HEALTH RELATED OUTCOME RESEARCH ON PATIENTS EXPERIENCED ADVERSE DRUG REACTION WITH NSAID USE *Vinay G. Pawar, Dixon Thomas, Molly Mathew, C. Vijaya Raghavan RIPER, Anantapur, A.P., Karpagam University, Coimbatore, T.N., Malik Deenar College of Pharmacy, Kasaragod, Kerala, PSG College of Pharmacy, Coimbatore, T.N.
It is a prospective study that evaluated the cost of illness and reduction in quality of life in male wage earners. The cost of Adverse Drug Reactions (ADRs) including cost at hospital, wages lost, and transportation cost for hospital visit if any. Naranjo's scale was used to assess the causality of adverse drug reactions due to NSAIDs ranging from nausea to peptic ulcer. The total cost spent for managing the ADR was on an average Rs.587 (range Rs. 130-1550). The average daily wage of the patients was around Rs.200. Average days of not working due to ADR were 2. Quality of Life (QOL) reduction in Karnofsky's performance rating scale was on an average 27% (range 10-60%). All popular NSAIDs were causing ADRs.
ADVERSE EVENTS AND PHARMACOECONOMIC EVALUATION IN CHRONIC KIDNEY DISEASE (CKD)
*S. Rubia, B. Narasimhulu, K. Yamini Priyanka, V. N. HariKiran, Seeba Zachariah RIPER, Anantapur, A.P
This qualitative and quantitative evaluation was performed on CKD patients in a South Indian tertiary care teaching hospital. Adverse reactions reported in one month period were hypotension (13), shivering (5), pruritis (7), vomiting (19), muscle cramps (7), chest pain (21), vascular access occlusion (6), hypertension (17), fever (20), dyspnea (14), headache (13) and cardiac arrest (2). Patient noncompliance incidences were not taking the medication7 (15%), missed doses 23 (49%), missed dialysis 12(25%), and demand to stop dialysis in between 5(11%). The average monthly cost of medication was Rs.572 +- 287.5; range 192.8-1412.8 and median Rs.551. Diabetic patients had a higher cost of medicines (average Rs.757.2) compared with non-diabetic patients (average 502.6) with a p-value 0.021.
EPIDEMIOLOGICAL ANALYSIS OF ENDSTAGE RENAL DISEASE (ESRD) PATIENTS ATTENDING HEMODIALYSIS *D. Giri Raja Sekhar, Seeba Zachariah, J. Valsala Kumari, Jacob George RIPER, Anantapur, A.P., Medical College, Trivandrum, Kerala This prospective study was conducted in a tertiary government teaching hospital for a period of six months in Kerala. Etiology of ESRD was identified as diabetes mellitus, hypertension, glomerulonephritis, and others. Co-morbidity of the patients includes hypertension, other cardiovascular diseases, diabetes, UTIs, COPD, chronic liver disease, dyslipidemia. Acetate buffer solution was used as dialysate in 79% of patients and bicarbonate buffer was used in 21% patients. The mean blood flow rate was 250ml/min; mean dialysate flow rate was 500ml/min and mean dialysis session was for 240 min. The longest period on dialysis was 26 months. This was very poor compared to the health standards in developed countries.
HIGH PREVALENCE OF ANEMIA IN WOMEN AT ANANTAPUR, A.P
*K. Usha, N. Sreelalitha, Rohit R. Bhavasar, M. Sophy, M.S. Kannan RIPER, Anantapur, A.P., RDT, Hospital, A.P. Data were collected from inpatients of a charitable multispecialty rural hospital with 400 beds at Anantapur, A.P. The study was for a period one month, April 2010. There was high prevalence of anemia due to various reasons, totaling 205 per month. The lowest age was one year and the highest was 74 years. Average hemoglobin level was 8.9g/dl (range 2-10.9). Common reasons for anemia were pregnancy (34%) and nutritional deficiency (7%). Different age groups affected with anemia include 6.8% (1-10yrs), 31.2 %( 11-20yrs), 35.2% (21-30yrs), 7.8% (31-40yrs), 6.8% (41-50yrs), 6.8% (51-60yrs), 5% (61-70+yrs). According to severity, 59 (28.7%) had mild anemia, 124 (60.4%) had moderate anemia and 22 (10.9%) had severe anemia. DRUG USE EVALUATION OF BROAD SPECTRUM PENICILLINS *Y. Samhita Reddy, G. Narayana, M. Jaffer, J. Raveendra Reddy, Y. Padmanabha Reddy RIPER, Anantapur, A.P., RDT, Hospital, A.P. This eight month study was conducted on the inpatients prescribed with broad spectrum penicillins in a rural South Indian tertiary care hospital. Out of 600 cases evaluated only 4 patients were prescribed with amoxicillin as a monotherapy. Ampicillin was commonly prescribed as monotherapy. ampicillin-cloxacillin combination was rarely prescribed. Patients treated with Amoxiclav stayed in the hospital for an average of 2.2 (+-1.4) days and those on ampicillin for 5.4 (+-2.3) days. Amoxiclav was prescribed three times a day for 96% of the cases and ampicillin was prescribed two times daily for 88% of cases. Antibiotics used along with amoxicillin include amikacin, ceftriaxone, clindamycin, erythromycin and cloxacillin. Antibiotic adjuvants of ampicillin include cefotaxim, amikacin, cefoperazone, amoxicillin and ceftriaxone.
COMPREHENSIVE EVALUATION OF PHARMACY HEALTH CARE PROVIDERS IN SUB URBAN AREAS OF SOUTHERN ANDHRA PRADESH
*A.Srinadh, G. Seetaram, D. K. Sudheer Naik, C. Sowmya, Y. Padmanabha Reddy RIPER, Anantapur, A.P. International Pharmaceutical Federation (FIP) scale for the 'eight star' pharmacies was used for this study. Among the working pharmacists one had M. Pharm, one had B. Pharm and 39 (64%) had diploma in pharmacy. There were 20 (33%) unqualified pharmacists. Out of the 61 pharmacists 51 (84%) were males and 10 (16%) were females. Public accessibility to the pharmacies were high for 18 (30%), medium for 15(15%) and low for 28 (45%) pharmacies. Only 38 (62%) pharmacies had the physical presence of pharmacist had average star score of 2.6 and 23(38%) pharmacies were working without a qualified pharmacist had scored its stars as 1.2 on an average.
EVALUATION OF ANTIMALARIAL DRUG USE IN A MALARIA EPIDEMIC AREA
*V. N. HariKiran, D. Giri Raja Sekhar, J. Raveendra Reddy, M. S. Kannan RIPER, Anantapur, A.P., RDT, Hospital, A.P. This six months study shows high prevalence of malaria in rural Andhra Pradesh. Total 110 patients were admitted in the hospital due to clinical malaria (90), Plasmodium vivax malaria (12) and Plasmodium falciparum malaria (08). Two patients in clinical and P.falciparum malaria were transfused with blood. Average number of hospital stay for all the groups were near to 4 days. Drug of choice for clinical malaria was chloroquine phosphate 39 (43%); for P.vivax it was primaquine 8(67%) and for P.falciparum malaria it was quinine 5 (63%). Monotherapy was used in 66% of clinical malaria, 42% of P.vivax malaria and 38% of P.falciparum malaria. Other commonly used drugs were artesunate, artemether and pyrimethamine.
DRUG OF CHOICE FROM MEDICAL ORDERS FOR FEBRILE SEIZURES AT A RURAL SOUTH INDIAN HOSPITAL *N. Sreelalitha, K. Usha, K. Thejomoorthy, Durgesh Tadepalli RIPER, Anantapur, A.P., RDT Hospital, A.P. In our tertiary care pediatric hospital, 53 patients were admitted due to febrile seizures with co-morbidities in the pediatric department (Male - 51%, Female 49%). The average duration for the hospital stay was 3 days. In typical febrile seizures the average hospital stay was one day and treated with diazepam and paracetamol. Commonly prescribed antiepileptic drugs were; diazepam (72%), lorazepam (30%), Phenytoin (15% - in patients who had secondary convulsive disorders other than febrile seizures), Carbamazepine (10% - in patients who had secondary convulsive disorders other than febrile seizures) & Sodium Valproate (09% - in patients who had secondary convulsive disorders other than febrile seizures). Patients with mono or combination therapy included, diazepam, the most common monotherapy (91%).
STEROIDAL ANTI-INFLAMMATORY DRUGS USED IN CHILDRENS' HOSPITAL
*G. Seetaram, S. K. R. Soumya, E.Vigneshwaran, K. Balaji, Y. Padmanabha Reddy RIPER, Anantapur, A.P., RDT Hospital, A.P. Out of 75 steroidal dosage forms prescribed, 61% were inhalations containing mainly budesonide (N=46); 32% were oral preparations containing prednisolone (N=20) and budesonide (N=4); 7% were injections of hydrocortisone (N=5). Out of 64 steroidal molecules prescribed in 50 patients, 47% were for asthma and other hyper sensitivity disorders, and another 47% were for bronchopneumonia. Other indications like urticaria, meningitis etc rarely demanded a steroid. One of the interesting find out was that out of 50, male patients were 35 and female patients were 15. The male to female ratio in need of steroidal anti inflammatory agents were 2.3:1.
EVALUATION OF DRUG PRESCRIBING INDICATORS FOR RATIONAL USE OF ANTIBIOTICS IN BRONCHOPNEUMONIA *Rohit R. Bhavasar, A. Srinadh, Dixon Thomas, Durgesh Tadepalli RIPER, Anantapur, A.P., RDT Hospital, A.P. The percentage of hospitalizations with one or more antimicrobial was found to be 41.66% in the first month and 32.97% in the second month. The average number of antimicrobial drugs prescribed per hospitalization was 2. The average cost of antimicrobial drugs prescribed per hospitalization was Rs.352 (SD+-177.52). The average duration of prescribed antimicrobial drug treatment was 4.5 days. The most commonly prescribed antibiotics were Amoxiclav (46%) followed by Amikacin (33%).
PRE-OPERATIVE AND POST-OPERTIVE ANTIMICROBIAL PROPHYLAXIS IN DIFFERENT TYPES OF SURGERIES *D. K. Sudheer Naik, Vinay G. Pawar, Y. Samhita Reddy, Hidayatulla Pathan, T. Raghavendra RIPER, Anantapur, A.P., RDT Hospital, Anantapur, A.P. Out of total 100 cases collected, hernia cases 16, appendectomy cases 12, haemorrhoid cases 16, fistula cases 12, Z-plasty cases 14, Miscellaneous 30. Cefazolin was the most commonly used pre operative antimicrobial in herniotomy. Metronidazole, Cefuroxime, Cefazolin were the commonly used pre and post operatively in appendicectomy. Metronidazole was prescribed commonly pre and post operatively in hemarrhoids. Metronidazole was used pre operatively and along with amoxiclav post operatively in fistula.
WARD ROUNDS FOR PATIENT SAFETY IN HIV / AIDS
*S. K. R. Soumya, K. Thejomoorthy, Gerardo RIPER, Anantapur, A.P., RDT Hospital, Anantapur, A.P., Care & Support Center, Anantapur, A.P. A daily ward round provides extensive patient support and bedside teaching. The survey was done on a 50 beds HIV/AIDS hospital in Anantapur district, Andhra Pradesh. The ward rounds start at 9.30 AM and extend for 21/2 to 3 hours. The ward round team spent 15 to 20 minutes for each patients. The team includes 4 doctors, 3 nurses, 2 ward attendants and 3 Pharm. D students. The bedside counseling affirms the confidence of patients on their rights. We follow USAIDS and UNAIDS guidelines for rights of HIV/AIDS patients.