Drug Related Problems
Drug related problem
Drug related problems (DRPs) are prevalent and causing considerable patient morbidity and mortality. Many of these DRPs are preventable through following the guidelines and rational drug used. There are many factors controlling the DRP occurrence such as patient age, disease status, drug characteristics, etc.
High risk factors
1. Elderly (> 65 years); due to age related changes in pharmacodynamic and pharmacokinetics
2. Acute diseases such as acute renal failure, sepsis, etc…
3. Patients with many chronic diseases; diabetes, hypertension, heart disease, liver problem, AIDS, etc…
4. Patients with renal impairment or haemodialysis
5. Patients in special situations; pregnancy, lactation,
6. Certain diseases and their medications: cancer, diabetes, heart failure.
7. Polypharmacy (taken many drugs > 5 drugs)
8. Drug; certain drug classes are commonly involved e.g. Warfarin, insulin, digoxin, TCAs, etc…
Classification of drug-related problems
1. Inappropriate drug choice: Unjustified deviation from management guidelines consensus therapeutic can worsen the condition. Deviations that are based on the patient’s individual treatment goal and risk factors are not considered to be DRPs (e.g. Antibiotic used for viral infection. Furosemide prescribed for patient with hypokalemia).
2. Lack of necessary drug: Either one or more drugs are missing according to established guidelines or a medical problem is being treated with too little of the appropriate drug (under-prescribed) or appropriate drugs may be not used for maximum effectiveness. Moreover, duration of treatment may be too short which can lead to incomplete treatment. Deviations from guidelines that are based on the patient’s individual treatment goals and risk factors are not considered to be DRPs (e.g. B-blockers in heart failure or post-MI, stop diuretic before edema treated or loop diuretic used only for
Drug related problems (DRPs) are prevalent and causing considerable patient morbidity and mortality. Many of these DRPs are preventable through following the guidelines and rational drug used. There are many factors controlling the DRP occurrence such as patient age, disease status, drug characteristics, etc.
High risk factors
1. Elderly (> 65 years); due to age related changes in pharmacodynamic and pharmacokinetics
2. Acute diseases such as acute renal failure, sepsis, etc…
3. Patients with many chronic diseases; diabetes, hypertension, heart disease, liver problem, AIDS, etc…
4. Patients with renal impairment or haemodialysis
5. Patients in special situations; pregnancy, lactation,
6. Certain diseases and their medications: cancer, diabetes, heart failure.
7. Polypharmacy (taken many drugs > 5 drugs)
8. Drug; certain drug classes are commonly involved e.g. Warfarin, insulin, digoxin, TCAs, etc…
Classification of drug-related problems
1. Inappropriate drug choice: Unjustified deviation from management guidelines consensus therapeutic can worsen the condition. Deviations that are based on the patient’s individual treatment goal and risk factors are not considered to be DRPs (e.g. Antibiotic used for viral infection. Furosemide prescribed for patient with hypokalemia).
2. Lack of necessary drug: Either one or more drugs are missing according to established guidelines or a medical problem is being treated with too little of the appropriate drug (under-prescribed) or appropriate drugs may be not used for maximum effectiveness. Moreover, duration of treatment may be too short which can lead to incomplete treatment. Deviations from guidelines that are based on the patient’s individual treatment goals and risk factors are not considered to be DRPs (e.g. B-blockers in heart failure or post-MI, stop diuretic before edema treated or loop diuretic used only for
References: 1. Bemt P and Egberts A (2007) Drug-related problems: definitions and classification. Journal of European Association of hospital Pharmacists (EAHP), 13, pp 62-64. 2. Ruscin M (2009) Drug-Related Problems in the Elderly. Merck, Available from World Wide Web: http://www.merck.com/mmpe/sec23/ch341/ch341e.html 3