International Journal of Basic & Clinical Pharmacology
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How ‘pill for every ill’-alarming source of polypharmacy in elderly patient
Get PDFAccording to WHO there is one elderly person i.e., age 60 year or older in every nine people and this value is expected to increase by 2050 accounting for about half of the total growth of the world population. This demographic transition poses a significant challenge for health care authorities as the age advances multiple chronic disease such as hypertension, DM, arthritis, chronic heart disease, renal disease come in to scenario. For the above-mentioned disease an elderly patient has to take life-long medications this leads to polypharmacy
A comparative study on the dependence potential of thienorphine and buprenorphine
Get PDFBackground: As part of research to discover partial opioid agonists for new treatments of opioid abuse and dependency, thienorphine, a buprenorphine analogue, was synthesised and reported to be a potent, long-acting oripavine in multiple mammalian models. Thienorphine binds non-selectively to μ-, δ-, and κ-opioid receptors, and partially stimulates μ- and/or κ-opioid receptors in vitro. Compared with buprenorphine, thienorphine exhibits better analgesic effects and has higher oral bioavailability. Poor oral absorption and dependence have hindered the use of buprenorphine for detoxification therapy and relapse prevention in the clinic. The addiction potential of thienorphine is unknown, and is worthy of in-depth investigation.
Methods: In the present study, we conducted a comparison of thienorphine and buprenorphine with respect to their physical and psychological dependence liabilities, using a naloxone-induced withdrawal test, a conditioned place preference test, and a self-administration experiment in rats.
Results: In contrast to chronic buprenorphine administration, we failed to observe any severe abstinence syndromes in mice or rats treated with thienorphine after naloxone challenge in a physical dependence model. Compared with the dependence potentials of buprenorphine, rats treated with chronic thienorphine did not show a place conditioning response, self-administration, or psychological dependence.
Conclusions: We demonstrated that thienorphine has a lower potential than buprenorphine for physical and psychological dependence. Our results indicate that thienorphine might be a good candidate to treat opioid addiction
Comparative evaluation of autologous platelet rich plasma and triamcinolone acetonide injection in the management of erosive lichen planus and oral submucous fibrosis: a clinical study
Get PDFBackground: It is need of an hour to establish an effective and efficient treatment modality for OLP and OSMF with lesser or no adverse effects. Platelet rich plasma can be used in mucosal lesions as it has a high concentration of various growth factors and anti-inflammatory properties. It could be a better novel substitute to the corticosteroid without any side effects. The present study is an effort to evaluate the therapeutic effects of intralesional injection of PRP in oral erosive lichen planus and OSMF compared to intralesional corticosteroids in the same patient.
Methods: It was a randomized controlled clinical study consisting of 40 patients between the age groups of 18-60 years visiting dental OPD diagnosed clinically with either erosive lichen planus or OSMF. Triamcinolone 40 mg(1mg/ml) mixed with 2% (1:80,000) lignocaine hydrochloride was injected into the lesion on one side in case of erosive lichen planus and into the submucosal plane and fibrous bands in case of OSMF patients. Autologous PRP was prepared and injected on the other side in same patients. At every visit, all the patients were evaluated for pain and burning sensations, size, and severity of the lesion, and interincisal mouth opening (mm). The parameters were measured and recorded during the patient’s every visit. All the results were obtained and statically analyzed.
Results: Intralesional injections of triamcinolone acetonide and PRP are effective in reducing pain and burning sensation in OSMF, but PRP is less effective in improving cheek flexibility as compared to triamcinolone acetonide. In OLP, both triamcinolone acetonide and PRP are almost equally effective in reducing the size of the lesion. However, PRP shows slightly better results in reducing the severity of the lesion and in pain and burning sensation in the patients of OLP as compared to intralesional triamcinolone acetonide.
Conclusions: Thus, PRP is an effective modality in treating both OSMF and oral erosive lichen planus with no adverse effects
A randomized controlled trial to compare ramipril and sacubitril/valsartan in post-acute coronary syndrome patients with left ventricular systolic dysfunction in terms of improvement in ejection fraction
Get PDFBackground: Ramipril and sacubitril/valsartan are used in the management of ACS patients with left ventricle systolic dysfunction. The objective of the study was to compare ramipril and sacubitril/valsartan in improving LVEF in post ACS patients with LVEF <40%.
Methods: A randomized, prospective, open label, comparative study was carried out in department of pharmacology and cardiology at Dr. R. P. G. M. C. Kangra at Tanda, Himachal Pradesh. The study was carried for a period of one and a half year. Out of 80 patients, 38 patients were in ramipril group and 42 were in sacubitril/valsartan group. Data was presented as mean±SD, frequency and percentage. Student’s t test and chi square test were used and p value<0.05 was considered significant.
Results: In both the groups, a statistically significant improvement was observed in terms of improvement in LVEF at 6th month when compared to baseline, however, at 6th month both the groups were comparable in terms of LVEF improvement with p value of 0.275.
Conclusions: The study concluded that both the drugs have same efficacy in improving LVEF in post ACS patients at 6th month
Evaluation of β-blockers dosage regimen rationality in heart failure patients
Get PDFBackground: β-Blockers are often associated with further cardiac function deterioration, ledding to them being often underused/underdosed by certain physicians in heart failure treatment, although they were seen to be beneficial in decreasing the rates of mortality and morbidity, duration of hospitalization in HFrEF patients, but data on their benefits in HFmEF and HFpEF patients is limited. Objective was to evaluate rationality of β-blockers’ dosage regimen and its effectiveness in HF patients.
Methods: 43 HF patients have been enrolled. Data were collected from the medication chart (dose, route, frequency); dosage regimen was evaluated and compared to that of ESC guidelines for HF treatment. Heart rates pre/post drug treatments, ejection fraction (at admission & post-discharge) were recorded; effectiveness was evaluated through heart rate control, reduction in: duration of hospitalization, rehospitalization and mortality rate. Post-discharge updates of the patients were obtained through out-patient consultation reports.
Results: In All 43 patients dosage regimen of selected β-Blockers was found to be rational and following the ESC guideline for HF treatment. 65% of patients spent not more than 5 days in the hospital, 16% Re-hospitalized for cardiovascular diseases, and death rate was 4%.
Conclusions: The dosage regimen of selected β-Blockers was found to be as per that of ESC-guidelines HF treatment. β-Blockers have also been found to have reduced: hospitalization stay, frequency of rehospitalization, and death rate among patients under study.
Drug utilization pattern evaluation and cost variation analysis of anti-fungal agents in tinea infected patients in dermatology department of a tertiary care teaching hospital
Get PDFBackground: Tinea infections are chronic superficial fungal infections, highly prevalent in tropical countries like India. Therefore, long-term therapy is needed and this can inflict a financial burden on the patients. Aim of the study was to assess drug utilization patterns in patients diagnosed with tinea infection and to evaluate the cost variability of anti-fungal agents.
Methods: A cross-sectional observational study was conducted in patients for 3 months after taking permission from IEC. All adult patients already diagnosed with tinea infection were enrolled. Evaluation of drug utilization pattern was carried out using WHO core drug prescribing indicators and percentage of cost variability was calculated between different brands of anti-fungal agents.
Results: A total of 252 patients were enrolled. Tinea corporis and cruris were the most commonly diagnosed tinea infection. Pruritus was the most common presenting symptom. Past history of similar illness was seen in 74 (29.4%) patients mean of 3.83±0.87 drugs were prescribed per patient. Drugs prescribed from NLEM was only 42.1%. Most commonly prescribed drugs were oral itraconazole and topical miconazole. Percentage of cost variability was seen maximum with capsule itraconazole 200 mg (237.5%) by oral route and luliconazole 30 gm (175.6%) by topical route.
Conclusions: Prescribing practices of drugs can be improved by promoting generic drug and prescribing drugs from NLEM. Wide range of cost variation can lead to high economic burden in tinea infected patients
Adverse drug reactions monitoring among breast cancer patients in a tertiary care teaching hospital
Get PDFBackground: Breast cancer is responsible for 13% of deaths among women globally. The present study aimed to assess adverse drug reactions (ADRs) in breast cancer patients receiving treatment in a tertiary care teaching hospital.
Methods: This retrospective and descriptive study was conducted in the oncology department at sree mookambika institute of medical sciences, Kulasekharam, covering six months from May 2022 to November 2022. The study includes patients of any age diagnosed with breast cancer, treated with chemotherapy, and who developed at least one ADR during or after treatment. Patients who developed ADRs due to fresh blood or blood product infusion and had a history of drug abuse or accidental poisoning were excluded from the study.
Results: Three hundred fifty-eight breast cancer patients were evaluated, of which 142 developed ADRs. The study revealed that breast cancer was most prevalent among women aged 41-50. Seven (4.92%) had a history of tobacco smoking, 129 (90.85%) patients were married, and only 13 (9.15%) were unmarried. The most commonly prescribed chemotherapeutic drug for breast cancer patients was docetaxel (19.01%), Cyclophosphamide (15.49%) and nab. paclitaxel (12.67%). The study found that the most frequent ADR observed among the patients was febrile neutropenia (18.30%), followed by nausea and vomiting 14.79%). Causality assessment reported that 61.27% (87) of the ADRs were probable, and 29.58% (42) were possible.
Conclusions: Spontaneous adverse drug reporting and structured management are essential for monitoring the safe use of drugs. The findings suggest the need for effective pharmacovigilance programs and improved patient care in administering chemotherapeutic agents
Association of proton pump inhibitors with renal dysfunction: a cross-sectional study
Get PDFBackground: Proton pump inhibitors are the most frequently prescribed class of medications for prescription and over-the-counter, and the data suggest that comorbidities, polypharmacy, self-medication, no clear indications and duration beyond the recommended guidelines PPIs use are associated with renal dysfunction. Aim was to study the proportion of renal dysfunction among patients using oral PPIs and determine the association between the duration of oral PPIs use and the severity of renal dysfunction.
Methods: The data collection of 250 patients was done at the time of contact, which included demographic profiles, complete medical history, physical examination, and laboratory investigation in this study. For analysis, name of oral PPIs used, duration and dosage of oral PPIs therapy, laboratory values of serum blood urea, serum creatinine, eGFR, and serum electrolytes parameters have been considered.
Results: Amongst 250 patients with PPIs used for a week, 23 patients showed mildly reduced kidney function (p=0.000), PPIs used for >1 to 2 weeks, 29 patients showed grade 2 kidney function (p=0.001), while PPIs used for >2-3 weeks only two patients showed grade 3 kidney function (p=0.44). Patients aged >50 years in all groups showed grade 2 renal function, regardless of the duration of PPIs use. Increasing age, males, rural, smoking, and alcoholics were the risk factors for renal dysfunction. PPIs use significantly impacts eGFR.
Conclusions: Collectively, this study found a significant association between PPIs use and renal dysfunction. PPIs used for >2 weeks in elderly patients have shown a 4−fold increased risk of developing renal dysfunction
Catastrophic consequences of the enormous use of hydroxychloroquine during COVID era on liver and kidney of male albino rats: an in-vivo study
Get PDFBackground: Hydroxychloroquine (HCQ) is mainly used for the treatment of malaria but during COVID trial, it was used against coronavirus though no history of the drug is known against SARS COV 2 or any other respiratory ailment. Many case studies showed the adverse effects on liver and kidney in many patients after the exposure of HCQ. The main aim of this study is to know the effect of HCQ drug on the liver and kidney of male albino rat at a range of human equivalent dose that was given during COVID period.
Methods: After institutional animal ethics committee (IAEC) approval, ten male albino rats were obtained and divided into two groups-control and treated. Treated groups receives HCQ through oral gavage for six days and then serum, tissue enzymes and total serum bilirubin were measured. Histopathological study was done from liver and kidney tissue. After that statistical analysis was done.
Results: We found significant increase in enzymes glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT) and alkaline phosphatase (ALP) in the HCQ-treated rats than in control and this signifies that there might be damages that occurred in liver and kidney. Increased level of bilirubin in HCQ-treated rats indicate hyperbilirubinemia and may be a sign of jaundice or any other hepatic disorder. From histopathological identification we also found liver and kidney tissues got damaged due to exposure of HCQ.
Conclusions: From this study, we can conclude that the exposure of this drug might have led to the impaired function of organs that could have potentiated their ill fate
Effect of combining estradiol valerate with sildenafil in increasing the thickness of the endometrium in infertile women before intrauterine insemination: a randomized clinical trial
Get PDFBackground: Therapies available for thin endometrium are limited and are mostly performed experimentally which most of these treatments have a similar function and increase blood flow to the endometrium, causing it to thicken and develop. The aim of the study was to compare the effect of estradiol valerate in combination with sildenafil on endometrial thickness in infertile women before intrauterine insemination.
Methods: In this randomized clinical trial 100 infertile women referred to Reyhaneh Infertility Center in Ardabil were randomly divided into two groups. Patients' endometrial thickness was assessed by vaginal ultrasound before treatment and then on day 9 of the cycle. The intervention group received one tablet of estradiol valerate every 12 h from the ninth day of menstruation for 4 days and sildenafil as 25 mg orally daily from day 9 to 12, but in the control group, patients received placebo tablets orally in addition to estradiol.
Results: There was no statistically significant difference between the intervention and control groups before and after the intervention in term of endometrial thickness. The rate of increase in endometrial thickness was 1.35 mm in the intervention group and 1.37 mm in the control group, but the difference was not statistically significant.
Conclusions: Estradiol valerate alone or in combination with sildenafil resulted in a significant increase in endometrial thickness and increasing oral sildenafil supplementation with oral estradiol valerate had no significant effect on increasing endometrial thickness