Developing PCP ( A PRACTICAL APPROACH)

DEVELOPING A PHARMACEUTICAL CARE PLAN : 

DEVELOPING A PHARMACEUTICAL CARE PLAN A PRACTICAL APPROACH

GATHERING INFORMATION : 

GATHERING INFORMATION

PERSONAL DATA : 

PERSONAL DATA NAME : Mrs. ABC CONTACT : 12345 AGE : 58 YEARS WEIGHT : 55 KG LOCATION : XYZ EDUCATION : 5 GRADE PHYSICIAN NAME : Dr. ABC CONTACT : 678910

DIAGNOSIS : 

DIAGNOSIS SINCE LAST 8 YEARS Cardiomegaly Systolic Congestive heart failure Atrial fibrillation Mitral valve stenosis Pulmonary congestion Moderate pain of joints Insomnia some times

PRESENT DIAGNOSIS : 

PRESENT DIAGNOSIS Cardiomegaly Systolic Congestive heart failure Atrial fibrillation Mitral valve stenosis Pulmonary congestion Moderate pain of joints Hypertension ( since last 3 months) Skeletal muscle spasm ( since last 3 months) Hypokalemia ( Since last three months)

LABORATORY RESULTS : 

LABORATORY RESULTS I.N.R = 1.8 POTASSIUM = 2.5 mEq/L SODIUM = 132 mEq/L Echo cardiogram shows enlarged left ventricle and mitral valve stenosis. ECG shows increased RR interval and QRS complex missing rarely.

OTHERS : 

OTHERS BLOOD PRESSURE 130/85 HEART RATE 45 BEATS PER MINUTE

DRUG ALLERGIES : 

DRUG ALLERGIES Allergic to penicillins

DRUG PROFILE : 

DRUG PROFILE Therapy since last 8 years Tab. Digoxin 0.25 microgram once daily Tab. Warfarin 2.5 mg once daily Tab. Furosamide 20 mg once daily Tab. Nise 100 mg When needed Tab. Alprazolam 0.5 mg When needed at night

RECENTLY ADDED DRUGS IN PROFILE : 

RECENTLY ADDED DRUGS IN PROFILE Tab. Neo-k (potassium supplement) One tablet once daily Tab. Atenolol 50 mg once daily

OBJECTIVE FINDINGS : 

OBJECTIVE FINDINGS Patient looks tired, restless and discomfort.

IDENTIFICATION OF DRUG RELATED PROBLEMS : 

IDENTIFICATION OF DRUG RELATED PROBLEMS

PROBLEMS IDENTIFIED : 

PROBLEMS IDENTIFIED 1. Drug Drug interaction has found in between digoxin and atenolol. 2. Potassium level is low due to the drug furosamide. 3. Patient’s joint pain may be due to drug induced Hyperuricemia.

Slide 14: 

4. I.N.R value is less than the recommended for this condition. 5. Renal and liver functions are not checked. 6. Lipid profile test has not performed. 7. Frequency of drugs have not been prescribed in the case of PRN drugs.

RESOLVING PROBLEMS : 

RESOLVING PROBLEMS Atenolol should be discontinued and an alternate antihypertensive drug should be started. Low potassium level is due to the drug furosamide therefore an additional drug such as spironolactone ( potassium sparing diuretic) should be added. As the drug spiroolactone will be added in regimen potassium level will recover automatically, then discontinue the potassium supplements.

Slide 16: 

Warfarin dose should be increased to achieve the recommended I.N.R value i.e. 2.0-2.5 Renal and liver functions should be checked because the patient is older. Lipid profile should be checked Patient should be suggested to consult the cardiac surgeon. Further investigation such as uric acid level required for joint pain.

MONITORING PARAMETERS : 

MONITORING PARAMETERS Blood Pressure Heart Rate I.N.R value Renal and Liver functions Potassium level ECG Mitral valve opening size Uric acid levels Lipid profile

THERAPEUTIC GOALS : 

THERAPEUTIC GOALS To normalize Blood Pressure To normalize Heart Rate Achieving I.N.R value in the range of 2.0-2.5. To normalize Potassium level To normalize ECG Slow the progress of Mitral valve stenosis