Pharmacotherapy

• Pharmacotherapy is therapy using pharmaceutical drugs.
• Principally concerned with the safe and effective management
of drug administration.

• Pharmacists are experts in pharmacotherapy and are

responsible for ensuring the safe, appropriate, and economical
use of pharmaceutical drugs.
• The skills required to function as a pharmacist require
knowledge, training and experience in biomedical,
pharmaceutical and pharmacotherapy.
Terminology of disease

• Pharmacists are familiar with classifying knowledge about a

drug into such categories as ‘indications’ and ‘side-effects’.
• This enables the comparison of similar drugs, and facilitates
learning about a new drug and anticipating its properties by
assigning it to an existing class.
• Knowledge about disease is systematically described using
specific categories, and this enables similar diseases to be
distinguished by certain features, and helps learning about a
newly encountered disease.
Terminology of disease
Terminology of disease
 Drug use process (DUP)

• Pharmacotherapy, unlike the discipline of pharmacy, is a comparatively

recent and variably implemented form of practice.

• It encourages pharmacists to shift their focus from a product-oriented

role towards more direct engagement with patients and the problems
they encounter with medicines.

• Over the past 20 years there has been an emerging consensus that the
practice of clinical pharmacy itself should grow from a collection of
patient-related functions to a process in which all actions are undertaken
with the intention of achieving explicit outcomes for the patient.
Drug use process (DUP)
The medication use process involves several steps
The medical process starts with the:
• Case history, which includes examination, investigation and
diagnosis, and culminates in a decision about management. A
similar if less elaborate process must be followed by a
pharmacist to respond to symptoms presented by a patient. All
this information is gathered together to provide a systematic
classification of information about a patient.

• A case history is a systematic account of the progress of a

patient’s disease, including the information and reasoning
behind diagnosis and management decisions. It is the core of
the medical process and provides a central database for all
concerned with the care of the patient. Taking a history and
making a coherent record of it are two of the most fundamental
skills of Pharmacotherapy.
Format of typical case history report
The Care Plan 
A care plan is developed for each of the patient's medical
conditions being managed with pharmacotherapy. The major
questions you must consider to construct a successful care
plan are:
1. What goals of therapy are you and your patient trying to
achieve with pharmacotherapy?
2. What are you going to do, or how are you going to
intervene, to resolve any drug therapy problems identified
during the assessment?
3. What interventions (drug therapies, devices, patient
education) are you going to provide to ensure that your
patient achieves the desired goals of therapy?
4. When are you going to follow-up with your patient to
determine the actual outcomes of drug therapies and other
interventions?
The purpose of the care plan is to determine, with the patient, how to
manage his or her medical conditions or illnesses successfully with
pharmacotherapy and includes all the work that is necessary to
accomplish this. The activities and responsibilities involved in care
planning are
Activities Responsibilities
Establish goals of therapy Negotiate and agree upon endpoints
and time frame for
pharmacotherapies

Inform patients of their responsibilities

to accomplish goals.
Determine appropriate Consider therapeutic alternatives
interventions to: resolve and select patient-specific
DTP/MRP, achieve goals of therapy, pharmacotherapy, patient
   prevent new problems education, and other nondrug
interventions.
Schedule follow-up evaluation Establish a schedule for follow-up
evaluation that is clinically appropriate
and convenient for the patient
Goals of therapy :
A goal of therapy is the desired response or endpoint that you
and your patient want to achieve from pharmacotherapy.
Goals of therapy have a specific structure and always include

❑ clinical parameters (signs and symptoms) and/or

laboratory values which are observable, measurable, and
realistic;
❑ a desired value or observable change in the parameter;
a specific timeframe in which the goal is to be met.
 Goals of therapy :
• Clearly defined (measurable or observable).
• established in collaboration with pt and other
member of health team provider
• Should be realistic
• With multiple medical problem, the
practitioner must consider the therapeutic
objective for each problem separately and in
aggregate

– Avoidance of ADRs
– Convenience
– Cost-effectiveness
Examples of Medical Conditions for the Goals of Therapy

Goal of therapy Medical condition

Cure a disease Streptococcal pneumonia
Otitis media
Diarrhea
Reduce or eliminate signs and/or Major depression
symptoms Allergic rhinitis
Common cold
Slow or halt the progression of Diabetes
disease Congestive heart failure
Ischemic heart disease
Prevent a disease Osteoporosis
Myocardial infarction
Pneumococcal pneumonia
Normalize laboratory values Hypokalemia
Anemia
Assist in the diagnostic process Anxiety associated with MRI procedures
Intraocular pressure tests for glaucoma
 Drug Therapy Problems

• An undesirable event, a patient experience that

involves, or is suspected to involve drug therapy,
and that actually or potentially, interferes with a
desired patient outcome

• Drug therapy problems define the unique scope of

the practitioner’s responsibility.
 Drug Therapy Problems

o Untreated indications. The patient has a medical problem

that requires drug therapy but is not receiving a drug for
that indication.

o Improper drug selection. The patient has a drug indication

but is taking the wrong drug, or is taking a drug that is not
the most appropriate for the special needs of the patient.
Identification of drug therapy Problems

Ask 4 questions:
– Does the patient have an indication for each of his/her drug
therapies, and is each of the patient's indications being treated
with drug therapy?

– Are these drug therapies effective for his/her medical condition?

– Are the drug therapies as safe as possible?

– Is the patient able and willing to comply with the drug therapies
as instructed?
Common Drug Therapy Problems

The following list covers the range of

DRPs that could be encountered by
pharmacist seeking to deliver
pharmaceutical care :
Drug Therapy Problems

o Subtherapeutic dosage. The patient has a

medical problem that is being treated with too little
of the correct medication.

o Overdosage. The patient has a medical problem

that is being treated with too much of the correct
medication.
 Drug Therapy Problems

o Failure to receive medication. The patient has a medical

problem that is the result of not receiving a medication
due to economic, psychological, sociological, or
pharmaceutical reasons.

o Adverse drug reactions. The patient has a medical

problem that is the result of an adverse drug reaction or
adverse effect.
 Drug Therapy Problems

o Drug interactions. The patient has a medical problem that is

the result of a drug-drug, drug-food, or drug-laboratory test
interaction.

o Drug use without indication. The patient is taking a medication

for no medically valid indication.

o Treatment failures. The patient has a medical problem that is

being treated with a medication that is generally considered
appropriate for the indication, but the desired therapeutic
outcome is not achieved.
 Drug Therapy Problems
o Therapeutic duplication.
o Allergic reaction to prescribed drug.
o Problem arising from the financial impact of medication
therapy on the patient.
o Medicine cannot be swallowed – stroke patient with
dysphagia
o Lack of understanding of the medication therapy by the
patient.
o failure of the patient to adhere to the medication therapy.
o Interference with medical therapy by social recreational
drug use.
The ability of a pharmacist to consult effectively is fundamental to
pharmacotherapy and this includes establishing a platform for achieving
adherence/concordance. Nurturing a relationship with the patient is
essential to understanding their medication-related needs.

Undertaking a pharmaceutical consultation can be considered as a series

of four interlinked phases, each with a goal and set of competencies.