Pharmacist
intervention
Content
• Importance
of pharmacist interventions
• Different
pharmacist interventions
Objective
After completion of this lecture, student will be able
to:
• Describe
the importance of pharmacist interventions
• Explain
different pharmacist interventions
Pharmacist intervention
Definition
Pharmacist intervention is defined as any contact made by
pharmacist during the dispensing process with a prescriber or a patient and
that was aimed at rationalizing drug prescribing or use
Pharmacist Interventions
Pharmacist intervention aimed at:
• Appropriate
pharmacotherapy
• Appropriate
indication
• Appropriate
medication
• Right
dose according to the patient’s clinical condition
• Appropriate
administration and duration of treatment
• Appropriate
patient
• Patient’s
adherence to treatment
• Monitoring
of the outcome of pharmacotherapy
• Monitoring
and evaluation of possible adverse
drug-to-drug reactions related to the treatment
Pharmacist intervention is required in medication related
problems such as
• Untreated
indications
• Sub-therapeutic
dosage
• Medication
overdose
• Adverse
drug reactions
• Drug
interactions
• Drug
use without indication
• Improper
drug selection
• Failure
to receive medications
Untreated indications
• When
reviewing the indication for drug therapy it is important to consider whether
the indication may be an unrecognized adverse drug reaction
• Example:
A patient who is having complaints of
nausea may be taking an
antibiotic or some other drug may contribute
to the problem
Improper drug selection
• It
is the pharmacist’s duty to ensure that the most appropriate drug has been
chosen to treat the patient’s medical condition
• Example:
Short course of NSAID is the usual first line treatment for acute gout. However
if the patient has renal impairment a short course of Prednisolone may be most
appropriate choice
Sub-therapeutic dose
• The dose below the therapeutic range that does
not provide the required pharmacological action
• The
therapeutic dose varies from patient to patient
• The
dose and the dosing regimen should be individualized based in the patient’s
medical condition
TDM can be a useful aid
• Drugs
with narrow therapeutic index
• Where
there is an established relationship between serum concentration and
therapeutic effect
Over-dosage
• Over-dosage
occurs when a patient takes a drug takes a drug for a longer period than
necessary
• It
can also occur if the same generic drug has been prescribed twice under
different brand names
Example: Antibiotic treatment may be continued after an
infection has resolved
• Thereby
exposing the patient to unnecessary risk of
ADR
• Additional expense
Failure to receive medications
It can occur due to many factors including
• Non
adherence
• Poor
administration techniques
• Missed
doses due to medication errors, substandard drugs
• Patient’s
inability to pay for the prescribed drug
Example: A patient with newly diagnosed hypertension who has
been
• Prescribed
an ACE inhibitor may continue to have high BP
• Patient
fails to take the drug because of its
high cost
Adverse drug reactions
• Pharmacist
should check that the patient is not allergic to the prescribed drug or has had
an adverse reaction to any drug in the past
• Patient
who are most susceptible to develop an ADR should be identified and monitored
on a daily basis
• Example:
Meformin-Weight loss
Aspirin, clopidogrel- GI bleeding
Drug -Drug Interactions
Drug interactions vary in their clinical significance
• The pharmacist needs to make a professional
judgment
• To
change in drug therapy is necessary
Example: A Patient who has been prescribed Ciprofloxacin and
iron tablets
• Ciprofloxacin
absorption is reduced if these drugs are given together
• The
problem can be resolved by spacing the doses of these drugs several hours apart
Drug use without indication
Pharmacist should verify that the patient have a medical
condition that is the:
• Result
of taking a drug
• For
which there is no valid indication
Example: Tricyclic antidepressants are often used for
indications such as
• Urinary
frequency
• Neuropathic
pain
• Pruritus
• A
pharmacist who concludes that a prescription for Amitriptylline has no
indication because the patient has no depression may be an incorrect conclusion
Summary
• Pharmacist
intervention is defined as any contact made by a pharmacist during the
dispensing process with a prescriber or a patient and that was aimed at
rationalizing drug prescribing or use
• Pharmacist
Interventions
• Untreated
indications
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