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

PHARMACOTHERAPY ANALYSIS OF PATIENTS ADMITTED IN MEDICAL WARD: ROLE OF THE PHARMACIST!
Iftikhar Ali, Roheena Zafar, Aziz Ullah Khan
Department of Pharmacy Services ,Northwest General Hospital & Research Centre, Hayatabad, Peshawar, Khyber Pakhtunkhwa, Pakistan.
Keywords: Drug related problems, pharmacist, drug interactions, and intervention
Abstract

The purpose of this study was to evaluate pharmacotherapy provided, to identify drug related problems and to highlight the role of pharmacist at ward level in tertiary care hospitals. Drug related problems are quite common in hospitalized patients and can results in patient’s morbidity, mortality, and increase the expenditure of therapy and lengthen the hospital stay. A total of 30 patient’s case histories were recorded in medical Ward at Hayatabad Medical Complex, Peshawar on the standard designed questionnaire. The percentage occurrence of different disease likediabetes mellitus (26.66%), Malaria (16.6%), COPD (10%), Stroke (10%), T.B (6.6%) and CHF (6.6%) were determined .Diabetes mellitus was higher among diseases. The drugs with potential drug interactions were dexamethasone, furosemide, omeprazole, aspirin, rifampicin.Interventions like addition of new drug was highest among the recorded interventions.With the focus on individual patient, extensive and responsible clinical pharmacy services will be a key segment of present-day health care.

Article Information

Identifiers and Pagination:
Year:2014
Volume:4
First Page:90
Last Page:93
Publisher Id:CanJAppSci (2014 ). 4. 90-93
Article History:
Received:June 21, 2014
Accepted:August 12, 2014
Collection year:2014
First Published:October 20, 2014

INTRODUCTION

Drug-related problems (DRPs) are pharmacotherapy problems that truly or potentially have an impact on desired health outcome [1]. This is most likely due to patients receiving multiple drugs to control their medical conditions, all of which promote DRPs. Several factors could put in to DRPs. In geriatrics, co-morbidities, poor medication adherence and poly-pharmacy are potential basis of DRPs [2, 3].

Drug related issues could be characterized by any occasion or condition including drug therapy which interferes on the other hand conceivably, interferes with the patient, attaining an ideal outcome of desired therapeutic goal. Drug related problems are frequent and may result in low quality of life, with even high morbidity and mortality.[4].Drug therapy has become so difficult that no one professional is  expected  to  optimize the  drug  therapy  and  control  drug related  problems  alone. Drug-related morbidity and mortality are often preventable, and pharmaceutical services can reduce the number of Adverse Drug Reactions (ADRs), the length of hospital stay and the cost of therapy.

Pharmacists must abandon factionalism and adopt patient-centered pharmaceutical care as their philosophy of practice [5]. In the current Case, different histories were collected from patients, which have different diseases. The disease incidence, drug-drug interactions, and interventions made by the concern physicians were compiled.

 

MATERIAL AND METHOD

A standard questionnaire was designed, for recording of patient’s case histories which include demographic information, chief complaint, Drug-therapy provided in the hospital, main cause of hospitalization, concomitant disease, side effects, adverse effects, drugs interactions and other relevant information. A total of 30 patient’s case histories were recorded in medical unit at Hayatabad Medical Complex from December 2013 to February 2014. The pertinent information was recorded with respect to demographic information, disease incidence and drug related problems like drug interactions, ADRs and lack of education.

 

RESULTS AND DISCUSSION

A total of 30 patients drug therapy were assessed during the 3 months study period. The most frequent DRP, drug-drug interaction were noted. On the basis of evaluation of different case histories, results are summarized in the table 01, 02, 03respectively .Out of 30 patients, (46.6%) were male and (53.33%) were female. Rate of illness was higher in female. The most prevalent disease was diabetes. The malaria was common in male while diabetes in female .The major diagnoses include Diabetes Mellitus,Stroke, Malaria, Chronic Obstructive Pulmonary Disease, and Chronic Heart Failure. The demographic details of the patients are summarized in Table 01.

The demographic details of the patients are listed below in Table: 01

Table :01 Demographic details of the study patients

Characteristics

Numbers (n=30)

Gender

Male      14

Female   16

Age group (Years )

Mean

Range

Years

49.23

62

 

 

The clinical data and main causes of hospitalization and concomitant diseases are given in Table: 02

Case No

Sex

Age (years)

Cause(s) of hospitalization

Concomitantcondition(s)



1

Female

40

Pericardial effusion

Nil


2

Female

60

DM-1

Asthma


3

Female

45

DM-2

HCV


4

Female

80

Stroke

Diabetes mellitus


5

Male

35

Scarlet fever

Nil


6

Female

25

Measles

Nil


7

Female

75

Diabetes mellitus-1

Nil


8

Female

30

Asthma

Nil


9

Female

40

Diabetes mellitus-1

Nil


10

Female

50

CRF

Hypertension


11

Male

23

Malaria

Nil


12

Male

18

Malaria

Nil


13

Male

75

Cerebral malaria

Tuberculosis


14

Female

21

Drug poisoning

Nil


15

Female

50

Diabetes mellitus-1

Hypertension


16

Male

64

Malaria

Nil


17

Male

70

CHF

Nil


18

Male

35

Poisoning

Nil


19

Male

70

Hemorrhagic stroke

Pneumonia


20

Male

20

Diabetes mellitus-1

Nil


21

Male

60

Pulmonary edema

Fits


22

Male

35

Malaria

Nil


23

Female

65

COPD

Nil


24

Male

23

Diabetes mellitus-1

Nil


25

Female

68

Tuberculosis

Nil


26

Female

65

CHF

Nil


27

Female

60

COPD

Kidney stone


28

Male

50

Ischemic stroke

Nil


29

Female

62

Tuberculosis

Nil


30

Male

63

Anemia

Nil


S.No

 Interacting drugs

Effects

Class

01

Dexamethasone +Aspirin

Increase risk of ulceration

Significant

02

Dexamethasone+Furosemide

Increase risk of hypokalemia

Minor

03

Dexamethasone+Glebenclimide

Decrease the activity of glebenclmide

Minor

04

Rifampicin +Dexamethasone

Increase the risk of ADR e.g. hypertension

Serious

05

Glimepiride +Ramipril

Increase risk of hypoglycemia

Significant

06

Furosemide+Sulbutamol

Increase risk of Hypokalemia

Significant

07

Furosemide+Chlorothizide

Increase risk of Hypokalemia

Significant

08

Furosemide+Mefanemic acid

Increase nephrotoxicity

Significant

09

Ciprofloxacin +Omeprazole

Decrease the effect of ciprofloxacin

Significant

10

Rifampicine+Omeprazole

Decrease the level of omeprazole 

Significant

11

Quinine+Arthmeter

Increased risk of arrhythmias

Significant

12

Levofloxacin+Quinine

Increased risk of ventricular arrhythmias

Significant

 

Table: 03 Potential drug interactions [6, 7]

 

 


 

Table: 04 Pharmacist interventions

Type of intervention

Frequency

Percentage

Drug choice

Addition of new drug

 

17

48.57%

Dosing

Dose modification

Dosage form modification

 

01

00

2.85%

Drug interactions

12

34.28%

Others *

15

42.85%

* Non-compliance, ADRs

 

CONCLUSION

Drug related morbidity and mortality in hospitalized patients is an integral issue which prolongsthe stay and increase the expense of medicine. Medication related issues can interfere with the accomplishment of desired therapeutic objectives. The most widely recognized DRP that were watched, include drug interaction which may cause morbidity and at times even mortality; poly-pharmacy which is a financial load for patient sake; therapeutic duplication; expense related issues and excessive dose. Medication therapy could be advocated or more issues might be tackled by putting pharmacist in the health care team in hospital.

 

REFERENCES:

Blix HS, Viktil KK, Moger TA, Reikvam A. Drugs with narrow therapeutic index as indicators in the risk management of hospitalised patients. Pharmacy Practice. 2010;8(1):50-5.

1.       Chan DC, Chen JH,Kuo HK, We CJ, Lu IS, Chiu LS, Wu SC: Drug-related problems (DRP) identified from geriatric medication safety review clinics.ArchGerontol Geriatrics 2011, 54(1):168-174. 

2.       Somers A, Robays H, Vander SR, Van MG, Bogaert M, Petrovic M: Contribution of drug-related problems to hospital admission in the elderly. J Nutr Health Aging 2010, 14(6):477-482

3.       Viktil KK, Blix HS. The Impact of Clinical Pharmacists on Drug-Related Problems and Clinical Outcomes. Basic & clinical pharmacology & toxicology. 2008;102(3):275-80.

4.       Hepler C, Strand L. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990; 47(3):533--543.

5.       British national formulary 58 (2009). Appendix 1 interactions. Pp.720-8.

6.       Reference.medscape.com.Multi-Drug Interaction Checker [internet]. 2014 [accessed 3 October 2014]. Available from: http://reference.medscape.com/drug-interactionchecker.


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Jiangsu University, Zhenjiang, China

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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.

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