ABSTRACT
Background: Beta blockers are known to cause attenuation of sympathetic stimulation mediated increase in cardiovascular parameters. Very few studies are available in Indian set-up comparing these changes between different beta blockers available in market. The objective of the study was to compare efficacy and safety of propranolol, atenolol and celiprolol on heart rare, blood pressure and airway resistance, both at rest and during exercise.Methods: A prospective interventional study was carried out involving 72 healthy volunteers in the clinical pharmacology laboratory. Participants were divided in three groups of 24 each and given single oral doses of propranolol 40 mg, Atenolol 50 mg and celiprolol 40 mg was given to the participants. Exercise given in the form of step ladder test and hand grip dynamometer and effect on the different parameters like HR, SBP, DBP and PEFR were recorded before and immediately after exercise and compared.Results: All the three drugs were effective in attenuating the exercise induced cardiovascular parameters (p <0.05). Drug A cause change in HR, SBP, DBP and PEFR significantly (p <0.05). Change in SBP was more significant with drug B while significant difference was found in HR, SBP and DBP before and after exercise in drug C in both SL and HGD tests. No significant difference was found between the drug groups (p >0.05). No adverse effects were reported in the study participants.Conclusions: All the three drugs are effective in attenuating cardiovascular changes after sympathetic stimulation like exercise and there was no significant difference among them.
ABSTRACT
Background: Most common ADRs associated with radiocontrast media are rash, fever, nausea, vomiting and shivering. Rarely life threatening anaphylaxis and acute hypersensitivity reaction may also occur. Very few studies are carried out in India focusing on this aspect. Aims & Objective: To study and report the Adverse Drug Reactions (ADR) caused by radio contrast media in a tertiary care teaching rural hospital. Material and Methods: Two hundred and fifty seven patients from Radiology department were observed for occurrence of adverse drug events (ADEs) from 01 Jul 2012 to 31 Jul 2012. ADEs were either spontaneously reported or elucidated from personal interviews were analysed. Results: Total 8 (3.11%) out of 257 patients who had undergone for ionic radio contrast dye investigation had a single event of ADR. Total occurrence rate of ADR is 3.11%. Most common ADR was rash followed by shivering, nausea, vomiting and fever with use of ionic contrast media. All Adverse Drug Reactions, according to WHO-UMC and Naranjo’s scale were of “probable” category. All the ADRs were at level-3 according to Modified Hartwig and Siegel severity scale. All the ADRs according to Modified Schumock and Thornton criteria for Preventability of an ADR are of “not preventable” category. All the ADRs were of “Bizarre” type. All the patients were treated with antihistaminic and steroids. Conclusion: It is recommended to use non-ionic contrast media instead of ionic media by all the health care professionals. Treatment with steroids and antihistaminic in patients who develop ADRs due to radiocontrast media can be effective.
ABSTRACT
Toxic Epidermal necrolysis (TEN) is a rare, life threatening dermatological disorder that is usually induced by medications. Anti-convulsants such as phenytoin, carbamazepine and phenobarbital have been enlisted as high risk drugs for causing TEN. A 25 year old man, a known case of epilepsy, who consumed inadvertently escalated daily dose of 600 mg/day of phenytoin for 10 days, developed TEN which involving more than 30% of body surface area with mucosal involvement. Rigorous treatment of 18 days using systemic and topical antibiotics along with glucocorticoids helped in complete recovery of the patient. Causality analysis of this Adverse Drug Reactions (ADR) showed a probable association on both World Health Organisation (WHO) – Uppsala Monitoring Centre (UMC) scale and Naranjo’s probability scale and Severity scale of 5 on Modified Hartwig and Siegel scale. Medication error is an important cause of such life threatening reactions which requires concern of all health care professionals.
ABSTRACT
Background: Cough and common cold are one of the commonest morbidities in the community. Cough and cold medicines are abound in Indian market despite the fact that majority of them lack scientific evidence of their use in this common condition. Aims & Objective: To analyze the prescribing pattern of ‘cough and cold’ medicines in Central Gujarat. Material and Methods: An observational, cross-sectional, questionnaire- based study was carried out to assess the prescribing pattern of doctors with regard to cough and cold. A total of 100 prescribers with a graduate degree (n=50) or a post-graduate degree (n=50) from Central Gujarat were selected randomly. After interviewing all doctors, data were analyzed to find the percentage of patients prescribed ‘cough & cold medicines’, their types of dosage form, use of FDCs, indications, any adverse events encountered and non-pharmacological measures advocated. Results: Prescribing FDCs for cough and cold was significantly higher (92% vs 72%, P<0.05) in post graduate prescribers attached to private hospitals than in graduate prescribers attached to government/teaching hospitals. Usage of solid dosage forms was significantly higher (p<0.05) in prescribers attached to government or teaching hospitals as compared to prescribers attached to private hospitals (84% vs 60%). About 18% of graduate and 25% of post graduate prescribers gave cough and cold medicines at patients’ behest. Only 15% prescribers prescribed cough and cold medicines for dry cough while antihistamines were advocated by 96% of prescribers. About 50% of the physicians prescribed these medicines for conditions like upper and lower respiratory tract infections. Non pharmacological measures were recommended by 75% prescribers. Conclusion: Efforts are needed to create awareness amongst prescribers about the rational use of cough & cold medicines and also pay attention to ADR caused by them. Reforms in medical education and CME are recommended.
ABSTRACT
Background: The benefits of optimum blood pressure (BP) control in patients with diabetes exceed the benefits of glycaemic control and extend to the prevention of both macro-vascular and micro-vascular complications in patients suffering from both hypertension and diabetes mellitus. Aims & Objective: To investigate the utilization patterns of anti-hypertensive drugs and to evaluate blood pressure (BP) control among diabetic-hypertensive patients with and without reduced renal function. Material and Methods: A prospective, observational study carried out at medicine department of SBKS Medical College and Research Centre, Piparia. The pattern of use of antihypertensive drugs in 50 hypertensive-diabetic patients was evaluated in correlation with its renal function and BP control achieved was compared in patients with and without reduced renal function. Results: Total 63 antihypertensive medication episodes were prescribed for 50 patients. Out of which 76% patients were receiving 1 drug, 22% receiving 2 drugs and 2% receiving 3 drugs of different antihypertensive class. Most patients were receiving Angiotensin-Converting-Enzyme-Inhibitors (ACE-I)/Angiotensin-Receptor-Blockers (ARBs) (60%), followed by CCBs (24%), beta-blockers (20%), and diuretics (16%). Patients on monotherapy were mostly receiving ACE-I/ARB (65.78%). Beta blockers were more commonly prescribed in patients with reduced renal function (p=0.005). BP control was achieved in 63.15% patients in monotherapy and 33.33% in polytherapy group. Control of systolic and diastolic BP was significantly higher in patients without reduced renal function than patients with reduced renal function (p<0.05). Conclusion: There was suboptimum use of combination therapy among diabetic-hypertensive patients in general and specifically in developing countries as reflected by control achieved in systolic and diastolic BP which requires concern of all healthcare professionals.