Midterm Flashcards
1
Q
Clinical kinetics
A
Application of PK principles for safe and effective therapeutic drug management in individual pts
2
Q
Therapeutic drug monitoring
A
Use of assay procedures to determine drug concentrations in plasma for developing safe and effective drug regimens
2
Q
Goals of clinical kinetics
A
Enhance efficacy
Decrease toxicity
3
Q
Interpatient variability causes
A
Variations in drug:
Absorption
Distribution
Metabolism
Disease states
Drug interactions
4
Q
When is therapeutic monitoring valuable?
A
Good correlation between pharmacologic response and plasma concentration
Wide intersubject variation
Narrow TI
5
Q
Drug concentration formula
A
(Amount of drug in body) / (volume in which drug is distributed)
5
Q
Process of therapeutic drug monitoring
A
Diagnosis
Drug selection
Dosage regimen
Administration
Concentration measurement
Model application
Dose adjustment
(Don’t Do Drugs At College. Might Die)
6
Q
Volume of distribution
A
Measure of drug distribution throughout the body
Large volume = wide distribution
7
Q
When does the peak drug level occur?
A
30 min - 1 hr after admin
8
Q
When does the drug level trough occur?
A
Immediately prior to next dose
8
Q
SBAR communication framework
A
Situation
Background
Assessment
Recommendation
9
Q
Pharmacist role in clinical PK
A
Designing pt specific dosage regimens
Monitoring & adjusting doses
Evaluating unusual pt responses
10
Q
Standards of effective communication
A
Clear
Complete
Brief
Timely
11
Q
Common barriers to interprofessional communication
A
Generational differences
Culture
Language differences
Personal values
Hiearchy
12
Q
Drug level collection timing considerations
A
- Steady state status
- Peak/trough/random level needed
- Drug-lab interactions
12
Q
General rules for team communication
A
Keep it concise
Include relevant info
Stick to facts
Avoid arrogance & judgement
13
Q
Medication Administration Record (MAR)
A
Tool used to document and track med admin in healthcare settings
14
Q
Options when drug level is not collected properly
A
Delay dose
Retime level
Order random level (rare)
15
Q
Sources for clinical kinetic info
A
Lexi-comp
Micromedex
Other pharm resources
16
Q
Number of marketed OTC meds
A
Over 300,000 in different therapeutic classes
16
Q
Self-care
A
Preventing, diagnosing, and treating one’s own illnesses without professional advice
17
Q
OTC medication market value
A
$102B annually in US healthcare system
18
Q
OTC medicine categories
A
- Respiratory
- GI
- Ophthalmic
- Otic
- Dermatologic/reproductive/
genital disorders - Pain & fever
(Really GOOD Party)
19
Q
OTC product sales increase
A
From $2B in 1965 to $17B in 2012
20
Average pharmacist OTC recommendations per week
29
21
Percentage of consumers who purchase pharmacist recommended OTC products
81%
22
Primary reason patients choose OTC meds
Convenience
23
Annual savings from increased OTC med use
$5.2B for consumers and taxpayers
24
What is QUEST/SCHOLAR? (Not what does it stand for)
Structured approach for pharmacists to counsel pts on self care
25
Low health literacy
Pt barrier to effective communication and self care
26
Lack of training
Clinician barrier to effective communication and self care
27
Lack of privacy
A healthcare setting barrier to effective communication and self care
28
Tamper evident packaging
Safety feature to protect consumers against criminal tampering
29
OTC drug facts label regulation publication date
March 1999
30
Number of OTC drug products affected by labeling rule
More than 100,000
31
Dietary supplements labeling
Regulated as food products with supplement facts panel
32
Ibuprofen overdose case
3 year old given incorrect dose due to babysitter’s measuring device
33
PSE misuse case
23 year old woman took four 240mg tabs in 8 hours instead of one per 24 hours
33
What percentage of OTC drugs are purchased by older Americans?
Almost 30%
34
What are the components of a drug facts label
Active ingredients
Purpose
Uses
Warnings
Dosage instructions
Inactive ingredients
35
OTC product info sources
Product labels
Lexicomp
36
What are the 5 vital signs
Temperature
HR
Respiratory rate
Oxygen saturation
BP
(THROB)
37
BP measurement preparation
Pt seated and rested for 5 min
No caffeine/nicotine/alcohol for 30 min prior
38
Proper cuff fit for BP
Index line between range lines
Bladder encircles 80% of arm
Width at least 1/2 arm circumference
39
Korotkoff sounds
Used to obtain systolic and diastolic BP measurements
40
Tachycardia
HR > 100 bpm
41
Normal oral temp range
95.9 - 99.5
41
Normal respiratory rate
8-16 breaths/min
41
Bradycardia
HR < 60 bpm
41
Tachypnea
Respiratory rate > 16 breaths/min
42
Bradypnea
Respiratory rate < 8 breaths/min
43
Fever threshold for oral temp
> 100*F
44
Fever threshold for rectal temp
> 101.8*F
44
Normal rectal temp range
97.9-100.4
45
What are the advantages of taking temperature rectally?
Closest to core temp
Preferred if < 6 months
46
Normal axillary temp range
94.5-99
47
Tympanic temp accuracy
More accurate in adults than oral or axillary
48
Normal tympanic temp range
96.4 - 100.4
48
Temporal temp sensitivity
More sensitive than tympanic for detecting fever
49
Sensitivity in lab tests
Probability of a positive result if the pt truly has the disease
50
Specificity in lab tests
Probability of a negative result if the pt does NOT have the disease
50
Positive predictive value
Probability that a pt w/ a positive test result actually has the disease
51
Negative predictive value
Probability that a pt w/ a negative test result does NOT have the disease
51
Biopsychosocial model
Concept that a pt’s health is influenced by multiple interacting factors within dynamic systems
52
Clinical reasoning
Process of integrating clinical info, preferences, medical knowledge, and contextual factors to make pt care decisions
52
Components of a medication list
Frequency
Purpose
Dose
Special notes
Name
Route
(Filling People’s Drugs? Sorry, No Refills)
52
What is the purpose of a personal medication record?
Decrease med related adverse events
Core component of med therapy management
53
Collect (PPCP)
- Gather pt info
- List diagnoses
- Relevant data for each condition
53
Assess (PPCP)
Evaluation collected information to ID drug therapy problems and prioritize issues
53
Pharmacist Patient Care Process
Orderly process with steps:
Collect
Assess
Plan
Implement
Follow-up
53
Implement (PPCP)
Execute chosen strategies, including med orders & pt education
53
Plan (PPCP)
Create SMART goals and generate strategies for each prioritized problem
54
Follow-up (PPCP)
Develop monitoring plan and evaluate outcomes for each problem
55
Drug therapy problems
Seven categories including unnecessary therapy, need for additional therapy, an ineffective drug
55
SMART goals
Pt centered objectives that are:
Specific
Measurable
Achievable
Relevant
Time-bound
56
Diagnostic reasoning
Process of determining the cause or nature of a problem/solution
57
Therapeutic reasoning
Process involved in pt management and treatment decisions
58
Medication efficacy
Evaluation of how well a drug achieves its intended purposes
58
Medication safety
Assessment of potential risks and adverse effects associated w/ drug therapy
58
Good clinical reasoning
Provides adequate and true explanations w/ logically strong, complete, and informative hypotheses
59
Adherence
Pt’s consistency in following prescribed treatment regimens
59
Drug therapy problem: unnecessary drug therapy
Pt taking medication without valid indication
60
Preventative care
Measures taken to prevent illness or disease before they occur
61
Drug therapy problem: needs additional therapy
Pt requires additional medication
62
Drug therapy problem: ineffective drug
Medication is not producing the desired therapeutic effect
63
Drug therapy problem: dosage too low
Dose insufficient to achieve therapeutic goals
63
Drug therapy problem: adverse drug reaction
Unwanted/harmful effects from med use
64
Drug therapy problem: Dosage too high
Dose exceeds safe/effective levels
65
Drug therapy problem: Inappropriate adherence
Pt not following regimen as prescribed
66
Pt centered issues in treatment selection
Cost
Safety
Efficacy
Evidence
Adherence ability
(Can’t SEE Anything)
67
Monitoring parameters
Specific indicators used to evaluate treatment effectiveness and safety over time
68
Clinical reasoning in pharmacy practice
Application of critical thinking to investigate, understand, and resolve drug therapy problems
69
How should capsules be stored?
In tight containers w/ constant, adequate humidity
69
Capsule shell materials
Gelatin
Starch
Cellulose polymers
70
What is the largest capsule size for humans?
00
71
How do you decide what size capsules to use
Based on weight of powder to be filled
Use capsule capacity table to determine
72
When compounding capsules, how much extra powder do you make?
10% to account for loss
73
Minimal weighable qty (MWQ)
Minimum amount that can be accurately weighed on a balance
74
When do you prepare an aliquot?
When drug amount is below the MWQ of the balance
75
How do you determine how much diluent you need in capsules?
Compare total powder amount to capsule capacity
76
Steps to create an aliquot
1. Weigh allowable amount of drug
2. Add diluent
3. Mix homogeneously
4. Measure desired amount
77
Capsule filling methods
Hand punch
Capsule machine
78
What is the advantage of a capsule machine?
Quicker for large batches
79
Hand punching capsules process
Create powder bed
Punch capsules
Fill
Cap
79
What is the disadvantage of a capsule machine?
May waste more powder
80
Quality control for capsules
Weigh to ensure within 5% of desired weight
81
BUD if using a manufactured product for the AI
25% of remaining time until exp or 6 months (whichever is earlier)
82
BUD if using USP or NF substance (bulk powder)
6 months
83
Compounding record essential components
Name
Qty
Therapeutic use
Dosage form
Route
BUD
Ingredients
Strength
(Never Quit Taking Down RBI Stats)
84
Geometric dilution
Technique for mixing powders to ensure uniform distribution
85
Auxiliary label for phenobarbital containing capsules
Do not use heavy machinery
86
Quality control data in compounding
Weight of empty and filled capsules
87
Infestation
Parasitic disease caused by animals such as arthropods and worms
88
Infection
Condition caused by protozoa, fungi, bacteria, or viruses
89
Head lice transmission
Direct contact w/ infested head or shared items like combs and hats
90
Nits
Eggs laid by female lice
Hatch in 7-8 days
91
Pruritus in head lice
Most common symptom
Allergic reaction to live saliva
92
First line therapy for head lice
Permethrin
93
Non-pharmacologic head lice management
Change clothing daily
Treat infested items
Wash hair tools
94
Mosquito bite effects
- Welt
- Itching
- Potential urticaria reactions and systemic symptoms
(WIP)
95
Flea bite characteristics
Multiple, grouped, often on legs and ankles
96
Insect bite prevention
Use of insect repellent
97
Bed bug hiding places
Crevices in walls, floors, bedding, suitcases
98
Scabies causative agent
Sarcoptes scabiei mite
99
Scabies transmission
Physical contact
100
FDA approved scabicides
Lindane
Crotamiton
Permethrin
Spinosad
(Let Cassie Pass Stats)
101
Tick removal method
CLEAN tweezers
Make sure the head is still attached to the tick
Must be done within 36 hours of attachment
102
Lyme disease vector
Deer tick
103
Rocky mountain spotted fever vector
Lone star tick
104
Chigger myth
They burrow into the skin and stay there
105
Life-threatening spider envenomations
Recluse and widow spiders
106
Recluse spider bite initial management
Rest
Ice
Compression
Elevation
(RICE)
107
Widow spider bite symptoms
Painful cramps
Abdominal muscle rigidity
Excruciating pain
108
Pinworm transmission
Fecal-oral through ingestion of eggs
109
OTC medication for pinworm infection
Pyrantel pamoate
110
Pyrantel pamoate mechanism
Depolarizing neuromuscular agent that paralyzes adult worms
111
Lyme disease symptoms
Bullseye rash
Acute headache
Tender urticarial lesions
(BAT)
112
Rocky mountain spotted fever symptoms
Rash
Fever
Nausea/vomiting
Muscle pain
Headache
(Really Fucking Need Mental Help)
