Evaluation of potential drug-drug interactions and adverse drug reactions among chronic kidney disease patients: An experience from United Arab Emirates

Purpose: To determine the prevalence and assessing nature of potential drug-drug interactions (pDDIs) and adverse drug reactions (ADRs) among chronic kidney disease (CKD) patients.Methods: This was a prospective observational study involving adult CKD patients. Occurrence of pDDIs was evaluated using Micromedex database 2.0. Suspected ADRs during the study period were documented and assessed.Results: Overall prevalence of pDDIs was found to be 85.3 %. A total of 811 pDDIs with 225 different pairs of interacting drugs were identified. Majority of the patients had ≥ 3 pDDIs regardless of type of severity. Thirty-five ADRs were identified in 25 CKD patients. Hyperkalemia was the most-commonly suspected ADR. Logistic regression analysis revealed that age (OR: 1.04, 95 % CI: 1.01 - 107), length of hospital stay (OR: 1.15, 95 % CI: 1.0 - 1.32), presence of comorbidity like diabetes (OR: 9.1, 95 % CI: 3.2 - 25.3) and number of drugs prescribed (OR: 6.88, 95 % CI: 1.5 - 30.0) were positively correlated with occurrence of pDDIs. Length of hospital stay (OR: 1.05, 95 % CI: 0.99 - 1.06) and number of drugs (OR: 0.16, 95 % CI 0.03 - 0.84) were identified as independent predictors of occurrence of ADRs.Conclusion: Prevalence of pDDIs was high in the study population. A majority of the pDDIs were of major severity type, fair documentation grade, and of unspecified onset. A majority of suspected ADRs were probably of moderate in severity and not preventable type

From textbooks to online sources: An Investigation of drug information resource preference and utilization among healthcare Professionals

Background: Providing drug information (DI) is one of the essential pharmaceutical care services. Previous research has documented varying DI preferences and utilization practices among Healthcare Professionals (HCPs). This study aimed to determine the preference and utilization of DI resources among HCPs and identify the main barriers that impede their ability to utilize them. Methods: A cross-sectional survey was conducted in selected government, private hospitals, and primary healthcare clinics. A thirteen-item survey instrument was developed to assess the utilization, accessibility, preferences, and satisfaction with various DI resources and barriers. HCPs meeting the inclusion criteria were identified and contacted. The collected data were analyzed using the Statistical Package for Social Sciences (SPSS) 27. Results: 311 responses were considered for the final analysis. Most HCPs who contributed to this survey were pharmacists, nurses, and physicians. Google was the most frequently used reference resource, at 64.3% (n = 200), followed by other subscription-based databases at 36% (n = 112) and package inserts at 30.5% (n = 95). UpToDate was the most commonly used database, i.e., 42.1% (n = 131) (RII = 0.749196). Treatment was the most common category of DI, and 69.8% (n = 217) searched (RII = 0.899517). Lack of time, 46% (n = 201), was the most limiting factor for seeking DI. Variables such as work experience, practice setting, education level, and continuing medical education hours were the significant (p < 0.05) predictors of some DI utilization components and preferences. Conclusion: This study shows differences in preference and utilization of drug information resources (DIR) by HCPs, depending upon their clinical practice and background. Therefore, educational strategies are needed to empower HCPs about DIR

Provision of clinical pharmacy education and services by RAK college of pharmaceutical sciences, Ras Al Khaimah, UAE

Objectives: Internationally, the role of pharmacist has now been extended from the provision of traditional services to patient specific care services. Unlike other developed countries, clinical pharmacy services are very rare in the health care settings of United Arab Emirates (UAE). Hence, clinical pharmacy based education and training is the need of the hour. Materials and Methods: RAK College of Pharmaceutical Sciences (RAKCOPS) through its innovative undergraduate pharmacy curriculum with a practice-oriented training, is enabling the students to acquire knowledge, skills, and practice to apply in a healthcare set up. RAKCOPS established a clinical pharmacy department in the year 2009 at Ibrahim Bin Hamad Obaidallah Hospital of Ras Al Khaimah, UAE, which is a 330 bedded tertiary care medical specialty hospital. In the year 2007, RAKCOPS initiated undergraduate pharmacy program of 4.6 years (B. Pharm) with a one semester of practice school training in the last semester. Results: Practice school training as a part of B. Pharm program is mainly designed to help the students to gain confidence in their ability to be an active and useful participant in the healthcare. Clinical pharmacy related services such as drug and poison related information, adverse drug reaction (ADR) monitoring, and reporting are also provided by the department of clinical pharmacy. Conclusion: Pharmacy practice related education and practice-based training provided for the undergraduate pharmacy students will be definitely a major contribution towards bringing up quality clinical pharmacists in UAE, who will be a major asset for the healthcare team

A common molecular and cellular pathway in developing Alzheimer and cancer

Globally cancer and Alzheimer's disease (AD) are two major diseases and still, there is no clearly defined molecular mechanism. There is an opposite relation between cancer and AD which are the proportion of emerging cancer was importantly slower in AD patients, whereas slow emerging AD in patients with cancer. In cancer, regulation of cell mechanisms is interrupted by an increase in cell survival and proliferation, while on the contrary, AD is related to augmented neuronal death, that may be either produced by or associated with amyloid-β (Aβ) and tau deposition. Stated that the probability that disruption of mechanisms takes part in the regulation of cell survival/death and might be implicated in both diseases. The mechanism of actions such as DNA-methylation, genetic polymorphisms, or another mechanism of actions that induce alteration in the action of drugs with significant roles in resolving the finding to repair and live or die might take part in the pathogenesis of these two ailments. The functions of miRNA, p53, Pin1, the Wnt signaling pathway, PI3 KINASE/Akt/mTOR signaling pathway GRK2 signaling pathway, and the pathophysiological role of oxidative stress are presented in this review as potential candidates which hypothetically describe inverse relations between cancer and AD. Innovative materials almost mutual mechanisms in the aetiology of cancer and AD advocates novel treatment approaches. Among these treatment strategies, the most promising use treatment such as tyrosine kinase inhibitor, nilotinib, protein kinase C, and bexarotene

Effect of Polymers and Permeation Enhancers in the Release of Quetiapine Fumarate Transdermal Patch through the Dialysis Membrane

Quetiapine Fumarate is potent, and the daily therapeutic dose can be delivered easily across the skin with the help of permeation enhancers. Quetiapine Fumarate-loaded transdermal patches were prepared by solvent evaporation technique. Various formulation parameters, excipients, and their combinations were optimized to get thin, translucent, smooth, stable, and high permeable character patches. A total number of 10 formulations were prepared. All formulations were subjected to various physicochemical evaluations. Three different formulations were prepared and F1, F2, and F3. Various physicochemical studies were carried out and found no significant difference between the three batches. The in vitro release study showed 74.29%, 82.73%, and 77.27%, respectively, up to 24 h. From the results, F2 has been selected as an optimized formulation and evaluated for skin irritation test. The results revealed that there is no irritation produced. The stability study results showed that there is no significant change from its initial nature till the period of three months in both temperatures. Quetiapine Fumarate Transdermal Patch F2 has achieved the goal of extended-release, cost-effectiveness, lowering the dose and frequency of drug administration, and thus may improve patient compliance

The Effect of Polymers on Drug Release Kinetics in Nanoemulsion In Situ Gel Formulation

Glaucoma is an ocular condition characterized by elevated intraocular pressure (IOP). Conventional treatments of glaucoma face poor corneal permeability and bioavailability. To address these issues, a nanoemulsion in situ gel of Timolol maleate was developed in this study by adding the polymer Carbopol 934p. Using Carbopol 934p, a novel ophthalmic pH-induced nanoemulsion in situ gel was formulated. The formulation was liquid at pH 4 and quickly gelled when the pH was raised to 7.4 (Lacrimal pH). The pH-triggered in situ gelling mechanism demonstrated continuous drug release over a 24 h cycle. A total of nine trial formulations were prepared (NEI1&ndash;NEI9) and subjected to various physicochemical and in vitro evaluations. According to the in vitro release kinetics, the drug release of Timolol maleate nanoemulsion in situ gel NEI5 followed zero-order kinetics, with a release exponent value of 0.902, indicating that the mechanism of release was non-Fickian diffusion regulated. In vivo results showed that Timolol maleate nanoemulsion in situ gel NEI5 provided a better-sustained release of the drug, compared with the Timolet OD eye drops. The formulation is stable in storage, with no distinguishable change in appearance, physical properties, quality, and percentage drug release. NEI5 also reduces drug administration frequency, which improves patient compliance. Timolol maleate nanoemulsion in situ gel NEI5 achieved the goal of controlled drug delivery with extended-release and cost-effectiveness, lowering the dosage and frequency of drug administration, and thus may improve patient compliance. In conclusion, the stable nanoemulsion in situ gel of Timolol maleate NEI5 decreases intraocular pressure (IOP) over a prolonged period