Clinical Intoduction - Hanouts, By Sir Irfan Hamid

7/30/2019 Clinical Intoduction - Hanouts, By Sir Irfan Hamid

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Clinical Pharmacy By Sir. Irfan HamidLecture: Clinical Pharmacy Introduction

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CLINICAL PHARMACY

Definition: Clinical Pharmacy is a health specialty which describes the activities and services

of a clinical pharmacist to develop and promote the rational and appropriate use ofmedicinal products and devices.

Clinical Pharmacyis the responsible provision of drug therapy for the purpose ofachieving definite outcomes which improves the patients quality of life.

Discussion Clinical Pharmacy means a closer

alliance of Pharmacist with

Physician and Nurses.

An alliance whose goal is toprovide safe and specific patient-

drug information to medical and

Nursing staff and critical eye in

prescribing drug therapy

Guidance of medical and Nursing Staff about monitoring of drug therapies andprocedures necessary to observe , record and detect information used for clinical

pharmaceutical judgment.

The aim of health care team is to provide safe and effective medication to patient. Information provided to physician about patient medication ,drug monitoring , drug

interaction ,adverse drug reaction , drug induced liver diseases and possible drug

toxicities.

Information provided Nursing staff about dosage time.

Information provided to patient about drug ,using drinks ,food and other meal ,doseand duration of drug and all other instructions for safe medication.

Aims of Clinical Pharmacy To maximize drug efficacy To minimize drug toxicity To promote cost effectiveness

Role of Clinical PharmacistThese are the functions that a pharmacist would perform in clinical role:

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Prescribing drugs2. Dispensing drugs and administering drugs3. Documenting professional activities4. Direct patient involvement5. Reviewing drug utilization6. Education7. Consultation8. Clinical Trials

PATIENT


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1. Prescribing Drugs Under certain circumstances , the pharmacist assist in planning drug therapy and

may prescribe medication at request of physician.

Pharmacist involved in refilling of prescription may be regarded as performing aprescribing function.

Pharmacist in complying with standing order of the physician may be performingand independent prescribing function (Standing order refer to a pre-arranged plan

between physician and pharmacist.

Prescribing Drugs Pharmacist and pharmacy residence often help medical students to planned drug

regimens.

Pharmacist prescribe OTC drugs. Pharmacist prescribe medication in emergency situation. Pharmacist after consulting with prescriber may select and dispensed a drug otherthen one prescribed by physician.

2. Dispensing and Administration of DrugThe responsibility for dispensing medication upon an order from a physician rests on

the pharmacist and the staff.

Pharmacist receive and interprets the drug order and supervises the dispensingfunction.

Pharmacist should consult with the physician when the later prescribes products ofsuspected or of low quality.

Pharmacist has responsibility for dispensing or supervising the filling of orders thatrequired technical skills(anticancer drugs, narcotics).

Pharmacist dispensing function in the hospitals overlaps with the administration ofdrugs performed by the nurse.

Pharmacist administer biological products for immunization e.g. vaccines , TPN3. Documenting Professional Activities

The Pharmacist is required to keep the certain record of his activities related topatients by checking of forms.

Pharmacist should have a meeting with the patient for purpose of reviewinginstructions and counseling for home use of medication.

Pharmacist can make proper reporting of adverse drug reactions. Pharmacist prepare adequate record to assure himself of documented source of

expending clinical experience which makes him drug specialist.

4. Direct Patient involvementPharmacist should have a direct contact with patient.

Following functions can be performed by clinical pharmacist.

Conduct an admission interview.


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Conduct a discharge interview. Provide patient education in personal health(smoking , drug reviews). Provide instruction in the use of appliances e.g. Inhalers. Interprets physician instructions as they relate to drug therapy as well as total

treatment regimens. Conduct a round in the hospital.

5. Reviewing Drug Utilization Developing or promoting plan for drug utilization review programme. Implementation of a local formulary system of a drug use control in the hospital and

in community.

Developing technique that will lead to identification of drug prescribing pattern byphysician.

6. Education Education refers to those ongoing activities that are designated to influence theprescribing , dispensing and use of drugs,

Participates in continuing education through self-directed study. Organize seminars and lectures for hospital staff Participate in health education of the patient Participate in public information programme to promote the respect for drug Educate in hospital through grand round, teaching round and nursing conference

7. Consultation Pharmacist should exert a consultative function by being available to physician for

advice and guidance. Some consultation with physician and patient are Screening process e.g. blood pressure determination Selection of drugs and monitoring of drug therapy

SCOPE OF CLINICAL PHARMACY There is a wide scope of clinical pharmacy. The need is the pharmacist practicing in

clinical setting must be equipped with knowledge about drug therapy and can provide

the latest and current information about each and every aspect of drug.

He must be familiar with latest literature of medical & pharmaceuticals e.g. journals &researches in both fields

Clinical pharmacist must be confident in providing information to physician Clinical pharmacist hopes to improve drug prescribing practicing by promoting safe

and efficacious drug usage.

Act as a resource person for drug therapy Can detect & prevent drug interactions and ADRs. Can detect & prevent possible drug interactions Can detect and prevent possible drug induced diseases Can detect & prevent possible drug toxicities


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Can offer more services about handling, storage, distribution of drugs& can manageproper administration of drug

The most common clinical pharmacy role model is that clinical pharmacist providesintensive services to patient in a hospital.

Another role model for clinical pharmacist services as faculty for medical , nursing andpharmacy students about drugs.

Another role model is associated with unit dose drug distribution system servicesprovided that pharmacist is available at patient beside for maintenance of clinical

reason.

Safe handling & administration of drug will be ensured Proper choice of drug therapy & patient education & compliance

HISTORY OF PHARMACYIn the catholic countries of Europe, the pation saint of pharmacy & medicine were

Domain & Cosmos, twin brothers, practicing together about 300 years A.D.Their healing powers of therapy were known throughout Asia.Domain was serving as a pharmacist while Cosmos was a Physician.The member of society of Apothecaries were found in 1617 not only dispense for

physician but also recommend themselves for prescribing medicine

Despite the protest from physician, the Apothecaries legal right was to give medicaladvice was upheld in the house of Lords judgment in 1703

Under the Apothecaries act of 1815, they were allowed to charge for medical advice aswell as for medicine they dispense

In this period, there is a close association b/w physician, pharmacist & patient; this wasanalogy to clinical pharmacy today.

There are several examples of clinical pharmacy practice.In 1969, announcing change in title of journal drug intelligence to clinical pharmacyClinical pharmacy practice was analogous to clinical practice.Development of unit dose drug distribution systemDevelopment of drug information center

PATIENT TAKING HISTORY

WWHAMWho is it for?

What are the symptoms?

How long has it been going on?Action taken?

Medicine taken?

CASE STUDY

MR.JOHNSTONE,

A young man who asks you to recommend something for Diarrhea.


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You question Mr. Johnstone using the WWHAM structure

W- Who is for?

It is for himself.

W- what are the symptoms?

He is passing regular watery stools.H- how long have the symptoms persisted?

Since late last night.

A- action taken already?

none,, but he has not eaten anything today.

M- medicines being taken for other problems?

Occasional Antacids for dyspepsia

From this information, as a pharmacist, you would want to explore : What may have triggers the symptoms? Obtain more detail about severity of symptoms

Any accompanying symptoms? Mr. Johnstone tells you that he had Pub meal in the early evening yesterday and

wonder whether this is?

What may have triggered the diarrhea? When question about other symptoms, he tells you He has also been sick, but there is no abdominal pain He is passing stools less frequent now. From this information you can conclude that it is likely due to: He has eaten food which has been microbiologically contaminated

Note:

This could be confirmed by locating other people who eat the same food with Mr.Johnstone at the pub last night, to find out if they are suffer from similar symptoms.

You recommend an oral rehydration sachet to Mr. Johnstone and advise him to fastfor a day, although if he does feel hungry he may eat , but to avoid milk and dairy

products as lactase is temporarily inactivated in the gut.

He should drink plenty of fluids and the diarrhea should subside completely in thenext 2 days.

If it does not, he should visit his G.P.He should also be advised to avoid taking Antacids that contain Mg2+ ion as they

tend to have a laxative action which may aggravate his current condition.

AS METTHOD

Age of the patient?Self or for someone else?

Medicine being taken?

Exactly what do you mean by the symptoms?

Time & duration of the symptom?

Taken any action( medicine or seen the doctor)?

History of any disease?


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Other symptoms?

Doing anything to alleviate or worsen the symptoms?

CASE STUDY

Miss Anderson,She asks to speak the pharmacist in private she looks embarrassed, worried

She tells you that she has had a vaginal discharge that is curdy and irritating for the last 2

days.

Your question to Miss Anderson using the ASMETTHOD

A- Age and appearance of the patient?

She is a student who looks healthy but is embarrassed about this problem

S- self or someone else?

She is suffering from the symptoms herself.

M- medication the patient is taking?

She is taking the contraceptive pills and recentally had a course of antibiotics forchest infection.

E-Exactally what does the patient mean by the symptoms

The discharge is thick and creamy but not colored or smelly. There is no

bleeding

T- Time/ duration of the symptoms?

She has noticed the symptoms from last 2 days.

T- Taken anything for it or seen the doctor?

No

H-History of any disease or condition?

No

O- Other symptoms being experienced?The vulval area is itchy and it is quite painful when she passes water

D- Doing anything to aggravate or alleviate the conditions?

She has been having hot baths to try to relieve the symptoms, but this has not

helped much.

The pharmacist suspects that Miss Anderson is having an attack of the fungalinfection, thrush, caused by the organism Candida albicans

This infection commonly follows a course of antibiotics, which kills the commensalbacteria of the vagina which normally keep the growth of Candida under control.

The symptoms confirm this:

There may also be a link b/w the use of oral contraceptives and candidiasis b/c thevaginal environment may be altered making it more susceptible to overgrowth of

Candida

There is no suggestion that there is any other vaginal infection as there is,

No offensive smell or coloured dischargeNow blood in the dischargeWhich might indicate a more serious underlying cause.


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The pharmacist asks Miss Anderson

If she has ever suffered from vaginal thrush b/f or she has not, to her knowledgeAs this is 1sttime she has suffer from the symptomsShe is advised to visit her G.P for confirmation of the suspected diagnosisAn intra vaginal Imidazole treatment such as pessary or cream, is the most effective

drug of choice but, must be prescribed by the G.P in this case

Hot bathes, especially if she has use perfumed bath additives, will probablyaggravate and irritate the condition.

Warm salt baths or showers may be more soothing.Miss Anderson can also be advised to avoid tight fitting and synthetic clothing such

as tights and to wear cotton under wear.

Topically application of vinegar or yogurt should be discouraged as this can reducedthe effectiveness of the Imidazoles.

SITDOWNSIRSite or location?

Intensity or severity?

Type or nature?

Duration?

Onset?

With other symptoms?

aNnoyed or aggravated by?

Spread or radiation?

Incidence or frequency pattern?

Relieved by?

ENCORE

E= Explore NOCEONature of symptoms?

Obtain identity of the patient?

Concurrent medication or treatment?

Exclude possibility of serious disease?

Other associated symptoms?

N No medication

C GPPLGeriatric patient (the patient at recovery stage)

Pediatric patient

Pregnant women

Lactating mother( During pregnancy B.P is increased called pre-eclampsia in this disease the foetus

may be aborted, the foetus is considered as foreign body. During 1st trimester no

hypotensive drug should be used


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O ODDOther telltale sign

Demeanor of the patient (general condition)

Dramatization of the patient

R= Refer PPPPotentially serious case

Persistent symptoms

Patient at increased risk

E = Explain ( discuss with the patient why this treatment given. The symptoms are relievedor not. It is decided by the physician which information should be given to the patient).

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Clinical Intoduction - Hanouts, By Sir Irfan Hamid