Clinical pharmacy involves the science and practice of rational medication use to optimize patient outcomes. It focuses on direct patient care activities like medication management, patient education, and monitoring. The clinical pharmacist aims to ensure safety and effectiveness of drug therapy through activities like reviewing medications, addressing non-adherence, identifying drug interactions, and providing counseling. Clinical pharmacists practice in various settings like hospitals, ambulatory clinics, and retail pharmacies.

1. Clinical pharmacy
Ravish Yadav

2. Clinical Pharmacy
Clinical pharmacy is defined as that area of pharmacy concerned with the
science
and practice of rational medication use.

3. • Clinical pharmacy has evolved as that specialization within pharmacy
practice which deals with patient care with emphasis on drug therapy.
• It is patient oriented pharmacy practice.
• The term clinical implies the practice of pharmacy in the presence of
patients whether they are hospitalized or ambulatory out patient or at
home.

4. •Objective & goals:
•The main objective of clinical pharmacy practice is to
render pharmaceutical care:
•It focuses on the pharmacist’s attitude
,behavior,commitment,concern,ethics,knowledge,
responsibilities & skills on the provisions of the drug
therapy & with the goal of achieving definite outcome
towards the improvement of patients quality of life.
•It address the need of the society & the individual
patient.
•It also focused on rational use of the drugs.

5. • Need:
• Growing need for enhancing the effectiveness, safety, potency & preciseness
of drug therapy.
• Reduce risk & cost factors associated with multifarious drug therapy & to
promote rational drug use, expert consultation is needed.

6. •Functions of clinical pharmacist:
•1) To develop & provide patient oriented services.
•2) Patient education & counseling.
•3) Preparation of patient medication histories
•4) Monitoring the drug therapy
•5) To look out at total parenteral nutrition,
intravenous therapy, clinical pharmacokinetics,
selection of drug therapy & determination of
therapeutic end points

7. • 6) Chronic drug management of patients like
hypertension, diabetes mellitus,COPD,arthritis &
cancer in co-operation with medical staff.
•7) Clinical drug investigations in collaboration with
other medical staff.
•8) Reporting of adverse drug reactions.
•9) TDM
•10)Control & proper distribution of drugs in medical
areas
•11)Participation in patient care audits.

8. • 12)Participation in management of medical
emergencies like cardiac pulmonary emergency,
drug overdose, toxicities, poisoning,antidotes &
providing first aid.
•13)Up to date information on all aspects of drug
therapy.
•14)Participation in the education of medical
pharmacy & nursing personnel in the patient care
areas.

9. • Responsibilities of clinical pharmacist:
• 1) In patient care areas:
• 1) Supervision of drug administration technique.
• 2) Reviewing of all doses missed, rescheduling
the doses.
• 3) Reviewing of IV doses.
• 4) Assistance to juniors regarding new technique of drug administration.
• 5) Acting as main agent between the different department of hospitals.

10. • 6) Ensuring the correct drug supplies are maintained in the wards &
co-ordinating pharmacy services within the hospitals.
• 7) Providing in service education to pharmacist,
interns,residents,nurses & medical students.
• 8) Providing drug information to physician & nurses.

11. •Responsibilities in direct patient care areas:
•1) Identify the drugs brought in to the hospitals.
•2) Communicating the patient information with the
physicians.
•3) Assisting in drug product & entity selection.
•4) Assisting the physician in selecting dosage regimen
& schedule & assigning drug administration times for
this schedule.

12. • 5) Monitoring patient’s total drug therapy for
effectiveness,ineffectivesness,side
effects,toxicity,allergic drug reactions & drug
interactions.
•6) Counseling patients on medication to be self
administered and discharged medication.
•7) Participation in drug monitoring programs.

13. • 8) Training the use of health care accessories like inhalers,orthopaedic
aids,diabetic supplies.
• 9) Provide guidance in public & preventive health education programs
on timely topics like drug abuse,first aid,contraception & vaccination.

14. •Clinical pharmacist in community (retail) pharmacy:
•1) Referral service:
•Serve as a referee for patients.
•2) Personalized patient care services:
•To monitor the response of drug in chronic ill patients,to
detect adverse drug reactions,or harmful drug
interactions,may ask about compliance & non-
compliance.
•3) Clinical services: he can help in to the therapeutic
drug monitoring programs. He can also monitor the
blood pressure of the patients.

15. • 4) Blood pressure screening programme:
•5) Diabetic screening & monitoring programme.
•6) Parenteral services:

16. • Implementation of clinical pharmacy services:
• Elements of good clinical pharmacy practice include:
• 1) Communication.
• 2) Consulting.
• 3) Counseling.

17. benefits & scope:
• 1) Value to patient.
• 2) Value to physician.
• 3) Value to pharmacist.

18. • The scope & responsibility of clinical pharmacist:
• 1) To participate in drug use decision making process.
• 2) Select the drug product,source of supply based on comparative
evaluation of their bioequivalence, bioavailabilty,blood levels achieved &
hence the time, intensity & duration of drug action.

19. • 3) By evaluating the pharmacokinetics of a patient
give him/her appropriate dose of drugs.
•4) Provide drugs to various patient care units.
•5) To counsel the patient regarding therapeutic
schedule.
•6) To monitor the patient regarding adverse drug
reactions,drug interactions,drug abuse & toxicities.

20. What is the difference?
Clinical Pharmacy
Pharmaceutical care

21. Pharmaceutical care
‘’Pharmaceutical care is the direct, responsible
provision of medication-related care for the purpose of achieving
definite outcomes that improve a patient’s quality of life.’’
• Cure of the disease
• Elimination or reduction
of symptoms
• Arrest or slowing of a
disease process
• Prevention of disease
or symptoms

22. How does clinical pharmacy differ from
pharmacy?
• the discipline of pharmacy embraces the knowledge on
synthesis, chemistry and preparation of drugs
• clinical pharmacy is more oriented to the analysis of population
needs with regards to medicines, ways of administration,
patterns of use and drugs effects on the patients.
• The focus of attention moves from the drug to the single
patient or population receiving drugs.

23. Clinical Pharmacy Requirements
Patient
care
Knowledge of
drug therapy
Knowledge of
the disease
Knowledge of
laboratory
and diagnostic
skills
Communication
skills
Patient
monitoring
skills
Physical
assessment
skills
Drug Information
Skills
Therapeutic
planning
skills
Knowledge of
nondrug therapy

24. Level of Action of Clinical Pharmacists
Clinical pharmacy activities may influence the correct use of medicines
at three different levels: before, during and after the prescription is
written.

25. 1. Before the prescription
• Clinical trials
• Formularies
• Drug information
• drug-related policies

26. 2. During the prescription
• Counselling activity
• Clinical pharmacists can influence the attitudes and priorities of prescribers
in their choice of correct treatments.
• The clinical pharmacist monitors, detects and prevents
Medication related problems
• The clinical pharmacist pays special attention to the dosage of drugs which
need therapeutic monitoring.
• Community pharmacists can also make prescription decisions directly,
when over the counter drugs are counselled.

27. Medication-related Problems
• Untreated indications.
• Improper drug selection.
• Subtherapeutic dosage.
• Medication Failure to receive
• Medication Overdosage.
• Adverse drug reactions.
• Drug interactions.
• Medication use without indication.

28. 3. After the prescription
• Counselling
• Preparation of personalised formulation
• Drug use evaluation
• Outcome research
• Pharmacoeconomic studies

29. Activities of Clinical Pharmacists
The principle activities of a clinical pharmacist include:
Consulting
Analysing therapies, advising health care practitioners on the correctness of
drug therapy and providing pharmaceutical care to patients both at hospital
and at community level.
Selection of drugs
Defining "drug formularies" or "limited lists of drugs" in collaboration with
hospital doctors, general practitioners and decision makers.
Drug information
Seeking information and critically evaluating scientific literature; organising
information services for both the health care practitioners and the patients.
.

30. Activities of Clinical Pharmacists
Medication Review
Review medication chart, Review medication history
Attending Rounds
Drug use studies and research
Drug use studies/ pharmacoepidemiology/ outcome research/
pharmacovigilance and vigilance in medicinal devices: collecting data on
drug therapies, their costs and patient outcome through structured and
scientific methods.
Pharmacokinetics/ therapeutic drug monitoring
Studying the kinetics of drugs and optimising the dosage.
Clinical Trials
Planning, evaluating and participating in clinical trials

31. Activities of Clinical Pharmacists
Pharmacoeconomy
Using the results of clinical trials and outcome studies
to determine cost- effectiveness evaluations.
Teaching & Training
Pre- and post-graduate teaching and activities to
provide training and education programmes for
pharmacists and other health care practitioners

32. Information Source
• Medical record
• Patient
• Family
• Health care team

33. Medical Record
•Admission Information
•Initial history
• physical examination
•Progress notes
•Consultations
•Nursing notes
•Laboratory data
•Diagnostic Procedures
•Radiology
•Surgery
•Orders
•Medication
administration orders
•Consent forms

34. Clinical Pharmacy Practice areas
• Ambulatory care
• Critical care
• Drug Information
• Geriatrics and long –term care
• Internal medicine and
subspecialties
• Cardiology
• Endocrinology
• Gastroenterology
• Infectious disease
• Neurology
• Nephrology
• Obstetrics and gynecology
• Pulmonary disease
• Psychiatry
• Rheumatology
• Nuclear pharmacy
• Nutrition
• Pediatrics
• Pharmacokinetics
• Surgery

35. Practice Guidelines for Pharmacotherapy
Specialists
• The pharmacotherapy specialist designs, implements,
monitors, evaluates, and modifies patient pharmacotherapy to
ensure effective, safe and economical patient care.
A Position Statement of the American College of Clinical Pharmacy

36. Practice Guidelines for Pharmacotherapy
Specialists
• The pharmacotherapy specialist retrieves , analyzes, evaluates, and
interprets the scientific literature as a means of providing patient- and
population-specific drug information to health professionals and patients
A Position Statement of the American College of Clinical Pharmacy

37. Practice Guidelines for Pharmacotherapy
Specialists
• The pharmacotherapy specialist participates in the generation
of new knowledge relevant to the practice of pharmacotherapy,
clinical pharmacy and medicine
• The pharmacotherapy specialist educate health care
professionals and students, patients, and the public regarding
rational drug therapy
• The pharmacotherapy specialist continually develops his/her
knowledge and skills in applicable practice areas and
demonstrates a commitment to continued professional growth
by engaging in a lifelong process.
A Position Statement of the American College of Clinical Pharmacy

38. How to Pursue a Profession in Clinical
Pharmacy in India.
• Pharm.D
• Master Degree in clinical pharmacy
• Residency with 3 years of training

39. Clinical pharmacokinetics
Clinical pharmacokinetics is the process of applying
pharmacokinetic principles to determine the dosage regimens
of specific drug products for specific patients
to maximize pharmacotherapeutic effects and minimize toxic
effects.
TDM stands for therapeutic drug mointoring

40. Clinical pharmacokinetics
• Application of these principles requires
an understanding of the absorption, distribution, metabolism, and
excretion characteristics of specific drug products in specific diseases
and patient populations

41. Drugs that can be monitored
• when the range between minimal effectiveness and toxicity is
narrow
• the results of the drug assay provide significant information for
clinical decision-making.

42. Why request TDM?
• Noncompliance
• Inappropriate dosage
• Poor bioavailability
• Drug interaction
• Kidney and liver disese
• Altered protien binding
• Fever
• Cytokines
• Genetically determined fast or slow metabolizers

43. Responsibilities
•Designing patient-specific drug dosage regimens
• Recommending or scheduling measurements of drug
concentrations in biological fluids
• Monitoring and adjusting dosage regimens
• Evaluating unusual patient responses to drug therapy for
possible pharmacokinetic and pharmacologic explanations.

44. Responsibilities
•Communicating patient-specific drug therapy
information to physicians, nurses, and other
clinical practitioners and to patients orally and in
writing, and including documentation of this in
the patient’s health record.

45. Responsibilities
• Educating pharmacists, physicians, nurses, and other clinical
practitioners about pharmacokinetic principles and appropriate
indications for clinical pharmacokinetic monitoring, including the cost-
effective use of drug concentration measurements.

46. Responsibilities
•Developing quality assurance programs for
documenting improved patient outcomes and
economic benefits
•Promoting collaborative relationships with other
individuals and departments involved in drug therapy

47. Responsibilities
Pharmacists with specialized education, training, or
experience may have the opportunity to assume the following
additional responsibilities:
1. Designing and conducting research
2. Developing and applying computer programs and
point-of-care information systems to enhance the
accuracy and sophistication of pharmacokinetic modeling
and applications to pharmaceutical care.

48. Responsibilities
3. Serving as an expert consultant to pharmacists with
a general background in clinical pharmacokinetic
monitoring.