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Rational Drug Treatment: Nicolaski Lumbuun DR., SPFK Clinical Pharmacologist Faculty of Medicine - Uph
Rational Drug Treatment: Nicolaski Lumbuun DR., SPFK Clinical Pharmacologist Faculty of Medicine - Uph
Rational pharmacotherapy
prescribing right drug, in adequate dose for the sufficient duration & appropriate to the clinical needs of the patient at lowest cost
Drug explosion:
Increase in the number of drugs available has incredibly complicated the choice of appropriate drug for particular indication. Irrational use of drugs may lead to the premature demise of highly efficacious & life saving new antimicrobial drug due to development of resistance. Today, the information about drug development, its uses & adverse effects travel from one end of the planet to the other end with amazing speed through various media. Increase in cost of the drug increases economic burden on the public as well as on the government. This can be reduced by rational drug use. Extension of CPA in medical profession may restrict the irrational use of drugs.
3.
Growing awareness:
4.
5.
Lack of information Faulty & inadequate training & education of medical graduates :
Lack of proper clinical training regarding writing a prescription during training period, dependency on diagnostic aid, rather then clinical diagnosis, is increasing day by day in doctors
3. 4. 5. 6. 7.
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
Medication-Related Problem
Risk of clinically serious ADR is 4 / 100 prescriptions, 1in 1000 will die.
Medication-related problems/ADRs are estimated to cost the US $200 billion annually. Cameron. Preventing medicationrelated problems among older Americans. Manag Care Interface, 1998.
Knowledge & ideas about drugs are constantly the new development in drug therapy.
Compare the advantages, disadvantages, safety & cost of the drug with existing drug for some indication.
Identify the patients problem based symptoms & recognize the need for action.
Attention & think carefully for presenting symptom & clinical feature of patient illness. (listening/patient)
Try to find & tell the patient about the potential consequences of their problems.(communication) Ask or try to know what is the patient expectations of his problems and the medications (Empathy)
Start the treatment by writing an accurate & complete prescription e.g. name of drugs with dosage forms, dosage schedule & total duration of the treatment. Given proper information instruction & warning regarding the treatment given e.g. side effects(ADR), dosage schedule & dangers/risk of stopping the therapy suddenly
Monitor the treatment to check, if the particular treatment has solved the patients problem. It may be:
Passive monitoring done by the patient himself. Explain him what to do if the treatment is not effective or if too many side effect occurs Active monitoring done by physician and he make an appointment to check the response of the treatment.
If the particular treatment has not solved the patients problem back to step II
Nierenberg DW, Melmon KL. Introduction to Clinical Pharmacology and Rational Therapeutics In: Carruthers SG, Hoffman BB, Melmon KL, Nierenberg DW, eds. Clinical Pharmacology: Basic Principles in Therapeutic. 4th ed. New york: Mc Graw-Hill 2000: 713-36.
An ideal situation
Indication for drug therapy in relation to all prevailing circumstances: age, disease, pregnancy, sex, nutrition, concomitant drug use or other strategy.
Choice of drug according to factual criteria: pathophysiology, mechanism of action, the above conditions, characteristics of drug product.
An ideal situation
Drug treatment should be carried out according to knowledge based principles: choice of dose, evaluation of effect, dose adjustment, therapy and adverse effect monitoring.
Therapy should be withdrawn when a defined and preset endpoint has been reached.
Continuous drug communication is the basis for rational drug use !!!!
New drugs New knowledge about old drugs How to use the drug-
treatment guidelines
Drug committees and Public drug information centres (komite bidang kajian obat dan pelayanan kefarmasian, PB-IDI) Drug regulatory agencies (Badan POM)
Drug monographs :
Presentation of all, including unpublished, clinical trials Safety assessment
Conclusion
Indiscriminate use of drugs not only waste scarce resources that could otherwise be spent on other essential services, but also leads to drug induced disease. The drug control authority, the teaching institutes, drug industries, YLKI & the patient himself may be helpful for rational drug use. Drug authority must circulate the list of essential drugs which could be updated from time to time. It must monitor the safe & proper use of these drugs & enforce a uniform regulation for promotional literature.
Conclusion
Teaching institute must conduct regular research work & proper training of undergraduates & post graduates. Motivation of BPOM to organize various programmes for public awareness.
The patient himself should observe strict compliance to the physician prescription & never indulge in self medication.
Conclusion
Thank You