Medication Management Case Study

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Medication Management Case Study

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Medication Management

The Classification of Pharmaco-Therapeutic Referrals helps guide the referral process between pharmacists and doctors. They publish a lengthy list of chemicals and plants whose trade and consumption where applicable is forbidden. OTC drugs are sold without restriction as they are considered safe enough that most people will not hurt themselves accidentally by taking it as instructed. Medical errors include overprescription and polypharmacy , misprescription, contraindication and lack of detail in dosage and administrations instructions. In the definition of a prescription error was studied using a Delphi method conference; the conference was motivated by ambiguity in the what a prescription error and a need to use a uniform definition in studies.

In many jurisdictions drug prices are regulated. In Canada, the Patented Medicine Prices Review Board examines drug pricing and determines if a price is excessive or not. In these circumstances, drug manufacturers must submit a proposed price to the appropriate regulatory agency. Furthermore, "the International Therapeutic Class Comparison Test is responsible for comparing the National Average Transaction Price of the patented drug product under review" [17] different countries that the prices are being compared to are the following: France, Germany, Italy, Sweden, Switzerland, the United Kingdom, and the United States [17].

In the United States, drug costs are unregulated, but instead are the result of negotiations between drug companies and insurance companies. High prices have been attributed to monopolies given to manufacturers by the government and a lack of ability for organizations to negotiate prices. Despite the enormous advances in science and technology, the number of new blockbuster drugs approved per billion dollars spent has halved every 9 years since In the pharmaceutical industry, a blockbuster drug is one that achieves acceptance by prescribing physicians as a therapeutic standard for, most commonly, a highly prevalent chronic rather than acute condition.

Patients often take the medicines for long periods. Antibiotics first arrived on the medical scene in thanks to Gerhard Domagk; [25] and were coined the "wonder drugs". The introduction of the sulfa drugs led to the mortality rate from pneumonia in the U. Penicillin, introduced a few years later, provided a broader spectrum of activity compared to sulfa drugs and reduced side effects. Streptomycin, found in , proved to be the first drug effective against the cause of tuberculosis and also came to be the best known of a long series of important antibiotics.

A second generation of antibiotics was introduced in the s: aureomycin and chloramphenicol. Aureomycin was the best known of the second generation. Lithium was discovered in the 19th century for nervous disorders and its possible mood-stabilizing or prophylactic effect; it was cheap and easily produced. As lithium fell out of favor in France, valpromide came into play. This antibiotic was the origin of the drug that eventually created the mood stabilizer category. Valpromide had distinct psychotrophic effects that were of benefit in both the treatment of acute manic states and in the maintenance treatment of manic depression illness. Psychotropics can either be sedative or stimulant; sedatives aim at damping down the extremes of behavior.

Stimulants aim at restoring normality by increasing tone. Soon arose the notion of a tranquilizer which was quite different from any sedative or stimulant. The term tranquilizer took over the notions of sedatives and became the dominant term in the West through the s. In Japan, during this time, the term tranquilizer produced the notion of a psyche-stabilizer and the term mood stabilizer vanished. Premarin conjugated estrogens, introduced in and Prempro a combination estrogen-progestin pill, introduced in dominated the hormone replacement therapy HRT during the s.

HRT is not a life-saving drug, nor does it cure any disease. HRT has been prescribed to improve one's quality of life. Doctors prescribe estrogen for their older female patients both to treat short-term menopausal symptoms and to prevent long-term diseases. In the s and early s, more and more physicians began to prescribe estrogen for their female patients. The first oral contraceptive, Enovid, was approved by FDA in Oral contraceptives inhibit ovulation and so prevent conception.

Enovid was known to be much more effective than alternatives including the condom and the diaphragm. As early as , oral contraceptives were available in several different strengths by every manufacturer. In the s and s, an increasing number of options arose including, most recently, a new delivery system for the oral contraceptive via a transdermal patch. In , a new version of the Pill was introduced, known as the "biphasic" pill. By , a new triphasic pill was approved. Physicians began to think of the Pill as an excellent means of birth control for young women. Stimulants such as Ritalin methylphenidate came to be pervasive tools for behavior management and modification in young children.

Ritalin was first marketed in for narcolepsy; its potential users were middle-aged and the elderly. It wasn't until some time in the s along with hyperactivity in children that Ritalin came onto the market. Consumption of methylphenidate in the U. The first minor tranquilizer was Meprobamate. Only fourteen months after it was made available, meprobamate had become the country's largest-selling prescription drug.

By , meprobamate had become the fastest-growing drug in history. The popularity of meprobamate paved the way for Librium and Valium, two minor tranquilizers that belonged to a new chemical class of drugs called the benzodiazepines. These were drugs that worked chiefly as anti-anxiety agents and muscle relaxants. The first benzodiazepine was Librium. Three months after it was approved, Librium had become the most prescribed tranquilizer in the nation.

Three years later, Valium hit the shelves and was ten times more effective as a muscle relaxant and anti-convulsant. Valium was the most versatile of the minor tranquilizers. Later came the widespread adoption of major tranquilizers such as chlorpromazine and the drug reserpine. In , sales began to decline for Valium and Librium, but sales of new and improved tranquilizers, such as Xanax, introduced in for the newly created diagnosis of panic disorder, soared.

Mevacor lovastatin is the first and most influential statin in the American market. The launch of Pravachol pravastatin , the second available in the United States, and the release of Zocor simvastatin made Mevacor no longer the only statin on the market. In , Viagra was released as a treatment for erectile dysfunction. Using plants and plant substances to treat all kinds of diseases and medical conditions is believed to date back to prehistoric medicine. The Kahun Gynaecological Papyrus , the oldest known medical text of any kind, dates to about BC and represents the first documented use of any kind of drug. Ancient Babylonian medicine demonstrate the use of prescriptions in the first half of the 2nd millennium BC. Medicinal creams and pills were employed as treatments.

On the Indian subcontinent, the Atharvaveda , a sacred text of Hinduism whose core dates from the 2nd millennium BC, although the hymns recorded in it are believed to be older, is the first Indic text dealing with medicine. It describes plant-based drugs to counter diseases. The Hippocratic Oath for physicians, attributed to 5th century BC Greece, refers to the existence of "deadly drugs", and ancient Greek physicians imported drugs from Egypt and elsewhere. Medieval medicine saw advances in surgery, but few truly effective drugs existed, beyond opium found in such extremely popular drugs as the "Great Rest" of the Antidotarium Nicolai at the time [35] and quinine.

Folklore cures and potentially poisonous metal-based compounds were popular treatments. Theodoric Borgognoni , — , one of the most significant surgeons of the medieval period, responsible for introducing and promoting important surgical advances including basic antiseptic practice and the use of anaesthetics. Garcia de Orta described some herbal treatments that were used. For most of the 19th century, drugs were not highly effective, leading Oliver Wendell Holmes, Sr. During the First World War , Alexis Carrel and Henry Dakin developed the Carrel-Dakin method of treating wounds with an irrigation, Dakin's solution, a germicide which helped prevent gangrene. In the inter-war period, the first anti-bacterial agents such as the sulpha antibiotics were developed.

The Second World War saw the introduction of widespread and effective antimicrobial therapy with the development and mass production of penicillin antibiotics, made possible by the pressures of the war and the collaboration of British scientists with the American pharmaceutical industry. Medicines commonly used by the late s included aspirin , codeine , and morphine for pain; digitalis , nitroglycerin , and quinine for heart disorders, and insulin for diabetes. Other drugs included antitoxins , a few biological vaccines, and a few synthetic drugs. In the s, antibiotics emerged: first sulfa drugs , then penicillin and other antibiotics. Drugs increasingly became "the center of medical practice".

Increasingly, biotechnology is used to discover biopharmaceuticals. In the s, new psychiatric drugs, notably the antipsychotic chlorpromazine , were designed in laboratories and slowly came into preferred use. Although often accepted as an advance in some ways, there was some opposition, due to serious adverse effects such as tardive dyskinesia. Patients often opposed psychiatry and refused or stopped taking the drugs when not subject to psychiatric control. Governments have been heavily involved in the regulation of drug development and drug sales. In the U. The Humphrey-Durham Amendment required certain drugs to be sold by prescription.

In , a subsequent amendment required new drugs to be tested for efficacy and safety in clinical trials. Until the s, drug prices were not a major concern for doctors and patients. As more drugs became prescribed for chronic illnesses, however, costs became burdensome, and by the s nearly every U. This also led to the U. As of , the United States is the leader in medical research , including pharmaceutical development. In , U. France, which imposes price controls, developed three. Throughout the s, outcomes were similar. Controversies concerning pharmaceutical drugs include patient access to drugs under development and not yet approved, pricing, and environmental issues.

Governments worldwide have created provisions for granting access to drugs prior to approval for patients who have exhausted all alternative treatment options and do not match clinical trial entry criteria. Often grouped under the labels of compassionate use, expanded access , or named patient supply, these programs are governed by rules which vary by country defining access criteria, data collection, promotion, and control of drug distribution.

These mechanisms, which fall under the label of expanded access programs, provide access to drugs for groups of patients or individuals residing in the US. Outside the US, Named Patient Programs provide controlled, pre-approval access to drugs in response to requests by physicians on behalf of specific, or "named", patients before those medicines are licensed in the patient's home country. Through these programs, patients are able to access drugs in late-stage clinical trials or approved in other countries for a genuine, unmet medical need, before those drugs have been licensed in the patient's home country. Patients who have not been able to get access to drugs in development have organized and advocated for greater access.

In , BioMarin Pharmaceutical was at the center of a high-profile debate regarding expanded access of cancer patients to experimental drugs. Essential medicines as defined by the World Health Organization WHO are "those drugs that satisfy the health care needs of the majority of the population; they should therefore be available at all times in adequate amounts and in appropriate dosage forms, at a price the community can afford. The Access to Medicine Index tracks how well pharmaceutical companies make their products available in the developing world. World Trade Organization negotiations in the s, including the TRIPS Agreement and the Doha Declaration , have centered on issues at the intersection of international trade in pharmaceuticals and intellectual property rights , with developed world nations seeking strong intellectual property rights to protect investments made to develop new drugs, and developing world nations seeking to promote their generic pharmaceuticals industries and their ability to make medicine available to their people via compulsory licenses.

Some have raised ethical objections specifically with respect to pharmaceutical patents and the high prices for drugs that they enable their proprietors to charge, which poor people in the developed world, and developing world, cannot afford. Novartis fought a protracted battle with the government of India over the patenting of its drug, Gleevec , in India, which ended up in India's Supreme Court in a case known as Novartis v.

The Supreme Court ruled narrowly against Novartis, but opponents of patenting drugs claimed it as a major victory. The environmental impact of pharmaceuticals and personal care products is controversial. PPCPs are substances used by individuals for personal health or cosmetic reasons and the products used by agribusiness to boost growth or health of livestock. PPCPs comprise a diverse collection of thousands of chemical substances, including prescription and over-the-counter therapeutic drugs, veterinary drugs, fragrances, and cosmetics.

PPCPs have been detected in water bodies throughout the world and ones that persist in the environment are called Environmental Persistent Pharmaceutical Pollutants. The effects of these chemicals on humans and the environment are not yet known, but to date there is no scientific evidence that they affect human health. From Wikipedia, the free encyclopedia. Substance used to diagnose, cure, treat, or prevent disease. For other uses, see Medicine disambiguation and Medication disambiguation. Main article: Drug class. See also: Category:Drugs by target organ system. This section may have too many subsection headers dividing up its content.

Please help improve the section by merging similar sections and removing unneeded subheaders. April Learn how and when to remove this template message. See also: Analgesic. See also: Anesthetic. See also: Barbiturate. Main article: Route of administration. Main article: Drug discovery. Main article: Drug development. Main article: Regulation of therapeutic goods. Main articles: Prescription costs and Pharmacoeconomics. This section needs expansion. You can help by adding to it. January Main article: Prescription drug prices in the United States. Main article: List of largest selling pharmaceutical products.

Main article: History of pharmacy. Main article: Expanded access. Main articles: Essential medicines and Societal views on patents. Despite having the diagnosis of dementia, the patient was able to ambulate prior to this hospitalization, but his activity level is now limited to a wheelchair. Risk Management Comments The insured nurse caring for the patient was assigned two other patients that needed close monitoring. The nurse informed the nursing supervisor of her concerns about not being able to provide adequate monitoring for this patient.

Despite her concerns regarding patient safety was told that no additional staffing was available. All but one required fall interventions were implemented by the insured in accordance with the ED policy. The one exception was not moving the patient closer to the nursing station until after the fall. The defense nursing expert opined that the nursing assessment completed in the ED correctly identified the patient as a high risk for falls and nursing interventions were implemented to help reduce the likelihood of a fall. However, documentation by the nurse indicated the patient was confused and uncooperative, and despite efforts to prevent a fall, the need for additional monitoring was warranted to minimize the risk of a fall and keep the patient safe.

Resolution A letter of intent to file a lawsuit, sent by the attorney representing the patient, was received by the hospital and the nurse. After an investigation of the incident was completed, including an interview with the nurse and obtaining a nurse expert review, negotiations pursued between the involved parties in the claim. A settlement was reached prior to a lawsuit being filed, with payment on behalf of the nurse being 45 percent of the total settlement. Failure to perform a post-operative assessment, failure to accurately document anesthesia complications in a medical record, and failure to complete a proper informed consent.

This case study involves a CRNA working in an outpatient endoscopy center. The patient was intoxicated and aggressive when brought to the ED, and had to be restrained. Shortly after an assessment check, the patient attempted to burn off his restraints with a cigarette lighter. He suffered severe burns over 25 percent of his body, resulting in permanent disability. This case study involves registered nurse working in an operating room setting and adult surgical unit. Search for:. Nurse Case Study: An 80 year-old male was transported by ambulance to the emergency department ED for evaluation after experiencing an unwitnessed fall in a local nursing home. Risk Management Recommendations : Know the organization's policies and procedures related to clinical practices and documentation.

Unfamiliarity to established policies and protocols is not a defense, especially if a clinician has acknowledged receiving education on such policies and protocols. Maintain thorough, accurate and timely patient assessment and monitoring , which are core nursing functions. For patients assessed as a fall- risk, implement fall prevention interventions in accordance with department protocols.

Contact the risk management department, or the legal department of your organization regarding patient or practice issues. Nurse Case Study: Alleged failure to properly assess and monitor the impaired, restrained patient The patient was intoxicated and aggressive when brought to the ED, and had to be restrained.

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