Drug Related Problems

Drug tie in problem Drug related problems (DRPs) be prevalent and causing considerable long-suffering morbidity and mortality. legion(predicate) of these DRPs are preventable through following the guidelines and rational dose use. on that point are many factors controlling the DRP occurrence such as long-suffering age, disease status, drug characteristics, etc. High bump factors 1. Elderly (> 65 years) repayable to age related changes in pharmacodynamic and pharmacokinetics 2. Acute diseases such as acute nephritic failure, sepsis, etc 3.Patients with many chronic diseases diabetes, hypertension, burden disease, liver problem, AIDS, etc 4. Patients with renal impairment or haemodialysis 5. Patients in special situations pregnancy, lactation, 6. Certain diseases and their musics cancer, diabetes, heart failure. 7. Polypharmacy (taken many drugs > 5 drugs) 8. Drug certain drug classes are ordinarily involved e. g. Warfarin, insulin, digoxin, TCAs, etc Classification of drug-related problems 1. In get hold of drug weft Unjustified variance from management guidelines consensus alterative can worsen the condition.Deviations that are based on the patient roles individual preaching goal and risk factors are not considered to be DRPs (e. g. Antibiotic apply for viral infection. Furosemide order for patient with hypokalemia). 2. Lack of inevitable drug Either one or more drugs are missing according to established guidelines or a medical problem is being treated with too little of the appropriate drug (under- confirming) or appropriate drugs whitethorn be not used for maximum makeiveness. Moreover, duration of treatment may be too compact which can clue to incomplete treatment.Deviations from guidelines that are based on the patients individual treatment goals and risk factors are not considered to be DRPs (e. g. B-blockers in heart failure or post-MI, stop diuretic forwards edema treated or loop diuretic used entirely for resistant edema). 3. Unnecessary drug and Duplication A drug is surplus if the indication is no longer present, with continuation/prolonged use or double prescription of two or more drugs from the same sanative group or gives the same result. This intensifies their therapeutic result and side effects.Duplication alike can occur when more than one physician prescribes medicaments to a private patient or when a patient takes over-the-counter drugs with the same progressive ingredient (e. g. Long-term antibiotic prescribed for simple infection. Used of ibuprofen and diclofenac concomitantly. 4. unelaborated medication history taking Inappropriate integration of patients medical history can lead to many interactions due to lack of patients information such as hypersensitivity medication allergy, other diseases, OTC or herbal and medication used (e. g.Patient has allergy to penicillin). 5. Inappropriate dose or government Dosing too postgraduate (overdose) or too low dose. Suboptimal dosing (inc luding dosing time and formulation) according to established national/international guidelines, including frequency of dosing or duration of therapy. Deviations that are based on the patients individual treatment goal and risk factors are not considered to be DRPs (e. g. too high adept inhibitor dose prescribed in relation to kidney snuff it. Too low paracetamol dose use in relation to symptom-giving arthritis). . Adverse drug reaction (ADR) Any noxious, unintended, and undesired effect of a drug, which occurs at doses in humans for prophylaxis, diagnosis, or therapy (e. g. orthostatic hypotension happens with inception pressure lowering drug or intolerance dry cough out due to ACE inhibitor). 7. Interaction Drugdrug interaction, drug-food interaction, drug-disease interaction, drug-herbal, etc An interaction is occurring when the effect of a drug is changed by the presence of another drug, food, drink, herbal or some environmental chemical agent.Drug combinations with intended overall effect are not considered to be DRP (e. g. Drugdrug interaction Furosemide and foxglove (increased effect/perniciousness of digitalis with hypokalemia). Drug-food interaction Amiodarone and Grapefruit, Grapefruit and simvastatin (increase drug serum concentrations), or Tetracycline and calcium. Drug-disease interaction used NSAIDs in chronic renal impairment). 8. Discontinuation of needed medication Some measure discontinuation of medication without reasonable medical indication can lead to therapeutic failure or a problem in treatment plan.In addition, stop some medications before controlling the disease or pee-pee good monitoring method can lead to failure in treatment plan (e. g. discontinue antibiotic before finishing its therapeutic course or stop Heparin injection before or just on start of Warfarin). 9. Contraindication the used of some drugs are interdict for some patients because to harmful risks of using these drugs are exceeding the benefits of their effect ( e. g. ACE inhibitor uses in treating high blood pressure in a large(predicate) lady or using sulfa-drug in G6PD deficiency patients). 10. split stoppage medication for certain medications, abrupt stopping can exacerbate the problem or lead to complications related to drug. The stopping process should be gradually (e. g. all of a sudden stopping B-blocker in MI patients or stopping Corticosteroid suddenly). 11. untreated medical conditions can lead to worsening of the disease or may lead to more serious problems (e. g. untreated dyslipidemia in patients with other risk factors). 12. Lack of necessary monitoring Monitoring with respect to effects and toxicity of drugs is not done or does not adhere to guidelines (e. . INR for Warfarin. Thyroid function tests in patients taking levothyroxine 13. Others In general, DRPs that do not belong to said(prenominal) categories. References 1. Bemt P and Egberts A (2007) Drug-related problems definitions and classification. Journal of European Association of hospital Pharmacists (EAHP), 13, pp 62-64. 1. lee side S, Schwemm A, Reist J, Cantrell M, Andreski M, Doucette W, Chrischilles E and Farris K (2009) Pharmacists and pharmacy students ability to identify drug-related problems using timer (tool to improve medications in the elderly via review).American Journal of Pharmaceutical Education, 73, 3, pp 52-62 2. PCNE Classification for drug related problems (2006) Pharmaceutical Care Network Europe Foundation. Available from beingness ample Web http//www. pcne. org/dokumenter/DRP/PCNE %20classification%20V5. 01. pdf 2. Ruscin M (2009) Drug-Related Problems in the Elderly. Merck, Available from World Wide Web http//www. merck. com/mmpe/sec23/ch341/ch341e. html 3. Ruths S, Viktil KK, Blix HS. Classification of drug-related problems. Tidsskr Nor Leageforen 2007 127 30736 Prescription Auditing SheetPatients Name time years Drug related problem Inappropriate drug choice Lack of necessary drug Unnecessary drug and Duplicati on Incomplete medication history taking 5. Inappropriate dose or regimen 6. Adverse drug reaction 7. Interaction 8.Discontinuation of needed medication 9. Contraindication 10. Abrupt stoppage medication 11. Untreated medical condition 12. Lack of necessary monitoring 13. Others Specification of the problem (and intervention if any) ) .. ( ) .. ( ) .. ( ) .. ( ) .. Patient Resume be on Sex Drug Allergies Medical History Medication History lab Data base