Study of adverse drug reactions in a tertiary care hospital

Background: The objectives of the study were to evaluate incidence and preventability of adverse drug events (ADEs) and potential ADEs and to analyse preventable events to develop prevention strategies.Methods: The study was retrospective observational study conducted at a rural tertiary care hospital at Maharashtra, for 12 months. Patients of both gender and all age group were included in the study. These entire adverse drug reactions were reported either by the PVPI assistance and/or hospital staff and their severity and causality assessments was performed as per Naranjo’s and Hartwig’s assessment criteria respectively. Data was analyzed by using Microsoft Excel.Results: There were total 256 ADR (adverse drug reactions) were reported in 12 months from January 2018 to December 2018 in various departments of the study center. Most of the adverse drug reactions were reported among age group of 21–40 years patients. Rash and itching (69) were most commonly reported ADR’s. ART (31.25%), antibiotics (28.90%) were reported to induce maximum number of ADRs. Most of the adverse drug reactions were possible (194, 75.78%) and mild (208, 81.25%) in nature.Conclusions: The antibiotics, ART drugs were most common drugs to reported ADRs. The commonly reported reactions were rash and itching

DRUG UTILIZATION STUDY IN GERIATRIC PATIENTS AT RURAL TERTIARY CARE HOSPITAL

AbstractObjective: To study the drug utilization pattern in geriatric patients at rural tertiary care hospital.Materials and Methods:  This was a cross-sectional observational study involving 600 geriatric outpatients. The study was carried out from May 2014 to July 2014. The data was collected using predesigned pro forma specially designed for this purpose. Relevant information was obtained by analyzing the prescriptions for WHO core drug indicators.Results: - The total numbers of prescriptions studied were 600. The total number of drugs prescribed is a product of actual drugs and number of patient prescriptions. The majority of the patients were in the age group 65-70 years (69.33%). There was male preponderance (58.66%). Musculoskeletal diseases were the most common (26.33%), followed by cardiovascular diseases (26%). The average number of drugs per prescription was 2.79. Out of total number of drugs prescribed, 380 drugs (22.64%)  were prescribed by their generic name and 1298 drugs (77.35%) were prescribed by their brand name. 1308 drugs (77.94%)  prescribed were from World Health Organization's Essential Medicines List 2011 (WHO-EML). Drugs acting on the cardiovascular system (23.36%) were the most frequently prescribed, followed by vitamins, minerals (18.23%) and drugs acting on the gastrointestinal system (15.73%).Conclusion:  The study has shown the pattern of diseases prevalent in geriatric patients and drug use among them. Thus drug utilization study can help in assessment and promotion of rational use of drugsKeywords: Drug utilization, geriatric, polypharmacy, rational use

Hypolipidemic and antioxidant activities of pioglitazone in hyperlipidemic rats

Background: Diabetes mellitus (DM) is an endocrine disorder characterized by abnormal carbohydrate, lipid and protein metabolism along with specific long-term complications which are associated with hyperlipidemia and oxidative stress. Hence, it is important to find hypoglycemic drug that improves lipid profile and reduces oxidative stress in diabetic patient. This study, therefore, was performed to investigate hypolipidemic and antioxidant potential of Pioglitazone (PIO) in hyperlipidemic rats.Methods: Hyperlipidemia was induced in normal rats by including 0.75 gm% cholesterol and 1.5 gm% bile salt in normal diet and these rats were used for the experiments. PIO hydrochloride was administered as 10 mg/kg and 30 mg/kg dose levels to the hyperlipidemic rats. Hypolipidemic activity was estimated by plasma lipid profile parameters while antioxidant potential was estimated by ascorbic acid, catalase activity, malondialdehyde and superoxide dismutase activity using standard methods. Statistical analysis was done by one way analysis of variance (ANOVA) followed by Dunnett’s test.Results:  Treatment with 10 mg/kg and 30 mg/kg dose levels of PIO hydrochloride resulted in a significant decrease in serum TG and VLDL only in 30 mg/kg PIO treated group and significant increase in serum HDL in both groups, but no significant decrease in cholesterol and LDL in both PIO treated groups. PIO increased activities of catalase enzyme and concentration of malondialdehyde significantly in only 30 mg/kg PIO treated group. But there were no significant changes in the superoxide dismutase activity and ascorbic acid concentration in both PIO treated groups.Conclusions: The present study demonstrated that treatment with 10 mg/kg and 30 mg/kg dose levels of PIO hydrochloride improves the plasma lipid profile and also reduces oxidative stress in hyperlipidemic animals

Study of drug prescription pattern in ischemic heart disease patients

Background: Drug utilization pattern studies helps to screen, assess and propose appropriate modifications in prescription practices, this would help to make patient care rational and cost effective. Study was intended to analyse the drug prescribing pattern for treatment of Ischemic heart disease using WHO indicators.Methods: This is a cross sectional observational study conducted on ischemic heart disease patients admitted at inpatient department of medicine in a tertiary care teaching hospital. The study consisted of analysis of drug utilization pattern of prescribed drugs.Results: IHD was more commonly seen in males (70.06%) than females (29.94%). IHD was most commonly seen in patients of age group of 61-70 year. Drugs prescribed to patients belong to various therapeutic classes ranging from anti-platelets, anticoagulants, anti-anginal, antithrombin, thrombolytic, hypolipidemics. The most commonly prescribed therapeutic class of drugs was antiplatelet (86.26%) followed by hypolipidemic (82.25%) and ACE inhibitors drugs (46.60%). Average number of drugs per encounter was 7.70. Drugs were prescribed by their generic names were 29.99%. Out of total study group 22.06% patients were prescribed at least one antibiotic. Injections were prescribed only in 1392 (27.86%) out of 4995 drugs. Of total drugs 3270 (65.45%) of drugs were from National List of Essential Medicines-2016 (NLEM -2016) and 2774 (55.53%) drugs prescribed were from WHO-EML-2016.Conclusions: Risk of artery disease increased with increasing age. IHD was more common in males than females. The most commonly prescribed drug classes in Ischemic heart disease were anti-platelet drugs followed by hypolipidemic agents

Lipid lowering and antioxidant potential of Asparagus racemosus in hyperlipidemic rats

Background: Atherosclerosis is associated with hyperlipidemia which is a major risk factor for coronary artery disease. Therefore, treatment of hyperlipidemia is one of the major approaches to decrease the atherogenic process. Many studies revealed that Asparagus racemosus (AR) possesses hypolipidemic and antioxidant potential, but results were not consistent. Therefore, the present study was undertaken to investigate lipid lowering and antioxidant potential of AR root powder in hyperlipidemic rats.Methods: Hyperlipidemia was induced in normal rats by including 0.75 gm% cholesterol and 1.5 gm% bile salt in normal diet and these rats were used for the experiments. Dried root powder of Asparagus racemosus was administered as feed supplement at 5 gm% and 10 gm% dose levels to the hyperlipidemic rats. Plasma lipid profile, malondialdehyde, ascorbic acid, catalase and superoxide dismutase were estimated using standard methods. Statistical analysis was done by one way analysis of variance (ANOVA).Results: Feed supplementation with 5 gm% and 10 gm% Asparagus racemosus resulted in a significant decrease in plasma cholesterol, LDL and significant increase in HDL. But there were no significant decrease in triglycerides and VLDL. The feed supplementation increased activities of catalase, superoxide dismutase and ascorbic acid content increased significantly in both the experimental groups (5 and 10 gm% supplemented groups). But there was no significant change in the concentration of malondialdehyde in these groups.Conclusions: The present study demonstrated that addition of Asparagus racemosus root powder at 5 gm% and 10 gm% level as feed supplement reduces the plasma lipid levels and also acts as an antioxidant

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

Study of drug prescription pattern among COPD patients admitted to medicine in-patient department of tertiary care hospital

Background: Drug utilization studies can provide insights into a pattern, quality, determinants and outcomes of drug use. COPD is one of the leading causes of death among Indian population and there is a lack of drug utilization studies in this field.Methods: A prospective, observational study was conducted among the patients admitted in inpatient department of medicine ward of Tertiary care hospital. Data has collected from COPD patients admission records. Parameters like demographic profile, common associated diseases, WHO core drug indicators and commonly prescribed drugs were assessed from the prescriptions.Results: A total 284 inpatient records were scrutinized. Out of 284 patients, 66.19% were male and 33.80% were female. Average numbers of drugs per prescription were 7. Mean age was 66.9 years. Antimicrobials (88.7%) were most commonly prescribed drugs followed by inhaled bronchodilators (84.5%).Conclusions: Study data highlights that average numbers of drugs prescribed were higher than WHO norms, antibiotics were commonly used, and drugs prescribed with brand names were higher than the generic names

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

Drug utilization pattern in geriatric out patient in tertiary care hospital

Background: Inappropriate drug prescribing is a global problem affecting the healthcare system. Aim and objective of the study was to study the drug utilization pattern in geriatric patient at rural tertiary care hospital.Methods: This was a cross- sectional observational study involving 600 geriatric outpatient. This study was carried out from Nov 2015 to May 2016. The data were collected using predesigned proforma specially designed for this purpose. Relevant information was obtained by analyzing prescription for World Health Organization (WHO) core drug indicators.Results: Total number 600 prescriptions analyzed at the end of six months were from general medicine department. The mean age of the patients was 63.9 years in which male (61.33%) outnumber the female. Total number 2598 drugs were prescribed to 600 patients for different diseases. The mean number of drugs per prescription were 4.33, drugs were prescribed by generic name 26.42%. drugs were prescribed from WHO essential drug list86.33. The type of formulations used were tablets and capsules in 88.5%, syrups in 5%, injections 3.5 % and inhalers 2%. Drug for Cardiovascular diseases were the most common (29.66) followed gastrointestinal (16.67), vitamins and minerals (14.66). Analgesic and NSAIDS (14.13) also prescribed commonly. Antimicrobial drugs prescribed in (7.46%) and common antibiotic prescribed were Amoxicillin ciprofloxacin and metronidazole.Conclusions: This study also effectively provides very useful baseline data also demonstrates the prescribing patterns of drugs in the geriatric patients

Drug utilization pattern in outpatient department of Government Medical College and C.P.R. Hospital, Kolhapur

Background: Drug utilization studies are used to analyze different aspects of the use of drugs and to implement methods of improving therapeutic quality. This study was conducted to study drug prescription pattern in outpatient department of Government Medical College and C.P.R. Hospital, Kolhapur which is one of the important medical college in western Maharashtra.Methods: One thousand prescriptions were screened & analyzed as per the study parameters from OPD of Government Medical College & C.P.R. Hospital, Kolhapur. Study parameters like demographic profile of the patient like age, sex and diagnosis were recorded. Also groups of drugs commonly prescribed, number of drugs per patient, drug profile and drawbacks of prescription if any were recorded and analyzed.Results: Most common group of drugs prescribed by physicians was Analgesics (32.83%), followed by Antimicrobials (22.82%), Multivitamins (16.42%) and Antacids (9.14%). The average number of drugs prescribed per patient was four; the average number of analgesic was one. The incidence of polypharmacy was common occurrence and some prescriptions had small drawbacks like absence of diagnosis, absence of doctor’s signature, etc.Conclusions: We conclude that most of the prescriptions which were analyzed at R.C.S.M. Government Medical College and C.P.R. Hospital, Kolhapur, were according to the standard norms of WHO prescriptions and also most of the drugs prescribed were from the list of essential drug list. But still there is scope for improvement in prescription pattern