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 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.

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 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, 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.

▪ 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.

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!