- Which of the following medications is typically administered via subcutaneous injection rather than intramuscular injection?
Answer: Insulin lispro
Insulin is administered subcutaneously (SubQ) into the adipose (fatty) tissue for slow and steady absorption. The influenza vaccine, long-acting antipsychotics like haloperidol decanoate, and oil-based hormone injections like testosterone are all typically administered via the intramuscular (IM) route for appropriate absorption.
- A pharmacy technician is preparing to dispense an oral suspension, such as amoxicillin suspension. What is the most critical instruction to provide to the patient or caregiver?
Answer: Shake the bottle well before measuring each dose.
In a suspension, drug particles are suspended, not dissolved, in a liquid and can settle at the bottom of the container. It is essential to shake the bottle vigorously before each use to redistribute the drug particles evenly and ensure that each dose administered is accurate. Not shaking can lead to under-dosing initially and over-dosing with the final doses. Household spoons are not accurate, and most suspensions should be refrigerated, not frozen.
- A pharmacy technician is dispensing a fentanyl transdermal patch. Which instruction is crucial for patient safety regarding the application site?
Answer: Rotate application sites with each new patch to avoid skin irritation.
To prevent skin irritation, sensitization, and potential damage, application sites for transdermal patches must be rotated. Applying to the same site can alter drug absorption. Cutting a fentanyl patch is extremely dangerous as it can damage the drug matrix and lead to a rapid, potentially fatal release of the opioid. Applying heat can also cause a dangerous increase in the rate of drug absorption.
- A patient's caregiver asks if it is okay to crush an oxycodone ER 20 mg tablet to mix with applesauce. Why is this a dangerous practice?
Answer: It can cause a rapid, potentially fatal overdose of the medication.
The "ER" in oxycodone ER stands for extended-release. These formulations contain a higher dose of medication designed to be released slowly over a prolonged period. Crushing the tablet destroys this extended-release mechanism, causing the entire dose to be absorbed at once. This phenomenon, known as "dose dumping," can lead to dangerously high blood levels of the drug and a potentially fatal overdose.
- Mesalamine is available as a suppository for the treatment of ulcerative colitis. This dosage form is intended for which route of administration?
Answer: Rectal
A suppository is a solid dosage form designed to be inserted into a body orifice where it melts or dissolves. Mesalamine suppositories are specifically designed for rectal administration to deliver the anti-inflammatory drug directly to the site of inflammation in the rectum and colon for the treatment of ulcerative colitis.
- Enoxaparin (Lovenox) is provided in a prefilled syringe for subcutaneous administration. Which is a key administration technique for this medication?
Answer: Do not expel the air bubble and inject into the abdomen.
For enoxaparin prefilled syringes, the manufacturer specifically advises not to expel the air bubble before injection. The bubble serves as an 'air lock' to ensure the full medication dose is delivered from the syringe and to prevent leakage from the injection site. The preferred site is the subcutaneous tissue of the abdomen, and rubbing the site should be avoided to minimize bruising.
- A patient is prescribed nitroglycerin sublingual tablets for angina. What is the most important administration instruction for this route?
Answer: Place the tablet under the tongue and allow it to dissolve completely.
Sublingual (SL) administration means placing the medication under the tongue. This route allows for rapid absorption of the drug directly into the bloodstream, bypassing the digestive system and first-pass metabolism in the liver. Swallowing, chewing, or dissolving the tablet in water would change it to an oral route, altering its absorption and delaying its onset of action, which is critical for treating acute angina.
- A prescription for clotrimazole is written for a "troche." This dosage form is intended to be administered by which method?
Answer: Dissolved slowly in the mouth.
A troche, also known as a lozenge, is a solid dosage form intended to be held in the mouth or buccal cavity and allowed to dissolve slowly. This provides a local effect in the mouth or throat. Clotrimazole troches are used to treat oral candidiasis (thrush).
- A medication designed for buccal administration should be placed:
Answer: Between the cheek and gum.
Buccal administration involves placing a drug in the buccal pouch, which is the space between the cheek and the gum. The medication dissolves and is absorbed through the oral mucosa directly into the bloodstream. This is different from sublingual administration, which is under the tongue.
- Which route of administration provides the most rapid onset of action and 100% bioavailability?
Answer: Intravenous (IV)
The intravenous (IV) route delivers medication directly into the bloodstream, bypassing all barriers to absorption. This results in an immediate therapeutic effect and ensures that 100% of the administered dose is available to the body (100% bioavailability). All other routes involve an absorption step, which slows the onset of action and may result in less than 100% bioavailability.
- The intradermal (ID) route of administration is most commonly used for:
Answer: Allergy testing and tuberculosis (TB) skin tests.
Intradermal (ID) injections are administered into the dermis, the layer of skin just beneath the epidermis. This route has a very slow absorption rate, making it ideal for diagnostic purposes like allergy testing and the tuberculin (PPD) skin test, where a visible local reaction is desired. Large fluid volumes are given IV, flu shots are typically IM, and insulin is given SubQ.
- When dispensing latanoprost ophthalmic solution, which instruction should be provided to ensure proper administration and prevent contamination?
Answer: Avoid touching the dropper tip to the eye or any other surface.
To maintain the sterility of the ophthalmic solution and prevent eye injury, it is essential that the tip of the dropper does not come into contact with the eye, eyelid, fingers, or any other surface. Contamination can lead to eye infections. The drop should be instilled into the lower conjunctival sac, and the patient should close the eye gently afterward.
- A physician chooses the sublingual route for a medication instead of the oral route primarily to:
Answer: Bypass the first-pass metabolism in the liver.
Medications absorbed through the sublingual mucosa enter systemic circulation directly, avoiding the gastrointestinal tract and the portal vein to the liver. This bypasses the 'first-pass effect,' where a drug taken orally is partially metabolized by the liver before it can exert its effect. Bypassing this effect increases the drug's bioavailability and allows for a more rapid onset of action.
- A prescription for ofloxacin otic solution has the sig "4 gtts AD q12h". How should the pharmacy technician instruct the patient to administer the medication?
Answer: Instill four drops into the right ear every 12 hours.
The Latin abbreviation "AD" stands for auris dextra, which translates to "right ear". "AS" (auris sinistra) means left ear, and "AU" (auris uterque) means both ears. Otic preparations are for the ear, while ophthalmic preparations are for the eye.
- A patient is prescribed alendronate (Fosamax). Which administration instruction is critical to prevent esophageal irritation?
Answer: Take the medication with a full glass of plain water and remain upright for at least 30 minutes.
Bisphosphonates, such as alendronate, are known to cause severe esophageal erosion and ulcers. To minimize this risk, patients must take the tablet on an empty stomach with a full glass of plain water (no other liquids) and remain sitting or standing for at least 30 minutes (60 minutes for ibandronate) after administration to ensure it passes quickly into the stomach and does not lodge in the esophagus.
- A patient is prescribed an ophthalmic gel. How does the administration of a gel typically differ from that of an ophthalmic solution (eye drops)?
Answer: The gel may cause temporary blurred vision and is often recommended for use at bedtime.
Ophthalmic gels are more viscous than solutions. This property allows them to remain in contact with the eye surface for a longer period, providing sustained drug delivery. However, this viscosity also causes temporary blurred vision after application. Because of this, patients are often advised to administer ophthalmic gels at bedtime to minimize disruption to their daily activities.
- A prescription for ipratropium/albuterol solution is intended for which route of administration?
Answer: Inhalation via a nebulizer
Ipratropium/albuterol solution for inhalation (brand name DuoNeb) is a liquid medication supplied in vials. It is administered by placing the solution into a nebulizer machine, which converts it into a fine aerosol mist that the patient inhales through a mouthpiece or mask. This delivers the bronchodilators directly to the lungs.
- A pharmacy technician is explaining the use of a spacer device with an albuterol metered-dose inhaler (MDI). What is the primary purpose of using a spacer?
Answer: To improve coordination and increase medication delivery to the lungs.
A spacer is a holding chamber that attaches to an MDI. It slows down the aerosol spray and holds it in the chamber, allowing the user to inhale the medication without needing to perfectly coordinate pressing the canister and breathing in. This improves the amount of drug that reaches the lungs and reduces the amount deposited in the mouth and throat, which can cause side effects like thrush.
- A pharmacy technician receives an order that includes the abbreviation "IVPB". This indicates the medication should be administered via:
Answer: An intermittent intravenous infusion.
IVPB stands for Intravenous Piggyback. This is a method for administering medication intermittently through an existing intravenous line. A smaller bag containing the drug is connected to the primary IV line and infused over a specified period (e.g., 30-120 minutes). This is distinct from a rapid IV push (IVP) or a continuous infusion.
