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Clinical Pharmacy
Departemen Farmasi Komunitas
Fakultas Farmasi
Universitas Airlangga
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Tata tertib kuliah

Kehadiran 75%
Tidak Titip Absen
Toleransi keterlambatan 10 menit
Tugas = 10% dari nilai
Tugas dikumpulkan di kelas di meja dosen, sebelum
kuliah dimulai
Tidak merekam kuliah tanpa izin
UTS = MCQ
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Clinical Pharmacy
Those services provided by pharmacists, in an
attempt to promote rational drug therapy
which is safe, appropriate and cost-effective.
(Oddis 1989)
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Farmasi Klinik
Segala pelayanan yang diberikan oleh seorang
farmasis dalam usahanya untuk mencapai terapi
obat yang rasional yang aman, tepat dan cost-
effective
(Oddis 1989)
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Clinical Pharmacy
That area of pharmacy concerned with the
science and practice of rational medication use
(American College of Clinical Pharmacy 2004)
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Clinical
An activity where pharmaceutical knowledge is
applied to the clinical situation
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History
The term was first used in 1953
Widely used in the 60s (US and UK)
A series of studies in the US ~ medication error
problem in hospital ~ 1960s
6-7 doses of medicine/day/patient
Estimated error rate = 6-15%
Changing in pharmacist role
From compounding and preparing drugs
To clinical involvement ~ solving drug therapy problems
Working with other health professionals in the interest of
the patient
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Factors that spurred the development of

clinical pharmacy
Unresponsiveness of health care delivery
systems to public needs
Absence of a single discipline with broad
responsibility for drug use control
Overeducated & underutilized pharmacists
Diminished demand for the traditional
compounding skills of pharmacists
Major unresolved problems with drug use in
society
Inadequate drug knowledge on the part of
health professionals and patients
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The Practice
Hospitals ~ sicker patients
Most drugs are not used in Hospitals
Also practiced in Community Pharmacy
The practice could be different by necessity
The aim will always be the same:
To solve drug therapy problems
To contribute to a safe and appropriate use of drugs
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Clinical Pharmacy in Community

Pharmacies
Service to healthy individuals
The pharmacists role in self-care
The patient with a prescription
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General Clinical Pharmacy Functions

and Services
A. General Clinical Pharmacy Functions & Services:
1. Providing drug information to other health
professionals
2. Obtaining patient medication histories and using
patient medication profiles to assure proper drug
utilization
3. Monitoring drug therapy
4. Providing patient education and medication counseling
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General Clinical Pharmacy Functions

and Services
5. Providing disease screening, monitoring, and
maintenance care for patients with chronic diseases
6. Participation in the management of emergency medical
care
7. Serving as health information and education source for
the public
8. Participation in drug use review and patient care audits
B. Specialized Functions and Services

TUGAS I (Kelompok)
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Fungsi Utama Seorang Farmasis Klinik

adalah:
Monitoring Drug Therapy
Individual patient
Global trends
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Tujuan yang ingin dicapai dari

monitoring terapi obat:
Mengoptimalkan terapi obat
Meminimalkan efek samping obat
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Pharmaceutical Care
The responsible provision of drug therapy for
the purpose of achieving definite outcomes
that improve a patients quality of life
(Hepler & Strand, 1990)
Added responsibility for clinical pharmacy:
ensuring that patient achieves positive outcomes
improve quality of life
the outcomes are what the patient desires
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Pharmaceutical Care Quality Circle

Data Collection

Monitor Identify
outcomes problems
Take action to resolve
and/or
prevent drug therapy
Individualize problems Set treatment
therapy goals

Evaluate therapeutic
alternatives
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The aims of those functions

Identification of
potential drug related problems (DRPs)
actual DRPs
Resolution of actual DRPs
Prevention of potential DRPs
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Drug Related Problem (DRP)

Drug related problem:
A DRP is an event or circumstance involving drug treatment
that actually or potentially interferes with the patients
experiencing an optimum outcome of medical care

(Hepler & Strand, 1990)


Drug Therapy Problem (DTP)
Drug therapy problem:
A DTP is any undesirable
event experienced by the
patient that involve drug
therapy and that actually or
potentially interferes with a
desired patient outcome
(Cipolle, et al, 1998)
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Drug therapy problem:
A DTP is any undesirable
event experienced by a
patient which involves, or is
suspected to involve, drug
therapy, and that interferes
with achieving the desired
goals of therapy.
(Cipolle, et al, 2000)

Klasifikasi
DRP
1. Untreated indication
2. Improper drug selection
3. Subtherapeutic dosage
4. Failure to receive drugs
5. Overdosage
6. Adverse drug reaction
7. Drug Interaction
8. Drug use without indication
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DTP
1. Additional drug therapy
2. Unnecessary drug therapy
3. Wrong drug
4. Dosage too low
5. Adverse drug reaction
6. Dosage too high
7. Compliance
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Example
Case:
A patient taking timolol eye drops for his glaucoma. Then,
he develops shortness of breath soon after starting on
timolol eye drops. He is subsequently diagnosed with
asthma and begins taking an inhaled corticosteroid and a
agonist.
Actual DRP:
Timolol eye drops as a precipitating factor
Timolol = blocker
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Example
Case
A patient was prescribed gentamicin for the management of
sepsis
Potential DRP
Side effect: nephrotoxicity & ototoxicity
Monitoring urea and electrolytes, urine output
Monitor serum gentamicin level
Decrease dose and increase interval in renal failure
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The functions of the pharmacist

under Pharmaceutical Care
1. Collection of patients data
2. Identification of problem
3. Setting outcome goals
4. Evaluating treatment alternatives
5. Individualizing drug regimens
6. Monitoring outcomes
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1. Collection of Data
Information:
Patient demographics (age, sex, weight, height)
Current problem (signs & symptoms)
Past medical & surgical history
Current medications (R/, OTC, complementary medicines)
Allergies
Pregnancy & lactation status
Tobacco & alcohol use
Financial status
Relevant laboratory data
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2. Identification of Problems
Problems:
Disease states
Drug related problems (DRP)
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Example
Flucloxacillin increase in liver function test
(DRPs: adverse drug reaction)
Ciprofloxacin iron preparation chelat, reduce
absorbtion and activity separate dose by 2 hours
(DRPs: drug interaction)
Tetracycline ~ antacids (Al, Mg), iron salts ~
reduce absorbtion, chelate complex
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3. Setting Outcome Goals

Potential Outcomes:
Cure of disease
Elimination or reduction of a patients
symptomatology
Arresting or slowing of disease process
Preventing a disease or symptomatology
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4. Evaluating Therapeutic Options

Efficacy:
Risk vs Benefit
Safety
Availability
Cost
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5. Individualizing Treatment
Regimens
Dependent on:
Patient characteristics
Age
Disease(s)
Concurrent illnesses
Psychosocial factors
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Individualizing Treatment Regimens

Previous drug use
Efficacy/tolerance/compliance
Possible benefits
Treatment vs non-treatment
Possible risks
Potential adverse effect
Cost
Cost to patient and/or hospital
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6. Monitoring Outcomes
Positive
(improvement in signs & symptoms)
Continue treatment until course completed
Negative
(worsening of signs & symptoms)
Reassess alternatives
Neutral (no change)
Reassess current treatment

4s: sign, symptoms, side-effects, sequelae

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Diagnosis Is No
pharmacological Discontinue
intervention necessary? medication

Yes No
Change
Is drug appropriate? medication
Yes

Is dose appropriate? No
Assess pharmacodynamic Change dose
and pharmacokinetic Change medication
parameters
Yes
No
Reassess Is medication
Discontinue
still needed?
Yes Yes Discontinue
Drug-induced disease Change dose
Change medication
No

Optimal
Pharmacotherapy
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Kompetensi yang diperlukan oleh

seorang farmasis klinis
A sound knowledge of the pharmacology, indications,
dosages, adverse effects, toxicology and drug
interactions of commonly used medications
A sound knowledge of the clinical features,
pathophysiology, diagnosis, management and clinical
outcomes of common diseases
Ability to develop and implement drug therapy
monitoring strategies for individual patients (including
review of drug prescribing, clinical and laboratory data)
Ability to undertake medication order review
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Kompetensi yang diperlukan oleh

seorang farmasis klinis
Ability to undertake medication history interviews
Ability to undertake patient medication counseling
Ability to identify, suggest management strategies for,
and document adverse drug reactions
Ability to identify and suggest management strategies for
drug interactions
A sound knowledge of drug information resources. And
skills in information retrieval and evaluation
Ability to communicate effectively with other health-care
professionals to promote rational and effective drug
therapy
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References
American Society of Hospital Pharmacists. Basic Skills in Clinical
Pharmacy Practice. North Carolina: Universal Printing and Publishing,
1983.
Cohen M.R. Medication Errors. Washington: The American
Pharmaceutical Association, 1999.
Cromarty J.A, Hamley J.G, Krska J. Clinical Pharmacy Practice. In:
Winfield A.J, Richards R.M.E, editors. Pharmaceutical Practice. 2nd Ed.
Edinburgh: Churchill Livingstone, 1999.
Hughes J. Clinical Pharmacy and Pharmaceutical Care. In: Hughes J,
Donnelly R, James-Chatgilaou G, editors. Clinical Pharmacy: A Practical
Approach. 2nd Ed, Melbourne: MacMillan Education Australia Pty Ltd,
2001.
Limmer D. Remington: The Science and Practice of Pharmacy. 20th Ed,
Philadelphia: Lippincott Williams & Wilkins, 2000.
Turakka H, Van der Kleijn E. Progress in Clinical Pharmacy III.
Proceedings of the Ninth European Symposium on Clinical Pharmacy,
Helsinki, Finland. Amsterdam: Elsevier, 1981.
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TUGAS 1
Tugas 1: Macam-macam Layanan Farmasi Klinik (Clinical Pharmacy
Services)

Presentasi tugas 1 pada minggu ke-2 dan ke-3

Waktu presentasi 5 menit
Tanya jawab 5 menit
Kumpulkan hard copy sebelum kuliah, di meja dosen di kelas:
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Makalah tertulis
Kertas A4
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Line spacing 1.5
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Cara penulisan pustaka: Harvard referencing system
Tugas kelompok, 10 kelompok, anggota min 5 orang, max 6 orang
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TUGAS 1
Upload soft copy (makalah tertulis saja) pada TURNITIN, 1 hari sebelum hari
kuliah (minggu ke 2), maksimal pukul 23.59 WIB
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Class Name: Farmasi Klinik
Class ID : 12268264
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TUGAS 1
Topik Tugas 1, masing-masing kelompok mendapatkan 1 topik sbb:

1. Handling of cytotoxic drug

2. Aseptic dispensing services
3. Total parenteral nutrition (TPN)
4. Therapeutic drug monitoring (TDM)
5. Anticoagulation clinic/service
6. Unit dose dispensing (UDD) service
7. Drug Utilisation Study (DUS)
8. Medication reconciliation
9. Antibiotic stewardship program
10. Seamless care pharmacy
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Tugas 1
Jelaskan:
Definisi layanan farmasi klinik tersebut
Lingkup layanan (apa yang dilakukan)
Mengapa layanan tersebut diperlukan
Peran Farmasis
Tambahkan gambar bila relevan