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Think Clinically

Clinical Pharmacy • • • • • • •

Hospital pharmacy Pharmacotherapy Patient Couseling Infection control Healthcare Clinical trials Biostatistics

Case l‌ 25 years old man feel illness , fatigue , and he vomited about 2 times daily for 4 days before and complain dryness , after lab diagnosis , there was a sever stomach ulcer ‌!!!

Think Clinically

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Patient information Acid-Base Sheet Stomach Biopsy report Lab. Result Other complication .

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2010 Guidelines Start with Antacid then H2 blocker then adjusted dose of PPI to prevent recurrence + healing agent Use antibiotic if there is bacterial inf. (H.pylori)

2013 Guidelines “Step-down” treatment: Starting with maximal therapy, such as therapeutic doses of PPIs, is always appropriate as a first-line strategy in patients with documented esophageal erosion. Advantages: Rapid symptom relief, avoidance of over-investigation Disadvantages: Potential overtreatment, higher drug cost, increase potential of adverse effects ii. “Step-up” treatment: Starting with lower-dose OTC products Advantages: Avoids overtreatment, lower initial drug cost Disadvantages: Potential under treatment (partial symptom relief), may take longer for symptom control, may lead to overinvestigation

Case ll‌.

K.E. is a 29-year-old asymptomatic patient who is human immunodeficiency virus (HIV) positive. She recently found out she is pregnant and is estimated to be early in her first trimester. Her most recent CD4 count was 170/mm3, and her viral load was 100,000 copies/mL by reverse transcriptase–polymerase chain reaction. Which one of the following is the best therapy for K.E. to prevent HIV transmission to her child?

• No drug therapy is needed—the risks to the fetus outweigh any benefits. • Administer zidovudine 300 mg 2 times/day orally throughout the pregnancy, followed by zidovudine during labor and consequently to the baby for 6 weeks. • No drug therapy is required now, but administer a single dose of nevirapine at the onset of labor. • Administer a potent combination antiretroviral therapy regimen that includes zidovudine throughout the pregnancy.

What is a clinical pharmacist?

Clinical pharmacists work directly with doctors, other health professionals, and patients to ensure that the medications prescribed for patients contribute to the best possible health outcomes

What do clinical pharmacists do?

Assess the status of the patient’s health problems and determine whether the prescribed medications are optimally meeting the patient’s needs and goals of care.

Recognize untreated health problems that could be improved or resolved with appropriate medication therapy.

Follow the patient’s progress to determine the effects of the patient’s medications on his or her health.

Advise the patient on how to best take his or her medications.

Support the health care team’s efforts to educate the patient on other important steps to improve or maintain health, such as exercise, diet, and preventive steps like immunization.

Refer the patient to his or her doctor or other health professionals to address specific health, wellness, or social services concerns as they arise.

Clinical pharmacy