Rational and Irrational Use of Drugs Questions and Answers

         Q1) Factors that Influence the Rational Drug Prescribing?

• v 1.Diagnosis the basic and main criteria for moving on to all rational processes. Poor diagnosis provide paved way toward poor drugs use/irrational drugs use or pathological drugs use. Second thing to be consider is to prioritize the problem when some co-morbidities are there. Just like one disease affect the rational use for other disease when factors (pharmacokinetic and pharmacodynamics factors of a disease) are not considered. Diagnosis followed by prognosis for a primary or secondary disease must be made properly. Poor prognosis may limit the benefits of the therapy or may lead to co-morbidities.   

• v 2.Drug Factors: Drug factors include pharmacokinetic, pharmacodynamics, safety and cost of drug. Pharmacokinetic factors include proper selection of route of administration, bioavailability, metabolic factors and Selecting proper surrogate or alternatives, depending at the site of disease for example Vancomycin use in lateral infection but limitations in meningitis due to poor perfusion to brain. Pharmacodynamics considerations involve factors like therapeutic index (drug with broad therapeutic index selected instead of narrow ones), and selecting a drug with other mechanism having a more safe profile (just like selection of ARBs instead of ACEIs in a patient with cough).  Safety include the increase risk of drug interactions and adverse effect or side effects. Selecting a drug which exaggerate the current problem or co-morbidities or cause new morbidities or not preferred. Cost effective alternative drugs can be selected by having choices like therapeutic equivalents, therapeutic alternatives and Generic drugs.  Selecting a cost effective therapeutic equivalent or therapeutic alternatives or other generic drug brings economic relief to country and patient.  

• v  Prescriber Factors: Prescriber factors include thing like proper knowledge of disease condition, knowledge of drugs and experience in tackling the problems. Lack in any of these may cause pathological drug use or irrational drug use. Follow up also is the important prescriber factor which must be considered.

• Patient Factors: Included are Propensity for drugs to be causing ADRs just like incase of patient allergic to penicillin turning for some other alternatives must be made.
• v Vulnerability to adverse effects of patient having other co-morbidities like renal and hepatic impairment. Co-morbidities (patient with multiple diseases) may also vulnerable for drug toxicities when proper drugs are not selected. Other patient factors include patient compliance which influence the rational drug prescription.

         Q2)  what are the Patient Factors that influence the rational drug prescribing?

• v   Patient Factors: Included are Propensity for drugs to be causing ADRs just like incase of patient allergic to penicillin turning for some other alternatives must be made.
• v   Vulnerability to adverse effects of patient having other co-morbidities like renal and hepatic impairment. Co-morbidities (patient with multiple diseases) may also vulnerable for drug toxicities when proper drugs are not selected. Other patient factors include patient compliance which influence the rational drug prescription.

         Q3) Examples of Irrational Drug Prescribing?

• v    Use of Drug when no therapy is indicated i.e use of antibacterial agent in upper respiratory tract infections.
• v   Use of doubtful drug i.e Use of Anti-motility agents in diarrhea.
• v    Overuse of under use of medicines i.e antibiotics leading to resistance.
• v    Use of costly medicines when generics are available instead of branded drugs.   
• v    Use of correct drug with incorrect administration, dosage and duration i.e use of IV Metronidazole instead when oral or rectal routes are effective.
• v    Un-necessary use of inert substances i.e supplements and multivitamins.
• v   Un-necessary use of drugs when some alternatives can be use i.e drastic use of drug in Hypertensive patient when the problem can be solved with some adaptations in life style and food.

Q4) Drawbacks of Irrational Drug Prescribing ?

1)Delay in the cure.

 2)More side or adverse effects.

3)  Prolong hospitalization.  

4)Emergence of antimicrobial resistance.

5) Loss of patient confidence on physician.

 6)Economic loss to patient.

7)Lowering of health Standards.

8)Low of patient compliance.

Q5) What is meant By Rational drug use? Examples

Usually the rational drug prescribing is confirmed by 5 Rights, which include Right drug to the right patient, at a right dose on Right time at the right route. But these 5 Right does not always confirm the rational drug use. Along with these 5 rights, Rational drug use include things like cost effectiveness, safety concerns and patient counseling and follow ups. Few Example/Considerations are:

• v   Use of Cost effective alternatives (generics, therapeutic alternatives and therapeutic equivalents).  Dose adjustments when renal or hepatic impairment.
• v    Proper selection and duration for antibiotics to prevent resistance.
• v    Preventing drug use in patient who can be treated with healthy alternatives.
• v  Preventing prescribing errors by double check system for Narrow therapeutic drugs and a double check system on prescription review to prevent other errors.

Q6) What is rational dispensing? Discuss the various steps in rational or dispensing process?

Rational Dispensing is the process of delivering effective form of correct medicines, to the right patient, in the correct dosage and quantity with clear instructions and in the package that maintain the potency of the medicines. Rational dispensing is required to take 100 percent benefit for the therapy.

Various Steps in Rational Dispensing are

• v   Receiving and Validation of Prescription : In this process Prescription is received form the patient, patient guardian and or responsible staff member followed by validation of prescription through conformation of name, gender and age etc.
• v   Understand and Interpretation of prescription: this step involve reading the prescription, interpretation of symbols used in prescription, conformation of dose, dose calculation and putting out occurring or potential drug-drug interactions.  All of this process should be counter checked by other staff member.
• v    Prepare and Label items for use: this step involve selection of drug, taking the required quantity and writing/making the label concomitantly when taking the required medicine. Taking medicines from the main container to the consumer container should follow clean processes and when necessary aseptic processing. Cross check or double check must be made before packing. Selection of required package/container also comes in this step. Care must be taken when selecting a package/container.  
• v    Making A Final Check : this involve checking of packed medicines against the prescription and the main container for which the medicines to avoid any mistake. And a final check mad by professional or authorized person.
• v    Record Maintenance: Record is maintained for future purpose, like follow ups and as legal requirement. It is mandatory in some countries. Record contain information like patient name, age, medicines name, strength, amount issued and dispenser name. Both manual and computer base record maintenance is done.
• v    Issuance, Counseling and Follow ups : Poor counseling ruin the whole above written efforts form prescribing up to packaging of the medicines. Counseling contain info like purpose of treatment, strengths of doses, frequency, potential ADRs and Side effects, info about drug-drug interaction (not to take these two drugs) and food drug interaction. Follow ups is done to confirm the desired outcomes of the therapy and to prevent any disastrous events mediate by Treatment or medicines.