Pharmaceutical Drugs Ebook

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Metaphorical Prescriptions

As part of the whole treatment program my patients are given concrete assignments reinforced with hypnotic suggestions for improved therapeutic outcome. These assignments which they are asked to complete, are designed so that the patient will metaphorically and concretely experience a feeling of success, as well as a sense of gaining mastery, control, and exercising new choices and options. Examples of such metaphorical prescriptions are the following

Development of Pharmaceutical Drugs

The development of new pharmaceutical drugs can serve as an example of how the scientific method is used in physiology and its health applications. The process usually starts with basic physiological research, often at cellular and molecular levels. Perhaps a new family of drugs is developed using cells in tissue culture (in vitro, or outside the body). For example, cell physiologists, studying membrane transport, may discover that a particular family of compounds blocks membrane channels for calcium ions (Ca2+). Because of their knowledge of physiology, other scientists may predict that a drug of this nature might be useful in the treatment of hypertension (high blood pressure). This drug may then be tried in experimental animals. The percentage of drugs that make it all the way through these trials to eventually become approved and marketed is very low. Notice the crucial role of basic research, using experimental animals, in this process. Virtually every prescription drug on the...

Prescription Drugs

Prescription drugs are drugs that the federal government has designated to be potentially harmful unless their use is supervised by a licensed health care provider, such as a nurse practitioner, physician, or dentist. Although these drugs have been tested for safety and therapeutic effect, prescription drugs may cause different reactions in some individuals.

Controlled Substances

Prescriptions for controlled substances must be written in ink and include the name and address of the patient and the Drug Enforcement Agency number of the primary health care provider. Prescriptions for these drugs cannot be filled more than 6 months after the prescription Prescription drugs, also called legend drugs, are the largest category of drugs. Prescription drugs are prescribed by a licensed health care provider. The prescription (see Fig. 1-2) contains the name of the drug, the dosage, the method and times of administration, and the signature of the licensed health care provider prescribing the drug.

Educating the Client on the Use of Herbs and Nutritional Supplements

The use of herbs and nutritional supplements to treat various disorders is common. Herbs are used for various effects, such as to boost the immune system, treat depression, and for relaxation. Individuals are becoming more aware of the benefits of herbal therapies and nutritional supplements. Advertisements, books, magazines, and Internet sites abound concerning these topics. People, eager to cure or control various disorders, take herbs, teas, megadoses of vitamins, and various other natural products. Although much information is available on nutritional supplements and herbal therapy, obtaining the correct information sometimes is difficult. Medicinal herbs and nutritional substances are available at supermarkets, pharmacies, health food stores, specialty herb stores, and through the Internet. The potential for misinformation abounds. Because these substances are natural products, many individuals may incorrectly assume that they are without adverse effects. When any herbal remedy...

Social history SH Tabic

The same principles of nests and layers in the selection of the appropriate questions to ask apply. For example, if an elderly patient presents with dementia or a fractured hip, the sexual orientation will be irrelevant and illicit drug misuse (although not alcohol abuse) so unlikely that any inquiries may cause upset and antagonism. However, inquiries about with whom the patienl lives, whether there is additional help at home, and whether the house is on Lhe ground floor or at the top of a tenement building may be crucial.

Third Party Information

The topics involved arc often highly sensitive, for instance sexual abuse, offending behaviour, drug misuse, eating disorder or domestic violence, and the informant may be genuinely concerned for the patient and apprehensive about the outcome should Ihe patient discover the intervention. In these circumstances, clinically relevant information obtained from a third party should be written on a separate sheet of paper, clearly identified as such and, located separately in the clinical records, preferably behind a casenote divider headed Third Party Information . This ensures that the patient would not have access to this pan of the clinical record (under the Health Records Act 1990). and this assurance should be given to the informant.

Nonnuisance Nonmaleficence

Ventions mentioned in this chapter, there remain open questions of drug safety. Stimulants, for example, have now been used for more than half a century, but fundamental questions of preclinical mechanisms and long-term safety remain unanswered and even unasked. This demonstrates that once a drug is widely accepted due to its high efficacy in short-term trials, long-term safety questions in general will not be addressed because there are no research sponsors interested in long-term safety studies and a correspondingly low public interest in these questions. It is only in the last few years that long-term safety has become a political issue and some funding has been provided to create clinical networks for pharmacovigilance and pharmacoepidemiological procedures, in order to establish and monitor safety in everyday practice. The standard voluntary reporting systems currently in place are not reliable because they depend on the patients' and doctors' willingness to report side effects,...

Mass For Screening Natural Products

For the past twenty years, natural products with their depth and diversity of compounds have been the source of many of the top selling prescription drugs. However, finding the biologically active components from natural product broths and extracts presents many challenges when using traditional biological assays. The issues include detection of active compounds present at low concentrations in a background of other active species and false positives that result from the summed activity of many weakly active compounds. In addition, the determination of the active component is often labor-intensive and requires large amounts of the fractionated broth or extract.

Private healthcare databases

Most of the epidemiologic research using healthcare databases was conducted to study prescription medications, and many healthcare plans have cooperative agreements with FDA to study pharmacoepidemiology. Medical devices to be studied are limited to those that can be inferred from a procedure code, which often are not specific to particular devices (see Chapter 3). The potential of these databases to contribute to the study of medical deices epidemiology can be illustrated with several examples from the cardiovascular arena, especially pacing leads, pacemakers, and heart valves 3 .

Style and Technique in Psychotherapy

The impact that therapeutic style has on technique is seldom formulated. It is well recognised that the way Freud practised deviated significantly from the technical prescriptions he recommended (see Chapter 3) he was much warmer and interactive than many of the therapists who have since assiduously tried to approximate the neutral, blank-screen persona advocated by Freud in his writings. We have much to learn about the influence of such non-specific factors on outcome. It would be surprising, however, given the emphasis that psychoanalysis places on the relationship between therapist and patient, if the person of the therapist did not emerge as a salient factor influencing outcome.

New Technologies Promise to Expedite the Discovery of New Pharmaceuticals

TIt is difficult to summarize all the ways in which genomics and proteomics might affect the development of pharmaceutical agents, but a few examples illustrate the potential. Hypertension, congestive heart failure, hypercholesterolemia, and obesity are treated by pharmaceutical drugs that alter human physiology. Therapies are arrived at by identifying an enzyme or receptor involved in the process and discovering an inhibitor that interferes with its action. Proteomics will play an increasing role in identifying such potential drug targets. For example, the most potent vasoconstrictor known is the peptide hormone urotensin II. First discovered in fish spinal fluid, urotensin II is a small cyclic peptide, with 11 amino acid residues in humans and 12 or 13 in some other organisms. The vasoconstriction it induces can cause or exacerbate hypertension, congestive heart failure, and coronary artery disease. Some of the methods described in Section 9.3 for elucidating

Educating the Patient and Family

The points included in a patient and family teaching plan depend on the type and severity of the musculoskeletal disorder being treated. The nurse must carefully explain that treatment for the disorder includes drug therapy, as well as other medical management, such as diet, exercise, limitations or nonlimitations of activity, and periodic physical therapy treatments. The nurse emphasizes the importance of not taking any non-prescription drugs unless their use has been approved by the primary health care provider. The following points for specific drugs are included in the teaching plan. Information included for the patient taking a cor-ticosteroid is explained in Chapter 50.

Standards of Care Security and Privacy

As use of the Internet becomes more common in the delivery of health care, standards of online care and service arise. Some are dictated through legislation, such as the HIPAA statute enacted by the federal government. State medical boards also will play a role in setting and enforcing regulations. Indeed, several state boards have already taken disciplinary action against practioners who have violated state board regulations related to online patient-physician interaction. These punitive actions have focused on the provision of care and the delivery of prescriptions when there is no pre-existing relationship between the physician and the patient. The need for a previously established patient-physician relationship is commonly recognized as a requirement in care delivered online.

Consumer concerns about regulatory safeguards for medical devices

Concerns about insufficient regulatory safeguards for medical devices reflect the differences between these devices and prescription drugs. Historically, most devices were used outside the body (such as scalpels and band-aids), and there was a perception that 'what you see is what you get', making research seem less important. As implanted medical devices have become more common, long-term research has become more important, but the safeguards and resources for regulatory agencies, in the USA and other countries, has not kept up with the increased importance of those devices. Consumer groups have the opportunity to influence regulatory decisions in countries using independent advisory panels, such as is the case in the USA and Canada. Consumers are represented on the advisory panels and also have the opportunity to speak during the open public comment periods. However, whatever the roles consumers play, there is reason to be concerned that advisory panels tend to be a rubber stamp for...

The Solution in This Environment

Common to this system is the lack of a uniform approach, often involving a multitude of ways of providing the same treatment, frequently without written guidelines. Other conditions typical of the hospital environment include a dependence on people for vigilance (for example, to follow up on investigation results) and lack of use of available technology, such as electronic prescribing with built-in protections against incorrect drug dosing, drug interactions, etc. (9).

Concerns about the Corruption of the True Nature of Human Beings

For reasons of convenience, we will follow Roughley in labeling these three concepts of human nature HN 1 , HN 2 , and HN 3 . In this way, they are merely descriptive concepts, devoid of any normative content. As we have pointed out, making each of them normatively relevant requires their affiliation with a valid norm, containing a so-called normative operator ( prohibited , obligatory , permissible ), which determines what should be the case with regard to the factual elements depicted by the descriptive concepts. We presuppose that only HN 2 and HN 3 can plausibly be taken as points of departure to effectuate normative prescriptions alongside their descriptive content. Possible norms to be invoked by such a theoretical operation lie readily at hand. For HN 2, the required norm could read as follows Certain basic features that constitute the particular human form of life are valuable for human individuals and society. Therefore, they should be preserved to the greatest extent...

Concerns about the Expanding Medicalisation of Human Behaviour

This certainly describes a serious problem, and one that is escalating not only in the US, but in European countries as well. However, in the context of our inquiry, it is not a problem in its own theoretical right. Rather, it belongs to the debate on the distinction between treatment and enhancement, which is itself closely affiliated with questions of distributive justice. Of course, this process of medicalisation might, to some extent, reflect a social demand for the re-definition of the treatment-enhancement distinction. Yet such a redefinition must not be left to free-market forces, but be based on conscious decisions by the competent institutions of democracy, since any such decision concerns a particularly sensitive area of social justice, As we have pointed out, legislators have a robust competence in this respect, the fact notwithstanding that there is no objectively provable criterion as to where the concrete borderline should run. However, by far the larger part of the said...

The Mental Enhancement of Detainees in Prison

The history of therapeutic interventions in the psyche is as old as the history of medicine. Ancient Egyptian, Chinese and Greek medicine already included prescriptions for the treatment of what would nowadays be called mental illness (Millon 2004). Similarly, beyond the realm of therapy mankind has always sought means to enhance and develop features of the mind, as is evidenced by varied traditions of religious and spiritual practices. It is important to bear this historical perspective in mind when commenting on the concerns raised by recent methods of intervention in the central nervous system (CNS) which, in addition to providing new opportunities for treating and enhancing the psyche, may have inadvertent effects on the mental level as well.

Currently used conventional diseasemodifying antirheumatic drugs

Table 4.1 classifies the available DMARDs according to the frequency of their use. At present, methotrexate is the most commonly used DMARD accounting for over 80 of DMARD prescriptions for RA in specialist units. Leflunomide and sulphasalazine are the two remaining DMARDs to be used to any appreciable extent.

Lack Of Regulation Of Antibiotic

The Indian Pharmaceutical Act restricts antibiotics to be dispensed only to someone with a valid, current prescription from an allopathic physician. In a study of pharmacies in India, the pharmacies tended to ignore the law and dispensed drugs for prescriptions from nonallopathic physicians and by self-request (17). The median number of tablets or capsules was five. As one client said to justify the self-prescribing behavior, Whenever I get these symptoms and I go to a doctor, he gives me the same medicine and charges me 10 rupees. So why not just buy the medicine The pharmacists saw themselves as business people and rarely offered unsolicited advice to change the purchase. Industrialized countries are not immune to the problem of self-prescription of inappropriate antibiotics. In a town on the U.S. side of the United States-Mexican border, 75 of the respondents had purchased prescription medications in Mexico without a prescription (18). Recently, it has been reported that in many of...

Other CBT Standardization Organizations

There are many other standardization organizations in the world such as ALIC 1 , EdNA 7 , IEEE LTSC, OKI 28 , SIF 43 , WSLT 5 . The ones described before are only examples that seem to be the most recognized. All of the organizations do not try to define they own prescriptions for distance learning systems. They do not compete but rather collaborate and complement one another in order to specify worldwide standards accepted by a majority of industry and academia. AICC, IMS, IEEE LTSC are for example the active members of the ADL Initiative and influence its standards.

Environmental Factors

Fetal Alcohol Syndrome Vulva

The role of chemical agents and pharmaceutical drugs in the production of abnormalities in humans is difficult to assess for two reasons (a) most studies are retrospective, relying on the mother's memory for a history of exposure and (b) pregnant women take a large number of pharmaceutical drugs. A National Institutes of Health study discovered that pregnant women took 900 different drugs, for an average of 4 per woman. Only 20 of pregnant women used no drugs during their pregnancy. Even with this widespread use of chemical agents, relatively few of the many drugs used during pregnancy have been positively identified as being teratogenic. One example is thalidomide, an antinauseant and sleeping pill. In 1961 it was noted in West Germany that the frequency of amelia and meromelia (total or partial absence of the extremities), a rare hereditary abnormality, had suddenly increased (Fig. 7.1). This observation led to examination of the prenatal histories of affected children and to the...

Preoperative and definitive radiation therapy

The goals of bladder conservation are often confused with the goals of minimizing treatment toxicity. A large number of patients who are elderly, have very massive disease and are unsuitable candidates for curative surgery, are referred for curative RT. The results of treatment for these patients are very poor. Often they are treated with high-dose per-fraction prescriptions and, instead of assessing the results of treatment in this group of patients in terms of symptom release and palliation, survival is being measured. Clearly, to assess the role of definitive RT in the bladder conservation approaches, reports of patients who are referred for RT by choice rather than by default should be considered.

Ineffective Therapeutic Regimen Management

The reasons for not following the drug regimen vary. For example, some people do not fill their prescriptions. Other patients skip doses, take the drug at the wrong times, or take an incorrect dose. Some may simply forget to take the drug others take a drug for a few days, see no therapeutic effect, and quit. Some find the adverse effects so bothersome that they discontinue taking the drug without notifying the health care provider. Display 4-1 identifies some reasons for this ineffective therapeutic regimen management.

Perfusion MRI of the Small Bowel to Assess Mesenteric Ischemia

Arterial Wall Ischemia

Perfusion imaging as a noninvasive method has been widely used for the determination of myocardial blood flow 34 . Cardiac perfusion examinations are usually performed during baseline conditions as well as during pharmacologically induced hyperemia 35,36 . Thus, a myocardial perfusion reserve can be determined, which accurately depicts individual graded coronary lesions 35 . This pathophysiological background can be transferred from myocardial perfusion to visceral perfusion, since processes in coronary artery disease are fairly comparable to those in mesenteric ischemia. Instead of increasing the blood flow and heart activity by the intravenous application of pharmaceutical drugs, the blood flow and bowel activity can be enlarged by the oral administration of a high caloric foodstuff. In fact, the reserve capacity of bowel wall perfusion, which is comparable to the myocardial perfusion reserve, has proven to be a reliable parameter for the differentiation between healthy volunteers...

Neighborhood Symptoms

Headache is probably the most common neighborhood symptom. It is present in three quarters of patients at some stage in their histories on careful questioning. It is believed that headache results from stretching of the dural lining of the pituitary fossa and diaphragma sellae. As in many headaches caused by mass intracranial lesions, the pattern is more common in the early morning but is usually not severe, except in apoplexy. It may, however, dominate some patients' lives, particularly in acromegaly and, to a lesser extent, in prolactinoma. In the latter it may complicate dopamine agonist therapy (q.v.) in the former, somatostatin analogs have a surprising effect not related to lowering of growth hormone and insulin-like growth hormone factor (IGF)-1 levels. In all patients with headache, it is essential to take a careful drug use history, because regular use of non prescription medication containing paracetamol may lead to so-called analgesia headache. Changing to nonsteroidal...

Pharmacologic Therapy

These compounds reduced basal and stimulated acid production but had no effect on lower esophageal sphincter pressure, esophageal peristalsis, or gastric emptying. They consistently reduced symptoms of heartburn and permitted reduced use of antacids, but significant healing of esophagitis did not reliably occur.99-101 The development of hyperplasia of gastrin-producing cells during chronic administration of H2 receptor antagonists led to initial concerns about the possibility of inducing gastric cancer, but more than two decades of experience has allayed these concerns.102 The H2 receptor antagonists are now available as non-prescription medications.

Multifaceted Interventions

The study was conducted over a 3-mo period, with baseline data from the same months of the prior year. Although antibiotic prescribing rates were similar among the four practices in the baseline period, prescribing fell significantly at the intervention site (from 74 to 48 ) but did not change in the control or limited intervention site in the study period. Prescriptions for nonantibiotic medications (i.e., bronchodilators) did not differ among sites, nor did return office visits for bronchitis or pneumonia. There

The Structure of Hospitals

For this potential (and often realized) benefit, patients are willing to sacrifice much, and even suspend rational thought (e.g. by pretending that their doctor nurse would always know the right thing to do). This model has many pluses and seems to perform reasonably well in the chronic care situation, where time allows for adjustments, consultations, change of mind, reassessment, second opinions, follow-up of initial therapeutic efforts, etc. In the acute care setting, it performs less well. Therefore, it is not surprising that hospitals are perhaps not as safe as they could be (1-5).They must, however, become safer, and this should be the administrator's viewpoint. This value judgment might mean that the traditional model of care has to be challenged. There are different tactical responses to this strategy of and need for greater safety for example, outside the traditional model of care, the use of information technology is increasingly being explored as 1 tactical approach to...

Illicit drug use

Sharing occurred whether drug dependence occurred any physical, mental or social problems arising from drug misuse (as for alcohol history) any treatment interventions. Inquiries concerning illicit drug use are fraught with even greater difficulty if the patient has been indulging in other illegal activities such as theft to fund the purchase of drugs, How far questioning should be pursued depends upon the urgency of the clinical problem. Information about drug-taking by a young person brought into casualty having collapsed may prove crucial. The past medical history may also include disorders which could be due to intravenous drug misuse while the social history may include interests like attending 'raves' where the use of stimulants is common. The patient may be more forthcoming if there is an established dependence on drugs which are being medically prescribed to control dependence and to reduce harm.

Justice

The three examples from the field of child psychopharmacotherapy have shown that, in general, the treatment of children today cannot be based on the same level of safety data as the treatment of adults. Consequently, a highly vulnerable subgroup of our population that should be particularly well protected ironically suffers from an unacceptable lack of data concerning age specific dosages and effects as well as side effects, even for the most commonly used drugs in child and adolescent psychopharmacotherapy. Children can therefore be described as therapeutic orphans. The health and economy discussion about justice of distribution of healthcare interventions is increasingly dominated by allocation issues. Will it be possible for everybody in a given society to be granted the same access to new intervention techniques Even now there are dramatic differences with respect to the use of new pharmacological agents between the United States, some countries of Europe and, especially,...

Exercises

Gentle isometric exercises for the quadriceps and hamstrings and antigravity exercises as tolerated for hip flexors, extensors, abductors, adductors, and rotators are recommended. See Chapter.56 for specific exercise prescriptions. Weight reduction is an important aspect of the treatment of hip disorders. The prognosis in many hip disorders is guarded if aggravating factors such as obesity are not addressed. Ideal patient weights are listed in Appendix C.

Telephonebased care

Although the use of the telephone has become an essential component of medical care, particularly in the outpatient setting, it has largely been relegated to an administrative tool for setting appointments, refilling prescriptions, billing, and related administrative requests and questions. Physicians generally are not reimbursed for providing telephone-based care and, as the demands of physicians have increased with the advent of managed care, patient frustrations related to poor telephone access to their doctor has increased. Numerous national studies, including a national survey of patients done by Harris Polls, confirm growing patient frustration in their inability to communicate with their physicians via the telephone.

Substance Abuse

Patients who are substance abusers vary in age, gender, and ethnicity as well as cultural, occupational, and social backgrounds. Patients' attitudes or feelings toward their prescriptions may dominate their thoughts and beliefs with regard to their pain, which can create an unrealistic response to their health problems. Patients requesting specific medications, dosages, and volumes should raise apprehension in the physician and may warrant a more critical evaluation. Patients who abuse the privilege of receiving medication are frequently deceptive. The abusive patient may appear apprehensive, embarrassed, resentful, or angry. Respond to these patients by communicating appropriately that you are concerned about their medical conditions, but that you are unable to comply with the request.

Hindrance

It might be tempting to see Freud's recommendations as superior to his actual technique. But the discrepancy between his written rules and his practice begs the question of what is effective, that is, which aspects of the analytic frame and attitude are essential to a good outcome. It is interesting to speculate as to who benefits from the adherence to the classical analytic frame and attitude. The frame and its prescriptions of neutrality, abstinence and anonymity exist not only for the patient's benefit but also for the therapist's - a fact frequently overlooked. The prevailing analytic persona may provide a safe screen for our own apprehensions about more spontaneous exchanges as it legitimises a more withdrawn, grave stance. Working analytically generates anxiety for both participants since any such exploration is an invitation to enter the uncharted territory of our own unconscious as well as that of our patients'. By keeping a careful reign on our spontaneity, we protect...

Required Rooms

An ophthalmologist does not need a nurse station or lab as such, but it is advisable to provide a work space in a niche off the corridor (Figure 4-67) for an assistant or tech. This is where phone calls can be received or made to reschedule patients, prescriptions authorized, and medications dispensed. Ophthalmologists dispense a number of eyedrops and medications, which may be stored in a rack in each examining room or at the assistant's work area.

Provider Education

In an early study, investigators evaluated the effect of three educational methods on antibiotic prescribing in office practices in Tennessee (27). The three educational methods included a mailed brochure, a 15-min visit by a pharmacist (drug educator), and a 15-min visit by a physician counselor. Topics of educational activities were three antibiotics contraindicated for office practice (chloramphenicol, clindamycin, and tetracycline for children 8 yr old) as a measure of the quality of care, and the use of oral cephalosporins as a measure of the cost of care. Based on their use of the mentioned antibiotics, 372 physicians were selected for the interventions. The mailed brochure had no measurable effect on prescribing, and the pharmacist visit had only a modest effect. The physician visit corresponded with a subsequent 44 reduction in patients receiving contraindicated drugs, and a 21 reduction patients receiving and prescriptions for oral cephalosporins. Therefore, the intervention...

Defensive Medicine

Because financing the cost of health care in the United States today is a zero-sum game, these direct and indirect costs of the malpractice crisis must be subtracted from funds available to fund the care of the uninsured and underinsured (2,5,31), and for medical research and innovation. Reasonable limits on noneconomic damages, by reducing both the direct costs of malpractice insurance and the cost of defensive medicine, would save enough money to fund a prescription drug benefit for Medicare beneficiaries and facilitate insurance coverage for millions of uninsured Americans (2).

Male Fertility

Oligospermic Mane And Enzymes Levels

A sperm concentration below about 20 million per milliliter is termed oligospermia (oligo few) and is associated with decreased fertility. A total sperm count below about 50 million per ejaculation is clinically significant in male infertility. Oligospermia may be caused by a variety of factors, including heat from a sauna or hot tub, various pharmaceutical drugs, lead and arsenic poisoning, and such illicit drugs as marijuana, cocaine, and anabolic steroids. It may be temporary or permanent. In addition to low sperm counts as a cause of in

Measurement models

The classical test theory model is the theory of psychological testing that is most often used in empirical applications. The central concept in classical test theory is the true score. True scores are related to the observations through the use of the expectation operator the true score is the expected value of the observed score. Thus, a researcher who sees intelligence as a true score on an intelligence test supposes that somebody's level of intelligence is his expected score on an IQ-test. Theories of psychological testing are usually related to a more or less coherent set of suggestions or prescriptions that the working researcher should follow, and classical test theory is no exception. For instance, a typical idea of classical test theory is that the main task of the researcher is to minimize random error. One way of doing this is by aggregating scores on different tests the longer the test, the more reliable and valid it will be.

Neutrality

Levy & Inderbitzin (2000) have proposed that Freud's technical recommendations were an attempt to manage the problem of suggestive influence.7 In his papers on technique, Freud (1912) advocated that the therapist should not give the patient direction concerning life choices nor assume the role of teacher or mentor. He emphasised that he should remain neutral in the sense that what the patient says, feels or phantasies about is responded to impartially by the therapist. Laudable though these prescriptions are, in practice we all make suggestions, if only to

Health Care Issues

Findings from the PORT study, in which one-sixth of the patients were age 55 and over, indicate that, with the exception of diabetes and hypertension, more than 30 of the schizophrenic patients who reported current physical problems were not receiving treatment for them (Dixon et al. 1999). A variety of patient, physician, and systemic factors have been identified as potential impediments to health care for schizophrenic persons in general. For example, patients may lack insight into a physical condition, have impaired ability to communicate with a physician, or have emotional behavioral problems that could interfere with the evaluation. Also, physicians may be more apt to conduct inadequate physical examinations, take a poor history, fail to repeat labs or tests as needed, misinterpret physical symptoms as manifestations of psychosis, or passively accept consultative recommendations (Felker et al. 1996). Systemic factors may also affect health care, especially among older...

Prescription Errors

These are a common source of litigation for family physicians. Prescriptions must be clearly written. There are so many instances of patients receiving Purinethol when propylthiouracil was prescribed that in June 2003, GlaxoSmithKline sent health care professionals a Medication Errors Alert, warning of the consequences of this error. Patients must be well-informed regarding the drugs they are prescribed. It is a good idea to include the indication on the prescription so that a patient does not inadvertently take an antibiotic in place of an antihypertensive, for example. Because Purinethol has its name imprinted on every tablet, an informed patient would not take the wrong drug. Patients need to be alerted about other look-alike and sound-alike medications. They should also be alerted regarding correct dosages, allergies, side effects, and the appropriate use of controlled substances. Informed consent is required and should be documented, especially for drugs that may have serious...