Basic Pharmacology (complete) Flashcards
Safe Medication Administration: the 11 Rights
- right patient
- right medication
- right dose
- right route
- right time
- right reason
- right assessment
- right documentation
- right response
- right education
- right to refuse (document this and know why they refused)
What is medication reconciliation and why is it done?
- performed at admission, discharge, every home visit and at each clinic visit
- compare orders to what the patient believes they are taking
- ask to have medicaiton list from home brought to hospital and at every visit (hospital drugs stay on list until reconciled)
- need to document meds, OTC, herbals, vitamins, supplements
Done to prevent:
- medication errors
- drug interactions
- multiple reactions of same medication
What are high alert medications?
7
Medications that have the highest risk of causing patient harm
include
- chemotherapy drugs
- insulin
- opioids
- potassium - IV (will stop the heart)
- parenteral nutrition
- anticoagulants
- look-alike and sound-alike drugs
Clinical Trial: Phase 1
- first time used in humans
Goals:
- to find highest dose of new treatment that can be given safely without causing severe side effects
- help to decide on best way to give new treatment
- to determine what the drug does to the body and what the body does with the drug
*first few people get very low dose and are monitored closely – volunteers are usually young, healthy males
Clinical Trial: Phase 2
Studies those who have the disease:
- group of 25-100 participants with the same disease
- usually participants get the same does (some studies randomly assign people to different treatment groups)
- groups may get different doses or get treatment in different ways - assessing best balance of safety and response
- may be done at major medical centers, community hospitals, or physician’s office
- continue to gather new information about side effects
Clinical Trial: Phase 3
- typically done on about 3000 participants
- evaluates how this medication works in comparison to existing medications for the same condition
- look at new indications (can it be used for other illnesses)
– look at new formulations (different routes)
– look at other patient populations (cancer, autoimmune, etc) - drug companies can apply for FDA approval upon the completion of the phase 3 trial
- fast tracking like with COVID
Clinical Trials: Phase 4
- post-marketing; drug approved by FDA
- studies may involve thousands of “real” people (those previously ineligible)
- safety type of clinical trial
Looks at other aspects of treatment:
- quality of life
- cost effectiveness
- newer indications
- newer formulations
What is a package insert (PI)?
- allows the practitioner to have the information needed to safely prescribe the medication
- has an HPI (highlights) and FPI (full details)
- must be evidence-based
What is “off-label” use?
Medication is used for an indication other than what it was approved for
- often supported in literature, but not FDA-approved use
Things to consider:
- issues related to dose
- may increase risk of adverse effects
- drug interactions
Estimated 1 in 5 prescriptions are for off-label use
Off-label use: Gabapentin (neurontin)
FDA approved for:
- focal seizures
- post herpetic neuralgia (pain after shingles)
Off label use:
- alcohol withdrawal
- fibromyalgia
- hiccups
- perimenopausal night sweats and hot flashes
- neuropathic pain
- chronic pruritis
- chronic cough
OTC Medications and Dangers
Are real meds, with real adverse effects, and can cause real problems
Dangers:
- can mask symptoms of disease
- hidden meds (theraflu has acetaminophen in it)
- increasing dose
- drug interactions
Alternative medications
Herbals and other alternative therapies are not approved by the FDA
- no agency making sure what is on the label is on the pill
- evidence-based care
Significant and serious drug interactions
- example: turmeric can potentiate anticoagulants and anti-platelets, causing hypoglycemia and increase stomach acid
What are orphan medications?
Medications developed to treat a rare condition
- small population (1000 or less usually)
Orphan Drug act: passed 1983; give drug companies incentives to develop treatments for rare diseases
- receive government assistance to produce
Rare Disease act 2002; developed office for rare diseases
What are enteric-coated medications?
- delay absorption until a certain part of GI tract has been reached (want absorption in small intestine)
- helps protect the stomach
Do not crush or chew
What are controlled-release medications?
have “MR”, “SR”, “ER”, or “LA attached to name
- MR: modified release
- ER: extended release
- SR: sustained release
- LA: long acting
formulated to be released slowly in the GI tract
- patient takes less frequently than regular (1-2x a day)
- can not be used interchangeably with regular drug
- do not crush or chew
