IPS 2: CLINICAL PHARMACY

a 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)

Clinical Pharmacy Definition

rational selection

monitoring

dosing

control of the overall drug therapy program

clinical pharmacy includes broad responsibility for safe and appropriate use of drugs in patients which include

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

pharmaceutical care definition

Not product oriented but patient oriented

practice in both community and hospital setting

primary objective: clinical drug use

multidisciplinary

the characteristics of clinical pharmacy (4)

rational drug use

the primary objective of clinical pharmacy

requires that patients receive medication appropriate to their clinical needs, in doses that meet their own time, and at the lowest cost to them and their community (WHO, 1985)

rational drug use definition

right drug

right disease

right dosage form

right patient

right route

Rs of hospital pharmacy

over the counter drugs

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

symptomatic and not as substitutes for prescription drugs

over the counter drugs are primarily used for

no it can be dangerous

in paracetamol will taking a higher dose than recommended provide more relief?

hepatotoxicity or hepatic necrosis

the overdose of paracetamol can lead to

infant drops

drug that can be significantly stronger for a specific demographic (children)

can cause stomach bleeding and risk is increased in people over 60 years of age.

what happens if you take NSAIDs too much

1. paracetamol

2. NSAIDs

3. COX

4. Codeine, Tramadol

5. Morphine/ Hydromorphone

give the hierarchy of pain relievers

blood thinners

steroid

other drugs can cause GI irritation

what other drugs can worsen NSAIDs abuse

stomach bleeding

ulcers

what history or disease of patients can worsen if taken with NSAIDs

Age >60

Diuretic intake

High BP and Heart Disease

Re-existing Kidney Disease

Children/teenagers recovering from a viral infection

Before taking NSAIDs what should be considered (5)

whether an expectorant or antitussive

in cough medications what ingredients or type included should be mindful of

7 days

use of cough preparations should be not more than how many days

seizures, brain damage, or death

in cough preparations using high doses can cause what

for ages 4-6, ask the physicians first

don’t give to children under 4

use the correct dose for children ages what, and what age should not be given without guidance; cough preparation

physical dependence

psychological dependence

two types of misuse and abuse

Decongestants

Antacids

Laxatives

Antihistamines

Sleep aids

Ephedrine

what are the OTC drugs that can be severely habit-forming

Hospitals

Community Pharmacies

Nursing Homes

Home-based care services

Clinics

Clinical pharmacy settings (5)

1. assess the patient for drug related problems

2. determine whether drug related problems are being treated

3. determine whether current drug therapy is appropriate

4. determine whether additional drug therapy is needed

5. determine if any of the drug-related problems may have been caused by medication.

give the pharmaceutical care process ASSESSMENT (5 steps)

1. approach normal physiology

2. slow progression of disease

3. alleviate symptoms

4. prevent adverse effects

5. control medication costs

6. educate the patient about the medication

give the pharmaceutical care process CARE PLAN (6 steps)

1. specify the patient’s progress

2. monitor potential adverse drug reactions

3. determine desires endpoints for each parameter and the frequency monitoring

give the pharmaceutical process OUTCOME EVALUATION (3 steps)

minimizing or eliminating patient’s symptoms

modifying or curing of disease process

improve the prognosis of patients

identifying and resolving drug related problems

preventing drug misadventures

what is the outcome of pharmaceutical care (5)

expert knowledge on drug and non-drug therapy

knowledge on lab and diagnostic test

good understanding of disease process

physical assessment skills

therapeutic planning skills

drug monitoring

provision of drug information

communication skills

give the knowledge and skills of clinical pharmacist (8)

interact with the healthcare team

interview and assess patient

review medication order and make therapeutic recommendations

monitor patient response to drug therapy

give the roles of a clinical pharmacist (4)

Patient Medication Profile

is the written summary of all the medicines take regularly, including over the counter and complementary medicines of patient.

assist to understand and manage medicines by informing how, why and when to take medicine

how does patient medication profiles assist

creates the most accurate list possible of all medication a patient is taking that is being compared against the physician’s admission, transfer, and discharge orders; with a goal of providing correct medications.

medication reconciliation process full definition.

drug name, dosage frequency and route

what are listed in the medication reconciliation process

it contains all significant clinical information which enables the physician to give effective continuing care to the patient

what does the patient medical chart contain and do

1. patient data sheet

2. consent form

3. history

4. physical assessment

5. physician’s order sheet

6. consultation, examination, and finding

7. graphic chart

8. fluid input and out put record

9. Medication Administration record

10. Multidisciplinary progress notes

11. Laboratory results

parts of patient medication sheet (11)

patient demographics

admission and final diagnosis

condition upon discharge

what are the parts of the patient data sheet

consent form

is a permission or approval given by the patient for admission, testing, procedure, and access to health related or personal information

chief complaint

history of present illness

past medical history

family history

social history

review of systems

parts of a history

Physical examination

are short description, systemic examination

temperature

pulse

RR

Blood pressure

pain

SPO2

what are the vital signs examined in the physical examination

oral, rectal, axillary (rectal being the most accurate)

the body temperature can be assessed in what sites of the body

37.5 + 0.5 0C

the normal body temperature

hyper or hypothermia

what may be the abnormal findings pertaining to body temperature

radial, femoral/ carotid

at what sites of the body can pulse rate be monitored

60-100 beats/min

normal range for pulse rate

bradycardia or tachycardia

what abnormal findings can be associated with pulse rate

16-20 breaths/min

RR normal range

prolonged expiration suggesting narrowing bronchioles, wheezing, or stridor sounds; apnea, Bradypnea, Tachypnea

abnormal findings associated with respiratory rate

<120/80

the normal range for blood pressure

HTN, cardiac disease, orthostatic HTN, venous congestion/ HTN

abnormal findings associated with blood pressure

Inspection

Palpation

Percussion

Auscultation

what are the physical assessment techniques (IPPA)

inspection

is a visual examination of the patient

use of the hand to feel skin texture, and contour, and masses below the surface; temperature and vibration (light and deep)

how palpation is performed in physical assessment

hard to reach organs such as kidney, liver, spleen

deep palpations are used to assess what organs

used to elicit a sound which reflects the density of underlying tissue and structures by tapping the body directly or a finger placed on the body (dull percussive sounds, hyperresonance on percussion)

how percussion is performed in physical assessment

Auscultation

a physical assessment technique in which involves listening to sounds produced by the body originating in internal organs (direct and indirect)

use of ears

what is the direct form of auscultation

use of stethoscope

what is the indirect form of auscultation

Inspection → Palpation → Percussion → Auscultation

what is the general sequence of physical assessment

Inspection → Auscultation → Percussion → Palpation

what is the general sequence for abdomen assessment

doctor progress notes (SOAP)

doctor orders

what are the parts of the physician’s order sheet

Documentation

means by which healthcare professionals communicate with one another

Doctors, Nurses, Medtech etc.

who uses the SOAP format of documentation

Pharmacy

who uses the FARM format of documentation

Medication Order Review is a multistep process in which pharmacists evaluate orders for safety, efficacy and appropriateness by examining drug and patient related factors

what is a MOR

are any preventable event that may lead to inappropriate medication use or cause harm to the patient while the medication is in control of the health care professional patient or consumer.

what is a medication error

Type A

circumstances or events that have the capacity to cause an error

Type B

error occurred but the medication did not reach the patient

Type C

error reaches the patient but did not cause harm

Type D

error occurred that resulted in the need for increased patient monitoring but no patient harm

Type E

error occurred that resulted in the need for treatment or intervention and caused temporary patient harm

Type F

and error occurred that resulted in initial or prolonged hospitalization and caused temporary patient harm

Type G

an error that resulted in permanent patient harm

Type H

an error that resulted in near death event

Type I

an error that resulted in patient Death

Prescription

are written order and instruction of validly registered physicians, dentist, veterinarians for use of specific drug for specific patient

1. prescribers information and signature

2. date of prescription written

3. patient information

4. Rx (superscription)

5. Inscription (body)

6. subscription (instruction to the pharmacists)

7. Signa (transcription, instruction to the px)

8. physician’s signature and other information

Parts of a Medication Order Review

Yellow Rx

prescription used to prescribe dangerous or regulated drugs

triplicate ( pharmacist, patient and physician)

how many copies does the Yellow Rx requires

can use white Rx but also in 3 copies, can do partial filling valid within 1 month

instruction according to DOH about having no Yellow Rx

opium and its components/ derivatives

coca leaf and its derivatives

hallucinogenic drugs

what are the prohibited drugs

amphetamine salts

hypnotics

what are the regulated drugs

Amikacin

Amphotericin B

Aztreonam

Ciprofloxacin

Ceftazidime

Chloramphenicol

Flucytosine

Linezolid

Nalidixic acid

Piperacillin + Tazobactam

Sodium Fusidate

Tobramycin

Cefuroxime

Ertapenem

Meropenem

restricted antimicrobials

noxious, unintended reaction to drug in doses used in prophylaxis, diagnosis, and treatment

give the definition of ADR

Augmented (A)

ADR class, that is based on pharmacologic activity, dose dependent, and predictable

Bizzare (B)

ADR class; abnormal reactions, unpredictable, non-dose dependent

dependence, tolerance, addiction

ADRs under Continuous (C)

carcinogenicity, teratogenicity, anticancer drugs

ADRs under Delayed (D)

End of use (E)

ADR class; tapering dose with steroids

Failure of therapy (F)

ADR class; antimicrobial resistance

1. analysis of each reported ADR

2. identification of drugs and patients at high risk for being involved in ADRs

3. The development of policies and procedures for ADR monitoring program

4. a description of the responsibilities and interactions of pharmacists, physicians, nurses, risk managers and other health professionals in the ADR program.

5. Use of the ADR program for educational purposes

6. Development, maintenance, and evaluation of ADR records within the organization

7. the organizational dissemination and use of information obtained through the ADR program

8. Reporting of serious ADRs to FDA or the manufacturer (or both)

the pharmacist should facilitate based on the ASHP Guidelines on ADR monitoring and Reporting (8)

pediatrics

geriatrics

pregnant

special populations in reporting and evaluating ADRs

underdeveloped organs

what characteristics pediatrics patient have that makes them susceptible to ADRs

UDP-glucoronosylacetyltransferase (Gray baby syndrome) and Kernicterus

most ADRs associated in pediatric patients are

chloramphenicol

gray baby syndrome induced by what drug

Comorbidity

Polypharmacy

Less functional organs

what are the ADRs or complications associated with geriatrics

teratogenic agents

what are the ADRs or complications associated with pregnant patients

Category A

Adequate well controlled studies in pregnant women have not shown an increased risk of fetal abnormalities to the fetus in any trimester of pregnancy

Levothyroxine

Folic Acid

Liothyronine

Drugs under FDA pregnancy Category A