PHARMACEUTICAL CARE

Learning outcome
1. To understand the empathy level and giving the examples of
empathy.
2. To analyze the patient’s need in terms of drug choices and
the suitable dosage depending on the patient’s need,
guidelines, and regulation.
3. To select the limit of self-medication allowed and to refer
the patients towards the doctor or the suitable facility if
required.
4. To formulate the appropriate medication depending on the
patient’s need and safety.
5. To inform the patients about the detailed information on the
indication of the drugs, administration, dosage and the side
effect.
6. To give in detail the information regarding the proper
storage condition to the patients and to make sure the
medications in the pharmacy is properly stored in the
proper humidity, temperature, and expiry dates.
7. To explain the reason behind the prohibition and the risk of
the patient’s request which cannot be processed.
8. To give description regarding the monitoring of the
treatment in both therapeutics and adverse effect with
subjective opinion from the patients.
9. To give detailed information regarding the data needed for
documentations in the self-medication service.
Sheet 1 : Patient’s assesment
PATIENT HISTORY FORM

Name : An (5 tahun) Date : 24/08/21

Date and place of birth :-
Address :-
Phone :-
Height : …-… Kg Weight : …-…cm HR :…-… BP: -. mm/Hg
Gender: Male/Female Pregnancy status: Pregnant/not …month
Allergies : Chil/ cold temperature Reactions :
Device : Condom/ injection/ pill/ IUD/other :-
PRESCRIPTION MEDICATION HISTORY
Name / Start Stop
strength Directions date date Physician Purpose Effectiveness

- - - - - - -

NONPRESCRIPTION MEDICATION HISTORY

Name /
strength Directions Purpose How Often Effectiveness

- - - - -

Conclusion : Pasien tidak memiliki riwayat pengobatan

sebelumnya

Medical Problems Have you experience or Do you have (check Y

or N)
Problem Y N Problem Y N
Kidney problem √ Sores on Legs or feet √
 Urunary Infection √ Blood clot problems √
Difficulty with urination √ Leg pain or swelling √
Urination at night frequently √ Unusual bleeding or bruising √
Hepatitis / liver problem √ Anemia √
Trouble eating certain food √ Thyroid problems √
Nausea / Vomit √ Known hormone problem √
Constipation / diarrhea √ Arthritis or joint problem √
Bloody or black bowel √ Muscle cramps or weakness √
movement
Abdominal pain or cramps √ Memory problems √
Frequent heatburn or √ Dizziness √
indisgestion
Stomach ulcer in the past √ Hearing or visual problem √
Short of breathness √ Frequent headache √
Coughing with sptum √ Rash or hives √
Chest pain √ Change in appetite or taste √
Fainting spell √ Walking or balanced problem √
Racing heart or thumping √ Other : Fever √

Medical History Have you or any blood relative had (mark all that
apply )

Self Relative Self Relative

High BP …-… …-…. Heart disease …-… …-….
Asthma …-… …-…. Stroke …-… …-….
Cancer …-… …-…. Kidney disease …-… …-….
Depression …-… …-…. Mental illness …-… …-….
Lung disease …-… …-…. Substance abuse …-… …-….
Diabetes …-… …-…. Other

Social History Please indicate your alcohol, tobacco, caffeine, and

dietary habbits
Nicotin use Caffeine intake
….-… never ….-…never consumed
….-… pack per day for - years ….-… drink per day
….-… stopped - years ago ….-… stopped - years ago
Alcohol consumption Diet restriction / Patterns
….-… never consumed - number of meals per day
….-… drinks / day ….-… food restriction
….-… stopped - years ago

Conclusion : pasien tidak memiliki masalah kesehatan, tidak

memiliki riwayat pengobatan sebelumnya, dan tidak memiliki
kebiasaan hidup yang buruk

Conclusion of clinical assessment, medication history,

administrative aspect of prescription
a.Clinical manifestation and clinical problem
Subjective
benjolan berwarna coklat kemerahan di bagian kulit, melepuh

Objective
demam 37,8oC

Clinical problem:
a. Actual : Dermatitis Paederus
b. Potential :-

b.Administrative aspect of prescription (legal/illegal) :

-

c.Diagnosis of Pharmaceutical Care :

Dermatitis paederus

Sheet 2 : Case study (Assesment)

Assessment with PAM Method

A. Problem
Patient : An (5 th) No RM. : .........................
Room/Ward : .......................
Date DRP Intervention regarding
 the DRP
24/8/2021 Pemilihan obat tidak Merekomendasikan
tepat kortikosteroid topical
(Rekomendasi untuk terapi dermatitis
Acyclovir tidak tepat) paederus

24/8/2021 Ada indikasi tidak ada Merekomendasikan

obat parasetamol sirup
(Pasien mengalami untuk mengatasi
demam dengan suhu demam pada pasien
37,8°C)

24/8/2021 Ada indikasi tidak ada Merekomendasikan

obat (Pasien kortikosteroid topikal
mengalami inflamasi (Hydrocortison cream)
ditandai dengan untuk mengatasi
benjolan coklat inflamasi
kemerahan dan lecet)

Patient : An (5th)
Location/Room :-
B. DRP ASESSMENT : Pharmacist :
Date : 24 Agustus 2021

DRUG THERAPY ASSESSMENT WORKSHEET (DTAW)

Presence of
Type of Drug Comments/Note
Assessment
Problem Related s
Problem
 Berdasarkan
Correlation artikel, terapi
between Paracetamol
drug efektif untuk
teraphy mengatasi
and 1. A problem
exists demam pasien
Medical Are there without a
Problems 2. More anak
medical indication?
information
Are any medication
is needed Link
unidentified (are any
for a Paracetamol :
labeled or any-prior to
determinati
administration/clinic
visit-unknown)?
on https://www.rese
Are there untreated 3. No archgate.net/pu
medical conditions? problem blication/567403
Do they require drug exists or an 7_Role_of_para
teraphy? interventio cetamol_in_treat
n is not ment_of_childho
needed
od_Fever_A_do
uble-
blind_randomize
d_placebo_contr
olled_trial
What is the 1. A problem Berdasarkan
Appropriate comparative efficacy exists artikel, terapi
drug of the chosen 2. More Hydrocortison
selection medication(s)? information krim efektif
What is the relative is needed
untuk mengatasi
safety of the chosen for a
medication(s)? determinati
dermatitis pada
Has the therapy been on pasien anak
tailored to this 3. No
individual patient? problem Link
exists or Hydrocortisone
an cream :
interventio
n is not https://pubmed.nc
needed bi.nlm.nih.gov/119
 23161/

Are the prescribed 1. A problem

Drug dose and dosing exists
regimen frequency appropriate- 2. More
within the usual information
therapeutic range is needed
and/or modified for for a
patient factors? determinati
Aren Prn uses on
appropriate for those 3. No
medications either problem
prescribed or taken exists or
that way? an
Is the route/dosage interventio
form/mode of n is not
administration needed
appropriate, -
considering efficacy,
safety, convenience,
patient limitations, and
cost?
Are doses scheduled
to maximize
therapeutic effect and
compliance and to
minimize adverse
effects, drug
interactions, and
regimen complexity?
Is there any
therapeutic
duplication?
Therapeutic Are there any 1. A problem -
duplication therapeutic exists
duplication? 2. More
information
is needed
 for a
determinati
on
3. No
problem
exists or
an
interventio
n is not
needed
Drug Is the patient allergic 1. A problem -
Allergy or to or intolerant of any exists
intolerance medicines (or 2. More
chemically related information
medications) currently is needed
being taken? for a
Is the patient using determinati
any method to alert on
health care providers 3. No
or the problem
allergy/intolerance (or exists or
serious medical an
problem)? interventio
n is not
needed
Adverse Are there symptoms 1. A problem
drug or medical problems exists
Events that maybe drug 2. More
induced? What is the information
likelihood that the is needed
problem is drug for a
related? determinati
on
3. No
problem
exists or
an
interventio
n is not
 needed
Interaction:Are there drug-drug 1. A problem -
Drug-Drug, interactions? Are they exists
Drug- clinically significant? 2. More
disease, Are any medications information
Drug- contraindicated is needed
Nutrient, (relatively or for a
and Drug- absolutely) given determinati
Laboratory patient characteristics on
Test and current/past 3. No
disease states? problem
Are there drug-nutrient exists or
interactions? Are they an
clinically significant? interventio
Are there drug- n is not
Laboratory Test needed
interactions? Are they
clinically significant?
Social or Is the patient’s current 1. A problem -
Recreation use social drug exists
al drug Use problematic? 2. More
Could the sudden information
decrease or is needed
discontinuation of for a
social drugs be related determinati
to patient symptomps on
(e.g., withdrawal)? 3. No
problem
exists or
an
interventio
n is not
needed
Failure to Has the patient failed 1. A problem -
receive to receive a exists
therapy medication due to 2. More
system error or non- information
compliance? is needed
Are there factors for a
 hindering the determinati
achievement of on
therapeutic efficacy? 3. No
problem
exists or
an
interventio
n is not
needed
Financial Is the chosen 1. A problem -
Impact medication(s) cost exists
effectiveness? 2. More
Does the cost of drug information
therapy represent a is needed
financial hardship for for a
the patient? determinati
on
3. No
problem
exists or
an
interventio
n is not
needed
Patient Does the patient 1. A problem -
Knowledge understand the exists
of drug purpose of his or her 2. More
therapy medication(s), how to information
take it, and the is needed
potential side effects for a
of therapy? determinati
Would the patient on
benefit from education 3. No
tools (e.g., written problem
patient education exists or
sheets, wallet cards, an
and reminder interventio
packaging)? n is not
needed
 Conclusion of DRP assesment:
DRP yang ada pada skenario :
1. Pemilihan obat tidak tepat = Asiklovir
2. Ada indikasi tidak ada obat = gejala demam tinggi,
rekomendasi diberikan Paracetamol syr 125mg/5ml
3. Ada indikasi tidak ada obat = inflamasi pada kulit,
rekomendasi Hydrocortisone cream 1%

Final diagnosis of Phamaceutical Care and Priority of

Pharmaceutical Care:
- Pasien mengalami dermatisis paedrus
Priority Rank of Pharmaceutical Care:
- Dermatitis paedrus
- Demam

C. Recommendation and Plan of Pharmaceutical Care

C.1.Recommendation and Plan of Drug Treatment Worksheet

Drugs / Total Patient

No Strength Frequency
Medication number Information
1 Paracetamol 125 mg/ 1 Botol 3x sehari,
sirup 5mL 5 ml (Jika Digunakan
Demam) sesudah
makan. Jika
sudah tidak
panas
 pemakaian
parasetamol
syrp
dihentikan

1% 1 tube 2-3x sehari

Hydrocortiso Dioles tipis-
ne krim tipis pada
2
bagian yang
diobati.

C.2. Pharmaceutical Care Plan

Medication goal and Medication, dose,
No Clinical Problems
outcome route & schedule
Demam Suhu tubuh normal
(suhu 37,8 C) (36,5 C-37,2 C) Parasetamol syr 125
mg/5ml, PO, jika
1 demam 3xsehari 1
sendok teh (5ml)
sesudah makan

Meredakan inflamasi Hydrocortisone cream

Benjolan pada kulit, mengatasi 1 %, Topikal, 2-3x
berwarna coklat permasalahkan kulit sehari dioleskan tipis-
kemerahan pada (melepuh, gatal dan tipis pada bagian yang
kulit, melepuh, lecet) diobati
gatal dan lecet
2
 C.3. Plan of Drug Monitoring
Monitoring therapeutical effect
Parameter
Drugs / Normal End Monitoring Recommenda
No of
Med value point frequency tion
monitoring
1 Paraceta Suhu Dilihats Suhu
Setelah 3- Jika efektif
mol Tubuh ecara normal
5 hari pengobata
Sirup visual (36.5°
pengobata n
(termo C-
n dilanjutkan
meter) 37,2°C
)

2 Hydrocor Benjolan, Dilihat Perma Setelah 1 Jika efektif

tisone melepuh, secara salaha minggu pengobatan
krim gatal visual n pengobata dilanjutkan
 berkurang berkur n
ang

ADR monitoring
Drugs / Parameter of Normal End Monitoring
No Recommendation
Med monitoring value point frequency
1. Paracet Mual Dilihat Tingka Setelah Hentikan
amol muntah, secara t menggun penggunaan jika
sirup sakit kepala subyekt kepara akan obat efek samping
if han bertambah
yang parah
dirasa
kan
bertam
bah
2. Hydro Terasa Dilihat Tingka Setelah Hentikan
cortiso terbakar, secara t menggun penggunaan jika
ne pengerasan visual kepara akan obat efek samping
krim kulit, han bertambah
kekeringan, pada parah
atau kulit
pengelupasa bertam
n kulit. bah
 Observation sheet in patient’s assessment and
pharmaceutical care planning: (tutorial)
Point
No Aspect
0 1 2
1 Student’s activity in the forum
2 Clear and defined question
Question and suggestion is appropriate to the
3
case
4 Applicate the discussion ethic
Question and suggestion is based on the
5
evidence
Total

Comment of Observer :

Sign of observer :
 PRESENTATION
Draft of presentation

Not
Available*
available*
Case number:
Sheet 1 : Patient’s assessment
Sheet 2 : Assessment/penilaian kasus :
1. Problem
● Objective / subjective (sign-
symptoms) of Cases
● Actual & potential problem
2. Assessment
● Clinical problem
● DRP (DTAW & DTPL)
● Pharmaceutical care problem/
Diagnosis of Pharmaceutical Care
3. Pharmaceutical care plan
3.1. Clinical problem, goal recommendation
and plan of treatment (doses, frequency
and route)
3.2. Monitoring
● Monitoring theurapetic effect
● Monitoring ADR
*) checked ( √ )
Recommendation from fasilitator : Prepared /
unprepared for presentation
Date :
Sign of fasilitator :