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Chapter 17 (Compounding III: Documentation & Preparation)

front 1

Which test confirms the integrity of a filter that will be used for terminal sterilization?

back 1

Bubble-point test

front 2

The Continental (dry gum) and the English (wet gum) are methods of preparing which type of dosage form?

back 2

Emulsions

front 3

The multi-dose vial of Herceptin will be used to prepare doses for multiple patients. What is the risk level of the Herceptin admixtures?

back 3

Medium-risk

Using a multi-dose vial to prepare multiple doses is considered medium-risk. To prepare multiple doses, the compounder will need to enter the same vial multiple times, increasing the risk of contamination.

front 4

Which of the following is a correct statement about withdrawing Herceptin from a vial when a closed-system transfer device (CSTD) is not available?

back 4

Air should not be injected into the Herceptin vial before drug removal

front 5

Compounding Method

  1. Grind lidocaine, benzocaine and tetracaine powders.
  2. Add polysorbate 80 to dissolve butylhydroxytoluene.
  3. Incorporate the powders into the mixture and mix well.
  4. Prepare PLO gel by triturating organic and aqueous phases.
  5. Add PLO gel to the mixture and mix well.
  6. Package and label

What technique should be used in step 3 of the instructions?

back 5

Geometric dilution

front 6

Which of the following drugs do NOT have a CSP risk level assigned by USP? (Select ALL that apply.)

back 6

Fluconazole in dextrose 400 mg/200 mL premixed bag

Meropenem in NS 500 mg/50 mL ready-to-use drug delivery system

front 7

Rank the following steps used to compound molded tablets in the correct order. (Left-click to drag and order the answer options; the first step must be placed in the top box. ALL options must be used.)

back 7

  1. Measure and weigh all ingredients
  2. Triturate the dry ingredients
  3. Mix the ingredients using geometric dilution
  4. Add alcohol and/or water moisten the powder mixture
  5. Compress the moist powder mixture into a tablet mold and allow to dry

front 8

Place the following steps for making an ointment in the correct order. (Left-click to drag and order the answer options; the first step must be placed in the top box. ALL options must be used.)

back 8

  1. Measure and weigh all ingredients
  2. Levigate the activate pharmaceutical ingredient on ointment slab
  3. Gradually add in the ointment base using geometric dilution
  4. Place the mixture in a plastic ointment jar
  5. Affix the prescription and the auxiliary label to the container

front 9

The pharmacy receives a prescription for 100 grams of 5% hydrocortisone ointment. The pharmacy has a 10% hydrocortisone ointment and a 2.5% hydrocortisone ointment available. Using only these products, how many grams of the 10% ointment should be used to compound this prescription? (Answer must be numeric; no units or commas; round the final answer to the nearest ONE DECIMAL PLACE.)

back 9

33.3

front 10

A technician is preparing the label for a calamine-zinc oxide ointment he has prepared.
Following is a list of ingredients with individual expiration dates:
Calamine powder, exp. 4/2022
Zinc oxide powder, exp. 7/2022
Aquaphor (non-aqueous ointment base), exp. 8/2022
Mineral oil, exp. 1/2023

If today's date is January 31, 2022, what is an appropriate BUD for this compounded product?

back 10

April 30, 2022

The BUD for non-sterile, non-aqueous formulations is up to 6 months from the date of preparation. Calamine expires 4/2022, which is sooner than 6 months; therefore, the BUD is April 30, 2022.

front 11

Which statement is correct regarding the use of intravenous (IV) medications in the hospital setting?

back 11

The pH of IV solutions should be close to neutral (pH of 7)

front 12

The pharmacy technician would like to prepare an emulsion using the Continental gum method (also known as the dry gum method). Place the steps that the technician will need to take in the correct order. (Left-click to drag and order the answer options; the first step must be placed in the top box. ALL options must be used.)

back 12

1. Levigate the gum with oil
2. Add water all at once
3. Triturate until cracking sound is heard and the mixture looks creamy white
4. Add other ingredients and water to sufficient to make the final volume
5. Homogenize the emulsion

front 13

Due to a nationwide shortage of sodium bicarbonate injection, a pharmacist is looking at the possibility of using non-sterile sodium bicarbonate powder to compound sterile intravenous sodium bicarbonate. What beyond-use date should be on the label if the final preparation will be stored at room temperature?

back 13

24 hours

High-risk sterile compounding uses non-sterile ingredients or equipment. The beyond-use date for a high-risk CSP stored at room temperature is 24 hours.

front 14

Which of the following can be used for sterility testing of high-risk compounded sterile products (CSPs)? (Select ALL that apply.)

back 14

Tryptic soy broth

Fluid thioglycollate medium

Bacterial endotoxin test

front 15

The technician has finished compounding a doxycycline IV admixture. Which of the following must be included on the label? (Select ALL that apply.)

back 15

Name and concentration of ingredients

Route of administration

Storage information

Appropriate auxiliary labels

front 16

The pharmacist is preparing intravenous conventional amphotericin B for a patient with AIDS with invasive aspergillosis. What diluent should be used to reconstitute the drug?

back 16

Sterile water for injection

front 17

All of the following must be documented in the compounding record EXCEPT:

back 17

When the compounding area was last cleaned

front 18

A pharmacy technician is compounding cefazolin 2 g in 50 mL of D5W for intravenous infusion. How should the pharmacist verify that the correct volume of ingredients was used in the preparation?

back 18

Direct visualization of the syringe before compounding

front 19

The density factor is needed to prepare which formulation type?

back 19

Suppository

front 20

A compounding pharmacist receives a prescription for thirty 60 mcg levothyroxine (T4) capsules. How many 150 mcg tablets will he need to compound this prescription? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)

back 20

12

30 x 60 mcg caps = 1800 mcg needed

1800 mcg / 150 mcg per cap = 12 capsules needed

front 21

The pharmacy receives a prescription for 50 grams of 5% salicylic acid ointment. The pharmacy has a 30% salicylic acid ointment and petrolatum available. Using only these products, how many grams of petrolatum should be used to compound the prescription? (Answer must be numeric; no units or commas; round the final answer to the nearest ONE DECIMAL PLACE.)

back 21

41.7

(50 g)(5%) = (x)(30%)x = 8.3 g
50 g - 8.3 g = 41.7 g

front 22

Which document provides directions on how to make a calamine-zinc oxide ointment?

back 22

Master formula

front 23

Stability: A beyond-use date of 56 days can be used for this preparation only when it is stored in a refrigerator. The reported stability study used the injection as the source of the drug

Today's date is January 31st.

What is an appropriate BUD for this compounded preparation if it is stored in the refrigerator?

back 23

March 28th

front 24

Put the required steps to complete preparation item #2 and #3 in the correct order? (Left-click to drag and order the answer options; the first step must be placed in the top box. ALL options must be used.)

back 24

1. Inject 50 ml of air into the vial of 0.9% sodium chloride
2. Withdraw 50 ml of liquid from the vial of 0.9% sodium chloride
3. Inject 50 ml of 0.9% sodium chloride into the vial of cyclophosphamide
4. Withdraw 50 ml of reconstituted cyclophosphamide solution from the vial
5. Add 50 ml of reconstituted cyclophosphamide solution to the graduated cylinder

front 25

A pharmacist has received an order to compound 200 mg progesterone suppositories. She will use a white, amorphous low density progesterone powder that aerosolizes easily.

The master formulation record includes the following ingredients:
Theobroma oil
Progesterone powder
Sodium lauryl sulfate

In the formula above, what is the purpose of the sodium lauryl sulfate?

back 25

Surfactant, charge neutralizer

front 26

What is the most commonly used dosage form for manufactured oral medications?

back 26

Compressed tablets

front 27

A pharmacy technician reconstitutes a single-dose vial of cefazolin and transfers it to a 50 mL bag of D5W. The dose is prepared in an ISO 5 horizontal airflow workbench, which is located in an ISO 7 cleanroom with an ISO 8 anteroom. What beyond-use date should be on the label if the cefazolin will be stored in the refrigerator?

back 27

14 days

The BUD date for a low-risk CSP stored in the refrigerator is 14 days.

front 28

A multi-dose vial of ondansetron is being used to prepare doses for multiple patients at the same time. The doses are prepared in an ISO 5 laminar airflow workbench, which is located in an ISO 7 cleanroom with an ISO 8 anteroom. According to USP 797, what BUD should be assigned to these IV admixtures if stored at room temperature?

back 28

30 hours

Batch preparation requires multiple entries into the same vial, which increases the risk of contamination. Batching is considered medium-risk compounding, and the BUD for medium-risk CSPs stored at room temperature is 30 hours.

front 29

A pharmacist needs to prepare a 4% hydrocortisone ointment to treat a rash on a patient’s forearms and to protect the skin from drying.

The master formulation includes these ingredients:
Hydrocortisone powder
Mineral oil
Petrolatum
Dimethicone

The compound is being prepared on January 1st. The earliest expiration date of any ingredients is December 30th of that same year. What is the beyond-use date (BUD) of the hydrocortisone ointment (assuming all are within the same year)?

back 29

July 1st

The BUD of non-sterile, nonaqueous formulations is up to 6 months from the preparation date. If any of the ingredients expire before 6 months, the earlier expiration date should be used.

front 30

Place the following steps for making the hydrocortisone ointment in the correct order. (Left-click to drag and order the answer options; the first step must be placed in the top box. ALL options must be used.)

back 30

1. Weigh the hydrocortisone powder

2. Plave the powder on an ointment slab.

3. Add a small amount of mineral oil to the powder

4. Levigate the powder using an ointment slab and spatula

5. Add petrolatum using geometric dilution

front 31

The pharmacist has prepared 60 g of the 4% hydrocortisone ointment and is concerned that the strength is too strong for the patient’s thin, cracked skin. How much petrolatum should be added to reduce the strength to 2.4%?

back 31

40 g

(60 g)(4%) = (x)(2.4%)x = 100 g

100 g - 60 g = 40 g

front 32

The pharmacist does not have enough petrolatum to use for the above preparation. The pharmacist will prepare 60 grams of the 2.4% by combining the 4% hydrocortisone ointment with a 1.5% hydrocortisone ointment the pharmacy has in stock. How many grams of each ointment will be required?

back 32

21.6 g 4%, 38.4 g 1.5%

front 33

The pharmacist receives the following compound prescription on March 5th.

Spironolactone/Hydrochlorothiazide Suspension
Spironolactone/Hydrochlorothiazide 25 mg/25 mg tablets - quantity 24 tablets
Ora-Plus - quantity 120 mL

The ingredients on the label of the Ora-Plus suspending vehicle are listed as: purified water, microcrystalline cellulose, carboxymethylcellulose sodium, xanthan gum, carrageenan, calcium sulfate, trisodium phosphate, citric acid, sodium phosphate, dimethicone, methylparaben and potassium sorbate.

The pharmacist notes that the Ora-Plus expires on 4/30 of this year and the spironolactone/hydrochlorothiazide tablets expire on 6/30 of this year. Assuming the product is packaged and stored correctly, which beyond use date is correct for this product?

back 33

March 19th

front 34

**case above**

Which auxiliary label must be placed on the final product?

back 34

shake well before using

front 35

Which of the following compounded preparations would have the shortest beyond use date?

back 35

A water-containing oral solution that is stored in the refrigerator

front 36

A pharmacist is compounding an emulsion by first combining acacia (gum) with water to form a mucilage and then slowly adding the oil to form the emulsion. What is this process called?

back 36

English method

front 37

A technician is compounding a minoxidil 5% and finasteride 0.1% topical liquid with the following ingredients:
Minoxidil
Finasteride
Propylene glycol
Ethanol 95%
Purified water
What technique should he use when mixing ingredients to ensure that all the ingredients are uniformly distributed in the final preparation?

back 37

Geometric dilution

front 38

A pharmacy technician is preparing amiodarone 150 mg in 100 mL D5W for intravenous infusion. After swabbing the rubber stopper of the amiodarone vial with alcohol, what is the correct order of the steps he should take to correctly remove the drug from the vial? (Left-click to drag and order the answer options; the first step must be placed in the top box. ALL options must be used.)

back 38

1. Pull back the syringe plunger to draw up the volume of air that is equal to the desired volume of amiodarone
2. Position the needle at 45-degree angle on the vial, with the bevel up
3. While pushing the needle through the stopper, reposition the needle to a 90 degree angle
4. Inject the air into the vial
5. Invert the vial and needle; withdraw the desired volume of amiodarone

front 39

According to USP 797, what beyond-use date should be placed on the vancomycin if it is stored at room temperature?

back 39

48 hrs

The vancomycin preparation is considered low-risk. The BUD for low-risk CSPs stored at room temperature is 48 hours.

front 40

A pharmacist is compounding a hard lozenge for sore throat relief. Which of the following would be an appropriate base for the lozenge?

back 40

Sucrose

front 41

A pharmacist is preparing a topical compound containing glycolic acid 5%, hydroquinone 1% and tretinoin 0.025% in a cream base. What is the maximum beyond-use date that can be applied to the label?

back 41

30 days

The cream base indicates that it is an aqueous formulation. The beyond-use date for water-containing topical formulations is 30 days.

front 42

JG is complaining of worsening nausea since the Exelon patch strength was increased last month. The medical director has ordered lansoprazole suspension 15 mg once daily, which the pharmacist will prepare using a compounding kit:

300 mL lansoprazole 3 mg/mL suspension

Ingredients: lansoprazole 0.9 g, artificial strawberry flavor, FD&C Red #40, Magnasweet 100 (ammonium glycyrrhizate), poloxamer 188, propylene glycol, purified water, simethicone emulsion, sodium bicarbonate, sodium citrate, sucralose, benzoic acid and xanthan gum.

What is the percentage strength (%w/v) of the prepared lansoprazole suspension?

back 42

0.3%

3 mg/mL = x/100 mL300 mg = 0.3 g = 0.3%

front 43

**case above**

The pharmacist will label the suspension using ratio strength. Which of the following provides the correct approximate ratio strength for the label?

back 43

1:333 lansoprazole solution

0.3 g/100 mL = 1/xx = 333

front 44

Which CSP risk level does NOT match the correlating non-hazardous area requirements?

back 44

low-risk; ISO 5 PEC, an ISO 8 buffer room and an ISO 8 ante area.

front 45

Rank the following steps for preparing capsules using the punch method in the correct order. (Left-click to drag and order the answer options; the first step must be placed in the top box. ALL options must be used.)

back 45

1. Triturate the dry ingredients
2. Mix all of the ingredients together using geometric dilution
3. Smooth the powder to a height that is one-third of the length of the capsule
4. Take the base of the capsule and "punch down" into the pile of powder
5. When the base is filled, fit the cap over the base