ASHP Clinical Skills Competition


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Yesterday, I had an amazing experience of participating in the ASHP Clinical Skills Competition. For those who are not familiar, ASHP Clinical Skills Competition is held annual in Twin Cities and Duluth campus and is organized by American Society of Health-System Pharmacists (To see examples of cases, click here). Basically, each group of two students is presented with a real-life scenario of clinical case encountered in a hospital setting. Then, we navigate through a mirage of health conditions, uncontrolled disease states, and current medication list to construct a therapeutic case plan. Each case plan identifies goals of the treatment (ex. To lower blood cholesterol level in 2 weeks), recommendations for therapy (ex. Provastatin 10 mg PO once daily), and the methods of monitoring parameters (At the next visit, follow up with a lipid panel: Total cholesterol must be <200mg/dl, and LDL level <190mg/dl). The time limit is 2 hours. Then, we present our case to the panel of judges from Twin Cities and Duluth in 15 minutes. We are asked why we were given specific agent over the other, and what was our rationale in choosing specific therapy (ex. Why did you decide to prescribe both provastatin and rosuvastatin for cholesterol therapy?). At the battle field (read competition), I saw a glimpse of what real clinical pharmacist may encounter on a daily basis. First, it is not always black and white as to which symptoms the patient is experiencing corresponds to which health condition. A rise in temperature may signal that she has a cold (based on her present symptoms of a runny nose, headache, and stuffy nose). OR, it may due to her diagnosed condition of periocardititis (inflammation of pericardium, a thin membrane surrounding the heart). So when we explore possible monitoring parameters, we must be specific as to what we are looking for for the clearance of condition. Also, for the patients who has multitude of conditions such as diabetes, hypertension, hyperlipidemia, and COPD, it is imperative to ensure there are no drug-drug interactions between the medications she currently takes. For example, the inhalers prescribed for COPD, such as albuterol, are beta agonists, which bind to the beta receptors on the lungs and stimulate the dilation of bronchial muscles, leading to the relaxation of airways. For hypertension, the patient is also prescribed beta antagonists, which also produces the opposite effect on the bronchial muscles by binding to the beta receptors in the lungs and inhibiting the action of dilation of bronchial muscles. Such interaction between two opposite class of drugs may increase the risk of bronchospasm. As a pharmacist, we must be aware of the fact that one medication may bind to different receptor sites in our body, and cause different results on the different parts of our body (called reduced selectivity). It is our role to ensure that each medication has the specificity (determines the rate of the effect) and selectivity (determines the site of the action) to act on the organ of interest, and to weigh the benefit to risk options to provide the safest and the most effective therapy for the optimal health of the patient.

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