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Individual drug evaluation services in a medical center
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Individual drug evaluation services in a medical center

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Next, this is a prescribing of a wrong dose case of saxagliptin in a male with type 2 diabetes. Under subjective, this is a 53-year old male who had type 2 diabetes. Currently, he was giving saxagliptine 5 mg PO every day. Under objective, we found out that he weighted 50 kilograms, and his serum creatinine was 2.3 mg/dl and his estimated creatinine clearance was about 26 ml/min. You may also want to include the HbA1C and blood glucose test. Under assessment, we wrote evaluate the dose for saxagliptin in type 2 diabetes patient. Saxagliptin is one of the Dipeptidyl Peptidase -4 (DPP-4) inhibitor class, there are 2 other DPP-4 inhibitors, sitagliptin and vildagliptin that need to adjust dose according to patient’s renal function.
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Linagliptin does not require renal adjustment.
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Under Plan, according to Lexi-comp, If patient’s creatinine clearance is below 50 ml/min including hemodialysis patient, the dose of saxagliptin should be lower to 2.5 mg PO every day. So, please consider to change to saxagliptinis 2.5 mg PO QD. Next, this is a prescribing of a wrong infusion rate case of gemcitabine in a male with pancreatic cancer. Under subjective, this is a 53-year old male who had metastatic pancreatic adenocarcinoma. Currently, he was giving gemcitabine 1760 mg IV stat and you infusion over 90 minutes. Under objective, we found out that he weighted 45 kilograms, and his serum creatinine was 0.8 mg/dl and his estimated creatinine clearance was about 68 ml/min. You may also want to include the result of blood cell data.
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Under assessment, we wrote evaluate the infusion time for gemcitabine in metastatic pancreatic adenocarcinoma patient. Prolong infusion time, usually over 60 minutes, is likely to increase hematologic toxicity. Under plan, according to Lexi-comp, if prolong the infusion time of gemcitabine, usually greater than 60 minutes, the accumulation of gemcitabine metabolite will lead to hematologic toxicity. So, please consider to change the infusion time to 30 minutes. Next, let us introduce the collaborative clinics. In Taiwan, the workload of outpatient clinic is very heavy. Having more than 60 patient appointments in a morning is very common. For a famous physician, he or she may have more than one hundred patient visits within 4 hours clinic schedule time.
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Often, they usually spend a whole day in the clinic to see these patients. So, doctors only can spend few minutes to explain their disease and treatment. In collaborative clinics, pharmacists can assist physicians to provide drug information and patient education to share physician’s workload. Also, physicians can consult pharmacist immediately. Next, let us introduce the pharmacist clinics. At this time, we have implemented two pharmacist run clinics, they are anticoagulation clinic and transplantation clinic. We accept patients from physician referral or on-line appointment registration. Detail service will explain in separated section. Next, let us move to drug information services. Our library has offered various medical databases, such as Lexi-Comp and Micromedex, electronic textbooks and journals for our staffs.
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We also display the latest edition of textbooks and reference books in our drug information center, such as Applied Therapeutics or Pharmacotherapy. When we edit our formulary or reply a consultation, we can access these references easily. It is essential to have one’s own formulary. Clinical pharmacists edit and revise the hospital formulary regularly. We have multiple versions for hospital formulary, including booklet publish every two years, online formulary update monthly and formulary APP (APPs) for smart phone user of employee. In addition, our pharmacy has several publications, including the monthly publish “Taipei Veterans General Hospital Drug Bulletin”, biannual publish “Journal of Hospital Pharmacy” and “Taipei Veterans General Hospital Formulary” every two years.
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To spread the updated drug information, patient can also access drug information from our departmental website. Our clinical pharmacists also give oral presentations, lectures in our scheduled academic activity. We hold Problem-Based Learning and continuing education three times a year. Inter-hospital cases conference forum and regular academic meeting are held weekly. Through these academic activities, clinical pharmacists provide updated drug information and treatment guidelines to medical staffs.

Ms Chao finishes up a case study of clinical drug evaluation service. Then she explains some professional pharmacy services in a teaching medical center.

Key concepts

Collaborative clinics:

Physicians have very heavy workloads. In collaborative clinics, pharmacists can assist physicians to provide drug information and patient education to share physician’s workload, it also allows physicians to consult pharmacists immediately.

Pharmacist clinics (this will be discussed in another section).

Drug information services

Pharmacists need to provide medical databases, such as Lexi-Comp and Micromedex, electronic textbooks, and journals for other healthcare staff. They also need to edit and update the hospital formulary regularly, publishing them in different forms (website, leaflet, applications).

This service also includes frequent academic activities, such as academic seminars, problem-based learning workshops, and other lectures. Inter-hospital cases conference forums and regular academic meetings are held weekly. In these academic activities, clinical pharmacists present updated drug information and treatment guidelines to medical staff.

Share and learn:

  • Have you ever attended an education seminar/lecture given by a clinical pharmacist before? If you have, please share your experiences.

  • Are there pharmacist clinics in your country?

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Good Pharmacy Practice: Introduction to Clinical Pharmacy Services

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