P drug by Dr madhuri chatterjee pharma.pdf

P drug

1. Pdrug

2. Objectives
TobeabletodefinePdrug
TobeabletodescribetheprinciplesofchoosingaPdrug
Tobeabletoapplytheseprinciples&chooseaPdrug

3. Q1.WhatisPdrug?
Ans.Pdrugsarethedrugofpersonal(P=Personal)choiceofadoctorwhoprescribethem
regularlyandisfamiliarwiththeirefficacy,sideeffects,contradiction suitabilityandcost.
Q.SelectionofaPdrug
1)DefinetheDiagnosis
2)SpecifytheTherapeutic objective
3)MakealistofEffectiveGroupofDrugs
4)ChooseanEffectiveGroupbyComparing Efficacy,Saftey,SuitabilityandCostof
Treatment.
5)ChooseaP-drugfromtheEffectiveGroupofDrugs

4. PDRUGCONCEPT
P-DRUGCONCEPT •Therightdrug
•Therightdose
•Therightduration
•Canthepatientaffordit
•Isthepatienttakinganyother
drug.
Doesthepatienthaveaknown
allergytothedrug

5. Properdiagnosis-usearifle,notashotgun
CHANVN
sCoRE
KEEPER
6
7
8
678 876
9
8
rangorey
6

6. CHOOSEATHERAPEUTICDRUG STEP
SAFETYS:Lessadverseeffects&drugswithahighertherapeuticIndex
otolerabilityI:Dependsonvariousfactors-agepediatrics,geriatrics
gender-pregnancy,Co-morbidconditions,DrugFormulation,
Concomitantdruguse
m/EFFICAcY E:ChoosetheappropriateclassIstetrmney
PriceP:pertablet/perunitdoseoftreatment
Costoftotalcostoftreatment
Costofhospitalisations,investigations,hospitalisations. Potentialside
effects

7. EFFICACY
Choosetheappropriate classofdrugs.
Choosetheappropriatedrugfromtheaboveclass.
SAFETY
Lowertheadverseeffects,saferisthedrug.
DrugswithhigherTherapeuticindexarecasierand
safertouse.
COSTCOMPARISON
>Pertablet,perUnitdose
SUITABILITY
Variesfronindividualtoindividual.
DependsOn.
•Age(pediatric. geriatric)
•Sex.prcgnamcy
-norbidconditions,hepatic andrenaldisorders
•Consciousness,bedridden,vomiting.
Drugformulationandrouteofdrugadministration
(oraldrugsbeingbetteracceptedthaninjectable)
>Costofonedayoftreatment
>Costoftotalcostoftreatment
-Costofhospitalization, investigations,injections,
treatmentofpotentialsideeffects

8. INFORMTHEPATIENT
•Educatethepatientonhowtotakethedrug
•Educateregardingsideeffects,toxicitiesshouldtheyoccur
•Importanceofcompliancetobestressed

9. MONITORTHEEFFECTOFTHERAPY
•Reviewthepatientatfollowupandconfirmwhetherhe/sheisbetter
ornotandwhetherfurtherdrugsareneeded/notneeded

10. A25-year-oldwomanisplanningtogoonatriponabuswithher
friends.Shehasahistoryofmotionsicknessandwantstoprevent
nauseaandvomitingduringthetrip.
sapiamp
What willbeyour PDrug/Drugs inthisscenario?
Tab.Ondansetron4mg-58.5rs/10tablets
Tab.Scopolamine0.4mg-36rs/10tablets
HM
XTab.Domperidone10mg-26rs/10tabletsCY
RaaHyoscine transdermalpatch-150Rs/patch
TabPromethazine25mg-19Rs/10tabletstl1then

11. Efficacy Safety Suitability Cost
Tab.
Scopolamine
+++ ++ ++ ++
Tab.
Ondansetron
+ +++ ++ ++
Tab.
Domperidone
++ ++ ++
Hyoscine/Scop+++
olaminepatch
+++ ++ +++
Promethazine
tablet
+++ ++
sedaton
DrMIg
++
(em

12. Definethediagnosis–Motionsickness
Therapeuticobjective-preventvomitingduringthejourneywith
Minimalsideeffects
Inventory ofdrugs-Anticholinergics, Antihistaminics,D2receptor
antagonist,serotoninantagonists
ChooseadrugbasedonSTEP
Informthepatientsofsideeffectsandhowtouse
Byovethazne

13. FinalP-drug
ThePdrugisPromethazine25mgtablets-1tabletatleast30mins
beforethejourney.Mayberepeatedafter6hours
Moy,
sebiton
IdeallyScopolamine1mgPatchbehindtheear.
Removeafterthejourney

14. A65yearoldmaleXYZcomestovisitmedicineOPD.HisBMIis27kg/m2.Initially
hewasadvicedweightreduction,lowsodiumintakeandotherlifestylemodification
.Heisnotdiabetic.Hestillsmokes2cigarettesperday.2monthsbacktocontrolhis
bloodpressure.nowcameforafollowupvisit.NowHisbloodpressureis160/
90mmHg.SelectaPDrugtocontrolhisbloodpressureandwriteaprescription
Lifestylemodification.
Atenolol25mg=Rs25/10tablets
Amlodipine5mg=Rs43.50/10tabletsCCB
Ramipril5mg=Rs73.50/10tabletsACEO/
Thiazide12.5mg=Rs10.5/10tabletslsbDI
Losartan25mg=Rs50/10tabletsAKB

15. StepsofPdrugselection
>Definediagnosis-stage2hypertension.
SpecifyTherapeuticObjective-TocontrolBloodpressureandto
preventlongtermcomplicationsofhypertension instage2
hypertension.
>Makealistofeffectivetreatmentmodalities
Lifestylemodification
Betablockers
Calciumchannelblockers
ACEinhibitor
Thiazide
ARB

16. Efficacy Safety Tolerability Costper10
tabletsinRs
Losartan +++ ++ +++ 50
Atenolol ++ +
25
Amlodipine
+++ +++
43.5
Ramipril
+++ ++ ++
73.5
Thiazide ++++ + +
12.5

17. ThePdrugforthis65yearoldpatientistabletAMLODIPINE5mg
1tablettobetakenorallyfor30days
Lifestylemodifications-exercise,saltrestricted,lowfatdiet
Stopsmoking

18. A42yearoldmalecomestovisitinmedicineOPD.Hisweightis9Okgandhisheight
is5feet10inches.Initiallyhehasbeenadvicedforweightreduction,lowsodium
intakeandotherlifestylemodificationmodalities2monthsbacktocontrolhisblood
owcameforafollowupvisit.NowHisbloodpressureis146/90mmHg.
SelectaPDrugtocontrolhisbloodpressure.
Lifestylemodification.
Carvedilol(3.125)=Rs40/1Otab
Diltiazem30mg=Rs40.25/10tabsCCB
Ramipril=(2.5mg)=Rs52/10tablets
Thiazide-(12.5 mg)=Rs10.5/10tablets
Telmisartan(40mg)=Rs69/10 ablets

19. 5.ChooseaP-drugfromthegroups.
6.Choiceoftherapy-ACEL(Tab.RAMIPRIL2.5mgoncedailyafter
breakfastfor2weeks)
7.Monitorthetreatmentthroughfollow-ups

20. StepsofPdrugselection
>Definediagnosis-stage2hypertension.
SpecifyTherapeuticObjective-TocontrolBloodpressureandto
preventlongtermcomplicationsofhypertension instage2
hypertension.
Makealistofeffectivetreatmentmodalities
Lifestylemodification
Betablockers
Calciumchannelblockers
ACEinhibitor
Thiazide
ARB

21. Efficacy Safety Suitability Cost
Telmisartan +++ +++ ++++
Carvedilol ++ + + ++
Amlodipine
++ +++ ++
Ramipril
++ +++ ++ +++
Thiazide ++ ++ +

22. WhyACEI?
>Younghypertensiveindividualhavemoreplasmareninactivity.
>ACElcanreverse/retardprogressionofchangesofnephropathyand
cardiacremodelling.
>ARBSareindicatedinACElinducedcough/angioedema.

23. CASEBASEDSTUDY

24. A27yearoldmalepatientMrCBisan
executiveinaprivatecompany.Hesmokes
cigarettesandoccasionallytakesalcohol
Hehasabdominalpainwhichismainlyinthe
upperabdomen.Thisisaggravatedatnightand
afterheavymeals.Thereisnobloodinvomiting
orinstools.Hishaemoglobin levelisnormal

25. HetakesRanitidineoverthecounter
Whatarethefactorsthatleadtopepticulcer
disease NSADsAlddsmke
Namethedrugsthatreducegastricacid
secretion
uestylemod P
WhyisFamotidinepreferredovercimetidine

26. •WhataretheregimensforHpylori?
Amoual

27. Predisposingfactors-acidandpepsin
secretion
•Hpylori
Drugs-NSAIDS&corticosteroids
Cigarette
•Alcohol

28. Mucosaldefenseforces-
Mucussecretion
Bicarbonatesecretion
•MucosalBloodflow
•PGsynthesis

29. Famotidine-greaterpotency,longerduration
thancimetidine
•
CimetidineCrossesBBB
•Cimetidine-antiandrogenicandCYPenzyme
inhibitor

30. 1)PPI+Amoxicillin/Metronidazole+
Clarithromycin
2)Bismuth+Tetracycline+Metronidazole+PPI