Pharmacist intervention

Pharmacist intervention



After completion of this lecture, student will be able to:

       Describe the importance of pharmacist interventions

       Explain different pharmacist interventions

Pharmacist intervention


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 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 


       A pharmacist who concludes that a prescription for Amitriptylline has no indication because the patient has no depression may be an incorrect conclusion


       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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