Didactic Exam

What are the 6 levels of Bloom’s Taxonomy?

Remember → Understand → Apply → Analyze → Evaluate → Create

What does “Remember” mean in pharmacy?

Know the medication. Recall facts and basic concepts

What does “Understand” mean in pharmacy?

Explain what a medication does

What does “Apply” mean in pharmacy?

Counsel and educate a patient

Why is it important to recognize a drug?

You cannot analyze a medication regimen if you don’t recognize the medication

Why do I need to know a drug’s adverse effects?

You have to know a drug’s adverse effects to recognize if your pt is experiencing one

Why do I need to understand a drug’s precautions?

To determine whether something about a pt’s therapy is concerning

What information do I need to know for each drug card?

Brand/Generic Name, Therapeutic Drug Class, Common Dosage Forms, FDA Indications/Dosages, Monitoring Parameters, Contraindications/Precautions, Adverse Effects, Patient Consultation, REMS/BEERS List, CII-CV Control Scheduled Medications

What do these Common Dosage Form abbreviations mean?

ODT, SL, IR, XL/XR/ER, SR, DR, EC

Orally Disintegrating Tablets, Sublingual, Immediate Release, Extended Release, Sustained Release, Delayed Release, Enteric Coated

What are the major purposes for laboratory testing?

Detect disease, guide treatment, monitor treament and/or disease progression

When should lab tests be ordered?

Discover disease, confirm diagnosis, differentiate between diagnoses, determine stage/severity of disease, detect disease recurrence, assess therapy effectiveness, guide the course of therapy

What are limitations of lab tests?

False negatives or positives, lab errors, influence of pt-specific factors

What is accuracy? What is precision?

Accuracy: The extent to which the measurement is close to the true value

Precision: Reproducability

What is a specimen?

A sample used for lab analysis

What is plasma? What is serum?

Plasma: Watery, acellular portion of blood

Serum: The liquid that remains after fibrin clot has been removed from plasma

What is qualitative? What is quantitative? What is semiquantitative?

Qualitative: Results are simply positive or negative

Quantitative: Results are an exact numeric measurement

Semiquantitative: Results are reported as negative OR 1+, 2+, 3+ 4+

Screening Tests vs. Diagnostic Tests

Screening Tests: Fairly simple. High sensitivity. Used for pts without signs/symptoms of disease. They always require confirmation with another test.

Diagnostic Tests: More complex. High specificity. Used for pts with signs/symptoms of disease.

What does “Sensitivity” mean in laboratory testing? What does “Specificity” mean in laboratory testing?

Sensitivity: Ability to identify positive results in pts who have disease (true pos)

Specificity: Ability to identify healthy people who do not have a disease as negative (true negative)

What is a Reference Range in laboratory testing?

A statistically derived numerical range obtained by testing a sample of healthy individuals

Describe the upper and lower limits of a Reference Range

Upper and lower limits of a reference range are NOT absolute. The usual mean value is ±2 standard deviation

What is a critical value?

A value far enough outside the reference range that it indicates impending morbidity (a highly likely state of severe illness)

What should be considered when interpreting lab results?

Baseline results, reference range, rate of change, isolated result vs. trend

When should you be suspicious of a laboratory error?

A result is inconsistent with a trend in serial (at least once a day) results, the magnitude of the possible error is great, the result does not coincide with a confirmatory test, the result is inconsistent with the pts clinical status

What can cause laboratory-specific errors?

Deteriorated reagents, calibration erros, calculation errors, misread lab results, documentation errors, improper sampling/handling

What are the 3 major types of laboratory testing?

Centralized laboratory testing, Point-of-Care testing (PCOT), Home testing

Centralized Laboratory Testing advantages/disadvantages

Advantages: Variety, higher quality-care, accuracy

Disadvantages: Costly, slow turnaround, one location

Point-of-Care Laboratory Testing advantages/disadvantages

Advantages: Portability, quick turnaround, lower cost

Disadvantages: Misinterpretation of results (pts taking tests at home), quality assurance issues

Home testing Laboratory Testing advantages/disadvantages

Advantages: Convenience, less costly, rapid turnaround, privacy

Disadvantages: Misinterpretation of results (!!) → delays in seeking medical advice

What are the 2 types of home testing kits?

Complete test kits (obtain own sample, test and read results)

Collection kids (Obtain own sample, mail sample to lab and recieve results)

Describe a PIC

Pharmacist in Charge:

Required by law in each community pharmacy, may only be PIC at ONE pharmacy at a time, does NOT need to be physically at the pharmacy at all times.

Describe a Pharmacist on Duty

A licensed pharmacist must be present and on duty at all times a community pharmacy is open for business. Pharmacist may not be absent for more than 3 hours daily or 1.5 hours at a time. Any compounding/dispensing/pickup activities must be halted when the pharmacist on duty is away.

Describe offering counseling to pts

A pharmacist or pharmacy intern/extern must at least OFFER to counsel all patients receiving NEW medications.

What are some things a licensed pharmacy technician CANNOT legally do?

Take telephoned rx, transfer rx into/out of the pharmacy, perform patient counseling, provide medication information, enter w rx order w/o pharmacist verification

How often should a pharmacy stock be reviewed for outdated drugs?

Every 6 months

When do non-controlled rx legally expire?

NEVER

When do CII rx legally expire?

NEVER

When do CIII, CIV, CV rx legally expire?

6 months from the date of issuance

What is the MAXIMUM number of refills for a CIII, CIV, CV rx?

5 refills within 6 months

How much medication may be dispensed when a patient has no refills remaining on a non-controlled legend medication?

Up to a 72-hour supply

How many times can a NON-CONTROLLED prescription be transferred?

Until no refills remain

How many times can a CII prescription be transferred?

ZERO (Makes sense— they have no refills)

How many times can a CIII, CIV, CV prescription be transferred?

ONCE. Unless within the same chain

What is OBRA ‘90? What something that happens under it?

Omnibus Budget Reconciliation Act of 1990

→ Requires DUR program (Drug Utilization Review)

What does HIPPA stand for?

Health Insurance Portability and Accountability Act

(Portability: The ability to transfer or exchange employment and continue health insurance coverage)

→ HIPPA signed statement from patient kept for 6 years

What is a list of things a pharmacist should do when dispensing a CII medication?

Sign their FULL name, check date of issuance (cannot fill early), ensure rx serial number

What is NOT legally required to be on a written rx?

DOB and Drug Allergies

What is NOT legally required to be on a rx label?

The name of the drug, strength of drug, quantity, and refills (computer generated labels will print with all of this though)

Describe/Define Aseptic Technique for Injection

Procedures used to prevent the transmission of a pathogen to a prepared injection (vaccine), thus the prevention of infecting a patient with a pathogen

How to prepare to Aseptically draw a dose

1. Scrub in (30 SEC!)

2. Have proper vial, syringe, needle, bandages

3. Check all info of all supplies

4. Swab the top of the vial with alcohol

5. Draw air equal to the dose

6. Stick in vial , release air

7. Invert vial and syringe

8. Draw past vol needed and remove all air bubbles, push back to correct vol

9. Pull vial off needle

10. If recapping use scoop method

Define Health. Define Public Health.

Health is the absence of death, disability, and disease. It can also be defined as a state of complete physical, mental, and social well-being.

Public Health is the science of protecting and improving the health of families and communitities.

What are the 3 core functions of Public Health? Describe them.

→ Assessment: What is happening?

→ Policy Development: What should we do?

→ Assurance: Are we actually doing what we need to do?

Public Health is guided by the 10 Essential Public Health Services. Describe them. What kind of process is this?

Assessment

• Monitor health status

• Investigate and diagnose health problems

Policy Development

• Communicate effectively

• Mobilize community partnerships

• Develop policies/plans

• Enforce public health laws/regulations

Assurance

• Enable access to healthcare

• Build a diverse workforce

• Continuously improve quality

• Have strong organized infrastructure

This is an ONGOING process!

Where are the 10 Essential Public Health Services applied?

National, state, local, tribal, territorial

Who has primary responsibility for health under the U.S. Constitution?

State and local health departments

What are some examples of major public health issues?

Chronic disease, mental health, substance abuse, infectious disease, health care access, widespread medication use

What public-health roles can pharmacists perform?

Immunizations, screenings, education, chronic-disease management

The Pharmacists’ Patient Care Process (PPCP)

Collect: Gather info

Assess: Identify pt problem

Plan: Develop strategies/changes

Implement: Counsel and provide

Follow-up: Communicate and reassess

What is Pharmacy Practice Activity Classification (PPAC)’s purpose?

Standardize and clarify pharmacists’ roles and activities

What is interprofessional education?

When two or more professions learn with, from, and about each other to IMPROVE collaboration and the quality of care

What is the purpose of increased emphasis on IPE in pharmacy education?

To advance collaboration and quality of patient care by having students learn about, from, and with members of the interprofessional healthcare team.

What are the 4 IPEC core competencies?

Values and Ethics

Communication

Roles and Responsibilties

Teams and Teamwork

What is poor communication? How may it impact patient care?

Poor communication: Unclear exchange of information between healthcare professionals that can compromise teamwork and patient safety

What is SBAR? How can it be used to communicate in a healthcare setting?

Situation— The immediate problem

Background— Relevant history or context

Assessment— Your interpretation of the problem

Recommendation— What should be done next?

How might you manage difficult situations in interprofessional communication?

→ Continue to communicate clearly, respectfully, and professionally, while making sure the relevant patient-safety concern is understood.

→ Stay professional, communicate clearly, advocate for the patient, and use the expertise of the whole team.

Define Impairment

Diminished function or ability/Unable to function normally or safely

T/F: Impairment and Intoxication are the same thing

FALSE

Define Diversion

The act of diverting/straying something from its intended course

What is the primary concern when dealing with impairment or diversion?

Patient safety!

What characterizes Substance Use Disorder (SUD)?

Compulsive use despite harm and loss of control

Tolerance and Dependence vs Addiction

A patient can be tolerant and dependent without having a disorder.

When does use become a disorder? (4 clusters of SUD criteria)

→ Impaired control: ex. cravings

→ Social impairment: ex. missed obligations

→ Risky use: ex. cont use despite harm

→ Pharmacologic: ex. tolerance and withdrawal

Approximately how many pharmacists will struggle with addiction/substance abuse during their professional careers?

1 in 7 pharmacists

Is the rate of substance-use problems in pharmacists lower than the general population?

No

Do pharmacists/interns have a professional duty to report an impaired pharmacy licensee who has endangered public health/welfare?

YES

If a diverted substance is scheduled/controlled, what type of crime is it?

A felony

What consequences can result from practicing pharmacy while impaired?

Criminal charges, civil penalties, loss/suspension/revocation of license, loss of employment

What are the 4 main categories of drug related problems?

Indication, effectiveness, safety, adherence

What does SOAP stand for? (SOAP Notes)

Subjective: What the patient reports (ex. pain scale)

Objective: Measurable data

Assessment: Diagnosis

Plan: Treatment

Systolic BP vs Diastolic BP

Systolic: The heart muscle contracts

Diastolic: The heart muscle rests between beats and is refilled with blood

What do Korotkoff Phase I and V represent?

Phase I = first tapping = SYSTOLIC
Phase V = silence = DIASTOLIC

What are the three pulse sites?

Radial, brachial, carotid