4 Pharmacist’s Role Today In the past: Take Rx order, dispensing, distributing, patient counselling.Today, the role of pharmacists is becoming increasingly patient-oriented. Therefore, is not uncommon for patients to have pharmacists solely providing patient assessment.
5 Future Pharmacist’s Role Future: provide some level of primary careAdminister Vaccinations.Order lab tests.Engage in disease management activities, including make diagnoses of certain clinical conditions.Change dosage of Rx, change Rx order, prescribing.Dispensing OTC products.
6 The evolving role of the pharmacist Move from counting & dispensing medications, more toward focus on treatment & knowledge of the product.More patient interaction and patient counselling.Play key role in patient safety.A greater involvement in assisting patients with managing their disease states.A greater information source for the patient.
9 Pharmaceutical CareDefinition: the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life. (Hepler CD, Strand LM.1990)Cure of disease.Elimination or reduction of a patient’s symptom.Arresting or slowing of a disease process.Preventing a disease or symptom.
14 Sequence and Components for Presenting Information Gen: General Patient Information.CC: Chief Complaint.HPI: History of Present Illness.PMH: Past Medical History.FH: Family History.SH: Social History.Allergy History.MedHx: Medication History (Prescription and OTC ).ROS: Review of System.
15 Sequence and Components for Presenting Information PE: Physical ExamLab: Laboratory and diagnostic test resultsAdmission DiagnosisHospital CourseComplicationDischarge DiagnosisRecommendations & MedicationsS O A P
18 S O A P S： CC HPI PMH FH SH Allergy MedHx ROS P： Recommendations & MedicationsCC: Chief Complaint.HPI: History of Present Illness.PMH: Past Medical History.FH: Family History.SH: Social History.MedHx: Medication History.ROS: Review of System.PE：Physical ExamLab：Laboratory and diagnostic test resultsO：PELabsOperationA：Admission DiagnosisHospital CourseComplicationDischarge DiagnosisDrugs List
27 Name of DrugAdministration, dosage, frequency, duration of usageSpecial instruction.Storage.Self-monitoring.Chronic usage, refill information.Contraindication, caution.ADR, side effect.Drug-Drug, Drug-Disease, Drug-Food interaction.What to do if you forget one dose.
30 s Chief Complaint (CC): History of Present Illness (HPI) : --chest tightness and general weakness for 2 week.History of Present Illness (HPI) :--78 y/o female with history of HTN, heart disease, hyperuricemia, CKD suffered from chest tightness and general weakness for 2 week, intermittent chest pain, no radiation pain, no cold sweating, no dyspnea, orthopnea(-), no leg edema, heart burn(+), hoarseness(+), few cough for 2 days-> r/o GERD,no stool passage for 3 days, no abdominal pain.
31 Past Medical History s 過去六個月就診錄: 日期 科別 診斷 96/10/16 腎臟科 背痛、慢性腎衰竭、痛風 96/10/23腎臟內科背痛、慢性腎衰竭、痛風、自發性高血壓96/11/20心臟科自發性高血壓、焦慮狀態、痛風、高尿酸血症、失眠、眩暈96/11/22急診內科眩暈、自發性高血壓
32 Physical Examination O General appearance: --acute illness, nourished. Mental state:--alert and well-orientated.Vital sign:--T/P/R: 36.2 / 70 / 18, BP: 135 / 67 mmHgPerfusion and oxygenation:--warm extremities without cyanosis.HEENT:-- gross normal; pink conjunctiva, anicteric sclera.Anicteric 無黃疸的
33 Physical Examination O Neck: --supple; no palpable lymphadenopathy or thyroid nodules.Chest:--symmetric expansion; Breath sound: clear.Heart:--regular heart beats with systolic murmur.Abdomen:--no tenderness or muscle guarding, normoactive bowel sounds.Extremities:--free movable, but muscle weakness.Lymphadenopathy
38 AHospital CourseDue to EKG in ER showed normal, and no increase in troponin I lever, ACS was no likely.After admission, she was arranged PES which showed gastric ulcer, GERD and CLO(+).Triple therapy was prescribed.Medicine as CV OPD, laxative agents, sedative agents, and analgesic agents were prescribed too.EKG: electrocardiographACS: Acute Coronary SyndromsPES: PendoscopeCLO(+): Endoscopic biopsy for rapid urase assay.
46 A & P The elderly hypertensive patient (>60 years) : --CCB (Amlodipine Besylate) decrease vascular resistance, have no adverse effects in lipid levels, are good choices for elderly.--Even though elderly patients tend to have low plasma renin activity, ACEI and ARB (Valsartan) may be effective agents in this population.--Long-term studies have documented the safety and efficacy of BB (Bisoprolol), especially after acute MI.The hypertensive patient with coronary artery disease:--is at increased risk for unstable angina and MI, BB (Bisoprolol) may be used as first-line agents in these patients.The Washington Manual of Medical Therapeutics, 29th Edition
47 A & P Amlodipine Besylate --Dosage Oral: Hypertension: initial, 5 mg once daily; maintenance 5-10 mg once daily.Elderly, fragile, or small: for hypertension, or when adding to otherantihypertensive therapy starting dose 2.5 mg once daily.Bisoprolol:-- Dosage Oral:Hypertension (JNC 7): mg once daily.Elderly: initial,2.5 mg/day, may be increased by mg/day;maximum recommended dose, 20 mg/day.ClCr < 40 mL/min: Initial: 2.5mg/day.Valsartan:Hypertension: Initial: mg once daily ( In patients who arenot volume depleted ); maximum recommended dose: 320 mg/day.The Washington Manual of Medical Therapeutics, 29th EditionDrug Information Handbook, 13th Edition.Drug Facts and Comparisons, 2006.
49 A & P Reflux esophagitis: --symptomatology includes heartburn, dysphagia, chest pain, and variety of ear, nose, and throat symptoms (hoarseness, sore throat). The lower esophageal sphincter (LES, e.g., theophylline, CCBs, BB, nitrate, anticholinergics.) is the major barrier against reflux.Rabeprazole:--short-term (4-8 weeks) treatment and maintenance of erosive or ulcerative GERD with Helicobater pylori infection.Dosage Oral: Adults > 18 years and elderly:GERD: 20 mg once daily for 4-8 weeks; maintenance: 20 mg once daily.H. pylori eradication: 20 mg twice daily for 7 days; to be administered with amoxicillin 1000 mg and clarithromycin 500 mg, also given twice daily for 7 days. All 3 medications should be taken twice daily with the morning and evening meals.The Washington Manual of Medical Therapeutics, 29th EditionDrug Information Handbook, 13th Edition.Drug Facts and Comparisons, 2006.
63 Patient-oriented: For or interested in a particular type of person or thing. Patient assessment: The critical analysis and evaluation or judgement of the status or quality of particular condition, situation or other subject of appraisal.Patient safety:對於健康照護過程中引起的不良結果或損害所採取的避免、預防與改善措施。