Natural products have been always using for several types of applications by humankind for so many years. Food and medical applications have been seen very much important for such products in their original forms or reproduction in new forms. As a main resource for generating so many other compounds, synthetic derivatives have been evaluated for the essential extractions of natural products for more specified applications especially for medical core with controlled dosage medication and compounds. Therefore, recognition of potency of natural products for such specified application have been always seen as a dominant factor for undergoing further improvements in this case. Besides the original extracted essentials, modifying chemical structures could help for lead optimization of such important compounds for possible efficient cares. Indeed, lead optimization could be provided very well by employing in silico approach for potent chemical compounds up to reaching them to specified medication.

Background: Given the special importance of preventing from medication, the present study aimed to investigate the determining Causes of Medication Errors (CMEs) and their Priorities for reducing interventions in a hospital.Methods: The present mixed, sequential and cross-sectional study was conducted in a teaching hospital (2016). For data collection, Fishbone Diagrams, interviews, note taking and checklists were used, and qualitative data were analyzed though the thematic approach. Moreover, the Maxqda Software v.14.0, Excel, Edraw Max v.9.0 were employed for data analysis and reporting.Results: Seventy-five CMEs were classified under two main themes (human and non-human) and four sub-themes (personal, network, organizational, and meta-organizational). Weakness of professionalism and low experience as the personal causes; Actions of pharmacy colleagues, physicians and other nurses as the network causes; Management of nurses and unit specialty as the organizational causes and the quality of academic education, drug features and macro policies of medication as meta-organizational causes were classified. Six causes were given priority for reducing interventions.Conclusion: In the short term, human factors should be considered with the aim of reducing medication errors. It is also recommended that teaching how to deal with nurses’ stress and psychological pressure (especially beginner nurse), resulting from critically ill patients and high workload, be paid special attention. Besides, it is suggested that professionalism be given priority to reduce personal neglects and to create safe environments for reporting personal neglects. In addition, more emphasis should be placed on the right route in the process of medication administration.

Background: The role of pharmacists has evolved from drug provision to patient care. Considering
the Doctor of Pharmacy curriculum in Iran and the small number of programs on pharmaceutical
care, Iranian pharmacy graduates may not be able to adjust to their new roles.Methods: A comprehensive online modular course was prepared by a group of well-experienced faculty members of eight universities of medical sciences in Iran. The course included 12 practical and challenging submodules on commonly encountered disorders and commonly used medications in the community pharmacy. Each submodule was followed by an online forum in which the teachers and participants discussed the educational questions. The increase in participants’ knowledge was evaluated using pre-and post-test. The usefulness of submodules and acceptance of the entire course were also evaluated by two specifically designed questionnaires. Results: After the announcement, 154 participants registered in the course. The knowledge of the participants increased significantly in all the 12 submodules. The majority of participants stated that all the submodules were useful. Moreover, the majority of respondents to questionnaires declared that the course has increased their confidence in providing patient counseling in the pharmacy. Conclusion: The comprehensive online course on patient counseling in the community pharmacy increased participants’ knowledge. Besides, the course was useful and well accepted by the participants.

Background: Serious games are the addition of game elements in order to motivate the user to participate more in the learning process. The purpose of this study is to design PharmQuiz educational game application in order to learn pharmaceutical information in the introductory internship course of pharmacy for incoming pharmacy students in2020.Methods: After reviewing the studies, the puzzle and matching mechanisms were selected for the game. The RAD software design model was used in order to design and implement, the game application was coded in Java programming languages. The game engine is unity and MySQL and PHP languages ​​were used to implement the game database, which contains learners' scores.Results: A total 70 students participate in the study. The mean age of the study participants was 22 years. Average student scores show that most students have used the PharmQuiz game app repeatedly. A survey of faculty members of the Clinical Department of the School of Pharmacy showed that 100% of the members agreed that the game improves the quality of learning.Conclusion: According to the positive attitude of students regarding the PharmQuiz educational game application and their welcome in using this application, it can be said that PharmQuiz game application is a useful tool to increase the motivation of students to study the introductory internship course of pharmacy and also to participate more in the educational process. This application can be used at higher levels as well as for learning pharmaceutical information in other medical sciences.

Backgrounds: Chemotherapy induced nausea and vomiting (CINV) is still distressing adverse effect for patients. Thus, we conducted this study to assess the compliance of CINV prophylaxis patterns with NCCN guideline.Methods: 136 Patients with any kind of malignancy who undergoes chemotherapy in Shahid Ghazi hospital, Tabriz, Iran, were included in this study. Adherence rate to the NCCN guideline of anti-emetic therapy for different emetogenic potential chemotherapy regimens was evaluated.Results: All patients received their prophylaxis 30 min before chemotherapy, which is completely adherent to guideline. Hematological malignancies were associated with higher adherence rate (P=0.032). For high and moderate emetic risk patients, dexamethasone and ondansetron were remarkably under-dosed, whereas Granisetron was over-dosed. Adherence rate to guideline in high and moderate and minimal emetic risk chemotherapy was 72.3%, 22.9% and 69.2% respectively. None of low emetic risk patients received guideline compliant prophylaxis. In all emetic risk levels, 50 (36.8%) patients received guideline adherent prophylaxis.Conclusion: As results indicated, adherence rate wasn’t optimal. Available dosage form of a medication has great impact on appropriate prescription. Thus, it is suggested for pharmaceutical companies to be informed about recent guidelines’ updates and subsequently produce proper dosage forms for different indications.

Background: Drug Utilization Evaluation (DUE) studies are designed to assess drug usage appropriateness. This study aimed to evaluate the drug utilization of antibiotics in the intensive care units (ICUs) of a referral teaching hospital.Methods: Patients hospitalized in ICU who received antibiotics were enrolled in this cross-sectional study. Patients’ medical charts were reviewed and data including indication of antibiotics, dosing, dose adjustment, and culture sensitivity test were recorded in a predesigned data collection form. Related guidelines and references were used for judgement about the correctness of these parameters.Results: Among 182 evaluated antibiotic prescriptions, 75.8% of the cases were prescribed empirically that for 31.88% of them, microbial culture and sensitivity test were requested. Indication was appropriate in 51.6%. Fifteen patients needed antibiotic dose adjustment that was performed just for 4 patients. Doses of antibiotics were correct in 58.5% of cases. Meropenem (15.9%), Metronidazole (15.9%), and vancomycin (11.5%) were the most frequently prescribed antibiotics.Conclusion: Use of antibiotics in ICUs of our hospital is associated with high rate of errors especially in the aspects of medical indication and dosage.

Background: The occurrence of drug–drug interactions (DDIs) and insufficient attention to medication reconciliation is one of the important challenges of pharmacotherapy in hospitalized patients. The aim of this study was to determine the extent of drug–drug interactions in patients based on medication reconciliation strategy. Methods: This descriptive cross-sectional study was performed for six months in patients admitted
to Imam Reza Hospital in Amol, North of Iran. The data were obtained by using a medication reconciliation tool through a random sampling of patients admitted in Hospital wards from May 2014 until October 2014. A total of 200 patients were enrolled in the study. All patients had a history of medication use before admission. The drug interactions have been checked according to Drug Interaction Facts between newly prescribed drug and medication patient using before admission. The number and frequency of data were summarized by SPSS21 statistical software. Results: Major and Moderate DDIs were found in 7.5% and 64% of prescriptions. The most frequent DDIs were seen in those who were taking psychiatric drugs (33%) and cardiovascular drugs (30%). Most DDIs occurred among women over 60 years of age. The most frequently occurring DDIs was pharmacokinetics interaction between clopidogrel and atorvastatin (n=9). Other frequent interactions were between ceftriaxone and heparin (n=8) and metoprolol and insulin (n=3). Conclusion: This study showed a high rate of drug interactions and especially confirms the importance of medication reconciliation in providing a comprehensive drug history and exploring drug interactions.

This study critically reviews the role of hypoxia in the progression of Multiple Myeloma (MM)and its therapy resistance. It explains the existence and role played by Hypoxia Inducible Factors (HIF) including HIF-1α and HIF-β in tumor (MM) progression. These HIF are key transcription factors of hypoxia and they aid the cellular adaptation of both normal and cancer cells to reduction in oxygen concentration. At initial stage of MM, the bone marrow environment sufficiently supports the growth and survival of the MM cells, but as the disease progresses and the plasma cells goes deeper into the bone marrow, they experience a more hypoxic condition. This then activates HIF-1 and HIF-2 which ultimately stimulates angiogenic factors. This is a description of the step by step approaches through which a review of Hypoxia: progressive multiple myeloma and its drug resistance was conducted using Google scholar and PubMed search engines to search articles published from 2000 to May 2020 using the following key words: hypoxia, progressive multiple myeloma, treatment resistance, hypoxia and multiple myeloma. This review suggests that agents capable of inhibiting the action of HIF’s, as well as those that would act specifically on the hypoxic zones will be helpful in minimizing/eliminating drug resistance and relapses in MM patients and would invariably improves the patient life expectancy.