[03.07] Rational Drug Use V2.2.pdf

Antibiotic resistance

What is the most important issue to prevent in drug use?

Philippines

Where is there a high prevalence of drug-resistant infections, particularly tuberculosis?

Tuberculosis (TB)

Which infection has made the Philippines a hotspot for drug-resistant strains?

Multi-drug resistant tuberculosis (MDR-TB)

What does an X-ray image depicting a patient with drug-resistant TB primarily show, according to Dr. Pereyra-Borlongan?

Uncertain, further evaluation ongoing

What is the current status regarding whether a case involves extensively drug-resistant tuberculosis (XDR-TB)?

Irrational antimicrobial use

What is a common major problem worldwide, especially in countries where antimicrobial stewardship is still developing?

Antimicrobial stewardship

What aims to educate and support healthcare professionals to follow evidence-based guidelines in prescribing and administering antimicrobials?

Almost half

What proportion of antimicrobial prescriptions for infections, especially respiratory infections, are not indicated?

Without signs of bacterial infections

When are antimicrobials sometimes given irrationally in cases of upper respiratory tract infections?

Prescription for non-over-the-counter drugs

What do patients usually expect when they leave the clinic, due to cultural beliefs?

Change in diet, lifestyle, and natural remedies (e.g., increased water intake, vitamins)

What could be the solution over medications in many cases?

Poor Selection, Overprescription, Non-compliance, Industry-related causes

What are the four main causes of irrational drug use discussed in the source?

Aminoglycosides

What is an example of an antibiotic that is only effective for aerobic organisms, highlighting the importance of appropriate selection?

Weight of the patient

What factor is more crucial than specific standards for dosing in pediatrics, making computation vital?

Polypharmacy

What is the term for overprescription involving too many medicines per patient?

Chronic kidney disease (CKD) patients undergoing dialysis

What patient group is typically prescribed a minimum of 10 medicines per patient, illustrating polypharmacy?

Anti-hypertensive drugs, insulin, sodium bicarbonate, calcium carbonate, sevelamer, iron (sometimes with folic acid), multivitamins, erythropoietin, heparin

What are some examples of medications typically prescribed to patients with chronic kidney disease undergoing dialysis?

Drug-drug or drug-food interactions

What potential issues must be noted when patients are taking multiple medications, especially anticoagulants?

Lack of education and failure of compliance to clinical patient guidelines (CPG)

What are primary causes of non-compliance in drug use?

Practices or medicines they are used to

What do patients usually fall back on, contributing to non-compliance?

Over-use of injections

What form of administration is often overused, even when oral formulations are more appropriate?

DM2 patients starting insulin injections

What patient group sometimes mistakenly believes they cannot return to oral hypoglycemic agents even if their condition improves?

Monitoring patient’s treatment and illness

What is important to determine if a patient with improved diabetes can shift back to oral hypoglycemic agents?

Lack of access to certain medications and/or medical supply

What is an industry-related cause of irrational drug use in Geographically Isolated and Disadvantaged Areas (GIDAs) and provincial health centers?

Department of Health (DOH)

Which entity is responsible for controlling the supply of medications and vaccines and for putting policies and regulations in place to promote healthy lifestyles?

Bacteria change and become resistant to antibiotics

When does antibiotic resistance happen?

Over-prescribing of antibiotics, patients not finishing their treatment, overuse of antibiotics in livestock and fish farming, lack of new antibiotics being developed, poor infection control in hospitals/clinics, lack of hygiene and poor sanitation

What are the causes of antibiotic/antimicrobial resistance?

Buying the total quantity on the prescription

What policy do some pharmacies implement to ensure patients complete their medication?

Cross infection

What can the overuse of antibiotics in livestock and fish farming sometimes lead to, especially for species with the possibility of disease transmission?

New mutations and new strains of influenza

What may cross infections generate?

Self-medication with antibiotics

What might expensive veterinary fees lead to among animal owners?

Old antibiotics being investigated for other uses

What is happening instead of producing new kinds of antibiotics, contributing to the lack of new developments?

Only prescribe and dispense antibiotics when truly needed

What is a key action to prevent antimicrobial resistance?

Take the right dose for the right duration and never share or use leftovers

What should patients be educated about regarding their antibiotic treatment?

Recommendations from peers or social circles

What sometimes leads to self-medication, which patients should be reminded to avoid?

Practice good infection control and keep vaccinations up to date

What two general practices are mentioned for preventing antimicrobial resistance?

Rational Drug Use

What term, according to WHO (2016), 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 duration, and at the lowest cost to them and their community"?

Pediatric patients

What patient group especially needs their doses to be computed to meet individual requirements?

Cost-effective and affordable

What characteristics should medications have to ensure the lowest cost to patients and their community?

Generic medications

What can be prescribed to give patients the freedom to find the brand that best caters to them?

Bioequivalent counterparts

What are generic medicines considered to branded ones, despite potential minor differences?

Slower effect

What is one aspect where some generic medications might differ from branded ones, though still within acceptable levels?

Appropriate indication, appropriate drug, appropriate patient, appropriate dosage and duration, appropriate route of administration, appropriate patient information, appropriate evaluation

What are the "Rule of Right"s in rational drug use?

Osteomyelitis

What disease is given as an example that might need 4-6 months of treatment, potentially involving IV antibacterial therapy outside of admission?

Hospitals

What is one systemic intervention level where drug use is determined by nurses and doctors?

Philippine National Drug Formulary (PNDF)

What is an example of a drug regulatory mechanism that sets which antibiotics will be dispensed in hospitals?

Primordial Prevention

What level of prevention alters societal structures and thereby underlying determinants of health?

Systems thinking and developing a social eye

What approach do ASMPH students adopt to understand patient needs beyond clinical applications, extending to external factors?

Environmental hygiene

What is an example of primary prevention that alters exposures leading to disease?

Installation of air filters and physicians requiring masks in clinics

What are examples of preventing exposure to respiratory droplets in primary prevention?

Secondary Prevention

What level of prevention detects and treats pathological processes at an earlier stage when treatment can be more effective?

Provision of antibiotics or any medication for the intended disease

What is an example of secondary prevention?

Tertiary Prevention

What level of prevention prevents relapses and further deterioration via follow-up care and rehabilitation?

Post-operative wound care and dressing

What is an example of tertiary prevention?

Referral of stroke patients to physical therapists

What is an example of tertiary prevention aimed at improving quality of life?

Illegibly and abbreviate orders

How may doctors sometimes write, leading to patient misunderstanding?

Verbally reiterate the prescription

What should a doctor do to ensure a patient understands an illegible or abbreviated prescription?

Pharmacy stocks drugs that may look alike

What is a contributory factor influencing clinical practice that can lead to confusion?

One nurse assigned to 30 patients

What common situation in government hospitals can lead to nurses confusing medical supplies and giving the wrong treatment?

Pharmacists mistaking one drug for another, intern mistakenly giving KCl instead of Vitamin K, nurses misreading orders (e.g., days becoming doses)

What are examples of care management problems?

MIMS (multichannel provider of drug or medical information)

What resource is recommended for doctors in private practice to fact-check available medications in the country?

Medication review

What should be performed to check if medications are correct and to avoid patients receiving double drugs?

Enalapril and Losartan

What two drugs are given as an example of having the same mechanism but being prescribed together, which should be avoided?

Enoxaparin and Apixaban

What two anticoagulants are given as an example of drugs that should not be given together due to increased bleeding risk?

Wrong interpretation of prescription, retrieval of the wrong drug from stock, wrong dosages, inadequate packaging/labeling, inaccurate counting/compounding, inadequate or non-existent labeling, lack of knowledge on proper drug compliance, insufficient knowledge of the disease process, insufficient time to talk with patients about their medications

What are potential errors in prescribing?

Numbers being misread (e.g., 2 as 3)

Why should words like "once a day" or "twice a day" be written out instead of just numbers on a prescription?

Date of expiration

What crucial information might be missing on the packaging of small quantities (tingi) of drugs, potentially leading to people taking expired medication?

Pulverize expired drugs

What should be done before throwing away expired drugs to prevent others from taking them?

Google

Where do some patients consult for their symptoms, potentially indicating insufficient knowledge of the disease process?

Medical students and practicing physicians, nurses and pharmacists, undergraduate students in the life and health care sciences, healthcare professionals who will care for patients

For whom is the WHO Rational Drug Use Model for Personal Drug (P-Drug) selection intended?

Logical, rational, and deductive process based on comprehensive and objective information

How should prescribing be, according to the WHO Rational Drug Use Model?

Knee-jerk reflex, a recipe from a cook-book, or response to commercial pressure

What should prescribing NOT be?

Bell-Kenz Pharma, Inc. incident

What incident is cited as an example of commercial pressure influencing drug prescription?

Define the diagnosis

What is the first step in P-Drug selection?

State and specify the therapeutic objective

What is the second step in P-Drug selection?

Choose an effective group

What is the third step in P-Drug selection?

Choose a P-drug based on ESSC criteria (Efficacy, Safety, Suitability, Cost)

What is the fourth step in P-Drug selection?

Give information, instructions, and warnings on possible adverse reactions

What is the fifth step in P-Drug selection?

Monitor and evaluate for responsiveness to the drug

What is the sixth and final step in P-Drug selection?

National and international treatment guidelines

What should be consulted to know which drugs to consider for a specific treatment?

Diseases/disorders, signs and symptoms, comorbid diseases, psychological/social problems, drug side effects, refill-request tendencies (polypharmacy), non-adherence to treatment tendencies

What are the factors to prioritize when defining the patient's problem/diagnosis?

Beta-blockers

What medication given to a diabetic patient can mask the symptoms of hypoglycemia, potentially pushing them into a comatose state?

Financial capacity

What is a primary concern under "social problems" when defining a patient's problem/diagnosis?

Guarantee letters from government offices

What do impoverished patients often need to obtain free or subsidized medications, which can sometimes be abused?

Eradication of pathogenic organisms, relief of signs and symptoms, prevention of resistance development, prevention of relapse and recurrence of infection

What are examples of specific and clear therapeutic objectives?

Surgery as an intervention

What is given as an example to prevent the recurrence of an infection?

First-line, second-line, and third-line treatment options

What should doctors list when considering drug groups to offer alternatives if a patient cannot afford the primary option?

Cephalosporins

For which class of antibiotics does Gram-negative activity generally increase with higher generations?

Quinolones

For which class of antibiotics does Gram-positive activity generally increase with higher generations?

Cefazolin

Which antibiotic do orthopedic surgeons prefer for prophylaxis in surgery due to its good distribution to bones and muscles?

Mucolytics (e.g., N-acetylcysteine, carbocysteine, erdosteine)

What type of medication should be prescribed for a productive cough to increase phlegm excretion?

Antitussives (e.g., dextromethorphan, codeine, sinecod, butamirate citrate, levodropropizine)

What type of medication should NOT be prescribed for a productive cough?

Mechanism of action, indications, spectrum of coverage, pharmacokinetic and pharmacodynamic properties

What considerations fall under "Efficacy" in the ESSC criteria?

Therapeutic indices, adverse effects, toxicity

What considerations fall under "Safety" in the ESSC criteria?

Drugs with a narrow therapeutic index

What kind of drugs may produce significant adverse effects if the dosage goes beyond or below the limit?

Patients with liver and kidney failure

What patient group has a limited number of drugs that can be safely prescribed due to potential toxicity?

Contraindications, hypersensitivity reactions, route of administration, frequency of administration

What considerations fall under "Suitability" in the ESSC criteria?

Subcutaneously injected

What is the correct route of administration for anticoagulants to avoid hematomas?

Compliance to drug administration

What is a very important factor related to "Cost" in the ESSC criteria?

Intermittent, non-radiating burning type of epigastric pain, relieved by intake of food, pain at night, transient relief from antacid, employed in stress-related work, chain smoker, direct tenderness in epigastric area

What were the key problems identified for patient R.G. with epigastric pain?