emergency treatments role of pharmacist

1. Emergency Treatment

2. A & E Departments
 The A&E department is traditionally an area that has had little pharmacist
input compared with that for other hospital departments. However, it is the
department with the highest turnover of patients in a hospital and is where
substantial quantities of medicines are administered. Thus, there are many
challenges for pharmacists in providing a service to these departments.

3. Role of Pharmacists in A & E Departments
Clinical Duties:
 Drug history taking:
Taking a drug history has been found to be a key role for pharmacists working on
medical admissions wards. It has also been acknowledged and well documented that
pharmacists are more accurate than doctors at taking drug histories.
The practice of pharmacists taking drug histories in A&E departments, before patients
are admitted to medical admissions wards, may have several benefits. For example, it
enables better judgments to be made by doctors about adjusting patients’ treatments
on ward rounds as accurate drug histories are already known. It also means that any
drug-related issues on admission, or potential drug-related problems, may be
highlighted early on in a patient’s stay.

4. Role of Pharmacists in A & E Departments
 On the ward round, the pharmacist’s role is to clarify drug histories, add any
new medicines that are required to the drug chart, provide advice to medical
and nursing staff and write discharge medication forms. As well as ensuring
the appropriateness of medicines for patients, having a pharmacist complete
discharge medication forms speeds up the discharge process.
 For patients who are discharged during the ward round, medicines are
dispensed by the pharmacist, or discharge technician, immediately after the
round has finished. The majority of discharge prescriptions can be dispensed
on the ward using pre-packs. This enables patients to be discharged
promptly and helps to clear beds ready for new admissions from the
emergency department, activities which help meet the four-hour target for the
emer- gency department.

5. Role of Pharmacists in A & E Departments
Providing consultative services that foster appropriate evidence-
based medication selection.
Providing consultation on patient-specific medication dosage and
dosage adjustments.
Monitoring for patient allergies and drug interactions.
Monitoring patient therapeutic responses (including laboratory
values).
Continuously assessing for and managing adverse drug reactions.

6. Source of Advice
 The pharmacist is a source of advice and information to all medical and
nursing staff.
 Common tasks that the pharmacist may undertake include:
 Giving advice on drug choice, particularly antibiotics.
 Providing dosage recommendations for elderly patients and those with
renal impairment.
 Providing information on the administration of intravenous drugs.
 Providing compatibility information.
 Carrying out dosage calculations.

7. Counselling at Discharge
 The emergency department pharmacists selectively counsel patients on
discharge, concentrating on seeing patients taking multiple medicines,
the elderly and those patients referred to them by medical and nursing
staff.
 Examples of patients that have been counselled on discharge include:
 A patient admitted to hospital with hypoglycemia because they were
unable to use their insulin devices correctly.
 Patients unable to remember to take their medicines.
 Patients unsure about why they have been prescribed their medicines.

8. Research
 The pharmacist is involved in the hospitals emergency department
research group. In addition to undertaking audits, the pharmacist
assists in research projects, helping with study design and
pharmaceutical issues.

9. Future Developments
 The role of the emergency department pharmacist is likely to continue to
expand as emergency department staff and managers realize the benefits
of having pharmacists as part of their teams. It is also possible that there
may be new roles for pharmacist in the emergency department as
attempts are made to streamline a patients journey through the health
service.

10. Epilepsy
 Epilepsy is a group of neurological diseases characterized by epileptic
seizures.
 Epileptic seizures are episodes that can vary from brief and nearly
undetectable to long periods of vigorous shaking. In epilepsy, seizures
tend to recur, and have no immediate underlying cause while seizures
that occur due to a specific cause are not deemed to represent
epilepsy.

11. I. Partial (focal) Seizures
A. Simple Partial Seizures
B. Complex Partial Seizures
II. Generalized Seizures
A. Generalized Tonic-Clonic Seizures
B. Absence Seizures
C. Tonic Seizures
D. Atonic Seizures
E. Clonic Seizures
F. Myoclonic Seizures
G. Infantile Spasms

12. Classification of AEDs
• Phenytoin
• Phenobarbital
• Primidone
• Carbamazepine
• Ethosuximide
• Valproate
(valproic acid)
Classical
Newer
Lamotrigine
Felbamate
Topiramate
Gabapentin
Tiagabine
Vigabatrin
Oxycarbazepine
Levetiracetam
Fosphenytoin

13. Pharmacokinetics
 Absorption: Good oral absorption (for Carbamazipine may
reach upto 85% )
 Distribution: Plasma protein binging high (90-95%) to low.
Distributed in all body fluids.
 Metabolism: Metabolised by liver.
 Excretion: predominantly via kidneys.

14. Mechanism of Action
 Drugs reduce seizures through such mechanisms as blocking voltage-
gated channels (Na+ or Ca2+), enhancing inhibitory γ-aminobutyric
acid (GABA)-ergic impulses and interfering with excitatory glutamate
transmission. Some antiepilepsy medications appear to have multiple
targets within the CNS, whereas the mechanism of action for some
agents is poorly defied. Antiepilepsy medications suppress seizures but
do not “cure” or “prevent” epilepsy.

15. Sodium
channel
Calcium
channel
GABA Glutamate Other
mechanis
ms
Carbamazepi
ne
Eslicarbazepi
ne acetate
Lacosamide
Lamotrigine
Oxcarbazepin
e
Phenytoin
Rufinamide
Zonisamide
Ethosuximid
e
Pregabalin
Zonisamide
Barbiturates
Benzodiazepin
es
Gabapentin
Tiagabine
Valproate
Vigabatrin
Felbamate
Perampane
l
Topiramate
Levetiracet
am
Lacosamid
e
Retigabine
(Ezogabine
)

16.  Therapeutic Uses:
 trigeminal neuralgia,
 bipolar disorder
 Anxiety,
 neuropathic pain
 ADRs:
 hyponatremia, ataxia, sedation
 Rash, teratogenecity, weight loss/gain, osteoporosis
 Hepatotoxicity, behavioral changes.