Rational Drug Use Research Articles

Acute effect of levodopa on orthostatic hypotension and its association with motor responsiveness in Parkinson's disease: Results of acute levodopa challenge test

ObjectiveLevodopa administration can induce or worsen orthostatic hypotension (OH) in patients with Parkinson's disease (PD). Understanding of acute OH post levodopa (AOHPL) is important for rational drug use in PD patients. Primary objective of this study was to investigate the incidence of AOHPL in PD patients. The secondary objectives were a) hemodynamic character of AOHPL; b) risk factors of AOHPL; c) relationship between motor responsiveness and blood pressure (BP) change. Methods490 PD inpatients underwent acute levodopa challenge test (LCT). Supine-to-standing test (STS) was done 4 times during LCT, including before levodopa and every hour post levodopa intake within 3 h. Patients were classified into two groups, AOHPL and non-AOHPL. A comprehensive set of clinical features scales was assessed, including both motor (e.g., motor response, wearing-off) and nonmotor symptoms (e.g., autonomic dysfunction, neuropsychology). Results33.1% PD patients had OH before drug, 50.8% the same subjects had AOHPL during levodopa effectiveness. PD patients who had better response to levodopa likely to have lower standing mean artery pressure (MAP) and severer systolic BP drop after levodopa intake. BP increased when the motor performance worsened and vice versa. Beneficial response was a risk factors of AOHPL (OR = 1.624, P = 0.017). ConclusionsAOHPL was very common in PD patients. We suggested that PD patients with risk factors should monitor hemodynamic change during LCT to avoid AOHPL following the introduction or increase of oral levodopa. The fluctuations of BP were complicated and multifactorial, likely caused by the process of PD and levodopa both.

Open a new epoch of arsenic trioxide investigation: ATOdb

Arsenic trioxide (ATO) is a great discovery in the treatment of acute promyelocytic leukemia (APL), which has been used in an increasing number of malignant diseases. Systematic integrative analysis will help to precisely understand the mechanism of ATO and find new combined drugs. Therefore, we developed a one-stop comprehensive database of ATO named ATOdb by manually compiling a wealth of experimentally supported ATO-related data from 3479 articles, and integrated analysis tools. The current version of ATOdb contains 8373 associations among 2300 ATO targets, 80 conditions and 262 combined drugs. Each entry in ATOdb contains detailed information on ATO targets, therapeutic/side effects, systems, cell names, cell types, regulations, detection methods, brief descriptions, references, etc. Furthermore, ATOdb also provides data visualization and analysis results such as the drug similarities, protein-protein interactions, and miRNA-mRNA relationships. An easy-to-use web interface was deployed in ATOdb for users to easily browse, search and download the data. In conclusion, ATOdb will serve as a valuable resource for in-depth study of the mechanism of ATO, discovery of new drug combination strategies, promotion of rational drug use and individualized treatments. ATOdb is freely available at http://bio-bigdata.hrbmu.edu.cn/ATOdb/index.jsp.

Rational Use of Drugs in the Complex Treatment of Bronchobstructive Syndrome in Children

Treatment of biofeedback in children and the complex use of drugs, that is, each drug must be pathogenetically justified, taking into account the individual characteristics of the child, and also based on knowledge of the mechanism of their action and pharmacokinetics. It is necessary to have a complex effect on individual links in the pathogenesis of broncho-obstructive syndrome in many cases, which justifies the use of complex drugs with a combined mechanism of action. Thus, the treatment of biofeedback in children is a responsible task for the pediatrician, which consists in the rational selection of drugs.

Sorafenib exhibits lower toxicity and comparable efficacy to sunitinib as a first-line treatment for metastatic renal cell carcinoma: A systematic review and meta-analysis.

To assess the safety and efficacy of sorafenib and sunitinib as first-line treatments for metastatic renal cell carcinoma (mRCC), to provide evidence-based support for clinical decision-making regarding rational drug use. Until May 10, 2023, a comprehensive search was conducted across PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov, China National Knowledge Infrastructure, and Wanfang databases to identify clinical studies comparing sorafenib with sunitinib as first-line treatment for mRCC. The literature was screened, data extracted, and quality evaluated independently by 2 researchers. Meta-analysis was conducted using Revman5.4 software. A total of 3741 patients were enrolled in 20 studies. The meta-analysis results indicated that there were no significant differences in the 2- and 5-year progression-free survival (PFS) and overall survival (OS) rates between the sorafenib and sunitinib groups (P > .05). The disease control rate (DCR) was comparable between the 2 groups (P > .05), while the objective response rate (ORR) was higher in the sunitinib group (P = .03). However, subgroup analysis revealed no significant differences in ORR, DCR, 2- and 5-year PFS, and OS rates between sorafenib and sunitinib among both Asian populations as well as European and American populations (P > .05). In terms of drug-related adverse events, the incidence of grade ≥ 3 hypertension, leukopenia, neutropenia, thrombocytopenia, anemia, nausea and vomiting were significantly lower in the sorafenib group compared to the sunitinib group (P < .05). In the first-line treatment of mRCC, sorafenib exhibits comparable efficacy to sunitinib but with lower toxicity.

Drug use Pattern with Standard Indicators in Chattogram Medical College Hospital in Bangladesh

Irrational prescription being a global problem leading to ineffective, unsafe treatment. This study was conducted between November 10, 2019 to January 20, 2020 to assess drug use pattern using WHO/INRUD core prescribing indicators at Chattogram Medical College Hospital (CMCH). Total 500 patients were selected randomly. The results showed average number of drugs per encounter is 4.41 (optimal range = 1.6–1.8), generic drug prescription was 1.54% (optimal value = 100%), encounters with an antibiotic prescribed were 32.6% (optimal range =20.0–26.8%), encounters with an injection prescribed were 24.8% (optimal range =13.4–24.1%), drugs prescribed from EDL were 50.43% (optimal value = 100%) and drugs prescribed from the WHO EDL were 56.96% (optimal value = 100%). Average consultation time was 3.1 min (optimal value ≥10 min), average dispensing time was 35 s (optimal value ≥90 s) and the patients’ knowledge of correct dosage was 62.1% (optimal value =100%. The hospital had no copy of EDL and key drugs available in the stock were 82% (optimal value =100%). The concept of generic prescribing was negligible. There was reduced prescription of drugs from the National List of Essential Medicines, the prescription of antibiotics and injections was slightly higher than normal. Shorter consultation and dispensing time may lead to inadequate information about the medication being given to patients and patients had little chance to obtain information about their treatment. This study necessitates we are in need of strict scrutiny on the prescribing method of our country. So, we can achieve the goal of rational use of drug.

Evaluation of Rational Drug Use Based on WHO/INRUD Core Drug Use Indicators in a Secondary Care Hospital: A Cross-Sectional Study in Western Uganda.

Rational drug use (RDU) promotes safe, efficient, and cost-effective utilization of medicines in hospital settings. The aim of this study was to assess rational drug use based on the World Health Organization (WHO) and the International Network for Rational Use of Drugs (INRUD) core drug use indicators. This prospective, descriptive, hospital-based cross-sectional study was conducted among patients attending the Outpatient Department of a secondary care hospital located in the Sheema District of Western Uganda. A total of 450 prescriptions were prospectively collected from eligible patients and subjected to evaluation by using the WHO/INRUD core drug use indicators (prescribing, patient care, and health-facility indicators). The average number of drugs prescribed per encounter was found to be 3.2 (optimal value=1.6-1.8). The percentages of drugs prescribed by their generic name (90.48%) and from the Essential Medicine List (96.23%) were close to the WHO reference (100%). The percentage of antibiotics (66.22%) and injections (25.22%) per encounter exceeded the WHO standards (antibiotics=20.0-26.8; injections=13.4-24.1). Among the patient-care indicators, the average consultation time (5.41 minutes), average dispensing time (131.03 seconds), percentage of medicines dispensed (76.11%), percentage of medicines adequately labeled (59.74%), and percentage of patients with dosage knowledge (49.50%) did not meet the WHO reference. Facility indicators such as the percentage of key medicines available in the stock (66.67%) did not conform to the WHO optimal value. The hospital made the EML hundred percent available to all practitioners. The study concludes that the prescribing, patient care, and health facility indicators at Sheema District Secondary Care Hospital deviate from the optimal values recommended by the WHO. Therefore, this study indicates a need for improvement on these indicators and a requirement for the ongoing educational initiatives focused on rational drug prescribing, dispensing, and patient use in order to comply with the standards set by the WHO.

Increased Pill Burden and Adverse Effects of Psychotropics Correlated with Poor Quality of Life and Medication Nonadherence: A Cross-sectional Drug Utilization Study at a Tertiary Care Hospital in Delhi during COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has led to an increase in mental health problems such as depression and anxiety. This study aims to investigate the prescribing pattern of psychotropic drugs in patients with common mental disorders which might be altered during the pandemic and also whether the pandemic could alter their quality of life (QOL) and medication adherence. After prior ethical approval, a descriptive cross-sectional drug utilization study (DUS) of 200 prescriptions was undertaken to evaluate the pattern of psychotropic drug usage as per WHO (World Health Organization)/International Network of Rational Use of Drugs (INRUD) guidelines. The correlation of the average number of drugs per prescription with QOL was observed. The correlation of adverse drug reactions (ADRs) with medication adherence was also analyzed. The average number of drugs per prescription during the pre-COVID-19 and COVID-19 period was estimated to be 2.48 and 2.96. The percentage of drugs prescribed by generic name in the two different periods (pre-COVID-19 and COVID-19) was 97.40 and 95.77%. The percentage of drugs prescribed from the list of essential medicines was 89.40 and 85.12%, respectively. The percentage of prescriptions with injections was 0.45% and 0.53%, respectively for the two periods. The QOL during the COVID-19 pandemic was found to be negatively correlated to the average number of drugs per prescription (correlation coefficient = -0.61) and medication adherence was found to be poor in patients who developed ADRs with the drugs prescribed (p-value of 0.001). In the tertiary care hospital described, rational drug prescribing was followed. Increase in the number of drugs per prescription was found to be associated with poor QOL and the development of ADRs led to medication nonadherence in the patients. Further studies with larger sample sizes are needed to confirm these results. How to cite this article: Kumar A, Halder S, Srivastava S, et al. Increased Pill Burden and Adverse Effects of Psychotropics Correlated with Poor Quality of Life and Medication Nonadherence: A Cross-sectional Drug Utilization Study at a Tertiary Care Hospital in Delhi during COVID-19 Pandemic. J Assoc Physicians India 2023;71(9):14-18.

Pharmaceutical care in the treatment of menstrual cycle disorders among women of reproductive age: rational choice and use of drugs

Pharmaceutical care in the treatment of menstrual cycle disorders among women of reproductive age: rational choice and use of drugs

Integration of metabolomics and machine learning revealed tryptophan metabolites are sensitive biomarkers of pemetrexed efficacy in non-small cell lung cancer.

Anti-folate drug pemetrexed is a vital chemotherapy medication for non-small cell lung cancer (NSCLC). Its response varies widely and often develops resistance to the treatment. Therefore, it is urgent to identify biomarkers and establish models for drug efficacy evaluation and prediction for rational drug use. A total of 360 subjects were screened and 323 subjects were recruited. Using metabolomics in combination with machine learning methods, we are trying to select potential biomarkers to diagnose NSCLC and evaluate the efficacy of pemetrexed in treating NSCLC. Furtherly, we measured the concentration of eight metabolites in the tryptophan metabolism pathway in the validation set containing 201 subjects using a targeted metabolomics method with UPLC-MS/MS. In the discovery set containing 122 subjects, the metabolic profile of healthy controls (H), newly diagnosed NSCLC patients (ND), patients who responded well to pemetrexed treatment (S) and pemetrexed-resistant patients (R) differed significantly on the PLS-DA scores plot. Pathway analysis showed that glycine, serine and threonine metabolism occurred in every two group comparisons. TCA cycle, pyruvate metabolism and glycerolipid metabolism are the most significantly changed pathways between ND and H group, pyruvate metabolism was the most altered pathway between S and ND group, and tryptophan metabolism was the most changed pathway between S and R group. We found Random forest method had the maximum area under the curve (AUC) and can be easily interpreted. The AUC is 0.981 for diagnosing patients with NSCLC and 0.954 for evaluating pemetrexed efficiency. We compared eight mathematical models to evaluate pemetrexed efficiency for treating NSCLC. The Random forest model established with metabolic markers tryptophan, kynurenine and xanthurenic acidcan accurately diagnose NSCLC and evaluate the response of pemetrexed.

A physiologically based pharmacokinetic model to optimize the dosage regimen and withdrawal time of cefquinome in pigs.

Cefquinome is widely used to treat respiratory tract diseases of swine. While extra-label dosages of cefquinome could improve clinical efficacy, they might lead to excessively high residues in animal-derived food. In this study, a physiologically based pharmacokinetic (PBPK) model was calibrated based on the published data and a microdialysis experiment to assess the dosage efficiency and food safety. For the microdialysis experiment, in vitro/in vivo relative recovery and concentration-time curves of cefquinome in the lung interstitium were investigated. This PBPK model is available to predict the drug concentrations in the muscle, kidney, liver, plasma, and lung interstitial fluid. Concentration-time curves of 1000 virtual animals in different tissues were simulated by applying sensitivity and Monte Carlo analyses. By integrating pharmacokinetic/pharmacodynamic target parameters, cefquinome delivered at 3-5 mg/kg twice daily is advised for the effective control of respiratory tract infections of nursery pig, which the bodyweight is around 25 kg. Based on the predicted cefquinome concentrations in edible tissues, the withdrawal interval is 2 and 3 days for label and the extra-label doses, respectively. This study provides a useful tool to optimize the dosage regimen of cefquinome against respiratory tract infections and predicts the concentration of cefquinome residues in edible tissues. This information would be helpful to improve the food safety and guide rational drug usage.

GAMBARAN KESESUAIAN PERESEPAN TERHADAP KETERSEDIAAN OBAT PUSKESMAS X DI BANJARMASIN SELATAN PERIODE DESEMBER 2021

Appropriateness of prescribing with the availability of medicine is a cycle that influences each other with the rational use of drugs. Rational prescribing is if the patient receives treatment appropriately in doses, in periods, and at affordable cost according to his clinical needs. This study aims to describe the appropriateness of prescriptions for medicine availability at the Public Health Center X in South Banjarmasin for the period of December 2021. This type of research uses a retrospective descriptive method with samples was take by random sampling. The results showed that of the 328 prescriptions, there was an inappropriate with the type of drug found as much as 29.57%, with the drug strength found as much as 12.50%, with the dosage form found as much as 1.52%, with the duration of administration was found to be 1.22%, for the route of drug administration it had 100% appropriate. The results of this study indicate that the incompatibility of the type of drug has the highest percentage, namely 29.57%.

Assessment on the Pattern of Drug Information Queries in a Tertiary Care Hospital, Chennai

The drug information services help to assist healthcare workers to address patient-specific drug-related needs and promote rational drug use. The objective of the study is to assess the pattern of drug information queries in a tertiary care hospital from the Physician, Nurses, Pharmacists, Students, and other healthcare professionals. In one year, the drug information queries have been received, documented and retrospectively analyzed for various parameters including the professional status of the requestor, mode of receipt and reply, type and purpose of query, and reference details. Out of 588 queries received, the majority were answered by Physicians (n=468; 79.59%), followed by Pharmacists (n=55; 9.35%), Nurses (n=15; 2.55%), also Technicians (n=9; 1.53%), Students (n=21; 3.58%), Patients (n=3; 0.5%) and other health care professionals (n=17; 2.90%). The secondary resources (Micromedex/Medscape) were used majorly, followed by Textbooks (n=117; 19.89%), Internet (n=103; 17.51%), Journals (n=23; 3.9%) and others (n=5; 0.85%). The most common drug-related query was Pharmacological drug profile (n=149; 25.34%) and including Product identification (n=132; 22.44%), Product Information (n=84; 14.28%), Adverse Drug Reactions (n=74; 12.58%), Therapeutic uses (n=55; 9.35%) and others (n=94; 15.98%). Drug Information Services has been developed to promote rational prescribing patterns among prescribers, reduce medication errors and provide better clinical outcomes.&#x0D; Keywords: Drug Information Centre (DIC), Query, Drug Information Services, Patient care, Tertiary Care Hospital, Clinical Pharmacist.

Evaluation of the Efficiency of the Lesson on Rational Drug Use Given to University Students

Akılcı ilaç kullanımı, koruyucu ve tedavi edici role sahiptir. Bu çalışmada üniversite öğrencilerine verilen akılcı ilaç kullanımı dersinin&#x0D; etkinliğinin değerlendirilmesi amaçlandı. Yarı deneysel olarak planlanan çalışma Şubat-Mayıs 2022 tarihleri arasında Doğu Karadeniz&#x0D; bölgesinde bir üniversitede yapıldı. Sağlık bilimleri fakültesinde okuyan, akılcı ilaç kullanımı dersine devam eden ve veri toplama araçlarını&#x0D; tam olarak dolduran 81 öğrenci çalışmaya dahil edildi. Veri toplama aracı olarak Kişisel Bilgi Formu ve Akılcı İlaç Kullanımı Ölçeği (AİKÖ)&#x0D; kullanıldı. Tanımlayıcı istatistikler için sayı, yüzde, sürekli değişkenler için ortalama (X) ± standart sapma (SS) minimum-maksimum&#x0D; kullanıldı. Ön ve son değerlendirme test sonuçları analizi için Wilcoxon işaretli sıralar testi kullanıldı. Öğrencilerin bazı özellikleri ile ölçek&#x0D; puanlarını karşılaştırmada Mann Whitney U testi ve Kruskal Wallis testi kullanıldı. Öğrencilerin yaş ortalaması 21,59±1,23 (min=19,&#x0D; max=26) olup kız öğrencilerin oranı %60,5’tir. Öğrencilerin ön test AİKÖ toplam puanı 35,35±4,37 (min=21, max=42) iken, son test&#x0D; AİKÖ toplam puanı 37,23±3,84 (min=24, max=42)’tür. Ön ve son test AİKÖ toplam puanları karşılaştırıldığında fark istatistiksel olarak&#x0D; anlamlı bulundu (z=-3,547, p

Rational use of drugs to alleviate adverse outcomes caused by COVID-19 quarantine in women with intrahepatic cholestasis of pregnancy.

This study aimed to investigate the impacts of home quarantine on pregnancy outcomes of women with intrahepatic cholestasis of pregnancy (ICP) during the COVID-19 outbreak and whether the rational use of drugs will change these impacts. This multi-center study was conducted to compare the pregnancy outcomes in women with ICP between the home quarantine group and the non-home quarantine group in southwest China. Propensity score matching was performed to confirm the pregnancy outcomes of the medication group and the non-medication group in women with ICP during the epidemic period. A total of 3,161 women with ICP were enrolled in this study, including 816 in the home quarantine group and 2,345 in the non-home quarantine group. Women with ICP in the home quarantine group had worse pregnancy outcomes, such as a growing risk of gestational diabetes mellitus A1, fetal growth restriction, pre-eclampsia, preterm delivery, and even stillbirth. Drug therapy could alleviate some adverse pregnancy outcomes caused by home quarantine, including pre-eclampsia, preterm delivery, and meconium-stained amniotic fluid. COVID-19 quarantine would increase the incidence of ICP and lead to adverse pregnancy outcomes in women with ICP. The rational use of drugs reduced some obstetrical complications and improved partial pregnancy outcomes. Our findings suggested that the government and hospitals should enhance their management and life guidance for women with ICP and speed up developing home quarantine guidelines.

Incidence and risk factors for polypharmacy among elderly people assisted by primary health care in Brazil

BackgroundPolypharmacy is recognized as a global public health problem and one of the greatest challenges related to the aging population. Few studies have investigated the incidence and risk factors for polypharmacy among elderly individuals. These studies provided important information on the issue but were developed in high-income countries. This study investigates the incidence and risk factors for polypharmacy among elderly people assisted by primary health care over a period of 11 years.MethodsThis was a census-based prospective longitudinal study that included people aged 60 years or older living in a small municipality in the state of Rio Grande do Sul, Brazil. The baseline occurred in 2010 and the second wave of the study occurred in 2021. The study population consisted of elderly individuals who did not use polypharmacy at baseline and were reinterviewed in 2021 (N = 128). Data collection in the first and second waves was performed through a household survey using a structured questionnaire. The dependent variable was polypharmacy, defined as the simultaneous use of 5 or more drugs. The independent variables included sociodemographic, health and functionality factors. For multivariate analyses, Poisson regression with robust variance was used, estimating the relative risk and 95% confidence intervals.ResultsThe incidence of polypharmacy was 46.1% in the 11-year period. The highest number of health problems was a risk factor for polypharmacy (RR = 1.177; 95% CI 1.093–1.267).ConclusionsThe incidence of polypharmacy among elderly people assisted in primary health care in Brazil is high. The number of diseases is a risk factor for polypharmacy. These results have implications for future primary health care practices and may support the development of policies, actions and services aimed at reducing polypharmacy and promoting the rational use of drugs in the population at higher risk.

Knowledge, attitude and practices of self-medication and rational drug use habits among medical students in Madinah city

Knowledge, attitude and practices of self-medication and rational drug use habits among medical students in Madinah city

Mechanism of Mongolian drug Naru-3 in initiation of neuroinflammation of neuropathic pain from MMP9/IL-1β signaling pathway

Neuropathic pain(NP) has similar phenotypes but different sequential neuroinflammatory mechanisms in the pathological process. It is of great significance to inhibit the initiation of neuroinflammation, which has become a new direction of NP treatment and drug development in recent years. Mongolian drug Naru-3 is clinically effective in the treatment of trigeminal neuralgia, sciatica, and other NPs in a short time, but its pharmacodynamic characteristics and mechanism of analgesia are still unclear. In this study, a spinal nerve ligation(SNL) model simulating clinical peripheral nerve injury was established and the efficacy and mechanism of Naru-3 in the treatment of NPs was discussed by means of behavioral detection, side effect evaluation, network analysis, and experimental verification. Pharmacodynamic results showed that Naru-3 increased the basic pain sensitivity threshold(mechanical hyperalgesia and thermal radiation hyperalgesia) in the initiation of SNL in animals and relieved spontaneous pain, however, there was no significant effect on the basic pain sensitivity threshold and motor coordination function of normal animals under physiological and pathological conditions. Meanwhile, the results of primary screening of target tissues showed that Naru-3 inhibited the second phase of injury-induced nociceptive response of formalin test in mice and reduced the expression of inflammatory factors in the spinal cord. Network analysis discovered that Naru-3 had synergy in the treatment of NP, and its mechanism was associated with core targets such as matrix metalloproteinase-9(MMP9) and interleukin-1β(IL-1β). The experiment further took the dorsal root ganglion(DRG) and the stage of patho-logical spinal cord as the research objects, focusing on the core targets of inducing microglial neuroinflammation. By means of Western blot, immunofluorescence, agonists, antagonists, behavior, etc., the mechanism of Naru-3 in exerting NP analgesia may be related to the negative regulation of the MMP9/IL-1β signaling pathway-mediated microglia p38/IL-1β inflammatory loop in the activation phase. The relevant research enriches the biological connotation of Naru-3 in the treatment of NP and provides references for clinical rational drug use.

Analysis of Adverse Drug Reaction Reports from a Public Hospital in Shanxi Province in 2022.

Through analyzing the characteristics and influencing factors of adverse drug reactions/adverse events (ADR/ADE) in a hospital to promote rational drug use in the clinic. A total of 1221 ADR/ADE reports collected from a hospital in 2022 were retrieved through the National Adverse Drug Reaction Monitoring Center. The effective reports were screened according to the Guiding Principles for Collection and Reporting of Individual Adverse Drug Reactions, and classified the standardized drugs. The systems/organs and main clinical symptoms affected by ADR/ADE were classified according to the WHO Glossary of Adverse Drug Reaction Terms. The severity, age and gender, occupational distribution, drug category, route of administration, drug dosage form, system/organ involved, and main clinical symptoms of ADR/ADE reports were analyzed. Among 1221 ADR/ADE reports, 890 cases (75.27%) reported by doctors; 144 cases (11.79%) were serious; Precisely 49.22% of ADR/ADE occurred in patients aged 51 to 70 years old; The highest incidence of adverse reactions was 636 cases (52.09%) by intravenous infusion, 406 cases (33.25%) by oral administration. The top categories of reported cases were anti-infective drugs (29.40%) and anti-tumor drugs (27.52%); Systems/organs involved in ADR/ADE were mainly the skin and its accessories (24.96%) and blood system (21.35%). 166 cases were cured, 893 cases were symptomatic, 160 cases were unknown, and 2 cases had sequelae. The occurrence of ADR/ADE is related to many influencing factors such as age, drug categories, and route of administration. Therefore, it is recommended that hospitals strengthen the monitoring of ADR/ADE, especially the elderly, anti-infective drugs and intravenous administration.

A Study of Drug Use in the Outpatient Pediatric Department of a Tertiary Care Hospital in Jammu and Kashmir

BACKGROUND&#x0D; The health care system around the world is concerned about rational drug use. To achieve this goal, the more vulnerable pediatric population necessitates additional attention. The study's objectives were to determine the most prevalent diseases and medications administered, as per WHO recommendations, by looking at prescription trends and the ailments for which they were prescribed.&#x0D; Objective&#x0D; The objective of this study was to find drug use in the outpatient pediatric department of a tertiary care hospital in Jammu and Kashmir.&#x0D; METHODS&#x0D; This four-month prospective study was undertaken in the paediatrics department of a tertiary care hospital in Jammu and Kashmir. The Institutional Ethical Committee gave its nod to the investigation, which was then carried out. The parent's or guardian's consent was obtained after discussion and explanation. The patient's and the prescriber's privacy were protected. Every pediatric prescription (from newborn to 12 years old) from the outpatient, inpatient, and critical care units was included in the research.&#x0D; RESULTS&#x0D; There were 498 prescriptions in total that were randomly collected and studied. There were a total of 1895 prescriptions, with an average of 4.01 per encounter. Prescriptions from the WHO's essential drug list (666) accounted for 35.14 percent of all prescriptions. There were 397 prescriptions written for antibiotics in total. A total of 79.72 percent of patient encounters involved an antibiotic prescription. The prescribed injections were used in 26.2% of the encounters.&#x0D; CONCLUSION&#x0D; With all the indicators, this study gives a positive outlook on drug use, especially for those on the EDL (Essential Drug List). It is possible to improve health care through regular auditing, continuous medical education, and evidence-based medicine (EBM). Drug prescribing patterns in a pediatric outpatient department have been analyzed in this research. To summarize, the role of the clinical pharmacist is critical in pediatrics, both as an integral part of the care team and in clearing up any confusion about the appropriate use of medications. As a pediatric patient, proper drug management is even more critical than for an adult. The prescribing patterns were improved, substantial issues with patients' or caretakers' grasp of consultant instructions were found, and even the financial burden on the patient was lessened with the aid of the WHO core indicators.

Characteristic analysis of adverse reactions of five anti-TNFɑ agents: a descriptive analysis from WHO-VigiAccess.

Introduction: Tumor necrosis factor (TNF) inhibitors (adalimumab, infliximab, etanercept, golimumab, and certolizumab pegol) have revolutionized the treatment of severe immune-mediated inflammatory diseases, including rheumatoid arthritis, Crohn's disease, psoriatic arthritis, ankylosing spondylitis, and ulcerative colitis. This study assessed adverse drug reactions (ADRs) after the use of TNFα inhibitors in VigiAccess of the World Health Organization (WHO) and compared the adverse reaction characteristics of five inhibitors to select the drug with the least risk for individualized patient use. Methods: The study was a retrospective descriptive analysis method in design. We sorted out five marketed anti-TNFα drugs, and their ADR reports were obtained from WHO-VigiAccess. Data collection included data on the age groups, sex, and regions of patients worldwide covered by ADR reports, as well as data on disease systems and symptoms caused by ADRs recorded in annual ADR reports and reports received by the WHO. By calculating the proportion of adverse reactions reported for each drug, we compared the similarities and differences in adverse reactions for the five drugs. Results: Overall, 1,403,273 adverse events (AEs) related to the five anti-TNFα agents had been reported in VigiAccess at the time of the search. The results show that the 10 most commonly reported AE manifestations were rash, arthralgia, rheumatoid arthritis, headache, pneumonia, psoriasis, nausea, diarrhea, pruritus, and dyspnea. The top five commonly reported AE types of anti-TNFα drugs were as follows: infections and infestations (184,909, 23.0%), musculoskeletal and connective tissue disorders (704,657, 28.6%), gastrointestinal disorders (122,373, 15.3%), skin and subcutaneous tissue disorders (108,259, 13.5%), and nervous system disorders (88,498, 11.0%). The preferred terms of myelosuppression and acromegaly were obvious in golimumab. Infliximab showed a significantly higher ADR report ratio in the infusion-related reaction compared to the other four inhibitors. The rate of ADR reports for lower respiratory tract infection and other infections was the highest for golimumab. Conclusion: No causal associations could be established between the TNFα inhibitors and the ADRs. Current comparative observational studies of these inhibitors revealed common and specific adverse reactions in the ADR reports of the WHO received for these drugs. Clinicians should improve the rational use of these high-priced drugs according to the characteristics of ADRs.