Gurumurthy Parthasarathi

Adverse drug reactions to antiretroviral therapy (ART): an experience of spontaneous reporting and intensive monitoring from ART centre in India.

To assess the nature, severity, predictability and preventability of adverse drug reactions (ADRs) and to identify risk factors for antiretroviral ADRs.

Clinical Pharmacy in a South Indian Teaching Hospital

OBJECTIVE: To describe how clinical pharmacy is helping to improve medication use at a South Indian teaching hospital by addressing medication use problems, which are commonly encountered in India. SUMMARY: Clinical pharmacy is practiced in many countries and makes a significant contribution to improved drug therapy and patient care. India is a country with significant problems with medication use, but until recently Indian pharmacists have not been educated for a patient-care role. Postgraduate pharmacy practice programs have been established at 2 pharmacy colleges in South India as a result of a joint Indo-Australian program of cooperation. At a teaching hospital associated with the colleges, clinical pharmacy services such as drug information, medication counseling, drug therapy review, adverse drug reaction reporting, and the preparation of antibiotic guidelines are assisting clinicians to improve drug therapy and patient care. Seven hundred twenty-seven requests for drug information were received from July 1997 to February 2001, and 543 suspected adverse drug reactions were evaluated from November 1997 to February 2001. The most common drug classes causing adverse drug reactions were antibiotics, nonsteroidal antiinflammatory drugs, and antitubercular agents. Physician opinion and service utilization have also been surveyed: 82% of respondents had sought drug information from the Clinical Pharmacy Department and 71% of respondents had sought advice on individual patient management. The success of this program is raising awareness of clinical pharmacy among pharmacy educators elsewhere in India and has led to the introduction of clinical pharmacy services at other Indian hospitals.

Assessment of Drug-Related Problems and Clinical Pharmacists' Interventions in an Indian Teaching Hospital

Aim: To identify drug‐related problems (DRPs) at a major Indian teaching hospital, to assess the acceptance of recommendations made by clinical pharmacists and evaluate the level of involvement of pharmacists in drug therapy decisions.

An adverse drug interaction of haloperidol with levodopa

Drug interactions are known to play a significant role in the incidence of adverse drug reactions (ADRs) both in the community and in hospitals. Both the newer atypical antipsychotics and their more traditional counterparts are subject to drug — drug interactions amongst themselves, with other psychotropics, and with the agents used in the treatment of various physical ailments. The most common interactions encountered in clinical practice are pharmacodynamic in nature. It is well established that antipsychotic drugs reduce the efficacy of levodopa in parkinsons disease by blockade of dopamine receptors in the corpus striatum. The case reported here illustrates a common pharmacodynamic drug interaction of haloperidol with levodopa in a 60-year-old female patient.

Health-related quality of life assessment using St. George's respiratory questionnaire in asthmatics on inhaled corticosteroids

Context: Chronic diseases like asthma have significant effects on patients’ health-related quality of life (HRQoL). HRQoL measures additional indices as compared to objective measurements like spirometry. Aims: To assess and compare disease-specific quality of life in asthma patients using St. Georges Respiratory Questionnaire (SGRQ) receiving fluticasone, beclomethasone, and budesonide (BUD). Settings and Design: A prospective, open label, randomized, parallel group study conducted at a tertiary care teaching hospital in South India. Materials and Methods: A 6-month follow-up of 277 patients with mild, moderate, and severe persistent asthma was randomized to receive fluticasone propionate (FP), BUD, or beclomethasone dipropionate (BDP) in equipotent doses according to their global initiative on asthma (GINA) severity. Statistical analysis used: Data analyzed using SPSS version: 13.0. General linear-repeated measures using the post-hoc bonferroni method assessed significance between treatment groups. Results: Significant decrease (P < 0.05) in each SGRQ domains and total scores as well as improvement in FEV1 (P < 0.05) was observed in all study subjects. A significant early response (P < 0.05) was noted after 15 days treatment in patients receiving FP with respect to SGRQ (activity, impact and total) scores and dyspnea indices, but not FEV1. This improvement with FP was due to its greater effect in patients with moderate and severe persistent asthma. No difference was noted subsequently in all outcome measures studied until 6 months. Conclusions: There was evidence for an early QoL improvement to FP as compared to BUD or BDP in moderate and severe persistent asthma. Subsequently, the three ICS showed similar improvements in lung functions and dyspnea indices throughout the study.

Frequency and Nature of Medication‐Related Problems in Elderly Indian Inpatients

Geriatrics is an emerging clinical specialty in India. Although studies on medication use in the elderly have been conducted in India, data on medication‐related problems (MRP) in the hospitalised elderly population are limited.

Sulfasalazine Induced Toxic Epidermal Necrolysis in a Rheumatoid Arthritis Patient-A Case Report

Toxic epidermal necrolysis also known as Lyells syndrome is a rare but potentially life threatening severe cutaneous adverse reaction with widespread epidermal detachment and mucosal erosions. Drug exposure and a resulting hypersensitivity reaction is the cause of the very large majority of cases of Steven Johnson Syndrome. This is a case of 34-year-old female patient, presented to hospital with a presentation of rash, throat pain, fever and eye pain with redness. The patient medical history shows that she is a known case of rheumatoid arthritis and treated with sulfasalazine 500 mg, paracetamol 650 mg and aceclofenac 100 mg which she took for 16 days and injection methylprednisolone IM for 20 days. She has no improvement of joint pain and developed few fluid filled lesions in oral cavity, which ruptured spontaneously. She gives history of a pain and burning sensation while swallowing and her first biopsy report showed erythema multiforme on hospital admission and was finally diagnosed as Toxic Epidermal Necrolysis. Patient was treated with capsule cyclosporine and injection dexamethasone. The patient showed good response to treatment and lesions, erosions decreased within span of 20 days. Toxic epidermal necrolysis is a severe cutaneous adverse drug reactions associated with high mortality. Patients prescribed with sulfanamides like sulfasalazine, educating them regarding the appropriate use of medications are of utmost importance.

Valproic acid-induced abnormal behavior.

A 12-year-old female was admitted to hospital with complaints of abnormal behavior. She was on valproic acid 200mg twice daily and clobazam 5mg at night for the past 13 weeks for her complex partial seizures with secondary generalized seizures. On day 60 of the treatment with valproic acid she developed behavioral disturbances and initiated treatment with tablet chlorpromazine, olanzapine and risperidone. During the present hospitalization, as there was no improvement in abnormal behavior, antipsychotics were discontinued and she was on observation for five days. On day 6, valproic acid was replaced with carbamazepine. Patient started recovering gradually from the abnormal behavior three days after the withdrawal of valproic acid and completely recovered after three months. Causality of valproic acid-induced abnormal behavior was ‘possible’. Behavioral disturbances associated with valproic acid are rare and is reversible upon discontinuation of the drug. There is a need for vigilance on abnormal behavioral effects in patients receiving valproic acid.