Wednesday, June 10, 2015
Tuesday, June 9, 2015
Criteria of rational Prescribing
* Accurate Diagnosis
* Appropriate Indications
* Appropriate Drug
* Appropriate Patients
* Appropriate Dosages
* Appropriate Duration
* Appropriate Route of
Administration
* Appropriate Information
* Appropriate Monitoring
P-Drug Concept
* To develop a rational pharmacological approach for the selection of
appropriate first choice drugs for common clinical conditions is known as
P-drug (preferred drug/personal drug.
It based on-
Efficacy-is compared on the basis pharmacodynamic considerations
Safety-is compared on the basis side effect profile
Suitability-applies to kinetic considerations matched with patient’s
factor (age, pregnancy, liver & kidney function etc.)
Cost-affordable prescribing
Monday, June 8, 2015
R.U.D (Rational use of drug)
*According to WHO- rational
use of drug requires that patients receive medications appropriate to their
clinical needs, in doses that meet their own requirements for an adequate
period of time, and the lowest cost to them and their community.
*Rational use of drug is based
on SANE criteria and Rule of rights.
SANE Criteria
* Safety
* Affordability
* Need
* Efficacy
Rule of Rights
The right drug being given to
the right patient at the right time with the right dosages.
Rational Prescribing
Guide to good prescribing, a new WHO training manual is an example of
one such approach, teaching skills that are not time limited. Students learn
how to develop a set of first choice of drugs, drawing on a wide range of
authoritative drug information. Students not only learn how to use drug
rationally but how to consult, understand and use existing treatment guidelines
intelligently and where necessary to adapt them to the individual patient. In
under- and postgraduate medical curricula of Bangladesh, have already introduced the teaching of
rational prescribing. Several workshops on that aspect have already been done
successfully.
Impact of Irrational use of drug
.Reduction in the quality of
drug therapy leading to increased morbidity and mortality.
.Waste of limited financial
resources!!
.Increased un-wanted affects
such as adverse drug reaction.
. Psychological Impact such as
when patient comes to believe that there is a pill for every illness this may
cause apparent increase in the demand of drug.
Changing the existing problem of drug use
There are number of different strategies to improve drug use. These can be grouped into three broad categories;
There are number of different strategies to improve drug use. These can be grouped into three broad categories;
.Educational approaches: It informs or persuade the prescribers,
dispensers or patients to use medicines in different ways.
.Managerial approaches: it gives decisions
through the use of specific
processes, forms, packages, or monetary incentives.
.Regulatory approaches: It restricts allowable decisions by placing
absolute limits on the availability of drugs.
Objectives of rational use of Drug
.The objectives of rational use of drugs are- a) to identify the
magnitude and nature of inappropriate medicine utilization; b) to describe
factors which influences the decision making processes; c) to identify the
factors which influence the behavior of the prescribers ; d) to relate issues
to specific medicine use problem ; and e) toassess which prescribers and
patients factors might be addressed in a program to reduce irrational use of
medicine.
Examples of some irrational prescription
1. Use of drugs when
no drug is indicated, as for example, use of antibiotic for viral upper respiratory infection.
2. Use of wrong drug
for specific conditions , as for example- Tetracycline in childhood diarrhea
requiring ORS.
3. The use of
medicines with doubtful/unproven efficacy. e.g., the use of antimotility agents
such as loparamide in acute diarrhoea.
4. use of medicines
having uncertain safety status, e.g., the use of dipyrone to relieve visceral
pain.
5. Failure to provide
available safe and effective drugs, e.g. , the failure to vaccinate against
measles or tetanus, failure to prescribe ORS for acute diarrhoea.
6 Use of correct
medicines with incorrect administration, dosages and duration, e.g. the use of
intravenous metronidazole when
suppository or oral formulation would
be appropriate.
7.The use of effective
medicine but one which has higher level of potential toxicity, e.g. injection
kanamycin/gentamicin;
8.Prescribing new
costly medicine even when an alternative cheaper medicine of equal efficacy is
available, e.g. prescribing diclofenac. ketoprofen and piroxicam.. Whereas
aspirin is available, cheap and efficacious with very similar risks of side
effects for the relieve of somatic pains and inflammation
9. Excessive cost for
unnecessary therapy-e.g., the use of terfenadine instead of chlorpheniramine.
10.Indiscriminate
use of injections e.g., AIDs, HB virus infection through unnecessary use
of injections.
11.Overuse and
misuse of antibiotics cause drugs resistance, adverse reaction, super
infection, and excessive cost.
Factors Influencing irrational drug use
Welcome
To
Integrated Teaching
To
Integrated Teaching
Department
of
Pharmacology
Rational Use of drug- Strategy & Perspective in
context of a Developing Country
Irrational drug use is prevalent in both developing
and industrialized countries. Consequently drug therapy may prove ineffective,
unnecessarily expensive or unsafe. Contemporary medical education emphasizes
diagnosis, and teaching in therapeutics is still, a neglected topic in most
countries. All health care professionals required training for irrational drug
use to be reduced.
. The actual use of drug often bears little resemblance to principles of scientific therapy based on sound
experimental or clinical data. The cost of such irrational drug use are
enormous in terms of both wastage of scarce resources as well as the occurrence of adverse events
and increased sufferings to the patient. most of the physicians in developing
countries go into the habit of prescribing irrational drugs. Drugs can cure
ailments when used rationally, on the other hand, they may become harmful and
can even threaten life when used irrationally.
Factors Influencing irrational drug use
Saturday, June 6, 2015
MARGIN PLACEMENT
•
MARGIN PLACEMENT
Finish line should be placed in enamel whenever possible.
•Many situations in which sub-gingival margins are unavoidable.
1.Caries
2.To increase retention
3.Esthetics
4.Extension of previous restoration
5.Trauma.
6.Lower contact area
7.Modification of Axial contour
MARGIN PLACEMENT
• Whenever possible, the margin of the preparation should be supragingival and in the enamel so that margin can be finished by the dentist easily and kept clean by thepatient. • In addition,finish lines must be placed so that they can be duplicated by the impression without tearing or deformation.
Friday, June 5, 2015
MARGINAL GEOMETRY
FINISH LINE CONFIGURATION
Chamfer
It’s a finish line
design for tooth preparation in which gingival aspect meets the external axial
surface at an obtuse angle. This type is prepared with a tapered round ended
fissure diamond bur.
Advantages
•
It provides
distinct margin
•
Adequate bulk
to the restoration
•
Easier to
control
•
Exhibits least
stresse
Disadvantage
•
Care needed to
avoid unsupported lip of enamel Indications:
•
Cast metal
restorations
•
Lingual margin
of the metal ceramic crowns
Shoulder
The shoulder finish line
is a design for tooth preparation in which the gingival floor meets the
external axial surfaces at approximately a right angle. This finishing line is
prepared with flattened end tapered diamond fissure bur.
Advantages
•
Bulk of the
restoration
•
Wide ledge
provides resistance to occlusal forces
•
Provides space
for healthy restorative contours
•
Maximum esthetics
•
It offers
resistance against distortion during processing
Disadvantages
•
Less conservative
of tooth structure
•
The sharp 90
internal line angle
Indications:
•
All ceramic
restorations
•
Facial margins of
metal--ceramic crowns
