Pharmacology p drug concept

1. P-drugs

6. RATIONAL PRESCRIBING
• Step 1: Define the patient's problem
• Step 2: Specify the therapeutic objective
• Step 3: Verify whether your P-treatment is suitable for this patient
• Step 4: Start the treatment
• Step 5: Give information, instructions and warnings
• Step 6: Monitor (stop) the treatment

7. • P- drugs are the drugs as the personal choice of a Clinician which includes
Name , Strength , Dosage form of drug and duration of treatment.
• Are going to be prescribed regularly and are familiar with these drugs –
P(personal) drugs
• These are personal to doctor and not to the patient and selected for
particular condition/disease.
• P-drugs will differ from country to country and between doctors:-
-Varying availability and cost of drugs
-Different national formularies and
-Essential drugs lists, medical culture and
-Individual interpretation of information.
• Advantages:- P-drugs enable you
-To avoid repeated searches for a good drug in daily practice. And,
-You will get to know their effects and side effects thoroughly with
obvious benefits to the patient.

8. Instead of compiling your own list, one of the most popular ways to
make a list of P-drugs is just to copy it from clinical teachers, or from
existing national or local treatment guidelines or formularies.
Should not be done
• You have final responsibility for your patient's well-being and you
cannot pass this on to others.
• Through developing your own set of P-drugs you will learn how to
handle pharmacological concepts and data.
• Through compiling your own set of P-drugs you will know the
alternatives when your P-drug choice cannot be used, for example
because of serious side effects or contraindications, or when your P-
drug is not available.
• You will regularly receive information on new drugs, new side effects,
new indications,

9. • In this selection process you will have to consult your pharmacology
textbook, national formulary, and available national and international
treatment guidelines.

12. THANK YOU

13. CASE-I
A 40 year old male patient comes to a doctor with complaints of
running nose, sneezing and stuffiness in the nose since 2 days. Choose
P-drug for this case.
1.Diagnosis – Common cold
2. Therapeutic objective – Treatment for common cold in adult patient
3. Inventory of Effective group of drugs :-
Highly Sedative
Moderately Sedative
Mild Sedative
Second Generation Antihistaminics

14. 4. Choose Effective group according to Criteria
Group of Drugs Efficacy Safety
(Side Effects)
Suitability
(Contraindications)
Cost
Highly Sedative +++ Sedation ++++ ,
CNS effects and
Antimuscarinic
Patients work with
psychomotor skills
+
Moderately
Sedative
+++ Sedation ++ , CNS
effects and
Antimuscarinic
Patients work with
psychomotor skills
+
Mildly Sedative +++ Sedation + , CNS
effects and
Antimuscarinic
Patients work with
psychomotor skills
+
Second Generation
Antihistaminic
+++ Very mild to No
sedation
NA +

15. 5. Choose a p-drug
Drug Efficacy Safety (Side Effects) Suitability
(Contraindications)
Cost
Promethazine +++ ++++ ++ +
Hydroxyzine +++ ++++ ++ +
Pheniramine +++ ++++ ++ +
Chlorpheniramine +++ ++++ ++ +
Cetirizine +++ + - ++
Levocetirizine +++ + - +++

16. 5. Choose a p-drug
Drug Efficacy Safety
(Side Effects)
Suitability
(Contraindications)
Cost
Desloratidine +++ - - +++
Ebastine +++ - - +++
Azelastine +++ - - +++
Rupatidine +++ - - +++

17. Hence P-drug for Common cold in 40 year male patient is :-
First Choice:
Active Substance- Rupatadine
Dosage Form-Tablet
Route of Administration-Oral
Dosage Schedule-10 mg Once daily
Duration of treatment-Until next visit after three days or Till complaint
resolved
Second Choice:
Active Substance- Levocetirizine
Dosage Form-Tablet
Route of Administration-Oral
Dosage Schedule- 5-10 mg Once daily
Duration of treatment-Until next visit after three days or Till complaint
resolved

18. Third Choice:
Active Substance- Azelastine
Dosage Form-Nasal Spray
Route of Administration- Intranasal
Dosage Schedule-0.14 mg per puff twice daily
Duration of treatment-Until next visit after three days or Till complaint
resolved

19. P- drug
• Essential Hypertension
• Diabetes Mellitus
• Enteric Fever
• Angina Pectoris
• Bronchial Asthma
• Respiratory Infection
• Diarrhoea in Children
• Amoebiasis
• Peptic Ulcer
• Urinary tract infection
• Vomiting
• Hyperlipidaemia
• Cough

20. • Case II
A male patient aged 30years brought in with Acute asthmatic attack,
probably precipitated by a Viral infection. Revealed nothing on taking
history and Physical examination. Choose a P-drug for this case.
• Case III
A female patient aged 22 years comes to hospital with complaint of dry
cough since 3 days. No history of fever , cold and any other symptoms.
Choose P-drug for the case

21. • Case II
A male patient aged 30years brought in with Acute asthmatic attack,
probably precipitated by a Viral infection. Revealed nothing on taking
history and Physical examination. Choose a P-drug for this case.
1.Diagnosis – Acute Asthma
2. Therapeutic objective – Treatment for Severe Acute attack of
bronchial Asthma in adult patient
3. Inventory of Effective group of drugs :-
β2-Sympathomimetics
Methylxanthines
Anticholinergics

22. 4. Choose Effective group according to Criteria
Group of Drugs Efficacy Safety
(Side Effects)
Suitability
(Contraindications)
Cost
β2-
Sympathomimetics
+++ Headache,
palpitations
,restlessness
- +
Methylxanthines + Dyspepsia,
headache,
palpitations
,insomnia
Cardiac diseases +
Anticholinergics + Atropinic side
effects
BHP, Glaucoma +

23. 5. Choose a p-drug
Drug Efficacy Safety (Side Effects) Suitability
(Contraindications)
Cost
Salbutamol ++ + + +
Salmeterol + + - NA
Terbutaline - + + -

24. Hence P-drug for Common cold in 40 year male patient is :-
First Choice:
Active Substance- Salbutamol
Dosage Form-Injection/Inhalation
Route of Administration-Intramuscular/Subcutaneous
Dosage Schedule-10 mg Once daily
Duration of treatment-Administer at the time of attack

25. • Case III
A male patient aged 40years diagnosed to have essential hypertension. You
advised him salt restricted diet , Exercise and Life style modifications. He will
comes back after 3 weeks later and his blood pressure is still
high(140/104).Your p-drug for hypertension in patient under age of 50 is Tab
Atenolol-50mg OD. On taking drug history, he revealed that he is suffering
from Asthma and use Salbutamol inhaler regularly. What would be your p-
drug for such patients.
1.Diagnosis – Essential Hypertension
2. Therapeutic objective – Treatment for Essential hypertension in an
Asthmatic patient
3. Inventory of Effective group of drugs :-
Thiazides
Calcium Channel Blockers

26. 4. Choose Effective group according to Criteria
Group of Drugs Efficacy Safety
(Side Effects)
Suitability
(Contraindications)
Cost
Thiazides +++ Nausea, Vomiting
,Diarrhoe,
Hypokalaemia,
hyponatremia,
hypocalcaemia
- +
Calcium Channel
Blockers
+++ Ankle
Oedema,palpitatio
ns,flushing,hypoten
sion
- +

27. 5. Choose a p-drug
Drug Efficacy Safety (Side Effects) Suitability
(Contraindications)
Cost
Hydrochlorothiazide +++ ++ + +
Amlodipine +++ ++ + +

28. Hence P-drug for Essential hypertension in 40 year old Asthmatic patient is :-
First Choice:
Active Substance- Hydrochlorothiazide
Dosage Form-Tablet
Route of Administration-Oral
Dosage Schedule-12.5-25 mg Once daily
Duration of treatment-Until next visit after two week
Second Choice:
Active Substance- Amlodipine
Dosage Form-Tablet
Route of Administration-Oral
Dosage Schedule- 5-10 mg Once daily
Duration of treatment-Until next visit after two weeks

29. • Case IV
A Male patient aged 55 years comes to hospital with complaint of
repeated attacks of constricting chest pain starting with exercise and
relieving on rest since one month. Choose P-drug for the given case.
1.Diagnosis – Angina Pectoris
2. Therapeutic objective – Treatment for Angina pectoris in 55 years
adult male patient.
3. Inventory of Effective group of drugs :-
Nitrates
Beta –blockers
Calcium channel blockers

30. 4. Choose Effective group according to Criteria
Group of Drugs Efficacy Safety
(Side Effects)
Suitability
(Contraindications)
Cost
Nitrates +++ Headache , nitrate
intoxication
Hypotension,
Anaemia and With
Sildenafil
+
Beta-Blockers +++ Hypotension,
Bradyarrhythmia,
impotence
+ +
Calcium channel
blockers
+++ Hypotension,
dizziness,
bradycardia
+ +

31. 5. Choose a p-drug
Drug Efficacy Safety (Side Effects) Suitability
(Contraindications)
Cost
Isosorbide dinitrate +++ +++ ++ ++
Glyceryl trinitrate +++ +++ +++ +
Isosorbide
mononitrate
++ +++ ++ ++

32. Hence P-drug for Common cold in 40 year male patient is :-
First Choice:
Active Substance- Isosorbide dinitrate
Dosage Form-Tablet
Route of Administration-Oral
Dosage Schedule-5-50 mg Once daily
Duration of treatment-Until next visit after two weeks
Second Choice:
Active Substance- Glyceryl trinitrate
Dosage Form-Tablet
Route of Administration- sublingual
Dosage Schedule- 5-15 mg Once daily
Duration of treatment-Until next visit after two weeks

33. • Case V
A male patient aged 4years come with complaints of watery diarrhoea for 3
days. On examination he was found to have no fever,but had rapid pulse and
low elasticity of the skin. Choose a P-drug for this case.
1.Diagnosis – Acute diarrhoea
2.Therapeutic objective – Treatment for Acute diarrhoea in adult patient
–To rehydrate patient
-To prevent further dehydration in the patient
3. Inventory of Effective group of drugs :-
No drug required
Oral rehydration Solution

34. Hence P-drug for Acute diarrhoea in 4 year male child patient is :-
First Choice:
Active Substance- ORS
Dosage Form-Powder
Route of Administration-Oral
Dosage Schedule-Mix with one litre water and consume regularly
Duration of treatment-Until next visit after two days or Till complaint
resolved

35. • Case VI
A male patient aged 30years comes with the complaints of fever for
past 7 days, gradually increased from day one and also complains of
abdominal pain, bloating, loose motions, loss of appetite, malaise and
weakness. On examination, Coated tongue and liver and spleen are
palpable . Blood culture suggestive of Enteric fever. Choose a P-drug for
this case.
1.Diagnosis – Enteric Fever
2. Therapeutic objective – Treatment for Enteric Fever in adult patient
3. Inventory of Effective group of drugs :-
Fluoroquinolones
Cephalosporins

36. 4. Choose Effective group according to Criteria
Group of Drugs Efficacy Safety
(Side Effects)
Suitability
(Contraindications)
Cost
Fluoroquinolones +++ Nausea,
Vomiting,dizziness,
headacheTendon
rupture
- +
Cephalosporins +++ Diarrhoea,pain
after injection and
nephrotoxicity
- +

37. 5. Choose a p-drug
Drug Efficacy Safety (Side Effects) Suitability
(Contraindications)
Cost
Ceftriaxone +++ +++ - +
Cefotaxime +++ +++ - +
Cefoperazone +++ +++ Alcohol intake +

38. Hence P-drug for Common cold in 40 year male patient is :-
First Choice:
Active Substance- Ceftriaxone
Dosage Form-Injection
Route of Administration-i.v
Dosage Schedule-2gm BD for 2 days followed by 1 gm BD till 2 days after
fever subsides
Duration of treatment-7-10 dys or till fever subsides
Second Choice:
Active Substance- Cefotaxime
Dosage Form-Injection
Route of Administration-IV/IM
Dosage Schedule- 1gm BD daily
Duration of treatment-Till fever subsides

39. • Case VII
A male patient aged 30years comes with complaints of high fever,
burning micturition , urge and increase in frequency of micturition.
Urine culture suggestive of Urinary tract infection. Choose a P-drug for
this case.
1.Diagnosis – Urinary tract infection
2. Therapeutic objective – Treatment for UTI in adult patient
3. Inventory of Effective group of drugs :-
Fluoroquinolones
Cephalosporins
Beta-lactam antibiotics

40. 4. Choose Effective group according to Criteria
Group of Drugs Efficacy Safety
(Side Effects)
Suitability
(Contraindications)
Cost
Fluoroquinolones +++ Nausea,
Vomiting,dizziness,
headacheTendon
rupture
- +
Cephalosporins +++ Diarrhoea,pain
after injection and
nephrotoxicity
- +
Beta-lactam
antibiotics
+++ Nausea,Vomiting,Di
arrhoea and allergic
reactions
- +

41. 5. Choose a p-drug
Drug Efficacy Safety (Side Effects) Suitability
(Contraindications)
Cost
Norfloxacin +++ ++++ - +
Ciprofloxacin +++ ++++ - +
Ofloxacin +++ ++++ - +

42. Hence P-drug for UTI male patient is :-
First Choice:
Active Substance- Ofloxacin
Dosage Form-Tablet
Route of Administration-Oral
Dosage Schedule-200-400 mg BD daily
Duration of treatment- 3-5 days/2-3 weeks
Second Choice:
Active Substance- Ciprofloxacin
Dosage Form-Tablet
Route of Administration-Oral
Dosage Schedule- 250-500 mg BD daily
Duration of treatment-3-5 days/2-3 weeks

43. • Case VIII
A male patient aged 25years comes to the hospital with complains of loose
motions associated with mucus and blood , abdominal pain and mild
fever.On Stool examination, entamoeba histolytica was detected. Choose a P-
drug for this case.
1.Diagnosis – Acute Amoebic Dysentery
2. Therapeutic objective – Treatment for Acute Amoebic Dysentery in adult
patient
3. Inventory of Effective group of drugs :-
Nitroimidazoles
Amide
Tetracyclines

44. 4. Choose Effective group according to Criteria
Group of Drugs Efficacy Safety
(Side Effects)
Suitability
(Contraindications)
Cost
Nitroimidazoles +++ Vomiting,loss of
taste,Disulfiram like
reaction
Alcohol intake +
Amides ++ Nausea,itching and
urticaria
Patients work with
psychomotor skills
+
Tetracyclines ++ Nausea,
Vomiting,hypersens
itive
reactions,Superinfe
ction
Children and
sensitive patients
+

45. 5. Choose a p-drug
Drug Efficacy Safety (Side Effects) Suitability
(Contraindications)
Cost
Metronidazole +++ ++++ ++ +
Tinidazole +++ ++++ ++ +
Ornidazole +++ ++++ ++ ++

46. Hence P-drug for acute Amoebic dysentery in 25 year male patient is :-
First Choice:
Active Substance- Metronidazole
Dosage Form-Tablet
Route of Administration-Oral
Dosage Schedule-800 mg TDS daily
Duration of treatment-7-10 days
Second Choice:
Active Substance- Tinidazole
Dosage Form-Tablet
Route of Administration-Oral
Dosage Schedule- 2gm Once daily
Duration of treatment-3 days

47. • CaseIX
A male patient aged 45years presents with epigastric pain worsening
gradually since one month which was partly relieved by food. On
examination Epigastric tenderness detected. Upper Gastroendoscopy
reveals Ulcer in the ist part of duodenum. Choose a P-drug for this
case.
1.Diagnosis – Peptic Ulcer
2. Therapeutic objective – Treatment for Peptic Ulcer in adult patient
3. Inventory of Effective group of drugs :-
H2 Blockers
Proton pump inhibitors

48. 4. Choose Effective group according to Criteria
Group of Drugs Efficacy Safety
(Side Effects)
Suitability
(Contraindications)
Cost
H2 Blockers +++ Head
ache,Diarrhoea/con
stipation,dizziness
- +
Proton pump
inhibitors
+++ Nausea,loose
stools,headache,ab
dominal
pain,muscle and
joint pain
- +

49. 5. Choose a p-drug
Drug Efficacy Safety (Side Effects) Suitability
(Contraindications)
Cost
Omeprazole +++ ++++ - +
Rabeprazole +++ ++++ - +
Pantoprazole +++ ++++ - +

50. Hence P-drug for Peptic ulcer in 45 year male patient is :-
First Choice:
Active Substance- Omeprazole
Dosage Form-Tablet
Route of Administration-Oral
Dosage Schedule-20 mg BD daily before meals
Duration of treatment-Until next visit after one month
Second Choice:
Active Substance- Pantoprazole
Dosage Form-Tablet
Route of Administration-Oral
Dosage Schedule- 40 mg Once daily before meals
Duration of treatment-Until next visit after one month