IPC exam 1 Flashcards

Question

What does the pharmacist collect for step 1 of ppcp

Answer 1

Current medication list/use history: Prescription, non-prescription, herbals, dietary supplements. Relevant health data: Medical history, health and wellness information, biometric test results, physical assessment findings Patient centered factors: Lifestyle habits, preferences and beliefs, health and functional goals, socioeconomic factors

Answer 2

The patient themselves Pharmacy records Patient records Other health care professionals

Answer 3

Pharmacy Records: Med List Refill history Patient themselves: Demographics Allergies Pregnancy Status Insurance Information Safety Caps- Y/N Medication History/List Prescription: Prescriber information subjective info: how does it feel, experience etc objective info: vital signs, lab tests etc

Answer 4

Onset: how long has it been happening, Provoking: what makes It worse palliating factors: what makes it better Quality: how does it feel Region/Radiation: where is the issue Severity: how bad is it form 1-10 Time (history): how often does It happen

Answer 5

C. Interviewing the patient

Answer 6

A. Ensure any and all pharmacists deliver consistent, high quality, patient centered, team based care no matter the practice setting.

Answer 7

Step 2: Assess The pharmacist assesses the information collected and analyzes the therapy in the context of the assesses the clinical effects of the patient’s patient’s overall health goals in identify and prioritize order to identify and prioritize problems and achieve optimal care.

Answer 8

assess Each disease state for proper treatment and monitoring ▪Each medication for appropriateness, effectiveness, safety, and patient adherence ▪Health and functional status, risk factors, health data, cultural factors, health literacy, and access to medications or other aspects of care ▪Immunization status and the need for preventive care and other health care services, where appropriate

Answer 9

E. all of the above - she is allergic to penicillin and amoxicillin is similar to penicillin - she was not taking her meds as she was supposed to because she lost them in the hurricane - she was taking omeprazole in the passed so we can assume that she had hypertension

Answer 10

B. Identifying medication related problems

Answer 11

H. Pylori/ peptic ulcer/stomach ulcer disease

Answer 12

Plan The pharmacist develops an individualized patient centered care plan, in collaboration with other health care professionals and the patient or caregiver that is evidence based and cost effective

Answer 13

Collaborate with other health care professionals and the patient or caregiver Establish a plan that will: ◦ Address medication-related problems (MRPs) and optimizes medication therapy ◦ Sets goals of therapy ◦ Engages the patient through education, empowerment, and self-management

Answer 14

▪Available through institution ▪Available through MCPHS library ▪Available through national organizations

Answer 15

D. Recommending /prescribing alternate therapy

Answer 16

implement The pharmacist implements the care plan in collaboration with other health care professionals and the patient or caregiver help patient navigate the medication use process

Answer 17

P- prescribe: select med. and send to pharmacy T- Transcribe (order verification): enter med. order into pharmacy computer. assess appropriateness and address any discrepancies D- Dispense: prepare and distribute med. from pharmacy to the patient or health care provider A- Administer: review med and give to patient M- monitor: assess patients response to the med and document outcomes.

Answer 18

Contributes to coordination of care, including referrals or transitions of care Provides education and self-management training to the patient or caregiver Initiates, modifies, discontinues, or administers medication therapy as authorized Addresses medication and health related problems and engages in preventive care strategies, including vaccine administration

Answer 19

What can you do? ◦ Scope of practice ◦ Collaborative practice agreements What can the patient do? ◦ With adequate counseling/education What healthcare professional is best suited to handle this? ◦ How to refer/transition the patient?

Answer 20

SBAR technique ◦ Phone vs. fax vs. email, etc. Counseling patients: ◦ Private area ◦ Language services ◦ Written materials ◦ Teach-back method: Have patient tell you what you talked about

Answer 21

A. Educating the patient on their medications

Answer 22

S- situation B- background A-Assessment R- recommendation

Answer 23

Step 5: Follow-up: Monitor and Evaluate The pharmacist monitors and evaluates the effectiveness of the care plan and modifies the plan in collaboration with other health care professionals and the patient or caregiver as needed.

Answer 24

Safety: is the drug causing adverse events? What labs or diagnostic tests are required to monitor for this? ◦ Efficacy: Is the drug causing the desired effect? What labs or diagnostic tests are required to monitor for this? ◦ Adherence: Is the drug being taken appropriately? ◦ Medication Appropriateness: Is this still the best treatment option for this patient? ◦ Treatment goals: Is the drug accomplishing what it should (overall health, symptom relief, increasing mortality, etc.)

Answer 25

A. Checking patient’s labs and refill history for adherence

Answer 26

Continue to repeat this for each patient encounter: What if the headaches didn’t go away? 1. Collect 2. Assess 3. Plan 4. Implement 5. Follow-up: monitor and evaluate

Answer 27

Document ◦ If you don’t document- it didn’t happen Collaborate ◦ It takes a team! ◦ “Stay in your lane” Communicate ◦ Other healthcare professionals: SBAR/SOAP ◦ With patient/caregiver: Motivational interviewing, OPQRST, etc.

Answer 28

important part of healthcare team!

Answer 29

E. All of the above

Answer 30

ANY patient, ANY time, in ANY healthcare setting.

Answer 31

Collaborative practice in healthcare occurs when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, caregivers, and communities to deliver the highest quality of care across settings.

Answer 32

Institute of Medicine Report: To Err is Human (2000) * 44,000 – 98,000 Americans die each year due to medical errors * Failure to communicate was identified as a common cause of medical errors

Answer 33

When learners, educators, or health care workers from two or more health professions learn about, from and with each other to enable effective interprofessional collaboration and improve health outcomes. Enables learners to acquire knowledge, skills and professional attitudes they would not be able to acquire effectively in any other way with the goal of improving patient care.

Answer 34

about, from, with

Answer 35

“Develop knowledge, skill, and attitudes that result in interprofessional team behaviors and competence. Interprofessional education should be incorporated throughout the entire curriculum in a vertically and horizontally integrated fashion.”

Answer 36

values/ethics for inter-professional practice roles/responsivities interprofessional communication teams and teamwork

Answer 37

IPE -> IPC -> Improved patient outcomes

Answer 38

Prepare you all to be knowledgeable and effective members of highly functioning interprofessional teams

Answer 39

Blood pressure is the force of blood against the walls of the arteries What can cause increases in BP? --Increased blood volume --Cardiac output (CO) --Increased peripheral vascular resistance (PVR)

Answer 40

Angiotensin II Receptor Blockers (ARB): decrease angiotensin Angiotensin II Converting Enzyme Inhibitors (ACE-I):decrease angiotensin Diuretics: reduce fluid through urine Beta Blockers (BB): reduce heart rate

Answer 41

ACC/AHA <130/80 mmHg

Answer 42

-Weight loss -DASH diet (Dietary Approaches to Stop HTN) --Fruits, vegetables --Low-fat dairy --Reduced saturated and total fat - Low sodium diet <2.3 grams (?) <1.5 grams/day - Increase physical activity - Decrease alcohol intake

Answer 43

HTN ACE inhibitor PO once daily

Answer 44

HTN ARB PO once daily

Answer 45

beta blocker

Answer 46

Dihydropyridine CCB HTN Patients experience a dip in BP

Answer 47

thiazide diuretic Hydro → water → diuretic

Answer 48

HTN and BPH Alpha-1 antagonist

Answer 49

losartan AAR… ARB

Answer 50

losartan and HCTZ H: hctz aar: ARB

Answer 51

valsartan van: valsartan

Answer 52

valsartan and HCTZ van: valsartan HCT: HCTZ

Answer 53

lisinopril and HCTZ Zest: Zestril (Lisinopril) –retic: thiazide diuretic

Answer 54

enalapril Vaso → vascular → HTN

Answer 55

furosemide Lasts six hours (peeing!) diuretic

Answer 56

hydrochlorothiazide & triamterene

Answer 57

spironolactone Ald: aldosterone antagonist

Answer 58

Which on this list are not once daily meds? Which beta-blocker also has alpha-blocking activity Which meds are for heart failure as well as HTN? Hypertension + edema → diuretics Hypertension + BPH → Alpha-1 antagonists Which medications are not PO?

Answer 59

HMG-CoA Reductase Inhibitors (statins) Only 1st line medication recommended by lipid guidelines Ezetimibe (Zetia) Fibric Acid Antilipemic agents

Answer 60

Cholesterol (TC), triglycerides (TG), and phospholipids Transported as complexes of lipid & proteins – lipoproteins

Answer 61

Low-density lipoproteins (LDL) High-density lipoproteins (HDL) Very-low-density lipoproteins (VLDL)

Answer 62

Elevated TC, LDL, or TG Low HDL concentration Some combination of these abnormalities

Answer 63

use station for patient

Answer 64

Weight loss Diet modifications --Decreased saturated and total fat --Increase fiber Increase physical activity Decrease alcohol intake

Answer 65

MI- myocardial infarction (heart attack) Angina Coronary artery stenosis

Answer 66

TIA- Transient ischemic attack; mini stroke Stroke Carotid artery stenosis

Answer 67

CVD LDL-C >190 mg/dL United States Preventative Services Task Force (USPSTF) Adults aged 40-75 years with both: > or equal to 1 CV risk factors (dyslipidemic, DM HTN, smoking) estimated 10-year CVD risk of > or equal to 10%

Answer 68

Dyslipidemia Statin / Hmg-coA reductase inhibitor PO Once daily

Answer 69

Dyslipidemia fibric acid antilipemic PO

Answer 70

All of the specialized words that medical professionals use to identify human anatomy and physiology, as well as words that indicate location, direction, planes of the body, medical status, and instructions for administering medication.

Answer 71

prefix root suffix

Answer 72

Word stem or root elements Can stand alone as words on their own Examples of common medical roots

Answer 73

Card(i, io): heart Cyst (o): cell Derm(a, o): skin Gastr(I, o): stomach Hem(o, ato): blood Myo: muscular Osteo: skeletal Neuro: nervous Nephro: kidney Pneumo: lung

Answer 74

Found at the beginning of a word Cannot stand alone Descriptive, expand the meaning of the word

Answer 75

Ante-: before Anti-: against Co-: with Ex-: out of, former Hyper-: above, extreme, excessive Hypo-: under, decreased, below Inter-: between Intra-: within Mid-: middle Macro-: large Micro-: small Multi-: many Non-: not Post-: after Sub-: under

Answer 76

Found at the end of a word Cannot stand alone Change the words meaning or part of speech

Answer 77

-algia: pain -emia: blood -ism: state or condition -itis: inflammation -lysis: breaking down -megaly: enlargement -oma: tumor -osis: condition -pathy: disease or suffering -spasm: involuntary condition

Answer 78

An order for medication issued by a physician, dentist or other properly licensed medical practitioner

Answer 79

Order recognition Order interpretation Order analysis is the order appropriate? -appropriate for patient?

Answer 80

Collect Assess Plan Implement Follow up

Answer 81

Prescribe Transcribe Dispense Administer Monitor

Answer 82

Broad Categories: Single component /product > one ingredient that requires compounding

Answer 83

Verb Dose Dosage form/formulation Route of administration Frequency/timing Duration

Answer 84

Verb and route of administration chart

Answer 85

one tablet 5 ml two puffs

Answer 86

Tablet, capsule, cream, ointment, etc Take one tablet by mouth three times daily Dosage form = Inhale two puffs by mouth twice daily Dosage form =

Answer 87

tab = tablet cap = capsule syr = syrup gtt = drop ung = ointment susp = suspension supp = suppository

Answer 88

By mouth, into ear, rectally

Answer 89

po = per os = by mouth or orally os = oculus sinister = left eye od = oculus dexter = right eye ou = oculus uterque = both eyes as = auris sinister = left ear ad = auris dexter = right ear au = auris uterque = both ears sl = sublingually = under the tongue pv = per vagina = vaginally pr = per rectum = rectally EN=each nostril

Answer 90

Take one tablet by mouth *daily*

Answer 91

q = quaque = every qd = quaque die = every day qhs = quaque hora somni = every day at bedtime bid = bis in die = twice a day BIW = twice a week tid =ter in die = three times a day TIW = three times a week qid = quater in die = four times a day q_h = quaque __ hora = every ___ hours prn= pro re nata = as needed

Answer 92

a.c. = ante cibos = before meals* i.c. = inter cibos = between meals* p.c. = post cibos = after meals* w.a. = while awake

Answer 93

For 10 days, for one week, for 30 days, etc

Answer 94

apply insert

Answer 95

take 1 tablet by mouth every 8 hours for 10 days

Answer 96

take 5mL by mouth four times daily while awake

Answer 97

name of patient date Address of patient (?) name of pharmacy Rx refills MD signature DEA of MD

Answer 98

verb: take dose: 1 dosage form: tablet route of admin.: by mouth frequency: daily no duration specified by MD

Answer 99

verb: take dose, dosage form/units: # tablets or # of capsules ROA: by mouth

Answer 100

verb: chew dose, dosage form/units: # of chewable tablets ROA: by mouth

Answer 101

verb: dissolve dose, dosage form/units: dissolve or place ROA: under the tongue

Answer 102

verb: take dose, dosage form/units: # of milliliters (if spoonfuls are indicated on Rx must convert to mls) ROA: by mouth

Answer 103

verb: as indicated on Rx dose, dosage form/units: as indicated on Rx ROA: by mouth

Answer 104

verb: inhale or take dose, dosage form/units: # of puffs ROA: by mouth

Answer 105

verb: inhale or take dose, dosage form/units: $ of inhalations ROA: by mouth

Answer 106

verb: inhale dose, dosage form/units: contents of the # of capsule(s) ROA: by mouth

Answer 107

verb: apply dose, dosage form/units: as specified on Rx ROA: topically (area specified on Rx)

Answer 108

verb: apply dose, dosage form/units: as specified on Rx ROA: topically (area specified on Rx)

Answer 109

verb: apply dose, dosage form/units: # of patches ROA: topically (area specified on Rx)

Answer 110

verb: shampoo or use dose, dosage form/units: as specified on Rx. ROA: area specified on Rx

Answer 111

verb: use or administer dose, dosage form/units: # of sprays ROA: in ____ nostril ( fill in blank as indicated on Rx)

Answer 112

verb: instill, place or put dose, dosage form/units: # of drops ROA: in ___ eye (s) or in ____ ear (s) fills in blank as indicated on Rx)

Answer 113

verb: gels: place, put ointments: apply dose, dosage form/units: as directed on Rx ROA: as indicated on Rx

Answer 114

verb: insert dose, dosage form/units: # of suppositories or # of ovules or # of applicatorfuls or as indicated by prescriber ROA: vaginally

Answer 115

verb: insert dose, dosage form/units: # of suppositories or # of applicatorfuls ROA: rectally

Answer 116

verb: inject dose, dosage form/units: # of suppositories or # of applicatorfuls ROA: rectally

Answer 117

verb: use dose, dosage form/units: as directed (unless otherwise specified on prescription--do not include dose) ROA: under the skin or subcutaneously

Answer 118

‘Wrong dose’ medication errors most commonly occur as a result of: --Misinterpretation of prescription --Errors in calculation --Selection of wrong medication concentration Higher rates of errors occur in pediatrics --More calculations needed for dose --Liquid medications with different concentrations

Answer 119

Read the question first – What am I being asked?- dose, total daily dose, quantity etc Read the entire problem carefully – highlight important info Pull out the appropriate facts you need to answer the question and block out the information that is not needed List conversion factors that you need to answer the question Set up the problem with the appropriate equations and perform the calculations required Then ask yourself does this answer make sense! – Is this around what you expected to get for an answer? Are the units correct? Double check your calculation, does the answer make sense? Should the answer be in the 20’s or the 100’s? etc

Answer 120

Do not round until the last step in your calculation. Traditional rounding rules apply to all calculations EXCEPT day supply. Traditional round: 5 or greater you round up, less than 5 you round down 6.5 rounded to a whole number would be 7 4.4 rounded to a whole number would be 4 On the exam you will be told which place to round your final answer. Round to one decimal point Round to a whole number

Answer 121

Dose Total Daily Dose (TDD) Quantity (Qty) to Dispense Day Supply (DS)

Answer 122

Dose: the amount of medication the patient will take at one time --How this information is given to the patient: e.g. # of tablets, capsules, volume of liquid (mL) --How this information is given to another healthcare professional: e.g. amount of mg, g, units Total Daily Dose (TDD): the total amount the patient will take in 24 hours --Total daily dose = dose x frequency --Medication likely mg

Answer 123

Quantity (Qty) to dispense: 1 tablet TID x 10 days = 30 tablets --The amount of medication that will be sent home with the patient or to the floor of an institution --Qty to dispense = dose (# of tablets, mL, etc.) x frequency x duration --*requires a duration Day Supply (DS): has to do with insurance  refill --The number of full days the quantity dispensed will last the patient --This is always a whole number! --For the purposes of this class we always round down!* --Days Supply = (quantity or units dispensed) (dose (# of tablets, mL, etc.) x frequency)

Answer 124

Institute for Safe Medication Practices (ISMP) All oral liquid doses should be express in milliliters (mL) for measuring dose. The dosing device you provide to the patient should only have metric measurements (mL) on it. Patients can’t measure mg and should not be relied on to convert tsp cannot be calibrated so convert 1 tsp = 5mL

Answer 125

Days supply is calculated according to the number of units/mL 100 units/mL “U-100” 200 units/mL “U-200” 300 units/mL “U-300” 500 units/mL “U-500” Since dosing is prescribed in units, you will need to convert to milliliters to calculate day supply Vials have a total volume of 10 mL Pens have a total volume of 3 mL One box of insulin pens (most) = 5 pens

Answer 126

Yes and God is gooddddd No but GOD IS STILL GOOD!

Answer 127

High Alert Medication = a medication that has a high rate of medication errors and/or high risk of causing great injury to a patient Insulins SIG codes should always include units as the dose for the patient NOT mL Insulin needles and insulin pens are created to measure the number of units (See photo on previous slide) Units should never be abbreviated as U; this is an inappropriate abbreviation and has lead to many medication errors It can be mistaken for a zero, leading to an overdose

Answer 128

15 mL or 3 teaspoons

Answer 129

15.4 grains

Answer 130

64.8 mg (approx. 65 mg)

Answer 131

28.4 grams (approx. 30 grams)

Answer 132

Weight loss DASH diet (Dietary Approaches to Stop HTN) Fruits, vegetables Low-fat dairy Reduced saturated and total fat Low sodium diet <2.3 grams (?) <1.5 grams Increase physical activity Decrease alcohol intake

Answer 133

Cholesterol (TC), triglycerides (TG), and phospholipids – major lipids in the body Transported as complexes of lipid & proteins – lipoproteins 3 major classes of lipoproteins: Low-density lipoproteins (LDL) High-density lipoproteins (HDL) Very-low-density lipoproteins (VLDL) Dyslipidemia: Elevated TC, LDL, or TG Low HDL concentration Some combination of these abnormalities

Answer 134

artery food plaque liver

Answer 135

total cholesterol: <200 - desirable 200-239 - borderline high > 240 - high LDL cholesterol <100 optimal 100-129 - near or above optimal 130-159 - borderline high 160-189 - high >190 very high HDL cholesterol <40 - low >60 mg/dL high triglycerides <150 - normal 150-199 borderline high 200-499 high >500 very high

Answer 136

Focus is on ASCVD Risk Reduction CVD – MI Angina Coronary artery stenosis Cerebrovascular disease TIA Stroke Carotid artery stenosis Previous goal was to achieve target LDL-C values based on presence of risk factors

Answer 137

CVD LDL-C >190 mg/dL United States Preventative Services Task Force (USPSTF) Adults aged 40-75 years with both: >1 CV risk factor (dyslipidemia, dm, HTN or smoking) estimated 10-year CVD risk of >10%

Answer 138

Crestor, Lipitor, Mevacor, Zocor, Pravachol Tor/cor: choles”TOR”ol Chol: cholesterol Tricor fenofibrate Tri: triglycerides Cor: choles”TOR”ol Zetia ezetimib

Answer 139

Weight loss Diet modifications Decreased saturated and total fat Increase fiber Increase physical activity Decrease alcohol intake

Answer 140

Coumadin warfarin Warfare → bleeding → anticoagulant Plavix clopidogrel Nix the platelets → antiplatelet Xarelto Rivaroxaban Xaban Factor Xa Inhibitor

Answer 141

Lanoxin digoxin ox → increases force of the heart’s contractions → strong like an ox Klor-Con, K-Tab potassium chloride Potassium: K Chloride: LOR Con: Spanish word for “with” NitroStat, Nitro-Dur nitroglycerin NitroStat → SL → Q5 min x 3 doses NitroDur → transDURmal → Duration: daily Imdur isosorbide mononitrate Nitrate: nitrate → vasodilator Duration: daily (ER formulation)

Answer 142

Synthroid, Unithroid, Tirosint levothyroxine Thyroid product: hypothyroidism Spanish for thyroid: tiroides Levoxyl: levothyroxine Synthroid: synthetic thyroid Armour Thyroid Desiccated thyroid Tapazole methimazole Anti-thyroid agent

Answer 143

Biguanides DPP-4 inhibitors SGLT2 inhibitors Thiazolidinediones Sulfonylureas Glucagon-Like Peptide-1 (GLP-1) Agonists Insulin Long-acting Rapid-acting

Answer 144

random glucose: prediabetes: none diabetes: >200 mg/dL w/ symptoms (polytriad) fasting plasma: prediabetes: 100-125 mg/dL diabetes: >126 mg/dL 2 hour plasma glucose: pre-diabetes: 140-199 mg/dL diabetes: >200 mg/dL HbA1C: prediabetes: 5.7-6.4% diabetes: >6.5% goal: <7% pre-prandial glucose: 80-130 post-prandial glucose: <180

Answer 145

Prevention of morbidity, mortality Microvascular Neuropathy Nephropathy Retinopathy Macrovascular Cerebrovascular disease CV disease Peripheral artery disease

Answer 146

Nutrition Weight loss Physical activity Bariatric surgery Education

Answer 147

Glucophage metformin Gluco: glucose phage: eat Januvia sitagliptan -gliptin: DPP-4 inhibitor Sit on the thrown of Januvia Invokana canagliflozin -gliflozin: SGLT2 inhibitors Invoke the kidneys Go with the flo…

Answer 148

Actos Pioglitazone TZD (thiazolidinedione) Sulfonylureas glimepiride Amaryl glipizide Glucotrol, Glucotrol XL Glucose control glyburide Glynase, Diabeta

Answer 149

Victoza liraglutide Lower glucose Trulicity dulaglutide

Answer 150

Humalog: rapid insulin: lispro product: Humalog onset: 10-30 mins peak: 1/2 to 3 hours duration: 3-5 hours novolog: insulin: aspart product: novolog onset: 10-30 mins peak: 1/2 to 3 hours duration: 3-5 hours levemir insulin: detemir product: levemir onset: 1-2 hours peak: minimal peak duration: 24 hours Lantus, basaglar, toujeo insulin: glargine product: Lantus, basaglar, toujeo onset: 1-2 hours peak: none duration: 24 hours tresiba insulin: degludec product: Lantus, basaglar, toujeo onset: 1 hour peak: 9 hours duration: 42 hours

Answer 151

Lantus/Toujeo/Basaglar insulin glargine Long acting Lantus Basaglar (basal, glargine) Levemir insulin detemir Long acting Levemir Dosed Once daily* Humalog insulin lispro Novolog insulin aspart huma: human Novo Nordisk log: analog Dosed TID

Answer 152

Protonix pantoprazole Proton: acid nix: nix it Nexium esomeprazole Nex: Next omeprazole Prilosec omeprazole Pr: protons/acid lo: low sec: secretion Prevacid lansoprazole Prevents acid Dexilant dexlansoprazole Dex: dex il: lansoprazole ant: antacid

Answer 153

Histamine-2 Receptor Antagonist (H2RAs) Pepcid, Zantac 360 famotidine tidine: to dine → heartburn Pepcid: peptic acid Phenergan Promethazine 1st generation antihistamine Used for N/V Add codeine: Purple drank/lean/sizzurp Zofran ondansetron Fran → friend when throwing up

Answer 154

Valtrex valacyclovir Prodrug for acyclovir trex: T-rex wrecks the virus Zovirax acyclovir ax: axes the zoster virus Diflucan fluconazole Die fungi! Nizoral, Nizoral A-D ketoconazole The key to avoid dandruff

Answer 155

BP is the force of blood against the walls of the arteries What can cause increases in BP? Increased blood volume Cardiac output (CO) Increased peripheral vascular resistance (PVR)

Answer 156

normal: systolic less than 120 and diastolic less than 180 elevated: systolic 120-129 and diastolic less than 80 high - HTN: systolic 130-139 and diastolic 80-89 high - HTN 2: systolic 140 + and diastolic 90 + High - HTN crisis: systolic 180 + and diastolic 120 +

Answer 157

Drug information (DI) retrieval and evaluation is an essential skill for pharmacists The provision of drug information is among the fundamental professional responsibilities of all pharmacists (ASHP) Responsibilities to be effective DI providers - provide accurate, unbiased, well-referenced, and critically evaluated information on any aspect of pharmacy Provide accurate & complete responses to DI requests This responsibility begins with effective searching-Use a systematic approach to address DI needs by effectively searching, retrieving, and critically evaluating the literature (ASHP)

Answer 158

Library web site – access all resources 24/7https://www.mcphs.edu/library/ Library chat – real time reference service Send text to us 1-617-299-7092 E-mail your liaison for consultations Set up your Google Scholar preferences Download mobile versions of resources Download LibKey Nomad browser extension to connect to the library's resources and other free resources right from the publisher's page: https://thirdiron.com/downloadnomad/ Circulation books-borrow for 3 weeks at a time Course Reserves: borrow for 3 hours anywhere on campus Honor system policy

Answer 159

Smart Search: Search across most of our resources at once Online catalog: find MCPHS owned print & e-books by campus. Access single books or collection of books. Collection of books include: Stat!Ref: 70 books Books@Ovid: 145 titles in medicine and related subjects ProQuest Ebook Central: 71,500 multidisciplinary titles R2Library: 3000 medical, nursing and allied health eBooks Print/Download books or chapters/Read online Download a book requires free Adobe Digital Editions software Publishers and vendors decide access limitations like how many readers per book at a time and printing/downloading options. These policies vary between publishers. World Cat: locate books, articles, videos, etc. near you

Answer 160

Databases: search for articles Journals: search within individual journals Media: mages, videos: pictures, drawings, tables, animations, film: Research Guide on Videos: https://mcphs.libguides.com/videos Research Guide on Images: https://mcphs.libguides.com/Images Primal Pictures Institutional Repository: MCPHS faculty publications, thesis, dissertations Research management and citation: EndNote and Zotero

Answer 161

WorldCat.org lets you search the collections of libraries (books, music, DVDs,etc.) in your community and around the world. Search many libraries at once for an item and then locate it in a library nearby Find books, music, and videos to check out Find research articles and digital items (like audiobooks) that can be directly viewed or downloaded.

Answer 162

Request form on library web site: https://my.mcphs.edu/Library/Services/InterlibraryLoan.aspx Request via a database search: Example Plan and request early Receive item in 72 hours-5 days in your e-mail 3 requests per day Most ILL requests are free

Answer 163

Informal organization of the medical literature Primary literature are the most up-to-date resources available (journal articles reporting original research, new ideas, etc.) Secondary resources include indexing and abstracting systems that organize and provide easy retrieval of primary resources (databases, reviews, bibliographies) Tertiary resources are sources that condense and summarize well established data from the primary literature (textbooks reference books, electronic databases)

Answer 164

AccessMedicine: 75 textbooks, self assessment, board reviews, drug monographs, diagnostic tests. Access Medicine Drug Index: Includes a description of the product, contraindications, interactions, dosage and administration, and the chemical structure. AccessPharmacy: 30+ textbooks, self assessment and board reviews, drug monographs, NAPLEX review. Access Pharmacy Drug & Supplements Index: same categories. By McGraw-Hill Medical PharmacyLibrary- Created by American Pharmacists Association (APhA). Find pharmacy eBooks, interactive case files and exercises. Review for the NAPLEX. LWW Health Library: Pharmacy Collection - A collection of core books for pharmacy as well as related videos and case studies. Includes both interactive and text-based self-assessment tools. Review for the NAPLEX.

Answer 165

Point to the original source of any specific information The number and quality of references is a distinguishing feature among tertiary resources Only the electronic versions of some texts may have references Just because some information in a resource may be referenced, doesn’t mean all information is referenced. If the specific source of the information you are using to answer a question is not identified, consider it “not referenced.” Exception: commonly known facts, e.g. penicillin is an antibiotic, diabetes is chronic disease… Speak to how current the monograph is Author’s bias

Answer 166

Do not panic!- Lack of information in a resource about a question does not necessarily mean that no information exists! Check currency of information-something may have been published recently. Look elsewhere Cross check information found At any point seek Librarian’s help. We are here to help you

Answer 167

Increased need for access to evidence-based clinical information Not one only centralized, trustworthy evidence-based resource for DI instead multiple resources and tools need to be consulted The rise of specialty medications which tend to be expensive and more complex to get increases need for the latest DI as well as patient education materials Spending too much time finding trustworthy drug information at the point of care can be burdensome when added to the many responsibilities Outdated information across databases Globally, medication errors are all too common, with an associated cost of $42 billion (World Health Organization, 2017). Awareness of specific patient population needs

Answer 168

First to consult-Most common resources used by pharmacists today Summarize and interpret the primary literature Convenient and easy to use Examples include: Lexi-Comp, Micromedex, Clinical Pharmacology They differ in scope, breadth, purpose, and price but have many similarities but neither one can answer complete information requests. More than one database needs to be consulted. Their most significant limitation is the lag time for publication, and updates-seen both with print and e-sources. Inline referencing varies

Answer 169

Lexicomp Online Clinical Pharmacology Micromedex Most common questions for Pharmacists: Dosage and administration, adverse effects, drug interactions, pharmacotherapy, and disease management, including the use of nonprescription medications and dietary supplements.

Answer 170

Cross check more than one resource before answering a question to validate the information found Check dates of information provided (e.g., number of references cited, in-text citations) Check quality of information to see if information is based on clinical studies and not opinion

Answer 171

A physician would like to know if atorvastatin is effective for rheumatoid arthritis. If so, what is the dose usually used? He would also like to know if alopecia can occur with the use of this drug? Type of Questions: Dosing /Therapeutic efficacy/Place in therapy; Adverse Events

Answer 172

A new pharmacy technician is having difficulty finding Xalatan eye drops on the shelf. Where is Xalatan stored? What is the typical dosing of Xalatan for ocular hypertension and where should it be stored after it is opened by the patient? Type of Questions: Dosage, Storage/Stability

Answer 173

You receive a prescription for valacyclovir 1000mg three times daily for a 13 year old patient for the treatment of cold sores. Is this the correct dose for this indication? The mother of the patient asks you if a solution is available since the child dislikes swallowing tablets/ capsules? If not, can it be prepared? Type of Question: Pediatric Dosing, Administration, Preparation

Answer 174

A 65 year old man with moderate symptoms of BPH asks you whether he can take saw palmetto while taking warfarin. His neighbor recommended it since it worked well for him. How would you advise the patient? Type of Question: Drug/herb interaction

Answer 175

Clear, concise, used at the point of need-quick review of drugs and adverse events (% included) Drug pronunciation feature Drug-interaction reviewing tool, patient education leaflets, a drug-identification database, lists of drug recalls and shortages, and recent drug news Patient information (19 languages) Smallest in size, least comprehensive Strongest resource for pharmacogenomic information Does not have investigational drugs and detailed reproductive risk References are not easily retrievable Includes current drug shortages, FDA recalls, dangerous drug abbreviations, therapeutically equivalent generic drugs (through the Orange Book, available at www.accessdata.fda.gov/scripts/cder/ob/default.cfm), and extemporaneous preparations (through the Pediatric Dosage Handbook found online in the Lexicomp series).

Answer 176

Comprehensive drug monographs on US Rx, OTC, Investigational, Herbal drugs or Nutritional Drug Information Drug class overviews, various interactions (drug–drug, drug–herbal, drug–nutritional, drug–food), and full-color product images Drug Interaction reports for professionals and consumers Drug comparison tool that easily generates information on product dosage forms, clinical attributes, and adverse events. Lists ingredients information, strength and more grouped by therapeutic use. Off-label drug info is included only if clinically relevant No foreign products, patient education in English and Spanish, no detailed reproductive risk, limited toxicology Product comparison tool that retrieves a list of products by allergy or dietary restriction (e.g., sugar free, alcohol free, latex free, sodium free, dye free) Most information is readily referenced with a link to PubMed citations. Although some information (e.g. adverse event reporting) is not referenced.

Answer 177

Searches databases that include extensive and summarized drug information, toxicology, alternative medicine, and reproductive risk evaluation: Drugdex: Drug Infromation (labeled uses, dosing, off labeled use, adverse events-summary of common and serious ADRs, Foreign products, poisons) PDR: Manufacturer’s Drug Leaflets Martindale’s (foreign medications) Poisindex identifies ingredients for commercial, biological, and pharmaceutical products and delivers summarized toxicology data. Identidex : identifies a medication using its embossed lettering or numbering and other descriptive characteristics, such as color and shape. Alternative Medicine – evidence-based info on herbals and dietary suppl. REPRORISK – reproductive risk info on drugs, chemicals, environmental agents. Drug interaction reviewing tool, patient education leaflets for both prescription drugs and dietary supplements, and clinical calculators to help determine body mass index, ideal body weight, metric conversions, and others. Contains also Red Book Online Well referenced throughout but some monographs could be outdated

Answer 178

Although Micromedex is a large database, the primary literature is readily referenced and easy to access. Therapeutic indications are given a graded evidence rating with usage recommendations. For the clinician, Micromedex offers comprehensive, easy-to-read, extensively referenced data on drugs.

Answer 179

Comprehensive evidence-based information on natural products, vitamins herbs, and integrative medicine. Information derived from clinical studies. Developed by international collaborators from highly regarded academic institutions to provide quality information that has been validated and peer reviewed. Monographs include MOA, ADRs, drug interactions and other information Evidence-based effectiveness ratings for a given disease Natural product/drug interaction checker Disease/Medical condition search

Answer 180

Advantages Very comprehensive Easy to use/user-friendly format Very well referenced Excellent herb/herb, herb/drug, and herb/disease interaction information Disadvantages Information is often more conservative than what is perceived by Complementary and Alternative Medicine (CAM) professionals Historical evidence information may be limited

Answer 181

AltHealthWatch: complementary, holistic and integrated approaches to health care and wellness with full text articles for more than 180 international, and often peer-reviewed journals and reports since 1984. AMED (Allied and Complementary Medicine Database): alternative medicine articles from over 500 journals, mainly European. produced by the Health Care Information Service of the British Library.

Answer 182

Who develops? Is technical support readily available? Is it an authoritative source? Do the authors/editors have adequate expertise? Is the information appropriately referenced from reliable sources? Is it "user-friendly?" How easy is it to find information? How frequently is it updated? How would you use it? What does it offer that alternative sources do not? How much does it cost relative to other systems

Answer 183

Apps and Mobile Sites Guidehttps://mcphs.libguides.com/ Mobile version may be different than the original database Usually less comprehensive than original database Helpful in patient care setting as a quick resource

Answer 184

All databases include a monograph with standard information about the drug (pharmacology, kinetics, dosing, ADRs, drug interactions. Resources differ in terms of how comprehensive and complete information is Substantial variation in ADR formatting exists between the most common DI databases (1) No single drug information resource covers every topic a pharmacist may need information about, therefore multiple resources may need to be consulted More than one resource should always be used to verify information

Answer 185

under preparations

Answer 186

“A profession without a history is merely an occupation with pretensions.” Dr. Gregory Higby – excerpt: speech at ACPE 2016 standards Open Comment Forum, 2014 AACP Annual Meeting, Grapevine, TX. A lecture on pharmacy history is required in the CAPE standards for pharmacy education. Have a better understanding of the origins and historical significance of your chosen profession!

Answer 187

Pharmacy is an ancient profession It is from the Greek word pharmakon = drug According to the American Heritage Dictionary: 1. the art and science of preparing and dispensing drugs and medicines. 2. a drugstore or place where drugs are sold; a drugstore. Also called apothecary.

Answer 188

It is a health profession that links health and the chemical sciences Pharmacy is responsible for ensuring the safe and effective use of medications Pharmacists are the experts on drug therapy Pharmacists are responsible for optimizing medication use for their patients for positive health outcomes

Answer 189

Ancient era to 1600 AD Empiric era: 1600-1940 Industrialized era: 1940-1970 Patient Care era: 1970- present Biotechnology and pharmacogenomics

Answer 190

Babylon: the cradle of civilization Evidence exists of apothecary practice Healers were priest, pharmacist, and physician all in one Archaeologists have found clay tablets that recorded: Symptoms of illnesses Prescription instructions for compounding

Answer 191

According to legend, the Chinese Emperor Shennong took interest in medicinal herbs He tested hundreds of herbs on himself First recorded use of marijuana as a medicinal drug in 2737 BC - He is regarded as the patron god of native Chinese drug guilds The Chinese may have practiced “inoculation” by scratching matter from a smallpox sore into a healthy person's arm: which was the earliest known version of… A Smallpox Vaccine

Answer 192

The smallpox vaccine, introduced by Edward Jenner in 1796, was the first successful vaccine to be developed in modern times. Jenner observed that milkmaids who previously had caught cowpox did not catch smallpox and showed that inoculated vaccines protected against inoculated variola virus.

Answer 193

Pharmacy practice was conducted by two classes of workers: Echelons: gatherers and preparers of drugs Chiefs of fabrication Papyrus Ebers Developed more dosage forms and compounded more complex formulas Maintain close links to supernatural and empirical healing

Answer 194

Willow bark contains salicin, which is metabolized in the body to salicylic acid (a precursor to aspirin – acetylsalicylic acid) first identified by Egyptians Hippocrates, the Greek physician, used willow bark and leaves for pain relief Used by indigenous people for pain An 18th century clergyman, Edward Stone, rediscovered aspirin and wrote about its use for malarial fevers

Answer 195

The aspirin we know today was developed in the late 1890s when Felix Hoffman at Bayer created acetylsalicylic acid (ASA). In 1899, Bayer distributed powder to doctors and pharmacists as an “ethical drug”

Answer 196

More than 2000 drugs are recorded in the Charaka Samhita - Compendium of Wandering Physicians Written in Sanskrit - an ancient Indian language

Answer 197

“Terra Sigillata” was the first therapeutic agent to bear a trademark symbol Theophrastus: “Father of Botany” Wrote extensively on the medicinal qualities of herbs. Hippocrates – Greek physician - manuscripts on medicine and apothecaries. Greece played a large role in the study of medicinal plants – Materia Medica was used for hundreds of years.

Answer 198

First apothecary established in 792 AD in the city of Baghdad As Muslims traveled across Africa, Spain and southern France, they brought this new system of pharmacy with them This system was eventually adopted by Western European countries- independent pharmacies started opening

Answer 199

The idea of a pharmacopoeia came about in Florence, Italy Became legal standard for all apothecaries A multidisciplinary collaboration- Guild of Apothecaries and Medical Society worked together with guidance from a Dominican monk

Answer 200

Pharmacopeias were used to protect public health Roots, bark, herbs, flowers were used and controlled by governments Practitioners questioned toxicological effects on the human body Created interest in testing of drugs and effect on the human body

Answer 201

William Proctor (1817-1874) - “Father of American Pharmacy” Graduated from Philadelphia College of Pharmacy and spent most of his life advancing the profession of pharmacy in this country Owned an apothecary, was a scientist, an editor and teacher Many “chemists” from Britain came to the New World to open apothecaries Practitioners adapted remedies from American Indians like cinchona bark (quinine for malaria) and willow bark The Revolutionary War (1775): Supplies from Britain were difficult to get - American druggists learn to manufacture drugs and preparations. After the war a network was developed for the production, packaging and distribution of drugs. War of 1812/Civil War: America developed its own resources to produce pharmaceuticals and patent drugs. Eli Lilly - 1876 Bristol Myers - 1858

Answer 202

Rise of “patent medicine” in the 1800s Independently owned stores Most had a “soda fountain” Pharmacist was diagnostician, compounder, dispenser, soda “jerk”

Answer 203

toothache oil made with cocaineSnake oil for all ailments “Gripe water” for baby tummy aches“Miracle Microbe Killer” Soothing Baby SyrupPink Pills for Pale People

Answer 204

Page’s Inhalers (1892) - Smoked "for the temporary relief of the paroxysms of asthma and to aid in the relief of hay fever and simple nasal irritations.” Directions for use of Page's Inhalers:…smoke one or two Page's Inhalers, INHALING THE SMOKE. Prescribed dosage four a day. How to inhale: Exhaust the lungs of air, then fill the mouth with smoke and take a deep breath, drawing the smoke down into the lungs. Hold a few seconds, then exhale, through mouth and nostrils.

Answer 205

1906 Pure Food and Drug Act (purity and labeling) First significant consumer protection law 1938 Food and Drug & Cosmetic Act: No drug could be marketed until proven safe for use under the conditions described on the label and approved by the FDA 1951 Durham-Humphrey Amendment Explicitly defined two categories of medications: legend (Rx) and non-legend (OTC) Until this law, there was no requirement that any drug be prescription only. 1962 Kefauver-Harris Amendment: After thalidomide tragedy in Europe, drugs had to prove safety AND efficacy 1820 - the first Pharmacopeia of the United States (USP) was published as the nationally accepted guide to drugs 1852: American Pharmaceutical Association established - first national association with goals of promoting professional code of ethics and legal standards for drug quality

Answer 206

1821: Philadelphia College of Pharmacy opened 1823: Massachusetts College of Pharmacy (Boston) opened 1868: Dr. Albert Prescott abandoned apprenticeships and pioneered a curricula including basic science and laboratories. Pharmaceutical Syllabus (1906) --Recommended 4-year BS in pharmacy; implemented 1932 Pharmaceutical Survey (1946) ---Recommended 6 year program of study, but 5-year BS implemented in 1960 Mills Report (1975) ---Recommended 6-year doctoral degree for pharmacy ---Implemented in 2004 (MCPHS last BS class 2001)

Answer 207

Early 1800s – First boards of pharmacy established to assess an individual's competence to prepare and dispense medications 1870’s: Many states passed laws that pharmacists must pass an examination to be registered - Since 2004, passing the North American Pharmacist Licensure Examination (NAPLEX) has been a requirement for earning initial pharmacy licensure in all 50 United States.

Answer 208

More demand - medications were mass produced through industrial machines 1920s – 80% of Rxs were compounded 1946 – 26% of Rxs were compounded

Answer 209

Scientific research and drug development was growing New drugs caused more reactions and interactions with other medications This led to the patient care era and marked the shift of pharmacy from focus on the drug to a focus on the patient

Answer 210

New and more complex problems! Allergic reactions Interactions Other drugs Food

Answer 211

Pharmacy has become more clinical in nature In 1990 the term pharmaceutical care was coined Today we use the term Pharmacist’s Patient Care Process The role of pharmacists has expanded to a variety of settings 6-year Doctor of Pharmacy degree is the entry level degree for all pharmacists Optional 1 or 2 year residencies or fellowships

Answer 212

ACA 2010 - Expansion of Medication Management Therapy (MTM) for pharmacists One-on-one interactions with patients to review all medications and to identify and resolve medication-related problems. Goal is to increase adherence to medications for better outcomes

Answer 213

Collaborative agreements Allows pharmacists to make changes to drug therapy States differ in regards to practice sites and protocols and continuing education Immunizations Certification/CEs required CPR training Automated/Central Filling Frees pharmacists to focus less on refills and maintenance medication filling Goal is to provide more time for clinical activities like MTM and immunizations

Answer 214

OBRA 90: Requires pharmacists to counsel Medicaid patients and conduct drug utilization reviews. USP <797>, USP <795>: Regulations regarding sterile and non-sterile compounding New England Compounding Center- Meningitis outbreak USP<800> New proposal for compounding of hazardous drugs affects facility design, personal protective equipment, cleaning, and equipment.

Answer 215

Community: A storefront with dispensary in the back Independent, part of a chain (CVS, Walgreen's), or grocery store Required to have a registered pharmacist on duty Can have a pharmacy dealing on only specialty drugs Many pharmacists (60%) are employed in a community setting Hospital: Multiple duties for pharmacist Controlled substance point person Work in the hood preparing intravenous products Work specialty with chemotherapy agents May work with investigational drugs Long-term care facility Federal prison system Ambulatory Care Compounding Specialty Consultant Veterinary Nuclear Military Academia: Teaching in a pharmacy program Typically requires post graduate training in a fellowship or residency program Areas: Pharmaceutical sciences Pharmacy practice / clinical sciences Social, economic, behavioral, and administrative pharmacy What we do Teach students Publish scholarly work Service –committees (department, school, university, national, international levels) industry: Marketing, safety, patient education, sales and administrative duties Post-graduate fellowship programs available federal: Armed services Rank of officer Great benefits but also sacrifices Veteran’s Administrations Public health US Public Health Services Federal prison system Indian Health services

Answer 216

Federal deficit Medicare and Medicaid funding ACOs An increasing number of older adults Cost of drugs Economy Quality of work environment Shortage of technicians Profitability pressure/metrics Shortages of essential drugs/supply chain Overseas manufacture of many drugs COVID-19 pandemic

Answer 217

From 1990-1996, pharmacists were THE MOST trusted professions according to the Gallup Poll 2022 poll: Three of the top four -- nurses, medical doctors and pharmacists -- are medical professions that enjoyed boosted ratings in 2020, likely because of their service to the public during the pandemic, but their ratings have fallen since. [