International Journal of Hospital Pharmacy

  • A project work on role of clinical pharmacist in a haemovigilance unit of a tertiary care hospital

    Blood is a very important component of the human body. Blood constituents of about 7% of the total bodies’ weight. An average Adult body that is having a weight of 150-180 pounds will have approximately 4.7-5.5 liters of blood. Blood is a fluid connective tissue that circulate continuously around the body, allowing the constant communication between tissues that are far away from each other. It transports: •Oxygen from the lung to the tissues, and carbon dioxide from the tissues to the lungs or excretion. •Nutrients from the alimentary tract to the tissues, and cell wash-es to the excretory organ, principally the kidney. •Hormones secreted by endocrine glands to their target organs and tissues. •Protective substance like Antibodies like to the site of infection •Clotting factor that coagulates blood, minimizing bleeding from ruptured blood vessel. Blood Is composed of a clear, straw-colored, watery fluid called plasma in which there are several types of blood cell are sus-pended. Blood plays a very important role in transport of nutrition and re-spiratory gases, act as a vehicle to transport hormones and en-zymes from their place or origin to the place where it is required, drain waste products, maintaining hemostasis, regulation of body temperature and, most importantly, act as a defense mechanism for the body.

  • Case Report On Hemophilia

    Hemophilia is a bleeding disorder that results from congenital deficiency in a plasma coagulation protein. Hemophilia A is due to deficiency of factor VIII, whereas hemophilia B is due to factor IX deficiency. Hemophilia A & B are recessive X-linked diseases. In general, the disease affects only males, while females are carriers.This is a case of 86 year old male patient admitted in a medical ward with complaints of fever associated with chills and headache, burning micturition, hematuria since 15-20 days, patient also complaints of vomiting occasionally 4-5 times a day and generalized weakness since 1 month. Patient is a known case of hypertension since 5 years and on medication which is combination of amlodipine and atenolol. Patient is also a known case of hemophilia A diagnosed in childhood. Patient has a history of fall 10 years back since then he can’t walk. Patient was recently diagnosed with type 2 diabetes, perisplenic abscess, urinary tract infection, bilateral knee effusion from respective lab data. During the course of treatment, physicians and other health care professionals were advised to avoid use of NSAIDs, aspirin, IM injections, cannulas and suggested the physician regarding the use of cryoprecipitates when necessary and to monitor factors level. During the course of treatment, physicians and other health care professionals were also informed about medication error in the prescription and advised to use suitable drugs for the management of anemia. Patient was referred to other hospital for further evaluation. The main goal in the treatment of hemophilia is to control and prevent bleeding episodes. Treatment response can be monitored through clinical parameters, such as cessation of bleeding and resolution of symptoms.

  • EVALUATION OF DRUG USE PATTERN USING WHO PRESCRIBING INDICATORS

    Medicines are essential requirements for the optimal care of patients. Appropriate use of medicine is an essential element in delivering quality of life for patients and the community as a whole. The aim of this study was to assess the prescription patterns, rationality of analgesics and frequency of antibiotic use at the hospital, using WHO core drug use indicators. A total of 40 prescriptions were collected from a teaching hospital in South India. The majority of patients were male 26 (65%), with female representing 14 (35%) from surgery department, over a period of 2 months, among 40 prescriptions a total of 246 drugs were found. The average number of drugs per encounter was 6.15, 11 drugs (4.4%) were prescribed by generic name, 56 drugs (22.7%) were antibiotics, 55 drugs (22.3%) were analgesics, 176 (71.5%) were injectable preparations. All the medicines encountered during the study was found to be prescribed from Essential Drug List. 11 Analgesics (20%) were found to be irrational. Most commonly used Antibiotic was Metronidazole (13times). Frequency of antibiotic use was 0.2. Most commonly used Analgesic was Diclofenac (22times). Frequency of analgesic use was 0.4 .Concurrent administration of Antibiotic was found to be 19. From the study irrational prescribing patterns were identified.

  • To analyze the occurrence and profile of potential drug interactions in ICU patients at the Alcides Carneiro University Hospital

    Introduction: As drug associations without treatment of chronic diseases are very common, especially in intensive care unit (ICU) patients, however, they may cause drug interactions, such as those that are responsible for therapeutic failure, life-threatening of patients and generating high costs for the hospital. Objective: This study aimed to analyze the occurrence and profile of potential drug interactions in ICU patients at the Alcides Carneiro University Hospital. Methodology: a data collection performed from January to June 2015, based on ICU prescriptions. The data were collected through a specific form for this purpose. For the Drug-Reax system of the Micromedex® Health Series software. Results: Among the 109 prescriptions evaluated, 76 (69.72%) presented some interaction, totaling 244 potential interactions. Among the 54 (49.5%) male patients, 41 (75.92%) had a MI. A median of 6.91 prescription medications was observed. All patients who used 10 or more drugs had some type of interaction. Conclusion: It was possible to evaluate an average of prescription drugs, more prescription drugs and their interactions, based on the profile of interactive pharmacological potentials of the Alcides Carneiro University Hospital.

  • Selective Serotonin Reuptake Inhibitors Induced Serotonin Syndrome

    Serotonin syndrome also known as serotonin toxicity is a potentially life threatening syndrome that is precipitated due to excess serotonin within CNS. It results in variety of mental, autonomic and neuromuscular changes which ranges in severity from mild to fatal. It is nearly always caused by drug interaction involving two or more serotonergic drugs atleast one which is SSRIs. This is a case of 35- year- old female patient, admitted to hospital with 2 episodes of seizures, fever, headache, depression and was put on sodium valproate, clonazepam+escitalopram, paracetamol, sertraline. The patient medical history reveals that she is a known case of major depression and syncopal attack and was on escitalopram oxolate from 1 year. After two days of therapy patient developed tremors, restlessness, muscle rigidity, shivering and was clonus. On examination, variation in vitals was noticed and diagnosed as serotonin syndrome by review of medication chart sertraline was stopped and lorazepam was administered and patient showed good response and felt better. Proper education and awarness about drugs, drug-drug interaction causing SS its accuracy of diagnosis that prevents morbitiy and mortality in patients prescribed with SSRIs is of utmost importance.

  • Assessing the strengths and weaknesses of a computer assisted medication review in hospitalized patients

    Introduction Medication reviews are an essential part of daily routine at a hospital ward but are prone to mistakes. With this study we want to assess the strengths and weaknesses of a Clinical Decision Support System (CDSS) and evaluate the additional value on the reduction of medication errors compared with manual medication reviews. Materials and Methods We gathered all remarks related to (potential) errors in the current medication regime (notifications) regarding medication errors for 332 patients from 12 grand rounds of the internal medicine ward and orthopedic ward at the Maastricht University Medical Centre during four months. Simultaneously, we electronically extracted data regarding the patient’s medication list, laboratory data and patient characteristics and entered these data into our CDSS. Results and Discussion One hundred thirty-eight notifications were made during grand rounds. One-hundred and seventy-nine relevant alerts were reported by the CDSS. Only three of the relevant notifications were reported by both. Overall, errors regarding indication without medication and medication without indication were most frequently noticed during grand rounds and contraindications or side effects were most frequently noticed by the CDSS. The CDSS may be a relevant addition to the manual performed medication reviews in the hospital. The strength of the present CDSS lies in the detection of errors regarding contraindications and side effects. Future developments include optimizing the cut off values at which the CDSS should provide an alert is an important next step in improving the CDSS. Additionally, in order to increase notifications about indication without medication and medication without indication, the medical history should be incorporated into the CDSS. Finally, relevance on patient outcome should be determined.

  • Bioassay guided fractionation-an emerging technique influence the isolation, identification and characterization of lead phytomolecules

    Natural products have thus played an important role in drug discovery in the past and promise to provide still more drugs in the future. The search for a new drug from nature is based on a biological and ecological rationale. Natural products have provided many effective drugs. These include older drugs such as quinine and morphine and newer drugs such as paclitaxel, camptothecin, etoposide, mevastatin, and artemisinin. The discovery of novel drugs from nature is also important because many isolated molecules are quite complex, and would not be obtained by a simple synthetic approach. Most bioactive compounds of natural origin are secondary metabolites, i.e. species-specific chemical agents that can be grouped into various categories. A typical protocol to isolate a pure chemical agent from natural origin is bioassay-guided fractionation, meaning step-by-step separation of extracted components based on differences in their physicochemical properties, and assessing the biological activity, followed by next round of separation and assaying.

  • Simulated Cases in Clinical Training for Pharmacists

    Clinical classes are the milestones that help pharmacy students gain clinical competency and to prepare them for their professional life. Although didactic methods provide theoretical knowledge, the retention rate of information is relatively low when compared with problem based teaching methods. Simulators such as high fidelity mannequins or standardized simulated patients are often preferred by clinical teachers in schools that teach health profession. High and low fidelity mannequins, and computerized simulators require a cost and dedicated space, which can be a disadvantage. On the other hand, standardized patients are advantageous to develop communication skills. Hence, use of simulation based methods in clinical training are useful in general, because they lead students to self-directed learning strategies, critical thinking and rational decision-making. Therefore, dissemination of simulation techniques is important to improve clinical skills.

  • Total Quality Management Approach to Drug and Therapeutics Committee Guidelines in a Tertiary Care Government Hospital in Nepal

    Background: Drug and Therapeutics Committee (DTC) is the principal policy making and recommending body for Civil Service Hospital (CSH). Condition of no functional DTC and guidelines based on the concept of total quality management (TQM) continuously presented inconsistencies health care delivery system at CSH. The present study was carried out at CSH from March 2012 to October 2015. Objective: The present guidelines were targeted to the prescribers, pharmacists, and nurses for providing rational health care and disseminating uniform and state-of-art medicine information at CSH. Methods: The present study was carried out at CSH from March 2012 to October 2015. The FOCUS-PDCA concept of TQM included following nine aspects: F: Find role of DTC for the improvement in the existing practice; O: Organize trained team knowledgeable of the process; C: Clarify operational definitions of DTC; U: Understand functions of DTC; S: Select rules and regulations for DTC members; P: Plan improvement procedures through the DTC meeting; D: Do improvement in DTC process; C: Check and analyze the results or outcomes obtained from the implementation of DTC guidelines; A: Act to explore the extent and scope of the guidelines. Results: The present guidelines were developed based on the FOCUS-PDCA concept of TQM. DTC also developed quality assurance criteria, medicine information provision, pharmacovigilance center, pharmacoeconomic evaluation criteria and defined roles and responsibilities of the members. Conclusions: DTC guidelines were developed at GoN CSH, based on FOCUS-PDCA model of TQM approach. The guidelines were based on rational pharmacotherapeutics concepts.

  • An Assessment of Knowledge and Evaluation of Risk on Developing Type II Diabetes Mellitus- a Prospective Study

    Background: As per WHO definition Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Recent study estimates that there were 171 million people in the world with diabetes in the year 2000 and this is projected to increase to 366 million by 2030. WHO projects that diabetes will be the 7th leading cause of death in 2030. Aim: To identify and improve the level of knowledge in type II Diabetes and to evaluate risk of developing type II DM among non-diabetics attending tertiary care hospital. Methods: A qualitative observational interview based method was conducted out in a 450 bedded tertiary care hospital for a period of 6 months. Patient data was collected through structured form and evaluated using standard validated scales DKQ – 24 item questionnaire form and Type II Diabetes Risk Assessment form. All patients admitted with Type II DM with/ without co-morbidities in the age range of 18-70years will be selected. The patients with increased risk of developing Type II DM will also be evaluated. The patients who are not interested to participate in study or due to serious illness or impairment are excluded. Results: 150 patients enrolled for study of both having diabetic and non-diabetics. They were also carried out the post survey for assessment diabetic knowledge after patient counseling. Patient counseling along with leaflets were provided to patients with poor knowledge. Patient improved from (SD +/-8.63) average pre-score of knowledge to post-score (SD +/-2.505) with P