Indonesian Journal of Pharmacy
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A Survey on Medicine Shortage in Community Pharmacies in Yogyakarta Province, Indonesia
Get PDFAccess to quality healthcare has been considered an apolitical objective on a global scale. Despite this, there are occasionally shortages of medicines because they are not always readily available. A drug supply problem that necessitates a change that affects patient care and requires the use of an alternative agent is known as a medicine shortage. A shortage can occur at any point during a medicine's lifecycle and in any part of the pharmaceutical distribution chain (pharmacy, pharmaceutical company, or wholesaler). This research aims to evaluate the availability of medications in pharmacies in Special Region of Yogyakarta. A cross-sectional survey was conducted in 120 pharmacies in Yogyakarta province, during March to May 2022. WHO essential medicine indicators were used to observe the list of medicine shortage, and its characteristics, including the reasons for medicine shortages in pharmacies, classification of unavailable drugs, and the consequences of medicine shortages. Data were presented descriptively. There were 650 drug items (a total of 1560 items) in one month that were unavailable at 91 pharmacies (75.83%) at least once every six months. The active ingredients that are in short supply are atorvastatin (44.17%), diazepam (21%), azythromycin (13.33%), and haloperidol (13.21%). The medications that were in high demand were also the ones that were in short supply. The reasons for the medicine shortages were rarely communicated to the pharmacies. Customers were able to fill their prescriptions since there were usually enough alternatives. But every third time, there were problems at the pharmacy because there weren't enough medicines. Due to the potential for unhappy customers and increased workload for the pharmacy staff, these shortages may be significant for both the customer and the pharmacy.
 
Cytotoxicity Screening of Endophytic Fungi from Phaleria macrocarpa (Scheff) Boerl) Collected in Yogyakarta District
Get PDFCancer is a disease that is a global problem with a high prevalence and mortality rate. Indonesia has biodiversity with enormous potential as a source of medicinal ingredients. Phaleria macrocarpa (Scheff) Boerl) It is known to contain active metabolites, potentially an anticancer. Some endophytes are reported to be able to produce secondary metabolites similar to their parent plants. This study aimed to obtain endophytic fungi from P. macrocarpa capable of producing compounds with anticancer potential. Endophytes producing anticancer compounds were explored by screening endophytic fungi producing secondary metabolites from parts of the plant P. macrocarpa collected in the Yogyakarta area. The anticancer bioassay (MTT assay) was performed in vitro using cancer cells T47D, MCF7, HeLa, and normal Vero cells. Potential extracts were traced for their mechanism of cell cycle modulation and apoptosis using Flowcytometry. First, fungal identification was carried out on fungi producing potential cytotoxic extracts. Then the compound content was analyzed using LC-HRMS. The results from the six extracts obtained from fruit, leaf, and stem parts showed that the endophytic extract from the leaves (code PC-L2) had the best cytotoxicity compared to other endophytes and showed the best result on MCF-7 cells with an IC50 value of 110.66 µg/mL. The producing PC-L2 extract fungi are closely associated with Clonostachys wenpingii strain DUCC5606. This extract induced apoptosis but not through the mechanism of cell cycle modulation
Antidiabetic Activity of Averrhoa bilimbi L. Fruit Extracts and the Identification of Active Compounds Using LC-MS and In silico Methods
Get PDFPatients with diabetes mellitus require drugs that do not cause side effects in long-term use. In this era, many people use herbal medicine to treat diabetes mellitus. One species we can use as herbal medicine is Averrhoa bilimbi L., a plant whose fruit is known as belimbing wuluh and is used because it has value as an alternative medicine. This study aims to determine the antidiabetic activity of the active fraction of Averrhoa bilimbi L. fruit in vitro and in silico and to obtain the active compounds contained in the fruit fraction of starfruit (A. bilimbi L.) using Liquid Chromatography Mass Spectrometer (LC-MS). Sixteen organic compounds were identified using LC-MS analysis of the n-hexane fraction, which had the highest IC50 (7.03 μg/mL) antidiabetic activity compared to ethyl acetate (102.77 μg/mL) and n-butanol (181.65 μg/mL). In silico molecular docking, analysis was performed for all identified compounds to support the antidiabetic characteristics further. Computational predictions in this investigation revealed that two A. bilimbi fruit compounds with the greatest RT value, namely 2,3,4,5,6-pentaphenylbenzazocine (-16.0 kcal/mol) and Thraustochytroside A (-6.2 kcal/mol), exhibited higher binding affinity values than miglitol (-5.4 kcal /mol). This indicates that both compounds have promising futures as α-glucosidase inhibitor alternatives for treating diabetic disorders
Predicting the Intention to Adhere to Hypertensive Medication among Seniors: A Cross-Sectional Survey
Get PDFNon-adherence to hypertension treatment is a wide problem, especially among senior citizens. Several approaches are needed to improve adherence, including identifying and prioritizing problems related to adherence. A formative study employing Theory of Planned Behavior (TPB) has revealed some salient beliefs underlying the intention to adhere to hypertension medication among seniors. To be the priority in a medication adherence strategy, the correlation of these beliefs on adherence needs to be further investigated. This study aims to determine which beliefs correlate most to the intention to hypertension medication adherence among seniors. A cross-sectional survey was conducted to seniors with hypertension in Yogyakarta and its surroundings. A questionnaire based on TPB was developed and utilized in this study. The questionnaire was distributed conveniently through two senior communities (offline) as well as Google Form link to some WhatsApp group of seniors (online) during September-October 2023. The data were analyzed using multiple linear regressions. Thirty-seven seniors completed the offline questionnaire, and 60 seniors completed the online questionnaire. The age of participants was 64.70 ± 7.123 years. Subjective norms and perceived behavioral control accounted significantly (p<0.001) for 59,3% of the variance in the adherence intention, but not attitude. Perceived behavioral control had the strongest correlation on intention. Participants’ beliefs of knowing how high their blood pressure was had the highest correlation to perceived behavioral control. Understanding which belief correlates most with intention to adherence provides insight to develop strategy to improve adherence among seniors
In Vitro Drug Release Study of Bisacodyl Enteric-Coated Tablet in Various Artificial Dissolution Media
Get PDFThis study aims to investigate the effect of dissolution media on the release of bisacodyl from an enteric-coated tablet. Genuine phosphate buffer pH 7.4 (phosphate buffer), rat cecal-containing phosphate buffer pH 7.4 (rat cecal), lactase-containing phosphate buffer pH 7.4 (lactase), probiotics-containing phosphate buffer pH 7.4 (probiotics), and probiotics & lactase-containing phosphate buffer pH 7.4 (probiotics-lactase) were used as the colon simulation media. The study was carried out in a modified type I dissolution test apparatus for 12 hours: 2 hours in HCl pH 0.1 M, 3 hours in phosphate buffer pH 6.8, and 7 hours on colon simulation media, sequentially. The sample aliquots were analyzed using a UV-Vis spectrophotometer. At the end of the dissolution period, the bisacodyl released from tablets in phosphate buffer, rat cecal, lactase, probiotics, and probiotics-lactase were, respectively, 42.095%; 85.835%; 70.594%; 92.832%; and 110.63%. The dissolution media, which contains probiotics and lactase, facilitated the highest bisacodyl release, followed by probiotics, rat cecal, lactase, and phosphate buffer. The drug-release profile among various dissolution media showed significant differences, with p-values < 0.05. It can be concluded that pH, microbial activity, and enzyme content significantly influence the release profile of bisacodyl from enteric-coated tablets
The Influence of MTHFR C677T Variants on Neuropathy Risk Among T2dm Patients Receiving Monotherapy Metformin
Get PDFNeuropathy is the most common microvascular complication among type 2 diabetes mellitus (T2DM). Metformin consumption increases neuropathy risk. The Methylenetetrahydrofolate reductase (MTHFR) enzyme has confirmed its role in neuropathy. Metformin and MTHFR could decrease folate and induce hyperhomoscysteine. One of the common variants of the MTHFR gene is C677T and its located in the exon area. This study aimed to observe the association between variant C677T in the MTHFR gene and the risk of neuropathy among newly diagnosed T2DM patients with naive metformin. This cross-sectional study recruited 103 patients. The neuropathy risk was examined according to medical judgment through Neuropathy Symptom Score (NSS) and Neuropathy Disability Score (NDS) criteria. Genotyping C677T was performed using PCR-RFLP. This study found only one patient has a homozygote mutant, but more than 50% of patients were detected with allele mutants. There were no statistical differences in patient characteristics between CC and CT genotypes (p>0.05). Association between C677T and neuropathy risk was not significant statistically, either in the genotype model (p=0.97), allele model (p=0.82), and dominant model (p=0.91). There was still no significant association after adjusting for several confounding factors. We conclude that C677T in our population did not influence neuropathy risk. More specific criteria and laboratory parameters indicated neuropathy should be examined in the future study.
Keywords: MTHFR, neuropathy, metformin, and T2D
Digital Health Literacy and Its Associated Factors in General Population in Indonesia
Get PDFDigital health literacy is expected to help individuals deal with information necessary during the pandemic. The study aimed to assess digital health literacy and identify its associated factors among the general population in Indonesia. A cross-sectional online survey was used to elicit the responses of the general population (aged ≥18 years) in Indonesia from 31 March to 7 April 2022. Along with sociodemographic characteristics, the measures included 8-subscales scores on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) from the eHealth Literacy Scale (eHEALS) tools to asses Digital Health Literacy (DHL) scores. Linear regression was performed to assess the association of sociodemographic characteristics with DHL. The significance level was set at 0.05. A total of 460 respondents participated in the study. The findings show that most respondents know how to find helpful health resources on the Internet (4.13±0.56), how to use the Internet to answer health questions (3.75±0.87), what kinds of health resources are available on the Internet (3.78±0.86), and how to use the health information on the Internet to help themselves (3.67±0.78). Digital literacy is significantly associated with age (p= 0.032), education level (p=<0.001), occupation (p=<0.001), family income (p=<0.001), experience of having chronic disease (p= 0.016), use of prescribed medicine (p= 0.021) and intensity of internet use (p=<0.001). The finding indicates that DHL in the general population in Indonesia is still limited in technical ability. Improving respondents’ educational status through computer training and smartphone access, and perceived usefulness was necessary to improve digital health literacy skills in evaluating the quality of the information so that respondents feel confident in using information from the Internet to make health decisions
Enhancement of Vitamin D2 Levels in Pleurotus ostreatus Using Ultraviolet Irradiation and Assessing Its Effect on Dexamethasone-Induced Osteoporosis in Mice
Get PDFMushrooms are a dietary source of vitamin D2 because they contain ergosterol, which can be converted into vitamin D2 after exposure to ultraviolet (UV) irradiation. UVB irradiated mushrooms contain high active vitamin D. A regular consumption of UVB‐irradiated mushrooms has been shown to be effective to increase bone calcification and modulation of host immunity. This study aimed to enhance vitamin D2 formation in oyster mushrooms (Pleurotus ostreatus) using UVB irradiation and to assess its effect on dexamethasone induced osteoporosis in mice.) Oyster mushrooms were UVB-irradiated with a UVB lamp at the dose of 8.01 J/cm2 - 24.03 J/cm2. The vitamin D2 level was measured using high performance liquid chromatography (HPLC) with calciferol as the standard. The powder of vitamin D enriched oyster mushroom powder was then referred to as Oyster-D. Dexamethasone (0.01 ml/g) induced osteoporosis in BALB/c mice. The number of osteoclasts, osteoblasts, osteocytes of the femur was assessed using hematoxylin-eosin staining. Serum calcium level was measured with spectrophotometry. UVB irradiation with the dose of 48.06 J/cm2 resulted in a highest vitamin D2 concentration, up to 11.333 µg/g. There was a significant increase in the number of osteoclasts, osteoblasts and serum calcium levels and decrease in the number of osteoclasts. The results suggest that UVB irradiation increased vitamin D2 levels in white oyster mushrooms and vitamin D enriched oyster mushrooms have a potential as anti-osteoporosis
Nephroprotective Effect of Ethanol Extract Abelmoschus manihot l. Leaves in Gentamicin-Induced Mice
Get PDFNephrotoxicity is the most common side effect of gentamicin, an aminoglycoside antibiotic group. It was mediated by oxidative stress mechanisms. Abelmoschus manihot L. leaves (AML) have antioxidant activity flavonoids. This study aims to determine the nephroprotective effect of AML in gentamicin-induced nephrotoxicity using mice models. It conducted an experimental design study in a pharmacology laboratory using mice models. It was conducted experimentally in 7 groups. There are normal, solvent, negative control, and four test groups (given an ethanolic extract of AML at doses of 50, 100, 200, and 400 mg/kgBW) which were administered orally for 7 days. Gentamicin 112 mg/kgBW was induced intraperitoneally on the 8th day. All mice were anesthetized on the 11th day to collect blood serum and renal organs for further examination. The data were analyzed using SPSS version 26 for One Way ANOVA test and followed by Duncan's post-hoc analysis test. The difference is considered significant if the p-value <0.05. Gentamicin successfully induced renal damage based on increasing creatinine and blood urea nitrogen (BUN) levels. This was by histopathology analysis which showed renal necrosis in the negative control group. Ethanolic extract of AML prevents nephrotoxicity due to gentamicin in a dose-dependent manner in creatinine level but not in BUN and histopathology. However, taken together all results showed that ethanol extract of AML has a nephroprotective effect in gentamicin-induced nephrotoxicity.
Keywords: Abelmoschus manihot L., gentamicin, nephroprotection, renal histopatholog
Optimizing the Formula of Polymeric-Based Aripiprazole Nanosuspension Using Response Surface Methodology for Intranasal Drug Delivery
Get PDFThis study aimed to optimize the formula of aripiprazole nanosuspension for intranasal drug delivery. Response Surface Methodology (RSM) was employed to determine the influence of independent variables, including drug concentration, polymer concentration, and the ratio of polymer combination, on the nanosuspension characteristics. The parameters under investigation were particle size (d mean), polydispersity index, and drug content. Fifteen formulas were prepared using the high-shear homogenization–ultrasonication method, and the Design Expert software was applied for optimum formula determination. The result showed significant effects of the independent variables on the nanosuspension characteristics, with particle sizes ranging from 143.6 – 334.6 nm, PDI values of 0.302 – 0.649, and drug content was 98.7 – 102.1 %. The predicted optimum formula had a drug concentration of 28 mg/mL in the organic solvent, polymer concentration of 1.5% (w/v), and HPMC to PVP ratio of 1.4 with desirability of 0.94. Additionally, it exhibited desirable characteristics, such as a particle size of 171.2 11.4 nm, a PDI value of 0.317 0.02, and a high drug content of 100.04 0.65%. In conclusion, the presented methodology appeared to be perfect for the optimization of the aripiprazole nanosuspension formula to ensure suitability for nose-to-brain drug delivery