This document discusses essential medicines and the concept of "P drugs". It defines essential medicines as those that satisfy the priority health care needs of most populations. The World Health Organization publishes an Essential Medicines List every two years that includes efficacious, safe, and cost-effective medicines for priority conditions. National governments also publish their own lists. Medicines are categorized as primary, secondary, or tertiary based on the level of health care needed. Choosing a "P drug" involves defining the diagnosis, treatment objective, listing effective drug groups, and selecting the most effective, suitable, safe, and affordable drug within the chosen group for treating a condition.

1. SMS MEDICAL COLLEGE, JAIPUR
PRINCIPLES OF ESSENTIAL MEDICINE
LIST AND CONCEPT OF ‘P’ DRUG
-DR.JAYA DADHICH

2. LEARNING OBJECTIVES
• Defining essential medicines
• Origin of concept of essential medicines
• History of essential medicine list
• Parts of essential medicine list
• How to choose essential medicines
• Good prescribing practises
• Rationality of use of drugs
• P DRUG concept
• How to choose a P drug

3. Definition
• As per WHO 1975
“The Essential Drugs are those drugs that
satisfy healthcare needs of the majority of the
population and which should, therefore, be
available at all times, in adequate amounts
and in appropriate dosage forms.”
• As per WHO 2002
“That satisfy the priority health care needs of
the population”

4. Why EML?
For
• Better health care
• Better drug management
• Lowering cost

5. 40 years of essential medicines

6. 1975- Only a handful of drugs are required to treat
most of the diseases, in most of the people for most of
the times….
According to WHO directives such drugs should be
available in all hospitals at all times…..

7. • 1977 first model of Essential drug list was
published by WHO which included 208 active
substances.
• The EML is updated and revised every two
years by the WHO Expert Committee on the
Selection and Use of Essential Medicines
• 2003 term “Essential Medicine” was used to
replace “Essential Drug.”
• 2015 19th model of Essential medicine list was
published
• 2017 Latest 20th essential medicine list has
been published which includes 433 drugs.

8. Choice of essential drugs
• Depends upon several factors such as

9. The Essential Medicines Target
S S
All the drugs
in the world
Registered medicines
National list of
essential medicines
Levels of use
Supplementary
specialist
medicines
CHW
dispensary
Health center
Hospital
Referral hospital
Private sector
Selection

11. list
• Who and NLEM AND STATE

12. Parts of Essential medicine list
• The core list presents a list of minimum
medicine needs for a basic health-care system,
listing the most efficacious, safe and cost–
effective medicines for priority conditions.
Priority conditions are selected on the basis of
current and estimated future public health
relevance, and potential for safe and cost-
effective treatment.

13. • The complementary list presents essential
medicines for priority diseases, for which
specialized diagnostic or monitoring facilities,
and/or specialist medical care, and/or specialist
training are needed.
In case of doubt medicines may also be listed as
complementary on the basis of consistent higher
costs or less attractive cost effectiveness in a
variety of settings.

14. • In India NATIONAL LIST OF ESSENTIAL MEDICINES
(NLEM) was first released in 1996 and revised in
2003.
• There were 348 medicines listed in NLEM 2011. A
total of 106 medicines have been added, and 70
medicines have been deleted to prepare NLEM
2015 which now contains a total of 376
medicines.

16. • Medicines in NLEM are listed with reference
to the levels of healthcare, namely
a) Primary (P)
b) Secondary (S)
c) Tertiary (T).
There are 209 medicine formulations listed
for all levels of health care (P, S, T), 115
medicine formulations for secondary and
tertiary levels (S, T) and 79 medicine
formulations for the tertiary level (T)

17. State list of medicines

18. Criterias for deletion of a medicine
• Medicine has been banned
• Medicine with better efficacy and safety
profile is available
• Disease burden is no longer a national health
concern
• In case of antimicrobials resistance pattern
has rendered the drug ineffective
• Reports of serious side effects

24. • In short rational use of drugs is based on Rule of
Right
1. Right drug to
2. Right patient
3. In Right dosage
4. At a Right cost
5. With the Right documentation
• SANE criteria which means that Safety,
Affordability, Need and Efficacy should always
be considered.

26. ‘P’ Drug
• P drug means preferred drug or personal drug
• Every doctor should choose his P drug to treat a
particular disease
• Steps in choosing a P drug are
i. Define the diagnosis
ii. Specify the therapeutic objective
iii. Make a list of effective group of drug
iv. Choose an effective group by comparing
efficacy, suitability, safety, and cost of treatment
v. Choose a P drug from effective group of drug

27. Example
1. Stable angina pectoris-final diagnosis according to
presentation and investigations
2. Aim of therapy will be…quick relief from pain
by increasing oxygen supply or by reducing the oxygen
demand
difficult to increase the oxygen supply in case of
arteriosclerotic occlusion so to reduce demand we can
• Decrease preload or
• Decrease contractility or
• Decrease heart rate or
• Decrease the afterload

28. 3. List of Effective group of drugs
• Nitrates
• Calcium channel blockers
• Beta blockers
4. Choosing an effective group
• Efficacy
• Safety side effects
• Suitability dosage forms
• Cost of treatment

29. 5. Choose a P drug from effective group
according to efficacy, safety, suitability, cost
Sublingual Nitroglycerine 1 mg
Isosorbide dinitrate