Clinical pharmacy may be defined as the science and practice of rationale use of medications, where the pharmacists are more oriented towards the patient care rationalizing medication therapy promoting health , wellness of people. It is the modern and extended field of pharmacy. “ The discipline that embodies the application and development (by pharmacist) of scientific principles of pharmacology, toxicology, therapeutics, and clinical pharmacokinetics, pharmacoeconomics, pharmacogenomics and other allied sciences for the care of patients”.

1. Clinical Pharmacy
Prepared By
Shivanee Vyas
M Pharmacy
Lakshmi Narain College of Pharmacy, Indore (MP)

2. Perceptions of Pharmacists
How do others see us?

3. “They just count a few tablets”

4. “They just weigh and measure things”

5. “A bunch of shop-keepers”

6. “Tell me how and when to use the
Medicine”

7. “Counter-prescribing”

8. “Not really health care practitioners – they’re
businessmen”

9. “Do you need a degree to be a pharmacist?”

10. Introduction; Clinical Pharmacy
Clinical pharmacy may be defined as the science and practice of rationale use of
medications, where the pharmacists are more oriented towards the patient care
rationalizing medication therapy promoting health , wellness of people.
It is the modern and extended field of pharmacy.
“ The discipline that embodies the application and development (by pharmacist) of
scientific principles of pharmacology, toxicology, therapeutics, and clinical
pharmacokinetics, pharmacoeconomics, pharmacogenomics and other allied
sciences for the care of patients”.
(Reference: American college of clinical pharmacy)

11. History
Until the mid 1960’s ; Traditional role.
The development of clinical pharmacy started in USA.
More clinically oriented curriculum were designed with the award of
PharmD degree.
These developments influenced the practice of pharmacy in U.K.,
Initially prescription and drug administration records were introduced followed
by an increasing pharmacy practice in hospital wards. Master degree programs
in clinical pharmacy were introduced for first time in 1976.
The progress of clinical pharmacy development remained at low profile in the
first decade after its birth in U.K. However, Nuffield report in1986 geared up the
momentum for progression of clinical pharmacy.
Until today, the clinical pharmacy practice in Nepal is in embryonic stage.

12. How does clinical pharmacy differ from pharmacy?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 ,drugs effects on the
Patients,
‘the overall drug therapy management’.
The focus of attention moves from the drug to the single
patient or population receiving drugs.

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

14. Level of Action of Clinical Pharmacists
Clinical pharmacy activities may influence the correct use
of medicines at three different levels:
Before the prescriptionBefore the prescription
During the prescriptionDuring the prescription
and
After the prescription is written.After the prescription is written.

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

16. 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 the 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.

17. Medication-related Problems
• Untreated indications.
• Improper drug selection.
• Sub therapeutic dosage.
• Medication Failure to receive
• Medication Over dosage.
• Adverse drug reactions.
• Drug interactions.
• Medication use without indication.

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

19. Functions of Clinical PharmacistsFunctions of Clinical Pharmacists
1. Taking the medical history of the patient
2. Patient Education
3. Patient care
4. Formulation and management of drug policies
5. Drug information
6. Teaching & training to medical and paramedical staff

20. 7.Research and development
8.Participation in drug utilization studies
9.Patient counseling
10.Therapeutic drug monitoring
11.Drug interaction surveillance
12.Adverse drug reaction reporting
13.Safe use of drugs
14.Disease management cases
15.Pharmacoeconomics

21. The service including clinical pharmacy/clinical pharmacistThe service including clinical pharmacy/clinical pharmacist
-Patients get right care from all the facets (all the drug related problems can
easily be eliminated)
-Physicians n other health care professionals get more focused in their
own, work-load to them is low
-Patients feel more comfortable
 "Every drug is poison, it’s the dose that differentiate poison or drug the
substance is."
 "To kill ill by pill, not by bill"

22. Medicines are Dangerous

23. Essential Components of Pharmaceutical Care
1.Pharmacist-patient relationship
Collaborative effort between pharmacist & patient
2.Pharmacist’s workup of drug therapy (PWDT)
Provision of pharmaceutical care is centered around this,
although the methods used for this purpose may vary.
Components are:
I.Data collection: Collect, synthesize & interpret relevant
information
Patient’s demographic data: age, sex, race etc.
Pertinent medical information

24. Medication Counseling
Patient counselling is defined as providing medication information orally
or in written form to the patients or their representatives on
directions of use, advice on side effects, precautions, storage, diet
and life style modifications
Objectives of patient counseling
1. Patient should recognize the importance of medication for his well
being.
2. A working relationship and a foundation for continuous interaction and
consultation should be established.
3. Patient's understanding of strategies to deal with medication side
effects and drug interactions should be improved.
4. Should ensure better patient compliance.
5. Patient becomes an informed, efficient and active participant in
disease treatment and self care management.
6. Drug interactions and adverse drug reactions should be prevented.

25. Clinical Output Review
• process by which health care professionals evaluate each
other’s clinical performance

26. Clinical skills & pharmacist’s role in
Pharmaceutical Care
Patient assessment
Physical assessment
Barriers to adherence
Psychosocial issues
Education & counseling
Interview skills
Communication skills (e.g. empathy, listening, speaking or
writing at patient's level of understanding)
Ability to motivate & inspire
Develop & implement patient education plan based on an initial
education assessment
Identification & resolution of compliance barriers

27. Patient Specific Pharmacist Care Plan
Recognition, prevention & management of drug interactions
Pharmacology & therapeutics
Interpretation of lab tests
Knowledge of community resources, professional referrals
Communication & support with community medical providers
Drug Treatment Protocol
Develop & maintain (update) protocols
Follow protocols as pharmacist-clinician
Monitor,aggregate adherence to the treatment protocols e.g. drug
utilization evaluation, especially for managed care or health
system facility

28. Dosage adjustment
Identify patients at high risk for exaggerated or
subtherapeutic response
Apply pharmacokinetic principles to determine patient
specific dosing
Prescriptive authority
In designated practice site and positions

29. A case
 44 year old lady with fever and green sputum and cough –
no known previous medical history – Diagnosed with URTI,
Prescribed:
 Co-Amoxiclav 1 tds
 Doxycycline 100mg D
 Prednisolone 40mg D
 Theophylline 200mg bd
 Omeprazole 20mg D
 Metoclopramide 10mg tds
 Salbutamol 2 puff inhale prn
Pharmaceutical problems
Common organisms for URTI?
History of asthma – risk vs benefit?
Need for acid suppression?
Why is she nauseous?
Benefit of brochodilation?
Does she know what to take?
Will she take it?

30. Question?
• Think of someone in your family or a friend
that has had something go “wrong” with their
medicines?
– Caused an adverse or unwanted effect ?
– Had medicines stopped when should have
continued?
– Not worked?
– What happened ?
– Could it have been avoided ?

32. So drugs are safe………………..
Photosensitivity from
Amiodarone
Severe extravasation of
amiodarone infusion

33. NSAID induced peptic ulcer

34. Formulary
Prescribing protocols
Prospective review
Clinical pharmacy
Admission medication history
Allergy check
Drug distribution system
Opportunity
For Error
Administration instructions
Clinical Pharmacy Role in Reducing Risks

35. Formulary
Prescribing protocols
Prospective review
Clinical pharmacy
Admission medication history
Allergy check
Drug distribution
system
Opportunity
For Error
Administration instructions
What if we are not there!

37. Today’s pharmacists

38. The End