Problems with Irrational Drug

Use

compiled by:
M.ilyas
final year pharm D
 Problems with Irrational Drug Use:
Diagnosis :
1. Complex diseases or health problems:
• Eg: A patient has many symptoms, but is
embarrassed to talk about the main one, so the
situation does not get addressed
2 . Lack of appropriate training skills by prescribers to
give proper diagnosis:
• Eg: Prescriber does not do a physical exam and
prescribes drugs based solely on oral information
provided by the patient
 Problems with Irrational Drug Use:
Diagnosis:
3 . Overworked prescribers:
Eg : health facility has only one prescriber, and an
average of 300 patients per day to consult.
4. Lack of basic diagnostic equipment and tests:
Eg 1 : No microscope or reagents to examine blood
and urine.
Eg 2 :No x-ray machine to test a patient suspected of
having tuberculosis.
 Problems with Irrational Drug Use:
Prescribing :
1. Prescribing unnecessary medical therapy:
E.g: prescribing a drug for no medical
indication.
E.g: drug duplication
2. Not prescribing a drug for any
aliment/ignoring few aliment for which drug is
not prescribed.
E.g: untreated condition of the patient,not giving
prophylactic therapy.
 Problems with Irrational Drug Use:
Prescribing :
3. Prescribing old drugs which is less efficacious
than newer more efficacious drugs.
4. Prescribing old drug which is less safer than
newer more safe drug.
5. Not identifying patient condition which is
refractory to the drug/not identifying drug is
not effective for the patient and switching
over other better drug.
 Problems with Irrational Drug Use:
Prescribing :
6. Prescribing drugs with in appropriate dose,
dosage frequency and /or duration of
therapy.
7. Prescribing drugs without the consideration
of drug –drug interactions, contraction.
8. Prescribing drug without informing the
necessary patient instructions. to the patient
 Problems with Irrational Drug Use:
Prescribing :
9 . Using expensive drugs when equivalent ones
are available in the local market.
Eg : Ampicillin injection is prescribed when the
patient could take ampicillin tablets , which
are cheaper, easy to take, and involve lower
risk of side effects
 Problems with Irrational Drug Use:
Prescribing :
10.Selecting the wrong drug or the patient’s
illness:
E.g: an antidiarrhoeal drug is prescribed when
the patient is dehydrated with simple diarrhea
and ORS is needed
 Problems with Irrational Drug Use:
Prescribing :
11. Prescribing several drugs when fewer drugs
would provide the same effect:
E.g: sulfadoxine/pyrimethamine and paracetamol
are prescribed when the patient has fever, but
not malaria

12. Prescribing drugs when the disease is self

limiting and the patient would get better
without taking any drugs:
E.g: ampicillin is prescribed when the patient has a
simple cold, without sore throat, cough or fever
 Problems with Irrational Drug Use:
Prescribing:
13: prescribing drugs without dose adjustment in
hepatic, renal failure patients.
14: Prescribing new drugs without updating the
drug information from authentic source.
15:prescribing with consideration of risk Vs benefit
ratio in special population like pregnancy,
lactation, and pediatrics.
 Problems with Irrational Drug Use:
Dispensing:
1.Wrong interpretation of the prescription:

E xample: Ampicillin is prescribed, but amoxicillin is

dispensed.

2. Wrong quantity dispensed:

Example: Artemether/Lumefantrine is prescribed to be taken

four tablets two times daily for three days (should be a
total of 24 tablets), but the patient only receives 16
tablets, which is sufficient for only two days
3.Labelling incorrect or inadequate
Example : sulphadoxine/pyrimethamine (white tablet) is
dispensed, but the name of the drug is not written on
the container label, meaning that the drug will be
unidentifiable once the patient leaves the pharmacy
4.Incorrect/insufficient dispensing information:
• Example: paracetamol 250mg is prescribed for a child,
but only paracetamol 500mg is available in the
pharmacy. The higher dosage pill is given to the child’s
mother without telling her to divide the tablet before
giving it to the child.
5. Unsanitary practices:
Example: 20 tablets of paracetamol 500mg were being
counted, when some tablets fell to the floor. These were
picked up and dispensed to be given to the patient
anyway