Journal of Pharmaceutical Care
Volume:1 Issue: 3, Summer 2013

It is around two decades that clinical pharmacy, as an academic major and health care profession, has been introduced to the pharmacy faculties and the health care system of the I.R. Iran. During this period, foremost steps have been taken towards establishment and development of this profession including clinical oriented revisions in the Pharm.D. curriculum; providing various clinical and pharmaceutical care services in university hospitals; introduction of the post-graduate training program of clinical pharmacy presented in 4 pharmacy schools throughout the country; directing patient-centered researches in the schools of pharmacy; setting up the Iranian Society of Clinical Pharmacists (ISCP); holding the ISCP''s scientific annual congress; building productive inter-professional relationship with other health care professionals and major medical specialty societies; interactive involvement in the continuous education of community and hospital pharmacists; building up international professional and scientific relationships and finally launching the Journal of Pharmaceutical Care (as a scientific high-profile outlet of the ISCP).

This study aimed to compare intermittent intravenous (IV) pantoprazole and ranitidine for control of gastric acid secretion and the possible prevention of Upper Gastrointestinal Bleeding (UGIB) in critical care patients. This was a randomized, double blind clinical trial study of IV pantoprazole (40 mg every 12 hour) or intermittent IV ranitidine (50 mg bolus every 8 hour) in patients at risk for UGIB. The primary endpoint was gastric pH. UGIB was measured as secondary endpoint. Ninety two Critical care patients were enrolled. Gastric pH was well controlled by two study drugs. Gastric pH increased in pantoprazole group than in the ranitidine group (4.40±0.39 versus 3.32±0.28; P=0.000). Upper GI bleeding was higher in ranitidine group than pantoprazole group (4/46 versus 2/46; P=0.404). This study indicates that intermittent IV pantoprazole compared with bolus IV ranitidine, more effectively controls gastric pH and may prevent UGIB in high risk critical care patients without the development of tolerance.

The provision of accurate and timely drug information to health care professionals is an important mechanism to promote safe and effective drug therapy for patients. World’s Drug and Poison Information Centers (DPICs) are mainly affiliated to hospitals, rather rarely with faculties of pharmacy or with faculties of medicine and other related organizations. Data was collected from a questionnaire which was distributed among 400 health care providers in April 2009. Data were analyzed using SPSS software (version 17). Medical reference books and drug information textbooks (36. 7%) and expert colleagues (29. 7%) were the «most commonly» used drug information resources. In addition, 77. 8% of respondents «almost never» use DPICs. About 77% of respondents were non- acquainted with these centers'' activities. Five expectations were considered ‘very important’ by respondents: Provide information on IV drugs incompatibilities (74%), Provide drug interaction information (70. 1%), Provide new drugs information (56. 5%), Education/training of health care professionals regarding rational drug therapy and prevention of medication errors (54. 9%), Providing information on dosage forms of drugs available in Iran (53. 5%). Being non acquaintance with services of DPIC centers can be considered as the most important reason of not using them. Considering «announcement of availability of drugs in pharmacy» as one of the activities of DPICs, shows that the health care professionals are not acquainted with real services of these centers. It shows an urgent need for culture building activities to introduce them to these centers services.

An increased oxidative stress in patients under treatment with high concentrationsof oxygen (hyperoxia) is considered to be one of the major mechanisms of lung injury. Between different mediators, transition metal ions especially iron, by generation of very reactive free radicals play an important role in oxidative stress process. Disruption of normal iron hemostasis has been reported in hyperoxic conditions. So we hypothesized that chelation of iron can reduce hyperoxia-induced lung injury. Mechanically ventilated patients, who received oxygen with FiO2 > 0.5 for at least 3 days, underwent bronchoscopy at baseline and 72 hours thereafter. Data from external control cases were collected prospectively to provide a comparative reference group. Iron and Iron-related proteins were measured in lavage fluid and plasma. In 24 patients and in comparison with the results of previous study, Iron concentration decreased significantly in lavage fluid (P<0.001). Reduction of ferritin was not significant in lavage fluid (P: 0.7).Transferrin decreased significantly in plasma (P: 0.01). Acute Physiology And Chronic Health Evaluation (APACHE) II (P: 0.006) scores decreased significantly after 7 days of follow-up. Deferasirox did not change Iron and Iron-related protein in hyperoxic condition and it just only could considered along with other supportive measures for better toleration of oxygen therapy.

Hyperlipidemia is one of the most important factors in progression of coronary heart diseases, because of the importance of lipid control for preventing heart disease; this study has done to explore the relation between health beliefs and medications adherences in patients with hyperlipidemia. This Correlation study has done in 82 patients with hyperlipidemia. For obtain information used a questionnaire with three parts; demographic characters, adherence to medications and health beliefs. The data analyzed by parametric and non parametric tests. Findings same as some studies showed relationship between health beliefs and adherences to medications in patients with hyperlipidemia (P<0.05) with high health beliefs, adherence to medication increased. For increasing adherence to medication, some strategies must provide for self efficacy and educational programs must be done with relationship between patient and health provider. Notice to the importance of high cholesterol and its relation with heart disease will increase adherence to medication.

Drug utilization studies are helpful in understanding the current practice. We have conducted a retrospective study to evaluate the relevant use of a group of most commonly prescribed antibiotics in a teaching Hospital in Iran. The results of this study may be of help for clinicians to improve the patient care. Patients who received parenteral ceftazidim, vancomycin and amikacin from December 2010 to May 2011 were enrolled in this study. Patient’s data including demographic, length of Hospital stay, drug allergy, first and final diagnosis were recorded in a predesigned data collection form. American Hospital Formulary Services (AHFS) book were used as a reference for evaluation of study drug indication and dosing according to diagnosis and microbiological culture. Defined daily dose (DDD) of each drug extracted from Anatomic and therapeutic chemical classification system (ATC/DDD) and drug usage data evaluated by calculating the ratio of prescribed drug to its DDD. The ratio of prescribed daily dose to DDD was 0.78, 0.95 and 0.86 for amikacin, ceftazidime and vancomycin respectively. Between amikacin group, 43 patients (86%) received drug empirically, the number of empiric treatments for ceftazidim and vancomycin were 45(90%) and 44 patients (88%). The renal function tests (Blood Urea Nitrogen, Serum Creatinin) were evaluated in 56% of amikacin group, 64% in ceftazidime group and 78% in vancomycin group. The results of this study indicate the need to establish continuing medical education (CME) courses for physicians to familiarize them with standards required to use and monitor these agents.

Diabetes and obesity are two common human disorders that affecting human health and invite various diseases and disorders in normal body functions. These diseases are very common worldwide. Diabetes occurs when high blood sugar levels develop. This happens when body can’t make and use all of the insulin it needs to blood sugar normally to keep blood sugar levels as normal as possible to control diabetes. Diabetic patients will need to follow a diet plan, do exercise and possibly take insulin injections. As part of eating plan, health care provider, and dietitian may ask to limit the amount of carbohydrates eat each day. Low-calorie sweeteners are one easy tool to help for follow eating plan. Obesity is more susceptible and often been associated with frequent ingestion of high energy food in high amount and high intake of sugars such as fermentable sugars such as sucrose, fructose, glucose, and maltose. Both diseases are may be genetically or due to hormonal imbalances. High energy sweeteners may causes caries in the teeth particularly susceptible to the children. Increased calorie intake associated with sugars and carbohydrates, especially when associated with physical inactivity, has been implicated in obesity. Fortunately, low calorie artificial and natural alternatives of sugars have been developed as alternatives to fermentable sugars and have shown promise in these health issues. Although there are only few artificial sweeteners (saccharin, aspartame, acesulfam potassium, sucralose, cyclamate) that have been approved as food additives by the Food and Drug Administration and additional other low-caloric sweeteners (sugar alcohols, neotame, stevia, erythritol, xylitol, tagatose) that have FDA-generally recognized as safe. Given the health impact of sugars and other carbohydrates, professionals should be aware of the marketed available low caloric sweeteners and both their benefits and potential risks.

We describe a patient with hypercalcemia associated with the injection of high doses vitamin D as supplement for a period of six months. A 76-year-old woman had been taking an intramuscular injection of vitamin D 300,000 IU every ten days for six months. She was hospitalized with symptoms of hypercalcemia: chronic constipation, unstable gait, a chronic generalized musculoskeletal pain and increased fatigue. On admission her 25 (OH) vitamin D and Calcium levels were 559 nmol/l and 13.85 mg/dl respectively, and Parathyroid Hormone (PTH) level was 7.1 pg/ml. Immediately she received diuresis therapy with saline and furosemide in conjunction with calcitonin and pamidronate. At discharge her serum calcium level was 11.5 mg/dL. To lower endogenous overproduction of calcitriol, prednisolone 20 mg/day for 10 days was administered at discharge time.