Herbal Products and Health Risks Pharmacy Technician Post-test After completing this continuing education activity, pharmacy technicians will be able to • List herbal products associated with liver, kidney and heart damage • Recognize the potential for herbal products to be unsafe • Describe certificates of analysis and how to retrieve them from manufacturers 1

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Herbal Products and Health Risks Pharmacy Technician Post-test After completing this continuing education activity, pharmacy technicians will be able to • List herbal products associated with liver, kidney and heart damage • Recognize the potential for herbal products to be unsafe • Describe certificates of analysis and how to retrieve them from manufacturers 1. Which of the following agencies review and inspect herbal products before coming to market? A. United States Food and Drug Administration B. National Center for Complementary and Alternative Medicine C. International Association of Traditional Chinese Medicine 2. John Goodman, a frequent customer at your pharmacy, comes to the counter to pick up his monthly medications. He asks, “Would it be a bother to have you check out the rest of my items here as well?” Always one to help a customer, you tell him, “Of course, that’s fine!” You notice he has a botanic extract tincture that claims to help with heartburn. The ingredient list includes greater celandine (Chelidonium Majus). What organ dysfunction has been associated with this herb? A. Liver injury B. Kidney injury C. Heart damage 3. A patient brings a brown bag of herbs and supplements for you to list on his profile. Which product may increase this patient’s risk for BOTH kidney and liver injury? A. Pennyroyal essential oils B. Germander weight loss tea C. Impila fertility boost capsules 4. Mr. Goodman returns to your pharmacy. He explains he has been trying to live a healthier lifestyle, but has been feeling exceptionally tired after taking his as-needed alprazolam. Mr. Goodman goes on to tell you he’s added a new herbal supplement to his daily routine. You refer the patient to the pharmacist because you know and interaction between alprazolam and ______ could be causing the excessive drowsiness. A. Echinacea B. Garlic C. Ginger 5. A customer at your pharmacy asks you for help in the herbal supplement aisle. She wants to take echinacea to boost her immune system, but she’d like more information about the manufacturer’s quality testing. You call the manufacturer for a certificate of analysis (CoA) only to be told they do not release them. Which of the following is most appropriate to tell this customer? A. All herbal manufacturers are held to the same standards, so this brand is safe to use B. This company likely has no quality assurance process; we should look for a better brand C. This means the company uses an in-house laboratory for testing, so it is trustworthy 6. Your pharmacy is now selling a new herbal product. Curious about the contents, you decide to search for a certificate of analysis. On the bottle, you are looking for what three pieces of information? A. product name, lot number, and expiration date B. product name, manufacturer, and country of production C. manufacturer, lot number, and date of production 7. Which of the following patients is most at risk of a serious adverse event associated with henbane (Hyoscyamus niger)? A. A 27-year-old female with an irregular menstrual cycle B. A 48-year-old male with a history of atrial fibrillation C. A 62-year-old male with new onset major depressive disorder 8. Mrs. Jin is a longtime customer of your pharmacy who is on warfarin therapy for her atrial fibrillation. You ask to update her medication list in the system, including prescription, over-the-counter, and herbal supplements. Which of the following herbals would prompt you to refer Mrs. Jin to the pharmacist for counseling? A. Chamomile B. Kava kava C. American ginseng 9. “These kids nowadays takin’ that codeine, and that awful dextromethorphan!” exclaimed Mr. O’Timer, “When I was a kid, and even now, all I ever took was licorice. My mom, bless her soul, would never let any poison enter MY body. To this day that’s all I use when I get a cold.” Trying to move him along before he inevitably tries to talk to you about politics, you stop as he mentions his busy day full of specialist appointments. Which specialist would be MOST LIKELY toned to know Mr. O’Timer is using licorice for his colds? A. Dentist B. Podiatrist C. Cardiologist 10. Which of the following patients would be at greatest risk if they accidentally took Asian ginseng instead of American ginseng? A. A 23-year-old female taking fluvoxamine for obsessive compulsive disorder B. A 40-year-old female taking ondansetron for chemotherapy-induced nausea C. A 67-year-old male taking clopidogrel after a myocardial infarction Aggression, Irritability, and Violence: Drug-induced Behaviors Technician Post-test Pharmacy Technician Learning Objectives: ? ? ? Describe aggressive and irritable behaviors that may be drug induced Recall common medications that can cause aggression/irritability Identify what complementary and alternative medicine can cause aggression/irritability ? Infer when to refer patients to the pharmacist for issues regarding aggressive behavior 1. Which of the following sets of symptoms would be consistent with irritability? A. Reduced or moderate sensitivity to external stimuli B. A State of physical and psychological tension that may suddenly escalate C. Excessive control over temper and verbal behavior outbursts 2. Under what circumstances might irritability, aggression, or violence be considered an adverse drug reaction? A. It is considered an unintended and undesired reaction to a medicine B. It is an extension of the drug’s intended effect. C. It is a natural consequence of the chemical reactions that take place between the drug and the body 3. What is the difference between agitation and aggression? A. Agitated individuals intend to harm themselves, an object, or another individual B. Aggression is directed at a specific person or object C. Aggressive episodes contain intense emotional arousal and motor restlessness 4. Which of the following medications has been most closely associated with irritability, aggression, or violence? A. Ribavirin B. Interferon Alfa-2b C. Montelukast 5. Which of these drugs is part of the top 10 with highest risk of aggressive behavior? A. Sertraline B. Duloxetine C. Quetiapine 6. Which of these frequently dispensed medications cause aggression/irritability/violence? A. Levothyroxine B. Gabapentin C. Sertraline 7. Kathy comes up to the counter raving about this new diet that she’s trying called the Modified Atkin’s Diet. She is losing weight rapidly. When her daughter places a soda bottle on the counter, Kathy immediately snaps at her for grabbing the wrong one. Her daughter tries to fix the situation, but Kathy just rolls her eyes and says it’s too late to grab the right one now. What is the most likely cause Kathy’s unpredictable anger and irritability? A. The caffeine in the soda B. The ketogenic diet C. Kathy’s personality 8. A patient arrives at the counter, carrying half the supplement aisle with him to pick up his GERD medication. He chats with you as you ring him out, mentioning that he was told by his granddaughter who is studying to be a nutritionist to start these supplements. She advised him to take Krill Oil for his cholesterol, melatonin for sleep, Saw Palmetto for his prostate, and manganese for his osteoarthritis. Which of these supplements can cause aggression/irritability/violence? A. Melatonin B. Krill Oil C. Manganese 9. A family comes to the drop off window with new prescriptions this spring. The two mothers and all three kids have prescriptions for montelukast because of the worsening allergy season. One mother is a nurse and asks which of her children would be most affected by the neuropsychiatric symptoms of montelukast. Their ages are 23, 20, and 14. Who would be most likely to be affected by neuropsychiatric symptoms? A. The 14-year-old B. The 20-year-old C. The 23-year-old 10. A patient, while picking up a prescription, mentions off-hand that she noticed she was experiencing bouts of frustration and irritability after starting the medication. After determining that she did not want to stop the medication and was properly managing her symptoms, she said she wished to tell someone about the adverse drug reaction she experienced so others starting the medication can know it may happen to them. Where should you refer the patient? A. The pharmacist B. Their doctor C. FAERS Anticoagulants and Reversal Agents: Algorithm for Patient Safety Pharmacy Technician Post-test Pharmacy Technician Objectives: 1. Discover resources for patient information 2. Identify the medications used in anticoagulation therapy 3. Recall the medications used to reverse anticoagulation therapy 4. Determine when to refer the patient to the pharmacist regarding anticoagulation therapy 1. A. B. C. Which selection has BOTH correct brand/generic drug names? Coumadin (warfarin)/Xarelto (edoxaban) Xarelto (rivaroxaban)/ Sayvasa (apixaban) Xarelto (rivaroxaban)/Pradaxa (dabigatran etexilate) 2. Which of the following medications is an anticoagulant? A. Phytonadione B. Idarucizumab C. Edoxaban 3. Which oral medication can counteract the effect of warfarin? A. Betrixaban B. Phytonadione C. Prothrombin concentrate 4. Which of the following patient complaints should prompt a referral to a pharmacist for more discussion? A. My doctor said my kidneys have gotten much worse B. It’s hard to cut the tablets in half with my kitchen knife C. I had a mild case of the flu last week 5. Which anticoagulant needs to be dispensed in the original bottle? A. Dabigatran B. Rivaroxaban C. Warfarin 6. The medical acronym DOAC refers to which of the following? A. Anticoagulant reversal agents B. A class of oral “blood thinners” C. Dual Oral Anti-Clotting drugs 7. A key to medication therapy success is adherence. What can technicians review to screen for adherence issues? A. Insurance coverage B. Refill history C. OTC choices 8. Which of the following is an anticoagulant reversal agent? A. Apixaban B. Andexanet alfa C. Rivaroxaban 9. KS is on warfarin. She visits the prescription window and states that since taking the new blood pressure medication samples from her physician, she noticed minor gum bleeding when brushing her teeth every day. What might this symptom indicate? A. A potential drug interaction between her new medication and warfarin B. The need for immediate medical attention for bleeding reversal C. The need to stop taking her warfarin immediately and call 911 10. SS is picking up her refill for rivaroxaban and also purchasing a bottle of aspirin 325 mg tabs stating that “I’m going to start taking two pills a day for my back pain.” What is your best response? A. This is an oldie but goody, but you’ll need to take more than two a day—read the directions on the bottle for the right dose. B. It’s better for your stomach to try the buffered formulation. Would you like me to find a bottle for you? C. You should speak to the pharmacist first about the risks of aspirin use and blood thinner medications 11. Which of the following is/are the BEST sources of information for a patient who is on anticoagulants as asks for more information? A. Suggest that the patient visit The American Heart Association’s webpage and talk to the local librarian or join some support group. B. Provide the link for The Michigan Anticoagulation Quality Improvement Initiative’s “Patient Toolkit” and provide the most current Medication Guide. C. Tell the patient to write down any questions he has over the course of a week or so, and to call the prescriber’s office for answers. Law: "A Danger to the Public"--Would that be me? Learning Objectives: • • • • Review the most common errors made by healthcare practitioners including pharmacy staff Identify the factors contributing to the occurrence of errors Describe the process of reporting errors Characterize modifications in the workplace intended to reduce errors. Posttest-Pharmacy Technician 1. Which of the following elements must be present for an incident to meet the standard definition of a medical error? A. It causes harm B. It is identified by the patient C. It is preventable 2. Approximately how many reports of a suspected medication error does the U.S. Food and Drug Administration (FDA) receive annually? A. 10,000 B. 100,000 C. 1,000,000 3. Estimates of the frequency of pharmacy errors are inconsistent. However, what is a generally accepted rate of errors? A. 1 per thousand. B. 1-2% C. 5% 4. What is the (approximate) estimated annual number of pharmacy errors (using the generally accepted rate) in the U.S.? A. 1 million B. 22.5 million C. 44 million D. 100 million 5. What is the most frequently reported dispensing error? A. Dispensing the wrong dose B. Dispensing the wrong drug C. Incorrect directions on the label 6. Why do error rate statistics reported by different organizations and researchers vary? A. Patients are more likely to report errors to researchers than to government agencies that collect data. B. Researchers develop better methodologies to gather data and are more diligent than other statisticians. C. Statisticians use only clinically significant errors (which are subject to interpretation) to analyze data. 7. Which of the following is an error of omission? A. Dispensing the wrong drug B. Misreading a prescription due to illegible writing C. Failing to counsel 8. What does the FDA do with respect to drug names that may contribute to errors? A. The FDA examines a drug name if the manufacturer requests that it do so. B. The FDA may request that a drug name be changed after it has been marketed. C. The FDA does not regulate drug names; a “watch dog” group performs that function. 9. What did a study examining community pharmacy errors reported to the New Hampshire Board of Pharmacy find? A. The largest number of errors occurred during the data entry phase, especially if the pharmacy was too hot or too cold. B. More errors occurred when a single pharmacist was on duty compared with having more than one pharmacist on duty. C. The type of error that generated the most complaints to the board was different from the most common error found in research studies. 10. What do most Boards of Pharmacy in the U.S. typically do when a pharmacy error is brought to their attention? A. Boards of pharmacy refer to a federal table of penalties and select the appropriate action. B. Boards of pharmacy apply inconsistent standards when making a decision on a sanction. C. Boards of pharmacy investigate all errors thoroughly and require corrective action plans. 11. What is the most common sanction applied by state Boards of Pharmacy for prescription errors? A. Mandated continuing education on safety practices B. Mandated implementation of a board-approved CQI program C. Suspension or revocation of pharmacist licenses. 12. The Chicago Tribune conducted an investigation to see what would happen if a person presented a pharmacist with two prescriptions that would produce a dangerous interaction. How often did the pharmacist fill both prescriptions without offering a warning to the “patient”? A. Less than 1% of the time B. Approximately 10% of the time C. More than 50% of the time 13. What position has the American Pharmacists Association (APhA) taken on workplace issues? A. They oppose the setting and use of operational quotas or time-oriented metrics. B. They support increasing the technician to pharmacist ratio to at least 5:1. C. They refused to take a position, indicating this is a decision for individual states. 14. Which of the following is a part of the new Illinois practice act that was revised as a response to pharmacy errors? A. It lengthens the typical pharmacist work shift and requires hourly breaks. B. It provides protection for whistle-blowers who report safety violations. C. It limits the number of prescriptions a pharmacist may fill per hour. 15. Which of the following situations is correct regarding breaks under the new Illinois practice act? A. The pharmacy must be closed and empty of employees if the pharmacist is on a break. B. If pharmacists are on duty for more than 7 hours, they must have a meal break. C. Pharmacists can forgo their breaks and leave early if they would like. 16. The new Illinois practice act changes the requirements for technicians. Which of the following is a part of the Act? A. Pharmacies must have at least one pharmacy technician on duty whenever the practice of pharmacy is conducted. B. Two technicians (with one a certified technician) plus the pharmacist must check a prescription before it may be dispensed. C. Pharmacies must provide staffing of at least 5 pharmacy technician hours per 500 prescriptions filled. 17. What changes did Idaho implement for technicians as part of its program to increase technician responsibilities? A. Passed a regulation that would discipline technicians in the same way they do pharmacists in the case of an error B. Permits technicians to provide completed prescriptions to patients while the pharmacist is on a break C. Mandated continuing education for technicians and required all technicians to be certified 18. Some states have adopted the tech-check-tech program. What does tech-check-tech allow? A. Allows a technician to enter prescriptions into the system remotely. B. Permits a technician to perform the final validation of a prescription. C. Requires technicians re-check prescriptions after pharmacists perform their final check. 19 To qualify for tech-check-tech participation in a state like Wisconsin, what requirement must a technician fulfill? A. Have a minimum of 4,000 hours of experience at the pharmacy B. Have at least one months of employment at the participating pharmacy C. Seek additional didactic and practical training, including error reporting procedures 20. Recently, Oklahoma took an uncommon step in response to pharmacy errors. What did the state do? A. Required pharmacists to obtain 2 CE hours on patient safety annually B. Required pharmacists to document every drug interaction over-ride C. Fined an employer for inadequate staffing and prescription errors ASSESSMENT-Law: When is a Medication Not a Drug 1. The term therapeutic claim refers to: a. A statement that a drug has been approved to treat a disease. b. A claim that a conventional drug may be used to treat a disease, but which cannot be asserted by homeopathic products nor by supplements. c. The drug indication that is included in the package insert, but serves no other legal purpose. d. How a drug affects the normal functioning of an organ. 2. Which of the following is NOT under the jurisdiction of the FDA? a. Dietary supplements. b. Tobacco products. c. Soaps. d. Medical devices. 3. The Durham Humphrey Amendment to the FDCA: a. Authorized the FDA to make the distinction between prescription and OTC drugs. b. Authorized the FDA to make the distinction between conventional (allopathic) and homeopathic drugs. c. Permitted foods to make health claims. d. Required drugs to demonstrate safety before they could be marketed. 4. Homeopathic products are legally considered drugs because: a. They are listed in an official Pharmacopeia b. They have gone through the FDA approval process. c. They have a history which predates the current federal drug law. d. None of these, as they are not considered to be drugs 5. The Homeopathic Pharmacopeia is: a. A document found as an appendix in the USP. b. An unofficial resource maintained by the FDA. c. An independently published resource officially recognized by the FDA. d. A guide to drug standardization which was eliminated after the Food Drug and Cosmetic Act was enacted. 6. The FDA recently withdrew its compliance guide policy for homeopathic drugs because: a. Too many manufacturers are not following HPUS quality control guidelines. b. The homeopathy industry is too small to justify FDA oversight resources. c. There are concerns that the guide does not follow modern risk-based approaches to regulation and enforcement. d. There are no reported adverse events due to homeopathic products. 7. The Federal Trade Commission recently made a regulatory decision on homeopathic drugs. What did the FTC do? a. The FTC mandated that homeopathic drugs need to follow good manufacturing practice standards. b. The FTC ruled that prescription homeopathic drugs can be sold over the counter. c. The FTC ruled that the vast majority of OTC homeopathic drugs lack adequate substantiation for their efficacy claims d. The FTC ruled that they cannot regulate the marketing of OTC homeopathic drugs. 8. Marketing of a homeopathic drug product requires: a. b. c. d. Formal approval by the FDA taking into account the FDCA’s safety and efficacy standards. Conformance with the standards in the Homeopathic Pharmacopeia. Meeting the approval requirements in the Dietary Supplement Health and Education Act. That homeopathic drugs not be subject to post-market surveillance for safety. 9. The Dietary Supplement Health and Education Act (DSHEA) was enacted in: a. 1914 b. 1938 c. 1951 d. 1994 10. What was the rationale for the passage of the DSHEA? a. Congress was concerned that the FDA was being too lax in adequately protecting consumers from the risks of supplements. b. Congress was concerned about the unsubstantiated health claims being made for foods. c. Congress wanted to provide consumers with more information about the intended use of dietary supplements. d. Congress was concerned about herb-drug interactions. 11. Marketing of a dietary supplement product requires: a. b. c. d. Formal approval by the FDA taking into account the FDCA’s safety and efficacy standards. Conformance with the standards in the Homeopathic Pharmacopeia. The manufacturer to be responsible for determining the safety of supplements. Notifying the FDA of the manufacturer’s intent to market. 12. Which of the following is/are permissible claims for a dietary supplement? a. Herbal Viagra. b. Promotes healthy joints. c. Relieves pain and stiffness of arthritis. d. All of the above. 13. The burden of proof to demonstrate safety of dietary supplements is: a. On the manufacturer before the drugs is marketed. b. On the manufacturer after at least one year of MedWatch reports. c. On the FDA before the drug can be marketed. d. On the FDA who must prove a lack of safety after post-marketing surveillance. 14. Which of the following is INCORRECT about safety concerns for supplements? a. Herbals can interact with prescription drugs. b. Supplements are organically grown and are therefore free of pesticide residues. c. Supplements with different combinations of plant ingredients may differ in their pharmacological/clinical activity. d. The active ingredient in some herbal products may not be known. 15. Which of the following is correct with respect to consumer information about supplements? a. Consumers know that the FDA does not approve dietary supplements. b. Consumers rely on the FDA-mandated disclaimer when making a decision to use a supplement. c. The pharmacist is the most commonly utilized source for consumer information about supplements. d. Consumers have many misconceptions about the regulation of supplements. 16. The Federal Trade Commission (FTC) regulates the advertising of the following EXCEPT: a. OTC Drugs. b. Dietary supplements. c. OTC homeopathic products. d. Prescription drugs. 17. What is the most commonly used supplement product in the U.S? a. Echinacea. b. St John’s Wort. c. Multivitamins. d. Colon cleansers. 18. The FDA announced its intention to strengthen its regulatory oversight of supplements in 2019 due to: a. Concerns about the safety of supplements. b. Pressure from health care organizations to make some supplements products prescription only. c. The growing influence of celebrity endorsements of supplements. d. Concerns about internet sales. 19. One of the more common and more serious adverse effects due to supplements is: a. Brain damage. b. Liver damage. c. Cancer. d. Stroke. 20. What is the FDA Medwatch program? a. A program where health care professionals and consumers can report an adverse event associated with a drug or supplement. b. A program open only to health care professionals who are required to report an adverse event associated with a drug. c. A program where health care professionals can access all adverse events about a specific drug submitted to the FDA. d. A program reporting on drugs currently undergoing clinical trials. The Mediterranean Diet’s Effect on Health LEARNING OBJECTIVES: At the end of this home study, the pharmacist and pharmacy technician will be able to 1. Review the Mediterranean diet’s history and essential components 2. Discuss the relationship between culture, associated foods, and proven health benefits 3. Describe the relationship between the Mediterranean diet and the human microbiome 4. Discuss the pharmacist’s role as a resource for disseminating accurate, concise information to patients about the Mediterranean diet. 1. Ancel Keys was considered an icon in: a. Coronary heart disease b. Cardiovascular nutrition c. Influencing diet 2. Why did Ancel Keys become interested in studying cholesterol? a. He was a vegetarian, which is notoriously a low-cholesterol diet b. He was Italian and thought everyone should eat like Italians do c. He noticed a significant increase in heart disease mortality 3. What did Ancel Keys observe while traveling to Europe in the 1950s? a. Individuals born and raised in France or Germany experienced almost no cardiovascular disease or dyslipidemia b. There was a stark difference in the foods consumed and the health in Mediterranean countries compared to the United States c. In both France and Germany, the wealthy had high rates of cardiovascular disease, but the working class poor people had almost no cardiovascular problems 4. At what meeting did Keys present his ideas? a. World Health Organization b. UNESCO c. PREDIMED 5. What percentage of calories come from a carbohydrate source for the Mediterranean diet? a. 20%-30% b. 45%-55% c. 60%-70% 6. What disease states can benefit from the Mediterranean diet? a. Kidney disease, diabetes, asthma, Crohn’s, ulcerative colitis b. Ulcerative colitis , cardiovascular disease, GERD, asthma c. Cardiovascular disease, diabetes, hypertension, kidney disease 7. What is the human microbiome? a. The human microbiome is the complete population of all microbial organisms in and on our body b. The human microbiome is the microbial composition in our gastrointestinal tract, their genes and the environment that they live in within our bodies c. The human microbiome is the complete species list of all organisms that could pose a potential threat to our bodies 8. Which disease states are likely to benefit from the microbiome? a. Kidney disease, diabetes, asthma, Crohn’s b. Ulcerative colitis , cardiovascular disease, GERD, migraines c. Cardiovascular disease, celiacs disease, obesity 9. Which of the following is NOT a function of the microbiome? a. The microbiome strengthens the impermeability of the intestine b. The microbiome helps produce sex hormones to provide optimal fertility c. The microbiome contributes to immune system function 10. Which of the following food groups provides the most amount of microbes to our bodies? a. Grains and cereals b. Meats c. Fruits and vegetables 11. What is the effect of Bifidobacterium and Lactobacillus in the microbiome? a. They create the perfect environment for bacteria to grow by enhancing the pH and water saturation throughout the GI tract b. They defend the intestines against opportunistic pathogens c. They stimulate the growth of other beneficial species 12. Which of the following is a major factor contributing to intestinal and extra intestinal diseases? a. Inadequate fluid intake b. Dysbiosis c. High sugar intake 13. What is the effect of re-diversifying a dysbiotic microbiome? a. New disease states will occur b. Loss of function in the microbiome c. Prevention of intestinal diseases 14. Which of the following best describes the Mediterranean Diet? a. Low carbohydrate, low fat, high animal protein diet b. High carbohydrate, high fat, low animal protein diet c. Low carbohydrate, high fat, high animal protein diet 15. The Historic Centre of Florence is an example of a ____________________. a. UNESCO Intangible Cultural Heritage b. UNESCO Cultural Heritage c. UNESCO Natural Heritage 16. What was the purpose of the PREDIMED trial? a. To test the efficacy of the Mediterranean diet on decreasing all-cause mortality b. To test the efficacy of the Mediterranean diet on cardiovascular health c. To test the efficacy of the Mediterranean diet on the composite endpoint 17. What did the Aging and Adherence to the Mediterranean Diet find? a. An association between adherence to the Mediterranean Diet and adherence to medication b. An inverse association between adherence to the Mediterranean Diet and adherence to medication c. An inverse association between adherence to the Mediterranean Diet, polypharmacy and cardiometabolic disorders 18. Which of the following is an example of a typical meal based on the normative Mediterranean diet? a. Bread with olive oil, charcuterie, cheese, a glass of wine b. Bread with olive oil, lentil salad, a glass of wine c. Bread with olive oil, grilled chicken, lentil salad 19. Which of the following can help pharmacists and pharmacy technicians analyze a patient’s diet? a. The Cardiac Rehabilitation UK Mediterranean Diet Scorecard b. The Oldways Diet online site c. The Mayo Clinic’s webpage on eating 20. Select the statement that is TRUE: a. The Mediterranean diet builds on inexpensive food that the poor, working class people ate traditionally. b. If researchers look at other regions of the world, no similar diets or health implications exist. c. Most pharmacists and techs instinctively follow a Mediterranean diet and can explain it to patients. Post Test Immunization: A Quick Refresher: Perfect Intramuscular Injection Technique 1. When injecting a vaccine into the deltoid muscle, which area should you be certain to AVOID? A. The lower 1/3 of the upside-down triangle in which the acromion process is the top edge B. The middle 1/3 of the upside-down triangle in which the acromion process is the top edge C. The upper 1/3 of the upside-down triangle in which the acromion process is the top edge 2. You have completed the steps necessary to prepare for injecting a vaccine. You are almost ready to insert the needle into the patient’s arm. What is the LAST STEP before inserting the needle? A. Pinch the skin on both sides so it makes a “mountain” and inject into the scrunched skin B. Use your non-dominant hand to pull the skin in one direction away from the injection site C. Tell the patient that it will not hurt and inject in whatever way is most comfortable for you 3. After injecting the vaccine, removing the needle, activating the safety mechanism, and discarding the syringe in the sharps container, what should you do to ensure the medication is absorbed? A. Nothing. If you have used good injection technique, your job is done! B. Massage the area for approximately one or two minutes. C. Apply a hot compress and have the patient hold it there for 15 minutes. 4. How quickly do most guidelines recommend to inject vaccines? A. 1 mL/second B. 0.1 mL/second C. 0.01 mL/second 5. Why does the Advisory Committee for recommend AGAINST aspiration when injecting vaccines? A. It increases risk of bleeding that will be difficult to stop B. It causes vaccine to leak from the muscle and decreases effectiveness C. No large blood vessels are present at the recommended injection sites 6. Which of the following are the MOST COMMON bloodborne pathogens? A. Hepatitis B, hepatitis C, and HIV B. Influenza, coronavirus, and HIV C. Pneumonia, pinkeye, and staphylococcus 7. Which of the following statements is TRUE? A. Always recap needles by hand B. Dispose of used needles in trash receptacles C. Use needles with safety features 8. If you absolutely must recap a syringe by hand, how many hands should you use? A. One B. Two C. Three (get someone else to help) 9. You are prepared to inject a vaccine and have uncapped the needle, and thrown away the cap. Your team leader enters the room and says she needs you immediately to answer some questions about your last patient. She has brought another immunizer to take over your station for 15 minutes. Which of the following is the BEST way to proceed? A. Hand the syringe with the uncapped needle to your replacement so he can finish this patient’s vaccination and leave with the team leader. B. Fish around in the trash can, find the cap, and recap the needle, and give the now-capped needle to your replacement to finish with this patient. C. Tell the team leader that you have discarded the cap, and suggest you finish with your current patient since it will only be a few seconds. 10. You inadvertently squirt something from a used syringe into your eye. What do you do? A. Irrigate with clean water, saline, or sterile irrigants B. Wash with soap and water C. Flush with detergent and water 11. Which of the following would be considered an “engineered injury protection”? A. Syringes with sliding sheath that shields the attached needle after use B. Using an open container in which to dispose used needles C. Asking employees for input on what needles they prefer 12. Select the statement that is TRUE for the current Pfizer and Moderna vaccines: A. Both vaccines do not come with administration devices B. Both must be stored in the refrigerator until 15 minutes before use C. Both require needles that are 22-25 gauge and 1-1.5 inches in length 13. You greet a patient and ask him to uncover his deltoid. As you assess him, you notice that he must weigh at least 350 pounds. Which factor needs to be adjusted before you administer the vaccine? A. The dose B. The needle gauge C. The needle length 14. Your patient looks at the syringe, pales, and begins to shake. She tells you that she has a “vasovagal” reaction to needles. You do not know what this means. What is the BEST way to proceed? A. Distract her with idle chit-chat B. Find a more experienced immunizer C. Tell her she will have reschedule 15. Patients can be quirky. Your current patient wants to stand to receive the vaccination. What is the BEST explanation for why both of you should sit? A. Immunizers who sit and administer vaccines to seated patients reduce the risk of injury to the patient’s shoulder. B. Immunizers who sit and administer vaccines to seated patients reduce the risk of needlestick injury to the immunizer. C. Immunizers who stand and administer vaccines to seated patients reduce the risk of the patient fainting. 16. Your patient is heavily tattooed. In this training, we emphasized the importance of finding the area of clearest skin. Why? A. We want to be able to see a local reaction if it develops. B. Injecting into tattooed skin is more painful for the patient. C. Current COVID vaccines cannot be given in a tattooed area. 17. What is the proper angle to give an IM injection? A. 45o B. 90o C. Inject at 45o, withdraw at 90o. 18. Which of the following questions should you be prepared to answer in case a patient asks? A. Does the vaccine’s vial have plastic in the stopper? B. Does the vaccine’s vial have latex in the stopper? C. Does the vaccine come in a multidose vial? 19. What is the BEST position for a patient’s arm while you are giving an IM injection? A. Relaxed with palms on legs or arm dangling at sides B. Taut with the patient squeezing a rubber ball C. Flexed as if they were showing you the size of their deltoid 20. You’ve vaccinated a patient with a COVID vaccine, disposed of the sharp, and finished your task. What is the BEST thing to tell the patient? A. Thanks for doing this, your nation appreciates you. B. See you for the follow-up dose in six weeks! C. Please remain in the clinic for 15 minutes. Fundamentals of Antimicrobial Stewardship Practices for Outpatient Pediatric Infectious Diseases Technician Posttest At the end of this activity, pharmacy technicians will be able to Identify common repercussions of irrational antibiotic use in pediatrics Describe the prescription and OTC products and processes most likely to be used when children have infections 3. Identify why and how to store and safely dispose of antibiotics 4. Discuss why patients and parents may need to be educated about issues other than antibacterial resistance 1. 2. 1. When a 2 year old pediatric patient develops an infection and a prescriber determines that the patient needs an antibiotic, what kind of antibiotic is the BEST one to choose? A. A liquid antibiotic B. A broad spectrum antibiotic C. A narrow spectrum antibiotic D. A penicillin antibiotic 2. Select the statement that BEST describes the reason why Antimicrobial Stewardship Programs are just as important in outpatient settings as in inpatient settings. A. 10% of prescribed antibiotics are unnecessary and up to 30% are inappropriate in choice, dose, or duration B. 30% of prescribed antibiotics are unnecessary and up to 30% are inappropriate in choice, dose, or duration C. 50% of prescribed antibiotics are unnecessary and up to 80% are inappropriate in choice, dose, or duration D. 30% of prescribed antibiotics are unnecessary and up to 50% are inappropriate in choice, dose, or duration 3. A parent comes to the pharmacy and says he has just taken his four year old to the pediatrician and learned that she has otitis media. The pediatrician did not write a prescription, but told the father that he can pick up what he needs to treat the child in the OTC aisle. The father cannot remember what he needs. Which of the following is the MOST LIKELY to have been recommended by the doctor? A. An analgesic like acetaminophen B. An analgesic like aspirin C. Wax-softening ear drops D. A decongestant/antihistamine 4. Where should pharmacy staff tell parents to store amoxicillin/clavulanate? A. Refrigerator B. Room temperature C. Freezer D. Medicine cabinet 5. Which of the following has NOT been associated with a high likelihood of S. pneumonia resistance and the need for a higher dose of amoxicillin? A. Severe illness B. Age younger than 2 years C. Daycare attendance D. No previous antibiotic use 6. You are preparing a prescription for amoxicillin/clavulanic acid 250 mg, #20, one tablet BID. Your pharmacy is out of amoxicillin/clavulanic acid 250 mg tablets. Which of the following is the MOST APPROPRIATE alternative? A. Advise the patient to come back tomorrow after 10 AM (which is when your order arrives) B. Fill the prescription with amoxicillin/clavulanic acid 500 mg, #10, ½ tablet BID C. Ask the pharmacist and parent if amoxicillin/clavulanic acid 250 mg suspension is acceptable D. Ask the pharmacist if you can call the pediatrician to change the antibiotic to azithromycin 7. Why would prescribers tend to avoid tetracycline or doxycycline in children who are 8 years old or younger who have community acquired pneumonia? A. Resistance is very likely B. Safer alternatives are available C. Most bacteria is not susceptible D. Its taste is a problem for kids 8. One Thursday evening, a parent presents a prescription for her son, who has GAS pharyngitis. She says that the pediatric nurse practitioner confirmed the diagnosis by culture. She has a prescription for penicillin and asks you not to mix it until Monday morning because they are going away for the weekend, and she plans to start the penicillin next Tuesday morning. Is this plan acceptable? A. Yes. You can fill the prescription now, and leave a note on the bag that the patient will reconstitute it at home. B. No. The child should start treatment within a few days because untreated pharyngitis can lead to spread of GAS to nearby physical structures. C. Yes. The infection may resolve over the weekend, so tell the parent to call if they decide not to fill the prescription. D. No. If the parent decides to wait to start the antibiotic, the very least she should do is to pick up some ibuprofen or aspirin for her son’s pain. 9. Which of the following infections is vaccine preventable? A. Influenza and pneumococcal disease B. Mastoiditis and influenza C. H. influenzae type and C. Difficile D. Group A Streptococcus and the common cold 10. A parent brings a prescription for her daughter to the pharmacy, and you begin the intake process. Which of the following information is most important to have on the prescription to ensure the antibiotic is appropriate? A. Patient weight, allergies, current diagnosis (if known) B. Patient age, address, current diagnosis (if known) C. Patient weight, allergies, whether the parent will be waiting D. Patient address, telephone number, vaccination history 11. A parent visits the pharmacy and is having difficulty understanding the risks of antibiotic use. He has a four month old infant who has a first episode of otitis media. He indicates that everybody takes antibiotics for a couple of weeks every year, and they are safe. Select the statement that is the BEST way to explain risks. A. Antibiotics are among the safest of all medications, but we all need to worry about bacterial resistance. B. Antibiotics are safe, but almost everybody who takes them gets diarrhea. Who needs that? C. Whenever an antibiotic is dispensed, there is a chance that your child may find the bottle, like the flavor, and overdose. D. Approximately 30% of all children who take antibiotics for at least 14 days experience an adverse event. 12. Which of the following is NOT a good response to a parent who is grumbling because the pediatrician refused to write a prescription for an antibiotic? A. Talk to the pharmacist. Pharmacists tend to be more “pro” antibiotic than physicians or other prescribers. B. Think about it this way: an unnecessary antibiotic increases risk of side effects or accidental overdose. C. Did you know that we’ve used so many antibiotics that they are present in soil, water, and plants? D. Although antibiotic overdoses don’t usually cause death, even one death from an antibiotic overdoses too many. 13. Which of the following is a reasonable way to help patients dispose of medications properly so they don’t infiltrate our water supply? A. Advise patients to flush medications down the toilet so that people don’t have access to them in garbage. B. Suggest that patients save any unused antibiotics so that they can use them the next time that they had an infection. C. Dispense liquid antibiotics as dry powders, and tell patients how to reconstitute them when they think they need them. D. Post signs and discuss mechanisms like National Take-Back Day and online resources to find appropriate disposal sites. 14. Which of the following problems should be corrected using workflow adjustments to improve antibiotic use? A. The local pediatric nurse practitioner calls the pharmacy and provides a diagnosis for every prescription when writes for antibiotics. B. Technicians who prepare prescriptions for cefdinir and rifamin suspensions rarely apply the “Make discolor urine or stool” auxillary label. C. Pediatric analgesic products are located on the top shelf and parents sometimes have trouble finding them. D. Pharmacists are assigned to the intake windows and talk to parents before the technicians prepare prescriptions for a final pharmacist check. 15. Which of the following is the BEST way to establish a sense of urgency about antibiotic stewardship with patients and communities? A. Educate patients and communities about antibiotic resistance, the potential for antibiotics to cause adverse events, the potential for poisonings, and widespread environmental concerns. B. Engage your local environmental organizations to take up the cause; they are likely to be able to reach more people than the healthcare system can. C. Place more emphasis on adverse effects and potential poisonings than on indication, dosing, and storage; this will frighten parents. D. Apply a large label with the National Poison Control Hotline to every prescription for antibiotics; this will heighten awareness of poisoning risk. 16. Which of the following antibiotic suspensions should be stored at room temperature after reconstitution? A. Amoxicillin/clavulanate B. Azithromycin C. Cephpodoxime D. Cefuxoxime PSA (PROSTATE SPECIFIC ADVANCEMENTS): UNDERSTANDING SUPPORTIVE CARE, UPDATED GUIDELINES, AND NOVEL MEDICATIONS Pharmacy Technician Post-test Pharmacy Technician Learning Objectives • • • RECALL common symptoms of prostate cancer and the typical medications used to treat them IDENTIFY medications that are typically appropriate for symptom management in patients with prostate cancer RECOGNIZE when to refer patients to the pharmacist for recommendations 1. Which of the following is a common symptom of ADVANCED prostate cancer? A. Prostate pain B. Back pain C. No symptoms (asymptomatic) 2. Which of the following medications can prevent bone pain requiring surgery or radiation therapy in a man with castrate-resistant metastatic prostate cancer? A. Alendronate B. Denosumab C. Gabapentin 3. A 69-year-old man with metastatic hormone-sensitive prostate cancer recently started androgen deprivation therapy with leuprolide 22.5 mg IM q 12 weeks. He comes into the pharmacy and is complaining of hot flashes that interrupt his sleep several times each night. He feels exhausted. Which of the following pharmacologic treatments could his physician prescribe? A. Citalopram B. Sildenafil C. Venlafaxine 4. A 76-year-old man has numerous symptoms that suggest prostate cancer. He undergoes a biopsy, and his doctor confirms he has localized prostate cancer. He is categorized as high risk and will begin treatment with docetaxel and prednisone following radiation therapy and androgen deprivation therapy. He comes to the pharmacy with a prescription for dexamethasone. Why would the physician prescribe dexamethasone? A. It can alleviate mineralocorticoid syndrome B. It can alleviate nausea and vomiting C. It can mitigate chemotherapy-induced reflux 5. A 67-year-old man with metastatic hormone-sensitive prostate cancer recently started on androgen deprivation therapy with leuprolide 22.5 mg IM q 12 weeks. Which of the following bone health medications should he begin immediately? A. Alendronate 70 mg po weekly B. Calcium 1000 mg/day + vitamin D3 400 international units/day C. Denosumab 120 mcg SQ q 4 weeks 6. A 76-year-old man recently diagnosed with very high-risk localized prostate cancer is starting his second cycle of docetaxel + prednisone this week. As he picks up his antihypertensive medication, he complains to you that since starting chemotherapy his stomach is a wreck with acid reflux. What could you recommend to the patient? A. Suggest that this patient talk to a pharmacist for counseling B. Ask if he takes his breakthrough antiemetic before taking prednisone C. Walk him to the antacid aisle and explain all the options 7. A 73-year-old man with a history of localized prostate cancer recently progressed to castrate-resistant nonmetastatic prostate cancer. He began taking enzalutamide about four months ago. He comes into the pharmacy to pick up his prescription refill and during your chat, he mentions he is having headaches and confusion quite frequently. What could you recommend to the patient? A. Recommend he talk with his primary care doctor the next time he is scheduled for a visit B. Refer him to the pharmacist; this could be signs of posterior reversible encephalopathy syndrome C. Recommend he take enzalutamide at night as this improves these common, expected side effects 8. A 71-year-old man with castrate-resistant nonmetastatic prostate cancer is taking apalutamide. He calls complaining of a rash on his chest. Which of the following medications might the pharmacist recommend as a first treatment option? A. Oral diphenhydramine B. Oral prednisone C. Topical lidocaine 9. Prostate cancer patients receiving androgen deprivation therapy often experience sexual dysfunction. Which of the following medications can be used to treat ejaculatory problems? A. Alendronate B. Fluoxetine C. Gabapentin 10. A 71-year-old man with BRCA1-mutated castrate-resistant metastatic prostate cancer is receiving olaparib. His wife picks up his refill and mentions he started having a cough that is worsening but no fever. She wants to know what over-the counter product he could use. What would you recommend to this patient’s wife? A. Recommend she call his primary care doctor to discuss B. Recommend she talk to the pharmacist because it could be pneumonitis C. Show her the over-the-counter cough suppressant options Changing Perspectives on Contraceptives: The Pharmacist's Guide to Prescribing & Counseling on Birth Control PHARMACY TECHNICIAN TEST QUESTIONS EDUCATIONAL OBJECTIVES: After participating in this activity, pharmacy technicians will be able to: 1. Discuss the basic facts about hormonal birth control 2. Acquire reputable sources for patients who have questions about birth control 3. Recognize over-the-counter and prescription drugs that may affect birth control effectiveness 4. Infer when to refer patients to the pharmacist for recommendations 1. A patient is picking up her oral contraceptives and also purchasing other items. Which item would prompt you to refer the patient to the pharmacist for further counseling? a. Male latex condoms b. Acetaminophen/aspirin/caffeine tablets for migraine c. Antacids for acid reflux d. Hydrocortisone cream for itching 2. A 16-year-old patient approaches your pharmacy and states she had unprotected sex about 48 hours ago. She is looking for emergency contraceptive; a friend told her she could get it at the pharmacy. What is the appropriate response? a. Apologize that you cannot sell her emergency contraceptive without a prescription due to her age b. Advise her that it is too late; emergency contraceptive must be taken within 24 hours to be effective c. Inform her that emergency contraceptives are by prescription only and offer to contact her physician d. Sell her LNG 1.5mg for emergency contraceptive and refer her to the pharmacist for further counseling 3. Which is true of the estrogen in combined hormonal contraceptives? a. Mestranol is the most common form found in COCs b. The dose range of ethinyl estradiol is 20-50mg c. It can slightly increase risk of venous thromboembolism d. Second-generation products cause the most side effects 4. Which of the following progestins is most likely to cause acne? a. Norgestimate b. Drosperinone c. Norethindrone d. Levonorgestrel 5. Your patient is interested in using contraceptives, but she has trouble remembering to take daily medication. Which of the following options requires the least patient adherence? a. Intrauterine device b. Vaginal ring c. Transdermal patch d. DMPA injection 6. A patient approaches the pharmacy consultation window with a spermicidal sponge for more information. Which is an appropriate counseling point? a. This wouldn’t happen; spermicidal sponges are prescription-only. b. The sponge should be in place 24 hours before the first sexual encounter. c. The sponge should be removed within one hour of intercourse. d. See a doctor if nausea, fever, rash, or dizziness occur. 7. A patient is experiencing breakthrough bleeding on day 15 of her cycle. Which of the following can cause this adverse effect? a. Too much progestin b. Not enough progestin c. Too much estrogen d. Not enough estrogen 8. You are making adherence outreach calls to follow up on patients who are late to refill their medications. One of your calls is regarding a prescription for norethindrone 0.35 mg. Upon talking with the patient, she states she has plenty left because she forgets to take her pill about once a week. What should you do? a. Explain that strict adherence to a POP is important, and refer her to the pharmacist for other options b. Suggest that she take emergency contraceptive, as she has likely gotten pregnant c. Refill the prescription for her and insist that she pick it up d. Tell her that you will leave the refill on file and advise her to call when she needs it 9. A patient asks your advice for the best medical tape to use to hold on her transdermal contraceptive patch that keeps falling off. What do you recommend? a. Use tape only around the edges to secure the patch in place b. Try sticking it to another area of the skin, it should stick on its own c. If the patch is no longer sticky, it should not be used d. Wear the patch under a tighter piece of clothing to hold it in place 10. A woman is buying the following items at the pharmacy pick-up counter. What two products would prompt a referral to the pharmacist for counseling? • A refill of norethindrone 0.35mg • Latex male condoms • Miconazole vaginal antifungal cream • Tampons • Antacid tablets a. Latex male condoms & norethindrone 0.35mg b. Miconazole vaginal antifungal cream & antacid tablets c. Norethindrone 0.35mg & tampons d. Latex male condoms & miconazole vaginal antifungal cream 11. Which statement is true about the etonogestrel implant? a. It is inserted into the vagina and left in place for three years b. Fertility can be delayed six-12 months after removal c. It is long-acting, and can be used by women of all ages d. It is not likely to cause bleeding irregularities 12. A patient on ethinyl estradiol 20 mcg/levonorgestrel 0.1 mg was prescribed penicillin for an acute illness. Why should you refer her to the pharmacist for counseling? a. Penicillin can increase estrogen levels in the blood b. Penicillin can decrease birth control effectiveness c. It is especially important not to get pregnant while acutely ill d. Penicillin increases the risk of menorrhagia 13. Which of the following is true of the ethinyl estradiol/norelgestromin transdermal patch? a. It is likely to cause breast discomfort b. It is more effective than oral contraceptives in obese patients c. A patch is applied and left on for three weeks, then removed for one week d. Patch placement should be consistent to the same area 14. Where should you direct patients who are wondering what the most costeffective birth control method may be for them? a. Office on Women’s Health website b. Planned Parenthood website c. American College of Obstetricians and Gynecologists website d. Wikipedia: Birth Control 15. A woman should place a diaphragm over the cervix _________ before intercourse, and should not remove it until at least _________ after. a. Up to six hours; 24 hours b. 15-40 minutes; six hours c. Up to six hours; 48 hours d. Up to six hours; six hours 16. Your patient is picking up her combination oral contraceptive and a bottle of St. John’s wort. Why would you refer this patient to the pharmacist? a. St. John’s wort is unsafe in pregnancy, so she should take a test first b. St. John’s wort can increase her birth control levels, leading to overdose c. St. John’s wort can make her birth control less effective d. There is no need to refer her to the pharmacist What is USP General Chapter and What Does It Have to Do with Me? Post-test (for pharmacists and technicians) EDUCATIONAL OBJECTIVES: After participating in this activity, pharmacists and pharmacy technicians will be able to: • • • • • DEFINE the United States Pharmacopeia’s functions and its responsibility for the USP DESCRIBE recent changes to USP and affected clinicians COMPARE sterile and non-sterile compounding and differentiate between the categories of Compounded Sterile Products. DESCRIBE the parts of a cleanroom suite and discuss cleaning procedures IDENTIFY recommended training requirements, general monitoring, and sampling procedures 1. Personnel involved in compounding CSPs must be trained and must complete recertification every 12 months in appropriate sterile compounding principles and practice. How often do these personnel need to complete a gloved fingertip and thumb sampling? A. Every month B. Every 6 months C. Every 12 months 2. You have these things on your to-do list this morning: prepare 17 injections, make a nasal spray, and make four irrigations for body cavities. Which one need NOT be prepared in a sterile environment? A. The injections B. The irrigations for body cavities C. The nasal sprays 3. How often does the buffer area (which is part of the cleanroom) need to be recertified? A. Every 3 months B. Every 6 months C. Every year 4. What are Dynamic Operating Conditions? A. When there is no one in the buffer room B. When there are lots of people working C. When the usual number of personnel are working 5. What are the action levels (i.e., number of colony forming units requiring corrective action) as applied to bacterial and fungal surface samples? A. ISO 5 >3, ISO 7 >5, ISO 8> 50 B. ISO 5 >1, ISO 7> 3, ISO 8 > 25 C. ISO 5 >1, ISO7 >3, ISO 8 >10 6. What is the suggested maximum temperature and humidity for a cleanroom in which you plan to prepare a medication that will have an expiration of 18 hours at room temperature and 36 hours under refrigeration? A. 20 degrees Celsius with 60% humidity B. 40 degrees Celsius with 30% humidity C. 20 degrees Celsius with 30% humidity 7. How often should surface sampling be conducted? A. Monthly B. Every 3 months C. Every 6 months 8. What is the correct BUD for a multiple dose vial that contains preservatives if it is kept under refrigeration? A. 12 hours B. 10 days C. 28 days 9. How often should SOPs be reviewed? A. Every 6 months B. Every 12 months C. Every 24 months 10. Which of the following constitutes a cleanroom suite? A. A segregated compounding area B. A room that contains PEC C. An ante room and buffer room 11. What is the action level for a subsequent (i.e., not initial) gloved fingertip and thumb sampling test (in total number of cfu for both hands)? A. >0 cfu B. >1 cfu C. >3 cfu 12. Which is a NEW addition regarding handwashing procedures? A. Personnel must wash hands and forearms up to the elbows B. Brushes must not be used for hand hygiene C. Soap must be dispensed from a closed system of non-refillable soap 13. Which statement is true? A. Garb must be donned and doffed in an exact order that is specified in the USP B. Employees should not don and doff garb in the ante room at the same time C. Cleanroom staff must throw gowns away when leaving the buffer room. 14. Which statement about the USP is TRUE? A. The USP consists of three well-paid groups who set public policy on healthcare B. The USP oversees policies pertaining to drug information and quality standards C. Local health departments enforce its standards when they do quarterly inspections. 15. Lori is the quality manager at your facility. She is making changes so you will be compliant on December 1, 2019. Which of the following is a change that she should make? A. She must administer a written or electronic test covering sterile compounding principles to personnel every 12 months. B. She must be sure that the handwashing sink is equipped with several nail brushes, some nail picks, and an antifungal agent. C. She must create a log of employees who have tattoos, piercings, or who have had rashes or conjunctivitis in the last year. 16. Once a media fill test has been completed, it must be incubated at what temperature and for how long? A. 7 days at 20-25°C then 7 days at 30-35 C B. 2 days at 20-25°C then 7 days at 30-35°C C. 7 days at 30-35 C then 2 days at 20-25°C 17. Of the three types of cleaning agents, which type is used to destroy fungal microorganisms ? A. Cleaning agents B. Disinfecting agents C. Sporicidal agents 18. What type of question will be most reliable in your annual written test? A. “K-type” questions that ask the test-taker to identify multiple correct answers for at least five possible answers. B. True/false questions provided you ensure that the most are not TRUE and they test knowledge. C. Multiple choice questions with the stem being a question and all answer about the same length. 19. What is the BEST reason to administer a written test to cleanroom employees? A. To meet the requirements of USP that will be implemented on December 1, 2019 B. To confirm that the learner has a good understanding of essential concepts and skills C. To provide documentation that supports a higher pay grade for cleanroom employees 20. Under what circumstances would you use application-based questions? A. When testing whether the employee has memorized cfu levels B. When testing if an employee knows what to do in challenging situations C. When testing to see if the employee knows what should be cleaned daily