Sunday, February 10, 2019

General Principles of Rational Drug Prescribing

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Rational Prescribing:


Rational Prescribing

Rational Prescribing

 Definition:

 rational prescribing is to prescribe the drug to treat a particular health problem safely effectively and at affordable cost


Steps in Rational Prescribing:

Like another process in medicine writing a prescription should be based on a series of rational steps

Step 1: RATIONAL DIAGNOSIS:

Prescription based on the desire to status for patient psychological needs for some type of therapy is often unsatisfactory and may result in an adverse effect


A specific diagnosing should be made before moving to the next the diagnosing should be shared with the patient National diagnosing is Amen step two rational prescribing it is done by
  • Physical Examination
  • Lab Data

STEP 2: PATHOPHYSIOLOGY:

If the disorder is well understood the prescriber is a much better position to offer effective therapy.
for example, if the patient is of rheumatoid arthritis there is an increased level of mediators of inflammation of the prescriber has sufficient knowledge about the mediators then it is easy for him to prescribe the best drug-like selecting the right NSAIDS And at a dose at right time at right interval this is most important for treatment purpose.
The patient should be provided with an appropriate amount of information about the pathophysiology.

STEP 3: GOALS OF TREATMENT:

Therapeutic objective or goal of treatment should be chosen for each of the pathophysiological condition
The goal should be short term and long term.

For example
Rheumatoid arthritis

Short Term Goals:

  • Relief of pain
  • Reduction in inflammation

Long term Goals:

  • Prevention of disease
  • Prevent recurrence
  • Prevent complications

If the patient is of rheumatoid arthritis then the relief of pain by the reduction of the inflammatory process is one of the major therapeutic goals that identify the drug group which will be considered.

STEP 4: DRUG OF CHOICE SELECTION:

First of all, prepare the list of the available option, one or more drug group will be suggested for each therapeutic goal.

The selection of the drug of choice from the drug group will be based on specific characteristics of the patient in a clinical presentation like age or other conditions in other drugs being taken or important in selecting the drug of choice for the management of present complaints.

For example:

if a patient is resistant to a drug in the past we should not use their drug again.

Similarly, the cost of the drugs should also be considered is safety and suitability should also be kept in mind.

STEP 5:DOSE REGIMEN:

The dose regimen should be based on the pharmacokinetics of the drug patient.

If the patient is suffering from the organ disease which causes the elimination of drugs selected adjustment and dose regimen are needed.

For the drugs like Ibuprofen which is mainly excreted by the kidney renal function test must be assessed

STEP 6:MONITORING OF DRUG THERAPY:


Monitoring of drug therapy should be:

1.Active Monitoring:

Done by the physician in the form of

  1. Lab Reports
  2. LFTs

2.Passive Monitoring:

Done by the patient himself. The patient must be aware of changes that are bringing about the drugs.

Inactive monitoring, the physician must inform the patient about the effect the drug can bring about changes and laboratory reports and various signs and symptoms that can be brought about by a particular drug.

For Example:

In treating infection the physician must tell the patient about the time required for the treatment so that the patient may not stop the medication before the date.

Similarly, the patient must be aware that gastrointestinal bleeding may occur in treating rheumatoid arthritis which requires immediate attention.

STEP 7: DRUG INFORMATION AND EDUCATION:

The prescriber and other members of the Healthcare Team should be prepared to repeat extend and reinforce the information transmitted to the patient as often as necessary.

The most toxic the drug prescribed the greater the importance of his educational program.

The importance of informing in involving the patient in each of the above steps must be recognized.

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Haseen Ullah Shah

Author & Editor

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