IPC Objectives for exam 1 Flashcards
Define what makes pharmacy a profession
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.
Describe the purpose of pharmacy
what do pharmacists do
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.
Identify settings in which pharmacists work
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
Discuss how the pharmacy profession is shaped and controlled
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
how pharmacy is changing
Scope of Practice
Technology
Support personnel responsibilities
Collaborative Drug Therapy (CDT)
Medication Therapy Management (MTM
Describe the features of a typical drug information database.
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
List the components of a drug monograph and identify the information found within each section.
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
Interpret the elements of the Pharmacists’ Patient Care Process.
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
Explain how implementation of the Pharmacists Patient Care Process works towards provision of standardized care for patients
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.
Define interprofessional collaborative practice and interprofessional education
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.
Identify the benefits of interprofessional education
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.”
Describe patient-centered care
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
Identify ways that IPE is integrated into the MCPHS curriculum
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)
Access and use 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
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
Discuss types of information available within key drug and alternative medicine information resources
Understand how the medical literature is organized
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
Evaluate computerized tertiary drug/herb information databases
which part of the pharm. patient care process does Rx terminology fall into
implement
what are the parts of an Rx
quantity dispensed
drug name
strength or concentration
directions to patient
what are the components of Rx directions
Verb
Dose
Dosage form/formulation
Route of administration
Frequency/timing
Duration
Define pharmacy
what word does it come from
can it be a place
what does it link
an ancient profession
pharmakon = drug
- 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
Explain how legislation has changed pharmacy practice
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
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
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
Understand specific advances in modern pharmacy
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
Community pharmacy
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Non-pharmacologic treatment for diabetes
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
When to initiate therapy for hypertension
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%
blood pressure
normal
elevated
high blood pressure
high blood pressure stage 2
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
