Pharm7e-Ch04-Presentation

[Audio] Welcome to the Pharmacology for Technicians, Seventh Edition, Watch and Learn lessons..

[Audio] Chapter 4, Prescription Orders and Medication Safety..

[Audio] In the prescription section of this chapter, you will learn about the components of a prescription and commonly used prescription abbreviations. You will also learn about the "rights" of correct drug administration. You will discover common dosage forms as well as the routes of administration and dosage forms in the corresponding section of this chapter..

[Audio] As you study the factors that influence drug action, you will develop an awareness of factors that influence the effects of drugs, particularly in older adults and pediatric populations. You will also explore the importance of and the components of teaching patients medication management. Finally, you will learn about the role of the pharmacy technician in medication safety..

[Audio] Chapter 4, Section 1, The Prescription. 4.1 The Prescription.

[Audio] A prescription is a written or oral direction for medication to be dispensed to a patient. It is issued by a physician or other licensed practitioner and filled by a pharmacist. The term prescription is used in noninstitutional settings, those that offer same-day patient care. These would include clinics or community pharmacies. An order, otherwise known as a medication order, is a prescription issued and dispensed in an institutional setting. An institutional setting is one that assumes total care of patients. Examples include hospitals and long-term care facilities..

[Audio] Table 4.1 lists the parts of a prescription as follows. Prescriber's information; date; patient's information; prescription symbol; inscription which includes the medication prescribed, strength, and amount to be dispensed; subscription which refers to the directions to the pharmacist on dispensing the medication; signa which communicates the directions for the patient to follow; additional instructions from the prescriber; and the prescriber's signature.

[Audio] Figure 4.1 illustrates the parts of a prescription. The pharmacy technician should always double-check these elements for accuracy and to ensure that all legal requirements have been met..

[Audio] E-prescriptions contain the essential elements of a prescription in an electronic format..

[Audio] Abbreviations are used in prescriptions by prescribers, pharmacists, and technicians. See Table 4.2 for abbreviations used in writing prescriptions. They are not used for patient instructions or for verbal orders. The patient instructions should be spelled out in full and phrased as simply as possible. Abbreviations can lead to medication errors. A medication error is a preventable event that may cause or lead to inappropriate medication use or patient harm..

[Audio] The abbreviations in the left column of this table have been identified as the cause of many errors and should never be used. The second column describes the potential problem introduced when the abbreviation is used. The third column provides the preferred alternative to the abbreviation in the first column..

[Audio] Institutions and hospitals have organizational policies on the prescribing, dispensing, administration, and documentation of medication administration. It is important that these policies address certain topics. In terms of medication orders, the policy should define which practitioners may prescribe medications, which format must be used, and if certain abbreviations may not be used. Institutional policies should define who may accept a verbal order and the process of transcribing the verbal order. Stop orders are used for medications that have a specific limit on the duration of use. A policy should be in place defining which medication orders will have an automatic stop. For controlled substances, policies should define the process and procedure on how controlled substances should be prescribed; who can prescribe them; and how they are stored, tracked, distributed, and documented..

[Audio] Chapter 4, Section 2, Correct Drug Administration Rights.

[Audio] The "rights" of medication administration offer guidelines for filling prescriptions. Throughout the process from prescribing through administration, this concept is used to prevent medication errors. A medication error can occur whenever the rights are not followed correctly..

[Audio] To make sure you have the right patient, verify the patient's name and use at least two patient identifiers before dispensing medication. These might include the patient's address, birth date, or phone number. To make sure you have the right drug, always check the medication against the original prescription and the patient's disease state. For determining that the right strength is correct, check the original prescription and pay attention to the age of the patient. As a double check for making sure that the right dose form is chosen, check the original label..

[Audio] As a way of making sure that the right route is chosen, check the physician's order. Check the prescription to determine the appropriate time for the medication to be administered. Some medications must be taken on an empty stomach, while others should be taken with food. In terms of documentation, you must accurately record that the correct patient has been given the correct medication with the right strength, route, and time..

[Audio] If something like a dose seems strange about a prescription, speak up. As a pharmacy technician, you are a valuable asset to your pharmacist. Your pharmacist will be glad you expressed your concern..

[Audio] Important information such as the drug name, dosage form, dosage strength, precautions, and usual dosage and frequency of administration will be provided on the medication dispensing container..

[Audio] Chapter 4, Section 3, Dosage Forms and Routes of Administration.

[Audio] A medication may be administered in many different forms for convenient and efficacious treatment of disease. The route and dosage form are determined by many factors. These factors include the disease state being treated, the area of the body that the drug needs to reach, and the drug's chemical composition. Each drug has its own characteristics related to absorption, distribution, metabolism, and elimination. The age and condition of the patient often determine the dosage form. For example, children and older adults often have special needs that influence dosage form and strength. Convenience may also play a role in dosage form selection..

[Audio] The oral route of administration is the most economical and most convenient way to give medications. The term oral means that the medication is given by mouth either in solid form or in liquid form. Once the medication enters the mouth, it must be swallowed to reach the stomach. Then it must pass to the area of absorption, most commonly the small intestine. A sublingual medication is placed under the tongue, whereas a buccal medication is placed between the cheek and gums administration. These routes are used when a rapid action is desired. When given by these routes, the medication enters the bloodstream directly from the richly vascularized mucous membrane of the mouth and produces its effects more quickly than drugs that are swallowed..

[Audio] When a drug is given by the parenteral route, it is given by injection. This route may be necessary for several reasons. For example, some drugs are inactivated in digestive juices or by first-pass metabolism. Swallowing them would be ineffective. Parenteral routes also offer the potential for quick absorption of injected medication into the bloodstream and a rapid effect. Parenteral products also offer an alternative during times when the patient cannot tolerate oral medications, such as during severe vomiting..

[Audio] Topical medications are applied to the surface of the skin or mucous membranes. The desired effect can either be local or systemic. Local effects are limited to a small area of the body while systemic effects involve the whole body. The inhalation route delivers medications to the respiratory system. The ophthalmic route describes administering medicine into the conjunctival sac of the eye. Drugs administered by the otic route are placed in the ear. Medications administered via the nasal route are given through the nose. Those that are given by the rectal route are inserted into the rectum. The primary advantage of rectal administration is that the medication does not depend on the digestive system to be absorbed into the bloodstream. Medications given by the vaginal route are inserted into the vagina..

[Audio] Chapter 4, Section 4, Factors That Influence Drug Action.

[Audio] A variety of factors can influence the effects of drugs and may require dosage adjustment. Children and older adults may require a reduced dose because of alterations in metabolism of drugs and reductions in excretion or elimination from the body. In these instances, if the dosage is not decreased, it may have toxic effects on the patient. Patients with specific diseases may be unable to absorb, metabolize, or excrete certain medications. Physicians also consider psychological and genetic factors when prescribing medications. Immune or allergic responses to food or medications are also evaluated before prescribing medications. An important role of the pharmacy technician is to ask whether the patient has had any new allergic responses in order to update the patient profile..

[Audio] Older adults have special needs in relation to their medications. Aging affects both the pharmacokinetics and the pharmacodynamics of drugs. In addition, older adults have more chronic diseases than the younger population and they typically take more medications. Aging can involve declines in both mental function, which is measured by the ability to continue to meet the demands of daily life, and physiologic well-being, which is the normal functioning of the body. Visual changes occur as the lenses of the eye become less elastic, more dense, and yellow. Auditory changes present as hearing loss, impairment of sound localization and loudness perception, and a delay in central processing of what is heard. Gastrointestinal changes with aging manifest as decreases in saliva production, esophageal motility, hydrochloric acid secretion, absorptive surface, and rate of gastric emptying. Older patients often complain of constipation. Pulmonary changes with aging include increased rigidity of the chest wall and decreased vital capacity, the maximum intake and exhalation. Aging also brings about a decreased response to both hypoxia, reduced oxygen in the blood, and hypercapnia, increased carbon dioxide in the blood..

[Audio] Cardiovascular changes include a decreased cardiac response to exertion and decreased cardiac output. Renal changes arising from aging include a decrease in the number of functioning nephrons, the structural and functional units of the kidney, and in renal blood flow. Older adults have a higher incidence of renal insufficiency, a reduced capacity to filter blood. Hormonal changes occur with some hormone levels increasing, some decreasing, and some staying the same. With aging, body composition changes bring about an increase in the proportion of total body weight composed of fat and a decrease in lean body mass. Albumin, the main blood plasma protein, production decreases with aging, and a loss of bone density from osteoporosis causes some loss of height..

[Audio] The physiologic changes outlined can alter the response to medications. The following factors play an important part in selecting a drug and its dosage. Absorption changes such as changes in GI function can affect the rate at which drugs dissolve and delay the intestinal absorption of some drugs. Distribution changes such as alterations in body composition with aging can affect the distribution of drugs and change their pharmacologic effects in older adults. Older adults may have impaired metabolism, which decreases clearance and allows the drug to accumulate, sometimes to toxic levels. Due to decreased kidney elimination of drug products in older adults, many dosages need to be reduced..

[Audio] The elderly tend to have a disproportionate number of adverse drug reactions. These are defined as unintended, harmful responses to a drug. Maintaining accurate medication profiles is important so that drug doses can be compared to the patient profile. A group of drugs that is especially important to monitor for older adult patients is included in the Beers Criteria. The Beers Criteria is list of potentially problematic drugs for older adult patients. Another problem is polypharmacy, which is the concurrent use of multiple medications. Polypharmacy can result from a patient seeing more than one physician, using multiple pharmacies, or not disclosing all of their conditions and medications. The final risk in older adults is nonadherence, or the failure to take a medication as prescribed. Some patients use a pillbox like the one shown on this slide to help with medication management. Nonadherence can take the form of failing to take the drug, unintentional overdosing, taking the medication for the wrong reason, or taking drugs prescribed for another person. It can result from an inadequate understanding of the need for the medication and the dosage directions..

[Audio] Providing drug therapy to children presents a unique set of challenges. Several factors should be considered when medications are prescribed for this patient population. Drug doses are based on body weight. Therefore, it is important to obtain an updated body weight with each new prescription. The OTC doses for very young or small children may not be on the package. In this case, the pharmacist may have to determine the child's dose for the caretaker. When OTC doses are marked on the package, the dosage should be appropriate for the child's age. As a safety measure, calculations for pediatric medications should be double-checked by a pharmacist and perhaps another pharmacy technician. All doses of chronic medication should be reevaluated regularly to account for patient growth..

[Audio] An allergy is a state of hypersensitivity of the immune system induced by exposure to a particular substance. Such a substance that causes an allergic reaction is called an allergen. Histamine is a chemical released by the body in response to an allergy. Histamines cause symptoms such as red, watery eyes; sneezing; urticaria; rash; and bronchiolar constriction. Allergies must be documented as part of the medical record..

[Audio] Life-threatening allergies may result in anaphylaxis. This may require that patient carries an epinephrine auto-injector. Antihistamines do not reverse anaphylaxis..

[Audio] The pharmacy technician must be keenly aware that dangerous allergic reactions are a possibility for some medications. One of the most important tasks for the technician is to screen patients for allergies. Allergies must be recorded before dispensing any drugs. The technician should enter NKA or NKDA if a patient has no allergies. NKA is the abbreviation for no known allergies while NKDA is the abbreviation for no known drug allergies..

[Audio] Chapter 4, Section 5, Teaching Patients Medication Management.

[Audio] The pharmacy technician can play an important role in helping patients learn how to manage medications. The pharmacy technician can positively affect patient adherence by providing clearly written instructions and aids. Recording the medication history in the patient's profile including OTC drugs can positively affect patient drug therapy. It is important for the technician to let the patient know that the pharmacist is available to answer questions or provide instructions. The pharmacy technician is permitted to read to the patient the exact wording on the label, medication guide, or educational materials. This is not considered counseling. Another way of helping patients manage their medication is to ensure that the patient knows how to read medication labels. It is important to keep in mind that, by law, no advice or counseling is to be provided by the technician..

[Audio] A medication container dispensed to a patient will sometimes include labels that provide instructions for how to self-administer the medication properly. These labels, referred to as auxiliary labels, use color and symbols to communicate their message..

[Audio] A medication regimen can be effective only if the patient or caregiver follows the directions for administration. When a patient does not adhere to instructions, there may be a relapse or aggravation of the disease. Numerous reasons for nonadherence have been identified. Side effects are a common reason. If a medication produces discomfort, the patient may discontinue its use. Patients may be willing to tolerate some side effects if they are aware of them and understand that they will experience relief over the long term. For this reason, side effects should be addressed initially. Failure to understand the disease or treatment is another reason for nonadherence. If a patient does not understand either of these, they may not understand the importance of consistent medication use. Confusion caused by complexity of a drug regimen can lead to nonadherence. Pharmacists and prescribers should evaluate therapeutic alternatives to optimize patient adherence. Confusion caused by cognitive impairment is yet another risk factor for poor adherence. Lastly, simple forgetfulness can result in poor adherence. Pharmacy technicians can encourage patients to use various reminders and alarms to help with this..

[Audio] Chapter 4, Section 6, Medication Safety. 4.6 Medication Safety.

[Audio] The complexity of the medication use process can lead to medication errors. The medication use process is an outline of the steps needed to provide medications to patients. It includes manufacturing, procuring, prescribing, filling or dispensing, administering, and monitoring medications..

[Audio] Pharmacy technicians are most involved in the dispensing step of the medication use process. Examples of potential errors include the following. Dispensing the incorrect medication from stock. Affixing the wrong label to a product. Dispensing the wrong medication to a patient. Incorrectly preparing the medication for dispensing. Delivering a medication to the wrong hospital unit. Filling a medication dispensing cabinet with the wrong medication..

[Audio] Medication errors can occur due to a number of reasons. The most common are rushing and miscommunication. Manu organizations have medication error reporting systems in which the person who identifies the error submits information regarding the incident. The institution or pharmacy then monitors and responds to these error reports. It is important to note that the purpose of error reporting systems is to improve patient care and make changes in the system to prevent the error from happening again. They are not meant to punish those involved in the original error..

[Audio] Technicians are an integral part of the medication dispensing system and pharmacists rely on them to catch and prevent errors. Technicians must verify the patient's address, date of birth, phone numbers, allergies, and conditions. Another role of the technician is to ensure the patient gets counseling from the pharmacist. E-prescribing is the process by which a prescriber enters a prescription into a computer program that communicates with the computer program at a pharmacy. This process can potentially reduce errors by eliminating illegible prescriptions. Another advantage of e-prescribing is that it automatically checks for drug allergies, interactions, dosing errors, and therapeutic duplications..

[Audio] Physician order entry, also called computerized physician order entry or CPOE, is the process by which a prescriber enters orders into a hospital database. The orders are then verified and dispense by pharmacy personnel. In hospitals, where physicians enter prescriptions into a database or electronic health record, a decrease in errors has been documented. Dispensing cautions apply to medications that must be dispensed in their original containers. Reasons for this requirement may include light or moisture sensitivity, or the requirement to be stored in glass. See Table 4.8 for examples of drugs that should be dispensed in original containers..

[Audio] Tamper-resistant prescription pads are required for prescribers who file for Medicaid reimbursement. If they are not used, the technician must call the prescriber to verify the prescription. Medication reconciliation is the sharing of information from patient profiles between community and hospital pharmacies. This process has been shown to improve patient safety during transitions of care. The purpose of reconciliation is to communicate drug therapy information to a patient's next care setting..

[Audio] Medication error reporting systems are designed to identify what mistakes have happened and where in the process the error occurred. The aim of these systems is to make changes in order to prevent another error from happening again. Risk Evaluation and Mitigation Strategy programs are mandated by the FDA for certain medications. The goal of these programs is to ensure that the benefits of a drug outweigh its risks. Requirements may include dispensing a medication guide or special dispensing and/or prescribing requirements..

[Audio] Chapter 4, Section 7, Understanding the Profession.

[Audio] As you pursue your studies, keep in mind your ultimate goals, one of which is obtaining certification as a pharmacy technician. Another is securing employment in your profession. It will be beneficial to familiarize yourself with several resourceful organizations. These include the Pharmacy Technician Certification Board, the American Association of Pharmacy Technicians, and the National Pharmacy Technician Association. These organizations offer highly informative websites and other resources you will likely find helpful as you advance in your chosen career..