Selecting P-drugs for a given clinical case - Competency based Skill

1. To prepare a list of P- drugs for a given case/condition
Dr. Kopal Sharma
Senior Demonstrator, Pharmacology
SMS Medical College

2. S.No Competency Name Level Suggested
Teaching
Method
1 PH 3.5 To prepare and explain a list of
P- drugs for a given
case/condition
P Skill Station

3. At the end of the learning session, the students will be able:-
• To choose P-Drug for various diseases.
• To effectively explain the choice of selecting the P-Drug.

4. Introduction
• P-Drugs are the drugs chosen by a physician to be prescribed regularly and with
which the physician has become familiar. They are his/her priority choice for
given indications.
• The selection of P-Drugs will vary from physician to physician and country to
country as a number of factors contribute towards its selection.

5. • For example:
- cost of the drug
- its availability in a particular region
- medical cultural aspects
- individual interpretation and understanding of information about a drug or class.

6. Selection of P-Drug involves five basic steps
1. Define the diagnosis
2. Specify the therapeutic objective
3. Make an inventory of the effective groups of drugs
4. Choose and effective group according to criteria
5. Choose a P-Drug

12. Clinical Case
A 40 years old man moderately obese is diagnosed case of mild
hypertension with BP 146/94. There is also left ventricular enlargement
in this patient. Choose P- drug for this patient.

13. 1) Define the diagnosis
Mild hypertension
2) Specify therapeutic Objective
Maintaining BP <140/90
3) Make inventory of the effective groups.
- ACE inhibitors
- AT receptor antagonists
- Diuretics
- Beta blockers
- Calcium channel blockers

14. 4) Choose a group according to criteria
Therapeutic
Group
Efficacy Safety Suitability Cost
ACE inhibitors
(tablet)
++ ++ ++ -
Beta blockers + + + -
Diuretics + + ++ +
CCBs + + + +

15. Choose a P-drug
Therapeutic
Group
Efficacy Safety Suitability Cost
Captopril
(tablet)
+ + - +
Ramipril
(tablet)
+ ++ ++ +
Lisinopril
(tablet)
+ + ++ +

16. • Active substance, dosage form: Ramipril, tablet 5 mg
• Dosage Schedule: 1 tablet OD
• Duration: length of monitoring interval

17. Exercise
Ques. A 42 years old woman is diagnosed case of hypertension with BP 150/96.
There is also coexisting anxiety in this patient. However the lipid profile is normal
for this patient. Choose P- drug for this patient.

20. Clinical Case
Ques. A 31 years old female patient came to OPD with a complaint of headache
from past one day. She explained that she had headache in the frontal region. She
also reported nausea with no vomiting or diarrhoea. According to the patient the
pain got worst on going out in sunlight. This was the second episode of attack of this
type in this patient. Choose a P-drug for this patient.

21. 1) Define the diagnosis
Mild migraine
2) Specify therapeutic Objective
Reliving the patient from pain
3) Make inventory of the effective groups.
- Simple analgesics/ NSAIDs
- Anti-emetics

22. Choose a P-drug
Therapeutic
Group
Efficacy Safety Suitability Cost
Paracetamol + ++ + +
Ibuprofen + + + +
Naproxen + + ++ +
Diclofenac + + +

23. Drug therapy for migraine
Severity Drug therapy
Mild Simple Analgesics/NSAIDs or their combinations (+ antiemetic)
Moderate NSAIDs combinations/ a triptan/ ergot alkaloids (+ antiemetic)
Severe • a triptan/ ergot alkaloids (+ antiemetic)
+Prophylaxis
• Propranolol/ other beta blockers
• Amitriptyline/ other tricyclic antidepressants
• Flunarizine/ other Calcium channel blockers
• Valproate/topiramte

25. Consistency is defined as the proportion of patients with a response (or pain free) in
at least 2 or 3 of 3 actively treated attacks.

26. Exercises
Q1. A 50 year-old male patient complains of bloody, mucoid stools and abdominal
pain. There is no history of alcohol abuse. You have diagnosed it as a case of acute
amoebic dysentery. Choose a P-drug for this patient.

27. THANK YOU