Pharmacotherapeutics is the study of therapeutic uses and effects of drugs. It involves determining treatment objectives, selecting appropriate drugs, dosages, and treatment durations based on factors like the disease stage and patient characteristics. Rational pharmacotherapy means medicines are prescribed, delivered, and explained properly to patients. Evidence-based medicine systematically uses clinical research evidence to make patient care decisions. An essential medicines list identifies the most effective and safe medicines needed in a health system, based on disease prevalence, costs, and availability.

1. INTRODUCTION TO
PHARMACOTHERAPEUTI
CS
By: Mr. Kiran B. Dhamak

2. Learning Objectives
 After studying the chapter, students will be able to
 Understand the concept of Pharmacotherapeutics
 Explain rational use of medicine
 Understand the concept of evidence based
medicine
 Use essential medicines list
 Understand the concept of standard treatment
guidelines
 Assess their knowledge and understand the
chapter through practice questions

3. Introduction
 Pharmacotherapeutics is a branch of
Pharmacology.
 It is the study of therapeutic uses and effects of
drugs.
 It is the application of pharmacological information
of drugs to prevent mitigate treat and diagnose
diseases as well as to change normal functions
(such as contraception).
 It includes determination of therapeutic objectives
selection of the most appropriate drug, route of
administration, dosage and duration of treatment
considering.

4. Pharmacotherapeutics is the study of
therapeutic uses and effects of drugs.
 Stage of disease
 The patient's current drugs
 Pharmacokinetics of drugs
 Contraindications
 Adverse effects of drugs
 The specific features of a patient

5.  Only Rational Pharmacotherapy brings good
treatment results.
 Rational pharmacotherapy means that medications
are prescribed sensibly delivered correctly and that
the patient is given the required information about
taking them.
 Knowledge of pharmacotherapy is essential to
practice medicine.
 Appropriate pharmacotherapy helps patients to
maintain their functional capacity and reduce the costs
to both patients and society.
 The other forms of therapies to treat diseases are
surgical therapy, physical therapy, radiation therapy,
etc

6. Scope
 The study of Pharmacotherapeutics imparts
knowledge and skills necessary to contribution to
quality use of medicines.
 Pharmacotherapy focuses on the relationship
between drugs and their safe and efficient use to
humans.
 It ensures proper and rational use of drugs.
 Determination of therapeutic objectives, selection
of the most appropriate drug dosage and duration
of treatment considering the stage of disease and
the specific feature of a patient are a part of
pharmacotherapeutics

7. Objectives
 The main objective of pharmacotherapeutics is to
enhance the safety of prescription maximize the
effects of drugs and to minimize side effects.
 To prepare individualized therapeutic plans based
on diagnosis
 To achieve defined therapeutic goals to improve a
patient's quality of life while minimizing harm.
 To maintain drug therapy costs at an optimum
level and still provide quality and effective
treatment
 To ensure patient compliance.
 To avoid medical errors.
 To exploit advances in knowledge made by
pharmacologists.

8. Rational Use of Medicine
 The rational use of medicines results into a
more effective treatment at an affordable cost.
 WHO defines rational use of medicines as
"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"

9.  As per the Standard Treatment Protocol,
Public Health Department, Government of
Maharashtra, throughout the world, more than
50% of all medicines are prescribed
dispensed, or sold inappropriately, while 50%
of patients fail to take them correctly.
Moreover, about one-third of the world's
population lacks access to essential
medicines.

10.  Some examples of irrational use of medicines
are: 1. Polypharmacy that is the use of at least
five drugs daily by an individual.
2. Inappropriate use of antibiotics, often in
inadequate dosage
3. Use of antibacterial antibiotics for viral
infections
4 Inappropriate self-medication, often for
prescription-only medicines.
5. Over-use of parenterals when oral
formulations would be more appropriate

11.  Reasons for irrational use of medicines are
 Lack of sufficient information
 Faulty and inadequate training and education of
health professionals
 No proper communication between health
professionals and patients
 Confusion about diagnosis
 Demand from the patient.
 Defective drug supply system.
 Ineffective drug regulation.
 Promotional activities of pharmaceutical

12.  Factors leading to need for rational use of medicines are:
 Drug explosion: Availability of number of medicines for a
particular disease complicates selection of appropriate
drug.
 Drug resistance: Irrational use of medicine may lead
development of resistance highly effective drugs to highly
effective drugs.
 Easy availability of drug information: With the rapid
spread of internet and mobile technology, information
about drug development, its uses and adverse effects can
be accessed by any part of the world and is available at
the fingertips of consumers
 Increased treatment cost: Rational use of medicine can
reduce the treatment cost and thus reduce economic
burden on the public as well as on the Government
 Consumer Protection Act (CPA): Extension of consumer
protection act in medical profession may restrict the
irrational use of medicines.

13. WHO defines rational use of medicines as
"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.”

14. Evidence Based Medicine
 Evidence based medicine (LBM) can be
defined as the "Systematic approach to
clinical problem solving which allows the
integration of the best available research
evidence with clinical expertise and patient
values".

15.  Clinical expertise is the knowledge, experience
and clinical skill of the doctor Patient values
are individual characteristics, such as gender,
race/ethnicity, socioeconomic status and
emotional status that may influence a patient's
health, age and wellness

16.  Evidence based medicine is a systematic
approach to medicine in which doctors and
other healthcare professionals use the
current, best scientific evidence from
clinical research to make decisions about
the care of individual patients.

17. Significance of Evidence Based
Medicine
 The use of EBM is crucial in maintaining quality
medical care and ensuring good clinical
outcomes.
 It provides cost effective medical care.
 It promotes consistency of treatment and optimal
outcomes.
 It helps to establish national standards of patient
care.
 It keeps doctors and other healthcare professional
updated.
 It identifies and promotes practices that work, and
eliminates those that are ineffective or harmful.

18.  Clinical Pharmacology is the scientific study of
drugs in man and woman.
 The aim of clinical pharmacology is to
generate data for optimum use of drugs and
the practice of evidence based medicine.
 The randomized controlled clinical trial is
considered to provide the most reliable
evidence on the effectiveness of a drug.

19.  Evidence based Medicine is dependant upon
wide availability and coverage of accurate
systematic reviews and meta-analysis of
clinical studies.
 A physician’s clinical experience and patient’s
values and preferences play important role in
the process of using the evidence to make
decisions. The practice of evidence based
medicine involves five essential steps:

20.  Converting information needs into answerable
questions.
 Finding the best evidence with which to
answer the questions.
 Critically appraising the evidence for its validity
and usefulness.
 Applying the results of appraisal into clinical
practice.
 Evaluating performance.

21. Essential Medicine List
 WHO defines EML as the medicines that
satisfy the priority healthcare needs of the
population.
 EML is prepared by considering:
 Disease prevalence
 Efficacy of medicines
 Safety of medicines
 Comparative cost effectiveness of medicines
 Easy availability of medicines

22.  The drugs from essential medicine list are
intended to be available in adequate amounts,
in appropriate dosage forms and strengths
with assured quality and adequate information,
and at an affordable price.
 The list of essential medicines needs to be
updated/revised periodically. The updated
WHO List of Essential Medicines and List of
Essential Medicines for Children are published
every two years.

23. History of the Essential Medicines List:
 In 1970, Tanzania became the first country to
prepare its EML Subsequently, the first WHO model
list of essential medicines was published in the year
1977 which contained 186 medicines.
 The latest WHO model list of essential medicines is
22 list published in 2021 The Ministry of Health and
Family Welfare, Government of India prepared and
released the first National List of Essential Medicines
(NLEM) of India in 1996 consisting of 279 medicines.
 This list was subsequently revised in 2003 containing
354 medicines, 2011containing 348 medicines, 2015
containing 376 medicines and now in 2021
containing 399 medicines.

24. Advantages of Essential Medicines List:
 An essential medicines list (EML) results in better
quality of medical care, better management of
medicines and cost-effective use of healthcare
resources.
 The essential medicines list has a positive impact
on the availability and rational use of medicines.
 The essential medicines list can be used as
guidelines for the procurement and supply of
medicines in public sector, schemes for
reimbursement of drug costs and local drug
production.
 In hospitals, it improves the quality of prescribing

25. Selection of Essential Medicines: The following
factors are considered for selection of essential
medicines:
 Incidence and prevalence of disease (public health
relevance)
 Efficacy, safety, and comparative cost effectiveness
of available medicines (price oftotal treatment is
considered and not the unit price of a medicine)
 The medicine should be aligned with the current
treatment guidelines for the disease
 Level of healthcare facility available.
 Treatment facilities available
 Training and experience of the available personnel
 Local availability of individual drugs
 Available financial resources

26. National List of Essential Medicines
(NLEM):
 ICMR under Ministry of Health and Family
Welfare, Government of India revises and
publishes NLEM in India. Essential medicines
in NLEM have been marked into three
categories for being available at primary,
secondary and tertiary levels of health care
facility.

27. Purpose of the National List of Essential
Medicines:
 Guide safe and effective treatment of priority
disease conditions of a population.
 Promote the rational use of medicines
 Optimize the available health resources
It is also a guiding document for:
a) State governments to prepare their list of
essential medicines
b) Procurement and supply of medicines in the
public sector
c) Reimbursement of cost of medicines by
organizations to its employees

28. STANDARD TREATMENT
GUIDELINES
 Standard treatment guidelines are also known as
standard treatment protocols (STP) standard
treatment schedules, therapeutic guidelines and
prescribing policies.
 These include the preferred pharmaceutical and
non-pharmaceutical treatments for common
health problems came across by people in a
specific health system.
 These guidelines usually represent one of the
approaches to promote therapeutically effective
and economically efficient use of medicines

29.  Purpose and Content of Standard Treatment
Guideline (STG):
 An effectively implemented guideline (STG) is
advantageous for beneficiaries, healthcare
providers supply managers and health policy
makers.
 As we know improper use or misuse of medicines
in the treatment of any medical condition is
extensive which is harmful for people.
 The idea behind having STG is to have
standardization in terms of treatment and promote
effective and efficient treatment options STG may
be used at different stages of the therapeutic
process.
 It could include medical supplies as also following
prescribed treatments. It could assist in better

30. Advantages of Standard Treatment Guidelines:
 Provides standardized guidance to practitioners
 Provides the most effective therapy in terms of
quality
 Encourages practitioners for high quality care
 The healthcare system needs to provide only the
medicines as per formulary or list of essential
medicines
 Provides valuable assistance to all practitioners,
especially to those with lower level skills
 Enables healthcare providers to concentrate on
making the correct diagnosis becausetreatment
options are available for them in the form of STG
 Provides a basis for evaluating quality of care

31. Some of the standard treatment guidelines available in
India are:
 Hypertension: Screening. Diagnosis Assessment, and
Management of Primary Hypertension in Adults in India,
AUGUST 2017, Ministry of Health and Family Welfare,
Government of India
 Treatment Guidelines for Antimicrobial Use in Common
Syndromes. 2 edition Publications of the ICMR, New Delhi
 Guidelines for Programmatic Management of Drug Resistant
TB (PMDT)in India, March 2021, National TB Elimination
Programme. Central TB Division, Ministry of Health and
Family Welfare, Government of India, New Delhi.
 National Guidelines for Clinical Management of Dengue
Fever. National Vector Borne Disease Control Programme
WHO, 2015
 Standard Treatment Protocol Public Health Department
Government of Maharashtra
 Standard Treatment Guidelines. A Manual for Medical
Therapeutics, First Edition 2014 Gujarat Medical Services
Corporation Ltd. Health and Family Welfare Department,
Government of Gujarat.
 Standard Treatment Guidelines (2016). Department of Public