hospital clinical pharmacy

1. Part II - Clinical pharmacy
Introduction to clinical pharmacy
practice
Content:
 Definition
 Functionof clinical pharmacist
 Role of clinical pharmacist
Definition:
It is health science discipline in which pharmacist provide care, advice,
treatment of patient that involve monitoring of drug therapy which promote
health, wellness and disease prevention.
Or
It is an area of pharmacy concerned with science and practice of rational
medication use.

2. Career prospective:
 Hospitals
 Academic
 Medical writing
 Medical billing
 Pharmacovigilance
 Clinical research and
Drug development
 Forensic pharmacy
 Contract research
organization
 Government sector
 Patient counseling
Scope of clinical pharmacy:
 Compounding and
dispensing of medicine
 Medication history
 Patient education and monitoring
 Participation in new drug investigation
 Formulation and management of drug policies
 Drug information
 Drug interaction
 Pharmacoeconomics

3. Role of clinical pharmacist in various area of making decisionon drug
therapy

4. Modern dispensing aspects
 Content
 Introduction
 Patient counseling
 Patient compliance
 Patient non compliance
 Advice for use of common drugs
 Medication history
Introduction:
The goal of therapy not achieved unless patient understand and follow
instruction for use of drug prescribed and minimize noncompliance.
As pharmacist is health professional his prior importance is to provide safe
and effective drug therapy to patient and increase their drug compliance.
Patient counselling:
Patient counselling is defined as providing medication information orally or
in written form to patient ondirection of use, advice onside effect, precaution,
storage, diet and lifestyle modification.

5.  Name and action of drug
 Route of administration
 Time of administration
 Duration of therapy
 Storage of drugs
 Restriction
 Allergic reaction
Role of Pharmacist in patient counselling-
1) Name of the drug and its action- The pharmacist should inform the
patient about not only the name of drug but also its other name .He must
explain the use of that drug and action on the body.
2) Route of administration- It is important for the
pharmacist to inform the patient about the route of
administration of drug, whether the drug is to be
taken orally or it is to be applied locally or to be used
into eye, ear or nose or inserted rectally or vaginally.
The pharmacist should be sure that the patient
understands how to use ophthalmic preparations and
suppositories.
3) Time of administration- The pharmacist should instruct the patient
when to take the medication e.g. some drugs should be taken on empty
stomach i.e. about 1 hour before meal or 2-3 hours after meal to ensure
adequate absorption of drug.
4) Duration of therapy- The pharmacist should encourage the patient to
continue taking the medicine for the prescribed duration of the treatment.

6. He should explain that the course of treatment must be completed to
achieve best results.
5) Storage of drugs- The pharmacist should instruct
the patient regarding storage of drugs as per label on
the container. The patient should advise to store the
drugs in a separate cabinet where children will not
reach.
6) Adverse effects of drugs- The patient should be informed about the
adverse effects of the drugs, but it not necessary to inform about all the
side effects e.g. .Headache. The patient should be informed of those side
effects which will allay fears and help him to avoid injury to himself e.g.
change in colour of urine, drowsiness.
7) Restrictions- The patient should be informed well that he should avoid
certain drugs and foods during the therapy. E.g. Restriction of Tyramine
containing food in patients on MAO inhibitor therapy

7. 8) Allergic reactions- Before dispensing the drugs like penicillin or
sulphonamide, the pharmacist should ask the patient about his allergic
reactions in the past. It helps in avoid in further complications of
treatment.
9) Removal of drug from package- The patient is not familiar with the
packing of the productas the pharmacist. Hence, the pharmacist should
demonstrate the method of removal of drug from the package to the
patient so that he can handle it properly.
Patient compliance:
Definition;
It is defined as, patient understanding and adherence to direction for use of
prescribed medicine.
Patient noncompliance:
Definition;
It is defined as, patient not following direction for use of prescribed
medicine.
Consequences of Non- Compliance
The patient noncompliance result in either underutilization or
overutilization of drugs.
1. Underutilization of medications:

8. It may happen due to following reasons
i).Taking less than the prescribed dose.
ii).Discontinuing the drug before completing the course.
iii).Omitting 1 or more doses.
Underutilization may result in:
a) Danger of death: - underutilization of anticonvulsant drug results in
uncontrollable seizures and death.
b) Patient with antibiotic therapy if stop taking the drug when symptoms
disappears this will result in recurrence of the infection. e.g. Tuberculosis
c) Omitting a single dose of contraceptive pill may results in unwanted
pregnancy
2. Overutilsation of medication:
Excessive doseof drug may cause serious adverse drug reactions and toxicity
in the patients. It may happen due to following reasons
i). Taking more amount/quantity than the prescribed dose.
ii). Taking more than prescribed number of doses.
iii). Taking a dose at a time other than when needed.
Factor affecting (reason) patient noncompliance
i. Poorunderstanding of instruction: the instruction given by physician or
pharmacist may not be followed correctly.
ii. Unpleasant taste of medication: It is common problem with use of oral
dosage form.
iii. Multiple drug therapy: Greater the number of drugs patients is taking,
higher is the risk of noncompliance.

9. iv. Asymptomatic nature of patient: In case of asymptomatic patient, it is
difficult to Convenience a patient by explaining the value of drug therapy
results in noncompliance.
v. Measurementofmedication:Many times there is confusion to the patient
in measuring liquid preparations or number of tablets.
vi. Cost of medication: Because of high cost of drugs, poor patients are not
purchase such drug.
vii. Frequency of medication: Regular schedule of dosage intake cannot be
followed due to work load.
viii. Duration of therapy: Long duration treatment lead to patient
noncompliance.
Steps to improve patient compliance
o Educating the patient: by written and verbal communication
o Development of treatment plan with recognition of patient normal
pattern of activities
o Designation of specific time of day at which medication is to be taken
o Patient motivation and Monitoring therapy
Advice for use of common medication:
Effective communication between pharmacist and patient and giving advice
to patient greatly reduce chance of noncompliance.
Following type of advice or information is required by patient on their
prescribed medicine
 Indication
 Dose to be taken

10.  Frequency of dosing
 Administration in relation to food
 Adverse effect
 Duration of therapy
Drugs Advice
salicylate Do not take on empty stomach
tetracycline Do not take with milk or antacid
Antacid tablet Chew do not swallow
MAO inhibitor Avoid cheese, chocolate, alcoholic beverages
Emulsion, suspension Shake well before use
phenytoin Expose yourself to sunlight in morning
phenolphthalein This laxative may color urine and feces pink
Medication history:
It is job of pharmacist to take complete medication history of the patient and
document it. It provide vital information about patient.
The history include
 Past and present use of medicine
 Drug allergy
 Adverse event
The initial drug history may completed within 24 to 28 hrs. After admission.
Objective:
To find out which drug cause allergy and ADR
To prepare list of patient current and past medication
To study patient compliance for drugs

11. To study his routine life
To know about diet preparation of patient

13. Questions:
 Define clinical pharmacy? What is scopeofclinical pharmacy?
 Give the function of clinical pharmacist?
 What is role of clinical pharmacist in various area of making decision on
drug therapy?
 Define : patient counselling, patient compliance, patient
Noncompliance.
 Describe patient consequences ofpatient noncompliance?
 How will you improve patient compliance?
 Name the factor contributing to patent noncompliance. Describe any four.
 What advice will you give about following drugs:
Salicylate, tetracycline, antacid tablet, MAO inhibitor, emulsion,
suspension.
 Write in short about medication history.
MCQ:
1. What is clinical pharmacy?
a. Productoriented approach
b. Patient oriented approach
c. Drug oriented approach
d. Hospital oriented approach
2. Objective of clinical pharmacy
a. To maximize patient role in drug use process
b. To decrease patient noncompliance
c. To maximize effective of drug therapy

14. d. All of above
3. Patient understanding and adherence to direction for use of
drugs is called as
a. Patient compliance
b. Patient noncompliance
c. Both a and b
d. None of above
4. Patient should not take milk with
a. Salicylate
b. Tetracycline
c. Barbiturate
d. NSAID
5. Which of following is not responsible for causing effect on
overutilization?
a. Taking more amount/quantity than the prescribed dose.
b. Taking more than prescribed number of doses.
c. Taking a dose at a time other than when needed.
d. Taking les then prescribed dose
6. It may cause sedation so don’t drive vehicle
a. Bisacodyl
b. Ampicillin
c. Diphenhydramine
d. All of above
7. Chew, do not swallow.
a. Antacid tablet
b. Rifampin
c. Tetracycline

15. d. Diclofenac
8. Factor that affect patient compliance
a. Cost of medication
b. Frequency of medication
c. Multiple drug therapy
d. All of Above
9. Role of pharmacist in counselling except
a. Information provider
b. Problem solver
c. Health promoter
d. Increase patient noncompliance
10. Medication history include
a. Past and present use of medication
b. Previous adverse effect
c. Drug allergy
d. All of above
11. The formula of % compliance
a. NDP+NME/NDP*100
b. NDP-NME/NDP*100
c. NME-NDP/NDP*100
d. NME+NDP/NDP*100