Selected pharmacokinetic issues of the use of antiepileptic drugs and parenteral nutrition in critically ill patients

<p>Abstract</p> <p>Objectives</p> <p>To conduct a systematic review for the evidence supporting or disproving the reality of parenteral nutrition- antiepileptic drugs interaction, especially with respect to the plasma protein-binding of the drug.</p> <p>Methods</p> <p>The articles related to the topic were identified through Medline and PubMed search (1968-Feburary 2010) for English language on the interaction between parenteral nutrition and antiepileptic drugs; the search terms used were anti-epileptic drugs, parenteral nutrition, and/or interaction, and/or in vitro. The search looked for prospective randomized and nonrandomized controlled studies; prospective nonrandomized uncontrolled studies; retrospective studies; case reports; and in vitro studies. Full text of the articles were then traced from the Universiti Sains Malaysia (USM) library subscribed databases, including Wiley-Blackwell Library, Cochrane Library, EBSCOHost, OVID, ScienceDirect, SAGE Premier, Scopus, SpringerLINK, and Wiley InterScience. The articles from journals not listed by USM library were traced through inter library loan.</p> <p>Results</p> <p>There were interactions between parenteral nutrition and drugs, including antiepileptics. Several guidelines were designed for the management of illnesses such as traumatic brain injuries or cancer patients, involving the use of parenteral nutrition and antiepileptics. Moreover, many studies demonstrated the in vitro and in vivo parenteral nutrition -drugs interactions, especially with antiepileptics.</p> <p>Conclusions</p> <p>There was no evidence supporting the existence of parenteral nutrition-antiepileptic drugs interaction. The issue has not been studied in formal researches, but several case reports and anecdotes demonstrate this drug-nutrition interaction. However, alteration in the drug-free fraction result from parenteral nutrition-drug (i.e. antiepileptics) interactions may necessitate scrupulous reassessment of drug dosages in patients receiving these therapies. This reassessment may be particularly imperative in certain clinical situations characterized by hypoalbuminemia (e.g., burn patients).</p

EVALUATION OF THE PARENTERAL NUTRITION SERVICES IN HOSPITAL PULAU PINANG

Parenteral nutrition (PN

EVALUATION OF THE PARENTERAL NUTRITION SERVICES IN HOSPITAL PULAU PINANG

Parenteral nutrition (PN) has been practiced in Hospital Pulau Pinang, Malaysia since 1986. However, there is no published data on the cost, complications and outcome of patients receiving PN in this hospital. A retrospective study was carried out to evaluate the cost, complications and outcome of PN. Data were obtained from patient medical records and analysed using SPSS version 11. From 2003 to 2005, 429 PN cases were evaluated. Of the PN cases, 65% were neonates, 28.2% adults and 6.8% paediatric, where 60.8% of patients were male and 38.5% were female. Malay patients constituted 57.3%, Chinese 30.8% and Indian 11.9%. The reasons for PN were feeding intolerence (86.7%), oral intake restrictions (9.3%), poor oral intake (1.4%) and others (2.6%). The average cost for PN in a neonate was found to be RM185 ± 69, RM 233 ± 126 for a paediatric patient and RM 235 ± 107 for an adult. PN-associated complications were bacterial sepsis (30.4%), metabolic acidosis (13.0%), catheter dislodgment (8.7%), long line swelling (8.7%), hepatic complication (21.8%), long line blockage (4.4%) and catheter-related infection (13.0%). A total of 82.7% of cases tolerated oral nutrition after PN, 7.4% expired, 5.3% developed PN complications and others were discharged, transferred to other ward, transferred to another hospital, or discharged at own risk (0.3%). The study showed a significant difference in the cost of PN in each group of patients (p = 0.002). We concluded that PN services in Hospital Pulau Pinang were associated with low PN-related complications and good outcomes

Evaluating community pharmacists' perceptions of future generic substitution policy implementation: A national survey from Malaysia

Objectives This study aims to provide baseline data to support the implementation of generic substitution policy in Malaysia by evaluating the community pharmacists' perceptions and opinions on generic substitution and current substitution practices.Methods A cross-sectional descriptive study involving the entire population of Malaysian community pharmacies (n = 1419) was undertaken using a self-completed anonymous mail questionnaire.Results A total of 219 responses were received for a response rate of 15.4%. Majority of the respondents (93.6%) agreed that pharmacists should have generic substitution rights. Almost all pharmacists (96.8%) viewed Poison Class C (pharmacist only medicine) as most suitable class of controlled medicines for substitution. About half (51.6%) of the pharmacists preferred a policy which allowed substitution on any prescription. The pharmacists prefer to consult the physician when substituting narrow therapeutic index medicines (88.1%) and prescription only medicines (51.3%). Less than 25.0% of the pharmacists routinely keep the medication records and follow-up the patients who received substitution. Monitoring the efficacy (79.2%) and patient's satisfaction with the generic medicines (74.9%) were the main reasons for following-up the patient if substitution occurs.Conclusions Malaysian community pharmacists are generally in favour of generic substitution policy implementation.Community pharmacist Perception Generic substitution Generic medicine Policy

Incorporating an immunization course in the pharmacy curriculum: Malaysian experience

To the Editor. The immunization system is a successful systematic program, especially during the last century. However, the immunization system is still imperfect because many countries still have unvaccinated children. The most common reasons for parents not having their child vaccinated are concern about immunization adverse effects, disbelief that the vaccine works, lack of awareness that the immunization is necessary, and lack of healthcare provider recommendation for the immunization.1 Health-care providers play an important role in child immunization because they have positive effects on parental decisions related to immunization.2 As a health care provider, pharmacists have played a role in promoting, maintaining, and improving immunization rates among children because the pharmacist is one of the most accessible healthcare professionals. A pharmacist can be trained to screen children for immunizations and counsel parents on immunization decisions, including providing information on immunizations risks and immunization benefits. In addition, pharmacists are highly regarded by the parents and by most immunization providers as drug information specialists, and often sought by people for medical advice. .....

A nationwide study on generic medicines substitution practices of Australian community pharmacists and patient acceptance

Objectives This study evaluated Australian community pharmacists' rate of generic medicine substitution, patient acceptance of generic substitution and cost-savings achieved for patients from substitution.Method A national stratified sample of 500 Australian pharmacies was randomly selected from different geographical areas. The data of the first 25 original PBS prescription items dispensed on one working day eligible for generic substitution were collected from each pharmacy.Results Responses were received from 82 pharmacies with a response rate of 16.4%. The pharmacists recommended generics for 96.4% (1461/1515) of the prescription items which were eligible for substitution. The generic substitution recommendation rate in urban (98.7%) and rural areas (98.0%) was significantly higher than remote areas (91.6%). Conversely, patients' acceptance in remote areas (84.5%) was significantly higher than rural (78.6%) and urban areas (73.2%). Patients with chronic diseases demonstrated significantly lower acceptability (72.4%) than patients with acute conditions (81.6%). Through acceptance of substitution, the patients' medicines expenditure reduced by around 21%.Conclusion Australian community pharmacists demonstrated a high rate of recommending generic substitution. However, to optimize the generic medicines utilization, patients' acceptance requires further improvement.Generic medicines Generic substitution Community pharmacists Patients Cost-saving