A patient presents to the pharmacy with a first time prescription for Bydureon BCise to manage her diabetes. Put the following steps in order of how she should prepare and administer her injection.

A. Holding the device upright, turn the knob from lock to the unlock position hearing a "click" upon successful completion.

B. Holding the device upright, unscrew the orange cap in a counterclockwise direction without pulling.

C. Shake the device up and down for at least 15 seconds to thoroughly mix the dose.

D. Push the pen against your skin, hearing a click once the injection begins. 

Answer with rationale: 

The correct order is C-A-B-D. The directions in more detail can be found here: https://www.bydureon.com/bydureon-bcise/how-to-use.html.  Knowledge of administration techniques or instructions for drug administration is NAPLEX competency statement 5.5: https://nabp.pharmacy/programs/examinations/naplex/competency-statements-2021/

This is important especially within unique dosage forms such as injectables and inhalers as they come in many forms and have unique administration techniques. Inhalers for asthma or COPD can come in many different dosage forms such as metered-dose inhalers or dry powder inhalers which require different administration techniques.  In addition, knowledge of what affects absorption of oral medications is important to know as well. For example, while fluoroquinolones are well absorbed orally after administration, multivalent cations, such as zinc or magnesium, can significantly decrease absorption. Medications like Xarelto should be taken with an evening meal to improve overall bioavailability. Some medications such as itraconazole or ferrous sulfate require an acidic environment for optimal absorption when given orally.

Good luck everyone as you prepare to take the examination!  A special shout out to the students of the University of Georgia College of Pharmacy, University of South Carolina College of Pharmacy, Medical University of South Carolina College of Pharmacy, and Virginia Commonwealth University School of Pharmacy. We very much enjoyed your hospitality given to myself and Dr. Scott Sutton over the past weeks during our live board reviews.