Clinical Pharmacy articles list

The government has implemented the Healthy Living Community Movement (GERMAS) program by promoting the pharmaceutical sector related to drug storage at home. However, many problems still exist in storing household medicines in the community. This activity was carried out through a community empowerment approach using the community capacity-building method for a community organization, Aisyiyah, which consists of Muslim women in the Grendeng village, Purwokerto. This activity was carried out in stages, namely pre-test methods, lectures, group teaching, self-empowerment through peer teaching and training, and measuring the success of activities using post-tests. Based on the activities, partners' knowledge about storing medicines at home has increased in a good category.

Much Ilham Novalisa Aji Wibowo

Using off-label drugs in obstetric-gynecology patients requires caution because of the high risk of pregnancy. Although there is still debate, data profiling its use in clinical practice is lacking. This study aims to observe the use of off-label drugs in obstetrics and gynecology patients in private hospitals, especially the pill Misoprostol. This study used a descriptive observational approach to hospital medical record data. Retrieval of research data retrospectively at Bunda General Hospital (X Hospital) for July 2017 – December 2017 and Sinar Kasih Hospital (Y Hospital) for January 2018 – December 2018. The number of samples was determined using the Slovin formula, with a systematic random sampling technique at X Hospital and total sampling at Y Hospital. The samples were 220 RM at X 130 Hospital and Y 90 Hospital. The research was conducted in the period January 2019 - March 2019. The results were analyzed univariately using several related references. The results showed 26.92% of misoprostol off-label use in X Hospital and 4% in Y Hospital. The off-label drug found was Misoprostol which belongs to the category of off-label indications (Missed Abortion, Incomplete Abortion, Blighted Ovum, and Induction of labor in cases of Serotinus, KPD, and IUFD), off-label doses (50 µg, 100 µg, and 400 µg), and off-label routes of administration (sublingual and vaginal). ​

Much Ilham Novalisa Aji Wibowo

Compliance with pharmacological therapy is the primary key to treating diabetes, but it has not received full attention from clinicians. Several systematic reviews of compliance factors have been conducted in several regions of the country. However, it does not feature studies from Indonesia. This study aims to systematically review the factors that can influence adherence to diabetes mellitus (DM) medication in Indonesia. A systematic literature review was conducted by searching the National (Garuda and Sinta) and International (PubMed and Science Direct) journal databases. Research that met the inclusion criteria was published from January 2011 to December 2020. The quality of the study was assessed using the SQAT guidelines. The research reporting method uses the PRISMA guidelines. Compliance factors are classified based on the domain of compliance factors, according to the World Health Organization (WHO). A total of 370 scientific research articles from the Garuda database (n=36); Science Direct (n = 108); PubMed (n = 18); Sinta (n= 208). Three hundred forty-one research articles were excluded, 29 full-text screening articles, and 16 research articles met the inclusion criteria for analysis. Factors that influence adherence to taking diabetes medication are social and economic (income, education level, and occupation), factors of personnel and health systems (health workers), factors of patient therapy (amount of diabetes medication, frequency of taking medication, and drug products), factors patient's disease (blood sugar levels, disease duration), patient factors (gender, emotional factors, social support, level of knowledge, and treatment satisfaction), and disease management factors (pharmacy counseling and education). Factors that influence adherence to taking DM medication in Indonesia are very diverse and are multi-factor. These factors can serve as relevant intervention targets. Clinicians must consider adjusting the frequency of taking medication and providing social support to DM patients.

Much Ilham Novalisa Aji Wibowo

Pharmacists are expected to play major roles as members of diverse perioperative care teams besides implementing medication safety standards, pharmacist’s roles include optimizing drug therapy and other clinical interventions. Yet, developing general perioperative management as another crucial role operation room, pharmacists play and incorporating it into pharmaceutical education would be important. Enriching perioperative care provided by pharmacists can contribute toward improving the clinical competence of these professionals. Presently, there are no pharmacists in Zawia who participate in perioperative care. The objective of this study was to assess the pharmacist's knowledge of general anesthesia and drugs used to anesthetize patients who suffer from hypertension. A cross-sectional study was conducted in Zawia City, Tripoli in 2023. A self-designed questionnaire was distributed to 100 pharmacists. The study found that more than half of the pharmacists have humble knowledge about the drugs used in anesthesia, the findings indicated weakness in their information about drugs used to manage hypertension in surgery, and 36.0% know that sodium nitroprusside is used to control blood pressure during the operation. In conclusion, this study reported that some of the study's pharmacist participants had weak points that contributed to a high percentage of incorrect knowledge. These weak points may be attributable to poor educational preparation or a lack of training before the pharmacists began working in hospitals.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Acenocoumarol is the only oral antivitamin K anticoagulant prescribed and marketed in Algeria for the prevention and treatment of thromboembolic diseases. Nevertheless, the difficulty of handling this drug linked to a narrow therapeutic index and to great inter- and intra- individual variabilities of the response to the treatment poses a major public health issue because of its iatrogenic risk. To improve the management of patients on acenocoumarol and optimize its dosage adjustment and reduce iatrogenic secondary to vitamin K antagonists, our main objective work is to assess the knowledge, attitude and practice of health care professionals regarding this anticoagulant agent. We conducted a multicenter descriptive cross-sectional study from April to May 2021. We interrogated 152 health professionals of all ages, all sexes and all grades from different health departments in Oran City (Algeria) prescribing anticoagulants, through a validated questionnaire made up of 26 questions. Statistical analysis was achieved by SPSS version 20 software. Thus, 59.9% were women with a sex ratio of 0.67, 92.8% knew that acenocoumarol belongs to the antivitamin K class, 45.0% chose INR and PT as follow-up parameters, 36.0% chose INR alone and 78.9% were unaware of acenocoumarol dose adjustment algorithms as well as 82.0% were unaware of the existence of pharmacogenetics testing. 54.0% use the recommendations of the HAS for dosage adjustment of patients on acenocoumarol. 07.9% suggested using pharmacogenetic tests to improve the dosage adjustment of acenocoumarol, 06.6% suggested patient follow-up and 05.9% suggested therapeutic patient education as well as 74.3%, wanted to do training on. Therefore, this study highlighted gaps in the medical practice of physicians in terms of dosage adjustment, pharmacogenetics and its impact on dosage optimization. However, the evaluation of their knowledge was considered unsatisfactory. To overcome this lack of knowledge, it seems necessary to make physicians aware of the contribution of pharmacogenetics of acenocoumarol in Algeria.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Febrile convulsions have been defined as any convulsion associated with a fever of more than 38 oC without central nervous system infection in a child aged six months to five years. Febrile convulsion can be divided into two groups of simple and complex seizures. This study aimed to determine the prevalence of febrile convulsions in Libyan children and to investigate the associated risk factors related to this type of seizure in children. 120 cases of febrile convulsions with one day - 12 years old were collected during from April to August 2022. A study has conducted in the Pediatrics Hospital in Bayda City, Libya about the prevalence of febrile convulsions in children, the data collection tool was a self-designed pre-tested validated questionnaire including general information such as age, gender, family history, and admission to the hospital. In addition, data such as body temperature, recurrent convulsion attacks, the condition of hospital admission, discharge status, the treatment in-hospital and out-hospital. The collected data were analyzed by using descriptive methods. Among the 120 children, the majority of the cases were aged between two years and five years old. The gender prevalence rate in this study was 55.0% in males and 97 of the children were hospitalized due to simple febrile seizure (80.8%), 92 of the cases with no family history of febrile convulsions (75.0%) and respiratory tract infections is the main cause of febrile convulsions. In conclusion, this study indicated that respiratory tract infections is the most common cause of febrile convulsions among Libyan children, however, a large sample study is needed to support this issue in Libya.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Diabetes mellitus (DM) is a complex and chronic illness requiring continuous medical care. Type 2 diabetes (T2D) is commonly associated with obesity, hypertension, and a tendency to develop thrombosis, and an increase risk of cardiovascular diseases (CVD). Diabesity is a term used to indicate the coexistence of obesity and DM. Diabesity increases as obesity is an emerging epidemic in modern societies, the co-incidence with DM is also rising, so a joint plan of anti-obesity and anti-hyperglycemia for the management approaches. Therefore, this study aimed to identify the impact of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on body weight and glycemic response in obese Libyan patients with T2D at the National Diabetes Centre in Tripoli, between July 2013 and May 2022. This prospective study included obese adults with T2D who were newly prescribed GLP-1RA therapy for six months with dulaglutide once weekly or liraglutide once daily. The study included 170 diabetic patients who were started on GLP1-RA as add on therapy to their treatment, with a regular follow-up with dietitian and their physicians to adjust their glucose-lowering medications, then comparing the effect of these agents on body weight and the level of glycated hemoglobin before and after 24 weeks of treatment. Most of the patients (n = 99, 58.23%) were in the age period from 54 to 74 years old and 101 of whom were female subjects (59.4%), with a mean duration of DM equal to 8.8 ± 7.3 years. The patients were divided randomly into two groups, the first group included 110 patients who received liraglutide pens showed a significant reduction in HbA1c from 9.6% (± 1.54) to 7.4% (± 1.03) by p < 0.001 and a significant weight loss from 88.3 kg (± 10.68) to 80.8 kg (± 11.83) by p < 0.001. The reported adverse events were in 23 cases of minor hypoglycemia due to gastrointestinal upset. The other group included 60 patients for dulaglutide pens and showed significant decrease in HbA1c = 9.6% (± 1.54) to 7.1% (± 1.2) by p < 0.05 and a significant reduction of bodyweight from 88.3 kg (± 10.68) to 83.8 kg (± 16.3) by p < 0.05. The reported adverse events were mild transient gastrointestinal distress for the initial week of a start and then subside with regular intake. Whereas, 115 patients (67.6%) with HbA1c above 10.0% before starting therapy, no patient with HbA1c above 10.0% after six months of both GLP-RA agents therapy. Thus, the uses of GLP-RA as add-on therapy for obese patients with T2D significantly improved glycaemic control with less hypoglycaemia, accordingly, reduce insulin requirement for blood glucose control and loss in body weight. It can thus be concluded that GLP-1RA therapy is an effective treatment option when used in obese patients with DM.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Inhalation of a gas anesthetic produces rapid induction of anesthesia without the need for intravenous drugs. Although it is specifically useful for patients who are afraid of injections or if their intravenous access is difficult, single-breath induction may also allow patients to wake up more quickly than intravenous induction drugs. The object of this study is to compare isoflurane and sevoflurane during inhalation in Libyan patients undergoing surgery in terms of side effects like blood pressure and heart rate changes and complications. Seventy- five patients were recruited in this study from different hospitals in Benghazi City, Libya (January to March, 2022) including Aljalaa Hospital and Alatfal Hospital, and data including side effects and complications were collected through data collection. Surgeries that used isoflurane, or sevoflurane or both inhalation gases for anesthesia were included in our data. While the surgeries which did not use any of these inhalation gases were excluded from our data. When we compared the side effects of using isoflurane with sevoflurane according to the age group, we found that hypotension is the most occurring side effect companies to the use of isoflurane in our adult population (28.6%) and in pediatrics (14.3%) but there was a low incidence of other side effects related to sevoflurane administration. Regarding to side effects related to the use of sevoflurane according to the age groups, 16 adult Libyan patients experienced no side effects (61.5%) compared to 10 children (38.5%). It can be concluded that both isoflurane and sevoflurane are suitable for daycare anesthesia. Sevoflurane might be an ideal drug for single-breath inhaled induction of anesthesia due to it has fewer side effects and complications.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Over the years, pharmacy has developed from a simple floor stock system to a complex unit dose, I.V. additive, and clinical pharmacy program. This development would have never been possible without the support of the nursing, medical, and administrative staff. The support of obtained slowly by developing services that increase the pharmacist's credibility as a team member concerned with the pediatric and neonate patients. These services include a unit dose program, I.V. additive program, drug information services, and pharmacy medication program. One area in which pharmacist does not obtain a background from generalized training is the area of pediatric dosing. Pediatric pharmacists must learn in clinical practice the proper dosing of the pediatric patient and neonate patient. The dose must be checked periodically. In the premature or newborn infant, the pharmacist must consider the immature renal and hepatic function so that he/she does not overdose initially and then underdose as the infant grows and matures. Neonates are a special group of children, they are less than 30 days, and within this group preterm babies (that means less than 37 weeks). Determining the correct dose for drugs used to treat neonates is a critically vital factor. Prematurity affects kidney and liver function and the proper adjustment of drug doses is crucial [1]. The absence of drug level necessitates the adjustment of drug doses and the presence of qualified oriented dependable pharmacists. Drug doses are not numbers, or decimals used within the therapeutic range. Neonatal Intensive Care Unit (NICU) needs a system for the calculation and preparation of drugs [2].

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Prescription drug misuse has emerged as a significant problem over the past decade, particularly topical corticosteroids for skin lightening. This study aimed to assess the misuse of topical corticosteroids among the female population in southern Libya; to determine prevalence, awareness, attitude, and practice regarding this drug misuse. A descriptive, cross-sectional questionnaire was distributed on January 2022 to females aged between 16-45 years old in southern Libya. Out of 200 distributed questionnaires, 155 were returned with a response rate of 77.5%. The majority of the participants were aged 16-25 years (n=138, 89.0%) and over two-thirds of participants, said they obtained lightening products containing cortisone from pharmacies (n=107, 69.0%) while 36 participants indicated they obtained these products from cosmetic shops (23.2%). More than three-quarters of the participants said they were aware that they should read product ingredients (n=120, 77.4%). Just over one-quarter of respondents indicated they used the product on their face almost daily (n=41, 26.5%) while 28 participants denied using it (18.1%). The most common source of information about topical corticosteroids among participants was the Internet (n=51, 32.9%), followed by dermatologists (n=41, 26.5%), and pharmacists (n=31, 20.0%). Almost half of respondents were aware that topical corticosteroids can cause harmful effects (n=75, 48.4%). The most common indications reported for using topical corticosteroids were whitening (23.3%), and acne treatment (54.2%). Over two-thirds of participants, declared they would not use topical lightening products if they contained corticosteroids (n=107, 69.0%). In a similar attitude, nearly a third of participants stated that they would never use corticosteroid medications again if they knew about the negative effects of whitening (n=51, 32.9%). The majority of females, (87.7%), concur that only pharmacies should be able to sell and prescribe topical corticosteroid medications. The study's findings indicate that topical corticosteroids are frequently misused and that to lessen contraindications, especially for prolonged use, it is imperative to provide basic care to females who continue using topical corticosteroids in public or unlicensed marketing settings.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Anemia is a common health problem among Libyan women. Age, heavy menstruation, and pregnancy are vital risk factors for this problem. In this study, we prospectively examined 60 Libyan women all of which were diagnosed with iron deficiency anemia, their hemoglobin levels were less than 10.0 g/dl. The level of hemoglobin is also analyzed for vegetarian and charcoal-eating women. We found that during pregnancy charcoal-eating women exhibit lower hemoglobin levels than non-eating women. Pregnant young women in the age of 17-27 years have the lowest hemoglobin levels than the other age groups. In addition, vegetarians, heavy coffee and tea drinking, and heavy menstruation in non-pregnant women, as well as breastfeeding, strongly lower hemoglobin levels as measured by their complete blood count.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

The purpose of this study was to determine the attitudes, expectations, experiences, and barriers that physicians in Tripoli hospitals experienced when working alongside Clinical Pharmacists (CPs). A descriptive self-administered questionnaire was used for the study, and participants were selected from several Tripoli hospitals. Most of the respondents agreed that CPs are an essential part of patient care teams and that they have the legal authority to review a patient's medication regimen and response. More than half of respondents believe CPs must be responsible for the medications they prescribe to patients. Half of the respondents agreed that CPs should be encouraged to play a more active role in hospitals and other healthcare facilities. The majority of participants agreed that CPs should participate in managing drug side effects and almost half agreed that CPs can contribute to decisions about drug interactions. By a low agreement rate, 42.7% of respondents thought CPs were specially qualified to counsel patients on drug therapy. A similar low trend was observed, with 40.9% agreeing to provide pharmacists with additional responsibility and authority in clinical departments, in contrast, 54.5% expressed their concern about the clinical responsibility of CPs in clinical practice. A minority of physicians agreed that Physicians should consult pharmacists in selecting the best pharmacological treatment. At the same time, the majority think that pharmacists lack clinical skills and 61.8% feel that physicians are unable to communicate effectively with CPs. 43.6% acknowledged that the traditional opposition between the two professions was a barrier to interprofessional collaboration while the absence of pharmacy space in clinical settings was cited by 39.1%. A majority of respondents agreed that physicians and pharmacists may improve their interprofessional collaboration by raising their awareness about it. A minority of respondents thought that laws and regulations governing physician collaboration should be put in place to promote effective collaboration between physicians and CPs. The study discovered that although most physicians endorse the introduction of clinical pharmacy services in hospitals and believe that physicians and pharmacists can collaborate on many tasks, respondents were not as impressed with the CPs' performance and believed that they lacked the professionalism required to carry out clinical responsibilities successfully. To facilitate the growth of clinical pharmacy services, laws and regulations must be put in place.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences