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100 Cards in this Set

  • Front
  • Back
First use of drugs?
Socrates drank "hemlock" in 399BC
a)Magic Potion?
a)drinkable medicine or poison
b)drug taken to cure or reduce symptoms of an illness
c)biological substance, synthetic or non-synthetic, that is taken primarily for non-dietary
Greek term for drug
3 meanings of pharmakon
Remedy(healing context)
Poison(when possessing adverse effects)
Magic charm(magical qualities)
Perceptions/Beliefs of drugs will influence...(1)...and who does the influencing (2)
1)how ppl will utilize and believe in their actions

1)health professionals
2)drug companies
Federal Gov't came into controlling drugs b/c... (2)
1)more dangerous compounds/drugs on market
2)protect public health
re-defining a personal or social problem as a medical condition
a)treatment in the health care system
b)complicate diagnosis and treatment (particularly those w/ poorly defined symptoms or diagnostic criteria)
Diseases w/ poorly defined criteria (2)
Society develops beliefs about drugs and drug effects that... (2)
1)form the basis for their use
2)social context which they can be used
Consumer beliefs can vary widely from health professionals especially regarding... (2)
Individual perception of a symptom in conjunction with their social knowledge MAY suggest a health problem but...(3)
1)may not recognize symptoms as an illness
2)may ignore symptoms
3)may choose to do nothing
Rx drug sales in 2002
Total Rx's filled in 2002 (and how many filled by chain/independent)
(50% chain)
(25% independent)
% of Rx volume accounted for by generics
Patient Compliance can be bad when... (6)
1)patients do NOT follow directions
2)misunderstand directions
3)deviant/inappropriate behavior
4)lack of information
6)intelligent noncompliance
Intelligent noncompliance? and ex
Don't comply due to side effects; like using a drug that causes drowsiness when your job involves heavy machinery
Medication adherence def.
degree to which the patient can adhere to a therapeutic program
Compliance def. (w/o regards to drugs)
giving in to a request
Adherence def. (w/o regards to drugs)
to stay firm in supporting/approving
Which is more patient friendly compliance or adherence
Good Medication taking behavior will only occur if... (2)
1)benefit of proposed action outweighs negative consequences
2)agree w/ patients attitudes & beliefs toward health
Health consequences of poor compliance (4)
1)cant eval therapy accurately
2)patient dissatisfaction w/ care
3)affects outcomes of clinical trials
4)uncontrolled chronic diseases
Why are physicians unable to evaluate the results of therapy accurately if poor compliance?
Don't know if patient is non-responsive or noncompliant
beta-blocker heart attack trial
BHAT results regarding compliance
In ppl who consumed less than 75% of their meds:
Females- 2.5x more likely to die after MI
Males- 2.6x more likely to die after MI
BHAT results regarding placebo
placebo ppl w/ worse compliance were 2x more likely to die after an MI; prolly cause good compliance ppl have better lifestyles
Poor compliance is responsible for... (2)
5% of all hospital admissions
1.7% of all health care expenses
Direct Costs of poor compliance are felt where...(5)
2)additional office visits
3)additional drugs
4)ER visits
Indirect costs of poor compliance are felt where (3)
1)loss of productivity
2)lost wages
Outcomes for cholesterol w/ good and bad compliance
Good-40% decrease
Bad-10% decrease
Outcomes for HTN w/ good and bad compliance
Good-20mmHg decrease
Bad-10mmHg decrease
Outcomes for antidepressant w/ good and bad compliance
Good-90% who took 90% of their meds improved
Bad-None of patients taking less than 80% of their meds improved
Societal cost of noncompliance (2)
20 million lost work days
$1.5billion in lost earnings
What is the MOST important reason for elderly admission to nursing homes
Drugs that average good compliance (4)
1)ACE inhibitors
2)Ca channel blockers
3)oral hypoglycemics
4)antihyperlipidemics (statins)
Drugs that average BAD compliance (2) (and probable reason why)

ppl take them prn when should be taking them on schedule
3 groups of medication taking patterns
1)Near-optimal compliers
2)partial compliers
Near-optimal compliers
a)% of patients
b)characterists (2)
c)intervention reqd
d)TTM stage
b1)predictable medication-taking behavior
b2)closely adhere to recommended regimen
c)little to none
Partial compliers
a)% of patients
b)characterists (3)
c)intervention reqd
d)TTM stage
b1)accept principle of drug therapy (+ health belief model)
b2)compliance pattern is poor and inconsistent
b3)prone to consequences of variable drug levels
c)YES, this group benefits most from intervention
a)% of patients
b)characterists (2)
c)intervention reqd
d)TTM stage
b1)MARKED deviation in compliance behavior
b2)may deliberately misrepresent behavior
c)YES, but prolly wont do much good
Other group not technically counted and what % they make up?
Overconsumers (same % as non-compliers)
Hardest part about medication taking patterns?
figureing out who is in what group
Non-NCPIE strategies to improve medication adherence (3) (for chronic diseases)
1)single intervention strategies are RARELY effective in chronic diseases
2)multiple interventions w/ educational & behavioral strategies are most successful in chronic diseases
3)support must be regular and continuous
NCPIE Strategies to improve medication adherence (4)
1)provide information
2)Patient-centered counseling
3)behavioral reinforcement & patient support strategies
4)medication regimen strategies
Provide information (NCPIE) (3)
1)written and verbal
2)drug specific
3)disease info
Patient-centered counseling (NCPIE) (3)
1)respect patient concerns
2)talk to patients about need for compliance
3)emphasize responsibility for self-care
Behavioral reinforcement & patient support strategies (NCPIE) (4)
1)Cues- link medication taking to daily activities
2)compliance packaging or compliance aids
3)include support of family/friends
4)refill reminders from the pharmacy
Medication Regimen Strategies (NCPIE) (4)
1)tailor regiment to lifestyle
2)simplify regimen
3)break treatment plan into stages
4)consider new DDS
What dosing schedules have "good compliance" (75%), what have bad
qd, bid

tid, qid
Hospital origin...
charitable institutions
How did the US medical system become "scientific based"
AMA adopts Flexner report
After Flexner hospitals became...
teaching and research center for the practice of medicine
____ provides financial stability for hospitals and is also...
health insurance

critical for funding new technologies
Hospitals grew as a result of...and this increased...
Hospital Survey Construction Act (hill-burton)

increased demand for health care
____ is reqd for chronic diseases
Continuum of care
DRG (Diagnosis Related Groups)
a)what are they?
b)when and what implemented them
c)how did they affect hospital pharmacies
d)and involved 2 other things
a)payment mechanism to control spending (standard payment for a procedure)
b)1983, Medicare Part A
c)went from profitable entity to controlling costs
d)Unbundling of services and Medicare Part B fee schedule
Medicare Part A is...
B is...
B)getting ppl out of hospital to save $
Ex of DRG
Pt can only spend x on drugs, x on surgery, x on room and board; above x the hospital has to pay for
Horizontal Integration (in reference to a hospital)
Like sending surgeries to other building
Vertical Integration (in refernce to a hospital)
bring a surgery center into the hospital
Hospitals are classified by... (7)
1)length of stay
2)type of services provided
6)# of beds
7)multihospital chains
Hospital competition came about b/c of...
capitated ways of financing health care (eg: DRGs)
Hospital management (3 sources from highest to lowest)
1)board of trustees in nonprofit; board of directors in for profit
2)hospital administration
3)medical staff
Organizational structure of a hospital (3 types)
1)Direct patient care services
2)Ancillary services
3)Support services
Direct patient care services (3 of many)
nursing, surgery, emergency, etc...
Ancillary services (3)
3)diagnostic imaging
Support services (4 of many)
3)materials management
Hospitals must get Accreditation b/c of.... (2)
1)1918 American College of Surgeons developed first accreditation standards
2)1951 Joint Commission on Accreditation of Healthcare Organizations developed standards
Pharmacist Roles in a hospital based practice (6)
1)Director of Pharmacy
2)Assistant Director of Pharmacy
3)Staff Pharmacist
4)Clinical Staff Pharmacist
5)Staff Pharmacy Technician
6)Medication Safety Officer
Responsibilites of Hospital Pharmacy Department (5)
1)Drug distribution systems
2)centralized pharmacy services
3)decentralized pharmacy services
4)IV admixture services
5)Non distributive pharmacy services
Hospital formulary system
a)what is it?
b)what decisions do they make?
a)list of drugs you can use in a system
b)adding or deleting drugs to and/or from the system
2 types of hospital formulary systems and the difference
1)closed system (HF not open for discussion)
2)open system
Hospital formulary system is decided by...
Pharmacy and Therapeutics Committee (usually headed by pharmacist)
P&T committee overall fxn
purchasing and inventory control
Careers in hospital pharmacy (5)
5)career fair
Hospital adapted to changes in medicare reimbursement by...
unbundling services
CEO is an example of...
hospital administration
Hospital formulary systems are designed to...
control drug costs in hospital
Who gets "Ambulatory care" and what is it?
a)Person presenting for personal health services who is not bedridden nor admitted to any health care institution
b)outpatient care that does not involve an overnight hospital stay
What established Ambulatory Care?
1983 Medicare Prospectie Payment System
Ambulatory Care Providers? (5)
3)nurse practitioners
Types of medical practices (3)
3)managed care organizations
2 types of managed care organizations
prepaid health plan where employers employers pay fixed fee (only can see certain MDs)
contract w/ health providers to get discounts, lets ppl go to MDs outside approved list for a fee
Settings providing ambulatory care? (6)
1)hospital clinics
2)teaching hospital clinics
3)surgery centers
4)free-standing diagnostic imaging
5)home IV services
6)home health care
Hospital clinics providing ambulatory care is an example of....
vertical integration
Indian Health Services (IHS)
a)established by...
b)type of clinics available (3)
a)early treaties that said that Indians would be provided health services
b)hospitals, ambulatory health centers, others
Pharmacists role in IHS ambulatory care model? (3)
1)take histories
2)perform physical assessments
3)prescribe treatment including Rx medication
IHS steps for counseling patients (5) and KEY
1)verify pt knowledge
2)purpose/use of drug
3)what to expect
4)fill in gaps w/ info pt can understand
5)final verification and arrangement of follow up

Ambulatory Pharmacy Services (pharmacy careers are available where?) (3)
1)hospital outpatient clinics
2)primary care and family practice clinics
3)community pharmacy
Long Term Care (LTC) definition
health, social, residential services provided to chronically disabled persons
5 ADL's (activites of daily living)
5)food preparation
How to decide on the type of Long Term Care (5)
1)level of disability
2)availability of informal caregivers
3)financial circumstances
4)availability of public programs
5)other personal circumstances
Risk factors for institutionalization in an LTC (10)
1)advanced age
2)diagnostic condition
3)living alone
4)Problems w/ ADL's
5)mental status
7)low social support
9)outpatient admissions
10)hospital admissions
Ppl who require LTC services (4)
2)patients w/ chronic diseases
3)patients w/ rehabilitative needs
4)patients w/ terminal illness
Financing LTC (4)
3)private insurance
4)out of pocket resources
Cost of nursing home per year
Cost of assisted living per year