2024 Pharmacy Resources Lecture Notes PDF

Pharmacy Resources and Selected Medical Terminology Dr. Lee PHAR 672 Fall 2024 1 Lecture Objectives 1. State the important features of a reliable source of medical or drug information; 2. Give examples of reliable...

Pharmacy Resources and Selected Medical Terminology Dr. Lee PHAR 672 Fall 2024 1 Lecture Objectives 1. State the important features of a reliable source of medical or drug information; 2. Give examples of reliable source of medical or drug information. 3. Given a drug information question, determine what selected source of drug information should be selected. 2 Where do PHARMACISTS go to find information about drug? If someone asks a pharmacist a question related to drugs, where should the pharmacist go to look up information? 3 Drug Information Resources: NEED to be reliable, reproducible, and transparent 4  Package Insert (Prescribing Information) https://dailymed.nlm.nih.gov/dailymed/ DailyMed (from the NIH) gives us a chance to find the prescribing information (“package insert’) The package insert (prescribing information) and the medication guide (for patients) come with the medications to the pharmacy. Some are also available at the drug’s website (if a website is available). 5  Package Insert (Prescribing Information) https://dailymed.nlm.nih.gov/dailymed/ DailyMed (from the NIH) gives us a chance to find the prescribing information (“package insert’) The package insert (prescribing information) and the medication guide (for patients) come with the medications to the pharmacy. Some are also available at the drug’s website (if a website is available). 6  Package Insert (Prescribing Information) The package insert (prescribing information) and the medication guide (for patients) come with the medications to the pharmacy. They are also available at the drug’s website (if a website is available). 7  Package Insert (Prescribing Information) Blackbox Warning The highest form of warning Dangerous considerations More severe than “warnings and precautions” 8 Older Style of Package Insert 9  Drug Information Resources: NEED DrugtoInformation be reliable,Resources: reproducible, and transparent $$ NEED to be reliable, reproducible, and transparent 10 Drug Information Resources Primary literature – Original studies – Clinical trials Fast, but may not be an aggregate in data weight Secondary literature – Summarize, interpret, reorganize primary literature Books, review of primary literature Tertiary literature – Assimilated medical information; summary or condensed literature Treatment guidelines, textbooks More aggerate in data, but slow to develop 11 Medical Information is like MILK… Some expires QUICKLY (weeks/months) Some expires a while (years, decades) It is your job to keep track of which information expires quickly! 12  Answer: What is the question asking? DRUG PROPERTY QUESTION DRUG THERAPY QUESTION (“Therapeutics” QUESTION) 13  Answer: What is the question asking? Examples Package insert (Prescribing information) With information on SOME clinical trials DRUG PROPERTY QUESTION Facts and Comparison Dailymed (by the National Institute of Health) UptoDate LexiDrugs (formerly Lexicomp) Clinical Pharmacology (database) Micromedex (database) Original studies (searched by Pubmed) Others DRUG THERAPY QUESTION (“Therapeutics” QUESTION) 14  Answer: What is the question asking? DRUG PROPERTY QUESTION Examples: Treatment guidelines Current medical literature (searched by Pubmed or OVID) Clinical Pharmacology (database) DRUG THERAPY QUESTION Micromedex (database) (“Therapeutics” QUESTION) Textbooks (may be outdated) UptoDate (MEDICAL treatment) not UptoDate Lexidrugs Others 15  Wait……. Examples Clinical Pharmacology (database) Micromedex (database) DRUG PROPERTY QUESTION Original studies (searched by Pubmed) Others Examples: Clinical Pharmacology (database) DRUG THERAPY QUESTION Micromedex (database) (“Therapeutics” QUESTION) Others 16 Practice 1. The doctor asks you “what is the recommended therapy for general anxiety disorder.” Where should you go look? Select ALL that apply a) Lexidrug (Lexicomp) b) UptoDate Lexidrug c) The treatment guidelines for anxiety from a professional organization d) Package insert of lorazepam (Ativan) e) UptoDate f) Micromedex 17 Practice 2. A patient asks you “I took a medication this morning. What side effects can happen to me?” Where should you go look? Select ALL that apply a) Lexidrug (Lexicomp) b) UptoDate Lexidrug c) The treatment guidelines for anxiety from a professional organization d) Package insert of that medication e) UptoDate f) Micromedex 18 Selected Medical Abbreviations 19 Lecture Objectives Given a case scenario, interpret the based on the medical abbreviation and medical terminology Given a case scenario, identify common serum laboratory parameters that are outside of the reference range Given a case scenario, briefly interpret the serum laboratory parameters that are outside of the reference range 20 Medical Specialties Medicine Surgery 21  Medical Specializations (Incomplete List) Discipline Organs Discipline Organs/Patients Cardiology Heart and blood vessels Joints, muscles, connective tissues, Rheumatology Pulmonology Lungs, respiratory system and autoimmune conditions Nephrology/Renal Kidneys Bones, joints, ligaments, tendons, Orthopedics and muscles Urinary tract, male reproductive Urology Oncology Cancer/Neoplasm system Gastroenterology (GI) Digestive tract Obstetrics and Female reproductive system; Gynecology (OBGYN) pregnancy and childbirth Neurology Brain and nervous system Radiology Imaging for diagnosis/treatment Psychiatry Mental health/mental disorders Diagnosis by laboratory/tissue Ophthalmology Eyes and vision Pathology biopsy Ear, nose, throat (ENT), and Family Medicine Patients of ALL ages Otolaryngology (ENT) head, neck Internal Medicine Adult Care Hematology Blood Health of infants, children, and Dermatology Skin Pediatrics adolescents Endocrinology Hormones and hormone glands Pre-term or babies within 28 days Neonatology Anesthesiology Pain relief and anesthesia of birth Infectious Diseases Infections Geriatrics Elderly patients 22 A Typical Prescription (for RX drugs, NOT OTC drugs) 23  MUST KNOW Common Rx Abbreviations Route of Administration Time and Frequency PO: By Mouth (Orally) Qday/daily: Every Day IV: Intravenous BID: Twice a Day IM: Intramuscular TID: Three Times a Day SC: Subcutaneous QID: Four Times a Day SL: Sublingual (Under the Tongue) PRN: As Needed PR: Per Rectum HS: At Bedtime TOP: Topical (Applied to the Skin) AC: Before Meals INH: Inhalation PC: After Meals ID: Intradermal Q4H: Every 4 hours Q6H: Every 6 hours Q8H: Every 8 hours Q12H: Every 12 hours ALL “PRN” should have an indication (what it is for) 24  MUST KNOW Common Rx Abbreviations “Forbidden”/Dangerous Abbreviations Special locations U: Unit (write "unit" instead) AAA: Apply to affected area (usually skin) IU: International Unit (write "international unit" instead) QD: Every Day (write "daily" instead) O.U.: Oculus Uterque (BOTH eyes) QOD: Every Other Day (write "every other O.S.: Oculus Sinister (LEFT eye) day" instead) O.D.: Oculus dexter (RIGHT eye) MS, MSO4: Morphine Sulfate (write the full drug name instead) A.U.: Auris Uterque (BOTH ears) MgSO4: Magnesium Sulfate (write the full A.S.: Auris Sinister (LEFT ear) drug name instead) A.D.: Auris dexter (RIGHT ear) 25  MUST KNOW Typical Prescription Directions: Signa: [DRUG NAME] [Dose] [Route] [Frequency] [PRN indication] Examples: Sig: Amoxicillin 500 mg PO q 8 hours Sig: Adderall 20 mg PO at 8 am, 11 am and 2 pm daily during school days Sig: Ambien 5 mg PO qHS PRN insomnia (or sleep) Sig: Vancomycin 500 mg IV PRN hemodialysis, give during the last hour of hemodialysis 26  MUST KNOW Typical Prescription Directions: Translate the following sigs to language that the patients can understand: 1. Timolol 2 drops OD BID Timolol 2 eye drop to RIGHT eye twice daily 2. Cortisporin suspension 2 drops AS BID q 12h Cortisporin 2 drops to LEFT ear every 12 hours (don’t forget to tell patients to shake the suspension before using!) 3. Triamcinolone ointment AAA BID x 5 days Triamcinolone ointment apply to affected area twice daily for 5 days 27 Some Other Terminology When we study and manage diseases 28  A Model in the Disease Process Risk Factors Comorbidities (Other coexisting diseases) Disease Etiology Pathogenesis Pathophysiology Complications Infectious Iatrogenic Idiopathic Clinical Lifestyle Presentations Environmental Nosocomial e.g. Magnetic resonance imaging, Signs Symptoms Laboratory Imaging MRI; computed tomography, (CT); x-ray, etc 29  MUST KNOW Terminology in Disease Concepts Terminology Discussion Etiology The CAUSE of a disease (e.g. genetics, infections, lifestyle) Idiopathic A disease that is cause by UNKNOWN causes (i.e. no identifiable causes) Iatrogenic A disease that is caused by medical treatment or procedures Nosocomial A disease that is acquired in a hospital or healthcare facility (e.g. surgery room, clinic) Risk Factor Conditions or behaviors that increase the likelihood of developing a disease (BUT NOT CAUSE) Pathogenesis The biological MECHANSIMS/PROCESS on HOW the disease develops PATHOPHYSIOLOGY The changes in the body’s physiology during or after the disease has developed Signs Abnormal features that the patient and/or other people can notice (e.g. vomiting) Symptoms Abnormal features that commonly only the patient can notice (e.g. nausea, pain) Clinical Presentation Signs and Symptoms, laboratory, imaging, biopsy findings of a disease together Complications Other medical conditions that often (but not always) develop Comorbidities Other medical conditions that often co-exist with the first disease 30  Example: Diabetes Mellitus Type II (DM2) Age, weight, etc Risk Factors Comorbidities: Obesity, High blood pressure, High blood cholesterol Kidney disease Change of DM2 Body not Heart disease & stroke Etiology Infection (e.g. foot, bone) body insulin responding to response insulin Loss of vision Lifestyle Poor diet Insulin lowers blood sugar Insufficient exercise Clinical High blood sugar Genetic Presentations DAMAGES many tissues Signs Symptoms Laboratory Imaging 31 Nothing specific Blood sugar ↑ Nothing specific  Terminology in Disease Concepts 2 Terminology Discussion Diagnosis Identification of a disease based on clinical presentations and testing Disease Course The stages and profession of a disease Prognosis The likely course and outcome of a disease Epidemiology The study of how much and how often a disease is present in a population Incidence The number of new cases of a disease in a population Prevalence The total number of new AND existing cases of a disease in a population Mortality The death rate of a population caused by a disease Onset of a disease How quickly does a disease occur or be detected Duration of a disease How long does the disease process last (e.g. days, weeks, lifelong) Insidious onset Disease onset that is gradual, subtle and often unnoticed Acute disease Disease with short duration; often with quick onset Chronic disease Disease with LONG duration; often with slow onset 32 Other Common Terminology __-emia (example: leukemia, magnesemia) In BLOOD __-oma (example: lipoma, sacoma, myeloma) An abnormal mass, usually (but not always) cancer a-__ (example: arrhythmia; agranulocytosis) NOT; without Arrhythmia – Irregular heart beat (no regular rhythm) Agranulocytosis – Lack of granulocytes, a group of white blood cells __-itis – INFLAMMATION Inflammation is a tissue repair process; it signifies tissue injury/damage Example: Arthritis – Joint inflammation (i.e. joint injury) Example: Nephritis – Kidney inflammation (i.e. kidney injury) Example: Hepatitis – Liver inflammation (i.e. liver injury) Example: Pneumonitis – Lung inflammation (i.e. lung injury) 33  MUST KNOW Serum Laboratory Values 34 35  MUST KNOW Laboratory Values (Reference) Basic Metabolic Panel (Blood) Lab value Reference Interpretation Na (Sodium) 136-145 mEq/L K (Potassium) 3.5-5 mEq/L Next FEW slides Cl (Chloride) 96-106 mEq/L Bicarbonate (HCO3) 24-30 mEq/L LOW: ACIDOSIS; HIGH: ALKALOSIS (basic) Blood urea nitrogen (BUN) 8-20 mg/dL INCREASED: LIVER or KIDNEY DISEASE Serum creatinine (SCr) 0.5-1.2 mg/dL INCREASED: KIDNEY DISEASE Blood glucose (sugar) 70-99 mg/dL INCREASED: Diabetes? Other Blood Tests Lab value Reference Interpretation Aspartate transaminase (AST) 8-42 IU/L INCREASED: LIVER DISEASE (Hepatitis) Alanine aminotransferase (ALT) 3-30 IU/L Serum lipase 96-106 mEq/L INCREASED: PANCREAS disease (Pancreatitis) 36 Descriptions Low sodium (HYPOnatremia) Na (Sodium) 136-145 mEq/L High sodium (HYPERnatremia) Low potassium (HYPOkalemia) K (Potassium) 3.5-5 mEq/L High potassium (HYPERkalemia) Low chloride (HYPOchloremia) Cl (Chloride) 96-106 mEq/L HIGH chloride (HYPERchloremia) 37  MUST KNOW Laboratory Values (Reference) Complete Blood Count (Blood cells) Lab Value Reference Interpretation White blood cells (WBC) 4.4-11.3 x103 cells/mm3 HIGH: Infection; LOW: Bone marrow failure Male: 14-17.5 g/dL Hemoglobin (Hg) HIGH: Polycythemia (disease) Female: 12.3-15.3 g/dL Male: 42%-50% LOW: Anemia (disease) Hematocrit Female: 35%-45% Platelets (Plt) 140-440 x103 cells/mm3 HIGH: Risk of clotting; LOW: Risk of bleeding 38