Potential drug-drug interactions among patient's prescriptions collected from medicine out-patient setting

Objective: To identify and evaluate the frequency, severity, mechanism and common pairs of drug-drug interactions [DDIs] in prescriptions by consultants in medicine outpatient department

Methods: This cross sectional descriptive study was done by Pharmacology department of Bahria University Medical and Dental College [BUMDC] in medicine outpatient department [OPD] of a private hospital in Karachi from December 2015 to January 2016. A total of 220 prescriptions written by consultants were collected. Medications given with patient's diagnosis were recorded. Drugs were analyzed for interactions by utilizing Medscape drug interaction checker, drugs.com checker and stockley's drug interactions index. Two hundred eleven prescriptions were selected while remaining were excluded from the study because of unavailability of the prescribed drugs in the drug interaction checkers

Results: In 211 prescriptions, two common diagnoses were diabetes mellitus [28.43%] and hypertension [27.96%]. A total of 978 medications were given. Mean number of medications per prescription was 4.6. A total of 369 drug-drug interactions were identified in 211 prescriptions [175%]. They were serious 4.33%, significant 66.12% and minor 29.53%. Pharmacokinetic and pharmacodynamic interactions were 37.94% and 51.21% respectively while 10.84% had unknown mechanism. Number wise common pairs of DDIs were Omeprazole-Losartan [S], Gabapentine- Acetaminophen [M], Losartan-Diclofenac [S]

Conclusion: The frequency of DDIs is found to be too high in prescriptions of consultants from medicine OPD of a private hospital in Karachi. Significant drug-drug interactions were more and mostly caused by Pharmacodynamic mechanism. Number wise evaluation showed three common pairs of drugs involved in interactions

Basic concepts of diabetes mellitus

Pakistan is at the seventh position on diabetes prevalence rates. Many risk factors are linked to the development of type 2 diabetes like increased body mass index [BMI], altered body lipids, increased blood pressure, smoking, less physical activity ,bad dietary habits, family history, and also some genes. Environmental factors together with a genetic tendency for diabetes set off an autoimmune response that causes damage of the pancreatic Beta-cells over prolong duration leading to type 1diabetes. Failure of Beta cell compensation for insulin resistance causes impaired glucose tolerance that can exhibit as type 2diabetes.Diabetes Mellitus either type 1 or type 2 can lead to various acute and chronic complications. Diagnosis can be made on levels of blood glucose concentration, urine ketone test, glycosylated hemoglobin [HbA1c], glycated serum protein and glycated serum albumin. Type 1 diabetic patients are directly given insulin. Patients with type 2 diabetes may be managed with diet and exercise. However when diet and exercise fail to control raised blood sugar level, an oral antidiabetic agent is started. This may be added with more drug[s] from the same family and or insulin depending upon the glycemic index of the patient.Type 2 diabetes is a progressive disease in which ultimately the function of Beta cells decreases, and eventually exogenous insulin may be required to maintain blood sugar level. This review thoroughly describes the prevalence, classification, etiology, pathophysiology,complications, diagnostic criteria and treatment of Diabetes Mellitus