Pharmacy law and Ethics

1. Clinical Pharmacy and Pharmacy
Law & Ethics
SELF-MEDICATION
DRUG ABUSE & DEPENDENCE

2. Self-medication
 It means the medication process or treatment of a disease which is not
prescribed by the physician is self-medication. Here, the prescription is
made by the patient or the drugs that are used for the treatment are chosen
by the patient. When a physician suffers from a disease the prescription
order written by the physician himself is also self-medication.
Benefits of self-medication
 Quick medication
 To relief from mental anxiety or physical discomfort (pain/fever)
 To experience benefits of medication (sleeping pill)
 Economic that is one can avoid physician visiting charge

3. Limitations of self-medication
 In case of self-medication proper diagnosis of
disease is not possible and
 So, proper treatment is not always done.
 In disease state a patient cannot understand
himself and mentally confused, nervous and
depressed
 Leading to the wrong diagnosis and wrong
prescriptions which may endanger patient life.
 Most importantly a patient is not a specialized
person and lack of knowledge.
 So, one should not have self-medication.

4. Dangers of self-medication
1. Complications of the treatment:
Normally, it takes 2 to 3 days to get sign of
relieving a particular disease. In case of self-
medication the patient wants prompt relief and for
this purpose he/she takes more drugs than
normally required. This increases the no. drugs
intake and ultimately creates complications.
2. Suicidal tendency:
Many people have attempted suicide by self-
medication. Over-enthusiastic medication without
medical advice can endanger patient life eg.
sedatives or hypnotics.

5. Contd.
3. Drug resistance:
In case of self-medication, antibiotics are used either
overdoses or insufficient doses and the treatment
course is not completed. So, this misuse of antibiotics
leads to a generation of resistant organisms which
may infect others in the population and infections are
very difficult to treat.
4. Habituation and drug dependence:
By self-medication, the patient gets overdoses of
sleeping or tranquilizing pills and thus drug habit is
formed to them. This leads to drug dependence-
addiction, and it is a nuisance to the family and to the
society.

6. Contd.
5. Poisoning, toxicity or adverse drug reactions:
If a potent drug is taken accidentally or overdose of
drug is taken then drug poisoning or toxicity occurs.
Again, if the drugs taken are contraindicated or not
suitable for the patient then drug adverse effects
develop. Examples-
(a) If aspirin is taken in overdoses for a long time, it
may cause gastric ulceration with severe bleeding –
causes drowsiness or coma, and it produces
respiratory alkalosis, metabolic acidosis- fatal effect.
(b) Penicillin may cause drug fever, rash, even
anaphylactic shock (hypotension, bronchospasm).

7. Contd.
6. Drug induced disease:
Self-medication produces drug induced disease from a
disease. Example- Streptozotocin is an anticancer drug
(pancreas) produces diabetes as a result of excessive
destruction of beta-cells.
7. Drug-drug interactions:
In self-medication drug-drug interaction is ignored which
may leads to toxic effects or no effects of drug.
8. Dose & dosage regimen:
Self-medication- dose, dosage regimen etc. is not exactly
maintained. So, one will not get the desired effect of
medication.

8. Prescription
Prescription is an authorized order for medication issued by a
physician. Includes- medication, dose, dosage form, interval, drug-
food interaction etc.
 Single drug prescription
A single drug is prescribed for the treatment of specific diseases. It
requires the skillness of the physician to find out the primary cause
of a specific disease. This primary cause is responsible for
secondary trouble.
 In iron deficiency anemia, the primary cause of disease is the
deficiency of iron which is associated- loss of appetite, body weight
loss, generalized weakness and growth retardation.
 The secondary troubles are the characteristics symptoms of the
primary disease. In such case disease, a single drug- iron
preparation is prescribed.

9. Requirement for single drug
therapy
 Single drug therapy requires the skillness of the physician to
find out the particular cause of the disease. The physician
should have vast knowledge about pharmacology, physiology,
toxicology and pathology.
Advantages of single drug therapy
 Economy
 No drug-drug interaction
 Very less adverse effects
 No confusion in taking drug since only one drug is
prescribed.

10. Drug Abuse and Drug Dependence
Every society has a history of use of drugs that affect mood, thought and feeling and
behavior. Even drugs used for therapeutic purposes have opportunity of causing
dependence.
Drug Abuse:
 Drug abuse refers to the inappropriate, excessive and persistent use of a drug for non-
therapeutic purposes. It means the use of a CNS active drug usually by self-medication
of the drugs in a manner that deviates from the acceptable medical and social use in a
given society.
 The term conveys social disapproval of the manner and purpose of drug use.
The purpose of drug abuse includes-
 To relive anxiety, tension, depression, for recreation.
 Drug abuse is a dangerous thing in that sequentially it can leads to drug dependence.
 Firstly, a person simply takes a drug
 It produces drug habituation
 Then, it results in drug addiction
 Lastly, drug dependence.

11. Class of Commonly Abused Drugs:
1. Opioids (morphine, heroine, codeine, pathidine)
2. CNS depressants (ethanol, benzodiazepines)
3. Psychostimulants (caffeine, nicotine, amphetamines,
cocaine)
4. Cannabinoids (Gaza, Marijuana)
5. Phenothiazine
Drug Misuse:
Drug misuse means taking a drug other than CNS
active drug for a wrong indication, in a wrong dosage,
for a duration other than the medical prescribed.

12. Tolerance Vs Cross-tolerance:
 Tolerance:
It is form of drug resistance induced by exposure of
the individual to the drug in question. If a drug is
taken repeatedly, it is likely to become progressively
less effective so that the dose has to be increased to
get the same original effect.
 Cross-tolerance:
The tolerance that develops to some drugs also causes
tolerance of drugs of the same pharmacological class.
This is the phenomenon cross tolerance.

13. Drug Habituation:
It is a condition resulting from the repeated consumption of a
certain drug.
It is characterized by-
 Less intensive involvement with the drug
 Withdrawal syndrome is mild (discomfort)
 Psychological dependence on the effect of drug (no physical
dependence).
Example- consumption of tobacco, tea, coffee and social
drink etc.
 Addiction & habituation imply different degrees of
psychological dependence.

14. Drug Addiction:
It is a state of chronic intoxication produced by the repeated
consumption of drug.
Its characteristics –
 An over powering desire or need (compulsive) to continue the
drug and to obtain by any means
 Procuring the drug and using it takes precedence over other
activities
 A tendency to increase the dose
 A psychic (sleep/euphoria) and physical dependence
(neuroadaptation) on the effect of drug.
 Withdrawal syndrome
Examples- Amphetamines, cocaine, cannabis, LSD (lysergic
acid diethylamide) etc.

15. Drug Dependence
 Drugs are capable of altering mood and feelings
are liable to repetitive use to derive euphoria,
withdrawal from reality, social adjustment etc.
 It results from the interaction between drug and
person due to repeated, periodic or continuous
administration of the drug.
 Example- Morphine, heroine, pathedine, cocaine,
codeine and alcohol.
Drug  Habituation Addiction  Dependence

16. 1. Psychological dependence:
It is a condition in which a drug produces optimal
state of well being and a psychic drive that require
continuous administration of the drug to produce
pleasure or to avoid discomfort.
Characteristics includes-
 Liking for the drug effects (psychic effect of drug)
 To avoid discomfort of drug
 May progress to compulsive (periodic/continuous) use
of drugs
 Tolerance may or may not develop
 Withdrawal symptoms characterized by psychic
disturbances like headache, restlessness, emotional
upset and convulsion.

17. 2. Physical dependence:
It is a physiological state produced by repeated administration
of a drug which requires the persistent presence of the drug to
maintain physiological equilibrium.
Characteristics includes-
 Discontinuation of the drug results in a characteristics
withdrawal syndrome which is manifested by physical
disturbances.
 Physical dependence cannot occur without tolerance.
 It is an altered or adaptive physiological state of body
(neuroadaptation- adapt nervous system to function normally
in the presence of the drug).
 Examples- Opioids, barbiturates, depressants like alcohol,
benzodiazepines.
Stimulants like amphetamine, cocaine produces little or no
physical dependence.

18. General Treatment of Drug Dependence
Drug dependence once developed, difficult to treat. A full co-
operation is necessary from the individual.
The principles of treatment are-
1. Gradual or sudden withdrawal of the drug. Abrupt withdrawal is
possible without any harm for the drugs not producing physical
dependence.
2. Specific substitution therapy is based on the advantage of
development of cross tolerance. Drugs which produce cross
tolerance and less severe side effects may be given eg. methadone
replaces morphine.
3. Psychotherapy and occupational therapy.
4. Specific drug therapy for example in case of alcohol poisoning a
drug antabuse (propietery: disulfirum) is used. Alcohol is
metabolized to acid and then to aldehyde. The end product aldehyde
is responsible for the severe condition. Antabuse helps in treatment
of alcohol by blocking the metabolism of alcohol to aldehyde.
5. Correction of nutritional deficiencies.
6. Community treatment and rehabilitation.