IPC Final Review (+ medicine) Flashcards
Exelon
Rivastigmine
Pysch
Alz
Cymbalta
Duloxetine
Psych
Depression
Zoloft
Sertraline
Psych
Depression
Risperdal
Risperdone
Psych
Bipolar, schizo
Seroquel
Quetiapine
Psych
Bipolar, schizo
Zyprexa
Olanzapine
Psych
Bipolar, schizo
Ambien
Zolpidem
Psych
Insomnia
Side effects of Ambien
Clumsiness Confusion Daytime drowsiness Unusual behavior while sleeping Headache Dizziness
Counseling points of Ambien
Potentially inappropriate for elderly population (beers criteria)
Antipsychotic counseling points
Risperal, seroquel, Zyprexa
With Alz increases mortality, so rule out causes of symptoms before initiating treatment
Side effects of antipsychotics
Risperal, seroquel, Zyprexa
Sedation Shuffling gait Somnolence Insomnia Headache Anxiety Dizziness Weight gain Constipation Nausea Tremor Aka thesis Increased cholesterol
Acetylcholinesterase inhibitors counseling points
Aricept, Exelon
Slows cognitive decline and lengthens ADL ability time
Exelon can be a patch which must be placed on the back
Side effects of Acetylcholinesterase inhibitors
Aricept, Exelon
Nausea
Vomiting
Diarrhea
Anorexia
Lanoxin
Digoxin
Heart failure, atrial fibrillation
Lopressor/toprol XL
Metoprolol tartrate/succinate
Angina, hypertension, myocardial infarction
Coreg
Carvedilol
Hypertension, heart failure
Norvasc
Amlodipine
Coronary artery disease, hypertension, angina
Lasix
Furosemide
Edema
Side effects of Lasix
Hypokalemia Hupomagnesemia Loss of electrolytes Ototoxicity Renal dysfunction with overdiuresis Confusion
Counseling points of Lasix
Take in morning and monitor electrolytes and renal function
Prinivil
Zestril
Lisinopril
Acute myocardial infarction, heart failure, hypertension
Side effects of prinivil/Zestril
Hypotension Headache Dizziness Cough (dry, persistent) Hyperkalemia
Aspirin
Aspirin
Stroke and myocardial infarction prevention
Lipitor
Atorvastatin
Dyslipidemia, prevent CVD
Glucophage
Metformin
Endocrine
Type 2 diabetes
Synthroid
Levothyroxine
Endocrine
Hypothyroidism
Proair HFA/Proventil HFA/Ventolin HFA
Albuterol
Lungs
Bronchospasm, asthma
Advair diskus
Fluticasone and salmeterol
Asthma, COPD
Aricept
Donepezil
Psych
Alz
Norco
Hydrocodone and acetaminophen
Pain
Advil/Motrin
ibuprofen
pain, fever
Side effects of advil/motrin
edema dizziness epigastric pain heartburn nausea
Counseling points of Advil/Motrin
may cause peptic ulcers and/or bleeding without symptoms
CNS adverse effects seen in overdose or high dose
Flomax
tamsulosin
benign prostatic hyperplasia
urinary
Fosamax
alendronate
osteoporosis
bone
Side effects of Fosamax
hypokalemia
hypophosphatemia
atypical femur fractures
osteonecrosis of the jaw
Counseling points of Fosamax
take first thing in the morning with a full glass of water, don’t eat or drink anything and remain upright for 30 minutes after
K -Dur/Micro-K
potassium chloride
hypokalemia
supplement
Nexium
esomeprazole
GERD, Heartburn
digestive
Side effects of Nexium
diarrhea nausea headache prolonged use may increase risk of hypomagnesemia fractures pneumonia CDiff infections
Counseling points of Nexium
best to take first thing in the morning
capsules may be opened and contents sprinkles if swallowed immediately
granules should not be chewed or crushed
Miralax
PEG 3350
constipation
digestive
Case Presentation
Brief synopsis
initials
race
age
sex
Case Presentation
Social History
marital status number of children education previous occupation dietary habits tobacco/alcohol use social support hobbies
Case Presentation
Family history
age and health of parents, sibling, children
ages and causes of death
Case Presentation
Allergies
allergies and rxn to medications, food, pets, environment
Case Presentation
Past medical history
serious illnesses
chronic diseases
surgical procedures
injuries
Case Presentation
Medications
medications and supplements (dose, frequency, indication)
Case Presentation
Other treatments
physical therapy
occupational therapy
Adherence defined.
the active voluntary and collaborative involvement of the patient in a mutually acceptable course of behavior to produce a therapeutic result
Compliance defined.
passively following the provider’s orders, and the treatment plan is not based on a therapeutic alliance or contract established between the patient and the physician
Consequences of non-adherence include…
increased ER visits and hospitalization rates
Healthcare Factors associated with non-adherence include…
Health-care System:
access to care, continuity of care, patient education material is not written in plain language
Health-care Team:
stress of health-care visits, discomfort in asking providers questions, patient’s belief or understanding, patient’s forgetfulness/carelessness, stressful life events, lack of immediate benefit of therapy
Provider Factors associated with non-adherence include…
communication skills, knowledge of health literacy issues, lack of empathy, lack of positive reinforcement, number of comorbid conditions, number of medications needed per day, prescribed length of therapy
Patient, Condition, and Therapy factors associated with non-adherence include…
Patient-related:
physical, psychological
Condition-and Therapy-related:
complexity of medication, frequent changes in regimen, treatment requiring mastery of certain techniques, unpleasant side effects, duration of therapy, lack of immediate benefit of therapy, medications with social stigma
Economic and Social Factors associated with non-adherence include…
Economic:
health insurance/medication cost
Social:
limited English proficiency, inability to access or difficulty accessing pharmacy, lack of family/social support, unstable living conditions
To what does the acronym SIMPLE relate?
S - simplify the regimen I - impart knowledge M - modify patient beliefs and behavior P - provide communication and trust L - leave the bias E - evaluate adherence
Types of MTM services
Comprehensive medication reviews, pharmacotherapy consults, targeted interventions, anticoagulation management, immunizations, health and wellness programs, etc.
Why is MTM needed?
Medication-related problems account for preventable adverse effects each year
Multiple players in the healthcare system
Patients see more than one physician
Patients fill prescriptions at more than one pharmacy
Complex medication regimens
MTM is the one opportunity to bring together all of the patient’s medications into one document in order to assess the effectiveness and safety of their regimen
Associate types of information needed to give effective MTM.
Age and sex: dosage adjustments
Height and weight: BMI, lifestyle/diet issues
Lab values: effectiveness of current therapy or need to initiate therapy
Nicotine, alcohol, and caffeine use/lifestyle issues: drug or disease interactions, effects on meds/overall health
Drug allergies/adverse rxn: avoid reactions
Medical conditions: what conditions the patient thinks they have
All RX/OTC/herbal medications and side effects: determine polypharmacy, drug interactions, possible causes of noncompliance
Prior therapies: history of what has been tried and its successes
Patient goals: determine what is important to the patient
Immunizations: prevent disease
Identify challenges of MTM.
disruption of workflow
how to obtain payment
physician perception of pharmacist effectiveness
Define drug abuse.
much like dangerous drinking; able to stop
Define chemical dependence.
much like compulsive drinking; a brain disease; not able to stop
Define compulsive drinking.
a brain disease (formerly “alcohol dependence”); not able to stop
Define dangerous drinking.
binge drinking, risky drinking, (formerly “alcohol abuse”); able to stop
A pharmacist is…
medication experts (provide medications, tech patients and other health care team members about optimal use of medications, monitor patient health and response to meds, etc.)
A nurse provides…
direct patient care
A doctor…
diagnoses and prescribes
A pharmacy technician…
fills medication orders, enters orders, insurance
A hospice worker…
usually a social worker who takes care of a patient’s hospice plan, ensures that all of the proper paperwork is filed and that they are getting the proper services
A surgical technician…
verifies that pre-op instructions were followed
Nutritionist/dietician…
develops a meal plan to meet adjusted nutritional requirements
Phlebotomist…
draws blood from patients for testing, donations, etc
Nurse practitioner…
directly works with patients, diagnoses, and manages illnesses, authorized to perform physical examinations/order and interpret tests/provide counseling/write prescriptions
A physician assistant…
assists the physician, some have prescribing authority
A psychologist…
provides professional evaluations on mental health, after Dx can recommend a doctor to Rx from evaluation
A nurse assistant…
helps with patient hygiene and administers meals
A volunteer…
provides services without monetary payment (filing, answering, phone, assisting patients, etc.)
A radiology technician…
if required a Rx with nuclear isotopes, the technician will come by the pharmacy to dropoff scans in order to make a Rx for the current line of therapy
A caregiver…
is a person who helps care for the patient, ensures that they are getting the proper medication, are fed and cleaned
Define primary hypertension and associated risk factors.
90-95% of cases
caused by age, race/genetics, diet, smoking, alcohol intake
Define secondary hypertension and associated risk factors.
5-10% of cases
caused by diseases, medications, “white coat hypertension”
What are the consequences of untreated hypertension?
cardiovascular disease (heart failure, MI, etc), stroke, renal disease
What are some medications used to treat hypertension?
Lisinopril Furosemide Amlodipine Metaprolol Carvedilol
Suggest lifestyle changes to control hypertension.
weight control
reduced dietary sodium
reduce excessive alcohol intake
increase physical activity
What are the function of lipid components?
Triglycerides are for energy and storage
LDL transports triglycerides and cholesterol in the blood to tissues
HDL is good cholesterol that transport cholesterol from arteries to liver for processing/elimination
Discuss diet influence on lipid levels.
Diets high in fat increase cholesterol and cardiovascular disease, but there is no consistent relationship with egg consumption and cardiovascular disease.
What class of medication is commonly used to treat hyperlipidemia?
statins
ie atorvastatin
How do statins work?
reduce liver production of cholesterol by inhibiting HMG-CoA, compensatory increase in LDL receptors in the liver so that the LDL digested in the liver is from the blood stream.
What are the adverse effects associated with statins?
muscle pain
diabetes
altered CNS
List the resident rights of medication administration.
- be treated with respect
- refuse medication or treatments
- be given privacy during med pass
- be free from physical and chemical restraints
What is done if controlled medications are missing?
- follow facility policy
- review reports related to medication and patient’s clinical record
- medication diverted then contact TSBP, DEA, DPS and notify the facility administrators and state board of nursing
Match procedure with right from “rights of medication administration”
Right patient:
check name, use 2 identifiers, ask patient to identify himself/herself, when available use technology
Match procedure with right from “rights of medication administration”
Right medication:
check the medication label, check the order
Match procedure with right from “rights of medication administration”
Right dose:
check the order, confirm appropriateness of the dose using a current drug reference, calculate dose if necessary
Match procedure with right from “rights of medication administration”
Right route:
check order and appropriateness, confirm that the patient can take/receive medication by the ordered route
Match procedure with right from “rights of medication administration”
Right time:
check the frequency of the ordered medication, confirm when last dose was given, double-check you are giving dose at the right time
Match procedure with right from “rights of medication administration”
Right documentation:
document administration after giving the ordered medication, chart route and any other specific information before giving drug
Match procedure with right from “rights of medication administration”
Right reason:
confirm rationale, revisit the reasons for long-term medication use
Match procedure with right from “rights of medication administration”
Right response:
make sure the drug led to the desired effect
