Faculty of Medical Sciences, University of Sri Jayewardenepura.
Abstract
Introduction: Laboratory investigations are an essential tool for health care professionals. Clinicalpharmacists (CP) are well placed to contribute to pharmacotherapy optimization using laboratorymonitoring in their armamentarium. Three examples describe CP associated laboratory monitoring fortherapy 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 prescribedeven after serum potassium level became high (5.6mmol/L). The CP informed the clinic doctor, whoordered a repeat serum electrolyte level. Serum potassium remained elevated and spironolactone wasdiscontinued.Case 2: A CKD stage V patient with anemia (hemoglobin 8.62g/dL) had self-discontinued weeklysubcutaneous erythropoietin injection two months previously. Since he remained anemic, the CPinformed the clinic doctor that the patient had defaulted treatment. The doctor prescribed weeklyerythropoietin and a full blood count for the next clinic visit.Case 3: In a patient with CKD Stage IV and hypercholesterolemia, atorvastatin had been unintentionallyomitted from the prescription. No recent lipid profile was available. The CP communicated this to thedoctor, who requested a lipid profile. Total cholesterol level was 293mg/dL. Atorvastatin was restartedat 20mg at night.Discussion: These cases illustrate the opportunities for CP to optimize pharmacotherapy in response tolaboratory monitoring to improve patients’ therapeutic outcomes. Collaboration of skills and knowledgeof healthcare professionals will result in improved patient management in busy renal clinics
