Overview of the range of medicinal extracts at the pharmaceutical market of Ukraine

Aim. To study the range of medicinal extracts at the pharmaceutical market of Ukraine as of 2020 in order to determine the feasibility of developing a new medicinal product based on them.Materials and methods. The bibliosemantic, analytical, logical research methods were used to analyze the literature sources; the analytical analysis was applied to study the segment of the domestic pharmaceutical market regarding the range of medicinal extracts as of 2020. Thus, their composition, distribution by the aggregate state, forms of production and country of origin, harmonization with the Ph. Eur. were analyzed.Results. It has been determined that the domestic pharmaceutical market has 18 extracts, all of them are liquid. Among all extracts registered in Ukraine the leading place (16 items) belongs to the Ukrainian manufacturers. The nomenclature of imported drugs consists of 1 extract of Vietnamese and 1 of Swiss production. Among the Ukrainian manufacturers, the largest market segment belongs to PJSC “Lubnipharm” ‒ 4 drugs; “Rotokan” is available in 55 and 110 ml bottles, while “Aloe extract”, solution for injection, 1 ml, No. 10, in ampoules is produced by PJSC “Lubnipharm” and CJSC “Darnytsia”; “Eleutherococcus extract”, 50 ml, in a bottle ‒ by LLC “Unipharma” (“Ternopharm”) and agricultural firm “Yan”. There are 19 drugs with extracts at the domestic pharmaceutical market; among them the largest market segment is occupied by drugs in the form of tablets and capsules (7 items), 2 oral solutions, 1 drug in the form of oral drops, 1 syrup and powder for oral solution. Most drugs containing extracts are made by the Ukrainian manufacturers (about 47 %), while manufacturers from Germany, France and Switzerland supply 2 drugs each, Spain, Bulgaria, Slovenia and the Czech Republic ‒ 1 drug each.Conclusions. There are 18 extracts and 19 preparations with extracts at the pharmaceutical market of Ukraine. Most of the drugs in this sample are hypnotics and sedatives (55 %), as well as drugs used in diseases of the liver and biliary tract, they improve digestion and the functional state of the gastrointestinal tract.

Longitudinal effects of using and discontinuing CNS medications on cognitive functioning

BackgroundMedications acting on the central nervous system (CNS) have been associated with accelerated cognitive decline and increased risk of dementia. However, results are inconsistent and the longitudinal effects of CNS medications on cognitive performance are still not known.MethodsUsing longitudinal cognitive data from healthy adults aged 25-100 years (N = 2,475) from four test waves five years apart, we investigated both the link between use of CNS medications (opioids, antidepressants, anxiolytics, hypnotics and sedatives) on cognitive task performance (episodic memory, semantic memory, visuospatial ability) across 15 years, and the effect of discontinuing these medications in linear mixed effects models.ResultsWe found that opioid use was associated with decline in visuospatial ability, whereas antidepressant use was associated with decline in semantic memory over 15 years. A link between drug discontinuation and cognitive improvement was seen for opioids, antidepressants as well as for anxiolytics, hypnotics and sedatives.ConclusionsAlthough our results may be confounded by subjacent conditions, they suggest that long-term use of CNS medications may have domain-specific negative effects on cognitive performance over time, whereas the discontinuation of these medications may partly reverse these effects. These results open up for future studies that address subjacent conditions on cognition to develop a more complete understanding of the cognitive effects of CNS medications.

To Compare the Efficacy of Oral Midazolam and Triclofos Sodium as Oral Premedication in Children of Sawangi, Maharashtra, India

BACKGROUND The perioperative habits contemplate showing that kids are in more danger of encountering fierce sedative enlistment and unfriendly social sequelae. In paediatric sedation, decent premedication is fundamental to lessen tension and disturbance in youngsters. Parental partition and odd operating room environment as a rule bring about blustery acceptance while giving general sedation. Narcotic premedication is vital for making kids quiet and cooperative in a weird environment. Our study was done to compare the efficacy of midazolam 0.5 mg / kg and triclofos sodium 100 mg / kg as oral premedications in children undergoing elective surgery. METHODS In this prospective randomised comparative study, sixty children posted for elective surgery were enrolled. The patients were randomly divided into midazolam group (Group M) and triclofos sodium group (Group T) of thirty each. Group M received oral midazolam 0.5 mg / kg 30 min before induction, and Group T received oral triclofos sodium 100 mg / kg 60 min before induction. All children were evaluated for level of sedation after premedication, behaviour at the time of separation from parents and at the time of mask placement for induction of anaesthesia. RESULTS Oral midazolam showed satisfactory sedation in children after premedication when compared to oral triclofos (P = 0.003). Both the drugs had a successful separation from parents, and the children were very cooperative during induction. No adverse effects attributable to the premedicants were seen. CONCLUSIONS Oral midazolam is better than triclofos sodium as a sedative anxiolytic in the paediatric population. KEY WORDS Anaesthesia, Hypnotics and Sedatives, Midazolam, Paediatrics, Premedication, Triclofos sodium

Análise das incompatibilidades medicamentosas em uma unidade cardiointensiva: estudo transversal

Objetivo: Evaluar las incompatibilidades de los medicamentos intravenosos en pacientes cardíacos ingresados en una unidad cardiointensiva, asociando posibles incompatibilidades con la gravedad y las características del evento adverso. Método: Estudio transversal, observacional y cuantitativo. Realizado en una Unidad Cardiointensiva de un Hospital Universitario en la ciudad de Rio de Janeiro. La recopilación de datos se realizó de marzo a junio de 2018. Para identificar y clasificar las incompatibilidades de medicamentos se utilizó Micromedex®. Resultados: Se analizaron 111 recetas, con un total de 1,497 medicamentos recetados, el número promedio de medicamentos recetados fue 13,49 (6 ± 24), 580 (38.74%) por vía intravenosa, de los cuales el 41.38% se administraron simultáneamente con otro medicamento. El estudio mostró 121 incompatibilidades y las clases de drogas que tuvieron el mayor número de incompatibilidades fueron diuréticos, hipnóticos y sedantes, estimulantes cardiovasculares (aminas vasoactivas), antibióticos para uso sistémico, corticosteroides para uso sistémico, vasodilatadores cardiovasculares y agentes antiarrítmicos. Destacando las incompatibilidades clasificadas como moderadas, furosemida con hidrocortisona y midazolam con omeprazol y fentanilo severo con amiodarona. Conclusión: El estudio destaca la importancia de la programación y administración de medicamentos por parte del equipo de enfermería con base en el conocimiento farmacológico. Se espera que el cuadro de recomendaciones preparado en el estudio, con atención de enfermería relacionada con incompatibilidades con mayor potencial de gravedad y sus eventos, pueda contribuir a la seguridad de los medicamentos. Objective: To evaluate the incompatibilities of intravenous medications in cardiac patients admitted to a cardiac intensive unit, associating possible incompatibilities with the severity and characteristics of the adverse event. Method: Cross-sectional, observational, and quantitative study, held in a Cardiac intensive Unit of a University Hospital in the city of Rio de Janeiro. Data collection took place from March to June 2018. Micromedex® identified and classified drug incompatibilities. Results: We analyzed 111 prescriptions with a total of 1,497 prescription drugs, the average number of prescription drugs was 13.49 (6 ± 24), 580 (38.74%) intravenously in which 41.38% were administered simultaneously with another medicine. The study showed 121 incompatibilities and the drug classes that had the highest number of incompatibilities were diuretics, hypnotics and sedatives, cardiovascular stimulants (vasoactive amines), antibiotics for systemic use, corticosteroids for systemic use, cardiovascular vasodilators, and antiarrhythmic agents. We highlight the incompatibilities classified as moderate, furosemide with hydrocortisone, and midazolam with omeprazole, and severe fentanyl with amiodarone. Conclusion: The study highlights the importance of medication scheduling and administration by the nursing team based on pharmacological knowledge. We expect that the chart of recommendations prepared in the study with nursing care related to incompatibilities with greater potential for severity and its events can contribute to drug safety. Objetivo: Avaliar as incompatibilidades de medicações intravenosas em pacientes cardiopatas internados em uma unidade cardiointensiva, associando as possíveis incompatibilidades com a gravidade e característica do evento adverso. Método: Estudo transversal, observacional e quantitativo. Realizado em uma Unidade Cardiointensiva de um Hospital Universitário do município do Rio de Janeiro. A coleta de dados ocorreu de março a junho de 2018. Para a identificação e classificação das incompatibilidades medicamentosas, foi utilizado o Micromedex®. Resultados: Foram analisadas 111 prescrições, com um total de 1.497 medicamentos prescritos, a média de medicamentos por prescrição foi 13,49 (6 ±24), sendo 580 (38,74%) por via intravenosa, destes, 41,38% foram administrados simultaneamente com outro medicamento. O estudo apresentou 121 incompatibilidades e as classes medicamentosas que apresentaram maior número de incompatibilidades foram diuréticos, hipnóticos e Sedativos, estimulantes cardiovasculares (aminas vasoativas), antibióticos de uso sistêmico, corticoides de uso sistêmico, vasodilatadores cardiovasculares e antiarrítmicos. Destacando-se as incompatibilidades classificadas como moderadas, a furosemida com hidrocortisona e o midazolam com omeprazol e grave o fentanil com amiodarona. Conclusão: O estudo destaca a importância do aprazamento e administração de medicamentos pela equipe de enfermagem com base em conhecimentos farmacológicos. Espera-se que o quadro de recomendações elaborado no estudo, com os cuidados de enfermagem relacionados as incompatibilidades com maior potencial de gravidade e seus eventos, possa contribuir para segurança medicamentosa.

Psychotropic use in children and adolescents in Scandinavia and Catalonia: a 10 years population-based study.

Background: Psychotropic drugs have not been deeply studied in the paediatric population as normally this population is not included in clinical trials and these drugs are not authorised for it use in under 18 years. Objectives: To describe the use of psychotropic drugs in children and adolescents in the North of Europe and Catalonia. Methods: Data on psychotropic drug consumption in children and adolescents were retrieved from the databases of Catalonia, Denmark, Norway, and Sweden from 2008 to 2017. Psychotropic drugs were divided in antipsychotics, anxiolytics (also hypnotics and sedatives), antidepressants and psychostimulants. Data were stratified by group of age (0-4, 5-9, 10-14 and 15-19/ 15-17 for Denmark and Catalonia) and sex. Results: Overall the group of anxiolytics shows the highest consumption and the group of antipsychotics the lowest. Sweden is the country with the highest consumption of psychotropic drugs and the highest increase in its consumption. Denmark has the lowest consumption for all groups. Catalonia shows a decrease in psychotropic drugs. Girls consume more than twice as many antidepressants as boys and the opposite is for psychostimulants. Risperidone and quetiapine are among the most consumed antipsychotics in the Nordic countries, in Catalonia they are risperidone and aripiprazole. Among the antidepressants sertraline is the most consumed. No differences are found among the psychostimulants. Differences regarding the use of anxiolytics, hypnotics and sedatives are found between the Nordic countries (melatonin is the most consumed) and Catalonia (hydroxyzine). Conclusions: Psychotropic consumption in younger populations is increasing though there are differences among the active substances among countries. Nordic countries show a higher prevalence of use than Catalonia. Psychotropic drug consumption increases with age being the only exception the psychostimulants consumption, which is highest in the 10-14 years group.

General practitioners’ concepts on issuing out-of-pocket prescriptions for hypnotics and sedatives in Germany

Background In Germany, almost 50% of prescriptions for benzodiazepines and drugs as Zolpidem and Zopiclone are as out-of-pocket (OOP) prescriptions—requiring patients to buy the drug at their own expense—although almost 90% of the population has statutory health insurance covering medication costs. Objective To understand why general practitioners (GPs) choose this prescribing method since needed medications are insurance covered, and unnecessary drugs should not be prescribed at all. Methods In this qualitative study, 17 semi-structured interviews with GPs were conducted, audio recorded and transcribed verbatim. Transcripts were analysed with grounded theory to extract a model explaining the described behaviour. Results Knowing the significant medical risks and insecurity about regulations makes GPs wish to avoid hypnotics and sedatives. They achieve this by ‘Creating a barrier’ (central phenomenon) and employing the strategy ‘Using an out-of-pocket prescription’, which not only generates costs for the patient but also reduces the physicians´ legal and financial accountability. The perceived patient type, expected problem duration and diagnosis influence the decision about the prescription form: patients with an alcohol or drug addiction or those with ‘uncomplicated’ insomnia are more likely to receive an OOP prescription. Patients with any psychiatric diagnosis will likely receive a statutory health insurance prescription. Discussion Current regulations do not provide guidance to GPs regarding hypnotics and sedatives. A clear regulatory framework and guidelines could possibly reduce physicians’ defensive attitudes about these drugs and their use of OOP prescriptions. The approach to use OOP prescriptions as a barrier to reduce patients’ medication use lacks evidence regarding effectiveness.

Evidence-based out-of-hours hospital medicine

Out-of-hours (OOH) hospital ward cover is generally provided by junior doctors and is typified by heavy workloads, reduced staff numbers and various non-urgent nurse-initiated requests. The present inefficiencies and management problems with the OOH service are reflected by the high number of quality improvement projects recently published. In this narrative review, five common situations peculiar to the OOH general ward setting are discussed with reference to potential areas of inefficiency and unnecessary management steps: (1) prescription of hypnotics and sedatives; (2) overnight fluid therapy; (3) fever; (4) overnight hypotension and (5) chasing outstanding routine diagnostic tests. It is evident that research and consensus guidelines for many clinical situations in the OOH setting are a neglected arena. Many recommendations made herein are based on expert opinion or first principles. In contrast, the management of significant abnormalities in outstanding blood results is based on well-established guidelines using high-quality systematic reviews.