1. Social Pharmacy
Lecture no. 8
Rational prescribing guidelines

2. Why we need to have prescribing guidelines?
Doctors – diagnostic aspect
Pure Pharmacologist – Drug focussed
- Mechanism of action
- Side effects
Lacking/weak in practical prescribing skills

3. Rational prescribing guidelines
Good prescribing requires a sound and up-to-date knowledge on pharmacology and applied therapeutics
Following are the general guidelines to be followed for a good prescribing
Define patient’s problem and specify the therapeutic objective
Decide drug therapy is required to achieve the objective

4. Un necessary drug usage can be avoided
Use drugs only when indicated – Potential benefits overweigh the risks
If drug therapy is required how will we choose the drug?

5. If required choose a drug of proven efficacy and safety and be affordable and suitable
Choose the suitable dose
Avoid using drugs of same class
Inform the patient
Monitor the effects of treatment
If treatment fails try and identify why?
Decide whether same treatment to be continued

6. Rational use of antibiotics
Antibiotics are used for infectious diseases
Major cause for morbidity & mortality
Irrational or misuse of antibiotics
When not indicated
Without diagnosis
Frequent change of antibiotics
Suboptimal dose of antibiotics
Not completing the course of treatment

7. ANTIBIOTIC RESISTANCE
1. Use of antibiotics only when indicated Culture and sensitivity before using antibiotic Choice of antibiotic Adequate dose and duration of treatment Check for history of allergy Prophylactic use of antibiotic- surgical prophylaxis Empirical therapy

8. Rational use of injections
Injections are preferred by patients and doctors for various health problems, though not justified.
Patient’s eyes – powerful & increased success rate
Doctor’s eyes – fear of non-compliance , economic factors.

9. Unnecessary use of injections can lead to
Higher cost
Need of more trained staff
Increased time to administer drug
Possible transmission of serious pathogens
Risk of abscess formation if unhygenically administered
Increased risk of Adverse Drug Reactions(ADRs)

10. Use of injections should be restricted to
Oral administration is not tolerated due to various reasons.
Formulation is available only as injectables
Non compliance
Absorption problem
High tissue conc.
Urgent treatment in rapidly progressing illness

11. Rational use of OTC drugs
What is an OTC drug? – Drugs which can be available without prescriptions
Antibiotics & various potent drugs ?
Inappropriate use of OTC drugs
Dangerous / fatal outcomes
Vitamins & tonics, iron prepns,analgesics,NSAIDs,cough mixtures etc. are sold from the community pharmacy without considering their genuine requirements

12. Patient’s desire for treatment(even if ineffective)
Pharmacist’s desire to please the patient and to sell his products.
Rational use of OTC drugs – rational prescribing guidelines
Take care that the medication is not contraindicated in a particular patient.
Enquire about other drug therapy to avoid drug- drug interactions

13. Summary
To summarize…