Canadian Journal of Applied Sciences


ISSN: 1925-7430
Short Key Title: Can J App Sci
DOI: http://dx.doi.org/10.21065/19257430
Start Year: 2011

PHARMACOTHERAPEUTICAL EVALUATION OF PATIENTS ADMITTED IN CLINICAL SETUP: A CASE REPORT
Muhammad Wasim, Taseer Ahmad, Aftab Ullah
1. Riphah Institute of pharmaceutical sciences, Riphah International University, Islamabad, Pakistan. 2. Shifa College of Pharmaceutical Sciences, STMU, Islamabad, Pakistan. 3. Institute of Pharmaceutical Sciences, COMSAT Institute of Information Technology, Abbottabad, Pakistan.
Keywords: Role of Pharmacist, Case histories, HMC, Ward level.
Abstract

The aim of this study was to evaluate case histories of patients admitted and also to highlight the role of pharmacist at ward level in Hayat Abad Medical Complex (HMC), Peshawar. A standard questionnaire was designed and thirty case histories of different diseases in medical ward were collected. The percentage incidence of different diseases like, diabetes mellitus (6.7%), respiratory tract infection (13.3%), chronic obstructive pulmonary disease (COPD) (16.6%) and hypertension (6.7%) were documented, in which percentage incidence of malaria (16.7%) was higher from the rest of diseases. The drugs which have observed for numerous drug interactions were steroidal drugs, warfarin, PPIs, benzodiazepines, NSAIDs, furosemide and anti T.B drugs. The most frequently recorded intervention was additive type (80%). In order to eliminate such undesired accomplishments clinical pharmacist services must be brought at ward level in health care system.

Article Information

Identifiers and Pagination:
Year:2014
Volume:4
First Page:33
Last Page:39
Publisher Id:CanJAppSci (2014 ). 4. 33-39
Article History:
Received:November 7, 2013
Accepted:December 19, 2013
Collection year:2013
First Published:January 1, 2014

INTRODUCTION

Pharmacist is the imperative part of health care team. Hospitalization and following discharge to home usually involve disruption of care, numerous changes in medication and lack of patient education and counseling that can lead to patient non-compliance and adverse drug events [1]. So it is of prime importance to counsel the patient and follow-up by the pharmacist. Pharmacists have clear role and must be the integral part of health care team because of increasing complexity in the management of drug therapy [2]. In the current study, different histories were collected from patients, which have different diseases. The disease incidence, drug-drug interactions, non-compliance and interventions made by the concern physicians, were compiled.

 

MATERIAL AND METHOD

 For recording patient’s case histories, a standard questionnaire was designed, which include name, age, sex, past history, chief complaint, treatment chart, main cause of hospitalization, concurrent disease, side effects, adverse effects, drug interactions and other relevant information. We collected thirty case histories of different diseases in the medical ward of Hayatabad Medical Complex Peshawar, Pakistan, from January to February 2013. The relevant information was recorded with respect to patient demographic data, disease incidence, drug interactions, adverse drug reactions and lack of education.

RESULTS AND DISCUSSION

Though in routine cases the therapy was satisfactory, but in majority cases no attention was given to the initial treatment and in most of the cases drug-drug interactions were reported. On the basis of evaluation of different case histories, results are summarized in Table 1, Table 2, Table 3, Figure1 and Figure 2.  Table 1 shows the incidence of diseases which are much more common in male (63.3%) than female (36.7%). The total numbers of patients were thirty, out of which 11 were females and 19 were males. Irrespective of sex the most prevalent diseases were malaria and chronic obstructive pulmonary disease (COPD). The most common disease in male was malaria and in female Chronic obstructive pulmonary disease (COPD). The other diseases were lower respiratory tract infection (LRTIs), hypertension, diabetes mellitus, empyema, deep vein thrombosis, addison’s disease, epilepsy, tetanus and pneumonia.


Figure 1: Percentage incidence of diseases in different age groups

Figure1 shows the incidence of diseases in different group’s age wise. We divided the patients into seven groups age wise as, 1 to 15, 16 to 30, 31 to 45, 46 to 60, 61 to 75, 76 to 90, with percentage incidence of different diseases 3.3%, 40%, 16.7%, 13.3%, 20%, 6.7% respectively. Patients who have age from 16 to 30 are more prone to infections (40%) and hence need extra care.

 

Figure2: Percentage incidence of different diseases.

Figure 2 described the percentage incidence of different diseases. The percentage incidence of malaria is greater from the rest of diseases (16.7%). The percentage incidence of different diseases like diabetes mellitus (6.7%), emphysema (6.7%), deep vein thrombosis (6.7%), respiratory tract infections (13.3%), chronic obstructive pulmonary disease (COPD) (16.6%), hypertension (6.7%), addison’s disease (3.3%), epilepsy (3.3%) and tetanus (3.3%) respectively. Mass awareness should be there about diseases which are more common like malaria, COPD and hypertension. The people should not be exposed to the risk factors especially those who are more vulnerable.

Table 2 elucidate, drug interactions which were recorded. The drugs for which more interactions documented were steroidal drugs, warfarin, PPI’s, benzodiazepines, NSAID’s, furosemide and anti T.B drugs.

Five different types of interventions were noted. The most common and frequently recorded intervention was additive type that is 80% and the rest were changes in drugs (therapeutic alternative and change in class of drugs), dose changes, dosage form changes and others, 56.7%, 16.7%, 10% and 13.3% respectively. The reasons for drug interventions may be therapeutic success, availability, first line treatment, patient condition, suitability, behaviour of the patient, pharmacoeconomics, non-compliance and toxicity. Drug intervention should be for therapeutic reasons not for economic burden. If the dose frequency is greater than the chances of non-compliance will be more. So, for the sake of compliance intervention should be there in dose frequency. If severe and life threatening adverse drug reactions are reported than the drug must be stopped or replaced by safer drug. If we need immediate therapeutic response or the patient is comatose, than the drug should be in parenteral form. Generally caution should be observed when physician do interventions.

Table 1: Patient demographic and other clinical data

S.NO.

Sex

Age

Main cause of hospitalization

Current disease

1

Female

65

Diabetes mellitus

CCF

2

Male

90

Emphysema

NIL

3

Male

70

CLD

NIL

4

Male

20

D.M-1

Pyelonephritis

5

Male

17

Malaria

NIL

6

Male

45

COPD

NIL

7

Female

20

Psychological disorder

NIL

8

Male

17

Epilepsy

NIL

9

Male

45

BNZ poising

NIL

10

Female

20

Hypoglycemia

CRF, HTN,D.M

11

Male

22

Hypertension

IHD and old CVA

12

Female

19

Addison’s disease

NIL

13

Male

40

Emphysema

NIL

14

Male

60

Pneumonia

CRF

15

Female

30

UTI

HTN, CRF

16

Male

45

Malaria

NIL

17

Female

65

COPD

NIL

18

Male

62

Hypertension

D.M

19

Male

50

DVT

NIL

20

Female

45

Pleural effusion

Epilepsy, HTN

21

Male

12

Cerebral malaria

NIL

22

Female

17

COPD

NIL

23

Male

65

COPD

NIL

24

Male

60

Tetanus

NIL

25

Male

85

DVT

Urethral carcinoma

26

Female

20

Malaria, enteric fever

NIL

27

Female

19

LRTI’S

Metral stenosis

28

Male

55

LRTI’S

HCV +ve

29

Male

45

COPD

NIL

30

Female

27

Malaria

NIL

 Keys: M = male; F = female; DM = Diabetes mellitus; CCF = congestive cardiac failure; CLD = chronic liver disease; COPD = chronic obstructive pulmonary disease; BNZ = benzodiazepine; CRF = chronic renal failure; HTN = hypertension; IHD = ischemic heart disease; CVA = cardio vascular accident; UTI = urinary tract infection; DVT = deep vein thrombosis; LRTI = lower respiratory tract infection.

 

Table 2: Potential drug Interactions

No.

Interaction in drugs

Effects

1

Lisinopril + aspirin

Decreased effects of ACE inhibitors

2

Lisinopril + furosemide

Enhance the effect of ACE inhibitor [3]

3

Lisinopril + insulin

Increased the sensitivity of insulin [6]

4

Metronidazole + warfarin

Decreased the hypoprothrombinemic response

5

Sulcef + warfarin

Enhanced the hypoprothrombinemic response

6

Myrin-p + warfarin

Increased the metabolism of warfarin

7

Moxifloxacin + warfarin

Inhibit the metabolism of warfarin [5]

8

Omeprazole + levofloxacin

Reduced the absorption of levofloxacin[3]

9

Hydrocortisone + piroxicam

Increased the risk of GI bleeding. [6]

10

Smoking + aminophylline

Increased dosing requirements [5]

11

Omeprazole + diazepam

Increased conc. of diazepam [1]

12

Esomeprazole + amlodipine

Increased conc. of amlodipine [6]

13

Calcium + amlodipine

Increased the effect of amlodipine

13

Calcium + amlodipine

Increased the effect of amlodipine

14

Furosemide + ceftriaxone

Increased risk of nephrotoxicity [6]

15

Salbutamol + furosemide

Cause serious hypokalemia

16

Dexamethasone +hydrochlorothiazide

Increased the blood glucose level [5]

17

Esomeprazole + diazepam

Increased the serum conc. of diazepam [6]

18

Prednisolone + isoniazid

Decreased the plasma conc. of isoniazid [3]

19

Sucralfate+ ethambutal

Decreased the plasma conc. of ethambutal [6]

20

Dexamethasone+ panadol

Increased the risk of GI bleeding [5]

21

Dexamethasone + pneumococcal vaccine                                               

Impaired the immune response of vaccine [3]

    22

   Teznidine + diazepam

Increased the sedative effects[5]

Table 3: Intervention

#

Types of Interventions

%age

Reasons

Remarks

1

Changes in drugs (Therapeutic alternative, changes in class of drugs)

56.7

Therapeutic success Pharmacoeconomics Physician first choice

For the attainment of good therapeutic response drug should be changed.

2

Addition of another drug

80

Therapeutic success        Availability Patient need                  First line treatment

Drug should be added for therapeutic success not for economic burden.

3

Changes in dosage form

10

Suitability                            Condition of the patient                    Patient behavior

Comatose patient should be treated via i.v route.                                                        Patient should feel comfortable.

4

Changes in doses

16.7

Disease condition                Patient need                  Toxicity

If the patient is ameliorating the dose should be decreased.   The drug should be start in lower dose than gradually it will be increased.

5

Others

13.3

Non-compliance                               ADR'S

If the dose frequency is greater the chances of non-compliance will be more.                                                                      In case of serious ADR’s the drug should be stop immediately and switch over safer drug.

 

 

CONCLUSION

 It conceivable, therefore, that due to lack of quality health care system, there is a need of legally qualified and professionally competent pharmacist in hospitals. Pharmacist can help in minimizing poly pharmacy, drug-drug interaction, irrational prescription, dispensing and counseling of patient regarding their treatment.

REFERENCES

1.      Schnipper JL, Kirwin JL, Cotugno MC, Wahlstrom SA, Brown BA, Tarvin E, Kachalia A, Horng M, Roy CL, McKean SC, Bates DW(2006). Role of pharmacist counseling in preventing adverse drug events after hospitalization, Arch Intern Med 166, 565-571.

2.      Hudson SA, Anaw JJM, Johnson BJ (2007). The Changing Roles of Pharmacists In Society, IeJSME 1, 22-34.

3.       David E, Moody (2004). Drug interaction with benzodiazepine. In, Ashraf Mozayani (ed). Hand Book of Drug Interaction, 1st edition. New Jersey, Humana press, pp3-88.

4.        Brunton LL, Chabner BA, Knollman BC (2011). Goodman & Gilman’s the pharmacological basis of therapeutics, 12th edition. USA, McGraw-ill companies pp. 1613-45.

5.       Katzung BG (2006). Important drug interaction and their mechanism. Basic And Clinical Pharmacology, 10th edition Mc Graw Hill Lang, pp.11, 10-24.

6.      British national formulary 58 (2009). Appendix 1 interactions. Pp.720-803.


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Editor in Chief
Xianghui Qi (PhD)
Jiangsu University, Zhenjiang, China

Bibliography

Dr. Xianghui Qi is working as Professor in the School of Food & Biological Engineering, Jiangsu University, China. His research interests: Biosynthesis of high value-added chemicals by microbes and engineered strains; Discovery of novel genes, enzymes and new strains; Rational & Irrational design of microbial enzymes; Isolation, identification and evolution of microbes; Metabolic engineering & Pathway engineering of functional microbes, and biotransformation; Metabolic regulation based on the research of microbial omics; Application of high value-added products including functional sugar alcohols by biosynthesis and biotransformation based on microbial engineered strains.

Journal Highlights
Abbreviation: Can J Appl Sci
doi: http://dx.doi.org/10.21065/19257430
Frequency: Annual
Current Volume: 7 (2017)
Next scheduled volume: December, 2018  
Back volumes: 1-7
Starting year: 2011
Nature: Online
Submission: Online
Language: English

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