Name ______Date ______Score ______

CHAPTER 35

Basic Pharmacology

CHAPTER PRE-TEST

Perform this test without looking at your book. 1. The Physician’s Desk Reference contains which of the following information? a. Brand and generic names of medications b. Classification or category c. Product information d. All of the above

2. An agent that produces numbness is called an: a. Analgesic b. Anesthetic c. Anticoagulant d. Antidote

3. Ibuprofen is considered which classification of medications? a. Sedative b. Nonsteroidal anti-inflammatory c. Vasopressor d. Decongestant

4. A liquid preparation of a drug is one that has been: a. Dissolved b. Suspended c. Crushed d. a and b

5. Misuse or overuse of medications is termed: a. Medication error b. Diversion c. Abuse d. All of the above 369

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6. Hydromorphone, oxycodone, and morphine are Schedule drugs. a. I b. II c. III d. IV

7. A drug’s official name assigned by the U.S. Adopted Names Council is: a. The generic name b. The brand name c. The chemical name d. All of the above

8. Which of the following are the responsibilities of the medical assistant as they relate to controlled substances? a. Provide security for prescription pads b. Properly dispose of and document the disposal of expired drugs c. Maintain legal inventories of medications d. All of the above

9. What is true about over-the-counter drugs? a. They require a prescription. b. They are safe to use without the provider’s supervision. c. They can be taken in unlimited quantities. d. None of the above.

10. Penicillin and Augmentin are considered which drug category: a. Antibiotic b. Anti-inflammatory c. Antiviral d. Antipyretic

VOCABULARY BUILDER

Misspelled Words I Find the words in Column A that are misspelled; circle them, and then correctly spell them in the spaces provided. Then match each of the vocabulary terms below with the correct definition in Column B.

Column A Correct Spelling Column B G 1. Abuse A. Term used to describe when a licensed practitioner gives a written order to be taken to a pharmacist to be filled E 2. Administer B. An allergic hypersensitivity reaction of the body to a foreign protein or drug B 3. Anaphalaxis Anaphylaxis C. To give the medication to the patient to be used at another time F 4. Contradication Contraindication D. The study of drugs; the science dealing with their history, origin, sources, physi- cal and chemical properties, uses, and effects on living organisms

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Column A Correct Spelling Column B C 5. Dispense E. To give a medication to a patient by mouth, injection, or any other method of delivery A 6. Perscribe Prescribe F. Any symptom or circumstance for which an otherwise approved form of treatment is inadvisable D 7. Pharmacology G. The misuse of legal and illegal drugs

Misspelled Words II Find the words in the list below that are misspelled; circle them, and correctly spell them in the spaces provided. Then insert the proper terms into the spaces provided in the following text, which discusses medical uses of drugs, name of drugs, and sources of drugs.

animal generic replacement chemicel genetic engineering sinthetic curative mineral therepuetic diagnostic plant trade name jean splicing prophalactic chemical prophylactic therapeutic gene splicing synthetic

A drug is a medicinal substance that may be used to vary or modify the functions of a living being. Of the five basic medical uses for drugs, antibiotics are an example of curative drugs (agents used for the killing or removal of the causative agent of a disease). An immunizing agent is an example of a preventive or prophylactic drug, which is one used to stave off or abate the severity of a disease. Another medical use for drugs is in the treatment of a condition to provide symptomatic relief; this is known as therapeutic . Insulin and hormones are examples of the medical use of drugs known as replacement drugs. A fifth basic medical use of drugs is in conjunction with radiology and allows providers to pinpoint the location of diseases’ manifestations. This usage is known as diagnostic . The knowledge of the names of drugs is as essential to the medical assistant as the knowledge of basic uses for drugs. The majority of drugs have three types of names. The generic name is the drug’s ­official name assigned by the U.S. Adopted Names Council.Aspirin is an example of this type of name. The drug’s chemical name describes its molecular structure and identification of its chemical structure. Acetylsalicylic­ acid is an example of this type of name. Ecotrin is an example of a trade or brand name, which is registered by the U.S. Patent Office and approved for usage by the U.S. Food and Drug Administration. Medical assistants must also have a comprehensive understanding of the five basic sources of drugs. The source of digitalis, the dried leaf of a foxglove plant, is an example of a plant source. Insulin, a hormone derived from the pancreas of cows and hogs, is an example of a drug derived from an animal source. Drugs that are artificially prepared in pharmaceutical laboratories are known as synthetic drugs. Syn- thetically prepared sulfur, used in pharmaceutical products (such as certain bacteriostatic drugs), is an example of a drug derived from a mineral source. One of the latest sources for drugs has been provided by genetic engineering. Using a technique called gene splicing , scientists are able to create hybrid forms of life that can treat certain diseases; interferon for cancer treatment is an example of this process.

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LEARNING REVIEW

Short answer 1. Under federal law, providers who prescribe, administer, or dispense controlled substances must register with the DEA and renew their registration as required by state law. Describe the five schedules of classification for controlled substances and give an example for each. Schedule I specifies drugs that have a high potential for abuse and are not accepted for medical use within the United States: LSD, heroin. Schedule II includes drugs that have a high abuse potential and do have an accepted medical use within the United States: amphetamines and cocaine. Schedule III drugs have a low-to-moderate potential for physical dependence, yet have a high potential for psychological dependency: barbiturates and vari- ous drug combinations containing codeine and paregoric. Schedule IV drugs include drugs that when missed or abused can lead to limited physical or psychological dependency: chloral hydrate and diazepam. Schedule V drugs have the lowest potential for abuse of controlled substances: Lomotil and Donnagel.

2. For each of the following, identify whether the drug involved is an OTC medication (OTC) or a prescribed medication (PM). What patient guidelines for proper use are illustrated in each example?

OTC A. Nora Fowler insists that Dr. Winston Lewis cannot help her rheumatoid arthritis and that ­simple ibuprofen is all she needs. Nora buys bulk generic bottles of ibuprofen at the ­drugstore for her rheumatoid arthritis and takes as many as she needs to help ease the painful ­inflammation in her joints and tissues.

The patient is using an OTC drug instead of seeking appropriate medical care. Because the safe maximum dose is not effective for her, she takes too much ibuprofen to relieve the pain of her arthritis and risks negative side effects associated with misuse of the drug.

PM B. When Jim Marshall experiences extreme stress while finishing the architectural designs for a new office building in the community, his girlfriend offers him a tablet or two of lorazepam, a benzodiazepine drug used to treat anxiety and insomnia. “Here, Dr. King gave me these, and they work great,” she says. “You can’t drive when you take this stuff, though. Oh, and these pills are about 2 years old, but I’m sure they’ll still work fine.”

The patient should not take any medication prescribed for another person. All warning labels on medication containers should be heeded. Unused medication should be discarded properly, and no medication should be used without checking the expiration date.

OTC C. At the slightest sniffle or sneeze, Lenore McDonell takes the strongest multisymptom cold medication she can find. Her philosophy is: “I might as well knock it out of my system.”

Many OTC medications have several active ingredients, which may prove to be undesired or un- necessary to properly treat the condition.

PM D. Abigail Johnson hates taking so many medications. So every now and then, when she feels ­especially good, Abigail just decides to stop taking the antihypertensive drug that is part of Dr. Elizabeth King’s treatment plan to control Abigail’s high blood pressure. On a bad day, she’ll take an extra pill.

The provider should be consulted before stopping any prescribed medication. Sudden cessation of the antihypertensive medication could cause Abigail’s blood pressure to rise dangerously. Also, medications should be taken exactly as prescribed.

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PM E. Patty McLean is susceptible to recurrent colds and ear infections. Patty’s symptoms are hard to control because she will almost always stop taking the antibiotics when she starts to feel better and she does not finish the entire regimen recommended by Dr. Lewis. The patient should continue to take the medication for the duration of the prescribed number of days, weeks, and so on.

3. Proper disposal of drugs has become increasingly important. How should outdated medications be disposed of? Outdated medications are to be taken back to the pharmacy for disposal by incineration.

4. The most frequently used routes of administering medication are oral and parenteral. List seven additional routes of administration. Seven additional routes of administration are: topical, sublingual, buccal, rectal, vaginal, inhalation, and instillation.­

5. Name three recently developed systems of drug delivery. Describe each and note their specific advantages. Three more recently developed systems of drug delivery are: (1) transdermal, where medication is received by means of a medicated adhesive patch applied to intact skin near the treatment site; (2) eye-curing lens system, where the drug is contained between two ultrathin plastic membranes and is placed inside the lower eyelid; (3) implantable de- vices, which are positioned just beneath the skin near the blood vessels that lead directly to the area to be medicated. The transdermal method is good for patients who cannot accept medications by mouth, and for its convenience. The eye-curing lens allows for controlled release of medication over an extended period of time, causes little or no dis- comfort, and is convenient. Implantable devices allow for a continuous supply of medication and have the advantage of delivering higher doses with fewer side effects than can be realized through the systemic route.

6. List four examples of the ways in which drugs may be classified, or arranged, in groups. Four examples are: (1) drugs used treat or prevent disease, (2) drugs that have a principal action on the body, (3) drugs that act on specific body systems or organs, (4) and drug preparation.

7. For each drug action, identify the correct drug classification. Then list one example of a drug contained in each class. The first row has been completed as an example for you.

Action Classification Drug Example

Controls or stops bleeding Hemostatic thrombin(hum plas)-fib-apro-Ca Top ­vitamin K Prevents or relieves nausea and Antiemetic Tigan®, Dramamine®, Phenergan®, Reglan®, vomiting Marinol® Neutralizes acid Antacid Amphojel®, Gelusil®, Mylanta®, milk of magnesia Decreases blood pressure Vasodilator Isosorbide dinitrate (Isordil®), nitroglycerine Reduces fever Antipyretic Aspirin, acetaminophen (Tylenol®) Loosens and promotes normal Laxative Metamucil® powder, Dulcolax® bowel elimination Prevents conception Contraceptive Envid-E® 21, Ortho-Novum® 10/11-21, 10/11-28; Triphasil® 21

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Kills or destroys malignant cells Antineoplastic Busulfan (Myleran®), cyclophosphamide (Cytoxan®) Prevents or relieves diarrhea Antidiarrheal Pepto-Bismol®, Kaopectate®, ­diphenoxylate HCL (Lomotil®) Produces a calming effect without Sedative Amobarbital (Amytal®), butabarbital ­sodium ­causing sleep (Buticaps®), phenobarbital

CERTIFICATION REVIEW

These questions are designed to mimic the certification examination. Select the best response. 1. All drugs available for legal use are controlled by the: a. Federal Food, Drug, and Cosmetic Act b. Council on Pharmacy of the American Medical Association c. Controlled Substance Act of 1970 d. Americans with Disabilities Act of 1990

2. Federal law requires that at the end of the workday, controlled substances that are used on the premises must be: a. locked in a provider’s office by a provider b. counted, verified by two individuals, and recorded on an audit sheet c. discarded by flushing down the toilet or hopper d. returned to a pharmacy

3. An inventory record of Schedule II drugs must be submitted to the Drug Enforcement Administration (DEA) every: a. week b. month c. year d. 2 years

4. An example of a drug requiring a prescription is the: a. antibiotic penicillin b. antihistamine Benadryl® c. analgesic acetaminophen d. antacid cimetidine

5. An example of an OTC drug is the: a. analgesic ibuprofen b. vasodilator nitroglycerin c. antitussive codeine d. narcotic morphine

6. When a drug acts on the area to which it is administered, it has what is known as a: a. systemic action b. remote action c. local action d. none of the above

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7. The four principal factors that affect drug action are absorption, distribution, biotransformation, and: a. elimination b. interaction c. contraindication d. excretion

8. By law, outdated and expired controlled substances must be: a. handed over to your local law enforcement agency b. thrown away c. returned to the pharmacy d. flushed down a toilet

9. Patients need to realize that OTC drugs can: a. interact with other drugs and cause undesirable or adverse reactions or complications b. mask symptoms and exacerbate an existing condition c. have little or no effect on disease processes d. a and b

10. The most frequently used routes of administering medication are: a. inhalation and sublingual b. parenteral and inhalation c. oral and parenteral d. transdermal and oral

LEARNING APPLICATION

Critical Thinking 1. What factor in determining the route selection for administering a medication is illustrated by each example below, and why? A. A patient diagnosed with insulin-dependent diabetes mellitus performs three self-injections of insulin daily, according to the provider’s treatment plan. The characteristics of a drug must be considered. Insulin is destroyed by digestive enzymes; therefore, the route of administration must be parenteral.

B. Chemotherapeutic drugs are used to attack cancer cells that may be traveling throughout a patient’s body, and usually they are administered intravenously. The action of the medication on the body—local or systemic—must be considered. Intravenous ­medication reaches the systemic circulation rapidly via the bloodstream and quickly becomes effective; thus it is the best choice for systemic chemotherapy agents. C. A patient in a nursing home who is in the end stages of Parkinson’s disease is bedridden, has trouble ­swallowing, and suffers from dementia. The patient, who is also suffering from angina as a result of poor blood circulation, is prescribed a nitroglycerin transdermal system instead of a sublingual dosage, to be held under the tongue, or time-released capsule to swallow. The physical and emotional state of the patient must be considered. Here, because of the patient’s ­inability to swallow easily and the presence of dementia, the patient may not be able to understand or tolerate the administration of nitroglycerine by sublingual or an oral route. The patient is better served by using a transdermal route.

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Case Studies

Case Study

While Anna Preciado RMA, a clinical medical assistant newly hired at the clinic of Drs. Lewis and King, is performing her shift duties, she notices a fellow employee exhibiting strange behavior. Audrey Jones, CMA (AAMA), is usually the model of efficiency. Since Anna began working at the Northborough Family Medical Group, she has always known Audrey to be alert, friendly, and able to handle difficult clinical situations with grace under pressure. Lately, however, when Anna asks Audrey questions, Audrey seems irritable and easily confused. Anna also notices Audrey exhibiting a sloppy technique during routine clinical procedures. Anna is disturbed by Audrey’s erratic behavior but does not mention anything to anyone. After all, Anna is new to the job. But while counting the contents of the controlled substance cabinet in preparation for the end of her shift, Anna notices that a bottle of phenobarbital is missing. Anna knows that office manager Marilyn ­Johnson will arrive shortly to verify and record the inventory count. Anna is now worried that perhaps Audrey is to blame for the missing drugs but is afraid of jumping to conclusions and of angering Audrey. Anna knows Audrey is in the staff lounge preparing to leave for a dinner break.

CASE STUDY REVIEW QUESTIONS

1. What is Anna’s first action under the circumstances? Should she confront Audrey? Anna’s first action is to report the missing drugs to the office manager. She should also report Audrey’s erratic behavior, but may do so without placing direct blame on Audrey or accusing her of stealing the controlled substances without firm evidence that Audrey has done so. Anna should not confront Audrey. The office manager will investigate both the missing bottle of phenobarbital and Audrey’s erratic behavior. If the two events are linked, the office manager will take appropriate action. 2. What special responsibilities do health care professionals, including medical assistants, have regarding the misuse or abuse of legal or illegal drugs? There has been a tremendous rise in the number of abuse cases involving legal and illegal drugs, and this increase is reflected in the workplace. All health care professionals, including medical assistants, have a responsibility to provide their patients with the highest quality of care and competent treatment. To maintain this quality of care, intentional misuse or abuse of drugs is not tolerated. Medical assistants may encounter patients or fellow health care professionals who are misusing or abusing drugs, and they have a responsibility to report such individuals to the proper authorities. Health care professionals also have the responsibility of becoming role models for good health practices and behaviors for their patients.

Research Activities The PDR is an invaluable resource and one of the most widely used publications in the medical industry. The ­annually updated publication is usually available in most clinics and medical offices. It provides medical ­professionals with practical information about thousands of medications and includes other useful data, such as lists of drugs new to the market and those that have been discontinued. It is essential that medical assistants ­become familiar with the publication and learn how to access the wealth of information stored within.

1. Use the PDR to locate the pertinent information for each of the following scenarios. Then identify the drug’s source or method of production. A. Herb Fowler, Dr. Winston Lewis’s patient, calls to report he is experiencing nausea, a symptom he believes may be a negative reaction to the Chronulac Syrup® Dr. Lewis recently prescribed for Herb’s chronic ­constipation. Using the PDR, locate the following information:

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Chronulac Syrup’s generic name: Chronulac Syrup’s® generic name is lactulose. The sugar that Chronulac Syrup contains is galactose. Identify the drug’s source or method of production: The drug’s source is a plant. B. Another patient of Dr. Lewis’s, Michael Zamboni, has recently been diagnosed with insulin-dependent type II diabetes. Dr. Lewis prescribes Humulin®. Using the PDR, find the following information: ­Humulin’s® generic name: Humulin’s® generic name is insulin. The source from which Humulin® is derived: The source from which it is derived is human (recombinant) DNA. Identify the drug’s source or method of production: The drug’s source is genetically engineered ­(genetically altered) human recombinant insulin. C. Susan Marshall, a new patient of Dr. Elizabeth King, acquired a high-pressure job about 1 month ago. ­Recently, she has been reporting an upset stomach, which has been attributed to her stressful job and poor eating habits. Dr. King orders prescription-strength Pepcid® for Susan. Using the PDR, locate the following­ information: Pepcid’s® generic name: Pepcid’s® generic name is famotidine. Pepcid’s® active ingredient: The drug’s active ingredient is the enzyme pepsin. Identify the drug’s source or method of production: The drug’s source is chemical.

2. Camille Saunders, another patient of Dr. King, has been taking Ortho Tri-Cyclen®, an oral contraceptive, for 6 months. It has just been discovered that Camille has epilepsy. Using the PDR, locate the following information: A. Does Ortho Tri-Cyclen® have any known contraindications to any drugs used in the treatment of epilepsy, and if so, which drugs? Ortho Tri-Cyclen® may interact with drugs used to treat epilepsy, such as barbiturates (e.g., Phenobarbital) and anticonvulsants (e.g., carbamazepine; Tegretol® is one brand of these). B. Identify the drug’s source or method of production. The drug’s source is synthetic, or chemical hormone.

CHAPTER POST-TEST

Perform this test without looking at your book. 1. Hybrid forms of life have been created that benefit human beings by providing an alternative source of drugs; an example is: a. ibuprofen b. interferon c. digitalis d. epinephrine

2. If the symbol ® follows a drug name, no other manufacturer can make or sell the drug for: a. 7 years b. 10 years c. 20 years d. 17 years

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3. One compound extracted from the adrenal gland of animals and used therapeutically is: a. cortisone b. acetaminophen c. insulin d. piroxician

4. Those drugs with a potential for abuse and dependency are monitored by the: a. FDA b. AAMA c. DEA d. CDC

5. An inventory record of Schedule II drugs must be submitted to appropriate authorities every: a. 2 years b. 1 year c. 5 years d. 7 years

6. The medication Isuprel is used to treat: a. seizures b. allergies c. heart block d. diabetic coma

7. The name describes the drug’s molecular structure and identifies its chemical structure. a. chemical b. trade c. generic d. brand

8. Schedule drugs have low-to-moderate potential for physical dependence. a. I b. II c. III d. IV

9. An agent that prevents or relieves cough is classified as: a. expectorant b. antipsychotic c. antitussive d. laxative

10. Medications for respiratory diseases such as asthma may require direct delivery of medications using which method: a. transdermal b. inhalation c. rectal d. eye-curing lens

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SELF-ASSESSMENT

Organize your medicine cabinet. Or, with permission, organize the medicine cabinet of a close family member.

1. First, determine which drugs are out of date and destroy them properly. Answers will vary according to each individual student’s personal situation. If students share their work with each other, be very certain that HIPAA rules of confidentiality are not compromised in the classroom.

2. Next, determine which drugs are no longer being prescribed, but rather are basically “left over” from a ­previous illness.

3. Make a decision. Should those leftover drugs be disposed of, or was it the intention of the provider for those medications to be available to you (or your family member) in the future? If they are not to be used in the future, dispose of them properly.

4. Separate the OTC drugs from the prescription drugs. Organize the OTC medications into categories of ­actions (the analgesics together, cough and cold medicines together, etc.).

5. If you (or your family member) are on a long-term drug therapy, make up a medicine card to be carried with you (or your family member) at all times. On the card, list the drug, strength, and dosage. Place this card in your wallet or purse (or that of your family member), so the medicine list is available at all times. Keep the list updated as prescriptions change.

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