rud
Post on 06-Aug-2015
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PRESENTED BYANJALI.CI YEAR M.PHARMGRACE COLLEGE OF PHARMACY
RATIONAL USE OF DRUGS (RUD)
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DEFINITION • In simplest words rational use means
“prescribing right drug, in adequate dose for the sufficient duration & appropriate to the clinical needs of the patient at lowest cost
• WHO: The rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, and at the lowest cost to them and their community
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‘CRITERIA’ FOR USING MEDICINES • Appropriate indication• Appropriate drug• Affordable• Appropriate
administration, dosage and duration• Appropriate patient• Appropriate patient
information
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FACTORS
THAT HAVE LED
SUDDEN
REALISATION FOR RUD
Drug explosion
Efforts to prevent the developme
nt of resistance
Growing awareness
Increased cost of the treatment
Consumer protection
Act
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REASONS FOR IRRATIONAL USE OF DRUGSLack of information
Faulty & Inadequate training & education of medical graduates
Poor communication between health professional & patient
Lack of diagnostic facilities/Uncertainity of diagnosis
Demand from patient
Defective drug supply system &ineffective drug regulation
Promotinal activities of pharmaceutical industries
Self –medication
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SOME BROAD CATEGORIES OF DRUGS WHICH ARE MISUSED OR
IRRATIONALLY USED ANTIBIOTICS•Penicillins•Ampicillin•Amoxicillin•TetracyclinsMUSCULO-SKELETAL
DRUGS•Dextropropoxyphene•Aspirin•Ibuprofen
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CENTRAL NERVOUS SYSTEM DRUGS•Diazepam•Lorazepam•Imipramine,Nortriptalline and
AmitriptallineALIMENTARY SYSTEM DRUGS•Antacids•Laxatives,Purgatives and Lubricants•AntidiarrhoealsRESPIRATORY SYSTEM DRUGS•Bromhexine•Salbutamol
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HORMONES•Estrogen-Progestin combination in high
doses(EF forte) used to cause abortion•Anabolic steroids like
androlone,stanozololVITAMINSOTHER MISCELLANEOUS DRUGS•Naphazoline and Xylomethazoline•Oral Antidiabetic
drugs:Glibenclamide,Gliclazide,metformin
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HAZARDS OF IRRATIONAL USE• Ineffective & unsafe treatment
▫over-treatment of mild illness▫inadequate treatment of serious
illness•Exacerbation or prolongation of illness•Distress & harm to patient• Increase the cost of treatment• Increased drug resistance - misuse of
anti-infective drugs • Increased Adverse Drug Events• Increased morbidity and mortality
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OBSTACLES EXIST IN RATIONAL DRUG USE•Lack of objective information & of
continuing education &training in pharmacology.
•Lack of well organized drug regulatory authority & supply of drugs.
•Presence of large number of drugs in the market & the lucrative methods of promotion of drugs employed by pharmaceutical industries.
•The prevalent belief that” every ill has a pill”
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RATIONAL DRUG USE CAN BE MONITORED BY
•Aggregate medicine consumption data:•WHO drug use indicators•The Anatomical Therapeutic Chemical (ATC)
classification and defined daily dose (DDD) methodology
•Drug Utilisation review(DUR) or focused drug use evaluation
•Qualitative methods
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Selected WHO/INRUD drug use indicators for health care facilities
• Prescribing indicators:• Average number of medicines prescribed per patient encounter• % of medicines prescribed by generic name• % of encounters with an antibiotic prescribed• % of encounters with an injection prescribed• % of medicines prescribed from essential medicines list or
formulary• Patient care indicators• Average consultation time:• Average dispensing time• % of medicine actually dispensed• % of medicines adequately labelled• % of patients with knowledge of correct doses.
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•Facility indicators•Availability of essential medicines list or formulary
to practitioners•Availability of clinical guidelines•% of key medicines available•Complementary drug use indicators:•Average medicines cost per encounter•% of prescriber in accordance with clinical
guidelines.
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STRATEGIES TO IMPRTOVE RATIONAL USE OF DRUGS(RUD)
• Educational
• Managerial
• Regulatory
• Economic
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EDUCATIONAL STRATEGIES
•Training prescribers•Format education•Continuing Education (CE)•Educational outreach•Patient and public education in drug use
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REGULATORY MEASURES• Drug registration• Evaluation of drug and product
information• Scheduling drugs for different levels of
use for both prescribing and distribution• Dispensing controls• Specifying minimum level of education
for prescriber or health care professional• Restrictions on use of packaging
materials of drugs and labelling• Regulating pharmaceutical promotion
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MANAGERIAL STRATEGIES
•Selection ,procurement and distribution of drugs
•Limited procurement list•DUR(drug utilization review)
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ECONOMIC•Offering incentives to institutions,
patients and providers.•Many insurance agencies and some
governments reimburse only if medicines are chosen from a restricted list.
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STEPS TO IMPROVE RATIONAL DRUG PRESCRIBING
Step:- I• Identify the patient’s problem
based on symptoms & recognize the need for action.
Step:-II• Diagnosis of the disease. Identify
underlying cause & motivating factors.
Step:-III• List possible intervention or
treatment
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Step:-IV•Start the treatment by writing an
accurate & complete prescription Step:-V•Given proper information instruction &
warning regarding the treatment given Step:-VI•Monitor the treatment to check, if the
particular treatment has solved the patient’s problem
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ROLE OF PHARMACIST IN THE PROMOTION OF RATIONAL USE OF DRUGS Member of the drug and therapeutics
committee
Drug procurement
Drug storage
Dispensing
Patient education
Pharmacovigilence
Drug information services
Pharmaceutical care
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