Presence of Affirmable Drug Affiliated Interactions in Medical Patients in Medical OPD of Pakistani Hospital

Drug-drug interactions (DDIs), are preventable medical related hazards having grave life menacing and unfavorable consequences Purpose: To find the clinical adverse effects and interaction frequency witnessed in prescriptions of a medical OPD Study Design: Comparative study Methodology: A sample of 546 patients who were being prescribed at least two drugs simultaneously was assessed using a drug interaction program Statistical analysis: SPSS v.20.0 was used to analyze the data to present results as proportions Results: The 546 patients (72.8% male having mean age of 58.3±14.7 years. Out of these 186 (4.7%), 2595 (65.6%) and 773 (19.5%) were severe, moderate and mild interactions respectively Conclusions: We concluded that large percentage of patients were detected having one or more potential drug-drug interactions Keywords: Adverse Drug Interaction, Drug-Related Problems, Drug-Drug Interaction and Pharmaco-epidemiology.

ADVERSE DRUG INTERACTION BETWEEN ASPIRIN AND FUROSEMIDE: A CASE REPORT

Drug–drug interaction between two drugs leads to a serious adverse drug reaction which is an adverse drug interaction. A 60-year-old female patient came with complaints of chest pain since 6 pm on the day of admission which is a burning type of pain and also a history of breathlessness. She was a known case of hypertension and diabetes mellitus since 5 years on medications, i.e. tablet atenolol-5 mg - 1-0-0, tablet amlodipine - 5 mg - 1-0-0, and tablet metformin - 500 mg - 1-0-1; the patient’s appetite was reduced and sleep was disturbed. On examination, blood pressure was 120/100 mmHg, pulse rate: 80 bpm, SpO2: 94% with room air, respiratory system: B/L coarse crept (+), and pallor (+) remaining systemic examination showing no any deformities. Laboratory reports show microcytic hypochromic with neutrophilia and thrombocytosis and ultrasonography (USG): B/L Grade I renal parenchymal disease. The patient ongoing treatment was tablet aspirin - 325 mg stat and 150 mg 0-1-0, tablet clopidogrel 300 mg stat and 75 mg 0-1-0, tablet atorvastatin 80 mg stat and 40 mg 0-0- 1, injection furosemide 40 mg IV 1-1-0, and injection nitroglycerin 2 amp in 1 pint NS at 12 drops/min and stopped on the 2nd day; injection pantoprazole 40 mg IV 1-0-1, injection heparin 5000 IU IV 1-1-1, and injection insulin R 8-8-6 S/C 1-0-1 started from the 2nd day; tablet enalapril 2.5 mg PO 1-0-1 given on the 2nd and 3rd days; tablet amlodipine 5 mg PO 1-0-1 given on the 2nd day and stopped; and injection insulin 1 pint in 25% dextrose, injection calcium gluconate, and nebulizer asthalin given only on the 3rd day. Here come 6 major interactions between amlodipine and clopidogrel, aspirin and furosemide (causes possible nephrotoxicity), clopidogrel with aspirin and heparin (increased risk of bleeding) and also heparin with nitroglycerin. The patient diagnosed as chronic kidney disease in the middle of the treatment which was adverse reaction interaction between aspirin and furosemide.

Suspected adverse drug interaction between spinosad and milbemycin oxime in a cat

Case summary A 12-year-old male neutered Tonkinese cat was presented for acute ataxia, weakness, altered mentation and generalised tremors. The cat had been administered oral spinosad (140 mg; 33.5 mg/kg) 48 h prior to the onset of clinical signs, and an oral anthelmintic containing milbemycin oxime (16 mg; 3.8 mg/kg) and praziquantel (40 mg; 9.6 mg/kg) 12 h before the onset of clinical signs. On physical examination, dull-to-obtunded mentation, tetraparesis, ataxia and mild tremors of facial, limb and trunk muscles were noted. Serum biochemical changes and urinalysis were consistent with haemoconcentration. The results of a complete blood count, urine culture and serology for feline leukaemia virus, feline immunodeficiency virus and cryptococcal antigen were negative. The patient was monitored in hospital and all clinical signs resolved within 24 h. Relevance and novel information The neurological signs in this case were consistent with macrocyclic lactone neurotoxicity, which is suspected to have occurred from an adverse drug interaction between spinosad and milbemycin oxime. This report serves to highlight the potential for this adverse drug interaction between these commonly used prophylactic drugs.

Studi Prospektif Potensi Interaksi Obat Golongan Antibiotik Pada Pasien Pediatri Di Rumah Sakit Ananda Purwokerto

Interaksi obat terjadi pada saat efek suatu obat (index drug) berubah akibat adanya suatu interaksi dengan obat lain (precipitant drug), makanan, atau minuman. Perubahan ini dapat berinteraksi menghasilkan efek yang dikehendaki (Desirable Drug Interaction), atau efek sebaliknya yaitu tidak dikehendaki (Adverse Drug Interaction). Dilaporkan bahwa kejadian interaksi obat lebih banyak terjadi pada pasien dewasa, sedangkan laporan mengenai kejadian interaksi obat pada pasien anak masih sedikit. Penelitian ini bertujuan untuk mengetahui potensi interaksi obat golongan antibiotik yang terjadi pada resep pasien pediatri di Rumah Sakit Ananda, Purwokerto. Penelitian dilakukan secara deskriptif noneksperimental dengan pengambilan data prospektif dilakukan pada data rekam medik dan resep pasien pediatri pada bulan Februari – April 2018. Sampel diperoleh secara purposive sampling dengan kriteria inklusi pasien pediatri yang tergolong bayi (usia 28 hari–23 bulan), anak–anak (usia 2–11 tahun), dan remaja (usia 12–18 tahun), pasien pediatri yang mendapat resep obat yang mengandung antibiotik, pasien pediatri yang mendapat obat ≥2 macam obat secara bersamaan, pasien pediatri yang dirawat di Instalasi Rawat Inap Rumah Sakit Ananda Purwokerto. Hasil penelitian menunjukkan terdapat 11 kasus kombinasi obat yang diidentifikasi berpotensi menyebabkan interaksi obat. Jenis interaksi obat terjadi pada interaksi farmakokinetik (54,5%) dan farmakodinamik (45,5%). Potensi interaksi antibiotik dengan antibiotik maupun dengan obat lain terjadi pada kategori mayor (18,2%), moderat (72,7%), dan minor (9,1%). Kesimpulan penelitian yaitu terdapat interaksi antara antibiotik dengan antibiotik maupun dengan obat lain. Interaksi obat terjadi pada fase farmakokinetik dan farmakodinamik. Tingkat keparahan interaksi yang terjadi yaitu mayor, moderat, dan minor.

Cyproheptadine adverse drug interaction with anti-epileptic drugs

Cyproheptadine is a H1 and 5- HT1/2 receptor antagonists, impairing the anticonvulsant activity of antiepileptic drugs and reduces threshold, increases severity of seizures, when administered chronically. Anuj a 13 years old male from Delhi, known case of SSPE stage-III with epilepsy, on oral anti-epileptic drug has seizure induction followed the use of oral cyproheptadine. Stopping cyproheptadine, patient didn’t sustain any further seizures.

Assessment of Drug-Drug Interaction in Ayder Comprehensive Specialized Hospital, Mekelle, Northern Ethiopia: A Retrospective Study

Introduction. Adverse drug interaction is a major cause of morbidity and mortality. Its occurrence is influenced by a multitude of factors. The influences of drug-drug interactions (DDIs) can be minimized through creation of awareness to health care professionals. Objective. The objective of this study was to assess DDIs in Ayder Comprehensive Specialized Hospital (ACSH). Methodology. A retrospective study design was employed on patient prescriptions available in the outpatient department of pharmacy and filled from September 2016 to February 2017 in ACSH. Result. From the 600 prescription records assessed, the average number of drugs on single prescription was 2.73. Regarding the interaction observed 34 (9.63%) prescriptions with major drug-drug interaction, 210 (59.5%) moderate, 87 (24.65%) minor, and 22 (6.22%) unknown were identified. Age category showed significant association to affect the occurrence of DDIs and polypharmacy had statistically significant association with DDIs in bivariate analysis which was lost in adjusted OR. Conclusion. From the current study it can be concluded that nearly half of the prescription ordered in ACSH contained DDIs and from the prescription with interacting medications majority of them had moderate DDIs.

DRUG-DRUG INTERACTIONS;

Introduction: This research paper is based on a study conducted on the in-doorpatients at a teaching hospital in Gujrat, Pakistan, in order to check for the frequency with whichPenicillins, Quinolones and Cephalosporins are being used together and in combinations withother drugs and the drug-drug interactions that occur due to these combinations and theirimpacts on the patients. Objectives: (1) To check the frequency with which Penicillins,Quinolone and Cephalosporins are being used in different combinations in patients. (2) Todetermine their drug-drug interactions. (3) Impact on patients due to these interactions. (4)Reasons for prescription of mismatched combinations by clinicians. Study Design: 270 randomprescriptions were collected from different wards of DHQ hospital, Gujrat. These prescriptionswere then analyzed for drug interactions among the above mentioned group of drugs, with thehelp of soft ware program named The Medical Letter Adverse Drug Interaction Program. Setting:Aziz Bhatti Shaheed Hospital (DHQ), Gujrat , Pakistan. Period: Prescriptions were collected overthe period of 3 months. Conclusions: Prescribing antibiotics for different indications in indoorpatients is unavoidable. However, it is the duty of the clinician to monitor the patient when he isusing two or more drugs together. This study recommends the use of drug-drug interactiondetecting software in hospitals, so that, the level of patients’ safety may be enhanced.

CORTICOSTERIOD;

Introduction: Indoor patients in hospitals frequently use corticosteriods for different indications. As the number of drugs inprescriptions increases, the risk of drug-drug interactions increases. This study deals with the frequent use and drug-drug ofcorticosteriods. Objective: The present study was designed to determine the frequency of use of corticosteriods in indoor patients andthe resulting drug-drug interactions. Study design: 270 Prescriptions of indoor patients from different wards of Aziz Bhatti Shahidteaching hospital Gujrat were collected randomly over the period of three months. These prescriptions were subjected to a drug-druginteraction software based analysis. The results were collected analysed and presented in the form of tables. Period: The patient chartscontaining prescriptions included in this study were collected over the period of three months. Material and Method: The software namedTHE MEDICAL LETTER ADVERSE DRUG INTERACTION PROGRAM was selected for finding the drug-drug interactions in randomlyselected indoor patient charts. Moreover, the frequency of use of corticosteriods was determined by simply counting the prescriptionscontaining corticosteriods out of total prescriptions and its percentage was found. Results: 29.25% patient charts were includingcorticosteriods in their prescriptions. Percentage of corticosteriod drug interactions found was 25.55%. Conclusions: Frequent use ofcorticosteriods in indoor patients can increase the risk of drug-drug interactions that should be monitored regularly.