REVIEWING THE CLINICIANS PRESCRIPTION AND TREATMENT PROGRESSION IS THE FUNDAMENTAL RESPONSIBILITY OF PHARMACIST. THIS PRESENTATION WILL DEAL WITH VARIOUS ASPECTS OF REVIEWING PATIENT DRUGTHERAPY PLAN
REVIEWING THE CLINICIANS PRESCRIPTION AND TREATMENT PROGRESSION IS THE FUNDAMENTAL RESPONSIBILITY OF PHARMACIST. THIS PRESENTATION WILL DEAL WITH VARIOUS ASPECTS OF REVIEWING PATIENT DRUGTHERAPY PLAN
Pharmacy and Therapeutic Committee (PTC) & Hospital Formulary
The Pharmacy and Therapeutic Committee (PTC) is an advisory group that considers essentially all the matters related to the use of drugs in a hospital including evaluation of drugs & dosage forms and safe use of investigational drugs.
What is a pharmacy and therapeutics committee?
Pharmacy and Therapeutics (P&T) is a committee at a hospital or a health insurance plan that decides which drugs will appear on that entity's drug formulary.
Patient medication adherence, Medication adherence, Causes of medication non-adherence, Problems linked with Medication Non-adherence, Factors affecting medication adherence, Patient related factors, Social and Economic factor, Disease related factor, Health care provider related factors, Therapy related factors, pharmacist role in the medication adherence, role of pharmacist in the medication adherence, monitoring of patient medication adherence, Direct method, Indirect method
Introduction to daily activities of clinical pharmacist.
Drug therapy monitoring,
Medication chart review
Clinical Progress
Pharmacist intervention
Detection and management of ADRs
Basic introduction to patient counselling for the clinical pharmacy services. Educating the patient on their disease, medication and lifestyle for better patient care and quicker recovery.
Patient Counselling is needed for
Better patient understanding to their illness and role of medication.
Improve medication adherence.
Improve dosage regimen adherence.
More effective Drug treatment.
Reduce incidence of adverse drug effect and unnecessary healthcare cost.
ADR reporting.
Improve quality of life for patient.
Raising image of Pharmacist & its profession.
Pharmacy and Therapeutic Committee (PTC) & Hospital Formulary
The Pharmacy and Therapeutic Committee (PTC) is an advisory group that considers essentially all the matters related to the use of drugs in a hospital including evaluation of drugs & dosage forms and safe use of investigational drugs.
What is a pharmacy and therapeutics committee?
Pharmacy and Therapeutics (P&T) is a committee at a hospital or a health insurance plan that decides which drugs will appear on that entity's drug formulary.
Patient medication adherence, Medication adherence, Causes of medication non-adherence, Problems linked with Medication Non-adherence, Factors affecting medication adherence, Patient related factors, Social and Economic factor, Disease related factor, Health care provider related factors, Therapy related factors, pharmacist role in the medication adherence, role of pharmacist in the medication adherence, monitoring of patient medication adherence, Direct method, Indirect method
Introduction to daily activities of clinical pharmacist.
Drug therapy monitoring,
Medication chart review
Clinical Progress
Pharmacist intervention
Detection and management of ADRs
Basic introduction to patient counselling for the clinical pharmacy services. Educating the patient on their disease, medication and lifestyle for better patient care and quicker recovery.
Patient Counselling is needed for
Better patient understanding to their illness and role of medication.
Improve medication adherence.
Improve dosage regimen adherence.
More effective Drug treatment.
Reduce incidence of adverse drug effect and unnecessary healthcare cost.
ADR reporting.
Improve quality of life for patient.
Raising image of Pharmacist & its profession.
Epidemiology is the study of occurrence, distribution and determinants of health and
diseases or disorders in man and its application in controlling health problems.
Epidemiology has by tradition two major areas.
First is the study of infectious diseases that spread to large populations, i.e., epidemics.
The second is the study of chronic diseases.
Epidemiological studies help to solve such health problems and provide a basis for
improving living conditions of the people.
During its progress and development, epidemiology has made available precise and
strict methodologies for the study of diseases.
Pharmacology is the study of the effects of drugs.
Clinical Pharmacology is the study of the effects of drugs in humans, It is traditionally
divided into two basic areas namely:
1. Pharmacokinetics
2. Pharmacodynamics.
Pharmacokinetics is the study of the relationship between dose administered of a drug
and the serum or blood level achieved, it deals with absorption, distribution, metabolism
and excretion.
Epidemiology is the study of the distribution and determinants of diseases in
populations.
Epidemics is the study of chronic/ infectious diseases in large populations.
Pharmacoepidemiology is the study of the use of and the effects of drugs in large
number of people.
It involves the examination of a single individual or large groups of people followed for
many years.
It involves gathering & analysis of information in order to identify possible causation &
related factors, that can be applied in clinical practice to group of people & also to
individuals undergoing treatment.
Clinical Pharmacology in Orphan Drug DevelopmentE. Dennis Bashaw
This is the fourth talk that I gave in Asia back in May. It was presented at the Konect (Korea National Enterprise for Clinical Trials) 3rd symposia that was held in Seoul at Seoul National University.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
NVBDCP.pptx Nation vector borne disease control program
COMPILED VERSION Sbh who good pharmacy practice(gpp)
1. T/Maj. Dr. Sitaram Khadka (Pharmacist)
Doctor of Pharmacy(Pak), PGDDM (Ind), R.Ph.
T/Capt. Dr. Mahesh Khatri (Pharmacist)
Doctor of Pharmacy(Pak), R.Ph.
5/31/2015WHO GPP: A clinical approach1
WHO Good Pharmacy
Practice(GPP): A Clinical Approach
2. Contents of the Presentation
5/31/2015WHO GPP: A clinical approach2
Background
Introduction to GPP; Global and SBH scenario
Clinical Pharmacy Practice
Rational prescribing and dispensing
Pharmacovigilance; Adverse Drug
Reactions(ADR)
Drug Information Centre(DIC)
National GPP
Questions/Answers session
3. “They just count a few
tablets”
Perception
s of
Pharmacis
ts
-How do others
see
pharmacists?
5/31/2015WHO GPP: A clinical approach3
“They just weigh and measure th
“A bunch of shop-keepers” “Tell me how and when to use the Medi
4. 5/31/2015WHO GPP: A clinical approach4
“Counter-prescribing” “Not really health care practitioners –
they’re
businessmen”
“Do you need a degree to be a pharmacist?
5. Background
In 1992 the International Pharmaceutical Federation (FIP)
developed standards for pharmacy services under the heading
“Good pharmacy practice in community and hospital
pharmacy settings”.
5/31/2015WHO GPP: A clinical approach5
6. 5/31/2015WHO GPP: A clinical approach6
Knowledge of Drug Therapy
Knowledge of Drug Therapy
Knowledge of Disease
Knowledge of communication skill
Communication skill
Patient monitoring skill
Physical Assessment skill
Drug Information skill
Therapeutic Planning
Skill
Knowledge of laboratory and diagnostic skill
Philosophy of Pharmacy
Pharmacoeconomics Drug
Information
Efficacy
Assurance
Health
Promotion
Pharmacovigilance Patient care
7. Good Pharmacy Practice
5/31/2015WHO GPP: A clinical approach7
GPP is the practice of pharmacy that responds to the
needs of the people who use the pharmacists’ services
to provide optimal, evidence-based care.
To support this practice it is essential that there be an
established national framework of quality standards
and guidelines.
Source: WHO FIP
8. GPP Framework
5/31/2015WHO GPP: A clinical approach8
A legal framework that:
defines who can practice pharmacy;
defines the scope of pharmacy
practice;
ensures the integrity of the supply
chain and the quality of medicines
A workforce framework that:
• ensures the competence of
pharmacy staff through
continuing professional
development (CPD or continuing
education (CE)) programs;
• defines the personnel resources
needed to provide GPP.
An economic framework that:
provides sufficient resources and
incentives that are effectively used
to ensure the activities undertaken
in GPP.
9. Clinical Pharmacy;
5/31/2015WHO GPP: A clinical approach9
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)
10. History and Development
5/31/2015WHO GPP: A clinical approach10
Traditional role
Sedentary practice
Clinical pharmacy services in Community/Hospitals
Ward pharmacy
Bedside pharmacy
11. In context of Nepal
5/31/2015WHO GPP: A clinical approach11
Education: Diploma level/Bachelor/Post Bacc
PharmD/Master/PhD
The clinical pharmacy practice in Nepal is still in embryonic
stage.
Efforts are being made by pharmacists in different parts of
country.
A milestone for Pharmacy practice in Nepal:
Hospital Pharmacy Directive 2070 : Accepted from the
minister level of Nepal Govt on 2070.07.14
Execution; not till now/in process
Competency/Patience/ IPC needed
12. Clinical Pharmacy:
A Shift in Practice Philosophy and Education
5/31/2015WHO GPP: A clinical approach12
Drug Product
Pharmacy
Dispenser
Solo
Knowledge
As ordered
Drug Therapy
Bedside
Caregiver
Team
Information
As best prescribed
From To
13. Level of Action of Clinical Pharmacists
5/31/2015WHO GPP: A clinical approach13
Clinical pharmacy activities may influence the correct use
of medicines at three different levels:
Before the prescription
During the prescription
After the prescription
"If your medicine is not working it may not be
your medicine, it may be you"
14. What we are doing in SBH???
5/31/2015WHO GPP: A clinical approach14
Formulary Yes
Drug Information No*
Clinical Trail No
Drug Policy No
Counseling NO Counseling Yes
Outcome Research No
Personalized Formulation Yes*
Pharmacoeconomic studies No
Before the
prescription
During the
prescription
Afterthe
Prescription
15. Aims of
Clinical Pharmacy Practice
Effective drug
therapy
Safe drug
therapy
Economic drug
therapy
Improve quality
of life
5/31/2015WHO GPP: A clinical approach15
17. High Profile Examples
• A patient with leukaemia received Intrathecal vincristine
instead of intravenously. Died beginning of February
2001. 14th such case over the last 16 years.
• Patient being operated for a AAA received bupivacaine
intravenously rather than epidurally. Patient died 3 days
later.
• A 3 year old girl, who had a convulsion post flu vaccine.
Attended hospital to get “checked out”. Received nitrous
oxide instead of oxygen in casualty.
• Elderly lady was prescribed Methotrexate (1997) for her
rheumatoid arthritis. Dose increased to 17.5mg weekly
over a 6 month period.
• A patient undergoes right TKR in hospital (2000). MTX
given as one tablet a week (only 2.5mg).Prescription for
MTX 10mg/daily written and dispensed. 30th April patient5/31/2015WHO GPP: A clinical approach17
18. Deaths from medicines in the UK
1999 - 2000 (ICD9 & 10 data)
5/31/2015WHO GPP: A clinical approach18
"Every drug is poison, it’s the dose that differentiate
poison or drug the substance is.”
19. So drugs are safe ………?
Photosensitivity from
Amiodarone Severe extravasation of amiodarone
infusion
5/31/2015WHO GPP: A clinical approach19
NSAID induced peptic ulcer
Goitre –
Hypothyroidism
Secondary to
Amiodarone
Bleeding due to anticoagulation
Erythemal rash from
penicillin – in patient with a
previous
Known allergy/ ADR
20. Some considerations for Rational prescribing
5/31/2015WHO GPP: A clinical approach20
Interdisciplinary collaboration:
Inter-professional collaboration
Intra-professional collaboration
Effective and safe use of pharmaceuticals
Economic and effective use of pharmaceuticals
"Medicine is for those who need them, not for
those who want them."
21. Some facts
5/31/2015WHO GPP: A clinical approach21
Over time, participation in medical ward rounds, medication history taking,
drug therapy selection,TDM services, provisin of drug information,ADR
monitoring, and prevention,DUE, research and teaching have become activities
that now form the basis of contemporary clinical pharmacy practice (Wilson
2000, Rahel 2000)
Studies have clearly shown that clinical pharmacy improves drug therapy and
overall patient health outcomes (Gattis 1999, Leape 1999, Stewarr 1999, Bond
1999), and reduces both drug costs and total health costs (Stewart 1999,
McMullin 1999)
The publication of editorial by Lundberg entitled “The clinical pharmacist” in
the Journal of the American Medical Association in 1983 was an important
milestone in the history of clinical pharmacy development in USA.
22. Human Error in clinical practice
(Mistakes, Slips, Lapses)
5/31/2015WHO GPP: A clinical approach22
Error is inevitable due to “our” limitations
We all make errors all the time
Patients suffer adverse events much more often than
previously realized
Types of errors that can be accounted:
Prescribing error/Dispensing error/Administration error/Lack
of user education
“The same error, even a minor one, can have quite different
consequences in different circumstances.”
23. “I assumed the brown glass
ampoule was frusemide”
5/31/2015WHO GPP: A clinical approach23
The System:
Only as safe as it’s designed to be!
24. Formulary
Prescribing protocols
Prospective review
Clinical pharmacy
Admission medication history
Allergy check
Drug distribution system
Opportunity
For Error
Administration instructions
Clinical Pharmacist Role in Reducing
Risks
5/31/2015WHO GPP: A clinical approach24
25. 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!
5/31/2015WHO GPP: A clinical approach25
26. Pharmacovigilance
5/31/2015WHO GPP: A clinical approach26
The WHO defines pharmacovigilance as ‘the
science and activities relating to the detection,
assessment, understanding and prevention of
adverse effects or any other drug related
problems.
27. 5/31/2015WHO GPP: A clinical approach27
Regional Pharmacovigilance
Centers :
TUTH
NMCH
KIST Medical College
Manipal TH
BPKIHS
Civil Hospital
Fig: Pyramid of ADR reporting system in N
28. Drug Information Center
5/31/2015WHO GPP: A clinical approach28
Drug information centers (DICs) in general, are service providers, which provide
drug information relating to therapies, pharmacoeconomics, education, and
research programs.
Drug Information Centers in Nepal
Department of Drug Administration (DDA), Ministry of Health
Drug Information Unit(DIU), Tribhuvan University Teaching Hospital
Resource Centre for Primary Health Care (RECPHEC)
Nepal Chemists and Druggists Association (NCDA)
29. National GPP
Facilities
Premises
Personnel
Equipments
Quality policy
Service strategy
Training
Complaints and recalls
Documentation systems
Procurement and inventory control
Storage
31/05/201529
30. National GPP Contd…
Prescription handling
Dispensing
Extemporaneous preparations
Patient information
Patient counseling
Medicine records and patients F/U
Self care
Health promotion
Enhancement and development of professional
role
Pharmacovigilance
Audit
31/05/201530
31. Recommendations
Technical manpower required in sufficient
number
Skill enhancement trainings
Quality control lab establishment
Centralized store room for drugs and related
items with centralized AC system
Surgical and other drug related items list
(similar to formulary) to be prepared
Clinical pharmacy practice
New and advanced technology needed
31/05/201531