Transcript Document

The Personal
Drug List
Introduction to Primary Care:
a course of the Center of Post Graduate Studies in FM
PO Box 27121 – Riyadh 11417
Tel: 4912326 – Fax: 4970847
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Aim-Objectives
• Aim: At the end of this presentation, the
participants will know how to develop their own
p-drug lists.
• Objectives: At the end of this session, the trainees
should;
– be able to count dimensions which are important in
drug selection
– be able to explain the method in preparing a p-drug list
– believe in the importance of rational prescription
– be able to develop his/her own p-drug list
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Rational prescription
“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 costs to the
community”
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RATIONALIZATION OF
PRESCRIPTION PRACTISES
• Introduction of Essential drug list limits the
use of non-essential drugs.
• Provided details of pharmacokinetics help
the physician in selecting right kind of drug
and dosage form.
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RATIONALIZATION OF
PRESCRIPTION PRACTISES
Prescription of Rational drugs requires:
• Accurate diagnosis.
• Selection of best drug from the available.
• Prescribing adequate drug for a sufficient
length of time.
• Choosing the most suitable drug, weighing
of effectiveness, safety, and availability and
cost.
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RATIONALIZATION OF
PRESCRIPTION PRACTISES
Most of the illness respond to simple,
inexpensive drugs,
Physician should avoid :
• Use of expensive drugs.
• Use of drugs in nonspecific conditions (e.g.,
use of vitamins).
• Use of not required forms (e.g. injection in
place of capsules, syrup in place of tablets)
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RATIONALIZATION OF
PRESCRIPTION PRACTISES
Most of the illness respond to simple,
inexpensive drugs, even of improve with no
therapy at all.
Physician should avoid :
• Multiple drug prescription (bullet treatment)
even if it is considered in the best of the patient
in a given situation.
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The Concept of p-drug list
• There is a need for evidence based, rational
prescription
• Each GP has his/her own context with different
needs and priorities
• Scientists at the University of Groningen
suggested a method where each doctor prepares a
list of essential drugs for different conditions
• P-drug concept has been propagated by the WHO
Action Program on Essential Drugs world wide
Kawakami J, Mimura Y, Adachi I, Takeguchi N. [Application of personal drug (P-drug) seminar to clinical
8 pharmacy
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education in the graduate school of pharmaceutical sciences]. Yakugaku Zasshi. 2002 Oct;122(10):819-29
The process of rational treatment
• Step 1: Define the patient’s problem
• Step 2: Specify the therapeutic objective
• Step 3: Verify the suitability of your P-treatment
• Step 4: Start the treatment
• Step 5: Give information, instructions and warnings
• Step 6: Monitor (and stop?) treatment
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http://p-drug.umin.ac.jp/34th-gakkai/slide/DrSunami/SunamiP-drug.PPT
Selecting a P-drug
• Step i : Define the diagnosis
• Step ii : Specify the therapeutic objective
• Step iii : Make an inventory of effective groups of drugs
• Step iv : Choose an effective group according to criteria
• Step v : Choose a P-drug
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Step iv: Choose an effective group
according to criteria
• Imagine you go shopping for a shirt. What
would be your criteria to select a product?
– Efficacy
– Safety
– Suitability
– Cost
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Weight of criteria will differ according
to condition
Efficacy
Safety
Suitability
Cost
%
%
%
%
General dis.
% 25
% 25
% 25
% 25
100
B. Meningitis
% 80
% 20
%0
%0
100
B. Cystitis
% 30
% 20
% 30
% 20
100
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P-drug example: angina pectoris
• Step i : Define the diagnosis
– 60 y male. Since one month repeated attacks of
constricting chest pain starting with exercise
and relieving with rest
– Diagnosis: stable angina pectoris due to partial
coronary occlusion and myocardial ischemia.
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P-drug example: angina pectoris
• Step ii : Specify the therapeutic objective
– To prevent pain coming with effort
– To decrease the oxygen need of myocardium
– To increase the perfusion of myocardium
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P-drug example: angina pectoris
• Step iii : Make an inventory of effective groups of drugs
(look for the evidence)
Preload
Contractility Rate
Afterload
Nitrates
++
-
-
++
Betablockers
+
++
++
++
Ca channel
blockers
+
++
++
++
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P-drug example: angina pectoris
• Step iii : Make an inventory of effective groups of drugs
(look for the evidence)
Efficacy (pharmacodynamics) Safety (Side effects) Suitability (Contraind.)
Nitrates
Peripheral vasodilatation
Headache, nitrate
intoxication
Hypotension, SIIP, anemia,
Sildenafil (Viagra) usage
Beta-blockers
Decrease in heart contractility
and rate
Hypotension,
bradiarrythmia,
impotence
Asthma, raynould,
decompansated heart failure,
DM, severe bradicardia
Calcium channel blockers
Coronary and peripheral
Hypotension,
vasodilatation, decrease in heart dizziness,
rate and contractility
bradicardia, Heart f.
Hypotension, congestive heart
failure, AV block 16 / 20
P-drug example: angina pectoris
• Step iv : Choose a group according to criteria (give
scores from 1-4. multiply by the criteria coefficient)
Efficacy
(40 %)
Safety
(30 %)
Suitability Cost
(20 %)
(10 %)
Total
(100 %)
Nitrates
4 (1.6)
3 (0.9)
3 (0.6)
4 (0.4)
3.5
Beta-blockers
4 (1.6)
3 (0.9)
2 (0.4)
3 (0.3)
3.2
Ca channel blockers
4 (1.6)
3 (0.9)
2 (0.4)
3 (0.3)
3.2
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P-drug example: angina pectoris
• Step v : Choose a P-drug (choose your brand name
from the medicine available in the market)
Efficacy Safety
(40 %) (30 %)
Suitability Cost
(20 %)
(10 %)
Total
(100 %)
Isosorbid dinitrate tablets
sublingual 5 mg
4 (1.6)
3 (0.9)
3 (0.6)
4 (0.4)
3.5
Glyceril trinitrate spray
4 (1.6)
3 (0.9)
4 (0.8)
2 (0.2)
3.5
Isosorbid dinitrate tablets
10 mg
3 (1.2)
3 (0.9)
3 (0.6)
3 (0.3)
3.0
Isosorbid mononitrate
tablets
3(1.2)
3 (0.9)
3 (0.6)
3 (0.3) 18
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3.0
P-drug form for this exercise
• Indication: stable angina pectoris
• P-drug 1 (first choice)
Name:
Isosorbid dinitrate
Dose available:
5mg, 50 tablets package
Use:
One tablet sublingually when pain arises
Duration:
Until next control visit
• P-drug 2 (second choice)
Name:
Glyceril trinitrate
Dose available:
…
Use:
…
Duration:
…
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