Drug utilization study in genitourinary infections used as a teaching tool for rational therapy for MBBS students in a Medical College at Dehradun, Uttarakhand

Background: There is a need to introduce clinical pharmacology at the undergraduate level in order to improve rational prescribing of medicines. The present study was undertaken to analyze drug utilization pattern of genitourinary infections to teach certain basic skills to MBBS students which will form an integral component of practicing rational therapeutics.Methods: The retrospective study was conducted by Pharmacology Department in Shri Guru Ram Rai Institute of Medical and Health Sciences (SGRRIM and HS). A total of 92 prescriptions were collected by second professional MBBS students and randomly evaluated for prescribing pattern using WHO drug indicators.Results: A total of 92 prescriptions were analyzed. Male:female ratio was 1.96:1. Age wise distribution was done: 0-15 years were 14 (15.21%), 16-30 years were 26 (28.26%), 31-45 years were 24 (26.08%), 46-60 years were 19 (20.65%), and >60 years were 9 (9.78%). A total of 260 drugs were prescribed. 116 (44.61%) antimicrobials, 70 (26.92%) antacids and antiemetics, 40 (15.38%) analgesics, 11 (4.23%) urinary alkalizers, 9 (3.23%) antifibrinolytics, and 14 (5.38%) miscellaneous drugs were prescribed. 144 (55.38%) injectable and 116 (44.61%) oral drugs were prescribed. Numbers of fixed-dose combinations were 32 (34.78%). 2.82 drugs per prescription were prescribed. 171 (65.76%) drugs were prescribed from National List of Essential Medicines 2013 (NLEM 2013). Majority of drugs were prescribed by brand names.Conclusion: Majority of drugs were prescribed from NLEM 2013. The main purpose of undergraduate medical curriculum is to develop the requisite diagnostic and therapeutic skills of a basic doctor. It is only by drug utilization studies that burden of diseases and corresponding utilization of drugs can be measured

Study of antimicrobial prescribing pattern in a tertiary care teaching hospital at Dehradun, Uttarakhand, India - A tool to teach clinical pharmacology to MBBS students

Background: Due to increasing resistance to a majority of antimicrobials, it becomes very necessary to teach undergraduate students, the future prescribers, about the judicious and rational use of antimicrobial drugs. The objective of this study was to impart the basic clinical skills to undergraduate MBBS students which will form an integral component of practising rational therapeutics.Methods: A total no of 737 cases were followed up by the 5th semester 2nd Professional MBBS students in the Department of Pharmacology at Shri Guru Ram Rai Institute of Medical and Health Sciences (SGRRIM and HS), Dehradun from June 2013 to July 2015. Patients were analysed on various WHO drug use indicators like drug formulations, drugs prescribed per prescription, Fixed dose Combinations (FDCs), drugs prescribed from National List of Essential Medicines (NLEM) and drugs prescribed by generic names.Results: A total of 737 prescriptions were analysed. Male: Female ratio was 1.74:1 (63.50%:36.50%). Majority of the patients 218 (29.58%) were in 16-30 years age group. A total of 1205 antimicrobials were prescribed. 304 (25.23%) cephalosporins were most frequent followed by 184(15.27%) penicillins, 176(14.61%) antitubercular drugs, 163(13.53%) nitroimidazoles, 143 (11.87%) fluoroquinolones, 102 (8.46%) aminoglycosides, 29 (2.41%) macrolides, 19 (1.58%) tetracyclines, 12 (1%) carbapenems, 11 (0.91%) antimalarials, 11 (0.91%) antihelminthics, 6 (0.50%) glycopeptides, 4 (0.33%) lincosamides and 41 (3.41%) miscellaneous antimicrobials. Most frequently prescribed antimicrobial was Ceftriaxone which was given in 97 (8.05 %) patients. A total of 424 (35.19%) oral antimicrobials, 777 (64.48%) injectable antimicrobials and 04 (0.33%) local/topical antimicrobial drugs were prescribed. 5.13 drugs per prescription and 1.64 antimicrobials per prescription were prescribed. 2100 (55.56%) drugs were prescribed from National List of Essential Medicine 2015 (NLEM 2015). 1177 (97.68%) antimicrobials were prescribed from NLEM. 1110 (92.12%) antimicrobials were prescribed by brand names. A total of 342 (28.38%); fixed dose combinations of antimicrobials were prescribed.Conclusions: Majority of the prescriptions revealed poly-pharmacy and a very high percentage of drugs were prescribed by their respective brand names. It is only by observing drug utilization patterns, current trends and common errors in prescriptions can be highlighted and rational prescription of antimicrobials can be taught to MBBS students

Study of prevalence and prescribing trends in infectious diseases: as a teaching tool for MBBS 2nd professional students

Background: Irrational prescription of drugs is a common occurrence in clinical practice. Introduction of clinical pharmacology at the undergraduate level as an integral part of rational therapeutics is the need of hour. The present drug utilization study, prevalence and prescribing pattern in infectious diseases in a tertiary care teaching hospital was carried out to teach clinical pharmacology to 2nd professional MBBS students, to sensitize and promote rational prescribing.Methods: A total of 621 prescriptions were collected by 2nd professional MBBS students at Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun. Prescriptions were analyzed on various parameters, using WHO drug use indicators.Results: A total of 621 prescriptions were analyzed. 477 (76.81%) were males and 144 (23.19%) were females. Majority of patients 357 (57.49%) were 16-60 years’ age group. The infectious diseases prevalence was 153 (24.63%) enteric fever, 132 (21.26%) hepatitis, 111 (17.87%) pyrexia of unknown origin, 90 (14.49%) cellulitis, 135 (21.74%) belongs to miscellaneous category respectively. A total of 4446 drugs were prescribed, which includes antibiotics 2025 (45.55%), multivitamins 969 (21.79%), antacids 699 (15.72%), analgesics 408 (9.18%), antiemetic 273 (6.14%) and antiepileptic 72 (1.62%) respectively. 3096 (69.64%) oral, 1350 (30.36%) injectable and 786 (17.68%) fixed dose combinations (FDCs) were prescribed. 3.26 antibiotics and 7.15 drugs per prescription were prescribed. 2622 (58.97%) drugs were prescribed from national essential medicine list 2015. 100% drugs were prescribed by brand names.Conclusions: The prescriptions revealed polypharmacy. This study can help to provide feedback to the prescribers, thereby increase in awareness and improve patient care by rational utilization of drugs

Comparative evaluation of various analgesic drugs in Wistar rats used as a teaching tool to teach animal experiments to post graduate MD Pharmacology students

 Background: Postgraduates when join Pharmacology department, they don’t have much idea about guidelines and methods to do animal experiments. This study was designed to sensitize postgraduate students to animal experiments by evaluating the anti-inflammatory effects and the efficacy of diclofenac, tramadol and etoricoxib in reducing paw edema in wistar rats.Methods: The wistar rats of 225-250gram were divided into four groups (n=10 each). In all the groups the paw edema on right paw was created using 0.1ml of 1% formalin subcutaneously. Group 1 rats (control), group 2 were given diclofenac, group 3 were given tramadol and group 4 were given etoricoxib orally. The parameters assessed were water displacement in plethysmography after 2, 4, 24, 48 hours of giving the drug. The circumference of edematous paws after 4 hours, licking of paw was observed over 30minutes of giving the drug and was compared. Pre and post study feedback were obtained from the students by using a preformed questionnaire to assess the knowledge gained by the students.Results: The test showed that all the drugs were effective in reducing inflammation, circumference of edema and the licking duration significantly (p<0.05). The post study answering of questions by postgraduate was 100% in comparison to pre-study answering which was 33%.Conclusions: A short animal study conducted as a teaching tool to postgraduate students was able to teach the guidelines of animal experiments and handling of animals effectively

Prescribing pattern in Rheumatoid Arthritis patients in a tertiary care teaching hospital

Background: Rheumatoid arthritis (RA) is associated with joint deformity and significant health care related expenses. This disease affects approximately 1% of the adult population, the prevalence of RA in India is approximately 0.75% and increasing trend has been observed. Irrational prescribing is a common phenomenon around the globe. The drug utilization studies form an important tool for the assessment of rational or irrational prescribing and WHO drug use indicators. Thus keeping this in view the prescribing pattern analysis in RA patients was done.Methods: This prospective study was carried out by the department of pharmacology in medicine OPD of SGRRIM and HS, Dehradun for one year. A total of 450 RA diagnosed patients were included in the study. The diagnosis was made on the basis of clinical assessment and lab parameters as rheumatoid factor and anti-ccp. The collected prescriptions were analyzed by using WHO drug use indicators.Results: Total of 450 prescriptions was analyzed. 378 (84%) were females and 72 (16%) were males. Most commonly presenting age group was 31-60 years 276 (61.33%). Family history and RA factor was positive in 168 (37.33%) and 318 (70.67%) patients respectively. Anti-ccp was raised in 408 (90.67%) patients. The comorbid conditions were type-2 diabetes mellitus 72 (16%), hypertension 48 (10.67%), hypothyroidism 36 (8%) and other associated illness 54 (12%). Total of 1655 drugs were prescribed during the study period. The prescribed drugs were disease modifying anti-rheumatic drugs (DMARDs) 582 (35.18%), vitamin-D3 and calcium supplements 320 (19.34%), analgesics 311 (18.80%), antacids 204 (12.33%), others 238(14.38%). 437 (26.40%) fixed dose combinations (FDCs), 3.67 drugs per prescription, 1145 (69.18%) drugs by brand names and 1161 (70.15%) drugs from the National List of Essential Medicine (NLEM) 2015 were prescribed.Conclusions: Drug prescribing pattern depicts that most commonly prescribed were DMARDs, vitamin-D3 and calcium supplements and analgesics. Most of the drugs were prescribed from NLEM 2015

Drug utilization pattern of analgesics as a teaching tool for rational therapy to MBBS students in a medical college at Dehradun, Uttarakhand, India

Background: As a need to introduce Clinical Pharmacology at the undergraduate level the drug utilization studies (DUS) offer useful methods for teaching and training in drug therapy. The indiscriminate use of medicines results in unwanted side effects, drug interactions. Thus keeping this view in mind, this drug utilization research was set to evaluate the prescribing pattern of analgesics to impart certain basic skills to MBBS students which will form an integral component of practicing rational therapeutics.Methods: The retrospective study was conducted by Pharmacology department in SGRRIM and HS. A total of 726 prescriptions were collected by 2nd professional MBBS students entering 5th semester and randomly evaluated for prescribing pattern using WHO drug use indicators.Results: A total of 726 prescriptions were analyzed. Male:Female ratio was 470:256(1.8:1). Age wise distribution of patients 0-15years 122(16.80%), 16-30 years 139(19.41%), 31-45years 242 (33.33%), 46-60 years 113(15.56%) and >60years 110 (15.15%). A total of 4663 drugs were prescribed. 435(9.32%) were analgesics. 208 (47.81%) Paracetamol, 66 (15.17%) Tramadol, 62(14.25%) Aceclofenac, 51 (11.72%) Diclofenac, 46 (10.57%) Ibuprofen and 2(0.45%) Buprenorphine were prescribed. 301 (69.20%) Oral drugs and 134 (30.80%) Injectable were prescribed. 108 (24.83%) Numbers of Fixed dose combinations. 0.60 of analgesics were prescribed per prescription. 381 (87.59%) analgesics were prescribed from National Essential Medicine list 2015. 369 (84.83%) drugs were prescribed by brand names.Conclusions: The main purpose of undergraduate medical curriculum is to develop the requisite diagnostic and therapeutic skills of a basic doctor. Such type of drug utilization studies is set with the objective to encourage rational prescribing, and to identify good and bad prescribing practices

Prescribing trends in respiratory tract infections in a tertiary care teaching hospital

Background: Respiratory tract infections are a major cause of morbidity and mortality in developing countries. Polypharmacy and irrational prescribing in respiratory diseases are common practice worldwide. Keeping in consideration this scenario, present study was undertaken to analyze the drug utilization pattern of respiratory tract infections.Methods: This drug utilization study was conducted by Pharmacology department at SGRRIM & HS to analyze drug utilization pattern of respiratory infections. A total of 585 prescriptions were collected from hospital and randomly evaluated for prescribing pattern using WHO drug indicators.Results: A total of 585 prescriptions were analyzed. Male:Female ratio was 1:0.77. Age wise distribution was done; 81(13.84%) 0-15 years, 54(9.23%) 16-30 years, 198(33.84%) 31-45 years, 75(12.82%) 46-60 years and 177(30.25%) patients belongs to >60 years of age group respectively. A total of 4869 drugs were prescribed, 2754(56.56%) antibiotics, 675(13.8%) bronchodilators, 630(12.93%) corticosteroids, 303(6.22%) antacids, 507(10.41%) in miscellaneous category respectively. 2562(52.61%) oral, 1491(30.62%) injectable and 816(16.75%) inhalational drugs were prescribed. Numbers of Fixed dose combinations were 645(13.24%). 8.32 drugs were prescribed per prescription. 2409(49.47%) drugs were prescribed from national essential medicine list 2015. 4320(88.72%) drugs were prescribed by their brand names.Conclusions: Irrational prescribing and polypharmacy was observed. The drug utilization studies are important tool to sensitize and increases awareness among physicians, which ultimately improves rational prescribing and patient care

Comparative evaluation of beta-blockers with or without statins in the treatment of essential hypertension at a tertiary health care setup

Background: The effects of statins apart from their role as cholesterol lowering agents have prompted this study to evaluate their antihypertensive role. Beta-blockers (BB) are one of the most effective drugs in hypertension. The present study was designed for comparative evaluation of BB with or without statins in the treatment of essential hypertension in a tertiary health care setup.Methods: This study was conducted in 20 hypertensive patients by Pharmacology Department in Medicine outpatient department at SGRRIM and HS Dehradun for 1 year. Initially, patients were stabilized for 4 weeks by BB and then subdivided into 2 groups. Group I: BB (n=10) and Group II: BB+statins (n=10). Patients were followed up every 4 weeks for 16 weeks. Systolic blood pressure (SBP) and diastolic blood pressure (DBP), waist hip ratio (WHR), body mass index (BMI) were done every visit. Lipid profile was done at 4 and 16 weeks. Analysis was performed using t test. p≤0.05 was significant.Results: At 4 and 16 weeks, SBP in Group I was 133.6±3.7 and 127±1.61 mmHg (p>0.05) and in Group II was 141.2±2.97 and 130.6±0.71 mmHg (p0.05) and in Group II was 84.6±1.39 and 83.8±1.45 mmHg (p>0.05), respectively. At 16 weeks intergroup SBP and DBP comparison was done, which was not significant (p>0.05). At 4 and 16 weeks improvement in lipid profile in Group I (p>0.05) was not significant, but a significant improvement in Group II (p0.05), respectively.Conclusions: Both groups showed significant improvement in BP. However, no significant difference was seen on intergroup comparison. Larger studies with more patients are needed to establish the role of statins in hypertension

Study on drug usage pattern of anxiolytics in psychiatric department in a tertiary care teaching hospital at Dehradun, Uttarakhand, India

Background: Psychopharmacology is a rapidly growing field, in which the number of patients is continuously increasing. Newly introduced drugs are projected as the better alternative to the traditional psychiatric medicines. The utilization and consequences on real life effectiveness and safety of antianxiety drugs in actual clinical practice need continuous monitoring. Aim of the present study was to analyze the pattern of various anxiolytic drugs prescribed to the patients in psychiatric department of a tertiary care teaching hospital.Methods: The present study was conducted by the department of pharmacology, in the department of psychiatry at SGRRIM and HS, Dehradun, for a period of 6 months from June 2016 to December 2016. Prescriptions of patients diagnosed with anxiety were analysed, using WHO drug use indicators.Results: A total of 603 prescriptions with anxiety disorder were collected. The mean age was 35.46±0.88 years. Majority of the patients were in 31-50 years age group 309 (51.24%). Male:Female ratio was 1:0.69. Disease pattern observed during the study were 177 (29.35%) generalized anxiety disorder, 147 (24.38%) depression, 99 (16.42%) obsessive compulsive disorder (OCD), 81 (13.43%) psychotic illness, 63 (10.45%) bipolar disorders and 36 (5.97%) patients categorized as others category respectively. A total of 1974 psychotropic drugs were prescribed, 654 (33.13%) antianxiety drugs, 648 (32.83%) antidepressants, 240 (12.16%) antipsychotics, 198 (10.03%) antiepileptics and 234 (11.85%) miscellaneous drugs were prescribed. 552 (91.54%) patients received monotherapy and 51 (8.46%) were given polytherapy of anxiolytics. All (100%) anxiolytics were orally prescribed. A total of 30 fixed dose combinations (FDCs) of anxiolytics were prescribed. The numbers of anxiolytics per prescription were 1.085. The anxiolytics prescribed from National Essential Medicine List 2015 were 555 (84.86%). The percentage of anxiolytics with brand names were 618 (94.5%).Conclusions: Most of the prescriptions were rational but there is a need to encourage prescribing by generic names so that more cost-effective and rational treatment can be provided to the patients

Recent scenario on psychotropic drug usage pattern among patients attending psychiatric outpatient department of a tertiary care teaching hospital in Nepal

Background: Due to increasing burden of psychiatric illnesses, it is essential to study the psychotropic drug utilization pattern in actual clinical practice. The objective of the study was to study the psychotropic drug usage pattern among patients attending psychiatric OPD of a tertiary care teaching hospital in Nepal.Methods: This observational retrospective study was conducted in Nepal Gunj Medical College, Nepal for a period of 6 months from January 2016 to June 2016. A total of 282 prescriptions from Psychiatric OPD were analysed for drug usage pattern. Prescriptions containing at least one psychotropic drug were included. Data was measured for number and percentage of prescriptions or drugs, using selected World Health Organization (WHO) drug use indicators.Results: A total of 282 prescriptions from Psychiatric OPD were analysed. Patients had a mean age of 35.01±1.17 years. Male and Female %age was 41.49% and 58.51% respectively. Majority of the patients (47.52%) were in 31-45 years age group. 70.57% patients were literate. Depression was the leading psychiatric illness seen in 144 (51.06%) patients followed by Anxiety disorders which were seen in 60 (21.28%) patients. A total of 2463 drugs were prescribed which included 591 (23.99%) antipsychotic drugs followed by 462 (18.76%) antidepressants, 390 (15.83%) antiepileptics, 312 (12.67%) supplements, 276 (11.21%) antianxiety, 171 (6.94%) antacids, 165 (6.7%) anticholinergics, 96 (3.9%) drugs in miscellaneous category. Drugs prescribed per prescription were 8.73 and psychotropic drugs per prescription were 6.09. Number of oral and injectable drugs were 2313 (93.91%) and 150 (6.09%) respectively. 87 fixed dose combinations (FDCs) of psychotropic drugs were prescribed. 903 (36.66%) drugs were prescribed from WHO’s 18th List of Essential Medicines.Conclusions: Depression was the most common psychiatric illness and antipsychotics were the most commonly prescribed medicines in psychiatry OPD. Majority of the prescriptions revealed polypharmacy