CLINICAL PHARMACY.pptx

POINTS TO BE INCLUDED
Definition, scope,
Technical definitions, common terminologies used in clinical
settings
Daily activities of clinical pharmacists
Ward round participation
 Treatment Chart Review
 Adverse drug reaction monitoring
Interprofessional collaboration

1. CLINICAL PHARMACY Archana Chavhan M.Pharm (QA)

2. DEFINATION “Clinical pharmacy is a health science discipline in which pharmacists are involved in direct patient care to ensure rational and safe use, to optimize medication therapy and to promote health, wellness and disease prevention”

3. SCOPE OF CLINICAL PHARMACY

4. Common abbreviations used in medical practice Abbreviation Medical term ACE Angiotensin-converting enzyme ATP BP Blood pressure ICU Intensive care unit CHD Congenital heart defects TB WHO   WBC RBC Hb BMI ECG Adenosine triphosphate World Health Organization Body mass index electrocardiogram Tuberculosis Hemoglobin Red blood cells White blood cells

5. Pharmaceutical latin terms Latin term Meaning Tabletta Tablet Pulvis Powder Mistura Mixture Pasta Paste Guttae Eye drop Hora somni At bed time Bis in die Twice a day Omni mane Every morning

6. Common terminologies used in clinical settings Absence of hydrochloric acid in gastric juice Drugs which decreases urine output Drugs that kill/inhibit the growth of microorganisms Agent that promotes the release of mucous from the RT Decreased blood sugar level Low body temp. Deficiency of oxygen into the blood Achlorhydria Antidiuretic Antimicrobial Expectorants Hypoglycemia Hypothermia Hypoxia

7. Abbreviations commonly used in measure of capacity & weight Symbol English Equal to m Minim 1 minim  ʒ  or “f ʒ ” Fl. Drachm 60 minim oz or “ fl oz ” Fl Ounce 29.57ml “O” Pint 16 fl ounce gr Grain 1 grain “℈” Scruple 20 grain lb Pound 5760 grain or 12 drachm

8. Role of Clinical Pharmacist Identification of drug interaction. Dose adjusting. Identification of side effects. Drug information source. Drug selection. Provide information about cost & cost effectiveness. Patient counseling. Provide the information about medication efficacy.

9. Activities of clinical pharmacist

10. Ward round participation A ward round is a visit made by a medicinal practitioner, alone or with a team of health professionals to hospital inpatients to review and follow up progress in their health. Types of ward rounds

11. Objectives for ward round Optimize therapeutic management by influencing drug therapy selection, monitoring and follow up Detect ADR and Drug interaction Investigate unusual doses/orders Provide additional information about the patient such as medication compliance or alternative medicines use. Participate in patient discharge planning

12. Role of clinical pharmacist in ward round participation Clinical pharmacist may participate in ward round along with medical staff & monitor the treatment of patient. Pharmacist can identify adverse effect and drug interactions with several food, other drug, alcohol, smoking, chemical as well as pregnancy condition. Pharmacist may suggest an alternate therapy if applicable to the staff and medical practitioner.

13. Patient profile form Medication history

14. The main drug related queries that may arise during ward rounds relate to: Dose and frequency Choice of medication Formulation Adverse effects Duration of therapy Drug availability miscellaneous

15. MEDICATION CHART

16. Medication chart review It involves the review of patient’s medication regimen to ensure that therapy is appropriate, safe, efficacious and cost-effective. The goal of MCR is to optimize drug therapy and patient health outcome by identifying and solving drug related problems and ensuring all therapeutic objectives are being achieved.

17. Steps of medication chart review Collection and interpretation of patient specific information (medication history interview) Assessment of therapeutic goals Identifications of drug related problems Individualization of medication regimens Monitoring of treatment outcomes Medication chart endorsement documentation

18. Medication chart endorsement Chart endorsement is one of the primary responsibility of pharmacist to ensure that medication orders are complete. The types of endorsement may be needed are determined by following keys; Is the identity of the patient on each medication chart? Is the allergy status of patient documented on each medication chart? Is the medication name clear? Is the drug prescribed by the generic name? Is the dose clear? Is the route of administration specified? Is the date and time of drug administration clear? Is there any over writing which may lead to confusion? Is the prescription signed by the doctor? Have medicines prescribed according to legal and local requirements?

19. Adverse drug reaction monitoring (ADR) WHO defines an “ Adverse drug reaction as any response to a drug which is noxious and unintended and which occurs at doses normally used in man for prophylaxis, diagnosis or therapy of disease.”

20. Reason / factors of ADR Patient related factors Age Gender Maternity status Body weight and fat distribution Allergy Hereditary factors Patient compliance Social factors Alcohol drinking Smoking Drug related factors Polypharmacy Drug dose and frequency Therapeutic index Pharmacokinetic of drug Disease related factors  Multiplr drug therapy Disease states

21. Classification of ADR’s 1 2 3 4 5 6

22. Excessive pharmacological effect This type of reaction will develop in patient if excessive dosage is given. It is commonly seen with cardioactive agent, CNS depressants etc. It is common in following groups of patients Examples; Excessive dose of digoxin produce bradycardia Excessive dose of morphine produce respiratory depression Neonates infants elder patients Patients with kidney disease Patients with liver damage

23. Secondary pharmacological effect A drug may have pharmacological actions t commonly administered dosage. Example; a patient receiving antihistamines for prevention of allergic skin reaction may become drowsy. Drowsiness

24. Rebound response after discontinuation After long use of many medications, tolerance may get developed at cellular level. Sudden withdrawal of such medicines may give rise to sever adverse effects. This type of drug reactions are common with drugs acting on CNS, narcotics, hypnotics etc. Example; Long term use of CNS-depressants like benzodiazepines, after sudden withdrawal results in confusion, tachycardia and convulsion. Sudden withdrawal of corticosteroids after long term use causes acute adrenal crisis. Convulsion

25. Idiosyncrasy ( is an unusual feature of a person. It can also mean an odd habit.) An idiosyncrasy produced by some drugs with usual doses in few individuals. Idiosyncrasy is qualitative drug intolerance due to pharmacogenetic factors. Example; Drug Idiosyncratic reaction Analgesics May induce tumor of kidney in patient with renal disease Long term use of estrogen Uterine cancer Long term use of cyclophosphamide May induce lymphoid tumors

26. Allergic drug reactions(Hypersensitivity) Drug allergy includes antigen antibody reactions involving lymphocytes. This undesirable effects like skin rashes, bronchospasm, angioedema etc. These reactions cause various kinds of tissue damage leading to signs and symptoms of drug allergy. Example; Causative drug Allergic reaction Penicillin Anaphylaxis Streptomycin, penicillin, sulfomides Skin rashes, itching Phenyl butazone , thiouracil Leucopenia Digoxin, quinidine thrombocytopenia

27. Genetically determined toxicity There is increased risk of drug toxicity specially in case of patients with special genotype or genetic makeup. Example; Hereditary conditions Drugs causing toxicity Prophyria Sulfonamides, tolbutamide Glaucoma Corticosteroids Methaemoglobinanemia Salicylates, phenacetin

28. Methods of detecting ADR Passive surveillance system: Health professionals are encouraged to report adverse reactions which they believe to be drug-related directly to the regulatory authority or the company marketing the suspected product on a voluntary basis SPONTANEOUS CASE REPORTS 1

29. The spontaneous reporting system process

30. India - 'Suspected Adverse Drug Reaction Reporting Form’ UK - 'Yellow Card', since 1964 Australia - 'Blue Card', since 1964 US- 'Med Watch' ADR reporting form;

31. Cohort means identifying a group of recipients of drug and observing these patients for varying length of time for what happens to them. It is used when detection of events occur with frequency more than 1 in 500 exposed. COHORT STUDIES 2

32. It involves the comparison of group of patients with a disease which is thought to be due to a drug (called case) and with a group of patients who do not have the disease (called control) . The drug histories of cases and controls are obtained and compared CASE CONTROL STUDIES CASE CONTROL 3

33. Role of pharmacist in the Management of ADR Monitoring patient who are at greater risk of developing ADRs. Monitoring patients who are prescribed with drugs likely to cause ADRs. Assessing patient previous allergic status, patient's drug therapy, possible drug interactions. Assisting health care professionals in the detection and assessment of ADRs Documentation of all suspected reported reactions Follow up patient to assess the outcome of the reaction and management. Educating the health care professionals about the importance of reporting an ADR Creating awareness about ADRs amongst healthcare professionals, patients and the public.

34. Interprofessional collaboration

35. DEFINITION WHO Defines” multiple health workers from different professional backgrounds works together with patients, families, careers and communities to deliver the highest quality of care”

36. Benefits of collaboration

37. THANK YOU