SEMINAR 6: Formularies

Context:

Common criteria for drug selection are arising from (bio-)chemical properties of the active ingredient (structure – activity – relationship), its molecular mechanism of action at the target site, pharmaceutical technology aspects, commercial criteria and supply fidelity, and – most important – therapeutic requirements. In case of therapeutic failure or adverse drug reactions, many criteria have to be re-evaluated. Pharmacological skills are needed to assess incidences and deviations from standard pharmacokinetic (LADME) and pharmacodynamic situations (targets for drug action). The individual patient’s genetic variation and/or diagnosed biomarkers may complete clinical information and influence the clinical outcome. These domains are more and more important for the hospital pharmacist’s daily business in supporting and significantly improving the therapists’ ability to diagnose, risk-stratify, and manage individual patients.

Teaching goals:

• to state the importance of key pharmacological aspects like P450 mono-oxygenases, conjugation reactions, P-glycoprotein, biological and genetic variations of drug targets, e.g. enzymes and cell surface receptors
• to outline systematically determinant pharmacological criteria for first level drug selection (committee) and for second level prescription (therapist)-To propose a concise selection of “mandatory” and “to omit” drugs depending on a hospital’s size and medical domains offered
• to illustrate high cost and high risk drugs in formularies and the justification of (no)reimbursement
• to analyse and assess therapeutic outcomes and how complaints or interventions are handled in order to continuously improve a formulary

Learning objectives:

• Delegates take home the message that an average in-patient has to take as much as 5 to 7 medicines in parallel, and that this number can easily rise to 15 or more in case of ICU, elderly, or nursing home patients and that interaction risks are arising from poly-pharmacotherapy
• Delegates are able to select drugs with a low incidence of adverse effects
• Delegates recognize the most important genetic variations influencing pharmacokinetics ad pharmacodynamics
• Delegates are able to criticize a short-term oriented economically driven selection and to defend a long-term oriented outcome proven drug selection.
• Delegates take home a formulary follow-up guideline applicable in their own hospital