Pattern of antiepileptic drug utilization in epilepsy patients in outpatient departments of a tertiary care hospital

Background: Epilepsy is one of the common neurological disorders diagnosed early in life. Availability of many antiepileptic drugs (AEDs) makes it difficult to choose the appropriate pharmacotherapy. Aim and Objective: Understanding the pattern of AED prescription to evaluate the rationality of AED prescriptions in epileptic patients. Materials and Methods: This was a retrospective, observational study carried out at new civil hospital, Surat for a duration of 6 months. The study involved collecting data from the case files of all the patients irrespective of age or gender diagnosed with epilepsy and undergoing treatment from any of the outpatient departments of the hospital. Demographic details, clinical diagnosis, and detailed data about the prescribed pharmacotherapy were recorded in a pre-approved data sheet. The WHO prescribing indicators were evaluated for each prescription. Descriptive statistics was used. Results: The average age of the patients was 21.64 ± 10.46 years. A total of 1565 drugs were prescribed in the 331 epilepsy patients’ prescriptions. Out of this, 551 drugs (35.21%) were antiepileptics. Most of the patients received monotherapy (75.53%). The most commonly prescribed drug was sodium valproate (46.10%) followed by phenytoin (30.13%) and carbamazepine (10%). The average AED per prescription was 1.70. Majority of the prescriptions (94.63%) used generic names. There were no injectable used and no fixed dose combinations were prescribed in any of the patients. Conclusion: The prescriptions followed the rational prescribing pattern. Treatment of epilepsy is usually by monotherapy with valproate being the most commonly used AED. Prospective studies to evaluate adverse effects and patient compliance will help in efficient policy-making decisions.

Exploring the safe and rational use of Epimedii Folium based on the evolution of efficacy/toxicity records in ancient and modern literature / 药学学报

Epimedii Folium is a traditional non-toxic Chinese herbal medicine. However, liver injury caused by Chinese herb preparations, including Epimedii Folium, is frequently reported over the years. Based on ancient and modern literature, this paper systematically summarized and analyzed the safe application of Epimedii Folium from the perspectives of varieties, processing methods, clinical adverse reactions, pharmacological effects and toxic mechanism. Combined with our team work, we build the comprehensive prevention and control system "human-drug-application", for the safe and rational application of Epimedii Folium. This study is expected to provide support for scientific evaluation and precise prevention and control of the safety risk of Epimedii Folium.

Comparison of two analysis methods of opioid consumption sum in medical institutions / 中国药房

OBJECTIVE To compare the similarities and differences of the two methods in analyzing the use of opioids in third grade class A medical institutions and provide a reference for the management of opioids in medical institutions. METHODS Two methods， Defined Daily Dose （DDD） and Oral Morphine Equivalent （OME）， were used to count the opioid prescription data of five comprehensive medical institutions of third grade class A （named H1-H5） in Shanxi province in 2020， calculate consumption sum of opioid， annual per capita consumption sum， patient cost burden and drug consumption sum ratio， compare the index results presented by the two analysis methods， and explore the application scenarios of the advantages of each of the two evaluation methods. RESULTS The ranking of consumption sum of opioid and patient cost burden calculated by the two methods was the same in the five sample medical institutions， but the ranking of per capita consumption sum was different. Taking the 5 medical institutions as a whole， the top 4 rankings of consumption sum ratio for each species of opioid compared by both methods were the same， i. e. remifentanil＞sufentanil＞oxycodone＞morphine. The ratio of remifentanil was close to 50%. When comparing the ranking of consumption sum ratio in each medical institution， the ranking calculated by the two methods was different for those medical institutions except for H1 medical institutions. The consumption sum ratio of fentanyl calculated by DDD method was significantly higher than that of OME method； whereas consumption sum ratio of remifentanil calculated by OME method was significantly higher than that of DDD method. Perioperative patients had the highest consumption sum ratio， about 50%. The consumption sum ratio of critically ill patients in H3 jwsydey@163.com medical institutions and inpatient patients with cancer pain and other patients in H5 medical institutions calculated by DDD method was significantly higher than that by OME method. There were differences in the order of cost burden of different types of patients calculated by two methods. CONCLUSIONS DDD method can accurately reflect the dosage of opioid drugs and facilitate the monitoring and management of the dosage； OME method can more reflect the analgesic effect and compare the cost burden of patients.

Systematic Review on Safety of Chinese Medicines Combined with Tripterygium wilfordii Preparations in Treatment of Rheumatoid Arthritis and Exploration on Underlying Network Regulatory Mechanisms of Enhancing Efficacy and Reducing Toxicity / 中国实验方剂学杂志

ObjectiveTo systematically evaluate the safety of Chinese medicines combined with Tripterygium wilfordii polyglycoside tablets/Tripterygium wilfordii tablets （TWPT/TWT） in the treatment of rheumatoid arthritis （RA）， and to explore the network regulatory mechanisms of enhancing efficacy and reducing toxicity of commonly used combination regimes. MethodThe literature involving the adverse reactions of TWPT/TWT in treating RA was searched and collected from three Chinese databases （CNKI， Wanfang Data， VIP） and three English databases （PubMed， Cochrane Library， Embase） from the inception of the databases to July 2021. All studies were assessed by the Cochrane risk of bias tool， and the data were extracted and analyzed by Stata 15.0. Furthermore， Integrative Pharmacology-based Research Platform of Traditional Chinese Medicine 2.0 （TCMIP v2.0，http：//www.tcmip.cn/） was used to construct a "drug target-symptom gene of efficacy and toxicity" interaction network， to explore the underlying network regulatory mechanisms of enhancing efficacy and reducing toxicity of common T. wilfordii preparation combinations. ResultA total of 2 132 articles on Chinese medicines combined with TWPT/TWT in the treatment of RA were retrieved， and 18 of them were finally included. The systematic review showed that the adverse reactions of TWPT/TWT against RA mainly occurred in the digestive system， blood system， and reproductive system， of which digestive system had the highest incidence of damages. However， the combination with Chinese medicines effectively alleviated the adverse reactions caused by TWPT/TWT ［RR （95% CI）=0.45 （0.30， 0.66）， P<0.01］. In addition， the subgroup analysis indicated that the age of RA patients， course of disease， combination regimen， medication dosage and duration of treatment all affected the occurrence of adverse reactions of TWPT/TWT. It was found in clinical studies that total glucosides of paeony （TGP） and TWPT/TWT was most widely combined， and the effect of TGP in reducing TWPT/TWT-induced hepatotoxicity was also more significant than that of other Chinese medicines. Moreover， taking this combination regime as an example， this paper explored the "efficacy-toxicity" association mechanisms of TGP-TWPT/TWT against RA. The "drug target-symptom gene of efficacy and toxicity" interaction network revealed that the core network targets of TGP-TWPT/TWT enhanced efficacy and reduced toxicity mainly through regulating immunity-inflammation-related pathways， metabolic pathways and cell signal transduction. Especially， interleukin-4 （IL-4） and interleukin-13 （IL-13）， which were involved in the "immunity-inflammation" module， were the common targets of TGP-TWPT/TWT to enhance efficacy and reduce toxicity. The endogenous sterols， bile acids and bile salts， insulin secretion and other metabolic pathways in the "body metabolism" module were closely associated with the mechanisms of TWPT/TWT inducing hepatotoxicity and TGP reducing hepatotoxicity. While cell function regulation pathways， such as stem cell factor （SCF）/tyrosine kinase receptor （KIT） signaling pathway and phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）signaling pathway were involved in both anti-RA effects and hepatotoxicity of TWPT/TWT. ConclusionClinical application of suitable Chinese medicines combined with TWPT/TWT in the treatment of RA can effectively improve the rheumatism and reduce the adverse reactions of TWPT/TWT， and TGP-TWPT/TWT has the most significant toxicity-reducing effect. Further biological network-based investigation indicates that the toxicity-reducing mechanism of TGP-TWPT/TWT may be related to the regulation of interleukin signaling pathway and bile acid metabolism pathway， and the synergistic efficacy-enhancing effect of the combination may be achieved by acting on interleukin signaling pathway and cell function regulation pathway.

Atuação de um centro regional de informação sobre medicamentos na baixada fluminense de 2020 a 2022 / Performance of a regional drug information center in the baixada fluminense from 2020 to 2022 / Acción de un centro regional de información médica en la baja fluminencia de 2020 a 2022

No ano de 2020 observou-se um aumento da divulgação de informações parciais e sem embasamento científico sobre COVID-19. Nesse contexto, o Centro Regional de Informação sobre Medicamentos (CRIM) em uma Universidade Pública, torna-se um importante disseminador de informações referenciadas. Este trabalho foi realizado para identificar, por meio dos dados obtidos nos canais de comunicação em que essas ações virtuais foram desenvolvidas, o alcance atingido por cada publicação e evento. Dentre os materiais produzidos, 38,5% foram relacionados à COVID-19; 26,9% ao uso de medicamentos; 21,1% às datas representativas da área da saúde; e 13,5% às informações sobre doenças. Destacaram-se temas como: "Qual a diferença entre medicamento referência e genérico?"; "A importância de tomar o medicamento com água"; "CAFEÍNA: Uso indiscriminado"; "Interações fármacos x alimentos"; e "Imunização Infantil: Devo vacinar meu filho contra a COVID-19?". As ações de educação continuada, somadas às visualizações dos eventos produzidos totalizaram 5.160 visualizações. Destaca-se o IV Simpósio sobre Uso Racional de Medicamentos (URM) e o I Simpósio de Direitos Humanos e Saúde Mental que, em sua totalidade, somaram 3.459 visualizações. As ações reforçam a necessidade de promover práticas voltadas à informação para garantia do uso eficaz, seguro e racional de medicamentos.

In 2020, there was an increase in the dissemination of partial and scientifically unsupported information about COVID-19. In this context, the Regional Drug Information Center (RDIC) in a Public University becomes an important disseminator of referenced information. This work was carried out to identify, through the data obtained from the communication channels in which these virtual actions were developed, the reach atteined by each publication and event. Amongst the materials produced, 38.5% were related to COVID-19; 26.9% to the use of medication; 21.1% to representative dates in the health area; and 13.5% to information about diseases. Topics such as: "What is the difference between reference and generic medicine?"; "The importance of taking the medicine with water"; "CAFFEINE: Indiscriminate use"; "Drug x food interactions"; and "Childhood Immunization: Should I vaccinate my child against COVID-19?". Continuing education actions, added to the views of the events produced, totaled 5,160 views. We highlight the IV Symposium on Rational Use of Drugs (RUD) and the I Symposium on Human Rights and Mental Health which, in their entirety, totaled 3,459 views. The actions reinforces the need to promote information-oriented practices to ensure the effective, safe and rational use of medicines.

En el año 2020 se produjo un aumento en la difusión de información parcial y no se obtuvo ninguna base científica sobre el COVID-19. En este contexto, el Centro Regional de Información sobre Medicinas (CRM) de una Universidad Pública se convierte en un importante difusor de información referenciada. Este trabajo se llevó a cabo para identificar, mediante los datos obtenidos en los canales de comunicación en los que se desarrollaron estas acciones virtuales, el alcance alcanzado por cada publicación y evento. De los materiales producidos, el 38,5% estaban relacionados con el COVID-19; el 26,9% con el uso de medicamentos; el 21,1% con las fechas representativas del área de salud; y el 13,5% con información sobre enfermedades. Temas como: "¿Cuál es la diferencia entre la medicina de referencia y la genérica?"; "La importancia de tomar el medicamento con agua"; "CAFEÍNA: uso indiscriminado"; "Interacciones medicamentosas versus alimentos"; e "Inmunización infantil: ¿debo vacunar a mi hijo contra COVID-19?". Las acciones de la educación continua, sumadas a las visualizaciones de los eventos producidos, alcanzaron un total de 5.160 visitas. Se destacan el cuarto simposio sobre el uso racional de los medicamentos (UDA) y el primer simposio sobre derechos humanos y salud mental, que en su totalidad sumaron hasta 3.459 visualizaciones. Las medidas adoptadas refuerzan la necesidad de promover prácticas orientadas a la información para garantizar el uso eficaz, seguro y racional de los medicamentos.

Clinical Evidence of Treatment of Constipation with Oral Chinese Patent Medicine： A Scoping Review / 中国实验方剂学杂志

This study systematically and comprehensively sorted out the application status of Chinese patent medicines for the treatment of constipation in the clinic， to provide scientific evidence for future research directions and clinical drug use in this field. Based on the method of scoping review， the Chinese patent medicines for the treatment of constipation were retrieved from three drug lists to obtain the medicines that needed to be evaluated. A comprehensive and systematic search was carried out on the included studies on the treatment of constipation by Chinese patent medicines through eight Chinese and English databases， and the included studies were integrated and analyzed. The results were displayed in combination with charts. Thirty-four Chinese patent medicines and 118 studies were included in this study. According to the efficacies， Chinese patent medicines were divided into 4 categories， namely eliminating accumulation， purging fire， promoting Qi， and moistening bowels， involving 125 Chinese medicines. The overall attention of constipation research is on the rise. Marenwan （granules or soft capsules） gained the highest attention， with 42 studies， followed by Qirong Runchang oral liquid， with 21 studies， and Biantong tablets （capsules）， with 19 studies. There are 10 studies on Congrong Tongbian oral liquid. Seventeen Chinese patent medicines had no corresponding clinical research. There were 8 study design types， and all drugs were mainly randomized controlled trials except Danggui Longhui pill. Among the intervention types， the comparison between Chinese patent medicines and western medicines was the most. The highest outcome indicators were efficacy， safety evaluation， and main symptoms or scores， and there was a lack of a unified core outcome indicator set. There were few studies on adverse reactions and the economy. Only 11.86% of the studies were funded. Clinically， Chinese patent medicines are widely used in the treatment of constipation， and the amount of related research shows an increasing trend. However， some Chinese patent medicines lack corresponding clinical evidence， and the published research has problems such as unrigorous design， ununified criteria for efficacy evaluation， lack of comprehensive evidence studies， and insufficient funds. It is hoped that more investment will be made in this field in the future， and more attention will be paid to drugs with relatively blank research and constipation syndromes with few treatments. Comprehensive evidence studies such as systematic reviews should be carried out actively. And the study design should be standardized to provide reliable evidence for the treatment of constipation with Chinese patent medicines.

Oral Chinese Patent Medicines for Hyperlipidemia： A Scoping Review of Clinical Evidence / 中国实验方剂学杂志

To summarize the status quo of clinical evidence on oral Chinese patent medicine in the treatment of hyperlipidemia through scoping review and thereby provide a reference for clinical application and decision-making in health care. Proprietary Chinese medicines for the treatment of hyperlipidemia （dyslipidemia） were retrieved from relevant catalogs and then screened based on their instructions. Articles on the selected Chinese patent medicines were searched from Chinese and english electronic databases and screened according to the inclusion criteria， followed by data extraction and analysis. The results were described with text and graphs. ①A total of 32 Chinese patent medicines and 1 010 related articles were screened out. ②All the included Chinese patent medicines were made from Chinese medicinal materials， of which 5 were Chinese medicinal extracts，and the remaining 27 were pure Chinese medicinal preparations （the compositions of 1 prescription is confidential）. ③As indicated in the instructions， all the 32 Chinese patent medicines can be used to treat hyperlipidemia with the main syndrome of combined phlegm and blood stasis， and the main effect of them is activating blood and resolving stasis. ④Among the 32 medicines， Xuezhikang tablets （Capsules） and Gypenosides Tablets have the lowest price. ⑤For the 328 key clinical studies， 248 were randomized controlled trials and 80 non-randomized controlled trials. ⑥As for the sample size， randomized controlled trials generally included 28-579 cases， and non-randomized controlled trials 24-152 cases. Clinical studies with more than 200 cases accounted for 9.3% （12/129）. ⑦The most common method was the comparison of the intervention effect of Chinese patent medicine and western medicine （36.5%） and Atorvastatin Calcium Tablets was the preferred western medicine control. The observation duration was generally 56 days （8 weeks）. ⑧In clinical practice， the absolute value of blood lipid decrease and （total） effective rate were often used to evaluate the efficacy， and the effective rate was generally determined based on Clinical Guidelines for New Chinese Medicines. The overall quality of clinical studies on oral Chinese patent medicines is uneven and there is a lack of high-quality clinical evidence. Moreover，there are the risks of unreasonable use and uneasy use of Chinese patent medicine.It is recommended that researchers on proprietary Chinese medicine should further broaden the research ideas，focus on the top-level design of the research plan， and standardize the research process，thereby provide high-quality research evidence for the clinical use of proprietary Chinese medicine. Moreover， more efforts should be made to establish a sound mechanism for information collection and feedback of proprietary Chinese medicine， so as to reduce the risk of uneasy use.We hope that in-depth investigation and discussion should be launched by price， economy， quality evaluation， and other departments headed by the supervision department to make the price of Chinese patent medicine reasonable and fair， thereby promoting the rational use of Chinese patent medicine.

Farmacêutico na farmácia básica: garantia de qualidade na assistência farmacêutica? / Pharmacist in Primary Health Care: quality assurance in Pharmaceutical Services?

A Assistência Farmacêutica se volta à promoção, proteção e recuperação da saúde por meio de atividades técnico-gerenciais e clínico-assistenciais. A atuação do farmacêutico nas unidades básicas de saúde parece favorecer esse processo, embora alguns municípios optem por não o incluir no quadro de recursos humanos das farmácias na atenção primária à saúde. Nesse contexto, ao realizar uma pesquisa para avaliar o acesso e o uso dos medicamentos em municípios de Minas Gerais, nosso grupo de pesquisa verificou que a presença do farmacêutico nas farmácias básicas tem influenciado sobre a qualidade dos produtos e serviços oferecidos nesses estabelecimentos. Um instrumento padronizado foi utilizado na coleta de dados e indicadores foram selecionados para avaliar qualidade no âmbito técnico-gerencial e clínico-assistencial. Como resultado, observou-se que a presença do farmacêutico nesses estabelecimentos não influenciou sobre a qualidade da Assistência Farmacêutica. Lacunas na formação desses profissionais podem estar comprometendo a atuação do farmacêutico em consonância com as necessidades do Sistema Único de Saúde.

Pharmaceutical Assistance is focused on health promotion, health protection and recovery through technical-managerial, and clinical-care activities. The role of pharmacists in basic health units seems to favor this process, although some municipalities choose not to include them in the human resources framework of pharmacies in primary health care. When conducting a survey to assess the access and use of medicines in municipalities of Minas Gerais, our research group verified that the presence of pharmacists in basic pharmacies has influenced the quality of products and services offered in these establishments. A standardized instrument was used for data collection and indicators were selected to assess quality in the technical-managerial and clinical-care areas. As a result, it was observed that the presence of the pharmacist in these establishments did not influence the quality of Pharmaceutical Services. Gaps in the training of these professionals may be compromising the pharmacist's performance in line with the needs of the Unified Health System.

Evaluación de la prescripción de hipoglucemiantes orales en población adulta con Diabetes Mellitus Tipo 2 / Evaluation of the prescription of oral hypoglycemic agents in the adult population with type 2 diabetes mellitus

En el nivel primario de atención se detectan errores en la prescripción del tratamiento farmacológico de la diabetes tipo 2. El objetivo de este estudio fue evaluar la calidad de la prescripción de hipoglucemiantes orales en pacientes atendidos en consultorios del médico de la familia del Policlínico Universitario Hermanos Cruz, municipio Pinar del Río, Cuba. Se realizó un estudio de utilización de medicamentos de tipo descriptivo y transversal clasificado dentro de estos como de indicación-prescripción con elementos de esquema terapéutico y de factores que condicionan los hábitos de prescripción. El universo estuvo conformado por 1575 pacientes con diagnóstico de diabetes mellitus tipo 2 tratados con hipoglucemiantes orales que pertenecían a los 20 consultorios médicos de la familia.La muestra de estudio se obtuvo por el método de muestreo no probabilístico (por conveniencia) (n=846). La información se obtuvo de la historia clínica y tarjeta control de los pacientes para adquirir estos medicamentos. Predominó la edad de 40-49 años, el sexo femenino y entre 5-10 años de evolución de la enfermedad. No se usó la primera línea de tratamiento en el 43,6 % de los casos, ningún caso tenía estudios de laboratorio para el uso de la Metformina. La prescripción y dosis fue adecuada no así su uso racional. Las interacciones más frecuentes fueron las farmacocinéticas.El uso racional de hipoglucemiantes orales fue deficiente lo que hace necesario ampliar la divulgación de un protocolo de tratamiento para mejorar el uso de estos fármacos en el nivel primario de atención.

Errors in the prescription of drug treatment for type 2 diabetes are detected at the primary level of care. the purpose of this study was to evaluate the quality of the prescription of oral hypoglycemic agents in patients attended in the family doctor's offices of the Hermanos Cruz University Polyclinic, Pinar del Río distrit, Cuba. A descriptive and cross-sectional study of the use of medications was carried out, classified within these as indication-prescription with elements of the therapeutic scheme and factors that condition prescription habits. The universe was made up of 1575 patients diagnosed with type 2 diabetes mellitus treated with oral hypoglycemic agents who belonged to the 20 family medical offices. The study sample was carried out by the non-probabilistic sampling method (for convenience) (n = 846). The information was obtained from the clinical history and control card of the patients to acquire these medications. The age of 40-49 years, the female sex and between 5-10 years of evolution of the disease predominated. The first line of treatment was not used in 43.6% of the cases; no case had laboratory studies for the use of Metformin. The prescription and dose was adequate, but not its rational use. The most frequent interactions were pharmacokinetic ones.The rational use of oral hypoglycemic agents was deficient, which makes it necessary to expand the dissemination of a treatment protocol to improve the use of these drugs at the primary level of care.

Analyses on the effects of prescription review of key monitored drugs in one district of Shanghai / 中华医院管理杂志

Objective:To analyze the effects of prescription reviews of key monitored drugs using the drug regulatory platform in a district of Shanghai, and the influencing factors for the rate of unqualified prescriptions.Methods:A drug regulatory platform in a district in Shanghai began to implement prescription reviews since June 2018, extracting the reviewed prescriptions of all key monitored drugs and related information from June to December. Taking the unqualified rate of prescription in June as the baseline data, the χ2 test and the logistics regression model were used for data analysis. Results:From June to December 2018, clinical pharmacists reviewed 19 084 outpatient and emergency prescriptions and 10 607 inpatient prescriptions. The unqualified rates of outpatient and emergency prescriptions and inpatient prescriptions dropped from 16.52% and 23.28% in June to 4.45% and 13.80% in December, respectively. Logistics regression analysis showed that the rate of unqualified reviews of outpatient and emergency prescriptions was lower than that of inpatient prescriptions, and the rate of unqualified prescriptions in hospital was significantly lower than that in community health service centers; the rate of unqualified prescriptions for auxiliary drugs and nutritional drugs was significantly lower than that of antibacterial drugs.Conclusions:The prescription reviews of key monitored drugs can effectively promote the rational use of drugs. In the future, it is recommended to strengthen technical support for community health service centers and professional training for clinicians and pharmacists.

Analysis on components of rational use of drugs / Монголын эм зүй, эм судлал

Introduction@#A drugstore runs its activities in the framework of the primary goal of providing quality guaranteed, high-treatment satisfaction, and safe drugs and medical devices uninterrupted access to pharmaceuticals at retail prices. Pharmacists and chemists, doctors, medical professionals, and consumers will also be involved in promoting the rational use of drugs in the community. </br> It is practical to study the role and involvement of components in the rational use of drugs. @*Method@#Processes and concludes using a one-moment model using a questionnaire survey method.@*Conclusion@#51.2% of the respondents for the questionnaire survey were 31-40 years old, 80% were women, and 20% were men. 82% of the respondents have a higher education degree. </br> According to the survey, 61.8% of respondents answered that there are long queues to see a doctor, 79.5% of them responded like pharmacists provide good enough instruction for the use of drugs, 66.4% of respondents aware of the rational use of drugs, and 78.5% of them buy prescribed antibiotics under the prescription from pharmacies. The response shows that the knowledge and information on the rational use of drugs among the population are improving. </br> According to a survey among physicians, 36.8% of the total number of physicians examines 21- 30 people, 47.4% prescribe prescriptions for 11-20 people per day, 42% gives instructions to their clients on the medications they prescribed, and 42% spends 6-10 minutes for a single client, and 63.2% recommends antifungal drugs when prescribing antibiotics. It shows that the number of people per doctor meets the norms and standards specified in the joint orders of the Minister of Labor and Social Welfare and the Minister of Health dated 30 May 2019 A / 185 and A / 252. </br> According to a survey of pharmacists, 42.1% of pharmacists surveyed spend an average of 3-5 minutes per customer, 89.5% do not prescribe drug prescription, 88.9% regularly advise their clients on the rational use of drugs, and 78.9% dispense medicine necessarily by prescription. The response to mandatory prescriptions indicates that the requirements of prescription and prescription standards are partially met, indicating the need further to improve the implementation of relevant standards and regulations.

Study of prescribing pattern of drugs used in the treatment of bronchial asthma at tertiary care hospital of northern India

Background: Asthma is a chronic inflammatory disease requiring long term treatment. For an effective control of asthma symptoms background knowledge of the prescribing pattern of anti-asthmatic drugs is a must.Methods: A prospective, observational study was conducted in the Department of Respiratory Medicine OPD, King George's Medical University, Lucknow. 114 patients of asthma were recruited for the study. A case report form was filled from patient’s prescription containing the demographic details of the patients, presenting complaints, investigations and drugs prescribed along with their dose, duration, frequency, route of administration.Results: 114 patients’ prescriptions were assessed which showed average number of drugs per prescription - 3.22. 42.8% and 50% of the drugs were prescribed in accordance with World Health Organization model list of essential medicines and National list of essential medicines. Short acting ?2 agonist (salbutamol), 61.4% was the most commonly and frequently prescribed single anti asthmatic drug. Combination of inhaled corticosteroid and long acting ?2 agonist, 86.8% was the most commonly prescribed fixed dose combination anti asthmatic drug. Inhalational route (75%) was the most preferred one over oral route (25%).Conclusions: Asthma being a chronic disease requires prolonged treatment which imposes economic burden on the patients. Judicious prescription of drugs not only improves the patient clinically but also removes the unnecessary burden. Data obtained from these studies can be used as a guide to make future decisions regarding standard prescription.

Serviços farmacêuticos clínicos na atenção primária à saúde do brasil / Clinical pharmaceutical services in brazil's primary health care / Servicios farmacéuticos clínicos en la atención primaria de salud en brasil

Resumo O farmacêutico executa importante papel no cuidado ao usuário da atenção primária, ao proporcionar ações emancipadoras de autocuidado, educação em saúde, promoção da saúde e do uso racional de medicamentos. Nesse contexto, este estudo, por meio de uma revisão integrativa da literatura, objetivou analisar os tipos e os benefícios dos serviços farmacêuticos clínicos desenvolvidos na atenção primária à saúde do Brasil. Foram recrutados, no SciELO e no PubMed/MEDLINE, artigos que tratavam dos serviços farmacêuticos clínicos desenvolvidos na atenção primária no Brasil publicados nos idiomas português, inglês ou espanhol no período de 2007 a 2017. O seguimento farmacoterapêutico é o serviço mais estudado, enquanto a dispensação e a orientação são as atividades realizadas com maior frequência pelos farmacêuticos da atenção primária. Já na esteira dos benefícios, a literatura demonstra a coexistência, a importância e a multidimensionalidade dos serviços farmacêuticos clínicos na promoção da saúde e do uso racional de medicamentos pela comunidade adstrita.

Abstract The pharmacist plays an important role in the care for the users of primary health care by providing emancipatory self-care actions, education in health, promotion of health and of the reasonable use of medications. In this context, the present study, through an integrative review of the literature, had the goal of analyzing the types and benefits of the clinical pharmaceutic services developed in primary health care in Brazil. In the SciELO and PUBMED/MEDLINE databases, we gathered articles on the clinical pharmaceutic services developed in primary health care in Brazil published in Portuguese, English and Spanish between 2007 and 2017. The pharmacotherapeutic follow-up is the most studied service, while dispensation and guidance are the activities most often performed by the primary health care pharmacists. Regarding the benefits, the literature shows the coexistence, the importance and the multidimensionality of the clinical pharmaceutic services in the promotion of health and in the reasonable use of medications by the circumscribed community.

Resumen El farmacéutico ejecuta un importante papel en el cuidado al usuario de la atención primaria, al proporcionar acciones emancipadoras de autocuidado, educación en salud, promoción de la salud y del uso racional de medicamentos. En ese contexto, este estudio, por medio de una revisión integrante de la literatura, tuvo el objetivo de analizar los tipos y los beneficios de los servicios farmacéuticos clínicos desarrollados en la atención primaria de salud en Brasil. Buscamos, en las bases de datos SciELO y PubMed/MEDLINE, artículos que trataban de los servicios farmacéuticos clínicos desarrollados en la atención primaria de salud en Brasil publicados en los idiomas portugués, inglés o español entre 2007 y 2017. El seguimiento farmacoterapéutico es el servicio más estudiado, mientras la dispensación y la orientación son las actividades realizadas con más frecuencia por los farmacéuticos de la atención primaria. Con relación a los beneficios, la literatura demuestra la coexistencia, la importancia y la multidimensionalidad de los servicios farmacéuticos clínicos en la promoción de la salud y del uso racional de medicamentos por la comunidad circunscripta.

Research progress in pharmacokinetics/pharmacodynamics and nephrotoxicity of polymyxin B / 中国药理学与毒理学杂志

In recent years, polymyxin B has played an important role in the salvage treatment of Gram-negative bacterial infections involving multi-drug-resistant bacteria and pan-drug-resistant bacteria. Its clinical value has been re-studied. However, it is difficult to use this antibitotoxin accurately under its potential nephrotoxicity and empirical administration, which restricts its rational use in clinic. In this paper, the pharmacokinetics and pharmacodynamics of polymyxin B, the mechanism of nephrotoxicity and the risk factors affecting nephrotoxicity were analyzed. It was possible that polymyxin B was mainly eliminated through the non-renal pathway. Clinically, loading doses are required for patients with severe infection. The incidence of nephrotoxicity can be reduced by controlling other covariates, and polymyxin B-induced nephrotoxicity involves the mitochondrial pathway and cell death receptor pathway. This paper is expected to provide reference for the clinical rational use of polymyxin B.

Pharmacovigilance and protective medication for drug-induced liver injury in treatment of COVID-19 / 中草药

The outbreak of COVID-19 coronavirus pneumonia in December 2019 has aroused great concern worldwide. At present, the COVID-19 coronavirus pneumonia is highly contagious, rapid and widespread. It has been reported that COVID-19 virus is spread by respiratory droplets and direct contact transmission, and it has various clinical manifestations and recurrent is common. Some patients do not even appear obvious fever and have negative results for throat swab virus culture at the onset of the disease, but the rapid deterioration in their clinical condition usually occurred, which bring difficulties to scientific diagnosis and treatment. At present, western medicine treats most patients with anti-viral drugs, hormones and other drugs, or treats critically ill patients with ECMO oxygenation, important organ function support and other emergency treatments. Traditional Chinese medicine (TCM) based on syndrome differentiation and treatment has obtained curative effects in this outbreak. In order to improve the effects and safety of Chinese and western drug therapy, we applied literature-mining method and network pharmacology, summarized the potential liver injury during the application of western medicine and discussed hepatotoxicity networks and potential pathway targets of ingredients in Chinese patent medicine and Chinese herbal compound. This study not only summarizes essential information regarding potential drug-induced liver injury and biomarkers for pharmacovigilance, but also provides insights for liver protection by TCM or TCM in combination with western medicine in the treatment of novel coronavirus.

Analysis of 16 618 Prescriptions of Chinese Patent Medicine Containing Aconiti Lateralis Radix Praeparata Based on Three Data Mining Models / 中国实验方剂学杂志

Objective::Through data mining analysis of Chinese patent medicine prescription containing Aconiti Lateralis Radix Praeparata (CPMCA) in a hospital, the characteristic rules of clinical medication of this kind of Chinese patent medicine were analyzed from the perspective of traditional Chinese medicine (TCM) syndrome differentiation and treatment, and the application prospect of data mining in TCM prescription analysis was explored. Method::CPMCA in the hospital outpatient clinics from November 2017 to October 2018 was conducted. The clinical application of this kind of Chinese patent medicine was retrospectively analyzed from the aspects of basic situation of patients, TCM diseases, TCM syndromes and so on. The clinical application of CPMCA was reviewed and analyzed. Three kinds of data mining algorithms in Microsoft SQL Server Analysis Services 2012 were used to analyze the characteristics of prescription medication. Result::A total of 8 kinds of Chinese patent medicines containing Aconiti Lateralis Radix Praeparata were used in a hospital, and most of them were used by patients under 14 years old, among them, the dosage of Xiaoer Feike granules was the largest. The TCM diseases were mostly cough, cold and asthma, while the TCM syndromes were mostly cold-heat complicated syndrome, wind-phlegm syndrome and external contraction of wind evil. The CPMCA for nourishing and warming kidney-Yang included Jingui Shenqiwan, Longlu capsules, Wangbi capsules and Guifu Dihuang pills. The TCM diseases were mostly arthralgia syndrome, vertigo, and consumptive disease, meanwhile, the syndromes were mainly deficiency of liver and kidney, kidney deficiency and blood stasis, and deficiency of spleen and kidney. Decision tree analysis showed that the CPMCA had the characteristics of age distribution, among which TCM diseases and syndromes were the main decision points. According to the age, sex, diagnosis of Chinese and western medicine, and TCM syndromes of this type of prescription, the CPMCA were divided into 10 categories by cluster analysis. Correlation analysis showed that the combination of Xiaoer Feike granules was the most common, but the correlation was not high. And Jingui Shenqiwan, Qili Qiangxin capsules, Longlu capsules and Wangbi capsules had their own strong associated medication. Conclusion::The application of data mining algorithm in multi-factor analysis of clinical prescription is close to the clinical dialectical treatment thinking of TCM. Combined with the basic statistics, it can be seen that the CPMCA in a hospital is consistent with the characteristics of TCM syndrome differentiation and treatment.

Drug Utilization Pattern In Paediatric Patients In A Secondary Care Hospital

Objective: The study was carried out to generate research on drug utilization pattern in paediatric patients in government headquarters hospital, Tiruppur, Tamilnadu, India using world health organization (WHO) and international network for rational use of drugs (INRUD) core indicator. Methods: The core prescribing indicators of the world health organization was used to assess the appropriate use of drugs. Index of rational drug prescribing (IRDP) developed by Zhang and Zhi was also used to find out the performance of a health care system in terms of drug utilization. Results: Out of 859 drugs in 200 cases the highest prescribed drug class is antibiotics 304(35.39%) and the majority of drugs were administered in injectable form 412(47.94%). It was analysed that a majority of prescriptions 117(58.5%) were discharged in between 4-7 d. 161(80.5%) patients were dismissed after completion of treatment. On analysing world health organization (WHO) prescribing core indicators, the average number of drugs per prescription was 4.29 which is higher than double the average number (i.e., 2). This indicates poly-pharmacy practice. 97.78% of drugs were prescribed were the generic name and percentage of encounters with antibiotic prescribed was 90.5% which is thrice greater than world health organization (WHO) standard<30%. Prescribing of injections is not within the world health organization (WHO) recommended range<20% and it was far higher showing 97.5% which is essential for paediatric inpatients. The prescribing practice in paediatric ward is in complete adherence to national essential drug list (EDL) or formulary. The mean value of the index of rational drug prescribing (IRDP) obtained was 3.09 which is very similar to that of optimal value world health organization (WHO). Conclusion: Prescription by generic name, prescribing drugs from essential drug list (EDL) and free government supply are encouraging findings in this hospital. The result shows poly-pharmacy and overuse of antibiotics are the areas to be concerned. The better clinical outcome shows rational prescribing is practised well.

Analysis of epidemiological characteristics of drug induced liver injury associated with Baixianpi Preparations / 中国中药杂志

A retrospective study was performed in drug-induced liver injury(DILI) cases associated with Dictamni Cortex(Baixianpi,BXP) Preparations,which were treated at grade Ⅲ class A liver disease hospitals from 2008 to 2016 and spontaneously reported for adverse reactions between 2012 and 2016 at HILI Cloud(hilicloud.net). The results showed 25 DLII cases associated with BXP Preparations treated at grade Ⅲ class A liver disease hospitals during the 9 years,including only 14 cases in line with the clinical diagnostic criteria of Guidelines for the Diagnosis and Treatment of Herb-Induced Liver Injury. And 74 DILI cases associated with BXP Preparations spontaneously reports adverse reactions,and 18. 92% of them had unreasonable medication,including polypharmacy(21. 43%),overdose(28. 57%) and repeated dosage(50%). And 47 DILI cases used BXP Preparations to treat psoriasis and vitiligo(a total of59. 57%). The time range of taking BXP Preparations until liver injury occurred was 1-366 d,with the median of 18 d. The dose of BXP Preparations was estimated to be 0. 09-12 g·d-1. And the cumulative dosage of taking drugs until liver injury occurred was 1. 1-336 g. Obvious associations with time-toxicity as well as quantity-toxicity could not be found based on the wide range of time-toxicity relations and quantity-toxicity relations. On the basis of the study,we found that DILI cases associated with BXP Preparations commonly occurred in patients with immune diseases,such as psoriasis and vitiligo,indicating specific individual differences. The results suggested that DILI cases associated with BXP Preparations would be correlated with the property of idiosyncratic drug-induced liver injury. In conclusion,the risk of liver injury clinically caused by BXP Preparations should be paid more attention,and the studies on the mechanism of idiosyncratic drug-induced liver injury must be enhanced,and those on risk factors,like irrational drug use,should be strengthened. Moreover,the evaluation of the risk-to-benefit ratio is supposed to be performed for the sake of improving the risk prevention and control standards for BXP preparations,and ensuring safe and rational clinical application of BXP Preparations.

Drug utilization study and prescribing patterns in psychiatry patients at a tertiary care hospital

Background: The Drug utilization research (DUR) compares drug use between different countries and regions and is used to assess the rationality of prescribing pattern of the drug therapy. With this background we decided to evaluate antipsychotic drugs prescribing pattern in the psychiatric patients in a tertiary care hospital.Methods: The study was carried out at Department of Psychiatry, DSMCH. It was open label, cross - sectional, prescribed Documents based study. Duration of the study was one month (May-2017). Out-Patient number, age, sex, diagnosis, prescribed generic name, brand name, dose, route of administration, duration of therapy obtained from the Prescription register of Out - Patient Department of the Psychiatry.Results: The clinical experiences of the Psychiatrist I, II and III were 17 years, 35 years and 10 years respectively. The Psychiatrist I, II and III prescribed treatment for 36 (31.9%), 61 (54%) and 16 (14.2%) patients respectively. Among overall (n=113) patients (average age 38.9 years), male n=56 (49.6%) and female=57 (50.4%) were treated by all the three psychiatrists. The percentage of prescription of various drugs used were: Escitalopram (15.7%), Clonazepam (14.6%), Sertraline (8.7%), Risperidone (7.5%), Propranolol (6.7%), Olanzapine (6.3%), Quetiapine (5.9%), Trihexyphenidyl (5.5%), Amitriptyline (5.1%) and Other prescribed drugs, were between (0.4 to 2.8%).Conclusions: From this study, it can conclude that rational usage of drugs were followed in this study. All three prescribers (Psychiatrist I, II, and III) prescriptions were found to be rationale.

Perfil de acceso y uso de medicamentos en un municipio del sur de Brasil* / Profile of access and use of drugs in a municipality of southern Brazil

Introducción: En Brasil, el acceso a medicamentos es considerado parte integral del derecho a la salud y es garantizado, junto con su uso racional, por la Política Nacional de Asistencia Farmacéutica en el Sistema Único de Salud Objetivo: Identificar el perfil de acceso y uso de medicamentos de usuarios del citado Sistema. Métodos: Estudio descriptivo realizado en el municipio de Balneario Piçarras, sur de Brasil. Se entrevistaron en su domicilio 936 personas, seleccionadas aleatoriamente de los registros del Sistema de Atención Básica del Sistema Único de Salud. Resultados: De los entrevistados, 60,1 por ciento manifestó haber usado medicamentos en los últimos 15 días. Se encontró mayor probabilidad de uso de medicamentos en mujeres, personas mayores de 40 años y pensionados (p<0,05). De los 1 393 medicamentos utilizados, el 16,4 por ciento eran automedicados, principalmente antiinflamatorios no esteroideos. El 98,8 por ciento de los medicamentos fueron prescitos por médicos del Sistema y pertenecían a la Relación Municipal de Medicamentos Esenciales. Los usuarios los obtuvieron en las Unidades Básicas de Salud. Se encontró mayor adherencia a la Relación Municipal por parte de los médicos del Sistema (79,2 por ciento), que de los médicos particulares (61,1 por ciento). Los 104 usuarios de medicamentos presentaron 118 interacciones medicamentosas. El riesgo de interacción aumentó con el número de medicamentos utilizados. Conclusiones: Existe buena cobertura y acceso a medicamentos en el Sistema Único de Salud, pero aún es necesario el fortalecimiento de estrategias que promuevan su uso adecuado, como es la mayor participación del profesional farmacéutico en los servicios de salud(AU)

Introduction: In Brazil access to medicines is considered a comprehensive part of the right to health. Objective: To identify the profile of access and use of medicines of the Sole Health System´s users. Methods: A descriptive and cross-sectional study in Balneario Piçarras municipality, Santa Catarina State, in southern Brazil. 936 people were randomly selected from the records of the Sole Health System´s Basic Care System, whom were interviewed at home. Results: Out of those interviewed, 60.1 percent reported having used medications in the last 15 days. There was a greater probability of drugs using in women, people over 40 years old and pensioners (p<0,05). Out of the 1 393 drugs used, 16.4 percent were used in a self-medicated way, mostly non-steroidal anti-inflammatory drugs. 98.8 percent of the medicines belonged to the Municipal List of Essential Medications, which are prescribed by physicians of the System and that were obtained by the users in the Basic Health Units. The average number of drugs per person was 2.5. The 104 drug users had 118 drug interactions (an average of 1.7 interactions per user), and the risk of interaction increased with the number of drugs used. Conclusions: There is good coverage and access to drugs in the Sole Health System, but it is still necessary to strengthen strategies that promote their adequate use. There is a need for greater participation of pharmaceutical professionals in health services(AU)