Journal of Research in Pharmacy Practice

Abstract

Abstract Objective: The present study aimed to assess the knowledge, attitude, and 
practice (KAP) of 3rd- and 4th-year medical, dental, and pharmacy students 
about hepatitis B (HB) infection at a private medical university, Malaysia. 
Methods: A cross-sectional, questionnaire-based study was conducted among 
482 medical, dental, and pharmacy students of 3rd- and 4th-year degree program 
of Asian Institute of Medicine, Science and Technology University to assess their 
KAP about HB infection using 34 prevalidated questions by convenient sampling 
method. A questionnaire was administered to the students, and their responses 
were measured at “yes” and “no” scale. Students’ responses were entered in 
SPSS version 22, and quantitative analysis was performed using descriptive 
statistics and nonparametric tests at P < 0.05. Findings: The medical, dental, 
and pharmacy students had good knowledge and practice with positive attitude 
about HB infection. Mann–Whitney U‑test determined a significant difference 
in knowledge (P < 0.001) and practice (P < 0.001) scores between medical 
and pharmacy, attitude (P < 0.001) scores between medical and dental, and 
attitude (P < 0.001) and practice (P < 0.001) scores between pharmacy and dental 
students. Students’ age was correlated with their attitude, practice, and KAP scores 
and family income with their knowledge, attitude, practice, and KAP scores. 
Conclusion: Although students’ knowledge and practice were good with positive 
attitude, all the students did not participate in health education program, screening, 
and vaccination of hepatitis B virus (HBV) infection which makes them more 
vulnerable to occupational HBV infection. Hence, it is recommended to organize 
a regular health education program for the students on screening and vaccination 
against HBV to prevent its infection.

Abstract Objective: Amphotericin B is an antifungal agent used to treat serious fungal 
infections mainly in critically ill patients. Despite its adverse effects including 
renal toxicity and electrolyte imbalances, amphotericin B remains one of the best 
choices for antifungal treatment. Information from animal studies has provided a 
strong scientific basis for the use of pentoxifylline as lowering nephroprotective 
agent. The present study was designed to evaluate the efficacy of pentoxifylline in 
preventing renal toxicity and electrolytes imbalances induced by amphotericin B. 
Methods: This study was conducted as a randomized controlled trial on 44 patients 
admitted to Sayyedoshohada Hospital, Isfahan, Iran, from October 2016 to August 
2018. Patients were assigned to one of the two groups: Pentoxifylline, 400 mg 
twice a day, or matching placebo, from the 1st day of amphotericin B therapy till 
minimum of 7 days. All patients’ information including lab data (serum and urine 
levels of Mg, Na, and K, serum creatinine level, blood urea nitrogen [BUN] and 
urinary creatinine excretion) were gathered at the time of drug initiation and during 
the study period. The results were analyzed by SPSS v. 20 software and Repeated 
measures test was used to assess the differences between groups Findings: This 
study did not show any significant differences between the two groups in terms of 
all the assessed variables, including serum and urinary levels of electrolytes, and 
creatinine, as well as the number of cases presented acute kidney injury during 
the study period. Conclusion: Despite the positive effects of pentoxifylline in 
preventing renal complications in previous studies, this study could not show a 
definitive result in salt wasting or renal damage induced by amphotericin B. So, 
Designing robust studies with more included samples would be valuable.

Abstract Objective: The treatment of hypertension requires special attention because of 
comorbidities and polypharmacy. In a previous study, polypharmacy has been 
associated with a high risk of drug-related problems (DRPs). This study aimed 
to analyze DRPs in Indonesian hypertensive patients focusing on drug therapy 
effectiveness and adverse drug reactions. Methods: A cross-sectional study was 
conducted using medical records’ data, prescriptions, and nursing records to observe 
DRPs that occurred in outpatients with hypertension from February to April 2019. 
A total of 114 outpatients aged ≥23 years with a primary diagnosis of primary 
hypertension were included in this study. DRPs were reviewed based on literature, 
recent guidelines, and drug interaction software. Classification DRPs were done 
using Indonesian-translated Pharmaceutical Care Network Europe V6.02. The data 
obtained were analyzed using univariate descriptive analysis. Findings: Of all 
participants, 65 (57%) outpatients were found to have DRPs related to treatment 
effectiveness (54 cases) and adverse drug reactions (36 cases). The primary cause 
of the problems was an inappropriate drug (94.14%) and dose selection (2.86%). 
Potential drug interactions were found high (62.14%) in the combination of an 
antihypertensive agent with other drugs among patients. Overprescribing drugs 
without clear indications, untreated indications, and subtherapeutic dosage were 
also reported in this study. Conclusion: A significant percentage of outpatients 
being treated for hypertension experienced DRPs. The role of clinical pharmacists 
and physicians in monitoring drug therapy needs to be prioritized to prevent and 
resolve DRPs in outpatients with hypertension.

Abstract Objective: Drug utilization studies provide information regarding the drug 
usage pattern in hospital settings, which can be used to promote cost‑efficient 
uses of drugs. The present observational retrospective study was conducted to 
evaluate the drug utilization pattern in a tertiary care center in India and create 
a baseline consumption data for the drugs, simultaneously identifying targets 
for improving drug prescribing pattern. Methods: The current retrospective 
cross-sectional study was conducted at All India Institute of Medical Sciences 
Raipur, wherein the 217 medical records of different departments for August 2019 
were chosen randomly (using systematic random sampling) for evaluation. The 
information was extracted from medical records regarding the basic demographic 
details, drug strength, route, and total amount, and eventually, the World Health 
Organization (WHO) core indicators were estimated. Drug utilization data were 
assessed using the WHO Anatomical Therapeutic Chemical/Defined Daily 
Dose (ATC-DDD) methodology. Potential drug–drug interactions were also 
analyzed. Findings: Most of the records analyzed were of male patients (56.2%). 
Drugs prescribed by their generic name were 50%. Prescriptions containing 
injection and antimicrobials were 68.1% and 83.6%, respectively. 49.3% of the 
patients had received a fixed‑dose combination, and 60.9% of drugs belonged 
to the National List of Essential Medicines 2015. A total of 15 potential drug 
interactions were found. Conclusion: Calculated prescribed daily dose of most of 
the antimicrobials and other groups of drugs was close to the WHO-DDD. Trade 
name prescription and polypharmacy were very common. Antibiotics accounted 
for the majority of drug costs.

Abstract Objective: This study was designed to evaluate the extent of inappropriate utilization 
of intravenous proton‑pump inhibitors (IV‑PPIs) and its financial burden in a Middle 
Eastern tertiary care university hospital. Methods: This was an observational, 
retrospective, cross-sectional study carried out in King Saud University Medical 
City, Riyadh, Saudi Arabia. During a study period of 6 consecutive weeks, all 
hospitalized adult patients (age ≥18) who received IV‑PPI selected and mapped 
with their indications. The patient indications analyzed in comparison with the 
appropriate indications developed based on the evidence from published literature 
and guidelines. Findings: A total of 347 patients were identified, with a mean age 
of 51.5 years, of which 51.9% were male. Of all the patients who received IV-PPIs, 
251 (72.3%), 66 (19%), and 30 (8.7%) received for stress ulcer prophylaxis (SUP), 
peptic ulcer disease (PUD) or gastroesophageal reflux diseases (GERDs), and upper 
gastrointestinal bleeding, respectively. Overall, only 110 (31.7%) of the 347 patients 
received IV-PPIs appropriately. The patients with SUP showed the highest percentage 
of inappropriate use of IV-PPI (80.59%) compared to PUD/GERD (19%). The total 
cost of inappropriate prescription of IV-PPI was 585,167 Saudi Riyal (SAR) (156,044 
USD). Conclusion: There is a high tendency of IV-PPI’s inappropriate prescription 
in our hospital setting. This large-scale inappropriate prescription of IV-PPI in the 
hospital setting not only may lead to increased financial burden but also expose 
patients to number of undesired effects.

Abstract Challenges faced by non-COVID-19 patients with chronic illness are limitless 
during the lockdown period. These patients are mostly immunocompromised and 
vulnerable to infection. The worst affected would be chronic disease patients with 
lower household income. Patients’ fear of approaching medical facilities and also 
travel restrictions limit the patients to reach the healthcare team, and either of 
this leads to poor health outcome. Frequent communication with chronic disease 
patients by healthcare professionals is a key to encourage the patients to be 
adherent to the medications and manage their disease conditions.

Abstract Serotonin toxicity is a common but often unrecognized toxicological condition. In 
most cases, a combination of two or more serotonergic drugs can cause serotonin 
syndrome. We describe a case of serotonin toxicity in a 17-year-old woman, 
secondary to suicidal ingestion of 1000 mg lamotrigine and 400 mg citalopram, 
which has been rarely reported. Our patient had a medical history of depression and 
was treated with lamotrigine and citalopram. She was brought to the emergency 
room with nausea, diaphoresis, agitation, shivering, tremor, vertigo, ataxia, 
mydriasis, nystagmus, hyperreflexia, myoclonus, tachycardia, tachypnea, and mild 
fever. The symptoms and signs were resolved within 3 days following hydration, 
sedation, and cyproheptadine. Minor cardiovascular symptoms are probably due 
to the less toxic dose of citalopram. Lamotrigine, especially in combination with 
other serotonergic drugs, should be considered a cause of serotonin toxicity.

Abstract Selective serotonin reuptake inhibitors (SSRIs) are widely used in the treatment of 
many types of mental disorders. Citalopram is commonly used as a new generation 
of SSRIs in this regard; however, unfortunately, its overdose is associated with 
seizure and heart disorders. The reported case in the present study indicated 
recurrent seizures, nonspecific ST-T changes, and prolonged QT interval due to 
the overuse of citalopram. The patient had bilateral anterior shoulder dislocation 
along with right proximal humerus fracture that was occurred during the seizure. 
The dislocation was initially reduced and then fixed. Moreover, the seizure was 
controlled with diazepam without any problems, and cardiac monitoring continued 
for 2 days. Massive citalopram overdose may be associated with recurrent seizures 
and QT prolongation. Complications postseizures, such as shoulder dislocations, 
should be examined for and managed appropriately.

Abstract

Abstract

Abstract