Patient Care Assessment and Planning Quiz

Integrated Therapeutics I - Overview

• Course taught by Gemedo Misha (B.Pharm, MSc in Clinical Pharmacy)
• Email: [email protected]
• Course covers an introduction to integrated therapeutics, including general principles, clinical pharmacokinetics, drug interactions, the pharmacist's role in patient care, and diagnostic tests.

Chapter One

• Introduction to the subject
• General principles of therapeutics
• Clinical pharmacokinetics
• Drug interactions
• Pharmacist's role in patient care
• Diagnostic tests

Introduction

• Integrated therapeutics integrates the pathophysiology of disease states with drug selection, dose optimization, and monitoring of therapeutic outcomes for safety and efficacy.
• Pharmacotherapeutics is the use of drugs in prevention, diagnosis, and treatment of diseases.
• Key concepts in pharmacotherapy: shared responsibility with the patient and prescriber, establishing trusting professional-patient relationships, and formal documentation.
• Clinical pharmacy specialists ensure safe, appropriate, and economic use of drugs in patient care, providing direct patient care, acting as members of multidisciplinary teams, and being the primary source of drug information for other healthcare professionals.
• Pharmaceutical care proactively provides drug therapy to improve patient quality of life.

Pharmacotherapeutics and Other Courses

• Pharmacotherapeutics involves various branches of medicine and integrates pharmaceutical sciences.
• Students need a strong foundation in pathophysiology and pharmacology before studying integrated therapeutics.
• Pharmacotherapy course content addresses pathophysiology and pharmacotherapeutics.

Rational for Pharmacotherapy

• Drugs are a cornerstone of modern therapeutics.
• Physician drug prescribing is prevalent, yet the process is complex due to the limited efficacy and potential toxicity of medications.
• Problems: medication errors, suboptimal therapy, unnecessary drug therapy, therapeutic duplication, drug-drug/disease/food interactions, drug allergies, and adverse drug reactions.
• The appropriate use and management of drug therapy is vital for national health care.
• Specific expertise of clinical pharmacists differentiates them from other professions.

Guiding Principles of Pharmacotherapy

• Justifiable and documented indication for all medications.
• Use lowest dosage and shortest duration to achieve desired outcome; monotherapy is preferred when possible.
• Newly approved medications should be used only if they have clear advantages over older medications.
• Evidence-based selection of medication regimens is preferred when available.
• The timing of drug administration should be considered, and medications should use the safest route when possible.
• Patient perceptions of illness and the risks/benefits of therapy can affect medication adherence.
• Patient response to treatment should be carefully monitored to confirm efficacy, manage adverse effects, and determine if dosage adjustments or discontinuation of drug therapy are needed.
• Lifestyle modifications should be considered before medications to address underlying needs.
• Choose the drug with lowest cost/or most convenient for patients, when possible.
• Inappropriate drug selection, non-adherence, improper dosage, misdiagnosis, concurrent illnesses, food/drug interactions, environmental/genetic factors are potential reasons for medication regimen failure.

Clinical Pharmacokinetics

• The study of how a drug reaches its target in the body and how the body affects the drug.
• Covers absorption, distribution, metabolism, and excretion (ADME) processes.
• Learning objectives include defining PK & CPK, clinical application of PK, therapeutic concentration range, factors causing interpatient variability, and situations requiring routine CPK monitoring.

Other Pharmacokinetic Parameters

• Clearance (CL): the volume of serum/blood completely cleared of the drug per unit time; used in calculating the maintenance dose (MD)= Css x CL, where Css is the target average steady-state drug concentration.
• Volume of Distribution (VD): a proportionality constant relating the amount of drug in the body to the serum concentration, used in loading dose (LD) calculation (LD = CpSS x VD for average VD until patient specific VD values ascertained).
• Half-life (t1/2): time required for serum concentration to decrease by 50% after absorption/distribution process is complete. It can guide dosing intervals; the elimination rate constant (k) = 0.693/t1/2.

Drug Distribution

• Process by which a drug leaves the bloodstream to enter interstitial fluid/tissues/cells. Important factors include plasma protein binding (albumin, glycoproteins), tissue uptake (bone, liver, etc.), presence of barriers (e.g., blood-brain barrier, placenta), and rate of blood flow to the tissue. The driving force is the concentration gradient between the blood and extravascular tissues; unbound/free drug diffuses to equilibrium.

Biotransformation/Metabolism

• Alteration of drug structure; may lead to drug inactivation or activation (promising inactive prodrug to active drug).
• Key site of biotransformation: liver, intestine, and plasma.
• The process has sequential phases (Phase I and Phase II), typically resulting in more polar metabolites.

Drug Excretion

• Passage of drug metabolites or unchanged drug from the body.
• The primary organ for drug and metabolite excretion: the kidneys.

Pharmacotherapy (Workup, Goals, Plan, and Evaluation)

• Workup: A logical/systematic thought process to guide decisions involving indications, efficacy, safety, and/or compliance with treatment.
• Goals: Clearly defined, observable/measurable clinical & laboratory parameters, negotiated with the patient, and realistic in relationship/consideration to their health situation.
• Plan: Interventions needed to resolve issues and achieve therapeutic goals; include regimen changes, dosage, drug route, additional medications, and related patient education.
• Evaluation: Assessing patient outcomes; determine if goals achieved and any safety/compliance issues; assess for new drug therapy problems; and note important clinical and laboratory data.

Drug-Related Needs

• Appropriateness (clinical indication)
• Effectiveness (sufficient dosage)
• Safety (no adverse/toxic reactions)
• Patient compliance with therapy.

SOAP Format

• Subjective: patient's own words regarding reason for visit, symptoms, and treatment history;
• Objective: measurable physical examination, lab data, diagnostic tests;
• Assessment: diagnosis and a brief description, assessment of problem type;
• Plan: further workup, treatment details, education, monitoring, and follow-up.

High-Risk Clinical Settings

• High risk groups who require close attention to potentially adverse drug interactions: patients on narrow-therapeutic-index drugs, polypharmacy cases, critically ill patients, HIV-positive patients, and patients with substance use disorders.

Principles of Prevention of Adverse Drug Interactions

• Document all medications
• Understand drug pharmacokinetics (PK) and pharmacodynamics (PD)
• Minimize the number of drugs
• Identify patients taking narrow therapeutic index drugs
• Be cautious in high-risk settings
• Regularly reassess for potential interactions
• Utilizes resources for information and guidance (textbooks, software programs).

Test your knowledge on the assessment phase in patient care and the critical components of the S&O process. This quiz covers important topics like drug therapy problems and strategies for preventing medication errors. Perfect for students and professionals in healthcare fields.