Shared Flashcard Set

Details

Pharmacology II Test 1
Partlow - Psychological Aspects of Pharm ( Placebo + Compliance ppt)
24
Pharmacology
Professional
01/21/2013

Additional Pharmacology Flashcards

 


 

Cards

Term

*NonCompliance

(3)

Definition

  • *Defined as failure to self-administer prescribed medicines according to the instructions given by the doctor and codified in a prescription. 
  • Noncompliance can be either intentional or unintentional.  
  • In either case, noncompliance is associated with poorer clinical results than compliance.

 

Term

The cost of noncompliance

(2)

Definition
  • The cost of noncompliance is extraordinarily high.  
  • It has been estimated that more than $15,000,000,000 per year is spent to treat the medical results of failure to appropriately self-administer prescription drugs.
Term
*Requirements That Must Be Met for a Patient to be in Compliance
Definition
  • Use right drug in the 
  • prescribed dosage 
  • by correct route 
  • at the proper times 
  • for the correct duration.  
  • *Conclusion: 
    • *Five Drug Related Decisions Need to be Made Every Time a Medicine is Taken
Term

Compliance

Filling

(2)

Definition
  • The most obvious form of noncompliance is the failure to ever fill prescriptions (20%).  
  • In addition, 30% of those that are filled initially are not properly refilled.
Term

The frequency of noncompliance

(7)

Definition

  • *Very Hard to accurately estimate; Variously set at 10-95%
  • Most studies suggest that the frequency is around 70%
    • 7 year UGDP study: 74% changed drug handling without consulting a physician
  • *The Frequency of noncompliance has been variously estimated between 10% and 95% with a median of about two thirds (66%) of patients.  
  • In one major study, 74% of the patients were found to have altered the handling of their medication without consulting a physician!
  • Such studies demonstrate that most/all patients are non-compliant to some degree.  
  • Furthermore, their degree of non-compliance has been shown to vary with factors such as health and age.

Term

The frequency of noncompliance

Best Assesment Method: Direct Observation?

Definition

  • Direct observation is arguably the best way to determine the frequency of noncompliance but it is usually impractical and is rarely used.  
  • In addition, direct observation might overestimate compliance because the patients would know that they were being watched.

 

Term

*What Conclusions Can We Reach Regarding Noncompliance?

(5)

Definition
  • *Most or all patients are noncompliant to some extent
  • *Their degree of noncompliance will vary with;
    • Intellect 
    • Health and 
    • Age
Term

Factors Which Encourage Pt Compliance

(5)

Definition
  • Keep it simple (KISS)!
    • *Once-per-day regimens are best
    • *Multiple doses are an enormous problem, esp. for the elderly and/or sick
    • Make it personal
      • Develop a personal relationship & frequency falls from 45% to 17%
Term
Drug decisions per day example
Definition
  • 15 doses from 13 bottles at 4 different times/day
  • 15 x 5 = 75 drug decisions/day
Term

*Patient Education Must Include

(10)

Definition
  • What are the drugs benefits?
  • How will tx be monitored?
  • Consequences of noncompliance?
  • Side effects & drug interactions?
  • Will the pt become addicted?
  • Rx Parameters:
    • How (what route)?
    • How much?
    • How long?
  • *Your goal should be to encourage your patients to "partner" with you in managing their health care

Term

*Other Factors Which Discourage Patient Compliance

(12)

Definition
  • Lack of discernible progress
  • Taste
  • Cost
  • Poor past Rx experiences
  • Peer pressure
  • Special patient factors
    • Intellect:
      • Confusion
      • Inability to understand instructions
      • Difficulty remembering to take meds
    • Poor eyesight/inability to read
    • Dependence on others (children & elderly)

Term

How Can One Best Assess Compliance?

(6)

Definition
  • PHYSICIANS ESTIMATION
  • PATIENTS REPORTS
    • Strep throat study
  • PILL COUNTING
  • MEDICATION MONITORS
  • DIRECT MEASUREMENT

Term

*Effects of Noncompliance

(4)

Definition
  • *IT MIGHT JEOPARDIZE THERAPY.
  • *  THE DOCTOR MIGHT BE MISLED.
  • *  DRUG TOXICITIES CAN RESULT FROM NONCOMPLIANCE IF DRUGS HAVE SMALL TIs
  • Noncompliance must always be considered a possible cause of therapeutic failure
Term

Placebos and the Placebo Effect

(4)

Definition
  • Placebo = Latin verb = I shall please
  • *A placebo is a drug/agent that lacks therapeutic effect and is merely given to please the patient.
  • Placebos have been used since the beginning of medicine by witch doctors, medicine men, and apothecaries who had little else to sell.

  ANY EFFECT ATTRIBUTABLE TO A PILL, POTION, OR PROCEDURE BUT NOT TO ITS PHARMACODYNAMIC OR SPECIFIC PROPERTIES  ---   WOLF, 1959

Term

How Does a Placebo Work?

(3)

Definition
  • It works in the CNS by calming a patients anxieties & reducing pain.
  • In cases involving pain, placebo effects have been shown to be blockable by naloxone so they must be due to release of endorphins.
  • Patterns of brain activity (right) show that placebos can produce  changes in brain activity
Term

How Powerful is the Placebo

(3)

Definition
  • Dr. Beecher and WWII; a battlefield surgeon who treated severely injured soldiers
    • *35% of patients respond positively to placebo Rx for conditions from postoperative wound pain to angina to the common cold.
    • *20-25% respond positively to asthma, hyper-tension, & depression.

Term

*Placebo Reactors

(4)

Definition
  • *They are individuals who obtain positive responses from use of a placebo.
  • *They cannot be identified in advance by psychological testing but can be by drug trials.
  • *Depending on current emotional state, every individual is potentially a placebo reactor
    • *Medical student study (30% responders)
Term

*"Toxicities" Resulting from Use of Placebos

(5)

Definition
  • It can destroy your relationship with the patient.
  • It can convince a sick patient that he/she is being adequately treated.
  • It can convince a well patient that he/she is sick.
  • It may promote psychological addiction
  • It might serve as a physicians crutch.
Term

*Possible Effects of Noncompliance on Clinical Trials

(3)

Definition
  • If unequally distributed, it can cause either false positives or false negatives.
  • It can diminish test sensitivity even if NCs are uniformly distributed
  • The presence of unrecognized NCs in the treatment group will cause underestimation of a drugs toxicity

Term

Summary: Noncompliance and Testing

(5)

Definition
  • *Monitoring compliance during clinical trials should be mandatory.
  • *Noncompliers can be partially or completely eliminated by use of a pretrial exclusionary test.
    • VA Cooperative Hypertension Study
    • Riboflavin tablets were used and the ingredient was measured in urine.
    • Insufficiently compliant patients (ca 50%) were eliminated prior to the real test.

Term

*Placebos and Clinical Testing

(6)

Definition
  • Used to account for the tendency of a patient to respond positively to any new treatment even if inactive (i.e., the placebo effect).
  • Used to take into account the fact that severity of a disease waxes and wanes irrespective of the use of drug or placebo.
  • New drugs are generally compared to (a) placebos and (b) a known effective drug but, if an illness is serious, it would not be ethical to test against a placebo.
  • Control for the placebo effect can only be achieved if the drug is administered under double-blind conditions
    • How important is the use of double-blind procedure?
  • Elimination of placebo responders from treatment groups  is possible by pretrial testing & often makes results clearer.

Supporting users have an ad free experience!