Pharmacy Part 2

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Opthalmic Drugs Mechanism of Action Opthalmic diagnostic –

Back 1

Fluorescein sodium (Fluress) – a yellow water-soluble dibasic acid xanthine dye; produces intense green fluorescent. color in alkaline (pH>5) solution
Corneal defects appear bright green and are easily seen (resulting from trauma, infection, or other causes)

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Artificial tears:

Back 2

Relief of dry eyes, and eye irritation associated with deficient tear production

Front 3

Flourescein sodium:

Contraindications

Back 3

Hypersensitivity to product component

DO NOT use with soft contact lenses (resulting to contact lenses discoloration)

Front 4

Route of Administration Flourescein sodium:

Back 4

Topical strips

Front 5

Artificial Tears:

Back 5

Ophthalmic lubricant

Front 6

Mechanism of Action for Otic drugs
Otic Analgesic:

Antipyrine-Benzocaine (Auralgan)

Back 6

Antipyrine is an analgesic while benzocaine is a local anesthetic

Also has glycerin (vehicle with emollient, hygroscopic and humectant properties)

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Otic Antibiotic:

Neomycin and Polymixin B Hydrocortisone (Cortisporin)

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Hydrocortisone is a corticosteroid used for its antiallergic, antipruritic and anti-inflammatory effects

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Otic Ear Wax Removal Agent:
Carbamide Peroxide (Debrox)

Back 8

Wax dissolvers emulsify and disperse excessive build up of cerumen

Debrox is an antibacterial agent that releases oxygen to help remove cerumen accumulation

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Auralgan:

Back 9

Topical anesthetic for relief of pain from otitis media

Front 10

Neomycin-Polymixin B:

Back 10

Tx superficial bacterial infection of the external auditory canal
Used to treat infection of mastoidectomy and fenestration cavities (perforated tympanic membrane)

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Carbamide Peroxide:

Back 11

Removal of excessive ear wax build up

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Auralgan/Neomycin-Polymixin B/ Carbamide Peroxide:
CONTRAINDICATIONS

Back 12

Hypersensitivities to any of its components

Front 13

Insulin:
ANTIDIABETIC DRUGS

Back 13

Pancreatic hormone classified as a hypoglycemic drug; lowers blood glucose levels

Front 14

Insulin hormone can correct

Back 14

Polyuria (excessive urination)
Polydipsia (excessive thirst)
Facilitates the movement of potassium from the extracellular fluid into the cell

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Potassium (K+):

Back 15

K+ is necessary for:
Nerve impulse transmission
Contraction of muscles
Tissue growth and repair
Acid-base balance maintenance

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Indications:
Insulin

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+Diabetic Ketoacidosis
Life-threatening insulin deficiency (severe hyperglycemia)

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Indications:
Potassium

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+Replacement therapy for hypokalemia due to condition that increase potassium excretion or depletion:
ALKALOSIS

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Contraindications:
Insulin

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Episodes of hypoglycemia
Sensitive to any ingredient of the product

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Potassium
contraindications

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Severe renal impairment with oliguria
Hyperkalemia from any cause
Taking potassium-sparing diuretics
+Acute dehydration

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Patient Information
Insulin

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Do not change the type of insulin except medical supervision
+Monitor blood and urine glucose levels and keep daily results
Use same type of syringe unit to avoid dosage errors
+Strict diet, exercise program, hygiene, and avoid infection are essential
When prescribed new medication, ask whether it will change the effectiveness of your insulin

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Patient Information:
Potassium

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May cause GI upset, take after meals or with food and with a full glass of water

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Mechanisms of action:
Estrogens

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+Estradiol – most potent estrogen produced
Important in development and maintenance of the female reproductive system
Stimulate contraction of fallopian tubes
Promote ovum movement
Modify properties of cervical mucous
Restore endometrium after menstruation

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Indications:
Progestins

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Amenorrhea and dysmenorrhea
Endometriosis

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Indications:
Estrogens

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Contraceptives
Estrogen deficiency
Atrophic vaginitis
Female hypogonadism
Abnormal uterine bleeding

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Contraindications:
Progestins

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Hypersensitivity
Breast cancer
+Liver disorders
Thromboembolic disease

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Patient information:
Estrogens

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Notify physician if:
Pain in the groin or calves
Sharp chest pain or sudden shortness of breath
Abnormal vaginal bleeding
Missed menstrual period/suspected pregnancy
Lumps in the breast
Sudden severe headache, dizziness or fainting
Vision or speech disturbance
+Weakness or numbness in an arm or leg
Severe abdominal pain
Yellowing of the eyes or skin
Severe depression

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Mechanisms of Action
contraceptives

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Levonorgestrel and Ethinyl Estradiol (Levlen, Nordette)
Combination of a progestin and an estrogen hormone

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Indications:
Contraception for prevention of pregnancy

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Emergency contraception for pregnancy prevention following unprotected intercourse or suspected contraceptive failure

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Patient Information (Roach, pg 376)
contraceptives

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Take exactly as directed at intervals not exceeding 24 hours, preferably at the same time each day
Missing a pill info can cause spotting or light bleeding

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Isometheptine mucate, acetaminophen and di-chloral-phenazone (Midrin) (Schedule IV drug)

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Isometheptine Mucate is an unsaturated aliphatic amine with symphatomimetic properties;
Constricts dilated cranial and cerebral arterioles,
Reducing the stimuli that lead to vascular HA
Acetaminophen - Analgesic/Antipyretic
Raises pain threshold against all types of headaches
Dichloralphenazone
Mild sedative
Reduce patients emotional to the pain of both vascular and tension headaches

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Contraindications:
antimigraine drugs

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Glaucoma
Severe cases of renal disease
Hypertension
Organic heart disease
Hepatic disease
MAO inhibitor therapy

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Comprehensive Drug Abuse Prevention and Control Act of 1970

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Establishes 5 schedules, dependent upon a drugs:
Potential for abuse, Medical usefulness, Degree of dependence, if any

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Schedule I substances

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Highest potential for abuse and no acceptable medical usefulness
Examples:
Heroin
Marijuana
LSD
Peyote

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Schedule II substances:

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High potential for abuse accepted medical usefulness
Abuse leads to severe psychological and physical dependence
Examples:
Morphine (AMMAL)
Pentobarbital
Meperidine (Demerol – some AMMALS)
Amphetamines
Codeine

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Schedule III substances:

Back 35

Have a lesser degree of abuse potential with accepted medical usefulness
Abuse leads to moderate dependence.
Examples:
Paregoric
Tylenol No.3 (AMMAL)
Most codeine preparations, except cough syrups

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Schedule IV substances:

Back 36

Low abuse potential with accepted medical usefulness
Limited Dependence problems
Examples:
Diazepam (AMMAL INJ/TABS)
Isometheptine mucate, Acetaminophen, and Dichloralphenazone (AMMAL)

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Schedule V substances

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Lowest abuse potential, accepted medical usefulness
Very limited dependence.
Example:
Lomotil

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Bulk Stock safe

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Bulk custodian shall hold the combination

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Recording of combinations

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Combination change envelope (SF 700) shall be used and placed in the custody of the CO or officer designated in writing

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Changing of combinations

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Accomplished upon:
Change of custody
Any suspicion of compromise
+Not less frequently than every 24 months

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Perpetual Inventory of Narcotics, Alcohol, and Controlled Drugs (NAVMED 6710/5)

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Inventory pages for bulk and working stock narcotics
+Must be changed every 12 months;beginning of each CY
+Accurate quality control data of bulk and working stock medicinals shall be annotated on each page. (MFR, Lot #, Exp Date, MFR Date, NSN)

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CSIB Inventories

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Controlled Substances Inventory Board (CSIB) shall inventory at least quarterly or more often if transactions warrant

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The board is composed of at least 3 members
Minimum of 3 members must be present to conduct the inventory

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Senior enlisted personnel (E7-E9) and Department of the Navy civilians (GS7 and above) may serve on the board at the CO’s discretion

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Excluded from serving on the board are:

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Commanding Officer
Executive Officer
Supply Officer
Bulk Stock custodian
Working Stock custodian

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Supply Dept provides

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the senior member a copy of all issue documents of all controlled substances

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CONTROLLED DRUG PRESCRIPTIONS

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All authorized prescribers must prescribe controlled substances either by:
Electronic-order-entry or
DD 1289 or coded facsimile

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Authorized prescribers, are exempt from DEA registration if in scope of Controlled Substance Act;

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These prescribers must include on all prescriptions:
The prescriber's branch of service or agency
Social Security Number

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Prescription numbers for controlled substances:

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Preceded by the letter "C" and numbered sequentially
CO (or designated rep) must countersign IDC written prescriptions for controlled substances

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Use DEA Form 106 to report theft, lost or stolen of controlled substances:

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Send one copy to the nearest Naval Investigative Service (NIS) representative

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Submit a DD 200 request to the CO

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Identifying controlled substances to be destroyed
Reasons for destroying them:
- deterioration - sub-potency
- purity - identity compromised

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When request is CO approved, destruction must be:

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Presence of at least one CSIB member
For a two-person integrity

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The DD 200 form used for requesting destruction must contain:

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Complete nomenclature and qty to be destroyed
Method used to accomplish destruction
Signatures of the witnessing officer(s)

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NAVMED 6710/5

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+Records are kept on file for THREE years and destroyed at the beginning of a new calendar year.
A separate NAVMED 6710/5 shall be prepared for each controlled medicinals received
Lot numbers will vary

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CONTROLLED DRUG INVENTORY REPORT

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+Submit report to CO within 5 working days after inventory
Preparation includes:
+Cover sheet is memorandum format IAW correspondence Manual
From: + Senior Member, CSIB
To: Commanding Officer
Via: Executive Officer
Subject is: CONTROLLED SUBSTANCES INVENTORY REPORT FOR MONTH OF OCT 2007

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Body of the report must address:
CDIR

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Dates of last Bulk and Working Stock safe combination changes
Signature block contains all three members of the CSIB

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Appointment letter format:
Standard Naval Letter

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Prepared on command letterhead from the CO to the individual
+Signed by the Commanding Officer
Dated (usually stamped) at the time signed
Collateral Duties List
Cover letter to list is signed by CO
Appointment must be by name, not position; updated regularly