Principles and Concepts applied in pharmacotherapy - All Global Updates

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.


Patient Assessment

·         In this step, 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;

o   Inappropriate drug selection

o   Need for additional drug therapy

o   Unnecessary drug therapy

o   Incorrect drug regimen

o   Therapeutic duplication

o   Drug allergy/adverse drug event

o   Drug Interactions

o   Medication adherence issues

·         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 ensuaring 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

§  The goals of therapy must be achievable and realistic for the patient.

§  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

  • 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;

  • 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

  • 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).

  • Signs and  symptoms

  • Laboratory and Other Diagnostic Tests

  • Diagnosis.

  • Treatment (Drug) plan

  • Follow-up plan
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References

           

Wells BG, DiPiro J, Schwinghammer T (2013), Pharmacotherapy Handbook (6th Ed). New York, NY: McGraw-Hill.


DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008): Pharmacotherapy: A Pathophysiologic Approach (7th 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 (7th ed): New York, NY: McGraw-Hill.

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