(4) Success in Therapeutics and Beyond/ Patient Work-Up (MORE OF WATCH/HOW TO-DO, PATIENT WORK-UP)

Pharmacists’ Patient Care Process

Collect → Assess → Plan → Implement → Follow-up/Monitor

• Collect

• Assess → identify medication-related problems

• Plan

• Implement

• Follow-up/Monitor → evaluate effectiveness + safety

Medication-Related Problems

Category	Medication-Related Problem
Indication	Unnecessary Medication Therapy
	Needs Additional Medication Therapy
Effectiveness	Ineffective Medication
	Dosage Too Low
	Needs Additional Monitoring
Safety	Adverse Medication Event
	Dosage Too High
	Needs Additional Monitoring
Adherence	Adherence
	Cost

Therapeutic Decision Making

Clinical Reasoning

→ What are my treatment options?

Clinical Judgment

→ What are the pros/cons of EACH option for THIS patient?

Clinical Decision Making

→ Choose THE BEST option for the patient

Easy memory:

Options → Compare → Choose

Patient Work-Up Order

Reason for encounter
↓
Medical problems
↓
Desired outcomes
↓
Medication list
↓
Labs + vitals
↓
Medication-related problems
↓
Develop plan
↓
Follow-up + monitoring

Reason for Encounter

If the patient comes in with a specific complaint:

→ that complaint is usually the priority medical problem

Medication List Rule

Check both directions:

Every medication → should have a reason/indication

AND

Every medical problem → determine whether therapy is needed

Labs + Vitals

Always assess:

• Renal/kidney function

• Hepatic/liver function

Every Drug Recommendation Needs

Drug + Dose + Route + Frequency

Then:

→ make sure it addresses the patient's problem
→ explain WHY it is the best choice for that patient

Justification

Why this drug instead of the alternatives for THIS patient.

Monitoring Plan

Working? → Safe? → When check again?

laboratory monitoring rules…

Always distinguish self-care monitoring from chronic therapy monitoring.

Absolute vs relative contraindication vs precaution

Absolute contraindication

→ Hard NO (Serious/life-threatening risk)

Relative contraindication

→ generally avoid
→ but weigh risk vs benefit

Precaution

→ medication may still be used but may require:

• extra monitoring

• dose adjustment

• counseling

• additional consideration

Adverse reaction

→ does NOT automatically mean the drug cannot be used

Often it may simply require counseling.

Assess whether DDIs actually apply to the…

patient/formulation

CASE RULE: DO NOT…

• ASSUME

• On exam cases: Use ONLY the information provided.

Patient has GI-bleed risk + Tension headache → med approach?

• NSAIDs/aspirin are less appropriate (↑ GI-bleed risk)→ acetaminophen is preferred.