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Questions and Answers
What is considered a primary role of the Clinical Pharmacist in Ethiopia?
What is considered a primary role of the Clinical Pharmacist in Ethiopia?
Which skill is essential for a Clinical Pharmacist as per the new roles required?
Which skill is essential for a Clinical Pharmacist as per the new roles required?
What aspect has seen an increased focus within the healthcare system mentioned?
What aspect has seen an increased focus within the healthcare system mentioned?
What was a significant change in the pharmacy curriculum in Ethiopia as per the 2008 revision?
What was a significant change in the pharmacy curriculum in Ethiopia as per the 2008 revision?
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What is one of the major challenges highlighted in pharmaceutical care?
What is one of the major challenges highlighted in pharmaceutical care?
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What is one role of pharmacists in clinical pharmacy services?
What is one role of pharmacists in clinical pharmacy services?
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Which of the following statements reflects a key issue with the old model of pharmacist involvement?
Which of the following statements reflects a key issue with the old model of pharmacist involvement?
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What can be inferred about the development of clinical pharmacy services in Ethiopia?
What can be inferred about the development of clinical pharmacy services in Ethiopia?
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What was a critical mistake in the case of the nine-month-old baby?
What was a critical mistake in the case of the nine-month-old baby?
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In the case of the 39-year-old female patient, what was the consequence of the medication error?
In the case of the 39-year-old female patient, what was the consequence of the medication error?
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Which aspect of pharmaceutical care emphasizes the pharmacist's role in the patient care process?
Which aspect of pharmaceutical care emphasizes the pharmacist's role in the patient care process?
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What broader responsibility do pharmacists have in healthcare besides dispensing medications?
What broader responsibility do pharmacists have in healthcare besides dispensing medications?
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Which group is least likely to handle the compounding role traditionally assigned to pharmacists?
Which group is least likely to handle the compounding role traditionally assigned to pharmacists?
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What causes heart block and bradycardia in some patients?
What causes heart block and bradycardia in some patients?
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Why are ACE inhibitors contraindicated during pregnancy?
Why are ACE inhibitors contraindicated during pregnancy?
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What is a risk associated with the use of rifampin (RIF) in relation to contraceptive methods?
What is a risk associated with the use of rifampin (RIF) in relation to contraceptive methods?
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Which of the following is essential when constructing a care plan?
Which of the following is essential when constructing a care plan?
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When establishing goals of therapy, what primary components should the goals include?
When establishing goals of therapy, what primary components should the goals include?
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What should the follow-up evaluation of a care plan assess?
What should the follow-up evaluation of a care plan assess?
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What is the primary purpose of a care plan in the context of patient treatment?
What is the primary purpose of a care plan in the context of patient treatment?
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What is a potential consequence of not selecting appropriate individualized interventions in a care plan?
What is a potential consequence of not selecting appropriate individualized interventions in a care plan?
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Which of the following best defines a Drug Therapy Problem (DTP)?
Which of the following best defines a Drug Therapy Problem (DTP)?
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Which component is NOT included in the assessment of patient sociodemographic data?
Which component is NOT included in the assessment of patient sociodemographic data?
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What drug therapy problem was identified in Case Study 1 involving KT?
What drug therapy problem was identified in Case Study 1 involving KT?
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In which of the following cases would the medication experience be significant to assess?
In which of the following cases would the medication experience be significant to assess?
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What clinical symptom might indicate a potential Drug Therapy Problem in Case Study 2 involving MR?
What clinical symptom might indicate a potential Drug Therapy Problem in Case Study 2 involving MR?
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Which laboratory finding is NOT typically associated with the assessment of Drug Therapy Problems?
Which laboratory finding is NOT typically associated with the assessment of Drug Therapy Problems?
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What is a common cause of Drug Therapy Problems as indicated in the content?
What is a common cause of Drug Therapy Problems as indicated in the content?
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What could be a possible recommendation for the patient experiencing frequent asthma attacks?
What could be a possible recommendation for the patient experiencing frequent asthma attacks?
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What was launched in 2009 in Ethiopia related to clinical pharmacy?
What was launched in 2009 in Ethiopia related to clinical pharmacy?
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Which of the following is NOT a duty of clinical pharmacists as per EHRIG 2010?
Which of the following is NOT a duty of clinical pharmacists as per EHRIG 2010?
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What is a key aspect of effective medication therapy management by pharmacists?
What is a key aspect of effective medication therapy management by pharmacists?
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Which statement best describes the practice vocabulary used by pharmaceutical care practitioners?
Which statement best describes the practice vocabulary used by pharmaceutical care practitioners?
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What is one of the responsibilities of pharmacists in patient care?
What is one of the responsibilities of pharmacists in patient care?
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How do pharmaceutical care practitioners optimize patient care?
How do pharmaceutical care practitioners optimize patient care?
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What does pharmaceutical care primarily focus on?
What does pharmaceutical care primarily focus on?
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What is a common terminology used by all health care practitioners?
What is a common terminology used by all health care practitioners?
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What is one of the major activities during the assessment process?
What is one of the major activities during the assessment process?
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Which of the following best describes 'medication experience'?
Which of the following best describes 'medication experience'?
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What is the first step to assess a patient's drug-related needs?
What is the first step to assess a patient's drug-related needs?
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What type of patient information is essential during the assessment?
What type of patient information is essential during the assessment?
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How should communication be conducted during the assessment process?
How should communication be conducted during the assessment process?
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What can significantly influence a patient's decision about medication?
What can significantly influence a patient's decision about medication?
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What information is NOT considered during the assessment of the patient's drug therapy?
What information is NOT considered during the assessment of the patient's drug therapy?
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Which factor is considered when determining the safety of a drug regimen?
Which factor is considered when determining the safety of a drug regimen?
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Study Notes
Introduction to Pharmaceutical Care Practice
- Integrated Therapeutics I
- Hanan Muzeyin (B.Pharm., MSc)
- Department of Pharmacology & Clinical Pharmacy, Addis Ababa University
- Email addresses provided
- Learning Objectives:
- Differentiate the pharmacist's role in clinical pharmacy services.
- Understand the development of clinical pharmacy and pharmaceutical care in Ethiopia.
- Identify pharmacist roles and responsibilities in patient care.
Do We Still Need Pharmacists?
- Purchase and handling of medicines
- Non-pharmacists
- Compounding role
- Pharmaceutical manufacturers
- Medicine availability
- Pharmacies vs. supermarkets and local markets
- Doctors' offices, clinic nurses
Case Study 1
- Nine-month-old baby died from a 10-fold morphine overdose due to a misplaced decimal in the prescription.
- Physician ordered 0.5 mg IV morphine, but the order was transcribed as 5 mg.
- An experienced nurse administered 5 mg and repeated the dose two hours later.
- The baby stopped breathing four hours later.
- Incident occurred in 2001.
- Source mentioned: Washington Post, April 20, 2001.
Case Study 2
- 39-year-old female treated for metastatic breast CA at Dana Farber Cancer Institute in 1995.
- The patient was prescribed 4 grams per meter squared of cyclophosphamide for days 1 through 4.
- Correct dosage was 1 gram/meter squared daily.
- The patient received the total dose each day.
- Massive overdose caused death from cardiotoxicity.
- Location: Dana Farber Cancer Institute, Boston, Mass.
What is Wrong with the 'Old Model'?
- "Physicians prescribe, and pharmacists dispense" model is inadequate.
- Poor accountability.
- High healthcare costs from medication errors.
- Hospitalizations, doctor visits, lab tests, and remedial therapy.
- Adverse drug reactions.
- Non-compliance with medication regimens.
- Drug resistance.
Clinical Pharmacy and Pharmaceutical Care
- The old "Physicians Prescribe and Pharmacists Dispense" model is no longer sufficient.
- Goals: reduce drug therapy problems, ensure safety and effectiveness, ensure adherence to drug therapy.
- Proposed solution: concept of clinical pharmacy and pharmaceutical care
Clinical Pharmacy
- Defined as the area of pharmacy concerned with the science and practice of rational drug use.
- Includes services performed by pharmacists in hospitals, community pharmacies, home-based care services, clinics and other settings where prescriptions/medication are prescribed and used.
Pharmaceutical Care
- Defined as a patient-centered practice in 1997 where a practitioner assumes responsibility for a patient's drug needs.
- Key responsibility to optimize all aspects of a patient's drug treatment irrespective of sources.
- Ensures better patient outcomes and improved quality of life.
- This involves collaboration with other healthcare providers.
- Goal is to identify, solve, and prevent drug therapy problems.
Aim of Pharmaceutical Care
- Cure disease.
- Eliminate/Reduce symptoms.
- Stop/slow disease process.
- Prevent disease/symptoms.
- Pharmacist Responsibilities:
- Ensure access to advice.
- Ensure quality drug products.
- Ensure rational drug use.
- Empower patients to manage their health and treatment.
Pharmaceutical Care: Practitioner Actions
- Applies expert pharmacotherapeutic knowledge in practice to benefit the patient.
- Takes responsibility for optimizing a patient's drug therapy regardless of its source to achieve better outcomes and improve patient's quality of life.
- Collaborative effort with other healthcare providers.
- Uses a rational decision-making process.
Pharmaceutical Care: Practitioner Actions (cont.)
- Makes assessments of a patient's drug-related needs to identify drug therapy problems.
- Develops care plans.
- Conducts follow-up evaluations to ensure effectiveness and safety of drug therapies.
Pharmaceutical Care: Patient-Related Needs
- All patients have drug-related needs.
- Assessment includes the patient, medical conditions, and drug therapies to see if needs are met.
- Drug-related needs: indication, effectiveness, safety, compliance
Pharmaceutical Care: Medication Appropriateness
- The medication is appropriate when there is a valid clinical indication.
- All the patient's medical conditions that can benefit from drug therapy have been identified.
Pharmaceutical Care: Medication Effectiveness
- The most effective drug product should be utilized.
- The dosage should be sufficient to achieve the therapy goals.
Pharmaceutical Care: Medication Safety
- There should be no adverse drug reactions.
- There should be no signs of toxicity.
- Patient is willing and able to take medications as intended.
- Missing these needs can cause drug therapy problems.
Pharmaceutical Care: Practitioner Responsibilities
- Prevent drug therapy problems.
- Resolve drug therapy problems with the patient.
- Ensure therapy goals are achieved.
- Develops care plans for each medical condition.
Pharmaceutical Care: Complementing Existing Practices
- The goal is to complement existing practices to optimize and improve drug therapy safety and effectiveness.
- The pharmaceutical care practitioner is not intended to replace any other healthcare professional, but a new element of care within the system.
Why Pharmaceutical Care Practitioners Are Needed
- Complexities in drug therapy.
- Multiple products used.
- Overwhelming drug information.
- Multiple practitioners prescribing for the same patient.
- Increased patient involvement in therapy selection.
New Roles and Skills Required for Pharmaceutical Care
- Medical terminology, clinical use of drugs in disease, and patients' management.
- Pathophysiology and therapeutics.
- Therapeutic problem-solving.
- Communication (verbal and written).
- Literature evaluation.
Clinical Pharmacy Service in Ethiopia
- Pharmaceutical care is a primary role of a pharmacist or clinical pharmacist as a full-time career.
- Pharmacists are trained for 5 years, focusing on pharmacology, pharmacotherapy, and pharmaceutical care practices.
- Old curricula: focus on pharmacotherapy, clinical, and hospital pharmacy.
- New curricula introduced in 2008, nation wide.
Clinical Pharmacy Service in Ethiopia (cont.)
- Revised curricula (2008, 2015) are more patient-oriented, including pharmacy UG curriculum (4 years + 1-year internship).
Clinical Pharmacy Service in Ethiopia (cont.): FHRIG 2010
- Clinical pharmacists provide advice to doctors and nurses on the clinical use of medications, and economic drug utilization and safety.
- Direct patient care
Clinical Pharmacy Service in Ethiopia: FMHACA
- Pharmacists provide effective medication therapy management.
- Management of patient medication therapy.
- Education of clients on health-related issues.
- Participation in patient care regarding pharmacotherapy.
- Standard operating procedures related to providing clinical pharmacy services.
Pharmacotherapy Workup
- All patient care practitioners need a structured, rational thought process for making clinical decisions.
- The pharmacotherapy workup guides the decision-making process done by the clinician to assess patients' drug-related needs and identify drug therapy problems.
Pharmacotherapy Workup (cont.)
- Organizes interventions that need to be made on behalf of the patient.
- Establishes parameters to evaluate follow-up.
- Applies clinical knowledge and skills with a systematic thought process, for identification, stating the causes, prioritization, problem solving, and prevention of drug therapy issues.
Patient Care Process
- The patient care process describes the interaction between the patient and the practitioner.
- It is a guide, standard, descriptive method of the practitioner's work, and it allows for rational decisions.
Patient Care Process (cont.)
- A systematic approach involves four processes:
- Assessing drug therapy needs and identifies DTPs
- Developing a care plan
- Implementing the care plan
- Evaluating and reviewing the care plan.
Patient Care Process (cont.)
- Quality of assessment: depends on the relationship you establish.
- Success of the care plan is a result of the performed assessment.
- Outcomes the patient achieves are based on the decisions made.
Assessment
- A systematic review of a patient's drug-related needs.
- Understand the patient well enough to make rational drug decisions with and for them.
- Determine if the patient's drug therapy is appropriate, effective, and safe, and if the patient is compliant with his/her medications.
Assessment (cont.)
- Information required includes:
- Patient data (demographics, medication experience)
- Disease data (current conditions, history, review of systems, nutrition)
- Drug data (current meds, past use, social drug use, immunizations, allergies)
Assessment Activities
- Elicit information from the patient.
- Make clinical decisions regarding medications and needs.
- Establish a therapeutic relationship.
- Discuss the patient's medication experience.
Assessment (cont.)
- Medication experience: it includes the patient's approach to taking medication, beliefs, perceptions, attitudes, and behaviors towards drug therapy.
- Assessment involves effective communication with patients; caregivers or relatives; communicate with other health care team members; review/examination of patient records; consistently assess drug-related needs with the same systematic order
Case Studies
- Case Study 1: Patient with congestive heart failure developed bradycardia and a second-degree heart block due to unsafe drug therapy (high digoxin dose/drug interactions).
- Case Study 2: Patient with hypertension was found to be pregnant, and the therapy (ACE inhibitors) is undesirable during pregnancy.
- Case Study 3: Patient with TB was prescribed a drug therapy with a low dose.
- Case Study 4: Patient with asthma has good inhalation techniques.
Common Causes of Drug Therapy Problems (DTPs)
- Need for additional therapy.
- Indication, multiple drugs, nondrug methods, avoidable adverse reactions.
- Effectiveness: wrong drug, not effective for condition, inappropriate dosage form, inaccurate dose.
- Safety: undesirable reaction (not dose-related); safer drug needed because of risk factors; dosing regimen changed too rapidly.
- Compliance: misunderstand or unable to follow instructions.
Developing a Care Plan
- Purpose is to organize work to meet the goals.
- Organize care plans/medical conditions.
- Establish therapy goals.
- Goals consist of a parameter, a value, and a timeframe.
Developing a Care Plan (cont.)
- Negotiate and agree upon endpoints and timeframe.
Developing a Care Plan (cont.)
- Select appropriate, individualized interventions to get desired results, and prevent new problems.
Follow-up Evaluation
- Evidence of actual patient outcomes and goals.
- Effectiveness.
- Safety (adverse drug reactions).
- Patient compliance.
Follow-up Evaluation (cont.)
- Document the clinical status and any changes.
- Assess for new DTPs (Drug Therapy Problems).
- Schedule the next follow-up evaluation.
- Clinical knowledge and experience.
Outcomes Status Terminologies
- Resolved: Goals achieved, therapy completed
- Stable: Goals achieved, continue therapy.
- Improved: Progress being made, continue same therapy.
- Partial Improvement: Progress made, minor adjustments required.
- Unimproved: No progress yet, continue same therapy.
- Worsened: Decline in health, adjust therapy.
- Failure: Goals not achieved, discontinue current therapy, initiate new therapy.
- Expired: Patient died while receiving the therapy.
Documentation
- Pharmaceutical care record/chart records information used, decisions made, and outcomes.
- Document all care, advice, services, and information given to the patient.
Reasons for Documentation
- High quality care; performance evaluation; justifies professional role; effectively manages large practices.
- Evaluate quantity and quality of care; evaluate economic impact; source of data in research/education.
Summary
- Lecture summary not provided in the given text, only the prompt.
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Description
Test your knowledge on the essentials of pharmaceutical care practice and the significant roles pharmacists play in patient care and clinical services. This quiz covers the evolution of clinical pharmacy in Ethiopia, the importance of proper medication management, and explores a critical case study in patient safety.
