Review of Clinical Questions Submitted to Norwegian Drug Information Centres Concerning Administration and Dosage to Older Patients of Relevance to Patient-Centric Care

Patient-centric care entails optimising healthcare provision to patients based on their perspective and opinion. It involves appropriate treatment at a reasonable cost and a focus on patient characteristics in the decision-making process to make it more personally useful. The optimisation of medicines in the older population is a challenge due to physiological changes, comorbidity, and polypharmacy. Furthermore, patient-centric care is difficult to achieve due to the high proportion of patients with dementia and frailty. Decision support concerning the appropriateness of indication, formulation, dose, administration, co-prescribing, and length of treatment to older patients is frequently in demand. In the current study, we aimed to review clinical questions concerning administration and dosage to older patients of relevance to patient-centric care. We analysed questions concerning medicines to patients 65 years or older in the database of the network of Norwegian drug information centres from 2010 to 2020. The analysis included the distribution of drugs, diseases, and recurring topics among the questions. Through a Boolean search that combined the indexed categories of “older” and “administration and dosage”, we retrieved 84 question-answer pairs. Questions about psychotropic and cardiovascular drugs in relation to therapy, adverse drug reactions, and pharmacokinetics dominated, and more than 60% of the questions came from physicians. Topics relevant to patient-centric pharmacotherapy were drug withdrawal (10 questions), drug formulation (8 questions), drug initiation (8 questions), and switching drugs (5 questions). One question concerned drug withdrawal and switching, and one question drug formulation and switching. Answers provided decision support regarding appropriate formulations of drugs to patients with dementia who chew capsules or tablets, the use of parenteral administration in patients who refuse to take oral formulations, and the pharmacokinetics of transdermal or rectal drug administration. The results highlight the importance of including pharmacological factors in the assessment of the acceptability and appropriateness of oral and parenteral medicine to older patients.

Exosome Limitations in the Treatment of Inflammatory Diseases

Background: Despite the great interest and numerous studies, there is currently no unified standard describing the sequential manipulation with cells to obtain exosomes for clinical use.The use of exosomes has become an attractive alternative to cell therapy, since the flexible nature of these biological vesicles allows scientists to manipulate their composition to produce the desired exosomes carrying specific drugs, RNA and proteins. This study aimed to analyse scientific literature on the changes in the functional characteristics of exosomes, depending on the method of manipulation, potentially contributing to the development of negative effects in the treatment of diseases of inflammatory genesis Results: The choice of isolation method affects the expressed sets of protein markers, nucleic acids and receptors on microparticles. Various surface receptors present on the exosome membrane can be engineered to target lesions. Exosomes from healthy patients help to reduce inflammation, normalize intercellular communication and have antifibrotic, antioxidant, and cytoprotective effects. Exosomes can change the microenvironment, but the microenvironment can also change the composition of exosomes. Conclusion: Exosomes obtained from sick patients carry markers characteristic of the corresponding disease. Such exosomes can have pro-inflammatory, pro-fibrotic, cytotoxic, and oncogenic properties, and disrupt cellular cooperation. Until now, questions regarding the dose, reactions to repeated administration, and dosage regimes have not been completely resolved.

Efficacy of systemic administration of riboflavin on a rabbit model of corneal alkali burn

Changes in the barrier mechanisms in the eye should determine the rational route for the administration and dosage of each drug in the treatment of traumatic injuries and other pathologies. The aim of this study was to examine the efficacy of intra-arterial delivery of 14C-riboflavin (as an “indicator”) and compare it with intravenous and intramuscular administration in an animal model of chemical eye burn. 14C-riboflavin (14C-I) was administered by intra-arterial (carotid artery), intravenous (femoral vein) and intramuscular (femoral muscle) routes. The total radioactivity was determined over 2 h in the plasma and structures of the rabbit’s eyes using a scintillation counter. The results of the study show that intravascular administration of 14C-I gives significantly higher concentrations of total radioactivity in the blood and is accompanied by a significant increase in the permeability of the blood-barrier and barrier in eyes suffering from burns. The highest concentration in the plasma and aqueous humour of the anterior chamber of the eye was observed during the first hour with the intra-arterial route of administration of 14C-I in either burnt and unburnt eyes. The distribution of total radioactivity in the structures of the eye over the 2 h of the experiment showed a higher level of the drug under intra-arterial administered in the uveal regions, namely: the iris, ciliary body, choroid, retina and also the sclera and cornea. This experimental model shows that intra-arterial administration can increase the bioavailability of a drug to the structures of the eye within a short period of time.

Biocompatibility and Carcinogenicity of Carbon Nanotubes as Biomaterials

With the development of nanotechnology in recent years, there have been concerns about the health effects of nanoparticles. Carbon nanotubes (CNTs) are fibrous nanoparticles with a micro-sized length and nano-sized diameter, which exhibit excellent physical properties and are widely studied for their potential application in medicine. However, asbestos has been historically shown to cause pleural malignant mesothelioma and lung cancer by inhalation exposure. Because carbon nanotubes are also fibrous nanotubes, some have raised concerns about its possible carcinogenicity. We have reported that there is no clear evidence of carcinogenicity by local and intravenous administration of multi-walled CNTs to cancer mice models. We firmly believe that CNTs can be a safe, new, and high-performance biomaterials by controlling its type, site of administration, and dosage.

ANTIBIOTIC PRESCRIBING PROFILE FOR PEDIATRIC AT THE PHARMACY OF MEDAN CITY IN 2016

Objective: The aim of this study was to determine antibiotics prescribing profile for pediatric in Medan, Sumatra Utara (Indonesia) in 2016.Methods: This study was using a retrospective cross-sectional method study which conducted from October to November 2016 with data from July to August 2016. From 93 pharmacies, there are 2195 prescribed for pediatric and 740 (33.71%) prescriptions contained antibiotic. The antibiotic analyzed based on the group, type, duration of administration, and dosage-drug form along with the dose.Results: The antibiotic that mostly prescribed for pediatric was penicillin (amoxicillin) 329 prescriptions (44.46%). The onset of antibiotic revealed that 581 prescriptions (78.51%) were valid. The dosage form that most prescribed was syrup 230 prescriptions (31.08%). From 278 prescriptions, it showed that 177 (61.67%) prescriptions within an appropriate dose.Conclusion: It shows that penicillin (amoxicillin) was the most prescribed antibiotic for pediatric in Medan and there are still in appropriate dose selections.

EVALUATION OF ANTIBIOTICS UTILIZATION ON PEDIATRIC OUTPATIENTS IN UNIVERSITAS SUMATERA UTARA HOSPITAL, MEDAN

Objective: The aim of this study was to determine antibiotics prescribing profile for pediatric outpatients in Universitas Sumatera Utara Hospital, Medan, Sumatera Utara (Indonesia) in 2018.Methods: This study was using a retrospective cross-sectional method study which conducted from March to April 2018 with data from January to December 2018. From Universitas Sumatera Utara Hospital, there are 211 prescriptions contained antibiotic that made as sample. The antibiotic analyzed based on the group, type, duration of administration, and dosage-drug form along with the dose.Results: The antibiotic that mostly prescribed for pediatric outpatients was antituberculosis for 211 prescriptions (72.99%) which is isoniazid. There are 15 prescriptions (7.11%) with mismatch the duration of use. From 211 prescriptions with complete data to assess the dose, there are 75 prescriptions (35.55%) with mismatch dose and the most dosage form is pulveres for 121 prescriptions (57.35%).Conclusion: It shows that isoniazid was the most prescribed antibiotic for pediatric outpatients in Universitas Sumatera Utara Hospital, Medan, and there is still mismatch in dose and duration of use in antibiotic prescribing for pediatric.