Shared Flashcard Set

Details

Pharm Law Exam 1
N/A
112
Pharmacology
Graduate
09/15/2010

Additional Pharmacology Flashcards


 

 


 

Cards

Term

Responsibilities of Professional

 

(6)

Definition

1.  Licensure

2.  Duty (fiduciary)-Must put welfare, health, and safety of community abover other considerations

3.  Duty (to members of profession)-Adherence to a Code of Ethics

4.  Adherence to laws (federal and state)

5.  One must be licensed which is a revocable privalage

6.  Professionals have liabilities others do not

Term
Scarlett Earle Pillars of Professional (7)
Definition

1.  Technical skill

2.  Social responsibility

3.  Knowledge of history

4.  Knowledge of literature and the arts

5. Personal integrity

6.  Faith that there is some meaning and value to life

7.  "The grace of humility"

Term
Written Communication Tidbits (4)
Definition

1.  Easily disseminated

2.  Errors are easily apparent

3.  Writings must be factual, not opinion based

4.  Do not put in writing anything you don't want subpoenaed

Term
Important things to keep in mind about oral communication (3)
Definition

1.  Tone

2.  Word Choice

3.  Grammar

Term
How to Actively Listen (8)
Definition

1.  Eye contact

2.  Schedule enough time for conversations

3.  Be genuine

4.  Avoid emotionality and attacks of others

5.  Paraphrase the message you heard

6.  Keep still and silent; do not talk to fill pauses

7.  Ask clarifying questions

8.  Avoid distracting gestures

Term
Define morals
Definition

Morals are personal judgements as to right and wrong

 

Typically societal in nature and can be thought of as shared ideals of a group even if not practiced

 

Morals differ between societies because of the different emphasis placed on them

Term
Define Ethics
Definition

Standards of right and worng dictaing actions in a given situation

 

Do not include personal feelings, morals, laws, or social standards

 

Term
Ethics are based on (5)
Definition

1.  Rights

 

2.  Obligations

 

3.  Benefits to society

 

4.  Fairness

 

5.  Specific virtues

Term
Ethical standards must be supported by
Definition
consistent and well-founded reasons
Term
Fundamental Principles of Healthcare Ethics (6)
Definition

1. Autonomy

2. Beneficence

3. Nonmaleficence

4. Truthtelling

5. Confidentiality

6. Justice

Term
Who made ancient Chinese pharmacopeia
Definition
Shen Nung
Term
How long did Greco-Roman medicinal practice dominate?
Definition
Until the middle ages when pharmacists split off from physicians
Term
First drug stores opened when?
Definition
8th century Arabia
Term
Who officially separated pharmacy from medicine?
Definition
Frederick II of Hohenstaufen, Emperor of Germany and King of Sicily in 1240 AD
Term
What period did physicians start to compete with pharmacists for dispensing fees?
Definition
17th Century England
Term

Year and founding and role of Society of Apothecaries

 

Definition

1617

 

1st example of pharmaceutical regulation by allowing inspection of apothecary shops (REALLY SECOND CASE OF REGULATION BECUASE KING FREDERICK II WAS THE FIRST!!!)

Term
Did initial regulations put limits on who could compound and dispense drugs?
Definition
No, pretty much anybody with chemicals did dispense drugs
Term
18th Century America Pharmacy Points (5)
Definition

1.  Most practitioners illiterate

2.  Combined medicine and pharmacy practiced by political leaders, clergymen, and midwives

3.  Only apothocary shops were in large cities

4.  No clear distinction between medicine and pharmacy

5.  Most medical conditions were acute

Term
First hospital in
Definition
Term
First hospital in america established in what year and what city
Definition
Philadelphia, 1751
Term
First hospital pharmacy in America founded in what year and where
Definition
1752 in Philly
Term

Early 19th Century America

 

1.  What prevailed as health risk?

 

2.  What began during this time period important to pharmacy?

Definition

1.  Infectious disease because of population boom

 

2.  Retail pharmacies began to open door

Term
How did first retail pharmacies come into being?
Definition
Family docs who owned medicine shops began to sell them off to their clerks so they could focus on medicine
Term
When was the US Pharmacopoeia first published?
Definition
1820 by physicians
Term
Name and date of first college of pharmacy founding
Definition

1821

 

Philadelphia College of Apothecaries

Term
Late 19th Century Characterized by (4)
Definition

1.  Drug Importation Act

 

2.  Domination of department and chain drug stores

 

3.  Huge advances in tech, diagnostic tools, available services, and drugs

 

4.  Need for regulation of pharmacy as a profession becomes evident to all parties

Term
3 Major Periods in 20th Century Pharmacy with Time Periods
Definition

1.  Traditional (1900-1940)

 

2.  Transitional (1940-1970)

 

3.  Patient-Care (1970-Present)

Term
Function of Drug Importation Act
Definition

Required inspection of imported drugs

 

Rapidly became corrupted

Term
When and where and why founding of APhA
Definition

1852, College of Pharmacy of the City of New York

 

Focused on pharmacist competancy and greater regulation which lead to uniform pharmacy act which created state regulations creating pharmacy as a profession

Term
Pure Food and Drug Act date and function
Definition
1906, food and drug safety
Term
Time of education improvement in pharmacy brought about by the American Conference of PHarmaceutical Faculties
Definition

1920s

 

Term
FDA created by which act and when
Definition
Food, Drug, and Cosmetics Act in 1938
Term
Time product-centered practice took hold
Definition
1950s
Term
Pharmacy autonomy rollback occured in 1952 how
Definition
Food, Drug, and Cosmetic Act amended to limit pharmacist autonomy and liability
Term
Time period when pharmacy power lessened b/c of government and physicians
Definition
1920-1950
Term
Define Pharmaceutical care as posited by Douglas Hepler and Linda Strand
Definition

The direct responsible provision of medicatio-related care for the purpose of achieving definite outcomes that improve a patients quality of life

 

Reduce Disease symptoms and prevent disease

Term
Define diversity as it relates to pharmacogenomics
Definition
Factors that make individuals or subgroups of a population different from the rest of the population
Term
Define pharmacogenomics
Definition
The study of the variability in drug response that is due to genetic variability
Term
4 Areas we will see PGx in pharmacy
Definition

1.  Class in P3

2.  NAPLEX

3.  Practice with metabolism screenings etc

4.  Law with increased liability

Term
How is current prescription knowledge assessed before PGx brings about all the changes it will (2)
Definition

1.  Normal dosage calculated from means of studies from fairly homogenous population

 

2.  Outcomes of individual trials as it relates to published literature

Term
What percentage of genetics accounts for variability in drug response?
Definition
20-95%
Term

Warfarin PGx

 

Two Important Enzymes and Functions

Definition

1.  VKORC1-Reduces vitamin K to allow coagulation.  Mutations that inhibit enzyme lead to less clotting anyway making warfarin overdose more dangerous

 

2.  CYP2C9-Metabolizes warfarin so that mutations inhibiting function can lead to decreased warfarin metabolism and increased bleeding risk

Term
Bad use of genetics in the past include
Definition
Eugenics
Term

Define:

1.  Nonmaleficience

2.  Beneficence

 

What is relevance to pharmacogenomics

Definition

1.  to do now harm and prevent harm

2.  to do good

 

Relevance to nonmaleficince is that you can withhold a drug that would do harm or tweak a dose

 

Relevance to beneficence is that alterative therapy treatment becomes more efficacious

Term

Azathioprine PGx

1.  Function

2.  Uses (3)

3.  Mtabolism

4.  Rare Adverse rxn

5.  What is mutatated and what does this mean

6.  Why is test not performed to detect mutation?

 

Definition

1.  Immunosuppressant

2.  Kidney transplant, severe rheumatoid arthritis, inflammatory bowel diseases

3.  Methylated by thiopurine-s-methyltransferase (TPMT) and elminated from body

4.  Myelosuppression

5.  TPMT is mutated (homozygotes worse off than heterozygotes)-->Give less azathioprine to prevent myelosuppression

6.  Not FDA approved or required meaning FDA doesn't consider genotype as cause (nonmaleficience bad)

 

Term
Can you give out a patient's genetic status to family?
Definition
Not to family or anyone else...treated as medical information
Term

Finding of Pate v. Threlkel, Florida Supreme Court 1995

 

1. What was case about

2.  Finding

Definition

1.  Woman sued b/c mom had inherited thyroid cancer and physican did not let mother of woman know so the woman did not know of increased risk

 

2.  Physician negligent, but had no right or obligation to disclose the information to the daughted b/c of patient-doctor confidentiality

Term

Safer v. Pack, New Jersey Superior Court Appellate Division 1996

 

1.  Case

2.  Finding

Definition

1.  Woman sued father's physican b/c father had polyp condition in colon she was not informed of so that she could not obtain preventative screening

 

2.  Court found liability with physican b/c he was obligated to protect the life of the daughter

Term
How does confidentiality apply to pharmacits with PGx?
Definition
Must inform patient properly, may need malpractice insurance later on
Term

1.  What is GINA

 

2.  What is not covered (3)

Definition

1.  Genetic Information Non-discrimination Act of 2008

 

Prevents discrimination based on genetic by health insurers and employers

 

2.  Life, Diability, and Long-term care insurance

Term
5 Steps Pharmacists Should Follow with PGx and Patients
Definition

1.  Inform risks and benefits

2.  Warn of hazards of genetic discrimination

3.  Do not talk with family unless given permission

4.  Encourage patients to discuss results with at-risk relatives

5.  Allow patients to make their own informed decisions regarding all issues related to genetic testing

Term
Define CMD
Definition

Assesses how decision-making process works prior to decision

 

How do you organize your activities to further human welfare, what is right and fair, and what are the reasons for doing right

Term
Who invented CMD and when and what is it grounded in
Definition

Kohlberg in 1958

 

Grounded in Piage's pioneering theories of how children develop logical and moral reasoning skills

Term
Cognitive portion of CMD explains what
Definition
How a person thinks by placing an emphasis on emotions (pyschodynamic theory)
Term
Structural portion of CMD explains what
Definition

Describes underlying innate mental process by placing interest on how decisions are arrived at

 

Different ages can hold the same view and arrive at that view through completely different reasoning

Term
What have studies supporting CMD found?
Definition
That moral reasoning was a bigger contributer toward clinical performance than GPA and standardized test scores
Term
Moral Reasoning Focuses on (3)
Definition

Self interest (pre-conventional)

Relationships (conventional)

Ethical Principles (post-conventional)

Term
What dose N2 score measure in CMD (2)
Definition

1.  Level of principled thinking

2.  Degree to which non-principled items receive lower ratings

Term
Number of prescriptions dispensed in 2009
Definition
3.61 billion
Term
Sales of prescriptions 2009
Definition
$269 billion
Term
Avg cost of prescription 2009
Definition

Brand-$155.45

Generic-$39.73

Term
Largest increasing branch of pharmacy and 2nd largest
Definition

Mail-order is number 1

 

Chain stores are number 2

Term
How much less is a community pharmacy's profit margin than the median Fortune 500 company?
Definition
less than 1/3 that of Fortune 500 company (1.6% profit margin which jumps to 2-3% if you exclude food-only stores)
Term

Typical Community Pharmacy

 

1.  Open how many days per week

2.  % of Sales based on medicines compared to chains

Definition

1.  6 days a week

 

2.  95% independents and 69% chains

Term
How do pharmacies generate revenue (2)
Definition

1.  Insurance reimbursement based on discount from AWP

 

2.  Pharmacies recieve small dispensing fee (<$5)

 

 

Term
Average Cost of Retail Presciption in 2009
Definition
$76.94
Term
% of healthcare costs accounted for by prescriptions
Definition
10%
Term
Threats to Pharmacy (3)
Definition

1.  Reimportation of drugs from Canada

2.  Medication errors and drug-related problems (DRP)

3.  Managed care and other cost-reduction efforts are leading people to obtain medications in different ways (ie mail and internet)

Term
Define Profession for Latif
Definition

1.  Study and training

2.  Code of ethics

3.  Associations

4.  Fiduciary responsibility to put client interest above self-interest

Term
First pharmacist to open office-based pharmacy in US and in what year
Definition
Eugene V. White 1960
Term

1.  Who regulates OTC drug advertising

 

2.  Who regulates prescription drug advertising

Definition

1.  FTC

 

2.  FDA

Term
What controls pharmacy (4)
Definition

1.  Licensure

2.  Laws

3.  Rules and Regulations

4.  Code of ethics

Term
Rough breakdown of who pays for prescriptions (3 sources)
Definition

50% by 3rd parties (Pharmaceutical Benefit Managers)

 

25% by cash

 

25% by state funded health insurance

Term
Number of pharmacits in US
Definition
200,000
Term

1.  What does Medicare not cover (3)?

 

2.  What % do seniors have to pick up?

Definition

1.  Dental, hearing, or vision

 

2.  22%

Term
% GDP WV spends on healthcare
Definition
20.3%
Term

National Health Spending

 

1.  $ amount in 2007

 

2.  Projected $ amount 2009

Definition

1.  $2.2 trillion

 

2.  $2.5 trillion

Term

National Health Spending as a Share of GDP

 

1.  What accounted for full % jump in healthcare as it related to GDP in 2009?

 

2.  Healthcare will account for $_ of every $_ of economic activity by 2018

Definition

1.  Recession

 

2.  $1 of every $5

Term

National Health Spending Per Persion (1997-2009)

 

1.  % increase in the amount spent per person on healthcare b/t 1997-2009

Definition
1.  81% increase
Term

Major Programs as a Share of the Federal Budget

 

1.  What has been gaining on Social Security recently?

Definition
Medicare
Term

Health Care Spending in Selected Developed Countries

 

1.  US spending greater than other developed countris in two ways...what are they?

 

2.  What is the majority of expense in other countries compared to US?

Definition

1.  Per capita spending and %GDP

 

2.  Public sector for other developed countries (private in US)

Term

Spending Distribution by Category, 2007

 

1.  What accounts for largest share of healthcare dollar in US?

 

2.  What % is from prescription drugs?

Definition

1.  Hospital and physician services

 

2.  10%

Term

Spending Summary, by Category

 

1.  What has declined and grown over the past 20 years as a share of health care dollars spent?

Definition
1.  Hospital care declined while prescription drugs increased
Term

Spending Distribution in Healthcare, by contributers (2007)

 

1.  3 major contributers to financing health care

Definition
1.  Households, businesses, and government
Term
3 ways that contributers to health care fund health care
Definition

1.  Buy services directly

 

2.  Purchase private insurance

 

3.  Fund public programs

Term
4 Major sources of healthcare payment
Definition

1.  State and local government

 

2.  Federal government

 

3.  Household

 

4.  Private Business

Term
What has the largest historical impact on the % of healthcare provided by federal government?
Definition
Implementation of Medicare and Medicaid
Term
% of public funds of medical spending
Definition
46% with the rest coming from private funding sources
Term

Services paid by Government by %

 

1.  Lowest type of treatment and %

 

2.  Prescription drug %

Definition

1.  Dental is the lowest at 6.4%

 

2.  Prescriptino drugs at 35.5%

Term

Private vs. Public Spending Distribution

 

1.  % comparison between public and private on hostpital and long term care

Definition
1.  Government is 40% and private is 28%
Term

What % of private insurance is spent on

 

1.  Hospital

2.  Physician Services

 

3.  What is consumer out-of-pocket concentrated in with private insurance (3)

Definition

1.  33%

2.  31%

 

3.  Prescription drugs, dental, and other professional services

Term
How many years has the growth in health spending been lower than the historical average?
Definition
3 years
Term
What is the only healthcare expenditure spending to see a decline and what is the new % for it
Definition
Prescription drugs and 4.9%
Term

1.  2 largest contributors to increase in health spending and their % contribution

 

2.  Other contributions and percentage

Definition

1.  Medical price inflation (>50%) and More tests and more expensive tests (25%)

 

2.  Population increase and old people (<25%)

Term
Number of times healthcare spending has increased since 1970
Definition
Over 20 times 1970 levels
Term

1.  What has seen the largest increase in prescription spending since 1980

 

2.  Why did Part D not increase government prescription spending

Definition

1.  Private insurance

 

2.  Part D just shifted cost form Medicaid to Medicare both of which are federal programs

Term
What percent of healthcare costs do consumers pay out-of pocket?
Definition
14%...this has actually declined as a percentage over the years even though the amount paid has increased
Term
Pros of US healthcare system (1)
Definition
1.  State-of-the-art treatments
Term
Cons of US healthcare system (4)
Definition

1.  Fragmented and inefficient

2.Spends more for less result than any other country

3.  Massive uninsured, uneven quality

4.  Administrative waste

Term
US Healthcare System Rank in the World
Definition
37th
Term
Why does the US have worse healthcare outcomes?
Definition
"we alone treat healthcare as a commodity distributed according to the ability to pay, rather than as a social service to be distributed according to medical need"
Term

Oregon Health Plan

 

1.  # of people Medicaid expanded to

2.  What did it do for pre-existing conditions

3.  Based on

4.  How did it manage care?

5.  Did it work?

Definition

1.  120,000

2.  High-risk pool

3.  Prioritized list of diagnoses and treatments removing quality of life measures

4.  Placing strict capitation (payment guidelines) on physicians

5.  So far the results have been positive

Term

TennCare

 

1.  # of new Medicaid patients

2.  Method of paying for it

3.  Why did it not work (3)?

4.  Benefits found (4)

Definition

1.  500,000

2.  Sliding scale for premioums and cost sharing based on means

3.  Rapid implementation, lack of provider participation, and underfunded

4.  Decreased uninsured, increased satisfaction, decreased hospital utilization, and improved outcomes for asthma and diabetes

Term

Massacheusetts Health Reform

 

1.  Method of operation

 

2.  Good and bad

 

Definition

1.  Impose financial penalty for those who don't get coverage and provide subsidies for low income

 

2.  Good is more people covered, bad is that costs increased if you don't qualify for subsidies

Term
What dose US healthcare system favor that could lead to worse outcomes (2)?
Definition

1.  Curative treatments

 

2.  Rehabilitative interventions

Term
Emerging Issues/Challenges for US Healthcare (8)
Definition

1.  Aging population

2.  Increased longevity, immigration, culturally diverse aged

3.  Major gaps in delivery system

4.  Multidisciplinary care needed

5.  More culturally sensitive, geriatric providers needed

6.  Chronic disabilities of age not covered

7.  New technology increasing costs

8.  Lack of mental health coverage

 

Term
% increase in life expectancy past 105 years
Definition
60%
Term
Unfunded Medicare liabilities total
Definition
$35.5 trillion
Term
Goal of collaborative care
Definition
To reduce number of procedures that will not greatly extend life (ie, new prostate cancer in a 95 year old man is not what will most likely kill the man)
Term
For every dollar spent on medications, how many are spent on problems with medications?
Definition
$1
Term
Define P score in CMD
Definition
Measures one's level of principled thinking
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