McGraw-Hill Education PTCE Review, 1st Edition (2020)

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Contents
CHAPTER 1 Introduction: Pharmacy Technicians and the PTCE
The Pharmacy Technician
Certified Pharmacy Technician
PTCE Overview
Preparing for the PTCE
CHAPTER 2 Medications
Generic Names, Brand Names, and Classifications of Medications
Top 200 Drug Generic and Brand Names and Drug Class
Dosage Forms and Routes of Administration
Routes of Administration
Cardiovascular System and Drugs
Gastrointestinal System and Drugs
Respiratory System and Drugs
Endocrine System and Drugs
The Nervous System and Drugs
The Urinary System and Drugs
The Immune System and Drugs
The Musculoskeletal System and Drugs
Special Senses and Drugs
Dietary Supplements
Drug Interactions
Therapeutic Equivalence
Narrow Therapeutic Index (NTI)
Drug Stability
Storage of Medications
Incompatibility
Review Questions
Answer Key
CHAPTER 3 Federal Requirements
Controlled Substances

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Restricted Drug Programs
FDA Recalls
Hazardous Drugs
Review Questions
Answer Key
CHAPTER 4 Patient Safety and Quality Assurance
ISMP Safe Medication Practices
Error Prevention Strategies
Medication Error Reporting
Pharmacist Intervention
Quality Control
Review Questions
Answer Key
CHAPTER 5 Order Entry and Processing
Pharmacy Calculations
Nonsterile Compounding Processes
Equipment and Supplies for Drug Administration
Lot Numbers, Expiration Dates, and National Drug Code (NDC) Numbers
Procedures for Identifying and Returning Medications and Supplies
Review Questions
Answers
Practice Test 1
Practice Test 1 Answer Key
Practice Test 2
Practice Test 2 Answer Key
Practice Test 3
Practice Test 3 Answer Key
Practice Test 4
Practice Test 4 Answer Key

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CHAPTER 1
Introduction: Pharmacy Technicians and
the PTCE
Congratulations on choosing to become a pharmacy technician! This book
will help you prepare for the Pharmacy Technician Certification Exam
(PTCE). Each chapter is broken down into corresponding domains from the
certification exam. Before we get started on test content, let’s take a minute
to review the pharmacy technician role and potential job opportunities. We’ll
also review the PTCE itself to make sure you are prepared for the structure
and requirements of this exam.
After reading Chapter 1, you will be able to:
▪ Explain the role of the pharmacy technician and importance to the
healthcare team
▪ Identify different career paths for pharmacy technicians
▪ Understand the requirements and preparation needed to become a
certified pharmacy technician
▪ Describe the content of the PTCE and requirements for continuing
education
▪ Recognize strategies for exam preparation
The Pharmacy Technician
A pharmacy technician is an integral part of the healthcare team and helps
serve patients by supporting the pharmacist through the completion of a

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variety of important tasks. The role of the pharmacy technician is dependent
upon practice setting, but typically includes filling prescriptions or
medication orders; working with insurance companies to troubleshoot or gain
approval of coverage; compounding IVs, chemotherapy, or nonsterile
products; and being an active customer service agent of the pharmacy.
Pharmacy technicians working in the community setting are based in a
retail pharmacy. The pharmacy may be part of a large chain or smaller
independent store. In the community setting, pharmacy technicians may input
and fill prescriptions. They may investigate insurance rejections; work on
inventory, including over-the-counter (OTC) drugs; or wait on customers and
ring out verified prescriptions.
Institutional pharmacy technicians practice in hospitals or long-term care
facilities. Hospital pharmacy technicians may compound IVs, repack unit
dose medications, fill and maintain automated dispensing cabinets, and stock
crash carts. Hospital technicians may interact with patients less than
community pharmacy technicians, but instead may interact more with nursing
staff and other healthcare providers. Pharmacy technicians may also
compound chemotherapy in hospitals or in a designated cancer center. Long-
term-care pharmacy technicians may also compound IVs and repack unit
dose medications in larger packages for nursing home patients. They may
also fill orders for facilities or be part of the customer service team who helps
answer nursing questions or direct orders to each facility.
Other places pharmacy technicians may work is in a nuclear,
compounding, or specialty pharmacy. Nuclear pharmacy technicians
compound radiopharmaceuticals to be used for diagnostic testing or cancer
treatment. Compounding technicians compound both sterile and nonsterile
preparations for patient-specific use. These technicians often require
additional training for compounding technique and calculations. Specialty
pharmacy is a growing area involving the dispensing of high-dollar drugs
used to treat complex disease states, such as multiple sclerosis. Pharmacy
technicians working in specialty pharmacy will review prescriptions and
work with insurance providers on authorization for patient coverage.
Mail-order pharmacies are an additional place for pharmacy technicians to
work. In this setting, pharmacy technicians may package large amounts of
medication to be shipped using packaging machines. Technicians may also
review prescriptions, assess insurance coverage, and work on authorizations
to have medications filled.

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Pharmacy technicians and pharmacists are in high demand in many
settings, and because of this, the role of the technician is expanding to allow
more time for the pharmacist to provide patient-centered care. Pharmacy
technicians may take medication histories for patients upon admission to a
hospital and reconcile home medication lists with what is currently
prescribed. This process is known as medication reconciliation (med rec), and
med rec techs are becoming more popular with the increase in patient safety
this role can provide. Additionally, community pharmacy technicians are
becoming more active in medication therapy management (MTM). MTM is a
service that pharmacists provide to patients where medications that are
currently prescribed are reviewed to ensure the best outcome is achieved
from the treatment. Technicians can assist with this process by monitoring
MTM databases, examining patients’ adherence to medications, and notifying
pharmacists of potential compliance issues. Because of this expansion of
responsibilities, it is essential that pharmacy technicians have sufficient
training and certification.
Certified Pharmacy Technician
The state in which you will practice will determine requirements for
certification, registration, or licensure. Certification is the completion or
passing of a designated standard, such as an exam, from an established
nongovernmental organization. Pharmacy Technician Certification is offered
through the Pharmacy Technician Certification Board (PTCB) and the
National Healthcareer Association (NHA). The PTCB uses the Pharmacy
Technician Certification Exam (PTCE) for certification, and the NHA uses
the Exam for the Certification of Pharmacy Technicians (ExCPT).
Registration is registering with an organization, such as with a board of
pharmacy, who may require pharmacy technicians to register annually.
Licensure is the regulation of a profession by a governmental body. Some
states may require pharmacy technicians to register or be licensed to practice.
You should check your state requirements when preparing to become
certified as a pharmacy technician.
PTCE Overview
The PTCE is divided into four knowledge domains, with specific content

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areas within each domain. Following are the four domains and the percentage
of the PTCE dedicated to each domain.
The Medications domain comprises the largest portion of the exam at 40
percent of content and also contains the most knowledge areas. The
breakdown of the Medications content of the PTCE follows.
▪ Generic names, brand names, and classifications of medications
▪ Therapeutic equivalence
▪ Common and life-threatening drug interactions and contraindications
(e.g., drug–disease, drug–drug, drug–dietary supplement, drug–
laboratory, drug–nutrient)
▪ Strengths/dose, dosage forms, routes of administration, special handling
and administration instructions, and duration of drug therapy
▪ Common and severe medication side effects, adverse effects, and
allergies
▪ Indications of medications and dietary supplements
▪ Drug stability (e.g., oral suspensions, insulin, reconstitutables,
injectables, vaccinations)
▪ Narrow therapeutic index (NTI) medications
▪ Physical and chemical incompatibilities related to nonsterile
compounding and reconstitution
▪ Proper storage of medications (e.g., temperature ranges, light sensitivity,
restricted access)
The Federal Requirements domain consists of laws, standards, and
regulations related to pharmacy practice, including controlled substances. The
five areas within this domain follow.
▪ Federal requirements for handling and disposal of nonhazardous,

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hazardous, and pharmaceutical substances and waste
▪ Federal requirements for controlled substance prescriptions (i.e., new,
refill, transfer) and Drug Enforcement Administration (DEA) controlled
substance schedules.
▪ Federal requirements (e.g., DEA, Federal Drug Administration [FDA])
for controlled substances (i.e., receiving, storing, ordering, labeling,
dispensing, reverse distribution, take-back programs, and loss or theft of)
▪ Federal requirements for restricted drug programs and related medication
processing (e.g., pseudoephedrine, risk evaluation and mitigation
strategies [REMS])
▪ FDA recall requirements (e.g., medications, devices, supplies,
supplements, classifications)
The Patient Safety and Quality Assurance domain consists of content areas
concerning patient safety and error prevention strategies and reporting
methods. The areas for this domain follow.
▪ High-alert/risk medications and look-alike/sound-alike (LASA)
medications
▪ Error prevention strategies (e.g., prescription or medication order to
correct patient, Tall Man lettering, separating inventory, leading and
trailing zeros, bar code usage, limit use of error-prone abbreviations)
▪ Issues that require pharmacist intervention (e.g., drug utilization review
[DUR], adverse drug event [ADE], OTC recommendation, therapeutic
substitution, misuse, adherence, post-immunization follow-up, allergies,
drug interactions)
▪ Event reporting procedures (e.g., medication errors, adverse effects, and
product integrity, MedWatch, near miss, root-cause analysis [RCA])
▪ Types of prescription errors (e.g., abnormal doses, early refill, incorrect
quantity, incorrect patient, incorrect drug)
▪ Hygiene and cleaning standards (e.g., handwashing, personal protective
equipment [PPE], cleaning counting trays, countertop, and equipment)
The Order Entry and Processing domain consists of areas related to
prescription processing, including calculations, equipment for drug
administration, and lot numbers and expiration dates. The areas for this
domain follow.

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▪ Procedures to compound nonsterile products (e.g., ointments, mixtures,
liquids, emulsions, suppositories, enemas)
▪ Formulas, calculations, ratios, proportions, alligations, conversions, sig
codes (e.g., b.i.d.k, t.i.d., Roman numerals), abbreviations, medical
terminology, and symbols for days supply, quantity, dose, concentration,
dilutions
▪ Equipment/supplies required for drug administration (e.g., package size,
unit dose, diabetic supplies, spacers, oral and injectable syringes)
▪ Lot numbers, expiration dates, and National Drug Code (NDC) numbers
▪ Procedures for identifying and returning dispensable, nondispensable,
and expired medications and supplies (e.g., credit return, return to stock,
reverse distribution)
Preparing for the PTCE
The Pharmacy Technician Certification Exam (PTCE) is a computer-based
exam consisting of 90 total questions, of which 80 are scored and 10 are
unscored. The exam is multiple choice, and each question has four possible
choices with one correct answer. You have two hours total to take the exam,
with 10 minutes being dedicated to a pre-exam tutorial and post-exam survey.
The cost to take the PTCE is $129. After passing the exam, you would earn
the Certified Pharmacy Technician (CPhT) credential. To be eligible for the
PTCE requires completion of one of two pathways. One pathway is
completion of a PTCB-approved education or training program. The second
pathway is equivalent work experience (minimum of 500 hours) as a
pharmacy technician. You must also disclose any criminal and state board of
pharmacy registration or licensure actions, and be compliant with all PTCB
certification policies. If you have met these criteria, you can apply to take the
exam by creating an account with the PTCB. Once approved, you can
schedule your exam.
Exams are taken at designated testing centers year-round. To prepare for
the PTCE, you can use this book you’re currently reading, and also check out
some of the PTCB online content for practice. After completion of the exam,
you will know if you passed immediately on the screen, though you will not
get your official score report until two to three weeks later. You will be able
to download your certificate through the PTCB website.

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As a CPhT, you will have specified requirements to maintain your
credentials. You must complete a minimum of 20 hours of continuing
education (CE) every two years. These 20 hours must include 1 hour in
pharmacy law and 1 hour in patient safety. The PTCB also requires that the
CE earned must be pharmacy-technician-specific, which can be earned
through CE with a designation of “T”.
So now you know what pharmacy technicians do and where they work.
You know how to apply to become certified and what is required for
certification. This book will help you prepare for the exam by breaking down
the contents of each domain throughout the next four chapters. You will be
able to study the material and then test your skills through practice questions
and exams.
Let’s get started in preparing for the PTCE!

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CHAPTER 2
Medications
PTCE Knowledge Domain: Medications
40% of Exam
Knowledge Areas:
▪ Generic names, brand names, and classifications of medications
▪ Therapeutic equivalence
▪ Common and life-threatening drug interactions and contraindications
(e.g., drug–disease, drug–drug, drug–dietary supplement, drug–
laboratory, drug–nutrient)
▪ Strengths/dose, dosage forms, routes of administration, special handling
and administration instructions, and duration of drug therapy
▪ Common and severe medication side effects, adverse effects, and
allergies
▪ Indications of medications and dietary supplements
▪ Drug stability (e.g., oral suspensions, insulin, reconstitutables,
injectables, vaccinations)
▪ Narrow therapeutic index (NTI) medications
▪ Physical and chemical incompatibilities related to nonsterile
compounding and reconstitution
▪ Proper storage of medications (e.g., temperature ranges, light sensitivity,
restricted access)

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After reading Chapter 2 you will be able to:
▪ Recognize pharmacology principles, including absorption, distribution,
metabolism, and elimination
▪ Identify the brand and generic names and drug class for the top 200
drugs
▪ Understand drug interactions and the impact on patient safety
▪ Describe dosage forms and routes of administration, and drug stability
▪ Recognize medication that have a narrow therapeutic index (NTI)
▪ Understand the proper storage of medications, including temperature
ranges, light-sensitivity requirements, and restricted access
In this chapter, we review the brand and generic names and drug
classifications of the top 200 prescribed medications. We also review side
effects and indications of these drugs. This chapter also reviews drug
interactions and stability as well as dosage forms and routes of
administration. It is important to start with some basic pharmacology
principles. This will help you understand drug interactions, side effects, and
stability of medications later on in the chapter.
Pharmacology is the study of the effect of and mechanism of action of
drugs. There are two divisions of pharmacology, known as
pharmacokinetics and pharmacodynamics. Pharmacokinetics is the study
of movement of drugs, or specifically, the absorption, distribution,
metabolism, and elimination or excretion processes. Absorption, distribution,
metabolism, and elimination/excretion are collectively known as ADME.
Pharmacodynamics is study of the effect a drug has on the body.
Let’s review the ADME processes more in depth:

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Absorption and distribution are the ways into the body, whereas
metabolism and elimination are the ways out. Recognizing the ADME
properties will help you understand drug action, such as why a medication
administered intravenously works more quickly than a drug taken by mouth
—the faster the drug can enter the bloodstream (absorption) and be
distributed, the quicker the onset of action. It will also help you understand
drug interactions and how impacting metabolism can lead to adverse effects
and toxicity.
Generic Names, Brand Names, and Classifications of
Medications
After a drug is approved by the FDA, it possesses three naming conventions:
chemical, generic, and brand names.
The chemical name is determined while the drug is being designed and
investigated. The drug is then assigned a generic name by USAN by
following a naming convention that identifies the active ingredient in the
drug. This naming convention specifies the drug class. A drug class is a
group of drugs that are similar in action or treat the same disease. For
example, ACE inhibitors used to treat blood pressure all end in -pril
(lisinopril, quinapril, enalapril).
The following are a few examples of drug classes identified through the
drug stem named by USAN. As we review the top 200 drugs, these are
identified with each class.

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After the generic name is selected, the drug company can give the drug a
brand or trade name. The brand name does not need to follow a naming
convention and is often designed to be appealing to patients or help them
remember what the drug is treating. For example, the brand name Lipitor is
used to treat high cholesterol or “lipids” in the body. This can help both
prescribers and patients remember names.
Once a brand name is developed, it is protected by a patent for a specific
period of time. The purpose in a drug patent is to allow the drug company to
sell the drug without a generic competitor. This helps the drug company
recover some of the costs of drug development. After a patent has expired,
other manufacturers are permitted to develop a generic version of the brand
name drug. The FDA must also approve generic drugs, but it is through an
accelerated process and takes less time and resources to complete, which
allows generic drugs to be sold at a cheaper price. Generic drugs must have
the same active ingredient and meet the same standards for quality and safety
as the brand name drug. Generic drugs are permitted to have different
inactive ingredients, and for patients who are sensitive to dyes and fillers, this
may result in different side effects of generic medications versus the brand
name.
Top 200 Drug Generic and Brand Names and Drug Class

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Learning the top 200 most frequently prescribed drugs is an important
component of the PTCE and also for becoming a successful pharmacy
technician. You’ll find the following table to be helpful for learning and
remembering generic and brand names, as well as the drug class for each of
the most commonly prescribed drugs. Remember that the top 200 drugs is
subject to change each year with the changes in prescribing and new drug
development, but this will make you knowledgeable about the 200 most
frequently prescribed drugs.

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Dosage Forms and Routes of Administration
Dosage forms are broken down into solid, liquid, and semisolid forms. Solid
dosage forms include tablets and capsules. Both are convenient methods of
administration and storage for patients. However, the onset of action can be
delayed when taking oral tablets due to the first pass through the stomach.
When medications are taken orally, absorption does not occur until the small
intestine. To help speed up the absorption time, tablets have been modified
into different forms, listed as follows.
Capsules are also frequently used for oral administration. They are made
of a gelatin shell that makes it easier to swallow. Inside of the shell is the
drug or active ingredient. You can open the capsule, and some can be
sprinkled onto food or dissolved in a liquid.
There are also dosage forms that are not designed to release the drug
immediately. These dosage forms can sometimes decrease the amount of
doses needed in one day. You will often see these abbreviated after the

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