Midterm Flashcards
Clinical kinetics
Application of PK principles for safe and effective therapeutic drug management in individual pts
Therapeutic drug monitoring
Use of assay procedures to determine drug concentrations in plasma for developing safe and effective drug regimens
Goals of clinical kinetics
Enhance efficacy
Decrease toxicity
Interpatient variability causes
Variations in drug:
Absorption
Distribution
Metabolism
Disease states
Drug interactions
When is therapeutic monitoring valuable?
Good correlation between pharmacologic response and plasma concentration
Wide intersubject variation
Narrow TI
Drug concentration formula
(Amount of drug in body) / (volume in which drug is distributed)
Process of therapeutic drug monitoring
Diagnosis
Drug selection
Dosage regimen
Administration
Concentration measurement
Model application
Dose adjustment
(Don’t Do Drugs At College. Might Die)
Volume of distribution
Measure of drug distribution throughout the body
Large volume = wide distribution
When does the peak drug level occur?
30 min - 1 hr after admin
When does the drug level trough occur?
Immediately prior to next dose
SBAR communication framework
Situation
Background
Assessment
Recommendation
Pharmacist role in clinical PK
Designing pt specific dosage regimens
Monitoring & adjusting doses
Evaluating unusual pt responses
Standards of effective communication
Clear
Complete
Brief
Timely
Common barriers to interprofessional communication
Generational differences
Culture
Language differences
Personal values
Hiearchy
Drug level collection timing considerations
- Steady state status
- Peak/trough/random level needed
- Drug-lab interactions
General rules for team communication
Keep it concise
Include relevant info
Stick to facts
Avoid arrogance & judgement
Medication Administration Record (MAR)
Tool used to document and track med admin in healthcare settings
Options when drug level is not collected properly
Delay dose
Retime level
Order random level (rare)
Sources for clinical kinetic info
Lexi-comp
Micromedex
Other pharm resources
Number of marketed OTC meds
Over 300,000 in different therapeutic classes
Self-care
Preventing, diagnosing, and treating one’s own illnesses without professional advice
OTC medication market value
$102B annually in US healthcare system
OTC medicine categories
- Respiratory
- GI
- Ophthalmic
- Otic
- Dermatologic/reproductive/
genital disorders - Pain & fever
(Really GOOD Party)
OTC product sales increase
From $2B in 1965 to $17B in 2012
Average pharmacist OTC recommendations per week
29
Percentage of consumers who purchase pharmacist recommended OTC products
81%
Primary reason patients choose OTC meds
Convenience
Annual savings from increased OTC med use
$5.2B for consumers and taxpayers
What is QUEST/SCHOLAR? (Not what does it stand for)
Structured approach for pharmacists to counsel pts on self care
Low health literacy
Pt barrier to effective communication and self care
Lack of training
Clinician barrier to effective communication and self care
Lack of privacy
A healthcare setting barrier to effective communication and self care
Tamper evident packaging
Safety feature to protect consumers against criminal tampering
OTC drug facts label regulation publication date
March 1999
Number of OTC drug products affected by labeling rule
More than 100,000
Dietary supplements labeling
Regulated as food products with supplement facts panel
Ibuprofen overdose case
3 year old given incorrect dose due to babysitter’s measuring device
PSE misuse case
23 year old woman took four 240mg tabs in 8 hours instead of one per 24 hours
What percentage of OTC drugs are purchased by older Americans?
Almost 30%
What are the components of a drug facts label
Active ingredients
Purpose
Uses
Warnings
Dosage instructions
Inactive ingredients
OTC product info sources
Product labels
Lexicomp
What are the 5 vital signs
Temperature
HR
Respiratory rate
Oxygen saturation
BP
(THROB)
BP measurement preparation
Pt seated and rested for 5 min
No caffeine/nicotine/alcohol for 30 min prior
Proper cuff fit for BP
Index line between range lines
Bladder encircles 80% of arm
Width at least 1/2 arm circumference
Korotkoff sounds
Used to obtain systolic and diastolic BP measurements
Tachycardia
HR > 100 bpm
Normal oral temp range
95.9 - 99.5
Normal respiratory rate
8-16 breaths/min
Bradycardia
HR < 60 bpm
Tachypnea
Respiratory rate > 16 breaths/min
Bradypnea
Respiratory rate < 8 breaths/min
Fever threshold for oral temp
> 100*F
Fever threshold for rectal temp
> 101.8*F
Normal rectal temp range
97.9-100.4
What are the advantages of taking temperature rectally?
Closest to core temp
Preferred if < 6 months
Normal axillary temp range
94.5-99
Tympanic temp accuracy
More accurate in adults than oral or axillary
Normal tympanic temp range
96.4 - 100.4
Temporal temp sensitivity
More sensitive than tympanic for detecting fever
Sensitivity in lab tests
Probability of a positive result if the pt truly has the disease
Specificity in lab tests
Probability of a negative result if the pt does NOT have the disease
Positive predictive value
Probability that a pt w/ a positive test result actually has the disease
Negative predictive value
Probability that a pt w/ a negative test result does NOT have the disease
Biopsychosocial model
Concept that a pt’s health is influenced by multiple interacting factors within dynamic systems
Clinical reasoning
Process of integrating clinical info, preferences, medical knowledge, and contextual factors to make pt care decisions
Components of a medication list
Frequency
Purpose
Dose
Special notes
Name
Route
(Filling People’s Drugs? Sorry, No Refills)
What is the purpose of a personal medication record?
Decrease med related adverse events
Core component of med therapy management
Collect (PPCP)
- Gather pt info
- List diagnoses
- Relevant data for each condition
Assess (PPCP)
Evaluation collected information to ID drug therapy problems and prioritize issues
Pharmacist Patient Care Process
Orderly process with steps:
Collect
Assess
Plan
Implement
Follow-up
Implement (PPCP)
Execute chosen strategies, including med orders & pt education
Plan (PPCP)
Create SMART goals and generate strategies for each prioritized problem
Follow-up (PPCP)
Develop monitoring plan and evaluate outcomes for each problem
Drug therapy problems
Seven categories including unnecessary therapy, need for additional therapy, an ineffective drug
SMART goals
Pt centered objectives that are:
Specific
Measurable
Achievable
Relevant
Time-bound
Diagnostic reasoning
Process of determining the cause or nature of a problem/solution
Therapeutic reasoning
Process involved in pt management and treatment decisions
Medication efficacy
Evaluation of how well a drug achieves its intended purposes
Medication safety
Assessment of potential risks and adverse effects associated w/ drug therapy
Good clinical reasoning
Provides adequate and true explanations w/ logically strong, complete, and informative hypotheses
Adherence
Pt’s consistency in following prescribed treatment regimens
Drug therapy problem: unnecessary drug therapy
Pt taking medication without valid indication
Preventative care
Measures taken to prevent illness or disease before they occur
Drug therapy problem: needs additional therapy
Pt requires additional medication
Drug therapy problem: ineffective drug
Medication is not producing the desired therapeutic effect
Drug therapy problem: dosage too low
Dose insufficient to achieve therapeutic goals
Drug therapy problem: adverse drug reaction
Unwanted/harmful effects from med use
Drug therapy problem: Dosage too high
Dose exceeds safe/effective levels
Drug therapy problem: Inappropriate adherence
Pt not following regimen as prescribed
Pt centered issues in treatment selection
Cost
Safety
Efficacy
Evidence
Adherence ability
(Can’t SEE Anything)
Monitoring parameters
Specific indicators used to evaluate treatment effectiveness and safety over time
Clinical reasoning in pharmacy practice
Application of critical thinking to investigate, understand, and resolve drug therapy problems
How should capsules be stored?
In tight containers w/ constant, adequate humidity
Capsule shell materials
Gelatin
Starch
Cellulose polymers
What is the largest capsule size for humans?
00
How do you decide what size capsules to use
Based on weight of powder to be filled
Use capsule capacity table to determine
When compounding capsules, how much extra powder do you make?
10% to account for loss
Minimal weighable qty (MWQ)
Minimum amount that can be accurately weighed on a balance
When do you prepare an aliquot?
When drug amount is below the MWQ of the balance
How do you determine how much diluent you need in capsules?
Compare total powder amount to capsule capacity
Steps to create an aliquot
- Weigh allowable amount of drug
- Add diluent
- Mix homogeneously
- Measure desired amount
Capsule filling methods
Hand punch
Capsule machine
What is the advantage of a capsule machine?
Quicker for large batches
Hand punching capsules process
Create powder bed
Punch capsules
Fill
Cap
What is the disadvantage of a capsule machine?
May waste more powder
Quality control for capsules
Weigh to ensure within 5% of desired weight
BUD if using a manufactured product for the AI
25% of remaining time until exp or 6 months (whichever is earlier)
BUD if using USP or NF substance (bulk powder)
6 months
Compounding record essential components
Name
Qty
Therapeutic use
Dosage form
Route
BUD
Ingredients
Strength
(Never Quit Taking Down RBI Stats)
Geometric dilution
Technique for mixing powders to ensure uniform distribution
Auxiliary label for phenobarbital containing capsules
Do not use heavy machinery
Quality control data in compounding
Weight of empty and filled capsules
Infestation
Parasitic disease caused by animals such as arthropods and worms
Infection
Condition caused by protozoa, fungi, bacteria, or viruses
Head lice transmission
Direct contact w/ infested head or shared items like combs and hats
Nits
Eggs laid by female lice
Hatch in 7-8 days
Pruritus in head lice
Most common symptom
Allergic reaction to live saliva
First line therapy for head lice
Permethrin
Non-pharmacologic head lice management
Change clothing daily
Treat infested items
Wash hair tools
Mosquito bite effects
- Welt
- Itching
- Potential urticaria reactions and systemic symptoms
(WIP)
Flea bite characteristics
Multiple, grouped, often on legs and ankles
Insect bite prevention
Use of insect repellent
Bed bug hiding places
Crevices in walls, floors, bedding, suitcases
Scabies causative agent
Sarcoptes scabiei mite
Scabies transmission
Physical contact
FDA approved scabicides
Lindane
Crotamiton
Permethrin
Spinosad
(Let Cassie Pass Stats)
Tick removal method
CLEAN tweezers
Make sure the head is still attached to the tick
Must be done within 36 hours of attachment
Lyme disease vector
Deer tick
Rocky mountain spotted fever vector
Lone star tick
Chigger myth
They burrow into the skin and stay there
Life-threatening spider envenomations
Recluse and widow spiders
Recluse spider bite initial management
Rest
Ice
Compression
Elevation
(RICE)
Widow spider bite symptoms
Painful cramps
Abdominal muscle rigidity
Excruciating pain
Pinworm transmission
Fecal-oral through ingestion of eggs
OTC medication for pinworm infection
Pyrantel pamoate
Pyrantel pamoate mechanism
Depolarizing neuromuscular agent that paralyzes adult worms
Lyme disease symptoms
Bullseye rash
Acute headache
Tender urticarial lesions
(BAT)
Rocky mountain spotted fever symptoms
Rash
Fever
Nausea/vomiting
Muscle pain
Headache
(Really Fucking Need Mental Help)
