Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5739_Библиотеки_им_академика_М_И_Перельмана.pdf
Pharmacy Practice168
patient’s drug-related needs and is held accountable for that
commitment. The following are the pharmaceutical care done
by the pharmacist:
i. Provide a consistent process of patient care that ensures
the appropriateness, effectiveness, and safety of the
patient’s medication use.
ii. Consult with the patient’s physicians and other health
care providers to develop and implement a medication
plan that can meet the overall goals of patient care
established by the health care team.
iii. Apply specialized knowledge of the scientific and clinical
use of medications, including medication action, dosing,
adverse effects, and drug interactions, in performing
their patient care activities in collaboration with other
members of the healthcare team.
iv. Call on their clinical experience to solve health problems
through the rational use of medications.
v. Rely on their professional relationships with patients to
tailor their advice to best meet individual patient needs
and desires.
ISOLISOL
ISOLISOL
ISOL
AA
AA
A
TED KEY POINTSTED KEY POINTS
TED KEY POINTSTED KEY POINTS
TED KEY POINTS
• The pharmacy services can be broadly classified as clinical,
hospital and community pharmacy services based on the
type of services.
• Clinical pharmacy is the branch of pharmacy in which
clinical pharmacists provide direct patient care that
optimizes the use of medication and promotes health,
wellness, and disease prevention.
• The various functions of clinical pharmacist are:
a. Check the status of the patient’s health problems and
monitor the prescribed medications that they meet the
patient’s needs and goals of care.
b. Check the appropriateness and effectiveness of the
patient’s medications.
c. Recognize untreated health problems which can be
resolved with appropriate medication or therapy.
Clinical Pharmacy 169
d. Follow the patient’s progress to determine the effects of
the patient’s medications on his or her health.
e. Consult with the patient’s physicians and other health
care providers in selecting the medication therapy.
f. Advise the patient regarding administration of medi-
cations.
g. Educate the patient on other important steps to improve
or maintain health such as exercise, diet, and preventive
steps like immunization.
• Drug therapy monitoring is an ongoing process in which
pharmacists actively review patients’ records, identify and
resolve drug therapy problems such as adverse drug events
(ADEs) and communicate with prescribers when problems
occur.
• Following are the three steps of monitoring:
i. Educate patients about their therapy, potential adverse
effects, and actions to take if problems occur.
ii. Regularly assess patients’ drug therapy. Check that
patients take their medications as prescribed, proactively
identify and resolve ADEs as they occur, and assess
therapeutic effectiveness.
iii. Adjust drug therapy as needed based on patient status.
• In medication chart review pharmacist ensures the
appropriateness of medication orders:
i. Medication chart review involve
ii. To prevent or minimize drug-related problems/medica-
tion errors.
iii. The patient’s medical record should be reviewed in
conjugation with the medication administration record.
• Clinical review of the patients’ progress for the purpose of
assessing the therapeutic outcome.
• The primary aims of the clinical review are to:
i. Assess the response to drug treatment.
ii. Evaluate the safety of the treatment regimen.
iii. Assess the progress of the disease and the need for any
change in therapy.
iv. Assess the need for monitoring, if any.
v. Assess the convenience of therapy (to improve com-
pliance).
Pharmacy Practice170
• Ward rounds are the routine clinical rounds where the
healthcare providers visit the patients in the ward to assess
the progress of the health condition of the inpatients.
• The goal of the ward round is to closely monitor the
patient’s condition and take immediate intervention to
improve the patient condition and avoid death.
• The ward team comprises doctors, nurses and pharmacists.
• The pharmacist in the ward round team decide upon the
matters of dosage regimens, formulary interpretations,
ADR monitoring, drug–drug interactions, drug–food
interactions and drug and poison information services.
• A medication history is the part of a pharmaceutical
consultation that identifies and documents allergies or other
serious adverse medication events, as well as information
about how medicines are taken currently and have been
taken in the past.
• Key components of a medication history:
i. Introduce yourself to the patient
ii. Identify any allergies or serious adverse reactions
iii. Ascertain information about prescribed and non-
prescribed treatments.
• Pharmaceutical care is a cooperative, patient-centered
system for achieving specific and positive patient outcomes
from the given medicines.
PRAPRA
PRAPRA
PRA
CTICE QUESTIONSCTICE QUESTIONS
CTICE QUESTIONSCTICE QUESTIONS
CTICE QUESTIONS
VV
VV
V
erer
erer
er
y Shory Shor
y Shory Shor
y Shor
t Answer Tt Answer T
t Answer Tt Answer T
t Answer T
ype Questionsype Questions
ype Questionsype Questions
ype Questions
1. Define clinical pharmacy.
2. Write the goals of medication history.
3. What is the importance of medication history?
4. What is ward round participation?
5. Define drug therapy monitoring.
6. Define pharmaceutical care.
7. What are good qualities of clinical pharmacist?
ShorShor
ShorShor
Shor
t Answer Tt Answer T
t Answer Tt Answer T
t Answer T
ype Questionsype Questions
ype Questionsype Questions
ype Questions
1. Write the responsibilities of clinical pharmacist.
2. Give the importance of ward round participation.
Clinical Pharmacy 171
3. Explain the classification and steps involved in ward round
participation.
4. Write the significance of drug therapy monitoring.
5. Write a note on pharmaceutical care.
6. Discuss the primary aims of clinical review.
LL
LL
L
ong Answer Tong Answer T
ong Answer Tong Answer T
ong Answer T
ype Questionsype Questions
ype Questionsype Questions
ype Questions
1. What is clinical pharmacy. What are the roles and responsi-
bilities of clinical pharmacist?
2. Explain the concept and scope of clinical pharmacy.
3. Write short note on the following:
A. Pharmaceutical care B. Clinical review
C. Medication history D. Ward round participation
Objective TObjective T
Objective TObjective T
Objective T
ype Questionsype Questions
ype Questionsype Questions
ype Questions
1. ______ is an ongoing process, in which pharmacist actively
review patient’s records, identify and resolve drug therapy
problems.
A. Clinical review B. Drug therapy monitoring
C. Pharmaceutical care D. None of these
2. Ward team comprises:
A. Doctors B. Pharmacist
C. Nurses D. All of these
3. ______ are routine clinical rounds where healthcare pro-
viders visit the patients to assess the progress of health.
A. Ward rounds B. Pharmaceutical care
C. Clinical care D. Drug therapy monitoring
4. _______ is a branch of pharmacy in which clinical pharma-
cists provide direct patient care, that optimizes use of
medication and promote health, wellness and disease
prevention.
5. ________ is a cooperative, patient centered system for
achieving specific and positive patient outcomes from the
given medicines.
AnswersAnswers
AnswersAnswers
Answers
1. B 2. D 3. A 4. Clinical pharmacy
5. Pharmaceutical care
Over-the-counter (OTC) drugs are those drugs, which can be
sold without prescription, thus is also called non-prescription
drugs.
In case of OTC drugs the companies directly approach the
consumer through mass media like television, newspaper, etc.
For example, Saridon, Disprin, Crocin, Vicks Action 500,
Anacin, etc. The term OTC stands for “over-the-counter”.
OTC drugs are those drugs which are sold without any
prescription. Some OTC medicines are used to relieve aches,
pain of itches. Some prevent or cure diseases like tooth decay
and athlete’s foot. Some are used to relieve pain and treat
symptoms of common cold, the flu and allergies.
According to the Food and Drug Administration (FDA)
regulations, a drug must be safe and effective to be sold OTC.
An OTC drug is safe when it has low incidence of adverse
reactions and side effects under conditions of widespread
availability.
An OTC drug is safe and effective, if there is a reasonable
expectation that when used under adequate directions for use
with warnings it will provide clinically significant relief for
the ailment for which it is being taken to a significant portion
of the targeted population.
OTC medicine should never be taken for longer time or in
higher doses than the label recommends.
OTC drug therapy: The pharmacist should have special
knowledge of drug and drug product whenever a pharmacist
Over-the-Counter
Drugs Sales
18
Over-the-Counter Drugs Sales 173
is dispensing OTC drug. He/she should be sure about the side
effects of the drug. Pharmacist should tell the patient about
other drugs which will interact with it.
TYPES OF OTTYPES OF OT
TYPES OF OTTYPES OF OT
TYPES OF OT
C DRUG PRODUCTSC DRUG PRODUCTS
C DRUG PRODUCTSC DRUG PRODUCTS
C DRUG PRODUCTS
There are four most common types of OTC products:
1. Pain reliever
2. Antihistamine
3. Decongestant
4. Cough medicine
1.1.
1.1.
1.
PP
PP
P
ain Rain R
ain Rain R
ain R
elievereliever
elievereliever
eliever
The OTC products that relieve headache, fever or muscle aches
are not all the same. In the local drug store or pharmacy they
are nonsteroidal anti-inflammatory drugs (NSAIDs). Examples
of pain relievers are:
i. Ibuprofen
ii. Aspirin
iii. Naproxen
iv. Ketoprofen or acetaminophen.
2.2.
2.2.
2.
AntihistaminesAntihistamines
AntihistaminesAntihistamines
Antihistamines
Antihistamines work by blocking the receptor that triggers
itching, nasal irritation, sneezing and mucus production. The
three types of antihistamines are:
i. Diphenhydramine: The medicine products such as
banophen, benadryl allergy and diphenhist.
ii. Bropheniramine: The medicine in products such as
Dimetapp allergy.
iii. Chlorpheniramine: The medicine in products such as
Aller-chlor, chlo-amine and chlor-trimeton allergy.
3.3.
3.3.
3.
DecongestantsDecongestants
DecongestantsDecongestants
Decongestants
Decongestants work by narrowing blood vessels, in the lining
of the nose. As a result less blood is able to flow through the
nasal area and swollen tissue inside the nose shrinks.
Pseudoephedrine is the only decongestant used in OTC
Pharmacy Practice174
product. Pseudoephedrine is a product such as Allermed,
Genamed and Sudafed.
4.4.
4.4.
4.
Cough MedicineCough Medicine
Cough MedicineCough Medicine
Cough Medicine
Cough medicines are grouped into two types:
i. Antitussives
ii. Expectorant
Antitussives or cough suppressants block the cough reflex.
Dextromethorphan is common antitussive and is in product
such as Delsym, Drixoral, Pertussin and Robitussin pediatric.
Expectorants are thought to thin mucus and make coughing
more productive in clearing the mucus from the airway.
Guaifenesin is the only expectorant used in OTC products and
is in product such as Robitussin and Tusibron.
OTC medicine can help us feel better. But if they are taken
the wrong way they are actually make us feel worse. To use
OTC medicine correctly one should follow the guidelines
below:
i. Talk to the family doctor before taking the OTC
medicines
ii. Know about the medicine.
iii. Know what to avoid while taking the medicine.
iv. Understand generic versus brand name.
Special groups: Some groups of people may be particularly
liable to have the side effects associated with OTC product:
Children, older adults pregnancy and breastfeeding mothers.
RARA
RARA
RA
TIONAL USE OF OTTIONAL USE OF OT
TIONAL USE OF OTTIONAL USE OF OT
TIONAL USE OF OT
C DRUGSC DRUGS
C DRUGSC DRUGS
C DRUGS
Rational use of medicines refers to the correct, proper and
appropriate use of medicines. Rational use requires that
patients receive the appropriate medicine, in the proper dose,
for an adequate period of time and at the lowest cost and use
of an appropriate, efficacious, safe and cost effective drug given
for the right indication in the right dose and formulation, at
right intervals and for the right duration of time.
Incorrect use of medicine occurs in all countries, causing
harm to people and wasting resources, which includes effects
like antimicrobial resistance due to overuse of antibiotics.
Over-the-Counter Drugs Sales 175
Programs to promote rational use of medicines through
policies, structures, information and education which includes:
i. A national body to coordinate policies on medicine use
and monitor their impact.
ii. Evidence-based clinical guidelines for supervision and
supporting decisions making about medicines.
iii. List of essential medicines used for medicine procure-
ment and insurance reimbursement.
Drug InteractionsDrug Interactions
Drug InteractionsDrug Interactions
Drug Interactions
Although mild and relatively uncommon, interactions
involving OTC drugs can produce unwanted results or make
medicines less effective. It is especially important to know about
drug interactions while taking Rx and OTC drugs at the same
time.
Some drugs can also interact with foods and beverages, as
well as with health conditions such as diabetes, kidney disease,
and high blood pressure. Here are a few drug interaction
cautions for some common OTC ingredients:
i. Avoid alcohol if while taking antihistamines, cough-cold
products with the ingredient dextromethorphan, or
drugs that treat sleeplessness.
ii. Do not use drugs that treat sleeplessness while taking
prescription sedatives or tranquilizers.
iii. Consult with the doctor before taking products contain-
ing aspirin if the person is having diabetes or gout.
iv. Do not use laxatives during stomach pain, nausea, or
vomiting.
v. Unless directed by a doctor, do not use a nasal deconge-
stant if the person is taking a prescription drug for high
blood pressure or depression, or if the person is having
heart or thyroid disease, diabetes, or prostate problems.
OTOT
OTOT
OT
C Medicine Check-upC Medicine Check-up
C Medicine Check-upC Medicine Check-up
C Medicine Check-up
i. Be sure to look through the medicine supply at least once a
year.
ii. Always store medicines in a cool, dry place or as stated on
the label.
Pharmacy Practice176
iii. Throw away any medicines that are expired.
iv. To make sure no one takes the wrong medicine, keep all
medicines in their original containers.
PREGNANCY AND BREASTFEEDINGPREGNANCY AND BREASTFEEDING
PREGNANCY AND BREASTFEEDINGPREGNANCY AND BREASTFEEDING
PREGNANCY AND BREASTFEEDING
Drugs can pass from a pregnant woman to her unborn baby.
A safe amount of medicine for the mother may be too much
for the unborn baby. During pregnancy consultation with
doctor should be taken before taking any drugs, Rx or OTC.
Although most drugs pass into breast milk in concentrations
too low to have any unwanted effects on the baby, breast-
feeding mothers still need to be careful. Always ask the doctor
or pharmacist before taking any medicine while breastfeeding.
A doctor or pharmacist can tell how to adjust the timing and
dosing of most medicines so that the baby is exposed to the
lowest amount possible, or whether the drugs should be
avoided altogether.
PP
PP
P
recaution for Childrenrecaution for Children
recaution for Childrenrecaution for Children
recaution for Children
OTC drugs rarely come in one-size-fits-all. Here are some tips
about giving OTC medicines to children.
i. Children are not just small adults, so do not estimate the
dosebase on their size.
ii. Read the label. Follow all directions.
iii. Follow any age limits on the label.
iv. Some OTC products come in different strengths. Be
aware!
v. Known the difference between TBSP (tablespoon) and
TSP (teaspoon). They are very different doses.
vi. Be careful about converting dose instructions. If the label
says two teaspoons, it is best to use a measuring spoon or
a dosing cup marked in teaspoons, not a common kitchen
spoon.
vii. Do not play doctor. Do not double the dose just because
your child seems sicker than last time.
viii. Before you give your child two medicines at the same
time, talk to your doctor or pharmacist.
Over-the-Counter Drugs Sales 177
ix. Never let children take medicine by themselves.
x. Never call medicine candy to get the kids to take it. If they
come across the medicine on their own, they are likely to
remember it as candy.
Patient counseling: It is necessary for OTC drugs when they
are directly purchased from the pharmacy shop without
consultation of the doctor. The cause of increase in the
medication error is due to the unawareness about the basic
information regarding drugs. Here the role of pharmacist
comes into play and the responsibility lies on the shoulders of
pharmacist to make them aware of the adverse reaction which
may occur. Cough syrups cause drowsiness so ideally it should
be taken-in nights as it can hinder in daytime activities. Also at
times they are habit forming like cocaine phosphate. So, patient
should be counseled regarding the side effect of those OTC
cough syrups and their potential to cause addiction if taken on
regular basis.
Analgesics: Most popular among the non-prescription drugs
and most abused drugs so patients have to be counseled
adequately regarding their use indicating side effects.
Examples: Paracetamol on prolong use can cause irritation,
heart burn, GI bleeding, etc. More often patients take some
analgesic for all types of pain. As, they are not aware that same
analgesic cannot work in all types of pain. When pain is not
alleviated, patients tend to gabble more tablets without
realizing the side effects. Therefore, the patients have to be
informed about this by pharmacist.
Nimesulide tablet should not be given to children below
5 years of age.
Multivitamin preparations: There is another category of
drugs which are promoted for the conditions which usually
have nothing to do with vitamin deficiency. This includes
fatigue, lethargy, anxiety, forgetfulness, stress, menopausal
symptoms and indigestion. The use of vitamins in these
conditions is irrational. Vitamin tonics are recommended as
growth stimulant for children. Children who eat a normal diet
receive more than an adequate amount of vitamins and do not
require any attitudinal supplementation. However, the sale of