Attn :Sameer- Re: Role of Pharmacist in Rational Use of Drugs

[Guest guest]

Hello All,

Sameer has very rightly outlined the role of pharmacist in rational use of medicines. The entire article is ideally written, describing the ideal conditions and role that a pharmacist should play.

I would like to mention that that the ideal conditions for a rational thinking pharmacist do not exist. In practise what the pharmacist does is only dispensing medicines with no accompanying instructions.Very few pharmacist are involved in research activities relating to DUS, ADR reporting, clinical studies,therapeutic drug monitoring or formulary preparation.

The situation may not be very bleak but neither it is something to be happy about.

kunda

From: Sameer <sameerdhingra78@...>Subject: Re: Role of Pharmacist in Rational Use of Drugsnetrum Date: Tuesday, 27 May, 2008, 1:21 PM

Dear Netrumians,This is one of our paper published in Indian Journal of Hospital Pharamcy in 2004 edition entitled "Rational Drug Use and Pharmacist" sharing with you.Rational Drug Use and PharmacistDefinitionRational drug use refers to drug therapy, which is & #61692; Safe & #61692; Effective & #61692; Economic & #61692; Used only when required.Rational drug use requires adequate diagnosis; correct prescribing of drug or non-drug treatment, and correct dispensing of medication and patient adherence (compliance) with treatment.Factors, which may contribute to undesirable drug use, are & #61656; Lack of independent, unbiased information to doctors. & #61656; The availability of more than 60,000 drug formulation in India. & #61656; High level of illiteracy and poverty amongst patients. & #61656; National Drug Policy, which is Industry, focused rather than

health focused. & #61656; Poor Government regulatory control of Drug registration, production and marketing. & #61656; Misleading and unethical advertising by pharmaceutical manufacturers. & #61656; Widespread sale of prescription and OTC drugs despite this being illegal. & #61656; Lack of awareness of principles of rational Drug use amongst Doctors and Pharmacists.Importance of rational drug use:Decisions about when to prescribe, what to prescribe, how much to prescribe and how long to prescribe are becoming increasingly complex because of ever increasing number of drugs. Poor drug information and inadequate training to under graduates lead to irrational drug use. This ultimately leads to unsafe and ineffective treatment, worsening of prolonged illness, ADR's highly expensive therapy length of stay increases some times ADR's may be fatal. & #61558; Safe and effective of

drugs & #61558; Prevention of ADR & #61558; Reducing the higher costs & #61558; Decreasing the worsening or prolongation od illness & #61558; Reducing the wide spread use of antibiotic resistance due to irrational prescribing & #61558; Improved clinical outcome.General Guidelines For Rational Drug Use & #61692; Define patient problems (diagnosed), and then specify therapeutic objectives. & #61692; Decide whether the drug is needed (use the drugs only when indicated). & #61692; Choose a drug of proven efficacy and safety for the patients. & #61692; The drug should be affordable. & #61692; Avoid using more than one drug of same chemical class. & #61692; Provide the information regarding drug use and counsel the patients. & #61692; Monitor treatment for successful outcome. & #61692; If treatment fails find the reason and rectify it.Guidelines For The

Rational Use Of AntibioticsUse antibiotics only when indicated: viral and self-limiting bacterial diseases don't benefit from the use of antibiotics.When appropriate, specimens for Gram stain, culture and sensitivity testing should be obtained before commencing antibiotic therapy: remember that laboratory data may be unreliable and must always be interpreted in the context of the overall clinical picture. When an antibiotic is indicated, the choice of agent should be based on factors such as spectrum of activity in relation to the known or suspected causative organism, safety, previous clinical response, cost, ease of use and the potential for selection of resistant organisms. The relative importance of these factors will depend on the severity of illness and whether the drug is to be used for prophylaxis, empirical therapy or therapy directed by identification of one or more pathogens.• An

adequate dose and duration of treatment is essential for all antibiotic therapy.• A history of allergy or other adverse effect to the drug under consideration should always be sought.• Prophylactic use of antibiotics should be restricted to situations where it has been shown to be effective or where the consequences of infection are disastrous. Most surgical prophylaxis should be parenteral and should be commenced just before the procedure. A single dose is usually adequate for surgery lasting less than 2 hours.• Empirical antibiotic therapy should be based where possible on local epidemiological data on potential pathogens and there pattern of sensitivities.• Antibiotic therapy directed at specific organisms should include the most effective least toxic and narrowest spectrum agent available.• Oral therapy should be used in preference in parental therapy wherever clinically

possible.• Reserve new antibiotics for situations where serious infections have not or are unlikely to respond to conventional agents..Guidelines For Rational Use.of InjectionsPatients and doctors for a variety of health problems prefer injections even when there administration is not clinically justified. Unnecessary use of injections is associated with:• Higher costs• Increased need for trained staff.• Increased time to administer the drug• Possible transmission of a range of serious pathogens like HIV.• Risk of abscess formation if injections are unhygienically administered.• Increased risk of ADR.In general, use of injections should be restricted to the following situations:• When an oral administration is not tolerated or is not possible.• When there is absorption problem.• When drug of choice is only formulated as parenteral product. Eg:

insulin• When high tissue concentration is needed and is not achieved by oral administration. Eg: meningitis• When urgent treatment is required due to severe and rapidly progressive illness. • When the patient is unlikely to comply with oral medications.Rational Use Of Common OTC DrugsRational use of OTC drugs requires the same systematic approach as outlined earlier for rational prescribing. Care must be taken to ensure that recommended OTC drug are not contraindicated in a particular patient. Eg: avoid sympathomimetic drugs containing cough or cold preparations in patients with hypertension.Care must also be taken to enquire about other drug therapy so that potential drug interactions can be avoided.Use of OTC drugs can be associated with serious adverse effects. Eg: side effects of NSAIDs include GI upset/ bleeding, hypertension, renal impairment etc.Pharmacist Role In

RDU.Pharmacist's role is very important in promoting rational drug use by providing following services to the patients as well as health care professional• Patient counselling• Drug information• ADR reporting and management• Drug therapy monitoring• Conducting educational workshops to the Doctors and other health care professionals• Preparing standard therapeutic guidelines• Development of formulary• Research on drug utilization evaluationPatient CounselingPatient counseling is one of the major important factor in promoting rational drug use.It consists of following factors:• Dose, duration and frequency• Possible ADR's• Management minor side effects• Prevent relapse by completing the course• Especially elderly patients demand to prescribe the hematonics, so advised to the patients to take nutrient food and fruits instead od taking

hematonic preparations.Drug InformationDrug information forms a part in promoting RDU because lack of unbiased informairton leads to irrational drug use. • Provide unbiased information about new drugs..• Drug information is also needed because more existence of new drugs and availability of more than 60 thousands formulations in India.ADR Reporting and ManagementClinical pharmacist play a vital role in reporting and management of many ADR which is due to irrational prescribing under diagnosis, more than 4 drugs in one prescription may lead to ADR, 8-10% of hospital admissions may develop ADR's.• Using a prophylaxis to other drugs to prevent future ADR's. Eg: pyridoxine should be given with ATT drugs to inhibit the occurrence of peripheral neuropathy.• Relative efficacy and safety of alternative therapies.Eg: if patient is allergic to penicillin choose other alternatives like

Amoxycillin.Documentation of ADR's is necessary to avoid reexposures.Drug Therapy Monitoring• It improves RDU by ensuring that the patient is receiving the proper dose in a proper way.• Minimizing the problems by regular monitoring • Managing any drug related problems• It improves the quality of life of patientEg: physician prescribed Imax (B-Complex) but patient receiving Imox (Amoxycillin)Conducting Education ProgrammesSometimes students or junior doctors are only expected to copy the prescribing habits of their clinical teachers or senior doctors, without any explanation as to why certain treatment should be given. To be spread the principles of RDU amongst the doctors and the pharmacists.Formulary developmentFormulary contains a list of drugs that should be widely used in the hospital. The prescriber and physician should know about the efficacy, safety, quality,

stability, ease of storage, price, availability and the other adverse effects.Preparing Standard Therapeutic GuidelinesIt is a very important tool; by preparing standard guidelines we can promote the RDU. The pharmacist including microbiologist prepare this guidelines. The treatment guidelines seems to have a positive impact towards the therapeutically effective and economic use of drugs. Guidelines are systematically developed statement that helps clinician to decide in appropriate treatment for specific clinical conditions.Eg: in respiratory disease there are many treatment options but the standard therapy guidelines contains only few options and they are cost effective too.Research On DUEDUE is a quality assurance/managemen t activity for drug therapy. Its purpose is to promote rational and economical drug use and improve drug therapy outcomes or in general describes the application of

quality assurance principle to drug use.E.g.: drug utilization evaluation of antibiotics. BIBLIOGRAPHY1) www.who.int/ medicines/ rational use/strudman. html2) www.healthnet. org3) http://icmr. nic.in4) www.ndp/medicines. html 5) British Medical Journal no. 7310, vol.316.6) Delhi Society for Promotion of Rational Use of Drugs, National Capital territory of Delhi, "Standard Treatment Schedules for Primary Health Care 1998".7) National Health policy 2002, India published by ministry of health, Government of India, section 5.Sameer Dhingra, Milind Parle & B.G.NagaviLord Shiva College of Pharmacy, Sirsa-125055Dept. of Pharmaceutical Sciences, GJU, HisarJSS College of Pharmacy, Mysore-570015Sameer Dhingra>> > > Dear All,> Sharing with you an article on the role of Pharmacist in Pharmacovigilance> Thanks > Shazia Jamshed> USM>

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