Clinical pharmacy part 2
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Clinical Pharmacy Part 2 . Outline. Describe the activities of clinical pharmacists Define Therapeutic Drug Monitoring Discuss the pharmacist role in Therapeutic Drug Monitoring. Practice Guidelines for Pharmacotherapy Specialists. Guideline I

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Clinical Pharmacy Part 2

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Clinical pharmacy part 2

Clinical PharmacyPart 2


Outline

Outline

  • Describe the activities of clinical pharmacists

  • Define Therapeutic Drug Monitoring

  • Discuss the pharmacist role in Therapeutic Drug Monitoring


Practice guidelines for pharmacotherapy specialists

Practice Guidelines for Pharmacotherapy Specialists

Guideline I

  • The pharmacotherapy specialist designs, implements, monitors, evaluates, and modifies patient pharmacotherapy to ensure effective, safe, and economical patient care.

ACCP, Pharmacotherapy 2000;20(4):487–490


Guideline i assessment factors

Guideline I Assessment Factors

  • Collaborates with other health professionals to make therapeutic decisions such as drug and drug product selection, therapeutic drug monitoring, and drug dosing

  • Reviews patient records and orders regarding drug therapy and recommends and initiates changes as appropriate

  • Evaluates patients by means of interview and physical assessment to determine past & present medical history, past & present medication use, and response to therapy


Guideline i assessment factors1

Guideline I Assessment Factors

  • Utilizes available state-of-the-art knowledge and technology to assess, improve, and monitor drug therapy regimens

  • In conjunction with licensed medical practitioners, develops, manages, and assists in the implementation of pharmacotherapeutic protocols

  • Works with other health care providers and relevant committees to develop programs for improving drug use and quality of patient care


Practice guidelines for pharmacotherapy specialists1

Practice Guidelines for Pharmacotherapy Specialists

Guideline II

  • The pharmacotherapy specialist retrieves, analyzes, evaluates, and interprets the scientific literature as a means of providing patient- and population-specific drug information to health professionals and patients.


Guideline ii assessment factors

Guideline II Assessment Factors

  • Identifies and retrieves the best available information about pharmacotherapy by searching appropriate tertiary, secondary, and primary sources

  • Evaluates biomedical and pharmacoeconomic literature to determine criteria for optimal use and monitoring of therapeutic agents


Practice guidelines for pharmacotherapy specialists2

Practice Guidelines for Pharmacotherapy Specialists

Guideline III

  • The pharmacotherapy specialist participates in the generation of new knowledge relevant to the practice of pharmacotherapy, clinical pharmacy, and medicine.


Guideline iii assessment factors

Guideline III Assessment Factors

  • Identifies pharmacotherapeutic questions to be studied or problems to be solved

  • Develops, implements, evaluates, and participates in scientifically valid and ethically designed studies

  • Collects data regarding the outcomes of patients managed by the pharmacotherapist

  • Presents research results at scientific meetings and publishes results in the scientific literature


Practice guidelines for pharmacotherapy specialists3

Practice Guidelines for Pharmacotherapy Specialists

Guideline IV

  • The pharmacotherapy specialist educates health care professionals and students, patients, and the public regarding rational drug therapy.


Guideline iv assessment factors

Guideline IV Assessment Factors

  • Assumes responsibility for the education of all members of the health care team

  • Participates in continuing education programs

  • Develops patient education materials and participates in patient instruction programs to facilitate appropriate medication therapy and compliance


Practice guidelines for pharmacotherapy specialists4

Practice Guidelines for Pharmacotherapy Specialists

Guideline V

  • The pharmacotherapy specialist continually develops his/her knowledge and skills in applicable practice areas and demonstrates a commitment to continued professional growth by engaging in a lifelong process.


Guideline v assessment factors

Guideline V Assessment Factors

  • Participates in professional organizations related to areas of expertise

  • Increases personal level of knowledge and skills by reading professional journals, and attending or participating in professional seminars, professional symposia, and national and international conferences

  • Obtains board certification


Pharmacist s role in clinical pharmacokinetic monitoring

Pharmacist’s Role in Clinical Pharmacokinetic Monitoring


Clinical pharmacokinetics

Clinical Pharmacokinetics

  • Clinical pharmacokinetics is the process of applying pharmacokinetic principles to determine the dosage regimens of specific drug products for specific patients to maximize pharmacotherapeutic effects and minimize toxic effects.


Clinical pharmacokinetics1

Clinical Pharmacokinetics

  • Application of PK principles requires an understanding of the absorption, distribution, metabolism, and excretion characteristics of specific drug products in specific diseases and patient populations.

  • The influence of factors such as age, sex, diet, pathophysiologic conditions, and concomitant use of other drug products must also be understood.


Therapeutic drug monitoring tdm

Therapeutic Drug Monitoring (TDM)

  • Is the measurement and interpretation of drug concentrations in biological fluids, and use of the results in individualizing dosage regimens or assessing drug effects

  • TDM is necessary when the range between minimal effectiveness and toxicity is narrow

    and

  • the results of the drug assay provide significant information for clinical decision-making


When is tdm required

When is TDM Required ?

  • Noncompliance

  • Inappropriate dosage

  • Poor bioavailability

  • Drug interaction

  • Kidney and liver disease

  • Altered protein binding

  • Genetically determined fast or slow metabolizers


The pharmacist responsibilities

The Pharmacist Responsibilities

  • Designing patient-specific drug dosage regimens

  • Recommending or scheduling measurements of drug concentrations in biological fluids (e.g., plasma, serum, blood, cerebrospinal fluid) or tissues in order to facilitate the evaluation of dosage regimens

ASHP, Am J Health-SystPharm. 1998; 55:1726–7.


The pharmacist responsibilities1

The Pharmacist Responsibilities

  • Monitoring and adjusting dosage regimens on the basis of pharmacologic responses and biological fluid and tissue drug concentrations in conjunction with clinical signs and symptoms or other biochemical variables

  • Evaluating unusual patient responses to drug therapy for possible pharmacokinetic and pharmacologic explanations


The pharmacist responsibilities2

The Pharmacist Responsibilities

  • Communicating patient-specific drug therapy information to physicians, nurses, and other clinical practitioners and to patients orally and in writing, and including documentation of this in the patient’s health record

  • Educating pharmacists, physicians, nurses, and other clinical practitioners about pharmacokinetic principles and appropriate indications for clinical pharmacokinetic monitoring, including the cost-effective use of drug concentration measurements


The pharmacist responsibilities3

The Pharmacist Responsibilities

  • Developing quality assurance programs for documenting improved patient outcomes and economic benefits

  • Promoting collaborative relationships with other individuals and departments involved in drug therapy monitoring to encourage the development and appropriate use of pharmacokinetic principles in pharmaceutical care.


The pharmacist responsibilities4

The Pharmacist Responsibilities

  • Pharmacists with specialized education, training, or experience may assume the following additional responsibilities:

    • Designing and conducting research to expand clinical pharmacokinetic knowledge

    • Developing and applying computer programs and point-of-care information systems to enhance the accuracy and sophistication of PK modeling

    • Serving as an expert consultant to pharmacists with a general background in clinical pharmacokinetic monitoring.


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