6.Rational Use of Drugs

8/3/2019 6.Rational Use of Drugs

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NATIONAL TRAINING FOR COMPREHENSIVEMANAGEMENT OF HIV/AIDS

THE UNITED REPUBLIC OF TANZANIA

MINISTRY OF HEALTH

Rational Drug Use

Module A1, session 6


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Case Study

A 26 yr old female has been on HAART (Highly ActiveAntiretroviral Therapy) for the past 12 months, with no

adherence problems. She comes for her repeat Rx at the

pharmacy and when you check the patient records you

discover that she is 1 week early for her refill. Further checking

reveals that she also collected 1 week early previous month

and that her CD4 count has dropped for first time since she

started HAART.

What could be the possible causes?

What action would you take at this point?


3/18

Pharmaceutical Management Cycle

Selection

ProcurementManagement

Support

Distribution

Use

Policy, Regulations, Laws


4/18

Objectives

Define Rational Drug Use (RDU) and describe specific

relevance to ART programs

Describe the different types of irrational drug use

Identify factors that influence irrational drug use of

ARVs

Discuss strategies and interventions that can improve

RDU in ART programs


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Definition

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.


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Importance of RDU in the context of ART

ART is:

Complex (a combination of many drugs)

a life treatment

Recent and in constant development

An irrational drug use of ARVs results in:

Treatment failure

Rapid development of drug resistance

Increase of toxicity riskWastage of money

The promotion of RDU in the context of ART is a

must from day one!


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Rational

Drug Use

Prescriber,

Dispenser &

their

workplaces

Drug Supply System

Patient &

community

Many Factors Influence Use of Medicines

Policy, Legal and Regulatory

framework


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Drug Use Process


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Diagnosis: Aspects that lead to

Irrational Drug Use

Inadequate examination of patient

Incomplete communication between patient and

doctor

Lack of documented medical history

Inadequate laboratory Resources


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Prescription: Types of Irrational Drug

Use (1)

Irrational

Drug Use Occurs If a Drug Is Prescribed When:

Underprescribing y Needed medications are not

prescribed

y Dosage is inadequate

y Length of treatment is too brief


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Use (2)

Irrational

Drug Use

Occurs If a Drug Is

Prescribed When:

Incorrect

prescribing

y Drug given for incorrect diagnosis

y

Wrong drug selected for diagnosis

y Prescription prepared improperly

y Adjustments not made for co-

existing medical, genetic,

environmental, or other factors


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Use (3)

Irrational


Extravagant

prescribing

y A less expensive drug provides

comparable efficacy and safety

y Symptomatic treatment of mild

conditions diverts funds from

treating serious illness

y Brand-name drug used when lessexpensive equivalents are

available


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Use (4)

Irrational


Overprescribing y Drug is not needed

y

Dose is too large

y Treatment period is too long

y Quantity dispensed is too great

for current course of treatment


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Use (5)

Irrational


Multiple

prescribing

Two or more medications are used

when fewer would achieve same

effect

Several related conditions are

treated when treatment of primary

condition would improve or cure the

other conditions


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Dispensing: Types of Irrational Drug Use

Incorrect interpretation of the prescription

Retrieval of wrong ingredients

Inaccurate counting, compounding, or pouring

Inadequate labeling

Unsanitary procedures

Packaging:

- Poor-quality packaging materials

- Odd package size, which may require

repackaging

- Unappealing package


16/18

ART Dispensing Differences?

Why is dispensing key for the success of ART

programs?

Are there significant differences between

dispensing ARVs and other medicines?


17/18

ART Dispensing Differences?

A stock-out of one ARV in regimen result in the cessation

of therapy until the drug is available again

Time of taking medicines more important than for many

other medicines Date of collection of medicines more important

reflects on adherence

Accurate and complete record keeping is vital

Regimens more complex so knowledge of treatment

guidelines more important.


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Participatory

Why do you think there is a need of

smooth communication between eg a

prescriber and a dispenser, a prescriber

and a Clinical nurse, a Clinical nurse anda block pharmacist, a Lab tech and a

Precriber

6.Rational Use of Drugs

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