A STUDY ON ROLE OF CLINICAL PHARMACIST IN IDENTIFICATION AND REPORTING OF DRUG INTERACTIONS IN PHYSCIATRIC WARD IN A TERITARY CARE TEACHING HOSPITAL

 

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ABOUT AUHTORS
M. Manasa Rekha*, T. Mubeena
Department of Pharmacy Practice,
Annamacharya college of Pharmacy,
Rajampet, Andhra Pradesh, India.
* manasarekharoyal@gmail.com

ABSTRACT: 
Clinical pharmacy is defined as that area of pharmacy concerned with the science and practice of rational medication use. The pharmacist, along with the prescriber has a duty to ensure that patients are aware of the risk of side effects and a suitable course of action should they occur. With their detailed knowledge of medicine, pharmacists have the ability to relate unexpected symptoms experienced by patients to possible drug interactions of their drug therapy. The practice in clinical pharmacy also ensures that drug interactions are minimized by avoiding drugs with potential side effects in susceptible patients. Thus, pharmacist has a major role to play in relation to prevention, detection, and reporting drug interactions.

REFERENCE ID: PHARMATUTOR-ART-2492

PharmaTutor (Print-ISSN: 2394 - 6679; e-ISSN: 2347 - 7881)

Volume 5, Issue 5

Received On: 30/01/2017; Accepted On: 14/02/2017; Published On: 01/05/2017

How to cite this article: Rekha MM, Mubeena T;A study on role of Clinical Pharmacist in identification and reporting of drug interactions in Physciatric Ward in a Teritary Care Teaching Hospital; PharmaTutor; 2017; 5(5);70-75

INTRODUCTION:
Clinical pharmacy is defined as that area of pharmacy concerned with the science and practice of rational medication use. Clinical pharmacy is the branch of pharmacy in which pharmacists provide patient care that optimizes the use of medication and promotes health, wellness, and disease prevention. Clinical pharmacists care for patients in all health care settings but the clinical pharmacy movement initially began inside hospitals and clinics. Clinical pharmacists often work in collaboration with physicians, nurse practitioners and other healthcare professionals. The Clinical Pharmacist Stating explicitly that the clinical pharmacist cares for patients in all health care settings emphasizes two points: that clinical pharmacists provide care to their patients and that this practice can occur in any practice setting.

The Role of Pharmacist in Management of Drug Interaction
The pharmacist, along with the prescriber has a duty to ensure that patients are aware of the risk of side effects and a suitable course of action should they occur. With their detailed knowledge of medicine, pharmacists have the ability to relate unexpected symptoms experienced by patients to possible adverse effects of their drug therapy. The practice in clinical pharmacy also ensures that drug interactions are minimized by avoiding drugs with potential side effects in susceptible patients. Thus, pharmacist has a major role to play in relation to prevention, detection, and reporting drug interactions.

 

Management options of drug interaction include

Avoiding the combination entirely: For some drug interactions, the risk always outweighs the risk, and the combination should be avoided. Because drug classes are usually heterogeneous with regard to drug interactions (as described above) one can often select a no interacting alternative for either the object drug or the precipitant drug.

Adjusting the dose of the object drug: Sometimes, it is possible to give the two interacting drugs safely as long as the dose of the object drug is adjusted.

Spacing dosing times to avoid the interaction: For some drug interactions involving binding in the gastrointestinal tract, to avoid the interaction one can give the object drug at least 2 h before or 4 h after the precipitant drug. In this way, the object drug can be absorbed into the circulation before the precipitant drug appears.

Monitoring for early detection: In some cases, when it is necessary to administer interacting drug combinations, the interaction can be managed through close laboratory or clinical monitoring for the evidence of the interaction.

Provide information on patient risk factors that increases the chance of an adverse outcome: It is clear from the clinical experience of physicians and pharmacists as well as published studies that most patients who take interacting drug combinations do not manifest adverse consequences.

Improve computerized screening systems: It is clear that computerized drug interaction screening systems have not been as successful as one hoped
Excessive number of drug interactions on the systems: Many pharmacists find that computerized drug interaction screening systems detect a large number of DDIs of questionable clinical significance.

Drug class differences not handled correctly: Almost all drug classes interact heterogeneously, because individual members of a drug class are often not metabolized by the same cytochrome P450 isozymes or ABC (ATP-binding cassette) transporters as other members of the class. The statins are a good example, because simvastatin and lovastatin are extensively metabolized by CYP3A4, atorvastatin is moderately metabolized by CYP3A4, fluvastatin is metabolized by CYP2C9, and pravastatin and rosuvastatin are not metabolized by cytochrome P450 isozymes.  Thus, combining all members of this drug class together is rarely justified when considering drug interactions.

Current Indian Scenario of Drug Interactions and its Management
The prescribing information for most drugs contains a list of potential drug interactions. Many of the listed interactions may be rare, minor, or only occur under specific conditions and may not be important. Drug interactions that cause important changes in the action of a drug are of the greatest concern. Drug interactions are complex and chiefly unpredictable. A known interaction may not occur in every individual. This can be explained because there are several factors that affect the likelihood that a known interaction will occur

These factors include differences among individuals in their:
•  genes,
•  physiology,
•  age,
•  lifestyle (diet, exercise),
•  underlying diseases,
•  drug doses,
•  the duration of combined therapy, and
• the relative time of administration of the two substances (Sometimes, interactions can be avoided if two drugs are taken at different times)

Management
•  Before starting any new prescription drug or over-the-counter drug, talk to your primary health care provider or pharmacist.
•    Make sure to read the patient information handout given to you at the pharmacy.
• Check the labels of your medications for any warnings and look for the “Drug Interaction Precaution.” Read these warnings carefully.
• Make a list of all your prescription medications and over-the-counter products, including drugs, vitamins, and supplements. Review this list with all health care providers and your pharmacist.
• If possible, use one pharmacy for all your prescription medications and over-the-counter products.

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