Drug-Related Problems

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Drug-Related Problems

• A Drug-related problem is an event or
  circumstance involving drug therapy that actually
  or potentially interferes with desired health
  outcomes.
• PCNE Classification scheme for Drug-Related
  Problems V5.01, 2006
• PCNE Pharmaceutical Care Network Europe
  Foundation

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Drug-Related Problems

• Suboptimal Prescribing
• Overuse or polypharmacy
• Inappropriate use
• Underuse
• Prescribing or dispensing errors
• Drug use process
• Inappropriate administration
• Lack of monitoring
• Adverse drug events

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A case of polypharmacy

• 75 y/o, male
• Homebound, bedridden
• ????
• On NG, on foley
• CVA, HTN
• Bladder Ca, metastatic

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1 Mekei Megestrol 160 mg 1 QD
2 Bonfos clodronate 400 mg 1 BID
3 Nexium Esomeprazole 40 mg 1 QDAC
4 Harnalidge Tamsulosin 0.2 mg 1 HS
5 Hytrin Terazosin 2 mg 1 HS
6 Tramadol 100 mg 1 Q12H
7 Sertraline 50 mg 1 HS
8 Flutamide 250 mg 1 TID
9 Etodolac 400 mg 1 Q5PM
10 MgO 250 mg 1 QID
11 Ambroxol 30 mg 1 TID
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• 8???,??????
• ?????20?/?
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• On NG,?????????

QID TID Q12H QD
BID QD AC
Q5PM
HS
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1 Nexium Esomeprazole 40 mg ??? (????)
2 Harnalidge Tamsulosin 0.2 mg ??????? ???????
3 Tramadol 100 mg ??????
4 Etodolac 400 mg ??????

• ?????
• Nexiumesomeprazole Mg???pH????
• ??????? ?????,???????
• ???????????????????????????

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• Bonefos? (clodronate sodium)
• Oral absorption ? by food, esp. those containing
  Ca2 or other polyvalent cation
• Maintain adequate hydration throughout treatment
• Adjust dose according to renal function
• Monitor
• serum and urinary calcium, serum phosphate, and
  SCr

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• Sertraline tramadol
• ? risk of seizures serotonin syndrome (HTN,
  hyperthermia, myoclonus, mental status changes)
• ?????????etodolac
• Na and water retention

10
?????

• 2 a-blockers
• Hytrin? (terazosin)
• For HTN and BPH
• Harnalidge? (tamsulosin)
• For BPH
• ????
• ????bladder Ca, on foley

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??????

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• Dulcolax tab (bisacodyl)
• ???????
• ??????
• ???????????

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• ???????????
• Antihistamine
• ???????
• ??????
• ???
• ????
• Diphenidol, Sibelium? (flunarizine)
• ??????
• Euclidan? (nicametate), Trental? (pentoxifylline)

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??????

• ??????????
• Benzodiazepine
• a-blocker
• ??CNS depressants
• Benzodiazepine, hypnotic, antihistamine, TCA

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??????

• ??????
• Fibrate statin
• ???????????
• BPH????anticholinergic??anticholinergic side
  effects???
• Imipramine, 1st generation antihistamine
• ?????????NSAIDs

15
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1 Gliben Glyburide 5 mg 0.5 QD AC
2 Glibudon Metformin 500 mg 1 QD

• 82??????????5???????????,???????70 mg/dL??
• ????
• Metformin???
• Glyburide??3?,??????

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• Hypoglycemic agent, diuretics, adsorbent
• Inhaler
• ???????
• ????????
• ??????????????
• Aspirin or NSAID related bleeding disorder
• ????

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