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.
The rational use of medicines was and still is a global health priority. In light of the COVID-19 Pandemic, ensuring and practicing the RUM has become even more challenging. Certain interventions from the list of core polciies recommended by the World Health Organization (WHO) bear additional importance in imporving RUM principles in practice. These recommendations are visited in this editorial.
Determination of Type 2 Diabetes Risk by Using of Diabetes Risk Questionnaire Prepared by Turkish Diabetes Association in People Living in the District of Zeytinburnu, Istanbul
Background: Type 2 diabetes is a serious condition that is rapidly increasing all over the world and can cause other metabolic diseases. In our study, we aimed to evaluate the probability of the participants having Type 2 diabetes by using diabetes risk questionnaire.
Methods: During the month of March 2019, a validated questionnaire prepared by the Turkish Diabetes Association was administered to 500 patients (M= 223, (44.6%); (F= 277), (55.4%)) who were applying to a pharmacy in Zeytinburnu, Istanbul. Statistical analyzes were performed using SPSS version 21. Data were expressed as mean, standard deviation (SD) and percentage (%). In this respect, the normality of data distribution was determined by the Shapiro-Wilk test. Results: The scale total scores of women were significantly lower than the total scale scores of men (p<0.001). It was found that the risk of developing diabetes increased significantly with age (p <0.001). Patients aged 60 and over were at the highest risk of Type 2 diabetes. It was determined that the risk of developing Type 2 diabetes was significantly higher in patients with high blood pressure (n= 111), (p<0.001). One hundred and thirty-seven physically inactive participants had a significantly higher risk of Type 2 diabetes (p<0.001). Finally, the risk of diabetes increased with increasing weight (p <0.001).
Conclusion: In conclusion, increasing age, high blood pressure, physical inactivity can increase the risk of Type 2 diabetes. To prevent the risk, people should be physically active and they should consume healthy and balanced diet.
Design, Implementation and Evaluation of a Student Mentoring Program for Pharmacy Students Based on Facilitation by the Pharmacist Assistant Website at the School of Pharmacy of Ahvaz Jundishapur University of Medical Sciences
Background: Mentoring is a learning and training process in which a qualified person with more experience (mentor) consults a person with fewer skills or less experience (mentee). The purpose of this study was to design, implement and evaluate the student mentoring program for entry Pharmacy students of academic year 2019-2020 (as mentees) and to use a website to communicate with students in order to use new methods of communication.Methods: In this project, 2015, 2016 and 2017 entry students were used as mentors. After assessing the needs of senior students, the mentoring program was designed and after revision, mentors and mentees were introduced to each other. Considering the outbreak of Corona virus in the middle of the project, the Pharmacist Assistant website was designed as a virtual learning platform and made accessible to students for keeping the mentoring members in touch with each other.Results: Preliminary results of a needs assessment showed that students prefer being consulted by senior students in the times of challenge. A survey of mentees showed that all mentees were satisfied with participating in the program and recommended its implementation, and almost half of them believed that the web design was successful in educating students during the pandemic.Conclusion: Due to the high satisfaction of the mentees with the mentoring program and their familiarity with the academic challenges before facing them, running mentoring programs can be very functional and helpful in Schools of Pharmacy. In the case of coronavirus pandemic, one way to prevent damage to the mentoring program and to keep the mentor and mentees in touch is to design a virtual platform such as the Pharmacist Assistant website.
Evaluation of Albumin Utilization in a Major Teaching Hospital in Iran Before and After Guideline Implementation
Background: Inappropriate use of drugs is one of the major issues in health care system. Rational drug utilization based on the appropriate guidelines has an important role in management of use of expensive medications. We aimed to evaluate albumin usage's appropriateness based on evidence-based indications before and after implementing albumin prescription guideline in a teaching hospital.Methods: This study was performed in two phases. During two-month periods, all the patients who were ordered to receive albumin were evaluated. The first phase was done in November and December of 2017, during which, based on physicians' comments, the guideline was finalized and then implemented. Phase two was performed in May and June 2018.Results: Albumin was prescribed appropriately in 33 patients (55%) in the first phase and 43 (70%) patients in the second phase. 299 vials in the first phase and 456 vials in the second phase were prescribed which 198 vials (66%) and 394 (86%) vials were used with appropriate indications, respectively. The number of vials consumed with inappropriate indication decreased significantly from 101 vials (34%) in the first phase to 62 vials (14%) in the second phase (P-value=0.01). The average cost of the inappropriate indication per patient decreased from $197.3 ± 131.6 in the first phase to $183.5 ± 126.8 in the second phase (P-value=0.52).Conclusion: This study showed implementing a DUE program and designing a guideline for rational prescribing of albumin and interventional methods can optimize treatment duration, significantly decrease inappropriate usage, and avoid unnecessary hospital costs.
Background: At the onset of the 2020 year, Coronavirus disease (COVID-19) has become a pandemic and infected many people worldwide. Despite all efforts, no cure was found for this infection. Bioinformatics and medicinal chemistry have a potential role in the primary consideration of drugs to treat this infection. With virtual screening and molecular docking, some potent compounds and medications can be found and modified and then applied to treat disease in the next steps.Methods: By virtual screening method and PRYX software, some Food and Drug Administration (FDA) approved drugs and natural compounds have been docked with the SPIKE protein of SARS-CoV-2. Some more potent agents have been selected, and then new structures are designed with better affinity than them. After that, we searched for the molecules with a similar structure to designed compounds to find the most potent compound to our target.Results: Because of the study of structures and affinities, mulberrofuran G was the most potent compound in this study. The compound has interacted strongly with residues in the probably active site of SPIKE.Conclusion: Mulberrofuran G can be a treatment agent candidate for COVID-19 because of its good affinity to SPIKE of the virus and inhibition of virus-cell adhesion and entrance.
Evaluation of Coronary Artery Calcification and Gremlin-1 Serum Level Correlation in Patients with Chronic Ischemic Heart Disease
Background: Available evidences have shown that bone morphogenetic proteins (BMPs), particularly BMP 2 and BMP 4, are involved in vascular calcification. Gremlin 1 is one of the important endogenous inhibitors of BMPs. This extracellular antagonist of bone morphogenic proteins has a very complex and cysteine-rich chain and establishes non-colonial transmissions to the members of the family with varying degrees of dependence and prevents them from binding to the receptor, thereby inhibit their function. The main objective of this study was clinical evaluation of the correlation between Gremlin-1 serum concentration and Coronary Artery Calcification.Methods: Eighty-four patients with coronary artery disease from cardiology ward of Razavi Hospital, Mashhad, Iran, who completed the inclusion criteria, entered in the study between November 2015 and March 2016. CT-Angiography was performed to define coronary artery calcium score and Gremlin-1 serum concentrations were measured by an ELISA kit.Results: Eighty-one patients, with mean age of 57.19±10.18 years were included to the study. The mean serum level of Gremlin-1 was 10.92±8.46 pg/mL. There was a reverse significant correlation between Gremlin-1 serum concentration and Coronary Artery Calcification of Right coronary artery(RCA) (P<0.05), in contrast to total Coronary Artery Calcification score, left artery Descending (LAD), Left Main (LM) and Circumflex (CX). However, there was no evidence that age and sex risk factor, hypertension, diabetes mellitus, hyperlipidemia, positive family history, current smoking and high BMI to be associated with serum level of Gremlin-1.Conclusion: Based on the results, Gremlin-1 serum concentration may be a suitable biomarker for predication coronary artery calcification severity. However, more researches on larger population are necessary for its validation.
Potential Drug–Drug Interactions among Hospitalized COVID-19 Patients Admitted to Medical Wards of a Referral Hospital, North-East of Iran: A Cross Sectional Study
Background: Hospitalized corona virus disease 2019 (COVID-19) patients are special population in term of drug-drug interaction (DDI), as they receive various experimental novel medications and also most of them are elderly with various comorbidities and consequently numerous medications. The aim of present study was to assess the prevalence and determinants of potential DDIs in hospitalized COVID-19 patients admitted to the medical ward of a Referral Hospital in North-East of Iran.Methods: A cross-sectional study was conducted among COVID-19 inpatients between March 2020 and April 2020. Prescribed medication being taken concurrently for at least 24 h were included and checked for DDI using Lexicomp® online drug reference. Data were analyzed using SPSS19.Results: A total of 88 patients were evaluated. The cardiovascular disease was the most common comorbidity (30.68%). The median number of medications prescribed for each patient was 5. Hydroxychloroquine was the most common prescribed medication for COVID-19 management (92.05%). About two-third (62.5 %) of patients were exposed to at least one potential C (84.09 %) or D (52.27%) DDI and no X DDIs were found. Patients with at least five prescribed medications were at higher risk of having DDI (P = 0.001).Conclusion: Drug–drug interaction in COVID-19 inpatients was common. Considering these DDIs, clinical pharmacist involvement can be helpful in minimizing the risk of these potentially harmful drug combinations.
A Review of Studies on the Use of New Non-Gabapentinoid Anticonvulsants and Muscle Relaxants in the Control of Acute Postoperative Pain
Postoperative pain management in any type of surgery is an important issue for patients. The pain relief contributes to decreased hospital costs, shorter hospital stay, and elevated patient consent. Correspondingly, in this review article we assessed the postoperative pain management efficacy of new non-gabapentinoid anticonvulsants and muscle relaxant drugs in pre-clinical and clinical studies. The scientific databases, including PubMed, Embase, Scopus, and Google Scholar, were searched using relevant keywords: surgery, postoperative pain, analgesia, non-gabapentinoid anticonvulsants, and muscle relaxants. New anticonvulsants reduce postoperative pain, length of stay at postoperative anesthesia care unit, and analgesic requirement after surgeries. Their mechanisms include the inhibition of glutamate release, blocking the N-type calcium channels of afferent neurons, inhibition of supraspinal 5-hydroxytryptamine-3 receptor, and prevention of cyclin-dependent kinase 5-mediated collapsin response mediator protein 2 phosphorylation. Also, muscle relaxants show the same effects by downregulation the Cacna1a, Cacna1b, and Runt-related transcription factor 1 genes of dorsal root ganglia, inhibition the release of glutamate, aspartate or substance P from the terminals of primary afferent C and Aδ fibers, expression of Neurokinin 1 receptor in the spinal dorsal horn, agonistic effect on α2-adrenoceptor, and stimulation of acetylcholine release in the spinal cord. With respect to the concerns regarding opioid abuse, muscle relaxants and non-gabapentinoid anticonvulsant drugs can be regarded as a safe option for postoperative pain control.