Drug therapy problems (DTPs) (or drug related problems, DRPs) represent the categorization and definition of clinical problems related to the use of medications or "drugs" in the field of

pharmaceutical care Pharmaceutical care is the direct, responsible provision of medication-related care for the purpose of achieving definite outcomes that improve a patient’s quality of life. Definition Hepler and Linda Strand's definition is the most well-known ...

. In the course of clinical practice, DTPs are often identified, prevented, and/or resolved by

pharmacists A pharmacist, also known as a chemist ( Commonwealth English) or a druggist (North American and, archaically, Commonwealth English), is a healthcare professional who prepares, controls and distributes medicines and provides advice and instru ...

in the course of

medication therapy management Medication therapy management, generally called medicine use review in the United Kingdom, is a service provided typically by pharmacists that aims to improve outcomes by helping people to better understand their health conditions and the medication ...

, as experts on the safety and efficacy of medications, but other healthcare professionals may also manage DTPs. A drug-therapy (related) problem can be defined as an event or circumstance involving drug treatment (

pharmacotherapy Pharmacotherapy is therapy using pharmaceutical drugs, as distinguished from therapy using surgery (surgical therapy), radiation (radiation therapy), movement (physical therapy), or other modes. Among physicians, sometimes the term ''medical ther ...

) that interferes with the optimal provision of medical care. In 1990, L.M. Strand and her colleagues (based on the previous work of R.L Mikeal and D.C Brodie, published respectively in 1975 and 1980) classified the DTPs into eight different categories. According to these categories, pharmacists generated a list of the DTPs for each patient. As a result, pharmacists had a cleaner picture of the patient's drug therapy and medical conditions. A second publication of R.J Cipolle with L.M Strand in 1998, change the eight categories into seven, grouped in four Pharmacotherapy needs: indication, effectiveness, safety and adherence.

Examples

*Patients who have chronic pain that are prescribed

opioid Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, replacement therapy for opioid use ...

painkillers (such as

morphine Morphine is a strong opiate that is found naturally in opium, a dark brown resin in poppies (''Papaver somniferum''). It is mainly used as a pain medication, and is also commonly used recreationally, or to make other illicit opioids. T ...

) may build up a tolerance to the effect of the painkillers, requiring higher doses to achieve the same pain reducing effect. This risky practice of dose escalation can lead to drug overdoses. *Some drugs reduce the body's absorption of

essential nutrients A nutrient is a substance used by an organism to survive, grow, and reproduce. The requirement for dietary nutrient intake applies to animals, plants, fungi, and protists. Nutrients can be incorporated into cells for metabolic purposes or excre ...

from food, which could lead to

nutritional deficiencies Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues ...

The original eight problems

According to page 73 in ''Introduction to Health Care Delivery: A Primer for Pharmacists'', drug therapy problems (DTP) originated from Strand et al. (1990) who defined eight problems that could result in poorer health outcomes in an attempt to categorize DTP. Helper and Strand later in 1990 stated the mission statement or raison d'etre of pharmacists should be to correct these drug therapy problems. The original eight problems have now been condensed into seven categories of problems. As given by Shargel, they are: # Unnecessary drug therapy. This could occur when the patient has been placed on too many medications for their condition and the drug is simply not needed. # Wrong drug. This could occur when a patient is given medication that does not treat the patient's condition. Ex. A heart medication to treat an infection. # Dose too low. This could occur when a patient is given medication that is not strong enough to get beneficial or therapeutic effects. # Dose too high. This could occur when a patient is given medication that is too strong and is causing detrimental effects or is simply not necessary. # Adverse drug reaction. This could occur when a patient has an allergic response to a medication. # Inappropriate adherence. This could occur when a patient chooses not to or forgets to take a medication. # Needs additional drug therapy. This could occur when a patient needs more medication to treat their condition.

Further breakdown of categories

DRPs can be broken down further into the following categories:

Indication

''Requires Additional Drug Therapy'' * Untreated condition * Preventative / prophylactic * Synergistic / potentiating ''Unnecessary Drug Therapy'' * No medical indication * Duplicate therapy * Non-drug therapy indicated * Treating avoidable ADR

Effectiveness

''Requires Different Drug Product'' * More effective drug available * Condition refractory to drug * Dosage form inappropriate * Not effective for condition ''Dosage Too Low'' * Wrong dose * Frequency inappropriate * Duration inappropriate * Drug interaction

Safety

''Adverse Drug Reaction'' * Undesirable effect * Unsafe drug for patient * Dose changed too quickly * Allergic reaction * Contraindications present ''Dosage Too High'' * Wrong dose * Frequency inappropriate * Incorrect administration * Drug interaction

Adherence

''Non-adherence'' * Directions not understood * Patient prefers not to take * Patient forgets to take * Drug product too expensive * Cannot swallow/administer * Drug product not available

References

{{reflist Therapy Pharmacy