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cardiomyopathy
any disease affecting the structure and fxn of the heart
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founder of pharmacy
william proctor jr
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cardiocentesis
heart surgery procedure
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centesis
surgical procedure
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cardiomegaly
heart enlargement
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dysuria
painful urination
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polyuria
excessive urination
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subhepatic
- sub-under
- hepat- liver
- ic - pertaining to
thus pertaining to under the liver
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parenteral
pertaining to alongside of the intestine
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hemiplegia
paralysis on one side of body
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adduction
movement of limb toward body
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diagnosis
knowledge thru testing
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hypo
under, below, less than normal
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purpura
pinpoint hemorrhages appearing as red/purple discolorations under skin
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erythr/o, eosin/o, rube
red
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cirrh/o, jaundo/o, xanth/o
yellow
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spasm
involuntary contraction
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rhinorrhea
discharge from nose
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dyspnea
difficulty breathing
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ectasis
expansion or dilation
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iasis
formation or presence of
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osis
condition or increase
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ptosis
falling or downward displacement
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centesis
puncture for aspiration
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amniocentesis
surgical puncture of amniotic sac to get fluid for analysis
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stomy
creation of an opening
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CAD
coronary artery disease
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PVCs
premature ventricular contractions
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americans take OTC drugs most routinely for
pain
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risks associated with OTC use
- -pt has difficulty reading/selecting the right product
- -lack of medical knowledge
- -complex directions
- -never reading the box/using expired meds
- -side effects, drug interactions
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examples that can interact with OTC drugs
- grapefruit juice - dextromethorphan (cough suppressant), omeprazole (prilosec-for acid reflux), (also dunno if you have to know but it also interactions with your quinolone antibiotics i.e. cipro, levaquin, oflaxacin)
- alcohol (acetaminophen, antihistamines)
- caffeine (excedrin, no-doz)
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Special populations that you need to consider how meds can work differently for them (2)
infants and children- may metabolize drugs faster or slower, dosing needs to be weight based, formulation differences (tablets vs liquids)
Elderly- may have kidney/liver problems that can affect metabolism), on multiple medications, may have more side effects
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Should kids with hemorrhoids or infants with acne be given an OTC recommendation or referred to a physician?
physician
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Minimum age for kids that can safely use cough/cold medication?
4 and up, under 4 not recommended
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What kind of meds cause the most of the complaints/calls to the poison control center (PCC)
cough and cold meds (antihistamines, decongestants, antitussives, expectorants)
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Goals of OTC pharmacoptherapy
appropriate product chosen, proper use and duration of Tx, response to therapy, monitor for allergies, ADR (adverse drug reactions), drug interactions
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name a few things for a patient assessment (hint, involves getting a brief pt history (hx))
- Brief pt Hx
- - who is the patient
- -signs and symptoms
- -duration of current condition
- -allergies to medications
- -existing medical conditions (diabetes, hypertension, etc)
- -current medication hx (rx and otc)
- -past and current experience/treatments
- -pt risk factors (age, health condition)
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What OTC product(s) do teens abuse?
- cough/cold meds: DM (dextromethorphan), decongestants, antihistamines
- also diet supplements/stimulants, laxatives,
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Practice of pharmacy governed by? and which rule do you follow if the two are a bit different?
Federal and state laws. Always follow the stricter law
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What is criminal law?
- government vs private party
- act or violation of a duty owed to society, prosecuted by the government
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What is civil law
- private party vs private party
- concerns private rights and parties (wtf does that mean??)
- civil cases an individual brings an action against someone else
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What does the FDA regulate?
- primarily regulates drug manufacturing and regulates clinical trials.
- also regulates product labeling and advertising, whether or not an med is Rx or OTC, and regulates dietary supplements
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What does the DEA do regarding pharmacy practice
- primarily regulates dispensing and sales of controlled substances
- licenses prescribers to write rx for controls
- licenses pharmacies to dispense controls
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CMS (centers for medicare and medicaid services)
- medicare for elderly- part D -federal program to pay for Rx drugs through private prescription drug providers.
- Medicaid- for indigents (means needy people)
both use formularies, medicaid is funded by federal and state
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Durham-Humphrey Act
defines which drugs require an Rx and include on the rx label "caution federal law prohibits dispensing without a prescription", bottles are labeled Rx only
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How are Rx drugs classified (distinguished from OTC drugs)?
Rx drugs are unsafe for use except under supervision of a prescriber due to toxicity and method of use (may cause harm without supervision), and collateral measures necessary for use
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what does the poison prevention packaging act do?
requires child resistant containers on most OTC and Rx drugs
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what is the Illinois dept of financial and professional regulation (IDFPR) responsible for?
licensing RPhs and techs
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what is the primary mission and main purpose of the IL state board of pharmacy?
- primary mission- protect public
- main purpose- to advise IDFPR
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Why does pharmacy need to be regulated?
to protect the public, increase health care quality, prevent drug diversion and abuse
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How many CE hours do RPhs need to renew their license in IL?
30 credit hours every 2 years
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Why is pharmacy regulated in IL?
To protect the health and safety of the public, and to only allow qualified people to practice pharmacy in IL, including techs
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What does Practice of Pharmacy include? (scope of practice)
- interpretation and assisting in monitorying, evaluating, and implementing Rx drug orders
- dispense rx, administer rx, DUR (Drug utilization review), patient counseling, MTM, compounding
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How long is a non controlled substance good for?
- 12 months from date it is written unless otherwise specified by MD, or it's accutane (good for 7 days)
- refills are allowed and good for 12 months (none on accutane) unless otherwise specified by physician
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What does prescription have to include?
pt name, address for controlled substances and syringes), date written, name and strength of drug, qty, directions for use, prescriber's full name/address/signature, DEA for controlled substances
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what should be printed on an rx label on an rx vial?
name and address of pharmacy, name/initials of RPh and tech, date rx is filled, name of pt, rx number, directions for use, name of drug, strength, and qty, last name of MD
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What can patient counseling include?
- pt med hx, allergies, health conditions
- help pt understand rx use
- how to use it
- major adverse side effects
- potential food -drug interactions
- the need to be compliant with therapy!
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Can pharm students or techs dispense/deliver rx, or counsel a pt if RPh not physically present and supervising?
nooooooooo
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Schedule I controlled substance: can it be dispensed?
no, only for research. High potential for abuse, no accepted medical use and MAY NOT BE PRESCRIBED.
i.e. heroin, marijuana, LSD
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schedule II- can it be prescribed? how long is a written rx good for? how is it stored in a pharmacy? any refills allowed? level of abuse?
- Yes, rx is good for 90 days from date it is written, RPh must sign and date face of rx when filling
- must be stored in a locked cabinet
- NO refills
- high potential for abuse/dependency
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Schedule III: abuse level? how long is written Rx good for? any refills?
moderate/low dependence physically, high psychologically, rx good for 6 months from date written, refills up to 5 times in 6 months, rx must be signed and dated by RPh after filling
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schedule IV: potential for abuse? How long is written rx good for? any refills?
low potential relative to schedule II, good for 6 months, refills up to 5 times in six months (from the day it is written!), RPh must sign and date rx after filling
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schedule V: abuse potential? how long is written rx good for? refills?
low potential compared to IV, good for 6 months from date written, refill up to 5 times in 6 months, RPh needs to sign and date rx after fillin
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What does MD need to write for a controlled substance?
Needs authorization from state, be registered with DEA, DEA # must be printed on each rx written for controlled substance
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Who can write for controlled substances in IL?
MD, DO, DVM (vet), DDS, DPM (podiatrist), PA C3-5 with MD consent), APN (advanced practice nurse) C3-5 with MD consent, and therapeutically cert optometrists within limits
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A valid rx for C-II must have what written on the rx? (several things)
dated and signed by MD, NO preprinted rx's, needs full name and address of pt, drug name, strength, dosage form, and qty (written and numeric), name/address/DEA of MD- must call MD if DEA missing
RPh must sign and date
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can you fill C-II from out of state?
yes
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Can verbal or faxed rx's be sent for C-IIs?
NO, unless emergency, but hard copy must be sent to pharmacy within 7 days
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can controls C3-5 be preprinted?
no
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can C3-5 be faxed or verbal?
yes
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What caution label has to be on C2-5's on rx vial label?
Caution: federal law prohibits transfer of this drug to any person other than the patient for whom it was prescribed
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What info is transmitted for PMP (prescription monitoring program)?
dispenser (pharmacy) DEA, recipient's name and address, NDC, qty, date filled, date written, MD DEA, Pt ID/Gender/DOB
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who can access prescription info library from PMP?
MD, dispenser
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How many times can non controlleds be transfered?
can only transfer if it's a refill, must be between 2 RPhs or real time data transfer online, can transfer until all refills are used
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how many times can C3-5 be transfered?
only once for refill unless it's from the same chain. transfer must be down between two RPhs or real time online data transfer
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What does OBRA '90 require?
- DUR- screen rx's before dispensing, counseling pt, document relevant info
- RPh MUST counsel or make offer to counsel on all new rx's
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What does prospective DUR screen for?
therapeutic duplication, drug-drug interactions, drug-drug contraindications, drug-food interactiosn
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what is the limits on PSE/EPH? just the strictest
3.6 g per day, max 7.5 g per month
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Who can immunize? min age of person you can immunize?
RPh or intern, need certification by ACPE and CPR cert. Pt needs to be 14 and up
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licensure req's for RPh
graduated from accredited school, pass boards, 21 and over, no felonies
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as a licensed RPh what are you held liable for personally?
- legal liability- can be prosecuted for misconduct
- negligence- failing to do something that should or must be done
- scope of practice- taking rx's and filling that are not part of the prescriber's scope of practice
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When rx is entered to computer what does it check for?
correct dose, drug allergies, drug drug interactions, drug disease interactions, deplicate therapy
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What are some examples of things written on auxiliary labels?
- special warnings -take on empty stomach
- adverse effect warnings- may cause drowsiness
- drug interaction warnings
- route of administration (eye, ear, or mouth? or up the ass)
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azepam stem are what class of rxs?
benzodiazepines
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-caine stem are what class of rxs?
local anesthetics
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cillin-stem are what class of rxs?
penicillin antibiotics (amoxacillin, dicloxacillin, ampicillin)
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-oxacine stem are what class of rxs?
quinolone antibiotics, ciprofloxacin, levofloxacine
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pril stem are what class of rxs?
ACE inhibitors, lisinopril etc
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statin stem are what class of rxs?
cholesterol lowering agents (pravastatin, simvastatin)
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sartan stem are what class of rxs?
ARBs (angiotensin II receptor antagonists) diovan (valsartan) losartan (cozaar)
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sulfa stem are what class of rxs?
sulfonamide antibiotics (sulfamethoxazole)
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drugs of the same class are similar how?
same mechanism of action, indication, side effects, drug interactions, counseling points
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antiemetics are used for?
preventing nausea and vomiting
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mimentic is agonist or antagonist?
agonist- mimics actions of certain NTs
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lytics -agonist or antagonist?
antagonist-blocks NT's like acetyl choline and epinephrine to block nerve transmission
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macrolides are what kind of antibiotics?
erythromycin, azithromycin, clarithromycin (your mycins)
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how do statins work to lower cholesterol? (I.e. what enzyme does it block)
HMG-CoA reducatase
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suffix for beta blockers
olol (atenolol)
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suffic for ACE inhibitors
april (benzapril, enalapril)
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ARB suffix?
artans (losartan)
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name 5 classes of rx's used to treat hypertension
diuretics (HCTZ, furosemide), Beta Blockers (BB) (metoprolol, atenolol), ACE inhibitors (benzapril), ARBs (losartan), and calcium channel blockers (CCB)
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define pt adherence
taking meds, taking them as prescribed
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define pt persistence
success at following medication therapy through duration
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why is adherence better than compliance?
adherence pt is active, empowered, pt feels supported
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what is the % that avg of pt's overall adherence to medications?
50%
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what is % is considered good med adherence?
80% for maintenance meds, 90% for HIV meds
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