Potential drug–drug interactions and radiodiagnostic procedures: an in-hospital survey

Objectives To evaluate the type, frequency, severity and predictors of potential Drug-Drug Interactions (DDIs) in a cohort of patients undergoing radiodiagnostic procedures. Setting Eight Radiology wards located in Tuscany (Italy). Methods All participants exposed to at least two medications were included in the analysis. DDIs were grouped according to their severity as ‘minor’, ‘moderate’ or ‘major’. A logistic model was used to estimate Odds Ratios and 95% Confidence Intervals for all predictors of potential DDI. Main outcome measures Type and predictors of potential DDI in a cohort of patients undergoing radiodiagnostic procedures. Results One-thousand-and-two subjects (57.6% females; mean age: 67.3 ± 12.2) entered the analysis, and 46.1% of them incurred in a potential DDI (78.9% ‘moderate’ in severity). The combination of allopurinol and ACE-inhibitors was the most frequent (21/153) among major potential DDIs, while steroids were involved in all cases of potential DDI due to premedication. Co-morbidity, number of co-medications, advanced age and premedication use increased the risk of potential DDI; a protective role was found for positive history of allergy. When the analysis was restricted to subjects with premedication (n = 93), only 12.9% of them reported a potential DDI directly attributable to premedication drugs. Conclusions Among patients undergoing radiological examination, types and predictors of potential DDIs appeared in agreement with other kind of in-hospital populations. Premedication revealed to be a proxy predictor for potential DDIs. Considering the poor capability of the prescriber in recognizing interactions, their systematic evaluation (using an informatics tool) in patients undergoing radiological examination might be helpful in preventing the occurrence of clinically relevant DDIs.     

Identification and physicians?? views of their commonly-used drug information sources in Singapore

Aim To examine physicians?? use and views of various sources for general drug information and to determine the kind of drug-related questions they receive. Method An online survey of general practitioners who were Singapore Medical Association members was conducted. The survey consisted of questions about the physicians?? demographics, the drug information source they used most often, their opinions on the information from that source, and the types of drug-related questions they received from patients. Results Among the 236 physicians who responded to the survey, 58.1% used reference texts most frequently; of these respondents, 80.3% used the Monthly Index of Medical Specialties. Only 4.2% most often go to pharmacists for drug information. Of the 75 (31.8%) respondents who chose online sources, about half used Google while the remainder used specific websites. Most respondents rated drug information from reference texts as somewhat comprehensive (71.5%) and usually reliable (81.8%). The choice of drug information sources was associated with physicians?? age, place of practice, access to the Internet, and clinical experience (P?Conclusion Most physicians in Singapore search for general drug information using reference texts and consider them to be comprehensive and reliable. Questions pertaining to adverse drug reactions were the drug-related questions physicians most frequently receive. It is important for physicians to have appropriate drug information references and learn methods with which to verify the credibility of drug information obtained from the Internet. Pharmacists can also work to improve their role as providers of drug information.     

Diabetes care in Qatar: a survey of pharmacists’ activities,attitudes and knowledge

Background Diabetes mellitus is recognized as a major public health issue and is one of the top ten causes of death in Qatar. Objective To describe the activities, and attitudes of Qatar pharmacists toward diabetes, to measure their diabetes knowledge and to assess their perceived barriers for diabetes care. Setting Community and ambulatory pharmacies in Qatar. Method Study objectives were addressed in a cross sectional survey of community and ambulatory pharmacists in Qatar. A phone call explaining the study was made to all community and ambulatory pharmacists in Qatar. Consenting pharmacists anonymously completed the survey either online or as paper. Main outcome measure Diabetes related activities, knowledge, attitudes and perceived barriers. Results Over 7 months, 126 surveys were collected (28% response rate). The majority of pharmacists always or often counselled patients on the appropriate time to take each medication and on medication side effects (90%, n = 100/111 and 73%, n = 81/111 respectively). Yet around 50% always or often provided education on the importance of screening for nephropathy (n = 59/112) and retinopathy (n = 58/109). In addition, 41% always or often provided education about the importance of immunization (n = 45/111) and 45% always or often provided therapy recommendations to physicians (n = 49/111). Using Diabetes Attitude Scale-3, most respondents had positive attitudes toward the need for special training, psychosocial impact of diabetes, and patient autonomy. Around 25% (n = 32/126) scored less than 6 out of 10 on the diabetes related knowledge test. The top three barriers for providing diabetes services were lack of time (53%, n = 67/126) shortage of personnel (42%, n = 53/126) and lack of private counseling area (42%, n = 53/126). Conclusion Qatar pharmacists mainly provide basic services for diabetic patients. They have an average diabetes related knowledge. Yet overall, they have positive attitudes toward diabetes, which is a vital component of any successful diabetes care service.

     

Can thermodynamic measurements of receptor binding yield information on drug affinity and efficacy?

The present commentary surveys the methods for obtaining the thermodynamic parameters of the drug-receptor binding equilibrium, DeltaG degrees, DeltaH degrees, DeltaS degrees, and DeltaC degrees (p) (standard free energy, enthalpy, entropy, and heat capacity, respectively). Moreover, it reviews the available thermodynamic data for the binding of agonists and antagonists to several G-protein coupled receptors (GPCRs) and ligand-gated ion channel receptors (LGICRs). In particular, thermodynamic data for five GPCRs (beta-adrenergic, adenosine A(1), adenosine A(2A), dopamine D(2), and 5-HT(1A)) and four LGICRs (glycine, GABA(A), 5-HT(3), and nicotinic) have been collected and analyzed. Among these receptor systems, seven (three GPCRs and all LGICRs) show "thermodynamic agonist-antagonist discrimination": when the agonist binding to a given receptor is entropy-driven, the binding of its antagonist is enthalpy-driven, or vice versa. A scatter plot of all entropy versus enthalpy values of the database gives a regression line with the equation TDeltaS degrees (kJ mol(-1); T = 298.15 K) = 40.3 (+/- 0.7) + 1.00 (+/-0.01) DeltaH degrees (kJ mol(-1)); N = 184; r = 0.981; P < 0.0001 - which is of the form DeltaH degrees = beta. DeltaS degrees, revealing the presence of the "enthalpy-entropy compensation" phenomenon. This means that any decrease of binding enthalpy is compensated for by a parallel decrease of binding entropy, and vice versa, in such a manner that affinity constant values (K(A)) of drug-receptor equilibrium (DeltaG degrees = -RT ln K(A) = DeltaH degrees - TDeltaS degrees ) cannot be greater than 10(11) M(-1). According to the most recent hypotheses concerning drug-receptor interaction mechanisms, these thermodynamic phenomena appear to be a consequence of the rearrangement of solvent molecules that occurs during the binding.     

Appropriateness evaluation of Drug Information Center’s Facebook page for evidence-based drug information dissemination

ObjectiveTo assess the characteristics of an unpaid Facebook page for drug information (DI) and its reachability to users.MethodsIn this retrospective observational study over a 6-month duration, a Facebook page for the DI Center was created. One drug-related clinical question recently asked in the DI Center by a hospital clinician and its evidence-based answer along with the appropriate references were framed in a scenario and posted on the Facebook page on working days. The Facebook page likes, consumption, reach, engagement, impressions, and total number of followers were obtained from Facebook insights. The monthly averages of these parameters were assessed using the augmented Dickey–Fuller (ADF) test.ResultsThe cointegration (ADF) test revealed a statistically significant time-dependent correlation trend between the mean engaged users and mean monthly reach (ADF, –4.904; P = 0.01). Similarly, a statistically significant time-dependent correlation trend was observed with mean engaged users and mean monthly impressions (ADF, –5.456; P = 0.01).ConclusionThe knowledge gap between quality DI and evidence-based medicine practice in a developing country can be bridged with a novel DI Center Facebook page initiative.     

Consistency of psychotropic drug–drug interactions listed in drug monographs

Background

With an increasing prevalence of psychotropic polypharmacy, clinicians depend on drug–drug interaction (DDI) references to ensure safe regimens, but the consistency of such information is frequently questioned.

Focusing pharmacoeconomic activities: reimbursement or the drug life cycle?

The purpose of this paper is to consider the role of pharmacoeconomic activities in the drug life cycle and not just as activities to support reimbursement applications and market entry.These activities are important in establishing the value case for a drug product to both internal and external audiences. Unless these activities are fully integrated into establishing the business case for a product from the pre-phase I period of drug discovery, manufacturers run the risk of establishing a unit price for the product and claims for cost-effectiveness which are inconsistent with achieving reimbursement. Importantly, manufacturers need to consider at an early stage the evidentiary and analytical needs for product evaluation under formulary submission guidelines (AMCP; NICE) and the integration of pharmacoeconomic activities over the life cycle. These activities include justifying assumptions for business opportunity assessments and an early commitment to developing a mock reimbursement submission at post-phase II. The integration of pharmacoeconomic activities in the drug cycle is not only an antidote to excessive clinical optimism but also provides the basis for an effective assessment of the likely performance of new products in the health-care market place at a price and formulary position acceptable both to the manufacturer and the reimburser.