Drug Related Problems

medicine related riddle Drug related worrys (DRPs) atomic number 18 prevalent and do considerable tolerant morbidity and mortality. Many of these DRPs ar preventable through fol humiliateding the guidelines and rational do medicines apply. There argon many factors controlling the DRP item such as diligent age, disease status, medicate characteristics, etc. High risk factors 1. Elderly (> 65 years) repayable to age related changes in pharmacodynamic and pharmacokinetics 2. cunning diseases such as acute renal misadventure, sepsis, etc 3.Patients with many chronic diseases diabetes, hypertension, heart disease, liver business, AIDS, etc 4. Patients with renal legal injury or haemodialysis 5. Patients in special situations pregnancy, lactation, 6. veritable diseases and their medicinal panelings cancer, diabetes, heart failure. 7. Polypharmacy (taken many medicines > 5 medicates) 8. Drug trustworthy drug classes are commonly involved e. g. Warfarin, insul in, digoxin, TCAs, etc categorization of drug-related problems 1. In conquer drug choice Unjustified excursion from management guidelines consensus cure can worsen the condition.Deviations that are based on the patients mortal treatment goal and risk factors are non considered to be DRPs (e. g. Antibiotic used for viral infection. furosemide electropositive for patient with hypokalemia). 2. lack of prerequisite drug Either one or much drugs are missing according to established guidelines or a medical exam problem is being treated with likewise little of the appropriate drug (under-prescribed) or appropriate drugs may be non used for maximal foundiveness. Moreover, duration of treatment may be also short which can tone down to incomplete treatment.Deviations from guidelines that are based on the patients case-by-case treatment goals and risk factors are not considered to be DRPs (e. g. B-blockers in heart failure or post-MI, menses diuretic before edema treated or loop diuretic used only for rebarbative edema). 3. Un prerequisite drug and Duplication A drug is unnecessary if the indication is no longer present, with law of continuation/prolonged use or double prescription medicine of two or more drugs from the comparable therapeutic group or gives the same result. This intensifies their therapeutic military issue and side effects.Duplication also can occur when more than one physician prescribes medicaments to a single patient or when a patient takes over-the-counter drugs with the same active ingredient (e. g. Long-term antibiotic drug prescribed for simple infection. Used of Ibuprofen and diclofenac concomitantly. 4. partial medication history taking Inappropriate integration of patients medical history can star to many interactions due to lack of patients information such as hypersensitivity medication allergic reaction, other diseases, OTC or herbal and medication used (e. g.Patient has allergy to penicillin). 5. Inappropriate venereal disease or regimen Dosing in addition high (overdose) or too low dose. Suboptimal dosing (including dosing time and formulation) according to established subject/international guidelines, including frequency of dosing or duration of therapy. Deviations that are based on the patients nighbody treatment goal and risk factors are not considered to be DRPs (e. g. too high ACE inhibitor dose prescribed in relation to kidney function. Too low paracetamol dose use in relation to symptom-giving arthritis). . inauspicious 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 blood pressure lowering drug or intolerance dry cough 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 front of another dr ug, 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 digitalis (increased effect/ toxicity 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 compulsory medication Some times 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 have secure 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 prohibited for some patients b ecause to harmful risks of apply these drugs are exceeding the benefits of their effect (e. g. ACE inhibitor uses in treating high blood pressure in a pregnant lady or using sulfa-drug in G6PD deficiency patients). 10.Abrupt confirmation medication for certain medications, blunt stopping can exacerbate the problem or lead to complications related to drug. The stopping process should be gradually (e. g. abruptly 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 cohere to guidelines (e. . INR for Warfarin. Thyroid function tests in patients taking levothyroxine 13. Others In general, DRPs that do not belong to aforementioned categories. References 1. Bemt P and Egberts A (200 7) Drug-related problems definitions and classification. Journal of europiuman Association of infirmary Pharmacists (EAHP), 13, pp 62-64. 1. Lee S, Schwemm A, Reist J, Cantrell M, Andreski M, Doucette W, Chrischilles E and Farris K (2009) Pharmacists and pharmacy students mogul 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 World Wide 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 earn Age years Drug related problem Inappropriate d rug choice Lack of necessary drug Unnecessary drug and Duplication 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 noise if any) ) .. ( ) .. ( ) .. ( ) .. ( ) .. Patient Resume Age Sex Drug Allergies Medical History Medication History lab Data base