Professional Documents
Culture Documents
Rational Drug Use in Pharmacies
Rational Drug Use in Pharmacies
Y_KITIYOT@YAHOO.COM
1. 2
2.
3.
4.
5. 120
update
LNG ECPs
LNG ECPs
1.5 mg
(2 0.75 mg)
120
stroke, VTE
estrogen
LNG ECPs
()
-
CHIEF COMPLIANT (CC)
HISTORY OF PRESENT ILLNESS (HPI)
/ PAST MEDICAL HISTORY (PMH)
MEDICATION HISTORY (MH)
FAMILY HISTORY (FH) / SOCIAL HISTORY (SH)
ALLERGIC HISTORY (ALL)
:
[QALT: QUALITY, QUANTITY, AGGRAVATING FACTOR, ALLEVIATING FACTOR,
LOCATION, TIMING]
QUIZ 1:
SULFONAMIDE
A. CELECOXIB
B. ACETAZOLAMIDE
C. SUMATRIPTAN
D. GLUCOSAMINE SULFATE
QUIZ 2:
A. BETAMETHASONE CREAM
B. DEXTROMETORPHAN TABLET
C. BISACODRYL TABLET
D. DIPHENHYDRAMINE TABLET
E. IBUPROFEN SOFT-GELATIN CAPSULE
Patient group
Physiologic factor
Neonates, infants, young
Increased gastric pH
children, pregnant, elderly
Neonates, infants, pregnant Increased gastric emptying time
Comments
F of basic is increased, F of
acidic drugs in reduced
F is unpredictable
Infants, children
F is unpredictable
Pregnant, elderly
Neonates
Neonates, infants, young
children
Comments
Vd of water-soluble is
increased
Increased fat-to-lean muscle ratio Vd of fat-soluble is increased,
Vd of water-soluble is reduced
Reduced albumin concentration and Vd is increased, concentration
protein binding
of free drug is increased
Immature BBB
Risk for CNS toxicity is
increased
High concentration of particular drugs Risk for infants exposure of
drugs
Elimination
Neonates, infants
Young children
Elderly
Pregnant
Comments
Increased half-life,
clearance reduced
Metabolism of drug is
more rapid, requiring
oxidation
Half-life increased
Clearance increased
Clearance decreased
Clearance increased
WWHAM: WHO, WHAT ARE THE SYMPTOMS, HOW LONG HAVE THE SYMPTOMS BEEN PRESENT,
ACTION TAKEN, MEDICATION BEING TAKEN
ENCORE: EXPLORE, NO MEDICATION, CARE, OBSERVE, REFER, EXPLAIN
ASMETHOD: AGE/APPEARANCE, SELF OR SOMEONE ELSE, MEDICATION, EXTRA MEDICINES,
TIME PERSISTING, HISTORY, OTHER SYMPTOMS, DANGER SYMPTOMS
SIT DOWN SIR: SITE/LOCATION, INTENSITY, TYPE OR NATURE, DURATION, ONSET, WITH (OTHER
SYMPTOMS), AGGRAVATED FACTORS, SPREAD OR RADIATION, INCIDENCE, RELIEVED BY
INSPECTION
AUSCULTATION
/ PALPATION
PERCUSSION
WEIGHT
HEIGHT
BODY TEMPERATURE
HEART RATE/ PULSE
RESPIRATORY RATE
BLOOD PRESSURE
PAIN
SPECIMEN
UNIT
SENSITIVITY | SPECIFICITY
ACCURACY | PRECISION
CONFOUNDERS
ROS/ PE
Interview
Lab
Patient
need
/
POSSIBILISTIC APPROACH:
PROBABILISTIC APPROACH:
PROGNOSTIC APPROACH:
PRAGMATIC APPROACH:
No indication
Duplicate therapy
Contraindications present
Drug not indicated for condition DRUG
More effective med. available
Drug interaction
Indication refractory to drug
Inappropriate dosage form
Wrong dose
Inappropriate frequency, duration
Incorrect storage
Incorrect administration
Drug interaction
Wrong dose
Inappropriate frequency, duration
Incorrect storage
Incorrect administration
Drug interaction
Adherence (Noncompliance)
IESAC
(EVIDENCE-BASED
PRACTICE)
Efficacy
Indication
Safety
Adherence/cost
No bacterial
Totals
infection
114 (83.8%) 136 (100%)
99 (94.3%) 105 (100%)
213 (88.4%)
241
TRAUMA AND INFLAMMATION
GROUP A BETA-HEMOLYTIC
STREPTOCOCCUS (GABHS)
ACUTE RHEUMATIC
FEVER
ACUTE
POSTSTREPTOCOCCAL
GLOMERULONEPHRITIS
Clinical finding
Absence of cough
Anterior cervical nodes
swollen or enlarged
Headache
Myalgia
Palatine petechiae
Pharyngeal exudates
Fever >38C
Tonsillar exudate
Sensitivity (%)
Specificity (%)
51-79
55-82
36-68
34-73
48
49
7
26
22-58
36
50-80
60
95
88
52-92
85
PHARYNGOTONSILLITIS
CLINICAL SYMPTOMS OF PHARYNGITIS
(ESP. TONSILLAR EXUDATE) + HIGH
GRADE FEVER, CHILL, SEVERE FATIGUE,
MYALGIA, ODYNOPHAGIA, DYSPHAGIA,
ANOREXIA, N/V
1
1. ( 38 )
2.
3.
4.
5.
15
15-45
45
1
1
1
1
1
0
-1
2 group A Streptococcus
()
0
< 10
1-2
10-17
3
28-35
52-53
DOT (DIRECTLY OBSERVED THERAPY)
MEASUREMENT OF RELIABLE SURROGATE MARKERS E.G., BLOOD LEVEL, METABOLITES
QUESTIONNAIRES, SELF-REPORT, DIARY
PILL COUNT
RATES OF PRESCRIPTION REFILLS
ASSESSMENT OF PATIENT RESPONSES, PHYSIOLOGIC MARKERS
M.A.A.R.I.E. (METHODS, ASSIGNMENT, ASSESSMENT, RESULTS, INTERPRETATION AND EXTRAPOLATION)
FLUOROQUINOLONES
ERYTHROMYCIN
- 1 2
KETOCONAZOLE, NSAIDS
2
ALFA-GLUCOSIDASE INHIBITOR
FLUOROQUINOLONES, MACROLIDES
MAOIS
WARFARIN
GRISEOFULVIN