The role of a pharmacist in pharmacovigilance system

Introduction: Although they represent an important mediator between patients and National Pharmacovigilance Centre, pharmacists still don't participate enough in system of reporting adverse drug reactions (ADR). By reporting ADR both quality of therapy and quality of patient's life are improving, and pharmaceutical industry is also encouraged to invent and produce new formulations which will be better beared and whose use will significantly improve risk-benefi t ratio. Aim: The aim of this work is that by collecting information about ADRs, based on direct contact of a pharmacist and patients, explain and improve the role of a pharmacist in pharmacovigilance system. Subjects and Methods: Information about adverse reactions were being collected in three private pharmacies in Inđija and in one private pharmacy in Sombor. In period from 20.12.2017.-10.01.2018. pharmacists collected data about adverse reactions of medicines. In period from 11.01.-01.02.2018. patients were additionally informed about unexpected and adverse drug reactions. The standard form for reporting an adverse reaction, which was taken from the site of Medicines and Medical Devices Agency of Serbia (ALIMS), was fi lled for each reported case and sent to National Pharmacovigilance Center (NPC). Suspect drugs were classified in categories according to Anatomical-Therapeutic-Chemical classification (ATC). Results: In first period, there were 19 reported reactions. After additional information given to patients, there were 33 reported adverse reactions. The most numerous adverse drug reactions were reported for the group of cardiovascular drugs (32.7%), the group of anti-infective drugs with systemic effects (15.4%) and for group of drugs which affect nervous system (13.5%). After analyzing reported reactions, according to NPC all of reactions were expected (52), but 3 of them fulfilled criteria of seriousness. Conclusions: Thanks to additional information and direct communication between a pharmacist and patients, reporting unexpected and adverse drug reactions is significantly improving

Drugs with the highest drug expenditure in the Republic of Serbia

Introduction: The policy concerning drugs represents a concentrated effort to achieve better health outcomes for all, with a particular focus on people's access to and rational use of medications. On the basis of pharmacoeconomic analyses, it is possible to modify established prescribing habits, it is possible to influence the creation of guidelines, development strategy and long-term health care planning. Aim: The aim of the work was to determine drugs with the highest expenditure in the Republic of Serbia, and to compare the results obtained in three consecutive years 2016, 2017 and 2018. Also, to analyze which are the most expensive medications listed in the National Register of Medications and what is the trend of changing them. Material and methods: The drug expenditure was monitored using the ATC/DDD methodology. It implies the classification of medications according to the internationally accepted ATC classification of drugs, while DDD, i.e. defined daily dose, is used as a statistical unit for consumption monitoring. The number of DDD/1,000 inhabitants per day provides an insight into how many inhabitants (out of 1,000 of them) used the observed medication and were exposed to its effects during one day. Results: The trend of expenditure of these medications was growing exponentially from 2016 to 2018. The most expensive medications per box are from group J - anti-infective drugs for systemic use and L - antineoplastics and immunomodulators, but their expenditure in the Republic of Serbia is very low. The drugs with the highest price per 1 DDD are: enzymes imiglucerase, laronidase and the biological medication basiliximab in all three years, but considering the indications and rare prescribing, the total cost for these drugs is not high. The largest funds in the Republic of Serbia for the mentioned period were spent on drugs such as: acetylsalicylic acid, paracetamol in combinations, trastuzumab, pantoprazole, amlodipine and rosuvastatin. Comparing the spending on L group of drugs in 2017 compared to 2016, there was a significant increase. Conclusion: The medications with the highest expenditure in the Republic of Serbia are used very little compared to countries with good pharmacotherapy practice. The most expensive drugs are those that are used for special and rare indications, and large amounts of money are not allocated for them as for some cheaper, but more frequently prescribed drugs

Pharmacy students’ knowledge and attitudes regarding cannabis for medical purposes

Introduction: With the growing trend for legalization of cannabis and its derivatives in Serbia, pharmacists are likely to be consulted on the safety, efficacy, and drug-drug or drug-disease interactions of medical cannabis. Thus, the aim of our study was to assess pharmacy students’ knowledge and attitude toward medical cannabis use in Serbia to determine if additional education is needed. Subjects and methods: In the study students from the final year of the study program of integrated academic studies of pharmacy at the Faculty of Medicine, University of Novi Sad were asked to complete an anonymous questionnaire regarding their knowledge and attitudes on the use of cannabis and its derivatives in medical purposes. After giving their written informed consent, they were instructed by the researchers on how to complete the questionnaire. All questionnaires were administered between August 1, 2017 and August 15, 2017. The study was approved by the Ethical Committee of the Faculty of Medicine in Novi Sad; a total of 80 questionnaires were distributed. The questionnaire consisted of 3 groups of statements on which they should mark level of their agreement related to students’ knowledge about the use of cannabis and its derivatives in therapeutical purposes, potential negative effects, dispensing in a pharmacy and legalization of cannabis and its derivatives in medical purposes. Results: Although 91.2% of the respondents agreed that cannabis and its derivatives could potentially have therapeutical effects, much lower percentage of respondents (51.3%) were familiar with possible therapeutical effects of cannabis. The same percentage of respondents learned about therapeutical effects of cannabis from sources other than school. About third (31.3%) of our respondents thought that the use of cannabis and its derivatives in therapeutical purposes could cause their abuse and the similar percentage of respondents (33.8%) thought that issuing cannabis and its derivatives in the pharmacy could expose a pharmacist to the certain dangers such as insisting on the issuing without the prescription or robbery. About 90% of the respondents agreed it is necessary to create clear guidelines for the use of cannabis and its derivatives in therapeutical purposes and 76.3% of the respondents thought that doctor’s prescription is necessary for their dispensing in a pharmacy. Most of the respondents (75%) agreed that, based on the experiences of the countries which have approved the use of cannabis and its derivatives in therapeutical purposes, its use in those purposes should be approved in Serbia. Conclusion: The majority of pharmacy students supported medical cannabis legalization but only with strict legal regulations and clear guidelines for their use implemented. Further education of the pharmacist about therapeutical effect of cannabis is necessary