Summary PHRM 100 IMM Module Comprehensive Exam Notes

IMM Cumulative Final Notes
Patient Centered Care
- Shared decision making: power and responsibility
- Mutual agreement: trusting, caring relationship
- All aspects of pt illness
- NOT product or task oriented
SOLER
- Squarely face, open posture, leaning forward, eye contact, relax
- Non verbal: kinesics, proxemics, environment, distracting factors
Guided Questioning
- Open ended to focused
- Eliciting graded responses
- One at a time series of questions
- Offering multiple choices
- Clarifying
- Encouraging w continuers
- Echoing
Empathy
- Communicating understanding
 PTs trust you, understand their own feelings
- Rarely effective in communicating empathy: judging/evaluating, generalizing,
challenging, warning/threatening, distracting
- Occasionally effective in communicating empathy: quizzing/probing,
analyzing/interpreting/diagnosing, advising, placating/reassuring
- Effective in communicating empathy: understanding, focusing
 ID feelings, REFLECT back, GIVE person chance to respond ( must be genuine and
accepting)
Pharmaceutical Care and Assessment
Describe pt centred pharmaceutical care process
- Cure, control, prevent, reduce symptoms
- Necessary, effective, safe, adhere
- Assessmentcare planevaluation, repeat
 Assessment: collect/interpret relevant PT info, assess drug therapy, ID/list/rank
DTPs understand if PT rational , NESA, DTPs
 Care plan: therapy goals, resolve DTPs, collaborate w PT, monitoring plan
 Evaluation: actual PT outcomes
- Practitioner assumes responsibility for PT drug needs and is held accountable for this
commitmentpurpose of achieving positive PT outcomes
- DTP: undesirable event experienced by PT involving/suspecting to involve drug therapy
that interferes w achieving desired goals of therapy they are identified in the PATIENT

,Describe assessment
- Identify DTPs
Define thought process and role in pt centered assessment
- NESA and unmet needs
Examine elements/questions applied in thought process to assess pt
- N: describe condition in pathophys/symtpoms/causes/risk factors, describe if consistent
w condition, explain if anything contributes to medical condition, articulate desired
therapeutic outcomes, recommended therapeutic regimen, Id drug therapy pt already
receiving, discuss any additional drug therapy required
- E: is drug indicated for condition, MOA, most effective drug, optimal/appropriate, is
clinical action onset and drug expectations appropriate, interactions affecting efficacy
- S: contraindications, adverse drug reactions, therapy duplication, interactions
- A: availability, lifestyle, regimen complexity, finances, beliefs/values, dosage form,
physical/mental challenges
- U: prophylactic therapy, non drug measures, referrals, other med conditions
DTPs
Differentiate between 7 categories of DTPs
- Actual: pt already experiencing
- Potential: pt at risk of experiencing
- N: unnecessary drug therapy (no medical indication, addictive, non drug therapy
indicated, duplicate therapy, treating avoidable ADR)-discontinue drug, needs additional
drug therapy (untreated condition, synergistic/potentiating, preventative/prophylactic)-
add a drug
- E: ineffective drug (dosage form inappropriate, condition refractory to drug, not indicated
for condition, more effective avail)-switch, dosage too low(ineffective dosage, interval too
long/short, incorrect storage, incorrect admin, drug interaction)
- S: adverse drug reaction (unsafe, allergy, incorrect admin, drug interaction, dosage
increase/decrease too fast, undesirable effect, contraindications)-change, dosage too
high (dose too high, freq too short, duration too long, drug interaction)
- A: non adherence (not available, cant afford, cant admin, directions not understood, pt
prefers not to take/forgets)
Define DTP statements and discuss value
- One DTP/statement, stated in positive terms
Apply ID and writing of DTPs to pharmacy practice
- PT identifier, undesirable event/risk of event, description of issue involved, drug therapy
involved, specific association bw drug therapy and pt condition
- Identifier, Issue, Drug, Association: IIDA
IA 2: References and Resources
CPS

, - Generic names
- Pr symbol indicates prescription product
- Dosage forms and corresponding strengths
 Active ingredients and their strengths
- Manufacturer information in yellow pages
- Therapeutic indication, side effects, adverse effects
- Storage instructions, dosing instructions, dosing amounts
- Pink pages: therapeutic categories of drugs for treatment of different diseases
- White pages: visual drug identification
- Green pages: Canadian available products, brand and generic index
- Special populations
- What pt should be monitored for
Drug Information Handbook
- American
- Side effects
Merck Manual
- Condition information, symptoms, non-drug and drug treatments
Merck Index
- Chemical formulas of drugs, solubility
Martindale
- International drug equivalents
- Not updated regularly
- Volume A and volume B alphabetical
Brigg’s Drugs in Pregnancy and Lactation
Medications and Mothers’ Milk
- What the baby should be monitored for
BC Children’s Hospital Pediatric Drug Dosage Guidelines
- Pediatric dosing
- Neonates: >28 days
- Infant
- Storage reconstitution
Pediatric and Neonatal Dosage Handbook
- Pt monitoring
- Pediatric dosing
Geriatric Dosage Handbook
- Geriatric dosing

, Handbook on Injectable Drugs
- IV concentrations
- Administration
- Compatibilities
Drug Prescribing in Renal Failure
- Dosages in normal and compromised renal failure
Sanfords
- Pathogens causing disease
- Dosing
- Antibiotic choices
- Outpatient treatments
- Spectrum of activity: + active, ++ recommended, +- variable, 0 not recommended
Bugs and Drugs
- Pathogens causing disease
- Dosing
- Canadian reference, reflects Canadian resistance patterns
- Antibiotic choices
- Outpatient treatments
- Treatment costs
Stockley’s Drug Interactions
- Drug drug interaction mechanisms
- Recommendations to manage interactions
- Adverse interactional effects
Natural Medicines
- Products for conditions, listed by effectiveness
- Dosing
- Efficacy studies
- Interactions
Drug information Requests
- Step 1: classify the requester
- Step 2: dissect the question
- Step 3: gather information
- Step 4: classify the request
- Step 5: search and evaluate
- Step 6: formulate and provide a response


Clinical Assessment
List the steps involving conducting a clinical assessment