Exam 2 Flashcards
(160 cards)
1
Q
Adherence
A
extend to which medication intake behavior corresponds with the recommendations of the provider
2
Q
Compliance
A
extent to which the patient follows the recommendations of the provider
3
Q
Persistence
A
Length of time between the first and last dose (when pt disc med)
4
Q
Unintentional nonadherence
A
unplanned behavior that is not commonly linked to beliefs or cognition
5
Q
Intentional nonadherence
A
patient ACTIVELY decides not to use treatment or follow recommendations
6
Q
How to calculate PDC (proportion of days covered)
A
(# of days in period “covered” / # of days in period)*100
7
Q
How to calculate MPR (medication possession ratio)
A
(sum of days’ supply for all fills in period / # of days in period)*100
8
Q
Implications of STAR ratings
A
reimbursement
insurance contracts
pharmacist responsibility
9
Q
STAR ratings are evaluated based on what
A
MTM complete rate
Statin use in diabetes
Adherence to diabetes med
Adherence to statins
Adherence to ACE-I/ARB
10
Q
What are the 5 dimensions of adherence
A
Social and Economic
Health Care System
Condition Related
Therapy Related
Patient Related
11
Q
Common contributing factors to nonadherence
A
adverse effect
cost
lack of understanding
forgetfullness
regimen complexity
12
Q
Investigating medication nonadherance objective information
A
claims data
clinical data
13
Q
Investigating medication nonadherence subjective information
A
motivational interviewing
creating no-judgement / honest environment
14
Q
Overcoming medication nonadherence adverse effect: perceived vs actual
A
perceived (patient eduation)
actual (prescribe alternative, switch formulation, review risk vs benefit and severity of symptoms)
15
Q
How to overcome medication nonadherence cost
A
manufacture coupons
insurance formulary
med assistance program
help pt select best insurance plan
utilize mail order pharmacy to lower copay
16
Q
What 4 things should you educate patients on
A
indication
administration
benefits
risk
17
Q
How to overcome medication nonadherence forgetfulness
A
set alarm
note around house
help pt incorporate it into routine
dose packaging or pill box
engage fam to help with adherence
18
Q
How to overcome medication nonadherence complexity
A
review: med list for duplicates and deprescribe when possible
change: change product or formulation to decrease dosing frequency
utilize: med synch at pharmacy
enroll: pt in adherence packaging
19
Q
Why do pharmacists need to assess patients
A
first line of communication
recognize when to refer to ER vs PCP
symptoms safe to treat at home
20
Q
Elements Needed to Assess Patient Illness
A
Characteristic patterns of signs and symptoms associated with each disorder
Characteristic presentation of potential drug-related problems
Chronic disease guidelines for diagnosis and treatment of specific disorder
21
Q
How to obtain a patients history
A
Start with open ended questions
Follow-up with more open ended or probing questions
Use LOQQSAM
Summarize the patient complaints/problems
22
Q
LOQQSAM
A
Location
Onset
Quality
Quantity
Setting
Associated Symptoms
Modifying Factors
23
Q
Hematologic Symptoms
A
Bleeding + Bruising
Stroke (Facial droop, Arm drop, Slurred speech, Time to call 911)
DVT (redness, swelling, pain)
24
Q
Metabolic Symptoms
A
Hyperglycemia
Hypoglycemia
25
What are the 5 vital signs
Temp
BPM
RR
Blood Pressure
Pain
26
Orthostatic Hypotension
Blood pressure that decreases when rising from sitting/lying to standing
-systolic BP decrease of at least 20 mmHg or diastolic blood pressure decrease of at least 10 mmHg
27
Measuring Orthostatics
1. Patient lays down for 5 minutes
2. Check blood pressure and pulse rate
3. Patient stands
4. Check blood pressure and pulse rate after 1 minute
5. Check blood pressure and pulse rate after 3 minutes
28
US Preventative Service Task Force (USPSTF)
Independent panel of experts in primary care and prevention
Systematically review evidence to develop recommendations for clinical preventative series
29
APP: AHRQ ePSS
Allows you to type in a patient's characteristics and receive a list of the required / recommended / suggested preventative services
30
Preventative Service Grade A
USPSTF recommends the service
High certainty net benefit is substantial
31
Preventative Service Grade B
USPSTF recommends the service
High certainty net benefit is moderate to substantial
32
Preventative Service Grade C
USPSTF recommends selectively offering or providing the service to individual patients based on professional judgement and patient preference
Moderate certainty that net benefit is small
33
Preventative Service Grade D
USPSTF recommends against the service
Moderate or high certainty that the service has no net benefit or that harms outweigh benefits
34
Preventative Service Grade I
USPSTF concludes current evidence is insufficient to assess balance for benefits and harms of the service
35
What does the PHQ-9 test for
depression
36
What does GAP-7 test for
anxiety
37
What is the progressive risk of diabetic feet
Over time uncontrolled blood sugar can damage nerves.
– This damage leads to diabetic neuropathy and loss of protective sensation in the extremities
38
Risk Factors for diabetic feet
poor glycemic control
neuropathy
cigarette
PAD
amputation
visual impairment
CKD
39
How to decrease risk for diabetes foot amputations
control blood sugar
quit smoking
foot care education
annual foot exam
refer high risk patients
treat for PAD
40
What is the 5 step program for Lower Extremity Amputation Prevention
– Annual Foot Screening
– Patient Education
– Daily Self Inspection
– Footwear Selection
– Management of Simple Foot Problems
41
What is the 3 step process for monofilament diabetic foot exam
Use a 3 step sequence that includes (1) touch the
skin, (2) bend the filament, and (3) lift from the skin
42
What does risk category 0 mean for diabetic feet
Diabetes, but no loss of protective sensation
in feet
43
What does risk category 1 mean for diabetic feet
Diabetes, loss of protective sensation in feet
44
What does risk category 2 mean for diabetic feet
Diabetes, loss of protective sensation in feet
with high pressure (callout/deformity), or poor
circulation
45
What does risk category 3 mean for diabetic feet
Diabetes, history of plantar ulceration or
neuropathic fracture
46
Category 0 Management
Education emphasizing disease control, proper
shoe fit/design
Follow-up yearly for foot screen
Follow as needed for skin/callus/nail care or
orthoses
47
Category 1 Management
Education emphasizing disease control
Proper fitting/design footwear
Routine follow-up 3 – 6 months
48
Category 2 Management
Education emphasizing disease control
Depth-inlay footwear, molded/modified
orthoses
Routine follow-up 1 – 3 months
49
Category 3 Management
Education emphasizing disease control
Depth-inlay footwear, molded/modified orthoses
Routine follow-up 1 – 12 week
50
Diabetic feet education
Look between your toes
Shoe selection
Check inside of shoes
Skin care
Treat dry skin
Nail care
Corn and callus care
51
What is POC testing
Medical testing at or near the site of patient care
Performed outside a laboratory using portable devices, test kits or cartridges
52
Advantages of POC testing
improve patient outcome
expedite medical decision making
allows for testing in a variety of locations
smaller sample volumes minimizes patient discomfort
53
Disadvantages of POC testing
Variable levels of training and experience
Competency assessments and trainings can be challenging
Not all are approved for use as a replacement o lab monitoring
Costs may be higher
54
Blood Glucose POC testing
Clean finger with alcohol swab, put strip into meter, lance finger, wipe first drop away, put strip up to drop of blood, give cotton ball and bandage for finger. Clean up appropriately
(International Normalized Ratio (INR))
55
Flu testing
Swab back of throat/nose, mix swab with solution in tube or machine (varies), wait for result with solution in machine or use test strip.
56
Covid-19 testing
Type 1: PCR tests (nasal swab)
Type 2: Antigen tests (rapid) (throat and nasal swab)
57
Human immunodeficiency virus POC testing
Saliva-based
Fingerstick, oral swab, or urine
Collect, mix with buffer, wait for result
58
Hepatitis C POC testing
Saliva-based
Fingerstick
Collect, mix with buffer, wait for result
59
What is PPM (provider performed microscopy)
Microscopic examinations performed by healthcare provider during a patient
visit
-involves specimens that are not easily transportable
-requires appropriate clinical privileges
60
What is urinalysis
Urine dipstick and sediment examination
obtain midstream, examine w/in 2 hours, place 10 mL in centrifuge for 5 min, invert tube and drain, review drop on glass slide
61
What is CLIA (clinical lab improvement amendments)
Requires facilities that examine register with CMS
Waived tests must use unprocessed specime
apply for CMS Form 116
Renew every 2 years
62
What is needed when handling specimen
two patient identifiers
Label any specimen tubes/containers with patient name and unique identifier
63
Morbidity
Refers to the state of having a specific illness or condition
64
Mortality
Refers to the number of deaths that have occurred dude to specific illness or condition
65
Health disparity
Differences in the incidence, prevalence, mortality, and burden of disease and other adverse health conditions that exist among specific population groups
66
What are health disparities groups often defined by
Race
Gender
Level of education
Socioecominic status
Geographic location of residence
67
What factors contribute to disparities
Lack of health care coverage
Socioeconomic status
Medical care
Patient related factors
68
What healthcare provider education is being done about disparities
Population based care
SDOH
Cultural competence
69
Primary focus population areas for healthcare education
Infant
Cancer
ASCVD
Diabetes
HIV
Immunization
Asthma
Substance abuse
Arthritis
Mental health
LGBTQ
70
Economic stability key issues
Poverty
Employment opportunities
Economic inequality
Housing instability
71
Education key issues
Poor education
Low literacy
Language barriers
72
Health care access and quality key issues
Access to health care
Health literacy
Access to primary care
73
Neighborhood and built environment key issues
Access to healthy foods
Housing/neighborhood quality
Safety/care
Environment conditions
74
Neighborhood and built environment key issues
Access to healthy foods
Housing/neighborhood quality
Safety/care
Environment conditions
75
Social and community context key issues
Discrimination, segregation, and inequality
Civic participation
Community support
Social cohesion
76
Culture
set of learned and shared beliefs and values that are applied to social interactions and to the interpretation of experience
77
Race
sociopolitical construct, having no scientific or anthropologic basis
socially defined category that divides people into groups on the basis of distinct physical traits and characteristics
78
Ethnicity
related to one's identity with a group that shares a history, religion, nationality, cultural patterns
social groups with a shared history, identity, geography, cultural roots regardless of racial difference
79
Complementary and alternative medicine practice (CAM)
health care efforts initiated by individual that are not presently considered an integral part of convention medicine
80
Examples of CAM practices
alternative medical systems
mind-body interventions
biologically based therapies
manipulative and body based methods
energy therapies
81
Traditional Healers
individuals who provide health care to their community by using plant resources, tenets of social and cultural belief
82
Cultural Competency
a set of attitudes, knowledge and skills which enhance a clinician's understanding and awareness, ability to adapt
83
Disease
abnormalities in the structure and function of body organs and systems
(physical phenomenon)
84
Illness
personal, interpersonal and cultural reactions to disease or discomfort shaped by cultural factors governing perception, labeling, explanation and evaluation of the discomforting experience
(sociological phenomenon)
85
Predictors of behavioral ethnicity
emigration from rural area
inexperience with western medicine
limited formal education
low socioeconomic status
segregation in ethnic subculture
86
Reasons for home remedy use
inadequate health education
poverty
limited access to health care
skepticism of western health
racial and cultural beliefs
region of residency
87
Cultural-Bound Syndromes
Limited to specific societies or cultural areas and are localized diagnostic categories that frame coherent meaning for certain repetitive, patterned, and troubling sets of experiences and observations
88
What are the 6 requirements for an ideal inhaler
Effective
Efficient
Engaging
Error-tolerant
Easy to teach
Easy to switch
89
What are the 3 inhaler classes
Metered Dose Inhaler (MDI)
Soft Mist Inhaler (SMI)
Dry Powder Inhaler (DPI)
90
What are the different kinds of metered dose inhalers
bronchodilators (ventolin)
corticosteroids (flovent)
combination (advair, dulera)
91
What are the advantages of metered dose inhalers
small size
inexpensive
dose quickly administered
92
What are the disadvantages of metered dose inhalers
requires coordination
deposits 10-20% of med into lungs
localized adverse effects
93
How do metered dose inhalers work
delivers consistent amount of pressurized medication as a fine mist
94
How to use a metered inhaler
shake, remove cap, prime
exhale completely, press down, hold breath 10 sec
replace cap, rinse mouth (steroids only)
95
Maintenance Specifications for metered dose inhalers
clean by holding under warm water for 30 sec, air dry
propellent may produce unmedicated mist once canister is empty
96
Benefits for spacers
reduces oropharyngeal deposition
increase admin in lungs
reduce coordination
97
What does a respimat inhaler do
deliver med with slower delivery and longer duration
-reduce need for coordination of breath
generate mist independent of pt inhalation
higher fine particle fraction (increased med deposition)
98
What are the different respimat inhalers
bronchodilators (combivent, spiriva, stiolto)
99
Advantages of respimat inhaler
easy to use
propellent free
-no shaking, no mist released when empty
100
Disadvantages of respimat
requires assembly
priming
increased cost
101
How to use a respimat inhaler
prime by turning base 180 three times, press dose release button
open cap, exhale, press dose, hold breath 5-10 sec
(full prime if unused for 21 days)
102
Maintenance specifications for respimat
damp cloth or tissue to clean
monitor dose counter (refill when red area on scale)
discard 3 months
103
What is a dry powder inhaler
dependent upon patient inhalation to carry med
micronized powder with large inactive carrier powder
104
What are the powder inhalers
bronchodilators (incruse, serevent)
corticosteroids (pulmicort, flovent)
combination (breo, advair)
105
Advantages of powder inhalers
coordination not needed
106
Disadvantages of powder inhalers
diminished dose delivery if breath slowly
med doses may clump with humidity
107
How to use a powder inhaler
open mouthpiece, load dose
exhale, inhale quickly and deeply
hold breath 10 sec
108
What is the proair respiclick
open red cap fully until click heard
do not block vent above mouthpiece
close cap after inhalation
cant use spacer
109
What is the spiriva handihaler
separate capsule must be loaded into center chamber
instruct patient not to swallow capsule***
close mouthpiece, press button once
after dose remove capsule
110
What is the diskus
hold horizontally with dose
slide lever from left to right
meds (flovent, serevent, advair)
111
What is the ellipta
open cover until click heard
hold without blocking vents
close cover over top
(breo, anoro, incruse, trelegy)
112
What is the asmanex twisthaler
hold pink base and twist cap counter clockwise
hold horizontally when placeing mouthpiece
replace cap and turn clockwise until click heard
113
What is the pulmicort flexhaler
twist brown grip fully in one direction
twist back until click
replace cover and twist shut
114
What is the tudorza pressair
green button on top
control window show a red to green color change
click heard when dose inhaled
make sure it returns to red color
115
Maintenance specifications with powder inhalers
wipe mouthpiece with dry cloth
monitor amount remaining with dose counter
116
What is a small volume nebulizer
convert liquid med into mist
face mask
for emergency situations
-jet: uses gas to aerosolize
-ultrasonic: uses high-frequency vibrations to aerosolize med
117
Small volume nebulizer advantages
deliver more than one med at same time
minimal patient coordination
modification of med dose and concentration
incorp normal breathing patterns
118
Small volume nebulizer limitations
longer treatment duration (15-25 min)
large bulky device
require access to power source
119
How to use small volume nebulizer
ope cup, med into cup, connect tubing, plug in device into outlet, turn on compressor power
breath normally, 5-10 sec, do until sputter heard
turn off, disassemble, allow to dry
119
Maintenance specifications for small volume nebulizer
wash everything with dish soap once weekly
disinfect with alcohol, hydrogen, vinegar
120
What is intranasal medication devices
allow delivery for topical and systemic benefits
avoid first pass metabolism
121
What is the baqsimi (glucagon) dry powder nasal spray
do not remove wrap or open tube until ready
insert tip into one nostril and push plunger
disappear green line indicated complete
contain once dose and cannot be reused
122
Kwikpen meds
humalog, humulin
123
Solostar meds
lantus, apidra, amelog, basaglar, toujeo
124
Flextouch meds
fiasp, levemir, tresiba
125
Flexpen meds
novolog
126
What are prefilled insulin pen injectors
dial dose for pt
attachment of pen needle
is needle >5 mm, pinch skin
127
Needle considerations with pen injectors
needle reuse may lead to increased scar tissue build up or infection
save outer pen needle cap for needle removal and disposal
128
How to prime prefilled insulin pen injectors
eliminate air bubbles
dial dose 2 units
hold upright
tap cartilage holder gently
push dose until 0 seen
repeat priming if insulin droplets not seen at tip
129
What are the sites for a subq inj
do not inject to area that is bruised, swollen, or tender
rotate sites
130
Instructions for subq inj
attack new pen needle
pull off outer and inner needle caps
prime
clean site
position needle at 90 angle
inject
131
Storage instructions for prefilled insulin pen injectors
unopen in refrigerator
open can be room temp
write date pen first opened
132
How to select a syringe for insulin vials and syringes
volume associated with number of units per dose
orange cap for U-100 and green cap U-500
133
How to inject insulin vial and syringe
same as giving normal shot except, push plunger in and hold 5-10 sec
134
Bydureon Bcise device and use
need to mix medication
push and hold needle 15 sec
135
Repatha SureClick device style and dosing
window turns yellow when injection is finished
2 wk dose
136
Rapatha Pushtronex device style and dosing
1 month dose
let sit outside fridge 45 minutes
137
Praluent device style and dosing
sit 30-40 min
yellow window
20 sec duration
138
EpiPen dosing
0.3mg, 0.15 mg
139
EpiPen instruction for use
blue sky, orange thigh
massage inj site after use
140
Auvi-Q device dosing
0.1, 0.15, 0.3
voice consideration
141
Glucagon device style and dosing
dispose in sharps container
142
Calcitonin Gene-Related Peptide Inhibitors device style and dosing
sit for 30 min
90 degree angle
do not shake
143
Aimovig device style and dosing
once monthly
sit for 30 min
monitor BP
144
Emgality device style and dosing
once monthly
cause hypersensitive rxns
145
Lovenox device style and dosing
lay down and punch skin
store at room temp
do not remove air bubble
146
How to properly dispose injectables
sharps container
make sure its puncture-resistant
clearly label
147
What is telehealth
provider training
administrative meetings
continuing education
clinical services
148
What is telemedicine
remote clinical services (non face to face)
-primary care offices
-specialists offices
-emergency departments
-ICU departments
149
Telehealth benefits
reduce barriers to access***
increase efficiency
reduce cost
improve quality of care
150
What are the most common telehealth applications
clinical services
educational services
admin meetings
151
Technology used for telehealth
camera
microphone
viewing screen
computer
152
Live-interactive (synchrounus)
face to face telemed connection, have provider to provider consults, group case discussions, provider to pt education
153
Store and forward (asynchronous)
radio and pathologic studies, photos, pt data, video clips of pt exams
153
Remote patient monitoring
digital tech to collect and transmit pt data (chronic disease management)
154
Mobile health technologies
blend services when acquired via mobile devices
155
E-consults
electronic communication between providers to enhance coordination
156
What are the telehealth models of care
hub and spoke: PCP connect w/ specialist
network of networks: pt connected to every hospital
consortia model: utilize contracts to enhance collab btw academic medical centers and other entities
pater and employer driven: urgent care
private telemedicine specialty: telestroke, telepsychiatry
157
What is remote patient monitoring (RPM)
use digital tech to collect and transmit health data from pt to health care providers
-helps promote engagement, education, self management
158
How to engage patients and caregivers in telehealth
introduce
explain
ask if familiar with meds
ask to eliminate distractions
