Current Issue : October - December Volume : 2013 Issue Number : 4 Articles : 7 Articles
Chronic kidney diseases a worldwide public health problem with an increasing incidence, prevalence, poor outcomes and high cost. Inappropriate use of drugs in patients with renal impairment (RI) may therefore be harmful and have deleterious effects. The aim of this study to know the drug use and dosing prescribed for patients with reduced renal function. The objective was to identify the use of renal risk drugs (RRDs) and frequency of drug-related problems (DRPs) in relation to risk rules in RI, establishing the frequency of inappropriate dosing at the time of discharge in accordance with renal function (RF). The prospective study was conducted for a period of 10 months in Rajiv Gandhi Institute of Medical Sciences (RIMS), an 800 bedded tertiary care teaching hospital, Kadapa. A total of 1718 drugs were found to be prescribed for 215 RI patients. Of which 551 were found to be RRDs. 299 (53%) drugs were those that required dosage adjustments, 219 (40%) were drugs to be used with caution and 33 (6%) drugs which were to be avoided. Out of 215 RI patients, 153 patients used 2 or more RRDs and 101 (47 %) had 196 DRPs. Around 26% of the RRDs associated with at least 1 DRPs regard to RF. DRPs were often associated with drugs which are to be avoided. The common drug classes used in RI patients linked to DRPs were Anti-bacterial’s (n=52), ACE inhibitors (n=26), oral hypoglycaemic drugs (n=15), allopurinol (n=12), ranitidine (n=9), aspirin (n=8) and atenolol (n=4). A clinical pharmacist role in a nephrology unit is a valuable asset in monitoring all drug related problems (contraindicated drugs and inadequate dosages), which results in optimization of pharmaceutical care in renal impaired patients....
Selective Serotonin Reuptake Inhibitors (SSRIs) represent the most widely used medications in clinical practice, especially who were diagnosed with depression and other heterogeneous mood and anxiety disorders. During the next two decades, the incidence of psychiatric diseases in the general population will progressively increase. Due to this reason, the prescribing pattern of Selective serotonin reuptake inhibitors (SSRIs) may further increase in future. Among the anti depressant classes SSRI’s are the most commonly prescribed anti depressant drugs when compared to other anti depressants because of their favourable safety profile. Serotonin has a role in control of the intra ocular pressure. Evidences were showing that in patients receiving SSRIs intraocular modifications were observed. In Indian scenario, literature regarding elevated intraocular pressure due to SSRIs was not up to the mark and by this study we made an attempt to observe the modifications in the intra ocular pressure in subjects who were under treatment with SSRIs. The main aim of our study is to observe the changes in the intra ocular pressure of the individuals who were under treatment with SSRIs for the first time and also observation of possible changes in the field of vision. For measuring the intraocular pressure, Goldman applantation tonometer and for testing the field of vision, Humphrey perimetry were used. Significant changes were observed in the intraocular pressure of the right eye in the 1st week (p=0.02) and in the intraocular pressure of left eye at 12th week (p=0.03). No significant changes were observed in case of field of vision. To avoid further and more hazardous ocular side effects we have to advice the patient to consult an ophthalmologist before starting SSRIs, if he/she is having ascertained glaucomatous risk factors such as gender, race, history of glaucoma, mid or high hyperopia, cataract, in the family....
To assess the impact of pharmacist providing patient counseling in bringing therapeutic outcomes and Quality of life (QOL) improvement in Type II Diabetes Mellitus (DM) patients. A prospective observational study was conducted for a period of 10 months from July 2011 to April 2012 at Rajiv Gandhi Institute of Medical Sciences (RIMS), a tertiary care teaching hospital, Kadapa. A total of 125 patients with Type II DM were assigned into 3 groups. They were received basic diabetic counselling (regarding disease, medication and life style modifications) for 3 months at each visit. RBS, FBS, PPBS, TC, TG, HDL, LDL and the effects of mono, double and triple combination therapies were measured at baseline and at the end of the study. QOL was assessed by the using the KAP questionnaire and SF 12. Significant reductions were found in FBS (228±10.5 to 140±5.6), RBS (350±25.5 to 203±10.6), PPBS (250±20.5 to 143±10.3) and also greater reductions were observed in TC, TG, HDL, LDL levels in all the groups after the counseling. Dramatic improvement in patient’s QOL was found. The study concluded that chronic diseases like DM affect the QOL of patients so the pharmacist providing patient counseling has a major impact in improving the health care outcomes like glycemic control and QOL....
The present study was to analyze the prescribing pattern of drugs in lactating women. A Prospective observational study was conducted in department of Obstetrics at 800 bedded multi-disciplinary tertiary care teaching hospital, Kadapa, A.P. 90 lactating women were followed during their hospital stay and the drug effects on neonates were observed. 452 drugs prescribed to lactating women were classified based on WHO, UNICEF classification and the prescribing frequency of drugs was studied based on Pharmacological class. Majority of the drugs prescribed are safer, compatible with breast feeding such as minerals, vitamins followed by antibiotics. Pharmacist should play an important role in surveillance program, should collect extensive information on drugs safety and its effects and provide the information to prescribers....
To evaluate the occurrence of Adverse Drug Reactions (ADRs) in the children who are hospitalized, the follow-up processes resulting from it and to evaluate the reporting of ADRs by health care professionals. The occurrence of ADRs among hospitalized children has not been well established. As the clinical trials involving neonates, infants and children are absent or limited, the safety and tolerability of drugs are not well established among them hence the pharmacological actions of drugs are not similar to those identified for adults. A prospective observational study was conducted between June 2012 and March 2013 at Rajiv Gandhi Institute of Medical sciences (RIMS) an 800 bedded tertiary care teaching hospital, Kadapa. A total of 109 ADRs were identified. The most of the ADRs were mild (54.12%), severe were least (12.85%) and the moderate were between them (20.2%). Maximum of ADRs (89.91%, n-98) identified were predictable and least (10.09%, n-11) were non-predictable. Highest incidence is of GI effects (22.02%) and the lowest is of tinnitus (0.91%). ADRs rated high in severity resulted from anticonvulsants (phenobarbitone), lowest resulted from Anti-malarials (Artemether). Mortality rate was restricted to 1.83% (n-2). Maximum ADRs were reported by pharmacists (89%), and least by patient representatives (2%). Measurements to be undertaken for the improvement of the detection and reporting of adverse drug reactions by all health care professionals, to enhance the impact of understand¬ing these reactions in children and to promote the safe use of drugs in the pediatric patients....
Asthma is a chronic pulmonary disease effecting and causing death of many people in india so to reduce death rate due to asthma effective medication therapy management should be done to reduce asthma symptoms and attacks like shortness of breath. Patients with comorbid diseases are also suffering a lot due to improper medication management. A prospective study was conducted in RIMS a tertiary care teaching hospital in inpatient units’ for Management of medication in asthmatics by clinical pharmacist to reduce asthma attacks and symptoms to improve life span in a tertiary care teaching hospital. A total of 122 asthmatic patients were selected and medication therapy management was done. Results showed most patients 105(86.06%) were admitted in hospital due to Bronchial Asthma and some of them 17(13.93%) were not related to Asthma but they have past history of Bronchial Asthma. Majority of patients are on Polypharmacy (43), secondary at least 3 drug therapy (41), thirdly 2 drug therapy (29) and only (9) were on monotherapy. Majority of patients had severe asthma 50.82 (50.82%) and least had mild asthma 10.66 (10.66%). Tablets (54) were found to be effective than Inhalers (24) in asthmatics. Polypharmacy was absorbed in the age group of 56-65 due to comorbid diseases. This study concludes effective medication therapy in asthmatics is combination therapy like poly pharmacy for better relief of asthma attacks, symptoms and improves lifespan in asthmatics....
To study types, pattern and distribution of headache associated with depression and its effect on daily activity. Selected 50 patients who had diagnosed on DSM-IV-TR & ICD-10 criteria for depression and had >9 score on HAMD. The structured questionnaire applied to investigate types, patterns and distribution, daily work loss and associated somatic symptoms. The most common pattern of distribution of headache is bilateral temporal (40%) followed by whole scalp and unilateral. The mode of onset is sudden (86%) , pulsatile (98%) due to poor early recognition of headache in low socio economic group. It is only recognized when pulsation begins after enough accumulation of toxic metabolites (trigemino vascular system). Headache affects daily activity; most common duration of work loss is 1-3 hours and least 2-3 days due to episodic nature of headache. Band like headache is the initial features of headache in depression but it is less reported seen only in 2% Most of the presentation are .Pulsatile Headache and migraine in 26% .These were late and waited till the conversion of band like (less recognizable ) into pulsatile headache ( more recognizable ). The different types of headache migraine, tension headache and cluster headache have same genesis pathways shared by depression or has bidirectional effect. Depression was an accidental finding for which they did not come to clinic .Depression remains as an iceberg....
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