PP 173: DRUG-RELATED PROBLEMS

On successful completion of the topic, the students should be able to:

define the term drug-related problems. differentiate between medical and drugrelated problems. discuss the distinction between actual and potential drug-related problems. discuss the various types of drug-related problems and its causes. discuss the systematic approach to identify, solve, and prevent DRPs

Definition of drug-related problems

A drug-related problem in any event or circumstance involving drug treatment that interferes or potentially interferes with the patient achieving an optimum outcome of medical care.

Medical problems
Uncontrolled hypertension Uncontrolled T2DM Infected wound Vomiting Intractable seizures Acute bronchitis Community acquired pneumonia Dyslipidemia

Difference between medical & DRPs

DRPs include A drug A problem An association between the drug, the problem and the patient. E.g. The patient is experiencing ineffective control of blood pressure due to a subtherapeutic daily dose of propranolol

Distinction between actual and potential drug-related problems

Potential DRPs Have not manifested but possibly influence outcome
Avoidable Non-avoidable

Actual DRP Manifest and influencing outcomes

Types of drug-related problems

8 categories of DRPs; Indication for drug therapy Inappropriate drug selection Too low a dose Too high a dose Adverse drug reactions Noncompliance Drug interactions Unnecessary drug therapy

Types of DRPs & its causes

Indication for drug therapy
Untreated indication Synergistic/potentiating therapy Prophylactic/preventive therapy

Types of DRPs & its causes

Inappropriate drug selection
Contraindication present More cost-effective therapy available More effective therapy available Onset of action is inappropriate Patient is refractory

Types of DRPs & its causes

Too low a dose
Incorrect dose Inappropriate dosing interval

Types of DRPs & its causes

Too high a dose
Incorrect dose Inappropriate dosing interval

Types of DRPs & its causes

Adverse drug reactions
Not safest therapy Allergic reaction Toxic reaction Idiopathic adverse reaction Known adverse reaction

Types of DRPs & its causes

Drug interactions
Drug-drug interaction Drug-food interaction Drug-disease interaction Drug-laboratory interaction

Types of DRPs & its causes

Unnecessary drug therapy
No medical indication Duplicate therapy Chronic medication for acute indication Non-drug therapy indicated Social/recreational drugs

Systematic approach to identify, solve & prevent DRPs 1. Identification of (A/P) DRP
Describe the current/potential undesirable S+Sx [after collecting pertinent patient info ] Match the drugs to the indications/medical problems

Systematic approach to identify, solve & prevent DRPs 1. Identification of (A/P) DRP
Determine if these undesirable S+Sx are being caused by a drug the patient is taking/not taking

Systematic approach to identify, solve & prevent DRPs

2. Determination of the desired therapeutic outcome
Primary outcomes Cure of disease Reduction/elimination of symptoms Arresting/slowing of the disease progression Preventing a disease/symptom

Systematic approach to identify, solve & prevent DRPs

Other important outcomes Not complicating/aggravating other existing disease states Avoiding/minimizing adverse effects of treatment Providing cost-effective therapy Maintaining patients QoL

2. Determination of the desired therapeutic outcome

Systematic approach to identify, solve & prevent DRPs 3. Assess therapeutic plan
Determine if there are undesirable S+Sx requires treatment Determine if the there are potential undesirable S+Sx requires treatment

Systematic approach to identify, solve & prevent DRPs

Drug need to be added Drug need to be changed Dose need to be changed Dosage form need to be changed Interval/duration need to be changed Drug need to be discontinued Drug not to be dispensed Counselling/medical information need to be provided

4. Design plan

Systematic approach to identify, solve & prevent DRPs 5. Dispense and communicate
Document the work actually done by the pharmacist to achieve the goals listed E.g.; The patient was counselled on the appropriate use of propranolol for anti-hypertensive therapy

Consists of a scheduled plan which is agreed upon by the patient & the pharmacist E.g.; The patient will be called in 7 days to evaluate efficacy of anti-hypertensive medication, presence or absence of adverse effects and compliance with therapy. Include outcome indicators ; SBP 110-160mmHg & no incidence of nausea, dizziness or orthostatic hypotension

Systematic approach to identify, solve & prevent DRPs 6. Implement monitoring plan

Systematic approach to identify, solve & prevent DRPs 7. Recognise problem Any new problem?

Systematic approach to identify, solve & prevent DRPs

8. Respond to problem
Start a new cycle