Pharmacology: Administrative and Clinical Competencies

Pearson's Comprehensive
Medical Assisting
Administrative and Clinical Competencies
THIRD EDITION
CHAPTER 5
Pharmacology
Lesson 1:
Pharmacology
Pearson's Comprehensive Medical Assisting:

Copyright © 2015, 2011 by Pearson Education, Inc.
Administrative and Clinical Competencies, 3/e
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Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly
Lesson Objectives
Upon completion of this lesson, students

should be able to:
1. Define and spell the terms to learn for
this chapter.
2. Differentiate between the legal
(generic) and commercial (trade) and
chemical names for a drug.

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Lesson Objectives
Upon completion of this lesson, students

should be able to:
3. Describe the drug reference resources
that should be accessible in all
physician offices.
4. List the five schedules of the Controlled
Substances Act.

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Pharmacology
• Pharmacology
 Study of medications and drugs
including their forms, intentions for use,
and effects
• Drugs come from many natural
sources: plants, animals, minerals;
others artificially created
• Some drugs, such as vitamins, found
naturally in the foods we eat
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Pharmacology
• Medications, such as penicillin and

other antibiotics, come from molds, a
form of plant life
• Vast majority of drugs today are
synthetic, created in a laboratory by
artificial means

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Pharmacology
• Drugs prescribed for a variety of

reasons
 To help improve a condition
 To eradicate a condition
 To prevent the onset of a condition

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Drug Names
• Generic Name
 "Official" or "nonproprietary" name of a
drug
 Typically written in lowercase letters
 Legal name for the drug
 Required by FDA regulations to have
same effectiveness, safety, active
ingredients, quality, strength, purity,
and stability as brand name drugs

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Drug Names
• Brand Name
 Typically written with capitalized initial
letters
 Name given to a drug by specific
manufacturer
 Called the proprietary name

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Drug Names
• Brand Name
 Often most familiar name for a specific
drug
 Company that holds the patent for the
drug can manufacture and produce that
drug, under that brand name, for 20
years from date of the patent

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Drug Names
• Brand Name
 Generic drugs cannot be sold as long as
a brand name manufacturer of that drug
holds a patent
 Once brand name patent expires, both
brand and generic version of same drug
may be sold
 Generic drugs usually priced lower than
drugs with brand names

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Drug Names
• Brand Name
 Bioequivalent
• Having same strength and action as
brand name version of the drug
 Active ingredients in generic drugs
required to be bioequivalent

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Drug Names
• Brand Name
 Nonactive ingredients, such as dyes or
flavorings, may differ
 Generic drugs not as closely monitored
as brand name drugs

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Drug Names
• Chemical Name
 Chemical formula typically used by
manufacturers and pharmacists
 Generic name of a drug is usually
somehow related to its chemical name

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Regulations and Standards
• Food and Drug Administration (FDA)

 Department within U.S. Department of
Health and Human Services
 Responsible for ensuring human drugs
are safe and effective
 That these products are honestly,
accurately, and informatively
represented to the public

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• Federal Food, Drug, and Cosmetic Act

of 1938
 Stipulates the control of drugs
 Law enacted to ensure the safety of
food, drugs, and cosmetics sold within
U.S. borders

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• Drug Enforcement Administration (DEA)

 Agency of federal government
responsible for drug control enforcement
 All physicians required to register with
DEA to prescribe, dispense, administer
controlled substances

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References
• Physicians' Desk Reference (PDR)

• Hospital Formulary
• United States Pharmacopeia National
Formulary (USP-NF)

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References

 Updated annually
 Information provided by drug
manufacturers
 Essentially a compilation of the package
inserts that come with drugs

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TABLE 54-1 The Three Names Given to a Drug

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References

 Divided into color-coded sections
• White section
• Manufacturer's index
• Pink section
• Product name index
• Blue section
• Lists drugs grouped by therapeutic classes

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References

• Gray/multi-colored
• Color photos of most commonly
prescribed tablets and capsules
• Second white section
• Product information; reprint of the
manufacturers' package inserts

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References

• Green section
• Diagnostic product information

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References
• Electronic References
 Many electronic health record (EHR)
platforms have electronic versions of
reference books
• Online Resources
 Web MD and Medline are two Internet
resources considered to be reliable

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Classifications of Drugs
• Prescription drug
• Nonprescription drug
 Over-the-counter (OTC)
• Controlled substance

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• Prescription Drugs
 Physicians responsible for prescribing
medications
 Some specially licensed professionals
(physician's assistants and advanced
practice nurses) can also write
prescriptions

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 Prescription is a written explanation to a
pharmacist specifying name of
medication, dose, route, and times of
administration

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 Antibiotics
 Antihypertensives
 Pain medications
 Others

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 When dispensed from a pharmacy, label
on drug container for one of these drugs
must read "Caution: Federal Law
prohibits dispensing without
prescription"

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• Nonprescription Drugs
 Also known as over-the-counter (OTC)
drugs
 Medications such as aspirin, cold
medications, antibiotic ointments
 Do not require prescription; regulated
by FDA

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 If taken incorrectly, some OTC drugs
can be unsafe
 Some OTC drugs may react negatively
with a prescription drug patient is taking

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 Remind patients that OTC medications
they need to report include supplements
like vitamins and herbs they may
purchase at a health food store and not
think of as drugs

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• Controlled Substances
 Have potential for addiction or abuse
 DEA strictly enforces control of these
medications
 CSA regulates manufacture and
distribution of drugs that can cause
dependencies
 Psychoactive drugs regulated by CSA:
narcotics, hallucinogens, depressants,
stimulants
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 CSA guidelines for controlled
substances; divided into five categories
(schedules) based on their potentially
addictive level of abuse
 Generally kept under double lock and
key in a non-movable secured cabinet
 Strict control must be maintained

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Schedule for
Controlled Substances
• Schedule I
 Highest potential for addiction and
abuse
 Not accepted for medical use
• Examples: cocaine, heroin,
methamphetamine

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Schedule for
• Schedule II
 High potential for addiction and abuse
 Accepted for medical use in United
States
• Examples: codeine, morphine, opium,
secobarbital

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Schedule for
• Schedule III
 Moderate to low potential for addiction
and abuse
• Examples: butabarbital, anabolic
steroids, APC (aspirin, phenacetin,
caffeine) with codeine

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Schedule for
• Schedule IV
 Lower potential than Schedule III drugs
• Examples: chloral hydrate,
phenobarbital, diazepam

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Schedule for
• Schedule V
 Low potential for addition and abuse
• Examples: low-strength codeine
combined with other drugs to form a
cough suppressant

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• Controlled Substances Log

 Track all controlled substances
 Inventory in stock
 Who administers controlled substance
 How much was given
 How much was wasted

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• Controlled Substances Log

 Date and name of patient receiving drug
 Must be kept on file for at least two
years
 Must be available for inspection from
DEA

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 Physicians required to register with DEA
to prescribe, dispense, administer
controlled substances
 Special form, DEA 224, must be
completed and submitted to the DEA
 Renewal required every three years,
using Form 224a

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 All controlled substances must be
labeled according to CSA specifications,
showing drug's assigned schedule
 Schedule identification number written
as Roman numeral inside a capital letter
C, which stands for controlled substance

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FIGURE 54-2 Label used to indicate a class IV controlled substance.

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 Anabolic steroids
 Butabarbital
 Chloral hydrate
 Codeine
 Diazepam
 Morphine
 Opium

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 Phenobarbital
 Secobarbital
 Acetaminophen (Tylenol) with codeine

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• Inventory of Office Medications

 Medications kept on hand can range
from samples provided by
pharmaceutical companies to
medications commonly used within the
office
 Offices and facilities store both oral
medications and injectable drugs

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Injectable Drugs Commonly
Stocked in the Medical Office
• Elavil
• Dimetane
• Thorazine
• Valium
• Dramamine
• Benadryl
• Diphtheria, tetanus toxoid
• Lasix
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• Garamycin
• Heparin sodium
• Dilaudid
• Xylocaine
• Compazine
• Phenergan
• Bacteriostatic 0.9% sodium chloride
• Tetanus and diptheria toxoids
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• Tetanus antitoxin
• Tine test
• Water for injection
• Cordarone
• Epinephrine
• Levophed
• Electrolytes/Ringer's 1,000 mL

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• Medication Logbook
 Paper document or electronic file
 Name of each medication stored
 Dosages of each medication
 Quantity on hand for each dosage
 Expiration dates
 Separate section used to indicate when
a medication is dispensed to a patient

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 Many electronic health record platforms
will allow for medications that are
dispensed to be scanned into patient's
record
 Can reduce or eliminate charting errors
 Once a month review inventory to ensure
that a sufficient supply of each drug is
available and that no medication has
expired
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 When disposing of expired medications,
follow office policy
 Individual state policies indicate
credentials needed of staff members
allowed to destroy medications
 Local DEA office should be contacted
regarding discarding practices for large
amounts of controlled substances

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Drug Abuse
• Drug abuse
 Use of a drug improperly or wrongly
• Drug dependency
 Reliance or use of medication for
psychological support
• Individuals who become physically
dependent are those who continuously
use a substance to function or to avoid
physical pain
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Drug Abuse
• For physical dependency to occur,

abused substance produces changes in
nervous system on which body begins
to rely
• Once substance removed, individual
experiences withdrawal symptoms
• Depending on level of addiction,
withdrawal symptoms mild to severe

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Drug Abuse
• Commonly Abused Drugs

 Analgesic
 Antianxiety
 Antidepressant
 Sedative
 Illegal drugs

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Drug Abuse
• Identifying Drug Abuse

 Step 1
• Notify the physician immediately
 Step 2
• Check local pharmacies to see if patient
is obtaining medications from multiple
pharmacies

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Drug Abuse

 Step 3
• Tell patients who are frequently calling
for refills that another refill will require
an office visit

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Drug Abuse

 Safeguard items in medical office that
could be stolen and misused for drug
abuse
• Syringes
• Needles
• Prescription pads

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TABLE 54-5 Drug Classifications and Descriptions of
Use

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TABLE 54-5 (continued) Drug Classifications and
Descriptions of Use

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Descriptions of Use

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Descriptions of Use

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Descriptions of Use

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Descriptions of Use

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Questions?

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Pearson's Comprehensive

Pearson's Comprehensive Medical Assisting:

Upon completion of this lesson, students

Pearson's Comprehensive Medical Assisting:

Upon completion of this lesson, students

Pearson's Comprehensive Medical Assisting:

• Medications, such as penicillin and

Pearson's Comprehensive Medical Assisting:

• Drugs prescribed for a variety of

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

• Food and Drug Administration (FDA)

Pearson's Comprehensive Medical Assisting:

• Federal Food, Drug, and Cosmetic Act

Pearson's Comprehensive Medical Assisting:

• Drug Enforcement Administration (DEA)

Pearson's Comprehensive Medical Assisting:

• Physicians' Desk Reference (PDR)

Pearson's Comprehensive Medical Assisting:

• Physicians' Desk Reference (PDR)

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

• Physicians' Desk Reference (PDR)

Pearson's Comprehensive Medical Assisting:

• Physicians' Desk Reference (PDR)

Pearson's Comprehensive Medical Assisting:

• Physicians' Desk Reference (PDR)

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

• Controlled Substances Log

Pearson's Comprehensive Medical Assisting:

• Controlled Substances Log

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

• Inventory of Office Medications

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting:

Pearson's Comprehensive Medical Assisting: