A case is given to the students, 1 week prior to the scheduled lecture, for them to read, analyze and

research on during this asynchronous session. The case contains guide questions for them to answer
during the synthesis with the facilitator. In the choice of the best drug to give, they have to be guided by
the Efficacy, Safety, Suitability and Cost Considerations using the following step-wise approach:
1. Formulate the goal of therapy
2. Formulate the “Criteria for Efficacy” that will meet the goal of therapy. This could be a PD or PK
property that the drug must possess or an evidence-based criterion. Once you have the “Criteria
for Grading Efficacy”, grade the individual drugs.
3. On Safety: List the known ADRs of the listed drugs in the table. Classify the ADRs according to
their severity and probability of occurrence. Formulate the “Criteria for Safety” then grade the
individual drugs.
4. On Suitability:
a. Identify the important clinical features of the case
b. Identify the characteristic of the patient and the co-morbid conditions relevant to the
choice of the drug to give
c. Identify the “plus factor” of the drug to the patient’s co-morbid condition/s
d. Generate the “Criteria for Suitability”
e. Generate the “Criteria for Grading Suitability”
f. Grade the individual drugs
5. On Cost:
a. Compute the total amount of the regimen when the drug is used based on the
recommended dosing.
b. Generate the “Cost Criteria”
c. Grade the individual drugs
6. Consolidate the grades to arrive at the most appropriate drug to give. The highest score
becomes the rational drug to give. In case of a tie, the drug with the highest efficacy grade will be
chosen. The students will then

The Synthesis: (Synchronous) At the end of the allotted time, the facilitator meets the group to discuss
the case, the guide questions, and the ESSC.

The other features of the case - problems, pathophysiology, non-pharmacologic, and other pharmacologic
management are also discussed at this time.

Reporting Format for the ESSC:

I. Goal of therapy #1:
Efficacy Criteria:
Ex.
1) The drug must be able to ...(what PD action do you want?)
2) The drug must reach the ... (what is the site of action that the drug must reach for it to be effective?
3) It must be cidal to the following.. (if the drug choices are antibiotics)

Efficacy Grading:
EFFICACY - Grade the efficacy (single or drug combination:
++++ meets all the criteria
+++ meets 75% of the criteria
++ meets 50% of the criteria
+ meets 25% of the criteria
 Table of Efficacy Grading:

Drug Choices Criteria 1 Criteria 2 Criteria 3 Criteria 4 Grade

Drug 1 x + + / +++

Drug 2 x x / / ++

Safety Criteria: use the known significant side effects

Safety Grading:
++++ has minor tolerable side effects, ceases when the drug is discontinued
+++ significant adverse effects that require intervention but not requiring hospitalization
++ side effect requires hospitalization
+ potentially life-threatening and can result in death

Table of Safety Grading:

Drug Choices ADR Safety Grading

Drug 1 ++++

Drug 2 ++

Suitability Criteria: identify the important clinical features of the patient - illness to be treated and
comorbid conditions, compliance to medications, significant drug interactions, etc. Use these to craft the
suitability criteria.
Ex 1). The drug must be effective for hypertensive emergencies. (the patient's problem)
2). The excretion must be....(esp if a patient has cirrhosis or renal failure
Suitability Grading:
++++ Has beneficial effect on co-morbid conditions; ideal for the patient's profile and
disease state
+++ not known to adversely affect co-morbid conditions
++ meets 50% of set goals
+ barely meets any criterion
0 the drug is contraindicated

Table of Suitability Grading:

Drug Choices Criteria 1 Criteria 2 Criteria 3 Total

Drug 1 ++

Drug 2 ++++

COST - identify the cost per treatment course; if long-term treatment, cost/month
Grade the cost as:
++++ least expensive of the choices
 +++ 0r ++ - in between
+ most expensive

Table of Cost Grading

Drug Choices Cost/week Cost Grading

Drug 1 500 x 3 x 7 = __ +

Drug 2 100 x 2 x 7 = __ ++++

Consolidated
Drug Choices Efficacy Safety Suitability Cost Grade

Drug 1 ++++ ++++ +++ + 12

Drug 2 ++ ++ ++ + 7