.

Y_KITIYOT@YAHOO.COM


1. 2
2.
3.
4.
5. 120


update

LNG ECPs

LNG ECPs

1.5 mg
(2 0.75 mg)

120

stroke, VTE
estrogen
LNG ECPs

RATIONAL USE OF MEDICINES 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, 1985)

()
-


CHIEF COMPLIANT (CC)
HISTORY OF PRESENT ILLNESS (HPI)
/ PAST MEDICAL HISTORY (PMH)
MEDICATION HISTORY (MH)
FAMILY HISTORY (FH) / SOCIAL HISTORY (SH)
ALLERGIC HISTORY (ALL)



:

[QALT: QUALITY, QUANTITY, AGGRAVATING FACTOR, ALLEVIATING FACTOR,
LOCATION, TIMING]

QUIZ 1:
SULFONAMIDE
A. CELECOXIB
B. ACETAZOLAMIDE
C. SUMATRIPTAN
D. GLUCOSAMINE SULFATE

QUIZ 2:
A. BETAMETHASONE CREAM
B. DEXTROMETORPHAN TABLET
C. BISACODRYL TABLET
D. DIPHENHYDRAMINE TABLET
E. IBUPROFEN SOFT-GELATIN CAPSULE

PHYSIOLOGIC FACTORS ALTERING PKS

component
Absorption

Patient group
Physiologic factor
Neonates, infants, young
Increased gastric pH
children, pregnant, elderly
Neonates, infants, pregnant Increased gastric emptying time

Comments
F of basic is increased, F of
acidic drugs in reduced
F is unpredictable

Infants, children

F is unpredictable

Pregnant, elderly
Neonates
Neonates, infants, young
children

Increased gastric and intestinal

motility
Decreased gastric and intestinal
motility
Decreased bile acids
Little muscle tissue and
immature peripheral circulation

Delayed onset of action

F is reduced
Drug absorption is
decreased

PHYSIOLOGIC FACTORS ALTERING PKS

component Age group
Physiologic factor
Distribution Neonates, infants, pregnants Increased total body water and ECF
Elderly
Neonates, infants, elderly
Neonates, infants
Breast-feeding mother

Comments
Vd of water-soluble is
increased
Increased fat-to-lean muscle ratio Vd of fat-soluble is increased,
Vd of water-soluble is reduced
Reduced albumin concentration and Vd is increased, concentration
protein binding
of free drug is increased
Immature BBB
Risk for CNS toxicity is
increased
High concentration of particular drugs Risk for infants exposure of
drugs

PHYSIOLOGIC FACTORS ALTERING PKS

component
Age group
Physiologic factor
Biotransformation Neonates, infants, elderly Decreased enzyme capacity

Elimination

Neonates, infants, young

children

Faster resting respiratory rate

Neonates, infants

Immature glomerular and

tubular function
Increased enzyme capacity
Decreased renal function
Increased renal blood flow,
increased GFR

Young children
Elderly
Pregnant

Comments
Increased half-life,
clearance reduced
Metabolism of drug is
more rapid, requiring
oxidation
Half-life increased
Clearance increased
Clearance decreased
Clearance increased


WWHAM: WHO, WHAT ARE THE SYMPTOMS, HOW LONG HAVE THE SYMPTOMS BEEN PRESENT,
ACTION TAKEN, MEDICATION BEING TAKEN
ENCORE: EXPLORE, NO MEDICATION, CARE, OBSERVE, REFER, EXPLAIN
ASMETHOD: AGE/APPEARANCE, SELF OR SOMEONE ELSE, MEDICATION, EXTRA MEDICINES,
TIME PERSISTING, HISTORY, OTHER SYMPTOMS, DANGER SYMPTOMS
SIT DOWN SIR: SITE/LOCATION, INTENSITY, TYPE OR NATURE, DURATION, ONSET, WITH (OTHER
SYMPTOMS), AGGRAVATED FACTORS, SPREAD OR RADIATION, INCIDENCE, RELIEVED BY

INSPECTION
AUSCULTATION
/ PALPATION
PERCUSSION

WEIGHT
HEIGHT
BODY TEMPERATURE
HEART RATE/ PULSE
RESPIRATORY RATE
BLOOD PRESSURE
PAIN


SPECIMEN
UNIT
SENSITIVITY | SPECIFICITY
ACCURACY | PRECISION
CONFOUNDERS

ROS/ PE
Interview
Lab

Patient
need

/
POSSIBILISTIC APPROACH:

PROBABILISTIC APPROACH:
PROGNOSTIC APPROACH:
PRAGMATIC APPROACH:

unnecessary drug therapy

Ineffective drug

Dosage too low

Dosage too high

No indication
Duplicate therapy
Contraindications present
Drug not indicated for condition DRUG
More effective med. available
Drug interaction
Indication refractory to drug
Inappropriate dosage form
Wrong dose
Inappropriate frequency, duration
Incorrect storage
Incorrect administration
Drug interaction
Wrong dose
Inappropriate frequency, duration
Incorrect storage
Incorrect administration
Drug interaction

Adverse drug reaction

Adherence (Noncompliance)

Additional drug therapy

Undesirable drug side effect

Allergic reaction
Drug interaction
Incorrect administration
Unsafe drug for patient
Cannot afford drug
Does not understand
instructions
Cannot administer the drug
Prefers not to take the drug
Drug not available
Untreated condition
Prophylactic therapy
Synergistic therapy

IESAC


(EVIDENCE-BASED
PRACTICE)


Efficacy
Indication
Safety

Adherence/cost

SPUTUM COLOR FOR BACTERIAL URI DIAGNOSIS

(ALTINER A, ET AL. SCAND J PRIM HEALTH CARE 2009;27(2):70-3.)
Bacterial
infection
Yellowish or greenish sputum 22 (16.2%)
Colorless sputum
6 (5.7%)
Totals
28 (11.6%)

No bacterial
Totals
infection
114 (83.8%) 136 (100%)
99 (94.3%) 105 (100%)
213 (88.4%)
241


TRAUMA AND INFLAMMATION
GROUP A BETA-HEMOLYTIC
STREPTOCOCCUS (GABHS)
ACUTE RHEUMATIC
FEVER
ACUTE
POSTSTREPTOCOCCAL
GLOMERULONEPHRITIS

Clinical finding
Absence of cough
Anterior cervical nodes
swollen or enlarged
Headache
Myalgia
Palatine petechiae
Pharyngeal exudates
Fever >38C
Tonsillar exudate

Sensitivity (%)

Specificity (%)

51-79
55-82

36-68
34-73

48
49
7
26
22-58
36

50-80
60
95
88
52-92
85

PHARYNGOTONSILLITIS
CLINICAL SYMPTOMS OF PHARYNGITIS
(ESP. TONSILLAR EXUDATE) + HIGH
GRADE FEVER, CHILL, SEVERE FATIGUE,
MYALGIA, ODYNOPHAGIA, DYSPHAGIA,
ANOREXIA, N/V

 1
1. ( 38 )
2.
3.
4.
5.
15
15-45
45

1
1
1
1
1
0
-1

 2 group A Streptococcus

()
0
< 10

1-2
10-17

3
28-35

52-53

ESCMID GUIDELINE FOR THE

MANAGEMENT OF ACUTE SORE
THROAT; 2012
EITHER NSAIDS (E.G., IBUPROFEN) OR
PARACETAMOL ARE RECOMMENDED FOR
RELIEF OF ACUTE SORE THROAT
SYMPTOMS (A-1).
SORE THROAT SHOULD NOT BE TREATED
WITH ANTIBIOTICS TO PREVENT THE
DEVELOPMENT OF RHEUMATIC FEVER
AND ACUTE GLOMERULONEPHRITIS IN
LOW-RISK PATIENTS (A-1).
IF ANTIBIOTICS ARE INDICATED,
PENICILLIN V, TWICE OR THREE TIMES
DAILY FOR 10 DAYS, IS RECOMMENDED
(A-1). THERE IS NOT ENOUGH EVIDENCE
THAT INDICATES SHORTER TREATMENT
LENGTH.

PARACETAMOL NSAIDS IBUPROFEN NAPROXEN ()

() ()



DOT (DIRECTLY OBSERVED THERAPY)
MEASUREMENT OF RELIABLE SURROGATE MARKERS E.G., BLOOD LEVEL, METABOLITES

QUESTIONNAIRES, SELF-REPORT, DIARY
PILL COUNT
RATES OF PRESCRIPTION REFILLS
ASSESSMENT OF PATIENT RESPONSES, PHYSIOLOGIC MARKERS


M.A.A.R.I.E. (METHODS, ASSIGNMENT, ASSESSMENT, RESULTS, INTERPRETATION AND EXTRAPOLATION)




FLUOROQUINOLONES
ERYTHROMYCIN
- 1 2


KETOCONAZOLE, NSAIDS

2



ALFA-GLUCOSIDASE INHIBITOR
FLUOROQUINOLONES, MACROLIDES
MAOIS
WARFARIN
GRISEOFULVIN