Evaluation of knowledge of Health Care Professionals on warfarin interactions with drug and herbal medicines

Objectives: To evaluate health care professionals' knowledge on warfarin interactions with drugs and herbs

Methods: A self-administered questionnaire was developed to assess health care professionals' knowledge on warfarin interactions with drug and herb. Respondents were asked to classify 15 drugs that may effect on warfarin action as "enhance", "inhibit ", "no effect". The study sample involved health care professionals [physicians, pharmacists and nurses] from king Salman hospital, Saudi Arabia

Results: About 92.2% of health care professionals identified warfarin interactions with aspirin, 4.4% for warfarin and fluoxetine .Warfarin and cardiac agents [atenolol] was correctly identified by 11.1% of respondents. In warfarin -herb interactions section, the majority of respondents [66.7%] identified the interaction between green tea and warfarin. Approximately one-third of respondents [n=33] correctly classified warfarin interactions with cardamom. No significant difference was found between the health care professionals [p=0.49] for warfarin-drug interactions knowledge score and p= 0.52 for warfarin- herb interactions knowledge score

Conclusion: This study suggests that health care professionals' knowledge of warfarin- drug-herb interactions was inadequate. Therefore, health care professionals should receive more education programs about drugdrug/ herb interactions to provide appropriate patient counseling and optimal therapeutic outcomes

Emerging frontiers of pharmacy education in Saudi Arabia: the metamorphosis in the last fifty years

The trends in the quality of biomedical education in pharmacy schools have witnessed significant changes in the 21st century. With the advent of continuous revision and standardization processes of medical curricula throughout the world, the focus has been on imparting quality education. This pedagogic paradigm has shifted to pharmacy schools. In Saudi Arabia, the concept of "medical and pharmacy education" is relatively new as mainstream pharmacy curriculum and universities were established only half a century ago. This period has seen major changes in the dimension of "pharmacy education" to keep pace with the education systems in the United States and Europe. As our knowledge and perceptions about pharmaceuticals change with time, this motivates educators to search for better teaching alternatives to the ever increasing number of enthusiastic and budding pharmacists. Recently, the academic system in Saudi Arabian Pharmacy has adopted a more clinically-oriented Pharm. D. curriculum. This paper deals with the major changes from the inception of a small pharmacy faculty in 1959, the College of Pharmacy at the King Saud University, Riyadh, to the model of progress and a prototype of pharmacy colleges in Saudi Arabia. The fifty year chronological array can be regarded as an epitome of progress in pharmacy education in Saudi Arabia from its traditional curriculum to the modern day Pharm. D. curriculum with a high population growth and expanding health care sector, the demand for qualified pharmacists is growing and is projected to grow considerably in the future. The number of pharmacy graduates is increasing each year by many folds and to meet the needs the system lays stress upon a constant revising and updating of the current curriculum from a global perspective

Preparation, In-vitro and In-vivo characterization of gliclazide / hydroxypropyl B-CD complexes and correlation with hypoglycemic effect

The effect of HP Beta-CD complexes on both pharmacokinetic and hypoglycemic parameters of gliclazide was evaluated and correli with in-vitro dissolution. The study involves the preparation of solid inclusion complexes of gliclazide [Gz] with hydroxypropyl beta-cyclodextrin [HP Beta-CD] using different techniques [recrystallization, kneading, neutralization and physical mixtures]. The prepared binary systems were subjected to X-ray diffraction [XRD] and infrared spectroscopy [IR]. Their dissolution behavior was evaluated using USP XXIV method. The dissolution performance of the various complexes appeared to be related to the preparation method of the solid system and showed significant enhancement for the kneaded and recrystallized systems. The plasma levels of Gz following oral administration of HP Beta-CD kneaded and recrystallized complexes to beagle dogs were found to be greater than those after administration of the drug alone. Pure Gz, recrystallized and kneaded complexes produced maximum plasma levels [Cmax] of 8.05, 16.00 and 16.30 micro/ml at 4.5, 4.3 and 3.2hours, respectively. The areas under the plasma concentration curve [AUC] of kneaded and recrystallized complexes were found to be 2.33 and 2.04 folds greater than that of Gz alone, respectively. The hypoglycemic activity was in the order of kneading > pure drug> recrystallization. The various measures of bioavailability correlated well with in-vitro tests, while neither in-vitro nor in-vivo adequately correlated with hypoglycenlic activity. In conclusion, recrystallized and kneaded complexes were the best in enhancing gliclazide dissolution characteristics and bioavailability. These enhancements have the potential of reducing inter-patient variability and decreasing the daily dose of Gz with little side effects

update on the management of manic depressive illness

Nearly 1% of adults in the united states suffer from manic-depressive illness [or bipolar disorder], a severe, chronic, and life-threatening disease. This disorder is divided into three stages as follows: acute mania, acute mania, acute depression, and maintenance. Lithium is the standard treatment for acute mania, and its effectiveness is solidly supported by experimental evidence. Over the past 40 years several studies including hundreds of patients have repeatedly shown the efficacy of lithium therapy, with approximately 80% of subjects responding favorably. However for those who do not respond, several other drugs have shown high success rates in well standardized trials. The anticonvulsant drug carbamazepine [CBZ] has been associated with improved symptoms in approximately 60 -70% of subjects in double-blind reials comparing it against placebo, neuroleptics, and/or lithium. Valproate [VPA] another another anticonvulsant drug has been shown to be comparable to lithium and superior to placebo in treating acute mania in several double-blind, placebo-controlled trials. In maintenance therapy clinical research has shown that lithium therapy lessens the frequency and severity of episodes of mania and depression in bipolar patients and helps stabilize mood between episodes. Furthermore, long-term lithium treatment reduces the risk of mortality of bipolar patients. Several other drugs have been studied as altematives or adjuncts to lithium therapy. Results from these studies have suggested that carbamazepine is similar in efficacy to lithium and significantly superior to placebo in the maintenance treatment of bipolar disorder. In addition, several open trials have reported moderate to good results with the combination of valproate and lithium or valproate alone. The purpose of this paper is to review the data supporting the use of CBZ and VPA for bipolar disorder, and where possible to compare them to lithium