1. Rational Use of Drugs (mind map - bottom/second image)

2. Factors and Reasons That Influence Use of Medicines (blue slide)

• Intrinsic (personal): Prior knowledge, habits
• Information: Scientific information, influence of the drug industry
• Workplace: Workload & staffing, infrastructure
• Workgroup: Relationships with peers, authority & supervision
• Societal: Social & cultural factors, economic & legal factors

3. Strategies to Improve Use of Drugs (top slide)

Summary

Drug use is influenced by many factors, and improving it requires a multi-pronged approach: education, management, economics, and regulation - always keeping the "rights" of rational drug use in focus.

Short Notes: Rational Use of Drugs

Definition

"Rational use of medicines 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."

The "Rights" of Rational Drug Use

Steps in Rational Prescribing

• Prescriptions must be based on a clear diagnosis, not just patient pressure or vague symptoms. A tentative but reasoned diagnosis is necessary before any drug is chosen.

• Understanding the disease mechanism helps select the most effective drug. For example, knowing the mediators of inflammation guides NSAID use in rheumatoid arthritis.

• Define what you want the drug to achieve - e.g., pain relief, disease modification, infection clearance. Different goals may point to different drug classes.

• Choose based on patient-specific factors: age, organ function, other diseases, concurrent medications (to avoid interactions), cost, and dosing convenience. This aligns with the concept of precision medicine.

• Dosing is determined by pharmacokinetics (half-life, route of elimination). Adjust for renal or hepatic impairment. For example, ibuprofen with a 2-hour half-life requires 3-4 times daily dosing.

• Specify laboratory tests, signs, or symptoms to monitor. For short-term therapy, tell the patient the expected duration. For chronic therapy, explain the need for ongoing use and when to seek help (e.g., GI bleeding with NSAIDs).

• Repeat and reinforce information about the drug, its purpose, how to take it, and its potential side effects. More toxic drugs require more thorough education.

Irrational Drug Use - Common Problems

• Polypharmacy - using too many drugs simultaneously
• Overuse of antibiotics - contributing to antimicrobial resistance
• Underuse - stopping treatment too early (e.g., antibiotics, antitubercular drugs)
• Wrong dose or wrong duration - leading to treatment failure or toxicity
• Self-medication without proper diagnosis
• Overuse of injections when oral drugs suffice
• Use of brand names over cheaper generics without clinical justification

Factors Influencing Drug Use (as seen in your lecture slides)

Strategies to Promote Rational Drug Use

Importance of Rational Drug Use

• Prevents adverse drug reactions and toxicity
• Reduces antimicrobial resistance
• Lowers cost of treatment for patients and health systems
• Improves therapeutic outcomes
• Ensures equitable access to medicines
• Prevents drug dependence and misuse

Key Organizations

• WHO - defines and promotes rational drug use globally
• INRUD (International Network for Rational Use of Drugs) - research and advocacy
• National drug regulatory authorities (e.g., CDSCO in India, FDA in USA) - enforcement