Journal of Pharmaceutical Care
Volume:2 Issue: 2, Spring 2014

Diabetes is on rapid increase in third world countries undergoing rapid transition in terms of development particularly in India, which is often being referred as Diabetic capital. It is a disease more prevalent at latter part of life of human beings when finances dwindle and social care gets neglected. The medication continues till the whole life on a regular basis. In present study, the objective has been to provide pharmacoeconomic medication to the diabetic pensioners in the backdrop as mentioned in above background. The data was collected at the medical reimbursement section of pensioners of the University. The data was examined to answer issues of therapeutic decisions in the light of the pharmacoeconomic considerations. In this paper essentially data on choice of prescriptions with the angle of pharmacoeconomic prudence were included. The dichotomy of specialist versus non specialist prescribers at the tertiary center (i.e. medical college hospital) was compared. Effort was made to define merit of the prescription based on comprehensive considerations of patient profile, disease profile and therapeutic choice. Total 72 prescriptions were analyzed for the study in which 475 drugs were prescribed to the patients. Total antidiabetic drugs prescribed to the patients were 169. Out of 72 cases 39 were males and 33 were females with mean age 66.04 ± 5.80 (Mean ± SEM). The average number of drugs per prescription was 6.59 which was very high as per guidelines. Most commonly prescribed antidiabetic drug was Metformin (63.89%) followed by Glimepiride (31.95%). This study reflects that there is need to make available the standard therapeutic option at University Health Care Facility based upon pharmacoeconomic considerations.

DUE (Drug Utilization Evaluation) studies can help identify and correct problems associated with irrational use of drugs. Considering lack of data regarding how rational vancomycin is being used, we evaluated this DUE study in a referral infectious center to evaluate compliance with guidelines in terms of rational use of this valuable antibiotic. This retrospective study was done for 6 months from March to September 2012 at Razi hospital, an educational hospital affiliated to Mazandaran University of Medical Sciences. Data including patients’ demographics, vancomycin dose, kidney function assessment, dose adjustments, sampling and culture were collected. Based on the HICPAC (Hospital Infection Control Practices Advisory Committee) and Up-to-date 2012 advices, the concordance of practice with standard guidelines was assessed. One hundred and forty six medical records were reviewed in this study. Fever and shortness of breath were the most common symptoms at the time of initiation of vancomycin. Skin infections, lower respiratory tract infection and septicemia were the most common initial diagnosis of patients. Sampling was done in almost one-third of patients. Most of patient with a specific order were received vancomycin in half an hour. Considering the indication, Vancomycin was administered appropriately in 58 percent of patients. Vancomycin was used irrationally in a great proportion of patients. The main observed drawbacks were empiric use of vancomycin without subsequent adjustment of antimicrobial agent according to culture and sensitivity data and lack of paying enough attention to calculation of creatinine clearance and dosage adjustment.

Drug-Drug Interactions (DDIs) are adverse reactions caused by a combination of drugs; they are often predictable and therefore avoidable or manageable. The objective of this study was to evaluate the nature, type and prevalence of potential DDIs in prescriptions dispensed in university-based community pharmacies in Tehran, Iran. From July 2012 to February 2014, sample of 1260 prescriptions were collected from community and outpatient hospital pharmacies affiliated to Tehran University of Medical Sciences (TUMS), Iran. The prescriptions were assessed using the reference text “drug interaction facts”. The identified DDIs were categorized according to their level of significance into three classes (minor, moderate, major). At least one drug-drug interaction was present in 339 (26.9%) of prescriptions and a total of 751 cases of interactions were found in prescriptions. Major DDIs represented 7.3% of all DDIs detected, whereas moderate DDIs were 75% of all DDIs. The mean number of drugs per prescriptions was 3.2, with a median of 4 (range, 2-10).There was a positive association between number of prescribed drugs and occurrence of DDIs (OR: 2.14, 95% CI: 1.9-2.4). The prescriptions of medical specialist had greater risk of occurrence of moderate severity DDIs than general practitioners (OR: 1.52, 95%CI: 1.08-2.15). Despite the prescriptions were collected from university-based pharmacies, but the overall prevalence of potential DDIs were high among patients. Physicians should be aware of potentially harmful DDIs. Meanwhile Pharmacists can contribute to the detection and prevention of drug-related injuries. Appropriate education, collaborating drug selection and pharmaceutical care are strongly recommended for physicians and pharmacists.

Infections in neutropenic patients are considered as major causes of mortality and the emergence of drug resistance. Gram positive bacterial infections are crucially important to be covered if indicated. Vancomycin is active against most Gram positive bacteria including Methicillin Resistant Staphylococcus Aureus (MRSA). In this study, we evaluated the appropriate utilization of this agent in bone marrow transplantation (BMT) patients. In a cross sectional study, all patients who received vancomycin in a seven months period at bone marrow transplantation research center in Shariati teaching hospital in Tehran, Iran, were entered to the study. Clinical and preclinical parameters such as serum creatinine, microbial culture, antibacterial sensitivity, WBC count and fever were collected and recorded for analysis. We also measured vancomycin trough level after administration of three doses. Fifty one patients were entered in the study and reviewed in two adult BMT wards. The age range was 18 to 65 years. Most patients received allogenic versus autologous transplantation (56.9%, 43.1%). About 80% of the vancomycin used for the patients with febrile neutropenia was compatible with National Comprehensive Cancer Network (NCCN) guideline. 21.6% of patients received appropriate doses. Vancomycin trough serum concentration range was 15.0±11.9 μg/mL. Vancomycin is an antibiotic used to treat resistant gram-positive infections and must be prescribed by a specialist. Vancomycin wrong dosing or initiation prescribing with dose 1 gr/q12h increases the resistance and toxicity to drug, and cause an inappropriate response to the drug.

Drug related problems can be defined as any event (or) circumstance involving the drug treatment, which interferes or potentially interferes with the patient in achieving an optimum outcome of medical care. The aim of the study was to identify drug therapy problems and to assess the pharmacist interventions in patients with cardiovascular diseases. The inpatient case records including drug history and other relevant details of the admitted patients under the cardiology department were collected and reviewed by the clinical pharmacist for drug related problems. In case if any drug related problem was identified, was discussed with the concerned physician and suitable interventions was provided and documented. A total of 112 patient case sheets were reviewed during the study period, out of which 53 drug related problems were identified from 44 patients. The most common drug related problem was found to be drug Interactions (49.05%) followed by Adverse Drug Reaction (18.86%), and failure to receive drugs (9.43%). The most frequent suggestions provided by the intervening pharmacist were cessation of drug (24.52%), followed by Change in frequency of administration (22.64%), change in drug dose (20.75%). The majority of level of significance of drug related problems was seen to have moderate significance in grade. The acceptance rate of recommendations and change in drug therapy was found to be high (96.21%). The current study highlights the importance of a pharmacist in a multidisciplinary team of routinely reviewing the drug therapy for identification and resolution of drug related problems which helps in achieving better therapeutic outcomes and improved patient care.

Virtual learning is a type of electronic learning system based on the web. It models traditional in- person learning by providing virtual access to classes, tests, homework, feedbacks and etc. Students and teachers can interact through chat rooms or other virtual environments. Web 2.0 services are usually used for this method. Internet audio-visual tools, multimedia systems, a disco CD-ROMs, videotapes, animation, video conferencing, and interactive phones can all be used to deliver data to the students. E-learning can occur in or out of the classroom. It is time saving with lower costs compared to traditional methods. It can be self-paced, it is suitable for distance learning and it is flexible. It is a great learning style for continuing education and students can independently solve their problems but it has its disadvantages too. Thereby, blended learning (combination of conventional and virtual education) is being used worldwide and has improved knowledge, skills and confidence of pharmacy students.The aim of this study is to review, discuss and introduce different methods of virtual learning for pharmacy students.Google scholar, Pubmed and Scupus databases were searched for topics related to virtual, electronic and blended learning and different styles like computer simulators, virtual practice environment technology, virtual mentor, virtual patient, 3D simulators, etc. are discussed in this article.Our review on different studies on these areas shows that the students are highly satisfied with virtual and blended types of learning.