Value of pharmacy services upon admission to an orthopedic surgery unit

Background In Lebanon, the role of the pharmacist remains underestimated in the medication reconciliation process, especially in surgical departments. This study aims to assess the impact of pharmacist-conducted medication reconciliation performed within 48 h of hospital admission to the orthopedic surgical department. Methods This was a prospective single-arm study conducted in a tertiary-care teaching hospital in Lebanon between October 2019 and April 2020. Participants were adult inpatients hospitalized for orthopedic surgeries with ≥ 1 outpatient medications. Properly trained pharmacy resident obtained the Best Possible Medication History (BPMH) and led the reconciliation process. The primary endpoint was the number of reconciliation errors (REs) identified. Descriptive statistics were used to report participants’ responses and relevant findings. Linear regression was performed with the number of REs as a continuous dependent variable using backward method. Results were assumed to be significant when p was < 0.05. Results The study included 100 patients with a mean age of 73.8 years, admitted for elective (54%) or emergency (46%) surgeries. Half of the study population had ≥ 5 home medications. The mean time for taking BPMH was around 8 min. A total of 110 REs were identified in 74 patient cases. The most common discrepancies consisted of medication omission (89.1%) and the most common medications involved were antihyperlipidemic agents. Twenty-four REs were judged as clinically significant, and four as serious. The most common interventions included the addition of a medication (71.9%). Most of the relayed interventions (84.5%) were accepted. The number of home medications was the only variable significantly associated with the number of REs (β 0.492; p < 0.001). Conclusion Pharmacy-led medication reconciliation upon admission to orthopedic surgery department can reduce reconciliation errors and improve medication safety. Trial registration Retrospectively registered in the Lebanon Clinical Trials Registry (LBCTR2020124680).

Molecular mechanisms of antiatherogenic drugs action

The purpose of this review is the analysis of the molecular mechanisms of lipid metabolism, their disorders leading to atherosclerosis, and the influence of modern antiatherogenic and antihyperlipidemic agents on atherogenic mechanisms. At the beginning of the review, a general description of atherosclerosis as pathology, its main characteristics and factors is given. The question of the complexity of the treatment of atherosclerosis and the problems arising in connection with the complexity is considered. Current models of the nature of atherosclerotic lesions are described. Next, we consider modern anti-atherosclerotic drugs used in clinical practice. Their nomenclature is given. Their basic biochemical mechanisms and the nature of their action are analyzed. Their negative effects and side effects are also considered. Then, the molecular and genetic mechanisms associated with atherosclerosis are analyzed in detail. The genes associated with lipid metabolism and the formation of atherosclerotic plaques, their expression and regulation are considered. The question of the influence of known anti-atherosclerotic agents on their expression is also covered. A group of azole drugs and their effect on lipid metabolism are considered in the context of the search for new anti-atherogenic drugs. The final part of the review examines the relevance of the search for new anti-atherosclerotic agents and methods for modeling dyslipidemia as a model of conditions that correlate with anti-atherosclerotic vascular lesions. It was concluded that the search for antiatherogenic drugs among imidazole derivatives is promising.

Effect of Organosulfur Compounds from Different Garlic Preparations on Hyperlipidemia: An in-silico Approach

Garlic is one of the most well-known medicinal plants in terms of hypolipidemic activities. Its organosulfur compounds (OSCs) are probably one of the major groups of potentially active compounds for treating hyperlipidemia. However, the hypolipidemic activities of many garlic OCSs have not been investigated. This study was conducted to predict the potential of garlic OSCs to interact with hyperlipidemia targets and to evaluate their pharmacokinetic properties. 25 OSCs were selected to interact with four major targets of hyperlipidemia named pancreatic lipase, HMG-CoA reductase, PPAR-α, and NPC1L1 using the AutoDock Vina program. The pharmacokinetic properties of OSCs were also evaluated by the SwissADME website. The best binding affinity values were obtained for γ-glutamyl-S-alk(en)ylcysteines. Other OSCs, such as S-alk(en)ylcysteine sulfoxides and ajoenes, presented a moderate to high affinity for the studied targets. However, in-silico evaluation of pharmacokinetic properties showed that γ-glutamyl-S-alk(en)ylcysteines have low absorption. The results displayed that γ-glutamyl-S-alk(en)ylcysteines can potentially be considered antihyperlipidemic agents mainly influencing the intestinal lumen. Therefore, it seems that fresh whole garlic, thermal dehydrated garlic, and freeze-dried garlic products are probably more potent antihyperlipidemic agents due to their higher levels of γ-glutamyl-S-alk(en)ylcysteines.

Barriers in utilizing lipid-lowering agents in non-institutionalized population in the U.S.: Application of a theoretical framework

Cardiovascular diseases are a major cause of death globally. Epidemiological evidence has linked elevated levels of blood cholesterol with the risk of coronary heart disease. However, lipid-lowering agents, despite their importance for primary prevention, are significantly underused in the United States. The objective of this study was to explore associations among socioeconomic factors and the use of antihyperlipidemic agents in 2018 in U.S. patients with hyperlipidemia by applying a theoretical framework. Data from the 2018 Medical Expenditure Panel Survey were used to identify the population of non-institutionalized U.S. civilians diagnosed with hyperlipidemia. This cross sectional study applied the Andersen Behavioral Model to identify patients’ predisposing, enabling, and need factors. Approximately 43 million non-institutionalized adults were diagnosed with hyperlipidemia. With the exception of gender and race, predisposing factors indicated significant differences between patients who used antihyperlipidemic agents and those who did not. The relation between income level and use of antihyperlipidemic agents was significant: X2 (4, N = 3,781) = 7.09, p <.001. Hispanic patients were found to be less likely to receive treatment (OR: 0.62; 95% CI: 0.43–0.88), as observed using a logistic model, with controls for predisposing, enabling, and need factors. Patients without health insurance were less likely to use lipid-lowering agents (OR: 0.33; 95% CI: 0.14–0.77). The present study offers essential data for prioritizing interventions by health policy makers by identifying barriers in utilizing hyperlipidemia therapy. Non-adherence to treatment may lead to severe consequences and increase the frequency of fatal cardiac events in the near future.

Intervention of Screening Programme for Hypertension and Lipid Profile on Prescribing Pattern of Antihypertensive and Antihyperlipidemic Agents

The aim of the present study is to assess the impact of screening programme for the patients visiting community pharmacies and factors influencing the prescribing pattern of antihypertensive and/ or antihyperlipidemic agents. The study was designed as a prospective cohort study conducted between December 2017 and November 2019. Data were collected from the hypertensive patients visiting regularly in the 5 selected community pharmacies located at 5 Taluks of Erode district, Tamil Nadu, India. The required data were collected either from the patient’s record or interview. Data were collected from 946 (75.68%) patients of 1250 patients visited the selected community pharmacies.49.4% and 50.6% of patients were randomly allotted to the control (group I) and intervention (group II) groups respectively.In this study 50.56% and 46.67% of males were in group I and II respectively. Average SBP was measured as 151.5 ± 11.8 mmHg and 168.1 ± 13.6 mmHg for the patients in group I and II respectively whereas 92.9 ± 9.3 mmHg and 92.6 ± 9.5 mmHg were the DBP readings among the patients in group I and II respectively. Average total cholesterol was measured as 253.66 ± 33.67 mg/dL and 271.04 ± 39.91 mg/dL for the patients in group I and II respectively. The difference in the prevalence is 0.7 and 2.05 for the antihypertensive and antihyperlipidemic agents respectively whereas the incidence was observed as 4.75 and 2.5 for the antihypertensive and antihyperlipidemic agents respectively. The odds ratio of SBP and DBP is 1.12 and 0.99 respectively in the group II. The values of multivariate analysis showed that there is an agreement between intervention and utilization pattern of antihypertensive and antihyperlipidemic agents. It is to conclude that the preliminary screening of blood pressure and lipid profile showed many patients were not visiting regularly for consultations. The screening programme has resulted in good improvement in the utilization pattern of antihypertensive and antihyperlipidemic agents. The age, lipid levels and comorbid conditions were main factors among the individuals which have determined the prescribing pattern of agents.

143 Medications Related Fall Incidents among Older Adults at a Teaching Hospital

Background The drugs prescribed for hypertension, hyperglycaemia, and mental disorders affects patients’ mental and postural stability, and ends up in fall related incidents in over 60% cases. Hence, a study was aimed to review the drugs prescribed in older patients with at-least one episode of fall incidents. Method A retrospective study was carried out at a 1000 bedded teaching hospital using electronic big data system to record patients’ information. Results Out of 135 patients who had fall incident(s) during the study period, 69 were male and 66 were female. Majority (n=77; 57%) of the patients were older than 60 years of age and have had at least one co-morbid conditions. Most of the fall incidents have occurred during their inpatient period and at the time of using toilets (67%) and at bedside (22%). Around 42% of the fall incidents were moderate to severe and sadly one patient died due to large subdural hematoma and intra-parenchymal bleeding secondary to fall. Corticosteroids (36%), diuretics (27%), antihypertensives (26%), antidiabetics (25%) and other class of drugs (45%) were commonly prescribed in the patients; and these drugs were given either alone or in combination with other drugs. These drugs have high impact on fall incidents as it may lower the blood volume, blood pressure and blood sugar; it may in turn cause postural instability. Most of the fall incidents where noticed in patients who had diuretics plus antihypertensives (26%), antihypertensives plus antidiabetics (22%), antihypertensives plus antidiabetics plus antihyperlipidemic agents (18%) and corticosteroids (15%) concurrently and at irregular dosing interval. Conclusion Regular monitoring of prescription drugs and its complications are of at most important to prevent future fall related incidents. Hence, an efficient and continuous medication review is warranted in an emergency basis to make the drugs safer to the patients.

A REVIEW: AZADIRACHTA INDICA AS ANTIHYPERLIPIDEMIC ACTIVITY

Antihyperlipidemic agents having various pharmacological actions are being tested clinically3. Elevated lipid levels result from increased absorption through the gut or enhanced endogenous synthesis and therefore two ways are feasible to reduce hyperlipidemia; to block endogenous synthesis or to decrease absorption. Whole plant of Azadirachta indica gives the Antihyperlipidemic activity. Several genetic conditions are known to responsible for primary Hyperlipidemia, such as lipoprotein lipase deficiency, apolipoprotein C-II deficiency etc. In our study we choose cholesterol diet which contains the common ingredients in our daily food. Cholesterol feeding has been often used to elevate serum or tissue cholesterol levels to assess the hypercholesterolemia- related metabolic disturbances in animals. Cholesterol feeding alone however does not affect the serum TG level. Keywords: Azadirachta indica, antihyperlipidemic, antiatherosclerotic activities, Maceration.