The Cannabis Extraction Product as an Adjuvant Treatment in Tourette’s Syndrome: A Case Report

Tourette’s syndrome (TS) is a pediatric onset of neuropsychiatric disorder characterized by motor and vocal tics. First line medication is dopaminergic blocking agents. Yet, these drugs are not effective in all patients and sometimes the side effects are intolerance. Cannabis and its derivatives are to use as an adjuvant treatment. They are used to improve tics in TS patients who failed from the first line treatment. The aim of the present report was to describe the clinical course after using the Government Pharmaceutical Organization (GPO) medical cannabis extraction product as an adjuvant treatment in TS patient. Here, the researchers reported a case of a 26-year-old female patient who had TS. She had received sublingual medical cannabis product. The clinical course and disease severity were recorded before and during the administration of the medical cannabis extraction product using several standards severity score: The Yale Global Tic Severity Scale (YGTSS), Tourette’s Syndrome Severity Scale (TSSS), Turette’s Disorder Scale (TODS), and quality of life using a standardized measure of health-related quality of life developed by the Euro Quality of life group (EQ-5D-5L). The researchers’ observation showed that sublingual administration of medical cannabis extraction product [tetrahydrocannabinol (THC):cannabidiol (CBD) 1:1 and THC enriched] improved both motor and vocal tics without significant adverse effect that came out to be improving the patient’s quality of life as a whole. Keywords: Tourette’s Syndrome (TS); The Government Pharmaceutical Organization (GPO); Medical cannabis extraction product; Cannabidiol; Tetrahydrocannabinol

IMPROVEMENT AND OPTIMIZATION OF COMMODITY POLICY AS A WAY TO INCREASE THE COMPETITIVENESS OF PHARMACIES

Gathering information is a key component of market research marketing. The search and analysis of marketing information is carried out through four auxiliary systems, namely, an internal reporting system, a system for collecting external current marketing information, a system of marketing research and analysis of marketing information. Based on the information received, marketing research of the drug market is carried out and the needs of the population for pharmaceutical products are studied. Among the many areas of marketing research on the activities of pharmacies, the study of the range of sold medical and pharmaceutical goods in order to determine ways to optimize it is of paramount importance. A prerequisite for marketing research is the study of drugs as a product, its main pharmacotherapeutic properties, indications for use, release forms and other merchandising characteristics. It is important to analyze the assessments of consumer properties and indicators of use for each name of medicinal products in the assortment of a pharmaceutical organization. This article provides approaches to the definition of the assortment policy of the enterprise, gives the classification of the assortment of the enterprise «Pharmacy of low prices». The groups of drugs are identified depending on their effect on the pharmacy income. Based on consumer preferences, the main positions of the assortment of pharmacies, which are needed by consumers of the city of Penza and the Penza region, have been determined. Along with determining the optimal assortment of the pharmacy and the number of drugs for each pharmaceutical group on sale, it is important to determine the optimal ratio of drugs for each pharmaceutical group. An algorithm for the formation of a new assortment of the Low-Price Pharmacy enterprise has been developed. Recommendations for improving the assortment policy of the «Low Price Pharmacy» enterprise are offered. The features of pharmaceutical marketing of the market of non-prescription and prescription drugs have been studied. Optimization of the product policy of pharmacy organizations, taking into account the distribution of drugs by pharmaceutical trade groups, will ensure the survival of small-scale retailers in a competitive environment.

EXTEMPORAL MANUFACTURE OF MEDICINES. PROBLEMS AND SOLUTIONS

Despite the decrease in the number of pharmacies having prescription and manufacturing departments the need for extemporally manufactured dosage forms remains high. Pharmaceutical organization dealing with medicines manufacture is currently facing a number of problems: lack of modern pharmaceutical substances at pharmacies, manufacture of medicines containing narcotic substances, psychotropic substances and their precursors, high costs, low profitability of in-pharmacy manufacture and etc. The urgency to preserve and revive ex tempore formulations at pharmacies is highlighted. The groups of patients for whom individual manufacture of medicines is most relevant are identified: children, especially newborn and children under 1 year old, elderly patients, as well as patients with orphan diseases and patients requiring palliative care. The advantages of the extemporal formulation are noted, in particular, the selection of an individual composition and dosage taking into account body characteristics, age, concomitant diseases of the patient, tolerance of medicinal substances and their excipients, etc. Some ways to solve problems arising are suggested. Promising directions for the development of extemporal manufacture are noted: the use of modern excipients, technologies, packaging facilities, the development of internal regulatory documentation for the pharmaceutical quality system and etc.

A Pilot Study of the Government Pharmaceutical Organization (GPO) Cannabis Extract for Multiple Sclerosis (MS) Spasticity Treatment in Thailand

Background: The prevalence of spasticity in multiple sclerosis (MS) patients is nearly 90%. Most patients do not respond to current anti-spastic medications. Objective: To evaluate the efficacy and safety of Government Pharmaceutical Organization cannabis extract (GPOCE) in the treatment of spasticity in MS patients in Thailand. Materials and Methods: This prospective pilot study in patients diagnosed with MS whose spasticity was not relieved under current spasticity treatments, was performed between November 2019 and June 2020. The GPOCE formulation of THC:CBD 1:1 was administered to all patients. The treatment outcomes were determined at 12 weeks and compared with their baseline. Results: Seven patients participated in the present study. Among these, two patients withdrew after receiving only a small dose of GPOCE. Finally, five patients were included in the final analysis. The primary outcome was a reduction in the Modified Ashworth Score (MAS), which decreased among participants from a baseline of 15 (IQR 12 to 19) to 6 (IQR 1 to 12) (p=0.043). The key secondary outcome was a clinically relevant response (CRR), which was defined as a reduction of the spasticity Numeric Rating Scale (NRS) of more than thirty percent compared to baseline. Four patients (80%) achieved CRR. Moreover, the overall spasticity NRS decreased from a median of 6 (IQR5 to 7) to 2 (IQR2 to 3). A reduction of other NRS parameters, including fatigue, pain, tremor, sleep, spasm, anxiety, and depression, was also observed after treatment. Moreover, GPOCE was generally well tolerated. Conclusion: GPOCE is useful in treating spasticity in patients with MS. The safety profile is acceptable under the supervision of a health care provider. Keywords: Multiple sclerosis (MS), Cannabis extract, Spasticity

Life-Saving Drugs in Sudan: A Matter of Defi nitions and Concepts

Background: Drugs are one of the most crucial pillars in the provision of healthcare services and achieving Universal Health Coverage (UHC). Life-Saving Drugs (LSDs) are the drugs that save someone’s life, require immediate administration in most of the cases, as they sustain life, and prevent complications. They are top priority healthcare needs, which required to be available and aff ordable at all time in adequate quantities and low cost for the whole population and thus achieving equity. Since pharmaceutical sector in Sudan is highly fragmented, this study is conducted to determine the degree of stakeholders’ knowledge about the defi nition of LSD, whether there is a policy governing them, if they have a standard list and their availability status in Sudan. Methods: G rounded theory qualitative (exploratory) study design. The theory is grounded from the actual data after being collected and analysed. Results: Only essential medicines is the well-known term for the stakeholders -mainly at the governance level- with its policy and list. The other LSDs terminologies were found to be ambiguous, with no policies or standard lists. The status of the availability of the diff erent LSDs terminologies (as it perceived by each stakeholder) was found to be poor and there is a signifi cant shortage mainly due to the economic issues. Conclusions: Unifi cation of pharmaceutical organization in Sudan is a must and a priority issue due to its ultimate importance in the provision of healthcare services. Consensus and participation of all the relevant stakeholders in designing policies is an important input for a well-designed health system governance. Further researches in diff erent areas must be conducted, and awareness of policymakers and service providers must be raised.

АНАЛИЗ НЕКОТОРЫХ СОЦИАЛЬНЫХ ФАКТОРОВ, ВЛИЯЮЩИХ НА ПОВЕДЕНИЕ ПОТРЕБИТЕЛЯ ФАРМАЦЕВТИЧЕСКИХ ОРГАНИЗАЦИЙ / ANALYSIS OF SOME SOCIAL FACTORS AFFECTING CONSUMER BEHAVIOR OF PHARMACEUTICAL ORGANIZATIONS

В результате исследования мы определили влияние различных факторов на поведение потребителей лекарств и парафармацевтических товаров. Среди них были выделены социально-демографические, социально-психологические и товарные оценочные факторы. Как социально-психологические оценочные факторы при выборе потребителем лекарств нами были рассмотрены мотивация; потребительский этноцентризм; престижность; потребительская враждебность. В ходе проведенного анализа характеризовано влияние функциональных и приданных характеристик лекарств на принятие решения о покупке. Исследованы социальные факторы среды мелкорозничной фармацевтической организации (аптеки) и доказано их влияние на потребительское поведение на месте продажи. Установлена прямая взаимосвязь между количеством стандартов обслуживания, удовлетворенностью персонала и частотой посещения аптеки потребителями. / In this article the influence of various factors on consumer’s behavior of pharmaceutical products is defined. Among such factors socially-demographic, socially-psychological and commodity estimated factors are allocated and described. Influence of the functional and structure characteristics of medical products on decision-making about purchase is separately characterized. Social factors of the environment of the pharmaceutical organization are investigated and their influence on consumer behavior is statistically proved. The lowest level of satisfaction is observed among pharmacists who are constantly busy serving consumers; the average degree of satisfaction – among employees who do not have contact with end users and the greatest satisfaction with work was found among the administrative and management personnel. The performed diagnostics of the social environment of the pharmacy made it possible to identify the main factors for the subsequent assessment of their influence on consumer behavior. The analysis of the dependence of consumer behavior (frequency of visits) on their social environment was carried out, which showed the presence of a direct relationship between the number of service standards, as well as the satisfaction of pharmacists. It was found that the greater the number of service standards, the greater the satisfaction of the personnel with labor motivation. And the greater the satisfaction of pharmaceutical workers with the quality of work, the higher the frequency of visits by consumers to the surveyed pharmacies.

Trends in implementation of good practices in pharmaceutical organizations

The level of knowledge and competencies of a graduate of a pharmaceutical university and specialist regarding the requirements of good pharmacy practice in pharmaceutical organizations of the Republic of North Ossetia-Alania is analyzed. A gap in the knowledge of graduates and specialists was identified and an author’s program for developing competencies for creating modern quality systems for pharmaceutical services and products was developed. The sample of the study was formed from the heads and pharmacists of retail pharmacy organizations of the Republic of North Ossetia-Alania of all forms of ownership, of which 38% were heads of a pharmaceutical organization, and the rest were pharmacists. Significant gaps and shortcomings of basic knowledge were identified among the management team, the main staff of pharmacists authorized for quality and implementation issues, as well as the creation of quality management systems in pharmaceutical organizations. Disadvantages associated with the lack of mechanisms for implementing the requirements of good pharmacy practice and the creation of a quality system in a pharmaceutical organization require action. So, it is necessary to develop modern educational modules that reflect the trends of modern transformations in the pharmaceutical industry. The low motivation of the staff of pharmaceutical organizations to improve their qualifications on the creation of quality systems was noted, due to the lack of basic knowledge among pharmacists and a sufficient amount of educational programs and modules. The author’s model of training specialists capable of creating modern quality systems in the pharmaceutical organization and the characteristics of the educational complex of the new discipline of choice are presented