Unit 1: Intro to Pharmacy Concepts Objectives

List the steps in the medication use process.

• Prescribing (Medication order),

• Transcribing/Documenting (pharmacist evaluation),

• Dispensing, Administering

• Monitoring (Patient assessment)

What are legend drugs?

medications that by law can only be obtained with a prescription

What are schedule drugs?

medications with high abuse/dependence potential

What are OTC medications?

nonprescription medications, bought off the shelf in stores, do not require a prescription

What is a prescription drug order?

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

What is a superscription?

"take thou", "you take", "recipe" if compounded; RX on the prescription

What is an inscription"?

the medication prescribed including name, strength, and dosage form

What is a subscription?

dispensing instructions to pharmacist including quantity to dispense (#tabs, volume)

What is signa (sig)?

• directions for use from physician; pharmacist must transcribe for patient on label

• should include dose, route and frequency

Dose

amount of drug taken at one time

Duration

•  how long the drug is to be taken; sometimes specified for acute therapies (antibiotics may state "x 10 days";

• sometimes determined based on days supply;

• "long term therapy" may be used for duration for cholesterol meds or unspecified time

medication titration

i)      slowing increasing the dose of a medication by small amounts over days, weeks, or months to find an effective dose; helps patients to develop tolerance to adverse effects

medication taper

gradually decreasing the total daily dose of a medication: the goal is discontinuing the medication

What are signs vs symptoms?

1. Signs: objective observable/identifiable by another person (labs, vitals)

2. Symptoms: subjective experience that is reported by the patient

prophylaxis

medication or intervention to prevent a condition

non-pharmacological therapy

intervention to treat or prevent a condition that is not based on medication; sleep, eating well, exercise

impact of having an illness or condition; conditions not treated well; lack of control causes nerve damage

morbidity

death due to an illness or condition

mortality

having more than one illness or condition simultaneously

co-morbidity

puts you at risk of something bad; increases the chances of developing a disease or increasing the severity of it; may not be a direct cause; an association has been established

risk factor

damage from something bad happening; usually from disease progression or lack of disease management

consequence/complication

What are the goals of therapy?

• cure a disease

• stop or slow progression

• reduce or eliminate symptoms

• prevent a disease or symptoms

*All while minimizing the risk

The clinical reasons a patient might require drug therapy; broader than a diagnosis, a disease, or the FDA labeled indication

Indication

• the reason we use the medication

• is it treating the disease?

• is the drug doing what I want it to do?

Efficacy

Can a medication be efficacious even if the patient is not at goal?

yes

• When medication causes harm

Safety

the degree to which an ADR can be tolerated by a patient (subjective info); generally considered "safe" but not tolerated

Tolerability

ability and willingness to take medication as prescribed

adherence

a harmful nonpreventable response that occurs with usual use of medication; side effect

ADR (Adverse Drug Reaction)

patient factor where a medication increases the risk of harm (reason to withhold the medication)

contraindication

patient factor where a medication might increase the risk of harm (warning to consider withholding the medication)

precaution

highest safety-related warning issued by FDA; reason not to use it

box warning

What are the drug-drug interactions categories?

1.     A: No known interaction

2.     B: No action needed

3.     C: Monitor therapy

4.     D: Consider therapy modification

5.     X: Avoid combination

Purpose for SOAP note?

1. Standardized method for documenting patient encounters in healthcare, promoting clarity, organization, and consistency in patient care.

What is a chief complaint?

1. The concise, stated reason a patient seeks medical attention, usually in their own words

Define history of present illness (HPI)

1.     Chronological account of patient’s current medical problem, detailing in development from the first symptom to the present

What is past medical history (PMI)?

1. A comprehensive record of a patient’s health information from before the current problem including major illnesses, surgeries, hospitalizations, injuries, allergies, medications, vaccinations, and lifestyle choices.

Describe situations in which pharmacists conduct patient interviews.

1. New complaints/symptoms

                                               i.     Main role for pharmacist is triage (preliminary assessment); know when to refer for follow up

2. Chronic disease monitoring and management

normal HR

60-100 BPM

respiratory rate

12-20 BPM

a.     Idea of how cells work when all things are working well

b.     Normal functions of life of living cells; how things should work normally

Physiology

• abnormal state    

• focuses on functional changes that occur within the body due to disease

• Idea of how cells work when things get screwed up; EXPLAINS WHY IT IS HAPPENING

pathophysiology

• the study of structural and functional changes in tissues due to a disease

pathology

• cause of disease

• a branch of medical science concerned with the causes and origins of diseases and abnormal conditions

etiology

• study of disease in a population

• branch of science that studies the incidence, distribution, and control of a disease in a population

epidemiology

what are the targets of drug therapy? - proteins

• receptors - receive signals (beta receptors)

• enzymes - catalyze reactions (ACE)

• ion channels - regulate ions (calcium channels)

• transporters - move substances

• RNA and DNA - targeted by drugs like aminoglycosides or chemotherapy agents

Which targets represent more of the drug therapies?

enzymes and receptors

what do enzymes do?

regulate the production of angiotensin

what do receptors do?

regulate contractility or nerve impulses

the specific biochemical way a drug produces its effect in the body often by binding to a molecular target like an enzyme or receptor to alter cell function.

MOA

• a drug that binds to and activates a receptor but produces a weaker response than a full agonist; doesn’t produce a full response; has the highest affinity because is shows affinity at lower concentration; most effective in binding because it binds at a lower concentration)

• activates receptor at less efficacy; more affinity

partial agonist

a.     binds to (affinity) and stimulate (intrinsic activity or efficacy) receptors; normal substance in the body or drug that binds to a receptor and turns it on; full efficacy

agonist

a substance, typically a drug, that slows down or stops the activity of an enzyme or receptor.

inhibitor

a drug or chemical that an enzyme acts upon causing a chemical reaction that transforms it into a different product, often a metabolite.

substrate

block endogenous or exogenous agonist (receptor); blocks all actions

antagonist

• What the body does to the drug

• The study of the concentration and activity of drugs in the bodies, tissues and fluids, overtime, including the processes by which drugs are absorbed, distributed, and tissues, influences, metabolized, and excreted; concentration of drug in the body over time

Pharmocokinetics (PK-ADME)

• What the drug does to the body

• The study of drugs molecular and biochemical actions and physiologic effects on human target (and non-target) cells, tissues, and organs, as well as pathogenic organisms; what effects/actions does the drug produce and how does it do that

Pharmacodynamics (PD)

movement of a drug from site of administration into circulation; parameter to measure is bioavailability (F)

Absorption

pattern of scatter of specified amount of drug among various locations in the body; volume of distribution (Vd)

Distribution

enzyme, catalyze, chemical transformation of drugs within living organisms; Clearance(CL) and half life (T 1/2)

Metabolism

elimination of drug metabolites outside the body; clearance (CL) and half life (T 1/2)

elimination

What phases of ADME does the drug enter the body and move around?

absorption and distribution

What phases of ADME does the body get rid of the drug; remove from plasma

metabolism and excretion

What is the major organ for drug absorption?

small intestines

Which tissues are more likely to get the drug?

1.     The kidney and liver are well perfused and have “porous” capillaries so they have exposure to get drug.

What can bind to drugs and slow their distribution from blood to other tissue organs in the body?

Albumin (plasma protein)

What happens to drugs that are highly bound by plasma proteins?

stay in plasma (blood) longer; have longer half-life therefore don’t have to take as often

What percent is considered high protein binding?

>90%

What is the major organ for drug distribution/metabolism?

liver

What is prescribing in the medication use process?

a.       Prescribing: evaluates patient’s condition and decides on a medication plan; assess medical history, determine appropriate drug, enter prescription (order) into system

What is transcribing/documenting in the medication use process?

a.       Transcribing/documenting: medication is ordered and is accurately recorded and communicated

What is Dispensing in the medication use process?

a.       Dispensing: pharmacy receives order and prepares the medication: verify RX for accuracy and potential drug interactions, prepare and package, barcode scanning

What is Administering in the medication use process?

a.       Administering: give medication to patient; right patient, right drug, right dose, right time, right route, right documentation

What is Monitoring in the medication use process?

a.       Monitoring: observes patient to assess the medication’s effects and identify side effects or adverse reactions; evaluate the patient’s response to treatment, order follow up tests, adjust medication if needed

Is there an absorption phase with IV?

• no absorption phase

• immediate effect; directly into bloodstream

What is dissolution?

• the process by which a drug dissolves in the GI tract before absorption

Two phases for metabolism? (how the liver modifies drugs to make them more water soluble for elimination)

• Phase I: Modification - oxidation, reduction, hydrolysis are performed by enzymes (specifically CyP450); metabolite is more polar (water soluble)

• Phase II: conjugation (add a larger more polar molecule to the site - the resulting conjugate is very water soluble and can be easily excreted via the kidneys (urine) or bile)

What are the most common enzymes?

• CYP3A4/5

• 2D6

• 2C9/19

What are the excretion and kidney mechanisms?

• glomerular filtration

• tubular secretion

• tubular reabsorption

What is half life?

• time for drug concentration to reduce by half

What is steady state concentration (Css)?

• when the concentration of the drug in the body stays constant

• occurs when the amount of drug absorbed is the same amount that is being cleared from the body. when the drug is taken continuously

Competitive receptor antagonist has a higher _________.

• affinity

• lines move parallel on graph

What does a non-competitive receptor antagonist do?

• attaches to another site on the receptor

• trend goes up and down on the graph