Journal of Research in Pharmacy Practice

Abstract

Abstract Objective: Etomidate is an imidazole derivative and formulated in 35% propylene 
glycol. When given without a rapid lidocaine injection, etomidate is associated with 
pain after injection. Magnesium (Mg) is a calcium channel blocker and influences the 
N‑methyl‑D‑aspartate receptor ion channel. The aim of the study is to evaluate the efficiency 
of preemptive injection of magnesium sulfate and lidocaine on pain alleviation on etomidate 
intravenous injection.
Methods: In a randomized, double‑blinded trial study, 135 adult patients scheduled for 
elective outpatient or inpatient surgery were divided into three groups. Group M received 
620 mg magnesium sulfate, Group L received 3 ml lidocaine 1% and Group S received normal 
saline, all in a volume of 5 mL followed by a maximal dose of 0.3 mg/kg of 1% etomidate. 
Pain was assessed on a four‑point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain and 
3 = severe pain at the time of pretreatment and etomidate injection.
Findings: About 60% of patients in the control group had pain during etomidate 
injection as compared to 22.2% and 40% in the lidocaine and magnesium sulfate groups, 
respectively. There was difference in induction pain score between three treatment groups, 
significantly (P = 0.01) and observed differences in pain scores between “normal saline 
and lidocaine group” (P < 0.001) and “normal saline and magnesium sulfate groups” were 
statistically meaningful (P = 0.044).
Conclusion: Intravenous magnesium sulfate and lidocaine injection are comparably effective 
in reducing etomidate‑induced pain.

Abstract Objective: The aim of this study was to review the current methods of pharmaceutical 
purchasing by Iranian insurance organizations within the World Bank conceptual framework 
model so as to provide applicable pharmaceutical resource allocation and purchasing (RAP) 
arrangements in Iran.
Methods: This qualitative study was conducted through a qualitative document 
analysis (QDA), applying the four‑step Scott method in document selection, and conducting 
20 semi‑structured interviews using a triangulation method. Furthermore, the data were 
analyzed applying five steps framework analysis using Atlas‑ti software.
Findings: The QDA showed that the purchasers face many structural, financing, payment, 
delivery and service procurement and purchasing challenges. Moreover, the findings of 
interviews are provided in three sections including demand‑side, supply‑side and price and 
incentive regime.
Conclusion: Localizing RAP arrangements as a World Bank Framework in a developing 
country like Iran considers the following as the prerequisite for implementing strategic 
purchasing in pharmaceutical sector: The improvement of accessibility, subsidiary mechanisms, 
reimbursement of new drugs, rational use, uniform pharmacopeia, best supplier selection, 
reduction of induced demand and moral hazard, payment reform. It is obvious that for Iran, 
these customized aspects are more various and detailed than those proposed in a World 
Bank model for developing countries.

Abstract Objective: We aimed to investigate the frequency of seizure after acute carbamazepine 
poisoning and the important risk factors related to the outcomes of therapy.
Methods: In this two-year cross‑sectional study conducted in a University Hospital in 
Iran, 114 patients with acute carbamazepine poisoning were divided into two groups of 
with seizure (n = 8) and without seizure (n = 106) after intoxication. Demographic data, 
average amount of drug ingestion, time elapsed from ingestion to hospital admission, history 
of seizure before poisoning, mental status, visual disturbances and nystagmus, duration of 
hospitalization, the outcomes of therapy, arterial blood gas values and serum biochemical 
indices were compared between the two groups.
Findings: Patients with seizure had an estimated (Mean ± SD) ingestion of 14,300 ± 570 mg 
carbamazepine, which was significantly higher (P < 0.0001) than the seizure‑free 
group (4600 ± 420 mg). The estimated average time between drug ingestion and hospital 
admission in patients with seizure and the seizure‑free group were 515 ± 275 and 
370 ± 46 minutes, respectively (P < 0.0001). In this study, 104 out of the total number of 
patients had recovered without any complication. Need for respiratory support, including 
airway support or intubation were the most recorded complication. One patient died after 
status epilepticus and aspiration pneumonia.
Conclusion: The ingested amount of carbamazepine and the time elapsed from the 
ingestion of drug to hospital admission may influence the occurrence of seizure after acute 
carbamazepine poisoning; however, the outcome of supportive care in these patients seems 
to be positive.

Abstract Objective: Emergence agitation (EA), a short‑lived, self‑limiting phenomenon, arises 
frequently after the use of inhalational agents and hampers the implementation of pediatric 
ambulatory surgery in spite of using so many drugs with variable efficacy.
Methods: In this prospective, double‑blinded, parallel group study (2008–2009), 80 children 
of both sex aged 3–7 years, with American Society of Anesthesiologists (ASA) physical status 
grade I-II, undergoing sevoflurane‑based general anesthesia for elective day care surgery 
were randomly assigned into groups C or D. Group C received 4 µg/kg intranasal clonidine, 
whereas group D received 1 µg/kg intranasal dexmedetomidine, 45 min before induction of 
anesthesia. In postanesthesia care unit (PACU), the incidence of EA was assessed with Aonos 
four‑point scale and the severity of EA was assessed with pediatric anesthesia emergence 
delirium scale upon admission (T0), after 5 min (T5), 15 min (T15), and 25 min (T25). 
Extubation time, emergence time, duration of PACU stay, dose and incidence of fentanyl 
use for pain control were noted.
Findings: Based on comparable demographic profiles, the incidence and severity of EA 
were significantly lower in group D as compared to group C at T0, T5, T15, and T25. But 
time of regular breathing, awakening, extubation, and emergence were significantly delayed in 
group D than C. The number and dose of fentanyl used in group C were significantly higher 
than group D. PACU and hospital stay were quite comparable between groups.
Conclusion: Intranasal dexmedetomidine 1 µg/kg was more effective than clonidine 
4 µg/kg in decreasing the incidence and severity of EA, when administered 45 min before the 
induction of anesthesia with sevoflurane for pediatric day care surgery. Dexmedetomidine 
also significantly reduced fentanyl consumption in PACU.

Abstract Objective: Currently, the method of early nasal continuous positive airway pressure 
(nCPAP) and selective administration of surfactant via an endotracheal tube is widely used 
in the treatment of respiratory distress syndrome (RDS) in premature infants. To prevent 
complications related to endotracheal intubation and even a brief period of mechanical 
ventilation, in this study, we compared the effectiveness of surfactant administration via a 
thin intratracheal catheter versus the current method using an endotracheal tube.
Methods: Thirty eight preterm infants ≤34 weeks’ gestation with birth weight of 1000–1800 g 
who were putted on nCPAP for RDS within the first hour of life, were randomly assigned 
to receive surfactant either via endotracheal tube (ET group) or via thin intratracheal 
catheter (CATH group). The primary outcomes were the need for mechanical ventilation 
and duration of oxygen therapy. Data were analyzed by independent t-test, Mann–Whitney 
U-test, and Chi-square test, using SPSS v. 21.
Findings: There was no significant difference between groups regarding to need for 
mechanical ventilation during the first 72 h of birth (3 [15.8%] in ET group vs. 2 [10.5%] in 
CATH group; P = 0.99). Duration of oxygen therapy in CATH group was significantly lower 
than ET group (243.7 ± 74.3 h vs. 476.8 ± 106.8 h, respectively; P = 0.018). The incidence of 
adverse events during all times of surfactant administration was not statistically significant 
between groups (P = 0.14), but the number of infants who experienced adverse events during 
surfactant administration was significantly lower in CATH group than ET group (6 [31.6%] vs. 
12 [63.2%], respectively; P = 0.049). All other outcomes, including duration of treatment with 
CPAP and mechanical ventilation, times of surfactant administration and the need for more 
than one dose of the drug, the rate of intraventricular hemorrhage, mortality and combined 
outcome of chronic lung disease or mortality were statistically similar between the groups
Conclusion: Surfactant administration via thin intratracheal catheter in preterm infants 
receiving nCPAP for treatment of RDS has similar efficacy, feasibility and safety to its 
administration via endotracheal tube.

Abstract Objective: The aim of this study was to assess the knowledge, attitude and practice of 
B.Sc. Pharmacy students about usage and resistance of antibiotics in Trinidad and Tobago.
Methods: This was a cross‑sectional questionnaire‑based study involving B.Sc. Pharmacy 
students. The questionnaire was divided into five components including Demographics data, 
knowledge about antibiotic use, attitude toward antibiotic use and resistance, self‑antibiotic usage 
and possible causes of antibiotic resistance. Data were analyzed by employing Mann–Whitney 
and Chi‑square tests using SPSS version 20.
Findings: The response rate was 83.07%. The results showed good knowledge of antibiotic 
use among students. The overall attitude of pharmacy students was poor. About 75% of 
participants rarely use antibiotics, whereas self‑decision was the major reason of antibiotic 
use (40.7%) and main source of information was retail pharmacist (42.6%). Common cold and 
flu is a major problem for which antibiotics were mainly utilized by pharmacy students(35.2%).
Conclusion: The study showed good knowledge of pharmacy students regarding antibiotic 
usage. However, students’ attitude towards antibiotic use was poor. The study recommends 
future studies to be conducted with interventional design to improve knowledge and attitude 
of pharmacy students about antibiotic use and resistance.

Abstract