PSD-1 Exam II

Discuss what an immunization schedule is and the organization that publishes them every year

• An immunization schedule is a recommended timeline for receiving vaccinations to protect individuals against various infectious diseases

• Center for Disease Control and Prevention (CDC)

--> Advisory Committee on Immunization Practices (ACIP)

Describe patient factors that help to determine the eligibility/recommendations to receive a vaccine

• Age

• PMH

• Social history

• Family history

List several examples of S or O data that need to be collected to determine vaccine eligibility

• childhood/adolescent vs adult

• medical conditions/comorbidities

• pregnancy

• occupation

• smoking

• alcoholism

• sexual activity

• travel

Describe the age at which a patient starts to use the CDC adult immunization schedule

≥19 years old

Discuss the role community pharmacy personnel assist in screening for vaccine eligibility

• screen for eligible vaccines based on patient factors

• screen for contraindications to receiving a vaccine

Describe the purpose of a vaccine information statement (VIS) and who needs to receive one

• Information sheet on benefits, risks, what to do IF adverse reaction occurs

• Federal law- MUST be provided to all patients receiving a vaccine

• must provide BEFORE the vaccine is given

• documentation required

Describe the age at which routine annual influenza vaccination is recommended to begin

annually starting at 6 months of age

Describe the age at which routine pneumococcal vaccination is recommended to begin

routine vaccination ≥ 65yo

Describe who/what types of patients are recommended to receive the Tdap vaccination

• DTaP- in childhood vaccination schedule

• Tdap- during every pregnancy, 1st tetanus vaccine received in the adult immunization schedule

• Tetanus immunization- requires a booster every 10 years

• Td- adult vaccine formerly used most often as the booster vaccine

• Tdap is now commonly being used as the booster because bc it does provide the T (tetanus)

Describe the age at which routine zoster vaccination is recommended to begin

routine vaccination ≥ 50 yo

List applications of medical/drug literature in pharmacy practice

• continuing education/staying up-to-date

• decision making- therapies + formulary

• guideline preparation

• education- healthcare professionals + patients

Define "Evidence-Based Medicine" and its application in pharmacy practice

"...conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients... and integrating individual clinical expertise with the best available external clinical evidence from systematic research"

Clinical expertise

- clinical setting

- research evidence

- patient preference

- healthcare resources

Describe the process that occurs in the dissemination of information that results from the completion of a research project

Dissemination of Scientific Information

1. completion of an original research project

2. preparation and submission of an abstract

3. acceptance of an abstract for presentation

4. publication of abstract and presentation of a project

Peer Review Process

1. completion of an original research project

2. preparation and submission of manuscript

3. review of manuscript by editor

4. review of manuscript by reviewers

5. modification of manuscript by authors

6. re-review of manuscript by editors and/or reviewers

7. acceptance and publication of manuscript

List the different type of published literature that can result from the completion of a research project

1. Original Research

- full article

- letter to the editor

- abstract

- symposium supplement

2. Descriptive Literature

- observational research

- case reports/ case series

3. Additional reference to an original research article

- editorial

- letter to the editor

4. Review Articles

- nonsystematic ("narrative") review

- systematic review

--> quantitative systematic review (meta-analysis)

--> qualitative systematic review

5. Clinical Practice Guidelines/Consensus Statements

- the code

Describe the importance of a letter to the editor, editorial, abstract, case report, meta-analysis, systematic review, narrative review (non-systematic), and clinical practice guidelines

• letter to the editor- reports a small study or an early report on an important study

• editorial- written by an editor or selected expert that brings attention to and comments on an original research article by either supporting it or questioning the results and attempting to refute the article, or at least interpret the results with caution

• abstract- initial incomplete report, generally published with all other abstracts from a meeting

• case report- observational... describe one or more patients about disease or treatment of interest... generally for rare or unique diseases or treatments

• meta-analysis- combines data from many studies and then analyzes the combined data set... allows for much larger sample sizes than can be seen from one individual trial

• systematic review- scientifically investigates original research articles with a pre-defined method and entry criteria including how studies are identified and how data are extracted

• narrative review (non-systematic)- reviews a particular topic... summarizes information that the author feels is important in a manner that lacks systematic searching or analysis of the literature... subjective summary and analysis

• clinical practice guidelines- systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances

Understand the hierarchy of evidence

(top to bottom)

1. Meta-analysis

2. RCTs (randomized control trials)

3. Cohort studies

4. Case-control studies

5. Cross-sectional studies

6. Case reports/ Case series

7. Ideas, opinions, anecdotal evidence

Describe "Evidence-Based Medicine" in context of the Pharmacist's Patient Care Process.

• Assess the patient and the problem

• Ask a clear and answerable question

• Aquire the evidence from appropriate sources

• Appraise the evidence to determine its value

• Apply the evidence to the particular problem

• Audit the quality and safety of your intervention(s)

• Amend your process/intervention for the future

List the 6 community pharmacy WORKFLOW STEPS in the correct order.

1. Prescription is received by the pharmacy

2. Data entry

3. Pre-check

4. Dispensing

5. Final check (verification)

6. patient receives the prescription & counseling

Identify if a required component of a written outpatient prescription is missing.

• dated on the day the Rx is issued

• full name + professional title of prescriber

• physical address of the prescriber

• prescribers phone number

• full name and address of patient

• drug name and strength (dosage form is not legally required)

• quantity to dispense

• directions

• refills

• for an Rx issued on paper, the prescriber manually signs the Rx on day os issuance

• DAW

For controlled substances only...

• DEA number of prescriber

• quantity to dispense has been written numerically and alphabetically

• ICD-10 code

Determine if a Rx may be initially filled or refilled based on the date it was issued.

Timeframe for the INITIAl filling

• a pharmacist should not dispense a dangerous drug for the first time beyond 6 months from the written date

• a prescription for an outpatient opioid analgesic (CII- CIV) must be filled for the first time within 14 days of the date the prescription was written

Timeframe for prescription REFILLS

• ZERO refills may be written on a prescription for a C-II controlled substance

• Refills for C-III and C-IV controlled substances are valid for 6 months from the date the prescription was written

• Refills for non-contolled and C-V controlled substances are valid for one year from the date the prescription is written

Classify a drug information request according to the specific type of problem / question asked

• DailyMed: package insert

• Martindale: foreign drug identification

• ASHP drug shortages: drug shortages

• Orange book: TE codes

• drugs.com: drug identification

Give examples of tertiary, secondary, and primary literature resources

tertiary

• textbooks

• drug monographs

• review articles

secondary

• abstract services

• indexes of bibliographic info

• PubMed

primary

• original research articles

• case reports

List the 5 steps of the PPCP (Pharmacist's Patient Care Process) in the correct order

• collect

• assess

• plan

• implement

• follow-up

Recognize whether data is subjective or objective

subjective data

- obtained by listening to the patient

– CC

- HPI

- ROS

- PMH

- SH

- FH

- allergies

- medication history if obtained from a patient interview

objective data

• direct measurement or observation

• lab tests

• diagnostic tests

• vital signs

• physical assessment

• calculated data

• medication history if in pharmacy system

Body Mass Index (BMI) formula:

[Body Weight (lbs.) / Height (Inches)²] x 703

Ideal Body Weight (IBW):

Males= 50 + 2.3(for every inch > 5 feet)

Females= 45.5 + 2.3(for every inch > 5 feet)

creatinine clearance (CrCl) formula:

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

important!

x 0.85 if female

important!

if ABW < IBW... use ABW

List the 4 characteristics that pharmaceutical equivalent drugs must have in common

• same active ingredient

• same dosage form

• same route

• same strength

Determine if 2 pharmaceutically equivalent products are therapeutically equivalent ("AB rated")

therapeutic equivalents: they are pharmaceutical equivalents AND can be expected to have the same clinical effect and safety profile

AB = therapeutically equivalent

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

Describe the purpose of the general assessment

to get an overall impression of the patient's health status

Identify the components of the general assessment

• age

• skin

• facial features

• level of consciousness

• acute distress

• nutrition

• dress and grooming

• body structure

• behavior

• mobility

List the 4 assessment techniques used during the physical examination of a patient

1. inspection

2. palpation

3. percussion

4. auscultation

Define the 4 assessment techniques used during the physical examination of a patient

inspection= visually looking at + evaluating a patient (sight)

palpation= touching or feeling with the hand (touch)

percussion= the striking of a body surface lightly but sharply to determine the position, size, and density of underlying structures... air or fluid in a cavity may also be detected... using sound (hearing)

auscultation= listening to body sounds (hearing)... stethoscope

Describe which assessment technique is most used by pharmacists

- general assessment

- health&medication history

- vital sign measurement

- inspection

Define what the core body temperature is

the temp of the blood supply surrounding the hypothalamus

Discuss the normal fluctuations that occur in body temperature

diurnal: body temp is lower in the morning, it increases in the day

age: babies normal temp tends to be higher, elderly body temp seems to be a little lower than the average adult

Recognize common examples of things than can increase or decrease body temperature

increase body temp:

- hormones

- exercise

- hyperthyroidism

- medications

- infections

decreases body temp:

- extreme cold exposure

- alcohol consumption

- hypothyroidism

- antipyretic medications

Describe the 5 routes that may be used to measure body temperature

1. oral

2. rectal

• most accurate way to measure the core body temp

• temp is ~1°F higher than oral temp

3. axillary

• less accurate

• temp is ~1°F lower than oral temp

4. tympanic membrane (eardrum)

5. temporal artery (forehead)

Provide several examples of antipyretic drugs

- acetaminophen

- aspirin

NSAIDS

- ibuprofen

- naproxen

Describe what is commonly referred to as the "5th vital sign"

pain

Describe common assessment tools that might be used in the process of assessing a patient's pain

P- palliative factors: what makes it better? previous treatment?... provocative factors: what makes it worse?

Q- Quality: describe the pain

R- Radiation: where is the pain? Does it move?

S- Severity (pain scale): how does it compare to other pain?

T- Timing: when did it start? does it change with time?

Recognize and/or give examples of subjective and objective behaviors of pain

subjective:

• verbal complaints of pain

• stating that they are taking pain meds

• review of systems

• pain scales

objective:

• facial expressions

• vocalizations

• body movement

Define what the HR and Pulse are, and the units used to define them

HR = the number of times the heart beats per minute

• beats per minute (bpm)

Pulse = a pressure wave, felt in a peripheral artery, created each time the heart contracts + pushes blood through the vasculature

• beats per minute (bpm)

Describe what a normal adult HR is and the definitions of what tachycardia and bradycardia are

• normal adult HR is 60-100 bpm

• tachycardia = fast heart rate > 100 bpm

• bradycardia = slow heart rate < 60 bpm

Provide examples of the types of drugs/substances that can ↑ or ↓ HR and/or BP

increase:

• caffeine

• nicotine/smoking/chewing

• decongestants

• stimulants

• albuterol

• NSAIDs

decrease:

• antihypertensive meds

• ACE inhibitors, ARBs, Renin inhibitors

• Diuretics

• beta-blockers

• alpha-blockers

• vasodilators

• calcium channel blockers

Describe the difference in location of the radial vs the brachial artery and what we assess with them

radial artery:

- on the wrist, just under the thumb

- commonly used to assess heart rate

bacterial artery:

- crease of elbow on side towards body

- commonly used to assess blood pressure

Define what systole and diastole are / what systolic and diastolic BP are

systole- contract, larger #

diastole- relax, smaller #

systolic BP- when sound starts

diastolic BP- when sound stops

Name some situations that might cause a person's HR or BP to increase

increase:

- pain, stress, anxiety

- orthostatic hypotension

- dehydration

- blood loss

- heart failure

- hyperthyroidism

- hypoglycemia

decrease:

- athletes

- hypothyroidism

- medications (beta blockers, verapamil + diltiazem

Identify what the four traditional vital signs are

- temperature

- blood pressure

- pulse'

- respiratory rate

Define what the respiratory rate (RR) is, and the units used to define it

RR = the number of breaths taken per minute

- units = RPM--> respirations per minute

describe what a normal adult RR is and the definitions of what tachypnea and bradypnea are

normal = 12-20 RPM

tachypnea = fast... RR >20 rpm

bradypnea = slow... RR <12 rpm

Name some situations that might cause a person's RR to increase or decrease

increase:

• lung conditions (COPD, asthma, pneumonia)

• pulmonary embolism

• pain

• stress

• anxiety/fear

decrease:

• opioid drugs

• drug overdose

• ethanol toxicity

• toxins

• head injury

• hypothyroidism

Describe the physical examination techniques used to assess respiratory function

- inspection

- palpation

- auscultation

- percussion

Define what cyanosis and dyspnea are and provide examples of lung sounds

cyanosis: blue discoloration of the skin, gums, fingernails, or mucous membranes due to lack of oxygen in the blood

dyspnea: difficulty breathing; "shortness of breath"

Discuss if spirometry or peak flow measurements are objective vs subjective

spirometry

- objective

peak flow

- subjective