Staff Of Pharmacology Department Faculty Of Medicine Suez Canal University
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Staff of Pharmacology Department Faculty of Medicine Suez Canal University
1
New Topics in Clinical Pharmacology
2
The Concept of Essential Drugs Essential drugs are those drugs that
satisfy the health care needs of the majority of the population. They should be available at all times in
adequate
amounts
and
in
the
appropriate dosage forms, and at a price that individuals and the community can afford (according to WHO).
3
New Topics in Clinical Pharmacology
4
P-Drugs (Personal Drugs) Definition: P-drugs are the drugs, which the doctor has
chosen personally to prescribe regularly. The P-drug concept is more than just the name of a pharmacological substance, it also includes the dosage form, dosage schedule and duration of treatment. Most doctors use only 40-60 drugs routinely.
Importance: Knowing the alternatives when your P-drug
choice cannot be used, for example because of serious side effects or contraindications, or when your P-drug is not available. Learning how to handle pharmacological concepts and data. This will enable you to 5
Steps in choosing a P-drug: Define the diagnosis. Specify the therapeutic objective. Make a list of effective groups of drugs. Choose an effective group according to criteria. Choose a P-drug. P-drugs and P-treatment: There is a difference between P-drugs and P-
treatment, as not all diseases need to be treated with a drug. The treatment may include advise information, non drug therapy, drug treatments, referral for treatment, or 6
Sample Page of a Personal Formulary Tablet 50, 100 mg DOSAGE
Beta blocker
ATENOLOL
Hypertension: start with 50 mg in the morning. Average: 50-100 mg per day. Angina pectoris: 100 mg per day in 1-2 doses Adjust to each patient individually, start as low as possible. Raise the dose after 2 weeks, if needed. WHAT TO TELL THE PATIENT Information Hypertension: drug decreases blood pressure, patient will usually not notice any effect. Drug will prevent complications of high blood pressure (angina, heart attack, cerebrovascular accident). Angina pectoris: decreases blood pressure, prevents the heart from working too hard, preventing chest pain. Side effects: hardly any, sometimes slight sedation. Instructions Take the drug .. times per day, for .. days Warnings Angina pectoris: do not suddenly stop taking the drug. Next appointment Hypertension: one week. Angina pectoris: within one month, earlier if attacks occur more frequently, or become more severe. FOLLOW-UP Hypertension: during first few months pulse and blood pressure should be checked weekly. Try to decrease dosage after three months. Higher dosages do not increase therapeutic effect, but may increase side effects. Try to stop treatment from time to time. 7 Angina pectoris: in case frequency or severity of the attacks increase,
New Topics in Clinical Pharmacology
8
Rational Drug Prescribing Definition: A medical prescription is a written order by a
medical doctor to a pharmacist for treatment to be provided to the doctor's patient.
Steps of Rational Prescribing: 1-Define the patient problem: study the pathophysiology of the disease. 2-Specify the therapeutic objectives: what do you want to achieve with the treatment, curative treatment or preventive treatment. 3-Verify the suitability of p-treatment. 4- Start the treatment. 5-Give information,instructions and warnings. 6-Monitor and stop treament. 9
New Topics in Clinical Pharmacology
10
Pharmacoepidemiology Definition: Pharmacology is the study of the effect of drugs and
clinical pharmacology is the study of effect of drugs on humans. Epidemiology can be defined as the study of the distribution and determinants of diseases in populations. Pharmacoepidemiology is the study of the use and the effects of drugs in large groups of people. Its background is the increasing understanding that the information gathered in pre-marketing studies does not adequately describe the true health impact of a drug, example, SSRI which cause ulcer bleeding (=pharmacovigilance). 11
Pharmacovigilance (Drug Surveillance)
Definition: • It is surveillance of side effects after
short term medicines.
and
long
term
use
of
How to Improve Pharmacovigilance? 4.Communication: between
local organizations and
pharmacovigilance patients. 5.Proposed measures to make side effect reporting mandatory rather than voluntary. 6.The patient’s information leaflets: Present the more clearly.
potential
adverse
reactions 12
New Topics in Clinical Pharmacology
13
Pharmaco-economics Definition: It is that branch of health economics that focuses on cost and
benefits of drug therapy. It is the cost/effectiveness of the drug.
Cost of a Disease:
3. Cost of physician (Single visit/ Repeated visit). 4. Cost of Lab. Investigation. 5. Cost of hospital stay (For patient/ Partner). 6. Cost of Drugs & other medications. 7. Cost of absence from work. 8. Cost of absence of partners from work. 9. Cost of change in quality of life. 10.Cost of adverse reactions of drugs used.
Applications for Cost/Effectivness of Drugs: Cost benefits of treatment of acute infections; e.g. Acute
Follicular Tonsillitis. Cost/Benefits of Prophylactic Drugs; e.g. Acute rheumatic
fever. 14
New Topics in Clinical Pharmacology
15
Pharmacogenetics Definition: It is the field concerned with unusual (idiosyncratic) drug
responses that have a hereditary basis , Or, It is the study in animal species of genetically determined variations that are revealed by the effects of drugs.
Examples: 1- Succinylcholine apnea It is a depolarizing neuromuscular blocker acts on nicotinic receptors at neuromuscular junction metabolized by plasma cholinesterase. some patients have atypical cholinesterase activity , so they suffered from a prolonged apnea due to failure to recover of respiratory muscle contractility. 2- Isoniazide polymorphism Acetylation is an important route of drug biotransformation. Slow acetylators and rapid acetylators : slow acetyltransferase activity is inherited as autosomal recessive genetic defect. slow acetylators may be susceptible to side effects due to elevated plasma levels. 3- Glucose – 6- phosphate dehydrogenase deficiency Deficient or impaired enzyme activity reduce the ability of blood cells to protect themselves from oxidative injuries and lead to 16 hemolysis.
New Topics in Clinical Pharmacology
17
18
1
New Topics in Clinical Pharmacology
2
The Concept of Essential Drugs Essential drugs are those drugs that
satisfy the health care needs of the majority of the population. They should be available at all times in
adequate
amounts
and
in
the
appropriate dosage forms, and at a price that individuals and the community can afford (according to WHO).
3
New Topics in Clinical Pharmacology
4
P-Drugs (Personal Drugs) Definition: P-drugs are the drugs, which the doctor has
chosen personally to prescribe regularly. The P-drug concept is more than just the name of a pharmacological substance, it also includes the dosage form, dosage schedule and duration of treatment. Most doctors use only 40-60 drugs routinely.
Importance: Knowing the alternatives when your P-drug
choice cannot be used, for example because of serious side effects or contraindications, or when your P-drug is not available. Learning how to handle pharmacological concepts and data. This will enable you to 5
Steps in choosing a P-drug: Define the diagnosis. Specify the therapeutic objective. Make a list of effective groups of drugs. Choose an effective group according to criteria. Choose a P-drug. P-drugs and P-treatment: There is a difference between P-drugs and P-
treatment, as not all diseases need to be treated with a drug. The treatment may include advise information, non drug therapy, drug treatments, referral for treatment, or 6
Sample Page of a Personal Formulary Tablet 50, 100 mg DOSAGE
Beta blocker
ATENOLOL
Hypertension: start with 50 mg in the morning. Average: 50-100 mg per day. Angina pectoris: 100 mg per day in 1-2 doses Adjust to each patient individually, start as low as possible. Raise the dose after 2 weeks, if needed. WHAT TO TELL THE PATIENT Information Hypertension: drug decreases blood pressure, patient will usually not notice any effect. Drug will prevent complications of high blood pressure (angina, heart attack, cerebrovascular accident). Angina pectoris: decreases blood pressure, prevents the heart from working too hard, preventing chest pain. Side effects: hardly any, sometimes slight sedation. Instructions Take the drug .. times per day, for .. days Warnings Angina pectoris: do not suddenly stop taking the drug. Next appointment Hypertension: one week. Angina pectoris: within one month, earlier if attacks occur more frequently, or become more severe. FOLLOW-UP Hypertension: during first few months pulse and blood pressure should be checked weekly. Try to decrease dosage after three months. Higher dosages do not increase therapeutic effect, but may increase side effects. Try to stop treatment from time to time. 7 Angina pectoris: in case frequency or severity of the attacks increase,
New Topics in Clinical Pharmacology
8
Rational Drug Prescribing Definition: A medical prescription is a written order by a
medical doctor to a pharmacist for treatment to be provided to the doctor's patient.
Steps of Rational Prescribing: 1-Define the patient problem: study the pathophysiology of the disease. 2-Specify the therapeutic objectives: what do you want to achieve with the treatment, curative treatment or preventive treatment. 3-Verify the suitability of p-treatment. 4- Start the treatment. 5-Give information,instructions and warnings. 6-Monitor and stop treament. 9
New Topics in Clinical Pharmacology
10
Pharmacoepidemiology Definition: Pharmacology is the study of the effect of drugs and
clinical pharmacology is the study of effect of drugs on humans. Epidemiology can be defined as the study of the distribution and determinants of diseases in populations. Pharmacoepidemiology is the study of the use and the effects of drugs in large groups of people. Its background is the increasing understanding that the information gathered in pre-marketing studies does not adequately describe the true health impact of a drug, example, SSRI which cause ulcer bleeding (=pharmacovigilance). 11
Pharmacovigilance (Drug Surveillance)
Definition: • It is surveillance of side effects after
short term medicines.
and
long
term
use
of
How to Improve Pharmacovigilance? 4.Communication: between
local organizations and
pharmacovigilance patients. 5.Proposed measures to make side effect reporting mandatory rather than voluntary. 6.The patient’s information leaflets: Present the more clearly.
potential
adverse
reactions 12
New Topics in Clinical Pharmacology
13
Pharmaco-economics Definition: It is that branch of health economics that focuses on cost and
benefits of drug therapy. It is the cost/effectiveness of the drug.
Cost of a Disease:
3. Cost of physician (Single visit/ Repeated visit). 4. Cost of Lab. Investigation. 5. Cost of hospital stay (For patient/ Partner). 6. Cost of Drugs & other medications. 7. Cost of absence from work. 8. Cost of absence of partners from work. 9. Cost of change in quality of life. 10.Cost of adverse reactions of drugs used.
Applications for Cost/Effectivness of Drugs: Cost benefits of treatment of acute infections; e.g. Acute
Follicular Tonsillitis. Cost/Benefits of Prophylactic Drugs; e.g. Acute rheumatic
fever. 14
New Topics in Clinical Pharmacology
15
Pharmacogenetics Definition: It is the field concerned with unusual (idiosyncratic) drug
responses that have a hereditary basis , Or, It is the study in animal species of genetically determined variations that are revealed by the effects of drugs.
Examples: 1- Succinylcholine apnea It is a depolarizing neuromuscular blocker acts on nicotinic receptors at neuromuscular junction metabolized by plasma cholinesterase. some patients have atypical cholinesterase activity , so they suffered from a prolonged apnea due to failure to recover of respiratory muscle contractility. 2- Isoniazide polymorphism Acetylation is an important route of drug biotransformation. Slow acetylators and rapid acetylators : slow acetyltransferase activity is inherited as autosomal recessive genetic defect. slow acetylators may be susceptible to side effects due to elevated plasma levels. 3- Glucose – 6- phosphate dehydrogenase deficiency Deficient or impaired enzyme activity reduce the ability of blood cells to protect themselves from oxidative injuries and lead to 16 hemolysis.
New Topics in Clinical Pharmacology
17
18
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