Study of adverse drug reactions in a tertiary care hospital

Background: The objectives of the study were to evaluate incidence and preventability of adverse drug events (ADEs) and potential ADEs and to analyse preventable events to develop prevention strategies.Methods: The study was retrospective observational study conducted at a rural tertiary care hospital at Maharashtra, for 12 months. Patients of both gender and all age group were included in the study. These entire adverse drug reactions were reported either by the PVPI assistance and/or hospital staff and their severity and causality assessments was performed as per Naranjo’s and Hartwig’s assessment criteria respectively. Data was analyzed by using Microsoft Excel.Results: There were total 256 ADR (adverse drug reactions) were reported in 12 months from January 2018 to December 2018 in various departments of the study center. Most of the adverse drug reactions were reported among age group of 21–40 years patients. Rash and itching (69) were most commonly reported ADR’s. ART (31.25%), antibiotics (28.90%) were reported to induce maximum number of ADRs. Most of the adverse drug reactions were possible (194, 75.78%) and mild (208, 81.25%) in nature.Conclusions: The antibiotics, ART drugs were most common drugs to reported ADRs. The commonly reported reactions were rash and itching.

Study of drug prescription pattern in ischemic heart disease patients

Background: Drug utilization pattern studies helps to screen, assess and propose appropriate modifications in prescription practices, this would help to make patient care rational and cost effective. Study was intended to analyse the drug prescribing pattern for treatment of Ischemic heart disease using WHO indicators.Methods: This is a cross sectional observational study conducted on ischemic heart disease patients admitted at inpatient department of medicine in a tertiary care teaching hospital. The study consisted of analysis of drug utilization pattern of prescribed drugs.Results: IHD was more commonly seen in males (70.06%) than females (29.94%). IHD was most commonly seen in patients of age group of 61-70 year. Drugs prescribed to patients belong to various therapeutic classes ranging from anti-platelets, anticoagulants, anti-anginal, antithrombin, thrombolytic, hypolipidemics. The most commonly prescribed therapeutic class of drugs was antiplatelet (86.26%) followed by hypolipidemic (82.25%) and ACE inhibitors drugs (46.60%). Average number of drugs per encounter was 7.70. Drugs were prescribed by their generic names were 29.99%. Out of total study group 22.06% patients were prescribed at least one antibiotic. Injections were prescribed only in 1392 (27.86%) out of 4995 drugs. Of total drugs 3270 (65.45%) of drugs were from National List of Essential Medicines-2016 (NLEM -2016) and 2774 (55.53%) drugs prescribed were from WHO-EML-2016.Conclusions: Risk of artery disease increased with increasing age. IHD was more common in males than females. The most commonly prescribed drug classes in Ischemic heart disease were anti-platelet drugs followed by hypolipidemic agents.

Experimental evaluation of analgesic activity of PPAR γ agonists: pioglitazone and rosiglitazone.

Background: To evaluate analgesic activity of pioglitazone and rosiglitazone by tail flick method in rats and acetic acid induced writhing method in mice. Methods: Albino wistar rats of either sex weighing 180-200 g and Swiss mice weighing 25-30 g were used. Study was conducted after approval from the Institutional Animal Ethics Committee. The tail flick method in rats described by D’Amour and Smith (1941) and acetic acid induced writhing in mice were used. The dose of pioglitazone and rosiglitazone were 20 mg/kg and 10 mg/kg respectively. Results: In tail flick method of analgesia, both, pioglitazone and rosiglitazone have analgesic activity which was statistically comparable to aspirin. In acetic acid induced writhing model of analgesia, the action of pioglitazone and rosiglitazone was significantly greater than the control group but it was less when compared to aspirin. Conclusions: Analgesic activity of pioglitazone and rosiglitazone was comparable to aspirin in tail flick model of analgesia in rats while it was significantly less when compared to tramadol. Analgesic activity of pioglitazone and rosiglitazone was significantly less than aspirin in acetic acid induced writhing method.

A review of objective structured practical examination (OSPE) in pharmacology at a rural medical college.

Background: 1. To evaluate the attitudes of undergraduate medical students towards objectively structured practical examination (OSPE) component of Pharmacology practical examination. 2. To investigate any gender differences and any influence of medium of instruction in school on these attitudes. Methods: The scores of 40 undergraduate medical students were analysed at S R T R Government Medical College, Ambajogai, Maharashtra, India. A Likert scale containing 9 items was used to assess the attitudes of students towards OSPE in Pharmacology. Student perspectives regarding the OSPE were obtained by asking them to respond to a questionnaire. Results: The study revealed that the OSPE was an acceptable tool in Pharmacology practical examination. The overall mean attitude score was 3.99. The response of male students towards OSPE (4.2) was more favourable as compared to that of female students (3.9) Students strongly agreed that OPSE covers wide range of skills and it is a good form of examination and learning experience. Majority of students were in favour of continuing OSPE as a method for examination in Pharmacology. Conclusions: OSPE was found to be a valuable tool to check the depth of understanding of undergraduate students. OSPE can be used as an index of the learning attitude of students. The present study is a small step in a direction of changing the traditional patterns of practical examination to a more objective and reliable way of evaluation in Pharmacology. It will help in modifying teaching-learning strategies so that both, the teachers as well as the students can gain maximum advantage.

Drug utilization pattern in outpatient department of Government Medical College and C.P.R. Hospital, Kolhapur.

Background: Drug utilization studies are used to analyze different aspects of the use of drugs and to implement methods of improving therapeutic quality. This study was conducted to study drug prescription pattern in outpatient department of Government Medical College and C.P.R. Hospital, Kolhapur which is one of the important medical college in western Maharashtra. Methods: One thousand prescriptions were screened & analyzed as per the study parameters from OPD of Government Medical College & C.P.R. Hospital, Kolhapur. Study parameters like demographic profile of the patient like age, sex and diagnosis were recorded. Also groups of drugs commonly prescribed, number of drugs per patient, drug profile and drawbacks of prescription if any were recorded and analyzed. Results: Most common group of drugs prescribed by physicians was Analgesics (32.83%), followed by Antimicrobials (22.82%), Multivitamins (16.42%) and Antacids (9.14%). The average number of drugs prescribed per patient was four; the average number of analgesic was one. The incidence of polypharmacy was common occurrence and some prescriptions had small drawbacks like absence of diagnosis, absence of doctor’s signature, etc. Conclusions: We conclude that most of the prescriptions which were analyzed at R.C.S.M. Government Medical College and C.P.R. Hospital, Kolhapur, were according to the standard norms of WHO prescriptions and also most of the drugs prescribed were from the list of essential drug list. But still there is scope for improvement in prescription pattern.

Hypolipidemic and antioxidant activities of pioglitazone in hyperlipidemic rats.

Background: Diabetes mellitus (DM) is an endocrine disorder characterized by abnormal carbohydrate, lipid and protein metabolism along with specific long-term complications which are associated with hyperlipidemia and oxidative stress. Hence, it is important to find hypoglycemic drug that improves lipid profile and reduces oxidative stress in diabetic patient. This study, therefore, was performed to investigate hypolipidemic and antioxidant potential of Pioglitazone (PIO) in hyperlipidemic rats. Methods: Hyperlipidemia was induced in normal rats by including 0.75 gm% cholesterol and 1.5 gm% bile salt in normal diet and these rats were used for the experiments. PIO hydrochloride was administered as 10 mg/kg and 30 mg/kg dose levels to the hyperlipidemic rats. Hypolipidemic activity was estimated by plasma lipid profile parameters while antioxidant potential was estimated by ascorbic acid, catalase activity, malondialdehyde and superoxide dismutase activity using standard methods. Statistical analysis was done by one way analysis of variance (ANOVA) followed by Dunnett’s test. Results: Treatment with 10 mg/kg and 30 mg/kg dose levels of PIO hydrochloride resulted in a significant decrease in serum TG and VLDL only in 30 mg/kg PIO treated group and significant increase in serum HDL in both groups, but no significant decrease in cholesterol and LDL in both PIO treated groups. PIO increased activities of catalase enzyme and concentration of malondialdehyde significantly in only 30 mg/kg PIO treated group. But there were no significant changes in the superoxide dismutase activity and ascorbic acid concentration in both PIO treated groups. Conclusions: The present study demonstrated that treatment with 10 mg/kg and 30 mg/kg dose levels of PIO hydrochloride improves the plasma lipid profile and also reduces oxidative stress in hyperlipidemic animals.

Newer drugs in the management of diabetes mellitus.

Modern life style with present days technological advances have made human life sedentary. This is causing increasing prevalence of obesity and physical inactivity amongst population. The number of cases of diabetes worldwide in the year 2000 among adults 20 years of age is estimated to be 171 million in recent reports and is said to rise to more than 300 million by 2025. The raised plasma glucose levels give rise to complications in the form of microvascular and macrovascular complications diminished quality of life with reduced life expectancy. The currently available drugs used in the management of type II DM are not completely satisfactory in regard of controlling blood glucose level, many of the times they are associated with undesirable side effects. Hence there is continuous ongoing work in development of newer drugs, which are safe, efficacious and potent as well as free of undesirable effects such as sustained hypoglycaemia. Fortunately there are newer drug, few of them approved while other still knocking the door from the classes of drug such as GLP-1Mimetic, DPP-4 Inhibitors and others. Here we have tried to cover them in brief.

Lipid lowering and antioxidant potential of Asparagus racemosus in hyperlipidemic rats.

Background: Atherosclerosis is associated with hyperlipidemia which is a major risk factor for coronary artery disease. Therefore, treatment of hyperlipidemia is one of the major approaches to decrease the atherogenic process. Many studies revealed that Asparagus racemosus (AR) possesses hypolipidemic and antioxidant potential, but results were not consistent. Therefore, the present study was undertaken to investigate lipid lowering and antioxidant potential of AR root powder in hyperlipidemic rats. Methods: Hyperlipidemia was induced in normal rats by including 0.75 gm% cholesterol and 1.5 gm% bile salt in normal diet and these rats were used for the experiments. Dried root powder of Asparagus racemosus was administered as feed supplement at 5 gm% and 10 gm% dose levels to the hyperlipidemic rats. Plasma lipid profile, malondialdehyde, ascorbic acid, catalase and superoxide dismutase were estimated using standard methods. Statistical analysis was done by one way analysis of variance (ANOVA). Results: Feed supplementation with 5 gm% and 10 gm% Asparagus racemosus resulted in a significant decrease in plasma cholesterol, LDL and significant increase in HDL. But there were no significant decrease in triglycerides and VLDL. The feed supplementation increased activities of catalase, superoxide dismutase and ascorbic acid content increased significantly in both the experimental groups (5 and 10 gm% supplemented groups). But there was no significant change in the concentration of malondialdehyde in these groups. Conclusions: The present study demonstrated that addition of Asparagus racemosus root powder at 5 gm% and 10 gm% level as feed supplement reduces the plasma lipid levels and also acts as an antioxidant.