Unit 1: Intro to pharmacy conceps pt 2

Medication Use Process

Prescribing → Transcribing/Documenting → Dispensing → Administering → Monitoring

Prescription Medications / Legend Drugs

Medications that by law can only be obtained with a prescription. May have the statement “Caution: Federal law prohibits dispensing without a prescription.”

Schedule Drugs (Controlled Drugs)

Medications with high abuse/dependence potential.

Over-the-Counter (OTC) Medications

Nonprescription medications. Bought off-the-shelf in stores and do not require a prescription.

Brand vs. Generic: Active Ingredient & Strength

There is NO difference in active ingredients or strength/dosage between brand and generic medications.

Brand Medications

Higher in cost. Covered by insurance if no generic form exists. Drugs are standard in size, color, packaging, etc. Include ® or trademark symbol.

Generic Medications

Lower in cost. Usually covered by insurance. Packaging and the drug itself may look different.

Prescription Drug Order (Rx)

A lawful order of a licensed practitioner for a medication, device, or pharmaceutical care for a specific patient.

Prescription / Script

Used in outpatient care. “Pre” = before; “script” = writing/written.

Medication Order

Used in hospital and institutional care settings. May also contain directions for procedures, lab tests, and discharge instructions.

Rx Component: Prescriber Identification

Name, license designation, address, and DEA number for controlled drugs. Also includes the signature of the prescribing practitioner.

Rx Component: Patient Identification

Full name, age/DOB, and street address.

Rx Component: Date

Date the prescription was written.

Rx Component: Superscription (Rx)

“Take thou,” “you take,” or “recipe” if compounded medication.

Rx Component: Inscription

The medication prescribed, including name, strength, and dosage form.

Rx Component: Subscription

Dispensing instructions to the pharmacist, including quantity to dispense (e.g., number of tablets or volume of liquid).

Rx Component: Signa (Sig)

Directions for use. The pharmacist must transcribe the directions for the patient on the label.

Rx Component: Special Labeling & Instructions

Includes refills and generic product substitution.

Drug

Active pharmaceutical ingredient.

Strength

Amount of drug (active ingredient) in one unit. Examples: 500 mg tablet; syringe containing 80 mg.

Concentration

Amount of drug (active ingredient) in a specific volume. Example: suspension containing 5 mg per mL.

Drug Product

Active + inactive ingredients. Includes dosage form and strength or concentration. Examples: metformin 500 mg tablet; ibuprofen suspension 100 mg/5 mL.

Dose

Amount of drug taken at one time unless specified as “total daily dose.” Examples: 500 mg tablet, take 2 tablets = 1000 mg dose; 5 mg/mL suspension, take 5 mL = 5 mL or 25 mg dose.

Route

How a medication is administered. Examples: by mouth, intravenous, subcutaneous, sublingual, rectal.

Frequency

How often a medication is taken. Examples: daily, twice per day, as needed.

Duration

How long the drug is to be taken. Sometimes specified for acute therapies (e.g., antibiotics “x 10 days”) and sometimes determined based on days’ supply.

SIG / Signa

Directions supplied by the prescriber to the pharmacist for interpretation. Should include dose, route, and frequency. Example: Take 2 tablets by mouth BID.

Instructions

Directions the pharmacy places on the product for the patient. Examples: “Take 2 tablets by mouth twice a day”; “Take 1 capsule as needed for pain.”

Quantity

Total amount dispensed to the patient; may be tablets, units, mL, etc. Does NOT include the amount provided on refills.

Days’ Supply

Number of total/complete days the amount dispensed will last. Based on the amount needed per dose, frequency, and duration. NOT the amount to be taken per day.

Total Daily Dose (TDD)

Amount of medication a patient takes every day. Example: carvedilol 25 mg twice daily = 25 mg/dose × 2 doses/day = 50 mg/day.

Medication Titration

Slowly increasing the dose of a medication by small amounts over days, weeks, or months to find an effective dose. Helps patients develop tolerance to adverse effects.

Medication Taper

Gradually decreasing the total daily dose of a medication. Typically, the goal is discontinuing the medication.

Initial Dose

Starting dose of a medication. Lisinopril example: 5–10 mg once daily.

Dose Titration

Lisinopril example: increase daily dose by doubling every 2–4 weeks as needed.

Maximum Dose

Lisinopril example: 40 mg once daily.

Medical Abbreviation Safety

Use common/standard abbreviations. Never create abbreviations. Never try to interpret a prescriber’s shorthand abbreviation if uncertain—ask the writer for clarification. Avoid abbreviations that lead to errors.

PO

Oral; by mouth.

SL

Sublingual.

IV

Intravenous.

IM

Intramuscular.

SQ

Subcutaneous.

PR

Rectal; per rectum.

AD

Right ear.

AS

Left ear.

AU

Both ears.

OD

Right eye.

OS

Left eye.

OU

Both eyes.

QD

Daily.

QAM

Every morning.

BID

Twice daily.

TID

Three times daily.

QID

Four times daily.

QOD

Every other day.

Q4h

Every 4 hours.

HS / QHS

At bedtime.

AC

Before meals.

PC

After meals.

D/C

Discontinue.

PRN

As needed.

Pharmacy Calculations

Used to calculate medication doses, quantities of pharmaceutical ingredients for compounding, dose adjustments for disease-state management, IV fluid/drip rates, days’ supply, and number of units to dispense.

Pharmacy Calculation Methods/Skills

Basic order of operations (PEMDAS), metric & US customary units, rounding basics for pharmacy, pharmacy calculation basics, proportions, and dimensional analysis.

Diagnosis

Process of identifying a disease, condition, or injury from its signs and symptoms.

Symptoms

Subjective experience reported by the patient. A symptom may also be a sign.

Signs

Objective; observable/identifiable by another person. Examples: labs and vital signs. A symptom may also be a sign.

Prophylaxis

Medication or intervention to prevent a condition.

Idiopathic

A disease, condition, or symptom that arises from an unknown cause.

Non-pharmacological Therapy

Intervention to treat or prevent a condition that is NOT based on medication.

Mortality

Death due to an illness or condition. Example: a patient passes away from complications of type 2 diabetes.

Morbidity

Impact or burden of a disease on the patient’s health. Example: uncontrolled diabetes causes nerve damage and kidney disease.

Co-morbidity

Having more than one illness or condition simultaneously. Example: a patient with type 2 diabetes also has hypertension and obesity.

Risk Factor

A patient factor that increases the chances of developing a disease or increasing its severity. It may NOT be a direct cause; an association has been established. Think: something that puts you at risk of “something bad.”

Modifiable Risk Factors

Examples: diet, exercise, smoking cessation.

Non-modifiable Risk Factors

Examples: age and genetics.

Risk Factor vs. Cause

A risk factor increases risk but does NOT necessarily cause the disease. Example: age is a risk factor for developing the flu, but age does not cause the flu. HIV is a risk factor for AIDS AND HIV causes AIDS.

Consequence / Complication

Damage from “something bad,” usually from disease progression or lack of disease management.

Regimen

Prescribed course of treatment.

Role of the Pharmacist

The prevention, identification, and management of medication therapy problems and their root causes as the medication specialist. Monitoring is a major area where pharmacists demonstrate expertise.

Goals of Therapy

Cure a disease; reduce or eliminate symptoms; prevent a disease or symptom; stop or slow progression — while minimizing risk.

IESA

Indication, Efficacy, Safety, Adherence.

Indication

The clinical reasons a patient might require drug therapy. Broader than a diagnosis, disease, or FDA-labeled indication.

Possible Reasons for an Indication

Cure; supplement; slow/prevent progression; correct labs; assist in diagnosis; provide comfort/relief.

FDA-Labeled Indication

FDA has approved the medication as safe and effective for a medical indication.

Off-Label Indication

FDA has approved the drug, but not for that indication; data exists to support its use.

Reasons for Off-Label Use

Specific population; life-threatening/terminal condition; drugs in same class; treat 2 conditions with 1 medication; given a different way.

Indication vs. Appropriateness

An FDA indication does NOT automatically mean the medication is appropriate for a particular patient. Example: metoprolol has an FDA-labeled indication for hypertension but is not generally first-line unless certain comorbidities, such as heart failure, are present.

Disease vs. Indication

Disease and indication are NOT the same. Different medications may be appropriate for the same disease depending on patient needs and goals. For type 2 diabetes, goals may include lowering A1c/glucose, protecting kidneys, reducing cardiovascular risk, or weight loss.

Indication Questions

Is therapy indicated to treat or prevent the condition? Is it recommended by evidence-based guidelines? Is it first-line or second-line? Is it appropriate for this patient?

Efficacy

When medication produces the desired, beneficial effect(s) to meet goals of therapy/therapeutic outcomes.

Goals of Efficacy

Reduce, resolve, or prevent signs, symptoms, progression, or consequences/complications of disease.

Efficacious but Not at Goal

A medication CAN be efficacious even if the patient has not yet reached the final therapeutic goal.

Efficacy Goal vs. Diagnostic Criteria

Efficacy goals are different from diagnostic criteria. Example: type 2 diabetes diagnosis = A1c ≥6.5%; efficacy goal of treatment = A1c <7%.

Efficacy Monitoring Questions

What are the goals of therapy? How will therapy work to treat/prevent the disease? What subjective and objective markers will be monitored? What is the monitoring timeline/interval?

Efficacy Monitoring

Must know the goals and duration of therapy (acute vs. chronic). Includes subjective and objective parameters. Include “resolution of…” or “prevention of…” and give a timeline for follow-up monitoring.

Safety

When medication causes harm. ALL medications have risks. Goal is to reduce/prevent medication-specific ADRs and avoid contraindications/precautions.

Adverse Drug Reaction (ADR)

A harmful, nonpreventable response that occurs with usual use of medication. Can be called a “side effect.”

Tolerability

Degree to which an ADR can be tolerated by a patient. Subjective information. Something may generally be considered “safe” but not tolerated.

Safety Questions

Will the medication cause harm? Do benefits outweigh risks for this patient? What relevant ADRs and contraindications/precautions exist? What subjective/objective markers should be monitored? What is the monitoring timeline?

Boxed Warning

Highest safety-related warning issued by the FDA. Reason not to use the medication.