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What are the total quantity and the total days supply for the following Rx: Forteo 250 mcg 20 mcg sq qd #1 pen ------------------------------------------------------------ The doctor has prescribed the brand-name drug Forteo 250mcg/mL injection. In fact, the pharmacist will dispense Forteo 600mcg/2.4mL injection pen. The doctor wants the pharmacist to dispense one pen. Since the Forteo pen provides 2.4 mL of medicine, the total quantity will be either 2.4mL or 3mL depending on the pharmacy computer system. The sig says: inject 20 mcg under the skin every day The patient will inject 20 mcg daily, that is, the patient will inject 1 dose daily. Each prefilled pen will deliver 28 subcutaneous doses, 20 mcg per dose. Since the patient uses 1 dose daily and the pen provides 28 doses, the total days supply will be 28 days. It is worth noting that Forteo 250mcg/mL is the same as Forteo 600mcg/2.4mL It is also worth noting that this medicine is kept in the refrigerator. |

What are the total quantity and the total days supply for the following Rx: Heparin sod 5000U/mL sig: 1 mL under the skin bid 1 month supply ------------------------------------------------------------ The doctor has prescribed Heparin sodium 5000U/mL injection. The sig says: inject 1 mL under the skin twice daily The patient will use 2 mL per day. The doctor wants the pharmacist to dispense enough medicine to last 30 days. In turn, the total quantity to be dispensed will be 2mL * 30 days which is 60mL Each vial has 10 mL of Heparin. If 1 vial = 10 mL, then 6 vials = 60 mL In this case, the pharmacist will dispense 6 vials. The total days supply is 30 days as stated by the doctor. |

What are the total quantity and the total days supply for the following Rx: Arixtra 2.5 mg 13 doses 2.5 mg sq qd x 13 days ------------------------------------------------------------ The doctor has prescribed the brand-name drug Arixtra solution for subcutaneous injection. In this case, the pharmacist will dispense 13 single-dose, prefilled syringes containing 2.5mg of medicine. Each syringe contains 2.5mg of medicine. So, the total quantity to be dispensed is 13 doses, that is, 13 syringes as stated by the doctor. The total days supply is 13 days as stated by the doctor. The sig says: inject 2.5 mg subcutaneously every day for 13 days Some pharmacists could re-write the sig directions: inject one syringe subcutaneously every day for 13 days |

What are the total quantity and the total days supply for the following Rx: Sandostatin 0.1 mg sq tid (1 month) ------------------------------------------------------------ The doctor has prescribed the brand-name drug Sandostatin 0.1 mg injection, that is, Sandostatin 100mcg/mL injection, but the pharmacist may very likely dispense the generic version Octreotide 100mcg/mL injection. Notice that 0.1mg/mL is the same as 100mcg/mL The package has 10 ampules (ampuls). Each ampul has 1 mL of medicine. The sig says: inject 1 mL (one ampule) under the skin three times daily The patient will use 3 mL per day, that is, the patient will use 3 ampuls per day. The doctor wants the pharmacist to dispense enough medicine to last 30 days. The patient will use 3 mL * 30 days which is 90mL total. In other words, the patient will use 3 ampuls * 30 days which is 90 ampuls total. So, the total quantity to be dispensed is either 90 mL or 90 ampules. In fact, the pharmacist will enter only the number 90 on the computer. The total days supply is 30 days as stated by the doctor. This medicine is kept in the refrigerator. It is worth noting that 0.1 mg (100mcg) is just the strength of the medication. |

What are the total quantity and the total days supply for the following Rx: EpiPen Jr 0.15mg inj sig: uad severe reaction to peanuts qty: 1 refill: 2 ------------------------------------------------------------ The doctor has prescribed an auto-injector for allergic emergencies. The doctor has prescribed the brand-name drug EpiPen Jr 0.15mg injection. The quantity to be dispensed is 1 pen as stated by the doctor. The sig says: use as directed for severe reaction to peanuts The days supply is 1 day because this medicine is just a single injection pen. Notice that the doctor has given two refills. |

What are the total quantity and the total days supply for the following Rx: Epipen Jr 2-pak sig: utd ------------------------------------------------------------ The doctor has prescribed the brand-name drug EpiPen Jr 0.15mg injection. This medicine is an auto-injector for allergic emergencies, and it is a single injection pen. The doctor has prescribed 2 injectors, that is, 2 pens. So, the quantity to be dispensed will be 2 pens as stated by the doctor. The sig says: use as directed The days supply is 2 days. It is worth noting that EpiPen Jr Auto-Injector is supplied either as one auto-injector pen or as a pack with two auto-injector pens. |

What are the total quantity and the total days supply for the following Rx: Methotrexate 25mg/mL #1 10cc vial sig: inj 0.4 mL sq q weekly for RA ------------------------------------------------------------ The doctor has prescribed Methotrexate 25mg/mL injection. The total quantity to be dispensed is 10 mL as stated by the doctor. In this case, the pharmacist will dispense one vial of 10mL The sig says: inject 0.4 mL subcutaneously every week for rheumatoid arthritis The total days supply will be 10 mL divided by 0.4 mL which is 25 weeks. In other words, 25 weeks = 175 days But, many insurance companies will reject 175 days. So, the pharmacist will very likely use 90 days for the total days supply. |

What are the total quantity and the total days supply for the following Rx: Humira syr 40 mg/0.8 mL inj 40 mg sq every other week qty: 2 ------------------------------------------------------------ The doctor has prescribed 2 trays. In this case, the pharmacist will have to choose either a Humira Pen carton or a Prefilled Syringe carton. The doctor has written Humira syr, which means Humira syringe. In turn, the pharmacist will dispense the Prefilled Syringe carton. The Prefilled Syringe carton contains 2 dose trays. Each dose tray consists of a single-dose prefilled syringe providing 40mg (0.8mL) of medicine. The total quantity to be dispensed is 2 trays as stated by the doctor. In reality, the pharmacist or the technician will enter only the number 2 on the computer. The sig says: inject 40 mg subcutaneously every other week The patient has two syringes and then will inject one syringe every other week. In turn, the total days supply is 28 days. It is worth noting that the Humira Pen carton contains 2 dose trays. Each dose tray contains a single-use prefilled pen providing 40mg (0.8mL) of medicine. This medicine is kept in the refrigerator. |

What are the total quantity and the total days supply for the following Rx: Humira 40 mg sig: 40 mg sq q week disp: 4 ------------------------------------------------------------ The sig says: inject 40 mg subcutaneously every week The doctor wants the pharmacist to dispense 4 syringes. The box comes with 2 single-dose syringes. In turn, the pharmacist really dispensed 2 boxes, that is, 4 syringes. The total quantity to be dispensed is 4 syringes. In reality, the pharmacist or the technician will enter only the number 4 on the computer. In this case, the pharmacist really dispensed the brand-name drug Humira syringe 40 mg/0.8 mL The patient will get 4 syringes and will use 1 syringe every week. In turn, 4 syringes will last 4 weeks, that is, 28 days. Then, the total days supply is 28 days. This medicine is kept in the refrigerator. |

Calculate the total quantity and the total days supply for the following Rx: Rebif 44mcg/0.5mL syr 1 inj sc tiw ------------------------------------------------------------ The doctor has prescribed the brand-name drug Rebif 44mcg/0.5mL syringes. The package has 12 single-use prefilled syringes for subcutaneous injection. Each syringe has 0.5 mL of solution. 1 syringe = 0.5 mL and, then, 12 syringes = 6 mL So, the total quantity to be dispensed is either 6 mL or 12 syringes depending on the pharmacy computer system. In this case, the pharmacist will dispense one package. The sig says: use one injection subcutaneously three times per week The patient will use 3 syringes per week. The package has 12 syringes and, thus, the patient has enough syringes to last 4 weeks. So, the total days supply is 28 days. This medicine is kept in the refrigerator. It is worth noting that 44 mcg is the dosage strength. |

Calculate the total quantity and the total days supply for the following Rx: Depo-Testosterone 200mg/mL 1cc IM q 2 weeks disp: 1 vial ------------------------------------------------------------ The doctor has prescribed Depo-Testosterone 200mg/mL injection, but most pharmacists will dispense the generic version Testosterone cypionate 200mg/mL injection. This medication is a C-III drug. The doctor wants the pharmacist to dispense one vial, that is, 10 mL Then, the total quantity to be dispensed is 10 mL The sig says: inject 1 mL intramuscularly every two weeks The vial has 10 mL of medicine. If 1 mL is to be used in a period of 2 weeks, then 10 mL are to be used in a period of 20 weeks. In other words, it will take the patient 20 weeks to inject all 10mL (1mL at a time) Now, 20 weeks = 140 days and, in turn, the total days supply is 140 days. It is worth noting that Testosterone cypionate 200mg/mL is available in 1mL vials and in 10mL vials. Also, this medicine is an androgen hormone used in men to provide testosterone when the body cannot produce enough. |

What are the total quantity and the total days supply for the following Rx: Edex 20 mcg kit qty: 3 inj utd no more than once a day ------------------------------------------------------------ The doctor has prescribed the brand-name drug Edex 20mcg cartridge pack. The pack contains one reusable injection device, two single-dose cartridges, and two sterile needles. The pack of two cartridges provides the patient with two injections of medicine. The sig says: inject as directed no more than once a day The pharmacist will dispense 3 packs as stated by the doctor. So, the total quantity to be dispensed is 3 packs. In this case, the patient will have 6 cartridges to be injected with. Since the patient may use 1 cartridge every day, we can say that the total days supply will be 6 days. Usually, there should be at least a 1-day interval before the next injection is given. |

What are the total quantity and the total days supply for the following Rx: Edex 40 mcg inject UD #1 box of 6 ------------------------------------------------------------ The doctor has prescribed the brand-name drug Edex 40 mcg cartridge pack. The doctor wants the pharmacist to dispense one box of 6 cartridges. The pack contains one reusable injection device, six single-dose cartridges, and six sterile needles. The pack of 6 cartridges provides the patient with 6 injections of medicine. The sig says: inject as directed The pharmacist will dispense 1 pack. So, the total quantity to be dispensed is 1 pack. Usually, there should be at least a 1-day interval before the next injection is given. Now, the pharmacist may assume 6 days or 12 days for the total days supply. |

Calculate the total quantity and the total days supply for the following Rx: Copaxone 20mg/mL sig: 1 mL qd #1 month ------------------------------------------------------------ The doctor has prescribed the brand-name drug Copaxone 20mg/mL syringes. This medication is supplied in cartons of 30 single-use prefilled syringes. Each syringe contains 1 mL solution with 20 mg of glatiramer acetate. The active ingredient is glatiramer acetate. It is worth noting that Copaxone is for subcutaneous use only. The ratio of the medicine in each syringe is 20mg per 1mL In turn, there are three different ways of writing the sig directions. The sig could say: inject 1 mL subcutaneously every day Another sig could say: inject 20 mg subcutaneously every day The best sig could say: inject one syringe subcutaneously once daily The patient will use one syringe daily and the doctor wants the pharmacist to dispense enough medicine to last 30 days. In turn, the pharmacist will dispense 1 carton of 30 single-use prefilled syringes. Then, the total quantity to be dispensed is 1 carton or 30 mL or 30 syringes depending on the pharmacy computer system. The total days supply is 30 days as stated by the doctor. Notice that subcutaneous means under the skin. Also, this product should be refrigerated. |

What are the total quantity and the total days supply for the following Rx: HCG (injection) 10,000 units sig: 10,000 U IM qd ------------------------------------------------------------ HCG is the abbreviation for human chorionic gonadotropin. HCG is a hormone, usually used in combination with fertility drugs to increase a woman's chance of pregnancy. The pharmacist may dispense the generic version Chorionic Gonadotropin, but the pharmacist may also dispense either Novarel or Pregnyl. The pharmacist may very likely dispense the generic drug Novarel. The Novarel package has two vials. One vial contains the sterile dried powder and the other vial contains the bacteriostatic water. These two vials will be used for reconstitution. The reconstituted solution is stable for 60 days when refrigerated. The reconstituted vial will provide 10 mL of medicine, that is, the vial will provide 10,000 units of medicine for intramuscular use only. The sig says: inject 10,000 units intramuscularly daily as directed The total quantity to be dispensed is either 10 mL or 1 package depending on the pharmacy computer system. Since the patient will inject 10,000 units, the total days supply is 1 day. It is worth noting that Chorionic Gonadotropin is the active ingredient in A.P.L. A.P.L. is a brand-name drug that has been discontinued. |

What are the total quantity and the total days supply for the following Rx: HCG injectable liquid 10,000units/10mL disp: 10 mL sig: 200IU/0.2mL first thing in the morning 40 days ------------------------------------------------------------ HCG is the abbreviation for human chorionic gonadotropin. The pharmacist may dispense the generic version Chorionic Gonadotropin, but the pharmacist may also dispense either Novarel or Pregnyl. The vial will provide 10 mL of medicine, that is, the vial will provide 10,000 units of medicine for intramuscular use only. The sig says: inject 200 units (0.2 mL) first thing in the morning for 40 days The patient will use 200 units daily for 40 days, that is, the patient will use a total of 8,000 units. The total quantity to be dispensed is 10 mL as stated by the doctor. In this case, the pharmacist will dispense one vial. We know that one vial provides 10,000 units and, in turn, the total days supply will be 10,000 divided by 200 which is 50 days. It is worth noting that Chorionic Gonadotropin is the active ingredient in A.P.L. A.P.L. is a brand-name drug that has been discontinued. |

Calculate the total quantity and the total days supply for the following Rx: SymlinPen 120 solution disp: 4 pens (2 boxes) sig: 120 mcg sc tid before meals ------------------------------------------------------------ The doctor has prescribed the brand-name drug SymlinPen 120. This medication comes in a carton and the carton has 2 pens, that is, the carton has two 2.7mL disposable multi-dose pen injectors. In other words, one pen provides 2.7 mL of medicine and then two pens provide 5.4 mL of medicine. The doctor wants the pharmacist to dispense four pens, that is, two boxes. In turn, if 1 pen provides 2.7mL, then 4 pens will provide 10.8mL So, the total quantity to be dispensed is 10.8 mL The sig says: inject 120 mcg subcutaneously three times daily before meals The patient will inject 120 mcg * 3 daily, that is, the patient will inject 360mcg daily. Now, we need to convert 360 mcg into mL in order to calculate the total days supply. The ratio is 1000mcg/mL, that is, 1mL/1000mcg In other words, 1 mL contains 1000 mcg of medicine. x / 360mcg = 1mL / 1000mcg x = (360mcg * 1mL) / 1000mcg x = 360 / 1000 x = 0.36 mL So, the patient will inject 0.36 mL daily. The total days supply will be 10.8 mL divided by 0.36 mL which is 30 days. On the other hand, some insurance companies may not want to pay for four pens (two boxes) all at once. In turn, the patient may have to get two pens (one box) at a time. In this case, the total quantity dispensed would be either 5.4mL or 6mL depending on the pharmacy computer system, but the total quantity prescribed would be either 10.8mL or 12mL depending on the pharmacy computer system. Notice that 10.8mL = 2 * 5.4mL and that 12mL = 2 * 6mL It is worth noting that the pen must be kept in the refrigerator. It is also worth noting that the pen provides doses of 60 mcg and doses of 120 mcg. Doctors can tell patients to inject either a dose of 60mcg or a dose of 120mcg |

What are the total quantity and the total days supply for the following Rx: Medroxyprogesterone contraceptive injection 150mg/mL syringe sig: uad by doctor ------------------------------------------------------------ The doctor has prescribed Medroxyprogesterone Contraceptive 150mg/mL prefilled syringe This medicine is an injectable suspension that the patient may use at home as long as the patient is able to use the prefilled syringe. Oftentimes, the patient buys this medicine at the pharmacy and, then, the patient goes back to the doctor's office for the nurse to do the injection. This medicine is to be given by injection into a muscle (upper arm or buttock) once every 3 months. The quantity to be dispensed is just a sealed package which contains 1 single-dose syringe for intramuscular use only. This medicine is a progestin hormone used to prevent pregnancy. So, the total quantity is 1 syringe and the total days supply is 90 days. It is worth noting that Depo-Provera contraceptive injection is the brand name while Medroxyprogesterone contraceptive injection is the generic name. |

What are the total quantity and the total days supply for the following Rx: Imitrex 6 mg injection sig: 6 mg sc prn ha. max 2 doses per day #6 ------------------------------------------------------------ The doctor has prescribed Imitrex 6 mg statdose system. The carton contains 2 prefilled single-dose syringe cartridges, 1 Imitrex statdose pen, and 1 carrying case. Each syringe cartridge contains 6 mg of medicine for subcutaneous injection. The sig says: inject 6 mg subcutaneously as needed for headache. Maximum of 2 doses per day In other words, the patient will use one syringe cartridge, but a maximum of two syringe cartridges per day. The doctor wants the pharmacist to dispense 6 single-dose syringe cartridges, but the pharmacist will dispense one system (box) containing 2 prefilled single-dose syringe cartridges, 1 Imitrex statdose pen, and 1 carrying case. So, the total quantity to be dispensed is 1 system. The total days supply is 1 day, but some insurance companies may not accept 1 day. Then, the total days supply may have to be 2 days. As we can see, the patient will get one system and, in turn, the patient will be using 2 syringe cartridges. Now, the patient still has 4 syringe cartridges for later use because the doctor has prescribed 6 syringe cartridges. At the next refill, the patient will get one carton with two single-dose prefilled syringe cartridges. At this point, the patient does not need to get the statdose system anymore because the patient already received the system at the very first time. Then, at the last refill, the patient will get another carton with two single-dose prefilled syringe cartridges and, again, the patient does not need to get the statdose system because the patient already received it at the very first time. Notice that the syringe cartridges are to be used with the statdose pen. |

What are the total quantity and the total days supply for the following Rx: Imitrex inj sig: 6 mg sc prn ha. max 2 per day #6 ------------------------------------------------------------ The doctor has prescribed Imitrex 6 mg injection, but the pharmacist may very likely dispense the generic version Sumatriptan 6mg injection kit. This kit contains 2 prefilled single-dose syringe cartridges, 1 autoinjector pen, and 1 carrying case. Each syringe cartridge contains 6 mg of medicine for subcutaneous injection. The sig says: use 1 injection subcutaneously as needed for headache. Maximum of 2 injections per day The doctor wants the pharmacist to dispense 6 single-dose syringe cartridges, but the pharmacist will dispense one kit (box) containing 2 prefilled single-dose syringe cartridges, 1 autoinjector pen, and 1 carrying case. So, the total quantity to be dispensed is 1 kit. The total days supply is 1 day, but some insurance companies may not accept 1 day. Then, the total days supply may have to be 2 days. As we can see, the patient will get one kit and, in turn, the patient will be using 2 syringe cartridges. Now, the patient still has 4 syringe cartridges for later use because the doctor has prescribed 6 syringe cartridges. At the next refill, the patient will get one carton with two single-dose prefilled syringe cartridges. At this point, the patient does not need to get the kit anymore because the patient already received the kit at the very first time. Then, at the last refill, the patient will get another carton with two single-dose prefilled syringe cartridges and, again, the patient does not need to get the kit because the patient already received it at the very first time. Notice that the syringe cartridges are to be used with the autoinjector pen. |

What are the total quantity and the total days supply for the following Rx: INTRON A 3 MIL IU SOLN MULTIDOSE PEN inject 3 million units 3 times weekly qty: 2 ------------------------------------------------------------ The doctor has prescribed INTRON A 3 million IU solution multidose pen. This pen has 6 doses of 3 million international units each, that is, the pen has 6 doses of 0.2mL each. As we can see, 3 MIU correspond to 0.2mL The pen has 6 doses of 0.2 mL each, that is, the pen has a total of 1.2mL of solution. The doctor wants the pharmacist to dispense 2 pens. In other words, if 1 pen has 1.2 mL, then 2 pens have 2.4 mL So, the total quantity to be dispensed is either 2 pens or 2.4 mL depending on the pharmacy computer system. The sig says: inject 3 million units three times weekly We know that 1 dose = 3 million units and, in turn, the patient will inject 1 dose three times weekly, that is, the patient will inject 3 doses per week. We also know that 1 pen has 6 doses and, in turn, 1 pen will provide 2 weeks of medicine (3 doses for each week) But, the doctor has prescribed 2 pens. Then, 2 pens will provide 4 weeks of medicine. In other words, the patient will have medicine for 28 days. So, the total days supply is 28 days. |

What are the total quantity and the total days supply for the following Rx: Intron A 3 million units 3x a week 1 month supply ------------------------------------------------------------ The doctor has prescribed INTRON A 3 million IU solution multidose pen. This pen has 6 doses of 3 million international units each, that is, the pen has 6 doses of 0.2mL each. As we can see, 3 MIU correspond to 0.2mL The pen has 6 doses of 0.2 mL each, that is, the pen has a total of 1.2mL of solution. The sig says: inject 3 million units three times a week The doctor wants the pharmacist to dispense enough medicine for one month, but the sig says for the patient to take the medication weekly. One month has approximately four weeks. In this case, the total days supply will be 28 days. We know that 3 million units correspond to 0.2 mL and, in turn, the patient will use 0.2mL three times weekly, that is, the patient will inject 0.6mL per week. The doctor wants the patient to get enough medicine for 4 weeks. If the patient uses 0.6mL weekly, then the patient will use 0.6 * 4, that is, 2.4mL total. We also know that 1 pen has 1.2 mL and, in turn, 2 pens have 2.4 mL So, the total quantity to be dispensed is either 2 pens or 2.4 mL depending on the pharmacy computer system. |

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