Impacts of counseling on knowledge, attitude and practice of medication use during pregnancy.

BACKGROUND: Counseling has a significant role in improving knowledge, attitude and practice outcomes of pregnant women towards medication use. Proper counseling thus could be beneficial to prevent any medication related misadventure during pregnancy. The present study was aimed to assess the knowledge, attitude and practice (KAP) of pregnant women towards their medications, to provide counseling regarding their understanding of medication use during pregnancy and evaluate the impacts of such counseling. METHODS: Pre- post interventional (counseling) study was conducted at Manipal Teaching Hospital, Nepal among pregnant women who presented with complication and were prescribed at least one medication. A total of 275 pregnant women were included in the study. A structured questionnaire was used to assess the knowledge, attitude and practice of pregnant women before and after counseling. The impacts of counseling were then evaluated using suitable statistical methods. RESULTS: Of the total participants 229 completed the post counseling survey. Majority of the participants were in the age group 20-24 (43.2%), primigravida (59.4%) and in third trimester (58.6%). Housewives comprised 61.1% of participants and majority had received a University degree (33.2%). The mean and median scores assessed before counseling showed that there was no significant difference in the KAP scores with respect to age, trimester and gravidity whereas KAP scores with respect to occupation and level of education were statistically significant. There was an increase in mean and median KAP scores after counseling and the impacts of counseling was found to be statistically significant (p = <0.001). CONCLUSION: Counseling had a positive impact on knowledge, attitude and practice of pregnant women towards medication and thus it could be considered a suitable method to encourage safe medication during pregnancy.

Herbal Fixed Dose Combinations in Nepal: Growing Concerns in a Developing Country.

Herbal medicines are mostly prepared as a combination therapy that has been used since therapeutic was first practiced. Combination products, also known as Fixed Dose Combinations (FDCs) of herbal remedies are in widespread use in Nepal. Herbal FDCs are in common practice because it is believed to have better adherence, less side effects and easy accessibility. Nevertheless, combination products possess greater risk of adverse effects, increases costs associated with treatments and leads to an ineffective dosages. Herbal FDCs are used extensively in Nepal although the rationality beyond the use of these combinations is still unidentified and at times are questionable. Legislations governing the use of herbal medicines is lacking in Nepal. Many herbal FDCs are not supported by any scientific data and test for the presence of ingredients mentioned in the package insert/container label is always difficult. A FDC of herbal products must be based on clear criteria that guarantee consumer safety and appropriate indications. These criteria helps to protect the consumers or patients from the misleading claims and risk associated with the use of unjustifiable combination of herbal substances. Strict monitoring from the regulatory body and the public awareness on the cost as well as advantages and disadvantages of herbal FDCs is urgently required.

Medication utilization pattern for management of pregnancy complications: a study in Western Nepal.

BACKGROUND: Drugs used during pregnancy can adversely affect the health and life of the mother and unborn child. However, the fact that drugs are needed to mitigate complications during pregnancy cannot be avoided. The present study was designed to identify the common complications during pregnancy and assess the medications that have been used to mitigate those complications in an attempt to improve drug prescribing during pregnancy. METHODS: A hospital based cross sectional study was conducted at Manipal Teaching Hospital, Nepal in 275 pregnant women presenting with at least one complication and the drugs prescribed for the management of those complications were analyzed. RESULTS: Majority of the patients in this study were in the age group 20-24 (44 %) and in the third trimester (53.8 %). Maximum patients complained pain (back, abdominal, lower abdominal, neck, pelvic) as primary complication (24.3 %) which was followed by nausea/vomiting, upper respiratory tract complications, acid reflux disease and others. Of the total prescriptions eighty six (86) did not have any medicines prescribed to the patients except multivitamins and nutritional supplements. The average drugs prescribed per patient was 2.78 in outpatient setting and 5.41 in in-patients. Ranitidine, hyoscine butylbromide, paracetamol were the most frequently prescribed medications. Antimicrobials comprised 12.8 % of total drugs prescribed and 18 % of total drugs were fixed dose combinations. Two hundred and thirty four (234) prescriptions out of 275 were prescribed by brand names. Most of the prescribed drugs were from FDA pregnancy category B and C. CONCLUSION: The present finding showed that pregnant patients were prescribed medications almost only when necessary and those considered safe during pregnancy were chosen to a large extent. However, few teratogenic drugs (2.49 % of total drugs prescribed) were also found to be prescribed which might need further assessments.

A study of potential drug-drug interactions among hospitalized cardiac patients in a teaching hospital in Western Nepal.

AIM: Drug-drug interaction (DDI) is of major concern in patients with complex therapeutic regimens. The involvement of cardiovascular medicines in drug interaction is even higher. However, reports of DDI between these groups of drugs are few. The study aims to identify the potential DDI among hospitalized cardiac patients. Furthermore, we assessed the possible risk factors associated with these interactions. SUBJECTS AND METHODS: The Type of study prospective observational study was conducted from May 2012 to August 2012 among hospitalized cardiac patients. Cardiac patients who were taking at least two drugs and who had a hospital stay of at least 24 h were enrolled. The medications of the patients were analyzed for possible interactions using the standard drug interaction database - Micromedex -2 (Thomson Reuters) × 2.0. RESULTS: From a total of 150 enrolled patients, at least one interacting drug combination was identified among 32 patients. The incidence of potential DDI was 21.3%. A total of 48 potentially hazardous drug interactions were identified. Atorvastatin/azithromycin (10.4%), enalapril/metformin (10.4%), enalapril/potassium chloride (10.4%), atorvastatin/clarithromycin (8.3%) and furosemide/gentamicin (6.3%) were the most common interacting pairs. Drugs most commonly involved were atorvastatin, enalapril, digoxin, furosemide, clopidogrel and warfarin. Majority of interactions were of moderate severity (62.5%) and pharmacokinetic (58.3%) in nature. Increased number of medicines, prolonged hospital stays and comorbid conditions were the risk factors found associated with the potential DDI. CONCLUSIONS: This study highlighted the need of intense monitoring of patients who have identified risk factors to help detect and prevent them from serious health hazards associated with drug interactions.

A study on factors affecting low back pain and safety and efficacy of NSAIDs in acute low back pain in a tertiary care hospital of Western Nepal.

INTRODUCTION: Low back pain is characterized by a range of symptoms which include pain, muscle tension or stiffness, and is localized between the shoulder blades and the folds of the buttocks, with or without spreading to the legs. Non-Steroidal Anti Inflammatory Drugs (NSAIDs) are the drugs of choice which provide an analgesic effect for acute low back pain. AIM: To study the factors affecting low back pain, efficacy and safety of different non-steroidal anti-inflammatory drugs (aceclofenac, diclofenac, naproxen and nimesulide) in low back pain. METHODOLOGY: Data collection form and numeric pain rating scale were used as study tools for studying patients' demographies and severities of pain respectively. Patients prescribed with aceclofenac 100 mg , diclofenac 100 mg, naproxen 500 mg and nimesulide 100 mg for acute low back pain at Orthopaedics Outpatients Department of Manipal Teaching Hospital, Nepal, were enrolled in this study. The decrease in pain scores was recorded on 5th and 10th days of follow-up and pain scores were calculated. Descriptive statistics and Kruskal Wallis non parametric test were used for analysis. RESULTS: Among 150 patients, 67.3% were females (n=101). Low back pain was more prevalent (24.7%) in age-group of 59-68 years and a positive correlation was seen. Similarly, low back pain was found to be high among people involved in agriculture, heavy weight lifters and non smokers. The decrease in average pain scores was more in the patients treated with aceclofenac (4.83 ± 0.537), followed by that in those who were treated with naproxen (4.13 ± 0.067) and diclofenac (3.84 ± 0.086). The decrease in pain scores was found to be lowest among patients who were treated with nimesulide (2.11 ± 0.148). Nimesulide presented more number of side-effects than the comparative drugs. CONCLUSION: Different factors affect low back pain, such as age, gender, personal habit, posture, occupation, weight lifting. Aceclofenac showed greater decrease in pain scores with lesser number of side-effects.

Initiation of social pharmacy research in Nepal: our experiences.

Nepal experiences several medicine-use problems like any other developing country. In the recent years, there have been initiatives to introduce the concept of social pharmacy in Nepal, and there has been only a limited research in this area. The staff members at the Manipal College of Medical Sciences, Pokhara have shown keen interest in initiating several social pharmacy-related researches in the country. The members of this institute have been collaborating with two international universities, namely Universiti Sains Malaysia located in Malaysia and Chulalongkorn University located in Thailand, to get academic and technical supports. In this manuscript, the authors share their experiences in initiating social pharmacy research in the country. Authors have also mentioned the priority areas of social pharmacy research in Nepal and the importance of initiating this concept in the country.

Evaluation of drug promotional materials in a hospital setting in Nepal.

OBJECTIVES: Unethical drug promotion is a common problem worldwide. In, Nepal, there is limited vigilance on the quality of information supplied by the drug companies to the doctors. The objectives of this study were to analyze the promotional materials provided by the drug companies as per WHO ethical criteria for medicinal drug promotion. METHODS: Promotional materials present in the Drug Information Center (DIC) during the period from September to December 2007 were collected. The collected promotional materials of different pharmaceutical companies were compared with WHO's Ethical Criteria for Medicinal Drug Promotion. RESULTS: The name of active constituent(s) was mentioned in 87.87% (n=29) of promotional items. Therapeutic indication was mentioned in 87.88% (n=29) of promotional material but information on side effects [33.33% (n=11)], drug interactions [9.09% (n=3)] and use in pregnancy and lactation [12.12% (n=4)] were lacking in the majority of promotional materials. CONCLUSION: In a country like Nepal with limited drug information resources, the promotional materials provided by the manufacturers can largely influence the prescription behavior of the clinicians. Our findings suggest the need for interventions to improve the content of the promotional materials provided by the drug companies.