1. The document discusses the basic concepts of pharmacotherapy and pharmaceutical care including the paradigm shift towards patient-centered care. It defines key terms like pharmacotherapy, pharmaceutical care, and drug therapy problems. 2. The patient care process is outlined including assessment of the patient, care plan development, interventions, and follow-up evaluation. Standards for developing a care plan and communicating the plan are also provided. 3. The roles of pharmacists in ensuring optimal medication therapy outcomes through activities like managing drug therapy, delivering pharmaceutical care, and engaging in collaborative practice are explored.

1. Basic concepts of
pharmacotherapy &
pharmaceutical care
Salahadin M.Ali, BPharm
Lecturer of Pharmacotherapy
School of Pharmacy
College of Health and Medical Sciences, Haramaya
University
1

2. Learning objectives
 To understand the principles of
pharmacotherapy
 To define pharmaceutical care &
discuss on how to develop care plan
 To understand the role of pharmacist
in patient care
2

3. Paradigm shift of the pharmacy
profession
 Product oriented Patient oriented
◦ The changing roles of pharmacists
3

4. Vision of the pharmacy
profession
 The mission of the pharmacy
profession is to provide
pharmaceutical care
 Pharmacists will be the health care
professionals responsible for providing
patient care that ensures optimal
medication therapy outcomes.
 Helping patients make the best use of their
medicines
4

5. Pharmacotherapy
 A science of drug therapy which
emphasizes on safe, effective and
appropriate use of drugs in patients.
 Enables you to have knowledge on drug
therapy so as to provide ‘pharmaceutical
care’
5

6. The format in
pharmacotherapy
 Disease state definition, etiology,
pathophsiology, clinical presentation &
diagnosis
 Management/treatment
 Goals of therapy
 Nonpharmacologic & pharmacotherapeutic
options
 Evaluation of therapeutic outcomes
6

7. Cont’d
 Drug therapy management
◦ Drug selection guidelines & algorisms
◦ Dosing recommendations
◦ Pharmacokinetic considerations
◦ Adverse effects & their management
◦ Clinically significant drug interactions
◦ Patient education & counseling
7

8. Factors to be considered while
selecting a drug for a given
disease
 Efficacy
 Safety
 Co-morbid conditions
 Drug interaction
 Availably & Cost
 Patient preference
8

9. Pharmaceutical care
A patient-centered, outcomes oriented
pharmacy practice that requires the
pharmacist to work in concert with the
patient and the patient’s other healthcare
providers
To promote health, to prevent disease
To assess, monitor, initiate, and modify
medication use
To assure that drug therapy regimens are
safe and effective
9

10. Cont’d…
 Pharmaceutical care involves the
identification, resolution, and
prevention of actual or potential ‘drug
therapy problems’.
10

11. Drug therapy problems
Any undesirable event experienced by
a patient which involves, or is
suspected to involve, drug therapy
and that interferes with achieving the
desired goals of therapy.
Q1. Examples of Drug Therapy
Problems
11

12. Drug therapy problems…
 Inappropriate indication
◦ The patient requires additional drug therapy
◦ The patient is taking unnecessary drug
therapy
◦ Patient is taking duplicated drug therapy
 Ineffective drug therapy
◦ The patient is taking a drug that is not
effective for his/her situation
◦ The medication dose is too low
◦ Drug interaction that reduces plasma
concentration
12

13. Drug therapy problems…
 Unsafe drug therapy
◦ The patient is experiencing an adverse drug
reaction
◦ The medication dose is too high
◦ Drug interaction that increases plasma
concentration
 Inappropriate adherence or compliance
◦ The patient is unable or unwilling to take the
medication as prescribed
◦ The drug product is not available/expensive
for the patient
13

14. Drug therapy problems…
Drug Therapy Problem
Unnecessary drug therapy
Needs additional drug therapy
Indication Drug product
Drug Therapy Problem
Ineffective drug
Adverse drug reaction
Dosage regimen
Drug Therapy Problem
Dosage too low
Dosage too high
Drug Therapy Problem
Noncompliance
Outcomes
Effectiveness
Safety
14

15. Patient care process
Assessment
Care plan
Follow-up
evaluation
15

16. Patient care process…
• Clinical
presentations
• Dx
Assessment
• Goals of
therapy
• Rx
Care plan
• Outcomes
Follow –up
evaluation
16

17. Patient care process…
 SOAP format (Subjective, Objective,
Assessment, Plan)
◦ S= Symptoms
◦ O= Signs & investigations
◦ A= Diagnosis
◦ P= Rx & further investigations
 FARM note (Findings, Assessment,
Recommendations, Monitoring)
17

18. Patient care process…
• Assess drug therapy
needs
• Identify drug therapy
problems
• Ensure drug therapy
is indicated
appropriately, safe
and effective
Assessment
• Resolve drug
therapy
problems
• Prevent drug
therapy
problems
• Set goals of
therapy
Care plan
• Record actual
patient outcomes
• Evaluate
achievement of
goals of therapy
• Reassess for
new drug therapy
problems
Follow-up
Evaluation
18

19. Patient care process…
Standards of care
 Collection of patient specific information
 Assessment of drug related needs
 Identification of drug therapy problem
 Developments of goals of therapy
 Statement of intervention
 Establishing a schedule for follow-up
 Follow-up evaluation
 Communicating the care plan
Care
plan
19

20. 1. Collection of pertinent patient
specific information
 Sources of information
 Patient
 Patient family or care giver
 Health professionals giving care to the patient
 Patient medical records
 Others
20

21. Cont’d…
Communication skills
 Pharmacists should have good
communication skills with
 Patients/care giver
 Health care team
21

22. Cont’d…
 Importance of Interviewing the
Patient
 Obtain subjective data on medical
problems
 Obtain patient-specific information on
drug efficacy and toxicity
 Assess the patient's knowledge, attitudes,
and pattern of medication use
 Formulate a problem list
 Formulate care plans to solve the
problems 22

23. Cont’d…
 How to Set the Stage for the Interview
◦ Introduce yourself
◦ Make the setting as private as possible
◦ Do not appear rushed
◦ Be polite
◦ Be attentive
◦ Maintain eye contact
◦ Listen more than you talk
◦ Be nonjudgmental
◦ Encourage the patient to be descriptive
◦ Clarify by restatement or patient demonstration
(e.g., of a technique)
23

24. Cont’d…
 General Interview Rules
 Review the chart/patient profile first
 Ask permission to conduct an interview
 Begin with open-ended questions
 Move to close-ended questions
 Document interaction
24

25. Cont’d…
 Information obtained from medical
record/chart
◦ Chief complaints, history of the present
illness, past medical history, physical
examination, vital signs & ROS
◦ Lab. Investigations & diagnosis
◦ Renal and hepatic function status
◦ Current & past medications
25

26. Cont’d…
 Information obtained from the patient
◦ Age, sex, weight and height
◦ Possibility of pregnancy in women of
childbearing age
◦ History of allergies
◦ History of adverse drug reactions
◦ Drugs: dose, route, frequency, and reason for
use
◦ Perceived efficacy of each drug
◦ Perceived side effects & any health concerns
◦ Adherence
◦ Nonprescription medication use (including
complementary and alternative medications)
26

27. 2. Assessment of drug related
needs & drug therapy problems
 Assess the indicated drug therapy for
◦ Appropriateness
◦ Safety
◦ Effectiveness
◦ Patient adherence
27

28. Cont’d…
Drug-related needs being
met?
Drug therapy problems
present?
28

29. Relationship of drug related needs and drug
therapy problem
Understanding
Expectations
Concerns
Behavior
Indication
Effectiveness
Safety
Compliance
Unnecessary drug therapy
Needs additional drug
therapy
Ineffective drug
Dosage too low
Adverse drug reaction
Dosage too high
Noncompliance
Patient’s
Expression
Drug-related
Needs
Drug Therapy
Problems
29

30. 3. Developing care plan
 The care plan outlines specific actions
to achieve the pharmacotherapy
needs and problems of specific patient
 Care plan contains
 Goals of therapy
 Specific interventions
 Plan for follow up evaluation
30

31. Care plan…
◦ Medication dosing, monitoring, timing of
tests, etc
◦ Identify alternative actions
◦ Specify monitoring or measurement to
assure goals are met
◦ Specify follow-up actions (e.g. return to
clinic)
31

32. Cont’d…
 Goal of therapy should contain
◦ Parameter
◦ Value
◦ Time frame
 Goal of therapy can be
◦ Cure of disease (e.g., bacterial infection)
◦ Reduction or elimination of symptoms
(e.g., pain from cancer)
◦ Achieving target levels (blood pressure,
glycemic control)
32

33. Goal of therapy…
◦ Arresting or slowing of the progression of
disease (e.g., rheumatoid arthritis, HIV
infection)
◦ Prevention of complications (diabetes,
coronary heart disease)
◦ Not aggravating other existing disease
states
◦ Avoiding or minimizing adverse effects of
treatment
◦ Providing cost-effective therapy
◦ Maintaining the patient’s quality of life
33

34. Care plan…
Interventions
◦ Specific actions to resolve drug therapy
problems, to optimize the patient’s
medication needs and prevent new drug
therapy problems.
34

35. Care plan…
INTERVENTIONS
 Initiate new drug therapy
 Increase dosages
 Decrease dosage
 Discontinue drug therapy
 Therapeutic alternative approaches
 Referrals
 Providing consultation for optimal use
of medications
35

36. 4. Follow up evaluation
 Evaluation of the patient outcomes and
progress towards the achievement of
goals of therapy
 Evaluation
 Effectiveness of drug therapy
 Safety of drug therapy
 Patient adherence
 Evaluation involves assessment of
◦ Clinical parameters (sign and symptoms)
◦ Laboratory evidence (eg. Blood glucose,
LDL, HDL, TG etc.
36

37. Cont’d…
 Assess
◦ Patient clinical status
◦ Patient compliance
◦ New drug therapy problems
 Intervention to resolve drug therapy
 Scheduling next follow-up evaluation
37

38. 38

39. 39

40. 5. Communicating the care
plan
 To the patient and/or family or
caregivers
 Patient education/counseling, follow up
appointment
 To health professionals involved in
caring the patient
 Recommendations/consultation
 Verbal Vs. written communication
 Documentation of the care plan
‘No documentation, no work!’
40

41. Pharmacists Roles in Patient
Care
 Pharmacists as drug therapy
managers
 Delivering pharmaceutical care
 Engage in collaborative practice
41

42. Collaborative Drug Therapy
Management (CDTM)
42

43. Pharmacists Roles…
 Assuring safe, accurate, rational and cost-
effective use of medications
 Engage in collaborative practice to
optimize drug therapy outcomes
 Applies evidence-based therapeutic
guidelines, evolving sciences &
technologies
43

44. Pharmacists Roles…
 Performing patient assessments
 Ordering and evaluating drug therapy-
related tests
 Selecting, initiating, monitoring,
continuing and adjusting drug regimens
 Assessing patient response to therapy
 Counseling and educating patients on
medications
44

45. Case presentation in
pharmacotherapy
 Patient demography
◦ Age, sex, Wt. & Ht, ethnicity etc.
 Chief complaint (Cc.)
◦ A brief statement of the reason why the
patient consulted the physician, stated in
the patient’s own words
 HPI
◦ Complete description of the patient’s
symptom(s)
45

46. Cont’d…
 HPI includes:
◦ Date of onset
◦ Precise location
◦ Nature of onset, severity, and duration
◦ Presence of exacerbations and
remissions
◦ Effect of any treatment given
◦ Relationship to other symptoms, bodily
functions, or activities (e.g., activity,
meals)
◦ Degree of interference with daily activities46

47. Cont’d…
 PMH: Includes serious illnesses, surgical
procedures, and injuries the patient has
experienced previously
 FH: Includes the age and health of
parents, siblings, and children
 SH
◦ Social characteristics of the patient (marital
status; number of children; educational
background; occupations)
◦ Environmental factors and behaviors
(physical activity; hobbies; dietary habits, use
of tobacco, alcohol, chat & other substance
abuse)
47

48. Cont’d…
 MEDS
◦ Past & current use of prescription
medications, nonprescription products,
and dietary supplements
◦ History of allergies to drugs, food, pets,
and environmental factors
◦ Patient concerns related to medications
48

49. Cont’d…
 ROS
◦ Review of pertinent findings related to
each body system from the head and
working toward the feet
◦ Includes the skin, head, eyes, ears, nose,
mouth and throat, neck, cardiovascular,
respiratory, gastrointestinal, genitourinary,
endocrine, musculoskeletal, and
neuropsychiatric systems.
49

50. Cont’d…
 PE
◦ Gen (general appearance)
◦ VS —blood pressure, pulse, respiratory rate, and
temperature, and pain as “the fifth vital sign.”
◦ Skin (integumentary)
◦ HEENT (head, eyes, ears, nose, and throat)
◦ Lungs/Thorax (pulmonary)
◦ CV (cardiovascular)
◦ Abd (abdomen)
◦ Genit/Rect (genitalia/rectal)
◦ MS/Ext (musculoskeletal and extremities)
◦ Neuro (neurologic)
50

51. Cont’d…
 Labs
◦ Electrolytes (Na, K, Cl, Mg, Ca)
◦ Blood tests
 Hgb, Hct, MCV, MCH, MCHC
 CBC (WBC, RBC, Plt, Neutrophils, Basophils,
Eosnophils, Monocytes, Lymphocytes, Bands)
 Coagulation studies (PT, INR)
◦ lipid profile ( LDL, HDL, C, TG)
◦ Blood gases (O2, CO2)
51

52. Cont’d…
 Labs…
◦ Endocrine tests (Glu, TSH, T4, T3)
◦ Cardiac test (troponin, CK-MB)
◦ Liver function test (AST, ALT)
◦ Renal function test (SCr, BUN)
◦ UA
◦ CSF analysis
◦ Others
52

53. 53

54. Pharmaceutical care patient record Draft
54

55. References
◦ Pharmacotherapy principles and practice
◦ Pharmaceutical care practice: The
clinician’s guide, 2nd ed.
◦ Applied Therapeutics: The Clinical Use Of
Drugs, 9th ed.
55