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P1 Fall 2023 > IPC exam 1 > Flashcards

IPC exam 1 Flashcards

1
Q

What is a profession?

A

A calling requiring specialized knowledge and often long and intensive academic preparation.

group of people who have gone thru specialized training

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2
Q

What is the Profession of Pharmacy?

A

A pharmacist’s professional commitment is to provide pharmaceutical care to their patients. The principal goal of pharmaceutical care is to achieve positive outcomes from the use of medication which improves patients’ quality of life with minimum risk.

Pharmacists are professionals, uniquely prepared and available, committed to public service and to the achievement of this goal.

here for patient care

most accessible healthcare professional

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3
Q

What is the value of pharmacy?

A

The most accessible health care professional!

Oversee the medication use process

Ensure medication safety

Optimize medication usage- deprescribe will be nice

Utilize efficient processes- manager in community have others under you

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4
Q

What do pharmacists do?

A

Pharmacists use their medication expertise to treat patients, collaborate with other healthcare professionals, promote population health, and manage pharmacy systems.

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5
Q

What do pharmacists do concerning patient care

A

Collect information about a patient’s health,social history,and medicationsincluding prescriptions, over-the-counter (OTC) medications, herbal products, and dietary supplements.

Assessapatient’s health, medications, risk factors, health literacy, and access to drugs and other care.

Help patients tosafely select OTC medications, herbal products, and dietary supplements.

Develop a medication treatment plan with other healthcare professionals, patients, and caregivers.
In some states, prescribe certain medications

Prepare and dispense prescriptions, ensuring the medications and doses are accurate and safe.

Identify and prevent harmful drug interactions with other medications, foods, vitamins, supplements, or health conditions.

Pharmacists are physicians for meds,

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6
Q

What else can pharmacists do concerning patient care

A

Educate patientsandcaregiversonthe appropriate use of medications, side effects, dosages, proper medication storage, anddrug-freetreatments (e.g., exercise).

Monitor a patient’s response to a medication treatment plan and recommendadjustments, as needed.
Use point-of-care tests to assess a patient’s health status (e.g., tests for flu, strep, COVID-19).

Administer immunizations for vaccine-preventable conditions(e.g., flu shots).

Provide wellnessservices, such as smoking cessation and blood pressure monitoring.

Help patients to safely reduceor eliminateacute (short-term) and chronic (long-term) pain, andminimizethe risk ofsideeffects,addiction, and overdose.

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7
Q

What do pharmacists do concerning med. expertise and pop. health

A

Use and share expertise about what the body does to a drug (pharmacokinetics) and how drugs affect the body (pharmacodynamics).

Apply knowledgeabout how genes affectaperson’sresponseto medicationstodevelopand selectdrugsand dosesthat are tailoredtoapatient’s genetic makeup(pharmacogenomics).

Counsel other health professionals and stakeholders ona variety ofmedication matters.

Developpolicies regarding what medications, treatments, and products best serve the health interests ofapatientpopulationina particularsetting (e.g., hospital).

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8
Q

What do pharmacists do concerning med. expertise and pop. health

A

Staycurrentonnew medicationson the market, related products(e.g., digital health devices), andchanges tohealth care systems.

Oversee or implement systems to prevent medication errors and improve patient outcomes.

Order, monitor, interpret, and verify lab and test results for various health conditions.

Promote the appropriate use of antibiotics to stop the spread of a disease in a patient or population(*antibiotic stewardship).

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9
Q

What do pharmacists do concerning Pharmacy Management?

A

Develop and maintain pharmacy procedures,protocols, inventories, and disaster response plansto ensure patientshave access to theright medications at the right time.

Identify themost affordablemedication options based ona patient’s health careorinsurance plan.

Keep permanent records ofallmedication treatment plans to improve patient care over time, measure outcomes and workload, andfulfilldocumentation requirementsfor the pharmacy.

Teach and supervise studentpharmacists and pharmacy residents to enhance their knowledge, skills, and understanding of the profession.

Supervise, train, and coordinate the activities of pharmacy technicians and other support staff.

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10
Q

your pharmacist =

A

your medication expert
- Interpret drug interactions
- counsel on prescription
-make meds. info. understandable
- OTC counseling
- provide vaccines
- Manage chronic diseases
- help you quit smoking
- Make it easier to take your meds
- verify prepare and check meds.

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11
Q

What does it take to be a good pharmacist?

A

Professional commitment
Trustworthy
Reliable
Detail-oriented
Good communication skills
Good problem-solving abilities
Good memory
Enjoy learning
Organized

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12
Q

Pharmacy Career Options

A

Academic Pharmacy
Community Pharmacy
Government Agencies
Hospice & Home Care
Hospital & Institutional Practice
Independent Ownership
Long-term Care
Consulting Pharmacy
Managed Care Pharmacy
Medical & Scientific Publishing
Pharmaceutical Industry
Trade & Professional Associations
Uniformed (Public Health) Service

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13
Q

Factors that Shape Pharmacy

A

Society
Scope of practice
Organizations
Standards of Practice
Evidence-based Medicine
Technology

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14
Q

Factors that Control Pharmacy

A

Licensure (personal and facility)
Federal and state regulations
State Boards of Pharmacy (BOP)
Department of Public Health (DPH)
Drug Enforcement Agency (DEA)
Food and Drug Administration (FDA)

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15
Q

How is Pharmacy Changing?

A

Scope of Practice
Technology
Support personnel responsibilities
Collaborative Drug Therapy (CDT)
Medication Therapy Management (MTM)

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16
Q

What is the Joint Commission of Pharmacy Practitioners (JCPP) Vision

A

“Patients achieve optimal health and medication outcomes with pharmacists as essential and accountable providers within patient-centered, team-based healthcare.”

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17
Q

how are Pharmacists as healthcare provider

A

Training and expertise in the appropriate use of medications

Provide patient care service in diverse practice settings

Reduce adverse drug events

Improve patient safety and medication adherence

Maximize positive health outcomes

Problem: Variability in how this is taught and practiced!

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18
Q

The goal of a Pharmacist

A

Deliver health care that is:
high quality

cost-effective

accessible health

team based

patient-centered

Framework in diverse practice settings

Consistency of pharmacist-provided care

Consistent and uniform teaching method

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19
Q

What are 5 points of pharmacists’ patient care process?

A

collect

assess

plan

implement

follow-up: monitor and evaluate

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20
Q

what is the Patient Care Process

A

Identifying medication-related problems in
community/dispensing

Comprehensive medication review and follow-up

Anticoagulant dosing

Medication reconciliation during transitions of care visits

Diabetes management

Immunizations

HTN Control

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21
Q

FQHC- Transitions of Care

A

Federally Qualified Health Center (FQHC)

Patients scheduled with PCP within 72 hours of being discharged

Pharmacist assists with medication reconciliation

Warm hand-off to the provider

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22
Q

Community- Dispensing

A

Reviewing patient’s medication profile for therapeutic duplications

Contacting providers with recommendations

Counseling patients on medications

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23
Q

Patient Case- MR

A

MR recently moved from PR

Received prescriptions for:
Omeprazole 20mg BID x 14 days
Clarithromycin 500mg BID x 14 days
Amoxicillin 1,000mg BID x 14 days

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24
Q

step 1 of PPCP

A

The pharmacist assures the collection of the necessary subjective and objective information in order to understand the relevant medical/medication history and clinical status of the patient.

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25
Q

What does the pharmacist collect for step 1 of ppcp

A

Current medication list/use history:
Prescription, non-prescription, herbals, dietary supplements.

Relevant health data:
Medical history, health and wellness information, biometric test results, physical assessment findings

Patient centered factors:
Lifestyle habits, preferences and beliefs, health and functional goals, socioeconomic factors

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26
Q

Where do you collect info from patient

A

The patient themselves

Pharmacy records

Patient records

Other health care professionals

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27
Q

what to collect from patient

A

Pharmacy Records:
Med List
Refill history
Patient themselves:
Demographics
Allergies
Pregnancy Status
Insurance Information
Safety Caps- Y/N
Medication History/List
Prescription:
Prescriber information

subjective info: how does it feel, experience etc

objective info: vital signs, lab tests etc

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28
Q

New symptom? OPQRST

A

Onset: how long has it been happening,

Provoking: what makes It worse
palliating factors: what makes it better

Quality: how does it feel

Region/Radiation: where is the issue

Severity: how bad is it form 1-10

Time (history): how often does It happen

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29
Q

Which of the following best describes Collect

A. Educating the patient on their medications

B. Identifying medication related problems

C. Interviewing the patient

D. Prescribing alternate therapy

A

C. Interviewing the patient

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30
Q

Which of the following best matches the goal of PPCP

A. Ensure any and all pharmacists deliver consistent, high quality, patient centered, team based care no matter the practice setting.

B. Ensure clinical pharmacists utilize the same approach when seeing patients in a hospital setting.

A

A. Ensure any and all pharmacists deliver consistent, high quality, patient centered, team based care no matter the practice setting.

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31
Q

What is step 2 of the PPCP

A

Step 2: Assess
The pharmacist assesses the
information collected and analyzes the therapy in the context of the assesses the
clinical effects of the patient’s
patient’s overall health goals in identify and prioritize order to identify and prioritize problems and achieve optimal care.

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32
Q

what is the assess process

A

assess
Each disease state for proper treatment and monitoring

▪Each medication for appropriateness, effectiveness, safety, and patient adherence

▪Health and functional status, risk factors, health data, cultural factors, health literacy, and access to medications or other aspects of care

▪Immunization status and the need for preventive care and other health care services, where appropriate

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33
Q

in class what was the Assessment of MR?

A. Drug-Allergy Interaction
B. Non-adherence
C. Uncontrolled hypertension
D. AandB
E. All of the above

A

E. all of the above

  • she is allergic to penicillin and amoxicillin is similar to penicillin
  • she was not taking her meds as she was supposed to because she lost them in the hurricane
  • she was taking omeprazole in the passed so we can assume that she had hypertension
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34
Q

Which of the following best describes Assess:

A. Educating the patient on their medications
B. Identifying medication related problems
C. Interviewing the patient
D. Prescribing alternate therapy

A

B. Identifying medication related problems

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35
Q

What disease would
omeprazole, amoxicillin and clarithromycin treat

A

H. Pylori/ peptic ulcer/stomach ulcer disease

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36
Q

what is step 3 of PPCP

A

Plan
The pharmacist develops an individualized patient centered care plan, in collaboration with other health care professionals and the patient or caregiver that is evidence based and cost effective

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37
Q

what is the plan process

A

Collaborate with other health care professionals and the patient or caregiver

Establish a plan that will:
◦ Address medication-related problems (MRPs) and optimizes medication therapy

◦ Sets goals of therapy

◦ Engages the patient through education, empowerment, and self-management

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38
Q

What resources are available to create evidence based plans for PPCP

A

▪Available through institution

▪Available through MCPHS library

▪Available through national organizations

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39
Q

Which of the following best describes Plan
A. Educating the patient on their medications
B. Identifying medication related problems
C. Interviewing the patient
D. Recommending /prescribing alternate therapy

A

D. Recommending /prescribing alternate therapy

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40
Q

What is step 4 of PPCP

A

implement
The pharmacist implements the care plan in collaboration with other health care professionals and the patient or caregiver

help patient navigate the medication use process

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41
Q

we are the experts in medication use process
what is the acronym for it (that I Michelle made up lol)

A

PTDAM

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42
Q

What does PTDAM stand for in the medication use process

A

P- prescribe: select med. and send to pharmacy

T- Transcribe (order verification): enter med. order into pharmacy computer. assess appropriateness and address any discrepancies

D- Dispense: prepare and distribute med. from pharmacy to the patient or health care provider

A- Administer: review med and give to patient

M- monitor: assess patients response to the med and document outcomes.

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43
Q

what does implement for PPCP consist of

A

Contributes to coordination of care, including referrals or transitions of care

Provides education and self-management training to the patient or caregiver

Initiates, modifies, discontinues, or administers medication therapy as authorized

Addresses medication and health related problems and engages in preventive care strategies, including vaccine administration

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44
Q

implement addresses
What can you do?

What can the patient do?

What healthcare professional is best suited to handle this?

what do these mean

A

What can you do?
◦ Scope of practice
◦ Collaborative practice agreements

What can the patient do?
◦ With adequate counseling/education

What healthcare professional is best suited to handle this?
◦ How to refer/transition the patient?

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45
Q

what techniques do you use when working with other professionals and patients

A

SBAR technique
◦ Phone vs. fax vs. email, etc.

Counseling patients:
◦ Private area
◦ Language services
◦ Written materials
◦ Teach-back method: Have patient tell you what you talked about

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46
Q

Which of the following best describes Implement:
A. Educating the patient on their medications
B. Identifying medication related problems
C. Interviewing the patient
D. Recommending /prescribing
alternate therapy

A

A. Educating the patient on their medications

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47
Q

what does SBAR stand for

A

S- situation

B- background

A-Assessment

R- recommendation

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48
Q

what is step 5 of the PPCP

A

Step 5: Follow-up: Monitor and Evaluate

The pharmacist monitors and evaluates the effectiveness of the care plan and modifies the plan in collaboration with other health care professionals and the patient or caregiver as needed.

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49
Q

what does follow up consists of

A

Safety: is the drug causing adverse events? What labs or diagnostic tests are required to monitor for this?

◦ Efficacy: Is the drug causing the desired effect? What labs or diagnostic tests are required to monitor for this?

◦ Adherence: Is the drug being taken appropriately?

◦ Medication Appropriateness: Is this still the best treatment option for this patient?

◦ Treatment goals: Is the drug accomplishing what it should (overall health, symptom relief, increasing mortality, etc.)

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50
Q

Which of the following best describes Follow-up:

A. Checking patient’s labs and refill history for adherence
B. Educating the patient on their medications
C. Identifying medication related problems
D. Interviewing the patient

A

A. Checking patient’s labs and refill history for adherence

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51
Q

Repeat! Repeat! Repeat!

A

Continue to repeat this for each patient encounter:

What if the headaches didn’t go away?
1. Collect
2. Assess
3. Plan
4. Implement
5. Follow-up: monitor and evaluate

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52
Q

For every step of the PPCP

A

Document
◦ If you don’t document- it didn’t happen

Collaborate
◦ It takes a team!
◦ “Stay in your lane”

Communicate
◦ Other healthcare professionals: SBAR/SOAP
◦ With patient/caregiver: Motivational interviewing, OPQRST, etc.

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53
Q

Patient is (THE MOST)

A

important part of healthcare team!

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54
Q

Which of the following needs to be done at EVERY step?
A. Document
B. Patient-centered care
C. Communicate
D. Collaborate
E. All of the above

A

E. All of the above

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55
Q

Patient Care Process
Can be used for

A

ANY patient, ANY time, in ANY healthcare setting.

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56
Q

Define interprofessional collaborative practice and interprofessional education

A

Collaborative practice in healthcare occurs when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, caregivers, and communities to deliver
the highest quality of care across settings.

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57
Q

What pharmacy accreditation requires IPE

A

ACPE

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58
Q

Why the Focus on “Collaborative Practice”?

A

Institute of Medicine Report: To Err is Human (2000)

  • 44,000 – 98,000 Americans die each year due to medical errors
  • Failure to communicate was identified as a common cause of medical errors
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59
Q

What is Interprofessional Education (IPE)

A

When learners, educators, or health care workers from two or more health professions learn about, from and with each other to enable effective interprofessional collaboration and improve health outcomes.

Enables learners to acquire knowledge, skills and professional attitudes they would not be able to acquire effectively in any other way with the goal of improving patient care.

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60
Q

What 3 words are essential in IPE

A

about, from, with

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61
Q

Goal of IPE at MCPHS

A

“Develop knowledge, skill, and attitudes that result in interprofessional team behaviors and competence. Interprofessional education should be incorporated throughout the entire curriculum in a vertically and horizontally integrated fashion.”

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62
Q

Core Competencies for Interprofessional Collaborative Practice

A

values/ethics for inter-professional practice

roles/responsivities

interprofessional communication

teams and teamwork

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63
Q

Bottom line of IPE

A

IPE -> IPC -> Improved patient outcomes

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64
Q

Our Goal of IPE

A

Prepare you all to be knowledgeable and effective members of highly functioning interprofessional teams

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65
Q

what is BP

What can cause increases in BP?

A

Blood pressure is the force of blood against the walls of the arteries

What can cause increases in BP?
–Increased blood volume
–Cardiac output (CO)
–Increased peripheral vascular resistance (PVR)

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66
Q

What does each class do to lower BP?
- Angiotensin II Receptor Blockers (ARB)

  • Angiotensin II Converting Enzyme Inhibitors (ACE-I)
  • Diuretics
  • Beta Blockers (BB)
A

Angiotensin II Receptor Blockers (ARB): decrease angiotensin

Angiotensin II Converting Enzyme Inhibitors (ACE-I):decrease angiotensin

Diuretics: reduce fluid through urine

Beta Blockers (BB): reduce heart rate

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67
Q

what is the Goal BP value:

A

ACC/AHA <130/80 mmHg

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68
Q

Non-pharmacologic treatment for hypertension

A

-Weight loss

-DASH diet (Dietary Approaches to Stop HTN)
–Fruits, vegetables
–Low-fat dairy
–Reduced saturated and total fat

  • Low sodium diet
    <2.3 grams (?)
    <1.5 grams/day
  • Increase physical activity
  • Decrease alcohol intake
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69
Q

-pril

A

HTN
ACE inhibitor
PO
once daily

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70
Q

-sartan

A

HTN
ARB
PO
once daily

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71
Q

-olol

A

beta blocker

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72
Q

-dipine

A

Dihydropyridine CCB
HTN
Patients experience a dip in BP

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73
Q

-thiazide

A

thiazide diuretic
Hydro → water → diuretic

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74
Q

-zosin

A

HTN and BPH
Alpha-1 antagonist

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75
Q

Cozaar

A

losartan
AAR… ARB

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76
Q

Hyzaar

A

losartan and HCTZ
H: hctz
aar: ARB

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77
Q

Diovan

A

valsartan
van: valsartan

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78
Q

Diovan HCT

A

valsartan and HCTZ
van: valsartan
HCT: HCTZ

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79
Q

Zestoretic

A

lisinopril and HCTZ
Zest: Zestril (Lisinopril)
–retic: thiazide diuretic

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80
Q

Vasotec

A

enalapril
Vaso → vascular → HTN

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81
Q

Lasix

A

furosemide
Lasts six hours (peeing!)
diuretic

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82
Q

Dyazide/Maxzide

A

hydrochlorothiazide & triamterene

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83
Q

Aldactone

A

spironolactone
Ald: aldosterone antagonist

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84
Q

Memorize the exceptions

A

Which on this list are not once daily meds?

Which beta-blocker also has alpha-blocking activity

Which meds are for heart failure as well as HTN?

Hypertension + edema → diuretics

Hypertension + BPH → Alpha-1 antagonists

Which medications are not PO?

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85
Q

Pharmacologic Categories/options

A

HMG-CoA Reductase Inhibitors (statins)
Only 1st line medication recommended by lipid guidelines

Ezetimibe (Zetia)

Fibric Acid Antilipemic agents

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86
Q

what are the major lipids in the body
how are they transported

A

Cholesterol (TC), triglycerides (TG), and phospholipids

Transported as complexes of lipid & proteins – lipoproteins

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87
Q

3 major classes of lipoproteins

A

Low-density lipoproteins (LDL)

High-density lipoproteins (HDL)

Very-low-density lipoproteins (VLDL)

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88
Q

Dyslipidemia

A

Elevated TC, LDL, or TG

Low HDL concentration

Some combination of these abnormalities

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89
Q

what should you use when
Total cholesterol is 160-189 (high) or >190 (very high)

A

use station for patient

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90
Q

Non-pharmacologic treatment for high TC

A

Weight loss

Diet modifications
–Decreased saturated and total fat
–Increase fiber

Increase physical activity

Decrease alcohol intake

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91
Q

What consists of CVD

A

MI- myocardial infarction (heart attack)

Angina

Coronary artery stenosis

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92
Q

what consists of Cerebrovascular disease

A

TIA- Transient ischemic attack; mini stroke

Stroke

Carotid artery stenosis

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93
Q

When to initiate therapy with statins

A

CVD

LDL-C >190 mg/dL

United States Preventative Services Task Force (USPSTF)
Adults aged 40-75 years with both: > or equal to 1 CV risk factors (dyslipidemic, DM HTN, smoking)

estimated 10-year CVD risk of > or equal to 10%

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94
Q

vastatin

A

Dyslipidemia

Statin / Hmg-coA reductase inhibitor

PO

Once daily

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95
Q

-fibrate

A

Dyslipidemia
fibric acid antilipemic
PO

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96
Q

Medical Terminology

A

All of the specialized words that medical professionals use to identify human anatomy and physiology, as well as words that indicate location, direction, planes of the body, medical status, and instructions for administering medication.

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97
Q

Medical Terminology-construction of a word

A

prefix
root
suffix

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98
Q

Root:

A

Word stem or root elements
Can stand alone as words on their own
Examples of common medical roots

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99
Q

Card(i, io):
Cyst (o):
Derm(a, o):
Gastr(I, o):
Hem(o, ato):

Myo:
Osteo:
Neuro:
Nephro:
Pneumo:

A

Card(i, io): heart
Cyst (o): cell
Derm(a, o): skin
Gastr(I, o): stomach
Hem(o, ato): blood

Myo: muscular
Osteo: skeletal
Neuro: nervous
Nephro: kidney
Pneumo: lung

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100
Q

Prefix

A

Found at the beginning of a word
Cannot stand alone
Descriptive, expand the meaning of the word

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101
Q

Ante-:
Anti-:
Co-:
Ex-:
Hyper-:
Hypo-:
Inter-:
Intra-:

Mid-:
Macro-:
Micro-:
Multi-:
Non-:
Post-: after
Sub-: under

A

Ante-: before
Anti-: against
Co-: with
Ex-: out of, former
Hyper-: above, extreme, excessive
Hypo-: under, decreased, below
Inter-: between
Intra-: within

Mid-: middle
Macro-: large
Micro-: small
Multi-: many
Non-: not
Post-: after
Sub-: under

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102
Q

Suffix

A

Found at the end of a word
Cannot stand alone
Change the words meaning or part of speech

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103
Q

-algia:
-emia:
-ism:
-itis:
-lysis:
-megaly:
-oma:
-osis:
-pathy:
-spasm:

A

-algia: pain
-emia: blood
-ism: state or condition
-itis: inflammation
-lysis: breaking down
-megaly: enlargement
-oma: tumor
-osis: condition
-pathy: disease or suffering
-spasm: involuntary condition

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104
Q

Prescription

A

An order for medication issued by a physician, dentist or other properly licensed medical practitioner

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105
Q

Prescription Processing

A

Order recognition

Order interpretation

Order analysis

is the order appropriate?
-appropriate for patient?

106
Q

Patient Care Process
C
A
P
I
F

A

Collect
Assess
Plan
Implement
Follow up

107
Q

Medication Use Process
P
T
D
A
M

A

Prescribe
Transcribe
Dispense
Administer
Monitor

108
Q

Prescription

A

Broad Categories:
Single component /product
> one ingredient that requires compounding

109
Q

Sig code

Components of Rx directions:

A

Verb
Dose
Dosage form/formulation
Route of administration
Frequency/timing
Duration

110
Q

Verb

A

Verb and route of administration chart

111
Q

Dose

A

one tablet
5 ml
two puffs

112
Q

Dosage form/formulation

A

Tablet, capsule, cream, ointment, etc

Take one tablet by mouth three times daily
Dosage form =

Inhale two puffs by mouth twice daily
Dosage form =

113
Q

Common dosage form abbreviations

tab =
cap =
syr =
gtt =
ung =
susp =
supp =

A

tab = tablet
cap = capsule
syr = syrup
gtt = drop
ung = ointment
susp = suspension
supp = suppository

114
Q

Route of administration (ROA)

A

By mouth, into ear, rectally

115
Q

Common ROA abbreviations
po = per os =
os = oculus sinister =
od = oculus dexter =
ou = oculus uterque =
as = auris sinister =
ad = auris dexter =
au = auris uterque =
sl = sublingually =
pv = per vagina =
pr = per rectum =
EN=

A

po = per os = by mouth or orally
os = oculus sinister = left eye
od = oculus dexter = right eye
ou = oculus uterque = both eyes
as = auris sinister = left ear
ad = auris dexter = right ear
au = auris uterque = both ears
sl = sublingually = under the tongue
pv = per vagina = vaginally
pr = per rectum = rectally
EN=each nostril

116
Q

Frequency/timing

A

Take one tablet by mouth daily

117
Q

Common Frequency Abbreviations

q = quaque =
qd = quaque die =
qhs = quaque hora somni =
bid = bis in die =
BIW =
tid =ter in die =
TIW =
qid = quater in die =
q_h = quaque __ hora =
prn= pro re nata =

A

q = quaque = every
qd = quaque die = every day
qhs = quaque hora somni = every day at bedtime
bid = bis in die = twice a day
BIW = twice a week
tid =ter in die = three times a day
TIW = three times a week
qid = quater in die = four times a day
q_h = quaque __ hora = every ___ hours
prn= pro re nata = as needed

118
Q

Common timing abbreviations

a.c. = ante cibos =
i.c. = inter cibos =
p.c. = post cibos =
w.a. =

A

a.c. = ante cibos = before meals*
i.c. = inter cibos = between meals*
p.c. = post cibos = after meals*
w.a. = while awake

119
Q

Duration

A

For 10 days, for one week, for 30 days, etc

120
Q

what is the verb for lopressor tablet

A

take

121
Q

what is the verb for Nitroglycerin Sublingual Tablets1 SL q5min#100

A

dissolve

122
Q

what is the verb for Albuterol Inhaler1 Puff Q4H PRN#1 inhaler

A

inhale

123
Q

cream

cream for vaginal

A

apply

insert

124
Q

Tablet: 1 Q8H 10 Days

A

take 1 tablet by mouth every 8 hours for 10 days

125
Q

Oral Solution: 5 ml QID WA

A

take 5mL by mouth four times daily while awake

126
Q

Nasal Spray: 2 EN QD

A

use 2…

127
Q

components of a prescription

A

name of patient
date
Address of patient (?)
name of pharmacy
Rx
refills
MD signature
DEA of MD

128
Q

sig code break down

example: take one tablet by mouth daily

what is the verb, dose, dosage form, route of admin., frequency, duration

A

verb: take
dose: 1
dosage form: tablet
route of admin.: by mouth
frequency: daily
no duration specified by MD

129
Q

capsules or tablets

verb
dose, dosage form/units
ROA

A

verb: take

dose, dosage form/units: # tablets or # of capsules

ROA: by mouth

130
Q

chewable tablets

verb
dose, dosage form/units
ROA

A

verb: chew

dose, dosage form/units: # of chewable tablets

ROA: by mouth

131
Q

sublingual tablets

verb
dose, dosage form/units
ROA

A

verb: dissolve

dose, dosage form/units: dissolve or place

ROA: under the tongue

132
Q

suspension, syrups or solutions

verb
dose, dosage form/units
ROA

A

verb: take

dose, dosage form/units: # of milliliters (if spoonfuls are indicated on Rx must convert to mls)

ROA: by mouth

133
Q

mouth washes

verb
dose, dosage form/units
ROA

A

verb: as indicated on Rx

dose, dosage form/units: as indicated on Rx

ROA: by mouth

134
Q

metered does inhaler (MDI)

verb
dose, dosage form/units
ROA

A

verb: inhale or take

dose, dosage form/units: # of puffs

ROA: by mouth

135
Q

dry powder inhaler (DPI)

verb
dose, dosage form/units
ROA

A

verb: inhale or take

dose, dosage form/units: $ of inhalations

ROA: by mouth

136
Q

(DPI): Capsule-based ex: Handihaler or neohaler

verb
dose, dosage form/units
ROA

A

verb: inhale

dose, dosage form/units: contents of the # of capsule(s)

ROA: by mouth

137
Q

creams, gels or ointments

verb
dose, dosage form/units
ROA

A

verb: apply

dose, dosage form/units: as specified on Rx

ROA: topically (area specified on Rx)

138
Q

lotions or solutions

verb
dose, dosage form/units
ROA

A

verb: apply

dose, dosage form/units: as specified on Rx

ROA: topically (area specified on Rx)

139
Q

patches

verb
dose, dosage form/units
ROA

A

verb: apply

dose, dosage form/units: # of patches

ROA: topically (area specified on Rx)

140
Q

shampoos

verb
dose, dosage form/units
ROA

A

verb: shampoo or use

dose, dosage form/units: as specified on Rx.

ROA: area specified on Rx

141
Q

nasal sprays

verb
dose, dosage form/units
ROA

A

verb: use or administer

dose, dosage form/units: # of sprays

ROA: in ____ nostril ( fill in blank as indicated on Rx)

142
Q

eye and ear drops (solutions or suspensions)

verb
dose, dosage form/units
ROA

A

verb: instill, place or put

dose, dosage form/units: # of drops

ROA: in ___ eye (s) or in ____ ear (s) fills in blank as indicated on Rx)

143
Q

gels or ointments

verb
dose, dosage form/units
ROA

A

verb: gels: place, put ointments: apply

dose, dosage form/units: as directed on Rx

ROA: as indicated on Rx

144
Q

vaginal products

verb
dose, dosage form/units
ROA

A

verb: insert

dose, dosage form/units: # of suppositories or # of ovules or # of applicatorfuls or as indicated by prescriber

ROA: vaginally

145
Q

rectal products

verb
dose, dosage form/units
ROA

A

verb: insert

dose, dosage form/units: # of suppositories or # of applicatorfuls

ROA: rectally

146
Q

insulin

verb
dose, dosage form/units
ROA

A

verb: inject

dose, dosage form/units: # of suppositories or # of applicatorfuls

ROA: rectally

147
Q

insulin syringes

verb
dose, dosage form/units
ROA

A

verb: use

dose, dosage form/units: as directed (unless otherwise specified on prescription–do not include dose)

ROA: under the skin or subcutaneously

148
Q

Why are calculations important?

A

‘Wrong dose’ medication errors most commonly occur as a result of:
–Misinterpretation of prescription
–Errors in calculation
–Selection of wrong medication concentration

Higher rates of errors occur in pediatrics
–More calculations needed for dose
–Liquid medications with different concentrations

149
Q

Solving calculation problems

A

Read the question first – What am I being asked?- dose, total daily dose, quantity etc

Read the entire problem carefully – highlight important info

Pull out the appropriate facts you need to answer the question and block out the information that is not needed

List conversion factors that you need to answer the question

Set up the problem with the appropriate equations and perform the calculations required

Then ask yourself does this answer make sense! – Is this around what you expected to get for an answer? Are the units correct?

Double check your calculation, does the answer make sense? Should the answer be in the 20’s or the 100’s? etc

150
Q

Rounding and Decimals

A

Do not round until the last step in your calculation.

Traditional rounding rules apply to all calculations EXCEPT day supply.

Traditional round: 5 or greater you round up, less than 5 you round down
6.5 rounded to a whole number would be 7

4.4 rounded to a whole number would be 4

On the exam you will be told which place to round your final answer.
Round to one decimal point
Round to a whole number

151
Q

Types of Calculations

A

Dose
Total Daily Dose (TDD)
Quantity (Qty) to Dispense
Day Supply (DS)

152
Q

Definitions: Dose vs TDD

A

Dose: the amount of medication the patient will take at one time
–How this information is given to the patient: e.g. # of tablets, capsules, volume of liquid (mL)
–How this information is given to another healthcare professional: e.g. amount of mg, g, units

Total Daily Dose (TDD): the total amount the patient will take in 24 hours
–Total daily dose = dose x frequency
–Medication likely mg

153
Q

Quantity vs Day Supply

A

Quantity (Qty) to dispense: 1 tablet TID x 10 days = 30 tablets
–The amount of medication that will be sent home with the patient or to the floor of an institution
–Qty to dispense = dose (# of tablets, mL, etc.) x frequency x duration
–*requires a duration

Day Supply (DS): has to do with insurance  refill
–The number of full days the quantity dispensed will last the patient
–This is always a whole number!
–For the purposes of this class we always round down!*
–Days Supply = (quantity or units dispensed)
(dose (# of tablets, mL, etc.) x frequency)

154
Q

Oral Liquid Dosing Devices

A

Institute for Safe Medication Practices (ISMP)
All oral liquid doses should be express in milliliters (mL) for measuring dose.

The dosing device you provide to the patient should only have metric measurements (mL) on it.

Patients can’t measure mg and should not be relied on to convert

tsp cannot be calibrated so convert
1 tsp = 5mL

155
Q

SubQ Injectable: Insulin

A

Days supply is calculated according to the number of units/mL
100 units/mL “U-100”
200 units/mL “U-200”
300 units/mL “U-300”
500 units/mL “U-500”

Since dosing is prescribed in units, you will need to convert to milliliters to calculate day supply
Vials have a total volume of 10 mL
Pens have a total volume of 3 mL
One box of insulin pens (most) = 5 pens

156
Q

have you mastered the calculations, concepts & TERMS?

A

Yes and God is gooddddd

No but GOD IS STILL GOOD!

157
Q

Insulins – High Alert Medications

A

High Alert Medication = a medication that has a high rate of medication errors and/or high risk of causing great injury to a patient

Insulins SIG codes should always include units as the dose for the patient NOT mL

Insulin needles and insulin pens are created to measure the number of units (See photo on previous slide)

Units should never be abbreviated as U; this is an inappropriate abbreviation and has lead to many medication errors

It can be mistaken for a zero, leading to an overdose

157
Q

1 milliliter (mL) is how many drops

A

20 drops

158
Q

1 teaspoon (tsp) is how many mL

A

5 mL

159
Q

1 tablespoon is how many mL or teaspoons

A

15 mL or 3 teaspoons

160
Q

1 fluid ounce (fl oz) in mL

A

29.57 mL

161
Q

1 pint is how many mLs

A

473 mL

162
Q

1 quart in mL

A

946mL

163
Q

1 gallon is how many mL

A

3785mL

164
Q

1 fluid ounce (fl oz) is how many mL

A

30 mL

165
Q

1 pint (pt) or 16 fl oz

is how many mL

A

480 mL

166
Q

1 gram (g) is how many grains

A

15.4 grains

167
Q

1 grain (gr) is how many mg

A

64.8 mg (approx. 65 mg)

168
Q

1 kilogram (kg) in lbs

A

2.2 lbs

169
Q

1 pound (lb) IN GRAMS

A

454 grams

170
Q

1 ounce (oz) is how many grams

A

28.4 grams (approx. 30 grams)

171
Q

1 inch (in)

A

2.54 cm

172
Q

1 foot (ft)

A

12 inches

173
Q

Non-pharmacologic treatment

A

Weight loss

DASH diet (Dietary Approaches to Stop HTN)
Fruits, vegetables
Low-fat dairy
Reduced saturated and total fat

Low sodium diet
<2.3 grams (?)
<1.5 grams

Increase physical activity

Decrease alcohol intake

174
Q

What are Lipids?

3 major classes of lipoproteins:

Dyslipidemia

A

Cholesterol (TC), triglycerides (TG), and phospholipids – major lipids in the body
Transported as complexes of lipid & proteins – lipoproteins

3 major classes of lipoproteins:
Low-density lipoproteins (LDL)
High-density lipoproteins (HDL)
Very-low-density lipoproteins (VLDL)

Dyslipidemia:
Elevated TC, LDL, or TG
Low HDL concentration
Some combination of these abnormalities

175
Q

what are the sources of cholesterol?

A

artery

food

plaque

liver

176
Q

Diagnosis, goals of therapy

classification of total, LDL, & HDL cholesterol and TG

A

total cholesterol:
<200 - desirable
200-239 - borderline high
> 240 - high

LDL cholesterol
<100 optimal
100-129 - near or above optimal
130-159 - borderline high
160-189 - high
>190 very high

HDL cholesterol
<40 - low
>60 mg/dL high

triglycerides
<150 - normal
150-199 borderline high
200-499 high
>500 very high

177
Q

Treatment Goals for TC

A

Focus is on ASCVD Risk Reduction
CVD –
MI
Angina
Coronary artery stenosis
Cerebrovascular disease
TIA
Stroke
Carotid artery stenosis

Previous goal was to achieve target LDL-C values based on presence of risk factors

178
Q

When to initiate therapy

A

CVD

LDL-C >190 mg/dL

United States Preventative Services Task Force (USPSTF)
Adults aged 40-75 years with both:

> 1 CV risk factor (dyslipidemia, dm, HTN or smoking)

estimated 10-year CVD risk of >10%

179
Q

Brand names

A

Crestor, Lipitor, Mevacor, Zocor, Pravachol
Tor/cor: choles”TOR”ol
Chol: cholesterol

Tricor
fenofibrate
Tri: triglycerides
Cor: choles”TOR”ol

Zetia
ezetimib

180
Q

Non-pharmacologic treatment

A

Weight loss

Diet modifications
Decreased saturated and total fat
Increase fiber

Increase physical activity

Decrease alcohol intake

181
Q

Anticoagulants

A

Coumadin
warfarin
Warfare → bleeding → anticoagulant

Plavix
clopidogrel
Nix the platelets → antiplatelet

Xarelto
Rivaroxaban
Xaban
Factor Xa Inhibitor

182
Q

Miscellaneous CV medications

A

Lanoxin
digoxin
ox → increases force of the heart’s contractions → strong like an ox

Klor-Con, K-Tab
potassium chloride
Potassium: K
Chloride: LOR
Con: Spanish word for “with”

NitroStat, Nitro-Dur
nitroglycerin
NitroStat → SL → Q5 min x 3 doses
NitroDur → transDURmal → Duration: daily

Imdur
isosorbide mononitrate
Nitrate: nitrate → vasodilator
Duration: daily (ER formulation)

183
Q

Thyroid products

A

Synthroid, Unithroid, Tirosint
levothyroxine
Thyroid product: hypothyroidism
Spanish for thyroid: tiroides

Levoxyl: levothyroxine

Synthroid: synthetic thyroid

Armour Thyroid
Desiccated thyroid

Tapazole
methimazole
Anti-thyroid agent

184
Q

Pharmacologic Categories

A

Biguanides

DPP-4 inhibitors

SGLT2 inhibitors

Thiazolidinediones

Sulfonylureas

Glucagon-Like Peptide-1 (GLP-1) Agonists

Insulin
Long-acting
Rapid-acting

185
Q

diagnosis for pre-diabetes and diabetes

A

random glucose:
prediabetes: none
diabetes: >200 mg/dL w/ symptoms (polytriad)

fasting plasma:
prediabetes: 100-125 mg/dL
diabetes: >126 mg/dL

2 hour plasma glucose:
pre-diabetes: 140-199 mg/dL
diabetes: >200 mg/dL

HbA1C:
prediabetes: 5.7-6.4%
diabetes: >6.5%
goal: <7%
pre-prandial glucose: 80-130
post-prandial glucose: <180

186
Q

Goals of therapy

A

Prevention of morbidity, mortality

Microvascular
Neuropathy
Nephropathy
Retinopathy

Macrovascular
Cerebrovascular disease
CV disease
Peripheral artery disease

187
Q

Non-pharmacologic Treatment for diabetes

A

Nutrition

Weight loss
Physical activity
Bariatric surgery

Education

188
Q

Brand names – oral agents

A

Glucophage
metformin
Gluco: glucose
phage: eat

Januvia
sitagliptan
-gliptin: DPP-4 inhibitor
Sit on the thrown of Januvia

Invokana
canagliflozin
-gliflozin: SGLT2 inhibitors
Invoke the kidneys
Go with the flo…

189
Q

Brand names – oral agents diabetes

A

Actos
Pioglitazone
TZD (thiazolidinedione)

Sulfonylureas
glimepiride
Amaryl
glipizide
Glucotrol, Glucotrol XL
Glucose control
glyburide
Glynase, Diabeta

190
Q

GLP-1 agonists

A

Victoza
liraglutide
Lower glucose

Trulicity
dulaglutide

191
Q

insulin rapid
what is the
insulin
product
onset
peak and duration of
humalog
novolog
levemir
lantus, basaglar, toujeo
tresiba

A

Humalog: rapid
insulin: lispro
product: Humalog
onset: 10-30 mins
peak: 1/2 to 3 hours
duration: 3-5 hours

novolog:
insulin: aspart
product: novolog
onset: 10-30 mins
peak: 1/2 to 3 hours
duration: 3-5 hours

levemir
insulin: detemir
product: levemir
onset: 1-2 hours
peak: minimal peak
duration: 24 hours

Lantus, basaglar, toujeo
insulin: glargine
product: Lantus, basaglar, toujeo
onset: 1-2 hours
peak: none
duration: 24 hours

tresiba
insulin: degludec
product: Lantus, basaglar, toujeo
onset: 1 hour
peak: 9 hours
duration: 42 hours

192
Q

Basal insulins: long acting

Prandial / Meal time insulins: rapid acting

A

Lantus/Toujeo/Basaglar
insulin glargine
Long acting Lantus
Basaglar (basal, glargine)

Levemir
insulin detemir
Long acting Levemir

Dosed Once daily*

Humalog
insulin lispro
Novolog
insulin aspart

huma: human
Novo Nordisk
log: analog

Dosed TID

193
Q

Heartburn, GERD, PUD – PPIs

A

Protonix
pantoprazole
Proton: acid
nix: nix it

Nexium
esomeprazole
Nex: Next omeprazole

Prilosec
omeprazole
Pr: protons/acid
lo: low
sec: secretion

Prevacid
lansoprazole
Prevents acid

Dexilant
dexlansoprazole
Dex: dex
il: lansoprazole
ant: antacid

194
Q

Other GI products

A

Histamine-2 Receptor Antagonist (H2RAs)
Pepcid, Zantac 360
famotidine
tidine: to dine → heartburn
Pepcid: peptic acid

Phenergan
Promethazine
1st generation antihistamine
Used for N/V
Add codeine: Purple drank/lean/sizzurp

Zofran
ondansetron
Fran → friend when throwing up

195
Q

Anti-virals
Anti-fungals

A

Valtrex
valacyclovir
Prodrug for acyclovir
trex: T-rex wrecks the virus

Zovirax
acyclovir
ax: axes the zoster virus

Diflucan
fluconazole
Die fungi!

Nizoral, Nizoral A-D
ketoconazole
The key to avoid dandruff

196
Q

BP

A

BP is the force of blood against the walls of the arteries

What can cause increases in BP?
Increased blood volume
Cardiac output (CO)
Increased peripheral vascular resistance (PVR)

197
Q

blood pressure categories

normal
elevated
high - HTN
high - HTN 2
High - HTN crisis

A

normal: systolic less than 120 and diastolic less than 180
elevated: systolic 120-129 and diastolic less than 80
high - HTN: systolic 130-139 and diastolic 80-89
high - HTN 2: systolic 140 + and diastolic 90 +
High - HTN crisis: systolic 180 + and diastolic 120 +

198
Q

why use library databases

A

Drug information (DI) retrieval and evaluation is an essential skill for pharmacists

The provision of drug information is among the fundamental professional responsibilities of all pharmacists (ASHP)

Responsibilities to be effective DI providers - provide accurate, unbiased, well-referenced, and critically evaluated information on any aspect of pharmacy

Provide accurate & complete responses to DI requests

This responsibility begins with effective searching-Use a systematic approach to address DI needs by effectively searching, retrieving, and critically evaluating the literature (ASHP)

199
Q

Library Resources and Services

A

Library web site – access all resources
24/7https://www.mcphs.edu/library/

Library chat – real time reference service

Send text to us 1-617-299-7092

E-mail your liaison for consultations

Set up your Google Scholar preferences

Download mobile versions of resources

Download LibKey Nomad browser extension to connect to the library’s resources and other free resources right from the publisher’s page: https://thirdiron.com/downloadnomad/

Circulation books-borrow for 3 weeks at a time

Course Reserves: borrow for 3 hours anywhere on campus

Honor system policy

200
Q

MCPHS Library Resources

A

Smart Search: Search across most of our resources at once

Online catalog: find MCPHS owned print & e-books by campus. Access single books or collection of books. Collection of books include:
Stat!Ref: 70 books
Books@Ovid: 145 titles in medicine and related subjects
ProQuest Ebook Central: 71,500 multidisciplinary titles
R2Library: 3000 medical, nursing and allied health eBooks

Print/Download books or chapters/Read online

Download a book requires free Adobe Digital Editions software

Publishers and vendorsdecide access limitations likehow many readers per book at a time and printing/downloading options. These policies vary between publishers.

World Cat: locate books, articles, videos, etc. near you

201
Q

MCPHS Library Resources

A

Databases: search for articles

Journals: search within individual journals

Media: mages, videos: pictures, drawings, tables, animations, film:
Research Guide on Videos: https://mcphs.libguides.com/videos
Research Guide on Images: https://mcphs.libguides.com/Images
Primal Pictures

Institutional Repository: MCPHS faculty publications, thesis, dissertations

Research management and citation: EndNote and Zotero

201
Q

WorldCat

A

WorldCat.org lets you search the collections of libraries (books, music, DVDs,etc.) in your community and around the world.

Search many libraries at once for an item and then locate it in a library nearby

Find books, music, and videos to check out

Find research articles and digital items (like audiobooks) that can be directly viewed or downloaded.

202
Q

Interlibrary Loan (ILL)*

A

Request form on library web site: https://my.mcphs.edu/Library/Services/InterlibraryLoan.aspx

Request via a database search: Example

Plan and request early

Receive item in 72 hours-5 days in your e-mail
3 requests per day

Most ILL requests are free

203
Q

Primary, Secondary and Tertiary Sources

A

Informal organization of the medical literature

Primary literature are the most up-to-date resources available (journal articles reporting original research, new ideas, etc.)

Secondary resources include indexing and abstracting systems that organize and provide easy retrieval of primary resources (databases, reviews, bibliographies)

Tertiary resources are sources that condense and summarize well established data from the primary literature (textbooks reference books, electronic databases)

204
Q

Online Curricular Resources*

A

AccessMedicine: 75 textbooks, self assessment, board reviews, drug monographs, diagnostic tests. Access Medicine Drug Index: Includes a description of the product, contraindications, interactions, dosage and administration, and the chemical structure.

AccessPharmacy: 30+ textbooks, self assessment and board reviews, drug monographs, NAPLEX review. Access Pharmacy Drug & Supplements Index: same categories. By McGraw-Hill Medical

PharmacyLibrary- Created by American Pharmacists Association (APhA). Find pharmacy eBooks, interactive case files and exercises. Review for the NAPLEX.

LWW Health Library: Pharmacy Collection - A collection of core books for pharmacy as well as related videos and case studies. Includes both interactive and text-based self-assessment tools. Review for the NAPLEX.

205
Q

Importance of Reference Citations to the Quality of Tertiary Resources

A

Point to the original source of any specific information

The number and quality of references is a distinguishing feature among tertiary resources

Only the electronic versions of some texts may have references

Just because some information in a resource may be referenced, doesn’t mean all information is referenced. If the specific source of the information you are using to answer a question is not identified, consider it “not referenced.” Exception: commonly known facts, e.g. penicillin is an antibiotic, diabetes is chronic disease…

Speak to how current the monograph is

Author’s bias

206
Q

What if I can’t find an answer to my question?

A

Do not panic!- Lack of information in a resource about a question does not necessarily mean that no information exists!

Check currency of information-something may have been published recently.

Look elsewhere

Cross check information found

At any point seek Librarian’s help. We are here to help you

207
Q

Challenges for Today’s Pharmacists (Walters Kluwer, 2022)

A

Increased need for access to evidence-based clinical information

Not one only centralized, trustworthy evidence-based resource for DI instead multiple resources and tools need to be consulted

The rise of specialty medications which tend to be expensive and more complex to get increases need for the latest DI as well as patient education materials

Spending too much time finding trustworthy drug information at the point of care can be burdensome when added to the many responsibilities

Outdated information across databases

Globally, medication errors are all too common, with an associated cost of $42 billion (World Health Organization, 2017).

Awareness of specific patient population needs

208
Q

Computerized Tertiary Drug Information Resources

A

First to consult-Most common resources used by pharmacists today

Summarize and interpret the primary literature

Convenient and easy to use

Examples include: Lexi-Comp, Micromedex, Clinical Pharmacology

They differ in scope, breadth, purpose, and price but have many similarities but neither one can answer complete information requests. More than one database needs to be consulted.

Their most significant limitation is the lag time for publication, and updates-seen both with print and e-sources.
Inline referencing varies

209
Q

Computerized Tertiary Drug Information Resources

A

Lexicomp Online

Clinical Pharmacology

Micromedex

Most common questions for Pharmacists: Dosage and administration, adverse effects, drug interactions, pharmacotherapy, and disease management, including the use of nonprescription medications and dietary supplements.

210
Q

Different tertiary resources may provide conflicting information

A

Cross check more than one resource before answering a question to validate the information found

Check dates of information provided (e.g., number of references cited, in-text citations)

Check quality of information to see if information is based on clinical studies and not opinion

211
Q

Types of Drug Information Questions

A

A physician would like to know if atorvastatin is effective for rheumatoid arthritis. If so, what is the dose usually used? He would also like to know if alopecia can occur with the use of this drug?

Type of Questions: Dosing /Therapeutic efficacy/Place in therapy; Adverse Events

212
Q

Types of Drug Information Questions

A

A new pharmacy technician is having difficulty finding Xalatan eye drops on the shelf. Where is Xalatan stored? What is the typical dosing of Xalatan for ocular hypertension and where should it be stored after it is opened by the patient?

Type of Questions: Dosage, Storage/Stability

213
Q

Types of Drug Information Questions

A

You receive a prescription for valacyclovir 1000mg three times daily for a 13 year old patient for the treatment of cold sores. Is this the correct dose for this indication? The mother of the patient asks you if a solution is available since the child dislikes swallowing tablets/ capsules? If not, can it be prepared?

Type of Question: Pediatric Dosing, Administration, Preparation

214
Q

Types of Drug Information Questions

A

A 65 year old man with moderate symptoms of BPH asks you whether he can take saw palmetto while taking warfarin. His neighbor recommended it since it worked well for him. How would you advise the patient?

Type of Question: Drug/herb interaction

215
Q

Lexi-Comp Online: Most Convenient to search medications quickly and easily

A

Clear, concise, used at the point of need-quick review of drugs and adverse events (% included)

Drug pronunciation feature

Drug-interaction reviewing tool, patient education leaflets, a drug-identification database, lists of drug recalls and shortages, and recent drug news

Patient information (19 languages)

Smallest in size, least comprehensive

Strongest resource for pharmacogenomic information

Does not have investigational drugs and detailed reproductive risk

References are not easily retrievable

Includes current drug shortages, FDA recalls, dangerous drug abbreviations, therapeutically equivalent generic drugs (through the Orange Book, available at www.accessdata.fda.gov/scripts/cder/ob/default.cfm), and extemporaneous preparations (through the Pediatric Dosage Handbook found online in the Lexicomp series).

216
Q

Clinical Pharmacology: Comprehensive and practical drug information resource

A

Comprehensive drug monographs on US Rx, OTC, Investigational, Herbal drugs or Nutritional Drug Information

Drug class overviews, various interactions (drug–drug, drug–herbal, drug–nutritional, drug–food), and full-color product images

Drug Interaction reports for professionals and consumers

Drug comparison tool that easily generates information on product dosage forms, clinical attributes, and adverse events. Lists ingredients information, strength and more grouped by therapeutic use.

Off-label drug info is included only if clinically relevant

No foreign products, patient education in English and Spanish, no detailed reproductive risk, limited toxicology

Product comparison tool that retrieves a list of products by allergy or dietary restriction (e.g., sugar free, alcohol free, latex free, sodium free, dye free)

Most information is readily referenced with a link to PubMed citations. Although some information (e.g. adverse event reporting) is not referenced.

217
Q

Micromedex: Most Comprehensive, E-Drug Information Resource

A

Searches databases that include extensive and summarized drug information, toxicology, alternative medicine, and reproductive risk evaluation:

Drugdex: Drug Infromation (labeled uses, dosing, off labeled use, adverse events-summary of common and serious ADRs, Foreign products, poisons)

PDR: Manufacturer’s Drug Leaflets

Martindale’s (foreign medications)

Poisindex identifies ingredients for commercial, biological, and pharmaceutical products and delivers summarized toxicology data.

Identidex : identifies a medication using its embossed lettering or numbering and other descriptive characteristics, such as color and shape.

Alternative Medicine – evidence-based info on herbals and dietary suppl.

REPRORISK – reproductive risk info on drugs, chemicals, environmental agents.

Drug interaction reviewing tool, patient education leaflets for both prescription drugs and dietary supplements, and clinical calculators to help determine body mass index, ideal body weight, metric conversions, and others.

Contains also Red Book Online

Well referenced throughout but some monographs could be outdated

218
Q

Micromedex

A

Although Micromedex is a large database, the primary literature is readily referenced and easy to access.

Therapeutic indications are given a graded evidence rating with usage recommendations.

For the clinician, Micromedex offers comprehensive, easy-to-read, extensively referenced data on drugs.

219
Q

Natural Medicines Database

A

Comprehensive evidence-based information on natural products, vitamins herbs, and integrative medicine.

Information derived from clinical studies.

Developed by international collaborators from highly regarded academic institutions to provide quality information that has been validated and peer reviewed.

Monographs include MOA, ADRs, drug interactions and other information

Evidence-based effectiveness ratings for a given disease

Natural product/drug interaction checker

Disease/Medical condition search

220
Q

Natural Medicines Database

A

Advantages
Very comprehensive

Easy to use/user-friendly format

Very well referenced

Excellent herb/herb, herb/drug, and herb/disease interaction information

Disadvantages
Information is often more conservative than what is perceived by Complementary and Alternative Medicine (CAM) professionals

Historical evidence information may be limited

221
Q

Alternative Medicine Journal Databases

A

AltHealthWatch: complementary, holistic and integrated approaches to health care and wellness with full text articles for more than 180 international, and often peer-reviewed journals and reports since 1984.

AMED (Allied and Complementary Medicine Database): alternative medicine articles from over 500 journals, mainly European. produced by the Health Care Information Service of the British Library.

222
Q

Evaluating Tertiary Drug Info Databases

A

Who develops? Is technical support readily available?

Is it an authoritative source? Do the authors/editors have adequate expertise?

Is the information appropriately referenced from reliable sources?

Is it “user-friendly?” How easy is it to find information?

How frequently is it updated?

How would you use it? What does it offer that alternative sources do not?

How much does it cost relative to other systems

223
Q

Computerized versus Mobile Databases

A

Apps and Mobile Sites Guidehttps://mcphs.libguides.com/

Mobile version may be different than the original database

Usually less comprehensive than original database

Helpful in patient care setting as a quick resource

224
Q

Important Points

A

All databases include a monograph with standard information about the drug (pharmacology, kinetics, dosing, ADRs, drug interactions.

Resources differ in terms of how comprehensive and complete information is

Substantial variation in ADR formatting exists between the most common DI databases (1)

No single drug information resource covers every topic a pharmacist may need information about, therefore multiple resources may need to be consulted

More than one resource should always be used to verify information

225
Q

Exercise: Valsartan, Rosuvastatin, Cephalexin, Black Cohosh

Generic Name:
Brand Name(s):
Common Indications/Uses:
How does this drug work (mechanism and onset):
How to administer the drug/additional advice for administration:
Common side effects (4-6 most likely or serious):
Commercially available strengths:

A
226
Q

where do you find controlled substance in lexicomp

A

under preparations

227
Q

Why Study History?

A

“A profession without a history is merely an occupation with pretensions.”
Dr. Gregory Higby – excerpt: speech at ACPE 2016 standards Open Comment Forum, 2014 AACP Annual Meeting, Grapevine, TX.

A lecture on pharmacy history is required in the CAPE standards for pharmacy education.

Have a better understanding of the origins and historical significance of your chosen profession!

228
Q

What is the definition of pharmacy?

A

Pharmacy is an ancient profession

It is from the Greek word pharmakon = drug

According to the American Heritage Dictionary:
1. the art and science of preparing and dispensing drugs and medicines.
2. a drugstore or place where drugs are sold; a drugstore. Also called apothecary.

229
Q

Pharmacy is an ancient profession

It is from the Greek word pharmakon = drug

According to the American Heritage Dictionary:
1. the art and science of preparing and dispensing drugs and medicines.
2. a drugstore or place where drugs are sold; a drugstore. Also called apothecary.

A

It is a health profession that links health and the chemical sciences

Pharmacy is responsible for ensuring the safe and effective use of medications

Pharmacists are the experts on drug therapy

Pharmacists are responsible for optimizing medication use for their patients for positive health outcomes

230
Q

Eras of pharmacy history

A

Ancient era to 1600 AD

Empiric era: 1600-1940

Industrialized era: 1940-1970

Patient Care era: 1970- present

Biotechnology and pharmacogenomics

231
Q

Ancient Mesopotamia

A

Babylon: the cradle of civilization

Evidence exists of apothecary practice

Healers were priest, pharmacist, and physician all in one

Archaeologists have found clay tablets that recorded:
Symptoms of illnesses
Prescription instructions
for compounding

232
Q

Ancient China

A

According to legend, the Chinese Emperor Shennong took interest in medicinal herbs

He tested hundreds of herbs on himself

First recorded use of marijuana as a medicinal drug in 2737 BC -

He is regarded as the patron god
of native Chinese drug guilds

The Chinese may have practiced “inoculation” by scratching matter from a smallpox sore into a healthy person’s arm:
which was the earliest known version of…
A Smallpox Vaccine

233
Q

A Smallpox Vaccine

A

The smallpox vaccine, introduced by Edward Jenner in 1796, was the first successful vaccine to be developed in modern times.

Jenner observed that milkmaids who previously had caught cowpox did not catch smallpox and showed that inoculated vaccines protected against inoculated variola virus.

234
Q

Ancient Egypt

A

Pharmacy practice was conducted by two classes of workers:
Echelons: gatherers and preparers of drugs
Chiefs of fabrication

Papyrus Ebers
Developed more dosage forms
and compounded more complex
formulas
Maintain close links to supernatural and empirical healing

235
Q

Ancient Egypt

A

Willow bark contains salicin, which is metabolized in the body to salicylic acid (a precursor to aspirin – acetylsalicylic acid) first identified by Egyptians

Hippocrates, the Greek physician, used willow bark and leaves for pain relief

Used by indigenous people for pain

An 18th century clergyman, Edward Stone, rediscovered aspirin and wrote about its use for malarial fevers

236
Q

Modern History of Aspirin

A

The aspirin we know today was developed in the late 1890s when Felix Hoffman at Bayer created acetylsalicylic acid (ASA).

In 1899, Bayer distributed
powder to doctors and
pharmacists as an “ethical drug”

237
Q

Ancient India

A

More than 2000 drugs are recorded in the Charaka Samhita - Compendium of Wandering Physicians

Written in Sanskrit - an ancient Indian language

238
Q

Ancient Greece

A

“Terra Sigillata” was the first therapeutic agent to bear a trademark symbol

Theophrastus: “Father of Botany”
Wrote extensively on the
medicinal qualities of herbs.

Hippocrates – Greek physician - manuscripts on medicine and apothecaries.

Greece played a large role in the study of medicinal plants – Materia Medica was used for hundreds of years.

239
Q

The Middle Ages (400-900 AD)

A

First apothecary established in 792 AD in the city of Baghdad

As Muslims traveled across Africa, Spain and southern France, they brought this new system of pharmacy with them

This system was eventually
adopted by Western
European countries-
independent pharmacies
started opening

240
Q

First Pharmacopoeia

A

The idea of a pharmacopoeia came about in Florence, Italy

Became legal standard for all
apothecaries

A multidisciplinary collaboration- Guild of Apothecaries and Medical Society worked together with guidance from a Dominican monk

241
Q

Empiric Age (1600-1940)

A

Pharmacopeias were used to protect public health

Roots, bark, herbs, flowers were used and controlled by governments

Practitioners questioned toxicological effects on the human body

Created interest in testing of drugs and effect on the human body

242
Q

American Pharmacy

A

William Proctor (1817-1874) - “Father of American Pharmacy”

Graduated from Philadelphia College of Pharmacy and spent most of his life advancing the profession of pharmacy in this country

Owned an apothecary,
was a scientist, an editor and
teacher

Many “chemists” from Britain came to the New World to open apothecaries

Practitioners adapted remedies from American Indians like cinchona bark (quinine for malaria) and willow bark

The Revolutionary War (1775): Supplies from Britain were difficult to get - American druggists learn to manufacture drugs and preparations.

After the war a network was developed
for the production, packaging and
distribution of drugs.

War of 1812/Civil War: America developed
its own resources to produce
pharmaceuticals and patent drugs.
Eli Lilly - 1876
Bristol Myers - 1858

243
Q

The Corner Drug Store circa 1880-1960

A

Rise of “patent medicine” in the 1800s

Independently owned stores

Most had a “soda fountain”

Pharmacist was
diagnostician,
compounder,
dispenser, soda “jerk”

244
Q

Patent Medicines

A

toothache oil made with cocaineSnake oil for all ailments “Gripe water” for baby tummy aches“Miracle Microbe Killer” Soothing Baby SyrupPink Pills for Pale People

245
Q

Patent Medicines

A

Page’s Inhalers (1892) - Smoked “for the temporary relief of the paroxysms of asthma and to aid in the relief of hay fever and simple nasal irritations.”

Directions for use of Page’s Inhalers:…smoke one or two Page’s Inhalers, INHALING THE SMOKE. Prescribed dosage four a day. How to inhale: Exhaust the lungs of air, then fill the mouth with smoke and take a deep breath, drawing the smoke down into the lungs. Hold a few seconds, then exhale, through mouth and nostrils.

246
Q

Laws regulating dispensing

A

1906 Pure Food and Drug Act (purity and labeling)
First significant consumer protection law

1938 Food and Drug & Cosmetic Act: No drug could be marketed until proven safe for use under the conditions described on the label and approved by the FDA

1951 Durham-Humphrey Amendment
Explicitly defined two categories of medications: legend (Rx) and non-legend (OTC)
Until this law, there was no requirement
that any drug be prescription only.

1962 Kefauver-Harris Amendment:
After thalidomide tragedy in Europe,
drugs had to prove safety
AND efficacy

1820 - the first Pharmacopeia of the
United States (USP) was published as
the nationally accepted guide to drugs

1852: American Pharmaceutical Association
established - first national association with
goals of promoting professional code of ethics
and legal standards for drug quality

247
Q

American Pharmacy Education

A

1821: Philadelphia College
of Pharmacy opened

1823: Massachusetts College of
Pharmacy (Boston) opened

1868: Dr. Albert Prescott abandoned apprenticeships and pioneered a curricula including basic science and laboratories.

Pharmaceutical Syllabus (1906)
–Recommended 4-year BS in pharmacy; implemented 1932

Pharmaceutical Survey (1946)
—Recommended 6 year program of study, but 5-year BS implemented in 1960

Mills Report (1975)
—Recommended 6-year doctoral degree for pharmacy
—Implemented in 2004 (MCPHS last BS class 2001)

248
Q

American Pharmacy regulation

A

Early 1800s – First boards of pharmacy established to assess an individual’s competence to prepare and dispense medications

1870’s: Many states passed laws that pharmacists must pass an examination to be registered -

Since 2004, passing the North American Pharmacist Licensure Examination (NAPLEX) has been a requirement for earning initial pharmacy licensure in all 50 United States.

249
Q

Industrialized Era (1940-1970)

A

More demand - medications were mass produced through industrial machines

1920s – 80% of Rxs were compounded
1946 – 26% of Rxs were compounded

250
Q

Industrialized Era

A

Scientific research and drug development was growing

New drugs caused more reactions and interactions with other medications

This led to the patient care era and marked the shift of pharmacy from focus on the drug to a focus on the patient

251
Q

Patient Care Era

A

New and more complex problems!
Allergic reactions
Interactions
Other drugs
Food

252
Q

Modern Pharmacy

A

Pharmacy has become more clinical in nature

In 1990 the term pharmaceutical care was coined

Today we use the term Pharmacist’s Patient Care Process

The role of pharmacists has expanded to a variety of settings

6-year Doctor of Pharmacy degree is the entry level degree for all pharmacists

Optional 1 or 2 year residencies or fellowships

253
Q

Modern Pharmacy Advances

A

ACA 2010 - Expansion of Medication Management Therapy (MTM) for pharmacists
One-on-one interactions with patients to review all medications and to identify and resolve medication-related problems.

Goal is to increase adherence to medications for better outcomes

254
Q

Modern Pharmacy

A

Collaborative agreements
Allows pharmacists to make changes to drug therapy
States differ in regards to practice sites and protocols and continuing education

Immunizations
Certification/CEs required
CPR training

Automated/Central Filling
Frees pharmacists to focus less on refills and maintenance medication filling
Goal is to provide more time for clinical activities like MTM and immunizations

255
Q

Legislation that has changed pharmacy practice

A

OBRA 90: Requires pharmacists to counsel Medicaid patients and conduct drug utilization reviews.

USP <797>, USP <795>: Regulations regarding sterile and non-sterile compounding
New England Compounding Center- Meningitis outbreak

USP<800> New proposal for compounding of hazardous drugs affects facility design, personal protective equipment, cleaning, and equipment.

256
Q

Pharmacy practice areas

A

Community: A storefront with dispensary in the back
Independent, part of a chain (CVS, Walgreen’s), or grocery store
Required to have a registered pharmacist on duty
Can have a pharmacy dealing on only specialty drugs
Many pharmacists (60%) are employed in a community setting

Hospital: Multiple duties for pharmacist
Controlled substance point person
Work in the hood preparing intravenous products
Work specialty with chemotherapy agents
May work with investigational drugs
Long-term care facility
Federal prison system

Ambulatory Care

Compounding

Specialty

Consultant

Veterinary

Nuclear

Military

Academia: Teaching in a pharmacy program
Typically requires post graduate training in
a fellowship or residency program
Areas:
Pharmaceutical sciences
Pharmacy practice / clinical sciences
Social, economic, behavioral, and administrative pharmacy
What we do
Teach students
Publish scholarly work
Service –committees (department, school, university, national, international levels)

industry: Marketing, safety, patient education, sales and administrative duties

Post-graduate fellowship programs available

federal: Armed services
Rank of officer
Great benefits but also sacrifices
Veteran’s Administrations
Public health
US Public Health Services
Federal prison system
Indian Health services

257
Q

Challenges for Pharmacy

A

Federal deficit
Medicare and Medicaid funding
ACOs

An increasing number of older adults

Cost of drugs

Economy
Quality of work environment
Shortage of technicians
Profitability pressure/metrics

Shortages of essential drugs/supply chain

Overseas manufacture of many drugs

COVID-19 pandemic

258
Q

Future of the Profession…

A

From 1990-1996, pharmacists were THE MOST trusted professions according to the Gallup Poll
2022 poll:

Three of the top four – nurses, medical doctors and pharmacists – are medical professions that enjoyed boosted ratings in 2020, likely because of their service to the public during the pandemic, but their ratings have fallen since.
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P1 Fall 2023 (66 decks)

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