2. Pharmacotherapy
The treatment of disease through the
administration of drugs
Rational drug use means “prescribing
right drug, in adequate dose for the
sufficient duration & appropriate to the
clinical needs of the patient at lowest
cost”
3. WHO definition
Rational drug use (RDU) 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
4. Requirements of RDU
correct drug
appropriate indication
appropriate drug considering efficacy, safety, suitability
for the patient, and cost
appropriate dosage, administration, duration
no contraindications
correct dispensing, including appropriate information
for patients
patient adherence to treatment
5. Many Factors Influence Use of Medicines
Treatment
Choices
Prior
Knowledge
Habits
Scientific
Information
Relationships
With Peers
Influence
of Drug
Industry
Workload &
Staffing
Infra-
structure
Authority &
Supervision
Societal
Information
Intrinsic
Workplace
Workgroup
Social &
Cultural
Factors
Economic &
Legal Factors
6. Irrational use of medicines is a very
serious global public health problem.
Much is known about how to improve
rational use of medicines but much more
needs to be done
◦ policy implementation at the national level
◦ implementation and evaluation of more
interventions, particularly managerial,
economic and regulatory interventions
7. Reason for Irrational Use
Lack of information
Poor communication between health
professional & patient
Lack of diagnostic facilities/Uncertainty of
diagnosis
Demand from the patient
Defective drug supply system & ineffective drug
regulation
Promotional activities of pharmaceutical
industries
8. Common patterns of irrational
prescribing :
The use of drugs when no drug therapy is
indicated, e.g. antibiotics for viral upper
respiratory infections.
The use of the wrong drug for a specific
condition requiring drug therapy, e.g.
tetracycline in childhood diarrhea requiring
ORS.
The use of drugs with doubtful or unproven
efficacy, e.g. the use of antimotility agents in
acute diarrhea
9. Common patterns of irrational
prescribing :
Failure to provide available, safe and effective drugs,
e.g. failure to vaccinate for measles or tetanus, or failure
to prescribe ORS for acute diarrhea.
The use of correct drugs with incorrect administration,
dosage and duration, e.g. using intravenous route where
oral or suppository routes would be appropriate.
The use of unnecessarily expensive drugs, e.g. the use of
a third generation, broad-spectrum antimicrobial when a
first line, narrow spectrum agent is indicated.
Antibiotics misuse
10. Obstacles exist in RDU :
o Lack of objective information & of continuing
education & training programs.
o Lack of well organized drug regulatory authority
& supply of drugs.
o Presence of large number of drugs in the market
& the lucrative methods of promotion of drugs
employed by pharmaceutical industries.
o The prevalent belief that “every ill has a pill.”
11. StepsTo Improve Rational Drug
Prescribing :
Make a specific diagnosis
Consider the pathophysiology of diagnosis
selected : If the disorder is well understood ,the
prescriber is in a better position to select
effective therapy.
Select a specific therapeutic objective or goal
and medications should be selected based on it.
Select a drug of choice .
12. StepsTo Improve Rational
Drug Prescribing :
Determine the appropriate dosing regimen to obtain
desired therapeutic levels and the drug must be
inexpensive, easily available and should be
prescribed in generic name.
Drug interaction and adverse effects must be taken
into account before initiating combination of drugs.
Device a plan for monitoring the drugs action and
determine an end point for the therapy.
Plan a program for patient education.
13. Strategies to Improve Use of Drugs
Economic:
Offer incentives
– Institutions
– Providers and patients
Managerial:
Guide clinical practice
– Information systems
– Drug supply / lab capacity
Regulatory:
Restrict choices
– Market or practice
controls
– Enforcement
Educational:
Inform or persuade
– Health providers
– Consumers
Use of
Medicines
14. Role of pharmacists
Establish a common approach to the
rational use of drugs by giving advice and
information to patient regarding the
proper use of drugs.
They have more opportunity to interact
closely with the prescriber and therefore,
to promote the rational prescribing and
use of drugs.
15. By having access to medical records, they
are in a position to influence the selection
of drugs, dosage regimens, to monitor
patient compliance and therapeutics,
response to drugs and to recognize and
report adverse drug reactions.
Control hospital manufacture and
procurement of drugs to ensure the supply
of high quality products.
18. Older patients have a higher prevalence
chronic and multiple illnesses and
physiological changes associated with
aging
This put them at a higher risk of suffering
adverse drug effects and drug-drug
interactions
So a more cautious approach should be
promoted when prescribing medications
for an older patients
19. To prescribe appropriately these things
must be considered :
1-Balance the potential harm and benefits
of the given agent
2- consider a regular review of patients
prescriptions
3- use appropriate formulations
20. Avoid symptomatic prescribing
Do not prescribe an agent to treat a normal
aspect of aging eg: alteration in
sleepwaking habits
The masking of symptoms may undermine
the ability to detect an evolving illness
Symptomatic prescribing tends to lead to a
vicious cycle of polypharmacy
21. Consider the effect of non-
prescribed medication
Its important to recognize that patients
may be taking OTC or complementary
preparations which could interact with
prescribed agents
A full drug history should be tacked
22. Anticipate the pharmacological
differences between younger and
older patients
Pharmacodynamic :
The older patients CNS is often more
sensitive to agents such as :antipsychotics,
opioids and benzodiazepins
Drugs with toxic GI side effects as
:NSAIDs and opioids must be used
carefully
23. Pharmacokinetics:
Most older people have reduced renal
clearance
Drugs may be excreted at a reduced rate ,
leading to accumulation and adverse
events
Particular care must be considered with
drugs known to cause nephrotoxicity as
:NSAIDs, ACE inhibitors and
aminoglycosides
24. Adverse drug reactions in older
patients
Adverse drug reactions may present in
nebulous and non specific ways in older
:patients
Confusion can be caused by virtually any
drug
Constipation , dizziness and dry mouth
and blurred vision are also common in
older patients
