Study of prescription pattern and adverse drug reactions in patients with cervical cancer in tertiary care teaching institute

Background: Cervical cancer is the second most common cancer in women especially in developing countries. In India, it is estimated that 1, 22, 644 new cases of cancer cervix occur every year. Incidence rate is 22 per lac population and mortality rate is 12.4 per lac population. The objective of this study was to study the prescription pattern and adverse drug reactions (ADRs) in patients with cervical cancer.Methods: Twenty five patients of cancer cervix Stage (IIa to IVb) receiving chemotherapy were enrolled in the study after written informed consent of patients. Approval was obtained from institutional ethics committee. It was cross sectional, observational study. Prescriptions were analysed for no. of drugs prescribed, time interval between two cycles, no. of cycles of chemotherapy. Any ADR observed by patient or treating physician was noted and causality was assessed by Naranjo’s algorithm. Preventability and severity of ADRs were assessed by modified Schumock and Thornton scale, modified Hartwig and Siegel scale respectively.Results: Twenty five patients were enrolled with mean age 52.24±8.66 years and mean weight 51.76±5.88 kg. 84% patients were on combination chemotherapy. Percentage of anticancer drugs prescribed were: cisplatin (72%); paclitaxel (40%); 5FU (36%); carboplatin (32%); gemcitabine (4%). Chemotherapeutic drugs were given at 3 weekly intervals for 6 cycles. ADR observed were nausea (76%), vomiting (40%), alopecia (32%), headache (12%), bodyache (12%), anorexia (12%), diarrhoea (8%) and malaise (4%). Causality assessment of ADR by Naranjo’s algorithm showed 89.8% probable and 10.2% possible reactions. According to modified Schumock and Thornton scale, 26.5% reactions are ‘not preventable’ however 73.5% are ‘definitely preventable’. According to modified Hartwig and Siegel scale, 75.5% were ‘mild level 1’severity however 24.5% were ‘moderate level 3’ severity.Conclusions: Among patients with CA cervix, cisplatin was most commonly prescribed drug. Nausea was most common ADR which is of ‘mild level 1’ severity

Effect of tylophora asthmatica on hepatotoxicity induced by antitubercular drugs in albino rats

Background: The burden of metabolism and exposure to dangerous chemicals make liver vulnerable to variety of disorders like acute or chronic inflammation, toxin/ drug related hepatitis or cirrhosis. Tuberculosis is a common problem in India and worldwide. Drug induced liver injury (DILI) is a problem of increasing significance, but has been a long standing concern in treatment of tuberculous (TB) infection. Several studies have revealed that, tylophora asthmatica (Burnf.) Merill. (Family: asclepidaceae) commonly known as antmul possess hepatoprotective property. There is less scientific work regarding the effect of Tylophora asthmatica on hepatotoxicity induced by antitubercular drugs, hence the present study was carried out with the aim of evaluating the effect of tylophora asthmatica on antitubercular drug induced hepatotoxicity in albino rats.Methods: Total 24 Albino rats weighing about 150-200 grams were divided in four groups, 6 animals in each group. In the study, antitubercular drugs: INH (50 mg/kg) and rifampicin (50 mg/kg), test drug: aqueous extract of tylophora asthmatica doses (200 mg/kg and 300 mg/kg) were used. Drugs were given by oral route for 14 days. Biochemical tests for Sr. ALT, AST, bilirubin (total and direct) and histopathological examination of liver was done.Results: Tylophora asthmatica treated group had no significant rise in values of Sr.ALT, AST, bilirubin (total and direct) and also there were no significant histopathological changes in this group, indicating hepatoprotective effect of tylophora asthmatica.Conclusions: It was concluded that tylophora asthmatica has hepatoprotective activity in antitubercular drug induced hepatotoxicity

Newer drugs in the management of diabetes mellitus

Modern life style with present days technological advances have made human life sedentary. This is causing increasing prevalence of obesity and physical inactivity amongst population. The number of cases of diabetes worldwide in the year 2000 among adults 20 years of age is estimated to be 171 million in recent reports   and is said to rise to more than 300 million by 2025. The raised plasma glucose levels give rise to complications in the form of microvascular and macrovascular complications diminished quality of life with reduced life expectancy. The currently available drugs used in the management of type II DM are not completely satisfactory in regard of controlling blood glucose level, many of the times they are associated with undesirable side effects. Hence there is continuous ongoing work in development of newer drugs, which are safe, efficacious and potent as well as free of undesirable effects such as sustained hypoglycaemia. Fortunately there are newer drug, few of them approved while other still knocking the door from the classes of drug such as GLP-1Mimetic, DPP-4 Inhibitors and others. Here we have tried to cover them in brief

A review of objective structured practical examination (OSPE) in pharmacology at a rural medical college

Background: 1. To evaluate the attitudes of undergraduate medical students towards objectively structured practical examination (OSPE) component of Pharmacology practical examination. 2. To investigate any gender differences and any influence of medium of instruction in school on these attitudes.Methods: The scores of 40 undergraduate medical students were analysed at S R T R Government Medical College, Ambajogai, Maharashtra, India. A Likert scale containing 9 items was used to assess the attitudes of students towards OSPE in Pharmacology. Student perspectives regarding the OSPE were obtained by asking them to respond to a questionnaire.Results: The study revealed that the OSPE was an acceptable tool in Pharmacology practical examination. The overall mean attitude score was 3.99. The response of male students towards OSPE (4.2) was more favourable as compared to that of female students (3.9) Students strongly agreed that OPSE covers wide range of skills and it is a good form of examination and learning experience. Majority of students were in favour of continuing OSPE as a method for examination in Pharmacology.Conclusions: OSPE was found to be a valuable tool to check the depth of understanding of undergraduate students. OSPE can be used as an index of the learning attitude of students. The present study is a small step in a direction of changing the traditional patterns of practical examination to a more objective and reliable way of evaluation in Pharmacology. It will help in modifying teaching-learning strategies so that both, the teachers as well as the students can gain maximum advantage

Study of prescribing practices of injections in outpatients of a rural tertiary care teaching hospital

Background: Injections are probably the most common of all medical procedures. The combination of injection overuse and unsafe practices creates a major route of transmission of blood borne pathogenic infections. Unnecessary use of injections can also lead to unnecessary burden on the institution in terms of efficiency, infrastructure, staff requirement and poor utilization of resources. Monitoring and analysis of prescribing practices can help to achieve rational use of injections. The present study was carried out to study the injection prescription patterns in outpatients of a rural tertiary care teaching hospital, Ambajogai, Maharashtra, India. Methods: A cross sectional descriptive study was conducted for duration of two months and 744 prescriptions were randomly collected and analyzed.Results: The total number of injections prescribed in 744 prescriptions was 205. Most (71.70%) of the patients receiving them were above 35 years of age. The most common complaint for which the injections were prescribed was musculoskeletal pain (45.36%) followed by fever. About 155 (75.60%) prescriptions contained injection diclofenac which was the most commonly used drug followed by injection paracetamol (11.21%). There was a high tendency of using brand names in prescriptions (89.30%). Conclusion: The study revealed high proportion of use of injectable drugs. There was overuse of analgesic injections like diclofenac, most of which were unnecessary and irrational. This leads to unnecessary burden on the institution in terms of efficiency, infrastructure, staff requirement and poor utilization of resources. There is a need to develop local guidelines for injection usage along with educational sessions for prescribing doctors

Experimental evaluation of analgesic activity of PPAR γ agonists: pioglitazone and rosiglitazone

Background: To evaluate analgesic activity of pioglitazone and rosiglitazone by tail flick method in rats and acetic acid induced writhing method in mice.Methods: Albino wistar rats of either sex weighing 180-200 g and Swiss mice weighing 25-30 g were used. Study was conducted after approval from the Institutional Animal Ethics Committee. The tail flick method in rats described by D’Amour and Smith (1941) and acetic acid induced writhing in mice were used. The dose of pioglitazone and rosiglitazone were 20 mg/kg and 10 mg/kg respectively.Results: In tail flick method of analgesia, both, pioglitazone and rosiglitazone have analgesic activity which was statistically comparable to aspirin. In acetic acid induced writhing model of analgesia, the action of pioglitazone and rosiglitazone was significantly greater than the control group but it was less when compared to aspirin.Conclusions: Analgesic activity of pioglitazone and rosiglitazone was comparable to aspirin in tail flick model of analgesia in rats while it was significantly less when compared to tramadol. Analgesic activity of pioglitazone and rosiglitazone was significantly less than aspirin in acetic acid induced writhing method

Osmotic controlled drug delivery system (OSMO technology) and its impact on diabetes care

Recently, focus on the development of controlled release drug delivery system has increased, as existing drugs exhibit certain pharmacokinetic limitations. The major goal of designing sustained release formulations is to improve the drug performance by prolonged duration of drug action, decreased frequency of dosing and reduced side effects by using smallest quantity of drug administered by the most suitable route. Osmotic-controlled release oral delivery system (OSMO technology) is the most promising strategy based system for sustained delivery of drug. Drug can be delivered in a controlled manner over a long period of time by the process of osmosis. Osmotic drug delivery system appears to be a promising solution for the limitations of conventional extended release formulations by virtue of their distinguished technological features. The present review describes briefly about various controlled drug delivery systems with special focus on advantages of osmotic-controlled release oral delivery system related to diabetes therapy and improved compliance

STUDY ON ACUTE ADVERSE DRUG REACTIONS OF ANTISNAKE VENOM IN A RURAL TERTIARY CARE HOSPITAL

  Objective: Snake bite is a major occupational hazard especially in rural areas. Majority of the anti-venom reactions are wrongly attributed to envenomation. There is inadequate reporting of anti-venom reactions leading to the paucity of true data of morbidity and mortality. The aim was to evaluate the adverse drug reaction (ADR) profile of anti-snake venom serum (ASV) in a rural tertiary care hospital.Methods: A prospective, observational study was conducted. A total number of 50 indoor cases of snake bites from May 2012 to January 2013 was included in the study, and the anti-venom reactions were assessed. In addition, basic epidemiological data and prescribing practices of ASV were also analyzed.Results: The incidence of snake bite was more in males (64%) as compared to females (36%) attributed to their out dwelling lifestyle. Vasculotoxic snake bites were more common (46%) than neuroparalytic ones (44%). Mild envenomation was the most common presentation. A total of 31 (62%) patients who received ASV suffered from anti-venom reactions. The most common nature of the reaction was chills, rigors (23.53%) followed by hypotension (21.57%). 52.94% cases of adverse reactions were of early anaphylactic type followed by 45.1% cases of pyrogenic reactions. 43.14% of cases of anti-venom reactions were probable in nature, and 13.73% were certain in nature with World Health Organization-Uppsala Monitoring Centre classification of ADRs. By using modified Hartwig Seigel scale, 70.59% cases were mild in severity, and 5.88% were severe in nature. Most of the reactions were classified as not preventable with the Schumock Thornton criteria. All the reactions were classified as hypersensitivity reactions with Karch and Lasanga classification.Conclusions: Present study showed a higher incidence of reactions to ASV at our institute. There was an inadequate documentation of clinical findings, investigations, and adverse reactions in most of the case papers.Keywords: Anti-snake venom, Adverse drug reactions, Pharmacovigilance, Snake bite.Â