Rational therapeutics
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This lecture slides are prepared for Refresher course for pharmacist. Essential Medicines, Rational use of drugs and Self medication, These are the topics covered in this ppt.These slides are also useful for other medical undergraduates and post graduates students.
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Rational therapeutics
- 1. Rational Drug Therapy DR MAYUR A. CHAUDHARI ASSISTANT PROFESSOR DEPARTMENT OF PHARMACOLOGY GOVERNMENT MEDICAL COLLEGE, SURAT
- 2. Objectives • Essential Medicines • Rational Use of Drugs • Self Medication
- 3. Why Prescribe? • At any time 40-50% patients take Prescribed medicine • Final Deciding point for illness of Patient • ↑ number of new drugs • Complex disease pattern • Polypharmacy
- 4. Essential Medicines • Medicine That Satisfy • Priority Healthcare needs • Majority of population • At all time.
- 5. Essential Medicines • Carefully selected, Limited Medicines • Better Healthcare • Better Drug management • Lower Cost
- 6. WHO Essential Medicine List • 1977 First list with 200 substances • Revised every two years • 2007, separate list for pediatric population • April 2015, 19th list for adults and 5th list for Pediatric population
- 7. Selection criteria • Disease Prevalence • Efficacy • Safety • Cost effectiveness
- 8. Purpose • Available at all time • Adequate amount • Appropriate dosage form • Assured quality • Cost effective
- 9. Implementation • Flexible • Adaptable • According to national needs
- 10. National list of essential Medicine • The first National List of Essential Medicines of India - 1996. • Subsequently revised in 2003. • 2011- publication of revised list containing 348 drugs. • 47 drugs were deleted and 43 newer drugs were added
- 11. List of Essential Medicines, Diagnostics and surgical Items (14-15) Primary Health Care (PH C, Sub Centres and Othe rs)-(249) Secondary Health Care ( CHC & T.B.Hospitals)-(3 66) Tertiary Health Care (Dis tricts, Sub-Districts & M edical Colleges)-(538) Tablets & Capsules-(92) Tablets & Capsules-(123) Tablets & Capsules-(157) Injections-(57) Injections-(86) Injections-(155) Miscellaneous-(71) Miscellaneous-(84) Miscellaneous-(105) Surgicals-(19) Surgicals-(55) Surgicals-(103) Instruments-(10) Instruments-(18) Instruments-(18)
- 12. Rational Use of Drugs
- 13. Rational Use of Drugs “Rational use of medicines requires that the patients receive medi cation appropriate to their clinical needs in doses that meet their own individual requirements for an adequate period of time, and at the lowest cost to them and to their community” - WHO
- 14. Why Rational Use of Drugs? • Drug Explosion • Efforts to prevent the development of resistance • Growing awareness • Increased cost of treatment • Consumer protection acts
- 15. Goals of Rational Use • Maximizing effectiveness • Minimizing Risk • Minimizing Cost • Respecting Patient Choice
- 16. Criteria for Rational Use of Drugs • Appropriate Indication • Appropriate Drug • Appropriate Dose, Route and Duration • Appropriate Patient • Correct Dispensing • Adequate Monitoring
- 17. Some Irrationalities • Use of drug when none is needed • Compulsive coprescription • Drugs not related to the diagnosis • Wrong drug • Ineffective/Doubtful efficacy drugs
- 18. Irrationalities • Incorrect route of administration, Dose and duration • Drug combinations • Expensive medicines • Unsafe use of drugs • Polypharmacy
- 19. Dispensing - irrationalities • Incorrect interpretation of the prescription • Retrieval of wrong ingredients • Inaccurate counting, compounding, or pouring • Inadequate labelling
- 20. Dispensing - Irrationalities • Unsanitary procedures • Poor-quality packaging materials • Odd package size, which may require repackaging • Unappealing package
- 21. Impact of Irrational Prescribing • Delay in cure • More Adverse Drug Reactions • Prolonged Hospitalization • Loss of patients confidence in Dr • Loss to patient/community • Lowering of health standard
- 22. Influences on Prescription • Knowledge • Role Model • Patient Load • Symptomatic Relief • Indefinite diagnosis • Drug Promotion • Unethical incentive • Patient Demand
- 23. Process of rational prescribing • Establish diagnosis • Definite therapeutic problem and goal • Select right drug • Provide proper information • Monitor Goal • Monitor Compliance • Modify if needed • Monitor for ADR
- 24. Information/Instructions to the patient • Effects of Drug • Side effects • Instructions • Precautions/Warnings
- 25. Strategies to promote Rational use of Drugs Use of Medicines Educational Managerial Economic Regulatory
- 26. Educational Strategies • Training to healthcare providers • Printed materials • Media based approach
- 27. Managerial Strategies • Changes in selection, procurement, distribution • Ensure availability of essential drugs • Strategies aimed at prescribers • Dispensing strategies
- 28. Economic strategies • Avoid perverse financial incentives • Offering incentives to institutions, patients and providers.
- 29. Regulatory strategies • Drug registration • Banning unsafe drugs • Regulating the use of different drugs to different levels of the health sector • Regulating pharmaceutical promotional activities
- 30. Pharmacist’s Role • Member of drug and therapeutic committee • Drug Selection and Procurement • Inventory control • Dispensing • Information and Education • Pharmaceutical care • Pharmacovigilance
- 31. Drug Selection • Selection based on Essential Drugs • Strict inventory control and cost effective procurement • Select reliable suppliers of high quality products • Ensure timely delivery. • Achieve the lowest possible total cost.
- 32. Inventory control • Monitoring of drug stocks and minimizing out of stock • Restrict the number and brands of drugs. • Drugs with overdue expiry dates should not be dispensed or st ored. • All the drugs required to health facility should be kept in stock.
- 33. Information and education • Interaction with other health professionals • Awareness for ADR • Patient counselling
- 34. Pharmaceutical care • Pharmaceutical care is a philosophy of practice in which the pa tient is the primary beneficiary of the pharmacist’s actions.
- 35. Pharmaceutical care • Focuses on Attitude, Behaviour, Commitment, Concern, Ethics, Function, Knowledge and skill of pharmacist. • To achieve therapeutic outcome • Patient health and Quality of life.
- 36. Self Medication
- 37. Self-care • What people do to maintain/improve their health • Hygiene • Nutrition • Lifestyle • Living standard • Self Medication
- 38. Self Medication Taking pills for any ailment without Dr’s Prescription
- 39. Common Drugs • Pain relievers/Opioids • Antibiotics • Stimulants • Anti-Allergies • Laxatives • Antacids • Vitamins
- 40. Advantages • Time saving • Convenient • Economical • Enable patient to control their illness • Useful for mild illness • Less load on healthcare system
- 41. Disadvantages • Adverse drug reactions • Lack of knowledge about dose • Chances of using wrong medication • Risk of disease aggravation • Drug interactions
- 42. OTC Drugs • Drugs which are legally allowed to be sold without prescription • “Over the Counter” by Pharmacist
- 43. Take Home Message • Irrational use of drugs is a very serious problem • Much is known about how to promote rational use of drugs. • But, Much more needs to be done.
- 44. Thank You