Chapter 3 Drug Rational Selection

Question 1

An estimated what % of drugs are prescribed, dispensed, and sold “inappropriately”

Answer 1

50%

Question 2

How many steps in the WHO’s model of rational prescribing

Answer 2

6

Question 3

Describe Step 1 of the WHO’s model of rational prescribing

Answer 3

Define the patient’s problem – Dx/indication
begins with the assessment of the patient and formulation of a working diagnosis and possible differential diagnosis

Question 4

Describe Step 2 of the WHO’s model of rational prescribing

Answer 4

Step 2: Specify the therapeutic objective – Goals: Cure/Sx management, prevent, etc. Investigate patient beliefs/preferences, consider cost

Question 5

Describe Step 3 of the WHO’s model of rational prescribing

Answer 5

Choose the treatment – Choosing the drug includes considering the pharmacokinetics and pharmacodynamics of the drug and cost-effectiveness

Question 6

Describe Step 4 of the WHO’s model of rational prescribing

Answer 6

Start the treatment – Rx + send to pharmacy and confirm pt can access drug

Question 7

Describe Step 5 of the WHO’s model of rational prescribing

Answer 7

Educate the patient – 50 % patients don’t take as prescribed. Educate in everyday words

Question 8

Describe Step 6 of the WHO’s model of rational prescribing

Answer 8

Monitor effectiveness Passive v Active monitoring (WHO). Active – therapeutic/drug level monitoring. Passive – educate patient on expected outcome/when to contact provider.

Question 9

Describe the two types of reasoning strategies when choosing treatment

Answer 9

Analytic and Non-analytic
-Novice providers use an analytical approach, which is slow, time-consuming, systematic, and evidence-based.
-More experienced providers use their experience and pattern recognition to carry out a nonanalytical process in a faster, subconscious manner

Question 10

Pharmacodynamic factors

Answer 10

Selective to target tissue with greatest therapeutic effect and least amt of side effects. Consider TI.

Question 11

Pharmacokinetic factors

Answer 11

-Consider if drug crosses Blood-brain barrier (BBB).
Neuro meds vs CNS side effects
-Liver and Kidney function
CYP metabolism, CKD
-Dose-Response curve and half-life to determine dose, schedule, and length of treatment

Question 12

What may be more effective when extrapolating drug effectiveness than randomized control trials

Answer 12

Using the “numbers needed to treat” (NNT) or “numbers needed to harm” (NNH), which compare the absolute risk of the medication versus the effectiveness, may be more useful than RCT results because RCT usually recruits relatively healthy patients

Question 13

What cost factors should be considered during drug selection

Answer 13

insurance, medicare, medicaid
“donut hole” coverage gap
generic vs brand name
knowing which drugs are on the $4 retail pharmacy prescription lists assists in keeping costs reasonable for the patient

Question 14

What is the Inflation Reduction Act

Answer 14

eliminates co-insurance above the catastrophic threshold in 2024 and reduces the out-of-pocket cap to $2,000 in 2025

Question 15

What safety factors should be considered during drug selection

Answer 15

Therapeutic Index
Population and disease specifics
Black Box Warnings

Question 16

What patient factors should be considered during drug selection

Answer 16

include drug adverse effects that influence adherence, health beliefs, values, and current drug therapy that may interfere with the new drug

patient’s age, pregnancy, mental health diagnosis, or another disease

Question 17

What Provider factors should be considered during drug selection

Answer 17

Insurance restricted formularies
The amount of follow-up required
NPs need to know what formularies they can prescribe from

Question 18

What are two factors that can influence rational prescribing

Answer 18

Pharmaceutical promotion and changes in guidelines.