Rational Use Of Drugs....

1. PRESENTED BY
ANJALI.C
I YEAR M.PHARM
GRACE COLLEGE OF
PHARMACY
RATIONAL USE OF DRUGS
(RUD)
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2. DEFINITION
• In simplest words rational use means
“prescribing right drug, in adequate dose for
the sufficient duration & appropriate to the
clinical needs of the patient at lowest cost
• WHO: The rational use of drugs requires that
patients receive medications 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 their community
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3. ‘CRITERIA’ FOR USING MEDICINES
• Appropriate indication
• Appropriate drug
• Affordable
• Appropriate administration,
dosage and duration
• Appropriate patient
• Appropriate patient
information
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4. FACTORS
THAT HAVE
LED SUDDEN
REALISATION
FOR RUD
Drug
explosion
Efforts to
prevent the
developme
nt of
resistance
Growing
awareness
Increased
cost of the
treatment
Consumer
protection
Act
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5. REASONS FOR IRRATIONAL USE OF DRUGS
Lack of information
Faulty & Inadequate training & education of medical graduates
Poor communication between health professional & patient
Lack of diagnostic facilities/Uncertainity of diagnosis
Demand from patient
Defective drug supply system &ineffective drug regulation
Promotinal activities of pharmaceutical industries
Self –medication
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6. SOME BROAD CATEGORIES OF DRUGS WHICH
ARE MISUSED OR IRRATIONALLY USED
ANTIBIOTICS
• Penicillins
• Ampicillin
• Amoxicillin
• Tetracyclins
MUSCULO-SKELETAL DRUGS
• Dextropropoxyphene
• Aspirin
• Ibuprofen
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7. CENTRAL NERVOUS SYSTEM DRUGS
• Diazepam
• Lorazepam
• Imipramine,Nortriptalline and Amitriptalline
ALIMENTARY SYSTEM DRUGS
• Antacids
• Laxatives,Purgatives and Lubricants
• Antidiarrhoeals
RESPIRATORY SYSTEM DRUGS
• Bromhexine
• Salbutamol
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8. HORMONES
• Estrogen-Progestin combination in high
doses(EF forte) used to cause abortion
• Anabolic steroids like androlone,stanozolol
VITAMINS
OTHER MISCELLANEOUS DRUGS
• Naphazoline and Xylomethazoline
• Oral Antidiabetic
drugs:Glibenclamide,Gliclazide,metformin
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9. HAZARDS OF IRRATIONAL USE
• Ineffective & unsafe treatment
▫ over-treatment of mild illness
▫ inadequate treatment of serious illness
• Exacerbation or prolongation of illness
• Distress & harm to patient
• Increase the cost of treatment
• Increased drug resistance - misuse of anti-
infective drugs
• Increased Adverse Drug Events
• Increased morbidity and mortality
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10. OBSTACLES EXIST IN RATIONAL DRUG USE
• Lack of objective information & of continuing
education &training in pharmacology.
• Lack of well organized drug regulatory authority
& supply of drugs.
• Presence of large number of drugs in the market
& the lucrative methods of promotion of drugs
employed by pharmaceutical industries.
• The prevalent belief that” every ill has a pill”
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11. RATIONAL DRUG USE CAN BE
MONITORED BY
• Aggregate medicine consumption data:
• WHO drug use indicators
• The Anatomical Therapeutic Chemical (ATC)
classification and defined daily dose (DDD)
methodology
• Drug Utilisation review(DUR) or focused drug use
evaluation
• Qualitative methods
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12. Selected WHO/INRUD drug use indicators for
health care facilities
• Prescribing indicators:
• Average number of medicines prescribed per patient encounter
• % of medicines prescribed by generic name
• % of encounters with an antibiotic prescribed
• % of encounters with an injection prescribed
• % of medicines prescribed from essential medicines list or
formulary
• Patient care indicators
• Average consultation time:
• Average dispensing time
• % of medicine actually dispensed
• % of medicines adequately labelled
• % of patients with knowledge of correct doses.
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13. • Facility indicators
• Availability of essential medicines list or formulary to
practitioners
• Availability of clinical guidelines
• % of key medicines available
• Complementary drug use indicators:
• Average medicines cost per encounter
• % of prescriber in accordance with clinical
guidelines.
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14. STRATEGIES TO IMPRTOVE RATIONAL
USE OF DRUGS(RUD)
• Educational
• Managerial
• Regulatory
• Economic
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15. EDUCATIONAL STRATEGIES
• Training prescribers
• Format education
• Continuing Education (CE)
• Educational outreach
• Patient and public education in drug use
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16. REGULATORY MEASURES
• Drug registration
• Evaluation of drug and product information
• Scheduling drugs for different levels of use
for both prescribing and distribution
• Dispensing controls
• Specifying minimum level of education for
prescriber or health care professional
• Restrictions on use of packaging materials of
drugs and labelling
• Regulating pharmaceutical promotion
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17. MANAGERIAL STRATEGIES
• Selection ,procurement and distribution of drugs
• Limited procurement list
• DUR(drug utilization review)
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18. ECONOMIC
• Offering incentives to institutions, patients and
providers.
• Many insurance agencies and some governments
reimburse only if medicines are chosen from a
restricted list.
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19. STEPS TO IMPROVE RATIONAL DRUG
PRESCRIBING
Step:- I
• Identify the patient’s problem based
on symptoms & recognize the need for
action.
Step:-II
• Diagnosis of the disease. Identify
underlying cause & motivating factors.
Step:-III
• List possible intervention or
treatment
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20. Step:-IV
• Start the treatment by writing an accurate &
complete prescription
Step:-V
• Given proper information instruction & warning
regarding the treatment given
Step:-VI
• Monitor the treatment to check, if the particular
treatment has solved the patient’s problem
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21. ROLE OF PHARMACIST IN THE PROMOTION
OF RATIONAL USE OF DRUGS
Member of the drug and therapeutics
committee
Drug procurement
Drug storage
Dispensing
Patient education
Pharmacovigilence
Drug information services
Pharmaceutical care
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