Browsing by Author "P, Mishra"
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Publication A study on rational drug prescribing and dispensing in outpatients in a tertiary care teaching hospital of Western Nepal(kathmandu University, 2006) K, Alam; P, Mishra; M, Prabhu; PR, Shankar; S, Palaian; RB, Bhandari; D, BistaObjectives: To analyze the prescriptions of out-patients for rational prescribing and dispensing and to evaluate the patient’s knowledge regarding use of drugs, using INRUD indicators. Methods: A cross-sectional, descriptive study was conducted at the Manipal Teaching Hospital, Pokhara, Nepal during the time period from June 10 th to August 19 th 2004. Results: Totally 247 prescriptions were randomly selected for analysis, wherein 720 drugs were prescribed. Only 15% of drugs were prescribed by generic name, 21.67% of the total drugs consisted of fixed-dose combinations, only 40% of drugs were from the Essential drug list of Nepal and 29.44% (n=212) were from the WHO Essential drug list. It was found that more than half (54.17 %) of the drugs were from Nepalese National Formulary and 35.69% were from WHO model formulary. Dermatological products were most commonly prescribed followed by drugs acting on central nervous system, antimicrobials and drugs acting on cardiovascular system. Among the drugs dispensed, 79.16% were oral followed by topical (18.19%) and parenteral forms (2.98%). Diagnosis was mentioned only in 3.23% (n=8) of the prescriptions and the average cost per prescription was found to be 241.11 Nepalese rupees (US$ 3.26). It was found out that pharmacist labelled only 0.4% of the medication envelopes with the name of the patient. However, 82.6% of the medication envelopes were labelled with name of the drug and 87.0 % with drug strength. Only 53.8% (n=133) of the patient knew both the duration of the therapy and administration time of drugs. Conclusion: There is a need for educational intervention for prescribers and both managerial and educational intervention for the hospital pharmacists to improve prescribing and dispensing. Key words: Rational use of drugs, Dispensing, Pharmacist, PrescribingPublication Drug induced hepatitis with anti-tubercular chemotherapy: Challenges and difficulties in treatment(Kathmandu University, 2007) PV, Kishore; S, Palaian; R, Paudel; P, Mishra; M, Prabhu; PR, ShankarTuberculosis is a major health burden worldwide. In Nepal, it is a significant cause of morbidity and mortality. Although better drugs are available for managing tuberculosis, treatment failure is one of the common problems encountered. Among the various causes which can cause treatment interruption, drug induced hepatotoxicity is a common cause. Isoniazid and Pyrazinamide are the common drugs causing hepatotoxicity. Upon occurrence of hepatotoxicity, the hepatotoxic drugs should be stopped and reintroduced as per the available guidelines. The healthcare professional should also counsel the patients for recognizing the early symptoms due to hepatotoxicity which could prevent morbidity. Key words: Adverse effects, Hepatotoxicity, Tuberculosis.Publication Initiating and strengthening medical student research: Time to take up the gauntlet(Kathmandu University, 2006) PR, Shankar; TS, Chandrasekhar; P, Mishra; P, SubishSelf-directed learning and evidence-based medicine are becoming increasingly important in medical education. Medical student research projects can enable students to learn research methodologies and critical analysis skills. Medical schools in developed countries have introduced research programmes for medical students. A few medical colleges in developing countries have initiated student research programmes. South Asia has a huge population and massive health problems and research may be helpful in finding solutions. Student research can contribute to the published output of institutions. Research projects can help students to develop critical analysis skills, teach them to write for peer-reviewed publications and can foster student-faculty interaction. In Nepal, opportunities and funding for research are limited. Principles of scientific research should be taught to students. A community research project should be made compulsory. Funding for research should be boosted and infrastructure strengthened. Faculty members actively involved in research can serve as powerful ‘role models’. Marks should be allotted for research projects and students must be encouraged to publish their findings. Publications and projects should be considered during admission to postgraduate courses. Student research should be initiated, actively pursued and strengthened.Publication Intensive care unit drug utilization in a teaching hospital in Nepal(Kathmandu University, 2005) PR, Shankar; P, Partha; AK, Dubey; P, Mishra; VY, DeshpandeObjectives: The intensive care unit (ICU) is a setting where a large number of drugs are administered to patients and the costs of hospitalization and drug treatment are high. Information on drug utilization in intensive care units (ICUs) are lacking in western Nepal. The present study was carried out to obtain information on the basic demographic pattern of the respondents , drug utilization during the study period, the antibiotic sensitivity patterns of isolated microorganisms and measure drug consumption in defined daily dose (DDD)/ 100 bed-days. Methods: A retrospective analysis of patients admitted to the ICU of the Manipal Teaching hospital, Pokhara, Nepal during the time period from 01/02/2002 to 31/05/2002 was carried out. The ICU mortality rate, length of stay greater than 7 days and median length of stay were calculated. Results: A total of 259 individuals were admitted. The ICU mortality rate was 15.4%; median length of stay was 4 days. E.coli, H.influenzae, K.pneumoniae, S.aureus and P.aeruginosa were the common organisms isolated and were found to be resistant to some of the commonly used antibiotics. Mean ± SD number of drugs and cost of drugs were 5.1 ± 2.7 and 1958.5 ± 1267.8 Nepalese rupees (25.1 ± 16.2 US$). Total drug consumption was 356.4 DDD/100 bed-days. Consumption of intravenous fluids was 25.8 litres/100 bed-days. Conclusions: An antibiotic use policy should be framed. Formation of a multidisciplinary team to oversee drug use and periodically review microbial sensitivity patterns will be helpful. Longitudinal surveillance of ICU drug use should be carried out. Key words: Antibiotic sensitivity patterns, Defined daily dose, Drug utilization, Intensive care unitPublication Interaction between warfarin and tamoxifen: A case report(Kathmandu University, 2007) D, Mishra; R, Paudel; PV, Kishore; S, Palaian; D, Bista; P, MishraWarfarin is a commonly used anticoagulant with documented reports of drug interactions. Tamoxifen is used in the adjuvant hormonal treatment of women with oestrogen-receptor- positive breast cancer. Warfarin and tamoxifen are known to interact with each other with a resultant increase in the bleeding tendency. These reports are mainly from the white population. We report a case of drug interaction between warfarin and tamoxifen with an acute onset. This report suggests that when these drugs are co administered, careful monitoring of the coagulation profile is needed. Key words: Drug interaction, Tamoxifen, WarfarinPublication Ocular side effects of antitubercular drugs- A focus on prevention, early detection and management(Kathmandu University, 2005) SB, Kokkada; R, Barthakur; M, Natarajan; S, Palaian; AK, Chhetri; P, MishraGiven the increasing prevalence of tuberculosis, antitubercular drugs frequently used are also associated with ocular toxicity. Ethambutol is the most commonly implicated drug. It is generally well tolerated, but known to cause optic neuritis, more specifically retro bulbar neuritis causing blurred vision, decreased visual acuity, central scotomas, and loss of red-green color vision. The exact mechanism of toxicity is not understood. Though optic neuritis due to ethmabutol is generally considered to be reversible upon prompt discontinuation of the drug, there are reports of reversible toxicity, particularly in the elderly population. Isoniazid can rarely cause retro bulbar neuritis. Dose relationship is usually not seen. Streptomycin is known to cause pseudo tumorcerebri. Thiacetazone can produce severe cutaneous reactions including Steven Johnson Syndrome affecting the skin and mucosa including conjunctiva. Educating the patients for early detection of the ocular manifestations and regular follow-ups are very essential. Keywords: Anti- tubercular drugs, Ethambutol, Ocular side effectsPublication Role of drug and therapeutics committee towards drug safety- experiences from western Nepal(Kathmandu University, 2005) S, Palaian; P, MishraNAPublication Safety monitoring of drugs - Where do we stand?(Kathmandu University, 2006) S, Palaian; P, Mishra; PR, Shankar; AK, Dubey; D, Bista; R, AlmeidaDrug related complications, a major cause of hospitalizations, lead to huge economic burden and significant human suffering. New chemical entities enter the market without sufficient safety data on patient population making rare (Adverse Drug Reactions) ADRs undetected in the clinical trials. ADR monitoring helps in detecting the occurrence of rare and unknown ADRs and helps in prevention of further occurrence. Several methods are adopted for effective monitoring of ADRs. An effective ADR monitoring program requires adequate infrastructure and trained manpower. In developed countries, the ADR monitoring system is well established. In Nepal, the concept of ADR monitoring is in the infant stage. A simple approach for ADR monitoring may be helpful in starting an ADR monitoring program in hospital setups in Nepal. Though it is difficult to prevent ADRs, a systematic approach will definitely helps in minimizing the further occurrence of similar ADRs. Key words: Adverse Drug Reactions, Causality assessment, Pharmacoeconomics, Pharmacovigilance, Safety monitoringPublication Therapeutic dimensions of ACE inhibitors- A review of literature and clinical trials(Kathmandu University, 2005) M, Prabhu; S, Palaian; A, Malhotra; P, Ravishankar; D, Bista; R, Almeida; P, MishraIn the 1970s, pharmacological therapy interrupting the renin-angiotensin system was considered beneficial for patients with high-renin hypertension. This gave rise to the development of ACE inhibitors. Surprisingly, the ACE inhibitors proved to be effective not only in patients with high renin hypertension, but also in many patients with normal levels of plasma renin activity. At present ACE inhibitors have a significant position in a wide range of chronic illnesses such as atherosclerosis, hypertension, myocardial infarction, diabetic complications, stroke etc. They are combined safely with drugs like angiotensin receptor blockers, calcium channel blockers and thiazides with varying degree of benefits. Though they are safe drugs, patients need monitoring for renal insufficiency, hypotension, hyperkalemia etc. The safety of these drugs in paediatrics patients is not established. It is better to avoid these drugs during pregnancy. Keywords: ACE inhibitors, Atherosclerosis, Diabetic complications, Hypertension, Myocardial infarctionPublication Withdrawal of rofecoxib- a wake up call for drug safety(Kathmandu University, 2004) P, Mishra; S, PalaianNA