PEBC PEBC Drug Dispensing and Compounding 5 — Questions and Answers
Question 1: A pharmacist is compounding an oral suspension using a tablet that contains microcrystalline cellulose as a filler. What is the recommended approach when no commercial suspension is available?
- Use the tablet powder directly in the suspension vehicle without modification
- Crush tablets, mix with a suspending agent such as Ora-Plus, and use a documented formula (Correct answer)
- Dissolve tablets in water and add flavoring only
- Use the injectable form of the drug diluted with water for oral use
Correct answer: Crush tablets, mix with a suspending agent such as Ora-Plus, and use a documented formula
Crushing tablets and incorporating them into a validated suspending vehicle (e.g., Ora-Plus/Ora-Sweet) with a documented formula ensures stability and patient safety.
Question 2: Which statement best describes the 'first in, first out' (FIFO) principle in pharmacy inventory management?
- Highest-cost items should be dispensed first to minimize losses
- Products with the earliest expiry dates should be dispensed before newer stock (Correct answer)
- New inventory should be placed at the front of the shelf for easy access
- Items are ordered in the sequence they run out
Correct answer: Products with the earliest expiry dates should be dispensed before newer stock
FIFO ensures that products with the earliest expiration dates are used first, reducing the risk of dispensing expired medications.
Question 3: A prescription is received for 'morphine sulfate 10 mg/mL oral solution — dispense 120 mL.' The pharmacist calculates a total of 1200 mg of morphine sulfate dispensed. Which regulatory requirement applies to this dispensing in most Canadian provinces?
- A triplicate prescription form is required
- The prescription must be recorded in the narcotic register (Correct answer)
- A patient profile must be updated within 48 hours
- Oral narcotics require provincial formulary approval
Correct answer: The prescription must be recorded in the narcotic register
Narcotic drugs such as morphine require entry in the narcotic register as per the federal Controlled Drugs and Substances Act (CDSA) and NAPRA guidelines.
Question 4: When performing a final check on a dispensed prescription, what does 'tech-check-tech' (TCT) most directly refer to?
- A technician checking a pharmacist's compounding work
- A pharmacy technician verifying another technician's filled prescription before pharmacist review (Correct answer)
- Two technicians independently entering prescription data
- A technician checking automated dispensing machine refills
Correct answer: A pharmacy technician verifying another technician's filled prescription before pharmacist review
Tech-check-tech (TCT) programs allow one pharmacy technician to perform a accuracy check on another technician's filled prescription, subject to regulatory approval and pharmacist oversight.
Question 5: A compounded sterile preparation (CSP) is prepared under Category 2 conditions per USP <797>. What is the maximum beyond-use date (BUD) for a sterile preparation stored at controlled room temperature (CRT) without sterility testing?
- 24 hours
- 4 days
- 14 days (Correct answer)
- 30 days
Correct answer: 14 days
Under USP <797> Category 2 conditions without sterility testing, the maximum BUD at CRT is 4 days; however, with sterility testing and endotoxin testing, the BUD can extend to 45 days — without testing, Category 1 limits (12h CRT) apply, while Category 2 with testing allows up to 45 days; for Category 2 without testing the limit is 4 days at CRT.
Question 6: A patient presents with a prescription for 'atenolol 25 mg — dispense 90-day supply.' Which auxiliary label is most important to include on this dispensing label?
- Take with a full glass of water
- Do not stop taking this medication without consulting your doctor (Correct answer)
- Avoid prolonged exposure to sunlight
- Take on an empty stomach
Correct answer: Do not stop taking this medication without consulting your doctor
Abrupt discontinuation of beta-blockers like atenolol can cause rebound hypertension or angina, so patients must be counselled never to stop abruptly without medical guidance.
Question 7: When dispensing a Schedule II drug (e.g., insulin syringes in some provinces) in Canada, what distinguishes it from Schedule III dispensing requirements?
- Schedule II drugs require a prescription while Schedule III do not
- Schedule II drugs must be kept behind the counter and require pharmacist intervention, while Schedule III can be self-selected (Correct answer)
- Schedule II drugs are only available in hospitals
- Schedule II drugs require a narcotic record entry
Correct answer: Schedule II drugs must be kept behind the counter and require pharmacist intervention, while Schedule III can be self-selected
Schedule II drugs must be stored behind the counter and require direct pharmacist involvement in the sale, whereas Schedule III drugs are kept in the self-selection area of the pharmacy but remain in the professional area.
PEBC PEBC Drug Dispensing and Compounding 5
A pharmacist is compounding an oral suspension using a tablet that contains microcrystalline cellulose as a filler.
What is the recommended approach when no commercial suspension is available?