2023 PREFINALS - Improving PH Thru Pharmacy

Improving Public
Health through
Pharmacy
PREFINALS
CONTENTS
 Roles of Pharmacists in Addressing Issues of
Public Health
 Current Existing Drug and Non-Drug related
Public Health Policies and Programs
 a. TB DOTS
 b. Diabetes Control
 c. Smoking Cessation Initiatives
 d. Promotion of proper Antibiotics Use
 e. Programs against Substance Abuse
 f. Reproductive health programs
 g. Other health Programs
Pharmacists who practice in hospitals and health
systems (health-system pharmacists) play a vital role
in maintaining and promoting public health. The
American Society of Health-System Pharmacists
(ASHP) believes that all health system pharmacists
have a responsibility to participate in global, national,
state, regional, and institutional efforts to promote
public health and to integrate the goals of those
initiatives into their practices.
Furthermore, health-system pharmacists have a

responsibility to work with public health planners to
ensure their involvement in public health policy
decision-making and in the planning, development, and
implementation of public health efforts.
https://www.ashp.org/-/media/assets/policy-guidelines/docs/statements/role-of-health-system-
pharmacists-in-public-health.ashx
Public Health Pharmacist Definition
Introduction
The pharmacist's role is expanding beyond the

traditional product-oriented functions of
dispensing and distributing medicines and
health supplies. The pharmacist's services of
today include more patient-oriented,
administrative and public health functions.
There are many functions of public health that
can benefit from pharmacists' unique expertise
that may include pharmacotherapy, access to
care, and prevention services.
Introduction
Pharmacists have thorough knowledge about

medicines and their use and are in a better
position to educate other health professionals
about the rational use of medicines. They help in
achieving the goal of rational use of medicines.
They are also involved in scientific
procurement & distribution of medicines.
THE ROLE OF
PHARMACISTS IN
PUBLIC HEALTH
Public health has been
defined simply as “what
we as a society do to
assure the conditions in
which people can be
healthy.
Public health is the science of protecting and

improving the health of people and their communities.
This work is achieved by promoting healthy lifestyles,
researching disease and injury prevention, and
detecting, preventing and responding to infectious
diseases.
https://www.cdcfoundation.org/what-public-health
Public health services have been characterized as
occurring on two levels: the planning (“macro”) level
and the implementation (“micro” or “provider”) level.
Macro-level Micro-level public health

public health services services
focus on the well-being of the population as a
include all the activities required to implement public
whole and emphasize the assessment and
health initiatives
prioritization of a community’s health-related
needs as well as planning to address those needs
Role Recognition Pharmacists are not
formally classified as a profession within the
public health work force, unlike public
health nutritionists, nurses and physicians.
https://www.apha.org/policies-and-advocacy/public-
health-policy-statements/policy-database/
2014/07/07/13/05/the-role-of-the-pharmacist-in-public-
health
The Role of Pharmacist in Public health
1. Population-based Care: 2. Prevention of Disease and 3. Health Education:

Medication Safety:
A pharmacist can be indulged
in the prevention and control
of disease in a many ways. The development of programs on
The health-system pharmacists They can help in the the safe and effective use of
can support public health efforts establishment of some medication, and other public
using designing and providing screening programs to check health-related topics, such as
disease management programs. out the status of exercise, healthy nutrition and
immunization, and tobacco cessation, is also an
identification of some important area where pharmacists
undiagnosed medical play their role.
conditions.
The Role of Pharmacist in Public health
4. Public Health Policy: 5. Research and

Training:
Health-system pharmacists can participate in the
development of public health policy concerned A health-system pharmacist must get adequate
with local boards of health as well as national education and training to carry out his
programs. Drugs are the central part of health responsibility in public health. Health-system
systems. Hence, the health policy, especially pharmacists should be expertise in
policy targeted for chronic disease, must be pharmacoepidemiology, research methodology,
prepared with better consideration of drug and biostatistics with their applications in
therapy as well as factors affecting the disease decision related to public health.
outcomes.
SUMMARY OF ROLES:
• Providing population-based care.

• Developing disease prevention and control programs
(including medication safety programs) in their
institutions and communities.
• Developing health-education policies and programs
within their institutions that address the needs of
patients, other health care professionals, community
leaders, and the public.
• Collaborating with state and local authorities,
including local and state health departments and
boards of health, to address local and regional health
care needs (including environmental hazard and
emergency preparedness programs).
• Advocating for sound legislation, regulations, and
public policy regarding disease prevention and
management.
• Engaging in population-based research and initiating
campaigns to disseminate new knowledge.
Current Existing Drug and Non-Drug
related Public Health Policies and
Programs
A. TB DOTS
Directly observed treatment, short-course (DOTS, also known as
TB-DOTS) is the name given to the tuberculosis (TB) control strategy
recommended by the World Health Organization. According to WHO, "The
most cost-effective way to stop the spread of TB in communities with a high
incidence is by curing it.
http://www.ntp.doh.gov.ph/aboutNTP.php
Current Existing Drug and Non-Drug
related Public Health Policies and
Programs
TUBERCULOSIS .The Philippines is among the 22 high-
burdened countries in the world according to WHO.
 TB is the 6th leading cause of illness and the 6th
leading cause of deaths among the Filipinos.
 Most TB patients belong to the economically
productive age-group (15-54 years old) according to
the 2nd National Prevalence Survey in 1997.
Seventy-five (75) Filipinos die of TB every day, most of them in
the prime of their life. If untreated, a person with tuberculosis can
transmit the TB bacteria to as many as 10 to 15 people during the
course of one year, who, in turn, may develop the disease.
What is TB? Tuberculosis is an infectious disease caused
by TB bacteria (Mycobacterium tuberculosis) that primarily
affects the lungs. This condition is known as pulmonary
tuberculosis (PTB). One may also have tuberculosis in the
bones, meninges, joints, genito-urinary tract, liver, kidneys,
intestines and heart and this is called extra- pulmonary
tuberculosis.
How is TB treated?
Tuberculosis is a curable disease. Patients are prescribed
with appropriate regimen to render them non-infectious and
cured, as early as possible. The treatment for TB is a
combination of 3-4 anti-TB drugs. NEVER should we
prescribe a SINGLE DRUG for TB treatment! This will
worsen the patient's condition.
What is DOTS? D.O.T.S stands for Directly-Observed
Treatment Short0course. It is a comprehensive strategy
endorsed by the World Health Organization (WHO) and
International Union Against Tuberculosis and Lung
Diseases (IUATLD) to detect and cure TB patients.
The Stop TB Strategy
Vision, goal, objectives and targets
Vision
 Components of the Stop TB A TB-FREE WORLD
strategy
Goal
1. Pursue high-quality DOTS expansion
To dramatically reduce the global burden of TB by 2015 in line with
and enhancement
the Millennium Development Goals and the Stop TB Partnership
a. Secure political commitment, with
targets
adequate and sustained financing
b. Ensure early case detection, and
Objectives
diagnosis through quality-assured
• Achieve universal access to high-quality care for all people with TB
bacteriology
• Reduce the human suffering and socioeconomic burden associated
c. Provide standardized treatment with
with TB
supervision, and patient support
• Protect vulnerable populations from TB, TB/HIV and multidrug-
d. Ensure effective drug supply and
resistant TB
management
• Support development of new tools and enable their timely and
e. Monitor and evaluate performance
effective use
and impact
• Protect and promote human rights in TB prevention, care and
control
Components of the Stop The Stop TB Strategy
TB strategy
3. Contribute to health system strengthening
based on primary health care
• Help improve health policies, human resource development,
2. Address TB-HIV, MDR-TB, financing, supplies, service delivery and information
and the needs of poor and • Strengthen infection control in health services, other congregate
vulnerable populations settings and households
a. Scale-up collaborative • Upgrade laboratory networks, and implement the Practical Approach
TB/HIV activities to Lung Health (PAL)
b. Scale-up prevention and • Adapt successful approaches from other fields and sectors, and
foster action on the social determinants of health
management of multidrug-
resistant TB (MDR-TB)
c. Address the needs of TB 4. Engage all care providers
contacts, and of poor and • Involve all public, voluntary, corporate and private providers
vulnerable populations through Public-Private Mix (PPM) approaches
• Promote use of the International Standards for Tuberculosis Care
(ISTC)
Components of the Stop The Stop TB Strategy
TB strategy
5. Empower people with

TB, and communities 6. Enable and promote research
through partnership • Conduct programme-based operational research
a. Pursue advocacy,
• Advocate for and participate in research to develop
communication and social
mobilization new diagnostics, drugs and vaccines
b. Foster community
participation in TB care,
prevention and health
promotion
c. Promote use of the Patients'

Charter for Tuberculosis Care
5 Components of TB-DOTS Program
1. Political or Management commitment
2. TB diagnosis through sputum microscopy (x-ray is only a
secondary diagnostic tool)
3. Availability of complete and quality anti-TB medications
4. Supervised treatment (a responsible person making sure
that the patient takes the anti-TB medication everyday)
5. Recording and reporting of cases and outcomes
WHO Report on the TB Epidemic, 1997:
• DOTS cure TB patients and it can produce cure rates as

high as 95% even in the poorest countries.
• DOTS prevent new infections among children and adults
DOTS can stop resistance to anti-TB drugs.
• DOTS is cost-effective.
DOTS is THE MOST EFFECTIVE STRATEGY available
for controlling the worldwide TB epidemic today.
The pharmacy is often the first health facility
that a patient can access. Therefore,
pharmacists are at the best position to detect
possible TB cases and conduct referrals to
the proper facilities.
http://scinet.dost.gov.ph/union/Downloads/327-766-2-
PB_367678.pdf
The involvement of pharmacists in
TB prevention and control in the Philippines started in
2004.
The Pharmacy DOTS Initiative (PDI) was conceptualized
by the Philippine Tuberculosis Initiatives for the Private
Sector (Phil TIPS) through the United States Agency for
International Development (USAID) .
 Through this initiative, pharmacy personnel participated
in training programs that aimed to increase knowledge
on TB, discourage dispensing of anti-TB drugs without
a valid prescription, and refer patients to TB facilities.
In 2014, the project Innovations and Multisectoral
Partnerships to Achieve Control of TB (IMPACT)
was launched by USAID Philippines through the
Philippine Business for Social Progress (PBSP).
Through this project, PPhA was awarded a sub-grant
as the technical assistance provider to scale up the
number of pharmacies engaged in PDI for the period
spanning January 2014 to September 2016.
TB-DOTS CLINIC
The DRMC TB-DOTS clinic is a diagnostic and

therapeutic unit that caters patients
diagnosed with TB or suspected of having
TB. The Directly Observed Treatment
Strategy (DOTS) is the most effective
approach in the diagnosis, treatment, and
control of TB. The clinic operates by the
standard protocol of the Department of
Health and World Health Organization.
b. Diabetes Control
Types of diabetes
There are three main types of diabetes – type 1, type 2 and gestational.
• Type 1 diabetes can develop at any age, but occurs most frequently in children and
adolescents. When you have type 1 diabetes, your body produces very little or no insulin,
which means that you need daily insulin injections to maintain blood glucose levels
under control.
• Type 2 diabetes is more common in adults and accounts for around 90% of all diabetes
cases. When you have type 2 diabetes, your body does not make good use of the insulin
that it produces. The cornerstone of type 2 diabetes treatment is healthy lifestyle,
including increased physical activity and healthy diet. However, over time most people
with type 2 diabetes will require oral drugs and/or insulin to keep their blood glucose
levels under control.
• Gestational diabetes (GDM) is a type of diabetes that consists of high blood glucose
during pregnancy and is associated with complications to both mother and child. GDM
usually disappears after pregnancy but women affected and their children are at
increased risk of developing type 2 diabetes later in life.
WHAT CAUSES IT?
Medical science has yet to identify the exact cause of alcohol

dependence, but research suggests that genetic, psychological, and
social factors.
C. Smoking Cessation
Initiatives
National Smoking Cessation
Program(NSCP)
Rationale:
The use of tobacco continues to be a major cause of health problems worldwide. There is
currently an estimated 1.3 billion smokers in the world, with 4.9 million people dying because
of tobacco use in a year. If this trend continues, the number of deaths will increase to 10
million by the year 2020, 70% of which will be coming from countries like the Philippines.
(The Role of Health Professionals in Tobacco Control, WHO, 2005)
The World Health Organization released a document in 2003 entitled Policy Recommendations for
Smoking Cessation and Treatment of Tobacco Dependence. This document very clearly stated that
as current statistics indicate, it will not be possible to reduce tobacco related deaths over the next 30-
50 years unless adult smokers are encouraged to quit. Also, because of the addictiveness of
tobacco products, many tobacco users will need support in quitting.
Initiatives
National Smoking Cessation
Program(NSCP)
Population survey reports showed that approximately one third of smokers attempt to quit each year and
that majority of these attempts are undertaken without help. However, only a small percentage of cigarette
smokers (1-3%) achieve lasting abstinence, which is at least 12 months of abstinence from smoking, using
will power alone (Fiore et al 2000) as cited by the above policy paper.
Vision: Reduced prevalence of smoking and minimizing smoking-related health risks.

Mission: To establish a national smoking cessation program (NSCP).
Initiatives
National Smoking Cessation Program(NSCP)
Objectives:
The program aims to:
1. Promote and advocate smoking cessation in the Philippines; and
2. Provide smoking cessation services to current smokers interested in quitting the habit.
Program Components:
The NSCP shall have the following components:
1. Training
The NSCP training committee shall define, review, and regularly recommend training programs that are
consistent with the good clinical practices approved by specialty associations and the in line with the rules and
regulations of the DOH.
All DOH health personnel, local government units (LGUs), selected schools, industrial and other government
health practitioners must be trained on the policies and guidelines on smoking cessation.
Initiatives
2. Advocacy
A smoke-free environment (SFE) shall be maintained in DOH and participating non-DOH facilities,
offices, attached agencies, and retained hospitals. DOH officials, staff, and employees, together with
the officials of participating non-DOH offices, shall participate in the observance and celebration of the
World No Tobacco Day (WNTD) every 31st of May and the World No Tobacco Month every June.
3. Health Education
Through health education, smokers shall be assisted to quit their habit and their immediate family members shall
be empowered to assist and facilitate the smoking cessation process.
4. Smoking Cessation Services

Initiatives
National Smoking Cessation Framework detailing Smoking Cessation services at different levels of care:
Initiatives
Initiatives
Initiatives
5. Research and Development
Research and development activities are to be conducted to better understand the nature of nicotine
dependence among Filipinos and to undertake new pharmacological approaches.
Partner Organizations:
The following institutions take part in achieving the goals of the program
- LUNG CENTER OF THE PHILIPPINES
- PHILIPPINE COLLEGE OF CHEST PHYSICIAN
- PHILIPPINE GENERAL HOSPITAL - PHILIPPINE PSYCHIATRIC ASSOCIATION
- WORLD HEALTH ORGANIZATION - METROPOLITAN MANILA DEVELOPMENT
- PHILIPPINE ACADEMY OF FAMILY PHYSICIANS - AUTHORITY
- PHILIPPINE MEDICAL ASSOCIATION
- FRAMEWORK CONVENTION ON TOBACCO CONTROL
- PSYCHOLOGICAL ASSOCIATION OF THE PHILIPPINES
- SEVENTH DAY ADVENTIST
- PHILIPPINE AMBULATORY PEDIATRIC ASSOCIATION
D. Promotion of
proper
Antibiotics Use
Antimicrobial Stewardship
Antimicrobial stewardship is any activity that helps
promote the appropriate dose, type, and duration of
antibiotics. The discovery and use of antibiotics have
transformed the practice of medicine. Infections that
were once fatal became treatable, and medical
procedures like chemotherapy and organ transplants
became possible..
The dispensing and use of antibiotics
without a health professional’s prescription
has worsened the emergence and spread of
antibiotic resistance. Furthermore, in many
places in the world, antibiotics are prescribed
and used even when they are not necessary,
that is, they are misused and overused, which
worsens antibiotic resistance.
The quick initiation of antibiotics to treat infections
has been proven to save lives; however, 20%-50%
of all antibiotics prescribed in U.S. acute-care
hospitals are either unnecessary or inappropriate.
Antibiotics can have serious side effects, including

adverse drug reactions and Clostridium difficile
infection. Unnecessarily prescribed antibiotics
place patients at-risk for serious adverse events
and provide patients with no clinical benefit.
The misuse of antibiotics has also contributed to an

increase in antibiotic resistance, which has become
one of the most serious threats in public health.
The Centers for Disease Control and Prevention

estimates more than two million people are infected
with antibiotic-resistant organisms, resulting in
approximately 23,000 deaths annually.
Antimicrobial stewardship is based on the "three

Ds", the right drug, the right dose and the right
duration
DOH PROGRAM ON COMBATING ANTIMICROBIAL
RESISTANCE
Guidelines FOR ANTIMICROBIAL STEWARDSHIP
GENERAL PRINCIPLES OF ANTIMICROBIAL THERAPY:
The fundamental questions to ask in anti-infective therapy are:
• WHAT am I treating? – The infectious disease/clinical syndrome and the likely or proven
pathogen [The MICROBIOLOGIC FACTORS]
• WHO am I treating? – The patient’s demographic, clinical, and behavioral characteristics

[The HOST-RELATED FACTORS]
• WHICH antimicrobial (or antibiotic combination) is most appropriate? [The

DRUGRELATED FACTORS]
• HOW do I administer the appropriate antimicrobial(s)? – Dose, interval/frequency, route of

administration, duration of treatment, etc. [The DOSING REGIMEN including duration of
therapy]
A. FACTORS TO CONSIDER IN THE CHOICE OF ANTIMICROBIALS:
1. MICROBIOLOGIC FACTORS: the disease/clinical syndrome and the
likely/proven pathogen(s)
i. Site of infection – adequate concentration of the antibiotic at the site of infection
must be attained.
ii. Severity of infection: serious life-threatening infections (e.g., sepsis, meningitis,
endocarditis, etc.) require early empiric therapy after appropriate specimens are
obtained to determine the pathogen involved.
iii. Bacterial load (inoculum size), virulence, regrowth pattern and susceptibility
pattern of the pathogen.
iv. Infection at sequestered sites, which may not be reached by significant levels of
the principal antibiotic being used (e.g., nasopharyngeal carriage).
v. Prior antimicrobial therapy: exert selection pressure for micro-organisms resistant
to the antibiotic previously given to outgrow the rest of the microflora, invade and
cause infection.
vi. Local factors – e.g., presence of pus, devitalized tissue, foreign body, pH
changes, impaired penetration of antibiotic into the affected area.
2. HOST-RELATED FACTORS influence the efficacy and toxicities of

antimicrobials
i. Age – a major factor that can influence gastric acidity, renal function and hepatic
function, as well as propensity to develop hypersensitivity.
ii. Genetic factors – e.g., glucose-6-phosphate dehydrogenase deficiency causes
hemolytic anemia and jaundice with the administration of primaquine,
sulfonamides, sulfones, nitrofurans, chloramphenicol, etc.; or aplastic anemia
from chloramphenicol as an idiosyncratic reaction.
iii. Hepatic and renal function – the ability of the patient to metabolize/inactivate or
excrete the antimicrobial is one of the most important host factors, especially
when high serum or tissue levels are potentially toxic.
iv. Pregnancy and Nursing Status (See Appendix for Pregnancy Risk Categories by
the US FDA).
2. HOST-RELATED FACTORS influence the efficacy and toxicities of

antimicrobials
v. Host defense mechanisms, both humoral and cellular; immunocompetent

vs.
immunocompromised host (e.g., HIV infection, recipients of cytotoxic drugs,
transplanted organs, burn patients, with vascular abnormalities, impaired
localized phagocytosis, etc.)
vi. Co-morbid conditions: HIV/AIDS, diabetes mellitus and other metabolic

disorders, atopy, pre-existing organ dysfunction, obesity, etc.
vii. Previous history of adverse drug reactions (e.g., allergy, intolerance,

etc.).
3. DRUG-RELATED FACTORS
i. Pharmacodynamics – “what the drugs does to the pathogen and to the body” – antimicrobial
spectrum; bacteriostatic vs. bactericidal; concentration dependent vs. time-dependent
bacterial killing.
ii. Pharmacokinetics – “what the body does to the drug” – includes the processes of absorption,
distribution, biotransformation/metabolism, excretion; the relationship between the
antimicrobial concentration at the site of action and the minimum inhibitory concentration for
the pathogen is the major determinant of successful therapy; poor antimicrobial penetration of
the blood-brain barrier, intraocular tissues and prostate, but increased with inflammation.
iii. Adverse effects: risk/benefit ratio.
iv. Drug interactions – could be pharmaceutical, pharmacodynamic or pharmacokinetic in nature.
v. Cost/benefit ratio – the total cost of the regimen and not the unit cost of the drug, should be
considered.
vi. Others: ease and accuracy of dosing, stability, and acceptability.

B. ANTIBIOTIC COMBINATION THERAPY:
Antibiotic combinations provide a broader spectrum coverage than single agents; hence, the physician
is often tempted to use a combination of 2 or more for the sense of security they provide. However,
when inappropriately used, antibiotic combination can lead to deleterious effects
E.Programs against
Substance Abuse
https://www.ddb.gov.ph/images/unodc_publications/
CBT_Guidance_Doc_Philippines_Final.pdf
E.Programs against
Substance Abuse
Drug use and dependence remain to be a burden to health, social and
economic stability of our country. They are interlinked with problems of
intoxication, development of mental illness and mental disorders, spread of
infectious diseases like HIV/AIDS and TB, disruption of peace and order due
to petty and heinous crimes, and loss of productivity which can have a direct
or indirect impact to an individual, family and community. Proactive ways in
addressing the ill-effects of drug use and dependence are therefore highly
essential. We need to try better approaches which are evidence-based and
culturally adaptive.
E.Programs against
Substance Abuse
Introduction
Substance abuse is a mal – adaptive pattern of substance use
resulting in repeated problems and adverse consequences.
Epidemiology of substance abuse

Substance abuse occurs in all segments of all societies, which
result in decreased work and school performance, accidents,
intoxication while drinking, absenteeism, violent crime, theft.
Adolescents are the most vulnerable age groups for
developing substance abuse problems.
Men are more at risk than women.
E.Programs against
Substance Abuse
A. Nature of substance use and dependence
People who use illicit drugs and other substances are a heterogeneous
population who may experience multiple and complex difficulties.
E.Programs against
Substance Abuse
Some Important Terms related to
Substance Abuse
Abuse: Mis-use, mal-treatment or excessive use
Addiction: before 1964 the term used but now

replaced by the term dependence (by WHO)
because it is no longer scientific term. However, it is
a physiologic or psychologic dependence on some
agent with a tendency to increase its use.
Intoxication . Problems from getting intoxicated usually
arise from the short-term effects of a drug. The problems that people
most often see are, by their nature, the most disturbing and visible
and are most likely to be social in nature.
Dependency. Drug dependence develops after a period of regular
use, with the time period varying according to the quantity, frequency and
route of administration, as well as factors of individual vulnerability and
the context in which the drug use occurs. Many young people who have
experimented with drug use do not become frequent users, and many who
become frequent users do not become dependent.
Dependence: The psychophysical state of a substance

users in which the usual or increasing dose of the
substances are required to prevent the on set of withdrawal
symptoms.
• It is a compulsion to take subs. To prevent on set of
withdrawal symptoms or discomfort
• A strong desire to obtain and take the substance.
• It is a persistent seeking behavior of substance.
Multiple factors, including the availability of drugs, family
and peer influences and the environmental context, contribute
to the initial decision to try drugs.
Once use has occurred, further factors contribute to the

likelihood of developing dependence, including: 
-environmental factors (cues, conditioning, external stressors); 
-drug-induced factors (molecular neurobiological changes resulting in

altered behaviors); 
-genetic factors through traits such as response to drug use,

personality, concurrent psychiatric disorders.
Smoking, sniffing, snorting or ingesting methamphetamine
(shabu) is a significant form of drug use in the Philippines.
Amphetamine-type stimulants (particularly

methamphetamine) are used to enhance the ability to work,
as well as in recreational or social situations.
Work requiring stamina, long hours and hard work is closely

linked to methamphetamine use for some people.
Such work provides higher income, but the user enters a
vicious cycle of using methamphetamine in order to be able
to do the work, but then has to work more to get enough
money to buy drugs and so on.
Alcohol consumption may also be linked to

methamphetamine use, and used to help relax, sleep and eat,
but also as a substitute when methamphetamine is not
available.
Marijuana, the second most commonly used drug in the
Philippines is mostly smoked or ingested.
There are several psychoactive preparations of the marijuana

(hemp) plant, Cannabis sativa.
They include marijuana leaf (in street jargon: grass, pot, dope,
weed, or reefers), bhang, ganja, or hashish (derived from the
resin of the flowering heads of the plant), and hashish oil.
Cannabis contains at least 60 cannabinoids, several of which

are biologically active. Cannabis intoxication produces a
feeling of euphoria, lightness of the limbs and, often, social
withdrawal.
Cannabis intoxication produces a feeling of euphoria, lightness of the
limbs and, often, social withdrawal. Its effects can include impairment
of driving or other complex, skilled activities.
Other signs of intoxication may include excessive anxiety,

suspiciousness or paranoid ideas in some and euphoria or apathy in
others, impaired judgment, conjunctival injection (redness in the eyes),
increased appetite, dry mouth, and tachycardia.
Cannabis is sometimes consumed with alcohol, a combination that is

additive in psychomotor effects.
Acute anxiety and panic states and acute delusional states have been
reported with cannabis intoxication; they usually remit within several
days.
Cannabinoids are sometimes used therapeutically for glaucoma and to
counteract nausea in cancer chemotherapy.
Cannabinoid use disorders are included in the psychoactive substance

use disorders in ICD-I0 (classified in Fl2)
‘Dependence’ is widely accepted as describing a characteristic set
of cognitive, behavioral and physiological symptoms.
As indicated by these criteria, drug dependence is not necessarily

heavy drug use, but a complex health condition that has social,
psychological and biological dimensions, including changes in the
brain – not a weakness of character or will.
The key elements of dependence are a loss of control over

use, and continued use despite awareness of problems caused
or exacerbated by the using behavior.
It is these aspects that make dependence particularly

damaging to the individual, family, and the community.
The high risk of harm to individual users, their families and the
community make this population the target for treatment
services
Tolerance:
• is the requirement for an increased amount of the
substance to achieve a desired effect or there is
markedly diminished effect regular use of the same
dose
Withdrawal:
• Specific
organic brain syndrome that resulting from
cessation or reduction in intake of substance.
Factors Associated with Substance Abuse
and Dependence
Many variables operate simultaneously to influence the
likelihood of any given person becoming a substance
abuser or dependent.
These variables can be organized in to 3 categories.
1.Agent / Drug Variables.

The abuse liability of a substance is enhanced by its:
Availability: easily available, substances are likely to
be abused.
Cost: low cost of substance, a likelihood of increase
abuse / dependent
Factors Associated with Substance Abuse and Dependence
Mode of administration: The possible modes of

administration of sub. Include: chewing, PO, intra-
nasal, SC, IM, IV, & inhalations.
The easy modes of administration (chewing, PO,
etc.) increased the tendency of abused.
Speed of onset: effect that occur soon after

administration.
- more likely to initiate the chain of events that leads
to loss of control of subs.taking.
Termination effect: Substance that has longer

duration of action is more likely to be abused.
• 2. Host / Users variables.

In general, the effect and the likelihood of
an individuals becoming substance
abused depend on:
-Genetic predisposition and vulnerability
Psychiatric disorder
-Psychiatric disorder
-Prior experience or expectations
-Propensity for risk taking behavior
3. Environmental Variables
Include: Social setting and community
attitudes
- peer influence
- Scarcity of other option for pleasure or
diversion
- Low employment or educational
opportunities.
Some of the substances that are commonly abused by individual
Substances that are commonly abused in the Philippines
- Alcohol
- Tobacco
- Rugby
- Marijuana
- Benzodiazepines
- Methamphetamine Chloride/Shabu
- Cough syrups
Diagnostic criteria for substance abuse
Clinical guideline (ICD-10) for a definite diagnosis of dependence drawn up by
WHO require that three or more of the following six characteristic features have
been experienced / exhibited namely -
a. A strong desire or sense of compulsion to take the

substance
b. Difficulties in controlling subs. Taking behavior in terms
of its on set, termination, or level of use.
c. A physiological with drawl state when substance users
have ceased or been reduced, as evidenced by: the
characteristic withdrawal syndrome for the
substance or use of the same (or a closely related)
substance with the intention of relieving or avoiding
withdrawal symptoms.
Diagnostic criteria for substance abuse
Clinical guideline (ICD-10) for a definite diagnosis of dependence drawn up by
WHO require that three or more of the following six characteristic features have
been experienced / exhibited -
d. Evidence of tolerance, such that increased doses of the psychoactive
substance are required in order to achieve effects originally produced by
lower dose.
e. Progressive neglect of alternative pleasures or interest because of

psychoactive substance use increased the amount of time necessary to
obtain or take the substance or to recover from its effect.
f. Persisting with substance use despite clear evidence of overtly harmful

consequences, such as harm to liver through excessive drinking,
depressive mood states consequent to periods of heavy substance use,
or drug related impairment of cognitive functioning, efforts should be
made to determine that the user was actually, or could be expected to be,
aware of the nature and extent of the harm.
The fourth Diagnostic and Statistical Manual (DSM-IV) of the
American Psychiatric Association uses the following criteria for
substance abuse. If any individual has experienced one or
more of the following at any time for at least in one-month
period:
- Recurrent drug use resulting in failure to fulfill major
responsibilities.
- Recurrent drug use in physically hazardous situation
- Recurrent drug – related legal problems
- Continued use despite drug related social / interpersonal
problem
Problems associated with substance abuse and
dependence
-The dependence producing properties of substance that
reinforce the users for continuation of the substance taking
behavior are responsible for ill effects of a substance on the
abuser & the society virtually, all substance that producer
dependence can cause varying degree of health, social &
economic problems.
-The degree of harm produced in general depends on
o The quantity of a substance consumed per occasion
o The frequency with which it is consumed
o The duration of consumption
Health related problems
a. Acute – toxicities – can cause death and / or ill health
b. chronic toxicities – e.g., liver damage
- coronary heart disease
-psychiatric problems
- lung cancer
Economic consequence (problems)

a. Un employment resulting in decrease national productivity
b. Economic crisis–because increase expenditure for buying substance
c. Decrease school performance
d. Increase school drop out
e. increase absenteeism leads decreased performance at school, work …
etc
f. Decrease productivity occupies vast area of the land that other wise be
used for cultivation of
useful crop and food.
Social consequence
i. Divorce broken families prostitution
ii. Crime (theft, hijacking, rape…)
iii. Violence
iv. Accident
v. Dangerous homelessness (Vagrancy)
Management of problems related to substance abuse and dependence
Many substance abusing patients are known by their dependent
personalities, denial and ambivalence.
The purpose and goal of Rx is to prevent and / reduce the incidence & severity
of problems associated with the use of substance.
The Rx include ---
a) Early detection of cases and early intervention before complicate occurs.
- Gradual withdrawal
- Substitution of less addictive
- Symptomatic treatment
- Pharmacotherapy (to prevent relapse once on initial remission)
c. Psychotherapy and counseling
Rx designed to produce a response by mental rather than by physical effects
d. Long term Rx and rehabilitation include
- education
- family / friend support
- self – help group
- vocation rehabilitation
Prevention and control
Primary prevention
- identifying and avoiding drugs alcohols that the community used
- information and education about alcohol, drug, mis-use to the
community to avoid the appearance of the new cases of drug or other
substance users
Secondary prevention
- early detection and management be fore complication occur
Tertiary prevention
- To avoid further disabilities & to reintegrate in to society
Control methods
Control of production, supply and availability
Include:
• stopping the supply process as its source
• crop eradication
• crop substitution
• control of distribution & access
Demand reduction
– reducing consumption
– increase price
– control of advertisement and promotion
Rational prescribing, dispensing and uses of narcotic and psychotropic
drugs
– Proper diagnosis and decide on the use of drugs
– Keep records
– Take as prescribed
– Not use for non – medical purpose etc…
- Increasing individual resistance from social pressure by health education.
Principles for a substance abuse treatment system
Principle 1: Addiction is a complex but treatable disease that affects

brain function and behavior. Drugs of abuse alter the brain’s structure
and function, resulting in changes that persist long after drug use has
ceased. This may explain why drug abusers are at risk for relapse even
after long periods of abstinence and despite the potentially devastating
consequences.
Principle 2:No single treatment is appropriate for everyone.

Treatment varies depending on the type of drug and the characteristics
of the patients. Matching treatment settings, interventions, and
services to an individual’s particular problems and needs is critical to
his or her ultimate success in returning to productive functioning in
the family, workplace, and society.
Principle 3: Evidence-informed dependence treatment
Evidence-based good practice and scientific knowledge on dependence

should guide interventions.
Principle 4: Dependence treatment, human rights, and patient dignity
Treatment interventions should comply with human rights obligations,

be voluntary and provide the highest attainable standards of health
and well-being.
Principle 5: Targeting special subgroups

Several groups within the larger population of those affected by
dependence require special attention, including adolescents,
women (including pregnant women), individuals with co-morbid
disorders (either mental or physical), sex-workers, ethnic
minorities and homeless people.
Principle 6: Dependence treatment and the criminal justice system

Dependence should be seen as a health care condition, and dependent
individuals should be treated in the health care system rather than the
criminal justice system with community-based treatment offered as an
alternative to incarceration where possible.
Principle 7: Community involvement, participation, and patient

orientation
Community-based treatment responses to drug and alcohol abuse
and dependence can promote community change and active
involvement of local stakeholders and support for community
funding models
Principle 8: Clinical governance of dependence treatment

services It is important that treatment services have clearly
defined policies, treatment protocols, programs, procedures, a
definition of professional roles and responsibilities, supervision,
and financial resources.
Principle 9: Treatment systems: policy development,
strategic planning and coordination of services
A systematic high-level policy approach to substance use

disorders and individuals in need of treatment, as well as a
logical, step-by-step sequence that links policy to needs
assessment, treatment planning, implementation, and to
monitoring and evaluation is most beneficial
The Philippine National Anti-Drug Strategy 2002 has
recently been updated, and the Philippine National Anti-
Drug Plan of Action (NADPA) 2015-2020 published
The NADPA expresses national concerns and charts the response to drug use
and abuse and efforts to prevent and control these problems. Its objectives
include the following:
a. to stop the production, processing, trafficking, financing and retailing of

dangerous drugs, precursors, and other essential chemicals;
b. to formulate policies in accordance with the new dangerous drugs law;
c. to develop and implement preventive education programs for various

target groups;
d. to adopt and utilize effective treatment and rehabilitation and after-care

programs; e. to continue the conduct of research on vital aspects of the
drug abuse problem;
Benefits of community-based interventions
It is expected that the implementation of community-based drug treatment will
enable people with drug-related problems to have improved access to a range of
quality services from education, information and drug counseling, to assistance
in stopping or reducing drug use.
This approach aims to help avoid the harmful health and social consequences of
drug use, especially HIV, hepatitis and sexually transmitted infections.
People who are affected by drug use and dependence will be offered help to
improve the overall quality of their life and well-being through social support
for rehabilitation and reintegration into the
F. Reproductive health programs
WHAT IS REPRODUCTIVE HEALTH?

Reproductive Health is a condition in which the reproductive functions
and processes are accomplished in a state of complete physical, mental
and social well-being.
WHAT IS REPRODUCTIVE RIGHTS?

Reproductive rights embrace certain human rights that are already recognized in
national laws, international laws and international human rights documents and
other consensus documents.
● Recognition of the basic rights of all couples and individuals to decide freely
and responsibly the number, spacing and timing of their children and to have the
information and the means to do so.
● Right to attain the highest standard of sexual and reproductive health.
● It also includes their right to make decisions concerning reproduction free of
discrimination, coercion and violence, as expressed in human rights documents.
WHAT IS SEXUAL HEALTH?

Name of Office: FHO, NCDPC
● Healthy sexual development
● Equitable and responsible relationships and sexual fulfillment,
and
● Freedom from illness, disease, disability, violence and other
harmful practices related to sexuality.
What are the reproductive health issues?

Common Reproductive Health Concerns for Women
• Endometriosis.
• Uterine Fibroids.
• Gynecologic Cancer.
• HIV/AIDS.
• Interstitial Cystitis.
• Polycystic Ovary Syndrome (PCOS)
• Sexually Transmitted Diseases (STDs)
• Resources.
Sexually Transmitted Diseases (STDs)
STDs are infections that you can get from having sex with someone who
has the infection. The causes of STDs are bacteria, parasites, and
viruses. There are more than 20 types of STDs.
Most STDs affect both men and women, but in many cases the
health problems they cause can be more severe for women. If a
pregnant woman has an STD, it can cause serious health problems
for the baby.
If you have an STD caused by bacteria or parasites, your health care

provider can treat it with antibiotics or other medicines. If you have
an STD caused by a virus, there is no cure, but antiviral medication
can help control symptoms. Sometimes medicines can keep the
disease under control. Correct usage of latex condoms greatly
reduces, but does not completely eliminate, the risk of catching or
spreading STDs.
The Responsible Parenthood
and Reproductive Health Act of 2012,
known as the RH Law, is a
groundbreaking law that guarantees
universal and free access to
nearly all modern contraceptives
for all citizens, including impoverished
communities, at government health centers.
ADOLESCENT REPRODUCTIVE HEALTH (ARH):
Adolescence is a period between 10-19 years where sexual

maturity develops but comes in with social demands (WHO,).
Adolescent is a time of:
• Experimentation and curiosity.
• Increasing confidence and self-esteem.
• Increased sexual feeling and impulse
• Beginning to reproduce
• Transition from child hood to adulthood
• Enjoy life before responsibilities of adulthood begins in a way which
doesn’t affect their life. Skills and knowledge are needed for positive
relationships with others (communication, decision making, overcoming
peer pressure, assertiveness. etc). It is one of the most crucial periods in
an individual life.
• A time when many key socioeconomic, biological and demographic
events occur that set for adult life.
• A period rapid psychological changes and vulnerability to physical,
psychological and environmental influences.
WHO Classify
- Adolescent – 10-19 years old
- Youth – 15-24 years old
- Therefore the aim of ARH service is -
o To enable them to undergo such changes, safely, with confidence
and best prospects, health and productive life.
Components of ARH
• Adolescents FP, IEC, service, counseling
• STIS/HIV
• Unwanted pregnancy and unsafe abortion
• Harmful traditional practices
o FGM
o Abduction and rape
o Early marriage
o Sexual violence (Gender-violence)
Problem of Adolescent Fertility
Adolescent health problem have been generally neglected because:
• Reported mortality and morbidity rate are low
• Health problems are less obvious
Adolescent sexual and reproductive health refers to the physical and emotional
well being of adolescents and includes their ability to remain free from unwanted
pregnancy, unsafe abortion, STIS including HIV/AIDS and all forms of sexual
violence and coercion. The major causes of adolescent reproductive health
problems are early unprotected sexual intercourse and unwanted pregnancy
which may occur due to:
• Lack of knowledge on physiology of the reproductive
system and human sexuality
• Declining age of menarche
• Early marriage
• Sexual violence and coercion
• Peer influence
• Lack of knowledge of family planning
• Unavailability and inaccessibility of service
• Attitude of the society towards use of family planning services by adolescents

The consequences of adolescent sexuality and pregnancy:

Psychological impact
• Poor psychological development
• lack of confidence
• isolation
• stigmatization.
Health impact
- Early child bearing (CPD, LBW, MM), each year about 15 million
adolescents aged 15-19 yrs. give birth, as many as 4 million obtain
abortion and
- STIs / HIV, globally up to 100 million adolescents become infected
with STIs and 40% of new HIV infections occur among 15-24 years
olds.
Socio-economic impact
- School dropouts
- Dwarfs futurity
- Curtails life options
- Juvenile deliquesces
- Dangerous vagrancy (homelessness)
- commercial sex workers
Strategies of ARH
A. Making clinical service available,
Meeting their Reproductive health needs include;
• Confidentiality
• Convenient location and time
• Youth friendly environment
• Range of choices
• Strong counseling component
• Specially trained professionals
• Comprehensive clinical services
Strategies of ARH
A. Making clinical service available
B. Provision of information
• Appropriate and relevant information about RH
• Clinic based education and counseling
• For practical skills use role plays, community visits, exercises
• Curriculum should address gender inequalities, that affect health
and promotes shared female-male responsibility for health.
C. Ensuring community support
D. School based clinics
E. Community based adolescent RH centers
F. Peer group education
G.ARH clubs at schools
H. Youth center
I. Participants
- Involve youngsters in ARH program and design its evaluation
- Parents should improve interaction with their children, guide
them in the right way.
- Support process of maturation of their children in the area of
sexual and RH
- Providers should not be judgmental not to make things worse
(trust, confidentiality, privacy, helpful)
Targets
Direct :
- in school adolescents
- out of school adolescent
- street adolescent
Indirect:
- Parents
- School teachers
- Policy makers
- Community leaders
- Religious leaders.
Conclusions and Recommendations:

For years, ARH has been neglected: However, recently it is
recognized as one of the major concern and determinants of
development thus, Government policy
makers should concern for ARH and allocate budget to:
- Parents should improve interaction with their children, guide them
the right way, enable them to comply with educational duties.
- support the process of maturation of their children in the area of
sexual behavior and RH
- Create more supportive Environment for youths efforts should be
made to overcome deep-seated adult discomfort with adolescent
sexuality in many developing countries.
- Young people should be given information on negotiating skills to
resist peer pressure that often leads them to be sexually active.
Studies show that sex education doesn’t increase sexual

activity, in fact it may delay or lead to responsible sexual
behavior for those who are sexually active, where as
keeping teenagers in the dark helps them to discover sex on
their won often with tragic consequences.
- Efforts should be made to overcome deep seated adult
discomfort with adolescent sexuality.
-Involve youngsters in ARH program design its evaluation.
- Health care providers should not be judgmental, help
Adolescents keep privacy and build trust.
- Educate young men to respect girls self determination
and share responsibility in matters of sexuality and RH.
. - Promote responsible sexual behavior including country

abstinence.
- Provide appropriate RH services appropriate to age
group.
- Train adolescents on Gender equality, equity,
assertiveness and gender violence.
Develop the following values in adolescents

 A respect of self and others
 Non-exploitation in sexual relationships
 Mutuality, honesty, and maturity
 Non exploration of rights, duties, responsibilities involved
in sexual relationships.
 Compassion, forgiveness and compromise when people
do not agree on their way of life.
 Acknowledge diversity (religion, culture etc).
 Self discipline in own sexuality.
END OF PREFINALS

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Improving Public

Furthermore, health-system pharmacists have a

The pharmacist's role is expanding beyond the

Pharmacists have thorough knowledge about

Public health is the science of protecting and

Macro-level Micro-level public health

1. Population-based Care: 2. Prevention of Disease and 3. Health Education:

4. Public Health Policy: 5. Research and

• Providing population-based care.

5. Empower people with

c. Promote use of the Patients'

• DOTS cure TB patients and it can produce cure rates as

The DRMC TB-DOTS clinic is a diagnostic and

Medical science has yet to identify the exact cause of alcohol

Vision: Reduced prevalence of smoking and minimizing smoking-related health risks.

4. Smoking Cessation Services

Antibiotics can have serious side effects, including

The misuse of antibiotics has also contributed to an

The Centers for Disease Control and Prevention

Antimicrobial stewardship is based on the "three

GENERAL PRINCIPLES OF ANTIMICROBIAL THERAPY:

The fundamental questions to ask in anti-infective therapy are:

• WHO am I treating? – The patient’s demographic, clinical, and behavioral characteristics

• WHICH antimicrobial (or antibiotic combination) is most appropriate? [The

• HOW do I administer the appropriate antimicrobial(s)? – Dose, interval/frequency, route of

2. HOST-RELATED FACTORS influence the efficacy and toxicities of

2. HOST-RELATED FACTORS influence the efficacy and toxicities of

v. Host defense mechanisms, both humoral and cellular; immunocompetent

vi. Co-morbid conditions: HIV/AIDS, diabetes mellitus and other metabolic

vii. Previous history of adverse drug reactions (e.g., allergy, intolerance,

iii. Adverse effects: risk/benefit ratio.

iv. Drug interactions – could be pharmaceutical, pharmacodynamic or pharmacokinetic in nature.

vi. Others: ease and accuracy of dosing, stability, and acceptability.

Epidemiology of substance abuse

Addiction: before 1964 the term used but now

Dependence: The psychophysical state of a substance

Once use has occurred, further factors contribute to the

-drug-induced factors (molecular neurobiological changes resulting in

-genetic factors through traits such as response to drug use,

Amphetamine-type stimulants (particularly

Work requiring stamina, long hours and hard work is closely

Alcohol consumption may also be linked to

There are several psychoactive preparations of the marijuana

Cannabis contains at least 60 cannabinoids, several of which

Other signs of intoxication may include excessive anxiety,

Cannabis is sometimes consumed with alcohol, a combination that is

Cannabinoid use disorders are included in the psychoactive substance

As indicated by these criteria, drug dependence is not necessarily

The key elements of dependence are a loss of control over

It is these aspects that make dependence particularly

1.Agent / Drug Variables.

Mode of administration: The possible modes of

Speed of onset: effect that occur soon after

Termination effect: Substance that has longer

• 2. Host / Users variables.

a. A strong desire or sense of compulsion to take the

e. Progressive neglect of alternative pleasures or interest because of

f. Persisting with substance use despite clear evidence of overtly harmful

Economic consequence (problems)

Principle 1: Addiction is a complex but treatable disease that affects

Principle 2:No single treatment is appropriate for everyone.

Principle 3: Evidence-informed dependence treatment

Evidence-based good practice and scientific knowledge on dependence