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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
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.
KEY POINTS
■■
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
KEY POINTS
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.
COSTS OF HEALTHCARE AND THE
IMPORTANCE OF TEACHING
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
