8. CLINICAL PHARMACY

INTRODUCTION TO CLINICAL PHARMACY

Definition:

• A branch of pharmacy concerned with patient care and rational drug use
• Involves active participation of pharmacists in patient treatment
• Focuses on individualized drug therapy

It includes advising patients and optimizing therapy for better outcomes.

Scope of Clinical Pharmacy:

A clinical pharmacist performs various patient-centered activities:

1. Patient Medication History: Collects complete drug history and assists diagnosis.
2. Rational Prescription: Helps in correct drug selection and avoids irrational combinations.
3. Bioequivalence and Generic Selection: Ensures therapeutic equivalence.
4. Patient Monitoring: Observes drug response, side effects, and toxicity.
5. ADR and Drug Interaction Monitoring: Identifies adverse reactions and interactions.
6. Diagnostic Test Interpretation: Detects drug-induced changes.
7. IV Admixtures: Prepares sterile solutions and ensures compatibility.
8. Drug Information Services: Provides drug and dosage information.
9. Retail Pharmacy Role: Maintains patient profiles and guides OTC use.
10. Patient Counseling and Compliance: Educates patients on drug use.
11. Clinical Research: Participates in trials and evaluation.
12. Medical Audit: Reviews drug use patterns.

Roles of Clinical Pharmacist:

• Ensures safe drug distribution
• Maintains patient medication records
• Detects ADRs and interactions
• Provides patient counseling
• Designs dosage regimen
• Promotes rational drug use
• Participates in disease management
• Reviews drug utilization
• Educates public on healthcare

Development of Clinical Pharmacy:

Global development:

• Origin around 1953
• Expanded during 1960s–1970s
• Development of drug information centers and clinical roles

In India:

• Started in 1992
• Developed in Mysore and Ooty
• Expanded to Bangalore, Chennai, and Manipal

Common Medical Terminologies:

Term	Meaning
Aetiology	Cause of disease
Anaphylaxis	Severe allergy
Bradycardia	Slow heart rate
Hyperglycemia	High blood sugar
Hepatitis	Liver inflammation
Immunity	Body resistance

Latin Prescription Abbreviations:

Abbreviation	Meaning
b.i.d.	Twice daily
t.i.d.	Three times daily
q.d.	Once daily
p.o.	Oral
h.s.	At bedtime
p.r.n.	As needed

Departments in Clinical Pharmacy:

• Pediatrics: Child healthcare
• Geriatrics: Elderly care
• Antenatal care: Pregnancy care
• Postnatal care: Care after delivery

Daily Activities of Clinical Pharmacist:

1. Ward round participation
2. Treatment chart review
3. ADR monitoring
4. Drug information services
5. Medication history collection
6. Patient counseling
7. Interprofessional collaboration

Ward Round Participation:

• Monitor patient progress
• Optimize therapy
• Detect ADRs
• Types: Pre-rounds, resident rounds, professor rounds, teaching rounds

Treatment Chart Review:

• Check drug appropriateness
• Verify dosage and timing
• Identify drug-related problems
• Develop care plan

ADR Monitoring:

• Detect ADRs and interactions
• Improve drug safety
• Educate healthcare professionals

Medication History:

• Detect interactions
• Identify allergies
• Improve therapy

Patient Counseling:

• Improve compliance
• Reduce side effects
• Enhance treatment success

Therapeutic Drug Monitoring (TDM):

• Maintain drug concentration in therapeutic range
• Used for narrow therapeutic index drugs
• Detect toxicity and interactions

Pharmaceutical Care:

1. Collect patient data
2. Identify problems
3. Develop care plan
4. Implement therapy
5. Monitor outcomes

Drug Related Problems:

• Drug selection problems
• Dosing problems
• ADRs
• Drug interactions
• Improper use

Medication Therapy Management (MTM):

• Medication review
• Therapy planning
• Monitoring outcomes

Home Medication Review (HMR):

• Improve compliance
• Reduce medication errors
• Enhance quality of life