GIVE RELAXED ATTENTION
ONE OF THE FIRST DUTIES OF THE PHYSICIAN IS TO EDUCATE THE     MASSES NOT TO TAKE         MEDICINE….!
PRINCIPLES OFPRESCRIBING  Dr. V.SATHYANARAYANAN M.D PROFESSOR OF PHARMACOLOGY          SRM MCH & RC
PRINCIPLES OF PRESCRIBING   AT ANY TIME 40-50% OF ADULTS TAKE    PRESCRIBED MEDICINE.   PRESCRIPTION IS THE FINAL DECIDI...
IMPACT OF IRRATIONAL    PRESCRIBING   Delay in cure   More adverse effects   Prolonged hospitalisation   Emergence of ...
WHAT DOES IT REQUIRE?
FOLLOW GOODPRESCRIBING
WHAT IS GOODPRESCRIBING?
WHAT IS GOOD     PRESCRIBING?   Appropriate drug   in the correct dosage of an Appropriate    formulation   At the corr...
GOOD PRESCRIBING   It includes not prescribing any drug at    all.
GOOD PRESCRIBINGREQUIRES:   DETAILED KNOWLEDGE OF THE    PATHOPHYSIOLOGY OF THE DISEASE   CLINICAL PHARMACOLOGY OF THE  ...
PRESCRIBING IS NOT SIMPLYMATCHING THE DISEASE ANDTHE DRUG….…!
INDIVIDUALISE THETHERAPY
TWO HELPFUL CONCEPTS   BENEFIT: RISK RATIO   EVIDENCE BASED MEDICINE
BENEFIT:RISK RATIOIN PRESCRIBING
THE BENEFIT:RISK RATIO IN    PRESCRIBING   Benefits to the patient is accompanied by    the risk of Adverse effects   Al...
ASSESSING RISK:BENEFIT      RATIO    Consider five factors:1)   The seriousness of the Problem to be treated1)   The effi...
SOME EXAMPLES   Choice of an antibiotic in UTI in a 2    month pregnant woman.
Elderly lady with giant cell arteritis treated withprednislone
Treating male elderly patient with Anginapectoris for impotence
EVIDENCE-BASED    MEDICINE   Search and evaluate the literature for    efficacy,    safety   Appropriateness of the pa...
Clinical decisions should be based on thebest scientific evidence available at the time.
EVIDENCE-BASED   MEDICINEThis can be obtained from: Standard text books Review articles from leading journals Other doc...
EVIDENCE-BASED MEDICINE     Therapeutic decisions should be     rationally guided by    Rigorous analysis of the best ava...
HOW TO CHOOSE A DRUG?
HOW TO CHOOSE A      DRUG ?   Ask the following sequence of questions before    writing the prescription   Indicated?!!...
HOW TO CHOOSE A     DRUG ?ASK THE FOLLOWING QUESTIONS BEFORE  WRITING THE PRESCRIPTION1)Is drug therapy indicated ? A) Is...
WHICH DRUG ? If drug therapy is indicated, select the therapeutic class Select the group within the class Select the p...
HOW TO MAKE A RATIONALCHOICE OF THE DRUG ?
HOW TO MAKE A RATIONALCHOICE? Choose the drugs which you are most familiar.Consider following factors: Pharmacokinetic (...
WHICH ROUTE OFADMINISTRATION?
WHICH ROUTE OFADMINISTRATION?     DICTATED BY THE DRUG CHOSEN. (Ex.      Dopamine)     Sometimes particular route is pre...
WHICH FORMULATION ?
WHICH FORMULATION ? Oral  tab, cap, granules, suspension, syrup Injection powders for reconstitution, solution  ready ...
WHAT DOSAGE REGIMEN?
WHAT DOSAGE REGIMEN?   IT HAS THREE ASPECTS:1) The dose of the drug.2) The frequency of it’s administration.3) The timing
PRINCIPLES THAT GOVERNDOSAGE REGIMEN: BE FLEXIBLE   Pharmacokinetic variability-(absorption,    metabolism, elimination) ...
TAILORING THE DOSAGE        REGIMEN : BE SYSTEMATIC   Look up in a reliable source.   Consider dose related toxicity of ...
HOW FREQUENTLY?
HOW FREQUENTLY TO     ADMINISTER?   Usually fixed of a given drug in a given    formulation   Sometimes need to be alter...
TIMING
TIMING OF DRUG       ADMINISTRATION   In most cases - Fixed.   To minimize the ADR- last thing at night   Timing may be...
FOR HOW LONG ?
FOR HOW LONG ?   It depends on nature of the disease,    symptoms & collective experience.   The scale varies from singl...
FOR HOW LONG SHOULD      TREATMENT LAST?   Antibiotics duration varies from infection    to infection   It depends on i...
GOOD PRESCRIBING IS TOGIVE:   RIGHT DRUG IN THE RIGHT DOSAGE   RIGHT FORMULATION   AT THE RIGHT FREQUENCY   FOR THE RI...
PROCESS OF RATIONALPRESCRIBING      Establish a diagnosis      Define therapeutic problem and goal      Select the righ...
INSTRUCTIONS TO THEPATIENT   Effects of the drug   Side effects   Why, How and when instructions   Precautions/ warnings
The good physician treats the disease;The great physician treats the patientwho has the disease !                      WIL...
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
Principles of prescribing --  satya
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Principles of prescribing -- satya

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an important ppt for medical students and prescribing clinicians of medicine..... which deals with the methodology of right prescribing...... enjoy reading.... <3.... satya

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Principles of prescribing -- satya

  1. 1. GIVE RELAXED ATTENTION
  2. 2. ONE OF THE FIRST DUTIES OF THE PHYSICIAN IS TO EDUCATE THE MASSES NOT TO TAKE MEDICINE….!
  3. 3. PRINCIPLES OFPRESCRIBING Dr. V.SATHYANARAYANAN M.D PROFESSOR OF PHARMACOLOGY SRM MCH & RC
  4. 4. PRINCIPLES OF PRESCRIBING AT ANY TIME 40-50% OF ADULTS TAKE PRESCRIBED MEDICINE. PRESCRIPTION IS THE FINAL DECIDING THING FOR THE ILLNESS PATIENT INCREASE IN NUMBER OF NEW DRUGS. COMPLEX DISEASE PATTERN. POLYPHARMACY.
  5. 5. IMPACT OF IRRATIONAL PRESCRIBING Delay in cure More adverse effects Prolonged hospitalisation Emergence of antimicrobial resistance Loss of patient’s confidence in the doctor Loss to the patient/community Lowering of health standards
  6. 6. WHAT DOES IT REQUIRE?
  7. 7. FOLLOW GOODPRESCRIBING
  8. 8. WHAT IS GOODPRESCRIBING?
  9. 9. WHAT IS GOOD PRESCRIBING? Appropriate drug in the correct dosage of an Appropriate formulation At the correct frequency of administration For the correct length of time.
  10. 10. GOOD PRESCRIBING It includes not prescribing any drug at all.
  11. 11. GOOD PRESCRIBINGREQUIRES: DETAILED KNOWLEDGE OF THE PATHOPHYSIOLOGY OF THE DISEASE CLINICAL PHARMACOLOGY OF THE DRUGS
  12. 12. PRESCRIBING IS NOT SIMPLYMATCHING THE DISEASE ANDTHE DRUG….…!
  13. 13. INDIVIDUALISE THETHERAPY
  14. 14. TWO HELPFUL CONCEPTS BENEFIT: RISK RATIO EVIDENCE BASED MEDICINE
  15. 15. BENEFIT:RISK RATIOIN PRESCRIBING
  16. 16. THE BENEFIT:RISK RATIO IN PRESCRIBING Benefits to the patient is accompanied by the risk of Adverse effects Always try to assess the likely Benefit : risk ratio before instituting therapy.
  17. 17. ASSESSING RISK:BENEFIT RATIO Consider five factors:1) The seriousness of the Problem to be treated1) The efficacy of the drug you intend to use.2) The seriousness & frequency of possible ADR3) The safety of other drugs that might be used instead4) The efficacy of other drugs that might be used instead
  18. 18. SOME EXAMPLES Choice of an antibiotic in UTI in a 2 month pregnant woman.
  19. 19. Elderly lady with giant cell arteritis treated withprednislone
  20. 20. Treating male elderly patient with Anginapectoris for impotence
  21. 21. EVIDENCE-BASED MEDICINE Search and evaluate the literature for efficacy, safety Appropriateness of the particular therapeutic measure
  22. 22. Clinical decisions should be based on thebest scientific evidence available at the time.
  23. 23. EVIDENCE-BASED MEDICINEThis can be obtained from: Standard text books Review articles from leading journals Other doctors (lectures, CME etc.) Systematic review of clinical trials (published and unpublished) Websites and Database
  24. 24. EVIDENCE-BASED MEDICINE Therapeutic decisions should be rationally guided by  Rigorous analysis of the best available evidence.  Unbiased analysis.
  25. 25. HOW TO CHOOSE A DRUG?
  26. 26. HOW TO CHOOSE A DRUG ? Ask the following sequence of questions before writing the prescription Indicated?!! Which drug? Which class---which group----which particular drug Which route? Which formulation? What dosage regimen? With experience, the process becomes automatic
  27. 27. HOW TO CHOOSE A DRUG ?ASK THE FOLLOWING QUESTIONS BEFORE WRITING THE PRESCRIPTION1)Is drug therapy indicated ? A) Is the intending treatment necessary? B) Is the benefit greater than the risk?Ex) Vitamins & minerals as tonics in the absence of any evidence of deficiency antibiotics in acute diarrheas cerebral vasodilators in senile dementia
  28. 28. WHICH DRUG ? If drug therapy is indicated, select the therapeutic class Select the group within the class Select the particular drug in the groupEx) infection antibiotic (therapeutic class)  penicillins (therapeutic group) amoxicillin (particular drug). CHF, hypertension  selection complicated
  29. 29. HOW TO MAKE A RATIONALCHOICE OF THE DRUG ?
  30. 30. HOW TO MAKE A RATIONALCHOICE? Choose the drugs which you are most familiar.Consider following factors: Pharmacokinetic (Absorption, distribution, metabolism, excretion) Pharmacodynamic ( potency-sulfonylureas in DM ) Therapeutic considerations.( disease features, severity, co-existing diseases, avoidance of ADR, Adverse drug Interactions) Patient compliance
  31. 31. WHICH ROUTE OFADMINISTRATION?
  32. 32. WHICH ROUTE OFADMINISTRATION?  DICTATED BY THE DRUG CHOSEN. (Ex. Dopamine)  Sometimes particular route is preferred for particular benefit. (Ex. Nitrates in angina pectoris)  Rectal route diazepam in children  I.M depot inj. In schizophrenia to ensure compliance.  S.C insulin for prolonged effect.  I.V Furosemide in CHF
  33. 33. WHICH FORMULATION ?
  34. 34. WHICH FORMULATION ? Oral  tab, cap, granules, suspension, syrup Injection powders for reconstitution, solution ready for inj. (Single, multiple dose)Choice depends on: Ability to produce adequate plasma concentration Patient compliance (sustained release) Side effects (enteric coated aspirin) Age- children –pleasant tasting suspension, old- tasteless solution
  35. 35. WHAT DOSAGE REGIMEN?
  36. 36. WHAT DOSAGE REGIMEN? IT HAS THREE ASPECTS:1) The dose of the drug.2) The frequency of it’s administration.3) The timing
  37. 37. PRINCIPLES THAT GOVERNDOSAGE REGIMEN: BE FLEXIBLE Pharmacokinetic variability-(absorption, metabolism, elimination) increase Or decrease Dose Pharmacodynamic variability- DRC varies between individuals, no response in initial dose increase the dose without ADR Patient factors- age, body wt, hepatic and renal function. Disease factors- degree of the disease (ex- NSAIDS in inflammation)
  38. 38. TAILORING THE DOSAGE REGIMEN : BE SYSTEMATIC Look up in a reliable source. Consider dose related toxicity of the drug (ex- more for lithium , gentamicin, digoxin, phenytoin) Decide on the initial dosage.( generally start at the lower end, increase it gradually), be flexible Consider pharmacokinetic factors that alter dosage ( renal insufficiency) Consider DRC (ex- insulin required more in diabetic ketoacidosis) Consider drug interactions Other factors like Age, weight
  39. 39. HOW FREQUENTLY?
  40. 40. HOW FREQUENTLY TO ADMINISTER? Usually fixed of a given drug in a given formulation Sometimes need to be altered according to the frequency of symptoms (ex- GTN in angina) To prevent ADR ex-corticosteroids on alternate days To improve compliance –(MR preparations)
  41. 41. TIMING
  42. 42. TIMING OF DRUG ADMINISTRATION In most cases - Fixed. To minimize the ADR- last thing at night Timing may be important in some cases ( ex- diuretics, sedatives, corticosteroids) Timing of symptoms ( ex- antacids, NSAIDS, GTN) Timing in relation to the meals (ex-most penicillins, tetracyclines, azithromycin best before food, NSAIDs like aspirin with food)
  43. 43. FOR HOW LONG ?
  44. 44. FOR HOW LONG ? It depends on nature of the disease, symptoms & collective experience. The scale varies from single dose of aspirin for headache to life long treatment for diabetes, hypertension. Difficulty & controversy arise in treatment of intermediate duration
  45. 45. FOR HOW LONG SHOULD TREATMENT LAST? Antibiotics duration varies from infection to infection It depends on infecting organism, site of infection, response to treatment( ex- penicillin for tonsillitis- 7-10 days, NGU - 10- 21 days, tuberculosis 6-12 months) Warfarin in DFT- duration uncertain
  46. 46. GOOD PRESCRIBING IS TOGIVE: RIGHT DRUG IN THE RIGHT DOSAGE RIGHT FORMULATION AT THE RIGHT FREQUENCY FOR THE RIGHT DURATION
  47. 47. PROCESS OF RATIONALPRESCRIBING  Establish a diagnosis  Define therapeutic problem and goal  Select the right drug by good prescribing  Provide proper information  Monitor compliance  Monitor goal  Modify if needed  Monitor ADR if occur & modify
  48. 48. INSTRUCTIONS TO THEPATIENT Effects of the drug Side effects Why, How and when instructions Precautions/ warnings
  49. 49. The good physician treats the disease;The great physician treats the patientwho has the disease ! WILLIAM OSLER

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