CLINICAL PHARMACY

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CLINICAL PHARMACY CONCEPTS
A. Definition

- application of pharmaceutical science in order to solve drug therapy

problems in individual patients
- Clinical Pharmacy practice in which the pharmacist
utilizes his professional judgement in the application of pharmaceutical
sciences to foster the safe and appropriate use of drugs, in or by patients,
while working with members of the health care team

B. Knowledge and Skills Required in Clinical Pharmacy

Knowledge Skills
disease physical assessment - BP monitoring
lab and diagnostic test therapeutic planning
drug therapy patient monitoring
non-drug therapy - exercise or diet communication
drug information - OTC

C. Clinical Pharmacy Functions

Today, the modern practice of pharmacy often integrates the traditional
distribution functions with the clinical services of the pharmacist:

a. Medication history taking and g. Health information source for the public
documentation h. Drug use review and patient care audits
b. Medication profile preparation i. Providing drug information to physicians
c. Drug therapy monitoring and other health professionals
d. Patient education and medication j. In-service education for physicians,
counseling nurses, and other health
e. Disease screening, monitoring, and professionals
maintenance care for patients with k. Other specialized function and services
chronic diseases
f. Participation in the management of
emergency
medical care

D. Pharmaceutical Care

• is the responsible provision of drug therapy for the purpose of

achieving definite outcomes that improve a patient’s (Hepler &
Strand, 1990)
• broad-based, patient-focused practice in which the practitioner
assumes responsibility for a patient’s drug-related needs & is held
accountable for this commitment (Cipolle, 1998)

E. Pharmaceutical Care Outcomes

a. Cure of disease

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CLINICAL PHARMACY

b. Elimination or Reduction of symptoms

c. Arrest or slowing of a disease process
d. Prevention of disease or symptoms

STANDARDS OF PRACTICE FOR CLINICAL PHARMACISTS

The list intends to articulate the clinical pharmacist’s process of care and
documentation and the standards define for the public, health professionals, and
policy-makers what they can and should expect of clinical pharmacists in countries
where clinical pharmacy is practiced as set forth by American College of Clinical
Pharmacy (ACCP).

a. Qualifications: licensed pharmacists with specialized education

and training necessary to practice in team-based, direct patient
care environments; they work closely with physicians and other
health care professionals.
b. Process of Care: Assess à Plan à Evaluate
c. Documentation
d. Collaborative, team-based practice and privileging
e. Professional development and maintenance of competence
f. Professionalism and ethics
g. Research and scholarship
h. Other responsibilities

DOCUMENTATION
A. Medication History Taking

Clinical pharmacists document directly in the patient’s medical record the

medication-related assessment and plan of care to optimize patient outcomes.

1. Standardized form: easy to complete and are easy to scan for specific
information; however, they are inflexible

2. SOAP format: traditional format of documenting; Subjective data, Objective data,

Assessment,
Plan
a. Subjective: comes from “subjective” experiences, personal
views or feelings of a patient or someone close to them (e.g.
Symptoms) - Patient complaints
b. Objective: physical data that comes from measurement or
direct observation. (e.g. Signs)
• Vital signs
• Physical exam findings
• Laboratory data
• Imaging results

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• Other diagnostic data
• Recognition and review of the documentation of other clinicians
c. Assessment: this section documents the synthesis of
“subjective” and “objective” evidence to arrive at a diagnosis. This
part includes the list of problems and differential diagnosis
d. Plan: details of the pharmacist’s intervention - drug therapy (Pharmacist)

3. – organizes the information into whatever structure the pharmacist

thinks best for the information

Table 1. Patient Case

General Patient
Date and time of admission, patient’s name, age, race, gender
Information

Chief Complaint Reason or reasons the patient is seeking medical care

(CC) e.g. chest pain, decreased appetite, shortness of breath

Narrative that describes the current medical problem. e.g. 47-year old female
History of presenting with abdominal pain
Present Illness
(HPI) Patient elaborates on the CC (Onset, Location, Duration, Characterization,
Alleviating and Aggravating factors, Radiation, Temporal factor, Severity)

Past Medical Brief description of current and previous patient problems unrelated to the
History (PMH) present illness
Contains information about the patients including:
Social History - use of tobacco - alcohol and illicit drugs
(SH) - occupation - marital status
- sexual history - living conditions
-
Family History
Brief summary of the medical histories of the patient’s first-degree relatives
(FH)

Medication - OTC meds - allergies

History - prescribed meds - patient compliance
(MH) - dietary supplements - ADRs

Review of
Summarizes all patient complaints not included in HPI
Systems (ROS)
Physical
Short description, vital signs, systemic examination
Examination
(skin, HEENT, chest, abdomen, genitalia, neurologic)
(PE)

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CLINICAL PHARMACY

- Hema: CBC - UA
Lab and - Coagulation: PT, aPTT - Gram stain and C&S
Diagnostic Test
Results - ABG - ECG
- Blood: BUN, Crea, Electrolytes - Imaging: X-ray, MRI, CT Scan

Patient Problem A listing of current health conditions and supporting data for the status of each
List condition; may include other medication-related problems and medical issues

Pharmacist Care Pharmacist’s assessment on health care needs, pharmacotherapeutic goals,

Plan recommendations, follow-up evaluation, and monitoring parameters

A. Prescriptions and Medication Orders

Prescribers information

Patient information
Date of Prescription

Superscription

Inscription (medication prescribed)

Subscription (instruction to pharmacist)

Signa (instruction to patient)

Special instruction

Figure 1. Parts of an Ordinary Prescription

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Figure 2. Typical Hospital Medication Order Sheet

EVALUATION OF MEDICATION THERAPY

A. Drug Utilization Review (DUR)

- review of medication profiles to ensure the appropriateness of

prescription or medication orders. Types include:

a. Prospective DUR: done prior to dispensing to assess appropriateness of

prescriptions
b. Concurrent DUR: performed during the course of treatment
c. Retrospective DUR: after the drug has been
dispensed; to review, analyze, and interpret patterns of drug
usage

- Drug-related Problems:

Indication Effectiveness Safety Adherence

i. Unnecessary drug i. Ineffective drug i. Adverse drug i. Patient not able
therapy ii. Dose is too low reaction or willing to take
ii. Needs additional ii. Dosage too high medication
drug therapy

B. Therapeutic Drug Monitoring

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CLINICAL PHARMACY

- the use of therapeutic drug monitoring ,

pharmacokinetics, and pharmacodynamics to individualize and optimize
patient responses to drug therapy
- is the clinical practice of measuring specific drugs at designated intervals to
maintain a constant concentration in a patient's bloodstream, thereby,
optimizing individual dosage regimens
- some drug categories that require monitoring include: cardiac drugs,
antibiotics, antiepileptics, bronchodilators, immunosuppressants, anti-
cancer and psychiatric drugs

| ---------------------------------------------------- MTC / MSC (min. toxic / safe concentration)

|
|
| steady state - Therapeutic window
| (absorbed=eliminated)
| dose--
| ----------------------------------------------------- MEC (min. effective conc.)
|
|__________________________________ Time to reach
Drugs requiring TDM (narrow therapeutic index) steady state = t 1/2 (4 - 5)
- cardiac drugs - antiepileptics - anticancer drugs conc = 4 hours ( 4 - 5)
- antibiotics - bronchodilators - psychiatric drugs = 16 - 20 hours

Clinical pharmacokinetics - adjusting the dose base on the steady state plasma conc of the patient

Table 2. Drugs Often Monitored using Serum Drug Concentrations

TARGET RANGE
DRUG
Cmin,ss Cmax,ss
Amikacin <10 μg/mL 20=30 μg/mL
Cyclosporine Varies widely with transplanted organ and other patient and treatment factors
Digoxin 0.8 ng/mL 2.0 ng/mL
Gentamicin <2 5-10 μg/mL
μg/mL
Phenytoin 10 20 μg/mL
μg/mL
Tobramycin 2 μg/mL 5-50 μg/mL
Vancomycin 5-10 μg/mL 30-50 μg/mL

C. Pharmacoeconomics

- a division of health economics that generally focuses on the cost and

outcomes of drug therapy
- designed to provide decision makers with information about the value of
the different pharmacotherapies

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- Examples of outcome measures:

a. Economic outcomes: costs associated with care or treatment failure

b. Clinical outcomes: length of hospital stay, presence of ADRs, death
c. Health outcomes: patient satisfaction, QALY

- Common pharmacoeconomic methodologies:

a. Cost of illness (COI): direct and indirect burden of a disease

with regards to costs; serves as baseline information and
there is no comparison made
E.g. Cost of illness of Type 2 DM in the Philippines
- Direct costs: costs of the medical intervention used to achieve the desired health outcome.
- Indirect costs: the expenses incurred from the cessation or reduction of work productivity
as a result of the morbidity and mortality associated with a given disease.
b. Cost-benefit analysis (CBA): determines priority for resource
allocation; compares costs and health benefits (and risks), all of
which are quantified in common monetary units
E.g. BCG Vaccination VS TB-DOTS

c. Cost-minimization analysis (CMA): only cost is compared

where the cheapest intervention will be chosen for
implementation; different treatments with equivalent outcomes
E.g. Generic drug VS Branded drug

d. Cost-effectiveness analysis (CEA): cost of a program or

intervention from a specified perspective is compared to the
incremental health effects; compares treatment alternatives
(within same therapeutic category) that yield different health
benefits e.g. ACEIs VS ARBs in lowering blood pressure

e. Cost-utility analysis (CUA): unlike CEA, it measures the

consequences in terms of the _________
quality-adjusted life year (QALY) gained.
Results are expressed as a cost per QALY.
E.g. AIDS with ARV VS AIDS without ARV
• QALY– incorporates quantity of life, quality of life and patient’s own
preferences

RESEARCH AND SCHOLARSHIP

Clinical pharmacists support and participate in research and scholarship
to advance human health and health care by contributing to the evolving literature
in evidence- based pharmacotherapy; and/or disseminating and applying
research findings that influence the quality of patient care.

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CLINICAL PHARMACY

A. Evidence-Based Medicine (EBM)

• the conscientious, explicit, and judicious use of

_________________in
current best evidence making decisions Preferences
about the care of the individual patient. best research
• means integrating individual clinical expertise with Expertise evidence
the best available external clinical evidence from
systematic research. Evidence

Figure 3. Components of EBM

B. Clinical Study Designs
STUDY
C HA R A C T E R IS T IC S E X A MP L E
D E S IG N
- One or a few subjects
Case report Kaposi’s sarcoma in
- Rare diseases account of multiple
and Non-randomized homosexual men –a report
patients with the same injury or
Case series of eight cases.
treatment
- Without a comparison or control group.

Cross- - Exposure and outcome measured at Prevalence of COVID-19

sectional “Epidemiological same point in time infection in patients
study snapshot” - Subjects with and without outcome are presenting with pulmonary
compared dysfunction.

Comparison of serum Vit D

Non-randomized - Exposure
Case-control levels in individuals who
- Cases (those with the condition) are
study + Control group experience migraine
compared with controls (those without
headaches with their
the condition) with respect to exposure
matched healthy controls

- Exposure Study of the effects of sleep

Non-randomized
Cohort study - A group of subjects free of the quality and duration on
+ Control group outcome is followed and compared development of coronary
based on the exposure heart disease

Randomized - placebo standard

Randomized Assessment of the effect of
Controlled Trials - Compares treatment/s and placebo adding Pilates to a
Experimental
- Participants are randomly assigned to treatment regimen of
study
an intervention and followed NSAID use for individuals
+ Control group prospectively
with chronic low back pain.

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- Uses statistical methods to summarize the results of Eight previously-conducted
independent studies (RCTs) studies were pooled and
Meta analysis - Often used to “combine” studies with small sample sizes to statistically analyzed to
increase the power (ability to find a significant difference) of determine the relationship
the studies between wearing
sunscreen and melanoma.

Effectiveness of Virgin
- Comprehensive summary of best available evidence to
systemic reviews answer a specific clinical question Coconut Oil in The
Provision of Injury Pressure
- Attempts to identify all studies that would meet the
eligibility criteria Sores Stroke Patients:
Systematic Review

Figure 4. Hierarchy of Evidence

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CLINICAL PHARMACY

C. Drug Development

1. Discovery of the lead compounds from biologic products

2. Involves processes of random screening, chemical synthesis,

formulation development and stability and safety testing.

PRE - C L IN IC A L
P HA S E I P HA S E I I P HA S E I I I P HA S E IV
T E S T IN G
Exploratory confirmatory
Pharmacologic /
Clinical
Pharmacokinetic / Controlled Post-marketing
pharmacology Broad trial phase
Toxicologic evaluation phase surveillance
phase
studies

Long-term safety
Efficacy and side Efficacy and and efficacy in
Safety Safety and dosage
effects monitoring of ADRs diverse population
after marketing

300-3,000 patients patients with target

animal study 20-100 healthy Several hundred w/
with disease/condition &
human volunteers disease/condition
disease/condition other factors

D. Drug Information Resources

There are three sources of drug information:

a. Primary: journals/clinical trials; provide the best and updated drug information
E.g. Clinical Pharmacology: Advances and Applications Journal

b. Secondary: indexing and abstracting services; for locating of

the primary literatures. It usually describes articles and clinical
studies from journals and locate journal articles
E.g. Medline/PubMed, Embase, Scopus

c. Tertiary: textbooks and computer databases; obsolete information

E.g. Pharmacy textbooks, Lexicomp, Epocrates Rx

PROFESSIONALISM AND ETHICS

Clinical pharmacists have a covenantal relationship with their patients. This
relationship relies on the trust placed in the clinical pharmacist by the patient and
the commitment to act in the best interest of individual patients and patient
populations, within the context of legal and ethical parameters.

A. Bioethical Principles

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a. Autonomy
- Patient’s right to make decisions
- Obligation to respect patients and to honor their preferences

b. Informed Consent
- Patients are informed of all benefits and risks of procedures
- Elements: disclosure, understanding, voluntariness, competence, consent

c. Confidentiality
- Withholding private information about the patient from others
unless the patient gives permission to release
- Republic Act 10173 – Data Privacy Act of 2012

d. Beneficence and Non-maleficence

- fundamental moral principle in which all ethical behavior is based
- Beneficence: to act in the patient’s best interest
- Non-maleficence: doing no harm; if the benefits of an intervention
outweigh the risks, a patient may make an informed decision to
proceed

e. Fidelity
- Loyalty bond between the patient and professional

f. Veracity
- Truthfulness to patients

g. Justice
- means that individuals have the right to be treated equally
regardless of any individual characteristics

B. Patient Medication Counseling

Provision of accurate and timely information about drugs and

other health-related information to a patient or his/her representatives during
dispensing process or hospital stays. Patient counseling is undertaken by
pharmacists:
• During dispensing
• In disease management
• In providing advice on self-care

Verbal Communication Skills

• Attending and active listening skills
• Interviewing skills
• Emphatic responding skills
• Influencing skills

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CLINICAL PHARMACY

CLINICAL LABORATORY TESTS

Data from laboratory and diagnostic tests and procedures provide
important information regarding the response to drug therapy, the ability of
patients to metabolize and eliminate specific therapeutic agents, the diagnosis of
disease, and the progression and regression of disease.

- Screening Tests: used in patients without signs or symptoms of a

disease

- Diagnostic Tests: done in patients with signs and

symptoms of disease or with an abnormal screening test

Pharmacists monitor laboratory tests to:

a. assess the therapeutic and adverse effects of a drug

b. determine the proper drug dose
c. assess the need for additional or alternate drug therapy
d. prevent test misinterpretation resulting from drug interference

HEMATOLOGICAL TESTS

Figure 5. Formed Elements in Blood Figure 6. Blood Components

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CLINICAL PHARMACY

REFERENCE
TEST L OW HIG H
RANGE

WHOL E B L OOD
Men:
4.3 to 5.9 x 1012 cells/L Indirect estimate of blood’s Hgb
RBC Count
Women: content
3.5 to 5.0 x 1012 cells/L
% by volume of packed RBCs in a whole blood
Men:
sample after centrifugation
42% to 52%
Hct
Women: - Anemia
- Polycythemia vera
37% to 47% - Overhydration
- Dehydration
- Blood loss

Men:
Estimates the oxygen-carrying capacity of the RBCs
14 to 18 g/dL
Hgb Test
Women:
- Anemia -
12 to 16 g/dL

R B C IN D IC E S
us e d to c a te go r i z e a ne m ia s
Ratio of Hct to the RBC count to assess

MCV 80 to 100
- Macrocytic:
- Microcytic: IDA
Vit B12 or B9 def.

MCH 26 to 34 Assesses amount of Hgb in an average RBC

Average conc. of Hgb in an average RBC

MCHC 31 to 37
- Hypochromia in IDA -

Provides a measure of immature RBCs, hence,

providing an index of bone marrow production of
mature RBCs
Reticulocyte 0.1% to 2.4% of
count total RBC count - Fe, B12 or B9
- Drug-induced aplastic supplementation
anemia - Hemolytic anemia
- Acute blood loss

Measures the rate of RBC settling of whole,

Men: uncoagulated blood over time
0 to 20 mm/hr
ESR value
Women: - infection
0 to 30 mm/hr - tissue necrosis -
- inflammation (RA, SLE)

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REFERENCE
TEST L OW HIG H
RANGE
Number of leukocytes in a given volume of
whole blood
4,000 to 11,000 x severe infection - Bacterial infection
WBC Count - chemotherapy
109 cells/L - Leukemia
HIV / TB - Tissue necrosis
- Corticosteroids

WB C D IF F E R E N T IA L S

Phagocytize and degrade particles

Neutrophils 50% to 70% - overwhelming
- infection
infections
- RA or gout
- chemotherapy
Men: Produce antibodies
14 to 18 g/dL
Lymphocytes
Women: - AIDS - viral or infection
12 to 16 g/dL bacterial
Men: Phagocytic and matures into macrophages
14 to 18 g/dL
Monocytes - TB
Women: -
12 to 16 g/dL - endocarditis
- acute allergy
Eosinophils - -
- parasitic infestations
Referred to as mast cells in the tissues
Basophils - - chronic
- myelogenous
leukemia (CML)

PLATELETS

Smallest; responsible for blood clotting

(hemostasis)
150,000 to - thrombocytopenic
Platelet count
300,000/mm 3 purpura
-
- quinidine
- sulfonamides

Activated Partial Thromboplastin Time

aPTT 22 to 35 sec
- - heparin

Prothrombin Time
PT 11 to 13 sec
- - warfarin

International Normalized Ratio

INR <1.1
- - Warfarin
INR range of warfarin 2-3

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CLINICAL PHARMACY

ADDED INFROMATION:
Blood Disorders

1. Anemia: group of diseases characterized by a decrease in either

hemoglobin or the volume of red blood cells, which results in decreased
oxygen-carrying capacity of the blood

Microcytic

Iron deficiency anemia

a. _____________________
- most common type of anemia
- decreased levels of ferritin and serum iron; aside from
microcytosis, RBCs are hypochromic
- DOC: oral or parenteral ferrous sulfate

b. Anemia of Chronic Disease

- due to chronic inflammation, infection, and malignancies
- serum iron level is decreased but serum ferritin is normal
- may occur in cases of RA, SLE, CA, chronic infections, CKD, IBD

c. Thalassemia
- inherited blood disorder when the body doesn’t make enough
hemoglobin
- genetic defect of α or β-chain of globin

d. Sickle cell anemia

- genetic defect of β-chain of globin where RBCs become
hard and sticky and look like a C-shaped farm tool called
“sickle”
- sickle cells get stuck and clog blood flow; RBCs die
early causing constant shortage

Normocytic

a. Hemolytic Anemia
- results in decreased survival time of RBCs secondary to
destruction in the spleen or circulation
- excessive RBC destruction → high reticulocyte count, LDH, and
bilirubin
ü Coombs Test: if positive, is indicative
of antibody-mediated hemolysis

b. Hemorrhage
- blood loss due to trauma, peptic ulcer, or hemorrhoids

c. Aplastic Anemia
- failure of bone marrow to produce RBCs, WBCs and platelets →
pancytopenia
- drug-induced: chloramphenicol, phenylbutazone, felbamates

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d. RBC Production Failure
- due to decreased erythropoietin (EPO) production in the kidneys
Macrocytic

a. Megaloblastic Anemia
- Vit B12 deficiency: caused by lack of ______________leading
intrinsic factor
to decreased B12 absorption, aka pernicious anemia
ü Schilling Test: used to identify
B12 malabsorption due to inadequate intrinsic
factor; measures amount of radiolabeled B12
excreted in urine
- Vit B9 deficiency: from inadequate intake, decreased
absorption, hyperutilization, or inadequate utilization

b. Non-Megaloblastic Anemia
- alcohol abuse
- hypothyroidism

2. Coagulopathies: bleeding disorders; problem in coagulation

resulting from a decreased number of platelets, decreased
function of platelets, coagulation factor deficiency, or enhanced
fibrinolytic activity

a. Intrinsic pathway: initiated when circulation factor

XII comes in contact with the subendothelial membrane

b. Extrinsic pathway: initiated by exposure of tissue during trauma

c. Common pathway: convergence of both pathways; activation of

factor X

Bleeding Disorders

a. Hemophilia
- inherited bleeding disorder
- congenital deficiency in Factor VIII (Hemophilia A) or IX (Hemophilia
B)

b. Von Willebrand Disease

- most common congenital bleeding disorder
- defect in von Willebrand factor, a glycoprotein that
plays in both platelet aggregation and coagulation

c. Idiopathic Thrombocytopenia Purpura (ITP)

- autoimmune destruction of platelets

d. Vitamin K Deficiency
- factors II, VII, IX, and X will remain inactive without Vit K
- K1: phytonadione; from green vegetables

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CLINICAL PHARMACY

- K2: menaquinone; from normal flora of colon

- newborns until neonatal period are always deficient →
intracranial hemorrhageand bleeding from umbilical cord
or GIT
- drug-induced: use of broad-spectrum antibiotics (prevents K2 production)

COMMON SERUM ENZYME TESTS

1. Creatine kinase (CK): aka creatine phosphokinase (CPK);

isoenzymes of CK are used to differentiate source of muscle
damage:
- CK-BB: Brain
- CK-MB: Heart
- CK-MM: Skeletal Muscle

2. Lactate dehydrogenase (LDH): catalyzes interconversion of lactate and pyruvate

- LDH 1&2: LDH 1 = heart muscle and erythrocytes
- LDH 3: lungs LDH 2 = leukocyte
- LDH 4&5: liver and skeletal muscle

3. Alkaline phosphatase (ALP): produced in liver and bones; indicates

biliary obstruction and bone disorders (paget disease,
hyperparathyroidism, osteomalacia)

4. Aspartate aminotransferase (AST): old name: serum glutamic-

transaminase (SG T);
found primarily in heart and liver
- High levels: MI, hepatitis, fatty liver

5. Alanine aminotransferase (ALT): old name: serum glutamic-

transaminase (SG T); found
primarily in liver
- High levels: extensive liver damage

6. Cardiac Troponins: identifies myocardial cell injury with superior

specificity → Gold standard for acute MI diagnosis

LIVER FUNCTION TESTS

REFEREN
TEST L HIG
CER A N OW H
GE
breakdown product of erythrocyte
Indirect: unconjugated, bound to
Total bilirubin: albumin Direct: conjugated, filtered
by glomerulus

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Serum 0.1 to 1.0
Indirect:
bilirubin mg/dL
- Hemolytic anemia
- - Neonatal
Direct
hyperbilirubinemia Direct:
bilirubin: 0 to
- viral & cholestatic hepatitis
0.2 mg/dL
- Bile stones

Produced in liver ; maintains serum

Albumin 4 to 6 g/dL osmotic pressure and transport
agent
- liver disease
- malnutrition
-

URINALYSIS

REFEREN
TEST L HIG
CER A N OW H
GE
- alkalosis
pH 4.5 to 9.0 - - acetazolamide use
- Proteus infection

Specifi - diabetes insipidus - diabetes mellitus

1.003 to 1.035 - nephrosis
c (low ADH: dil.
gravit urine) vasopressin
y
- proteinuria (renal
Protein 50 to 80 - dse, bladder
mg/day infection, fever)
<180 mg/dL
Glucose - - DM
(typically absent)
excreted when the body has used available
Ketones Absent glucose stores and begins to metabolize
fat stores
- uncontrolled DM
- - keto-diet (low carb)

- trauma, tumor
RBCs Absent -
- bleeding disorder

RENAL FUNCTION TESTS

REFEREN
TEST L HIG
CER A N OW H
GE
Urea is increased when protein in diet is high
and in reduced renal blood flow

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CLINICAL PHARMACY

BUN 8 to 18 mg/dL - significant liver dse - renal dse

Better indicator of renal damage than

Serum
BUN; creatinine clearance
creatinine 0.6 to 1.2
measures GFR
(SCr) mg/dL
- - reduced renal
function

Creatinin Men:
e 75 to 125 Rate at which creatinine is removed (renally)
clearance mL/min from the blood
(ClCr) Women:
ClCr x
0.85

QUICK QUIZZES

Video Part Quick Quizzes

Part 1 – Introduction to 1. Which of the following is NOT a characteristic of clinical pharmacy?
Clinical Pharmacy
A. Multidisciplinary practice
B. Product-oriented practice
C. Patient-oriented practice
D. Promotes rational drug therapy

2. Which of the following essential clinical pharmacy services is a direct

application of communication skills?

A. Patient counseling
B. Patient monitoring
C. Formulary development
D. Evaluation of drug therapy

3. Which of the following is NOT an expected outcome of pharmaceutical

care?

A. Prevention of diseases
B. Reduction of costs
C. Palliative care
D. Cure of disease

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4. What is defined as the responsible provision of drug therapy for the
purpose of achieving definite outcomes that improve a patient’s quality of
life?

A. Pharmacy practice
B. Pharmaceutical care
C. Clinical pharmacy
D. Multidisciplinary care

5. Which of the following is NOT a function of a clinical pharmacist?

A. Drug therapy monitoring

B. Patient assessment
C. Medication order review
D. Drug distribution

Part 2 – Medication 1. Which of the following is true in cost-minimization analysis?

Therapy Evaluation
A. Patient satisfaction is measured
B. Outcomes are equivalent
C. Costs are equivalent
D. Both costs and outcomes are different

2. Which of the following is true regarding cost of illness study?

A. Outcomes are in monetary units

B. Determines priority for resource allocation
C. Determines cheapest intervention
D. No comparison is made

3. Which of the following is an authorized, structured and continuing

program that reviews, analyzes and interpret patterns of drug usage in a
given health care delivery system against pre-determined standards?

A. TDM
B. QA
C. COI
D. DUR

4. Which of the following pharmaceutical sciences aims to assess the value

of a drug product compared to its effects?

A. Pharmacoeconomics
B. Pharmacogenetics
C. Pharmacodynamics
D. Pharmacology

5. Which of the following is an inotropic drug that requires therapeutic drug

monitoring?

A. Digoxin
B. Phenytoin

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CLINICAL PHARMACY

C. Gentamicin
D. Vancomycin

Part 3 – Research and 1. Which of the following study designs is prospective, randomized, and
Scholarship controlled?

A. RCTs
B. Cross-sectional
C. Cohort
D. Case control

2. Which of the following is a retrospective comparison of causal factors or

exposures in a group of persons with disease and those of persons without
the disease?

A. RCTs
B. Case series
C. Case control
D. Meta-analysis

3. Which of the following is a study that examines the presence or absence

of a disease and other variable in a defined population and the potential risk
factor at a particular point in time or time- interval?

A. Cohort
B. Cross-sectional
C. Case control
D. Both A and C

4. Stage of drug development which aims to determine the relative safety of

the drug in humans by conducting pharmacologic, pharmacokinetic, and
toxicologic studies in animals:

A. Pre-clinical
B. Phase II
C. Phase I
D. Phase III

5. Primary literature includes which of the following?

A. Special reports
B. Letters to the editor
C. Original clinical trials
D. Systematic reviews

Part 4 – 1. What is the fundamental moral principle on which all ethical behavior is
Professionalism and based?
Ethics
A. Distributive justice

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B. Beneficence and non-maleficence
C. Patient confidentiality
D. Informed consent

2. Non-disclosure of patient information to others fall into which bioethical

principle?

A. Veracity
B. Fidelity
C. Confidentiality
D. Informed consent

3. Which of the following is/are medium used when counseling patients

about their medications?

A. Face-to-face
B. Email
C. Telephone
D. All of the above

4. Which of the following is NOT a barrier to verbal communication?

A. Noise
B. Eye level communication
C. Window security bars
D. Lack of privacy

5. When is patient counseling done?

A. During dispensing
B. In disease management
C. In providing advice on self-care
D. All of the above

Part 5 – Laboratory 1. Which of the following hematologic test results indicate presence of an
Test Part 1 infection?

A. High reticulocyte count

B. Low WBC count
C. Low MCV
D. High WBC count

2. Which of the following tests is used to screen for anemia, determine its
severity, and monitor patient’s response to treatment?

A. ESR
B. PT
C. Hgb
D. INR

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CLINICAL PHARMACY

3. What term refers to low counts of all three types of blood cells?

A. Leukopenia
B. Polycythemia
C. Pancytopenia
D. Thrombocytopenia

4. All of the following are clotting factors inhibited by warfarin, except:

A. X
B. VII
C. II
D. VIII

5. What will happen to aPTT value in a patient receiving anticoagulation

therapy?

A. Increase
B. Remain the same
C. Decrease
D. Insufficient data to determine

Part 6 – Laboratory 1. Which of the following LDH isoenzyme fractions is/are used to
Test Part 2 identify cardiac muscle damage?

A. LDH 1
B. LDH 5
C. LDH 3
D. All of the above

2. An alcoholic patient had an increased CK level along with other

abnormal lab results. All of the following could explain the increase
in CK, EXCEPT which one?

A. Bruising due to trauma

B. Evidence of some liver damage
C. Patient had heart attack
D. Had a muscle tear recently

3. Which of the following serum proteins must be considered in

monitoring of drugs and electrolytes that are protein-bound?

A. Creatinine
B. Bilirubin
C. Troponin
D. Albumin

4. An increased AST level would mean which of the following?

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A. skeletal muscle injury
B. congestive heart failure
C. brain damage
D. pneumonia

5. Which of the following is considered to be the gold standard for

diagnosis acute MI?

A. Cardiac Troponins
B. AST
C. LDH 1
D. CK BB

Part 7 – Laboratory 1. What is the most abundant intracellular cation?

Test Part 3
A. Sodium
B. Magnesium
C. Potassium
D. Chloride

2. Which mineral is important for blood coagulation and muscle

contraction?

A. Chloride
B. Calcium
C. Sodium
D. Potassium

3. Low bicarbonate levels in a patient may be due to the following

reasons, EXCEPT which one?

A. Metabolic acidosis
B. Renal failure
C. ASA overdose
D. Pulmonary disease

4. All of the following are important functions of Mg, EXCEPT which

one?

A. Nerve conduction
B. Carbohydrate metabolism (as enzyme co-factor)
C. Phospholipid synthesis
D. Muscle contractility

5. Among the pairs of ions and minerals, which of the following often
exhibits inverse proportional relationship in terms of serum
concentration?

A. Ca++ & PO4-

B. Na+ & Cl-
C. Mg++ & Cl-
D. H+ & K+

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CLINICAL PHARMACY

Part 8 – Others 1. Which of the following abnormal lab results is indicative of

uncontrolled DM?

A. Increased HbA1c
B. Increased RBS
C. Increased FBS
D. Increased uric acid

2. Initial examination of a patient who is candidate for Pulmonary

Tuberculosis (PTB) may be performed using which diagnostic
procedure?

A. MRI
B. Acid fast stain
C. CT Scan
D. CXR

3. Which of the following diagnostic procedures is safe for pregnant

mothers?

A. MRI
B. CT Scan
C. Ultrasound
D. Both A and C

4. Mucosal lining perforation in case of Peptic Ulcer Disease (PUD)

may be viewed using what procedure?

A. Angiography
B. Colonoscopy
C. Endoscopy
D. Ultrasound

5. Which of the following diagnostic procedures is useful in diagnosing

epilepsy?
A. MRI
B. ECG
C. 2D echo
D. EEG

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