Leelavathi D Acharya

Assessment of drug-drug interactions among renal failure patients of nephrology ward in a south Indian tertiary care hospital

Polypharmacy is common in drug prescriptions of chronic kidney disease patients. A study of the prescription patterns of drugs with potential interactions would be of interest to prevent drug related adverse events. A prospective observational study of six months (Dec 2009-May 2010) was carried out among the chronic kidney disease patients admitted to the nephrology ward of a South Indian tertiary care hospital. The pattern and rates of drug-drug interactions seen in the prescriptions of these patients was studied. Among the 205 prescriptions included, a total of 474 interactions were reported, making 2.7 interactions per prescription with incidence rates of 76.09%. Around 19.62% of interactions were of major severity. Most common interactions were found between ascorbic acid and cyanocobalamine (12.45%), clonidine and metoprolol (3.80%) respectively. Hypo or hypertension (31.65%), decreased drug efficacy (29.11%) and hypo or hyperglycemia (14.14%), were the most commonly reported clinical outcomes of the drug interactions. Cardiovascular drugs (calcium channel blockers and beta blockers; 52%) constitute the major class of drugs involved in interactions. As most of the interactions had a delayed onset, long term follow-up is essential to predict the clinically significant outcomes of these interactions. Hence, drug interactions are commonly seen in the prescriptions of chronic kidney disease patients which can lead to serious adverse events if not detected early. Need for collaboration with a clinical pharmacist and electronic surveillance, which are absent in developing countries like India, is emphatic.

Study and evaluation of the various cutaneous adverse drug reactions in Kasturba hospital, Manipal

The present study emphasizes on implementation of the adverse drug reaction reporting and monitoring system, in the Dermatology department of Kasturba Hospital, Manipal, by a clinical pharmacist, using different promotional activities. Documented adverse drug reactions were assessed and analyzed for incidence, purpose of visit, types, drug classes, individual drug causing adverse drug reactions, type of cutaneous reaction, and various predisposing factors. Management and outcome of the adverse drug reactions were also studied. Adverse drug reactions were also assessed for causality, using Naranjos scale, severity, and preventability, using Hartwig et al. scale. Adverse drug reaction attributes to 77% of the hospital visit. Incidence of reported cutaneous adverse drug reactions, were 2.85%. Majority of the adverse drug reactions (96%) were of type B. Antibiotics (30%), were the common class of drugs, causing a cutaneous adverse drug reactions. Maximum number of adverse drug reactions were due to Acetaminophen, Amoxicillin, antitubercular drugs, and Phenytoin. Most of the adverse drug reactions were managed by withdrawal of drug (81%), and 58% patients were recovered from the reaction. Naranjos scale classifies, 29 as probable, 21 as possible, and 3 as definite adverse drug reactions. Most of the adverse drug reactions were of moderate severity, however 13 adverse drug reactions were severe. All the adverse drug reactions were probably preventable on extreme caution.

Development of hospital formulary for a tertiary care teaching hospital in south India

Formulary is a continually revised compilation of pharmaceuticals (plus important ancillary information) that reflects the current clinical judgment of medical staff. Kasturba Hospital is a 1400 bedded tertiary care teaching hospital with different specialties, having more than 3000 brands and ancillary products in use. The hospital does not have a formulary of any kind. Present study involved development of a formulary for the hospital and comparing it with WHO Model Formulary. Monographs of the drugs were prepared as per the recommendation of Pharmacy and Therapeutic Committee of the hospital. Prepared hospital formulary consisted of 476 generic drugs of various categories and 95 fixed dose combinations. Availability of brands varied from single to many. About 75 medicines recommended by the essential medicine list were not present in the prepared hospital formulary. The drugs to be avoided or used with caution in renal failure, hepatic failure and in pregnancy were categorized and included in the formulary as additional information. The prepared hospital formulary was recommended for implementation in the hospital, which could thereby help as a tool to promote rational drug use.

Trends in Prescribing Antihypertensive Medications and Lipid Lowering Therapy in type-2 Diabetic Patients in South Indian Tertiary Care Hospital

Objectives: To evaluate trends in prescribing antihypertensive medications and lipid lowering therapy in type 2 diabetic patients Methods: The study was conducted as cross sectional observational study. The drug utilization data was collected for the years 2008 to 2010 after obtaining ethical committee approval. Collected data were analyzed using appropriate statistical techniques. Results: As per the study criteria, data were collected from 773, 700 and 647 type 2 diabetic patients who were admitted during the years 2008, 2009 and 2010 respectively in the medicine wards. Overall 56.53% diabetic patients had hypertension. Majority of them were males (61%), maximum number (36%) of diabetic hypertensive patients are in the age group of 55-64 years and about 39% patients had history of 1-5 years of hypertension. On evaluation of prescription pattern of antihypertensive medication in diabetic patients, most of the patients were on monotherapy and they are on calcium channel blockers (CCBs). Among CCBs amlodipine was commonly prescribed drug. About 30% of diabetic patients were on lipid lowering drugs. Conclusion: In diabetic patients with hypertension, calcium channel blockers were preferably used contrary to the guidelines which usually recommend ACE inhibitors or ARBs in these patients.

Effectiveness and safety of heparinized saline versus normal saline in maintaining patency of peripheral intravenous locks in neonates at a tertiary care hospital

Introduction: Heparinized saline is usually used as a regular flush solution to prevent occlusion of peripheral intravenous locks in neonates but the risks associated with the use of heparin cannot be ignored in these patients. Aim: To assess and compare the efficacy and safety of Heparinized Saline (HS) and Normal Saline (NS) flush solution in neonates. Materials and Methods: A prospective study was conducted for a period of 12 months using 1 unit/ml HS and NS 0.9% solution. The mean number of catheters removed due to nonelective reasons was calculated to evaluate the effectiveness of flushing solutions. To evaluate the safety, the reason for catheter removal was noted and platelet nadir was used to assess the thrombocytopenia. Poisson regression, Pearson Chi-square test and stratified analysis were conducted. Results: Data were analysed from 100 neonates. We found no significant difference between HS and NS flushes in neonates in maintaining the patency of 24 gauge peripheral intravenous locks {rate ratio= 1.12, p-value =0.584}. Gestational age, body weight and site of insertion did not significantly affect the patency. The reasons for removal of catheter were similar in both the groups and majority were due to non-elective reasons. HS group reported more cases of thrombocytopenia that was attributed to sepsis. Conclusion: Standard NS can be considered as an alternative flush in neonates as both the solutions were found to be equally efficacious and safe in our patient group. Factors like gestational age, body weight and site of insertion did not significantly affect the patency.