Medication Therapy Management Practice of A Chronic Disease Patient with Adverse Drug Reactions Caused by Candesartan / 中国药房

OBJECTIVE： To provide reference for the evaluation of the correlation between drugs and adverse drug reaction （ADR） and the implementation of medication therapy management （MTM）. METHODS： Clinical information of a elderly patient with chronic disease （hypertension and coronary heart disease） whose suffered from leukocyte and platelet counts reduction and abnormal liver biochemical examination after taking candesartan were analyzed retrospectively in outpatient department of Tianjin Third Central Hospital. MTM pharmacists analyzed the correlation of candesartan with ADR using Naranjo evaluation scale method. The reasons for abnormal liver biochemical examination were analyzed by Naranjo evaluation scale method combined with Roussel Uclaf causality analysis method （called RUCAM method for short）. The medication reconciliation was conducted according to the results， and pharmacists cooperated with doctors to set individualized medication regimen and follow-up. RESULTS： By Naranjo evaluation scale method， analysis results showed that candesartan was “probably related” to ADR. By RUCAM method， analysis results showed that candesartan was “probably related” to liver biochemical abnormalities. MTM pharmacists suggested that candesartan should be stopped in time and the patient’s medication should be adjusted. The physician and the patient adopted the pharmacist’s advice. After 38 days of drug withdrawal， the patient’s ADR symptoms disappeared， and leukocyte count， platelet count and liver biochemical examination were normal. After adjustment of medication， the patient was followed up for 6 months with normal blood pressure. CONCLUSIONS： Naranjo evaluation scale method and RUCAM are simple and feasible in evaluating the correlation of drugs with ADR and hepatotoxicity. The two methods are consistent in evaluating the correlation between drugs and hepatotoxicity. Naranjo scale method and RUCAM method can be combined to analyze the correlation between drugs and ADR with abnormal liver biochemical examination.

Effect of scale method on vancomycin through concentration and nephrotoxicity in ICU patients / 中国生化药物杂志

Objective To evaluate the vancomycin trough concentration and nephrotoxicity in ICU patients with scale method.Methods The patients in ICU were evaluated from September 2011 to December 2013 in the hospital by prospective randomized controlled study.Experience using drug was applied in control group (n=116).Scale method was applied in test group (n=117), vancomycin concentration and renal toxicity were compared between two groups.Results The percentage of patients with an initial vancomycin trough concentration 15.0μg/mL or higher increased in the test group as compared with control group (73%vs 38%, P=0.004).The test group also demonstrated that an increase in the percentage of patients with initial trough concentration from 15.0 to 20.0μg/mL (41% vs.19%, P=0.008), and no statistical difference in the percentage of patients with an initial vancomycin trough concentration above 20μg/mL (31% vs.17%, P=0.340).There was no difference in nephrotoxicity in test group compared with control group (17% vs.16%, P=0.953).Conclusion Use of scale method increases the percentage of initial vancomycin trough concentrations 15.0μg/mL or higher in ICU patients and is not associated with an increased occurrence of nephrotoxicity.

Physico-Chemical Evaluation of Guduchyadi Kwatha for Instant Use: An Ayurvedic Herbal Formulation.

Introduction: Kwatha (decoction) preparations are one among commonest practiced Ayurvedic dosage forms, which are highly effective, but they are to be used when freshly prepared due to short shelf life (i.e. 1/2- 1 day), and they are often overlooked due to the preparation method and palatability. In present study, Guduchyadi Kwatha, a known Ayurvedic formulation used in Jwara (~pyrexia), was converted into a different dosage form for instant use by Rasakriya method (to convert into semi solid state), to make it easy to dispense, increase the shelf life, make it palatable, for dose fixation, etc. Aims and Objectives: To evaluate physico-chemical profile of fresh Guduchyadi Kwatha (GKF) and Guduchyadi Kwatha for instant use (GKI). Materials and Methods: Five batches of GKI and GKF were prepared and findings were systematically recorded. Organoleptic evaluation (Hedonic scale method) Physicochemical parameters (Loss on drying, Ash value, Acid insoluble ash, pH, Total solid content, Specific gravity, Water and Methanol soluble extractive, solubility and dissolution rate tests), High performance thin layer chromatography (HPTLC) profile, and microbial over load were carried out. Results and Conclusion: Comparative organoleptic screening of GKF and GKI showed no major differences in color and smell. In GKF, pH value, total solid content, specific gravity, and surface tension were found as 6.0, 95.14%, 1.009 w/w and 27.19 dynes/cm respectively. In finished product (GKI), pH value, loss on drying, Ash value, water soluble and alcohol soluble extractives were obtained as 6.16, 1.93% w/w, 7.90% w/w, 63.69% w/w and 37.29% w/w respectively. No microbial overload was detected in the sample.