[INTRODUCTION] Clinical Pharmacy and Therapeutics

Proverbs 16:3

Clinical Pharmacy

[INTRODUCTION]

Health science discipline in which pharmacist provide patient care that optimizes medication therapy and promotes health, wellness, and disease prevention. (American College of Clinical Pharmacy)

American College of Clinical Pharmacy

[INTRODUCTION]

According to ___________, CLINICAL PHARMACY is a health science discipline in which pharmacist provide patient care that optimizes medication therapy and promotes health, wellness, and disease prevention.

Clinical Pharmacy

[INTRODUCTION]

This health science discipline that includes broad responsibility for safe and appropriate use of drugs in patients which include:

● Rational selection

● Monitoring

● Dosing

● Control of the overall drug therapy program

● Rational selection

● Monitoring

● Dosing

● Control of the overall drug therapy program

[INTRODUCTION]

Clinical Pharmacy is a health science discipline that includes broad responsibility for safe and appropriate use of drugs in patients which include _____ [4]

Pharmaceutical Care

[INTRODUCTION]

This is a cooperative, patient-centered system for achieving specific and positive patient outcomes from the responsible provision of medicines. (Hepler and Strand, 1990)

Hepler and Strand (1990)

[INTRODUCTION]

According to ________, Pharmaceutical Care is a cooperative, patient-centered system for achieving specific and positive patient outcomes from the responsible provision of medicines.

● Not a product-oriented but PATIENT-ORIENTED

● Practice in BOTH community and hospital setting

● Primary objective is RATIONAL DRUG USE

● Multidisciplinary

[INTRODUCTION]

Characteristics of Clinical Pharmacy [4]

Rational Drug Use

[RATIONAL DRUG USE]

This requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, and at the lowest cost to them and their community. (WHO, 1985)

WHO (1985)

[RATIONAL DRUG USE]

According to _______, Rational drug use requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, and at the lowest cost to them and their community.

Right:

● Dose

● Disease

● Dosage form

● Dosage schedule

● Route

● Cost

● Patient

📌Mnemonic: “DDDD” “RCP”

[RATIONAL DRUG USE]

Rational drug use requires RIGHT _______ [7]

Non-prescription/Non-Rx drugs

[RATIONAL DRUG USE]

These are drugs which are safe and effective for use by the general public without doctor's prescription.

Non-prescription/Non-Rx drugs

[RATIONAL DRUG USE]

These drugs are primarily used for asymptomatic relief and not as substitutes for prescription drugs.

TRUE

[RATIONAL DRUG USE]

TRUE OR FALSE:

• Taking a higher dose than recommended will not provide more relief and can be dangerous.

Hepatic necrosis (Hepatoxicity)

[RATIONAL DRUG USE]

Overdose of paracetamol can lead to __________.

4000 mg/4 g/ 8 tablets per day

[RATIONAL DRUG USE]

Maximum dose of paracetamol per day:

TRUE

[RATIONAL DRUG USE]

TRUE OR FALSE:

Paracetamol infant drops can be significantly STRONGER than regular children's medications.

Intravenous N-acetylcysteine (IV NAC)

[RATIONAL DRUG USE]

Rescue drug for paracetamol toxicity

● < 2 years → 100 mg/mL

● 2 to 6 years → 125 mg/5 mL

● 6 to 12 years → 250 mg/5 mL

● Chewable tablets → 250 mg/tab

● Adult tablets → 500 mg/tab

[RATIONAL DRUG USE]

Dosage strength for paracetamol based on age [4]

stomach bleeding

[RATIONAL DRUG USE]

Too much NSAIDs can cause ________ and risk is increased in people over 60 years of age, concurrently taking blood thinners, steroid and other drugs which can cause GI irritation, and who have history of stomach bleeding or ulcers.

● Over 60 years of age

● Concurrently taking blood thinners

● Steroids or other drugs that can cause GI irritation

● History of stomach bleeding or ulcers

[RATIONAL DRUG USE]

Too much NSAIDs can cause stomach bleeding and risk is increased in people _______ [4]

● Age > 60 years

● Diuretic intake

● Hypertension

● Heart disease

● Pre-existing kidney disease

● Children/teenagers recovering from a viral infection

• <2yr of age → TOXICITY

• Naproxen, Flanax,Skelan

📌Mnemonic: “ADH” “HPC”

[RATIONAL DRUG USE]

Before taking NSAIDs, consider the following ____ [6]

Mild → severe pain

● Paracetamol

● NSAIDs (Ibuprofen, Naproxen)

● Tramadol, Codeine

● COX-2 inhibitors (Celecoxib,Enterecoxib)

● Opoids (Morphine, Hydromorphone)

[RATIONAL DRUG USE]

Hierarchy of pain relievers (mild to severe pain):

● Ingredients included (whether an expectorant or antitussive)

● Avoid using cough preparations for more than 7 days

● Use only the correct dose (high doses can cause serious problems such as brain damage, seizure, or death)

● Use the correct dose for children (for ages 4-6, consult a physician first; do not give to children under 4)

[RATIONAL DRUG USE]

Important points to remember for cough medicines [4]

Expectorants

• Examples:

  • Guaifenesin

  • Ammonium chloride

[RATIONAL DRUG USE]

_______ -

• These are cough medicines that loosen and thin mucus, making it easier to cough up and clear from the respiratory tract

• Are commonly used in patients with bronchitis.

bronchitis

[RATIONAL DRUG USE]

Expectorants are commonly used in patients with _______.

Antitussives

• Examples:

  • dextromethorphan

  • codeine

[RATIONAL DRUG USE]

________-

• These are cough medicines that block the cough reflex in the brain.

• They are used for dry cough without mucus, particularly in patients with allergic rhinitis (hay fever).

allergic rhinitis (hay fever)

[RATIONAL DRUG USE]

Antitussives are used in patients with ______

7 days

[RATIONAL DRUG USE]

Avoid using the cough preparations for more than ____ days.

twice a day

[RATIONAL DRUG USE]

Cough preparations are commonly used within 5 days like NAC, which is given ____ a day.

● Brain damage

● Seizure

● Death

[RATIONAL DRUG USE]

High doses of cough preparations can cause serious problems such as ______ [3]

4-6 years old

[RATIONAL DRUG USE]

For children aged ____, consult a physician before giving cough medicines, and do not administer these medications to children under 4 years old.

under 4 years old

[RATIONAL DRUG USE]

For children aged 4-6, consult a physician before giving cough medicines, and do not administer these medications to children under ____ years old.

● Physical dependence

● Psychological dependence

[RATIONAL DRUG USE]

Misuse and abuse can lead to _______ [2] , such as habit-forming behavior.

● Decongestants

● Antihistamines

● Sleep aids

● Antacids

● Laxatives

● Ephedrine

📌Mnemonic: “DA” “SALE”

[RATIONAL DRUG USE]

OTC drugs that can be severely habit-forming [6]

● Hospitals

● Community pharmacies

● Nursing homes

● Home-based care services

● Clinics

● Pharmacovigilance

📌Mnemonic: “HCN” “HCP”

Clinical Pharmacy Settings include ____ [6]

● Pfizer

● Cognizant

Pharmacovigilance corporations include _____ [2]

● Assessment

● Care Plan

● Outcome evaluation

📌Mnemonic: “ACO”

[PHARMACEUTICAL CARE PROCESS]

Pharmaceutical Care Process includes [3]

Assess the patient for drug-related problems

↓

Determine whether drug-related problems are being treated

↓

Determine whether current drug therapy is appropriate

↓

Determine whether additional drug therapy is needed

↓

Determine if any of the drug-related problems may have been caused by medication

[PHARMACEUTICAL CARE PROCESS]

Process in ASSESSMENT [5]

Approach normal physiology

↓

Slow progression of disease

↓

Alleviate symptoms

↓

Prevent adverse effects

↓

Control medication costs

↓

Educate the patient about the medication

📌Mnemonic: “ASAP” “CE”

[PHARMACEUTICAL CARE PROCESS]

Process in CARE PLAN [6]

Specify patient's progress

↓

Monitor potential ADRs

↓

Determine desired end points for each parameter and the frequency of monitoring

📌Mnemonic: “SMD”

[PHARMACEUTICAL CARE PROCESS]

Process in OUTCOME EVALUATION [3]

● Minimizing/eliminating patient's symptoms

● Modifying/curing of disease process

● Improve the prognosis of patients

● Identifying and resolving drug-related problems

● Preventing drug misadventures

📌Mnemonic: “MMI” “IP”

[PHARMACEUTICAL CARE PROCESS]

Outcomes of Pharmaceutical Care [5]