International Journal of Basic & Clinical Pharmacology
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Drug utilization study in patients visiting psychiatric OPD in tertiary care hospital
Get PDFBackground: The illness due to psychiatric diseases and behavioral disorders is enormous, but it remains under represented by conventional public health statistics; which mainly targets mortality more than morbidity or dysfunction. The drug utilization study was conducted to find out problems and provide feedback to prescribers so as to create awareness about irrational use of drugs. This study was conducted in psychiatry outpatient department (OPD) of a tertiary care hospital.Methods: A prospective, observational and cross-sectional study was conducted in Department of Pharmacology in collaboration with department of psychiatry in a tertiary care hospital. Patients fulfilling the inclusion criteria visiting psychiatric OPD from 01 October 2018 to 31 December 2018 period of 3 months were enrolled in the study. Assessment of the prescriptions was done as per the ICD-10 criteria and World Health Organization-indicators for rational use of drugs (WHO-INRUD).Results: Among total 390 prescriptions; 71.54% was males and 28.46% were females. All the drugs were oral formulations. The burden of diseases are depression 35.89%, anxiety 20.51%, schizophrenia 18.97% and bipolar disorder 11.28% and other psychiatric diseases were 13.33%. Olanzapine was the most common drug which was prescribed followed by alprazolam. Total 1,140 drugs were prescribed out of which 86.32% was psychotropic drug and 13.68% were other like vitamin B-complex, analgesics, anta-acids, antibiotics and NSAIDS. The Most common prescribed class was atypical antipsychotics 26.31% followed by benzodiazepines 20.26%, antipsychotics 19.74%, tricyclic antidepressants 8.16%, anticonvulsants 9.21%, antiepileptics 2.37% and lastly selective serotonin reuptake inhibitors.Conclusions: Atypical antipsychotics was most commonly prescribed drug followed by benzodiazepines. All the drugs were prescribed by their generic names which suggests awareness among prescribers regarding WHO policies for generic prescribing
Appraisal and discernment of prevalent drug-drug interactions in patients with psychiatric disorders
Get PDFBackground: Drug-drug interactions (DDIs) contribute majorly to hospital admissions, treatment failures, avoidable medical complications and subsequent healthcare costs. Thus, we employ a mechanistic approach to prospectively investigate the incidence of potential DDIs in the psychiatric patients in a clinical setting.Methods: In this prospective, observational, multi centred study conducted for a span of 6 months, psychiatric inpatients (≥18 years) prescribed with 2 or more medications daily for any medical illness were included. The secured prescriptions of the inpatients selected in accordance to the inclusion criteria were then assessed for DDIs using Micromedex(TM) as a standard.Results: Of the total 400 enrolled participants, 383 (95%) of them showed at least one pDDI regardless of the severity. An average of 7.33 interactions per patient was also deduced. A high prevalence of pDDIs totalling to 2900 was recorded in our study with an average of 7.33 interactions per patient. Most of the interactions were of major (56.52%) and moderate severity (39.07) followed by contraindicated (2.55) and minor (1.83). Cardiovascular system (41.77%) had the highest potential to be affected due to the pDDIs identified. Trihexyphenidyl, haloperidol, promethazine, amisulpride, risperidone, divalproex, trifluoperazine, olanzapine and clozapine where among the most commonly encountered drugs in these interactions.Conclusions: A high prevalence of pDDIs totalling to 2900 was recorded in our study with an average of 7.33 interactions per patient. A significant association of the pDDIs with variables such as age, gender, diagnosis and total number of drugs used was identified. More studies are required to explore the overall pattern of DDIs in psychiatric patients along with their levels and correlation with different risk factors. Careful monitoring and documentation are necessary to prevent further complications thereby improving the therapeutic outcome
Antibiotic resistance situation in Dhaka, Bangladesh: a review
Get PDFAntibiotic resistance is global trouble and in the megacities, it is causing more rapidly due to the misuse and overuse of antibiotics. This systematic evaluation used to be carried out to summarize the contemporary day kingdom of affairs of antibiotic resistance in Dhaka, to emerge as aware of gaps in close observation, and to prink tips primarily based on honesty and surely on the findings. Google scholar, PubMed, and Bangladeshi journals online have been searched for the use of applicable key phrases to select articles connected to antibiotic resistance in Dhaka, Bangladesh published between 2004 to 2020. The resistance of a bacterium to a given drug was once added as the median resistance and interquartile fluctuate. Forty-one articles have been blanketed in this systematic review. Antimicrobial susceptibility trying out used to be once as quickly as carried out via disk diffusion approach in 97.56% of studies, at the equal time as the clinical and laboratory standards institute suggestions had been accompanied in 92.68%. Data concerning the susceptibility attempting out method and furnish of sickness (hospital/community) had been absent in 12.19%, 10.52%, and 90.24% of the research, respectively. An excessive prevalence of resistance used to be detected in most examined pathogens, and many of the normal first-line pills have been the most importantly ineffective. Resistance to carbapenems was once low in most cases. An excessive incidence of resistance to most antibiotics used to be detected, alongside necessary gaps in surveillance and facts gaps in the methodological data of the show up to be up
Medication omissions in the first 48 hours after admission: failure in prescribed medicines reaching in-patients in paediatrics wards at the University Teaching Hospitals, Children’s Hospital in Lusaka, Zambia
Get PDFBackground: The first few days of in-patient care are possibly the most significant in a patient’s recovery and any omitted medications during this period may harm the patient or increase their hospital length of stay. Therefore, our study aimed at assessing the frequency of medication administration omission errors and their reasons for the omission in the paediatric wards after admission at University Teaching Children’s Hospital.Methods: This was a descriptive study in which 259 patient files and drug charts were reviewed. Admission prescription charts were studied in detail over a period of four weeks and all drugs prescribed but then not given in the first 48 hours were recorded as omitted medications, along with the reason given for their omission.Results: From the 259 drug charts, a total of 1598 doses of drugs were ordered within 48 hours of admission. However, from this, only a total of 1132 doses were administered with the remaining 466 doses omitted, which accounted for a frequency of 29.2%. When the frequency of medication omission errors was compared, parenteral drugs (70.8% vs. 25.3%, [p=0.0001]), afternoon shift (48.5% vs. 15.8%, [p=0.0001]), and anti-infective medications (69.1% vs. 39.4%, [p=0.0001]) were found to be the most frequently omitted medications. There were also considerably more medication omissions in patients prescribed with more medications (median number: 4, I QR [2, 6] vs. median number: 2, IQR [2, 4], [p=0. 0.001]). The most common reason for the omission was medication unavailability (89.3%), followed by work overload (71.4%), and the patient is off the ward (71.4%).Conclusions: This study revealed that medication omissions are a continuing problem and this may result in increased morbidity and mortality rates. There is a need to put in place specific strategies to reduce this problem.
Comparison of efficacy and safety of topical luliconazole with topical fluconazole against tinea corporis in a tertiary care hospital
Get PDFBackground: Dermatophytosis is a common cutaneous infection worldwide with prevalence varying from 20% to 25%. Luliconazole is a newer topical antifungal applied once daily with greater reservoir property in stratum corneum. Objective of the study was to compare the clinical efficacy and safety of luliconazole 1% cream with Fluconazole 1% cream in patients with mild to severe grades of tinea corporis.Methods: A total of 100 patients with mycologically confirmed tinea corporis were randomised into group A and B respectively. Group A, 50 patients received luliconazole 1% for 2 weeks and group B, 50 patients received fluconazole 1% cream for 4 weeks. Patients were clinically and mycologically evaluated on 0, 2nd and 4th week of treatment and followed up on 8th week for any relapse.Results: Significant improvement in efficacy was seen in Luliconazole while compared with fluconazole group against tinea corporis infection. Mycological cure and clinical improvement showed significant difference in group A. The safety and tolerability profile of both groups were good and statistically comparable.Conclusions: Luliconazole 1% cream is found to be safe, effective and tolerable with low incidence of relapse than fluconazole 1% cream
Cost variation analysis of different brands of oral anti-epileptic drugs available in India
Get PDFBackground: Epilepsy is a group of neurological disorders, characterized by seizures, loss of consciousness, muscular contraction. Prevalence of epilepsy in India is about 1%. High medical care cost should be cause of concern for policy makers and service providers. Hence, a study was planned to analyse cost ratio and percentage cost variations of oral antiepileptic drugs available in India.Methods: An analytical study with maximum and minimum price of 10 tablets/capsules and syrup of one bottle of available strength of each drug was noted in Indian Rupee, using “Current Index of Medical Specialties” July to October 2020; “Drug Today” July To October 2020 volume-1 and “Indian Drug Review” 2020 volume-26 issue 6. Percentage cost variation and cost ratio for individual drugs was compared.Results: Significant cost variations were found in different brands of same drug. Among established oral antiepileptic drugs, Divalproex sodium 250 mg has highest cost ratio 16.071 and 1507.14% price variation and Clonazepam 0.25 mg with cost ratio 16.005 and 1500.55% price variation. Diazepam 2 mg has lowest cost ratio 1.024 and 2.43% price variation. Among newer oral antiepileptic drugs, Levetiracetam 500 mg has highest cost ratio 66.389 and 6538.93% price variation; least is Oxcarbazepine 450 mg with cost ratio 1.317 and 31.75% price variation.Conclusions: Epilepsy has long course of treatment. Increased adherence to treatment is achieved by switching to cost-effective therapy and by making Pharmacoeconomics an integral part of Undergraduate and Postgraduate Curriculum
Systemically administered central nervous system drugs induced ocular side effects: a review
Get PDFSeveral systemic drugs have reported ocular and visual side effects that affect patient management. It is imperative to be familiar with the associated side effects which can be mild or transient and may seriously threaten vision. This article deals briefly with the mechanisms and reasons that account for the impact that systemically administered central nervous system (CNS) drugs can exert on the visual or ocular system. The eye care practitioner can be instrumental in detecting and reporting ocular side effects, advising patients and collaborating with other members of the patient’s healthcare team. One of the difficulties include becoming familiar with the countless systemic medications prescribed to patients. Another is being able to correlate a particular side effect with a suspected drug. Several of the ocular adverse effects such as glaucoma, cataract, blurred vision, color vision, optic neuritis, maculopathy, dry eye, etc., are vision threatening and often patients fail to recognize or describe the symptoms appropriately. Therefore, physicians and paramedical members like staff nurses, clinical pharmacists and other members must make adequate observations while recommending these drugs to patients
Discarded old antibiotics as a new arsenal for multi-resistant isolates in diabetic foot ulcer infections: therapeutic value of parenteral colistin versus multi-resistant Pseudomonas species isolate strains: case report
Get PDFAntimicrobial resistance to current novel antibiotics is posing a major threat to both human and zoonotic life. In the absence of new novel antibiotics molecules, clinicians have resorted into a desperate last resort to review and re-introduce prior discarded antibiotics as their new weaponry in the fight against multi-resistant gram negative bacteria. We reported a case of a 77 year old bed ridden diabetic and hypertensive with renal impairment diagnosed with bilateral lower limbs wet gangrene. She underwent transfemoral on her right and transtibial amputation on her left lower limb. She developed surgical site infection on her right stump and wet gangrene on her left stump. Pus swab on her right stump revealed carbapenem resistant strains of Pseudomonas aeruginosa. She was instituted on parenteral colistin and showed no bacterial growth 7 days post treatment. She suffered an ischaemic cerebral vaso-occlusive stroke during her hospital stay. CT angiography of lower lung fields showed a large filling defect in the right main pulmonary artery extending to the lower lobe branches suggestive of right-sided pulmonary embolism. Our patient succumbed from her co-morbidities. Despite our patient succumbing to her multiple co-morbidities we reported this case to highlight the isolation of carbapenem resistant strains of P. aeruginosa and the efficacy and safety of colistin as a salvage antibiotic in renal impaired patients. Colistin can be safely used as a last reserve antibiotic for multi-resistant strains of P. aeruginosa infection even in patients with renal impairment
Automation in pharmaceutical sector by implementation of artificial intelligence platform: a way forward
Get PDFWorldwide, there are technological advances that swift automation in several aspects of the pharmaceutical industry such as pharmacovigilance, clinical research, medical affairs, and marketing. Innovative technology like artificial intelligence (AI) emphasizes the massive use of the internet for drug development, drug safety, data analytics, communication marketing, and customer engagement to achieve the goal of pharmaceuticals and patient-centric healthcare. Presently, escalating the number of individual case safety reports (ICSRs) necessitate the support of AI in the transformation of drug safety professional. AI can be transformed and evolve the clinical trial process from the conventional method alongside benefited the cutting cost, enhancing the trial quality, and alleviate trial time by almost half. Today, AI may be efficiently implemented to lower the cost of medical information requests, besides the online chatbots to communicate with health care professionals (HCPs) and consumers. There are numerous forthcoming uses of AI which need to be executed for renovation in the field of pharmaceuticals
Novel poly herbal muco-adhesive formulation for treatment of oral aphthous ulcer
Get PDFBackground: Oral ulcers are the most frequent lesions that cause discomfort for which the patients seek treatment for alleviating pain and facilitate early healing. Various treatment modalities from modern medicine and Ayurveda are used in the form of ointments and mouthwashes with varying efficacy. Anti-inflammatory medicines, enzymatic preparations, gamma globulins and immune suppressants have been used.Methods: Extracts of five chosen herbs, Glycyrrhiza glabra, Acacia catechu, Punica Granatum, Curcuma longa and Mentha piperita were used for preparing mucoadhesive gel for the treatment of oral aphthous ulcers of any etiology. Gel was prepared by cold method of Schmolka at M/s Pharmanza Herbals Pvt. Ltd., India. Five formulations were prepared with using different concentration of active pharmaceutical ingredient (API) extracts.Results: Formulations were analyzed for different physical and chemical properties. Preliminary trial was done with five formulations. The F5 formulation has the premier viscosity because of its higher polymer content; it is able to remain on mucous surface long enough to release its API effect. Since the uniformity, proper appearance, stability and acceptable viscosity and gel strength the F1 formulation was selected as the superior formulation which could prove ideal for treatment of oral aphthous ulcers.Conclusions: The results provide strong evidence that polyherbal gel containing extracts of Glycyrrhiza glabra, Acacia catechu, Punica granatum, Curcuma longa and Mentha piperita on the basis of their analgesic, anti-inflammatory, antioxidant, wound healing, antimicrobial and local anesthetic properties can be used as an effective and safe alternative for the management of aphthous ulcers