Social Pharmacy, Hospital and Clinical Pharmacy: Practice and Patients
Core concepts
This domain tests the pharmacist as a health-system actor. Know hospital pharmacy organisation (pharmacy and therapeutics committee, formulary, drug distribution systems - unit dose, floor stock, ward pharmacy), inventory and procurement (ABC/VED analysis, economic order quantity, lead time, buffer stock), and clinical pharmacy activities (medication history, reconciliation, therapeutic drug monitoring, dose adjustment in renal and hepatic impairment, adverse drug reaction reporting, pharmacovigilance). Understand social pharmacy themes: health behaviour, adherence, health literacy, pharmacoeconomics, essential medicines lists, rational drug use, and national health programmes.
Traps examens use
- Confusing ABC analysis (cost-based) with VED analysis (criticality-based); they are complementary.
- Mixing compliance (following instructions) with adherence (agreed, patient-centred behaviour).
- Forgetting that renal dose adjustment usually uses creatinine clearance, not serum creatinine alone.
- Assuming formulary inclusion means unrestricted use; many drugs are restricted to specified indications or prescriber categories.
Worked example
A patient with estimated creatinine clearance of 25 mL/min is prescribed a renally cleared drug whose standard dose is 500 mg every 8 hours. If the fraction excreted renally is 0.8, the adjusted dose ≈ standard dose × (0.2 + 0.8 × 25/100) = 500 × 0.4 = 200 mg every 8 hours. Show the formula, the substitution and the units - examiners award method marks even where arithmetic slips.