Dispensing 2 - University of Southern Mindanao PDF

UNIVERSITY OF SOUTHERN MINDANAO Dispensing 2 Instructor: Theresa May R. Niala, RPh  Latin abbreviations and meanings Latin Full Latin word English meaning abbreviation ā ante Before ac...

UNIVERSITY OF SOUTHERN MINDANAO Dispensing 2 Instructor: Theresa May R. Niala, RPh  Latin abbreviations and meanings Latin Full Latin word English meaning abbreviation ā ante Before ac ante cibum Before meals achs ante cibum et hora somni Before meals and at bedtime bid bis in die Twice a day c̅ cum With HS hora somni At bedtime *Use upper case HS; lower case “hs” may be mistaken for half- strength. dieb. alt. diebus alternis every other day Insert Running Title 2  Latin abbreviations and meanings Latin Full Latin word English meaning abbreviation p̄ post After p.c post cibum After meals P.M post meridiem In the evening PRN pro re nata as needed Stat statim Immediately qd, QD quaque die Every day qh quaque hora Every hour qhs quaque hora somni Every night at bedtime 3 Insert Running Title  Latin abbreviations and meanings Latin Full Latin word English meaning abbreviation qid, QID quater in die Four times a day q6h quaque 6 hora Every 6 hours qod, q.o.d, quaque altera die Every other day QOD, Q.O.D qs quantum satis As much as needed; a sufficient quantity S̅ sine Without TID, t.i.d ter in die Three times a day qam quaque die ante meridiem Every morning q8h quaque 8 hora Every 8 hours Insert Running Title 4  Latin abbreviations and meanings Latin Full Latin word English meaning abbreviation q12h quaque 12 hora Every 12 hours ud, ut dict, UD ut dictum As directed AD auris dextra Right ear AS Auris sinister Left ear AU auris utraque both ears cap capsula Capsule Inj, IJ injectio Injection OD oculus dexter Right eye OS oculus sinister Left eye Insert Running Title 5  Latin abbreviations and meanings Latin Full Latin word English meaning abbreviation OU oculus uterque Both eyes PO per os By mouth or orally ung unguentum Ointment gtt, gtts guttae Drops aa ana of each agit agita stir/shake w =with w/o =without X =times Insert Running Title 6 This Photo by Unknown Author is licensed under CC BY 7  Medication Related Problems Medication-related problems are common in older adults and include drug ineffectiveness, adverse drug effects, overdosage, underdosage, inappropriate treatment, inadequate monitoring, nonadherence, and drug interactions. 8 Medication Related Problems An undesirable event experienced by a patient that involves or is suspected to involve drug therapy and actually potentially interferes with a desired patient outcome. 9  Medication Related Problems Adverse drug effects are effects that are unwanted, uncomfortable, or dangerous. Common examples are oversedation, confusion, hallucinations, falls, and bleeding. At any age, adverse drug effects may occur when drugs are prescribed and taken appropriately; eg, new-onset allergic reactions are not predictable or preventable. However, adverse effects are thought to be preventable in at least 25% of cases in older adults. 10  Medication Related Problems In older adults, a number of common causes for adverse drug effects, ineffectiveness, or both are preventable. One major cause involves inadequate communication with patients or between health care practitioners 11  Symptoms of Medication Related Problems Changes in speech Confusion Depression Delirium Insomia Parkinson’s like symptoms Incontinence Weakenss Loss of Appetite 12 TYPES OF MEDICATION RELATED PROBLEMS 13  Reasons older patients are at greater risk for Medication Related Problems Multiple chronic diseases Multiple medications Multiple prescribers Physiologic changes associated with aging Under representation in clinical trials, particularly those over age 75 Shortage of Professionals with specific training to work with older adults 14  Reasons Medication Related Problems are not Addressed. The patient has been taking this medication for many years without a problem One provider did not prescribe all the medications the patient is taking. Patients and prescribers are concerned that the risk of discontinuing the medication is greater than the benefit. Patients often resist changes in their drug therapy. The problems the patient is experiencing are not usually seen with this medication. 15  Preventing Medication Related Problems 1. Communicate with Health care providers about medications. 2. Designate a medication manager. 3. Keep a medication list. 4. Consult with a doctor or pharmacist before taking OTC drugs or herbal supplements. 5. Use common sense when using medications 6. Obtain refills in a timely manner. 16  five common medication-related problems 1. Too Many Medicines Research has shown that the more medications a person takes, the greater the risk of experiencing a medication- related problem. One way to prevent what is known as polypharmacy is through communication. Here are some questions to ask the doctor or pharmacist for each medication: 17  1. Too Many Medicines Is this medication really needed? Is the medication the most appropriate for the medical condition being treated? Will the medication be a problem with other medical conditions that are occurring at the same time? Is the medication being prescribed at the right dose? Does the medication interact with other medications? Can the medication be taken correctly based on specific patient circumstances? 18  five common medication-related problems 2. Unnecessary Medication To help avoid this medication-related problem, make sure you have a clear understanding of what to expect — and when to expect it — when the patient is taking medications. Drug reconciliation refers to a formal process of reviewing all prescribed drugs at each transition of care and can help eliminate errors and omissions. 19  five common medication-related problems 3. Dose Too Low or Too High Perhaps the most common medication-related problem among older persons is when the correct medication is prescribed, but the dose is too high. This often happens because physical changes of aging can alter the way our bodies process and react to medications. For example, the ability to eliminate medication from the body becomes less efficient with aging due to reductions in kidney and liver function. A “normal dose” of a medication can be an overdose for many older persons. 20  3. Dose Too Low or Too High If you believe a drug dose may be too low or too high, contact your patient’s primary care provider or pharmacist. 21  five common medication-related problems 4. Adverse Drug Reactions Drug-to-drug interactions are common because older adults often take many drugs. An adverse drug reaction happens when the patient is receiving a medication considered to be unsafe based on: the characteristics of the patient an allergic reaction to the medication an interaction with another medication or food the incorrect administration of the medication a medication dosage increased or decreased too rapidly 22  4. Adverse Drug Reactions The best way to avoid adverse drug reactions is to ensure that all health care providers have a current list of all medications, vitamins, and dietary supplements your loved one is taking and to document all symptoms and address them with a medical professional. 23  5. Lack of Adherence Up to half of older adults do not take drugs as directed. The patient might be confused about why and how to take the medication, or maybe they find it inconvenient to take the medication. Perhaps they perceive that the medication has caused or will cause some adverse event. Financial and physical constraints may also make purchasing drugs difficult. 24  5. Lack of Adherence Yet for medications to be safe and effective, they must be taken at a particular dosage, at specified times, and for a specific period of time. Pharmacists and nurses can help by providing education and reviewing prescription instructions 25  Other reasons for Medication Related Problems Drug-disease interactions drug given to treat one disease can exacerbate another disease regardless of patient age, but such interactions are of special concern in older adults. Distinguishing often subtle adverse drug effects from the effects of disease is difficult. Many drugs have adverse effects that resemble symptoms of disorders common in older adults or changes due to aging. The following are examples: Antipsychotics, Cholinesterase inhibitors, CCB 26  Other reasons for Medication Related Problems Drug-drug interactions Because older adults often take many drugs, they are particularly vulnerable to drug-drug interactions. Older adults also frequently use medicinal herbs and other dietary supplements and may not tell their health care providers. Medicinal herbs can interact with prescribed drugs and lead to adverse effects. 27  Other reasons for Medication Related Problems Drug-drug interactions For example, ginkgo biloba extract taken with warfarin can increase risk of bleeding, and St. John's wort taken with a selective serotonin reuptake inhibitor (SSRI) can increase risk of serotonin syndrome. Therefore, physicians should ask patients specifically about dietary supplements, including medicinal herbs and vitamin supplements. 28  Other reasons for Medication Related Problems Inadequate monitoring Monitoring drug use involves: Documenting the indication for a new drug Keeping a current list of drugs used by the patient in medical records Monitoring for achievement of therapeutic goals and other responses to new drugs Monitoring necessary laboratory tests for efficacy or adverse effects Periodically reviewing drugs for continued need 29  Other reasons for Medication Related Problems Inadequate monitoring Such measures are especially important for older patients. Lack of close monitoring, especially after new drugs are prescribed, increases risk of polypharmacy, adverse effects and ineffectiveness. 30  Other reasons for Medication Related Problems Inappropriate drug selection A drug is inappropriate if its potential for harm is greater than its potential for benefit. Inappropriate use of a drug may involve: Choice of an unsuitable drug, dose, frequency of dosing, or duration of therapy Duplication of therapy Failure to consider drug interactions and appropriate indications for a drug Appropriate drugs that are mistakenly continued once an acute condition resolves (as may happen when patients move from one health care setting to another and the indication is not reevaluated) 31  Other reasons for Medication Related Problems Lack of patient adherence Drug effectiveness is often compromised by lack of patient adherence among the ambulatory older adults. Financial and physical constraints, which may make purchasing drugs difficult Cognitive problems, which may make taking drugs as instructed difficult Use of multiple drugs (polypharmacy) Use of drugs that must be taken several times a day or in a specific manner Lack of understanding about what a drug is intended to do (benefits) or how to recognize and manage adverse effects (harms) 32  Other reasons for Medication Related Problems Overdosage Overdosage can also occur when drug interactions increase the amount of drug available or when different practitioners prescribe a drug and are unaware that another practitioner prescribed the same or a similar drug 33  Other reasons for Medication Related Problems Poor communication Poor communication of medical information at transition points (from one health care setting to another) causes up to 50% of all drug errors and up to 20% of adverse drug effects in the hospital. Lack of communication may result in unintentional omission of a necessary maintenance drug. Drug reconciliation refers to a formal process of reviewing all prescribed drugs at each transition of care and can help eliminate errors and omissions. 34  Other reasons for Medication Related Problems Under prescribing Appropriate drugs may be underprescribed—ie, not used for maximum effectiveness. Underprescribing may increase morbidity and mortality and reduce quality of life. Clinicians should use adequate drug doses and, when indicated, multidrug regimens. Patients and caregivers should be active participants in decision making about drug treatment so that clinicians can understand patients' priorities and concerns. 35