PHC 505

PHARMACEUTICAL CARE
DRUG RELATED PROBLEMS &
PHARMACEUTICAL CARE ISSUES
NURWAHIDAH BT MOH WAHI
2012894654
PH 210 5 E

DRUG RELATED PROBLEMs & PHARMACEUTICAL CARE ISSUEs

Drug related problem (DPR) is problems in the pharmacotherapy of the individual

patient that actually or potentially interfere with desired health outcomes (Chua et al.,
2012). Some may refer as drug therapy problem. Whereas, pharmaceutical care issue is an
element of a pharmaceutical need which is addressed by the pharmacist (Janet Krska, 2000).
That term is commonly utilized in the UK. All these terminologies may refer to the same
concepts as drug related problems. So it is crucial to define the concept properly before
using it in research or publication (Mil, 2005).
Drug related problem is the major causes of drug related morbidity and mortality.
This problem would be better if it is preventable rather than to correct them. However, it
may not be possible if the pharmacotherapy is much more complex, lack of training of
health care providers and the behaviour of the patients (Mil, 2005). According to Mil, DRP
can occur during prescribing of medication by the doctor, dispensing by the pharmacist and
drug use process by the patient. It can also be categorised into real and potential DRP.
Further subdivision into problems that are unavoidable and avoidable. DRP may be due to
therapeutic failure for example inadequate therapy and also adverse drug reactions.
Adverse drug reaction is any effects that the patient encounter that is noxious and
unintended. Polypharmacy also a common drug related problem. Other drug related
problems are drug choice problem, dosing problem, drug use or administration problem,
drug-drug interaction or drug-food interaction.
The first type of DRP is adverse drug reaction. Adverse drug reaction is any effects
that the patient encounter that is noxious and unintended. A 67 year old woman with an
extensive rash is referred urgently to hospital. The rash started on the backs of her hands
and spread very quickly to the arms, trunk, neck, and face. The lesions consist of concentric
rings with frank blistering in some areas. Lesions have also started to appear on her lips and
inside her mouth. Her medications include: ramipril 10mg once daily, simvastatin 40mg at
night, aspirin 75mg once daily, metformin 1g twice daily, gliclazide 40mg each morning. She
was prescribed with glicazide recently like 2 months ago. The use of sulphonylureas may
cause hypersensitivity. It mainly of allergic skin reaction and may progress to erythema
multiforme. Ramipril also include erythema multiforme as a side effects. However, the side

effects only begin when gliclazide newly prescribed. Therefore in order to manage this side
effect, gliclazide should be stopped.
Another type of DRP is dosing problem. Dosing problem may be under dose or over
dose. This is particularly dangerous. If it is under dose there is no therapeutic effect to the
patient and the disease cannot be managed. However if it is over dose it can lead to
different type of side effects which may even lead to death. For example in a case Mrs A, an
87 year old lady, has been taking digoxin 0.25 mg daily for her atrial fibrillation for 3 years.
Recently you have noticed that she is getting increasingly frail and may have lost weight. On
a Saturday morning she presents a new prescription for digoxin. While you prepare the
prescription, she tells that she has been having visual disturbance and wonders if she needs
her glasses replaced. In this case, Mrs A has already suffered the side effect of high plasma
level of digoxin. This may be result from the lack of therapeutic monitoring. In the case of
Mrs A it is much more appropriate to refer her back to her physician to consider a new dose
of digoxin.
Polypharmacy is also a type of DRP. Elderly person for instance are vulnerable as
they usually diagnosed with a lot of different major diseases. They will require to consume
many different type of medication compare to other people. They may also consume some
other non prescription drug. Therefore, they are at risk for having polypharmacy which may
later lead to deutilization of drugs. They may encounter problems with medication
adherence that cause therapeutic failure or adverse drug reaction (JSTOR: Medical Care,
Vol. 39, No. 2 (Feb., 2001), pp. 109-112, n.d.).
Another DRP is drug-drug interaction. Mrs Beverly March is a 72- year-old who has
well controlled hypertension and no other risk factors for cardiovascular disease. She suffers
from reflux oesophagitis and occasionally requires pain relief for knee pain. Her current
medications are: atenolol 50mg mane enalapril 10mg ranitidine 150mg bd piroxicam 20mg
prn for knee pain On, questioning and discussing her medications we learn that she is also
taking a multivitamin and sometimes uses ibuprofen which she buys from the pharmacy. In
addition she sometimes forgets her antihypertensive medications. Mrs March weighs 65kg.
In this case, there is drug-drug interaction between ibuprofen (NSAIDs) with enalapril which
is antihypertensive. NSAIDs has potential to reduce the efficacy of enalapril. Therefore, it is
recommended to decrease the use of ibuprofen or substitute with paracetamol.

REFERENCE

Chua, S. S., Kok, L. C., Yusof, F. A. M., Tang, G. H., Lee, S. W. H., Efendie, B., & Paraidathathu, T.
(2012). Pharmaceutical care issues identified by pharmacists in patients with diabetes,
hypertension or hyperlipidaemia in primary care settings. BMC Health Services Research,
12(1), 388. doi:10.1186/1472-6963-12-388
JSTOR: Medical Care, Vol. 39, No. 2 (Feb., 2001), pp. 109-112. (n.d.). Retrieved November 15, 2014,
fromhttp://www.jstor.org/discover/10.2307/3768033?uid=3738672&uid=2&uid=4&sid=211
05209446793
Janet Krska, J. A. C., Fiona Arris,Deborah Jamieson, and Denise Hansford,. (2000). Providing
pharmaceutical care using a systematic approach. The Pharmaceutical Journal, Vol 265(No
7120), 656-660.
Mil, F. v. (2005). Drug-related problems:a cornerstone for pharmaceutical care. Journal of the Malta
College of Pharmacy Practice(Issue 10 Summer 2005).