Pharmacotherapy

Dr. R. Setiaji, M.Sc

Dept. of Pharmacology
Hasanuddin University

Topics of discussion

Guide line of rational

pharmacotherapy
Source of information
Implementation pharmacotherapy in
immunologic disorders (Assignment)

Problem and Diagnosis

Follow previous lecture

Choose Treatment

Determine first choice treatment

Give advice
Treat without drug
Treat with drug: P-drug
Refer for treatment
Combination

Check suitability for the patients

P-drug

Personal drug choices from all drugs

available
Practical, avoid repeated searches
Priority choice for certain
indications

How to select P-drugs

Specify diagnosis
Define therapeutic objective
Make inventory of groups. Group1,Group2 etc
Compare according to criteria
Efficacy
safety suitablity
Group1
Group2
Choose a group
Group X
Choose a P-drug
Efficacy
safety suitablity
Group X
Drug1
Drug2
Drug3
Active substance
..
Dosage form

Dosage schedule

Duration

cost

cost

Active substance
Pharmacodynamic
Effect
Side effect

Pharmacokinetic
Posologi

Check suitabilty of PDrug

Active substance
Dosage
Schedule
Duration

Start Treatment

Write prescription
Give information, instruction and
warning

Monitor Treatment

Monitor
Stop

Diagnosis

Main symptom:erythematous plaque

Other data:
At wrist
Warm
Itchy
Painless on pressure
Relapse after washing

Find Possible diagnosis

DD

A
B
C

Main
Other Other
complai data data
nt

Data
confir
m
X

Mechanism?
DD

A
B
C

Main
Other Other
complai data data
nt

Data
confir
m
X

Mechanism?

Group of drug

Active substance

Erythematous
Plaque

Table 55-1. Descriptions of Primary Skin Lesions

Macule: A flat, colored lesion, <2 cm in diameter, not raised above the surface
of the surrounding skin. A "freckle," or ephelid, is a prototype pigmented
macule.
Patch: A large (>2 cm), flat lesion with a color different from the surrounding
skin. This differs from a macule only in size.
Papule: A small, solid lesion, <1 cm in diameter, raised above the surface of
the surrounding skin and hence palpable (e.g., a closed comedone, or
whitehead, in acne).
Nodule: A larger (1-5 cm), firm lesion raised above the surface of the
surrounding skin. This differs from a papule only in size (e.g., dermal nevus).
Tumor: A solid, raised growth >5 cm in diameter.
Plaque: A large (>1 cm), flat-topped, raised lesion; edges may either be distinct
(e.g., in psoriasis) or gradually blend with surrounding skin (e.g., in
eczematous dermatitis).
Vesicle: A small, fluid-filled lesion, <1 cm in diameter, raised above the plane
of surrounding skin. Fluid is often visible, and the lesions are often translucent
[e.g., vesicles in allergic contact dermatitis caused by Toxicodendron (poison
ivy)].
Pustule: A vesicle filled with leukocytes. Note: The presence of pustules does
not necessarily signify the existence of an infection.
Bulla: A fluid-filled, raised, often translucent lesion >1 cm in diameter.
Cyst: A soft, raised, encapsulated lesion filled with semisolid or liquid
contents.
Wheal: A raised, erythematous papule or plaque, usually representing shortlived dermal edema.
Telangiectasia: Dilated, superficial blood vessels.

Source: Harrison Principle of Internal Medicine15th edition

DD
Atopy D
psoariasis

Contact
D

plaqu interfin
e
ger

itch

confirm
ation

Each Diagnosis

Clinical feature
Laboratory
Treatment
Anatomy/Histology, Physiology,
Pathology, other related theory
Hypersensitive type
Etc

How to select P-drugs

Specify diagnosis
Define therapeutic objective
Make inventory of groups. Group1,Group2 etc
Compare according to criteria
Efficacy
safety suitablity
Group1
Group2
Choose a group
Group X
Choose a P-drug
Efficacy
safety suitablity
Group X
Drug1
Drug2
Drug3
Active substance
..
Dosage form

Dosage schedule

Duration

cost

cost

Chronic Running
Nose

DD

rhinore Post
nasal
drip

R. Alergy

R vasomotor

Polyp

Atopic Confirm
hystor examina
y
tion
x

Reevaluate Each
Diagnosis

Clinical feature
Hypersensitive Mechanism
Laboratory
Treatment
Prognosis

Assignment

Make list of drug groups for:

Allergic rhinitis
Allergical Contact dermatitis
Atopy Dermatitis
Allergic asthma bronchiale

List of active substance, dosage, schedule,

duration, side effects and contra
indications.

Clue

Open your Harrison Principle of

Internal medicine CD
Type in your diagnosis
Find out the diseases mechanism
Take a note of possible available
drug group
Organize it in your List of P-Drug