Therapeutic Duplications/Drugs with Special Requirements/Drug Stability - RxTechExam

Therapeutic duplications vs combination therapy:

Therapeutic duplication is when a patient takes 2+ meds that treat the same condition in the same way, and combination therapy is when a patient takes 2+ meds that treat the same condition in different ways.

Why might therapeutic duplications occur (3 reasons)?

Multiple prescribers/pharmacies, hospital admissions/discharges, and patient confusion

What are 5 common therapeutic duplications:

1 - same med, different strength, 2 - same med, different dosage form (IR/ER), 3 - same class of meds, 4 - different classes, work similarly, 5- prescriptions/otc forms of the same or similar medications

(ARBs, ACEi), 5 - different medications, share an active ingredient/medication in common

REMS definition:

Risk evaluation and mitigation strategies, manage risks of certain medications, required by FDA for certain meds.

iPLEDGE REMS program details:

Isotretinoin REMS program (teratogenic). All patients enroll, those who can get pregnant take 2 forms of birth control, get a pregnancy test before every prescription, and pick up the prescription within 7 days of that test. Pharmacists verify the RMA number, do not provide refills, and can only give up to a 30-day supply of isotretinoin.

What REMS programs require MedGuide dispensing?

Opioid analgesic programs, BTOD (buprenorphine-containing transmucosal products such as suboxone or subtex) programs, and certain NSAIDs/antidepressants. MedGuides are dispensed with every fill, not just the first prescription.

VIS definition:

Vaccine information statements(benefits/risk of vaccines), provided to patients/guardians before receiving a vaccine.

OTC special rules for nicotine replacement therapy or dextromethorphan:

Must be 18+ to purchase nicotine replacement therapy in most states or to purchase dextromethorphan in some states.

OTC special rule for pseudoephedrine:

No more than 3.6g/day or 9g/month, need a valid ID and must sign a logbook, done to prevent methamphetamine production. Some states are more strict.

Drug stability definition:

How long a med stays safe + effective when stored properly

Expiration date vs beyond-use date (BUD):

expiration date is 2-3 years after manufacturing, beyond-use date is applied to meds that are opened/prepared/dispensed, and are typically 12 months for most meds but can be hours/weeks/months.

Three factors that affect drug stability (explain temp a bit more):

temperature, light, and moisture. Temp = room temp(68-77), fridge(36-46), or freezer(-58-5).

Tablet/capsule stability (Nitroglycerin/Pradaxa (Dabigatran):

Nitroglycerin tablets are light-sensitive, dispensed in amber-glass bottles. Pradaxa (Dabigatran) capsules are moisture-sensitive, good for 4 months after opening.

Injectable stability (Insulin injectables/Vaccines):

Insulin injectables are temp-sensitive, unopened = fridge, opened = room temp for 28-56 days. Vaccines are temp-sensitive, most stored in fridge, Proquad/Varivax in freezer, Multi-dose vials have a standard 28-day expiration limit from the first punctur

Reconstituted med stability (antibiotic oral suspensions, bowel preps, reconstituted injectable meds/vaccines):

Antibiotic oral suspensions = mixed in pharmacy, good for 10-14 days after reconstitution. Bowel preps = mixed by patient, good for 48 hours after reconstitution. Injectable meds/vaccines = mixed right before use, good for minutes/hours after reconstitution.

Inhaled meds/Ophthalmic meds/Suppository stability:

Inhaled meds = moisture/temp sensitive, good for month(s) after opening (inhalers). Ophthalmic meds = light/temp sensitive, good for weeks after opening (eyedrops). Suppositories = temp-sensitive, stored in fridge to prevent melting.