Transcript: Used IV for rapid digitalization in emergency situations clinicians should take caution with the use of In the event of an allergic or hypersensitivity reaction rapid substitution of alternative therapy not belonging to the hydantoin chemical class Nasogastric tube (NGT) feedings, for example, raise stomach pH and can interfere with absorption of AEDs ( Anti epileptic drugs) that require an acidic environment. For example, phenytoin levels can Drop sharply after NGT feedings are initiated. One solution for this problem is to bolus-feed the patient when possible, limiting the patient to a number of boluses of nutrition per day, more closely mimicking normal eating. Holding continuous NGT feedings for several hours before and after administration of phenytoin elixir can help, but serum levels must be monitored carefully to assess the effect on absorption Administer a loading dose based upon projected peak digoxin body stores. Peak digoxin body stores of 8–12 mcg/kg generally provide therapeutic effect with minimum risk of toxicity www.professionals.epilepsy.com www.globalrph.com enoxaparin in patients with moderate renal impairment It's better to know the weight inorder to adjust the loading dose Minimize loss of phenytoin oral suspension during oral administration via a nasogastric tube (secondary to adherence to PVC tubing) by diluting (e.g., threefold) the suspension with a compatible diluent (e.g., sterile water, 5% dextrose, 0.9% sodium chloride) prior to administration, combined with flushing the tube with at least 20 mL of diluent after administration. www.medscape.com Also consider a reduced dose or if the condition they are treating is thought to be high risk, they may use the current recommended dose, but consider monitoring an anti factor Xa level via blood draw after three to five days and adjust the dose based on the result (if accumulation above the recommended level is occurring) The use of therapeutic doses of digoxin may cause prolongation of the PR interval and depression of the ST segment on the electrocardiogram Digoxin may produce false positive ST-T changes on the electrocardiogram during exercise testing Dosage: Preventing deep vein thrombosis in ill patients with limited mobility: 40 mg subcutaneous injection once daily. Normal levels of creatinine in the blood are approximately 0.6 to 1.2 milligrams (mg) per deciliter (dL) in adult males. He has high serum creatinine Aya Abbas 910064 Clexan ( Enoxaparin ) is used for preventing deep vein thrombosis after abdominal, hip replacement or knee replacement surgeries, and in patients with reduced mobility due to illness. Mary Ezzat 910069 Medication related problem No , there is no a medication related problem Dina Zaki If you are taking phenytoin to treat seizures, keep taking the medication even if you feel fine. You may have an increase in seizures if you stop taking phenytoin. Do not change your dose of phenytoin without your doctor's advice. Tell your doctor if the medication does not seem to work as well in treating your condition. Wear a medical alert tag or carry an ID card stating that you take phenytoin. Any medical care provider who treats you should know that you are taking a seizure medication. Rapid digitalization Medication related problem No , there is no a medication related problem Presented by: • Maintenance Dose = Peak Body Stores (i.e., Loading Dose) x % Daily Loss/100 Where: % Daily Loss = 14 + Ccr/5 • (Ccr is creatinine clearance, corrected to 70 kg body weight or 1.73 m2 body surface area.) Third case The physician`s order for digoxin loading dose calculated as 240 mcg for rapid digitalization is written as : 120 mcg IV , then after 8 hrs 60 mcg iv then after 8 hr 60 mcg iv . Obtain ECG 6 hours after each dose to assess potential toxicity . www.Drugs.com enoxaparin (lovenox) is mainly excreted through the kidneys therefore any renal impairement may result in its blood accumulation Second case An epileptic patient on oral phenytoin has been admitted to the ICU . She is unable to swallow food or medication and the physician has asked the nurse to administer the same oral dose of phenytoin by adding phenytoin syrup to the enteral feeding preparation and administer through the nasogastric tube. Mirna louis 910079 Medication related problem Yes , there is a medication related problem Obtained by beginning an appropriate loading dose Allowing digoxin body stores to accumulate slowly Steady-state serum digoxin concentrations will be achieved in approximately five half-lives of the drug for the individual patient ECG 910112 www.medicinenet.com Medication related problem Yes , there is a medication related problem Dose: No problem with dose it's correct as Maintenance dose: 100 mg IV every 6 to 8 hours. But you should take care to : Monitor serum phenytoin concentrations as necessary when a patient is switched from a phenytoin sodium to a phenytoin formulation or from extended phenytoin sodium capsules to prompt phenytoin
Transcript: CP 1. Ahmad Harith Idham Bin Noor Azmi (59215118022) 2. Faisal Iskandar Bin Mohd Faisal Farish (59215118020) 3. Wan NurNasuha Hanis binti Kamaruzailani (59215118025) 4. Wani Zulaikha binti Saufi (59215118004) 5. Anis Farhana Binti Jumait (59215118038) 6. Anis Najwa Binti Suhaini (59215118039) 7.Nurul Diyana Shahirah Binti Noor Azmi (59215118029) 8. Nursyazana binti Sharif Zaidi (59215118023) 9. Nur A'ina Nabilah Binti Mutaza (59215118024) 10. Siti Aisyah Bt Abu Bakar (59215118011) CLINICAL PHARMACY L Introduction providing the patient care & guideline for the patients 1 involved directly with other health professionals 2 pharmacist is very responsible in the operating system of the pharmacy 3 directly in dispensing of the medicines and drugs to the patients 4 Double responsible in monitoring the patient’s progression and outcome to edit 5 A JOB SCOPES adverse drug reaction and drug interactions, patient monitoring Preparation of patient medication history rational prescription Research and continuing education programme retail pharmacy stores bioequivalence and generic equivalence of pharmaceutical formulations Drug information specialist Medical audit drug diagnostic test inferences, Discharge counselling and patient compliance C QUALIFICATION taking 4 years of bachelor degree 1 1 year training as a Provisionally Registered Pharmacist (PRP) 2 followed by services as fully registered pharmacist 3 Qualifying Examination to Practice Pharmacy’ organized by Pharmacy Board Malaysia (PBM) 4 must have a wide therapeutic knowledge to effectively assist in rational medication use 5 I SALARY Government Sector minimum RM2,740 maximum of RM9,656 excl. allowances Annual salary increase rate: RM225 As UF54 grade, the minimum rate is RM6,182 while maximum is RM13,256 with annual salary increase rate of RM320. Minimum approximately RM2,600 to RM3,0000 Private Sector N Current Scenario lack of medicine supply in government hospital the patient did not believe in the drug that has been dispensed by the pharmacist due to the changes brand’s name of the medicine FUTURE I collaborative ventures between pharmacists in 1 & 2 care 1 Interventions of clinical pharmacists 2 Allow high patient burden 3 good and active communications 4 Increased need to demonstrate added value of pharmaceutical services 5 Patient-centred 6 Changes in market place &decision making 7 use Drug Information Centre (DIC) service 8 New tech, robotics & the expansion IT 9 Shift to disease orientation 10 Changes in training and education 12 L Qualification - M. Burke, Willim A. Miller, Christopher W. Crank (2012) Clinical Pharmacist Competencies Retrieved from: https://onlinelibrary.wiley.com/doi/abs/10.1592/phco.28.6.806 ( skills required)Ministry of Health Malaysia (2018) . - Guidelines on Liberalisation of PRP Training in Private Sector for Graduates of Pharmacy Degree Programme Retrieved from https://www.pharmacy.gov.my/v2/en/documents/guidelines-liberalisation-prp-training-private-sector-graduates-pharmacy-degree-programme.html ( education qualification) Salary - Pharmacist Salaries in Malaysia.(2018). Retrieved fromhttps://www.indeed.com.my/salaries/Pharmacist-Salaries (salary) - Mak Wen Yao.Pharmacist Salaries: How competitive is Malaysia? (2016).Retrieved fromhttps://today.mims.com/pharmacist-salaries--how-competitive-is-malaysia- (salary) -Pharmacist UF41. Retrieved November 29,2018 fromhttp://erecruit.usm.my/html/upload/skim_jawatan/PEGAWAI_FARMASI_GRED_UF41.pdf (salary)Pharmacist UF41. Retrieved November 29,2018 fromhttp://www.spa.gov.my/deskripsi-tugas/ijazah/1128 References Current Scenario National Health Service in Scotland. Clinical pharmacy in the hospital pharmaceutical service: a framework for practice. 1996. The Scottish Office Calvert R. Pharmaceutical Care: Can we deliver it in hospitals? Pharm J. 1996;256:212. Cousins D, Gerrett D, Luscombe D. Reliability and validity of hospital pharmacists’ clinical intervention data. Am J Health Syst Pharm. 1997;54:1596–1603. [PubMed] (current scenario) Future -(n.a.) (2014) Limitations on current clinical pharmacy service from the health care providers perspective Retrieved from: https://www.researchgate.net/figure/Limitations-on-current-clinical-pharmacy-service-from-the-health-care-providers_fig2_297680066 -Tegegn, H.G.; Abdela, O.A.; Mekuria A.B.; Bhagavathula A.S.; Ayele, A.A. (2018) Challenges and opportunities of clinical pharmacy services in Ethiopia: A qualitative study from healthcare practitioners’ perspective Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5881484/ -Calvert, R.T. (1999) Clinical pharmacy—a hospital perspective Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2014215/ -Leufkens H, Haaijer-Ruskamp F, Bakker A, Dukes G. Scenario analysis of the future of medicines. Br Med J 1994; 309: 1136–40. Introduction -About clinical pharmacist.(2018) . Retrieved from https://www.accp.com/about/clinicalpharmacists.aspx -J.Jacobi(2016) Clinical pharmacists : Job
Transcript: 16 Is Antimicrobial X Appropriate for Infection Y? Figure 2: Irrational Prescribing Other Patient care Activities Why Clinical Intervention? Pharmaceutical care Clinical interventions for first Prescription Patient Care Patient Counseling Patient Education Patient Monitoring Disease Management Clinics Pharmacotherapy Workup Monitoring Drug Effectiveness Monitoring Side Effects & Drug Interactions Extemporaneous pharmaceutical compounding. Sterile Products TDM DIPC Drug Distribution Pharmacovigilance Pharmacy & Therapeutic Committee CHR Arrhythmia MI Diabetes Dyspepsia Anxiety Hypertension Cor Pulmonale Part 1: Introduction Pharmacy Practice Strands of Pharmacy Practice Pharmaceutical Care Clinical Intervention Patient Care nafarelin Why Clinical Intervention? Increased Morbidity and Mortality Other Patient care Activities Why Patient Care? Incidence of Medication Errors The dosage of the medication is sufficient to achieve the goals of therapy. The medication is safe. There are no ADRs being experienced. There are no signs of toxicity. The patient is adhering to medications. The patient is willing and able to take the medications as intended. Pharmacy practice is the discipline of pharmacy which involves developing the professional roles of pharmacists. Optimize therapy Reduce DTPs Improves adherence to medication Reduce complications. Reduce hospitalizations Decrease in expenses. Decrease the burden on the medical staff, and health care facilities. Increased Drug Interactions The Patient's DRNs Increased ADRs Patient Counseling Steps of Patient Counseling P Why Clinical Intervention? Monitors patients for: Side effects Drug interaction. Why Clinical Intervention? What other drugs for patient not responded to X, Y, and Z for condition A Patient B? Runs disease management clinics in the hospitals such as: Anticoagulation Heart failure Lipid clinic In collaboration with doctors to optimize patient care. Why Patient Care? Examples of Patient Monitoring Why Patient Care? A structured critical examination of patient’s medication for: Optimizing positivity of medicine (DRNs) and Minimizing negativity of medicine (DTPs). Increased ADRs Collaborates with doctors to: Plan Monitor Review Evaluate drug effectiveness. Figure 3: Irrational Prescribing Figure 6: Irrational Non-adherence D T P/s Steps for Patient Education Is Group or Medication A Superior to B for Disease Y? Strands of PP in Community Pharmacy adherence Medication are: The most appropriate The most effective Additional drug are not required 3. The most proper: Dosage form Dose Frequency Duration Route of administration Inappropriate Medications Inappropriate Dose Regimen Increased Cost of Treatment Increased Teratogenicity Increased Medication errors. Increased ADRs. Increased Drug interactions. Increased Non adherence to medications Increased Relapsing Rate. Increased Readmission. Increased Morbidity and mortality. 1. Introduction and confirmation of patient. 2. Purpose of Patient Counseling 3. Disease 4. Data gathering 5. Medication name 6. Dosing regimen 7. Duration of therapy. 8. Difficulties or Precautions 9. Interactions 10. Storage 11. Goals of therapy and monitoring: 12. Check for understanding ADRs By Drug Class 11 Disease Management Clinics Increased Cost of Treatment Can drug X cause problem Y? Benefits of Patient Care Medication Errors Agenda Increased Cost of Treatment 4. No: More than ONE prescription sheet Drug duplication; Non allergic drugs Drug interactions Incompatibilities Contraindications Difficulties in adherence Pharmacogenomic problem Pharmacoeconomics problem Other drug therapy problem. 23 Is X ADR for Y? 1 Bacterial Resistance Increased Relapsing Rate 12 Why Clinical Intervention? 3 Part 2: Extemporaneous Preparations Pharmacovigilance Drug Distribution in Hospital Pharmacy Drug & Poison Information Center Pharmacy and Therapeutic Committee Drug & Hospital Formulary Aseptic Services Why Clinical Intervention? Impact of Pharmacist Intervention on Diabetes Patients in an Ambulatory Setting : Julie Stading, 2012 Introduction Concor Capozide Marevan Rythonorm Aspocid Lanoxin Becozym Amaryl Vilatel Pharmacy Practice PP Increased Cost of Treatment Why Clinical Intervention? Is Antibiotic X Appropriate for Infection Y? The role of pharmacists in control and management of type 2 Diabetes Mellitus; a review of the literature Why Clinical Intervention? Is the efficacy of drug X worth ADRs it causes for Y? What is the best way to monitor whether X can treat Y? Increased Drug Interactions Why Patient Care? Increased Non-adherence to Medications Current and future research in the area of pharmacy practice Pharmaceutical Care Why Clinical Intervention? The process of providing written material to the patient to improve understanding of the disease, instruction about behaviors and activities and prevent complications. It must be simple and effective. Why Clinical Intervention? The scope of pharmacy practice has changed drastically over the
Transcript: Drug Effectiveness 12 Why Clinical Intervention? 15 Variability in Cost of Medications 28.5.2012 Increased Non-adherence to Medications 76 16 The scope of pharmacy practice has changed drastically over the past 4 decades especially in the field of patient care. Pharmacy Practices were transferred from dispensing of prescriptions to many clinical aspects. The terms clinical pharmacy, pharmaceutical care, patient counseling, patient education, patient care, drug therapy management, specialist clinical pharmacist etc are prevailing over dispensing of prescriptions. Is Antibiotic X Appropriate for Infection Y? Results of Nullified Clinical Intervention Why Patient Care? 1 Why Clinical Intervention? Patient Care Pharmaceutical Care Concor Capozide Marevan Rythonorm Aspocid Lanoxin Becozym Amaryl Vilatel 100 Other Patient care Activities Increased Cost of Treatment Inappropriate Medications Inappropriate Dose Regimen Increased Cost of Treatment Increased Teratogenicity Increased Medication errors. Increased ADRs. Increased Drug interactions. Increased Non adherence to medications Increased Relapsing Rate. Increased Readmission. Increased Morbidity and mortality. 5 7 17 The role of pharmacists in control and management of type 2 Diabetes Mellitus; a review of the literature Incidence of Medication Errors Other Patient care Activities Overall Clinical Intervention Agenda 1. Introduction and confirmation of patient. 2. Purpose of Patient Counseling 3. Disease 4. Data gathering 5. Medication name 6. Dosing regimen 7. Duration of therapy. 8. Difficulties or Precautions 9. Interactions 10. Storage 11. Goals of therapy and monitoring: 12. Check for understanding Increased Morbidity and Mortality 10 Inappropriate medications 77 Pharmacy practice is the discipline of pharmacy which involves developing the professional roles of pharmacists. 49 22 Other Patient care Activities Effect of patient counseling on quality of life of hemodialysis patients in India Increased ADRs 1. The medication is appropriate. 2. There is a clinical indication for each medication being taken. 3. All of the patient's medical conditions that can benefit from drug therapy have been identified. 4. The medication is effective. 5. The most effective drug product is being used. Figure 5: Irrational Dispensing 14 37 Increased Cost of Treatment Attends ward rounds with doctors for selecting and managing the pharmacotherapy of patients 103 D T P/s adherence Increased Drug Interactions Patient Education Pharmacotherapy Workup Definition of disease Risk factors of disease Causes of disease Prevention of disease Diagnosis of disease Treatment of disease Personal Follow up of patient Why Patient Care? 6 Why Clinical Intervention? The Patient's DRNs Why Clinical Intervention? Optimize therapy Reduce DTPs Improves adherence to medication Reduce complications. Reduce hospitalizations Decrease in expenses. Decrease the burden on the medical staff, and health care facilities. Pharmaceutical care Clinical interventions for first Prescription Patient Care Patient Counseling Patient Education Patient Monitoring Disease Management Clinics Pharmacotherapy Workup Monitoring Drug Effectiveness Monitoring Side Effects & Drug Interactions Extemporaneous pharmaceutical compounding. Sterile Products TDM DIPC Drug Distribution Pharmacovigilance Pharmacy & Therapeutic Committee Is X ADR for Y? Strands of Pharmacy Practice in Hospitals 42 Can drug X cause problem Y? Agenda Benefits of Patient Care Why Patient Care? Figure 2: Irrational Prescribing Evaluation of the community pharmacist´s behavior towards a prescription of antidiabetic and antiasthma drugs Increased Cost of Treatment Other Patient care Activities Figure 3: Irrational Prescribing Selection of Inappropriate Dose Regimen 4 nafarelin Examples of Patient Monitoring Head, Department of Pharmacy Practice and Clinical Pharmacy, FUE , Egypt Member, IC Commission, Accreditation Commission Pharmacy Education, USA Professor Faculty of Pharmacy, Cairo and King Saud Universities, Egypt and KSA Ex-Dean, Faculty of Pharmacy, Helwan University, Egypt Ex-Dean, Dubai Pharmacy College, Dubai, United Arab Emirates Ex-Dean, College of Pharmacy, Al Ain University for Science & Technology, UAE Ex-Dean, College of Dentistry, Al Ain University for Science & Technology, UAE Ex-Dean, College of Pharmacy and Nursing, Nizwa University, Oman Ex-Director, Al Ain University for Science & Technology, Abu-Dhabi, UAE 9 Strands of PP in Community Pharmacy Teratogenicity 52 Bacterial Resistance 73 Why Clinical Intervention? Increased Medication Errors 53 The process of providing written material to the patient to improve understanding of the disease, instruction about behaviors and activities and prevent complications. It must be simple and effective. Clinical Intervention What other drugs for patient not responded to X, Y, and Z for condition A Patient B? 13 Why Clinical Intervention? 94 The dosage of the medication is sufficient to achieve the
Transcript: Clinical pharmacy seems to be the best choice for me right now. But, to be honest, I'm still not sure about the branch of Pharmacy I will choose at the end of seriously hard studies.(Hopefully) It is necessary to securely know the pharmacological qualities of medicine because of the interaction with diseases. Besides, progress of basic techniques for studying indicators of clinical efficacy, risks of pharmacotherapy and others must be included as well. What actually clinical pharmacy is? My Future Life? And what else? Clinical Pharmacy is an individual scientific branch which is focused on research of factors affecting rational selection and application of medicine for both treatment and prevention. Clinical Pharmacy Clinical Pharmacy and I
Transcript: Thinking about what to do after graduating from pharmacy school? Clinical Pharmacy an introduction Clinical Pharmacy branch of Pharmacy where pharmacists provide patient care that optimizes the use of medication and promotes health, wellness, and disease prevention movement initially began inside hospitals and clinics. Clinical pharmacists often collaborate with physicians and other healthcare professionals Clinical pharmacists have extensive education in the biomedical, pharmaceutical, sociobehavioral and clinical sciences Within the system of health care, clinical pharmacists are experts in the therapeutic use of medications. They routinely provide medication therapy evaluations and recommendations to patients and other health care professionals Clinical pharmacists are a primary source of scientifically valid information and advice regarding the safe, appropriate, and cost-effective use of medications. Clinical pharmacists are also making themselves more readily available to the public. In the past, access to a clinical pharmacist was limited to hospitals, clinics, or educational institutions However, clinical pharmacists are making themselves available through a medication information hotline, and reviewing medication lists, all in an effort to prevent medication errors in the foreseeable future. In some states, clinical pharmacists are given prescriptive authority under protocol with a medical provider, and their scope of practice is constantly evolving. In the United Kingdom clinical pharmacists are given independent prescriptive authority. Basic components of clinical pharmacy practice 1.Prescribing drugs 2.Administering drugs 3.Documenting professional services 4.Reviewing drug use 5.Communication 6.Counseling 7.Consulting 8.Preventing Medication Errors Scope of clinical pharmacy: Drug Information Drug Utilization Drug Evaluation and Selection Medication Therapy Management Formal Education and Training Programs Disease State Management Application of Electronic Data Processing (EDP) Always remember Making the difference in the lives of others makes all the difference in the lives and careers of hospital and or clinical health system pharmacy. Thats all folks
Transcript: Clinical Pharmacy Pharmacotherapy Professional Diploma & the American Board of Pharmacy Specialties Preparation (BPS) from Oxford Academy for Medical Science - United Kingdom, with an international certificate documented from the Egyptian Ministry of Foreign Affairs Studying System The Academy has two studying systems Online Attendance CLINICAL PHARMACY (Pharmacotherapy) Professional Diploma Diploma Contents The academy has 8 well equipped classrooms in 3 branches Mohandeseen Nasr City Mansoura Endocrine & Metabolic Disorders Fluids, Electrolytes, and Nutrition Oncology Supportive Care Gastrointestinal Disorders Men’s & Women’s Health HIV/Infectious Diseases Acute Care Cardiology Outpatient Cardiology Pharmacoeconomics Infectious Diseases General Psychiatry Regulatory Issues Pharmacokinetics Ambulatory Care Clinical Trials Critical Care Biostatistics Nephrology Pediatrics Geriatrics Neurology Class Attendance 10 Months 40 Lectures 4 Hours Weekly 120 Credit Hours
Transcript: How to improve the clinical pharmacist's skills? clinical training at major hospitals e.g. 57357 OTC sessions at the university community pharmacy theoretical and practical training Camping with 1st class professionals for more experience Preparation courses for the American Board PharmD orientation courses participation in medical camps all over the country Thank You! What do clinical pharmacists do? Clinical Pharmacy 62 ECG bpm
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