Patient Information Needed for Practice

Dimension
Timeframe Personal Environmental Physiological
 Health concerns
 Living situation
 Expectations of  Indications for drug therapy
 Who lives with the
treatment outcomes  Diagnosis, conditions
Present patient
 Understanding of  Signs and symptoms
 Who cares for the
disease and drug  Medications
patient
therapies
 Change in mood or  Change in living
History of  Change in signs and symptoms
behavior situation
present  Change in physical condition
 Change in habits  Change in physical
condition Change in medications
 Change in mental outlook environment
 Socioeconomic
 Risk factors
status,
 Allergies/alerts
 Personality traits Coping  Cultural influences,
Background  Family history
mechanisms  Job/employment,
 Hereditary factors
 Insurance benefits
 Cultural traits
 Personal relationships

Department of Clinical Pharmacy, UOG-CMHS, Gondar, Ethiopia. In collaboration with University of

Maryland, USA
 Disease information for Pharmaceutical care
 Definition of the disease:
 Presentation of the disease
 Structural abnormalities including disturbances of the normal anatomic
and/or biochemical conformation of the body
 Functional abnormalities including disturbances in the normal
performances and actions of cells, tissues, and organs
 Results including clinical presentation or signs, symptoms, and laboratory
abnormalities
Characteristics of  Epidemiology:
the disease  Frequency and distribution of causes
 Incidence—rate at which a disease occurs (numbers/time)
 Prevalence—total number of cases in existence at a given time
 Causes/etiology:
 What brings about the condition or produces the effect
 Natural course of the disease:
 Onset
 Severity/intensity
 Prognosis
Specify:
Pharmacotherapy
Nondrug therapy
Intent of treatment For the following purposes: Curative
Preventive
Palliative
Diagnostic
Clinical (physiological): Resolution of signs and symptoms, laboratory
abnormalities
Improvement in: Physiological activities, Quality of life, Behavioral
(psychological)
Goals of therapy
Patient satisfaction: Adherence, Economic (cost savings)
Avoid unnecessary clinic or office visits Reduce drug costs, Reduce employee sick
days, Reduce missed days of school, Prevent emergency department visits, Prevent
admissions to longterm care facility, Prevent hospitalization

Department of Clinical Pharmacy, UOG-CMHS, Gondar, Ethiopia. In collaboration with University of

Maryland, USA
Pharmacotherapeutic Knowledge Needed for Pharmaceutical Care Practice

 Description of the drug

 Efficacy for an indication
 Dosage regimen for the drug
 Dose (initial, adjustments, maximum)
 Dosing interval
 Frequency
Characteristics of the drug  Duration
 Pharmacology (actions of the drug)
 Mechanism of action
 Sites of action
 Toxicology
 Contraindications
 Adverse effects
 Precautions
Pharmaceutical process
 Bioavailability
 Physiochemical properties
 Formulations and dosage forms
 Methods of drug administration
Pharmacokinetic process
 Absorption
Activity of drug in the patient
 Distribution
 Metabolism
 Elimination
 Pharmacodynamic process
 Impact of the drug on cell, tissue, or organs
 Time course of the effects

Therapeutic process
 Effectiveness: The therapeutic effect–expected beneficial
pharmacological effects of the drug on the course of the patient's
disease or illness
The outcome of drug therapy  Improvement in signs, symptoms, and/or laboratory findings
 Safety: Detrimental pharmacological effects of the drug on the
patient
 Undesirable or harmful effects and adverse drug reactions

Department of Clinical Pharmacy, UOG-CMHS, Gondar, Ethiopia. In collaboration with University of

Maryland, USA
 Care Plan Reference Outline
Definition
 Includes an explanation of: the condition described in this care
plan both generally (e.g., hyperlipidemia) and specifically
INDICATION (e.g., hypercholesterolemia)
 how patients contract the condition (idiopathic, hereditary,
etc.) possible complications during the course of the disease
(e.g., heart attack, end organ damage, etc.)
Presenting signs and symptoms
Define key terms
Frequency and incidence
 Include information that is relevant to the condition, total
number of people with the condition
 number of diagnosed vs. undiagnosed people with condition
 number of new people diagnosed each year
 age groups
 men vs. women
 ethnic groups
 Also include evidence related to the morbidity and mortality of
the condition
Risk factors
Include genetic and lifestyle risk factors
Unique diagnostic criteria
 Tests, exams, or lab values that determine a diagnosis
 Short explanation of what the test/exam entails.
 For example, fasting plasma glucose>126 mg/dL.
 Fasting is defined as no caloric intake for 8 hours.
 Explain whether the test/exam is an xray, scan, blood, or other
test
Assessment checklist
 You are not diagnosing but need to assess what the state of the
patient's
condition is. Include information needed to establish goals of
therapy and to evaluate effectiveness and safety on a consistent
basis. (e.g., signs and symptoms, recent lab values, medication
experience)
 Why/how the value may be used. For example, “current weight
and height for BMI and normal growth development”
Shortterm goals of therapy (timeframe)
EFFECTIVENESS Each goal must include a parameter, value, and timing.
These goals of therapy are related to the patient's drug therapy

Department of Clinical Pharmacy, UOG-CMHS, Gondar, Ethiopia. In collaboration with University of

Maryland, USA
 Longterm goals of therapy
Includes prevention of complications/end organ damage and/or risk
reduction.
Therapeutic alternatives
The standard approach to the treatment (or prevention) of the
indication
Synopsis of the current guidelines for initial drug selection in patients
without complications
Rationale
when adding or changing drug therapies
Rationale
The reasoning behind the order used to list the pharmacological
classes and the drugs within each class is explained
Pharmacological class
Pharmacology:
Efficacy:
Dosage guidelines:
Subclass of drugs if applicable (e.g., loop diuretics)
Pharmacology: if applicable
Efficacy: if applicable.
Dosage guidelines:
Generic drug name (brand name if only available in brand)
Initial dosage:
Adjustments: include intervals and dosage changes
Maximum dosage

General safety concerns for the condition that apply to all patients are
explained.
Pharmacological class
Contraindications: The contraindications and warnings. If there is a
pregnancy contraindication, give the risk category (e.g., risk category
X)
Consider discontinuation of drug:
Adverse drug reactions: Percentage is used when possible
Doserelated toxicity: If it is doserelated for therapeutic doses (not
overdoses).
General patient instructions
Effectiveness: The positive outcomes patients should expect to see
and when
ADHERENCE Safety: Safety concerns that all patients should be aware of regardless
of the drug therapy they are taking. For example, with hypertension,
what patients need to know about hypotension (There may be some
repeat from the “SAFETY” section.)
Pharmacological class
Take with meals.
Avoid alcohol (increased risk of hypoglycemia).
Department of Clinical Pharmacy, UOG-CMHS, Gondar, Ethiopia. In collaboration with University of
Maryland, USA
 Self care
Includes additional instructions that the patient can follow to optimize
the therapeutic response and prevent progression of the disease
(exercise, nutrition, quit smoking, check blood glucose regularly).
What the patient should do, for how long, what the activity entails,
and how it will affect their condition (lower blood pressure 2–4
mmHg)
Therapeutic lifestyle changes are described here
Drug Therapy Problem Category (%)
Unnecessary drug therapy
Additional drug therapy needed
DRUG THERAPY Ineffective drug
PROBLEMS Dosage too low
Adverse drug reaction
Dosage too high
Nonadherence
Effectiveness
Followup when the patient is not at goal. Include parameter, value,
FOLLOW UP
and timing
EVALUATION
Followup when the patient has met goal and is stable. Include
parameter, value, and timing.
Safety
Pharmacological class: listed by class in the same order as in
“EFFECTIVENESS” and in “SAFETY.”
Evaluate: For each class, the parameters (exams, lab tests) that the
practitioner should evaluate and when to evaluate them are described
here

REFERENCES All appropriate and up-to-date references will be listed here

Department of Clinical Pharmacy, UOG-CMHS, Gondar, Ethiopia. In collaboration with University of

Maryland, USA