Pharmaceutical Care

Theory Lecture no. 1

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 Objective
• Define pharmaceutical care

• 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 clinical pharmacists

• Define what is Therapeutic Drug Monitoring

• Discuss the different types of Therapeutic Drug Monitoring

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 Definition
Pharmaceutical care is the responsible provision of drug
therapy for the purpose of achieving definite outcomes
that improve a patient's quality of life . These outcomes
are:
 cure of a disease;

 Elimination or reduction of a patient's symptomatology;

 Arresting or slowing of a disease process; or

 Preventing a disease or symptomatology. (1)

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 Definition
Pharmaceutical care involves the process through which a
pharmacist cooperates with a patient and other professionals in
o Designing

o Implementing, and

o Monitoring a therapeutic plan

that will produce specific therapeutic outcomes for the patient.
(1)

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 Definition
Pharmaceutical care involves three major functions:

 Identifying potential and actual drug-related problems;

 Resolving actual drug-related problems; and

 Preventing drug-related problems.

Pharmaceutical care is a necessary element of health care
and should be integrated with other elements.
Pharmaceutical care is, however, provided for the direct
benefit of the patient, and the pharmacist is responsible
directly to the patient for the quality of that care. (1)

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 Development and Scope of Clinical
Pharmacy
Clinical Pharmacy
Clinical pharmacy is defined as that area of pharmacy concerned
with the science and practice of rational medication use.
What is the difference between?

 &
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
outcomes that improve a patient’s quality of life.’’
 Cure of the disease

 Elimination or reduction 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, nursing homes, 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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How does clinical pharmacy differ
?from pharmacy
The discipline of pharmacy embraces the knowledge on
synthesis, chemistry and preparation of drugs

clinical pharmacy is more oriented to the analysis of

population needs with regards to medicines, ways of
administration, patterns of use and drugs effects on the
patients.

The focus of attention moves from the drug to the single

patient or population receiving drugs.

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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-induced adverse
events
minimising the expenditures for pharmacological
treatments.

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Clinical Pharmacy Requirements
Knowledge of
drug therapy

Knowledge of
nondrug Knowledge of
therapy the disease

Knowledge of
Therapeutic
laboratory
planning
and diagnostic
skills
Patient skills

care

Drug
Communication
Information
skills
Skills

Physical Patient
assessment monitoring
skills skills

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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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Before the prescription .1
Clinical trials

 Formularies

 Drug information

 drug-related policies

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During the prescription .2
Counselling activity

Clinical pharmacists can influence the attitudes and

priorities of prescribers 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 of drugs 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.
Sub therapeutic dosage.
Medication Failure to receive
Medication Overdosage.
 Adverse drug reactions.
Drug interactions.
Medication use without indication.

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After the prescription .3

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:

Consulting
Analysing therapies, advising health care practitioners
on the correctness of drug therapy and providing
pharmaceutical care to patients both at hospital and
at community level.
Selection of drugs
Defining "drug formularies" or "limited lists of drugs"
in collaboration with hospital doctors, general
practitioners and decision makers.
Drug information
Seeking information and critically evaluating
scientific literature; organising information services
for both the health care practitioners and the patients.
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 Activities of Clinical Pharmacists
Medication Review :
Review medication chart, Review medication history

Attending Rounds

Drug use studies and research

Drug use studies/ pharmacoepidemiology/ outcome
research/ pharmacovigilance and vigilance in medicinal
devices: collecting data on drug therapies, their costs
and patient outcome through structured and scientific
methods.

Pharmacokinetics/ therapeutic drug monitoring

Studying the kinetics of drugs and optimising the
dosage.
Clinical Trials
Planning, evaluating and participating in clinical trials
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 Activities of Clinical Pharmacists
.

Pharmacoeconomy

Using the results of clinical trials and outcome studies

to determine cost- effectiveness evaluations.

Teaching & Training

Pre- and post-graduate teaching and activities to

provide training and education programmes for
pharmacists and other health care practitioners

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 Information Sources
Medical record

Patient

Family

Health care team

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 Medical Records
•Admission Information •Diagnostic Procedures

•Initial history •Radiology

• physical examination •Surgery

•Progress notes •Orders

•Consultations •Medication

•Nursing notes • administration orders

•Laboratory data •Consent forms

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Clinical Pharmacy Practice Areas

 Ambulatory care  Nephrology

 Critical care  Obstetrics and gynecology
 Drug Information  Pulmonary disease
 Geriatrics and long –term care  Psychiatry
 Internal medicine and subspecialties  Rheumatology
 Cardiology  Nuclear pharmacy
 Endocrinology  Nutrition
 Gastroenterology  Pediatrics
 Infectious disease  Pharmacokinetics
 Neurology  Surgery

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 Practice Guidelines for
Pharmacotherapy Specialists

The pharmacotherapy specialist designs, implements,

monitors, evaluates, and modifies patient

pharmacotherapy to ensure effective, safe and economical
patient care.

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 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

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 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.

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How to Pursue a Profession in Clinical
Pharmacy in Saudi Arabia
 Pharm.D

Master Degree in clinical pharmacy

Residency with 3 years of training

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 Clinical pharmacokinetics
Clinical pharmacokinetics is the process of :

1. applying pharmacokinetic principles to determine the

dosage regimens of specific drug products for specific
patients
2. to maximize pharmacotherapeutic effects and
minimize toxic effects.

TDM stands for therapeutic drug monitoring

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 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

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 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.

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 Why request TDM?
 Noncompliance

 Inappropriate dosage

 Poor bioavailability

 Drug interaction

 Kidney and liver disease

 Altered protein binding

 Fever

 Cytokines

 Genetically determined fast or slow metabolizers

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 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.

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 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.

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.

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 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

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 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.

3. Serving as an expert consultant to pharmacists with a

general background in clinical pharmacokinetic
monitoring.

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 References
(1) Helper, D.D. & Strand, L.M., Opportunities and Responsibilities
in Pharmaceutical Care, Am.J. Pharm. Educ., 53, 7S-15S(1989).

(2) Karen Tietze., Clinical Skills for pharmacists: A patient focused

approach. 2012. Mosby Inc.

Additional:

PHARMACY What It Is and How It Works

WILLIAM N. KELLYCRC PRESS
Boca Raton London New York Washington, D.C.

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