MIDTERM Flashcards

Question

Standards of Practice

Answer 1

the minimum standards of practice a pharmacist must meet and against which their performance will be measured

Answer 2

publicly-funded the national health insurance program is mandated under the Canada Health Act of 1984 42,584 pharmacists 10,572 pharmacies

Answer 3

doctor shortage - causes lengthy wait times, ER traffic DRP's ($2-9 billion a year) - aging population means senior requires more medications, and more chance of error - increase in complexity of medications

Answer 4

in order to use HCP's more effectively, theres an increased importance placed on the standards of practice for them - due to shifting and overlapping scope of practice - emphasis on accountability of professionals throughout their careers - literature documented that SOP are the fundamental basis of the continuing competence

Answer 5

HCP's - use pharmacists more effectively and allow them to expand their scope as they are both fairly accessible and competent - ensure pharmacists practice "pharmaceutical care" to do whatever is possible to make sure the patient achieves positive outcomes from drug therapy - regulate and utilize pharmacy technicians to aid in expanded role

Answer 6

- National Association of Pharmacy Regulatory Authorities - voluntary, not for profit corporation founded in February 1995 - represents all provincial and territorial pharmacy licensing authorities

Answer 7

Provides national leadership in pharmacy regulatory practices that enhance patient care and public protection

Answer 8

specify the minimum standards of practice a pharmacists must meet and against which their performance will be measured by their regulatory authority

Answer 9

current MSOP developed by NAPRA in late 2007 - adopted by council in september 2009 - implemented in 2010

Answer 10

specifying the standards against which pharmacists performance can be judged when the RPh's are undertaking the activities required for safe and effective pharmacy practice

Answer 11

Minimum standards of practice that all licensed Canadian pharmacists must meet not applicable only to pharmacists at entry to practice NAPRA acknowledges that there are a number of professional roles fulfilled by pharmacists

Answer 12

``` patient care drug information drug distribution management education ```

Answer 13

Expertise in medications and medication-use collaboration safety and quality professionalism and ethics

Answer 14

central domain: expertise in medications and medication-use, collaboration critical attributes: safety and quality, and professionalism and ethics

Answer 15

61 general standards - Pharmacists must maintain their competence - Continued education programs, conferences, life-long learning - Pharmacists must apply their medication and medication-sue - Pharmacists provide evidence of application of their medication and medication-use expertise - Recommend non-prescription drug therapy - Must show no significant drug interactions - Recommend self-care measures - For disease management and cost-effective - Educate patients - Collaboration (central domain for pharmacists

Answer 16

- 21 general standards - Pharmacists must work constructively with students, peers, and members of the inter-professional team - Pharmacists must communicate effectively

Answer 17

- 16 general standards - Pharmacists undertake continuing professional development, quality assurance and quality improvement - Pharmacists respond to safety risks

Answer 18

11 general standard statements Pharmacists demonstrate professionalism

Answer 19

``` Establishes credibility Distinguishes us from other professions Creates foundation Sets level of accountability Support workplace initiatives Advancement of the profession ```

Answer 20

each of the 4 domains is divided into the 5 pharmacist roles identified by NAPRA 1. MSOP for pharmacists providing patient care 2. MSOP for pharmacists when providing drug information 3. MSOP when responsible for dug distribution 4. MSOP when managing a pharmacy 5. MSOP when educating pharmacy students/interns

Answer 21

1. The pharmacy manager shall ensure that non-prescription products are in the area which is consistent with the appropriate drug classification 2. The pharmacist shall respect the patients right to privacy and confidentiality 3. When the patient requests a consultation regarding a schedule 2 or 3 product, the pharmacist shall collect information regarding patient knowledge and needs 4. The pharmacist shall take the necessary steps to fulfill their professional obligations when recommending a schedule 2 or 3 drug 5. The pharmacist shall document the patient interaction on patient profile if deemed appropriate

Answer 22

Schedule 2 - behind the counter Schedule 3 - sold in pharmacy but out in the self-serve area

Answer 23

- changing scope is a reality around the world - Canada and UK ahead internationally regarding regulating technicians - Canada lagging with prevention, screening, and disease specific professional services - Alberta was leading the way for Canada with prescribing models and reimbursement

Answer 24

defines the scope of pharmacy practice - the custody, compounding, dispensing of drugs the provision of non-prescription drugs, healthcare aids, and devices the provision of information related to drug use - tells us the controlled acts we are allowed to do - dispense, sell, compound a drug - supervise the part of a pharmacy where drugs are kept

Answer 25

ON passed bill 179 which permitted pharmacists to perform services normally limited to doctors, to increase access to care for Ontarians by expanding the scope of practice - certain HCPs are given the ability to administer, by inhalation, certain substances that are designated under regulations - physiotherapists can diagnose and order x-rays for patients conditions - dieticians can take blood samples

Answer 26

a change to bill 179 included an expanded list of substances to be administered and inhalation for routine purposes, including immunizations included deletion of the clause which restricts administration of injections to demonstration purposes

Answer 27

bill 179 significantly amended the pharmacy act, creating a greater role for RPh's in the delivery of primary healthcare

Answer 28

As the spectrum of HCPs that can prescribe drug expands, patients may be taking more drugs than needed New market opportunities for the pharmaceutical industry Monitoring of all the HCPs with greater prescribing and dispensing abilities to ensure that they’re being diligent in acting with best interests of the patient

Answer 29

2007 - original MedsCheck program 2010 - expanded medscheck program (LTC, diabetics, home-bound)

Answer 30

april 2011 - first stage of expanded services launched september 2011 - program criteria altered - pharmaceutical opinion program is an expanded professional pharmacy service in which a drug-related problem and clinical intervention are identified - smoking cessation program: NRT for ODB recipients only

Answer 31

Oct 2012, expanded scope of practice, allowing part a pharmacists to: 1. initiate smoking cessation therapy (wellbutrin and zyban) 2. renew or adapt prescriptions (chronic/stable condition by renewing prescription, alter dose formulation, regimen or ROA) 3. perform a procedure on tissue below the dermis 4. administer substances by injection or inhalation

Answer 32

- administer travel and other vaccinations - patients 5 years or older - not all vaccines require a prescription from a primary care provider - vaccines that are part of Ontario's publicly funded immunization program are free if administered by doctor, but those who receive at pharmacy will have to pay

Answer 33

- Administer the flu vaccine to children as young as 2 years old - Renew prescriptions in quantities up to a year’s supply - Administer certain substances by injection or inhalation

Answer 34

1. Members have an obligation to protect and promote health of patients 2. Members are accountable for practicing within their scope of practice, know the terms, conditions, and limitations of their registration 3. The services included within the expanded scope of pharmacy practice are ongoing medical care and take place in the context of a collaborative relationship between the pharmacist, patient, and patient’s primary care provider 4. Members initiate, adapt, and renew prescriptions, administer substances by injection or inhalation only for the benefit of the patient and based on individual nature of the patients need/history and professional judgement exercised accordingly 5. When initiating, adapting and/or renewing prescriptions, the member assumes full responsibility and liability for that prescription, documents actions as required, and undertakes notifications as appropriate a. When adapting, you are the prescriber and assuming full responsibility and liability for the prescription b. Must document everything and then forward on to the primary care provider 6. Pharmacy services are provided within the context of the legislative requirements, standards of practice, and code of ethics

Answer 35

Held responsible and accountable for technical aspects of prescriptions, within the NAPRA standards of practice - Registered technicians are to have liability insurance as well - A technician can fill an Rx, as well as complete a final check - Responsible for the right medication, strength, patient, Dr., as well as the correct quantity of the medication - Pharmacist must check therapeutic appropriateness and counsel the patient if necessary - Assist pharmacists in taking the best possible medication history - Identify any drug interactions or medical conditions - Provide information that does not require application of therapeutic knowledge to patients requiring assistance in selecting non-prescription drug

Answer 36

-30 years of unregistered assistants or technicians assisting pharmacists in technical aspects of dispensing Began with no status - Required in order to maximize the time necessary for the delivery of clinical services - With pharmacists taking on more roles, technicians took on some of the roles, so the pharmacist has more time to do other things

Answer 37

1998 - college began process 2007 - bill 171 was passed in Ontario legislation which enabled the regulation of pharmacy technicians 2010 - pharmacy technicians became recognized as pharmacy regulated roles

Answer 38

you do not need to be registered if working in community pharmacy, but DO need to be registered in a hospital

Answer 39

Counsel for Accreditation of Pharmacy Programs - 2-year program - Graduate from CCAAP registered program - Register with the OCP - Complete the structured practical training (rotation) - 35 hours a week for a minimum of 12 weeks - JP exam - PEBC

Answer 40

Legal, ethical, professional responsibilities - Meet legal requirements - Uphold and act on ethical principles - Demonstrate professionalism Professional collaboration and Teamwork - Collaborate to meet patient healthcare needs, goals, outcomes Drug distribution: Prescription and Patient Information - Receive prescription - Process the prescription - Transfer prescription Drug distribution: product preparation - Select, prepare, package products for release Drug distribution: product release - Ensure accuracy - Collaborate with the pharmacist in the release - Document all aspects of drug distribution activities Drug distribution: system and inventory controls - Manage inventory and drug distribution system Communication and education - Establish and maintain effective communications - Provide information and education - Document standards, policies, and procedures

Answer 41

Pharmacy assistants: job trained members that answer phones, placing orders, maintain stock levels - Some colleges have a 1-year assistant training Technicians: accountable and responsible for the technical aspects of both new and refill prescriptions Pharmacists: remain responsible for the therapeutic/clinical appropriateness of all new and refill prescriptions and therapeutic consultations

Answer 42

Responsible and accountable for the technical aspects of both new and refill prescriptions Each prescription must contain the signature of both the technician (for the technical functions) and the pharmacist (for the therapeutic functions) Perform a procedure on tissue below the dermis (lancet) under the direction of a pharmacist Accept verbal prescriptions - Exception: narcotics and controlled drug substances Independently receive & provide prescription transfers ◦ Exception: narcotics and controlled drugs

Answer 43

- Any form of a plant or plant product (leaves, stems, flowers, roots, seeds) - Sold raw or as extracts - Contains dozens of chemicals (Alkaloids, flavonoids, glycosides, fatty acids, etc.)

Answer 44

- Tea/infusion (water is poured over finely chopped plant material) - Decoction (cold water is added then heated and strained) - Plant juice - Tincture – soaked in alcohol and water then filtered - Extract – very popular and most common (Start with plant material (either dried or fresh), then soaked in a solvent for several hours, filtered, then concentrated and prepared as dry or liquid form) - Tablet or capsule - Others (lozenges, syrups)

Answer 45

``` batch-to-batch variation variation between manufacturers plant: o Portion of plant o Extraction method o Age of plant o Season of harvest o Soil constituents o Plant origin o Growth conditions ```

Answer 46

system of alternative medicine - different than regular western medicine - created in 1800 in Germany - Homeopathic remedies can use plant, animal, mineral substances

Answer 47

like of similar - like cures likes - injecting a person with their allergen to cure them (cure the person with what is causing their illness)

Answer 48

using very small doses - Mother tincture - Dilution and Succession

Answer 49

- 1 small amount from the mother tincture, mixed with diluent - 1 drops of the tincture, with 99 drops of alcohol, shaken vigorously - Dilutes repeatedly - More you dilute it, the stronger it gets - More potent, more dilute

Answer 50

- Every time you take a dilution, you shake it – calling it a succession - The remedy is diluted several times (alcohol or water), and each time undergoes vigorous shaking or succession - This potentizes or dynamizes the remedy; the energy of the active ingredient is released into the diluent - More dilute = more potent

Answer 51

C scale – diluted 100 each time - 1C: 1 hundred times diluted - 2C: 2 hundred times diluted - 3C: 3 hundred times diluted - 200C: 200 times diluted X scale – diluted by 10 each time - 1x = 1:10 - 5X = 1:10^5

Answer 52

- Herbal medicines are used (along with other modalities such as acupuncture) to restore balance of yin and yang - Typically use combination of herbs - Common examples – ginseng, licorice, Ma hang

Answer 53

- A system of traditional medicine native to India | - Incorporates herbal therapies

Answer 54

- Live microorganisms which when administered in adequate amounts confer a health benefit on the host - Usually, bacteria but can be yeast as well - Common probiotics: Lactobacillus sp., Bifidobacterium sp., Saccharomyces boulardii - Common uses – treatment of antibiotic-associated diarrhea, IBS, infantile colic, bacterial vaginosis Ex. Florastor – contains yeast rather than bacteria

Answer 55

- Fish oil capsules - Glucosamine - Caffeine - 5-HTP

Answer 56

- Digoxin – heart failure, from the foxglove plant - Aspirin – made from salicylic acid - Morphine – poppy

Answer 57

- NHPs are regulated which came into effect 2004 - Regulated as a subset of drugs - Pre-market review required for NHP to obtain a product license - Approved products are given either a Natural Product Number (NPN) or DIN-HM (homeopathic medicines) - Product license application must contain information on safety, efficacy, quality, and proposed label text - Slightly different regulatory processes

Answer 58

- Type of evidence depends on the type of application and claim - Compendial application – only need to refer to single ingredient or product monographs, available from Health Canada - All other applications must submit evidence from all relevant sources to support evidence and safety for recommended conditions of use - Evidence from human use is required - Applicants must conduct a systematic, well-constructed literature search to review totality of evidence (favorable and unfavorable)

Answer 59

-Are applications that rely on monographs, which are written to guide industry when preparing product license applications Not written for patient counseling Applicant is referencing an official NHP monograph already published Applications do not require additional data supporting safety or efficacy

Answer 60

drug interactions - Impurities - Quantity different than what was listed on the label - No need to prove efficacy - Sample study – quantity of active ingredient in St. John’s Wart - 54 products analyzed from Canadian and USA, looking at the content of the active ingredients Hypericin and psuedohypericin - Only 2 products contained within 10% of label claim - Very far off from what they contained - Capsules ranged from 0 to 108% of label claim, median 59% A new Health Canada directorate - NHPD – Natural Health Products Directorate was formed to mandate that all Canadians have ready access to natural health products that are safe, effective, high quality while respecting freedom of choice and philosophical and cultural diversity - Now called: Natural and Non-prescription Health Products (NNHPD

Answer 61

- Evidence must demonstrate use of medicinal ingredients as part of a recognized system of traditional medicine - Efficacy is based on theories/belief systems of the healing system - Must show >2 generations of traditional use - Evidence comes from sources like The Pharmacopoeia of the People’s Republic of China - Traditional claim wording examples:

Answer 62

- More stringent requirements for scientific evidence - Sources of evidence: - Clinical studies - Textbooks - Peer-reviewed published articles - Expert opinion reports

Answer 63

- not always, depends on level of risk - only required for high risk - not required for low risk - Traditional claims do not require RCTs

Answer 64

Class 1 – high certainty, low level of review needed - Quickest application review, within 60 days - Rely on single compendial monographs

Answer 65

Class 2 – medium level certainty, medium level of premarket review - Review takes ~ 90 days - Rely on a combination of monographs

Answer 66

Class 3 – low level of certainty, higher level of pre-market review - Ex. Previously unlicensed claims, never seen ingredients or combinations - Review takes ~ 180 days

Answer 67

- Require a product license application (DIN-HM) - Ingredients must be based on those found in a pharmacopoeia such as Homeopathic pharmacopeia of the US (HPUS), and prepared based on the description in these resources - Evidence for efficacy is typically pharmacopoeias, homeopathy, encyclopedias - Must be classified as a homeopathic medicine

Answer 68

- Standards are described in Health Canada document “evidence for quality of finished natural health products” - Manufacturers must provide a copy of the specifications to which the natural health product will comply Examples include: - Product purity - Pesticides, heavy metals, microbial contaminants - Quantity of medicinal ingredients - Potency - Description of testing methods - Chemical identification - Tablet disintegration times

Answer 69

``` For every licensed product listen in the LNHPD, the following details are: Product name Product license holder NPN/DIN Medicinal and non-medicinal ingredients Dosage form Recommended use/purpose Risk information ```

Answer 70

- Recommend if evidence support efficacy and safety - Accept, maybe recommend if evidence supports safety but not all criteria is met - Accept, if evidence for efficacy is inconclusive but is safe - Discourage if evidence indicates inefficacy or serious risk

Answer 71

- Range from effective to ineffective - Effective if the product has a very high level of reliable clinical evidence supporting its use - Ineffective if the product has a very high level of reliable clinical evidence showing ineffectiveness for its use - Effective, likely effective, possibly effective, possibly ineffective, likely ineffective, ineffective

Answer 72

``` Knowledge and health literacy Mental wellbeing Physical activity Healthy eating Risk avoidance Good hygiene Rational use of products and services ```

Answer 73

- Self-care contributes to improved outcomes (WHO) - Increased coverage and access - Increased quality of services - Reduced health disparities and increased equity - Reduced cost and more efficient use of healthcare resources and services - Improved health, human rights, social outcomes

Answer 74

- Accountability - Empowering - Resource-optimized - Relevant - Collaborative - Evidence-based - People-centred

Answer 75

-If just 2% of Canadians with colds, headaches, heartburn who seek professional care despite mild symptoms practiced self-care, then Canada could eliminate more than 3 million unneeded doctor visits/year and free up physician resources to allow an additional 500,000 Canadians access to a family doctor Switching prescription drugs to non-prescription drugs 458 million in reduced cost of medicines $290 million in reduced cost for doctor visits 1 of 7 people would go to the doctor in regard to a minor ailment COVID enhances the knowledge for health literacy and selfcare 65% of Canadians rate healthcare as top public policy issue

Answer 76

Federal food and drugs act Principles for requiring a prescription: - Supervision of HCP is necessary - Level of uncertainty or its effects justify supervision - Use can cause harm or risk to the public

Answer 77

- The provinces, through pharmacists, can set 4 conditions of sale for drugs Schedule 1 – require prescription Schedule 2 – professional intervention required Schedule 3 – must be sold in a pharmacy Unscheduled - sold anywhere

Answer 78

Overlaps with provincial scheduling process Inefficient, not transparent, or predictable - NAPRA makes scheduling for everything but Quebec No protections for innovators - Second entry products can enter the product before the innovator which is hard to get the investments

Answer 79

Quebec - 98 ingredients are more restricted in Quebec pharmacies than in other provinces Including: - Allergy treatments - Heart burn remedies - Emergency contraception - Anti-nauseants - Hair regrowth products - Omega-3 - Yeast infection treatments

Answer 80

Cosmetics - no therapeutic claim, no inspections, no recall authorities, topical/dental/acne therapy/oral health NHP: therapeutic claim and natural ingredient, reviews done on traditional evidence, no inspections, adverse reactions possible OTC: therapeutic claim, product review based on science, recall authorities, averse reactions possible

Answer 81

must recommended non-prescription drug therapy, and recommend self

Answer 82

- Standard 1: The pharmacy manager shall ensure that non-prescription products are in the pharmacy which is consistent with the appropriate drug schedule classification stated in the legislation - Standard 2: the pharmacist shall respect the patients right to privacy and confidentiality - Standard 3: When the patient requests a consultation regarding a schedule 2 or 3 product, the pharmacist shall collect information to assess the patient’s knowledge and needs before providing advice - Standard 4: the pharmacist shall take the necessary steps to fulfill their professional obligations when recommending schedule 2, 3 or unscheduled products - Standard 5: the pharmacist shall document the patient interaction on the patient profile if deemed appropriate

Answer 83

*no universal single definition - The ability of individuals to promote health, prevent disease, and maintain health and to cope with illness and disability - The decision take and the practices adopted by an individual specifically for the preservation of his or her health. Simply put, encouraging self-care means encouraging healthy choices

Answer 84

- Health literacy - Self-awareness - Physical activity - Healthy eating - Risk avoidance - Good hygiene - Rational and responsible use of products and services

Answer 85

Shared decision making - Consumers/patients and healthcare professionals working together to make decisions - Associate risk and benefits, and patient preferences Individual self-efficacy - Individuals confidence to exert control over their behaviour - Does an individual have the capacity to take control of their one self-care? - Essential precursor of effective self-care in patients

Answer 86

- Self-care activities - Self-care behaviours - Self-care context - Self-care environment

Answer 87

- Decreased costs - Easing workload - Increasing healthcare access and equity - Time and money - The more self-care you do, the less healthcare you need

Answer 88

symptomatic relief of mild conditions controls of signs and symptoms

Answer 89

-One element of selfcare -The selection and use of medicines by individual to treat self-recognized illness or symptoms -Majority of OTC purchases are made by the consumer alone using product info from packaging -Facilitated self-medication: when consumers seek help at the point of purchase One study found that Consumers altered their purchasing decision (25% and 43%) when proactively approached by pharmacy

Answer 90

- nonprescription medication (schedule 2 or 3 drugs) - natural health products (vitamins/minerals/herbals) - non-pharmacological therapy (heat pack for pain) - diagnostic tests and monitoring devices (pregnancy/glucose tests) - devices for treatment (ice packs, nasal strips, vaporizers)

Answer 91

- 40% of chronic illnesses can be prevented through the practice of better self-care at all stages in life - 90% of Canadians agree it’s important that governments in Canada provide Canadians with the resources they need to practice self-care for healthy living, so that the health-care system can remain sustainable

Answer 92

- The patient is always the partner in crime - Advice is evidence based - The approach to selfcare is based on patients’ improvement of health - The relationship between pharmacist and patient is based on trust and confidence - Pharmacist must personalize all recommendations to match the uniqueness of every patient - Pharmacist must always be analytical: and be able to problem solve by synthesizing and integrating all information

Answer 93

Health conditions that can be managed with minimal treatment and/or self-care strategies - Usually, a short-term condition - Lab results aren’t usually required - Low risk of treatment masking underlying conditions - Medications and medical histories can reliably differentiate more serious conditions - AKA - Common ailments, self-limiting conditions, ambulatory conditions/ailments

Answer 94

- The terms are not interchangeable | - Self-care is a broad approach that will be taken, minor ailment is a condition

Answer 95

1. Muscle aches and pains (49%) 2. Cold/flu (42%) 3. Headaches (37%) 4. Cough (27%) 5. Back pain (26%) 6. Heartburn/indigestion (21%) 7. Allergies (15%) 8. Insomnia (11%) 9. Menstrual cramps (11%)

Answer 96

- Financial advantages - Lightened workload for tired healthcare system - Convenience - Wide variety of OTC products available

Answer 97

- Potential for drug-drug and drug-disease interactions - Overuse or misuse of OTC - Incorrect diagnosis of the self-care condition - Misinterpretation of the drug facts label - Patient confusion caused by combination products and brand line extensions

Answer 98

A profile of the Canadian self-care product market, 2004 - Studies have shown that many patients are visiting doctors for treatable conditions - 50% of physicians believe that 25% of their consultations were unnecessary and 65% were for minor complaints of the self-limiting kind - The industry estimates that if only 10% of people who currently seek formal care as a first step in treating a self-treatable illness were to treat themselves, the Canadian system could save billions of dollars - Cost of treatment of colds and flu-like symptoms approach $300 million

Answer 99

Disease states No-drug products Nonpharmacologic therapies Non-prescription drug products

Answer 100

- New health council of Canada report ranks Canada poorly in international comparison on ability to get timely access to a family doctor - Expanding pharmacists’ authority and compensation to formally assess and prescribe for minor ailments will reduce costs and take pressure off the system - Decreased physician workload, allowing them to concentrate more on acute and serious illnesses

Answer 101

Benefits for the profession: - Better use of the RPh’s training and skill - Improved relationships with patients Benefits for the public - Appropriate, convenient, timely access to medication and advice - Improved patient care for a variety of conditions - A team approach to healthcare delivery where the expertise of each HCP is utilized to their fullest potential - RPh review of patient medication therapy to determine an effective treatment regimen

Answer 102

adherence is poor - up to 20% of rx's are not filled - up to 50% of patients disregard instructions

Answer 103

Collaborate - Work jointly on an activity to produce something - As applicable, may occur with Colleagues, patients, caregivers, family members, other pharmacists, physicians, and other healthcare practitioners - Happens at every step - Improves patient outcomes - Required for standards of practice Communicate - Exchange information - As applicable, may occur with Colleagues, patients, caregivers, family members, other pharmacists, physicians, and other healthcare practitioners - Happens at every step - Improves patient outcomes - Required for standard of practice - Open ended: allow for more room for conversation - Avoid leading questions

Answer 104

1. Closed questions (yes or no) 2. Avoid leading questions, already stating the outcome 3. Compound/Stacked Questions (only ask 1 specific question at a time)

Answer 105

- “To record something in written, photographic or other form” - Happens at every step - Improves patient outcomes - Required to standards of practice - Purposes: Legal record of care provided Communicate information to the rest of team If you didn’t document it, you didn’t do it

Answer 106

``` about presenting illness S - Symptoms C - Characteristics H - History O - Onset L - Location A - Aggravating Factors (What makes this worse?) R - Remitting Factors (What has been done so far?) ```

Answer 107

about patient H - Health Status (Conditions, wellness, physical assessment) A - Allergies/Intolerances (drugs, environment) M - Medication History S - Social History (lifestyle, goals, preferences, beliefs)

Answer 108

Why - Why are you on this medication? What did the doctor tell you this medication is for? How - How did the doctor tell you to take this prescription? What - What did the doctor tell you to expect from this medication?

Answer 109

Why - Why are you taking this medication? How - How are you taking it? What - What is it doing for you? Is it working/helping?

Answer 110

- Analyze information that has been collected to identify any real of potential drug therapy problems - In addition to patient-specific information, requires in depth understanding of pathophysiology, pharmacology, medicinal chemistry, pharmacokinetics, therapeutics - Drug therapy problems - A drug therapy problem is any undesirable event experienced (or expected) by a patient that involves or is suspected to involve, drug therapy, and that interferes with achieving the desired goals of therapy and requires professional judgement to resolve

Answer 111

``` Collect Assess Plan Implement Follow-up ```

Answer 112

-You will need to communicate and document your assessment - Explain to prescriber, patient, other pharmacists’, other team members what the problem is -Triage No treatment needed oRecommend therapy oRefer but recommend self-care until other HCP seen oRefer for medical care (ER)

Answer 113

patient centredness | - ensuring the patient is comfortable and confident

Answer 114

Action – mechanism of action, onset of action, benefits Administration – drug name, dosage, frequency, route and time of administration, length of therapy Adverse Effect – common side effects, side effect management

Answer 115

"If you dont follow up, you dont care" - Tell them to come in or call if any issues - delegate that to another member - Continuous medication appropriateness/effectiveness/safety - Don't forget to communicate, collaborate, document

Answer 116

- Pain or discomfort in the head, scalp, neck - Most prevalent neurological disorder - Lifetime prevalence of 66% - Women >>> men - 2.1 millions vs 1 million (women vs men) - Tend to decline as individuals reach 40 years of age - Account for 20% of work absences

Answer 117

- ~90% of headaches - Not associated with an underlying illness ``` Ex: TTH Cluster Migraine Benign exertional HA Cold-stimulus headache ```

Answer 118

Associated with organic cause; symptoms of an underlying condition Ex: Medication overuse headache Sinus headache

Answer 119

- Infections - Temporal arthritis (over 50 years of age) - Subdural hematoma - Subarachnoid haemorrhage - Cerebral ischemia (stroke) - Transient ischemic attack - Systemic/CNS vasuclitides

Answer 120

``` o ACEIs o BBs o CCBs o H2 antagonists o Nitrates o NSAIDs o Oral contraceptives and HRT o Other antihypertensives o SSRIs ```

Answer 121

Antibiotics Corticosteroids Other

Answer 122

Pressing/Tightening (non-pulsating pain) | Usually mild to moderate pain

Answer 123

Throbbing and pulsating pain | Moderate to severe pain

Answer 124

penetrating and stabbing feeling | excruciating pain

Answer 125

pressure behind the eyes or face | dull type of pain, worse in the morning****

Answer 126

Gradual onset | Can last 30 minutes to 7 days

Answer 127

sudden onset | can last for 4-72 hours

Answer 128

onset is random | can last for 15-180 minutes

Answer 129

simultaneously with sinus issues | Can last days

Answer 130

muscle pain radiating along the neck/trapezius muscles and scalp bilateral pain

Answer 131

nausea and vomiting photophobia - cant look in light phonophobia - sensitive to sound unilateral (fronto-temporal)

Answer 132

lacrimation, nasal congestion, sweating, eyelid swelling unilateral pain orbital or temporal pain

Answer 133

sinus like symptoms nasal discharge/congestion bilateral, on the face and forehead area - in your sinuses

Answer 134

TTH (stress headache) - no nausea or vomiting - thought to happen because of mental stress, anxiety, depression, emotional conflicts, stimuli

Answer 135

Migraine - stress, fatigue, oversleeping, caffeine, missing a meal, menses, food - certain foods (nitrates, oral contraceptives, hormones)

Answer 136

Sinus headache | - also accompanied with nasal pain, facial pain, pressure-like pain

Answer 137

cluster headache - in 25-50 year olds (have several attacks of them) must be referred to emergency - nasal congestion, facial swelling

Answer 138

``` S - systemic: fever, N/V, appears ill S - Severe ? N - Neurologic symptoms O - onset is abrupt or new O - associated conditions P - Prior history? Headache history? P - pain? unilateral? vision? ```

Answer 139

- secondary causes of headache TTH or migraines - more than 8 headaches/month - therapy? - 1st headache ever - occurrence at night or morning? - Patient is over 50 with tenderness in temporal artery - onset with exercise or sexual activity - pain is a 6

Answer 140

worst headache ever, loss of balance or consciousness, reflexes/sensations, vision, fever, mental status

Answer 141

chronic and progressive pain | significant change in headache patterns

Answer 142

TTH Migraine Cluster headache Medication overuse headache

Answer 143

intermittent TTH mild-moderate migraine sinus headache in a diagnosed sinus infection

Answer 144

mild to moderate TTH not relieved by nonRx/self-care measures mild to moderate migraine

Answer 145

1 - prodrome - a burst of energy or burst of fatigue (24-48 hours) 2 - Aura - Visual sensation, auditory sensations, motor issues 3 - Headache 4 - Postdrome - exhaustion, head movement causes pain

Answer 146

after 4-6 weeks

Answer 147

6-12 weeks

Answer 148

``` Nonpharmacological management (HA diary) loading doses for NSAIDS, triptan use, timing if aura present - Avoidance of MOHs Side effects of chosen treatment ```

Answer 149

``` rest in a dark, quiet room apply a cold cloth/ice pack avoid bright lights, loud sounds, and stressful situations avoid triggers stretching head and neck muscles ```

Answer 150

Ibuprofen - 400mg Aspirin - 1000mg Naproxen 550mg Acetaminophen 1000mg

Answer 151

1st line treatment: amitriptyline 10-100 mg/day nortriptyline 10-100 mg/day second line: Mirtazapine 30 mg/d venlafaxine 150mg/d

Answer 152

ibuprofen 400mg Aspirin 1000mg Naproxen 500 or 825mg acetaminophen 1000mg

Answer 153

ibuprofen 400mg aspirin 1000mg naproxen 500mg or 825mg acetaminophen (less effective) 1000mg

Answer 154

Sumatriptan 100mg Rizatriptan 10mg Almotriptan 12.5mg Domperidone 10mg Metoclopramide 10mg QID PRN

Answer 155

naproxen and triptan 500-550mg

Answer 156

fixed dose-combination analgesics | may be with codeine if necessary

Answer 157

use of analgesics should be limited to 3 days per week increased risk of adverse effects medication overuse headaches

Answer 158

may occur in migraine or TTHA | may happen due to continuous HA associated with use of analgesic medication for greater than 3 months

Answer 159

1st line - nonpharmacologic measures - migraines often improve during pregnancy - TTHAs do not lessen during pregnancy - breastfeeding tends to reduce migraine frequency

MIDTERM Flashcards

(187 cards)