The glossary on Rx-wiki is an ongoing project to provide definitions to various terms used throughout the site and in the field of pharmacy. The terms have been placed in alphabetical order to aid in finding them.

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A

acceptable error - Acceptable error is the error rate from which the measuring device may reasonably deviate according to accuracy of the device and accepted practice for what is being prepared. The acceptable error is commonly listed as a percentage (i.e., 5%).

acute - The word acute is derived from the Latin word acutus, which means sharp. In medicine, acute can mean either a condition with rapid onset or that it is a short-lived condition. In some situations it can carry both meanings.

addiction - An addiction is a physical and/or psychological dependence/craving for something that interferes with accomplishing other activities regardless of potential negative effects. An addiction commonly involves some form of drug/substance abuse.

additive - An additive, in the context of sterile compounding, is a drug that is added to a parenteral solution.

admixture - An admixture is the resulting solution when a drug is added to a parenteral solution.

adrenergic - The word adrenergic literally means having the quality of adrenaline.

adverse drug event - An adverse drug event (ADE) is any undesirable experience temporally associated with the use of a medication.

agonist - An agonist is a chemical that can combine with a receptor in the body to cause a physiological reaction.

aliquot - An aliquot signifies or relates to a divisor of a quantity or number. Three is an aliquot part of 12 as it can divide into 12 four times. In pharmacy math, an aliquot number is typically rounded up to the next whole number if there is a non zero value anywhere to the right of the decimal. An aliquot value of 4.001 would therefore be rounded up to 5.

aliquot method - The aliquot method is a method of measuring ingredients below the sensitivity of a scale by proportional dilution with inactive ingredients.

alligation - An alligation is when two items with different concentrations of the same substance are being mixed together, and the final (or desired) concentration (which must be in-between the other two concentrations) is known. The alligation method may be used for this kind of problem. If one of the starting ingredients is actually a diluent/solvent with a concentration of 0%, then you may also solve this with either the dilution formula or as a series of ratio-proportions.

amebicide - An amebicide (or ameobicide) is a drug that can be used to kill ameobas/protozoans.

anabolic steroids - Anabolic steroids are synthetic derivatives of the male hormone testosterone, having pronounced anabolic properties and relatively weak andronergic properties (i.e., producing masculine characteristics), which are used clinically mainly to promote growth and to repair body tissue in senility, debilitating illness, and convalescence. Anabolic steroids may also be referred to as andronergic-anabolic steroids.

anaphylaxis - Anaphylaxis is an extreme hypersensitivity to a drug or foreign protein. Anaphylaxis results in a potentially life threatening systemic reaction causing the constriction of the trachea, preventing proper respiration; this is sometimes referred to as anaphylactic shock.

angina pectoris - Angina pectoris (often known as angina) is chest pain often caused by ischemia of the heart muscle.

antagonist - In medicine, an antagonist is a chemical that binds to a receptor within the body but does not produce a physiological response, blocking the action of agonist chemicals.

ante area - An area that is ISO class 8 or better where hand hygiene and garbing is performed. It also functions as a transition area between the buffer area and the rest of the facility.

anti-infective - For definition of anti-infective, see antimicrobial.

antibiotic - An antibiotic is any substance that can destroy or inhibit the growth of bacteria.

antidote - Antidote, derived from the Greek antidoton where anti is a prefix that means against and doton means given. Therefore we can think of an antidote as being working against what has already been given. A more contemporary definition would be a remedy or other agent used to neutralize or counteract the effects of a poison or other deleterious agent.

antifungal - An antifungal is a drug that inhibits the growth of fungi.

antimicrobial - An antimicrobial is a substance that kills or inhibits the growth of microbes such as bacteria, fungi, protozoans or viruses. Classes of medications used to fight these types of infections include antibiotics, antifungals, amebicides, and antivirals.

antineoplastic agents - Antineoplastic agents are drugs that inhibit and combat the development of tumors.

antiviral - An antiviral is a medication that can inhibit the growth and reproduction of a virus. This is different from a viricide, which actually deactivates virus particles outside the human body.

arrhythmia - An arrhythmia is an irregular heartbeat.

arthritis - Arthritis is an inflammation of a joint or joints causing pain and/or disability, swelling and stiffness, and due to various causes such as infection, trauma, degenerative changes or metabolic disorders.

aseptic techniques - Aseptic techniques are techniques or methods that maintain the sterile condition of products.

athlete's foot - Athlete's foot is a fungal infection of the skin of the foot, usually between the toes, caused by the pathogen fungi, tinea pedis.

automated compounding device (ACD) - An automated compounding device is a machine used to prepare CSPs (e.g., PN).

autonomic nervous system (ANS) - The autonomic nervous system (ANS) is the portion of the nervous system that regulates cardiac and smooth muscle (involuntary muscles) of the internal organs and glands. The ANS can either increase or decrease the activity of these organs through two subdivisions of the ANS known as the sympathetic and parasympathetic nervous systems. These subdivisions work in opposition to each other.

average wholesale price (AWP) - This is the average price at which wholesalers typically sell medications to pharmacies.

B

bacteria - A bacterium (singular form of bacteria) is a single celled microorganism without a nucleus. Bacteria treated by antibiotics are usually broken into two categories, gram-positive and gram-negative.

bactericidal - Bactericidal drugs are drugs that actually kill the bacteria.

bacteriostatic - Bacteriostatic drugs are drugs that inhibit the growth of bacteria.

bank identification number (BIN) - On a health insurance card a BIN is a six digit number used to identify a specific plan from a carrier making it easier for the PBM to process your prescription online. No actual bank is involved in this part of the process, the name is a hold over from early electronic banking jargon.

batch preparation - A batch preparation is one in which multiple identical units are prepared in a single operation in anticipation of prescriptions.

behind the counter (BTC) - These are medications that do not require a prescription, but can only be obtained at the pharmacy counter. Examples of this include:

• products containing pseudoephedrine,
• emergency birth control,
• insulins, and
• some states allow cough syrups with small amounts of codeine.

benign prostatic hyprtrophy (BPH) - Benign prostatic hypertrophy (BPH), also called benign prostatic hyperplasia, involves hyperplasia (increased tissue size) of prostatic stromal and epithelial cells, resulting in the formation of large, fairly discrete nodules in the periurethral region of the prostate. When sufficiently large, the nodules compress the urethral canal to cause partial, or sometimes virtually complete, urinary tract obstruction by the urethra, which interferes with the normal flow of urine. It leads to symptoms of urinary hesitancy, frequent urination, increased risk of urinary tract infections, urinary retention,

beta-lactam - Many antibiotics have a beta-lactam (β-lactam) ring, a four-membered ring structure, which allows them to bind to the cell walls of many bacteria and inhibit cell wall synthesis. Antibiotics that have this structure (penicillins, cephalosporins, carbapenems, and monobactams) are often referred to as beta-lactam antibiotics.

beta-lactamase - Beta-lactamase is an enzyme produced by certain bacteria that can break the beta-lactam ring in some antibiotics (such as penicillins), and is responsible for their resistance to beta-lactam antibiotics.

beta-lactamase inhibitors - A beta-lactamase inhibitor is a molecule used in conjunction with a beta-lactam antibiotic (such as a penicillin) to extend its spectrum of activity. Although beta-lactamase inhibitors have little or no antibiotic activity of their own, they instead inhibit the activity of beta-lactamases (a family of enzymes that break the beta-lactam ring in beta-lactam antibiotics) and allowing these antibiotics to still work.

bioavailability - Bioavailability is a measure of the rate and extent (amount) of active ingredient which reaches the general circulatory system.

bioequivalents - Bioequivalants are pharmaceutical equivalents which, when administered under similar conditions, will produce comparable bioavailabilities.

black box warning - A black box warning is a warning, surrounded by a black border, contained in prescription drug package inserts to indicate that the drug may cause serious or life-threatening effects.

blocker - See antagonist for definition.

Board of Pharmacy (BOP) - Each state has its own board of pharmacy. The BOP sets standards, roles, and requirements for pharmacy personnel and practice setting in their state.

brand name - This is the manufacturers trademark designation. Each brand name is owned by the company and begins with a capital letter, and it is protected by a trademark. Drugs often have several brand names. The terms trade name and proprietary name may also be used interchangeably with brand name.

bronchconstriction - Bronchconstriction is a narrowing of the air passages through the bronchi of the lungs.

bronchodilation - Bronchodilation is the expansion of the air passages through the bronchi of the lungs.

buffer area - An area that is required to be ISO class 7 or better. A primary engineering control (PEC) such as a laminar airflow workbench would be located in this area.

C

cancer - Cancer is a disease in which the cells of a tissue undergo uncontrolled (and often rapid) proliferation.

candidiasis - Candidiasis (or thrush) is a fungal infection (mycosis) commonly referred to as a yeast infection. Candidiasis encompasses infections that range from superficial, such as oral thrush and vaginitis, to systemic and potentially life-threatening diseases.

cardiac arrest - Cardiac arrest is the sudden and complete cessation of the heartbeat resulting in the loss of effective circulation of the blood.

cardiac muscle - Cardiac muscle is the striated and involuntary muscle of the heart.

cart-fill - Cart-fill (sometimes listed as cartfill) is the process of providing patients with a short term supply of all the medications they need (typically 24 hours worth). This process is commonly practiced in institutional settings.

cell - The basic unit of a living organism which is able to synthesize proteins and replicate itself.

cell membrane - A cell membrane is the semipermeable membrane that surrounds the cytoplasm of a cell.

cell wall - A cell wall is a thick, fairly rigid, layer formed around individual cells of bacteria, Archaea, fungi, plants, and algae (but not animals and other protists which generally have cell membranes without cell walls). The cell wall is external to the cell membrane and serves a structural function helping the cell maintain its shape and protecting the cell from damage.

chemical name - A chemical name is the chemical formula for a drug. Medications are commonly referred to by either their brand name or generic name, but drugs may also be referenced by their chemical name.

chronic - In medicine, the word chronic can be defined as a condition that lasts over an extended period of time.

classification - This is how a medication is grouped and is typically defined according to its use in treating a particular disease or disorder. A potential source of confusion is that many medications could be grouped multiple ways. An example of this is aspirin, which can be classified as an analgesic, antipyretic, and anti-inflammatory agent.

closed formulary - Under a closed formulary, the drug inventory is limited to a list of approved medications.

communication - Communication is the activity of providing information through the exchange of thoughts, messages, or information, as by speech, visuals, signals, writing, electronic means, or by behavior. This information is exchanged between two or more people.

compounded sterile preparations (CSP) - Compounded sterile preparations are admixtures that need to be assembled under aseptic conditions to prevent contamination.

computer cracker - A computer cracker is someone who makes unauthorized use of a computer, especially to tamper with data or programs. The media commonly refers to these individuals as hackers.

computerized prescriber order entry (CPOE) - Computerized prescriber order entry, also called computerized physician order entry, is a process of electronic entry of practitioner instructions for the treatment of patients under their care. CPOE systems are used for processing orders in institutional settings.

congestion - Congestion is an excess of mucus or fluid in the respiratory system; congestion of the lungs, or nasal congestion.

contraindication - A contraindication is a condition or factor that serves as a reason to withhold a certain medical treatment.

controlled substances - Controlled substances are medications with restrictions due to abuse potential. There are 5 schedules of controlled substances with various prescribing guidelines based on abuse potential counter balanced by potential medicinal benefit as determined by the Drug Enforcement Administration and individual state legislative branches.

coring - Coring occurs when a needle damages the rubber closure of a parenteral container causing fragments of the closure to fall into the container and contaminate its contents.

curie - A curie (Ci) is a unit measuring the activity of radioactive isotopes and is named after French-born scientists Pierre and Marie Curie whom did a significant quantity of early research on radioactive isotopes.

D

database - A database is an organized collection of data.

database management system (DBMS) - A database management system (DBMS) is a software system designed to allow the definition, creation, querying, update, and administration of databases.

deoxyribonucleic acid (DNA) - Deoxyribonucleic acid (DNA) is a molecule that encodes the genetic instructions used in the development and functioning of all known living organisms and many viruses.

dependence - Dependence is a physiological need for a drug related to prolonged use. Commonly dependence is associated with addiction, but sometimes there are other underlying reasons for dependence such as an organ system requiring an exogenous chemical to continue functioning correctly.

desensitization therapy - Desensitization therapy is the concept of exposing the patient to exceedingly small quantities of a substance that they are believed to have an allergy to. The exposure is slowly increased in order to desensitize the patient to the offending substance and eventually allow them to have an appropriate response to a normal quantity of the substance. The patient should be closely monitored with each dose to ensure there is no severe reaction.

diabetes - Diabetes refers to a group of diseases that affect how your body uses blood glucose, commonly called blood sugar. There are two primary types of this disease: type 1 diabetes mellitus and type 2 diabetes mellitus. Some less common forms of diabetes include gestational diabetes (a form of diabetes that occurs transiently while pregnant) and diabetes insipidus (often related to a tumor in the pituitary gland).

dietary supplements - A dietary supplement is intended to supply nutrients, (vitamins, minerals/electrolytes, and amino acids) that are missing or not consumed in sufficient quantity in a person's diet. This category may also include herbal supplements.

diluent - A diluent is a solvent that dissolves a lyophilized powder or dilutes a solution.

dilution - Mixing a substance (such as a medication) with a diluent/solvent to decrease its concentration is considered a dilution. As this method is intended only for when mixing 2 items, one with a particular ingredient, and the other without the same ingredient, this can always be solved with either the dilution formula or as a series of ratio-proportions. If the starting concentration of the ingredient is known as well as its final (or desired) concentration, then you can use the alligation method also because the diluent/solvent has a concentration of 0%.

direct purchasing - Direct purchasing entails ordering medications directly from the original drug manufacturer. This typically requires completion of a purchase order - generally, a preprinted form with a unique number, on which the product name(s), amount(s), and price(s) are entered.

dispense as written (DAW) codes - DAW codes are used to provide a quick explanation of whether or not a generic version of the medication is allowed to be dispensed, and if not then why and whom deemed the brand name product to be necessary. A DAW code of '0' applies to most prescriptions as they allow for generic substitution and patients are generally willing to receive the more affordable version. If a physician requires a specific medication to be dispensed, they will typically note this on the prescription. This is considered a DAW code of '1'. Sometimes a patient may request that they receive a brand name product even if a prescriber allowed for generic substitution. This would be classified as a DAW code of '2'. Other DAW codes are less frequently used. The following is a succinct list of the other DAW codes; 3 = substitution allowed - pharmacist selected product dispensed, 4 = substitution allowed - generic drug not in stock, 5 = substitution allowed - brand drug dispensed as generic, 6 = override, 7 = substitution not allowed - brand drug mandated by law, 8 = substitution allowed - generic drug not available in marketplace, and 9 = Other.

dispensing fee - A dispensing fee (also referred to as a professional fee) represents the charge for the professional services provided by the pharmacy when dispensing a prescription and includes a distribution of the costs involved in running the pharmacy such as salaries, rent, utilities, costs associated with maintaining the computer system, etc.

dosage form - A dosage form is the physical form of a dose of medication, such as capsule, patch, or injection. The route of administration is dependent on the dosage form of a given drug. As an example, persistent vomiting may make it difficult to use an oral dosage form; therefore, an antiemetic in suppository form may be desirable.

dose - A dose of medication is simply a quantification of how much is taken at a time and may or may not relate to the frequency with which it is used.

Drug Enforcement Administration (DEA) - The Drug Enforcement Administration (DEA) is a United States Department of Justice law enforcement agency, a federal police service tasked with enforcing the Controlled Substances Act of 1970.

E

e-prescribing - E-prescribing is the computer-based electronic generation, transmission and filling of a medical prescription, taking the place of paper and faxed prescriptions. E-prescribing allows a physician, nurse practitioner, or physician assistant to electronically transmit a new prescription or renewal authorization to a community or mail-order pharmacy.

endogenous - In medicine endogenous means something is of a natural process or caused by factors within the body

enzyme - An enzyme is a globular protein that catalyzes a biological chemical reaction. Enzymes typically end in -ase.

equivalent - The equivalent (symbol: Eq or eq) is a measurement unit used in chemistry and the biological sciences such as pharmacy. It is a measure of a substance's ability to combine with other substances, and is a comparison of an ion's charge in comparison to a mole of the product. As an example, if you look at potassium on a periodic table, you will find that it typically has an ionic charge of +1 when it binds to other ions. Therefore, 1 mole of potassium would equal 1 equivalent of potassium. Likewise, if we look at oxygen, it typically has a charge of -2 when it combines with other elements, so 1 mole of oxygen equals 2 equivalents of oxygen.

eukaryote - A eukaryote is any single-celled or multicellular organisms whose cells contain at least one distinct nucleus.

excipient - An excipient is anything in a medication other than its active ingredient. Common categories for excipients include antiadherents, binders, coatings, disintegrants, fillers, flavors and colors, glidants, lubricants, preservatives, sweeteners, and printing inks.

exogenous - In medicine the term exogenous means that it is something produced outside of the body and then being brought into it. As an example, vitamin K is required for proper clotting, but the body does not produce vitamin K; instead, vitamin K is typically brought into the body through either food, such as leafy green vegetables, or dietary supplements. In this scenario vitamin K is an exogenous factor required for clotting.

extemporaneous compounding - Extemporaneous compounding can be defined as the preparation, mixing, assembling, packaging, and labeling of a drug product based on a prescription from a licensed practitioner for the individual patient in a form that the drug is not readily available in (extemporaneous = impromptu, compounding = the act of combining things).

F

fetus - A fetus is a human embryo after the eighth week of pregnancy.

first-pass effect - The first-pass effect is a phenomenon of drug metabolism whereby the concentration of a drug is greatly reduced before it reaches the systemic circulation. It is the fraction of lost drug during the process of absorption which is generally related to the liver and gut wall. Notably, drugs that experience a significant first-pass effect may be more suitable for parenteral administration.

Food and Drug Administration - The Food and Drug Administration (FDA) is an agency within the Department of Health and Human Services. The FDA is responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, our nation’s food supply, cosmetics, and products that emit radiation, and by regulating the manufacture, marketing, and distribution of tobacco products.

formulary - A formulary is a list of medications available for use within a health care system. There are two major types of formularies: open formularies and closed formularies.

fraud - Fraud can be broadly defined as an act of deliberate deception performed to acquire an unlawful benefit. In a pharmacy, that may include billing for a medication or device the patient did not receive, or over billing for a medication or device that the patient did receive.

fungus - A fungus (the plural form is fungi) is any member of a large group of eukaryotic organisms that have cell walls containing chitin. Common examples of fungi include microorganisms such as yeasts and molds, as well as the more familiar mushrooms. Fungal infections can be difficult to treat because they are eukaryotes, like animal cells.

G

generic name - This is the official non-proprietary name assigned by the manufacturer with the approval of the USAN (United States Adopted Name) Council. The Federal Food and Drug Administration (FDA) requires that each drug has a generic name, even if currently it is only available as a brand name product. A generic name may also be referred to as the non-proprietary name.

generic substitution - Generic substitution is the act of dispensing a different branded or unbranded drug product for the drug prescribed. “Generic substitution,” “brand interchange,” and “drug product selection” are but a few of the more common names used to mean the same thing.

geometric dilution - Geometric dilution, also called geometric incorporation, is the process by which a homogeneous mixture of even distribution of two or more substances is achieved. When using this method, the smallest quantity of active ingredient is mixed thoroughly with a proportion quantity of the diluent or base on the ointment slab. More diluent (base) is added in amounts proportionate to the volume of the mixture on the ointment slab. This process is repeated until all of the ingredients are incorporated in the mixture.

GI motility GI motility is the movement of food and other products thorough the gastrointestinal (GI) system. The smooth muscles throughout the GI tract enables this motility through either peristalsis or segmentation.

glucocorticosteroid - Glucocorticosteriods (glucocorticoids, corticosteroids) are steroids used to treat inflammation and various allergic conditions. They are similar to the steroid created in the adrenal cortex, although they could be either from natural sources or synthetically manufactured. As your body naturally produces a glucocorticoid, introducing an exogenous source through medication interferes with your bodies negative feedback loop for production of these steroids. This is why it is often necessary to taper a patient off of a steroid so their body slowly starts creating its own endogenous source of steroids again.

gram-negative - Gram-negative bacteria can not retain the crystal violet stain (like gram-positive bacteria do). Instead, they they take up the counterstain (safranin or fuchsin) causing them to appear red or pink.

gram-positive - Gram-positive bacteria are those that are stained dark blue or violet by Gram staining. Gram-positive organisms are able to retain the crystal violet stain because of the high amount of peptidoglycan in the cell wall. Gram-positive cell walls typically lack the outer membrane typically found in gram-negative bacteria.

gross profit - Gross profit is calculated as sales minus all costs directly related to those sales, or in simpler terms we can think of it as the difference between the selling price and the acquisition price.

group number - A group number identifies your group, or business, from other groups, or businesses, who are insured by the same insurance company.

H

hazardous drugs - Hazardous drugs are drugs that are known to cause genotoxicity, which is the ability to cause a change or mutation in genetic material; carcinogenicity, the ability to cause cancer in animal models, humans or both; teratogenicity, which is the ability to cause defects on fetal development or fetal malformation; and lastly hazardous drugs are known to have the potential to cause fertility impairment, which is a major concern for most clinicians. These drugs can be classified as antineoplastics, cytotoxic agents, biologic agents, antiviral agents and immunosuppressive agents.

health information exchange (HIE) - Health information exchange (HIE) is the mobilization of healthcare information electronically across organizations within a region, community or hospital system.

HEPA filter - A HEPA filter is a high efficiency particulate air filter.

hepatitis - Hepatitis is the inflammation of the liver, often caused by a virus. There are various types of hepatitis (hepatitis A, hepatitis B, hepatitis C, hepatitis D, hepatitis E, and possibly a hepatitis G).

hepatotoxic - The term hepatotxic simply means toxic to the liver.

herpes - Herpes is a viral infection, caused by the Herpes simplex virus, marked by painful, watery blisters in the skin or mucous membranes or on the genitals. There are various forms of herpes such as oral herpes, genital herpes, herpes zoster (chicken pox), and various other less frequently occurring forms such as ocular herpes.

Hippocratic Oath - The Hippocratic Oath is an oath traditionally taken by physicians pertaining to the ethical practice of medicine. It is widely believed that the oath was written by Hippocrates, the father of medicine, in the 4th Century B.C., or by one of his students. Although mostly of historical and traditional value, the oath is considered a rite of passage for practitioners of medicine.

hirsutism - Hirsutism is excessive and increased hair growth in women in locations where the occurrence of terminal hair normally is minimal or absent.

human immunodeficiency virus (HIV) - The human immunodeficiency virus (HIV) is a slowly replicating retrovirus that causes the acquired immunodeficiency syndrome (AIDS), a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive.

hypertension - Hypertension is a disease or disorder of abnormally high blood pressure.

hypertonic - A hypertonic solution has a greater osmolarity than that of blood

hypotension - Hypotension is a disease or disorder of abnormally low blood pressure.

hypotonic - A hypotonic solution has a lesser osmolarity than that of blood

I

idiosyncratic reaction - An idiosyncratic reaction is a reaction to a medication that is unusual/unpredictable, and is specific to a particular patient.

indication - This is the primary condition(s) treated by a particular drug. This may include both FDA approved uses as well as off-label (generally based on scientific studies but lacking FDA approval) medication uses.

influenza - Influenza is an acute contagious disease of the upper airways and lungs, caused by a virus, which rapidly spreads around the world in seasonal epidemics. In layman's terms, it is commonly referred to as "the flu".

innervation - Innervation is the excitation or stimulation of any portion of the nerves within the body.

inscription - The inscription is also called the body of the prescription, and provides the names and quantities of the chief ingredients of the prescription. Also in the inscription you find the dose and dosage form, such as tablet, suspension, capsule, syrup.

interactions - Medications have the potential to interact with other medications, dietary supplements, and constituents of various foods. Medications may also interact with various diseases.

International unit (IU) - In pharmacology, the International unit (IU, alternatively abbreviated UI, from French unit internationale) is a unit of measurement for the amount of a substance, based on measured biological activity (or effect). It is used for vitamins, hormones, some drugs, vaccines, blood products and similar biologically active substances. Despite its name, the IU is not part of the International System of Units used in physics and chemistry. The precise definition of one IU differs from substance to substance and is established by international agreement. To define an IU of a substance, the Committee on Biological Standardization of the World Health Organization provides a reference preparation of the substance, (arbitrarily) sets the number of IUs contained in that preparation, and specifies a biological procedure to compare other preparations to the reference preparation. The goal here is that different preparations with the same biological effect will contain the same number of IUs.

inventory - Inventory is simply the entire stock on hand for sale at a given time.

inventory value - Inventory value is the total value of the drugs and merchandise in stock on a given day. Inventory value is usually determined by how much was spent acquiring the merchandise and it is not typically based on how much it might sell for.

ions - Ions are molecular particles that carry electric charges.

ischemia - ischemia is a local disturbance in blood circulation due to mechanical obstruction of the blood supply (vasoconstriction, thrombosis or embolism).

ISO Class - The International Organization for Standardization has established various levels of air cleanliness. The lower the number the fewer particles that are suspended in it and the cleaner the air is. The ISO classes commonly discussed in sterile compounding are ISO Class 5 (3,520 particles of 0.5 micron or larger in a cubic meter), ISO Class 7 (352,000 particles of 0.5 micron or larger in a cubic meter), and ISO Class 8 (3,520,000 particles of 0.5 micron or larger in a cubic meter).

isotonic - An isotonic solution has an osmolarity equivalent to that of blood

J

K

L

laminar airflow - Laminar airflow provides continuous air movement at a uniform rate in one direction.

legend drug - Legend drugs are medications that require a prescription prior to dispensing. These medications may or may not be considered abusable, but consultation with a medical professional that has prescribing authority is necessary due to the complex health conditions that these medications may be able to treat or ameliorate. Often, you will see the phrase "Rx only" used to denote legend drugs.

levigation - Levigation is the process of reducing particle size of a solid by triturating it in a mortar or spatulating it on an ointment slab or pad with a small amount of a liquid called a levigating agent. Levigating agents make incorporating solids easier, and they make a smooth, elegant preparation.

lot number - A lot number is an identification number assigned to a particular quantity (or lot) of material from a single manufacturer made in a specific batch. Sometimes also called a batch number or control number.

lupus - Lupus is a debilitating autoimmune disease which attacks the whole body, causing skin sores, pains throughout the body, lack of breath, and kidney and heart problems. Many individuals with lupus have a "butterfly rash" on their face -- a rash that has a similar appearance to the wings on a butterfly.

lyophilized - Lyophilized powders are simply freeze-dried powders.

M

Material Safety Data Sheet (MSDS) - OSHA-required notices on hazardous substances which provide hazard, handling, clean-up, and first aid information.

medication errors - A medication error is any incorrect or wrongful administration of a medication, such as a mistake in dosage or route of administration, failure to prescribe or administer the correct drug or formulation for a particular disease or condition, use of outdated drugs, failure to observe the correct time for administration of the drug, or lack of awareness of adverse effects of certain drug combinations.

MedWatch - MedWatch is the Food and Drug Administration’s reporting system for an adverse event.

member number - A member number is a number in correlation to relationship to the family member that provides the insurance. Typically, the individual that is primarily insured has a member number of '00' or '01' and the next number is reserved for their spouse (even if the individual is not currently married). Therefore, the spouse would be either '01' or '02'. Then, any children that they provide insurance for continues consecutively from oldest to youngest.

meningitis - Meningitis is the inflammation of the meninges, characterized by headache, neck stiffness and photophobia and also fever, chills, vomiting and myalgia. Various microbial organisms may be responsible for meningitis including bacterial, viral, and fungal.

millicurie - A millicurie (symbol: mCi) is one-one thousandth (1/1000) of a curie.

milliequivalent - A milliequivalent (symbol: mEq or meq) is one-one thousandth (1/1000) of an equivalent.

millimole - A millimole (symbol: mMol) is one-one thousandth (1/1000) of a mole.

minimum measurable quantity (MMQ) - Minimum measurable quantity (MMQ) is the smallest amount you can accurately measure with a given device and is determined by taking 100 percent of the sensitivity requirement and dividing it by the acceptable error. Some will also refer to this as minimum weighable quantity (MWQ) when dealing with prescription balances.

minimum weighable quantity (MWQ) - See minimum measurable quantity (MMQ) for definition.

miosis - Miosis is the contraction of the pupil of the eye. In healthcare miosis typically refers to extreme contraction of the pupil (pinpoint pupils) due to either diseases or drugs such as opioids, cholinergic agents, etc.

mixture - A mixture involves mixing 2 or more ingredients of varying concentrations together. If the mixture only contains one starting ingredient with active substance in it, it may be treated as a dilution. If it has two initial components containing active ingredient, and you know what the final (or desired) concentration is supposed to be, you may treat it as an alligation. If it has two or more components containing the measured ingredient, and you need to solve for the final concentration, then you would use a series of ratio-proportions.

mole - The mole (symbol: mol) is the System International (SI) base unit that measures an amount of substance. One mole contains Avogadro's number (approximately 6.022 × 10²³) entities. A mole is much like "a dozen" in that both are absolute numbers (having no units) and can describe any type of elementary object, although the mole's use is usually limited to measurement of subatomic, atomic, and molecular structures. The goal is to acquire a sufficient quantity of a material to be able to measure it, and since individual atoms and molecules are so small, having an entire mole of a substance makes it easier to work with. Once you acquire a mole of a particular substance, you may reference its atomic mass to know how much its mass in grams is.

mondegreen - A mondegreen is the mishearing or misinterpretation of a phrase as a result of near-homophony, in a way that gives it an unintended meaning.

moon-face - A moon-face is a swollen and rounded face, often indicative of a disease (Cushing's syndrome) or of a steroid side-effect.

mydriasis- Mydriasis is the dilation of the pupil. In healthcare, mydriasis refers to the condition of having abnormally large and dilated pupils due to disease or drugs, particularly stimulants such as amphetamines, cocaine, etc.

N

National Drug Code (NDC) - Each medication is assigned a unique 10-digit, 3-segment number. This number, known as the National Drug Code (NDC), identifies the labeler or vendor, product, and trade package size.

• The first 4 or 5 digits indicate the manufacturer
• The second 3 or 4 indicate the medication, strength, and dosage form
• The third set of numbers always has 2 digits and indicates the package size

National Provider Identifier (NPI) - A National Provider Identifier is a unique 10-digit identification number issued to health care providers (physician, physician assistants, nurse practitioners, dentists, etc.) by the Centers for Medicare and Medicaid Services (CMS). An NPI is a required identifier for Medicare services, and is also used by other payors, including commercial healthcare insurers. If you need to check a find/verify a particular providers NPI, you may look it up at http://www.npinumberlookup.org.

negative pressure room - If a pharmacy prepares more than a low volume of hazardous drugs the appropriate type of PEC should be located within a negative pressure room. A negative pressure room has a has a lower pressure than adjacent rooms and therefore the net flow of air is into the room.

net profit - Net profit is the difference between the gross profit and the sum of all the costs associated with filling the prescription. The costs associated with filling the prescription are accounted for with a dispensing fee or a professional fee. With that in mind, you can determine the net profit by subtracting a professional fee from the gross profit.

nosocomial infection - A nosocomial infection is an infection acquired while in the hospital.

O

obese - Extremely overweight, especially: weighing more than 20% (for men) or 25% (for women) over their ideal weight determined by height and build; or, having a body mass index over 30 kg/m².

Occupational Safety and Health Administration (OSHA) - OSHA is a government agency within the United States Department of Labor responsible for maintaining safe and healthy work environments.

off-label uses - Off-label use is the use of a medication in a manner different from that approved by the FDA including:

• for an unapproved indication,
• in an unapproved age group,
• unapproved dosage, or
• unapproved form of administration.

open formulary - An open formulary implies that the pharmacy must stock, or have ready access to, all drugs that may be written by the prescribers in their practice area.

orphan disease - An orphan disease is a disease affecting fewer than 200,000 people in the United States or low prevalence is taken as prevalence of less than 5 per 10,000 in the community. Often, an orphan disease is simply referred to as a rare disease.

osmolarity - Osmolarity, also called osmotic pressure, is a characteristic of a solution determined by the number of dissolved particles in it.

out-of-pocket - Out-of-pocket expenses are the costs that are considered the responsibility of the patient, including non-covered items, deductibles, and copays.

over the counter (OTC) - Over the counter medications are drugs that do not require the use of a prescription for a patient to obtain it. These medications are generally considered sufficiently safe for a patient to acquire and self medicate with by following the instructions included on the vial.

P

parasympathetic nervous system - The parasympathetic nervous system is part of the autonomic nervous system that tends to act in opposition to the sympathetic nervous system, by primarily regulating body functions during rest, digestion, and waste regulation. Stimulation of the parasympathetic system increases the activity of the gastrointestinal and genitourinary system while decreasing the activity of the cardiovascular system.

parenteral - A parenteral can be defined as any administration route not involving the GI tract, but it is used more commonly used in reference to routes that require sterile preparations (injectable routes, ophthalmic, and inhalation).

parenteral nutrition (PN) - Parenteral nutrition is a complex solution with two base solutions (amino acids and dextrose) and additional micronutrients. Lipids may or may not also be present in parenteral nutrition.

patient package insert - A patient package insert or medication guide is a document provided along with a prescription medication to provide additional information about that drug.

perpetual inventory - A perpetual inventory is a system that maintains a continuous count of every item in inventory so that it always shows the stock on hand. Some pharmacies maintain perpetual inventories on all products while others only do this with their schedule II medications.

personal protective equipment (PPE) - Personal protective equipment is worn by an individual to provide both protection to the wearer from the environment or specific items they are manipulating, and to prevent exposing the environment or the items being manipulated directly to the wearer of the PPE.

pharmaceutical alternatives - Drug products are considered pharmaceutical alternatives if they contain the same therapeutic moiety, but are different salts, esters, or complexes of that moiety, or are different dosage forms or strengths (e.g., tetracycline hydrochloride, 250 mg capsules vs. tetracycline phosphate complex, 250 mg capsules; quinidine sulfate, 200 mg tablets vs. quinidine sulfate, 200 mg capsules). Data are generally not available for FDA to make the determination of tablet to capsule bioequivalence. Different dosage forms and strengths within a product line by a single manufacturer are thus pharmaceutical alternatives, as are extended-release products when compared with immediate-release or standard-release formulations of the same active ingredient.

pharmaceutical equivalents - Drug products are considered pharmaceutical equivalents if they contain the same active ingredient(s), are of the same dosage form, route of administration and are identical in strength or concentration (e.g., chlordiazepoxide hydrochloride, 5 mg capsules). Pharmaceutically equivalent drug products are formulated to contain the same amount of active ingredient in the same dosage form and to meet the same or compendial or other applicable standards (i.e., strength, quality, purity, and identity), but they may differ in characteristics such as shape, scoring configuration, release mechanisms, packaging, excipients (including colors, flavors, preservatives), expiration time, and, within certain limits, labeling.

pharmaceutical substitution - Pharmaceutical substitution is the act of dispensing a pharmaceutical alternative for the drug product prescribed (e.g., different salt [codeine phosphate for codeine sulfate], different ester [testosterone propionate for testosterone enanthate], different dosage form [ampicillin suspension for ampicillin capsules]).

pharmacodynamics - Pharmacodynamics is a branch of pharmacology that studies the effects and modes of action of drugs upon the body.

pharmacokinetics - Pharmacokinetics is a branch of pharmacology concerned with the rate at which drugs are absorbed, distributed, metabolized, and eliminated (ADME) by the body.

pharmacology - The term pharmacology is derived from two Greek words "pharmakon" and "logos". Pharmakon can mean sacrament, remedy, poison, talisman, cosmetic, perfume or intoxicant, but in this case, it can be broadly defined as drug. Logos can be translated as a principle of order and knowledge. By combining the terms you can see that pharmacology is concerned with the knowledge of drugs.

pharmacy benefits manager (PBM) - A PBM is a company that acts as an intermediary between the pharmacy and the insurance plan.

pharmacy informatics - Pharmacy informatics (a.k.a., pharmacoinformatics) is the use and integration of data, information, knowledge, technology, and automation in the medication use process. The goal of this integration is to improve health outcomes.

photosensitivity - Photosensitivity simply means sensitive to light. In medicine this can either mean that a medication is sensitive to light and need s to be protected form overexposure to the light or that a medication will cause a patient to be increasingly sensitive to the light (i.e., more likely to get sunburned).

positive pressure room - A room that has higher pressure than adjacent spaces and therefore has a net flow of air out of the room.

precipitate - A precipitate is an insoluble substance separated from a solution due to a reaction between incompatible substances.

pregnancy category - The pregnancy category of a pharmaceutical agent is an assessment of the risk of fetal injury due to the pharmaceutical, if it is used as directed by the mother during pregnancy. It does not include any risks conferred by pharmaceutical agents or their metabolites that are present in breast milk. The United States FDA has the following definitions for the pregnancy categories:

• Pregnancy Category A - Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).
• Pregnancy Category B - Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women OR Animal studies which have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.
• Pregnancy Category C - Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
• Pregnancy Category D - There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
• Pregnancy Category X - Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.

prescription origin code (POC) - Prescription origin codes (POC) were first created by the Centers for Medicare and Medicaid Services (CMS) to help gather data on where prescriptions come from (0 = Unknown, 1 = Written, 2 = Telephone, 3 E-prescription, 4 = Fax). POCs are now mandatory for both Medicare and Medicaid patients and many other insurance companies require this as well.

primary engineering control (PEC) - A primary engineering control, which could include a room or device, provides an ISO Class 5 environment for compounding sterile products. Examples of primary engineering control may include laminar airflow workbenches (LAFW), compounding aseptic isolators (CAI), biological safety cabinets (BSC), compounding aseptic containment isolators (CACI), and clean rooms that create an ISO Class 5 environment.

prime vendor purchasing - Prime vendor purchasing involves an agreement made by a pharmacy for a specified percentage or dollar volume of purchases in exchange for being given lower acquisition costs.

professional fee - See dispensing fee for definition.

prospective drug utilization review - Prospective drug utilization review (ProDUR) require state Medicaid provider pharmacists to review Medicaid recipients' entire drug profile before filling their prescription(s). The ProDUR is intended to detect potential drug therapy problems.

protein - Proteins are large biological molecules, or macromolecules, consisting of one or more long chains of amino acids. Proteins perform a vast array of functions within organisms, including catalyzing metabolic reactions, replicating DNA, responding to stimuli, and transporting molecules from one location to another. Proteins differ from each other primarily in their sequence of amino acids, which is dictated by the nucleotide sequence of their genes, and which usually results in folding of the protein into a specific three-dimensional structure that determines its activity.

protozoa - Protozoan are usually single-celled and heterotrophic eukaryotes containing non-filamentous structures that belong to any of the major lineages of protists. They are restricted to moist or aquatic habitats.

purchasing - Purchasing is the ordering of products for use or sale by the pharmacy, and is usually carried out by either an independent or group process.

pyrogens - Pyrogens are chemicals produced by microorganisms that can cause pyretic (fever) reactions in patients

Q

quality assurance (QA) - Quality assurance refers to the activities implemented so that requirements for a product or service will be fulfilled without error.

quality control (QC) - Quality control is the process of routinely checking/monitoring products to verify accuracy and/or appropriateness. Quality control typically looks at specific items at a given moment in time.

quality improvement - Quality improvement is the process of devising a method (quality assurance) to address concerns identified as potential sources of medication errors.

query - In computing, a query is a precise request for information retrieval with database and information systems.

R

reconciliation - In pharmacy, the term reconciliation can have two different definitions. Reconciliation can involve correcting a pharmacy charge to correspond with the proper fees for the item dispensed. Reconciliation can mean evaluating the patient's response to a therapy and making the necessary changes to better ensure that the patient's medical treatment better coincides with their needs.

reference listed drug (RLD) - A reference listed drug is the original brand (or innovator) drug that the generic drug is based off of, in which the Orange Book will make its comparisons to.

reorder point - A reorder point provides minimum and maximum (a.k.a., par and max) stock levels which determine when a reorder is placed and for how much.

reverse distribution - Reverse distribution involves the returning of medications to specialized brokers for management, and may involve a monetary credit to the provider. Reasons for using reverse distribution may vary, but often include controlled substances, expired or short-dated medications, excessive stock, and improperly stored products.

rheumatoid arthritis - Rheumatoid arthritis is a chronic and progressive disease in which the immune system attacks the joints. It is characterized by pain, inflammation and swelling of the joints, stiffness, weakness, loss of mobility and deformity. Tissues throughout the body can be affected, including the skin, blood vessels, heart, lungs, and muscles.

ribonucleic acid (RNA) - Ribonucleic acid (RNA) is a ubiquitous family of large biological molecules that perform multiple vital roles in the coding, decoding, regulation, and expression of genes.

ringworm - Ringworm (properly known as dermatophytosis) is a clinical condition caused by fungal infection of the skin in humans, pets such as cats, and domesticated animals such as sheep and cattle. The term "ringworm", commonly used to refer to such infections, is a misnomer, since the condition is caused by fungi of several different species and not by parasitic worms. The fungi that cause parasitic infection (dermatophytes) feed on keratin, the material found in the outer layer of skin, hair, and nails. These fungi thrive on skin that is warm and moist, but may also survive directly on the outsides of hair shafts or in their interiors.

risk evaluation and mitigation strategy - A risk evaluation and mitigation strategy (REMS) is a plan to manage a known or potential serious risk associated with a drug or biological product.

risk management - Risk management is intended to identify errors, assess the root cause(s), and implement procedures to reduce medication errors. Risk management also involves measuring outcomes to determine if successful and then making additional process changes as necessary.

S

schedule II medications - Schedule II medications must be stocked separately in a secure place or distributed throughout your inventory, and require a DEA 222 form for reordering, whether using a triplicate paper version or an authorized electronic system. Their stock must be continually monitored and documented. Some states may place additional restriction on purchasing and storage requirements for these medications.

sensitivity requirement - Sensitivity requirement is the quantity of material (weight or volume) required to move one point on an index plate on a balance or one marking on a syringe or graduated cylinder. On an electronic balance, it would be the smallest quantity that the balance responds to below which is not registered by the balance.

side effect - A side effect is an effect, whether therapeutic or adverse, that is secondary to the one intended. The term is predominantly employed to describe adverse effects, but it can also apply to beneficial consequences of the use of a drug. A side effect of diphenhydramine (an antihistamine) is drowsiness, which would be an adverse effect if someone needed to be alert, but could be beneficial if they required help going to sleep.

skeletal muscles - Skeletal muscles are voluntary muscles, which are striated and anchored by tendons to bone and is used to effect skeletal movement such as walking.

signatura - The signatura (also called sig, or transcription), gives instructions on a prescription to the patient on how, how much, when, and how long the drug is to be taken. These instructions are preceded by the symbol “S” or “Sig.” from the Latin, meaning "write" or "label." Whenever translating the signatura into instructions for a patient, begin it with an action verb such as take, inhale, spray, inject, place, swish, or whatever other verb seems appropriate for the medication.

spatulation - Spatulation is the mixing of powders and semi-solids (ointments, creams, etc.) on an ointment pad or slab using a spatula. With this method there is no particle size reduction, so the powders to be mixed must be fine and of uniform size.

superscription - The superscription consists of the heading on a prescription where the symbol Rx is found. The Rx symbol comes before the inscription.

sympathetic nervous system - The sympathetic nervous system is part of the autonomic nervous system that tends to act in opposition to the parasympathetic nervous system, by speeding up the heartbeat and causing contraction of the blood vessels. It regulates the function of the sweat glands and stimulates the secretion of glucose in the liver. The sympathetic nervous system, which is usually activated under conditions of stress, causes the 'fight or flight' response.

sympatholytic Sympatholytic drugs are medications that block the functioning of the sympathetic nervous system.

T

tachycardia - Tachycardia is a rapid resting heart rate, especially one above 100 beats per minute.

teratogen - A teratogen is a drug/substance with the ability to cause defects on fetal development or fetal malformation.

The Joint Commission (TJC) - The Joint Commission, formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is a nonprofit organization that accredits more than 20,000 healthcare organizations and programs in the United States.

therapeutic alternates -Therapeutic alternates are drug products containing different therapeutic moieties which are of the same pharmacologic and/or therapeutic class that can be expected to have similar therapeutic effects when administered to patients in therapeutically equivalent doses.

therapeutic equivalents - Drug products are considered to be therapeutic equivalents only if they are available in the same dosage strength, dosage form, achieve the same blood levels, and if they can be expected to have the same clinical effect and safety profile when compared to the original innovator drug. To ensure that a specific generic product is considered to be a therapeutic equivalent, it is recommended that you refer to the Orange Book, a publication from the Food and Drug Administration (FDA). If the products being compared in the Orange Book are considered therapeutic equivalents, it will be given a Therapeutic Equivalence (TE) Code that begins with an "A". If the products are not considered therapeutic equivalents, they will be given a TE Code that begins with a "B". Sometimes these will be referred to as "A" ratings and "B" ratings. These ratings are typically two letters long and will sometimes include a number as well. Usually, a tablet or capsule that is therapeutically equivalent to the innovator drug will have a TE Code 'AB' (with the first letter establishing whether or not the drugs are therapeutically equivalent, and the second letter establishing dosage form category). If a number is included after the two letter code that must also match to be considered therapeutically equivalent.

therapeutic substitution - Therapeutic substitution is the act of dispensing a therapeutic alternate for the drug product prescribed. Examples are:

• chlorothiazide for hydrochlorothiazide
• cephradine for cephalexin

third-party payor - A third-party payor (also spelled payer) is an organization other than the patient (first party) or pharmacy/health care provider (second party) involved in the financing of personal health services including, but not limited to, prescriptions medication.

trituration - Trituration is a method to reduce particle size (comminution); it may also include the grinding together of two or more substances in a mortar to mix them as you should want a fine powder to make incorporation better. Trituration is achieved by firmly holding the pestle and exerting a downward pressure with it while moving it in successively larger circles starting at the center of the mortar, moving outward to the side of the mortar, then back again toward the center.

U

United States Pharmacopeia (USP) - The United States Pharmacopeia (USP) is the official pharmacopeia of the United States, published dually with the National Formulary as the USP-NF. Prescriptions and over-the-counter medicines and other healthcare products sold in the United States are required to follow the standards in the USP-NF. The USP also sets standards for food ingredients and dietary supplements. Chapters in the USP that are listed as below 1000 are considered enforceable, while chapters enumerated as 1000 or greater are considered guidelines. Therefore, USP 797 and USP 795 are considered enforceable, while USP 1075 and USP 1160 are simply considered guidelines for best practices.

USP 795 - USP Chapter 795, Pharmaceutical Compounding-Nonsterile Preparations, codifies the rules pharmacists and pharmacy technicians must follow when compounding nonsterile formulations intended for humans and animals.

USP 797 - USP Chapter 797, Pharmaceutical Compounding-Sterile Preparations, provides the first set of enforceable sterile compounding standards issued by the United States Pharmacopeia (USP). USP Chapter 797 describes the procedures and requirements for compounding sterile preparations and sets the standards that apply to all settings in which sterile preparations are compounded.

USP 1075 - USP Chapter 1075, Good Compounding Practices, is intended to provide guidelines on applying best practices in compounding, both sterile and nonsterile.

USP 1160 - USP Chapter 1160, Pharmaceutical Calculations in Prescription Compounding, provides general information on the mathematical concepts required for compounding pharmaceutical preparations.

usual and customary price (U&C) – Usual and customary price is commonly known as the retail price and is the price paid for a prescription by a patient without insurance.

V

vaccine - A vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe, its toxins or one of its surface proteins.

Vaccine Adverse Event Reporting System - Vaccine Adverse Event Reporting System (VAERS) is a post-marketing safety surveillance program, collecting information about adverse events (possible side effects) that occur after administration of vaccines.

vasoconstriction - Vasoconstriction is the narrowing (constriction) of the blood vessels.

vasodilation Vasodilation is the expansion (dilation) of the blood vessels.

virus - A virus is a submicroscopic infectious organism. It has a non-cellular structure consisting of a core of DNA or RNA surrounded by a protein coat. It requires a living cell to replicate, and often causes disease in the host organism.

W

wholesaler purchasing - Wholesaler purchasing enables the pharmacy to use a single source to purchase numerous products from numerous manufacturers. Most drug ordering of this fashion is done online.

X

Y

Z