Transcript Chapter 6 pptx

Understanding Pharmacology
for Health Professionals
FIFTH EDITION
CHAPTER
6
The Prescription,
Pharmacy, and
Pharmacist
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Multimedia Directory
Slide 59
Pharmacist Video
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Learning Objectives
1. Give the definition of a prescription.
2. Name and describe the types of
prescriptions.
3. Describe medication orders and other types
of orders.
4. Describe the difference between the
components of a prescription and a
medication order.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Learning Objectives
5. Describe the various types of pharmacies
and the role that technology plays in
pharmacy activities.
6. Describe the role of the pharmacist in filling
a prescription.
7. Describe the function and goals of
medication therapy management.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Learning Objectives
8. Discuss the proper storage and disposal of
drugs.
9. Define the Key Words and Phrases for this
chapter.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Definition of a Prescription
• Origin comes from Latin praescriptio,
meaning a written order.
• Prescription
 The action of writing [that takes place]
before [a drug is dispensed]
 pre- (before)
 script/o- (write)
 -ion (action)
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Definition of a Prescription
• A written, computerized, electronic, or
verbal order from a physician (or other
qualified healthcare provider) to a
pharmacist, giving instructions as to
how to dispense a drug to a specific
patient
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Definition of a Prescription
• A medicolegal document
• Conveys precise information
• Legal document that can be used in
court
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Figure 6–1 Prescription abbreviation. Prescriptions have been written since ancient
times. The practice of medicine began with the Romans and Greeks, and the familiar
abbreviation Rx stands for the Latin word recipere, meaning to take. Prescriptions were,
in the past, actually recipes listing several ingredients to be mixed by the apothecary
before dispensing.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Types of Prescriptions
• Handwritten prescription
 Single preprinted form from a
prescription pad
 Must be written in ink
 Must be recorded in the patient's
medical record
 Traditional way in which prescriptions
have been written for centuries
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Figure 6–2 Handwritten prescription. A prescription form is used by a physician to
convey to a pharmacist a written record of a drug order for a patient. This physician may
be prescribing a new drug or ordering a refill of a drug for the patient. Source: Monkey
Business/Fotolia
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drug Alert
• Handwritten prescriptions can be
notoriously difficult to read.
• Various studies have found that 5
percent or 16 percent or even 25
percent of all handwritten prescriptions
are illegible.
• Pharmacists often become familiar with
a particular physician's handwriting and
can decipher illegible handwriting.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drug Alert
• However, when in doubt, the
pharmacist always calls the physician to
confirm the drug and dose.
• Some states, such as Florida, have
passed a law that all handwritten
prescriptions must be legible.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Focus on Health Care
• It is not uncommon for people to steal
prescription pads and write
prescriptions on them for drugs of
abuse.
• To prevent theft of prescription pads,
medical office personnel know that it is
important to take these precautions.
 Store extra prescription pads in a locked
drawer or closet.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Focus on Health Care
• To prevent theft of prescription pads,
medical office personnel know that it is
important to take these precautions.
 Have the physician carry just one
prescription pad on his/her person from
examining room to examining room.
 Never leave a prescription pad on the
counter or in an unlocked drawer in the
examining room.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Focus on Health Care
• To prevent theft of prescription pads,
medical office personnel know that it is
important to take these precautions.
 The physician should sign the
prescription form only at the time
he/she writes the prescription.
 The physician should never pre-sign
blank prescription forms.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Types of Prescriptions
• Computerized or electronic prescription
 Typed into the medical office's software
system
 Copy of prescription is printed out.
 Signed by the physician and given to
the patient
 May be faxed directly to the pharmacist
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Types of Prescriptions
• Computerized or electronic prescription
 Generated by a computer
 Not signed by the physician
 Digital electronic signature is
automatically imprinted.
 May also be faxed directly to the
pharmacist
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Types of Prescriptions
• Verbal prescription
 Given over the telephone
 If not for a controlled substance, the
pharmacist can fill the prescription
without:
• A printed-out prescription
• The physician's signature
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Did You Know?
• In 2012, there were 4 billion
prescriptions written, compared to 3.3
billion in 2006.
• On average, 48% of people taking at
least one prescription drug
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Medication Orders and Other
Types of Orders
• Medication order
 Written record of a physician's orders
 Handwritten on large preprinted order
sheet known as the physician's order
sheet
 Located in the front of the patient's
medical record
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Medication Orders and Other
Types of Orders
• Medication order
 For facilities with electronic records
• Typed into the computer on a designated
screen
• Screen serves as the physician's order
sheet.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Medication Orders and Other
Types of Orders
• Verbal order (telephone orders)
 When a patient is in the hospital
 Physician may give a verbal order over
the phone to a licensed nurse.
 The nurse writes the order on the
physician's order sheet.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Medication Orders and Other
Types of Orders
• Verbal order (telephone orders)
 It is marked as a verbal order (V.O.).
 The nurse signs his or her name.
 Physician must personally sign the order
within a specific amount of time.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Medication Orders and Other
Types of Orders
• Stat order
 Physician wants drug to be dispensed
and administered immediately.
• Standing order
 Group of specific orders
 Preprinted on the facility's physician's
order sheet
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Medication Orders and Other
Types of Orders
• Standing orders
 Often pertain to protocol of treatment to
a specific disease or surgical procedure
 In addition, a physician would also write
more specific medication orders to
address a particular patient's medical
needs.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Medication Orders and Other
Types of Orders
• Automatic stop order
 Originates with the hospital pharmacy
and not the physician
 For certain types of drugs
• Controlled substances
 Only valid for a certain number of days
 Determined by hospital's Pharmacy
Committee policy
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Medication Orders and Other
Types of Orders
• Automatic stop order
 Pharmacy automatically stops sending
the drug.
 An entirely new order must be written.
 All drugs carry an automatic stop order.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Medication Orders and Other
Types of Orders
• Automatic stop order
 Activated when a patient:
• Has a change in situation
• Is transferred to another nursing unit
• Is discharged to another healthcare
facility or home
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Focus on Health Care
• In a hospital or other healthcare
facility, the physician's office address
and phone number are not needed on
the physician's order sheet because the
physician is already a member of the
facility's medical staff.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Focus on Health Care
• Prior to joining the medical staff, each
physician must provide his/her name,
office address, home address, and
phone numbers (as well as Social
Security number, state medical license
number, federal and state DEA number,
educational background, and board
certifications) in a written application
that is kept on file in the facility's
credentialing department.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Focus on Health Care
• No physician is permitted to write
orders, including medication orders,
unless he/she is already an approved
member of that facility's medical staff.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Identifying information about the
physician
 Prescription form
• Preprinted at the top
• To identify the prescriber
• Name
• Office address
• Phone number
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Figure 6–3 A prescription form. Prescription forms are used for handwritten
prescriptions when patients are seen in a medical office or when patients are discharged
from the hospital. The blank prescription form has several standard component parts.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Identifying information about the
physician
 Physician's order sheet
• Physician's signature
• All other information is on file with the
hospital.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Identifying information about the
patient
 Prescription form
• To positively identify the patient
• First and last name
• Address
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Identifying information about the
patient
 Physician's order sheet
• Patient information already on order
sheet
• If computerized record, it is
preprogrammed to be there.
• If paper record, hospital card is created
and used to imprint order sheet.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Patient's age and weight
 Prescription form
• Not always included but can be useful
• Age
• Child
• Mandatory for Schedule II
• Weight
• Dose may be adjusted for low or high
weights.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Patient's age and weight
 Physician's order sheet
• Already entered onto demographics face
sheet
• Not included on medication order
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Date
 Prescription form
• Physician writes full date
• Month/day/year
• Prescription good for:
• 1 year from date of prescription
• 6 months for Schedule III through
Schedule V drugs
• 7 days for Schedule II drugs
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Date
 Physician's order sheet
• Full date and time next to each
medication order
• Orders in the hospital are time sensitive.
• Must be filled and administered in a
timely manner
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Rx
 Have been written since ancient times
 Symbol stands for recipere, meaning to
take
 Were at one time actually recipes
• Listed several ingredients
• Crushed and mixed by pharmacist before
dispensing
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Rx
 Prescription form
• Most come with a large Rx
• Just to the left of the area where the
prescription itself will be handwritten
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Rx
 Physician's order sheet
• Symbol not preprinted
• Page is large
• Used to order other types of treatments
in addition to drugs
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Drug name
 Same for both prescription form and
physician's order sheet
 May write either:
• Drug's generic name
• Trade name
 Chemical name is not used.
 Abbreviations of drugs are avoided.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Drug strength
 Same for both prescription form and
physician's order sheet
 A number appears right after the drug
indicating strength.
 Followed by a unit of measurement
 Must prescribe a drug strength that
corresponds exactly to the strength the
drug is manufactured
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Drug strength
 Example
• If drug is manufactured in 25mg and 50
mg tablets, physician cannot order 80
mgs.
• However, if the tablet is scored,
physician can order exactly one half of
amount of one tablet.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Drug form
 Same for both prescription form and
physician's order sheet
 Specific form must be included.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Quantity to be dispensed
 Prescription form
• Symbol # read as number
• Indicates to the pharmacist the number
of capsules, tablets, etc. to dispense
• Sometimes will preface the number with
the word dispense
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Quantity to be dispensed
 Physician's order sheet
• Does not need to indicate total number
• Medication order continues while patient
is in the hospital.
• Exception is controlled substances.
• Only amount needed for one day is sent
to the unit
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Directions for use
 Prescription form
• Abbreviation Sig. indicates directions
• Pharmacist will type on the label,
translating any Latin abbreviations
• Amount of dose
• Route of administration
• Frequency of the dose
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Directions for use
 Physician's order sheet
• Abbreviation Sig. not included
• Pharmacist doesn't translate Latin
abbreviations
• Nurse on the unit understands
abbreviations
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Signature
 Prescription form
• At the bottom of form
• Preprinted line with M.D.
• Physician must sign his or her name on
that line for prescription to be valid
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Signature
 Physician's order sheet
• Physician signs name, with M.D. following
• Directly below the last medication order
• Prevents insertion of an order at a later
time
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Refills
 Prescription form
• How many times the patient is permitted
refills
• Preprinted Refills area: 0 (sometimes NR
for "no refills"), 1, 2, or 3
• Only be refilled for a year
• No refills for Schedule II
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Refills
 Physician's order sheet
• No indication of refills
• Pharmacy continues to send as long as
patient is hospitalized or until physician
orders drug to be discontinued.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Generic substitution
 Prescription form
• Some states mandate pharmacists fill
prescriptions with a generic drug.
• If physician wants trade name, must
specifically state so
• Dispense as written ("DAW")
• No substitution
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• Generic substitution
 Physician's order sheet
• Hospital has formulary for all stocked
drugs.
• Pharmacist will dispense generic
equivalent unless physician specifically
requests trade name.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• DEA number
 Prescription form
• If drug has potential for abuse
• Controlled substance
• Assigned federal DEA number in order for
prescription to be valid
• Consists of 9 characters
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Components of Prescriptions and
Medication Orders
• DEA number
 Physician's order sheet
• Does not need to be provided when
physician in hospital or other healthcare
facility
• Kept on file in hospital's credentialing
department
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Focus on Health Care
• Prescriptions for Schedule II drugs
must be written on a special
prescription form.
• This is known as an "official prescription
form," and it is only printed by certain
printing companies designated by that
state.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Focus on Health Care
• Official prescription forms contain
security features (a control number,
thermochromatic ink, and an imprinted
seal) that are designed to prevent
alterations and forgeries.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Focus on Health Care
• This is a precaution to avoid the
unauthorized use of drugs that have a
high potential for drug abuse and
addiction.
• In addition, these prescription forms
may include background repetition of
the word "void" that becomes visible if
someone attempts to photocopy or fax
these forms.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Focus on Health Care
• Even with this precaution, thousands of
prescriptions for Schedule II drugs are
forged each year.
• A pharmacist may contact a physician's
office to verify that a Schedule II
prescription is indeed valid and not
forged.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Focus on Health Care
• Occasionally, unscrupulous physicians,
dentists, and pharmacists prescribe or
dispense Schedule II drugs to patients
who have a drug habit in exchange for
money.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Focus on Health Care
• These individuals can be investigated
by the state licensing board and the
DEA and denied renewal of the federal
DEA number needed to prescribe
schedule drugs.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Focus on Health Care
• Of interest is the fact that some states
(e.g., New York in 2006) now require
that an "official prescription form" be
used to prescribe all prescription drugs,
not just Schedule II drugs.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drug Controversy
• Prescriptions for generic drugs only
accounted for 13 percent of all new
prescriptions filled in 1995, but
accounted for 45 percent of all new
prescriptions filled in 2006.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drug Controversy
• The use of generic rather than trade
name drugs can result in considerable
savings to consumers, but for certain
critical drugs—such as digoxin
(Lanoxin) for congestive heart failure,
phenytoin (Dilantin) for seizures, and
anticoagulant drugs—many physicians
prefer to rely on the proven therapeutic
action of a trade name drug.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
The Pharmacy
• After prescription submitted
 It becomes the property of the
pharmacy.
 Pharmacy is responsible for keeping it
on file.
• Kept for several years
• Specified by state law
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
The Pharmacy
• Hospital (inpatient) pharmacy
 Only dispenses to patients admitted to
the hospital
 Satellite pharmacies
• One large central pharmacy for large
hospital complexes
 Medication carts
• For transporting patients' drugs
• Moved to each patient's room
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
The Pharmacy
• Hospital (inpatient) pharmacy
 Nurse administers, then charts
medication on patient's medication
administration record (MAR)
• Abbrev. e-MAR in the electronic health
record
• Outpatient pharmacy
 Or ambulatory pharmacy
 Hospital's ambulatory clinic
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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The Pharmacy
• Outpatient pharmacy
 Clinic
 Community pharmacy
 Compounding pharmacy
• Prepares, mixes, and packages drug
ingredients under sterile conditions
• Telepharmacy
 Communities in remote locations
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Figure 6–4 Compounding pharmacy. Both of these pharmacists are using mortars
and pestles to crush dry ingredients that will be mixed with other ingredients, reformed
into a drug, and then packaged to be sold. Source: Terry Vine/Getty Images
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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The Pharmacy
• Pharmacoinformatics (pharmacy
informatics)
 Computerized database to store drug
information and automate its retrieval
when needed
 Bar code technology
 Pill imaging technology
 Corporate pharmacy chain
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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The Pharmacy
• Online pharmacies
 Provide convenient service to patients
 Order prescriptions over the Internet
 Drugs are mailed to the patients at
home.
 Legitimate pharmacies have a seal on
the home page of their website:
"Verified Internet Pharmacy Provider
Site"
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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The Pharmacy
• Online pharmacies
 Patients mail in their actual
prescriptions
 Internet pharmacy calls the doctor to
verify the validity of the prescription.
 Some internet pharmacies
• Do not require a prescription form
• Do not check with the patient's physician
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
The Pharmacy
• Online pharmacies
 Some advertise that they provide
"prescription drugs without
prescriptions."
• Patient fills out a medical questionnaire
online.
• Online pharmacy company doctor
• Does not examine the patient
• Writes the prescription the patient wants
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
The Pharmacy
• Online pharmacies
 Ethical concerns
• Internet an easy source of drugs for an
addict
• People can forge a prescription for a
prescription drug or even a schedule
drug.
• Send it to several Internet pharmacies at
the same time
• Obtain multiple bottles of drugs
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
The Pharmacy
• Online pharmacies
 Ethical concerns
• Some online pharmacies obtain their
drugs from foreign countries.
• Quality and purity of drug may be
compromised.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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The Pharmacist
• Healthcare professional with advanced
degree in pharmacy (Pharm.D.)
• Knowledgeable about all aspects of
drugs
• Pharmacy technician
 May complete pharmacist's tasks
 Checked for accuracy
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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by Pearson Education, Inc.
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The Pharmacist
• Hospital pharmacy responsibilities
 Receives physician's order
 Verifies drug and dose
 Checks patient medical record for
possible allergies, interactions
 Checks drug formulary for stock
 Dispenses drug
 Consults with physicians on site
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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The Pharmacist
• Outpatient pharmacy responsibilities
 Verifies drug and dose prescribed
 Checks patient medical record for
possible allergies, interactions
 Checks drug formulary for stock and
that drug is approved by patient's
insurance plan
 Fills prescription
 Creates unique Rx #
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Figure 6–5 Filling a prescription. (a) The pharmacist carefully compares the prescription to the
drug names on stock bottles in the pharmacy. This is a critical step in assuring that the patient receives
the correct drug. (b) A number of tablets or capsules are removed from the stock bottle and placed on
a manual pill-counting tray. The number specified in the prescription is counted out using a spatula and
then moved into the side section of the tray. The extra tablets or capsules are poured back into the
stock bottle, and those in the side section are poured into the plastic prescription bottle that is given to
the patient. The image on the pill-counting tray says "Check, Counsel, Communicate." Large, highvolume pharmacies have automatic "pill-counting machines." Source: Dmitry Kalinovsky/Shutterstock;
Darren McCollester /Getty Images
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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The Pharmacist
• Outpatient pharmacy responsibilities
 Places warning labels if applicable
 Applies childproof cap
 Attaches preprinted patient information
sheet
 Dispenses drug
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Figure 6–6a Labels on a prescription bottle. (a) The label on a prescription bottle includes the
following information (some of this information has been deleted to protect the privacy of the patient):
the name, address, and phone number of the pharmacy, the patient's name, the unique Rx # (in
yellow), the name of the prescribing physician, the initials of the pharmacist, and the drug name. This
prescription is for Cardizem CD, a heart drug. The physician requested the trade name drug, but the
generic name of the drug (diltiazem HCl) is written below it in parentheses. The label also includes the
strength of the drug (360 mg), the dose (one capsule), the frequency (each day), and the number of
refills allowed (6). (b) The pharmacist then applies any caution or warning labels that pertain to the
drug.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Figure 6–7 Childproof cap. The pharmacist, not the physician, asks if the patient
would like a childproof cap on the prescription bottle. This cap is meant to keep children
from opening the prescription bottle. Some childproof caps are pressed down and then
turned to open. On this cap, the orange tab must be held down before the cap is turned.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Figure 6–8 Patient medication guide. The printing on this drug bottle reminds the
pharmacist to "Dispense the accompanying Medication Guide to each patient." Other
drug companies call this printed sheet a Patient Information Leaflet.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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The Pharmacist
• Other responsibilities
 Offer advice about diseases and drugs
 Provide personalized assistance to
customers
• Consultation about disease management,
weight management, or smoking
cessation
• Medication therapy management (MTM)
facilitates communication.
• Patient-centered
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
continued on next slide
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The Pharmacist
• Other responsibilities
 Provide personalized assistance to
customers
• Medication therapy management (MTM)
facilitates communication.
• Comprehensive annual or as-needed
review of all medications
• Patient Protection and Affordable Care Act
("Obamacare") pays for this service.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Figure 6–9 Drug information. Pharmacists provide free pamphlets to customers to
explain how to take drugs safely and, for senior customers, how to enroll and pay for
drugs through the Medicare Part D Prescription Drug Program.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Pharmacist Video
Click on the display above to view a video on the topic of the pharmacy profession.
Click again to pause the video.
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Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Focus on Health Care
• The president of the National Association
of Chain Drug Stores (which represents
94,000 pharmacists and 32,000 drug
stores) reported that pharmacists "see
firsthand the struggle of seniors having
to choose between food and their drugs
because they lack prescription drug
coverage for what have become
increasingly complex and effective, but
expensive drugs."
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Focus on Health Care
• Many older adults rely on the kindness of
their primary care physicians to supply
them with enough drug samples to last
until their next visit, they cut down on
the frequency of doses, or they simply
do without their drugs.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Storing and Disposing of Drugs
• Heat and moisture in bathroom
medicine cabinets can break down
drugs.
• Best place is cool environment in a
locked storage box.
 Especially if children in house
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Storing and Disposing of Drugs
• Dispose of drugs safely when no longer
in use.
 Do not flush down toilet
 Most pharmacies will accept and dispose
by incineration.
 Police department may have a program
to dispose of narcotic or schedule drugs.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Storing and Disposing of Drugs
• Dispose of drugs safely when no longer
in use.
 If absolutely necessary to do oneself,
crush or dissolve in a small amount of
water and mix with coffee grounds, kitty
litter, or another inedible substance.
• Put in sealed plastic bag, then put in
trash.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved