Pattern of medication related problems in patients admitted to intensive care units at a Teaching Hospital in Western Nepal: a Pharmacovigilance Study (original) (raw)
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2020
Drug interaction may cause an increase in the toxicity of a drug, increases the likelihood of adverse drug reactions, or cause a reduction in the efficacy of particular drug therapy, which may worsen the patient’s condition directly or indirectly. This study aims to assess the potential drug-drug interactions (pDDIs) and their associated factors in the Medical Intensive Care Unit (MICU). We carried out a descriptive retrospective study based on the hospital records of 100 MICU patients. Micromedex Interaction application, designed by Truven Health Analytics Inc., was used to screen prescribed medications. We found 219 drug interactions out of 856 drugs prescribed. The average number of drug interactions per patient was 2.19. The frequency of drugs prescribed, the number of days in MICU, and age had a positive correlation with the occurrence of pDDIs. There were 44.7% major pDDIs; pharmacodynamic being the commonest mechanism for it. Most patients in MICU were at the risk of developi...
2000
A prospective study was conducted at Manipal Teaching Hospital, Pokhara, Nepal to identify and analyze the pattern of the potential DDIs (drug-drug interaction) in diabetes patients. A total of 182 patients who were prescribed 685 drugs (average, 3.76 drugs per prescription) were enrolled. Patients 51 to 60 years of age had a higher risk [43 patients, or (23.6%)] of developing DDIs. It was found that 174 (92.1%) of the potential DDIs were of "moderate" severity. Cardiovascular drugs carried a risk of DDIs (187 drugs, or 49.5%). The most common potential DDI observed was between metformin and enalapril (n = 64).
2013
Adverse drug reactions (ADRs) are the common problems faced in the setups like ICU where the poly pharmacy is involved in treating the patients. Control of such events is possible if the culpable drug is known or if it is identified and reported. However, reporting of adverse drug reactions still remains in its infancy for problems in many. Awareness about adverse drug reactions can decrease irrational use of medicines, poly pharmacy and adverse drug-drug interactions. A prospective, observational and non-interventional study was conducted over a period of 18 months in medical ICU of Dhiraj hospital, Piparia with the goal to highlight the responsibility of health care professionals in preventing, identifying, diagnosis, treating and reporting ADRs. The patients were monitored daily for ADRs. The data was analyzed for demographic parameters. The causality relationship between suspected drugs and the reactions were assessed by using various standard causality assessment scales. 1000 p...
Pharmacy Practice (internet), 2023
Background: Most hospitalized patients experience Drug Therapy-Related Problems (DTRPs) resulting in morbidity, mortality, and an increase in the cost of treatment. DTRPs are an important issue and a serious yet preventable problem. Objective: To identify DTRPs in the department of critical care medicine of a tertiary care center in Nepal. Methods: This was a cross-sectional study carried out at the department of critical care medicine in a tertiary care hospital in Kathmandu, Nepal from August to November 2021. All the patients admitted to ICU/ high care unit (HCU) for more than 48 hours during the study period were recruited in this study. Two clinical pharmacists visited the ICU/ HCU daily to identify any drug therapy-related problems. The Pharmaceutical Care Network Europe (PCNE) Classification system version 9.1 was referred for the classification of identified DTRPs. Descriptive statistics were applied for demographic variables. The Chi-square test was used for categorical variables. Pearson correlation was used to study the relationship between patient variables and the number and types of DTRPs. Results: DTRPs were identified in 74.2% (n=89) of patients. More than one DTRP was identified in 38.5% of patients. The identified DTRPs were primarily classified into two sections: Problems and Causes. A total of 106 problems were identified among which unnecessary drug treatment (40.5%, n=43) was the most common problem. For the causes: total of 137 were identified, out of which the drug and dose selection accounted for 44.5 and 16.8%, respectively. The average DTRP per patient was 1.5± 0.7. Antibiotics 30 (22%) and multivitamins, 10 (7%) were the maximal involved in DTRPs. More DTRPs were observed in male patients (n=60, 80%). The association between dose selection and gender was significant. Drug selection issues were observed more in patients prescribed multiple drugs and with a shorter hospital stay. Conclusion: Most DTRPs identified in the study were those that could be prevented. More focus is needed on antibiotic usage in the ICU and special monitoring measures are needed for vulnerable patient groups such as the elderly. Inclusion of more clinical pharmacists can help to identify and mitigate DTRPs.
Objective: To analyze the clinical profile of patients admitted to the intensive care unit (ICU) of Manipal Teaching Hospital (MTH) at Pokhara, Nepal, identify the commonly prescribed drugs, drug categories, dosage forms, antimicrobials, sensitivity pattern of antimicrobials and the treatment outcomes. Materials and Methods: A cross sectional, descriptive study in which he case records of all the patients admitted in the ICU during 1st August to 30 th September, 2007 were collected and the details were entered in the patient profile form. The filled patient profile forms were retrospectively analyzed as per the study objectives. Results: Altogether, 201 patients [males 101 (50.25%)] were admitted. Most common diagnosis was 'Myocardial Infarction /Ischemic heart disease' [13.96 % (n=62)]. The median (interquartile range) of the ICU stay was 3 (2-4) days. Cardiovascular drugs [31.7% (n=761) were the most commonly prescribed. Among the antimicrobials, metronidazole was most com...
Nepal Journal of Epidemiology
Background The risk of adverse drug reaction ranges nearly from zero to high level depending upon the drug itself and the patient factor. The process of detection, assessment, monitoring and reporting of adverse drug reaction is necessary to prevent its occurrence in future. Materials and Methods Information related to suspected Adverse Drug Reactions(ADRs) were collected by pharmacists from general medical ward using ADRs reporting form from Manipal Teaching Hospital (MTH)during ward rounds. The details of suspected drug, drug reaction and all related data were documented. Naranjo Algorithm, modified Hartwig and Siegel and modified Shumock and Thornton scale were used for assessment of causality, severity and preventability respectively. All suspected ADRs were reported to National Pharmacovigilance Center and then to Uppsala Monitoring centre through the electronic online data base named Vigiflow. Results Among 1,105 patients, 51 patients experienced ADR (4.61%). Incidents of ...
2018
Background: Drug interactions are estimated to occur between 3% and 5% in patients to whom few drugs are prescribed and 20% among those who use 10 to 20 drugs simultaneously. In critical care units (CCUs), patients are at increased risk for the development of drug interactions due to use of more medications to treat multifaceted conditions of patients. Aim: To estimate incidence and to assess the predictors involved in causing potential drug-drug interactions in patients admitted to critical care units of a tertiary care hospital at Mysuru. Methodology: It was a prospective interventional study. All the patients who satisfied the study criteria were included in the study and patients were followed till their discharge. All the required data were collected and documented. Each prescription was subjected for review in order to identify the drug - drug interactions by using the standard references such as Micromedex, Medscape and Stockleys drug interaction. The incidence was estimated....
International Journal of Basic & Clinical Pharmacology
Background: Adverse drug reactions (ADRs) constitute a major clinical problem in terms of human suffering and increased health care costs. To study the adverse drug reactions reported in a tertiary care hospital and study of causality assessment and severity of adverse drug reaction (ADR) cases reported.Methods: A prospective observational study was conducted as part of pharmacovigilance program over 12months between September 2015 and August 2016. Adverse drug reactions reported from hospital were filled into Suspected ADR - CDSCO forms and submitted to pharmacovigilance unit. Causal relationship was assessed and categorized by Naranjo’s algorithm and WHO - UMC causality scale. The severity of each ADR was assessed using Modified Hartwig and Siegel scale.Results: Total 120 cases were reported over 12 months. Among them, 66% were in males and 55% were in females. The majority of ADRs were due to antimicrobial agents (40.78%) followed by haematinics (12%) and anti-epileptics (10%). M...
International Journal of Pharmacy and Pharmaceutical Sciences
Objective: To study the pattern of drug interactions (DI) in our hospital and to identify whether it is associated with polypharmacy. To determine the level of severity of potential drug-drug interactions (PDDI), to detect, monitor and prevention of ADRs in the hospitalized patients and to identify the medication errors (ME). Methods: A prospective interventional study was conducted in a 300 bedded tertiary care South Indian hospital for a period of 6 mo. Prescriptions were analysed for PDDI using Micromedex software 2.2. The causality and severity of ADRs were assessed by using Naranjo’s, WHO UMC Scales and Hart wigs severity scales. ME was identified by review of patient drug charts. Results: Total 190 prescriptions were analyzed, in which 1028 drug interactions were seen. Out of which 718 were DDI, 198 DFI, 100 DEI, and 12 DTI were observed. More number of DI was seen in cardiovascular drugs, antibiotics followed by antacids and antiulcer agents. A total of 52 ADRs were identifie...