Pharmacy Preceptors Guild of the Philippines

HOSPITAL PHARMACY VIRTUAL INTERNSHIP PROGRAM (MAJOR)

CLINICAL PHARMACY – DRUG THERAPY ASSESSMENT
ACTIVITY ASSIGNMENT – 33

Name of Student: Chua, Ma. Victoria P.

School: Fellowship Baptist College
Batch Number: 03

Objective:

● Able to use strategies that develop effective and efficient data gathering and able to obtain
accurate, comprehensive medication-related histories despite of potential barriers in
communication.
● To effectively communicate medication-related information and drug-related problems to other
healthcare professionals.

Instruction:

❖ Using the patient’s medication list created in activity assignment – 32 Medication Review
Process -TRANSCRIBING:
o Analyze and assess the list using Drug Therapy Assessment
▪ Reference: American Society of Health-System Pharmacists. (2012). ASHP Clinical Skills
Competition LOCAL COMPETITION CASE. Retrieved August 24, 2020, from
https://www.ashp.org/-/media/assets/about-ashp/docs/awards-clinical-skills-
competition-2012-local-case.ashx?
la=en&hash=32490D786F0E27A4A1305786EFD4F7F75063642F
o Identify any drug related problem(s) from the list.
o Write your analysis and assessment based on SOAP (Subjective- Objective-Assessment-
Plan) Format
▪ Reference:
https://www.researchgate.net/publication/317296730_Assessment_of_SOAP_note_eva
luation_tools_in_colleges_and_schools_of_pharmacy
o One drug therapy problem = one SOAP
o On the last column of SOAP, please indicate the target respondent to whom you will
refer the drug-related problem you identified. (e.g., plan to discuss with the Prescribing
Physician, Nurse-in-charge or to the patient).

Patient’s name: ________________________

Age: 88
Gender: Female
Allergies: ______________________________

Drug Therapy Assessment

Subjective Objective Assessment Plan Target

Page 1 of 5
 Pharmacy Preceptors Guild of the Philippines
HOSPITAL PHARMACY VIRTUAL INTERNSHIP PROGRAM (MAJOR)
CLINICAL PHARMACY – DRUG THERAPY ASSESSMENT
ACTIVITY ASSIGNMENT – 33

Respondent

Duplication of Senna Concentrate All medication is Give only 1 laxative Recommended

Therapy (2 Tablets OD) vs. used to relieve or give those to MD and
Lactulose (30 ml constipation and in medications with endorsed to
OD) vs. Bisacodyl the same class. intervals. bedside nurse.
(10 mg Promotes
suppository OD) peristalsis. The risk
or severity of
adverse effects can
be increased when
they are combined
together.
Drug Interactions Norvasc (5 mg/tab Closely monitor Give 1 hr interval Recommended
I tab OD) vs. with Calcium when taking Norvasc to MD and
Calcium Carbonate Carbonate as it and Calcium endorsed to
(500 mg/Tab 1 tab decreases the carbonate. bedside nurse.
2x a day) effects of
Amlodipine by
Pharmacodynamic
antagonism.

Dexamethasone
decreases the level
Norvasc (5 mg/tab of effect of Give 1 hr interval
I tab OD) vs. amlodipine by when taking Norvasc
Dexamethasone (5 affecting hepatic/ and Dexamethasone.
mg/IV every 6 intestinal enzyme
hours) CYP3A4
metabolism.

Drug Interaction Nebicar (2.5 Closely monitor Give 1 hr interval Recommended

mg/tab 1 tab OD) with Calcium when taking to MD and
vs. Calcium Carbonate as it Nebivolol and endorsed to
Carbonate (500 decreases the Calcium carbonate. bedside nurse.
mg/Tab 1 tab 2x a effects of
day) Nebivolol by
unspecified
interaction.
Duplication of Insulin Glargine Both are indicated Consider intervals Recommended
Therapy (16 units SC OD) to improve when taking these to MD and

Page 2 of 5
 Pharmacy Preceptors Guild of the Philippines
HOSPITAL PHARMACY VIRTUAL INTERNSHIP PROGRAM (MAJOR)
CLINICAL PHARMACY – DRUG THERAPY ASSESSMENT
ACTIVITY ASSIGNMENT – 33

vs. Insulin Glulisine glycemic control in medications. endorsed to

(6 units SC while adults and bedside nurse.
on NPO CBG>240 pediatric patients
mg/dL) with type 1
diabetes mellitus
and in adults with
type 2 diabetes
mellitus. The risk
or severity of
hypoglycemia can
be increased when
Insulin glargine is
combined with
Insulin glulisine.

Duplication of Cetirizine (10 mg They both are in The patient may take Recommended
Therapy tab OD) vs. the same class and Loratadine as it is to MD and
Loratadine (10 both used in less drowsy. endorsed to
mg/tab OD) allergic conditions. bedside nurse.
Both piperidine
derivatives
selectively inhibit
histamine H1-
receptors on
effector cells.
Antihistamines
should not be
taken
simultaneously
because it can
increase the risk of
adverse effects.
Drug Interaction Dexamethasone (5 Use caution or Give 1 hr interval Recommended
mg/IV every 6 monitor closely when taking to MD and
hours) vs. Dexamethasone Dexamethasone and endorsed to
Atorvastatin (20 decreases the level Atorvastatin. bedside nurse.
mg tab, 1 tab OD) or effect of
Atorvastatin by
affecting
hepatic/intestinal
enzyme CYP3A4

Page 3 of 5
 Pharmacy Preceptors Guild of the Philippines
HOSPITAL PHARMACY VIRTUAL INTERNSHIP PROGRAM (MAJOR)
CLINICAL PHARMACY – DRUG THERAPY ASSESSMENT
ACTIVITY ASSIGNMENT – 33

metabolism.

Duplication of Diazepam (10mg / Both in the same Consider intervals Recommended

Therapy 2ml given 5 mg via drug class. when taking to MD and
SIVP vs. Increased risk of Diazepam and endorsed to
Clonazepam (2 mg the adverse effects Clonazepam. bedside nurse.
per tab, ½ tab of clonazepam
ODHS) especially
overdoses of
benzodiazepines.

Major drug-drug
Diazepam (10mg / Interaction.
2ml given 5 mg via Decreases the The patient may
SIVP vs. Tramadol metabolism of need a dose
(25 mg /IV every 8 Diazepam, so adjustment or more
hr as needed) plasma level will frequent monitoring
decrease and to safely use both
increased risk of medications.
overdose of
Diazepam.

Note: Diazepam,
clonazepam and
tramadol both
increase sedation.
Drug Interaction Diazepam (10mg / Increased Give 1 hr interval Recommended
2ml given 5 mg via metabolism of when taking to MD and
SIVP vs. Diazepam, so Diazepam and endorsed to
Dexamethasone (5 plasma levels will Dexamethasone. bedside nurse.
mg/IV every 6 decrease that will
hours) make it ineffective
when combined
with
Dexamethasone.

Page 4 of 5
 Pharmacy Preceptors Guild of the Philippines
HOSPITAL PHARMACY VIRTUAL INTERNSHIP PROGRAM (MAJOR)
CLINICAL PHARMACY – DRUG THERAPY ASSESSMENT
ACTIVITY ASSIGNMENT – 33

Page 5 of 5