1. Ambulatory Care Pharmacy
Fern Chau-Devera, PharmD

2. 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.

3. 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?

4. 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?

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

6. 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

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