Patient Name __KL__________________________ Pharmacist Name__EB________________________ Date__March 4____________

Medical Desired Outcomes / Goals Drug Therapy Problems Therapeutic Alternatives Recommendation Monitoring Parameters
Condition / of Therapy (Pharmacologic and Non- with Justification
Indication pharmacologic)
Parameter Value Parameter Frequency
Timeframe Who
Alzheimer’s 1)  Slow  progression  of   KL  is  experiencing  nausea   Discontinue rivastigmine Hold Rivastigmine
disease alzheimer’s  disease   ,abdominal  distension,   Hold rivastigmine then lower Adverse  effects  are   Efficacy
*Decrease  progression  of   increased  bowel  sounds,  and   dose dose  dependent  and  
memory  loss  and  maintain   diarrhea  ,  an  adverse  effect   Change to another alternative more  likely  to  occur  in   Resolution  of  nausea,  diarrhea,  
MMSE  equal  to  or  greater   of  taking  rivastigmine   such as donepezil or the  early  titration   abdominal  distention,  and  rebound  
than  17  within  24  weeks   galantamine phase,  on  an  empty   tenderness  in  2  days  to  be  followed  up  
2)Resolve  signs  and   stomach,  and  with  fast   by  the  pharmacist  
symptoms     titration.  
*Ensure  patient  is  able  to   Cognitive  function  including  (ADAS-­‐
remember  groceries,  attend   Cog,  MMSE,  CIBIS-­‐Plus  Scale)  Initially  
bridge  club  and  complete   at  4-­‐6  weeks  to  assess  for  need  to  
other  activities  of  daily  living   titrate  dose  then  every  3  months  by  
within  24  weeks   the  geriatrician  
3)    Improve  quality  of  life   Forgetting  to  attend  bridge  club  and  
4)  Minimize  adverse  drug   pick  up  groceries  at  same  frequency  
events     as  cognitive  function  by  pharmacist
*No  diarrhea,  nausea,  
abdominal  distension,  
increased  bowel  sounds   Toxicity
within  48  hours  
5)  Minimize  cost  
CNS:  Headache  and  dizziness,  fatigue,  
insomnia,  agitation,  anxiety,  
parkinsonism  symptoms,  depression  
RESP:  Rhinitis  
CVS:  bradycardia  (HR),  syncope,  HTN  
(BP)  
GI:  Nausea,  vomiting,  diarrhea,  
anorexia,  abdominal  distension  and  
rebound  tenderness,  weight  
 
Assess  all  the  above  ADRs  initially  
every  1-­‐2  weeks  and  if  tolerating  then  
every  3  months  with  each  follow  up  
visit  by  the  pharmacists
Clinical  Care  Plan  Template  –  AY  13   1  
                    

Medical Desired Outcomes / Goals Drug Therapy Problems Therapeutic Alternatives Recommendation Monitoring Parameters
Condition / of Therapy (Pharmacologic and Non- with Justification
Indication pharmacologic)
Parameter Value Parameter Frequency
Timeframe Who
Non-pharmacologic
Insomnia Resolve morning KL is experiencing morning Non-pharmacologic options will be chosen Efficacy
drowsiness within one week time drowsiness and is - Reduce day time naps given this patient is
Ensure patient is able to unable to sleep at night, a -­‐  Avoid  (or  minimize)   elderly and at risk of Number of hours of sleep each night
sleep at least 8 hours per possible indication for drug caffeine  later  lunch   serious side effective by the patient
night therapy from use of sedative Morning fatigue by the patient
Decrease day time naps to -­‐  Ensure  a  quiet   agents
no more than 1 hour per environment  to  sleep   In addition, the patient Patient to monitor each day and
day -­‐  Increase  daytime  exercise   has a number of pharmacist to follow up in 1 week
Prevent complications such -­‐  Relaxation  techniques   reversible lifestyle then at each visit
as falls, worsening causes of insomnia
confusion or delirium
  and sleep
Improve quality of life Pharmacologic   disturbances that are Safety
Minimize events to -­‐ Benzodiazepine   likely contributors
treatment receptor  agonists   None as non-pharmacologic therapy
-­‐ Benzodiazepines   chosen
-­‐ Antihistamines  

Clinical  Care  Plan  Template  –  AY  13   2