PSD1 EXAM 1

What are the community pharmacy workflow steps?

1. prescription is received by pharmacy

2. data entry

3. pre-check

4. dispensing

5. final check

6. patient receives prescription & counseling

what are the requirements for written prescriptions?

- full name and title of prescriber

- prescribers address

- prescribers phone number

- patients name and address

- drug name and strength

- quantity

- directions

- refills

- prescribers signature

- DAW

what is required for prescriptions of controlled substances?

- prescribers DEA

- quantity to dispense is written numerically AND alphabetically

- ICD-10 code

how to calculate validity of DEA#?

1. add the 1st, 3rd, 5th numbers

2. add together the 2nd, 4th, and 6th numbers and then multiply by 2

3. add these two numbers together, the number on the right should be the same as the last number of the DEA#

what do the first and second letters of the DEA# represent?

first letter: type of practitioner

second letter: the first initial of the practitioner's last name

can a pharmacist dispense a dangerous drug for the first time beyond 6 months from the date a prescription is written?

no

a prescription for an outpatient opioid analgesic (CII-CIV) must be filled for the first time within ___________ of the date the prescription was written

14 days

how many refills can CII prescriptions have?

ZERO

how long are refills for CIII and CIV valid from the date the prescription was written?

6 months

how long are refills for noncontrolled and CV drugs valid from the date the prescription was written?

one year

introduction to drug information:

1. drug information (DI)

- systematic approach to solve problems in patient care

2. evidence-based medicine (EBM)

- systematic approach to clinical problem-solving

3. basic drug information skills

- practiced by all pharmacists

what are the steps of the systematic approach to using and providing drug information?

1. classify the request

• Who is requesting? what is the timeframe for response?

2. obtain background information

• understand what the requester wants to know and why

3. systematic literature research

• tertiary, secondary, and primary literature

4. formulation and communication of a response

• evaluate literature, and formulate a response (written or verbal)

5. follow-up

• assess outcome and impact, recommend future changes in therapy

what is tertiary literature?

• information that has been gathered and summarized by editors, authors, experts...

• summarizes and interprets the original work(s) of others

what are examples of tertiary literature?

• textbooks

• reference books/databases

• drug monographs

• review articles

what are advantages and disadvantages of tertiary literature?

advantages:

• convenient

• accessible

• easy to use

disadvantages:

• may out of be out of date

• info reflects interpretation of author(s)

what to think about when evaluating tertiary resources?

• who are the authors

• year published

• any references?

• use of references/footnotes

• how easy to use?

what is the definition of a drug monograph?

a factual document on a drug product that describes the properties, claims, indications, and conditions of use of the drug and contains any other information that may be required for optimal, safe, and effective use of the drug

what are the parts of a drug monograph?

1. name (brand/generic)

2. pharmacology

3. pharmacokinetics

4. contraindications

5. warnings

6. pregnancy

7. lactation

8. adverse reactions

9. drug interactions

10. stability/storage

11. indications and usage

12. dosing

13. dosing in special populations

14. administration

15. overdose/toxicology

16. monitoring parameters

17. dosage forms

18. patient education

19. black-box warnings

what is the pharmacist's patient care process?

1. Collect

2. Assess

3. Plan

4. Implement

5. Follow-up: Monitor and Evaluate

what is the pharmacist's patient care process as it applies to the community pharmacy?

1. Collect

• pharmacy receives Rx + collects pt info

2. Assess

• pre-check and/or final check of the data entry

3. Plan

• dispensing

4. Implement

• patient receives Rx + medication counseling

5. Follow-up: Monitor and Evaluate

• evaluation of refill status, asking abt side effects/problems

what is the pharmacist's patient care process as it applies to the systematic approach to using/providing drug info?

1. Collect

• classifying the request, collecting background info

2. Assess

• do more searching + assess while doing it

3. Plan

• formulate the response

4. Implement

• communicating the response

5. Follow-up: Monitor and Evaluate

• follow up

what is the pharmacist's patient care process as it applies to documentation + evaluating patients/developing a patient care plan?

1. Collect

• subjective + objective data

2. Assess

• prioritized problem list + assessment statements

3. Plan

• recommendations + goals

4. Implement

• put your plan into action

5. Follow-up: Monitor and Evaluate

• how did it go? measure effectiveness, monitor safety, modify as needed

what is the purpose of documentation?

- communicate w other health professionals

- demonstrate our contribution to patient care

- ensure continuity of care

- protect their professional liability

- submit billing & receive reimbursement

what are characteristics of good documentation?

- accurate

- organized

- legible

- easy to understand

- includes relevant info only

what does SOAP stand for?

subjective, objective, assessment, plan

What is a SOAP note?

it documents a systematic thought process: pharmacists patient care process

what is subjective data?

- what the patient tells you

- CC

- HPI

- ROS

- PMH

- SH

- FH

- allergies

- pain scale

the quality of information comes from?

good communication skills

what is objective data?

- direct measurement/observation

- lab/diagnostic tests

- vital signs (temp, RR, HR, BP)

- physical assessment

- calculated data (age, BMI, IBW, CrCl)

how to calculate IBW in males?

50 + 2.3 (every inch > 5 ft)

how to calculate IBW in females?

45.5 + 2.3 (every inch > 5 ft)

what are the units for IBW?

kilograms (kg)

• round 1 decimal place

how to calculate BMI?

pt's weight (pounds)/(height in inches)^2 X 703

what is the units for BMI?

kg/m2

• round 1 decimal place

how to calculate CrCl in men?

(140-age)(IBW)/(72)(SCr)

--> if pt's ABW < IBW... use ABW!!!!!

how to calculate CrCl in women?

(140-age)(IBW)/(72)(SCr) x 0.85

--> if pt's ABW < IBW... use ABW!!!!!

what is the units for CrCl?

ml/min

• round to nearest whole number

what does NDC stand for?

National Drug Code

• 10 digit number

what combination can an NDC be?

5-4-1

5-3-2

4-4-2

what does the first number of the NDC indicate?

manufacturer

what does the second number of the NDC indicate?

drug/dose/dosage form

what does the third number of the NDC indicate?

package size

why are NDCs important?

ensures proper dispensing

what is the "proprietary name"?

brand/trade name

What is a "nonproprietary name"?

generic name

what is a USAN?

United States Adopted Names

what is INN?

international nonproprietary name

- naming system managed by the World Health Organization

what is BAN?

British Approved Name

what is JAN?

Japanese accepted name

what is DCF?

french approved nonproprietary name

which book provides the official pronunciation of a drug?

• USP Dictionary of USAN and International Drug Names

• not a resource for availability

requirements to be pharmaceutically equivalent:

• same active ingredient

• same dosage form

•same route

• same strength

requirements for generic equivalence

if it has no bioequivalence problems

what determines therapeutic equivalence?

- pharmaceutical equivalents

- they can be expected to have the same clinical effect and safest profile when administered to patients under the conditions specified in the labeling

TE Codes - 1st Letter B:

- the FDA does not consider it therapeutically equivalent to other products

- indicates bioequivalence problems

TE Codes - 1st Letter A:

FDA considers is therapeutically equivalent

AB code meaning:

actual/potential bioequivalence problems

AA, AN, AO, AP, AT code meaning:

no issues with bioequivalence

which book is recommended to be used for TE codes?

orange book

which source provides the most recent version of a package insert?

DailyMed

what are ways a prescription can be transferred?

- fax

- phone

- electronic

what is required information for a transfer?

- date of transfer

- patient info

- name and address of pharmacy

- pharmacy's DEA (if controlled)

- full name of receiving/transferring pharmacist/intern

- Rx info

- when Rx was originally issues

- when Rx was originally dispensed

- the date the last time the Rx was filled

what is the format for refills remaining on transfered prescriptions?

1 + X

what is the purpose for a physical assessment?

to get an overall impression of the patients health status

What are the assessment techniques (observation)?

Inspection

Palpation

Percussion

Auscultation

what is inspection?

visually looking at patient

what is palpation?

touching or feeling

what is percussion?

the striking of a body surface lightly but sharply to determine the position, size, and density of underlying structures

--> using sound (hearing)

what is auscultation?

listening through a stethoscope

--> using sound (hearing)

influenza vaccine:

- routine vaccination

- annually starting at 6 months of age

Pneumococcal vaccine:

routine vaccination ≥ 65 years old

Tetanus, Diphtheria, Pertussis (Tdap) vaccine:

• DTaP- in childhood vaccination schedule

•Tdap- during pregnancy

how often are tetanus boosters requred?

every 10 years (Td formally used, now Tdap)

Zoster (RZV) Shingles vaccination:

routine vaccination ≥ 50 years old

What is core temperature?

temp of the blood supply surrounding the hypothalamus

what is the thermoregulatory "set point"?

the temp the hypothalamus tries to maintain

what is the average oral body temperature range?

97.5°F to 99°F

Diurnal fluctuation:

body temp is lower in the morning and increases later in the day

age fluctuation in temp:

• babies normal temp tends to be higher

• elderly body temp is lower than average adult

what are causes for increases in body temp?

1. hormones (progesterone) temp increases after ovulation

2. exercise

3. hyperthyroidism

4. medications

5. infection

what are causes for decreases in body temp?

1. extreme cold exposure

2. alcohol consumption

3. hypothyroidism

4. antipyretic medications

- acetaminophen

- aspirin

- ibuprofen (NSAID)

- naproxen (NSAID)

what are the 5 routes used to measure body temp?

1. oral

2. rectal

3. axillary

4. tympanic membrane (ear drum)

5. temporal artery (forehead)

what is the most accurate way to measure body temp?

rectal

how much higher is rectal measurement of temp compared to oral?

1°F higher than oral temp

how much lower is axillary measurement of temp compared to oral?

1°F lower than oral temp

how are tympanic membrane and temporal artery temp measured?

infrared measurement

What is the 5th vital sign?

pain

what are the 4 vital signs?

temperature, pulse, respiration, blood pressure

PQRST

provocative/palliative

• what makes it worse/what makes it better?

quality

• describe the pain

radiation

• where is the pain?

severity

• how does it compare to other pain?

timing

• when did it start? does it change w time?

subjective pain behaviors:

- verbal complaints

- stating they are taking pain meds

- ROS

- pain scales

objective pain behaviors:

- facial expressions

- vocalizations

-body movement