Essential Medicine List Concept and Rational

Use of MedicineFor MBBS 1st Year Dr. Pravin Prasad

2nd Year Resident, MD Clinical PharmacologyMaharajganj Medical Campus, T.U.

11th December, 2016 (Mangsir 26, 2073), Sunday

Objectives

• Essential Drug Concept

• Rational use of Drugs

Essential Medicine(Drug) Concept

“Those drugs that satisfy the priority of healthcare needs of the population”

- World Health Organization

Med

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Regi

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ed M

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ines

Public Health Relevance

Efficacy and safetyCost effective

Essential Medicines: Selection

Essential Medicines

Essential Medicine Concept

At all times

Should be available within the context of functioning health systems

In adequate amount

In appropriate dosage forms

Essential Medicine Concept

Assured Quality

Should be available within the context of functioning health systems

Adequate information

Affordable price to individual (community)

Essential Medicine List: What’s included?

• Drug name• Dosage forms• Dosage strength• Indications*

Single vs Fixed Dose Combinations??

Main vs Complementary List

Essential Medicine List

• First Model List of Essential Drugs by WHO in 1977 AD

• Current Edition – 19th Edition, April 2015 (Amended August 2015)

• Separate List for Paediatric Population – 5th Edition (2015)

Nepal’s Essential Medicine List

• National List of Essential Medicines

• Current Edition: 2011, 4th

• No separate list for paediatric population

• Modified for different level of health facilities

• 368 medicines

Rational Use of Medicines

Rational Use of Medicines

• 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

So, what would you understand by Irrational use of Medicines?

Why Rational Use is Important?Irrational Use has various harms.

Ineffective & unsafe treatment

Increased morbidity (Adverse Drug Events, prolonged illness) and mortality

Distress, harm and cost burden to patient and community as a whole

Increased drug resistance

Why used irrationally??

• Lack of information

• Role models – Teachers or seniors

• Lack of diagnostic facilities/Uncertainty of diagnosis –

medicine for all possible causes

• Demand from the patient

Why used irrationally??

• Patient load

• Promotional activities of pharmaceutical industries

• Drug promotion and exaggerated claim by companies

• Defective drug supply system & ineffective drug regulation

choosing treatment options

Irrational Use: Few examples• Injudicious use of

antimicrobials• Unnecessary combinations• Use of drugs not related to

diagnosis• Incorrect route• Incorrect dosing – under or

overdose

• Incorrect duration – prolong or short term use

• Unnecessary use of expensive medicines

• Unsafe use of corticosteroids

• Polypharmacy

Moving towards Rational Use…

That will be all for today!!

• Any Queries?

• Next class we will be discussing about:

• Adverse Drug Reaction

•Thank you!