1. Hon. Shri. Babanrao Pachpute Vichardhara Trust’s, Group of Institution, Faculty
of Pharmacy, Kashti, Shrigonda
Pharmacy Practice
Final Year B. Pharmacy
Semester - VII
Topic Name
CLINICAL PHARMACY
Presented by:
Mr. Afroj Ayyaj Shaikh
(final Year B. Pharm)
Roll no. 74
Guided by:
Prof. Shruti Sonawane
(M.Pharm)

2. Content
• Clinical review
• Pharmacist intervention
• Ward round participation
• Medication history
• Pharmaceutical care
• Dosing pattern & drug therapy based on pharmacokinetics & disease
pattern.

3. Clinical Review
• Clinical review is one of the integral component of medication
review & should preferably be performed on a daily basis.
• It is the review of the patient progress for the purpose of assessing
the therapy outcome.
• Therapeutic goal for the specific disease should be clearly
identified before the review.
Goals
1. Assess the response to drug treatment.
2. Evaluate the safety of the treatment.
3. Assess the progress of the disease & the need for the any change in
therapy.
4. Assess the need for monitoring.
5. Assess the convenience of therapy

4. 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.

5. Pharmacist Intervention
• Pharmacist intervention & comment written on the prescription
were used to revise each error by advocating the proper use of
medication.
• Intervention is done by pharmacist can be active or passive or
reactive.
• Decision are made regarding inpatient management during ward
round and clinical pharmacist participating on ward round may
influence these decisions.
Different Aspects of Pharmacist interventions
• Reducing Health cost
and Utilization.
• Medication adherence
• Patient education
• Effective communication &
establishing patient relationships
• Medication therapy management
• As per member of health care team

6. Ward Round Participation
• A word round is a visit made by a medical practitioner alone or
with a team of health care professional & medical student to
hospital in patient at their bedside to review & follow up the
progress in their health.
• Usually at least one word round is conducted every day to review
the progress of each inpatient.
Role in 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.

7. Medication History
• Medication history is interview session, In which the clinical
pharmacist start to interview of the patient & introduce himself
and explain the actual purpose of the interview.
• The clinical pharmacist documented accurate and complete patient
medication history as well as collect general information such as
Name, Age, Gender, Blood group, Addresses, smoking, alcohol
intake & eating habits etc.,
• After the end of session clinical pharmacist transfer all collected
information to the medical practitioner.
• On the basis of medication history medical practitioner giving
accurate drug and treatment to patient.

8. Pharmaceutical Care
• Pharmaceutical care involves the process through which a
pharmacist co-operate with a patients and medical staff for
designing, implementing & monitoring a therapeutic plan that will
produce specific therapeutic outcome to improving a patient
condition.
Function
• Collection of patient data.
• Identification of problems.
• Establishing outcome goals.
• Monitoring outcomes.

9. Dosing pattern and drug therapy based on the
pharmacokinetic and the disease pattern
• Designing the correct dose is important for achieving the desired
therapeutic effect and the avoiding undesired effect.
• Various factors like metabolizing enzymes, drug interactions
(drug-drug, food-drug, herb-drug), multiple treatments and the
dosage form affect the drug deposition.
Different Types of Doses
• Effective dose : It is amount of drug which will produce specific
intensity of effect to treat or prevent the disease.
• Median effective dose: The amount of drug which produce the
desired therapeutic effect in 50% of experimental animals
• Lethal dose: The amount of drug when giving to an animals, will
kill those animal.
• Fetal dose: When lethal dose reaches 100%.

10. • Median lethal dose: The amount of drug when given to an
animal as result kills 50% of those animals.
• Initial loading dose: In some condition certain drugs are given in
layer doses in the beginning to obtain an effective blood level
rapidly, this is known as initial loading dose.
• Maintenance dose: After achieving a desired blood level by
initial loading dose, smaller quantity of drug is then required to
maintain the blood level, this is known as maintenance dose.
Dose Adjustment in Renal & Hepatic disease
A. Dose Adjustment in Renal Disease
• In patient with renal failure, the half-life of the drug is increases &
its clearance decreases if it is predominantly eliminated by way of
excretion.
• Hence, the dose adjustment should take into account the renal
function of the patient & the fraction of unchanged drug excreted
in urine.

11. a. Dose Adjustment based on the total body clearance
• The average drug conc. at steady-state css,av is a function of
maintenance dose X0 , the fraction T of the drug clearance Cl‫ז‬F,
the dosing interval & of dose absorbed.
General Approach:
• No change in the desired or target plasma concentration.
• Diminished renal clearance but unchanged
• non-renal clearance.
• Unaltered drug protein binding & volume of distribution in the
renally impaired patient.
• Unchanged drug absorption from the GIT.
Three Major Approaches are:
• Dose adjustment based on Total body clearance.
• Dose adjustment based on Elimination rate constant or half life.
• Dose adjustment in renal failure.

12. Css,av = Fxo / ClT
Dose adjustment based on Elimination rate constant or Half-life:
• The average drug conc. at steady-state is a function of
maintenance dose, the fraction of dose absorbed, the dosing
interval of dose & volume of distribution & half-life of the drug.
Css, av = 1.44 Fxo t1/2 Vd
• Diseases are the major source of variation in drug response.
• Both pharmacokinetic and Pharmacodynamic of many drugs are
altered by disease other than the one which is being treated.
Disease State:
 Renal dysfunction: It greatly impair the elimination of drug
especially those that are primarily excreted by the kidney. Causes
of renal failure are hypertension, diabetes mellitus.

13.  Uremia: It is characterized by impaired glomerular filtration and
accumulation of fluid and protein metabolism. In both the cases
the half life of the drug are increased as a consequences drug
accumulation and toxicity increases.
A. Adjustment of Dosage in Hepatic Disease:
• The influence of Hepatic disorder on the drug bioavailability &
disposition is unpredictable because of the multiple effects that
liver produces.
• The altered response to drugs in liver disease could be due to
decreased metabolizing capacity of the hepatocytes, impaired
biliary elimination, due to biliary obstruction.
• Impaired Hepatic blood flow leading to an increase in
bioavailability caused by a reduction in first pass metabolism.

14. • Decreased protein binding and increased toxicity of drugs highly bound to plasma protein
due to impaired albumin production, altered volume of distribution of drugs due to increased
extracellular fluid.
• Decreased protein binding and increased toxicity of drugs highly
bound to plasma protein due to impaired albumin production,
altered volume of distribution of drugs due to increased
extracellular fluid.
• Oedema in liver disease may be increased by drugs that cause
fluid retention (e.g. Acetylsalicylic acid, Ibuprofen).
• Generally , drug doses should be reduced in patients with hepatic
dysfunction since clearance is reduced & bioavailability is
increased in such a situation.
Thank You !