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
Inappropriate drug use in hospitalized elderly patients of medicine and cardi...Apollo Hospitals
National committee on quality assurance, USA convened an expert consensus panel and identified the list of drugs which should be avoided in the elderly people. This resulting list of drugs after 2003 beers criteria were added to the 2006 Health Plan Employer Data and Information Set (HEDIS) to assess the drug prescribing in elderly people.
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.
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
Inappropriate drug use in hospitalized elderly patients of medicine and cardi...Apollo Hospitals
National committee on quality assurance, USA convened an expert consensus panel and identified the list of drugs which should be avoided in the elderly people. This resulting list of drugs after 2003 beers criteria were added to the 2006 Health Plan Employer Data and Information Set (HEDIS) to assess the drug prescribing in elderly people.
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.
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
A study on drug utilization evaluation of anticoagulant therapy INA tertiary ...SriramNagarajan16
Objectives
Evaluation of a prospective observational study of the Anticoagulants used in tertiary care hospital, to provide
information and correct rationale pertaining to Anticoagulants which also describes various distribution wise of
Anticoagulants by age groups, genders, pattern of prescription, drug wise, dose, route, class and department to assess
the statistical incidence regarding usage and its right provision.
Methodology
Study site was at SUNSHINE HOSPITALS, conducted for a period of 6 months. Both male and female individuals of
age group 16-75years were included.
Results
Study included assessment of utilization of Anticoagulants with total of 200 prescriptions; of which males (54.5%),
females (44.67%), age groups of 60-69 (34%) followed by age groups 70-80(27.5%), parenteral SC route (59%) and
followed by intravenous route. (38%) and oral route was rare (3%), orthopaedics (64, 32%), followed by cardiology
(43, 21.5%), neurology (29, 14.5%), pulmonology (22, 11%).
Conclusion
To conclude with, Anticoagulants are effective drugs in an array of treatment of diseases involving careful
consideration of factors such as potency, formulation, responsiveness and cost. Anticoagulanting agents were mostly
given in cases of post or pre operative care followed by prophylaxis for thrombosis for better patient outcome.
Should Metformin Be Continued after Hospital Admission in Patients with Coron...asclepiuspdfs
Background: In most patients with diabetes, guidelines recommend discontinuation of oral anti-diabetic agents. Preliminary data suggest that pre-admission metformin use may have a mortality benefit in patients with coronavirus disease (COVID)-19 admitted to the hospital. Objective: The objective of the study was to review the impact of metformin on morbidity and mortality among hospitalized patients with COVID-19. Methods: Review of English literature by PUBMED search until November 10, 2020. Search terms included diabetes, COVID-19, metformin, retrospective studies, meta-analyses, pertinent reviews, pre-print articles, and consensus guidelines are reviewed.
Evaluation of Anti-Retroviral Combination Therapy In Patients With HIV/Aids I...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
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.
Mark Remley is the Former Executive Vice President and Chief Information Officer of Signal Corporation, a company he stayed with from 1987 to 2004. In those first three years at Signal, he worked towards getting both his Microsoft Certified Solutions Expert (MCSE) certification as well as his Novell Netware Engineer certification, both of which he held from 1990 to 2000.
A study on drug utilization evaluation of anticoagulant therapy INA tertiary ...SriramNagarajan16
Objectives
Evaluation of a prospective observational study of the Anticoagulants used in tertiary care hospital, to provide
information and correct rationale pertaining to Anticoagulants which also describes various distribution wise of
Anticoagulants by age groups, genders, pattern of prescription, drug wise, dose, route, class and department to assess
the statistical incidence regarding usage and its right provision.
Methodology
Study site was at SUNSHINE HOSPITALS, conducted for a period of 6 months. Both male and female individuals of
age group 16-75years were included.
Results
Study included assessment of utilization of Anticoagulants with total of 200 prescriptions; of which males (54.5%),
females (44.67%), age groups of 60-69 (34%) followed by age groups 70-80(27.5%), parenteral SC route (59%) and
followed by intravenous route. (38%) and oral route was rare (3%), orthopaedics (64, 32%), followed by cardiology
(43, 21.5%), neurology (29, 14.5%), pulmonology (22, 11%).
Conclusion
To conclude with, Anticoagulants are effective drugs in an array of treatment of diseases involving careful
consideration of factors such as potency, formulation, responsiveness and cost. Anticoagulanting agents were mostly
given in cases of post or pre operative care followed by prophylaxis for thrombosis for better patient outcome.
Should Metformin Be Continued after Hospital Admission in Patients with Coron...asclepiuspdfs
Background: In most patients with diabetes, guidelines recommend discontinuation of oral anti-diabetic agents. Preliminary data suggest that pre-admission metformin use may have a mortality benefit in patients with coronavirus disease (COVID)-19 admitted to the hospital. Objective: The objective of the study was to review the impact of metformin on morbidity and mortality among hospitalized patients with COVID-19. Methods: Review of English literature by PUBMED search until November 10, 2020. Search terms included diabetes, COVID-19, metformin, retrospective studies, meta-analyses, pertinent reviews, pre-print articles, and consensus guidelines are reviewed.
Evaluation of Anti-Retroviral Combination Therapy In Patients With HIV/Aids I...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
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.
Mark Remley is the Former Executive Vice President and Chief Information Officer of Signal Corporation, a company he stayed with from 1987 to 2004. In those first three years at Signal, he worked towards getting both his Microsoft Certified Solutions Expert (MCSE) certification as well as his Novell Netware Engineer certification, both of which he held from 1990 to 2000.
Similar to Use of potentially inappropriate medicines in elderly A prospective study in medicine out-patient department of a tertiary care teaching hospital
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.
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.
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.
The safe use of medicines is perhaps the single most important criteria that any regulatory authority within a given country has to ensure in order both to protect the public health and the integrity of its health care system. For the same purpose pharmacovigilance was established. According to WHO, Pharmacovigilance is the science and activities related to the collection, detection, and assessment of ADR’s. It promotes the systematic, rational use and assures the confidence for the safety of drugs. It improves patient care and safety. Significance of pharmacovigilance is growing as the patients or consumers have become more responsive about the advantage and hazard of medicines. Pharmacovigilance is a complex process and a robust system is essential to undertake the activity. A good pharmacovigilance system will identify the hazard aspects in the short period of time. This review article tries to explain the some basic principles, history and developments, methods and some scope of this developing field i.e. Pharmacovigilance in India.
Polypharmacy appropriate and inappropriate based on risk and benefit assessment case study, negative consequences of polypharmacy, deprescribing tools,
According to WHO, Drug utilization research is defined as ‘the marketing, distribution, recommendation and utilize of drugs in a society, with particular focus on the resulting medical, social and economic results. In many developed countries, a number of studies about utilization of drug have been conducted, which indicates a wide proof of irrational drug use. The drug use indicators are considered as objective measures that can be extended to identify practices of medicines utilization in any health facility, country or an entire region. To check the drug utilize pattern in Primary Health Care (PHC) facilities of Bhakkar district Punjab Pakistan. Using WHO core drug use indicators, a prospective cross-sectional descriptive study was carried out in health facilities of Bhakkar district. A total of 40 prescriptions were analyzed. The average age of patients visiting HC centers was 33.11 years (female 35.79; male 30.40). 3.65 was the average number of prescribed drugs. 27% was the percentage of encounters with at least one prescribed antibiotic whereas 35% was the percentage of encounters with at least one prescribed injection prescribed, which was low. 25% is the total percentage of drugs given using generic names was noticed. The average consultation and dispensing time of 40 prescriptions was 2.02 minutes and 42.52 seconds. The study demonstrates that trend toward irrational practice mainly on use of antibiotics and non-generic prescribing in most of health facilities studied. Patient care given by health facilities studied was inadequate and thus for encouragement of rational drug use practice, an effective intervention program is recommended.
POINTS TO BE INCLUDED
Definition, scope,
Technical definitions, common terminologies used in clinical
settings
Daily activities of clinical pharmacists
Ward round participation
Treatment Chart Review
Adverse drug reaction monitoring
Interprofessional collaboration
A systemic review on antibiotic use evaluation in paediatricsJing Zang
Drug utilization is the marketing, distribution, prescription, and use of drug in a society, with special emphasis on the resulting medical, social and economic consequences. Antibiotics are valuable discoveries of modern medicine and their definitive and or appropriate use has led to a decline in the morbidity and mortality associated with various infectious diseaseswhile inappropriate use of antibiotics can increase morbidity, mortality, patient cost and bacterial antibiotic resistance.Antimicrobial agents are among the most commonly prescribed drug in Paediatrics. Because of an overall rise in health care costs, lack of uniformity in drug prescribing and the emergence of antibiotic resistance, monitoring and control of antibiotic use are of growing concern and strict antibiotic policies should be warranted. The caution use for antimicrobial agents is very important as their unavailability or resistance can be life threatening. Irrational drug use is a common practice in developing countries. In India, clinician often prescribe three or four drugs to treat the most trivial conditions for the sake of satisfying the patients need to receive drugs or the drug sellers need for profit. Thus drug use evaluation studies are required for all drugs in general and particularly for antibiotics.
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
Pharmacovigilance is defined as, The pharmacological science and activities concerned with the detection, assessment, understanding and prevention of adverse reactions to medicines or Pharmacovigilance is the name given to the mechanisms and controls that together map and ensure the safety of a medicine throughout its life span – from test tube to patient.
Similar to Use of potentially inappropriate medicines in elderly A prospective study in medicine out-patient department of a tertiary care teaching hospital (20)
Use of potentially inappropriate medicines in elderly A prospective study in medicine out-patient department of a tertiary care teaching hospital
1. 95Indian J Pharmacol | April 2010 | Vol 42 | Issue 2 | 95-98
Use of potentially inappropriate medicines in elderly: A
prospective study in medicine out-patient department of a
tertiary care teaching hospital
H.G. Zaveri, S.M. Mansuri1
, V.J. Patel
Research Article
Department of Pharmacology,
NHL Municipal Medical College,
Ahmedabad,
1
Department of Pharmacology,
Kesar Sal Medical College,
Ahmedabad, India
Received: 30-11-2008
Revised: 12-10-2009
Accepted: 30-04-2010
DOI: 10.4103/0253-7613.64499
Correspondence to:
Dr. Varsha J. Patel.
E-mail: drvarsha4@rediffmail.com
Introduction
The elderly population is increasing rapidly world wide.[1]
About 55% of community prescriptions dispensed in 2001 in
UK were meant for elderly people. However, safe and effective
prescribing of medicines in elderly continues to present a major
challenge.[2]
In spite of the fact that elderly people are reported
to be responsible for half the total drug usage, less than 5% of
randomized controlled trials have been designed for people over
65 years! With limited evidence available to guide prescribing
for elderly, the prescribers tend to depend on data available
for younger subjects. Moreover, elderly form a heterogeneous
group due to various factors like co-morbidities, interindividual
variability in the aging process and interindividual differences
in age-related pharmacokinetic and pharmacodynamic
changes.[3]
Obviously inappropriate use of drugs is expected to
be high in this population.
Multiple drug use and polypharmacy is highly prevalent
in elderly, exposing them not only to adverse drug reactions
but also to drug interactions, increased cost of therapy, and
compliance errors.[4,5]
The prevalence of adverse reactions
increased in the older people and reactions are reported to be
ABSTRACT
Objective: The present study was undertaken with the aim to detect extent of drug use
in elderly at medicine outpatient department at tertiary care hospital and to evaluate
inappropriate prescribing with the help of Beers’ criteria 2002.
Materials and Methods: The study was carried out at medicine out patient department of
our hospital. 407 geriatric patients were included during the study period of three and
half months. The data was collected in a proforma which included the patients' details
and the prescriptions.
Results: The results reveal that 7.42% of total drugs were prescribed in an inappropriate
manner and 23.59% of total patients received at least one inappropriate drug prescription.
Administration of a drug which is avoided in elderly forms a common category of
inappropriate drug use. Antihistamines, anticholinergic, sedatives and hypnotics and
cardiac glycosides are the most common drug groups prescribed in inappropriate manner.
Conclusion: To conclude, this study shows high prevalence of inappropriate use of drugs
in geriatric practice suggesting urgent need for sincere efforts to improve the situation.
KEY WORDS: Beers criteria, drug use study, elderly, potentially inappropriate medicines
more severe.[6]
Studies on hospitalization due to adverse drug
reactions reveal that elderly are several times more likely to
be admitted due to adverse drug reactions and about half of
these reactions are preventable.[6,7]
In order to prevent adverse reactions in the elderly it
is important to identify the pattern of inappropriate use of
medicines in this population. To evaluate the appropriateness of
drugs prescribed for elderly, Beers defined criteria for potentially
inappropriate medicines in 1997[8]
which were updated in
2003.[9]
Several studies have reported use of potentially
inappropriate medicines (PIMs) in elderly people based on
Beers criteria.[10-14]
The literature related to the use of potentially inappropriate
medications (PIMs) from India is scarce. Hence, this study
was undertaken at a tertiary care teaching hospital with the
objectives of evaluating the prevalence and pattern of PIMs
using Beers criteria 2003.
Materials and Methods
This study was carried out in medicine out-patient
department (OPD) of a tertiary care teaching hospital. The
hospital caters to the health care needs of millions of patients
[Downloaded free from http://www.ijp-online.com on Saturday, April 18, 2015, IP: 202.131.108.40]
2. 96 Indian J Pharmacol | April 2010 | Vol 42 | Issue 2 | 95-98
from Ahmedabad city, many villages and towns around the
city and also to the patients from other neighboring states like
Rajasthan, Madhya Pradesh, and Maharashtra.
The data were collected prospectively. Patients reporting
to medicine OPD for treatment who were aged 65 years and
above and consented for study were included. Only new cases
were included in the study during the period November 2005
to February 2006. Data were collected in a proforma, which
included patient’s demographic details, OPD registration
number, diagnosis/provisional diagnosis, and complete
prescription.
Data Analysis
About 62% drugs were prescribed by their brand names.
After identification of the drugs by their generic name, they
were evaluated for potentially inappropriate use with the help
of Beers criteria 2003. Beers criteria are comprehensive set
of explicit criteria for potentially inappropriate drug use in
ambulatory elderly aged 65 years and above.[8,9]
According to these criteria, drugs which are prescribed
inappropriately are classified into one of the following
categories:
Category A: Drugs that generally should be avoided in older
adults.
Category B: Drugs that exceed maximum recommended daily
dose.
Category C: Drugs to be avoided in combination with specific
co-morbidity.
Statistical Analysis
Data obtained were analyzed with the help of SPSS software
version 13. The chi-square test was used and values with
P<0.05 were considered statistically significant.
Results
A total 407 patients were included during the study period.
Of these, 216 (53.07%) were males and 191 (46.93%) were
females. The age of patients ranged from 65 years to 85 years.
Morbidity Pattern
The morbidity pattern based on ICD-10[15]
during the study
period is shown in Figure 1. Cardiovascular disorders (59.95%)
formed the most common cause for attending the OPD followed
by respiratory disorders (22.85%). Hypertension (40.29%) was
the most common condition affecting the geriatric patients
visiting Medicine OPD, followed by diabetes mellitus (12.28%),
ischemic heart disease (11.30%), upper respiratory infection
(10.31%), and chronic obstructive pulmonary disease (10.31%).
Drug Use Pattern
All 407 patients received a total 1738 drugs. The average
number of drugs per patient was 4.27 (range 1 to 25). Atenolol
was the most frequently used drug, being prescribed to 26.53%
of patients. Other commonly prescribed drugs were paracetamol
(21.86%), aspirin (19.41%), and Vitamin B complex (12.53%).
Use of Potentially Inappropriate Medicines (Beers criteria)
Out of 407 patients, 96 patients (23.58%) received at least
one drug which was potentially inappropriate and 129 out of
total 1738 drugs were prescribed inappropriately; drugs to
be avoided in geriatric patients (Category A) being the most
common category of inappropriate use [Table 1]. According to
Beers criteria 2003, out of 14 drugs prescribed inappropriately
in this study, 10 carried a high degree of risk to the elderly
patients. There was highly significant association between the
number of drugs prescribed and frequency of use of PIMs (P<
0. 0002).
Common Conditions for PIMs
Inappropriate drug use was most frequent in upper
Figure 1: Morbidity pattern in elderly attending medicine OPD (ICD-
10), n= 407
Table 1:
Frequency of use of potentially inappropriate medicines in elderly*
Category Name of drugs (Severity rating) Total=129
A Generally should be avoided in older adults 71
Pheniramine (high) 25
Chlorpheniramine maleate (high) 19
Dicyclomine (high) 13
Dextropropoxyphene (low) 10
Amiodarone (high) 1
Amitriptyline (high) 1
Diazepam (high) 1
Clonidine (high) 1
B Drugs that exceed maximum recommended daily
dose
35
Digoxin >0.125 mg/day (low) 20
Alprazolam >2 mg/day(high) 10
Ferrous sulfate >325 mg/day (low) 3
Lorazepam >3 mg/day (high) 2
C To be avoided in combination with specific
co-morbidity
23
Phenylpropanolamine with hypertension (high) 18
Nifedipine with constipation (low) 5
*According to Beers criteria
Table 2:
Common conditions for use of PIM in elderly
Condition Frequency (%) n=129
Upper respiratory tract infection 51 (39.53)
Abdominal pain 23 (17.82)
Congestive heart failure 18 (13.95)
Hypertension 6 (4.65)
Insomnia 6 (4.65)
Zaveri, et al.: Use of potentially inappropriate drugs in elderly
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3. 97Indian J Pharmacol | April 2010 | Vol 42 | Issue 2 | 95-98
respiratory tract infection (URTI) followed by abdominal pain
and congestive cardiac failure [Table 2].
Antihitamines pheniramine and chlorpheniramine were
prescribed to 6.1% and 4.6% of patients with URTI, respectively.
Dicyclomine, an antimuscarinic drug, with anticholinergic
properties, was used in 3.1% of elderly patients. There was
no significant association between any disease condition and
use of PIMs.
Discussion
The study reveals typical morbidity pattern observed in
India.[16]
Cardio-vascular system (CVS) was the most common
(45%) system affected. Most common indication in CVS
was hypertension followed by coronary artery disease and
congestive heart failure. The second most common system
affected was the respiratory system, i.e. 17% of total patients.
Upper respiratory tract infection was the most common
respiratory condition followed by COPD.
In this study, 7.42% of total drugs prescribed were
potentially inappropriate, which is higher than that reported
(4.1%) by a study conducted in south India.[16]
Total 96 patients
out of 407, i.e. 23.59%, elderly patients received potentially
inappropriate prescription of at least one drug. These findings
are in agreement with a study from the Netherlands, in which
20% of ambulatory older adults received at least one potentially
inappropriate drug prescription.[10]
In a study carried out in
Japanese long-term facility overall prevalence was 39.1%.[11]
Another study in ambulatory patients reported lower prevalence
at 13.4%.[19]
Several studies carried out in hospitalized patients
show prevalence from 25% to 49%.[12-14,17,18]
Category A which includes drugs which should be avoided
in elderly and should not be prescribed, forms a major category
of inappropriate use of drugs. Beers has enlisted 46 drugs/drug
groups under this category.[9]
Older antihistamines (pheniramine
and chlorpheniramine) prescribed to 10.7%, antispasmodic
drug dicyclomine to 3.1% and dextropropoxyphene to 2.4% of
patients form the majority of PIMs in category A. Other drugs
like amiodarone, a class III antiarrhythmic, amitryptyline,
an antidepressant drug with sedative property, clonidine, a
centrally acting antihypertensive drug and diazepam, a long
acting sedative hypnotic were prescribed to each patient. When
compared to the Netherlands study, our figures are higher for
some drugs such as antihistamines (0.1%), dextropropoxyphene
(0.1%), and clonidine (0.1%), while lower use is evident for
diazepam (2.8%), amitriptyline (2.0%), and amiodarone
(0.7%).[10]
In the Japanese study, the reported prevalence for
different drugs is antihistamines (1.4%), antispasmodic (0.1%),
amitriptyline (0%), and long acting benzodiazepines (0.1%).[11]
Beers criteria define maximum daily dose of certain drugs
for elderly. If dose of any of these drugs exceeds the maximum
dose it is considered as PIM category B, 4 drugs/drug groups
being listed in this category.[9]
Digoxin, a drug with narrow
safety margin, was prescribed to 4.9% patients in a higher
dose (>0.125 mg/day), the prevalence being higher than in
the Netherlands study-0.5%[10]
and 0% in the Japanese study.[11]
Similarly for benzodiazepines, daily doses should not exceed 2
mg for alprazolam, 3 mg for lorazepam, 60 mg for oxazepam,
and 15 mg for temazepam. In our study alprazolam was given
in higher doses to 2.45% of patients and lorazepam to 0.49%
of patients. This is higher compared to the Netherlands study
reporting such use of alprazolam (0%) and lorazepam (0.1%)
and compared to the Japanese study in which none of the
patients were reported with such inappropriate use for these
drugs.[10,11]
According to Beers criteria if dose of ferrous sulfate
exceeds 325 mg daily, then it is inappropriate. In this study 0.7%
of patients received a higher dose (>325 mg/day) compared
to none in the Netherlands study[10]
and 0.2% in the Japanese
study.[11]
Phenylpropanolamine (PPA) is still available as one of
the ingredients of cough and cold preparations in India. It is
inappropriate in a patient of hypertension, as it may produce
elevation of blood pressure secondary to sympathomimetic
activity. Hence, it is a PIM category C which includes drugs
to be avoided in combination with specific co-morbidity.
PPA was prescribed to 4.42% of patients with hypertension.
Similarly,nifedipine, a dihydropyridine calcium channel blocker
and a commonly used antihypertensive was prescribed in
1.22% of patients who had constipation. None of these two
drugs was reported inappropriate by C.S. van der Hooft[10]
However, Niwata et al reported 30.1% prevalence of use of
calcium channel blockers, anticholinergics, and tricyclic
antidepressants in patients with chronic constipation.[11]
The same study has reported inappropriate use of NSAIDs
and anti-platelet drugs in patients with clotting disorder
or on anticoagulant (14.8%), use of metoclopramide and
conventional antipsychotic in patients with Parkinson’s
disease(11.4%) and use of short/intermediate acting
benzodiazepines and tricyclic antidepressants in patients
with history of syncope or falls (22.3%).[11]
In our study none
of these PIMs which carry high risk according to Beers criteria
were observed, which is a positive finding.
Studies to identify the factors for PIM have reported older
patients, polypharmacy, depression immobilization, and
hypertension as some of the factors associated with increased
risk of PIM.[12,19]
In our study polypharmacy is the only factor
associated with use of PIMs, while disease condition and age
did not show significant association.
Some other criteria also exist for evaluating the use of
PIMs in elderly.In a study designed to compare PIM prevalence
rates based on the 1997 Beers criteria and Zhan criteria with
the rate obtained using the 2003 Beers criteria, the prevalence
was estimated at 13.4% based on the 2003 Beers criteria,
compared with 8.8% based on the 1997 Beers criteria and
4.2% based on the Zhan criteria.[20]
STOPP (Screening Tool of
Older Persons' potentially inappropriate Prescriptions) is a new,
systems-defined medicine review tool. In a study comparing the
performance of STOPP to that of established Beers criteria in
detecting potentially inappropriate medicines (PIMs) and related
adverse drug events in older patients presenting for hospital
admission, STOPP criteria identified a significantly higher
proportion of patients requiring hospitalization as a result of
PIM-related adverse events than Beers criteria.[21]
Conclusion
This study suggests that use of PIMs is common in
elderly patients, some of them associated with high degree
of risk in terms of adverse drug reactions or worsening of
the co-morbidity. Evidence indicates that high prevalence of
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4. 98 Indian J Pharmacol | April 2010 | Vol 42 | Issue 2 | 95-98
inappropriate prescribing of medicines in elderly people is
associated with increased morbidity and mortality, increased
cost, and decreased quality of life. Our study has been limited
to only one specialty. More studies in other specialties and
general practice are necessary to sensitize the practitioners
to this important public health issue.
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Source of Support: Nil Conflict of Interest: None declared.
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