Drug therapy evaluation

Pharmacoeconomic data can be a powerful tool to support various clinical decisions, ranging from the level of the patient to the level of an entire health care system. Figure 1-2 shows various decisions that may be supported using pharmacoeconomics, including effective formulary management, individual patient treatment, medication policy, and resource aUocation. For discussion purposes, the application of pharmacoeconomics to decision making is divided into two basic areas drug therapy evaluation and clinical pharmacy service evaluation. 

Before giving a nonnarcotic analgesic to a patient, the nurse assesses the type, onset, and location of the pain. It is important to determine if this problem is different in any way from previous episodes of pain or discomfort. If the patient is receiving a nonnarcotic analgesic for an arthritic or musculoskeletal disorder or soft tissue inflammation, the nurse should examine the joints or areas involved. The appearance of the skin over the joint or affected area or any limitation of motion is documented. The nurse evaluates the patient s ability to carry out activities of daily living. This important information is used to develop a care plan, as well as to evaluate the response to drug therapy. 

Respiratory depression can be a serious event requiring administration of a respiratory stimulant. When an analeptic is administered, the nurse notes and records the rate, depth, and character of the respirations before the drug is given to provide a database for evaluation of the effectiveness of drug therapy. Oxygen is usually ordered for before and after administration of a respiratory stimulant. After administration, the nurse monitors respirations closely and records the effects of therapy. 

Educating the Patient and Family The nurse evaluates the patient s ability to understand the therapeutic drug regimen, ability to care for himself or herself in the home environment, and ability to comply with the prescribed drug therapy. If any type of assistance is needed, the nurse provides a referral to the discharge planning coordinator or social worker. 

Educating the Patient and Family Noncompliance is a problem with some patients once they are discharged to the home setting. It is important for the nurse to accurately evaluate the patient s ability to assume responsibility for taking dragp at home. The administration of antipsychotic dru becomes a family responsibility if the outpatient appears to be unable to manage his or her own drug therapy. 

When expectorants are given to those with chronic pulmonary disease, the nurse evaluates the effectiveness of drug therapy (ie, the patient s ability to raise sputum) and records this finding in the patient s chart. 

The nurse examines areas of edema daily to evaluate the effectiveness of drug therapy and records the finding in the patient s chart. The nurse examines the patient s general appearance and condition daily or more often if the patient is acutely ill. 

During the preadministration assessment, the nurse reviews the patient s chart for the medical diagnosis and reason for administration of the prescribed drug. The nurse questions the patient regarding the type and intensity of symptoms (such as pain, discomfort, diarrhea, or constipation) to provide a baseline for evaluation of the effectiveness of drug therapy. 

The nurse takes vital signs every 4 to 8 hours, depending on the patient s condition. The nurse evaluates the patient s response to drug therapy based on original assessments. Responses that may be seen include a decrease in pain, an increase in appetite, and a feeling of well-being. 

Factorial trial designs are used to evaluate, simultaneously, two or more treatments through the use of varying combinations of the treatments. An example of a simple trial to evaluate drugs A and B is illustrated in Table 5.1. These trials are particularly relevant where multiple drug therapies are anticipated. 

The objective of economic evaluations of health and social care interventions is to inform decision-makers about the relative costs and benefits to society of two or more methods of providing care. In the context of dementia these may be comparisons of different drug therapies (pharmacoeconomic... 

Care for people with dementia is demanding of resources, while the outcomes of care are uncertain. To date, the economic analyses of care strategies have been limited to new drug therapies for people with Alzheimer s disease. Full economic evaluations to compare both the costs and consequences have only been conducted for one of these dmgs, donepezil. However, problems with the design and data used in these studies mean that they do not provide robust evidence to determine appropriate management strategies for dementia. 

Monitor blood pressure to evaluate for hypotension caused by drug therapy. 

To assess for prevention of disease progression, practitioners may utilize serial echocardiograms every 6 months to assess cardiac function and evaluate the effects of drug therapy. 

Evaluate current drug therapy for potential adverse drug reactions and drug interactions. 

Once remission is achieved, evaluate the patient s drug regimen to determine if dose reductions or changes in frequency of administration are required. Reinforce the need for adherence to drug therapy in order to maximize effectiveness. 

Assess patients for improvement of anxiety symptoms and for return to baseline occupational, social, and interpersonal functioning. With effective treatment, the patient should have no or minimal symptoms of anxiety or depression. While drug therapy is being initiated, evaluate patients more frequently to ensure tolerability and response. Increase the dose in patients exhibiting a partial response after 2 to 4 weeks on an antidepressant or 2 weeks on a benzodiazepine. Individualize the duration of treatment because some patients require up to one year of treatment.27... 

Evaluate patients for symptom improvement frequently (e.g., weekly) during the first 4 weeks of therapy. The goal is to alleviate panic attacks and reduce anticipatory anxiety and phobic avoidance with resumption of normal activities. Alter the therapy of patients who do not achieve a significant reduction in panic symptoms after 6 to 8 weeks of an adequate dose of antidepressant or 3 weeks of a benzodiazepine. Regularly evaluate patients for adverse effects, and educate them about appropriate expectations of drug therapy. 

Evaluate for adverse effects and drug interactions. For patients on topical therapy, evaluate for local adverse effects. For patients on acetaminophen or NSAIDs, inquire about alcohol use. 

Voruganti, L. N. P. 8t Awad, A. G. (2002). Personal evaluation of transitions in treatment (PETiT) a scale to measure subjective aspects of antipsychotic drug therapy in schizophrenia. Schizophr. Res., 56, 37-46. 

Cardiopulmonary arrest is diagnosed initially by observation of clinical manifestations consistent with cardiac arrest. The diagnosis is confirmed by evaluating vital signs, especially heart rate and respirations. Electrocardiography (ECG) is useful for determining the cardiac rhythm, which in turn determines drug therapy. 

The purpose of pharmacy administration course work is to teach pharmacy students how to design and manage medication use systems that produce optimal results for patients. In pharmacy administration courses, students learn how to conduct medication use evaluations that measure patient outcomes. They are taught how to communicate effectively with patients and with other health care providers. Pharmacy administration courses also teach ethical and legal responsibilities to monitor drug therapy and to protect patients from problems with drug therapy. 

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