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
Drug
distribution
system
Drug
information
Drug
utilization
Drug
evaluation
& selection
Education
& training
program

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. 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
• Medical teaching round • Private physician round
• Special round Pharmacy round

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

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. Medicationchart 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;
1. Is the identity of the patient on each medication chart?
2. Is the allergy status of patient documented on each medication chart?
3. Is the medication name clear?
4. Is the drug prescribed by the generic name?
5. Is the dose clear?
6. Is the route of administration specified?
7. Is the date and time of drug administration clear?
8. Is there any over writing which may lead to confusion?
9. Is the prescription signed by the doctor?
10. Have medicines prescribed according to legal and local requirements?

20. 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.”

21. 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

22. Classification of ADR’s
Excessive pharmacological effect
Secondary pharmacological effect
Rebound response after discontinuation
Idiosyncrasy
Allergic drug reactions(Hypersensitivity)
Genetically determined toxicity
1
2
3
4
5
6

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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
SPONTANEO
US
CASE
REPORTS

30. The spontaneous
reporting system
process
Data
acquisition
• which depends on information derived
from reports submitted by the health
professionals who have encountered what
they suspect is an ADR
Data
assessment
• which involves assessment of the
individual case reports and assessment of
pooled data obtained from various
sources such as the international database
of the WHO
Data
interpretation
• based on the available data and the
assessments made, a signal related to the
adverse reaction may be generated

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

33.  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

34. 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
CONTRO
L
STUDIES
CASE CONTROL

35. 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.

36. Interprofessional
collaboration

37. 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”

38. Benefits of collaboration
collaboration
Improved
efficiency
Reduction
in medical
error
Innovation
and
creativity
Improved
access to
funds
Earlier
treatment
Sharing
costs