1. Terminology and Abbreviations Every profession has its own unique language. In the worlds of finance, accounting and equity markets, analysts look at P & L statements, statements of cash flow, accounts receivables, etc. The medical professions have their own unique language. These terms are usually combinations of prefixes, root words, and suffixes. The terms have their roots in Greek and Latin.

2. Prefix A word that when attached to the beginning of a root word modifies it in someway. i.e. Bio means “life” from the Greek word bios (βίος) If you add this to logy meaning “study of” from the Greek logos (λόγος) you get biology meaning “study of life” i.e. geront0 means “old” from the Greek word, γέρων (geront) meaning old man and you add this to logy you get gerontology, meaning the study of the social, physiologically and mental aspects of aging. Geriatrics is the branch of medicine that studies disease in elderly people. A harder one: glio means “gluey” in Greek and glial cells in the brain refers to cells that support other cells in the brain. Blasto comes from a Greek word meaning “sprouting” and refers in science to a developing cell. When this two prefixes are added to “oma” (typically refers to cancer cells) you have the word glioblastoma meaning a cancer of young glial cells in the brain and is the most highly malignant type of brain cancer.

3. Important Prefixes for pharmacy “an” means without/ example: anesthesia “ante” means before/example: anterior “anti” means inhibit/example: antibiotic “brady” means slow/ example:bradycardia, slow heart rate “Contra” means against/ example: contraindicated “dys” means abnormal/ example: dysmorphic, abnormal shape “hyper” means too much/ example: hyperkalemia, too much potassium “hypo” means too little/ exampe: hypokalemia, too little potassium in the blood “Intra” means within/ example: intradermal (within the skin), intervenous (within a vein) “micro” means very small or can mean (1 per 1,000,000) in the metric system i.e. microgram (one millionth of a gram) “neo” means new/ neonate is a newly born baby. “poly” means too many/ polypharmacy is used to mean the practice of prescribing to many medications for the same purpose. “Sub” means below/ sublingual means below the tongue. Subcutaneous means below the skin Tachy means fast/Tachycardia is a rapid heart rate

4. Important root words in Pharmacy ROOTMEANINGEXAMPLE ArterArteryArterial ArthrJointArthritis BronchAirway in the lungBronchitis CarcinoCancerCarcinogen CardiHeartCardiac DermaSkinDermatitis EnterIntestineEnteral nutrition GastrStomachGastric pain GlucoSugarGlucometer HemoBloodHematology

5. Important Root words in Pharmacy ROOTMEANINGEXAMPLE HepatLiverHepatitis MyMuscleMyalgia NasaNoseNasal NephrKidneyNephrology NeurNerveNeurology OsteBoneOsteoporosis PneuLungpneumonia ProctoRectumProctotitis PulmoLungPulmonary RenKidneyRenal ThrombClotthrombosis

6. Suffix A suffix is a word that is added at the end of a root word to indicate or qualify its meaning. For example, arthr (joint) plus itis yields the word arthritis which meaning inflammation of a joint.

7. Important pharmacy related suffixes SUFFIXMEANINGEXAMPLE AcPertaining toCardiac AlPertaining toRenal AlgiaPainMyalgia AseEnzymeProtease CyteCellHepatocyte EctomySurgical removalHysterectomy EmiaBlood conditionhyperkalemia ItisInflammationHepatitis LogyStudy ofCardiology RrheaFlowing dischargeDiarrhea, rhinorrhea UroUrineUrology

8. General Pharmacy Abbreviations MeaningAbbreviation Adverse drug reactionADR Average wholesale priceAWP Controlled releaseCR DiscontinueDC Dispense as writtenDAW Drug utilization reviewDUR Enteric coatedEC Extended releaseER FluidFl. Maximum allowable costMAC No known drug allergiesNKDA Nothing by mouthNPO

9. General Pharmacy Abbreviations Table 2 MEANINGABBREVIATION Over the counterOTC PediatricPed PrescriptionRx Schedule 1CI Schedule 2CII Schedule 3CIII Schedule 4CIV Schedule 5CV SolutionSoln SuppositorySupp Wholesame acquisition costWAC

10. Case in point In 2001, a case was report to the FDA via medwatch, see article, http://www.fda.gov/downloads/Drugs/DrugSafety/MedicationErrors/UCM080654 http://www.fda.gov/downloads/Drugs/DrugSafety/MedicationErrors/UCM080654 The case involved an infant transferred from an obstetrics unit to a nursery for well babies with an order for DTO 0.7 ml PO q4h. The pharmacist in the case recognized the order as deodorized tincture of opium USP, which has a concentration of 60 mg/ml morphine. The prescribed dose translates into give 0.7 ml (42 mg) by mouth every four hours. This dose is 252 mg per day of morphine, a dose that can kill or send a newborn baby to the nicu for respiratory arrest. The pharmacist verified the order as diluted tincture of opium which is 25 fold dilution of the original drug. The actual dose is 0.7 ml(1.6 mg) by mouth every four hours.

11. Most commonly abbreviated medical conditions you will see Medical ConditionsAbbreviationCommon meaning Myocardial InfarctionMIHeart attack Congestive Heart failureCHFHeart muscle is dying Atrial fibrillationAFibA cardiac heart beat that is fast and abnormal Ventricular FibrillationVFA cardiac heart beat that is fast and almost always fatal Cerebral Vascular Accident CVAStroke/loss of blood flow to brain Diabetes MellitusDMA disorder of carbohydrate metabolism HypertensionHTNHigh blood pressure

12. Medical ConditionsAbbreviationCommon meaning CABGCoronary artery bypass graft Surgery to re-establish blood flow to the heart ATNAcute tubular necrosisA disorder of the kidney RARheumatoid ArthritisA joint disease that effects older people RIRenal InsufficiencyPoorly functioning kidneys PEPulmonary EmbolismA blood clot that travels to the lung DVTDeep vein ThrombosisA blood clot in the leg that often travel to the lung Not an all inclusive but include very common conditions

13. Medication Abbreviations AbbreviationDrugIndication ASAAspirinPain, post MI use APAPAcetaminophenPain, fever reducer in children 5FUFlurouracilAnti cancer drug SMX/TMPSulfamethoxazole/trimeth oprim Antibiotic HCTZHydrochlorothiazidediuretic INHIsoniazidAnti-TB (tuberculosis) drug 6-MP6 mercaptopurineImmune suppressant

14. Medication Abbreviations AbbreviationDrugIndication NTGNitroglycerinChest pain (angina) SSKISuper saturated potassium iodide Hyperthyroidism T4Levothyroxine (synthroid®)hyperthyroidism KCLPotassium chloridePotassium deficiency MgSO4Magnesium SulfateMagnesium deficiency MSO4Morphine sulfatePain killer PCNPenicillinantibiotic

15. Medication Abbreviations AbbreviationDrugIndication AZTZidoviduneHIV NSNormal SalineIV fluid D5WDextrose 5% in waterIV fluid D5WNSDextrose 5% in water with normal saline IV fluid MVIMultiple vitaminsVitamin replacement ISDNIsosorbide dinitrateChest pain MTXMethotrexateCancer drug

16. Most Common Sig Codes in Pharmacy Sig CodeMeaning Sig:Let it be written PCPost Cena (after meals) ACAnte Cena (before meals) UDAs directed Ad libAs desired PRNAs needed HSAt bedtime Qddaily

17. SigMeaning QEvery Q+blank+HEvery blank hours BIDTwice a day TIDThree times a day QIDFour times a day QODEvery other day QWEvery week (once) BIWTwice a week TIWThree times a week

18. Common Routes of Administration RouteMeaning POBy mouth SLSublingually BUBuccally INH or INInhalation IVPIntravenous Push IVPBIntravenous Piggyback IMIntramuscular SC or SubQSubcutaneously OpthVia the eyes

19. RouteMeaning OTOtic (via ears) PRRectally PVVaginally EXTopically IPIntraperitoneal

20. Uncommon Routes of administration Certain routes are not commonly used Often to avoid confusion and the potential for error the routes are spelled out on medical orders Example 1 Epidural Medication is given just outside the spinal cord next to the dura mater. Used in cases where high doses of pain medications are needed but side effects need to be minimized. Used in obstetrics ward in women undergoing labor Used for post operative patients in PACU Example of a drug is Fentanyl 2 mcg/ml with 0.0625% bupivacaine in 250 ml of NS

21. Example 2 Intrathecal Route Involves passing the medication through the spinal cord into the subarachnoid space to allow for direct bathing of the neural tissue in the drug Intrathecal chemotherapy i.e. methothexate, cytarabine Intrathecal Baclofen in cerebral palsy patients Advantages are that very small amounts of drug can be used leading to less side effects Disadvantages are high risk for infections and inadvertent overdoses

22. Epidural Injection Courtesy of: http://richardspatafora.com/2011/05/19/lumbar-epidural- cortisone-injection/

23. Common Abbreviations for quantities AbbreviationMeaning MgMilligrams GGrams GrGrains MlMillilter LLiter Fl. OZOunces (fluid) TabTablets mEqMilliequivalents TspTeaspoon TBSPTablespoon ccCubic centimeter (= 1 ml) Gtt(s)Drop(s)

24. JCAHO’s Minimum Do not use List In 2004, JCAHO published its minimum do not use list which the joint commission encourages health care institutions it accredits to use (at a minimum) AbbreviationProblemPreferred IUMistaken as IV or 10International units MS, MSO4 or MgSO4Confused for each otherMorphine sulfate/magnesium sulfate Q.D. and QODConfused for each otherDaily and every other day Trailing zero and no preceding zero (3.0 or.3) 10 fold overdose possible 3 or 0.3 ULook like 0Use “units” Mistake for mgWrite microgram HS or qHSMistaken for every hourWrite at bedtime g

25. AbbreviationProblemPreferred AS, AD, AU and OS, OD, OU Mistaken for each otherUse “left eye”, “left ear”, etc DC or D/CMistaken for discontinue meds Write discharge CcMistaken for zero’sWrite mls SC or SQMistaken for SL or 5 everyUse subQ or write subcutaneously TIWMistaken for three times a day Write three times a week

26. Less commonly known pharmacy terminology TermMeaning AnalgesicA drug for pain AnorecticA drug for appetite suppression AnalepticA drug that stimulates the CNS IV AdmixtureA drug product made by adding the drug to an IV bag AnestheticA drug that block sensations of pain or feeling in general Anaphylactic ShockA severe allergic reaction to a drug AnticoagulantA drug that blocks blood clotting AntitussiveA drug that blocks coughing AntiemeticA drug that stop N/V AntipruriticA drug that stop itching

27. TermMeaning Aseptic TechniquesTechniques used in making parenteral drug products that minimizes microrganism contamination Clinical TrialsMandated by the FDA for the marketing of new drugs in the US ContraindicationAn aspect of a patient’s condition that is not compatable with the treatment EmulsionA pharmaceutic dosage form where two immiscible liquid drugs are mixed together NSAIDNon steroidal anti-inflammatory drugs CorticosteroidsSteroid drugs used in autoimmune conditions GlucocorticoidsSame as above. Two terms are used interchangeable NeurolepticsDrugs that cause an effect on the CNS used to refer to old type of anti psychotic drugs like Haldol®

28. TermMeaning NarcoticA drug that induces sleep (from the greek word for “stupor”) AntisialagogueA drug that dry mucus and saliva secretion. Used before anesthesia to dry secretions. NMBNeuromuscular blocker SuspensionA drug dosage form that consists of suspended drug particles in aqueous solution SolutionA uniform homogenous mixture of a drug in water OintmentA semisolid mixture of drug in oily solid base TrocheA drug made into a lozenge dose form TinctureAn alcoholic mixture of a drug with at 25% V/V alcohol EnemaA drug in a fluid vehicle delivered into the rectum

29. TermMeaning NACDSNational Association of chain drug stores AphAAmerican Pharmaceutical Association NDCNational drug code issued by the FDA. The first five digits are the manufacturer; the second set of four digits are the drug, dose, dosage form; the third set of two number is the package size UPC codeBarcoded drug information COGSCost of goods sold MARMedication administration record eMARElectronic medication administration record ASHPAmerican society of health system pharmacists

30. TermMeaning BioavailabilityThe amount of drug that reaches the blood stream from a route of administration other than intravenous BioequivalenceThe comparison of bioavailability between two dosage forms Enterohepatic circulationThe excretion of the drug from the liver in the bile flow and its reaborption back to the liver First PassThe amount of drug that is metabolized by the liver before it reaches the blood, i.e. expressed as a percentage. Example is Lidocaine Geometric dilutionThe mixing of powder of unequal sizes Glomerular FiltrationThe process of kidney filtration of the blood Orange BookThe FDA official collection of approved drugs OBRA 90Omnibus budget reconciliation act of 1990 which require pharmacist’s counseling

31. TermMeaning Enteral or AlimentaryDescribes the organs of digestion and nutrient absorption from the mouth to the anus Aseptic techniqueA technique used in the manipulation of a IV products to maintain their sterile condition USP 797A standard published by the USP to provide guidance in the use of aseptic technique Auxiliary LabelAn extra label placed on a dispensed product that may add information for the patient Extemporaneous CompoundingThe preparation of a patient specific drug product HypersensitivityEqual to allergic drug reaction; anaphylaxis is the most severe type TeratogenicityA characteristic of drug that produces known birth defects