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Management
Pathogenesis Pathophysiology
Non
Pharmacology
pharmacology
Life-‐style
The
drugs
changes
Surgery
physiotherapy
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otherwise
Create
other
No
use
problems
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otherwise
Create
other
No
use
problems
Cost
é
Die
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Some examples…
Incorrect
dose
• Too
low
• Too
high
Incorrect
administration
• i.v
vs.
i.m;
p.o
vs.
s.l
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Is
using
the
drug
that
complicated???
No
•
Be
rational
• Use
the
drug
appropriately
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+ 8
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Appropriate indication
Appropriate
drug(s)
Appropriate
dosage,
admnistration&
duration
of
treatment
50%
Appropriate
patient
Appropriate information
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Appropriate
indica-on
• Based
on
medical
reasons
• If
pharmacotherapy
is
the
best
alterna-ve
Appropriate
administra-on
• If
not
à
ineffec-ve,
harmful
or
uneconomical
treatment
Appropriate
pa-ent
• No
contraindica-on
• Likelihood
of
AE
is
minimum
Appropriate
informa-on
• As
an
integral
part
of
prescribing
process
• To
ensure
their
correct
&
safe
use;
to
ensure
pa-ent
compliance
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Then…
Focus on the real problem Ac-ve substance & dosage form
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q Pharmacist/assistant
q Nurse
Yes:
reconsider
Was
it
dosage
OR
drug
Yes,
but
not
choice
effec-ve?
Any
SAE?
yet
complete
No:
con’t
the
treatment
No,
disease
is
VERIFY
ALL
not
cured
STEPS!!
So…
NOT
ENOUGH
Understanding
pathogenesis
&
pathophysiology
Of
the
disease
is
very
fundamental
Understanding
the
properties
of
the
drugs
will
be
given
is
also
very
important
Otherwise
Irrational
use
of
the
drugs
(IrUD)
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IrUD
Examples:
-‐
No
drug
needed
Why
it’s
happened?
-‐
Wrong
drug,
etc
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Community
Health
Patient
system
Prescription
writer
IrUD
Dispenser
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IrUD:
types
EXTRAVAGANT
PRESCRIBING
• Expensive
&
newer
drugs
instead
of
• Less
expensive
&
older
drug
WITH
SAME
EFFICACY
&
SAFETY
OVER
PRESCRIBING
• AB
for
common
cold
• Too
long
or
too
large
dose
MULTIPLE
PRESCRIBING
• Use
>
1
drugs
for
1
condition/symptom
UNDER
PRESCRIBING
• Insufficient
dosage
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Adverse events
Bacterial resistance
Costly
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Managerial
n Hospital
&
community
à
stewardship
Regulation
n Restrictions
Drug
n Bulletin,
Drug
Information
System
information
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Managerial strategies
• price
setting
Financing
• capitation-‐based
budgeting
• Universal
coverage
(by
2014)
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Regulation strategies
Drug registration
Prescribing
restriction
• Antibiotic
stewardship
program
Dispensing restriction
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q Understanding
the
profile
of
the
drugs
will
be
used
q Prescribing
is
one
of
the
fundamental
element
in
RUD
q Use
your
brain
–
knowledge
your
heart
–
wisdom
all
information
available
–
the
latest
evidence
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acknowledgement
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