1.1Recognize medications by generic name, brand name, and drug class.
- 1.2Spot therapeutic duplication, where two drugs in a regimen do the same job.
- 1.3Recognize common or dangerous interactions and contraindications involving other drugs, supplements, lab tests, nutrients, and disease states.
- 1.4Know strengths and doses, dosage forms, routes, special handling and administration directions, and how long therapy lasts (includes calculations).
- 1.5Recognize common and serious side effects, adverse effects, and drug allergies.
- 1.6Know what conditions each medication is used to treat.
- 1.7Know how long products stay stable, such as oral suspensions, insulins, reconstituted drugs, injectables, and vaccines (includes calculations).
- 1.8Store medications correctly: temperature range, protection from light, and restricted access.
Where people lose points: Learning drugs one flashcard at a time. The questions lean on class: a shared stem in the generic name (such as -pril, -olol or -vastatin) usually tells you the class, and the class tells you the side effects and interactions. The other leak is tasks 1.4 and 1.7, which carry calculations. A duration-of-therapy or stability question is arithmetic with a drug fact attached, and people who studied only names have not practiced the arithmetic.
2Federal Requirements18.8%
Know the DEA schedules and what changes from one to the next: how a prescription may be written, refilled and transferred, and how the pharmacy orders, receives, stores, counts, returns and destroys the stock. Then the rules that are not about controlled substances: hazardous and pharmaceutical waste, restricted programs such as pseudoephedrine sales limits and REMS, what to do in a product recall, and the tracing and quarantine rules of the Drug Supply Chain Security Act.
- 2.1Apply federal rules for storing, handling, and disposing of non-hazardous, hazardous (such as P-listed), and pharmaceutical substances and waste.
- 2.2Apply federal rules for new, refilled, and transferred controlled-substance prescriptions, and know the DEA schedules (includes calculations).
- 2.3Apply federal rules for ordering, receiving, storing, labeling, dispensing, returning, taking back, reporting loss or theft of, and destroying controlled substances.
- 2.4Process medications covered by federal restricted-drug programs, such as pseudoephedrine sales limits and REMS (includes calculations).
- 2.5Follow FDA requirements when a medication is recalled.
- 2.6Follow Drug Supply Chain Security Act rules for product serialization, tracking and tracing, handling, and quarantine.
Where people lose points: Answering from your state or your store. The domain is called Federal Requirements and the federal rule is what it tests, even where the practice you learned at work is stricter. Also the paperwork: which form or system belongs to ordering a Schedule II drug, which to reporting a loss or theft, and which to destruction. The pseudoephedrine limits are a calculation task (2.4): expect to total a quantity and compare it with a limit.
3Patient Safety and Quality Assurance23.8%
Know which medications are high-alert and which names are routinely confused, and the habits that stop errors: matching the order to the right patient, tall man lettering, separated stock, barcode scanning, and the zero rules for decimals. Know what a technician must hand to the pharmacist, which channel each kind of event is reported through, and the hygiene and cleaning standards for counting trays, counters and equipment.
- 3.1Identify high-alert medications and look-alike/sound-alike drug pairs.
- 3.2Use error-prevention strategies: matching the order to the right patient, tall man lettering, separating stock, leading and trailing zero rules, barcode scanning, and avoiding error-prone abbreviations.
- 3.3Recognize situations that must go to the pharmacist, such as DUR alerts, adverse drug events, OTC advice, therapeutic substitution, misuse, adherence problems, post-immunization care, allergies, and interactions (includes calculations).
- 3.4Report events through the right channel: medication errors, adverse effects, product quality problems, MedWatch, VAERS, near misses, root-cause analysis, and continuous quality improvement.
- 3.5Classify prescription errors, such as wrong dose, quantity, patient, drug, or route (includes calculations).
- 3.6Follow infection prevention and cleaning standards: hand hygiene, PPE, and cleaning counting trays, counters, and equipment.
Where people lose points: The line between technician and pharmacist. Options in which the technician counsels the patient, recommends an OTC product or decides what to do about a DUR alert are written to sound helpful, and they are wrong: anything that needs clinical judgment goes to the pharmacist (task 3.3). Next, the reporting channels: MedWatch for adverse events and product quality problems, VAERS for events after a vaccine. Last, the zero rules: always a leading zero (0.5 mg), never a trailing one (5 mg, not 5.0 mg).
4Order Entry and Processing22.5%
The method domain. Task 4.1 is calculation outright: days' supply, quantity to dispense, dose, concentration and dilution, built from sig codes, ratios, proportions and unit conversions. The rest is the working knowledge around a prescription: which supplies go with which drug, how to read an NDC, a lot number and an expiration date, and what happens to stock that is returned, expired or cannot be dispensed.
- 4.1Use formulas, ratios, proportions, conversions, sig codes, abbreviations, medical terms, and symbols to work out days' supply, quantity, dose, concentration, and dilutions (calculations).
- 4.2Select the equipment and supplies needed to give a drug, such as diabetic supplies, spacers, oral and injectable syringes, filters, diluents, immunization supplies, and nebulizers (includes calculations).
- 4.3Read and use lot numbers, expiration dates, and National Drug Code (NDC) numbers (includes calculations).
- 4.4Identify and return dispensable, non-dispensable, and expired medications and supplies: credit returns, return to stock, and reverse distribution.
Where people lose points: Units. A sound method with one missed conversion still gives a wrong answer: milligrams against grams, teaspoons against milliliters, pounds against kilograms. Write the unit on every line and cancel as you go. Drill days' supply for products that are not counted tablets (insulin, eye drops, inhalers, liquids), because the quantity has to be turned into doses before you can divide.