Betul Okuyan

Assessment of medication knowledge and adherence among patients under oral chronic medication treatment in community pharmacy settings

This study aimed to determine whether there is a relationship between the lack of medication knowledge and the self‐reported rates of patient medication adherence.

Adverse drug reactions due to drug-drug interactions with proton pump inhibitors: assessment of systematic reviews with AMSTAR method.

ABSTRACT Introduction: Many systematic reviews resulted in claims on drug-drug interactions (DDIs) with proton pump inhibitors (PPIs). Such a large number begs for consensus on the clinical significance of findings. Areas covered: We critically evaluated the safety of PPI use with respect to DDIs with a meta-review of systematic reviews published between 1978 and 2015. We assessed the evidence by their reliability, repeatability, transparency, and objectivity according to the Assessment of Multiple Systematic Reviews (AMSTAR) criteria. Expert opinion: Clinicians must assess risks for each PPI for certain comorbid conditions. DDIs don’t substantiate class effect for PPIs; each PPI could induce unique DDIs. Concomitant use of PPIs with thienopyridines (e.g. clopidogrel) could be justified in patients without strong affinity to cytochrome CYP2C19 and with high risk of bleeding (e.g. patients with prior upper gastrointestinal bleeding, Helicobacter pylori infection, advanced age, steroid treatment, and nonsteroidal anti-inflammatory drug use). DDIs could occur in an AIDS subpopulation treated with highly active antiretroviral therapy (HAART). DDIs exist for cancer patients undergoing targeted therapy. Hypomagnesemia could increase in the setting of advanced age and polypharmacy. Omeprazole poses high risks owing to its pharmacokinetic DDI profile. Future systematic reviews should incorporate these additional risks for better clinical guidance

Comparison of the protective effects of various antiulcer agents alone or in combination on indomethacin-induced gastric ulcers in rats.

The aim of this study which was structured with the objective of determination of the optimum protective therapy against the long term NSAID therapy-induced ulcers was to compare the gastro-protective effects of various antiulcer drugs (ranitidine, omeprazole, bismuth and misoprostol) alone or in combination with each other in different doses on indomethacin-induced gastric ulcers in rats. In this experimental study the protective effect of misoprostol (100 μg/kg/day and 10 μg/kg/day i.g.), omeprazole (5 mg/kg/day and 1.5 mg/kg/day i.p.), ranitidine (40 mg/kg/day and 10 mg/kg/day i.p.), bismuth (70 mg/kg/day and 15 mg/kg/day i.g.), combinations of misoprostol (10 μg/kg/day i.g.) plus omeprazole (1.5mg/kg/day i.p.) and misoprostol (10 μg/kg/day i.g.) plus ranitidine (10 mg/kg/day i.p.) are investigated on indomethacin (50 mg/kg/day s.c.) induced gastric ulcers. Half an hour before indomethacin administration, each group received the above treatment regimens for 5 days. After 5-day treatment, the rats were sacrificed and histopathological and hematological examinations were performed. The following regimens were found to be effective in the prevention of indomethacin-induced gastric lesions: 100 μg/kg misoprostol, 10 μg/kg misoprostol, 5mg/kg omeprazole, combination of 10 μg/kg misoprostol plus 1.5 mg/kg omeprazole and 10 μg/kg misoprostol plus 10 mg/kg ranitidine. The prevention rates achieved by these treatments were 71.4%, 50%, 47.6%, 52.4% and 50%, respectively. As a result of this study, misoprostol and omeprazol were found to be effective in protection against NSAID-induced gastric problems; while, ranitidine and bismuth were not. Also, the combinations of these agents were not found to have additive or synergistic effects.

Protective effect of ferulic acid on cisplatin induced nephrotoxicity in rats

This study aims to determine the potential protective effects of ferulic acid against cisplatin-induced nephrotoxicity and to compare its effect with curcumin, a well-known protective agent against cisplatin- induced toxicity in rats. Administration of cisplatin resulted in high BUN (Blood Urea Nitrogen), creatinine, MDA (Malondialdehyde), MPO (Myeloperoxidase), TOS (Total Oxidative Status), PtNT (Protein Nitrotyrosine) levels (p<0.05). Histological observations showed abnormal morphology of kidney; in addition with appearance of TUNEL positive cells indicating apoptosis in cisplatin administered group. HO-1 (Heme Oxygenase-1) levels measured by RT-PCR (Real Time Polymerase Chain Reaction), and TAS (Total Antioxidative Status) revealed antioxidant depletion due to cisplatin toxicity in animals (p<0.05). All parameters showed improvement in groups treated with ferulic acid (p<0.05). Ferulic acid treatment was found significant in preventing oxidative stress, increasing antioxidative status and regaining histological parameters to normal, indicating nephroprotective and antioxidant effects of this phenolic compound.

Turkish pharmacy technicians' counseling practices and attitudes regarding emergency contraceptive pills

Supplying emergency contraception pills through community pharmacies without the need for a doctor’s prescription is an important public health role for the pharmacy staff, as a way of reducing unwanted pregnancies and induced abortions. Therefore, we aimed to assess the Turkish pharmacy technicians’ counseling practices and attitudes regarding emergency contraception pills. A survey tool which was structured to question pharmacy technicians’ demography, professional experience, counseling practices and attitudes regarding emergency contraception pills was administered to pharmacy technicians at the end of the “pharmacy technician certification program”. The fully completed questionnaires (n=145) were further analyzed. Mean [SEM] age of the pharmacy technicians was 25.3 [0.4] years and majority (89%) of them were practicing in a community pharmacy. Despite their positive attitude towards the emergency contraception pills, pharmacy technicians were found to provide insufficient emergency contraception pill counseling to clients. We suggest that organization of continuing education programs on “reproductive and sexual health and emergency contraception” for the pharmacy technicians could help increase the quality of emergency contraception pill counseling provided by the pharmacy technicians.

Erratum to and corrections on the article entitled "Assessment of medication knowledge and adherence among patients under oral chronic medication treatment in community pharmacy settings".

The mean duration of medication utilization was 26.77 40.62months (range = 3–504months). In the four-item (Morisky, Green, and Levine) adherence scale,2 although scale questions have been incorrectly scored in the published article, the content of the items have been preserved. The following questions were asked, “Do you ever forget to take your medicine?”, “Are you careless at times about taking your medicine?”, “When you feel better do you sometimes stop taking your medicine?”, and “Sometimes if you feel worse when you take the medicine, do you stop taking it?”.2 Patients with a total score ≥4 on the medicationtaking knowledge questionnaire was classified as “high medication knowledge.” The relevant statistics about the medication knowledge questionnaire in the result section of the original paper has been done according to this classification. This cut-off was particularly selected because of the total medication knowledge score calculated out of seven in the original paper. In the original paper, the mean medication knowledge scores for female and male gender were 3.95 0.07 and 4.17 0.08, respectively (p< 0.05) Table 2. The following corrections have been used in scoring the medication adherence scale: “Each question was scored as 0 for ‘yes’ and 1 for ‘no’. The total score ranged from 0 to 4, representing low adherence to high adherence.2” The newly calculated values are shown as median in Table 1. We consulted a statistician who identified a better method to improve our study. We applied this positive criticism to our study and updated our conclusion as follows:

Evaluation of rational antibiotic dispensing in the community pharmacy setting: a simulated patient study

The irrational utilization of antibiotics is still a serious global problem which, if one takes into consideration the magnitude of antibiotic resistance, threatens both public health and the economy. In Turkey, the high rate of irrational antibiotic dispensing is a well-recognized fact that has existed for many years in the community pharmacy setting. In Turkey today, it is illegal to dispense antibiotics without prescription. Since 2014, the control of antibiotic dispensing has increased in the community pharmacy setting. However, it is more common to use simulated patient techniques to control antibiotic dispensing in countries in which the rate of antibiotics being dispensed without prescription is high.1-3 ABSTRACT

The effect of topical ethanol extract of Cotinus coggygria Scop. on cutaneous wound healing in rats

The aim of this study is to determine the cutaneous wound healing effects of the ethanol extract of Cotinus coggygria leaves in rats by excision wound model to provide scientific evidence for the traditional use of C. coggygria Scop. The levels of malondialdehyde, catalase, superoxide dismutase, glutathione and hydroxyproline were investigated in wound tissues. Histopathological examination was also performed. The hydroxyproline content of the granulation tissue and the glutathione levels were both significantly higher in the treatment group than in the control group (p < 0.05 for both); while the malondialdehyde levels were significantly lower in the treatment group (p < 0.05). These results were supported with histological results. The ethanol extract of C. coggygria Scop could be considered as an effective agent in wound healing in accordance with its traditional use.

The effect of pharmacist-led education on inhaler use skills in hospitalised patients with chronic obstructive pulmonary disease

Objective To assess patient inhalation skills and the effect of pharmacist-led education on these skills in chronic obstructive pulmonary disease (COPD) patients using inhalers in a hospital setting. Methods Pre- and 1 month post-intervention were evaluated by scoring essential steps during inhaler use for each inhaler device. Results 41 patients participated in the study (mean age 64.36±11.78 years, range 29–83 years). The female–male ratio was 7 : 34. Patients’ inhaler administration skills were found to be improved by pharmacist-led education (p<0.05). Conclusions Evaluation of accurate inhaler device usage in patients with COPD should be performed periodically, and training regarding the inhaler device should be reconsidered according to the needs of patients.

Determination Of Potential Drug-Drug Interactions By Using Various Software Programs At Community Pharmacy Setting

Objectives: The aim of the present study was to compare various software programs in detecting potential drug–drug interactions in a community pharmacy setting. Materials and Methods: Details of prescriptions were collected from 50 community pharmacies located in İstanbul in March and April 2015 (two days per week). From each pharmacy, the first 20 prescriptions that included more than one drug were collected to evaluate potential drug–drug interactions. The following software programs were utilized to detect potential drug–drug interactions: micromedexsolutions.com, medscape.com, and drugs.com. The number of potential interactions detected by the software programs was determined. Results: At least one potential drug–drug interaction was detected in 39.2% of the 1000 prescriptions by one of the software programs. According to the rates of total drug–drug interactions gathered from various software programs, these programs gave the following results: medscape.com 33.3%, drugs.com 31.3%, and micromedexsolutions.com 21.2%. Conclusion: After comparing different software programs, the potential drug–drug interactions found by the programs proved to be different. Therefore, we recommend that pharmacists confirm with a different program before making a decision when they detect clinically significant potential drug-drug interactions.