Question

question 22

which of the following elements of the prescription below should a pharmacy technician clarify?

levothyroxine .112 mcg i po qd ac

strength
frequency
route
time

Explanation:

Analyze the prescription elements

Using the Prescription Clarification knowledge point, we examine the written order: "Levothyroxine .112 mcg i po qd ac".

• Drug: Levothyroxine
• Strength: ".112 mcg"
• Dose: "i" (one tablet/capsule)
• Route: "po" (by mouth)
• Frequency: "qd" (every day)
• Time: "ac" (before meals)

Identify safety issues and error-prone elements

Using the Leading Decimals and Error-Prone Abbreviations knowledge points

$$ \text{Strength: } .112\text{ mcg} \implies \text{Missing leading zero (should be } 0.112\text{ mcg or converted to } 112\text{ mcg)} $$

$$ \text{Frequency: } \text{qd} \implies \text{On the ISMP list of error-prone abbreviations (should be "daily")} $$

The decimal point in ".112 mcg" is extremely dangerous because it can easily be misread as "112 mcg" (a 1000-fold overdose if interpreted as milligrams, or a misread of the decimal point itself). According to standard safety guidelines, a leading decimal point must always be preceded by a zero (e.g., "0.112"). However, looking at the options provided (Strength, Frequency, Route, Time), we must evaluate which element contains the primary error requiring clarification.

Let's re-examine the strength: Levothyroxine is commercially available in microgram (\(\text{mcg}\)) strengths such as \(112\text{ mcg}\) (\(0.112\text{ mg}\)). Writing ".112 mcg" is highly anomalous because \(0.112\text{ mcg}\) is not a standard dose (it is likely a typo for \(112\text{ mcg}\) or \(0.112\text{ mg}\)). Therefore, the numerical value of the strength itself is highly ambiguous and dangerous, requiring immediate clarification.

Select the correct option

The strength is written as ".112 mcg". This contains a naked decimal point and represents an extremely unlikely dose for Levothyroxine (standard doses are in whole micrograms, such as \(112\text{ mcg}\)). This makes "Strength" the primary element that must be clarified to prevent a medication error.

Answer:

• Strength (Correct answer)
• Frequency
• Route
• Time