Long-Term-Care asynchronous Flashcards
Describe an Assisted living facility
-living environment with added services:
-shared meals
-supervision
-assistance with prescriptions
-long-term care
What are the duties of a pharmacist in a long-term-care facility?
-must perform a drug regimen review for every resident of long-term care facility (LTCF) every 30 days
-assists the facility with medication ordering, labeling, storage, security (especially controlled substances); administration, monitoring, and record keeping
Describe a Long-term care facility (LTCF)
-a 24-hour care environment for individuals who require significant assistance
-must have a pharmacist
Describe a skilled nurse facility
-healthcare institution that provides nursing care 24 hours a day
-at least 1 full-time RN
-1 prescriber
-has a place to store and dispense medication
-post-surgical care, wound care, stroke recovery
What does the staffing look like in a skilled nurse facility?
-Medical Director
-Director of Nursing
-Supervising nurse (RN)
-Charge nurse (RN or LPN) – at least one on duty at all times
-Nursing aids/assistants
-Adjuncts (Therapists, Pharmacy Services, Dieticians, Social Services)
What are key drugs a pharmacist should target in a long-term-care facility?
-proton-pump inhibitors
-insulin pens
-erythropoiesis-stimulating agents (Procrit, Aranesp)
-low-molecular-weight heparins
-antibiotics
What are the pharmacy-related F-tags?
-Unnecessary Drugs
-Medication Error Rate (less than 5%)
-Pharmacy services (med ordering, receiving, and more)
-Drug regimen review
-Labeling and storage
The medication error rate must be less than..
5%
What are the different sources of Medication payment in Nursing facilities?
-Medicare Part A (first, later Medicare D, Medicaid, private or insurance)
-Medicare Part D
-Medicaid
-Private Pay or Commercial Insurance
Why is the annual state survey important for facilities?
because it determines if the facility meets the requirements to receive Medicare and Medicaid payments
A to L, the higher the letter, the greater the risk for harm (bad survey)
Where can pharmacists learn about the CMS regulations to prepare for the annual survey?
FYI
Guidance to Surveyors for Long-Term Care Facilities (available at www.cms.gov).
What are the 5 M’s that are relevant in age-friendly care?
Mind
Mobility
Medication
Multicomplexitiy
Matter most
What must be on the label of drugs and biologicals in a long-term care facility?
Which type of drugs should be limited in long-term care settings?
-antipsychotics
-CNS agents
PRN Psychotropic and Antipsychotics are limited to how many days in an LFTC?
14 days
reevaluate use after 14 days, if the drug is still needed
What are the rules for extending psychotropics and antipsychotics beyond 14 days?
Psychotropics: extension is allowed with documentation and duration
(haloperidol, quetiapine, apriprazole, olanzapine)
Antipsychotics: reevaluate before extending
(anti-depressant, anxiolytics, mood stabilizer: lithium, lamotrigine, VPA)
How many dose reductions are required for psychotic drugs during the first year and following years?
2 dose reductions within the first year
1 dose reduction a year, each year thereafter
Which drugs cause urinary incontinence?
diuretics !!! (polyuria)
α agonist (muscle constriction -> urinary retention)
α antagonist (muscle relaxation)
-CCB
-anticholinergics
-antipsychotics
Which drugs can cause urinary retention by reducing bladder contraction?
-CCB
-narcotic analgesics
-anticholinergics
-antipsychotics
-TCAs
Which drugs are preferred for urgent urinary Incontinence?
Antimuscarinics
-Oxybutinin
-Tolterodine
-Solifenacin
M3 antagonists
ADE: dry mouth, drowsiness, blurry vision, constipation
Which patients should avoid antimuscarinics?
-hypersensitive
-having urinary retention (makes it worse)
-gastric retention
-narrow-angle glaucoma
What are the differences between Delirium and Dementia in regards to Onset, Course, and Duration?
Delirium:
Onset: acute
Course: fluctuating
duration: days to weeks
Dementia:
Onset: gradual, chronic
Course: progressive
Duration: months to years
What are the common causes of Delirium?
-electrolyte imbalance
-constipation
-infection
-hypoxia
-sleep deprivation
-hypoglycemia
Which drugs are known to cause Delirium?
anticholinergics
TCAs
antipsychotics, antidepressants
sedatives
opioids
CNS agents
corticosteroids
and more
What are the drugs of choice for Delirium?
typical: Haloperidol
atypical: Risperidone, Olanzapine, Quetiapine
start low and go slow
try to taper if symptoms are controlled (short-term use recommended)
ADE: EPS, tardive dyskinesia
Which drugs make memory loss in dementia worse?
anticholinergics
antihistamines
Which drugs are used for Alzheimer’s disease?
cholinesterase inhibitors
-donepezil
-rivastigmine
NMDA antagonist
-memantine
Which drugs are used for Frontotemporal dementia?
SSRIs
Which drugs are used for Dementia with Lewy Bodies?
Levodopa/carbidopa (for EPS)
memantine/donepezil (for hallucinations)
SSRI as adjunct
