1. Introduction to Clinical Pharmacy

2. 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

3. 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

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

5. 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

6. 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

7. 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

8. 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 !

9. 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

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

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

12. 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

13. 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

14. Clinical pharmacy practice
Clinical Pharmacy practice settings
Hospitals
Community based

15. Clinical practice in hospitals

16. 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

17. Clinical role of pharmacist in hospitals

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

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

20. 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

21. 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

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

23. 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

24. Community pharmacy role in india

25. 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.

26. 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.

27. 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.

28. 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.)

29. THANK YOU -PHARMA STREET