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
Blue and Silver Stetoscope



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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