Lesson 23 — Pharmacology

The clinical medical assistant may help prepare prescriptions, also referred to as R-X. An M-A may be responsible to prepare an R-X for the physician to sign. M-As with specialized credentials may transmit e-prescriptions through the electronic health record, or E-H-R system.

There are many benefits to e-scribed or e-prescribed medications as a component of the E-H-R. The E-H-R automatically checks for allergies. Interactions with other prescribed medications are identified. Coverages are confirmed with the patient's insurance policy. Patient prescriptions are securely transmitted to their preferred pharmacy using the computerized provider order entry, or C-P-O-E.

C-P-O-E is part of Medicare's E-H-R incentive program, also called meaningful use. Meaningful use strives to benefit patients AND the organization by: Reducing errors and improving patient safety with easy to read, standardized orders. Improving efficiency by electronically submitting prescriptions directly. And integrating with insurance plans to provide pre-approval on medications, reducing denied claims and improving reimbursement.

The superscription includes the patient's name, address, and date. The R-X symbol is placed here. R-X is the Latin word for recipe. It directs the patient to "take thou," or "you take." The inscription identifies the medication. The example specifies Synthroid as the prescribed medication. The dosage is seventy-five micrograms. When using written prescriptions, the provider's name and address are usually at the top of the prescription. The remaining components are: Superscription, Inscription, Signature, Subscription, and the physician's signature. The subscription provides dispensing information. Based on this prescription, the pharmacist would dispense thirty tablets and determine whether: Refills are available or generics are permitted. Sig, or signa, comes from the Latin word for "let it be labeled." The sig provides directions to the patient on dosing and timing. In this example prescription, the sig directs the patient to take one tablet every morning, or Q-A-M. It must be taken on an empty stomach, thirty to sixty minutes before eating, or A-C. The final step is the physician signature. The Drug Enforcement Administration, or D-E-A, assigns all physicians a D-E-A number. Physicians include their D-E-A number when prescribing controlled substances. This number allows the D-E-A to monitor fraud and abuse.

gm or g: gram. prn: as needed. pc: after meals. tid: three times a day. dil: dilute. IV: intravenous. OTC: over-the-counter (drugs). cap: capsule. ac: before meals. q2h: every 2 hours. qid: four times a day. ext: extract. NKA: no known allergies. gr: grain. bid: twice a day. IM: intramuscular. mg: milligram. ID: intradermal. disp: dispense. R: rectal. h: hour. Fe: iron. qh: every hour. S, Sig: give the following directions. mL: milliliter. amp: ampule. gtt: drops. tab: tablet. kg: kilogram. ASA: aspirin. SC, SQ, subQ: subcutaneous. C: cup, Celsius. q3h: every 3 hours. q4h: every 4 hours. pr: per rectum. po: by mouth. hs: at bedtime.

Acetylsalicylic acid (ASA), ibuprofen, naproxen. CLASSIFICATION: Nonsteroidal anti-inflammatory drugs (NSAIDs); analgesics. Indicated for Inflammation and pain relief. Acetaminophen (Tylenol). CLASSIFICATION: Analgesic, antipyretic. Indicated for Relief of pain and fever. Pseudoephedrine (Sudafed). CLASSIFICATION: Decongestant. Indicated for Relief of common cold and allergy symptoms. Dextromethorphan (Dayquil Cough, Delsym, Robitussin). CLASSIFICATION: Antitussive. Indicated for Suppression of cough reflex. Diphenhydramine (Benadryl and other combination products). CLASSIFICATION: Antihistamines. Indicated for Cough, cold, allergy, and insomnia. Tums, Gaviscon, Pepto-Bismol. CLASSIFICATION: Antacids. Indicated for Treatment of heartburn, GERD symptoms.

Alternative therapies, which some patients may actively seek or utilize in addition to or in place of traditional medicine, are the focus of this presentation.

Complimentary or holistic medicine is another name for alternative therapy. Patients may use this as an adjunctive or substitute to traditional treatment, which can include: Supplements, Vitamins, and alternative treatment like acupuncture, chiropractic care, mind-body medicine, and homeopathy.

It is imperative for the M-A to document ALL additional forms of therapy. The clinical medical assistant should ask relevant questions to ensure accurate information is captured. Patients may not realize the importance of sharing these alternative choices. Or they may be shy or forget all together.

Mind-body therapy is another alternative therapy and is also known as energy therapy. This is aimed at teaching patients to control certain thoughts. Energy therapy promotes health, balance, and relaxation.

One alternative therapy is acupuncture. This is derived from traditional Chinese medicine. An acupuncturist inserts metal needles into the body to stimulate certain areas. This can relieve pain and treat various conditions.

Patients may also seek chiropractic care. A trained and licensed professional uses manual techniques to treat the patient. This primarily includes manipulation of the spine to correct spinal alignment problems that may otherwise lead to various health conditions.

Over the counter, or O-T-C, medications, vitamins, and herbal supplements may be beneficial. However, some can interact with medication. For example, both fish oil and vitamin E can thin blood. Patients on blood thinners may not be aware of this interaction, which may increase bleeding risk.

Additionally, homeopathic care was first utilized in Germany more than two-hundred years ago. It is based on the principle that, with stimulation, the body will heal itself. Plants and other natural resources are used for stimulation.