Tips for Passing the New York Pharmacist Compounding Exam "Patience and preparation are your most important study tools"

The New York State Pharmacy Compounding Exam (Part III, aka “wet lab”) is a requirement for individuals seeking to earn their pharmacist license in the state of New York. It’s in addition to the mandatory NAPLEX (Part I) and MPJE (Part II) exams that every state requires.

The compounding exam is provided twice a year during the beginning of both January and June. The NY Board of Pharmacy website will list the upcoming dates of the exam, as well as important application information (http://www.op.nysed.gov/prof/pharm/pharmlic.htm). Note that you have to submit an application for the exam by a specified date. For the January exam, the application must be submitted before November 1st of the previous year and by April 1st for the June exam.

It’s not an easy exam, but if you’re smart about your preparation and stay determined, then it becomes easier. The secret is to start studying early. There is a great deal of information that is available for the Board of Pharmacy to include within the exam. You want to cover as much as possible so that you’re not surprised when you take the exam.

There are review sessions provided at various pharmacy colleges that can help prepare you for the exam. The review sessions generally take place a few weeks before the actual exam, but I would begin studying before attending the review session. This will allow you to cover more material in general and prepare you with questions for the review instructors.

The exam is divided into two parts taking place over two days. Day 1 is the written portion of the exam which constitutes 40% of the entire exam grade. This consists of three topics: look-alike/sound-alike drugs (LASA), patient medication profiles, and prescription verifications (aka “errors & omissions”). Day 2 is the practical portion which includes the physical compounding of “prescription” medications and makes up the remaining 60% of the exam grade.

Look-Alike/Sound-Alike (LASA) Drugs

On the exam, you will be given a table consisting of eight pairs of LASA drugs. On the page opposite from the table, you’ll be given a numbered list of approximately 100 drug indications. You’ll be required to write a number representing an indication next to an appropriate drug name within the table. The indications can be used more than once.

Each LASA pair is worth one point. No partial credit is given, therefore you have to get both indications within the pair correct to obtain the full point.

The easiest and most effective way for me to prepare for this section of the exam was to make flash cards.

I started by obtaining the List of Confused Drug Names from the Institute for Safe Medication Practices’ (ISMP) website (https://www.ismp.org/tools/confuseddrugnames.pdf). All of the drug pairs are listed twice, therefore I began by going through the entire list and crossed out the second set of each drug pair. Otherwise I would have had twice as many flash cards as I needed.

On the front of each flash card I wrote one drug pair from the list. The back side is where I wrote each drug’s most common indication(s). In addition to the indications, I included the drug’s brand or generic name(s) at the bottom of the back side. This portion of the exam only tests you on the indication, but studying the brand/generic names at the same time helped me prepare for the overall exam.

I studied my LASA flash cards everyday. Even if I only found time to look over two or three cards during my commute, for example, this helped me inch closer to completing all of them.

Although this section is only worth eight points, the studying helped prepare me for the entire exam. Knowing the drug’s generic & brand names and indications is crucial for every section of the exam, including the practical compounding portion on Day 2.

Patient Medication Profiles

The exam will include three patient profiles that contain the patient’s identifying data, past and current medications, allergies, diagnoses, lab work, and other information. You’ll be presented with a new prescription or medication order and must determine if there will be any problems involved with dispensing the new medication.

If an issue does exist, you must write a description of the problem (2 points) and include a recommendation on how to correct the issue (2 points). Each profile is worth a total of four points.

When writing your recommendation, don’t try to get too fancy. Describe the issue and your recommendation and move on to the next question. If your recommendation is correct, but includes additional information that is wrong, you will lose points even though you were technically correct.

Some helpful tips for identifying and correcting the dispensing issues:

• Be aware of any possible drug allergies listed
• Look for contraindications due to patient’s age, sex, etc. (ex. Drugs on the Beers List)
• Look for any possible drug-drug interactions between the new drug and an existing medication or for duplicate therapy (NOTE: look at the dates to be sure the patient is currently taking the medication)
• Is there a contraindication involved with the new medication? (ex. renal or hepatic dysfunction that would contraindicate the use of the medication)
• Make sure the drug is indicated for the patient’s diagnosis
• Be aware of dosages
• Think about possible adverse events that could occur

Prescription Verifications (aka Errors & Omissions) 

You will be given ten examples of prescriptions and medication orders. Each example will include a pharmacy-generated label for dispensing the medication plus an image of the medication package that was used to fill the prescription/medication order. Looking at the three items presented, you must determine if the prescription/medication order will be dispensed properly or if there is an issue that will prevent it from being dispensed correctly.

You must indicate if the prescription/medication order can be dispensed or not. If it cannot be dispensed, then a brief description of the issue must be included. It’s generally recommended to write a description of 10 words or less. Too much explanation within your description runs you the risk of including incorrect information. Each example is worth two points.

Some helpful tips for identifying and correcting the dispensing issues:

• Check to see if the medication package used is for the same drug that is written within the prescription (i.e. “Was the right drug pulled from the shelf?”)
• Make sure the dosage is appropriate and correct on the prescription label, the medication package, or the prescription itself
• Verify that the drug prescribed is within the prescriber’s scope of practice (ex. “Should a veterinarian be prescribing a person oxycodone for back pain?”)
• Make sure the directions on the prescription are correct and that they match the directions on the pharmacy-generated label
• Be aware of generic substitution requirements
• Be aware of the legal requirements for proper prescribing and labeling
• Be aware of new prescribing and dispensing laws – the exam usually includes at least one question that incorporates a new law

Compounding

Day 2 is when the actual compounding takes place and the day that most applicants dread. You will be required to perform calculations related to drug compounding and dispensing as well as be required to perform proper compounding techniques. The medications being compounded will consist of 3 of 4 examples: ointment, suspension/solution, capsules, or intravenous drug. Every exam will include an IV drip and most likely an ointment.

The best way to prepare for this portion of the exam is to constantly practice compound-related calculations, compounding techniques, and USP sterile and non-sterile compounding requirements (ex. beyond use date [BUD]).

Calculations

To practice calculations, look for examples from school, the Internet, and work. Anything you can get your hands on will be helpful. Don’t underestimate the exam calculations. You want to be prepared for everything and anything. You also want the calculations to come to you instinctively because you need to perform both calculations and physical compounding within the three hours allotted for the exam.

Below I’ve listed some examples of calculations that will come in handy:

• Dosages based on ratios, percentages, weight, etc. (NOTE: it will be helpful to memorize conversion shortcuts, such as mg/ml to %, ratio to mg/ml, etc.)
• IV drip rates (including rate titrations)
• Aliquots
• Electrolyte replacement
• Unit conversions
• Know the sigs and directions used within a compounded-medication prescription – there are notations that you wouldn’t otherwise see on a regular prescription

Compounding Techniques

Many candidates lose points for poor compounding technique. Unless you’ve spent time within a compounding pharmacy, most of us are not regularly compounding ointments, capsules, or even suspensions from scratch. If you work within a pharmacy that produces IV drips, such as a hospital, then you’re at an advantage.

You will also be responsible for creating labels for each compounded product. For each product, you will be given a blank label and you must write the necessary information required by law to dispense the prescription. Study USP <795> to brush up on BUDs for non-sterile compounded preparations (http://www.usp.org/sites/default/files/usp_pdf/EN/gc795.pdf).

The best way to practice your compounding technique is to attend a compounding exam review course. As mentioned above, these are provided by some pharmacy colleges and are a great way to obtain practice examples, ask questions, and receive general tips. Videos are also available online by various sources that demonstrate and/or explain some common compounding techniques. But be careful when watching the videos, because some techniques may vary and I’ve found that some videos aren’t entirely accurate. The NY Board of Pharmacy is very particular about what they want to see performed during the examination.

Last Minute Pep Talk

I can’t stress the importance of PRACTICE enough. Practice your calculations, practice your compounding technique, practice writing labels, and practice your drug names/indications.

In addition to practicing, make sure to stay ORGANIZED. There’s a lot of information that needs to be covered for the exam and it can get overwhelming. By staying organized you’ll be able to get through everything more efficiently and you’ll be more productive.

Find a POSITIVE LOCATION to study. I can easily become distracted if I’m trying to study somewhere that is very noisy. Therefore, I planned ahead and studied at locations that I knew would be quiet and where I could relax. I also like to change my location from time-to-time so that I don’t get bored. This way my mind won’t drift while I’m trying to study.

Be THOROUGH during your studying and preparation. You will receive a set of instructions and two letters of admission prior to your exam. Read the instructions carefully. There may be instructions included that you need to follow during the exam. Instructions may have been added or changed since the previous exam.

I hope some of this information helps. I personally know how difficult it can be to carve out time to study for an exam, especially one as content heavy as this one. I constantly reminded myself that if I sacrifice the time now for the exam, then all the time afterwards will be mine.

The exam can be intimidating and time consuming, but with plenty of practice and hard work you’ll be well prepared to conquer it.

Citations:

Featured Image: http://www.usada.org/how-does-pharmacy-compounding-affect-anti-doping/

Prescription Image: http://gazettereview.com/2015/07/physicians-influenced-by-peers-when-it-comes-to-prescriptions/