Social Pharmacy

Lecture no. 8

Rational prescribing guidelines

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

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

• 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?

• 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

Rational use of antibiotics

Antibiotics are used for infectious diseasesMajor cause for morbidity & mortalityIrrational or misuse of antibiotics• When not indicated• Without diagnosis• Frequent change of antibiotics• Suboptimal dose of antibiotics• Not completing the course of treatment

1. Use of antibiotics only when indicated 2. Culture and sensitivity before using antibiotic 3. Choice of antibiotic 4. Adequate dose and duration of treatment 5. Check for history of allergy 6. Prophylactic use of antibiotic- surgical prophylaxis 7. Empirical therapy

ANTIBIOTIC RESISTANCE

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.

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)

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

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

• 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

Summary

• To summarize…