Pharmacy Practice and Patient Care
The pharmaceutical care model
Practice questions test whether you can move from dispensing to a documented care process: collect a best-possible medication history, reconcile at admission and discharge, identify drug-related problems (indication, effectiveness, safety, adherence), set a plan, and monitor outcomes. The SOAP note (Subjective, Objective, Assessment, Plan) is the usual documentation format, and the care plan must name the specific parameter to monitor and its frequency.
Counselling and adherence
Use plain language, teach-back, and a written schedule. Adherence barriers are practical (cost, complexity, side-effects, health literacy) before they are motivational. Always close the loop: ask the patient to repeat the key instructions in their own words.
Safety systems and traps
- High-alert medications (insulin, heparin, concentrated electrolytes, chemotherapy, opioids) require independent double-checks.
- Error-prone abbreviations are a classic distractor: "U" for units, "QD"/"QOD", trailing zeros (2.0 mg), missing leading zeros (.5 mg).
- Dose adjustments must cite a method: Cockcroft–Gault for creatinine clearance, Child–Pugh for hepatic impairment, or a validated nomogram.
- Beers criteria flag potentially inappropriate medicines in older adults (benzodiazepines, anticholinergics, long-acting sulfonylureas).
Worked example
Cockcroft–Gault: CrCl (mL/min) = [(140 − age) × weight kg] ÷ (72 × SCr mg/dL), × 0.85 for females. For a 70-year-old woman, 60 kg, SCr 1.2 mg/dL: (140 − 70) × 60 ÷ (72 × 1.2) = 4200 ÷ 86.4 ≈ 48.6 mL/min, then × 0.85 ≈ 41 mL/min. That value, not the serum creatinine alone, drives the renal dose adjustment.