Clinical Pharmacy Practice Lecture 3 PDF

CLINICAL PHARMACY PRACTICE NOHA ALAA HAMDY, PHARM D, PHD ASSOC. PROF. OF CLINICAL PHARMACY FACULTY OF PHARMACY ALEXANDRIA UNIVERSITY NOHA ALAA, PHARMD, PHD 1  LECTURE 3 DRUG PRESCRIBING NOHA ALAA, PHARMD, PHD 2  INTENDED LEARNING OUTCOMES: At the end of thi...

CLINICAL PHARMACY PRACTICE NOHA ALAA HAMDY, PHARM D, PHD ASSOC. PROF. OF CLINICAL PHARMACY FACULTY OF PHARMACY ALEXANDRIA UNIVERSITY NOHA ALAA, PHARMD, PHD 1  LECTURE 3 DRUG PRESCRIBING NOHA ALAA, PHARMD, PHD 2  INTENDED LEARNING OUTCOMES: At the end of this lecture, you will be able to:  Identify elements in Case assessment  Mention some examples how to select drug therapy.  Understand the concepts of diseases management (as blended learning). NOHA ALAA, PHARMD, PHD 3  Patient History Clinical Examination & Diagnosis by Lab investigations Physician Clinical Guidelines or Evidence-based Prescribing and Drug NO selection YES Dose Calculation & Administration Guidelines according to Precautions BW or BSA YES According to Kidney or Need adjustment Liver function NO Monitoring YES ADR, Drug Interaction, disease Parameters complication to be followed NO Patient Education & improving patient Adherence Discuss supportive measures According to Guidelines T.A. NOHA ALAA Follow up of Care Plan 4  Goal of Treatment American Diabetes Association Recommendations A1c* < 7.0% Before Meal Glucose Level 80-130 mg/dl NOHA ALAA, PHARMD, PHD After Meal Glucose Level < 180 mg/dl 5  DIAGNOSIS OF DIABETES NOHA ALAA, PHARMD, PHD 6  Patient History Clinical Examination & Diagnosis by Lab investigations Physician Clinical Guidelines or Evidence-based NO Prescribing YES Dose Calculation & Administration Guidelines according to Precautions BW or BSA YES According to Kidney or Need adjustment Liver function NO Monitoring YES ADR, Drug Interaction, disease Parameters complication to be followed NO Patient Education & improving patient Adherence Discuss supportive measures According to Guidelines T.A. NOHA ALAA Follow up of Care Plan 7  PRESCRIBING Drug selection Precautions of Dosage administration form Dose Drug interval Dose NOHA ALAA, PHARMD, PHD 8  Prescribing & Drug Selection  The choice of drug and drug therapy is usually made by the physician. However, many practitioners consult with the clinical pharmacist in drug product selection and dosage regimen design.  Drugs with similar therapeutic indications may differ in dose, pharmacokinetics…… The pharmacist may choose one drug over another based on many factors: 9 NOHA ALAA, PHARMD, PHD  Prescribing & FACTORS AFFECTING PRESCRIBING OR Drug DRUG SELECTION Selection Patient Factors Drug Factors  Age  Bioavailability & biopharmaceutics  Weight  Pharmacokinetics (including absorption,  Pathophysiology distribution and elimination)  Drug Interactions  Nutritional Status  Receptor sensitivity  Genetic Variability  Rapid or Slow metabolism  Gender 10 NOHA ALAA, PHARMD, PHD Patient Factors AGE NOHA ALAA, PHARMD, PHD 11 Patient Factors WEIGHT For diabetic patients (type II DM) For obese patients For non-obese patients Metformin is used initially Sulfonylureas (glimepiride, glyburide…..) In recent years, alternative medications for diabetes that are weight neutral or promote weight loss have become available. These medications include metformin, GLP-1 receptor agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors, and sodium- glucose cotransporter 2 (SGLT2) inhibitors. NOHA ALAA, PHARMD, PHD 12 Patient Factors PATHOPHYSIOLOGY (OTHER DISEASES) ▪ Liver disease e.g.High Dose MTX should be postponed when s.bilirubin > 5 mg/dl & ALT>450 U/L ▪ Renal disease e.g. Cisplatin is omitted if Cr.Cl.