World Health Organization's List of Essential Medicines

burton117

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Here's one of the the smallest and perhaps most important formulary lists out there in terms of number of people that it should be used to treat.

Any recommendations or discussion on why certain drugs are on here is welcome as well or why shouldn't some drugs be?

If you guys could direct me to any articles or resources which discuss the essential medicines that every person in the world shoud have access to, that would be really cool.

I am curious to see what you pharmacy students/ pharmacists have to say about this formulary and its relevance to your scope of practice.
 

jdpharmd?

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I just looked quickly, but...

no diphenhydramine, no loperamide, no NSAIDS?

Edit: I found some NSAIDS...
 

28657

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I looked quickly too, but....

amitryptiline instead of SSRIs?
streptokinase instead of ateplase?
 

Sosumi

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I haven't read through the entire list, but I've been surprised by some of them. Ether for general anesthetics -- I thought that's only used now for teaching purposes? No methotrexate for disease modifying agents? None of the newer quinolones or antibiotics? Weird how they prefer really old drugs with numerous side effects still like chloramphenicol, spectinomycin, and ergotamine. I guess for world-wide use, older and cheaper drugs are much preferred.

Some notable exceptions that I didn't see on the list are Lortab (#1 retail drug in U.S.), fluconzaole, and lisinopril. I can understand Lortab not on there when codeine or morphine will do, but I wonder why captopril was chosen over lisinopril?
 

dgroulx

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AmandaRxs said:
I looked quickly too, but....

amitryptiline instead of SSRIs?
streptokinase instead of ateplase?
For clot busting, streptokinase is the drug of choice in Europe, where in the USA tenectaplase is preferred. Most of the drugs seemed to be geared towards Europe - Paracetamol was listed instead of Tylenol which was a big clue.
 

MNnaloxone

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My thought (through a congested and still asleep head)--Most of the ACEi trials used captopril? If you could only choose one...wouldn't you choose the one you knew the most about?
 

28657

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dgroulx said:
For clot busting, streptokinase is the drug of choice in Europe, where in the USA tenectaplase is preferred. Most of the drugs seemed to be geared towards Europe - Paracetamol was listed instead of Tylenol which was a big clue.
Hmm...we didn't even really learn about tenectaplase. We were told tPA(ateplase) is the drug of choice for clot busting.
As for streptokinase being the DOC in Europe...that doesn't really make sense. SK can cause allergic reactions and shouldn't be used if the patient has previously had strep throat. Why mess with these dangers when there are safer drugs? I researched it a little and found that NICE, the UK's version of the NIH says this....

The National Institute for Clinical Excellence (United Kingdom)

"In summary, given the evidence on clinical effectiveness in the hospital setting it can be concluded that: standard alteplase is as effective as streptokinase, reteplase is at least as effective as streptokinase, and tenecteplase is as effective as accelerated alteplase."

Although the newer drugs cost substantially more than streptokinase, economic evidence of longer-term costs and outcomes such as strokes and heart failure showed that the newer drugs were likely to be cost effective compared with streptokinase.


....so I would imagine SK isn't the DOC, although it does say that SK is used most often. :)
 

dgroulx

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AmandaRxs said:
Hmm...we didn't even really learn about tenectaplase. We were told tPA(ateplase) is the drug of choice for clot busting.
As for streptokinase being the DOC in Europe...that doesn't really make sense. SK can cause allergic reactions and shouldn't be used if the patient has previously had strep throat. Why mess with these dangers when there are safer drugs? I researched it a little and found that NICE, the UK's version of the NIH says this....

The National Institute for Clinical Excellence (United Kingdom)

"In summary, given the evidence on clinical effectiveness in the hospital setting it can be concluded that: standard alteplase is as effective as streptokinase, reteplase is at least as effective as streptokinase, and tenecteplase is as effective as accelerated alteplase."

Although the newer drugs cost substantially more than streptokinase, economic evidence of longer-term costs and outcomes such as strokes and heart failure showed that the newer drugs were likely to be cost effective compared with streptokinase.


....so I would imagine SK isn't the DOC, although it does say that SK is used most often. :)
You really didn't learn about tenectaplase? That's pretty much all that is used in hospitals down here. At least, it is the drug on their formulary. Of course, we have more retired people per capita than any other state and probably use it more. :laugh:

SK will be used more often because of socialized medicine. You don't get the best, just the cheapest.
 

28657

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dgroulx said:
You really didn't learn about tenectaplase? That's pretty much all that is used in hospitals down here. At least, it is the drug on their formulary. Of course, we have more retired people per capita than any other state and probably use it more. :laugh:

SK will be used more often because of socialized medicine. You don't get the best, just the cheapest.
But the newer generation of drugs were found to be more cost effective than SK?!?!?! How do I get to be the decision maker of socialized medicine formularies? :laugh:

As for tenecteplase, I haven't been in the clinical setting enough to know what is actually used. However, the professor who taught us the "virtues" of ateplase is the only pharmacy professor in the nation that offers a cardiology residency. So I'm pretty sure in his hospital tPA is used most.
 

ultracet

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AmandaRxs said:
But the newer generation of drugs were found to be more cost effective than SK?!?!?! How do I get to be the decision maker of socialized medicine formularies? :laugh:

As for tenecteplase, I haven't been in the clinical setting enough to know what is actually used. However, the professor who taught us the "virtues" of ateplase is the only pharmacy professor in the nation that offers a cardiology residency. So I'm pretty sure in his hospital tPA is used most.
We did tPA and SK not tenecteplase.... i'm sure it was probably mentioned but it was not in our algorhithms for treatment nor emphasized in classes at all..
 

dgroulx

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bbmuffin said:
We did tPA and SK not tenecteplase.... i'm sure it was probably mentioned but it was not in our algorhithms for treatment nor emphasized in classes at all..
Ours was just the opposite. We covered them all but tenectaplase was preferred because of the single dosing. Our lecturer is a PharmD who works in the ED of Shands hospital, so we pretty much focused on what is actually used there. This is one of the few areas where we were told that the textbooks sections were not to be used, just his lecture notes. He also teaches at UF med school. Tenectaplase is a newer drug and has single dosing. They did a study in their hospital and found that nursing would sometimes miss the next dosing on the other drugs. I'm doing a rotation at a large hospital chain in the Tampa Bay area and they also are using Tenectaplase. Generally, QD drugs will be used when they have the same efficacy as the drug with the more complicated dosing regimen.