Pharmacotherapeutics Principles and Rational Drug Use (RUM)
Fundamentals of Pharmacotherapeutics
The word Pharmacotherapeutics is derived from two Greek words: Pharmakon (meaning ‘the drugs’) and therapeutic (meaning ‘diagnosis or treatment of any disease’). It is the branch of pharmacology that deals with drug absorption, drug distribution, drug elimination, and their actions or effects. Pharmacotherapy is included as drug therapy used to treat diseases, often following surgical, radiation, or physical therapy.
Scope and Objectives of Pharmacotherapeutics
- Gaining correct knowledge regarding drug chemical reactions in the body.
- Deciding the correct drug categories for treating specific diseases.
- Determining the correct dose and formulation for treating specific diseases.
- Selecting the right patient for a particular drug.
- Choosing the suitable and effective route of administration.
Rational Use of Medicine (RUM)
The Rational Use of Medicine (RUM) is an important and vital aspect included in pharmacodynamics. Since the body mechanisms of individuals vary (e.g., based on obesity, body type, sex, and age), the involvement of RUM helps us determine the correct medicine for the correct individual at the correct time for the correct disease.
Factors Affecting Rational Drug Use
A. Issues Arising During Manufacturing Procedures
This is an initial factor responsible for issues related to RUM because, during manufacturing, drug quantity and measure are important aspects regarding drug formulation. These issues can be avoided by ensuring:
- Correct platform.
- Correct equipment.
- Correct procedure.
B. Issues Arising Due to the Individual
Body physiology varies from person to person, so chemical requirements for treating any disease also vary. This depends on different factors:
- Body structure.
- Sex of the person.
- Age of the person.
- Prior disease history.
- Drug contraindication and allergy.
- Drug tolerance or resistance.
Improving the Rational Use of Medicine (RUM)
- Educational Promotion: Providing skilled educational behaviors, laboratory and practical knowledge, and access to libraries. Providing health and yoga camps, etc.
- Regulatory and Management Promotion: Management is an important factor for regulating and promoting RUM. Proper inspection and supervision help determine the correct requirements (skilled personnel, raw material, perfect platform, perfect equipment, etc.) for manufacturing.
- National Policy Establishment: Establishment of a multidisciplinary national body to coordinate policies on medicine use, development and use of national essential medicine lists, and sufficient government expenditure to ensure the availability of medicines and staff.
Irrational Use of Drugs (IUD)
Irrational Use of Drugs means using medicines in an improper manner or improper formulation. This involves:
- Selection of the wrong medicine.
- Selection of the wrong dose.
- Selection of the wrong person.
- Selection of the wrong time.
Causes of Irrational Drug Use
- Improper Diagnosis:
- Improper examination of patients.
- Communication problems between the Registered Medical Practitioner (RMP) and the patient.
- Improper documentation of history.
- Prescription Problems:
- Incorrect prescriptions.
- Multiple prescriptions.
- Prescription through multimedia (e.g., by calling).
- Dispensing and Compounding Issues:
- Unsuitable platform/place.
- Counting and compounding errors.
- Unsanitary procedures.
- Common Factors:
- Lack of knowledge.
- Over-the-counter (OTC) medication misuse.
- Financial constraints and lack of adherence.
Management of Specific Diseases
Hyperthyroidism
Definition
Hyperthyroidism is a disease of the thyroid associated with the excessive release of thyroid hormones.
Clinical Manifestations
- Tachycardia
- Tremors
- Heat intolerance
Pharmacological Management
- Thioamides: Methimazole, Propylthiouracil.
- Iodide Salts: Lugol’s solution.
- Iodinated Contrast Media: Ipodate.
- Beta Blockers: Propranolol, Esmolol.
Non-Pharmacological Management
- Follow a diet plan according to the physician’s indication, as maintaining low iodine levels is a major task during thyroid disorders.
- Consume a diet rich in calcium, vitamin D, magnesium, and selenium.
- Avoid intake of sugar, caffeine, and alcohol products.
Diabetes Mellitus
Definition
Diabetes Mellitus is a group of metabolic disorders sharing the common feature of hyperglycemia.
Clinical Manifestations
- Excessive hunger and thirst.
- Frequent urination.
- Progressive weight loss.
- Sudden vision changes.
Pharmacological Management
- Insulin:
- Long acting: Ex. Insulin degludec, Insulin glargine.
- Intermediate acting: Ex. Insulin Zinc suspension.
- Enhancing Insulin Secretion (Dipeptidyl Peptidase-4 Inhibitors):
- Ex. Alogliptin, Linagliptin, Saxagliptin, Sitagliptin, Teneligliptin, Vidagliptin.
Non-Pharmacological Management
- Increasingly sedentary lifestyles and poor eating habits have contributed to the simultaneous escalation of diabetes and obesity, which some have called the diabesity epidemic.
- Avoid any type of injury.
Key Medical Definitions and Drug Examples
Definitions and Acronyms
- Pharmacotherapeutics Definition: The study of how drugs are used to treat, prevent, or cure diseases.
- COPD Full Form & Definition: Chronic Obstructive Pulmonary Disease. COPD is a chronic inflammatory disease that causes obstructed airflow from the lungs.
- Anemia Definition: Low level of healthy Red Blood Cells (RBC) to carry oxygen throughout your body.
- Diabetes Definition: A metabolic disease that causes a high blood sugar level.
- Hypertension Definition: High blood pressure, a condition where the force of blood against the artery walls is consistently too high.
- HIV: Human Immunodeficiency Virus.
- DASH: Dietary Approaches to Stop Hypertension.
- Glaucoma Definition: A group of eye conditions that damage the optic nerve, which transmits visual information from the eye to the brain.
- UTI Full Form: Urinary Tract Infection.
- TB Full Form: Tuberculosis.
- Causative Organism of TB: Mycobacterium tuberculosis.
- SARS Cause: SARS was caused by a coronavirus, the same family of viruses that causes some common colds.
Types of Conditions
- Three types of Diabetes: Type I diabetes, Type 2 diabetes, and Gestational diabetes.
- Second name of Type 1 diabetes: IDDM (Insulin Dependent Diabetes Mellitus).
- Second name of Type 2 diabetes: NIDDM (Non-Insulin Dependent Diabetes Mellitus).
- Two types of Asthma: Allergic asthma and Non-allergic asthma.
- Two types of Anemia: Acute anemia and Chronic anemia.
- Two types of Viral Infections: Respiratory infections and Digestive system infections.
- Three most common types of Hepatitis: Hepatitis A, B, and C.
Hormones and Symptoms
- Hormones of the Thyroid: Thyroxine, Triiodothyronine, and Calcitonin.
- Symptoms of Psychosis: Hallucinations, delusions, and disorganized thinking or behavior.
- Symptoms of Alzheimer’s Disease: Difficulty with planning and problem-solving, trouble completing familiar tasks, confusion about time or place, and changes in mood or personality.
- Symptoms of Pneumonia: Cough, fever, chills, and difficulty breathing.
- Symptoms of Dysmenorrhea: Lower abdominal pain, lower back pain, and pain in the thighs and legs.
Drug Examples for Specific Conditions
- Two drugs used for Rheumatoid Arthritis: Ibuprofen, Methotrexate.
- Two drugs for Osteoarthritis: Acetaminophen, Ibuprofen.
- Two drugs of Diabetes along with their classes:
- Sulfonylurea derivatives: Tolbutamine and Glibenclamide.
- Biguanides: Metformin and Buformin.
- Two drugs of Angina Pectoris: Nitroglycerin, Atenolol.
- Two drugs for Hyperlipidemia: Atorvastatin (Lipitor) and Rosuvastatin.
- Two drugs of Myocardial Infarction: Aspirin and Clopidogrel.
- Two drugs for Epilepsy: Sodium Valproate and Carbamazepine.
- Two drugs of Tuberculosis: Isoniazid (INH) and Rifampin (RIF).
- Two drugs of Conjunctivitis: Ciprofloxacin, Azithromycin.