Table 3 Description of drug therapy problems

Additional drug therapy required

• A medical condition requires the initiation of drug therapy.

• Preventive drug therapy is required to reduce the risk of developing a new condition (according to the national guidelines).

• A medical condition requires additional pharmacotherapy to produce an additive of synergistic effect.

• The patient is suffering from pain with no analgesic therapy.

• A patient with chronic heart failure due to left ventricular systolic dysfunction, without an ACE-inhibitor or an angiotensin receptor blocker.

• A patient with atrial fibrillation without antithrombotic therapy.

• Calcium and vitamin D supplements for a patient with osteoporosis who is already taking a bisphosphonate.

Unnecessary drug therapy

• There is no current valid medical indication for the drug therapy for the individual patient.

• Multiple drug products are being used for a medical condition that requires single drug therapy.

• The medical condition is more appropriately treated with non-drug therapy or lifestyle changes.

• Drug therapy is being taken to treat an avoidable adverse event associated with another medication.

• Lifestile ( e.g. drug abuse, alcohol use, diet, smoking) is causing the problem.

• A patient is using a low dose of aspirin without a high risk of cardiovascular disease or any signs of a cardiovascular disease.

• A patient is using three different laxative products in an attempt to treat his constipation.

• A patient is using a benzodiazepine every night as a hypnotic drug for three years while it is better to recommend alternative sleeping patterns, sleep hygiene and exercise.

• A patient is using furosemide to prevent swollen ankles.

• A patient is using paracetamol combined with codeine (500/10) and is suffering from constipation which is treated with lactulose and bisacodyl occasionally.

• A patient uses a protonpump inhibitor to treat dyspepsia associated with alcohol abuse.

Ineffective drug therapy

• The drug is not effective for the medical problem.

• The drug product is not the most effective for the indication being treated.

• The formulation of the drug products is inappropriate.

• The drug is not effective because of the characteristics of the patient. (e.g. renal impairment, hepatic function)

• A patient is using an antibiotic for a common cold (viral infection).

• A patient with benign prostatic hyperplasia uses doxasozine for more than four years.

• • A patient with severe COPD uses salbutamol in a turbuhaler.

• A patient with renal impairment uses a thiazide to lower the blood pressure.

Dosage too low

• The dose is too low to produce the desired outcome.

• The dosage interval is too long to produce the desired outcome.

• A drug-drug interaction reduces the amount of active drug available and the dose is not adjusted too produce the desired outcome.

• The duration of the drug therapy is too short to produce the desired outcome.

• A patient is prescribed simvastatine 10 mg every other day after a myocardial infarction.

• A patient uses 500 mg paracetamol, only twice a day, to control chronic pain in osteoarthritis.

• A patient uses 375 mg amoxicilline, only once a day, to treat an airway infection.

• A patient uses acenocoumarole and vitamin K.

• A patient uses paroxetine for 4 days to treat anxiety.

Adverse drug event

• The drug causes an undesirable reaction that is not dose-related.

• A safer product is required due to risk factors.

• A drug interaction, with another drug or food, causes an undesirable reaction that is not dose-related.

• The drug is contraindicated due to risk factors or other diseases.

• The drug causes an allergic reaction.

• A drug dosage was increased or decreased too fast.

• A drug alters the patient's laboratory test results due to interference from a drug he/she uses.

• A patient on a low dose of aspirin is experiencing bruises.

• An elderly patient uses flurazepam to sleep and is experiencing drowsiness at day time.

• A patient who uses methotrexate gets prescribed co-trimoxazole for an infection (increase of anti-folate effect which can result in haematopoietic suppression).

• A patient gets prescribed indometacin to control chronic pain, which is contraindicated because of his/her history with a peptic ulcer.

• A patient is prescribed flucloxacillin for a dermal infection and develops a rash after the second dose.

• A patient who uses prednisolone 20 mg every day for the last 6 months for arthritis symptoms iss instructed to take 10 mg for 2 more days and then discontinues the medication.

• A patient had high blood glucose levels, due to the start of prednisolone therapy.

• Positive ketone test in urine due to captopril use.

Dosage too high

• The drug causes an undesirable reaction due to too high dose.

• The dosing frequency of the drug is too short.

• The duration of drug therapy is too long.

• The drug dose is too high in the patient because of its characteristics (excretion).

• A drug-drug interaction occurs resulting in a toxic reaction to the drug.

• The dose of the drug was administered too rapidly.

• A patient develops bradycardia resulting from a high (0.5 mg) daily dose of digoxine.

• Hyperkaleamia after a dose of amiloride 10 mg three times a day.

• A patient who experienes nasal congestion uses a nasal spray with xylometazoline for four weeks.

• A patient with impaired renal function (CrCl: 20 ml/min) is prescribed a normal dose of 300 mg allopurinole a day, which causes nausea.

• A patient has an increased INR after given metronidazole while also using acenocoumarole.

• Cardiac arrest after infusion of a bolus of potassium phosphate (5 ml intravenously) instead of slow infusion.

Drug use problem

• • The patient does not understand the instructions.

• The patient prefers not to take the medication.

• • The patient forgets to take the medication.

• • The patient cannot administer the drug appropriately him/herself.

• • The drug therapy does not comply with the lifestyle of the patient.

• • The patient has no access to the medication.

• The patient uses naproxen only when pain is unbearable while it is prescribed three times a day.

• The patient is afraid of taking fluvoxamine because of possible side-effects.

• The patient forgets to take his antihypertensive medication.

• The patient is unable to administer the timolol eyedrops for her glaucoma.

• A patient does not take furosemide because of attending activities at home.

• A patient is not able to fetch the medication at the pharmacy.