Integrated Pharmacy Case Studies

453 Pages·2015·22.535 MB·English

by  Felicity J. Smith

Integrated Pharmacy Case Studies

Integrated
Pharmacy Case
Studies
SALLY-ANNE FRANCIS
FELICITY SMITH
JOHN MALKINSON
ANDREW CONSTANTI
KEVIN TAYLOR
PharmaceuticalPress
PublishedbyPharmaceuticalPress
1LambethHighStreet,LondonSE17JN,UK
Copyright©TheRoyalPharmaceuticalSociety2015
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Malkinson,AndrewConstantiandKevinTaylortobeidentified
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accordancewiththeCopyright,DesignsandPatentsAct1988.
AcataloguerecordforthisbookisavailablefromtheBritish
Library.
Althoughconsiderableeffortshavebeenmadetocheckthe
materialinIntegratedPharmacyCaseStudies,theauthorsand
publishermakenorepresentation,expressorimplied,with
regardtotheaccuracyoftheinformationcontainedinthis
bookandcannotacceptanylegalresponsibilityorliabilityfor
anyerrorsoromissionsthatmaybemade.Also,thereaderis
assumedtopossessthenecessaryknowledgetointerpretthe
informationprovided.Itistheresponsibilityofpractitionerand
readerstointerpretIntegratedPharmacyCaseStudiesinlight
ofprofessionalknowledgeandrelevantcircumstancesandto
supplementitasnecessarywithspecialistpublicationsandby
referencetoproductliterature,codesofconductandsafety
regulations.
Contents ts
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Foreword by Catherine Duggan "vii 3 Nebulised therapy for chronic obstructive
Acknowledgements "viii pulmonary disease "97
4 Paediatriccysticfibrosis "101
Abouttheeditors "ix
5 Cough "108
List ofcontributors "x
Abbreviations "xiii
4 Central nervous system cases "113
Introduction "xvii
INTRODUCTION "113
1 Types of anxiety, their treatment and
1 Gastrointestinal, liver and renal associated issues "116
cases "1 2 Treatmentoptions inschizophrenia–
INTRODUCTION "1 antipsychotics and side effects "118
1 Uninvestigateddyspepsia "3 3 Bipolar disorder and its treatment "122
2 Inflammatory bowel disease "7 4 Treatment-resistant depression ina patient
3 Treatment ofthreadworm "10 onhaemodialysis "124
5 Self-medication of depression with St John’s
4 Liverdisease in anelderly patient "13
5 Alcoholic liver cirrhosis "15 wort, a herbal remedy "128
6 Extemporaneous preparation of
6 Liverdisease with ascites "19
7 Management of paracetamol overdose with methadone "131
acetylcysteine "22 7 Neuropathic pain "134
8 Differentialindicatorsfor migraine and
8 Chronic kidneydisease "26
9 Haemofiltration "31 medication-overuse headache "138
10 Renalreplacement therapy "35 9 Epilepsy "142
10 Phenytoinandacute therapeutics "146
11 Drug therapy of Parkinson’s disease "149
2 Cardiovascular cases "39 12 Smoking cessation in community
INTRODUCTION "39 pharmacy "153
1 Atrialfibrillation "43 13 Dementia/Alzheimer’sdisease "159
2 Anginamanagement "49 14 Dementiaand its pharmacotherapy "163
3 Heartfailure "52
4 Acute coronary syndromes "56
5 Infections cases "169
5 Management of hypertension in black
patients "61 INTRODUCTION "169
6 Cardiovascular (blood pressure) support in 1 Cellulitis and MRSA "173
an elderly hypotensive patient "66 2 Typhoid "178
7 Deep vein thrombosis and warfarin "70 3 Community-acquired pneumonia "183
8 Treatment ofacuteischaemic stroke "75 4 Urinary tract infection "187
5 Uncomplicated genital Chlamydia
9 Secondary stroke prevention "78
10 Drug interactions "82 trachomatis infection "189
6 Surgical antibiotic prophylaxis "193
7 Diarrhoeaandantibiotictreatment "196
3 Respiratory cases "87 8 ‘Fever with no focus’ ina young infant "198
INTRODUCTION "87 9 Management oftuberculosisand its
1 Asthma "89 complications "202
2 Treating an acute severe asthma — [continued over]
exacerbation "93
v
ts 10 Managementof latentTB infection and 2 Approaches to theeffective treatment of
n
e pharmacy interventions "205 non-specific, low back pain "314
t
on 11 Influenza "207 3 DMARDs and treatment for rheumatoid
C
12 Chronic hepatitisC "210 arthritis "317
13 Primary HIV Infection "215 4 Glucosaminesupplements forosteoarthritis
14 Immunisations against infectiousdiseases and joint stiffness "324
and malaria chemoprophylaxis "221 5 Treatingjuvenile idiopathic arthritisin young
people "327
6 Systemic lupus erythematosus "331
6 Endocrinology cases "225
INTRODUCTION "225
1 Insulin pumpusein achild "228 9 Eye, nose and throat cases "335
2 Hypoglycaemia during insulintherapy "232 INTRODUCTION "335
3 Type 2 diabetes mellitus "235 1 Conjunctivitis in pregnancy "337
4 Serious lactic acidosis inducedby 2 Chronicopen-angle glaucoma "341
metformin "239 3 Wet age-related macular degeneration "345
5 Anunusual case of Cushing’s 4 Sore throat "348
syndrome "242 5 Hay fever "352
6 Addisonian crisis "248
7 Hypothyroidism "254
10 Skin cases "357
8 Osteoporosis in ayoungerwoman "258
9 Osteoporosis in anelderly woman "262 INTRODUCTION "357
10 Treatment for Hypercalcaemia "266 1 Atopiceczema "359
2 Contactdermatitis "363
3 Management of anacuteflare of
7 Malignant disease,
psoriasis "366
immunosuppression and haematology
4 Acne "369
cases "271 5 Antibacterialtreatment of acne in young
INTRODUCTION "271 people "372
1 Lung cancer "274 6 Fungalinfection ofthefoot "376
2 The use of antimetabolites in the treatment 7 Treatment ofhead lice "380
ofbreastcancer "278
3 Clinical verification of prescriptions for oral
11 Special cases "383
anticancer medicines "282
4 Thromboprophylaxis ina patient undergoing INTRODUCTION "383
surgery for cancer "287 1 Paediatricpharmacokinetics ina newborn
5 Febrile neutropenia in paediatric preterm infant "385
oncology "291 2 Falls and care ofelderly people "389
6 Managing chemotherapy-inducednausea and 3 Treatinga patient with benign prostatic
vomitingina patient with lungcancer "295 hyperplasia "396
7 Drug therapy ofmultiple sclerosis "299 4 Pain management using strongopiatesin
8 Managementof vaso-occlusive crisisin sickle palliative care "399
cell disease "304 5 Human papillomavirus and cervical
cancer "404
6 Black cohosh formenopausal
8 Musculoskeletal and joint disease
symptoms "406
cases "309
Index "411
INTRODUCTION "309
1 Gout "311
vi
Foreword d
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For many years there has been a debate across the professionof
pharmacy aboutthe‘divide’ between scienceand practice. The
argument hasoften centredontheapparent dilution ofthesciencein
pharmacy, alongside astrengthening clinical role whereas, in fact, the
opposite istrue. Clinical practitionersuse their science ateverystage
of everydrug intervention and patient encounter, and are able to
demonstrate theirunique contribution asa direct result. These
contributions form thebasisfor the interactions that pharmacists
have with patients everyday: from the drug and formulation choice,
to managingdrug stabilityissues;from assessing the patient’sability
to swallow,to recommending the best route of administration; the
assessment of the impact of prescribed and non-prescribeddrugs on
thepharmacokineticsof a newly prescribed drug; all this together
with doing thebestfor the confused patient, nomatter what the age
or stage of life, understanding the challengesbehind medicine
preparationandtaking.
Acrossthe profession, we want to ensurethat clinical practiceis
strengthened by the integration of pharmaceutical science. Integrated
PharmacyCaseStudies is ahugely valuable and unique text, covering
majordisease systems,rare andcommon,providing a text forall: for
those learningthe concepts from scratch, as well asforthose at
experiencedstages of career development. Each case study presented
is usefully set out with clear learningoutcomesand questions that
target the needs of thepatient through the underlying science. The
focusis onthepatient, whereas the text provides details and
information on the disease/condition, the drugsinvolved inits
management,their pharmacological mechanism of action (according
to current understanding), theirchemical structures and active
groups,formulations,stabilityand interactions, relevant to the case in
hand. The cases navigatethe issues behind thescience,
pharmacokinetics, interactions and side effects and are followed by
somepertinent questions, referencesand further reading for the
readerto consult. The work is atrue collaboration between academic
pharmacists and practitionersso thatthe clinical cases are used to
illustrate clearlythat the best patient care results from clinical
practice being truly integrated with the pharmaceutical sciences.
DRCATHERINEDUGGAN
PhD, FRPharmS, Director of ProfessionalDevelopment and Support
Royal Pharmaceutical Society
vii
ts Acknowledgements
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n The editors would like to take this opportunity to acknowledge those
k
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A whohave assisted in thepreparationof this book. We are very
indebted to the following:
The authors:for the time and effort thatthey have put into their
respective case discussions. Professional life provides few spare
moments, so the time that these individuals have made available to
make such knowledgeable contributions isgreatly valued. The nature
of this book hasmeant that thecasesreturned to the originalauthors
for approval were often very different from those originally submitted,
as they hadbeen edited and added to, to ensure that they met the
objectives of this project.The authors’ flexibility and positive
responses atall stages have been greatly appreciated.
Catherine Baumber (Pharmaceutics Department, UCL School of
Pharmacy): for her considerable secretarial, administrative and
organisationalsupport throughout thisbook’s preparation from
inception to submission to thepublisher.
Ourrespective partners andfamilies:for their help, support,
patience and tolerance as this book was written, edited and prepared
in what euphemistically might be called our ‘sparetime’.
viii
About the editors rs
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SALLY-ANNEFRANCIS,BPharm, PhD, MRPharmS, teachingand learningand is aFellow of the Ab
FHEAis anHonorary SeniorLecturer in the Higher Education Academy.
Departmentof Practice and Policyat UCL School
ANDREWCONSTANTI,BSc(Pharm), PhD, FBPhS is
of Pharmacy, having previously held academic
aReaderin Pharmacologyin the Department of
appointments attheschoolfor 10 years. During
Pharmacology atthe UCL Schoolof Pharmacy. He
thistime, shewas responsible forthecurriculum
studied for his PhD while employed asa Research
design and deliveryof postgraduate MSc Assistantat StBartholomew’sMedical Collegeand
programmes inClinical Pharmacy; shehasalso
received his PhD in Pharmacologyfrom the
taught and examined ontheMPharm and PhD
University of London in 1975. He thenjoinedthe
programmes ofstudy.She isco-author of academicstaffof the School of Pharmacy,
International Research inHealthcare,a textbook
University of London (now UCL School of
for studentsand researchers undertaking
Pharmacy) asa teachingfellow, later being
multicentre research projectsin health services,
promoted to lecturer, senior lecturerand reader.
medicines useandprofessional practice.
Dr Constantihas 40 years of experience in
FELICITYSMITH,BPharm, MA, PhD, FRPharmSis teachingand administration in all 4 years of the
currently Professor of PharmacyPractice at UCL MPharm degree course as well ascontributingto
Schoolof Pharmacy. After afew years in hospital MSc courses and the trainingof PhD students. He
and then communitypharmacy, she completedan isalso a Visiting Professor ofNeuroscienceat the
MAin African Studies at SOAS and aPhD atSt University of Trieste, Italy, where he currently
Bartholomew’sMedical College. She then joined teaches in the international neuroscience MSc
theacademicstaffof the Schoolof Pharmacy, course. His research in neuropharmacology/
University of London, now UCL School of neuronal electrophysiology hasled to the
Pharmacy. Professor Smith has25years’ publication of over 100 originalarticles in refereed
experience in teachingand research inpharmacy journals and he was the main authorof the
practice. Duringthis time she hasbeen actively textbookBasicEndocrinology: for students of
involved in curriculumdesign and teachingin pharmacyand alliedhealth sciences, intended
pharmacy practice across all 4years ofthe primarilyfor pharmacy undergraduates. He isa
MPharm degree, aswell asMSc and PhD memberof the Physiological Society and an
programmes. She isauthor of other texts including elected Fellow of theBritishPharmacological
Conducting Your Pharmacy Practice Research Society.
Project which is intended for studentsor other
KEVINTAYLOR,BPharm, PhD, FRPharmSis
first-time researchers in pharmacy.
Professor of Clinical Pharmaceuticsat UCL School
JOHNMALKINSON,BPharm, PhD, MRPharmS, of Pharmacy. Professor Taylor has more than 25
MRSC, CChem, FHEA isSenior Lecturer in years’ experience inteaching and research in the
PharmaceuticalScienceApplied to Practice at areas of formulation science, medicines
UCL School ofPharmacy. Dr Malkinson registered manufacture and drug delivery. Duringthis time
as apharmacist in 1997, beforecompleting aPhD he has been activelyinvolved in curriculum design
in pharmaceutical chemistry and then post- and teaching in pharmaceutics acrossall 4years of
doctoral research attheUniversity of London. Dr the MPharm degree aswell as MSc and PhD
Malkinson has nearly 15 years of teaching programmes. He has been external examiner for a
experience acrossall 4 years the MPharm numberof MPharm programmes intheUK. He is
programme and on several MSc programmes.His co-authoror co-editorof several other texts,
teaching focuses primarilyon organic and includingAulton’sPharmaceuticsand Pharmacy
medicinal chemistry and on applied sciencein a Practice,whichare intended foruseby
clinicalcontext. He hasan active interest inthe undergraduate pharmacy students.
application of technology for the enhancementof ix