Trends in Prescribing Patterns and Drug Related Problems of Kidney Disease Patients

2021 ◽  
Vol 71 (11) ◽  
pp. 2629-2636
Author(s):  
Muhammad Arfat Yameen ◽  
Mubashra Tafseer ◽  
Warda Khan ◽  
Sanaa Anjum ◽  
Raza-E-Mustafa ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Kidney Disease ◽  
Drug Interactions ◽  
Professional Staff ◽  
Prescribing Patterns ◽  
Dose Error ◽  
Drug Related Problems ◽  
Prescribing Trends ◽  
Nephrotoxic Drugs ◽  
Drug Drug Interaction

Objective: The aim of the study was the evaluation of drug-related problems, including drug-drug interactions, dose error, use of nephrotoxic drugs and polypharmacy with special emphasis on kidney disease patients. Methods: Descriptive cross-sectional study from January to April 2019 was carried out in nephrology ward of Ayub teaching hospital, Abbottabad, Pakistan to review patient’s medication orders for evaluation of drug-related problems. Doses of medicine and drug-drug interactions were evaluated by comparing it with standard protocols given in BNF and Lexicomp software. Prescriptions were also evaluated for polypharmacy and use of nephrotoxic drugs. Results: Out of 131 patients, majority were males 72 (55%). Drug-drug interactions were found in 69 (52.7%) patients among which the highest percentage was of the moderate drug-drug interaction (48.1%) followed by major and minor drug-drug interaction (29.8% and 20.6% respectively). Incidence of polypharmacy (51.9%) and use of nephrotoxic drug (77%) was high while dose error was low up to 10.7%. All the drug-related problems were present with a high percentage in patients with CKD as compare to other kidney diseases. There was significant association of CKD stages with DDIs, polypharmacy, dose error and prescribing drugs. There was significant positive correlation among DDIs-polypharmacy and prescribing drugs was noted in the study. Conclusion: The higher incidence of drug-related problems in our study setting reflects irrational prescribing trends and deficiency of professional staff dealing kidney disease patients. Key Words: kidney disease, drug-drug interactions, polypharmacy, nephrotoxic drugs, dose error. Continuous...

scholarly journals Polypharmacy and potential drug-drug interactions among medications prescribed to chronic kidney disease patients

2021 ◽  
Vol 9 (1) ◽  
pp. 25-32
Author(s):  
Shrijana Kumari Chaudhary ◽  
Naresh Manadhar ◽  
Laxman Adhikari
Keyword(s):  
Chronic Kidney Disease ◽  
Drug Interaction ◽  
Kidney Disease ◽  
Drug Interactions ◽  
Teaching Hospital ◽  
College Teaching ◽  
Potential Drug ◽  
Comorbid Conditions ◽  
Medical College ◽  
Drug Drug Interaction

Background and Objectives: Chronic kidney disease is a major systemic condition. Presence of comorbid conditions with the deteriorating renal function, lead them to use multiple drugs. Polypharmacy is common among chronic kidney disease. The possibility of drug interaction rises when a patients concurrently receive more than one drug and the chances increase with the number of drugs taken, which may be associated with increased morbidity, mortality, length of hospital stay and health-care cost. The aim of this study was to assess the polypharmacy and pattern of drug- drug interactions in chronic kidney disease patients attending OPD and ward of nephrology unit in Kathmandu Medical College teaching hospital. Material and Methods: This was a prospective cross sectional study conducted among 143 chronic kidney disease diagnosed patients in Kathmandu Medical College Teaching Hospital. The Lexi-comp database was used to evaluate patient’s medications for potential drug-drug interactions. Results: Chronic kidney disease was predominant among male (65.7%) than the female (34.3%). The most common age group was 41-60yrs followed by 61-80 yrs. The mean age of the patients was 54.38 ± 16.43 years. Chronic kidney disease was associated with multiple co-morbid conditions. The most common comorbid conditions were hypertension 52 (36. 4%) and hypertension and diabetes both in 42 (29.4%). A total of 143 prescriptions were included in this study. Average number of drugs per prescription was 6.1. Almost 5-8 medicines per prescription were observed among 95(65.73%) patients. A total of 837 medicines were prescribed. A total number of 206 potential drug-drug interactions were observed among 143 patients. Depending upon the risk rating categorize, the most common were,  risk rating C 178( 86.4%) and the most frequent drug interaction was between amlodipine and calcium carbonate 65 (45.45%) . Conclusion: The prevalence of potential drug-drug interaction is high among chronic kidney disease patients. About 63% of interactions have moderate severity. The safest approach to avoid potentials drug-drug interaction is the implementation of appropriate guidelines, detailed and rationalize knowledge of drugs and to utilize available drug-drug interaction software to avoid harmful drug-drug interaction among chronic kidney disease patients.

Pharmacokinetic Drug-drug Interaction of Antibiotics Used in Sepsis Care in China

2020 ◽  
Vol 21 ◽  
Author(s):  
Xuan Yu ◽  
Zixuan Chu ◽  
Jian Li ◽  
Rongrong He ◽  
Yaya Wang ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Drug Interactions ◽  
Penicillin G ◽  
Literature Mining ◽  
Human Pharmacokinetics ◽  
P450 Enzyme ◽  
Drug Drug Interaction ◽  
Pharmacokinetic Drug ◽  
Sepsis Care

Background: Many antibiotics have a high potential for having an interaction with drugs, as perpetrator and/or victim, in critically ill patients, and particularly in sepsis patients. Methods: The aim of this review is to summarize the pharmacokinetic drug-drug interaction (DDI) of 45 antibiotics commonly used in sepsis care in China. Literature mining was conducted to obtain human pharmacokinetics/dispositions of the antibiotics, their interactions with drug metabolizing enzymes or transporters, and their associated clinical drug interactions. Potential DDI is indicated by a DDI index > 0.1 for inhibition or a treated-cell/untreated-cell ratio of enzyme activity being > 2 for induction. Results: The literature-mined information on human pharmacokinetics of the identified antibiotics and their potential drug interactions is summarized. Conclusion: Antibiotic-perpetrated drug interactions, involving P450 enzyme inhibition, have been reported for four lipophilic antibacterials (ciprofloxacin, erythromycin, trimethoprim, and trimethoprim-sulfamethoxazole) and three lipophilic antifungals (fluconazole, itraconazole, and voriconazole). In addition, seven hydrophilic antibacterials (ceftriaxone, cefamandole, piperacillin, penicillin G, amikacin, metronidazole, and linezolid) inhibit drug transporters in vitro. Despite no reported clinical PK drug interactions with the transporters, caution is advised in the use of these antibacterials. Eight hydrophilic antibacterials (all β-lactams; meropenem, cefotaxime, cefazolin, piperacillin, ticarcillin, penicillin G, ampicillin, and flucloxacillin), are potential victims of drug interactions due to transporter inhibition. Rifampin is reported to perpetrate drug interactions by inducing CYP3A or inhibiting OATP1B; it is also reported to be a victim of drug interactions, due to the dual inhibition of CYP3A4 and OATP1B by indinavir. In addition, three antifungals (caspofungin, itraconazole, and voriconazole) are reported to be victims of drug interactions because of P450 enzyme induction. Reports for other antibiotics acting as victims in drug interactions are scarce.

scholarly journals Review of Impact and Handling of Potential Antihypertensive Drug Interactions in Chronic Kidney Disease Patients

2021 ◽  
Vol 7 (1) ◽  
pp. 39-53
Author(s):  
Ni Made Susilawati ◽  
Eli Halimah ◽  
Siti Saidah
Keyword(s):  
Drug Interaction ◽  
Drug Interactions ◽  
Heart Function ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Potential Drug ◽  
Analysis Program ◽  
Drug Related Problems ◽  
Related Effect ◽  
Complete Knowledge

Drug interaction is a type of Drug-Related Problems (DRPs) that caneventually increase morbidity and mortality rates. CKD patients have asignificant risk of developing polypharmacy due to comorbid diseases andpharmacokinetics' alteration. The literature review was conducted byexploring all of the articles related to the drug interaction using druginteraction analysis program in CKD patients, which obtained from threedatabases, namely Google Scholar, PubMed, and Science Direct, usingseveral keywords combination. Based on the comprehensive reviewsconducted, it is known that the most common effects of antihypertensivedrug interactions in CKD patients are decreasing effects of antihypertensivedrugs, hypotension, and hyperkalemia. Handling management used for theemergence of potential drug interactions is based on the severity of the druginteractions and complete knowledge of the patients' clinical condition. Themanagement of drug interaction by monitoring blood pressure, diuresis, andpotassium levels; Monitor the related effect symptoms; Monitor the fluidand body weight; Monitor the kidney and heart function. On the conditionwhere the handling management of potential drug interactions is not carriedout, elevated morbidity and mortality rates are the risks of complicationsarising from the drug interactions.

Comparison of eight screening tools to detect interactions between herbal supplements and oncology agents

2020 ◽  
Vol 26 (8) ◽  
pp. 1843-1849
Author(s):  
Faisal Shakeel ◽  
Fang Fang ◽  
Kelley M Kidwell ◽  
Lauren A Marcath ◽  
Daniel L Hertz
Keyword(s):  
Drug Interaction ◽  
Positive Predictive Value ◽  
Drug Interactions ◽  
Predictive Value ◽  
Screening Tools ◽  
Herbal Supplements ◽  
Interaction Detection ◽  
Natural Medicine ◽  
Interaction Screening ◽  
Drug Drug Interaction

Introduction Patients with cancer are increasingly using herbal supplements, unaware that supplements can interact with oncology treatment. Herb–drug interaction management is critical to ensure optimal treatment outcomes. Several screening tools exist to detect drug–drug interactions, but their performance to detect herb–drug interactions is not known. This study compared the performance of eight drug–drug interaction screening tools to detect herb–drug interaction with anti-cancer agents. Methods The herb–drug interaction detection performance of four subscription (Micromedex, Lexicomp, PEPID, Facts & Comparisons) and free (Drugs.com, Medscape, WebMD, RxList) drug–drug interaction tools was assessed. Clinical relevance of each herb–drug interaction was determined using Natural Medicine and each drug–drug interaction tool. Descriptive statistics were used to calculate sensitivity, specificity, positive predictive value, and negative predictive value. Linear regression was used to compare performance between subscription and free tools. Results All tools had poor sensitivity (<0.20) for detecting herb–drug interaction. Lexicomp had the highest positive predictive value (0.98) and best overall performance score (0.54), while Medscape was the best performing free tool (0.52). The worst subscription tools were as good as or better than the best free tools, and as a group subscription tools outperformed free tools on all metrics. Using an average subscription tool would detect one additional herb–drug interaction for every 10 herb–drug interactions screened by a free tool. Conclusion Lexicomp is the best available tool for screening herb–drug interaction, and Medscape is the best free alternative; however, the sensitivity and performance for detecting herb–drug interaction was far lower than for drug–drug interactions, and overall quite poor. Further research is needed to improve herb–drug interaction screening performance.

scholarly journals Chronic Kidney Disease Management in General Practice: A Focus on Inappropriate Drugs Prescriptions

2020 ◽  
Vol 9 (5) ◽  
pp. 1346
Author(s):  
Maria Antonietta Barbieri ◽  
Michelangelo Rottura ◽  
Giuseppe Cicala ◽  
Rossella Mandraffino ◽  
Sebastiano Marino ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Predictive Factors ◽  
Descriptive Analysis ◽  
Prescribing Patterns ◽  
Lower Probability ◽  
Logistic Regression Models ◽  
Inappropriate Drugs ◽  
Nephrotoxic Drugs ◽  
Inappropriate Prescriptions

Nephrotoxic drugs prescriptions are often prescribed inappropriately by general practitioners (GPs), increasing the risk of chronic kidney disease (CKD). The aim of this study was to detect inappropriate prescriptions in patients with CKD and to identify their predictive factors. A retrospective study on patients with creatinine values recorded in the period 2014–2016 followed by 10 GPs was performed. The estimated glomerular filtration rate (eGFR) was used to identify CKD patients. The demographic and clinical characteristics and drugs prescriptions were collected. A descriptive analysis was conducted to compare the characteristics and logistic regression models to estimate the predictive factors of inappropriate prescriptions. Of 4098 patients with creatinine values recorded, 21.9% had an eGFR <60 mL/min/1.73 m2. Further, 56.8% received inappropriate prescriptions, with a significantly lower probability in subjects with at least a nephrologist visit (Adj OR 0.54 (95% CI 0.36–0.81)) and a greater probability in patients treated with more active substances (1.10 (1.08–1.12)), affected by more comorbidities (1.14 (1.06–1.230)), or with serious CKD (G4/G5 21.28 (7.36–61.57)). Nonsteroidal anti-inflammatory drugs (NSAIDs) were the most used contraindicated drugs (48.5%), while acetylsalicylic acid was the most inappropriately prescribed (39.5%). Our results highlight the inappropriate prescriptions for CKD authorized by GPs and underline the need of strategies to improve prescribing patterns.

Potential Drug Interactions— Fact or Fallacy?

1975 ◽  
Vol 9 (11) ◽  
pp. 586-590 ◽  
Author(s):  
Curtis D. Black ◽  
Nicholas G. Popovich
Keyword(s):  
Drug Interaction ◽  
Drug Interactions ◽  
Patient Care ◽  
Clinical Studies ◽  
Literature Search ◽  
Potential Drug ◽  
Careful Evaluation ◽  
Current Drug ◽  
Drug Drug Interaction

At present, the pharmacist is faced with a perplexing number of potential drug interactions as they relate to patient care. The purpose of the investigation was to evaluate current drug-drug interaction literature, specifically gastrointestinal drug interactions. Literature search and review evaluated the authoritative basis on which conclusions were made. From this, a review was written to illustrate fallacies and misconceptions that could be derived from the literature with the intent it would serve as a guide in interpreting and evaluating drug-drug interactions. The overall study illustrates the vast need for careful evaluation of drug interaction literature before erroneous recommendations are made on conceivably inconclusive clinical studies.

Impact of Patient-Specific Drug Interaction Information on Physician Prescribing Patterns

1980 ◽  
Vol 14 (4) ◽  
pp. 280-283
Author(s):  
Thomas R. Adams ◽  
William J. Murray ◽  
J. Heyward Hull
Keyword(s):  
Drug Interaction ◽  
Drug Therapy ◽  
Drug Interactions ◽  
Prescribing Patterns ◽  
Study Patient ◽  
Patient Specific ◽  
Utilization Review ◽  
Control Groups ◽  
Anticoagulant Drug ◽  
Physician Prescribing

Patient exposure to potential anticoagulant drug interactions was identified by computerized drug-therapy surveillance, as part of a peer-review program. To evaluate the response of clinicians provided with data on the potential drug interactions, 119 “exposed” patients were randomly divided and assigned to study or control groups. Physicians prescribing for the 60 study patients were informed of the potential problem by letter and were furnished with information on the drug interaction, while the 59 control patients were only monitored. Physicians provided with the information made statistically more changes in drug therapy than those not informed ( p < 0.05). Over 75 percent of study-patient physicians responding to a questionnaire accompanying the drug interaction data indicated that the service was useful and should be expanded to other drugs. Application of methods similar to that used in this study should offer drug utilization review committees an effective approach to improving drug therapy.

scholarly journals DRUG-DRUG INTERACTION;

2017 ◽  
Vol 24 (03) ◽  
pp. 357-365
Author(s):  
Hina Hasnain ◽  
Huma Ali ◽  
Farya Zafar ◽  
Ali Akbar Sial ◽  
Kamran Hameed ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Adverse Event ◽  
Drug Interaction ◽  
Drug Interactions ◽  
Multidisciplinary Approach ◽  
Drug Information ◽  
Drug Effects ◽  
Information Provision ◽  
Drug Drug Interaction ◽  
Drug Order

Drug-drug interaction (DDI) is a specific type of adverse event, which developsdue to multiple regimen therapy, and that may lead to significant hospitalization and death.Clinical and economic impact of drug interactions are increasingly accredited as a chiefconcern in critical care. Potentiating effects of DDIs in intensive care units are far more criticaldue to complex medications regimen, high risk severely ill population and associated metabolicand physiological disturbances which can impede drug effects. Pharmacist contribution isclassified as clarification of drug order, appropriate drug information provision, and advice forsubstitute treatment. A multidisciplinary approach is very necessary in developing a pharmacotherapeuticregimen designed to optimize patient outcome and minimize any potential dugdrug interactions. This review encompasses the prevalence, categorization, significance interm of patient safety and prescription efficacy, clinical and economic burdens, national andinternational data comparisons related to drug-drug interactions.

scholarly journals PRESCRIPTION PATTERN OF DIURETICS IN A TERTIARY CARE HOSPITAL

2019 ◽  
Vol 8 (3) ◽  
Author(s):  
P G Chithara ◽  
Dr. Yogananda R ◽  
Dr. Bharathi DR
Keyword(s):  
Drug Interaction ◽  
Tertiary Care ◽  
General Medicine ◽  
Oral Route ◽  
Prescribing Patterns ◽  
Research Centre ◽  
Intravenous Route ◽  
Care Hospital ◽  
Prescribing Pattern ◽  
Drug Drug Interaction

Diuretics are drugs that increase the rate of urine flow; clinically useful diuretics also increase the rate of excretion of Na+ (natriuresis) and an accompanying anion, usually Cl. Diuretics are a mainstay of therapy for a wide variety of diseases ranging from hypertension to the nephrotic syndrome. Objective: To study the prescribing patterns of diuretics in General Medicine and ICU. To assess the drug-drug interaction of diuretics. To study the route of administration of diureics. Materials and methods: A prospective observational study was conducted over a period of six months at general medicine and ICU department of Basaveshwara Medical College and Hospital and Research Centre, Chitradurga.a otal of 100 in-patients are included as study subject. Results: Mostly prescribed diuretic in this study were furosemide (52.9%), followed by mannitol (28.1%), spironolactone (11.57%), torsemide (5.79%), amiloride (0.82%) and hydrochlorothiazide (0.82%). Out of 100 prescriptions 84.4% of diuretics prescribed in intravenous route, 15.6% of diuretics prescribed in oral route. Out of 100 prescriptions total 89 drug interactions with diuretics are found. In that 2.3% major interactions and 67.4% moderate interactions and 30.3% minor interactions are found. Conclusion: Prescription monitoring helped to reduce the diuretic usage errors with respect to dose and drug-drug interaction with other prescribed drugs to provide better patient care. Keywords:  prescribing pattern, drug-drug intraction, diuretics

scholarly journals Safe Non-opioid and Non-barbiturate containing Acute Medication Combinations in Headache: An Exhaustive Approach Based on DrugBank Database

2020 ◽  
Author(s):  
Victor Kaytser ◽  
Pengfei Zhang
Keyword(s):  
Drug Interaction ◽  
Drug Interactions ◽  
Drug Combinations ◽  
Exhaustive Search ◽  
Common Elements ◽  
Acute Medication ◽  
Drug Drug Interaction ◽  
Drugbank Database ◽  
Exhaustive List

Structured AbstractBackgroundRational polypharmacy in abortive medications use is often inevitable for patients with refractory headaches.ObjectiveWe seek to enumerate an exhaustive list of headaches abortive medications that are without drug-drug interactions.MethodsWe updated a list of acute medications based on the widely used Jefferson Headache Manual with novel abortive medications including ubrogepant, lasmiditan, and rimegepant. Opioids and barbiturate containing products are excluded. We then conducted an exhaustive search of all pair-wise interactions for this list of medication via DrugBank API. Using this interaction list, we filtered all possible two, three, and four drug combinations of abortive medications. The resultant list of medication was then reapplied to DrugBank to verify the lack of known drug-drug interaction.ResultsThere are 192 medication combinations that do not contain any drug-drug interactions. Most common elements in these combinations are ubrogepant, prochlorperazine, followed by tizanidine. There are 67 three-drug combinations that do not contain interaction. Only 2 of the four-drug combinations do not yield some form of drug-drug interactions.ConclusionThis list of headaches abortive medications without drug-drug interactions is a useful tool for clinicians seeking to more effectively manage refractory headaches.

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