HOSPITAL PHARMACY 2ND PART

Pharmaceutical care

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PHARMACEUTICAL CARE Pharmaceutical care is the responsible

provision of drug therapy for the purpose of achieving definite outcomes that improve/ maintain a patient’s quality of life.

Maintainance of QOL for chronic progressive diseases such as HIV/AIDs and diabetes

Review prescription, or pt medication record Talking to patients, assess needs, create a plan Document, monitor and review the care given

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PHARMACEUTICAL CARE PROCESS

Pt receiving or requiring a pharmaceutical product or service

Step1Assess needs and identify drug problems

Step2Develop a care

planStep3Implement the care plan

Step4Monitor and review the care plan

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1 -ASSESS NEEDS & IDENTIFY DRUG THERAPY PROBLEMS

How ??? (Pt, HCT, Records)1- needing pharmacotherapy and not receiving it.

(Drug indication)2-Taking or receiving a drug for no valid indication.3-Taking or receiving wrong drug4-low dose5-too much dose6-ADR7-DDI-D-food8- poor compliance 4

TYPE OF DRUG THERAPY PROBLEMS Actual Potential

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CASE 1 : Mrs W, a 53-year-old woman has had

gastrointestinal acid-related disorders (GORD). Diagnosed by endoscopy. Mrs W has a history of asthma, hypertension and duodenal ulcer (DU). Her current drug therapy includes amlodipine (10 mg in the morning), Salbutamol inhaler (two puffs as required) beclometasone inhaler 2oomcg twice daily), and theophyllin (300mg twice daily). Mrs W has recently undergone successful H. pylori eradication therapy, which has been confirmed by carbon urea breath test. Mrs W smokes 10 cigarettes a day, has a body mass index of 35 and does not drink alcohol.

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Identify

Life style

Medicine

And disease factors

For the above patient

CASE2 Mrs T, aged 78, has a history of coronary

heart disease, for which she has recently undergone coronary angioplasty and stenting. She is currently taking clopidogrel 75 mg, aspirin 75 mg, atrovastatin 80 mg, nicorandil 30 mg, and atenolol 50 mg. She stopped smoking a year ago. Mrs T presents to the community pharmacist complaining of black, bloody stools. The problem has gradually worsened over the last day or two. She has no previous history of gastrointestinal problems.

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1. What risk factors does Mrs T have for drug-

induced gastric ADR?

2. What advice should the community pharmacist give?

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CASE 3 Mr B is a 71-year-old man who recently

completed a 10-day course of flucloxacillin 500 mg three times a day for cellulites.

Three weeks later he presents to his doctor complaining of lethargy and increasing nausea.

Several days ago he noted sight yellowing of his eyes and that his urine was dark in color.

Over the last 2 days he has suffered from an itch at over his trunk and legs which is interfering with sleep.

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1-WHAT FORM LIVER DISEASE IS SUGGESTED BY THE PRESENTATION?

2-The patient was admitted to hospital. LFTs on admission were as follows.

• Albumin 37 g/L (normal 35-55)• Aspartate transaminase (AST) 172 units/L (<35)• Alanine transaminase (ALT) 211 units/L (<50)• Alkaline phosphatase 1975 units/L (70-290)• Bilirubin 172 µmonl/L (3-17) What type of liver dysfunction is

indicated by these results?

3. How would you treat the symptoms? 11

CASE 4 : Mrs P, aged 74 years, has recently been

diagnosed with Parkinson's disease. Her only medical condition listed is angina. Her current drug therapy is as follows:

Glycerytl rinitrate (GTN) 500mcg one tablets sublingually as required haloperidol 0.5 mg capsules one capsule three times daily.

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IDENTIFY DRUG THERAPY PROBLEMS FOR THIS PATIENT AND INDICATE WHETHER THEY ARE ACTUAL OR POTENTIAL PROBLEMS.1- antiplatelet

2-prophylactic anti-anginal

3-Haloperidol??

4-ADR of Haloperidol &parkinsonism diag13

CASE5 Mr. D aged 52 years has been diagnosed

with hyperlipedemia and advised on diet and lifestyle measures for the past year.

His medical history include hypertension, and atrial fibrillation. His blood pressure was recently measured as 140/85 mm Hg , pulse 40 beats/minute and lipid screen showed total cholesterol of 8.4 mmol/l (N = 5 mmol/L or less). On the interview, the patient complains of tiredness and weight loss.

Current drug therapy is as follow: Amiodarone 200 mcg in the morning Thiazide 10 mg in the morning 14

Identify drug therapy problems for this patient and indicate whether they are actual or potential problems.

Develop a care plan to resolve or prevent these drug therapy problems

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