Clinical Pharmacy

Poonam Pant
M.Pharm
 Clinical Pharmacy

• Clinical pharmacy defined as the branch of pharmaceutical

science dealing with a set of functions that promote the safe,
effective and economic use of medicines for individual
patients (i.e, rational medication use)
• Clinical pharmacy process requires;
specific knowledge of pharmacology, pharmacokinetics,
pharmaceutics and therapeutics to patient care.

Safe, effective and economic use of medicines

 Need ??

• In developed countries like United States of America.

Canada etc. Clinical Pharmacy has already taken good shape.
• In Nepal, the role of the retail pharmacist is as simply;
transferring pills from a large bottle to a small one
counting tablets,
typing labels and
calculating the price.
Today there is 'drug-explosion' and 'information explosion'
in relation to the drugs.
On one hand there is development of newer and more-
effective drugs and on other hand their potential hazards of
side effects are on rise.
 Need ??

• Little time for doctor-patient dialogue as the doctor usually

has too little time to spend with each patient.
• Doctors to patients by excessive and wrongful use of drugs.
• More and more people fall in what is called iatrogenesis
(drug induced diseases) and misuse of drugs.
• has been increase in "self-medication" by the patients.

Led to the development of "Clinical Pharmacy" as a new

subject.
 Pharmacy vs Clinical Pharmacy

• Pharmacy is the knowledge on synthesis, chemistry

and preparation of drugs
• Clinical pharmacy is more oriented to the analysis of
societal needs with regards to medicines, ways of
administration, patterns of use and drugs effects on
the patients.

Clinical Pharmacy focused to individual or

community
 Goal

• Maximizing the clinical effect of medicines, i.e.,

using the most effective treatment
• Minimizing the risk of treatment-induced adverse
events, i.e., monitoring the therapy course and the
patient's compliance with therapy
• Minimizing the expenditures for pharmacological
treatments i.e., trying to provide the best treatment
alternative for the greatest number of patients.
 Responsibilities of clinical pharmacist
• Consulting 
• Selection of drugs
• Drug information: Seeking information and critically evaluating
scientific literature; organising information services for both the
health care practitioners and the patients. .
• Medication Review
• Attending Rounds 
• Drug use studies and research
• Pharmacokinetics/ therapeutic drug monitoring
• Clinical Trials
• Pharmacoeconomy: Using the results of clinical trials and outcome
studies to determine cost- effectiveness evaluations.
• Teaching & Training: Pre- and post-graduate teaching and
activities to provide training and education programmes for
pharmacists and other health care practitioners
 Responsibilities
1. Designing patient-specific drug dosage regimens
2. Recommending or scheduling measurements of drug
concentrations in biological fluids
3. Monitoring and adjusting dosage regimens
4. Evaluating unusual patient responses to drug therapy for
possible pharmacokinetic and pharmacologic
explanations.
5. Communicating patient-specific drug therapy information
to physicians, nurses, and other clinical practitioners and
to patients orally and in writing, and including
documentation of this in the patient’s health record.
6. Educating pharmacists, physicians, nurses, and other
clinical practitioners about pharmacokinetic principles and
appropriate indications for clinical pharmacokinetic
monitoring, including the cost-effective use of drug
concentration measurements.
 Responsibilities
7. Developing quality assurance programs for documenting
improved patient outcomes and economic benefits
8. Promoting collaborative relationships with other
individuals and departments involved in drug therapy
9. Pharmacists with specialized education, training, or
experience may have the opportunity to assume the
following additional responsibilities:
• Designing and conducting research
• Developing and applying computer programs and point-of-care
information systems to enhance the accuracy and
sophistication of pharmacokinetic modeling and applications to
pharmaceutical care.
• Serving as an expert consultant to pharmacists with a general
background in clinical pharmacokinetic monitoring.
 Level of Action of clinical pharmacists

Correct use of medicines at three different levels:

1. Before the prescription
2. During the prescription
3. After the prescription
 1. Before the prescription

• Clinical trials: involved in clinical trials at different levels

• Development of formularies
• Drug information
• Drug related policies: i.e., making decisions on which drugs
deserve to be marketed, which drugs should be included in
national and local formularies, which prescribing policies and
treatment guidelines should be implemented.
• Participating in ethical committees
• Monitoring; dispensation and preparation of investigational
drugs.
 2. During the prescription

• Counseling activity
• Can influence the attitudes and priorities of prescribers in
their choice of correct treatments.
• Monitors, detects and prevents harmful drug interaction,
adverse reactions and medication errors through evaluation
of prescriptions' profiles.
• The clinical pharmacist pays special attention to the dosage
of drugs which need therapeutic monitoring.
• Community pharmacists can also make prescription
decisions directly, when over the counter drugs are
counseled.
 3. After the prescription
• Counseling: Play a key role in communicating and
counseling patients
• Preparation of personalized formulation
• Drug use evaluation
• Outcome research
• Pharmacoeconomic studies
• Can improve patients' awareness of their treatments, monitor
treatment response, check and improve patients' compliance
with their medications.
• As members of a multidisciplinary team, Clinical
pharmacists also provide integrated care from 'hospital to
community' and vice versa, assuring a continuity of
information on risks and benefits of drug therapy
Skills required for clinical pharmacist
 SCOPE OF CLINICAL PHARMACY
1. Preparation of patient medication histories
• any hypersensitivity's or allergies to specific drugs
observed in the past, any particular drug or food habits,
drug dependence or intoxication with chemicals due to
occupational hazards, all of which are likely to interfere
with the therapy.
• This will help in saving physicians time and efforts and
thus will result in faster and more accurate selection of
drug therapy.

2. Rational prescription
• Suggest the physician and help him in selecting the
right drug.
• Examples of irrational combinations:
• Haloperidol + Diazepam + Amitriptiline
• Reserpine + Sintamil 
3. Patient monitoring

• Observes the signs and symptoms that indicate the need

for or reaction to drugs.
• Help in monitoring the drug therapy for safety and
efficiency.
• Drugs with narrow therapeutic index, or when drugs
administered in patients who are critically ill or are
suffering from chronic diseases.

Hypertension --- Diuretics --- Blood pressure changes

should be measured
Diabetes --- Insulin therapy ---- Urine glucose levels
4. Adverse drug reactions and drug interactions

• Can compile and process data using computers and make

it available to the medical staff.
• May suggest an alternate therapy if applicable
• Identify drug effect modifications due to interactions with
several foods, alcohol, smoking, environmental chemicals,
as well as due to pregnancy.

5. Discharge counseling and patient compliance

6. Clinical research and continuing education program
7. Medical Audit 
Thank you