Concept of Clinical Pharmacy

8/12/2019 Concept of Clinical Pharmacy

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Concept Of Clinical Pharmacy

Kishori Kedia

Ashwini NitsureTanvi Shah

Pranjal Taskar

Dipesh Suvarna


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Objective

Define clinical pharmacy

Differentiate between traditional pharmacists role

and Clinical Pharmacist Explain the qualification required for clinical

pharmacists

List the clinical pharmacists responsibility

Describe the daily work activity of clinicalpharmacists

Define what is Therapeutic Drug Monitoring

Discuss the different types of Therapeutic DrugMonitoring


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Goal

To promote the correct and appropriate use of

medicinal products and devices.

These activities aim at:

maximising the clinical effect of medicines

minimising the risk of treatment-inducedadverse events

minimising the expenditures for

pharmacological treatments.


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What is the difference?

Clinical Pharmacy

Pharmaceutical care


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Pharmaceutical care

Pharmaceutical care is the direct, responsible

provision of medication-related care for the purpose of

achieving definite outcomesthat improve a patientsquality of life.

Cure of the disease

Elimination or reductio

of symptoms

Arrest or slowing of a

disease process

Prevention of disease

or symptoms


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Clinical Pharmacy

Clinical Pharmacy includes all the services

performed by pharmacists practising in

hospitals, community pharmacies, nursinghomes, home-based care services, clinics and

any other setting where medicines are

prescribed and used.

The term clinical does not necessarily imply

an activity implemented in a hospital setting.


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Clinical Pharmacy Requirements

Patientcare

Knowledge ofdrug therapy

Knowledge ofthe disease

Knowledge oflaboratory

and diagnosticskills

Communicationskills

Patientmonitoring

skills

Physicalassessment

skills

DrugInformation

Skills

Therapeuticplanning

skills

Knowledge ofnondrugtherapy


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Level of Action of Clinical

Pharmacists

Clinical pharmacy activities may influence

the correct use of medicines at three

different levels

before,

during and after the prescription is written.


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1. Before the prescription

Clinical trials

Formularies

Drug information

Drug-related policies


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2. During the prescription Counselling activity

Clinical pharmacists can influence the attitudes and priorities ofprescribers in their choice of correct treatments.

The clinical pharmacist monitors, detects and prevents

Medication related problems

The clinical pharmacist pays special attention to the dosage ofdrugs which need therapeutic monitoring.

Community pharmacists can also make prescription decisions

directly, when over the counter drugs are counselled.


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Medication-related Problems

Untreated indications. Improper drug selection.

Subtherapeutic dosage.

Medication Failure to receive

Medication Overdosage. Adverse drug reactions.

Drug interactions.

Medication use without indication.


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3. After the prescription

Counselling

Preparation of personalised formulation

Drug use evaluation

Outcome research

Pharmacoeconomic studies


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Activities of Clinical Pharmacists

The principle activities of a clinical pharmacist include:

ConsultingAnalysing therapies, advising health care practitionerson the correctness of drug therapy and providingpharmaceutical care to patients both at hospital and atcommunity level.

Selection of drugsDefining "drug formularies" or "limited lists of drugs" in

collaboration with hospital doctors, general practitionersand decision makers.

Drug informationSeeking information and critically evaluating scientificliterature; organising information services for both the

health care practitioners and the patients.


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Pharmacoeconomy

Using the results of clinical trials and outcome studies todetermine cost- effectiveness evaluations.

Teaching & TrainingPre- and post-graduate teaching and activities to providetraining and education programmes for pharmacists and otherhealth care practitioners

Pharmacokinetics/ therapeutic drug monitoringStudying the kinetics of drugs and optimising the dosage.

Clinical TrialsPlanning, evaluating and participating in clinical trials


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Responsibilities

Designing patient-specific drug dosageregimens

Recommending or scheduling measurements of drugconcentrations in biological fluids

Monitoring and adjusting dosage regimens

Evaluating unusual patient responses to drug therapyfor possible pharmacokinetic and pharmacologic

explanations.


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Communicating patient-specific drug therapy

information to physicians, nurses, and other clinical

practitioners and to patients orally and in writing,

and including documentation of this in the patientshealth record.

Educating pharmacists, physicians, nurses, and

other clinical practitioners about pharmacokineticprinciples and appropriate indications for clinical

pharmacokinetic monitoring, including the cost-

effective use of drug concentration measurements.


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Developing quality assurance programs for

documenting improved patient outcomes and

economic benefits

Promoting collaborative relationships with

other individuals and departments involved indrug therapy


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Pharmacists with specialized education, training, or

experience may have the opportunity to assume the followingadditional responsibilities:

1. Designing and conducting research

2. Developing and applying computer programs and point-of-careinformation systems to enhance the accuracy and sophisticationof pharmacokinetic modeling and applications to

pharmaceutical care.

3. Serving as an expert consultant to pharmacists with a general

background in clinical pharmacokinetic monitoring.


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Rational use of drugs

The rational use of drugs requires that:

patients receive medications appropriate

to their clinical needs,

in doses that meet their own individualrequirements

for an adequate period of time, and

at the lowest cost to them and their

community.


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Rational

Drug Use

Prescriber,

Dispenser &

their

workplaces

Drug Supply System

Patient &

community

Many Factors Influence Use ofMedicines

Policy, Legal and Regulatory

framework


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Therapeutic Drug Monitoring

Measure Serum Drug Levels

Narrow Therapeutic Drug Windows

Maximize Efficacy Minimize Toxicity


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Therapeutic Drug Monitoring

The need for TDM :-

Noncompliance

Inappropriate dosage Poor bioavailability

Drug interaction

Kidney and liver disese

Altered protien binding

Fever

Cytokines

Genetically determined fast or slow metabolizers


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Tdm used for:

1. Maximizing & speeding up efficacy

2. Minimizing toxicity

3. Patient's drug history uncertain

4. Poor response to initial Rx or deterioration after good response

5. When hepatic or renal function is changing

6. Antiepileptics: Phenobarbital, Phenytoin, Carbamazepine, Valproate

7. Cardiac Drugs : Digoxin*, Procainamide, Lidocaine

8. Psychoactive Drugs: Lithium, TCA

9. Analgesics: Aspirin, Paracetamol


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Clinical usefulness:

Maximizing efficacy

Avoiding toxicity

Identifying therapeutic failure

Facilitating adjustment of dosage.


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Clinical Pharmacy Practice areas

Ambulatory care

Critical care

Drug Information Geriatrics and longterm care

Internal medicine andsubspecialties

Cardiology

Endocrinology

Gastroenterology

Infectious disease

Neurology

Nephrology

Obstetrics and gynecology

Pulmonary disease Psychiatry

Rheumatology

Nuclear pharmacy

Nutrition

Pediatrics Pharmacokinetics

Surgery


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Outcome

With a growing but already wide range of medicines and the

increasing prevalence of chronic diseases in all countries

the best use of medicines is of growing importance. Some

of the outcomes of clinical pharmacy and the best use ofmedicines are

Better patient health outcomes

Better patient medication understanding

Better patient medication usage

Decreased cost to the government and patient (decreased

use of unnecessary medicines, decreased risk of hospital

admissions from medication issues)

Increased availability of medicines (medicines are used on

only the people who need them).


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Concluding..


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THANK YOU..!!

Concept of Clinical Pharmacy

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