Transcript PHARMACY MEDICATION ISSUES FOR SHELTER/FIELD …

PHARMACY MEDICATION ISSUES
FOR SHELTER/FIELD COMMUNITY
SUPPORT MISSIONS
Saundra J. Martino, RpH
DISASTERS
*Each disaster is different in the health
care/medical needs that it creates
*Epidemiological differential across the types of
disasters—helps to predict exacerbations in
patients with pre-existing conditions
FIRES/VOLCANIC ERUPTIONS/EARTHQUAKES
increase in particulate matter in the air which
can exacerbate underlying pulmonary conditions
HEAT WAVES
added stress on people with underlying
cardiac issues
HURRICANES AND FLOODING
see an increase in gastrointestinal illnesses
and dermatological conditions
DESTRUCTION OF HOUSING
increased risk of venous thromboembolism
STRESS OF DISASTERS
can exacerbate underlying cardiovascular
and psychological issues
*recent disasters have highlighted the need for
medications to treat chronic disease states in
addition to the usual acute ones that present in
these situations
*after Hurricane Katrina the majority of
medications dispensed were for chronic
diseases of people displaced by the storm
SHELTERS/FIELD MISSIONS
*acute issues
*cardiovascular disease
*diabetes
*pulmonary issues/asthma
*mental illness
Chronic conditions (cardiovascular disease, diabetes, pulmonary issues)
impair an older adult’s ability to prepare, respond, or recover from a disaster
Pharmacy Specific Related Issues
*limited medication availability
*limited drug selection
*increased need for therapeutic substitution
*missing, incomplete, or inaccurate health care records
*increased risk of adverse effects
*compromised ability to maintain continuous care
*poor access to fresh food and clean water
*inability to store medications properly
*donated drugs---often “dumped” –not useful for that particular situation/also
short dated or expired
Addressing Some of The Problems
• ICE Rx
provides dispensing information from major PBM’s, and participating state Medicaid
programs
available to “credentialed” physicians and pharmacists
• RxResponse
collaboration of healthcare organizations involved in the manufacturing, distribution,
and dispensing of medications
pharmacy status reporting tool
• Emergency Prescription Assistance Program (EPAP)
federal program to pay for prescription medications and a limited amount of durable
medical equipment (DME) in federal disaster areas
one time fill of medications up to a 30 day supply for people with no prescription
insurance
ACUTE ISSUES
•
•
•
•
•
•
•
•
Wound care
Rashes
Burns
Hypothermia
Crush injuries
Acute diarrhea
Infections
Immunizations
OTC’s
Antibiotics
Analgesics
Pedialyte
Loperamide
Kaopectate
Xifaxan
Meclizine
Ondansetron inj
TETANUS
Spores of C. Tetani reside in the soil
and enter the body through open
wounds
---travels to CNS
---block neurotransmission
---disinhibit the motor cortex
--- extensive nerve spasms
Tetanus Immune Globulin
Prophylaxis of infection in patients
with traumatic injuries
Pediatric Dtap
Adult Tdap
CARDIOVASCULAR DISEASE
HYPERTENSION
systolic bp> or= 140mmHg
diastolic bp> or = 90mm Hg
CONGESTIVE HEART FAILURE
MYOCARDIAL INFARCTION
*83.6 million American adults have 1 or
more types of CVD
*20% of adults over age 65 have coronary
heart disease
* 1 in every 5 individuals has
hypertension=18.38% of the population or
50 million people
*STRESS is a known risk factor for the
development and progression of heart
disease
*physically limited
*on oxygen
*complex medication regimens
*food in shelters is high in sodium,
carbohydrates and fat
SITUATIONS
*heart attacks spiked in Japan after the
2011 earthquake and tsunami
*Katrina: admissions to Tulane University
Hospital
heart attacks represented 2.4% of
patients in the 6.5 years following the
storm whereas they only represented 1% in
the 2 years prior to the storm
CARDIOVASCULAR DRUGS
•
•
•
•
•
•
•
•
ACE INHIBITORS
BETA-BLOCKERS
CALCIUM CHANNEL BLOCKERS
DIURETICS
CARDIAC GLYCOSIDES
DIRECT VASODILATORS
NITRATES
CENTRALLY ACTING ALPHA2
AGONISTS
ACE INHIBITORS
*chf
*hypertension
Lisinopril 20mg tablets
Enalapril 1.25mg/ml inj 2ml
BETA BLOCKERS
*angina
*hypertension
*arrhythmias
Atenolol 50mg tablets
Metoprolol tartrate 50mg tablets
Metoprolol inj 1mg/ml 5ml
Propranolol 20mg tablets
Propranolol inj 1mg/ml
CARDIOVASCULAR DRUGS
CALCIUM CHANNEL BLOCKERS
CARDIAC GLYCOSIDES
*angina
*hypertension
*supraventricular arrhythmias
Nifedipine 10mg caps
Verapamil 80mg tabs
Verapamil SR 240mg tabs
Diltiazem hcl inj 5mg/ml 5ml
*chf
*atrial fibrillation
Digoxin 0.125mg tabs
Digoxin inj 0.25mg/ml 2ml
DIRECT VASODILATORS
*hypertensive crisis
Hydralazine 20mg/ml 1ml
DIURETICS
*edema
*hypertension
Hydrochlorothiazide 25mg tabs
Furosemide 40mg tabs
Furosemide inj 10mg/ml 10ml
NITRATES
*relief of angina pain
Nitroglycerin SL 0.4mg tabs
Nitroglycerin transderm 0.2mg/hr
Nitroglycerin inj 5mg/ml 10ml
Isosorbide 10mg tabs
CARDIOVASCULAR DRUGS
CENTRALLY ACTING ALPHA 2
AGONIST
*hypertension
Clonidine 0.1mg tablets
DIABETES
affects 25.8 million Americans
Katrina
*11% of the population living in New Orleans and
Jefferson parishes had diabetes
*1 million people evacuated=100,000 displaced diabetics
*Civic center at Baton Rouge housed > 6000 individuals
would have to care for >600 diabetics
Considerations:
*dietary intake
*physical activity
*stress
*other comorbidities
hypertension
dyslipidemia
neuropathy
kidney disease
macular degeneration
Diabetic Supplies
alcohol pads
lancets
blood glucose monitors
test strips
syringes
sharps containers
glucose tabs/gels
Drugs
Glucagon for injection
Glyburide 5mg tabs
Pioglitazone 15mg tabs
Humulin N/Novolin N
Humulin R/Novolin R
Humulin 70/30 / Novolin 70/30
DIABETES
GLUCAGON FOR INJECTION
emergency treatment of severe hypoglycemia
increase in blood glucose levels
>44lbs 1mg IM/IV/SQ
GLYBURIDE 5MG TABLETS
second-generation oral sulfonylurea
stimulates pancreatic islet cells which results in an increase in
insulin secretion
onset of action is within 2 hours
maximum decrease of serum glucose occurs in 3 to 4 hours
once daily dosing with the first meal of the day
PIOGLITAZONE 15MG TABLETS
thiazolidinedione (TZD)
“insulin sensitizer”—target insulin resistance in type II
diabetics
increased risk of heart failure, edema, weight gain
once daily dosing
INSULINS
*various manufacturers/not normally what the
patient uses
*refrigerated (36-46 F) unopened is good until
the expiration date on the box
* un- refrigerated (59-86F) maintains its potency
up to 28 days
*>86F loss of potency and loss of blood glucose
control over time
General Rule: insulin loses its potency according
to the temperature it is exposed to and the
length of the exposure
INSULIN SWITCHING
Humulin/Novolin
Humulin R/Novolin R
Humulin N/Novolin N
Humalog/Novolog
Substitutable on a unit-for-unit basis—just
monitor
DIABETES
INSULIN PUMPS TO INJECTABLE
Can substitute intermediate acting
(NPH) for the 24 hour total basal
dose of infused insulin on a unit –
per-unit basis
make sure total dose of NPH is split
between morning & evening doses
if regular insulin is available
patients should administer mealtime
insulin according to their previous
system for calculating their bolus
insulin doses
PULMONARY ISSUES/ASTHMA
ASTHMA
2011= 25.9 million Americans
highest prevalence in 5-17 year olds
characterized by swelling and inflammation
of the lining of the airway…muscles tighten
around the airway and mucus clogs the
airway…narrows the airway and breathing
becomes difficult
often occurs in response to specific “triggers”
pollen, tobacco, mold, etc.
COPD
(chronic obstructive pulmonary
disease)
characterized by an obstruction to airflow
that interferes with normal breathing
affects 13 million
LUNG CANCER
SITUATIONS
WORLD TRADE CENTER 9/11/01
July 2002-April 2004 rescue and recovery
workers … 61% developed respiratory
symptoms
HURRICANE KATRINA
respiratory issues increased due to mold
produced by the flooding
RESPIRATORY TRACT AGENTS
STEROIDS
QVAR 40 mcg inhaler
(beclomethasone dipropionate)
Dexamethasone 4mg/ml inj
Methylprednisolone 4mg dosepak
Methylprednisolone 125mg inj
Methylprednisolone 1000mg inj
Prednisone 5mg tablets
Prednisone 20mg tablets
RESPIRATORY ANTIMUSCARINIC
Ipratropium Bromide HFA inh
(atrovent)
RESPIRATORY SMOOTH MUSCLE
RELAXANTS
Theophylline ER 200mg tablets
BRONCHODILATORS
Albuterol HFA inhaler
Albuterol soln for inh 0.083%
Albuterol syrup 2mg/5ml
Albuterol tablets 4mg
Terbutaline sulfate inj 1mg/ml
Terbutaline sulfate tablet 5mg
MENTAL ILLNESS
*Psychological distress
*Anxiety
*Insomnia
*Depression
*Post-traumatic stress disorder
MENTAL HEALTH AGENTS
ANTIMANIC AGENT
Lithium 300mg tablets
ANTIPSYCHOTIC
Haloperidol 1mg tablets
Haloperidol 5mg/ml inj
Risperidone tabs 1mg
ANXIOLYTIC
Diazepam 5mg tab
Diazepam 5mg/ml
SEDATIVE/HYPNOTIC
Zolpidem 10mg
TRICYCLIC ANTIDEPRESSANT
Nortriptyline 25mg caps
HETEROCYCLIC
ANTIDEPRESSANT
Trazodone 50mg tabs
SSRI
Fluoxetine 20mg caps
CONCLUSION
CHALLENGE
Continuity of care—chronic
medication use
Attacks on the World Trade Center
on 9/11/01 created greater
awareness for the needs of the
chronically ill population
When the catastrophic hurricanes hit
the Gulf Coast in 2005 public health
and other professionals fully grasped
the urgency to address the chronic
health needs of the vulnerable
populations during disasters