Basic Pharmacology (complete)

Question 1

Safe Medication Administration: the 11 Rights

Answer 1

• right patient
• right medication
• right dose
• right route
• right time
• right reason
• right assessment
• right documentation
• right response
• right education
• right to refuse (document this and know why they refused)

Question 2

What is medication reconciliation and why is it done?

Answer 2

• performed at admission, discharge, every home visit and at each clinic visit
• compare orders to what the patient believes they are taking
• ask to have medicaiton list from home brought to hospital and at every visit (hospital drugs stay on list until reconciled)
• need to document meds, OTC, herbals, vitamins, supplements

Done to prevent:
- medication errors
- drug interactions
- multiple reactions of same medication

Question 3

What are high alert medications?

7

Answer 3

Medications that have the highest risk of causing patient harm

include
- chemotherapy drugs
- insulin
- opioids
- potassium - IV (will stop the heart)
- parenteral nutrition
- anticoagulants

• look-alike and sound-alike drugs

Question 4

Clinical Trial: Phase 1

Answer 4

• first time used in humans

Goals:
- to find highest dose of new treatment that can be given safely without causing severe side effects
- help to decide on best way to give new treatment
- to determine what the drug does to the body and what the body does with the drug

*first few people get very low dose and are monitored closely – volunteers are usually young, healthy males

Question 5

Clinical Trial: Phase 2

Answer 5

Studies those who have the disease:
- group of 25-100 participants with the same disease
- usually participants get the same does (some studies randomly assign people to different treatment groups)
- groups may get different doses or get treatment in different ways - assessing best balance of safety and response

• may be done at major medical centers, community hospitals, or physician’s office
• continue to gather new information about side effects

Question 6

Clinical Trial: Phase 3

Answer 6

• typically done on about 3000 participants
• evaluates how this medication works in comparison to existing medications for the same condition
• look at new indications (can it be used for other illnesses)
  – look at new formulations (different routes)
  – look at other patient populations (cancer, autoimmune, etc)
• drug companies can apply for FDA approval upon the completion of the phase 3 trial
• fast tracking like with COVID

Question 7

Clinical Trials: Phase 4

Answer 7

• post-marketing; drug approved by FDA
• studies may involve thousands of “real” people (those previously ineligible)
• safety type of clinical trial

Looks at other aspects of treatment:
- quality of life
- cost effectiveness
- newer indications
- newer formulations

Question 8

What is a package insert (PI)?

Answer 8

• allows the practitioner to have the information needed to safely prescribe the medication
• has an HPI (highlights) and FPI (full details)
• must be evidence-based

Question 9

What is “off-label” use?

Answer 9

Medication is used for an indication other than what it was approved for
- often supported in literature, but not FDA-approved use

Things to consider:
- issues related to dose
- may increase risk of adverse effects
- drug interactions

Estimated 1 in 5 prescriptions are for off-label use

Question 10

Off-label use: Gabapentin (neurontin)

Answer 10

FDA approved for:
- focal seizures
- post herpetic neuralgia (pain after shingles)

Off label use:
- alcohol withdrawal
- fibromyalgia
- hiccups
- perimenopausal night sweats and hot flashes
- neuropathic pain
- chronic pruritis
- chronic cough

Question 11

OTC Medications and Dangers

Answer 11

Are real meds, with real adverse effects, and can cause real problems

Dangers:
- can mask symptoms of disease
- hidden meds (theraflu has acetaminophen in it)
- increasing dose
- drug interactions

Question 12

Alternative medications

Answer 12

Herbals and other alternative therapies are not approved by the FDA
- no agency making sure what is on the label is on the pill
- evidence-based care

Significant and serious drug interactions
- example: turmeric can potentiate anticoagulants and anti-platelets, causing hypoglycemia and increase stomach acid

Question 13

What are orphan medications?

Answer 13

Medications developed to treat a rare condition
- small population (1000 or less usually)

Orphan Drug act: passed 1983; give drug companies incentives to develop treatments for rare diseases
- receive government assistance to produce

Rare Disease act 2002; developed office for rare diseases

Question 14

What are enteric-coated medications?

Answer 14

• delay absorption until a certain part of GI tract has been reached (want absorption in small intestine)
• helps protect the stomach

Do not crush or chew

Question 15

What are controlled-release medications?

Answer 15

have “MR”, “SR”, “ER”, or “LA attached to name
- MR: modified release
- ER: extended release
- SR: sustained release
- LA: long acting

formulated to be released slowly in the GI tract
- patient takes less frequently than regular (1-2x a day)
- can not be used interchangeably with regular drug
- do not crush or chew

Question 16

MR

Answer 16

modified release

Question 17

ER

Answer 17

extended release

Question 18

SR

Answer 18

sustained release

Question 19

LA

Answer 19

long acting

Question 20

What are Schedule 1 Controlled substances

Answer 20

• highest potential for abuse
• has no currently accepted medical use in treatment in US
• lack of accepted safety for use of drug under medical supervision
• examples: heroin, LSD, ecstasy, marijuana (now state regulated but federally still not allowed)

Question 21

What are schedule 2 controlled substances?

Answer 21

• has high potential for abuse that may lead to severe psychological or physical dependence
• has a currently accepted medical use in treatment in US
  – OR currently accepted medical use with severe restrictions
• examples: morphine, cocaine, fentanyl, hydromorphone, oxycontin, PCP, methadone, Adderall

Question 22

What are schedule 3 controlled substances?

Answer 22

• has potential for abuse but less so than 1 or 2
• has a currently accepted medical use in treatment in US
• abuse may lead to moderate or low physical dependence; high psychological dependence

examples: low doses of hydromorphone, tylenol with codeine, anabolic steroids

Question 23

What are schedule 4 controlled substances?

Answer 23

• low potential for abusive relative to drugs in schedule 3
• has a currently accepted medical use in treatment in US
• abuse may lead to limited physical or psychological dependence relative to schedule 3

Examples: benzodiazepines and tramadol

Question 24

What are schedule 5 controlled substances?

Answer 24

• low potential for abuse relative to drugs in schedule 4
• has currently accepted medical use in treatment in the US
• abuse may lead to limited physical or psychological dependence relative to schedule 4

Examples: Phenergan, codeine, cough syrup

Question 25

What are challenges to drug therapy?

Answer 25

the patients are the consumers - they should not know more than you - they need to understand what they know - cost/medical needs - illicit drug use - insurance issues - pre-conceived beliefs about medications