The Personal Drug List
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The Personal Drug List. Introduction to Primary Care: a course of the Center of Post Graduate Studies in FM. PO Box 27121 – Riyadh 11417 Tel: 4912326 – Fax: 4970847. Aim-Objectives. Aim: At the end of this presentation, the participants will know how to develop their own p-drug lists.

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The Personal Drug List

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The personal drug list

The Personal Drug List

Introduction to Primary Care:

a course of the Center of Post Graduate Studies in FM

PO Box 27121 – Riyadh 11417

Tel: 4912326 – Fax: 4970847

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Aim objectives

Aim-Objectives

  • Aim: At the end of this presentation, the participants will know how to develop their own p-drug lists.

  • Objectives: At the end of this session, the trainees should;

    • be able to count dimensions which are important in drug selection

    • be able to explain the method in preparing a p-drug list

    • believe in the importance of rational prescription

    • be able to develop his/her own p-drug list

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Rational prescription

Rational prescription

“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 costs to the

community”

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Rationalization of prescription practises

RATIONALIZATION OF PRESCRIPTION PRACTISES

  • Introduction of Essential drug list limits the use of non-essential drugs.

  • Provided details of pharmacokinetics help the physician in selecting right kind of drug and dosage form.

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Rationalization of prescription practises1

RATIONALIZATION OF PRESCRIPTION PRACTISES

Prescription of Rational drugs requires:

  • Accurate diagnosis.

  • Selection of best drug from the available.

  • Prescribing adequate drug for a sufficient length of time.

  • Choosing the most suitable drug, weighing of effectiveness, safety, and availability and cost.

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Rationalization of prescription practises2

RATIONALIZATION OF PRESCRIPTION PRACTISES

Most of the illness respond to simple, inexpensive drugs,

Physician should avoid :

  • Use of expensive drugs.

  • Use of drugs in nonspecific conditions (e.g., use of vitamins).

  • Use of not required forms (e.g. injection in place of capsules, syrup in place of tablets)

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Rationalization of prescription practises3

RATIONALIZATION OF PRESCRIPTION PRACTISES

Most of the illness respond to simple, inexpensive drugs, even of improve with no therapy at all.

Physician should avoid :

  • Multiple drug prescription (bullet treatment) even if it is considered in the best of the patient in a given situation.

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The concept of p drug list

The Concept of p-drug list

  • There is a need for evidence based, rational prescription

  • Each GP has his/her own context with different needs and priorities

  • Scientists at the University of Groningen suggested a method where each doctor prepares a list of essential drugs for different conditions

  • P-drug concept has been propagated by the WHO Action Program on Essential Drugs world wide

Kawakami J, Mimura Y, Adachi I, Takeguchi N. [Application of personal drug (P-drug) seminar to clinical pharmacy education in the graduate school of pharmaceutical sciences]. Yakugaku Zasshi. 2002 Oct;122(10):819-29

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The process of rational treatment

The process of rational treatment

  • Step 1: Define the patient’s problem

  • Step 2: Specify the therapeutic objective

  • Step 3: Verify the suitability of your P-treatment

  • Step 4: Start the treatment

  • Step 5: Give information, instructions and warnings

  • Step 6: Monitor (and stop?) treatment

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http://p-drug.umin.ac.jp/34th-gakkai/slide/DrSunami/SunamiP-drug.PPT


Selecting a p drug

Selecting a P-drug

  • Step i : Define the diagnosis

  • Step ii : Specify the therapeutic objective

  • Step iii : Make an inventory of effective groups of drugs

  • Step iv : Choose an effective group according to criteria

  • Step v : Choose a P-drug

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Step iv choose an effective group according to criteria

Step iv: Choose an effective group according to criteria

  • Imagine you go shopping for a shirt. What would be your criteria to select a product?

    • Efficacy

    • Safety

    • Suitability

    • Cost

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Weight of criteria will differ according to condition

Efficacy

Safety

Suitability

Cost

%

%

%

%

B. Meningitis

B. Cystitis

Weight of criteria will differ according to condition

% 25

% 25

% 25

% 25

100

General dis.

100

% 80

% 20

% 0

% 0

% 30

100

% 20

% 30

% 20

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P drug example angina pectoris

P-drug example: angina pectoris

  • Step i : Define the diagnosis

    • 60 y male. Since one month repeated attacks of constricting chest pain starting with exercise and relieving with rest

    • Diagnosis: stable angina pectoris due to partial coronary occlusion and myocardial ischemia.

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P drug example angina pectoris1

P-drug example: angina pectoris

  • Step ii : Specify the therapeutic objective

    • To prevent pain coming with effort

    • To decrease the oxygen need of myocardium

    • To increase the perfusion of myocardium

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P drug example angina pectoris2

P-drug example: angina pectoris

  • Step iii : Make an inventory of effective groups of drugs (look for the evidence)

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P drug example angina pectoris3

P-drug example: angina pectoris

  • Step iii : Make an inventory of effective groups of drugs (look for the evidence)

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P drug example angina pectoris4

P-drug example: angina pectoris

  • Step iv : Choose a group according to criteria (give scores from 1-4. multiply by the criteria coefficient)

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P drug example angina pectoris5

P-drug example: angina pectoris

  • Step v : Choose a P-drug (choose your brand name from the medicine available in the market)

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P drug form for this exercise

P-drug form for this exercise

  • Indication: stable angina pectoris

  • P-drug 1 (first choice)

    Name:Isosorbid dinitrate

    Dose available:5mg, 50 tablets package

    Use:One tablet sublingually when pain arises

    Duration:Until next control visit

  • P-drug 2 (second choice)

    Name:Glyceril trinitrate

    Dose available:…

    Use:…

    Duration:…

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The personal drug list

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