HOSPITAL PHARMACY 2ND PART
Pharmaceutical care 1
PHARMACEUTICAL CARE
Pharmaceutical care is the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve/ maintain a patient’s quality of life. Maintainance of QOL for chronic progressive diseases such as HIV/AIDs and diabetes
Review prescription, or pt medication record Talking to patients, assess needs, create a plan Document, monitor and review the care given 2
PHARMACEUTICAL CARE PROCESS Pt receiving or requiring a pharmaceutical product or service Step1 Assess needs and identify drug problems Step4
Monitor and review the care plan
Step3
Step2
Develop a care plan
Implement the care plan
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ASSESS NEEDS & IDENTIFY DRUG - 1 THERAPY PROBLEMS How ??? (Pt, HCT, Records)
1- needing pharmacotherapy and not receiving it. (Drug indication) 2-Taking or receiving a drug for no valid indication. 3-Taking or receiving wrong drug 4-low dose 5-too much dose 6-ADR 7-DDI-D-food 4 8- poor compliance
TYPE OF DRUG THERAPY PROBLEMS Actual Potential
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: CASE 1 
Mrs W, a 53-year-old woman has had gastrointestinal acid-related disorders (GORD). Diagnosed by endoscopy. Mrs W has a history of asthma, hypertension and duodenal ulcer (DU). Her current drug therapy includes amlodipine (10 mg in the morning), Salbutamol inhaler (two puffs as required) beclometasone inhaler 2oomcg twice daily), and theophyllin (300mg twice daily). Mrs W has recently undergone successful H. pylori eradication therapy, which has been confirmed by carbon urea breath test. Mrs W smokes 10 cigarettes a day, has a body mass index of 35 and does not drink alcohol. 6
Identify Life style Medicine And disease factors For the above patient 7
CASE2 Mrs T, aged 78, has a history of coronary heart disease, for which she has recently undergone coronary angioplasty and stenting. She is currently taking clopidogrel 75 mg, aspirin 75 mg, atrovastatin 80 mg, nicorandil 30 mg, and atenolol 50 mg. She stopped smoking a year ago. Mrs T presents to the community pharmacist complaining of black, bloody stools. The problem has gradually worsened over the last day or two. She has no previous history of gastrointestinal problems.
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1. What risk factors does Mrs T have for druginduced gastric ADR? 2. What advice should the community pharmacist give?
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CASE 3 Mr B is a 71-year-old man who recently completed a 10-day course of flucloxacillin 500 mg three times a day for cellulites. Three weeks later he presents to his doctor complaining of lethargy and increasing nausea. Several days ago he noted sight yellowing of his eyes and that his urine was dark in color. Over the last 2 days he has suffered from an itch at over his trunk and legs which is 10 interfering with sleep.
WHAT FORM LIVER DISEASE IS-1 ?SUGGESTED BY THE PRESENTATION 2-The patient was admitted to hospital. LFTs on admission were as follows. • Albumin 37 g/L (normal 35-55) • • • •
Aspartate transaminase (AST) 172 units/L (<35) Alanine transaminase (ALT) 211 units/L (<50) Alkaline phosphatase 1975 units/L (70-290) Bilirubin 172 µmonl/L (3-17)
What type of liver dysfunction is indicated by these results? 3. How would you treat the symptoms?
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: CASE 4 Mrs P, aged 74 years, has recently been diagnosed with Parkinson's disease. Her only medical condition listed is angina. Her current drug therapy is as follows: ď&#x201A;˘ Glycerytl rinitrate (GTN) 500mcg one tablets sublingually as required haloperidol 0.5 mg capsules one capsule three times daily. ď&#x201A;˘
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IDENTIFY DRUG THERAPY PROBLEMS FOR THIS PATIENT AND INDICATE WHETHER THEY ARE ACTUAL OR POTENTIAL PROBLEMS. 1- antiplatelet 2-prophylactic anti-anginal 3-Haloperidol?? 4-ADR of Haloperidol &parkinsonism diag 13
CASE5 Mr. D aged 52 years has been diagnosed with hyperlipedemia and advised on diet and lifestyle measures for the past year. His medical history include hypertension, and atrial fibrillation. His blood pressure was recently measured as 140/85 mm Hg , pulse 40 beats/minute and lipid screen showed total cholesterol of 8.4 mmol/l (N = 5 mmol/L or less). On the interview, the patient complains of tiredness and weight loss. Current drug therapy is as follow: Amiodarone 200 mcg in the morning Thiazide 10 mg in the morning
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Identify drug therapy problems for this patient and indicate whether they are actual or potential problems.
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Develop a care plan to resolve or prevent these drug therapy problems
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