Pharmacy Technicians Course. LaGuardia Community College

Terminology and AbbreviationsEvery profession has its own unique language.In the worlds of finance, accounting and equity markets, analysts look at P & L statements, statements of cash flow, accounts receivables, etc.The medical professions have their own unique language. These terms are usually combinations of prefixes, root words, and suffixes.The terms have their roots in Greek and Latin. Some knowledge of Greek/Latin will help you in figuring out this complex world of medical terminology.PrefixA word that when attached to the beginning of a root word modifies it in someway.i.e. Bio means life from the Greek word bios () If you add this to logy meaning study of from the Greek logos () you get biology meaning study of lifei.e. geront0 means old from the Greek word, (geront) meaning old man and you add this to logy you get gerontology, meaning the study of the social, physiologically and mental aspects of aging. Geriatrics is the branch of medicine that studies disease in elderly people.A harder one: glio means gluey in Greek and glial cells in the brain refers to cells that support other cells in the brain. Blasto comes from a Greek word meaning sprouting and refers in science to a developing cell. When this two prefixes are added to oma (typically refers to cancer cells) you have the word glioblastoma meaning a cancer of young glial cells in the brain and is the most highly malignant type of brain cancer.Important Prefixes for pharmacy (other listed in text book)an means without/ example: anesthesiaante means before/example: anterioranti means inhibit/example: antibioticbrady means slow/ example:bradycardia, slow heart rateContra means against/ contraindicateddys means abnormal/ dysmorphic, abnormal shapehyper means too much/ hyperkalemia, too much potassiumhypo means too little/ hypokalemia, too little potassium in the bloodIntra means within/ intradermal (within the skin), intervenous (within a vein)micro means very small or can mean (1 per 1,000,000) in the metric system i.e. microgram (one millionth of a gram)neo means new/ neonate is a newly born baby.poly means too many/ polypharmacy is used to mean the practice of prescribing to many medications for the same purpose.Sub means below/ sublingual means below the tongue. Subcutaneous means below the skinTachy means fast/Tachycardia is a rapid heart rate

Important root words in Pharmacy ROOTMEANINGEXAMPLEArterArteryArterialArthrJointArthritisBronchAirway in the lungBronchitisCarcinoCancerCarcinogenCardiHeartCardiacDermaSkinDermatitsEnterIntestineEnteral nutritionGastrStomachGastric painGlucoSugarGlucose meterHemoBloodHematologyImportant Root words in Pharmacy continuedROOTMEANINGEXAMPLEHepatLiverHepatitisMyMuscleMyalgiaNasaNoseNasalNephrKidneyNephrologyNeurNerveNeurologyOsteBoneOsteoporosisPneuLungpneumoniaProctoRectumProctotitisPulmoLungPulmonaryRenKidneyRenalThrombClotthrombosisSuffixA suffix is a word that is added at the end of a root word to indicate or qualify its meaning. For example, arthr (joint) plus itis yields the word arthritis which meaning inflammation of a joint.

Important Pharmacy related suffixesSUFFIXMEANINGEXAMPLEAcPertaining to CardiacAlPertaining toRenalAlgiaPainMyalgiaAseEnzymeProteaseCyteCellHepatocyteEctomySurgical removalHysterectomyEmiaBlood conditionhyperkalemiaItisInflammationHepatitisLogyStudy ofCardiologyRrheaFlowing dischargeDiarrhea, rhinorrheaUroUrineUrologyThere are literally hundred of root words and prefixes and suffixes. These list is not all inclusive by any means.It is based on my experience on what is important to knowA medical dictionary is key to have and to review on a regular basisLearning or knowing different languages always helps

General Pharmacy AbbreviationsMeaningAbbreviationAdverse drug reactionADRAverage wholesale priceAWPControlled releaseCRDiscontinueDCDispense as writtenDAWDrug utilization reviewDUREnteric coatedECExtended releaseERFluidFl.Maximum allowable costMACNo known drug allergiesNKDANothing by mouthNPOGeneral Pharmacy Abbreviations Table 2MEANINGABBREVIATIONOver the counterOTCPediatricPedPrescription RxSchedule 1CISchedule 2CIISchedule 3CIIISchedule 4CIVSchedule 5CVSolutionSolnSuppositorySuppWholesame acquisition costWACPharmacy SIG codesSIG is the part of the prescription that includes the directions for use. SIG is short for the Latin signetur let it be writtenYou will see on an Rx (remember this abbreviation?)Sig: 1 tab qd po HSQnty: 30Refills: 1This means take one tablet very day by mouth at bedtime dispense 30 tablets and give one refillWe will cover this list in class.

Dangers of SIG codes and medical abbreviation in generalThe Institute of Safe Medication Practices (ISMP) publishes a list of unsafe medication codes whether SIG codes or other codes for which many hospitals and institutions adhere to in the goal of preventing medication related errors.The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) also in collaboration with the ISMP publishes a minimum Dont abbreviate List (Do not use list)that healthcare organization must include. We will cover this list in class in our discussion.Both the ISMP and JCAHOs do not use list apply to all health related communication between healthcare practitioners. This means that in addition to drug orders, these abbreviation are not to be used anywhere in a patients chart, documentation or reports.The Institute of Medicine (IOM) in 1999 published a report stating that between 44,000 and 96,000 deaths each year happen due to medical errors, many because of unclear abbreviations and codes

Case in pointIn 2001, a case was report to the FDA via medwatch, see article, http://www.fda.gov/downloads/Drugs/DrugSafety/MedicationErrors/UCM080654The case involved an infant transferred from an obstetrics unit to a nursery for well babies with an order for DTO 0.7 ml PO q4h.The pharmacist in the case recognized the order as deodorized tincture of opium USP, which has a concentration of 60 mg/ml morphine. The prescribed dose translates into give 0.7 ml (42 mg) by mouth every four hours. This dose is 252 mg per day of morphine, a dose that can kill or send a newborn baby to the hospital for respiratory arrest.The pharmacist verified the order as diluted tincture of opium which is 25 fold dilution of the original drug. The actual dose is 0.7 ml(1.6 mg) by mouth every four hours.

How to report medication errorsBoth patients and healthcare providers can report errors involving medications to the ISMP through its website, www.ismp.org. Click onto the MERP, medication error reporting program.United States Pharmacopeia, www.medmarx.com collects medication errors and adverse events data.

Milans List of Must Know DrugsBRAND DRUGGENERIC NAMEMOST COMMON INDICATIONACTIVASEALTEPLASEPULMONARY EMBOLISMACCUPRILQUINAPRILHYPERTENSIONACTONELRISEDRONATEOSTEOPOROSISADENOCARDADENOSINERAPID HEART RATEALDACTONESPIRONOLACTONEHYPERTENSIONALLEGRAFEXOFENADINEALLERGIESALTACERAMIPRILHTN(?), HEART DISEASEBRAND DRUGGENERIC NAMEMOST COMMON INDICATIONAMARYLGLIMEPIRIDEDIABETES MELLITUS (DM)AMBIENZOLPIDEMINSOMNIAAMIKIN AMIKACIN SULFATEBACTERIAL INFECTIONSAMOXIL AMOXICILLINBACTERIAL INFECTIONSKEFZOLCEFAZOLINBACTERIAL INFECTIONSAPRESOLINEHYDRALAZINEHYPERTENSION (HTN)ARICEPTDONEPEZILALZHEIMERS DISEASEBRAND DRUGGENERIC NAMEMOST COMMON INDICATIONASTRAMORPH PFMORPHINE SULFATEPOST OP PAIN, EPIDURAL ANALGESIAATACAND CANDESARTANHTNATARAXHYDROXYZINEALLERGIESATIVAN LORAZEPAMANXIETYATROVENTIPRATROPIUM BROMIDECOPD, ASTHMAAUGMENTIN AMOXICILLIN/CLAVULANATE, POTASSIUMBACTERIAL INFECTIONSAVAPRO IRBESARTANHTNBRAND DRUGGENERIC NAMEMOST COMMON INDICATIONBENADRYLDIPHENHYDRAMINEINSOMNIA, ALLERGYBIAXINCLARITHROMYCINBACTERIAL INFECTIONSBUSPARBUSPIRONEDEPRESSIONCALANVERAPAMIL HCLHTN, RAPID HEART RATECAPOTENCAPTOPRILHTN, CARDIAC HEART FAILURECARBATROLCARBAMAZEPINESEIZURESCARDIZEMDILTIAZEMHTN, RAPID HEART RATEBRAND DRUGGENERIC NAMEMOST COMMON INDICATIONCATAPRESCLONIDINEHTNCEFTINCEFUROXIMEBACTERIAL INFECTIONSCELEBREXCELECOXCIBRA CELEXACITALOPRAMDEPRESSIONCIPROCIPROFLOXACINBACTERIAL INFECTIONSCLARITINLORATIDINESESSIONAL ALLERGIESCLEOCINCLINDAMYCINBACTERIAL INFECTIONSBRAND DRUGGENERIC NAMEMOST COMMON INDICATIONCOMBIVENTALBUTEROL/IPRATROPIUMCOPDCOMBIVIRZIDOVUDINE/LAMIVUDINEHIV CORDARONEAMIODARONECARDIAC ARRTHYMIASCOUMADINWARFARINBLOOD CLOTTINGCRIXIVANINDINAVIR MESYLATEHIVDEPAKOTEDIVALPROEX SODIUMSEIZURESDIABETAGLYBURIDEDMBRAND DRUGGENERIC NAMEMOST COMMON INDICATIONDIFFERINADAPALENEACNEDIFLUCANFLUCONAZOLEFUNGAL INFECTIONDIGITEK OR LANOXINDIGOXINHEART FAILUREDILANTINPHENYTOIN SODIUMSEIZURESDILAUDID CIIHYDROMORPHONE HCLPAINDIOVANVALSARTANHTNDOBUTREXDOBUTAMINEHEART FAILURE, LOW BLOOD PRESSUREBRAND DRUGGENERIC NAMEMOST COMMON INDICATIONEFFEXORVENLAFAXINEDEPRESSIONE-MYCIN ERY-TABERYTHROMYCIN BASEBACTERIAL INFECTIONFEOSOL FERROUS SULFATEIRON DEFFICIENCYFIORICETBUTALBITAL, CAFFEINE AND ACETAMINOPENPAINFIORINALBUTALBITAL, CAFFEINE AND ASPIRINPAINFLAGYL, METROGELMETRONIDAZOLEPROTOZOAN INFECTIONFOSAMAXALENDRONATEOSTEOPOROSISBRAND DRUGGENERIC NAMEMOST COMMON INDICATIONFUNGIZONEAMPHOTERICIN BSEVERE FUNGAL INFECTIONSFURADANTINNITROFURANTOINURINARY TRACT INFECTIONSGAMMAGARDINTRAVENOUS IMMUNE GLOBINBLOOD DISORDERSGLUCOPHAGEMETFORMINDMIIGLUCOTROLGLIPIZIDEDMIIHALDOLHALOPERIDOLSCHIZOPRENIA, TRANQUILIZERHUMALOGHUMAN INSULIN LISPRODMI AND DMIIBRAND DRUGGENERIC NAMEMOST COMMON INDICATIONHYDRODIURIL, EsidrixHYDROCHLOROTHIAZIDEHTNIMODIUMLOPERAMIDEDIARRHEAINDERALPROPRANOLOLHTN, CARDIAC FAILUREIMDURISOSORBIDE MONONITRATECARDIAC PAIN (ANGINA)INTROPINDOPAMINE HCLLOW BLOOD PRESSUREISOSORDILISOSORBIDE DINITRATEANGINAKAYEXELATESODIUM POLYSTRENE SULFONATEHYPERKALEMIABRAND DRUGGENERIC NAMEMOST COMMON INDICATIONKEFLEXCEPHALEXINBACTERIAL INFECTIONSLASIX FUROSEMIDEHEART FAILURE, EDEMALIPITORATORVASTATINHIGH CHOLESTEROLLOPRESSORMETOPROLOL TARTARATEHTN, CARDIAC FAILURELOVENOX ENOXAPARINDVT, PE, AND MIMAALOXALUMINUM AND MAGNESIUM HYDROXIDEGASTROINTESTINAL UPSET/ACID REFLUXMARCAINBUPIVACAINE HCLLOCAL ANESTHETICMost commonly abbreviated medical conditions you will see Medical ConditionsAbbreviationCommon meaningMyocardial InfarctionMIHeart attackCongestive Heart failureCHFHeart muscle is dyingAtrial fibrillationAFibA cardiac heart beat that is fast and abnormalVentricular Fibrillation

VFA cardiac heart beat that is fast and almost always fatalCerebral Vascular AccidentCVA

Stroke/loss of blood flow to brainDiabetes MellitusDMA disorder of carbohydrate metabolismHypertensionHTNHigh blood pressureMedical ConditionsAbbreviationCommon meaningCABGCoronary artery bypass graftSurgery to re-establish blood flow to the heartATNAcute tubular necrosisA disorder of the kidneyRARheumatoid ArthritisA joint disease that effects older peopleRIRenal InsufficiencyPoorly functioning kidneysPEPulmonary EmbolismA blood clot that travels to the lung DVTDeep vein ThrombosisA blood clot in the leg that often travel to the lungNot an all inclusive but include very common conditionsMedications commonly abbreviatedThe following medications are commonly abbreviated in the fieldJoint Commission and the ISMP however have established guidelines to reduce the use of such shortcuts.Medication AbbreviationsAbbreviationDrugIndicationASAAspirinPain, post MI useAPAPAcetaminophenPain, fever reducer in children5FUFlurouracilAnti cancer drugSMX/TMPSulfamethoxazole/trimethoprimAntibioticHCTZHydrochlorothiazidediureticINHIsoniazidAnti-TB (tuberculosis) drug6-MP6 mercaptopurineImmune suppressantMedication AbbreviationsAbbreviationDrugIndicationNTGNitroglycerinChest pain (angina)SSKISuper saturated potassium iodideHyperthyroidismT4Levothyroxine (synthroid)hyperthyroidismKCLPotassium chloridePotassium deficiencyMgSO4Magnesium SulfateMagnesium deficiencyMSO4Morphine sulfatePain killerPCNPenicillin antibioticMedication AbbreviationsAbbreviationDrugIndicationAZTZidoviduneHIV NSNormal SalineIV fluidD5WDextrose 5% in waterIV fluidD5WNSDextrose 5% in water with normal salineIV fluidMVIMultiple vitaminsVitamin replacementISDNIsosorbide dinitrateChest painMTXMethotrexateCancer drugMost Common Sig Codes in PharmacySig CodeMeaningSig:Let it be writtenPCPost Cena (after meals)ACAnte Cena (before meals)UDAs directedAd libAs desiredPRNAs neededHSAt bedtimeQddailySigMeaningQEveryQ+blank+HEvery blank hoursBIDTwice a dayTIDThree times a dayQIDFour times a dayQODEvery other dayQWEvery week (once)BIWTwice a weekTIWThree times a weekCommon Routes of AdministrationRouteMeaningPOBy mouthSLSublinguallyBUBuccallyINH or INInhalationIVPIntravenous PushIVPBIntravenous PiggybackIMIntramuscularSC or SubQSubcutaneouslyOpthVia the eyesRouteMeaningOTOtic (via ears)PRRectallyPVVaginallyEXTopicallyIPIntraperitonealUncommon Routes of administrationCertain routes are not commonly usedOften to avoid confusion and the potential for error the routes are spelled out on medical ordersExample 1 Epidural Medication is given just outside the spinal cord next to the dura mater.Used in cases where high doses of pain medications are needed but side effects need to be minimized.Used in obstetrics ward in women undergoing laborUsed for post operative patients in PACUExample of a drug is Fentanyl 2 mcg/ml with 0.0625% bupivacaine in 250 ml of NS

Example 2 Intrathecal RouteInvolves passing the medication through the spinal cord into the subarachnoid space to allow for direct bathing of the neural tissue in the drugIntrathecal chemotherapy i.e. methothexate, cytarabineIntrathecal Baclofen in cerebral palsy patientsAdvantages are that very small amounts of drug can be used leading to less side effectsDisadvantages are high risk for infections and inadvertent overdosesEpidural Injection

Courtesy of: http://richardspatafora.com/2011/05/19/lumbar-epidural-cortisone-injection/Common Abbreviations for quantitiesAbbreviationMeaningMgMilligramsGGramsGrGrainsMlMillilterLLiterFl. OZOunces (fluid)TabTabletsmEqMilliequivalentsTspTeaspoonTBSPTablespoonccCubic centimeter (= 1 ml)Gtt(s)Drop(s)Putting the Rx togetherA prescription will consist of the following elementsSig:A numerical quantity (with the dosage form)Route of administrationTime FrequencyDay supply or total quantityRefills Example:Vasotec 5 mgSig: take 1 tab qd30 tabletsRefills: 2 A tougher example:Humulin NSig: inject 25 units qam and 25 units qhsRefills: 11Example 3Amoxicillin Susp 400 mg/5 mlSig: 1 tsp TIDFor 14 daysRefills: 2Total amount to dispense for 14 days?JCAHOs Minimum Do not use ListIn 2004, JCAHO published its minimum do not use list which the joint commission encourages health care institutions it accredits to use (at a minimum)

AbbreviationProblemPreferred IUMistaken as IV or 10International unitsMS, MSO4 or MgSO4Confused for each otherMorphine sulfate/magnesium sulfateQ.D. and QODConfused for each otherDaily and every other dayTrailing zero and no preceding zero (3.0 or .3)10 fold overdose possible3 or 0.3ULook like 0Use unitsMistake for mgWrite microgramHS or qHSMistaken for every hourWrite at bedtime

gAbbreviationProblemPreferredAS, AD, AU and OS, OD, OUMistaken for each otherUse left eye, left ear, etcDC or D/CMistaken for discontinue medsWrite dischargeCcMistaken for zerosWrite mlsSC or SQMistaken for SL or 5 everyUse subQ or write subcutaneouslyTIWMistaken for three times a dayWrite three times a weekLess commonly known pharmacy terminologyTermMeaningAnalgesicA drug for painAnorecticA drug for appetite suppressionAnalepticA drug that stimulates the CNSIV AdmixtureA drug product made by adding the drug to an IV bagAnestheticA drug that block sensations of pain or feeling in generalAnaphylactic ShockA severe allergic reaction to a drugAnticoagulantA drug that blocks blood clottingAntitussiveA drug that blocks coughingAntiemeticA drug that stop N/VAntipruriticA drug that stop itchingTermMeaningAseptic TechniquesTechniques used in making parenteral drug products that minimizes microrganism contaminationClinical TrialsMandated by the FDA for the marketing of new drugs in the USContraindicationAn aspect of a patients condition that is not compatable with the treatmentEmulsionA pharmaceutic dosage form where two immiscible liquid drugs are mixed togetherNSAIDNon steroidal anti-inflammatory drugsCorticosteroidsSteroid drugs used in autoimmune conditionsGlucocorticoidsSame as above. Two terms are used interchangeableNeurolepticsDrugs that cause an effect on the CNS used to refer to old type of anti psychotic drugs like HaldolTermMeaningNarcoticA drug that induces sleep (from the greek word for stupor)AntisialagogueA drug that dry mucus and saliva secretion. Used before anesthesia to dry secretions.NMBNeuromuscular blockerSuspensionA drug dosage form that consists of suspended drug particles in aqueous solutionSolutionA uniform homogenous mixture of a drug in waterOintmentA semisolid mixture of drug in oily solid baseTrocheA drug made into a lozenge dose formTinctureAn alcoholic mixture of a drug with at 25% V/V alcoholEnemaA drug in a fluid vehicle delivered into the rectum