Lecture 2 - Pharmacotherapy Flashcards
What does PCCP stand for?
Patient centered care process
Explain what PCCP (patient centered care process) is
an approach to care that consciously adopts a patient’s perspective
Respect for a patient’s values, preferences and expressed needs
What are some drug therapy problems
nonadherence
drug ineffectiveness
adverse drug events
over/under dose
drug interactions
common drug-related problems in older adults
what is a significant public health issue in the healthcare system, resulting in an annual cost of $528.4 billion
drug therapy problems
nonoptimized medication therapy
What is the MISSION of pharmacy practice
to provide pharmaceutical care
Pharmaceutical care involves….
identifying, resolving, and preventing actual and potential DTP’s (drug therapy problems)
What is the CENTRAL TENET of pharmaceutical care
the recognition that patients have drug therapy needs — and problems can occur
What is the definition of pharmacotherapy
treatment of disease through the use of medications
What is the area of pharmacy practice that ensures the safe, appropriate, and economical use of medications?
pharmacotherapy
What is a good guiding principle to follow
there should be a justifiable and documented indication for every medication that is used
This includes STOPPING the medication when it’s no longer needed
Explain the guiding principle to follow for the length that a medication should be taken
a medication should be used at the LOWEST DOSAGE and for the SHORTEST DURATION that is likely to achieve the desired outcome
what is preferred – monotherapy or multitherapy
When a patient can be treated with a single drug, then monotherapy is preferred.
ie: avoid concomitant use of omeprazole and famotidine
What is the guiding principle to follow regarding newly approved medications?
newly approved medications should be used ONLY IF there are clear advantages over older medications
ie:
less drug interactions
less likely to cause bothersome side effects
longer duration of action
failure on older medications
Whenever possible, the selection of a medication regimen should be based upon evidence from……
CONTROLLED CLINICAL TRIALS
the _____ of drug administration should be considered as a possible influence on drug efficacy, adverse events, and interactions with other drugs
TIMING
ie:
-taking cipro with dairy decreases its absorption
-one drug binds to another in the stomach
-adderall is taken for ADHD so its taken in the morning instead of at bedtime
What fact about the patient may affect adherence and treatment outcomes?
a patient’s perception of an illness or the risks and benefits of therapy
ie:
-hypertension – “i dont need pills i dont feel sick”
-flu – i dont need medicine ill just be sick for a couple of days ( risk of developing pneumonia)
-“my fever is gone so i can stop the antibiotic”
What is a good way to avoid nonoptimal treatment outcomes associated with patient’s perception of the illness or the therapy?
counseling and the teach back method
A medication should not be given by injection when giving it by mouth would be just as effective and safe. Why does this principle exist?
because giving by mouth is less invasive, cost effective, and decreases the risk of infection
How do you avoid the “prescribing cascade”?
a drug regimen should only be initiated with full recognition that a medication may cause disease, symptoms, etc, or abnormal lab tests
THIS WILL HELP TO NOT TREAT SIDE EFFECTS OF A DRUG AS A NEW DISEASE
When a variety of drugs are equally efficacious and equally safe, which drug should be chosen?
the drug that results in the lowest health care cost or is most convenient for the patient
ie: brand vs generic, formulary issues
What should be done before medications are used?
lifestyle modifications or non-pharmacologic interventions should be made to potentially eliminate the need for drug therapy
When making decisions about drug therapy for individual patients, ______ effects should be considered
societal
what are some societal effects
cost, education, access, equity
-social determinants of health
Possible reasons for failure of medication regimen—-
-inappropriate drug selection
-poor adherence
-misdiagnosis
-concurrent illness (substance use and mental health disorder at the same time)
-interactions with food or drugs
-environmental factors
-genetic factors
Define drug therapy problem
any undesirable event experienced by a patient that involves drug therapy. Interferes with achieving the desired goals of therapy
How are drug therapy problems resolved?
by professional judgment
what are the 3 primary components of a drug therapy problem-
-the undesirable event/risk experienced by the patient
-the drug therapy that caused the problem
-the RELATIONSHIP between the undesirable event and the drug therapy
name 2 drug therapy problems under the drug related need of “indication”
-unnecessary drug therapy
-additional therapy needed
name 2 drug therapy problems that fall under the drug related need of”effectiveness”
-ineffective drug
-dose is too low
name 2 drug therapy problems that fall under the drug related need of “safety”
-adverse drug reaction
-dose is too high
name a drug therapy problem falling under the drug related need of “adherence”
-nonadherence or noncompliance
issues related to indication….
-needs additional therapy
-unnecessary drug therapy
issues related to the drug product…
-ineffective drug
-adverse drug reaction
issues related to the dosage regimen…
-dosage too low (ineffective)
-dosage too high
Explain when unnecessary drug therapy exists
-duplicate therapy
-no medical indication
-nondrug therapy is more appropriate
-addiction/rec use
-prescribing cascade — treating adverse reactions
explain when additional therapy would be needed
preventative therapy
untreated condition
synergistic therapy — need 2 meds to work together to produce outcome
explain why a drug would be ineffective
-a more effective drug is available
-the condition is refractory (untreatable)
-the dosage form is inappropriate
-contraindication is present
-the drug is not indicated for the condition present
DOSES NEED TO BE….
PATIENT SPECIFIC
If the dosing is too high, the dosing interval could be too ____
short
if the dose is too low, the dosing interval could be too _____
long
What are some causes of an adverse drug reaction
-drug interaction
-incorrect administration
-allergic reaction
-dosage increase/decrease too fast
What are some factors that could cause nonadherence?
-pt does not understand directions
-pt cannot afford medication
-pt prefers not to take medication
-pt forgets to take
-med is not available
-cannot swallow/administer drug
-pt afraid of adverse events
-previous medication experiences
Stating a drug therapy problem should consist of 3 components:
-description of the patient’s medical record or clinical state
-the DTP
-the specific association between the drug therapy and the patient’s condition
Patient’s may have several DTP’S.
The problems should be prioritized based on:
-extent of potential harm
-patient’s perception of potential harm
-rate at which the harm is likely to occur
Once you prioritize the problems, what should you ask yourself?
-which problem must be resolved immediately?
-Which problem can be resolved by the practitioner and patient?
-Which problems require intervention by another member of the healthcare team?
What do you document if there are NO drug therapy problems?
focus on achieving the goals of therapy and ensure that the pt is not at high risk of DEVELOPING any problems
we still need to develop a PLAN and periodic follow up
What question should you ask yourself to recognize if there is any unnecessary drug therapy
“Why is the patient taking this medication?”
does the pt have a medical condition warranting its use?
What questions should you ask yourself to determine if there is need for additional therapy?
what are the untreated medical conditions
what is the status of the current condition
does the pt require therapy
what is the treatment
If a therapy is indicated, how do you choose which therapy to use?
evidence based reasoning (clinical trials)
If a drug isn’t working (ineffective), what questions should you ask yourself?
is the pharmacotherapy appropriate?
is the drug contraindicated
is the most optimal agent being used
If the dose is too low or too high, what questions should you ask to determine the issue
-is the dose appropriate for the patient’s renal and hepatic function
-do any drugs require adjustment based on weight or age
-what is the recommended dosage range and administration
-is the length of therapy appropriate
-where is the pt storing these meds
If a patient is experiencing adverse reactions, what questions should you ask them?
what have you noticed different since starting this medication?
what has changed since starting this medication?
(ie: lifestyle changes, otc meds)
If a patient is allergic to penicillin and you get a script for them for amoxicillin, what is the term for this?
contraindication – reason NOT to take the medication due to the harm it would cause
