Lecture 2 - Pharmacotherapy

Question 1

What does PCCP stand for?

Answer 1

Patient centered care process

Question 2

Explain what PCCP (patient centered care process) is

Answer 2

an approach to care that consciously adopts a patient’s perspective

Respect for a patient’s values, preferences and expressed needs

Question 3

What are some drug therapy problems

Answer 3

nonadherence
drug ineffectiveness
adverse drug events
over/under dose
drug interactions
common drug-related problems in older adults

Question 4

what is a significant public health issue in the healthcare system, resulting in an annual cost of $528.4 billion

Answer 4

drug therapy problems
nonoptimized medication therapy

Question 5

What is the MISSION of pharmacy practice

Answer 5

to provide pharmaceutical care

Question 6

Pharmaceutical care involves….

Answer 6

identifying, resolving, and preventing actual and potential DTP’s (drug therapy problems)

Question 7

What is the CENTRAL TENET of pharmaceutical care

Answer 7

the recognition that patients have drug therapy needs — and problems can occur

Question 8

What is the definition of pharmacotherapy

Answer 8

treatment of disease through the use of medications

Question 9

What is the area of pharmacy practice that ensures the safe, appropriate, and economical use of medications?

Answer 9

pharmacotherapy

Question 10

What is a good guiding principle to follow

Answer 10

there should be a justifiable and documented indication for every medication that is used

This includes STOPPING the medication when it’s no longer needed

Question 11

Explain the guiding principle to follow for the length that a medication should be taken

Answer 11

a medication should be used at the LOWEST DOSAGE and for the SHORTEST DURATION that is likely to achieve the desired outcome

Question 12

what is preferred – monotherapy or multitherapy

Answer 12

When a patient can be treated with a single drug, then monotherapy is preferred.
ie: avoid concomitant use of omeprazole and famotidine

Question 13

What is the guiding principle to follow regarding newly approved medications?

Answer 13

newly approved medications should be used ONLY IF there are clear advantages over older medications

ie:
less drug interactions
less likely to cause bothersome side effects
longer duration of action
failure on older medications

Question 14

Whenever possible, the selection of a medication regimen should be based upon evidence from……

Answer 14

CONTROLLED CLINICAL TRIALS

Question 15

the _____ of drug administration should be considered as a possible influence on drug efficacy, adverse events, and interactions with other drugs

Answer 15

TIMING

ie:

-taking cipro with dairy decreases its absorption
-one drug binds to another in the stomach
-adderall is taken for ADHD so its taken in the morning instead of at bedtime

Question 16

What fact about the patient may affect adherence and treatment outcomes?

Answer 16

a patient’s perception of an illness or the risks and benefits of therapy

ie:

-hypertension – “i dont need pills i dont feel sick”
-flu – i dont need medicine ill just be sick for a couple of days ( risk of developing pneumonia)
-“my fever is gone so i can stop the antibiotic”

Question 17

What is a good way to avoid nonoptimal treatment outcomes associated with patient’s perception of the illness or the therapy?

Answer 17

counseling and the teach back method

Question 18

A medication should not be given by injection when giving it by mouth would be just as effective and safe. Why does this principle exist?

Answer 18

because giving by mouth is less invasive, cost effective, and decreases the risk of infection

Question 19

How do you avoid the “prescribing cascade”?

Answer 19

a drug regimen should only be initiated with full recognition that a medication may cause disease, symptoms, etc, or abnormal lab tests

THIS WILL HELP TO NOT TREAT SIDE EFFECTS OF A DRUG AS A NEW DISEASE

Question 20

When a variety of drugs are equally efficacious and equally safe, which drug should be chosen?

Answer 20

the drug that results in the lowest health care cost or is most convenient for the patient

ie: brand vs generic, formulary issues

Question 21

What should be done before medications are used?

Answer 21

lifestyle modifications or non-pharmacologic interventions should be made to potentially eliminate the need for drug therapy

Question 22

When making decisions about drug therapy for individual patients, ______ effects should be considered

Answer 22

societal

Question 23

what are some societal effects

Answer 23

cost, education, access, equity
-social determinants of health

Question 24

Possible reasons for failure of medication regimen—-

Answer 24

-inappropriate drug selection
-poor adherence
-misdiagnosis
-concurrent illness (substance use and mental health disorder at the same time)
-interactions with food or drugs
-environmental factors
-genetic factors

Question 25

Define drug therapy problem

Answer 25

any undesirable event experienced by a patient that involves drug therapy. Interferes with achieving the desired goals of therapy

Question 26

How are drug therapy problems resolved?

Answer 26

by professional judgment

Question 27

what are the 3 primary components of a drug therapy problem-

Answer 27

-the undesirable event/risk experienced by the patient -the drug therapy that caused the problem -the RELATIONSHIP between the undesirable event and the drug therapy

Question 28

name 2 drug therapy problems under the drug related need of "indication"

Answer 28

-unnecessary drug therapy -additional therapy needed

Question 29

name 2 drug therapy problems that fall under the drug related need of"effectiveness"

Answer 29

-ineffective drug -dose is too low

Question 30

name 2 drug therapy problems that fall under the drug related need of "safety"

Answer 30

-adverse drug reaction -dose is too high

Question 31

name a drug therapy problem falling under the drug related need of "adherence"

Answer 31

-nonadherence or noncompliance

Question 32

issues related to indication....

Answer 32

-needs additional therapy -unnecessary drug therapy

Question 33

issues related to the drug product...

Answer 33

-ineffective drug -adverse drug reaction

Question 34

issues related to the dosage regimen...

Answer 34

-dosage too low (ineffective) -dosage too high

Question 35

Explain when unnecessary drug therapy exists

Answer 35

-duplicate therapy -no medical indication -nondrug therapy is more appropriate -addiction/rec use -prescribing cascade --- treating adverse reactions

Question 36

explain when additional therapy would be needed

Answer 36

preventative therapy untreated condition synergistic therapy --- need 2 meds to work together to produce outcome

Question 37

explain why a drug would be ineffective

Answer 37

-a more effective drug is available -the condition is refractory (untreatable) -the dosage form is inappropriate -contraindication is present -the drug is not indicated for the condition present

Question 38

DOSES NEED TO BE....

Answer 38

PATIENT SPECIFIC

Question 39

If the dosing is too high, the dosing interval could be too ____

Answer 39

short

Question 40

if the dose is too low, the dosing interval could be too _____

Answer 40

long

Question 41

What are some causes of an adverse drug reaction

Answer 41

-drug interaction -incorrect administration -allergic reaction -dosage increase/decrease too fast

Question 42

What are some factors that could cause nonadherence?

Answer 42

-pt does not understand directions -pt cannot afford medication -pt prefers not to take medication -pt forgets to take -med is not available -cannot swallow/administer drug -pt afraid of adverse events -previous medication experiences

Question 43

Stating a drug therapy problem should consist of 3 components:

Answer 43

-description of the patient's medical record or clinical state -the DTP -the specific association between the drug therapy and the patient's condition

Question 44

Patient's may have several DTP'S. The problems should be prioritized based on:

Answer 44

-extent of potential harm -patient's perception of potential harm -rate at which the harm is likely to occur

Question 45

Once you prioritize the problems, what should you ask yourself?

Answer 45

-which problem must be resolved immediately? -Which problem can be resolved by the practitioner and patient? -Which problems require intervention by another member of the healthcare team?

Question 46

What do you document if there are NO drug therapy problems?

Answer 46

focus on achieving the goals of therapy and ensure that the pt is not at high risk of DEVELOPING any problems we still need to develop a PLAN and periodic follow up

Question 47

What question should you ask yourself to recognize if there is any unnecessary drug therapy

Answer 47

"Why is the patient taking this medication?" does the pt have a medical condition warranting its use?

Question 48

What questions should you ask yourself to determine if there is need for additional therapy?

Answer 48

what are the untreated medical conditions what is the status of the current condition does the pt require therapy what is the treatment

Question 49

If a therapy is indicated, how do you choose which therapy to use?

Answer 49

evidence based reasoning (clinical trials)

Question 50

If a drug isn't working (ineffective), what questions should you ask yourself?

Answer 50

is the pharmacotherapy appropriate? is the drug contraindicated is the most optimal agent being used

Question 51

If the dose is too low or too high, what questions should you ask to determine the issue

Answer 51

-is the dose appropriate for the patient's renal and hepatic function -do any drugs require adjustment based on weight or age -what is the recommended dosage range and administration -is the length of therapy appropriate -where is the pt storing these meds

Question 52

If a patient is experiencing adverse reactions, what questions should you ask them?

Answer 52

what have you noticed different since starting this medication? what has changed since starting this medication? (ie: lifestyle changes, otc meds)

Question 53

If a patient is allergic to penicillin and you get a script for them for amoxicillin, what is the term for this?

Answer 53

contraindication -- reason NOT to take the medication due to the harm it would cause