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77 Cards in this Set

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short term insommnia
more than 7 days, less than 3 weeks
transient insomnia
less than 7 days
long term insomnia
more than 3 weeks
insomnia lasting less than ___________ is self treatable with OTC medications
2 weeks
drugs approved for OTC treatment of insomnia
diphenhydramine and doxylamine
OTC sleep aids are contraindicated in people with
breathing problems, glaucoma, difficulty urinating due to enlarged prostate
Sleep aid - analgesic combos should only be recommended for patients who have_______
sleeplessness combined with occasional minor aches and pains
alternative therapies (sleep aids)
melatonin
valerian

neither proven safe or effective. should not be recommended
patient behaviors and practices that effect sleep
sleep hygiene
alcohol as a sleep aid
does induce sleep, but heavy drinkers subjected to more awakenings than normal
only sleep disturbance treatable with OTCs
insomnia
sleep efficiency
percentage of time in bed that one is actually asleep
sleep latency time
period of time from laying down to falling asleep
insomnia (definition)
unusual difficulty falling asleep and sleeping, sleep that is unusually disturbed, or sleep that causes the individual to suffer from residual daytime tiredness
caffeine, nicotine, alcohol
should be avoided to promote sleepfullness
most-dangerous sleep related problem
obstructive sleep apnea
OTC product
one that can be used safely by a person who reads and follows all instructions provided in the package insert
label content requirements
requirements for categories of information on the label
include: title, headings and time of information that must be included beneath each heading
label format requirements
specifies the method of presentation of that information
systematic approach to answering questions
(5 steps)
1. classification of the request
2. obtaining background information
3. systematic search
4. response
5. reclassification
modified systematic approach
(7 steps)
1. secure demographics of requestor
2. obtain background information
3. determine/catagorize ultimate question
4. develop strategy, conduct search
5. preform evaluation, analysis, synthesis
6. formulate/provide response
7. conduct follow-up and documentation
requestor demographics
position, training, anticipated knowledge, mechanism for delivery of response
background questions
"why is requestor asking for this information?"

-name/contact info/affiliation
-patient specific/ academic
-resources checked
formulation/provision of response
think about how info will be used.
present both sides of conflicting data
follow up
process of verifying the appropriateness, correctness, and completeness of a response following the communication
follow-through
process of readdressing a request based on availability of new data or a change in the situation/circumstances that were decisive factors in synth of response.
analysis
critical assessment of the nature, merit and significance of individual elements, ideas or factors

review/evaluation of weight of available evidence

negative findings should NOT be overlooked
synthesis
careful,systematic, orderly process of combining varied/diverse info/factors into a coherent response.

integration of info about patient, disease, and medication with background info to arrive at judgment or conclusion.
primary literature
journals.

original research results published for the first time
secondary literature
databases and search devices that lead to primary or tertiary

ie, PubMed
tertiary literature
references, textbook
adverse drug reaction
drug response that is noxious, unintended and occurs at NORMAL doses

harm directly caused by drug at NORMAL doses
medication error
any PREVENTABLE event that may cause or lead to inappropriate medication use or patient harm while the medication is in control of the healthcare professional, patient or consumer

inappropriate use of drug that may or may not result in harm
side effect
predictable or dose-dependent effect of drug that is not principal effect for which drug was chosen.

may be desirable, undesirable or inconsequential.
majority of medical errors result of _______________
faulty systems
swiss cheese model
gaps in defense, if line up, error occur

no indiv. caused the error --> system error
prescribing errors
med should have appropriate indication
order = legible
verbal order = minimized
include relevant patient info (ie weight, age etc)
avoid abbreviations
incl directions for use
dispensing errors
order reviewed by RPh
patient profiles = current
properly designed dispensing area
establish series of checks
labels read >3x
RPh counsel patients
communication errors
inability to reach prescriber
prescriber's unwilling to listen
omission of important patient info
insufficient drug identity knowledge
assumptions
patient factors (ie literacy, vision, etc)
administration errors
5 rights
-right drug
-right patient
-right dose
-right time
-right route

BARCODES
joint commission mandated do not use
NO:
trailing 0s
U for units

spell out drugs, use leading zeros
TALL man lettering
some letters capitalized to make differences in similar drug names stand out.

predniSONE
prednisoLONE
NDC
(national drug code)
# that identifies drug

00135 - 0315 - 52

labeler code (FDA) 00135
-firm that manuf., repacks, or distributes drug product
product code 0315
-strength, dosage form, formulation
package size 52
high-alert medications
meds that bear a heightened risk of causing significant patient harm when used in error
CDER
center for drug evaluation and research
ISMP
institute for safe medication practices
AHRQ
agency for healthcare research and quality
NCC MERP
national coordinating counsel for medication error reporting and prevention
quantitative
exact numerical measurements
qualitative
reported as a positive or negative result
accuracy
how close is mean to true value
precision
reproducibility of a measurement
screening test characteristic
high sensitivity (lower FN)
diagnostic test characteristic
high specificity
ability of test to identify POSITIVE RESULTS in patients who ACTUALLY have the disease
sensitivity

(true positive rate)
ability of test to identify NEGATIVE RESULT in patients who DON'T HAVE the disease
specificity

(true negative rate)
semiqualitative
associated with degrees of positivity or negativity
sensitivity
[TP / (TP + FN)] *100
specificity
[TN / (TN + FP)] *100
reference range
encompasses +/- 2SDs

95% of population
BUN
5-25 mg/dL
SCr
0.5 - 1.3 mg/dL
Chem 7 profile
includes:
Na. Cl. BUN Glucose
K CO2 SCr
Na
135 - 145 mEq/L
Cl
98 - 107 mEq/L
K
3.5 - 5.0 mEq/L
CO2
22 - 30 mEq/L
glucose
70 - 110 mg/dL
complete blood count (CBC)
HgB
WBC Plts
Hct
WBC
4000 - 11000 /mm3
HgB
male: 12 - 17 gm/dL
female: 11 - 15 g/dL
Hct
male: 40 - 50%
female: 38 - 47%
Plts
150,000 - 400,000 /mm3
critical value
result that is far enough outside the reference range that it indicates impending morbidity
number needed to screen

(definition)
number of people that need to be screened for a given duration to prevent one death or one adverse event
laboratory error
result that is not the true result

inaccurate results that occur because of error made by laboratory personnel or equipment
categories of drug-laboratory interactions
-methodological interference
-drug induced end-organ damage
-direct pharmacologic effect
-miscellaneous