Increasing the Number of Adverse Drug Reactions Reporting: the Role of Clinical Pharmacy Residents

Abstract Detection of adverse drug reactions (ADRs) in hospitals provides an important measure of the burden of drug related morbidity on the healthcare system. Spontaneous reporting of ADRs is scare and several obstacles to such reporting have been identified formerly. This study aimed to determine the role of clinical pharmacy residents in ADR reporting within a hospital setting.Clinical pharmacy residents were trained to report all suspected ADRs through ADRreporting yellow cards. The incidence, pattern, seriousness, and preventability of the reported ADRs were analyzed. During the period of 12 months, for 8559 patients, 202 ADR reports were received. The most frequently reported reactions were due to anti-infective agents (38.38%). Rifampin accounted for the highest number of the reported ADRs among anti-infective agents. The gastro-intestinal system was the most frequently affected system (21.56%) of all reactions. Fifty four of the ADRs were reported as serious reactions. Eighteen of the ADRs were classified as preventable. Clinical pharmacy residents involvement in the ADR reporting program could improve the ADR reporting system

The effect of atorvastatin treatment duration on oxidative stress markers and lipid profile in patients with coronary artery diseases: A case series study

BACKGROUND: The major aim of this study was evaluating the effect of atorvastatin treatment on thiobarbituric acid reactive substances (TBARS), ferric reducing the ability of plasma (FRAP), small dense low-density lipoprotein cholesterol (sdLDL) and lipid profile in coronary artery disease (CAD) patients.METHODS: This study was carried out on 83 patients with angiographically proven coronary artery stenosis (52 men and 31 women) at Shahid Madani Hospital, Khorramabad, Iran, in 2015. The patients were divided into the 3 groups. 27 patients were classified statins consumption less than 6 days, 28 patients for 6 to 90 days, and 28 patients for more than 90 days. The level of sdLDL, lipid profile, TBARS and FRAP were assayed.RESULTS: FRAP levels of patients that received atorvastatin for more than 90 days (832 ± 101) were significantly elevated (P = 0.01) compared to the patients received atorvastatin less than 6 days (688 ± 75), whereas the levels of TBARS diminished significantly (P = 0.04). Also, the levels of total cholesterol (TC) and LDL-C were significantly decreased after 3 months of atorvastatin receiving (158 as compared to patients that consumed atorvastatin less than 6 days), (P = 0.02 and 0.03, respectively). The level of sdLDL was slightly increased with long-time consumption of atorvastatin (37 ± 14) in patients in comparison with patients that received atorvastatin less than 6 days (32 ± 15) (P = 0.06), but was not significant.CONCLUSION: The serum level of TBARS decreased and the serum level of FRAP increased in patients with long-time receiving atorvastatin. Therefore, atorvastatin contributes to the lowering oxidative stress in these patients. </p

Predictors of Post-Traumatic Stress Disorder among Victims of Serious Motor Vehicle Accidents

Background: Compelling evidence has shown that motor vehicle accidents have an enormous impact on mental health. Post-traumatic Stress Disorder (PTSD) is one of the most common psychological consequences in adult survivors of accidents, so it is important to understand the prevalence and predictors of this issue since delay causes damage to crucial daily functioning. This study aimed at investigating the prevalence and predictors of PTSD after motor vehicle accident. Methods: This cross-sectional study was conducted on 528 injured patients six weeks to six months after motor vehicle accident in Imam Reza Clinic of Poursina hospital, Rasht in 2015. Data collection tools were three questionnaires including post-traumatic stress-self report (PSS), Beck Depression Inventory (BDI-II), and the Numeric Rating Scale (NRS) for pain. The data were analyzed in SPSS (Version 19) using Chi-square, Fischer’s exact test and multivariate logistic regression. Significance level was considered P≤0.05. Results: The prevalence of PTSD and depression was 30.49% and 19.89% in participants, respectively. Chi-square test indicated a significant relationship among age (P=0.02), sex (P<0.001), education level (P<0.001), work status (P<0.001) and PTSD. Participants who reported pain (P<0.001) and depression (P<0.001) were more likely to have high score of PTSD than the others. Multivariate logistic regression showed this significance in sex, depression, age, educational status and pain, as constant risk factors in developing PTSD after accident. Conclusion: This study suggests that primary care setting should be readily prompted for diagnosis of these disorders in non-treatment seeking individuals in the community

Determination of Voriconazole Plasma Concentration by HPLC Technique and Evaluating Its Association with Clinical Outcome and Adverse Effects in Patients with Invasive Aspergillosis

Purpose. Invasive aspergillosis is a prevalent fungal disease, especially in Asian countries with a high mortality rate. Voriconazole (VRZ) is the first choice for invasive aspergillosis treatment. Plasma concentration of this drug is unpredictable and varies among individuals. This variability is influenced by many factors leading to clinical implication. Therapeutic drug monitoring (TDM) may have a crucial role in the patients’ treatment process. The HPLC method provides sufficient specificity and sensitivity for plasma VRZ concentration determination for TDM purposes of this drug. Methods. Patients who initiated oral or intravenous VRZ for invasive aspergillosis were enrolled in this study. Demographic characteristics and clinical data, outcome, and adverse effects were documented. For each patient, the plasma sample was collected under steady-state condition and analyzed using a validated HPLC method. Results. A total of 22 measurements were performed. Fifty percent of patients were out of the therapeutic range. From them, 27.27% and 22.73% were in subtherapeutic and supratherapeutic ranges (5.5 μg/mL), respectively. There was a significant correlation between VRZ plasma concentration and treatment outcomes (P=0.022). Treatment failure was five times higher than treatment success in those in the subtherapeutic range. Adverse effects were observed more frequently in patients with supratherapeutic concentrations compared to those with non-supratherapeutic levels. Furthermore, the mortality rate in patients experiencing treatment failure was 2.17 times higher than those with treatment success. Conclusions. TDM of VRZ plays an important role in better evaluation of efficacy and toxicity during treatment. Therefore, determination of the drug level may be of clinical significance