The concept of
drug related problems and pharmaceutical care, their importance and role in today’s
life and future was not well developed until 1990 when a first paper was
published dealing with the drug related problems [1,2]. In this term “problem”
is actually “an undesirable drug related event”  and the definition of
drug-related problems is “an undesirable patient experience that interferes
with a desired patient outcome” . It involve errors in medication (either
during prescribing, dispensing or administering the drug) and adverse drug
reactions (any harmful response of a drug which occurs at doses normally used
in human beings for prevention, diagnosis or treatment of disease or for the
enhancement of physiological function)[5,6]. Sometimes the terms drug-related
problems (DRP), drug therapy problems (DTP), medicine related problems (MRP)
and medication-related problems are used synonymously . Drug-related
problems are the main cause of increased cost of therapy[8,9] and are the 5th
most common cause of morbidity and mortality behind the carcinoma, heart
diseases, stroke (brain attack) and pulmonary disorders[10,11].
In order to
better understand and correctly identify, the drug-related problems are
categorized as the medical conditions resulting from following medication
Wrong type of drug is being taken.
The patient is not receiving right
medication therapy for the condition he is suffering.
Wrong dose is being taken (either too
little or too much).
Due to an adverse drug reaction.
Due to a drug-food, drug-drug and drug
Due to not receiving the prescribed
Due to taking of a drug without any valid
Due to wrong route of administration of
Due to wrong rate/frequency of the drug.
Due to wrong time of administration of
drug related problems in above mentioned eleven types is very useful as it
shows how adverse drug reactions can occur which is a useful point for the
pharmacists to identify, solve and prevent all types of drug related problems
. It helps the pharmacist in convincing the administrator that these
problems are important and need an expert and also makes easy for the
pharmacist to point out the DRPs and counsel other health care professional on
that, which is the major role of pharmacist in clinical and hospital setup.
interactions are important type of drug-related problems and are easily
predictable from previous medication record. Some of the drug related problems
are responsible for the increased morbidity and mortality which resulted in the
removal of some of the popular medications from the market . Some Drug
related problems are more common in the hospitalised patients and need an
expert for the overlook of these problems in order to achieve definite patient
outcomes and also to achieve the cost effectiveness for those patients who
cannot afford the medication expenses in country like Pakistan as most of the
population is below average line of poverty and the cost of medication is very
In order to
study the drug related problems in different aged patients of medical ward and peads Ward of Khyber teaching hospital (KPK)
Pakistan a data collection form was used which included the patient
demographics, his past medical history, family history, previous surgery
history, current cause of hospitalization, current laboratory data and current
medication record. The data of 60 patients was collected from medical ward and
paeds ward of Khyber Teaching Hospital, Peshawar, (KPK) Pakistan and was
analysed for any possible drug related problems. Detailed interviews of the
patients were also conducted for data collection. The data was analysed and
graphs were plotted for the results.
Out of 60
medication histories 43 were collected from Medical Ward of Khyber Teaching
Hospital (KPK) Pakistan and 17 histories were collected from Paeds Ward of
Khyber Teaching Hospital (KPK) Pakistan. The most commonly prevailed diseases
in Medical ward were as Tuberculosis (9.3% of 43 cases), Cerebrovascular
diseases (18.6% of 43 cases), HCV with CLD (11.6% of 43 cases) GIT diseases
(9.3% of 43 cases), Renal diseases (11.6% of 43 cases), CNS infections (4.65%
of 43 cases), Anaemia (6.66% of 43 cases), Fever (11.6% of 43 cases), Malaria
(14% of 43 cases), Diabetes mellitus (9.3% of 43 cases) and Rheumatoid
Arthritis (2.32% of 43 cases).
Fig 1: Graphical presentation of disease
statistics in Medical Ward. N= frequency of disease.
Fig 2: Graphical presentation of disease
statistics in Paeds Ward. N= frequency of disease.
Similarly the 17
cases were collected from the Paeds Ward of Khyber Teaching Hospital (KPK)
Pakistan and analysed. The most common diseases in Paeds ward were GIT diseases
(5.88% of 17 cases), Respiratory Tract Infections (41.2% of 17 cases), Malaria
(5.9% of 17 cases), Anaemia (5.88% of 17 cases), CNS Disorders (11.7% of 17
cases), Urinary Tract Infections (5.88% of 17 cases), Fever (17.6% of 17 cases)
and CVS Disorders (5.88% of 17 cases). Graphical presentation of the diseases
is presented in figure 1 and 2.
commonly prescribed class of drugs at medical ward of Khyber Teaching Hospital
(KPK) Pakistan were cardiovascular drugs (24%), tonics (20%), antibiotics
(18%), steroids (9%), analgesics (9%), diuretics (6%), anti-T.B (6%),
anti-malarial (4%), anti-emetics (4%).
class of drugs most commonly prescribed at paeds ward of Khyber Teaching
Hospital during the four weeks were as Antibiotics (60%), Tonics (8%),
anti-emetics (4%), Diuretics (4%), analgesics (12%), steroids (4%),
anti-malarial (8%). The graphical presentation is shown in figure 3 and 4.
Fig 3: Graphical presentation of Drugs
used in Medical Ward.
Fig 4: Graphical presentation of Drugs
used in Paeds Ward.
The Dosage form
prescribed at both medical ward and paeds ward are as syrups (6%), nebulizers
(8%), Tablets (40.5%), Capsules (3.9%), Injections (43%). The graphical
presentation of dosage form statistics is shown in figure 5.
Graphical presentation of Dosage form & their frequency in Paeds & Medical Ward. N= frequency of
Graphical presentation of Gender wise distribution in Paeds & Medical Ward.
n = frequency of gender.
Graphical presentation of Age-wise distribution in Paeds B & Medical C
frequency of age.
Out of 60 selected patients only
3% showed non-compliance and 15% showed poor compliance. Rest of the 82% showed
a good compliance to the treatment regimen.
Graphical presentation of Compliance in Medical Ward and Paeds Ward.
The drug related
problems observed during the analysis of the prescriptions in medical ward and
paeds were untreated conditions (24.93%), Drugs given without any indication
(20%), Improper drug selection (15%), Therapeutic duplication (7.5%), Improper
dosage form (5%) and other than these wee categorized as miscellaneous problems
Fig 10: Graphical presentation of Drug
The study was
conducted in two different wards of Khyber Teaching Hospital, Peshawar (KPK)
Pakistan for the prevalence of drug-related problems in different age patients.
From results of the data we came to know that out of various diseases Coronary
obstructed pulmonary disease (COPD 20%) was the most frequent cause of
hospitalization. Other common diseases were tuberculosis, malaria, nephritic
syndrome, hypertension, diabetes mellitus, pneumonia etc. When the data was
analysed for drug related problems the most frequent problems were untreated
conditions, therapeutic duplication , drug without indication, improper drug
selection etc. For example regarding the
drug interaction, in one of the case, a patient was receiving both phenotab and
chloramphenicol. The efficiency of phenotab is increased in the presence of
chloramphenicol leading to increased sedative effect of phenotab. Regarding
improper drug selection, one of the cases, a patient was presented with
Plasmodium falciparum malarial infection along with previous G6PD deficiency.
He was dispensed with Quinine and quinine is reported to cause haemolysis,
leucopoenia, agranulocytosis and thrombocytopenia in G6PD deficient patients.
It is obvious that quinine is not a right selection.
In a study regarding
drug-related problems carried out by K. K. Vktil et al suggested that Polypharmacy
is one of the potential causes of DRPs and require identification of the
drug-related problems and the patients need special attention . In his
study he found that nearly half of the patients who were admitted to hospital
were prescribed with more than five drugs and hence they were exposed to
Polypharmacy according to a common definition. Authors of a study carried among
old age patients in Washington, Lowa, Maryland and Georgia reported that high
rates of duplicative therapies, inappropriate duration of therapies,
inappropriate dosages and contraindication persisted . Linda M. Strand et
al wrote detail information on drug related problems in hospitalised patients
and differentiated their types for a clear identification so that these
problems can be easily prevented .
The result of this study indicate
that presence of a pharmacist is very much necessary in Khyber Teaching
Hospital at ward level in order to minimize the drug related problems along
with counselling of the patient regarding the use of medication so that a
maximum compliance is achieved. Training programmes for all the medical staff
should be arranged periodically and establishment of satellite pharmacy can
also decrease the prevailing problems related to the drug administration and
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