Transcript Ch. 23 PPT File - Northwest ISD Moodle

Chapter 23: Chapter XX:
Chapter Title
Pharmacology
Learning Outcomes
 Cognitive Domain
Note: AAMA/CAAHEP 2015 Standards are italicized.
 1. Spell and define key terms
 2. Describe the relationship between anatomy and physiology of all body
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systems and medications used for treatment in each
3. Identify chemical, trade, and generic drug names
4. Discuss all levels of governmental legislation and regulation as they
apply to medical assisting practice, including FDA and DEA regulations
5. Explain the various drug actions and interactions including
pharmacodynamics and pharmacokinetics
6. Identify the classifications of medications, including indications for
use, desired effects, side effects, and adverse reactions
7. Name the sources for locating information on pharmacology
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Learning Outcomes (cont'd.)
 ABHES Competencies
 1. Properly utilize PDR, drug handbook, and other drug
references to identify a drug’s classification, usual dosage,
usual side effects, and contradictions
 2. Identify and define common abbreviations that are
accepted in prescription writing
 3. Understand legal aspects of writing prescriptions, including
federal and state laws
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Introduction
As a clinical medical assistant, you may
be responsible for administering
medications under the supervision of
the physician.
pharmacology:
study of drugs and
their origin, nature,
properties, and
effects upon living
organisms
drug: any
substance that
may modify one
or more of the
functions of an
organism
It is important that you acquire knowledge of medications, their uses and
potential abuses, range of dosages, methods of administration, and adverse effects.
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Medication Names
 Medications have chemical name,
generic name and trade name:
o Chemical name:
• First name given to a drug
• Identifies chemical components
o Generic name:
• Name given to drug during
research and development
• Begins with lower case letter
• Can coexist with trade names
chemical name: exact
chemical descriptor of
a drug
generic name: official
name given to a drug
whose patent has
expired
trade name: name
given to a medication
by the company that
owns the patent
When the drug is available for commercial use and distribution by the original
manufacturer, it is given a brand, or trade, name.
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Medication Names (cont’d.)
Trade (a.k.a. brand) name:
• Name given when drug available commercially
• Registered with U.S. Patent Office
• Trademarked
 Drugs classified according to their actions and effects on
body
o
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Medication Names (cont’d.)
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Medication Names (cont’d.)
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Checkpoint Question
What is the difference between a drug’s
chemical name and trade name?
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Checkpoint Answer
A drug’s chemical name identifies the chemical
components of the drug; the trade name is the
name under which the manufacturer distributes
the drug commercially.
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Legal Regulations
 Food and Drug Administration
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Protects consumers
FDA regulates manufacture and distribution of drugs
Ensure accuracy in the ingredients listed on labels
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Legal Regulations (cont’d.)
 Drug Enforcement Administration
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
DEA governs substances that may be abused or are
addictive
Bureau of Narcotics and Dangerous Drugs (BNDD)
o Anyone who manufactures, prescribes, administers, or
dispenses controlled substances must register
DEA is a branch of the Department of Justice (DOJ) and is designated to
exercise strong regulatory control over all drugs listed by the BNDD.
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Legal Regulations (cont’d.)
 Physician gets a DEA number every 3 years from U.S.
Attorney General
o Law enforcement official recommend that the DEA number
not be preprinted on the prescription
 Controlled substance inventory:
o If controlled substance are prescribed but not administered
at office, some states require information to be recorded in
patient’s chart
o Other require separate file of prescription copes of
controlled substances
As a medical assistant, you may be responsible for maintaining or
reminding the physician about professional records and licensure, including
registration with the DEA.
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Legal Regulations (cont’d.)
 Schedule of Controlled Substances
o
o
Drug dependence — psychological, physiological, or both
Patients prescribed controlled substances must be
monitored for dependence
Drug dependence, sometimes referred to as addiction, can be either
psychological, physical, or both.
Law enforcement officials recommend that the DEA number not be preprinted on
the prescription.
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Legal Regulations (cont’d.)
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Legal Regulations (cont’d.)
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Checkpoint Question
After a controlled substance is administered,
what information should Elaine document and
where should this information be recorded?
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Checkpoint Answer
When a controlled substance is administered,
you must document:
1. Drug name
2. Patient
3. Dose
4. Date
5. Ordering physician
6. Your name as the employee who
administered the drug
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Legal Regulations (cont’d.)
 Inventory, Storage, Dispensation, and Disposal of Medications
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Medications kept in office should be stored away from patients
Disposal:
o Disposing of noncontrolled substance — follow office policy
and procedure manual
o Controlled substances:
• Should have witness watch disposal
• Sign appropriate DEA forms
Ideally, the medication area should be locked and accessible only by authorized
clinical staff. It will be your responsibility to keep this medication area clean, neat,
and organized.
Never dispose of expired medications in regular trash containers.
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Legal Regulations (cont’d.)
Controlled substance inventory form.
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Sources of Drugs (cont’d.)
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Drug Actions and Interactions
 Pharmacodynamics
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Drug action — cellular change due to
drug
Drug effect — physiological change
due to drug
Effects:
o Local — limited to area of
application
o Systemic — throughout body
pharmacodynamics:
study of how drugs
act within the body
All drugs cause cellular change (drug action) and some degree of physiologic
change (drug effect).
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Drug Actions and Interactions (cont’d.)
 Influenced by many physical factors in each patient:
o
o
o
o
o
Age:
• Older adults have slower metabolism
• Children have more immediate response
Weight — generally, larger patient, greater dose
Sex:
• Women and men react differently
• Ratio of fat/body mass
• Hormones
Existing pathology — body compromised by diseases
Tolerance — if given over time, body resist effects
Medical assistants should always administer medications under the direct order
of a physician. Under no circumstance should the dosage be adjusted or altered
unless specifically instructed to do so by the physician.
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Drug Actions and Interactions (cont’d.)
 Pharmacokinetics

Route of administration:
o Oral
o Sublingual (under tongue)
o Rectal
o Injection
o Transdermal (through skin)
o Inhalation
pharmacokinetics:
study of the action of
drugs within the
body from
administration to
excretion
Specifically, the processes included in pharmacokinetics include absorption
(getting the drug into the bloodstream), distribution (movement of the drug from the
bloodstream into the cells and tissues), metabolism (the physical and chemical
breakdown of drugs by the body, including the liver), and excretion (byproducts sent
to the kidneys to be removed from the body).
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Drug Actions and Interactions (cont’d.)
 Rate of absorption:
How fast drug enters bloodstream once it is
administered
o How and where in body it is distributed
 Duration of action:
o How long drug is effective
 Rate of elimination:
o How fast drug is metabolized and excreted
o
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Checkpoint Question
Why should pharmacokinetics be taken into
consideration before administering
medications?
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Checkpoint Answer
Before giving any medication, you should be
familiar with the drug, including the actions of
the medication and specific patient responses
to the medication. Pharmacokinetics is based
on the route of administration, rate of
absorption, duration of action, and how the
drug is eliminated from the body.
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Drug Actions and Interactions (cont’d.)
 Drug Interactions
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One drug can affect the action of
another
o Can include alcohol, herbal
remedies, or OTCs
Interaction types:
o Synergism
o Antagonism
o Potentiation
Interactions can be undesirable
or used deliberately to create
desired effect
interaction: effects, positive or
negative, of two or more drugs
taken by a patient
synergism: harmonious action of
two agents, such as drugs or
organs, producing an effect that
neither could produce alone or that
is greater than the total effects of
each agent operating by itself
antagonism: mutual opposition or
contrary action with something else;
opposite of synergism
potentiation: describes the
action of two drugs taken
together in which the combined
effects are greater than the sum
of the independent effects
When two or more drugs are taken simultaneously, one drug may increase,
decrease, or cancel the effects of the other.
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Drug Actions and Interactions (cont’d.)
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Drug Actions and Interactions (cont’d.)
 Side Effects and Allergies

Allergic reactions include:
o Hives
o Dyspnea
o Wheezing
o Anaphylaxis — life
threatening
allergy: acquired abnormal
response to a substance (allergen)
that does not ordinarily cause a
reaction
anaphylaxis: severe allergic
reaction that may result in
death
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Drug Actions and Interactions (cont’d.)
 Immediate or delayed 2+ hours
 Patient should wait in office 20 to 30 minutes if given a
drug with a known high incidence of allergy such as
penicillin
Allergic reactions can be immediate or delayed 2 hours or longer,
depending on the route of administration; however, many allergic reactions occur
within minutes if the medication is administered by injection.
Because of the possibility of an anaphylactic reaction, patients should never be
given medications that they have had an allergic reaction to in the past.
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Drug Actions and Interactions (cont’d.)
 Side effects:
o
o
o
Often mistaken for allergy by patient
Predictable response in some patients
Not life threatening
Side effects:
reactions to
medications
that are
predictable and
occur in some
patients who
take the
medication
Side effects are reactions to medications that are predictable (as noted by the
manufacturer of the medication) and that occur in some patients who take the
medication.
While side effects are often annoying, they are not life threatening
and should not be noted on the patient’s allergy list.
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Checkpoint Question
How does synergism differ from antagonism?
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Checkpoint Answer
Synergism refers to an interaction between two
drugs or other substances in which the action
of one is enhanced by the other.
Antagonism is an interaction in which one drug
or substance decreases the effects of another.
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Sources of Information
 Physicians’ Desk Reference
o
o
Supplies the different names
of a drug, properties,
indications/contraindications
, dosages, etc.
Photographs of pills, etc.
The PDR.
The Physician’s Desk Reference (PDR) is widely used as a reference for drugs
in current use.
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Sources of Information (cont’d.)
 United States Pharmacopeia Dispensing Information
Supplies complete information on drugs and prescribing
information
o No photographs
 American Hospital Formulary Service
• Concise information for physicians
 Compendium of Drug Therapy
o Photos, contact information for pharmaceutical firms and
poison control centers
o
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Prescriptions
 Prescription protocol:
o
o
o
o
o
Line 1. Date
Line 2. Patient’s name and address
Line 3. Superscription
• Symbol Rx at top left of blank prescription pad —
means recipe, or “take thou”
Line 4. Inscription name
• Form (e.g., liquid, tablet, capsule)
• Strength (e.g., 250 mg, 500 mL)
Line 5. Subscription
• Amount to be dispensed (e.g., 60 tablets, 120 mL)
Medications may be administered (given in the office), dispensed (a supply
given for later use), or prescribed (a written order to be filled by a pharmacist).
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Prescriptions (cont’d.)
o Line 6. Signature
Instructions for taking the medication (e.g., with meals,
three times a day, four times a day)
o Line 7. Refills
• Generally no more than five times within 6 months
• If no refills indicated, the word “none” should be circled,
or 0 written in
o Line 8. Physician’s signature
o Line 9. Generic
• Some physicians and insurance companies allow
generic substitutes for some medications but not others
•
If the physician does not want a specific medication substituted with
a generic drug, “DAW” can be written on the prescription, which means “dispense
as written.”
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Prescriptions (cont’d.)
Prescription form.
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Prescriptions (cont’d.)
Documentation of a prescribed medication in a patient record.
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Prescriptions (cont’d.)
 All prescribed medications must be documented in patient’s
record
 Prescriptions that are called or faxed to the pharmacist
must also be documented
 Chart is a legal document and may be called into court in
the event of legal action
If the medication order is not recorded, it will be presumed that the medication
was never ordered.
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Prescriptions (cont’d.)
 Refilling Prescriptions
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
Always check with the physician before authorizing the
refill of any medication
Some drugs with cumulative effects may become toxic if
blood levels are not monitored closely
Immediately notify physician with results of blood tests
ordered to monitor the effects of medications
In most situations, a patient needing one or more prescriptions refilled will be
required to make an appointment to see the physician, especially if the medications
are controlled substances.
You should pull the patient’s chart and check with the physician before calling
any prescriptions into the pharmacy.
It will be your responsibility to help patients understand the importance of
maintaining therapeutic blood levels of these medications.
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Checkpoint Question
What does the superscription on the
prescription indicate, and how does it differ
from the subscription?
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Checkpoint Answer
The superscription indicates the medication
name, desired form, and strength. The
subscription indicates the amount of
medication to dispense.
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