Pharmacy medication issues for shelter field community support missions
This presentation is the property of its rightful owner.
Sponsored Links
1 / 20

PHARMACY MEDICATION ISSUES FOR SHELTER/FIELD COMMUNITY SUPPORT MISSIONS PowerPoint PPT Presentation


  • 71 Views
  • Uploaded on
  • Presentation posted in: General

PHARMACY MEDICATION ISSUES FOR SHELTER/FIELD COMMUNITY SUPPORT MISSIONS. Saundra J. Martino, RpH. DISASTERS *Each disaster is different in the health care/medical needs that it creates

Download Presentation

PHARMACY MEDICATION ISSUES FOR SHELTER/FIELD COMMUNITY SUPPORT MISSIONS

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Pharmacy medication issues for shelter field community support missions

PHARMACY MEDICATION ISSUES FOR SHELTER/FIELD COMMUNITY SUPPORT MISSIONS

Saundra J. Martino, RpH


Pharmacy medication issues for shelter field community support missions

DISASTERS

*Each disaster is different in the health care/medical needs that it creates

*Epidemiological differential across the types of disasters—helps to predict exacerbations in patients with pre-existing conditions

FIRES/VOLCANIC ERUPTIONS/EARTHQUAKES

increase in particulate matter in the air which can exacerbate underlying pulmonary conditions

HEAT WAVES

added stress on people with underlying cardiac issues

HURRICANES AND FLOODING

see an increase in gastrointestinal illnesses and dermatological conditions


Pharmacy medication issues for shelter field community support missions

DESTRUCTION OF HOUSING

increased risk of venous thromboembolism

STRESS OF DISASTERS

can exacerbate underlying cardiovascular and psychological issues

*recent disasters have highlighted the need for medications to treat chronic disease states in addition to the usual acute ones that present in these situations

*after Hurricane Katrina the majority of medications dispensed were for chronic diseases of people displaced by the storm


Shelters field missions

SHELTERS/FIELD MISSIONS

*acute issues

*cardiovascular disease

*diabetes

*pulmonary issues/asthma

*mental illness

Chronic conditions (cardiovascular disease, diabetes, pulmonary issues) impair an older adult’s ability to prepare, respond, or recover from a disaster


Pharmacy specific related issues

Pharmacy Specific Related Issues

*limited medication availability

*limited drug selection

*increased need for therapeutic substitution

*missing, incomplete, or inaccurate health care records

*increased risk of adverse effects

*compromised ability to maintain continuous care

*poor access to fresh food and clean water

*inability to store medications properly

*donated drugs---often “dumped” –not useful for that particular situation/also short dated or expired


Addressing some of the problems

Addressing Some of The Problems

  • ICE Rx

    provides dispensing information from major PBM’s, and participating state Medicaid programs

    available to “credentialed” physicians and pharmacists

  • RxResponse

    collaboration of healthcare organizations involved in the manufacturing, distribution, and dispensing of medications

    pharmacy status reporting tool

  • Emergency Prescription Assistance Program (EPAP)

    federal program to pay for prescription medications and a limited amount of durable medical equipment (DME) in federal disaster areas

    one time fill of medications up to a 30 day supply for people with no prescription insurance


Acute issues

ACUTE ISSUES

  • Wound care

  • Rashes

  • Burns

  • Hypothermia

  • Crush injuries

  • Acute diarrhea

  • Infections

  • Immunizations

OTC’s

Antibiotics

Analgesics

Pedialyte

Loperamide

Kaopectate

Xifaxan

Meclizine

Ondansetron inj


Tetanus

TETANUS

Spores of C. Tetani reside in the soil and enter the body through open wounds

---travels to CNS

---block neurotransmission

---disinhibit the motor cortex

--- extensive nerve spasms

Tetanus Immune Globulin

Prophylaxis of infection in patients with traumatic injuries

Pediatric Dtap

Adult Tdap


Cardiovascular disease

CARDIOVASCULAR DISEASE

HYPERTENSION

systolic bp> or= 140mmHg

diastolic bp> or = 90mm Hg

CONGESTIVE HEART FAILURE

MYOCARDIAL INFARCTION

*83.6 million American adults have 1 or more types of CVD

*20% of adults over age 65 have coronary heart disease

* 1 in every 5 individuals has hypertension=18.38% of the population or 50 million people

*STRESS is a known risk factor for the development and progression of heart disease

*physically limited

*on oxygen

*complex medication regimens

*food in shelters is high in sodium, carbohydrates and fat

SITUATIONS

*heart attacks spiked in Japan after the 2011 earthquake and tsunami

*Katrina: admissions to Tulane University Hospital

heart attacks represented 2.4% of patients in the 6.5 years following the storm whereas they only represented 1% in the 2 years prior to the storm


Cardiovascular drugs

CARDIOVASCULAR DRUGS

  • ACE INHIBITORS

  • BETA-BLOCKERS

  • CALCIUM CHANNEL BLOCKERS

  • DIURETICS

  • CARDIAC GLYCOSIDES

  • DIRECT VASODILATORS

  • NITRATES

  • CENTRALLY ACTING ALPHA2 AGONISTS

ACE INHIBITORS

*chf

*hypertension

Lisinopril 20mg tablets

Enalapril 1.25mg/ml inj 2ml

BETA BLOCKERS

*angina

*hypertension

*arrhythmias

Atenolol 50mg tablets

Metoprolol tartrate 50mg tablets

Metoprolol inj 1mg/ml 5ml

Propranolol 20mg tablets

Propranolol inj 1mg/ml


Cardiovascular drugs1

CARDIOVASCULAR DRUGS

CALCIUM CHANNEL BLOCKERS

*angina

*hypertension

*supraventricular arrhythmias

Nifedipine 10mg caps

Verapamil 80mg tabs

Verapamil SR 240mg tabs

Diltiazem hcl inj 5mg/ml 5ml

DIURETICS

*edema

*hypertension

Hydrochlorothiazide 25mg tabs

Furosemide 40mg tabs

Furosemide inj 10mg/ml 10ml

CARDIAC GLYCOSIDES

*chf

*atrial fibrillation

Digoxin 0.125mg tabs

Digoxin inj 0.25mg/ml 2ml

DIRECT VASODILATORS

*hypertensive crisis

Hydralazine 20mg/ml 1ml

NITRATES

*relief of angina pain

Nitroglycerin SL 0.4mg tabs

Nitroglycerin transderm 0.2mg/hr

Nitroglycerin inj 5mg/ml 10ml

Isosorbide 10mg tabs


Cardiovascular drugs2

CARDIOVASCULAR DRUGS

CENTRALLY ACTING ALPHA 2 AGONIST

*hypertension

Clonidine 0.1mg tablets


Diabetes affects 25 8 million americans

DIABETESaffects 25.8 million Americans

Katrina

*11% of the population living in New Orleans and Jefferson parishes had diabetes

*1 million people evacuated=100,000 displaced diabetics

*Civic center at Baton Rouge housed > 6000 individuals would have to care for >600 diabetics

Considerations:

*dietary intake

*physical activity

*stress

*other comorbidities

hypertension

dyslipidemia

neuropathy

kidney disease

macular degeneration

Diabetic Supplies

alcohol pads

lancets

blood glucose monitors

test strips

syringes

sharps containers

glucose tabs/gels

Drugs

Glucagon for injection

Glyburide 5mg tabs

Pioglitazone 15mg tabs

Humulin N/Novolin N

Humulin R/Novolin R

Humulin 70/30 / Novolin 70/30


Diabetes

DIABETES

GLUCAGON FOR INJECTION

emergency treatment of severe hypoglycemia

increase in blood glucose levels

>44lbs 1mg IM/IV/SQ

GLYBURIDE 5MG TABLETS

second-generation oral sulfonylurea

stimulates pancreatic islet cells which results in an increase in insulin secretion

onset of action is within 2 hours

maximum decrease of serum glucose occurs in 3 to 4 hours

once daily dosing with the first meal of the day

PIOGLITAZONE 15MG TABLETS

thiazolidinedione (TZD)

“insulin sensitizer”—target insulin resistance in type II diabetics

increased risk of heart failure, edema, weight gain

once daily dosing

INSULINS

*various manufacturers/not normally what the patient uses

*refrigerated (36-46 F) unopened is good until the expiration date on the box

* un- refrigerated (59-86F) maintains its potency up to 28 days

*>86F loss of potency and loss of blood glucose control over time

General Rule: insulin loses its potency according to the temperature it is exposed to and the length of the exposure

INSULIN SWITCHING

Humulin/Novolin

Humulin R/Novolin R

Humulin N/Novolin N

Humalog/Novolog

Substitutable on a unit-for-unit basis—just monitor


Diabetes1

DIABETES

INSULIN PUMPS TO INJECTABLE

Can substitute intermediate acting (NPH) for the 24 hour total basal dose of infused insulin on a unit – per-unit basis

make sure total dose of NPH is split between morning & evening doses

if regular insulin is available patients should administer mealtime insulin according to their previous system for calculating their bolus insulin doses


Pulmonary issues asthma

PULMONARY ISSUES/ASTHMA

ASTHMA 2011= 25.9 million Americans

highestprevalencein 5-17 year olds

characterized by swelling and inflammation of the lining of the airway…muscles tighten around the airway and mucus clogs the airway…narrows the airway and breathing becomes difficult

often occurs in response to specific “triggers”

pollen, tobacco, mold, etc.

COPD

(chronic obstructive pulmonary disease)

characterized by an obstruction to airflow that interferes with normal breathing

affects 13 million

LUNG CANCER

SITUATIONS

WORLD TRADE CENTER 9/11/01

July 2002-April 2004 rescue and recovery workers … 61% developed respiratory symptoms

HURRICANE KATRINA

respiratory issues increased due to mold produced by the flooding


Respiratory tract agents

RESPIRATORY TRACT AGENTS

STEROIDS

QVAR 40 mcg inhaler

(beclomethasone dipropionate)

Dexamethasone 4mg/ml inj

Methylprednisolone 4mg dosepak

Methylprednisolone 125mg inj

Methylprednisolone 1000mg inj

Prednisone 5mg tablets

Prednisone 20mg tablets

RESPIRATORY ANTIMUSCARINIC

Ipratropium Bromide HFA inh

(atrovent)

RESPIRATORY SMOOTH MUSCLE RELAXANTS

Theophylline ER 200mg tablets

BRONCHODILATORS

Albuterol HFA inhaler

Albuterol soln for inh 0.083%

Albuterol syrup 2mg/5ml

Albuterol tablets 4mg

Terbutaline sulfate inj 1mg/ml

Terbutaline sulfate tablet 5mg


Mental illness

MENTAL ILLNESS

*Psychological distress

*Anxiety

*Insomnia

*Depression

*Post-traumatic stress disorder


Mental health agents

MENTAL HEALTH AGENTS

ANTIMANIC AGENT

Lithium 300mg tablets

ANTIPSYCHOTIC

Haloperidol 1mg tablets

Haloperidol 5mg/ml inj

Risperidone tabs 1mg

ANXIOLYTIC

Diazepam 5mg tab

Diazepam 5mg/ml

SEDATIVE/HYPNOTIC

Zolpidem 10mg

TRICYCLIC ANTIDEPRESSANT

Nortriptyline 25mg caps

HETEROCYCLIC ANTIDEPRESSANT

Trazodone 50mg tabs

SSRI

Fluoxetine 20mg caps


Conclusion

CONCLUSION

CHALLENGE

Continuity of care—chronic medication use

Attacks on the World Trade Center on 9/11/01 created greater awareness for the needs of the chronically ill population

When the catastrophic hurricanes hit the Gulf Coast in 2005 public health and other professionals fully grasped the urgency to address the chronic

health needs of the vulnerable populations during disasters


  • Login