Identifying and Classifying Drug Therapy Problems in Pharmaceutical Care, Exams of Pharmacy

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Drug Therapy Problems

_____ are the clinical domain of the pharmaceutical care practitioner - drug therapy problems The purpose of identifying drug therapy problems is - to help patients achieve their goals of therapy and realize the best possible outcomes from drug therapy. Identification of drug therapy problems is the focus of - the assessment. Although drug therapy problems is technically part of the assessment process- it truly represents a unique contribution made by pharmaceutical care practitioners - Drug therapy problems are the consequence of - patients drug related needs that have gone unmet _____ any undesirable event experienced by a patient that involves, or is suspected to involve, drug therapy, and that interferes with achieving the desired goals of therapy and requires professional judgement to resolve - drug therapy problem KEY CLINICAL CONCEPT- Identifying drug therapy problems is to pharmaceutical care, what makes a medical diagnosis is to medical care - Pharmaceutical care practitioners use the term PROBLEM to denote -

an event associated with or caused by drug therapy that is amenable to detection, treatment, or prevention. PATIENTS HAVE DRUG THERAPY PROBLEMS- DRUG PRODUCTS DO NOT HAVE DRUG THERAPY PROBLEMS - Drug therapy problems always have 3 primary components - problem drug therapy relationship Drug therapy problems always have 3 primary components problem - An undesirable event or risk of an event experienced by the patient. The problem can take the form of a medical complaint, sign, symptom, diagnosis, disease, illness, impairment, disability, abnormal lab value, or syndrome. The event can be the result of physiological, psychological, sociocultural, or economic conditions. Drug therapy problems always have 3 primary components drug therapy - The drug therapy (products and/or dosage regimen) associated with the problem Drug therapy problems always have 3 primary components The relationship that exists (or is suspected to exist) between the undesirable patient event and the drug therapy. This relationship can be -

The consequence of drug therapy, suggesting a direct association of even a cause and effect relationship The need to add or modify drug therapy for its resolution or prevention KEY CLINICAL CONCEPT- stating the problem and identifying the cause require that all three components be known- this step involves clinical judgement by the practitioner - There is no "right answer" as to whether or not a drug therapy problems exists. There is only the practitioners clinical judgement How many types of drug therapy problems are there - 7 what do drug therapy problems include - any and all side effects, toxic reactions, treatment failures, or the need for additive, synergistic, or preventive medications, as well as adherence problems and noncompliance 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 dosage is too low to produce the desired response in the patient. -
4. The drug product is not being effective at producing the desired response in the patient. -

6. The dosage is too high, resulting in undesirable effects experienced by the patient. -
7. The drug is causing an adverse reaction in the patient. -
8. The patient is not able or willing to take the drug therapy as intended. - What are the 4 classifications of drug therapy problems - indication effectiveness safety adherence Which DTP deal with indication -
   1. The drug therapy is unnecessary because the patient does not have a clinical indication at this time.
9. Additional drug therapy is required to treat or prevent a medical condition in the patient. Which DTP deal with effectiveness -
   3. The drug product is not being effective at producing the desired response in the patient.
10. The dosage is too low to produce the desired response in the patient. Which DTP deal with safety -
    5. The drug is causing an adverse reaction in the patient.
11. The dosage is too high, resulting in undesirable effects experienced by the patient.

Which DTP deal with adherence -

7. The patient is not able or willing to take the drug therapy as intended. Drug products do not cause toxicity until they are taken by a patient Drug products can not prevent diseases unless they are taken at the appropriate time and at the appropriate dosage by patients - Drug products can not cure a disease unless and until a sufficient dosage is provided to and take by the patient Drug therapy cannot be considered to have failed to manage a disease unless it was actually taken by by the patient Therefore, drug therapy problems always involve the patient, medical condition, and the drug therapy that connects them - In what order should you address DTP - decisions concerning INDICATION are addressed first, then decisions concerning EFFECTIVENESS can be established, followed by SAFETY considerations What is the most frequent DTP - additional/new drug therapy needed What is the second most common DTP - dosage of medication was incorrect Unnecessary Drug Therapy - drug therapy is unnecessary because the patient does not have a clinical indication at this time Common Unnecessary Drug Therapy Problems -

Multiple-drug products are being used for a condition that requires single-drug therapy. There is no valid medical indication for the drug therapy at this time. The medical condition is more appropriately treated with nondrug therapy. Drug abuse, alcohol use, or smoking is causing the problem. Drug therapy is being taken to treat an avoidable adverse reaction associated with another medication. Needs Additional Drug Therapy - Additional drug therapy is required to treat or prevent a medical conditions or illness from developing Common causes of drug therapy problems involving patients who require additional therapy to meet their needs - Preventive drug therapy is required to reduce the risk of developing a new condition. A medical condition requires the initiation of drug therapy. A medical condition requires additional pharmacotherapy to attain synergistic or additive effects. Key Clinical Concepts- Patients taking no medications can have drug therapy problems- prevention chronic medical conditions is a major objective of pharmaceutical care practice - Ineffective Drug - The drug product is no being effective at producing the desired response or outcome. Common causes of drug therapy problems involving patients who are taking drugs that are not effective

The drug product is not the most effective for the indication being treated. The medical condition is refractory to the drug product. The dosage form of the drug product is inappropriate. Contraindication is present. The drug is not effective for the medical problem. Key Clinical Concepts- Effectiveness can only be realized if an appropriate drug product is selected and the dosage used is sufficient to produce the desired outcome in a particular patient - Key Clinical Concepts- Selecting a drug product for a patient that is likely to be effective requires a thorough understanding of the pathophysiology of the patient's disorder and the pharmacology of the drug product being considered - Dosage Too Low - The dosage is too low to produce the desired response or outcome Common causes of drug therapy problems involving patients whose dosage regimens are insufficient to produce the desired effects: - The dose is too low to produce the desired response. Needs additional monitoring to determine that the dosage is too low. The dosage interval is too infrequent to produce the desired response. Incorrect administration of the drug.

A drug interaction reduces the amount of active drug available. Incorrect storage of the drug. The duration of drug therapy is too short to produce the desired response. Adverse Drug Reaction - The drug is causing an adverse reaction Common causes of therapy problems involving patients who are taking drug products that are not safe for them - The drug product causes an undesirable reaction that is not dose-related. A safer drug product is required due to risk factors. A drug interaction causes an undesirable reaction that is not dose-related. Incorrect administration of the drug products The drug product causes an allergic reaction. The dosage regimen was administered or changed too rapidly. The drug product is contraindicated due to risk factors. Dosage to High - Dosage is too high, resulting in undesirable toxic effects Common causes of therapy problems involving patients whose dosage regimen of drug is too high - Dose is too high. Need additional monitoring to determine if dosage is too high. The dosing frequency is too short.

The duration of drug therapy is too long. A drug interaction occurs resulting in a toxic reaction to the drug product. Adherence (Noncompliance) - Patient is not able or willing to take the drug therapy as intended Common causes for patients not adequately complying with drug therapy - The patient does not understand the instructions. The patient cannot afford the drug product. The patient prefers not to take the medication. The patient forgets to take the medication. The drug product is not available for the patient. The patient cannot swallow or self-administer the drug product appropriately. _______ is defined as the patient's inability or unwillingness to take a drug regimen that the practitioners has clinically judged to be appropriately indicated, adequately efficacious, and able to produce the desired outcomes without any serious harmful effects - non adherence It is important to describe the patients drug therapy problems in a concise, accurate, and informative manner - A statement describing the patients drug therapy problems consists of 3 components -

1. A description of the patient's medical condition or clinical state.

2. The drug therapy involved (causing or solving the problem).
3. The specific association between the drug therapy and the patient's condition. Key Clinical Concepts- The description of the patient's drug therapy problem directly influences the changes that will be made in the patient's pharmacotherapy regimens. - Review examples of how to write drug therapy problems in the chapter - Prioritizing DTP - depends upon the extent of the potential harm each problem might inflict on the patient, the patient's perception of the potential harm, and the rate at which this harm is likely to occur. Once the list of drug therapy problems is prioritized according to risk to the patient, the list is reviewed and the following issues addressed: -
   1. Which problems must be resolved (or prevented) immediately and which can wait?
4. Which problems can be resolved by the practitioner and patient directly?
5. Which require the interventions by someone else (perhaps a family member, physician, nurse, care giver, or some other specialist). Drug therapy problems are clinical problems because they affect individual patients and require professional judgment to resolve. The rational assessment of a patient's drug-related needs follows the logic of indication, effectiveness, safety, and adherence. -