New Topics in phaRMcology (97-2003)

Staff of Pharmacology Department
Faculty of Medicine
Suez Canal University
1
New Topics in
Clinical Pharmacology
2
The Concept of
Essential Drugs
Essential drugs are those drugs that
satisfy the health care needs of the

majority of the population.
They should be available at all times in
adequate amounts and in the

appropriate dosage forms, and at a price
that individuals and the community can
afford (according to WHO). 3
New Topics in
4
P-Drugs
(Personal Drugs)
Definition:
 P-drugs are the drugs, which the doctor has
chosen personally to prescribe regularly.
 The P-drug concept is more than just the
name of a pharmacological substance, it also
includes the dosage form, dosage schedule
and duration of treatment.
 Most doctors use only 40-60 drugs routinely.
Importance:
 Knowing the alternatives when your P-drug
choice cannot be used, for example because of
serious side effects or contraindications, or
when your P-drug is not available.
 Learning how to handle pharmacological
concepts and data. This will enable you to 5
Steps in choosing a P-drug:
Define the diagnosis.
Specify the therapeutic objective.
Make a list of effective groups of drugs.
Choose an effective group according to
criteria.
Choose a P-drug.
P-drugs and P-treatment:
 There is a difference between P-drugs and P-
treatment, as not all diseases need to be
treated with a drug.
 The treatment may include advise
information, non drug therapy, drug
treatments, referral for treatment, or 6
Sample Page of a Personal Formulary
 Tablet 50, 100 mg Beta blocker ATENOLOL
 DOSAGE
Hypertension: start with 50 mg in the morning. Average: 50-100 mg per
day.
Angina pectoris: 100 mg per day in 1-2 doses Adjust to each patient
individually, start as low as possible. Raise the dose after 2 weeks, if
needed.
 WHAT TO TELL THE PATIENT
Information
Hypertension: drug decreases blood pressure, patient will usually not
notice any effect. Drug will prevent complications of high blood pressure
(angina, heart attack, cerebrovascular accident).
Angina pectoris: decreases blood pressure, prevents the heart from
working too hard, preventing chest pain. Side effects: hardly any,
sometimes slight sedation.
Instructions
Take the drug .. times per day, for .. days
Warnings
Angina pectoris: do not suddenly stop taking the drug.
Next appointment
Hypertension: one week.
Angina pectoris: within one month, earlier if attacks occur more
frequently, or become more severe.
 FOLLOW-UP
Hypertension: during first few months pulse and blood pressure should be
checked weekly. Try to decrease dosage after three months. Higher
dosages do not increase therapeutic effect, but may increase side effects.
Try to stop treatment from time to time.
Angina pectoris: in case frequency or severity of the attacks increase, 7
New Topics in
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Rational Drug Prescribing
Definition:
 A medical prescription is a written order by a
medical doctor to a pharmacist for treatment
to be provided to the doctor's patient.
Steps of Rational Prescribing:
1-Define the patient problem: study the
pathophysiology of the disease.
2-Specify the therapeutic objectives: what do
you want to achieve with the treatment, curative
treatment or preventive treatment.
3-Verify the suitability of p-treatment.
4- Start the treatment.
5-Give information,instructions and warnings.
6-Monitor and stop treament.
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New Topics in
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Pharmacoepidemiology
Definition:
 Pharmacology is the study of the effect of drugs and
clinical pharmacology is the study of effect of drugs
on humans.
 Epidemiology can be defined as the study of the
distribution and determinants of diseases in
populations.
 Pharmacoepidemiology is the study of the use and
the effects of drugs in large groups of people.
 Its background is the increasing understanding that
the information gathered in pre-marketing studies
does not adequately describe the true health impact
of a drug, example, SSRI which cause ulcer
bleeding (=pharmacovigilance).
11
Pharmacovigilance
(Drug Surveillance)
Definition:
• It is surveillance of side effects after
short term and long term use of
medicines.
 How to Improve Pharmacovigilance?
4.Communication: between local
pharmacovigilance organizations and
patients.
5.Proposed measures to make side effect
reporting mandatory rather than
voluntary.
6.The patient’s information leaflets:
Present the potential adverse reactions
more clearly. 12
New Topics in
13
Pharmaco-economics
 Definition:
 It is that branch of health economics that focuses on cost and
benefits of drug therapy.
 It is the cost/effectiveness of the drug.
 Cost of a Disease:
3. Cost of physician (Single visit/ Repeated visit).
4. Cost of Lab. Investigation.
5. Cost of hospital stay (For patient/ Partner).
6. Cost of Drugs & other medications.
7. Cost of absence from work.
8. Cost of absence of partners from work.
9. Cost of change in quality of life.
10.Cost of adverse reactions of drugs used.
 Applications for Cost/Effectivness of Drugs:
 Cost benefits of treatment of acute infections; e.g. Acute
Follicular Tonsillitis.
 Cost/Benefits of Prophylactic Drugs; e.g. Acute rheumatic
fever.
14
New Topics in
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Pharmacogenetics
Definition:
 It is the field concerned with unusual (idiosyncratic) drug
responses that have a hereditary basis , Or,
 It is the study in animal species of genetically determined
variations that are revealed by the effects of drugs.
Examples:
1- Succinylcholine apnea
 It is a depolarizing neuromuscular blocker acts on nicotinic
receptors at neuromuscular junction metabolized by plasma
cholinesterase. some patients have atypical cholinesterase activity
, so they suffered from a prolonged apnea due to failure to recover
of respiratory muscle contractility.
2- Isoniazide polymorphism
 Acetylation is an important route of drug biotransformation.
 Slow acetylators and rapid acetylators : slow acetyltransferase
activity is inherited as autosomal recessive genetic defect.
 slow acetylators may be susceptible to side effects due to elevated
plasma levels.
3- Glucose – 6- phosphate dehydrogenase deficiency
 Deficient or impaired enzyme activity reduce the ability of blood
cells to protect themselves from oxidative injuries and lead to
hemolysis. 16
New Topics in
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Staff of Pharmacology Department

satisfy the health care needs of the

adequate amounts and in the

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