this is pharmacotherapy one

1. PHARMACOTHERAPY-I
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Yohannes W (B.Pharm, MSc in Clinical Pharmacy)
Department of Clinical Pharmacy and Pharmacy Practice
School of Pharmacy, CMHS, Mizan Tepi University

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What is Pharmacotherapy ?

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Introduction
Pharmacotherapy is the treatment of a disorder or disease
with medication.
 Crucial to provide patient-centered services that promote the
appropriate selection and utilization of medications.
 It helps to optimize individual therapeutic outcomes.
 The Pharmacotherapy Workup is a process that guide the
patient's drug-related needs and identifies drug therapy
problems

4. Introduction ..........
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 It helps to determine a patient's drug therapy is appropriately
indicated, effective, and safe
 determine if the patient is being compliant.
 Pharmacotherapy helps to elicit vast amounts of patient-
specific information, pharmacological data, and optimal
therapeutic approaches as needed.

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Clinical Pharmacists in patient care

6. Clinical Pharmacists in patient care
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In patient care process, clinical pharmacists provide pharmaceutical
care.
Pharmaceutical care is the responsible provision of drug therapy for
the purpose of achieving definite outcomes that improve or maintain a
patient’s quality of life.
Clinical pharmacists have three basic objectives in the patient care
process.
assessment
care plan
follow up and evaluation

7. The patient care process
What does my
patient want and
need?
What am I going to
do for my patient?
How will we know
if it is working?
Continuous Follow-up
ASSESSMENT CARE PLAN EVALUATION

8. Patient assessment
 is to determine if a patient's drug-related needs are being met
and if any drug therapy problems are present
 In order to do this the pharmaceutical care practitioner
 collects, analyzes, and interprets information about the patient, the
patient's medical conditions, and the patient's drug therapies
 Patients can have drug-related needs whether they are taking
medications or not

9. The Patient's Medication Experience
Definition:
 The patient's medication experience is the sum of all the events a
patient has in his/her lifetime that involve drug therapy.
 This is the patient's personal experience with medications.
 This lived experience shapes the patient's attitudes, beliefs, and
preferences about drug therapy.
 It is these characteristics that principally determine a patient's
medication taking behavior

10. Components of the Medication Experience
 The patient’s description of the medication experience
The medication history
The current medication record

11. Subjective and Objective Data
 Pharmaceutical care practitioners collect two types of data to help them
evaluate and manage patients’ drug therapy:
 Subjective data
 Is data that cannot be measured directly and may not always be accurate or reproducible.
 Most of the data that the pharmacist collects directly from patients, such as medical history,
are subjective.
 Objective data
 are measurable and observable, and are not influenced by emotion or prejudice.
 Much objective information is numerical.

13. Drug Therapy Problems (DTPs)
 A DTP is defined as an ‘event or circumstance involving a
patient’s drug treatment that
actually, or potentially, interferes with the achievement of an optimal
therapeutic outcome.
 The identification, resolution, and prevention of drug therapy
problems are the heart and soul of pharmaceutical care practice

14. Drug-related needs Categories of drug therapy
problems
INDICATION 1. Unnecessary drug therapy
2. Needs additional drug therapy
EFFECTIVENESS 3. Ineffective drug
4. Dosage too low
SAFETY 5. Adverse drug reaction
6. Dosage too high
COMPLIANCE 7. Noncompliance
Description of Drug Therapy Problem Categories

15. Drug therapy problem Common causes of drug therapy problems
Unnecessary drug
therapy
There is no valid medical indication for the drug therapy at this time.
Multiple drug products are being used for a condition that requires single
drug therapy.
The medical condition is more appropriately treated with nondrug therapy.
Drug therapy is being taken to treat an avoidable adverse reaction
associated with another medication.
Drug abuse, alcohol use, or smoking is causing the problem.
Need for additional drug
therapy
A medical condition requires the initiation of drug therapy.
Preventive drug therapy is required to reduce the risk of developing a new
condition.
A medical condition requires additional pharmacotherapy to attain
synergistic or additive effects.
Ineffective drug The drug is not the most effective for the medical problem.
The medical condition is refractory to the drug product.
The dosage form of the drug product is inappropriate.
The drug product is not an effective product for the indication being treated.

16. Dosage too low The dose is too low to produce the desired response.
The dosage interval is too infrequent to produce the desired response.
A drug interaction reduces the amount of active drug available.
The duration of drug therapy is too short to produce the desired response.
Adverse drug reaction The drug product causes an undesirable reaction that is not dose-related.
A safer drug product is required due to risk factors.
A drug interaction causes an undesirable reaction that is not dose-related.
The dosage regimen was administered or changed too rapidly.
The drug product causes an allergic reaction.
The drug product is contraindicated due to risk factors.

17. Dosage too high Dose is too high.
The dosing frequency is too short.
The duration of drug therapy is too long.
A drug interaction occurs resulting in a toxic reaction to the drug
product.
The dose of the drug was administered too rapidly.
Noncompliance The patient does not understand the instructions.
The patient prefers not to take the medication.
The patient forgets to take the medication.
The drug product is too expensive for the patient.
The patient cannot swallow or self-administer the drug product
appropriately.
The drug product is not available for the patient.

18. Identifying Drug Therapy Problems
 The Process Used to Identify Whether or Not the Patient Is
Experiencing a Drug Therapy Problem
 Requires a Continuous Assessment of Four Logical Questions:
Does the patient have an indication for each of his/her drug
therapies, and is each of the patient's indications being treated
with drug therapy?
Are these drug therapies effective for his/her medical condition?
Are the drug therapies as safe as possible?
Is the patient able and willing to comply with the drug therapies
as instructed?

19. INDICATION
 Questions to consider
 Is there an untreated indication? Why?
 Does the patient need synergistic therapy to supplement
therapy already being administered?
 Does the patient need prophylactic therapy?
 Does each medication the patient is taking correlate with a
medical condition?

20. INDICATION
 Questions to consider……….
 Is the patient misusing medication, whether unintentionally or
deliberately?
 Would nondrug therapy be preferable for any of the patient’s
conditions?
 Is the patient taking duplicate therapy without adequate
cause?
 Are any drugs being administered unnecessarily to treat
adverse effects

21. EFFECTIVENESS
 Questions to consider
 Are the dose, dosage interval, duration of therapy, and dosage
form appropriate for each medication the patient is taking?
 How long has the patient been receiving the current dose of
each medication?
 Is the patient responding appropriately to the drug?

22. SAFETY
 Questions to consider
 Is there evidence of adverse effects or drug allergies?
 Are the medications being stored properly and is any past expiration
dates?
 Are medications being administered correctly?
 Are there any potential or actual drug interactions?

23. COMPLIANCE
 Questions to consider
 Is the patient complying with drug therapy, and if not, why not?
 If the patient finds a therapy too expensive, what alternatives
are possible?
 What are the possible disadvantages to switching therapy?

24.  what is the most likely drug therapy problem(DTP)?
1) A child with chronic, persistent asthma is being treated with
nebulized albuterol treatments four times daily.
2) A patient who travels for work keeps his insulin in the car’s
glove compartment.

25. Actual and Potential Drug Therapy Problem
 An actual problem
 is one that has already occurred. Action should be taken to resolve it.
 A potential problem
 is one that is likely to occur. The necessary steps should be taken
prevent it. Before deciding to contact the prescribing physician, they
should consider how severe the consequences of the potential problem
could be.

26. Patients with No Drug Therapy Problems
 In cases when the patient does not have DTP, focuses on
assuring that the goals of therapy are being met and that the
patient is not at risk of developing any new problems.
 Providing continuous care and maintaining the desired goals of
therapy.
 Patients who have no drug therapy problem, require a care
plan and follow-up evaluation to ensure that goals of therapy
continue to be met and no new drug therapy problems develop.

27. CARE PLAN
A structure for working together with a patient and the practitioner to
work towards the same goals of therapy
Develop goals of therapy
Select interventions to achieve goals of therapy

28. Care plan……
 Establish goals including time frame to achieve
 Base on medical literature, agreed with patient
 Select interventions / alternative therapies to resolve and
prevent drug-therapy problems
 May include pharmacotherapy, lifestyle modifications…
 Schedule follow-up evaluation

30. Establishing Goals of Therapy
 Goals of therapy are necessary in order to produce and
document positive outcomes.
 For each medical condition, you and the patient must agree
upon clear and concise goals of therapy.

31. Establishing Goals of Therapy……
 It is important to note that patients often have multiple medical
conditions requiring drug therapy.
 Some conditions are acute and can be resolved with effective
drug therapy,
 while many are chronic disorders requiring long-term
pharmacotherapy management plans.
 Therefore, the pharmaceutical care practitioner constructs a
separate care plan for each indication.

32. Establishing Goals of Therapy….
The goals of drug therapy are to:
 Cure a disease
 Reduce or eliminate signs and/or symptoms
 Slow or halt the progression of a disease
 Prevent a disease
 Normalize laboratory values
 Assist in the diagnostic process

34. Interventions
 Develop a Care Plan that Includes Interventions to:
 Resolve Drug Therapy Problems,
 Achieve Goals of Therapy, and
 Prevent Drug Therapy Problems.

35. Interventions to Resolve Drug Therapy Problems
 The resolution of drug therapy problems is given highest
priority within a pharmaceutical care plan.
 Drug therapy problems need to be resolved because they
interfere with patients realizing their goals of therapy and
meeting their drug-related needs.

36. Interventions to Resolve Drug Therapy Problems….
 Interventions designed to resolve drug therapy problems
include the full spectrum of modifications in drug dosage
regimens.
 These might include initiating new drug therapy, changing the
drug product, altering the dose and/or the dosing interval, or
discontinuing drug therapy.

37. Interventions to Resolve Drug Therapy Problems….
 In pharmaceutical care practices, 75–80% of interventions to
resolve drug therapy problems are negotiated and agreed upon
directly between the patient and the practitioner.
 The original prescriber is involved in the remaining 20–25%
either through direct contact or via preapproved protocols or
collaborative practice agreements

38. Cost Considerations
 Cost is an important management issue, but effectiveness and
safety always take precedence in the decision-making process
of a clinician.
 After you have considered the evidence of efficacy and safety,
then convenience and cost considerations can be applied.

39. Cost Considerations…….
 The least expensive drug therapy is the one that is effective
and does not cause the patient harm.
 Any drug therapy that is ineffective for a patient or results in
toxicity is too expensive.

40. Follow-Up Evaluations
 Develop a Schedule to Follow-Up and Evaluate the
Effectiveness of Drug Therapies and Assess Any Adverse
Events Experienced by the Patient.

41. Follow-Up Evaluations….
Measurement Criteria
1. The clinical and laboratory parameters to evaluate effectiveness are
established, and a timeframe for collecting the relevant information is
selected.
2. The clinical and laboratory parameters that reflect the safety of the patient's
medications are selected, and a timeframe for collecting the relevant
information is determined.
3. A schedule for the follow-up evaluation is established with the patient.
4. The plan for follow-up evaluation is documented.

42. Follow-Up Evaluations……
 You have not provided pharmaceutical care unless and until
you have followed-up with your patient to determine what has
happened as a result of your clinical decisions, drug therapy
advice and care planning.
 Follow-up evaluations provide the evidence of effectiveness
and safety.

43. Follow-Up Evaluations…..
 During the follow-up evaluation, the practitioner is looking for evidence
of effectiveness, safety, and any new problems that may have
occurred since the last visit.
 At each follow-up, the practitioner is looking for good, bad, and new.
 In general, the good (effectiveness) comes in the form of the
disappearance of the signs and symptoms of the disease or illness.
The bad (safety) comes in the form of adverse and harmful effects
from drug therapies.

44. Follow-Up Evaluations…..
 The follow-up evaluations are the most productive times for
clinicians to learn which medications and which dosage
regimens are most effective, and which cause harm.
 If you want to learn about side effects, talk to your patients.
They will teach you about side effects.

45. Follow-Up Evaluations
 Pharmaceutical care practitioners must understand the impact
that drug therapies have on specific laboratory tests in order to
determine if they are effective.
 The timing of when to collect the sample for the laboratory test
is an important clinical decision.

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Thank you !