Understanding Drug Therapy Problems and Pharmaceutical Care, Exams of Pharmacy

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Identifying and Classifying Drug Therapy Problems

What is Pharmaceutical care - Practice in which a practitioner takes responsibility for a patient's drug-related needs and is held accountable for this commitment Why is pharmaceutical care provided - For the purpose of achieving positive patient outcomes WOF is an example of pharmaceutical care - a) Dispensing medication in a community pharmacy b) Answering a hypothetical drug information question c) Monitoring a patient's response to drug therapy d) Recommending a medication different than prescribed e) Counseling patients about their medications f) Evaluating medication errors g) Recommending TALL man lettering for sound-alike drugs h) Counseling a patient about expected therapeutic response to prescribed medication(s) What should be taken into consideration for drug therapy? - Benefits vs. burden What is drug misadventuring? - -Describes the risk and negative effects of the use of drugs as part of the medial-care treatment plan -An inherent risk when drug therapy is indicated -Created through either omission or commission by the administration of a drug or drugs where the patient is harmed -Always unexpected and unacceptable to patient and prescriber

-5% of admissions to public medical services are caused by drug reactions

• At least 15% of hospitalized patients experience an adverse drug reaction while being treated What are a practitioner's responsibilities - -Make sure the patient's drug therapy is appropriately indicated the most effective available, the safest possible, and able to be taken as intended -To identify and resolve and prevent any drug therapy problems that might interfere with the first set of responsibilities -To make sure the patient's goals of therapy are met and optimal outcomes are realized What is a drug therapy problem? - -An undesirable event experienced by the patient, which involves or suspected to involve drug therapy that interferes with a desired patient outcome -Pharmaceutical care use the term "problem" to denote a drug related event amendable to detection, treatment or prevention Two primary components to drug therapy? -
  1. An undesirable event or risk of an event experienced by the patient -medical complaint, symptom, disease, impairment
• Can be the result of psychological, physiological or economic conditions

2. Some relationship must exist (or suspected to exist) between the undesirable patient event and drug therapy -consequence of a drug therapy -an event that requires drug therapy for its resolution or prevention Drug Therapy problems (TEST QUESTION) -
   1. Need for additional drug therapy
3. Unnecessary drug therapy
4. Dosage too high
5. Dosage too low

5. Adverse drug reaction
6. Drug interaction
7. Wrong drug
8. Non adherence to therapy Reasons to need additional drug therapy? - Patient has: -New medical condition requiring initiation of new drug therapy -A chronic disorder requiring continuation of drug therapy

• Medical condition that requires combination pharmacotherapy to attain synergism -At risk to develop a new medical condition preventable by the use of prophylactic drug therapy Reasons unnecessary for drug therapy - -Patient is taking a medication for which there is no valid medical indication at this time
• The patient accidentally or intentionally ingested a tocsin amount of a drug or chemical, resulting in the resent illness or condition -The patient's medical condition is better treated with non drug therapy -Patient's medical problem are associated with drug abuse, alcohol use or smoking -The patient is taking multiple drugs for a condition for which only a single-drug therapy is indicated -The patient is taking drug therapy to treat and. avoidable adverse reaction associated with another medication Reasons for wrong drug - -Patient has a medical problem for which this drug is not effective -Patient is allergic to this medication -Patient is receiving a drug that is not the most effective for the indication being treated -Patient has risk factors that contraindicate the use of this drug -Patient is receiving a drug that is effective but not the least costly -Patient is receiving a drug that is effective but not the most safe

-Patient has an infection involving organisms that are resistant to this drug -The patient has become refractory to the present drug therapy The patient is receiving an unnecessary combination product when a single drug would have been appropriate Reasons for dose being too low - -Dosage used is too low to produce the desired response for this patient -Patient's serum drug concentrations are below the desired therapeutic range -Timing of prophylaxis was inadequate for this patient -Drug, dose, route or formulation conversions were inadequate for this patient -Dose and interval flexibility were inadequate for this patient -Drug therapy was altered prior to adequate therapeutic trial for this patient Reasons for adverse drug reaction - -Drug was administer too rapidly for this patient -Patient is having an allergic reaction to this medication -Patient has identified risk factors that make this drug too dangerous to be used -Patient has experienced an idiosyncratic reaction to this drug Reasons for drug interaction - -Bioavailability of the drug is altered due to an interaction with another drug or food patient is taking -The effect of the drug has been altered due to enzyme inhibitor/induction form \another drug the patient is taking -The effect of the drug has been altered due to displacement from binding sites by another drug the patient is taking -The patient's laboratory test result has been altered due to interference from a drug the patient is taking Reasons Dosage is too high -

-Dosage is too high for the patient -The patient's serum drug concentrations are above the desired therapeutic range -The patient's drug dose was escalated too rapidly -Drug, dose, route, formulation conversions were inappropriate for this patient -Dose and interval flexibility were inappropriate for this patient Reasons for noncompliance or adherence - The patient did not -Receive the appropriate drug regimen because of a medication error -Comply (adhere) with the recommended directions for using the medication -Take the drug as directed owing to the high cost of the product -Take the drugs as directed because of lack of understanding of the directions -Take the drugs as directed because it would not be consistent with the patient's health benefits Define Triage - Process of determining the priority of the patient's treatments based on the severity of their condition What will triage result in? - Determining the order and priority of emergency treatment, the order and priority of emergency transport, or the transport destination What is the medical screening for treatment priority - -1st priority - patients needed treatment to survive -Patients who will not survive regardless -Patients who will recover without treatment Triage severity options - a) Potentially life-threatening

b) Mortality or significant morbidity could occur if patient not further evaluated, but not immediately life-threatening c) Mortality or significant morbidity may occur if currently prescribed treatment is not continued, but further evaluation is unnecessary d) Mortality or significant morbidity is unlikely Shortened Severity options -

1. Potentially/immediately life threatening 2)Severe- could become life threatening
2. Moderate- interferes with activity
3. Mild - present but well tolerated Triage in pharmacy practice - -Recommend self treatment -Do nothing -Refill existing therapy -Call MD to recommend change in therapy -Refer to patient for further medical evaluation Three C's by American Red cross - Check Call Care ABC's by American red cross - Airway Breathing Circulation