DRUG THERAPY PROBLEMS: A REVIEW OF LITERATURE

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About Authors:
Languluri Reddenna1*, Sree Nagavalli K2
1Department of Pharmacy Practice, Rajiv Gandhi Institute of Medical Sciences, Kadapa, Andhra Pradesh, India-516003
2Department of Pharmacy Practice, S.J.M College of Pharmacy, Chitradurga, Karnataka, India-577502
*reddennapharmd@gmail.com

Abstract
The improper use of drugs can leads to patient morbidity and even mortality. Drug therapy problems are the clinical territory of the pharmaceutical care practitioner and the resolution of identifying drug therapy problems help patients to achieve their goals of therapy and understand the best possible outcomes from drug therapy. To identify, resolve and prevention of drug therapy problems, the practitioner must understand how patients with drug therapy problems present in the clinical setting. Stating the problem and identifying the cause requires involves clinical judgment by the practitioner. All patient problems involving medications can be categorized into seven types. These include all side effects, toxic reactions, treatment failures, or the need for additive, synergistic, or preventive medications, as well as noncompliance. During 2002, there were 3.3 billion prescriptions dispensed from community pharmacies throughout the United States and over 44,000 hospitalized patients die each year resulting from medical errors. Recent research, on drug-related problems and adverse drug reactions has identified several categories of risk factors that may be used to identify patients who are susceptible to drug related problems and adverse drug reactions. It is essential that practitioners who intend to provide pharmaceutical care understand the descriptions and identification of each type of drug therapy problem as well as their common causes. Continuous referral to the seven categories of drug therapy problems ensures that a consistent, rational, comprehensive, and effective care plan can be established for even the most complicated patient.

REFERENCE ID: PHARMATUTOR-ART-2112

PharmaTutor (ISSN: 2347 - 7881)

Volume 2, Issue 2

Received On: 11/01/2014; Accepted On: 17/01/2014; Published On: 10/02/2014

How to cite this article: L Reddenna, S Nagavalli, Drug Therapy Problems: A Review of Literature, PharmaTutor, 2014, 2(2), 111-116

Introduction
Drug therapy problems are the clinical territory of the pharmaceutical care practitioner and the resolution of identifying drug therapy problems help patients to achieve their goals of therapy and understand the best possible outcomes from drug therapy. The identification of drug therapy problems is precisely part of the assessment process andsignifies the accuratelysole contribution made by pharmaceutical care practitioners.[1] A drug therapy problem is any undesirable event experienced by a patient which involves, or is suspected to involve, drug therapy, and that interferes with the desired goals of therapy. Drug therapy problems represent the foremost responsibility of the pharmaceutical care practitioner. A drug therapy problem is a clinical problem and it must be identified, resolved in a method similar to other clinical problems. Every health care practitioner is responsible for helping patients with problems that require a certain level of professional complexity to identify, prevent, or resolve. [2] Drugs are a dualistic therapeutic tool. A drug can be defined as any substance or product that is used to modify or explore physiological systems or pathological states for the benefit of the recipient.[3] The improper use of drugs can leads to patient morbidity and even mortality. In general, problems related to the use of approved drugs can be summarized with the term “Drug-Related Problems”.[4] When reviewing a patient's drug therapy, one of the main objectives is to identify and resolve any drug-related problems.[5] In 2003, 13.7% of the total population in the Netherlands over 65 years of age and the proportion of older adults are estimated to increase (18.2%) in 2020. A survey in Indonesia showed that 78 % of elderly suffered up to four medical illnesses, 38 % of them had 6 diseases more and 13 % suffered more than eight diseases.[6]

Stating the problem and identifying the cause requiresinvolves clinical judgment by the practitioner. No other practitioner can identify and resolve drug therapy problems as regularly and systematically as the pharmaceutical care practitioner because there is only practitioner's clinical judgment and rationale for the decision. All patient problems involving medications can be categorized into seven types. These include all side effects, toxic reactions, treatment failures, or the need for additive, synergistic, or preventive medications, as well as noncompliance.[7] During 2002, there were 3.3 billion prescriptions dispensed from community pharmacies throughout the United States and over 44,000 hospitalized patients die each year resulting from medical errors. This categorization of drug therapy problems was first defined, described, and developed in 1990 by the research group at the Peters Institute of Pharmaceutical Care at the University of Minnesota. The first two categories of drug therapy problems are associated with the indication. The third and fourth categories of drug therapy problems are associated with effectiveness. The fifth and sixth categories of drug therapy problems are associated with safety. The seventh category deals with patient compliance.[8] These categories of drug therapy problems are not specific to pharmacological class, area of practice, medical service, and unique patient group based on age, disease state, or health care plan. All practitioners who deliver pharmaceutical care must capable to identify, prevent, and resolve and all of the seven types of drug therapy problems for a given patient.Drug therapy problems can occur at any stage of the medication use process. Therefore, the practitioner must anticipate drug therapy problems in order to prevent them.[9]

Causes of drug therapy problems

Drug/Dose Selection: The cause of the drug related problems related to the selection of the drug and/or dosage schedule, inappropriate drug selection, inappropriate dosage selection, more cost-effective drug available. Pharmacokinetic problems including ageing/deterioration in organ function and interactions, Synergistic/preventive drug required and not given, deterioration/improvement of disease state, new symptom or indication revealed/presented, manifest side effect and no other cause.

Drug Use Process: It Includes Inappropriate timing of administration and/or dosing intervals, Drug underused/ under-administered, drug overused/ over-administered, Therapeutic drug level not monitored, drug abused (unregulated overuse), Patient unable to use drug/form as directed.

Information: It Includes Instructions for use/taking not known, Patient unaware of reason for drug treatment, Patient has difficulties reading/understanding Patient Information Form/Leaflet, Patient unable to understand local language, Lack of communication between healthcare professionals.

Patient/Psychological: It Includes Patient forgets to use/take drug, Patient has concerns with drugs, Patient suspects side-effect, Patient unwilling to carry financial costs, Patient unwilling to bother physician, Patient unwilling to change drugs,Patient unwilling to adapt life-style, Burden of therapy, Treatment not in line with health beliefs, Patient takes food that interacts with drugs.

(Pharmacy) Logistics:It Includes prescribed drug not available (anymore), prescribing error (only in case of slip of the pen), dispensing error (wrong drug or dose dispensed).[10]

Risk factors for drug therapy problems
Although medications provide a beneficial effect in most patients, the elderly are at particular risk for drug-related problems, which have been defined as undesirable patient experiences related to drug therapy that actually or potentially interfere with desired patient outcomes. Recent research, on drug-related problems and adverse drug reactions has identified several categories of risk factors that may be used to identify patients who are susceptible to drug related problems and adverse drug reactions. These categories include specific medications, certain therapeutic categories of drugs, and patient status.

Specific medications Several therapeutic agents commonly used in geriatric patients have been targeted as high-risk medications. Specific medications that are potential risk factors include digoxin, warfarin, lithium and chlorpropamide. Each of these medications is highly potent and requires careful dosing calculations based on the patient’s status. Monitoring patient response in light of laboratory results related to liver and kidneyfunction is critical in ensuring appropriate patient outcome when these agents are prescribed.

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