Appendix D: Understanding Drug Information, Drug Names, and Pronunciations

in Manual for Pharmacy Technicians
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Drug therapy has become increasingly complex and the number of new drugs approved for use has significantly increased during the past decade. The result is that pharmacy technicians are frequently challenged with drug information questions throughout the workday and must become knowledgeable about the handling, availability, and uses of medications. A basic knowledge of drug information resources available will help prepare technicians to assist pharmacists with certain drug information requests.

Pharmacy reference books and electronic media, including the Internet, that are available in practice settings often hold the answers to typical, day-today practice-related questions. These resources can also be used as study aids for the technician certification examination and to expand a technician’s general knowledge about medications. Therefore, it is essential that technicians understand the basics about frequently used reputable pharmacy references.

The purpose of this appendix is to classify the various types of drug information requests, explain which types of questions are appropriate for pharmacy technicians to answer, and list resources that can be used to find answers to drug information requests. This appendix also provides information regarding drug naming conventions and pronunciations. With time and practice, technicians will be able to find the information that they need quickly and efficiently and become even more valuable members of the healthcare team.

THE DRUG INFORMATION REQUEST

A drug information request is simply a question regarding a medication. The person requesting the information, the requestor, can be a nurse, doctor, other healthcare professional, or patient. The request might be asked over the telephone, in person, or via fax or e-mail. The request may be simple, requiring little time to research and answered quickly, such as “What is the generic name of Lipitor?” Other requests may be complicated, requiring a significant amount of research before they can be answered, such as “What is the safety of fluoxetine (Prozac) in pregnancy?”

Before responding to a drug information request, technicians must clearly differentiate questions that fall within their scope of practice. In general, if a question requires specific knowledge about a medication and/ or professional judgment, it should be answered by a pharmacist. An example is a patient wanting to know whether he or she is experiencing a side effect from a medication. The pharmacist needs to obtain patient-specific information, research whether the medication could cause the side effect, and use his or her professional judgment to determine whether the side effect could be due to the medication or something else going on with the patient. In some cases, the distinction between the two types of questions may not be apparent. If there is any doubt about the nature of the question, the technician should defer the question to the pharmacist.

It is important to identify the person initiating the request, and when the request comes over the telephone, to obtain contact information (phone, pager, fax, etc.) in case the person needs to be called back. The search for and response to drug information requests will differ depending on who requests the information. Knowing information about the requestor, including his or her training and knowledge of the subject, will impact the final response and how it is given. For example, if a pharmacist is asked how the drug ondansetron (Zofran) works, he or she would respond differently if the request was from a patient compared to a physician. When answering questions from patients, medical terminology should be avoided, and the response should be put into language that patients can understand. The answer would be more in-depth to a physician, and written information might also be provided. Obtaining information about the purpose of the request will help to determine the needs of the requestor and whether it involves clinical judgment, requiring the expertise of a pharmacist. It will also make the search for information more efficient. It is important to find out if the information is for general knowledge or if it pertains to a specific patient. If the question involves a specific patient, the pharmacist will need to obtain background information to respond to the question. For example, if a physician asks what the dose of gabapentin (Neurontin) is, the pharmacist needs to know if it is for a specific patient and, if so, what the indication is, the patient’s age, kidney function, other medications, allergies, etc.

The urgency of the request and the extent of information needed should also be determined so that an appropriate amount of time is allotted to answer the request. Often, part of the question can be answered initially (if needed urgently), with the remainder of the answer provided later, allowing time to research a more thorough response. For example, a physician calls and wants to know if the pharmacy stocks a new drug that has recently been Food and Drug Administration (FDA) approved. Upon further questioning, it is discovered that she has a patient in her office that might benefit from the drug and she needs to know if the drug is available. She would also like some written information about the drug. This is an urgent request, and the initial answer is no, the drug is not stocked in the pharmacy and does not appear to be available at the wholesaler yet. Because the drug is not even available yet, the request is no longer urgent. The technician can call the wholesaler and/or the manufacturer to find out when the drug will be available and the pharmacist can gather information about the new drug and follow up with the physician at a later time.

After information is gathered about the request and the requestor, it is helpful to identify the type of question that is asked, or to classify the request. Classifying the type of request helps to narrow the search and make the search process more efficient. Many of the questions that technicians encounter fall into the categories outlined in Table D-1.

Table D-1.

Classifications of Drug Information Questions Answered by Technicians

Question ClassificationExamples
General
  • What is the brand name of warfarin?
  • Do Naprosyn and Aleve contain the same active ingredient?
  • Who manufactures Humira?
  • Is Prilosec available in a generic? Is it a prescription or over-the-counter (OTC) product?
  • Where can I find the phone number for Allergan?
  • When will the patent for Trintellix expire?
  • Where can I find the Vaccine Information Sheet for the influenza vaccine?
Availability and Cost
  • Which dosage forms of Imitrex do you have in stock?
  • Is Zoloft available in a liquid? What size and concentration is available?
  • What are the prices of Adalat CC and Procardia XL?
  • How long it the shortage of albumin expected to last?
Storage and Stability
  • Should enoxaparin be stored in the refrigerator?
  • How long is a flu shot stable after it is drawn up in a syringe?
Calculations
  • How many milliliters are in an ounce?
  • How many milliliters of azithromycin are needed for a 5-day course of therapy?
Preparation
  • How should ampicillin injection be reconstituted?
  • What is the recipe for spironolactone suspension?

CONDUCTING THE SEARCH: CHOOSING THE RIGHT REFERENCES

There are many drug information resources available. The key to answering questions quickly and accurately is to know where the necessary information is likely to be found. Not all references contain every possible answer to every drug information question. At times, it may be difficult to find a reference that contains the information that you are seeking. Pharmacists may use multiple resources to validate the information that is found, such as the dose of a medication for a pediatric patient or the significance of a drug interaction. As part of a systematic search strategy, tertiary references are used first, then secondary references, and, finally, primary references

Tertiary references include print or electronic textbooks (e.g., compendia such as American Hospital Formulary Service Drug Information (AHFS DI), Micromedex, or Lexi-Comp handbooks; review articles; or information found on the Internet). Secondary references include indexing systems such as PubMed/Medline, which provides a list of journal articles on the topic that is being searched. Primary references are original research articles published in scientific journals, such as the American Journal of Health-System Pharmacists (AJHP) or the Journal of the American Pharmacists Association (JAPhA).

Drug information databases are integrated within many computer systems and automated dispensing cabinets, offering drug information directly at the point of care. There are many references that are also available as mobile phone apps. Other resources include pharmaceutical manufacturers and specialized drug and poison information centers. Table D-2 lists examples of commonly used drug information resources and a summary of the type of information contained in the resources.

Internet

The Internet is a useful source for drug information when used appropriately. Pharmaceutical manufacturers often have reputable sites because they should only have FDA-approved content on them. Government sites are usually reputable because experts have reviewed the information and there is no conflict of interest (i.e., they aren’t selling anything). Pharmacy and medical organizations often have their information reviewed by experts in the particular field and are therefore considered reputable. Commercial or personal sites can contain erroneous and/or misleading information, especially if a product is being sold. Information found on the Internet should always be evaluated for believability, the validity of the source, accuracy, supporting evidence, and timeliness. Table D-3 lists useful websites that can be accessed for drug information, including a brief description of what each site contains.

Table D-2.

Commonly Used Drug Information Resources

ResourcePublisherDescription
AHFS Drug InformationASHPGeneral drug information (drug monographs and therapeutic guidelines) in print and electronic formats
AHFS Clinical Drug InformationASHPGeneral drug information (combines AHFS DI, off-label drug use, current drug shortage information, real-time drug and safety updates) in an interactive electronic format
Lexicomp

Drug Information Handbook

Pediatric & Neonatal Handbook

International Trade Names Index

Drug Information Handbook for Oncology
Wolters KluwerAvailable as print handbooks, online, and mobile drug information with an interactive drug interactions tool

Provides general drug information and specialty information for pediatrics and oncology
Facts & Comparisons eAnswers

 Drug Facts and Comparisons

 A to Z Drug Facts

 Off-Label Drug Facts

Brigg’s Drugs in Pregnancy and Lactation

 Natural Products Database

 Manufacturer Index
Wolters KluwerOnline drug information database with drug monographs and comparative charts

Additional modules for off-label drug use, drug use in pregnancy and lactation, natural products, and manufacturer index and contact information
Clinical Pharmacology

 Trissel’s 2 Clinical Pharmaceutics

 MedCalc 3000

 Index Nominum
Elsevier/Gold StandardOnline drug information database with drug monographs for general drug information

Additional modules available for injectable and extemporaneous compounded products, clinical calculators, and global drug name directory
Micromedex

 Drug Information

 NeoFax and Pediatrics

 CareNotes patient information

 Red Book

 Toxicology Management
IBM Watson HealthOnline drug information interactive database for general and specific drug information

Drug monographs, IV compatibility, drug interactions, price and availability, patient information, toxicology
Drugs.comDrugs.comComprehensive online drug information on prescription, OTC, and natural products

Contains a drug database, pill identifier, interactions checker, patient information, a pharmaceutical company database, and other features
United States Pharmacopeia and the National Formulary (USP–NF)The United States Pharmacopeial ConventionThe USP contains monographs for drugs, dosage forms, and compounded preparations

The NF contains excipient monographs

This reference is the official compendia for drugs marketed in the United States, and drugs must conform to the standards in this reference
The Orange Book: Approved Drug Products with Therapeutic Equivalence EvaluationsUS Food and Drug Administration (FDA)Drug products approved by the FDA, including therapeutic equivalence evaluations for multisource prescription products, as well as biologics, discontinued drugs, OTC drug products, and patent and exclusivity information
USP Dictionary of US Adopted Names and International Drug NamesThe United States Pharmacopeial Convention (USP)Illustrations of chemical structures and names of nonproprietary drugs in the United States and other countries as well as a pronunciation guide
Physician’s Desk Reference (PDR)PDR, LLCDrug prescribing information and tablet identification in print, online, and mobile options
Pediatric Injectable Drugs: The Teddy Bear BookASHPInjectable drug information specifically addressing issues unique to pediatric patients
Handbook on Injectable DrugsASHPCompatibility, stability, storage, and preparation of injectable drugs
King Guide to Parenteral AdmixturesKing Guide PublicationsStability and compatibility data for injectable drugs
Extended Stability for Parenteral DrugsASHPStability of injectable drugs beyond the usual 24-hour limit for alternate infusion sites
Trissel’s Stability of Compounded FormulationsAPhAStability information of drugs compounded for oral, enteral, topical, ophthalmic, and other specialized preparations
Natural MedicinesTherapeutic Research CenterEvidence-based database of information on safety and effectiveness of natural medicines and alternative therapies
Pharmacist’s LetterTherapeutic Research CenterDrug information, drug comparisons charts, pharmacy practice and disease-related charts and guidelines, latest clinical trial results, patient education, and best practice information
Pharmacy Technician’s LetterTherapeutic Research CenterTechnician tutorials for essential skills, error prevention, dispensing, and patient-oriented resources, latest news and research
Handbook of Nonprescription Drugs: An Interactive Approach to Self-CareAPhANonprescription drugs, nutritional supplements, medical foods, and complementary therapies, and nondrug and preventive care
Poison Control CentersAmerican Association of Poison Control Centers (AAPCC; 800-222-1222)In case of poisoning or if overexposure occurs, a poison control center should be called

Callers will be automatically routed to their local poison control center 24 hours a day, 7 days a week

Local poison control centers have valuable resources and training materials for poison prevention activities
Safety Data Sheets (SDS), formerly called Material Safety Data Sheets (MSDS)Available directly from manufacturers; various online sites offer limited access or subscriptions

Refer to employer for information on how to access
Information on the potential hazards associated with a material or product, safe use and spill-handling procedures

IV = intravenous, OTC = over-the-counter.

Drug Names

The Food, Drug, and Cosmetics Act requires that all drugs have an “established name,” or a nonproprietary name, other than the chemical name. The United States Adopted Names (USAN) Council establishes nonproprietary names for drugs and biological substances. The United States Pharmacopeial Convention (USP), FDA, American Medical Association, and American Pharmacists Association participate in the USAN Council. The USP Nomenclature Expert Committee usually accepts the nonproprietary names adopted by the USAN.1 The Nomenclature committee also develops and maintains a Pronunciation Guide for drug substances and excipients, which is used by USAN.2

Oversight of brand names is the responsibility of FDA, which works with the applicants (drug manufacturers) when reviewing and approving New Drug Applications, Abbreviated New Drug Applications, and Biologics License Applications. The FDA division responsible for reviewing and approving new product names is the Division of Medication Error Prevention and Analysis (DMEPA) and the Office of Prescription Drug Promotion (OPDP). The DMEPA’s focus is on safety, comparing proposed names to existing ones to determine the likelihood for confusion. The OPDP focuses on reviewing names that could lead someone to draw an overly positive conclusion about the products’ benefits. They assess whether a name might overstate the product’s efficacy, imply minimized risk, broaden product indications or make unsubstantiated superiority claims.

Despite this review prior to marketing, medication errors can occur due to similar names. Healthcare professionals are encouraged to report drug names that have the potential to or have contributed to medication errors to FDA’s MedWatch website: www.fda.gov/medwatch.4

Table D-3.

Useful Websites for Obtaining Drug Information

Website NameDescriptionAddress (URL)
US Food and Drug Administration (FDA)Home page for the FDA; contains numerous useful links for consumers and healthcare professionalswww.fda.gov/default.htm
Drugs@FDA: FDA Approved Drug ProductsInformation about FDA-approved drugs; complete prescribing information and approval historywww.accessdata.fda.gov/scripts/cder/daf/index.cfm
REMS @FDA: Approved Risk Evaluation and Mitigation Strategies (REMS)Links to REMS for individual drugs that are required by FDA to have a REMS to ensure that the benefits of a drug or biologic product outweigh the riskswww.accessdata.fda.gov/scripts/cder/rems/index.cfm
Medication GuidesLinks to FDA-approved Medication Guideswww.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=medguide.page
FDA Drug ShortagesInformation about current and resolved drug shortages and discontinuations reported to FDAhttps://www.accessdata.fda.gov/scripts/drugshortages/default.cfm
FDA Drug RecallsLinks to voluntary drug recalls taken by companies to remove a defective drug product from the marketwww.fda.gov/Drugs/DrugSafety/DrugRecalls/default.htm
MedWatch: The FDA Safety Information and Adverse Event Reporting ProgramInformation from FDA about safety information regarding medical products; one can report a problem here alsowww.fda.gov/Safety/MedWatch/default.htm
Centers for Disease Control and Prevention (CDC)Home page for the CDC; information about diseases and conditions, vaccines, traveler’s health, emergency preparedness, and other topicswww.cdc.gov
CDC Vaccine Information StatementsLink to Vaccine Information Statements (VIS) that explain the risks and benefits of vaccineswww.cdc.gov/vaccines/hcp/vis/index.html
CDC Immunization SchedulesInformation on recommended vaccination schedules for adults and pediatrics and other resourceswww.cdc.gov/vaccines/schedules/index.html
National Institutes for Health (NIH)Home page for the NIH; information about health topics, clinical trials, and the various divisions of the NIHwww.nih.gov
US National Library of Medicine: DailyMedOfficial provider of FDA label information (package inserts) of drugs marketed in the United Stateshttps://dailymed.nlm.nih.gov/dailymed/
US National Library of Medicine: PubMedPubMed is a searchable database of millions of citations for biomedical literature from MEDLINE, life science journals, and online bookswww.ncbi.nlm.nih.gov/pubmed/
US National Library of Medicine: MedlinePlusMedlinePlus is a website for consumers with information about diseases, conditions, health topics, drugs and supplements; also contains videos and toolshttps://medlineplus.gov
US National Library of Medicine: ClinicalTrials.govA database of clinical trials being conducted around the worldwww.clinicaltrials.gov
ASHPHome page for ASHP; news related to health-system pharmacy and many helpful links for pharmacy professionalswww.ashp.org
ASHP Pharmacy TechnicianPharmacy technician section of the ASHP website; information on news, articles, toolkits, forums, and other resources geared for technicianswww.ashp.org/pharmacy-technician
ASHP Drug Shortages Resource CenterUp-to-date information on current drug shortages, including which products are affected and why, the anticipated time to resolution, and alternativeswww.ashp.org/Drug-Shortages
ASHP SafeMedicationWebsite for patient medication information, including My Medicine list and medication tips and toolswww.safemedication.com
American Pharmacist Association (APhA)Home page for APhA; news related to pharmacy and many helpful links and resources for pharmacy professionalswww.pharmacist.com
Institute for Safe Medication Practices (ISMP)Homepage for the ISMP; medication error education and alerts, a section for reporting, medication error tools and resourceswww.ismp.org
NeedyMedsOnline resource for medication and healthcare-related patient assistance programswww.needymeds.org/about

Drug names contain a “stem” to identify a group of related drugs with common characteristics, such as similar mechanisms of action. Table D-4 lists stem elements of common drug names. The stem can be a prefix (at the beginning of the name), infix (middle of the name), or suffix (end of the name).5,6

There are prefixes and infixes with specific meanings. For example, Ar–, es–, lev–, and dex– are used to name stereoisomers of drugs that are already named, such as formoterol–arformoterol, albuterol–levalbuterol, and lansoprazole–dexlansoprazole.

Drugs that have two-word names are usually salts, esters, or prodrugs. The active portion of the drug is listed first and the second word is the inactive portion, or the part of the ester or prodrug that is released in the body to the pharmacologically active component.7 Examples include enalapril maleate, which is a prodrug that is converted to enalaprilat, and fosaprepitant dimeglumine, which is a prodrug that is converted to the active drug, aprepitant.

Monoclonal antibodies are named similarly. They all contain a prefix, an infix that represents the target, and the stem –mab used as a suffix. The prefix is a syllable or group of syllables that is used to create a unique name. The inflix contains information about the action or use of the antibody. The USAN has specific syllables that represent diseases or targets8:

  • ami- = serum amyloid protein (SAP)
  • ba- = bacterial
  • ci = cardiovascular
  • d(e) = endocrine
  • fung = antifungal
  • gros = skeletal muscle mass-related growth factors and receptors
  • ki = interleukins
  • li = immunomodulating
  • ne = neural
  • os = bone
  • ta = tumors
  • toxa = toxin target
  • vet = veterinary use
  • vi = viruses, antiviral indications

Understanding monoclonal antibody naming can help differentiate the drugs from each other and provide a clue to the drug’s target. For example, infliximab contains the inflix –li– and the suffix –mab. It is a monoclonal antibody that has immunomodulating properties. Abciximab contains the inflix –ci– and is a monoclonal antibody that is used to prevent cardiac ischemic complications.

Biosimilar products have a naming convention also. The biosimilar products are required to have a distinguishing suffix with four lowercase letters.9 Some examples of biosimilar products include infliximababda, infliximab-dyyb, and filgrastim-sndz.

Table D-4.

USAN STEM List4,5

Table D-4.

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IV = intravenous.

PRONUNCIATION GUIDE

The USAN developed and approved a pronunciation guide to help with pronunciation of drug names. Syllables are based on phonetics. A prime mark (‘) follows the primary accent syllable, and a double prime mark (“) follows a secondary accent syllable. Syllables are separated by a blank space, such as filgrastim (fil gra’ stim) and fosaprepitant (fos” a pre’ pi tant). Short vowels do not contain any special designations, but long vowels are designated as follows10:

  • a = ay
  • e = ee
  • I = eye
  • o = oh or oe (if used with a consonant)
  • u = ue
  • y = ee or eye

Many drug information references incorporate pronunciations and phonetic spelling in their databases. Prescribing information, including patient package inserts and Medication Guides, also lists the phonetic spelling and pronunciation of brand names and/or generic names. Some references have verbal pronunciations, such as drugs.com. Table D-5 lists common drug names with their phonetic spelling.

Table D-5.

Common Drug Names and Their Phonetic Spelling

Generic NamePhonetic Spelling
Acetaminophena seet’ a min’ oh fen
Albuterolal byoo’ ter ole
Allopurinolal oh pure’ i nole
Alprazolamal pray’ zoe lam
Amlodipineam loe’ di peen
Amoxicillina mox i sil’ in
Aspirinas’ pir in
Atenolola ten’ oh lole
Atorvastatina tore’ va stat in
Azithromycinaz ith roe mye’ sin
Bupropionbyoo proe’ pee on
Carvedilolkar’ ve dil ol
Citalopramsye tal’ oh pram
Clonazepamkloe na’ ze pam
Clopidogrelkloe pid’ oh grel
Cyclobenzaprinesye kloe ben’ za preen
Duloxetinedoo lox’ e teen
Escitaloprames sye tal’ oh pram
Fluoxetinefloo ox’ e teen
Fluticasonefloo tik’ a sone
Furosemidefyoor oh’ se mide
Gabapentinga’ ba pen tin
Glipizideglip’ i zide
Hydrochlorothiazidehye” droe klor” oh thye’ a zide
Hydrocodonehye” droe koe’ done
Ibuprofeneye byoo’ proe fen
Insulin glarginein’ su lin glar’ geen
Levothyroxinelee voe thye rox’ een
Lisinoprillyse in’ oh pril
Losartanloe sar’ tan
Meloxicammel ox’ i cam
Metforminmet for’ min
Methylphenidatemeth” il fen’ i date
Metoprololme toe’ proe lole
Montelukastmon te loo’ kast
Omeprazoleoh mep’ ra zole
Oxycodoneox i koe’ done
Pantoprazolepan toe’ pra zole
Potassiumpoe tass’ i um
Pravastatinpra’ va stat in
Prednisonepred’ ni sone
Propranololproe pran’ oh lole
Ranitidinera ni’ ti deen
Rosuvastatinroe soo’ va sta tin
Sertralineser’ tra leen
Simvastatinsim’ va stat in
Tamsulosintam soo’ loe sin
Tramadoltra’ ma dole
Trazodonetraz’ oh done
Venlafaxineven’ la fax een
Warfarinwar’ far in
Zolpidemzol’ pi dem

REFERENCES

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