Journal of Research in Pharmacy Practice

Abstract

Abstract A rough 24-hour cycle driven endogenously in biochemical, physiological or behavioral 
processes is called circadian rhythm. Chronobiology is the study of biological temporal 
rhythms. For decades, we know that the biological rhythm and the drug metabolism are also 
affected from daylight and chronopharmacology became recognized by scientists in the early 
1970s. Its lateral branch chronocopharmacokinetics is the study of rhythmic, predictablein-time differences in the pharmacokinetics of drugs. Chronopharmacokinetic studies are 
performed at every step of the biotransformation i.e., absorption, distribution, metabolism 
and excretion. Feeding schedules, sex and phenotype must be taken into consideration while 
applying pharmacotherapy to increase the efficiency and to decrease side effects. The impact 
of drugs on circadian rhythm should be not neglected. On the other hand, new special drug 
delivery systems can be used to synchronize drug concentrations according to circadian 
rhythms. “Chronopharmaceuticals” can identify the proper dosing time and this amelioration 
will lead to improved progress and diffusion of pharmacotherapy. Chronopharmaceuticals 
coupled with nanotechnology could be the future of drug delivery systems, and lead to 
safer and more efficient disease therapy in the future. In this review, we will discuss the 
pharmacokinetic effects of circadian rhythm and its toxicological outcomes. Besides, we will 
try to give some practical points for clinical pharmacist/pharmacy practitioners, concerning 
chronopharmacokinetics.

Abstract Medication errors (ME) and adverse drug reactions still continue to be the important 
factors for out- and in-patient treatments. MEs are critical troubles in all hospitalized 
populations that can increase length of hospital stay, expenses, mortality and morbidity. In 
many countries, clinical pharmacists have been involved in reducing MEs from years ago. 
A growing body of evidence suggests that pharmacist interventions have major impact on 
reducing MEs in pediatric patients, thus improving the quality and efficiency of care provided. 
This paper presents a literature review on the role of clinical pharmacists in reducing MEs, 
and underscores the importance of pharmacist-physician-patient collaboration for all patients 
notably in the pediatric age group.

Abstract Objective: There is a great recognition that store interiors and exteriors can be designed 
to create feelings in potential customers which can have an important reinforcing effect 
on purchase. In this study it is mainly aimed to explore the behaviors of the community 
pharmacists related to their store’s physical environment. Also we aimed to determine 
whether any difference exist between behaviors of pharmacists serving in high and low 
socio-economic regions.
Methods: A total of 200 pharmacists that work socio-economically different regions were 
randomly selected from 1424 pharmacists registered in Ankara Chamber of Pharmacists. 
A uniform questionnaire was applied to the pharmacists by using a face-to-face interview 
technique.
Findings: There are differences in terms of behavior between the pharmacists serving in high 
and low socio-economic regions within the context of putting importance to their stores’ 
atmosphere. More pharmacists attach importance to the physical sight of their pharmacy 
serving in high socio-economic regions (90%) vs. pharmacists in low socio-economic regions 
(70%). Also pharmacists in high socio-economic regions indicated higher importance level 
of selection of the decoration equipments (84%) than pharmacists serving in high socioeconomic regions (60%).
Conclusion: Our study suggests that some pharmacists pay more attention to interior 
atmospheric elements and others do not. There is a difference in terms of attaching 
importance to some store atmospheric elements (i.e. physical site, decoration equipment, 
it’s color, wall color, etc.) serving in high versus low socio-economic regions in this context.

Abstract Objective: Synergistic effect between commonly used antibiotics against nosocomial 
multidrug-resistant strains of Staphylococcus aureus, if present, could provide a viable 
option as an alternative therapy for infections due to this pathogen. The aim of this study 
was searching for any synergistic effect between several antibiotics against drug-resistant 
strains of S. aureus with nosocomial origin using double-disk synergy test and to determine 
the applicability of this test for such a purpose.
Methods: Over a 6-month period, strains of S. aureus isolated from clinical specimens 
of hospitalized patients with documented nosocomial infection underwent disk diffusion 
test using antibiotic disks of oxacillin, cephalothin, clindamycin, ciprofloxacin, vancomycin, 
cotrimoxazole, rifampin, erythromycin, gentamicin and meropenem. Double-disk synergy test 
was performed for all isolates resistant to at least two of applied antibiotics. Combinations 
of all possible pairs of antibiotics (to which the microorganism was resistant) were tested 
by placing antibiotic disks at distance of 20 mm from each other (center to center). After 
16-20 hours of incubation, if synergistic effect was present among two antibiotics, an inhibition 
zone was formed between their disks.
Findings: Among all of possible two-antibiotic combinations tested for 41 resistant isolates, 
only two cases of synergistic effect were detected; both effects were among rifampin and 
cotrimoxazole.
Conclusion: The combination of rifampin and cotrimoxazole could provide a viable option 
for treatment of infections due to resistant strains of S. aureus; however, clinical trials are 
needed before any new recommendation. Also, double-disk synergy test seems to be capable 
of detecting the synergistic effect between antibiotics at in vitro level.

Abstract Objective: It is well known that a brief exposure to 100% oxygen for only a few minutes 
could be toxic for a preterm infant. The effectiveness of neonatal resuscitation was compared 
with low concentration oxygen (30%) and high concentration oxygen (HOG) (100%).
Methods: Thirty-two preterm neonates were born in Isfahan Shahid Beheshti hospital 
with gestational age of 29-34 weeks who required resuscitation were randomized into 
two groups. The resuscitation was begun with 30% O2 in low concentration oxygen group 
(LOG). The infants were examined every 60-90 seconds and if their HR was less than 100, 
10% was added to the previous FIO2
 (fraction of inspired oxygen) until the HR increased 
to 100 and SO2
 (saturation of oxygen) increased to 85%. In HOG resuscitation begun with 
100% O2
 and every 60-90 seconds, FIO2
 was decreased 10 – 15% until the HR reached to 
100 and SO2
 reached to 85%.
Findings: The FIO2
 in LOG was increased stepwise to 45% and in HOG was reduced to 
42.1% to reach stable oxygen saturation more than 85% at the fifth minute in both groups. 
At the first and third minutes after birth and there was no significant differences between 
groups in heart rate and after 1,2,4 and 5 minutes after the birth there was also no significant 
differences in SO2
 between groups, regardless of the initial FIO2
.
Conclusion: We can safely initiate resuscitation of preterm infants with a low FIO2
(approximately 30%) oxygen and then oxygen should be adjusted with the neonates needs.

Abstract Objective: About 73% of death cases in the first 5 days after burning are due to infection 
complications. The aim of this study was to identify the causing agents of infections in burn 
patients and the sensitivity pattern of them to the commonly used antimicrobials in an 
Iranian Burn center University Hospital.
Methods: In this cross-sectional study, patients who were admitted to one of the Iranian 
Burn center University hospitals in 2009 and had nosocomial infection due to burn wound, 
whom received antimicrobial agents for therapeutic reasons, with a hospitalization period of 
more than 48 hours were enrolled. Gram stain analyses were performed to help identifying 
growing colonies. Differential tests for identification of pathogenic bacteria species were 
performed following primary tests. E-test strips of each antimicrobial were placed on the 
culture medium plate in order to determine the minimum inhibitory concentration Studied 
antimicrobials for isolated Gram-negative bacteria were meropenem, piperacillin/tazobactam, 
ceftriaxone, cotrimoxazole, and for Staphylococcus aureus, vancomycin, piperacillin/
tazobactam, cotrimoxazole, and cephalothin.
Findings: Only 16% of Pseudomonas aeruginosa species were sensitive to meropenem, and 
13% were sensitive to piperacillin/tazobactam. Ten out of 29 Klebsiella species (34%) were 
sensitive to meropenem and piperacillin/tazobactam. All isolated strains of Staphylococcus 
aureus were sensitive to vancomycine while they were all resistant to cotrimoxazole.
Conclusion: Pseudomona, Klebsiella and Staphylococcoci are the most common species 
causing burn infection in this medical center. Results showed the importance of limiting 
irrational use of wide-spectrum antimicrobials and recommends strict management of 
infections in burn injury centers.

Abstract Objective: Coronary artery disease is one of the leading causes of morbidity and mortality 
in populations. In opium abusers, level of circulating coagulation factors differs from nonabusers. The aim of this study was to evaluate response to thrombolytic therapy in opium 
abusers vs. non-abusers.
Methods: In this prospective observational study, 83 patients (36 opium abusers and 47 nonabusers) with AMI were evaluated for the presence and degree of response to thrombolytic 
agent. All patients were monitored for electrocardiographic changes and response to 
thrombolysis 2 hours before and after administration of thrombolytic agent. Serum CPK 
and LDH were measured 2 hours before and after thrombolysis. Quantitative and qualitative 
data were analyzed by independent t-test and chi-square using SPSS, respectively.
Findings: ST-resolution 2 hours after thrombolysis was 63.8% and 44.4% in opium users and 
non-users, respectively. Serum level of CPK cardiac biomarker 2 hours after thrombolysis 
was 980 ± 245 and 847 ± 130 IU/L in opium users and non-users, respectively.
Conclusion: Our data demonstrate that in those patients with opium abuse, 
electrocardiographic changes after thrombolysis were significantly lower than opium nonusers (P < 0.05). Opium users showed better ST-resolution compared with non-users. Opium 
addiction had effect on cardiac enzymes despite their effect on response to streptokinase.

Abstract Enteral feeding tube is employed for feeding of critically ill patients who are unable to eat. 
In the cases of oral medication administration to enterally fed patients, some potential 
errors could happen. We report a 53-year-old man who was admitted to intensive care 
unit (ICU) of a teaching hospital due to the post-CPR hypoxemic encephalopathy. The 
patient was intubated and underwent mechanical ventilation. A nasogastric (NG) tube 
was used as the enteral route for nutrition and administration of oral medications. Oral 
medications were crushed then dissolved in tap water and were given to the patient 
through NG tube. In present article we report several medication errors occurred during 
enterally drug administration, including errors in dosage form selection, methods of oral 
medication administration and drug interactions and incompatibility with nutrition formula. 
These errors could reduce the effects of drugs and lead to unsuccessful treatment of 
patient and also could increase the risk of potential adverse drug reactions. Potential 
leading causes of these errors include lack of drug knowledge among physicians, inadequate 
training of nurses and lack of pharmacists participation in medical settings.