Ambulatory Care Pharmacy
Fern Chau-Devera, PharmD
Role of an Ambulatory Care
Pharmacist
• Interact with patients in an outpatient clinic
setting for the management of chronic conditions
under protocol
• Responsible for adjusting medication doses
counseling patients on side effects of
medications and the importance of medication
adherence, and making therapy
recommendations to prescribing physicians.
Patient MJ
MJ is a 68 year old male referred to you by Dr. Smith to manage high blood pressure.
Past Medical History
Hypertension
Diabetes
Cholesterol
Allergies
Penicillin – rash
Medications
Lisinopril 20mg 1 tablet daily
Hydrochlorothiazide 25mg 1 tablet daily
Simvastatin 40mg 1 tablet daily
Metformin 500mg 1 tablet 2 times per day
Vitals
BP 175/92 HR 72 (4/5/12)
BP 160/90 HR 69 (2/12/12)
BP 150/85 HR 85 (1/6/12)
Labs
Scr 1.8 (kidney function)
ALT 24 (liver function)
WHAT IS YOUR PLAN?
What do you need to know?
MJ is a 68 year old male referred to you by Dr. Smith to manage high blood pressure.
What is MJ’s blood pressure goal? Does he exercise? How
often? Eat excessive salty foods?
Past Medical History
Hypertension
Diabetes
Cholesterol
Allergies
Penicillin – rash
What blood pressure medications to avoid with
penicillin allergy?
Medications
Lisinopril 20mg 1 tablet daily
Hydrochlorothiazide 25mg 1 tablet daily
Simvastatin 40mg 1 tablet daily
Metformin 500mg 1 tablet 2 times per day
Vitals
BP 175/92 HR 72 (4/5/12)
BP 160/90 HR 69 (2/12/12)
BP 150/85 HR 85 (1/6/12)
Labs
Scr 1.8 (kidney function)
ALT 24 (liver function)
What are these medications and for what conditions? Any
interactions? Duplicates? Safe for elderly? Adherent to therapy?
Experiencing side effects? Follow recommended treatment
guidelines? Cost savings opportunities? Reduce quantity of
medications?
What do these lab results mean? Are medications
safe given this labs?
ASSESSMENT / PLAN:
BP goal is < 130/80
Combine lisinopril and hydrochlorothiazide into 1 pill called prinzide
Start atenolol 25mg 1 tablet daily. Monitor heart rate
Start aspirin 81mg 1 tablet daily for heart protection
Continue all other medications
Recheck BP in 4 weeks
What settings do Ambulatory Care
Pharmacists Work?
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Internal medicine
Oncology
Nephrology
Gastrointestinal
Endocrine
HIV
Chronic Pain
Hospice
Much more…
Why choose Ambulatory Care?
• Manage chronic conditions and educate
patients
• Build great working relationships with
physicians, nurses, medical assistants
• Develop expertise in a specialized area
The road to Ambulatory Care
Pharmacy School (3-4yrs)
AND
Residency (1 year)