I understand you're going through a difficult time with the loss of your husband. While sleep aids can help in the short term, depression often requires longer term treatment. Let me see if I can arrange for you to speak with one of the counselors here - they may be able to provide support that will help you cope and feel better over time. There are also medications and therapies that a doctor can recommend specifically for depression if needed. How does that sound? I'm here if you need anything else.
Based on the information provided:
- Mrs. Tigist's drug-related need is for effective treatment of her depression
- Recommending an OTC sleep aid would not meet this need and could potentially cause harm
- The appropriate action would be to advise Mrs. Tigist that her symptoms suggest she may be depressed and recommend she see her physician for evaluation and treatment
pharmacy practice and scope in Ethiopia: An over viewMohammed Mohammed
This document provides an overview of clinical pharmacy education and practice. It discusses how clinical pharmacy has evolved globally to focus on patient care rather than just dispensing medications. It notes that while clinical pharmacy services have been implemented well in developed countries, practice in Africa still focuses more on traditional dispensing due to various challenges. The document argues that Ethiopia should shift pharmacy practice and education towards a clinical model to optimize patient outcomes and rational medication use, given issues seen in studies like high rates of drug therapy problems and prescribing errors. Implementing clinical pharmacy services could help address gaps and improve health outcomes, quality of life and cost-effectiveness.
Current Trends in Pharmacy Practice and Overview of (1).pptShakirAliyi
The document discusses current challenges in pharmacy practice in Ethiopia, including knowledge and skill gaps among professionals. It proposes strategies to improve practice through implementing patient-focused training, in-service clinical pharmacy training, and advancing clinical pharmacy services. Clinical pharmacy aims to shift the focus from drug products to patient care by applying pharmaceutical expertise to maximize drug efficacy and safety.
Clinical pharmacy is still developing in India. Clinical pharmacists work directly with patients, physicians, and other healthcare professionals to ensure safe and effective medication use. They collect patient medical histories, identify potential drug-related problems, establish treatment goals, evaluate treatment alternatives, monitor outcomes, and individualize drug regimens. In hospitals, clinical pharmacists are involved in prescription monitoring, advising medical staff, monitoring medication errors and adverse reactions, patient education, and participating in ward rounds.
The document discusses clinical pharmacy and its status in Bangladesh. It defines clinical pharmacy as dealing with patient care and advising on safe drug use. In Bangladesh, clinical pharmacy services are still in early stages of development compared to other countries. The pharmacy education focuses more on industrial practices rather than patient care. There is a lack of clinical training and roles for pharmacists in patient care settings. The goals of clinical pharmacy are outlined as maximizing treatment effects, minimizing adverse events, and minimizing costs of treatment.
The document discusses opportunities for pharmacy practice research in community settings. It begins by outlining the changing role of pharmacists from product-focused to patient-centered care. There is a need for pharmacy practice research in community settings to optimize medication use, support self-care, and improve health outcomes. The presentation then describes development of a clinical tool called STARZ-DRP, which is a step-by-step approach for minor illness consultation and triaging decisions in community pharmacies. A study was conducted to evaluate STARZ-DRP which found it improved identification of drug-related problems and referral decisions compared to usual care.
Role of pharmacist in interdepartmental communication and community health ed...akankshasrivastava121
By- Akanksha (B.pharma 4th year, Galgotias University)
Role of pharmacist, Professsion of pharmacy practice, Interdepartmental communication of pharmacist, Communication with health proffesions , with paitients , Information leaflets, Medication counselling for patient, Impact of internal dysfunction
This document discusses the transition of pharmacy education and practice in Ethiopia from a product-focused model to a more patient-centered clinical model. It outlines the drawbacks of the old education system which focused more on products than patients. Initiatives are described that have been implemented to shift the curriculum, including revisions in 2008 to incorporate more clinical pharmacy courses. The goals of the new curriculum are to train pharmacists in identifying and solving drug therapy problems, educating patients, selecting effective therapies, and monitoring drug therapy outcomes. Hospitals have provided positive feedback on clinical pharmacy services. Future directions may include training all pharmacists in the old curriculum with clinical services and potentially launching a PharmD program.
Based on the information provided:
- Mrs. Tigist's drug-related need is for effective treatment of her depression
- Recommending an OTC sleep aid would not meet this need and could potentially cause harm
- The appropriate action would be to advise Mrs. Tigist that her symptoms suggest she may be depressed and recommend she see her physician for evaluation and treatment
pharmacy practice and scope in Ethiopia: An over viewMohammed Mohammed
This document provides an overview of clinical pharmacy education and practice. It discusses how clinical pharmacy has evolved globally to focus on patient care rather than just dispensing medications. It notes that while clinical pharmacy services have been implemented well in developed countries, practice in Africa still focuses more on traditional dispensing due to various challenges. The document argues that Ethiopia should shift pharmacy practice and education towards a clinical model to optimize patient outcomes and rational medication use, given issues seen in studies like high rates of drug therapy problems and prescribing errors. Implementing clinical pharmacy services could help address gaps and improve health outcomes, quality of life and cost-effectiveness.
Current Trends in Pharmacy Practice and Overview of (1).pptShakirAliyi
The document discusses current challenges in pharmacy practice in Ethiopia, including knowledge and skill gaps among professionals. It proposes strategies to improve practice through implementing patient-focused training, in-service clinical pharmacy training, and advancing clinical pharmacy services. Clinical pharmacy aims to shift the focus from drug products to patient care by applying pharmaceutical expertise to maximize drug efficacy and safety.
Clinical pharmacy is still developing in India. Clinical pharmacists work directly with patients, physicians, and other healthcare professionals to ensure safe and effective medication use. They collect patient medical histories, identify potential drug-related problems, establish treatment goals, evaluate treatment alternatives, monitor outcomes, and individualize drug regimens. In hospitals, clinical pharmacists are involved in prescription monitoring, advising medical staff, monitoring medication errors and adverse reactions, patient education, and participating in ward rounds.
The document discusses clinical pharmacy and its status in Bangladesh. It defines clinical pharmacy as dealing with patient care and advising on safe drug use. In Bangladesh, clinical pharmacy services are still in early stages of development compared to other countries. The pharmacy education focuses more on industrial practices rather than patient care. There is a lack of clinical training and roles for pharmacists in patient care settings. The goals of clinical pharmacy are outlined as maximizing treatment effects, minimizing adverse events, and minimizing costs of treatment.
The document discusses opportunities for pharmacy practice research in community settings. It begins by outlining the changing role of pharmacists from product-focused to patient-centered care. There is a need for pharmacy practice research in community settings to optimize medication use, support self-care, and improve health outcomes. The presentation then describes development of a clinical tool called STARZ-DRP, which is a step-by-step approach for minor illness consultation and triaging decisions in community pharmacies. A study was conducted to evaluate STARZ-DRP which found it improved identification of drug-related problems and referral decisions compared to usual care.
Role of pharmacist in interdepartmental communication and community health ed...akankshasrivastava121
By- Akanksha (B.pharma 4th year, Galgotias University)
Role of pharmacist, Professsion of pharmacy practice, Interdepartmental communication of pharmacist, Communication with health proffesions , with paitients , Information leaflets, Medication counselling for patient, Impact of internal dysfunction
This document discusses the transition of pharmacy education and practice in Ethiopia from a product-focused model to a more patient-centered clinical model. It outlines the drawbacks of the old education system which focused more on products than patients. Initiatives are described that have been implemented to shift the curriculum, including revisions in 2008 to incorporate more clinical pharmacy courses. The goals of the new curriculum are to train pharmacists in identifying and solving drug therapy problems, educating patients, selecting effective therapies, and monitoring drug therapy outcomes. Hospitals have provided positive feedback on clinical pharmacy services. Future directions may include training all pharmacists in the old curriculum with clinical services and potentially launching a PharmD program.
The document outlines a curriculum for a Master in Clinical Pharmacy (MClinPharm) degree program in Zambia. It provides the rationale for establishing the program, which is the need for specialized clinical pharmacists in Zambia to provide pharmaceutical care services and for the University of Zambia to develop specialized pharmacy staff. The curriculum covers various clinical pharmacy topics over 3 years of study and includes clinical rotations. The goal is to train pharmacists in specialized areas to improve patient care and build pharmacy expertise in Zambia.
This document outlines the curriculum for a Master in Clinical Pharmacy (MClinPharm) degree program in Zambia. It provides the rationale for establishing the program, which is to train clinical pharmacists to provide specialized pharmaceutical care services. The two-year program will equip pharmacists with skills in various clinical pharmacy specialties like oncology, psychiatry, critical care, and pediatrics. The goal is to develop a pool of trained clinical pharmacists to meet the needs of Zambia's health system and the University of Zambia's department of pharmacy.
This document outlines the curriculum for a Master in Clinical Pharmacy degree program in Zambia. It provides the program's vision, aims, objectives, structure and course descriptions. The curriculum was designed to train clinical pharmacists to address issues with traditional drug distribution systems like high rates of medication errors and adverse drug reactions. It incorporates courses in areas like pharmacotherapy, clinical skills, research methods and various medical specialties to prepare pharmacists for patient-centered practice focusing on pharmaceutical care.
Presentation deals with the topic "scope of pharmacy". The topic is part of paper IV P.G final year syllabus of Rasashastra and Bhaishajya Kalpana. It will provide basic information regarding this topic.
The document describes the author's experience completing a pharmacy practice training at Nayati Medical Pvt. Ltd, located in Mathura. It discusses the layout and organization of the pharmacy, including separate areas for tablets, liquids, refrigerated items, and restricted medications. It also outlines the roles of the 4 staff members and workflow process. Additionally, it covers important skills for community pharmacy practice like patient counseling, communication skills, medication adherence, drug interactions, and functions of a pharmacy.
Patient Safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities.
It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care.
A cornerstone of the discipline is continuous improvement based on learning from errors and adverse events.
Let us see what Pharmacists, Doctors and Patients can do about it.
1) The document discusses pharmaceutical care, which aims to ensure safe and effective drug use through identifying and resolving drug-related problems.
2) It defines pharmaceutical care as the responsible provision of drug therapy to achieve definite outcomes that improve a patient's quality of life.
3) Key aspects of pharmaceutical care include assessing a patient's medication needs, developing and implementing a care plan to address actual or potential drug therapy problems, and monitoring the care plan.
This document discusses the justification and roles of an Emergency Medicine Pharmacist (EMP). It begins by outlining the objectives which include explaining the justification for an EMP, describing their core roles and strategies for implementation, and ways EMPs can improve patient care. It then discusses how the emergency department is inherently a patient safety risk due to factors like high volume and distractions. Having an EMP can help fill gaps in medication safety. The document outlines the roles of an EMP which include clinical consultation, order screening, high-risk medication preparation, and education. It concludes by providing strategies for implementing an EMP position, overcoming challenges, and demonstrating return on investment through cost savings from reducing adverse drug events.
The Indo-American Journal of Life Sciences and Biotechnology of the journal uses recommended electronic formats for submitting articles, which helps speed up the overall process.Once an article is submitted, it undergoes an initial rapid screening by the editors of the Scopus indexing Journal.
Introduction to Clinical Pharmacy Practice.pptxSHIVANEE VYAS
Clinical pharmacy is a branch of hospital pharmacy that deals with various aspects of patient care, including the dispensing of drugs and advising the patient on the safe and rational use of those drugs.
Interaction & discussion on pharmacy practice, pharmacy practice Dr. Sharad Chand
This document discusses the roles and goals of good pharmacy practice. It outlines four main roles for pharmacists: 1) prepare and distribute medical products, 2) maintain professional performance, 3) contribute to healthcare system effectiveness and public health, and 4) provide effective medication therapy management. Some key responsibilities within these roles include ensuring safe and effective medicine use, health promotion, and improving patient outcomes. The document also lists several competencies and services pharmacists can provide, such as medication therapy management, patient counseling, and clinical research support. Overall, the goal of pharmacy practice is to optimize patient care and health through safe, evidence-based use of medicines.
Code of Ethics for Pharmacists and Pharmacy Technicans Project Areej Abu Hanieh
This document outlines the code of ethics for pharmacists and pharmacy technicians. It discusses seven core principles that guide the profession: (1) make patient care the top priority, (2) use professional judgement in the patient and public's interest, (3) show respect for others, (4) encourage patient participation, (5) develop professional knowledge, (6) be honest and trustworthy, and (7) take responsibility for work practices. Each principle is then further explained and examples are given of its application to ensure patient safety, public trust, and high ethical standards within the profession.
Ομιλία – Παρουσίαση: Raymond Anderson, President Commonwealth Pharmaceutical Association and Member of the Pharmacovigilance Risk Assessment Committee (PRAC) at EMA
«Best Practices to inform citizens on Self-medication»
Clinical pharmacy is defined as the science and practice of optimizing medication therapy and promoting health. It encompasses patient care in healthcare settings and applies therapeutic guidelines, evidence-based practices, and relevant principles. The practice of clinical pharmacy began in the 1920s and has expanded globally. Barriers to its development include lack of management support, training opportunities, and incentives for pharmacists. Evidence-based medicine emphasizes using research evidence in healthcare decisions. Therapeutic guidelines aim to reduce medication errors and ensure proper medication use through complete, clear prescriptions and instructions.
There are many career options available to pharmacists with a PharmD degree beyond just working in a retail pharmacy setting. Some of the major options include working in hospital pharmacies providing medication management services; industrial pharmacy roles in research, development, production, and quality control; government agency roles ensuring safety standards; roles in pharmaceutical education and research; nuclear pharmacy preparing radioactive materials; clinical research associate roles overseeing trials; and roles in sales, marketing, and community pharmacy patient services. Compensation remains relatively consistent across these varied practice settings.
Clinical pharmacy is defined as a health specialty that promotes safe and effective medication use through the provision of patient care services. [SENTENCE 2] The concept of clinical pharmacy emerged in the 1960s in response to drug-related issues like the thalidomide tragedy and phenytoin toxicity. [SENTENCE 3] Over subsequent decades, the need for clinical pharmacy services was further recognized due to issues like poor health outcomes from drug misuse, antibiotic resistance, and adverse drug reactions.
An introduction to medication therapy managementKabito Kiwanuka
Pharmacists: An Untapped Resource: Pharmacists receive more training on the safe, effective and appropriate use of medications than any other healthcare professional
This document summarizes research on improving adherence to oral chemotherapy through nursing interventions. It describes barriers to adherence such as side effects and costs. It then outlines several studies that tested nursing interventions like education using tools like MOATT, follow-up calls, and oral chemotherapy clinics. These interventions showed improvements in medication knowledge and adherence and reduced side effects and health care costs. The document advocates for standardizing oral chemotherapy education and monitoring to help patients better manage treatment at home.
This document discusses the evolution of pharmacy education and practice in Ethiopia. It describes how the traditional curriculum focused more on products than patients, lacking clinical training. Reforms were implemented in 2008 to make the curriculum more patient-centered, with additional clinical pharmacy courses and master's programs. This shift was needed to address Ethiopia's disease burden and meet global pharmacy standards. The new curriculum focuses on applying drug therapy clinically and monitoring treatment. Pharmacists trained this way are now recognized members of healthcare teams. While challenges remain, future plans include training all pharmacists clinically and potentially launching a PharmD program.
This document discusses medication adherence and proposes a mHealth approach using automated medication reminders triggered from pharmacy dispensing data to improve adherence. Key points:
- Medication non-adherence is a major healthcare problem, with 50% of chronic patients not following treatment plans. This costs $100-290 billion annually in the US.
- An automated reminder system would use dispensing data like medication name, dose, frequency from pharmacies to set reminders in an app to prompt users when to take medications and track adherence.
- This approach could improve medication adherence rates especially as more use smartphones and wearables, helping address the large costs and health impacts of non-adherence.
1-1-Computing and Pharmaceutical Numeracy.pdfMuungoLungwani
This document provides a summary of a lecture on pharmaceutical numeracy and calculations. It covers topics such as fractions, decimals, dosage forms, weights and measures, dilution, concentration, and calculations for reducing/enlarging formulas and percentage preparations. Study questions are also provided to help reinforce concepts related to quantitative pharmaceutical procedures and calculations.
The document discusses states of matter and pharmaceutical materials. It begins by comparing gases, liquids, and solids, noting that solids have molecules in close contact that do not move. It then discusses intermolecular forces, ideal gas laws, liquefaction of gases, and the solid state including crystals, unit cells, polymorphism, and amorphous solids. It notes that polymorphism can impact properties like solubility, melting point, and bioavailability which are important for pharmaceutical processes and drug performance.
The document outlines a curriculum for a Master in Clinical Pharmacy (MClinPharm) degree program in Zambia. It provides the rationale for establishing the program, which is the need for specialized clinical pharmacists in Zambia to provide pharmaceutical care services and for the University of Zambia to develop specialized pharmacy staff. The curriculum covers various clinical pharmacy topics over 3 years of study and includes clinical rotations. The goal is to train pharmacists in specialized areas to improve patient care and build pharmacy expertise in Zambia.
This document outlines the curriculum for a Master in Clinical Pharmacy (MClinPharm) degree program in Zambia. It provides the rationale for establishing the program, which is to train clinical pharmacists to provide specialized pharmaceutical care services. The two-year program will equip pharmacists with skills in various clinical pharmacy specialties like oncology, psychiatry, critical care, and pediatrics. The goal is to develop a pool of trained clinical pharmacists to meet the needs of Zambia's health system and the University of Zambia's department of pharmacy.
This document outlines the curriculum for a Master in Clinical Pharmacy degree program in Zambia. It provides the program's vision, aims, objectives, structure and course descriptions. The curriculum was designed to train clinical pharmacists to address issues with traditional drug distribution systems like high rates of medication errors and adverse drug reactions. It incorporates courses in areas like pharmacotherapy, clinical skills, research methods and various medical specialties to prepare pharmacists for patient-centered practice focusing on pharmaceutical care.
Presentation deals with the topic "scope of pharmacy". The topic is part of paper IV P.G final year syllabus of Rasashastra and Bhaishajya Kalpana. It will provide basic information regarding this topic.
The document describes the author's experience completing a pharmacy practice training at Nayati Medical Pvt. Ltd, located in Mathura. It discusses the layout and organization of the pharmacy, including separate areas for tablets, liquids, refrigerated items, and restricted medications. It also outlines the roles of the 4 staff members and workflow process. Additionally, it covers important skills for community pharmacy practice like patient counseling, communication skills, medication adherence, drug interactions, and functions of a pharmacy.
Patient Safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities.
It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care.
A cornerstone of the discipline is continuous improvement based on learning from errors and adverse events.
Let us see what Pharmacists, Doctors and Patients can do about it.
1) The document discusses pharmaceutical care, which aims to ensure safe and effective drug use through identifying and resolving drug-related problems.
2) It defines pharmaceutical care as the responsible provision of drug therapy to achieve definite outcomes that improve a patient's quality of life.
3) Key aspects of pharmaceutical care include assessing a patient's medication needs, developing and implementing a care plan to address actual or potential drug therapy problems, and monitoring the care plan.
This document discusses the justification and roles of an Emergency Medicine Pharmacist (EMP). It begins by outlining the objectives which include explaining the justification for an EMP, describing their core roles and strategies for implementation, and ways EMPs can improve patient care. It then discusses how the emergency department is inherently a patient safety risk due to factors like high volume and distractions. Having an EMP can help fill gaps in medication safety. The document outlines the roles of an EMP which include clinical consultation, order screening, high-risk medication preparation, and education. It concludes by providing strategies for implementing an EMP position, overcoming challenges, and demonstrating return on investment through cost savings from reducing adverse drug events.
The Indo-American Journal of Life Sciences and Biotechnology of the journal uses recommended electronic formats for submitting articles, which helps speed up the overall process.Once an article is submitted, it undergoes an initial rapid screening by the editors of the Scopus indexing Journal.
Introduction to Clinical Pharmacy Practice.pptxSHIVANEE VYAS
Clinical pharmacy is a branch of hospital pharmacy that deals with various aspects of patient care, including the dispensing of drugs and advising the patient on the safe and rational use of those drugs.
Interaction & discussion on pharmacy practice, pharmacy practice Dr. Sharad Chand
This document discusses the roles and goals of good pharmacy practice. It outlines four main roles for pharmacists: 1) prepare and distribute medical products, 2) maintain professional performance, 3) contribute to healthcare system effectiveness and public health, and 4) provide effective medication therapy management. Some key responsibilities within these roles include ensuring safe and effective medicine use, health promotion, and improving patient outcomes. The document also lists several competencies and services pharmacists can provide, such as medication therapy management, patient counseling, and clinical research support. Overall, the goal of pharmacy practice is to optimize patient care and health through safe, evidence-based use of medicines.
Code of Ethics for Pharmacists and Pharmacy Technicans Project Areej Abu Hanieh
This document outlines the code of ethics for pharmacists and pharmacy technicians. It discusses seven core principles that guide the profession: (1) make patient care the top priority, (2) use professional judgement in the patient and public's interest, (3) show respect for others, (4) encourage patient participation, (5) develop professional knowledge, (6) be honest and trustworthy, and (7) take responsibility for work practices. Each principle is then further explained and examples are given of its application to ensure patient safety, public trust, and high ethical standards within the profession.
Ομιλία – Παρουσίαση: Raymond Anderson, President Commonwealth Pharmaceutical Association and Member of the Pharmacovigilance Risk Assessment Committee (PRAC) at EMA
«Best Practices to inform citizens on Self-medication»
Clinical pharmacy is defined as the science and practice of optimizing medication therapy and promoting health. It encompasses patient care in healthcare settings and applies therapeutic guidelines, evidence-based practices, and relevant principles. The practice of clinical pharmacy began in the 1920s and has expanded globally. Barriers to its development include lack of management support, training opportunities, and incentives for pharmacists. Evidence-based medicine emphasizes using research evidence in healthcare decisions. Therapeutic guidelines aim to reduce medication errors and ensure proper medication use through complete, clear prescriptions and instructions.
There are many career options available to pharmacists with a PharmD degree beyond just working in a retail pharmacy setting. Some of the major options include working in hospital pharmacies providing medication management services; industrial pharmacy roles in research, development, production, and quality control; government agency roles ensuring safety standards; roles in pharmaceutical education and research; nuclear pharmacy preparing radioactive materials; clinical research associate roles overseeing trials; and roles in sales, marketing, and community pharmacy patient services. Compensation remains relatively consistent across these varied practice settings.
Clinical pharmacy is defined as a health specialty that promotes safe and effective medication use through the provision of patient care services. [SENTENCE 2] The concept of clinical pharmacy emerged in the 1960s in response to drug-related issues like the thalidomide tragedy and phenytoin toxicity. [SENTENCE 3] Over subsequent decades, the need for clinical pharmacy services was further recognized due to issues like poor health outcomes from drug misuse, antibiotic resistance, and adverse drug reactions.
An introduction to medication therapy managementKabito Kiwanuka
Pharmacists: An Untapped Resource: Pharmacists receive more training on the safe, effective and appropriate use of medications than any other healthcare professional
This document summarizes research on improving adherence to oral chemotherapy through nursing interventions. It describes barriers to adherence such as side effects and costs. It then outlines several studies that tested nursing interventions like education using tools like MOATT, follow-up calls, and oral chemotherapy clinics. These interventions showed improvements in medication knowledge and adherence and reduced side effects and health care costs. The document advocates for standardizing oral chemotherapy education and monitoring to help patients better manage treatment at home.
This document discusses the evolution of pharmacy education and practice in Ethiopia. It describes how the traditional curriculum focused more on products than patients, lacking clinical training. Reforms were implemented in 2008 to make the curriculum more patient-centered, with additional clinical pharmacy courses and master's programs. This shift was needed to address Ethiopia's disease burden and meet global pharmacy standards. The new curriculum focuses on applying drug therapy clinically and monitoring treatment. Pharmacists trained this way are now recognized members of healthcare teams. While challenges remain, future plans include training all pharmacists clinically and potentially launching a PharmD program.
This document discusses medication adherence and proposes a mHealth approach using automated medication reminders triggered from pharmacy dispensing data to improve adherence. Key points:
- Medication non-adherence is a major healthcare problem, with 50% of chronic patients not following treatment plans. This costs $100-290 billion annually in the US.
- An automated reminder system would use dispensing data like medication name, dose, frequency from pharmacies to set reminders in an app to prompt users when to take medications and track adherence.
- This approach could improve medication adherence rates especially as more use smartphones and wearables, helping address the large costs and health impacts of non-adherence.
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1-1-Computing and Pharmaceutical Numeracy.pdfMuungoLungwani
This document provides a summary of a lecture on pharmaceutical numeracy and calculations. It covers topics such as fractions, decimals, dosage forms, weights and measures, dilution, concentration, and calculations for reducing/enlarging formulas and percentage preparations. Study questions are also provided to help reinforce concepts related to quantitative pharmaceutical procedures and calculations.
The document discusses states of matter and pharmaceutical materials. It begins by comparing gases, liquids, and solids, noting that solids have molecules in close contact that do not move. It then discusses intermolecular forces, ideal gas laws, liquefaction of gases, and the solid state including crystals, unit cells, polymorphism, and amorphous solids. It notes that polymorphism can impact properties like solubility, melting point, and bioavailability which are important for pharmaceutical processes and drug performance.
The document discusses phase diagrams and phase equilibria. It introduces key concepts like the Gibbs phase rule, cooling curves, and classification of equilibrium diagrams. The Gibbs phase rule establishes the relationship between the number of phases, components, and degrees of freedom in a system. Cooling curves show the phases present at different temperatures during solidification. The classification of equilibrium diagrams includes diagrams for pure metals, binary solutions, eutectic alloys, and off-eutectic alloys. Hume-Rothery rules govern solid solubility based on factors like atomic size and chemical affinity. Phase diagrams provide important information about phase boundaries, solubility, and temperatures of phase changes.
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This document defines key terms and concepts related to the physical properties of pharmaceutical materials, including:
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2. It explains physical and chemical properties, including properties related to phase changes like melting, boiling, freezing, and condensation. Density, color, and conductivity are given as examples of physical properties.
3. Chemical properties like flammability and reactivity that result in chemical changes forming new substances are also addressed. The differences between physical and chemical changes are summarized.
1. The document discusses phase equilibria and phase diagrams, including:
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2. Systems with a single component can have three phases (solid, liquid, gas) that meet at the triple point on the phase diagram, with boundaries between phases that change with temperature and pressure.
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The document discusses preformulation characterization of new drug candidates. It covers assessing key physical properties like crystallinity, polymorphism, hygroscopicity, particle size and shape, bulk density, and flow properties which influence formulation development, stability, and bioavailability. Solubility analysis including determining pKa, pH solubility profiles, and effects of temperature are also important to understand for formulation. Together, preformulation studies provide essential information to guide development of a stable, safe and effective dosage form with optimal bioavailability.
PMY 6120_1-2-Pharmaceutical Formulation Systems_Compound and Dispensing Proce...MuungoLungwani
This document discusses a course on pharmaceutical compounding and dispensing. The course covers background topics, dispensing and patient care, and extemporaneous dispensing. It aims to help students understand the roles of compounding pharmacists, resolve problems in making specific preparations, apply techniques to administrative and clinical aspects of drug delivery, determine dosages based on patient conditions, and apply principles of good pharmacy practice. Extemporaneous dispensing involves considerations for the intended use, safety, formula calculation, preparation method, container choice, and labeling for compounded products.
This document contains course information from Dr. L.T.M. Muungo on various pharmaceutical topics:
1. The document outlines several courses on formulation systems, pharmaceutical calculations, dispensing, manufacturing, compounding, clinical pharmacy practice, and other related topics.
2. Many of the courses discuss dosage forms, drug delivery systems, pharmaceutical ingredients, sterile and non-sterile processing, and other areas of pharmaceutics.
3. The document also provides information on clinical pharmacy year attachments, case studies, health systems, rational drug use, and research processes including proposal writing, data collection, analysis, and publication.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
2. Overview of Clinical Pharmacy…
• All patients have drug-related needs, and it is the PC practitioner's
responsibility to determine whether or not a patient's drug-related needs are
being met.
27/10/2013 Mohammed A 2
3. The Pharmaceutical Care Cycle
• In PC practice, talking with the patient is a vital component to uncovering more and
different drug therapy problems
27/10/2013 Mohammed A 3
4. Do we still need pharmacists? Ask yourself
Case-I
• A nine-month old baby died after misplaced decimal causes 10-
fold morphine overdose
• Physician ordered Morphine .5 mg IV for post-op pain, unit
secretary does not see the decimal and transcribes the order as
Morphine 5 mg IV
• Experienced nurse administered 5 mg of Morphine and repeats the
dose 2 hours later
• Four hours later baby stops breathing
Washington Post, April 20, 2001
27/10/2013 Mohammed A 4
5. Case-II
• 44 y/o F in died in an emergency department after
receiving 8,000 mg IV phenytoin instead of 800 mg
• A nurse administered overdose
– 32 vials of 50 mg / mL, 5 mL
– Required removing medication from several automated
dispensing machines
ISMP Medication Safety Alert, March 8, 2007
27/10/2013 Mohammed A 5
6. Case-III
An elderly woman from Harar died after she received IV
injection of potassium phosphate that was supposed to be
administered via a feeding tube.
ISMP Medication Safety Alert, March 8, 2007
Case-IV
• An intern doctor in a hospital in Addis writes a script for 20 vials
of heparin for a patient admitted to the ER for DVT
Case-V
• A women with unadjusted dose of anti Tb meds at a CrCl of 7.5
JUSH 2012.
27/10/2013 Mohammed A 6
7. Why pharmacist??
• Pharmacies are open all the time.
• No need for an appointment to see the pharmacist.
• Accessible and trusted source of advice
• Convenient for most people
• First stop for help with common ailments.
• Have the expertise to advise both on the choice of
medicines and their safe and effective use.
27/10/2013 Mohammed A 7
8. What is wrong with the “old model?
(Physicians Prescribe and Pharmacists Dispense)
• Healthcare costs
– Medicine related errors are costly in terms of hospitalizations, physician
visits, laboratory tests and remedial therapy
• Adverse drug reaction:
– 4%-10% of all hospital in-patients in developed countries.
– The 4th-6th leading cause of death in USA
– Estimated cost: upto US $ 139 billion a year in the USA
– £ 466 million (over $812 million): in the UK
‘’No documented data in our country’’
27/10/2013 Mohammed A 8
9. What is Wrong with the Current/old System?
Cont…
More than 50% of all prescriptions are incorrect
50%–90% of medicines purchased are paid for out-of-
pocket in developing countries.
non compliance is a major issue.
>50% of the people involved fail to take
them correctly.
27/10/2013 Mohammed A 9
10. What is Wrong with the Current/old System?
Cont…
• Up to 90% developed resistance to original first-line antibiotics
such as ampicillin and cotrimoxazole for shigellosis,
• Up to 70% resistance to penicillin for pneumonia and bacterial
meningitis,
• Up to 98% resistance to penicillin for gonorrhea, and
• Up to 70% resistance to both penicillin and cephalosporin for
hospital-acquired S.aureus infections.
‘’ no documented data in Ethiopia’’
27/10/2013 Mohammed A 10
11. What is Wrong with the Current/old System?
Cont…
Inadequate of Accountability?????
If a patient died after taking a prescription drug that
was dispensed according to the physician order
correctly, who is responsible?
27/10/2013 Mohammed A 11
12. What is Wrong with the Current/old System?
Cont…
The old
“Physicians Prescribe and Pharmacists Dispense” model
is no longer fully appropriate to
reduce drug therapy problems,
ensure safety,
ensure effectiveness and
adherence to drug therapy.
What could be a solution?????
27/10/2013 Mohammed A 12
13. Role change
• Sweeping changes continue to reshape the practice of
pharmacy.
• The pharmacy professional needed today is a
knowledgeable drug expert and skilled, persuasive
communicator and not a pill counter.
This pharmacist embraces a new
practice model - pharmacy care.
27/10/2013 Mohammed A 13
14. Global shift in the Practice of Pharmacy
• US and Iran: early 1960s: Pharm D
• US: 2000 Pharm.D mandatory for Pharmacy Schools
Other continents:
• Asia: India: Pharm.D: 2007
• Africa: Egypt: Alexandria University
• South Africa, Zambia: baccalaureate degree + internship in clinical areas
• UK, Australia, malasyia, KSA, Jordan,palastine:
M.clinpharm (MSc Clinical Pharmacy)
27/10/2013 Mohammed A
14
15. Why in Ethiopia?
• Ethiopia is one of the countries in the world with a critical
shortage of health workers and not to fully utilize its trained
workforce
• in a better position to have the expertise to advise both on the
choice of medicines and their safe and effective use.
• Major issues with medication access, quality, and rational use
27/10/2013 Mohammed A 15
16. Why Now?
• HIV/AIDS is a major burden in developing countries
– 40 million people death because of HIV/AIDS
– Close to 3 million annually
• Life style is becoming westernized DM, HTN, HF, CKD, chronic
illnesses. New meds are being imported to Ethiop
demand to meds expert is clear
• Though critical shortage of HC professionals but the existing
should be utilized to their fullest capacity including pharmacists
• Existing skills should be upgraded to cope up with demand
27/10/2013 Mohammed A 16
17. Pharmaceutical Care in Ethiopia
• Curricular revision 2008: nationwide
• Pharmacy curriculum: more patient oriented (4 years + 1
internship)
• FMoH: EHRIG May 2010
27/10/2013 Mohammed A 17
19. Definition
“Pharmaceutical care is the responsible provision of drug therapy
for the purpose of achieving definite outcomes that improve or
maintain patient’s quality of life” (Hepler and Strand, 1990) & 1999 FIP
preventing a disease or Sx
elimination or reduction of a patients Sx
arresting or slowing of a disease process
cure of a disease
19
Mohammed A
27/10/2013
20. Background
• In the last 4 decades the trend in the pharmacy practice moved
from medicine supply more inclusive patient care
• Pharmacists role evolved from compounder, supplier of
pharmaceuticals a provider of services, info & patient care.
• Pharmacists tasks is to ensure
pts drug therapy is appropriately indicated
the most effective available
Safest possible and convenient for the pt
Unique contribution for : DT outcome and pts Quality of life
27/10/2013 Mohammed A 20
21. Background...
• The literature provides powerful evidence of need for
pharmacist to change.
Crisis in health care funding,
cost of Rx,
need to add value to basic commodities like Rx.
• A pharmacist who is unable or unwilling to adapt to a new
role places millions/billions of money at loss.
21
Mohammed A
27/10/2013
22. Background...
• ‘Pharmacy’ believes clinically and financially in increased patient
care, but pharmacists have not fully adopted a new practice
philosophy.
• Probably a combination of inadequate
Knowledge (easy to fix)
Skill (easy to fix)
Attitude (hard to fix)
• PC is not the current standard of practice. What you see at work
rarely reflects what you hear in class
22
Mohammed A
27/10/2013
23. Background...
• Consider what you have seen in almost all pharmacies so far in our
country.
Meds without prescriptions, inadequate counseling, lack monitoring, missing of DDI checker
• Most problems are discovered only when a pharmacist thinks
“that can’t be right! or when the computer goes beep, beep, beep!
• Did the pharmacist find the problem or did the problem find the
pharmacist?
‘’not safe to assume the practice we see today is the same practice w/c will
be few yrs from now’’ hope vs hard work?????
23
Mohammed A
27/10/2013
24. Background...
• Expert knowledge of therapeutics
• A good understanding of disease process
• Knowledge of pharmaceutical products
• Drug monitoring skills
• Provision of drug information
• Communication skills
24
Mohammed A
27/10/2013
25. Pharmaceutical Care - Benefits
• Decrease medication misadventures
• Increase patient compliance to therapy
– Empowers patients to take in-charge of their own health and treatment
• Decrease healthcare cost and demand
• Decrease morbidity of mortality
• Increase patients’ quality of life
27/10/2013 Mohammed A 25
26. Goal of Pharmacists
Clinical Training
• To make them experts in:
– identifing and solving medication therapy problems
– becoming patient educators
– selecting the most effective therapy
– monitoring the outcome of drug therapy
26
Mohammed A
27/10/2013
27. What is the Focus of the
New Pharmacy Curriculum?
• Clinical Application of Drug Therapy
• Treatment guideline, Disease state knowledge
• Diagnostic procedures (to identify a drug problem)
• Monitoring parameters (lab, physical exam, other diagnostic tools) to
follow efficacy and safety of drug therapy.
27
Mohammed A
27/10/2013
28. Change in Pharmacy Education
• Are we behind by 20 years from the rest of the world?
• Pharmacists may be expert in medicinal chemistry and
pharmaceutics – but is this enough?
• Need the knowledge to apply to patient care (direct patient care
involvement)
• Pharmacy education around the world has made a shift
– From lab-based to practical or clinical based.
– From technical aspect to professional aspect of pharmacy 28
Mohammed A
27/10/2013
29. The Pharmaceutical Care Cycle
• In pharmaceutical care practice, talking with the patient is a vital component to
uncovering more and different drug therapy problems
27/10/2013 Mohammed A 29
30. PC Cycle…
• A pharmacist practices PC when he/she finds and fixes or prevents
drug therapy problems in patients.
Medical problems
• A disease state ; A change in physiology that (potentially) results in clinical
evidence of damage to an organ system. E.g. HTN, HF, DM, etc.
Drug therapy problems
• A patient problem that is either caused by a drug or may be
treated/prevented by a drug
27/10/2013 Mohammed A 30
31. Comparing Problems and Treatments
• The pharmacist needs to answer the following
questions:
1. Are all conditions being managed?
2. Are all drug therapies managing a condition?
27/10/2013 Mohammed A 31
32. Medical Vs drug therapy problems
• So, how does this differ from a medical problem?
• Who in the health care system finds and fixes medical
problems?
• Who in the health care system finds and fixes drug
therapy problems?
27/10/2013 Mohammed A 32
33. Drug Therapy Problem
• A drug therapy problem is 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.,
27/10/2013 Mohammed A 33
34. Components of a Drug Therapy Problem
1. An undesirable event or risk of an event experienced by the patient.
{medical complaint, S/S, Dx, d/ses, illness, impairment, disability, abnormal
laboratory value, or syndrome. The event can be the result of physiological,
psychological, sociocultural, or economic conditions.}
The problem
1. The drug therapy (products and/or dosage regimen) involved.
2. The relationship (exists or is suspected to exist) b/n the undesirable
patient event and drug therapy.
• the consequence of drug therapy, suggesting a direct association or even a cause and effect
relationship, or
• to require the addition or modification of drug therapy for its resolution or prevention.
27/10/2013 Mohammed A 34
35. Drug Therapy Problems
1. The drug therapy is unnecessary because the patient does not have a
clinical indication at this time.
2. Additional drug therapy is required to treat or prevent a medical
condition in the patient.
3. The drug product is not being effective at producing the desired response
in the patient.
4. The dosage is too low to produce the desired response in the patient.
5. The drug is causing an adverse reaction in the patient.
6. The dosage is too high, resulting in undesirable effects experienced by
the patient.
7. The patient is not able or willing to take the drug therapy as intended.
27/10/2013 Mohammed A 35
36. Drug-Related Needs of Patients
1. Patients need every medication they are taking to have an
appropriate indication.
• If a drug does not have an appropriate indication, the drug therapy problem “unnecessary
drug therapy” will be identified.
2. Patients need their drug therapy to be effective
• When a patient’s need for medication to be effective is not met, two possible drug
therapy problems can arise. They are “wrong drug” and “dosage too low”.
3. Patients need their drug therapy to be safe
• Not meeting a need for medication safety can result in the drug therapy problems of
“dosage too high” or “adverse drug reaction.”
4. Patients need to be able to comply with drug therapy and
other aspects of their care plans
• Not meeting a need for medication safety can result in the drug therapy
problem of “noncompliance” results.
5. Patients need to receive all drug therapies necessary to resolve
any untreated indications.
27/10/2013 Mohammed A 36
37. Drug-related needs Categories of drug therapy
problems
INDICATION 1. Unnecessary drug
therapy
2. Needs additional drug
therapy
EFFECTIVENESS 3. Ineffective drug
4. Dosage too low
SAFETY 5. Adverse drug reaction
6. Dosage too high
COMPLIANCE 7. Noncompliance
27/10/2013 Mohammed A 37
38. Identifying Drug Therapy Problems
• A pharmaceutical care practitioner should have a tacit
understanding of the common causes of drug therapy problems
identification is the essence of PC practice.
• the practitioner & patient can rationally construct a care plan to
resolve that DT-problem the patient to achieve his/her goals
of therapy.
27/10/2013 Mohammed A 38
39. Identifying DTP…
• These problems are identified during the assessment process, so
that they can be resolved through individualized changes in the
patient's drug therapy regimens.
Sociological, pathophysiological,
knowledge (pt, d/se), identified in the assessment step
drug therapy information
• The synthesis and application of this knowledge occurs in a
logical, systematic manner using the Pharmacotherapy Workup.
27/10/2013 Mohammed A 39
40. Identifying DTP…
The Process Used to Identify Whether or Not the Patient Is Experiencing a Drug
Therapy Problem Requires a Continuous Assessment of Four Logical
Questions:
1. Does the patient have an indication for each of his/her drug therapies, and is
each of the patient's indications being treated with drug therapy?
2. Are these drug therapies effective for his/her medical condition?
3. Are the drug therapies as safe as possible?
4. Is the patient able and willing to comply with the drug therapies as
instructed?
27/10/2013 Mohammed A 40
42. 1. Unnecessary drug therapy
• no valid medical indication. problem
• duplication of therapy
• nondrug therapy more appropriate
• Treating an avoidable ADR.
• Addiction/recreational use
Appropriate indication = Need
27/10/2013 Mohammed A 42
Causes
43. 2. Need for additional drug therapy
• condition requires initiation of DT.
• Preventive/prophylactic DT is required
• additional DT for synergistic/additive effects.
27/10/2013 Mohammed A 43
Causes
44. Minicase 1
• you are the pharmacy intern on community pharmacy rotations at Hiwot
Fana hospital Pharmacy and Mrs.Tigist comes in to ask you to
recommend an OTC sleep aid. In your conversation with her, you learn
her husband has recently passed away and she is not coping well. You
believe she is probably depressed and feel you should probably call her
physician.
• What is her drug related need?
• What is her drug therapy problem?
• How do you contact her physician and not appear to be“practicing medicine”?
DTP occur when one or more of a patient s needs for drug therapy are not met.
27/10/2013 Mohammed A 44
45. Clinical Questions to consider
• Is there an untreated indication? Why?
• Does the patient need synergistic therapy to supplement
therapy already being administered?
• Does the patient need prophylactic therapy?
• Does each medication the patient is taking correlate with a
medical condition?
27/10/2013 Mohammed A 45
46. 3. Ineffective drug
• Contraindications present. BB for class-IV CHF
• The medical condition is refractory to the drug
product.
• The dosage form of the drug product is inappropriate.
PO meds for comatose pts
• More effective drug is available.
Amilodipine for nephrotic syndrome. Verapamil, ACEIs
• not an indicated drug for the condition.
Anbt for URTI, ACEI/BB for hypertensive pregnant women
27/10/2013
Mohammed A
46
47. 4. Dosage too low
• The dose is too low to produce the desired response.
Wrong dose. insulin
• The dosage interval is too infrequent to produce the desired
response. Frequency inappropriate
• The duration of drug therapy is too short to produce the desired
response. Penicillins 2 14 days for L.monocytogens
• A drug interaction reduces the amount of active drug available.
Warfarin + phenobarb
• Incorrect storage
27/10/2013 Mohammed A 47
48. 5. Dosage too high
• Dose is too high
• The dose administered too rapidly Wrong dose
• The dosing frequency is too short
• The duration of drug therapy is too long.
Antibiotics for several months . JUSH
• A drug interaction occurs resulting in a toxic reaction to the drug
product. Warfarin + clarithromycin
27/10/2013 Mohammed A 48
49. Clinical Questions to consider
• Are the dose, dosage interval, duration of therapy, and
dosage form appropriate for each medication the
patient is taking?
• How long has the patient been receiving the current
dose of each medication?
• Is the patient responding appropriately to the drug?
27/10/2013 Mohammed A 49
50. 6. Adverse drug reaction
• The drug is Unsafe for the patient.
Amg for CKD, ACEIs for ARF, floroqiunolones and TTC in children
• A drug interaction causes an undesirable reaction that is not dose-related.
• dose inc/dec too rapidly.
• Incorrect administration of the drug. extravasations with Chemos
• The drug causes allergic reactions.
• Undesirable effect.
27/10/2013 Mohammed A 50
51. Questions
• Is there evidence of adverse effects or drug allergies?
• Are the medications being stored properly and are any past
their expiration dates?
• Are medications being administered correctly?
• Are there any potential or actual drug interactions?
27/10/2013 Mohammed A 51
52. 7. Inappropriate compliance
• The patient does not understand the instructions.
• The patient prefers not to take the medication.
• The patient forgets to take the medication.
• The patient cannot swallow or take appropriately. clindamycin
• The drug is too expensive for the patient. vancomycin
• The drug is not available for the patient. psychiatry, cardiac, statins
27/10/2013 Mohammed A 52
53. Questions
• Is the patient misusing medication, whether
unintentionally or deliberately?
• Would nondrug therapy be preferable for any of the
patient’s conditions?
• Is the patient taking duplicate therapy without adequate
cause?
• Are any drugs being administered unnecessarily to treat
adverse effects
27/10/2013 Mohammed A 53
54. Most common medical diseases/conditions associated
with drug therapy problem
• Over age 65
• DM
• Arthritis
• Depression
• Hypertension
• Asthma
• Anxiety
• Hyperlipdemia
27/10/2013 Mohammed A 54
55. Discovering Drug Therapy Problems requires more
than chart review
Example
• KT, a 67-year-old man admitted with a probable thrombotic stroke. The patient
was on warfarin 1 mg tablet for atrial fibrillation, esomeprazole 20 mg for
gastric reflux, and an albuterol inhaler for occasional mild asthma.
• In talking with the patient, the pharmacist found that KT was not taking his
warfarin because he runs out. His stroke and hospitalization are a direct result
of the drug therapy problem of noncompliance.
• The pharmacist uncover the drug therapy problem by discussing with the
patient
• The pharmacist would not be able to get this if he only relies on the patient
chart.
27/10/2013 Mohammed A 55
56. Mini-cases
which patient need is not met, what is the most likely drug therapy
problem, and what is the cause of the drug therapy problem?
Case-1: A woman who is 6 weeks pregnant presents a new
prescription for atorvastatin 20 mg daily written by a cardiologist
who she saw for the first time.
Case-2: A patient with Parkinson’s’ Disease has tremor that make it
nearly impossible to administer his glaucoma eye drops.
27/10/2013 Mohammed A 56
57. Mini-cases…
• Case-3: A child with chronic, persistent asthma is being treated
with nebulized albuterol treatments four times daily.
Case-4: An obese patient with blood pressure controlled by
felodipine starts the “grapefruit juice” diet.
Case-5: A patient who travels for work keeps his insulin in the car’s
glove compartment.
27/10/2013 Mohammed A 57
58. Steps in the Pharmaceutical Care Process
1. Developing a profession relationship with the patient
2. Collecting patient-specific medical information
3. Evaluate patient-specific medical information and develop a drug
therapy plan mutually with the patient.
4. Ensure the patient has all supplies, information, and knowledge
necessary to carry out the drug therapy plan.
5. Review, monitor, and modify the therapeutic plan as necessary and
appropriate, in concert with the patient and health care team.
27/10/2013 Mohammed A 58
59. Actual and Potential Drug Therapy Problem
a. An actual problem
– Is one that has already occurred. Action should be taken to resolve it.
– The best you can do is treat them
b. A potential problem
Is one that is likely to occur.
Potential problems have not occurred.
They can be prevented. The necessary steps should be taken prevent it
Prevention is a HOT topic and a great professional opportunity!
27/10/2013 Mohammed A 59
60. Actual and Potential DTP…
Case-1:
While working at Jogla Hospital out patient Pharmacy during
your internship, you accidentally fill an Rx for penicillin for
Bilal Adil who is allergic to penicillin.
a) Before you can call him he takes the penicillin. He claims he’s fine
when you reach him by phone that evening.
b) Before you can call him he takes the penicillin. When you reach his
home his neighbor tells you he he’s in the s emergency room!! !!
What type is the DRP ??
27/10/2013 Mohammed A 60
61. Actual and Potential DTP…
Case-2:
• A patient requests a new albuterol inhaler every two or three
weeks. The pharmacist determines his inhalation technique is
adequate but the patient complains of frequent shortness of
breath.
• Case-2:
• A woman who is 6 weeks pregnant has just been diagnosed with
atrial fibrillation and presents a new prescription for wafarin 5 mg
daily written by a cardiologist who she saw for the first time.
27/10/2013 Mohammed A 61
62. Actual and Potential DTP… (Communications tips)
Communications tips
• Docs do not care about drug therapy problems. They care about
patients with problems.
NB: Wording is critical to success - “Dr, I think I have
discovered the drug therapy problem of WRONG DRUG in your
patient!!!”
Re-phrase them ALL as patient problems
27/10/2013 Mohammed A 62
63. Actual and Potential DTP… (Communications tips)
Mini-case:
While you were on your ambulatory care rotations, A resident Dr started
amlodipine10mg po qd for a patient with BP of 164/102. This patient has never
had it before. You think this is too high a dose (usual initial dose is 2.5-5mg qd)
How do you re-phrase the “dose too high” problem in words that will not offend
the Doctor.
i.e. what’s the patient problem?
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64. SOAP Notes
PC practitioners collect two types of data to help them evaluate and
mange patients’ drug therapy:
Subjective data
– Cannot be directly measured
– May not always be accurate or reproducible
– Often supplied directly by the patient
– Generally includes PMH, CC, HPI, SH, FH
the pharmacist collects directly from patients
NB: Only information pertinent to specific drug therapy should be included
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65. SOAP Notes…
Objective data
• Can be measured and observable
• Not influenced by prejudice or emotion
• Typically numerical
• Often includes vital signs, lab measures
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66. SOAP Notes…
Chief complaint (C/C)
Brief statement of the reason why the patient consulted the
physician, stated in the patient’s own words. In order to convey
the patient’s symptoms accurately, medical terms and diagnoses
are generally used.
“What is your main health related problem
today? Health-today?”
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67. SOAP Notes…
History of Present Illness (HPI, HOPI)
• A more complete description of the patient’s symptom(s). Usually
included in the HPI are:
– 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 activities
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68. SOAP Notes…
Past Medical History (PMH)
– PMH includes serious illnesses, surgical procedures, and injuries the patient
has experienced previously. Minor complaints (e.g., influenza, colds) are
usually omitted.
Family History (FH)
– FH includes the age, and health of parents, siblings, and children.
– For deceased relatives, the age and cause of death are recorded
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69. SOAP Notes…
Social History (SH)
• SH includes the social characteristics of the patient as well as the
environmental factors and behaviors that may contribute to the
development of disease.
Medications (Meds)
• The medication history should include an accurate record of the
patient’s current prescription and non-prescription medication use.
Allergies (All)
• Allergies to drugs, food, pets, and environmental factors (e.g., grass,
dust, pollen) are recorded.
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70. SOAP Notes…
Review of Symptoms (ROS)
• In ROS the examiner questions the patient about the presence of
symptoms related to each body system.
• In many cases, only the pertinent positive and negative findings
are recorded.
• In a complete ROS, body systems are generally listed starting from
the head and working toward the feet and may include:
the skin, head, eyes, ears, nose, mouth and
throat, neck, cardiovascular, respiratory, gastrointestinal, genitourinary,
endocrine, musculoskeletal, and neuropsychiatric systems.
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71. SOAP Notes ROS …
Physical Examination (PE)
• The exact procedures performed during the physical examination
vary depending upon the chief complaint (C/C) and the patient’s
medical history.
The general sections of PE are outlined as follows:
– GA (general appearance)
– VS (vital signs)-blood pressure (BP), pulse(PR), respiratory rate (RR),
temperature (T)
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72. SOAP Notes ROS …
• HEENT (head, eyes,ears, nose, and throat)
• Lungs/Thorax (pulmonary)
• Cor or CV (cardiovascular)
• Abd (abdomen)
• GU (genitali/rectal)
• MS/Ext (musculoskeletal and extremities
• Skin (integumentary)
• Neuro (neurologic)
• Laboratory Results (Labs)
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73. Pharmacotherapy Workup
• Are Always Generated as a Response to Two Basic Questions.
1. Is the patient's problem caused by drug therapy?
2. Can the patient's problem be treated with drug therapy?
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74. Activities and Responsibilities in the
Patient Care Process
Assessment (identifying DRP)
Construct Care plan
• Knowing the cause of a drug therapy problem helps to create the plan to fix it
• Disagreements common use judgment -
Follow-up evaluation
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75. Care Plan
• A care plan is the method by which the pharmacist helps the
patient achieve a pre--determined health care goal.
• Care plans MUST be developed cooperatively between the
pharmacist and patient.
• Physicians should always be informed, and usually be involved.
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76. Care Plan… Prioritizing a DTP
If a patient has ≥1 DTP, it is usually preferable to solve
them one at a time, not all at once.
Acute problems VS serious
problems
#1 priority --DTP is acute and serious
DKA, serious infection, stroke.
could be fatal,
Note: possibly be life threatening and there is no
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77. Care Plan… Prioritizing a DTP
#2 priority --DTP is acute, but not serious
pain, diarrhea.
Not fatal, but patient hurts now
Note: may or may not be life threatening, but there is no
time to waste in solving it.
#3 priority --DTP is serious, but not acute
HTN, diabetes.
May be fatal in the long run, but
Note: you have time to spare solving it.
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78. Care Plan… Prioritizing a DTP
Mini-case
• A patient comes to your private pharmacy seeking
therapy for a sunburn. You came to know that he is also
diabetic and takes metformin 500 mg bid which upsets
his stomach. His am sugars run 140-160mg/dL.
Identify and prioritize his
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79. Care Plan… Goals for pharmacotherapy
• Before you can develop a care plan, you must develop a
goal
• A goal is simply the outcome you want the patient to
achieve
• Who has goals for therapy?
• How are they stated?
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80. Care Plan… Goals
Your Goals Must be
• Measurable
• Achievable
• Considers your practice setting. Eg. HgBA1c
• Consistent with the pharmacist’s Responsibilities
Mini-Case:
A patient requires radiation for pain for bone mets CA. What
goal should the pharmacist set?
is radiation within our scope of practice????
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81. Care Plan… (Goals)
Your Goals should not be
• Vague or ill defined
E.g., a patient with HTN is poorly compliant with her Enalapril 5 mg
po bid. BP is 150/105.
Consider goals like “improve compliance” or “control blood
pressure.”
– Is compliance from 50% to 70% “improved”?
– Is BP decreased to 140/86 “ controlled”?
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82. Care Plan… (Goals)
• The best care plan is rarely the first one that comes to
mind, i.e., THINK before you act.
E.g. if Indocin upsets the stomach, saying “take it with
food” is not very useful if the better option is to discontinue the
drug.
• What do you want to do?
– Before answering, what are all your choices and which is
best/least bad?
• You may need to do additional research.
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83. Care Plan…
Drug focused care plans:
• Require a change in a patient’s drug therapy
• Usually require physician’s cooperation (unless OTC)
• Add a drug, d/c a drug, change a dose, dosing interval or dosage form
BE SPECIFIC
• --“Let’s start to our patient a beta blocker” is NOT a care plan
Rather : Start him/her metoprolol 100 mg qd IS a care plan
• “to eliminate the orthostatic hypotension by holding enalapril for 1 day and
then reducing the daily dosage regimen of enalapril to 10 mg twice each day,
beginning on Tuesday.“
include the timeframe in which you expect to achieve each goal
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84. Care Plan…
Lifestyle related care plans:
• Stop smoking, lose weight, start exercising etc.
• the most difficult to implement and
• are generally best handled as part of a formal disease
management program, not a routine intervention.
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85. Care Plan…
Implementing
• Care plans require pharmacist’s action to implement
them
• You need to make sure that all parties:
Agree with the care plan
Understand who is responsible for what & when
Are capable of complying with the care plan
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86. Care Plan…
Implementing… Question
• Does the patient agree with it and understand it?
• Does the patient have everything necessary to put the
care plan into action?
• Does the patient know when to follow up and with
whom?
• Does the patient agree to follow up if needed?
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87. Patient monitoring
• How else will you know if your goal has been
achieved?
• Make sure the patient knows you will be
following up.
• Consider when you will follow up, where, and
how (by phone, in person, by email, by appointment,
etc.)
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88. Exercise
• J.R is a 55 year old female with HTN, and ESRD. She is currently
receiving hemodialysis 3 times a week (MWF). She presents today
to the ER with complaints of general muscle weakness and a mild
fever. She also admits to palpitation and feelings of “a racing
heart” prior to hospital presentation. JR missed her dialysis
appointment because she felt tired, experienced flank pain, and
painful urination on Friday.
• PMH: HTN for 10 years – poorly controlled IDDM for 15 years,
ESRD for 5 years, and a history of chronic urinary tract infection.
• FH: Father died from a stroke 2 years ago, mother living with HTN
and CHF, grandmother with Diabetes and Asthma.
• SH: Smoker for 10 year (stopped 3 years ago), drinks alcohol
occasionally.
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89. Exercise…
• Allergies: Sulfa
PE:
GA:
Alert and oriented, but in mild to
moderate distress,
VS:
BP 155/89, HR 74, RR 18, T 37.2
• HEENT: WNL
• NECK: No JVD or swollen nodes
• LUNGS: Clear to auscultation
• CV: Peaked T waves and ST segment
depression
• ABD: Soft and non-tender, N & V
• GU: WNL
Laboratory tests today show:
• WBC = 10,500 mm3
• Cl = 108 mEq/L
• Glucose = 160 mg/dL
• Na =136 mEq/L
• CO2 =24 mMol/L
• Ca =6.6 mEq/L
• SCr =6 mg/dL
• K = 6.7 mEq/L
• BUN = 25 mg/dL
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90. Exercise…
Current Medications:
– Captopril 25 mg PO TID
– HCT/triamterene 1 capsule daily
– Human NPH Insulin 30 units SQ AM
Questions
– What subjective and objective data can you get from
this patient’s case.
– Make your assessment of the condition and
– formulate pharmaceutical care plan for the patient.
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92. 1. In what ways has the pharmacy practice changed in over the past 40
years? (2 points)
2. Explain the benefits of clinical pharmacy services in the health care
system? (2 points)
3. List common drug related needs and associated drug related problems
for each? (2 points)
4. Mentions risk factors for drug interactions? (2 points)
5. Compare and contrast direct and indirect measure of adherance? (2
points)
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93. 1. List different drug interactions classifications
systems?
2. List PK drug interactions and give examples
for each?
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