Post on 29-Apr-2019
Essential pharmacotherapy concepts
and terminology applied to medication
reconciliation for Medical/Healthcare
Interpreters.
Instructor:
Dr. Lizbeth N Mendoza, MD-FMG-Mexico, CMI-Spanish
Contact: bvcmi@comcast.net
2
Objectives At the end of the workshop the participant will be able to:
• Identify, define, exemplify and interpret key concepts in medication
reconciliation such as generic and brand names, dosage form, route of
administration, dosage regimen, contraindications, and drug reactions.
• Identify, define, exemplify and interpret key concepts in pharmacotherapy
such as: pharmacokinetics, pharmacodynamics, bioavailability, mechanism
of action, receptors, drug efficacy and safety, and drug interactions.
• Identify 20 frequently mentioned medications, both prescription drugs
and OTC’s, including their therapeutic category and pharmacologic class.
5/6/2016 © LNMM - BVCMI
Medication reconciliation
Formal process for creating the most complete and
accurate list possible of a patient’s current medications and
comparing the list to those in the patient record or
medication orders.
High-risk clinical situation for LEP patients
Includes the transmission of specific information about
medications such as name, dosage, frequency, and route.
3 5/6/2016 © LNMM - BVCMI
Examples of interpreter errors of potential
clinical consequence
• Omitting questions about drug allergies.
• Omitting instructions about antibiotic dose, frequency, and duration.
• Instructing a mother to give an antibiotic for 2 instead of 10 days.
• Erroneously adding that hydrocortisone cream must be applied to an infant’s entire body, instead of solely to a facial rash.
• Explaining that an antibiotic was being prescribed for the flu.
• Instructing a mother to put oral amoxicillin into her child’s ears to treat otitis media.
Ref: Flores, G., Laws, M.B., Mayo, S.J. et al, Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics. 2003;111:614
4 5/6/2016 © LNMM - BVCMI
5
Ideas?
5/6/2016 © LNMM - BVCMI
6
Tools
5/6/2016 © LNMM - BVCMI
20 + frequently mentioned medications
7 5/6/2016 © LNMM - BVCMI
Pharmacology
8
Definitions
5/6/2016 © LNMM - BVCMI
Pharmacotherapy
9
Definitions
5/6/2016 © LNMM - BVCMI
Chemotherapy
10
Definitions
5/6/2016 © LNMM - BVCMI
Pharmacogenomics (or pharmacogenetics)
11
Definitions
5/6/2016 © LNMM - BVCMI
Chronopharmacology
12
Definitions
5/6/2016 © LNMM - BVCMI
Toxicology
13
Definitions
5/6/2016 © LNMM - BVCMI
Definitions
DRUG
(“medicine”)
14 5/6/2016 © LNMM - BVCMI
Definitions
DRUG
(informal)
15 5/6/2016 © LNMM - BVCMI
Definitions
Prodrug
16 5/6/2016 © LNMM - BVCMI
Definitions
Orphan drug
17 5/6/2016 © LNMM - BVCMI
Definitions
Substance
18 5/6/2016 © LNMM - BVCMI
Definitions
Molecule
19 5/6/2016 © LNMM - BVCMI
Definitions
Active ingredient (active pharmaceutical
ingredient)
20 5/6/2016 © LNMM - BVCMI
Definitions
Inactive ingredients (vehicles, excipients)
21 5/6/2016 © LNMM - BVCMI
Definitions
Biological Product
22 5/6/2016 © LNMM - BVCMI
Definitions
Generic drug
23 5/6/2016 © LNMM - BVCMI
Definitions
Brand drug
24 5/6/2016 © LNMM - BVCMI
Generic Drugs vs. Brand Name Drugs
= Active ingredient(s)
= Use / Effect
= Mechanism of action
= Dosage strength*
= Route **
= Side effects
= Safety
25
* How much of the active ingredient is present in each dosage
** A way of administering a drug to a site in a patient 5/6/2016 © LNMM - BVCMI
≠ Name
≠ Packaging
≠ Appearance
≠ Taste
≠ Price
26
Generic Drugs vs. Brand Name Drugs
5/6/2016 © LNMM - BVCMI
GENERIC DRUGS BRAND DRUGS
Acetaminophen, Paracetamol Tylenol
Ibuprofen Advil
Warfarin Coumadin
Metformin Glucophage
Cephalexin Keflex
27
Generic Drugs vs. Brand Name Drugs
5/6/2016 © LNMM - BVCMI
28
Generic Drugs vs. Brand Name Drugs
5/6/2016 © LNMM - BVCMI
29
Generic Drugs vs. Brand Name Drugs
5/6/2016 © LNMM - BVCMI
30
Generic Drugs vs. Brand Name Drugs
5/6/2016 © LNMM - BVCMI
Definitions
Dosage forms
31 5/6/2016 © LNMM - BVCMI
32
Dosage forms
The means by which drug molecules are delivered to sites of action within the body.
Solid: Tablets, capsules, caplet, coated caplet, pills, suppositories, lozenge,
troche, bead, pellet, etc.
Semisolid: Ointment, gel, cream, paste, ointment, foam, etc.
Liquid: Suspension, solution, emulsion, syrup, lotion, shampoo, injection,
tintcture, etc.
Other: Gas, film, patch, plaster, poultice, etc.
Variations: Coated tablets, uncoated tablets, soluble tablets, dispersible
tablets, effervescent tablets, sublingual tablets, buccal tablets, chewable
tablets, grooved tablets, delayed-release, sustained-release, etc.
5/6/2016 © LNMM - BVCMI
Definitions
Routes of
administration
33 5/6/2016 © LNMM - BVCMI
34
Enteral: Oral, buccal, sublingual, rectal.
Parenteral: Intravenous (IV), intramuscular (IM), subcutaneous
(SubQ, SC), epidural.
Topical: Ophthalmic, auricular/otic, nasal, vaginal.
More: Transungueal, transtympanic, intraperitoneal , intratechal,
intrauterine, intracavernosal, intraarticular, intraosseous,
endosinusial, endotracheal, etc.
A way of administering a drug to a site in a patient
Routes
5/6/2016 © LNMM - BVCMI
Definitions
Strength
35 5/6/2016 © LNMM - BVCMI
How much of the active ingredient is present in each dosage (form).
36
Strength
Metric Units: 500 mg tablet, 250 mg capsule, 0.5g/tablet, 5 µg or mcg tablet.
Units: penicillin, insulin, bacitracin, heparin, nystatin, polymixin, and vitamins A, D, and E. Examples: 400,000 U penicillin, 100 U Insulin.
Concentration: For liquid and topical preparations.
• Liquids = w/v: 500 mg/5 mL amoxicillin suspension, 100 units/ml of insulin suspension.
• Solid topical = weight/weight (w/w): 100,000 units/g nistatin cream.
Percentage: specific weight/volume concentration of g/100 units: Example: 5% means 5g of x drug /100ml in liquids. For solids like creams, 1% means 1 gram of x drug / 100 grams of cream.
5/6/2016 © LNMM - BVCMI
Definitions
Dose
37 5/6/2016 © LNMM - BVCMI
5 mL (every 8 hrs)
10 mg (every 12 hrs)
1 tablet (every 24 hrs)
2 drops (every 6 hrs)
10 units (per day)
0.2 units/kg (per day divided in 2 doses)
15 mg/kg (every 6 hours)
5 mg/dose
12.5 mg/kg/dose
2 puffs 15 minutes before exercise and as needed
38
Dose
Amount of drug taken at any one time.
5/6/2016 © LNMM - BVCMI
39
Common household system of measurement and
equivalents
1 Teaspoonful or tsp ≈ 5mL
1 Tablespoon or Tbsp ≈ 15mL
Dropperful ≈ 1 mL
Dose
5/6/2016 © LNMM - BVCMI
40 5/6/2016 © LNMM - BVCMI
41 5/6/2016 © LNMM - BVCMI
42 5/6/2016 © LNMM - BVCMI
43 5/6/2016 © LNMM - BVCMI
44 5/6/2016 © LNMM - BVCMI
Definitions
Dosage Regimen
45 5/6/2016 © LNMM - BVCMI
Frequency at which the drug doses are given.
• Every X hours, minutes, days…
• PRN - as needed
• Daily / Weekly / Monthly
• bid (bis in die) - twice a day; tid (ter in die) - 3 times a day; qid
(quater in die) - 4 times a day
• Before, during, with, after…. meals, sleep time, exercise,
intercourse, etc…
46
Dosage Regimen
5/6/2016 © LNMM - BVCMI
Definitions
Prescription drug
47 5/6/2016 © LNMM - BVCMI
Definitions
OTC (Over The Counter) drug
48 5/6/2016 © LNMM - BVCMI
Definitions
Therapeutic
category
49 5/6/2016 © LNMM - BVCMI
Drugs classification typically based on diseases or
symptoms that drugs are used to treat.
Examples:
Analgesics, Anti-inflammatory agents, Antibiotics, Anesthetics,
Anticonvulsants, Antiemetics, Cardiovascular agents,
Gastrointestinal agents, etc.
50
Therapeutic category
5/6/2016 © LNMM - BVCMI
Definitions
Pharmacologic class
51 5/6/2016 © LNMM - BVCMI
Group of active moieties that share scientifically documented
properties and is defined on the basis of any combination of
three attributes of the active moiety: 1) Mechanism of Action
(MOA); 2) Physiologic Effect (PE); 3) Chemical Structure (CS).
Examples:
• Non-opioid analgesics, opioid analgesics, Nonsteroidal Anti-
inflammatory drugs, glucocorticoids, antidiabetics agents, insulins,
anticoagulants, beta-adrenergic blocking agents, calcium channel
blocking agents, etc.
52
Pharmacologic class
5/6/2016 © LNMM - BVCMI
Drug reactions
53
Definitions
5/6/2016 © LNMM - BVCMI
Warnings and
precautions
54
Definitions
5/6/2016 © LNMM - BVCMI
Contraindications
55
Definitions
5/6/2016 © LNMM - BVCMI
Side effects
56
Definitions
5/6/2016 © LNMM - BVCMI
Activity
57 5/6/2016 © LNMM - BVCMI
Definitions
Pharmacokinetics
(ADME)
58 5/6/2016 © LNMM - BVCMI
Definitions
Absorption
(ADME)
59 5/6/2016 © LNMM - BVCMI
Definitions
Distribution
(ADME)
60 5/6/2016 © LNMM - BVCMI
Definitions
Metabolism or Biotransformation
(ADME) 61 5/6/2016 © LNMM - BVCMI
Definitions
Elimination or Excretion
(ADME) 62 5/6/2016 © LNMM - BVCMI
Definitions
Bioavailability
63 5/6/2016 © LNMM - BVCMI
Definitions
First pass effect
64 5/6/2016 © LNMM - BVCMI
Definitions
Half life
65 5/6/2016 © LNMM - BVCMI
Definitions
Bioequivalence
66 5/6/2016 © LNMM - BVCMI
Definitions
Pharmacodynamics
67 5/6/2016 © LNMM - BVCMI
Definitions
Receptor
68 5/6/2016 © LNMM - BVCMI
Definitions
Affinity
69 5/6/2016 © LNMM - BVCMI
Definitions
Agonist
70 5/6/2016 © LNMM - BVCMI
Definitions
Antagonist
71 5/6/2016 © LNMM - BVCMI
Definitions
Potency
72 5/6/2016 © LNMM - BVCMI
Definitions
Efficacy
73 5/6/2016 © LNMM - BVCMI
Definitions
Effective dose 50%
74 5/6/2016 © LNMM - BVCMI
Definitions
Toxic dose 50%
75 5/6/2016 © LNMM - BVCMI
Definitions
Lethal dose 50%
76 5/6/2016 © LNMM - BVCMI
Definitions
Therapeutic index
77 5/6/2016 © LNMM - BVCMI
Definitions
Drug Interactions
(ADME)
78 5/6/2016 © LNMM - BVCMI
Definitions
Drug Interactions 1+1 =2 -Addition-
1+1=3 - Synergism-
1+1=0 -Antagonism-
0+1=2 -Potentiation-
79 5/6/2016 © LNMM - BVCMI
Drug interactions
80
Definitions
5/6/2016 © LNMM - BVCMI
ACTIVITY
81 5/6/2016 © LNMM - BVCMI
82 5/6/2016 © LNMM - BVCMI
Conclusions
83 5/6/2016 © LNMM - BVCMI
Conclusions
84 5/6/2016 © LNMM - BVCMI