Rational use of the drugs

based on P-drug selection

Rovina Ruslami, dr., SpPD, PhD

Dept. of Pharmacology & therapy
FKUP / RSHS
 Aim of drug management system

to deliver the correct drugs to the

correct patient

To use the drug in accordance to

principles of rational prescribing

It is an essential element for effective,

safe & economical use of the drugs
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 please refresh previous topic

rational use of the drug (RUD)

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 Process of rational treatment

6. Monitor (cont or
1. Define patients problem
stop) treatment

2. Specify therapeutic objective:

- Symptomatic 5. Give information,
- Causative instruction & warning

3. Verify suitability of
individual patient: from 4. Start the treatment
available drugs (its E,S,S,C)
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 Patient might come to you with...
Try to get their real problem, by
Careful
request observation

Structured
HT
complaint
PE

questions Working
diagnosis

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 Process of rational treatment

6. Monitor (continue or
1. Define patients problem
stop) treatment

2. Specify therapeutic
objective: 5. Give information,
- Symptomatic instruction & warning
- Causative

3. Verify suitability of
individual patient: from 4. Start the treatment
available drugs (its E,S,S,C)
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 When you start the treatment

Write the prescription (prescribing)

Prescription is an instruction from prescribers
dispenser
It has to be clear!!!
Dispenser could be
Pharmacist/assistant
Nurse

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 When giving prescription
It has to be clear
You need to give information, instructions & warnings
What is/are the drugs(s)
For what (the effect)
Instruction: how to take them
Possible SE
Warnings
Next appointment
EVERY THING IS CLEAR?
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 By this step (no.5)

You improve patients adherence (and it is very important!)

R/ a well-chosen treatment
Build a good doctor-patient communication
(relationship)
Spend time to give information, instructions & warning

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 Clinical setting

A 45 y-o male suffered from chest pain every time he has

exercise or in stressful condition and disappeared with resting.
History of hypertension since 4 years ago.

1. Define the problem (diagnosis)

Stable angina pectoris

2. Specify the TO
To prevent the angina symptoms (NOT CAUSATIVE)
By reducing the myocardial need through: decrease preload,
contractility, HR or afterload
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 3. Choose a group according
Then to the criteria (E, S, S, C)

group E S S C
Inventory of effective
nitrates + +/- +/- +/-
groups of drug
B-Blockers + +/- ++ +
Nitrates Ca-channel + +/- + -
B-blockers blockers
Ca-channel blockers K-channel + +/- +/- -
K-channel blockers blockers

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 Last step is..

Choose a P-drug Decision made is

group E S S C Active substance: atenolol

propranolol + +/- +/- + Dosage form: 50 mg tablet
atenolol + +/- + +
Dosage schedule: 50 mg, once
metoprolol + +/- + +
daily
bisoprolol + +/- + -
Note: all in tablet form Duration: accordance with
monitoring interval (next visit)

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 The bottom line is

Consider

Patients personal Drugs factor

factor - Effect
- Problem (efficacy) - PK, AE
- Other conditions (safety) - Dosage form, schedule
(suitability)
- Preference (cost)

Do not forget the legal issue of prescribing

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 acknowledgement

Prof. Dr. Herri S. Sastramihardja, dr., SPFK(K)

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