concept of clinical pharmacy
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Concept Of Clinical Pharmacy
Kishori Kedia
Ashwini NitsureTanvi Shah
Pranjal Taskar
Dipesh Suvarna
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Objective
Define clinical pharmacy
Differentiate between traditional pharmacists role
and Clinical Pharmacist Explain the qualification required for clinical
pharmacists
List the clinical pharmacists responsibility
Describe the daily work activity of clinicalpharmacists
Define what is Therapeutic Drug Monitoring
Discuss the different types of Therapeutic DrugMonitoring
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Goal
To promote the correct and appropriate use of
medicinal products and devices.
These activities aim at:
maximising the clinical effect of medicines
minimising the risk of treatment-inducedadverse events
minimising the expenditures for
pharmacological treatments.
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What is the difference?
Clinical Pharmacy
Pharmaceutical care
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Pharmaceutical care
Pharmaceutical care is the direct, responsible
provision of medication-related care for the purpose of
achieving definite outcomesthat improve a patientsquality of life.
Cure of the disease
Elimination or reductio
of symptoms
Arrest or slowing of a
disease process
Prevention of disease
or symptoms
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Clinical Pharmacy
Clinical Pharmacy includes all the services
performed by pharmacists practising in
hospitals, community pharmacies, nursinghomes, home-based care services, clinics and
any other setting where medicines are
prescribed and used.
The term clinical does not necessarily imply
an activity implemented in a hospital setting.
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Clinical Pharmacy Requirements
Patientcare
Knowledge ofdrug therapy
Knowledge ofthe disease
Knowledge oflaboratory
and diagnosticskills
Communicationskills
Patientmonitoring
skills
Physicalassessment
skills
DrugInformation
Skills
Therapeuticplanning
skills
Knowledge ofnondrugtherapy
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Level of Action of Clinical
Pharmacists
Clinical pharmacy activities may influence
the correct use of medicines at three
different levels
before,
during and after the prescription is written.
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1. Before the prescription
Clinical trials
Formularies
Drug information
Drug-related policies
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2. During the prescription Counselling activity
Clinical pharmacists can influence the attitudes and priorities ofprescribers in their choice of correct treatments.
The clinical pharmacist monitors, detects and prevents
Medication related problems
The clinical pharmacist pays special attention to the dosage ofdrugs which need therapeutic monitoring.
Community pharmacists can also make prescription decisions
directly, when over the counter drugs are counselled.
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Medication-related Problems
Untreated indications. Improper drug selection.
Subtherapeutic dosage.
Medication Failure to receive
Medication Overdosage. Adverse drug reactions.
Drug interactions.
Medication use without indication.
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3. After the prescription
Counselling
Preparation of personalised formulation
Drug use evaluation
Outcome research
Pharmacoeconomic studies
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Activities of Clinical Pharmacists
The principle activities of a clinical pharmacist include:
ConsultingAnalysing therapies, advising health care practitionerson the correctness of drug therapy and providingpharmaceutical care to patients both at hospital and atcommunity level.
Selection of drugsDefining "drug formularies" or "limited lists of drugs" in
collaboration with hospital doctors, general practitionersand decision makers.
Drug informationSeeking information and critically evaluating scientificliterature; organising information services for both the
health care practitioners and the patients.
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Pharmacoeconomy
Using the results of clinical trials and outcome studies todetermine cost- effectiveness evaluations.
Teaching & TrainingPre- and post-graduate teaching and activities to providetraining and education programmes for pharmacists and otherhealth care practitioners
Pharmacokinetics/ therapeutic drug monitoringStudying the kinetics of drugs and optimising the dosage.
Clinical TrialsPlanning, evaluating and participating in clinical trials
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Responsibilities
Designing patient-specific drug dosageregimens
Recommending or scheduling measurements of drugconcentrations in biological fluids
Monitoring and adjusting dosage regimens
Evaluating unusual patient responses to drug therapyfor possible pharmacokinetic and pharmacologic
explanations.
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Communicating patient-specific drug therapy
information to physicians, nurses, and other clinical
practitioners and to patients orally and in writing,
and including documentation of this in the patientshealth record.
Educating pharmacists, physicians, nurses, and
other clinical practitioners about pharmacokineticprinciples and appropriate indications for clinical
pharmacokinetic monitoring, including the cost-
effective use of drug concentration measurements.
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Developing quality assurance programs for
documenting improved patient outcomes and
economic benefits
Promoting collaborative relationships with
other individuals and departments involved indrug therapy
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Pharmacists with specialized education, training, or
experience may have the opportunity to assume the followingadditional responsibilities:
1. Designing and conducting research
2. Developing and applying computer programs and point-of-careinformation systems to enhance the accuracy and sophisticationof pharmacokinetic modeling and applications to
pharmaceutical care.
3. Serving as an expert consultant to pharmacists with a general
background in clinical pharmacokinetic monitoring.
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Rational use of drugs
The rational use of drugs requires that:
patients receive medications appropriate
to their clinical needs,
in doses that meet their own individualrequirements
for an adequate period of time, and
at the lowest cost to them and their
community.
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Rational
Drug Use
Prescriber,
Dispenser &
their
workplaces
Drug Supply System
Patient &
community
Many Factors Influence Use ofMedicines
Policy, Legal and Regulatory
framework
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Therapeutic Drug Monitoring
Measure Serum Drug Levels
Narrow Therapeutic Drug Windows
Maximize Efficacy Minimize Toxicity
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Therapeutic Drug Monitoring
The need for TDM :-
Noncompliance
Inappropriate dosage Poor bioavailability
Drug interaction
Kidney and liver disese
Altered protien binding
Fever
Cytokines
Genetically determined fast or slow metabolizers
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Tdm used for:
1. Maximizing & speeding up efficacy
2. Minimizing toxicity
3. Patient's drug history uncertain
4. Poor response to initial Rx or deterioration after good response
5. When hepatic or renal function is changing
6. Antiepileptics: Phenobarbital, Phenytoin, Carbamazepine, Valproate
7. Cardiac Drugs : Digoxin*, Procainamide, Lidocaine
8. Psychoactive Drugs: Lithium, TCA
9. Analgesics: Aspirin, Paracetamol
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Clinical usefulness:
Maximizing efficacy
Avoiding toxicity
Identifying therapeutic failure
Facilitating adjustment of dosage.
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Clinical Pharmacy Practice areas
Ambulatory care
Critical care
Drug Information Geriatrics and longterm care
Internal medicine andsubspecialties
Cardiology
Endocrinology
Gastroenterology
Infectious disease
Neurology
Nephrology
Obstetrics and gynecology
Pulmonary disease Psychiatry
Rheumatology
Nuclear pharmacy
Nutrition
Pediatrics Pharmacokinetics
Surgery
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Outcome
With a growing but already wide range of medicines and the
increasing prevalence of chronic diseases in all countries
the best use of medicines is of growing importance. Some
of the outcomes of clinical pharmacy and the best use ofmedicines are
Better patient health outcomes
Better patient medication understanding
Better patient medication usage
Decreased cost to the government and patient (decreased
use of unnecessary medicines, decreased risk of hospital
admissions from medication issues)
Increased availability of medicines (medicines are used on
only the people who need them).
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Concluding..
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THANK YOU..!!