Chapter 02: Pharmacy Procedures and Dosage Calculations
Bill: Clinical Pharmacology and Therapeutics for Veterinary Technicians, 4th Edition

MULTIPLE CHOICE

	1.	Controlled substances are drugs that
a.	have a small margin of safety.	
b.	cannot be prescribed.	
c.	have a potential for human abuse.	
d.	are not used in veterinary medicine because they are dangerous.	

ANS:	C
Controlled Substances are drugs like narcotics, strong sedatives, analgesics, or hallucinogenic drugs that have the potential for abuse. In the United States the veterinarian cannot legally prescribe any Controlled Substances without being registered with the DEA.

DIF:	1|Cognitive Level: Remembering	REF:	p. 22

	2.	The DEA requires that all records of controlled substance inventory and use be maintained and readily available for inspection for a minimum of:
a.	the drugs expiration date.	
b.	6 month past the drugs expiration date.	
c.	1 year.	
d.	2 years.	

ANS:	D
The DEA requires that all records of the Controlled Substance inventory and their use be maintained and readily available for inspection for a minimum of 2 years.

DIF:	1|Cognitive Level: Remembering	REF:	p. 23

	3.	In the medical record indication of  mL of a drug was given subQ can be denoted
a.	.5 mL subQ	
b.	0.5 mL subQ	
c.	.5 mL SC	
d.	0.5 mL sub	

ANS:	B
Always put a zero in front of any decimal number less than zero (e.g., use 0.5 mL, not .5 mL). If the decimal point is overlooked, the number could be interpreted to be much higher (e.g., thought to be 5 mL instead of .5 mL).

DIF:	2|Cognitive Level: Interpretation	REF:	p. 27

	4.	A 2 % solution contains
a.	.2 mg/mL.	
b.	2 mg/mL.	
c.	20 mg/mL.	
d.	200 mg/mL.	

ANS:	C
A percentage solution is most commonly used in liquid dosage forms as the number of grams of drug (not mg) per 100 mL of liquid. This percentage solution is referred to as a “weight by volume” percentage solution because it is a weight (grams) of drug in a volume (100 mL) of medium.

DIF:	2|Cognitive Level: Interpretation	REF:	p. 33

	5.	Compounding laws were put in place by the FFDCA to
a.	ensure pharmacies could make their drug.	
b.	to protect animal against extra-label drug use.	
c.	to prevent drug residues from entering food products.	
d.	to protect patients.	

ANS:	C
Compounding laws were designed primarily to protect the public by preventing drug residues in meat and food products like eggs and milk, and hence the laws have a greater impact on the practice of food animal medicine than on small animal medicine.

DIF:	1|Cognitive Level: Remembering	REF:	p. 38

	6.	Drugs that must be reconstituted before use
a.	often contain preservatives to prevent bacterial growth.	
b.	are chemically very stable once reconstituted.	
c.	can be stored indefinitely once reconstituted.	
d.	are easily contaminated by repeated insertion of needles into the vial.	

ANS:	D
Drugs that must be reconstituted before use (for example, a powder in a vial to which a liquid is added) often do not contain preservative agents to prevent bacterial growth should the container become contaminated after reconstitution. Repeated insertion of needles increases the risk for contaminating vials. Reconstituted products may be chemically unstable once reconstituted and have a very short period of time in which they can be used.

DIF:	1|Cognitive Level: Remembering	REF:	p. 40

	7.	Cytotoxic drugs
a.	include chemotherapeutic drugs.	
b.	must be handled with extreme care.	
c.	should be stored away from other drugs to prevent mistakes.	
d.	All of the above	

ANS:	D
The concern for safe handling and storage becomes even more important when cytotoxic drugs are being used. Cytotoxic (“cell poison”) drugs can be especially poisonous to mammalian cells and include antineoplastic agents used to treat cancer, and some antimycotic agents used to treat fungal infections.

DIF:	1|Cognitive Level: Remembering	REF:	p. 40

	8.	All of the following are requirements on prescriptions except one. Which item is not required to be included on every prescription?
a.	Date the prescription was written	
b.	Name of the drug	
c.	The label “C” with a roman numeral indicating the DEA schedule level	
d.	Signature or equivalent of the prescribing veterinarian	
e.	The symbol “Rx”	

ANS:	C
The DEA schedule designation is only required to be present for those drugs that are considered controlled substances. All other prescription drugs can lack that label.

DIF:	2|Cognitive Level: Interpretation	REF:	p. 22

	9.	The United States Drug Enforcement Administration classifies drugs that carry the potential to cause human dependence on a scale from 1 to 5, denoted by roman numerals I to V. Regarding their ability to be abused, category ____ is considered the least likely, while category ____ is the most likely.
a.	I, V	
b.	V, I	
c.	I, II	
d.	III, I	
e.	IV, II	

ANS:	B
The DEA considers category I drugs to have the highest likelihood of causing dependence and being abused. As the category number gets larger, up to the maximum of 5 (V), the likelihood for abuse decreases. All controlled substances that are used require the oversight of a DEA licensed veterinarian.

DIF:	1|Cognitive Level: Remembering	REF:	p. 23

	10.	Why are DEA schedule I drugs not encountered in veterinary therapy regimens?
a.	They are too valuable to use.	
b.	They are too expensive for most veterinary applications.	
c.	They aren’t considered therapeutically useful.	
d.	They are too potent.	
e.	The DEA doesn’t want to risk resistance developing.	

ANS:	C
Category I drugs are not legally used in the United States as therapeutics, since they are not considered to be medicinally useful. This category contains many of the illegal recreational drugs such as heroin, LSD, and other hallucinogenic or abuse drugs that do not have any clear medical use.

DIF:	1|Cognitive Level: Remembering	REF:	p. 23

	11.	A drug _______ is the amount of medication given to a certain patient at one instance, while a drug _________ is an amount of medication per a unit of body size.
a.	dose, dosage	
b.	dosage, dose	
c.	concentration, dose	
d.	regimen, concentration	

ANS:	A
This is the definition of dose and dosage. A dosage is the amount of drug administered per unit of body weight, so that every treated animal would have the same amount of drug per pound or kilogram of body mass.

DIF:	1|Cognitive Level: Remembering	REF:	p. 23

	12.	What is the main problem with writing SID on a prescription that is filled at a local human pharmacy?
a.	SID means 6 times a day, which is not reasonable	
b.	Human medications are never given just once a day	
c.	Pharmacists may not understand what SID means	
d.	There is nothing wrong with writing SID on a human script	

ANS:	C
Pharmacists in human medicine don’t use the SID moniker to denote a dose frequency of once a day. They instead us “qd” to stand for this frequency, so this should replace SID when writing a script for such a situation.

DIF:	1|Cognitive Level: Remembering	REF:	p. 26

	13.	There are two pieces of information that are required to perform a proper dose-calculation. In addition to the size of the animal, what component must be available to calculate the correct dose of medication to a patient?
a.	The gender of the patient	
b.	The breed of animal you are treating	
c.	The trade name of the medication	
d.	Potential side effects for the drug	
e.	The amount of drug to give per unit of mass	

ANS:	E
The dosage is the amount of drug needed per unit (usually pounds or kilograms) of patient mass. Combined with the mass of the patient, a technician can calculate the amount of drug they need to deliver to the animal. Depending on the form and concentration of the medication, the calculation can be extended to determine how much (mass or volume) is needed for treatment.

DIF:	1|Cognitive Level: Remembering	REF:	p. 29

	14.	What is unique about calculating doses for drugs such as chemotherapeutics?
a.	They are extremely large doses	
b.	They are often calculated by patient surface area and not mass	
c.	They are not calculated, but are instead standard doses	
d.	The therapeutic dose is always much less than the toxic dose	

ANS:	B
Toxic medications are often dosed based on m2 of body surface area to account for the individual variation that exists between dogs that are heavier or lighter than the average member of the species or breed. These drugs are quite dangerous, and thus have a very narrow therapeutic index. Every attempt is made to not overdose an animal because of calculations based on weight.

DIF:	1|Cognitive Level: Remembering	REF:	p. 31

	15.	If you need to prepare a 15 mL volume of a 2.3% solution of Drug A, how much of the Drug A powder would you add to the diluent to produce the desired solution?
a.	2.3 mg	
b.	2.3 g	
c.	345 mg	
d.	34.5 mg	
e.	3.45 mg	

ANS:	C
A conversion factor is required to make comparisons from mass to volume and vice versa when calculating weight by volume (w/v) percentage solutions. One milliliter of water weighs 1 gram, so the 1 mL = 1 g conversion factor is helpful for making such comparisons. Since 1 g (or 1000 mg) = 1 mL, 1000 mg of a solute in a total of 1 mL of solution would be a 100% solution. Therefore a 2.3% solution is equivalent to 23 mg per 1 mL. In 15 mL, the amount would be 23 mg/mL ´ 15 mL, or 345 mg.

DIF:	3|Cognitive Level: Problem Solving	REF:	p. 36

	16.	Mixing several medications together in one syringe to deliver premedication for an animal about to be induced for surgery is considered ___________.
a.	formulating	
b.	dosing	
c.	100% prohibited	
d.	compounding	

ANS:	D
Any manipulation of a medication, including changing the form of the drug, mixing multiple drugs in a single syringe, and including additives to a drug to increase its palatability is considered drug “compounding” and must be performed under a specific set of guidelines to be legally performed.

DIF:	1|Cognitive Level: Remembering	REF:	p. 39

	17.	In an effort to save money, a clinic purchased 5 L jugs of vitamin B complex and proceeded to fill 500 mL bottles and place them for sale. No additional compounds were added to the vitamin, the bottles were purchased from a medical supply company, and the medication was filled under aseptic conditions using a laminar flow hood. Is this activity considered compounding?
a.	Yes	
b.	No	
c.	Maybe	
d.	Not enough information	

ANS:	A
Any time a drug is split into smaller volumes, regardless of the reason, the activity is considered compounding. Medications may be compounded only if they are used on a specific patient. This is not the case when repackaging is down to save money on bulk medications, so this type of compounding is not acceptable.

DIF:	2|Cognitive Level: Interpretation	REF:	p. 39

	18.	Upon opening a shipment of vaccines, the technician notices the boxes state “Keep Cool” on their labels. Since the technician knows how sensitive vaccines can be to heat, she places them promptly in the freezer. In what temperature should the vaccines have been placed?
a.	Less than 8° C	
b.	Greater than 8° C but lower than 15° C	
c.	Greater than 15° C but lower than 30° C	
d.	Greater than 40° C	

ANS:	B
“Cool” is designated for temperatures between 8° C and 15° C. This product is likely damaged by freezing, so although the technician correctly noted that the vaccines need to stay colder than room temperature, they should not have been placed in an environment so cold that freezing would occur.

DIF:	2|Cognitive Level: Interpretation	REF:	p. 40

	19.	Why are certain drugs packaged in amber colored glass containers?
a.	The drugs are light sensitive	
b.	These bottle are cheaper than clear bottles	
c.	The drugs are unpleasant to look at	
d.	Amber bottles contain preservatives to help the drug’s shelf life	
e.	Clear bottles aren’t available	

ANS:	A
Certain compounds, such as many vitamins and antimicrobials, are deteriorated when exposed to long periods of light. In an effort to block light penetration, these medications are packaged in amber colored bottles.

DIF:	1|Cognitive Level: Remembering	REF:	p. 40

	20.	What does MSDS stand for?
a.	Memorandum of Safety and Disease Statistics	
b.	Material Safety Data Sheet	
c.	Microbial Sanitation and Disinfection Standards	
d.	Minimum Standard Dose Solubility	

ANS:	B
An MSDS functions to provide all of the guidelines required when working with a potentially hazardous material. Proper use, precautions, and disposal methods are explained on each chemical’s MSDS, and they should be readily available for review in the clinic.

DIF:	1|Cognitive Level: Remembering	REF:	p. 41

	21.	Which of the following are violations of proper handling of hazardous chemicals?
a.	Crushing a cytotoxic tablet while wearing a respirator and using a fume hood	
b.	Donning double layers of latex gloves prior to opening the drug vial	
c.	Keeping all food and drink away from the area of drug reconstitution	
d.	Wearing a dedicated, clean cotton lab coat while handling cytotoxic agents	

ANS:	D
Impervious lab gowns or coats should be worn while handling hazardous chemicals. Traditional lab attire or street clothes don’t prevent spills from absorbing and providing contact with underlying skin.

DIF:	2|Cognitive Level: Interpretation	REF:	p. 41

	22.	What type of syringes should be used when administering hazardous medications?
a.	Slip tip	
b.	Catheter tip	
c.	Luer lock	
d.	Automatic	

ANS:	C
Screw lock syringes and attachments are less likely to leak or detach while handling the drug, thereby decreasing the risk to the administrator or patient.

DIF:	1|Cognitive Level: Remembering	REF:	p. 42

	23.	A veterinarian decided to prepare a compounded drug as described below. Which activity associated with this specific scenario would deem this practice not allowable based on the FFDCA, the ELDU regulations and the AMDUCA?
a.	The mixture contained a generic supplement	
b.	A licensed veterinarian prepares the mixture	
c.	A conservative withdrawal time is provided on the drug label	
d.	The mixture does not consist of any drug prohibited by the FDA	

ANS:	A
Only medications that have FDA approval for use in human or veterinary therapies are allowed to be compounded. Supplements are not regulated or approved by the FDA to treat diseases, and so they cannot be contained in a compounded formulation.

DIF:	2|Cognitive Level: Interpretation	REF:	p. 38

	24.	Suppose a technician calculates that a patient needs a 2.35 mg oral dose of a medication. This drug, which has a wide therapeutic index, is only available in 2.5 mg tablets. How should this medication be dosed?
a.	Crush the tablet and weigh exactly 2.35 mg.	
b.	Cut the tablet into tenths and measure out the appropriate dose.	
c.	Cut the tablet into fourths and administer 3 pieces.	
d.	Round down the dose to 1.25 mg and give a  tablet.	
e.	Give a whole 2.5 mg tablet.	

ANS:	E
Tablets should only be administered whole or split-in-half whenever possible to ensure accurate dosing. Because of the wide range of safety for this drug, slight overdosing by rounding up to the nearest whole tablet is acceptable.

DIF:	2|Cognitive Level: Interpretation	REF:	p. 33

	25.	Several units of drug measurement are from a time prior to the modern era of pharmacology. These terms include “grain” and “minims.” The measurement system to which these units belong is the _______________ system.
a.	metric	
b.	household	
c.	apothecary	
d.	pharmacopeia	
e.	modernist	

ANS:	C
Older apothecarial terms were used well before the current language of pharmacology was developed. Although not used often, several drugs such as the barbiturates and some anti-inflammatories still are represented by these units.

DIF:	2|Cognitive Level: Interpretation	REF:	p. 28