Erenumab aooe: a milestone for the preventive treatment of migraine

Migraine is a complex neurological condition, which can affect the whole body and can result in many symptoms as nausea, vomiting, photophobia (Increased sensitivity to light), phonobhobia (Increased sensitivity to sound) and osmophobia (Increased sensitivity to smell). Neurological symptoms that include visual disturbances such as blind spots, distorted vision, flashing lights or zigzag patterns. Other common symptoms includes- dizziness, vertigo, tingling sensations in the limbs, an inability to concentrate, confusion, difficulty in speaking, paralysis or loss of consciousness (in very rare cases). These symptoms, often called ‘aura’. Migraine attacks may differ in their frequency, duration and severity, although, normally they last between 4 and 72 hours, and most people are symptom-free between attacks. There are many drugs for the treatment of acute attack of migraine which can be divided into mild, moderate and severe attacks. In mild case NSAIDs like Paracetamol, Ibuprofen are prescribed. In moderate cases Anti-emetics like metoclopramide, domperidone can be prescribe with combinations of NSAIDs or triptans as sumatriptan. In case of severe cases triptans can be prescribed with ergot alkaloids and antiemetics. Following drugs are prescribed for the prophylaxis of migraine as sodium valproate, amitriptyline (Tricyclic antidepressant), propranolol and metoprolol (beta blockers). Erenumab-aooe is a calcitonin gene-related peptide receptor antagonist. It is specifically indicated for the preventative treatment of migraine in adults. Erenumab-aooe is supplied as an injection for subcutaneous use. The recommended dosage is 70 mg injected subcutaneously once monthly. Some patients may benefit from a dosage of 140 mg injected subcutaneously once monthly, which is administered as two consecutive subcutaneous injections of 70 mg each. Erenumab-aooe is a human monoclonal antibody that binds to the calcitonin gene-related peptide (CGRP) receptor and antagonizes CGRP receptor function.

Study of self drug administration among second professional medical students

Background: Self-medication is very common in our day to day life which is an unhealthy and risky practice. Present study was done to determine the knowledge, attitude and practice among second professional medical students.Methods: A questionnaire related to self-medication with consent was prepared and distributed among the students of second professional. Data was collected and analysed the results expressed as counts and percentages.Results: Total 100 students participated in the study for taking self-medication and was no need to visit the doctor for minor illness. In maximum students, source of information of the drugs used for self-medication pharmacological based and learning process in the college. The source of drug was medical store. Most of the students took self-medication for loose motion and headache followed by cough, cold and fever. Out of total 100 students most of the students took paracetamol tablet as self-medication.Conclusions: This study showed that second professional medical students after studying pharmacological books they do not use any wrong medicine as self-medication. High level of awareness of second professional students has minimized self medication.

The comparative effects of Itopride and Levosulpiride orally used in patients suffering from Non-ulcer dyspepsia

Background: Itopride and Levosulpiride both comes under the group of Prokinetic drugs. These drugs are used for the treatment of non-ulcer dyspepsia, heart burn, nausea and vomiting. Both drugs act on dopaminergic D2 receptor as antagonist and increases the concentration of acetylcholine so that gastric peristalsis will be increase and that time pressure at lower oesophageal sphincter will be increase thus gastric motility increases and there will be good gastro-duodenal co-ordination.Method: This study has to conduct on patients with complains of non-ulcer dyspepsia attended Medical outdoor and department of pharmacology of SKMCH Muzaffarpur, Bihar, India. The total 60 patients have to include in the study, which have to randomly divide in two groups. Group A (itopride) comprising of 30 patients and Group B (Levosulpiride) comprising of 30 patients. Patients have to randomly allocate to receive one tablet of itopride hydrochloride, 50 mg three times daily before meal and one tablet Levosulpiride of 75 mg three times daily before meal. Authors have to enroll the patients at the interval of two weeks and continue it upto 3 months.Results: Study did not found any remarkable change in biochemistry profile. Only QT prolongation changes were found in two patients, but no serious cardiac toxicity was observed with patient receiving Levosulpiride. Neither QT prolongation nor serious cardiac toxicity was observed with itopride hydrochloride therapy.Conclusions: In present study, efficacy of Itopride was comparable to Levosulpiride in relieving the symptoms of non-ulcer dyspepsia. Both the drugs were clinically and biochemically well tolerated. QT prolongation changes were found in two patients, but no serious cardiac toxicity was observed with patient receiving Levosulpiride. Itopride does not show cardiac toxicity and any changes in ECG.

Beneficial role of Avocado oil orally used in Osteoarthritis: experience in a tertiary care hospital of Bihar, India

Background: Osteoarthritis is the most common type of joint disease. It represents a heterogeneous group of conditions resulting in common histopathologic and radiologic changes. It is a degenerative disorder arising from biochemical breakdown of articular (hyaline) cartilage in the synovial joints.Methods: Total of 90 patients were randomly selected from outdoor and indoor of Orthopaedics department (IGIMS Patna). Study was done in Department of Pharmacology & Orthopaedics at IGIMS Patna. Three groups A, B and C were taken. Each group was consist of 30 patients of both sexes and age groups between 18 to 65 years. Group A was received Multivitamin with Exercise. Group B was received NSAIDS only. Group C was received Avocado oil orally along with Exercises as Muscle strengthening exercises of Quadriceps, Hamstrings, Abductor and Adductor muscles of thigh. We had compared pain thresholds among all these three groups with the help of Visual analogue scale and Oxford Knee score.Results: After 3 months of treatment the patients belonging to group C showed better response as compared to group A and B. When we compared pain threshold among group A, B and C on the basis of Oxford Knee score group C had occupied maximum score, which meant satisfactory joint functions and did not require any formal treatment. we also compared average visual analogue scale and average oxford knee score, Group C showed better response.Conclusions: Avocado oil is a food supplement and does not contain any side effects as compared to NSAIDS [Non-steroidal anti inflammatory drugs], glucosamine sulfate, chondroitin sulfate, sulfasalazine etc so avocado oil can be used for long duration in case of osteoarthritis.

To study the cost variation analysis of oral H2 receptor blockers available in different brands in Indian pharmaceutical market

Background: Aim of the study was to study percentage price variations among different brands of the commonly prescribed H2 receptor blockers.Methods: The maximum and minimum price of each brand of the drug in INR was noted by using CIMS January to April 2018 edition, Drug Today April to June 2018 Vol-1. The price ratio and the percentage price variation for individual drug brands was calculated. The price of 10 tablets/capsules were calculated. At last the price ratio and percentage price variation of various brands were compared.Results: Percentage variation in price for H2 receptor blockers marketed in India was found to be tablet cimetidine 200mg:81.89, tablet cimetidine 400mg:91.27, tablet ranitidine 150mg:295.64, tablet ranitidine 300mg:123.19, tablet famotidine 20mg:939.62, tablet famotidine 40mg:1110.09, tablet roxatidine 75mg:38.65, tablet roxatidine 150mg:21.85.Conclusions: H2 receptor blocker is the most common drug prescribed for prolonged period in case of gastritis, Gastro-Esophageal Reflux Disease (GERD), peptic ulcer. If a costly brand is prescribed, the patients have to pay more money unnecessarily for their treatment. The doctors prescribing these drugs should be aware of these variations in price to reduce the price of drug therapy.

Apalutamide: a better option for the treatment of non-metastatic castration resistant prostatic carcinoma

Prostate cancer is cancer of the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, some grow relatively quickly. The cancer cells may spread from the prostate to other area of the body, particularly the bones and lymph nodes. Factors that increase the risk of prostate cancer include older age, a family history of the disease, and race. About 99% of cases occur in males over the age of 50. Clinical features include hematuria, dysuria (painful urination),nocturia(urination at night). Lower blood levels of vitami D may increase the risk of developing prostate cancer. Infection with the sexually transmitted diseases, chlamydia, gonorrhea, syphilis and prostatitis seem to increase risk of prostate cancer. Diagnosis can be confirmed by digital rectal examination (DRE) with prostate-specific antigen (PSA) blood test, cystoscopy, transrectal ultrasonography and biopsy (The removal of small pieces of the prostate for microscopic examination). Medicines like 5-alpha-reductase inhibitors (finasteride and dutasteride) reduce the overall risk of prostate cancer. Apalutamide, sold under the brand name Erleada, is a nonsteroidal antiandrogen (NSAA) medication which is used in the treatment of prostate cancer. It is specifically indicated for use in conjunction with castration in the treatment of non-metastatic castration-resistant prostate cancer (NM-CRPC). It is taken by mouth. Apalutamide was first described in 2007 and was approved for the treatment of prostate cancer in February 2018. Apalutamide is used in conjunction with castration, either via bilateral orchiectomy or gonadotropin-releasing hormone analogue (GnRH analogue) therapy, as a method of androgen deprivation therapy in the treatment of non-metastatic castration-resistant prostate cancer (NM-CRPC).

Cost variation analysis of proton pump inhibitors available in Indian market

Background: In now days proton pump inhibitors are prescribing more and more by Indian physicians not only in peptic ulcer,gastroesophageal reflux disease, gastritis but also along with non steroidal anti-inflammatory drugs to overcome the side effects as gastric irritation and discomfort by non steroidal anti inflammatory drugs.There are many brands of PPI drugs available in Indian market. Costly drugs can lead to economic burden which results in decreased compliance or even non-compliance. Non 朿ompliance leads to incomplete treatment which tends to increase morbidity.Increase in the patient medication cost was found to associated with decreased adherence to prescription medication.Hence this study was done to assess the cost variation of proton pump inhibitors [PPI] drugs.Methods: The maximum and minimum price of each brand of the drug in INR was noted by using CIMS January to April 2018 edition Drug Today April to June 2018 Vol-1. The cost ratio and the percentage cost variation for individual drug brands was calculated. The cost of 10 tablets/capsules was calculated in case of oral drug and the cost of one 1 vial or ampoule was noted in case of injectable drug. At last the cost ratio and percentage cost variation of various brands was compared.Results: Percentage variation in cost for proton pump inhibitors marketed in india was found to be tablet/capsule Esomeprazole [20mg]:141.17, tablet/capsule Esomeprazole [40mg]:196.29, capsule/tablet Omeprazole[20mg]: 569.53, Tablet/capsule Pantoprazole[40mg]: 248.8, tablet /capsule Rabeprazole[20mg]: 815.78, capsule/tablet Lansoprazole[30mg]: 173.33, Inj. Esomeprazole [40mg] 1 vial: 81.81, Inj. Omeprazole[40mg] 1vial: 47.95, Inj. Pantoprazole[40mg] 1vial: 66.66, Inj.Rabeprazole [20mg] 1vial: 176.625.Conclusions: Tablet Rabeprazole[20mg] shows highest cost ratio and percentage cost variation as 9.15 and 815.78. While Inj. Omeprazole[40mg] 1 vial shows lowest cost ratio and percentage cost variation as 1.47 and 47.95.

Efficacy and safety of topical 2% dorzolamide and 0.5% timolol in cases of open angle glaucoma in a tertiary care hospital of East Singhbhum: an observational, prospective and comparative study

Background: Present study was undertaken to evaluate and compare the efficacy and side effects of 2% dorzolamide and 0.5% timolol in patients with open angle glaucoma.Methods: There were 60 randomly selected patients were equally divided into Group I (n=30) and Group II (n=30). Further both groups were divided into IA (n=10), IB (n=20), IIA (n=10) and IIB (n=20). 2% Dorzolamide hydrochloride in Group IA and IIA and 0.5% Timolol maleate in Group IB and IIB was administered for 24 weeks. Patients were evaluated for general and ocular examinations on day of enrolment and then at the end of 1st, 4th, 8th and 24th week. Adverse effects of the drug during study period were also noted. Mean±SD, t value, p value and comparison between groups were analysed by graph pad software.Results: At the end of 24 weeks difference in mean reduction of IOP was not significant with 6.2±1.85mm Hg (Right eye) and 5.55±1.68mm Hg (left eye) and 4.72±2.97mm Hg (Right eye) and 5.37±1.24mm Hg (left eye) in Group IA and Group IIA respectively. At the end of 24 weeks difference in mean reduction of IOP was not significant with 5.06±1.62mm Hg (Right eye) and 4.40±1.96mm Hg (left eye) and 4.30±1.41mm Hg (Right eye) and 4.12±2.08mm Hg (left eye) in Group IB and Group IIB respectively. Fall in both systolic and diastolic blood pressure in both the groups were significant. Both drug regimens were well-tolerated, and no serious drug-related adverse effects were reported.Conclusions: Dorzolamide was more efficacious for reduction of intra ocular pressure, well-tolerated, had low allergic response and had a favourable ocular, cardiovascular and respiratory safety profile than Timolol.

Undergraduate medical students’ perception regarding computer assisted learning in experimental pharmacology practical

Background: Main objective of this study was to find out the students’ perception and to obtain feedback towards the use of Animal Simulator to demonstrate drug effects in terms of its acceptability, advantages and disadvantages of Computer Assisted Learning (CAL) in experimental pharmacology practical as an educational tool.Methods: Questionnaire based study, done on randomly and voluntarily selected ninety-six fourth and fifth semester MBBS Students. Divided into four groups and each group contained 24 students. Students were taught experimental pharmacology practical online using Animal simulator (CAL- Computer Assisted Learning) for 2 hours on different days in three sessions. Questions and their feedback was taken during these sessions and presented in tables. Statistical analysis of data was done using Graph Pad software.Results: Majority of students i.e. 64 (66.67%) agreed that in vitro and in vivo experiments on animals are essential for better understanding and learning of the biological process. Students were agreed to the majority of the statements for CAL like enjoyable and time saving, easy to perform, contributes more to understanding theoretical concepts, no experimental error seen, welcome change and best alternative to laboratory practical and many experiments can be demonstrated in a short time. Students were disagreed on statements like CAL is an effective method of teaching practical aspects and preferred experimentation than laboratory practical. Majority of students given yes/positive response to questions showing advantages of using CAL. Also, positive feedback was obtained regarding questions showing disadvantages of using CAL software.Conclusions: Students’ perception regarding practical with CAL laboratory using animal simulator was good. The overall view was expressed that they found the exercises interesting and educationally beneficial. Computer assisted learning is a feasible and very effective teaching and learning method in pharmacology with huge potential to change the way of learning as it meets the majority of the learning objectives.

Students’ attitudes on personal drug selection exercise in writing prescription

Background: This study was developed to know the students’ views regarding personal drug (P-drug) concept in rational prescription of drugs and also giving them training of creating and using personal drug concept.Methods: 40 medical students (5th semester) divided in four groups were involved voluntarily in a three phase, questionnaire based and prospective study. In first and second phase students were taught and asked to derive P-drug using different standard text books and Current Index of Medical Specialties (CIMS) by analyzing efficacy, safety, cost and convenience of drugs used for type II diabetes mellitus. Third phase was designed to know the students’ perception regarding the exercise and difficulties faced in the process of P-drug selection. It contained demographic and 12 questions with answer using Likert scale.Results: Students selected biguanide (metformin) as a P-drug in terms of efficacy, safety, cost and convenience. 95% (36 out of 40) responded in the questionnaire, out of which 92% (33 out of 36) had given answer with mean score ?4. Overall median score was 4 and Interquartile Range was 4-5. 89% (32) strongly agreed that P-dug selection teaching helped them to understand pharmacology better. Majority (83% or 30) were in favour of introducing P-drug selection exercises in undergraduate pharmacology curriculum.Conclusions: P-drug selection exercise helped students to understand the differences among various drugs used for the treatment of type II diabetes mellitus and given them a strong foundation for developing rational use of the medicine in their future career as a doctor.