Ambulatory Care Pharmacy Fern Chau-Devera, PharmD

Role of an Ambulatory Care Pharmacist Interact with patients in an outpatient clinic setting for the management of chronic conditions under protocol Responsible for adjusting medication doses counseling patients on side effects of medications and the importance of medication adherence, and making therapy recommendations to prescribing physicians.

Patient MJ WHAT IS YOUR PLAN? MJ is a 68 year old male referred to you by Dr. Smith to manage high blood pressure. Past Medical History Hypertension Diabetes Cholesterol Allergies Penicillin – rash Medications Lisinopril 20mg 1 tablet daily Hydrochlorothiazide 25mg 1 tablet daily Simvastatin 40mg 1 tablet daily Metformin 500mg 1 tablet 2 times per day Vitals BP 175/92 HR 72 (4/5/12) BP 160/90 HR 69 (2/12/12) BP 150/85 HR 85 (1/6/12) Labs Scr 1.8 (kidney function) ALT 24 (liver function) WHAT IS YOUR PLAN?

What do you need to know? MJ is a 68 year old male referred to you by Dr. Smith to manage high blood pressure. Past Medical History Hypertension Diabetes Cholesterol Allergies Penicillin – rash Medications Lisinopril 20mg 1 tablet daily Hydrochlorothiazide 25mg 1 tablet daily Simvastatin 40mg 1 tablet daily Metformin 500mg 1 tablet 2 times per day Vitals BP 175/92 HR 72 (4/5/12) BP 160/90 HR 69 (2/12/12) BP 150/85 HR 85 (1/6/12) Labs Scr 1.8 (kidney function) ALT 24 (liver function) ASSESSMENT / PLAN: BP goal is < 130/80 Combine lisinopril and hydrochlorothiazide into 1 pill called prinzide Start atenolol 25mg 1 tablet daily. Monitor heart rate Start aspirin 81mg 1 tablet daily for heart protection Continue all other medications Recheck BP in 4 weeks What is MJ’s blood pressure goal? Does he exercise? How often? Eat excessive salty foods? What blood pressure medications to avoid with penicillin allergy? What are these medications and for what conditions? Any interactions? Duplicates? Safe for elderly? Adherent to therapy? Experiencing side effects? Follow recommended treatment guidelines? Cost savings opportunities? Reduce quantity of medications? What do these lab results mean? Are medications safe given this labs?

What settings do Ambulatory Care Pharmacists Work? Internal medicine Oncology Nephrology Gastrointestinal Endocrine HIV Chronic Pain Hospice Much more…

Why choose Ambulatory Care? Manage chronic conditions and educate patients Build great working relationships with physicians, nurses, medical assistants Develop expertise in a specialized area

The road to Ambulatory Care Pharmacy School (3-4yrs) AND Residency (1 year)