Hospital and Clinical Pharmacy
Hospital and clinical pharmacy covers formulary management, drug distribution, sterile compounding, therapeutic drug monitoring, adverse drug reaction reporting and renal dosing. The exam favours practical safety decisions.
Core rules
- A Pharmacy and Therapeutics Committee maintains the hospital formulary and reviews drug use. Unit-dose distribution reduces medication errors compared with uncontrolled floor stock.
- Intravenous admixtures and total parenteral nutrition require aseptic technique, compatibility checks and appropriate filters. Clinical pharmacists review interactions, duplications and dose adjustments.
- Adverse drug reactions are reported to the national pharmacovigilance programme through PvPI. Renal dosing uses creatinine clearance, commonly estimated by Cockcroft-Gault.
Worked example
A 60-year-old man weighing 70 kg has serum creatinine 1.4 mg/dL. Cockcroft-Gault gives CrCl = (140 − age) × weight / (72 × SCr) = (80 × 70) / (72 × 1.4) = 5600 / 100.8 ≈ 55.6 mL/min. This moderate impairment may require dose reduction of renally cleared drugs such as aminoglycosides.
Traps
Serum creatinine must be in mg/dL for this equation. Do not adjust a loading dose merely because maintenance is reduced. Report an ADR even if the reaction is already listed, and do not confuse an ADR with a medication error. Check compatibility before adding a drug to an infusion.