Benefits of having a clinical pharmacist in an out-patient renal clinic in Sri Lanka

Authors

  • N D D Wickramasinghe
  • C B Lynch
  • J Coombes
  • S F Jayamanne
  • S T De Silva

Abstract

Introduction: Laboratory investigations are an essential tool for health care professionals. Clinical
pharmacists (CP) are well placed to contribute to pharmacotherapy optimization using laboratory
monitoring in their armamentarium. Three examples describe CP associated laboratory monitoring for
therapy improvements in an out-patient renal clinic in Sri Lanka.
Case Report:
Case 1: Spiranolactone 12.5mg was commenced in a patient with stage IV chronic kidney disease
(CKD) when a low serum potassium level of 2.9mmol/L was detected. This continued to be prescribed
even after serum potassium level became high (5.6mmol/L). The CP informed the clinic doctor, who
ordered a repeat serum electrolyte level. Serum potassium remained elevated and spironolactone was
discontinued.
Case 2: A CKD stage V patient with anemia (hemoglobin 8.62g/dL) had self-discontinued weekly
subcutaneous erythropoietin injection two months previously. Since he remained anemic, the CP
informed the clinic doctor that the patient had defaulted treatment. The doctor prescribed weekly
erythropoietin and a full blood count for the next clinic visit.
Case 3: In a patient with CKD Stage IV and hypercholesterolemia, atorvastatin had been unintentionally
omitted from the prescription. No recent lipid profile was available. The CP communicated this to the
doctor, who requested a lipid profile. Total cholesterol level was 293mg/dL. Atorvastatin was restarted
at 20mg at night.
Discussion: These cases illustrate the opportunities for CP to optimize pharmacotherapy in response to
laboratory monitoring to improve patients’ therapeutic outcomes. Collaboration of skills and knowledge
of healthcare professionals will result in improved patient management in busy renal clinics.

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Published

2017-10-10