Current Issue : October - December Volume : 2011 Issue Number : 4 Articles : 11 Articles
The purpose of writing this review on medication adherence in asthma and copd: was to compile the recent literature with special focus on role of pharmacist on medication adherence in asthma and copd. Patient adherence can be defined as the extent to which a person’s behavior coincides with health related advice and ability of the patient to attend clinic appointments as scheduled, take medications as prescribed, make possible life style changes and complete recommended investigations. Adherence to pharmacologic therapy has been reported to be low among patients with Chronic Obstructive Pulmonary Disease (COPD) and related to poor prognosis. Currently, little is known about the extent and management of adherence problems among patients with chronic bronchitis and emphysema..In chronic airflow obstruction different classes of drugs are often used in combination, and in regimens requiring multiple daily doses of each agent. The resulting dosage schedules are often extremely complex. It has been considered that complex treatment regimens should result in poor compliance. Pharmacists may be able to enhance patients’ compliance and outcomes by engaging in pharmaceutical care activities monitoring symptoms, providing medication counseling, helping resolve drug-related problems, facilitating communication with physicians. Pharmacists with their knowledge, irrespective of their working place either in hospital/community; can employ their technique in educating the patients, enhancing adherence, medication knowledge assessment and counseling to overcome the problem....
Background\r\nHerb-drug interactions are an important issue in drug safety and clinical practice. The aim of this epidemiological study was to characterize associations of clinical outcomes with concomitant herbal and antipsychotic use in patients with schizophrenia.\r\nMethods and Findings\r\nIn this retrospective, cross-sectional study, 1795 patients with schizophrenia who were randomly selected from 17 psychiatric hospitals in China were interviewed face-to-face using a structured questionnaire. Association analyses were conducted to examine correlates between Chinese medicine (CM) use and demographic, clinical variables, antipsychotic medication mode, and clinical outcomes. The prevalence of concomitant CM and antipsychotic treatment was 36.4% [95% confidence interval (95% CI) 34.2%ââ?¬â??38.6%]. Patients using concomitant CM had a significantly greater chance of improved outcomes than non-CM use (61.1% vs. 34.3%, OR = 3.44, 95% CI 2.80ââ?¬â??4.24). However, a small but significant number of patients treated concomitantly with CM had a greater risk of developing worse outcomes (7.2% vs. 4.4%, OR = 2.06, 95% CI 2.06ââ?¬â??4.83). Significant predictors for concomitant CM treatment-associated outcomes were residence in urban areas, paranoid psychosis, and exceeding 3 months of CM use. Herbal medicine regimens containing Radix Bupleuri, Fructus Gardenia, Fructus Schisandrae, Radix Rehmanniae, Akebia Caulis, and Semen Plantaginis in concomitant use with quetiapine, clozapine, and olanzepine were associated with nearly 60% of the risk of adverse outcomes.\r\nConclusions\r\nConcomitant herbal and antipsychotic treatment could produce either beneficial or adverse clinical effects in schizophrenic population. Potential herb-drug pharmacokinetic interactions need to be further evaluated....
Background\r\nIn the elderly in Scandinavia, multi-dose drug dispensing (MDD) is a common alternative to ordinary prescriptions (OP). MDD patients receive their drugs in unit bags, one for each dose occasion. The prescribing procedure differs between MDD and OP. The aim of the present study was to investigate the association between MDD and quality of drug treatment (QDT).\r\nMethodology/Principal Findings\r\nA cross-sectional study was performed of all inhabitants in Region VÃ?¤stra GÃ?¶taland alive on December 31st 2007, aged =65 years, with =1 prescribed drug and =2 health care visits for =2 diagnoses for obstructive pulmonary disease, diabetes mellitus, and/or cardiovascular disease in 2005ââ?¬â??2007 (n = 24,146). For each patient, drug treatment on December 31st 2007 was estimated from drugs registered in the Swedish Prescribed Drug Register. QDT was evaluated according to established quality indicators (=10 drugs, Long-acting benzodiazepines, Drugs with anticholinergic action, =3 psychotropics, and Drugs combinations that should be avoided). Logistic regression, with adjustments for age, sex, burden of disease, and residence, was performed to investigate the association between MDD and QDT. Mean age was 77 years, 51% were females, and 20% used MDD. For all quality indicators, the proportion of patients with poor QDT was greater in patients with MDD than in patients with OP (all P<0.0001). Unadjusted and adjusted odds ratios (95% confidence intervals) for poor QDT (MDD patients vs. OP patients) ranged from 1.47 (1.30ââ?¬â??1.65) to 7.08 (6.30ââ?¬â??7.96) and from 1.36 (1.18ââ?¬â??1.57) to 5.48 (4.76ââ?¬â??6.30), respectively.\r\nConclusions/Significance\r\nPatients with MDD have poorer QDT than patients with OP. This cannot be explained by differences in age, sex, burden of disease, or residence. These findings must be taken into account when designing alternative prescribing systems. Further research is needed to evaluate causative factors and if the findings also apply to other dose dispensing systems....
Neuropathic pain is characterized by diabetic neuropathic peripheral pain (5) (24) and attack of herpes zoster following neuralgia (28). Pregabalin is the first drug of its kind used to treat diabetic neuralgia and post-herpatic neuralgia conserning with neuropathic pain. Pregabalin is also used to treat neuropathic pain, Fibromyalgia and Generalized Anxiety Disorders (GAD), a disorder characterized by a chronic illness impacting a person’s well-being and mental functioning ability (5). Clinical trials have shown that pregabalin has efficacy similar to the benzodiazepines and venlafaxine (4). Also it has been shown activity as anxiolytic, and sleep-modulating activities. Irritable bowel syndrome (IBS) is visceral hypersensitivity complex disorder that is having multiple characteristics and identified by abdominal pain and altered bowel habit, and often and mainly associated with other gastrointestinal symptoms, these symptoms include feelings of incomplete bowel movement and abdominal bloating, and extra-intestinal symptoms such as headache, dyspareunia, heartburn, muscle pain, and back pain(3). Pregabalin has anti-hyperalgesia properties similar to gabapentin since it is structurally similar to it. It is successfully used for peripheral neuropathic pain and for partial seizures. Gabapentin is used to treat chronic pain states and behavioral disorders and pregabalin was developed to alter and increase the pharmacological activity of gabapentin (17). This review article has been put on to focus the pharmacological activity of pregabalin and how this anti-epileptic drug is having multi-modal and quick onset of the pharmacological action with delayed potential in all of the disorder for which it is recommended....
Introduction. The safety of vitamin K antagonists (VKA) use can be compromised by many popular herbal supplements taken by individuals. The literature reports that 30% of warfarin-treated patients self-medicates with herbs. Possible interactions represent an health risk. We aimed to identify all herbs-oral anticoagulants interactions collected in the Italian database of suspected adverse reactions to ââ?¬Å?natural healthââ?¬Â products. Methods. The Italian database of spontaneous reports of suspected adverse reactions to natural products was analyzed to address herb-VKAs interactions. Results. From 2002 to 2009, we identified 12 reports with 7 cases of INR reduction in patients treated with warfarin (n = 3) and acenocoumarol (n = 4), and 5 cases of INR increase (all warfarin associated). It was reported 8 different herbal products as possibly interacting. Discussion. Our study confirms the risk of interactions, highlighting the difficulty to characterize them and their mechanisms and, finally, prevent their onset. The reported data underline the urgent need of healthcare providers being aware of the possible interaction between natural products and VKA, also because of the critical clinical conditions affecting patients. This is the first step to have the best approach to understand possible INR alterations linked to herb-VKA interaction and to rightly educate patients in treatment with VKA....
Antibiotics are chemical substances, either produced naturally by microorganisms or manufactured synthetically, that are lethal to other microorganisms. Antibiotic resistance (AR) describes the ability of a microorganism to be unaffected by (or resistant to) the effects of a particular antibiotic.The issue of antibiotic misuse is of global concern because of the spreading and developing resistance of most common bacteria to most inexpensive generic antibiotics. Antibiotic resistance now has been universally identified as public health priority and necessary plan of action to combat resistance should be developed....
Antibiotic resistance is one of the major public health problems today’s the word face. This denotes increased tolerance of a bacteria or specific type of bacteria against specific types of antibiotics. Frequency of antibiotic resistance is increased for all major classes of antibiotics which are used to treat a wide range of infectious disease. In under developed countries and developing countries like India, this resistance is a burning issue because of irrational practice of antibiotic use. Pharmacists have a responsibility to impart a war against infections and antibiotic resistance. The recognition of pharmacists as key members of infectious diseases control teams in health systems is a milestone in antibiotic pharmacy practice. Proper framing of antibiotic usage guidelines, awareness and adequate training programmes for public and health professionals are inevitable to counteract this ice-berg problem for survival of human race....
In the past, much of the pharmaceutical waste occurring at a pharmacy was due to expired pharmaceuticals. Actually in practice there are number of other factors also responsible for waste generation in pharmaceutical industry. The current Good Manufacturing Practice (cGMP) and effluent emission (use and disposal) regulations of the U.S. Food and Drug Administration (FDA) and manufacturing effluent discharge, emission regulations of the U.S. Environmental Protection Agency (U.S. EPA) and ministry of environment protection of India require contained manufacture, use, and disposal of pharmaceuticals with the goal of minimizing the release of pharmaceutical chemicals into the environment. The presented review is focused on waste generation procedures and minimization efforts, procedure to dispose of different kinds of wastes in pharmaceutical industry....
Pharmacovigilance is the pharmacological science and activities relating to the detection, assessment, understanding and prevention of adverse drug effects or any other drug related problem according to World Helth Organization (WHO). It is concered with the post marketing surveillance of medicines and the use of the information generated for education and effective drug regulation. Spontaneous (voluntary) ADR reporting contributes significantly to successful pharmacovigilance. ADR – databases obtained from these reporting is enormously significant in ascertainment of the benefit-risk ratio of some drugs as well as in singal detection of unsuspected and unusual ADRs previously undetected in initial evaluation of drug. This information may be useful in identifying and minimizing preventable ADRs more efficiently. At the same time proper ADR database contributes a lot in withdrawal of harmful drugs from the market. Under reprting however remains a major draw-back of spontaneous reporting. A reason for under reporting includes lack of knowledge, awareness and training. Good ADR-database can be generated by encouraging the doctors for spontaneous reporting. Hence, every country needs an effectively functioning pharmacovigilance programme and knowledge about the programme in health professional. Pharmacovigilance are highly approached by developed country like USA& UK. In the present rieview we discuss various pharmacovigilance system like Med Watch, Yellow Card, PSUR etc. Here also discuss pharmacpvigilance scenario in India. Pharmacovigilance is also important factor in clinical trial. In upcoming year pharmacovigilance is need based strategies to established safety concern of drugs....
Background\r\nDementia is a major and increasing health problem worldwide. This study aims to investigate dementia treatment strategies among physicians specialised in complementary and alternative medicine (CAM) by analysing prescribing patterns and comparing them to current treatment guidelines in Germany.\r\nMethods\r\nTwenty-two primary care physicians in Germany participated in this prospective, multicentre observational study. Prescriptions and diagnoses were reported for each consecutive patient. Data were included if patients had at least one diagnosis of dementia according to the 10th revision of the International Classification of Diseases during the study period. Multiple logistic regression was used to determine factors associated with a prescription of any anti-dementia drug including Ginkgo biloba.\r\nResults\r\nDuring the 5-year study period (2004-2008), 577 patients with dementia were included (median age: 81 years (IQR: 74-87); 69% female). Dementia was classified as unspecified dementia (57.2%), vascular dementia (25.1%), dementia in Alzheimer's disease (10.4%), and dementia in Parkinson's disease (7.3%). The prevalence of anti-dementia drugs was 25.6%. The phytopharmaceutical Ginkgo biloba was the most frequently prescribed anti-dementia drug overall (67.6% of all) followed by cholinesterase inhibitors (17.6%). The adjusted odds ratio (AOR) for receiving any anti-dementia drug was greater than 1 for neurologists (AOR = 2.34; CI: 1.59-3.47), the diagnosis of Alzheimer's disease (AOR = 3.28; CI: 1.96-5.50), neuroleptic therapy (AOR = 1.87; CI: 1.22-2.88), co-morbidities hypertension (AOR = 2.03; CI: 1.41-2.90), and heart failure (AOR = 4.85; CI: 3.42-6.88). The chance for a prescription of any anti-dementia drug decreased with the diagnosis of vascular dementia (AOR = 0.64; CI: 0.43-0.95) and diabetes mellitus (AOR = 0.55; CI: 0.36-0.86). The prescription of Ginkgo biloba was associated with sex (female: AOR = 0.41; CI: 0.19-0.89), patient age (AOR = 1.06; CI: 1.02-1.10), treatment by a neurologist (AOR = 0.09; CI: 0.03-0.23), and the diagnosis of Alzheimer's disease (AOR = 0.07; CI: 0.04-0.16).\r\nConclusions\r\nThis study provides a comprehensive analysis of everyday practice for treatment of dementia in primary care in physicians with a focus on CAM. The prescribing frequency for anti-dementia drugs is equivalent to those found in other German studies, while the administration of Ginkgo biloba is significantly higher....
Background\r\nAdherence to pharmacological therapy is a complex and multi-factorial issue that can substantially alter the outcome of treatment. It has been shown that cancer patients, especially when using long-term medication, have similar adherence rates to those of patients with other diseases. The consequences of poor adherence are poor health outcomes and increased health care costs. Only few studies have focused on the use of oral anticancer agents in daily practice. Information about the reasons for non-adherence is essential for the development of interventions that may increase adherence. This paper presents the CAPER-erlotinib protocol, which is designed to study the relationship between adherence to erlotinib and both the plasma concentration and side-effects in patients with NSCLC. Further, the relationships between patient characteristics, disease characteristics, side-effects, quality of life, patient beliefs and attitude towards disease and medication, dose adjustments, reasons for discontinuation and plasma concentration of erlotinib will be explored.\r\nMethods/Design\r\nIn this prospective observational cohort study 65 NSCLC patients of 18 years or older starting treatment with erlotinib will be followed for a period up to 16 weeks. The main study parameters are adherence, the plasma concentration of erlotinib and the number and grade of side-effects. At baseline and on erlotinib treatment in weeks 3-4, 8-9, 12 and 15-16, patients will be asked to fill out a questionnaire. In weeks 3-4, 8-9 and 15-16 blood samples are collected, which will be analysed for plasma concentration of erlotinib. Adherence will be measured using a medication event monitoring system.\r\nDiscussion\r\nThe present study aims to get more insight into patients' experiences with the use of erlotinib in daily practice and the various aspects that govern adherence. We hypothesize that side-effects play an important role in the way patients use erlotinib. We expect that the present study will provide valuable knowledge which will be useful for health care professionals to develop interventions to support patients. This approach will improve the adherence and persistence with the use of erlotinib in order to derive optimal benefit from the medication....
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