Kheirollah Gholami, Professor
Journal of Pharmaceutical Care is an open access journal officially published by the Research Center for Rational Use of Drugs (RCRUD) of the Tehran University of Medical Sciences, and Iranian Society of Clinical Pharmacists which is focused on experimental and clinical pharmaceutical practices to present researches, hot topics, requirements and regulations of the pharmaceutical practice area. Manuscript in Clinical Pharmaceutical Practice, Pharmaceutical Care Regulations, Pharmaceutical Care in hospitals and community pharmacies, Pharmacotherapy, Pharmacoepidemiology, Pharmacogenomics, Pharmacokinetics, Pharmacoeconomics, Clinical pharmacokinetics, Drug Utilization Evaluation review, Medication safety, Drug and Poison Information Services and Health services research are welcome.Content includes Original Articles, Systematic Review or Meta-Analysis, Review Articles, Case Reports and Letters to the Editor.
JPC is an open access, peer-reviewed, and quarterly journal that considers for publication articles in all fields and specialties ofpharmaceutical care in English language. This journal has both online and print versions and no charges are levied for publication.
Journal of Pharmaceutical Care is indexed and abstracted in: Dimensions, Google Scholar, Magiran, Directory of Open Access Journal (DOAJ) and Islamic World Science Citation Center (ISC).
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Background: Dyslipidemia is an important risk factor for development of macrovascular disease. Altered lipid metabolism and abnormality in serum lipid profile results atherogenic dyslipidemia this can worsen the prognosis of diabetic patients and increases risk of cardiovascular disease and stroke. This study aims to evaluate the effect of metformin monotherapy and combination therapy with glimepiride on lipid profile of drug naive type-2 diabetes patients after 10-12 weeks of treatment. Methods: In this study, prescriptions of 120 OPD (Outpatient department) patients of drug naive type-2 diabetes were collected. The detailed observation of: demographic, drug details and investigations done were noted in a specially designed preform. The data was analyzed statistically and results were expressed as numbers and percentage. Results: The total of 120 patients prescriptions was analyzed. Among these male was 62.5% and female were 37.5%, most common affected age group was between 31-50 years with mean age of 43.82 yrs. Metformin was most commonly prescribed drug 42% followed by its combination with glimepiride 58%. Average blood glucose level prior therapy was 193.4mg/dl and post therapy it was 135.2mg/dl. After 10-12 weeks of metformin monotherapy and combination therapy with glimepiride LDL was significantly reduced from 92.3mg/dl to 83.2mg/dl, TG was reduced from 145.5mg/dl to 132 mg/dl and HDL increased from 29.1 mg/dl to 32.9 mg/dl. Conclusion: Metformin monotherapy and combination therapy with glimepiride appreciably improved dyslipidemia in drug naive type-2 diabetes patients.
Background: Renal colic is one of the most common urologic diseases that constitutes the majority of the emergency department (ED) patients. Intravenous ketorolac is usually prescribed for adequate pain control, but it is usually insufficient and morphine is required. The starting time and amount of morphine needed for acute renal colic is still under discussion. Methods: This prospective, observational study was conducted for 6 months at ED of Sina hospital, Tehran, Iran. 44 patients were investigated. pain intensity with numeric rating scale (NRS) were observed at baseline and then continued every 5 min for 2hr. Patients were received ketorolac (30 mg) and if NRS>6 morphine loading dose (0.05mg/kg) initially if NRS>6. morphine rescue dose ordered if the NRS remain >6. Morphine consumption pattern was the primary outcome. Also total morphine dose, time to reach NRS<4, and adverse reaction were evaluated. Results: At baseline, almost all patients had NRS>6, and about 65.8% had history of renal colic. The mean NRS was 8.98(±0.98), Therefore, all patients required a loading dose of morphine and 50% received at least one rescue dose. The patient with history of renal colic had higher NRS score at baseline, prolonged pain, higher total morphine dose and rescue dose. There wasn’t any significant side effect occurred. Conclusion: Patients with acute renal colic have severe pain and should receive morphine primarily. In addition, patients with a history of renal colic had higher pain intensity scores, and required higher morphine doses.
Background: Epilepsy is the second most common neurological disorder that affects 1 percent of global population. Since antiepileptics have narrow therapeutic index having multiple adverse drug reactions (ADRs) thus have significant safety concerns. The aim of this study was to observe adverse drug reactions due to antiepileptics in neurology department M.Y.H. Indore, India.Methods: An observational prospective study was done from November 2021 to January 2022. Patients having history of seizures attending neurology outpatient department at MYH Hospital, who were on antiepileptic drugs were recruited. Suspected adverse drug reaction forms were recorded and their causality assessment was done by Naranjo’s scale. Results: Data of total 70 patients were recorded. Males reporting ADRs due to antiepileptics were 67.1% and females 32.8%. Using Naranjo’s scale, we noted 93.3% ADRs as “probable” and 6.7% as “possible”. Common causes of prescribing antiepileptic drugs were known case of epilepsy (78.5%),old case of neurocysticercosis (11.4%),post traumatic(4.3%),gliosis (2.8%) and tuberculoma (2.8%) .Most ADRs were dermatological 76% (rashes),central nervous system (16%) (nocturnal enuresis, poor school performance, dizziness, headache, sleep disturbances, personality changes) ,Gastrointestinal (8%) (gastric irritation, nausea, vomiting and hepatotoxicity) .Most common drug for causing ADRs were sodium valproate(58.5%),carbamazepine(17.14%),phenytoin(14.2%),leviteracetam(7.1%),and lamotrigine(2.8%). Conclusion: Our study aimed us to know the incidence and patterns of adverse drug reactions due to antiepileptics in a tertiary care institute of central India. Despite of recent advances and novel therapies used for the treatment of epilepsy, conventional drugs like sodium valproate, phenytoin and carbamazepine still are the first choice for the management and treatment of seizures and their ADRs are very common.
Background: Effective clinical care and identifying susceptibility to COVID-19-related mortality requires rapid recognition of risk factors and their relations with disease outcomes. This study aimed to cluster and identify various subgroups of COVID-19 patients and examine the relationship between these subgroups and the causes of death. Methods: This retrospective study assessed the risk factors contributing to COVID-19 patients’ death (n = 128) by evaluating deceased patients' demographic, clinical, and laboratory features and clustering various subgroups of individuals to investigate any correlation. Results: The mean age of deceived patients was 69.7 years, and the majority of them were male (65.6%). The levels of blood urea nitrogen, creatinine, alkaline phosphatase, erythrocyte sedimentation rate, lactate dehydrogenase, and C-reactive protein were high at admission and increased during the hospitalization. Shortness of breath (68%) and cough (62.5%) were the most common symptoms, and hypertension (50.8%) was the most common comorbidity among deceased patients. The clustering quality based on the underlying disease and symptoms was not acceptable. However, clustering based on vital signs showed significant differences in body temperature, pulse rate, respiratory rate and oxygen saturation (P<0.001). Furthermore, disseminated intravascular coagulation (DIC) was significantly higher in patients with weaker vital signs than those with better vital signs (15.36% vs. 0.0% P = 0.002). Conclusion: Older age, male sex, hypertension, and high inflammatory markers might be the risk factors for COVID-19-related mortality. Furthermore, considering that patients with poor vital signs were susceptible to develop DIC, prevention of these consequences might be helpful in COVID-19 management.
Background: Acute bronchitis is one of the most common infectious diseases in children and a major cause of hospital admissions. Treatment of acute bronchitis is usually symptomatic, analgesics and antipyretics are often used. The simultaneous intake of drugs brings pharmacological interactions with it. These interactions are important for the success of the treatment. The aim of our investigation is to determine the prevalence and severity of possible drug interactions; draw attention to drug interactions in children and adolescents. Methods: This study was conducted on 99 patients, 48 males and 51 females, with bronchitis hospitalized between 2019 and 2021 in Rize, Turkey. Patient records were retrospectively evaluated, and drug interactions were determined using database Medscape data by clinical pharmacists. Data was analyzed by SPSS 15.0v. statistical program p<0.05 was considered significant. The severity of the interactions was assessed as an alternative to serious use, close monitoring and minor interactions. Results: In this study, it was found that the mean age of the patients was 5.17 ± 2.31 years. A total of 69 drug-drug interactions were identified, most of which (63.6%) were identified on the ‘Close Monitor', and the interaction rate at the 'Serious Use Alternative' level was found to be 16.2%. There was no interaction in some patients in this study; but some patients experienced up to 4 interactions. Conclusion: Healthcare professionals should be more cautious about polypharmacy and more aware of the rational use of drugs. By raising awareness of drug interactions among healthcare professionals, drug interactions can be minimized.
Bleomycin is a chemotherapeutic medication commonly use in the treatment of Hodgkin's disease and germ cell tumors. Pulmonary fibrosis is major and dose limiting adverse effect of the drug. There is not currently any equal alternative approach or a medical agent for prevention of its pulmonary injury. We searched scientific databases in order to find investigational pharmacologic medicines in prevention of bleomycin-induced lung toxicity (BILI). Results revealed that some anti-inflammatory and antioxidant preparations such as statins, N-acetylcysteine (NAC), supplements (vitamin D3, L-arginine, selenium), and renin-angiotensin-aldosterone system (RASS) inhibitors might be effective in preclinical models of pulmonary toxicity mediated by bleomycin. However, we still need more in vivo studies and large human randomized clinical trials to confirm their benefits.
Taxane-induced peripheral neuropathy (TIPN) is a dose-limiting adverse effect of chemotherapy without any specific treatment. The aim of this paper is to evaluate the effects of natural products and supplements on TIPN. PubMed, Google Scholar and Web of Science databases were searched through August 2022 regarding TIPN and effects of natural products and supplement therapy. Data consists of preclinical studies, randomized controlled trials and case reports. After screening of 230 papers, we found 13 relevant animal and human studies regarding possible benefits of vitamin E, glutamine, omega-3, acetyl-L-carnitine and group of B vitamins on TIPN. Results demonstrated that vitamin E can be helpful on prevention and duration of TIPN. Glutamine and B vitamins showed hopeful results on reducing pain sensation. Omega-3 also shows promising results on incidence of TIPN. However, acetyl-L-carnitine might develop and worsen neuropathy. Although some supplements revealed promising effects on prevention and treatment of TIPN, researches are still limited and we need further long-term large sample size trials to confirm clinical efficacy of these supplements.
Coronavirus disease 2019 (COVID-19) has different clinical manifestations that besides its iatrogenic intervention could affect brain cognitive function. Medication omission has serious effects on a patient’s clinical course changing the disease’s mortality and morbidity; herein possible role of the iatrogenic intervention that increased the risk of psychological disturbance including medication omission was reported. A 40-years-old man with a history of gout treated with allopurinol was admitted due to productive cough and hemoptysis. His physical exam and lung spiral chest CT scan revealed moderate to severe lung infiltrations in favor of COVID-19 which was confirmed with COVID-19 RT-PCR. Due to his clinical course tocilizumab, methylprednisolone pulse, and other conservative therapies were started while allopurinol was omitted. During his hospitalization anxiety and irritability appeared and progressed gradually making him refuse to get oxygen supplementation. Through immediate intervention and controlling his behavioral symptoms with psychotherapy, selective serotonin reuptake inhibitors, benzodiazepines, and initiation of allopurinol, the patient’s psychological disturbance were relieved. In the end, he died due to acute respiratory distress syndrome.
COVID-19 and its iatrogenic interventions could trigger a psychiatric disturbance in patients with a variety of pathways. Corticosteroid therapy, non-hypnotic antihistamines, quarantine stress conditions, hypoxia, and medication omission are underlying factors for it. Reporting this medication omission would help physicians become familiar with this pharmacological phenomenon, its prevention, and the way to respond to it. On the other hand, researchers can study the etiology of this phenomenon to understand the mood-stabilizing role of allopurinol in additional studies.
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