2.1 2.2 chloral hydrate * diazepam * morphine * promethazine Analgesics, antipyretics, nonsteroidal anti-inflammatory drugs NSAIDs, drugs used to treat gout and disease-modifying agents
Trang 1Appendix hTheWorld Health Organization model list
of essential drugs'
We reprint the current list (by permission) Whilst
the WHO programme (revised 1999) was instituted
particularly to help less developed countries, the list
has interest and lessons for all societies facing, as they
now are, the problems of delivering economically
affordable health care to all We commend a study of
the list to our readers (see also p 18)
The list of essential drugs may be considered
against the background of the available marketed
medicines worldwide Any national or local group
of health workers wishing to produce a formulary
to provide for the needs of their own community
would be well advised to study the current version
in addition to other sources
A major standard reference work (Martindale 1996
The extra pharmacopoeia 31st edn., Pharmaceutical
Press, London), describes 62500 preparations or
groups of preparations from 17 different countries
1 WHO Drug Information Vol 13, No 4,1999
Explanatory notes
We print the list in full
Drugs marked* represent an example of a
thera-peutic group, i.e various other drugs could serve as
an alternative say, on cost grounds
Complementary drugs are for use where, for any
reason, drugs in the main list are unavailable, or there are exceptional medical circumstances, e.g bacterial resistance, rare disorders
Spelling of drug names The World Health
Org-anization devises recommended International Non-proprietary Names (rINN) These are becoming universal; most do not give rise to any confusion, but occasionally we insert an alternative name or spelling Not every entry in the list is discussed in this book Conversely, the book may give drug treatments for specific conditions that differ from those listed here
1.
1.1
1.2
1.3
Anaesthetics
General anaesthetics and
oxygen
ether, anaesthetic
halothane
ketamine
nitrous oxide
oxygen
* thiopental
Local anaesthetics
* bupivacaine
* lidocaine (lignocaine)
COMPLEMENTARY DRUG
ephedrine (in spinal
anaesthesia during
delivery to prevent
hypotension)
Preoperative medication and
sedation for short-term
procedures
atropine
2
2.1
2.2
chloral hydrate
* diazepam
* morphine
* promethazine
Analgesics, antipyretics, nonsteroidal anti-inflammatory drugs (NSAIDs), drugs used to treat gout and disease-modifying agents used in rheumatic disorders (DMARDs)
Non-opioids and NSAIDs acetylsalicylic acid (aspirin)
* ibuprofen paracetamol Opioid analgesics
* codeine
* morphine
2.3
2.4
3
COMPLEMENTARY DRUG
* pethidine Drugs used to treat gout allopurinol
colchicine Disease-modifying agents used in rheumatic disorders azathioprine
chloroquine cyclophosphamide methotrexate penicillamine sulfasalazine
Antiallergics and drugs used in anaphylaxis
* chlorphenamine
* dexamethasone epinephrine (adrenaline) hydrocortisone
prednisolone
Trang 24.1
4.2
5
6
6.1
6.3.1
6.1.2
6.1.3
Antidotes and other
substances used in
poisonings
Nonspecific
* charcoal, activated
ipecacuanha
Specific
acetylcysteine
atropine
calcium gluconate
deferoxamine
(desferrioxamine)
dimercaprol
* DL-methionine.
methylthioninium chloride
(methylene blue)
naloxone
penicillamine
potassium ferric
hexacyanoferrate(II) 2H 2 O
(Prussian blue)
sodium calcium edetate
sodium nitrite
sodium thiosulfate
Anticonvulsants/
antiepileptics
carbamazepine
* diazepam
ethosuxirnide
magnesium sulfate
phenobarbital (phenobarbitone)
phenytoin
valproic acid
COMPLEMENTARY DRUG
* clonazepam
Anti-infective drugs
Anthelminthics
Intestinal anthelminthics
albendazole
levamisole
* mebendazole
niclosamide
praziquantel
pyrantel
Antifilarials
diethylcarbamazine
ivermectin
COMPLEMENTARY DRUG
suramin sodium
Antischistosomals and other
antitrematode drugs
praziquantel
triclabendazone
6.2 6.2.1
6.2.2
6.2.3
6.2.4
6.3
COMPLEMENTARY DRUG oxamniquine
Antibacterials
Beta-lactam drugs
* amoxicillin
ampicillin benzathine benzylpenicillin benzylpenicillin
* cloxacillin phenoxymethylpenicillin procaine benzylpenicillin
RESTRICTED INDICATIONS
* amoxycillin + *clavulanic acid
ceftazidime
* ceftriaxone imipenem + cilastatin
Other antibacterials
* chloramphenicol
* ciprofloxacin
* doxycycline
* erythromycin
* gentamicin
* metronidazole nalidixic acid nitrofurantoin spectinomycin
* sulfadiazine
* sulfamethoxazole + trimethoprim trimethoprim COMPLEMENTARY DRUGS chloramphenicol clindamycin
RESTRICTED INDICATIONS
vancomycin
Antileprosy drugs
clofazimine dapsone rifampicin
Antituberculosis drugs
ethambutol isoniazid pyrazinamide rifampicin streptomycin
COMPLEMENTARY DRUG
thioacetazone Antifungal drugs amphotericin B
* fluconazole griseofulvin nystatin
COMPLEMENTARY DRUGS
flucytosine potassium iodide
6.4 6.4.2
6.4.2
6.5
6.5.1
6.5.2
6.5.3
6.5.4
6.5.5
Antiviral drugs
Antiherpes drug
aciclovir
Antiretroviral drugs
nevirapine zidovudine
Antiprotozoal drugs
Antiamoebic and antigiardiasis drugs
* diloxanide
* metronidazole
Antileishmaniasis drugs
* meglumine antimoniate
pentamidine COMPLEMENTARY DRUG amphotericin B
Antimalarial drugs (a) For curative treatment
* chloroquine primaquine
* quinine
COMPLEMENTARY DRUGS
* doxycycline (for use only
in combination with quinine)
mefloquine
* sulfadoxine + pyrimethamine
RESTRICTED INDICATIONS
artemether artesunate
(b) For prophylaxis
chloroquine doxycycline mefloquine proguanil (for use only in combination with chloroquine)
Antipneumocystosis and antitoxoplasmosis drugs
pentamidine pyrimethamine sulfamethoxazole + trimethoprim
Antitrypanosomal drugs (a) African trypanosomiasis
melarsoprol pentamidine suramin sodium
COMPLEMENTARY DRUG
eflorni thine
(b) American trypanosomiasis
benznidazole nifurtimox
Trang 37
7.1
7.2
8.
8.1
8.2
8.3
8.4
9
Insect repellent
diethyltoluamide
Antimigraine drugs
For treatment of acute attack
acetylsalicylic acid (aspirin)
ergotamine
paracetamol
For prophylaxis
* propranolol
Antineoplastic and
immunosuppressant drugs
and drugs used in palliative
care
Immunosuppressant drugs
* azathioprine
* ciclosporin (for organ
transplantation)
Cytotoxic drugs
asparaginase
bleomycin
calcium folinate
chlorambucil
chlormethine
cisplatin
cyclophosphamide
cytarabine
dacarbazine
daunorubicin
dactinomycin
* doxorubicin
etoposide
fluorouracil
levamisole
mercaptopurine
methotrexate
procarbazine
vinblastine
vincristine
Hormones and
antihormones
* prednisolone
tamoxifen
Drugs used in palliative care
The drugs are included in the
relevant sections of the model
list, according to their
therapeutic use, e.g.
analgesics
Antiparkinsonism drugs
* biperiden
levodopa + *carbidopa
10
10.1
10.2
I I
11.1
11.2
12
12.1
12.2
12.3
Drugs affecting the blood
Antianaemia drugs ferrous salt ferrous salt + folic acid (nutritional supplement for use during pregnancy)
folic acid hydroxocobalamin COMPLEMENTARY DRUG
* iron dextran Drugs affecting coagulation desmopressin
heparin sodium phytomenadione protamine sulfate
* warfarin
Blood products and plasma substitutes
Plasma substitutes
* dextran 70
* polygeline Plasma fractions for specific uses
albumin, human COMPLEMENTARY DRUGS
* factor VIII concentrate,
* factor IX complex (coagulation factors II, VII, IX, X) concentrate
Cardiovascular drugs
Antianginal drugs
* atenolol glyceryl trinitrate
* isosorbide dinitrate
* verapamil Antiarrhythmic drugs
* atenolol digoxin lidocaine verapamil COMPLEMENTARY DRUGS epinephrine (adrenaline) isoprenaline
* procainamide
* quinidine Antihypertensive drugs
* atenolol
* captopril
* hydralazine
* hydrochlorothiazide methyldopa
* nifedipine
12.4
12.5
12.6
13
13.1
13.2
13.3
13.4
* reserpine COMPLEMENTARY DRUGS prazosin
* sodium nitroprusside Drugs used in heart failure
* captopil digoxin dopamine
* hydrochlorothiazide Antithrombotic drugs acetylsalicylic acid (aspirin) COMPLEMENTARY DRUG streptokinase Lipid-lowering agents HMG Co-A reductase inhibitors (statins) have been shown to reduce the incidence
of fatal and non-fatal myocardial infarction, stroke and mortality (all causes), as well as the need for coronary artery bypass surgery Since no single drug has been shown to be significantly more effective or less expensive than others in the group, none is included in the model list; the choice of drug for use in patients at highest risk should be decided
at national level.
Dermatological drugs (topical)
Antifungal drugs benzoic acid + salicylic acid
* miconazole sodium thiosulphate COMPLEMENTARY DRUG selenium sulfide Anti-infective drugs
* methylrosanilinium chloride (gentian violet)
* neomycin + *bacitracin potassium permanganate silver sulfadiazine Anti-inflammatory and antipruritic drugs
* betamethasone
* calamine lotion
* hydrocortisone Astringent drugs aluminium diacetate
Trang 413.6
13.7
14
14.1
14.2
15
15.1
15.2
16.
Drugs affecting skin
differentiation and
proliferation
benzoyl peroxide
coal tar
dithranol
fluorouracil
* podophyllum resin
salicylic acid
urea
Scabicides and pediculicides
* benzyl benzoate
permethrin
Ultraviolet-blocking agents
COMPLEMENTARY DRUGS
topical sun protection agent
with activity against UVA
and UVB cream, lotion
or gel
Diagnostic agents
Ophthalmic drugs
fluorescein
* tropicamide
Radiocontrast media
* amidotrizoate
barium sulfate
* iohexol
* iopanoic acid
* propyliodone (for
administration only into the
bronchial tree)
COMPLEMENTARY DRUG
* meglumine iotroxate
Disinfectants and
antiseptics
Antiseptics
* chlorhexidine
* ethanol
* polyvidone iodine
Disinfectants
* chlorine base compound
chloroxyenol
glutaral
Diuretics
* amiloride
* furosemide (frusemide)
* hydrochlorothiazide
spironolactone
COMPLEMENTARY DRUG
* mannitol
17
17.1
17.2
*
17.3
17.4
*
17.5
17.6
*
17.7
17.7.1
17.7.2
18
18.1
*
18.2
18.3
18.3.1
*
*
*
*
*
28.3.2
Gastrointestinal drugs
Antacids and other antiulcer drugs
aluminium hydroxide cimetidine
magnesium hydroxide Antiemetic drugs metoclopramide promethazine Antihaemorrhoidal drugs local anaesthetic, astringent and anti-inflammatory drug Anti-inflammatory drugs hydrocortisone
sulfasalazine Antispasmodic drugs atropine
Laxatives senna Drugs used in diarrhoea
Oral rehy drat ion
oral rehydration salts (for glucose-electrolyte solution)
Antidiarrhoeal (symptomatic) drugs
codeine
Hormones, other endocrine drugs and contraceptives
Adrenal hormones and synthetic substitutes dexamethasone hydrocortisone prednisolone
COMPLEMENTARY DRUG fludrocortisone
Androgens COMPLEMENTARY DRUG testosterone Contraceptives
Hormonal contraceptives
ethinylestradiol + levonorgestrel ethinylestradiol + norethisterone levonorgestrel COMPLEMENTARY DRUGS levonorgestrel medroxyprogesterone acetate norethisterone enantate
Intrauterine devices
copper-containing device
18.3.3
18.4
*
18.5
*
18.6
*
18.7
18.8
19
19.1
19.2
*
19.3 19.3.2
19.3.2
Barrier methods condoms with or without spermicide (nonoxinol) diaphragms with spermicide (nonoxinol)
Estrogens ethinylestradiol Insulins and other antidiabetic agents
glibenclamide insulin injection (soluble) intermediate-acting insulin metformin
Ovulation inducers clomifene
Progestogens norethisterone COMPLEMENTARY DRUG medroxyprogesterone acetate Thyroid hormones and antithyroid drugs levothyroxine potassium iodide propylthiouracil
Immunologicals
Diagnostic agents tuberculin, purified protein derivative (PPD)
Sera and immunoglobulins anti-D immunoglobulin (human) antitetanus immunoglobulin (human)
antivenom serum diphtheria antitoxin immunoglobulin, human normal
rabies immunoglobulin Vaccines
For universal immunisation
BCG
diphtheria pertussis tetanus hepatitis B measles poliomyelitis
For specific groups of individuals
influenza meningitis mumps rabies rubella
Trang 521
21.1
21.2
21.3
21.4
21.5
22.
22.1
typhoid
yellow fever
Muscle relaxants
(peripherally acting) and
cholinesterase inhibitors
* alcuronium chloride
* neostigmine
pyridostigmine bromide
suxamethonium chloride
COMPLEMENTARY DRUG
vecuronium bromide
Ophthalmological
preparations
Anti-infective agents
* gentamicin
* idoxuridine
silver nitrate
* tetracycline
Anti-inflammatory agents
* prednisolone
Local anaesthetics
* tetracaine (amethocaine)
Miotics and antiglaucoma
drugs
acetazolamide
* pilocarpine
* timolol
Mydriatics
atropine
COMPLEMENTARY DRUG
epinephrine (adrenaline)
Oxytocics and
antioxytocics
Oxytocics
* ergometrine
oxytocin
22.2
23.
24
24.1
*
* 24.2 24.2.1
* 24.2.2
24.3
24.4
25
25.1
*
*
Antioxytocics salbutamol
Peritoneal dialysis solution
intraperitoneal dialysis solution (of appropriate composition)
Psychotherapeutic drugs
Drugs used in psychotic disorders
chlorpromazine fluphenazine haloperidol Drugs used in mood disorders
Drugs used in depressive disorders
amitryptiline
Drugs used in bipolar disorders
carbamazepine lithium carbonate valproic acid Drugs used in generalised anxiety and sleep disorders diazepam
Drugs used in obsessive-compulsive disorders and panic attacks
clomipramine
Drugs acting on the respiratory tract Antiasthmatic drugs aminophylline beclometasone epinephrine (adrenaline) ipratropium bromide salbutamol
25.2
26.
26.1
26.2
26.3
27.
theophylline COMPLEMENTARY DRUG
* cromoglicic acid (sodium cromoglycate)
Antitussives
* dextromethorphan
Solutions correcting water, electrolyte and acid-base disturbances
Oral rehydration oral rehydration salts (glucose-electrolyte solution)
potassium chloride Parenteral glucose glucose with sodium chloride potassium chloride
sodium chloride sodium hydrogen carbonate
* compound solution of sodium lactate
Miscellaneous water for injection
Vitamins and minerals
ascorbic acid
* ergocalciferol iodine
* nicotinamide pyridoxine
* retinol riboflavin
* sodium fluoride thiamine COMPLEMENTARY DRUG calcium gluconate
Appendix 2:The prescription
The prescription is the means by which medicines and efficacy and to prevent fraudulent misuse; full that are not considered safe for sale directly to the details will be found in national formularies and public are delivered to patients Its format is officially prescribers have a responsibility to comply with regulated to ensure precision in the interests of safety these
Trang 6Prescriptions of pure drugs or of formulations
from the British National Formulary (BNF)1 are
satisfactory for almost all purposes The composition
of many of the preparations in the BNF is laid down
in official pharmacopoeias, e.g British
Pharmaco-poeia (BP) There are also many national and
international pharmacopoeias
Traditional extemporaneous prescription-writing
art, defining drug, base, adjuvant, corrective,
flav-ouring and vehicle is obsolete, as is the use of the
Latin language Certain convenient Latin
abbrevia-tions do survive for lack of convenient English
substitutes (chiefly in hospitals where instructions
are given to nurses and not to patients) They are
listed below, without approval or disapproval
The elementary requirements of a prescription are that it
should state what is to be given to whom and by whom
prescribed, and give instructions on how much should be
taken how often, by what route and for how long or total
quantity to be supplied, as below.
1 Date.
2 Address of doctor
3 Name and address of patient: age is also
desirable for safety reasons; in the UK it is a legal
requirement for children under age 12 years
4 R
This is a traditional esoteric symbol2 for the
word 'Recipe' — 'take thou', which is addressed
to the pharmacist It is pointless; but since many
doctors gain a harmless pleasure from writing
it with a flourish before the name of a
proprietary preparation of whose exact nature
they are ignorant, it is likely to survive as a
sentimental link with the past
5 The name and dose of the medicine
Abbreviations Only abbreviate where there is
an official abbreviation Never use unofficial
1 Supplied free to all doctors practising in the UK National
Health Service.
2 Derived from the eye of Horus, ancient Egyptian sun god.
abbreviations or invent your own; it is not safe
to do so
Quantities (after BNF)
— 1 gram or more: write 1 g etc
— Less than 1 g: write as milligrams: 500 mg,
not 0.5 g
— Less than 1 mg: write as micrograms, e.g 100 micrograms, not 0.1 mg
— For decimals a zero should precede the decimal point where there is no other figure, e.g 0.5 mL, not 5 mL, or for a range, 0.5 to 1 g
— Do not abbreviate microgram, nanogram or unit
— Use millilitre, ml or mL, not cubic centimetre, cc
— Home/domestic measures, see below State dose and dose frequency; for 'as required', specify minimum dose interval or maximum dose per day
6 Directions to the pharmacist, if any: 'mix', 'make a solution' Write the total quantity to be dispensed (if this is not stated in 5 above); or duration of supply
7 Instruction for the patient, to be written on container by the pharmacist Here brevity, clarity and accuracy are especially important It
is dangerous to rely on the patient remembering oral instructions The BNF provides a list of recommended 'cautionary and advisory labels for dispensed medicines' representing a balance between 'the unintelligibly short and the inconveniently long', e.g 'Do not stop taking this medicine except on your doctor's advice' Pharmacists nowadays use their own initiative in giving advice to patients
8 Signature of doctor
Example of a prescription for a patient with an annoying unproductive cough
1,2,3, as above
4.9
5 Codeine Linctus, BNF, 5 ml
6 Send 60 ml
7 Label: Codeine Linctus [or NP] Take 5 ml twice a day and on retiring
8 Signature of doctor
Trang 7Computer-issued prescriptions must conform
to recommendations of professional bodies If
altered by hand (undesirable), the alteration must
be signed
Medicine containers Reclosable child-resistant
containers and blister packs are increasingly used,
as is dispensing in manufacturers' original sealed
packs containing a patient information leaflet
These add to immediate cost but may save money
in the end (increased efficiency of use, and safety)
Unwanted medicines Patients should be
encour-aged to return these to the original supplier for
disposal
Drugs liable to cause dependence or be the subject
of misuse Doctors have a particular responsibility
to ensure that (1) they do not create dependence, (2)
the patient does not increase the dose and create
dependence, (3) they are not used as an unwitting
source of supply to addicts To many such drugs
special prescribing regulations apply (see BNF)
Abbreviations (see also Weights and measures,
below)
a.c.: ante cibum before food
b.d.: bis in die twice a day (bid is also
used) BNF British National Formulary
BP British Pharmacopoeia
BPC British Pharmaceutical
Codex i.m.: intramuscular by intramuscular injection
IU International Unit
i.v: intravenous by intravenous injection
NP: nomen
propnum
o.d.: omni die
o.m.: omni mane
o.n.: omni nocte
p.c.: post cibum
p.o.: per os
p.r.: per rectum
p.r.n.: pro re nata
p.v.: per vagmam
proper name every day every morning every night after food
by mouth
by the anal/rectal route
as required It is best to add the maximum frequency of repetition, e.g Aspirin and Codeine Tablets, 1 or 2 prn, 4-hourly
by the vaginal route
q.d.s.: quater die sumendus
q or q.q.: quaque q.q.h.: quarta quaque hora q.s.: quantum sufficiat rep: repetatur
s.c.: subcutaneous s.o.s.: si opus sit
stat: statim t.d.s.: ter (in) die sumendus
4 times a day (qid is also
used)
every, e.g qq6 h = every 6 h every 4 hours
a sufficiency, enough let it be repeated, as in rep mist(ura), repeat the mixture
by subcutaneous injection
if necessary It is useful to confine sos to prescriptions
to be repeated once only and to use prn where many repetitions are intended immediately
3 times a day (tid is also used)
Weights and measures
In this book doses are given in the metric system, or
in international units (IU) when metric doses are impracticable
Equivalents:
1 litre (1 or L) = 1.76 pints
1 kilogram (kg) = 2.2 pounds (Ib) Abbreviations:
1 gram (g)
1 milligram (mg) (1 x 10~3 g)
1 microgram3 (1 x 10-6 g)
1 nanogram3 (1 x 10-9 g)
1 decilitre (dL) (1 x 10-11)
1 millilitre (mL) (1 x 10-31)
Home/domestic measures A standard 5 ml spoon and a graduated oral syringe are available Otherwise the following approximations will serve:
1 tablespoonful = 14 ml (or mL)
1 dessertspoonful = 7 ml (or mL)
1 teaspoonful = 5 ml (or mL)
3 Spell out in full in prescribing.
Trang 8Percentages, proportions, weight in volume
Some solutions of drugs (e.g local anaesthetics,
epinephrine/adrenaline) for parenteral use are
labelled in a variety of ways: percentage, proportion,
or weight in volume (e.g 0.1%, 1:1000,1 mg per mL)
Also, dilutions may have to be made by doctors at
the time of use Such drugs are commonly
dangerous in overdose and great precision is
required, especially as any errors are liable to be by
a factor of 10 and can be fatal Doctors who do not feel confident with such calculations (because they
do not do them frequently) should feel no embarrassment,4 but should recognise that they have a responsibility to check their results with
a competent colleague or pharmacist before proceeding
4 Called to an emergency tension pneumothorax on an intercontinental flight, two surgeons, who chanced to be passengers, were provided with lignocaine 100 mg in 10 ml (in the aircraft medical kit) They were accustomed to thinking in percentages for this drug and 'in the heat of the moment' neither was able to make the conversion Chest surgery was conducted successfully with an adapted wire coat-hanger as a trocar ('sterilised' in brandy), using a urinary catheter The patient survived the flight and recovered in hospital Wallace W A 1995 Managing in-flight emergencies: A personal account British Medical Journal 311: 374.