A prospective study of prescribing pattern of drugs among in-patients of gynaecology department in a tertiary care teaching hospital in South India

Background: Analysis of prescribing pattern can be helpful for the assessing the beneficial and adverse impacts of the prescribed drugs. Even though drugs used for gynaecological disorders are one of the commonly used, they are least studied in terms of prescribing patterns. Hence the present study was planned to analyse the prescribing pattern of drugs among in-patients of gynaecology department in our institute.Methods: A prospective observational study was carried out in a total of 162 in-patients of department of gynaecology in our institute for a period of one year. Along with baseline demographic data, the total number and categories of drugs prescribed, percentage of individual drugs in each category, their dosage forms, percentage of drugs prescribed by generic name and drugs prescribed from essential drug list were analysed.Results: Overall a total of 1647 drugs were prescribed. Antimicrobial agents (35.76%), vitamin and mineral preparations (28.29%) and anti-ulcer drugs (10.32%) were the top three categories of drugs prescribed in our study. Metronidazole (27.34%) was the most commonly prescribed antimicrobial drug whereas ferrous sulphate (31.97%) was the highest prescribed vitamin and mineral preparation. Among the anti-ulcer drugs, ranitidine (89.42%) was the most frequently prescribed drug. Most commonly used analgesic was diclofenac (59.05%), antiemetic was ondansetron (77.92%) and intravenous fluid was ringer lactate (37.03%). Tablet was the most common dosage form (38.01%) followed closely by injection (33.27%). The percentage of drugs prescribed by generic name was 26.17% and from essential drug list was 84.86%.Conclusions: Antimicrobial agents and vitamins and mineral preparations were the most commonly prescribed drugs. Usage of injections should be reduced as they were relatively more commonly prescribed in our study. Prescription of drugs by generic names must be increased substantially to reduce the economic burden on patients

Prevalence, severity, causes and drugs used for depression, stress and anxiety among junior doctors in a tertiary care teaching hospital in South India

Background: Due to various reasons, junior doctors experience high level of stress in their workplace. However, very few studies have been done to analyze the stress levels and pertinent causative factors among junior doctors in India. So the present study was done to investigate the prevalence, severity and causes of depression, stress and anxiety among junior doctors along with the drugs used to mitigate them.Methods: A cross sectional, questionnaire based study was conducted on a total of 114 junior doctors who include 80 interns and 34 post graduates belonging to  2013-14 batch, utilizing the 21-item depression, anxiety and stress scale (DASS 21). A personal interview was also conducted to enquire into the causes responsible for the stress and the medications employed by them to overcome it.Results: Among the interns, the mean depression score was 5.64±3.85, mean anxiety score was 6.69±3.86 and mean stress score was 7.33±3.22. Among the post graduates, the mean depression score was 4.73±2.15, mean anxiety score was 5.18±3.19 and mean stress score was 7.82±2.68. The percentage of junior doctors who had severe or extremely severe scores of depression was 11.40%, anxiety was 40.35% and stress was 9.65%. Alcohol was the most commonly used psychotropic drug (60.87%). Frequent calls during night duties and late working hours were the leading causes for stress among junior doctors.Conclusions: Overall higher stress was observed among post graduates compared to interns and females compared to males. Anxiety was more severe compared to depression and stress among junior doctors. Reducing working hours and increasing workplace flexibility are some measures to reduce stress among the junior doctors

Loop diuretic-induced hyponatremia: a case report

Hyponatremia is the most common encountered electrolyte abnormality where the serum sodium concentration is <136 mEq/L. The most common causes are either the concurrent illnesses or the medications. Diuretics top the list of drugs inducing hyponatremia and this occurs more frequent within 2 weeks of initiating therapy. Though thiazide diuretics are frequently the culprits of inducing hyponatremia, the role by/risk with loop diuretics cannot be ignored. Prompt diagnosis and management of hyponatremia needs a sound knowledge with which permanent neurologic sequelae and morbidity could be prevented. Here, we report a case of hyponatremia induced by loop diuretic and spironolactone combination, where the presenting complaints of the patient were only intractable nausea and altered taste. The patient was successfully managed with hypertonic saline and the vasopressin receptor antagonist, tolvaptan, which belongs to a new class of drugs called aquaretics

Prescribing pattern and WHO core prescribing indicators in post-operative patients of Gynaecology department of a tertiary care teaching hospital

Background: Prescription pattern analysis is an essential tool to provide an insight regarding the existing drug usage and to ensure rational drug therapy. Even though drugs used for gynecological disorders are one of the commonly used, they are least studied in terms of prescribing patterns. Hence the present study was planned to analyze the prescribing pattern and WHO core prescribing indicators among post-operative patients of Gynaecology department in our institute.Methods: A prospective observational study was conducted in 76 post-operative patients of Gynaecology department for a period of six months. Each prescription was analyzed for demographic data, total number and various categories of drugs prescribed, the percentage of individual drugs prescribed in each category, the dosage forms and the percentage of drugs prescribed by generic name, and from essential drug list were also analyzed.Results: A total of 990 medications were prescribed among which anti-microbial agents (32.52%) were the most commonly prescribed category followed by analgesics (19.60%) and Intravenous fluids (13.53%). Metronidazole (27.02%) was the most commonly prescribed antimicrobial, Diclofenac (68.04%) was the commonly prescribed analgesics and Ringer lactate (38.81%) was the commonly prescribed Intravenous fluid. Most commonly prescribed antiulcer drug was ranitidine (75.0%), antiemetic was Ondansetron (76.39%). Majority of drugs (72.54%) were prescribed by generic name. Average number of drugs per prescription was 13.03. Percentages of encounters with antibiotics were 32.52%. The percentage of drugs prescribed from the National List of Essential Medicines (NLEM) was 82.16%. Injection (57.78%) was the most common drug formulation.Conclusions: Antimicrobial agents and analgesics were the most commonly prescribed drugs. Prescription by generic name was high, usage of antibiotics and injections were also high and Poly-pharmacy was common, especially among antimicrobial agents. Prescribing according to the national essential list of medicines was high, which indicates rational prescription

WHO core prescribing indicators in patients with allergic contact dermatitis in a coastal town of South India

Background: Prescribing pattern analysis utilizing WHO core drug prescribing indicators can be helpful for the assessing the beneficial and adverse impacts of the prescribed drugs.Even though many drugs are commonly used in treatment of Allergic contact dermatitis (ACD) they are least studied in terms of prescribing patterns. Hence the present study was planned to analyze the prescribing pattern and study the WHO core prescribing indicators in patients with ACD in our institute.Methods: A prospective observational study was carried out with prescriptions of 81 outpatients who attended the dermatology OPD with the diagnosis of ACD over a period of six months. Details such as basic demographics, specific drugs prescribed with their dose and dosage forms were recorded and WHO core prescription indicators analysed.Results: Overall, corticosteroids both topical and systemic were the most commonly prescribed drugs (45.54%) followed by antihistamines (30.69%) and antimicrobials (13.86%). The most commonly prescribed topical corticosteroid was desonide (58.82%), systemic corticosteroid was prednisolone (47.61%), antihistamine was cetirizine (54, 83%) and antimicrobials were cephalosporins (42.86%). Average drugs per prescription for patients of ACD were 6.8. Percentage of drugs prescribed by generic name was 22.77%. Percentage of encounters with antibiotic prescribed was 13.86% whereas injection prescribed was 9.90%. Percentage of drugs prescribed from National list of essential medicines (NLEM) was 53.57%.Conclusions: Corticosteroids remain the mainstay of treatment in ACD. The percentage of encounters with an injection and the use of systemic steroids were low and were according to the guidelines. But drugs prescribed by generic name and those prescribed from NELM were found to be satisfactory but can further be improved

A RETROSPECTIVE STUDY ON DRUG UTILIZATION PATTERN OF POISONING CASES ADMITTED IN A TERTIARY CARE TEACHING HOSPITAL

Objective: Poisoning with suicidal intention is a serious health issue among adults. Poisoning, as an emergency, is more common in India due to the easy availability of poisons, increased use of chemicals in industrial and domestic purposes. The objective of the study is to evaluate the nature of poisoning cases and the drug utilization pattern of poisoning cases. Methods: A medical record-based retrospective data collection was conducted over a period of 21/2 years. Each prescription was analyzed by the demographic profile, the manner of poisoning (accidental or suicidal), the number of pharmacological agents causing poisoning, and type or name of the pharmacological agent responsible for the poisoning. Results: Among 127 total patients, 113 cases were suicidal. Systemic poisons (47.24%) were more consumed in our study, among which benzodiazepines (16.54%) being the most common sub-class ingested. Of the 862 medications prescribed, normal saline (38.97%) was the most commonly infused intravenous fluid. Gastric lavage (38.1%) has been the most frequently used general measures. Injection pantoprazole (50.6%) was the commonly prescribed anti-ulcer drug. The most commonly used analgesic (47.83%) was paracetamol, antimicrobial agent was cefotaxime (25%), Vitamin and minerals were Vitamin B complex (68%), steroid was hydrocortisone (76%), and antidote was atropine (37.5%). Conclusion: The magnitude of poisoning was high for suicidal purposes, in the young age group and in females. Intravenous fluids and general measures were the mainstay of the management of poisoned cases. Educational programs with an emphasis on preventive measures for toxic exposures are necessary to create awareness and to construct preventive strategies. Suggestions like poisoning centers in tertiary care hospitals will also help decrease morbidity and mortality

Prevalence, severity, causes and drugs used for depression, stress and anxiety among junior doctors in a tertiary care teaching hospital in South India

Background: Due to various reasons, junior doctors experience high level of stress in their workplace. However, very few studies have been done to analyze the stress levels and pertinent causative factors among junior doctors in India. So the present study was done to investigate the prevalence, severity and causes of depression, stress and anxiety among junior doctors along with the drugs used to mitigate them.Methods: A cross sectional, questionnaire based study was conducted on a total of 114 junior doctors who include 80 interns and 34 post graduates belonging to  2013-14 batch, utilizing the 21-item depression, anxiety and stress scale (DASS 21). A personal interview was also conducted to enquire into the causes responsible for the stress and the medications employed by them to overcome it.Results: Among the interns, the mean depression score was 5.64±3.85, mean anxiety score was 6.69±3.86 and mean stress score was 7.33±3.22. Among the post graduates, the mean depression score was 4.73±2.15, mean anxiety score was 5.18±3.19 and mean stress score was 7.82±2.68. The percentage of junior doctors who had severe or extremely severe scores of depression was 11.40%, anxiety was 40.35% and stress was 9.65%. Alcohol was the most commonly used psychotropic drug (60.87%). Frequent calls during night duties and late working hours were the leading causes for stress among junior doctors.Conclusions: Overall higher stress was observed among post graduates compared to interns and females compared to males. Anxiety was more severe compared to depression and stress among junior doctors. Reducing working hours and increasing workplace flexibility are some measures to reduce stress among the junior doctors

WHO core prescribing indicators in patients with allergic contact dermatitis in a coastal town of South India

Background: Prescribing pattern analysis utilizing WHO core drug prescribing indicators can be helpful for the assessing the beneficial and adverse impacts of the prescribed drugs.Even though many drugs are commonly used in treatment of Allergic contact dermatitis (ACD) they are least studied in terms of prescribing patterns. Hence the present study was planned to analyze the prescribing pattern and study the WHO core prescribing indicators in patients with ACD in our institute.Methods: A prospective observational study was carried out with prescriptions of 81 outpatients who attended the dermatology OPD with the diagnosis of ACD over a period of six months. Details such as basic demographics, specific drugs prescribed with their dose and dosage forms were recorded and WHO core prescription indicators analysed.Results: Overall, corticosteroids both topical and systemic were the most commonly prescribed drugs (45.54%) followed by antihistamines (30.69%) and antimicrobials (13.86%). The most commonly prescribed topical corticosteroid was desonide (58.82%), systemic corticosteroid was prednisolone (47.61%), antihistamine was cetirizine (54, 83%) and antimicrobials were cephalosporins (42.86%). Average drugs per prescription for patients of ACD were 6.8. Percentage of drugs prescribed by generic name was 22.77%. Percentage of encounters with antibiotic prescribed was 13.86% whereas injection prescribed was 9.90%. Percentage of drugs prescribed from National list of essential medicines (NLEM) was 53.57%.Conclusions: Corticosteroids remain the mainstay of treatment in ACD. The percentage of encounters with an injection and the use of systemic steroids were low and were according to the guidelines. But drugs prescribed by generic name and those prescribed from NELM were found to be satisfactory but can further be improved

Prescribing pattern and WHO core prescribing indicators in post-operative patients of Gynaecology department of a Tertiary Care Teaching Hospital

Background: Prescription pattern analysis is an essential tool to provide an insight regarding the existing drug usage and to ensure rational drug therapy. Even though drugs used for gynecological disorders are one of the commonly used, they are least studied in terms of prescribing patterns. Hence the present study was planned to analyze the prescribing pattern and WHO core prescribing indicators among post-operative patients of Gynaecology department in our institute.Methods: A prospective observational study was conducted in 76 post-operative patients of Gynaecology department for a period of six months. Each prescription was analyzed for demographic data, total number and various categories of drugs prescribed, the percentage of individual drugs prescribed in each category, the dosage forms and the percentage of drugs prescribed by generic name, and from essential drug list were also analyzed.Results: A total of 990 medications were prescribed among which anti-microbial agents (32.52%) were the most commonly prescribed category followed by analgesics (19.60%) and Intravenous fluids (13.53%). Metronidazole (27.02%) was the most commonly prescribed antimicrobial, Diclofenac (68.04%) was the commonly prescribed analgesics and Ringer lactate (38.81%) was the commonly prescribed Intravenous fluid. Most commonly prescribed antiulcer drug was ranitidine (75.0%), antiemetic was Ondansetron (76.39%). Majority of drugs (72.54%) were prescribed by generic name. Average number of drugs per prescription was 13.03. Percentages of encounters with antibiotics were 32.52%. The percentage of drugs prescribed from the National List of Essential Medicines (NLEM) was 82.16%. Injection (57.78%) was the most common drug formulation.Conclusions: Antimicrobial agents and analgesics were the most commonly prescribed drugs. Prescription by generic name was high, usage of antibiotics and injections were also high and Poly-pharmacy was common, especially among antimicrobial agents. Prescribing according to the national essential list of medicines was high, which indicates rational prescription