Pharmacotherapeutics

Chapter Topic Pharmacotherapeutics – Introduction, scope, and objectives.

Rational use of Medicines, Evidence Based Medicine, Essential Medicines List, Standard Treatment Guidelines (STGs) Definition, etiopathogenesis, clinical manifestations, non- pharmacological and pharmacological management of the diseases associated with (a) Cardiovascular System • Hypertension • Angina and Myocardial infarction • Hyperlipidaemia • Congestive Heart Failure (b) Respiratory System • Asthma • COPD (c) Endocrine System • Diabetes • Thyroid disorders - Hypo and Hyperthyroidism (d) Central Nervous System • Epilepsy • Parkinson’s disease • Alzheimer’s disease • Stroke • Migraine (e) Gastro Intestinal Disorders • Gastro oesophageal reflux disease • Peptic Ulcer Disease • Alcoholic liver disease • Inflammatory Bowel Diseases (Crohn’s Disease and Ulcerative Colitis) (f) Haematological disorders • Iron deficiency anaemia • Megaloblastic anaemia (g) Infectious diseases • Tuberculosis • Pneumonia • Urinary tract infections • Hepatitis • Gonorrhoea and Syphilis • Malaria • HIV and Opportunistic infections • Viral Infections (SARS, CoV2) (h) Musculoskeletal disorders • Rheumatoid arthritis • Osteoarthritis (i) Dermatology • Psoriasis • Scabies • Eczema (j) Psychiatric Disorders • Depression • Anxiety • Psychosis (k) Ophthalmology • Conjunctivitis (bacterial and viral) • Glaucoma (l) Anti-microbial Resistance (m) Women’s Health • Polycystic Ovary Syndrome • Dysmenorrhea • Premenstrual Syndrome PHARMACOTHERAPEUTICS – PRACTICAL Course Code: ER20-24P 25 Hours (1 Hour/week) Scope: This course is designed to train the students in the basic skills required to support the pharmaceutical care services for selected common disease conditions.

Course Objectives: This course will train the students on

1. How to prepare a SOAP (Subjective, Objective, Assessment and Plan) note for clinical cases of selected common diseases

2. Patient counselling techniques/methods for common disease conditions Course Outcomes: Upon successful completion of this course, the students will be able to

1. Write SOAP (Subjective, Objective, Assessment and Plan) notes for the given clinical cases of selected common diseases

2. Counsel the patients about the disease conditions, uses of drugs, methods of handling and administration of drugs, life-style modifications, and monitoring parameters.

Practicals I. Preparation and discussion of SOAP (Subjective, Objective, Assessment and Plan) notes for at least SIX clinical cases (real / hypothetical) of the following disease conditions.

1. Hypertension

2. Angina Pectoris

3. Myocardial Infarction

4. Hyperlipidaemia

5. Rheumatoid arthritis

6. Asthma

7. COPD

8. Diabetes

9. Epilepsy

10. Stroke

11. Depression

12. Tuberculosis

13. Anaemia (any one type as covered in theory)

14. Viral infection (any one type as covered in theory)

15. Dermatological conditions (any one condition as covered in theory) II. Patient counselling exercises using role plays based on the real / hypothetical clinical case scenarios. The students are expected to provide counselling on disease condition, medications, life-style modifications, monitoring parameters, etc. and the same shall be documented. (Minimum 5 cases) III. Simulated cases to enable dose calculation of selected drugs in paediatrics, and geriatrics under various pathological conditions. (Minimum 4 cases) HOSPITAL AND CLINICAL PHARMACY – THEORY Course Code: ER20-25T 75 Hours (3 Hours/week) Scope: This course is designed to impart fundamental knowledge and professional skills required for facilitating various hospital and clinical pharmacy services.

Course Objectives: This course will discuss and train the students in the following

1. Hospital and Hospital Pharmacy organization and set-ups

2. Basics of hospital pharmacy services including the procurement, supply chain, storage of medicines and medical supplies

3. Basics of clinical pharmacy including introduction to comprehensive pharmaceutical care services

4. Basic interpretations of common laboratory results used in clinical diagnosis towards optimizing the drug therapy Course Outcomes: Upon successful completion of this course, the students will be able to

1. Explain about the basic concepts of hospital pharmacy administration

2. Manage the supply chain and distribution of medicines within the hospital settings

3. Assist the other healthcare providers in monitoring drug therapy and address drug related problems

4. Interpret common lab investigation reports for optimizing drug therapy S. No.

Topic Hospital Pharmacy • Definition, scope, national and international scenario • Organisational structure • Professional responsibilities, Qualification and experience requirements, job specifications, work load requirements and inter professional relationships • Good Pharmacy Practice (GPP) in hospital • Hospital Pharmacy Standards (FIP Basel Statements, AHSP) • Introduction to NAQS guidelines and NABH Accreditation and Role of Pharmacists Different Committees in the Hospital • Pharmacy and Therapeutics Committee - Objectives, Composition, and functions • Hospital Formulary - Definition, procedure for development and use of hospital formulary • Infection Control Committee – Role of Pharmacist in preventing Antimicrobial Resistance Supply Chain and Inventory Control • Preparation of Drug lists - High Risk drugs, Emergency drugs, Schedule H1 drugs, NDPS drugs, reserved antibiotics • Procedures of Drug Purchases – Drug selection, short term, long term, and tender/e-tender process, quotations, etc.

• Inventory control techniques: Economic Order Quantity, Reorder Quantity Level, Inventory Turnover etc.

• Inventory Management of Central Drug Store – Storage conditions, Methods of storage, Distribution, Maintaining Cold Chain, Devices used for cold storage (Refrigerator, ILR, Walk-in-Cold rooms) • FEFO, FIFO methods • Expiry drug removal and handling, and disposal. Disposal of Narcotics, cytotoxic drugs • Documentation - purchase and inventory Drug distribution • Drug distribution (in- patients and out - patients) – Definition, advantages and disadvantages of individual prescription order method, Floor Stock Method, Unit Dose Drug Distribution Method, Drug Basket Method.

• Distribution of drugs to ICCU/ICU/NICU/Emergency wards.

• Automated drug dispensing systems and devices • Distribution of Narcotic and Psychotropic substances and their storage Compounding in Hospitals. Bulk compounding, IV admixture services and incompatibilities, Total parenteral nutrition Radio Pharmaceuticals - Storage, dispensing and disposal of radiopharmaceuticals Application of computers in Hospital Pharmacy Practice, Electronic health records, Softwares used in hospital pharmacy Clinical Pharmacy: Definition, scope, and development - in India and other countries Technical definitions, common terminologies used in clinical settings and their significance such as Paediatrics, Geriatric, Anti-natal Care, Post-natal Care, etc.

Daily activities of clinical pharmacists: Definition, goal, and procedure of • Ward round participation • Treatment Chart Review • Adverse drug reaction monitoring • Drug information and poisons information • Medication history • Patient counselling • Interprofessional collaboration Pharmaceutical care: Definition, classification of drug related problems. Principles and procedure to provide pharmaceutical care Medication Therapy Management, Home Medication Review Clinical laboratory tests used in the evaluation of disease states - significance and interpretation of test results • Haematological, Liver function, Renal function, thyroid function tests • Tests associated with cardiac disorders • Fluid and electrolyte balance • Pulmonary Function Tests Poisoning: Types of poisoning: Clinical manifestations and Antidotes Drugs and Poison Information Centre and their services – Definition, Requirements, Information resources with examples, and their advantages and disadvantages Pharmacovigilance • Definition, aim and scope • Overview of Pharmacovigilance Medication errors: Definition, types, consequences, and strategies to minimize medication errors, LASA drugs and Tallman lettering as per ISMP Drug Interactions: Definition, types, clinical significance of drug interactions HOSPITAL AND CLINICAL PHARMACY – PRACTICAL Course Code: ER20-25P 25 Hours (1 Hour / Week) Scope: This course is designed to train the students to assist other healthcare providers in the basic services of hospital and clinical pharmacy.

Course Objectives: This course will train the students with hands-on experiences, simulated clinical case studies in the following:

1. Methods to systematically approach and respond to drug information queries

2. How to interpret common laboratory reports to understand the need for optimizing dosage regimens

3. How to report suspected adverse drug reactions to the concerned authorities

4. Uses and methods of handling various medical/surgical aids and devices

5. How to interpret drug-drug interactions in the treatment of common diseases.

Course Outcomes: Upon completion of the course, the students will be able to

1. Professionally handle and answer the drug information queries

2. Interpret the common laboratory reports

3. Report suspected adverse drug reactions using standard procedures

4. Understand the uses and methods of handling various medical/surgical aids and devices

5. Interpret and report the drug-drug interactions in common diseases for optimizing the drug therapy Note: Few of the experiments of Hospital and Clinical Pharmacy practical course listed here require adequate numbers of desktop computers with internet connectivity, adequate drug information resources including reference books, different types of surgical dressings and other medical devices and accessories.

Various charts, models, exhibits pertaining to the experiments shall also be displayed in the laboratory.

Practicals

1. Systematic approach to drug information queries using primary / secondary / tertiary resources of information (2 cases)

2. Interpretation of laboratory reports to optimize the drug therapy in a given clinical case (2 cases)

3. Filling up IPC’s ADR Reporting Form and perform causality assessments using various scales (2 cases)

4. Demonstration / simulated / hands-on experience on the identification, types, use / application /administration of • Orthopaedic and Surgical Aids such as knee cap, LS belts, abdominal belt, walker, walking sticks, etc.

• Different types of bandages such as sterile gauze, cotton, crepe bandages, etc.

• Needles, syringes, catheters, IV set, urine bag, RYLE’s tube, urine pots, colostomy bags, oxygen masks, etc.

5. Case studies on drug-drug interactions (any 2 cases)

6. Wound dressing (simulated cases and role play –minimum 2 cases)

7. Vaccination and injection techniques (IV, IM, SC) using mannequins (5 activities)

8. Use of Hospital Pharmacy Software and various digital health tools Assignments The students shall be asked to submit written assignments on the following topics (One assignment per student per sessional period. i.e., a minimum of THREE assignments per student)

1. Typical profile of a drug to be included in the hospital formulary

2. Brief layout and various services of the Central Sterile Supplies Department (CSSD)

3. Various types of sterilizers and sterilization techniques used in hospitals

4. Fumigation and pesticide control in hospitals

5. Role of Pharmacists in Transition of Care: Discharge cards, post hospitalization care, medicine reconciliation activities in developed countries

6. Total parenteral nutrition and IV admixtures and their compatibility issues

7. Concept of electronic health records

8. Invasive and Non-invasive diagnostic tests - HRCT, MRI, Sonography, 2D ECHO, X-rays, Mammography, ECG, EMG, EEG

9. Home Diagnostic Kits - Pregnancy Test, COVID testing etc

10. Measures to be taken in hospitals to minimize Antimicrobial Resistance

11. Role and responsibilities of a pharmacist in public hospital in rural parts of the country

12. Safe waste disposal of hospital waste Field Visit The students shall be taken in groups to visit a Government / private healthcare facility to understand and witness the various hospital and clinical pharmacy services provided. Individual reports from each student on their learning experience from the field visit shall be submitted.