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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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