Liraglutide for the treatment of obesity

Obesity and being overweight have become significant global health concerns, and may actually be seen as chronic disease conditions or even as a worldwide epidemic. In addition to the necessary life-style modifications required to effect weight-loss, which constitutes an essential healthcare intervention in this patient population, the use of adjunctive pharmacotherapeutic agents is often required. This article provides an overview of the first injectable treatment option, namely liraglutide, in the management of obesity, or of patients that are overweight in the presence of significant co-morbid conditions.Keywords: liraglutide, overweight, obesity, weight-loss, incretin, GLP-1, type 2 diabetes mellitu

Reducing medication errors in HIV-positive patients: Influence of a clinical pharmacist

Background: The roll-out of antiretroviral medicines has improved life expectancy in people living with HIV (PLHIV). This has resulted in more patients being hospitalised for non-communicable diseases, increasing risk for medication errors (MEs). Pharmacists, through medication reconciliation, may identify and reduce MEs in this population. Objectives: To describe the importance of a pharmacist’s involvement in identifying and quantifying types of MEs. Method: A quantitative, prospective observational study was conducted over 14 weeks. A pharmacist reviewed HIV-positive, hospitalised patients’ files, using a data collection instrument, to determine the prevalence of MEs in PLHIV. The study pharmacist recommended appropriate actions to the prescriber to resolve MEs and documented resolution of the MEs. Results: The study population of n = 180 patient files were reviewed 453 times, identifying 466 MEs. Medication errors included incorrect medication reconciliation from history (19; 4.1%), prescription omission (17; 3.7%), duplication of therapy (10; 2.2%), missed doses (265; 57.1%), incorrect dosing (103; 22.2%), incorrect administration frequency (2; 0.4%), incorrect duration of therapy (15; 3.2%) and drug-drug interactions (18; 3.9%). More than half (58.2%) of the MEs were resolved in less than 24 h, with involvement of the pharmacist. Conclusion: This study demonstrates the magnitude of MEs experienced in hospitalised PLHIV and highlights the role clinical pharmacists play in identifying and resolving MEs to improve patient outcomes

Using mystery shoppers to determine practices pertaining to antibiotic dispensing without a prescription among community pharmacies in South Africa—a pilot survey

Background: Inappropriate use of antimicrobials is a key factor increasing antimicrobial resistance, a major global public health problem including South Africa. Key drives include antibiotics being dispensed without a prescription. Objectives: To determine the accessibility of antibiotics without a prescription in community pharmacies in urban areas in South Africa, and determine if counselling was provided when antibiotics were dispensed. Patients and methods: Prospective, observational study, employing simulated patients (SPs), presenting with upper respiratory tract infections (URTIs) and urinary tract infections (UTIs), undertaken to establish if antibiotics can be obtained without a valid prescription in South Africa. This pilot study was conducted in privately owned (n=20) and corporate (franchised - n=14) community pharmacies in three regions in Gauteng Province. Results: Antibiotics were sold in privately owned pharmacies without a prescription in 80% (16/20) of cases while no antibiotics were dispensed in corporate (franchised) pharmacies. Of the 16 pharmacies selling antibiotics without a prescription, pharmacist assistants were involved in 37.5% (n=6) and counselling was not provided to 19% of SPs. Ciprofloxacin (42.9%) and metronidazole (28.6%) were the most common antibiotics dispensed. No antibiotics were dispensed for URTIs, only UTIs. Conclusion: Dispensing antibiotics without prescriptions can be common among privately owned pharmacies in urban areas in South Africa. Corporate pharmacies, which probably have a greater income, appear to follow current legislation banning such activities. To limit selling with no prescription, community pharmacists and assistants especially in urban areas should be educated on appropriate patient care and legal requirements, with dispensing electronically monitored

Social media and COVID-19 – perceptions and public deceptions regarding colchicine, hydroxychloroquine and ivermectin and resultant lessons for future pandemics

Background: The capacity for social media to influence the consumption of re-purposed medicines to manage COVID-19 despite limited safety and efficacy data at the start of the pandemic is cause for concern. Objective: To ascertain links between social media reports and utilization for three re-purposed medicines (hydroxychloroquine (HCQ), ivermectin and colchicine) to direct future activities. Methods: A combined retrospective analysis of social media posts for these re-purposed medicines was performed in South Africa between January and June 2021 together with utilization and clinical trials data. Utilisation data from IQVIA from three different platforms included private and public markets. Clinical trials data was obtained from various databases. Chloroquine data was analysed in South Africa (HCQ was not available). Results: 77257 posts were collected across key social media platforms during the study period of which 6884 were relevant. Ivermectin had the highest number of posts (55%) followed by HCQ (44%), with limited posts for colchicine (1%). The spike in ivermectin utilisation was closely correlated with social media posts. Similarly, with chloroquine social media interest was enhanced by comments from local politicians. Sentiment analysis showed that the posts regarding the effectiveness of particularly ivermectin and HCQ were positive. Of concern is that the origin of the majority of reporters in social media (85%) was unidentifiable. Conclusion: This is the first study of its kind in South Africa providing evidence that social media is a driver of re-purposed medicine use. Healthcare professionals have a key role to provide evidence-based advice especially with unidentifiable posts

Social media and COVID-19 – perceptions and public deceptions of ivermectin, colchicine and hydroxychloroquine : lessons for future pandemics

The capacity for social media to influence the utilization of re-purposed medicines to manage COVID-19, despite limited availability of safety and efficacy data, is a cause for concern within health care systems. This study sought to ascertain links between social media reports and utili-zation for three re-purposed medicines: hydroxychloroquine (HCQ), ivermectin and colchicine. A combined retrospective analysis of social media posts for these three re-purposed medicines was undertaken, along with utilization and clinical trials data, in South Africa, between January 2020 and June 2021. In total, 77,257 posts were collected across key social media platforms, of which 6884 were relevant. Ivermectin had the highest number of posts (55%) followed by HCQ (44%). The spike in ivermectin use was closely correlated to social media posts. Similarly, regarding chlo-roquine (as HCQ is not available in South Africa), social media interest was enhanced by local politicians. Sentiment analysis revealed that posts regarding the effectiveness of these repurposed medicines were positive. This was different for colchicine, which contributed only a small number of mentions (1%). Of concern is that the majority of reporters in social media (85%) were uniden-tifiable. This study provides evidence of social media as a driver of re-purposed medicines. Healthcare professionals have a key role in providing evidence-based advice especially with unidentifiable post

Bipolar disorder: an overview

Bipolar disorder (BD) is a chronic disorder characterised by abnormal mood changes and fluctuation in energy levels. The disease is characterised by a depressive episode, which can last up to a few months, and include low energy levels, hypersomnia, cognitive impairments, decreased sexual desire, carbohydrate craving, and weight gain. Conversely, bipolar disorder also has a stage of exhilaration and excitement, which can be classified as a manic episode. The typical presentation of these episodes of mania includes high energy hallucinations and delusions, sleep deprivation, fast speech and a constant need to be active. Risk factors that contribute to development of BD include the use of cannabis, influenza during the third trimester of pregnancy, as well as smoking during pregnancy, the use of cocaine, opioids, tranquilisers, stimulants and sedatives during pregnancy, and regular substance use during a period of a year. Parental loss before the age of five, war trauma and stress, as well as traumatic head injury may influence the condition. Clinical criteria are the mainstay of diagnosis of BD. Differentiating features, which were found to be related to BD, include early age of onset, family history, atypical features and mixed symptoms. Screening tools like the Mood Disorder Questionnaire (MDQ) and Hypomania Checklist (HCL-32) have shown the ability to differentiate BD from major depressive disorder (MDD). Treatment differs between the different phases of BD, but lithium can be considered as initial monotherapy, since it is effective against manic, depressive and mixed relapses, and has shown better evidence for prevention of new episodes. It is also associated with a reduced risk of suicide and self-harm in BD patients

Liraglutide for the treatment of obesity

Obesity and being overweight have become significant global health concerns, and may actually be seen as chronic disease conditions or even as a worldwide epidemic. In addition to the necessary life-style modifications required to effect weight-loss, which constitutes an essential healthcare intervention in this patient population, the use of adjunctive pharmacotherapeutic agents is often required. This article provides an overview of the first injectable treatment option, namely liraglutide, in the management of obesity, or of patients that are overweight in the presence of significant co-morbid conditions

An overview of ivabradine

This article provides an overview of the therapeutic effects of ivabradine in the treatment of coronary artery disease (CAD), and in the management of stable angina pectoris (SAP) and congestive cardiac failure (CCF). Patients with SAP have a reduced quality of life and are unable to work efficiently, resulting in the increased use of healthcare resources. Unlike the other antianginal drugs (i.e. the beta-blockers, calcium-channel blockers and organic nitrates), ivabradine specifically targets the If current of the sinus node. It reduces the frequency of angina attacks and increases the time until symptoms during work appear. Clinical evidence has shown that ivabradine is an effective anti-ischaemic and antianginal agent, comparable to the beta-blockers and calcium-channel antagonist in controlling the symptoms of myocardial ischemia

Creating and evaluating an opportunity for medication reconciliation in the adult population of South Africa to improve patient care.

Adverse drug events (ADEs) are a major cause of morbidity and mortality, with more than 50% of ADEs being preventable. Adverse Drug Reactions (ADRs) are typically the result of an incomplete medication history, prescribing or dispensing error, as well as over- or under-use of prescribed pharmacotherapy. Medication reconciliation is the process of creating the most accurate list of medications a patient is taking and subsequently comparing the list against the different transitions of care. It is used to reduce medication discrepancies, and thereby ultimately decreasing ADEs. However, little is known about medicine reconciliation activities among public hospitals in South Africa.Prospective quantitative, descriptive design among Internal and Surgical wards in a leading public hospital in South Africa.145 study participants were enrolled. Over 1300 (1329) medicines were reviewed of which there was a significant difference (p = 0.006) when comparing the medications that the patient was taking before or during hospitalisation. A total of 552 (41.53%) interventions were undertaken and the majority of patients had at least 3.96 medication discrepancies. The most common intervention upon admission was transcribing the home medication onto the hospital prescription (65.2%) followed by medication duplication (13.44%). During patient's hospital stay, interventions included patient counselling (32.5%) and stopping the previous treatment (37.5%).To ensure continuity of patient care, medication reconciliation should be implemented throughout patients' hospital stay. This involves all key professionals in hospitals

Vitamin D supplementation in a post-pandemic era: A narrative review

Vitamin D is a fat-soluble molecule referring to the different isoforms, ergocalciferol (D2) and cholecalciferol (D3). Its physiological functions include increasing calcium serum concentrations. 25-hydroxyvitamin D3 (25(OH)D) (Calcifediol), a non-active, circulating instant precursor is seen as a pre-hormone. Studies have shown that a deficiency in calcifediol is related to chronic conditions such as cardiovascular, musculoskeletal, immune system, neurological, and anti-neoplastic functions. Vitamin D supplementation has shown its benefit as prophylaxis and treatment during the coronavirus disease 2019 (COVID-19) pandemic and an increase in the prescribing of vitamin D supplementation has been observed. The intention of this review article is to provide guidance on the recommended dosage regimen as a prophylactic measure during COVID-19 and its use as a supplement in general. From this review article, it is clear that vitamin D has an important role to play not only in COVID-19 but also in various other health aspects of the human body.Contribution: This review article highlighted the role of vitamin D in managing vitamin D deficiency and its role as a supplement in the management of respiratory tract infections, especially COVID-19. This overview can assist physicians in optimising healthcare by optimised dosing recommendations and indications