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PTCE
1. PHARMACY PTCE
The PTCE is computer based and lasts two hours. It has 90
multiple-choice questions that must be answered in the first
hour and fifty minutes. The PTCB offers a “blueprint,” with
an approximate percentage of questions related to specific
content areas. However, there are several versions of the
The PTCE PTCE exam, and students taking the same test in the same
location will receive different versions of the exam. Some
may contain more or less of a particular content area than
another. Once you have passed the PTCE, you are entitled
to use the CPhT designation. You must recertify with the
PTCB every two years and complete 20 hours of continuing
education (CE) per two-year recertification cycle.
Certification
In addition to the national certification, you may be required
to become certified or registered with your state pharmacy
board. Each state has different requirements for pharmacy
technicians, and some do not require either national certi-
fication or state registration.
Licensure/Registration by State
WORLD’S #1 QUICK REFERENCE GUIDE
PTCE
Everything you need to know about passing the PTCE
Laws
Federal pharmacy laws are listed below. Indi-
vidual states also have pharmacy laws. Where
they differ, always follow the stricter law.
EX: Some medications are considered a
controlled substance under state laws, but
not federal.
• Effectively created the Food and Drug
Administration (FDA), giving them the
responsibility to approve all new drugs
and ensure purity standards by enforcing
the rules against adulteration and mis-
branding. Adulteration includes con-
tamination or failure to meet purity and
quality standards. Misbranding includes
false, inaccurate, improper, or confusing
labelingoriftheproductisharmfulwhen
used according to the label directions.
• The FDCA gives the FDA the power to
enforce recalls if any product is in viola-
tion of these rules. These recalls may
occur at the wholesaler, retail, or con-
sumer level. There are three levels of
FDA recalls:
– Class I: For risk of “serious adverse
health consequences or death.”
– Class II: For risk of “temporarily or
medically reversible adverse health
consequences” or low-probability of
serious adverse health consequences.
– Class III: For products unlikely to have
adverse health consequences.
HIPAA is far reaching and regulates the way
health care personnel handle Protected Health
Information (PHI). HIPAA defines PHI as
any individually identifiable health informa-
tion. Under HIPAA, pharmacies must:
• Ensure the confidentiality of PHI. This
includes all manner of transmission,
whether written, electronic, or oral (pa-
tient counseling, phone calls with provid-
ers, etc.). Under HIPAA, pharmacy staff
may not disclose any PHI to anyone
other than the patient, including spous-
es and relatives unless the patient has
given express consent.
• Train pharmacy staff on HIPAA
regulations and periodically retrain
or update training.
• Protect against possible breaches with
security measures.
• Dispose of PHI in accordance with
HIPAA (through measures such as incin-
eration or shredding).
• Appoint a designated privacy officer.
• Inform patients of their privacy rights
and how the pharmacy handles their in-
formation.
• Provide patients with their PHI records
if requested.
Most importantly, any breach must be re-
ported in a timely manner to the Department
of Health and Human Services Office for
Civil Rights. If the breach affects fewer
than 500 individuals, it must be reported
within 60 days of the end of the calendar
year. If it affects more than 500 individuals,
it must be reported within 60 days of the
breach.
The Occupational Safety and Health Act of
1970 created the Occupational Safety and
Health Administration (OSHA) to ensure
the safety of workers nationwide. As it re-
lates to pharmacy, OSHA requires workers
to be trained in safety measures, safety
sheets to be available for all hazardous
substances, and personal protective equip-
ment (PPE) to be worn/utilized when ex-
posure to hazardous substances is possible.
Controlled Substance Act of 1970
This act created formal scheduling of drugs
with the potential for abuse and depen-
dency as controlled substances. It led to
the creation of the Drug Enforcement Ad-
ministration (DEA) in 1973 to help with
regulatory enforcement.
DEA Number Calculations
A DEA number is required to prescribe
controlled substances except for by military
practitioners and employees in public-health
services, prisons, and certain long-term care
facilities. Each DEA number has its own
validation within its digits. Each DEA num-
ber consists of two letters and seven digits,
enabling you to manually validate a DEA
number. Here’s how:
• The first letter corresponds to the pre-
scriber’s registration type.
• The second letter is the first letter of the
prescriber’s last name.
• The 1st, 3rd, and 5th numbers are added
together, and the 2nd, 4th, and 6th letters
are added together and multiplied by 2.
Add the two resulting figures together,
and the final digit should match the 7th
digit, also known as the check digit.
EX: Dr. James Bryant sends in a pre-
scription with a DEA number of
1
AB6390467.
6 + 9 + 4 = 19
3 + 0 + 6 = 9 × 2 = 18
19 + 18 = 37
Since the B in the DEA number matches
the “B” in Bryant, and the 7 in 37 match-
es the check digit, this is a potentially
valid DEA number.
Schedules (I-V)
Controlled substances are categorized into
five different schedules, according to their
potential for abuse and dependency:
Schedule I: No accepted medical use/high
abuse potential.
EX: Illegal drugs such as LSD and heroin
Note: Cocaine is not schedule I, but
schedule II, although it is rarely used
medically.
Schedule II: High abuse potential. Accord-
ing to the DEA, use of schedule II drugs
potentially leads to “severe psychologi-
cal or physical dependence.”
EX: ADHD drugs such as Ritalin, Con-
certa, and Adderall; opioid analgesics
such as morphine and oxycodone; and
synthetic opioids such as fentanyl
Schedule III: Moderate abuse and depen-
dency potential.
EX: Codeine-containing products (less
than 90 mg) and testosterone
Schedule IV: Low abuse and dependency
potential.
EX: Benzodiazepines and sleep aids such
as Ambien
Schedule V: Lowest abuse and depen-
dency potential.
EX: Codeine-containing cough syrups,
Lyrica, Vimpat
This act requires child safety caps on all
dispensed prescriptions. Easy open caps
may be used if requested, and a record must
be kept of the request.
This act established rules for all drug man-
ufacturers to supply a current drug list to
the FDA. Each drug is assigned its own
NDC (national drug code). The NDC is
unique to the manufacturer and package
size; thus, the same medication from dif-
ferent manufacturers (e.g., generics) will
each have their own NDC. An NDC is usu-
ally broken down into three sections.
• The first section refers to the manufac-
turer or repackager.
• The second section refers to the specific
drug itself (including strength and form).
• The third section refers to the packaging
size.
• Requireswholesaledistributorstobelicensed.
• Samples of prescription medication may
only be given to licensed prescribers.
• Exported prescription drugs may not be
reimported.
OBRA was a widespread federal deficit re-
duction budget bill, the pharmacy implica-
tions of which initially only pertained to
Medicaid recipients. However, as it was up
to individual states to determine how to en-
force OBRA, most expanded the act to in-
clude all patients. Under OBRA, three major
requirements are pertinent for pharmacy:
• Pharmacists must offer counseling to all
patients, documenting patient refusals
for counsel. (Under no circumstances
should a technician counsel patients.)
• Pharmacists must perform a “prospective
drug utilization review” (DUR) prior to
filling each prescription, which evaluates
therapy for potential problems (e.g., in-
teractions, allergies, therapeutic duplica-
tion, and other adverse effects).
• Record-keeping mandates: Pharmacies
must keep patient profiles of medications
dispensed for two years on-site.
• Requires pharmacies to limit sales of
over-the-counter medications containing
pseudoephedrine or ephedrine to 3.6
grams per purchaser per day and no more
than 7.5 grams within a 30-day period.
Products containing these ingredients
must be kept behind the pharmacy coun-
ter or in a locked cabinet and can only
be purchased by customers over the age
of 18 with a valid photo ID.
• Pharmacies must maintain a logbook of
each regulated purchase, including the
customer’s signature, address, product
purchased, quantity purchased, and date
and time of the sale. This logbook may
be physical or electronic and must be
maintained for a period of two years.
Combat Methamphetamine
Epidemic Act of 2005
Omnibus Budget Reconciliation
Act of 1990 (OBRA-90)
Prescription Drug Marketing Act
of 1987
Drug Listing Act of 1972
Poison Prevention Packaging Act
of 1970
Occupational Safety & Health Act
of 1970
Health Insurance Portability &
Accountability Act of 1996
(HIPAA)
Federal Food, Drug & Cosmetic
Act of 1938 (FDCA)
2. - one
- two (or )
- three (or )
- four (or )
50
10
Frequency
250 mg
=
500 mg
MATH
Alligation is a method of calculating quantities
needed to produce a mixture with a certain per-
centage of a drug when you have stock products
in two other percentages. Alligation is often
referred to as the tic-tac-toe method.
EX: I want a 30% solution of substance A. I
have a 20% solution and a 50% solution. What
mixture will I need of the two solutions to make
what I want? In alligation, place the percentage
you want in the center of the tic-tac-toe board.
Place the higher percentage you have in the
top left corner. Place the lower percentage you
have in the bottom left corner.
Subtract the percentage you want from the
higher percentage you have and place it in
the bottom right corner. Subtract the lower
percentage you have from the percentage
you want and place it in the top right corner.
10 parts of the 50% solution to 20 parts of the
20% solution (this can be reduced to 1:2 parts)
Cross Multiplication
Otherwise known as ratio/proportions math, it
is a valuable tool that you can utilize for many
pharmacy calculations.You can use it for dosage
calculations and calculating day supplies and
needed quantities. Cross multiplication can be
utilized whenever you have three values and are
looking for a fourth.
EX: You have a prescription for Amoxicillin
Suspension 500 mg TID × 10d. The only avail-
able suspension you have is 250 mg/5 mL.
How many mL should be given three times
per day? First, place the known proportion on
the left-hand side. Then, set up the right-hand
side with the units matching the proportion,
with one blank spot being x.
5 mL xmL
Multiply diagonal values and place on two
sides:
250 * x = 5 * 500 or 250x = 2,500
Divide both sides by 250: x = 10
You should give 10 mL three times per day.
It may seem easy to calculate these figures in
your head, especially when they seem straight-
forward. But it is always a good idea to double-
check your mental math with cross-multiplica-
tion. Many errors have been prevented by doing
so—miscalculating by a single digit could have
devastating effects.
IV Flow Rate/Drip Rate
At its core, calculating drip rates can be done by
conversions and cross multiplication. Drip rates
are usually expressed as drops per minute (DPM).
The formula to calculate DPM is:
Total volume (in mL)
×
Drop factor
=
Drops
Total time (in minutes) 1 mL Minute
The drop factor is usually indicated in drops per
mL on the tubing or administration set that you
select (e.g., 60 gtts/mL).
Dosage Calculations
QS is a sig abbreviation that stands for “quan-
tity sufficient” and is used when doctors want
the pharmacy to calculate the necessary quan-
tity for the duration of the course they have
specified.
QS is never allowable on controlled substance
prescriptions, where the prescriber must speci-
fy the quantity.
Dosage calculation questions are fairly
straightforward and usually consist of how
many tablets will be given in a day? and how
much of the medication is needed?
This is usually a case of simple interpretation
of the sig.
EX: Q: How many tablets will be needed for a
prescription that reads 3 tablets QID 10d? A: 3
tablets 4 times per day for 10 days. 3 × 4 × 10
= 120 tablets
Q: For a prescription that reads 1 tablet TID,
how many tablets would you need to give
quantity sufficient for a 30-day supply? A: 1
tablet 3 times per day for 30 days = 1 × 3 × 30
= 90 tablets.
Below are common Roman numerals. When a smaller Roman numeral precedes
a larger one, it is subtracted from the larger one.
EX: IV is 5 (V) minus 1 (I) or 4.
I 1 XI 11 XXX 30
II 2 XII 12 XL 40
III 3 XIII 13 L 50
IV 4 XIV 14 LX 60
V 5 XV 15 LXX 70
VI 6 XVI 16 LXXX 80
VII 7 XVII 17 XC 90
VIII 8 XVIII 18 C 100
IX 9 XIX 19 D 500
X 10 XX 20 M 1000
Metric Conversions
Most numbers and calculations in pharmacy use metric measurements in variants
of grams or liters.
You can remember the metric prefixes using this mnemonic:
Kittens Hate Diving Under Dusty Couches Most Mischievously
Kittens Hate Diving Under Dusty Couches Most Mischievously
kilo- hecto- deca- UNIT deci- centi- milli- micro-
1000 100 10 1 .1 .01 .001 .0001
kilogram hectogram decagram gram decigram centigram milligram microgram
kg* hg dag g* dg cg mg* µg*, mcg*
kiloliter hectoliter decaliter liter deciliter centiliter milliliter microliter
kL hL daL L* dL cL mL** µL
*Most frequently used in pharmacy **Also known as cc (cubic centimeter)
In pharmacy strengths, you will most often see milligrams and micrograms. Pay
close attention: mg and mcg can look alike in poor handwriting. One drug to
pay close attention to is Levothyroxine (Synthroid), which is often labeled in
micrograms (but not always). Levothyroxine 100 mcg is the same as Levothy-
roxine 0.1 mg.
Common conversions of household measurements into metric are:
one teaspoon 5 mL
one tablespoon 15 mL
one fluid ounce 30 mL (29.57, but can be rounded for
most calculations)
one pint 480 mL (473.176)
one ounce 30 g (28.35)
Apothecary Measurement Conversions
Two apothecary measurements you may come across are drams and grains.
The vials typically used in a pharmacy are sized according to fluid drams (by
volume). Drams are also a unit of weight equal to 60 grains. Rarely, you will
come across drugs labeled according to grains rather than milligrams. The
typical example is phenobarbital. For conversion, remember that 1 grain (gr,
not to be confused with g for gram) equals 64.8 mg.
Sig Abbreviations
**Note: Best prescribing practices is to
include a frequency together with prn
on orders to prevent overdose. You will
often see pain medicine prescribed this
way (e.g., q4h prn [every four hours as
needed]).
Quantity
• qs: quantity sufficient
• #: signifies quantity to follow
(e.g., #30 is a quantity of 30)
• Disp: dispense; signifies quanti-
always fit on the prescription label.
If you are unable to reduce the direc-
tions to clear and understandable
instructions that fit, it may be neces-
sary to provide a separate instruction
sheet. Obtain prescriber permission
before doing so. You may then write
“Take as directed according to taper
instructions.” Prescribers know this
and will often do the same for their
patients. If you receive a pre-
scription that refers to outside
instructions (for tapers, bowel
prep, or any other medication),
make sure to ask the patient if they
have a copy of the instructions, and
*Note: q12 and bid could conceivably produce the same dosing schedule
because there are 24 hours in a day; however, they are not equivalent. If a
prescriber writes “q12,” they may want to ensure the doses are separated
by 12 hours, whereas this is not necessarily the case with “bid.”
ty to follow
• IU: international unit
• g: grams
• oz: ounces
2
Tapers & Titrations
Tapers and titrations often consist
of lengthy instructions that may not
whether they would mind sharing it
with you.
• ud, ad: as directed
30
Roman Numerals
20
20
Route
Alligations
50
30
20
q every bid* twice daily
qam every morning tid three times daily
qpm every evening qid four times daily
qhs every night at bedtime
(hs = hour of sleep)
prn** as needed
qd every day ac before a meal
qod, qad every other day pc after a meal
qh every hour cf with food
q12, q12h* every 12 hours stat immediately
q#, q#°, q#h every # hours d/c, dc discontinue
q#–#, q#–#h every #–# hours (e.g.,
q4–6 = every 4–6 hours)
MDD maximum daily
dose
qw, qweek weekly p̄ after
PO by mouth
NPO nothing by mouth
RECT, PR rectally
VAG, PV vaginally
AT, top apply topically
AAA apply to affected area
IM inject intramuscularly
SC, SubQ inject subcutaneously
IV intravenously
SL sublingually
IN intranasally
NEB via nebulizer
INH by inhalation
3. Topicals
• ung., oint: ointment
• cr: cream
Liquids
• tsp: teaspoon
• tbsp: tablespoon
• oz: ounce
• sol: solution
• susp: suspension
• syr: syrup
• liq: liquid
Forms
• ER, XL, XR: extended release
• LA: long acting
• DR: delayed release
• SR: slow release
• SA: sustained action
• CD: controlled diffusion
• CR: controlled release
• tab: tablet
• cap: capsule
• loz: lozenge
• supp: suppository
• amp: ampule
EAR & EYE
• gtt: drop
• gtts: drops
• OU: both eyes
• OS: left eye
• OD: right eye
• AU: both ears
• AS: left ear
• AD: right ear
Out of all of the SIG abbreviations,
the ones for eyes and ears can
sometimes be the most difficult to
remember. Perhaps this is because
we tend to deal with them less
frequently than with tablets and
liquids. Here are some tips to help
you remember:
• S (left) and D (right): The term
for left-handed in Latin is sinis-
ter. Anecdotally, a left-handed
person was influenced by the
devil, and so “sinister” came to
etymologically acquire evil con-
notations. The original meaning
persists in OS (oculus sinister)
and AS (auris sinistra).
• OU/AU: Both of the letters in the
abbreviation are vowels, so they
mean both eyes or both ears.
• O versus A: Look at the shape.
The O looks like a staring eye.
Note: You need to know
these abbreviations because
they are still used; however,
they are no longer recom-
mended by various patient
safety organizations. A badly
written “a” can be misread as
an “o” and vice versa. On top
of that, there are some eye
drops that can be used in the
ear and vice versa, and there
are eye/ear drops that have
the same name, the only dif-
ference being eye versus ear
formulation. Consult with a
pharmacist if there is any con-
fusion, and they may decide
to consult with the MD.
Other
• K: potassium
• NaCl: sodium chloride
• NS: normal saline (0.9% sodi-
um chloride)
• PCN: penicillin
• SMZ-TMP: Bactrim DS
There is no guarantee that questions about particular drugs
on the PTCE test will fall within the top 100 drugs. But
these are the most prescribed drugs and the most important
to know about. As you are studying these drugs, pay atten-
Brand Name
(Not All Generic
Class/What It’s For
Names Are Name
Listed)
Zestril,
Prinivil
Lisinopril
ACE inhibitor / hypertension
(high blood pressure)
Synthroid,
Levoxyl
Levothyroxine
thyroid hormones /
hypothyroidism (low thyroid
production), goiter
Lipitor Atorvastatin
“statin” or HMG CoA
reductase inhibitor /
hypercholesterolemia (high
cholesterol)
Fortamet,
Gluco-
phage
Metformin
HCl
antihyperglycemic, not
related to other classes / type
2 diabetes (DMII)
Zocor Simvastatin
“statin” or HMG CoA
reductase inhibitor /
hypercholesterolemia (high
cholesterol)
Prilosec Omeprazole
“PPI” or proton pump
inhibitor / gastrointestinal
reflux disease (GERD),
erosive esophagitis,
heartburn
Norvasc Amlodipine
calcium channel blocker /
angina, hypertension
Lopressor,
Toprol XL
Metoprolol
Tartrate,
Metoprolol
Succinate
beta-blocker/angina,
hypertension
Vicodin,
Norco,
Lortab†
Hydrocodone/
Acetamino-
phen†
opiate analgesic (narcotic) /
pain
Proventil,
Ventolin,
ProAir
Albuterol bronchodilator/asthma
Microzide,
Hydrodiuril
Hydrochloro-
thiazide
(HCTZ)
thiazide diuretic (water pill) /
congestive heart failure,
edema, hypertension
Cozaar
Losartan
Potassium
angiotensin II receptor
agonists / hypertension
Neurontin Gabapentin
anticonvulsant / neuropathic
pain, seizures
Zoloft
Sertraline
Hydrochloride
selective serotonin reuptake
inhibitor (SSRI) /
depression, obsessive-com-
pulsive disorder, PTSD,
anxiety
Lasix Furosemide
loop diuretic (water pill) /
congestive heart failure,
edema, hypertension
Tylenol
Acetamino-
phen
analgesic, antipyretic / pain,
fever
Tenormin Atenolol
beta-blocker / angina,
hypertension
Pravachol
Pravastatin
Sodium
“statin” or HMG CoA
reductase inhibitor/
hypercholesterolemia
Amoxil Amoxicillin
penicillin antibiotic /
infection
TOP 100 DRUGS
tion to the generic (chemical) name. Names with similar
endings are often in the same class, so if you have the top
100 drugs down, you can often make educated guesses about
similar sounding drugs. Additionally, since the questions
Prozac,
Serafem
Fluoxetine
Hydrochloride
selective serotonin reuptake
inhibitor (SSRI) / depression,
obsessive-compulsive
disorder, premenstrual
dysphoric disorder
Celexa Citalopram*
selective serotonin reuptake
inhibitor (SSRI) / depression
Desyrel
Trazodone
Hydrochloride
serotonin modulator /
depression
Xanax† Alprazolam†
benzodiazepine / anxiety,
panic disorders
Flonase,
Flovent Fluticasone
corticosteroid / nasal
congestion, allergies
Wellbutrin,
Buproban,
Zyban
Bupropion
aminoketone antidepressant /
depression, smoking
cessation
Coreg Carvedilol
beta-blocker / heart failure,
hypertension
Klor-Con,
K-Tab
Potassium
essential mineral /
hypokalemia (low
potassium)
Ultram†
Tramadol
Hydrochlo-
ride†
opioid analgesics (narcotic) /
pain
Protonix
Pantoprazole
Sodium*
proton pump inhibitor (PPI) /
gastrointestinal reflux
disease (GERD), erosive
esophagitis
Singulair Montelukast
leukotriene inhibitor /
asthma prevention, allergies
Lexapro
Escitalopram
Oxalate*
selective serotonin reuptake
inhibitor (SSRI) /
depression, anxiety
Deltasone Prednisone*
corticosteroid / anti-inflam-
matory or immunosuppres-
sant
Crestor
Rosuvastatin
Calcium
“statin” or HMG CoA
reductase inhibitor /
hypercholesterolemia
Advil, Motrin Ibuprofen
non-steroidal anti-inflamma-
tory (NSAID) / fever, pain,
inflammation
Mobic Meloxicam
non-steroidal anti-inflamma-
tory (NSAID) / rheumatoid
arthritis, osteoarthritis
Lantus
Insulin
Glargine
long-acting insulin / diabetes
types 1 and 2
Zestoretic,
Prinzide
Hydrochloro-
thiazide/
Lisinopril
thiazide diuretic and ACE
inhibitor / hypertension
Klonopin† Clonazepam†
benzodiazepine / seizures,
panic disorders
Aspirin
Acetylsalicylic
Acid
non-steroidal anti-inflamma-
tory (NSAID) / pain, fever,
inflammation
Plavix
Clopidogrel
Bisulfate
antiplatelet / blood thinner,
lowers chance of stroke,
heart attack
Glucotrol,
Glucotrol XL Glipizide
sulfonylurea / diabetes type
2
Coumadin Warfarin
anticoagulant / blood
thinner, lowers chance of
stroke, heart attack
3
on the PTCE are multiple choice, you may be able to use
your knowledge of the top 100 drugs to aid with the process
of elimination.
Flexeril
Cyclobenzap-
rine
muscle relaxant / pain
Humulin R
Insulin
Regular
short-acting insulin /
diabetes types 1 and 2
Flomax
Tamsulosin
Hydrochloride
alpha-blocker / improves
urination
Ambien†
Zolpidem
Tartrate†
hypnotic / insomnia, sleep
disorders
Ortho Cyclen,
Ortho
Tri-Cyclen
Ethinyl
Estradiol /
Norgestimate
progestin and estrogen /
contraception
Cymbalta Duloxetine
selective serotonin and
norepinephrine reuptake
inhibitor (SSNRI) /
depression, anxiety,
neuropathy
Zantac Ranitidine
histamine-2 blocker / acid
reducer, gastroesophageal
reflux disease (GERD)
Effexor,
Effexor XR
Venlafaxine
Hydrochloride
selective serotonin and
norepinephrine reuptake
inhibitor (SSNRI) /
depression, anxiety, panic
disorders
Advair
Fluticasone/
Salmeterol
corticosteroid and
bronchodilator / asthma
attack prevention, COPD
Oxycontin,
Roxicodone†
Oxycodone†
opioid analgesic (narcotic) /
pain
Zithromax Azithromycin
macrolide antibiotic /
bacterial infections
Evekeo
Amphetamine
Sulfate
central nervous system
stimulant / ADHD,
narcolepsy
Ativan† Lorazepam† benzodiazepine/anxiety
Zyloprim Allopurinol
xanthine oxidase inhibitor /
gout, kidney stones
Paxil Paroxetine
selective serotonin reuptake
inhibitor (SSRI) /
depression, obsessive-com-
pulsive disorder, anxiety
Ritalin,
Concerta,
Metadate ER†
Methylpheni-
date†
central nervous system
stimulant / ADHD,
narcolepsy
Estrace Estradiol
estrogen replacement for
menopause symptoms
Hyzaar
Hydrochloro-
thiazide /
Losartan
Potassium
thiazide diuretic and
angiotensin II receptor
agonist / hypertension
Femhrt
Ethinyl
Estradiol /
Norethindrone
estrogen replacement for
menopause symptoms
Tricor Fenofibrate fibrate/hypercholesterolemia
Inderal,
Inderal LA
Propranolol
Hydrochloride
beta-blocker / angina,
hypertension
Amaryl Glimepiride
sulfonylurea / diabetes type
2
Vitamin D2 Ergocalciferol
vitamin / vitamin D
deficiency
4. The United States
Pharmacopeia & National
Formulary (USP-NF or USP)
• The USP contains monographs
detailing strength, quality,
purity, packaging, and labeling
standards for all drugs and
dietary supple- ments, as well as
inactive ingredi- ents and food
additives.
• Manufacturers (including com-
pounders) of prescription and
over-the-counter drugs must com-
ply with USP standards by law.
Manufacturers of vitamins, herbs,
and supplements may comply and
use the designation USP-NF.
Drug Classes
Sometimes it’s easier to memorize the drugs if you see a general breakdown of the classes. Here are some
of the most common ones found in the top 200 drugs. *LOOK ALIKE / SOUND ALIKE DRUGS are com-
mon in pharmacy, and labels and packaging often use
TALL MAN lettering to help distinguish between
look alike / sound alike drugs. This is when certain
syllables are presented in all capitals to draw attention
to differences.
EX: Prednisone and prednisolone would be rendered
as predniSONE and prednisoLONE, respectively.
† Controlled substances
The FDA requires the following to be on
Controlled Substances
• Controlled substance prescriptions that scriptions if the bottle is 1,000 ct. or
all labels for controlled substances:
“CAUTION: Federal law prohibits the
transfer of this drug to any person other
than the patient for whom it was pre-
scribed.”
The DEA has specific regulations for
controlled substances and how they may
be handled and prescribed. Again, as in
all other areas of pharmacy, state boards
may be stricter.
Prescription Elements
All of the following elements must be
present: Date written (may not be post-
dated), patient’s name, patient’s address,
drug name, drug strength, drug form,
quantity prescribed, directions for use,
and the name, address, signature, and
registration number (DEA number) of the
practitioner.
Various state pharmacy boards have dif-
ferent rules as to which elements can be
added or changed with or without the
prescriber’s authorization.
EX: In New York State, a pharmacist
may not add a date or quantity even via
communication with the prescriber.
However, they may change a quantity,
but not a date. They may add a pa-
tient’s address without prescriber au-
thorization.
Transmission
Controlled substances may be prescribed
electronically when the transmission sys-
tem meets all of the DEA’s requirements.
are printed must be manually signed
by the physician.
• CII prescriptions may be faxed by the
prescriber and considered the original
prescription in the following circum-
stances:
– For immediate parenteral, IV, IM,
SC, or intraspinal infusion adminis-
tration
– For use in a long-term care facility
(LTCF must be indicated on the pre-
scription)
– For use in hospice
• CIII-V prescriptions may be faxed.
• CII prescriptions may be phoned in for
emergency supplies only when:
– The immediate administration of the
drug is necessary for proper treat-
ment of the intended ultimate user
– No alternative non-controlled treat-
ment is available
– It is not possible for the prescribing
practitioner to provide a written pre-
scription for the drug at that time.
The prescriber must provide the phar-
macy with a “cover” (a written prescrip-
tion to match the oral order) within 7
days, with “Authorization for Emergen-
cy Dispensing” written on it. If the pre-
scriber fails to do so, the pharmacy is
required to report it to the local DEA
diversion field office.
• CIII-V prescriptions may be phoned
in (but many states will require a
cover).
• CII prescriptions may be partially filled
if and only if the remaining portion is
supplied within 72 hours (e.g., the
pharmacy does not have the full quan-
tity on hand). If the remaining portion
is not supplied within 72 hours, then
the balance is void, and the prescriber
must be notified.
• CII prescriptions may not have refills.
• CIII and CIV prescriptions may have
five refills for up to six months from the
date written, whichever comes sooner.
• CV prescriptions may be refilled as
authorized.
• When a controlled substance is refilled
at the pharmacy, the dispensing phar-
macist must initial and date the back of
the prescription along with noting the
quantity dispensed. If the prescription
was received electronically, the phar-
macist must make an electronic note.
Records
• Records of CII prescriptions must be
kept separately from other prescription
records and must be maintained for
two years.
• When a pharmacy obtains a DEA li-
cense, an initial inventory of all con-
trolled substances must be performed
and every two years thereafter.
• CII prescriptions must be inventoried
with exact counts of all open bottles.
You may use approximate counts for
open bottles of CIII, CIV, and CV pre-
4
less (if it is over, you must provide an
exact count). A record must be kept of
these inventories; however, you are not
required to submit the inventories to
the DEA.
• All controlled substances must have
their schedule (CII–CV) printed on the
bottle’s label.
• CII prescriptions must be ordered on
a DEA 222 form in triplicate. Copies
1 and 2 are sent to the supplier, and
copy 3 is retained for the pharmacy’s
records. Each of these forms has a se-
rial number. Pharmacies may only have
six books of seven forms each in their
possession. If the forms are lost or
stolen, it must be reported to the DEA.
Topamax Topiramate
sulfamate (anticonvul-
sant) / seizures,
migraines
Augmentin
Amoxicillin /
Clavulanate
Potassium
penicillin antibiotic / bac-
terial infection
Lyrica† Pregabalin†
alpha-2 delta ligand
(anticonvulsant) /
seizures, fibromyalgia
Folate Folic Acid vitamin B9 / anemia,
folic acid deficiency
Fosamax
Alendronate
Sodium
bisphosphonate/
osteoporosis
Hysingla ER†
Hydrocodone
Bitartrate†
opioid analgesic
(narcotic) / pain
Elavil Amitriptyline
tricyclic antidepressant /
depression
Voltaren Diclofenac
non-steroidal anti-inflam-
matory (NSAID) / pain
Novolog Insulin Aspart
fast-acting insulin /
diabetes types 1 and 2
Spiriva Tiotropium
bronchodilator / COPD,
emphysema, asthma
attack prevention
Seroquel,
Seroquel XR
Quetiapine
Fumarate
dibenzothiazepine /
schizophrenia, bipolar
disorder
Vasotec
Enalapril
Maleate
ACE inhibitor / hyperten-
sion
Nexium
Esomepra-
zole*
proton pump inhibitor
(PPI) / gastrointestinal
reflux disease (GERD),
erosive esophagitis
Aldactone
Spironolac-
tone
potassium sparing
diuretic / hypertension,
hypokalemia
Claritin Loratadine antihistamine/allergies
Aleve,
Naprosyn
Naproxen
non-steroidal anti-inflam-
matory (NSAID) / pain,
inflammation
Lamictal,
Lamictal XR
Lamotrigine
phenyltriazine
(anti-epileptic) / seizures,
bipolar disorder
Dyazide,
Maxzide
Hydrochloro-
thiazide/
Triamterene
diuretic (water pill) /
edema, hypertension
Zyrtec
Cetirizine
Hydrochloride antihistamine/allergies
Bactrim DS,
Septra DS
Sulfamethoxa-
zole/
Trimethoprim
sulfonamide antibiotic /
bacterial infections
Mevacor Lovastatin
“statin” or HMG CoA
reductase inhibitor /
hypercholesterolemia
Cardizem,
Tiazac
Diltiazem
Hydrochloride
calcium channel blocker /
hypertension, angina
Catapres Clonidine
central alpha agonist /
hypertension
Refills
Neosporin,
Triple
Antibiotic
Ointment
Bacitracin /
Neomycin /
Polymyxin B
topical antibiotic /
bacterial infection
Januvia
Sitagliptin
Phosphate
DPP-4 inhibitor /
diabetes type 2
Valium,
Diastat† Diazepam†
benzodiazepine / anxiety,
seizures
Xalatan Latanoprost
prostaglandin analogue /
glaucoma
Cipro Ciprofloxacin
fluoroquinolone
antibiotic / bacterial
infection
Symbicort
Budesonide
Formoterol
corticosteroid and
bronchodilator / asthma,
COPD
Vistaril Hydroxyzine
antihistamine / sedative,
anxiety, hives
Aviane
Ethinyl
Estradiol /
Levonorg-
estrel
progestin and estrogen /
contraception
Colace
Docusate
Sodium
stool softener /
constipation
Diovan Valsartan
angiotensin II receptor
agonist / hypertension
Propecia,
Proscar
Finasteride
type II 5 alpha-reductase
inhibitor / hair loss,
benign prostatic
hyperplasia (BPH)
Zofran Ondansetron
selective 5-HT3 receptor
antagonist / nausea and
vomiting
Antibiotics Depression Blood Pressure Pain
penicillins tri-cyclic antidepressants diuretics NSAIDs
sulfonamides SSRI ACE inhibitors opioid narcotics
cephalosporins SNRI angiotensin receptor II blockers COX-2 inhibitors
macrolides MAOI calcium channel blockers non-narcotic analgesics
tetracyclines beta blockers
aminoglycosides
5. Pharmacology
Pharmacology is the study of pharma-
ceuticals and how they act in the body.
For the most part, this is knowledge that
is the responsibility of the pharmacists
and the prescribers. Yet, as technicians,
it is important to have a basic understand-
ing of some of the broadest topics of
pharmacology. The possibility for error
arises from every step of the prescribing
process, from incomplete information
gathered from patients, to incorrect pre-
scribing, incorrect interpretation, and
incorrect dispensing. Since we are part
of the dispensing process, pharmacology
knowledge will help us to assist pharma-
cists. Most interactions will be flagged
by your pharmacy software, but the sys-
tem cannot flag information it has not
been given, which is why it is extremely
important to ask about other medications
or supplements patients may be on, dis-
eases they may have, and allergies to be
aware of (even food/dye allergies).
An interaction is anything that can alter a
drug’s effect on the body. There are sev-
eral types of interactions to be aware of:
• Drug-disease: Some drugs are contra-
indicated with certain diseases and may
produce unwanted side effects.
• Drug-allergy: When a patient has an
allergy to a drug or a potential cross-
sensitivity (e.g., a person with a peni-
cillin allergy has a 10% chance of
being allergic to cephalosporins).
• Drug-drug: When a drug alters the effect
of another. These can be synergistic
(increasing the effects of both drugs)
or antagonistic (decreasing the effect
of one or both drugs). The interactions
can also be metabolic, meaning they
change the way another drug is pro-
cessed in the body.
• Drug-dietary supplement, drug-
nutrient: You should always encour-
age patients to tell the pharmacist about
any over-the-counter medications or
supplements they may be using. Ad-
ditionally, there are some drugs that
require dietary restrictions (e.g., pa-
tients on certain statins should avoid
grapefruit and grapefruit juice).
• Drug-laboratory: When drugs inter-
fere with or affect laboratory results.
A drug is considered contraindicated
with another when an interaction could
be severe enough that a therapy change
should be considered (one or both drugs
d/c’d or changed). A contraindicated drug
presents a risk to the patient, but may still
be administered with prescriber discre-
tion, given other factors. A drug is abso-
lutely contraindicated when the therapy
is inappropriate for any reason whatso-
ever due to risk for severe adverse reac-
tions or death.
Some typical examples of interactions
and contraindications to be aware of are:
• QT prolongation
– The QT interval is a heart-related
measurement.
– A long QT interval can indicate risk
for cardiac problems such as arrhyth-
mias and even sudden death. This is
a topic still under current study, and
there is a growing list of drugs that
prolong the QT interval, such as
certain antidepressants and antipsy-
chotics that have traditionally been
prescribed together.
– The co-administration of two drugs
that prolong the QT interval involves
complicated risk assessments that
should be conducted between the pa-
tient, pharmacist, and the prescriber.
• Acetaminophen
– Excessive doses of acetaminophen
can cause liver failure. The FDA cur-
rently recommends an MDD (maxi-
mum daily dose) of 4,000 mg, but a
max of 3,000 mg is often recom-
mended on OTC packaging.
– Acetaminophen is contained in many
over-the-counter products and pre-
scription products, so if a patient has
a prescription for a product contain-
ing acetaminophen, make sure to ask
them about any other over-the-coun-
ter medications they may be taking.
• Warfarin
– Warfarin is a blood thinner that in-
teracts with or is contraindicated with
many medications, including over-
the-counter supplements. The two
biggest to watch out for with warfa-
rin are NSAIDs and aspirin.
– A warfarin interaction can cause
excessive bleeding and can be ex-
tremely dangerous. Patients on war-
farin should get routine PT/INR
checks done to see whether their dose
needs adjustment.
– When a new therapy is started with
a drug that interacts with warfarin,
the physician may choose to lower
the dose, change therapies, or mon-
itor PT/INR levels more closely for
the duration of the therapy.
• Digoxin
– Digoxin interacts with certain med-
ications such as verapamil and
amiodarone and has the potential for
digoxin toxicity.
• Metronidazole
– Metronidazole interacts severely
with alcohol. Pharmacists recom-
mend that patients not even use
mouthwash containing alcohol for
the duration of a metronidazole treat-
ment and for three days afterward.
Adverse Drug Event Reporting
An adverse drug event is any harm (e.g.,
allergic reaction, medication errors, and
overdose) that is related to medication
treatment. There are two primary adverse
event voluntary reporting programs: the
ISMP-MERP and MedWatch.
• ISMP-MERP (or Medication Error
Reporting Program) is run by the In-
stitute of Safe Medication Practices
(ISMP).
– The ISMP provides pharmacies with
other safety measures such as black
box warnings, error-prone abbrevia-
tion lists, do not crush lists, and sug-
gested tall man lettering.
– All reported information is made
available to regulatory agencies and
manufacturers.
• MedWatch is run by the FDA and is
entered into their database: FAERS (FDA
Adverse Event Reporting System).
COMPOUNDING
Compounding occurs both in retail phar-
macies and hospital pharmacies and can
be performed by practitioners or pharma-
cists (or interns and technicians under the
supervision of a pharmacist).
• Compounding: Mixing two or more
products together to arrive at a formu-
lation that is not otherwise available.
• The USP (United States Pharmaco-
peia) provides proprietary standards
for both sterile and non-sterile com-
pounding as well as monographs for
many pre-established compounding
formulations.
• Compounded products are subject to
beyond use dating (BUD), which is
dictated according to the compounding
procedures and is not the same as a
manufacturer’s expiration date. The
maximum length of a BUD is either 6
months or 1 year, depending on the
state board of pharmacy.
Non-Sterile Compounding
(USP 795)
Repackaging is considered compounding
under the USP and must be performed
according to USP standards, including
labeling.
• Repackaged labels must include the
generic name of the drug, strength,
dosage form, manufacturer, lot number,
and beyond use date.
• Pharmacies that repackage must maintain
a log containing all of this information
in addition to the date, manufacturer’s
original expiration date, quantity repack-
aged, pharmacy tech’s initials, and the
signature of the pharmacist.
Other types of non-sterile compounding
include reconstitution of powdered
antibiotics or injectables, admixtures of
topical applications, and preparation of
suppositories or custom-made capsules.
Scales must be inspected annually by the
department of taxation.
Sterile Compounding (USP 797)
The sterility of compounded sterile
products (CSPs) depends on aseptic
technique and a sterile (typically ISO
class 5) environment.
• All sterile compounding personnel
must be trained and pass both written
and procedural examinations at least
annually.
• Sterilization of materials may be com-
pleted through filters, dry heat, or au-
toclaving. Procedures are determined
by whether the CSP is considered a
low, medium, or high risk of contam-
ination. The higher the risk of con-
tamination, the stricter the time limits
are for storage before administration.
• Special PPE to cover clothing and pre-
vent particle shedding is donned in
order from dirtiest to cleanest areas.
All personal outer garments must be
removed, including jewelry and cos-
metics. USP provides an appropriate
order of garbing that must be followed
in the buffer area.
• A laminar flow hood may be vertical
or horizontal and directs HEPA filtered
air over the CSP and toward the user
to prevent any particles from the user
from contaminating the CSP. Flow
hoods should be running for at least
30 minutes before use.
• Negative pressure isolation rooms
are used to store radioactive materials
and other hazardous substances. In
these rooms, the air pressure is lower
than surrounding rooms, thus prevent-
ing airflow out of the room.
Prescription Intake & Order Entry
Intake
The pharmacy technician is the first
source ensuring that all the necessary
information is gathered. When you are
presented with the prescription, you
should verify that all of the necessary
elements are present.
Required elements:
• Patient’s full name
• Patient’s address (pharmacy may add
if not present)
• Prescriber’s name
• Prescriber’s address
• Prescriber’s phone number
• Prescriber’s identification numbers
(DEA [if controlled] and/or NPI)
• Date of prescription (check to ensure
it is not expired—one year for non-
controlled substances)
• Drug name
• Drug strength
• Drug form
• Directions for use
• Route of administration
• Dispense quantity
• Number of refills
• Signature of the prescriber
5
• DAW (dispense as written) if required
If one or more of these elements are miss-
ing, notify the pharmacist, who will decide
whether they are able to get clarification
from the physician or whether they will
refuse the prescription. In addition to these
elements, there are pieces of information
you should ask the patient for:
• Date of birth
• Any known allergies (medication or
otherwise)
• Whether they have had this medication
before
• Whether their insurance has changed
or they have received any new insurance
cards
Order Entry
Each pharmacy software system is dif-
ferent as to which information you need
to input first.
1. Usually, you will need to select the
right patient first. Verify the spelling
of the patient’s name and date of birth.
Always double check every piece of
information as you go along, and then
double check again once the entire
prescription has been entered.
Interactions &
Contraindications
![- one
- two (or )
- three (or )
- four (or )
50
10
Frequency
250 mg
=
500 mg
MATH
Alligation is a method of calculating quantities
needed to produce a mixture with a certain per-
centage of a drug when you have stock products
in two other percentages. Alligation is often
referred to as the tic-tac-toe method.
EX: I want a 30% solution of substance A. I
have a 20% solution and a 50% solution. What
mixture will I need of the two solutions to make
what I want? In alligation, place the percentage
you want in the center of the tic-tac-toe board.
Place the higher percentage you have in the
top left corner. Place the lower percentage you
have in the bottom left corner.
Subtract the percentage you want from the
higher percentage you have and place it in
the bottom right corner. Subtract the lower
percentage you have from the percentage
you want and place it in the top right corner.
10 parts of the 50% solution to 20 parts of the
20% solution (this can be reduced to 1:2 parts)
Cross Multiplication
Otherwise known as ratio/proportions math, it
is a valuable tool that you can utilize for many
pharmacy calculations.You can use it for dosage
calculations and calculating day supplies and
needed quantities. Cross multiplication can be
utilized whenever you have three values and are
looking for a fourth.
EX: You have a prescription for Amoxicillin
Suspension 500 mg TID × 10d. The only avail-
able suspension you have is 250 mg/5 mL.
How many mL should be given three times
per day? First, place the known proportion on
the left-hand side. Then, set up the right-hand
side with the units matching the proportion,
with one blank spot being x.
5 mL xmL
Multiply diagonal values and place on two
sides:
250 * x = 5 * 500 or 250x = 2,500
Divide both sides by 250: x = 10
You should give 10 mL three times per day.
It may seem easy to calculate these figures in
your head, especially when they seem straight-
forward. But it is always a good idea to double-
check your mental math with cross-multiplica-
tion. Many errors have been prevented by doing
so—miscalculating by a single digit could have
devastating effects.
IV Flow Rate/Drip Rate
At its core, calculating drip rates can be done by
conversions and cross multiplication. Drip rates
are usually expressed as drops per minute (DPM).
The formula to calculate DPM is:
Total volume (in mL)
×
Drop factor
=
Drops
Total time (in minutes) 1 mL Minute
The drop factor is usually indicated in drops per
mL on the tubing or administration set that you
select (e.g., 60 gtts/mL).
Dosage Calculations
QS is a sig abbreviation that stands for “quan-
tity sufficient” and is used when doctors want
the pharmacy to calculate the necessary quan-
tity for the duration of the course they have
specified.
QS is never allowable on controlled substance
prescriptions, where the prescriber must speci-
fy the quantity.
Dosage calculation questions are fairly
straightforward and usually consist of how
many tablets will be given in a day? and how
much of the medication is needed?
This is usually a case of simple interpretation
of the sig.
EX: Q: How many tablets will be needed for a
prescription that reads 3 tablets QID 10d? A: 3
tablets 4 times per day for 10 days. 3 × 4 × 10
= 120 tablets
Q: For a prescription that reads 1 tablet TID,
how many tablets would you need to give
quantity sufficient for a 30-day supply? A: 1
tablet 3 times per day for 30 days = 1 × 3 × 30
= 90 tablets.
Below are common Roman numerals. When a smaller Roman numeral precedes
a larger one, it is subtracted from the larger one.
EX: IV is 5 (V) minus 1 (I) or 4.
I 1 XI 11 XXX 30
II 2 XII 12 XL 40
III 3 XIII 13 L 50
IV 4 XIV 14 LX 60
V 5 XV 15 LXX 70
VI 6 XVI 16 LXXX 80
VII 7 XVII 17 XC 90
VIII 8 XVIII 18 C 100
IX 9 XIX 19 D 500
X 10 XX 20 M 1000
Metric Conversions
Most numbers and calculations in pharmacy use metric measurements in variants
of grams or liters.
You can remember the metric prefixes using this mnemonic:
Kittens Hate Diving Under Dusty Couches Most Mischievously
Kittens Hate Diving Under Dusty Couches Most Mischievously
kilo- hecto- deca- UNIT deci- centi- milli- micro-
1000 100 10 1 .1 .01 .001 .0001
kilogram hectogram decagram gram decigram centigram milligram microgram
kg* hg dag g* dg cg mg* µg*, mcg*
kiloliter hectoliter decaliter liter deciliter centiliter milliliter microliter
kL hL daL L* dL cL mL** µL
*Most frequently used in pharmacy **Also known as cc (cubic centimeter)
In pharmacy strengths, you will most often see milligrams and micrograms. Pay
close attention: mg and mcg can look alike in poor handwriting. One drug to
pay close attention to is Levothyroxine (Synthroid), which is often labeled in
micrograms (but not always). Levothyroxine 100 mcg is the same as Levothy-
roxine 0.1 mg.
Common conversions of household measurements into metric are:
one teaspoon 5 mL
one tablespoon 15 mL
one fluid ounce 30 mL (29.57, but can be rounded for
most calculations)
one pint 480 mL (473.176)
one ounce 30 g (28.35)
Apothecary Measurement Conversions
Two apothecary measurements you may come across are drams and grains.
The vials typically used in a pharmacy are sized according to fluid drams (by
volume). Drams are also a unit of weight equal to 60 grains. Rarely, you will
come across drugs labeled according to grains rather than milligrams. The
typical example is phenobarbital. For conversion, remember that 1 grain (gr,
not to be confused with g for gram) equals 64.8 mg.
Sig Abbreviations
**Note: Best prescribing practices is to
include a frequency together with prn
on orders to prevent overdose. You will
often see pain medicine prescribed this
way (e.g., q4h prn [every four hours as
needed]).
Quantity
• qs: quantity sufficient
• #: signifies quantity to follow
(e.g., #30 is a quantity of 30)
• Disp: dispense; signifies quanti-
always fit on the prescription label.
If you are unable to reduce the direc-
tions to clear and understandable
instructions that fit, it may be neces-
sary to provide a separate instruction
sheet. Obtain prescriber permission
before doing so. You may then write
“Take as directed according to taper
instructions.” Prescribers know this
and will often do the same for their
patients. If you receive a pre-
scription that refers to outside
instructions (for tapers, bowel
prep, or any other medication),
make sure to ask the patient if they
have a copy of the instructions, and
*Note: q12 and bid could conceivably produce the same dosing schedule
because there are 24 hours in a day; however, they are not equivalent. If a
prescriber writes “q12,” they may want to ensure the doses are separated
by 12 hours, whereas this is not necessarily the case with “bid.”
ty to follow
• IU: international unit
• g: grams
• oz: ounces
2
Tapers & Titrations
Tapers and titrations often consist
of lengthy instructions that may not
whether they would mind sharing it
with you.
• ud, ad: as directed
30
Roman Numerals
20
20
Route
Alligations
50
30
20
q every bid* twice daily
qam every morning tid three times daily
qpm every evening qid four times daily
qhs every night at bedtime
(hs = hour of sleep)
prn** as needed
qd every day ac before a meal
qod, qad every other day pc after a meal
qh every hour cf with food
q12, q12h* every 12 hours stat immediately
q#, q#°, q#h every # hours d/c, dc discontinue
q#–#, q#–#h every #–# hours (e.g.,
q4–6 = every 4–6 hours)
MDD maximum daily
dose
qw, qweek weekly p̄ after
PO by mouth
NPO nothing by mouth
RECT, PR rectally
VAG, PV vaginally
AT, top apply topically
AAA apply to affected area
IM inject intramuscularly
SC, SubQ inject subcutaneously
IV intravenously
SL sublingually
IN intranasally
NEB via nebulizer
INH by inhalation](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)