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CLINICAL PHARMACOLOGY 2003 (PART 2)

PRESCRIBING, CONSUMPTION AND ECONOMICS Prescribing, consumption and economics The reasons for taking a drug history from patients are: • Drugs are a cause of disease. Withdrawal of drugs, if abrupt, can cause disease, e.g. benzodiazepines, antiepilepsy drugs. • Drugs can conceal disease, e.g. adrenal steroid. • Drugs can interact causing positive adverse effect, or negative adverse effect, i.e. therapeutic failure. • Drugs can give diagnostic clues, e.g. ampicillin and amoxicillin causing rash in infectious mononucleosis — a diagnostic adverse effect, not a diagnostic test. • Drugs can cause false results in clinical chemistry tests, e.g. plasma cortisol, urinary catecholamine, urinary glucose | PRESCRIBING. CONSUMPTION AND ECONOMICS Prescribing consumption and economics The reasons for taking a drug history from patients are Drugs are a cause of disease. Withdrawal of drugs if abrupt can cause disease e.g. benzodiazepines antiepilepsy drugs. Drugs can conceal disease e.g. adrenal steroid. Drugs can interact causing positive adverse effect or negative adverse effect i.e. therapeutic failure. Drugs can give diagnostic clues e.g. ampicillin and amoxicillin causing rash in infectious mononucleosis a diagnostic adverse effect not a diagnostic test. Drugs can cause false results in clinical chemistry tests e.g. plasma cortisol urinary catecholamine urinary glucose. Drug history can assist choice of drugs in the future. Drugs can leave residual effects after administration has ceased e.g. chloroquine amiodarone. Drugs available for independent patient selfmedication are increasing in range and importance. See also Appendix 2 The prescription. Prescribing should be appropriate.34 Appropriate prescribing is that which bases the choice of a drug on its effectiveness safety and convenience relative to other drugs or treatments e.g. surgery or psychotherapy and takes cost into account only when those criteria for choice have been satisfied. In some circumstances appropriateness will require the use of more costly drugs. Only by giving appropriateness high priority will health payers be able to achieve their aim of ensuring that patients clinical needs will be met Report . Prescribing that is inappropriate is the result of several factors Giving in to patient pressure to write unnecessary prescriptions. The extra time spent in careful explanation will in the long run be rewarded. Continuing patients especially the elderly on courses of medicinal treatment over many months without proper review of their medication. Doctors frequently prescribe brand-name drugs rather than cheaper generic equivalents even where there is no conceivable therapeutic advantage in so doing.