Electroencephalographic and behavioral effects of intracerebroventricular or intraperitoneal injections of toxic honey extract in adult Wistar rats and GAERS.

Toxic honey, containing grayanotoxin, is obtained from nectar and polen of rhododendron. Consumed in excess it produces seizures and convulsions. In order to investigate whether the toxic honey extract can be used as a seizure model, we examined the electroencephalographic (EEG) and motor effects of intracerebroventricular (icv) or intraperitoneal (ip) injection of toxic honey extract in Wistar rats or in genetic absence epilepsy rats from Strasbourg (GAERS). Male Wistar rats or GAERS were stereotaxically implanted with bilateral cortical recording electrodes in all ip groups and cannula in the icv groups. Based on the previous study, an extract was obtained from the non-toxic and toxic honey. After the injection of the non-toxic or toxic honey extract, seizure stages and changes in EEG were evaluated from 9 am to noon. The icv administration of toxic honey extract produced stage 4 seizures and bilateral cortical spikes within 30-60 min and these effects disappeared after 120 min in Wistar rats or GAERS. The mean of bilateral cortical spike acitivity in EEG of Wistar rats was 804.2 ± 261.0 s in the 3-h period. After the icv administration of toxic honey extract to GAERS, the mean duration of spike-and-wave discharges (SWDs) in GAERS significantly decreased during the first 60 min and then returned to baseline level. Ip injection of toxic honey extract caused no seizure and no change in EEG in either GAERS or Wistars. These results suggest that the icv administration of toxic honey extract can be used as a seizure model.

Patient knowledge about drugs prescribed at primary healthcare facilities.

OBJECTIVE: Providing adequate information to the patients about their drugs is an essential principle of rational pharmacotherapy. This study investigates the knowledge of general practice patients about their drugs, since the level of knowledge of the patient about the medication is highly associated with the outcome of the therapy. METHODS: A total of 1618 patients who applied to primary healthcare centers in Istanbul and accepted to participate in the study were asked about the name(s) and effect(s) of the drug(s) on their prescriptions. Factors that might influence the background knowledge and perception of patients such as sociodemographic characteristics, drug-use habits and practitioners' attitudes were also questioned. Information provided by the patients was compared with the prescriptions. RESULTS: Only 10.9% of the respondents could recall the names of their drug(s) correctly. Level of education, and gender, had a positive impact on recalling drug names. Patients, who received a refill prescription, with a chronic disease, and who had self-medication before applying to the health center reported more accurate information. Less than half of the practitioners had informed their patients about the drug effects; and 7% of the patients have been requested to repeat the instructions and warnings about his/her medication(s). The patients to name their drugs correctly also knew the drug effects twice as much the patients who could not recall their drug(s)' name. The drugs which were correctly named were the ones used in chronic diseases. CONCLUSION: It appears that patients, particularly who are poorly educated, males, and who received a first prescription know little about their prescribed drugs. These results suggest that patients' education about drugs is an important issue regarding rational drug use which deserves urgent improvement.

Therapeutic drug monitoring of immunosuppressant drugs in Marmara University Hospital.

Immunosuppressive therapy is the most crucial treatment of organ-transplanted patients. Both cyclosporin and tacrolimus have become a part of the standard immunosuppressive therapy for prevention of rejection. However, lower levels of these drugs are associated with insufficient therapy and eventually result in rejection of the organ, and, on the contrary, higher levels are associated with toxicity to certain organs such as liver and kidneys. Therefore, the levels of these drugs in body fluids should be monitored for the prevention of unwanted situations. In this retrospective study, the authors evaluated the 18-month profile of blood drug concentrations of cyclosporin and tacrolimus in patients admitted to the TDM Unit of the Marmara University Hospital (Istanbul, Turkey) between June 2000 and November 2001. A total of 578 blood samples (347 cyclosporin and 231 tacrolimus) from 134 patients (88 for cyclosporin, 46 for tacrolimus) were evaluated in this period. The therapeutic trough ranges were accepted as 100-350 ng/mL for cyclosporin and 5-20 ng/mL for tacrolimus, and levels below or above the identified levels were accepted to be subtherapeutic or toxic. Most of the results were found within the range of therapeutic levels (67.48% for cyclosporin and 82.71% for tacrolimus). Subtherapeutic levels were found in 19.92% of all cyclosporin and 10.53% of all tacrolimus assays, whereas toxic levels were seen in 12.60% and 6.77% of cyclosporin and tacrolimus results, respectively. In conclusion, this study gives information about the TDM practice in institutional clinical laboratory and also indicates the importance of critical information such as sampling time for individual decision making in dosage regiment.