Introduction to Pharmacotherapy

Ghada A Bawazeer. MSc, PharmD. BCPSKing Saud University-College of Pharmacy

Sept. 2013

How many Prescription Drugs are available?a. 500b. 1000c. 3000d. Too many for me to

memorize as a pharmacist

Case This is an 85-year-old, 60-kg woman with a

serum creatinine of 1.8 mg/dL has atrial fibrillation. A decision has been made to use digoxin to control the rapid heart rate. Do agree with such drug selection? Why or why not? What factors would make you select digoxin?

Case A 35-year-old man presents with a blood pressure of

150/95 mm Hg. He has been generally healthy, non-smoker, and is sedentary. His father died of a myocardial infarction at age 50. Physical examination is remarkable only for moderate obesity. Total cholesterol is 220, and high-density lipoprotein (HDL) cholesterol level is 40 mg/dL. Fasting glucose is 112 mg/dL. Chest x-ray is normal. Electrocardiogram shows left ventricular enlargement. How would you manage this patient to minimize his risk of cardiovascular events?

JM is a 24 year old female with a diagnosis of major depression disorder. There are more than 35 antidepressant agents in the market.. How would you select from them?

Pharmacotherapeutics Study of drug use in the treatment of disease

as associated with patient care. Cure, prevent, and treat diseases and

alleviate symptomsPrinciples of pharmacotherapy help to

guide the optimal use of drugs to attain maximal efficacy with minimal adverse effects.

Is the study of pharmacology enough to help you make a good judgment about drug selection for a patient?

Pharmacology

“The study of the effects of drugs on the function of living organisms.” Pharmacology deals with knowledge

about: Mechanism of action Clinical uses Adverse effects

Pharmacokinetics & Pharmacodynamics

Knowledge about Pharmacokinetics & Pharmacodynamics assist in:

Recommending patient-specific drug-dosing that increase the efficacy and decrease the toxicity of many medications. Routine monitoring of serum or plasma samples for many drugs and modify doses for optimal patient outcomes, e.g.

antibiotics (e.g., aminoglycosides and vancomycin) antiepileptics (e.g., phenytoin, carbamazepine, valproic acid, phenobarbital, and ethosuximide) lithium immunosuppressants (e.g., cyclosporine and tacrolimus)

Pharmacogenetics Pharmacogenetics involves the search for genetic

variations that lead to interindividual differences in drug response Drug metabolism, drug transporter, and drug target proteins,

as well as disease-associated proteins. The goal is to optimize drug therapy and limit drug

toxicity based on an individual's genetic profile.

Genotype-guided therapy Warfarin Clopidogrel

Pharmacoeconomics Deals with identifying, measuring, and comparing the

costs, risks, and benefits of programs, services, or therapies and determining which alternative produces the best health outcome for the resource invested.

Better, more informed decisions regarding the use of pharmaceutical products and services

“It's more important to know what kind of person has a disease than what kind of disease a person has”

~ Hippocrates

Any pharmacotherapy decision should

contain assessment of :

economic, clinical, and humanistic

outcomes (ECHO)

Pharmacotherapeutics

Involves knowledge about almost every branch of medicine, and integrates a wide variety of sciences: Anatomy, physiology, pathophysiology,

biochemistry, Pharmaceutical sciences: pharmacology,

pharmacokinetics, pharmacokinetics, pharmacogenetics, pharmacoeconomics, etc

Evidence-Based Medicine EBM Pharmacotherapy

An approach to decision making whereby clinicians appraise scientific evidence and its strength to support their therapeutic decisions

The practice of EBM is to recognize an information need while caring for a patient, identify the best existing evidence to help resolve the problem, consider the evidence in light of the actual circumstances, and integrate the evidence into a medical plan

Clinical Practice Guidelines

“Systematically developed statements to assist

practitioners and patient’s decisions about

appropriate health care for specific

circumstances.”

Patient-Centered Care and Pharmaceutical care skills

Pathophysiology and Therapeutics Modules

412 Cardiology414 Respiratory and nephrology422 Gastroentrology424 Endocrine432 Neurology & Psychiatry434 Infectious diseases477 Oncology/hematology478 Acute care, geriatric, pediatric,

drug-induced diseases