Escolar Documentos
Profissional Documentos
Cultura Documentos
licensed intern)
DONT ASSUME
Once a week
SC
prn
ut dict
atc
As needed
As directed
Around the clock
ID
IA
IT
qh
Every hour
With
IC
SL
Def.
By mouth
Right eye
Left eye
Both eyes
Right ear
Left ear
Both ears
Intramuscularly
Intravenously
(Bolus/Drip)
Subcutaneous
(Under skin)
Intradermal
Intra Arterial
Intrathecal (mostly
spinal)
Intracardiac
Sublingual
Without
rect
IN or NAS
TD
Drug Form
tab
Rectally
Intranasal
Transdermal
Def.
Tablet
cap
pul
Capsule
Pulvule
w or c
wo or s
How Much
cc
fl
g or gm
Def.
Cubic centimeter
(ml)
Fluid
Gram
etc)
Allergies to one drug could mean the same for similar drugs
Concurrent Medications
Co-pay or self-pay
Coverage of prescribed drugs
Coverage of certain drugs under certain circumstances
Diference between generic and proprietary distribution
sometimes.
Current prescription and refill information
Shows the status of the patients various prescriptions.
Amount dispensed and amount remaining on prescription must
match.
NEEDS TO BE UPDATED REGULARLY AFTER EVERY REFILL
Address
Age/DOB
Adverse Reactions
Medical History
Special considerations (Physical, Mental,
Cultural)
Current prescription and Refill
information*
Height
Weight
Diagnosis
Treatment
Therapy
Diet plans
Blood tests
Lab Results
Statement of
goals
Billing
Information
Patients Billing
#
Measuring
of Liquid Medications
IN A SANITARY
Solutions
and suspensions must be measured at room
SETTING
temperature using accurate devices
MARKINGS ON
If concentration is not listed on bottle then. (total mg of
DISPENSING
drug)/(total ml) to acquire strength (concentration)
BOTTLES OR
needed to fill order.
DOSAGE CUPS ARE
An order of almost any amount can be filled as long as
NOT ACCURATE.
the amount dispensed is appropriate. (I.E. 10ml is too
much for a IM injection)
Choosing the Proper Container for Dispensing
Compounding of Prescriptions
Preparing a solution, ointment, or powder from a WRITTEN PROCEDURE
is often performed by the technician.
Legally, these dosage forms must be prepared by the technician
according to a standardized, written procedure written out by the
pharmacist.
EXTEMPORANEO Extemporaneous Compounding preparation of a dosage form for
US
drug delivery that is customized for a particular patient.
COMPOUNDING
This requires a degree of judgment therefore is performed by the
ALL IS PERFORMED
pharmacist.
IN A SANITARY
If the pharmacist generates a written protocol for the
SETTING
preparation of the dosage form, it may be prepared by the
technician.
Precautions:
Sepsis Blood Poisioning
Aseptic technique Technique of preparing a drug without
contaminating it with bacteria or other organisms.
Perform all procedures inside a sterile laminar flow hood with
clean, disinfected hand, hair tied back and covered.
Laminar Flow Hood Creates a barrier between the workspace
and the environment.
Avoid talking, sneezing, and coughing in the hood.
Disinfect withdrawal site on the drug vial (Septum) with alcohol
before withdrawal of the drug.
Both syringe and needle must be kept sterile.
Open syringe packing from end that will attach to the needle.
DO NOT TOUCH SYRINGE OR NEEDLE
Protective cap should be left on needle unless its withdrawing or
injecting drug.
Laminar flow hood and gloves are not guaranteed sanitary.
Withdrawing the Drug:
Needle should be placed on septum beveled side up
Needle should pierce the septum at a 45 angle
Prevents rubber fragments from entering the needle
Coring when rubber fragments from septum enter
needle
When medication is being withdrawn the needle should be at a
90
Avoid touching the plunger and depositing organisms on the
plunger as it leaves the barrel of the syringe
After withdrawal of medication:
1. Place Protective cap on needle
2. Open hood.
Label should go on the plunger end of the barrel.
Re-sanitize septum with alcohol.
Drug Withdrawal Process Recap:
1. Place needle on septum
*Bevel side up
2. Pierce Septum at 45
angle
*Tilt everything up to 90. Draw
3. Draw out Medication
slowly.
*Tap on barrel
4.Remove air bubbles
*Push air bubbles out of syringe
into vial
5.Withdraw needle from vial *Do not touch the plunger
6. Place Protective cap on
*Immediately
Needle
7. Open Hood
8. Label syringe
9. Re-sanitize septum w/
Alcohol
Protective clothing
Completely covers body
Lab coat (protect clothing and skin)
Safety glasses/goggles
Safety glasses must have splash guard
Additional Safeguards (Disposable body coverings)
Prevent contamination of technician and pharmacy
Coverings can be removed and discarded at the door of
the IV room
Accidental Drug Exposure
Dont touch yourself while preparing drugs
hazardous/non-hazardous.
When working with a sterile drug, particularly one that is
hazardous, keep hands at least six inches inside the hood
away from other parts of the body
Location
(Usually Too Cold)
Refrigerator
Pharmacy Shelf
(Drugs May lose
Potency)
(Too Hot for Drugs)
received.
Look up specific coverage information in the Pharmacys database.
After establishment of coverage or method of payment:
Forms that need to be filled out must be identified and
completed
Price of medication must be calculated
Institutional pharmacy billing Role of MAR
Medication Administration Record (MAR):
Charges are billed to patients account as soon medication is
dispensed
Unused medication is returned to the pharmacy and the MAR
account is credited. *insurance verification is done at a separate
accounting department
ASA
325mg =
ASA 5
1
1
1
1
1
tsp
tbsp
pt
qt
gal
Conversion
60 mg 65 mg
gr xx
454 g
30 ml
4 ml
approximately 1
gtt
5 ml
15 ml
16 fl. oz.
2 pints
4 quarts
1,200 mg
16 oz
8 drams
3 scruples
1 L
Dosage Conversion
Conversion can only happen if the dosage form is correct
Tablets must be scored in order to be split.
Steps:
1. Make sure the units match. If not convert the order to match the stock.
2. Divide the order by the available stock to obtain amount dispensed
3. Make sure answer is appropriate.
Clarks Rule:
Weight of Child
( Adult Dose )=Chil d ' s Dose
150
Volume of fluid
Time of infusion
Volume of Fluid
of Drops
x Drop Factor=
( Time
)
of I nfusion
Time
Drops per time
ml
=(
Drop Factor
time )
Drops per time:
Drop factor:
gtt
time
gtt
ml
Concentration
Flow Rate
Dispensing fee:
Added to Price
May be a flat fee or percentage of selling price
ONLY added to drugs dispensed at the pharmacy
NOT added to medication sold over the counter.
Pharmacology section
Chapter 21 Introduction to Pharmacology
Introduction/Objectives
Drug information
Proprietary and Generic names
Classification
Mechanism of Action
General Uses
Side Efects
Interactions
Physiological actions of the drug
Possible Adverse efects
Possible Drug Interactions
Food and Lifestyle Contradictions
Form and Common Dosage amount
Proprietary Drug Nomenclature
Drugs may be named according to a particular quality or property of the drug
(i.e. function, classification, etc.)
Less frequently names may reflect some other property.
Fast onset, long duration, dosing interval, dosage form, etc.
Many drugs simply take part of the generic name as the trade name.
These concepts help establish patterns among drugs and associate drugs.
Allow for educated guesses.
Form vs. Use Recognizing Various Forms of a Generic Drug
Many drugs are treated with an acid or base and thus salts of the original
drug.
A salt allows the drug to be more easily utilized by the body.
Various chemical forms of a particular drug have diferent clinical uses.
Specification of the type of salt does not always exist. (Drugs are usually
referred to simply by name)
Drug salts are specified on a medication order if it is needed for efective
administration by a certain route or the patient has a particular condition.
Addition of letters to a drug name may denote a certain type of formulation.
Understanding the Pharmacology of Chemotherapeutic Agents
Drugs are presented in classes and in the order in which they would be
chosen for therapy.
Mechanism of action Various biological and biochemical changes within the
body.
Drugs within the same class usually have similar mechanisms of action,
adverse efects and contraindications. (only diferences in lipid solubility,
duration, etc. may be seen)
Choice of Drug Therapy:
First line drugs [Drug of Choice (DOC)] Very efective; acceptable
adverse efect profile
Second line drugs
These drugs are
either not as efective
or have a lot of
undesirable efects.
The therapeutic efects are often nothing more than the physiological efects
of the drugs and what the drug does in the body
Pharmacokinetics and Pharmacodynamics What Happens to the Drug
after it is Administered
Pharmacokinetics a study of the movement of and changes in the drug
within the body.
Absorption: How the drug gets into the plasma
Usually refers to how the drug gets into the bloodstream from
outside of the body.
By definition drugs administered through intravenous injection
are not absorbed, as they are injected directly into the
bloodstream.
Absorption:
pH of compartment:
Likes does not dissolve likes.
Acidic drugs will be dissolved in a basic setting
(Duodenum)
Basic drugs will be dissolved in an acidic setting
(Stomach)
Lipid soluble drugs will be absorbed by fat and tend
to not remain in the plasma (composed of water).
The more vessels in a region the quicker the
absorption.
Distribution: Where the drug goes in the body
Where the drug goes and where the drug is stored in the body.
Storage:
Sites: Fat, Tissue Protein, Plasma Protein
Binding of drugs to protein stabilizes the drug
Binding of drugs to protein prevents the breakdown of the
drug by the liver or kidneys.
Drug Equilibrium:
Protein-Bound drugs and drugs existing in plasma exist in
equilibrium.
Drugs in the plasma (Free Drug) contribute to the
therapeutic efect and are free to be cleared by the kidney
or liver.
As free drugs are being cleared they are constantly being
replaced by bound drugs.
The equilibrium between Bound:Free Drugs are not
necessarily a 1:1 ratio.
Volume of distribution (Vd) The volume o space that the drug
occupies in the body.
It gives an idea of how much drug must be taken before a
state of equilibrium is reached.
urine.
Some drugs are not metabolized and go out with the urine.
Lipid soluble drugs and not metabolized go out with the bile.
Drug-Drug Interactions Competition for Drug Clearance
Efects of Age, Organ Damage, and Drug Use
Age: as a person gets older the functions of the clearance organs
(kidney and liver) decrease and the dosage of the drug must be altered
to compensate.
Organ Damage: If the patient has a damaged organ (I.E. Liver) due to
disease or drug use this could potentially decrease the rate of
clearance.
The decreasing of the rate of clearance could potentially cause the
buildup of that drug in the blood system to toxic levels.
Drug Toxicity and Interactions
All drugs are, to some extent, poisons.
Dosages are established to minimize harmful efects and maximize
beneficial efects.
Sometimes by taking two drugs concurrently one drug may set up
another to produce toxic efects.
Drug Agonism and Antagonism
Agonist A drug that mimics the actions of an endogenous substance.
Stimulates a cellular or biochemical pathway
Indirect Agonism - Inhibits the breakdown of the endogenous
substance
Endogenous substance Substances that originate within the human
body.
Antagonist A drug that attaches to a receptor and stimulates it once
(or not at all) and then stays attached to the receptor, blocking any
other transmitters.
Partial Agonist Normalizes activity. They are used when there are
erratic levels of strong agonist.
When there is not enough of the agonist when its needed then
the partial agonist will act as an agonist
When there is too much of the strong agonist when its not
needed then it acts as a antagonist, blocking the receptor.
Additive, Synergistic, and Antagonistic Efects
Therapeutic Efects Physiological efects of medicine
Additive and Synergistic Drug Toxicity Additive efects may produce
drug toxicity
Efects of Alcohol with CNS Depressants
Alcohol taken with sedating drugs, antiseizure medications,
antipsychotics, and antidepressants, or barbiturates may
depress the central and autonomic nervous system to the extent
that they arent able to function.
Synergistic Therapeutic Efects Too Much of a Good Thing
Some drugs may synergize and produce too much of a beneficial
efect.
Enzyme
SGOT
AST
SGPT
ALT
GGT