PERSONAL DRUGS SELECTION

BY: I A A WIDHIARTINI, DRA, APT, MSI

 Outcome

Skills on
Selecting drug therapy based on
pharmacotherapeutic principles and
Monitoring drug therapy based on
pharmacotherapeutic principles
Issues on Rational prescribing and the
globalization process
If we (doctors) were asked to clarify why they
were taking specific medicine , we have to
clarify clearly
Drug treatment similarly to financing so they
must be accountable dan auditable
Medical science is an open-ended science

There is a part of professionalism behaviour in

globalization and reformation processes
 Treating a Patient
History: Listen to the patient, he tells
you the diagnosis
Examination: How much is enough?
Diagnosis: Lots of guess work and
good judgement
Treatment: Know your drugs
Follow up: Check predictions whether
true
Post mortem: Learning from mistakes
 6 STEPs in Rational Prescribing WHOs

Define the Patients Problems

Specify the Therapeutic Objective

Verify whether the P drugs Suitable for patients

Start the therapy/Prescribe

Educate/Give information, instruction and warning

Check/ Evaluation, monitor or stop/Termination

or modification therapy
 Define the Patients Problems

One problem may be Patients problems are not

caused by many different only confined to complaints
etiologies which require due to disease. It may also
be related to the need of
different approach.e.g., prophylaxis, sickness
cough sould be due to: certificate, refill of
Smoking excessively prescription, side effect, etc.
Food Allergy Failure to correctly identify
the patients problem and
COPD establish the diagnosis may
Asthma lead to irrational use of drugs
Heart failure
TB
ACE Inh. Captopril
 Contionued Pr

Evaluate the patients Evaluate current therapy

disease states:
Make alist of diases states
and indicate the status od
each
Describe the
etiology/pathophysiologca
l mechanism of each
problem supported with
the complaints,
sympytoms and results of
the patient
for each disease state:
Determine if current
therapy is effective and
safe (without side effects)
Support this by comparing
the relationship between
the pathophysiology of the
medical problem with the
mechanism of action of
thetherapy and evaluating
the patients complaints,
signs, and symptoms
 Continued Pr

Evaluate of Patient
specific parameters that
can influence therapy:
Patient specific data (PK,
allergies, side effects)
Drug specific data (dose,
cost, interaction)
Diseases specific data
(drug disease interaction)
 SSpecify the Therapeutic Objective
Smoking excessively
Different problem stop habit
leads a different Food Allergy avoid
objectives taking food, Antihistamin 1
COPD
Oxygen/Ipatropium
Bromide
Asthma Bronkodilator,
Steroid
Heart failureACE Inh,
Diuretics
TB.. AntiTB
Verify whether the P drugs Suitable for patients

4 Criteria to be considered
while selecting P-drugs (de
Vries, 1994)

Determine a
Cost
group of drugs
for patients Efficacy Suitability

individual and a Safety

drug within the

group P-Drugs
 Continued

For new drugs considered the evidence based medicine

See Guide to Good Prescribing Table 3 and 4
Considered the Essential drugs and Local Formulary
Antibiotics? Use Guidelines!
Consider benefit-risk ratio
Site of infection
Spectrium of antibiotics indication
Pharmacokinetics
Clinical Efficacy
Clinical experience
AB Safety
Potency of resistency
Cost
Masking Effect
 Kualitas Evidence-based

Disalin dari: Hogerzeil HV, Barnes KI, Henning, RH, Kocabasoglu YE,
Moller H,Smith AJ, Summers RS, De Vries TPGM, 2001, Teachers Guide to
Good Prescribing,WHO, France
 Prescribe /Start the therapy

Write a therapy plan

based on your evaluation
Specify for each therapy the
Indicate your plan for
dose, route, frequency, and
current therapy (stop, duration
continue, increase) Provide the rationale for your
choice of therapy, dose, etc.
decrease dose, etc Support this by describing the
Choose (if necessary)new mechanism of action and
impact of patient-specific data
therapy (non drug, drug, Do not forget the national
surgical, etc) regulations on R/ such as a
written a generic name of
drug for doctors who work for
public hospital/health service
Educate/Give Information, Instruction and
Warning
Tell the important thing that may influence their
compliance to taking drug
..to maintain the patients compliance
 Check/Monitor or Evaluate and Stop/Terminate
or modify the therapy

Monitor therapy plan

Decribe the goals and

Drug treatment can not monitoring parameters to
be left open ended determine efficacy patient
specific pathophysiological
The doctor must be symptoms) of the therapy
monitor the Describe
monitoring/parameters to
therapeutic outcome side effects and
toxicity(pharmacological
symptoms) of the therapy
Establish appropriate time
intervals and frequencies for
these parameters
 What will you do on this practical session?

Individualized Therapy Evaluation and Plan for 4

pharmacotherapy case
Thank you