PSD 2 Exam 1

What are the 5 parts of the Pharmacists' Patient Care Process?

Collect

Assess

Plan

Implement

Follow-up

What are Ohio law requirements for prescriptions?

• Legitimate medical purpose (50%/50%)

• Signed and dated on day of issuance (manually signed)

• Full name, professional title, address of prescriber

• Prescriber telephone number

• Full name and address of patient

• Drug name and strength

• Quantity

• Directions for use (SIG)

• Number of refills (times or period of time)

• DEA number or CTP number (Controlled substances)

Original Rx must be filled within _______ from date written (*except opioid analgesics)

6 months

Outpatient Rx for opioid analgesics (CII-IV) must be filled within _____ from date written

14 days

Refills good for _____ from date written (non-controls and C-V)

1 year

Refills good for _____ from date written (C-III and C-IV)

6 months

How many refills can you have on C-II prescriptions?

0

Medication Therapy Management (MTM)

a way to help patients get the most benefit out of their medications (provided by pharmacists)

focus to ensure the most effective use of drug therapy

What are the components of MTM?

Medication Therapy Review

Personal Medication Record

Medication Action Plan

Intervention/Referral

Documentation and Follow-up

Medication Therapy Review

May also be called a Complete Medication Review (CMR)

Review the patient's medication with them

Interview the patient to figure out what they are actually doing

How are they taking their medications?

What medication are they taking?

What problems are they experiencing?

Personal Medication Record (PMR)

A list for the patient including all of the medications they take

Prescription

Non-prescription

Herbal products

Dietary supplements

How they take them

What they take them for

Medication Action Plan (MAP)

A plan that helps the patient focus on what they need to do regarding their medications and health

This may include:

Action steps (What I need to do…)

Lifestyle goals

Appointment information

Tests they should schedule or have scheduled

Tools they can use (ex: adherence)

Intervention/Referral

Interventions are things we will do to address a medication related problem

Working with the prescriber

Medication changes

Medication adjustments

Monitoring of high-risk medications

Education for the patient

May need to refer the patient for further evaluation or diagnosis by other Healthcare Professionals

What is the purpose of patient counseling?

Providing medication information verbally or in written format to the patient or caregiver

Improves patient care by:

Reducing medication errors

Increasing patient understanding/management of their medical condition

Minimizes incidence of adverse effects and drug interactions

Enhances patient outcomes and satisfaction with care

What did the Omnibus Budget Reconciliation Act of 1990 do?

Requires the following to improve quality of use and distribution of prescriptions:

Prospective drug utilization review (DUR)

Offer to counsel the patient, caregiver or patient representative provided by a pharmacist or pharmacy intern under pharmacist supervision

Record of comments relevant to the individual’s drug therapy

How can you say these in patient friendly language?

Hypertension

Subcutaneous

high blood pressure

under the skin

What do open-ended questions often start with?

what

how

why

What do closed-ended questions often start with?

do

is

have

What are essential parts of the beginning of a patient counseling session?

introduction (name, title)

confirm patient identity and verify allergies

explain purpose

assess patient knowledge

What are the three prime questions for new prescriptions?

What did the doctor tell you this medication is for?

How did the doctor tell you to take this medication?

What did the doctor tell you to expect?

What are the three prime questions for refill prescriptions?

What do you take this medication for?

How do you take this medication?

What problems have you experienced?

What is the teach back method?

Determine patient understanding of information discussed

Opportunity to correct any misunderstandings

Ask them to repeat back to you key information from the counseling session

May be framed as making sure the provider did not miss any information instead of testing patient knowledge

What is a Drug Utilization Review?

Authorized, structure, ongoing review of provider prescribing, pharmacist dispensing and patient use of medication

prospective DUR

evaluation of a patient's therapy before medication is dispensed

concurrent DUR

ongoing monitoring of drug therapy during the course of treatment

retrospective DUR

review of drug therapy after patient has received the medication

pharmacist's role: prospective DUR

Assess dosage and directions reviewing patient information for interactions or duplicate therapy

pharmacist's role: concurrent DUR

Similar to prospective.

Check therapy with patient records. Mostly in hospital settings

pharmacist's role: retrospective DUR

Help detect patterns in provider's prescribing or pharmacy dispensing.

Used many times for research or education

Why are DURs completed?

• Reduce inappropriate use of medications

• Improve adherence

• Decrease adverse effects of drug interactions

• Continuously evaluate medication use and their associated outcomes

What are examples of DURs?

• Drug - disease contraindication

• Drug allergy interaction

• Drug dosage modification

• Drug - drug interaction

• Drug - patient precautions

• Formulary substitutions

• Duration of treatment

• Overuse/underuse

• Therapeutic duplication

drug interaction

An alteration in the duration or magnitude of pharmacological effects of one drug that is caused by another drug, food, or any other substance.

object drug

drug affected by the interaction

precipitant drug

drug that causes interaction

pharmacokinetics

ADME, what our body does to the drug

pharmacodynamics

additive/synergistic effects, antagonistic effects, what the drug does to our body

common additive/synergistic effects

electrolytes

antidiabetic medications

antihypertensives

QT prolongation

CNS depression

anticholinergic

serotonin syndrome

bleeding

amoxicillin/clavulanic acid

common antagonistic effects

• Naltrexone/Opioids & Alcohol

• Naloxone/Opioids

• Warfarin/Vitamin K

• Antihypertensives/NSAIDs

• Antihypertensives/decongestants

• Beta-Blocker/beta2 Agonist (albuterol)

questions to ask yourself during a DUR

• Why are they receiving this?

• Who prescribed it?

• What is the timeline of events? (new vs refill, duration)

• What is the route of administration?

• What is the dose?

• Is there an alternative?

• Is this clinically significant to age, illness, unstable disease, renal/hepatic function?