Browsing by Author "Palaian, S"
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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) Alam, K; Mishra, P; Prabhu, M; Shankar, PR; Palaian, S; Bhandari, RB; Bista, DObjectives: 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) Kishore, PV; Palaian, S; Paudel, R; Mishra, P; Prabhu, M; Shankar, PRTuberculosis 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 Drug information services in Nepal: The changing perspectives(Kathmandu University, 2008) Chhetri, AK; Palaian, S; Mishra, PNAPublication Interaction between warfarin and tamoxifen: A case report(Kathmandu University, 2007) Mishra, D; Paudel, R; Kishore, PV; Palaian, S; Bista, D; Mishra, PWarfarin 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 Irrational fixed dose combinations in Nepal: Need for intervention(Kathmandu University, 2008) Poudel, A; Palaian, S; Shankar, PR; Jayasekera, J; Izham, MIMAbstract A large proportion of drugs available are of little importance in terms of ful lling primary healthcare needs. Combination drugs increase the risk of side effects, lead to an ineffective dosage and liability to abuse and may also needlessly increase the cost. Drug combinations make it more dif cult to nd the causative agent responsible for the adverse reactions. In many cases their stability is doubtful, reducing the ef cacy of many preparations. The Fifteenth WHO model list of essential medicines (March 2007) contains only 25 approved xed dose combinations, whereas in Nepal, there are innumerable examples of irrational drug combinations, which are easily available and can be bought even without a prescription. A system of screening the drug combinations that are already licensed and available in the market is implemented in many developed and developing countries. Rational combinations can be of immense help to the health care system. These combinations may improve the quality of life for many and increase compliance. But irrational xed dose combination products can be equally harmful. Key words: Adverse drug reaction, Combination drugs, Fixed dose combination, Irrational drug use, NepalPublication Ocular side effects of antitubercular drugs- A focus on prevention, early detection and management(Kathmandu University, 2005) Kokkada, SB; Barthakur, R; Natarajan, M; Palaian, S; Chhetri, AK; Mishra, PGiven 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 Prevalence of adverse drug reactions with commonly prescribed drugs in different hospitals of Kathmandu valley(Kathmandu University, 2008) Alam, K; Palaian, SNAPublication Regarding the article “Irrational fixed dose combinations in Nepal: Need for intervention”(Kathmandu University, 2008) Poudel, A; Khanal, S; Alam, K; Palaian, SNAPublication Role of drug and therapeutics committee towards drug safety- experiences from western Nepal(Kathmandu University, 2005) Palaian, S; Mishra, PNAPublication Safety monitoring of drugs - Where do we stand?(Kathmandu University, 2006) Palaian, S; Mishra, P; Shankar, PR; Dubey, AK; Bista, D; Almeida, RDrug 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) Prabhu, M; Palaian, S; Malhotra, A; Ravishankar, P; Bista, D; Almeida, R; Mishra, PIn 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 Understanding the essentials of drug interactions: A potential need for safe and effective use of drugs(Kathmandu University, 2007) Bista, D; Palaian, S; Shankar, PR; Prabhu, MM; Paudel, R; Mishra, PDrug interactions (DIs) represent an important and widely under recognized source of medication errors. An interaction is said to occur when the effects of one drug are changed by the presence of another drug(s), food, drink or an environmental chemical. When a therapeutic combination could lead to an unexpected change in the condition of the patient, this would be described as an interaction of potential clinical significance. DIs can arise in numerous ways; such as pharmacodynamic interaction, in which receptor effects of different agents interacts to produce synergy or antagonism of drug effects. In pharmacokinetic interaction, the blood levels of given agents may be raised or lowered based on the type of interaction. Special attention and thorough monitoring is needed for the patients who are predisposed to develop DIs and those on drugs with narrow therapeutic index. DIs can be a very important contributory factor for the occurrence of adverse drug reactions and adverse drug events. DIs monitoring programs should be initiated and strengthened in order to minimize their occurrence. Herbal drug interactions and DIs comprising over the counter medicines should also be considered seriously. Key words: Drug interaction, Herbal drug interactions, Drug interaction monitoring, Over the counter medicationsPublication Why treat? Better prevent: Adult immunization(Kathmandu University, 2008) Kishore, PV; Palaian, S; Paudel, R; Paudel, B; Mishra, P; Prabhu, MAbstract Immunization is a safe, effective and simple way to prevent life threatening illnesses not only in children but also in adults. Vaccines are some of the safest medicines available which can relieve suffering costs related to these preventable diseases. The reason for underutilization of vaccines in adults are 1) Low prioritization of the importance of vaccines preventable diseases among adults 2) Uncertainty or lack of knowledge about the safety and efficacy 3) Lack of universal recommendations for all adults and 4) Financial constraints, especially in developing countries. Adult immunizations are administered in primary series like previously immunized, booster doses and periodic doses. Agents include Toxoids (Diphtheria and Tetanus), Live Virus Vaccines (Measles, Mumps and Rubella), and inactivated virus vaccines (Influenza), Inactive viral particles (Hepatitis B), inactivated bacterial polysaccharide vaccine (Pneumococcal) and Conjugate / Polysaccharide vaccine (Meningococcal). And also vaccines like Hepatitis A, Polio and Varicella may be recommended in some. Since the economy and literacy rate has shown a steady rise in the South Asia and people are being aware of different health problems through the recently advanced global communication, the education and awareness for immunization not only in children but also in adults need a special consideration. Keeping in view the statistical data of suffering costs related to the non-utilization of immunization in adults, the need of hour has come for utilization of immunization to emphasize its importance. Key words: Adult immunization, Vaccines.Publication Withdrawal of rofecoxib- a wake up call for drug safety(Kathmandu University, 2004) Mishra, P; Palaian, SNA