IPC Objectives for exam 1

Question 1

Define what makes pharmacy a profession

Answer 1

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.

Question 2

Describe the purpose of pharmacy

what do pharmacists do

Answer 2

Oversee the medication use process

Ensure medication safety

Optimize medication usage

Utilize efficient processes

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

Question 3

Identify settings in which pharmacists work

Answer 3

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

Question 4

Discuss how the pharmacy profession is shaped and controlled

Answer 4

shaped:
Society

Scope of practice

Organizations

Standards of Practice

Evidence-based Medicine

Technology

control:
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

Question 5

how pharmacy is changing

Answer 5

Scope of Practice

Technology

Support personnel responsibilities

Collaborative Drug Therapy (CDT)

Medication Therapy Management (MTM

Question 6

Describe the features of a typical drug information database.

Answer 6

Reputable pharmacy database

Searchable drug monographs

Prescription drugs

Accurate information

Top 200 Rx medications

adult drug info

pediatric and neonatal drug info

geriatric drug info

natural products

international drug info

natural products

pharmacogenomics

infectious diseases

lab and diagnostic procedures

Primary indication

pharm. cate.

brand

generic

ROA

Dosing frequency

controlled substance

Question 7

List the components of a drug monograph and identify the information found within each section.

Answer 7

pronunciation

brand names

pharm category

dosages

uses

clinical practice guideline

admin. and storage issues

patient counseling points

Medi. safety issues

med. guide and or vaccine info. statement

warnings & precautions

reproduction and lactation

adverse drug rxns

interactions

patient & therapy management

preparations

pharm & pharmacokinetics

dental info

pearls & related nfo

index terms

FDA approval date

references

brand names: international

trissel’s IV compatibility

interactions

drug I.D

patient ed

calculations

more clinical tools

Question 8

Interpret the elements of the Pharmacists’ Patient Care Process.

Answer 8

Collect - info from patient, chart, provider, collect subjective and objective info.

assess - assess info collected and analyze the clinical effects of patient’s therapy to identity and prioritize problem

plan - plan with other providers to come up with plan that will address medication related problem. engages patient through education, empowerment and self management

implement - execute plan, help patient navigate med. use

follow up: monitor and evaluate effectiveness of care plan and modifies plan if need be with other providers

Question 9

Explain how implementation of the Pharmacists Patient Care Process works towards provision of standardized care for patients

Answer 9

makes sure all pharmacist operate the same way by following these steps

by doing so:

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. This process includes establishing a care plan that: Addresses medication-related problems and optimizes medication therapy.

Question 10

Define interprofessional collaborative practice and interprofessional education

Answer 10

interprofessional collaborative practice: “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.”

interprofessional education: 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.

Question 11

Identify the benefits of interprofessional education

Answer 11

improve patient outcomes by making the healthcare team well versed in what the other person does

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.

“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.”

Question 12

Describe patient-centered care

Answer 12

A partnership among practitioners, patients, and their families ensures that decisions respect patients wants, needs and preferences and that patients have the education, support they need to make decisions and participate in their own care

patient and family’s needs are at the center of healthcare

Question 13

Identify ways that IPE is integrated into the MCPHS curriculum

Answer 13

Overall IPE occurs longitudinally throughout the didactic and experiential curriculum, contain the criteria for an IPE activity plus, has minimal curricular redundancy, and collectively addresses activities that address all 4 competencies.

IPE may also occur asco-curricular activities to complement what students learned and/or participated in during their didactic curriculum.

IPE must be integrated within the curriculum throughout the first two years (didactic curriculum)
Experiential curriculum including introductory and advanced experiences (IPPEs and APPEs) must also include IPE
Hands-on collaboration with other health care professionals
IPPE: beginning of second year
APPE: entire third year

Activities developed collaboratively among members of the IPE Working Group for Worcester/Manchester
IPE activities:
Roles & Responsibilities (P1 Fall, IPC-1)
Spirit Book Club (P1 Spring, SPPD 1B)
IPE Day (P2 Summer, SPPD 3)

Question 14

Access and use library resources and services

Answer 14

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

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

Question 15

MCPHS Library Resources

Answer 15

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

Question 16

Discuss types of information available within key drug and alternative medicine information resources

Question 17

Understand how the medical literature is organized

Answer 17

primary source: a first-hand or contemporary account of an event or topic

secondary: one that was created later by someone who did not experience firsthand or participate in the events in that the author is writing about

tertiary: sources that index, abstract, organize, compile, or digest other sources. Some reference materials and textbooks are considered tertiary sources when their chief purpose is to list, summarize or simply repackage ideas or other information

Question 18

Evaluate computerized tertiary drug/herb information databases

Question 19

which part of the pharm. patient care process does Rx terminology fall into

Answer 19

implement

Question 20

what are the parts of an Rx

Answer 20

quantity dispensed

drug name

strength or concentration

directions to patient

Question 21

what are the components of Rx directions

Answer 21

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

Question 22

Define pharmacy

what word does it come from

can it be a place

what does it link

Answer 22

an ancient profession

pharmakon = drug

1. the art and science of preparing and dispensing drugs and medicines.

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– how drugs affect the body

Question 23

Explain how legislation has changed pharmacy practice

Answer 23

1906 Pure Food and Drug Act (purity and labeling)

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 both were pharmacists- 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 the thalidomide tragedy in Europe,
drugs had to prove safety
AND efficacy

Frances Kelsey: The primary reason why it
Was not dispensed because she believed
There was not enough data

Question 24

Describe various types of pharmacy practice areas and the role of the pharmacist in each

community pharmacy

hospital

consultant

vet

nuclear

military

academia

fed. pharmacy

armed services

Answer 24

Community
A storefront with a dispensary in the back
Independent, part of a chain (CVS, Walgreens), or grocery store
Required to have a registered pharmacist on duty
Can have a pharmacy dealing 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

federal pharmacy
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

Pharmaceutical IndustryPharmaceutical Industry
—Marketing, safety, patient education, sales, and administrative duties, investigational trials
—-Post-graduate fellowship programs available

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)

Challenges for Pharmacy
Federal deficit
Medicare and Medicaid funding
ACOs- helps patient gets comprehensive care and control costs
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

Question 25

Understand specific advances in modern pharmacy

Answer 25

ACA 2010 - Expansion of Medication Management Therapy (MTM) for pharmacists

Goal is to increase adherence to medications for better outcomes

Collaborative agreements

Immunizations (we give more now than ever)

Certification/CEs required
CPR training

Question 26

Community pharmacy

Answer 26

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

Question 27

Ancient era to 1600 AD

Mesopotamia

China
- who was the patron god
- what did he do
- what was first established here
- what did Jenner do

Egypt
- what were the two classes of workers
- where was salicin found, what is it used for today
- what Hippocrates do
- what did Edward Stone do
- what was the first ethical drug

India
- what did the Charaka Samhita have and what language was it written n

Greece
- what was the first therapeutic agent
- why did they sell clay as medication
- who was the father of botany
- what is the Materia Medica

middle ages
- what was the first apothecary in Baghdad
- what did Muslims bring with them

first pharmacopeia
- where was the idea from
- what was it for apothecaries

Answer 27

Mesopotamia:
priest, pharmacist, and physician all in one, clay tablets found with symptoms of illness, Rx info

• China:
  ———-Shennong tested 100s of herbs on himself, the first use of marijuana, he was the patron god of native Chinese drugs
  ———First vax. take smallpox from a sick person and put it into a healthy person: this became the smallpox vaccine (by Edward Jenner)
  ———-Jenner took his milkmaids who had cowpox and found that they did not catch smallpox so it showed that inoculated vaccines protected against the virus
• Egypt:
  ———-had two classes of workers: Echelons (pharm. techs) and chiefs of fabrication (pharmacist). Had papyrus Ebers that had dosage forms and complex formulas. The close relationship between supernatural and empirical healing
  ———Found willow bark to have salicin which turned into salicylic acid which is aspirin
  ———Hippocrates used willow bark for pain relief
  ———Edward Stone rediscovered aspirin and wrote about its use for malarial fevers
  ——–acetylsalicylic acid (ASA- which Is aspirin developed by Felix Hoffman at Bayer. Then became an ethical drug
• India:
  ———-2000 drugs in Charaka Samhita written in Sanskrit
• Greece
  ———-Terra sigillata was the first therapeutic agent to bear a trademark symbol
  ———-Sell clay as a medication because like antacid, milk of magnesia has a clay component to it
  ———-Theopharastus “father of botany,” wrote about medicinal herbs
  ———–Materia Medica Greece played a large role in the study of medicinal plants
• middle ages
  ———–first apothecary in Baghdad
  ———–Muslims brought pharmacy with them and now is turned into independent pharmacy
• first pharmacopoeia
  ———–idea from Florence, Italy
  ———–legal standard for apothecaries

Question 28

empirical era
- what were pharmacopeias used for
- what was controlled by the government
- what did practitioners question
- what did this create interest in
- what happened after the war, what two companies were a result of it
- what is a corner drugstore
- what is snake oil
- what is Radam’s microbe
- what is Gripe water
- what is Page’s inhalers
- what does USP establish
- what college of pharmacy came first

Answer 28

Empirical era: 1600-1940
————Pharmacopeias were used to protect public health
————Roots, bark, herbs, and 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
————William Proctor, spent most of his life advancing the profession of pharmacy in this country
————After the war a network was developed
for the production, packaging and
distribution of drugs.
———–Civil War- America developed
its own resources to produce
pharmaceuticals and patent drugs:
Eli Lilly – 1876, insulin (like Humalog)
Bristol Myers Squibb - 1858
———-The Corner Drug Store: Independently owned stores, Most had a “soda fountain. Pharmacist was diagnostician, compounder, dispenser, soda “jerk”
———-snake oil: no real medicinal value and thought to be a cure all for all diseases, today: any product that is not worth much but claims to be the answer to be everything, promise amazing things but really does not do anything
———-Radam’s microbe killer: for tuberculosis, no cure. All diseases have a single original so you can cure with all, this is basically snake oil: sulfur, soda, wine and pink dye and water
———–Gripe water: helps infants when they have gas, has 3.6% alcohol (bud light is 4%) does have diloil for gas
———–Page’s inhalers: Smoked “for the temporary relief of the paroxysms of asthma and to aid in the relief of hay fever and simple nasal irritations.” was like smoking tobacco
———–USP: the standard of quality
———–education: Philly college of pharm then MCPHS boston

Question 29

industrialized era
- what was developed
- what did what was developed cause

patient care era
- what the pharmacy become more of
- what do we use to ensure the best care for the patient
- what is ACA MTM and what is the goal
- what is collaborative agreement and does it do
- what pharmacists do more of now
- what is automated/central filling

Answer 29

Industrialized era: 1940-1970
————new drug development
————New drugs caused more reactions and interactions with other medications

Patient Care era: 1970- present
————Pharmacy has become more clinical in nature
————Today we use the term Pharmacist’s Patient Care Process, steps to best take care of the patient
————ACA MTM- 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
————Collaborative agreements- Allows pharmacists to make changes to drug therapy
————Immunizations
————Automated/Central Filling Frees pharmacists to focus less on refills and maintenance medication filling automatically. Goal is to provide more time for clinical activities like MTM and immunizations

Question 30

insulin rapid
what is the insulin product
onset
peak and duration of

Humalog
novolog
levemir
lantus, basaglar, toujeo
tresiba

Answer 30

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

Question 31

diagnosis for pre-diabetes and diabetes for

random glucose
prediabetes:
diabetes:

fasting plasma
prediabetes:
diabetes:

2-hour plasma glucose
prediabetes:
diabetes:

HbA1C
prediabetes:
diabetes:
goal
pre-prandial
post-prandial

Answer 31

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

Question 32

Diagnosis, goals of therapy

total
- what is desirable
- borderline high
- high

LDL
- optimal
- near or above optimal
- borderline high
- high
- very high

HDL
- low
- high

TG
- normal
- borderline high
- high
- very high

Answer 32

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

Question 33

What are the major Lipids in the body?

how are lipids transported?

3 major classes of lipoproteins:

DyslipidemiaWhat are Lipids?

3 major classes of lipoproteins:

what is Dyslipidemia in context of TC, LDL, TG and HDL

Answer 33

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

Question 34

Non-pharmacologic treatment for diabetes

Answer 34

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

Question 35

When to initiate therapy for hypertension

Answer 35

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%

Question 36

blood pressure

normal

elevated

high blood pressure

high blood pressure stage 2

Answer 36

normal
- systolic: <120
- diastolic: <80

elevated
- systolic: 120-129
- diastolic: <80

high blood pressure
- systolic: 130-139
- diastolic: 80-89

high blood pressure stage 2
- systolic: >140
- diastolic: >90