به نام و یاد خالق هستی هم او که آفرید شور و مستی

به نام و یاد خالق هستی هم او که آفرید شور و مستی

فراینددرمان منطقی • اصول نسخه نویسی -دکتر علیر ضا مهدانیان ALI REZA MAHDANIAN-MD کارشناس کمیته تجویز منطقی دارو معاونت غذا و داروی دانشگاه علوم پزشکی اصفهان

Rational use of grugs 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 Rational Use of Drugs

ReasonsforIrrationaluseofDrugs 1---Lack of information ; 2---Role models – Teachers or seniors 3---Lack of diagnostic facilities/ Uncertainty of diagnosis – medicine for all possible causes 4---Demand from the patient 5---Patient load 6---Promotional activities of pharmaceutical industries 7---Defective drug supply system & ineffective drug regulation

AbsolutelyIrrationalUse • Injudicious use of antimicrobials: Antibiotics in Viral fever and diarrhea • Unnecessary combinations • Use of drugs not related to diagnosis • Incorrect route • Incorrect dosing – under or overdose • Incorrect duration – prolong or short term use • Unnecessary use of expensive medicines • Unsafe use of corticosteroids • Polypharmacy Rational Use of Drugs

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 Rational Use of Drugs

1- اخذ شرح حال ، معاینه فیزیکی و .. 2-تشخیص 3-تعیین و شروع برنامه درمانی 4-ارائه اطلاعات لازم به بیمار 5-پیگیری درمان مراحل درمان منطقی

Steps of rational drug use • Step:- I • Identify the patient’s problem based on symptoms & recognize the need for action • Step:- II • Diagnosis of the disease – define the diagnosis • Step:- III • List possible intervention or treatment (drug or no drug) – Identify the drug • Step:- IV • Start the treatment by writing an accurate & complete prescription e.g. name of drugs with dosage forms, dosage schedule & total duration of the treatment

… contd. • Step:-V • Give proper information, instruction & warning regarding the treatment given e.g. side effects (ADR), dosage schedule & dangers/risk of stopping the therapy suddenly • Step:-VI • Monitor the treatment to check, if the particular treatment has solved the patient’s problem. • Passive monitoring – done by the patient himself. Explain him what to do if the treatment is not effective or if too many side effect occurs • Active monitoring - done by physician and he make an appointment to check the response of the treatment

1- نام دارو 2-شکل دارو 3-واحد دارو 4-تعداد دارو 5-راه مصرف دارو 6-فواصل مصرف دارو اجزای تشکیل دهنده یک نشخه

تجویز غیر منطقی انتی بیوتیک ها

تجویز غیر منطقی انتی هیستامین ها ، کورتیکوستروییدها و .....

تجویز غیر منطقی انتی بیوتیک ها

ده سالی که گذشت

نمونه گزارش ارسالی شاخص های دارویی پزشکان

محتوای گزارشات ارسالی براي پزشکان میانگین اقلام تجویزی نسخ درصد بیماران دریافت کننده داروی تزریقی درصد بیماران دریافت کننده آنتی میکروبیال درصد بیماران دریافت کننده کورتیکوسترویید ده داروي اول تجويز شده از نظر درصد بيماران دريافت کننده

5-55% of PHC patients receive injections - 90% may be medically unnecessary Source: Quick et al, 1997, Managing Drug Supply • 15 billion injections per year globally • half are with unsterilized needle/syringe • 2.3-4.7 million infections of hepatitis B/C and up to 160,000 infections of HIV per year associated with injections % of primary care patients receiving injections

Overuse and misuse of antimicrobials contributes to antimicrobial resistance Source: WHO country data 2000-3 • Malaria • choroquine resistance in 81/92 countries • Tuberculosis • 0-17 % primary multi-drug resistance • HIV/AIDS • 0-25 % primary resistance to at least one anti-retroviral • Gonorrhoea • 5-98 % penicillin resistance in N. gonorrhoeae • Pneumonia and bacterial meningitis • 0-70 % penicillin resistance in S. pneumoniae • Diarrhoea: shigellosis • 10-90% ampicillin resistance, 5-95% cotrimoxazole resistance • Hospital infections • 0-70% S. Aureus resistance to all penicillins & cephalosporins

اصفهان خیابان هزار جریب کوچه ششم معاونت غذا و دارو-دفتر وتحقیق و توسعه-کمیته RUD تلفن :36693242 آدرس ما :

به نام و یاد خالق هستی هم او که آفرید شور و مستی

به نام و یاد خالق هستی هم او که آفرید شور و مستی

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