TOPIC 1: CLINICAL PHARMACY

CONCEPTS OF
PHARMACOTHERAPY
CARE PLANNING
 OBJECTIVES
At the end of the presentation, students are expected to:
1. Learn the importance of clinical pharmacy in healthcare
settings.
2. Learn the concept of pharmacotherapy care planning.
3. Formulate a pharmaceutical care plan.
CLINICAL PHARMACY
Patient-oriented rather
than product-oriented
Ensures the right
patient get the BEST
THERAPEUTIC
OUTCOME
 CHARACTERISTICS OF CLINICAL PHARMACY
1. Not a product-oriented but a patient-
oriented
2. Primary Objective: RATIONAL USE OF
DRUG
1.
3. Practice in both community and hospital
setting
4. Multidisciplinary - involves different fields
of study
 PHARMACEUTICAL CARE
Responsible provision of
drug therapy for the
purpose of achieving
DEFINITE OUTCOMES
and improvement of
patient’s QUALITY OF
LIFE
 OUTCOMES

Modify or Identify and

Minimize or
cure the Resolve
eliminate
Disease Drug-Related
patient’s Problems
Process
symptoms (DRP)
 DRUG RELATED PROBLEMS (DRP)EXAMPLES

NSAIDs = GI Irritation due to Inhibition of PGE1 (Mucosal Protective) =

Take with Food
Anticancer Drugs = Nausea and Vomiting = Ondansetron (5-HT3
Antagonist)
Orlistat (Blocks the absorption of Fats) = Blocks the absorption of ADEK
(Hypovitaminosis) = Give multivitamins containing ADEK at Different
time
Fluoroquinolones + Tetracyclines = Decreases absorption of metal
containing products = Provide Intervals
 ESSENTIAL CLINICAL KNOWLEDGE AND
SKILLS OF CLINICAL PHARMACIST
Knowledge on Drug and Nondrug therapy
Knowledge on Laboratory and diagnostic test
Good understanding of disease process
1.
Physical assessment skills
Therapeutic Planning Skills
Drug Monitoring Skills
Provision of Drug Information
Good Communication Skills
 CLINICAL PHARMACY SERVICES
1. Medication History Taking and Documentation
2. Medication Order Review
3. Reporting and Evaluating ADR’s
4. Therapeutic Drug Monitoring (TDM)
5. Monitoring
1. of Legal, Institutional and Other Guidelines
6. Evaluation of Drug Use
7. Review of Cost-effectiveness
8. Selection of Drug Therapy
9. Drug Information Services
 CLINICAL PHARMACY SERVICES
1. MEDICATION HISTORY TAKING AND DOCUMENTATION
a. General Data or Demographic Data
b. Chief Complaint (CC)
c. History of Present Illness (HPI)
d. Past Medical History (PMH)
1.
e. Social History (SH)
f. Family Medical History (FMH)
g. Medication History (MH)
h. Review of Systems (ROS)
i. Physical Examinations (PE)
 CLINICAL PHARMACY SERVICES
2. MEDICATION ORDER REVIEW (MOR)
PRESCRIPTION - written order of validly
registered physicians, dentist and veterinarians
for a specific patient (BEQ).
TWO TYPES OF DRUGS
1.
Prescription or Ethical Drugs - drugs that
are dispense WITH prescription (BEQ)
Non-Rx or Over-the-Counter (OTC) Drugs -
drugs that can be dispense WITHOUT
prescription (BEQ)
 PRESCRIPTION

1.

Retrieved from: http://www.mapharm.com/prescr_parts.htm

MEDICATION ORDER OR DOCTOR’S ORDER
 CLINICAL PHARMACY SERVICES
2. MEDICATION ORDER REVIEW (MOR)
MEDICATION ERRORS - any preventable events that
may lead to inappropriate medication use and may
cause harm to patient (BEQ)
TYPES OF MEDICATION ERRORS
a . U n a u t h o r1.i z e d o r U n o r d e r e d D r u g E r r o r
b. Extra Dose Error
c. Omission Error
d. Wrong Dose
e. Wrong Dosage Form
f. Wrong Timing
g. Wrong Route of Administration
 CLINICAL PHARMACY SERVICES
3. REPORTING AND EVALUATING
ADVERSE DRUG REACTIONS
PHARMACOVIGILANCE - responsible
for continuous monitoring of the
u n w a n1.t e d e f f e c t s a n d o t h e r s a f e t y -
related aspects of marketed drugs
Example: Roficoxib (Vioxx) - cause
myocardial infarction
 CLINICAL PHARMACY SERVICES
3. REPORTING AND EVALUATING ADVERSE
DRUG REACTIONS
ADVERSE DRUG REACTION (ADR) - noxious,
unintended effects of drugs used in the
diagnosis, prophylaxis and treatment
1. Types of ADR
A. Type A (Augmented)
related to pharmacologic activity;
predictable and dose dependent
Example: Codeine = Constipation
 CLINICAL PHARMACY SERVICES
B. Type B (Bizarre)
Opposite of Type A
Abnormal, unusual or rare reaction
Example: Hypersensitivity rxn on Beta-
lactam antibiotic
C . T y p e C1. ( C o n t i n u o u s )
Long period of administration of HIGHER
DOSES
Example: Cushing’s Syndrome by Steroids
 CLINICAL PHARMACY SERVICES
D. Type D (Delayed)
Occurs long after exposure
Example: Teratogenicity and Carcinogenicity
E. Type E (End of Use)
W i t h d r a w a l S y n d r o m eF
1.
Example: Diazepam
F. Type F (Failure of Use)
Incomplete use of medications
Example: Resistance due to antibiotic misuse
 CLINICAL PHARMACY SERVICES
4. THERAPEUTIC DRUG MONITORING
Individualization and optimization of dosage to
maintain therapeutic blood concentration within the
target range
Use in drugs with LOW THERAPEUTIC INDEX (LTI)
F o r d r u g1.s w i t h b i o l o g i c e f f e c t s c a n n o t b e d e t e r m i n e d
Examples:
Warfarin
Digoxin
Theophylline
Barbiturates
Heparin
 CLINICAL PHARMACY SERVICES
5. MONITORING OF LEGAL, INSTITUTIONAL AND
OTHER GUIDELINES
JNC 8 - Guidelines for Tx of Hypertension
6. EVALUATION OF DRUG USE
DRUG UTILIZATION REVIEW (DUR) - interprets
p a t t e r n1.s o f d r u g u s e i n a g i v e n h e a l t h c a r e
system

3 Types of Drug Utilization Review

Retrospective - after dispensing

Concurrent - during dispensing
Prospective - before dispensing
 CLINICAL PHARMACY SERVICES
7. REVIEW OF COST-EFFECTIVENESS
PHARMACOECONOMICS - tool that
measures, identifies and compares cost
(inputs) and outcomes (output) of
different pharmacotherapies or
1.
interventions
Components:
Economic
Humanistic - Px satisfaction and
Quality of Life)
 CLINICAL PHARMACY SERVICES
8. SELECTION OF DRUG THERAPY
Judicious and explicit use of BEST
CURRENT EVIDENCE in making
decisions about the care of
individual patient
1.
Components:
Clinical Expertise- clinician’s
education, skills and experience
Patient Values
Best-evidences
 CLINICAL PHARMACY SERVICES
9. DRUG INFORMATION SERVICE
Provide drug-related
information to all units such
as emergency room, hospital
1.
wards, ICU, CCU
Check for drug-drug
interaction, compatibilities,
stabilities and calculations
PHARMACEUTICAL CARE PLAN

Retrieved from: Joint Commission of Pharmacy Practitioners.

Pharmacists’ Patient Care Process. May 29, 2014
case study 1
 formulate a pharmaceutical CARE PLAN

1. COLLECT 3. PLAN

2. ASSESS 4. IMPLEMENT

5. MONITOR AND EVALUATE

case study 2: ASSIGNMENT
Px Harry Potter is a 65 years old, male and was rushed to
ER due to rapid pulse and breathing but unresponsive. His
niece informed the ER nurse that the Px is taking gliclazide
60mg OD and metformin 500mg BID as maintenance for
DM. No noted allergies.
His laboratory results are as follows:
*HbA1c - 9.8% (Normal: Below 6%)
*RBS - 260mg/dL (Normal: 110-140mg/dL)
*Creatinine - 1.9mg/dL (Normal: 0.7 - 1.3 mg/dL)
 CASE STUDY 2 GUIDE QUESTIONS
Formulate a Pharmaceutical Care Plan (Total
Points: 25)
1. Collect. What are the data in the case that you
need to check to confirm the disease of the
patient? Explain your answer. (5 Points)
1.
2. Assess. Do you think that the current medication
management of the patient is sufficient to manage
his condition? Elaborate your answer. (5 Points)
3. Plan. What will be your recommendation as a
clinical pharmacist in this case? (5 Points)
 CASE STUDY 2 GUIDE QUESTIONS
Formulate a Pharmaceutical Care Plan
4. Implement. How are you going to
implement your treatment plan? (5 Points)
5. Monitor and Evaluate. What will be your
1.
next steps after your implementation and
how are you going to conduct your
monitoring and evaluation? (5 Points)