Chapter 9: Community Pharmacy

Objectives After reading this chapter, you will be able to: Understand the importance of a patient profile. Review a patient profile form for complete and accurate information. Understand the types of problems that missing or inaccurate patient information can cause in the pharmacy. Identify strategies to resolve problems arising from incomplete patient profile forms. Evaluate unprocessed prescriptions for completeness and accuracy.

Objectives, continued Understand the additional checking steps needed when reviewing controlled-substance prescriptions. Compare a processed prescription to the printed label for completeness and accuracy. Identify practices to correct errors on printed labels generated from the processed prescription. Differentiate between antidepressant, antipsychotic, and anti-anxiety drugs. Discuss the different classes of antidepressant drugs, their uses, and their side effects.

Objectives, continued Discuss how lithium and other drugs are used in treating bipolar disorders. Discuss the drugs that prevent the side effects caused by antipsychotics drugs. Explain the definition and symptoms of anxiety, as well as the drugs used to treat anxiety. Recognize the course and treatment of panic disorders, insomnia, and alcoholism.

Chapter Overview Community pharmacy practice is an evolving practice area with pharmacists and pharmacy technicians taking on more involved roles in medication management and patient care.

Ability to accurately complete a patient profile for a new patient Chapter Overview Skills every pharmacy technician must master: Ability to compare a processed prescription label with the original prescription Ability to evaluate unprocessed prescriptions for completeness and accuracy Ability to accurately complete a patient profile for a new patient

The Patient Profile The patient profile should include: Patient preferences Patient's full name Birth date Insurance information Adverse drug reactions Prescriber Special patient needs Patient's address Gender Allergies Previously filled prescriptions OTC meds being taken Email address Telephone number Herbal remedies being taken Emergency contact Medical diagnoses

Maintain an Accurate Patient Profile Maintaining an accurate and up-to-date patient profile helps protect against: Dangerous drug side effects Drug interactions Drug allergies

The New Prescription Prescriptions come into the community pharmacy via handwritten prescriptions, e-prescribing, and fax. E-prescribing has the benefit of legibility.

Prescription Information The information necessary on every prescription: Prescriber's phone number Prescriber's address Drug name Prescriber's DEA number (for controlled substances) Drug strength Drug quantity to dispense Drug directions Written date of the prescription Patient's name Patient's address Number of refills Patient's birthday DAW or substitution allowed Prescriber's name

Reviewing the New Prescription Review the new prescription in this order: Patient-Related Information Prescriber-Related Information Drug-Related Information

New Prescriptions for Controlled Substances Categories: Schedule II (CII) prescriptions cannot be refilled. Schedule III, IV (CIII, and CIV) are valid for only six months from the date noted on the prescription. V (CV) are covered by different laws in different states. The most commonly altered items on a controlled-substance prescription are the drug strength, the drug quantity to dispense, and the directions.

Drug Insights Antidepressants, antipsychotics, and anti-anxiety agents are used to treat mental-health diseases.

Depression Common symptoms: Lack of motivation Decreasing interest in daily activities Eating disorders Sleeping disorders Feelings of guilt Weight changes Inability to concentrate Indecisiveness

Treatments for Depression Psychotherapy combined with a drug-treatment pathway. Reuptake inhibitors keep the neurotransmitter in the synapse for a longer period. Monoamine oxidase inhibitor (MAOI) drugs prevent the neurotransmitter from being destroyed in the synapse.

Antidepressant Drug Categories Selective serotonin reuptake inhibitor (SSRI) drugs Serotonin and norephinephrine reuptake inhibitor (SNRI) drugs Tricyclic antidepressant (TCA) drugs Monoamine oxidase inhibitor (MAOI) drugs

Common Antidepressants Reuptake Inhibitor Drugs Citalopram Escitalopram Tricyclic Drugs Amitriptyline Doxepin Monoamine Oxidase Inhibitor Drugs Phenelzine Selegiline

Drug Therapies for Other Mental Illnesses Bipolar Disorder Mood-stabilizing agents Lithium Psychosis Antipsychotic Drug Therapy Loxapine Anxiety Anti-Anxiety Drug Therapy Diazepam Sleep Disorders Barbiturates and Hypnotics Amobarbital

Alcoholism Treatment for alcoholism includes: Mental health counseling Family support Drug therapy including: Antabuse (disulfiram) ReVia (naltrexone)