Sources of drug information and their influence on the prescribing behaviour of doctors in a teaching hospital in Ibadan, Nigeria

Background: Pharmaceutical drug promotion is a means of informing health professionals about new drugs. The approach is often times unethical and inappropriate and may promote irrational prescribing. Dearth of information on impact of pharmaceutical drug promotion on prescribing behaviour of doctors in developing African countries has necessitated this study. We therefore aimed to determine the sources of drug information for doctors working in a teaching hospital in Nigeria and to assess the self-reported impact of the sources on their prescribing behaviour. Methods: A total of 163 doctors working at the University College Hospital (UCH), Ibadan in Nigeria were evaluated with a questionnaire for their demographics and sources of drug information. For doctors who relied on drug promotion, they were asked to self-report and self-rate their opinion on extent of interactions with pharmaceutical companies as well as how such interactions had impacted on their prescribing behaviour. Apart from the demographics, each question was evaluated with a typical five-level Likert item. Data analyses were with simple descriptive statistics. Results: Of the 400 doctors working at UCH, only 40.8% participated in the study. Drug information was sourced from colleagues (161, 98.8%), reference books (158, 96.9%), pharmaceutical sales representatives-PSRs (152, 93.2%), promotion materials (151, 92.6%), scientific papers/journals/internet (149, 91.4%), and drug promotion forum/product launches (144, 88.3%). Each source was highly utilized but there was no wide variation in their pattern of use. According to the self-report of over a half of the respondents, PSRs was an accurate and reliable drug information resource; PSRs increased their awareness of the promoted drugs; and their prescribing behaviours were influenced by information from PSRs. Conclusion: Respondents tend to rely on a broad range of drug information resources which include potentially inappropriate resources such as PSRs. Since this study was based on self-report, the influence of drug information resources reported by the respondents on their prescribing behaviour may have been underestimated. Measures should be taken to minimize interactions between PSRs and the respondents.Key words: Drug, prescription, information source, promotion, pharmaceutical company, influence, doctors, Nigeri

Antinociceptive and anti-arthritic properties of hydroethanolic leaf extract of Clausena anisata (Willd.) Hook. f. ex Benth (Rutaceae) in Rodents: possible mechanism of actions

Summary: The leaves of Clausena anisata (Willd.) Hook. f. ex Benth (Rutaceae) is used in Traditional African medicine for the treatment of various ailments including arthritis. The present study sought to investigate the antinociceptive and anti-arthritic properties of hydroethanolic leaf extract of Clausena anisata (HeCA). HeCA (100, 200 or 400 mg/kg, p.o.) was administered 1 h before intraplantar injection of formalin 1%v/v in saline to evaluate antinociceptive effect. Moreover, its possible mechanism of antinociceptive action was investigated through pretreatment of mice with antagonists of receptors implicated in nociception. Anti¬inflammatory effect of the extract was investigated using the carrageenan-induced paw oedema and complete Freund's adjuvant (CFA)-induced arthritis models in rats. HeCA (400 mg/kg) treatment significantly reduced the duration of paw licking/biting during both in the early (42.12%) and late (75.79%) phases of formalin-induced nociception. However, the antinociceptive effect elicited by HeCA was reverse by pretreatment of mice with naloxone, prazosin, yohimbine, ketanserin, L-arginine, and parachlorophenylalanine (PCPA). HeCA produced dose-dependent and time course decrease in carrageenan-induced paw oedema. Pre- and post-treatment of rats with HeCA ameliorated CFA-induced arthritis evidenced in the significant decrease in arthritic index comparatively similar to the effect of celecoxib. CFA- induced oxidative and nitrosative stress were attenuated by subchronic treatment with HeCA. Findings from this study shows that C. anisata possesses antinociceptive activity through possible interaction with opioidergic, noradrenergic, L-arginine-nitric oxide and serotonergic pathways as well as anti-arthritic property which could be attributed to its ability to prevent the release of inflammatory mediators and oxidative stress.Keywords: Complete Freund's adjuvant; L-arginine-nitric oxide; nociception; antioxidant; rheumatoid arthritis; serotonergic

Potential drug-drug interactions in paediatric outpatient prescriptions in Nigeria and implications for the future

BACKGROUND: Information regarding the incidence of drug-drug interactions (DDIs) and adverse drug events (ADEs) among paediatric patients in Nigeria is limited. METHODS: Prospective clinical audit among paediatric outpatients in four general hospitals in Nigeria over a 3-month period. Details of ADEs documented in case files was extracted. RESULTS: Among 1233 eligible patients, 208 (16.9%) received prescriptions with at least one potential DDI. Seven drug classes were implicated with antimalarial combination therapies predominating. Exposure mostly to a single potential DDI, commonly involved promethazine, artemether/lumefantrine, ciprofloxacin and artemether/lumefantrine. Exposure mostly to major and serious, and moderate and clinically significant, potential DDIs. Overall exposure similar across all age groups and across genders. A significant association was seen between severity of potential DDIs and age. Only 48 (23.1%) of these patients presented at follow-up clinics with only 15 reporting ADEs. CONCLUSION: There was exposure to potential DDIs in this population. However, potential DDIs were associated with only a few reported ADEs

EVALUATION OF THE ANTI-ARTHRITIC ACTIVITY OF THE HYDROETHANOLIC LEAF EXTRACT OF ALCHORNEA CORDIFOLIA IN RATS

Background: Different decoctions of Alchornea cordifolia leaves are used by Yoruba herbalists (Southwest Nigeria) for the local treatment of ulcers, rheumatic pains, febrile convulsions, and for enhancing physical performance. Materials and methods: In this study, the anti-arthritic effect of 100 – 400 mg/kg/day of the hydroethanolic leaf extract of Alchornea cordifolia (HEAC) was investigated in Complete Freund’s Adjuvant (CFA)-induced arthritic rats as a way of evaluating its efficacy in the local management of arthritis. In addition, the effects of HEAC on liver and renal function parameters as well as its effect on the antioxidant enzyme system were investigated. Arthritis was induced using 0.1 ml of 10 mg/ml of Complete Freund’s Adjuvant (CFA) following 1 h oral pretreatment and 8th day post-arthritic induction with 100, 200 and 400 mg/kg/day of HEAC and 3 mg/kg/day of celecoxib as the reference drug. The anti-arthritic activity of HEAC was assessed based on the ability of HEAC to alter the paw edema diameter, body weight, full blood count, renal and liver function markers, glycoprotein, lysosomal enzymes and possible antioxidant potential in the arthritic rats. Results: Oral pretreatment with 100, 200, and 400 mg/kg/day of HEAC produced significant (

Antiretroviral Therapy‑related Problems among Human Immunodeficiency Virus‑infected Patients: A Focus on Medication Adherence and Pill Burden

Background: There are problems associated with antiretroviral therapy despite its achievement. Poor medication adherence and inability to tolerate large pill burden are major problems facing patients with chronic illnesses. These drug therapy problems are under-studied among people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in Nigeria. We evaluated adherence and pill burden among this set of patients in a tertiary hospital in Lagos. Methods: Data for eligible HIV‑infected adults were documented from case notes and through interviews using a well‑structured  questionnaire. Important details extracted were sociodemographics, pills information, and CD4 counts. The main outcome measures were drug adherence, as assessed by the four‑item Morisky Medication Adherence Scale and pill burden, as measured by daily pill >5. Results: Of the 296 patients, 219 (74%) were females. Median age (interquartile range) was 40 (35.0–47.7) years. Majority (262; 88.5%) were married, had at least a secondary education (142:48.0%), and CD4 count >500 cells/ml (215; 72.6%). Pill burden >5 pills/day was observed in 12.2% of the patients, while adherence was documented for 83.4% of the patients. Majority (259; 87.5%) were receiving fixed‑dose  combination of antiretroviral drugs. Forgetfulness (16.5%) and being too busy to take pills (10.5%) were the most common reasons for nonadherence. Pill burden in those who were not receiving fixed‑dose combination was significantly associated with medication nonadherence. However, only pill burden was found to be an independent prognosticator of non-adherance. (Odd ratio = 0.67, confidenceinterval = 0.03–1.66, P < 0.00). Conclusion: Medication nonadherence and pill burden were observed in more than one‑tenth of patients. These were the two major  antiretroviral therapy‑related problems reported in this study. Keywords: Adherence, antiretroviral therapy, human immunodeficiency virus, people living with human immunodeficiency virus/acquiredimmunodeficiency syndrome, pill burde

Drug safety in Nigeria

Medication safety, which is defined as the freedom from preventable harm with medication use, is a global public health concern and part of the primary mission of pharmacy practice. Medication safety issues negatively impact patient health outcomes including hospitalization, increased length of hospital stay, mortality, and overall health care costs. These issues are more profound in developing countries. In Nigeria, there are many issues and challenges related to medication safety culture among patients and health care professionals including underreporting of medication errors (MEs) and adverse drug reactions (ADRs), and beliefs in certain traditional norms. Currently, there are global concerted efforts and action plans geared toward patient safety in health care and minimizing preventable harm. This chapter discusses the status of medication safety issues in Nigeria, including, but not limited to, pharmacovigilance activities and ADR reporting, ME prevalence and reporting, self-medication practices, drug misuse and abuse, storage practices and disposal of pharmaceutical wastes, counterfeit medicines, safety issues related to the use of traditional, complementary, and alternative medicines, as well as research, education, and regulations governing these issues

Antidiabetic Effects of the Ethanolic Root Extract of Uvaria chamae P. Beauv (Annonaceae) in Alloxan-Induced Diabetic Rats: A Potential Alternative Treatment for Diabetes Mellitus

Diabetes mellitus has been a menace to mankind from time immemorial. However, a natural product such as U. chamae P. Beauv (Annonaceae) offers alternative treatment for diabetes mellitus. The study aimed at evaluating antidiabetic activity of the ethanolic root extract of U. chamae in alloxan-induced diabetic rats. Diabetes was induced in Sprague Dawley rats after overnight fast with 150 mg/kg alloxan intraperitoneally. After 72 h, those with plasma glucose levels >200 mg/dl were classified as diabetic. Five diabetic rats in each group were treated daily for 14 days orally with 100, 250, and 400 mg/kg of the extract, glibenclamide (71 µg/kg) and pioglitazone (429 µg/kg), respectively, while another group was untreated. Control received 0.5 ml of Acacia senegal. Effects of extract on glucose, other biochemical, and hematological parameters were evaluated. α-amylase and α-glucosidase inhibitory activities of extract and its fractions were also evaluated. Percentage inhibition and IC50 values were determined. Diabetic control was achieved on the 7th day of the study with 100, 250, and 400 mg/kg of the extract showing glucose reduction of 72.14%, 78.75%, and 87.71%, respectively. The HDL-cholesterol levels of diabetic rats treated with extracts were significantly increased. Extract and its fractions caused α-amylase and α-glucosidase inhibition. Histologically, pancreas of diabetic rats treated with extract showed regenerated islet cells which were not seen in rats treated with glibenclamide and pioglitazone. This study showed that U. chamae has antidiabetic activity which may be through α-amylase and α-glucosidase inhibition and regeneration of pancreatic beta cells. Also, it may reduce the risk of cardiovascular disease by increasing HDL-cholesterol levels

Analgesic and anti-inflammatory actions of Alafia barteri: Involvement of monoaminergic, nitrergic and opioidergic pathway.

Background: We have earlier reported the antinociceptive and anti-inflammatory effects of Alafia barteri Oliver (Apocynaceae) in rodents but its mechanism of actionsare yet to be elucidated.Objective: This study sought toinvestigate the involvement of monoaminergic, nitric oxide-cyclic GMP-K+ channel and opioidergic pathways in its mechanism of actions.Methods: methanol root extract of Alafia barteri (ALA) (100-400 mg/kg, p.o.) was given 1 h before administration of chemical or thermal - induced nocicept ion andhistamine/serotonin-induced inflammation. Themechanism of the antinociceptive effect was investigated through intraperitoneal injection of prazosin (62.5 μg/kg; á adrenoceptor antagonist), yohimbine (1 1- mg/kg; á adrenoceptor antagonist) NG-nitro-L-arginine (L- 2 , NNA) (20 mg/kg; nitric-oxide-synthase inhibitor), cyproheptadine(10mg/kg;5-HTR2antagonist),glibenclamide (10 mg/kg; ATP-sensitive K+- channel inhibitor), or naloxone (5 mg/kg; opioid-receptor antagonist) before the nociceptive models.Results: ALA(100-400 mg/kg)treatment produced dose and time dependent (P<0.001; 87.11%)increase in pain threshold in acetic acid-induced-writhing, inhibition ofneurogenic (50.96%), and inflammatory (70.02%) phases of formalin test, and 41.75% maximum possible effect (MPE) in tail immersion testat 400 mg/kg in comparison with vehicle-treated control. The antinociceptive-effect was blocked by pretreatmentof mice withprazosin, yohimbine or L-NNA, (P<0.001) in writhingassay. Similarly, naloxone pretreatment blocked the inhibition of neurogenic- and inflammatory-pain induced by ALA in formalin test. Interestingly, ALA produced dose related time course inhibition (P<0.05) of histamine and serotonin-induced paw inflammation with peak effects (57.89, and 81.82%), respectively, at 400 mg/kg.Conclusion: Findings from these studies suggest central and peripheral analgesic effect of A. barteri through interaction with L-arginine-nitric-oxide pathway, á - 1/2 adrenoceptors, and/or, opioidergic pathway, while, the antiinflammatoryeffect involves marked inhibition of histamine and serotonin release.Keywords: á-adrenoceptor; ATP-sensitive potassium channel; histamine; opioidergic ;pathway; serotonin; formalin-induced nociception