Drug related problem
Drug related problems (DRPs) are prevalent and causing considerable patient morbidity and mortality. Many of these DRPs are preventable through following the guidelines and rational drug used. There are many factors controlling the DRP occurrence such as patient age, disease status, drug characteristics, etc.
High risk factors
1. Elderly (> 65 years); due to age related changes in pharmacodynamic and pharmacokinetics
2. Acute diseases such as acute renal failure, sepsis, etc…
3. Patients with many chronic diseases; diabetes, hypertension, heart disease, liver problem, AIDS, etc…
4. Patients with renal impairment or haemodialysis
5. Patients in special situations; pregnancy, lactation,
6. Certain diseases and their medications: cancer, diabetes, heart failure.
7. Polypharmacy (taken many drugs > 5 drugs)
8. Drug; certain drug classes are commonly involved e.g. Warfarin, insulin, digoxin, TCAs, etc…
Classification of drug-related problems
1. Inappropriate drug choice: Unjustified deviation from management guidelines consensus therapeutic can worsen the condition. Deviations that are based on the patient’s individual treatment goal and risk factors are not considered to be DRPs (e.g. Antibiotic used for viral infection. Furosemide prescribed for patient with hypokalemia).
2. Lack of necessary drug: Either one or more drugs are missing according to established guidelines or a medical problem is being treated with too little of the appropriate drug (under-prescribed) or appropriate drugs may be not used for maximum effectiveness. Moreover, duration of treatment may be too short which can lead to incomplete treatment. Deviations from guidelines that are based on the patient’s individual treatment goals and risk factors are not considered to be DRPs (e.g. B-blockers in heart failure or post-MI, stop diuretic before edema treated or loop diuretic used only for resistant edema).
3. Unnecessary drug and Duplication: A drug is unnecessary if the indication is no longer present, with continuation/prolonged use or double prescription of two or more drugs from the same therapeutic group or gives the same result. This intensifies their therapeutic effect and side effects. Duplication also can occur when more than one physician prescribes medications to a single patient or when a patient takes over-the-counter drugs with the same active ingredient (e.g. Long-term antibiotic prescribed for simple infection. Used of Ibuprofen and diclofenac concomitantly.
4. Incomplete medication history taking: Inappropriate integration of patient’s medical history can lead to many interactions due to lack of patient’s information such as hypersensitivity “medication allergy”, other diseases, OTC or herbal and medication used (e.g. Patient has allergy to penicillin).
5. Inappropriate dose or regimen: Dosing too high (overdose) or too low dose. Suboptimal dosing (including dosing time and formulation) according to established national/international guidelines, including frequency of dosing or duration of therapy. Deviations that are based on the patient’s individual treatment goal and risk factors are not considered to be DRPs (e.g. too high ACE inhibitor dose prescribed in relation to kidney function. Too low paracetamol dose use in relation to symptom-giving arthritis).
6. Adverse drug reaction (ADR): Any noxious, unintended, and undesired effect of a drug, which occurs at doses in humans for prophylaxis, diagnosis, or therapy (e.g. orthostatic hypotension happens with blood pressure lowering drug or intolerance dry cough due to ACE inhibitor).
7. Interaction: Drug–drug interaction, drug-food interaction, drug-disease interaction, drug-herbal, etc... An interaction is occurring when the effect of a drug is changed by the presence of another drug, food, drink, herbal or some environmental...
References: 1. Bemt P and Egberts A (2007) Drug-related problems: definitions and classification. Journal of European Association of hospital Pharmacists (EAHP), 13, pp 62-64.
2. Ruscin M (2009) Drug-Related Problems in the Elderly. Merck, Available from World Wide Web: http://www.merck.com/mmpe/sec23/ch341/ch341e.html
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