IMM 07 and IMM 09: Pharmaceutical Care III (A) and IV – Drug Therapy Problems (Identification and Statements)

Question 1

What is a drug therapy problem (DTP)?

Answer 1

any undesirable event (or risk) experienced by a patient that involves (or is suspected to involve) drug therapy, and that interferes with achieving the desired goals of therapy and requires professional judgement to resolve

Question 2

What are the 7 categories of DTPs?

Answer 2

• unnecessary drug therapy (N)
• needs additional drug therapy (N)
• ineffective drug (E)
• dosage too low (E)
• adverse drug reaction (S)
• dosage too high (S)
• non-adherence (A)

Question 3

What are the sub-categories for the unnecessary drug therapy (N) DTP category? (5)

Answer 3

• no medical indication
• addiction/recreational use
• non-drug therapy more appropriate
• duplicate therapy
• treating avoidable ADRs with another drug

Question 4

What is the solution for the unnecessary drug therapy (E) DTP category?

Answer 4

discontinue drug

Question 5

What are the sub-categories for the needs additional therapy (N) DTP category? (3)

Answer 5

• untreated condition – medical condition requires therapy
• preventive/prophylactic – preventative therapy needed to decrease risk of developing new condition
• synergistic/potentiating – medical condition requires combination therapy for synergy/additive effects

Question 6

What is the solution for the needs additional therapy (E) DTP category?

Answer 6

add drug

Question 7

What are the sub-categories for the ineffective drug (E) DTP category? (5)

Answer 7

• dosage form inappropriate
• condition is refractory to drug
• not effective for condition
• more effective drug available
• previous trial of drug – and it was ineffective

Question 8

What is the solution for the ineffective drug (E) DTP category?

Answer 8

switch to more effective drug

Question 9

What are the sub-categories for the dosage too low (E) DTP category? (6)

Answer 9

• ineffective dose
• frequency/interval too long (ie. once daily instead of QID)
• duration of therapy too short (ie. 3 days instead of 10)
• incorrect storage
• incorrect administration (ie. dose of drug was given too slowly)
• drug interaction – resulting in reduced amount of active drug available in body

Question 10

What is the solution for the dosage too low (E) DTP category?

Answer 10

depends on cause

• increase dose
• change interval
• change drug

Question 11

What are the sub-categories for the adverse drug reaction (S) DTP category? (7)

Answer 11

• unsafe drug for patient – due to risk factors
• allergic reaction
• incorrect administration
• drug interaction (not dose-related)
• dosage increase/titrated up, or decreased/withdrawn too quickly
• undesirable effect
• drug is contraindicated

Question 12

What is the solution for the adverse drug reaction (S) DTP category?

Answer 12

change drug

Question 13

What are the sub-categories for the dosage too high (S) DTP category? (5)

Answer 13

• dose too high
• frequency too short (ie. q4h vs. q24h)
• duration of therapy too long (ie. 14 days vs. 3 days)
• drug interaction – causing toxic reaction to drug product
• incorrect administration leading to drug being too high a dose

Question 14

What is the solution for the dosage too high (S) DTP category?

Answer 14

depends on cause

• decrease dose
• change frequency
• change drug

Question 15

What are the sub-categories for the non-adherence (A) DTP category? (6)

Answer 15

• drug product not available
• cannot afford drug product
• cannot swallow/self-administer
• directions not understood
• patient prefers not to take
• patient forgets to take

Question 16

What is the solution for the non-adherence (A) DTP category?

Answer 16

depends on cause

Question 17

What is the value of DTP statements?

Answer 17

• helps keep your thinking focused
• states clearly what you are trying to avoid or control (undesirable sign, symptom, disease, etc.)
• accurately identifying the cause helps identify the solution
• provides clear, concise communication with other health care professionals
• provides a focused summary of a particular DTP

Question 18

What are the 4 components of DTP statements?

Answer 18

• patient identifier (name or initials, age, male/female) – undesirable event or risk of an event experienced by the patient, description of patient’s medical complaint, signs and symptoms, diagnosis, disease, etc.
• drug therapies involved
• specific association between drug therapy and patient’s condition
• state whether the DTP is actual or potential – include main, general, and sub-category

example: CT is at risk of experiencing ongoing/unresolved/unmanaged community acquired pneumonia (=fever of 38.5 ºC, purulent cough, chest pain) secondary to being prescribed too low a dose of amoxicillin (500mg PO BID vs 1g PO TID x 5 days) [Potential Effectiveness DTP: Dose too low – ineffective dose & frequency too long]