Intro to Pharmacy Test 2

It is subjective.

• 1) Sudden traumatic experiences
• 2) Continuing pressure that are out of control
• 3) Build up of small irritations

Yes!

General Adaptation Syndrome (GAS)

Physiological and psychological response to situations that threaten or challenge someone and requires some kind of adjustment.

• 1) Alarm
• 2) Resistance
• 3) Exhaustion

Selye believed that the intensity of a stressor was a major factor of stress, while Lazarus beleived that a mental process determined the intensity of stress.

When it is causing harm, threat, or challenge.

Search for coping resources. Then, search for emotion-changing strategies or problem-focused strategies.

The level of stress endured depends mainly on the adequancy of resources for coping, and how much of it is drained by the stressor.

It is the wear and tear that the body endures via repeated cycles of allostasis [activation of effector cells that fight stressors] that may be due to inefficient shutting on and off of these responses.

• 1) adaptation
• 2) lack of adaptation.

Good stress and bad stress

Acute stress is stress that is very sharp, but it passes quickly.

Chronic stress is stress that is constantly endured due to routine change.

• 1) Body-Brain Psychoneuro-Immunology
• 2) Brain-Mind The biological basis of psychiatric disorders
• 3) Mind-Body Medically unexplained physical symptoms

Psychoneuroimmunology (PNI)

Always acheiving, irritable, and impatient

Less intense

Pathological niceness, over-patient

Emotional Inhibition

• 1) Optimistic
• 2) Pessimistic

Primary control (Western culture) “fighting back”

Secondary control (Eastern culture) “learn live with it”

• 1) Reappraising the situation
• 2) Learning from the experience
• 3) Making social comparisons
• 4) Cultivating a sense of humor

• Theory of the Problem = Explanatory Theory
• Theory of the Action = Change Theory

To choose targets of change, concoct strategies, and evaluate effectiveness.

• 1) Health Belief Model
• 2) Theory of Reasoned Action and Theory of Planned Behavior
• 3) Transtheoretical Model

• 1) Pre-contemplation
• 2) Contemplation
• 3) Determination/Preparation
• 4) Action
• 5) Maintenance
• 6) Relapse/Recycle

Pre-determination Denial of a problem, no action planned.

Contemplation On the fence — maybe will take action in 6 months

Prepartion Motivated; let's go!, will take action in 30 days, has taken steps towards behaviors

Action Doing it; go!

Maintenance Living it!

Termination or Relapse/Recycle

Freedom from preventable harm with medication use.

• 1) U or u
• 2) IU
• 3) q.d. or QD
• 4) q.o.d. or QOD
• 5) X.0 mg
• 6) .X mg
• 7) MS
• 8) MSO₄

• 1) Always write out COMPLETE drug names
• 2) Use metric units instead of apothecary units
• 3) Do not use error-proned abbreviations.
• 4) Exercise extra caution with high-alert drugs.
• 5) Triple check when using look-alike, sound-alike medications.
• 6) Avoid
• 7)
• 8) Check everything

Adverse Drug Event (ADE)

Adverse drug reactions

Allergy

Side effect

• 1) Dose errors
• 2) Known allergy
• 3) Wrong drug/patient
• 4) Route error
• 5) Frequency
• 6) Missed dose
• 7) Wrong technique
• 8) Illegible Order
• 9) Duplicate Therapy
• 10) Drug-drug interaction
• 11) Equipment failure
• 12) Inadequate monitoring
• 13) Preparation error

• 1) Rash
• 2) Change in respiratory rate, heart rate, hearing, or mental state
• 3) Seizure
• 4) Anaphylaxis
• 5) Diarrhea
• 6) Fever

Of particular importance to the Food and Drug Administration (FDA) are suspected adverse drugreactions for a new drug (i.e., within 3 years of entry to market) and suspected severe adverse drugreactions for any drug, no matter when the drug entered the market (see below).In practice, a good rule of thumb is to document adverse drug reactions that have caused harm or alteredtherapeutic care and/or where future use of the drug might cause danger or harm to a patient.

Document should take place in your clinic note and in the allergies/adverse reactions data field in CPRS.The latter allows for highlighting the adverse reaction on the cover sheet so others can view theinformation and allows for triggering alerts for you or other providers. You or a clinical pharmacist can dothis.

This simple process takes about 30 seconds. Use the Order menu in CPRS, click on Allergies, enter thedrug name and complete the form.

The purpose of documenting is to prevent future injuries for your patients and for others.

Medication Therapy Management Services

A set of services that seek to achieve the best possible patient outcome from drug treatments. MTMS is independent of, but often concurrent with the provision of drug product. It is a collaborative process between health care providers, patients, and the pharmacist where the pahramcist identifies, prioritizes and resolves medication-related problems.

• 1) What did the prescriber tell you this was for?
• 2) How did the prescriber tell you to take it?
• 3) What did the prescriber tell you to expect?

• 1) How has this medicine been working for you?
• 2) How have you been taking it?
• 3) Are you having any problems with it?

• 1) What the patient's allergic to and his/her symptoms
• 2) What the patient's intolerant to and his/her symptoms
• 3) The patient's medical conditions
• 4) The patient's medical issues
• 5) The patient's medications

• 1) Wrong drug
• 2) Need a drug
• 3) Adverse drug reactions
• 4) Safety Dosage Issues
• 5) Needs a different drug
• 6) Efficacy Dosage Issues
• 7) Economic barriers
• 8) Behavioral barriers
• 9) Physical barriers

• 1) Intervention Counseling patient
• 2) Referral to the correct care provider
• 3) Communication with the primary care provider

• 1) Patient Counseling
• 2) Consultaions
• 3) Disease Management Programs
• 4) Collaborative Drug Therapy Management

The provision of unbiased, well-referenced, and critically evaluated information on any aspect of pharmacy practice.

During the 1950s.

1962

1975

Drug information is important to train pharmacy students, for Medication Usage Evaluation (MUE), reporting adverse drug reactions, poison control information, provides drug monographs, provides dosages, drug identification, drug interactions, adverse events, product stability, etc.

• 1) Identify the requestor
• 2) Obtain background information
• 3) Categorize the question [academic or case?]
• 4) Literature search
• 5) Evaluate the information [random, double-sided]
• 6) Synthesize response
• 7) Follow-up

Provides information about a topic which has been complied from primary literature (and other) sources.

• 1) Textbooks
• 2) Compendia
• 3) Review articles
• 4) Online/website/database sources
• 5) Product package inserts

Description, clinical pharmacology, clinical studies, indications and usage, contraindications, warnings, precautions, adverse reactions, overdosage, dosage and administration, how supplied, and references.

Drug inserts, manufacturer's index, brand/generic name index, product category, product identificaton guide, and product information.

Orphan drugs, investigational drugs, drug monographs for both prescription and OTC, identification, indications, administration, dosage, actions, contraindications, adverse effects, overdosage, and patient information.

American Hospital Formulary Service-Drug Information

Single-agent monographs [arranged by Pharmacologic/Therapeutic class], FDA approved uses, non-labeled uses, drug interactions, cautions, toxicity, dosage, administration, pharmacology*, pharmacokinetics*, prescription, OTC, ophthalmic drugs, dermatologic drugs, vitamins, and parenteral products.

absorbtion and secretion, the half-life of absorption

The Health-Care Professional.

The hospital pharmacist.

Any pharmacist.

Retail pharmacists.

Any pharamacist.

Volume I

Volume II

Volume III

On-label information, off-label information, prescriptions, OTCs, nutritional supplements, indications index, monographs, MED Watch form, and identification.

The Redbook is mainly used for the cost of drugs. Wholesale and manufacturer prices are found, along with emergency information, clinical reference guide, practice management, organizations, drug reimbursement, product identification, strengths, national drug code, oragne book code, OTCs, and herbal/complementary products. This book is all about the economics.

The Orange Book is mostly used for searching for therapeutic equivalents. This book only include FDA approved drugs. It also include drugs who have been approved, but not manufactured, drugs that have been discontinued, and drugs that have had their approval withdrawn.

This term describes drugs with the same active ingredient(s), same dosage form, same route of administration, and same strength/concentration. The two drugs must be classified as this prior to being classed a therapeutic equivalent.

In order for two drugs to be classified under this term, they must first be pharmaceutical equivalents. After being classified as such, they must then have the same clinical effect and the same safety profile.

therapeutically equivalent

• 1) bioequivalence
• 2) not confirmed

The Martindales is mostly used for European drugs. This also provides therapeutic equivalents, so that if a foreigner asks for a refill on a foreign drug, the pharmacist may provide a therapeutic equivalent.

MicroMedex is a database of tertiary* and secondary* sources. It can include drug information, toxicology, acute care, patient education, dosing, pharmacokinetics, interactions, adverse effects, product information, and herbal and dietary supplements.

points to the primary reference, gives an overview of the primary reference

peer reviewed, clinically-relevant information on drugs, on-label uses, off-label uses, dosages [prescription and OTC], drug interactions, adverse effects, herbal supplements, nutritional products, investigational drugs, IV compatibilities, and product identifications.

Review articles [due to being biased], treatment guideline, and textbooks.

Bibliographic information and abstracts.

• 1) MEDLINE
• 2) PubMed
• 3) Gateway
• 4) OVID
• 5) IDIS (Iowa Drug Information Services)
• 6) IPA (International Pharmaceutical Abstracts)

Medical Subject Headings are controlled vocabulary and are used for indexing articles in MEDLINE.

Terms used for searching through articles in MEDLINE. This terms may be conjugated by the terms AND/OR/NOT.

Primary resources describe the results of clinical research studies.

• 1) Article submitted to journal
• 2) Editorial staff evaluates article
• 3) Staff then sends article to multiple reviewers
• 4) Reviewers critically evaluate article
• 5) Reviewers send evaluation back to editor
• 6) Editor suggest changes to author
• 7) Author makes changes
• 8) Article is published

Clinical use of drugs.

A concise medical library for practitioner and student.

Indication/Therapeutic Index.

The objectives of this improtant reference book are to correlate pharmacology information with other related medical sciences, reinterpret the actions and uses of drugs from the viewpoint of important advances in medicine, and place emphasis on the applications of pharmacodynamics to therapeutics.

Information on over-the-counter products for pharmacists and consumer arranged under broad chapter headings suc as Antacid Products, Diabetes Care Products, etc.

The PDR presents essential information on major pharmaceutical and diagnostic products including composition, action, use, dosage, side effects, etc. Data are presented for over 4,000 drugs by product and generic name, manufacturer, and category.

A pharmacological reference resource covering herbal rememdies.

A classic reference work for pharmacists. The format consists of eight parts covering orientation, pharmaceutics, pharmaceutical chemistry, testing/analysis/control, pharmacokinetics and pharmacodynamics, pharmaceutical and medicinal agents, pharmaceutical manufacturing, and pharmacy practice.

• 1) The topic
• 2) Current information or historical?
• 3) What would be the best sources?

• 1) Define the topic
• 2) Review secondary sources
• 3) Select the most appropriate primary source
• 4) Translate the problem statement into key words
• 5) Search the primary sources
• 6) Locate and read primary sources
• 7) Write notes
• 8) Organize notes
• 9) Write report

progressing

• 1) A missed drug test
• 2) A late drug test
• 3) A diluted, altered, or substituted drug test

dangerous and prohibited

high potential for abuse, limited medical use

Less potential abuse, limited medical use

less potential abuse, fewer limits on use

limited abuse potential, little limit on use

Food Drug & Cosmetic Act

• 1) Adulteration
• 2) Misbranding

Poison-prevention Packaging Act

Health Insurance Portability & Accountability Act