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    1. ??????????????????????????? ?. ????? ?????????

    2. ??????? ?????????????? ??????? ????????? ?????????????????????????????? ?????????? ??? 5 ???? ??????????????? ?????? ???????????????? ??????????? ?????????????????????????

    4. ????????????????????? ????????????????????????????????????? ?????????????????? ????????????????????????????????????????? ?????????????????????????????

    5. ?????????????? (Care)

    6. ???????? ?????????????????????

    7. ?????????????????????

    8. ?????????????????????????????????????? ????? ????? ?????????? Hepler and Stand

    9. Drug related problems ????????????????????????????? (Untreated indications) ???????????????????????????? (Improper drug selection) ?????????????????????????????????????????? (Subtherapeutic dosage) ????????????????????????????????????????? (Overdosage) ???????????????????????????????????????? (Adverse drug reactions) ??????????????????????????????? (Drug interactions) ?????????????????????????????? (Failure to receive medication) ?????????????????????????????????????????? (Medication use without indication)

    10. Drug Therapy Assessment Worksheet by ASHP (American Society Hospital Pharmacy ) 2006 Correlation between drug therapy and medical problems Appropriate drug selection Drug regimen Therapeutic duplication Drug allergy or intolerance

    11. Drug Therapy Assessment Worksheet by ASHP (American Society Hospital Pharmacy ) 2006 Adverse drug events Interactions: drug-drug, drug-disease, drug-food, drug-lab Social or recreational drug use Failure to receive therapy Financial impact Patient Knowledge of drug therapy

    12. Correlation between drug therapy and medical problems ???????????????????????????????????????????? Vit B1-6-12 ?? diabetic neuropathy ???????????????????????????????? ???? ???????????????????? ?????? ??. , ?????????????????????, ???????, ????? ?????/??????????????????????????????????????? ??????????????????????????????—?? ??. ???? GI bleeding ????????????????????????

    13. Appropriate drug selection ?????????? Efficacy ???????? (1st line)? ???????? Safety ??????? ?????????????????????????????

    14. Drug regimen Dose and Dosing interval ??????? (?? textbook or ?????????????????????????????) ?????????????????? ??????????????? ??????????????????? Route/dosage form, mode of administration ?????????????? ??????? Efficacy, Safety, Convenience, Patient limitation, and Cost Dose: ???????????????? ??compliance??????, ????????????? interaction ???????????????????????????????? ??????????????????????????????

    15. Therapeutic duplication ??????????????????????????? ???? ??????????????????? ????Indomethacin ??? Diclofenac ???????????????????????

    16. Drug allergy or intolerance ???????????????????????? ??????????????????????????????????? ???????????/???????/?????????????

    17. Adverse drug events ???????/???????????????????????????

    18. Interactions: drug-drug, drug-disease, drug-food, drug-lab ?? Drug-drug interaction? Significance? ????????????????????????????????????? ???? beta-blocker in asthma ???????????????????????????? Significance? ???????????? Lab?????????? Significance?

    19. Social or recreational drug use ?????????????????????????????? ????????????????? ???????????????????????????????? ??????????????????????????????????????? (withdrawal)

    20. Failure to receive therapy ?????????????????????????????????????????????????? noncompliance ???????? ??????????????????????????????????????

    21. Financial impact ??????????????????????????????????????? ??????????????????????????????????????

    22. Patient Knowledge of drug therapy ????????????????????????????????? ???????????? ??????????????????????????? ???????? ????????????????????????????????????????????????????????????? ???? ???????? ?????? ?????????????

    23. ASHP Clinical Skill Completion/ Pharmacist’s Care Plan ????????????????????????????????????? ??????????????????????????????????????? ?????? 1 = ?????????????????????????????????? (???????????????????????????????????) 2 = ??????????????????????????????? ????????? 1 3 = ??????????????????????????????? (???? ??? 1 ???????)

    24. ASHP Clinical Skills Completion-Pharmacist’s Care Plan Health Care Priority Therapeutic Recommendations Monitoring Problem Goals for Therapy Parameters and Endpoints Hypertension 2 BP<130/80 -Off Propranolol BP - Enalapril (5) 1 tab od Diabetes 2 FPG 90-130 - Encourage FPG, A1C Mellitus A1C<7% compliance Steven Johnson 1 Cure -Stop propranolol BP, rash, temp Syndrome Osteoarthritis 3 No symptoms –Continue regimen pain

    25. ??????????????????????????? (Drug related Problems) ?????? SOAP note ??????????????????????????? ????????????????????????????????? ??????????????? ???????????????? ????? SOAP

    26. ???????????????????? 1) ?????????????????????????????????????????? ????????????????????????? ???????????????????? Chief complain (CC) ?????????????????????????????????????????????? Past medical history (PMH) ?????????????????????????????????????????????? ?????????????????? Untreated indications

    27. ???????????????????? (???) Drug allergy ????????????????????????????????????????????????? ???????????????? Preventable Adverse drug reactions Medication history ???????????????????????????????????? ??????????????? ????????? ????????? ???????? ??????????????????? Drug interactions/ Adverse drug reactions/ Medication use without indication

    28. ???????????????????? (???) ????????????????????????????????????? (Failure to receive medication) ???????????? ???? “?? 1 ???????????????????????????????????? ??????????????” ???????????? “?????????????????” ???????????????????????? “???” ????

    29. ???????????????????? (???) ???????????????????????????(Adverse drug reactions) ????????????? ???? “?????????????????????????????????????????”

    30. ???????????????????? 2) ????Problem list ??? Medical Problems and Drug related Problems (DRPs) ????????????????????????????????????????? ?????????????????????????????? ??????????????????????????????? ????????????????????? ?? Problem list ???????? Medical problem ????????????? ?????? DRPs ????????????? Medical problem ?????

    31. ???????????????????? Problem list Hypertension (DRP: Improper drug selection) Diabetes Mellitus (DRP: Failure to receive medication) Steven Johnson Syndrome ? DRPs ????????????????????? Medical problem ??? Osteoarthritis (DRP: Untreated Indication)

    32. ???????????????????? 3) ?????????????????????????????????????? SOAP note ???????????? SOAP note 3.1) ???????????????????????? SOAP ???? 3.2) ?? Problem list ??????? SOAP ?????? 3. Steven Johnson Syndrome

    33. 3. Steven Johnson Syndrome S (Subjective Data): ?????????????????????????????????????????????? ???????????? ??????????????????????? ???????? ??? ?????????????????? ???? ???????????? ???????????????? ?????????????????????????????? ??????????????????? ??????????????? O (Objective Data): ???????????????????????????????????????????????????????????????????? ???? ?????????????? ??????????????????????? ???????????? ??????????????????????????????? ?????????????????????????? ???? BT : 38 ? C HEENT: slight edema and erythema to his left lower eyelid Eosinophil 8%

    34. 3. Steven Johnson Syndrome A (Assessment): ?????????????????????????????????????????????????? ???????????????????????? Etiology: ??????????????????????????????????? ?????????????????????????? ?????????????????????????????? ????????????????????? ???????????????? ??????????????????? ?????????????? Drug induced disease ???? Adverse drug reactions ??????????????????? ???????????????????? (Risk Factors) ????????????????????????? ???? ????????????????????????? ?????????????????????????? ?????????? Failure to receive medication ???? ?????????????????????????????????????? ???????

    35. 3. Steven Johnson Syndrome A (Assessment): (???) Assessment of therapy: ?????????????????????????????????? ????????????????? ???????????????????? ???????????????????????? ????????????? ??????????????? ??????????? IESAC ???????????? ?????? I = indication ????????????????????????????? ?????????????????????????????????????????

    36. A (Assessment): (???) Assessment of therapy: E = efficacy ????????????????????????????????? ???????? Drug of choice ?????????????????? ???? ??????????????????????????????????????????????????? S = safety ??????????????????????????????????? ???????? ???????????????? ????????????????????????????? ??????????????????? ?????????????????????????????? ( E ??? S ????????????????????) A = adherence ????????????????????????????? ?????????????????????????????????????????????????????????????????? C = cost ??????????????????????????????????????????

    37. A (Assessment): (???) Assessment of therapy: ?????????? ??????????????? I ? E and S ? A ? C ???????????? ???????? C (cost) ?????????????????????????????????????????????????????? ??????????????????????????????? Improper drug selection, Subtherapeutic dosage, Overdosage, Drug interaction ???????

    38. P (Plan): ??? ????????????????????????????????? ?????????????? Therapeutic plan ???????????????????????????????????? ??????????? intervention ???????????????????????? ???? ?????????????????????? ?????????? ?????? ???? ??????????????????? Goal of therapy ??? ????????????????????????????????? ???????????????????????? ???? ?????????????????? ?????????????????? < 140/90 mmHg ??????? ????????????????????????? ???? ?????????????????????????????????? ??????????????? ?????????????????????????????? ???????

    39. P (Plan): Therapeutic monitoring ????????????? ??????????????????????????????????????????????????????? ADR monitoring ???? ADRs ????????????????????????????? Patient education ??????????? ?????????????????????????? Future plan ???????????????? ??????????????????? ???? ??????????????????????????? ?????????????????????? ???????????????? future plan

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