a) Budget preparation and implementation Budget preparation and implementation
b) Clinical Pharmacy Introduction to Clinical Pharmacy, Concept of clinical pharmacy, functions and responsibilities of clinical pharmacist, Drug therapy monitoring – medication chart review, clinical review, pharmacist intervention, Ward round participation, Medication history and Pharmaceutical care. Dosing pattern and drug therapy based on Pharmacokinetic & disease pattern.
c) Over the counter (OTC) sales
Introduction and sale of over the counter, and Rational use of common over the counter medications.
People consult a doctor to find out what (if anything) is wrong (the diagnosis), and what should be done about it (the treatment). If they are well, they may nevertheless want to know how future problems can be prevented. Depending on the diagnosis, treatment may consist of reassurance, surgery or other
interventions. Drugs are very often either the primary therapy or an adjunct to another modality (e.g. the use of anaesthetics in patients undergoing surgery). Sometimes contact with the
doctor is initiated because of a public health measure (e.g. through a screening programme). Again, drug treatment is
sometimes needed. Consequently, doctors of nearly all specialties use drugs extensively, and need to understand the scientific basis on which therapeutic use is founded.
A century ago, physicians had only a handful of effective drugs (e.g. morphia, quinine, ether, aspirin and digitalis leaf)
at their disposal. Thousands of potent drugs have since been introduced, and pharmaceutical chemists continue to discover new and better drugs. With advances in genetics, cellular and
molecular science, it is likely that progress will accelerate and huge changes in therapeutics are inevitable. Medical students and doctors in training therefore need to learn something of the principles of therapeutics, in order to prepare themselves to adapt to such change. General principles are dis-
cussed in the first part of this book, while current approaches to treatment are dealt with in subsequent parts.
ADVERSE EFFECTS AND RISK/BENEFIT
Medicinal chemistry has contributed immeasurably to human
health, but this has been achieved at a price, necessitating a new philosophy. A physician in Sir William Osler’s day in the nineteenth century could safely adhere to the Hippocratic principle ‘first do no harm’, because the opportunities for doing good were so limited. The discovery of effective drugs has transformed this situation, at the expense of very real risks of doing harm. For example, cures of leukaemias, Hodgkin’s disease and testicular carcinomas have been achieved through
a preparedness to accept a degree of containable harm. Similar considerations apply in other disease areas. All effective drugs have adverse effects, and therapeutic judgements based on risk/benefit ratio permeate all fields of medicine. Drugs are the physician’s prime therapeutic tools,
and just as a misplaced scalpel can spell disaster, so can a thoughtless prescription. Some of the more dramatic instances make for gruesome reading in the annual reports of the medical defence societies, but perhaps as important is the morbidity and expense caused by less dramatic but more common errors.
How are prescribing errors to be minimized? By combining a general knowledge of the pathogenesis of the disease to be treated and of the drugs that may be effective for that disease
with specific knowledge about the particular patient. Dukes and Swartz, in their valuable work Responsibility for drug- induced injury, list eight basic duties of prescribers:
1. restrictive use – is drug therapy warranted?
2. careful choice of an appropriate drug and dose regimen with due regard to the likely risk/benefit ratio, available
alternatives, and the patient’s needs, susceptibilities and preferences;
3. consultation and consent;
4. prescription and recording;
6. supervision (including monitoring);
7. termination, as appropriate;
8. conformity with the law relating to prescribing.
As a minimum, the following should be considered when deciding on a therapeutic plan:
2. coexisting disease, especially renal and or hepatic impairment;
3. the possibility of pregnancy;
4. drug history;