Rational Drug USe - Pharmacotherapeutics -1

Rational Drug Use - Pharmacotherapeutics-1

1. Rational Drug Use Ravinandan AP Asst. Professor Sree Siddaganga College of Pharmacy Tumkur

2. DEFINITION Rational drug use (RDU) is a conventionally defined as the use of an appropriate, efficacious, safe and cost effective drug given for the right indication in the right dose and formulation, at right intervals and for right duration of time.

3. The rational use of drugs requires that patients receive medications appropriate to their clinical needs , in needs, in doses that meet their requirements for an adequate period and at the lowest cost to them and their community. WHO conference of experts, Nairobi 1985

4. Importance of rational drug use Irrational drug use leads to the ineffective and unsafe drug treatment, worsening or prolonging of illness, and adverse drug reactions. In appropriate treatment also increases the costs of the patient, government or insurance system. So RDU is very important to achieve the better results.

5. Examples of irrational prescribing practices Unnecessary prescribing for self-limiting conditions Prescribing costly drugs and formulations. When cheaper drugs are available. Over dosing Under dosing Using Injectables when oral drugs are available

6. Aspects of Irrational Drug use Diagnosis Inadequate examination of patient Incomplete communication between patient & doctor Lack of documented medical history Inadequate laboratory Resources Prescribing Extravagant prescribing Over-prescribing Incorrect prescribing Under-prescribing Multiple prescribe( ing )( ers )

7. Dispensing : 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 re-packaging – Unappealing package

8. Patient adherence: Poor labeling Inadequate verbal instructions Inadequate counseling to encourage adherence Inadequate follow-up/support of patients Treatments or instructions that do not consider the consider the patient’s beliefs, environment, or culture or culture

9. Rational Use Of Drugs Throughout the world, unnecessary drugs or prescribed for self-limiting condition Many times, the prescriber uses the prescription as a substitute for counseling or to satisfy the expectations of the patient Usually a mixture of two Where they both feel that the prescription should be the outcome of the visit Rational use of drugs not only includes the selection of the right medicines and the correct dose but also a piece of the right advice

10. The availability of many brands, unnecessary combinations, & aggressive promotional activity by pharmaceutical origination confuses the prescriber. Thus, there is a need to learn about the rational use of drugs. In 1984, WHO decided to introduce the concept of rational drug therapy. In implementing this programme, Sudan and Zimbabwe made a sincere effort to set the modules for their countries.

11. In Zimbabwe, the pharmacy department highlighted the concept of essential drugs through introductory lectures in medical schools. The whole concept of country’s health and drug policy is introduced along with the history and development of international drug market, essential drugs, legislative activities, prescribing practices and cooperative relationship between the members of the health.

12. Essential Drug Concept: WHO has defined essential drugs as those that satisfy the health care needs of the majority of the population. These must be available at all times in adequate amounts and appropriate dosage form

13. Pharmacists role in rational drug use Pharmacists play a significant role in Selection of drugs, Procurement, Distribution, Dispensing, and education, Provision of pharmaceutical care.

14. Drug Procurement: The selection and range should be based on the essential drug concept relevant to the situation’s needs. Strict inventory control and cost-effective procurement should be practiced. Increased costs of drugs are a significant problem in India, so all measures should be taken to provide affordable and quality drugs.

15. Four strategic objectives of pharmaceutical procurements are Procure the most cost-effective drugs in the right quantities. Select reliable suppliers of high-quality products. Ensure time delivery. Achieve the lowest possible total cost.

16. Efficient transport management for procurement procedures using open criteria to award contracts is essential. Good financial management to maximize the use of financial resources should ensure the availability of adequate quantities of drugs at all times.

17. Inventory Control: Monitoring of drug stocks and minimizing ‘out-of-stock’ situations can be achieved by reasonable inventory control. The use of a drug formulary or drug list to restrict the number and brands of drugs stocked will be helpful. Drugs that are going to expire should not dispensed or stored. All drugs required for the health facility should be kept in stock, and patients should not turned away due to the unavailability of drugs.

18. Information & Education: Pharmacists, as part of a collaborative healthcare team, should interact with other healthcare professionals and inform them about new drug introductions, hospital drug policy changes, drug availability, and drug-related problems. This can be done verbally or in writing. Any ADR is noted may be reported to appropriate monitoring centre in the hospital, region or the country.

19. Suitable programmes should be evolve to raise the awareness of prescribers about ADR’s and drug induced illness. Patients should be counseled regarding appropriate drug use, and patient compliance should be monitored. Pharmacists can also promote RDU by speaking to community groups and organizing public education programs.

20. Pharmaceutical Care: The main aims of pharmaceutical care are to optimize patient health related quality of life and achieve positive and cost effective outcomes. An individualize drug therapy plan to achieve specific outcomes must be made in consultation with health care professionals and patients.

21. The patient must be assured of all drug supplies and given information and assistance to carry out the drug therapy plan. The other significant role of the pharmacist is to monitor the treatment outcomes and make suggestions to modify the treatment.

22. Role of pharmacist in prescription preview in RDU: Clinical pharmacists should review the patient’s drug treatment or suggest changes to treatment. Pharmacist's role is to identify patient problems & give appropriate treatment suggestions to the prescriber. Pharmacist should check whether the drugs correctly indicated & the potential benefit of drug therapy, outweigh the potential risk. If drug therapy is indicated, the pharmacist should check whether the drug has proven efficacy and safety. The drug must also be suitable for the individual patient and affordable.

23. Pharmacists should check whether the prescribed dose suits the individual patient. Careful dose adjustment is required for children, the elderly, and patients with renal and hepatic impairment. Pharmacists should make prescribers avoid using more than one drug of the same chemical class at the same time. The pharmacist should inform the patient how to take the medicine, how long to work, how long to continue the same treatment, and the positive side effects.

24. If treatment has not been effected then pharmacist should suggest the prescriber to reconsider the diagnosis, the treatment which he was chosen, whether the dose was too low, whether the patient actually used the drug in the way which was intended and whether his monitoring is correct. The pharmacist should suggest whether the drug should be continued at the present dose, at a different dose, or stopped.

25. Rational Use Of Antibiotics: Almost 1/3 rd of drug use is for antibiotics. Studies in India has shown that there is a great irrationality in use of antibiotics. Antibiotics are widely misused for condition where they are not needed, such as treatment of common goal and upper respiratory infections of viral origin.

26. Common practices which may lead to antibiotic resistance: Starting antibiotics without any diagnosis. Frequently change in antibiotics. Not completing the course of treatment. Giving sub-optimal doses.

27. Following guidelines will ensure that antibiotics are used in a way that minimizes the emergence & spread of resistant organisms, & maximizes their efficacy & safety: Use antibiotics only when indicated. Where appropriate, gram stain, culture, and sensitivity testing specimens should be obtained before commencing antibiotic therapy. When an antibiotic is indicated the choice of the agent should be based on factors such as spectrum of activity in relation of the known or suspected organism, safety, previous clinical response, cost, ease of use and potential for selection of resistant organism.

28. An adequate dose and duration of treatment are essential for all antibiotic therapy. A history of allergy or other adverse effects of the drugs under consideration should always be sought. Prophylactic use of antibiotics should be restricted to situations where they have been shown to be effective or where the consequences of infection are disastrous.

29. Empirical antibiotic therapy should be based, where possible, on local epidemiological data on potential pathogens and their sensitivity pattern. Antimicrobial combinations should only be used where indicated. To extend the spectrum of cover in mixed infections. To achieve synergistic bactericidal effect. To prevent the emergence of resistant organisms. Topical antibiotics should be restricted to a few proven indications such as eye infection Reserve new antibiotics for severe infections.

30. Rational Use Of Injections: Patients and doctors with a variety of health problems prefer injections even when their administration is not medically justified. An injection into the patient’s eyes may suggest a powerful, modern drug and increase the chance of successful treatment.

31. Higher cost Increased the need for trained staff Increase the time to administer the drug Possible transmission of a range of serious pathogens, such as HIV and Hepatitis-B. Increase the risk of adverse drug reaction Risk of abscess formation if injection are unhygienically administer

32. In general, the use of injections should be restricted to the following situations: Oral administration is not tolerated or possible, for example, swallowing difficulties. There is a clear absorption problem , ex: vomiting and severe diarrhea. The drug of choice is only formulated as a parenteral product, e.g., insulin. High tissue concentrations are needed and are not achieved by oral administration, e.g., or treatment of meningitis.

33. Adjunct treatment is required due to severe and rapidly progressing illness, e.g., septicemia. The patient is unlikely to comply with oral treatment.

34. Rational Use Of Common OTC Drugs: In India, almost all drugs can be bought over the counter without a prescription. This leads to the misuse of drugs, especially antibiotics and other potent drugs. OTC drugs serve a good purpose in places where drugs can’t be readily bought from a pharmacist with a prescription; the pharmacist should not prescribe drugs if the diagnosis is uncertain or requires highly potent agents.

35. Dispensing a few tablets for headaches or other minor ailments is acceptable. Vitamins & tonics, iron preparations, analgesics, NSAIDs & cough mixtures are widely used in the community. Pharmacists can recommend & sell these products without considering whether there is a genuine need for treatment. Two important factors are a patient’s desire for treatment and a pharmacist's desire to please the patient and to make the sale.

36. Vitamin preparations are often promoted for conditions or symptoms that usually have nothing to do with vitamin deficiency. This include fatigue, lethargy, anxiety, forgetfulness, stress and indigestion. Care must ensure that recommended OTC products are not contraindicated in a particular patient. For example, sympathomimetics containing cough or cold preparations should be avoided in patients with hypertension. Care must also be taken to enquire about other drug therapies so that potential drug interactions can be avoided.

37. Conclusion: Irrational use of drugs may lead to ineffective, unsafe drug treatment, worsening or prolonging the illness, and adverse drug reactions. Therefore, the pharmacist should play a major role in avoiding these complications by motivating health care professionals and patients.

38. Thank You