Journal of Pharmaceutical Care
Volume:10 Issue: 3, Summer 2022

Dementia could be defined as a range of cognitive and behavioral symptoms, including memory loss, executive dysfunction, and change in personality, and a reduction in a person's ability to carry out daily activities. The most common types of dementia are Alzheimer's disease (AD), vascular dementia, mixed dementia, dementia with Lewy bodies, and frontotemporal dementia (1). All currently approved treatments for dementia are symptomatic treatments that could influence cognitive and behavioral symptoms without changing the underlying neuropathological progression of the disease (2).

The Cardiovascular disease is emerging as one of the leading cause of morbidity and mortality worldwide. To determine the appropriateness of the prescriptions and various trends in treatment, so as to provide the basis for modification in the future drug usage in accordance with risk factors and clinical presentations and also assess the improvement of health-related quality of life of patients with coronary artery disease. 

A prospective, observational and cross-sectional study was conducted in Department of Pharmacology in collaboration with Department of Medicine of tertiary healthcare hospital. As per inclusion criteria, patients visiting Medicine Outpatient department (OPD) from November 2021 to January 2022 were enrolled in the study. 

Total 360 prescriptions were analysed, most of them belonged to the age group of 61-75 years. The prevalence was higher in Females (54%) than males (46%). An average number of drugs per prescription was 4.5. All the drugs were prescribed by generic names. 90.63% drugs prescribed were included in World Health Organization (WHO) essential drugs list 2021. 98.40% drugs prescribed were included in National list of essential medicines (NLEM) 2015. Antiplatelets (99.44%) were the most commonly prescribed category of drugs, followed by hyperlipidaemic (96.67%). 

The overall analysis of prescription pattern suggests that most of the drugs were prescribed rationally according to current American College of Cardiology Federation/American Heart Association (ACC/ AHA) guidelines. The incidence of polypharmacy was in the normal limits as per WHO recommendation. Generic drugs were prescribed majorly, which promotes awareness amongst prescribers, supporting WHO policies.

The coronavirus disease 2019 (COVID-19) is highly contagious and has turned into a global health problem.  In this study, we investigated the role of clinical and laboratory characteristics along with administered therapeutic agents in patients with COVID-19, and identified some effective factors on the mortality of these individuals. 

In this retrospective study, we evaluated the data from all the hospitalized patients who had been diagnosed with COVID-19 between February 23 and May 23, 2020. The data were obtained from medical records. Additionally, a checklist was used to record demographic, clinical, laboratory, imaging, and treatment data for each patient. 

Totally, 478 patients were involved in this study, and their median age was 58.5 years. Of these, 53.3% patients were male. The most common pre-existing underlying disease was hypertension (37.9%), and the mortality group had significantly more comorbidities (85.4%).  Higher neutrophil lymphocyte ratio (NLR), lymphopenia, and reduced hemoglobin were more frequent in the mortality group (p < 0.001).  Similarly, the need to be admitted to the intensive care unit was significantly greater in the mortality group (p<0.001). The most frequently administered therapeutic regimens included hydroxychloroquine and lopinavir/ritonavir, which did not have any correlation with survival outcome. 

Older age, opioid addiction, cardiovascular disease, kidney disease, baseline NLR and hemoglobin, and ICU admission were independently associated with COVID-19 mortality. On the other hand, hydroxychloroquine and lopinavir/ritonavir indicated no beneficial effects on patients’ outcome.

Proton pump inhibitors (PPIs) are one of the most frequently prescribed class of drugs worldwide contributing to the increase in economic burden on the healthcare system. To study the utilization of intravenous proton-pump-inhibitors (PPIs) according to its indications, comorbidities and related pharmacoeconomics in a tertiary care teaching hospital 

A prospective-observational study was conducted over 3 months. Case-records of 300 indoor patients were reviewed for IV (intravenous) pantoprazole prescription, as it was the only PPI available at the hospital in IV as well as oral formulations and relevant data was procured. 

Amongst 300 patient records, 72% were males whereas 28% were females and mean age was 41.18 years (S.D. ± 15.91). 37.33% of the patients were prescribed PPIs for Stress ulcer prophylaxis and 62.66% for non-stress ulcer prophylaxis. 62.66% patients were prescribed IV PPIs inappropriately and 74% were found to be potential candidates for oral pantoprazole therapy without affecting patient outcomes. Utilisation of PPIs was found to be 0.87 defined daily dose (DDD)/100 bed days. The cost of administration for intravenous pantoprazole therapy per patient per day accounted to INR 64.34 and that for oral formulation of the same summed up to INR 1.36. The percentage reduction in the cost of administration of PPI therapy per patient in potential candidates for oral PPI therapy was found to be 97.8%. Antimicrobials (36%) were the most common drugs prescribed concomitantly followed by antiemetics (25%). 

Subtle changes like shifting the patient to oral formulations when clinically permissible can make a significant positive contribution in resource limited settings without negatively impacting patient outcomes. This will effectively reduce the economic burden on the patients and the healthcare system which is of utmost importance in a resource limited setting like tertiary care hospitals.

Hospitalized infants and children are usually treated with many medications in the hospital. Concurrent use of multiple drugs, known as polypharmacy, is inevitable in critically ill patients. This study aims to investigate the possible interactions as well as their type and number, and their effect on the treatment process plus the duration of hospital stay of patients. 

 In this descriptive study, the medical records of 189 patients admitted to the ICU ward of Mofid Children's Educational Hospital in Tehran were prospectively studied over six months. The collected data included disease diagnosis, patient medication information, age and gender, and treatment interventions. Interactions between drugs were identified using Up-to-date database, with the results analyzed by SPSS software. 

The results revealed that hospitalization increased with an increasing number of drugs. The findings also indicated a direct relationship between the number of drug interactions and the duration of hospital stay. After examining the relationship between intensive care unit (ICU) outcome and the number of drug items as well as the number of drug interactions, it was found that there is a direct relationship between the two. There was also a direct relationship between Class D plus X interactions and mortality rate along with duration of stay. 

This study showed a direct relationship between drug interactions and the duration of hospitalization. In other words, as drug interactions increased, so did the duration of hospital stay.

Proton pump inhibitors (PPIs) are one of the first-line drugs for acid-dependent diseases. Inappropriate use of PPIs, especially the Intravenous (IV) formula of pantoprazole, can result in excessive cost. This study aimed to evaluate IV pantoprazole usage's appropriateness and optimize its use in accordance with guidelines at Razi educational and remedial center, Rasht, Iran. 

This cross-sectional study was executed in five months among 344 patients of Razi hospital who received IV pantoprazole for stress ulcer prophylaxis (SUP). Demographic data, route and doses of pantoprazole, risk factors for stress ulcer, and other related medical data were recorded. In addition, the appropriate use of IV pantoprazole was measured according to recommendations arranged by this center and the American Society of Health-System Pharmacists. 

Out of 197 patients who received SUP with an appropriate indication, 183 patients (92.9%) were able to tolerate the drug orally, and only 14 patients (7.1%) had an indication for receiving IV pantoprazole. There was a significant difference between patients who received SUP with an indication regarding having or not having an indication for IV pantoprazole (P = 0.007). 5029 vials (96.5%) with a cost of 17,822 US dollars were used inappropriately and imposed an additional cost on the health care system. 

This study presented that the majority of IV pantoprazole use in this center was not well-matched with guidelines in most cases, containing appropriate indication and right dosing. In order to prescribe this drug as SUP, it is necessary to be more careful about the criteria for prescribing and conforming the prescribed drug and the prescribed dose to the relevant instructions.

The review on diverticulitis disease, is the most prevalent non-cancerous pathology of the colon is diverticular disease and diverticulitis. It has long been thought to be a disease of the elderly, linked to cultural and dietary patterns. Our understanding of this condition, as well as the therapy protocols, has progressed. To give an updated assessment of the epidemiology, pathophysiology, and classification of diverticulitis, as well as to highlight developments in medicinal and surgical management. Treatment of Diverticular Disease represented an important challenge in clinical practice, especially concerning the management of symptomatic uncomplicated diverticular disease (SUDD) and the primary and secondary prevention of acute diverticular disease (AD). Antibiotics and supportive treatments are the mainstays of non-operative treatment, while antibiotics may be skipped in moderate cases. Acute surgery is required for the most severe and refractory cases, whereas elective resections should be considered for chronic, smoldering, or recurrent forms, as well as their associated complications (stricture, fistula, etc.) and patients with factors that are highly predictive of recurrent attacks. Diverticulitis isn't just a condition that affects the elderly. Our growing understanding of diverticulitis as a clinical entity has resulted in a more nuanced approach to its medicinal and surgical therapy. For more than 70% of patients, non-surgical care is still the best option. In the acute, chronic, or elective-prophylactic environment, a segmental colectomy remains the most effective surgical treatment for those with non-relenting, persistent, or recurrent symptoms, as well as those with severe disease and sequelae.

In the first stage of viral replication, Covid-19 may cause a remarkable inflammatory response in patients. Molnupiravir is an oral antiviral medicine which functions through inhibiting the viral replication of RNA viruses including Corona virus (SARS-CoV-2). The present study intends to help the policymakers decide on using of this medication in Iran. This study is conducted on Jan. 22, 2022 (from Jan. 2014 -the year of molnupiravir production for treatment of RNA virus diseases), using a rapid review of evidence as well as reviewing reliable databases including the Cochrane library, PubMed and Google scholar. The inclusion criteria were the randomized controlled trials that investigated the safety and efficacy of Molnupiravir at different doses in patients with Covid-19, comparing with placebo or other routine care methods (Population: Covid-19 patients, Intervention: molnupiravir, Control: placebo or other routine care methods, Outcome: Safety, Efficacy and Economic status, Study design: the randomized controlled trials or HTA reports). Prescription for oral administration in 800 mg dose twice daily for 5 days to inpatients and outpatients with mild, moderate or severe symptoms in the early stages of the disease (viral phase) had the most desirable level of efficacy. This medicine has no serious side effects; since the mutations caused by this medication have not been clarified yet, it is not recommended during pregnancy and/or for women planning to become pregnant. According to the manufacturing company, in the United States, each drug package is priced at $712 for a 5-day treatment period. Molnupiravir can be used in outpatients and inpatients (Over 18 years old) with moderate or severe symptoms in the early stages of the disease. But it is not recommended during pregnancy and/or for women planning to become pregnant.

Cancer is one of the most common human diseases and a leading cause of human mortality in rencent years. Doxorubicin (DOX) is an important anti-cancer agent belonging to anthracyclines drug category. This chemotherapeutic agent acts against cancer cells through different mechanisms; however, its use is related with numerous acute and chronic dose-related side effects and toxicities including hepatotoxicity. The aim of this study was to conduct a comprehensive review of in vitro, in vivo and any human studies regarding the protective effects of synthetic compounds against DOX-induced liver injury.The search was conducted in embase, PubMed and Scopus databases using the following keywords: “doxorubicin”, “Adriamycin”, “hepatotoxicity”, “liver injury”, “liver damage” and “hepatoprotective” to find experimental and preclinical studies regarding the effects of various compounds on DOX-induced hepatotoxicity. Twenty-one eligible studies to the end of May 2022 finally were reviewed (19 in vivo and 2 both in vivo and in vitro studies). Our results demonstrated that all of these drugs, except acetylsalicylic acid, had considerable hepatoprotective effects against DOX (deferoxamine had a mild effect). In addition, except glutathione, none of the studied drugs and compounds attenuated the antitumor efficacy of DOX treatment. Moreover, no human study was available in this fieild. Altogether, our results demonstrated that most of compounds with anti-apoptosis, anti-inflammatory and antioxidant properties are efficacious against DOX-induced hepatotoxicity and may have potential for being considered for inclusion in the chemotherapeutic regimes of cancer patients, after fully been assessed in well-desgined large clinical trials.

Baricitinib, a Janus kinase inhibitor, was originally approved as anti-rheumatic drug in 2017. In 2020, it was approved for the treatment of COVID-19 in selected hospitalized adults. Baricitinib received priority review designation for treatment of adult patients with severe alopecia areata and got USFDA approval on June 23, 2022 based on the results of 02 phase III trial: BRAVE-AA1 and BRAVE-AA2. In this review, we aim to summarize the different pharmacokinetic and pharmacodynamics aspects including drug interactions, adverse effects/black box warnings and their clinical relevance. We reiterate that oral JAK inhibitors are expensive, may carry significant risks, and are not yet recommended for routine treatment of alopecia areata. There is ongoing research on other topical and oral JAK inhibitors (tofacitinib and ruxolitinib), giving hope that better treatments for alopecia areata will become available in future.

Sudden cardiac arrest correlates with QT-interval prolongation and torsade de points (TdP). Several medicines frequently used in geriatric aged care populations can cause QT prolongation. Major predisposing factors and QT-prolonging medications enhance QT interval prolongation incidence in medical inpatients. Pharmacists can help ensure safe drug therapy and in-hospital patient safety by paying attention to QT prolongation and extra risk factors for prolonged QT intervals during medication reconciliation. We recommend pharmacists improve knowledge and awareness of corrected QT prolongation (QTc) when conducting drug reviews. Implementation of Pharmacist-driven QTc monitoring is required to lower the risk of QTc prolongation.

A fever above 38°C is a common complication in the first few days after major surgery. Drug-induced fever is the most common cause of fever among the noninfectious causes of postoperative fever. Antimicrobial drugs and heparin, widely used for venous thromboembolism prophylaxis after major orthopedic surgery, are the drugs most commonly associated with postoperative fever. This case study, showing that enoxaparin may be the drug responsible for unexplained fever, may help significantly reduce patient morbidity and the additional costs of investigating the underlying causes of fever. At this stage, the approaches of the clinical pharmacist to provide counseling services to the patient and the healthcare professional in the treatment of medications, the detection of side effects of medications and the suggestion of a solution are important.

Neurologic complications in patients with coronavirus disease 19 (COVID-19) are common particularly in hospitalized patients. Guillain–Barré syndrome (GBS) is a rare complication of COVID-19. Most patients with GBS and COVID-19 presented with progressive, ascending limb weakness evolving over one to four days. There are some reported cases of GBS, mostly in form of case reports or case series, and also a comprehensive review on this topic. However, none of these cases experienced multiple sclerosis (MS) as an underlying disease. So, in this manuscript we reported three cases of COVID-19 induced GBS; one of them with history of MS and promising outcome after receiving five session of plasmaphresis and corticosteroid therapy.