This document discusses the essential medicine concept and rational use of medicines. It defines essential medicines as those that meet the health needs of a population based on effectiveness, safety, and cost. Essential medicine lists include generic drug names, dosage forms, strengths, and indications. Irrational medicine use can lead to ineffective or unsafe treatment, increased costs and resistance. Rational use means using medicines appropriately for each patient's needs in terms of drug choice, dosage, duration, and cost. The document outlines various educational, managerial, regulatory and economic strategies to promote rational medicine use.

1. Essential Medicine List Concept
and Rational Use of Medicine
For BNS 1st Year
Dr. Pravin Prasad
1st Year Resident, MD Clinical Pharmacology
Institute of Medicine, Maharajgunj, Kathmandu
1st December, 2015 (Mangsir 14, 2072), Tuesday
General Pharmacology

2. Objectives
 Introduction to Clinical Pharmacology
 Terminologies and abbreviations used in Pharmacology
 Drug Nomenclature
• Essential Drug Concept
• Rational use of Drugs

3. Essential Medicine(Drug) Concept
• “Those drugs that satisfy the priority of healthcare needs of the
population” – World Health Organization
• Selection on the basis of:
• Public health relevance
• Evidence on efficacy and safety
• Comparative cost effectiveness

4. Essential Medicine Concept
• Should be available within the context of functioning health systems:
• At all times
• In adequate amounts
• In appropriate dosage forms
• With assured quality, and
• With adequate information
• At an affordable price to individual and community

5. Essential Medicine Concept
• Includes
• Drug name
• Dosage forms
• Dosage strength
• Indications ??
• Includes single formulations
• Fixed drugs are included only if its efficacy is proven to be higher
• Anti-Tubercular Agents
• Anti-Malarial Agents
• Drugs listed as Main List and Complementary List

6. Essential Medicine Concept
• First Model List of Essential Drugs by WHO in 1977 AD
• Current Edition – 19th Edition, April 2015 (Amended August 2015)
• Separate List for Paediatric Population – 5th Edition (2015)
• Nepal’s Essential Medicine List:
• National List of Essential Medicines
• Current Edition: 2011, 4th
• No separate list for paediatric population
• Modified for different level of health facilities
• 368 medicines

7. Objectives
 Introduction to Clinical Pharmacology
 Terminologies and abbreviations used in Pharmacology
 Drug Nomenclature
 Essential Drug Concept
• Rational use of Drugs

8. Rational Use of Medicines (Drugs)
• The rational use of drugs requires that 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.
WHO conference of experts Nairobi 1985
• So, what would you understand by Irrational use of Medicines?
• Irrational or non-rational use is the use of medicines in a way that is not
compliant with rational use as defined above.

9. Why Rational Use is Important??
Irrational Use has various harms as follows:
 Ineffective & unsafe treatment
 over-treatment of mild illness
 inadequate treatment of serious illness
 Increased morbidity (Adverse Drug Events,
prolonged illness) and mortality
 Distress, harm and cost burden to patient and
community as a whole
 Increased drug resistance

10. Why medicines are used irrationally??
• Lack of information
• Role models – Teachers or seniors
• Lack of diagnostic facilities/Uncertainty of diagnosis – medicine for all
possible causes
• Demand from the patient
• Patient load
• Promotional activities of pharmaceutical industries
• Drug promotion and exaggerated claim by companies
• Defective drug supply system & ineffective drug regulation

11. Influences over choosing treatment options

12. Irrational Use: Few examples
• Injudicious use of antimicrobials: Antibiotics in Viral fever and diarrhea
• Unnecessary combinations
• Use of drugs not related to diagnosis
• Incorrect route
• Incorrect dosing – under or overdose
• Incorrect duration – prolong or short term use
• Unnecessary use of expensive medicines
• Unsafe use of corticosteroids
• Polypharmacy

13. Moving towards Rational Use…

14. Educational Strategies
Training for Providers
• Undergraduate education
• Continuing in-service medical
education (seminars,
workshops)
• Face-to-face persuasive
outreach e.g. academic
detailing
• Clinical supervision or
consultation
Printed Materials
• Clinical literature and
newsletters
• Formularies or therapeutics
manuals
• Persuasive print materials
Media-Based Approaches
• Posters
• Audio tapes, plays
• Radio, television

15. Managerial Strategies
Changes in selection, procurement, distribution to
ensure availability of essential drugs
• Essential Drug Lists, morbidity-based quantification, kit systems
Strategies aimed at prescribers
• targeted face-to-face supervision with audit, peer group monitoring,
structured order forms, evidence-based standard treatment guidelines
Dispensing strategies
• course of treatment packaging, labelling, generic substitution

16. Economic Strategies
Avoid perverse financial incentives
• prescribers’ salaries from drug sales
• insurance policies that reimburse non-essential drugs or incorrect
doses
• flat prescription fees that encourage polypharmacy by charging
the same amount irrespective of number of drug items or quantity
of each item

17. Regulatory Strategies
Drug registration
Banning unsafe drugs - but beware unexpected results
• Substitution of a second inappropriate drug after banning a first inappropriate
or unsafe drug
Regulating the use of different drugs to different levels of
the health sector e.g.
• Licensing prescribers and drug outlets
• Scheduling drugs into prescription-only & over-the-counter
Regulating pharmaceutical promotional activities

19. That will be all for today!!
• Next class we will be discussing about:
• Routes of Drug Administration
• Assignments for you….. Posters making
• Use A4 papers
• Don’t get stressed - its something you have been doing
• Thank you!