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					UNIT – V (PHARM 235)                                            HEALTH EDUCATION & RATIONAL DRUG THERAPY




                                                    UNIT – V
                10.       Health Education
                          WHO Definition of health, and health promotion, care for children, pregnant &
                          breast feeding women, and geriatric patients.
                          Role of Pharmacist in family planning, prevention of communicable diseases,
                          nutrition.

                11.       Pharmacoepidemiology & Pharmacoeconomics
                          Brief introduction

                12.       Rational drug therapy
                          Brief introduction


                                                  HEALTH EDUCATION
WHO
       WHO stands for world health organization. It is a big organization, which works in
many countries in the world. In other worlds:-
       “WHO is a health organization which mainly works for the health Promotion thing
programs.”
       The world Health Organization is the United Nations specialized agency for
health. It was established on 7 April, 1948. Health is defined in WHO’s Constitution as a
state of complete physical, mental and social well-being and not merely the absence of
disease or infirmity.
       WHO is governed by 193 member States through the World Health Assembly.
The Health Assembly is composed of representatives from WHO’s Member States. The
main tasks of the World Health Assembly are to approve the WHO programme and the
budget for the following biennium and to decide major policy questions.

WHO Definition of Health
               a healthy state of wellbeing free from disease; “physicians should be held
                responsible for the health of their patients”.
          Health can be defined negatively, as the absence of illness, functionally, as
           the ability to cope with everyday activities, or positively, as fitness and well-
           being. In any organism, health is a form of homeostasis. This is a state of
           balance, with inputs and outputs of energy and matter in equilibrium
           (allowing for growth). Health also implies good prospects for continued
           survival. In sentient creatures such as humans, health is a broader concept.
     It is spectral zed agency of the united nations. Its global programs targets on
many areas the affects people’s health:
               Communicable diseases.
               Vaccination program
               Child care
               Promote health environment
B. Pharm – IIIrd Sem – Lecture Notes
Kanpur Institute of Technology & Pharmacy (550)                                                       Page 1
UNIT – V (PHARM 235)                                 HEALTH EDUCATION & RATIONAL DRUG THERAPY




               Care of pregnant and breast feeding woman.

Constitution of Organisation
        The constitution of WHO is approved in 1946. WHO has 192 members ration.
The member nations of WHO that make up the world health assembly decide WHO’s
policies, budget and programs. This groups meets in may each year at world
headquarters in Geneva, Switzerland.
PROGRAMS OF WHO
        WHO is a health promoting organization, so it works only for the health of the
people. For this purpose, it carry on many programs like:
1. Vaccines and immunization : After world war II many diseases were spread in
increasing amount. At that, time WHO began the programs of vaccination and
immunization. In which many raciness for small pox, polio, measles, diphtheria, tetanus,
tuberculosis are provided to the people. By this programs, WHO play an effective role in
controlling these diseases.
2. Disease prevention of treatment : Diseases are spread by many sources. To
prevent these sources WHO starts many programs which aware the people for the
health. In these programs, mainly included the rural area where the peoples one not
educated for health. For the health education, WHO starts many camps. In these
camps, many doctors, health-care workers gives the knowledge about the disease, its
prevention and treatments. They increases the awareness in the people for health and
environmental.
3. Mother and Child health : WHO plays a very essential role in promoting the
programs of mother and child health. For this purpose, WHO provide the education of
health for mother and her child. In which mainly included nutrition because a healthy
mother can give birth to a healthy child. For this purpose, WHO starts a guidelines i.e.,
Mother’s care. This guideline provide the information about the health of mother. This
line also give information like vaccination during the pregnancy and nutrition.
4. Environmental sanitation : Environmental sanitation is a special area where the
WHO works. In this area, WHO inspired the people for the advantages of a good
environment. for this purpose, WHO flirts comps and gives the knowledge about the
proper disposal of wastage, clarity of water, house etc. By this works, WHO helps to
make a good and healthy environment.
5. Nutrition : Nutrition is a very important things for the health of people. If a man is not
gain proper nutrition then they suffer from many diseases.
        WHO starts many programs in many poor countries like Bangladesh, Afghanistan
etc. where the economic conditions are very poor and people are not aware for Health
so in these areas, WHO provides the proper food material and gives the information’s
about the safe and nutrition’s food.
        The organization also works to promote cooperation among scientists and
researchers. It helps governments of many countries improve the health services
available to their people. WHO’s top priorities include childhood immunization safe


B. Pharm – IIIrd Sem – Lecture Notes
Kanpur Institute of Technology & Pharmacy (550)                                       Page 2
UNIT – V (PHARM 235)                                HEALTH EDUCATION & RATIONAL DRUG THERAPY



drinking water and prevention of disease. It is playing a major role in helping the people
in developing countries to live safer healthier lives.

HEALTH PROMOTION :
     It is aimed at improving the general health and quality of life of individuals and
communities. It involves the comprehensive approach towards a change in life style and
human behavior. The important interventions for health promotion are :
     (1)     Health education: A number of diseases can be prevented by adequate
             health education about the diseases. According to WHO’s constitution.
             “The extension to all people of the benefit of medical, psychological and
             related knowledge is essential to the fullest attainment of health”, the
             targets of health education may include the general public, patients,
             priority groups, health providers, community leaders and decision makers.
     (2)     Environmental modifications : These include provision of safe water,
             installation of sanitary latrines, control of insects and rodents,
             improvement of housing, etc. Through environmental modifications may
             infectious diseases have been controlled.
     (3)     Nutritional interventions : These consist of food distribution and nutrition
             improvement of vulnerable groups, child feeding programmes, food
             fortification, nutrition education etc.
     (4)     Life style and behavioral changes : For health promotion, it is important
             to improve the life style and behavioral pattern of the individual and of the
             society. Consumption of alcohol, smoking and drug abuse should be
             avoided. There should be improvement in the standard of living of people.
             The mis-beliefs and customs which are helpful in the spread of a disease
             should be discouraged.
MEASURES OF HEALTH PROMOTION
(Steps involved in health promotion)
      (i)    Improving food distribution and nutrition
      (ii)   Improving environmental sanitation
      (iii)  Improving level of education
      (iv)   Improving personal hygiene
      (v)    Health education
      (vi)   Sex education
      (vii) Genetic counseling
      (viii) Family planning
      (ix)   Limiting the use of tobacco, alcohol and drugs
      (x)    Health legislation
‘CHILDCARE’
       “Childcare is the act of caring for and supervising minor children”.
       Childcare is providing care and / or supervision for children and their daily needs
in a home or center setting.
       Child care includes many steps. These are as follows :
B. Pharm – IIIrd Sem – Lecture Notes
Kanpur Institute of Technology & Pharmacy (550)                                      Page 3
UNIT – V (PHARM 235)                                       HEALTH EDUCATION & RATIONAL DRUG THERAPY




                  Mother’s Role in care of her child.
                  Feeding Tips
                  Infants and Movements
                  Maintenance of Body Temperature
                  The importance of Sleep
                  Preventive care (Immunization)
                  Baby Massage
                  Height calculator (Prediction of child’s right).

MOTHER’S ROLE IN THE CARE OF HER CHILD
       The health and survival of the newborn baby depends upon the health status of
the mother and her awareness, ideation and skills in mother craft.
       ‘Mother is the best primary health worker’. She has the advantages of instinct
concern. Mother looks after her child with love, affection and sense of sacrifice. Mother
is the best person to identify minor developmental deviations and early evidences of
diseases process.

‘TIPS FOR FEEDING BABIES’
      1. Breast feeds for several months, at least till nine months.
      2. Avoid cow’s milk or dairy milk till six months of age.
      3. Juices are introduced at the age of 60 days, given initially diluted with water,
          after one months undiluted fruit juice.
      4. Introduce semi-solid foods when the infant is 6kg or by the age four months.
      Provide an intake of milk 500-750 ml daily when the intake of solid food is well
      established or older infants, establish a diet can such with the ‘basic four’
      elements
          (a) Milk group
          (b) Cereal group
          (c) Vegetables / fruits
          (d) Meat / Egg.
      By ten to 12 months, a planned diet according to the family’s choice.
      In the second year of like, a child no longer needs a special infant diet provide
      less spicy food.




B. Pharm – IIIrd Sem – Lecture Notes
Kanpur Institute of Technology & Pharmacy (550)                                             Page 4
UNIT – V (PHARM 235)                                        HEALTH EDUCATION & RATIONAL DRUG THERAPY



INFANTS AND MOVEMENTS

     Age                 Movement and Posture

     6 Weeks             When pulled from supine to sitting, head lag is not quite completely
                         Vocalins with gurgles smiles briefly when talked to by mother.
     4 Months            Holds head up in sitting position and is steady. Tries to group objects.
                         Turns head to sound. Recognizes mother.
     7 Months            Sites unsupported watches small morning objects. Puts objects in
                         month.
     10 Months           Crawls. Gets to sitting position without help.
     3 Months            Walks unsupported. Understands simple questions.
     18 Months           Runs and jumps. Recognizes animals and care in a book.

MAINTENANCE OF BODY TEMPERATURE
       Adequate maintenance of thermo neutrality is cranial for the survival of newborn
babies. The body temperature in newborn bodies unstable.
       The hands and feet for the body must be kept warm and pink as it resurges that
baby is not having any cold stress.
THE IMPORTANCE OF SLEEP
       If the baby is unable to sleep and is unable to get any rest and thus many remain
imitable or cranky. This may lead to depletion of energy reserves with poor weight gain
due to constant state of arousal.
PREVENTIVE CARE (IMMUNIZATIONS)
       BCG and oral Polio and hepatitis B vaccines are given at Birth.
SCHEDULE OF VACINATION FOR IMMUNIZATION
                              Age                                         Vaccines
                             At birth                       Oral polio I, B. C. G., hepatitis B
                             1                             Oral Polio II, D.P.T. I, hepatitis B
                         1     Months
                             2
                             1                             Oral Polio III, D.P.T. II, hepatitis B
                         2     Months
                             2
                         9 Months                                         Measles
                     1 year or after                            Chicken pox, hepatitis AI
                         1                                       DPT Booster, Oral VIIs
                     4     or 5 years
                         2
B. Pharm – IIIrd Sem – Lecture Notes
Kanpur Institute of Technology & Pharmacy (550)                                                Page 5
UNIT – V (PHARM 235)                                HEALTH EDUCATION & RATIONAL DRUG THERAPY



       Baby Massage : Baby massage is culturally accepted and has scientifically
proven benefits. It improves the circulation and tone of muscles gives comfort to the
baby, strengths material bonding and provides additional energy to baby. It prevents
dryness and chaffing of skin.
       Height Calculator : For prediction of max height child can attain as he/she
grows adult, a simple formula that has over 90% accuracy may be used.
       For Boys : (Father’s height + Mother height + 5) /2
       For Girls : Father’s height + Mother’s height – 5) / 2
Childcare Link Services
       The govt. launched the child care link help line services in December 1999 as
part of the national child care link services comprises the details of local children’s
information services (CIS).
       The childcare link services is funded by the department for education and skills.

BREAST FEEDING
       Research by many decades and experience of many mothers and babies over
the years, have established that breast milk is perfectly suited to nourish infants and
protect them from illness. The primary benefit of breast milk is nutritional.
       Breast milk contains about 100 components not found in formula milk. It contains
just the right amount of fatty acids, lactose, water and amino acids required for human
digestion, development of the brain and for growth. The mother’s natural antibodies
against a number of diseases are transferred to the child through breast milk. About 80
percent of the cells in breast milk are macrophages, cells that kill bacteria, fungi and
viruses. A breast-fed baby’s digestive tract contains large amounts of a good bacteria
Lactobacillus bifidus, that prevent the growth of harmful organisms in the body.
       No body is allergic to their mother’s milk, although they may have a reaction to
something the mother eats. If she avoids it from her diet, the problem will be solved.
Also, milk straight from the breast is always sterile, never contaminated by polluted
water or dirty bottles, which can cause diarrhea in the infant. Breast-fed babies are
protected from a number of illnesses, including pneumonia, botulism, bronchitis,
staphylococcal infections, influenza, ear infections, and German measles often suffered
by bottle-fed babies.

Best for Baby
       A mother’s milk has just the right amount of fat, sugar, water and protein that is
needed for a baby’s growth and development. Most babies find it easier to digest breast
milk than they do formula. Breast milk has agents (called antibodies) in it to help protect
infants from bacteria and viruses and to help them fight off infection and disease.
Human milk straight from the breast is always sterile.

Best for Mom
      Breastfeeding saves times and money. You do not have to purchase, measure
and mix formula and there are no bottles to warm in the middle of the night.
B. Pharm – IIIrd Sem – Lecture Notes
Kanpur Institute of Technology & Pharmacy (550)                                      Page 6
UNIT – V (PHARM 235)                                 HEALTH EDUCATION & RATIONAL DRUG THERAPY



Breastfeeding also helps a mother bond with her baby. Physical contact is important to
newborns and can help them feel more secure, warm and comforted. Nursing uses up
extra calories, making it easier to lose the pounds gained from pregnancy. It also helps
the uterus to get back to its original size more quickly and lessens any bleeding a
woman may have after giving birth. Breastfeeding also may lower the risk of breast and
ovarian cancers.

The U. S. Surgeon Recommendation
       The U. S. Surgeon General recommends that babies be fed with breast milk only
– no formula – for the first 6 months of life. It is better to breastfeed for 6 months and
best to breastfeed for 12 months, or for as long as you and your baby wish. Solid foods
can be introduced when the baby is 6 months old, while you continue to breastfeed.

CARE OF GERIATRIC PATIENTS
        Geriatric patients care refers to the care of old age patients. Society has
traditionally classified everyone over 65 as “elderly”, but most authorities consider the
field of geriatrics to apply to persons over 75 – even though this too is an arbitrary
definition. Furthermore, chronologic age is only one determinant of the changes
pertinent to drug therapy that occur in older people. Important changes in response to
some drugs occur with increasing age in many individuals. For other drugs, age related
changes are minimal, especially in the “healthy old”. Drug usage patterns also change
as a result of the increasing incidence of disease with age and the tendency to
prescribe heavily for patients in nursing homes. General changes in the lives of older
people have significant effects on the way drugs are used. Among these changes are
the increased incidence with advancing age of multiple diseases, nutritional problems,
reduced financial resources, and – in some patients – decreased dosing compliance for
a variety of reasons. The health practitioner should be aware of the changes in
pharmacologic responses that may occur in older people and how to deal with these
changes.
        The format of the health and medication history for geriatric patients also is
similar to that for adult patients; however, elderly patients have unique qualities that the
pharmacist should keep in mind.
        (i)    First, these patients frequently have lengthy histories, with several
               interacting illness, and these diseases may present as a general functional
               decline (e.g., he or she can no longer prepare meals, weight loss) rather
               than as typical symptoms.
        (ii)   Second, because of the normal aging process (e.g. hearing loss), it may
               be difficult for elderly patients to communicate effectively with the
               pharmacist. If the patient cannot provide an adequate history, the
               pharmacist should ask the spouse, child or caregiver for information. Many
               elderly patients also may disregard certain symptoms, because they think
               these symptoms are simply part of “growing old”. Thus elderly patients
               tend to underreport illness.
        (iii)  In addition, elderly persons are more sensitive to adverse effects of
               medications, and they commonly ask their pharmacist about symptoms
B. Pharm – IIIrd Sem – Lecture Notes
Kanpur Institute of Technology & Pharmacy (550)                                       Page 7
UNIT – V (PHARM 235)                                 HEALTH EDUCATION & RATIONAL DRUG THERAPY



               that actually may be caused by the medications that he or she is taking.
               Therefore, the pharmacist should always review the patient’s medication
               history when assessing the patient’s symptoms.
       Elderly patients are more prone to certain types of medical problems (e.g., falls,
malnutrition, incontinence, and noncompliance with taking medications), So the
pharmacist should assess the patient’s activities of daily living, Which are crucial to the
older person’s ability to live alone. Ask the patient if he or she is able to get out of bed,
go to the bathroom, bathe, eat, dress, manage household chores, and take medications
independently.
       Drug therapy has considerable potential for both helpful and harmful effects in
the geriatric patient. The balance may be tipped in the right direction by adherence to a
few principles :
       1. Take a careful drug history. The disease to be treated may be drug-induced,
           or drugs being taken may lead to interactions with drugs to be prescribed.
       2. Prescribe only for a specific and rational indication. Do not prescribe
           omeprazole for “dyspepsia”.
       3. Define the goal of drug therapy. Then start with small doses and titrate to the
           response desired. Wait at least three half-lives (adjusted for age) before
           increasing the dose. If the expected response does not occur at the normal
           adult dosage, check blood levels. If the expected response does not occur at
           the appropriate blood level, switch to a different drugs.
       4. Maintain a high index of suspicion regarding drug reactions and interactions.
           Know what other drugs the patient is taking.
       5. Simply the regimen as much as possible. When multiple drugs are
           prescribed, try to use drugs than can be taken at the same time of day.
           Whenever possible, reduce the number of drugs being taken.

ROLE OF PHARMACIST IN GERIATRIC PATIENT CARE
     1. The pharmacist should provide the individualized information necessary for
        patients to modify their behavior towards the good health.
     2. Pharmacist should tell them about an appropriate diet in old age free from
        fatty acids and rich in roughage which can help them for prevention of may
        diseases.
     3. The keynote of pharmacist’s health education activities is an informed
        awareness of the early signs and symptoms of the major diseases of society.
     4. The pharmacist should support them in early diagnosis and treatment of
        disease.
     5. Pharmacists should enclose them to obtain routine physical examinations,
        pap smears, mammograms, colon-rectal examinations, or other tests.
     6. They should be educated about stopping tobacco use, controlling high blood
        pressures, lowering cholesterol intake, increasing physical activity and having
        a good overall health consciousness.
     7. The pharmacist can take patient’s blood pressure readings, but these may be
        temporarily high or low and thus must be followed by at least two more
        measurements at later dates.

B. Pharm – IIIrd Sem – Lecture Notes
Kanpur Institute of Technology & Pharmacy (550)                                       Page 8
UNIT – V (PHARM 235)                                 HEALTH EDUCATION & RATIONAL DRUG THERAPY



         8. A large number of old people suffer from tooth decay or periodontal disease.
            The pharmacist should educate them that most oral conditions are avoidable
            by appropriate self-care and use of fluorinated toothpastes, oral fluoride
            supplements, dental sealants, flossing, avoidance of tobacco use and regular
            dental visits.
         9. Pharmacist can make significant contribution suggesting special dietary
            instructions for patients with diabetes and food allergies.

Family Planning
        Family planning is often used as a euphemism for birth control, though its
connotations are somewhat different. It is most usually applied to the circumstance of a
monogamous heterosexual couple who wish to limit their number of children, to control
the timing of pregnancy (also known as spacing children), or both. Inherent in the idea is
that the couple does have at least one child, that is, they use birth control to plan, not to
prevent.
        Family planning may include more or less permanent abstinence, or the
marginally effective withdrawal method, or methods of sexual satisfaction other than
genital intercourse, More commonly, however, it is considered to be a system that
allows a couple to have sexual intercourse on a long-term, regular basis, during which
the man normally reaches orgasm and ejaculation in the woman’s vagina, while
nevertheless sharply and reliably reducing the chance that she will become pregnant
until such time as the couple wish. Family planning thus often incorporates methods of
birth control that either prevent fertilization or work after fertilization to prevent the
implantation of an embryo. The essence of family planning, then, is to make intercourse
purely a means of expressing love, building stability in the relationship, and sharing
physical pleasure, and not a means of reproducing (except at a particular time)
Components of Family Planning
        Counseling : Counseling is an important prerequisite for the initiation and
continuation of a family planning method. Service providers should be trained to provide
counseling about all available methods of family planning.

Use of Contraceptives
       Contraceptives should be provided to clients to accordance with approved
method-specific guidelines and by service providers who have been trained in the
provision of that method.

Record Keeping
      All family planning service providers should maintain adequate records to identify
each client, the type of contraception provided and any special circumstances
associated with its provisions.




B. Pharm – IIIrd Sem – Lecture Notes
Kanpur Institute of Technology & Pharmacy (550)                                       Page 9
UNIT – V (PHARM 235)                                              HEALTH EDUCATION & RATIONAL DRUG THERAPY



Supervision
       Supervision is an essential component of program evaluation. It helps ensure
that the needs of clients are being met and service delivery guidelines are being
followed. The supervisor is a team member who promotes staff motivation, helps in
problem solving and ensures that the right of service providers and clients are
observed.

Logistics
       Maintenance of an effective logistic and supply system helps staff at service
delivery points (SDPs) avoid both under stocking and overstocking. In order to maintain
quality services, SDP staff should adhere to procedures for proper storage and handling
of contraceptive commodities as well as other supplies.

Various method of Family Planning
                                                  Birth Control
  Behavioral :               Avoiding vaginal intercourse : Abstinence, Anal sex, Oral sex,
                             Non-penetrative sex, masturbation.
                             Including vaginal intercourse : Fertility awareness, Rhythm
                             Method, Withdrawal, Breastfeeding infertility
 Barrier :                   Condom, Female condom, Diaphragm, Lea’s shield, Cervical Cap
 Spermicide                  Contraceptive sponge
 Hormonal :                  Combined : Combined oral contraceptive pill (“the Pill),
                             Contraceptive patch, NuvaRing.
                             Progestogen only : Progestogen only pill (‘minipill), Depo-
                             Provera, Norplant/Jadelle, Implanon.
 Anti-estrogen :             Ormeloxifene (a. k. a. Centchroman)
 Intra-uterine :             IUD (Copper or progestogen), IUS (progestogen).
 Post-                       Contraception : Emergency contraception (pills or copper IUD).
 intercourse :               Abortion: Surgical abortion, Medical abortion (RU-486/abortion
                             pill).
 Sterilization :             Men: Vasectomy
                             Women : Tubal ligation, Essure.

COMMUNICABLE DISEASE
       Disease: Malfunctioning of body organs or mind due to nutritional deficiency,
pathogenic invasion, genetic disorder or any other reason is called as Disease.
       Communicable disease : Disease caused by various micro-organism like
bacteria, virus etc. and these can be transmitted by/from the diseased person to healthy

B. Pharm – IIIrd Sem – Lecture Notes
Kanpur Institute of Technology & Pharmacy (550)                                                   Page 10
UNIT – V (PHARM 235)                                     HEALTH EDUCATION & RATIONAL DRUG THERAPY



person through agencies like air, water, food, insects etc. are called communicable
diseases or infectious disease.
STAGE OF DISEASE
      There are three distinct stages in every disease caused by germs :
      1. Incubation : This is the length of time between the pathogen’s gaining a
         foothold in the body and the appearance of first symptoms of the disease.
         During this period germs increase in number & circulate their position.
         Ex. 8-16 days in Measles.
      2. Acute Stage : Even if the body is not able to resist the disease and actually
         suffers from it does not give up fighting and producing antibodies antitoxins.
         If this stage is passed safely then the symptoms gradually disappear leaving
         the person completely exhausted.
      3. Convalescence : It takes days or even weeks to acquire the severity of the
         attack, for the patient to recover this normal health and strength.
         This is the period in which proper care in diet and rest is very necessary
         especially in case like typhoid where there is not only a fear of relapse, but
         also a chance for invasion of some other disease causing bacteria such as
         those cause brancho-pneumonia.
I.       TRANSMISSION OF DISEASE
         Disease can be transferred from infected person to healthy person by following
ways :
       (1) Direct Transmission
              a. Contact with infected person : (Gonorrhea, AIDS).
              b. Droplet Infection : (throwing out of tiny drop much by sneezing,
                  coughing e.g., Measles, Diphtheria).
              c. Animal bite (e.g., Rabies)
       (2) Indirect Transmission
              a. Through Housefly : it carries the pathogens in mouth and leg as it
                  transfers from faces to food and drinks. (i.g., Polio)
              b. Air-borne method
              c. Formite borne method ; Through air dust, towels, cloths of diseased
                  person, handkerchief etc.
II.    A WAY VIRUSES INFECT A CELL
       Viruses present outside the cell for entering virus composed of protein coat and a
nuclei acid core.
               Cell began to trap viruses “Thinking” they might be food by the process of
                phagocytes.
               Cell enzyme begain to strip of viral protein coat.
               Viral nuclei acid cores are release by rupturing the protein coat.
B. Pharm – IIIrd Sem – Lecture Notes
Kanpur Institute of Technology & Pharmacy (550)                                          Page 11
UNIT – V (PHARM 235)                                                 HEALTH EDUCATION & RATIONAL DRUG THERAPY




                  Viral nuclei acid gets into the cell nucleus and takes over the cell’s chemical
                   manufacturing system.
                  Cell ignores its own chemical needs and making new viruses.
                  Cell is sometimes destroyed in the process (ex-invaded by polio viruses)
                   and then many of the new viruses are formed in the cell and they are
                   released to infect whole body.

SYMPTOMS, CAUSATIVE AGENTS, PREVENTION OF COMMUNICABLE DISEASE

1-         SOME VIRAL DISEASES
           Disease                Causative agent                 Symptoms                           Prevention
 (i) Chicken pox               Varicella            zoster Skin eruptions as Isolation, burn of
                               virus                       red papules and scab, (cleanliness,
                                                           appear as tear drop ZIG is given by I/M
                                                           vesicles.
 (ii) Polio myelitis           Smallest             known Destroys        motor Passive immunity
                               polio virus                area in spinal coral, developed through
                                                          paralysis of limbs    salk vaccine.
 (iii)  Hepatitis              Hepatitis  viruses Liver    cells    are                        Persona
 (epidemic                     e.g. (HAV), (HBV) damaged,        yellow                        cleanliness,
 jaundice)                     etc.               colouration of eye                           prevention        of
                                                  and skin, change in                          contaminated food,
                                                  urine colour                                 water and milk,
                                                                                               Immunisation      by
                                                                                               Hepatitis B vaccine.

2.         SOME BACTERIAL DISEASES
               Disease                Causative agent                Symptoms                           Prevention

 (i)    Tetanus                Clostridium tetani           Affects the neuromuscular          Active immunization with DPT
                                                            junction resulting in painful      vaccine, ATS injection is
                                                            contraction of neck, jaw and       given to neutralize the
                                                            causes death                       tetanus poison

 (ii)   Teberculosis           Mycobacterium tuberculosis   Lungs and lymph glands are         Vaccination            (B.C.G.)
                                                            affect pain in chest, blood with   antibodies, isolation of patient
                                                            suptum, loss of wt, appetite

 (iii) Syphills                Traponema palladium          Inflammation of urinogenital       Avoid sexual contact taking
                                                            trach                              antibiotics

 (iv)    Typhoid               Salmonella typhi             Continued fever, weakness,         Proper            sanitation,
                                                            relapse of fever                   immunization by (TAB), clean
                                                                                               liness.




B. Pharm – IIIrd Sem – Lecture Notes
Kanpur Institute of Technology & Pharmacy (550)                                                                      Page 12
UNIT – V (PHARM 235)                                      HEALTH EDUCATION & RATIONAL DRUG THERAPY



3.       SOME PROTOZOAL DISEASES
         Disease                  Causative agent       Symptoms                Prevention
 (i) Malaria (Mala- Unicellular                     High fever (upto        Spraying     D.D.T.,
     bad, aria-air) Plasmodium                      105o – 106oF) with      spray the ponds
                                                    chill,      profuse     with kerosene oils
                                                    sweating       head     to kill the larvae.
                                                    ache, nausea. It        Drug is quinine,
                                                    also damages the        chloroquine.
                                                    spleen and liver
                                                    chronic cases.
 (ii) Amoebiasis               Entamoeba            Erode            the    Purification      of
                               histolytica          submucosal layer of     water,        proper
                                                    intestine ad cause      sanitation,
                                                    ulcer,   acute,     a   cleanliness,
                                                    mobile    dysentery     antibiotics
                                                    abdominal       pain,   (terramyclin,
                                                    nausea.                 Fumogillin)

PREVENTION OF COMMUNICABLE DISEASE
       It occurs at 3 levels
       (1)    Primary Prevention : It is defined as the measure taken prior to the onset
of diseases which ensure that disease will never occur.
                  By vaccination : Vaccination is a process of introducing
                   inactivated/attenuated pathogens into the body to generate prim. Immune
                   response.
                   Ex : OPV for Polio, DPT for Diphtheria.
              Promoting Health Education Programms : This is the most important
               Step to eradicate the infectious disease by giving education to public
               about the disease-how it spreads, how it prevent it and what steps they
               can take to control its spread.
      (2)      Secondary Prevention : Secondary prevention halts the progress of a
disease at its incipient stage and prevents complication.
               It is more expensive and less effective as compared to primary prevention.
               (a) Isolation : Infected person should be separated from other members
                    (healthy), until he is free from disease.
               (b) Disinfection and sterilization : Destroy the germs as soon as they
                    leave the body, by using various disinfectants like Lysol, Potassium
                    permanganate, iodine etc.
               (c) Clinical medicine / Drugs : Proper type of drug is very effective in
                    maximum cure of disease.
                    Ex. : Antibiotics – penicillin, tetracycline.
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                  Sulfa drugs
                  DEC (Diethyl carbamine) – Lymphatic filariasis
                  ZIG (I/M) – Chicken pox
                  Quinine – Malaria
           Fumagillin, Auremycin – Amoebiasis.
      (3) Tertiary Prevention : It includes all measures available to reduces or limit
impairments and disabilities.
      Promotes patients adjustments to untreatable conditions.

NUTRITION
        Nutrition is a science that examines the relationship between diet and health.
Dietitians are health professionals who specialize in this area of study, and are trained
to provide safe, evidence-based dietary advice and interventions.
        Deficiencies, excesses and imbalances in diet can produce negative impacts on
health, which may lead to diseases such as cardiovascular disease, diabetes, scurvy,
obesity or osteoporosis, as well as psychological and behavioral problems. Moreover,
excessive ingestion of elements that have no apparent role in health, (e.g. lead,
mercury, PCBs, dioxins), may occur toxic and potentially lethal effects, depending on
the dose.
        The human body is made up of chemical compounds such as water, amino acids
(proteins), fatty acids (lipids), nucleic acids (DNA/RNA), and carbohydrates (e.g. sugars
and fiber). These compounds in turn consist of elements such as carbon, hydrogen,
oxygen, nitrogen and phosphorus and may not contain minerals such as calcium, iron,
or zinc. Minerals can not commonly occur in the form of salty salts and electrolytes. All
of these chemical compounds and elements occur in various forms and combinations
(e.g. hormones / vitamins, phospholipids, hydroxyapatite), both in the human body and
in organisms (e.g. plants, animals) that humans eat.

Nutrition and health
       There are six main classes of nutrients that the body needs : carbohydrates,
proteins, fats, vitamins, minerals and water. It is important to consume these six
nutrients on a daily basis to build and maintain healthy bodily function.
       Poor health can be caused by an imbalance of nutrients, either an excess or
deficiency, which, in turn, affects bodily functions cumulatively.
       According to the United Nations World Health Organization (WHO : 1996), more
than starvation the real challenge today is malnutrition the deficiency of micronutrients
(vitamins, minerals and essential amino acids) that no longer allows the body to ensure
growth and maintain its vital functions.

Essential and non-essential amino acids
     Most meats such as chicken contain all the essential amino acids needed for
humans.

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      The body requires amino acids to produce new body protein (protein retention)
and to replace damaged proteins (maintenance) that are lost in the urine. In animals
amino acid requirements are classified in terms of essential (an animal cannot produce
them) and non-essential (the animal can produce them from other nitrogen containing
compounds) amino acids. Consuming a diet that contains adequate amounts of
essential (but also non-essential) amino acids is particularly important for growing
animals.

Vitamins
       Twelve vitamins and about the same number of minerals are recognized as
“essential nutrients”, meaning that they be consumed and absorbed – or, in the case of
vitamin D, alternatively synthesized via UV radiation – to prevent deficiency symptoms
and death. Certain vitamin-like substances found in foods, such as carnitine, have also
been found essential to survival and health, but these are not strictly “essential” to eat
because the body can produce them from other compounds. Moreover, thousands of
different phytochemicals have recently been discovered in food (particularly in fresh
vegetables), which have many known and yet to be explored properties including
antioxidant activity.

Fatty acids
       In addition to sufficient intake, an appropriate balance of essential fatty acids –
omega-3 and omega-6 fatty acids – has been discovered to be crucial for maintaining
health. Both of these unique “omega” long-chain polyunsaturated fatty acids are
substrates for a class of eicosanoids known as prostaglandins which function as
hormones. The omega-3 eicosapentaenoic acid (EPA) (which can be made in the body
from the omega-3 essential fatty acid alpha-linolenic acid (LNA), or taken in through
marine food sources), serves as building block for series 3 prostaglandins (e.g. weakly-
inflammation PGE3). The omega-6 dihomo-gamma-linolenic acid (DGLA) serves as
building block for series 1 prostaglandins (e.g. anti-inflammatory PGE1), whereas
arachidonic acid (AA) serves as building block for series 2 prostaglandins (e.g. pro-
inflammatory PGE2). Both DGLA and AA are made from the omega-6 linoleic acid (LA)
in the body, or can be taken in directly through food. An appropriately balanced intake of
omega-3 and omega-6 partly determines the relative production of different
prostaglandins, which partly explains the importance of omega-3/omega-6 balance for
cardiovascular health. In industrialized societies, people generally consume large
amounts of processed vegetable oils that have reduced amounts of essential fatty acids
along with an excessive amount of omega-6 relative to omega-3.

Intestinal bacterial flora
        It is now also known that the human digestion system contain a population of a
range of bacteria and yeast such as Bacteroides, L. acidophilus and E. coli which are
essential to digestion, and which are also affected by the food we eat. Bacteria in the
gut fulfill a host of important functions for humans, including breaking down and aiding
in the absorption of otherwise indigestible food; stimulating cell growth; repressing the


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growth of harmful bacteria, training the immune system to respond only to pathogens;
and defending against some disease.
Protein
        People who exercise at greater intensity, and especially those whose activity
grows muscle bulk, have significantly higher protein requirements. According to Clinical
Sports Nutrition, active athletes playing power sports (such as football), those engaged
in muscle-development training, and elite endurance athletes, all require approximately
1.6 grams of protein per day kilogram of body weight, roughly double that of a sedentary
persons. Older athletes seeking primarily to maintain developed muscle mass require 1
to 1.2g / day / kg
Water and Salts
        Maintaining hydration during periods of physical exertion is key to good
performance. While drinking too much water during activities can lead to physical
discomfort, dehydration in excess of 2% of body mass (by weight) markedly hinders
athletic performance. It is recommended that an athlete drink about 400-600 mL 2-3
hours before activity; during exercise he or she should drink 150-350 mL every 15 to 20
minutes and after exercise that he or she replace sweat loss by drinking 450-675 mL for
every 0.5 kg body weight loss during activity. Some studies have shown that an athlete
that drinks before they feel thirsty stays cooler and performs better than one who drinks
on thirst cues, although recent studies of such, races as the Boston Marathon have
indicated That this recommendation can lead to the problem of over hydration.
Additional carbohydrates and protein before, during, and after exercise increase time to
exhaustion as well as speed recovery. Dosage is based on work performed, lean body
mass, and environmental factors, especially ambient temperature and humidity.
        Excess water intake, without replenishment of sodium and potassium salts, leads
to hyponatremia, which can further lead to water intoxication at more dangerous levels.

Carbohydrates
       The main fuel used by the body during exercise is carbohydrates, which is stored
in muscle as glycogen – a form of sugar. During exercise, muscle glycogen reserves
can be used up, especially when activities last longer than 90 min. When glycogen is
not present in muscles, the muscle cells perform anaerobic respiration producing lactic
acid, which is responsible for fatigue and burning sensation, and post exercise stiffness
in muscles. Because the amount of glycogen stores in the body is limited, it is important
for athletes to replace glycogen by consuming a diet high in carbohydrates. Meeting
energy needs can help improve performance during the sport, as well as improve
overall strength and endurance.
                                    _______________




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                                     PHARMACOEPIDEMIOLOGY
Pharmacoepidemiology is derived from two words :
     (i)   Pharmaco : Meaning a drug
     (ii)  Epidemiology : (epi = amongs; demos = people; logos : study)
           Epidemiology is a quantitative science and practice concerned with the
           occurrence and determinates of status of health in population.
           So, Epidemiology is defined as the study of the distribution and
           determinants of health related states or events in specified population and
           the application of this study to control health problems.

SCOPE OF EPIDEMIOLOGY
    The three Important Components of Epidemiology are –
            (a) Disease frequency
            (b) Distribution of disease
            (c) Determinates of disease
    (a) Disease frequency : The frequency of a disease is measured as rate or
        ratio e.g. death rate, incidence rate. There rates are required for comparing
        the frequency in different population or sub-groups. Epidemiology involves
        also measurement of health related events like height, weight, blood pressure
        etc.
    (b) Distribution of disease : The distribution of disease is not uniform but it
        occurs in certain patterns. The pattern varies in relation to person, population,
        place and time. The incidence of disease may be high in one area and less in
        another. It may be high at one time and less at a different time. An analysis of
        these data helps in identifying risk factors.
    (c) Determinates of disease : The unique feature of epidemiology is to test a
        etiological hypothesis and to identify the causes (risk factors). This aspect of
        epidemiology is known as ‘analytical epidemiology’. It helps in formulating
        health programmes, interventions and policies.
“Pharmacoepidemiology or drug epidemiology, is the study of the effects of drugs in
populations of people”. This discipline is an amalgam of clinical pharmacology, clinical
epidemiology, medical informatics, and biostatistics.

Aims of Epidemiology :
     (a)    to describe the distribution and size of disease problems in human
            populations.
     (b)    to identify etiological factors in the pathogenesis of disease, and
     (c)    to provide the data essential to the planning, implementation and
            evaluation of services for the prevention, control and treatment of disease
            and to the setting up of priority among these services.

Uses of epidemiology :
      1.    To study the health history of population and their disease trends. This
            helps in identifying health problems.

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         2.        To arrive at community diagnosis. This is necessary for initiating
                   preventive and control measures.
         3.        To plan and evaluate health services.
         4.        Evaluation of risk and chances of a single individual e.g. risk of bearing a
                   mongol child.
         5.        Searching for causes and risk factors e.g. smoking as a cause of lung
                   cancer.
         6.        Identification of disease syndromes e.g. association of iron deficiency
                   anemia and Patterson. – Kelley syndrome.
Methods of Epidemiology :
Types of methods :
Four different types of methods (studies) are followed in epidemiology. They are :
                 1. Quantitative studies.
                 2. Descriptive studies
                 3. Analytical studies
                 4. Experimental (or intervention) studies
Quantitative Studies
         The basic measurements used in epidemiology are :
         1. Rate               2.      Ratio          3.      Proportion
Rate :
         Rate measures the occurrence of a particular event (like occurrence of disease
or death) in a population during a given time period. Death rate is the frequently used
rate. It is expressed by the formula :
                          Number of deaths in one year
         Death rate =                                   1000
                             Mid - year population
Ratio :
         It is another measure of disease frequency. It expresses a relation in size
between two random quantities. Broadly it is the result of dividing one quantity by
another. It is expressed in the form of :
                                                       x
                 X       :     y               or
                                                       y
         For example the ratio of WBC to RBC is 1:600 or 1/600. It means that for each
WBC there are 600 RBCs. Other examples are male-female ratio, doctor – population
ratio etc.
Proportion :
         It is the relation in magnitude of a part of the whole. The numerator is always
included in the denominator. Proportion is usually expressed as percentage.
                       Number of pregnant women at a certain ti me (NUMERATOR )
Example -                                                                              100
                 Total number of women in the village at the same time (DENOMINAT OR)



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MEASUREMENT OF MORBIDITY AND MORTALITY
Mortality : Mortality is death. The frequency of death and the number of people who die
is a measure of health of a community. Rates and ratios are frequently used for
measuring mortality. Example are :
                                      Number of death during the year
    1. Crude death rate =                                              1000
                                          Mid - year population
    2. Specific death rate for disease =
                             Number of deaths due to disease  during a calender year
                                                                                       1000
                                            mid - year population
                                                  Total number of deaths due to a particular disease
    3. Case fatality rate (ratio) =                                                                  1000
                                                   Total number of cases due to the same disease

Morbidity : It is defined as ‘any departure or deviation, form a state of physiological
well-being’. Morbidity may be a sickness, illness or disability. Morbidity is also measured
in terms of rates and ratios. The two important measurements of disease frequency (i.e.
the rate at which disease occurs) are incidence and prevalence.
Incidence : Incidence rate is defined as ‘the number of NEW cases of a specific
disease occurring in a defined population during a specified period of time. It is given by
the formula :
 Number of NEW cases of specific diseases during a given time period
                                                                      1000
                         Population at risk
For example : The population of a particular year is 20,000. The number of new cases
                                              500
of a disease is 500. The incidence will be           1000  25 per 1000 year.
                                            20000
Incidence rate refers 1- only the new cases. 2- during a particular period (usually one
year) 3- a specified population (population at risk).
Uses of incidence rate : 1- to control the disease 2- for research in a etiology,
pathogenesis and distribution of diseases.
Prevalence : The term disease prevalence refers to all current cases (old and new) in a
given population at a particular point of time or over a period of time. The term incidence
refers only to new cases, but prevalence refers to both new and old cases. Prevalence
is classified into two types :
       1. Point prevalence : It refers to the number of all current cases (old and new) a
            a particular point of time (e.g. particular day or particular week).
       2. Period prevalence : It refers to the number of all current cases (old and new)
            during a particular period of time (e.g. period of one year).

                         Relationship between prevalence and incidence
          Prevalence depends on 2 factors : The incidence and duration of illness. This
         relationship is expressed as :
                Prevalence =        incidence X duration

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                            P         =            IXD
         Example
         Incidence (new cases) population       =     20 cases per year per 1000
         Duration of the disease                =     5 years
         Prevalence = 20 X 5                    =     100 per 1000 population
         Incidence and prevalence can be exemplified with a tub provided with an inlet tap
         and outlet. The amount of water pouring through the inlet tap is the incidence
         (new cases). Prevalence is the amount of water in the tub at any point of time or
         period of time. (old and new cases). The outlet is the cases died due to the
         disease or recovered from the disease.




                                                    Recovery or death
                                 Fig. : Relationship between incidence and prevalence

Descriptive Studies (Descriptive epidemiology)
It is a broad description of the distribution of disease in terms of person, place and time.
It involves observation of the disease or health related problems. In descriptive studies
three questions are asked : Who, Where, When.
        (a) Who is getting the disease? -           Person distribution
        (b) Where the disease occurs? -             Place distribution
        (c) When the disease occurs?        -       Time distribution

Aims of descriptive studies :
     1. Evaluation of health status
     2. To make comparison between different population or countries.
     3. To provide a basis for planning and evaluation of health services.
     4. To identify problems that can be solved by analytical methods.

Analytical studies (Analytical epidemiology)
       These studies are focused on the determinants of disease i.e., reasons for high
or low frequency. The aims of analytical studies are :
       1. To find out the association if any between a disease and a suspected factor.
       2. To study the problems identified in descriptive epidemiology.
       3. To provide a basis for health planning and disease prevention.

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Types of analytical studies :
     The two types of analytical studies are :
     1. Case control study
     2. Cohort study

Case Control Study :
       It is also called as retrospective study. The three features of case control study
are :
       1. The study is done after the disease has occurred and produced its effect.
       2. From the effect produced, the cause of the disease is analysed backwards.
       3. It makes use of controls (persons without disease) and cases (persons with
            disease) for comparison.
Steps of case control study :
       1. Selection : Identical cases and controls are selected.
       2. Matching : Cases and controls are matched relation to factors such as age,
            sex etc.
       3. Data : Information about exposure to risk factors is obtained both in cases
            and controls.
       4. Analysis : The association if any of the risk factor with a specific disease is
            analysed.
An example of case control study is the study of association between smoking and lung
cancer. Here, the cases are those who have lung cancer. Controls are those do not
have lung cancer.
COHORT STUDY :
       It is also called as prospective study. The features of cohort study are :
       1. The individuals involved in the study are selected before the appearance of
            the disease.
       2. These individuals are observed over a period of time for the appearance of
            the disease.
       3. The study proceeds forwards from the cause of the disease (e.g. smoking) to
            the effect (e.g. lung cancer).
Steps of cohort study :
       1. Selection of study subjects : The subjects for cohort study are selected
            from :
            (a) general population of specified areas
            (b) from people who can be easily followed like doctors, nurses teachers etc.
       2. Collection data : Information about exposure to risk factors is obtained
            through interviews or mailed questionnaires.
       3. Comparison groups : They may be selected from the same area or from
            people with similar profession.

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         4. Follow up : The study subjects and comparison groups are followed by :
            (i) periodic medical examination.
            (ii) reviewing hospital records
            (iii) letters or phone calls
         5. Analysis : The data are analysed for incidence rate and the risk involved.
                   Difference between case control and cohort studies
              Case control study             Cohort study
1        Proceeds from ‘effect to cause’     Proceeds form ‘cause to effect’
2        Starts with the disease             Starts before the appearance of the
                                             disease
3        Tests whether the cause is present Tests whether the disease is present in
         in those with the disease           those with the cause
4        Involves less number of subjects    Involves larger number of subjects
5        Gives quick results                 Long follow up. So results are delayed
6        Inexpensive study                   Expensive study

EXPERIMENTAL STUDIES :
(Experimental epidemiology) : It is the study of disease among colonies of
experimental animals such as rats and mice. Experimental studies may be conducted in
humans also.
Aim of experimental studies :
      1. To obtain scientific proof of risk factors.
      2. To measure the effectiveness of health services in the control and prevention
         of diseases.
Types of experimental studies : The two types of experimental studies are :
      1. Randomized control trials
      2. Non-randomized trials

DYNAMICS OF DISEASE TRANSMISSION
Source of infection is defined as the person, animal object or substance from which an
infectious agent is transmitted.
Reservoir is any person, animal, insect, plant or soil in which the infectious agent lives,
multiplies and reproduces to get transmitted to the lost.
Types of reservoir : The three types of reservoirs : 1. Human reservoir 2. Animal
reservoir 3. Reservoir in non-living things.
Human reservoir : A number of diseases are commucated from one man to the other.
He may be called as :
        (i)   Case, If he has infectious agent and suffers from the disease caused by it.
        (ii)  Carrier, If he has the infectious agent but does not suffer from the
              disease.


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Carrier : A carrier is defined as an infected person or animal who has the infectious
agent without the symptoms of the disease. Carrier is a potential source of the infection
and the transmits infections to other persons. The different types of carriers are :
        1. Incubatory carriers : They shed the Infectious agent during the incubation
           period of the disease. They can infect others even before the onset of illness.
        2. Convalescent carriers : They shed the infectious agent during the period of
           recovery.
        3. Healthy carriers : They are apparently healthy individuals with subclinical
           infection. But they can transmit the disease.
        4. Temporary carriers : They shed the infectious agent for short periods.
        5. Chronic carriers : They shed the infections agent for indefinite period.
Animal reservoir : Sometimes the source of infection may be animals and birds. They
transmit a variety of diseases. Diseases transmitted by animals and birds are called as
Zoonotic diseases e.g. rabies, yellow fever.
        Reservoir in non-living things : Soil and inanimate objects can act as reservoir
of infections. For example, soil acts as a reservoir for tetanus and anthrax.

MODES OF TRANSMISSION ;
       From the source or reservoir, the infectious agent can be transmitted to the host
either directly or indirectly.
       Direct transmission : It can occur by :
       1. Direct contact : This can occur from skin to skin, skin to mucosa or mucosa
           to skin of the same or different person.
       2. Droplet infection : The infectious agent is sprayed as droplets of saliva or
           other secretions. This can occur while coughing, sneezing or talking.
       3. Contact with soil : Infections like tetanus are contacted from soil.
       4. Inoculation to skin or mucosa : AIDS is transmitted through contaminated
           needles and syringes.
       5. Transplacental (or vertical) transmission : Diseases like syphilis and AIDS
           are transmitted through placenta.
       Indirect transmission : It occurs through the fie traditional F’s
       1. Fluid and Food – vehicles borne
       2. Flies – vector borne
       3. Fomies – Fomite born
       4. Fingers and hands – Finger borne.
       1. Vehicle borne transmission occurs through water and food. e.g. typhoid
           fever, cholera and polio are transmitted through water and food.
       2. Vector borne transmission occurs through insects like flies and mosquitoes.
           e.g. malaria is transmitted through mosquitoes. Vector is defined as an
           arthropod or a living carrier which transports the infectious agent to a host.

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        3. Fomite borne transmission occurs through inanimate articles like clothes,
             towel, pencil, books, toys etc. e.g. diphtheria and typhoid fever can be
             transmitted through fomites.
        4. Finger borne transmission includes those transmitted through contaminated
             fingers and hands. e.g. dysentery and hepatits A.
        Air borne transmission may occur through droplet nuclei and dust.
Droplet nuclei are particles (1 to 10 micron size) which contain dried residue of
droplets. Droplet nuclei are formed by the evaporation of droplets coughed or sneezed
into the air,
Dust : The droplets expelled during coughing or sneezing may settle on the floor and
become part of the dust. Infection can occur when the dust is propogated through wind
or through the act of sweeping, dusting etc. Examples of diseases transmitted through
dust are tuberculosis and pneumonia.
Susceptible Host : In the host, four stages are involved in an infection. 1. Entry, 2.
Colonisation, 3. exit, 4. survival outside.
        1. Entry : The infectious agent enters the host through any possible route e.g.
             respiratory tract, alimentary tract, skin etc.
        2. Colonisation : After entry into the host, the infectious agent chooses a
             suitable site in the body like lungs, brain or liver. It grows and multiplies at
             these sites.
        3. Exit : After multiplication it comes out of the host through any possible route
             like faces, urine or saliva.
        4. Survival outside : After exist from the host, the infectious agent survives in
             the external environment till it finds a new host.
Incubation period :
        It is defined as ‘the time interval between invasion by an infectious agent and the
appearance of the first sign or symptom of the diseases’. During incubation period, the
infectious agent multiplies in the best. The disease manifests only when the disease
agent grows to a sufficient density (or population). Generally, infectious diseases are
not communicable during the incubation period (exceptions are measles, hepatitis,
chicken pox and whooping cough).
        The length of incubation period varies from one disease to the other. Some
diseases like cholera and influenza have very short incubation period (few hours to 2 to
3 days). Some diseases like measles and mumps have a long incubation period (10
days to 3 weeks).
IMMUNITY AND IMMUNISATION
       Immunity : Immunity is defined as the resistance against an infecting organism.
The immune mechanism of the body is capable of recognizing, destroying and
eliminating infectious micro organisms. The immune mechanism is due to antibodies
produced in the body.
       Antigen : An antigen is a foreign protein. When an antigen is introduced into the
body, it stimulates the production of specific antibody.


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      Antibody : It is protein substance produced in the body in response to an
antigen. The antibody recognizes the disease producing organism and destroys it. Thus
antibodies protect the body against disease. The protection is specific. Antibodies
against small pox give protection only against small pox and not any other disease.
Antibodies are produced by spleen, lymph nodes and plasma cells (small lymphocytes).
TYPES OF IMMUNITY :
       Immunity can be classified into : 1. Natural immunity 2. Artificial immunity.
       Natural immunity : This type of immunity is inherited from birth itself. This type
of immunity provides natural resistance against diseases. For example, man is naturally
resistant to a virus which produces a disease called rinderpest in cattle.
       Artificial immunity : It involves the stimulation of the body to produce its own
antibodies. The stimulation of antibody production is achieved by the administration of
vaccines, toxoids etc. Active immunity takes sometime to develop, but it is of long
duration.
       Passive immunity : It involves the administration of an antibody produced in one
body (man or animal) to another i.e. readymade antibodies are administered. Passive
immunity develops rapidly, but it is of short duration. Passive immunity is produced by
the administration of antisera and gamma globulin.

IMMUNIZATION :
     Immunization is defined as ‘production of immunity or resistance in the body by
means of immunological agents’. Immunization is classified as :
     1. Passive immunization which makes use of antisera and gamma globulin.
     2. Active immunization which makes use of vaccines and toxoids. Active
          immunization may be primary or secondary.
     Primary imunnization : It is commonly caried out in infants and children to
     induce primary immunity. It consists of administering two or more doses of the
     vaccine or toxoid at suitable intervals. A mixture of two or more vaccines (e.g.
     T.A. B with cholera vaccine) or toxin – toxoid mixture (e.g. diphtheria and tetanus
     toxoid with whooping cough vaccine) may be used for primary immunization. This
     procedure is called as combined immunization.
             Secondary immunization : It is carried out to reinforce primary immunity.
     It is achieved by giving a single ‘booster dose’ of the antigen. It is done as a
     routine procedure in a planned immunization programme in children. It is also
     carried out during an epidemic or before undertaking journey to endemic zones.
             Immunological products : Immunological products (immunizing agents)
     are those which are used to produce immunity. They are classified as
             1. vaccines 2. immunoglobulins 3. antisera.

VACCINES
       Vaccine is a preparation containing an antigen which stimulates the production of
specific antibody. Vaccines can be classified into : 1. live vaccines 2. killed vaccines 3.
toxoids 4. mixed vaccines.


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Kanpur Institute of Technology & Pharmacy (550)                                     Page 25
UNIT – V (PHARM 235)                               HEALTH EDUCATION & RATIONAL DRUG THERAPY



Live Vaccines : Live vaccines are prepared from live attenuated organisms. Examples
of live vaccines are BCG, small pox, oral polio, measles, mumps and yellow fever.
Except polio vaccine, others are administered in single dose.
Killed vaccines : They contain organisms which are killed by heat or chemicals.
Examples are vaccines used for the prevention of cholera, typhoid, rabies, influenza etc.
The killed vaccines are administered in larger doses since they are weak compared to
live vaccines.
Toxoids : They are obtained by detoxicating the exotoxins produced by
microorganisms e.g., tetanus toxoid.
Mixed vaccines : These vaccines contain more than one type of immunizing agent e.g.
DPT (triple vaccine). The mixed vaccines simplify administration, reduce the cost and
decrease the number of vaccinations.

IMMUNOGLOBULINS
There are five classes of immunoglobulins (Ig G, Ig M, Ig A, Ig D and Ig E) in the human
system. Also there are subclasses within them. All antibodies are immunoglobulins. Two
types of immunoglobulin preparations are available. They are : 1. Normal human
immunoglobulin 2. Specific humanimmunoglobulin.

Uses of immunoglobulins :
       1. Prophylaxis of viral and bacterial infections.
       2. For replacement of antibodies in immunodeficient patients.
Administration :
       Immunoglobulins are administered by intramuscular injection. Recently
intravenous preparations have been developed.
Advantages of immunoglobulins
       1. They are free from hepatitis B.
       2. They can be concentrated in small volume for intramuscular injection.
       3. They are stable, if properly stored.
Antisera (or Antitoxins)
       The term antiserum is applied to materials prepared in animals e.g. horses. They
are used for passive immunisation against diseases like tetanus, diphtheria, botulism
etc.

IMMUNIZATION SCHEDULE
       Vaccine preventable diseases (VPD) : The six diseases which can be
prevented by vaccination (immunisation) are 1. Diptheria 2. Pertussis 3. Tetanus 4.
Polio 5. Tuberculosis 6. Measles.
      Expanded programme of immunization (EPI) : It was launched by WHO may
1974. It is a global immunisation programme. Its aim was to protect all the children of
the world against the six vaccine preventable diseases.



B. Pharm – IIIrd Sem – Lecture Notes
Kanpur Institute of Technology & Pharmacy (550)                                    Page 26
UNIT – V (PHARM 235)                                HEALTH EDUCATION & RATIONAL DRUG THERAPY



      Universal immunisation programme : It is a national programme of India. It
was launched on November 19, 1985. It was dedicated to the memory of Srimati Indira
Gandhi. Its aim was to provide immunisation coverage of eligible population by 1990.

       IMMUNIZATION SCHEDULE : The following is the immunisation schedule for
children :
                      Age                     Immunisation
                0 – 15 days                Oral polio and BCG
                  6th Week                  DPT and oral polio
                     th
                 10 Week                    DPT and oral polio
                 14th Week                  DPT and oral polio
                   th
                  9 Month                  Measles vaccination
                    th
                 18 month                  Booster dose of DPT
                                         Booster dose of oral poilo
                   5 years                    DT and typhoid
                  10 years              Tetanus toxoid and typhoid
                  15 years              Tetanus toxoid and typhoid

DPT or TRIPLE ANTIGEN :
       It contains 1. diphtheria toxoid 2. tetanus toxoid 3. pertussis vaccine. Also it
contains aluminum phosphate as a mineral carrier and thiomersal as a preservative.
DPT produces immunisation against three diseases 1. diphtheria 2. pertussis (whosping
cough) 3. tetanus. DPT is given in children in the 6 th, 10th and 14th Weeks for
immunisation. Again a booster dose is given at 1½ years. At 5 years, DT is given. A
mild to moderate reaction may be produced in children occasionally and it is due to
pertussis component.

ATS or ANTI-TETANUS SERUM :
       It is administered for passive immunity against tetanus. ATS is obtained from the
serum of immunized horses. On subcutaneous injection, ATS reaches high level in
blood in 1 to 2 days and rapidly eliminated within 2 weeks. So it does not cover the
incubation period of tetanus (upto 21 days). This is a disadvantage of ATS. Also ATS
produces hypersensitive reactions in some individuals when administered for a second
time.

TETANUS TOXOID (TT) :
       It is the best vaccine used for active immunisation against tetanus. It is available
in two preparations : 1. Plain toxoid 2. Absorbed vaccine (PTAP), PTAP contains an
aluminum adjuvant. It produces long lasting immunity than plain toxoid. Tetanus toxoid
is administered 3 doses. The interval between the first and second dose is 6 to 12
months.

POLIO VACCINE :
      It is used for immunisation against poliomyelitis. It is available as : 1. Salk
vaccine, 2. Sabin vaccine.

B. Pharm – IIIrd Sem – Lecture Notes
Kanpur Institute of Technology & Pharmacy (550)                                     Page 27
UNIT – V (PHARM 235)                                  HEALTH EDUCATION & RATIONAL DRUG THERAPY



        Salk vaccine is a killed vaccine containing all three types (type 1, 2 and 3) of
killed polio virus. It is given by subcutaneous or intramuscular injection in 3 or 4 doses.
        Sabin vaccine is a live oral polio vaccine. It is prepared from attenuated strains of
all the three types of polio virus. It is administered once every four weeks doses are
given. (See immunisation schedule). A booster dose is given at 18 months.
COLD CHAIN
       It is system of transport and storage of vaccines at low temperature from the
manufacturer to the point of use.
Importance of cold chain
       Vaccines are sensitive to heat. If they are exposed to heat, they will loose their
potency. When potency is lost, the protective effect is also lost. So vaccines must be
stored and transported at low temperature.
COLD CHAIN EQUIPMENTS :
       At the state and regional stores : Cold rooms and walk in coolers are available.
       At the district stores : Freezers, refrigerators, cold refrigerator (ILR), cold boxes
and vaccine carriers are available.
       At the subcentre : Cold boxes, vaccine carriers, thermocole boxes and thermos
flasks are available.
Storage of vaccines : Of all the vaccines, polio is most sensitive to heart. It must be
stored at minus 20oC. Vaccines which should be stored in the freezer compartment of
the refrigerator are polio, measles and BCG. Vaccines which must be stored in the cold
part of the refrigerator but never allowed to freeze are typhoid, DPT and tetanus toxoid.

PRINCIPLES OF DISEASE CONTROL AND PREVENTION
Communicable diseases can be controlled and prevented by adequate measures which
involve :
1. Diagnosis 2. Notification 3. Isolation 4. Treatment 5. Quarantine 6. Investigation 7.
Disinfection 8. Blocking of transmission 9. Immunisation 10. Health education.
1. Diagnosis : It is first step in the control of a disease. The disease should be
diagnosed and treated immediately and effectively. This will prevent the spread of an
infection.
2. Notification : As soon as a disease is detected, it should be notified immediately to
the local health authority. This helps in taking immediate preventive measures to control
the spread of the disease.
3. Isolation : The infected patient must be isolated in hospital or at home, if
hospitalisation is not possible. The period of isolation depends on the period of
communicability of the disease. Isolation of the infected cted cted cted cted cted patient
prevents the spread of infection.
4. Treatment : Treatment should be given to the infected patient and also to the carrier
of the infection. Sometimes all the people I the community are treated, even if they do
not have the disease. These measures effectively prevent the spread of infection.
5. Quarantine : It means isolation of healthy and normal persons till the incubation
period of a disease is over. These healthy persons might have come in contact with the
disease without actually suffering from it. So quarantine is necessary to prevent the
spread of infection from these persons to others who have not been exposed to the

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Kanpur Institute of Technology & Pharmacy (550)                                       Page 28
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disease. Quarantine is necessary for international travellers who have the possibility of
carrying infections.
6. Investigation : The health authorities should conduct field investigation of infected
person and also infected areas. Suspected and also infected cases must be conformed
by laboratory tests.
7. Disinfection : Disinfection of the excreta and articles used by the patient will prevent
the spread of infection. Disinfection must be done both when the patient is suffering
from the disease and after recovery or death.
8. Blocking of Transmission : Most of the diseases spread through water, air and
insect. So adequate measures should be taken to prevent the spread of infection
through these channels.
(i)    Water borne infections can be prevented by boiling water and also milk.
(ii)   Air bone infections can be prevented by wearing masks, isolating the
       patient in a separate room, dust control and disinfection of air.
       (iii)  Insect born diseases can be prevented by using suitable insecticides.
9. Immunisation : It is a very effective and easy method by which communicable
diseases can be prevented. The diseases which can be effectively controlled by
immunisation are small pox, poliomyelitis, diphtheria, whooping cough, tetanus,
tuberculosis and measles.
10. Health Education : The public should be thought about the importance of
maintaining a clean environment. immunisation etc. It involves the responsibility of
paramedical persons and the cooperation of the public.
HOSPITAL ACQUIRED INFECTION
Hospital infections : (Hospital – acquired infections or nosocomial infections) : There
are infections developing in hospitalized patients which were not present at the time of
their admission. These infections produce their symptoms either during hospital stay or
after discharge. These infections may occur during diagnostic or treatment procedures.
Features predisposing for hospital infections :
        1. Improved defence mechanism of the patient due to diseases.
        2. contaminated hospital environment.
        3. Asepsis in hospital procedures.
        4. Resistance of hospital infections to drugs and antibiotics.
        5. Increased risk of infection from other patients.
Types of hospital infections :
        1. Wound infections like those of post- operative wound infections and infections
           caused by injections.
        2. Urinary tract infections which may occur due to catheterization.
        3. Respiratory infections which occur due to aspiration, pulmonary ventilation or
           instrumentation.
        4. Bacteremia and septicemia which are caused by infected intravenous
           canulae.
Prevention and control :
B. Pharm – IIIrd Sem – Lecture Notes
Kanpur Institute of Technology & Pharmacy (550)                                     Page 29
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         1. Diagnosis by routine bacteriological methods like smear, culture and
             sensitivity testing.
         2. When an outbreak occurs, the source is identified and eliminated. The
             sources may be hospital staff, water, air or food.
         3. Sterilisation techniques must be tested. A defective autoclave or sterilizer must
             be repaired or replaced.
         4. Infection control teams may be established in hospitals. These teams should
             consist of microbiologists. This team should investigate outbreaks. Also it should
             monitor admission, treatments, sterilisation, disinfection etc.
                                   PHARMACOECONOMICS
         Economics : It is the study of how men and society end up choosing with or without
the use of money to employ scare productive resource that could have alternative use
produce varies commodities and distributes them for consumption now or in future among
various groups and society.
Pharmacoeconomics :
It is a sub field of health economics. The field of pharmacoeconomics consist of comparing
outcomes (decimal, economic and cost (resource consumption) of pharmaceutical product,
program and service to the next best alternative from select perspective.
Pharmacoeconomics refers to the practice of pharmacy in relation to the economic
challenges being faced by pharmacy practitiones to discover new therapies.
The continuing effect of cost-containment is causing administrators and policy makers in all
pharmacy fields to examine closely the costs and benefits of both proposed and existing
programs.
Therefore pharmacoeconomics is the scientific discipline that compares the value of one
pharmaceutical drug or drug therapy to another. It is a sub-discipline of Health economics.
A pharmacoeconomic study evaluates the cost (expressed in monetary terms) and effects
(expressed in terms of monetary value, efficacy or enhanced quality of life) of a
pharmaceutical product. There are several types of pharmacoeconomic evaluation as :
cost-minimization analysis, cost-benefit analysis, cost-effectiveness analysis and cost-utility
analysis. Pharmacoeconomics studies serve to guide optimal healthcare resource
allocation, in a standardized and scientifically grounded manner.
Scope of Pharmacoeconomics :
          Cost Benefit Analysis
The use of CBA is not a new concept in evaluating health programs. CBA is a basic tool
that can be utilized to improve the decision-making process in the allocation of funds to
health and other programs. Although the overall concept of CBA is simple, many of the
methodological considerations require a certain degree of technical expertise to apply CBA
appropriately.
         CBA evolved from the need to ascertain estimates of the costs and benefits of public
and benefits of public investment projects. Expenditures for health care should produce net
social benefits for the public. CBA technique can be applied to make such resource
allocation decisions in the health-care field. Economists have indicated that medical care is
both an investment good and a consumption good. When considered an investment good,
medical care is an investment in human capital.
         In economic terms, the present value of a person’s lifetime. Productivity is generally
considered the appropriate measure of the benefit from investment in human capital.

B. Pharm – IIIrd Sem – Lecture Notes
Kanpur Institute of Technology & Pharmacy (550)                                        Page 30
UNIT – V (PHARM 235)                                        HEALTH EDUCATION & RATIONAL DRUG THERAPY




Measuring Costs and Benefits :
       The economic benefits of a health program are defined as the reduction in costs
realized because of the implimentation of that program. The conventional classification of
these costs is threefold: direct, indirect and intangible.

Direct Costs :
       Direct costs are defined as the portion of costs currently borne that are associated
with spending for health services; they represent potential expenditures in the use of health
resources. Direct benefits are estimations of savings on direct costs. Direct costs include
those costs incurred before diagnosis and hospitalization, during hospitalization, during
convalescent care, and during continued medical surveillance.

Intangible Costs :
        Intangible costs of ill health are difficult, if not impossible, to measure. These costs
may be described as the psychic costs of disease such as those incurred from pain,
suffering, and grief.
        The measurement of such intangible benefits poses an almost insuperable task.

Discount Rates :
        Cost-benefit methodology is based on certain assumptions; it is important to have
these assumptions clearly in mind before proceeding. The basic assumptions of CBA are
these :
        1. it is possible to separate one service from another service in a sensible way.
        2. There is a possibility of choice between the interventions.
         3. It is possible to estimate the outcomes associated with each service.
         4. It is possible to value these outcomes.
         5. It is possible to estimate the cost of providing each service.
         6. These costs and benefits can be weighed against each other.
         Using these assumptions, there are several mathematical methods for developing a
         benefit-to-cost ratio. All have the same objective, but they differ in the way in which
         they handle the data mathematically. The most common method is the following
         calculation :
                                           n

                                          [B /(1  r ) ]
                                          t 1
                                                  t
                                                       t

                   Cost Benefit Ratio      n

                                          [C /(1  r ) ]
                                          t 1
                                                  t
                                                       t



        Where Bt = total benefits for time period t Ct – total costs for time period t, r =
discount rate, and n = number of time periods. The decision criterion is as follows :
If B/C > 1,    then benefits exceed costs and program is socially valuable.
If B/C = 1,    then benefits equal costs.
If B/C < 1,    then benefits are less than costs; therefore, program is not socially
               beneficial.
The major problem with selecting this method is in choosing r, the discount rate that was
discussed earlier.
B. Pharm – IIIrd Sem – Lecture Notes
Kanpur Institute of Technology & Pharmacy (550)                                             Page 31
UNIT – V (PHARM 235)                                  HEALTH EDUCATION & RATIONAL DRUG THERAPY



A second equation used in CBA relates to the logical concept of net present value (NPV)
represented in the equation below.
                                n
Benefits - costs  NV   [( Bt  Ct ) /(1  r )t ]
                               t 1
Cost-Effectiveness Analysis : In CEA, costs are calculated in dollars, but alternative ways
are then compared for achieving a specific set of results such as blood pressure or life-
expectancy changes. The objective the constraint that similar output measurements must
be achieved to compare interventions. Thus, CEA is applied to health matters in situations
for which the program’s inputs can be readily measured in dollars, but the program’s
outputs more appropriately stated in terms of the health improvement created (e.g., life
years extended).
Calculations for A Pharmacoeconomic Consult :




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Kanpur Institute of Technology & Pharmacy (550)                                       Page 32
UNIT – V (PHARM 235)                              HEALTH EDUCATION & RATIONAL DRUG THERAPY




Outcomes and Quality-of-Life - Measurement Approaches
Basic-outcomes list
       Death
       Disease
       Disability
       Discomfort
       Dissatisfaction
Major quality-of-Life domains
       Physical status and functional abilities
       Psychological status and well-being
       Social interactions
B. Pharm – IIIrd Sem – Lecture Notes
Kanpur Institute of Technology & Pharmacy (550)                                   Page 33
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       Economic status and factors
Expanded outcomes List
       Clinical endpoints
       Symptoms and signs
       Laboratory values
       Death
Functional parameters
       Physical (activities)
       Mental (depression)
       Social (friends)
       Role (work)
General well-being
       Pain
       Energy/fatigue
       Opportunity (future)
       Life satisfaction
Satisfaction with care
       Access
       Convenience
       Financial coverage
       Quality
       General
Sample of instruments for outcomes measurement
       Generic instruments – Sickness Impact Profile (SIP), Nottingham,
               Quality of well Being (QWB), Medical outcome Study (MOS)
       Specific instruments – Pain, Arthritis, Epilepsy, Cancer
Pharmacoeconomics Results :
        A key effect that pharmacy needs to give more attention to is the idea that the
gratest benefit we can generate for society as a whole is to target and take more
responsibility towards decreasing mortality, not just decreasing morbidity.
It is hoped that the new reimbursement plans will include incentives to decrease patient
mortality rates and improve quality of life.
        Pharmacy practitioners and managers must consider cost benefit and cost
effectiveness based on the outcomes and the effects that pharmacy services provide.
There are several ways that pharmacy can produce positive outcomes. For example,
pharmaceutical services can
      decrease morbidity in patient populations;
      increase the percentage of patients in therapeutic control;
      reduce the costs of the treatment by use of more efficient modes of therapy;
      reduce the number of physician visits;
      reduce the rate of hospitalization attributable to or affected modes of therapy;
      reduce the number of physician visits;
      reduce the rate of hospitalization attributable to or affected by the improper use
        of drugs;
      contribute to better use of health manpower by utilizing computers and
        technicians.


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Kanpur Institute of Technology & Pharmacy (550)                                     Page 34
UNIT – V (PHARM 235)                                          HEALTH EDUCATION & RATIONAL DRUG THERAPY




      decrease the incidence and intensity of iatrogenic disease, such as adverse drug
       reaction.
Pharmacoeconomic evaluation : Pharmaceconomics evaluation are on two basic
question
        1. Are there two or more alternatives
          2. Do the intervention examine costs and health effects.
There are the five types of economic evaluation :
         1. Cost-minimization Analysis (CMA)
         2. Cost-effectiveness Analysis (CEA)
         3. Cost-benefit Analysis (CBA)
         4. Cost-utility Analysis (CUA)
         5. Cost-consequence analysis (CCA)
                                                  ______________




B. Pharm – IIIrd Sem – Lecture Notes
Kanpur Institute of Technology & Pharmacy (550)                                               Page 35
UNIT – V (PHARM 235)                                 HEALTH EDUCATION & RATIONAL DRUG THERAPY




                                     RATIONAL DRUG THERAPY
Defining Rational Use of Drugs
        The terms “appropriate” and “rational” use of drugs will be used interchangeably
throughout the session. What is rational use of drugs? What does rational means?
People may have different perceptions and meanings regarding rational use of drugs, or
more specifically regarding rational prescribing. However, the Conference of Experts on
the Rational Use of Drugs, convened by the World Health Organization in Nairobi in
1985 defined that :
        “Rational use of drugs 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 the lowest cost to them and their community.”
        This is very much a medical model definition.
        These requirements will be fulfilled if the process of prescribing is appropriately
followed. This will include steps in defining patient’s problems (or diagnosis); in defining
effective and safe treatments (drugs and non-drugs); in selecting appropriate drug,
dosage and duration; in writing a prescription; in giving patients adequate information;
and in planning to evaluate treatment responses.
        The definition implies that rational use of drugs, especially rational prescribing
should meet certain criteria as fallows :
        Appropriate indication : The decision to prescribe drug(s) is entirely based on
medical rationale and that drug therapy is an effective and safe treatment.
        Appropriate drug : The selection of drugs is based on efficacy, safety, suitability
and cost considerations.
        Appropriate patient : No contra-indications exist and the likehood of adverse
reactions is minimal, and the drug acceptable to the patient.
        Appropriate information : Patients should be provided relevant, accurate,
important and clear information regarding his or her condition and the medication(s) that
are prescribed.
        Appropriate monitoring : The anticipated and unexpected effects of
medications should be appropriately monitored.
        Unfortunately, in the real world, prescribing pattern do not always conform to
these criteria and can be classified as inappropriate or irrational prescribing Irrational
prescribing may be regarded as “pathological” prescribing, where the above-mentioned
criteria are not fulfilled. Common patterns of irrational prescribing, may, therefore be
manifested in the following forms :
        The use of drugs when no drug therapy is indicated, e.g., antibiotics for viral
upper respiratory infections,
        The use of the wrong drug for a specific condition requiring drug therapy, e.g.,
tetracycline in childhood diarrhea requiring ORS,
        The use of drugs with doubtful/unproven efficacy, e.g., the use of antimotility
agents in a cute diarrhea.
        The use of drugs of uncertain safety status, e.g., use of dipyrone (Baralgan, etc.),
        Failure to provide available, safe, and effective drugs, e.g., failure to vaccinate
against measles or tetanus failure to prescribe ORS for acute diarrhoea.


B. Pharm – IIIrd Sem – Lecture Notes
Kanpur Institute of Technology & Pharmacy (550)                                      Page 36
UNIT – V (PHARM 235)                                        HEALTH EDUCATION & RATIONAL DRUG THERAPY



       The use of correct drugs with incorrect administration, dosages, and duration,
e.g., the use of IV metronidazole when suppositories or oral formulations would be
appropriate.
       The use of unnecessarily expensive drugs, .e.g., the use of a third generation,
broad spectrum antimicrobial when a first-line, narrow spectrum, agent is indicated.
       Some examples of commonly encountered inappropriate prescribing practices I n
many health care settings include :
                       Overuse of antibiotics and anti-diarrhoeals for non-specific childhood
                        diarrhoea.
                       Indiscriminate use of injections, e.g., in malaria treatment,
                       Multiple drug prescriptions,
                       Excessive use of antibiotics for treating minor ARI.
               Minerals and tonics for malnutrition.
Consumers may have a very different prespective as what is rational.
The drug use system is complex and varies from country to country. Drugs may be
imported or manufactured locally. The drugs may be used in hospitals or health centers,
by private practitioners and often in a pharmacy or drug shop where OTC preparations
are sold. In some countries, all drugs are available over the counter! Finally, the public
includes a very wide range of people with differing knowledge, beliefs and attitudes
about medicines.
Factors Underlying Irrational Use of Drugs
       There are many different factors, which affect the irrational use of drugs. In
addition, different cultures view drugs in different ways, and this can affect the way
drugs are used.
       The major forces can be categorized as those deriving from patients, prescribers,
the workplace, the supply system including industry influences, regulation, drug
information and misinformation, and combinations of these factors.

 Patients – drug misinformation      misleading beliefs
                                     patient demand/expectations
 Prescribers – lack of education and Inappropriate role models
 training                            lack of objective drug information
                                     generalization beliefs about drugs
                                     efficacy
 Workplace – heavy patient load          - pressure to prescribe
                                                       -   lack of adequate lab capacity
                                                       -   insufficient staffing
 Drug Supply System – unreliable drug shortages
 suppliers                               expired drugs supplied
 Drug Regulation-non-essential available non-formal prescribers
                                         lack of regulation enforcement
 Industry promotional activities         misleading claims

B. Pharm – IIIrd Sem – Lecture Notes
Kanpur Institute of Technology & Pharmacy (550)                                             Page 37
UNIT – V (PHARM 235)                               HEALTH EDUCATION & RATIONAL DRUG THERAPY



All of these factors are affected by changes in national and global practices. For
example, the frequent use of injections is declining in many. African countries because
of the feat of AIDS. In some countries, however, the use of injectables remains high due
to false assumption of prescribers that injections will improve patient satisfaction and
that they are always expected by the patients.
Impact of Inappropriate Use of Drugs
        The Impact of this irrational use of drugs can be seen in many ways :
        Reduction in the quality of drug therapy leading to increased morbidity and
mortality,
        Waste of resources leading to reduced availability of other vital drugs and
increased costs.
        Increased risk of unwanted affects such as adverse drug reactions and the
emergence of drug resistance, e.g., malaria or multiple drug resistant tuberculosis.
        Psychosocial impacts, such as when patients come to believe that there is “a pill
for every ill”. This may cause an apparent increased demand for drugs.
                                     ________________




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Kanpur Institute of Technology & Pharmacy (550)                                    Page 38

				
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