8. pharmacotherapy

1. PHARMACOTHERAPY

2. PharmacotherapyPharmacotherapy
Principally concerned with the safesafe
and effectiveeffective management of drug
administration.
Implies an understanding of
pharmacokinetics (PK) and
pharmacodynamics (PD) so that individual
dosing guidance, can be provided to
optimize patient response .

3. Pharmacokinetics
What the body does to the drug
–Absorption
–Distribution
–Metabolism
–Elimination
Pharmacodynamics
What the drug does to the body
–Response
–Toxicity

4. PharmacotherapyPharmacotherapy
METABOLISM
ABSORPTION
ELIMINATION
- Site (i.e., GIT, skin, tissue
depot)
- First-pass effect (oral)
- Drug properties (i.e., solubility)
-Pathway(s)
-Sites (GIT, liver,
lung)

DISTRIBUTION
SITE(S) FOR
THERAPEUTIC
EFFECT(S)
SITE(S) FOR
TOXIC
EFFECT(S)
Pharmacologic
Activity
Toxic
Activity
Free Drug in Plasma
or Extracellular Fluid
Distribution in
Blood Cells
Bound to
plasma proteins
- Unchanged
drug
- Metabolites
- Sites (Tissues, fat, etc)
- Binding
Excretory
Sites
Urine, Feces, Expired AirActive/inactive metabolites

5. Rational Drug Use
Supported by USAID
Prescribing, Dispensing,
Counseling and Adherence

6. Definition
The rational use of drugs 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.
WHO conference of experts, Nairobi 1985

7. DRUG
DOSE
TIME
ROUTE OF ADMINISTRATION
PRICE

8. Importance of RDU
An irrational drug use results in the
following:
–Treatment failure
–Rapid development of drug resistance
–Increase of toxicity risk
–Wastage of money

9. Rational
Drug Use
Prescriber,
Dispenser &
their
workplaces
Drug Supply System
Patient &
community
Many Factors Influence Use of
Medicines
Policy, Legal and Regulatory
framework

10. Drug Use Process

11. Diagnosis: Aspects that lead to
Irrational Drug Use
Inadequate examination of patient
Incomplete communication between patient
and doctor
Lack of documented medical history
Inadequate laboratory resources

12. Prescription: Types of Irrational
Drug Use (1)
Irrational
Drug Use

Occurs If a Drug Is Prescribed When:
Underprescribing · Needed medications are not prescribed

· Dosage is inadequate

· Length of treatment is too brief

13. Prescription: Types of Irrational
Drug Use (2)
Irrational
Drug Use
Occurs If a Drug Is
Prescribed When:
Incorrect
prescribing
· Drug given for incorrect diagnosis

· Wrong drug selected for diagnosis

· Prescription prepared improperly

· Adjustments not made for co-existing
medical, genetic, environmental, or other
factors

14. Prescription: Types of Irrational
Drug Use (3)
Irrational
Drug Use

Occurs If a Drug Is Prescribed When:
Extravagant
prescribing
· A less expensive drug provides
comparable efficacy and safety

· Symptomatic treatment of mild
conditions diverts funds from treating
serious illness

· Brand-name drug used when less
expensive equivalents are available

15. Prescription: Types of Irrational
Drug Use (4)
Irrational
Drug Use

Occurs If a Drug Is Prescribed When:
Overprescribing · Drug is not needed

· Dose is too large

· Treatment period is too long

· Quantity dispensed is too great for
current course of treatment

16. Prescription: Types of Irrational
Drug Use (5)
Irrational
Drug Use

Occurs If a Drug Is Prescribed When:
Multiple
prescribing
 Two or more medications are used
when fewer would achieve same effect

 Several related conditions are treated
when treatment of primary condition
would improve or cure the other
conditions

17. Dispensing: Types of Irrational
Drug Use
Incorrect interpretation of the prescription
Retrieval of wrong ingredients
Inaccurate counting, compounding, or pouring
Inadequate labeling
Unsanitary procedures
Packaging:
–Poor-quality packaging materials
–Odd package size, which may require
repackaging
–Unappealing package

18. Adherence vs Compliance
Adherence: The act or quality of sticking
to something; steady devotion; the act of
adhering
The acceptance of an active role in
ones health care
Compliance: the act of yielding,
conforming,

19. Consequences of Poor Adherence
For the individual:
–Treatment failure: incomplete viral suppression,
continued destruction of the immune system, disease
progression
–Drug resistance: emergency of resistant viral strains
–Limited future treatment options: more complex
treatment, more toxicity, uncertain prognosis

20. SLEPT
IN
AWAY
FROM
HOME
RAN
OUT
OF
PILLS
FELT
ILL
FELT
BETTERPILLS
DO NOT
HELP
FEAR
SIDE
EFFECTS
DID NOT
WANT
OTHERS
TO SEE
FAMILY SAID
NO TO
MEDICATION
FORGOT
/ BUSY
DID NOT
UNDERSTAND
INSTRUCTION
S
MISSED DOSES
TAKING
PILL
HOLIDAYS
UNABLE
to CARE
FOR
SELF
Adherence: Why do Patients Miss Doses?
(Barriers to adherence)
Let’s find together a solution for
your problem
•I am listening
•You can trust me
•I understand
•I suggest…
•What do you think?
•I’ll explain to you how to take these
medicines

21. Other Barriers to adherence
Communication
difficulties
Literacy levels
Inadequate knowledge
of disease
Inadequate understanding
of effectiveness of
medications
Lack of social support
Discomfort with
disclosure status
Difficult life conditions
Alcohol and drug use
Depression and other
psychiatric problems

22. Adherence Multi-disciplinary
Roles
Same message from all!
Adherence
Message for the
patient
Doctors
Adherence
Nurse
Pharmacist
Family/
Friends
Counselor
Social Worker

23. Methods and Challenges of
Measuring Adherence
Self reports
Pill counts
Pharmacy records
Provider estimate
Pill identification test
Biological markers
Electronic devices
Measuring drug levels

24. A multi-disciplinary team work is
required to achieve Rational Drug
Use !!!
Doctor
Pharmacist
Counselor /
Treatment
supporter
Nurse
Community

25. CLASSES of DRUGS
Drugs affecting the Autonomic Nervous System
Drugs affecting the CNS
–Antiparkinson drug
–Anti-anxiety
–Hypnotic drugs
–CNS Stimulants
–Anesthetics
–Antidepressant drugs
–Anti-epilepsy

26. Drugs affecting Cardiovascular system
–Drugs for congestive heart failure
–Anti-arrythmic drugs
–Antianginal drugs
–Antihypertensive drugs
–Drugs affecting blood
–Antihyperlipidemic drugs

27. Drugs affecting respiratory system
Diuretic drugs
Gastro-intestinal drugs
Antiemetics
Oral Hypoglycemic drugs and Insulin
Hormones of the Pituitary and thyroid
Steroid hormones
Anti-inflammatory drugs

28. Chemotherapeutic drugs
–Antibacterial
–Antifungal
–Antiprotozoal
–Anthelmintic
–Antiviral
–Anticancer