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P A R T 1
Introduction to nursing pharmacology
not be as dependent on the drug. With the new matrix
delivery systems used for many medications, however,
splitting the drug can cause it to become toxic or inef-
fective. People should be specifically alerted to avoid
cutting drugs when it could be dangerous, especially
if they are being advised to cut other tablets to be eco-
nomical. The cost of treating the toxic reactions may far
exceed the cost of the original drug.
Generic drug availability in many cases reduces the
cost of a drug. Generic drugs are preparations that are
off patent and therefore can be sold by their generic
name, without the cost associated with brand-name
products. Generic drugs are tested for bioequivalence
with the brand-name product, and resulting infor-
mation is available to prescribers. When a drug has a
small margin of safety (a small difference between the
therapeutic and the toxic dose), a prescriber may feel
more comfortable ordering the drug by brand name to
ensure that the dose and binders are what the prescriber
expects. When “brand substitution not permitted” is on
a prescription, the prescription is filled with the brand-
name drug—such as
Lanoxin
instead of digoxin, or
Coumadin
instead of warfarin. In some situations the
generic drug is not less expensive than the brand-name
drug, so using only generic drugs does not guarantee
that the person is getting the least expensive prepara-
tion. Some pharmacies post the costs of commonly used
drugs, and people may do a
cost comparison
to compare
the relative cost of the same drug among various phar-
macies or the cost differences among manufacturers of
drugs and request that a different drug be prescribed.
The nurse or midwife is often the person who is in the
middle of this issue and must be able to explain the
reason for the drug choice or request that the prescriber
consider an alternative treatment.
Table 6.2 presents an example of a cost comparison
of some beta-blockers commonly used to treat hyper-
tension. When deciding which drug to use, the person,
nurse or midwife may need to consider the range of costs.
Drug Facts and Comparisons
provides a cost compari-
son of drugs in each class, and
The Medical Letter on
Drugs and Therapeutics
provides cost comparisons of
drugs that are reviewed in each issue.
In the last few years, with the cost of drugs becoming
a political as well as a social issue, many people have
begun ordering drugs on the Internet, often from other
countries. These drugs may be cheaper, do not require
the person to see a healthcare provider (many of these
sites simply have customers fill out a questionnaire that
is reviewed by a doctor) and are delivered right to the
person’s door. On checking, many discrepancies have
been identified between what was ordered and what is in
the product, as well as problems in the storage of these
products. Some foreign brand names are the same as
brand names in this country but are associated with dif-
ferent generic drugs. Many warnings have been issued to
consumers about the risk of taking some of these drugs
without medical supervision, reminding consumers that
they are not protected by Australian or New Zealand
laws or regulations when they purchase drugs from
other countries. The TGA website,
/
consumers/import.htm provides important information
and guidelines for people who elect to use the Internet to
get cheaper drugs.
PHARMAC is part of New Zealand’s medicines
system. The medicines system of New Zealand includes
the Ministry of Health, MEDSAFE and District Health
Boards, all working together to improve New Zea-
landers access to and optimal use of medicines. The
central role of PHARMAC is to manage the pharma-
ceutical budget on behalf of District Health Boards and
to decide which medicines are funded by the Govern-
ment. For more information about PHARMAC, please
access the website:
/
your-guide-to-pharmac.
DRUG ABUSE
Illicit drug use is a growing problem. Professional athletes
are cited regularly for abusing anabolic steroids. High
profile television and movie stars are often part of the
drug scene, using
street drugs
—non-prescription drugs
with no known therapeutic use—to enhance their mood
and increase pleasure. Alcohol and nicotine are two
commonly abused drugs that cause serious problems for
the abuser or can interact with various drugs and alter a
person’s response to a prescribed drug but that are often
not seen as drug addiction issues. Parents are often very
concerned that their children will use street drugs. The
“everyone is doing it” argument is hard to counter when
today’s heroes are thought to be heavily involved. Some
people abuse and become addicted to prescription drugs
following an injury, when confronted with chronic pain,
■■
TABLE 6.2 Generic or trade-name drugs?
Drug name
30-day supply Approximate cost
of daily dose
atenolol (generic)
Tenormin
50–100 mg
$11.80
$15.98
labetalol (generic)
Trandate
200–800 mg
$13.50
$21.40
metoprolol (generic)
Betaloc
50–200 mg
$5.90
$9.99
pindolol (generic)
Visken
10–30 mg
$9.40
$7.39
propranolol (generic)
Inderal
40–320 mg
$17.70
$31.50
This table shows general prescription prices for
common beta-blockers used to treat hypertension. It is
presented to illustrate the difference in pricing between
generic and trade-name drugs.
