Introduction to Clinical Pharmacy

What topics are covered in this course ? What are different stages in drug development Special emphasis on clinical development Drug Development DDI ADR Drugs used in special populations Rational Use of Drugs In depth review of this major role of pharmacist in healthcare Pharmacist as councilor What is TDM Role in treating patient Application TDM What is clinical pharmacy Concept

What is clinical pharmacy ? In short its is area of pharmacy concerned with the “Science and Practice of Rational medication use” Clinical Pharmacy is branch of pharmacy where pharmacist promote RATIONAL DRUG THERAPY that is SAFE, APPROPRIATE, COST EFFECTIVE

How did clinical pharmacy evolve SEPARATE ROLES FOR DOCTORS & PHARMACIST “PHARMACEUTICS” ROLE DOCTOR + PHARMACIST “CLINICAL” ROLE PURE “PHARMACEUTICS” ROLE

How did clinical pharmacy evolve 3 Major reasons for the evolution of clinical pharmacy No more formulator role Pharma companies take over the role as major formulator Only dispensing role left that can be given to tech Opportunity for pharmacist to utilize his expertise for clinical setting, improving patient care

How did clinical pharmacy evolve 3 Major reasons for the evolution of clinical pharmacy 2: Large increase products along with complexity Dramatic increase in number of drug products Increase in tech improvement, diagnosis, treatment Also requires parallel increase in knowledge for diverse areas Difficult for doctors to maintain expertise in “drug therapy” and “disease diagnosis and management” Opportunity for Pharmacist to support doctors here for safe & effective drug therapy

How did clinical pharmacy evolve 3 Major reasons for the evolution of clinical pharmacy 3: Promote Better Drug Usage Effectiveness, safety of drug depends on drug & HOW it is used as well Pharmacist can take this role as a guide to help doctors to optimize use of drugs This increases EFFICACY & Lowers SIDE EFFECTS

Pharmaceutical care Pharmaceutical care requires Rational & Safe drug Use In the new concept of pharmaceutical care , Patient Pharmacist Doctor Pharmacist directly interacts with patient & Doctor Takes Direct responsibility of patient care With Common goal >>>> Improving patient care !

Different Components of Pharmaceutical care Assessment of the patient Evaluation of medication therapy Development and implementation of a plan of care Follow-up evaluation and medication monitoring

Different Components of Pharmaceutical care Prioritize Patient Medication Needs Understanding/ interpreting Patient Data Medical History Review medical Records Assessment of the patient

Different Components of Pharmaceutical care Identify medication related problems Asses medication behavior , adherence Evaluate Effectiveness, safety, affordability Asses therapeutic Goals Evaluation of medication therapy

Different Components of Pharmaceutical care Establish pt specific parameters Educate patient on plan Formulate comp plan Review patients problem list Develop & Implement Plan of care

Different Components of Pharmaceutical care Modify, monitor care plan if needed Conduct ongoing asses & refine plan if needed Review updates on clin status Followup aligned with Med needs Follow up & Monitoring

Clinical pharmacy practice Clinical Pharmacy practice settings Hospitals Community based

Clinical practice in hospitals

Clinical role of pharmacist in hospitals Drug Therapy Selection Education program Right Dose Provide pts with right medication Therapeutic Drug Monitoring Drug Education Drug Use Evaluation

Clinical role of pharmacist in hospitals

Health care professionals MOST accessible to public Community Pharmacist Health care professionals MOST accessible to public

Major roles of community pharmacist PROCESSING OF PRESCRIPTIONS Verify if prescription is LEGAL, SAFE, Appropriate Check Patient record before dispensing

Major roles of community pharmacist CARE OF PATIENTS Collect, Integrate Info on Patient drug history Counsel patient on dosing regimen, method administration Advise on precautions to be taken

Major roles of community pharmacist Monitoring of drug utilization Participate in monitoring drug use Analyze prescription use for patterns of Adverse events Responding to symptoms of Minor Ailments Provides advise to general public on minor ailments Can directly supply non-prescription medication

Major roles of community pharmacist Informing health care professionals and the public New drugs Evolving new information Health promotion Health related, drug-related topics

Role of Clinical Pharmacist in health care Drug Therapy Expert Objective, evidence based source of Information Ensure & Advance Rational Drug Therapy Unique set of knowledge & skills clinical pharmacist is recognized as providing a unique set of knowledge and skills to the health care system and is therefore qualified to assume the role of drug therapy expert Primary source of valid information and best use of medication

Community pharmacy role in india

Actual Case studies A 68-year-old man, was discharged from the hospital after a myocardial infarction (MI) 2 weeks ago. At the routine office visit, the patient is diagnosed with depression. His doctor considers prescribing a tricyclic antidepressant (TCA), but contacts his community pharmacist for a recommendation.

Actual Case studies Background of MI & Drug use in this condition: Studies suggest that 1 in 5 patients become depressed during their initial hospitalization for an MI, and that a significant number of patients experience continued depression 1 month or longer after discharge. Furthermore, the medical literature suggests an unfavorable association might exist between post-MI depression and cardiac-related mortality, implying that proper diagnosis and treatment are important.

Actual Case studies What are the guidelines: Physicians guidelines for the detection and management of post-MI depression recommend that post-MI patients with depression be treated with selective serotonin reuptake inhibitors (SSRIs) rather than TCAs. WHY? : This recommendation is based upon TCA's tendency to cause cardiac adverse effects, including heart rate and conduction disturbances.

Actual Case studies What in Pharmacist Recommendation: Based upon the proven efficacy and the lack of cardiac toxicity associated with SSRIs, SSRI (Fluoxetine, paroxetine etc.) be prescribed instead of a TCA (amitriptyline, imipramine etc.)

THANK YOU -PHARMA STREET