Hospital formulary Dr Motghare.pptx

8/18/2019 Hospital formulary Dr Motghare.pptx

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Hospital DrugFormulary

Dr. V. M. Motghare,Professor and head,

Department of Pharmacology,

SRTR Medical College,Ambajogai, Maharashtra

ISRPTC! "#$", %ol&ata


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De'nition(

Hospital Formlary is a continally re!isedcompilation of pharmaceticals incldingimportant ancillary information that

re"ects the crrent clinical jdgement ofthe medical sta#$

Formlary system is method %hereby themedical sta# of an instittion, %or&ingthrogh the PTC, e!alates, appraises, andselects from among the nmeros

a!ailable drg entities ' drg prodctsthose that considered most sefl in


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The need for HospitalFormulary

(

The increasing nmber of ne% drgsmanfactred and mar&eted by drgcompanies$

) *ncreasing in"ence of add+ on drgs %hich

inclde both scientic and nscientic,ethical and nethical$

- *ncreasing comple.ity of nto%ard e#ects ofmodern potent drgs$

/ 0e%er sales promotion strategies ofpharmacetical indstry$

1 The pblic interest in getting possible

health care at lo%est possible cost$


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PR*P+R+TI! FHSPIT+

FRM-+R


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$. Introdu/toryinformation

Ac&no%ledgement

2ist of abbre!iations

*ntended sage of theformlary manal


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". 0asi/ information of thedrug

3eneric name, dosage form, strength

*ndications

Pharmacological action Precations

Side e#ects

Dosage 4 form, fre5ency *nstrctions

Drg interactions


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1. Supplementary information on ea/h drug

Price

Reglatory category

Storage gidelines

Patient conselling information

6rand names


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2. Pres/ri3ing and dispensingguidelines

Principles of prescription %riting

0ame and address of the patient

Prescribed drg shold be %ritten informlary terminology

Strength of prescribed medicationmst be gi!en in accepted metricsystem$

Correct dispensing gidelines

Pre!ention and reporting of ADRs


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ad6i/e

7se of *8 additi!es

Prescribing in special sitations

Poisoning and antidotes


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7. ther /omponents

Formlas for !arios diagnostic stains,diagnostic aids

Table of common 2ab9!ales

Posological tables

*nde. of the drgs inclded in theformlary

Metric nits

*nde.es:by generic name, brand name,therapetic category;


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8. The Format

Pharmacist decides the format beforecommencing %or& on printing andpblishing in the hospital$

He has to collect formlaries of someleading hospitals as %ell as theirformat$

Copies of nally pblished formlarymay be sent to bodies li&e directorategeneral of health ser!ices, 3o!t of

*ndia, PC* etc$


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9. Si:e

*t is s


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;. Type of format

2oose leaf or 6ond

Printed or Mimeographed

*nde.ing and Assigning categories


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*SS*!TI+ DR-5S


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Defnition

>ssential drgs are those that satisfy thehealth care needs of majority of the

poplation and therefore shold bea!ailable at all the times in ade5ateamonts and in appropriate dosage forms$

>ssential drg list is same as limited drglist$ :Synonymos terms;


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drug list

More cost e#ecti!e drg control,management, prchase, storage, trno!erand distribtion$ More patients treated pernit cost$

*mpro!ed drg se in terms of safety,simplied and more e


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Benefts o essentialdrug list

>asy identication and a!oidance ofad!erse drg reactions and interactions

%ith fe%er drgs$

Stimlation of local drg formlation andprodction depending on the re5irement$


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fguring in essential drugslist useless or redundant?

2ist of essential drgs does not imply thatno drgs otside it are sefl$

These drgs may be more e.pensi!ealternati!es or sefl only for ncommonailments$

May be harmfl or ha=ardos$

May be irrational .ed dose combination$


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Milestonesntial drugs concept & rational u

E i l d &


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Essential drugs concept &rational use

(?@ Concept of essential drgs :%as 2anchedand milestone in the eld of health policy, selectionof )9)1 essential drgs ' odd drgs %hich%old be sssential Drg 2ist TRS E(1:)1 drgs;

(?@ Technical Discssions HA and ResoltionHA -($-)

(?( >stablishment of the H Actionprogrammed on >ssential Drgs$

E i l d &


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(?) Second re!ision of H >ssential Drg 2ist9 Title Changed to GTH> 7S> F >SS>0T*A2 DR73S:TRS E1;

(?- Fll implementation of the ActionProgrammed$

(?1 Conference on Rational 7se of Drgs in0airobi :*0R7D;

(?E HA-?$)@ The Rational 7se of drgs

Resoltion$


E i l d &


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(? Pblication of se!eral docments called for inD3Is Report on the Re!ised Drgs Strategy $

(??1 Si.th report of the H >.pert Committee on

The se of >ssential Drgs$ :H TRS 1;

(??@ Se!enth report of the H >.pert Committeeon The se of >ssential Drgs$ :H TRS E@;

)1 Forteenth report of the H >.pertCommittee on The se of >ssential Drgs$ :H

TRS ?)(;

)@ Fifteenth report of the H >.pert Committee



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drugs be changed rom

time to time? (?@@ H pblished the selection of

essential drgs :H TRS E(1;

Reglar re!ision of the list:(?@?,(?),(?19latest )1 and )@4(1 model 2ist9H9TRS ?/E;,and March)?9(Eth model listJ>M29child

The crrent H GModel 2ist of >ssentialMedicines is re!ised in March, )(( and is

the (@th edition for adlts %ith )- FDCs


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$;;7 *ndia for the rst time pblished!ational *ssential Drugs ist

*n "##1, it %as re!ised and renamed as!*M?.

@une "#$$ 9 third 0ational >ssentialMedicine 2ist :0>M2;$

*t contains -/ drgs and (E Fi.ed DoseCombinations$


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establishing a list oessential drugs

Drg Committee$

6enet and safety e!alations$

*nternational 0on9proprietary:generic;names$

Kality

Cost$ 2ocal 2e!el of e.pertise$ 2ocal Health problems$

6enet ris& ratio$


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Preferential factors for e!alatinge5i!alent drgs$

hen t%o or more drgs aretherapetically e5i!alent, preferenceshold be gi!en to+9

The drg %hich has the most thoroghlyin!estigated on therefore,best nderstood%ith respect to its benecial properties and

limitationsL


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The drg posscessing clinical tility for thetreatments of more than one condition ordiseaseL

The drg %ith the most fa!orablepharmaco&inetic properties$e$g$,toimpro!e compliance, to minimi=e ris& in!arios pathophysiological stats etc$

Drgs that are in a dosage form that iseasy for the health sta# to dispense oreasily and safely administrated to the

patientL


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Drg that are easy for the patient to ta&eL

Drgs, pharmacetical prodcts anddosage forms %ith fa!orable stabilitynder anticipated local conditions for%hich storage facilities e.istL

Drgs for %hich local, reliablemanfactring facilities e.ist for itsprodction$

Fixed atio


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Fixed atio!ombinations

Fi.ed ratio combinations are onlyacceptable if one or more of the follo%ing

considerations are satised$

The concomitant !ale of more than onedrg is clinically docmented$

The therapetic benet of the combinationis greater than the sm of each of the

indi!idal components$

Fixed atio


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The combination is safer than is the se ofan indi!idal drg$

The cost of the combination prodct is lessthan the sm of the indi!idal components$

Compliance is impro!ed by se of thecombination$

Fixed atio


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S


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list

The essential drg list may need tore!ie%ed yearly or %hene!er necessary, toincorporate signicant ne% therapetic

ad!ances and information$3enerally ne% drgs shold be introdcedonly if they o#er distinct ad!antages o!erdrgs pre!iosly selected$

*f, on the basis of ne% information, drgsalready on the list are fond to no longerposses a fa!orable benetJris& ratio, theyshold be replaced by safer drgs$


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selection o

Essential Drugs Choice of drgs depends on + Pattern of pre!alent diseases

Treatment facilities Training and e.perience of health personnel

Financial Resorces ther factors 4 3enetic, Demographic,

>n!ironmental$


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!riteria or selectiono Essential Drugs

H*CH DR73S

S


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selection o

Essential Drugs Formlation as Single compond$

>ase of administration and compliance$

2ocal manfactre and storage$

Fi.ed dose combination appro!ed by Hon the basis of e


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o "harmaceuticaldosage orm

Type of dosage form :Tablet, Capsles, SRpreparation; based on &inetic,bioa!ailability, stability and localpreference$

Strength of the drugs :Dose range,

pediatric preparation;

Exclusion of the drugs :2o% solbility,npredictable bioa!ailability, 0e%er

dosage forms;

Selection o Anti


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Selection o Anti%microbial agents

Sensiti!ity of micro organisms$

Pre!alence of type of infection$

Resistance to Anti microbial agents$ :AMA;

A!ailability of AMA :Safe, >#ecti!e, Cheap;

Cost of the drgs$


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Essential Drug ist

ho shold prepare it

Ho% many drgs

:H Model list, 0ational, regional le!el,Hospital and primary health centre;

hich drgs :e#ecti!e, safe, cheap, forcommon ailments;

Re!ision and pdating of the list yearly$


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)b*ecti#es

Ma.imm cstomer ser!ices$ Minimm in!entory in!estment$

2o% cost plant operation$ A6C Analysis+9:Al%ays better control

techni5e$; A *tem 4 Costly items :F>;

6 *tem 4 0either costly nor cheap C *tem 9 Comparati!ely cheaper in cost


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!lassifcation o Drugs

A6C analysis of drgs$

6ase on their cost and e.penditre$

Category A 4 (B of the total itemsconsme @B of the bdget$

Category 6 4 )B of the total itemsconsmes )B of the bdget$

Category C 4 @B of the total itemsconsmes (B of the bdget$


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No A ITEMS B ITEMS C ITEMS

1 10% OF Total 20% of Total 70% of Total

2 70% of Total Budget 20% of Total Budget 10% of total Budget

3 Requires very strict control Moderate Control oose Control

! Requires "it#er no or lo"safety stoc$s

o" afety toc$s &t requires 'is#safety stoc$s

( )eeds *a+i*u* follo" u, -eriodic Follo" u, Close Follo" u,

. 'andled /y senior officers- or -rof

'andled /y *iddleManage*ent -#ar*acist

cl&&

'andle /y-#ar*acist


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!lassifcation ) Drugs

8 > D Analysis 4 according to theircriticality in patient care$

8 4 8ital drgs$ 4 (B of the total , theyare !ital lifesa!ing drgs and theirabsence cannot be accepted$ They ha!egot to be administered to the patients$ 0odrgs are a!ailable as sbstittes for theseitems$ Therefore e!ery e#ort has to bemade, at %hate!er cost to a!oid ot9ofstoc& position for any of these items$


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!lassifcation ) Drugs

E – Essential drugs 4 Constitting /B of thetotal items$ And their absence can be

tolerated for short stretches of time$ Theycold be made a!ailable %ithin a day or t%oand alternati!e medicines made a!ailable forse in their place$


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!lassifcation o Drugs

D – Desirable Drugs :090on essentialitems$; Constitte 1B of the items$ And

their non9a!ailability can be tolerated forlonger period of time$ They may bere5ired for treatment of chronic and lessserios patients$


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!ombination ) A B !

And + E D Anal(sisV * D

+ +V +* +DCat I A items $4

B

0 0V 0* 0D

Cat II A items

2# B

C CV C* CDCat III A items

24 B


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/0

> 9 e 9 ease of administration : dosage form;$ 0 9 need of poplation$

T 9 total cost$

* 9 irrational combination to a!oid

A9 a!ailable

2 9 listing reglarly : pdating;

a e ome message


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a e ome message/0

“Essential Drug Concept Is

Not A Short Cut To Escape

rom Therapeutic !ungle"

#ut To Choose" $se" Store"The %ight &ind 'f (idden

Treasure In It)*


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is one feature hi/h


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TH+!% -

is one feature hi/h

distinguishes man, the animal

from his fello /reatures. It is

one of the most serious

diE/ulties ith hi/h e ha6eto /ontend=

illiam sler $9;$

Hospital formulary Dr Motghare.pptx

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