McKenna's Pharmacology for Nursing, 2e

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P A R T 1  Introduction to nursing pharmacology

person reports the use of an unusual or difficult-to-find remedy, try looking it up on the Internet at http://nccam. nih.gov, the National Center for Complementary and Alternative Medicine (NCCAM) in the US, a site with general information about complementary and alterna- tive medicines.

and midwife need to be cognisant of off-label uses, and know when to question the use of a drug before admin- istering it. Liability issues surrounding many of these uses are very fuzzy, and the care provider should be clear about the intended use, why the drug is being tried and its potential for problems.

KEY POINTS

KEY POINTS

COSTS OF HEALTHCARE AND THE IMPORTANCE OF TEACHING

■■ OTC drugs have been deemed safe when used as directed and do not require a prescription or advice from a healthcare provider. ■■ OTC drugs can mask the signs and symptoms of disease, can interact with prescription drugs and can be taken in greater than the recommended dose, leading to toxicity. ■■ Herbal or alternative therapies are considered to be dietary supplements and are not tightly regulated by the TGA. ■■ Herbal therapies can produce unexpected effects and toxic reactions, can interact with prescription drugs and can contain various unknown ingredients that alter their effectiveness and toxicity. OFF-LABEL USES When a drug is approved by the TGA or MEDSAFE, the therapeutic indications for which the drug is approved are stated. Off-label use refers to use of a drug that is not part of the stated therapeutic indications for which the drug was approved. Once a drug becomes available for use, it may be found to be effective in a situation not on the approved list. Using it for this indication may eventually lead to a new approval of the drug for that new indication. Off-label use is commonly done for groups of people for which there is little premarket- ing testing, particularly paediatric and geriatric groups. With the ethical issues involved in testing drugs on children, the use of particular drugs in children often occurs by trial and error when the drug is released with adult indications. Dosing calculations and nomograms become very important in determining the approxi- mate dose that should be used for a child. Drugs often used for off-label indications include the drugs used to treat various psychiatric problems. The fact that little is really known about the way the brain works and what happens when chemicals in the brain are altered has led to a polypharmacy approach in psychiatry—mixing and juggling drugs until the wanted effect is achieved. That same combination might not work in another person with the same diagnosis because of brain and chemical differences in that person. Off-label use of drugs is widespread and often leads to discovery of a new use for a drug. The nurse

Costs of medical care and drugs have increased in the last few years. This is partly due to the demand to have the best possible, most up-to-date, safest care and drug therapies. The research and equipment requirements to meet these demands are huge. At the same time, the rising cost of health insurance to pay for all of this is a major complaint for employers and consumers. To save costs, people are being discharged from hospitals far earlier than ever before, and many are not even admitted to hospitals for surgical or invasive procedures that once required several days of hospitalisation and monitoring. As a result, there is less monitoring of the person, and more responsibility for care falls on the person or their significant others. Teaching the person about self-care, drug therapies and what to expect is even more crucial now. The nurse and midwife are most often responsible for this teaching. Role of the Pharmaceutical Management Agency (PHARMAC) in New Zealand In an effort to contain the cost of medicines and medical devices, PHARMAC, the Pharmaceutical Management Agency, was introduced as part of the New Zealand Medicines System that works to ensure New Zealand- ers have affordable access to medicines. PHARMAC’s central role is to manage the pharmaceutical budget on behalf of District Health Boards, and to decide which medicines are government funded. The list of funded medicines is published in the Pharmaceutical Schedule. PHARMAC also play an important role in helping New Zealanders understand how to make the optimal use of their medicines. They have an Access and Optimal Use team which runs information campaigns and other promotions to encourage people to use medicines well, or to improve their health through better and healthier lifestyles. Pharmaceutical Benefits Scheme (PBS) in Australia The Australian Commonwealth Department of Health and Ageing operates the Pharmaceutical Benefit Scheme (PBS) which is administered by Medicare. The Scheme lists medicines that are available at prices subsidised by the government to reduce costs to the public. It is eligible