Assessment of Interactions of Drugs Prescribed for Pediatric Patients in Bangladesh

2021 ◽  
Vol 24 (2) ◽  
pp. 91-98
Author(s):  
Shahela Ahmed ◽  
Saquiba Yesmine ◽  
Mizanur Rahman ◽  
Masum Shahriar
Keyword(s):  
Drug Interactions ◽  
Pediatric Patients ◽  
Clinical Problem ◽  
Pharmaceutical Journal ◽  
Demographic Characteristics ◽  
Unknown Mechanism ◽  
Pharmacodynamic Interactions ◽  
Drug History ◽  
Important Clinical Problem ◽  
Proactive Monitoring

Drug-drug interactions (DDIs) represent an important clinical problem. During inpatient admissions, infants, children, and adolescents are typically exposed to different medications, increasing their risk of potential drug-drug interactions (pDDIs). While drug interactions are reported to be common, there are only few publications of the prevalence of such interactions among pediatric patients in Bangladesh. The present study tries to estimates the prevalence and characteristics of pDDI exposure of pediatric patients treated in children’s hospitals. This observational retrospective study was carried out on 155 patients admitted to a children’s hospital located at Dhaka during January 2019 to August 2019. The medications of the patients were analyzed for pDDIs by using Medscape drug interaction checker. The prescriptions were analyzed for demographic characteristics, medical and detailed drug history. Drug-drug interactions (DDIs) were evaluated for total numbers, types and severity of DDIs. Total 155 prescriptions with mean age 2.12±2.08 years were analyzed and a total of 25 pDDIs were recorded. The prevalence of pDDI was 17%, of which 12 (48%) were pharmacodynamic interactions, 10 (40%) were pharmacokinetic interactions and 3 (12%) of unknown mechanism. According to the severity of interaction, 4 (18%) cases were categorized as serious, 15 (55%) cases as moderate and 6 (27%) cases as minor. The occurrence of DDIs were significantly associated (r=0.912, p<0.05) with the number of drugs prescribed. The present study has identified pDDIs and also documented interactions in pediatrics patients. It has highlighted the need for screening prescriptions of pediatric patients for pDDIs and proactive monitoring of patients who have identified risk factors in order to promote detection and prevention of possible adverse drug interactions. Bangladesh Pharmaceutical Journal 24(2): 91-98, 2021

scholarly journals Potential drug-drug interactions in the psychiatric hospital: Frequency analysis

2019 ◽  
Vol 5 (4) ◽  
pp. 1-6
Author(s):  
Oleg O. Kirilochev ◽  
Inna P. Dorfman ◽  
Adelya R. Umerova ◽  
Svetlana E. Bataeva
Keyword(s):  
Drug Interactions ◽  
Clinical Significance ◽  
Psychiatric Hospital ◽  
Psychiatric Inpatient ◽  
Clinical Problem ◽  
Drug Combinations ◽  
Drug Prescriptions ◽  
Inpatient Setting ◽  
Potential Drug ◽  
Important Clinical Problem

Introduction: Drug-drug interactions are an important clinical problem in pharmacotherapy. This study is focused on different types of drugs used in a psychiatric hospital. Materials and methods: The pharmacoepidemiological study included the analysis of medical records of 500 psychiatric inpatients. The patients were divided into 2 groups: under 65 and over 65 years of age. All the drug prescriptions were analyzed to identify the combinations of drugs that can induce drug-drug interactions and determine their clinical significance. Results and discussion: Over 77% of hospitalized patients were administered drug combinations that could induce drug-drug interactions, most of which were of moderate clinical significance. A reliable association was found between the patient’s age, the clinical significance of drug-drug interactions, and the pharmacotherapy structure. The most common irrational drug combinations were identified. Conclusion: Timely analysis of drug prescriptions for potential drug-drug interactions can enhance the safety of pharmacotherapy and decrease the risk of adverse drug reactions in the psychiatric inpatient setting.

scholarly journals Late Protective Effect of Netrin-1 in the Murine Acetaminophen Hepatotoxicity Model

2020 ◽  
Vol 175 (2) ◽  
pp. 168-181 ◽  
Author(s):  
Luqi Duan ◽  
Benjamin L Woolbright ◽  
Hartmut Jaeschke ◽  
Anup Ramachandran
Keyword(s):  
Liver Injury ◽  
Alanine Aminotransferase ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Clinical Problem ◽  
The United States ◽  
Therapeutic Window ◽  
Protective Effects ◽  
Apap Overdose ◽  
Important Clinical Problem

Abstract Acetaminophen (APAP) overdose-induced acute liver failure is an important clinical problem in the United States and the current antidote N-acetylcysteine, has a short early therapeutic window. Since most patients present late to the clinic, there is need for novel late-acting therapeutic options. Though the neuronal guidance cue netrin-1, has been shown to promote hepatic repair and regeneration during liver ischemia/reperfusion injury, its effect in APAP-induced hepatotoxicity is unknown. In the quest for a late-acting therapeutic intervention in APAP-induced liver injury, we examined the role of netrin-1 in a mouse model of APAP overdose. Male C57BL/6J mice were cotreated with exogenous netrin-1 or vehicle control, along with 300 mg/kg APAP and euthanized at 6, 12, and 24 h. Significant elevations in alanine aminotransferase indicative of liver injury were seen in control mice at 6 h and this was not affected by netrin-1 administration. Also, netrin-1 treatment did not influence mitochondrial translocation of phospho-JNK, or peroxynitrite formation indicating that there was no interference with APAP-induced injury processes. Interestingly however, netrin-1 administration attenuated liver injury at 24 h, as seen by alanine aminotransferase levels and histology, at which time significant elevations in the netrin-1 receptor, adenosine A2B receptor (A2BAR) as well as macrophage infiltration was evident. Removal of resident macrophages with clodronate liposomes or treatment with the A2BAR antagonist PSB1115 blocked the protective effects of netrin-1. Thus, our data indicate a previously unrecognized role for netrin-1 in attenuation of APAP hepatotoxicity by enhancing recovery and regeneration, which is mediated through the A2BAR and involves resident liver macrophages.

scholarly journals Biomarkers of Carotid Stenosis

2021 ◽  
Vol 3 (1) ◽  
pp. 104-130
Author(s):  
Sergey G. Sсherbak ◽  
Tatyana A. Kamilova ◽  
Svetlana V. Lebedeva ◽  
Dmitry A. Vologzhanin ◽  
Alexander S. Golota ◽  
...  
Keyword(s):  
Matrix Metalloproteinases ◽  
Carotid Stenosis ◽  
Plaque Rupture ◽  
Early Recognition ◽  
Clinical Problem ◽  
Vascular Wall ◽  
Inflammatory Factors ◽  
Atherosclerotic Lesions ◽  
Important Clinical Problem ◽  
Definition Of

Early recognition of rupture-prone atherosclerotic lesions in patients with high-graded carotid stenosis is an important clinical problem for preventing ischemic stroke. Various pathophysiological mechanisms are responsible for the progression and instability of plaques, such as changes in lipid composition, infiltration by immunoinflammatory cells and degradation of the extracellular matrix of the vascular wall by matrix metalloproteinases, enhanced inflammatory response and plaque neovascularization. These features are the main cause of plaque rupture and, as a consequence, neurologic symptoms. Therefore, matrix metalloproteinases and inflammatory factors can serve as possible markers for patients with severe unstable stenosis of carotid arteries. Due to the heterogeneity of atherosclerotic lesions, only one biomarker is not enough to reliably predict the development of a stroke. The use of a combination of biomarkers is better correlated with clinical data and, therefore, exceeds the analysis of individual factors. To increase the overall sensitivity and specificity and more reliable diagnosis of stroke in patients with symptomatic and asymptomatic carotid stenosis, the biomarker panel should include independent biomarkers. Further preclinical experiments and clinical trials are needed to assess the significance and precise definition of the threshold levels of such biomarkers before they can be used in clinical practice.

scholarly journals Epidemiology of Polypharmacy and Potential Drug–Drug Interactions Among Pediatric Patients in ICUs of U.S. Children’s Hospitals*

2016 ◽  
Vol 17 (5) ◽  
pp. e218-e228 ◽  
Author(s):  
Dingwei Dai ◽  
James A. Feinstein ◽  
Wynne Morrison ◽  
Athena F. Zuppa ◽  
Chris Feudtner
Keyword(s):  
Drug Interactions ◽  
Pediatric Patients ◽  
Potential Drug ◽  
Children's Hospitals ◽  
Children’S Hospitals

Psychopharmacologic Treatment Issues in AIDS Psychiatry

2010 ◽  
Author(s):  
Kelly L. Cozza ◽  
Harold W. Goforth
Keyword(s):  
Drug Interactions ◽  
Receptor Site ◽  
Metabolic Enzymes ◽  
Hiv And Aids ◽  
Pharmacodynamic Interactions ◽  
Introductory Overview ◽  
Full Explanation ◽  
Metabolic Interactions ◽  
The Subject ◽  
Hiv Aids

Persons with HIV and AIDS are often prescribed a plethora of medications, all of which require special attention and are based on well-defined principles. In the first part of this chapter, Drug Interaction Principles, we provide a short but essential review of these principles in order to prepare the reader to critically weigh the potential for drug interactions between psychotropics and antiretroviral therapy (ART) and those between ART and other medications. In the second part, Psychotropics and HIV, a brief review of the available literature on the effectiveness of psychotropics in treating patients with HIV is provided, followed by an overview of issues relating to drug interactions for each psychotropic or class of psychotropic. The third part of the chapter, Antiretrovirals, provides an introductory overview of currently available antiretrovirals and of medications prescribed in treating HIV/AIDS. Readers are referred to an excellent review of pharmacological treatment for persons with addictions and HIV/AIDS, by Wynn and colleagues (2005), and to Chapters 2, 6, 8, and 10 of this handbook for more information on treating substance abuse and dependence. Understanding drug–drug interactions in the care of HIV patients is essential. For a full explanation of psychotropic pharmacology and drug interactions, the reader is referred to additional texts on the subject (Cohen and Gorman, 2008; Schatzberg and Nemeroff, 2009; Wynn et al., 2009). Pharmacodynamic interactions are those that occur at the intended receptor site of a medication and involve absorption, distribution, metabolism, and excretion. ART drugs may be affected by timing with food or buffers, which is relatively predictable. Metabolic interactions are a bit more complex, as they are affected by metabolic inhibition, induction, and pharmacogenetics (the particular metabolic enzymes that a patient is born with). Metabolic interactions may occur in either phase I or II metabolic enzymes and also may include the cell membrane transporter enzymes (also known as p-glycoproteins). For a complete explanation of pharmacokinetic interactions, the reader is referred to the text by Wynn et al. (2009).

Drug–drug interactions

ESC CardioMed ◽  
2018 ◽  
pp. 226-233
Author(s):  
Jeffrey K. Aronson
Keyword(s):  
Drug Interaction ◽  
Protein Binding ◽  
Drug Interactions ◽  
Adverse Reactions ◽  
Mechanisms Of Action ◽  
Intravenous Drug ◽  
Cellular Distribution ◽  
Drug Infusion ◽  
Pharmacodynamic Interactions ◽  
Site Of Action

A drug interaction occurs when the effects of a drug are altered by the effects of another drug, a vaccine, herb, foodstuff, or device. In drug–drug interactions, a precipitant drug increases or reduces the effects of an object drug by pharmaceutical, pharmacokinetic, or pharmacodynamic mechanisms. Pharmaceutical interactions occur during intravenous drug infusion; they are avoidable by infusing drugs separately. Pharmacokinetic interactions can arise from altered absorption, protein binding, cellular distribution, metabolism, or excretion of an object drug. The last two mechanisms are the most important. Pharmacodynamic interactions can be direct (antagonism or synergism at the same site of action, or summation or synergism of similar effects at different sites) or indirect (when an outcome of an action of a precipitant drug alters the effects of an object drug). Some drug–drug interactions are beneficial, through combining drugs with different beneficial mechanisms of action or using drugs to reverse or prevent adverse reactions.

scholarly journals Scar-Free Embryonic Wound Healing and the Prevention of Scarring Following Wound Healing in the Adult

1997 ◽  
Vol 1 (1) ◽  
pp. 1-11 ◽  
Author(s):  
R. L. McCallion ◽  
M. W. J. Ferguson
Keyword(s):  
Wound Healing ◽  
Clinical Problem ◽  
Scar Formation ◽  
Accidental Injury ◽  
Matrix Deposition ◽  
Disease States ◽  
Important Clinical Problem ◽  
Extracellular Matrix Deposition ◽  
And Function ◽  
Fetal Wound

The development of scarring following accidental injury or surgery is an important clinical problem, often resulting in adverse effects on frowth and function, as well as an undersirable cosmetic appearance. Adult wound healing and scar formation are characterised by acute inflammation, wound contraction and disordered collagen deposition. Similar processes may also be involved in the progression of fibrotic disease states such as pulmonary fibrosis and hepatic cirrhosis. A major clinical objective is therefore, the reduction, and ideally the prevention, of scarring. The embryo and early fetus respond to injury in a way that is fundamentally different from the adult. In general, the early fetus heals rapidly, without scar formation. Extracellular matrix deposition in the fetal wound is rapid and organised in its structure, much more similar in appearance to unwounded skin, whilst, in the adult, matrix deposition is disordered. The inflammatory response, charasterisitic of the early phase of adult wound healing, is absent, or highly limited, in the fetus and the levels of cytokines are generally greatly reduced. Research into fundamental cellular and molecular differences between adult and fetal wound healing have revealed a number o targets in the adult wound which can be manipulated to more closely resemble the fetal wound environment and hence result in the reduction of adult scarring.

scholarly journals Pilot study: Evaluation of potential drug–drug interactions in hospitalized pediatric patients

2020 ◽  
Vol 61 (3) ◽  
pp. 279-289 ◽  
Author(s):  
Fabiola Medina-Barajas ◽  
Estefanía Vázquez-Méndez ◽  
Edsaúl Emilio Pérez-Guerrero ◽  
Virginia Aleyda Sánchez-López ◽  
Iván I. Hernández-Cañaveral ◽  
...  
Keyword(s):  
Pilot Study ◽  
Drug Interactions ◽  
Pediatric Patients ◽  
Potential Drug ◽  
Study Evaluation

Heparin-induced thrombocytopenia (HIT): Clinical and economic outcomes

2008 ◽  
Vol 100 (12) ◽  
pp. 1130-1135 ◽  
Author(s):  
Chiara Piovella ◽  
John Fanikos ◽  
Matthew Labreche ◽  
Jay Lin ◽  
Samuel Z. Goldhaber ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Management Strategies ◽  
Hospital Costs ◽  
Group Versus ◽  
Patient Characteristics ◽  
Clinical Problem ◽  
Primary Outcome Measure ◽  
Heparin Induced Thrombocytopenia ◽  
Important Clinical Problem ◽  
Characteristics Development

SummaryHeparin-induced thrombocytopenia (HIT) is an immune-mediated adverse drug reaction that occurs following exposure to unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH).HIT with thrombosis (HITT) can cause devastating venous thromboembolism or arterial clots, prolonged hospitalization, and increased costs. To explore the economic and clinical implications of HIT and HITT, we initiated a single-center patient registry. In this report, we describe patient characteristics, comorbidities, management strategies, clinical outcomes, and costs. We enrolled 349 hospitalized patients with an enzyme immunoassay-confirmed diagnosis of HIT over a 40-month period. Patients were assessed for the primary outcome of 30-day mortality, as well as baseline characteristics, development of thrombosis, and the economic impact of HIT. The primary outcome measure was 30-day mortality and occurred in 58 (16.6%) patients, 40 (15.3%) in the HIT group versus 18 (20.7%) in the HITT group (p=0.25).The frequency of HIT was greater in patients exposed to UFH than in patients exposed to LMWH (0.8% vs. 0.2%, respectively, p<0.001). Both HIT and HITT patients who were exposed to UFH had higher hospital costs than those exposed to LMWH ($113,100 vs. $56,352, respectively, p<0.001). HIT remains an important clinical problem with a high mortality rate and significant cost, regardless of development of thrombosis. Prospective controlled trials need to be conducted to determine the optimal strategy to reduce the frequency of HIT.

scholarly journals Drug-drug Interactions of Statins Potentially Leading to Muscle-Related Side Effects in Hospitalized Patients

2015 ◽  
Vol 53 (4) ◽  
pp. 329-335
Author(s):  
Camelia Bucsa ◽  
Andreea Farcas ◽  
D. Leucuta ◽  
Cristina Mogosan ◽  
M. Bojita ◽  
...  
Keyword(s):  
Side Effects ◽  
Drug Interactions ◽  
Elevated Serum ◽  
Statin Treatment ◽  
Demographic Characteristics ◽  
Hospitalized Patients ◽  
Muscular System ◽  
Interventional Study ◽  
Additional Risk ◽  
Muscle Disorders

Abstract Introduction. The associations of drugs that may interact with the statins resulting in elevated serum concentration of the statins are an important risk factor for statin induced muscle disorders. We aimed to determine the prevalence of these associations in all hospitalized patients that had been prescribed statins before/during hospitalization and to find out how often they are associated with muscle-related side effects. Methods. This prospective, non-interventional study performed in two internal medicine departments included patients with statin therapy before/during hospitalization. Data on each patient demographic characteristics, co-morbidities and treatment was collected from medical charts and interviews. We evaluated patients’ therapy for the targeted associations using Thomson Micromedex Drug Interactions checker and we ranked the identified drug-drug interactions (DDIs) accordingly. Each patient with statin treatment before admission was additionally interviewed in order to identify muscular symptoms. Results. In 109 patients on statin treatment we found 35 potential (p) DDIs of statins in 30 (27.5%) patients, most of which were in the therapy before admission (27 pDDIs). The pDDIs were moderate (20 pDDIs) and major (15 pDDIs). Of the total number of pDDIs, 24 were targeting the muscular system. The drugs most frequently involved in the statins’ pDDIs were amiodarone and fenofibrate. Two of the patients with pDDIs reported muscle pain, both having additional risk factors for statin induced muscular effects. Conclusion. The prevalence of statins’ pDDIs was high in our study, mostly in the therapy before admission, with only a small number of pDDIs resulting in clinical outcome.

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