Pharmaceutical Care Overview

Pharmaceutical Care

• Optimizes drug therapy for better patient outcomes and quality of life.
• Focuses on rational drug use, ensuring proper drug use for treatment.
• IRP is a key concept:
  • I: Identification of both drug and patient-related problems.
  • R: Resolving both patient and drug-related problems.
  • P: Prevention of both patient and drug-related problems.

Outcomes of Pharmaceutical Care

• Cure: Eliminating the disease.
• Elimination: Reducing the disease impact.
• Slow down disease: Inhibiting disease progression.
• Prevention: Avoiding the development of the disease.

Pharmaceutical Care Plan

• An individualised written plan for drug therapy based on specific therapeutic goals.

Pharmacotherapy

• Utilizes drugs for disease treatment, prevention, and diagnosis (without radiation or surgery).
• Relies on one or more drugs.

Steps in Pharmaceutical Care

• Patient-Doctor Relationship: Establishing a strong connection for effective care.
• Data Collection: Gathering information about the patient, their condition, and medications.
• Data Interpretation: Analyzing the collected data to identify potential problems.
• Identification of Drug-Related Problems: Recognizing issues related to drug therapy.
• Prioritizing Drug-Related Problems: Determining the urgency of identified issues.
• Developing a Therapeutic Plan: Creating a strategy for addressing the problems.
• Implementing a Monitoring Plan: Establishing a system for tracking progress and potential side effects.
• Follow-up: Regularly assessing the plan's effectiveness and making adjustments as needed.

Drug Related Morbidity (DRH)

• Therapeutic malfunction resulting in new effects or toxicities.
• Major contributing factors:
  • Untreated Indications: Inadequate treatment of underlying conditions.
  • Overdose: Exceeding the recommended drug dosage.
  • Subtherapeutic Dose: Insufficient dosage for achieving desired therapeutic effect.

Adverse Drug Reactions (ADRs)

• Unwanted outcomes of drug therapy.
• Classification:
  • Onset of action: Based on the time it takes for ADRs to appear.
  • Active, Subactive, Latent: Categories based on the time between drug exposure and symptom onset.
  • Severity: Classifying ADRs based on their intensity: Minor, Moderate, Severe, Lethal.
• Types of Reactions:
  • ABCDEF: Based on suspected drug interaction.
  • Hypersensitivity Reactions: Allergic responses to drugs.
  • Allergic Shocks: Severe, life-threatening allergic reactions.
  • Toxic Effects: Adverse reactions caused by high drug concentrations.
• Acute, Subactive, Latent:
  • Acute: ADRs occurring within 60 minutes.
  • Subactive: ADRs appearing between 1-2 hours.
  • Latent: ADRs developing after 72 days.
• Severity:
  • Minor: ADRs requiring no specific treatment.
  • Moderate: ADRs requiring therapy modifications.
  • Severe: ADRs needing intensive care.
  • Lethal: ADRs directly or indirectly causing death.
• Types of ADR:
  • Type A: Augmental, dose-dependent ADRs.
  • Type B: Bizzore, dose-independent ADRs.
  • Type C: Chronic ADRs occurring due to drug metabolism.
  • Type D: Delayed ADRs appearing years after exposure.
  • Type E: End-of-therapy ADRs related to drug withdrawal.
  • Type F: Failure-of-therapy ADRs often resulting from drug interactions.

Individualization of Dosage Regimen

• Tailoring drug therapy for optimal outcomes based on patient and drug factors.
• Patient-Related Factors:
  • Diagnosis
  • Therapeutic Goals
  • Contraindications
  • Allergy
  • Patient Compliance
  • Patient Medical History
  • Patient Cooperation
• Drug-Related Factors:
  • Efficacy
  • Adverse Effects
  • Drug Administration
  • Pharmacokinetic and Pharmacodynamic Properties
  • Dosage Forms
  • Ability to Monitor
  • Route of Administration

Reasons for Non-Compliance

• Factors Contributing to Non-Compliance:
  • Healthcare provider behavior
  • Inappropriate prescriptions
  • Dispensing errors
  • Patient idiosyncrasies

Pharmacist Workup Drug Therapy (PWDT)

• Comprehensive assessment of drug therapy by a pharmacist.

Systemic Documentation

• Provides guidelines for pharmacist documentation.

Formats

• PHARME: A mnemonic for documenting pharmaceutical care.
  • P: Pharmacotherapy problem list
  • H: History
  • A: Assessment
  • R: Recommendation
  • M: Monitoring
  • E: Evaluation
• PRIME: Another mnemonic for documenting pharmaceutical care.
  • P: Pharmacotherapy Problem
  • R: Risk Factors
  • I: Interactions between drugs, food, and the patient
  • M: Mismatch
  • E: Efficacy
• SOAP: A common method for documenting patient care.
  • S: Subjective
  • O: Objective
  • A: Assessment
  • P: Plan
• CORE: An alternative method for documenting pharmaceutical care.
  • C: Condition or Factor
  • O: Outcomes
  • R: Regimen
  • E: Evaluation

Chapter 2: Adverse Drug Reactions (ADRs)

• Definition: Unwanted outcomes of drug therapy.
• Classification:
  • Onset of action: Based on the time it takes for ADRs to appear.
  • Active, Subactive, Latent: Categories based on the time between drug exposure and symptom onset.
  • Severity: Classifying ADRs based on their intensity: Minor, Moderate, Severe, Lethal.
• Types of Reactions:
  • Type A: Augmental, dose-dependent ADRs.
  • Type B: Bizzore, dose-independent ADRs.
  • Type C: Chronic ADRs occurring due to drug metabolism.
  • Type D: Delayed ADRs appearing years after exposure.
  • Type E: End-of-therapy ADRs related to drug withdrawal.
  • Type F: Failure-of-therapy ADRs often resulting from drug interactions.
• Pharmaceutical ADRs: Related to changes in dosage form, leading to toxicity or therapeutic index issues.
• Drug Index Diseases: Diseases caused by drug exposure.
  • Drug Withdrawal: ADRs occurring due to rapid cessation of drug use.
  • Drug Elimination: Adverse reactions due to insufficient drug elimination from the body.