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ISMP maintains a “List of Confused Drug Names” highlighting look-alike/sound-alike name pairs with a history of mix-ups. Chlordiazepoxide (a benzodiazepine) and chlorpromazine (a typical antipsychotic) are a classic LASA pair on ISMP lists and in technician study materials, given their similar prefixes (“chlor…”) and length/appearance, leading to documented wrong-drug errors. While other pairs may also resemble one another, ISMP’s established examples include chlordiazepoxide/chlorpromazine specifically.

References (Pharmacy Technician documents / Study Guides):

• ISMP List of Confused Drug Names (community/inpatient).

• PTCB/ExCPT Medication Safety: LASA examples and tall-man lettering strategies.

• ASHP/ISMP LASA risk-reduction recommendations for selection, storage, and labeling.

Nitroglycerin sublingual tablets are light- and moisture-sensitive, requiring storage in tight, light-resistant containers. Removing them from their original glass container can compromise potency. Therefore, they must always be dispensed in the original container provided by the manufacturer.

According to USP Packaging and Storage Requirements and Mosby’s Pharmacy Technician:

“Nitroglycerin SL tablets lose potency quickly when exposed to air or light. Do not repackage; dispense only in manufacturer-supplied container.”

Other options do not require original container for stability:

Methotrexate – may be repackaged

Metoprolol XL – stable in unit-dose or amber vials

Allopurinol – routine packaging allowed

Diflucan (Fluconazole) is an antifungal medicationused to treatsystemic and local fungal infections, including:

Candidiasis (oral thrush, vaginal yeast infections)

Cryptococcal meningitis

Fungal infections in immunocompromised patients (HIV/AIDS, chemotherapy patients, etc.)

Fluconazole works byinhibiting fungal ergosterol synthesis, which is essential for fungal cell membrane integrity.

A. Bacterial infections❌→Incorrect

Fluconazole does NOT treat bacterial infections; antibiotics are required instead.

B. Gastroesophageal reflux disease (GERD)❌→Incorrect

Proton pump inhibitors (PPIs) or H2 blockers(e.g., omeprazole, ranitidine) are used for GERD.

C. Altitude sickness❌→Incorrect

Acetazolamide (Diamox) is used for altitude sickness, not fluconazole.

FDA Fluconazole Drug Label– Confirms antifungal indications.

Centers for Disease Control and Prevention (CDC) Guidelines– Lists fluconazole asa treatment for candidiasis and cryptococcal meningitis.

PTCB PTCE Exam Content Outline– Covers antifungal medications and their indications.

Why Not the Other Options?Key References:

USP compounding standards require maintaining a Master Formulation Record (MFR) and a Compounding Record (CR). The primary purpose is to ensure the compounded preparation can be consistently and identically reproduced with documented components, calculations, equipment, steps, and quality checks. While documentation can incidentally aid billing or inventory, those are not the primary objectives.

References (Pharmacy Technician documents/Study Guides):

• USP <795> Pharmaceutical Compounding—Nonsterile Preparations: requirements for Master Formulation Records and Compounding Records, including content and purpose (consistent, reproducible compounding and quality assurance).

• ASHP guidelines on compounding documentation and quality systems.

• PTCB/ExCPT study guides—compounding documentation, records, and reproducibility.

Outdated (expired) medicationsmust not be dispensedand should bequarantinedin a separate area to prevent accidental use.

Remove outdated products from active stock immediately.

Label and store them separatelyuntil proper disposal.

Follow DEA, FDA, and state board guidelines for disposal.

Some medications (e.g., controlled substances) require special disposal procedures.

(A) Shipped to the DEA for disposal❌Incorrect – Only controlled substances require DEA disposal (viaReverse Distributor).

(B) Kept on the shelf to be dispensed first❌Incorrect – Expired medications should NEVER be dispensed.

(C) Isolated from active dispensing stock✅Correct – Medications must be separated from usable stock to prevent dispensing errors.

(D) Reported to the ISMP for tracking❌Incorrect – ISMP (Institute for Safe Medication Practices) monitors medication errors, not expiration management.

FDA Drug Disposal Guidelines: https://www.fda.gov/drugs/disposal-unused-medicines

DEA Controlled Substance Disposal Regulations: https://www.deadiversion.usdoj.gov

PTCB Exam Content Outline – Inventory Management & Drug Disposal

Pharmacy Technician Guidelines for Handling Expired Medications:Analysis of Answer Choices:References for Pharmacy Technicians:

ISMP’s “Do Not Use” / error-prone abbreviations and dose designations emphasize avoiding trailing zeros (e.g., “120.0 mcg”), because the decimal point can be overlooked, potentially causing a tenfold error (e.g., read as 1200 mcg). ISMP also recommends using a leading zero before a decimal (e.g., 0.2 mg) to prevent misreads; thus 0.2 mg (A) and 1.4 mg (D) adhere to that guidance. 300 mcg (B) uses an acceptable unit (“mcg” rather than “µg”). Therefore, “120.0 mcg” (C) is the most error-prone due to the trailing zero.

References (Pharmacy Technician documents / Study Guides):

• ISMP Error-Prone Abbreviations, Symbols, and Dose Designations list: avoid trailing zeros; always use a leading zero before a decimal.

• PTCB/ExCPT medication safety sections covering safe dose expressions and ISMP recommendations.

• NCC MERP/ISMP educational materials on decimal point misinterpretation and tenfold dosing errors.

When adrug recalloccurs due totemperature excursions(exposure to temperatures outside the manufacturer’s recommended range during transport or storage), the pharmacy mustimmediately remove all affected productfrom its inventory to prevent dispensing compromised medication.

Remove the Affected Product:Quarantine the recalled drug to ensure it is not dispensed.

Verify the Recall Details:Confirm the lot number, expiration date, and reason for the recall using FDA or manufacturer recall notices.

Document the Recall Action:Log details in the pharmacy's recall records for compliance.

Follow Manufacturer or FDA Instructions:Some recalls require returning the product, while others require disposal according to hazardous waste guidelines.

Notify Patients and Providers (If Necessary):If the medication has already been dispensed, further action may be needed depending on recall severity.

B. Contact patients who received a therapeutically equivalent product.→ Incorrect. The recall applies to thespecificaffected lot, not all similar medications. Pharmacists would first verify which patients received the recalled drugbefore contacting them.

C. Switch patients from the oral solution to oral capsules.→ Incorrect. The recall does not automatically require a formulation change. The pharmacy must verify availability of unaffected stock or alternative treatments before making substitutions.

D. Contact all prescribers who recently prescribed the product.→ Incorrect. While prescribersmayneed notification if the recall affects patient treatment, thefirst stepis ensuring the recalled product is removed from stock to prevent further dispensing.

PTCB PTCE Exam Content Outline – Medication Safety and Recall Procedures.

FDA Drug Recall Guidelines (www.fda.gov).

USP <1079> Good Storage and Distribution Practices for Pharmaceuticals.

National Association of Boards of Pharmacy (NABP) Recall Compliance Standards.

Manufacturer Recall Notices (Example: Pfizer, Eli Lilly, etc.).

Mosby’s Pharmacy Technician: Principles and Practice – Recall Classifications and Actions.

Steps to Follow in a Drug Recall:Why the Other Answer Choices Are Incorrect:Pharmacy Technician References:

Atorvastatin and Zocor (simvastatin) are both HMG-CoA reductase inhibitors (statins). Prescribing two drugs from the same class for the same indication represents therapeutic duplication, which increases risk of adverse effects (e.g., myopathy, rhabdomyolysis) without added benefit. In contrast, Cardizem (diltiazem) is a calcium channel blocker, Lopressor (metoprolol) a beta-blocker, and Norvasc (amlodipine) a dihydropyridine calcium channel blocker—these are not statins.