I.

LECTURE CONTRACT

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TATA TERTIB KULIAH
Kehadiran 75%
Tidak Titip Absen
Toleransi keterlambatan 15 menit
Tugas IPE = 30% , Quiz = 10%, UTS = 30%, UAS
=30%

UTS DAN UAS = MCQ

JADWAL KELAS A SELASA JAM 12.20. PJ Kelas A:
JADWAL KELAS B JUMAT JAM 09.00. PJ Kelas B: FIMA
ASKA
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 MATERI UTS FARMASI
KLINIK
TM MATERI KULIAH RENCANA
KE- PELAKSANAAN
1 Konsep dan Pengantar Farmasi Klinik 20 DAN
23/8/2019
2 Metode Analisis Kasus dan Model 27 DAN
Dokumentasi Penyelesaian Masalah 30/8/2019
3 Interpretasi Hasil Pemeriksaan Fisik dan EBM 3 DAN 6/9/2019
4 Identifikasi DRP 10 DAN
13/9/2019
5 Farmakokinetika Klinik 17 DAN
20/9/2019
6 Penanganan Sitostatika 24 DAN
27/9/2019
7 Pelayanan Pemberian Antikoagulan & KUIS 1 DAN
4/10/2019
8 UTS 7-11 OKTOBER
2019 3
 MATERI UAS FARMASI
KLINIK
TM MATERI KULIAH TANGGAL
KE-
9 Pharmacovigilence 15 DAN 18 /10/2019
10 Interpretasi data klinik hematologi 22 DAN 25 /10/2019
11 Gangguan keseimbangan asam basa 29/9 DAN 1/11/2019

12 Penggunaan obat pada ibu hamil dan 5 DAN 8/11/2019

menyusui
13 Penggunaan obat pada geriatri 12 DAN 15/11/2019
14 Penggunaan obat pada pediatri 19 DAN 22/11/2019
15 Penggunaan obat pada penyakit hati dan 26 DAN 29/11/2019
KUIS
8 UAS 2-6 DESEMBER
2019

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II. INTRODUCTION

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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)

Segala pelayanan yang diberikan oleh seorang

farmasis dalam usahanya untuk mencapai terapi obat
yang rasional yaitu aman, tepat dan cost-effective

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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 60’s (US and UK)
A series of studies in the US ~ medication error
problem in hospital ~ 1960’s
 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 pharmacist’s 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
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source for the public
FUNGSI UTAMA SEORANG
FARMASIS KLINIK ADALAH:
Monitoring Drug Therapy
Individual patient
Global trends

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PHARMACEUTICAL CARE

The responsible provision of drug therapy for

the purpose of achieving definite outcomes
that improve a patient’s 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 problem

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

Evaluate therapeutic
alternatives

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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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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 patient’s experiencing an optimum
outcome of medical care

(Hepler & Strand, 1990)

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DRUG THERAPY
PROBLEM (DTP)
Drug therapy problem: Drug therapy problem:
A DTP is any undesirable A DTP is any undesirable
event experienced by event experienced by a
the patient that involve patient which involves,
drug therapy and that or is suspected to
actually or potentially involve, drug therapy,
interferes with a desired and that interferes with
patient outcome achieving the desired
goals of therapy.

(Cipolle, et al, 1998)

(Cipolle, et al, 2000)

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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
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 β–
agonist.
Actual DRP:
 Timolol eye drops as a precipitating factor
 Timolol = β 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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3. SETTING OUTCOME
GOALS
Potential Outcomes:
 Cure of disease
 Elimination or reduction of a patient’s
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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