1. Rational use of the drugs based on P-drug selection
1/17/2019
Rational use of the drugs based on P-drug selection
Rovina Ruslami, dr., SpPD, PhD
Dept. of Pharmacology & therapy
FKUP / RSHS
file name

2. Aim of drug management system
to deliver the correct drugs to the correct patient
To use the drug in accordance to principles of rational prescribing
It is an essential element for effective, safe & economical use of the drugs
1/17/2019
Rational prescribing

3. Talk about Rational Use of the Drug (RUD)
Appropriate to their clinical needs in doses
Meet their own individual requirement
For adequate period of time
At the lowest cost to them & their community
1/17/2019
Rational prescribing

4. So, it has to be Correct diagnosis Appropriate indication
Appropriate drug(s)
Appropriate dosage, administration & duration of treatment
Appropriate patient
Appropriate information
Appropriate evaluation & follow-up
50%
50%
1/17/2019
Rational prescribing

5. Appropriate indication
Based on medical reasons
If pharmacotherapy is the best alternative
Appropriate drug(s) – P-drug concept
Considering efficacy, safety, suitability and cost (ESSC)
Appropriate administration
If not  ineffective, harmful or uneconomical treatment
1/17/2019
Rational prescribing

6. Appropriate information
Appropriate patient
No contraindication
Likelihood of AE is minimum
Appropriate information
As an integral part of prescribing process
To ensure their correct & safe use; to ensure patient compliance
Appropriate evaluation & follow up
As important as other aspect, but often is neglected
If not  lead to treatment failure/harmful (drug-induced problem)
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Rational prescribing

7. The drug use process
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Rational prescribing

8. Process of rational treatment
1. Define patient’s problem
2. Specify therapeutic objective:
- Symptomatic
- Causative
3. Verify suitability of individual patient: from available drugs (for its E, S, S, C)
4. Start the treatment
5. Give information, instruction & warning
6. Monitor (cont’ or stop) treatment
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Rational prescribing

9. Let’s imagine you’re a doctor
Which is not too long from now…
Rational prescribing
1/17/2019

10. Patient might come to you with...
request
complaint
questions
Careful observation
Structured HT PE
Working diagnosis
Try to get their real problem, by
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Rational prescribing

11. So, in RUD… 1. Define their problem(s)
And remember specific patients group
Disease or disorder (Diagnosis)
Sign of underlying disease
Psychological or social problems
Side efect of drugs
Polypharmacy
Non-adherence to treatment
Request for preventive treatment
Pregnancy
Lactation
Children
Elderly
Renal failure
Hepatic failure
Drug allergy
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Rational prescribing

12. Then… 2. Specify the Therapeutic Objective (TO)
3. Verify the SUITABILITY the P-drugs
Active substance & dosage form
Standard dosage schedule
Standard duration of treatment
For all above, check the Effectiveness (Indication & convenience) and Safety (CI, DDI, specific group of pts)
Focus on the real problem
WHAT TO BE ACHIEVED
Unnecessary drug use 
Irrational prophylactic prescribing 
Discuss your TO with the patient
1/17/2019
Rational prescribing

13. When you start the treatment…
Write the prescription (prescribing)
Prescription is an instruction from prescribers  dispenser
It has to be clear!!!
Dispenser could be
Pharmacist/assistant
Nurse
1/17/2019
Rational prescribing

14. When giving prescription…
It has to be clear
You need to give information, instructions & warnings
What is/are the drugs(s)
For what (the effect)
Instruction: how to take them
Possible SE
Warnings
Next appointment
EVERY THING IS CLEAR?
1/17/2019
Rational prescribing

15. By this step (no.5)
You improve patient’s adherence (and it is very important!)
R/ a well-chosen treatment
Build a good doctor-patient communication (relationship)
Spend time to give information, instructions & warning
1/17/2019
Rational prescribing

16. Last step: monitor the treatment
Was it effective?
Yes, disease is cured
Stop the treatment
Yes, but not yet complete
Any SAE?
Yes: reconsider dosage OR drug choice
No: con’t the treatment
No, disease is not cured
VERIFY ALL STEPS!!
1/17/2019
Rational prescribing

17. Clinical setting 1. Define the problem (diagnosis) 2. Specify the TO
A 45 y-o male suffered from chest pain every time he has exercise or in stressful condition and disappeared with resting. History of hypertension since 4 years ago.
1. Define the problem (diagnosis)
Stable angina pectoris
2. Specify the TO
To prevent the anginal symptoms (NOT CAUSATIVE)
By reducing the myocardial need through: decrease preload, contractility, HR or afterload
1/17/2019
Rational prescribing

18. Inventory of effective groups of drug
Then…
3. Choose a group according to the criteria (E, S, S, C)
Inventory of effective groups of drug
Nitrates
B-blockers
Ca-channel blockers
K-channel blockers
group E S C
nitrates +
+/-
B-Blockers ++
Ca-channel blockers -
K-channel blockers
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Rational prescribing

19. Last step is.. Choose a P-drug Decision made is…
Note: all in tablet form
Active substance: atenolol
Dosage form: 50 mg tablet
Dosage schedule: 50 mg, once daily
Duration: accordance with monitoring interval (next visit)
group E S C
propranolol +
+/-
atenolol
metoprolol
bisoprolol -
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Rational prescribing

20. Patient’s personal factor
The bottom line is
Consider
Do not forget the legal issue of prescribing
Patient’s personal factor
- Problem (efficacy)
- Other conditions (safety)
- Preference (cost)
Drug’s factor
- Effect
- PK, AE
- Dosage form, schedule (suitability)
1/17/2019
Rational prescribing

21. Prof. Dr. Herri SS, SpFK(K)
Acknowledgement...
Prof. Dr. Herri SS, SpFK(K)
1/17/2019
Rational prescribing