Exam 1 Study Questions Flashcards
What step of the PPCP differentiates pharmacists from other healthcare providers?
Assess
List the five components of the PPCP.
- Collect…necessary information about the patient in order to undersand relevant medical history and clinical status
- Assess…information collected and analyze the clinical effects of the patient’s therapy in the context of overall health goals to identify and prioritize problems and achieve optimal care
- Plan…develop a patient-centered plan in collaboration with other professionals and the patient/caregiver that is evidence-based and cost-effective
- Implement…the care plan
- Follow-up: monitor and evaluate…the effectiveness of the care plan and modify with other professionals and the patient/caregiver as needed
What are some examples of the “collect” step of the PPCP?
Med history, allergies, current diagnoses, insurance coverage, socioeconomic status, substance use/abuse, physical exam findings, lifestyle, beliefs/preferences, etc.
What are some examples of the “assess” step in the PPCP?
Medication appropriateness, health literacy, risk factors, immunization history/need for preventative care, etc.
What are some examples of the “plan” step of the PPCP?
Medication-related problems, settings goals of therapy, providing education/empowerment/self-management, supporting follow-up and transitions of care
What are some examples of the “implement” step of the PPCP?
Addressing medication- and health-related problems, initiating/modifying/discontinuing/administering medications, educating, helping coordinate care, scheduling follow-ups
What are some examples of the “follow-up” step of the PPCP?
Medication appropriateness/effectiveness/safety based on data/test results/feedback, review clinical endpoints, review outcomes of care and progression toward goals
What are the four drug-related needs?
- Is the drug appropriate?
- Is the drug effective?
- Is the drug safe?
- Is the patient willing/able to take as instructed?
List two indication DTPs.
- Unnecessary drug therapy
- Needs additional drug therapy
List two effectiveness DTPs.
- Ineffective drug
- Dose too low
List two safety DTPs.
- Dose too high
- Adverse drug reaction
List the four written documentation types.
- SOAP note
- Progress note
- SBAR note
- Care plan
What are the three components that make up assessment?
- Drug-related needs
- Drug therapy problems
- Medication experience
Do care plans go into an EMR?
No
List in order of most to least formal: progress notes, SOAP notes, SBAR notes
SOAP > SBAR > Progress
In what form should verbal communications be?
SBAR format
What are some examples of subjective information?
Chief complant, PMH/HPI, medication history, allergies, social/family history, lifestyle, health and functional goals, beliefs/preferences, and socioeconomic factors
What are some examples of objective information?
Vitals, labs/diagnostic tests, physical exam findings, current medications (per chart), refill records, immunization records, history documented in medical record, and drug information
What is the acronym (and meanings) for HPI?
- Symptoms
- Characteristics
- History
- Onset
- Location
- Aggravating factors
- Remitting factors
Generally speaking, what kind of information qualifies as objective?
Measurable/observable facts
Generally speaking, what kind of information qualifies as subjective?
Opinions, point of view, judgements, emotions
List the clinical process for collecting information step-by-step.
- Review chart
- Utilize drug information resources
- Communicate (to patient and other providers)
How do you calculate creatinine clearance?
CrCl = ((140 - age) x weight) / (72 x SCr)
(x 0.85 if female)
How do you calculate ideal body weight?
IBW = 50 + 2.3 x (inches > 60)
How do you calculate % overweight?
% overweight = ABW/IBW
How do you calculate adjusted body weight?
AdjBW = IBW + 0.4 (ABW - IBW)
When should you use adjusted body weight?
If patient is 40% overweight
List the seven types of drug therapy problems
- Unnecessary drug therapy (indication)
- Needs additional drug therapy (indication)
- Ineffective drug (effectiveness)
- Dose too low (effectiveness)
- Dose too high (safety)
- Adverse drug reaction (safety)
- Non-adherence (adherence)
In order to assess for DTPs, what are the four key questions that should be asked for each medication a patient is taking?
- Is it indicated?
- Is it effective?
- Is it safe?
- Can the patient adhere?
When stating DTPs, list the three components of the problem that must be described.
- A description of th patient’s medical condition or clinical state
- The drug therapy involved (causing or solving the problem)
- The specific association between the drug therapy and the patient’s condition
What are the five core elements of MTM?
- Medication Therapy Review (MTR): medication review and identification of DTPs
- Personal Medication Record (PMR): comprehensive record of patient medications, involves “implement” step; education and self-management support
- Medication-Related Action Plan (MAP): a patient-centric document containing a list of actions for the patient to use in tracking progress for self-management; involves “implement” step also
- Intervention and/or Referral: pharmacist intervenes to resolve a medication-related problem
- Documentation and Follow-Up
What is a progress note?
A concise, less detailed note written after a brief encounter with a patient or to detail a change made in the patient’s care
What is a SOAP note?
A note added to a patient’s medical record detailing subjective and objective information from the encounter as well as containing the assessment made, plan implemented, and follow-up
What is a care plan?
Focuses on one disease state, with the rationale or thought process provided, and is NOT added into the patient’s medical record
What is an SBAR note?
A note provided to a physician or other medical provider alerting them to a situation you encountered with their patient, the assessment made, and recommendations
What are the five essential skills for an effective assessment?
- Inquiry
- Listening
- Observational skills
- Pharmacotherapy knowledge
- Organization
What three major components should be taken into account for a complete assessment?
- Patient demographics
- Medication experiences
- Clinical information
List the five components necessary for creating a goal of therapy
- Goals for each indication
- Described within clinical/lab parameters to evaluate efficacy and safety
- Include the patient and other practitioners
- Realistic to patient’s present and potential capabilities
- Includes a time frame for achievement
What six types of goals are commonly used for drug therapy?
- Cure a disease
- Reduce or eliminate signs/symptoms
- Slow/halt disease progression
- Prevent a disease
- Normalize lab values
- Assist in diagnostic process
What are the guiding principles of shared-decision making?
Self-determination and relational autonomy
What are the three key steps in shared-decision making?
- Choice talk: inform that reasonable options are available
- Option talk: provide more detailed information about options
- Decision talk: support consideration of preferences and decision
What are the three categories of interventions?
- Resolve DTPs
- Achieve goals of therapy
- Prevent problems
What category of intervention is highest-priority and why?
Resolving DTPs; they interfere with the ability to achieve goals and meet drug-related needs
Give five reasons that may require an early follow-up.
- Past treatment failures
- Past adverse effects
- Worsening clinical status
- Lack full capacity to engage in plan
- High-risk medication (and not at goal)
What three factors affect how independently an implementation may be achieved?
- Practice site
- Scope of privileges
- Type of plan used
Timing for a patient follow-up is most dependent upon what?
The most likely time for benefit or side effects (whichever occurs sooner); must be long enough to see effects vs. too long and overlooking problems. Related to medication onset, time to maximum effect, and should consider patient’s abilities to manage care and overall status.
How is a follow-up session different from an initial assessment?
Follow-ups are shorter and more focused, tracking progress towards foals and outcomes, identifying new DTPs, and revising plans.
List the nine terms used to describe patient outcomes.
- Initial: status at the time drug therapy started and goals are being established
- Resolved: goals of therapy achieved; drug therapy has been completed and can be D/Ced; usually associated with acute disorders
- Stable: goals of therapy achieved; continue drug therapy with no changes; usually associated with chronic disorders
- Improved: adequate progress toward achieving goals; continue same drug therapy with no changes
- Partially improved: some measurable progress toward achieving goals; adjustments in therapy needed
- Unimproved: no/minimal progress toward achieving goals; more time is needed to evaluate full response; continue same drug therapy
- Worsened: decline in health; adjustments in therapy required
- Failure: goals not achieved despite adequate dose/duration; D/C current drug therapy and start new drug therapy
- Expired: patient died while receiving drug therapy
Describe the typeology of chronic disease/chronic illness (4 parts).
- Onset: acute or gradual
- Course: progressive, relapsing, or constant
- Outcome: terminal prognosis
- Incapacitation: function, disabilitity, quality of life
Describe the cyclical process of chronic illness.
- Diagnosis: grieving begins
- Initial coping
- Long-term coping
- Grieving revisited
What eight fears do people experience in the face of chronic illness?
- Loss of control
- Loss of self-image
- Dependency
- Stigma
- Abandonment
- Anger
- Isolation
- Death
List the seven stages of the Kubler-Ross stages of grief.
- Shock
- Fear and anxiety
- Denial
- Anger and guilt
- Bargaining
- Depression
- Acceptance
What is empathy?
Identifying with a patient’s experience.
What are the five types of non-supportive responses?
- Judging: “you shouldn’t feel that way”
- Advising: offering an immediate suggestion
- Reassuring: “it’s going to be okay”
- Generalizing: “everyone experiences this”
- Distracting: changing the subject
What five techniques can be used to communicate assertiveness?
- Use “I” statements
- Avoid using “you” statements
- Avoid using “yes, but…” statements
- Respond in a way that de-escalates conflict
- Identfy behaviors causing the conflict
What is the framework for the RESPECT model of patient interaction?
- Respect
- Empathy
- Support
- Partnership
- Explanations
- Cultural competence
- Trust
What are the seven signs of limited literacy?
- Excuses
- Length of time to complete forms
- Inappropriate answers or “blanks” on forms
- Doesn’t turn paper right side up
- Frequent errors
- Missed appointments
- Nonverbal behaviors
Identify seven clear communication strategies to address literacy issues.
- Assess understanding
- Use teach-back technique
- Use plain language
- Avoid vague words
- Emphasize 1-3 key points
- Encourage questions
- Provide and evaluate written materials
Define compliance.
The extent to which the patient’s behavior matches the prescriber’s recommendations
Define adherence.
The extent to which a person’s behaviour, taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider
Define persistence.
INSERT HERE
Define concordance.
INSERT HERE.
What is the SIMPLE approach to improving adherence?
- Simplify regimen
- Impart knowledge
- Modify patients’ beliefs and human behavior
- Provide communication and trust
- Leave the bias
- Evaluate the adherence
Define primary nonadherence.
Define secondary nonadherence.
Define white coat nonadherence.
Define intentional nonadherence.
Define unintentional nonadherence.
Explain the health belief model.
Perceived severity and susceptibility lead to perceived threat, which is responsible for likelihood to take action, affected by perceived benefits and barriers.
What is the social cognitive theory?
Outcome and efficacy expectations create expectations of ability and success; determines whether a behavior is attempted
What is the theory of planned behavior?
Actions and behaviors are evaluated by individuals before they are performed; behavior is attempted based on beliefs that encourage an attempt of the behavior
What are the three main components of the theory of planned behavior?
- Attitude
- Subjective norm
- Perceived behavioral control
Explain the transtheoretical model.
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
What is dramatic relief?
“Shocking” a patient into change; powerful images used
What is self re-evaluation?
Comparing current self to future self (with and/or without change)
What is environmental re-evaluation?
Considering future self (with and/or without change) and its impact on others
What is self liberation?
Setting a date for the change
What is counterconditioning?
Substituting a healthy behavior for an unhealthy one
What is positive reinforcement?
Rewarding good behavior
What is negative reinforcement?
Punishing unwanted behavior
What is stimulus control?
Removing unhealthy temptations or encouraging healthy behaviors
What are helping relationships?
Participating support groups or identifying individuals who will encourage and support health behaviors.
What is cognitive restructuring?
Modifying beliefs or perceptions, as well as destructive verbalizations (negative self-talk) or irrational thoughts
What is problem solving?
Role playing or visualization; thinking though different scenarios prior to their occurrence; “if this happens, then I will…”
What is self-monitoring?
Writing/monitoring progress or daily habits
What are prompts?
Creating reminders to encourage behavior
What is skills training?
Instruction in order to break down behavior/action into steps in order
What is motivational interviewing?
- Person-centered
- Guided
- Goal directed
- Seeks patient’s arguments to change
- Enhances intrinsic motivation to change by exploring and resolving ambivalence and resistance.
What method should be employed when faced with ambivalence/resistence?
- Roll with resistence
- Express empathy
- Avoid argumentation
- Develop discrepancies
- Support self-efficacy
What are the characteristics of change talk?
- Desire
- Ability
- Reason
- Need
What is tertiary information?
Information that has been summarized to provide a topic overview; textbooks, compendia, guidelines, review articles, and internet websites
What is secondary information?
A resource with access to articles and primary resources; PubMed
What is primary information?
A published scientific article
Where can be prescribing information be found?
Drugs@FDA, DailyMed, manufacturer’s website
What kind of drug information does PI provide?
- Approved uses and dosing
- Mechanism of action
- Clinical studies for approval
- Information about use in special populations
- Drug interactions
