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8/18/2019 Hospital formulary Dr Motghare.pptx
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Hospital DrugFormulary
Dr. V. M. Motghare,Professor and head,
Department of Pharmacology,
SRTR Medical College,Ambajogai, Maharashtra
ISRPTC! "#$", %ol&ata
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De'nition(
Hospital Formlary is a continally re!isedcompilation of pharmaceticals incldingimportant ancillary information that
re"ects the crrent clinical jdgement ofthe medical sta#$
Formlary system is method %hereby themedical sta# of an instittion, %or&ingthrogh the PTC, e!alates, appraises, andselects from among the nmeros
a!ailable drg entities ' drg prodctsthose that considered most sefl in
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The need for HospitalFormulary
(
The increasing nmber of ne% drgsmanfactred and mar&eted by drgcompanies$
) *ncreasing in"ence of add+ on drgs %hich
inclde both scientic and nscientic,ethical and nethical$
- *ncreasing comple.ity of nto%ard e#ects ofmodern potent drgs$
/ 0e%er sales promotion strategies ofpharmacetical indstry$
1 The pblic interest in getting possible
health care at lo%est possible cost$
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PR*P+R+TI! FHSPIT+
FRM-+R
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$. Introdu/toryinformation
Ac&no%ledgement
2ist of abbre!iations
*ntended sage of theformlary manal
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". 0asi/ information of thedrug
3eneric name, dosage form, strength
*ndications
Pharmacological action Precations
Side e#ects
Dosage 4 form, fre5ency *nstrctions
Drg interactions
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1. Supplementary information on ea/h drug
Price
Reglatory category
Storage gidelines
Patient conselling information
6rand names
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2. Pres/ri3ing and dispensingguidelines
Principles of prescription %riting
0ame and address of the patient
Prescribed drg shold be %ritten informlary terminology
Strength of prescribed medicationmst be gi!en in accepted metricsystem$
Correct dispensing gidelines
Pre!ention and reporting of ADRs
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ad6i/e
7se of *8 additi!es
Prescribing in special sitations
Poisoning and antidotes
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7. ther /omponents
Formlas for !arios diagnostic stains,diagnostic aids
Table of common 2ab9!ales
Posological tables
*nde. of the drgs inclded in theformlary
Metric nits
*nde.es:by generic name, brand name,therapetic category;
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8. The Format
Pharmacist decides the format beforecommencing %or& on printing andpblishing in the hospital$
He has to collect formlaries of someleading hospitals as %ell as theirformat$
Copies of nally pblished formlarymay be sent to bodies li&e directorategeneral of health ser!ices, 3o!t of
*ndia, PC* etc$
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9. Si:e
*t is s
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;. Type of format
2oose leaf or 6ond
Printed or Mimeographed
*nde.ing and Assigning categories
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*SS*!TI+ DR-5S
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Defnition
>ssential drgs are those that satisfy thehealth care needs of majority of the
poplation and therefore shold bea!ailable at all the times in ade5ateamonts and in appropriate dosage forms$
>ssential drg list is same as limited drglist$ :Synonymos terms;
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drug list
More cost e#ecti!e drg control,management, prchase, storage, trno!erand distribtion$ More patients treated pernit cost$
*mpro!ed drg se in terms of safety,simplied and more e
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Benefts o essentialdrug list
>asy identication and a!oidance ofad!erse drg reactions and interactions
%ith fe%er drgs$
Stimlation of local drg formlation andprodction depending on the re5irement$
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fguring in essential drugslist useless or redundant?
2ist of essential drgs does not imply thatno drgs otside it are sefl$
These drgs may be more e.pensi!ealternati!es or sefl only for ncommonailments$
May be harmfl or ha=ardos$
May be irrational .ed dose combination$
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Milestonesntial drugs concept & rational u
E i l d &
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Essential drugs concept &rational use
(?@ Concept of essential drgs :%as 2anchedand milestone in the eld of health policy, selectionof )9)1 essential drgs ' odd drgs %hich%old be sssential Drg 2ist TRS E(1:)1 drgs;
(?@ Technical Discssions HA and ResoltionHA -($-)
(?( >stablishment of the H Actionprogrammed on >ssential Drgs$
E i l d &
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(?) Second re!ision of H >ssential Drg 2ist9 Title Changed to GTH> 7S> F >SS>0T*A2 DR73S:TRS E1;
(?- Fll implementation of the ActionProgrammed$
(?1 Conference on Rational 7se of Drgs in0airobi :*0R7D;
(?E HA-?$)@ The Rational 7se of drgs
Resoltion$
Essential drugs concept &rational use
E i l d &
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(? Pblication of se!eral docments called for inD3Is Report on the Re!ised Drgs Strategy $
(??1 Si.th report of the H >.pert Committee on
The se of >ssential Drgs$ :H TRS 1;
(??@ Se!enth report of the H >.pert Committeeon The se of >ssential Drgs$ :H TRS E@;
)1 Forteenth report of the H >.pertCommittee on The se of >ssential Drgs$ :H
TRS ?)(;
)@ Fifteenth report of the H >.pert Committee
Essential drugs concept &rational use
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drugs be changed rom
time to time? (?@@ H pblished the selection of
essential drgs :H TRS E(1;
Reglar re!ision of the list:(?@?,(?),(?19latest )1 and )@4(1 model 2ist9H9TRS ?/E;,and March)?9(Eth model listJ>M29child
The crrent H GModel 2ist of >ssentialMedicines is re!ised in March, )(( and is
the (@th edition for adlts %ith )- FDCs
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$;;7 *ndia for the rst time pblished!ational *ssential Drugs ist
*n "##1, it %as re!ised and renamed as!*M?.
@une "#$$ 9 third 0ational >ssentialMedicine 2ist :0>M2;$
*t contains -/ drgs and (E Fi.ed DoseCombinations$
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establishing a list oessential drugs
Drg Committee$
6enet and safety e!alations$
*nternational 0on9proprietary:generic;names$
Kality
Cost$ 2ocal 2e!el of e.pertise$ 2ocal Health problems$
6enet ris& ratio$
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establishing a list oessential drugs
Preferential factors for e!alatinge5i!alent drgs$
hen t%o or more drgs aretherapetically e5i!alent, preferenceshold be gi!en to+9
The drg %hich has the most thoroghlyin!estigated on therefore,best nderstood%ith respect to its benecial properties and
limitationsL
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establishing a list oessential drugs
The drg posscessing clinical tility for thetreatments of more than one condition ordiseaseL
The drg %ith the most fa!orablepharmaco&inetic properties$e$g$,toimpro!e compliance, to minimi=e ris& in!arios pathophysiological stats etc$
Drgs that are in a dosage form that iseasy for the health sta# to dispense oreasily and safely administrated to the
patientL
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establishing a list oessential drugs
Drg that are easy for the patient to ta&eL
Drgs, pharmacetical prodcts anddosage forms %ith fa!orable stabilitynder anticipated local conditions for%hich storage facilities e.istL
Drgs for %hich local, reliablemanfactring facilities e.ist for itsprodction$
Fixed atio
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Fixed atio!ombinations
Fi.ed ratio combinations are onlyacceptable if one or more of the follo%ing
considerations are satised$
The concomitant !ale of more than onedrg is clinically docmented$
The therapetic benet of the combinationis greater than the sm of each of the
indi!idal components$
Fixed atio
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Fixed atio!ombinations
The combination is safer than is the se ofan indi!idal drg$
The cost of the combination prodct is lessthan the sm of the indi!idal components$
Compliance is impro!ed by se of thecombination$
Fixed atio
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Fixed atio!ombinations
S
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list
The essential drg list may need tore!ie%ed yearly or %hene!er necessary, toincorporate signicant ne% therapetic
ad!ances and information$3enerally ne% drgs shold be introdcedonly if they o#er distinct ad!antages o!erdrgs pre!iosly selected$
*f, on the basis of ne% information, drgsalready on the list are fond to no longerposses a fa!orable benetJris& ratio, theyshold be replaced by safer drgs$
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selection o
Essential Drugs Choice of drgs depends on + Pattern of pre!alent diseases
Treatment facilities Training and e.perience of health personnel
Financial Resorces ther factors 4 3enetic, Demographic,
>n!ironmental$
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!riteria or selectiono Essential Drugs
H*CH DR73S
S
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selection o
Essential Drugs Formlation as Single compond$
>ase of administration and compliance$
2ocal manfactre and storage$
Fi.ed dose combination appro!ed by Hon the basis of e
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o "harmaceuticaldosage orm
Type of dosage form :Tablet, Capsles, SRpreparation; based on &inetic,bioa!ailability, stability and localpreference$
Strength of the drugs :Dose range,
pediatric preparation;
Exclusion of the drugs :2o% solbility,npredictable bioa!ailability, 0e%er
dosage forms;
Selection o Anti
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Selection o Anti%microbial agents
Sensiti!ity of micro organisms$
Pre!alence of type of infection$
Resistance to Anti microbial agents$ :AMA;
A!ailability of AMA :Safe, >#ecti!e, Cheap;
Cost of the drgs$
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Essential Drug ist
ho shold prepare it
Ho% many drgs
:H Model list, 0ational, regional le!el,Hospital and primary health centre;
hich drgs :e#ecti!e, safe, cheap, forcommon ailments;
Re!ision and pdating of the list yearly$
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)b*ecti#es
Ma.imm cstomer ser!ices$ Minimm in!entory in!estment$
2o% cost plant operation$ A6C Analysis+9:Al%ays better control
techni5e$; A *tem 4 Costly items :F>;
6 *tem 4 0either costly nor cheap C *tem 9 Comparati!ely cheaper in cost
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!lassifcation o Drugs
A6C analysis of drgs$
6ase on their cost and e.penditre$
Category A 4 (B of the total itemsconsme @B of the bdget$
Category 6 4 )B of the total itemsconsmes )B of the bdget$
Category C 4 @B of the total itemsconsmes (B of the bdget$
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No A ITEMS B ITEMS C ITEMS
1 10% OF Total 20% of Total 70% of Total
2 70% of Total Budget 20% of Total Budget 10% of total Budget
3 Requires very strict control Moderate Control oose Control
! Requires "it#er no or lo"safety stoc$s
o" afety toc$s &t requires 'is#safety stoc$s
( )eeds *a+i*u* follo" u, -eriodic Follo" u, Close Follo" u,
. 'andled /y senior officers- or -rof
'andled /y *iddleManage*ent -#ar*acist
cl&&
'andle /y-#ar*acist
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!lassifcation ) Drugs
8 > D Analysis 4 according to theircriticality in patient care$
8 4 8ital drgs$ 4 (B of the total , theyare !ital lifesa!ing drgs and theirabsence cannot be accepted$ They ha!egot to be administered to the patients$ 0odrgs are a!ailable as sbstittes for theseitems$ Therefore e!ery e#ort has to bemade, at %hate!er cost to a!oid ot9ofstoc& position for any of these items$
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!lassifcation ) Drugs
E – Essential drugs 4 Constitting /B of thetotal items$ And their absence can be
tolerated for short stretches of time$ Theycold be made a!ailable %ithin a day or t%oand alternati!e medicines made a!ailable forse in their place$
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!lassifcation o Drugs
D – Desirable Drugs :090on essentialitems$; Constitte 1B of the items$ And
their non9a!ailability can be tolerated forlonger period of time$ They may bere5ired for treatment of chronic and lessserios patients$
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!ombination ) A B !
And + E D Anal(sisV * D
+ +V +* +DCat I A items $4
B
0 0V 0* 0D
Cat II A items
2# B
C CV C* CDCat III A items
24 B
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/0
> 9 e 9 ease of administration : dosage form;$ 0 9 need of poplation$
T 9 total cost$
* 9 irrational combination to a!oid
A9 a!ailable
2 9 listing reglarly : pdating;
a e ome message
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a e ome message/0
“Essential Drug Concept Is
Not A Short Cut To Escape
rom Therapeutic !ungle"
#ut To Choose" $se" Store"The %ight &ind 'f (idden
Treasure In It)*
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is one feature hi/h
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TH+!% -
is one feature hi/h
distinguishes man, the animal
from his fello /reatures. It is
one of the most serious
diE/ulties ith hi/h e ha6eto /ontend=
illiam sler $9;$