Prescribing pattern of angiotensin receptor blocker: a study of errors and drug-drug interactions

Prescriptions comprising multi-drug therapy mostly illustrate the prescribing error. The phenomenon of error is bonded with human inaccuracy. The erroneous practice is observed in under developed countries like Pakistan, Bangladesh and also in developed ones. Consequently drug-drug interaction is one of the most common error associated with potentially serious adverse response even death. Accordingly the present study was conducted to assess the prevalence of prescribing errors and drug-drug interactions in out-patients receiving angiotensin receptor blockers. The study was done with population size one hundred fifty prescriptions obtained from different out-patient settings in Karachi. The prescriptions were screened for prescribing errors and risk factors for drug-drug interactions. Drug-drug interactions were recognized by Micromedex.2.0.Drug-Reax®database. The most common type of error was omission error. These errors were patient's age, weight and diagnosis found in 51.3%, 97.3% and 74% of prescriptions, respectively. The prevalence of drug-drug interaction was 38%. A total of 746 drugs were prescribed with an average of 5 drugs per prescription and 450 medication errors were detected. Majority of the interaction were moderate [19.33%], others were minor [14%] and major [6%] in severity. Patients who prescribed many drugs [more than 5 drugs in a while] had a higher risk of developing drug-drug interactions [OR=4.76; 95% CI=2.30-9.64; p=0.0001*].The study data reports the occurrence of prescribing errors in Karachi and also necessitate the need of clinical pharmacist's services in health care system. The step will help to minimize the risk factors by having the drug prescriptions reviewed by the pharmacists

Some novel piperidine analogues having strong alpha glucosidase inhibition

The idea of this study is based on the marvelous fact of nojirimycin and deoxy nojirimycin, naturally occurring from piperidine class and having their role as alpha glucosidase inhibitors. In the present work some hydroxyl piperidine analogues have been synthesized and analysed for their hypoglycemic effect through glucosidase inhibition owing to the structural resemblance with nojirimycin. The activity was done by spectral absorbance analysis using acarbose as standard. Two analogues [I and IV] were found to pose excellent activity having 87.4 and 54.7% inhibition respectively, hence strengthening the idea of studying piperidine analogiues as glucosidase inhibitors due to structural similarity with nojirimycin

Incidence of medication error associated with the use of beta-blockers in Pakistan

Medication errors [ME] are human errors, which are very frequent in cardiovascular patients and result in patient morbidity and mortality. This study was focused to evaluate the quality of prescriptions and to emphasize the placement of clinical pharmacist in health care team. This study was carried out in different outpatient settings of [in] Karachi, Pakistan. The study period was June'2011 till June'2012. Retrospective data was analyzed for the outpatients' prescription of beta blocker drugs. During the study, prescriptions [n=450] were collected from different outpatient settings of [in] Karachi, Pakistan. Prescription containing beta-blockers were analyzed for the essential elements to be mentioned in prescription. Drug-drug interactions were identified by the Micromedex.2.0 Drug-Reax database and severity of medication error was determined by NCCMERP Index. A total of 1627 medication errors were identified in 450 prescriptions. The most frequent error was not mentioning the patient's weight [95%], followed by missing diagnosis [79.4%] and drug-drug interactions [69.5%]. Twenty-two prescriptions were placed in the most severe category I [4.88%]. Average number of drugs per prescription was 4.76. Significant difference was observed [x[2]=52.418, p<0.05] using SPSS 19 for those prescription orders having more than 5 drugs with Beta-blockers. This indicates that the errors in prescription such as drug-drug interactions, wrong dose etc. was significantly increased with the number of drugs per prescription. Results showed that medication errors are very frequent in prescription written in outpatient setting of various hospitals and clinics in Karachi. This shows that the irrational prescribing is a common practice in developing countries. Placement of skilled pharmacist in the health care system is the only solution for avoidance of these medication related problems.

Emergence of resistance to fluoroquinolones among gram positive and gram negative clinical isolates

Fluoroquinolones are broad-spectrum antibiotics that are considered as first line drugs to treat infectious diseases. In order to find out useful fluoroquinolones, the antibiotic resistance of fluoroquinolones, namely, ofloxacin [OFL], ciprofloxacin [CIP], norfloxacin [NRF], enoxacin [ENX], pefloxacin [PFL] and levofloxacin [LVF] was investigated against ninety five clinical isolates that includes Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae and Proteus mirabilis. In vitro activity of these isolates was carried out by agar dilution method. All Staphylococcus aureus were sensitive to OFL at 2 microg/ml. About 6% isolates of Klebsiella pneumoniae were found to be resistance to LVF and ENX, 6% to CIP, OFL and PFL and none of the isolates were resistant to LVF and ENX. Percentage resistance of P. aeruginosa was found to be 4.35% to CIP, 7% to OFL and 2.2% to NRF, whereas 8.69% to ENX, 0% to PFL and 17.4% to LVF, respectively. The present study provides the data about the emergence of resistance to fluoroquinolones among gram positive and gram negative bacteria and strongly recommends the rational and appropriate use of these antibiotics