Pharmacist intervention

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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