PHM 552 EXAM II

PHM 552 EXAM II
medicationsmanagement

-keystosmedicationsmanagementsinsashospitalsissthes*formularyssystem*s-
sDescribessthesprocesssusedstosassures*safesandseffective*susesofsdrugssinsascostsconscio

ussmanner

drugsformularys-
s•sAs*continuallysupdatedslistsofsmedications*sestablishedsbysthesPharmacysandsTherapeu

ticss(P&T)sCommittee

•sSupportedsbys*currentsevidence-
basedsmedicine*,sjudgmentsofsphysicians,spharmacistssandsothersexpertssinsthesdiagnosi
ssandstreatmentsofsdiseasesandspreservationsofshealth

•sThesprimaryspurposesisstosencouragesthesusesofs*safe,seffective,sandsmostsaffordablesm
edications*

closedsformularys-
s•sListsofsmedicationsswhichslimitssaccesssofsasprescriberstoscertainsmedications



•sLimitedsselections-->s↓scost

•sAscommonspracticesinstheshospitalssetting

opensformularys-
sAslistsofsmedicationssinswhichsprescribersshavesnosrestrictionssonsordering/prescribingsm

edications

•sBroadersselections-->↑scosts

RESTRICTEDsformularysmedications

-usuallystosminimizessideseffectssandscostss-
sCertainsmedicationssonsthesformularysareslimitedsorsrestrictedstosspecificsphysicians,spati

entscaresareas,sorsdiseasesstatessviasformularysrestrictions

•sExample:sCertainsantibioticsscansonlysbesorderedsbysInfectioussDiseases(ID)sphysicians

-Asnon-formularysmedicationswillsgosthroughsans*approvalsprocess*sifsitsis
needed
-ManysCPOEssystemssgivesansalertstosthesprescribersthatsthesmedicationsissnon-formulary

,-
Thesphysicianswills*needstospresentsevidence*sthatsthesmedicationsissappropriatesforsthesp
atient
----Typically,sthespatientshasstriedsothersmedications,sorsthesalternativesissnotsappropriate
(Analogousstosfillingsoutsaspriorsauthorizationsinsthesout-patientssetting)s-
sWHATsHAPPENSsWHENsAsNON-

FORMULARYsMEDICATIONsISsORDEREDsINsAsCLOSEDsFORMULARYsHOSPITAL?

"isstheresastherapeuticsinterchange?"

"arestheresanyscontraindications?

ETC.s-sWhatsquestionsswouldsyousasksthesprescribersifshe/shesorderssasnon-
formularysantibiotic?

PharmacysandsTherapeuticss(P&T)s-s-
Composedsofsrepresentativessfroms*medicalsstaff,sadministration,spharmacy,sandsnursing
*

-Ascommitteeswithsoversightsforsmedicationsmanagementsincludingsthesdrugsformulary

-
*Reviewssthesmedicationslist*sandsguidelinessonsasregularsbasisstosassuresthatsitsisscurrent
sandsmeetssthesneedssofsthesmedicalsstaffsandspatients



P&TsCommittees-s•sEstablishessands*maintainssthesformulary*

•sPreventssandsmonitorss*adversesdrugsreactions*sandsmedication
errors

•s*Educates*shealthsprofessionalsstosthesoptimalsusesofsmedications

•sDevelopssofs*protocolssandsprocedures*sforsmedicationssonsthesformulary

-DURs(drugsutilizationsreview)
-MUEs(medicationsusesevaluation)s-sHowsaresformularysdrugssevaluated?

DrugsUtilizationsReviews(DUR)sakasDUEs(evaluation)s-
sAssystemsofsongoing,ssystematic,scriteria-

basedsevaluationsofsdrugsusesthatswills*helpsensuresthatsmedicinessaresusedsAPPROPRIA
TELY*sgenerallysinstermssofsprescribing

•sIfstherapysissdeemedstosbesinappropriate,sinterventionsswithsproviderssorspatientsswillsbes
necessarystosoptimizesdrugstherapy

•sExamplessincludes*inappropriatesusesorsincorrectsdosessofsasmedication*

, *medicationsusesevaluations(MUE)*

-similarstosDURsbutsbroader

*didsthespatient'ssconditionsimprove*s-
semphasizessimprovingspatients*outcomessandsindividualsqualitysofslife*



•sDependentsonsas*multidisciplinarysapproach*sinvolvingsallsprofessionalssdealingswithsdru
gstherapy

•sExamplessinclude:sinfectionscuresrates,sdecreasedslipidslevels,sUsesofstigecyclinesforsap
propriatesinfections

•sDidsthesphysiciansprescribestigecyclinesappropriately?
s•sDidsthespatient'ssconditionsimprove?



*developsdrugsmonograph*

•sPharmacistsshavesthesopportunitystosassumesasleadershipsrolesinsintroducingsnewsmedic
ationsstosthesformulary
•sPharmacistsswillspresentsthesdrugsmonographstosthesP&TsCommittees-
sHOW sAREsNEW sDRUGSsADDEDsTOsTHEsFORMULARY?



drugsmonographs-
sAswritten,s*unbiasedsevaluationsofsspecificsmedication*swithsthesfollowingscomponents...



-Drugsname
-Pharmacology
-Indicationssforsuse
-Summarysofsclinicalstrials
-Pharmacokinetics/dynamics
-Adverseseffectssandsdrugsinteractions
-Comparativescosts,sefficacy,sandssafetysprofileswithsdrugssinsthessamesclass

•sWhysissthissdrugsbettersthansothersdrugs?sIssthescostsworthsit?s-
sCOMPONENTSsOFsDRUGsMONOGRAPH



A.sHowsdoessthissdrugscomparesins*efficacy*stosothersdrugssinsthessame/similarsclass?
B.sHowsdoessthissdrugscomparesins*cost*stosothersdrugssinsthessame/similarsclass?
C.sHowsdoessthissdrugscomparesins*toxicity*stosothersdrugssinsthessame/similarsclass?s-
sYousaresthesclinicalspharmacistsonsthesP&TsCommittee.sAsclinicalspharmacistsisstryingstos

getsasnewsantibioticsonsthesformulary.sWhatsaressomesquestionssyouswouldsasksthesclinica
lspharmacistswhosisstryingstosgetsthesnewsantibioticsonsthesformulary?

*managedscare*