Anatomical Therapeutic And Chemical Research Articles

Generation of a drug-induced renal injury list to facilitate the development of new approach methodologies for nephrotoxicity

Drug-induced renal injury (DIRI) causes >1.5 million adverse events annually in the USA alone. Although standard biomarkers exist for DIRI, they lack the sensitivity or specificity to detect nephrotoxicity before the significant loss of renal function. In this study, we describe the creation of DIRIL - a list of drugs associated with DIRI and nephrotoxicity - from two literature datasets with DIRI annotation, confirmed using FDA drug labeling. DIRIL comprises 317 orally administered drugs covering all 14 anatomical, therapeutic and chemical (ATC) classification categories. Of the 317 drugs, 171 were DIRI-positive and 146 were DIRI-negative. DIRIL will be a relevant and invaluable resource for discovery of new approach methods (NAMs) to predict the occurrence and possible severity of DIRI earlier in drug development.

Trend analysis of proton pump inhibitor consumption and expenditure: The real-world evidence.

Proton pump inhibitors (PPIs) constitute a widely utilized pharmaceutical class, frequently associated with notable instances of therapeutic inappropriateness. Such patterns of misuse not only contribute to elevated healthcare expenditure, but may also exacerbate clinical conditions in certain patients. A comprehensive analysis was conducted between 2019 and 2023 to assess all prescriptions dispensed using the Anatomical, Therapeutic and Chemical (ATC) classification system, which allowed trends among primary PPIs to be visualized. This was achieved by calculating the defined daily dose (DDD) and then defining the total expenditure incurred on these drugs. With regard to the prescription of PPIs, an upward trend in consumption was observed with a decreasing expenditure, due to the phenomena of drug generics and increased competition between pharmaceutical companies, ranging from €9,512,481.22 in the first six months of 2019 to €8,509,820.80 in the first sixmonths of 2023. From 2019 to 2023, consumption increased by approximately 3 million DDDs for a total ranging from 18,483,167.59 DDDs to 21,480,871.00 DDDs. Pantoprazole and esomeprazole, the most expensive drugs compared to omeprazole, rabeprazole and lansoprazole, accounted for 61.4% of therapies in the first sixmonths of 2023, up from 2019, where these two drugs were prescribed 54.9%. Within this analysis, we provide an illustrative representation of the prescribing trends for PPIs within a European context. Omeprazole, rabeprazole and lansoprazole appear to be the cheapest drugs compared to pantoprazole and esomeprazole. However, the results show that the most widely used PPIs, despite their therapeutic equivalence, are precisely the high-cost ones, thus generating higher expenditure for central governments.

Evaluation of Antibiotic Prescribing Pattern Using WHO Access, Watch and Reserve Classification in Kinshasa, Democratic Republic of Congo.

The AWaRe tool was set up by the World Health Organization (WHO) to promote the rational use of antimicrobials. Indeed, this tool classifies antibiotics into four groups: access, watch, reserve and not-recommended antibiotics. In The Democratic Republic of Congo, data on antibiotic dispensing (prescribing) by health professionals according to the AWaRe classification are scarce. In this research work, we aimed to explore antibiotic dispensing pattern from health professionals according to the WHO AWaRe classification to strengthen the national antimicrobial resistance plan. For this purpose, a survey was conducted from July to December 2022 in the district of Tshangu in Kinshasa. From randomly selected drugstores, drug-sellers were interviewed and randomly selected customers attending those drugstores were included in the study for medical prescriptions collection. The prescribed antibiotics were classified into the access, watch, reserve and not-recommended antibiotics group and by antibiotics number by prescription among pharmacies surveyed. 400 medical prescriptions were collected from 80 drugstores and among which, 301 (75.25%) contained antibiotics. Out of 301 prescriptions, we noticed 164 (54.5%) containing one antibiotic, 117 (38.9%) containing two antibiotics, 15 (5%) containing three antibiotics and 5 (1.6%) containing four antibiotics. A total of 463 antibiotics were prescribed and distributed as 169 (36.5%) were from the access group, 200 (43.2%) from the watch group and 94 (20.3%) from not-recommended antibiotics group, respectively. This can explain the fact of emerging bacterial strains, as, according to the WHO recommendations, the access group should be prioritized because of its activity against a wide range of commonly encountered pathogens and its showing low resistance susceptibility compared to antibiotics from other groups. Based on the anatomical, therapeutic and chemical (ATC) classifications, we observed that third generation cephalosporins represented 34.33% of the prescribed antibiotics, followed by penicillins (17.17%), macrolides (7.63%), aminoglycosides (7.36%) and Imidazole (7.36%), thus accounting approximately for 74% of the classes of antibiotics prescribed. Additionally, among them, the most frequently prescribed antibiotics were Ceftriaxone (21.38%), Amoxicillin (11.01%), Gentamycin (5.61%), Amoxicillin-clavulanic acid (5.61%), Azithromycin (4.97%) and Metronidazole (4.75%), thus accounting for approximately 54% of all the prescribed antibiotics. These results highlight the importance of strict implementation of the national plan to combat antimicrobial resistance and the need to train health workers in the correct application of the WHO AWaRe classification.

Medicine shortages in France: a 6-year retrospective study in a university medical centre

ObjectivesMedicine procurement disorders, commonly referred to as ‘shortages’, are a health-threatening phenomenon that have been reported by several stakeholders around the world. This study aimed to describe data from a...

Utilization Trends of Antiviral and Antifungal Agents for Human Systemic Use in Tanzania From 2010 to 2017 Using the World Health Organization Collaborating Centre for Drug Statistics Methodology

IntroductionThe increase in antimicrobial consumption contributes to the emergence of antimicrobial resistance (AMR). Many studies have investigated the patterns of antibacterial consumption and antibacterial resistance. However, there is a paucity of data on the utilization of antivirals and antifungals in low and middle-income countries to serve as a baseline for monitoring and surveillance of AMR. Therefore, this study determined Tanzania’s systemic antifungal and antiviral utilization trends from 2010 to 2017, based on the Tanzania Medicines and Medical Devices Authority (TMDA) medicine importation archives.MethodologyAn analytical, longitudinal retrospective survey covering 2010 to 2017 was conducted. The study utilized the Anatomical Therapeutic and Chemical (ATC) classification and Defined Daily Dose (DDD) developed by the World Health Organization (WHO) Collaborating Centre for Drug Statistics and the WHO Collaboration Centre for International Drug Consumption Monitoring. Human medicine importation data were collected from TMDA headquarters and used to assess the systemic antiviral and antifungal consumption trends. The importation data included the date, generic name, strength, brand name, currency, quantity, ATC classification, supplier country, port of entry and product supplier. The data were cleaned, reorganized and analyzed. Reference was made to the latest revised DDD list to assign antifungals and antivirals to their respective ATC/DDDs and then adjusted to the population estimates from the National Bureau of Statistics of Tanzania.ResultsThere was a high proportion of systemic antivirals and antifungals utilization with 367.1 and 10.8 DDD per 1000 inhabitants per day (DID) respectively over eight years. In regression model, there was a significant increase in both antiviral (p-value = 0.043) and antifungal (p-value = 0.015) agents’ utilization trends in Tanzania in the study period. Fluconazole had the highest proportion of utilization for antifungals, followed by ketoconazole, itraconazole, miconazole and amphotericin B. For systemic antivirals, a high proportion was attributed to antiretrovirals used for HIV infections.ConclusionFindings from this study suggest an increase in the utilization of systemic antiviral and antifungal agents. These findings may be used to further benchmark utilization and AMR studies in Tanzania.

Consumption Trends of Antibiotic for Veterinary Use in Tanzania: A Longitudinal Retrospective Survey From 2010-2017

BackgroundWith increased livestock keeping, multiple prevailing infections, antimicrobial agents’ use and pattern in Tanzania, the development of antimicrobial resistance (AMR) becomes inevitable. Antibiotic-resistant pathogens have increasingly become a major challenge in human and animal medicine. Although inappropriate use of antibiotics in humans is the principal cause of resistance, antibiotic-resistant bacteria originating from animals contribute to the emergence and spread of these bacteria. Antibiotics help control a multitude of bacterial infections that are major causes of diseases in both animals and humans. Rational use in animals is crucial to control any development and transfer of AMR to humans. This study aimed to create quantitative evidence of animal antimicrobial usage patterns in Tanzania to serve as a baseline for surveillance of antimicrobial use and antimicrobial resistance control.MethodologyThis descriptive longitudinal retrospective study was conducted to explore the trend of veterinary-antibiotics consumed in the eight years, from 1st January 2010 to 31st December 2017 in Tanzania mainland. The data source was records of all antibiotics imported for veterinary use into Tanzania’s mainland according to the Tanzania Medicines and Medical Devices Authority (TMDA) records. The analysis employed the World Health Organization (WHO) Collaborating Centre for Drug Statistics Methodology using Anatomical Therapeutic and Chemical (ATC) classification. Regression and time series analysis was used to establish trends in antibiotics consumption.ResultsA total of 12,147,491 kg of antibiotics were consumed in Tanzania from 2010 to 2017. Tetracycline, sulfonamides and trimethoprim, quinolones, aminoglycosides, beta-lactams and antibacterial combinations were the most commonly used antibacterial agents in Tanzania. Tetracycline class topped the list with about 8,090,798 kg (66.6%) out of 12,147,491 kg total quantity of antimicrobials consumed. Non-significant, linear curve estimations and time series analysis indicate a decline in the quantities of veterinary antibiotics used in the eight years from 2010 to 2017.ConclusionsThis study suggests that tetracycline is the most used antibiotic class for veterinary medicine in Tanzania. The trend of antimicrobial use is generally decreasing compared to other countries in Africa. Even though some antibiotics have the lowest consumption rate, they are also prone to AMR, prompting follow-up by the relevant regulatory authorities.

Developing an Integrated Electronic Medication Reconciliation Platform and Evaluating its Effects on Preventing Potential Duplicated Medications and Reducing 30-Day Medication-Related Hospital Revisits for Inpatients.

The aims were to develop an integrated electronic medication reconciliation (ieMR) platform, evaluate its effects on preventing potential duplicated medications, analyze the distribution of the potential duplicated medications by the Anatomical Therapeutic and Chemical (ATC) code for all inpatients, and determine the rate of 30-day medication-related hospital revisits for a geriatric unit. The study was conducted in a tertiary medical center in Taiwan and involved a retrospective quasi pre-intervention (July 1-November 30, 2015) and post-intervention (October 1-December 31, 2016) study design. A multidisciplinary team developed the ieMR platform covering the process from admission to discharge. The ieMR platform included six modules of an enhanced computer physician order entry system (eCPOE), Pharmaceutical-care, Holistic Care, Bedside Display, Personalized Best Possible Medication Discharge Plan, and Pharmaceutical Care Registration System. The ieMR platform prevented the number of potential duplicated medications from pre (25,196 medications, 2.3%) to post (23,413 medications, 3.8%) phases (OR 1.71, 95% CI, 1.68-1.74; p < .001). The most common potential duplicated medications classified by the ATC codes were cardiovascular system (28.4%), alimentary tract and metabolism (26.4%), and nervous system (14.9%), and by chemical substances were sennoside (12.5%), amlodipine (7.5%), and alprazolam (7.4%). The rate of medication-related 30-day hospital revisits for the geriatric unit was significantly decreased in post-intervention compared with that in pre-intervention (OR = 0.12; 95% CI, 0.03-0.53; p < .01). This study indicated that the ieMR platform significantly prevented the number of potential duplicated medications for inpatients and reduced the rate of 30-day medication-related hospital revisits for the patients on the geriatric unit.

The 12-year trend report of antipsychotic usage in a nationwide claims database derived from four million people in Japan

The current study aimed to describe the use of antipsychotics to clarify the gap between clinical guidelines and health care practice in Japan. We used data from the JMDC Claims Database (JMDC Inc., Tokyo, Japan), a nationwide claims database, from 2005 to 2016. Antipsychotics were defined as drugs coded as N05A with the Anatomical Therapeutic and Chemical (ATC) codes. We described the annual changes in proportions based on the number of patients prescribed any antipsychotics. From the database of 4,081,102 people, the data of 12,382 patients was extracted by applying the following exclusion criteria: no use of antipsychotics, missing the prescription date or dose, inpatients, prescribed antipsychotics only for use as needed, prescribed only injectable antipsychotics except for long-acting injections (LAIs), without schizophrenia as the primary disease, not exceeding 75 mg/day chlorpromazine equivalent, and less than 18 years old. The use of second-generation antipsychotics (SGA) has been expanding, while the use of first-generation antipsychotics has been decreasing. Aripiprazole accounted for the highest proportion of prescribed antipsychotics (31.9%) in 2016. Even though clozapine is categorized as a SGA, it accounted for a paltry 0.2%. The proportion of prescribed antipsychotics accounted for by LAIs was less than 5%. Although the use of antipsychotics for schizophrenia in Japan mostly corresponds to various clinical guidelines, limited use of clozapine and LAIs was identified. Further research focusing on the factors affecting the prescription of these underused antipsychotics may help advance the pharmacological therapy of schizophrenia.

Effects of restrictive reimbursement on the prescribing and expenditures on non-essential lipid-lowering drugs.

The rapid cost escalation of the government employee scheme in Thailand was driven by the overprescription of non-essential drugs (NEDs), which were not listed in the National Lists of Essential Medicines. A restrictive reimbursement policy implemented in October 2012 required prescribers to base the prescription of NEDs on six criteria, including A and B for safety, C for effectiveness, D for availability, and E and F for costs, hence known as the A-F policy. The A-F policy was examined in terms of its outcomes regarding the prescription volume and reimbursement expenditure for lipid-lowering drugs (LLDs). Data on LLD prescription in 2012-2015 from outpatient settings in 29 public hospitals were standardized using quantities based on the World Health Organization's Anatomical, Therapeutic and Chemical (ATC) classification and the defined daily dose (DDD) system. The policy effects were estimated using an interrupted time-series analysis. The restrictive reimbursement policy decreased both the prescription volume and the reimbursement value of non-essential LLDs. Within the first month of policy implementation, the percentage of NEDs, as defined by DDDs and reimbursement expenditure, immediately decreased by 15.1 and 15.2% points in provincial hospitals and by 8.3 and 4.4% points in military hospitals, respectively. The prescription of NEDs continued to decrease thereafter, despite there being no statistically significant changes in the trend of decreased prescribing compared with the prepolicy period. The decrease in the prescription of NEDs resulted in the declining reimbursed amount per day and stable expenditure of LLDs as a whole. The effectiveness on the A-F restrictive reimbursement on NED prescribing helped stabilize the expenditure on LLDs.

Monitoring Of Antimicrobial Consumption – Aim, Methodology And Use

Abstract Monitoring of antibiotic consumption is one of the basic tools of the strategies to combat antibiotic resistance, is an integral part of the antibiotic stewardships and helps to ensure the rational antibiotic therapy. It is used to describe the structure and dynamics of antibacterials usage. The defined daily dose (DDD) methodology and ATC (anatomical, therapeutic and chemical) classification used in the monitoring programs determine the reliability of the analyzed data and enable the comparison of the antibiotic consumption between departments, centers and regions. 1. Introduction. 2. What is the monitoring and what it is used for? 3. Antimicrobial consumption methodology. 4. ATC methodology. 5. Defined daily dose (DDD). 6. Antimicrobial consumption measures. 7. Summary

Immunosuppressants in Brazil: underlying drivers of spending trends, 2010–2015

ABSTRACTBackground: Immunosuppressants are recommended for treatment of autoimmune diseases, and in transplant therapy. The high cost of these drugs has been causing an important impact on global pharmaceutical spending.Objective: Analyzing immunosuppressant expenditure in Brazil, using data from the Federal Procurement System database (SIASG), between 2010 and 2015.Methods: The pharmaceutical products were classified in accordance with the Anatomical, Therapeutic and Chemical (ATC) classification system recommended by World Health Organization (WHO) and aggregated by volume and by expenditure. The expenditure variation was decomposed into three broad categories: price effects, quantity effects, and drug mix effects.Results: During the period, annual expenditure increased by 49%, ranging from USD 494.5 million in 2010 to USD 738.7 million in 2015, while purchased quantities increased by 294%, ranging from 49.8 million in 2010 to 196.5 million in 2015. Two factors drove expenditures: the quantity effect and the drug-mix effect.Conclusion: These findings may contribute to understand immunosuppressant spending trends and the factors that influence them in order to formulate effective cost containment strategies and design optimum drug policy. Rigorous evaluations are recommended to reduce the drug-mix effect, including systems to monitor price, effectiveness, safety, therapeutic value and budget impact of pharmaceutical innovations.

Analysis of the drug formulary and the purchasing process at a Moroccan university medical center

ABSTRACTAim: To give an overview of the pharmaceutical policy in the largest medical center in Morocco, a developing country in socio-economic transition.Methods: This is an analytical descriptive study of the drug formulary and the purchasing process carried out at the Ibn Sina University Medical Center.Results: Our formulary included 830 drugs belonging to 14 classes according to the Anatomical, Therapeutic and Chemical (ATC) Classification System. There was a respective predominance of class N (21.8%), class B (13.5%), and class J (12.6%). Injectable route was dominant (46%). Drugs had a significant actual benefit in 70% (according to the French Data), reimbursable in 42.8%, essential in 29.2% according to World Health Organization (WHO) list, and in 36.9% according to the Moroccan list. The calls for tenders included 542 drugs representing 65% of the formulary, and the attribution rate was 71%. The main reason for non-attribution was the lack of offers. Generics accounted for 45% by volume and 26.5% by value.Conclusion: With this first study, we were able to identify key indicators on drugs used in the largest medical center in Morocco. The current challenge is to introduce pharmacoeconomics in decision making concerning the updates of the drug formulary.

Geriatric information analysis of the molecular properties of mexidole

Objective : by using the pharmacoinformation profiling, to comprehensively assess all possible effects of the molecules of mexidol, choline alfoscerate, piracetam, glycine, and semax in accordance with the anatomical therapeutic and chemical (ATC) classification system. Material and methods. Chemoreactomic, pharmacoinformation, and geriatric information analyses of the properties of the molecules are based on chemoreactomic methodology. The chemoreactomic analysis uses the information from the PubChem, HMDB, and String databases; the pharmacoinformation analysis applies the information from the international ATC classification and a combined sample of data from the Therapeutic Target Database (TTD), SuperTarget, Manually Annotated Targets and Drugs Online Resource (MATADOR), and Potential Drug Target Database (PDTD); geriatric information analysis employs the data on the geroprotective effect of individual substances from the PubChem database and the data available in the literature data on geroprotection from the PubMed database, which have been collected through the artificial intelligence system. Results and discussion. Mexidol is characterized by the maximum set of positive effects (the drug is used to treat CNS and cardiovascular diseases and metabolic disorders and has anti-inflammatory and anti-infective properties, etc.). Mexidol and glycine are predicted to cause the lowest frequency of adverse reactions, such as itching, constipation, paresthesia, vomiting, etc. Geriatric information assessments of changes in the life span of model organisms have shown that mexidol contributes to the higher life expectancy of C. elegans (by 22.7±10%), Drosophila (by 14.4±15%), and mice (by 14.6±3%); the control drugs do by no more than 6.1%. Conclusion. The results of the study indicate that mexidol has a high potential to be used as a geroprotector.

Les effets indésirables médicamenteux en pédiatrie : expérience d’un centre régional de pharmacovigilance

To describe the adverse drug reactions (ADR) and the drugs involved in pediatrics. An observational study on all ADR notifications recorded in the French pharmacovigilance database by the Regional Pharmacovigilance Center of Champagne-Ardenne between 1 January 1985 and 31 December 2014 involving children from 0 to 17 years inclusive was performed. For all notifications, we studied the patient and the ADR characteristics. During the study period, 632 notifications were collected. The most frequently reported ATC (anatomical, therapeutic and chemical) classes were vaccines (15.9%), antineoplastics (12%) and antibiotics (11.1%). Forty-six percent of the notifications were serious. For serious ADRs, the most involved drugs were paracetamol, asparaginase and ibuprofen. Skin reactions were the most often reported ADRs. The most common lowest level terms (LLT) were urticaria (4.9%), hypersensitivity (4.1%), fever (2.9%) and vomiting (2.8%). ADR reporting to the pharmacovigilance system, in particular pediatric ADRs, should be encouraged. Information on the use of medicinal products, especially on self-medication use, need to be improve.

Transition from hospital to primary care: an audit of discharge summary - medication changes and follow-up expectations.

The clinical discharge summary remains a critical, but often poorly implemented tool in communication with primary care. An area of concern is the documentation of medication lists and appropriate follow up of medication changes. To assesses the accuracy of documentation of medication changes and expectations with regard to follow up from an acute assessment unit (AAU) of a tertiary metropolitan hospital. All patients who were admitted and discharged directly from the unit during the month of June 2013 were audited. For all admissions, discharge summaries were audited for medication errors and for the appropriate documentation of indications and follow up for prescribed medications. All medications prescribed on discharge were collated using the World Health Organization Anatomical, Therapeutic and Chemical (ATC) classification. In total, 219 admissions were analysed. There were 204 out of 219 (93.1%) discharge summaries that had an accurate medication list. Of 219 (74%) patients, 163 had at least one change to their medications during admission. Of 163 discharge summaries, 82 (50%) contained information regarding their indication and outpatient management. The most commonly prescribed classes along with the rates of indication and follow up documentation were anti-infectives (62%), gastrointestinal (51%), cardiovascular (50%) and central nervous system (44%). Although there were fewer documentation errors in discharge summaries than previously described in the literature, concerns regarding the documentation of medication indication and follow up remain.

Use of Drugs, Tobacco, Alcohol and Illicit Substances in a French Student Population

ObjectiveTo investigate perceived health status and prevalence of drug use, tobacco smoking, consumption of alcohol and illicit substances in a student population. MethodsData were obtained from an anonymous questionnaire distributed to first-year students of the Toulouse University. Collected data concerned socio-demographic characteristics, perceived health status, and consumption of tobacco, alcohol, illicit substances and drugs. ResultsFifty seven percent of the 3 561 responders declared to have taken at least one drug during the week preceding the questionnaire. Most commonly Anatomical, Therapeutic and Chemical (ATC) classes used were genito-urinary system and sex hormones (29.6%), nervous system (16.4%) and alimentary tract and metabolism (14.1%). Twenty three percent of students were smokers. Differences according to health perception were found for tobacco and cannabis consumption. Anxiety was significantly more prevalent among students reporting that they did not consume alcohol (p<0.05) ConclusionMore than half of students use drugs. Other consumptions (tobacco, alcohol and illicit substances) are related with perceived health status.

Inappropriateness of medication prescriptions to elderly patients in the primary care setting: a systematic review.

BackgroundInappropriate medication prescription is a common cause of preventable adverse drug events among elderly persons in the primary care setting.ObjectiveThe aim of this systematic review is to quantify the extent of inappropriate prescription to elderly persons in the primary care setting.MethodsWe systematically searched Ovid-Medline and Ovid-EMBASE from 1950 and 1980 respectively to March 2012. Two independent reviewers screened and selected primary studies published in English that measured (in)appropriate medication prescription among elderly persons (>65 years) in the primary care setting. We extracted data sources, instruments for assessing medication prescription appropriateness, and the rate of inappropriate medication prescriptions. We grouped the reported individual medications according to the Anatomical Therapeutic and Chemical (ATC) classification and compared the median rate of inappropriate medication prescription and its range within each therapeutic class.ResultsWe included 19 studies, 14 of which used the Beers criteria as the instrument for assessing appropriateness of prescriptions. The median rate of inappropriate medication prescriptions (IMP) was 20.5% [IQR 18.1 to 25.6%.]. Medications with largest median rate of inappropriate medication prescriptions were propoxyphene 4.52(0.10–23.30)%, doxazosin 3.96 (0.32 15.70)%, diphenhydramine 3.30(0.02–4.40)% and amitriptiline 3.20 (0.05–20.5)% in a decreasing order of IMP rate. Available studies described unequal sets of medications and different measurement tools to estimate the overall prevalence of inappropriate prescription.ConclusionsApproximately one in five prescriptions to elderly persons in primary care is inappropropriate despite the attention that has been directed to quality of prescription. Diphenhydramine and amitriptiline are the most common inappropriately prescribed medications with high risk adverse events while propoxyphene and doxazoxin are the most commonly prescribed medications with low risk adverse events. These medications are good candidates for being targeted for improvement e.g. by computerized clinical decision support.

Adequacy of antithrombotic therapy and gender differences in hypertensive patients with atrial fibrillation

Atrial fibrillation (AF) is the most common type of arrhythmia [1]. Stratification of the risk of stroke is based on the presence of certain risk factors [2], and clinical practice guidelines base the indication for anticoagulation or antiplatelet therapy on the different scores [3]. However, despite these recommendations, the use of anticoagulation is suboptimal and patients do not always receive it adequately [4,5]. Few data are available on adherence to clinical guidelines regarding prescription of anticoagulants in relation to stroke risk stratification according to the CHADS2 scale. Studies have reported anticoagulation levels between 39 and 70% in high risk patients [4,5]. One study, however, reports similar levels of oral anticoagulant (OAC) use for all scale scores, with underuse in high risk patients and overuse in those with low risk [6]. It has been suggested that OAC is underused in women, but the results have been inconclusive [7]. A substudy of the Euro Heart survey reported gender differences in AF patients, with more comorbidities, lower quality of life andmore conservative management in women, and with no differences found in the degree of OAC [8]. The main objective of our study was to evaluate the adequacy of oral anticoagulation and its gender differences based on application of the CHADS2 scale in all hypertensive patients with AF treatedmedically in a primary health care area in Spain. We designed a cross-sectional study based on computerized registries of hypertensive patients belonging to Health Area 6 in Madrid (661,611 inhabitants). The study population was being treated with antihypertensive agents and visited their health centers in 2008; from this group we selected all patients with a diagnosis of AF, based on the International Classification of Primary Care, version 2 (ICPC-2, Circulatory system) [9], which in turn is taken from hospital discharge reports based on diagnostic criteria and a characteristic electrocardiogram. Prescriptions were analyzed based on the anatomical, therapeutic and chemical (ATC) classification [10]. The CHADS2 scale was used to calculate the risk of stroke [11]. Anticoagulation was considered to be indicated for patients with CHADS2 score equal to or greater than 2. Of the 92,079 patients with hypertension treated pharmacologically, 5731 patients with AF were identified (6.2% of the total, 95% CI 6.0%– 6.3%). Table 1 shows the general characteristics of these patients. Table 2 presents the data on stroke risk stratification by age group and gender. Fig. 1 depicts the results of the level of use of antithrombotic drugs according to CHADS2 category and gender. The overall level of OAC was 56.6% (60.8% in men and 53.6% in women), with greater use of OAC in men than in women in all categories (Pb0.05). This is the only study that has analyzed the adequacy of antithrombotic treatment and gender differences in a large number of hypertensive patients with AF. The results show that just over half are anticoagulated andalmostone-third arenot receivinganyantithrombotic treatmenteven though all are at least at moderate risk due to their hypertension. Gender differences are also seen in the use of antithrombotic therapies sincemen areprescribedmoreOACoverall and a largerproportionofwomenarenot treatedwith antithrombotics or are treatedwith antiplatelets. This occurs in all categories of the scale, despite women's higher risk of stroke.

Changing beta-blockers in heart failure: when is a class not a class?

Are all the drugs in a class the same? Take the COX-2 inhibitors, for example. Rofecoxib increases the risk of a heart attack or stroke; but do other COX-2 inhibitors, such as celecoxib, do likewise? In other words, is this adverse effect of rofecoxib a class effect? The concept of grouping compounds in classes is useful, because it prompts questions regarding their similarities and differences. But what makes a class? The short answer is that drug class is best defined by the most important attribute of a drug: its main pharmacological target of action. Because the target is so important, the terms ‘on-target’ and ‘off-target’, originally invented in the context of drug discovery, are sometimes used to differentiate drug actions. However, in colloquial parlance not all drug classes are named according to their target, even in the World Health Organization's Anatomical Therapeutic and Chemical (ATC) drug classification system1 (Table 1). The idea of a class of drugs, even when it is based on the pharmacological target, is one that does not always bear close scrutiny, for several reasons. View this table: Table 1 Origins of the colloquial names of some classes of drugs. Firstly, the main pharmacological target may not be known. Secondly, some classes of drugs, such as monoclonal antibodies, have no common target, although they may have some effects in common, such as adverse effects. Thirdly, some drugs have more than one main target: spironolactone, for example, is an antagonist at aldosterone receptors through its active metabolite canrenone, which is why it is a potassium-sparing …

Utilización de Neurolépticos atípicos en el Centro Penitenciario de Málaga

we studied the use of psychotropic drugs belonging to the group of atypical neuroleptics in Malaga State Prison (Centro Penitenciario de Málaga) from 2003 to 2004. We also compared the results of this study with references taken from the Primary Health Care District of Guadalhorce. A retrospective study was carried out on the use of antipsychotic drugs from 2003 to 2004 in Malaga State Prison. A comparison was then made with the use of this type of medication in the Primary Health Care District of Guadalhorce. Data on medication consumption was taken from medical orders received at the prison during this study. The ATC (Anatomical Therapeutic and Chemical Classifying System) was used for classifying the active principles. The prison´s own data base (SANIT) was used for calculating the number of containers. For calculating the DDD, the ratio DDD/1000 inmates/day was utilised. The use of atypical antipsychotic medication in the prison increased. There is an increasing trend towards the use of quetiapine in small doses. The use of risperidone went down during the period of this study, although it is still the most commonly used drug in DDD and in consumed containers. The Primary Health care results indicate a trend in the opposite direction. The use of the group of drugs in this study has decreased in the Primary Health Care area, possibly because of special medical control measures such as the control stamp. In Malaga Prison use of these drugs has increased. The reasons for this difference are as yet unknown.