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PCC > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Adherence

A

extend to which medication intake behavior corresponds with the recommendations of the provider

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2
Q

Compliance

A

extent to which the patient follows the recommendations of the provider

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3
Q

Persistence

A

Length of time between the first and last dose (when pt disc med)

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4
Q

Unintentional nonadherence

A

unplanned behavior that is not commonly linked to beliefs or cognition

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5
Q

Intentional nonadherence

A

patient ACTIVELY decides not to use treatment or follow recommendations

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6
Q

How to calculate PDC (proportion of days covered)

A

(# of days in period “covered” / # of days in period)*100

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7
Q

How to calculate MPR (medication possession ratio)

A

(sum of days’ supply for all fills in period / # of days in period)*100

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8
Q

Implications of STAR ratings

A

reimbursement
insurance contracts
pharmacist responsibility

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9
Q

STAR ratings are evaluated based on what

A

MTM complete rate
Statin use in diabetes
Adherence to diabetes med
Adherence to statins
Adherence to ACE-I/ARB

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10
Q

What are the 5 dimensions of adherence

A

Social and Economic
Health Care System
Condition Related
Therapy Related
Patient Related

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11
Q

Common contributing factors to nonadherence

A

adverse effect
cost
lack of understanding
forgetfullness
regimen complexity

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12
Q

Investigating medication nonadherance objective information

A

claims data
clinical data

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13
Q

Investigating medication nonadherence subjective information

A

motivational interviewing
creating no-judgement / honest environment

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14
Q

Overcoming medication nonadherence adverse effect: perceived vs actual

A

perceived (patient eduation)
actual (prescribe alternative, switch formulation, review risk vs enefit and severity of symptoms)

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15
Q

How to overcome medication nonadherence cost

A

manufacture coupons
insurance formulary
med assistance program
help pt select best insurance plan
utilize mail order pharmacy to lower copay

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16
Q

What 4 things should you educate patients on

A

indication
administration
benefits
risk

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17
Q

How to overcome medication nonadherence forgetfulness

A

set alarm
note around house
help pt incorporate it into routine
dose packaging or pill box
engage fam to help with adherence

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18
Q

How to overcome medication nonadherence complexity

A

review: med list for duplicates and deprescribe when possible
change: change product or formulation to decrease dosing frequency
utilize: med synch at pharmacy
enroll: pt in adherence packaging

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19
Q

Why do pharmacists need to assess patients

A

first line of communication
recognize when to refer to ER vs PCP
symptoms safe to treat at home

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20
Q

Elements Needed to Assess Patient Illness

A

Characteristic patterns of signs and symptoms associated with each disorder
Characteristic presentation of potential drug-related problems
Chronic disease guidelines for diagnosis and treatment of specific disorder

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21
Q

How to obtain a patients history

A

Start with open ended questions
Follow-up with more open ended or probing questions
Use LOQQSAM
Summarize the patient complaints/problems

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22
Q

LOQQSAM

A

Location
Onset
Quality
Quantity
Setting
Associated Symptoms
Modifying Factors

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23
Q

Hematologic Symptoms

A

Bleeding + Bruising
Stroke (Facial droop, Arm drop, Slurred speech, Time to call 911)
DVT (redness, swelling, pain)

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24
Q

Metabolic Symptoms

A

Hyperglycemia
Hypoglycemia

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25
Q

What are the 5 vital signs

A

Temp
BPM
RR
Blood Pressure
Pain

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26
Q

Orthostatic Hypotension

A

Blood pressure that decreases when rising from sitting/lying to standing
-systolic BP decrease of at least 20 mmHg or diastolic blood pressure decrease of at least 10 mmHg

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27
Q

Measuring Orthostatics

A
  1. Patient lays down for 5 minutes
  2. Check blood pressure and pulse rate
  3. Patient stands
  4. Check blood pressure and pulse rate after 1 minute
  5. Check blood pressure and pulse rate after 3 minutes
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28
Q

US Preventative Service Task Force (USPSTF)

A

Independent panel of experts in primary care and prevention
Systematically review evidence to develop recommendations for clinical preventative series

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29
Q

APP: AHRQ ePSS

A

Allows you to type in a patient’s characteristics and receive a list of the required / recommended / suggested preventative services

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30
Q

Preventative Service Grade A

A

USPSTF recommends the service
High certainty net benefit is substantial

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31
Q

Preventative Service Grade B

A

USPSTF recommends the service
High certainty net benefit is moderate to substantial

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32
Q

Preventative Service Grade C

A

USPSTF recommends selectively offering or providing the service to individual patients based on professional judgement and patient preference
Moderate certainty that net benefit is small

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33
Q

Preventative Service Grade D

A

USPSTF recommends against the service
Moderate or high certainty that the service has no net benefit or that harms outweigh benefits

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34
Q

Preventative Service Grade I

A

USPSTF concludes current evidence is insufficient to assess balance for benefits and harms of the service

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35
Q

What does the PHQ-9 test for

A

depression

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36
Q

What does GAP-7 test for

A

anxiety

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37
Q

What is the progressive risk of diabetic feet

A

Over time uncontrolled blood sugar can damage nerves.
– This damage leads to diabetic neuropathy and loss of protective sensation in the extremities

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38
Q

Risk Factors for diabetic feet

A

poor glycemic control
neuropathy
cigarette
PAD
amputation
visual impairment
CKD

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39
Q

How to decrease risk for diabetes foot amputations

A

control blood sugar
quit smoking
foot care education
annual foot exam
refer high risk patients
treat for PAD

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40
Q

What is the 5 step program for Lower Extremity Amputation Prevention

A

– Annual Foot Screening
– Patient Education
– Daily Self Inspection
– Footwear Selection
– Management of Simple Foot Problems

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41
Q

What is the 3 step process for monofilament diabetic foot exam

A

Use a 3 step sequence that includes (1) touch the
skin, (2) bend the filament, and (3) lift from the skin

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42
Q

What does risk category 0 mean for diabetic feet

A

Diabetes, but no loss of protective sensation
in feet

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43
Q

What does risk category 1 mean for diabetic feet

A

Diabetes, loss of protective sensation in feet

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44
Q

What does risk category 2 mean for diabetic feet

A

Diabetes, loss of protective sensation in feet
with high pressure (callout/deformity), or poor
circulation

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45
Q

What does risk category 3 mean for diabetic feet

A

Diabetes, history of plantar ulceration or
neuropathic fracture

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46
Q

Category 0 Management

A

Education emphasizing disease control, proper
shoe fit/design
Follow-up yearly for foot screen
Follow as needed for skin/callus/nail care or
orthoses

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47
Q

Category 1 Management

A

Education emphasizing disease control
Proper fitting/design footwear
Routine follow-up 3 – 6 months

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48
Q

Category 2 Management

A

Education emphasizing disease control
Depth-inlay footwear, molded/modified
orthoses
Routine follow-up 1 – 3 months

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49
Q

Category 3 Management

A

Education emphasizing disease control
Depth-inlay footwear, molded/modified orthoses
Routine follow-up 1 – 12 week

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50
Q

Diabetic feet education

A

Look between your toes
Shoe selection
Check inside of shoes
Skin care
Treat dry skin
Nail care
Corn and callus care

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51
Q

What is POC testing

A

Medical testing at or near the site of patient care
Performed outside a laboratory using portable devices, test kits or cartridges

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52
Q

Advantages of POC testing

A

improve patient outcome
expedite medical decision making
allows for testing in a variety of locations
smaller sample volumes minimizes patient discomfort

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53
Q

Disadvantages of POC testing

A

Variable levels of training and experience
Competency assessments and trainings can be challenging
Not all are approved for use as a replacement o lab monitoring
Costs may be higher

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54
Q

Blood Glucose POC testing

A

Clean finger with alcohol swab, put strip into meter, lance finger, wipe first drop away, put strip up to drop of blood, give cotton ball and bandage for finger. Clean up appropriately
(International Normalized Ratio (INR))

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55
Q

Flu testing

A

Swab back of throat/nose, mix swab with solution in tube or machine (varies), wait for result with solution in machine or use test strip.

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56
Q

Covid-19 testing

A

Type 1: PCR tests (nasal swab)
Type 2: Antigen tests (rapid) (throat and nasal swab)

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57
Q

Human immunodeficiency virus POC testing

A

Saliva-based
Fingerstick, oral swab, or urine
Collect, mix with buffer, wait for result

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58
Q

Hepatitis C POC testing

A

Saliva-based
Fingerstick
Collect, mix with buffer, wait for result

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59
Q

What is PPM (provider performed microscopy)

A

Microscopic examinations performed by healthcare provider during a patient
visit
-involves specimens that are not easily transportable
-requires appropriate clinical privileges a

60
Q

What is urinalysis

A

Urine dipstick and sediment examination
obtain midstream, examine w/in 2 hours, place 10 mL in centrifuge for 5 min, invert tube and drain, review drop on glass slide

61
Q

What is CLIA (clinical lab improvement amendments)

A

Requires facilities that examine register with CMS
Waived tests must use unprocessed specime
apply for CMS Form 116
Renew every 2 years

62
Q

What is needed when handling specimen

A

two patient identifiers
Label any specimen tubes/containers with patient name and unique identifier

63
Q

Morbidity

A

Refers to the state of having a specific illness or condition

64
Q

Mortality

A

Refers to the number of deaths that have occurred dude to specific illness or condition

65
Q

Health disparity

A

Differences in the incidence, prevalence, mortality, and burden of disease and other adverse health conditions that exist among specific population groups

66
Q

What are health disparities groups often defined by

A

Race
Gender
Level of education
Socioecominic status
Geographic location of residence

67
Q

What factors contribute to disparities

A

Lack of health care coverage
Socioeconomic status
Medical care
Patient related factors

68
Q

What healthcare provider education is being done about disparities

A

Population based care
SDOH
Cultural competence

69
Q

Primary focus population areas for healthcare education

A

Infant
Cancer
ASCVD
Diabetes
HIV
Immunization
Asthma
Substance abuse
Arthritis
Mental health
LGBTQ

70
Q

Economic stability key issues

A

Poverty
Employment opportunities
Economic inequality
Housing instability

71
Q

Education key issues

A

Poor education
Low literacy
Language barriers

72
Q

Health care access and quality key issues

A

Access to health care
Health literacy
Access to primary care

73
Q

Neighborhood and built environment key issues

A

Access to healthy foods
Housing/neighborhood quality
Safety/care
Environment conditions

74
Q

Neighborhood and built environment key issues

A

Access to healthy foods
Housing/neighborhood quality
Safety/care
Environment conditions

75
Q

Social and community context key issues

A

Discrimination, segregation, and inequality
Civic participation
Community support
Social cohesion

76
Q

Culture

A

set of learned and shared beliefs and values that are applied to social interactions and to the interpretation of experience

77
Q

Race

A

sociopolitical construct, having no scientific or anthropologic basis
socially defined category that divides people into groups on the basis of distinct physical traits and characteristics

78
Q

Ethnicity

A

related to one’s identity with a group that shares a history, religion, nationality, cultural patterns
social groups with a shared history, identity, geography, cultural roots regardless of racial difference

79
Q

Complementary and alternative medicine practice (CAM)

A

health care efforts initiated by individual that are not presently considered an integral part of convention medicine

80
Q

Examples of CAM practices

A

alternative medical systems
mind-body interventions
biologically based therapies
manipulative and body based methods
energy therapies

81
Q

Traditional Healers

A

individuals who provide health care to their community by using plant resources, tenets of social and cultural belief

82
Q

Cultural Competency

A

a set of attitudes, knowledge and skills which enhance a clinician’s
-understanding and awareness, ability to adapt

83
Q

Disease

A

abnormalities in the structure and function of body organs and systems
(physical phenomenon)

84
Q

Illness

A

personal, interpersonal and cultural reactions to disease or discomfort shaped by cultural factors governing perception, labeling, explanation and evaluation of the discomforting experience
(sociological phenomenon)

85
Q

Predictors of behavioral ethnicity

A

emigration from rural area
inexperience with western medicine
limited formal education
low socioeconomic status
segregation in ethnic subculture

86
Q

Reasons for home remedy use

A

inadequate health education
poverty
limited access to health care
skepticism of western health
racial and cultural beliefs
region of residency

87
Q

Cultural-Bound Syndromes

A

Limited to specific societies or cultural areas and are localized diagnostic categories that frame coherent meaning for certain repetitive, patterned, and troubling sets of experiences and observations

88
Q

What are the 6 requirements for an ideal inhaler

A

Effective
Efficient
Engaging
Error-tolerant
Easy to teach
Easy to switch

89
Q

What are the 3 inhaler classes

A

Metered Dose Inhaler (MDI)
Soft Mist Inhaler (SMI)
Dry Powder Inhaler (DPI)

90
Q

What are the different kinds of metered dose inhalers

A

bronchodilators (ventolin)
corticosteroids (flovent)
combination (advair, dulera)

91
Q

What are the advantages of metered dose inhalers

A

small size
inexpensive
dose quickly administered

92
Q

What are the disadvantages of metered dose inhalers

A

requires coordination
deposits 10-20% of med into lungs
localized adverse effects

93
Q

How do metered dose inhalers work

A

delivers consistent amount of pressurized medication as a fine mist

94
Q

How to use a metered inhaler

A

shake, remove cap, prime
exhale completely, press down, hold breath 10 sec
replace cap, rinse mouth (steroids only)

95
Q

Maintenance Specifications for metered dose inhalers

A

clean by holding under warm water for 30 sec, air dry
propellent may produce unmedicated mist once canister is empty

96
Q

Benefits for spacers

A

reduces oropharyngeal deposition
increase admin in lungs
reduce coordination

97
Q

What does a respimat inhaler do

A

deliver med with slower delivery and longer duration
-reduce need for coordination of breath
generate mist independent of pt inhalation
higher fine particle fraction (increased med deposition)

98
Q

What are the different respimat inhalers

A

bronchodilators (combivent, spiriva, stiolto)

99
Q

Advantages of respimat inhaler

A

easy to use
propellent free
-no shaking, no mist released when empty

100
Q

Disadvantages of respimat

A

requires assembly
priming
increased cost

101
Q

How to use a respimat inhaler

A

prime by turning base 180 three times, press dose release button
open cap, exhale, press dose, hold breath 5-10 sec
(full prime if unused for 21 days)

102
Q

Maintenance specifications for respimat

A

damp cloth or tissue to clean
monitor dose counter (refill when red area on scale)
discard 3 months

103
Q

What is a dry powder inhaler

A

dependent upon patient inhalation to carry med
micronized powder with large inactive carrier powder

104
Q

What are the powder inhalers

A

bronchodilators (incruse, serevent)
corticosteroids (pulmicort, flovent)
combination (breo, advair)

105
Q

Advantages of powder inhalers

A

coordination not needed

106
Q

Disadvantages of powder inhalers

A

diminished dose delivery if breath slowly
med doses may clump with humidity

107
Q

How to use a powder inhaler

A

open mouthpiece, load dose
exhale, inhale quickly and deeply
hold breath 10 sec

108
Q

What is the proair respiclick

A

open red cap fully until click heard
do not block vent above mouthpiece
close cap after inhalation
cant use spacer

109
Q

What is the spiriva handihaler

A

separate capsule must be loaded into center chamber
instruct patient not to swallow capsule***
close mouthpiece, press button once
after dose remove capsule

110
Q

What is the diskus

A

hold horizontally with dose
slide lever from left to right
meds (flovent, serevent, advair)

111
Q

What is the ellipta

A

open cover until click heard
hold without blocking vents
close cover over top
(breo, anoro, incruse, trelegy)

112
Q

What is the asmanex twisthaler

A

hold pink base and twist cap counter clockwise
hold horizontally when placeing mouthpiece
replace cap and turn clockwise until click heard

113
Q

What is the pulmicort flexhaler

A

twist brown grip fully in one direction
twist back until click
replace cover and twist shut

114
Q

What is the tudorza pressair

A

green button on top
control window show a red to green color change
click heard when dose inhaled
make sure it returns to red color

115
Q

Maintenance specifications with powder inhalers

A

wipe mouthpiece with dry cloth
monitor amount remaining with dose counter

116
Q

What is a small volume nebulizer

A

convert liquid med into mist
face mask
for emergency situations
-jet: uses gas to aerosolize
-ultrasonic: uses high-frequency vibrations to aerosolize med

117
Q

Small volume nebulizer advantages

A

deliver more than one med at same time
minimal patient coordination
modification of med dose and concentration
incorp normal breathing patterns

118
Q

Small volume nebulizer limitations

A

longer treatment duration (15-25 min)
large bulky device
require access to power source

119
Q

How to use small volume nebulizer

A

ope cup, med into cup, connect tubing, plug in device into outlet, turn on compressor power
breath normally, 5-10 sec, do until sputter heard
turn off, disassemble, allow to dry

119
Q

Maintenance specifications for small volume nebulizer

A

wash everything with dish soap once weekly
disinfect with alcohol, hydrogen, vinegar

120
Q

What is intranasal medication devices

A

allow delivery for topical and systemic benefits
avoid first pass metabolism

121
Q

What is the baqsimi (glucagon) dry powder nasal spray

A

do not remove wrap or open tube until ready
insert tip into one nostril and push plunger
disappear green line indicated complete
contain once dose and cannot be reused

122
Q

Kwikpen meds

A

humalog, humulin

123
Q

Solostar meds

A

lantus, apidra, amelog, basaglar, toujeo

124
Q

Flextouch meds

A

fiasp, levemir, tresiba

125
Q

Flexpen meds

A

novolog

126
Q

What are prefilled insulin pen injectors

A

dial dose for pt
attachment of pen needle
is needle >5 mm, pinch skin

127
Q

Needle considerations with pen injectors

A

needle reuse may lead to increased scar tissue build up or infection
save outer pen needle cap for needle removal and disposal

128
Q

How to prime prefilled insulin pen injectors

A

eliminate air bubbles
dial dose 2 units
hold upright
tap cartilage holder gently
push dose until 0 seen
repeat priming if insulin droplets not seen at tip

129
Q

What are the sites for a subq inj

A

do not inject to area that is bruised, swollen, or tender
rotate sites

130
Q

Instructions for subq inj

A

attack new pen needle
pull off outer and inner needle caps
prime
clean site
position needle at 90 angle
inject

131
Q

Storage instructions for prefilled insulin pen injectors

A

unopen in refrigerator
open can be room temp
write date pen first opened

132
Q

How to select a syringe for insulin vials and syringes

A

volume associated with number of units per dose
orange cap for U-100 and green cap U-500

133
Q

How to inject insulin vial and syringe

A

same as giving normal shot except, push plunger in and gold 5-10 sec

134
Q

Bydureon Bcise device and use

A

need to mix medication
push and hold needle 15 sec

135
Q

Repatha SureClick device style and dosing

A

window turns yellow when injection is finished
2 wk dose

136
Q

Rapatha Pushtronex device style and dosing

A

1 month dose
let sit outside fridge 45 minutes

137
Q

Praluent device style and dosing

A

sit 30-40 min
yellow window
20 sec duration

138
Q

EpiPen dosing

A

0.3mg, 0.15 mg

139
Q

EpiPen instruction for use

A

blue sky, orange thigh
massage inj site after use

140
Q

Auvi-Q device dosing

A

0.1, 0.15, 0.3
voice consideration

141
Q

Glucagon device style and dosing

A

dispose in sharps container

142
Q

Calcitonin Gene-Related Peptide Inhibitors device style and dosing

A

sit for 3 0min
90 degree angle
do not shake

143
Q

Aimovig device style and dosing

A

once monthly
sit for 30 min
monitor BP

144
Q

Emgality device style and dosing

A

once monthly
cause hypersensitive rxns

145
Q

Lovenox device style and dosing

A

lay down and punch skin
store at room temp
do not remove air bubble

146
Q

How to properly dispose injectables

A

sharps container
make sure its puncture-resistant
clearly label

PCC (2 decks)

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