Clinical Reasoning

Question 1

How does clinical reasoning apply to a pharmacist?

Answer 1

• The Pharm.D.’s role should be understanding the literature behind a particular drug or drug class’ role in therapy
• Knowledge of literature helps support a drug therapy recommendation
• Facilitates the pharmacist’s ability to clinically reason between multiple drug therapy options; customizes best drug therapy for a given patient
• Epitomizes the practice of evidence-based medicine

Question 2

What is clinical reasoning?

Answer 2

• used to communicate your rationale
• assessment in the SOAP note
• used for drug information question response

Question 3

Organization of a drug information response

Answer 3

• Understanding the Question
• Introduction
• Body
• Recommendation

Question 4

Examples of tertiary literature

Answer 4

• Package Inserts
• Lexicomp®
• Micromedex®
• Trissel’s
• Clinical Pharmacology
• Drug Information Handbook
• Goldfrank’s Toxicologic Emergencies
• Review Articles
• Guidelines…

Question 5

Examples of secondary literature

Answer 5

▫ Review articles 
▫ Guidelines 
▫ Editorials
▫ Medline 
▫ OVID 
▫ PubMed

Question 6

Examples of primary literature

Answer 6

▫ “Landmark studies” 
▫ Prospective 
▫ Retrospective 
▫ Cohort 
▫ Meta-analysis
▫ Case report 
▫ New England Journal of Medicine 
▫ Archives of Internal Medicine 
▫ Lancet (academic journal) 
▫ American Journal of Cardiology

Question 7

Introduction

Answer 7

• Should be relatively short
• Provide context to requestor’s question
• If applicable, describe the controversy
• Acceptable to be comprised of mainly tertiary literature

Question 8

Body of the Response

Answer 8

▫ Where you present the evidence
▫ Incorporate and discuss primary literature -> Search via secondary literature
▫ Summarize each piece of literature and how it relates to your patient or
patient population
▫ Results
▫ Conclusions
▫ Compare and contrast primary literature

Question 9

Recommendation

Answer 9

• What is the “big picture?”
• Provide a firm, concrete recommendation, based on comparing the risk(s) versus the benefit(s)
• Opportunity to provide clinical reasoning behind your recommendation
• Provide your references at the end of your response