This study analyzed 150 prescriptions of patients with rheumatoid arthritis treated at a tertiary care hospital in India. The study found:
1. Hydroxychloroquine was the most commonly prescribed drug (20.1%), followed by paracetamol (18.6%). Combination therapy using 3 or more drugs was preferred over monotherapy.
2. The majority of patients were female (91.3%) and the average age was 50 years old. Common comorbidities included hypertension (60%), diabetes (26.6%), and asthma (13.3%).
3. A total of 552 drugs were prescribed and 221 drug-drug interactions were identified. The highest number of interactions occurred with
Use of potentially inappropriate medicines in elderly A prospective study in ...Dr. Hemant Zaveri
This study aimed to evaluate the prevalence and pattern of potentially inappropriate medication use in elderly patients based on the Beers criteria 2003. The study analyzed prescriptions from 407 elderly patients at a tertiary care hospital in India. The results found that 23.59% of patients received at least one inappropriate medication, and 7.42% of total drugs prescribed were inappropriate. The most common inappropriate medications belonged to category A of the Beers criteria, which are drugs that should generally be avoided in elderly patients. Antihistamines, anticholinergics, sedatives, and cardiac glycosides were among the most frequently inappropriate prescribed drug classes. The high prevalence of inappropriate medication use suggests the need for improved prescribing practices for elderly patients
When a psychiatric patient is diagnosed, the practitioner selects a medication therapy from a variety of therapeutic approaches and according to the severity and condition of a patient; through peer evaluation. This requires the writing of a prescription. Prescribing accounts for a large proportion of errors [1]: Medication errors, problems related to strength and frequency of medication, quantity per dose, instructions for use, total quantity to be dispensed, dosage form etc; if absent, can cause great deal of patients’ harm. Medicines are a key component of healthcare and errors relating to medication, may impact on patient’s safety [1-4].
Human errors can be understood through a lot of suggested models and frameworks but the findings vary from country to country [5,6]. Prescribing errors are harmful to the patients and in worst cases they may lead to fatality. To avoid errors in prescriptions and its amelioration at the time of writing; is the easiest way of prevention of prescription errors [6-10]
Theories of human error states that, “a series of planned actions may fail to achieve their desired outcome because the plan itself was inadequate or because the actions did not go as planned. The definition reflects this distinction, including failures both in the prescribing decision and the prescription writing process” [5]. In 2005, Department of Health in the United Kingdom planned to reduce prescribing errors by 40% [10]. Such initiatives are also required in a developing country like Pakistan. Apparently, psychiatrists know a little about prescribing errors. Irrational drug therapy can cause patient’s harm by exacerbation or prolongation of illness, distress and higher costs [8] in some cases. Irrational prescribing is a global problem and may also be regarded as "pathological" prescribing [9].
All prescriptions must include the name, address, specialty and signature of the prescriber as well as the name, sex, and age of the patient and the strength, quantity, dose, frequency, dosage form and instructions for use of the medication [11–15]. The dispensing system of Pakistan is different than some other countries. The medication is available in already packed in containers etc by the pharmaceutical industries, to be dispensed. There is no option of refill instructions to the pharmacist etc. Adherence by the physician to good quality prescribing will minimize errors and ultimately improve patient’s care. Prescribing errors can occur as a result of errors in haste, poor concentration to the patient or attendant (in case the patient is unable to deliver the correct information), decision-making or the prescription-writing process. Incorrect prescribing habits are common unfortunately [16-20].
The purpose of this study was to investigate drug prescriptions of Psychiatry for the essential elements of prescriptions mentioned above, and to study the prescribing trends in psychiatric practice in Peshawar area, Pakistan.
Preliminary study of Prescription audit for evaluation of prescribing pattern...SriramNagarajan16
Prescription audit is necessary to know the art of prescription practices to improve rational pharmacotherapy.
Present study is an observational study and was undertaken from August 2018 to October 2018 for which data
was collected from Medical OPD. Prescribing is a technique with an expert academic pharmacological
knowledge.
Irrational prescribing leads to diminished therapeutic outcome. The present study is the first preliminary one at
Pandit Jawaharlal Lal Nehru Govt. Medical College and Hospital, Chamba- HP Before July 2016, it was a
district hospital College. It is a hilly district and caters the need of 5 Lakh people. A total of 420 prescriptions
were analyzed. These prescriptions comprised of 3000 drugs. Average drugs prescribed per patient were 7.3 .
male and female ratio was 40% and 60% respectively. More prescription were carried out in the age group of 51
- 60 yrs. Prescriptions in generic were only 3.65% fixed dose combination was used in 300 prescriptions and
comprised of 71.4% drugs. Oral prescriptions were used maximally and intravenous medication was minimally
used. Multivitamin prescriptions were observed in bulk.
FACTORS ASSOCIATED WITH UNNECESSARY DRUG THERAPY AND INAPPROPRIATE DOSAGE IN ...Jing Zang
To assess factors associated with unnecessary drug therapy and inappropriate dosage in hospitalized patients. A hospital based cross-sectional study design was employed. The study was conducted in Jimma University Specialized Hospital, Jimma, which is 345 Km from South west of Addis Ababa. All patients who were admitted to medical ward from February 5 – March 21, 2011 were included in the study. Data on socio-demographic variables, past medical history, past medication history, current diagnosis, current medications, vital signs and relevant laboratory data were collected by using bed side patient interview guided semi-structured questionnaire and data abstraction formats for card review. The data were analysed by using SPSS version 16 for windows. Descriptive statistics, cross-tabs, chi-square and logistic regression were done. Out of 257 study participants 140(54.5%) had unnecessary drug therapy or inappropriate dosage. The only independent factors which predicted the unnecessary drug therapy in study population was polypharmacy while not considering organ function test, polypharmacy and clinically significant potential drug-drug interaction were independent factors associated with inappropriate dosage . The prevalence of unnecessary drug therapy or inappropriate dosage is significantly high.
The document summarizes research on the benefits of clinical pharmacists participating as members of medical teams. Several studies found that including clinical pharmacists reduced mortality rates in hospitals and improved outcomes across disease states. Pharmacists improved medication management by addressing drug-related problems, which led to decreased mortality for conditions like heart attacks. Their interventions enhanced clinical outcomes for diabetes, cardiovascular disorders, and other conditions. Effective implementation of these pharmacy services requires support from healthcare organizations and infrastructure support within facilities.
A study on prescription pattern and rational use of statins in tertiary care ...SriramNagarajan16
Objectives
Our objectives are to evaluate prescription pattern and rational use of statins in a tertiary care corporate hospital.
Methodology
It was a prospective observational study conducted for a period of 6 months and included various departments of 300
bedded multi specialty tertiary care corporate hospital. A total of 200 patients were included and the study criteria
was inpatients and induvial more than 18 years of either gender who are prescribed with HMG-CoA reductase
inhibitors.
Results
In the present study 200 patients belonged to the age group of above 18 years, out of which about 65% were male
and 35% were female. Atorvastatin (67%) was prescribed mostly and Rosuvastatin (29.5%) was also used.
Conclusion
It is finally concluded that Rational and prophylactic use of statins can reduce further complications of Diabetes
Mellitus (DM) and cardiac events.
Statins treatment is favourable in long term treatment of diseases, it is most effectively used in treatment of serious
disease conditions which has shown its immense therapeutic role in treatment
Use of potentially inappropriate medicines in elderly A prospective study in ...Dr. Hemant Zaveri
This study aimed to evaluate the prevalence and pattern of potentially inappropriate medication use in elderly patients based on the Beers criteria 2003. The study analyzed prescriptions from 407 elderly patients at a tertiary care hospital in India. The results found that 23.59% of patients received at least one inappropriate medication, and 7.42% of total drugs prescribed were inappropriate. The most common inappropriate medications belonged to category A of the Beers criteria, which are drugs that should generally be avoided in elderly patients. Antihistamines, anticholinergics, sedatives, and cardiac glycosides were among the most frequently inappropriate prescribed drug classes. The high prevalence of inappropriate medication use suggests the need for improved prescribing practices for elderly patients
When a psychiatric patient is diagnosed, the practitioner selects a medication therapy from a variety of therapeutic approaches and according to the severity and condition of a patient; through peer evaluation. This requires the writing of a prescription. Prescribing accounts for a large proportion of errors [1]: Medication errors, problems related to strength and frequency of medication, quantity per dose, instructions for use, total quantity to be dispensed, dosage form etc; if absent, can cause great deal of patients’ harm. Medicines are a key component of healthcare and errors relating to medication, may impact on patient’s safety [1-4].
Human errors can be understood through a lot of suggested models and frameworks but the findings vary from country to country [5,6]. Prescribing errors are harmful to the patients and in worst cases they may lead to fatality. To avoid errors in prescriptions and its amelioration at the time of writing; is the easiest way of prevention of prescription errors [6-10]
Theories of human error states that, “a series of planned actions may fail to achieve their desired outcome because the plan itself was inadequate or because the actions did not go as planned. The definition reflects this distinction, including failures both in the prescribing decision and the prescription writing process” [5]. In 2005, Department of Health in the United Kingdom planned to reduce prescribing errors by 40% [10]. Such initiatives are also required in a developing country like Pakistan. Apparently, psychiatrists know a little about prescribing errors. Irrational drug therapy can cause patient’s harm by exacerbation or prolongation of illness, distress and higher costs [8] in some cases. Irrational prescribing is a global problem and may also be regarded as "pathological" prescribing [9].
All prescriptions must include the name, address, specialty and signature of the prescriber as well as the name, sex, and age of the patient and the strength, quantity, dose, frequency, dosage form and instructions for use of the medication [11–15]. The dispensing system of Pakistan is different than some other countries. The medication is available in already packed in containers etc by the pharmaceutical industries, to be dispensed. There is no option of refill instructions to the pharmacist etc. Adherence by the physician to good quality prescribing will minimize errors and ultimately improve patient’s care. Prescribing errors can occur as a result of errors in haste, poor concentration to the patient or attendant (in case the patient is unable to deliver the correct information), decision-making or the prescription-writing process. Incorrect prescribing habits are common unfortunately [16-20].
The purpose of this study was to investigate drug prescriptions of Psychiatry for the essential elements of prescriptions mentioned above, and to study the prescribing trends in psychiatric practice in Peshawar area, Pakistan.
Preliminary study of Prescription audit for evaluation of prescribing pattern...SriramNagarajan16
Prescription audit is necessary to know the art of prescription practices to improve rational pharmacotherapy.
Present study is an observational study and was undertaken from August 2018 to October 2018 for which data
was collected from Medical OPD. Prescribing is a technique with an expert academic pharmacological
knowledge.
Irrational prescribing leads to diminished therapeutic outcome. The present study is the first preliminary one at
Pandit Jawaharlal Lal Nehru Govt. Medical College and Hospital, Chamba- HP Before July 2016, it was a
district hospital College. It is a hilly district and caters the need of 5 Lakh people. A total of 420 prescriptions
were analyzed. These prescriptions comprised of 3000 drugs. Average drugs prescribed per patient were 7.3 .
male and female ratio was 40% and 60% respectively. More prescription were carried out in the age group of 51
- 60 yrs. Prescriptions in generic were only 3.65% fixed dose combination was used in 300 prescriptions and
comprised of 71.4% drugs. Oral prescriptions were used maximally and intravenous medication was minimally
used. Multivitamin prescriptions were observed in bulk.
FACTORS ASSOCIATED WITH UNNECESSARY DRUG THERAPY AND INAPPROPRIATE DOSAGE IN ...Jing Zang
To assess factors associated with unnecessary drug therapy and inappropriate dosage in hospitalized patients. A hospital based cross-sectional study design was employed. The study was conducted in Jimma University Specialized Hospital, Jimma, which is 345 Km from South west of Addis Ababa. All patients who were admitted to medical ward from February 5 – March 21, 2011 were included in the study. Data on socio-demographic variables, past medical history, past medication history, current diagnosis, current medications, vital signs and relevant laboratory data were collected by using bed side patient interview guided semi-structured questionnaire and data abstraction formats for card review. The data were analysed by using SPSS version 16 for windows. Descriptive statistics, cross-tabs, chi-square and logistic regression were done. Out of 257 study participants 140(54.5%) had unnecessary drug therapy or inappropriate dosage. The only independent factors which predicted the unnecessary drug therapy in study population was polypharmacy while not considering organ function test, polypharmacy and clinically significant potential drug-drug interaction were independent factors associated with inappropriate dosage . The prevalence of unnecessary drug therapy or inappropriate dosage is significantly high.
The document summarizes research on the benefits of clinical pharmacists participating as members of medical teams. Several studies found that including clinical pharmacists reduced mortality rates in hospitals and improved outcomes across disease states. Pharmacists improved medication management by addressing drug-related problems, which led to decreased mortality for conditions like heart attacks. Their interventions enhanced clinical outcomes for diabetes, cardiovascular disorders, and other conditions. Effective implementation of these pharmacy services requires support from healthcare organizations and infrastructure support within facilities.
A study on prescription pattern and rational use of statins in tertiary care ...SriramNagarajan16
Objectives
Our objectives are to evaluate prescription pattern and rational use of statins in a tertiary care corporate hospital.
Methodology
It was a prospective observational study conducted for a period of 6 months and included various departments of 300
bedded multi specialty tertiary care corporate hospital. A total of 200 patients were included and the study criteria
was inpatients and induvial more than 18 years of either gender who are prescribed with HMG-CoA reductase
inhibitors.
Results
In the present study 200 patients belonged to the age group of above 18 years, out of which about 65% were male
and 35% were female. Atorvastatin (67%) was prescribed mostly and Rosuvastatin (29.5%) was also used.
Conclusion
It is finally concluded that Rational and prophylactic use of statins can reduce further complications of Diabetes
Mellitus (DM) and cardiac events.
Statins treatment is favourable in long term treatment of diseases, it is most effectively used in treatment of serious
disease conditions which has shown its immense therapeutic role in treatment
This study evaluated drug prescription patterns among medical specialties in West Azerbaijan, Iran between 2014-2015. A total of over 500,000 prescriptions were analyzed using prescription software. The results showed that antibiotics were most prescribed by ENT, gynecology, infectious disease, urology and general surgery specialists. Neurosurgeons, GPs and ENT specialists prescribed the most corticosteroids. Neurosurgeons, orthopedists and cardiologists prescribed most central nervous system drugs. Overall, antibiotics and corticosteroids were overprescribed compared to guidelines. The study concludes certain specialties prescribed drugs outside their expertise and some specialists overprescribed antibiotics and corticosteroids.
This document summarizes research on potential adverse effects of herbal medicine use in cardiac patients taking prescription medications. It reviews 5 studies that explored interactions between common herbal medicines (e.g. cranberry, garlic) and cardiac drugs (e.g. warfarin). The studies found that certain herbal medicines can increase or decrease the effects of drugs like warfarin when taken together, potentially causing issues like abnormal bleeding or clotting in patients. However, many of the studies had limitations like small sample sizes. Overall, more research is still needed but the document suggests herbal medicine use should be carefully monitored in cardiac patients on multiple medications.
Patterns of Prescription Writing in Psychiatric ClinicsHafiz Saad Salman
This study analyzed 602 psychiatric prescriptions from private clinics in Peshawar, Pakistan to evaluate prescription writing practices and prescribing trends. The key findings were:
1) On average, 3.34 drugs were prescribed per prescription. Central nervous system drugs accounted for 71% of all drugs prescribed.
2) Important prescription elements like drug strength, quantity, and dosage instructions were missing in about 30% of prescriptions evaluated.
3) The most commonly prescribed medications were fluoxetine (8.4%), sodium valproate (7.9%), and alprazolam (7.7%). Non-steroidal anti-inflammatory drugs and vitamins were also regularly prescribed.
4
Thesis_PhD_Improving medication safety in the elderlyHA VO THI
The document discusses medication safety issues for elderly patients, noting that physiological changes with aging increase their risk of adverse drug reactions and interactions from polypharmacy. Polypharmacy, defined as using multiple medications, is common in elderly patients due to multiple chronic conditions but can increase problems with adherence and side effects. Improving medication safety for elderly patients requires addressing polypharmacy issues through individualized treatment reviews that consider life expectancy, treatment goals and targets.
Adverse drug reactions among critically ill patients at cairoAlexander Decker
The study aimed to assess the frequency and outcomes of adverse drug reactions among critically ill patients at Cairo University Hospital. The study found that 21% of the 150 critically ill patients studied experienced adverse drug reactions, ranging from mild to moderate or severe. Over half of the reactions were life-threatening. Due to the prevalence of adverse drug reactions in critically ill patients and their potential severity, the study recommends hospitals establish policies for managing adverse drug reactions and for healthcare providers to closely monitor patients and potential drug interactions when initiating new medications.
This document discusses drug risk assessment and pharmacoepidemiology. It notes that clinical trials prior to drug approval are limited in detecting uncommon or long-term side effects. Observational studies using large patient populations are needed to further evaluate drug safety issues and understand rare or long-term side effects. The document compares different pharmacoepidemiological study designs like cohort studies and case-control studies that can be used to investigate drug safety questions following a drug's approval and entry into widespread use.
1. Chemotherapy medication errors pose significant risks to patient safety, ranging from 0.4% to 31.9% of incidents according to literature, with around 11% causing patient harm.
2. Common chemotherapy medication errors involve administering the wrong dose or wrong drug, as well as failures during the prescribing, preparation, and administration phases.
3. Numerous guidelines and standards have been introduced over time to improve chemotherapy medication safety, including checklists, error reporting systems, education, and standardized processes.
This document outlines a study on the influence of pharmacogenomics on drug therapy and personalized medicine. The study focused on analyzing gene polymorphisms related to thyroid function in the Saudi population and their association with thyroid cancer risk and thyroxine drug dose requirements. The study found several novel and common single nucleotide polymorphisms in genes like DIO1, DIO3, PAX8, TSHB, and NIS. Some of these gene variants were associated with increased thyroid cancer risk. Additionally, polymorphisms in DIO1, PAX8 and TSHB were found to predict differences in required thyroxine drug doses for patients.
The document outlines 8 strategies to improve patient safety in healthcare facilities in Saudi Arabia:
1. Develop a national strategy for patient safety improvement and work to implement it.
2. Work to develop policies, procedures and propose legislation and regulations to improve medical practices and patient safety.
3. Conduct analytical research on patient safety issues and publish research and studies to identify best practices.
4. Monitor medical errors nationally and find appropriate solutions to promote patient safety by identifying causes.
5. Publish and disseminate best practices, research findings and specialized scientific journals to all healthcare institutions.
6. Increase public awareness and education on patient rights and safety.
7. Organize educational workshops and
This study identified and characterized drug-related problems (DRPs) in 104 elderly orthopedic patients with femoral neck fractures at an Israeli hospital. They found that 69% of patients had at least one DRP, for a total of 145 identified DRPs. The most common DRP categories were safety issues (34%) and indication problems (32%). Most recommendations were to add or discontinue medications, suggesting over- or under-treatment. Having more chronic medications was correlated with more DRPs. A clinical pharmacist was added to the orthopedic ward team based on these findings.
This study evaluated the efficacy and safety of lacosamide in treating diabetic neuropathic pain through an 18-week double-blind trial of 370 patients with doses of 200 mg/day, 400 mg/day, and 600 mg/day compared to a placebo. The 400 mg/day dose was found to significantly improve pain scores over the placebo and had the optimal balance of efficacy and side effects. Common side effects included dizziness, tremor and headache. While lacosamide showed potential for treating diabetic neuropathic pain, the study period was short and the 600 mg/day group had a high withdrawal rate due to adverse events.
The document discusses various methods for measuring outcomes in pharmacoepidemiology studies. It describes:
1) Common outcome measures including functional status, symptom status, patient satisfaction, economic measures, and quality of life studies.
2) How therapeutic outcomes can be classified as cure, improvement, no change, or deterioration and as success or failure.
3) How drug use is also measured using monetary units, number of prescriptions, units dispensed, defined daily doses, and medication adherence.
4) How risk is expressed using attributable risk, relative risk, time-risk relationships, and odds ratios to quantify the probability of outcomes in exposed versus unexposed groups.
The document provides information on several professors and their research areas at College of Pharmacy. It includes the names and areas of research for Professors Jing-Ping Liou, Chieh-Hsi Wu, Shawn Hsiang-Yin Chen, Wei-Chiao Chang, Jen-Ai Lee, David Hui-Wen Cheng, and Tzu-Hua Wu. The research areas include medicinal and organic chemistry, cardiovascular and cancer pharmacology, clinical pharmacy, pharmacogenomics, bioanalytical chemistry, pharmaceutical management and regulatory affairs, and clinical pharmacy and therapeutics. It also lists some representative publications for each professor.
Pharmacoepidemiology is the study of the use and effects of drugs in large populations. The document discusses the definition, origins, need and applications of pharmacoepidemiology. Specifically, it notes that pharmacoepidemiology applies epidemiological techniques to study drug use and effects in populations. It also discusses limitations of pre-marketing drug trials that pharmacoepidemiology aims to address through post-marketing surveillance and other techniques.
This study evaluated the utilization pattern of antibiotics at a tertiary care teaching hospital in North Karnataka, India by analyzing 250 patient prescriptions. The most commonly prescribed antibiotic classes were cephalosporins and fluoroquinolones. Comparison to clinical guidelines found deviations in diagnostic testing and treatment. For many conditions like pneumonia and bronchitis, sputum testing was not performed before antibiotic prescription. Overall antibiotic use could be more rational by adhering closer to treatment guidelines. Pharmacist involvement in drug use evaluation programs may help improve antibiotic use and patient outcomes.
Assessment and evaluation of poly pharmacy associating factors including anti...MUSHTAQ AHMED
This study aimed to estimate the prevalence of polypharmacy, antibiotic and nutritional supplement use in hospital and community patients. A retrospective cross-sectional study analyzed 100 prescriptions from Lahore and Faisalabad, finding a 40% polypharmacy prevalence. 19% of patients took nutritional supplements. The most common drug interactions involved NSAIDs, antihypertensives and antibiotics. Polypharmacy was associated with diseases like diabetes and hypertension.
This study analyzed 2,000 antibiotic prescription records from Bangladesh to evaluate rational antibiotic prescribing practices. It found that the majority (63%) of patients visited unlicensed village healthcare workers due to their widespread availability. The most commonly prescribed antibiotic classes were cephalosporins (36%), macrolides (25.5%), and quinolones (21%). However, 81% of prescriptions lacked clinical tests to justify antibiotic use. Only 66.5% of patients completed their full antibiotic course. The study concludes that irrational antibiotic prescribing in Bangladesh contributes to growing antibiotic resistance and calls for national treatment guidelines and public education programs.
This study evaluated whether continuing dual antiplatelet therapy (DAPT) beyond one year after drug-eluting stent placement reduces adverse events. It was a large randomized controlled trial comparing aspirin + thienopyridine to aspirin + placebo in patients who had completed one year of standard DAPT. Continuing thienopyridine therapy until 30 months reduced stent thrombosis and major adverse cardiovascular events, but increased moderate or severe bleeding risks compared to placebo. The study provides evidence that prolonging DAPT to 30 months may benefit patients who complete one year of standard therapy without adverse events.
The document summarizes a study that evaluated the use of the antibiotic ceftriaxone at a referral hospital in Ethiopia. The study reviewed 127 patient medical records to assess ceftriaxone use based on World Health Organization criteria. It found that ceftriaxone was inappropriately prescribed in 70% of cases, most often due to short treatment durations. Inappropriate antibiotic use contributes to growing antimicrobial resistance, posing a major public health threat. The study concludes that improved antibiotic stewardship programs are needed to promote more prudent ceftriaxone prescribing and preserve its effectiveness.
This study evaluated drug prescription patterns among medical specialties in West Azerbaijan, Iran between 2014-2015. A total of over 500,000 prescriptions were analyzed using prescription software. The results showed that antibiotics were most prescribed by ENT, gynecology, infectious disease, urology and general surgery specialists. Neurosurgeons, GPs and ENT specialists prescribed the most corticosteroids. Neurosurgeons, orthopedists and cardiologists prescribed most central nervous system drugs. Overall, antibiotics and corticosteroids were overprescribed compared to guidelines. The study concludes certain specialties prescribed drugs outside their expertise and some specialists overprescribed antibiotics and corticosteroids.
This document summarizes research on potential adverse effects of herbal medicine use in cardiac patients taking prescription medications. It reviews 5 studies that explored interactions between common herbal medicines (e.g. cranberry, garlic) and cardiac drugs (e.g. warfarin). The studies found that certain herbal medicines can increase or decrease the effects of drugs like warfarin when taken together, potentially causing issues like abnormal bleeding or clotting in patients. However, many of the studies had limitations like small sample sizes. Overall, more research is still needed but the document suggests herbal medicine use should be carefully monitored in cardiac patients on multiple medications.
Patterns of Prescription Writing in Psychiatric ClinicsHafiz Saad Salman
This study analyzed 602 psychiatric prescriptions from private clinics in Peshawar, Pakistan to evaluate prescription writing practices and prescribing trends. The key findings were:
1) On average, 3.34 drugs were prescribed per prescription. Central nervous system drugs accounted for 71% of all drugs prescribed.
2) Important prescription elements like drug strength, quantity, and dosage instructions were missing in about 30% of prescriptions evaluated.
3) The most commonly prescribed medications were fluoxetine (8.4%), sodium valproate (7.9%), and alprazolam (7.7%). Non-steroidal anti-inflammatory drugs and vitamins were also regularly prescribed.
4
Thesis_PhD_Improving medication safety in the elderlyHA VO THI
The document discusses medication safety issues for elderly patients, noting that physiological changes with aging increase their risk of adverse drug reactions and interactions from polypharmacy. Polypharmacy, defined as using multiple medications, is common in elderly patients due to multiple chronic conditions but can increase problems with adherence and side effects. Improving medication safety for elderly patients requires addressing polypharmacy issues through individualized treatment reviews that consider life expectancy, treatment goals and targets.
Adverse drug reactions among critically ill patients at cairoAlexander Decker
The study aimed to assess the frequency and outcomes of adverse drug reactions among critically ill patients at Cairo University Hospital. The study found that 21% of the 150 critically ill patients studied experienced adverse drug reactions, ranging from mild to moderate or severe. Over half of the reactions were life-threatening. Due to the prevalence of adverse drug reactions in critically ill patients and their potential severity, the study recommends hospitals establish policies for managing adverse drug reactions and for healthcare providers to closely monitor patients and potential drug interactions when initiating new medications.
This document discusses drug risk assessment and pharmacoepidemiology. It notes that clinical trials prior to drug approval are limited in detecting uncommon or long-term side effects. Observational studies using large patient populations are needed to further evaluate drug safety issues and understand rare or long-term side effects. The document compares different pharmacoepidemiological study designs like cohort studies and case-control studies that can be used to investigate drug safety questions following a drug's approval and entry into widespread use.
1. Chemotherapy medication errors pose significant risks to patient safety, ranging from 0.4% to 31.9% of incidents according to literature, with around 11% causing patient harm.
2. Common chemotherapy medication errors involve administering the wrong dose or wrong drug, as well as failures during the prescribing, preparation, and administration phases.
3. Numerous guidelines and standards have been introduced over time to improve chemotherapy medication safety, including checklists, error reporting systems, education, and standardized processes.
This document outlines a study on the influence of pharmacogenomics on drug therapy and personalized medicine. The study focused on analyzing gene polymorphisms related to thyroid function in the Saudi population and their association with thyroid cancer risk and thyroxine drug dose requirements. The study found several novel and common single nucleotide polymorphisms in genes like DIO1, DIO3, PAX8, TSHB, and NIS. Some of these gene variants were associated with increased thyroid cancer risk. Additionally, polymorphisms in DIO1, PAX8 and TSHB were found to predict differences in required thyroxine drug doses for patients.
The document outlines 8 strategies to improve patient safety in healthcare facilities in Saudi Arabia:
1. Develop a national strategy for patient safety improvement and work to implement it.
2. Work to develop policies, procedures and propose legislation and regulations to improve medical practices and patient safety.
3. Conduct analytical research on patient safety issues and publish research and studies to identify best practices.
4. Monitor medical errors nationally and find appropriate solutions to promote patient safety by identifying causes.
5. Publish and disseminate best practices, research findings and specialized scientific journals to all healthcare institutions.
6. Increase public awareness and education on patient rights and safety.
7. Organize educational workshops and
This study identified and characterized drug-related problems (DRPs) in 104 elderly orthopedic patients with femoral neck fractures at an Israeli hospital. They found that 69% of patients had at least one DRP, for a total of 145 identified DRPs. The most common DRP categories were safety issues (34%) and indication problems (32%). Most recommendations were to add or discontinue medications, suggesting over- or under-treatment. Having more chronic medications was correlated with more DRPs. A clinical pharmacist was added to the orthopedic ward team based on these findings.
This study evaluated the efficacy and safety of lacosamide in treating diabetic neuropathic pain through an 18-week double-blind trial of 370 patients with doses of 200 mg/day, 400 mg/day, and 600 mg/day compared to a placebo. The 400 mg/day dose was found to significantly improve pain scores over the placebo and had the optimal balance of efficacy and side effects. Common side effects included dizziness, tremor and headache. While lacosamide showed potential for treating diabetic neuropathic pain, the study period was short and the 600 mg/day group had a high withdrawal rate due to adverse events.
The document discusses various methods for measuring outcomes in pharmacoepidemiology studies. It describes:
1) Common outcome measures including functional status, symptom status, patient satisfaction, economic measures, and quality of life studies.
2) How therapeutic outcomes can be classified as cure, improvement, no change, or deterioration and as success or failure.
3) How drug use is also measured using monetary units, number of prescriptions, units dispensed, defined daily doses, and medication adherence.
4) How risk is expressed using attributable risk, relative risk, time-risk relationships, and odds ratios to quantify the probability of outcomes in exposed versus unexposed groups.
The document provides information on several professors and their research areas at College of Pharmacy. It includes the names and areas of research for Professors Jing-Ping Liou, Chieh-Hsi Wu, Shawn Hsiang-Yin Chen, Wei-Chiao Chang, Jen-Ai Lee, David Hui-Wen Cheng, and Tzu-Hua Wu. The research areas include medicinal and organic chemistry, cardiovascular and cancer pharmacology, clinical pharmacy, pharmacogenomics, bioanalytical chemistry, pharmaceutical management and regulatory affairs, and clinical pharmacy and therapeutics. It also lists some representative publications for each professor.
Pharmacoepidemiology is the study of the use and effects of drugs in large populations. The document discusses the definition, origins, need and applications of pharmacoepidemiology. Specifically, it notes that pharmacoepidemiology applies epidemiological techniques to study drug use and effects in populations. It also discusses limitations of pre-marketing drug trials that pharmacoepidemiology aims to address through post-marketing surveillance and other techniques.
This study evaluated the utilization pattern of antibiotics at a tertiary care teaching hospital in North Karnataka, India by analyzing 250 patient prescriptions. The most commonly prescribed antibiotic classes were cephalosporins and fluoroquinolones. Comparison to clinical guidelines found deviations in diagnostic testing and treatment. For many conditions like pneumonia and bronchitis, sputum testing was not performed before antibiotic prescription. Overall antibiotic use could be more rational by adhering closer to treatment guidelines. Pharmacist involvement in drug use evaluation programs may help improve antibiotic use and patient outcomes.
Assessment and evaluation of poly pharmacy associating factors including anti...MUSHTAQ AHMED
This study aimed to estimate the prevalence of polypharmacy, antibiotic and nutritional supplement use in hospital and community patients. A retrospective cross-sectional study analyzed 100 prescriptions from Lahore and Faisalabad, finding a 40% polypharmacy prevalence. 19% of patients took nutritional supplements. The most common drug interactions involved NSAIDs, antihypertensives and antibiotics. Polypharmacy was associated with diseases like diabetes and hypertension.
This study analyzed 2,000 antibiotic prescription records from Bangladesh to evaluate rational antibiotic prescribing practices. It found that the majority (63%) of patients visited unlicensed village healthcare workers due to their widespread availability. The most commonly prescribed antibiotic classes were cephalosporins (36%), macrolides (25.5%), and quinolones (21%). However, 81% of prescriptions lacked clinical tests to justify antibiotic use. Only 66.5% of patients completed their full antibiotic course. The study concludes that irrational antibiotic prescribing in Bangladesh contributes to growing antibiotic resistance and calls for national treatment guidelines and public education programs.
This study evaluated whether continuing dual antiplatelet therapy (DAPT) beyond one year after drug-eluting stent placement reduces adverse events. It was a large randomized controlled trial comparing aspirin + thienopyridine to aspirin + placebo in patients who had completed one year of standard DAPT. Continuing thienopyridine therapy until 30 months reduced stent thrombosis and major adverse cardiovascular events, but increased moderate or severe bleeding risks compared to placebo. The study provides evidence that prolonging DAPT to 30 months may benefit patients who complete one year of standard therapy without adverse events.
The document summarizes a study that evaluated the use of the antibiotic ceftriaxone at a referral hospital in Ethiopia. The study reviewed 127 patient medical records to assess ceftriaxone use based on World Health Organization criteria. It found that ceftriaxone was inappropriately prescribed in 70% of cases, most often due to short treatment durations. Inappropriate antibiotic use contributes to growing antimicrobial resistance, posing a major public health threat. The study concludes that improved antibiotic stewardship programs are needed to promote more prudent ceftriaxone prescribing and preserve its effectiveness.
ADVERSE DRUG REACTION | PHARMACY PRACTICE | PDF | SHIVAM DUBEY B PHARMA | PHA...MrHotmaster1
PHARMACY PRACTICE
SHIVAM DUBEY
BPYN1PY18041
ADVERSE DRUG REACTION Abstract
We define an adverse drug reaction as "an appreciably harmful or
unpleasant reaction
Medication therapy is becoming increasingly more complex as new drugs are developed and more therapeutic targets are elucidated. In addition, polypharmacy (≥5 scheduled medications) has become exceedingly common in geriatric patients and in patients with chronic disease states. As the complexity of drug therapy and the number of medications increase, patients are at a high risk for medication errors and adverse drug events (ADEs), or injuries resulting from medication. The type of adverse events may be associated with professional practices, healthcare products, procedures, and systems including prescription, communication through instructions, drug labeling, packaging and nomenclature, reformulation, dissolution, distribution, administration, education, monitoring, and use. Classification and evaluation of medication errors according to their importance may constitute an important factor for process improvement in order to render the administration of medicines as safe as possible. In hospitals, medication errors occur at a rate of about one per patient per day. A dispensing error is one made by pharmacy staff when distributing medications to nursing units or directly to patients in an ambulatory-care pharmacy; the error rates for doses dispensed via the cart-filling process range from 0.87% to 2.9%. Technology has grown to be a constituent part of medicine these days. A few advantages that technology can supply are categorized as follows: the assisting of communication between clinicians; enhancing medication safety; decreasing potential medical errors and adverse events; rising access to medical information and encouraging patient-centered healthcare. The aim of this article is to provide a compendious literature review regarding Medication errors
Assessment of drug utilization and rational drug use on WHO indicationZaibaFathima8
This is a study done in the outpatient department for a short period of time to recognize the drug utilized and use of rational drug use based on WHO indicators under the guidance of Dr. GOPINATH S, M Pharm., Ph.D.,
by Prabhavathi S co. B Pharmacy final year project.
Pharmacoepidemiology is the study of the use and effects of medications in large populations. It provides estimates of drug benefits and risks in real-world populations, helping to detect adverse effects that may have been missed in pre-market clinical trials due to limited sample sizes and patient populations that do not represent those seen in practice. Pharmacoepidemiology uses epidemiological methods like cohort studies and case-control studies to understand drug effects, interactions, and outcomes in patient populations. It also includes pharmacovigilance to monitor drug safety after market approval.
International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases
Scope on medicatio error in a sample of iraqi two cities samawa and diwania.Ali Al Samawy
Summery
Introduction:
The pregnancy is sensitive period and administration of drugs may lead to threating of fetus life or cause malformations and teratogenicity etc.
Methodology:
A cross-sectional study of medication errors of 100 prescriptions dispensed to a pregnant women in a sample of Iraqi two cities (Al Sammawah & Al Diwania) during October, 2016.
A formal was used to collect data included the name of pregnant, age, trimester, doctor diagnosis, the drug dispensed and their dose, rout, duration, frequency, strength and notes section. The formal filled during visits of the research team to pharmacies that most of the prescriptions they dispense are for pregnant women prescribed by a nearby gynecology &obstruct doctors.
Then the data analyzed to identify the medication errors that includes; inappropriate and irrational, ineffective, over and under prescribing and drug interactions using available literature and drugs.com drug interaction checker.
Result:
Total number of prescriptions involved in the study is 100 prescriptions, they contain 487 medication dispensed to the patients. The total number of medication errors identified were 364(74.7%), included 110 irrational & inappropriate prescribing, 47 over prescribing. 19 under prescribing, and 8 ineffective prescribing. The drug interactions were classified to drug-drug interactions 126 interactions identified and drug food interactions 54 interactions were recorded. 0.8 % of all drug-drug interactions were major, 76 % moderate and 23% mild. Phenobarbital (luminal) is the drug that caused the most of medication error that identified as it dispensed 23 times but in all of these patient luminal was irrational and inappropriate and it caused the most of interactions recorded as 44 interactions were caused by luminal.
While Dydrogesterone was prescribed as a tocolytic 21 times, and this considered as irrational & inappropriate prescribing. Isoxsuprine prescribed irrationally 17 times. The parenteral iron administered without calculating the dose depending on the body weight and blood Hb. Most of antibiotics and antifungal prescribed for incorrect duration or dose. The other errors were related to other drugs duration, dose, and indication errors.
Conclusion:
Percentage of medication errors was high. Types of medication errors were mostly drug-drug interaction, irrational and inappropriate use. The impact of these medication errors may include teratogenic effect.
Recommendations:
Adherence to the treatment guidelines and further studies to assess the impact of medications errors on pregnant women and her fetus.
This document summarizes a talk on adverse reactions to oral contraceptives (birth control pills). It discusses how third generation oral contraceptives with modern progesterone types have a higher risk of venous thromboembolism than second generation pills. It also notes that the new progesterone drospirenone seems to increase the risk compared to older pills. While risks exist, the overall benefits of oral contraceptives in preventing pregnancy and some cancers outweigh the risks. The talk aims to examine the evidence behind controversies on health risks and discuss implications for the growing number of potential oral contraceptive users in India.
A prospective study of the pattern of drug use in primary dysmenorrhea in a t...pharmaindexing
This study analyzed 100 prescriptions from patients diagnosed with primary dysmenorrhea (PD) at a tertiary care hospital in India. The mean age of patients was 22 years. Most (61%) experienced severe dysmenorrhea. The most frequently prescribed treatment was a combination of mefenamic acid and dicyclomine (72% of patients), followed by mefenamic acid alone (16%) or diclofenac (12%). While the majority (43%) of patients with severe dysmenorrhea received the mefenamic acid/dicyclomine combination, the severity of dysmenorrhea did not statistically influence prescription patterns. Instructions regarding dosages were provided but not prophylactic use of NSAIDs
It is very important to incorporate clinically relevant practicals into the undergraduate pharmacology practical (UGPP) curriculum. Various medical colleges in the state of Gujarat have included clinical practicals in their UGPP curriculum. [2] Rai has recommended the inclusion of the 'P-drug' concept in the UGPP curriculum.
The conference of experts on the rational use of drugs, convened by the World Health Organization in Nairobi in 1985, stated that: "Rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, at the lowest cost to them and their community." This goal can be achieved by acquiring knowledge of the principles of rational drug usage during undergraduate training. This correspondence emphasizes the importance of this concept.
» What is a P-drug?
The drugs you are going to prescribe regularly and with which you will become familiar are called P(ersonal)-drugs. The P-drug concept includes the name of a drug, dosage form, dosage schedule and duration of treatment for a specified condition. Due to varying availability and cost of drugs, different national formularies and essential drug lists, medical culture and individual interpretation of information, P-drugs differ from country to country and between doctors.
There are four reasons that indicate why a P-drug should never be the one that has been suggested or dictated by clinical teachers, senior colleagues or by sales representatives: a) the latest and the most expensive drug is not necessarily the best, the safest or the most cost-effective, b) by developing one's own set of P-drugs, one can learn to handle pharmacological concepts and drug-related data in an effective manner, c) by compiling one's own set of P-drugs, one can prescribe alternatives when the P-drug cannot be used and d) one has the final responsibility for his / her patient's well being, which he / she cannot pass on to others. While physicians can and should draw on expert opinion and consensus guidelines, they should always think for themselves.
» Example for selecting a P-drug for acute amoebic dysentery Top
Amoebiasis is one of the common infections encountered in clinical practice and it is relatively easy to understand the pathophysiology as well as the treatment of amoebiasis. Therefore, we have selected the example of acute amoebic dysentery and analyzed it in consultation with standard textbooks of pharmacology.
This study assessed the impact of pharmacist counseling on treatment outcomes, knowledge, attitudes, and quality of life in patients with diabetes and hypertension. Patients receiving counseling showed greater improvements in blood pressure, blood sugar levels, knowledge, and physical quality of life scores compared to the control group. However, counseling had no significant effect on mental quality of life scores. The study demonstrates that pharmacist counseling can positively impact treatment outcomes and aspects of quality of life for patients managing diabetes and hypertension.
Prospective Observational Study of Sodium Valproate in Seizure Control and As...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A PROSPECTIVE STUDY OF DRUG UTILIZATION PATTERN AND EVALUATION USING WHO GUI...M.Arumuga Vignesh
This document describes a prospective study conducted to evaluate drug utilization patterns and prescribing practices in a government hospital in India using WHO prescribing indicators. Data was collected from 282 patient records over 6 months across various wards. The study aimed to promote rational drug use, avoid polypharmacy, prevent antibiotic resistance, and estimate disease prevalence. Key metrics analyzed included the average number of drugs per prescription, percentage of generics prescribed, consultation times, and drug availability. The findings could provide insights into prescribing quality and opportunities for improvement.
2016: Considerations on Polypharmacy and Adverse Drug Events-WatanabeSDGWEP
The document discusses issues related to polypharmacy and adverse drug events in older adults. It notes that polypharmacy is common in seniors, putting them at higher risk for adverse drug events, hospitalizations, and costs. The document also reviews tools that can help reduce inappropriate polypharmacy and prescribing, such as Beers criteria, STOPP criteria, and comprehensive medication reviews.
This study evaluated the prescribing patterns and rational use of antibiotics at the surgery department of a tertiary care teaching hospital. The study analyzed 150 patient prescriptions over 6 months. It found that penicillins were the most commonly prescribed antibiotics, accounting for 56.47% of prescriptions. Most patients (77.3%) received single antibiotic therapy. The antibiotic use was found to be reasonable and rational in all cases, as all antibiotics were prescribed from the essential drug list. The study concluded that antibiotic use at the hospital was generally rational and in accordance with treatment guidelines.
Neurological adverse drug reactions of anticancer drugspharmaindexing
The document summarizes a study analyzing neurological adverse drug reactions to anticancer drugs reported to an adverse drug reaction monitoring center over 21 months. Some key findings:
1) Neurological adverse reactions accounted for 5.9% of all reported adverse drug reactions to anticancer drugs.
2) The leading drug regimen associated with neurological adverse reactions was CAPOX (capecitabine and oxaliplatin), accounting for 15.5% of cases.
3) The most common neurological adverse reaction reported was neuropathy, seen in 72.6% of neurology-related cases. The majority of neuropathies were grade 2 in severity.
Neurological adverse drug reactions of anticancer drugspharmaindexing
The document summarizes a study analyzing neurological adverse drug reactions to anticancer drugs reported to an adverse drug reaction monitoring center over 21 months. Some key findings:
1) Neurological adverse reactions accounted for 5.9% of all reported adverse drug reactions to anticancer drugs.
2) The leading drug regimen associated with neurological adverse reactions was CAPOX (capecitabine and oxaliplatin), accounting for 15.5% of cases.
3) The most common neurological adverse reaction reported was neuropathy, seen in 72.6% of neurology-related cases. The majority of neuropathies were grade 2 in severity.
GUIDELINES FOR RATIONAL USE OF ANTIBIOTICS AND SURGICAL.pptxImmanuel Jebastine M
This document provides guidelines for the rational use of antibiotics and surgical prophylaxis. It defines rational drug use and discusses the importance of promoting it. Guidelines are presented for rational prescribing and use of antibiotics. Key points include using antibiotics only when necessary, obtaining cultures before treatment when possible, choosing appropriate agents, doses and durations. Guidelines for surgical prophylaxis emphasize using antibiotics only for specific procedures shown to reduce infections and administering the appropriate agent at induction of anesthesia for most surgeries under 4 hours. Causes of non-responsiveness to antibiotics are also summarized.
This document provides information on establishing pharmacovigilance programs and resources in pharmacovigilance. It discusses the importance of classification systems like ATC, ICD, and INN for monitoring drugs and adverse events. Primary resources include clinical trial data and reports, while secondary resources summarize primary sources. Tertiary sources compile information from multiple sources. Establishing an effective pharmacovigilance program requires a structured organization, trained staff, coordination between stakeholders, and support from regulatory authorities and healthcare priorities. Monitoring drug safety is crucial for public health.
Rheumatic diseases include rheumatoid arthritis and psoriatic arthritis. Rheumatoid arthritis is an autoimmune disease that causes inflammation and destruction of joints, tendons, and bones. It affects around 1% of the adult population and women more than men. While the cause is unknown, genetic and environmental factors are involved. Symptoms include joint stiffness, pain, swelling and decreased range of motion. Treatment involves medications like NSAIDs, DMARDs and corticosteroids to relieve symptoms and slow disease progression. Psoriatic arthritis causes joint pain and swelling in some joints and scaly skin patches, with symptoms varying between individuals.
This document discusses a study on determining severe acute malnutrition and managing children under 59 months in the Theni District of Tamil Nadu, India. The study analyzed 138 malnourished children between July 2012 and January 2013. It found high rates of malnutrition in female children and children cared for by mothers. Many common signs of malnutrition were observed including myopia, metropia, xerophthalmia, Bitot's spots, gum bleeding, and angular stomatitis. The study provided nutritional supplementation and found improvement in many symptoms over multiple visits from 1 to 3 months.
This study evaluated prescribing patterns in outpatient departments at 24 secondary-level government hospitals in Tamilnadu, India. A total of 4,750 prescriptions were analyzed. The most common diagnoses were diseases of the respiratory system (990 cases), certain infectious and parasitic diseases (427 cases), and diseases of the skin and subcutaneous tissue (667 cases). On average, prescriptions contained 4 drugs, with antibiotics prescribed in 56% of cases. Based on the findings, an essential medicines list was prepared for each hospital category to improve prescribing practices.
This document defines and describes several communicable diseases including their symptoms and modes of transmission. Tuberculosis is a bacterial infection of the lungs that spreads through the air when infected individuals cough or sneeze. Symptoms include chronic cough, fever, night sweats and weight loss. Hepatitis is an inflammation of the liver that causes jaundice, fatigue and abdominal pain. It spreads through contact with infected blood or bodily fluids. Malaria is a parasitic infection spread by mosquitos that causes fever, chills and flu-like symptoms.
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CODEN (USA): IAJPBB ISSN: 2349-7750
IINNDDOO AAMMEERRIICCAANN JJOOUURRNNAALL OOFF
PPHHAARRMMAACCEEUUTTIICCAALL SSCCIIEENNCCEESS
Available online at: http://www.iajps.com Research Article
PRESCRIPTION PATTERN OF DRUGS USED IN MANAGEMENT OF
RHEUMATOID ARTHRITIS IN A TERTIARY CARE HOSPITAL – A
RETROSPECTIVE STUDY
Immanuel Jebastine M*1, Nasmi N 2, Neena Elias 2, Neethu V V2, B Arul 3
1
Asst. Professor, Dept of Pharmacy Practice, Vinayaka Mission’s College of Pharmacy, Yercaud Main Road,
Kondappanaickenpatty, Salem-636 008.
2
Research Scholar, Dept of Pharmacy Practice, Vinayaka Mission’s College of Pharmacy, Yercaud Main Road,
Kondappanaickenpatty, Salem-636 008.
3
Professor & Head, Dept of Pharmacy Practice, Vinayaka Mission’s College of Pharmacy, Yercaud Main Road,
Kondappanaickenpatty, Salem-636 008.
Abstract: This study was conducted about the prescription pattern of drugs used in rheumatoid arthritis includes obtain
information about various anti-rheumatoid drugs prescribing pattern, to calculate the average number of anti-rheumatoid drugs
per prescription and to find out the drug-drug interaction present in the each prescription. The study is conducted in the
orthopaedics department of VMKVMCH in Salem district, Tamil Nadu between months of November 2014 to April 2015. The
data is collected from the case records and the information is recorded on age, gender, associate illness, articular
manifestations, laboratory measurements and study of prescription, which include DMARDS, STEROIDS, NSAIDs and the type
of combinations.The results showed that, RA was commonly seen in female patients. Out of 150 patients 13(8.6%) patients were
males and 137(91.3%) patients were females. The present study also revealed that RA commonly occurred in average age of
50.07±10.49. Combination therapy was preferred over monotherapy in the management of RA, in that 3 drug and 5 drug therapy
was most preferred over other combinations. The overall drug usages in this study revealed that a total of 552 drugs were
prescribed. Out of which, Hydroxychloroquine was most prescribed [111(20.10%)] followed by Paracetamol in [103(18.75%)],
Diclofenac in [88(15.94%)], sulfasalazine in [86(15.57%)], methotrexate in [41(7.42%)], methylprednisolone in [40(7.24%)],
Aceclofenac in [21(3.80%)], tramadol and the combination of Seratopeptidase in [17(3.07%], prednisolone in [13(2.3%)],
sodium chondrotinsulfate and sodium hyalourate in [4(0.7%)], Ibuprofen, Chloroquine and indomethacin in [2(0.3%)], patient.
Among this 150 patients, 15 cases with co-morbidities like hypertension in 9(60%), diabetes in 4(26.66%), and asthma in
2(13.34%) patients Out of 150 cases maximum number of interactions occurred with 5 drug therapy [88(47.06%)] and least with
2 drug therapy Out of 150 patients the most of the interactions were occurred in the 5 drugs therapy and least with 2 drug
therap. Hence it also proves that whenever the Polypharmacy is there, it also increases the chance of drug-drug interactions.
Corresponding Author:
Immanuel Jebastine M,
Asst. Professor.
Department of Pharmacy Practice,
Vinayaka Mission’s College of Pharmacy,
Yercaud Main Road, Kondappanaickenpatty, Salem-636 008.
Email: masilaarul@gmail.com
Mobile: 09994169248
Please cite this article in press as Immanuel Jebastine et al , Prescription Pattern of Drugs Used In Management
of Rheumatoid Arthritis in A Tertiary Care Hospital – A Retrospective Study, Indo Am. J. Pharm. Sci, 2015;2(8).
QR code
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INTRODUCTION:
Drug utilization research was defined by WHO in
1977 as the marketing, distribution, prescription, and
use of drugs in a society, with special emphasis on
the resulting medical, social and economic
consequences. The principle aim of drug utilization
research is to facilitate the rational use of drugs in
populations. For the individual patient, the rational
use of a drug implies the prescription of a well-
documented drug at an optimal dose, together with
the correct information, at an affordable price.
Without knowledge of how drugs are being
prescribed and used, it is difficult to initiate a
discussion on rational drug use or to suggest
measures to improve prescribing habits. Rheumatoid
arthritis (RA) is a devastating inflammatory arthritis
affecting up to 1% of the developed world. Without
aggressive, early medical treatment with disease-
modifying antirheumatic drug (DMARDs), severe
damage can occur. However, many patients do not
end up in this trajectory early enough to benefit
maximally from rheumatology care. . Furthermore,
rheumatology referral was delayed especially in
patients of older age, lower socioeconomic status,
and low proximity to specialty care [1]. Drug
utilization research can increase our understanding of
how drugs are being used .It can be used in the
application of quality indicators to patterns of drug
utilization [2]. Drug prescribing studies aim to
provide feedback to the prescriber and to create
awareness among them about rational use of
medicines [3].
The other form inflammatory arthritis—results from
swelling in the joints. Rheumatoid arthritis is a
common type of inflammatory arthritis4. Little is
known about the current disease-modifying
antirheumatic drug (DMARD) preferences of British
rheumatologists. Sulphasalazine was the agent of first
choice for British rheumatologists in a previous UK
survey, but currently methotrexate is widely regarded
as the standard against which other DMARDs should
be compared. Several recent surveys, from North
America, have shown that combinations of DMARDs
are preferred in contemporary practice [5].
Recent analysis of Quebec administrative data
revealed that of all new-onset or suspected RA cases
in the year 2000, only a small proportion (just over
one quarter) were referred to relevant specialists.
Furthermore, rheumatology referral was delayed
especially in patients of older age, lower
socioeconomic status, and low proximity to specialty
care. The cause of RA is unknown. The combination
of genetic susceptibility with an as-yet-unidentified
inciting event (or events) leads to disease expression.
The concordance of RA in identical twins is reported
as 15% to 30%, suggesting that nongenetic factors
have a predominant impact on disease
expression. However, the association of HLA-DR
with RA is well established. There is an increased
relative risk of RA of about 4 to 5 in patients with
this allele.6 Treatment should normally be initiated
with the least expensive drug (taking into account
administration costs, required dose and product price
per dose). This may need to be varied in individual
cases due to differences in the mode of
administration and treatment schedules
MATERIALS AND METHOD:
The study is conducted in the orthopaedics
department of VMKVMCH in Salem district, Tamil
Nadu, between months of November 2014 to April
2015.
The age and gender data including co-
morbidities are collected from the prescription.
The data collected from orthopaedics
department through designed proforma were
assessed.
A separate data entry proforma was
designed .The proforma format has been designed
to collect the details such as patient name, age,
gender, DOA, DOD, and medication details.
Proforma 1- Patient details &treatment chart
RESULTS AND DISCUSSION:
Most Commonly Prescribed Class of Drugs
during the Study Period (N=150)
The most commonly prescribed class drugs for RA in
our hospital include DMARDS, NSAIDS, Simple
analgesics, Corticosteroids, Uricosuric acid.
DMARDS was the most commonly prescribed drugs
in the study population in the hospital. The data were
shown in Table.No.1 and Figure.No.1
Table 1: Most Commonly Prescribed class Drugs
during the Study Period
Class of Drugs Number of
Drugs
Prescribed
Percentage
DMARDS 240 43.48%
NSAIDS 131 23.74%
Simple
analgesic
103 18.65%
Corticosteroids 53 9.61%
Opioid
analgesic
17 3.07%
Uricosuric acid 8 1.45%
Total 552 100
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Fig 1: Most commonly Prescribed class Drugs during the Study Period
Most Commonly Prescribed Anti-rheumatoid
Drugs
Out of 150 patients the most commonly prescribed
classes of anti-rheumatic drugs were
Hydroxychloroquine [111(20.11%)] followed by
Paracetamol [103(18.66%)]. The data were shown in
Table.No.2 and Figure.No.2.
Table No: 2 most commonly prescribed Anti-rheumatoid drugs.
Drug name Number of prescriptions Percentage (%)
Hydroxychloroquine 111 20.11%
Paracetamol 103 18.66%
Diclofenac 88 15.94%
Sulfasalazine 86 15.57%
Methotrexate 41 7.42%
Methyl prednisolone 40 7.24%
Aceclofenac 21 3.80%
Seratopeptidase 17 3.08%
Tramadol 17 3.07%
Prednisolone 13 2.36%
Sodium chondroitin sulphate 4 0.73%
Sodium hyalourate 4 0.73%
Chloroquine 2 0.37%
Ibuprofen 2 0.37%
Indomethacin 2 0.37%
Aspirin 1 0.18%
Total 552 100
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Fig 2: Most Commonly Prescribed Anti-Rheumatoid Drugs
Co- Morbid Conditions Prevalent In Rheumatoid
Arthritis(n=150)
Co- morbid conditions that are prevalent in
rheumatoid arthritis were found out. Out of 150 cases
15 cases were with comorbidity, diseases that
accompanied with RA were Hypertension, Diabetes,
Asthma. They were clearly indicated in table.No.3
and figure.No.3.
Details of Drug-Drug Interactions
Out of 150 patients, 221 interactions were found. In
that 44 interactions between Sulfasalazine and
prednisolone followed by 39 interactions between
Diclofenac and Sulfasalazine. The data were shown
in Table.No.4 and Figure.No.4.
Table 3: Co- Morbid Conditions Prevalent In
Rheumatoid Arthritis(n=150)
Co-Morbidities No.of
Prescriptions
Percentage
Hypertension 9 60%
Diabetes 4 26.66%
Asthma 2 13.34%
Total 15 100%
Number Of Prescriptions
Hypertensio
n
Diabetes
Asthma
Fig 3: Co- Morbid Conditions Prevalent In
Rheumatoid Arthritis(n=150)
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Table: 4 Details of Drug-Drug Interactions:
Drug Interactions Number of Interactions Percentage (%)
Sulfasalazine *Prednisolone 44 19.90
Diclofenac *Sulfasalazine 39 17.64
Hydroxychloroquine*Methotrexate 31 14.03
Diclofenac *Methotrexate 25 11.33
Diclofenac *Prednisolone 22 9.94
Sulfasalazine*Methotrexate 15 6.78
Folic acid *Methotrexate 10 4.52
Pantoprazole*Methotrexate 7 3.17
Sulfasalazine*Enalapril 3 1.36
Metformin *Prednisolone 3 1.36
Indomethacin*Sulfasalazine 3 1.36
Gelusil * Sulfasalazine 2 0.92
Diclofenac*Indomethacin 2 0.92
Indomethacin *Prednisolone 2 0.92
Clonazepam*Acetaminophen 1 0.45
Gelusil *Enalapril 1 0.45
Sulfasalazine*Atenolol 1 0.45
Amlodipine *Nifedipine 1 0.45
Atenolol*Nifedipine 1 0.45
Sertraline*tramadol 1 0.45
Aspirin*Methotrexate 1 0.45
Clopidogrel*Diclofenac 1 0.45
Aspirin*Sulfasalazine 1 0.45
Aspirin *Clopidogrel 1 0.45
Aspirin*Diclofenac 1 0.45
Indomethacin*Methotrexate 1 0.45
Methotrxate*Aceclofenac 1 0.45
TOTAL 221 100
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Fig: 4 Details of Drug-Drug Interactions
Details of Effects of Interactions
Out of 150 patients, 221 interactions were found. In
those 129 interactions shows synergism and 92
antagonisms. The data were shown in Table.No.5and
Figure.No.5.
Table 5: Details of Effects of Interactions
Effect Number of
interactions
Percentage
Synergism 129 58.37%
Antagonism 92 41.63%
Total 221 100% Fig: 5 Details of Effects of Interactions
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Differentiation of Drug Interaction of anti-
rheumatic Drugs with RA Drugs and Other Drugs
Out of 150 patients, 221 interactions were found. In
that 187 interactions between anti-rheumatic drugs
and 34 interactions between other drugs. The data
were shown in Table.No.6 and Figure.No.6.
Table 6: Differentiation of Drug Interaction of
Anti-rheumatic Drugs with RA Drugs
and other Drugs
Interactions Number of
interactions
Percentage
Between anti-
rheumatoid drugs
187 84.61%
Between anti-
rheumatoid and
other drugs
34 15.39%
Total 221 100%
Fig 6: .Differentiation of Drug Interaction of Anti-
rheumatic Drugs with RA Drugs and other
Drugs
Fig: 7 Details of Interaction between Anti-
rheumatic Drugs
Details of Interaction between Anti-Rheumatic
Drugs
Out of 150 patients the most of the interactions were
occurred in the 5 drugs therapy followed by 4 drug
therapy, more than 5 drug therapy and 3 drug
therapy. No interactions were found in 2 drugs. The
data shows the maximum interactions were found at
5 drug combinations, i.e. 88 interactions. It also
proves that whenever the polypharmacy is there it
always increase the chance of drug-drug interactions.
The data were shown in Table.No.7and Figure.No.7.
Table No: 7 Details of Interaction between Anti-
rheumatic Drugs
Class of drugs Number of
interactions
Percentage
2 drugs 0 0
3 drugs 26 13.90%
4 drugs 46 24.60%
5 drugs 88 47.06%
More than 5
drugs
27 14.44%
Total 187 100%
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CONCLUSION:
Whenever the Polypharmacy is there, it also
increases the chance of drug-drug interactions. It can
be concluded that, the utilization of DMARDS
increased in patients with RA and the use of
corticosteroids utilization decreased also the use of
both NSAIDs and narcotics increased.
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