ExCPT flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

First-pass effect

Metabolism of an oral drug by the liver and gut wall before it reaches the systemic circulation, which lowers oral bioavailability; intravenous administration bypasses this effect entirely.

Therapeutic index

Ratio of the toxic dose to the effective dose (TD50/ED50); a low index means a narrow margin of safety, as with warfarin, digoxin, lithium, and phenytoin.

Steady state

Reached after roughly four to five elimination half-lives of consistent dosing, when the amount of drug entering the body equals the amount being eliminated.

Naloxone

Opioid antagonist used to reverse respiratory depression in opioid overdose; its duration is shorter than most opioids, so the patient requires monitoring for returning sedation.

DEA Form 222

Official order form used to purchase Schedule I and II controlled substances; it must be completed accurately, and a form containing errors must be replaced rather than corrected.

Refills for Schedule II

Federal law prohibits refills on Schedule II prescriptions; each additional supply requires a new prescription, and an emergency oral order needs written follow-up within seven days.

HIPAA minimum necessary

Rule limiting use and disclosure of protected health information to the least amount needed for the purpose, such as confirming only what a claim requires.

Poison Prevention Packaging Act

Requires child-resistant containers for most oral prescription drugs, with exceptions such as sublingual nitroglycerin and non-child-resistant packaging requested by the patient.

DEA number check digit

Add the first, third, and fifth digits to twice the sum of the second, fourth, and sixth; the last digit of that total matches the seventh digit of a valid DEA number.

NDC format

Eleven-digit identifier in 5-4-2 layout: the first segment identifies the labeler, the second the product, and the third the package size; claims require the 11-digit form.

Tall man lettering

Mixed-case formatting applied to look-alike drug names, such as hydrOXYzine versus hydrALAZINE, to reduce selection errors during order entry and dispensing.

Therapeutic interchange

Substituting a therapeutically equivalent alternative product for the prescribed drug; it requires prescriber authorization or a documented, approved protocol before dispensing.

Nonaqueous compound beyond-use date

Under USP <795>, a nonaqueous compounded preparation is assigned a beyond-use date of no more than 180 days, provided no stability data require an earlier date.

USP 800 requirements

Chapter governing hazardous drug handling, requiring negative-pressure rooms, external venting, closed-system transfer devices, and two pairs of chemotherapy-tested gloves for handling.

Filter needle use

A needle with an in-line filter used to withdraw solution from a glass ampule, trapping glass particles; a regular needle replaces it before administration.

Percent weight-in-volume

Expresses grams of drug per 100 milliliters of preparation; a 1% w/v solution contains 1 gram in 100 mL, which equals 10 mg per mL.

High-alert medications

Drugs carrying heightened risk of significant harm when used in error, including anticoagulants, insulin, opioids, and concentrated electrolytes; many require independent double checks.

Do-not-use abbreviations

Abbreviations banned on medication orders, including U for units, QD, trailing zeros, and MSO4 or MgSO4, because they are frequently misread and cause dosing errors.

Medication reconciliation

Formal process of comparing a patient's current medication list with new orders at transitions of care to identify omissions, duplications, and interactions.

Refrigerator storage range

Most medications requiring refrigeration are stored between 2 and 8 degrees Celsius, or 36 to 46 Fahrenheit, with temperatures logged and excursions documented.

FEFO stock rotation

First-expired, first-out rotation means stock with the earliest expiration date is dispensed first, and expired products are removed from active inventory.

Inventory turnover ratio

Calculated as cost of goods sold divided by average inventory value; a higher ratio indicates stock is being sold and replenished more quickly.

DEA Form 106

Report filed with the DEA for theft or significant loss of controlled substances, submitted within one business day of discovery along with documentation of the circumstances.

FDA Class I recall

Recall of a product likely to cause serious adverse health consequences or death; the affected stock must be quarantined immediately and handled per the recall notice.

BIN number

Six-digit Bank Identification Number on a pharmacy benefit card that routes an electronic claim to the correct processor, used with the PCN and group number.

Days supply calculation

Estimated number of days a dispensed quantity will last based on the directions; it must be accurate because payers use it for refill-too-soon edits.

DAW-1 code

Dispense-as-written code indicating the prescriber requested the brand as medically necessary, which may allow brand-level reimbursement instead of the generic rate.

Prior authorization

Payer requirement that the prescriber document medical necessity before a non-formulary or restricted drug is covered; the claim rejects until approval is received.

Teach-back method

Technique in which the patient explains in their own words how the medication will be taken, confirming understanding rather than relying on yes-or-no questions.

Metered dose inhaler technique

Shake the inhaler, exhale fully, actuate while inhaling slowly, hold the breath about ten seconds, and wait 30 to 60 seconds before a second puff.

Warfarin counseling points

Consistent vitamin K intake, regular INR monitoring, and prompt reporting of unusual bleeding or bruising are key; many drug and herbal interactions increase bleeding risk.

Health literacy

The ability to obtain and understand health information; patient materials should be written near a fifth-to-sixth grade reading level and avoid medical jargon.