Vous êtes sur la page 1sur 17



Outcome Skills on  Selecting drug therapy based on pharmacotherapeutic principles and  Monitoring drug therapy based on pharmacotherapeutic principles .

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 .Issues on Rational prescribing and the globalization process  If we (doctors) were asked to clarify why they were taking specific medicine .

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 WHO’s Define the Patients Problems Specify the Therapeutic Objective Verify whether the P drugs Suitable for patients Start the therapy/Prescribe Educate/Give information. monitor or stop/Termination or modification therapy . instruction and warning Check/ Evaluation.

prophylaxis.  Food Allergy  Failure to correctly identify the patient’s problem and  COPD establish the diagnosis may  Asthma lead to irrational use of drugs  Heart failure  TB  ACE Inh..g.e. sickness cough sould be due to: certificate. Captopril . Define the Patients Problems  One problem may be  Patient’s problems are not caused by many different only confined to complaints etiologies which require due to disease. etc. side effect. It may also be related to the need of different approach. refill of  Smoking excessively prescription.

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

Continued Pr  Evaluate of Patient specific parameters that can influence therapy:  Patient specific data (PK. side effects)  Drug specific data (dose. cost. interaction)  Diseases specific data (drug disease interaction) . allergies.

Steroid  Heart failure…ACE Inh. Antihistamin 1  COPD …Oxygen/Ipatropium Bromide  Asthma …Bronkodilator. AntiTB .. Diuretics  TB. SSpecify the Therapeutic Objective  Smoking excessively  Different problem …stop habit leads a different  Food Allergy …avoid objectives taking food.

1994)  Determine a Cost group of drugs for patients Efficacy Suitability individual and a Safety drug within the group P-Drugs .Verify whether the P drugs Suitable for patients 4 Criteria to be considered while selecting P-drugs (de Vries.

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.WHO. France . Teacher’s Guide to Good Prescribing. Summers RS. 2001. RH. Moller H. Kocabasoglu YE. De Vries TPGM. Henning.Smith AJ. Barnes KI.

drug. dose. route. etc) regulations on R/ such as a written a generic name of drug for doctors who work for public hospital/health service . Prescribe /Start the therapy Write a therapy plan based on your evaluation  Specify for each therapy the  Indicate your plan for dose. frequency. etc Support this by describing the  Choose (if necessary)new mechanism of action and impact of patient-specific data therapy (non drug. duration continue. decrease dose. increase)  Provide the rationale for your choice of therapy. etc. and current therapy (stop.  Do not forget the national surgical.

to maintain the patients compliance .Educate/Give Information. Instruction and Warning  Tell the important thing that may influence their compliance to taking drug  …..

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 .