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Transcript of 111014 lec clin pharm
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Clinical pharmacy
11/10/14 LECTURE
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Practice Guidelines for Pharmacotherapy Specialists
• The pharmacotherapy specialist designs, implements, monitors, evaluates, and modifies patient pharmacotherapy to ensure effective, safe and economical patient care.
A Position Statement of the American College of Clinical Pharmacy
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Practice Guidelines for Pharmacotherapy Specialists
– The pharmacotherapy specialist retrieves , analyzes, evaluates, and interprets the scientific literature as a means of providing patient- and population-specific drug information to health professionals and patients
A Position Statement of the American College of Clinical Pharmacy
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Practice Guidelines for Pharmacotherapy Specialists
• The pharmacotherapy specialist participates in the generation of new knowledge relevant to the practice of pharmacotherapy, clinical pharmacy and medicine
• The pharmacotherapy specialist educate health care professionals and students, patients, and the public regarding rational drug therapy
• The pharmacotherapy specialist continually develops his/her knowledge and skills in applicable practice areas and demonstrates a commitment to continued professional growth by engaging in a lifelong process.
A Position Statement of the American College of Clinical Pharmacy
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Rational Drug Therapy
Basically follows the Rule of Rights, RIGHT PATIENT, RIGHT DRUG, RIGHT DOSAGE AND ADMINISTRATION AND RIGHT FREQUENCY.
Factors that will provide rational drug therapy:
1. Having strong distribution system
2. Putting the knowledge in action thru pxs
3. Clinical experience
4. Role models
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Rational use of drug
S afe
A ffordable
N eeded
E ffective
Q uality
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Rule of right:
• Right drug• Right patient• Right dose• Right time• Right duration• Right route of administration• Right information• Right price
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GOAL
Outcome
Therapeutic Effects
Adverse Effects
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Clinical pharmacokinetics
Clinical pharmacokinetics is the process of applying pharmacokinetic principles to determine the dosage regimens of specific drug products for specific patients
to maximize pharmacotherapeutic effects and minimize toxic effects.
TDM stands for therapeutic drug monitoring
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Clinical pharmacokinetics
• Application of these principles requires
an understanding of the absorption, distribution, metabolism, and excretion characteristics of specific drug products in specific diseases and patient populations
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Drugs that can be monitored
• when the range between minimal effectiveness and toxicity is narrow
• the results of the drug assay provide significant information for clinical decision-making.
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Drug Concentration measurement is USEFUL in research since this will be predictive of therapeutic or toxic effects.
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Why request TDM?
• Noncompliance• Inappropriate dosage• Poor bioavailability• Drug interaction• Kidney and liver disese• Altered protien binding• Fever• Cytokines• Genetically determined fast or slow metabolizers
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Responsibilities• Designing patient-specific drug dosage
regimens
• Recommending or scheduling measurements of drug concentrations in biological fluids
• Monitoring and adjusting dosage regimens
• Evaluating unusual patient responses to drug therapy for possible pharmacokinetic and pharmacologic explanations.
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Responsibilities
• Communicating patient-specific drug therapy information to physicians, nurses, and other clinical practitioners and to patients orally and in writing, and including documentation of this in the patient’s health record.
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Responsibilities
• Educating pharmacists, physicians, nurses, and other clinical practitioners about pharmacokinetic principles and appropriate indications for clinical pharmacokinetic monitoring, including the cost-effective use of drug concentration measurements.
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Responsibilities
• Developing quality assurance programs for documenting improved patient outcomes and economic benefits
• Promoting collaborative relationships with other individuals and departments involved in drug therapy
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Responsibilities
Pharmacists with specialized education, training, orexperience may have the opportunity to assume the
following additional responsibilities:
1. Designing and conducting research
2. Developing and applying computer programs andpoint-of-care information systems to enhance theaccuracy and sophistication of pharmacokinetic modelingand applications to pharmaceutical care.
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Responsibilities
3. Serving as an expert consultant to pharmacists with a general background in clinical pharmacokinetic monitoring.
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Example of Drugs for TDM
• Valproic acid• Quinidine• Procainamide• Cyclosporine• Aminoglycoside• Phenytoin• Phenobarbital• Digoxin
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Clinicians Approach to TDM
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Is therapy appropriate?
Is a less toxic alternative Available?
Re-evaluate therapy
NO Yes
Is immediate effectRequires/ expected?
Use less toxic agent that does not require drug conc monitoring
YesNO
Dosing estimations shouldLean towards a higher dose
Rather than lower doseStart w/ a low dose
And slowly titrateupward
NOYes
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Are drug conc measurements predictiveOf drug efficacy or toxicity?
Can the efficacy or toxicity be measured by immediate
Clinical endpoints?
Yes NO
Drug concentration monitoring likely only to Be beneficial for
verifying adherence
Drug concMonitoring indicated
Yes NO
Drug conc monitoring
Probably unnecessary