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34 Cards in this Set
- Front
- Back
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What is CAM?
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CAM - Complementary and Alternative Medicine
-A complex mixture of several ingredients --> limited info on its efficacy/potency |
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What does CAM include? What kinds of medicine?
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Herbal
Homeopathic (gives small doses of symptoms) Neutraceuticals (medically active foods) Acupuncture Massage/Aroma Therapy |
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The German Commision E Ref incl?
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Regualted by german govt
monographs of useful herbs incl side effects, indications, interactions |
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What is NCCAM?
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Nat' Center for CAM
Best source for herbs! |
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Stockley's Herbal Drug Interactions Ref incl?
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info on herbs; supplements; food items;
Monograph contains: synonyms; species; source; compounds; constituents; uses and indications; pharmacokinetics; interaction overview |
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Stockley's Ref Monograph Cont:
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abstract; clinical evidence/citations; references; recomm. for management;
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Stockley's Interaction Ratings
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Action: avoid --> no actions needed
Severity: severe --> nothing expected Evidence: weight of evidence? Extensive ---> theoretical/weak |
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Natural Medicines Comprehensive Database
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Evidence-based monographs; scientific names; uses; safety; effectiveness; adverse rxns; dose admin; interactions and ratings; ref
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Nat. Med Comprehensive Database: Safety ratings?
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Likely safe: appropriate
Possibly safe: some evidence of safety but not high quality evidence Possibly unsafe: advise not to take Likely unsafe: discourage use Unsafe: high level of evidence it is not safe |
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Nat. Med Comprehensive Database: Effectiveness ratings?
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Effective: very high clinical evidence
Likely effective: appropriate to rec; high level clin. evi Possibly effective: some clinical evidence supporting use Possibly INeffective: advise people not to take Likely Ineffective: discourage use Ineffective: high evidence not effective |
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Nat. Med Comprehensive Database: Interaction Ratings?
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Severity: high; mod; mid; insignif
Occurrences: likely; probably; possible; unlikely |
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Stockley's Interaction Pictures/Symbols
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Stop sign, X: life threatening
Yield sign; !: concurrent use may be hazardous Yield sign; ~: maybe hazardous but data is poor square; ~: soubt about outcome; consider monitoring circle; check mark: interaction not significant; none occurs |
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Handbook of Drug-Nutrient Interaction
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Overview of mechanism; influence of nutritional status on drug disposition; effect; drug-nutrient interactions. and in specific conditions.
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Homeopathy
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Admin of small quantities of meds that if given in large doses would generate symptoms of disease being treated.
Homeopathic Pharmacopeia of the US |
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The Review of Natural Product: Ref
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Monograph with reference; updated monthly; evidenced-based herb-drug interaction tables;
Appendix incl info on use during pregnancy and lactation |
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AltMedDex: Ref
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NOT REC as primary source for herbal
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Common features of research designs
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indep variable
depend. variable extraneous variables research hypothesis |
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Independent variables also called
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exposures
antecedent events treatments interventions it gets manipulated! |
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Dependent variable
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Effects on I.V
Objective & measurable Can incl both primary and secondary outcomes primary: most pertinent info secondary: supporting evid. |
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Types of Research Designs (3)
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Descriptive
Observational Experimental |
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Descriptive Research (2)
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Case study
Case series Sources: pharmacotherapy; annals; NE journal of medicine; Morbidity & mortality reports |
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Observational Research (3)
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Case-control study: groups are DEFINED BY OUTCOME (btw outcome and something happening before -backwards)
Cohort study: groups are DEFINED by EXPOSURE of variable (relationship btw exposure & outcome... goes forward). Cross-Sectional study: relationship btw exposure and outcome at a single point in time or short interval. Looking at a snapshot at a particular point in time. |
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Experimental Research (2)
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Randomized Controlled Trial
-placebo or active control -placebo control is GOLD standard to det. efficacy or safety of an intervention. -CONSORT publishes guidelines |
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Elements of Negligence 4D's
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Duty breached: legal v. ethical v. moral
Damages Direct causation Defenses Absent |
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Liability in provision of DI
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incomplete info; inappropriate quality info; outdated; inapp analysis; poor dissemination of info
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Incomplete info:
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failt to warm of ADR; fail to do a complete search; medication guides not incl.
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Inapprop info
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wrong info or inaccurate
did not consult correct source or did not find correct answer Ex: Calis |
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Outdated info
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consulted old reference
old package insert |
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inappropriate analysis of info
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pharmacist's role is to INTERPRET; EVALUATE; and PROVIDE a recommendation.
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ASHP guidelines for documenting info - general info
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date time received
requestor's name, role person who received call how was it received (phone, email) question? classification of request |
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ASHP guidelines for documenting info -- pertains to question
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pt-specific info obtained
response reference date time response/ talked to who materials provided to requestor outcome measure if appropriate |
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Ways to minimize liability
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Do not trust your memory
Do not present only positive data Do not extrapolate pediatric dose from adult Do not recommend unapproved dose Do not recomm. dose or use based on foreign lit/ or animal studies Triage question appropriately |
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Ethical Issues (5categories)
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Confidentiality
Truth telling Social Responsibility Professional v. private ethics: what you want to do vs. what you should do. Paternalism: person wants to know your idea/opinion |
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Beneficence what is it?
Nonmaleficence? |
duty to promote good and act in the best interest of pt and health
Nonmaleficence: duty to protect and do no harm |
