Week 1 Chapter 2 Pharmacology and Drug Administration for Flashcards
AHFS Drug Information
AHFS DI is the most comprehensive evidence-based source of drug information complete with therapeutic guidelines and off-label uses. With expanded and revised content supported by more than 97,000 references and incorporating the advice of numerous subject matter experts, AHFS DI helps you protect your patients.
Bureau of Narcotics and Dangerous Drugs (BNDD)
Agency (DEA) as either a manufacturer or a researcher of narcotic and dangerous drugs.
Schedule C-II drugs are legal for prescription use in patients and have the highest potential for abuse. Generally, these drugs cause marked euphoria with mind-altering effects. Potent narcotics such as morphine and strong stimulants such as amphetamine fall into this category. There are strict regulations regarding the control and monitoring of drugs in this schedule. Each and every dosage unit must be accounted for; if counts are inaccurate by as little as one dosage unit, a report must be filed with the state agency, such as the Bureau of Narcotics and Dangerous Drugs (BNDD), responsible for controlling these medications. Anyone who has the responsibility to dispense or administer this schedule of medication should store the drugs under double lock and key (a locked cabinet inside a locked room) and should require two signatures for removing the medication from the supply bin. All drugs should be accounted for at the beginning and end of each employee shift. Two employees should verify the count of every C-II drug in the bin. The count should agree with the previous shift count, minus any medications that have been administered to patients. If the count is not correct, an investigation must take place immediately to determine why.
charting
The patient chart is a legal medical record belonging to the hospital. Charting should tell an accurate, chronologic history of events as they occur under the supervision of medical professionals. Members of all medical disciplines rely on the accuracy and input of others when looking through the chart. As an imaging technologist, you should respect this document and comply with the institutional procedures when entering information into the chart. This document is retained when the patient is discharged and will be used for various functions, such as patient and insurance billing, auditing, research, epidemiology, readmission information, and legal affairs. Most medical records or charts are arranged in a format to include a summary sheet, legal consents and advance directives, a history and physical examination sheet, a problem list, physician orders, progress notes, graphic records (e.g., blood and urine results), laboratory tests, and consultations. Most hospitals use a problem-oriented medical record (POMR) format. Figs. 2-2 through 2-11 show various forms and records that use the POMR format.
controlled substance schedule
Medications that have a high potential for abuse are generally placed into one of five controlled substance schedules Drugs of this nature include the narcotic pain relievers, such as morphine, meperidine, codeine, hydromorphone, hydrocodone, pentazocine, propoxyphene, methadone, fentanyl, alfentanyl, and other opiate analogs. Also included are the sedative-hypnotic and antianxiety drugs, such as chloral hydrate and the benzodiazepines (e.g., diazepam, lorazepam, midazolam, temazepam, halazepam, flurazepam, triazolam, oxazepam, chlordiazepoxide). Stimulant medications such as cocaine and amphetamines are also classified as controlled substances.
Drug Enforcement Agency (DEA)
Schedule C-I drugs are illegal for patient use in the United States. To acquire these drugs, an institution must be registered with the federal Drug Enforcement Agency (DEA) as either a manufacturer or a researcher of narcotic and dangerous drugs.
drug references
All health care professionals should have a library of useful drug references to help answer any questions that may arise. For most pharmacologic questions, a combination of the following references can be used.
Physician’s Desk Reference (PDR) is a general reference that is simply a compilation of various package inserts put out by pharmaceutical manufacturers. Only the FDA-approved uses and labeling are allowed to be printed. Manufacturers pay for their drugs to be listed in this reference. The PDR is a good reference for finding phone numbers of the major pharmaceutical companies, which are a valuable resource for information. It is important to note that the PDR does not necessarily contain current information on all drugs. In fact, it does not contain all drugs. However, the PDR is a highly recommended reference because most physicians use it. The PDR is updated once per year. This reference is also available online at www.pdr.net, on CD-ROM, and through handheld personal digital assistant (PDA) technology.
Drug Interaction Facts
Drug Interaction Facts and Hansten’s Drug Interactions are invaluable in determining whether a drug-to-drug interaction may occur when combination therapy is used. These references are available at www.factsandcomparisons.com.
Drugs in Pregnancy and Lactation
Drugs in Pregnancy and Lactation is highly recommended in any practice that deals with pregnant patients or women who breast-feed their children.
Other drug reference sources that should not be overlooked include the pharmacist, poison control centers, and computer drug information sources such as MicroMedex Drug Information, Iowa Drug Information Service, Medline, and Epocrates. Of all the references, MicroMedex is probably the most complete for intense and rapid information gathering; however, it is extremely expensive and is generally supplied through hospital-wide contracts.
Facts and Comparisons
Facts and Comparisons is available in loose-leaf and bound versions, on CD-ROM, and online. The loose-leaf three-ring binder is recommended because the quarterly updates provided can be easily inserted into the manual. This reference is moderately extensive and concisely written, with multiple tables. The format of the text is good for quick reference, ease of use, and comprehensiveness. For a complete list of electronic databases provided by this reference, you can log on to www.factsandcomparisons.com.
Handbook on Injectable Drugs
Handbook on Injectable Drugs is a comprehensive textbook that discusses physical and chemical stability of injectable drugs when combined with one another in the same intravenous tubing or syringe. All hospital and infusion pharmacies should maintain and update this book for questions regarding parenteral drug products (the parenteral route bypasses the gastrointestinal tract).
Hansten’s Drug Interactions
Drug Interaction Facts and Hansten’s Drug Interactions are invaluable in determining whether a drug-to-drug interaction may occur when combination therapy is used. These references are available at www.factsandcomparisons.com.
Food and Drug Administration (FDA)
A drug has many names given to it before it becomes available for use. These names include chemical name, code number, generic name, and trade or proprietary (brand) name. Most health care workers and the general public are familiar with the generic name and the brand name. The other names are used primarily for research and manufacturing purposes. Because of the length of these other names, the U.S. Food and Drug Administration (FDA), the federal agency responsible for protecting the public against fraudulent claims by manufacturers or merchants of foods or drugs, allows the name to be shortened for ease of memory. The shortened version is the generic drug name and is the official name given to the active chemical ingredient contained in a particular drug product.
informed consent
The imaging technologist is responsible for placing various documents into the medical record. These include the specific radiologic procedure and medication orders, informed consents for the various procedures and medications, patient history regarding radiologic procedures, patient assessment during and after procedures, and any medication administration performed. (Routes and techniques of drug administration are discussed in detail in later chapters.) Nursing and physician charting forms can be modified to fit the radiology department. Figs. 2-12 and 2-13 provide examples of important documents that should be in the radiology department chart
LD50
The multibillion-dollar pharmaceutical industry is constantly screening substances with potential marketability as new drugs. Prospective drugs may take years and huge amounts of money to progress through the following FDA testing sequence:
AAnimal studies, to ascertain:
1.Toxicity
a.Acute toxicity: as determined by LD50 (dose lethal to 50% of animals); also known as median lethal dose
b.Subacute toxicity
c.Chronic toxicity
legend drugs
Medications that require a prescription are called legend drugs. These all have a written legend (or caption) on the package stating, “CAUTION: Federal Law prohibits dispensing without a prescription.” Radiopaque contrast agents and other medications administered in the radiology department fall into the category of legend drugs. The imaging technologist must therefore know what constitutes a legal prescription before dispensing or administering drugs or diagnostic agents ordered.
