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PHARMACOLOGY
1.1C RATIONAL DRUG USE PROCESS
PROCESS OF RATIONAL TREATMENT

Define the problem

Pathophysiology of the diagnosis
Specify therapeutic objective
Select a drug of choice
Verify the suitability of
P-treatment
Treatment
Appropriate dosing regimen
Give information, instruction and warnings
Monitoring treatment
Determine and point of therapy
Patients education

Course
Procedure
Practice
Development
Progression
Method

Define problems
Pathophysiology
Therapeutic objectives
Treatment
Monitoring
Patients education

PROCESS

RATIONAL TREATMENT

DEFINING THE PROBLEM

Andeng 5 y/o was brought to the E.R because of severe

DOB, slight coughing, and Low grade fever. 2 days PTC
she had cough and colds, PE showed signs of
respiratory distress with expiratory wheeze, no viscid
sputum

VS:
BP= 110/70 mmhg HR= 120/min;
T= 36 C PE: Pale palpebral conjunctiva,
pale lips with spoon shaped nails

Laboratory Exams:
Hgb = 8 g/dl
PS = microcytic
Abnormal laboratory results
Hypochromic cells
Stool exam: Hookworm ova 4-5/lpf
DEFINING THE PROBLEM:

Easy fatigability, weakness, dizziness

PE: Tachycardic, pale with spoon shaped nails
Low High PS - microcytic presence of hookworm ova
Iron Deficiency Anemia
Hookworm Infestation

PROBLEMS MAY BE
Disease or disorder
Signs of underlying disease
Psychological or social problem (anxiety)
S/E of the drug
Refill request
Non adherence to treatment,
Request for preventive treatment
Combination of the above
THERAPEUTIC OBJECTIVES

1.

2.

Problem: Severe difficulty of breathing

Severe acute asthmatic attack probably precipitated by
viral infection

3.
LB 2 y/o suddenly develop vomiting, this occurred every
after each feeding. Few hours after this is followed by
loose bowel movement, non-bloody. Temp was 37.8 C
Problem: Vomiting, loose bowel movement, low grade
fever

4.

Coco 2 y/o suddenly develop profuse non bloody

diarrhea. Coco is weak looking, unable to drink with
poor skin turgor, abdomen distended with hypoactive
bowel sounds.

Problem : Acute Diarrhea, Severe dehydration,

Electrolyte Imbalance

CASE
Bethany 18 years old came in for consult because of
easy fatigability, weakness and dizziness.

Signs of
underlying disease

Mara 18 yrs old w/ dx of Iron Deficiency anemia

secondary to Hookworm infestation
T.O. :
a. Eradicate hookworm
b. Correct Iron Deficiency anemia
Beh 3 y/o at the ER because of severe difficulty of
breathing with impression of Severe acute asthmatic
attack probably precipitated by viral infection
T.O. :
a. relieve bronchospasm
b. prevent recurrence of attack
LB 2 years with vomiting suffering from Acute watery
diarrhea with no dehydration
T.O. :
a. Prevent dehydration
b. Prevent nutritional deficiency
c. Prevent recurrence of diarrhea
Coco 2 years old is suffering from acute diarrhea with
severe dehydration with electrolyte imbalance
a. Correct fluid loss
b. Correct electrolyte imbalance
c. Prevent recurrence
Straightforward
- Tx of an infection
- Tx of a condition
Focus on the real problem
Limits the number of tx procedure
Prevent unnecessary drug use
- Should not prevent from treatment of 2 diseases at the
same time
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Pharmacology

TREATMENT
Mara 18 years old with Iron deficiency Anemia and
hookworm infestation

Objective
Correct iron
deficiency anemia

Eradicate
hookworm
infestation

1.1C RATIONAL DRUG USE PROCESS

Non-Pharma
Diet: Food rich in
Iron
Ex. Green leafy
veggies
Dairy products
Pharmacologic
Iron Preparation
Personal
Hygiene
- Hand washing
- Waste disposal
- Food handling
Pharmacologic
Anti-helminths

Eradicate
hookworm
infestation

Pharmacologic
Drugs that will
increase Hgb
Iron preparations

Drug Inventory
Parenteral
Oral
Anti-helminths

Drug Inventory
Albendazole
Mebendazole
Pyrantel pamoate

CASE

Pharmacologic
Bronchodilator

Mara 18 years old with Iron deficiency Anemia and

hookworm infestation

Iron Prep
Oral
(13)

SUITABILITY
Active substances and
dosage form
Standard dosage
schedule
Standard duration of tx

Drug Inventory
Beta 2 agonist
- Salbutamol
- Terbutaline
Tablet
MDI
Parenteral (IV/IM)
Nebulization

Ex.
Objective
Correct Iron
deficiency
Anemia

Drug Inventory
Preparations
- Oral
- Parenteral

Cost
Less
expensive

+++
Anaphylaxis
Pain on
injection
site
++

++++
More costly

++

CHECK
Effectiveness
Safety

TREATMENT SUITABILITY
Are the active substance and dosage form suitable
EFFECTIVE - Drugs really needed, Easy to handle
SAFE - Contraindication, Interaction

Ex
Objective
Immediately
relieve difficulty
of breathing

Safety
Gastric
irritation
Blackening
of stool

325 mg 65 mg
200 mg 65 mg
325 mg 36 mg
100 mg 33 mg
325 mg 106 mg
= Compute for the amount of iron and the duration of
tx that would normalize the hemoglobin

Drug Inventory
Beta 2 agonist

Efficacy
- Drugs to reach minimum plasma concentration
- Kinetic profile
Safety
Suitability
Cost

+++
Rapid
increase in
Hb

Suitability
Dosage
form
Standard
dosage
schedule
Standard
duration of
treatment
+++
IM/IV

++++
++
Oral Preparation
- Ferrous sulfate
o
Hydrated
o
Dessicated
o
Gluconate
o
Fumarate

CHOOSING P-drug
CRITERIA

Efficacy
Increase Hb
dependent
on
elemental
iron

Parenteral
(10)

Beh is a 3 year old suffering from DOB with impression of

BA in acute exacerbation

Objective
Immediately
relieve difficulty
of breathing

Pyrantel pamoate
Mebendazole
Albendazole

TREATMENT
Is the dosage schedule suitable
EFFECTIVE - Adequate dosage, Convenient, Easy to
memorize
SAFE - Contraindication, Interaction (drug, food, alcohol)
Is the duration suitable
EFFECTIVE - Adequate duration to treat infection, Easy to
store
SAFE - Contraindication (side effects, dependence, suicide),
Quantity too large

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Pharmacology

1.1C RATIONAL DRUG USE PROCESS

FOLLOW UP
Set end point to follow
Assess the improvement from previous complaint
Physical examination
INFORMATION

Mara 18 years old with Iron deficiency Anemia and

hookworm infestation
P-DRUG
Ferrous SO4
Albendazole

INFORMATION
Effect of the drug
Side effects
Instructions
- Dosage
- Storage
- Duration
INFORMATION FOR
PATIENTS

Warnings

Future consultation

Check for clarity

HIGH RISK FACTORS / GROUPS

Hepatic failure
History of drug allergy
Other disease
Other medications
CASE
A 62 year old man presents with classical chest pain of angina
pectoris. Had history of bronchial asthma
- Drugs that will provide immediate relief of chest pain during
attack
- Drugs that will prevent future attacks
- Drugs that will not trigger attack of bronchial asthma
SUMMARY
TREATMENT OPTIONS
Advice / information
Non-drug treatment
Drug treatment
Referral
PROCESS OF RATIONAL TREATMENT
Process of treating a patient follows a systemic methodology
Rational treatment is based on a thorough understanding of the
pathophysiology of the disease

PRACTICING THERAPEUTICS

Accurate diagnosis

Understanding pathophysiology

Therapeutic options

Specific dose regimen

Select end point to follow

Monitoring response
__________________________________________________________
END OF TRANX

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