3. INTRODUCTION
Those that satisfy the priority healthcare needs of the population
• They are selected with due regard to
1. Public health relevance
2. Evidence on efficacy and safety and
3. Comparative cost effectiveness.
4. INTRODUCTION Cont …
• Essential medicines are intended to be available (within the context of
functioning health systems)
At all times and in adequate amounts
In appropriate dosage forms
With assured quality and adequate information
At a price the individual and the community can afford
5. CRITERIA FOR SELECTION OF
ESSENTIAL MEDICINE (WHO)
(1) Adequate data on its efficacy and safety should be available from
clinical studies.
(2) It should be available in a form in which quality, including
bioavailability, and stability on storage can be assured.
(3) Its choice should depend upon pattern of prevalent diseases;
availability of facilities and trained personnel; financial resources;
genetic, demographic and environmental factors.
6. CRITERIA FOR SELECTION OF
ESSENTIAL MEDICINE (WHO) cont
(4) In case of two or more similar medicines, choice should be made on the
basis of their relative efficacy, safety, quality, price and availability. Cost-
benefit ratio should be a major consideration.
(5) Choice may also be influenced by comparative pharmacokinetic
properties and local facilities for manufacture and storage.
(6) Most essential medicines should be single compounds. Fixed ratio
combination products should be included only when dosage of each
ingredient meets the requirements of a defined population group, and when
the combination has a proven advantage in therapeutic effect, safety,
adherence or in decreasing the emergence of drug resistance.
7. CRITERIA FOR SELECTION OF
ESSENTIAL MEDICINE (WHO) cont
(7) Selection of essential medicines should be a continuous process
which should take into account the changing priorities for public health
action, epidemiological conditions as well as availability of better
medicines/formulations and progress in pharmacological knowledge.
(8) Recently, it has been emphasized to select essential medicines based
on rationally developed treatment guidelines.
8. WHO MODEL LIST OF ESSENTIAL
DRUGS
• 1st list by WHO in 1977 along with their dosage forms and strengths
• Revised every 2 years by expert committee
• It is to guide the member countries which could be adopted after
suitable modifications according to local needs
• Current version (September 2021) –
22nd WHO essential medicine list
8th WHO essential medicine list for children
9. The WHO Model List Consists Of
CORE LIST COMPLEMENTARY LIST
• List of minimum medicine needs for
a basic health-care system,
• Listing the most efficacious, safe and
cost–effective medicines for priority
conditions (selected on the basis of
current and estimated future public
health relevance, and potential for
safe and cost-effective treatment).
• Essential medicines for priority
diseases, for which specialized
diagnostic/monitoring
facilities/specialist medical
care/specialist training are needed.
• In case of doubt medicines - listed as
complementary on the basis of
consistent higher costs or less
attractive cost-effectiveness in a
variety of settings.
10. Importance Of The WHO List
• Forms the basis of national drug policy.
• Procurement & supply of medicines in the public sector, schemes that
re-imburse medicine costs, medicine donations, and local medicine
production.
• International organizations, including UNICEF, UNFPA, NGOs and
international non-profit supply agencies, adopt the essential medicine
concept & base their medicine supply system mainly on the Model list.
• Powerful tool to promote health equity.
11. INDIAN LIST OF ESSENTIAL DRUGS
• 1st list in 1996
• Subsequently has revised it in 2003, 2011,2015 and now in Sep-2022
with the title "National List of Essential Medicines 2022".
• The latest list includes 384 drugs (34 added & 26 dropped from
previous list)
12. Need For National List Of Essential
Medicine (NLEM)
• Guide safe & effective treatment of priority disease conditions of a
population.
• Promote the rational use of medicines.
• Optimize the available health resources of a country
• It can also be a guiding document for:
State governments to prepare their list of essential medicines.
Procurement & supply of medicines in the public sector.
Reimbursement of cost of medicines by organizations to its employees.
Reimbursement by insurance companies.
Identifying the ‘MUST KNOW’ domain for the teaching & training of health
care professionals.
13. Levels Of Healthcare In NLEM
• The medicines are categorized based on level of healthcare system
as
P- Primary
S- Secondary
T- Tertiary
15. Prepare An Essential Drug List For An
Emergency Care Unit
STEP 1
• First visit an Emergency Care Unit & look carefully all the drugs that
are present in the emergency tray.
• You may find the following categories of drugs –
Analgesics
Antiemetics
Antacids
Antiallergics
Bronchodilators
Sedatives
Antiepileptics
Local anaesthetics
Anti-pyretic
Anti-cholinergics
Diuretics
Antibiotics
Drugs for hyperglycemia
Drugs for hypoglycemia
IV fludis
Miscellaneous
16. Prepare An Essential Drug List For An
Emergency Care Unit
STEP – 2
• Now go through the National List of Essential Medicines, India
(https://cdsco.gov.in/opencms/opencms/en/consumer/Essential-
Medicines/) and make a list of essential medicines.
20. INTRODUCTION
• The drugs that a physician is going to prescribe regularly and with
which he/she became familiar is called P (personal/preferred) - drug.
• Physician’s priority choice for given indications.
• P-drugs differ from country to country and between doctors.
• The P-drug concept includes –
Name of a drug, dosage form, dosage schedule, duration of
treatment for a specified condition.
21. Protocol To Select A P-drug
Step 1 – Define the diagnosis
Step 2 – Specify the therapeutic objectives
Step 3 – Make an inventory of effective groups of drugs
Step 4 – Choose an effective group according to criteria
Step 5 – Choose a P-drug from the Effective Group of Drugs.
22. Protocol To Select A P-drug Cont …
• A table of the various drugs and the four criteria (efficacy, safety,
suitability, and cost) is created and positive or negative points are
given to the various criteria for each drug.
Drug
Groups
Efficacy Safety Suitability Cost
Group 1
Group 2
Group 3
23. Step 1: Define the diagnosis
Case
A 60 years old male is getting repeated attacks of constricting chest pain
starting with exercise and relieving with rest, since one month.
Diagnosis
Stable angina pectoris due to partial coronary occlusion and myocardial
ischemia.
24. Step 2: Specify the therapeutic objective
To prevent pain coming with effort
To decrease the oxygen need of myocardium
To increase the perfusion of myocardium
25. Step 3: Make an inventory of effective
groups of drugs (look for the evidence)
Preload Contractility Rate Afterload
Nitrates ++ - - ++
Beta-
blockers
+ ++ ++ ++
Ca channel
blockers
+ ++ ++ ++
26. Step 3: Make an inventory of effective
groups of drugs (look for the evidence)
Cont …
Efficacy
(Pharmacodynamics)
Safety
(Side effects)
Contraindications
NITRATES
Peripheral vasodilatation Headache, nitrate intoxication Hypotension, anemia, Sildenafil usage
BETA-BLOCKERS
Decrease in heart contractility and
rate
Hypotension, bradyarrhythmia,
impotence
Asthma, Decompensated heart
failure, DM
CACIUM CHANNEL BLOCKERS
Coronary and peripheral
vasodilatation, decrease in heart rate
and contractility
Hypotension, dizziness, bradycardia,
heart failure
Hypotension, congestive heart
failure, AV block
27. Step 4: Choose a group according to
criteria
Efficacy Safety Suitability Cost
Nitrates +++ +++ ++ -
Beta-blockers +++ ++ + ++
Ca channel
blockers
+++ ++ + ++
Hence it can be concluded that among the three groups of drugs, nitrates are the
group of first choice considering efficacy, safety, suitability and the cost.
28. Step 5: Choose a P-drug from the Effective
Group of Drugs
Efficacy Safety Suitability Cost
Glyceryl
trinitrate
+++ ++ +++ +
Isosorbide
dinitrate
+++ ++ ++ ++
Isosorbide
mononitrate
+++ ++ ++ ++
29. Protocol To Select A P-drug Cont …
• Indication : stable angina pectoris
• P-drug
Name: Glyceryl trinitrate
Dose available :
Use:
Duration:
• Here we can note that
The selection of group of drugs was based on the knowledge of
pathophysiology and pharmacology.
In selection of drug from the selected group, other factors were
given importance.
30. Protocol To Select A P-drug Cont …
• Write the P- drug as :-
Active substance (generic name)
Dosage form
Route of administration
Dosage schedule
Duration of treatment
Information and warning to the patient
• Monitor the treatment through follow-ups
32. Case Situation
A 40 years old male patient comes to a physician with complains of
running nose, sneezing, headache and pain in nose and throat since
yesterday. On examination patient is not febrile but throat is inflamed.
• In this case the physician decides to prescribe
One antihistaminic
One NSAID
33. Case Situation Cont …
• Physician prescribes
Tablet Cetirizine 10 mg orally once a day and
Tablet Paracetamol 500 mg orally three times a day.
• The physician has been using these drugs since many years and is
confident of the safety, efficacy, suitability, and cost of therapy of
these drugs.
• So rather than doing a literature review the physician selected these
drugs from his list of P-drugs.
