off record
Shaukat Ali Jawaid


What a Physician
should know about Drugs?


Rational prescribing not only saves cost but also helps prevent drug resistance particularly in case of antimicrobial agents which then increases the cost of healthcare manifold. Every practicing physician must ensure that he or she has the basic minimum following information about any drug they prescribe. Professional ethics also demand that all drugs prescribed must be indicated in that particular situation.

Firstly they must know the cost of the drug and treatment. The drug prescribed must be safe, effective and affordable by the patient. If an expensive drug is prescribed and the patient cannot afford it, it will result in non-compliance thus treatment failure.

Secondly they must know the safe and effective dose as well as duration of treatment which must be conveyed to the patient.  In some diseases like diabetes and hypertension, the patients require lifelong therapy hence the patients should be properly educated stating that there was no cure for these diseases and the drugs will help control the disease and also avoid complications.

Thirdly one must know the half-life of the rug.  In some diseases like Hypertension one needs twenty four hour blood pressure control. These patients also need more than two or three drugs to control their blood pressure. Hence either one should use effective combinations in appropriate dosage and also ensure that drugs are prescribed as such that blood pressure remain under control round the clock. Some antihypertensive agent can be prescribed in the morning while others can be advised in the evening.  In interventional cardiology procedures Heparin is used which has a very short half-life and if the procedure gets prolonged, one might require the second dose.

Fourthly one must know how the drug is excreted. If the drug being prescribed is excreted through kidney, do not prescribe it to patients with kidney disorders. Instead opt for a drug which is excreted through the liver. Similarly if the drug is excreted through the liver, avoid prescribing it to patients suffering from liver diseases.  The drugs which are excreted through kidney and liver both, are considered much safe.

Finally it is also important that one knows the known adverse effects, side effects of the drugs and drug-drug interactions. For example if a patient suffering from hypertension is prescribed ACE Inhibitor, it has a known side effect of cough which may develop in some patients. Hence, while prescribing ACEIs if the patients are not told beforehand about this side effect and is not educated properly, they may discontinue the drug therapy without consulting the doctor thus exposing himself/herself to dreaded complications. In certain conditions and particularly elderly patients are always taking too many drugs to take care of various disorders. Hence, some drugs might interfere with the efficacy of other class of drugs. As such all these facts must be kept in mind while prescribing various drugs.

After taking proper history and thorough clinical examination, give some time to the patient, listen to them instead of rushing to write the prescription. This will result in enhanced patient satisfaction and also earn you respect and patient’s gratitude.

Tail Piece: The leaves fall off trees and later reappear. Change is essential to our evolution as a civilization and it is necessary to our very survival. In fact change is humanity’s best friend.

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