Download Tool Kit- How to create a brown bag drug review

Tool Kit- How to create a brown bag drug review
1.
2.
3.
Define what aspects of the drug utilization review process you will be focusing.
(Drug-disease interactions, Drug-drug interactions, Therapeutic duplications, Incorrect drug dosage or
duration of drug treatment, Drug-allergy interactions, Clinical abuse or misuse etc.)
Select medications/disease states that correspond with what the students have learned.
Work backwards.
9 Identify the desired results – What should the students know?
9 Determine how to assess – How will you know if students have achieved the desired results?
9 What materials/resources are best suited to meet these goals?
Nebraska Drug Utilization Review Regulations
1. Therapeutic duplication
2. Drug-disease contraindications
3. Drug-drug interactions
4. Incorrect drug dosage or duration of drug treatment
5. Drug-allergy interactions
6. Clinical abuse or misuse
Drug-Disease Interaction:
• β-blockers (metoprolol/HCTZ) and diabetes -- -- Tachycardia, tremor, palpitations, and increases in systolic and diastolic blood pressure are sympatheticmediated responses to hypoglycemia. β-blockers frequently blunt the adrenergic response so common symptoms of hypoglycemia are not experienced.
Sweating is a parasympathetic mediated response to hypoglycemia not affected by β-blockers. Patients with diabetes who are receiving β-blockers may be
counseled to be aware of sweating, confusion, and fatigue as key signs of hypoglycemia.
• Corticosteroids (prednisone) and diabetes -- Endogenous counter-regulatory hormones such as glucocorticoids are released in response to hypoglycemia.
When released, blood glucose concentrations rise. When corticosteroids are administered exogenously, increases in blood glucose concentrations would be
expected.
• et cetera
Drug-Drug Interaction:
• Formoterol/budesonide (Symbicort) and metoprolol/HCTZ (Lopressor HCT) – Formoterol (β2-agonist) and β-blockers (metoprolol) are pharmacologic opposites
and will counteract each other when given concomitantly. Non-cardioselective β-blockers may also lead to severe bronchospasm in asthmatic patients.
Concurrent use should be avoided – However, if no acceptable alternative exists, a cardioselective β-blocker (e.g. atenolol, metoprolol) may be used with caution.
• Doxycycline (Vibra-Tab) and calcium carbonate -- Divalent or trivalent cations readily chelate with tetracycline antibiotics, forming insoluble compounds. The
oral absorption of these antibiotics will be significantly reduced. Doxycycline should be given 1-2 hours before or 4 hours after the administration of antacids.
• et cetera
Therapeutic Duplication:
• Glipizide (Glucotrol) and metformin (Glucophage) are antidiabetic agents. Both have different mechanisms of action and we may need this additive effect to
reduce blood glucose. The patient may take both concurrently.
• Lisinopril (Prinivil) and metoprolol/HCTZ (Lopressor HCT) are antihypertensive agents. All have different mechanisms of action and we may need all three to reduce
blood pressure. The patient may take all of these concurrently.
• Pentasa (mesalamine) and Apriso (mesalamine) both contain the same medication. If the patient is currently taking both medications, he is exceeding the
maximum daily dose (1.5g per day for Apriso and 4g per day for Pentasa). The physician needs to be contacted to determine what medication the patient should
be taking. Additionally, on the prescription labels two different physicians are prescribing these medications.
• et cetera
Incorrect Drug Dose:
• Pioglitazone (Actos) is dosed 15 mg or 30 mg PO once daily (with a maximum of 45mg/day). The dosing interval is incorrect and the maximum dose per day is exceeded.
• Cefdinir (Omnicef) is dosed 300 mg PO every 12 hours or 600 mg PO every 24 hours for 10 days (with a maximum of 600mg/day). The dosing interval is incorrect and the
maximum dose per day is exceeded.
• et cetera
Drug-Allergy Interaction: * Determining the type of reaction the patient has had is essential.
• Cross-allergenicity (anaphylaxis, skin rash) may occur between sulfonamide-related compounds (metoprolol/HCTZ and sulfa allergy).
• Cross-allergenicity (anaphylaxis, skin rash) may occur between sulfonamide-related compounds (glipizide and sulfa allergy).
• et cetera
Other Recommendations/Suggestions (Bonus):
• Calcium carbonate and itraconazole (Sporanox) – Itraconazole oral bioavailability requires an acidic environment for solubility. H2-antagonists, proton pump
inhibitors, and antacids have been shown to reduce plasma concentrations of itraconazole. Administer calcium carbonate and other antacids two hours after oral
administration of itraconazole to minimize this interaction.
• Budesonide/formoterol (Symbicort); prednisone and calcium carbonate: Calcium absorption is reduced when calcium carbonate is taken concomitantly with
systemic corticosteroids.
• Thiazides (metoprolol/HCTZ), sulfonylureas (glipizide), and doxycycline (Vibra-Tab) have all been reported to cause photosensitivity reactions; concomitant use
may increase the risk of photosensitivity.
• et cetera
Rating
Yes No
Possible
Points
1. Did the student correctly identify Drug-Disease Interactions?
The student identified 4 to 5 Drug-Disease Interactions.
The student Identified 1 to 3 Drug-Disease Interactions.
The student identified no Drug-Disease Interactions.
5
3
0
2. Did the student correctly identify Major Drug-Drug Interactions?
The student identified 3 to 4 Drug-Drug Interactions.
The student identified 1 to 2 Drug-Drug Interactions.
The student identified no Drug-Drug Interactions.
4
2
0
3. Did the student correctly identify Therapeutic Duplications?
The student identified 3 to 4 Therapeutic Duplications.
The student identified 1 to 2 Therapeutic Duplications.
The student identified no Therapeutic Duplications.
4
2
0
4. Did the student correctly identify Inappropriate Doses?
The student identified 2 Inappropriate Doses.
The student identified 1 Inappropriate Dose.
The student identified no Inappropriate Doses
2
1
0
5. Did the student correctly identify Drug-Allergy Interactions?
The student identified 2 Drug-Allergy Interactions.
The student identified 1 Drug-Allergy Interactions.
The student identified no Drug-Allergy Interactions.
2
1
0
6. Other Recommendations/Suggestions (BONUS)
The student had other appropriate recommendations or suggestions
(Additional identification of other interactions, potential adverse drug reactions,
additional therapy that should be added to regimen according to national
guidelines, etc.)
15–19 Excellent; 10–14 Good; 5– 9 Fair; 0–4 Needs Improvement
Total
Points
_____/5
_____/4
_____/4
_____/2
_____/2
_____/2*
_____/17*
*Bonus points not included in total
Notes:
Begley, Castillo, and Augustine.
Creighton University.
[email protected]