Medical therapeutics

Question 1

Average number of Px per capita per year for USA and Canada

Answer 1

Roughly 14 and 16/capita/year

Question 2

Average cost of new drug development

Answer 2

rough 1.3 billion dollars. Some is 4-12 billion (due to fails).

Question 3

Who uses the most prescriptions?

Answer 3

The elderly (80+). Average is 74/capita/year.

Question 4

Questions to ask when someone is on multiple drugs

Answer 4

Why? Which to keep? Which to eliminate? Which are working? How do you know? How do they interact? What if there is a problem, which drug is it? What does the patient think about this?

Question 5

Steps to rational therapeutics

Answer 5

1. MAKE DIAGNOSIS WITH REASONABLE CERTAINTY 2. UNDERSTAND PATHOPHYSIOLOGY OF DISEASE 3. CONSIDER THERAPEUTIC OPTIONS 4. SELECT & INDIVIDUALIZE THERAPY 5. MONITOR CHOSEN ENDPOINTS 6. MAINTAIN THERAPEUTIC ALLIANCE WITH THE PATIENT

Question 6

Make diagnosis with reasonable certainty

Answer 6

Develop awareness of the limitations inherent in a particular diagnostic label. (ie Symptom, sign, abnormal test result, System involvement, Descriptive, Cause - external/internal, Syndrome)

Question 7

understanding of the underlying physiological process

Answer 7

Something could be due to a list of problems. This understanding will provide you with the opportunities for therapeutic interventions.

Question 8

Consider therapeutic options

Answer 8

non drug options (diet, lifestyle), drugs with scientific evidence (evidence based!) or drugs without scientific evidence. hmm,

Question 9

Principles of Evidence-based medicine

Answer 9

1. EBM uses a hierarchy of objective evidence to guide clinical decision making. (random clinical trials) 2. Decision-makers must balance the benefits and risks, inconvenience, and costs associated with the different therapeutic options for the good of the individual patient.

Question 10

Select individualize therapy

Answer 10

Option of non-pharmacological (ie diet change affects drug?); drug therapy: pharmacodynamics (what drug does to body) and pharmacokinetics (what body does to drug) balance

Question 11

LADMER acronym for pharmacokinetics

Answer 11

Liberation, Absorption, Distribution, Metabolism, Elimination, Response

Question 12

Factors affecting variation b/w patients

Answer 12

Age, Gender, Pregnancy, Pharmaco-genetic phenotypes, Renal function, Hepatic function, Concurrent drugs - drug interactions, Concurrent diseases, Drug allergies/previous adverse drug reaction

Question 13

Categories of adverse drug reactions

Answer 13

Predictable and Non-predictable: (a) idiosyncratic (b) allergic

Question 14

Common problems with drug prescribing

Answer 14

1. Failure of communication with the patient 2. Prescription itself flawed or illegible 3. Dose too high 4. Dose too low 5. Drug that is unnecessary 6. Drug more toxic than necessary 7. Drug that produces drug-drug interaction 8. Drug more expensive than necessary

Question 15

Last part of individualized therapy

Answer 15

(I) Maximize likelihood of clinical efficacy/Minimize likelihood of adverse effects (II) Maximize functional improvements/Minimize adverse effect on quality-of-life (III) Maximize patient satisfaction/Minimize cost of treatment

Question 16

Focus and monitor chosen endpoints

Answer 16

Efficacy (a) Clinical outcomes (b) Functional parameters (c) Quality of life measures. Consider toxicity. Reappraise need for therapy periodically

Question 17

Maintain therapeutic alliance with patient

Answer 17

need to ‘Listen’ to the patient; need for proper COMMUNICATION/EDUCATION; TRUST has to be earned; MUTUAL RESPECT

Question 18

Questions to ask before prescribing drugs (conclusion)

Answer 18

What benefit to the patient am I seeking? Does this drug provide this benefit? How does this drug work? (pharmacodynamics) How do I get the drug where it matters? (pharmacokinetics) Potential side-effects/adverse effects/ contraindications. Any drug interactions? Cost involved? Acceptance by the patient.