Final Flashcards
Most common estrogen component in hormonal birth control:
Ethinyl estradiol
Who makes the guidelines for contraception?
CDC
What form of estrogen is used after menopause?
estradiol valerate
What does HB2879 say?
That a pharmacist may prescribe and dispense hormonal birth control to anyone over age 18 w/o evidence of a prior prescription or someone under age 18 with evidence of a prior prescription.
What does a pharmacist have to so in order to become certified to prescribe hormonal birth control?
Complete a training program approved by the board of pharmacy
Provide a self-screening tool to the patient
Refer the patient to their women’s health care practitioner.
Provide the patient with a record of their prescription.
Can a pharmacist prescribe hormonal birth control for a patient that they prescribed to three years ago if they have not visited a women’s health provider since then?
No. However, the patient may be tricky and go to the pharmacy across the street to get it prescribed.
Can insurance cover this birth control?
Yes.
What has to be ACPE accredited?
The pharmacist training must be ACPE accredited.
What is a difference between pharmacists and doctors prescribing to self and family members?
Doctors are recommended not to, while pharmacist are prohibited from prescribing to self and family members.
What subjects are covered in the pharmacists training program?
Foundation for women's health Pharmacology Therapeutics Patient Self-Assement Workflow
What contraception method is most widely used?
The pill, while male condom comes in second. The 1st line option, the IUD is only 10% of the contraception used.
Is the rate of VTE higher for birth control, during pregnancy, or during postpartum?
VTE risk is the highest postpartum, second-highest during pregnancy, and third-highest while on OC’s.
What percentage of pregnancies are unintended?
50%
What did the Direct Access Study do?
- 2008
- Used a validated self-assessment questionnaire
- Collaborative practice agreement
- It was determined that pharmacist could effectively screen women and provide birth control. Women and pharmacists were satisfied.
What laws do Colorado, Washington, and California have in place regarding pharmacists providing birth control?
Washington has a window sticker law. California and Colorado have a state protocol that is identical to Oregon’s protocol. New Mexico also has a state protocol, while Missouri and Tennessee have a CPA.
What is US MEC?
Medical Eligibility Criteria
What are the categories for eligibility for contraceptive use?
- No restrictions
- Benefits usually outweigh risks
- Risks usually outweigh benefits
- Unacceptable health risk if contraceptive is used
What has the self-assessment questionnaire shown?
That women are capable of assessing their own risk more than a provider. However, OTC status is not a good idea, as studies have to be done first.
What are the patient-care centered steps?
Collect Assess Plan Implement Follow-up
How much medication can you give the patient?
Initially, 3 months worth. Then another 9 months. The more medication you can give the patient, the more adherent they will be.
For continuing ex’s, can do 12 months.
What important documents are needed?
Standard procedures algorithm Self-Screening questionnaire Rules and regulations policies and procedures Patient visit summary US MEC List of nearby clinics for referral
What steps are required in order to prescribe someone birth control as a pharmacist?
- Health and history screen
- Pregnancy screen (period w.i last 7 days, 6 month old baby w/ no periods, abstaining since last period, using a contraceptive method consistently and correctly, etc.)
- Medication screen (cabamezepine, phenytoin, phenobarbital, primidone, topiramate. NOT St. John’s wort)
- Blood pressure (<140/90)
- After-visit summary may be provided, or circle referral instead, where it will have you list the reason. Provide list of nearby clinics.
- Discuss initiation strategy for treatment/change in treatment (counsel on starting now, using backup for 7 days, SE of bleeding irregularities, adherence, follow-up)
- Discuss and provide referral or visit summary.
**Pharmacy has to retain a cope of AVS and questionnaire, and send a copy to the PCP if they have one. Will still collect a fee.
What are the necessary things to counsel on?
Take by mouth At same time every day Set up first pill back Start ASAP and use backup if needed for 1 week. Placebo week, or not When follow-up is needed Hormonal contraception does not protect against STI's Some drug interactions Adherence is very important Have back-up method on hand (condoms)
Expect:
Common- breakthrough bleeding for about 3 months
Serious - blood clots (five people in 10,000)
If side effects don’t go away, there are alternate formulations
What types of patients should be referred to a women’s healthcare provider?
No insurance - refer to free clinic
Contraindications
What do pharmacies need to have to for a pharmacist to prescribe hormonal contraceptives?
A pharmacist’s NPI needs to be changed to a pharmacist clinician.
Certify their pharmacists as providers with each insurance company
Some have software to interface pharmacy systems with billing.
Do you bill pharmacy or medical coverage for prescribing birth control?
Medical coverage
What is antimicrobial stewardship?
It is a professional role in infectious control. They make sure that inappropriate prescribing is not going on to curb resistance.
What is the difference between bacteriostatic and bactericidal? Which is more important for getting the right dose?
Bacteriostatic stops growth, while bactericidal kills bacteria. Bactericidal is more important for getting the right dose.
What is important to ask about allergies?
What the reaction was it, and how long ago was it?
What are the “when in doubt” antibiotic counseling points?
May cause n/v/d and GI upset
Drink with a full glass of water
Complete full course of therapy despite feeling better
Look for s/s of hives, rash, difficulty breathing, and other s/s of allergic reactions (hypersensitivity reaction causes allergy 2nd time)
What are the skin organisms?
Gram positive.
Either strep or staph. Penicillin will probably fail to treat skin infections.
What would you cover for when treating a bug in the gut?
Gram negative anaerobes
What normally causes UTI’s?
E. coli
What bugs normally cause pneumonia?
Staph and strep
Gram positive bacteria: Stain - Periplasmic space - Cell wall thickness - Porin channels- Analogy - Examples -
Stain - Pink Periplasmic space - Small Cell wall thickness - Thick Porin channels- Mostly absent Analogy - Thick fence Examples - strep, staph, enterococcus Thick peptidoglycan layer
Gram negative bacteria: Stain - Periplasmic space - Cell wall thickness - Porin channels- Analogy - Examples -
Stain - purple Periplasmic space - big Cell wall thickness - thin Porin channels- common Analogy - kevlar vest Examples - pseudomonas Thin peptidoglycan layer
Which type of bacteria is harder to kill?
Gram negative bacteria
What are ways of developing resistance for the bacteria?
Deactivate drug through beta lactamases Have active efflux channels Change binding sites Make the cell wall impenetrable Can change metabolic pathway despite what antibiotics are doing
MOA - Beta lactams
Inhibit cell wall synthesis
What generation of beta-lactams will treat MRSA? Pseudomonas?
5th gen (Ceftaroline) will treat MRSA 4th gen and Ceftazidime will treat pseudomonas
1st gen cephalosporins
PEcK
Proteus, E. coli, Klebsiella
2ns gen cephalosporins
HEN PEcK
H. influenza, Enterobacter, Neissera
Proteus, E. coli, Klebsiella
3rd gen cephalosporins
HEN PEcK CAMPS
Citrobacterm Acinetobacter, Morganella, Pseudomonas
4th gen cephalosporins
HEN PEcK CAMPS + Provendencia
5th gen cephalosporins
HEN PEcK CAMPS + MRSA
What will the Carbapenems cover?
Pseudomonas but not MRSA
What could you use if you had a penicillin allergy?
Aztreonam, a monobactam.
Cephalosporins are LAME
Do not have activity against Listeria, atypical, MRSA, Enterococci
Which beta lactic can you take if you have liver problems?
Ceftriaxone
Which two cephalosporins cover pseudomonas?
Cefepime and ceftazadine
Which cephalosporin has activity against MRSA?
Ceftaroline
What antibiotics inhibit 50s ribosomal protein synthesis?
Macrolides
Clindamycin
Linezolid
What antibiotics inhibit the 30S ribosomal protein synthesis?
Aminoglycosides
Tetracycline
What inhibits DNA topoisomerase IV and DNA gyrase?
Floroquinolones
What antibiotics inhibit the folic acid pathway?
SMX/TMP
What antibiotics use strand breakage to inhibit protein synthesis?
Metronidazole
What inhibits cell synthesis? (D-Ala D-Ala)?
Nitrofurantoin
Vancomycin (D-Ala D-Ala)
Which antibiotics do you get photosensitivity from?
Floroquinolones
SMX/TMP
Tetracycline
Which antibiotic has the greatest risk of C. dif?
Clindamycin
Which antibiotic is red man syndrome associated with?
Vancomycin
Which antibiotics have to be monitored carefully due high risk of nephrotoxicity and ototoxicity?
Aminoglycosides
What is the DOC for C. dif infection?
Metronidazole
Which drugs have Q-T prolongation risks?
macrolides
floroquinolones
Which drug has a black box warning for colitis?
Clindamycin
What does vancomycin treat?
C dif in the PO form, not IV
What drug do you have to be cautious with serotonin-increasing agents?
Linezolid
What drugs cover pseudomonas?
Cefepime, ceftzadime ciprofloxacin, levofloxacin Imipenem, dirpenem, meropenem Aztreonam Aminoglycosides
What drugs cover atypical?
Macrolides
Doxycycline
Fluoroquinolones
What drugs cover anaerobes?
Metronidazole Piperacillin/Tazobactam Carbapenems Clindamycin Ampicillin/Sulfbactam Augmentin
What drugs cover MRSA?
CLindamycin SMX/TMP Tetracyclines Linezolid Vancomycin Daptomycin Telavancin Oritavancin Dalbavancin Ceftaroline
