Intro 1

Cards (21)

  • Clinical Pharmacy
    The area of pharmacy concerned with the science and practice of rational medication use. (Patient oriented)
  • Where to practice clinical pharmacy
    • Hospitals
    • Community pharmacies
    • Nursing homes
    • Home-based care services
    • Clinics
    • Any other setting where medicines are prescribed and used
  • The term "clinical" does not necessarily imply an activity implemented in a hospital setting
  • Qualifications to be an expert clinical pharmacist
    • Clinical Pharmacy Fellowship
    • Board of Pharmacy Specialties
    • Clinical Pharmacy Diploma
    • PharmD
    • Clinical pharmacy Master, and PhD
    • Clinical pharmacy Bachelor
  • Responsibilities of a clinical pharmacist in outpatient care
    • Medication reconciliation
    • Adjust medication doses as necessary
    • Improve patient compliance
    • Report medication errors
    • Educate patients and providers about medications
  • Drug information center (DIC)

    • Provision of specific comprehensive drug information upon request from healthcare providers, and consumers from the general public in a timely manner, based on a complete analysis of available evidence
    • Maintenance of resources to provide the most current and accurate information to inquirers
    • Publishing a drug information newsletter
    • Educating pharmacy students, and professionals about resources and medical literature analysis and enhancing the skill of accurately communicating response (both verbally and in-writing)
  • Ward clinical pharmacist role
    • Involved in medical rounds with the other health care professionals
    • Documenting patient information on a specially designed record
    • Creating a pharmaceutical care plan
    • Identify Medication related problems
    • Answering Medication information queries to physicians & other health professionals
    • Patient education and counseling
  • Pharmaceutical care plan
    • A written, individualized, comprehensive medication therapy plan based on clearly defined therapeutic goals
    • The pharmaceutical care plan, which is available to all pharmacists caring for a patient, is updated with each major change in patient status
    • It is important that the physician be informed about the care plan to ensure common goals
    • Patients should also be informed about the general content of the care plan as means of gaining their agreement regarding drug therapy
  • Information included in the patient database for the pharmaceutical care plan
    • Patient demographics
    • Diagnoses and past medical history
    • Present medications and medication history
    • Medication allergies/intolerances
    • Smoking/alcohol/caffeine/drug use history
    • Abnormal laboratory and physical exam results
    • Renal and liver function
  • Types of drug-related problems

    • Not receiving an indicated drug
    • Receiving the wrong drug
    • Receiving too little of the drug (Subtherapeutic dose)
    • Receiving too much of the drug (Supratherapeutic dose)
    • Experiencing an adverse drug reaction
    • Experiencing a drug interaction
    • Not receiving the prescribed drug
    • Drug without indication
  • Therapeutic goals
    • Approach normal physiology (i.e., normalize blood pressure)
    • Slow progression of disease (i.e., slow progression of cancer)
    • Alleviate symptoms (i.e., optimize pain control)
    • Prevent adverse effects
    • Educate the patient about his or her medication
  • Monitoring parameters must also include potential adverse effects
  • General steps in creating a pharmaceutical care plan
    • Create comprehensive patient database
    • Assess for actual and potential drug-related problems
    • Establish therapeutic goals
    • Specify monitoring parameters with end points and frequency
    • Document the patient's progress towards therapeutic goals
  • Items in the drug checklist for the ICU
    • Drug interactions
    • Medication without indication
    • Right dose
    • Dosage adjustment according to hepatic and renal functions
    • Right preparation and administration
    • Monitoring ADR
    • Monitoring of treatment response
    • Lab values monitoring
    • Indication without medication
    • Stress ulcer prophylaxis
    • DVT prophylaxis
    • Feeding
    • Analgesia and Sedation
    • Head of bed elevation
    • Glycemic control
  • Risk rating scale for drug interactions
    A, B, C, D, X
  • Use of antibiotics in case of viral infections is an example of medication without indication
  • The dose of enoxaparin for VTE prophylaxis in critically ill patients is 40 mg SC daily
  • The dose of enoxaparin for treatment of VTE is 1 mg/kg q12hr or 1.5 mg/kg q24hr
  • Equations for dosage adjustment in renal impairment
    • Acute Renal Failure: JELLIFFE multi-step
    • Chronic Renal Failure: Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)
  • Some drugs require special equations to calculate dosage in renal impairment
  • Examples of drugs adjusted according to Child-Pugh score
    • Metronidazole
    • Tigecycline
    • Caspofungin