ABSTRACT
BACKGROUND: Drug use in pregnancy and lactation is challenging. It becomes more challenging in pregnant and lactating women with certain critical clinical conditions such as COVID-19, because of inconsistent drug safety data. Therefore, we aimed to evaluate the various drug information resources for the scope, completeness, and consistency of the information related to COVID-19 medications in pregnancy and lactation. METHODS: Data related to COVID-19 medications from various drug information resources such as text references, subscription databases, and free online tools were used for the comparison. The congregated data were analyzed for scope, completeness, and consistency. RESULTS: Scope scores were highest for Portable Electronic Physician Information Database (PEPID), Up-to-date, and drugs.com compared to other resources. The overall completeness scores were higher for Micromedex and drugs.com (p < 0.05 compared to all other resources). The inter-reliability analysis for overall components by Fleiss kappa among all the resources was found to be 'slight' (k < 0.20, p < 0.0001). The information related to the older drugs in most of the resources, provides in-depth details on various components such as pregnancy safety, clinical data related to lactation, the effect of the drug distribution into breast milk, reproductive potential/infertility risk and the pregnancy category/recommendations. However, the information related to these components for newer drugs was superficial and incomplete, with insufficient data and inconclusive evidence, which is a statistically significant observation. The strength of observer agreement for the various COVID-19 medications ranged from poor to fair and moderate for the various recommendation categories studied. CONCLUSION: This study reports discrepancies in the information related to pregnancy, lactation, drug level, reproductive risk, and pregnancy recommendations among the resources directing to refer to more than one resource for information about the safe and quality use of medications in this special population.The present study also emphasizes the need for development of comprehensive, evidence-based, and precise information guide that can promote safe and effective drug use in this special population.
Subject(s)
COVID-19 , Lactation , Pregnancy , Humans , Female , Reproducibility of Results , Breast Feeding , Milk, HumanABSTRACT
Introduction: Patients with psychiatric disorders receives multiple medications associated with their comorbid conditions and mental illness increasing the risk of drug related problems leading to frequent hospitalization, healthcare expenditure and reduced quality of life. Aim/Objective: To assess and evaluate the Drug Related Problems (DRPs) encountered in patients with psychiatric disorders in a Secondary Care Hospital in Ras Al-Khaimah. Methodology: A prospective observational study was carried out for a period of six months in the department of psychiatry of a secondary care teaching hospital. All the necessary details including the demographics, drug therapy and laboratory parameters were collected from the patient case records. The patient medication orders were reviewed and screened for any DRPs. The identified DRPs were documented and later evaluated to identify the types, frequency, class of drugs involved and for the level of clinical significance by using the descriptive statistics. Results: A total of 61 DRPs were identified from 50 patients. Male predominance was noted over females. DRPs were commonly seen in patients aged between 21-40 years of age. Schizophrenia (42%) was the most common psychiatric illness identified in the study. The most common DRPs was found to be drug-drug interaction (36.06%) followed by adverse drug reaction (27.86%) and medication non-adherence (24.59%). The level of significance of DRPs was found to be 'minor' significance in the grade. Conclusion: The study identifies the DRPs in patients with psychiatric illness and necessitates the need for a regular medication review which will help to rationalize the drug therapy, achieve better therapeutic outcomes and improved quality of patient care.
ABSTRACT
Background Drug interactions are a significant issue in mental illnesses and coronavirus disease 2019 (COVID-19) infections. Inconsistency in drug interaction resources makes prescribing challenging for healthcare professionals. To assess the scope, completeness, and consistency of drug-drug interactions (DDIs) between psychotropic and COVID-19 medications in six specific drug information (DI) databases. Methodology For the comparison, six DI resources were used: Portable Electronic Physician Information Database, Micromedex®, Medscape.com, UpToDate®, Drugs.com drug interaction checker, and WebMD.com drug interaction checker. Using the Statistical Package for the Social Sciences (SPSS) software version 27 (IBM Corp., Armonk, NY), the gathered data were examined for scope, completeness, and consistency. Results Scope scores were higher for PEPID© than all the other resources (p < 0.001) for each comparison. PEPID© had better overall completeness scores (median 5, Interquartile range [IQR] 5 to 5; p<0.05 for each comparison), except for Drugs.com (p < 0.05 for each comparison), and were more remarkable for Micromedex® (median 5, IQR 5 to 5). The Fleiss kappa scores among the six different DI sources were poor (k < 0.20, p < 0.05) for the category of information related to clinical effects and level of documentation, moderate agreement (k = 0.4 - 0.6, p < 0.05) for the severity and course of action of DDIs, and fair agreement (k = 0.4 - 0.6, p < 0.05) for mechanism. Conclusion A comprehensive, accurate information among DI resources is essential for healthcare professionals that will significantly impact patient care in the clinical practice. Banking on high-quality resources will help healthcare professionals to make an informed decision while prescribing to avoid inappropriate combinations that can adversely affect patient outcomes.