Prologue to Pharmacy Practice

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Prologue to Pharmacy Practice Chapter 5: Home Care Pharmacy Practice

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Learning Outcomes Identify purposes behind building up home care administrations & development of home care industry Cite 7 objectives of home care treatment Identify individuals & parts of home care group Identify conditions treated with home care administrations Identify best medications utilized as a part of home imbuement treatment List 1-2 parameters for these medications in home care

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Learning Outcomes Compare implantation frameworks for use in patient's home List marking prerequisites for clean items in home care Outline essential components for deciding termination dates for clean items utilized as a part of home care setting

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Key Terms Case supervisor Elastomeric swell framework Extravasation Intake facilitator Patient controlled absense of pain (PCA) Patient administration delegate Peripherally embedded focal catheter (PICC) Rate confined IV organization set frameworks Smart pumps Universal precautionary measures

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Historical Overview First home treatment in 1970s less costly & less hardship for patient Currently assessed $9 - $11 billion dollars for each year Serviced by 700 to 1,000 mixture drug stores Home implantation safe & viable less costly pumps are convenient, little, effortlessly programmable keep away from nosocomial diseases

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Home Infusion Services Provided by clinics, group drug stores, home wellbeing nursing organizations, incorporated human services frameworks, and free home implantation organizations Technician parts readiness of parenteral items stock upkeep & control making & keeping up patient supply stock making conveyances to patients' homes

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The Home Care Process Entering home care handle doctor suggestion patient, patient's family advocate home treatment patient's insurance agency may direct caseworker will intercede area of treatment healing facility may likewise start handle

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Intake organizer Retrieves patient's related data Nurse or expert uniquely prepared for employment Technician required in get ready medications Registered attendant makes introductory patient visit

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Steps in Home Care Services Initial referral prepare as a rule takes 24 to 48 hours Members of group must be accessible to patient all day, every day Care arrange home care group screens patient's treatment look for inconveniences of treatment signs that treatment is successful visit or contact patients on customary premise supplies & medications are readied &delivered week by week understanding released from home care benefit as proper

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Home Care Team Physician Nurses Pharmacists Pharmacy specialists Registered dietitians Respiratory advisors Social laborers Physical & word related advisors Certified nursing associates

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Physician Leader of the group Major changes in treatment need doctor's endorsement Signs "Authentication of Medical Necessity & Plan of Treatment" Physician sedate requests (solutions) by means of telephone as in group drug store setting. through copy machine Rules & directions for opiates particular to state

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Nurse & Pharmacist Coordinate patient supplies Develop plan of care Monitor , archive patient's status Communicate with doctor Coordinate doctor orders Make suitable mediations Assess & teach home care patients Work together to play out association's clinical quality affirmation exercises

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Nurse Primary patient instructor Assesses patient's physical status patient's adherence to treatment arrange state of catheter psychosocial issues Maintenance of intravenous catheters Placement of fringe catheter Insertion of fringe long haul catheters or PICC Schedule & play out all blood work

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Pharmacist Responsible for legitimate procurement, intensifying, apportioning, & stockpiling of medications Responsible for educating persistent & nurture on medications being controlled Clinical drug store parts pharmacokinetic dosing of vancomycin & aminoglycosides healthful bolster administrations contribution to choice of most fitting medication for patient Pharmacist is medication data hotspot for all other colleagues

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Pharmacy Technician Generates prescription marks Prepares & names solutions Maintains clean room & sedate capacity regions Coordinator of IV room Works with drug specialist on blending plan, requesting & keeping up medication & blending supplies, performing quality confirmation on exacerbating exercises Manage stockroom/stock of non-medication supplies Track of records receivable Pick/pack supplies for shipment to patients

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Reimbursement Specialist Key to financial feasibility of organization Interface among back up plan, home implantation organization, & understanding Coordinate all charging for administrations Negotiate cost of administrations with safety net providers Well-versed openly help & government repayment programs (Medicaid & Medicare)

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Patient Service Representative Controls patient's stock of provisions Contacts patient or parental figure on routine premise Coordinate pickup of provisions at end of treatment Pharmacy expert might be in charge of this employment

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Patient and Caregiver Involved being developed of care plan Patient has right to be included Clearly expressed in rights & duties report Established on beginning visit

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Antibiotics Account for 40% - 70 % of current home mixtures Cephalosporins ceftriaxone (Rocephin) cefazolin (Ancef) cefepime (Maxipime) low occurrence of antagonistic responses require negligible observing stable for 10 days - perfect for week after week conveyances ceftriaxone is regularly endorsed given once every day, numerous cephalosporins can be regulated as IV push

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Penicillins Common IV anti-infection agents Difficult to use in home recurrence of measurements steadiness of medicine hypersensitivities Phlebitis Ambulatory pumps-frequently utilized with penicillins Other frameworks utilized ADD-Vantage® Add-Ease®

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Vancomycin Red Man Syndrome Individualized dosing Irritating to veins

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Other Antibiotics Azithromycin (Zithromax) Doxycycline Fluoroquinolones Carbapenems Daptomycin (Cubicin) Linezolid (Zyvox) Quinupristin/dalfopristin (Synercid)

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Antifungals Uses transplant tolerant immunocompromised patient Common pharmaceuticals Intravenous amphotericin B premedication for responses oral acetaminophen and diphenydramine. meds for extreme responses IV meperidine & hydrocortisone flush with Dextrose 5 % (incongruent with saline)

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Other Antifungals Intravenous azole antifungal operators fluconazole (Diflucan) voriconazole (Vfend) Echinocandins anidulafungin (Eraxis), caspofungin (Cancidas) micafungin (Mycamine)

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Antivirals & Other Meds Ganciclovir HIV with cytomegalovirus (CMV) contamination cytotoxic - causes bone marrow harmfulness in AIDS patients Filgrastim (Neupogen) balances bone marrow lethality Foscarnet hydrate with 1,000 mL of ordinary saline Acyclovir Pentamidine through an extraordinary nebulizer Respigard®

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Parenteral Nutrition (TPN) Crohn's malady Malnutrition Infusion choices Over 24 hours Cyclically Catheter Flush

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Typical TPN Ingredients Dextrose Amino acids Electrolytes Trace minerals, Multivitamins 3-in-1 Clinimix®

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Drugs Added to TPN Insulin Heparin Vitamins H2-receptor enemies

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Monitoring of TPN Patients Laboratory tests science and finish blood tally (CBC ) blood glucose liquid status understanding weights liver poisonous quality bone breakdown Pharmacist may counsel with dietician

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Enteral Nutrition Therapy Nutrients given by means of stomach some portion of small digestive system (jejunum) Nasogastric tube (NG tube) Gastrostomy tube (G tube) Jejunostomy (J tube)

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Chemotherapy 5-fluorouracil Cyclophosphamide Doxorubicin (Adriamycin) Oxaliplatin (Eloxatin) Vincristine Vinblastine Paclitaxel (Taxol)

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Complications of Chemo Extravasation Bone marrow danger low platelets (thrombocytopenia) low white platelets (neutropenia) low red platelets (pallor)

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Supportive Therapies for Chemo Filgrastim (Neupogen) Sargramostim (Leukine) IV liquids Anti-queasiness medicines prochlorperazine (Compazine) metoclopramide (Reglan) ondansetron (Zofran)

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Biological Response Modifiers High-innovation or biotech drugs filgrastim (Neupogen) pegfilgrastim (Neulasta) erythropoietin(Epogen, Procrit) darbepoetin alfa (Aranesp) interferons development hormone

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Pain Management Morphine represents 90% home care opiates Others: hydromorphone (Dilaudid) fentanyl with bupivacaine, Routes of organization intravenously subcutaneously intrathecally epidurally

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Cardiovascular Agents Congestive heart disappointment (CHF) Continuous implantations of parenteral inotropic specialists dobutamine dopamine inamrinone (Inocor) milrinone

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Other Therapies Intravenous immunoglobulin (IVIG) Anticoagulants Intravenous corticosteroids Deferoxamine Blood consider substitution items Alemtuzumab (Campath)

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Other Therapies Anakinra (Kineret) Infliximab (Remicade) Nesiritide (Natrecor) Pantoprazole (Protonix IV) Treprostinil sodium (Remodulin) Zoledronic corrosive (Zometa)

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High-Technology Systems Five sorts of home imbuement frameworks minibag mixture by means of gravity framework syringe imbuement by means of syringe gadget syringe imbuement by means of IV push strategy rate-confined IV organization set frameworks mobile electronic implantation pumps elastomeric inflatables frameworks

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Mechanical Systems Paragon® Ambulatory Infusion I-Flow's ON-Q® PainBuster® SilvaGard® catheter Fixed Flow Select-a-Flow™ ONDEMAND™

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Controlled Pressure Systems Eureka™ mixture pump Eureka-LF (low stream) implantation pump beeLINE®

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Ambulatory Infusion Pumps More than 30 walking electronic implantation gadgets accessible little lightweight Therapy-particular gadgets Multiple-thera