Exam One

Question 1

Adverse effects

Answer 1

Occur after administration, undesired effect of a drug

Question 2

Drug interactions

Answer 2

Occur after administration

Question 3

Pharmacokinetic drug interactions

Answer 3

One drug affects the absorption, distribution, metabolism, or excretion of the other. The second drug’s effects and/or adverse effects may be increased or decreased.

Question 4

Pharmacodynamic

Answer 4

Two drugs have additive or antagonistic pharmacological effects.

Question 5

Incompatibility

Answer 5

Occurs before administration

Question 6

Signs of incompatibility

Answer 6

A change in visible or electronically-determined (even if not visible) particulates, haziness or turbidity, frank precipitation, color, or gas evolution occurs.

Question 7

Y-site

Answer 7

To test y-site compatibility 1:1 mixtures of solutions are tested (solution concentrations are provided)

Question 8

Admixture

Answer 8

Admixture compatibility- test masses of the two drugs are combined in various test diluents (normal saline (NS), ringers(R), lactated ringers (LR), 5% dextrose lactated ringers (D5LR), etc)

Question 9

Syringe

Answer 9

Syringe compatibility- two already diluted drugs are combined in stated concentrations without signs of incompatibility

Question 10

Compendium

Answer 10

A collection of concise but detailed information about a particular subject.

Question 11

Drug monograph

Answer 11

Is a concise summary of the important information about a drug’s properties, and therapeutic use

Question 12

Drug info compendia

Answer 12

Collections of drug monographs

Question 13

Clinical Pharmacology

Answer 13

1. Custom Report Tools
Interactions-professional level
Interactions-consumer level
IV compatibility-based on Trissel's 
Adverse Effects
2. Monographs

*FDA-approved and “off-label” (as yet unapproved) uses.

Question 14

LexiComp Native Interface

Answer 14

1. LexiComp Custom Report Tools
   Interactions-professional level
   IV compatibility
2. Monograph Sets in LexiComp Interface
   Lexi-Drugs (LexiComp-owned monograph sets) includes drug prices
   Martindale (The Complete Drug Reference) includes all names (English generic name, foreign generic name, investigational names, chemical/scientific name, CAS registry number, U.S. and foreign trade/proprietary/brand name)
   AFHS Drug Information (pearls of information not found elsewhere) (Extremely thorough monographs. Good source for odd little pieces of info)

• FDA-approved and “off-label” (as yet unapproved) uses.
• Compare monographs from different sources.

Question 15

DailyMed

Answer 15

Free

*FDA-approved uses only.
*Include chemical structures.
Composed of FDA-approved package inserts for generic and brand name drugs

Manufacturer-specific monographs with manufacturer-specific inactive ingredients

Question 16

Physician’s Desk Reference (PDR)

Answer 16

The best known collection of PPI’s
Available online, not free
Manufacturers have to pay for inclusion so generics rarely, if ever, included

Question 17

Primary Resources

Answer 17

Journal articles, case reports, conference proceedings

Original Works-
Experimental or observational studies (Randomized control trials (double-blind))
Research abstracts
Case reports/case series (rare side effects)
Clinical meeting symposia
Conference proceedings
Newsletters

Desired When:
Recent information is necessary
Detailed information is being sought, rather than an overview or summary
When tertiary references fail to fulfill a specific request or resolve a patient problem

Disadvantages:
Difficult to keep up-to-date with the massive amount of clinical literature published annually
Studies do vary in their accuracy, validity, and generalizability to various patients/practice settings; primary resources must be critically analyzed and carefully interpreted

Question 18

Secondary Resources

Answer 18

Bibliographies, abstracting and indexing publications

Assist in location of primary literature:
Indexing and/or abstracting services
Bibliographic citations

Examples:
MEDLINE
IPA (International Pharmaceutical Abstracts)

*Require proficiency in searching skills.

Question 19

Tertiary Resources

Answer 19

General reference works, textbooks, compilations, review articles

Advantages:
Summarize
Easily available

Disadvantages:
Easily outdated
Big/heavy
Errors
Inconvenient 

• Use other health professionals
• Call drug companies (tedious)

Question 20

Systemic Approach

1. Receive

Answer 20

Understand from where or from whom the question is coming

1. Who is the requester?
   Healthcare provider vs. layperson
2. What is the urgency/acuity of the request?
3. How would the requester like to receive the response?

Question 21

Systemic Approach

2. Expand

Answer 21

Determine the true question

Ask appropriate background questions
Restate the question to ensure that the true question has been defined

Question 22

Systemic Approach

3. Classify

Answer 22

Classify the true question in order to determine the most relevant references for research

Question classification is also often used for administrative purposes

Question 23

Systemic Approach

4. Search

Answer 23

Search general to specific

Use specialized references for the question category

Be aware of requesters time frame for needing the information

Question 24

Systematic Approach

5. Evaluate

Answer 24

Objectively critique the information retrieved

Consider the strengths/weaknesses of the references consulted

1. Do multiple tertiary references provide parallel information? What is the year/edition of the text? Who are its authors/reviewers/editorial panel? Are statements referenced?
2. What type of information was available from primary sources? Were study designs/statistical analyses performed appropriately?
3. Bias?

Question 25

Systematic Approach 6. Formulate

Answer 25

``` The most effective consultations are: Organized Succinct yet complete Objective/balanced Timely Referenced ``` When compiling the response, include: Restatement of expanded question Discussion of search strategy Statement of any assumptions made by the person responding Objectively prepared answer Reference list Invitation for requester to ask further questions if necessary Anticipate related questions that the requester may ask based on the answer provided

Question 26

Systematic Approach 7. Communicate

Answer 26

Tips for oral communication: 1. Use terminology that is appropriate for requester 2. Articulate information in an organized, logical manner 3. Display confidence, credibility, persuasiveness, and professionalism 4. Establish rapport with requester 5. Ensure that all terminology can be pronounced correctly Tips for written communication: 1. Use terminology that is appropriate for requester 2. Articulate information in an organized, logical manner 3. Utilize a professional style and tone 4. Ensure response is free of grammatical, spelling, punctuation errors

Question 27

Systematic Approach 8. Follow-up

Answer 27

With the requester to determine: 1. Was the actual question addressed? 2. Are there other questions that need to be researched? 3. How does the provider anticipate that he/she will utilize the information? 4. How did the response influence the patient's outcome? 5. Did the patient contact his/her healthcare provider in follow-up of the information provided? DOCUMENT 1. Essential for reducing liability 2. Provides support for pharmacists' value in clinical interventions 3. Means to track questions for quality assurance 4. May streamline provision of answers to commonly-asked questions or identify areas of practitioner continuing education need