Lec 4.pdf

Pharmaceutical care plans (continued--------) Identify therapy recommendations: • • • • Drug selection. Dose and dosing frequency. Route of administration. Length of therapy. Case study – diabetes: Drug selection: • Oral antidiabetic agents: Sulphonylureas (e.g. gliclazide) or biguanides (e.g. me...

Pharmaceutical care plans (continued--------) Identify therapy recommendations: • • • • Drug selection. Dose and dosing frequency. Route of administration. Length of therapy. Case study – diabetes: Drug selection: • Oral antidiabetic agents: Sulphonylureas (e.g. gliclazide) or biguanides (e.g. metformin) • Insulin – short acting (e.g. insulin aspart) or intermediate acting (e.g. insulin zinc suspension). Dose and dosing frequency: • Insulin mixture or biphasic preparation (e.g. biphasic insulin aspart – 30% insulin aspart, 70% insulin aspart protamine). • Number of doses per day vs meal times. Route of administration: • Syringe vs injection device (pen). • Once the patient’s healthcare needs are defined and the pharmacotherapeutic goals established (pharmaceutical care issues), healthcare providers need to collaborate and go through a decision- making process to identify a therapeutic regimen which may include nonpharmacological approaches. • This therapeutic plan has to be verified and confirmed by different members of the healthcare professions. Patient monitoring: • Quantitative and qualitative parameters (i.e clinical assessment). • Define pharmacotherapeutic end-points. • Determine monitoring frequency. Case study – diabetes Patient monitoring: • Glucose control (blood glucose, HbA1c). • Assessment of quality of life. • Assessment of onset of side-effects due to medications (e.g. nausea, hypoglycemic attacks). Case study – cancer: Patient monitoring: • Use of pain scales to assess pain perception. • Assessment of quality of life. • Assessment of onset of side-effects due to medications (e.g. nausea, constipation). Example of pharmacist care plan in community pharmacy setting: üPatients with diabetes participate in monthly consultations with community pharmacists. üPharmacist contributes to education of the patient, clinical assessment and recommending referrals as necessary. Education: • Glucose and lipid management. • Training on self-monitoring blood glucose and interpretation of results. • Medication management. Clinical assessment: • Feet, skin, blood pressure, body weight. Follow-up and referral: • Referral as needed. Outcome measures: • • • • HbA1c. Home blood glucose measurements. Health-related quality-of-life measurement. Evaluation of patient satisfaction with pharmacy services. Summary: q Pharmaceutical care requires integration of clinical pharmacy knowledge which has a pharmaceutical science baseline within a multidisciplinary approach. q Pharmaceutical care is practiced in both primary and secondary care settings. q Documentation is required in the practice of pharmaceutical care: Patient profile, medication profile, laboratory tests and the pharmaceutical care plan. v Checks and changes to the pharmaceutical care plan are required to ensure quality assurance of the care provided. v Checks require patient monitoring using clinical cues such as patient interviews, laboratory markers, quantitative tools to establish disease progression, and occurrence of signs and symptoms. v Changes take place when there is modification of the original pharmaceutical care plan during plan verification, treatment monitoring and patient outcomes evaluation.