8. pharmacotherapy

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  • 2. PharmacotherapyPharmacotherapy Principally concerned with the safesafe and effectiveeffective management of drug administration. Implies an understanding of pharmacokinetics (PK) and pharmacodynamics (PD) so that individual dosing guidance, can be provided to optimize patient response .
  • 3. Pharmacokinetics What the body does to the drug Absorption Distribution Metabolism Elimination Pharmacodynamics What the drug does to the body Response Toxicity
  • 4. PharmacotherapyPharmacotherapy METABOLISM ABSORPTION ELIMINATION - Site (i.e., GIT, skin, tissue depot) - First-pass effect (oral) - Drug properties (i.e., solubility) -Pathway(s) -Sites (GIT, liver, lung) DISTRIBUTION SITE(S) FOR THERAPEUTIC EFFECT(S) SITE(S) FOR TOXIC EFFECT(S) Pharmacologic Activity Toxic Activity Free Drug in Plasma or Extracellular Fluid Distribution in Blood Cells Bound to plasma proteins - Unchanged drug - Metabolites - Sites (Tissues, fat, etc) - Binding Excretory Sites Urine, Feces, Expired AirActive/inactive metabolites
  • 5. Rational Drug Use Supported by USAID Prescribing, Dispensing, Counseling and Adherence
  • 6. 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. WHO conference of experts, Nairobi 1985
  • 8. Importance of RDU An irrational drug use results in the following: Treatment failure Rapid development of drug resistance Increase of toxicity risk Wastage of money
  • 9. Rational Drug Use Prescriber, Dispenser & their workplaces Drug Supply System Patient & community Many Factors Influence Use of Medicines Policy, Legal and Regulatory framework
  • 10. Drug Use Process
  • 11. 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
  • 12. Prescription: Types of Irrational Drug Use (1) Irrational Drug Use Occurs If a Drug Is Prescribed When: Underprescribing Needed medications are not prescribed Dosage is inadequate Length of treatment is too brief
  • 13. Prescription: Types of Irrational Drug Use (2) Irrational Drug Use Occurs If a Drug Is Prescribed When: Incorrect prescribing Drug given for incorrect diagnosis Wrong drug selected for diagnosis Prescription prepared improperly Adjustments not made for co-existing medical, genetic, environmental, or other factors
  • 14. Prescription: Types of Irrational Drug Use (3) Irrational Drug Use Occurs If a Drug Is Prescribed When: Extravagant prescribing A less expensive drug provides comparable efficacy and safety Symptomatic treatment of mild conditions diverts funds from treating serious illness Brand-name drug used when less expensive equivalents are available
  • 15. Prescription: Types of Irrational Drug Use (4) Irrational Drug Use Occurs If a Drug Is Prescribed When: Overprescribing Drug is not needed Dose is too large Treatment period is too long Quantity dispensed is too great for current course of treatment
  • 16. Prescription: Types of Irrational Drug Use (5) Irrational Drug Use Occurs If a Drug Is Prescribed When: 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
  • 17. 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
  • 18. Adherence vs Compliance Adherence: The act or quality of sticking to something; steady devotion; the act of adhering The acceptance of an active role in ones health care Compliance: the act of yielding, conforming,
  • 19. Consequences of Poor Adherence For the individual: Treatment failure: incomplete viral suppression, continued destruction of the immune system, disease progression Drug resistance: emergency of resistant viral strains Limited future treatment options: more complex treatment, more toxicity, uncertain prognosis
  • 20. SLEPT IN AWAY FROM HOME RAN OUT OF PILLS FELT ILL FELT BETTERPILLS DO NOT HELP FEAR SIDE EFFECTS DID NOT WANT OTHERS TO SEE FAMILY SAID NO TO MEDICATION FORGOT / BUSY DID NOT UNDERSTAND INSTRUCTION S MISSED DOSES TAKING PILL HOLIDAYS UNABLE to CARE FOR SELF Adherence: Why do Patients Miss Doses? (Barriers to adherence) Lets find together a solution for your problem I am listening You can trust me I understand I suggest What do you think? Ill explain to you how to take these medicines
  • 21. Other Barriers to adherence Communication difficulties Literacy levels Inadequate knowledge of disease Inadequate understanding of effectiveness of medications Lack of social support Discomfort with disclosure status Difficult life conditions Alcohol and drug use Depression and other psychiatric problems
  • 22. Adherence Multi-disciplinary Roles Same message from all! Adherence Message for the patient Doctors Adherence Nurse Pharmacist Family/ Friends Counselor Social Worker
  • 23. Methods and Challenges of Measuring Adherence Self reports Pill counts Pharmacy records Provider estimate Pill identification test Biological markers Electronic devices Measuring drug levels
  • 24. A multi-disciplinary team work is required to achieve Rational Drug Use !!! Doctor Pharmacist Counselor / Treatment supporter Nurse Community
  • 25. CLASSES of DRUGS Drugs affecting the Autonomic Nervous System Drugs affecting the CNS Antiparkinson drug Anti-anxiety Hypnotic drugs CNS Stimulants Anesthetics Antidepressant drugs Anti-epilepsy
  • 26. Drugs affecting Cardiovascular system Drugs for congestive heart failure Anti-arrythmic drugs Antianginal drugs Antihypertensive drugs Drugs affecting blood Antihyperlipidemic drugs