rational pharmacotherapy

1. Dr. Renu Yadav
Resident Pharmacology
“Medicine is an art whose magic and creative ability have long been recognized as
residing in the interpersonal aspects of patient–physician relationship”

2. History
Rational pharmacotherapy
Irrational pharmacotherapy
Process of rational prescribing
Conclusion

3. The concept of the rational use of medicines is an old
one (300 B.C), when the Greek physician Herophilus
said that
“medicines are nothing in themselves, but are the very
hands of god if employed with reason and prudence”
(prudence = cautiousness)

4. In 1985, WHO definition
“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”

5. Rational – A decision/act based on clear thought
and reason
Latin word – “rationalis”- reasonable/ logical

6. This may manifest in five different ways, namely:
under-prescribing.
over-prescribing.
incorrect prescribing.
extravagant prescribing.
multiple prescribing.

7. A 5 year old boy (weight -15kg) diagnosed with
otitis media is prescribed Syp. Amoxycillin
(200mg/5ml) 2.5ml three times a day for 5 days.

8. A 20 year old male suffering from follicutis of mild
grade since 2 days, was prescribed IV ceftriaxone 2g
bd for 7 days.

9. A 55 years old known asthmatic presents to casualty
with BP 180/100 mm Hg, ECG shows no significant
abnormality. He was prescribed propranolol 40mg
OD for control of hypertension.

10. A 14 years old female is suffering from acne vulgaris
(grade 2) is prescribed Tab doxy 100mg BD,
Tab isotretinoin 20mg once a
day,
Clindamycin gel,
Tretinoin cream,
Adapalene gel,
Benzoyl peroxide cream,

11. Case :
A 52-year old taxi-driver complains of a sore throat and cough
which started two weeks earlier with a cold.
He has stopped sneezing but still has a cough, especially at
night. The patient is a heavy smoker.
Further history and examination reveal nothing special,
apart from a throat inflammation. The doctor advises him to
stop smoking, and writes a prescription for
Codeine tablets 15 mg, 1 tablet 3 times daily for 3 days.

14. P-drugs are the drugs you have chosen to prescribe
regularly, and with which you have become familiar.
They are your priority choice for given indications.

15. The key point is that not all diseases need to be treated
with a drug. Not every P-treatment includes a P-drug!

16. Constipation
List of possible effective treatments is as follows.
Advice and information: - Drink a lot of fluids, eat fruit and
high fibre diet
- Do not try to pass stools by
force.
- Reassure patient
Non-drug treatment: Physical exercise.
Drug treatment: Laxative (your P-drug).
Referral for treatment: Not indicated.

17. 1. Define the diagnosis
2. Specify the therapeutic objective
3. Make an inventory of effective groups of
drugs
4. Choose an effective group according to
criteria
5. Choose a P-drug

18. ANGINA PECTORIS:
A 60-year old man, with no previous medical history.
During the last month he has had several attacks of
suffocating chest pain, which began during physical
labour and disappeared quickly after he stopped.
He has not smoked for four years. His father and
brother died of a heart attack. Apart from occasionally
taking some aspirin he has not used any medication in
the past year.

19. Source : Goodman and Gilman’s pharmacological basis of therapeutics

20. Provide the patient’s diagnosis on the prescription
order
Write clearly. Poor handwriting is a well-known and
preventable cause of dispensing errors
In emergency situations :
Immediate administration is necessary
No appropriate alternative treatment is available
It is not reasonably possible for the physician to
provide a written prescription prior to the dispensing

21. Write all using metric measurements of weight and
volume
Use Arabic (decimal) numerals rather than Roman
numerals (e.g., does “IL-II” mean “IL-11” or “IL-2”?)
Use leading zeros (0.125 milligrams, not .125
milligrams);never trailing zeros (5 milligrams, not 5.0
milligrams).
 Avoid abbreviating drug names and directions

22. 1.Effects of the drug
2. Side effects
3. Instructions
4. Warnings
5. Future consultations
6. Ask if Everything clear?

23. Boy, 5 years. Diagnosed with Pneumonia. R/amoxicillin
syrup, 5 ml (= 250 mg) three times daily.

24. Man, 40 years. Review visit after pneumonia, treated
with oral ampicillin (2 grams daily) for one week. No
symptoms remain, only slight unproductive cough.
Examination normal

25. WHO advocates 12 key interventions to
promote more rational use:
1. Establishment of a multidisciplinary national body to coordinate
policies on medicine use
2. Use of clinical guidelines
3. Development and use of national essential medicines list
4. Establishment of drug and therapeutics committees in districts
and hospitals
5. Inclusion of problem-based pharmacotherapy training in
undergraduate curricula
6. Continuing in-service medical education as a licensure
requirement

26. 7. Supervision, audit and feedback
8. Use of independent information on medicines
9. Public education about medicines
10. Avoidance of perverse financial incentives
11. Use of appropriate and enforced regulation
12. Sufficient government expenditure to ensure availability of
medicines and staff.
…… contd