Drug utilisation in medical intensive care unit: a retrospective analysis from a tertiary care teaching hospital

Background: The World Health Organisation has defined drug utilization study as “the marketing, distribution, prescription and use of drugs in a society, with special emphasis on the resulting medical, social, and economic consequences. The objective was to evaluate drug utilization pattern in medical intensive care unit (MICU) in a tertiary care teaching hospital.Methods: A retrospective observational study was conducted in MICU for adult patients admitted from October to December 2013. Data collected was analysed for demographics, indication, duration of stay, World Health Organisation (WHO) prescribing indicators including anatomical therapeutic chemical classification and defined daily dose (DDD).Results: A six hundred encounters from 63 male and 44 female patients with a mean age of 60.88±16.87 were studied. Average duration of stay was 5.61±3.88 days. The common indications for admission were dyspnoea 20 (18.69%), upper gastrointestinal bleed 16 (14.95%), cerebrovascular accident 14 (13.08%) and sepsis 13 (12.15%). Total number of drugs prescribed was 246. Total drug encounters were 7695. Average number of drugs per encounter was 12.83. Percentage of drugs prescribed by generic name was 38.21%, 44.7% and 40.65% of the drugs were prescribed from National and WHO essential medicine list respectively. Among the drugs prescribed 65.44%, 32.93% and 17.48% were oral, injectable and fixed dose combination preparations respectively. Percentage of encounters resulting in prescription of an antibiotic and an injection were 59% and 85.83% respectively. The most commonly prescribed drugs were pantoprazole (100%), human regular insulin (52.83%), piperacillin + tazobactam (45%) and ceftriaxone (38%). Their DDD/100 bed days were found to be 83.79, 12.78, 12.50, and 17.81 respectively.Conclusions: Overall the prescribing pattern seems to be rational but may be further strengthened by increasing generic drug prescription, judicious use of pantoprazole and periodic longitudinal surveillance studies

Effect of gabapentin on haloperidol induced inhibition of conditioned avoidance response in rat

Background: Haloperidol, an antipsychotic adversely affects acquisition and retention of a learned task. We decided to test the effect of Gabapentin, a new anti-epileptic drug using conditioned avoidance response model with cook’s pole climbing apparatus and haloperidol.Methods: Four groups of six rats were taken for this purpose. All the rats were first given drugs for five days and then trained for a period of 15 days. Gabapentin was given in a dose of 100mg/kg intra peritoneal, while haloperidol was given 0.5mg/kg intra peritoneal.Results: At the end of the training duration rats in the vehicle and gabapentin treated group achieved ≥85% acquisition responses. While the haloperidol and haloperidol + gabapentin group did not achieve the desired percentage of learning. A learning curve was plotted by using the percentage of conditioned responses in each group versus number of days. The mean ± SD percentage of conditioned responses of day 14 and 15 were for haloperidol group 26.19 ±11.90, for vehicle group 86.90 ± 4.29, for the gabapentin treated group 95.24 ± 2.38 and for the gabapentin + haloperidol group 46.42 ± 12.20. These figures and the learning curve suggest that gabapentin treated rats had a better acquisition response and haloperidol depressed learning.Conclusions: At the end of study duration we found that gabapentin significantly improved the acquisition response than the vehicle control group. Also haloperidol depressed the acquisition response. Gabapentin did not lead to reversal of haloperidol induced depression of acquisition process

Impact of proton pump inhibitors on efficacy of clopidogrel: Review of evidence

Clopidogrel is a prodrug which requires cytochrome P450 2C19 (CYP 2C19) enzyme for its conversion to an active thiol metabolite. Proton pump inhibitors (PPIs) inhibits enzyme CYP 2C19 interfering with the conversion of clopidogrel into its active metabolite. Studies document the possible interaction of clopidogrel and PPIs leading to a decrease in the antiplatelet efficacy of clopidogrel. A PubMed/MEDLINE database literature search was carried out and the bibliographies of found articles were checked for other relevant literature. Most retrospective cohort studies and studies using platelet markers found a significant association between PPI use especially omeprazole and decreased efficacy of clopidogrel while few comparative trials using clinical outcomes found no association between the same. Pantoprazole was not associated with the decrease in the antiplatelet efficacy of clopidogrel. Patients on dual antiplatelet therapy and/or with a history of gastrointestinal bleed will require gastroprotection in the form of PPIs. In such cases, pantoprazole should be the preferred PPI. Rabeprazole can be used as an alternative