A CASE REPORT ON DIGOXIN INTOXICATION IN A CLINICAL PHARMACIST'S PERSPECTIVE

  Context: Digoxin is a commonly used inotropic drug that has a narrow therapeutic range and is monitored poorly for its plasma concentration. It is commonly used in the management of cardiovascular disorders for its inotropic effects. Increased risk of chronic digoxin toxicity among the patients receiving digoxin pharmacotherapy is related to its narrow therapeutic range. Apart from its inotropic properties, it can also produce chronotropic and dromotropic effect. Its serum levels vary due to changes in body weight, age, renal function, hepatic impairment, and concomitant drug administrations. Patients receiving digoxin should be monitored periodically for potential drug interactions, adverse effects, toxicity, and other drug-related problems. Symptoms of digoxin-induced cardiotoxicity are difficult to be identified and may become fatal too. Therapeutic drug monitoring will play a significant role in reducing such drug therapy problems and will ensure safety and efficacy of the given drug. Case Report: We report a case of chronic digoxin toxicity in a 22-year-old male with congestive cardiac failure - Class IV and atrial fibrillation with ventricular bigeminy. Results: Patient's renal parameters were elevated and among electrolytes, sodium level was decreased and potassium level was increased. A reduction in the volume of the distribution of digoxin, due to impairment of renal function or congestive cardiac failure, might be one of the reasons for digoxin toxicity. Drug therapy problems (DTPs) such as untreated indication, inappropriate drug therapy, potential major drug-drug interactions, and drugs prescribed when contraindicated were observed. Conclusion: Monitoring digoxin drug therapy can bring down the risk of digoxin intoxication

A PROSPECTIVE OBSERVATIONAL STUDY ON HEALTH-RELATED AND MENTAL QUALITY OF LIFE ASSESSMENT IN GERIATRIC PATIENTS

ABSTRACTObjective: The objective of this study is to evaluate health-related and mental quality of life in geriatric patients and to determine the factorsinfluencing the same.Methods: World Health Organization-BREF, EuroQoL-5D, and Mini Mental State Examination scales were used for evaluation and scoring of healthrelatedandmentalquality oflifeingeriatric patients.Logistic regressionmodelswereused todeterminethepredictorsofhealth-relatedandmentalqualityof life.All statistical analyseswereperformedusing IBM SPSS 17.0.Results: Comorbid disease conditions were found to be the significant predictor of health-related quality of life. Education and social history werepredictors of cognitive function in the elderly.Conclusion: Patients in these risk line should keenly be monitored for declining health-related and mental quality of life. Disease has a significantimpact on the quality of life in geriatric population. However, education, financial status, and social history were found to be the significant predictorsof mental health and declining cognition. Hence, geriatric patients in the above-mentioned risk line should keenly be monitored; thereby their qualityof life can be focused and improved.Keywords: Comorbidity, Geriatrics, Mental health, physical health, Quality of life

Drug utilization evaluation of third generation cephalosporins using core drug use indicators

Abstract: To evaluate the drug utilization of third generation cephalosporins using core drug use indicators in various wards of Sri Ramachandra Hospital. Third generation cephalosporins are the most commonly prescribed broad spectrum antibiotic even before the culture sensitivity results arrives. Hence this study was undertaken to study the drug utilization evaluation of third generation cephalosporins in the inpatient department of various wards of Sri Ramachandra Hospital. A prospective study was conducted between July 2009 and February 2010. Prescriptions of 364 patients containing third generation cephalosporins admitted in inpatient department of various wards of Sri Ramachandra Hospital, Chennai were collected and using WHO basic drug indicators, the utilization pattern were analyzed. The average number of drugs per prescription was found to be 7.89 on prescription analysis. Cefixime was the most frequently prescribed (32.69%) oral third generation cephalosporins, followed by cefotaxime (31.32%). Among IV third generation cephalosporins, cefotaxime was the most frequently prescribed injections (35.4%). Only 28.02% of drugs were prescribed by generic name. The results obtained represent the over all prescribing pattern of third generation cephalosporins in the Tertiary Care Teaching Hospital, Chennai