Journal of Pharmaceutical Care
Volume:1 Issue: 1, Winter 2013

Considering the emergence of both Gram negative and Gram positive resistant bacterial strains in the recent years, makes it more prominent to utilize the existed antibiotics in an appropriate and justified way in the treatment of drug resistant infections. Many of the agents currently used to treat bacterial, viral and fungal infections do not need to be pharmacokinetically monitored; it means we do not require their serum levels in order to adjust the dose in a routine manner. Examples of these antibiotics are penicillins, cephalosporins, macrolides, tetracyclines, fluoroquinolones, etc. Of course these agents need dose adjustment based on renal and hepatic functions. On the other hand there are antibiotics which need to be monitored through their serum levels because of three main following reasons:1- To avoid overdosing patient and reduce the incidence of toxicities.2- To avoid underdosing patient, this may lead to the emergence of resistant strains and treatment failure.3- To optimize the dose of antibiotic to achieve the bactericidal or bacteriostatic effects needed to suppress the infective agent.

A high percentage of patients admitted to the intensive care unit (ICU) have systemic inflammatory response syndrome (SIRS) criteria. Free radicals play an important role in initiation and development of SIRS. The purpose of this study was to assess and compare the molecular changes of cellular antioxidant power in patients with SIRS who received enteral nutrition (EN) or EN combined with parenteral nutrition (PN). Two groups of 10 patients were enrolled in this randomized, controlled clinical trial. Those in the treatment group received EN+PN and the control group received only EN. Venous blood samples were taken just prior to initiation of nutritional support and then 24, 48 and 72 hours following entry into the study for examination of antioxidant parameters including total thiol, total antioxidant capacity and lipid peroxidation. The two supportive regimens had different affects on total antioxidant capacity (P=0.005). In the EN group the amount of total antioxidant capacity was not significantly different in different days (P>0.05), but in the EN+PN group it was significantly different on third and forth days as compared to the first day. The two other parameters had no significant differences between the two groups. These results are suggesting that an increase in oxidative stress bio-markers are not necessarily related to the route of pharmaconutrition and may occur independently during metabolic support measures.

Following establishment of Iranian Adverse Drug Reaction (ADR) Monitoring Center in 1997, ADR committees were established in all hospitals of Mazandaran Province of Iran. Clinical pharmacists from Mazandaran University of Medical Sciences have been involved with these committees since 2007. The aim of this study was to compare the results of the pharmacovigilance system before and after active involvement of clinical pharmacists. This study included Yellow Cards filled out by healthcare providers in Mazandaran Province during 2004-2010. Frequency of Adverse Drug Reactions (ADRs), route of administration, reporters, number of reports in each years and damaged organs were focuses. Statistical analysis was performed by SPSS 16 software. P< 0.05 was considered as significant difference. A total of 793 yellow cards were completed during 2004 – 2010. Only 38 ADRs (4.8%) were related to 2004-2007. Most of the reports generated by Nurses (49.3%) followed by Pharmacists and Physicians (P< 0.001). Forty-one reactions (5.2%) were serious, most related to Ceftriaxone, Desfonac and Vancomycin. Clinical pharmacists’ intervention regarding establishing ADR committees in the hospitals improved the output of the pharmacovigilance system, although under-reporting is still a major drawback of spontaneous reporting.

The purpose of this study was to characterize the pharmacokinetic parameters of mycophenolic acid (MPA) in Iranian kidney transplant patients. Plasma MPA concentration of mycophenolate mofetile (MMF) 1 gram two times a day was measured in 21 Iranian kidney transplant recipients receiving treatment. Patients who entered the study had been transplanted for more than 3 months and their drug level was supposed to be at steady state. MMF concentration was measured with high-performance liquid chromatography (HPLC). The plasma MPA concentration-time curve was characterized by an early sharp peak at about 1 hour postdose. The mean Area Under Curve (AUC), Cmax and Tmax were 47.0±18.3 µg.h/ml, 18.6±8.5 µg/ml and 1.0±0.5 hours respectively. The plasma MPA concentration-time curve pattern of Iranian patients was similar and consistent with previously reported profiles in other populations taking the same dose.

The principles of pharmaceutical care are embedded in the concept of Good Pharmacy Practice (GPP). GPP is poorly applied in community pharmacies not only in Asian countries, but even in United States and Europe. The present study was undertaken to evaluate the knowledge, attitude and practice of the community pharmacists in Iran, regarding GPP. A total of 794 pharmacists were evaluated with a reliable and validated KAP (Knowledge, Attitude, and Practice) questionnaire regarding GPP in September 2008. The most important finding in the present study was the pharmacists’ low knowledge (Mean= 13.42) and practice (Mean= 29.85) level about GPP, while their attitude towards this subject was at a high level (Mean= 74.83). Increase in their knowledge of good pharmacy practice aligned with an increase in their attitudes towards this issue. Also increase in our pharmacists’ knowledge and attitude aligned with an increase in quality of their practice. The current practice of Iranian community pharmacists needs further improvement. National pharmaceutical organizations should organize educational programs for the community pharmacists to equip them for their main role in community practice: promoting rational drug use.

It has been shown that serum total homocysteine (HC) is a risk factor for vascular disease which characterizes endothelial damage in the general and in the End-Stage Renal Disease (ESRD) population as well. Whether n-3 polyunsaturated fatty acids decrease homocysteine (Hcy) level has been a subject of controversy. Renal transplant patients were randomized in 2 groups and received 6 months of dietary supplementation with 6 g/day of Fish oil or placebo. Homocysteine level and total cholesterol level were measured. In 40 renal transplant recipients, increase in homocysteine level was greater after Fish oil administration but not significantly, total cholesterol was decreased significantly. Based on these data omega3 fatty acids supplementation doesn''t decrease serum homocysteine in renal transplant recipients but decreases total cholesterol level.

Beta-lactams are a group of antibiotics with a broad spectrum of both Gram-negative and Gram-positive coverage. The goal of this study is to evaluate the results from studies regarding Ig-E mediated hypersensitivity to Penicillin and cross-reactivity with other beta-lactams. Review was conducted of both retrospective and prospective studies by searching in PubMed and Medline for the original and systematic review articles by using the keywords: penicillin allergy, beta-lactams and cross-reactivity. The rate of true Penicillin allergy is about 10% of reported cases by the patients. The rate of Ig-E mediated cross-reactivity between Penicillin and Cephalosporins is less than 10% for the first and second generations and less than 5% for the third and fourth generations. According to the reviewed studies, Imipenem has between 9.2% to 25.6% cross-reactivity with Penicillin. Recent studies have shown safe use of Meropenem in patients with penicillin allergy even with positive skin test. The only member of Monobactam family, Aztreonam, has no cross-reactivity with any of Penicillins, Cephalosporins (with the exception of Ceftazidime) and Carbapenems. Due to the low rate of true Penicillin allergy, the patient’s self report of this adverse reaction must be justified carefully before avoiding beta-lactams. Even in the cases of true penicillin allergy, Meropenem appears to be safe, if indicated. There are also a few case reports regarding hypersensitivities to Clavulanate itself and also its cross-reactivity with Penicillin.