Journal of Pharmaceutical Care
Volume:2 Issue: 4, Autumn 2014

Community pharmacies are considered as ideal settings to provide cardiovascular risk screening (CRS). However, little is known about pharmacists’ views on providing such services in developing countries including Iran. In the present study, we evaluated the pharmacists’ attitudes and perceived barriers to providing CRS services. In a cross-sectional study, a questionnaire in three sections was developed by the investigators (attitudes, perceived barriers, and demographics). Five likert items (5 points bipolar scale) were designed to evaluate pharmacists’ attitudes about their professional role in providing CRS services in community pharmacies. Seven likert items were designed to assess the pharmacists’ perceived importance of possible barriers to providing the services. The study tool was distributed among a convenient sample of 500 pharmacists, who had participated in a national continuing education event. The response rate was 44% and descriptive statistics and Chi squared test were used to analyze data. Results showed that 70.4% participants had an overall positive attitude to providing CRS services. Pharmacists who were pharmacy owner and pharmacist-in-charge simultaneously were more positive about providing CRS services. Lack of regulatory policy and compensation mechanism, limited physical space in pharmacy and time limitation were reported to be the most important barriers to providing CRS services (> 50% rated as highly important). Low human resource and time limitation were significantly associated with negative attitudes (P: 0.02 and 0.001, respectively). The Iranian pharmacists’ attitudes seem to be positive about providing CRS services; however, their perceived barriers should be addressed prior to CRS service implementation.

Aspartate transaminase (AST) is an important enzyme in parasite and liver tissue. The purpose of this investigation is to evaluate triclabendazole (TCBZ) effect on AST activity of Fasciola gigantica parasite. To compare of enzyme level of parasite and its host tissue, enzyme activity of F. gigantica parasite and liver tissues were also determined. The livers were collected from sheep slaughtered in local slaughterhouse and living F. gigantica parasites were isolated. The washed parasites were cultured in buffe rmedia with or without Triclabendazole (Egaten®); 15μg/mL in an incubator at 37° C. Extractions of collected parasites and liver tissues were prepared by homogenizing buffer in a Mortar and pestle. Extraction samples were examined for protein measurement, AST activity assay and protein recognition. The results of AST assay revealed, enzyme activity for treated and untreated is not significant. Healthy liver tissue shows significantly higher enzyme activity than parasite. Enzyme activity for healthy and infected liver tissues was significant. Enzymatic proteins including Cathepsin L & B (Protease) were recognized in parasite samples. Although AST could not be concerned as an indicator for efficiency treatment, however may be involved as a biomarker for biochemical comparison of parasite and host tissue.

Antibiotics can be life saving if they are used correctly, and can have unwanted side effects specially resistance with incorrect use. Unfortunately in fear of no response, physicians use broad spectrum antibiotics meticulously. In this Drug Utilization Evaluation (DUE), improper use of Vancomycin and five broad-spectrum antibiotics are studied to find faults and solution for this problem. This descriptive cross-sectional study performed during the March of 2012 to March of 2013.DUE of Imipenem, Meropenem, Piperacillin-Tazobactam, Cefepime, Ciprofloxacin and Vancomycin was done in 6 wards of Imam Hossein Hospital in Tehran. Demographic, clinical, laboratory, imaging and treatment data were looked for in medical records of 686 patients. Evaluation was done by three infectious disease specialist based on reference text book of Mandell’s Principles and Practice of Infectious Diseases 2010 and IDSA Guidelines. This study showed 38.5% of prescriptions were correct and the remained 61.5% were incorrect with different faults predominantly incorrect overuse in 51.1%.Ciprofloxacin was the most common incorrect used drug in 74.8% cases and Piperacillin-Tazobactam with 48.7% cases had the least common incorrect use. There was no fault in prescription of antibiotics observing age and sex (pregnancy, breast feeding) factors. Our results reveal a significant high level of the inappropriate use of Antibiotics mostly as overuse and empirically without culture results. It is needed to establish continuing medical education (CME) courses and a locally conformable guideline of antibiotic use based on antibiogram results.

Oxidative stress is described as the formation of toxic effect due to the deficiency of cellular antioxidative level toward the level of reactive oxygen species (ROS). The excess production of ROS or the decrease in the antioxidative defense system could be the cause for oxidative stress. 7,12-dimethylbenz[a]anthracene (DMBA) that is known to be the major cause the increment in lipid peroxidation level and the oxidative damage in the rat liver. As a fundamental trace elements, selenium as a part of anti-oxidative defense system is responsible for the immune system as part of enzymes in defense system. Organoselenium compounds [1-isopropyl-3- methylbenzimidazole-2-selenone (Se I) and 1, 3-di-pmethoxybenzylpyrimidine- 2-selenone (Se II)] that were prepared in the laboratories. The effects of synthetic organoselenium compounds (Se I and Se II) against DMBA-induced changes in levels of some [catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx), and glutathione reductase (GR) activities and total glutathione (GSH), malonedialdehyde (MDA)] parameters in rat liver were investigated. Histopathological changes in the liver tissues of rats were examined by light microscopy. Because the selenium has an anti-oxidative properties toward the damaged induced cells, organoselenium compounds prepared in our laboratories, Se I and Se II, have tested for chemically induced rat liver tissues. The results showed that endogen antioxidant enzymatic activities changes and the preventing of oxidative damage in lipid peroxidation are important findings in vivo of this research. Various changes were observed in liver tissue of rats in the all experimental groups.

Drug use evaluation (DUE) aims at improving the patients’ care. Studying the administration pattern of intravenous immunoglobulin (IVIG) is an important research topic due to its significant role in the treatment and controlling of many disorders, high prices, and limited availability of this drug. This observational cross-sectional study was conducted at Shahid Sadoughi Hospital in Yazd, central Iran, from May to September 2014. The orders of different wards in the hospital for IVIG given to the hospital central pharmacy were surveyed. Also, a special form developed for evaluation the method of administration. The related physician and nurse were consulted on drug complications and the causes. Finally, the gleaned data were compared to the available standards on the prescription and administration of IVIG. A total of 75 patients received IVIG during this study. 58.7% of the prescriptions belonged to the cases approved by Food and Drug Administration (FDA). The most frequent cause of the use of IVIG was idiopathic thrombocytopenic purpura (ITP). The rate and dose of administration was suitable in most of the patients, yet, the measurement of laboratory parameters required for IVIG were observed in only a few cases. Complications occurred in 26.7% of the patients receiving it, which was mostly related to infusion-related reactions. On the whole, 3922 g IVIG was used during this study of which 1848 g belonged to the cases approved by FDA. Regarding the high costs of IVIG, complications, and limited information on the quality of the effect of this drug in the treatment of many cases, physicians should be cautious enough with its appropriate use. Besides, the presence of a clinical pharmacist in the health-care team not only improves the quality of drug therapy and treatment results, but also plays an important part in decreasing the treatment costs for the patients.

Magnetic Resonance Imaging (MRI) contrast agents most commonly agents used in diagnosing different diseases. Several agents have been ever introduced with different peculiar characteristics. They vary in potency, adverse reaction and other specification, so it is important to select the proper agent in different situations. We conducted a systematic literature search in MEDLINE/PUBMED, Web of Science (ISI), Scopus, Google Scholar by using keywords "gadolinium" and "MRI contrast Medias", "Gadofosvest", "Gadobenate" and "Gadoxetate". The most frequent contrast media agents made based on gadolinium (Gd). These are divided into two categories based on the structure of their chelating parts, linear agents and macrocyclic agents. All characteristics of contrast media factors, including efficiency, kinetic properties, stability, side effects and the rate of resolution are directly related to the structure of chelating part of that formulation. In vitro data has shown that the macrocyclic compounds are the most stable Gd-CA as they do not bind to serum proteins, they all possess similar and relatively low relaxivity and the prevalence of Nephrogenic Systemic Fibrosis (NSF) has decreased by increasing the use of macrocyclic agents in recent years. No cases of NSF have been recorded after the administration of any of the high-relaxivity protein interacting agents, the vascular imaging agent gadofosveset trisodium (Ablavar), the hepatic imaging agent gadoxetate meglumine (Eovist), and the multipurpose agent gadobenate dimeglumine (MultiHance). In pregnancy and lactating women, stable macrocyclic agent is recommended.

Warfarin is the most commonly used oral anticoagulant drug in clinical practice with extreme inter and intra-individual variation in pharmacokinetic properties. Na Valproate, a broad spectrum anticonvulsant agent, is best known for its enzyme inhibition properties and also displacement of protein binding sites. Interaction between Warfarin and psychotropic drugs including Valproate are important and perhaps under recognized. In this report, we present a 48 year old female patient with chief complaints of abdominal pain, tea-color urine, blurred vision and headache. She had been suffering from "migraine headache" for 15 years that was relatively well controlled with Na Valproate 200mg twice daily. She was experienced a deep vein thrombosis (DVT) following oral contraceptive. For management of DVT, she was received Warfarin 5mg/day which was increased to 7.5 mg /day after 2 weeks. Three days after this increment of dose, her Prothrombin Time (PT) rose to 35.3 seconds (three times of normal value) and evidences of bleeding including hematuria and hematemesis were observed. Based on the history and laboratory findings, "Warfarin toxicity" was the first impression and she was treated with fresh frozen plasma and vitamin K with a well recovery. This experience emphasizes the clinical significant interaction between Warfarin and Na Valproate, which may take place even with the usual doses of each agent.