Essential Drugs Concept and Rational Drug therapy

 

Essential Drugs Concept & Rational Drug Therapy –

1. Essential Drugs (Essential Medicines) Concept

Definition (WHO)

Essential medicines are medicines that satisfy the priority healthcare needs of the population.

Selection of Essential Medicines

Essential medicines are selected based on:

• Disease prevalence in the country/region
• Scientific evidence of efficacy
• Safety
• Cost-effectiveness
• Available healthcare facilities
• Skills and training of healthcare personnel
• Ease of administration
• Storage facilities
• Patient acceptability

Mnemonic: DESC HSP

• Disease prevalence
• Efficacy
• Safety
• Cost-effectiveness
• Healthcare facilities
• Skills of staff
• Patient acceptability

Importance of Essential Medicines

Essential medicines should be:

• Available at all times
• Available in adequate quantities
• In proper dosage forms
• Of assured quality
• Accompanied by proper information
• Affordable to individuals and the community

They are expected to cover 80–90% of the healthcare needs of the population.

2. Essential Medicines List (EML)

Definition

An Essential Medicines List (EML) is a limited list of carefully selected medicines that satisfies the priority healthcare needs of a population.

Selection is based on:

• Disease prevalence
• Safety
• Efficacy
• Cost-effectiveness

The EML is regularly updated considering:

• New scientific evidence
• Drug resistance patterns
• Emerging diseases
• New medicines
• Improved formulations

3. Advantages of Essential Medicines List

Public Health

• Prevents deaths from treatable diseases
• Ensures medicine availability
• Improves quality of healthcare

Drug Management

• Easier procurement
• Easier storage
• Prevents stock-outs
• Better inventory control
• Easier transportation

Cost

• Lower procurement cost
• Lower storage cost
• Easier quality testing

For Doctors & Pharmacists

• Better knowledge of fewer medicines
• Improved prescribing
• Better patient counseling
• Fewer medication errors

Standard Treatment

• Encourages treatment according to Standard Treatment Guidelines (STGs)

4. Rational Use of Drugs (RUD)

Definition

Rational use of drugs means:

Using the right drug for the right patient, in the right dose, by the right route, for the right duration, at the right time, after proper diagnosis.

Factors Leading to Irrational Drug Use

• Self-medication
• Medicines taken for minor illnesses
• Easy access to medicines
• Advice from friends or relatives
• Avoiding doctor consultation

5. Common Types of Irrational Drug Use

1. Polypharmacy

Use of too many medicines for one patient.

2. Irrational Antibiotic Use

• Wrong antibiotic
• Wrong dose
• Wrong duration
• Antibiotics for viral infections

3. Overuse of Injections

Using injections when oral medicines are sufficient.

4. Inappropriate Self-medication

Especially with prescription medicines.

5. Not Following STGs

Failure to prescribe according to Standard Treatment Guidelines.

6. Strategies to Improve Rational Drug Use

A. Managerial

• Supervise prescribing
• Use STGs
• Prescription audits
• Feedback to doctors

B. Economic

• Incentives for rational prescribing
• Insurance reimbursement only for EML medicines
• Competitive pricing

C. Regulatory

• Drug laws
• Licensing doctors and pharmacists
• Drug scheduling
• Ban unsafe medicines
• Regulation of pharmaceutical promotion

D. Educational

• Continuing education
• Training programs
• Formularies
• Clinical supervision
• Patient counseling
• Monitoring and feedback

7. National Strategies (WHO)

WHO recommends:

1. National medicine policy body
2. Evidence-based STGs
3. Essential Medicines List
4. Drug & Therapeutics Committee (DTC)
5. Problem-based pharmacotherapy training
6. Mandatory Continuing Medical Education (CME)
7. Independent drug information
8. Prescription audit and feedback
9. Public education
10. Remove financial incentives for irrational prescribing
11. Enforce drug regulations
12. Adequate government funding

8. Role of Pharmacist in Rational Drug Use

1. Drug & Therapeutics Committee (DTC)

• Helps select essential medicines
• Assists in EML preparation
• Develops medicine policies

2. Drug Procurement

• Purchase quality medicines
• Buy at reasonable prices
• Forecast medicine requirements
• Ensure EML medicines are procured

3. Drug Storage

• Follow Good Storage Practices (GSP)
• Prevent stock-outs
• Avoid expiry
• Proper handling of narcotics and costly medicines

4. Dispensing

• Accurate dispensing
• Reduce medication errors
• Prevent pilferage
• Maintain records

5. Patient Education

• Counsel patients
• Explain dosage
• Improve adherence
• Provide verbal and written instructions

6. Pharmacovigilance

• Detect adverse drug reactions (ADRs)
• Report ADRs
• Monitor medicine safety

7. Drug Information Service

Provide unbiased information to:

• Doctors
• Nurses
• Patients
• Public
• Other healthcare workers

8. Pharmaceutical Care

A patient-centered practice where the pharmacist:

• Takes responsibility for drug-related needs
• Collaborates with doctors
• Optimizes drug therapy
• Suggests dose adjustments
• Improves patient outcomes

Important Definitions for Exams

Essential Medicines

Medicines that satisfy the priority healthcare needs of the population.

Essential Medicines List (EML)

A limited list of carefully selected medicines based on efficacy, safety, disease prevalence, and cost-effectiveness.

Rational Drug Use

Use of the right medicine, for the right patient, in the right dose, by the right route, for the right duration, at the right cost.

Polypharmacy

Use of multiple medicines in a single patient unnecessarily.

High-Yield Mnemonics

Selection of Essential Medicines

DESC HSP

• Disease prevalence
• Efficacy
• Safety
• Cost-effectiveness
• Healthcare facilities
• Skills of healthcare personnel
• Patient acceptability

Strategies to Improve Rational Drug Use

MERE

• Managerial
• Economic
• Regulatory
• Educational

Pharmacist's Roles

PDSD PDPP

• Procurement
• DTC member
• Storage
• Dispensing
• Patient education
• Drug information
• Pharmacovigilance
• Pharmaceutical care

Frequently Asked Exam Questions

1. Define Essential Medicines.
2. Write the selection criteria for essential medicines.
3. Explain the advantages of the Essential Medicines List (EML).
4. Define Rational Use of Drugs.
5. Describe the types of irrational drug use.
6. Explain the strategies to improve rational drug use.
7. List the WHO national strategies for promoting rational drug use.
8. Discuss the role of pharmacists in promoting rational use of medicines.