IPC exam 1 Flashcards
What is a profession?
A calling requiring specialized knowledge and often long and intensive academic preparation.
group of people who have gone thru specialized training
What is the Profession of Pharmacy?
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
What is the value of pharmacy?
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
What do pharmacists do?
Pharmacists use their medication expertise to treat patients, collaborate with other healthcare professionals, promote population health, and manage pharmacy systems.
What do pharmacists do concerning patient care
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,
What else can pharmacists do concerning patient care
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.
What do pharmacists do concerning med. expertise and pop. health
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).
What do pharmacists do concerning med. expertise and pop. health
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).
What do pharmacists do concerning Pharmacy Management?
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.
your pharmacist =
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.
What does it take to be a good pharmacist?
Professional commitment
Trustworthy
Reliable
Detail-oriented
Good communication skills
Good problem-solving abilities
Good memory
Enjoy learning
Organized
Pharmacy Career Options
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
Factors that Shape Pharmacy
Society
Scope of practice
Organizations
Standards of Practice
Evidence-based Medicine
Technology
Factors that Control Pharmacy
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)
How is Pharmacy Changing?
Scope of Practice
Technology
Support personnel responsibilities
Collaborative Drug Therapy (CDT)
Medication Therapy Management (MTM)
What is the Joint Commission of Pharmacy Practitioners (JCPP) Vision
“Patients achieve optimal health and medication outcomes with pharmacists as essential and accountable providers within patient-centered, team-based healthcare.”
how are Pharmacists as healthcare provider
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!
The goal of a Pharmacist
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
What are 5 points of pharmacists’ patient care process?
collect
assess
plan
implement
follow-up: monitor and evaluate
what is the Patient Care Process
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
FQHC- Transitions of Care
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
Community- Dispensing
Reviewing patient’s medication profile for therapeutic duplications
Contacting providers with recommendations
Counseling patients on medications
Patient Case- MR
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
step 1 of PPCP
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.
What does the pharmacist collect for step 1 of ppcp
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
Where do you collect info from patient
The patient themselves
Pharmacy records
Patient records
Other health care professionals
what to collect from patient
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
New symptom? OPQRST
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
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
C. Interviewing the patient
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. Ensure any and all pharmacists deliver consistent, high quality, patient centered, team based care no matter the practice setting.
What is step 2 of the PPCP
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.
what is the assess process
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
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
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
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
B. Identifying medication related problems
What disease would
omeprazole, amoxicillin and clarithromycin treat
H. Pylori/ peptic ulcer/stomach ulcer disease
what is step 3 of PPCP
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
what is the plan process
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
What resources are available to create evidence based plans for PPCP
▪Available through institution
▪Available through MCPHS library
▪Available through national organizations
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
D. Recommending /prescribing alternate therapy
What is step 4 of PPCP
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
we are the experts in medication use process
what is the acronym for it (that I Michelle made up lol)
PTDAM
What does PTDAM stand for in the medication use process
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.
what does implement for PPCP consist of
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
implement addresses
What can you do?
What can the patient do?
What healthcare professional is best suited to handle this?
what do these mean
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?
what techniques do you use when working with other professionals and patients
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
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. Educating the patient on their medications
what does SBAR stand for
S- situation
B- background
A-Assessment
R- recommendation
what is step 5 of the PPCP
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.
what does follow up consists of
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.)
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. Checking patient’s labs and refill history for adherence
Repeat! Repeat! Repeat!
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
For every step of the PPCP
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.
Patient is (THE MOST)
important part of healthcare team!
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
E. All of the above
Patient Care Process
Can be used for
ANY patient, ANY time, in ANY healthcare setting.
Define interprofessional collaborative practice and interprofessional education
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.
What pharmacy accreditation requires IPE
ACPE
Why the Focus on “Collaborative Practice”?
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
What is Interprofessional Education (IPE)
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.
What 3 words are essential in IPE
about, from, with
Goal of IPE at MCPHS
“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.”
Core Competencies for Interprofessional Collaborative Practice
values/ethics for inter-professional practice
roles/responsivities
interprofessional communication
teams and teamwork
Bottom line of IPE
IPE -> IPC -> Improved patient outcomes
Our Goal of IPE
Prepare you all to be knowledgeable and effective members of highly functioning interprofessional teams
what is BP
What can cause increases in BP?
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)
What does each class do to lower BP?
- Angiotensin II Receptor Blockers (ARB)
- Angiotensin II Converting Enzyme Inhibitors (ACE-I)
- Diuretics
- Beta Blockers (BB)
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
what is the Goal BP value:
ACC/AHA <130/80 mmHg
Non-pharmacologic treatment for hypertension
-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
-pril
HTN
ACE inhibitor
PO
once daily
-sartan
HTN
ARB
PO
once daily
-olol
beta blocker
-dipine
Dihydropyridine CCB
HTN
Patients experience a dip in BP
-thiazide
thiazide diuretic
Hydro → water → diuretic
-zosin
HTN and BPH
Alpha-1 antagonist
Cozaar
losartan
AAR… ARB
Hyzaar
losartan and HCTZ
H: hctz
aar: ARB
Diovan
valsartan
van: valsartan
Diovan HCT
valsartan and HCTZ
van: valsartan
HCT: HCTZ
Zestoretic
lisinopril and HCTZ
Zest: Zestril (Lisinopril)
–retic: thiazide diuretic
Vasotec
enalapril
Vaso → vascular → HTN
Lasix
furosemide
Lasts six hours (peeing!)
diuretic
Dyazide/Maxzide
hydrochlorothiazide & triamterene
Aldactone
spironolactone
Ald: aldosterone antagonist
Memorize the exceptions
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?
Pharmacologic Categories/options
HMG-CoA Reductase Inhibitors (statins)
Only 1st line medication recommended by lipid guidelines
Ezetimibe (Zetia)
Fibric Acid Antilipemic agents
what are the major lipids in the body
how are they transported
Cholesterol (TC), triglycerides (TG), and phospholipids
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
what should you use when
Total cholesterol is 160-189 (high) or >190 (very high)
use station for patient
Non-pharmacologic treatment for high TC
Weight loss
Diet modifications
–Decreased saturated and total fat
–Increase fiber
Increase physical activity
Decrease alcohol intake
What consists of CVD
MI- myocardial infarction (heart attack)
Angina
Coronary artery stenosis
what consists of Cerebrovascular disease
TIA- Transient ischemic attack; mini stroke
Stroke
Carotid artery stenosis
When to initiate therapy with statins
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%
vastatin
Dyslipidemia
Statin / Hmg-coA reductase inhibitor
PO
Once daily
-fibrate
Dyslipidemia
fibric acid antilipemic
PO
Medical Terminology
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.
Medical Terminology-construction of a word
prefix
root
suffix
Root:
Word stem or root elements
Can stand alone as words on their own
Examples of common medical roots
Card(i, io):
Cyst (o):
Derm(a, o):
Gastr(I, o):
Hem(o, ato):
Myo:
Osteo:
Neuro:
Nephro:
Pneumo:
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
Prefix
Found at the beginning of a word
Cannot stand alone
Descriptive, expand the meaning of the word
Ante-:
Anti-:
Co-:
Ex-:
Hyper-:
Hypo-:
Inter-:
Intra-:
Mid-:
Macro-:
Micro-:
Multi-:
Non-:
Post-: after
Sub-: under
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
Suffix
Found at the end of a word
Cannot stand alone
Change the words meaning or part of speech
-algia:
-emia:
-ism:
-itis:
-lysis:
-megaly:
-oma:
-osis:
-pathy:
-spasm:
-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
Prescription
An order for medication issued by a physician, dentist or other properly licensed medical practitioner
Prescription Processing
Order recognition
Order interpretation
Order analysis
is the order appropriate?
-appropriate for patient?
Patient Care Process
C
A
P
I
F
Collect
Assess
Plan
Implement
Follow up
Medication Use Process
P
T
D
A
M
Prescribe
Transcribe
Dispense
Administer
Monitor
Prescription
Broad Categories:
Single component /product
> one ingredient that requires compounding
Sig code
Components of Rx directions:
Verb
Dose
Dosage form/formulation
Route of administration
Frequency/timing
Duration
Verb
Verb and route of administration chart
Dose
one tablet
5 ml
two puffs
Dosage form/formulation
Tablet, capsule, cream, ointment, etc
Take one tablet by mouth three times daily
Dosage form =
Inhale two puffs by mouth twice daily
Dosage form =
Common dosage form abbreviations
tab =
cap =
syr =
gtt =
ung =
susp =
supp =
tab = tablet
cap = capsule
syr = syrup
gtt = drop
ung = ointment
susp = suspension
supp = suppository
Route of administration (ROA)
By mouth, into ear, rectally
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=
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
Frequency/timing
Take one tablet by mouth daily
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 =
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
Common timing abbreviations
a.c. = ante cibos =
i.c. = inter cibos =
p.c. = post cibos =
w.a. =
a.c. = ante cibos = before meals*
i.c. = inter cibos = between meals*
p.c. = post cibos = after meals*
w.a. = while awake
Duration
For 10 days, for one week, for 30 days, etc
what is the verb for lopressor tablet
take
what is the verb for Nitroglycerin Sublingual Tablets1 SL q5min#100
dissolve
what is the verb for Albuterol Inhaler1 Puff Q4H PRN#1 inhaler
inhale
cream
cream for vaginal
apply
insert
Tablet: 1 Q8H 10 Days
take 1 tablet by mouth every 8 hours for 10 days
Oral Solution: 5 ml QID WA
take 5mL by mouth four times daily while awake
Nasal Spray: 2 EN QD
use 2…
components of a prescription
name of patient
date
Address of patient (?)
name of pharmacy
Rx
refills
MD signature
DEA of MD
sig code break down
example: take one tablet by mouth daily
what is the verb, dose, dosage form, route of admin., frequency, duration
verb: take
dose: 1
dosage form: tablet
route of admin.: by mouth
frequency: daily
no duration specified by MD
capsules or tablets
verb
dose, dosage form/units
ROA
verb: take
dose, dosage form/units: # tablets or # of capsules
ROA: by mouth
chewable tablets
verb
dose, dosage form/units
ROA
verb: chew
dose, dosage form/units: # of chewable tablets
ROA: by mouth
sublingual tablets
verb
dose, dosage form/units
ROA
verb: dissolve
dose, dosage form/units: dissolve or place
ROA: under the tongue
suspension, syrups or solutions
verb
dose, dosage form/units
ROA
verb: take
dose, dosage form/units: # of milliliters (if spoonfuls are indicated on Rx must convert to mls)
ROA: by mouth
mouth washes
verb
dose, dosage form/units
ROA
verb: as indicated on Rx
dose, dosage form/units: as indicated on Rx
ROA: by mouth
metered does inhaler (MDI)
verb
dose, dosage form/units
ROA
verb: inhale or take
dose, dosage form/units: # of puffs
ROA: by mouth
dry powder inhaler (DPI)
verb
dose, dosage form/units
ROA
verb: inhale or take
dose, dosage form/units: $ of inhalations
ROA: by mouth
(DPI): Capsule-based ex: Handihaler or neohaler
verb
dose, dosage form/units
ROA
verb: inhale
dose, dosage form/units: contents of the # of capsule(s)
ROA: by mouth
creams, gels or ointments
verb
dose, dosage form/units
ROA
verb: apply
dose, dosage form/units: as specified on Rx
ROA: topically (area specified on Rx)
lotions or solutions
verb
dose, dosage form/units
ROA
verb: apply
dose, dosage form/units: as specified on Rx
ROA: topically (area specified on Rx)
patches
verb
dose, dosage form/units
ROA
verb: apply
dose, dosage form/units: # of patches
ROA: topically (area specified on Rx)
shampoos
verb
dose, dosage form/units
ROA
verb: shampoo or use
dose, dosage form/units: as specified on Rx.
ROA: area specified on Rx
nasal sprays
verb
dose, dosage form/units
ROA
verb: use or administer
dose, dosage form/units: # of sprays
ROA: in ____ nostril ( fill in blank as indicated on Rx)
eye and ear drops (solutions or suspensions)
verb
dose, dosage form/units
ROA
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)
gels or ointments
verb
dose, dosage form/units
ROA
verb: gels: place, put ointments: apply
dose, dosage form/units: as directed on Rx
ROA: as indicated on Rx
vaginal products
verb
dose, dosage form/units
ROA
verb: insert
dose, dosage form/units: # of suppositories or # of ovules or # of applicatorfuls or as indicated by prescriber
ROA: vaginally
rectal products
verb
dose, dosage form/units
ROA
verb: insert
dose, dosage form/units: # of suppositories or # of applicatorfuls
ROA: rectally
insulin
verb
dose, dosage form/units
ROA
verb: inject
dose, dosage form/units: # of suppositories or # of applicatorfuls
ROA: rectally
insulin syringes
verb
dose, dosage form/units
ROA
verb: use
dose, dosage form/units: as directed (unless otherwise specified on prescription–do not include dose)
ROA: under the skin or subcutaneously
Why are calculations important?
‘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
Solving calculation problems
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
Rounding and Decimals
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
Types of Calculations
Dose
Total Daily Dose (TDD)
Quantity (Qty) to Dispense
Day Supply (DS)
Definitions: Dose vs TDD
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
Quantity vs Day Supply
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)
Oral Liquid Dosing Devices
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
SubQ Injectable: Insulin
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
have you mastered the calculations, concepts & TERMS?
Yes and God is gooddddd
No but GOD IS STILL GOOD!
Insulins – High Alert Medications
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
1 milliliter (mL) is how many drops
20 drops
1 teaspoon (tsp) is how many mL
5 mL
1 tablespoon is how many mL or teaspoons
15 mL or 3 teaspoons
1 fluid ounce (fl oz) in mL
29.57 mL
1 pint is how many mLs
473 mL
1 quart in mL
946mL
1 gallon is how many mL
3785mL
1 fluid ounce (fl oz) is how many mL
30 mL
1 pint (pt) or 16 fl oz
is how many mL
480 mL
1 gram (g) is how many grains
15.4 grains
1 grain (gr) is how many mg
64.8 mg (approx. 65 mg)
1 kilogram (kg) in lbs
2.2 lbs
1 pound (lb) IN GRAMS
454 grams
1 ounce (oz) is how many grams
28.4 grams (approx. 30 grams)
1 inch (in)
2.54 cm
1 foot (ft)
12 inches
Non-pharmacologic treatment
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
What are Lipids?
3 major classes of lipoproteins:
Dyslipidemia
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
what are the sources of cholesterol?
artery
food
plaque
liver
Diagnosis, goals of therapy
classification of total, LDL, & HDL cholesterol and TG
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
Treatment Goals for TC
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
When to initiate therapy
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%
Brand names
Crestor, Lipitor, Mevacor, Zocor, Pravachol
Tor/cor: choles”TOR”ol
Chol: cholesterol
Tricor
fenofibrate
Tri: triglycerides
Cor: choles”TOR”ol
Zetia
ezetimib
Non-pharmacologic treatment
Weight loss
Diet modifications
Decreased saturated and total fat
Increase fiber
Increase physical activity
Decrease alcohol intake
Anticoagulants
Coumadin
warfarin
Warfare → bleeding → anticoagulant
Plavix
clopidogrel
Nix the platelets → antiplatelet
Xarelto
Rivaroxaban
Xaban
Factor Xa Inhibitor
Miscellaneous CV medications
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)
Thyroid products
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
Pharmacologic Categories
Biguanides
DPP-4 inhibitors
SGLT2 inhibitors
Thiazolidinediones
Sulfonylureas
Glucagon-Like Peptide-1 (GLP-1) Agonists
Insulin
Long-acting
Rapid-acting
diagnosis for pre-diabetes and diabetes
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
Goals of therapy
Prevention of morbidity, mortality
Microvascular
Neuropathy
Nephropathy
Retinopathy
Macrovascular
Cerebrovascular disease
CV disease
Peripheral artery disease
Non-pharmacologic Treatment for diabetes
Nutrition
Weight loss
Physical activity
Bariatric surgery
Education
Brand names – oral agents
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…
Brand names – oral agents diabetes
Actos
Pioglitazone
TZD (thiazolidinedione)
Sulfonylureas
glimepiride
Amaryl
glipizide
Glucotrol, Glucotrol XL
Glucose control
glyburide
Glynase, Diabeta
GLP-1 agonists
Victoza
liraglutide
Lower glucose
Trulicity
dulaglutide
insulin rapid
what is the
insulin
product
onset
peak and duration of
humalog
novolog
levemir
lantus, basaglar, toujeo
tresiba
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
Basal insulins: long acting
Prandial / Meal time insulins: rapid acting
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
Heartburn, GERD, PUD – PPIs
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
Other GI products
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
Anti-virals
Anti-fungals
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
BP
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)
blood pressure categories
normal
elevated
high - HTN
high - HTN 2
High - HTN crisis
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 +
why use library databases
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)
Library Resources and Services
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
MCPHS Library Resources
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
MCPHS Library Resources
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
WorldCat
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.
Interlibrary Loan (ILL)*
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
Primary, Secondary and Tertiary Sources
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)
Online Curricular Resources*
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.
Importance of Reference Citations to the Quality of Tertiary Resources
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
What if I can’t find an answer to my question?
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
Challenges for Today’s Pharmacists (Walters Kluwer, 2022)
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
Computerized Tertiary Drug Information Resources
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
Computerized Tertiary Drug Information Resources
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.
Different tertiary resources may provide conflicting information
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
Types of Drug Information Questions
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
Types of Drug Information Questions
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
Types of Drug Information Questions
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
Types of Drug Information Questions
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
Lexi-Comp Online: Most Convenient to search medications quickly and easily
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).
Clinical Pharmacology: Comprehensive and practical drug information resource
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.
Micromedex: Most Comprehensive, E-Drug Information Resource
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
Micromedex
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.
Natural Medicines Database
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
Natural Medicines Database
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
Alternative Medicine Journal Databases
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.
Evaluating Tertiary Drug Info Databases
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
Computerized versus Mobile Databases
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
Important Points
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
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:
where do you find controlled substance in lexicomp
under preparations
Why Study History?
“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!
What is the definition of pharmacy?
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.
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.
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
Eras of pharmacy history
Ancient era to 1600 AD
Empiric era: 1600-1940
Industrialized era: 1940-1970
Patient Care era: 1970- present
Biotechnology and pharmacogenomics
Ancient Mesopotamia
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
Ancient China
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
A Smallpox Vaccine
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.
Ancient Egypt
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
Ancient Egypt
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
Modern History of Aspirin
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”
Ancient India
More than 2000 drugs are recorded in the Charaka Samhita - Compendium of Wandering Physicians
Written in Sanskrit - an ancient Indian language
Ancient Greece
“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.
The Middle Ages (400-900 AD)
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
First Pharmacopoeia
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
Empiric Age (1600-1940)
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
American Pharmacy
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
The Corner Drug Store circa 1880-1960
Rise of “patent medicine” in the 1800s
Independently owned stores
Most had a “soda fountain”
Pharmacist was
diagnostician,
compounder,
dispenser, soda “jerk”
Patent Medicines
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
Patent Medicines
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.
Laws regulating dispensing
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
American Pharmacy Education
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)
American Pharmacy regulation
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.
Industrialized Era (1940-1970)
More demand - medications were mass produced through industrial machines
1920s – 80% of Rxs were compounded
1946 – 26% of Rxs were compounded
Industrialized Era
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
Patient Care Era
New and more complex problems!
Allergic reactions
Interactions
Other drugs
Food
Modern Pharmacy
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
Modern Pharmacy Advances
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
Modern Pharmacy
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
Legislation that has changed pharmacy practice
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.
Pharmacy practice areas
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
Challenges for Pharmacy
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
Future of the Profession…
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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