1. ANEMIA Cynthia Jackevicius, B.Sc.Phm., M.Sc., FCSHP

2. Mrs. JP’s drug-related problems

3. Mrs. JP is at risk of continuing to experience S and Sx of iron-deficiency anemia (IDA), secondary to not receiving iron therapy Mrs. JP may be experiencing gastritis and associated blood loss, and therefore IDA, secondary to the use of ASA Mrs. JP is experiencing heartburn, most likely due to the use of plain ASA

4. Mrs. JP’s drug-related problems Mrs. JP has the potential to experience peptic ulcer disease, secondary to the use of ASA, which may not be the most appropriate drug for the management of her headaches. Mrs. JP may be at risk for osteoporosis and may benefit from prophylactic therapy (RF: thin, post-menopausal)

5. Mrs. JP’s drug-related problems Mrs. JP is at risk of continuing to experience S and Sx of iron-deficiency anemia (IDA), secondary to not receiving therapy

6. Justification of main DRP Mrs. JP is experiencing signs & Sx of iron- deficiency anemia What is anemia?

7. Justification of main DRP what is iron-deficiency anemia? What are some Sx of Fe-deficiency anemia? Chronic onset:recent onset: other Sx?

8. Justification of main DRP What Sx does JP have? Can it be diagnosed based on Sx alone? What are some signs of Fe-deficiency anemia?

9. Justification of main DRP What are some general causes of Fe- deficiency anemia? Drug-induced causes:

10. Justification of main DRP What RF does JP have for Fe-deficiency anemia? Is she on any drugs that may cause this?

11. Role of Fe in the body Needed for Hgb synthesis daily requirement: serum Fe: ferritin: TIBC: MCV: RDW:

12. Other Terminology Macrocytic, microcytic, normocytic: hypochromic, normochromic:

13. Justification of main DRP What are other types of anemia? Why are these ruled out? Therefore, justified that Mrs. JP is experiencing signs and Sx of IDA

14. Justification of main DRP Justify relationship of S and Sx to drug therapy: secondary to not receiving therapy assumption: treatment is needed - WHY?

15. Consider treatment options Diet Oral formulations injectable formulations

16. Consider treatment options Efficacy Onset Side effects

17. Consider treatment options Drug interactions convenience cost

18. Anemia Therefore, we have provided justification to state that: Mrs. JP is at risk of continuing to experience S and Sx of iron-deficiency anemia, secondary to not receiving therapy

19. Anemia Mrs. JP may be experiencing gastritis and associated blood loss, secondary to the use of regular ASA Does ASA cause gastritis? Does it cause PUD? Do the original signs and Sx for which she is receiving this need Tx? - consider management of her headaches

20. Anemia Mrs. JP is at risk of continuing to experience S and Sx of iron-deficiency anemia (IDA), secondary to not receiving therapy Mrs. JP may be experiencing gastritis and associated blood loss, and therefore IDA, secondary to the use of ASA Mrs. JP has the potential to experience peptic ulcer disease, secondary to the use of ASA, which may not be the most appropriate drug for the management of her headaches.

21. Pharmacy Care Plan clinical outcome pharmacotherapeutic outcome pharmacotherapeutic endpoints

22. Pharmacy Care Plan Alternatives and assessment

23. Pharmacy Care Plan Therapeutic Plan Therapeutic Plan Endpoints

24. Pharmacy Care Plan Monitoring Plan and follow-up

25. Common Drug-Related Problems seen in patients with Anemia Lack of response due to: non-compliance EC / SR products being prescribed Interactions with other medications and diet Inadequate duration of therapy