Download - Hospi Clin Review
-
7/29/2019 Hospi Clin Review
1/349
Clinical/Hospital
PharmacyMargarita M. Gutierrez, RPh, MHPEd (OnGoing)
University of the Philippines Manila
-
7/29/2019 Hospi Clin Review
2/349
HOSPITAL PHARMACY
It may be defined as the practice of
pharmacy in a hospital setting including its
organizationally related facilities or
services.
-
7/29/2019 Hospi Clin Review
3/349
HOSPITAL PHARMACY
It is the department or division of the
hospital wherein the procurement, storage,
compounding, manufacturing, packaging,
controlling, assaying, dispensing,
distribution and monitoring of medications
through drug- therapy management for
hospitalized and ambulatory patients areperformed by legally qualified,
professionally competent pharmacists.
-
7/29/2019 Hospi Clin Review
4/349
Clinical Pharmacy
A practice in which the pharmacist utilizes
his professional judgment in the
application of pharmaceutical sciences to
foster the safe and appropriate use of
drugs, in or by patients, while working with
members of the health care team (Francke
1969)
-
7/29/2019 Hospi Clin Review
5/349
Clinical Pharmacy
Health science specialty whose
responsibility is to assure the safe and
appropriate use of drugs in patients
through the application of specializedknowledge and functions in patient care
-
7/29/2019 Hospi Clin Review
6/349
Clinical pharmacist
Interact with the health care team
Interview and assess patients
Make therapeutic recommendations Monitor patient response to drug therapy
Provide drug information
-
7/29/2019 Hospi Clin Review
7/349
Pharmaceutical Care
Is the responsible provision of drug
therapy for the purpose of achieving
definite outcomes that improves a
patients quality of life (Hepler and
Strand 1990)
-
7/29/2019 Hospi Clin Review
8/349
Pharmaceutical Care
A patient-centered practice in which the
practitioner assumes responsibility for a
patients drug-related needs and is held
accountable for this commitment
(Cipolle 1998)
-
7/29/2019 Hospi Clin Review
9/349
Major Functions of
Pharmaceutical Care
- Identifying potential and actual drug-
related problems
- Resolving actual drug-related problems
- Preventing potential drug-related
problems
-
7/29/2019 Hospi Clin Review
10/349
-
7/29/2019 Hospi Clin Review
11/349
Expected Outcomes of
Pharmaceutical Care
Cure of disease
Elimination or reduction of symptoms
Arrest or slowing down of a diseaseprocess
Prevention of disease or symptoms
-
7/29/2019 Hospi Clin Review
12/349
Knowledge and Skills Required
in Clinical Pharmacy
Knowledge
Diseases
Drug therapy Non-drug
therapy
Laboratory anddiagnostic
testing
Skills
Communication
Patient monitoring Physical assessment
Drug information
provision Therapeutic planning
-
7/29/2019 Hospi Clin Review
13/349
General Clinical Pharmacy
Functions
Providing drug information to physicians andother health professionals
Medication history taking
Medication profile preparation
Drug therapy monitoring
Patient education and medication counseling
Disease screening, monitoring andmaintenance care for patients with chronicdiseases
-
7/29/2019 Hospi Clin Review
14/349
General Clinical Pharmacy
Functions
Participation in the management of
emergency medical care
Health information source for the public
Drug use review and patient care audits
In-service education for physicians, nurses
and other health professionals Specialized functions and services (ASHP
1983)
-
7/29/2019 Hospi Clin Review
15/349
DRUG INFORMATION
SOURCES
-
7/29/2019 Hospi Clin Review
16/349
A. TERTIARY RESOURCES
>> textbooks, compendia, review articles in
journals, full text computer databases andother general information such as those that
maybe found in the Internet
-
7/29/2019 Hospi Clin Review
17/349
easy to use
familiar to most practitioners concise overview of info on a specific topic convenient fairly complete info
Less current info due to lagtimeInformation may not be complete
Transcription errors/incorrect infointerpretation Human bias
Lack of expertise by authors
-
7/29/2019 Hospi Clin Review
18/349
B. Secondary Resources
INDEXINGconsists of providing bibliographic
citation information (e.g., title, author, &
citation of the article)
ABSTRACTINGincludes a brief description (or
abstract) of the info provided by the article or
resource cited
-
7/29/2019 Hospi Clin Review
19/349
C. PRIMARY LITERATURE = consists of published
and unpublished clinical research studies and
reports
NOT A PRIMARY LITERATURE:reviewarticles or editorials found in journals
REVIEW ARTICLES: general overviews and meta-analyses
PRIMARY LIT: controlled trials, cohortstudies, case series & case reports
-
7/29/2019 Hospi Clin Review
20/349
access to more detailed information
personally assess the utility & validity of results
more recent
may provide misleading conclusions based on only 1 trial
need to have good skills in evaluationtime needed to evaluate the large volume of literature
-
7/29/2019 Hospi Clin Review
21/349
STUDY DESIGNS
-
7/29/2019 Hospi Clin Review
22/349
Descriptive versus analytic studies
Descriptive studies
report frequency of conditions and
characteristics of study population
Analytic studies
examine relation between variable
to detect risk factors and make
inferences
-
7/29/2019 Hospi Clin Review
23/349
Observational versus experimental studies
Observational studiesthe exposure to a factor is observed and
not manipulated
EXPOSURE versus OUTCOME
Experimental studies
Manipulation of study factor or exposure;
randomization of subjects
-
7/29/2019 Hospi Clin Review
24/349
Analytic studies/Observational studies
COHORT
-
7/29/2019 Hospi Clin Review
25/349
Analytic studies/Observational studies
PostMenopausal
women free of
Endometrial Cancer
Use Estrogens
Dont useestrogens
Cases of
endometrialcancer
Non-cases
Cases of
endometrial
cancer
Non-cases
Example: Cohort study of the risk of estrogens for endometrial cancer
-
7/29/2019 Hospi Clin Review
26/349
Subjects
selected
for the study
With
outcome
w/ooutcome
Onset of study-
time
No direction of inquiry
CROSS-SECTIONAL STUDY DESIGN
Question: What is happening?
Case Control Study
-
7/29/2019 Hospi Clin Review
27/349
Case-Control Study
Example: Case Control Study of the risk of estrogens forEndometrial Cancer
Use Estrogens
Dont use
estrogens
CASES OFENDOMETRIAL
CANCER
Use Estrogens
Dont use
estrogens
CONTROLS
-
7/29/2019 Hospi Clin Review
28/349
RANDOMIZED CLINICAL TRIAL
DESIGN
-
7/29/2019 Hospi Clin Review
29/349
EXPERIMENTALCROSSOVER DESIGN
-
7/29/2019 Hospi Clin Review
30/349
TYPES OF BLINDING TO ASSIGN
TREATMENT IN CLINICAL TRIALS
Knowledge of Tx Knowledge of Tx
BLINDING PATIENT INVESTIGATOR
None Yes Yes
Single No Yes
Double NO No
-
7/29/2019 Hospi Clin Review
31/349
Other epidemiologic study designs
Case Reports: reports of events observed
in single patients
Case Series: collections of patients, all ofwhom have single exposure, whose
clinical outcomes are the evaluated and
described
-
7/29/2019 Hospi Clin Review
32/349
REVIEW!!!
A. Classified by how subjects are recruited into thestudy
Case-Control studies
Cohort studies
o Experimental studies
B. Classified by how data are collected for thestudy
Retrospective studies Prospective studies
Cross-sectional studies
-
7/29/2019 Hospi Clin Review
33/349
To test the pharmacy-based disease managementprogram for a group of hypertensive patients andto assess its impact on patients selected outcomemeasures, selected pharmacies were randomizedto either an intervention or control group;intervention pharmacists received specific trainingto follow patients over 8 weeks while control
pharmacists continued to provide standard care.
IDENTIFY THE STUDY DESIGN
-
7/29/2019 Hospi Clin Review
34/349
IDENTIFY THE STUDY DESIGN
Children with diarrhea who sought admission
to San Lazaro Hospital were chosen as cases
in the study. Controls were neighbors of thecases who were of the same age. Mothers
of both groups of children were interviewed
on sanitation practices related to child
feeding.
-
7/29/2019 Hospi Clin Review
35/349
Study was set-up to identifycharacteristics that are associated
with the development of ADEs inhospitalized patients through ADEreports generated and
pharmacists interviews of patients
IDENTIFY THE STUDY DESIGN
-
7/29/2019 Hospi Clin Review
36/349
PHASES OF PRODUCT
DEVELOPMENT
http://localhost/var/www/apps/conversion/tmp/scratch_5/new%20chemical%20entity -
7/29/2019 Hospi Clin Review
37/349
New Chemical Entity
Preclinical Studies
Investigational New Drug
Application
Clinical Trials Preclinical Studies
New Drug Application
Postmarketing
http://localhost/var/www/apps/conversion/tmp/scratch_5/new%20chemical%20entityhttp://localhost/var/www/apps/conversion/tmp/scratch_5/new%20chemical%20entityhttp://localhost/var/www/apps/conversion/tmp/scratch_5/new%20chemical%20entity -
7/29/2019 Hospi Clin Review
38/349
STEPS IN DRUG DEVELOPMENT
New Chemical Entity
Organic synthesis
Molecular modification Isolation from plants
-
7/29/2019 Hospi Clin Review
39/349
STEPS IN DRUG DEVELOPMENT1. PRE-CLINICAL RESEARCH
Chemistry
Physical Properties
Biologic Characterization
Pharmacology
Drug Metabolism
Toxicology
Preformulation Studies2. Synthesis & Purification
3. Animal Testing
-
7/29/2019 Hospi Clin Review
40/349
STEPS IN DRUG DEVELOPMENT
4. Investigational New Drug Application
to protect the rights and safety of the subjects
to ensure that the investigational plan is sound
designed to achieve the stated objectives
clinical hold
Investigational Review Board
5. CLINICAL STUDIES
-
7/29/2019 Hospi Clin Review
41/349
CLINICAL STUDIES
Phase I
o for assessing safety
o 20-100 Human subjects: healthy volunteers
(patients in some protocols)
o designed to determine: human pharmacology of
the drug, SAR, side effects (dose-dependent)
-
7/29/2019 Hospi Clin Review
42/349
CLINICAL STUDIES
Phase II
o evaluates the effectiveness for individual
patients with the disease/condition
o short-term side effects and risks
-
7/29/2019 Hospi Clin Review
43/349
CLINICAL STUDIES
Phase III
o expanded patient base
o additional data on effectiveness & safety to
evaluate overall benefit-risk relationship
-
7/29/2019 Hospi Clin Review
44/349
CLINICAL STUDIES
Phase IV
o continued clinical investigations and
postmarketing surveillance
o manufacturing scale up
o drug formulation may be modified slightly
o Phase V
o product development may continue
o additional clinical studies on special
populations; for new indication
-
7/29/2019 Hospi Clin Review
45/349
OTHER APPLICATIONS
Supplemental New Drug Application
Abbreviated New Drug Application
-
7/29/2019 Hospi Clin Review
46/349
THERAPEUTIC GUIDELINES
-
7/29/2019 Hospi Clin Review
47/349
provide clear and concise,independent and evidence-
based recommendations about
patient management that havebeen developed by experts
-
7/29/2019 Hospi Clin Review
48/349
Objectives of TGS
To reduce chance of error by
establishing standard protocolfor how care is carried out
To improve quality and
consistency of medicalcare
-
7/29/2019 Hospi Clin Review
49/349
THERAPEUTIC DRUG
MONITORING
-
7/29/2019 Hospi Clin Review
50/349
Therapeutic Drug Monitoring
Encompasses the measurement of serumdrug levels and the application of clinical
pharmacokinetics to improve patient care
-
7/29/2019 Hospi Clin Review
51/349
Clinical Pharmacokinetics
Study of the time course of the ADME ofdrugs and their corresponding
pharmacological response
Applications: Time to maximal response
Need for a loading dose
Dosage alterations Choosing a formulation
-
7/29/2019 Hospi Clin Review
52/349
Therapeutic Drug Monitoring
to ensure appropriate, safe, efficacious,and economical drug therapy to the patient
Economical, Clinical and Humanistic
Outcomes of drug therapy for a specificpatient
-
7/29/2019 Hospi Clin Review
53/349
Drugs requiring TDM
Intensity of pharmacologic effect is proportionalto the drug concentration at the site of action
Drugs have an established therapeutic
plasma range Relationship between plasma drug
concentration and clinical effect is better
than the relationship between drug dose
and its effect Drug toxicity and disease presentation are
difficult to distinguish from clinical assessmentalone
-
7/29/2019 Hospi Clin Review
54/349
Commonly monitored drugs
Aminoglycosides: gentamicin, tobramycin,netilmicin, amikacin, vancomycin
Anticonvulsants: phenytoin,carbamazepine and occasionallyphenobarbital
-
7/29/2019 Hospi Clin Review
55/349
Commonly monitored drugs
Cardioactive agents: digoxin,procainamide, lidocaine, disopyramide,flecainide
Others: theophylline, lithium,methotrexate and ciclosporin
Th ti D M it i
-
7/29/2019 Hospi Clin Review
56/349
Therapeutic Drug Monitoring
Monographs
Digoxin
Therapeutic Range: 1-2 ng/mL
Signs of toxicity:
Diarrhea, vomiting, abdominal pain, visual
disturbances, drowsiness, confusion,
arrhythmias
Therapeutic Drug Monitoring
-
7/29/2019 Hospi Clin Review
57/349
Lithium prophylaxis
Therapeutic range:
Acute mania (0.6-1.0 mmol/L)
Therapeutic Drug Monitoring
Monographs
Therapeutic Drug Monitoring
-
7/29/2019 Hospi Clin Review
58/349
Lithium prophylaxis
Signs of toxicity
Blurred vision, polyuria, polydipsia, anorexia,
nausea, vomiting, diarrhea, abdominal pain,
muscle weakness, lethargy, drowsiness,
tremor, confusion, ataxia, renal impairment
Serious toxicity: disorientation, convulsions,coma and possibly death
Therapeutic Drug Monitoring
Monographs
Therapeutic Drug Monitoring
-
7/29/2019 Hospi Clin Review
59/349
Phenytoin
Therapeutic range: 5-20 ug/mL
Signs of toxicity
Nystagmus, blurred vision, ataxia, drowsiness
(> 30 mg/L): dysarthria, lethargy, coma
Therapeutic Drug Monitoring
Monographs
Therapeutic Drug Monitoring
-
7/29/2019 Hospi Clin Review
60/349
Carbamazepine
Therapeutic range: 4-12 ug/mL
Signs of toxicity
Nystagmus, diplopia, drowsiness, ataxia
Therapeutic Drug Monitoring
Monographs
Therapeutic Drug Monitoring
-
7/29/2019 Hospi Clin Review
61/349
Theophylline
Therapeutic range:
Asthma (10-20 ug/mL)
Neonatal apnea (5-15 ug/mL)
Signs of toxicity
Nausea, vomiting, cardiac arrhythmias,
seizures
Therapeutic Drug Monitoring
Monographs
-
7/29/2019 Hospi Clin Review
62/349
DRUG-RELATED
PROBLEMS
Categories of Drug-related problems
-
7/29/2019 Hospi Clin Review
63/349
Categories of Drug-related problems
1. Medication Errors
any preventable event that may lead to inappropriate
medication use or cause harm to the patient while the
medication is in the control of a health care
professional, patient or consumer.
- National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP)
O O O
-
7/29/2019 Hospi Clin Review
64/349
TAXONOMY OFMEDICATION ERRORSNO ERROR
1.1 Category A
Circumstances or events that have the capacity to
cause error
ERROR, NO HARM
Note: Harm is defined as death, or temporary or permanent
impairment of body function/structure requiringintervention. Intervention may include monitoring the
patients condition, change in therapy, or active medical or
surgical treatment.
-
7/29/2019 Hospi Clin Review
65/349
1.2 Category B
An error occurred but the medication did not reach
the patient
1.3 Category C
An error occurred that reaches the patient, but did
not cause harm.
1.3.1 Medication reaches the patient and is administered
1.3.2 Medication reaches the patient but not administered
1.4 Category D
An error occurred that resulted in the need for
increased patient monitoring, but no patient harm.
CLASSIFICATION OF MEDICATION ERRORS
-
7/29/2019 Hospi Clin Review
66/349
CLASSIFICATION OF MEDICATION ERRORS
1.5 Category E
An error occurred that resulted in need for treatmentor intervention and caused temporary patient harm
1.6 Category F
An error occurred that resulted in initial or prolongedhospitalization and caused temporary patient harm
CLASSIFICATION OF MEDICATION ERRORS
-
7/29/2019 Hospi Clin Review
67/349
CLASSIFICATION OF MEDICATION ERRORS
1.7 Category G
An error occurred that resulted in permanent patient
harm
1.8 Category H
An error occurred that resulted in a near-death event
(e.g., Anaphylaxis, cardiac arrest)
1.9 Category IAn error occurred that resulted in patient death
Categories of Drug-related problems
-
7/29/2019 Hospi Clin Review
68/349
2. Adverse Drug Events
2.1 Patient FactorsAdverse drug reactions
Patients reactions to the drug
2.2 Drug Factors
Drug-Drug interactions
Drug-Food Interactions
Drug-Disease Interactions
Other incompatibilities
Categories of Drug related problems
-
7/29/2019 Hospi Clin Review
69/349
SPECIAL POPULATIONS
-
7/29/2019 Hospi Clin Review
70/349
The Neonates
http://images.google.com.ph/imgres?imgurl=http://www.uniklinikum-giessen.de/grid/sgl.jpg&imgrefurl=http://www.uniklinikum-giessen.de/grid/klinik.html&h=435&w=620&sz=88&hl=tl&start=2&tbnid=IV4b8VIlpuLPaM:&tbnh=95&tbnw=136&prev=/images?q=neonates&gbv=2&hl=tl -
7/29/2019 Hospi Clin Review
71/349
Human Pregnancy
Normal length of human pregnancy
(TERM): 37-42 completed weeks of
gestation Preterm: 42 weeks onwards
**Earliest in pregnancy at which newborn babies can
sometimes survive is 23-24 weeks gestation.
-
7/29/2019 Hospi Clin Review
72/349
Neonates and Birth Weights
Neonatal Period: first 28 postnatal days
Low Birth Weight (LBW): < 2500 g
Very low birth weight (VLBW): < 1500 g
Extremely low birth weight (ELBW):
-
7/29/2019 Hospi Clin Review
73/349
Drug Disposition in Neonates
Placenta
Cross-section through a third-trimester placenta with baby. The placenta
(blue) consists of about 20 tree-like structures called cotyledons (see
circular magnified area). The babys blood vessels, arriving by way of
the umbilical cord, spread out within the placenta, sending a large branch
into each cotyledon. Mothers blood (darker red) intimately surrounds
the cotyledons.
http://www.answersingenesis.org/assets/images/articles/am/v2/n1/placenta-fig-4.gifhttp://images.google.com.ph/imgres?imgurl=http://www.acmc.uq.edu.au/images/projectimages/Fresh_Placenta.jpg&imgrefurl=http://www.acmc.uq.edu.au/Projects/Virtual_Placenta.html&h=375&w=500&sz=113&hl=tl&start=1&tbnid=sYEv898rh5DHyM:&tbnh=98&tbnw=130&prev=/images?q=placenta&gbv=2&hl=tl -
7/29/2019 Hospi Clin Review
74/349
Available Routes
Enteral erratic in newborns
IV ensures maximum bioavailability
Rectal e.g. paraldehyde and diazepam
(seizures), paracetamol (analgesia)
Buccal e.g. glucose gel (hypoglycemia)
-
7/29/2019 Hospi Clin Review
75/349
Available Routes
(Preterm Babys) Skin extremely thinand poor barrier to water loss; permeable
to substances
E.g. alcohol (chlorhexidine in 70% methylatedspirit) chemical burn and systemic methyl
alcohol poisoning
IM avoided (except for Vitamin K) dueto small muscle bulk
-
7/29/2019 Hospi Clin Review
76/349
Pediatrics
International Committee on
http://images.google.com.ph/imgres?imgurl=http://www.southnassau.org/images/pediatrics_cut.jpg&imgrefurl=http://www.southnassau.org/services/pediatric.cfm&h=157&w=222&sz=11&hl=tl&start=10&tbnid=A5PQueBdqlWYIM:&tbnh=76&tbnw=107&prev=/images?q=pediatrics&gbv=2&hl=tlhttp://images.google.com.ph/imgres?imgurl=http://www1.istockphoto.com/file_thumbview_approve/704934/2/istockphoto_704934_pediatrics.jpg&imgrefurl=http://www.istockphoto.com/file_closeup/?id=704934&refnum=362802&h=253&w=380&sz=29&hl=tl&start=7&tbnid=IcnFA4zkcacYmM:&tbnh=82&tbnw=123&prev=/images?q=pediatrics&gbv=2&hl=tl -
7/29/2019 Hospi Clin Review
77/349
International Committee on
Harmonization (2000)
Preterm newborn infant
Term newborn infant (0-7 days)
Infants and toddlers (28 days to 23
months)
Children (2-11 years)
Adolescents (12 to 16-18 years)
** reflect biological changes
-
7/29/2019 Hospi Clin Review
78/349
Adverse Drug Reactions
Typically occur at lower doses than inadults, and are usually atypical
Enamel hypoplasia and permanent
discoloration of teeth: tetracyclines Growth suppression: corticosteroids
Paradoxical hyperreactivity: phenobarbital
Ad D R i
-
7/29/2019 Hospi Clin Review
79/349
Adverse Drug Reactions
Hepatotxicity: valproate
Reyes syndrome: salicylates (drowsiness,
coma, hypoglycemia, seizures and liver
failure)
-
7/29/2019 Hospi Clin Review
80/349
The Elderly
Age Related Changes in
-
7/29/2019 Hospi Clin Review
81/349
Age Related Changes in
Pharmacokinetic Processes
Drug
Absorption
iintestinal blood flow, surface area, & motilitydelay drug absorption; slow onset of drugaction
DrugDistribution
ibody water, lean body mass & plasmaproteins; hfat content; hplasma drugconcentrations & pharmacologic effects
Drug
Metabolism
iliver blood flow, liver organ size & enzymeconcentration; i the rate of drug
metabolism & hduration & intensity of drugaction
Drug
Excretion
irenal function & blood flow slow the rate ofdrug excretion, & hduration & intensity of drugaction
Ph d i
-
7/29/2019 Hospi Clin Review
82/349
PharmacodynamicsUCSF Division of Geriatric Primary Health Care Lecture May 2001
Some effects are increasedAlcohol, fentanyl, diazepam, morphine,
theophylline
Some effects are decreased isoproterenol and beta -blockers
High Risk Situations
-
7/29/2019 Hospi Clin Review
83/349
High Risk SituationsUCSF Division of Geriatric Primary Health Care Lecture May
2001
Patient seeing multiple providers
Patient on multiple drugs
Patient lives alone and/or hascognitive impairment
Discharge from hospital or any
change in venue
-
7/29/2019 Hospi Clin Review
84/349
The Pregnant
and Lactating
Problem Drugs in Pregnancy
-
7/29/2019 Hospi Clin Review
85/349
Problem Drugs in Pregnancy
Alcohol
fetal alcohol syndrome
small skull (microcephaly) abnormal facial features
heart defects
impeded growth and mental retardation
Problem Drugs in Pregnancy
-
7/29/2019 Hospi Clin Review
86/349
Problem Drugs in Pregnancy
Tobacco
miscarriage or premature labor
Nicotine depresses the appetite Reduced ability of the lungs to absorb
oxygen
Problem Drugs in Pregnancy
-
7/29/2019 Hospi Clin Review
87/349
Problem Drugs in Pregnancy
Cocaine and Methamphetamine
Miscarriage
premature labor abruptio placentae
Withdrawal symptoms for babies
Problem Drugs in Pregnancy
-
7/29/2019 Hospi Clin Review
88/349
Problem Drugs in Pregnancy
Heroin and Other Narcotics
premature birth
low birthweight breathing difficulties
Hypoglycemia
intracranial hemorrhage
Problem Drugs in Pregnancy
-
7/29/2019 Hospi Clin Review
89/349
Problem Drugs in Pregnancy
PCP
(phencyclidine, or angel dust)
withdrawal symptoms (lethargy withtremors)
Problem Drugs in Pregnancy
-
7/29/2019 Hospi Clin Review
90/349
Problem Drugs in Pregnancy
Marijuana
premature birth
Low birthweight
Problem Drugs in Pregnancy
-
7/29/2019 Hospi Clin Review
91/349
Problem Drugs in Pregnancy
Other Medications
Isotretinoin
chronic malformations Phenytoin and carbamezapine
heart and face defects
mental retardation
Problem Drugs in Pregnancy
-
7/29/2019 Hospi Clin Review
92/349
Problem Drugs in Pregnancy
Other Medications
Ergotamine and methylsergide
premature labor
Problem Drugs in Pregnancy
-
7/29/2019 Hospi Clin Review
93/349
Problem Drugs in Pregnancy
Other Medications
Aspirin, ibuprofen, and other NSAIDs
increased risk of uncontrolled bleeding
delayed or extended labor
Pregnancy Category
-
7/29/2019 Hospi Clin Review
94/349
Pregnancy Category
an assessment of the risk of fetal injury
due to the pharmaceutical, if it is used as
directed by the mother during pregnancy does notinclude any risks conferred by
pharmaceutical agents or their metabolites
that are present in breast milk
-
7/29/2019 Hospi Clin Review
95/349
CategoryInterpretation
A Adequate, well-controlled studies in pregnant womenhave not shown an increased risk of fetal abnormalitiesto the fetus in any trimester of pregnancy.
B Animal studies have revealed no evidence of harm tothe fetus, however, there are no adequate and well-
controlled studies in pregnant women. OR
Animal studies have shown an adverse effect, butadequate and well-controlled studies in pregnantwomen have failed to demonstrate a risk to the fetus inany trimester.
Eg. Amoxicillin, paracetamol
C Animal studies have shown an adverse effect and there are noadequate and well-controlled studies in pregnant women. OR
-
7/29/2019 Hospi Clin Review
96/349
adequate and well controlled studies in pregnant women. ORNo animal studies have been conducted and there are noadequate and well-controlled studies in pregnant women.
Eg. Rifampicin, theophylline
D Adequate well-controlled or observational studies in pregnantwomen have demonstrated a risk to the fetus. However, thebenefits of therapy may outweigh the potential risk. Forexample, the drug may be acceptable if needed in a life-
threatening situation or serious disease for which safer drugscannot be used or are ineffective.
Eg. phenytoin, tetracycline
X Adequate well-controlled or observational studies in animals orpregnant women have demonstrated positive evidence offetal abnormalities or risks.
The use of the product is contraindicated in women who are ormay become pregnant.
Eg. isotretinoin, thalidomide
Drug Safety in Lactation
-
7/29/2019 Hospi Clin Review
97/349
Drug Safety in Lactation
Nearly all drugs transfer into breast milk to
some extent
milk (7.2) is slightly more acidic thanplasma (7.4) weakly basic drugs
transfer more readily into breast milk
-
7/29/2019 Hospi Clin Review
98/349
PATIENT CASE
-
7/29/2019 Hospi Clin Review
99/349
Generalpatientinformation
Date and time ofadmission, patients name,age, race, gender
Chiefcomplaint Reason or reasons the
patient is seeking medicalcare
-
7/29/2019 Hospi Clin Review
100/349
History of
presentillness
Narrative that describes the
current medical problem
Pastmedical
history
Brief description of current andprevious patient problems
unrelated to the present illness
-
7/29/2019 Hospi Clin Review
101/349
Socialhistory
Contains information about thepatients use of tobacco, alcohol,
and illicit drugs; patients
occupation, marital status, sexual
history, & living conditions
Family
history
Brief summary of the medical
histories of the patients first
degree relatives
Medicationhistory
Include demographic
i f ti di t
-
7/29/2019 Hospi Clin Review
102/349
history information, dietary
information, social habits,
current & past prescription &non-prescription medications,allergies, ADRs & compliance
Review of
systems Summarizes all patient
complaints not included in the
HPI
Physical
examination
Short description, vital signs,
systemic examination (skin,HEENT, hear, chest, abdomen,
genitalia, neurologic)
-
7/29/2019 Hospi Clin Review
103/349
Laboratory & diagnostic test results
Patient problem list and plans
-
7/29/2019 Hospi Clin Review
104/349
COUNSELING AND
COMMUNICATION
Non-compliance
-
7/29/2019 Hospi Clin Review
105/349
Non compliance
Non-compliance or non-adherence, is apatients failure to follow a drug regimenas instructed inadequate/excessive intake
incorrect frequency
discontinuation
intake of medication other than prescribed
Verbal Communication Skills
-
7/29/2019 Hospi Clin Review
106/349
Verbal Communication Skills
Includes the ability to listen, understand andrespondto other peoples statements and the
ability to interpret the nonverbal ways of other
people.
Active listening makes people feel thatthey have the full attention of the health
professional
Active Listening
-
7/29/2019 Hospi Clin Review
107/349
Active Listening
LISTENING FILTERSOrganizational
Role AttitudesPrevious
experiencesValues Bias, etc.
HEARI
NG
UNDERSTANDING INTERPRETING
EVALUATING
REMEMBERIN
G
RESPONDING
Body Language
-
7/29/2019 Hospi Clin Review
108/349
Body Language
Raising the hand
Shifting body positions
Crossed arms
Leaning toward the speaker
Raising the hands and thenletting them fall limply
Frequent throat clearing
Desire to speakor interrupt
Desire tointerrupt
Shutting out theother person
Receptiveness
Hopelessness
Disagreement
-
7/29/2019 Hospi Clin Review
109/349
Barriers to Verbal Communication
Physical barriers
Lack of privacy
Hindering Behaviors
-
7/29/2019 Hospi Clin Review
110/349
Hindering Behaviors
technical language and medical jargon frequent interruption
expressing bias
closed posture/ threatening posture
reading notes during interview Avoiding eye contact
Asking multiple questions at once
Engaging in sarcasm
Ignoring emotion of patient
mumbling
-
7/29/2019 Hospi Clin Review
111/349
PHARMACEUTICAL CARE
PLAN
Pharmaceutical Care Plan
-
7/29/2019 Hospi Clin Review
112/349
Pharmaceutical Care Plan
Assessment
Plan
Monitoring
-
7/29/2019 Hospi Clin Review
113/349
DRUG UTILIZATION
REVIEW
Drug Utilization Review
-
7/29/2019 Hospi Clin Review
114/349
Drug Utilization Review
Review of medication profiles to ensurethe appropriateness of prescriptions or
medication orders
Prospective DUR (before dispensing) orRetrospective DUR (after dispensing)
-
7/29/2019 Hospi Clin Review
115/349
PHARMACOECONOMIC
METHODOLOGIES
Cost of Illness (CI)
-
7/29/2019 Hospi Clin Review
116/349
Cost of Illness (CI)
evaluates the direct and indirect costs of aparticular disease
non comparative
serve as a baseline information
Measures of Cost
-
7/29/2019 Hospi Clin Review
117/349
Measures of Cost
Direct: paid directly by the health service
medical
non-medical
Measures of Cost
-
7/29/2019 Hospi Clin Review
118/349
Measures of Cost
Indirect: costs experienced by the patientor society
e.g. loss of earnings; loss of productivity
Intangible: impossible to measure inmonetary terms
e.g. pain, worry, distress of patient/family
Cost Minimization Analysis (CMA)
-
7/29/2019 Hospi Clin Review
119/349
Cost-Minimization Analysis (CMA)
identify the alternative with the lowest costamong various interventions with
equivalent outcomes or consequences
e.g. comparing generic drugs with theirbranded counterparts
Example: CMA
-
7/29/2019 Hospi Clin Review
120/349
Example: CMA
DRUG A DRUG B
Costs
Acquisition cost 250 350
Administration 75 0
Monitoring 75 25
Adverse Effects 100 25
Subtotal 500 400
Outcomes
Antibiotic Effectiveness 90% 90%
Result = Cost of Drug A > Cost of Drug B
Cost of Therapies
Note:bothinterventionsare consideredequally effective
Cost-Effectiveness Analysis (CEA)
-
7/29/2019 Hospi Clin Review
121/349
y ( )
compares treatment or other forms of healthintervention that yield different levels of health
benefits
Benefits can be defined and measured in the
same natural units
Example: CEA
-
7/29/2019 Hospi Clin Review
122/349
Example: CEA
DRUG A DRUG B
Costs
Acquisition cost 300 400
Administration 50 0
Monitoring 50 0
Adverse Effects 100 0Subtotal 500 400
Outputs
Extra years of life 1.5 1.6
Cost-effectiveness ratio 500/1.5 400/1.6
=$333 =$250
per extra year of life
Cost of Therapies
Cost-Benefit Analysis (CBA)
-
7/29/2019 Hospi Clin Review
123/349
y ( )
comparing the resources consumed(costs) and the output (benefit) expressed
in monetary terms
CBA: Example
-
7/29/2019 Hospi Clin Review
124/349
CBA: Example
DRUG A DRUG B
Costs
Acquisition cost 300 400
Administration 50 0
Monitoring 50 0
Adverse Effects 100 0
Subtotal 500 400
Benefits
Days at work ($) 1,000 1,000
Extra months of Life ($) 2,000 3,000
Subtotal ($) 3,000 4,000
Benefit to Cost ratio 3000/500 = 6:1 4000/400 = 10:1
Net Benefit 2500 3600
Cost of Therapies
Cost-Utility Analysis (CUA)
-
7/29/2019 Hospi Clin Review
125/349
y y ( )
assess perceived mental, physical andgeneral functioning over time of the
management of chronic diseases
outcome is a unit of utility
CUA: Example
-
7/29/2019 Hospi Clin Review
126/349
p
DRUG A DRUG B
Costs
Acquisition cost 300 400
Administration 50 0
Monitoring 50 0Adverse Effects 100 0
Subtotal 500 400
Utilities
Extra years of Life 1.5 1.6
Quality of life index 0.33 0.25
QALYs 0.5 0.4
Cost-to-utility ratio 500/0.5 400/0.4
= $1000 =$1000
per extra quality of life year
Cost of Therapies
-
7/29/2019 Hospi Clin Review
127/349
PHARMACY ETHICS
Nonmaleficence: To do no harm
-
7/29/2019 Hospi Clin Review
128/349
Nonmaleficence: To do no harm
Beneficence: Duty to promote good
Respecting the patient-professional
relationship
Respect for autonomy: Respect for theindividuals right to decide on issues that
affect self
Consent: right to be informed and to choose
a course of action
-
7/29/2019 Hospi Clin Review
129/349
Confidentiality: right to give or refuse consent
relative to release of privileged information
Respect for persons
Veracity: obligation to tell the truth, orhonesty
-
7/29/2019 Hospi Clin Review
130/349
CLINICAL
LABORATORYTESTS
GENERAL PRINCIPLES
-
7/29/2019 Hospi Clin Review
131/349
Sources of Laboratory Error
- spoiled / incomplete specimen
- Improper timing of obtaining the specimen
- Faulty reagents, technical errors, wrong
procedures
- Failure to take diet and medication into
account
GENERAL
PRINCIPLES
-
7/29/2019 Hospi Clin Review
132/349
PRINCIPLESClinical Performance
Sensitivity small changes or deviations from
normal can be detected
Specificity false (+) results are minimal
Laboratory Results
Quantitative ranges (e.g. 1.2 3 mEq/L)
Qualitative (+) or (-) outcomes Semi-quantitative varying degrees of (+) ,
e.g. 1+, 2+, 3+ for glucose in urine
GENERAL PRINCIPLES
-
7/29/2019 Hospi Clin Review
133/349
Accuracy versus Precision
Accuracy extent to which mean measurement is
close to the true value
Precision reproducibility of the assay
HEMATOLOGICAL TESTS
-
7/29/2019 Hospi Clin Review
134/349
3 Types of Formed Elements
Red Blood Cells (RBC)
White Blood Cells (WBC)
Platelets
Complete Blood Count (CBC)
Hemoglobin (Hb), hematocrit (Hct),total WBC, total RBC, mean cell volume
(MCV), and platelet count
HEMATOLOGICAL TESTS
-
7/29/2019 Hospi Clin Review
135/349
A. Red Blood Cells (erythrocytes)
1. RBC Count
indirect estimate of the bloods Hb
content
HEMATOLOGICAL TESTS
-
7/29/2019 Hospi Clin Review
136/349
2. Hct (Packed Cell Volume, PCV)
Low Hct: Anemia, over hydration, or blood
High Hct: polycythemia vera or dehydration
HEMATOLOGICAL
TESTS
-
7/29/2019 Hospi Clin Review
137/349
TESTS
3. Hemoglobin estimates the oxygen carrying capacity of
the RBC
Low Hb: anemia
HEMATOLOGICALTESTS
-
7/29/2019 Hospi Clin Review
138/349
TESTS
4. RBC Indeces (Wintrobe indices)
Mean Cell Volume (MCV)ratio of Hct
to RBC count
Low MCV: microcytic RBCs High MCV: macrocytic RBCs
HEMATOLOGICALTESTS
-
7/29/2019 Hospi Clin Review
139/349
TESTS
Mean Cell Hemoglobin (MCH) amount of Hb in an average RBC
Mean Cell Hemoglobin Concentration
(MCHC)average concentration of Hb inan average RBC
Low MCHC : hypochromia
HEMATOLOGICALTESTS
-
7/29/2019 Hospi Clin Review
140/349
TESTS
5. Reticulocyte Count measure of immatureRBCs with remnants of
nuclear material
Inc: hemolytic anemia, acute blood loss,response to treatment of a factor deficiency
Dec:drug-induced aplastic anemia
HEMATOLOGICAL TESTS
-
7/29/2019 Hospi Clin Review
141/349
6. Erythrocyte Sedimentation rate
Inc: used to differentiate conditions withsimilar symptomatology
(angina pectoris vs. myocardial infarction)
HEMATOLOGICAL
TESTS
-
7/29/2019 Hospi Clin Review
142/349
TESTS
B. White Blood Cells
5 Major Types:
Granulocytes (a) Neutrophils
(b) Basophils(c) Eosinophils
Nongranulocytes (d) Lymphocytes
(e) Monocytes
-
7/29/2019 Hospi Clin Review
143/349
HEMATOLOGICAL
TESTS
-
7/29/2019 Hospi Clin Review
144/349
TESTSB. White Blood Cells
Inc. WBC count (Leukocytosis): infection
(esp.bacterial), leukemia, or tissue necrosis
Dec. WBC count (Leukopenia): bone marrow
depression w/c may result from metastaticcarcinoma, lymphoma, or toxic reactions to
substances such as antineoplastic agents.
HEMATOLOGICAL TESTS
-
7/29/2019 Hospi Clin Review
145/349
NEUTROPHILS mature: Polymorphonuclear
leukocytes (PMNs), polys, segmented neutrophils,
or segs
- immature: bands or stabs
- NEUTROPHILIC LEUKOCYTOSIS:
e.g.pneumonia
HEMATOLOGICAL TESTS
-
7/29/2019 Hospi Clin Review
146/349
OTHER CAUSES OF NEUTROPHILE COUNT INC
Certain viruses (herpes zoster, chicken pox) Rickettsial disease (Rocky Mountain spotted fever)
Fungi and stress (physical exercise, acute hemorrhageor hemolysis, acute emotional stress)
Inflammatory diseases (acute rheumatic fever, RA, acutegout)
HEMATOLOGICAL TESTS
-
7/29/2019 Hospi Clin Review
147/349
OTHER CAUSES OF NEUTROPHILE COUNT INC
Hypersensitivity reactions to drugs
Tissue necrosis (MI, burns, certain CA) uremia, diabetic ketoacidosis
Myelogenous Leukemia
Epinephrine and Lithium
HEMATOLOGICAL TESTS
-
7/29/2019 Hospi Clin Review
148/349
NEUTROPENIA
decreased number of neutrophils
- overwhelming infection of any type
- Viral infections (mumps, measles)- Idiosyncratic drug reactions
- Chemotherapy
HEMATOLOGICAL
TESTS
-
7/29/2019 Hospi Clin Review
149/349
TESTS
BASOPHILS referred as MAST CELLS
BASOPHILIA CML (ChronicMyelogenous Leukemia)
A decrease in number is not
apparent.
HEMATOLOGICALTESTS
-
7/29/2019 Hospi Clin Review
150/349
TESTS
EOSINOPHILS
EOSINOPHILIA acute allergic
reactions and parasitic infestations
HEMATOLOGICAL
TESTS
-
7/29/2019 Hospi Clin Review
151/349
TESTS
LYMPHOCYTES
produce antibody
B lymphocytes(antibody mediated)
T lymphocytes(cell mediated)
LYMPHOCYTOSISviral infection
LYMPHOPENIAimmunodeficiency, AIDS
HEMATOLOGICALTESTS
-
7/29/2019 Hospi Clin Review
152/349
TESTS
MONOCYTES
phagocytic cells
MONOCYTOSIS
TB, subacute bacterial endocarditis
HEMATOLOGICAL TESTS
-
7/29/2019 Hospi Clin Review
153/349
C. Platelets (thrombocytes)
smallest formed elements in the blood
Thrombocytopenia: idiopathic thrombocytopenic
purpura, or from drugs as quinidine and sulfonamides
COMMON SERUM ENZYMETESTS
-
7/29/2019 Hospi Clin Review
154/349
A. Creatinine Kinase (CK) Formerly known as Creatine Phosphokinase
myocardium, skeletal muscles and brain tissue
aids in the diagnosis of acute myocardial or skeletalmuscle damage
() vigorous exercise, a fall, deep IM injection
COMMON SERUMENZYME TESTS
-
7/29/2019 Hospi Clin Review
155/349
B. Lactate Dehydrogenase (LDH)
LDH1, LDH2 heart
LDH3 lungs LDH4 and LDH5- liver and skeletal muscle
COMMON SERUM
ENZYME TESTS
-
7/29/2019 Hospi Clin Review
156/349
ENZYME TESTS
C. Alkaline Phosphatase (ALP)
Inc.: partial or mild biliary obstruction,
increase osteoblastic activity (Pagetsdisease, hyperparathyroidism, or
osteomalacia)
COMMON SERUMENZYME TESTS
-
7/29/2019 Hospi Clin Review
157/349
D.Aspartate Aminotransferase (AST) SGOT (Serum Glutamic Oxaloacetic
Transaminase)
Major (heart, liver tissues); minor (skeletalmuscle, kidney tissue, pancreatic tissue)
COMMON SERUMENZYME TESTS
-
7/29/2019 Hospi Clin Review
158/349
E. Alanine Aminotransferase (ALT)
SGPT (Serum Glutamic Pyruvic
Transaminase)
Found in the liver (major), heart, skeletalmuscles, and kidney
COMMON SERUM ENZYMETESTS
-
7/29/2019 Hospi Clin Review
159/349
TESTS
F. Cardiac Troponins (I, T, and C)
I (cardiac muscles)
C (skeletal and cardiac muscles) T (cardiac and skeletal muscles)
LIVER FUNCTION
TESTS
-
7/29/2019 Hospi Clin Review
160/349
TESTSA. Liver enzymes (LDH, ALP, AST, ALT)
- only indicate liver damage NOT livers ability tofunction
B. Serum Bilirubin
BILIRUBIN breakdown product of Hb;predominant pigment of the bile
3 major causes of increase (jaundice)
Hemolysis Biliary obstruction
Liver Necrosis
URINALYSIS
-
7/29/2019 Hospi Clin Review
161/349
1.APPEARANCE normal: clear, pale yellow todeep gold
Red color presence of blood or
phenolphthalein
Brownish yellow color presence of direct
bilirubin
Red, orange, yellow, brown drugs
(rifampicin)
URINALYSIS
-
7/29/2019 Hospi Clin Review
162/349
2. pH normal: 4.5 9
3. SPECIFIC GRAVITY normal: 1.003 1.035
() DM, Nephrosis; () Diabetes insipidus
4. PROTEIN abnormal glomerular permeability
- PROTEINURIA
- ALBUMINURIA
URINALYSIS
-
7/29/2019 Hospi Clin Review
163/349
5. GLUCOSE GLYCOSURIA (+) DM
6. KETONES
KETONURIA uncontrolled DM, starvation,or low CHO diets
URINALYSIS
MICROSCOPIC EVALUATION
-
7/29/2019 Hospi Clin Review
164/349
MICROSCOPIC EVALUATION
- Normal: 0 1 RBC, 0 4 WBC, occasional casts
HEMATURIA trauma, tumor, systemic
bleeding disorder
(+) squamous cell vaginal contamination(menstruation)
CASTS (+) renal disease
CRYSTALS
BACTERIA UTI
RENAL FUNCTION TESTS
-
7/29/2019 Hospi Clin Review
165/349
A. BUN (BLOOD UREA NITROGEN)UREA end product of purine metabolism,produced by liver, excreted by kidneys
Inc.: renal disease
Dec.: significant liver diseaseB. SERUM CREATININE
CREATININE metabolic breakdown product of
muscle creatinine phosphateC. CREATININE CLEARANCE
Cockroft and gault
-
7/29/2019 Hospi Clin Review
166/349
CLcr(male) mL/min
= [(140 -age in yr) (BW kg)]
[72 x Pcr in mg/dL]
CLcr(female) = CLcr male x 0.85
ELECTROLYTES
-
7/29/2019 Hospi Clin Review
167/349
Sodium (Na+)
major extracellular fluid cation
Hyponatremia Total body depletion of Na
mineralocorticoid deficiency
Overhydration
CHF
Cirrhosis renal failure
ELECTROLYTES
-
7/29/2019 Hospi Clin Review
168/349
Hypernatremia
Loss of free water
DI
Excessive Na intake
Impaired Na excretion
ELECTROLYTES
-
7/29/2019 Hospi Clin Review
169/349
B. Potassium (K+)most abundant intracellular cation
Hypokalemia
Excessive mineralocorticoid activity Vomiting, diarrhea, laxative abuse
Diuretic use (mannitol, loop, thiazides)
Glucosuria
ELECTROLYTES
-
7/29/2019 Hospi Clin Review
170/349
Hyperkalemia
Renal insufficciency, excessive intake, drugs
During vigorous exercise
Cellular breakdown
Metabolic acidosis
ELECTROLYTESC. Chloride (Cl-)
-
7/29/2019 Hospi Clin Review
171/349
C C o de (C )
major extracellular anion; maintains acid basebalance
Hypochloremia Excessive loss of GI fluids, CRF
Diuretic therapy, Fasting, Adrenal Insufficiency
Hyperchloremia ARF, Dehydration, excessive salt/ Cl intake
MINERALS
-
7/29/2019 Hospi Clin Review
172/349
C. Magnesium
2nd most abundant intra and extracellular cation
nerve conduction
muscular contractility membrane transport and integrity
MINERALS
-
7/29/2019 Hospi Clin Review
173/349
Hypomagnesemia
- poor intestinal absorption
- excessive GI loss
Hypermagnesemia- increased intake w/ RF
- Hepatitis
- Addisons disease
MINERALS
-
7/29/2019 Hospi Clin Review
174/349
Calcium (Ca2+) bone and tooth structural integrity
nerve impulse transmission
muscle contraction pancreatic insulin release
H+ release from stomach
cofactor for some enzyme reactions
blood coagulation
MINERALSHypocalcemia
deficiency in production or response to parathyroid
-
7/29/2019 Hospi Clin Review
175/349
- deficiency in production or response to parathyroid
hormone- Hypoparathyroidism
- Pseudohypoparathyroidism
- Hypomagnesemia
- Low intake of vit D
- Loop diuretics
Hypercalcemia
- Hyperparathyroidism
- Pagets disease
- high intake of Ca or vit D
- Thiazide therapy
MINERALSB. Phosphate (PO4)
j i t ll l i h h t f
-
7/29/2019 Hospi Clin Review
176/349
major intracellular anion, phosphate source for
ATP synthesis- influenced by Ca (inversely proportional)
Hyperphosphatemia- low Vit D intake
- Hypoparathyroidism
- hyperthyroidism
Hypophosphatemia
- Al containing or Ca acetate containing antacids- chronic alcoholics
- Hyperparathyroidism
- High vit D
OTHER LABORATORY
TESTS
-
7/29/2019 Hospi Clin Review
177/349
A. Prothrombin Time (PT) Warfarin monitoring
Extrinsic Pathway: Factors II, VII, IX, X (1972)
N: 10-12 sec Inc PT
Inadequate Vit K in the diet
Drugs (coumarins)
OTHER LABORATORY
TESTS
-
7/29/2019 Hospi Clin Review
178/349
B. Activated Partial Thromboplastin Time (aPTT) Intrinsic Pathway : Factors VIII, IX, XI, XII
Common Pathway: Factors II, V, X
MONITORS Heparin Therapy N: 21- 45 sec
Inc aPPT
Severe liver dysfunction
Inadequate vit K Poor or inadequate nutrition
-
7/29/2019 Hospi Clin Review
179/349
Clinical Pharmacy for
Common Diseases
1. Hypertension
-
7/29/2019 Hospi Clin Review
180/349
1. Primary/ essential
2. Secondary/ underlying disease
-
7/29/2019 Hospi Clin Review
181/349
Stages of hypertension
-
7/29/2019 Hospi Clin Review
182/349
Systolic (+19) Diastolic (+9) Remedy
normal 100
Other types
-
7/29/2019 Hospi Clin Review
183/349
Emergency HPN (BP 180/120) with targetorgan damage
Gestational HPN (BP 140/90) Pregnancy induced
-no underlying Dx
DOC: Methyldopa
Non pharmaceutical treatmentin HPN
-
7/29/2019 Hospi Clin Review
184/349
1.stop smoking2. limit sodium intake
3. limit alcohol intake
4. exercise
5. healthy diet
6. loose weight
-every 10kg lost in weight BP drops
-
7/29/2019 Hospi Clin Review
185/349
CHOICE OF ANT
HYPERTENSIVE DRUGS
BASED ON PATIENT
CHARACTERISTIC
1. DM + kidney disease
-
7/29/2019 Hospi Clin Review
186/349
Ace inh and aRBSC/I: thiazide diretics
S/E: hyperuricimia (incuric acid and TGA)
Hypertriglyceremia
Hyperglycemia
2. CHF ( congestive heart failure)
-
7/29/2019 Hospi Clin Review
187/349
-signs and symptoms edema bipedaledema
- ace inh + diuretics
CCBs only severe oxidation
Effects: vasodilaton
-
7/29/2019 Hospi Clin Review
188/349
3.) Miocardial infarctionAce Inh + b-blockers
4.) asthama or with pulmonary disease
Asthma- not for b-blockers
Selective BEAMS dec sensitivity to high
dose- bronchoconstriction
DIABETES MELLITUS
-
7/29/2019 Hospi Clin Review
189/349
Risk factor: obese
BMI: kg/m2
Based on BMI
-
7/29/2019 Hospi Clin Review
190/349
30 Obese II
Complication
-
7/29/2019 Hospi Clin Review
191/349
a. macrovascular (CAD, MI)b. microvascular
1. retinopathy
2. neuropathy
3. nephropathy
-
7/29/2019 Hospi Clin Review
192/349
Post prandialInsulin will be released
-to utilize glucose ( glycogen storage)
Obese: always eat
-receptors become insensitive to insulin
-glucose accumulate
Diagnosis
-
7/29/2019 Hospi Clin Review
193/349
1. Fasting blood sugar
6-8 hrs fasting
-screening of fat
2. RBS-(randomized blood sugar)
-
7/29/2019 Hospi Clin Review
194/349
N (mg/dL)impaired DM
FBS 126
RBS 200
-
7/29/2019 Hospi Clin Review
195/349
Type I Type IICauses Insulin dependent Non insulin
dependent
autoimmune Increase
glucose uptake
Antibodie are
againsta beta cell
Insulin
resistance
Impaired insulinsecretion
T I vs T II
age early Delayed
-
7/29/2019 Hospi Clin Review
196/349
age early Delayed
FMH - +
body thin obese
sy - +
symptoms Polyphagia-
Polydipsia
Polyuria
Asymptomatic
Ketone bodies (+) (-)
Gestational diabetes
-
7/29/2019 Hospi Clin Review
197/349
When pregnantinsuin resistant DM screening 50g glucose
challenge(interferes with release of insulin)
Confirmatory test- 100glucose/ tolerance
Test (3 hrs ,140 RO)
DOC: insulin sq lipid
Inhibitors of insulin
-
7/29/2019 Hospi Clin Review
198/349
a. glucosan b. epinephrine
c. NE
d.cortisol e. growth hormone
TX for DM type II
-
7/29/2019 Hospi Clin Review
199/349
Step 1
SI: lifestyle modification, diet, exercise,
Step II: OHA
-
7/29/2019 Hospi Clin Review
200/349
a.) sulfonyl urea( glipizide, glibenclamide) Adv: most fast blood glucose reduction
AE: weight gain, hypoglycaemia
b.) biguanide (metformin)
-obes patient
- adv: good lipid profile
AE: metabolic acidosis
-
7/29/2019 Hospi Clin Review
201/349
c. Alpha-glucosidae inhibitor (acarbose)Ae: gi flatulence
d. insulin sensitizer ( thiazolidine)resiglitazone
step III
-
7/29/2019 Hospi Clin Review
202/349
insulin
a.) rapid acting (insulin aspo, aspu, gluco)
b. slow acting (reg insulin, pregnant IV)c. intermediate (NPH) neutral protein of
hagedorn
d.) long acting- glargne (lantus)
BRONCHIAL ASTHMA
SEVERITY MILD MID/MODERATE SEVERE
-
7/29/2019 Hospi Clin Review
203/349
SEVERITY MILD MID/MODERATE SEVERE
Daytime sy
-
7/29/2019 Hospi Clin Review
204/349
Sx/Sy: dyspnea ( diff in beam)
Orthopenea ( diff in breathing in supine)
Paroxysmal nocturnal dyspnea (sudden and
nightly)
New York heart association
CI Within the limit of normal
-
7/29/2019 Hospi Clin Review
205/349
CI Within the limit of normal
CII Ordinary extraction (dyspnea)
CIII Less than ordinary exertion
CIV At rest
DOC ACE inh delivered first line
-
7/29/2019 Hospi Clin Review
206/349
HOSPITAL PHARMACY
THE HOSPITAL
-
7/29/2019 Hospi Clin Review
207/349
A hospital has been defined in terms of itsform, that is, its physical make up and the
quantitative nature of its services.
Clinic
-
7/29/2019 Hospi Clin Review
208/349
a facility or area where ambulatorypatientsare seen for special study and
treatment bya group of physicians
practicing together, andwhere the patient
is not confined in a hospital.
Classification of hospital
-
7/29/2019 Hospi Clin Review
209/349
Type of service
General
Special
- patient w/ any type of illness
- ex: cancer, psychiatric, pediatric
Classification of hospital
-
7/29/2019 Hospi Clin Review
210/349
Length of stay
Short-term -
Long-term
< 30 days
- 30 days
Classification of hospital
-
7/29/2019 Hospi Clin Review
211/349
- federal & state hospitals
(county & city hospitals)
- non-profit oriented: church
operated
- profit oriented: individual,
partnership & corporation
Ownership Governmental
Non-governmental
Classification of hospital
-
7/29/2019 Hospi Clin Review
212/349
Bed capacity Under 50 beds
50-99 beds
100-199 beds 200-299 beds
300-399 beds
400-499 beds
500 beds & over
Supporting Services
-
7/29/2019 Hospi Clin Review
213/349
1. Nursing service
2. Dietary service
3. Central supply
service
- nursing care
- procurement, planning &
preparation of food for the
patient & hospital staff
- supplies sterile linen, OR
packs & other medicalsurgical supplies
Supporting Services
-
7/29/2019 Hospi Clin Review
214/349
4. Medical recordservice - serve as basis for planning& continuity of patient care
- provide data for use in
research education
- serve as basis for review&evaluation of the care
rendered to the patient
Supporting Services
-
7/29/2019 Hospi Clin Review
215/349
5. Blood bank
6. Pathology
- generally under thesupervision of a licensed
physician who has a basic
interest in hematology
- cytological & gross anatomical
analysis
- clinical laboratories
Supporting Services
-
7/29/2019 Hospi Clin Review
216/349
7. Radiology
8. Anesthesia
9. Medical social
service
- diagnostic & therapeuticapplication of radiant energy
- anesthesia care
- very important liaison
between the hospital & the
patient & his community
Main type of Medical Staff
-
7/29/2019 Hospi Clin Review
217/349
OPEN STAFF - one in which certain
physicians, other than
those on the attending or
active medical staff, areallowed to use the private
room facilities
These physicians are
termed members of the
courtesy medical staff.
CLOSE STAFF - one in which all
professional services,
private & charity are
provided and controlledby the attending or active
medical staff
Specific Types of Medical Staff
-
7/29/2019 Hospi Clin Review
218/349
1. Honorary staff
- consists of former staff members, retired
or emeritus, & of other practitioners whomthe medical staff chooses to honor
Specific Types of Medical Staff
-
7/29/2019 Hospi Clin Review
219/349
2. Active staff- responsible for the delivery of the
pre-ponderance of medical service within
the hospital
- most involved in the organizational &
administrative duties pertaining to themedical staff
Specific Types of Medical Staff
-
7/29/2019 Hospi Clin Review
220/349
3. Associate staff
- consists of individuals who are being
considered for advancement to the activemedical staff
- appointed & assigned to the various
services in the same manner as aremembers of the active medical staff
Specific Types of Medical Staff
-
7/29/2019 Hospi Clin Review
221/349
4. Courtesy staff- consists of practitioners who are
eligible for staff membership, who are
given privileges to admit an occasionalpatient to the hospital
- may neither vote nor hold office in the
medical staff organization
Specific Types of Medical Staff
-
7/29/2019 Hospi Clin Review
222/349
5. Consulting staff
- consists of medical practitioners of
recognized professional ability who are notmembers of the preceding categories of
staff membership
Specific Types of Medical Staff
-
7/29/2019 Hospi Clin Review
223/349
6. Resident staff
- receiving specialized clinical training
in a hospital, usually after completing aninternship
Hospital PharmacistsResponsibilities
-
7/29/2019 Hospi Clin Review
224/349
I. Central pharmacists responsibilitiesA. Dispensing Area
1. Ensures that established policies and
procedures are followed2. Checks for accuracy of dose prepared:
a) IV admixture
b) unit dose
Hospital PharmacistsResponsibilities
-
7/29/2019 Hospi Clin Review
225/349
3. Provides for proper drug control:a) Ensures that drugs are stored and
dispensed properly and
b) ensures that all drug laws arefollowed
4. Ensures that good techniques are used in
compounding IV admixtures andextemporaneous preparations
Hospital PharmacistsResponsibilities
-
7/29/2019 Hospi Clin Review
226/349
5. Provides for proper record keeping andbilling:
a) patient- medication records,
b) extemporaneous compounding records,c) IV admixture records and billing
d) investigation- drug records
e) reports
Hospital PharmacistsResponsibilities
-
7/29/2019 Hospi Clin Review
227/349
6. Maintains professional competence,particularly in knowledge of drug stability
and incompatibilities
7. Ensures that new personnel are trainedproperly in the policies and procedures of
the dispensing area
8. Coordinates the activities of the area with
the available staff to make the best
possible use of personnel and resources
Hospital PharmacistsResponsibilities
-
7/29/2019 Hospi Clin Review
228/349
9. Keeps the dispensing area neat andorderly
10. Communicates with all pharmacy staffregarding new developments in the area
and assists in employee evaluations
Hospital PharmacistsResponsibilities
-
7/29/2019 Hospi Clin Review
229/349
11. Provides drug information as necessaryto the pharmacy, medical, and nursing
staffs
12. Coordinates the over- all pharmaceutical
needs of the patient- care areas with the
dispensing area
Hospital PharmacistsResponsibilities
-
7/29/2019 Hospi Clin Review
230/349
B. Patient- Care Area1. Supervision of drug administration:
A. reviews and interprets each unit dose
and IV admixture medication order toensure that it is entered accurately into the
unit dose or IV admixture system
Hospital PharmacistsResponsibilities
-
7/29/2019 Hospi Clin Review
231/349
B. confirms periodically that administereddoses are noted correctly on the patients
chart
C. ensures that records from administerednarcotics are kept correctly and that the
physician is informed of all automatic stop
orders
D. ensures that proper drug administration,
techniques are used
Hospital PharmacistsResponsibilities
-
7/29/2019 Hospi Clin Review
232/349
E. acts as liaison between the pharmacistand the nursing and medical staffs
F. communicates with nurses and
physicians concerning medication-administration problems
G. periodically inspects the medication
areas on the nursing units to ensure that
adequate levels of floor stock drugs and
supplies are maintained
Hospital PharmacistsResponsibilities
-
7/29/2019 Hospi Clin Review
233/349
H. ensures that drugs and supplies areprocured from the dispensing area as
required
I. ensures that the other supportiveservices performed by the department of
pharmacy are carried out correctly
J. coordinates all pharmacy services on the
nursing- unit level
Hospital PharmacistsResponsibilities
-
7/29/2019 Hospi Clin Review
234/349
K. ensures that the medication area is neatand orderly
L. ensures that proper security is maintainedin the medication area to prevent pilferage
Hospital PharmacistsResponsibilities
-
7/29/2019 Hospi Clin Review
235/349
2. Direct patient careA. identifies drugs brought into the
hospital by patients
B. obtains patient medication historiesand communicates all pertinent
information to the physician
C. assists in drug- product and entityselection
Hospital PharmacistsResponsibilities
-
7/29/2019 Hospi Clin Review
236/349
D. assists in drug- product and entityselection
E. assists the physician in selecting dosageregimens and schedules, then assigns
drug- administration times for these
schedules
Hospital PharmacistsResponsibilities
-
7/29/2019 Hospi Clin Review
237/349
F. monitors patients total drug therapy foreffectiveness/ uneffectiveness, side
effects, toxicities, allergic drug reactions,
drug interactions, and appropriate
therapeutic outcomes
G. counsels patients on:
a) medications to be self- administered in
the hospital
b) discharge medications
Hospital PharmacistsResponsibilities
-
7/29/2019 Hospi Clin Review
238/349
H. participates in cardiopulmonaryemergencies by:
a) procuring and preparing needed drugs,
b) charting all medications given
c) performing cardiopulmonary
resuscitation, if necessary
Hospital PharmacistsResponsibilities
-
7/29/2019 Hospi Clin Review
239/349
II. Ambulatory pharmacistsresponsibilities
A. Dispensing Area
1. Ensures that established policies andprocedures are follow
2. Checks for accuracy in the work ofsupportive personnel
Hospital PharmacistsResponsibilities
-
7/29/2019 Hospi Clin Review
240/349
3. Ensures that proper techniques are usedin extemporaneous compounding
4. Provides for adequate record keepingand billing: patient medication records,
investigational drug records, outpatient
billing, reports, and prescription files
Hospital PharmacistsResponsibilities
-
7/29/2019 Hospi Clin Review
241/349
5. Maintains professional competence
6. Ensures that new personnel are trained
properly in the policies and procedures ofthe ambulatory pharmacy
Hospital PharmacistsResponsibilities
-
7/29/2019 Hospi Clin Review
242/349
7. Coordinates the activities of the area withthe available staff to make the best use of
personnel and resources
8. Keeps the ambulatory pharmacy area
neat and orderly at all times
Hospital PharmacistsResponsibilities
-
7/29/2019 Hospi Clin Review
243/349
B. Patient Care Area1. Inspects the medication areas on the
nursing unit periodically to ensure an
adequate supply of stock drugs and their
proper storage
2. Identifies drugs brought into the clinic bypatients
Hospital PharmacistsResponsibilities
-
7/29/2019 Hospi Clin Review
244/349
3. Obtains patient-medication histories andcommunicates pertinent information to the
physician
4. Assists in drug product and entity
selection
5. Assists the physician in selecting dosage
regimens and schedules
Hospital PharmacistsResponsibilities
6
-
7/29/2019 Hospi Clin Review
245/349
6. Monitors the patients total drug therapyfor effectiveness, side effects, toxicities,
allergic drug reactions, drug interactions,
and appropriate patient outcomes
7. Counsels patients on the proper use of
their medication
Hospital PharmacistsResponsibilities
8 P di i f IV
-
7/29/2019 Hospi Clin Review
246/349
8. Prepares medications for IVadministration
9. Provides medications and/ or supplies forpatient home care
DivisionsAdministrative Services
1 Pl & di t d t t l ti iti
-
7/29/2019 Hospi Clin Review
247/349
1. Plan & coordinate departmental activities.2. Develop policies.
3. Schedule personnel & provide
supervision.4. Coordinate administrative needs of the
Pharmacy & Therapeutics Committee.
5. Supervise departmental office staff.
Education & Training
1 C di t f d d t &
-
7/29/2019 Hospi Clin Review
248/349
1. Coordinate programs of undergraduate &graduate pharmacy students.
2. Participate in hospital wide educationalprograms involving nurses, doctors, etc.
3. Train newly employed pharmacydepartment personnel.
Pharmaceutical Research
1 D l f l ti f d
-
7/29/2019 Hospi Clin Review
249/349
1. Develop new formulations of drugsespecially dosage forms not commercially
available & of research drugs.
2. Improve formulations of existing products.
3. Cooperate w/ the medical research staffon projects involving drugs
In-patient Services
1 P id di ti f ll i ti t f
-
7/29/2019 Hospi Clin Review
250/349
1. Provide medications for all in-patients ofthe hospital on a 24-hour per day basis.
2. Inspection & control of drugs on alltreatment areas.
3. Cooperate w/ medical drug research.
Out-patient Services
1 C d & di t ti t
-
7/29/2019 Hospi Clin Review
251/349
1. Compound & dispense out-patientprescriptions.
2. Inspect & control all clinic & emergency
service medication stations.
3. Maintain prescription records.
4. Provide drug consultation services to staff
& medical students.
Drug Information Services
1 P id d i f ti d & d
-
7/29/2019 Hospi Clin Review
252/349
1. Provide drug information on drugs & drugtherapy to doctors, nurses, medical &
nursing students & the house staff.
2. Maintain the drug information center.
3. Prepare the hospitals pharmacy
newsletter.
4. Maintain literature files
Departmental Services
1 C t l & di IV fl id
-
7/29/2019 Hospi Clin Review
253/349
1. Control & dispense IV fluids.
2. Control & dispense controlled substances.
3. Coordinate & control all drug delivery &
distribution systems.
Purchasing & Inventory Control
1 M i t i d i t t l
-
7/29/2019 Hospi Clin Review
254/349
1. Maintain drug inventory control.
2. Purchase all drugs.
3. Receive, store & distribute drugs.
4. Interview medical service representatives
Central Supply Services
1 D l & di t di t ib ti f
-
7/29/2019 Hospi Clin Review
255/349
1. Develop & coordinate distribution ofmedical supplies & irrigating fluids.
Assay & Quality Control
1 P f l d t
-
7/29/2019 Hospi Clin Review
256/349
1. Perform analyses on productsmanufactured & purchased.
2. Develop & revise assay procedures.
3. Assist research division in special
formulations
Manufacturing & Packaging
1 Man fact re ide ariet of items in
-
7/29/2019 Hospi Clin Review
257/349
1. Manufacture wide variety of items incommon use at the hospital.
2. Operate an overall drug packaging &
prepackaging program.
3. Undertake program in product
development.
4. Maintain a unit dose program
Sterile Products
1 Produce small volume parenterals
-
7/29/2019 Hospi Clin Review
258/349
1. Produce small volume parenterals.
2. Manufacture sterile ophthalmologics,
irrigating solutions, etc.
3. Prepare aseptic dilution of lyophylizal &
other unstable sterile injections foradministration to patients.
Radiopharmaceutical Services
1 Centralize the procurement storage &
-
7/29/2019 Hospi Clin Review
259/349
1. Centralize the procurement, storage &dispensing of radioisotopes used in clinical
practice
IV Admixture
1. Centralize the preparation of IV solution
-
7/29/2019 Hospi Clin Review
260/349
admixture.
2. Review each IV admixture for physico-chemical incompatibilities.
-
7/29/2019 Hospi Clin Review
261/349
PHARMACY AND
THERAPEUTICS COMMITTEE
Objective
To achieve optimal patient care and safety
th h ti l d th
-
7/29/2019 Hospi Clin Review
262/349
through rational drug therapy
Primary Purposes
Policy development
-
7/29/2019 Hospi Clin Review
263/349
- formulates policies regarding
evaluation, selection, and therapeutic useof drugs and related devices
Primary Purposes
Education
-
7/29/2019 Hospi Clin Review
264/349
- recommends or assists in the formulation
of programs designed to meet the needsof the professional staff for complete
current knowledge on matters related to
drugs and drug use
Organization
The PTC should be composed of at least
th ff ti b h i i
-
7/29/2019 Hospi Clin Review
265/349
the ff. voting members: physicians,
pharmacists, nurses, administrators,
quality assurance coordinators, and others
as appropriate.
Organization
A chairperson from among the physician
t ti h ld b i t d
-
7/29/2019 Hospi Clin Review
266/349
representatives should be appointed.
A pharmacist should be designated assecretary
Functions and Scope
To serve in an evaluative, educational,
d d i it t th di l t ff
-
7/29/2019 Hospi Clin Review
267/349
and advisory capacity to the medical staff
and organizational administration in all
matters pertaining to the use of drugs
To develop a formulary of drugs accepted
for use in the organization and provide for
its constant revision
Functions and Scope
To establish programs and procedures
th t h l f d ff ti d
-
7/29/2019 Hospi Clin Review
268/349
that help ensure safe and effective drug
therapy
To establish programs and procedures
that help ensure cost- effective drug
therapy
Functions and Scope
To establish or plan suitable educational
f th i ti
-
7/29/2019 Hospi Clin Review
269/349
programs for the organizations
professional staff on matters related to
drug use
To participate in quality assurance
activities related to distribution,
administration, and use of medications
Functions and Scope
To monitor and evaluate ADRs in the
health care setting and to make
-
7/29/2019 Hospi Clin Review
270/349
health- care setting and to make
appropriate recommendations to prevent
their occurrence
To initiate or direct (or both) drug use
evaluation program and studies, review
the results of such activities, and make
appropriate recommendations to optimizedrug use
Functions and Scope
To advise the pharmacy department in the
implementation of effective drug
-
7/29/2019 Hospi Clin Review
271/349
implementation of effective drug
distribution and control procedures
To disseminate information on its actions
and approved recommendations to all
organizational healthcare staff
Formulary System
Definition: A method whereby the medical
staff of an institution working through the
-
7/29/2019 Hospi Clin Review
272/349
staff of an institution, working through the
PTC, evaluates, appraises, and selects
from among the numerous available drug
entities and drug products those that areconsidered useful in patient care
Formulary
Definition: A continually revised compilation
of pharmaceuticals that reflects the current
-
7/29/2019 Hospi Clin Review
273/349
of pharmaceuticals that reflects the current
clinical judgement of the medical staff
Main Parts of a Formulary
Part I. Information on hospital policies and
procedures concerning drugs This
-
7/29/2019 Hospi Clin Review
274/349
procedures concerning drugs. This
includes:
1. categories of drugs
2. brief description of the PTC
3. hospital regulations regarding prescribing,
dispensing, and administration of drugs
4. pharmacy operating procedures5. information on using the formulary
Part II. Drug Product Listing
This is the heart of the formulary and
consists of descriptive entries for each
-
7/29/2019 Hospi Clin Review
275/349
consists of descriptive entries for eachformulary item plus one or more indices to
facilitate use of formulary. The entries may
be arranged in any of the ff. ways: alphabetically by generic name
alphabetically within therapeutic
class combination of the two systems
Those entries must contain the ff.
minimum information:
generic name of the basic drug entity
common synonyms and brand names
-
7/29/2019 Hospi Clin Review
276/349
common synonyms and brand names dosage form/s, strength/s, packaging/s
and size/s stocked by the formulary
formulation (active ingredients) of acombination of product
additional information such as: unusual
pediatric and adult dose, special cautionsand notes, controlled substances symbol
Part III. Special Information
This varies from hospital to hospital and may
include:
-
7/29/2019 Hospi Clin Review
277/349
include:
list of hospital- approved abbreviations
rules of calculating pediatric dosages dosing guides for patients with renal
impairment
lists of dialyzable poisons, etc.
Purchasing & Inventory Control
Turnover rate:
t f d ld
-
7/29/2019 Hospi Clin Review
278/349
cost of good sold
--------------------------------------------------------
average of beginning & ending inventory
Purchasing & Inventory Control
Low turnover causes:
d li ti f t k
-
7/29/2019 Hospi Clin Review
279/349
duplication of stocks
large purchases of slow moving items
dead inventoryHigh turnover causes:
small volume purchasing
Satisfactory turnover rate: 4 times a year
Dispensing
In-patient Dispensing
1 U f h l t f l ti
-
7/29/2019 Hospi Clin Review
280/349
1. Use of charge plate - use of a plastic or
metal card prepared on patients
admission
2. Envelope system - used to dispense
drugs to the nursing station & at the same
time is also used as a charge ticket
Dispensing
3. Drug basket method - used by hospitals
for stocking non-charge floor stock drugs
-
7/29/2019 Hospi Clin Review
281/349
for stocking non charge floor stock drugs& related products on the nursing station
4. Mobile dispensing unit - utilizes aspecially constructed stainless steel truck
5. Mechanical dispensing - Ex. Brewersystem
-
7/29/2019 Hospi Clin Review
282/349
I. Erroneous Prescription
The brand name precedes the generic
name
-
7/29/2019 Hospi Clin Review
283/349
name.
The generic name is the one in
parenthesis.
The brand name is not in parenthesis.
Prescription 1
-
7/29/2019 Hospi Clin Review
284/349
Erroneous prescription
II. Violative Prescription
The generic name is not written.
The generic name is not legible and a
-
7/29/2019 Hospi Clin Review
285/349
The generic name is not legible and a
brand name that is legible is written.
The brand name is indicated andinstructions added (such as the phrase
No substitution) that tend to obstruct,
hinder, or prevent generic dispensing.
Prescription 3
-
7/29/2019 Hospi Clin Review
286/349
Violative prescription
III. Impossible Prescription
Only the generic name is written but is not
legible
-
7/29/2019 Hospi Clin Review
287/349
legible.
The generic name does not correspond to
the brand name.
Both the generic name and the brand
name are not legible.
Prescription 5
-
7/29/2019 Hospi Clin Review
288/349
Impossible prescription
Procedures to be followed for each
incorrect prescription:
Erroneous prescriptions shall be filled. Such
prescription shall be kept and reported by
-
7/29/2019 Hospi Clin Review
289/349
prescription shall be kept and reported by
the pharmacist to the nearest DOH office
for proper action.
Violative or impossible prescriptions shall
not be filled. They shall be kept and
reported to the nearest DOH office forappropriate.
Drug Distribution Systems
The pharmacy department makes drugs
available at the nursing unit for patient use
-
7/29/2019 Hospi Clin Review
290/349
available at the nursing unit for patient use
usually in one of four ways:
1. a complete floor- stock system
2. individual prescription medication for each patient
3. a combination of 1 & 2
4. unit dose dispensing, either centralized in the pharmacyor decentralized at the nursing unit level
. Floor-stock System
used in small hospitals where pharmacists
are not available to dispense individual
-
7/29/2019 Hospi Clin Review
291/349
are not available to dispense individual
doses for patients.
2 classes
Free floor stock- consists of a
predetermined list of medications that are
-
7/29/2019 Hospi Clin Review
292/349
predetermined list of medications that are
available on every nursing unit of the
hospital for use at no specific charge to
the patient.
Charge floor stock- is medication available
at each nursing unit of the hospital and for
which a charge is made to the patient
Advantages:
ready availability of the required drugs
elimination of drug returns
-
7/29/2019 Hospi Clin Review
293/349
elimination of drug returns
reduction in number of drug order
transcriptions for the pharmacy
reduction in the number of pharmacy
personnel needed
Disadvantages possible increase in medication errors due to
elimination order review
-
7/29/2019 Hospi Clin Review
294/349
increased drug inventory on the pavilion
greater opportunity for pilferage
increased hazards associated with drugdeterioration
possible lack of proper storage facilities on the
ward
greater in roads are made upon the nurses time
II. Individual Prescription Order System-
used predominantly in small hospitals
where a pharmacist is not on the premises
-
7/29/2019 Hospi Clin Review
295/349
p p
all the time.
Advantages: reduced manpower requirements
individualized service
-
7/29/2019 Hospi Clin Review
296/349
individualized service
all medications directly reviewed by the
pharmacist
provides interaction of pharmacist, doctor,
nurse, and patient
provides closer control of inventory
Disadvantages: possible delay in obtaining required
medication
-
7/29/2019 Hospi Clin Review
297/349
increase in cost to the patient
III. Combination of I & II-
use the individual drug order system as
the primary means of dispensing but also
-
7/29/2019 Hospi Clin Review
298/349
p y p g
utilize a limited floor stock; most commonly
used, incorporates unit-dose dispensing
as well.
IV. Unit Dose Dispensing-
the pharmacist prepares every dose of
medication ready for administration
-
7/29/2019 Hospi Clin Review
299/349
y
Advantages: improved pharmaceutical service 24 hours
a day and patients are charged only those
-
7/29/2019 Hospi Clin Review
300/349
y p g y
doses which are administered to them
all doses are prepared in the pharmacy
giving nurses more time for direct patientcare
allows checking or interpreting of the
doctors original order thus reducingmedication error
Advantages
eliminates excessive duplication of orders
and paper works at the nursing station and
-
7/29/