Download File - Mercer College of Pharmacy Class of 2015

PHA 371 Final Study Guide
-OBJECTIVES
•Identify bloodborne pathogens, the potential for exposure, routes of
transmission, and symptoms of infection
•State the requirements for pharmacists and pharmacies to comply with the
OSHA Bloodborne Pathogens Standard
•Describe work practices that minimize the risk of exposure
•Describe proper procedures to follow when potential bloodborne pathogen
exposure occurs

OSHA
Occupational Safety and Health Administration
o Federal Legislation passed in 1970
o Covers all acts of occupational hazards including Bloodborne
Pathogen Standard
 Bloodborne Pathogen Standard
 Released December, 1991
 Effective March, 1992
 Reviews all occupational potential exposure to blood
and other potentially infectious materials
 Requires use of Universal Precautions
 Requires use of Exposure Control Plan
 Requires Hepatitis B vaccine for employees with
potential risk of exposure
o Components of OSHA Training
 Epidemiology of bloodborne pathogens (BBP), transmission,
and symptoms of diseases
 Components of Exposure Control Plan
 Knowledge of tasks and activities involving exposure
 Explanation of use and limitations of methods that may
prevent or reduce exposure using protective equipment and
safety devices
o OSHA Citations
 Failure to have an Exposure Control Plan
 Failure to follow Universal Precautions
 Failure to have an annual review and plan update
 Failure to comply with current CDC recommendations
regarding BBP
 Failure to document exposure incidents
o Bloodborne Pathogens
–Human Immunodeficiency Virus (HIV)
–Hepatitis B Virus (HBV)
–Hepatitis C Virus (HCV)
o Infectious Material – Body Fluids
 Blood
 Semen
 Vaginal secretions
 Cerebrospinal, synovial, peritoneal, pleural, and amniotic fluids
 Saliva
 Unfixed human tissue or organs other than intact skin
 Cell or tissue cultures
 Any medium contaminated by HIV or HBV
o HIV
 Methods of Transmission
 Sexual Contact
 Blood Contact
 Mother to Child Contact during Pregnancy or Birth
 Persons of Highest Risk
 Homosexual men
 IV drug users
 Recipients of multiple blood transfusions
 Those with sexually promiscuous behaviors
 Symptoms
 Enlarged lymph nodes
 Persistent fever
 Involuntary weight loss
 Persistent fatigue
 Diarrhea nonresponsive to standard therapies
 Purple blotches on skin or in mouth
 White, cheesy coating on tongue
 Night sweats
 Forgetfulness
o HBV
 Virus that attacks the liver causing inflammation
 Virus can live on surfaces for up to 7 days if exposed to air
 60,000 new cases annually in U.S.
 Virus can survive in bodily fluids for years and cause:
 Chronic hepatitis
 Cirrhosis of the liver
 Liver failure
 Liver cancer
 Death
 Methods of Transmission
 Blood
 Tears
 Saliva
 Semen
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o HCV
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Symptoms
 Variable from person to person
 ~ 30% of persons are unaware of infection
 Most common symptoms
o Jaundice
o Rashes
o Internal bleeding
o Joint pain
Virus that attacks the liver, causing inflammation
Risk for chronic hepatic disease
Methods of transmission
 Primarily through chronic or repeated direct
percutaneous exposure to infected blood
 *Blood transfusions
 *Needle sticks and sharing of needles (IV drug use)
 *Mother-to-Child transmission during birth
 Symptoms
 Jaundice
 Fatigue
 Dark urine
 Abdominal pain
 Loss of appetite
 80% of cases are asymptomatic
o Management of BBP Infections
 HIV
 Combination therapy with antiretroviral agents
 Management of ADRs and supportive care
 HBV
 Interferons
 Antivirals
 HCV
 Interferons
 Antivirals
o BBP Transmission to HCPs
 Needlesticks
 Broken glass
 Splatter of contaminated fluids
 Rubbing or touching eyes, nose, mouth
 Open sores, cuts, and rashes
o Exposure Control Plan (ECP)
 Required by OSHA Standard
 Must be a written plan designed to eliminate or minimize
employee exposure
 Establish a compliance officer
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Reviewed annually to reflect changes in tasks that affect
exposure and technology to reduce exposure
Must be accessible to employees
ECP Elements
 Exposure Determination
o List of job classifications/jobs/tasks/procedures
with potential occupational exposure
 Tasks with Exposure Risks
o Cleaning up blood or broken contaminated glass
o Dental procedures
o Fingerstick testing
o Handling contaminated protective gear or
medical waste
o Performing First Aid and CPR/BLS
o Providing injections
 Universal Precautions
o Treat all human blood and bodily fluids as if they
were contaminated with BBP
o Must be observed in all situations where there is
a potential for contact with blood or other
potentially infectious materials
 Eating, drinking, smoking prohibited in work areas
when exposure to BBP is possible
 Storage of food and/or drinks in work areas is
discouraged
 Engineering and Work Practice Controls
o Safer Medical Devices
 Syringes and Lancets
o Handwashing Facilities
o Personal Protection Equipment
 Disposable gloves
 Microshields, Eye Protection
o Used needles and lancets
 Do NOT bend or recap
 Stored in Sharps Container
 Post Exposure
o Evaluation and Follow-Up
 Description of incident
 Documentation of events of exposure
 Results of source blood testing
 Employee’s medical records as related to
exposure, including vaccination status
 Written opinion of HCP, including
treatment recommendations and followup
OBJECTIVES
1.Define the acronym and terminology for “HIPAA”.
2.Paraphrase the seven basic (patient) rights under HIPAA.
3.Given a case situation, identify and or describe issues related to HIPAA.

HIPAA
o Privacy in Health Care
 Health Insurance Portability and Accountability Act of 1996 –
HIPAA – “The Privacy Rule”
 Provides Federal protections for personal health information
(PHI) held by covered entities (health care providers and
health care institutions)
 National standards for electronic healthcare transactions and
national identifiers for providers, health plans and employers
 Personal health information must be kept private
 In the event the patient is incapacitated, the health care
professional may disclose personal health information if it is in
the best interest of the patient
o Basic (patients’) rights under HIPAA
 Request a restriction on certain uses and disclosures of PHI
 Upon request, obtain a paper copy of the notice of information
practices
 Inspect and/or receive a copy of PHI
 Request an amendment or correction to PHI
 Obtain an accounting of disclosure of PHI
 Request for communication of PHI by alternative means or at
alternative locations
 Revoke authorization to use or disclose PHI except to the
extent that action has been taken
OBJECTIVES
•To review Georgia’s definition of the practice of pharmacy
•To describe the parts of the prescription
•To describe the labeling requirements for prescription medications
•To discuss some of the rules and regulations for community and institutional
pharmacy practice
•To describe the Georgia Controlled Substances Act

Law – Prescription basics and the process of dispensing
o Pharmacy Practice Act of Georgia
 Interpretation, evaluation, or dispensing of prescription drug
orders in the patient’s best interest
 Participation in drug and device selection, drug administration,
drug regimen reviews, and drug or drug-related research
 Provision of patient counseling and the provision of those acts
or services necessary to provide pharmacy care
 Responsibility for compounding and labeling of drugs and
devices
 Performing capillary blood tests and interpreting the results as
a means to screen for or monitor disease risk factors and
facilitate patient education
 Pharmacists performing such functions shall report the
results obtained from such blood tests to the patient’s
physician of choice

o Prescription
 A lawful order of a practitioner for a drug or device for a
specific patient
 Such order includes an electronic visual image
prescription drug order and an electronic data
prescription drug order
o Responsibility of the Pharmacist
 Upon receipt of a prescription, review for clarity and
completeness
 Right patient
 Right medication
o Based on the patient
o Based on the dose
 Right time
 Triage or Prioritize filling prescriptions
o Prescription Drug Orders
 Requirements for prescription drug order:
 Full name and address of the patient
 Name and address of prescriber
 DEA number of prescriber (if a controlled substance)
 Date of issuance (the date it was written)
 Name, strength (if necessary), dosage form and quantity
of prescribed drug
 Directions for use by the patient
 Refills authorized, if any
 If a written prescription, prescribing practitioner’s
signature
 A serial number assigned by the pharmacy for filing
Georgia Prescription Label Requirements
 Name, address, phone number of dispensing pharmacy
 Rx (serial) number
 Name of patient
 Name of prescriber
 Directions for use
 Date filled or refilled
 Expiration date of drug
 If the prescriber checks “Label”: the drug name and
strength should appear on the prescription label
 Identification of pharmacist filling the prescription
 Auxiliary “caution” Labels
 Shake Well
 For External Use Only
 May Cause Drowsiness
 For the Eye
 For the Ear
 Avoid Sunlight
 Take with food or milk
 Controlled Substances – Label
 Label must include Federal transfer warning
 Any controlled substance (II, III, IV, V)
o Caution: Federal law prohibits the transfer of
this drug to any person other than the patient for
whom it was prescribed
o Patient Counseling Law
 1998 Georgia Pharmacy Practice Act
 Enacted to comply with the requirements of the Omnibus
Budget Reconciliation Act of 1990 and to enhance the public
health and welfare
 Amended January 2009
 Requires a pharmacist, pharmacy intern, or pharmacy extern
to at least offer to counsel all patients on medications received
 The need for counseling on refills resides in the professional
judgment of the dispensing pharmacist
 FYI—Hospital inpatients, Prison inmates, and Health
Department patients are exempt from this counseling
law
 What to discuss with the patient:
 Name and description of drug prescribed
 Instructions for use and proper storage
 Intended use and expected action
 Special directions and precautions
 Possible adverse effects and common drug interactions
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 Techniques for self-monitoring
Requires documentation that the patient received or refused
counseling on each prescription
Refills
 May refill prescription as long as refills remain on the
original prescription order
 If patient has no refills remaining on a prescription
order:
o Must attempt to contact prescriber
o May dispense up to 72 hour supply of a
prescribed non-controlled medication
o Must make a new original prescription to fill the
prescription
o No limit to number of times this can occur
 “PRN” Refills
o What number does PRN represent?
 Must use “professional judgment”
 Most practitioners limit filling to one year
from date of prescription
o Patient must maintain a relationship with the
prescribing physician to be valid
o Patient must be taking medication correctly
o Prescription Drug Order Transfers
 Transfer shall immediately be reduced to writing to create a
hard-copy prescription drug order
 Requirements for incoming transfer:
 Name of pharmacist/intern/extern receiving order
 Name and phone number of transferring pharmacy
 Name of pharmacist/intern/extern providing transfer
 Date the transfer was received
 Date the drug was originally dispensed
 Number of valid refills remaining
 Date of last fill
 Pharmacy’s name, address, phone number, DEA
number, and Rx serial number from transferring
pharmacy
 Requirements for outgoing transfers:
 “Transfer” shall be indicated on the face of the
prescription
 Name and phone number of pharmacy where
prescription was transferred
 Name of pharmacist who received information
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 Date of prescription transfer
o Georgia’s Drug Substitution Law
 Purpose is to make available the lowest retail priced drug
product in stock
 Dispensing brand drugs
 Rx must state “Brand Necessary” written in the same
handwriting as the rest of the Rx
 Georgia does not recognize DAW (Dispense As Written)
boxes
 Generic products
 If the prescription is written using the generic name of
the drug, the pharmacist must dispense the least
expensive product in stock
 Cannot indicate a generically written prescription as
“Brand Necessary”
o Rules and Regulations of Institutional Practice
 Personnel of a Hospital Pharmacy
 Director of pharmacy must be a pharmacist
o “Pharmacist-in-charge”
o Develops policy and procedures
o Ensures proper training of support staff
o Supervision
 Supportive personnel
o As determined by the Director
o Technicians
o Secretarial and clerical assistance
o Hospitals have flexibility with staffing ratios
 Absence of a Pharmacist
 Night cabinets
 Access to Pharmacy
 Emergency Kits/Crash Carts
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Written policies, procedures, and protocols must be in
place to ensure appropriate access to medications when
pharmacy is closed
Drug Distribution and Control
 Labeling
o Appropriate containers for use inside hospital
o Unit-Dose or Unit-of-Use Packaging
 Brand or generic name
 Strength
 Lot number
 Expiration date
o The medication will be administered to the
patient by the nurse using the MAR (Medication
Labeling
o Appropriate containers for use outside hospital
 Name, address, phone number of hospital
pharmacy
 Date and serial number
 Patient’s name
 Name of drug and strength
 Directions for use
 Name of prescriber
 Precautionary information
o These are discharge meds or those filled in the
outpatient pharmacy
o Parenteral solutions (IV meds)
 Supplementary label
 Name and amount of drug added
 Date and time of addition
 Expiration date
 Identity of person making solution
 The medication will be administered to
the patient by the nurse using the MAR
o Overview of the Georgia Controlled Substances Act
 Schedule I Substances
 Have a high potential for abuse
 Have no currently accepted medical use in treatment in
the United States
 There is a lack of accepted safety for use of the drug or
other substance under medical supervision
o Examples: Heroin, Mescaline, Peyote, LSD,
Rohypnol, Tetrahydrocannabinols
 Schedule II Substances
 Have a high potential for abuse
 Have a currently accepted medical use in treatment in
the United States or a currently accepted medical use
with severe restrictions
 Abuse of the drug or other substance may lead to severe
psychological or physical dependence.
o Examples: Oxycodone, Hydromorphone,
Fentanyl, Cocaine, Methadone, Methylphenidate
 Schedule III Substances
 Have a potential for abuse less than the drugs or other
substances in Schedules I and II
 Have a currently accepted medical use in treatment in
the United States
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Abuse of the drug or other substance may lead to
moderate or low physical dependence or high
psychological dependence.
o Examples: Ketamine, Dronabinol (Marinol),
Buprenorphine, Nalorphine, Testosterone,
Sodium Oxybate
Schedule IV Substances
 Have a low potential for abuse relative to the drugs or
other substances in Schedule III
 Have a currently accepted medical use in treatment in
the United States
 Abuse of the drug or other substance may lead to
limited physical dependence or psychological
dependence relative to the drugs or other substances in
Schedule III.
o Examples: Alprazolam, Carisoprodol, Modafinil,
Phenobarbital, Zolpidem
Schedule V Substances
 Have a low potential for abuse relative to the drugs or
other substances in Schedule IV
 Have a currently accepted medical use in treatment in
the United States
 Abuse of the drug or other substance may lead to
limited physical dependence or psychological
dependence relative to the drugs or other substances in
Schedule IV.
o Examples: Pregabalin, Lomotil,
Pseudoephedrine
Controlled Substance Prescriptions
 Requirements of the prescription
o Prescriber’s name, address, phone, and DEA
number
o Prescriber’s signature
o Date of prescription
o Patient’s name and address
o Drug name, strength, instructions for use
o Refills (limited to six months from date written)
 No refills* for C-II prescriptions
 *partial fills are allowed in some
situations
Emergency Dispensing of
Schedule II Drugs
 Emergency dispensing is possible when the prescriber
determines that
o immediate administration of a C-II drug is
necessary
o there are no appropriate alternative treatment,
AND
o it is not reasonably possible for the prescriber to
provide a written prescription to the pharmacy
prior to dispensing
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Oral authorization from prescriber
Only adequate quantity to get through emergency
Prescription immediately reduced to writing except for
signature
 Reasonable effort to determine oral authorization came
from licensed practitioner
 7 days to receive written prescription from prescriber
Partial Filling of C-II Drugs
 Situations leading to partial filling in a retail pharmacy
o Pharmacy does not have sufficient stock
o Patient is in a LTCF or Hospice care
o Patient is terminally ill
 Situations in which partial fills are NOT permitted
o Patient only requests part of the quantity
prescribed
o Prescription is written for a larger quantity than
the physician wants patient to have at one time
The Process of Dispensing
 Receive prescription order
 Verify patient data/create database
 Verify components of prescription
 Fill (enter data, select product, verify payment) and
label prescription
 Verify (pharmacist’s check) filled Rx against original
order
 Provide patient counseling (setting dependent)
Signs of Prescription Fraud
 Improper spelling
 Too much or too little information on prescription
 Prescription is “too perfect”
 Inconsistent font size
 Different color inks or handwriting
Basics of Hypertension
o Learning Objectives:
1.Access www.webmd.com and access the “Hypertension/ High
Blood Pressure Health Center”.
2.Define the terms hypertension, essential hypertension,
secondary hypertension.
3.Describe the skills to measure blood pressure.
4.State the parameters (numbers) for monitoring hypertension.
5.Broadly describe the treatment modalities for hypertension.
6.List the trade name and generic name for medications (from
the Top 200 Drugs List) used in the management of
hypertension.
o
o Hypertension
 Blood Pressure
 The force of blood pressing against arterial walls as
it moves through the circulatory system
 Hypertension
 Increased BP (over normal) over a sustained period
of time can cause damage to vascular walls
 Hypertension related to:
 Increase in blood volume and/or
 Decreased elasticity of blood vessel walls
 Hypertension is the leading cause of:
 Stroke
 Myocardial infarction
o Types of Hypertension
 Essential or Primary
 NO underlying cause has been identified
 Associated with risk factors
 Genetics, Age, Race
 Influenced by diet and lifestyle
 “Salt Sensitive”
 Obesity and/or Diabetes
 Stress
 Inadequate intake of K+, Ca++, Mg++
 Lack of physical activity
 Chronic alcohol consumption
o Secondary
 A direct cause has been identified
 Renal disease
 Adrenal gland malfunctions
 Estrogen containing oral contraceptives
 Pregnancy
 Vasoconstrictors
 Corticosteroids
 NSAIDs
 Sleep Apnea
o Diagnosis and Monitoring of Hypertension
 Measure BP – Systolic and Diastolic
 Use correct procedures….a skill to practice
 Normal
< 120 and <80
 Pre hypertension 120-139 or 80-89
 HIGH
 Stage I
140-159 or 90-99
 Stage II
>160 or >100
o Hypertension Therapies
 Life Style Modifications
 Exercise
 Minimize stress
 DASH Diet
o Dietary Approaches to Stop Hypertension
o Hypertension Therapies
 ACEIs..the “..prils”
 Angiotensin Converting Enzyme Inhibitors
 Cause vasodilation and lower BP
 “Protect” the kidneys from damage
 Adverse Effects
o Cough
o Metallic taste
o Increased K+ levels
o Angioedema…swelling of neck, face, and
tongue
 Angiotensin II Receptor Blockers..the “..sartans”
 Cause vasodilation and lower BP
 Useful when patient cannot tolerate an ACEI
 Adverse Effects
o Cough…less than with ACEI
o Increased K+ levels….less than with ACEI
 Diuretics
 Cause elimination of fluids and salts
 Thiazide Diuretics - Management of HBP
 Loop Diuretics - Management of Heart Failure
 Potassium Sparing Diuretics – Adjunct therapy
 Adverse Effects
o Decreased K+ levels
o Possible cardiac arrhythmias
o Muscle cramps
 Urinary Frequency
 Beta-Blockers..the “..olols”
 Block effects of the sympathetic nervous system on
the heart
 Reduces work load of the heart….reduces need for
oxygen and blood and in turn reduces BP
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Also control heart rate and are useful in
arrhythmias
 Adverse Effects
o Fatigue, cold extremities, breathing
problems, depression, may interfere with
symptoms of hypoglycemia
Calcium Channel Blockers..two classes
 Slow movement of Ca++ into cells which reduces
cardiac work load and causes vasodilation
 Adverse Effects
o Possible cardiac arrhythmias
o Possible anticholinergic effects
o Edema, swelling
o Constipation or diarrhea
Basics of Diabetes
o OBJECTIVES
1.Access www.webmd.com and click “Diabetes Health Center”.
2.Define the terms diabetes, Pre-Diabetes, Type 1 diabetes, Type
2 diabetes.
3.List the symptoms and complications of diabetes.
4.State the clinical parameters (numbers) for monitoring
diabetes.
5.Broadly describe the treatment modalities for diabetes.
6.List the trade name and generic name for medications (from
the Top 200 Drugs List) used in the management of diabetes.
o Endocrine disease characterized by elevated glucose levels resulting
from
 Decrease in insulin levels AND/OR
 Altered response to insulin
o Insulin functions to allow glucose utilization by cells
o Pre-Diabetes – Impaired glucose tolerance
o Type 1 Diabetes – destruction of pancreatic beta cells
o Type 2 Diabetes – decrease in production of insulin
o Symptoms of Diabetes
 Type 1
 Increased thirst
 Increased hunger (especially after eating)
 Dry mouth
 Frequent urination
 Unexplained weight loss (even though you are eating
and feel hungry)
 Fatigue (weak, tired feeling)
 Blurred vision
 Labored, heavy breathing (Kussmaul respirations)
 Loss of consciousness (rare)
 Type 2
 Same as for Type 1
 Slow-healing sores or cuts
 Itching of the skin (usually in the vaginal or groin area)
 Yeast infections
 Recent weight gain
 Numbness or tingling of the hands and feet
 Impotence or erectile dysfunction
o Complications of Diabetes
 Damage to the nervous system
 Infections
 Macrovascular disease
 Microvascular disease
 Skin Problems
 Insulin Resistance Syndrome
o Monitoring Diabetes
 NORMAL Fasting BG 70-100mg/dL
 Diabetes Diagnosis: Two Fasting BG > 126mg/dL
 Home or Self Glucose Testing
 Hemoglobin A1C Testing
 Average BG over 6 to 12 weeks
 Normal 4% - 6% ….for diabetics <7%
 Oral Glucose Tolerance Testing
 Urine Testing
o Diabetes Therapies
 Insulins’
 Rapid-acting
 Short-acting
 Intermediate-acting
 Long-acting
 Pre-mixed
 Oral Medications
 Sulfonylureas
o Lower blood glucose by stimulating pancreas to
release more insulin
 Biguanides
o Improve insulin’s ability to move glucose into
muscle cells
o Prevent liver from releasing stored glucose
 Thiazolidinediones
o Improve insulin’s effectiveness in muscle and fat
 Alpha-glucosidase inhibitors
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o Block enzymes that digest sugars, slowing the
rise in glucose levels
 Meglitinides
o Lower blood glucose by stimulating pancreas to
release more insulin BASED on blood glucose
levels
 Dipeptidyl peptidase IV (DPP-IV) inhibitors
o Increase insulin secretion from pancreas and
reduce production of glucose
 Combination therapy
Basics of Hyperlipidemia
o OBJECTIVES
1.Access www.webmd.com and access the “Cholesterol
Management Health Center”.
2.Define the term “hyperlipidemia”.
3.Describe the tests to measure hyperlipidemia and state the
parameters (numbers) for monitoring hyperlipidemia.
4.Broadly describe the treatment modalities for hyperlipidemia.
5.List the trade name and generic name for medications (from
the Top 200 Drugs List) used in the management of
hyperlipidemia.
o Hyperlipidemia, Hypercholesterolemia
 General terms that refer to elevated levels of overall
cholesterol and/or several types of cholesterol
o Cholesterol (CHO)
 Waxy substance produced primarily in the liver
 ALSO present in foods
 Functions in hormone production, Vitamin D metabolism, bile
acid production, and cell metabolism
o Measuring CHO levels
 Screening provides Total CHO, HDL and TG…must calculate
LDL
 Full Lipid Panel with Patient History and Workup
o Types of Cholesterol
 Lipoproteins – cholesterol/protein package that travels
through the blood; named according to density of protein to fat
 LDL – Low Density Lipoprotein (Bad Cholesterol)
 Little protein, mostly fat…buildup in arterial walls
known as plaque….Leads to heart disease…
 The LOWER the Better: Goal < 100
 If CAD, Goal < 70
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HDL – High Density Lipoprotein (Good Cholesterol)
 Mostly protein, little fat…Helps rid body of LDL..protects
against heart disease
 The HIGHER the Better: Goal > 60
VLDL – Very Low Density Lipoprotein
 Similar to LDL
 The LOWER the Better
TG – Triglycerides
 Increased by excess calories, alcohol, or sugar
 Another type of fat carried by VLDL
 The Lower the Better: Goal < 150
Total Cholesterol – Mixture of types of CHO
 The Lower the Better: Goal < 200
Therapies for Hyperlipidemia
 Life Style Modifications
o Diet
o Low CHO, Low fat, High Protein, Adequate
Hydration
o Plant sterols, nuts, omega-3 fatty acids, oatmeal,
soy
o Exercise
o Minimize stress
o Weight loss
o ? Red Yeast Rice?
 HMG-Co A Reductase Inhibitors…the “Statins”
o Inhibits 3-hydroxy-3-methylglutaryl-coenzyme A
reductase
o The enzyme that catalyzes the rate-limiting step
in CHO biosynthesis
 Decreases the production of CHO in the liver
 Lowers LDL, Lowers TG, (Mild) Raises in HDL
 Adverse Effects
o GI effects
o Hepatic damage
o Muscle pain leading to rhabdomyolosis with ARF
 Niacin or Nicotinic Acid
o B-Complex Vitamin
o Lowers LDL, Raises HDL
o Adverse Effects
 Flushing
 Tingling feeling
 Itching
 Headache
 Bile Acid Resins

o Bind to bile and prevent bile from being
reabsorbed into the circulatory
system…therefore depleting body CHO levels
o Lowers LDL
o Adverse Effects
 Constipation
 “Gas” or flatulence
 Upset stomach
 Folic Acid Derivatives or Fibrates
o Reduces production of TG
o Lowers VLDL, Increases HDL (modest)
o Adverse Effects
 Constipation
 “Gas” or flatulence
 Upset stomach ~ Nausea
 CHO Absorption Inhibitors
o Prevent CHO absorption (from dietary sources)
in the intestine
o Lowers Total CHO, Lowers LDL, Lowers TG and
Raises HDL
o Adverse Effects
 Diarrhea
 Increases hepatic enzymes if
administered with
HMG-Co A RIs
Basics of Pulmonary Disease
o OBJECTIVES
1.Access www.webmd.com and access the “Lung Disease &
Respiratory Health Center”.
2.Define the terms “chronic lung disease”, asthma and COPD.
3.Describe the tests to measure and monitor lung diseases.
4.Broadly describe the treatment modalities for asthma and
COPD.
5.List the trade name and generic name for medications (from
the Top 200 Drugs List) used in the management of chronic lung
diseases.
6.Complete (and submit via Blackboard) the activity related to
Pharmacy Practice and Chronic Lung Disease.
o Asthma
 Chronic inflammation of lungs
 Characterized by
 Wheezing, breathlessness
 Cough, chest tightness
 Asthma “attacks”
 Reactive airway disease


Often has an allergic component
Features of Asthma
 Airway Obstruction
 Inflammation
 Airway irritability
Types of Asthma
 Childhood vs. Adult
 Allergic
 Exercise induced
 Cough
 Occupational
 Nocturnal
 Tests for Asthma
 Lung function tests
o Spirometry
 Allergy testing
 X-rays
 Asthma Therapies
 Control inflammation
 Ease severity of asthma attacks
 Anti-inflammatory Agents
o Reduce swelling and mucous production
o Corticosteroids
 Bronchodilators
o Relax and open airways
o Short acting and long acting beta agonists
o Anticholinergic agents
 Inhaler
o Metered Dose Inhaler (MDI)
o Dry Powder Inhaler
 Nebulizer
o Changes medication from a liquid to a mist for
delivery deep into the lungs
o COPD (Chronic Obstructive Pulmonary Disease)
 Combination of two conditions
 Bronchitis
o Inflammation of airways
o Accumulation of mucous
 Emphysema
o Damaged airsacs
o Cannot expand and allow for correct airway
exchange
 Results from SMOKING or other chemical irritation (pollution,
etc)

Features of COPD
 Long Lasting or Chronic Cough
 Mucous that comes up when coughing
 Chronic SOB
 Frequent bacterial respiratory infections
 Diagnosed by history and lung function tests
 COPD Therapies
 STOP SMOKING
 Avoid pulmonary toxins
 Medications
o Short-acting and long-acting bronchodilators
o Coticosteroids
o Expectorants
 Chronic Oxygen
 Antibiotics
Basics of Mental Health Disorders
o OBJECTIVES
1.Access www.webmd.com and access the “Schizophrenia Health
Center”, the “Depression Health Center”, and the “Anxiety &
Panic Disorders Health Center”.
2.Define the terms schizophrenia, depression and anxiety.
3.Describe the tests to measure and monitor mental health
diseases.
4.Broadly describe the treatment modalities for schizophrenia,
depression, and anxiety disorders.
5.List the trade name and generic name for medications (from
the Top 200 Drugs List) used in the management of
schizophrenia, depression, and anxiety disorders.
6.Complete (and submit via Blackboard) the activity related to
Pharmacy Practice and Mental Health Disorders.


o Schizophrenia
 A type of psychosis
 Change in thinking and behaviors
 Social withdrawal
 Depersonalization
 Loss of appetite
 Loss of hygiene
 Delusions
 Hallucinations
 Sense of being controlled by outside forces
 Schizophrenia Symptom Clusters
 Positive Symptoms
o Hearing voices
o Suspiciousness



o Feeling under constant surveillance
o Delusions
o Making up words without a meaning
(neologisms)
 Negative (Deficit) Symptoms
o Social withdrawal
o Difficulty in expressing emotions (in extreme
cases called blunted affect)
o Difficulty in taking care of themselves
o Inability to feel pleasure (these symptoms cause
severe impairment and are often mistaken for
laziness)
 Cognitive Symptoms
o Difficulties attending to information
o Difficulties processing of information
o Difficulties in understanding the environment
o Difficulties in remembering simple tasks
 Affective (Mood) Symptoms
o Depression….accounting for a very high rate of
attempted suicide in people suffering from
schizophrenia
Diagnosis
 Licensed Mental Health Professional
 Thorough history to rule out medical problems
 Mental Status Testing
o MSE - Mental Status Exam
o MMSE - Folstein Mini-Mental Status Exam
 Diagnosis based on DSM
o Diagnostic and Statistical Manual of Mental
Disorder (DSM) compiled by the American
Psychiatric Association
Therapies for Schizophrenia
 Mental Health Counseling
 Medications
Antipsychotic Agents
 Neuroleptics
o Mostly effective against “positive symptoms”
o Adverse effects significant in nervous system
 Chlorpromazine - Thorazine
 Haloperidol - Haldol
 Thioridazine* - Mellaril
o *Black Box Warning* deadly arrhythmia
 Atypical Antipsychotic Agents
o Effective against “negative symptoms”
 Aripiprazole - Abilify




Ziprasidone - Geodon
Risperidone - Risperdal
Quetiapine - Seroquel
Olanzapine - Zyprexa
o Patient Counseling on Medication Side Effects
o Depression
 Intense Sadness
 At least FIVE of the following NINE symptoms at the same
time:
 Depressed mood during most of the day, particularly in
the morning
 Fatigue or loss of energy almost every day
 Feelings of worthlessness or guilt almost every day
 Impaired concentration, indecisiveness
 Insomnia or hypersomnia (excessive sleeping) almost
every day
 Markedly diminished interest or pleasure in almost all
activities nearly every day
 Recurring thoughts of death or suicide (not just fearing
death)
 A sense of restlessness -- known as psychomotor
agitation -- or being slowed down -- retardation
 Significant weight loss or gain (a change of more than
5% of body weight in a month)
 Types of Depression
 Major Depression
 Chronic Depression (Dysthymia)
 Atypical Depression
 Postpartum Depression
 Bipolar Depression (Manic Depression)
 Seasonal Depression (SAD)
 Psychotic Depression
 Diagnosis
 Licensed Mental Health Professional
 Thorough history to rule out medical problems
 Mental Status Testing
o Depression Rating Scales (Hamilton Depression
Scale)
 Diagnosis based on DSM
o Diagnostic and Statistical Manual of Mental
Disorder (DSM) compiled by the American
Psychiatric Association
 Therapies for Depression
 Mental Health Counseling

Medications
o Tricyclic Antidepressants – TCAs
 Older agents
 Problematic side effects
 Anticholinergic effects
 Sedation
 Cardiovascular effects
 Amitriptyline - Elavil
 Desipramine - Norpramin, Pertofrane
 Doxepin - Adapin, Sinequan
 Imipramine - Tofranil
 Nortriptyline - Aventyl, Pamelor
 Protriptyline - Vivactil
 Trimipramine – Surmontil
o Selective Serotonin Reuptake Inhibitors – SSRIs
 Most commonly used class
 Side effects are generally mild
 stomach upset, sexual problems, fatigue,
dizziness, insomnia, weight change, and
headaches
 Citalopram – Celexa
 Escitalopram – Lexapro
 Paroxetine – Paxil
 Fluoxetine – Prozac
 Sertraline – Zoloft
o Serotonin and Norepinephrine Reuptake
Inhibitors – SNRIs
 Side effects are generally mild
 upset stomach, insomnia, sexual
problems, anxiety, dizziness, and fatigue
 Venlafaxine - Effexor
 Desvenlafaxine – Pristiq
 Duloxetine - Cymbalta
o Monoamine Oxidase Inhibitors – MAOIs
 First antidepressants
 Many & Serious drug/food interactions
 Phenelzine- Nardil
 Tranylcypromine - Parnate
 Selegiline - EMSAM
 Dopaminergics
 –Bupropion – Wellbutrin
o Also for smoking cessation
 –Trazodone – Desyrel
o Often use for sedation
o “Others” –
 Mirtazapine - Remeron
 Patient Counseling on Medication Side Effects
o Anxiety Disorders
 Anxiety - Normal human reaction to stress
 Anxiety Disorder – Reaction that interferes with functioning
 Symptoms
 Feelings of panic , fear, or uneasiness
 Uncontrollable, obsessive thoughts
 Repeated thoughts or flashbacks of traumatic
experiences
 Nightmares
 Ritualistic behaviors, such as repeated hand washing
 Problems sleeping
 Cold or sweaty hands and/or feet
 Shortness of breath
 Palpitations
 An inability to be still and calm
 Dry mouth
 Numbness or tingling in the hands or feet
 Nausea
 Muscle tension
 Dizziness
 Types of Anxiety Disorders
 Panic Disorder
 Obsessive-Compulsive Disorder (OCD)
 Post Traumatic Stress Disorder (PTSD)
 Social Anxiety Disorder
 Specific Phobias
 Generalized Anxiety Disorder
 Diagnosis
 Medical Evaluation may be combined with Licensed
Mental Health Professional
 Thorough history to rule out medical problems
 Mental Status Testing
o Anxiety Rating Scales (Hamilton Anxiety Scale)
 Diagnosis based on DSM
o Diagnostic and Statistical Manual of Mental
Disorder (DSM) compiled by the American
Psychiatric Association
 Therapies for Anxiety Disorders
 Mental Health Counseling/Psychotherapy
 Cognitive/Behavioral /Relaxation Therapy
 Dietary/Lifestyle Changes
 Medications


o Benzodiazepines
 May cause drowsiness and potentially
addicting
o Selective Serotonin Reuptake Inhibitors – SSRIs
o Serotonin and Norepinephrine Reuptake
Inhibitors – SNRIs
 Patient Counseling on Medication Side Effects
Medical Terminology and Abbreviations
o Standard abbreviations are used by health care providers…effective
and efficient
o In pharmacy practice, accepted abbreviations, acronyms, and symbols
are common in prescriptions and medication orders
 Interprofessional
 Patients…in lay terminology
o Never make up your own
o Uses for Medical Terminology
 Disease States
 CHD, DVT, HTN
 Vital signs and Labs
 BP, T
 BUN, CBC
 Instructions
 IM, DNR, NPO
 Prescriptions
 QID, PO, PRN
 Procedures
 CXR, ECG, CABG
 Data Entry
 HPI, PMH, ROS
 SOAP
o Abbreviations May Have Multiple Meanings
 CC
 Chief Complaint
 Critical Care
 Creatinine Clearance
 ARF
 Acute Renal Failure
 Acute Respiratory Failure
 RA
 Renal Artery
 Rheumatoid Arthritis
 Right Arm
 Right Atrium
Rubric For Blood Pressure
o Repositions the patient with arm at heart level, legs uncrossed, feet

flat, and sitting straight in the chair. Palm should be facing up.
o Verbalizes that the patient should be seated for at least 5 minutes
before the blood pressure reading. Also, caffeine, exercise, and
smoking should be avoided for at least 30 minutes prior to
measurement.
o Cuff is placed in appropriate orientation with the lower edge of the
cuff about 1 inch above the bend of the elbow and is snug, but not too
tight.
o Ask student – Is blood pressure cuff size important? Yes, size is based
on arm circumference and use of an inappropriately sized cuff can
lead to erroneous blood pressure readings. Using a cuff that is too
small for the patient’s arm can produce a falsely high reading and vice
versa.
o Student palpates for radial pulse and then inflates the cuff by
squeezing the bulb until she can no longer feel the radial pulse.
o The cuff is then deflated.
o Palpates for a brachial pulse over the brachial artery. Stethoscope is
placed where brachial pulse is palpated.
o Stethoscope is placed in the ears, with curvature facing forward and
into ears. Bulb is in one hand and the pressure gauge is placed where
student can see the dial.
o The student re-inflates the cuff to 20-30 mmHg above the level
required for radial pulse obliteration.
o Slowly releases the pressure in the cuff by opening the airflow valve
counter clockwise. The gauge should fall only 2 mmHg per second.
Student watches the gauge throughout the reading.
o Continues releasing pressure until systolic can be heard (the point
when the first of 2 or more Korotkoff sounds is heard) and diastolic
(the point when Korotkoff sounds disappear) can be determined.
o At 10 to 20 mmHg below the diastolic blood pressure, the cuff can be
rapidly deflated.
o Ask the student – How similar (mmHg) should two consecutively
measured blood pressure readings be, in the same patient, before
additional readings are needed? Student states that a 2nd
measurement should be obtained after 1-2 minutes in the same arm.
If the systolic or diastolic readings differ by > 5 mmHg an additional
reading should be taken.
o Provides a reading that is within 10mmHg (SBP and DBP) of that
heard by faculty member via teaching stethoscope.
o Student tells patient their blood pressure and offers to provide it in
writing.
o Ask the student – I have hypertension but am otherwise healthy. What
is the goal for my blood pressure? Student should answer that blood
pressure should be less than 140/90.
Rubric for Cholesterol
o Before beginning, the student needs to make sure that all the needed

testing material is available: gloves, lancing device and lancets, alcohol
swabs, cotton (or gauze), bandages, capillary tubes (if require), monitor
and test strips.
o The student briefly explains the procedure to the patient: “I am going to
prick your finger to get a small amount of blood, just enough to fill this
little tube right here.” The student shows the patient that the tube is very
small and that a minimal volume of blood is needed.
o Before beginning, the student wears gloves on both hands.
o The student prepares the alcohol swab, the lancing device and the capillary
tube and asks the patient to extend one finger.
o The student swabs the finger and successfully uses the lancing device on
the side of the finger (to minimize pain and discomfort.) The lancet is
discarded immediately into SHARPS container. The patient’s finger is
gently massaged until a drop of blood forms on the finger.
o The first drop of blood is wiped away with gauze or cotton and the blood
is then collected for testing.
o The student holds the capillary tube at an angle (not perpendicular to the
drop). The tube automatically fills.
o The student makes sure that the capillary is filled to the black line and that
no air bubbles are present.
o Cotton (or gauze) is used to stop the bleeding and a bandage is applied.
o The contents of the capillary tube are emptied in the well on the test strip
and the machine is operated as directed.
o Student must verbalize that the patient should wait for the meter to count
down until it beeps. The test is now complete and test result appears on
the display.
o Student must verbalize that if a warning message appears due to a high or
low level, the test should be repeated.
o The student verbalizes to patient that if the same result is obtained, to
follow their health care provider’s instructions or call immediately.
o To turn the meter off, remove the used test strip and discard. Clean up all
materials. Remove gloves & discard in trash.
Rubric for Blood Glucose
o Gather necessary supplies (alcohol swab, cotton ball, glucose test strips,
glucometer, lancet, sharps container, Band-Aid)
o Wash your hands thoroughly with soap and water. Rinse your hands
completely and dry them. (For test, may use provided hand sanitizer)
o Follow the steps to code the meter. Make sure the test strip vial is
compatible with the glucometer. If it is not, change code per meter
instructions.
o Check the expiration date on the vial.
o Recap vial once test strip is removed.
o Insert the test strip, contact bars end first and facing up, into the test port.
Push the strip in until it will go no further. Meter will turn on
automatically.
o Be sure the meter’s display and test strip codes match.

o Next, the apply blood symbol will appear. (Student must show the patient
how to know when to apply blood.)
o Student prepares the lancing device by twisting off the small blue or
purple “stick” at the end of the lancing device and then pulling to remove
it. Student then asks the patient to extend one finger.
o Student successfully demonstrates using the lancing device (on the side of
the fingertip, not the fleshy central pad of the finger, to minimize pain and
discomfort).
o Student places used lancet device directly into the sharps container and not
on the table or anywhere else.
o Student demonstrates how the patient’s hand is gently massaged from the
palm to the finger until a drop of blood forms on the finger.
o The blood is collected for testing by placing the edge of the test strip UP
TO the blood drop, so that it is drawn into the strip via capillary action.
The window must be filled completely. *If the window does not fill, you
MAY reapply blood within 5 seconds.*
o Student must verbalize that the patient should wait for the meter to count
down until it beeps. The test is now complete and test result appears on
the display.
o Student must verbalize that if a warning message appears due to a high or
low level, the test should be repeated.
o The student verbalizes to patient that if the same result is obtained, to
follow their health care provider’s instructions or call immediately.
o To turn the meter off, remove the used test strip. Test results are
automatically stored in memory.
Medication Safety
o OBJECTIVES
•Describe the problem of medication safety in the U.S. healthcare
system.
•List strategies and resources available for insuring medication
safety in the prescribing of medications.
•Describe examples of medication safety issues and strategies to
improve medication safety.
o Medication Administration
 The 5 Rights for Every Medication
 Right patient
 Right drug
 Right dose
 Right route
 Right time
o U.S. Issues
 4 of 5 adults take a prescription, an OTC, or a dietary
supplement every week
 33% of adults take 5 or more Rxs weekly
 1.5 million people are injured yearly by medication errors
Medication errors are involved in
 1 out of 131 outpatient deaths
 1 out of 854 inpatient deaths
 Medication errors cost ~ $3.5 billion yearly
 FAQs on Medication Error Rates
 http://www.ismp.org/faq.asp#Question_1
o Institute for Safe Medication Practices
 The Institute for Safe Medication Practices (ISMP) is the
nation’s only nonprofit organization devoted entirely to
medication error prevention and safe medication use.
 ISMP represents over 30 years of experience in helping
healthcare practitioners keep patients safe, and continues to
lead efforts to improve the medication use process.
 The organization is known and respected worldwide as the
premier resource for impartial, timely, and accurate
medication safety information.
o Resources for Medication Safety
 Institute for Safe Medication Practices (ISMP)
 www.ismp.org
 http://www.ismp.org/tools/tallmanletters.pdf
 http://www.ismp.org/Tools/highalertmedications.pdf
 http://www.ismp.org/Tools/confuseddrugnames.pdf
 http://www.ismp.org/Tools/DoNotCrush.pdf
 http://www.ismp.org/Tools/errorproneabbreviations.
pdf
 http://www.ismp.org/Tools/drugnamesuffixes.pdf
 The Joint Commission (TJC)
 http://www.jointcommission.org/
 National Patient Safety Goals
 Consumer Medication Safety issues
 http://www.consumermedsafety.org/
