Download viva question

Concise &Conceptual Series
VIVA QUESTIONS OF DISEASES
What is kerning’s syndrome?
It is elicited with the patient in the supine position. The tight is flexed on
the abdomen, with the knee flexed, attempts to passively extends the legs,
elicit pain when meningitis irritation is present.
What is brudniski syndrome?
The presence or absence of the Brudzinski sign may be helpful in confirmation
of meningitis.The Brudzinski sign is elicited with the patient in the supine
position and is positive when passive flexion of the neck results in spontaneous
flexion of the hips and knees.
What is the strain of malaria that causes the cerebral malaria?
Falciparum is the strain that cause infection which may be asymptomatic severely
enfeebling or fatal.
When RBCs rupture, parasites, Hemoglobin and metabolites of parasite released.These
products are taken up by Reticuloendothelial system
marked pigmentation and
enlargement of spleen, liver, lymph nodes and bone marrow.RBCs become sticky and
plug up the smaller vessels especially in patients with falciparum malaria.Obstructive
action of the “sludge blood” has effects like:
a. Tissue anoxia and necrosis, bursting of vessels, electrolyte imbalance.
b. Organs including the brain (cerebral malaria) and kidneys may be affected.
What is CSF value in normal man?
Normal values
Volume
Pressure
Cellular component
Protein
Glucose
= 150ml
= 50—150mmH2O
= 5 cells/uL
= 0.4g/L
= 60% of blood glucose
(2.2—4.4mmol/L)
Concise &Conceptual Series
What is hypertension crisis?
When patient have BP 210>130
Value of hypertension
In case of malignant hypertension above 120mmHg
In case of beningn hypertension is 90-120 mmHg
What is diastolic pressure?
Minimum arterial pressure during contraction is known as diastolic pressure
What is systolic pressure?
Maximum arterial pressure during contraction is known as systolic pressure
In 120/80 what is 120 and 80?
120 is systolic pressure
80 is diastolic pressure
According to you who patient will be at danger and why
A. A patient with hypertension?
Or
B. A patient with hypotension?
The patient with hypotension is at risk due to circulatory collapse and state of
hypotension will leads to the death
Concise &Conceptual Series
What are examples of microbes that cause meningitis?
Bacteria
N .menigitidis, H.influenzae type b, s.aureus, E.coli streptococcus pneumonia
Viruses
Mumps, polic, small pox, herpes simplex virus,HIV virus
Fungi
Cryptococcus neoformans, candida, actinomyces, aspergillus
Why we recommend chicken broth to patient rather meat?
As chicken broth contains water soluble aminoacids and it helps the patient to cure
soon
What is the effect of tea along with NSAIDS?
As tea contains the alkaloids theophylline and caffeine which cause irritation to GIT
lining and concominenet use cause ulceration
What kind of suggestions you can give to diabetic patients?
A patient suddenly has angina pain and hospital is at distance and how
can you provide initial help to him?
We ask the patient to cough as coughing helps to provide the oxygen to the cells and
this mechanism helps the patient to avoid major angina attack
There are certain drugs which are not recommended to children. Name
them
Ciprofloxacin, cimetidine, ofloxacin
Name the drug or antibiotic used in treatment of ulcer?
Macrolides
Concise &Conceptual Series
Which types of bacteria are responsible for diahorrea?








Vibrio cholerae.
Enterotoxigenic Escherichia coli (ETEC).
Verotoxin-producting
Shigella dysenteriae type 1.
Clostridium perfringens.
Clostridium difficile.
Vibrio parahaemolyticus.
Some strains of Staphylococcus aureus
Name the antibiotic that can be used in pregnancy?
A patient came to a hospital in unconscious state and he is diahorreatic
patient and how can you judge what kind of diarrhea he had and what kind
of therapy you will provide to him?
What kind of therapy is suggested for viral diarrheatic patient?
Most cases can be managed with supportive measures (oral fluid
replenishment) on an outpatient basis.Infants and debilitated patients may
require hospital admission and intravenous administration of fluids and
electrolytes.No specific antiviral agents or vaccines are available for rotavirus or
the Norwalk virus.
What is the effect of amilodipine and anti hypertensives which are
prescribed in prescription together?
They both will cause hypotension
Concise &Conceptual Series
VIVA QUESTIONS RELATED TO LABORATORY DATA
What is PT and its value and importance?
NAME OF TEST
NORMAL
VALUE
DESCRIPTION
CLINICAL
SIGNIFICANCE
INCREASED
IN
PROTHROMBIN
TEST
11-13
SECONDS
THE PROTHROMBIN TEST IS
SENSITIVE TO CHANGES IN
THE LEVELS OF CLOTTING
FACTORS PROTHROMBIN
(FACTOR II), FACTOR 7 AND
FACTOR 10.IT IS
PERFORMED BY ADDING
THE THROMBOPLATIN AND
CALCIUM TO A PLASMA
SAMPLE.AFTER THE
ADDITION OF THESE
REAGENTS THE TIME IT
TAKES THE BLOOD TO CLOT
IS MEASURED
THE PT IS USED
TO MONITOR
WARFARIN
THERAPY.
BECAUSE THE PT
MAY VARY
ACCORDING TO
THE
THROMBOPLATIN
USED TO USED
TO TEST THE
SAMPLE,THE INR
IS A BETTER
MONITORING
TOOL
ANTICOAGU
LATION
THERAPY
LIVER
DISEASE
VITAMIN K
DEFICIENCY
CLOTTING
FACTOR
DEFICIENCIE
S
What is the source of production of creatinine and its importance?
MUSCLE CREATINIE AND PHOSPHOCREATININE BREAK DOWN TO FORM
CREATININE. IT IS RELEASED IN THE BLOOD AND EXCRETED BY THE GLOMERULAR
FILTRATION IN THE KIDNEY AND IT IS A TOOL TO IDENTIFY THE RENAL
DYSFUNCTION
Bilirubin normal value and what are the effects of high and low bilirubin?
Bilirubin value is 0.2-1mg/dl
High level of unconguated bilirubin indicates biliary obstruction or hepatoceelular
disease
High level of unconjugated bilirubin indicates hemolysis
Concise &Conceptual Series
And very low level of bilirubin indicates patient is suffering from chronic liver failure
What is DLC and TLC?
DLC is differential leucocyte count where TLC is total leucocyte count
What is ESR? And its importance?
SOURCE
OF NORMAL
PRODUCTION
VALUES
INCREASED IN
BONE MARROW
IS THE SITE OF
PRODUCTION OF
BLOOD AND IT IS
USEFUL
TO
CHECK
THE
PROGRESS
OF
DISEASE
IF
PATIENT
IS
IMPROVING ESR
TEND TO FALL
AND VICE VERSA
IT IS INCREASED IN INFANTS WITH
IN
THE
ALL ANEMIAS
INFECTIONS
EXCEPT THE MILD
LOCAL
INFECTIONS.
IT
INCREASES
IN
THEG 3RD MONTH
OF PREGNANCY
MALE
0-15mm/hour
FEMALE
0-20mm/hour
DECREASED IN
2. What is the importance of RBC count?
SOURCE
OF DIAGNOSTIC
PRODUCTION
VALUE
INCREASED
RED
BLOOD IN MEN
CELLS
BONE
4.5-6 *1012 /L
MARROW
POLYCYTHEMIA
DECREASED
IN
VERA,COPD,IT
VARIOUS
TYPES
MAY
INC.
IN OF ANEMIAS
CHRONIC
SMOKERS
AND
PEOPLE WHO LIVE
AT
HIGH
ALTITUDE OR DO
VIGOROUS
EXCERCISE
IN FEMALE
4.3-5.5*1012 /L
DECREASED IN
IN
Concise &Conceptual Series
Importance of liver function tests?
It helps to find out the working of liver cells as well as we know that most of
the drugs are metabolized by this route and show action so proper working of
liver is very important
What is the importance of uric acid?
It is a metabolic product of purine bases of DNA. And excees production cause
renal dysfunctioning. It is caused by excessive protein intake. So drugs which
are important t decrease the level are probencid, high doses of aspirin and
vitamin C
If PT is higher what kind of suggestions you can give it to your patient?
Then patient have to take vitamin k , spinach etc
If a patient comes with higher blood sugar what kind of treatment will you
give?
Give him I/V insulin
VIVA QUESTIONS RELATED TO PHARMACOECONOMICS
What is pharmacoeconmoics?
Pharmacoeconomics is the measurement of the costs and consequences of
therapeutic decision making
What is CBA, CEA, and CUA AND CMA?
Cost benefit analysis
In CBA consequences are measured in terms of the total cost associated with a
program where both cost and consequences are measured in monetary terms
Cost effective analysis
It is an examination of the costs of two or more programs which have the same
clinical outcomes as measured in the units
Concise &Conceptual Series
Example
1. Life saved or reduces morbidity
2. Treatments with dissimilar outcomes can also be analysed by this technique
Cost minimization analysis
Where 2 or more interventions have been shown to be or are assumed to be, similar
then if all other factors are equal for example
Convenience, side effects, availability etc. selection can be made on the basis of cost
this is konown as CMA
Cost utility analysis
An alternative measurement for the consequences of a health care intervention is the
concept of utility
VIVA RELATED TO TDM
Define TDM
TDM is the measurement of specific drug at intervals in order to maintain a relatively
constant conc. Of medication in the blood stream
Examples of TDM
a)
b)
c)
d)
e)
f)
Lithium
Aminoglycosides
Theophylline
Digoxin
Methotrexate
Anticonvulsants like phenytoin, carbamezpine, sodium valporate etc
Why TDM is necessary?
Understanding the principles of drug disposition and factors which determine these
principles in the individual patient will facilitate an understanding of the use of and
need for therapeutic drug monitoring.
Concise &Conceptual Series
By adjusting doses to maintain plasma drug concentrations within a target range,
variability in the pharmacokinetic phase of drug action is greatly reduced.
Define creatnine clearance?
1. Creatinine is a metabolic by-product of muscle and an individual’s muscle mass or lean
body weight primarily determines its rate of formation.
2. Cockcroft and Gault equation:
CrCl: (140 - age) x IBW / (Scr x 72) (x 0.85 for females)
IBW (Ideal body weight)
Males: IBW = 50 kg + 2.3 kg for each inch over 5 feet.
Females: IBW = 45.5 kg + 2.3 kg for each inch over 5 feet.
What is the effect of protein binding and which drug is most affected by
it?
What is the optimum drug concentration of digoxin, theophylline,
carbamezepine and aminoglycosides?
What is pharmacokinetics?
It is concerned with the study and characterization of the time course of drug
absorption, distribution, metabolism and excretion, and with the mathematical
relationships required to develop models to interpret such date.
Define clinical pharmacokinetics?
A health science discipline dealing with the application of pharmacokinetics to the safe and
effective therapeutic management of the individual.
What is steady state?
At steady state the rate of drug administration is equal to drug elimination and the mean
concentration remains constant.
Concise &Conceptual Series
When we remove the blood sample?
When steady state is achieved
What kinds of techniques are used for serum analysis?
Radio immune assay RIA is the most acceptable method for digoxin analysis
Fluorescence polarization immune assay FPIA is most frequently used
Why we perform TDM of digoxin?





Non-compliance is frequent especially in the elderly
Drug interaction are important factor or indicaqtor for the TDM of digoxin (as pglycoprotein inhibitors increases the serum concentration of digoxin)
Drug toxicity such as nausea, vomiting, abdominal pain and arrhythmias are
related to concentration
Since it is excerted renally alteration in the renal and thyroid function requiring
monitoring
Poor response even with the recommended doses require digoxin measurement
(sub therapeutic conc. Detected for side effects)
Why we perform TDM of phenytoin?
It is necessary as
1. Detection of non adherence to regimen
2. Suspected toxicity
3. Adjustment of dose as drug levels can only guide to optimizing the dosage
Management of pharmacokinetic interactions
Why we perform TDM of aminoglycosides?
It is based on 2 facts
1. Too much aminoglycosides cause patient harm in terms of nephrotoxicity and
ototoxicity
2. Too little aminoglycosides may harm by allowing the progress of overwhelming
infection . it follows the concentration dependent killing
Concise &Conceptual Series
Why we perform TDm of carbamezepine?
1.
2.
3.
4.
Detection of non adherence to regimen
Suspected toxicity
Adjustment of the dose as drug levels can only guide to optimize the dosage
Management of pharmacokinetic interactions
Why we perform TDM of theophylline?
1. Narrow therapeutic index
2. Serious reported toxicities that is life threatening seizures and arrhythmias without any
warning sign
3. Known correlation between serum level and toxicity
4. Significant inter patient variability in drug clearance known factors that may alter the
clearance
Why are we obtained the blood sample after weeks in case of phenytoin?
Steady state concentration are reached in 5-10 days
What type of response is shown by carbamezepine?
It exhibit dose dependent p/k therefore adjust dose according to response rather than plasma
conc. level
What is dose dependent response?
a range of doses over which response occurs. Doses lower than the threshold produce
no response while those in excess of the threshold exert no additional response. The
shape of the curve is usually hyperbolic when plotted with linear axes and gives a
sigmoidal curve when response is plotted versus the log of the dose. Beneficial drug
responses are typically plotted on separate dose response curves. Because the dose
response and the chemotherapeutic index can overlap to some degree and may have
different slopes, the margin of safety is often considered to be a better index.
What is time dependent response?
Concise &Conceptual Series
What is the difference between blood, plasma and serum?
Blood plasma, or plasma, is prepared by obtaining a sample of blood and removing
the blood cells. The red blood cells and white blood cells are removed by spinning with
a centrifuge. Chemicals are added to prevent the blood's natural tendency to clot. If
these chemicals include sodium, than a false measurement of plasma sodium content
will result. Serum is prepared by obtaining a blood sample, allowing formation of the
blood clot, and removing the clot using a centrifuge. Both plasma and serum are light
yellow in color
Define following terms
Dose fractions
In radiation therapy, the small doses given to reach the total radiation dose during the
treatment period.
Infectious dose 50 (ID50)
That amount of pathogenic microorganisms that will produce infection in 50% of the
test subjects.
Infective dose (ID)
That amount of pathogenic microorganisms that will cause infection in susceptible
subjects.
Lethal dose (LD)
The amount of toxin or drug that will kill an animal.
Dose level
The amount administered per unit of body weight.
Loading dose
The initial large dose of a drug given to bring tissue and fluid levels to an effective
concentration quickly. Called also priming dose.
Maintenance dose
Concise &Conceptual Series
The smaller doses given to maintain effective levels in body fluids and tissues after the
loading dose has achieved the concentration desired.
Median curative dose (CD50)
a dose that abolishes signs in 50% of test animals.
Median effective dose (MED)
the dose that produces the desired effect in 50% of the test animals.
Median lethal dose (MD50)
the quantity of an agent that will kill 50% of the test subjects; in radiology, the
amount of radiation that will kill, within a specified period, 50% of individuals in a
large group or population.
Minimum lethal dose (MLD)
The lowest dose which kills all of the test subjects.
Dose rate
The amount administered per unit of time.
Dose response
1. the incremental change in the subject per unit of additional dose. The response as a
function of the dose.
2. the frequency of occurrence of a disease as the intake of the suspected risk factor
increases. The relationship is expressed by the proximity of the illustrative curve to the
expected relationship.
Skin dose
1. the air dose of radiation at the skin surface, comprising the primary radiation plus
backscatter.
2. the absorbed dose in the skin.
Tolerance dose
Concise &Conceptual Series
The largest quantity of an agent that may be administered without harm.
Name the drugs for which we are not able to perform TDM with examples?
When the acton is produce by the active metabolite . so in that case we are not
allowed to monitor parent drug example is of primidone. So when we are using this
drug it is not advisable to monitor primidone
Idiosyncratic effects are not related to plasma concentrations example is of aplastic
anemia due to chloramphenicol
For drugs who showed action when plasma concentration fall to zero example aspirin
shows antiplatelet effects
Drugs with complex actions example like ACE inhibitors where its action is not related
to plasma concentration
When the drug action is not related to the site of action example penicillin used for
UTI’S
How we can measure salt factor?
1. 500mg of erthyromycin HCL is equivalent to 480 mg of erythromycin. Find salt
factor
500mg of erthyromycin HCL is equivalent to= 480 mg of erythromycin
I mg……………………………………………………………..=480
500
100mg…………………………………………………………=480 multiply 100
500
2. Chloroquine po4/so4 600mg
600mg of chloroquine so4/po4 is equivalent to =200mg of chloroquine
1mg…………………………………………………………………=200
600
100mg……………………………………………………………..=200 multiply by 100=0.33
600
Concise &Conceptual Series
What is the dose of aminoglycosides in extended and conventional
dosing?
Conventional dosing
1. By conventional multidose regimen higher peak conc. of 10-12mg/liter of gentamicin is
required for severe gram negative sepsis
2. While a lower peak conc. of 3-6 mg/liter is acceptable for gram positive endocarditis
when used in combination with beta lactum antibiotics
3. Peak conc is drawn
 IV bolus or IM route…….after 1 hour
 IV infusion…………………..after 30 minutes
4. Trough conc. should not fall below 1mg/liter and sampled immedialtely before
the next dose is administered
5. Peaks of aminoglycosides and vancomycin are sharp
Extended dosing
1. New concept is 1daily dose
2. Once daily extended interval dosing is more preferred based on the principal of
conc. dependent killing, post antibiotic effects, reduction in renal accumulation
and less chances of induction of resistance in bacteria
3. Initial dosage for this regimen is 3-7mg/kg/day
4. This is subsequently adjusted on the basis of blood level
5. The monitoring is also different in this case
6. Sample is drawn at 6-1 hour after administration
7. Then standard conc. time graph is made
8. If the conc. is below the target, dosage regimen is continued
9. If too high the dosing interval is extended
10. At trough we take the dose
11. If trough is higher than the interval is exceeded
12. Peak conc. is not calculated in following cases
 Pediatrics
 Pregnancy
 Breast feeding
13. Therefore conventional regimen is given
Concise &Conceptual Series
How can we interpret the result in TDM?
1.
2.
3.
4.
Check time interval between last dose and taking the drug
Therapeutic range apply to trough level
In case where drug have longer half lives timing is not a big issue
Check protein/albumin level example is of phenytoin, carbamezepine and
theophylline
5. Free fraction is checked for toxicity
6. Use your judgment
VIVA RELATED TO GENERAL CLINICAL PHARMACY
What is the rational use of following drugs
ASPIRIN:(75MG)
The U.S. Preventive Services Task Force (USPSTF) strongly recommends that clinicians
discuss aspirin chemoprevention with adults who are at increased risk for coronary
heart disease (CHD). Discussions with patients should address both the potential
benefits and harms of aspirin therapy.
Rationale: The USPSTF found good evidence that aspirin decreases the incidence of
coronary heart disease in adults who are at increased risk for heart disease. They also
found good evidence that aspirin increases the incidence of gastrointestinal bleeding
and fair evidence that aspirin increases the incidence of hemorrhagic strokes. The
USPSTF concluded that the balance of benefits and harms is most favorable in
patients at high risk of CHD (5-year risk of greater than or equal to 3 percent) but is
also influenced by patient preferences.
RANITIDINE (150MG)
Rationale: The use of Ranitidine is that it should be used for 7 days in case of Gastric
irritation as 300 mg/day. It should only be used in adults.
Concise &Conceptual Series
ISOSORBIDE MONONITRATE (40MG)
Rationale: Isosorbide mononitrate is used to prevent chest pain in patients with a
heart condition known as angina. This medication is normally taken twice a day. The
first dose should be taken in the morning and second dose should be taken 7 hours
later. This medication works by dilating blood vessels throughout the body. This can
cause dizziness and lightheadedness when standing quickly and during the first days
of therapy. This medication can cause headache - which also indicates the drug is
working. These headaches are relieved with aspirin or acetaminophen. For this drug to
be most effective it should be taken as prescribed, separating doses by 7 hours.
Missed doses should not be doubled up
ATENOLOL (100MG)
1. The initial dose of Atenolol is 50 mg given as one tablet a day. If an optimal
response is not achieved within one week, the dosage should be increased to
ATENOLOL 100 mg given as one tablet a day. Some patients may require a dosage
of 200 mg once a day for optimal effect
2. Twenty-four hour control with once daily dosing is achieved by giving doses larger
than necessary to achieve an immediate maximum effect. The maximum early
effect on exercise tolerance occurs with doses of 50 to 100 mg, but at these doses
the effect at 24 hours is attenuated, averaging about 50% to 75% of that
observed with once a day oral doses of 200 mg
3. If withdrawal of ATENOLOL therapy is planned, it should be achieved gradually and
patients should be carefully observed and advised to limit physical activity to a
minimum.
SIMVASTATIN (20MG)
1. For patients at high risk for a CHD event due to existing CHD, diabetes, peripheral
vessel disease, history of stroke or other cerebrovascular disease, the
recommended starting dose is 40 mg/day. Lipid determinations should be
performed after 4 weeks of therapy and periodically thereafter.
2. All patients starting therapy with SIMVASTATIN should be advised of the risk of
myopathy and told to report promptly any unexplained muscle pain, tenderness or
weakness.
3. It is recommended that liver function tests be performed before the initiation of
SIMVASTATIN, and thereafter when clinically indicated
Concise &Conceptual Series
RAMIPRIL (2.5MG)
For patients with hypertension and renal impairment, the recommended initial dose is
1.25 mg RAMIPRIL once daily. Dosage may be titrated upward until blood pressure is
controlled or to a maximum total daily dose of 5 mg.
1. Angioedema: Angioedema, including laryngeal edema, can occur with
treatment with ACE inhibitors, especially following the first dose. Patients
should be so advised and told to report immediately any signs or symptoms
suggesting angioedema (swelling of face, eyes, lips, or tongue, or difficulty
in breathing) and to take no more drug until they have consulted with the
prescribing physician
2. Symptomatic Hypotension: Patients should be cautioned that
lightheadedness can occur, especially during the first days of therapy, and it
should be reported
3. Hyperkalemia: Patients should be told not to use salt substitutes
containing potassium without consulting their physician
4. Neutropenia: Patients should be told to promptly report any indication of
infection (e.g., sore throat, fever), which could be a sign of neutropenia
METFORMIN (850MG)
The usual starting dose of Metformin hydrochloride is 500 mg twice a day or 850 mg
once a day, given with meals. Dosage increases should be made in increments of 500
mg weekly or 850 mg every 2 weeks, up to a total of 2000 mg per day, given in
divided doses.
CLOPIDEOGERAL (75MG)
1. For patients with non-ST-segment elevation acute coronary syndrome
(unstable angina/non-Q-wave MI), Clopidogrel should be initiated with a
single 300-mg loading dose and then continued at 75 mg once daily. Aspirin
(75 mg-325 mg once daily) should be initiated and continued in combination
with Clopidogrel.
2. Patients should be told that it may take them longer than usual to stop
bleeding, that they may bruise and/or bleed more easily when they take
Plavix or Plavix combined with aspirin, and that they should report any
unusual bleeding to their physician. Patients should inform physicians and
dentists that they are taking Plavix and/or any other product known to affect
bleeding before any surgery is scheduled and before any new drug is taken.
Concise &Conceptual Series
GTN (0.5MG)
1. One tablet should be dissolved under the tongue or in the buccal pouch at
the first sign of an acute anginal attack. The dose may be repeated
approximately every 5 minutes, until relief is obtained. If the pain persists
after a total of 3 tablets in a 15-minute period, prompt medical attention is
recommended. Nitrostat may be used prophylactically 5 to 10 minutes prior
to engaging in activities which might precipitate an acute attack.
2. If possible, patients should sit down when taking Nitrostat tablets. This
eliminates the possibility of falling due to lightheadedness or dizziness.
3. Nitroglycerin should be kept in the original glass container, tightly capped.
4. Headaches can sometimes accompany treatment with nitroglycerin. In
patients who get these headaches, the headaches may be a marker of the
activity of the drug.
CIPROFLOXACIN
IV infusion over 30 – 60 minutes. 10 mg/kg t.i.d max. 1.2g daily. The infusion contains
15.4 mmol/100 ml in bottle so Na overload should be monitored.
ERYTHROMYCIN
Continuous infusion at 50mg/kg daily. Dissolve initially in water for injection (I g in
20ml) then dilute to a concentration of 1mg/ml, for continuous infusion
BOTULISM ANTITOXIN:
Patient should be tested for hypersensitivity reactions and past antitoxin
administration.
What is rational use of drug?
The right dose, of the right drug, for the right diagnosis, to the right patient, at the
right time, and via the right route
Define adverse drug reaction?
WHO DEFINITION OF ADRS
Any response to the drug which is noxious, un -intended, and occurs at doses used for
prophylaxis, diagnosis, or therapy of disease or for modification of physiological
function
Concise &Conceptual Series
FDA DEFINITION OF ADR
A serious event (events related to drugs and devices) as one in which patient
outcomes in death, life threatening, hospitalization, disability or congenital abnormality
or required intervention to prevent permanent impairments or damage
Define drug interactions?
The phenomenon that occurs when the effects or pharmacokinetics of a drug are
altered by prior administration or co-administration of a second drug.
Define pharmaceutical care?
Pharmaceutical care is that component of pharmacy practice which entails the direct
interaction of pharmacist with the patient for the purpose of caring for that patient’s
drug related needs
What are PRIME, CORE and FARM?
CORE




C = condition or patient need
O= outcome desired for that condition
R = regimen selected to achieve that outcome
E = evaluation parameters to assess outcome achievement
PRIME
This includes pharmacist's intervention. The goal is to identify actual or
potential problems that could compromise the desired patient outcome




P = pharmaceutical based problems
R = risks to patient
I = interactions
M = mismatch between medication & condition or patient needs
Concise &Conceptual Series
 E = efficacy
Description & documentation of interventions intended or provided by
pharmacist
FARM
F = FINDINGS,
Pt-specific information—gives basis for recognition of pharmacotherapy problems
or indication for pharmacist intervention
A = ASSESSMENT,
The pharmacist’s evaluation of the findings, including a statement of:
1. Any additional information needed to best assess the problem to make
recommendation
2. The severity, priority or urgency of the problem
3. The short term & long term goals of the intervention proposed
SHORT TERM GOALS:
1. elimination of symptoms
2. Lowering of BP
3. Management of acute asthma without requiring hospitalization
LONG TERM GOALS
1. Prevent recurrence of disease
2. Control B.P.
3. Prevent progression of diabetes
R = RESOLUTION, INCLUDING PREVENTION
1.
2.
3.
4.
5.
Observing & reassessing
Counseling or educating the patients & care givers
Informing the prescriber
Making recommendation to prescriber
Withholding medication or advising against use
Concise &Conceptual Series
M = MONITORING TO ASSESS THE EFFICACY, SAFETY &
OUTCOME OF THE INTERVENTION
This should include
1. The parameters to be followed (e.g. pain, depressed mood, serum levels)
2. The intent of monitoring e.g. efficacy, toxicity, adverse events
3. How the parameters will be monitored e.g. interview patients, serum drug
level, physical examination
4. Frequency of monitoring—weekly or monthly
5. Duration of monitoring e.g. until resolved, while on antibiotic, Until resolved
then monthly for one year
6. Anticipated or desired finding e.g. no pain, healing of lesion
7. Decision point to alter therapy when or if outcome is not achieved e.g. pain
still present after 3 days, mild hypoglycemia more than 2 times a week.
VIVA QUESTIONS RELATED TO DUR
What is the difference between DUE, DUR and MUE?
DUE
Processes that involves the development of use, monitoring, refinement and
adjustment of objective, measurable criteria that describe the appropriate use of a
drug
MUE
It is a prospective assessment that focuses on the outcome of the patient’s medication
therapy according to pre determined criteria
DUR
Process used to assess the appropriateness of drug therapy by engaging in the
evaluation of data on drug use in a given health care environment against pre
determined criteria and standards
Concise &Conceptual Series
Why we perform DUR of cimetidine, corticosteroids and vancomycin?
Can we prescribe cimetidine to infants?
Because in infants there they are on feed and their stomach produce enzyme rennin
that protect them from ulceration
Toxic dose of cimetidine and management?
Toxic dose is uto 20g
Gastric lavage together with the induction of vomiting and maintainence of supportive
therapy
Toxic dose of vancomycin and management?
Toxic dose is 30mg/dl and symptoms are nephrotoxicity,ototoxicity,anaphlaxia
Treatment: Supportive care is advised with maintenance of GF,haemofilteration has
been reported to be of benefit
What are the steps of DUR?
A. Planning
B. Data collection & evaluation
C. Intervention
D. Program evaluation
Definitions to be remembered
Criteria
These are predetermined parameters of drug prescribing & use established in a
DUR program for comparison to actual practice
Concise &Conceptual Series
Threshold
It is the percentage set that identifies the point at which a drug therapy
problem exists
Prospective DUR
It involves comparing drug orders with criteria before the patient receives the
drug. This type of evaluation is ideal for its preventive potential and for its
individual patient-centered intervention
Concurrent DUR
It helps to review drug orders during the course of therapy. This type of
evaluation is ideal where adjustments to drug therapy may be necessary based
on ongoing diagnostic and lab tests
Retrospective DUR
It helps to review drug prescribing and use after they have occurred. Easiest &
least costly approach
Interventions
The activities selected by DUR committee to correct drug therapy problems
identified during DUR monitoring and evaluation