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What is stress?
It is subjective.
Stress may include what three factors?
- 1) Sudden traumatic experiences
- 2) Continuing pressure that are out of control
- 3) Build up of small irritations
The three connections of stress is mind, body, and brain. If one is effected, will the other two eventually get effected as well?
In 1959, Hans Selye came up with this approach to stress:
General Adaptation Syndrome (GAS)
What is Hans Selye's definition of stress?
Physiological and psychological response to situations that threaten or challenge someone and requires some kind of adjustment.
What are the three steps to the stress reaction?
- 1) Alarm
- 2) Resistance
- 3) Exhaustion
What did Selye consider to be a major factor of stress, and compare that to what Lazarus considered to be a major factor of stress.
Selye believed that the intensity of a stressor was a major factor of stress, while Lazarus beleived that a mental process determined the intensity of stress.
What makes a stressor negative?
When it is causing harm, threat, or challenge.
In order to combat stress, what is a good way of approaching it?
Search for coping resources. Then, search for emotion-changing strategies or problem-focused strategies.
What was Lazarus and Folman's theory on what effects the level of stress one endured?
The level of stress endured depends mainly on the adequancy of resources for coping, and how much of it is drained by the stressor.
In 1999, what did McEwen and Seeman state allostatic load to be?
It is the wear and tear that the body endures via repeated cycles of allostasis [activation of effector cells that fight stressors] that may be due to inefficient shutting on and off of these responses.
Type I allostatic response results in __________ while Type II allostatic response results in __________.
- 1) adaptation
- 2) lack of adaptation.
What is eustress and what is distress?
Good stress and bad stress
What is acute stress and what is chronic stress?
Acute stress is stress that is very sharp, but it passes quickly.
Chronic stress is stress that is constantly endured due to routine change.
In the biopsychosocial model, the body, brain, and mind refer to what symtpoms?
- 1) Body-Brain Psychoneuro-Immunology
- 2) Brain-Mind The biological basis of psychiatric disorders
- 3) Mind-Body Medically unexplained physical symptoms
The study of the relationships among psychology, the nervous and endocrine systems and the immune system.
Type A Personality
Always acheiving, irritable, and impatient
Type B Personality
Pathological niceness, over-patient
A personality trait involving a to deny feelings of anger, anxiety, or fear; in stressful situations, phyiological responses such as heart rae and blood pressure rise sharply.
What are two explanatory styles?
- 1) Optimistic
- 2) Pessimistic
What are the two limits of control and describe them.
Primary control (Western culture) “fighting back”
Secondary control (Eastern culture) “learn live with it”
What are the four cognitive coping methods?
- 1) Reappraising the situation
- 2) Learning from the experience
- 3) Making social comparisons
- 4) Cultivating a sense of humor
Theory of the Problem =
Theory of the Action =
- Theory of the Problem = Explanatory Theory
- Theory of the Action = Change Theory
What is the purpose of the explanatory and change theories?
To choose targets of change, concoct strategies, and evaluate effectiveness.
What are the three models for the intrapersonal/individual theory?
- 1) Health Belief Model
- 2) Theory of Reasoned Action and Theory of Planned Behavior
- 3) Transtheoretical Model
What are the six stages of Prochaska's Transtheoretical Model?
- 1) Pre-contemplation
- 2) Contemplation
- 3) Determination/Preparation
- 4) Action
- 5) Maintenance
- 6) Relapse/Recycle
Describe the six stages of Prochaska's Transtheoretical Model.
Pre-determination Denial of a problem, no action planned.
Contemplation On the fence — maybe will take action in 6 months
Prepartion Motivated; let's go!, will take action in 30 days, has taken steps towards behaviors
Action Doing it; go!
Maintenance Living it!
Termination or Relapse/Recycle
Define medication safety.
Freedom from preventable harm with medication use.
- 1) U or u
- 2) IU
- 3) q.d. or QD
- 4) q.o.d. or QOD
- 5) X.0 mg
- 6) .X mg
- 7) MS
- 8) MSO4
List ways to ensure medication safety.
- 1) Always write out COMPLETE drug names
- 2) Use metric units instead of apothecary units
- 3) Do not use error-proned abbreviations.
- 4) Exercise extra caution with high-alert drugs.
- 5) Triple check when using look-alike, sound-alike medications.
- 6) Avoid
- 8) Check everything
An injury from a medicine or lack of an intended medicine. Includes adverse drug reactions and harm from medication incidents.
Adverse Drug Event (ADE)
Harm directly caused by drug at normal doses, during normal use.
Adverse drug reactions
ADR facilitated by an immune response (ex. rash, hives)
Expected & known drug effect that is NOT the intended therapeutic outcome
Identify common medication errors that lead to adverse drug events.
- 1) Dose errors
- 2) Known allergy
- 3) Wrong drug/patient
- 4) Route error
- 5) Frequency
- 6) Missed dose
- 7) Wrong technique
- 8) Illegible Order
- 9) Duplicate Therapy
- 10) Drug-drug interaction
- 11) Equipment failure
- 12) Inadequate monitoring
- 13) Preparation error
Typical signs and symptoms of Adverse Drug Events:
- 1) Rash
- 2) Change in respiratory rate, heart rate, hearing, or mental state
- 3) Seizure
- 4) Anaphylaxis
- 5) Diarrhea
- 6) Fever
When does adverse drug event reporting occur?
Of particular importance to the Food and Drug Administration (FDA) are suspected adverse drugreactions for a new drug (i.e., within 3 years of entry to market) and suspected severe adverse drugreactions for any drug, no matter when the drug entered the market (see below).In practice, a good rule of thumb is to document adverse drug reactions that have caused harm or alteredtherapeutic care and/or where future use of the drug might cause danger or harm to a patient.
Where does adverse drug event reporting occur?
Document should take place in your clinic note and in the allergies/adverse reactions data field in CPRS.The latter allows for highlighting the adverse reaction on the cover sheet so others can view theinformation and allows for triggering alerts for you or other providers. You or a clinical pharmacist can dothis.
How does adverse drug event reporting occur?
This simple process takes about 30 seconds. Use the Order menu in CPRS, click on Allergies, enter thedrug name and complete the form.
Why does drug adverse drug event reporting occur?
The purpose of documenting is to prevent future injuries for your patients and for others.
What does MTMS stand for?
Medication Therapy Management Services
A set of services that seek to achieve the best possible patient outcome from drug treatments. MTMS is independent of, but often concurrent with the provision of drug product. It is a collaborative process between health care providers, patients, and the pharmacist where the pahramcist identifies, prioritizes and resolves medication-related problems.
What is the Three Question Assessment upon the patient's first visit/prescription?
- 1) What did the prescriber tell you this was for?
- 2) How did the prescriber tell you to take it?
- 3) What did the prescriber tell you to expect?
What is the Three Question Assessment upon the patient's refill?
- 1) How has this medicine been working for you?
- 2) How have you been taking it?
- 3) Are you having any problems with it?
The Medication Check-Up of the MTMS include:
- 1) What the patient's allergic to and his/her symptoms
- 2) What the patient's intolerant to and his/her symptoms
- 3) The patient's medical conditions
- 4) The patient's medical issues
- 5) The patient's medications
What are some things to assess when undergoing the medication action plan?
- 1) Wrong drug
- 2) Need a drug
- 3) Adverse drug reactions
- 4) Safety Dosage Issues
- 5) Needs a different drug
- 6) Efficacy Dosage Issues
- 7) Economic barriers
- 8) Behavioral barriers
- 9) Physical barriers
What actions should be taken when finding something wrong in the assessment of the medication action plan?
- 1) Intervention Counseling patient
- 2) Referral to the correct care provider
- 3) Communication with the primary care provider
Types of MTM Services:
- 1) Patient Counseling
- 2) Consultaions
- 3) Disease Management Programs
- 4) Collaborative Drug Therapy Management
What is drug information?
The provision of unbiased, well-referenced, and critically evaluated information on any aspect of pharmacy practice.
During what era did the pharmacist shift from being dispensers to drug informationists?
During the 1950s.
What year did the first Drug Information Center at University of Kentucky Medical Center open?
What year did the Mills Commission Report state that the main function of pharmacists is to be providers of drug information?
Why is drug information important?
Drug information is important to train pharmacy students, for Medication Usage Evaluation (MUE), reporting adverse drug reactions, poison control information, provides drug monographs, provides dosages, drug identification, drug interactions, adverse events, product stability, etc.
What are the steps taken while answering drug information questions?
- 1) Identify the requestor
- 2) Obtain background information
- 3) Categorize the question [academic or case?]
- 4) Literature search
- 5) Evaluate the information [random, double-sided]
- 6) Synthesize response
- 7) Follow-up
Define a tertiary source.
Provides information about a topic which has been complied from primary literature (and other) sources.
Give examples of a tertiary source.
- 1) Textbooks
- 2) Compendia
- 3) Review articles
- 4) Online/website/database sources
- 5) Product package inserts
The product package inserts include:
Description, clinical pharmacology, clinical studies, indications and usage, contraindications, warnings, precautions, adverse reactions, overdosage, dosage and administration, how supplied, and references.
The physicians desk reference include:
Drug inserts, manufacturer's index, brand/generic name index, product category, product identificaton guide, and product information.
The Drug Facts and Comparisons include:
Orphan drugs, investigational drugs, drug monographs for both prescription and OTC, identification, indications, administration, dosage, actions, contraindications, adverse effects, overdosage, and patient information.
What does AHFS-DI stand for?
American Hospital Formulary Service-Drug Information
The AHFS-DI includes:
Single-agent monographs [arranged by Pharmacologic/Therapeutic class], FDA approved uses, non-labeled uses, drug interactions, cautions, toxicity, dosage, administration, pharmacology*, pharmacokinetics*, prescription, OTC, ophthalmic drugs, dermatologic drugs, vitamins, and parenteral products.
absorbtion and secretion, the half-life of absorption
Who uses the USP-DI?
The Health-Care Professional.
Who uses the AHFS-DI?
The hospital pharmacist.
Who uses the Drug Facts and Comparisons?
Who uses the PDR?
Who uses the Product Package Insert?
Which of the three volumes of USP is for the health care professional?
Which of the three volumes of USP is for the patient?
Which of the three volumes of USP is for finding manufactury practices/therapeutic equivalents?
The USP-DI Volume I includes:
On-label information, off-label information, prescriptions, OTCs, nutritional supplements, indications index, monographs, MED Watch form, and identification.
What is the Redbook mainly used for?
The Redbook is mainly used for the cost of drugs. Wholesale and manufacturer prices are found, along with emergency information, clinical reference guide, practice management, organizations, drug reimbursement, product identification, strengths, national drug code, oragne book code, OTCs, and herbal/complementary products. This book is all about the economics.
What is the Orange Book used for?
The Orange Book is mostly used for searching for therapeutic equivalents. This book only include FDA approved drugs. It also include drugs who have been approved, but not manufactured, drugs that have been discontinued, and drugs that have had their approval withdrawn.
Define Pharmaceutical Equivalent.
This term describes drugs with the same active ingredient(s), same dosage form, same route of administration, and same strength/concentration. The two drugs must be classified as this prior to being classed a therapeutic equivalent.
Define Therapeutic Equivalents.
In order for two drugs to be classified under this term, they must first be pharmaceutical equivalents. After being classified as such, they must then have the same clinical effect and the same safety profile.
“A” codes describe drugs that are ________________ to the reference product.
“B” codes describe drugs in which its __________________ to the reference drug is ______________________.
- 1) bioequivalence
- 2) not confirmed
What are the uses for the Martindale?
The Martindales is mostly used for European drugs. This also provides therapeutic equivalents, so that if a foreigner asks for a refill on a foreign drug, the pharmacist may provide a therapeutic equivalent.
Describe MicroMedex and its uses.
MicroMedex is a database of tertiary* and secondary* sources. It can include drug information, toxicology, acute care, patient education, dosing, pharmacokinetics, interactions, adverse effects, product information, and herbal and dietary supplements.
points to the primary reference, gives an overview of the primary reference
The Clinical Pharmacology includes:
peer reviewed, clinically-relevant information on drugs, on-label uses, off-label uses, dosages [prescription and OTC], drug interactions, adverse effects, herbal supplements, nutritional products, investigational drugs, IV compatibilities, and product identifications.
Give some examples of tertiary resources.
Review articles [due to being biased], treatment guideline, and textbooks.
What is expected to be found with secondary resources?
Bibliographic information and abstracts.
What are some examples of secondary sources?
- 1) MEDLINE
- 2) PubMed
- 3) Gateway
- 4) OVID
- 5) IDIS (Iowa Drug Information Services)
- 6) IPA (International Pharmaceutical Abstracts)
Medical Subject Headings are controlled vocabulary and are used for indexing articles in MEDLINE.
Define Boolean expressions.
Terms used for searching through articles in MEDLINE. This terms may be conjugated by the terms AND/OR/NOT.
Describe primary resources.
Primary resources describe the results of clinical research studies.
State the peer review process.
- 1) Article submitted to journal
- 2) Editorial staff evaluates article
- 3) Staff then sends article to multiple reviewers
- 4) Reviewers critically evaluate article
- 5) Reviewers send evaluation back to editor
- 6) Editor suggest changes to author
- 7) Author makes changes
- 8) Article is published
What is the Applied Therapeutics used for?
Clinical use of drugs.
What is the Basic and Clinical Pharmacology?
A concise medical library for practitioner and student.
What is the Drug Information Handbook used for?
What is the Goodman and Gilman's The Pharmacological Basis of Therapeutics used for?
The objectives of this improtant reference book are to correlate pharmacology information with other related medical sciences, reinterpret the actions and uses of drugs from the viewpoint of important advances in medicine, and place emphasis on the applications of pharmacodynamics to therapeutics.
What is the Handbook of Nonsprecription Drugs used for?
Information on over-the-counter products for pharmacists and consumer arranged under broad chapter headings suc as Antacid Products, Diabetes Care Products, etc.
What is the Physician's Desk Reference (PDR) used for?
The PDR presents essential information on major pharmaceutical and diagnostic products including composition, action, use, dosage, side effects, etc. Data are presented for over 4,000 drugs by product and generic name, manufacturer, and category.
What is the Physician's Des Reference for Herbal Medicines used for?
A pharmacological reference resource covering herbal rememdies.
What is the Remington, The Science and Practice of Pharmacy used for?
A classic reference work for pharmacists. The format consists of eight parts covering orientation, pharmaceutics, pharmaceutical chemistry, testing/analysis/control, pharmacokinetics and pharmacodynamics, pharmaceutical and medicinal agents, pharmaceutical manufacturing, and pharmacy practice.
What three things you should know before you conduct a research?
- 1) The topic
- 2) Current information or historical?
- 3) What would be the best sources?
What are the steps of the research process?
- 1) Define the topic
- 2) Review secondary sources
- 3) Select the most appropriate primary source
- 4) Translate the problem statement into key words
- 5) Search the primary sources
- 6) Locate and read primary sources
- 7) Write notes
- 8) Organize notes
- 9) Write report
You are only considered an intern when you are ___________.
What, other than actual presence of drug, implies a positive drug test?
- 1) A missed drug test
- 2) A late drug test
- 3) A diluted, altered, or substituted drug test
Drugs that are under the schedule C-I are considered ________________________.
dangerous and prohibited
Drugs under the schedule C-II are considered ____________________________________________.
high potential for abuse, limited medical use
Drugs under the schedule C-III are considered ______________________________________.
Less potential abuse, limited medical use
Drugs under the schedule C-IV are considered ______________________________________.
less potential abuse, fewer limits on use
Drugs under the schedule C-V are considered _________________________________________.
limited abuse potential, little limit on use
What does FDCA stand for?
Food Drug & Cosmetic Act
Which two things do the FDCA monitor?
- 1) Adulteration
- 2) Misbranding
What does PPA stand for?
Poison-prevention Packaging Act
What does HIPAA stand for?
Health Insurance Portability & Accountability Act