STUDY OF FIXED DOSE COMBINATIONS IN A TERTIARY CARE HOSPITAL

ABSTRACTObjective: To study and analyze the pattern of fixed dose combinations (FDCs) in medicine outpatient clinic.Methods: The study is prospective cross-sectional study was conducted for 2 months in medicine outpatient clinic in tertiary care hospital. Aftertaking approval from Institutional Ethics Committee, the data were collected on every working day of the hospital. Prescriptions from the patientscoming to medicine outpatient clinic outpatient department were taken and required information is filled in data record form.Results: A total of 83 prescriptions were included in the study. Out of 287 drugs, 111, i.e., 39.92% were fixed dose formulations. As per drug categoryanalysis, nutritional supplements were used (47.74%). While 27.02% and 9.03% of FDCs were given for cardiovascular complains and respiratorycomplains, respectively. FDCs used for other conditions were 16.21%. About 29.72% of total FDCs are included in approved list of FDCs by DrugsController General of India (DCGI), November 2014.Conclusion: 39.92% drugs are FDCs out of total prescribed drugs. Nutritional supplements are prescribed in higher concentrations. Out of total FDCsonly 29.72% were included in DCGI approved list of FDCs and only four FDCs are found in the WHO list of essential drugs.Keywords: Fixed dose combinations, Prescriptions, Approved, Drugs Controller General of India

Effects of angiotensin converting enzyme inhibitor: ramipril on different biochemical parameters in essential hypertensive patients

Background: Hypertension is a major risk factor for macrovascular diseases. The beneficial effects of lowering blood pressure on the vascular morbidity and mortality are well documented and demonstrated. The beneficial effects of antihypertensive agents on cardiovascular system can be counter-balanced by the induction of metabolic disorders. The modifications in various metabolic parameters (like lipids, serum electrolytes, uric acid, blood glucose levels, etc) are responsible for different adverse drug reactions of antihypertensive drugs. It might also have potential to produce secondary morbidities after long term use. The present study was designed to evaluate the effect of the commonly used first line antihypertensive drugs on these different biochemical parameters. Recent comparative studies suggest that, for the prevention of cardiovascular events, angiotensin converting enzyme inhibitor (ACEI) may be superior to alternative antihypertensive agents, independently of their antihypertensive effect and also claimed to have neutral or favourable effects on carbohydrate metabolism, lipid profile, uric acid. The metabolic abnormalities can be improved by ACEI. Therefore, this study was conducted to evaluate the effects of ramipril on different biochemical parameters in essential hypertensive patients. Objective was to study effects of six months monodrug therapy with ramipril on different biochemical parameters in essential hypertensive patients.Methods: 30 newly diagnosed patients of either gender with essential hypertension were included in the study. Patients having co-morbidities like diabetes mellitus, hyperlipidemia, gout, pregnant females were excluded from the study. Baseline readings of lipid profile, serum electrolytes, fasting blood sugar and uric acid were recorded before starting ramipril drug therapy. Same biochemical tests were repeated after six months ramipril monodrug treatment.Results: After comparing the means there is significant decrease in triglyceride levels, highly significant decrease in LDL, uric acid, sodium and fasting sugar level and highly significant increase in HDL levels.Conclusions: Ramipril has beneficial effects on RAS (Renin angiotensin system) and kinin system or both may contribute to the improvement in different biochemical parameters by ramipril

A study of prescribing pattern of drugs in patients of cardiovascular emergencies at a tertiary care hospital of Western Maharashtra

Background: The main objective of drug utilization research is to assess the rationality of drug use. Recently it has been found that cardiovascular disease is the most frequent cause of morbidity and mortality throughout the world. The objective of present study was to focus on the trends in prescribing patterns of most frequently treated cardiovascular emergencies.Methods: A retrospective descriptive study was carried out in cardiovascular emergency patients. From the medical records the following data was collected:  Distribution of cardiovascular emergencies (age and sex wise), most common cardiovascular emergencies treated, outcome of each patient, average duration of stay in the hospital and drugs prescribed per patient,  correlation of clinical outcome with treatment if possible, drug utilization trend in cardiovascular emergencies. From the data, master chart was prepared for data analysis.Results: Total 82 patients case records were studied. Myocardial infarction (50%) was the most common cardiovascular emergency treated during study period followed by unstable angina (36.58%).  Male to female ratio was 1.83. Average hospital stay was found 5.75 days. The average number of drugs per patient was 8.4.  Hypertension (42.24%) and diabetes mellitus (19.51%) were the most common comorbidities found associated with cardiovascular emergencies. Aspirin clopidogrel combination (80.49%), enoxaparin (75.61%), atorvastatin (73.17%), glyceryl trinitrate (73.17%) were the most commonly prescribed drugs. The utilization rate of ACE inhibitors and ARBs (56.10%) was found higher than that of beta blockers (28.05%). Stool softeners (52.46%) and anxiolytics (28.58%) were the most commonly used non-cardiovascular drugs. Improvement was seen in 82.93% patients.Conclusions: Protocol of management strategy of cardiovascular emergencies in our tertiary care hospital was found near to standard recommended guidelines. Keywords:

ANTIMICROBIAL UTILIZATION PATTERN OF URINARY TRACT INFECTION IN TERTIARY CARE HOSPITAL

Objective: To study and analyze the pattern of antimicrobial utilization in urinary tract infection (UTI).Methods: A descriptive retrospective study was conducted in tertiary care hospital for 6 months including both male and female patients of all agegroups. Case sheets diagnosed with UTI based on ICD-10 disease coding were collected from medical records department. The demographic dataand prescription pattern of each case sheet were evaluated in detail. Drug utilization pattern was compared among different age groups of patients.Results: A total of 108 patients were included in the study, out of which 44.4% were males, and 55.6% were females. Most of the patients were in40-60 years age group (40.7%). UTI confirmed by culture in 59.26% patients; in which Escherichia coli was isolated in 35.9% patients followedby Klebsiella species (14.06%) and Pseudomonas aeruginosa (7.8%). Cephalosporins (70.37%) were most commonly used antibiotic followed byfluoroquinolones (38.89%), penicillins (29.63%), azithromycin (17.59%), and aminoglycosides (15.74%). Among the cephalosporins, third generationparenteral was most commonly used. In penicillins, amoxicillin + clavulanic acid combination was used in 9 patients. Amikacin was most commonlyused aminoglycoside followed by gentamicin. Mean duration of treatment was 6.28±3.02 days.Conclusion: Third generation cephalosporins (ceftriaxone and cefixime) were used as first line drug in most of the cases irrespective of the causativeorganism. This group should be reserved for complicated UTIs.Keywords: Urinary tract infections, Escherichia coli, Cephalosporins, Fluoroquinolones

Effect of Mirtazapine Pre-treatment on Haloperidol, Ergometrine and Fluoxetine Induced Behaviours in Albino Rats

Background: Central 5-HT2A and 5-HT2C serotonergic receptors are mainly involved in the control of nigrostriatal and mesolimbic dopaminergic neuronal activity has been well proved and established. 5-HT has facilitatory effect on stimulated dopamine release by stimulating central 5-HT2A receptors and inhibitory effect by stimulating 5-HT2C receptors. Aim and Objectives: To evaluate 5-HT2A and 5-HT2C receptor blocking activity of Mirtazapine (MIR) and the effect of mirtazapine pre-treatment on Ergometrine (ERG) induced behaviours, Fluoxetine (FLU) induced penile erections and Haloperidol (HAL) induced catalepsy in rats. Material and Methods: Each group was subdivided into different subgroups consisting 6 animals in each. Control group received Dimethyl Sulfoxide (DMSO) and other groups received different doses of mirtazapine one hour before ERG/FLU/HAL. Values obtained from control group were compared with all remaining groups pre-treatment with different doses of MIR. Results: MIR (MIR) at 2.5, 5, 10 and 20 mg/kg intraperitoneally (i.p) did not produce any per se effects. Pre-treatment with 5, 10 and 20 mg/kg i.p. MIR significantly antagonised ERG induced behaviours. 5 mg/kg i.p. MIR significantly antagonised whereas 10 and 20 mg/kg i.p. MIR abolished FLU (10 mg/kg) induced penile erections in rats. MIR 5 and 20 mg/kg i.p. significantly antagonised HAL (1mg/kg) induced catalepsy at 1 hr testing time interval while 10 and 20 mg/kg MIR significantly antagonised HAL (1 mg/kg) induced catalepsy at 2 hr testing time interval. Conclusion: Our results indicate that MIR at 5, 10 and 20 mg/kg possesses 5-HT2A and 5-HT2C receptors blocking activity. At 5, 10 and 20 mg/kg MIR, by blocking central 5-HT2C receptors predominantly, causes release of dopamine from nigrostriatal dopaminergic neurons and therefore antagonizes HAL induced catalepsy

Effect of parachlorophenylalanine, a specific 5-HT depleter on fluoxetine and d-fenfluramine induced penile erections in rats

Objective: To determine whether fluoxetine (FLU) induces penile erection (PE) in rats either indirectly via its 5-HT neuronal reuptake inhibiting activity or directly by stimulating the 5-HT2c receptors in the brain. Method: The effect of pre-treatment with para-Chlorophenylalanine (PCPA) on fluoxetine and d-fenfluramine (d-FEN) induced PEs (Penile erections) was studied in albino rats. Results: FLU (10mg/kg) and d-FEN (2.5mg/kg) treated groups exhibited a significant increase in number of PEs as compared to their respective control (DW treated) groups. Pre-treatment with PCPA (100mg/kg/day) had no significant effect on the PEs induced by FLU (10mg/kg) but did significantly decrease the PEs induced by d-FEN (2.5 mg/kg). Conclusion: Our results indicate that pre-treatment with selective 5-HT depleter PCPA (100mg/kg/day) significantly decreased PEs induced by d-FEN (2.5mg/kg) but had no significant effect on the number of PEs induced by FLU (10 mg/kg). This indicates that the PE inducing effect of FLU is probably due to the stimulation of 5HT2C receptors

CURRENT PERSPECTIVES ON APPLICATIONS OF NANOPARTICLES FOR CANCER MANAGEMENT

In the realm of cancer diagnostics, imaging and therapeutics, nanocarrier-based drug delivery systems have gained extensive importance owing to their promising attributes and potential to enhance therapeutic effectiveness. The primary area of research revolves around formulating innovative intelligent nanocarriers such as nanoparticles (NPs) which are capable of selectively responding to cancer-specific conditions and efficiently delivering medications to target cells. These nanocarriers, whether operating in a passive or active manner, can transport loaded therapeutic cargos to the tumor site while minimizing drug elimination from the drug delivery systems. This review primarily focuses on presenting recent advancements in the development and utilization of nanoparticles in the treatment of various cancer types, such as pancreatic cancer, prostate cancer, colorectal cancer, cervical cancer, and breast cancer

Antinociceptive Effect of Ondansetron in Albino Mice Using Acetic Acid Induced Writhing Model

Background: Pain is an unpleasant sensory and emotional experience. Pain is a protective mechanism. Pain occurs whenever any tissues are being damaged, and it causes the individual to react and to remove the pain stimulus. Aim and Objectives: To evaluate the antinociceptive effect of ondansetron in comparison with the standard diclofenac. Material and Methods: The antinociceptive effect was tested by using the acetic acid induced writhing model in Swiss Albino mice. Animals were divided into 4 groups of 6 animals each. Animals were received distilled water (control), diclofenac (standard), ondansetron 0.5mg/kg (test I) and ondansetron 1mg/kg (test II). After 30 minutes of drug administration, 0.1 ml of 1% acetic acid was injected. Mice were placed individually into glass beakers and five minutes were allowed to elapse. They were then observed for a period of ten minutes and the numbers of writhes were recorded in each animal. The results were expressed as mean ± SEM. One way ANOVA with post-test was used for statistical calculation. Results: The numbers of writhes were 1.33±0.494 for diclofenac; 6.33±1.872 and 9.33±1.706 for ondansetron 0.5 and 1mg/kg respectively. Conclusion: Ondansetron demonstrated statistical significant antinociceptive activity at both doses (0.5mg/kg and 1mg/kg) and statistically similar effect as diclofena