Trends in Special Pharmacy Services

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Trends in Special Pharmacy Services

1. Identify the special population of patients requiring pharmacy services.

Clinically, special populations are infants, paediatrics, pregnant women, geriatrics, psychosomatic patients. Pharmaceutically, special populations are recognized by specialties of pharmacy services. The special populations are to be served as per the condition and need of the patient. For example, the infants cannot be administered tablets and capsules. They need to be medicated in the form of draught and drops whereas some drugs are banned for administration during pregnancy.

The special services in pharmacy include

Oncology, allergic asthma, Anemia/neutropenia,

Crohn's disease

Cystic fibrosis

Enzyme replacement therapy

Fertility Services

Growth deficiency

Hemophilia/von Willebrand's disorder

Hepatitis C

Hereditary angioedema

HIV/AIDS

Immune disorders/IVIG

Lysosomal storage diseases

Multiple sclerosis

Oncology

Phenylketonuria (PKU)

Severe psoriasis

Psoriatic arthritis

Pulmonary arterial hypertension

Rheumatoid arthritis

Respiratory syncytial virus (RSV)

Transplant

2. What are the special consideration and precautions to be taken while treating neonates?

The newly born baby less than four weeks is metabolically active and physiologically delicate in the sense the poor development of blood brain barrier. One should take extra precaution and advice the nursing mother to abstain from medication as far as possible and to consult the neonatology pharmacist while calculating the doses for infants.

3. What are the special consideration and precautions to be taken while treating pediatrics?

The pediatrics range is from birth to 18 years however the younger children have low body volume and calculation of the dose on body surface area is more appropriate than body weight. The children are having robust, fast regenerating liver and hence capable of metabolizing the drugs in a better manner. The major considerations regarding the high toxicity of drugs on CNS as drugs can easily enter brain due to less developed blood brain barrier. However, they are also sensitive to drugs like aspirin due to drug allergy.

4. What are the special consideration and precautions to be taken while treating geriatrics?

The age group 65+ is considered as geriatrics. These patients are delicate in a sense that tissue regeneration is slowed, hence extra precaution should be exercised while administering drugs metabolized in liver. These patients are usually on poly pharmacy and need a proper workout regarding usage of medicines. The geriatric patients usually have a caregiver. It is very important to inform and educate the caregiver who can administer the drugs for the patients.

5. What are the special consideration and precautions to be taken while treating people during pregnancy?

Pregnancy is a stage where drugs need to be avoided to the maximum extent. The fear and apprehension of the passing of the drugs across the placenta and causing damage to the fetus is an avoidable risk. There are already national and international guidelines for drug administration. One needs to refer and advice regarding the risks of using drugs in expecting mothers. The adherence to guidelines can bring down drug-induced effects on the fetus.

6. What are the alterations in pharmacy services for treating the CKD patients?

The compromised kidney is unable to excrete urine and purify blood. Hence, the drug excretion gets altered in comparison to normal person. The adjustment of dose of each drug becomes important consideration for administering drugs known for excretion via kidney.

7. What are the alterations in pharmacy services for treating the patients with liver ailments?

The liver is an organ of metabolism and place for proteins which are extensively used for fat and carbohydrate turnover in the body. It makes variety of proteins including serum albumin and several other important proteins, proteins like coagulation factors. The damage to the liver leads to the functional impairment and several functions associated with the above proteins get deranged. In such condition, the capacity to metabolize drugs will come down leading to alteration in pharmacokinetics. There is a need to adjust the dose accordingly and monitor the blood concentration of the drug in order to manage the drug levels so that the plasma concentrations remain well within therapeutic range.

8. How the pharmacists render services in anticoagulation therapy?

The pharmacists with the background of human physiology, drug action along with the pharmacokinetic profile are able to identify whether the drug administered to the patients is within the therapeutic window. In case, a drug given in concentration is very high then there are chances of internal bleeding and may result in stroke and heart attack. On the contrary, if the drug concentration falls below then it may trigger blood to clot in the vascular system and form infarctions due to impairment in blood flow.

9. What are the special areas of Therapeutic drug monitoring?

The drugs which have narrow therapeutic index like digoxin require high precision in dosing. The decrease or increase above or beneath therapeutic window can be disastrous for the patients as it leads to a serious casualty. The methotrexate when used as DMARD in the treatment of rheumatoid arthritis, there is a need to follow and contain the blood concentrations as the pharmacokinetics of methotrexate is quite different from conventional drugs. The therapeutic drug monitoring is the pragmatic approach for patient safety and optimized treatment.

10. What is the contribution of pharmacists in drug de-addiction?

The pharmacist being accessible to the consumer and has skills in social pharmacy is poised to deliver customized service especially in areas like drug de-addiction. It is very important to see that no addicted patient suffers due to non-availability of drugs whenever required to contain the withdrawal symptoms. It is also necessary to oversee the dispensed medicine being not misused for addiction purposes. The role of community pharmacist in dispensing the legal drugs is an important service for the drug-addicted patients.

11. What is the role of pharmacists in cessation of smoking?

Smoking is a harmful habit which effects the self and the people surrounding in the form of passive smoking. The challenge in smoking cessation is to outreach the smoker and to convince him about the harm he is causing to self and to other near and dears. The biggest challenge is to update the patient regarding the products available to contain and control smoking. For example, latest information on electronic cigarettes.

12. What are the immunization schemes a pharmacist can deliver to the public?

The immunization has become essential especially in diseases like H1N1 influenza and other diseases wherever prophylactic vaccination is available. The pharmacist are licensed to vaccinate the public in US and other developed countries after getting certified by an exam. The large population at risk needs huge healthcare services to be rendered in a quick and efficient manner. Conventional healthcare professionals such as doctors and nurses are less in number to meet this public health challenge.

References:

http://www.who.int/medicines/publications/WHO_PSM_PAR_2006.5.pdf

http://www.acpi.in/Pre%20-%20final%20report.pdf

http://www.fip.org/files/fip/Statements/latest/Dossier%20003%20total.PDF

About the Author

Anantha Naik Nagappa's picture

I am professor, intrested in developing the community pharmacy services in India, We have an association called ASSOCIATION OF COMMUNITY PHARMACISITS OF iNDIA. CHECK AT www.acpi.in for further detials

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