Big pharma has been a hot button topic for some time in the United States. The costs of medications can make obtaining easily affordable healthcare for the masses difficult to say the least. Many other countries cap the costs of pharmaceuticals such as Spain, South Korea and the UK, while the US continues to allow pharmaceutical companies to set the price point presumably to allow innovation (Keyhani, et al., 2010). In the study written by Keyhani, et al., they analyze 288 new drugs developed in more than 20 different countries. What they found was interesting in that pharmaceutical innovation that stemmed from the US was proportional to its spending on prescription drugs. Other countries with direct price control were found to have proportionally more innovation when compared to their own prescription drug spending (Keyhani, et al., 2010). Take-away: price controlled countries produce proportionally more new drugs at a cheaper cost to their patients compared to the United States where there is no price control.

 

Keyhani, S., Wang, S., Hebert, P., Carpenter, D., & Anderson, G. (2010). US pharmaceutical innovation in an international context. American journal of public health, 100(6), 1075–1080. https://doi.org/10.2105/AJPH.2009.178491

Discuss the development of new drugs in the United States as compared to other countries and evaluate the pharmacoeconomic issues that lead to high prescription costs in the United States.

 

The development of new drugs in the United States is a long process. According to Adams et al., (2016), the process can take several years to be approved. Once the drug’s trade name is approved (proprietary product or brand name), the drug developer has the exclusive right to this drug for 17 years. The reason behind having these exclusive rights is so the drug developer can recoup the millions of dollars it costs in research and development of the new drug.

 

The pharmacoeconomic issues that lead to high prescription costs in the United States are because the exclusive rights that are given to the developer can lead to an increase in the cost of the drug because no one else has access to the drug and the generic form is not available yet. once the drug name is approved (Adams, et al., 2016). In contrast with the United States, all other countries have some form of drug pricing regulation to keep the cost of medications low (Keyhani et al., 2010) 

 

Adams, M. P., Holland, N., & Urban, C. Q. (2016). Pharmacology for Nurses (5th ed.). Pearson

Education (US). https://online.vitalsource.com/books/9780134255378

Keyhani, S., Wang, S., Hebert, P., Carpenter, D., & Anderson, G. (2010, June). US pharmaceutical innovation in an international context. American journal of public health. Retrieved January 7, 2023, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866602/

Docusate sodium (Colace)

Classification: Stool Softener

Indications: Constipation

Mechanism of action: lowers surface tension of stool, allowing water and lipid absorption into stool mass. This results in softer stool that can pass through the intestines easier (Hannoodee, 2022).

Administration: Comes in a variety of forms for oral administration including tablet, capsules, liquid and syrup. Can be administered rectally as enemas or suppositories. Frequency is in daily or divided doses. Promote increased fluid intake to absorb into stool.

Adverse Effects: For normal use, abdominal cramping is the noted adverse effect. Excess use of medication can result in diarrhea, vomiting and anorexia (Hannoodee, 2022).

Pregnancy Category: C. Considered generally safe for breastfeeding.

Contraindications: Allergy to any ingredients. Nausea and vomiting because increased fluid intake is required. Acute abdominal pain, appendicitis or intestinal obstruction.

Examples of when drug is used: There is no textbook definition delineating what constipation actually is, however many would consider infrequent bowel movements of less than three per week (Hannoodee, 2022). Symptoms may include abdominal cramping, hard stool, difficulty passing stool and incomplete evacuation of stool.

One interesting indication that many people don’t know about is its use as a ceruminolytic. Buildup of cerumen in the ear canal may be treated with 1mL of liquid docusate. The ability of docusate to lower the surface tension of cerumen allows it to soften for better irrigation with normal saline afterwards. One clinical trial involving 50 individuals tested between using Cerumenex versus docusate and favored better results with docusate 81% success rate versus 35% (Singer et al., 2000).

References:

Hannoodee, S. & Annamaraju, P., 2022. Docusate. StatPearls [Internet].
https://www.ncbi.nlm.nih.gov/books/NBK555942/

Links to an external site.

Singer, A. J., Sauris, E., & Viccellio, A. W. (2000). Ceruminolytic effects of docusate sodium: a randomized, controlled trial. Annals of emergency medicine, 36(3), 228–232. https://doi.org/10.1067/mem.2000.109166

There are several drug classifications (e.g., benzodiazepines, ACE inhibitors). Choose a classification and one drug within that classification and discuss the pharmacological aspects of this particular drug. Give examples of how and when this drug is used.

The medication I choose to discuss is Ativan or lorazepam. This drug classification is a benzodiazepine. This medication is used to treat anxiety, The medication will have a sedative effect on the patient by acting on the central nervous system. Benzodiazepines interact with GABA-A allowing the medication to have a calming effect on the patient (Griffin et al., 2013).

Ativan has many uses, including anticonvulsants, acute agitation and mania treatment, alcohol withdrawal, and sedation. I work in a neuro-intermediate unit and some of our patients come in for epileptic monitoring for 5-7 days. Should the patient have a seizure, the provider has a standing order available for nurses to administer Ativan, especially if the seizure lasts longer than 5 minutes to stop the seizure activity. Ativan can also be used in cases of severe ETOH abuse to prevent alcohol withdrawal. With the use of the CIWA tool, the nurse will know whether to administer Ativan or not and how much to administer depending on the score (Knight & Lappalainen, 2017).

 

 

Griffin, C. E., Kaye, A. M., Bueno, F. R., & Kaye, A. D. (2013). Benzodiazepine pharmacology and central nervous system-mediated effects. The Ochsner journal. Retrieved January 7, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684331/

Knight, E., & Lappalainen, L. (2017, September). Clinical Institute withdrawal assessment for alcohol-revised might be an unreliable tool in the management of alcohol withdrawal. Canadian family physician Medecin de famille canadien. Retrieved January 9, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5597013/