Rational Drug Use Research Articles

Prescription, Dispensing, and Rational Medicine Use in a Nigerian Teaching Hospital

Abstract Background: Rational use of medicine in a teaching hospital is critical for effective and efficient patient care. This study assessed prescription, dispensing, and rational medicine in a Nigerian tertiary care facility. Materials and Method: This was an analytic cross-sectional study with data collected using validated tools underpinned by the World Health Organisation (WHO) and the International Network for the Rational Use of Drugs (INRUD) core indicators for prescription, patient care, and facility. A cluster sample of 10 specialist clinics and servicing pharmacies were selected. Simple random sampling was deployed to retrieve 600 medicine prescriptions in the pharmacies over a six-month period (June 1, 2021–November 30, 2021). Patient care indicators were assessed using 330 patient encounters, and 48 prescribers across the 10 clinics were randomly selected for assessing factors influencing prescribing practices. Exploratory and confirmatory analyses were conducted with SPSS version 25, and findings were compared with WHO/INRUD recommendations. Results: The mean medicine count per visit was 3.4 ± 1.9 with 40.2% and 24.8% of prescriptions containing antibiotics and injections, respectively. Nonproprietary prescriptions were 43.6% and 97.1% of medicines prescribed were contained the essential medicines list (EML). The mean times spent were 17.5 ± 8.0 and 7.7 ± 3.8 min with prescribers and dispensers, respectively. Most (99.8%) of the dispensed medicines were labeled properly while 82% of patients knew the regimen. Most (93.3%) tracer medicines were in the pharmacies, but no clinic had copies of the EML. Significant differences in prescription and patient care indicators were reported across specialty units. Conclusion: Gaps exist in medicine prescription and dispensing. The preponderance of brand prescription, polypharmacy, and antibiotic prescription calls for implementation of extant policies and guidelines on the use of medicines as well as training and monitoring on rational medicine use among prescribers and dispensers in the teaching hospital.

The scientific achievements of the pharmacologists from the Republic of Moldova between years 1988–2024

The main areas and directions of the scientific research are revealed, with a brief description of the most important outcomes obtained as a result of their implementation in medical practice, recognized and confirmed in various ways: scientific publications, patents, domestic drugs developed and authorized, published monographs and textbooks, scientific theses, state programs, scientific projects and grants obtained, various national and international scientific forums – all aimed at ensuring rational, effective and harmless pharmacotherapy. The discipline "Clinical Pharmacology" has been included in the university curriculum; the specialty "Pharmacologist-clinician" has been implemented in the Public Medical-Health Institutions of the Republic of Moldova; the concept of rational use of drugs and the Pharmaco-therapeutic Formulary System have been developed and implemented; the scientific support dedicated to the "Clinical Pharmacology" service has been edited.

Study on prescription pattern in acute myocardial infarction in a tertiary care teaching hospital

Background: Prescription pattern monitoring studies refer to drug utilization studies that primarily examine the prescribing, dispensing, and administration of medications to promote the rational use of drugs. Aims and Objectives: The present study aimed to examine the prescription patterns among patients with acute myocardial infarction (MI) who were admitted to intensive care unit of a tertiary care center. Materials and Methods: This was a prospective, cross-sectional study carried out in 201 acute MI patients. Patients’ demographics, clinical history, laboratory and imaging findings, the name of the drug (brand name or generic name), dosage form, and percentage of drugs prescribed from the WHO and National Essential Medicine List were noted. Results: In the present study, the majority of the study participants (73.14%) belonged to the age group of 41–65 years, with male predominance (60.20%). Most patients reported having a mixed diet (49.26%) and were from rural areas (63.68%). Aspirin, clopidogrel, and atorvastatin were prescribed to all the patients, followed by pentazocine (70.42%) and streptokinase. Percentage of drugs prescribed by generic name was 62%, while percentage of drugs prescribed from the WHO Model List of Essential Medicines (2021) and National Essential Drugs List (2022) was 70% and 68%, respectively. Conclusion: The present study findings revealed that the majority of patients belonged to the age group of 41–65 years, with male predominance. The present study revealed a low percentage of prescriptions with generic names, indicating a pressing need to revise the prescription standards in tertiary care hospitals.

Drug utilization studies in Turkiye: A systematic review.

Drug utilization studies (DUS) provide a framework for drug utilization at the national or targeted population level and important information on unmet medical needs, particularly in assessing the rationality of drug use. We aimed to systematically review DUS conducted in Turkiye. We examined 162 DUS with an accessible full-text, published as "research articles" and conducted in Turkiye between 2000 and 2021 using medical records and prescription data. We included English or Turkish papers with English abstracts. We examined the scientific characteristics of the publications, source of the data, place/time of collection, research designs, and studied drug groups. We found that 79.6% of articles were in English, 45.1% were listed in SCI/SCIE, and 63.0% were on the WOS platform with 3.5 (interquartile range: 1-15) citations. The mean study period and publication time were 2.9±3.1 and 2.9±2.1 years, respectively. The highest number of studies (17.9%) were published in 2021 and (26.5%) were conducted nationwide. We identified that 93.8% of the studies had retrospective design, 67.8% were conducted in secondary/tertiary health-care institutions, and 54.9% used direct hospital data. We detected that 68.5% of the studies were conducted on the general population, 19.1% on adults, 12.4% on children, and 44.4% were antibiotic oriented. Our study showed that a significant portion of the DUS, the trend of which has gained momentum in recent years, was antibiotic focused and conducted with a retrospective design from hospital-based data collected on the general patient population. This situation points to the necessity of expanding the existing DUS range by effectively using the new advantages provided by medical record databases and conducting more DUS that can provide critical clues for specific patients and drug groups.

Evaluation of Drug Use in Three Secondary Health Facilities in Liberia Using the World Health Organization Indicators

Background: Effective and quality healthcare is achieved through rational drug use. The consequences of irrational drug use manifest as drug related problems like unnecessary drug prescription, ineffective therapy, inappropriate dose and adverse drug reactions. Objectives: To evaluate drug use and drug related problems in three secondary health facilities in Liberia. Methods: A retrospective analysis of 1200 prescriptions was conducted in the outpatient section of Liberia Government Hospital (LGH), Redemption Hospital (RH) and James Davis Junior Hospital (JDJH) to assess drug use with the WHO drug use indicators followed by assessment of drug-related problems (DRP) using the DRP-Registration Form 8.0. A prospective cross-sectional study was then conducted to evaluate consultation and dispensing time, and the availability of essential drugs list. Data were analysed by one-way analysis of variance using Statistical Package for Social Sciences (SPSS) version 20.0. Results were expressed as mean ± SD and values were considered significant at P < 0.05. Results: The average numbers of medicines per prescription were 4.5 ±1.3, 3.6 ±1.1, and 3.7 ± 1.2 in LGH, RH and JDJH hospitals respectively (WHO value-1.6-1.8). The percentages of encounters with antibiotics were 77.5%, 74.3% and 82.5% respectively (WHO value - 20.0% - 26.8%). Observed DRPs were more in LGH for ‘no indication for drug use’ (6.50%) and ‘prescription of more drugs than clinically indicated’ (4.75%) while JDJH recorded more ‘inappropriate medication per established guidelines’ (4.00%) and ‘preventive/synergic drug not given for clinical indication’ (5.50%). Conclusion: Irrational use of drugs existed in all the three hospitals studied.

Effectiveness of Program for Older People’s Health Literacy on Drug and Health Products: Northeast of Thailand

Abstract Introduction: A health literacy promotion program in drugs and health products was collaboratively developed and evaluated for effectiveness by researchers and stakeholders. Methods: A Solomon four-group randomized study was conducted in 2022. The participants were people aged ≥60 years enrolled at senior schools in Northeast Thailand. One hundred and eighty older people were randomly selected using multistage sampling and allocated into four groups, 45 members. The designed program covers six skills: access to health information, cognition, communication, decision-making, media literacy, and self-management. ANOVA and t-test were used. Results: One hundred percent response rate, participants of the program (Group 1) showed a significant improvement (pre–post) of 62.2% in their health literacy in drugs and health products use (151.54 ± 37.88, 245.73 ± 9.33, P < 0.001). Group 3, older people who joined the program with posttest only showed health literacy of 248.67 ± 11.54. In contrast, Group 2 and Group 4 with no program showed less health literacy of 149.02 ± 32.08 and 145.22 ± 34.14, respectively. On each item, the older people with the program consistently scored significantly higher across all domains (P < 0.001). The average score was 247.20 ± 10.54, which showed a high level of health literacy (≥75%). Among areas, decision-making skills revealed the highest score of 45.97 ± 1.81 out of 50. The overall satisfaction score on the program was 47.60 ± 1.50. Conclusion: The program demonstrated its effectiveness in improving the older population’s health literacy regarding drug and health product use. It holds potential as a strategy to encourage older people to rational drug use. Participants expressed a significant satisfaction with the program, recommended for the broader Thai older people community.

Investigation of rational drug use behaviors and knowledge levels of older individuals: a cross-sectional study.

The aim of this study was to examine older individuals' rational drug use behavior, their knowledge of rational drug use, and the factors affecting it. This study was conducted cross-sectionally with 440 patients aged 65 years who received inpatient treatment in internal medicine and surgery clinics between October 2021 and November 2022 using a Rational Drug Use Scale and rational drug use behavior questions. The findings showed that the mean age of older adults was 72.56±5.84 years, and 51.8% were men. It was determined that 79.1% of the older adults did not check their expiration date before using the medicines, and 85.9% of them retained the remaining medicines after treatment. Results indicated that 77.3% of older adults knew less about rational drug use. Additionally, a significant difference was observed between older adults' marital status, educational status, possession of outdated drugs at home, self-use of antibiotics without examination, and mean score on the Rational Drug Use Scale (p<0.05). The results showed that the rational drug use knowledge level of older adults was low and that there were differences in the knowledge levels of rational drug use according to certain behaviors and factors.

A novel surface-enhanced Raman based molecular identification platform for multiplexed and highly accurate clinical diagnosis of viral diseases.

During the infection process, the interactions among respiratory viruses impact the dynamics of transmission and clinical outcomes. Therefore, efficient molecular detection methods provide a basis for rational drug use and effective health management. Surface-enhanced Raman scattering (SERS) is an ultra-sensitive spectroscopic technique capable of generating extremely narrow spectra (∼1-2 cm-1), enabling simultaneous detection of multiple targets. By judiciously designing plasmonic nanostructures as SERS substrates, Raman signals can be amplified by several orders of magnitude (∼105-1015), facilitating the detection of trace biomolecules. In this highlight, we highlight the work about a novel SERS platform for the high-precision multi-virus molecular identification. This may offer a highly sensitive, specific, and accurate method for the detection of multiple viruses.

Rational Drug Use in Type 2 Diabetic Patients Who Applied To The Family Medicine Diabetes Outpatient Clinic

Rational Drug Use in Type 2 Diabetic Patients Who Applied To The Family Medicine Diabetes Outpatient Clinic

Swamedig Prototype: The Integrating Application for Interprofessional Practice of Pharmacists, Nurses, and Midwives

Related to the participating of midwives and nurses in the self-medicate by community outside of pharmacist supervision, since the public is more able to expect improper medication. Instead of efforts to eliminate the involvement of both stakeholders, employing the information system that integrates interprofessional practice with pharmacists will be a suitable deal. After that we carried out a literature review by searching several national publications related to the development of online self-medication applications, flowcharts were compiled using web-based online diagramming software; draw.io. Microsoft Office Power Point version 2019 was used to create the user interface. The prototype outcomes were displayed in a scientific discussion board for pharmacy students, and members granted reviews and feedback. Here in, we show our “Swamedig” prototype, the integrating application for interprofessional practice of pharmacists, nurses, and midwives. Our prototype is an application integrating interprofessional practice of pharmacists, nurses, and midwives. The program connects them in collaboration of expertise to support the community taking self-medication. The core of our menu, pharmacists supervising drug selection and administration based on assessments performed by nurses and midwives. Thus, our project is developed to realize the rational drug use. In addition, our prototype was ready for the next stage on the engineering to complete the software development process.

A patient-centered approach can improve rational drug use. A cross-sectional study

A patient-centered approach can improve rational drug use. A cross-sectional study

Multiomics profiling of the therapeutic effect of Dan-deng-tong-nao capsule on cerebral ischemia-reperfusion injury

BackgroundStroke is a complex physiological process associated with intestinal flora dysbiosis and metabolic disorders. Dan-deng-tong-nao capsule (DDTN) is a traditional Chinese medicine used clinically to treat cerebral ischemia-reperfusion injury (CIRI) for many years. However, little is known about the effects of DDTN in the treatment of CIRI from the perspective of gut microbiota and metabolites. PurposeThis study aimed to investigate the regulatory roles of DDTN in endogenous metabolism and gut microbiota in CIRI rats, thus providing a basis for clinical rational drug use and discovering natural products with potential physiological activities in DDTN for the treatment of CIRI. MethodsThe chemical composition of DDTN in vitro and in vivo was investigated using ultra-high performance liquid chromatography-high resolution mass spectrometry (UHPLCHRMS), followed by target prediction using reverse molecular docking. Secondly, a biological evaluation of DDTN ameliorating neural damage in CIRI was performed at the whole animal level. Then, an integrated omics approach based on UHPLCHRMS and 16S rRNA sequencing was proposed to reveal the anti-CIRI effect and possible mechanism of DDTN. Finally, exploring the intrinsic link between changes in metabolite profiles, changes in the intestinal flora, and targets of components to reveal DDTN for the treatment of CIRI. ResultsA total of 112 chemical components of DDTN were identified in vitro and 10 absorbed constituents in vivo. The efficacy of DDTN in the treatment of CIRI was confirmed by alleviating cerebral infarction and neurological deficits. After the DDTN intervention, 21 and 26 metabolites were significantly altered in plasma and fecal, respectively. Based on the fecal microbiome, a total of 36 genera were enriched among the different groups. Finally, the results of the network integration analysis showed that the 10 potential active ingredients of DDTN could mediate the differential expression of 24 metabolites and 6 gut microbes by targeting 25 target proteins. ConclusionThis study was the first to outline the landscapes of metabolites as well as gut microbiota regulated by DDTN in CIRI rats using multi-omics data, and comprehensively revealed the systematic relationships among ingredients, targets, metabolites, and gut microbiota, thus providing new perspectives on the mechanism of DDTN in the treatment of CIRI.

Assessment of prescription pattern and impact of statin in lipid profile among ischemic heart disease patients.

Analysis of prescription patterns and lipid profiles can play a crucial role in rational drug use and patient safety. This study aimed to analyze the prescription pattern and impact of statin in lipid profile among ischemic heart disease (IHD) patients. A prospective observational study was conducted for 7 months in the cardiology department. IHD patients above 18 years and undergoing statin therapy for at least 3 months were enrolled. Patients with elevated liver enzymes and unfit for statin therapy, pregnant women, psychiatry patients, and critically ill subjects were excluded. Of the total participants, 214 (71.8%) were males and 84 (28.2%) were females, with a mean age of 62.55 ± 9.56 years. The most common age group diagnosed with IHD was between 60 and 69 years. Hypertension was observed in 64.4% of the patients, while diabetes was present in 55.7% as the most commonly associated comorbidities. The majority of patients (75.8%) received atorvastatin. The prescription pattern for various drug classes included proton pump inhibitors (93%), antiplatelet agents (82.2%), statins (82.2%), nitrates (60.4%), beta-blockers (34.6%), diuretics (16.8%), biguanides (17.4%), and insulin (15.1%). After 3 months of statin therapy, a statistically significant change was observed in the lipid profile (P < 0.001). Statin agents were the most frequently prescribed class of drugs, followed by antiplatelets. Significant improvements were observed in the lipid profile after a 3-month course of statin therapy. Effective therapeutic monitoring can significantly impact a positive health outcome in patients.

Evaluation of Drug Prescription using WHO Prescription Indicators at a Tertiary Care Teaching Hospital, Raipur Chhattisgarh, India: A Cross-sectional Study

Introduction: Prescription patterns significantly impact healthcare quality and patient outcomes. Evaluating these patterns using World Health Organisation (WHO) indicators helps identify areas for improvement and ensures rational drug use. The present study was conducted to evaluate prescription patterns via WHO indicators, aiming to uncover insights, identify discrepancies and enhance prescription quality within the institute for improved healthcare outcomes. Aim: To evaluate drug prescription patterns using WHO prescription indicators in the prescriptions of outdoor patients at a tertiary care teaching hospital in Chhattisgarh, India. Materials and Methods: A cross-sectional study was conducted in the Department of Pharmacology at Department of Pharmacology, Pt. J.N.M. Medical College, Raipur, Chhattisgarh, India, from July 15, 2023, to October 15, 2023 (a duration of 3 months), involving 1,000 outpatient prescriptions at Dr. Bhimrao Ambedkar Memorial Hospital (BRAM), Raipur, Chhattisgarh. Ethical clearance was obtained from the Institutional Ethics Committee (IEC) (No./MCI/Ethics/2023/45 Raipur, dated 12/07/2023). Data were collected using a digital form and analysed statistically. Parameters evaluated included the average number of medicines per prescription, the percentage of drugs prescribed by generic name, the percentage of prescriptions containing antibiotics, the percentage of prescriptions containing injections, and the percentage of drugs prescribed from the Essential Drug List (EDL). Descriptive statistics were used to summarise the data, and analysis was performed using Microsoft (MS) Excel 2021. Results: The present study included 1,000 prescriptions. A total of 4,320 medicines were prescribed across these prescriptions, with 2,853 (66.04%) prescribed by their generic name. Injections accounted for 483 (11.18%) prescriptions, while antibiotics were included in 663 (15.34%) prescriptions. Additionally, 2,973 (68.81%) medicines were prescribed from the EDL. The average number of medicines prescribed per prescription was 4.3. Conclusion: The study revealed that while certain aspects of prescription practices aligned with WHO indicators, notable discrepancies persisted. The percentage of antibiotics prescribed per prescription was in accordance with WHO guidelines. Strategic measures are needed to enhance prescription practices and align them more closely with WHO guidelines.

Этиологическая структура и антибиотикорезистентность возбудителей сепсиса у больных COVID-19

The purpose — to study the etiological structure and antibiotic resistance of sepsis pathogens in patients with COVID-19. Material and methods. A retrospective observational, uncontrolled study was conducted. We analyzed the results of an examination survey of 584 patients with severe and extremely severe forms of COVID-19 hospitalized at the Republic Clinical Infectious Diseases Hospital in Kazan from April 1, 2020 to October 1, 2022. Identification of the pathogen in blood and other biological materials was carried out using a Microflex LT Bruker mass spectrometer. The antibiotic sensitivity of the isolated bacterial strains was determined by the disk diffusion method using an ADAGIO analyzer (France). Results. Various types of bacteria were isolated from the blood of 76 (13%) patients with severe and critical forms of COVID-19, including: A. baumannii (23.7%), K. pneumoniae (19.7%), S. haemolyticus (19.7%), S. aureus (7.9%), E. faecium (11.8%), E. faecalis (7.9%), E. coli (3.9%), R. planticola (2.6%), P. aeruginosa (2.6%), S. pneumoniae (2.6%), S. maltophilia (1.3%), and B. cereus (1.3%). In 15 patients (19.7%) associations of 2–3 types of bacteria were isolated from the blood. A. baumannii isolates were resistant to carbapenems (94.5%), fluoroquinolones and aminoglycosides (100%), and trimethoprim-sulfamethoxazole (83.3%) strains. K. рneumoniae strains were resistant to carbapenems (60%), cephalosporins (cefixime, ceftazidime) (73.3%), fluoroquinolones (ciprofloxacin) (80%), aminoglycosides (60%), and semisynthetic penicillins (100%). 33.3% of S. aureus strains were resistant to trimethoprim-sulfamethoxazole, 16.7% — to oxacillin, erythromycin and gentamicin. Resistance of S. haemolyticus to trimethoprim-sulfamethoxazole was detected in 86.7%, to erythromycin — in 80%, to norfloxacin — in 50% of strains. 93.3% of S. haemolyticus strains were methicillin-resistant. 88.9% of E. faecium strains were resistant to ampicillin, 22.2% to tigecycline, 11.1% to linezolid. 50% of E. faecalis strains were resistant to norfloxacin, 16.7% of strains were resistant to amoxicillin, ampicillin and piperacillin. P. aeruginosa 50% of strains were resistant to levofloxacin. R. planticola was resistant to all antibiotics tested. S. maltophilia demonstrated sensitivity to co-trimoxazole only with increased exposure. Conclusion. Bacterial sepsis was diagnosed in 13% of severe and extremely severe patients with COVID-19. The etiological structure of sepsis includes a wide range of pathogens with a predominance of multi-resistant bacteria from the group of ESKAPE pathogens. Data on the etiological structure and antibiotic resistance of isolated pathogens should be taken into account for the rational use of antimicrobial drugs in the treatment of sepsis in patients with COVID-19.

Neratinib safety evaluation: real-world adverse event analysis from the FAERS database.

Neratinib has emerged as significant theraputic option for breast cancer treatment. However, despite its approval, numerous adverse drug events (ADEs) associated to it remain unrecognized and unreported. This study aims to mine and analyze the signals of ADEs related to neratinib from the US Food and Drug Administration Adverse Event Reporting System (FAERS) database, providing insights for safe and rational clinical use of drug. All the neratinib-related ADEs data were collected from FAERS database from the third quarter (Q3) of 2017 to the fourth quarter (Q4) of 2023. After standardizing the data, 4 disproportionality methods were used to assess the correlation between neratinib and ADEs. Of the 1,544 ADEs implicating neratinib as the primary suspected drug, a combined total of 48 preferred terms (PTs) and 10 system organ classes (SOCs) showed significant disproportionality accross all four algorithms simultaneously. These SOCs included gastrointestinal disorders (n = 2,564, ROR 7.14), general disorders and administration site conditions (n = 958, ROR 0.77) and injury poisoning and procedural complications (n = 474, ROR 0.58) among others. Upon comparison with the neratinib manual, 34 ADEs not documented in the manual were found at the PT level. Our study provide new real-world evidence for drug safety information of neratinib. While the majority of our findings were aligned with the information provided in the manual. We identified additional ADEs not previously documented. Consequently, further studies are needed to validate unreported ADEs to ensure the efficacy and safety of neratinib for patients.

Determining knowledge of antimicrobial therapy in practitioners (results of the KANT-IV project)

Objective. To determine the level of knowledge of doctors on the rational use of antimicrobial drugs in clinical practice and to compare with data of the previous stage of the study and results obtained from students in a parallel project. Materials and Methods. A multicenter questionnaire survey of practitioners with analysis of results – stage of KANT project (full name of the project – «Physicians’ (Students’) knowledge in antimicrobials usage») conducted in 2020–2023. Results. A total of 336 participants were surveyed in 5 centers (10 Russian regions: Belgorod, Novosibirsk, Rostov, Voronezh, Lipetsk, Sakhalin, Primorsky, Krasnodar, and Krasnoyarsk regions, Republic of Tatarstan). The average level of correct answers (LCA) for the whole questionnaire was 47.5% (taking into account the extended analysis of sub-items questions No. 8 and 9 – 46.8%). Doctors showed the best results in answering questions about the time interval during which the effectiveness of antimicrobial therapy is evaluated (LCA – 84.2%); about choosing the most rational action if antimicrobial therapy (AMT) has a positive clinical effect, but requires a long course of therapy (LCA – 72.6%); selection of rational diagnostic/treatment action in the diagnosis of acute tonsillitis or pharyngitis, in a case where etiologic diagnosis is required (LCA – 63.1%). The worst results were recorded in answering to the following questions: indication of the antimicrobial drug of choice in the treatment of various infections (LCA – 29.1%); the choice of auxiliary drugs in addition to the justified appointment of antimicrobial drugs in the treatment of bacterial infections of the respiratory tract for the entire period of the disease or in certain phases (LCA – 26.6% – 35.1%); indication of a combination of antimicrobial drugs that is irrational to prescribe in clinical practice due to a similar mechanism and/or spectrum of activity against pathogens (LCA – 24.4%). Significant differences were found between centers in a number of questions, between physicians in KANT-III and KANT-IV projects (p &lt; 0.001), and between physicians and students in a parallel project (KANT-IV students, LCA – 42.6%, p &lt; 0.001). Conclusions. An unsatisfactory level of physicians’ knowledge of AMT and choice of adjuvant agents, as well as appropriateness of antimicrobial combination was found. The authors believe there is a need for making more efforts in areas of increasing physicians’ compliance to clinical recommendations, expertise and quality control of pharmacotherapy, recruitment of clinical pharmacologists; to optimize the educational process in universities, to expand the scope and availability of additional educational programs within the system of continuous education, as well as to train physicians in using modern sources of scientific medical information.

Effect of High Altitude Environment on Pharmacokinetic and Pharmacodynamic of Warfarin in Rats.

High altitude environment affects the pharmacokinetic (PK) parameters of drugs and the PK parameters are an important theoretical basis for guiding the rational clinical use of drugs. Warfarin is an oral anticoagulant of the coumarin class commonly used in clinical practice, but it has a narrow therapeutic window and wide individual variation. However, the effect of high altitude environment on PK and pharmacodynamic (PD) of warfarin is unclear. The objective of this study is to investigate the effect of a high altitude environment on PK and PD of warfarin in rats. Rats were randomly divided into plain group and high altitude group and blood samples were collected through the orbital venous plexus after administration of 2 mg/kg warfarin. Warfarin concentrations in plasma samples were determined by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and PK parameters were calculated by the non-compartment model using WinNonlin 8.1 software. Meanwhile, the expression of PXR, P-gp and CYP2C9 in liver tissues was also determined by western blotting. The effect of high altitude environment on PD of warfarin was explored by measuring activated partial thromboplastin time (APTT) and prothrombin time (PT) values and then calculated international normalized ratio (INR) values based on PT. Significant changes in PK behaviors and PD of warfarin in high altitude-rats were observed. Compared with the plain-rats, the peak concentration (Cmax) and the area under the plasma concentration-time curve (AUC) increased significantly by 50.9% and 107.46%, respectively. At the same time, high altitude environment significantly inhibited the expression of PXR, P-gp and CYP2C9 in liver tissues. The results of the PD study showed that high altitude environments significantly prolonged PT, APTT and INR values. High altitude environment inhibited the metabolism and increased the absorption of warfarin in rats and increased the effect of anticoagulant effect, suggesting that the optimal dose of warfarin for patients at high altitude should be reassessed.

Optimising antidiabetic medication management for type 2 diabetes and renal dysfunction in Can Tho City, Vietnam.

The research aimed to delineate and investigate the utilisation of antidiabetic drugs in type 2 diabetes patients with kidney failure at a hospital in Can Tho City, Vietnam. The research analysed the use of antidiabetic drugs at various time points, determined the drug interaction rate, and evaluated the appropriate use of drugs and the relationship with the achievement of target blood glucose and HbA1c levels. A two-tailed Student's t-test was employed to compare continuous variables, an ANOVA test was used to assess multiple values, and an χ2 test was utilised to evaluate categorical variables. Insulin monotherapy was the predominant regimen for treating type 2 diabetes in patients with impaired kidney function. Metformin was the most prescribed oral medication. Approximately 85.78% of patients received safe and appropriate diabetes treatment. Statistical analysis revealed a significant relationship between achieving target blood glucose and HbA1c after 3 months and factors such as safe drug use and minimal drug interactions (p < 0.05). Patients with chronic kidney disease demonstrated better blood glucose control compared to those with acute kidney disease. The most common drug used for type 2 diabetes patients with impaired kidney function was insulin monotherapy, with usage increasing with the severity of chronic kidney disease. The chronic kidney disease group exhibited a higher rate of achieving target blood glucose and HbA1c compared to the acute kidney disease group. Rational, safe, and interaction-free drug use significantly contributed to better blood sugar control compared to less prudent medication choices.

Comparison of Imipenem Prescription Model in Imam Khomeini and Taleghani Educational Center of Urmia

Introduction: Drug utilization evaluation (DUE) studies are designed to evaluate the rational use of drugs. Our purpose in this study is to evaluate the pattern of Imipenem, a broad-spectrum antibiotic used in different parts of Imam Khomeini and Taleghani Educational Center of Urmia.&#x0D; Method and material: This is a cross-sectional and retrospective study. The study was conducted by reviewing medical records of 200 admitted patients who received Imipenem during March 2016 to 2017.&#x0D; Results: In the study Imipenem was prescribed most frequently for intra-abdominal infection in 71 cases (35.5%), 41cases (20.5%) respiratory infection, 31 cases (15.5%) urinary tract infection, 25 cases (12.5%) skin infection, 15 (7.5%) cases septicemia infection, 7 (3.5%) cases bone and neutropenic infection, endocarditis infection were reported in 3 cases (1.5%). The highest incidence was related to intra-abdominal infections. 61% of Talehgsni hospital patients and 46% of Imam Khomeini hospital patients received Imipenem less than a week. The used dose in all patients was between one to four grams per day and the frequency of use was not correct in 7% of Taleghani hospital patients and 23% of patients in Imam Khomeini hospital.&#x0D; Conclusion: Some AB combination was proved to be inappropriate to the guidline consedering the indication or the microorganism to be covered. It is necessary to take action to improve prescribing habit in order to reduce the unnecessary usage of antibiotic thus enhance rational antibiotic use.