Journal of Research in Pharmacy Practice

Abstract

Abstract Objective: Antipsychotic medications are the frontline treatment for the most psychotic 
disorders. The aim of this study is to compare the onset of action of the first and second 
generation antipsychotics and the rate of their side‑effects in the treatment of acute 
psychosis.
Methods: In a double‑blind, controlled clinical trial, 40 acute psychotic patients were 
randomly allocated in four groups and treated with each of the four antipsychotics: 
olanzapine, risperidone, haloperidol or thiothixene. The onset of action of each drug 
was assessed by the Positive and Negative Symptoms Scale. The data were analyzed by 
Wilcoxon (Gehan) survival and Log Rank analysis, using SPSS version 20.0.
Findings: Initial response was observed in 97.5% (N = 39) of subjects during 2 weeks of 
intervention. The mean time to the first response was 6.15 ± 2.9 days and this was significantly 
shorter for risperidone than others. The most common side‑effects were sedation and 
drug induced Parkinsonism.
Conclusion: Risperidone represented shorter onset of action for the treatment of acute 
psychotic symptoms compared with olanzapine, haloperidol and thiothixene.

Abstract Objective: Incomplete medication histories obtained on hospital admission are responsible 
for more than 25% of prescribing errors. This study aimed to evaluate whether pharmacy 
technicians can assist hospital physicians’ in obtaining medication histories by performing 
medication reconciliation and prescribing reviews. A secondary aim was to evaluate whether 
the interventions made by pharmacy technicians could reduce the time spent by the nurses 
on administration of medications to the patients.
Methods: This observational study was conducted over a 7 week period in the geriatric 
ward at Odense University Hospital, Denmark. Two pharmacy technicians conducted 
medication reconciliation and prescribing reviews at the time of patients’ admission to the 
ward. The reviews were conducted according to standard operating procedures developed 
by a clinical pharmacist and approved by the Head of the Geriatric Department.
Findings: In total, 629 discrepancies were detected during the conducted medication 
reconciliations, in average 3 for each patient. About 45% of the prescribing discrepancies 
were accepted and corrected by the physicians. “Medication omission” was the most 
frequently detected discrepancy (46% of total). During the prescribing reviews, a total of 860 
prescription errors were detected, approximately one per medication review. Almost all of 
the detected prescription errors were later accepted and/or corrected by the physicians. 
“Dosage and time interval errors” were the most frequently detected error (48% of total). 
The time used by nurses for administration of medicines was reduced in the study period.
Conclusion: This study suggests that pharmacy technicians can contribute to a substantial 
reduction in medication discrepancies in acutely admitted patients by performing medication 
reconciliation and focused medication reviews. Further randomized, controlled studies 
including a larger number of patients are required to elucidate whether these observations 
are of significance and of importance for securing patient safety.

Abstract Objective: Suicide is the second major reason of death in the age range of 15‑24 and is the 
eighth reason for overall death of adults. Because of high accessibility of people to different 
medications in our society, one of the easiest ways for suicide is intentional self‑poisoning 
with medications. Therefore, the aim of this study was to determine the rate of suicide with 
respect to influencing social factors on patients with intentional self‑poisoning.
Methods: This was an analytic‑descriptive prospective study. All study data were collected 
through a checklist in patients with intentional self‑poisoning who had been referred to 
referral hospital within 2011‑2012.
Findings: A total of 400 patients (60% female) were evaluated. Age average ± standard 
deviation of participants was 22.57 ± 9.20 years. About 78.2% had high school degree or 
less. Nearly 27.8% of all happened suicides take place as a result of family disputes, marital 
problems (21%) and poverty (11.5%). Love issues with a rate of 10.3% were set in the next 
step. About 23.2% had a history of a past psychological disorder. Around 97.5% of the patients 
survived. The shorter the time of hospitalization is for each patient, the better survival rate 
is obtained through post‑suicidal medical care. A statistically meaningful relationship was 
observed between self‑poisoning to commit suicide and absence of academic education 
(P = 0.02).
Conclusion: Suicide attempt through self‑poisoning is more common in female, married 
individuals, people without academic education and those with a poor socio‑economic status. 
Furthermore, results announce family disputes as the most pre‑disposing factor for suicide.

Abstract Objective: Chronic myeloid leukemia (CML) is a clonal hematopoietic disorder caused 
by acquired genetic defect in pluripotent stem cells characterized by acquisition of the 
philadelphia chromosome. The aim of this study was to compare the efficacy, safety and 
quality of life (QoL) in CML patients treated with imatinib or hydroxyurea.
Methods: A prospective observational study was conducted on 40 patients with 
pathologically confirmed CML in an in‑patient department of Mahavir Cancer Sansthan 
and Research Centre (tertiary care cancer hospital) in India. Patients were divided 
into two groups (group A: Imatinib consuming patients and group B: Hydroxyurea 
consuming patients). Complete blood count was done every month to assess the efficacy 
and safety/toxicity profile of these drugs. The results were analyzed 12 months after 
completion of treatment. QoL was assessed by The European Organization for Research 
and Treatment of Cancer QoL Questionnaire core 30. Hematological response was 
analyzed using kaplan‑meier survival analysis. Chi‑square test was applied to assess the 
association of two regimens with complete hematological response, hematological and 
non‑hematological toxicity. White blood cell (WBC) was noted each month in every 
patient of each group and analyzed by generalized linear mode (repeated measures) 
analysis of variance (ANOVA). Independent t‑test was used to compare changes in QoL 
between treatment groups.
Findings: At the end of treatment, significant improvement (P = 0.001) in hematological 
response was observed in the group A (95%) compared to group B (30%). WBC count 
analyzed at each month of treatment by ANOVA achieved better results for patients 
treated with imatinib (P = 0.0001). The hematological toxicity was higher in imatinib 
group while non‑hematological toxicity was higher in the hydroxyurea group; however 
only little toxicities such as nausea and constipation were statistically significant. QoL 
assessment of patients related to functional scale showed significantly better results in 
group A (P = 0.046).
Conclusion: The study showed that imatinib has better profile compared to hydroxyurea, 
with siginificant statistical differences in terms of efficacy, non‑hematological toxicity and 
QoL in CML patients. Even with such better efficacy and safety profile, pharmacoeconomic 
evaluation needs to be done to justify and support the use of imatinib for CML patients 
in India.

Abstract Objective: Asthma as the most common chronic disease in childhood reduces the quality 
of life of children and their families. We aimed to estimate the cost of managing childhood 
asthma in Iran and to examine its variability depending on asthma severity.
Methods: The cost of asthma was estimated by building a cost assessment model regarding 
the factors that influence the cost of asthma in children including age and sex distribution, 
prevalence of disease severity, level of resource utilization depending on disease severity 
(3 groups of controlled, partly controlled and uncontrolled were defined). The model was 
comprised of both medical (cost of medication, physician visit and respiratory tests) and 
non-medical (transportation and hoteling) costs. Furthermore, the average family income in 
each category was figured and the share of asthma managing costs from the average income 
was calculated in different groups.
Findings: According to model, the total cost of childhood asthma in Iran was around 
516.5 million dollars. Moreover, direct medical cost represented 49% of the total costs, 
among which 66% accounting for medication cost. Direct non-medical costs were estimated 
51% with the majority (93%) expended on transportation. In addition, the mean annual cost 
per child was approximately 466 dollars. In addition, the results indicate the vast majority 
of patients (46%) are categorized in the uncontrolled group.
Conclusion: The cost of childhood asthma in Iran is extremely high comparing to the 
average income of Iranian families in all categories of asthma severity. Considering the high 
amount of transportation cost, the accessibility of asthma treatment does not appear to 
be acceptable. The major source of costs is found to be related to medicine expenditure. 
Since it has been proven that using medicine does not necessarily result in a well-controlled 
disease status, alternative approaches should be considered in asthma management.

Abstract Fixed drug eruption (FDE) is an unusual adverse effect of any drug, especially antibiotics like 
clarithromycin. Herein we report a case of clarithromycin induced FDE in a 30‑year‑old man 
who presented with recurrent erythematous and pruritic cutaneous lesions on the lower 
lip, right hand and left thigh. The lesions were initially misdiagnosed as lichen planus and 
treated with topical steroids. Each recurrence was at the same site and the lesions faded 
within 2 weeks leaving behind violacceous pigmentation. All the cutaneous lesions were 
reproduced following an oral provocation test thus confirming the diagnosis of clarithromycin 
induced FDE, which is a rare occurrence. When it does occur, it is often misdiagnosed, so 
physicians should be aware of this condition in order to prevent future recurrences as it 
causes a lot of cosmetic and physical discomfort to the patient.