Farmasi Klinis Dr. Yusi Anggriani, M.Kes, Apt Sesilia Andriani K, M.Pharm, Apt Mita Restinia, S.Farm, M.Pharm, Apt
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Farmasi Klinis
Dr. Yusi Anggriani, M.Kes, Apt
Sesilia Andriani K, M.Pharm, Apt
Mita Restinia, S.Farm, M.Pharm, Apt
Topics
Introduction1
Pharmaceutical Care Plan2
Evaluation of the References3
Laboratory Data Interpretation4
Clinical Pharmacokinetic5
Case Study6
Sess
ion
1Sess
ion
2
Clinical Pharmacy
2. Drug Product selection
3. Drug Therapy Monitoring
4. Patient communication
6. Education
7. Research
Clinical
Pharmacy
1. Drug Information
8. Miscellaneous
5. Drug Distribution & administration
Drug Information
Goal of clinical pharmacists in providing drug information: To contribute to patient care and optimize drug therapy.
Information and advice may be provided verbally and or in written form to persons involved in the prescribing, administration or consumption of drugs.
It should be at level appropriate to the particular situation.
Drug Information : Basic Requirement
To provide accurate drug information,clinical pharmacists require:
1. An understanding of the abilityto efficiently use the resourcesavailable for drug informationretrieval
2. Knowledge of and competence inthe evaluation, critical selection,and utilization of relevantliterature
3. Awareness of external druginformation resources,
4. Competence in interpersonalcommunication techniques
Phases of providing drug information
1 2 3 4
History
and
nature of
enquire
Information
retrieval
and
Evaluation
Response Follow up
Phases of providing drug information
1. History and nature of enquire
• Obtain the necessary patient information and circumstances surrounding the enquiry. This is essential to clarify the enquiry and provide a specific response. Determine the urgency of the enquiry. Priority should be given to enquiries regarding patient care.
Phases of providing drug information
2. Information retrieval and evaluation
• Answer the request at the time of the enquiry if
confident that the information is accurate and
sufficient.
• If the enquiry requires research:
• systematically retrieve information using the
resources available
• evaluate the information obtained in an accurate
and balanced manner
• consult with specialist in the field of enquiry or
refer to drug information centers, as appropriate
Phases of providing drug information
3. Response
• Using the information retrieved
• Formulate a replay which appropriately meets the specific needs of the enquirer take into account the clinical circumstances
• Communicate the response in verbal and/or written form. Provide references and record in patient document
• Document enquiry in pharmacy records
Phases of providing drug information
4. Follow up
• Follow up previously communicated responses, particularly patient specific enquiry, to determine
• Response supplied was sufficient
• Further assistance is required
Drug Product Selection
The Clinical pharmacist must be able to offer advice to
prescribes and, where appropriate, other health profesionals,
and patients regarding:
1. The appropriateness of a
drug in the treatment of a
disease state at any given
patients
2. The appropriate dosage and
dosage form for a patient,
taking into account all factors
which might influences such
option
3. The availability of selected
drug product both in the
hospital and the community
4. The cost of the drug product
selected
5. The adverse effects that may
be encountered during
treatment and the mean of
minimizing these
6. Possible interaction and
incompatibilities with other
drugs, foods and laboratory
tests.
Drug product selection
Medicine
FactorPatient
Factor
When providing advice on drug therapy
selection, the clinical pharmacist should
consider and review the above factors.
Medicines Factor
Efficacy of the drug in the management of particular disease or symptom:
Comparative efficacy of therapeutic alternatives
Adverse effect of the drug and comparison with therapeutic alternatives: → relevance or adverse effects
→ ability to minimize adverse effects
Cost of drug therapy selected: → hospital cost - community cost
→ patient cost
→ cost of therapeutic alternatives
→ cost/benefit consideration
Pharmacokinetic & pharmacodynamic properties of drug
Route and methods of administration of the drug
Medicines Factor
Dosage form:
→ Comparative efficacy & adverse effectprofile of dosage forms available
→ Site of action required
→ Dose required
Availability of drug therapy selected
Ability to monitor drug therapy for therapeutic& adverse effect
Interaction with concurent medications &previous drug treatment, diet, laboratory test,environmental factors etc
Presentation & packaging
Working diagnosis
Goal of treatment
Physiological and pathophysiological characteristics; renal & hepatic function, cardiac status, age, weight, etc
Past medical history and recent progress
Past and current medication use, in particular the use and effect of therapeutic alternatives
Contraindications to the use of a particular drug
History of allergy and adverse effects
Socio-economic and demographic consideration
Patient acceptability
Patient compliance, cooperation and convenience
Special consideration; eg dysphagia, nasogastric suction, nasogastric tube feeding, nasoenteric tube feeding, vomiting, intravenous access, etc
Patient Factors
The application of pharmacology,
pharmacokinetics, genetics,
pathology and clinical medicine to
interpretation and use of
measured drug concentrations
Therapeutic Drug Monitoring (TDM)
Therapeutic Drug Monitoring (TDM)
Identification of patients required TDM Patients receiving drug that require particular attention:
Narrow therapeutic window
High incidence of side effect
Produce clinically significant interaction
Patient diagnosed with drug induce reaction/hypersensitivity
Multiple iv therapy
Newly marketed drug
Patient Communication & counseling
1. Obtain from patients accurate drug use histories
• Prescription & non prescription drugs
• Drugs of abuse, alcohol, smoking
• Exposure to industrial, domestic or environmental chemicals
• Allergy history
2. Identify drug brought into hospital by the patient
3. Counsel patient on:
• Medication to be self-administered in the hospital or at home
• Discharge medication
• Non prescription drug
4. Asses patient compliance with medication & recommend and
institute suitable action to improve patient compliance
Drug distribution and administration
The pharmacist coordinate and supervise the
distribution and administration of drugs :
Ensure correct
storage of drug in the
ward
Sort out any supply
problem
Monitor ward drug
use
Organize ward stock
changes
Recycle drug at
ward level
Drug distribution & administration
Review and interpret all medication orders with
regard to the following:
Legibility & legality
of prescription
Use of approve drug
name
Appropriate dosageAppropriate dosage
schedule
Suitable route of
administration
Appropriate time of
administration
Correct
administration
records
Education
The clinical pharmacist must be able to provide and participate in educational programs for: pharmacist, medical
staff, nursing staff, paramedical staff and general public
Educational activities are:
Drug therapy rounds; pharmacist accompanies a nurse on a
drug administration round to provide advise on drug action,
adverse effect, administration details etc.
Medical officer round; participation on medical officer round
may provide a useful avenue of pharmacist input and provide
useful learning environment for the pharmacist
Ward based tutorial; presentation of current drug information
to ward staff.
Research
The clinical pharmacist should initiate and participate in research activities
whenever possible.
Research may be practice based such as Drug Utilization Review (DUR), Clinical trial participation, procedural studies.
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