Therapeutic
Alternatives: Determination of therapeutic alternatives
The
nest step is directed towards identifying the kinds of treatments
that might be beneficial in achieving the outcome. The pharmacist
should ensure that all feasible pharmacotherapeutic alternatives
available for achieving the predefined therapeutic outcome(s) are
considered before choosing a single therapeutic regimen. Non-drug
therapies (e.g., diet, exercise, psycotherapy) that might be useful
or beneficial should be included in the list of therapeutic
alternatives when appropriate.
Optimal
Plan: Design of an optimal individualized pharmacotherapeutic plan.
The
purpose is to determine the drug, dosage form, dose, schedule, and
duration of therapy that are best suited for a given patient.
Individual patient characteristics should be takent into
consideration when weight the risks and benefits of each available
therapeutic alternative.
The
reason for avoiding specific drugs should be stated in the
therapeutic plan. Potential reasons for drug avoidance include drug
allergy, drug-drug or drug-disease interactions, patient age, renal
or hepatic impairment, adverse effects, poor compliance, and high
treatment cost.
Assessment
Parameters: Identification of assessment parameters
One
must identify the clinical and laboratory parameters necessary to
evaluate the therapy for achievement of the desired therapeutic
outcome and for detection and prevention of adverse effects. The
outcome parameters selected should be directly related to the
therapeutic goals, and each parameters should have a defined end
point. If the goal was to cure a bacterial pneumonia, one should
outline the subjective and objective clinical parameters (e.g.,
relief of chest discomfort, cough, and fever), laboratory tests
(e.g., normalization of white blood cell count and differential),
and other procedures (e.g., resolution of infiltration of chest
x-ray) that provide sufficient evidence of bacterial eradication and
clinical cure of the disease. The intervals at which data should be
collected are dependent upon the outcome parameters selected and
should be established prospectively.
Adverse
effects parameters must also be well-defined and measurable. For
examples, it is insufficient to state that one will monitor for
potential drug-induced “blood dyscrasias”. Rather, one should
identify the likely specific hematologic abnormality (e.g., anemia,
leucopenia, or thrombocytopenia) and outline a prospective schedule
for obtaining the appropriate parameters (e.g., obtain monthly
hemoglobin / hematocrit, white blood cell count, or platelet count,
respectively).
Patient
Counseling: Provision of patient counseling
The
concept of pharmaceutical care is based on the existence of a
convenantal relationship between the patient and the provider of
care. Self-care is becoming more widespread as increasing numbers of
prescription medications receive over-the-counter status. For these
reasons, patients must be provided with sufficient information to
enhance a compliance, ensure successful therapy and minimize adverse
effects. Pharmacists should consider including the following items:
