|
Individualization
of Drug Therapy
Sedentary
life style, laborious work schedules and several other factors have
necessitated judicious patient care and individualization of drug
therapy, where a pharmacist can play vital role, says Nitin Mahurkar
Pharmacist
as Consultant
Today
the latest concept in medicine is towards individualization of drug
therapy (IDT). We are aware of the fact that, the animal studies
extended to humans or in-vitro experiments extended to humans may
not produce the same clinical response. Similarly when two formulations
are given to two individuals with same disease, they may not produce
the same pharmacological responses or relief. In such situations
the management of drug therapy, its dosage regimen, design etc.
play an important role.
The
drugs especially with a narrow margin of safety carry the risk of
toxicity with them and pose more problems. Every individual is unique
creation with his/her own identity like, the mental built up, the
individual life style, the unique functional status of vital organs,
glands, the stress and stain experienced, which play a role in eliciting
the drug responses apart from all the well established theories
of geographic, demographic variations or pharmacokinetic, physicochemical
and physiological factors.
Rationalised
administration
Presently
the medicines are available in uniform dosage preparations, which
are rationalized for infants, children and adults. The formulations
are optimized and suitable overages and added in respective preparations
to take care of variations, so that there is neither over drugging
nor under dosage. Thus even though the dosage is generalised it
is not individualized. Such rationalized preparations are not available
for aged and the elderly.
The
unmonitored or erratic use of these drugs may cause toxic and untoward
effects in many. Considering the dosages for adult category which
varies from 12-60 years generally, the dosage regimen usually remains
the same. These variations at times can become too wide to cause
toxicities if the therapy is prescribed as per optimized unit preparations
available or the prescription remains unchecked without taking into
consideration individual factors.
Even
if we categorise the individuals with 8-10 years of variation in
each group, namely, 12-20 years in group-I, 21-30 years in group
II etc, we can find wide variation in physiological factors within
and between each group like, heart rate, blood pressure, pulse rate,
respiration etc. The pulse in tall persons is generally slower than
the short persons (Avg. 60/min in tall persons with 5.8’ or
more to 66-67 in short person 5.3’ or less). The sex variation,
pregnancy state and menstrual cycle also affects the pulse rate.
Variations in height, weight can also be noted in these groups.
The weight variation among the same group may vary from 55-85 kg
generally, which has a gap of 30 kgs besides the overweight (obese)
and underweight category. Apart from these, the occupational status,
financial status, the temperament, outlook of life, the supportive
environment at home or working place, negative or positive attitude
can also influence the drug therapy.
Bad
habits
Habit
forming agents like smoking, alcohol also affect the drug therapy
substantially. In many instances the management of therapy can get
complicated also. The influence of these agents varies from person
to person. In case of smokers, there is a wide variation from a
habit of 2-3 cigarettes to 10-20 cigarettes (or even more than 20)
per day and among alcoholics also, there is a wide variation in
consumption and consumption pattern. Similarly tobacco chewing also
alters the drug response. All these factors can bring changes in
functioning of vital organs such as liver lungs, kidney etc. and
the dosage prediction further becomes difficult for them. Even the
common beverages like tea, coffee can also influence the response
to drugs. Sedentary life style or laborious work schedules may also
affect the drug therapy. It has been found that in certain individuals
or during beginning stages of a disease, a subtherapeutic dose of
the drug may be therapeutically effective. Eq. Phenytoin, carbamazepine
therapy in epileptics has been reported for this and on the other
hand in some, higher dose of the drug may produce the desired effect
without toxic effects.
Pharmacists’
role
All
the above factors necessitate judicious patient care and this is
where individualisation of drug therapy (IDT) becomes a need, and
a pharmacist can play a vital role in this. A physician who is per-occupied
with patient diagnosis, treatment, surgery, supervision etc. may
find it difficult to spare time for patient counselling regarding
pharmacoeconomics, drug information, diet counselling, supportive
therapy, alternative therapy, indigenous drugs, moral supporting
etc.
A
pharmacist can set up a separate consultation room/cabin in his
pharmacy and or independently can start only a consultation pharmacy
service or hire the service of a competent pharmacist for the same.
He can store the details of patient history, allergies, previous
exposure to drugs, presently used drugs, drug profiles, their interactions,
storage and stability, left-over medicines, signs of improvements,
signs of allergies or toxicities and such other details necessary
for therapy, namely, blood pressure, pulse, height, weight etc.
A computer would facilitate the storage, access and retrieval of
the data as and when needed.
These
services can be offered by fixing prior appointment with patients
and can be charged for services from patients. This would help the
patients in getting additional healthcare services and also help
the pharmacists to generate a better revenue and employment. Many
professional pharmacists can take up this either as a full time
career or in their evening hours as a part time service and utilise
their professional skills and knowledge for the benefits of the
society.
Presently
these kind of services and therapeutic drug monitoring service are
available in developed countries and super specialty hospitals in
our country for patients in metro cities only who are undergoing
organ transplant, major surgeries etc. and not for general population
undergoing acute to chronic treatment for various day-to-day ailments.
This is a right and ripe time for a pharmacist to enter this a venue
he can pick up these services and make a career in this faculty
and practice the profession independently like architects, engineers,
advocate, doctors etc.
The
writer is Asst. Professor with HKE’s College of Pharmacy, Gulbarga
|
