Lecture presentation for BNS 1st year students

1. Essential Medicine List Concept
and Rational Use of Medicine
For BNS 1st Year
Dr. Pravin Prasad
MBBS, MD Clinical Pharmacology
Assistant Professor, Department of Clinical Pharmacology
Maharajgunj Medical Campus, Kathmandu
3 July 2020 (19 Asar 2077), Friday

2. Objectives
• 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. Medicines
RegisteredMedicines
Public Health
Relevance
Efficacy and
safety
Cost
effective
Essential Medicines: Selection
Essential
Medicines

5. Essential Medicine Concept
At all times
Should be available within the context of functioning health
systems
In adequate
amount
In appropriate
dosage forms

6. Essential Medicine Concept
Assured Quality
Should be available within the context of functioning health
systems
Adequate
information
Affordable price to
individual (community)

7. Essential Medicine List:
What’s included?
• Drug name
• Dosage forms
• Dosage strength
• Indications*
Single vs Fixed Dose
Combinations??
Main vs
Complementary List

8. Essential Medicine List
• 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)

9. 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

10. 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.

11. 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

12. 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

13. Influences over choosing treatment options

14. 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

15. Moving towards Rational Use…