Medication Review Flashcards
A structured evaluation of a patient‘s medicines with
the aim of optimizing medicines use and improving health
outcomes
Pharmaceutical Care Network Europe (PCNE)
entails detecting drug-related problems and
recommending interventions
MEDICATION REVIEW
Different Factors to Determine Proper Medication
Prescription and Individualized Patient Use
Indication
Dose
Frequency
Duration of Therapy
Route of Administration
Therapeutic Duplication
Allergies
Drug Interactions
Other Patient Factors
T/F: Drug dose must be optimized based on clinical guidelines
and recommendations, as well as individual patient
parameters such weight, renal and hepatic functions, body
surface area, clinical response, etc.
true
EFFECTS OF MEDICATIONS WITH LONG-TERM USE:
Laxatives
Dependence
EFFECTS OF MEDICATIONS WITH LONG-TERM USE:
Opioid analgesics
Dependence and Addiction
EFFECTS OF MEDICATIONS WITH LONG-TERM USE:
Nitrates
Tolerance
EFFECTS OF MEDICATIONS WITH LONG-TERM USE:
Corticosteroids
Adrenal insufficiency
FACTORS TO CONSIDER IN DRUG ADMINISTRATION:
Target Site
Patient Status
Dosage Formulation
T/F: Extended-release tablets should be
crushed, thus, these are not
recommended for patients on NGT
true
A patient is on Metoclopramide (antiemetic) 10 mg IV
every 8H RTC and Ondansetron (also an antiemetic) 4 mg
IV every 8H as needed for nausea and vomiting
THERAPEUTIC DUPLICATION
A patient is on Fentanyl patch 50 mcg every 72H
transdermally and Morphine 10 mg tab, 1 tab every 8H as
needed for breakthrough pain
THERAPEUTIC DUPLICATION
A patient is on Tramadol 50 mg cap, 1 cap every 6H as
needed for pain and Tramadol 50 mg IV every 8H as
needed for pain
THERAPEUTIC DUPLICATION
Use of 2 or more medications belonging to the same
therapeutic class or with the same mechanism of action or
with the same target site of action together
THERAPEUTIC DUPLICATION
A patient is on Ceftriaxone 2g IV once daily for CAP and to
be given Cefazolin 2g IV for 1 dose as preoperative
antibiotic prophylaxis
THERAPEUTIC DUPLICATION
A patient is on Enoxaparin 40mg every 12H
subcutaneously and Warfarin 1mg tab, 1 tab once daily
THERAPEUTIC DUPLICATION
also called “hypersensitivity” reaction to a drug
ALLERGIES
Sensitivity of a patient to a different drug which possesses
similar structures to a known allergy-causing agent for the
patient
CROSS-SENSITIVITY (OR CROSS-REACTIVITY)
Intradermal injection or pricking with a
small amount of a diluted drug to
determine reactivity based on a control
test
Skin Testing
Usually used for antimicrobial agents
Skin Testing
Intravenous administration of a small
amount of a drug to determine reactivity
based on patient response
Test Dosing
Conversion of a patient with a drug
allergy from a highly sensitive state to a clinically tolerable state by temporarily
modifying patient response to a drug to
allow safe treatment
Desensitization
WHAT FDA PREGNANCY SAFETY CATEGORY:
Controlled studies in women fail to demonstrate
a risk to the fetus in the first trimester (and
there is no evidence of risk in later trimesters)
A
WHAT FDA PREGNANCY SAFETY CATEGORY:
Possibility of fetal harm is remote
A
WHAT FDA PREGNANCY SAFETY CATEGORY:
Animal studies have shown no fetal risk but no
controlled studies in pregnant women
B
WHAT FDA PREGNANCY SAFETY CATEGORY:
Animal studies have shown adverse effect that
was not confirmed in women during first
trimester (and there is no evidence of risk in
later trimesters)
B
WHAT FDA PREGNANCY SAFETY CATEGORY:
Animal studies have revealed adverse effects on
the fetus and there are no controlled studies in
women
C
WHAT FDA PREGNANCY SAFETY CATEGORY:
Studies in humans and animals are not available
C
WHAT FDA PREGNANCY SAFETY CATEGORY:
Positive evidence of human fetal risk is available
but the benefits may outweigh the risk for
life-threatening or serious diseases for which
safer drugs cannot be used or are ineffective
D
WHAT FDA PREGNANCY SAFETY CATEGORY:
Studies in animals or humans have shown fetal
abnormalities OR there is evidence of fetal risk
based on human experience OR both
X
WHAT FDA PREGNANCY SAFETY CATEGORY:
The risk of use of the drug in pregnant women
clearly outweighs any possible benefit
X
WHAT FDA PREGNANCY SAFETY CATEGORY:
Contraindicated for women who are or may
become pregnant
X
LACTATION SAFETY CATEGORY:
Drug which has been taken by a large
number of breastfeeding mothers
without any observed increase in
adverse effects in the infant
L1
LACTATION SAFETY CATEGORY:
Controlled studies in breastfeeding
women fail to demonstrate a risk to the
infant and the possibility of harm to
the breastfeeding infant is remote; or
the product is not orally bioavailable in
an infant
L2
LACTATION SAFETY CATEGORY:
Drug which has been studied in a limited
number of breastfeeding women without
an increase in adverse effects in the
infant;
L2
LACTATION SAFETY CATEGORY:
There are no controlled studies in
breastfeeding women, however the risk
of untoward effects to a breastfed infant
is possible; or, controlled studies show only minimal non-threatening adverse
effects
L3
LACTATION SAFETY CATEGORY:
And/or, the evidence of a
demonstrated risk which is likely to
follow use of this medication in a
breastfeeding woman is remote
L2
Drugs should be given only if the
potential benefit justifies the potential
risk to the infant
L3
There is positive evidence of risk to a
breastfed infant or to breastmilk
production, but the benefits of use in
breastfeeding mothers may be
acceptable despite the risk to the infant
L4
if the drug is needed in a
life-threatening situation or for a
serious disease for which safer drugs
cannot be used or are ineffective
L4
Studies in breastfeeding mothers have
demonstrated that there is significant
and documented risk to the infant based
on human experience, or it is a
medication that has a high risk of
causing significant damage to an infant
L5
The risk of using the drug in
breastfeeding women clearly
outweighs any possible benefit from
breastfeeding
L5
The drug is contraindicated in women
who are breastfeeding an infant
L5
no known or
theoretical contraindications for their
use, and it is considered safe for the
mother to take the drug and continue to
breastfeed
Compatible with
Breastfeeding
cause side-effects in
the infant but have either not been
observed to do so or have only
occasionally caused mild side-effects
Compatible with
Breastfeeding:
Monitor Infant for
Side-Effects
T/F: For Drugs Compatible with Breastfeeding but MAY produce side effects, If the mother cannot stop taking the
drug, she may need to stop
breastfeeding and feed her baby
artificially until her treatment is
completed
True
reported to cause side-effects
in the infant, especially if the side-effects
could be serious
Avoid if possible:
Monitor Infant for
Side-Effects
Drugs classified this way may reduce
breastmilk production
Avoid if possible:
May Inhibit
Lactation
have dangerous side-effects on the
baby
Avoid
US FDA initiative that revised label requirement for
medications regarding pregnancy and breastfeeding safety
from previously-assigned letters to ____________
summary of available
data
New Labeling
Category include
○ Pregnancy (includes Labor and
Delivery)
○ Lactation (includes Nursing Mothers)
○ Females and Males of Reproductive
Potential (newest category)
4 Headings of Pregnancy in the new labeling category
Pregnancy Exposure Registry
Risk Summary
Clinical Considerations
Data
Lactation 3 Headings in the new labeling category
Risk Summary
Clinical Considerations
Data
Females and Males reproductive potential 3 Headings in the new labeling category
Pregnancy Testing
Contraception
Infertility
Off label use Instances
1 Unapproved indication
2 Doses outside the recommended therapeutic range
3 Unusual route of administration
4 Use in other patient population
5 Unapproved concentration / dilution / preparation
Reasons for Off-Label Use
1 No approved drug as treatment for the condition
2 Conventional treatment had no therapeutic effect
3 Patient is unable to take approved treatment (allergy,
contraindicated with other comorbidities, intolerance to
side effects, etc.)
4 Conventional treatment is inaccessible
5
Clinical trials of already-marketed drugs for new
indications may show effectiveness
