Community Pharmacists’ Perception of the Relevance of Drug Package Insert as Source of Drug Information in Southwestern Nigeria

Purpose: To evaluate the opinions of community pharmacists on the usefulness and reliability of drug package inserts (DPI) as drug information source, and necessary modifications needed to improve theircontents.Methods: A prospective cross-sectional study using a pretested questionnaire was administered to sixty-one superintendent community pharmacists (CP) across two cities in southwestern Nigeria. Descriptive statistics was used to summarize the data and evaluate respondents’ opinion. Kruskal-Wallis test was used to evaluate the rank variables with p < 0.05 considered significant.Results: A majority of CP believed that information from DPI was precise and may be helpful in achieving therapeutic success (n = 42; 72.8 %). CP believed there is need for the modification of DPI content with respect to patient-related information (n = 52; 92.8 %) and health provider-relatedinformation (n = 52; 94.5%), non-uniformity of information on the same generic medicines (n = 31; 50.8 %), and ambiguity of content (n = 29; 47.5 %). Years of experience in practice significantly influenced respondents’ perception of precision and satisfaction with DPI as source of information.Conclusions: Community pharmacists in southwestern Nigeria believed that a properly modified drug package insert could be a useful and reliable source of drug information in daily practice.Keywords: Community pharmacist, Drug information, Drug package inser

Hypoglycemic Effect Of Treculia africana Decne Root Bark In Normal And Alloxan-Induced Diabetic Rats

The solvent partitioned purified fractions of the hydro-acetone root bark extract of the African breadfruit (Treculia africana Decne) were evaluated for hypoglycemic activities in normal and diabetic albino rats. Fasting blood glucose levels were estimated by the use of a glucometer at pre-determined intervals after oral administration of the test extracts/fractions. Results revealed that the test fractions have only a slight effect on blood sugar level of normal rats. On short term and chronic administration in diabetic rats however, diethyl ether-soluble (DEF) and the water-soluble (WSF) fractions significantly reduced the fasting blood sugar levels (

Self-reported use of complementary and alternative medicine (CAM) products in topical treatment of diabetic foot disorders by diabetic patients in Jeddah, Western Saudi Arabia

<p>Abstract</p> <p>Background</p> <p>There is little published on current Saudi diabetic patients' practices when they are exposed to foot disorders such as open wound, ulcer, and skin cracks. These factors are usually influenced by local culture and communities beliefs. The aim of the current study was to identify the pattern of patients' use of CAM products in dealing with diabetic foot disorders topically in a group of diabetic patients.</p> <p>Findings</p> <p>A Cross-sectional descriptive study of a representative cohort of diabetic patients living in Jeddah, Saudi Arabia was designed. A pre-designed questionnaire to identify local diabetics' practices in dealing topically with foot disorders including open wound, chronic ulcer, and skin cracks was designed. Questionnaire was administered by a group of trained nutrition female students to diabetics face to face living in their neighborhood. A total of 1634 Saudi diabetics were interviewed. Foot disorders occurred in approximately two thirds of the respondents 1006 (61.6%). Out of the 1006 patients who had foot disorders, 653 reported trying some sort of treatment as 307 patients (47.1%) used conventional topical medical treatment alone, 142 (21.7%) used CAM products alone, and 204 (31.2%) used both treatments. The most commonly used CAM product by the patients was Honey (56.6%) followed by Commiphora Molmol (Myrrh) in (37.4%) and Nigellia Sativa (Black seed) in (35.1%). The least to be used was Lawsonia inermis (Henna) in (12.1%). Ten common natural preparations used topically to treat diabetic foot disorders were also identified.</p> <p>Conclusions</p> <p>The use of CAM products in topical treatment of diabetic foot disorders is fairly common among Saudi diabetic patients. Honey headed the list as a solo topical preparation or in combination with other herbs namely black seeds and myrrh. The efficacy of the most common products needs further research.</p

Inhibition of Gastric Lipase as a Mechanism for Body Weight and Plasma Lipids Reduction in Zucker Rats Fed a Rosemary Extract Rich in Carnosic Acid

BACKGROUND: Rosemary (Rosmarinus officinalis L.) extracts (REs) exhibit hepatoprotective, anti-obesity and anti-inflammatory properties and are widely used in the food industry. REs are rich in carnosic acid (CA) and carnosol which may be responsible for some of the biological activities of REs. The aim of this study was to investigate whether inhibition of lipase activity in the gut may be a mechanism by which a RE enriched in CA (40%) modulates body weight and lipids levels in a rat model of metabolic disorders and obesity. METHODS AND PRINCIPAL FINDINGS: RE was administered for 64 days to lean (fa/+) and obese (fa/fa) female Zucker rats and body weight, food intake, feces weight and blood biochemical parameters were monitored throughout the study. Lipase activity (hydrolysis of p-nitrophenylbutyrate) was measured in the gastrointestinal tract at the end of the study and the contents of CA, carnosol and methyl carnosate were also determined. Sub-chronic administration of RE moderately reduced body weight gain in both lean and obese animals but did not affect food intake. Serum triglycerides, cholesterol and insulin levels were also markedly decreased in the lean animals supplemented with RE. Importantly, lipase activity was significantly inhibited in the stomach of the RE-supplemented animals where the highest content of intact CA and carnosol was detected. CONCLUSIONS: Our results confirm that long-term administration of RE enriched in CA moderates weight gain and improves the plasma lipids profile, primarily in the lean animals. Our data also suggest that these effects may be caused, at least in part, by a significant inhibition of gastric lipase and subsequent reduction in fat absorption

World Antimalarial Resistance Network (WARN) IV: Clinical pharmacology

A World Antimalarial Resistance Network (WARN) database has the potential to improve the treatment of malaria, through informing current drug selection and use and providing a prompt warning of when treatment policies need changing. This manuscript outlines the contribution and structure of the clinical pharmacology component of this database. The determinants of treatment response are multi-factorial, but clearly providing adequate blood concentrations is pivotal to curing malaria. The ability of available antimalarial pharmacokinetic data to inform optimal dosing is constrained by the small number of patients studied, with even fewer (if any) studies conducted in the most vulnerable populations. There are even less data relating blood concentration data to the therapeutic response (pharmacodynamics). By pooling all available pharmacokinetic data, while paying careful attention to the analytical methodologies used, the limitations of small (and thus underpowered) individual studies may be overcome and factors that contribute to inter-individual variability in pharmacokinetic parameters defined. Key variables for pharmacokinetic studies are defined in terms of patient (or study subject) characteristics, the formulation and route of administration of the antimalarial studied, the sampling and assay methodology, and the approach taken to data analysis. Better defining these information needs and criteria of acceptability of pharmacokinetic-pharmacodynamic (PK-PD) studies should contribute to improving the quantity, relevance and quality of these studies. A better understanding of the pharmacokinetic properties of antimalarials and a more clear definition of what constitutes "therapeutic drug levels" would allow more precise use of the term "antimalarial resistance", as it would indicate when treatment failure is not caused by intrinsic parasite resistance but is instead the result of inadequate drug levels. The clinical pharmacology component of the WARN database can play a pivotal role in monitoring accurately for true antimalarial drug resistance and promptly correcting sub-optimal dosage regimens to prevent these contributing to the emergence and spread of antimalarial resistance.Bill and Melinda Gates Foundation

Effect of number and type of antidiabetes medications on adherence and glycemia of ambulatory type 2 diabetes patients in southwestern Nigeria

Objective: To determine the influence of number and type of antidiabetes medications on adherence and glycemia of ambulatory type 2 diabetes patients in southwestern Nigeria.Methods: A cross-sectional study using pre-tested structured questionnaire among 176 consented patients recruited from the endocrinology clinics of two teaching hospitals between November, 2010 and January, 2011; and a retrospective review of case notes of the cohort for details of prescribed medications and blood glucose values. Descriptive statistics were used to summarize the data. Tests of proportions were evaluated using Chi-square or Fisher’s exact test as appropriate. The differences in mean fasting blood glucose (FBG) between and among categorical variables were compared using student t-test and ANOVA respectively, with p4 medications. Adherence was better among patients on >4 medications compared to those on ≤4 medications (p=0.05). However, patients on >4 medications were mostly older adults (>60 years of age), and they were in the majority (66.7%) who had tertiary education compared to 33.3% of those on ≤4 medications who had tertiary education (p=0.02). Adherence rates to antidiabetes medications were in the ranking of oral antidiabetes medications (OAM) alone (50.0%) > insulin plus OAM (44.0%) > insulin alone (41.7%) with no significant difference (p=0.77). There was a significant difference in mean FBG among patients on >4 medications (172.1 ±61.1mg/dL) versus (198.8 ±83.8mg/dL) among those on ≤4 medications (p=0.02). Conclusion: Prescribing more than four medications is linked to improved adherence and glycemic outcome. However, age and educational background of patients are important factors that need to be considered when prescribing multiple medications for type 2 diabetes

Evaluation of knowledge base of hospital pharmacists and physicians on herbal medicines in Southwestern Nigeria

The use of herbal medicines among Nigerian patients and the tendency to combine this class of medicines with allopathic drugs while on hospital admission have been on the increase. Earlier studies show that community pharmacists from Nigeria believe that they need more training to counsel patients on their use of herbal medications. Objective: To evaluate knowledge base, use, acceptability, attitudes and beliefs of hospital pharmacists and physicians in South-western Nigeria on herbal products / phytopharmaceuticals /dietary supplements (HP/PP/DS). Methods: A 20-odd questionnaire including an 8-item herbal medicine question was used to assess the knowledge of the physicians and pharmacists in the area of pharmacology of HP/PP/DS. Effects of demographic information such as age, sex, year post graduation, years of experience and area of specialization on the scores obtained were evaluated using Fisher’s exact tests. Level of significance was set at p<0.05.Results: Pharmacists (51.4%) believed that the training they had was not adequate while physicians (44.6%) believed HP/PP/DS are not safe and 18.5% believed they are not effective. Pharmacovigilance centres were not significantly used for adverse reactions reported by patients. Pharmacists (67.6%) and physicians (29.3%) believed phytopharmaceuticals interact with other drugs. Year of graduation had a significant effect on the perception of the possibilities of interaction for pharmacists. 5.6% of the physicians and 62.4% of the pharmacists scored ≥50% with the questions on use and interaction potentials of HP/PP/DS, with cadre and years of practice having significant effects. Conclusions: There is a deficiency in the knowledge base of physicians, especially on the pharmacology and potential interaction of herbal medicines. There is an urgent need for the inclusion of pharmacology of common herbal medicines in the curriculum of Nigerian medical degree and an improvement in the pharmacy curriculum in this area

Knowledge, Attitude and Self-management Practices of Patients with Type 2 Diabetes in an Ambulatory Care Setting in Ibadan, Nigeria

Diabetes education is likely to be more effective if patients&#8217; characteristics and attitude toward diabetes is well understood. This study aims to assess knowledge and attitude of patients with type 2 diabetes about diabetes and its complications, self-care practices to recognize and manage diabetes crisis, as well as selfmonitoring of blood glucose with a view to identify the areas to focus for diabetes self management education and to improved diabetes care. A cross sectional study was conducted at Adeoyo General Hospital, a secondary care setting located in Ibadan, southwestern Nigeria. Pre-tested questionnaire was administered to 200 randomly selected type 2 diabetes patients between 2nd March and 31st May, 2009. Of these, 175 (87.5%) properly filled questionnaires were subsequently analyzed and descriptive statistics were used to summarize data. Chi-square was used for tests of proportions, while student t-test and ANOVA were used to compare continuous variables, with P &lt; 0.05 considered significant. Only 18 (10.3%) knew the most probable cause of diabetes, more than three fourth (77.7%) were not aware that poor control of blood glucose levels could result in complications. Only 24.1% could mention at least a symptom to recognize hypoglyacemic episode, while 75.9% were not aware of the self care approach to manage such crisis. Polyuria, 65 (37.4%) was the most commonly cited signal to recognize hyperglyacemic episode. Only 3.4% practice self monitoring of blood glucose. Overall, 47 (26.9%) had a good knowledge and attitude about diabetes. Knowledge, attitude and self management practices among type 2 diabetes patients is low. This knowledge gap about diabetes suggests the need for an institutionalized and effective standard for diabetes self management education so as to ensure improved diabetes care for the patient.Keywords: Type 2 diabetes, knowledge, attitude, self management practices, secondary care facilit

Utilization and Incidence of Adverse Drug Reactions to Artemisinin-Based Combination Therapy Among Pregnant Women in an Ambulatory Care Facility in Southwestern Nigeria

As increasing number of countries in sub-Sahara Africa is changing to artemisinin-based combination therapy (ACT) as first or second line treatment for malaria, hence, post-marketing surveillance of ACT use in vulnerable population is a necessity. This study aimed at evaluating the extent of use and assessing the incidence of adverse reactions to artemisinin-based combination therapy among pregnant women in Ibadan, southwestern Nigeria. A prospective cross-sectional study was conducted at the antenatal clinic of Adeoyo Maternity Hospital in Ibadan, between 15th March and 16th May, 2008. Pre-tested questionnaires were administered to 140 consented pregnant women at the study site. Of these, 134 (95.7%) properly filled questionnaires were subsequently analyzed. Descriptive statistics were used to summarize the data. Chisquare was used for tests of proportions, with p&lt;0.05 considered statistically significant. More than three fourth, 120 (89.6%) of the respondents had malaria in their current pregnancy. Of these, 115 (95.8%) took antimalarial drugs. Of the cohort, 70 (60.9%) took ACT group of antimalarials with 42 (60.0%) of the respondents having their administered ACTs prescribed by physician, 15 (21.4%) took ACTs on recommendation or advice by other healthcare professionals, while 13 (18.6%) took the ACT on selfinitiated basis. Fifteen (21.4%) utilized the ACT during the first trimester. Incidence of experiences of adverse reactions to ACT was generally mild, &lt;10% for most of the reactions. The majority, (75.0%) did not report the reactions to health care practitioners, mostly for reason of tolerability of the adverse reactions (50%). The use of ACT for malaria treatment among pregnant women in Ibadan, is common. Efforts to monitor the use of ACTs among this group of vulnerable population are recommended. Furthermore, institutionalization of a functioning and effective mechanism to increase awareness and improve reporting of adverse effects of ACT generally is also suggested.Keywords: Malaria, artemisinin-based combination therapy, pregnancy, adverse drug reaction, Nigeri