Clinical Pharmacy Overview Quiz

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Questions and Answers

What is the primary goal of pharmaceutical care?

  • To maximize the cost of medication therapy
  • To create new medications
  • To eliminate the need for healthcare providers
  • To enhance or preserve a patient’s quality of life (correct)

Clinical pharmacy exclusively focuses on medication therapy optimization.

False (B)

What philosophy does clinical pharmacy embrace?

Pharmaceutical care

Match the following elements of clinical pharmacy with their corresponding descriptions:

<p>Optimizes medication therapy = Improves the effectiveness of drug treatments Promotes health = Encourages healthy lifestyle choices Disease prevention = Reduces the risk of developing health issues Patient-related outcomes = Improvements in the patient's health status</p> Signup and view all the answers

Clinical pharmacists work in a variety of ______ settings.

<p>healthcare</p> Signup and view all the answers

Which of the following is NOT a target for clinical pharmacy?

<p>Pharmaceutical companies (A)</p> Signup and view all the answers

Clinical pharmacists are only found in hospital settings.

<p>False (B)</p> Signup and view all the answers

List one of the core frameworks used in clinical pharmacy.

<p>CORE, PRIME, or SOAP/FARM</p> Signup and view all the answers

What is a key indicator of therapeutic drug monitoring (TDM)?

<p>Performing a quantitative procedure for drugs with a narrow therapeutic index (B)</p> Signup and view all the answers

The trough concentration reflects the highest level of drug in the blood.

<p>False (B)</p> Signup and view all the answers

What is the first step in the medication reconciliation process?

<p>Develop a list of current medications</p> Signup and view all the answers

Therapeutic drug monitoring is performed for drugs with a ________ therapeutic index.

<p>narrow</p> Signup and view all the answers

Match the following concentrations with their definitions:

<p>Trough Concentration = Lowest level of drug in the blood Peak Concentration = Highest level of drug in the blood after administration</p> Signup and view all the answers

What happens to the trough level if the clearance rate of a drug increases?

<p>The trough level decreases (D)</p> Signup and view all the answers

All medications require therapeutic drug monitoring.

<p>False (B)</p> Signup and view all the answers

What is the consequence of overdosing and underdosing for certain medications?

<p>Serious consequences</p> Signup and view all the answers

What is the primary goal of medication reconciliation?

<p>To avoid medication errors (C)</p> Signup and view all the answers

Medication reconciliation should only be done when a patient is admitted to the hospital.

<p>False (B)</p> Signup and view all the answers

List two types of errors that medication reconciliation aims to prevent.

<p>Omissions and drug interactions</p> Signup and view all the answers

The process of comparing a patient’s medication orders to all medications they have been taking is known as __________.

<p>medication reconciliation</p> Signup and view all the answers

Match the types of medication errors with their definitions:

<p>Omissions = Failure to include a medication Duplications = Taking the same medication twice Dosing errors = Incorrect dose administered Drug interactions = When two or more drugs negatively affect each other</p> Signup and view all the answers

Which drug class requires therapeutic drug monitoring (TDM) to assess cardiac contractility?

<p>Cardioactive Drugs (D)</p> Signup and view all the answers

Drug interactions can affect therapeutic drug monitoring.

<p>True (A)</p> Signup and view all the answers

What is the recommended therapeutic range for digoxin levels?

<p>0.8-2 ng/mL</p> Signup and view all the answers

_______ patients are known to be resistant to digoxin.

<p>Hyperthyroid</p> Signup and view all the answers

Which factor critically affects the interpretation of drug levels for bronchodilators?

<p>Time of blood collection (D)</p> Signup and view all the answers

Match the following drug classes with their characteristics:

<p>Antibiotics = Serum electrolytes affect therapeutic action Anti-epileptic Drugs = Large dose inhibits Na-K-ATPase Immunosuppressive Drugs = Variable absorption in the GIT Anti-Inflammatory/Analgesics = Free drug sequestered into muscle cells</p> Signup and view all the answers

Renal filtration only affects the elimination of the free form of drugs.

<p>True (A)</p> Signup and view all the answers

What is a common physiological change that can unpredictably affect drug concentrations?

<p>Change in the patient's physiologic state</p> Signup and view all the answers

What is the bioavailability fraction (BA) of IV route administration?

<p>1 (B)</p> Signup and view all the answers

PO-administered drugs should achieve a bioavailability fraction of 0.5.

<p>False (B)</p> Signup and view all the answers

What is the therapeutic level of a drug in ng/mL?

<p>0.5-2 ng/mL</p> Signup and view all the answers

The elimination of Digoxin primarily occurs through __________.

<p>Hepatic Metabolism</p> Signup and view all the answers

Match the following cardioactive drugs with their primary classifications:

<p>Lidocaine = Class I - Rapid sodium channel blockers Propanolol = Class II - Beta receptor blockers Amiodarone = Class III - Potassium channel blockers Verapamil = Class IV - Calcium channel blockers</p> Signup and view all the answers

Which of the following is a symptom of drug toxicity?

<p>Nausea/Vomiting (N/V) (D)</p> Signup and view all the answers

What concentration of free drug is considered toxic?

<blockquote> <p>2 ng/mL</p> </blockquote> Signup and view all the answers

Lidocaine can be administered orally without any concerns about hepatic metabolism.

<p>False (B)</p> Signup and view all the answers

What is the therapeutic level range for Monoethylglycinexylidide (MEGX)?

<p>1.5-4.0 ug/mL (A)</p> Signup and view all the answers

Quinidine is primarily eliminated through renal filtration.

<p>False (B)</p> Signup and view all the answers

What is the peak serum level time for Quinidine sulfate after oral administration?

<p>2 hours</p> Signup and view all the answers

Propranolol is used to treat __________, hypertension, and coronary artery disease.

<p>angina</p> Signup and view all the answers

Match the following medications with their primary toxicity effects:

<p>Propranolol = Bradycardia Quinidine = Cinchonism Procainamide = CHF and Heart Block Amiodarone = Seizure</p> Signup and view all the answers

What is the toxic level for Procainamide?

<blockquote> <p>8.0 ug/mL (D)</p> </blockquote> Signup and view all the answers

Disopyramide has an anticholinergic effect when its level exceeds 4.5 ug/mL.

<p>True (A)</p> Signup and view all the answers

What percentage of Quinidine is protein bound?

<p>85%</p> Signup and view all the answers

The therapeutic level for Amiodarone is __________.

<p>50-100 ng/mL</p> Signup and view all the answers

Which medication is NOT used to treat cardiac arrhythmias?

<p>Verapamil (B)</p> Signup and view all the answers

Flashcards

Pharmaceutical Care

The responsible administration of medication therapy to achieve specific goals that improve or maintain a patient's quality of life.

Clinical Pharmacy

The area of pharmacy that focuses on the science and practice of medication use in a way that is safe, effective, and efficient.

Clinical Pharmacy (Unabridged)

A health science discipline where pharmacists provide patient-centered care to optimize medication therapy, promote health, wellness, and disease prevention.

Pharmaceutical Care Philosophy

It is the philosophy that guides clinical pharmacy practice, aiming to provide patient-centered medication therapy management.

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Clinical Pharmacists' Practice Setting

Clinical pharmacists can work in various healthcare settings, such as hospitals, clinics, and community pharmacies.

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Medication Therapy Management

A systematic process used to manage and monitor a patient's medication therapy.

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SOAP/FARM

A method of recording patient medication information and observations, often used in clinical pharmacy practice.

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Patient Outcomes in Clinical Pharmacy

Clinical pharmacy aims to achieve positive outcomes for patients, such as improved health, reduced hospitalizations, and improved quality of life.

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What is Medication Reconciliation?

Comparing a patient's current medications to those they've been taking, ensuring accuracy and preventing errors like omissions, duplications, dosing mistakes, and drug interactions.

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What's a Trough Concentration?

The process of measuring the lowest concentration of a drug in the bloodstream, usually taken right before the next dose.

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What is a Peak Concentration?

The highest concentration of a drug in the bloodstream, typically measured after administration.

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Why Is Reviewing Drug Use Important?

A crucial step in preventing medication errors, this process analyzes a patient's medication orders to identify potential issues like omissions, duplications, or wrong dosages.

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Why Is Communication Key in Medication Management?

A critical component of medication reconciliation, ensuring accurate and clear communication about a patient's medications between healthcare providers.

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Transition in Care

Changes in the setting, service, practitioner, or level of care provided to a patient.

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Medication Reconciliation

The process of identifying and resolving potential discrepancies in medication orders during transitions in care.

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Therapeutic Drug Monitoring (TDM)

A quantitative procedure used to measure drug levels in the blood to ensure safe and effective medication use.

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Trough Concentration

The lowest concentration of a drug in the blood, measured just before the next dose is given.

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Peak Concentration

The highest concentration of a drug in the blood, measured after a dose is given.

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Mixed Function Oxidase (MFO) System

The biochemical pathway responsible for the majority of drug metabolism in the body.

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Drug Clearance

The process of eliminating a drug from the body.

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Therapeutic Range

The range of drug concentrations that are safe and effective for treatment.

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Bioavailability

The amount of a drug that reaches the bloodstream after administration.

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Half-life (t½)

The time it takes for the concentration of a drug in the bloodstream to decrease by half.

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Drug Toxicity

A state where the concentration of a drug in the body is too high, potentially causing harmful effects.

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Cardioactive Drug

A type of drug that affects the heart's rhythm and function.

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Class I - Rapid Sodium Channel Blockers

A class of drugs that block the rapid flow of sodium ions through the heart's channels, used for arrhythmias and heart failure.

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Class II - Beta Receptor Blockers

A drug that blocks the beta receptors in the heart, used for treating arrhythmias and heart failure.

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Class III - Potassium Channel Blockers

A drug that blocks the flow of potassium ions through the heart's channels, used for treating arrhythmias.

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Class IV - Calcium Channel Blockers

A drug that blocks the flow of calcium ions through the heart's channels, used for treating arrhythmias and heart failure.

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Drug Concentration and Therapeutic Effect

A situation where the amount of drug in the body (dose) doesn't directly match the drug levels in the blood, but there's a clear link between blood levels and how effective or toxic the drug is.

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Physiological State Affecting Drug Levels

Changes in a patient's body that can unexpectedly alter the amount of drug in their blood.

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Drug Interaction

When one drug affects how another drug works in the body, potentially causing a different effect than expected.

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Patient Compliance Monitoring

Tracking how well a patient is taking their medication as prescribed.

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Common Drug Classes for TDM

A group of medications that are often monitored using therapeutic drug monitoring (TDM).

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Digoxin

Cardiac glycoside used to treat irregular heart rhythms and heart failure. Serum electrolytes (like potassium) can impact its effects and potential toxicity.

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Anti-Epileptic Drugs

Drugs used to prevent seizures.

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Psychoactive Drugs

Drugs that affect mood and behavior.

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Disopyramide

A drug used to treat cardiac arrhythmias, it's rapidly and completely absorbed through the gastrointestinal tract (GIT), and is largely eliminated through renal filtration.

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Quinidine

A naturally occurring drug used to treat arrhythmias, it's highly protein bound and almost entirely eliminated via hepatic metabolism.

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Propranolol

A non-selective beta receptor antagonist used to treat angina, hypertension, coronary artery disease, and thyrotoxicosis. It also suppresses the conversion of T4 to T3.

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Procainamide

A drug used to treat ventricular arrhythmias, it's rapidly and completely absorbed through the GIT, and is eliminated by both the kidneys and liver.

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Amiodarone

A drug used to treat cardiac arrhythmias, it has a wide spectrum of actions and is effective for various types of arrhythmias.

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Therapeutic Level

The level of a drug in the blood that is considered safe and effective for treating a condition.

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Toxic Level

The level of a drug in the blood that can lead to adverse effects or toxicity.

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Cinchonism

A side effect of quinidine that can include tinnitus, blurred vision, headache, and gastrointestinal disturbances.

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Anticholinergic Effect

A group of side effects that include symptoms like dry mouth, constipation, and urinary retention due to anticholinergic effects.

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Cardiac Arrhythmia

An irregular heartbeat, often caused by a disturbance in the electrical activity of the heart.

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Study Notes

Clinical Pharmacy and Pharmacotherapeutics

  • Clinical pharmacy is the science and practice of rational medication use
  • Clinical pharmacy optimizes medication therapy, promotes health and wellness, and prevents disease
  • Clinical pharmacists provide care in all healthcare settings
  • Pharmaceutical care is the responsible provision of medication therapy to enhance a patient's quality of life
  • CORE, PRIME, and SOAP/FARM are documentation methods for pharmaceutical care
  • CORE documents patient condition, medication therapy evaluation, and outcomes
  • PRIME documents pharmacotherapy needs and issues
  • FARM/SOAP documents findings, assessment, resolution, and monitoring
  • Medication reconciliation is the process of comparing a patient's current medications with prescribed medications
  • Therapeutic Drug Monitoring (TDM) is a quantitative procedure for drugs with a narrow therapeutic index
  • It allows for safe medication use when dealing with drugs that have toxic effects at small differences between therapeutic and toxic doses
  • TDM involves measuring drug concentrations in the blood
  • Trough concentrations are measured immediately before the next dose
  • Peak concentrations are measured one hour after an oral dose, or after the infusion for IV drugs
  • Drugs like Digoxin, Lidocaine, Quinidine, Procainamide, Disopyramide, Propranolol, Amiodarone, and Verapamil are common drugs that require TDM
  • Some common drug classes that require TDM include cardioactive drugs, antibiotics, anti-epileptic drugs, psychoactive drugs, bronchodilators, immunosuppressants, antineoplastic drugs, anti-inflammatory/analgesics, and neuroleptics
  • Routes of administration include intravenous (IV), intramuscular (IM), and oral (PO)
  • Causes of drug toxicity include elevated free drug concentration, abnormal response, and presence of active drug metabolites

Medication Reconciliation

  • Medication reconciliation compares a patient's current medications to prescribed medications
  • Its goal is to prevent medication errors by identifying omissions, duplications, and dosage errors
  • It is performed at every transition of care

Therapeutic Drug Monitoring (TDM)

  • TDM measures drug concentrations in the blood to optimize therapy
  • It is used for drugs with narrow therapeutic indexes
  • Trough concentrations are measured before the next dose to ensure adequate drug levels
  • Peak concentrations are measured after drug administration to evaluate drug absorption
  • Indications for TDM include serious consequences of overdosing or underdosing the drug, small differences between therapeutic and toxic doses, poor correlation between the circulating dose and the therapeutic/toxic effects, and change in the patient's physiological state that might unpredictably affect the circulating drug concentrations

Common Drug Classes Requiring TDM

  • Cardioactive drugs
  • Antibiotics
  • Anti-epileptic drugs
  • Psychoactive drugs
  • Bronchodilators
  • Immunosuppressants
  • Antineoplastic drugs
  • Anti-inflammatory/Analgesics
  • Neuroleptics

Anti-Inflammatory/Analgesics

  • Salicylates (aspirin), Acetaminophen, and Ibuprofen are commonly used analgesic/anti-inflammatory drugs
  • Salicylates, like aspirin, can cause chronic toxicity with side effects such as anemia, renal damage, and GI disturbance if abused
  • Acetaminophen, when taken in high doses, can cause hepatotoxicity
  • Ibuprofen, compared to the other two, carries minimal risks for toxicity.

Carbohydrates

  • Carbohydrates are hydrates of aldehyde or ketone (e.g., glucose)
  • Sugars are classified as reducing or non-reducing based on their chemical structure
  • The brain depends on blood glucose for energy

Pancreas

  • The pancreas has both exocrine and endocrine functions
  • Islets of Langerhans are clusters of cells within the pancreas
  • Beta cells secrete insulin
  • Alpha cells secrete glucagon
  • Delta cells secrete somatostatin
  • F cells secrete pancreatic polypeptide

Diabetes Mellitus (DM)

  • DM is characterized by hyperglycemia due to defects in insulin secretion or insulin receptors
  • Types include Type 1 (insulin-dependent), Type 2 (non-insulin-dependent), Gestational, and other types
  • Classification is based on the underlying cause of hyperglycemia
  • Symptoms include polyuria, polydipsia, polyphagia, weight loss, and possible loss of consciousness.
  • DM is often screened by fasting blood sugar (FBS), oral glucose tolerance test (OGTT), glycosylated hemoglobin (HbA1c), and other biomarkers.

Atypical Antipsychotics

  • Atypical antipsychotics commonly include Risperdal, Olanzapine, Quetiapine, and Aripiprazole

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