CLINICAL PHARMACOLOGY

RATIONAL DRUG
THERAPY

Rx
Endang Isbandiati Soediono,
DR, dr, MS, SpFK
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DRUG THERAPY : more than matching the name of
the drug to the name of a disease;
it requires knowledge, judgement, skill and
wisdom, but above all
a SENSE of RESPONSIBILITY

Drugs are used in three principal ways :

. to
CURE
the disease

. to
suppressdisease

. to
preventdisease :
(prophylaxis)
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Rational Approach to Therapeutics
. Drugs should only be prescribed when they are
necessary, and in all cases the benefit of
administering the medicine should be considered
in relation to risk involved.
. Bad prescribing habits lead to :

1. Ineffective and unsafe treatment

2. Exacerbation or prolongation of illness
3. Distress and harm to the pts.
4. Higher cost
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 P-Treatment
Optimal treatment : aware of
the sources of variation
in response to drugs

Diagnosis, severity and stage of the

disease, concurrent diseases or
drug treatment, acceptable
efficacy and toxicity
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Approach to Individualization

Pharmacotherapy to modify
the symptoms or outcome of a disease

qualitative (a specific drug)

quantitative ( dosage regimen)

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 Rational Drug Therapy
Efficacy
Safety
Suitability
Cost

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Rational Treatment:Process
Step 1 : Define the patients problem
Step 2 : Specify the therapeutic objective
What do you want to achieve with ?
Step 3 : Verify the suitability of your P-Tx.
Check effectiveness and safety
Step 4 : Prescription writing
Start the treatment
Step 5 : Give information, instructions and
warnings
Step 6 : Monitor (and stop ?) treatment
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 Steps in Choosing P-Drug
i. Define the diagnosis
ii. Specify the therapeutic
objective
iii. Make an inventory of effective
groups of drugs
iv. Choose an effective group
according to criteria
v. Choose a P-drug
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 Selecting
Your P(ersonal) Drugs
Key point : not all diseases need
to be treated with a drug
Priority choice for given
indications
Essential drugs and standard
treatment guidelines
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 Example of selecting a P DRUG

Case :

ANGINA PECTORIS

?????
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1. Define the Diagnosis

Stable angina pectoris

Causa :
partial occlusion of the
coronary artery

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 2. Specify
Therapeutic Objective
Stop attack as soon as possible

Reduced oxygen need by

decreasing preload,
contractility, heart rate or
afterload
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 3. Make Inventory
of Effective Groups

Nitrates

blockers

Calcium channel blocker

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 SOA : Angina Pectoris
Drug Groups
Preload Contractility Frequency Afterload

. Nitrates ++ - - ++

. Beta-Blockers + ++ ++ ++

. Calcium Channel
Blockers + ++ ++ ++

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 4. Choose a Group
According to Criteria

Efficacy Safety Suitability Cost

Nitrates + ++ +
(tablet)

- blocker + - -
(injection)

Ca-channel blocker + - -
(injection)
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 Choose a P-Drug
efficacy safety suitability cost

Glyceryl trinitrate
. Tablet + + +
. Spray + (+) -
Isosorbide dinitrate
. Tablet + +
Isosorbide mononitrate
. Tablet + (+)

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 Comparison Between Drugs
Within Nitrates Groups
Efficacy Safety Suitability Cost/100 ()*
Glyceryl trinitrate NB : volatile
Sublingual tab 0.4-1 mg 0.5-30 min No No 0.29-0.59
Oral tab 2.6mg, cap 1- 0.5-7 hours difference difference
3.25-4.28
2.5mg 1-24 hours between between
42.00-77.00
Transdermal patch 16- NB:tolerance individual individual
50mg nitrates nitrates

Isosorbide dinitrate 1.45-1.51

Sublingual tab 5mg 1.10-2.15
2-30 min
Oral tab 10-20mg 9.52-18.95
0.5-4 hours
Oral tab (retard) 20-40
0.5-10 hours
mg
NB:tolerance
Pentaeritritol 4.45
Oral tab 30 mg
1-5 hours 5.70-13.30
Isosorbide mononitrate
0.5-4 hours 25.00-40.82
Oral tab 10-40 mg
1-10 hours
Oral tab/caps (retard)
*Indicative prices only, based on prices given in the British National Formulary of March 1994
NB:tolerance

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 EFFICACY
Considerations :

EMERGENCY
should be

EFFICACY : excellent
OOA : immediate
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 SAFETY
Consideration :

Could be a relatively
UNSAVE

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SUITABILITY
Consideration :

Easy to reach and use

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 COST
Consideration :
Short periode of usage

No matter about the

cost
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Indication CChoosing P-Drug: Angina pectoris
DCate : Surabaya, .2007
Efficacy Safety Suitability Cost Total
? (......%) (......%) (......%) (......%) (100%)
60 5 20 15 100

Glyceryl
trinitrate
9 8 8,5 8
(540) (40) (170) (120)
717
. tablet

B -blocker
4 5 3 2
.injection
(240) (25) (60) (30) 355
Ca-channel
blocker 4 6 3 2 360
. injection (240) (30) (60) (30)

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 Indication CChoosing P-Drug: Angina pectoris
DCate Choosing P-Drug
: Surabaya, .2007
Efficacy Safety Suitability Cost Total
? (......%) (......%) (......%) (......%) (100%)
60 5 20 15 100

Glyceryl
trinitrate 9 8 8,5 8 717
. tablet
(540) (40) (170) (120)
B
-blocker. 4 5 3 2 355
injection (240) (25) (60) (30)

Ca-channel
4 6 3 2 360
blocker (240) (30) (60) (30)
. injection

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 CONCLUSION

Active substance : Glyceryl trinitrate

Dosage form : sublingual tablet, 1 mg

Dosage schedule : 1 tablet as needed,

second tablet if pain persists

Duration : length of monitoring interval

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THANK YOU
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