Age- and gender-related differences in drug utilisation and adverse drug reaction patterns among patients in a coronary care unit

<p><b>INTRODUCTION</b>This study aimed to examine age- and gender-related differences in the comorbidities, drug utilisation and adverse drug reaction (ADR) patterns of patients admitted to a coronary care unit (CCU).</p><p><b>METHODS</b>The present study was a retrospective cohort study. Two trained physicians independently reviewed the case records of CCU patients over a period of one year (Jan-Dec 2008). The demographic, clinical, and drug prescription data of the patients were analysed according to age group (18-59 years vs ≥ 60 years) and gender.</p><p><b>RESULTS</b>A total of 574 patients were admitted to the CCU during the study period. Of these 574 patients, 65.2% were male, and 48.4% were ≥ 60 years old. No significant gender-based differences were found for the prescription of cardiovascular and non-cardiovascular drugs, and ADR patterns (p > 0.05). Male patients aged ≥ 60 years were found to have a higher rate of polypharmacy than those aged 18-59 years (p = 0.001). The duration of hospital stay was longer in male than female patients (p = 0.008), and the duration of CCU stay was longer for male patients aged ≥ 60 years than males aged 18-59 years (p = 0.013). Compared to patients aged 18-59 years, a greater number of patients aged ≥ 60 years were prescribed cardiovascular (p = 0.006) and non-cardiovascular drugs (p = 0.015). Patients aged ≥ 60 years also had a higher rate of polypharmacy (p = 0.001) and ADRs (p = 0.013), and a longer duration of CCU stay (p = 0.013). Renal (p = 0.047) and cutaneous (p = 0.003) ADRs were found to be more common in patients aged ≥ 60 years.</p><p><b>CONCLUSION</b>No major gender-related differences were observed in the prescription, drug utilisation and ADR patterns of our study cohort. Higher drug utilisation, ADR rates, and longer duration of CCU stay were noted in patients aged ≥ 60 years.</p>

Utilization profile of gastrointestinal medications among the critically ill patients in a tertiary care hospital

Pharmacotherapy in critically ill is complicated by altered physiology, presence of multi organ system failure and utilization of multiple medications. The present study assessed the utilization pattern of gastrointestinal drugs among the inpatients of the intensive care unit. The study was carried out in medical intensive care unit [ICU] of a tertiary care hospital in South India. The medical records of all inpatients of the ICU were reviewed over a period of twelve months. The demographic data, clinical data, and drug details were recorded. WHO-Anatomic Therapeutic Chemical classification system was used to classify drugs. Descriptive statistical analysis was carried out, values are expressed as percentage, mean +/- SD and range. Of the 728 inpatients of the ICU, a total of 695 patients received gastrointestinal drugs. Male to female ratio was 1:9. The mean and standard deviation [SD] for age was 49.21 +/- 15.84 years with a range of 18-90 years. The mean length of stay in the medical ICU was 7.4 +/- 4.3 days. Drugs for gastrointestinal system and drug metabolism [ATC-A] [23.3%] were most commonly utilized drug class of all the drugs prescribed in the ICU. Among the anti-peptic ulcer agents, pantoprazole [A02BC02] 607 [87%] followed by ranitidine [A02BA02] 68 [9.7%] were the frequently prescribed drugs. Metoclopramide [A03FA01] 136 [19.5%] and ondansetron [A04AA01] 105 [15%] were the frequently utilized anti-emetic agents. Lactulose [A06AD11] 82 [11.7%] was the most common laxative given while Glycopyrrolate [A03BA01] 44 [6.3%] was the most frequent anti-secretory agent prescribed. Gastrointestinal drugs were the widely prescribed drug class among the critically ill prescribed both as prophylactic as well as therapeutic indications

Cardiovascular medications use among the critically ill patients of a tertiary care hospital: a drug utilization study

In the medical intensive care unit it is often necessary to utilize extensive pharmacologic interventions and multiple intravenous medications in order to stabilize a critically ill patient. In patients diagnosed with heart disease in the intensive care unit, pharmacotherapy is the primary line of management. We evaluated the utilization pattern of cardiovascular drugs among the inpatients in the intensive care unit. The study was carried out in medical intensive care unit of a tertiary care hospital in South India. The medical records of all inpatients of the ICU were reviewed over a period of twelve months. The demographic data, clinical data, and drug details were recorded. WHO Anatomic Therapeutic Chemical classification system was used to classify drugs. Descriptive statistical analysis was carried out, and values are expressed as percentage, mean +/- SD and range. A total of 1173 cardiovascular drugs prescribed among the 728 patients were included in the study. 337 [29%] drugs were anti-hypertensives and 836 constituted the other cardiovascular drugs. Noradrenaline [CO1CA03] 220 [30%], dopamine [C01CA04] 165 [22.5%], and atorvastatin [C10AA05] 109 [15%] were commonly utilized drugs. Polytherapy among ionotropes was noticed in 145 [20%] prescriptions. Among 337 anti-hypertensive drugs prescribed, calcium channel blockers 117 [34.7%], beta-blockers 90 [20.4%] and angiotensin converting enzyme inhibitors [ACEIs] 73 [16.6%] represented the major classes. Amlodipine [C08CA01] was the single most commonly prescribed anti-hypertensive drug 110 [32.6%]. Anti-hypertensive polytherapy was noticed in 295 [40.5%] prescriptions. A wide spectrum of cardiovascular drugs was utilized from various drug classes. Polytherapy of various drug classes was noticed. Overall, the scope for improving rational use of drugs exists

Critically ill patients and use of hormones and hormone-related medications

Critical illness can induce a number of neuroendocrine changes which often necessitates the use of hormones and related medications among the critically ill along with the other extensive pharmacologic interventions. The utilization pattern of hormonal therapy was determined among the inpatients of the intensive care unit in the present study. The study was carried out in medical intensive care unit of a tertiary care hospital in South India. The medical records of all inpatients of the ICU were reviewed over a period of twelve months. The demographic data, clinical data, and drug details were recorded. WHO-Anatomic Therapeutic Chemical classification system was used to classify drugs. Descriptive statistical analysis was carried out, and values are expressed as percentage, mean +/- SD and range. 728 [81%] consecutive patients who got hospitalized were included for the analysis. Male to female ratio was 1.9. The mean and standard deviation [SD] for age was 49.21 +/- 15.84 years with a range of 18-91 years. Sepsis 198 [27%] and acute renal failure 168 [23%] were the most common primary clinical diagnosis. 90% of prescriptions were by generic name. Prescription for insulin was noticed in 306 [42%] prescriptions and was the most commonly utilized hormone. Corticosteroid prescription was noticed in 280 patients [38.5%] and a total of 341 [46.8%] corticosteroids was utilized. Hydrocortisone [H02AB09] 182 [25%] was the preferred corticosteroid. Polytherapy among corticosteroids was noticed in 278 [38.2%] prescriptions. Thyroxine was utilized among 31 patients [4.3%]. Overall, rational use of hormones and hormonal drugs was noticed among the critically ill patients

Drug utilization study of antimicrobial agents in medical intensive care unit of a tertiary care hospital

Patients admitted to the Intensive care unit receive multiple medications from a variety of pharmacological classes due to life threatening illnesses. This study was conducted to assess the patterns of antimicrobial agents and to suggest necessary modifications in prescribing practices to achieve rational therapeutic practices. The present study aims to study the prescribing patterns of drugs and rationality of antimicrobial drug use in the medical ICU of a tertiary care hospital. A prospective observational study was carried out at the 15 bedded medical ICU of St. John's Medical College Hospital, Bangalore from October 15[th] 2005 to September 15[th] 2006. The relevant data on drug prescription of each patient was collected from the inpatient case record. Drugs were classified into different groups based on WHO-ATC classification. The demographic data, disease data and the utilization of different classes of drugs as well as individual drugs were analyzed. Of the 902 patients admitted in the medical ICU during the study period, 728 [81%] consecutive patients were included for the analysis. Male to female ratio was 1.9. The mean age was 49.21 +/- 15.84 years. Sepsis 198 [27%] and acute renal failure 168 [23%] were the most common primary clinical diagnoses. Maximum number of co-morbid conditions found in a single patient was 15. The average number of drugs per patient [prescription] was 11.6 +/- 2.09. Anti-peptic ulcer drugs 709 [97.4%], antimicrobial agents 679 [93%], ionotropes 340 [46.5%] were the most commonly prescribed drugs. Cephalosporins 622 [37.3%] were the commonly prescribed antimicrobial drug class. Cefoperazone [JO 1DD12] 218 [30%] was the commonly prescribed antimicrobial drug class. A total of 228 perscriptions [31.3%] contained two antimicrobial prescription and [187] 25.7% contained 3 drugs. Cefoperazone + sulbactam [J01DD62] 224[62%] was the most common FDC noticed. A wide spectrum of disorders was noticed. Extensive poly-pharmacy and Poly-therapy of antimicrobial agents were noticed