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The pharmacy technician should suspect the possibility of a counterfeit medication if the:

  1. Last two digits of the NDC number change

  2. Manufacturer's container indicates "new color" on the label

  3. Bottle is written in English but manufactured out of the country

  4. Patient reports that the drug tastes or looks different and does not work as well

The correct answer is: Patient reports that the drug tastes or looks different and does not work as well

Counterfeit medications can pose serious health risks to patients, so it is crucial for pharmacy technicians to be vigilant in identifying potential counterfeit products. In this scenario, option D is the correct choice because if a patient reports that the drug tastes or looks different and does not work as well as expected, it is a strong indicator that the medication may be counterfeit. Changes in taste, appearance, or efficacy of a medication can signal that it may not be authentic or is of poor quality, prompting further investigation and raising suspicion of counterfeiting. Options A, B, and C are incorrect as they do not directly relate to the possibility of the medication being counterfeit. Changes in the last two digits of the National Drug Code (NDC) number, a manufacturer's container indicating a "new color" on the label, or a bottle being written in English but manufactured in another country do not necessarily indicate the presence of counterfeit medication. Patients' feedback regarding the taste, appearance, and efficacy of the drug is a more reliable indicator in this context.