Introduction to the Clinical Pharmacy

7/25/2019 Introduction to the Clinical Pharmacy

1/22

Introduction To TheIntroduction To The

Clinical PharmacyClinical PharmacyByBy

Amgad A. Ragab, Pharm D, CCPAmgad A. Ragab, Pharm D, CCP

New York ni!er"ity #edical CollegeNew York ni!er"ity #edical College

New York ni!er"ity Cancer CenterNew York ni!er"ity Cancer Center

New York $ANew York $A


2/22

%uman Body%uman Body

& ' ((,)*+,- /$ ' +).**

& +*** gm o0 Bone #arrow 1'2,ooo3gm4 Total5 '2,***,***

& ). gm o0 DNA 1'+.2**,***3gm4 Total5'-.)**,***

& +*-. gm o0 Immune globulin Ig6 1'7),***3gm4

Total5 ' ),2+7,(**& +* unit" o0 erythro8oietin hormone 1'3u4

& Total 5 ' +**.**


3/22

%uman Body 9rgan"%uman Body 9rgan"

& The %eart 5 ' ),***

& The :i!er 5 ' (,++*

&The :ung 5 ' ;,** < = ' ++7,(**& The >idney 5 ' (,)** < = ' +-(,***

& The Pancrea"e 5 ' (2,-**

& The Cornea 5 ' (,*** < = ' ;,***& The ?gg = ' ),*** each

& The $8erm = ' ).** each e@aculation


4/22

%uman Chemi"try%uman Chemi"try

& Iron ' *.2* Pota""ium ' .-

& Carbon ' +.-; Calcium ' *.+;

& Chloride ' *.+) Pho"8hour" ' ).+& Iodide ' *.*+ $ul8hur ' +.7*

& inc ' *.*2 $odium ' *.++

& T9TA: ' +).**


5/22

CA$? $TDYCA$? $TDY

& A yearold male wa" admitted to the ho"8italwith 0e!er and 0atigue. :ab te"t" re!ealed that hewa" 8ancyto8enic

& BC +***, ANC 2**, %6B .), %CT +)Platelet" -),***, BN 72, Creatinine .

& P#$5 9rthoto8ic heart tran"8lant +( month"be0ore thi" e!ent

& #edication"5 Cyclo"8orine +**mg P9 BIDAEathio8rine +*mg P9 BIDPredni"one +*mg P9 FD


6/22

CA$? #ANA6?#?NTCA$? #ANA6?#?NT

& Pt. wa" admitted to IC with 8recaution"related to neutro8enia

&%e recei!ed a blood tran"0u"ion 1( unit"40or anemia

& Broad"8ectrum AB 0or neutro8enia

& GluconaEole and 6anciclo!ir 0or 8o""ible0ungal or !iral in0ection"

& B# bio8"y 0or 8o""ible C#/ in0ection


7/22

#?DICA: PR9B:?# DI$C9/?RY#?DICA: PR9B:?# DI$C9/?RY

& Clinical 8harmaci"t inter!iewed the 8t.

& It wa" di"co!ered that 8t. wa" beingtreated with allo8urinol 2**mg P9 FD 0orhy8eruricemia 1di"order a""ociated withcyclo"8orin thera8y4 month" be0ore theho"8italiEation

& Drugdrug interaction between allo8urinoland aEathio8rine cau"e" 8ancyto8enia

& Naran@o "core i" )


8/22


9/22

#?C%ANI$# 9G ACTI9N#?C%ANI$# 9G ACTI9N

& AEathio8rine i" metaboliEed to 7merca8to8urine 7#P and then to inacti!e8roduct" by Hanthine oHida"e

& Allo8urinol i" a Hanthine oHida"e inhibitor& ToHic e00ect" on the bone marrow due to

higher 8la"ma concentration o0 7#P

& Pt. remained in ho"8ital 0or 2+ day" till thebone marrow "lowly reco!ered

& Total co"t o0 thi" "tay wa" ' +;*,--,)2


10/22

Inter!entionInter!ention

& It i" recommended change" in the drug thera8y 0or anyo0 the 0ollowing rea"on"5

ntreated indication. Drug u"e without an indication.

Im8ro8er drug "election. Gailure to recei!e drug $ubthera8eutic do"age 9!erdo"e

Ad!er"e Drug Reaction Drug interaction Ina88ro8riate route #onitoring reuired


11/22

AD/?R$? DR6 ?/?NT 1AD?4AD/?R$? DR6 ?/?NT 1AD?4

& De0initionAny in@ury that re"ult" 0rom the u"e o0 a

drug


12/22

C:A$$IGICATI9N$ 9G AD?C:A$$IGICATI9N$ 9G AD?

& Ad!er"e Drug Reaction 1ADR4Any re"8on"e to a drug that i" noHiou" and

unintended and that occur" at do"e" normallyu"ed in human" 0or 8ro8hylaHi", diagno"i", or

thera8y o0 di"ea"e& #edication ?rror

Any 8re!entable drug e!ent that may cau"eor lead to ina88ro8riate medication u"e or

8atient harm& Thera8eutic Gailure A "ubo8timal re"8on"e to drug thera8y


13/22

AD? C:A$$IGICATI9N$ 1C9NT.4AD? C:A$$IGICATI9N$ 1C9NT.4

& Ad!er"e Drug ithdrawal ?!ent 1AD?4

A noHiou" or unintended re"8on"e that occur"when a drug i" di"continued 1eg,

benEodiaEe8ine" withdrawal, reboundhy8erten"ion with abru8t di"continuation o0clonidine

Accidental3Intentional 9!erdo"e5

A drug e!ent due to a "u8rathera8eutic le!el o0a drug, either accidental 1childhood 8oi"oning4or intentional 1"uicide attem8t4


14/22

INT?R/?NTI9N T9 R?$9:/?INT?R/?NTI9N T9 R?$9:/?


15/22

INT?R/?NTI9N T9 R?$9:/?INT?R/?NTI9N T9 R?$9:/?PATI?NTJ$ DR6 T%?RAPYPATI?NTJ$ DR6 T%?RAPY

PR9B:?#PR9B:?#& The do"e o0 aEathio8rine "hould be reduced by*

& AEathio8rine do"ing "hould al"o be reduced in

8atient" that ha!e a renal in"u00iciency& AEathio8rine K li0e elimination5

Parent drug5 + minute"

7#P5 *.)2hr"#ay be taken with 0ood,2 hr" di00erence at lea"t

between aEathio8rine and allo8urinol


16/22

C:A$$IGICATI9N 9G ADRC:A$$IGICATI9N 9G ADR

& Ty8e I5 Augmented reaction"Related to 8harmacologic e00ect"

eg5 hy8oglycemic coma 0rom in"ulin

hy8o8rothrombinemia 0rom war0arin;*; o0 all ADR", con"idered 8redictable

& Ty8e II5 BiEarre reaction"Related to hy8er"en"iti!ity or immune mediated

reaction" +*o0 all ADR", con"idered un8redictable


17/22

AD?" L %?A:T% CAR?AD?" L %?A:T% CAR?

$?TTIN6$$?TTIN6$

& A Community

& +; o0 8atient" eH8erience an AD?

& #ore than * o0 o00ice !i"it" due to AD?" are

8re!entable& +.); o0 ?D !i"it" are related to medication

mi"management 1)* are 8re!entable4

& +* o0 all ho"8ital" admi""ion" are related to

AD?"& +32 o0 drug related ho"8italiEation" in!ol!e

8atient noncom8liance i""ue"


18/22

C9NT.C9NT.

& B. %o"8ital"

& +*2* o0 ho"8italiEed 8atient"eH8erience an AD?, +2 "igni0icant

& ?ach AD? co"t" a88roHimately '***

& 2** o0 AD?" in ho"8italiEed 8atient"

are 8re!entable


19/22

C9NT.C9NT.

& C. :ongterm Care

& +.;- AD?" 8er +** re"ident" occur

& #ore than * o0 AD?" are 8re!entable

& Poly8harmacy5 The a!erage number o0medication" taken by elderly 8atient" ; 8erday

& The AD? rate among 8atient" recei!ing +2drug"5 7

& #ore than 7 drug" the rate i"


20/22

AD?" $TATI$TIC$AD?" $TATI$TIC$

& ar0arin -

& Antidiabetic agent" -(

& N$AID" ;-

& DigoHin ;

& Antie8ile8tic drug" 7-

& Inadeuate monitoring o0 drug thera8y 7)

& Ina88ro8riate do"e +

& Patient com8liance 22

& Drugdrug interaction 7

& Contraindication 2

& Allergy +


21/22

C9NC:$I9NC9NC:$I9N

& T%? ANNA: C9$T 9G DR6R?:AT?D #9RBIDITY AND #9RTA:ITY?


22/22

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Introduction to the Clinical Pharmacy

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