PAS FINAL STUDY GUIDE

Medication Nonadherence

• Definition: Failure to take medications as prescribed, encompassing:

  • Skipping doses

  • Stopping medications early

• Significance:

  • Leads to worse health outcomes

  • Increases hospitalizations

  • Higher healthcare costs

• Why it’s a Behavioral Problem:

  • Influenced by:

    • Patient habits

    • Beliefs

    • Forgetfulness

    • Motivation

    • External barriers (e.g. cost, access)

Spending on Prescription Drugs

• Problem:

  • High costs stem from:

    • Research & Development (R&D)

    • Clinical trials

    • Marketing

    • Patent protections

• Relation to Nonadherence:

  • Elevated drug costs may lead patients to skip medications, worsening nonadherence.

Extemporaneous Compounding

• Definition: Preparation of custom medications tailored to specific patient needs, often when no commercial options are available.

Outsourcing Pharmacy

• Definition: Specialized pharmacies that compound and prepare medications in bulk for healthcare facilities, ensuring quality and consistency.

Generic vs. Brand Drugs

• Difference:

  • Generic drugs are bioequivalent and typically cheaper.

  • Brand drugs are patented and costlier due to extensive R&D costs.

• Cost Factors for New Drugs:

  • Extensive research and development

  • Regulatory hurdles

  • Clinical trial expenses

Drug Substitution Types

• Generic Substitution:

  • Replacing a brand drug with its generic equivalent (e.g. CVS brand with NyQuil, Lipitor with atorvastatin).

  • Generics become available once the branded product's patent expires (10-12 years).

• Therapeutic Substitution:

  • Replacing a prescribed drug with another within the same therapeutic class.

  • Examples:

    • Most substitutions occur intra-class but can occur inter-class (e.g., beta blockers, calcium channel blockers).

    • Not legal unless under Collaborative Drug Therapy Management (CDTM) or similar circumstances.

Common Pharmacy Practices

• Most Common Type: Generic substitution, favored for cost-effectiveness and equivalence.

CPhT and PTCB

• CPhT: Certified Pharmacy Technician.

• PTCB: Pharmacy Technician Certification Board, certifying technicians.

• Roles in Pharmacy:

  • Assist pharmacists

  • Ensure accuracy

  • Improve medication safety.

DTC Commercials

• Definition: Direct-to-consumer advertisements for prescription drugs.

• Role:

  • Increase public awareness of treatments.

  • Raise ethical concerns about influencing prescribing practices.

Learning Types

• Didactic Learning: Classroom-based theoretical understanding.

• Experiential Learning: Hands-on, practical training in clinical settings.

OTC vs. BTC Medications

• OTC (Over-the-Counter): Available without a prescription.

• BTC (Behind-the-Counter): Requires consultation with a pharmacist, but no prescription needed.

FDA Drug Approval Criteria

• Key Criteria:

  • Safety

  • Efficacy

  • Quality

  • Benefit-risk balance

  • Labeling

  • Post-market monitoring.

Drug Patent

• Definition: Legal protection granting exclusive rights to manufacture and sell a drug for 20 years, encouraging innovation.

Off-Label Prescribing

• Definition: Utilizing drugs for unapproved indications.

• Controversy:

  • Especially relevant with GLP-1 weight loss drugs (e.g. Ozempic, Wegovy).

  • Prescribed for weight loss despite being designed to lower sugar levels, raising safety concerns.

Asheville Project

• Importance: Showcased pharmacists' critical role in managing chronic diseases and improving health outcomes while reducing costs.

ECHO Outcomes vs. Pharmaceutical Care

• ECHO Outcomes: Economic, Clinical, Humanistic framework:

  • Economic: Cost-effectiveness and resource utilization.

  • Clinical: Health improvement.

  • Humanistic: Patient quality of life improvements.

• Relation to Pharmaceutical Care: Evaluates pharmacy interventions' impacts on quality of life.

Professionalizing Activities Pre/Post Graduation

• Before Graduation:

  • Internships: Supervised by state boards, can occur before or after graduation.

  • Externships: Patient care settings, part of academic credit programs.

  • Clerkships: Clinical pharmacy services in various settings, supervised.

• After Graduation:

  • Residencies: Focus on practice skills (PGY1 and PGY2).

  • Fellowships: Emphasis on research and specialization.

  • Continuing Education: Required for licensure maintenance, enhancing critical thinking and practice.

PBMs and Managed Care Pharmacy Practice

• PBMs: Pharmacy Benefit Managers, e.g. Express Scripts managing drug benefits.

• Managed Care: Optimizing medication use and controlling costs for populations.

BPS Certification

• Definition: Board of Pharmacy Specialties certification.

• Importance: Demonstrates expertise in specialized fields (e.g. oncology, pediatrics).

Health Promotion Theories in Sociology

• Importance: Predict and modify patient behavior for better health outcomes.

• Roles in Health Care and Pharmacy Practice:

  • Understanding Patient Behavior

  • Designing Tailored Interventions

  • Encouraging Preventive Health Measures

  • Improving Communication

  • Enhancing Patient Outcomes

• Examples of Theories:

  • Health Belief Model: Adherence based on perceived risks/benefits.

  • Social Cognitive Theory: Emphasizes self-efficacy and environmental influences on behavior change.

  • Application: Aiding diabetic patients in developing regular medication habits.