4. Answer Key for Sample Questions (p 35)

Transcription

1 Module Four Prescriptions, Insurance, and Inventory Table of Contents 1. Prescriptions A. Pharmacy Prescription Settings (p 3) i. Community Pharmacy (p 3) ii. Institutional Pharmacy (p 3) iii. All Pharmacy Settings (p 4) B. Processing a Prescription i. Entering a Prescription into a Retail Pharmacy Computer (p 5) ii. Entering a Prescription into a Hospital Pharmacy Computer (p 5) C. Important Prescription Information i. Avoiding Errors (p 6) ii. Directions for Use on a Prescription (p 6) iii. Auxiliary Labels (p 7) D. Sample Questions (p 8) E. Transcribing of Prescriptions iv. A Prescription Pad (p 10) v. Important Information for Processing a Prescription (p 10) vi. The Information on a Written Prescription (p 11) vii. Exercise: Transcribing Prescriptions (p 12) F. Computer-Generated Prescription Labels (p 13) G. Sample Questions (p 14) i. Bonus Sample Question (p 15) H. Package Insert (p 16) I. Patient Information Leaflet (p 16) J. Prescription Signature Log (p 17) K. Important Reminders for Filling Prescriptions (p 17) L. Sample Questions (p 18) 1

2 2. Important Insurance Information A. Online Claim Information Needed to Enter into the Computer (p 19) i. Dispense as Written (p 20) ii. Insurance Claim Rejections (p 20) iii. Insurance Billing Codes (p 21) iv. Computer and Third Party Billing (p 22) B. Pharmacy Benefit Managers (p 22) C. Different Types of Third Party Programs (p 23) i. Managed Care Programs (p 23) ii. Private Health Insurance (p 23) iii. Public Health Insurance (p 23) iv. Workers Compensation (p 23) D. Disease State Management Services (p 24) E. Sample Questions (p 25) 3. Inventory Control A. Inventory Management (p 27) i. Types of Inventory Awareness (p 28) ii. Automated Dispensing Systems (p 29) iii. Receiving Orders (p 29) iv. Bar Coding (p 29) v. Returning and Crediting Products (p 30) vi. Recordkeeping (p 30) vii. Repackaging of Drugs (p 30) B. Pharmacy Database System (p 31) i. Computers (p 31) C. Other Important Factors (p 32) i. Refrigeration of Drugs (p 32) ii. Hand Washing (p 32) iii. Disposal of Drugs (p 32) D. Sample Questions (p 33) 4. Answer Key for Sample Questions (p 35) 2

3 1. Prescriptions A prescription is a written order from a practitioner for the preparation of a drug or medical device giving the name, route, quantity, directions and refills. Remember, not only a medical physician can write prescriptions, but doctors of osteopathy, dentists, veterinarians, podiatrists, nurse practitioners, and opticians can also. Medications that are prescribed by those other than physicians are limited to their field of practice. Prescriptions are subject to state and federal laws and regulations. Pharmacy abbreviation comes from Latin and English words. They are used for prescriptions to communicate to the public information on formulations, preparation, dosage, and administration of the medications. All technicians need to know pharmacy abbreviations and their meanings. A. Pharmacy Prescription Settings i. Community Pharmacy This is a retail pharmacy and the prescription is dispensed directly to an outpatient customer or patient. When the customer or patient picks up their prescription they will receive information and counseling about the medication from the pharmacist. ii. Institutional Pharmacy This setting is either in a hospital, long term care pharmacy or home health care pharmacy. The medication is usually package in a unit dose meaning a single dose of medicine is individually wrapped for one dose, at one time of day, for one patient. This is administered by a nurse or a person who is certified in administering certain medications. 3

4 iii. All Pharmacy Settings Whether you are in a community or hospital pharmacy, the prescriber writes the prescription for the patient and the prescription is entered into the computer and a label is generated. The pharmacy technician completes the data and then fills the medication in the appropriate container. The pharmacist then checks the final prescription before the patient receives the medication.! Remember the Pharmacist always has the final check.! Rx is an abbreviation of the Latin word recipe, meaning to take.! "Sig" is an abbreviation of the Latin word signa, meaning to write or give directions for use and the administration route on a prescription. 4

5 B. Processing a Prescription i. Entering a Prescription into a Retail Pharmacy Computer! Check the new prescription for clearness.! Can you read it in its entirety?! Check the medication and see if this is an over-the-counter drug or a controlled substance schedule II.! Check the date when the prescription was written.! If this is a new customer you need to get the persons name, address, telephone number, date of birth, allergies and insurance information.! Is this drug available in your pharmacy?! Is the prescription suspicious of forgery in anyway?! If the prescription is for a compound medication that is not made in advance, let the customer know when it will be ready. ii. Entering a Prescription into a Hospital Pharmacy Computer! The patient s physician writes the prescription order on the patient s chart in the hospital and the unit secretary will transfer the order to a pharmacy medication sheet. Once the nurse on duty checks the transcription she will send it to the pharmacy.! The pharmacy technician enters the prescription into the computer and prints out a Medication Administration Record (MAR) on the patient.! The prescription is then filled by the pharmacy technician in a unit dose form and placed in a cart where every patient has their own drawer labeled with their name and room number.! The medications are stocked for a 24 hour period.! The pharmacist has the final check before going to the floor where the nurse will administer the medication to the patient. 5

6 C. Important Prescription Information i. Avoiding Errors Make sure you have the:! Right medication.! Right strength.! Right dosage.! Right quantity.! Right directions.! Right patient.! And... do not dispense if you suspect forgery! ii. Directions for Use on a Prescription! Always give the directions that the physician has ordered, never alter.! Directions should always start with a verb, one that is familiar to the public.! Use verbs such as take, give, instill, insert, place, inject, apply and inhale.! Always indicate the route of administration.! Use words such as by mouth, in eye, in ear, rectally, vaginally, intramuscularly, intravenously, subcutaneously, to affected area, under the tongue.! Always use whole words.! Use words such as capsules, tablets, cream, and ointment.! Always use milliliters in terms of household measurements. Instead of using 5 mls use 1 teaspoonful. 6

7 iii. Auxiliary Labels Many prescriptions written by a physician do not give the patient directions for consumption and use. Auxiliary labels can be added to the prescription bottle by the pharmacist in order to provide additional information for the patient while taking their medication. Auxiliary Labels include but are not limited to the following directions: Take medication with food. Take on an empty stomach. For the ear. For the eye. For external use. Do not drink alcohol. Do not take aspirin. May cause drowsiness. Shake well. Sample Auxiliary Label 7

8 D. Sample Questions 1. What type of pharmacy setting uses a unit dose system to fill prescriptions? a. Community b. Nuclear c. Hospital d. Retail 2. What does the pharmacy abbreviation Rx mean? a. Order b. Write c. Take d. Prescribe 3. What does the word signa mean? a. Fill b. Take c. Write d. Order 4. In what type of pharmacy setting is a Medication Administration Record used? a. Retail b. Hospital c. Community d. Compounding 5. When entering the directions on a prescription, always start with what type of word? a. Verb b. Noun c. Name of drug d. Route of administration 8

9 6. What label is added to some prescription containers to give the patient more information about the drug? a. Storage information b. Drug information c. Auxiliary d. Package insert 9

10 E. Transcribing of Prescriptions i. A Prescription Pad ii. Important Information for Processing a Prescription 10

11 iii. The Information on a Written Prescription (1) Dr. William Jones (2) 3311 Park Ave Suite 200 Lakeside, Virginia (3) (804) Fax (804) (4) DEA # AJ (5) Name Charles Edward (7) Date Aug. 19, 2006 (6) Address 2607 Chapin Lane Lakeside, VA (11) Refill 5 (8) Atenolol 25 mg (9) Sig: i po qd (10) #30 (12) Dispense as Written (13) Prescriber s Signature (1) Prescriber s Name (2) Prescriber s Address (3) Prescriber s Telephone and Fax Numbers (4) Prescriber s DEA Number (5) Patient s Name (6) Patient s Address (7) Date the prescription was written (8) Name and Strength of the medication (9) Sig: means to write indicates the directions and route of administration (10) Quantity to be Dispensed (11) Number of Refills (12) DAW Dispense as Written or Generic Substitution Allowed (13) Prescriber s Signature 11

12 iv. Prescriptions are always written in ink, typed, or electronically produced. Exercise: Transcribing Prescriptions Practice transcribing the prescriptions below. # Cover up the right side of the table below. # Use a verb to start transcribing the direction for use. Lipitor 10 mg 1 qhs po #30 Lasix 50 mg 1 po qd #30 Timoptic 0.1% 1 gtt ou qid Anusol H-C Sig: 1supp bid Amoxil 125mg/5ml po 5ml qid NPH Insulin 10 units in am ac 8 units in pm ac qd Take one tablet by mouth at bedtime. Take one tablet by mouth every day. Instill one drop in both eyes 4 times a day. Insert one suppository rectally two times a day. Give 1 teaspoonful by mouth 4 times a day. (Use give instead of take when you are giving directions to a parent to administer to a child.) Inject 10 units subcutaneously before breakfast and 8 units before dinner every day. (Insulin is always given subcutaneous.) 12

13 F. Computer-Generated Prescription Labels Once the customer s information has been entered into the pharmacy computer system, a label is generated for the prescription container. Marshall s Pharmacy Ph: Parkside Ave. Edward, Charles Lakeside, Virginia Chapin Lane Lakeside, VA RX: Prescriber: William Jones, MD TAKE ONE TABLET BY MOUTH EVERY DAY Atenolol 25 mg Tablets (Tenormin) Refillable 5 times before Qty: 30 RPh: Marshall, Travis Tech: DB Date filled: Orig: Date: Discard after

14 G. Sample Questions What verb should be used for the following medications when transcribing a prescription? Key words to use: Take, Give, Inhale, Inject, Instill, Place, or Apply 1. Paxil 20 mg 1 tab p.o. qd #30 2. Kenalog cream 0.1% bid 15 gm 3. Atrovent Inh #1 2-3 puffs tid 4. Premarin 1.25 mg #21 I qd x 21 d off 7 5. Biaxin 500 mg po bid x 7 days 6. Lopressor 50 mg po qd 7. Tobramycin 2 gtts ou bid 5ml 8. Cortisporin 1gtt as qid 9. Ambien 5 mg p.o. hs prn 10. Vitamin B mcg/1ml IM stat 11. Darvocet-N 100 I or II q4h prn 12. Amoxicillin 125mg/5ml qs qid for 10 days 14

15 i. Bonus Sample Question 13. How many Prednisone tablets do you dispense for the following prescription? Prednisone 10 mg 1 qid x 2 days, 1 tid x 2 days, 1 bid x 2 days, 1 qd x 2 days, ½ qd x 2 days Take one tablet by mouth 4 times a day for 2 days, then one tablet 3 times a day for 2 days, then, 1 tablet 2 times a day for 2 days, then one tablet every day for 2 days, then ½ tablet every day for 2 days. a. 18 b. 21 c. 25 d

16 H. Package Insert A package insert contains information about the prescription drug. It is inserted with the drug by the manufacturer giving the following information:! Description! Clinical Pharmacology! Indications and usage! Contraindications! Warnings! Precautions! Adverse reactions! Drug abuse and dependence! Over dosage! Dosage and administration! How supplied I. Patient Information Leaflet A patient information leaflet contains information about the medication that has been prescribed by the prescriber s prescription. This is given to the patient when they pick their prescription up from the pharmacy. It will contain the following information:! Medication name! Drug Class! How to use this medication! Side effects! Precautions! Drug interactions! Missed dose! Storage! Any caution information 16

17 J. Prescription Signature Log Every prescription that is picked up from a pharmacy needs to be recorded in a log for third-party billing and as proof the prescription was picked up. Patient or Cardholder Signature Do you have any questions about your prescription for the Pharmacist? Yes/ No Computer label Rx, date, plan, name Charles Edward No Rx /19/06 Insurance company There is also a question asking Do you want child-resistant safety caps? This requires the pharmacy technician s signature if the answer is no. K. Important Reminders for Filling Prescriptions! The date the prescription was written.! Identify the product by the NDC # (National Drug Code) and manufacturer.! Have correct insurance information from the patient! Check the pricing of the drug.! Refer the customer or patient to the pharmacist for any questions about OTC s (Over-the-Counter) or prescription medication questions outside of the cost and location of the drug.! Accuracy is extremely important when reading the prescription, translating, entering into the computer, pulling the medication from the shelf, counting, labeling and doing any math calculations. 17

18 L. Sample Questions 1. What is some of the information contained in a package insert? a. Description b. Usage c. Warnings d. All of the above 2. Why is a prescription signature log maintained in a pharmacy? a. Third party billing. b. Proof of pick-up. c. Signature for non-safety caps. d. All of the above. 3. What number should you use to identify a product from a manufacturer? a. UPC b. NDC c. OTC d. DEA 18

19 2. Important Insurance Information A. Online Claim Information Needed to Enter into the Computer Retail Settings:! Insurance Company! Cardholder I.D. Number! Group Number! Name of Patient! Date of Birth! Sex! Relationship to Cardholder! Date Rx Written! Date Rx Dispensed! New or Refill Prescription! National Drug Code (NDC) of Medication! Dispense as Written (DAW)! Quantity Dispensed! Days Supply! DEA # of Prescriber! DEA # of Pharmacy! Retail Price of Medication! Deductible or Co-pay! Balance Due 19

20 i. Dispense as Written (DAW) DAW codes are entered into the computer when filling a prescription to the insurance company. The numbers 0-8 represents the code to enter into the computer. # 0 No DAW # 1 DAW handwritten on the prescription by the prescriber # 2 Patient requested brand # 3 Pharmacist requested brand # 4 Generic is not in stock # 5 Brand name dispensed but priced as generic # 6 N/A # 7 Substitution not allowed; brand mandated by law # 8 Generic not available ii. Insurance Claim Rejections The following is a list of reasons for insurance claim rejections. # Invalid person code # Invalid birth date # Invalid sex # Dependent exceeds age limit # Unable to connect # Patient not covered # Refill too soon # Refills not covered # Drug not covered # Pre-authorization required # NDC not covered # Prescriber is not a network provider 20

21 iii. Insurance Billing Codes CPT Common Procedural Terminology Used to describe clinical interactions with patients. Code information includes (1) new or established patient (2) complexity of the clinical situation (3) pharmacist time spent with the patient. ICD-9 International Classification of Disease Designates patient s disease from the physician. This is for the pharmacist to get reimbursed for services. HCPCS HCFA Common Procedure Coding Procedure Codes are used to get reimbursed for medical devices such as walkers, syringes, wheelchairs, hospital beds, etc. HCFA 1500 Health Care Financing Administration To bill for pharmaceutical care service such as disease state management. PCCF Pharmacist Care Claim Form Developed by the National Community Pharmacists Association to provide pharmacists a way of billing for their clinical services. 21

22 iv. Computer and Third Party Billing There are procedures for pharmacies to submit third party insurance claims. With the computer age, we hope to eliminate any type of universal forms (paper claims) to be submitted. However most of the paper forms are filed electronically. B. Pharmacy Benefit Managers Pharmacy Benefit Managers (PBM) are companies that administer drug benefit programs by signed contracts from participating pharmacies. This process is done before the patient can get his or her prescription filled at that pharmacy and billed to their insurer or pharmacy benefit manager. # Co-insurance is an agreement for the cost-sharing between the insured and insurer. # Co-pay is the portion of the cost of the prescription that the patient is responsible to pay. # Dual co-pays have two prices, one for a generic and one for a brand name drug. # A Deductible is a set amount that is paid by the patient each calendar year before the insurance coverage will take place. # Managed care programs include: HMO (health maintenance organization), POS (point of service programs), PPO (preferred provider organization) programs. # An HMO is a network of providers for which cost is covered inside of the system s list of authorized physicians and medical facilities. # A POS is a network of providers where the patient s primary care physician must be a member and the patient may go outside of the system with only a partial reimbursement. # A PPO is a network of providers where costs outside the network may be partially reimbursed and the primary care physician does not have to be a member. 22

23 C. Different Types of Third Party Programs i. Managed Care Programs An HMO is a public, basic health insurance program with a network of inside providers for which cost are covered. A POS is a network of providers where the patient s primary care physician must be a member inside of the network. A PPO is a network of providers where costs outside the network may be reimbursed. Most of these use pharmacy benefit managers (PBM s) to manage their drug benefit coverage. ii. Private Health Insurance A basic health insurance policy that may pay for prescriptions for an individual or have a deductible before a individual is covered. iii. Public Health Insurance Covered in the United States by Medicare and Medicaid. These are federal programs that cover individuals age 65+ or individuals who need state welfare. Under the new Medicare Part D program, all individuals receive prescription coverage when they sign up for coverage with insurance companies that have plans for seniors at an affordable monthly premium. iv. Workers Compensation The federal government and every state has guidelines for reporting an employee s injury on-the-job. All on-the-job accidents are reported to the public board that grants compensation to the injured worker. Most workers compensation claims are processed through online adjudication but some may require paper claim forms. Pharmacy benefit managers (PBMs) may administer prescription drug benefits. 23

24 D. Disease State Management Services Disease State Management Services is a growing business in the health care profession. It includes any type of pharmaceutical care, such as programs monitoring diabetes, asthma, blood pressure, cholesterol, and smoking cessation management. # Pharmacy Technicians are responsible for properly filing documents for these programs. # Pharmacist are paid by the insurance companies for services rendered. 24

25 E. Sample Questions 1. Which DAW (Dispense as Written) code is used when a patient requests brand name only? a. 0 b. 1 c. 2 d What is the name of the standard paper claim form used for insurance billing? a. PCCF b. Clinical form c. Universal form d. CPT 3. What online claim information is not needed to enter the patient into the computer? a. Name b. Insurance company c. Age d. Sex 4. What is not a reason for an insurance claim rejection? a. Invalid person code. b. Dependent exceeds age limit. c. Refill too soon. d. NDC covered. 5. What form is used to bill for pharmaceutical care services such as disease state management? a. CPT b. ICD-9 c. HCFA 1500 d. PCCF 25

26 6. What companies administer drug benefit programs by signed contracts from participating pharmacies? a. PBM b. HMO c. POS d. PPO 7. Under what federal program can senior citizens receive prescription coverage? a. Manage Care b. Private companies c. Medicare Part D d. Worker s compensation 8. What types of service programs are used in disease state management? a. Asthma b. Blood pressure c. Diabetes d. All of the above 26

27 3. Inventory Control An inventory is an item that will be used in a business within its normal day-to-day operations. Pharmacies should always have enough inventory in stock for the customer or patient. This is an importance responsibility for a pharmacy technician. A. Inventory Management # The inventory process can have many participants involved. # Inventory does not stop with brand and generic drugs. Pharmacies stock vials, tops, labels, copy paper, bags, tape, staples, paper clips, and more. # Pharmacies receive their drugs and supplies from Drug Manufactures, Wholesalers, and Supply Stores. # The Drug Enforcement Agency (DEA), Food and Drug Act (FDA), and State Board of Pharmacy all have control over the drugs in a pharmacy. # A pharmaceutical inventory system such as the pharmacy computer keeps track of the inventory needs and generates reorders to maintain the correct amount of drugs in a pharmacy. # A Formulary is a list of medications approved for use in the system by hospitals, HMO s, insurers, and other health-care systems. $ Open formulary allows the purchase of any medication prescribed. $ Closed formulary is a limited list of approved medications. 27

28 i. Types of Inventory Awareness Turnover This is the rate at which the inventory is used. Availability Sometimes a drug will not be available due to a manufacture s recall, raw materials are unavailable to make the drug or the manufacturer may have some other difficulties. Spoilage Storage conditions and expiration dates may cause the chemical compounds in medications to break down. This could be dangerous. Point of Sale This operation is used to deduct an item which has been dispensed from the inventory. Reorder Points To maintain an adequate inventory you need to have a system with maximum and minimum reorder points. Example: An amount of a certain drug comes in bottles of 100 tablets. The pharmacy needs to keep in stock at all times 300 tablets (minimum) and no more that 500 tablets (maximum). Today you have dispensed 250 tablets and lowered your inventory to 250 tablets. The computer automatically reorders 3 bottles of 100 tablets each to maintain your inventory. Order Entry Devices This is another way to order stock for your inventory. This is a portable hand-held device that scans the product s bar code and allows you to enter the quantity needed to order. A want book Used primarily in hospital pharmacies. When all of the medication has been dispensed from its bottle during the day, a pharmacy technician will enter the name, strength, and quantity of the empty bottle into the want book to ensure the person in charge of ordering will re-order it. 28

29 ii. Automated Dispensing Systems There are several types of automated dispensing systems. They are used in retail pharmacies to count and label with a robotic type machine. Hospital pharmacies use them to fill unit dose medications for the patient s drawer in the medication cart. # Each floor of a hospital has a med-station for emergency or floor stock items that are available to nurses for their patients. Some Examples of Med-Stations: $ Baker Cell $ Pyxis Supply Stations $ Mobile Robots # In a hospital setting, emergency carts or crash carts are refilled by the pharmacy technician after each use and sealed with a yellow tie. iii. Receiving Orders Receiving orders is one of the most important parts of pharmacy operations. Products ordered from the wholesaler, manufacturer, or retailer should be carefully checked in when delivered. Pharmacy Technicians must verify the purchase order with the name of the product, the dosage, strength, package size, and expiration date. Also check for any items damaged during delivery. iv. Bar Coding The bar coding of products can decrease the medication error rate by ensuring the correct drug is being ordered. Scanning the bar code on a prescription that you are giving to the patient ensures the correct drug is being dispensed. Bar coding is also used with the Robotic systems in hospitals using unit dose systems. 29

30 v. Returning and Crediting Products The manufacture or wholesaler should be notified immediately when items are damaged, incorrectly pulled for delivery, or expired. An authorization will be sent to the pharmacy for the return and credit of the product. vi. Recordkeeping All records for wholesale distributors should be filed in a separate place with the date and signature of the time the order was checked into the pharmacy for two years. Have the records readily available for inspection by your state board of pharmacy and federal agencies. vii. Repackaging of Drugs Repacking of a drug takes place when drugs are packaged in bulk supply. Most commonly, repackaging occurs for a unit dose (one drug, for one patient, for one time of the day). In assisted living home the medication is packaged in a single dose cart with a 31 day supply and is for one time of day, for one patient. o This medication is administered by certified medication aids. Usually there is a 6 month expiration put on all repackaged medication. Documentation needs to include the date of repacking, name of medication, strength, lot number, expiration date, and the name of the technician who performed the repackaging. The medication is then checked by the pharmacist for accuracy and initialed. 30

31 B. Pharmacy Database System A database system is a collection of information in specific files that can be retrieved easily and used. i. Computers System Care and Maintenance is important with all of the computer equipment in the pharmacy. Factors that can adversely affect computers are: # Dust # Moisture # Temperature # Vibrations # Movement # Power surges # Neglect Make sure your pharmacy has a back-up database of all information in case there is a malfunction in the computer system. Make sure that back-up files are generated on a regular basis. 31

32 C. Other Important Factors i. Refrigeration of Drugs All refrigerators in the pharmacy where medications are stored should be equipped with a thermostat. Every day, the thermostat should be read and the daily temperature recorded.. Normal refrigerated temperature should be degrees Fahrenheit and 2-8 degrees Celsius. Food should never be stored in the same refrigerator with drugs. ii. Hand Washing Every pharmacy should have a sink for hand washing only. No other items should be put in the sink unless it is pharmacy equipment for compounding use. iii. Disposal of Drugs Expired, deteriorated, or contaminated drugs in the pharmacy should be removed and disposed of according to state and federal law. All states have different procedures for disposal and disposal should be done according to the rules and regulations of your state s board of pharmacy. 32

33 D. Sample Questions 1. In order to maintain adequate inventory in the pharmacy, the computer has maximum and minimum inventory levels for each drug. What are these called? a. Point of sale b. Order entry device c. Turnovers d. Reorder points 2. From where do pharmacies order their drugs? a. Manufactures b. Wholesalers c. Supply warehouses d. All of the above 3. From where do pharmacies order their supplies? a. Manufacturers b. Wholesalers c. Supply houses d. All of the above 4. What is an open formulary? a. Allows the purchase of any medication prescriptions. b. A limited list of approved medication. c. Maintains the correct amount of drugs. d. None of the above. 5. What is the rate at which the inventory in a pharmacy is used? a. Spoilage b. Turnover c. Reorder points d. Point of sale 6. In what pharmacy setting is a want book primarily used? a. Hospital b. Retail c. Long term care d. Home infusion 33

34 7. What color tie seals emergency and crash carts in a hospital? a. Red b. Blue c. Yellow d. Green 8. What factors can effect a computer? a. Moisture b. Movement c. Power surges d. All of the above 34

35 4. Answer Key for Sample Questions 1. D. 1. G. 1. L 2. E. 3. D. 1. c 2. c 3. c 4. b 5. a 6. c 1. Take 2. Apply 3. Inhale 4. Take 5. Take 6. Take 7. Instill 8. Place 9. Take 10. Inject 11. Take 12. Give 1. d 2. d 3. b 1. c 2. c 3. c 4. d 5. c 6. a 7. c 8. d 1. d 2. d 3. d 4. a 5. b 6. a 7. c 8. d Bonus 13. b 35