Published on November 10, 2014
4th years, this is the slides covered for the 11/10. its a continuation from the first lecture we did.
1. Clinical pharmacy 11/10/14 LECTURE
2. Practice Guidelines for Pharmacotherapy Specialists • The pharmacotherapy specialist designs, implements, monitors, evaluates, and modifies patient pharmacotherapy to ensure effective, safe and economical patient care. A Position Statement of the American College of Clinical Pharmacy
3. Practice Guidelines for Pharmacotherapy Specialists – The pharmacotherapy specialist retrieves , analyzes, evaluates, and interprets the scientific literature as a means of providing patient- and population-specific drug information to health professionals and patients A Position Statement of the American College of Clinical Pharmacy
4. Practice Guidelines for Pharmacotherapy Specialists • The pharmacotherapy specialist participates in the generation of new knowledge relevant to the practice of pharmacotherapy, clinical pharmacy and medicine • The pharmacotherapy specialist educate health care professionals and students, patients, and the public regarding rational drug therapy • The pharmacotherapy specialist continually develops his/her knowledge and skills in applicable practice areas and demonstrates a commitment to continued professional growth by engaging in a lifelong process. A Position Statement of the American College of Clinical Pharmacy
5. Rational Drug Therapy Basically follows the Rule of Rights, RIGHT PATIENT, RIGHT DRUG, RIGHT DOSAGE AND ADMINISTRATION AND RIGHT FREQUENCY. Factors that will provide rational drug therapy: 1. Having strong distribution system 2. Putting the knowledge in action thru pxs 3. Clinical experience 4. Role models
6. Rational use of drug S afe A ffordable N eeded E ffective Q uality
7. Rule of right: • Right drug • Right patient • Right dose • Right time • Right duration • Right route of administration • Right information • Right price
8. GOAL Outcome Therapeutic Effects Adverse Effects
9. Clinical pharmacokinetics Clinical pharmacokinetics is the process of applying pharmacokinetic principles to determine the dosage regimens of specific drug products for specific patients to maximize pharmacotherapeutic effects and minimize toxic effects. TDM stands for therapeutic drug monitoring
10. Clinical pharmacokinetics • Application of these principles requires an understanding of the absorption, distribution, metabolism, and excretion characteristics of specific drug products in specific diseases and patient populations
11. Drugs that can be monitored • when the range between minimal effectiveness and toxicity is narrow • the results of the drug assay provide significant information for clinical decision-making.
12. Drug Concentration measurement is USEFUL in research since this will be predictive of therapeutic or toxic effects.
13. Why request TDM? • Noncompliance • Inappropriate dosage • Poor bioavailability • Drug interaction • Kidney and liver disese • Altered protien binding • Fever • Cytokines • Genetically determined fast or slow metabolizers
14. Responsibilities • Designing patient-specific drug dosage regimens • Recommending or scheduling measurements of drug concentrations in biological fluids • Monitoring and adjusting dosage regimens • Evaluating unusual patient responses to drug therapy for possible pharmacokinetic and pharmacologic explanations.
15. Responsibilities • 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 patient’s health record.
16. Responsibilities • Educating pharmacists, physicians, nurses, and other clinical practitioners about pharmacokinetic principles and appropriate indications for clinical pharmacokinetic monitoring, including the cost-effective use of drug concentration measurements.
17. Responsibilities • Developing quality assurance programs for documenting improved patient outcomes and economic benefits • Promoting collaborative relationships with other individuals and departments involved in drug therapy
18. Responsibilities Pharmacists with specialized education, training, or experience may have the opportunity to assume the following additional responsibilities: 1. Designing and conducting research 2. Developing and applying computer programs and point-of-care information systems to enhance the accuracy and sophistication of pharmacokinetic modeling and applications to pharmaceutical care.
19. Responsibilities 3. Serving as an expert consultant to pharmacists with a general background in clinical pharmacokinetic monitoring.
20. Example of Drugs for TDM • Valproic acid • Quinidine • Procainamide • Cyclosporine • Aminoglycoside • Phenytoin • Phenobarbital • Digoxin
21. Clinicians Approach to TDM
22. Is therapy appropriate? NO Yes Is a less toxic alternative Available? Re-evaluate therapy NO Yes Is immediate effect Requires/ expected? Use less toxic agent that does not require drug conc monitoring Yes NO Dosing estimations should Lean towards a higher dose Rather than lower dose Start w/ a low dose And slowly titrate upward
23. Are drug conc measurements predictive Of drug efficacy or toxicity? Yes NO Can the efficacy or toxicity be measured by immediate Clinical endpoints? Drug concentration monitoring likely only to Be beneficial for verifying adherence Yes NO Drug conc Monitoring indicated Drug conc monitoring Probably unnecessary