Introduction to Pharmacotherapy
PST 06106
BASIC PHARMACOTHERAPY
Session 1: Introduction to Pharmacotherapy
Learning objectives
By the end of this session students are expected to be able to:
Define terminologies used in Pharmacotherapy
Describe principles and concepts applied in Pharmacotherapy
Explain importance of Pharmacotherapy in the management of common diseases
Definition of Common Terminologies used in Pharmacotherapy
Pharmacotherapy
is application of knowledge in making therapeutic decisions that are most likely to have maximum positive benefit for a specific patient.
Pharmacotherapy specialist:
is an individual who is specialized in administering and prescribing medication, and requires extensive academic knowledge in pharmacotherapy.
Pharmaceutical
personel
are experts in pharmacotherapy and are responsible for ensuring the safe, appropriate, and economical use of pharmaceutical drugs.
Definition of Common Terminologies used in Pharmacotherapy Cont.…..
Pathophysiology
is the physiology of abnormal states; specifically: the functional changes that accompany a particular syndrome or disease.
Also is the study of changes in the way the body works that result from disease or injury
Pharmaceutical care involves the process through which a pharmacist/ other pharmaceutical personnel cooperates with a patient and other professionals in designing, implementing, and monitoring a therapeutic plan that will produce specific therapeutic outcomes for the patient
Principles
and Concepts applied in pharmacotherapy
There
are
three
steps that are involved in the Pharmacotherapy process which are
;
Patient assessment
Development of the pharmacotherapy care plan
Evaluation of the impact or results of the care plan
Principles and Concepts applied in pharmacotherapy
Cont
…..
Fig 1.1 Patient Care Process in the Pharmacotherapy
Patient Assessment
The focus
is on drug therapy problems in which case it is important to assess if the patient’s problem(s) is/are be caused by drug therapy and can be managed by a change in drug therapy
The following is the list of drug therapy problems that should be identified;
Inappropriate drug
selection,
Need for additional drug therapy
Unnecessary drug therapy
Incorrect drug regimen
Therapeutic
duplication
Drug allergy/adverse drug event
Drug Interactions
Medication adherence issues
Patient Assessment
Cont
…..
Once a drug therapy problem is identified and categorized, it is then necessary to identify the cause of the problem, thereby leading to potential solutions.
The process of drug therapy problem identification is to assessing the patient’s drug therapy needs and ensuring appropriateness, effectiveness and safety of medications, and the patient’s adherence
Pharmacotherapy
Care Plan
The
pharmacotherapy care plan is important in order to achieve improved pharmacotherapy outcomes.
It
is the action plan developed from assessment of patient described
above.
Each
item in the patient’s problem list must be addressed in the care plan, and the care plan should be prioritized in the same way as the problem list.
The pharmacotherapy care plan has several key components for each
problem:
Current
drug regimen
Drug
therapy
problems
Therapy
goals, desired endpoints
Pharmacotherapy Care Plan
Cont
…
The
goals of therapy must be achievable and realistic for the
patien
Drug
therapy may aim to
cure a disease;
reduce or eliminate signs and/or symptoms
slow or halt the progression of a disease
prevent a disease
normalize laboratory values
and/or
assist in the diagnostic process
Therapeutic recommendations
Rationale
Therapeutic alternatives
Monitoring
Pharmacotherapy Care Plan
C
ont
…
Monitoring
helps in determining whether treatment goals and endpoints (achieving positive goals and avoiding negative endpoints) are being reached.
An effective monitoring plan must be realistic for the patient setting and include
specific monitoring parameters (clinical and laboratory/diagnostic test)
frequency of monitoring, and
When the patient needs to be seen again for follow-up.
Patient
education
Evaluation
The
patient care process involves continuous follow-up.
As
the pharmacotherapy care plan is implemented, the patient’s response to
therapy is
monitored, and changes in therapy may be necessary.
Changes in previous problems or the development of new signs and symptoms will require the assessment process and changes in the pharmacotherapy care plan
During the Pharmacotherapy process, it is important to consider/review the following factors for optimal therapeutic outcome
;
Evaluation
Cont
…….
Patient
Dermographics
—name, age, etc.
Chief Complaint—why the patient is seeking help, in the patient’s own words
History of Present Illness (HPI)—the patient’s story about why they are seeking help
Past Medical History (PMH)—including all significant illnesses, surgical procedures, injuries
Family History—age and health of immediate family (parents, siblings, children); for deceased relatives, the age and cause of death are included; any hereditary diseases should be noted
E
valuation
Cont
…….
Social
History—may include where the patient is from or lives, ethnicity/race, marital status, number of children, educational background, occupation, diet
Tobacco/Alcohol/Substance
Use
Allergy/Intolerances/Adverse
Drug Events (ADEs)—a common area where information from the patient is missing or
incomplete
Medication
History—should include current (or medications prior to admission if hospitalized) and previous medications; the list should include what the patient actually is taking, not just what is prescribed, and must include OTC drugs and dietary supplements (including herbal and complementary/alternative products
).
Evaluation
Cont
…….
Signs
and symptoms
Laboratory
and Other Diagnostic Tests
Diagnosis
.
Treatment
(Drug) plan
Follow-up plan
Activity: Small Group Discussion
What is the importance of Pharmacotherapy?
Importance of pharmacotherapy
Helps in optimization of drug treatment in complex pharmacotherapy patients such as;
Patients with multiple medications
Patients with multiple disease states or conditions
Patients on narrow therapeutic index medications
Patients on medications requiring laboratory monitoring
Helps in optimization of drug therapy in patients with high risk for loss of continuity of care such as;
Patients with multiple prescribers
Patients with recent transitions of care (e.g., hospital discharge, rehabilitation, skilled nursing facility discharge)
Importance of pharmacotherapy cont…
Helps in reduction of medication nonadherence especially in patients with;
Irregular refill history
History of failure to pick up new prescriptions
Stockpiling or incorrect pill counts
Financial burden (e.g., uninsured or underinsured)
Low health literacy
Patient’s beliefs indicate resistance to treatment
High-cost regimens
Noticeable decline in the health or functionality
Improves patients-pharmaceutical personnel relationship which is important for better therapeutic
outcome
Key Points
Pharmacotherapy
is the therapy that is provided using pharmaceutical
Pharmacotherapy comprises the safe, applicable, and cost-effective use of pharmaceutical drugs.
Steps that are involved in the Pharmacotherapy process which are Patient assessment, Development of the pharmacotherapy care plan and Evaluation of the impact or results of the care plan.
Pharmacotherapy helps in improving quality of patient care through optimal medication management based on sound
pharmacotherapeutic
principles.
Evaluation
What
is pharmacotherapy?
What are the steps involved in the pharmacotherapy process?
What is importance of pharmacotherapy?
References
Wells
BG,
DiPiro
J,
Schwinghammer
T (2013),
Pharmacotherapy Handbook
(6
th
Ed). New York, NY: McGraw-Hill.
DiPiro
JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008):
Pharmacotherapy: A Pathophysiologic Approach
(7
th
ed
): New York, NY: McGraw-Hill.
Katz M D., Matthias KR., Chisholm-Burns M A., Pharmacotherapy(2011)
Principles & Practice Study Guide: A Case-Based Care Plan Approach
: New York, NY: McGraw-Hill.
Schwinghammer
TL, Koehler JM (2009)
Pharmacotherapy Casebook: A Patient-Focused Approach
(7
th
ed
): New York, NY: McGraw-Hill.
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