Download Medication Safety and Management: A Comprehensive Guide for Healthcare Professionals and more Papers Pharmacy in PDF only on Docsity!
A Note of Thanks & Your Invitation to Impact
Congratulations on kickstarting your journey to PTCB exam success with our Study Guide! Your dedication to excellence is inspiring, and we're thrilled to be part of your journey. If you find the guide helpful as you delve into it, we would be honored if you could leave us a review. Beyond enriching our work, a review from you also helps other aspiring pharmacy technicians like you navigate their study paths.
SCAN THE QR CODE TO LEAVE A REVIEW
(it only takes you 60 seconds)
If you prefer, you can leave a review also using the link below:
https://www.amazon.com/review/create-review/?asin=B0CVF2F7MC
Thank you for choosing High Score Publishing - where your career leap is our mission. P.S. Should you have any insights or suggestions for how we can make our study guide even better, don't hesitate to reach out to us at guide.delivery@highscorepublishing.com. Your suggestions are the key to refining our resources and helping future pharmacy technicians achieve their goals.
TABLE OF CONTENTS
- SECTION 1: Medications
- Drug Names and Classification
- Pharmacodynamics
- Pharmacokinetics
- Drug Metabolism
- Drug Elimination
- Generic and Brand Names
- OTC (Over-the-Counter) Medications....................................................................................................
- Supplement Drugs...................................................................................................................................
- Therapeutic Equivalence and Dosage
- Drug Dosage Forms
- Half-Life
- Drug Classifications
- Drugs Related to The Nervous System
- Cardiovascular System Drugs
- Digestive System Drugs..........................................................................................................................
- Renal System Drugs................................................................................................................................
- Respiratory System Drugs
- Endocrine System Drugs
- Antimicrobial Drugs
- Reproductive System Drugs
- Most Common Drugs List
- Drug Interactions, Indications, Contraindications
- Drug Interactions
- Common Drug Interactions to Know for The PTCB Exam:
- Routes of Drug Administration:
- Enteral Route:
- Local Route:
- Parenteral Route
- Special Drug Handling............................................................................................................................
- Side Effects, Adverse Effects and Allergies
- Drug Side Effects and Adverse Effects
- Allergic Reactions...................................................................................................................................
- Drug Stability..................................................................................
- Narrow Therapeutic Index (NTI) Medications
- Drug Compounding and Storage.....................................................
- Sterile Compounding
- Non-Sterile Compounding
- Procedures to Compound Non-Sterile Products
- Physical and Chemical Compounding Incompatibilities
- SECTION 2: Federal Drug Regulations
- Handling and Disposal of Pharmaceutical Substances and Waste
- Federal Laws
- State Laws
- Pharmacy Technician Code of Ethics
- Role of Pharmacy Technician in Record-Keeping and Documentation
- Federal Requirements for Controlled Substance
- CSA Classification
- Controlled Substances Prescription Refills and Transfer
- Controlled Substances Records and Inventory
- Poison Prevention Packaging Act
- Restricted Drug Programs
- FDA Recall Requirements: Recalls, Corrections, and Removals (Devices)
- SECTION: 3 Patient Safety and Quality Assurance
- Medication Safety and Quality Assurance
- Prescription Errors
- Hygiene and Cleaning Standards
- SECTION 4: Order Entry and Processing
- Pharmacology Calculations.............................................................
- Alligations
- Storage and Disposal
- Drug Order Entry and Processing
- Test 1: QUESTIONS
- Test 1: ANSWERS........................................................................
- Test 2: QUESTIONS
- Test 2: ANSWERS........................................................................
- Test 3: QUESTIONS
- Test 3: ANSWERS........................................................................
- References
- Credits
SECTION 1: Medications
This section covers the classification of drugs, indications and contraindications, drug interactions, route of drug administrations, allergies, Narrow therapeutic index and drug compounding and storage.
Drug Names and Classification
Pharmacology encompasses the study of the effects and actions of drugs or medications on living organisms, including their interactions with human physiological systems. It can be broadly categorized into two branches: pharmacodynamics and pharmacokinetics.
Pharmacodynamics
Pharmacodynamics is the field dedicated to understanding how drugs exert their effects. One of the primary ways drugs achieve this is by interacting with specific receptors found in cell membranes or intracellular fluid. Agonist and antagonist:
- The degree of receptor activation and the resulting biological response is directly influenced by the concentration of the activating drug, known as the 'agonist.' The potency of a drug, acting as an 'agonist', is determined by its concentration, which in turn affects the degree of receptor activation and the resulting biological response. As the dose of the drug increases, so does its effect, up to a point where the maximum response is achieved. Beyond this point,
- further increases in dose will not produce a greater effect. This relationship is quantified using a dose-response curve, which delineates the escalation of the drug's effect with increasing doses, illustrating the saturation of receptors as the drug concentration rises. This curve is vital for understanding the drug's efficacy and establishing the optimal therapeutic range. Various factors, including patient-specific elements such as age and underlying medical conditions, can influence the interplay between drugs and receptors.
- Additionally, other drugs competing for binding at the same receptor, known as receptor 'antagonists ,' can also impact the pharmacodynamic relationship. Different drugs acting on the same receptor or tissue can exhibit varying levels of efficacy, determining the magnitude of their biological responses and potency, which denotes the required drug dosage for a response. Drug receptors can be categorized based on their specific response to various drugs, enabling a more comprehensive understanding of their mechanisms.
Pharmacokinetics
The principle of pharmacokinetics, influenced by the philosophy of Paracelsus, states that "only the dose makes a thing not a poison." In essence, the dose determines whether a substance acts as a drug or a poison.
At therapeutic doses, a chemical substance is considered a drug, whereas, at higher or non-therapeutic doses, it becomes toxic. Pharmacokinetics is a scientific field that examines drug absorption, distribution, metabolism, and excretion (ADME) within the body. It delves into how the body processes and interacts with drugs, including the study of associated toxicity (ADMET). All four processes (ADME) require in-depth investigation to fully understand the pharmacokinetics of a drug. These processes involve the movement of drugs across cellular membranes within the body. Nonpolar, lipid-soluble (lipophilic) drugs can directly dissolve into the lipid bilayer of membranes, allowing them to cross easily. On the other hand, polar drugs face challenges in crossing membranes. Let us look more closely at the four processes:
- Absorption , the first process, refers to the drug's movement from the site of administration into the bloodstream. Drugs can cross membranes through passive absorption, facilitated diffusion, or carrier-mediated diffusion. o Factors such as molecule size, lipophilicity, and pH environment influence the rate of absorption. o For instance, acidic drugs are better absorbed in the stomach's acidic pH, while basic drugs are more efficiently absorbed in the alkaline pH of the intestine.
- Distribution , the next process, involves the movement of drug molecules throughout the body to reach their target sites. o Tissue perfusion rates (blood flow to tissues) play a crucial role in determining drug distribution. Highly perfused tissues receive a greater proportion of the drug.
- Metabolism , or biotransformation, is the process by which the body transforms drugs into water- soluble metabolites for easy excretion through the kidneys. This process is essential because drugs and chemicals are considered foreign substances (xenobiotics) in the body. Metabolism converts lipophilic drugs into hydrophilic forms, promoting their elimination. In some cases, the metabolites may even be more active than the original drug. Enzymes act as biological catalysts in the metabolism process. Some enzymes are highly specific, targeting specific compounds, while others, like pepsin, have broader enzymatic activity. o Phase I metabolism chemically transforms drugs through oxidation, reduction, and hydrolysis. o Phase II metabolism involves conjugating the drug or its metabolites with polar groups, such as sulfates and glucuronides, to facilitate excretion.
- Excretion is the final process of eliminating drugs from the body. Some drugs exit the body unaltered, while others are transformed into hydrophilic metabolites and excreted via urine or bile. Natural routes of drug elimination include tears, sweat, breath, and saliva. Patients with kidney or liver impairment may have elevated drug levels in their system due to decreased metabolism, necessitating careful monitoring of drug dosage to avoid toxicity. Applications of Pharmacokinetics extend to various areas of biomedical sciences:
- Pharmacological Testing: Here, pharmacokinetic principles are vital for establishing the relationship between drug concentrations and their pharmacological effects. This is key in determining the optimal therapeutic dose that maximizes efficacy while minimizing side effects, as well as in choosing the most effective route of administration.
- Toxicological Testing: Pharmacokinetics plays an important role in evaluating the distribution of drugs within tissues and their potential toxicity, providing insights crucial for safety assessments.
o Transferase enzymes, including uridine diphosphate (UDP)-glucuronosyltransferases, sulfonyl transferase, and glutathione transferases, catalyze these reactions. The resulting conjugated metabolites have increased molecular structure, size, weight, and polarity. Drug metabolism holds significant importance as it leads to the pharmacological inactivation of drugs, rendering metabolites with reduced or no pharmacological activity. Conversely, it can also result in toxicological activation, producing metabolites that exhibit high tissue reactivity and potential harm. Additionally, drug metabolism can facilitate the pharmacological activation of prodrugs, converting them into highly active forms to enhance their therapeutic effects. Drug Elimination Elimination of drugs and their metabolites from the body occurs through a vital process known as excretion. This process involves the transfer of substances from the internal environment of the body to the external environment. Effective excretion of the unchanged drug is crucial for terminating its pharmacological effects. Among the various organs involved in drug excretion, the kidneys play a primary role. Non-renal excretion through organs such as the
- Lungs
- Intestines
- Biliary system
- Salivary glands Drugs and metabolites can be excreted through several pathways, including:
- Urine
- Feces
- Exhaled air
- Saliva
- Sweat
- Milk Urine : Polar, non-volatile, and relatively small-sized drugs or metabolites (less than 500 Daltons) that undergo slow metabolism are typically excreted in the urine. The kidneys primarily handle drugs' excretion and metabolites to varying extents.
- For instance, Gentamicin is exclusively eliminated through renal excretion. Feces : The unabsorbed fraction of drugs found in feces is derived from bile. The liver plays a role in transporting organic acids, organic bases, lipophilic drugs, and steroids into bile through specific active transport mechanisms. Relatively larger molecules (with a molecular weight greater than 300 Da) are eliminated through bile.
- Examples of drugs that exhibit higher concentrations in bile include erythromycin, ampicillin, rifampin, tetracycline, oral contraceptives, and phenolphthalein. Some drugs, such as anthracene purgatives and heavy metals, may also be excreted directly in the colon.
Exhaled Air : Gases and volatile liquids, including general anesthetics, paraldehyde, and alcohol, are eliminated through the lungs. The transfer of these substances occurs in the alveoli and depends on their partial pressure in the blood.
- Additionally, the lungs serve as a filtering mechanism, eliminating any particulate matter that may have been injected intravenously. Saliva and Sweat : Certain drugs can be excreted in sweat and saliva. Saliva and sweat can contain significant amounts of substances such as lithium, rifampicin, potassium iodide, and heavy metals.
- In the case of saliva, most of it, along with any drug present, is swallowed and follows a similar pathway to orally administered drugs. Milk : During lactation, some drugs may be excreted in breast milk. While this excretion may not pose significant concerns for the mother, the nursing infant unintentionally receives the drug. Drugs mainly enter breast milk via the process of passive diffusion.
- Lipid-soluble drugs with lower protein binding are more readily excreted in milk. The administration of tetracyclines to lactating mothers can have adverse effects on the nursing infant, such as tooth discoloration. Generic and Brand Names Each medication possesses a designated generic name , which serves as its approved name. Medications with similar therapeutic actions often share similar-sounding generic names, creating groups of related medicines. For instance, phenoxymethylpenicillin, ampicillin, amoxicillin, and flucloxacillin belong to a single group of antibiotics. The brand name is the selection of a name made by the manufacturing company. It is possible for multiple companies to produce the same generic medicine, each with its own unique brand name. The choice of brand name is often influenced by factors such as memorability for advertising purposes or the desire for a name that is easier to pronounce or spell compared to a generic name. For instance, " paracetamol " is a generic name, while various companies produce it under brand names such as Panadol®, Calpol®, and others. OTC (Over-the-Counter) Medications Over-the-counter (OTC) medications, also known as non-prescription medicines , provide a convenient solution for addressing various health concerns without the need for a prescription. These readily available products are safe and effective when used as directed, making them a popular choice for individuals seeking relief from common symptoms. These include drugs such as pain relievers and cough suppressants.
- In the United States, the market offers more than 80 classes of OTC medications , catering to a multitude of health needs.
- Renowned examples include well-known pain relievers like: o Acetaminophen (Tylenol) o Ibuprofen (Advil, Motrin) o Cough suppressants such as dextromethorphan (Robitussin) o Antihistamines like loratadine (Claritin 24H)
Vitamin D (Calciferol):
- Function: Aids in bone and teeth formation and helps with the absorption of calcium and phosphorus.
- Sources: Sunlight, fortified dairy products, and fatty fish.
- Indications: Vitamin D deficiency, rickets, osteoporosis.
- Contraindications: Hypercalcemia, sarcoidosis, certain cancers. Vitamin E (Tocopherols):
- Function: Acts as an antioxidant, protecting cells from damage.
- Sources: Nuts, seeds, vegetable oils, and leafy greens.
- Indications: Vitamin E deficiency, antioxidant support, skin health.
- Contraindications: Bleeding disorders, high doses without medical supervision. Vitamin K (Phytomenadione):
- Function: Essential for blood clotting (coagulation).
- Sources: Leafy greens, broccoli, and vegetable oils.
- Indications: Vitamin K deficiency, bleeding disorders, osteoporosis.
- Contraindications: Anticoagulant therapy and certain medications (e.g., warfarin).
Water-Soluble Vitamins:
Vitamin C (Ascorbic Acid):
- Function: Aids in the healing of wounds, the functioning of the immune system, and the synthesis of collagen.
- Sources: Citrus fruits, peppers, berries, and leafy greens.
- Indications: Vitamin C deficiency, immune support, skin health.
- Contraindications: Iron overload conditions, kidney disorders (high doses). Vitamin B1 (Thiamine):
- Function: Important for normal appetite and nervous system function.
- Sources: Whole grains, beans, nuts, and pork.
- Indications: Thiamine deficiency, nerve disorders, alcoholism.
- Contraindications: Allergy or hypersensitivity to thiamine. Vitamin B2 (Riboflavin):
- Function: Essential for vision and maintaining healthy skin.
- Sources: Dairy products, mushrooms, leafy greens, and lean meats.
- Indications: Riboflavin deficiency, skin disorders, migraines.
- Contraindications: Allergy or hypersensitivity to riboflavin. Vitamin B3 (Niacin):
- Function: Supports digestion, appetite, and healthy skin.
- Sources: Meat, fish, whole grains, and legumes.
- Indications: Niacin deficiency, high cholesterol, pellagra.
- Contraindications: Liver disease, active peptic ulcers.
Vitamin B5 (Pantothenic Acid):
- Function: Involved in hormone formation and nutrient metabolism.
- Sources: Meat, avocados, broccoli, and whole grains.
- Indications: Pantothenic acid deficiency, skin conditions, adrenal support.
- Contraindications: None known. Vitamin B6 (Pyridoxine):
- Function: Important for red blood cell formation, insulin production, and hemoglobin synthesis.
- Sources: Poultry, fish, bananas, and potatoes.
- Indications: Pyridoxine deficiency, anemia, PMS symptoms.
- Contraindications: High doses without medical supervision. Vitamin B7 (Biotin):
- Function: Supports protein and carbohydrate metabolism.
- Sources: Eggs, nuts, seeds, and sweet potatoes.
- Indications: Biotin deficiency, hair and nail health, glucose metabolism.
- Contraindications: None known. Vitamin B9 (Folic Acid):
- Function: Essential for red blood cell formation and prevention of neural tube defects during pregnancy.
- Sources: Leafy greens, legumes, fortified grains, and citrus fruits.
- Indications: Folic acid deficiency, pregnancy support, heart health.
- Contraindications: Recent chemotherapy, untreated vitamin B12 deficiency. Vitamin B12 (Cobalamins):
- Function: Necessary for red blood cell production, energy metabolism, and provides nutrients for collagen synthesis.
- Sources: Meat, fish, dairy products, and fortified cereals.
- Indications: Vitamin B12 deficiency, anemia, nerve disorders.
- Contraindications: Allergy or hypersensitivity to cobalamin, certain medications (e.g., metformin).
- Proportion Method : Like the Ratio (Rainbow) Method, the Proportion Method utilizes cross- multiplication. Step 1: Set up proportions. Step 2: Cross multiply. Step 3: Solve for "x" algebraically.
- Formula Method : The Formula Method employs an equation to calculate an unknown quantity (x), like the ratio/proportion method. Conversion factors are utilized in drug calculations. D/H × Q = Dose Dose ordered (D) / supply on hand (H) × Quantity (Q) = answer
- Dimensional Analysis : This method follows the formula Dose ordered (D) × Quantity (Q) / supply on hand (H) = dose. Dimensional Analysis is employed when calculating the number of medications or drugs needed for a patient, given that the medication's strength is already known. Additionally, drug dosage strategies involve considering the volume of distribution (Vd ) and are categorized into loading dose and maintenance dose. A loading dose, administered initially, aims to quickly achieve the steady-state, while a maintenance dose is given subsequently to maintain a lower plasma concentration of the drug. This strategy is implemented for patients experiencing severe pain or emergencies requiring rapid relief. Half-Life Half-life is the time required for the drug concentration in the body or plasma to decrease by half. It is denoted as t½. The half-life refers to the period needed for the concentration of a medication in the body or plasma to reduce by fifty percent. It is represented as t½. The plasma half-life refers to the duration it takes for the concentration of the medication in plasma to diminish by half of its initial amount. Understanding half-life is essential as it determines the duration of action, time to reach a steady state, and dosing frequency. The estimation of time for drug elimination is critical for determining the total drug elimination duration. The elimination half-life (t1/2) is the time taken for the drug amount and plasma concentration to decline by 50% from the initial value. It depends on parameters such as clearance (CL) and apparent volume of distribution (Vd). Note : The half-life is directly proportional to Vd and inversely proportional to CL, meaning an increase in Vd prolongs the half-life, while a decrease in clearance shortens it. Approximately five half-lives are required for a drug to be eliminated by about 97%. Thus, it is commonly stated that a drug has no pharmacological action after four half-lives since approximately 97% of it is eliminated from the body. The elimination rate constant (KE) describes the rate at which a drug is t1/ 2 = 0.693 Vd/Cl
removed or excreted from the body. It is represented as a fraction of the substance eliminated per unit of time. KE is the sum of rate constants for various elimination processes, including urinary excretion, metabolism, biliary excretion, and pulmonary excretion.
depression and certain anxiety disorders. Contraindications include concurrent use of SSRIs, TCAs, and foods high in tyramine. o Examples include Phenelzine, Tranylcypromine and Isocarboxazid.
- Antipsychotics:
- Typical Antipsychotics : Blocking dopamine receptors, typical antipsychotics are used for treating schizophrenia and other psychotic disorders. They should be avoided in individuals with Parkinson's disease, blood dyscrasias, and liver disease.
- Atypical Antipsychotics : Acting on various neurotransmitter systems, including dopamine and serotonin receptors, atypical antipsychotics are prescribed for schizophrenia and bipolar disorder. Contraindications include QT prolongation, dementia-related psychosis, and uncontrolled diabetes.
- Anxiolytics: Anxiolytics are used to reduce anxiety and promote relaxation in the treatment of generalized anxiety disorder and other anxiety-related conditions.
- Buspirone is A non-benzodiazepine anxiolytic drug acting on serotonin receptors. Buspirone is prescribed for generalized anxiety disorder. Contraindications include concurrent use of MAOIs, liver impairment, and hypersensitivity.
- Antiepileptic Drugs (AEDs):
- Sodium Channel Blockers : These drugs inhibit abnormal neuronal firing by blocking voltage-gated sodium channels. They are prescribed for epilepsy and seizure disorders. Contraindications include heart block, liver impairment, and pregnancy. o Examples include Phenytoin, Carbamazepine, Lamotrigine and Oxcarbazepine.
- GABAergic Drugs : Increasing the inhibitory effects of GABA, these drugs reduce neuronal excitability. They are indicated for epilepsy, neuropathic pain, and mood disorders and are also known as GABA enhancers. Contraindications include hepatic encephalopathy and porphyria. o Examples include Valproic acid, Gabapentin and Pregabalin.
- Analgesics:
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs ): These drugs reduce pain, inflammation, and fever by inhibiting the enzyme cyclooxygenase (COX). They are indicated for mild to moderate pain and inflammatory conditions. Contraindications include peptic ulcers, renal impairment, and bleeding disorders. o Examples include Ibuprofen, Naproxen and Diclofenac. Note : Commonly used NSAIDs have the suffix "profen", "proxen", or "fenac"
- Opioids : Acting on opioid receptors, opioids provide moderate to severe pain relief. They are prescribed for acute and chronic pain management. Contraindications include respiratory depression, bowel obstruction, and substance abuse disorders. o Examples include Morphine, Oxycodone, Hydrocodone and Codeine.
- Local Anesthetics: Local anesthetics cause reversible numbing or loss of sensation and pain in the specific area. These drugs block sodium channels, leading to local anesthesia by preventing nerve impulse generation and conduction. They are used for various surgical and dental procedures. o Contraindications include known hypersensitivity and infection at the injection site. o Common examples are Lidocaine, Bupivacaine, Procaine and Mepivacaine.
Cardiovascular System Drugs
- Antihypertensive Drugs: Antihypertensive drugs are medications used to manage high blood pressure. They are classified based on their mechanisms of action.
- ACE Inhibitors : ACE inhibitors are commonly used in the treatment of hypertension, heart failure, and diabetic nephropathy. Their mechanism of action involves the inhibition of the ACE enzyme, which leads to a decrease in the production of a hormone known as angiotensin II. o This hormone causes blood vessels to narrow, leading to increased blood pressure. ACE inhibitors help lower blood pressure and reduce strain on the heart. They are indicated for patients with high blood pressure, heart failure, and certain kidney conditions. o However, individuals with a history of angioedema or those who are pregnant should avoid using ACE inhibitors. o Examples include Lisinopril, Enalapril, and Ramipril
- Angiotensin II Receptor Antagonists/Blockers : Angiotensin II receptor antagonists/blockers also play a significant role in managing hypertension, heart failure, and diabetic nephropathy. They act by blocking the effects of angiotensin II at specific receptors, resulting in blood vessel relaxation and lowered blood pressure. o These are indicated for patients with high blood pressure, heart failure, and certain kidney conditions. However, individuals with a history of angioedema or those who are pregnant should avoid using these drugs. o Examples include Losartan, Valsartan, Irbesartan
- Beta-Blockers : Beta-blockers are versatile drugs used for various cardiovascular conditions. They are prescribed for hypertension, angina (chest pain), arrhythmias (irregular heart rhythms), and heart failure. Beta-blockers block the effects of adrenaline on beta receptors in the heart, which leads to a decreased heart rate and relaxed blood vessels. o By reducing the heart's workload, they help lower blood pressure. o Examples include Atenolol, Metoprolol, and Propranolol Point to remember : Beta-blockers are contraindicated in individuals with severe bradycardia (slow heart rate), heart block, and asthma Note : Beta-blockers have the suffix "olol".
- Calcium Channel Blockers : Calcium channel blockers are used for the management of hypertension, angina, and arrhythmias. They work by blocking calcium channels in blood vessel walls and the heart, leading to the relaxation of blood vessels and reduced cardiac contractility. This leads to a reduction in blood pressure and an enhancement in blood flow. o Examples include Nifedipine, Amlodipine, Diltiazem, and Verapamil Note : They should be avoided in individuals with heart block, severe hypotension (low blood pressure), and acute myocardial infarction.
- Diuretics : Diuretics increase urine production, helping to lower blood pressure and reduce fluid retention. They are used for the treatment of hypertension, edema (fluid accumulation), and heart failure. Diuretics increase the excretion of sodium and water from the body, resulting in decreased fluid volume and reduced blood pressure. o They are indicated for patients with high blood pressure, fluid retention, and heart failure. However, diuretics should be used with caution in individuals with anuria (lack of urine production) and those at risk of electrolyte imbalances. o Examples include Hydrochlorothiazide, Furosemide, and Spironolactone. Note : Diuretics are described in detail in the renal drugs section.
