RESUMEN
The lack of (or poor) response to drugs has very important medical, social and economic consequences today. An unsatisfactory response to treatment implies not only a worsening or prolongation of the pathological state, but also prolonged hospitalisation, longer withdrawal from social and active life, and waste of community resources. Poor response to drugs has many and varied causes, among which 4 major categories can be identified: pharmacokinetic, cellular, genetic and medical. After a brief description of the terminology, the phenomena of tachyphylaxis, tolerance and drug resistance are analysed and critically described on the basis of the available evidence. Whenever possible, alternative or operative behaviours aimed at reducing the incidence of the above phenomena are commented on. On the question of medical causes, irrational prescriptions and poor compliance with the prescribed regimen stand as two major issues whose prevalence is worrying. In order to limit the waste of professional responsibility and economic resources, efforts aimed at reducing the present insufficiencies are needed at organisational and educational levels.
Asunto(s)
Resistencia a Medicamentos/genética , Quimioterapia/normas , Tolerancia a Medicamentos/genética , Farmacocinética , Taquifilaxis/genética , Regulación hacia Abajo , Utilización de Medicamentos , Humanos , Nitratos/efectos adversos , Nitratos/uso terapéutico , Cooperación del Paciente , Terminología como AsuntoRESUMEN
We describe a pharmacologic revision program in a military primary health-care facility, following the criteria of efficacy and safety proposed in the Spanish "Pharmacological guide for primary health care". After the revision, the number of products used dropped from 133 to 63, and the monthly expenditure in medicines from 940 to 300 pesetas/person. We have also calculated the daily defined dose per 1.000 inhabitants/day (DHD) in some drugs and compared them to others previously published. Some of our DHD were higher than those of other primary-health care groups. Therefore, we think that in rationalization programs on the use of medicines, the reduction of products to be prescribed is only the first part. Afterwards, DHD should be calculated, and, in case of being unjustifiably high, a revision of the indications should be undertaken.