Emergency Pharmacy PDF

***CHAPTER 04*** **Pharmacovigilance** the science of detecting, assessing, and preventing adverse effects of pharmaceutical products **SCOPE:** Drug monitoring ADRs , Reporting product , surveillance post marketing legislation. **ISSUES** Medication error Substandard medication Lack of eff...

***CHAPTER 04*** **Pharmacovigilance** the science of detecting, assessing, and preventing adverse effects of pharmaceutical products **SCOPE:** Drug monitoring ADRs , Reporting product , surveillance post marketing legislation. **ISSUES** Medication error Substandard medication Lack of efficiency report Un approved medicine use Case reports of acute and chronic poisoning Study of drug related disease ( morbidity) Abuse and misuse of medicine (irrational use of drug) ADRs medicine with chemical with other medicine and food drug intrection ***CHAPTER 05*** **CLINICAL TRIALS** A type of research study that tests how well new medical approaches work in people **PHASES** **PHASE01** Assaying initial safety and dose **Phase 02** Evaluating effectiveness and side effect **Phase 03** Confirming efficiency comparison to a standard **Phase 04** Allowing of long term use after approval **Phase 01** Number of participants are less than 100 They may be are diseased or healthy It is pharmacokinetic study Developing condition Drug interactions **Phase 02** Thus the treatment work In this several hundreds involved In this we detect ADRs **Phase 03** Participant are thousands Experimental work compare with standard **Phase 04** Drug ready to use **[Emergency Pharmacy]** Emergency treatment is the medical speciality, concerned with the care of emergency situations Exemples trauma, sepsis, burn, acute coronary syndrome, poisoning, stroke and pulmonary emergencies **Emergency pharmacy** The pharmaceutical intervention during emergency treatment is known as emergency pharmacy **Responsibilities of the pharmacist** 1. Participating in resuscitation efforts, 2. Providing consultative services that foster appropriate evidence-based medication selection, 3. Providing consultation on patient-specific medication dosage and dosage adjustments, 4. Providing drug information consultation to emergency physicians, emergency nurses, and other clinicians, 5. Monitoring for patient allergies and drug interactions, 6. Monitoring patient therapeutic responses (including laboratory values), continuously assessing for and managing adverse drug reactions, and Gathering or reviewing medication histories and reconciling patients' medications **[1- First aid:]** **[2- Basic Life Support (BLS):]** **[3- Intermediate Life Support (ILS):]** **[4- Advanced Life Support (ALS):]** **[5- Critical Care Transport (CCT):]** **[6-Intensive care service:]** **[Emergency care protocols]** Emergency care protocols include the following steps... **[Step 1- Triage]** Triage is the process of determining the severity of a patient's condition. according to the following scale: Level 1 -- cardiopulmonary Resuscitation (immediate life-saving intervention); Level 2 -- Emergency; Level 3 -- Urgent; Level 4 -- Semi-urgent; Level 5 -- Non-urgent. **[Step 2 -- Registration]** The registration process is important for two reasons it lets the emergency care staff to gather information for patient record obtain consent for treatment. **[Step 3 -- Treatment]** During the treatment, the staff in the emergency department will help make sure you are comfortable and informed. **[Step 4 -- Reevaluation]** An emergency care physician or mid-level practitioner will reevaluate patient conditions whether the patient should be admitted to the hospital or treated and sent home. **[Step 5 -- Discharge]** All patients receive written home-care instructions to follow when discharged. **[Cardiopulmonary resuscitation: (CPR)]** When a person suffers cardiac arrest, the heart stops functioning, and the blood stop circulation that proceed into respiratory failure and person become unable to breathe. **[Parameters followed before commencement of CPR:]** 1. Check that there is no further danger for rescuer. 2. Check for response: try to wake up patient by moving his/her shoulder and scan the chest for movement. 3. Call for emergency: one should call the concerned rescue department before making any effort for affected person. 4. Get an AED (automated external defibrillator) if possible. AED is a medical device used to diagnose and maintain heart rhythm by supplying electrical impulses. 5. Check the carotid pulse by placing fingers on upper neck for 5-10 sec. If the pulse is found support the causality with rescue breathes. If the pulse is not found, commence CPR. **[Hospital codes:]** Following codes are used commonly in hospital. 1. **Color codes** i.e. code black (for bomb threat), code red (for fire) and code blue (for emergency resuscitation). 2. **Doctor codes:** These codes are announced through paging system. The doctor's name is a code word for dangerous situation or a patient in crisis. 3. **Resus codes:** these codes are specific for emergency medicines. **[Code blue:]** Code blue is the most universally recognized emergency code. Code blue means there is a medical emergency occurring within the hospital. **The team is comprised of:** 1. Doctors 2. Nurses 3. A Respiratory therapist 4. A Pharmacist Less blood supply to an organ or part of the body, especially the heart muscles. **CAUSES** 1. Atherosclerosis 2. Deposition of fatty acids in blood capillaries 3. Blood clots **CAD** :Coronary artery disease **CHD** :Coronary Heart disease **Causes** They are due to narrowing of arteries due the formation of plaque **Signs and symptoms** Chest discomfort , chest pain , chest stiffness , chest tightness , heaviness **Dyspnea ** the feeling of shortness of breath or difficulty breathing **dysrhythmia** irregular heartbeat **Tachycardia** means that your heart is beating faster than normal, usually more than 100 beats per minute. Bradycardia is a slower than normal heart rate RISK FACTORS MODIFIED NON MODIFIED ---------------------------------- -------------- Increase in cholesterol age Obesity gender Lack of estrogen in female race Lack of physiological activities hereditary Lack of exercise **IHD DIAGNOSTIC METHODS** ECG ECHO Cardiogram CT Scanning MRI ( Magnetic resonance imaging ) Angiography **Pathophysiology of IHD** Exact mechanism is unknown Cause by hypercholesterolemia LDL( Low density lipoprotein ) Triglycerides **Endothelial cells** Present in the lumen of the capillaries (LDL damage the Endothelial cells) **stable angina ( plaque formation)** **symptoms** chest pain, chest heaviness , diameter of the arteries exceeds 50% more than normal **unstable angina (thrombosis formation)** immediate hospitalization due to the blockage of arteries **management of IHD** 1. stable condition 2. unstable condition A Antianginal Aspirin --- -------------------- ------------------------ B Beta blocker Blood pressure control C Cholesterol Smoking D Dietary management Diabetic control E Education Exercises **Treatment** Aspirin Clopidogrel Beta blocker Nitrates Lipid lower drug Ca+ chemical blocker ACE inhibitor