Journal of Research in Pharmacy Practice

Abstract

Abstract Cyclic nucleotide phosphodiesterases (PDEs) are known as a super‑family of enzymes 
which catalyze the metabolism of the intracellular cyclic nucleotides, cyclic‑3’,5’‑adenosine 
monophosphate (cAMP), and cyclic‑3’,5’‑guanosine monophosphate that are expressed in 
a variety of cell types that can exert various functions based on their cells distribution. The 
PDE4 family has been the focus of vast research efforts over recent years because this family 
is considered as a prime target for therapeutic intervention in a number of inflammatory 
diseases such as asthma, chronic obstructive pulmonary disease, and rheumatoid arthritis, 
and it should be used and researched by pharmacists. This is because the major isoform of 
PDE that regulates inflammatory cell activity is the cAMP‑specific PDE, PDE4. This review 
discusses the relationship between PDE4 and its inhibitor drugs based on structures, cells 
distribution, and pharmacological properties of PDE4 which can be informative for all 
pharmacy specialists.

Abstract Objective: Methicillin‑resistant Staphylococcus aureus (MRSA) ranks top among the 
nosocomial pathogens. Nasal formulation of mupirocin is found to eradicate MRSA from 
colonized individuals, but the emergence of resistant strains is a matter of concern.
Methods: Nasal swabs were collected from 200 health care workers (HCWs) who were 
screened for MRSA. Kirby–Bauer disc diffusion method was used to perform antibiotic 
susceptibility test. MRSA detection was done using a cefoxitin 30 µg disc and interpreted 
according to the Clinical and Laboratory Standards Institute guidelines. Determination of 
mupirocin resistance was performed using Epsilometer test (E‑test).
Findings: About 14% of HCWs showed nasal carriage of MRSA. Nursing orderlies were 
the predominant carriers. E‑test showed four mupirocin resistant isolates. The antibiogram 
of the MRSA isolates revealed the higher resistance to antibiotics as compared to 
methicillin‑sensitive Staphylococcus aureus. All the MRSA isolates were sensitive to linezolid.
Conclusion: HCWs in our hospital showed high nasal carriage rate of MRSA, particularly 
the nursing orderlies which is statistically significant. It is advisable to detect mupirocin 
resistance among the isolates obtained from the HCWs so that in case of resistance, 
alternative treatment should be sought.

Abstract Objective: In some medical circumstances, pediatric patients may need premedication for 
transferring to the operating room. In these situations, using intravenous premedication 
is preferred. We assessed the efficacy and safety of intravenous midazolam, intravenous 
ketamine, and combination of both to reduce the anxiety and improve behavior in children 
undergoing general anesthesia.
Methods: In a double‑blind randomized clinical trial, 90 pediatric patients aged 6 months 
to 6 years with American Society of Anesthesiologist grade I or II were enrolled. Before 
anesthesia, children were randomly divided into three groups to receive intravenous 
midazolam 0.1 mg/kg, or intravenous ketamine 1 mg/kg, or combination of half doses 
of both. Behavior types and sedation scores were recorded before premedication, after 
premedication, before anesthesia, and after anesthesia in the postanesthesia care unit. 
Anesthesia time, recovery duration, blood pressure, and heart rate were also recorded. For 
comparing distribution of behavior types and sedation scores among three groups, we used 
Kruskal–Wallis test, and for comparing mean and standard deviation of blood pressure and 
heart rates, we used analysis of variance.
Findings: After premedication, children’s behavior was significantly better in the combination 
group (P < 0.001). After anesthesia, behavior type was same among three groups (P = 0.421). 
Sedation scores among three groups were also different after premedication and the 
combination group was significantly more sedated than the other two groups (P < 0.001).
Conclusion: Combination of 0.05 mg/kg of intravenous midazolam and 0.5 mg/kg of 
intravenous ketamine as premedication produced more deep sedation and more desirable 
behavior in children compared with each midazolam 0.1 mg/kg or ketamine 1 mg/kg.

Abstract Objective: There is few data regarding the correlation between serum Vitamin D level 
and unfavorable intensive care unit (ICU) outcome in postsurgical patients. In this study, 
correlation between serum 25(OH)D level and length of ICU stay and in‑hospital mortality 
has been evaluated in critically ill surgical patients.
Methods: Serum 25(OH)D has been evaluated in 70 surgical, critically ill patients. 
Demographic, laboratory, and clinical data of the patients were collected. Correlation between 
serum 25(OH) D level and duration of ICU stay and hospital mortality was evaluated using 
two‑factor analysis of covariance. Multivariable Cox‑regression analysis was used for adjusting 
the effect of season of blood sampling and type of surgery on the main variables. For all 
the analyses, P values less than or equal to 0.05 were considered as statistically significant.
Findings: Serum 25(OH)D deficiency was identified in 52 (74.3%) of the patients. Patients 
with serum Vitamin D levels < 30 ng/ml had longer length of ICU stay than those with 
serum Vitamin D levels ≥ 30 ng/ml (7.8 ± 5.1 vs. 4.05 ± 2.12 days, P = 0.003). Although 
hospital mortality was more common in Vitamin D deficient patients than sufficient ones 
(25% in deficient group versus 22.2% in sufficient group), there was no significant difference 
regarding hospital mortality rate between the groups.
Conclusion: Statistically significant association was found between low 25(OH)D level 
and increased length of ICU stay in critically ill surgical patients. It could be explained by 
favorable effects of Vitamin D on immune system functions, reducing tissue dysfunction, and 
risk of organ failure and overall complications. However, there was no correlation between 
serum Vitamin D level and patients’ in‑hospital mortality. Further, well‑designed prospective 
clinical studies with adequate sample size are needed to evaluate correlation between serum 
Vitamin D level and mortality in critically ill patients.

Abstract Objective: In the past decades economic sanctions have been used by different countries 
or international organizations in order to deprive target countries of some transactions. 
While the sanctions do not target health care systems or public health structures, they 
may, in fact, affect the availability of health care in target countries. In this study, we used 
media analysis to assess the impacts of recent sanctions imposed by the Central Bank of 
Iran in 2012 on access to medicines in Iran.
Methods: We searched different sources of written news media including a database of 
nonspecialized weeklies and magazines, online news sources, web pages of daily newspapers 
and healthcare oriented weeklies from 2011 to 2013. We searched the sources using the 
general term “medicine” to reduce the chances of missing relevant items. The identified news 
media were read, and categorized under three groups of items announcing “shortage of 
medicines,” “medicines related issues” and “no shortage.” We conducted trend analyzes to 
see whether the news media related to access to medicines were affected by the economic 
sanctions.
Findings: A total number of 371 relevant news media were collected. The number of news 
media related to medicines substantially increased in the study period: 30 (8%), 161 (43%) 
and 180 (49%) were published in 2011, 2012 and 2013, respectively. While 145 (39%) of 
media items referred to the shortage of medicines, 97 (26%) reported no shortage or 
alleviating of concerns.
Conclusion: Media analysis suggests a clear increase in the number of news media reporting 
a shortage in Iran after the sanctions. In 2013, there were accompanying increases in the 
number of news media reporting alleviation of the shortages of medicines. Our analysis 
provides evidence of negative effects of the sanctions on access to medicines in Iran.

Abstract Objective: Acute myocardial infarction (AMI) is one of the main leading causes of mortality 
and morbidity. Reteplase is a fibrin‑specific thrombolytic which is used in the treatment 
of AMI. There is a limited number of studies reporting the postmarketing adverse drug 
reactions (ADRs) induced by reteplase. This study was aimed to examine the reteplase 
pattern of ADR and its associated risk factors in patients with acute ST‑elevation myocardial 
infarction.
Methods: A cross‑sectional, prospective study in an 8‑month period was done at the 
University affiliated referral cardiovascular center. The Naranjo probability scale and World 
Health Organization criteria for severity of ADRs were used for assessing the ADRs. The 
linear regression and logistic regression tests were used to evaluate the correlation between 
ADRs and risk factors.
Findings: The all 20 patients who received reteplase during the study period were entered. 
The majority of patients (n = 17) experienced at least one ADR. The results showed that 
the incidence of ADRs was mainly associated with gender and age, and the number of ADRs 
was associated with the history of diabetes and taking anti‑diabetic agents. The gender was 
the main predictor in the occurrence of ADRs (odds ratio: 32, 95% confidence interval: 
1.38–737.45; P = 0.030).
Conclusion: The results showed that gender, age, diabetes mellitus, and using of anti‑diabetes 
medications are the risk factors associated with the incidence of ADRs by reteplase.

Abstract Objective: Adverse drug reactions (ADRs) are known as a cause of hospital admission. We 
have carried out a prospective study to characterize and assess the frequency, probability, 
preventability, and severity of ADRs, which lead to hospital admission in children.
Methods: In a prospective observational study, a cohort of children admitted to a tertiary 
pediatric hospital was randomly screened to assess ADR as the cause of admission from June 
2014 to January 2015. ADRs causing admissions were detected based on patients’ records, 
interviewing their parents, and confirmation by medical team. The probability of the ADRs 
was assessed based on WHO criteria and Naranjo tool. The preventability assessment was 
performed using Schumock and Thornton questionnaire.
Findings: Of the 658 evaluated emergency admissions, 27 were caused by an ADR giving 
an incidence of 4.1%. Among ADRs, 37.1% were estimated to be preventable. Antibiotics 
were the most common medication class which caused hospital admission.
Conclusion: Pediatric pharmacotherapy still needs evidence‑based strategies to improve 
child care including education, monitoring, planning for medications after ADR occurrence, 
and implementing preventive measures when applicable.

Abstract Objective: This study was aimed to determine the prevalence of drug‑related 
problems (DRPs), identify the most common drugs, and drug classes involved in DRPs as 
well as associated factors with the occurrence of DRPs.
Methods: A prospective cross‑sectional study was conducted on 225 patients admitted to 
medical wards of Tikur Anbessa Specialized Hospital, Addis Ababa from March to June 2014. Data 
regarding patient characteristics, medications, diagnosis, length of hospitalization, investigation, 
and laboratory results were collected using data abstraction forms through review of patients’ 
medical card and medication charts. Identified DRPs were recorded and classified using DRP 
registration forms. The possible intervention measures for the identified DRPs were proposed 
and communicated to either the physician or the patient. Data were entered into Epi Info 
7 and analyzed using SPSS version 21 (IBM Corp. Released 2012, Armonk, NY: IBM Corp).
Findings: DRPs were found in 52% of study subjects. A drug‑drug interaction (48% of all DRPs) 
was the most common DRP followed by adverse drug reaction (23%). Anti‑infectives and 
gastrointestinal medicines were commonly involved in DRPs. Drugs with the highest drug 
risk ratio were gentamycin, warfarin, nifedipine, and cimetidine. The number of drugs taken 
by the patient per day is an important risk factor for DRPs.
Conclusion: DRPs are common among medical ward patients. Polypharmacy has a significant 
association with the occurrence of DRP. Drugs such as gentamycin, warfarin, nifedipine, and 
cimetidine have the highest probability of causing DRP. So, patients who are taking either 
of these drugs or polypharmacy should be closely assessed for identification and timely 
correction of DRPs.

Abstract Objective: The inappropriate use of antibiotics remains the primary factor in antimicrobial 
drug resistance. In this study, we evaluate the use of meropenem in surgical/medical wards 
of Imam Khomeini Tertiary Referral Hospital, Sari, Iran.
Methods: This retrospective observational study was used to assess rational use of 
meropenem. The study was conducted by reviewing medical records of 100 admitted patients 
who received meropenem during March 2013 to January 2014.
Findings: Meropenem was prescribed most frequently in Intensive Care Unit (22%), and 
pneumonia was the most common diagnosis(35%). The third‑generation cephalosporins were 
the most frequently prescribed antimicrobials after meropenem (53%). In 21% of the patients, 
imipenem was changed to meropenem. Most of the inappropriate uses were seen in terms 
of frequency of meropenem use (34%), followed by duration of meropenem therapy (28%).
Conclusion: Comparing our study results has shown higher inappropriate use. It is necessary 
to take action to improve prescribing habit in order to reduce the unnecessary usage of 
antibiotic thus enhance rational antibiotic use.