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Look Alike And Sound Alike (LASA) Drugs


Editors:

Elham Reshid and Hailemariam Shimelis

Medication use is a complex process that comprises the sub-processes of medication prescribing, order processing, dispensing, administration, and therapeutic effects monitoring. The Institute for Safe Medication Practices (ISMP) has identified 10 key elements with the greatest influence on medication use including, drug labeling, pack-aging and nomenclature, noting that weaknesses in these can lead to medication errors.

Medications in which packaging is visually similar to another medication or have generic names which sounds similar in the spoken or written word comes in the category of look-alikes and sound-alikes, respectively. According to the United States Pharmacopeia (USP), more than 3100 pairs of drugs marketed in the United States have brand or generic names that are close enough that confusion between the agents has resulted in a medication error and tens of thou-sands of them are significant.

Look Alike Sound Alike Drugs
Look Alike Sound Alike Drugs

Errors due to look-alike/sound-alike (LASA) name confusion usually occur in the dispensing phase of the medication process (64%) involving pharmacy technicians or pharmacists. However, about 20% of the errors have been attributed to nurses and 7% to physicians. And, factors contributing prescriptions, incomplete knowledge of drug include illegible handwriting, misinterpretation of names, newly available products, the failure of manufacturers and regulatory authorities to recognize the potential for error and to conduct rigorous risk assessments.

These errors may be manageable since most medications have a large margin of safety. Nevertheless, a small number of drugs named “high-alert medications” (can be accessed at http://www.ismp.org/Tools/ highAlertMedicationLists.as ) have a high risk of causing injury when they are misused. Errors may or may not be more common with these drugs than with the use of any others; however, the consequences of the errors are more devastating. For this reason, special considerations are required.

At present, the ISMP, USP and the FDA collect and track medication errors and make information available to health care providers and the public, making the following recommendations. And, please, to archive on the common LASA drugs encountered, check on www.ismp.org.

 Physicians, Nurse Practitioners

  • Clearly write the prescriptions using tall man letter whenever possible (Tall Man lettering involves highlighting the dissimilar letters in two names to aid in distinguishing between the two. e.g. ceFAZolin and cefTRIAXONE (can be accessed @ http://www.ismp.org/tools/ tallmanletters.pdf  )).
  • Avoid using short forms or abbreviation of drug names and make further comment about the drugs (include both generic and brand names.
  • Avoid verbal prescriptions to a maximum extent.

Pharmacists

  • Separating LASA drugs from one another
  • Double checking the drug
  • Contacting the physician in case of any clarification regarding the prescription
  • Becoming familiar with LASA drugs

To download the article in pdf click here

If you have any drug related question  ask the TASH DIC By using our Online form here.

 References:

http://www.ismp.org/faq.asp  
http://www.apicareonline.com/?p=1927   
http://www.jointcommision.ord/assets/1/18/SEA19.pdf  
http://www.medindia.net/patients/patientinfo/sala-drugs.htm 

Metformin use just got Safer

volume 1 issue 6

Editors:

Elham Reshid and Hailemariam Shimelis
volume 1 issue 6
volume 1 issue 6

Metformin is an anti-hyperglycemic agent which improves glucose tolerance in patients with type 2 diabetes. Its pharmacologic mechanisms of action appear to be different from other classes of oral anti-hyperglycemic agents. It decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization. This alert will shed light on the current status of metformin’s use during pregnancy.

An accumulating body of evidence strongly suggests that abnormal blood glucose levels during pregnancy are associated with a higher incidence of congenital abnormalities. Most experts recommend that insulin be used during pregnancy to maintain blood glucose levels as close to normal as possible. Metformin was long known to cross the placenta and enter the bloodstream of the fetus. This fact formed the rationale for clinicians to avoid metformin during pregnancy unless clearly needed. Moreover, the lack of adequate and well-controlled studies in pregnant women made clinicians to be hesitant from using metformin during pregnancy.

A systematic review done on the efficacy and safety of metformin during pregnancy in women with gestational diabetes mellitus (GDM) or polycystic ovary syndrome (PCOS) suggests that there are potential advantages for the use of metformin over insulin. In GDM, the advantages for metformin are with respect to maternal weight gain, neonatal outcomes and acceptability. The use of metformin throughout pregnancy in women with PCOS has also been shown to reduce the rates of early pregnancy loss and preterm labor and protect against fetal growth restriction. Moreover, there have been no demonstrable teratogenic effects, intra-uterine deaths or developmental delays with the use of metformin.

Based on this and other studies, the FDA has now classified metformin as a class B medication during pregnancy. A class B medication is considered safe to be administered during pregnancy, though class B rating presupposes that evidence for safety is largely derived from animal studies, as there are limited human studies.

To sum up, there is currently no warning with metformin and pregnancy and is considered to be safe for use. Studies involving metformin and animals have shown no ill effects to the mother pregnancy, or the offspring upon birth.

References:

http://www.drugs.com/pro/metformin.html 

http://www.drugsdb.com/rx/metformin/metformin-during-pregnancy-breastfeeding/

http://www.ncbi.nlm.nih.gov/pubmed/23886298

Crushing Medicine and its Downside

Volume 1 issue 5

Editors:

Elham Reshid and Hailemariam Shimelis

Drug products designed to reduce the frequency of dosing by modifying the rate of drug absorption have been available for many years. Many terms are used to describe modified-release products including extended-release, prolonged release, controlled-release, controlled-delivery, slow-release and sustained-release. Among the advantages of these products include sus-tained blood levels, attenuation of adverse effects and improved patient compliance.

There are multiple reasons for crushing tablets or capsule contents before administering medications, – by both patients and healthcare professionals – for example, in cases where patients need their medicines and there are no alternative formulations available or they are taking the medications via Nasogastric tube (NGT). However, there are numerous medications that should not be crushed due to their specific formulations and their pharmacokinetic properties.

volume 1 issue 5
volume 1 issue 5

Most of the no-crush medications are modified release dosage forms, sustained-release, oral-dosage formulas and enteric coated tablets. The majority of extended release products should not be crushed or chewed, although there are some slow-release tablet formulations available that are scored and can be divided or halved (e.g. Toprol XL). Indeed, a survey in the United States found that 21% of critical care nurses (n=1167) reported routinely crushing and administering enteric-coated medications through feeding tubes. Similarly 15% reported routinely crushing sustained-release medications.

However these sustained-release products contain significantly higher amounts of active drug than are present in their normal release counterparts. The matrix contained in these drugs is actually a highly specialized delivery system which is destroyed by crushing. In most cases, tampering with these products damages the mechanism by which the medication is released. The consequence of this would be for a potentially toxic dose of medication to be delivered upon administration with an increased risk of ad-verse effects. Conversely, while there is the risk of initial overdosing, there will also be under dosing at later times which could result in a lack of clinical efficacy.

These risks are starkly illustrated by Schier et al who reported a case in which a woman diagnosed with acute pulmonary edema and pneumonia was administered labetalol and crushed nifedipine XL through the nasogastric tube. And the crushed extended-release (XL) nifedipine tablet contributed to a 38-year-old woman patient fatality by developing bradycardia with hypotension and ultimately died. In this instance the administration of a crushed nifedipine XL tablet resulted in severe hypotension and the con-current administration of labetalol prevented a compensatory heart rate increase in the patient.

Berkovitch et al also compared pharmacokinetic parameters be-tween frail elderly patients taking a sustained-release theophylline formulation twice daily orally (n = 17, group I) and those receiving it via NGT (n = 15, group II) for chronic obstructive lung disease. The result from the study revealed all pharmacokinetic measure-ments were lower in group I as compared with group II.

In conclusion, crushing modified release products could alter the pharmacokinetic behavior of the medicament and might elicit an exaggerated therapeutic response or toxicity. Thus, every health professional should refer to the specific package inserts before administration of such products to patients. One should take note that almost all sustained-release and controlled-release formula-tions are not to be crushed or opened.

To download the pdf click here.

References:

Lloyd N. Sansom. Oral extended-release products. Aust Prescr 1999;22:88-90.

http://dysphagia-medicine.com/splitting-and-crushing-tablets.html accessed date 19/4/2014
http://www.the-hospitalist.org/article/to-crush-or-not-to-crush/  accessed date 19/4/2014
Schier JG, Howland MA, Hoffman RS, Nelson LS.Fatality from administration of labetalol and crushed extended-release nifedipine. Ann Pharmacother. 2003 Oct; 3
Berkovitch M, Dafni O, Leiboviz A, Mayan H, Habut B, Segal R. Therapeutic drug monitoring of theophylline in frail elderly patients: oral compared with nasogastric tube administration. Ther Drug Monit. 2002 Oct; 24(5):594-7.

Mortality benefit and survival rate with Digoxin

volume 1 issue 4

Editors:

Elham Reshid and Hailemariam Shimelis

Digoxin was approved for heart failure in 1998 (PROVED, RADIANCE, and DIG clinical trials) under current regulations by the Food and Drug Administration. It was also approved for the control of ventricular response rate for patients with atrial fibrillation. It is a safe and well tolerated drug when dosed appropriately. Moreover, it is inexpensive and can be afforded by most patients with heart failure throughout the world.

volume 1 issue 4
volume 1 issue 4

Most heart failure patients achieve a serum concentration of 0.5 to 1.0ng/mL with doses of 0.125 to 0.25 mg/d.

Digoxin was long known for symptomatic relief and decreased rate of hospitalization. However, data from post hoc analyses of the DIG trial suggest that digoxin reduces mortality at low (0.5–0.9 ng/ml) serum digoxin concen-trations (SDC), but had not effect at higher (≥1 ng/ml) SDC. Digoxin is now also known to suppress sympathetic and renin-angiotensin-aldosterone systems and it has been suggested that the neurohormonal properties of digitalis are more pronounced at low SDC.

The beneficial effects of digoxin at the neurohumoral mechanisms are reducing plasma norepinephrine level

(by improving impaired baroreceptor reflexes in heart failure) and lowering plasma renin levels.

However, it was also suggested that the results of this post hoc analysis of DIG trial should be interpreted with caution. Patients in the DIG trial were younger than real life HF patients and were predominantly male and whites, and had normal sinus rhythm, thus limiting generalizability to other patients. Randomized clinical trials are needed to determine the effect of digoxin in contemporary chronic HF patients.

Different journals discussing the contemporary use of digoxin in the Management of Cardiovascular Disorders, the idea was similar with the DIG trial and they shared similar conclusion. Although digoxin should not be used instead of other heart failure medications with proven mortality benefits, it should be considered an adjunct in all patients with symptomatic heart failure, particularly when heart failure is severe or atrial fibrillation with a rapid ventricular response is present.

To download the pdf click here.

References:

http://circ.ahajournals.org/cotent/113/21/2556.full

http://www.aafp.org/afp/2000/0715/p409.html  

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900803/

በኤች አይ ቪ ቫይረስ የሚከሰት ሞት በግማሽ ቀነሰ


ኃይለማርያም ሽመልስ

(የጥናት ትምህርትና መድኃኒት ፖሊሲ ኬዝ ቲም ሀላፊ)


በጥቁር አንበሳ ስፔሻላይዝድ ሆሰፒታል የመድኃኒት መረጃ ማእከል

የተባበሩት መንግሥታት ድርጅት ፕሮግራም (UNAids) ሪፖርት እንዳሳየው ከ2005 ዓ.ም. እ.ኤ.አ. በዓመት ውስጥ በኤች አይ ቪ / ኤድስ ከሞቱት 1.9 ሚሊዮን ሰዎች አንጻር ባለፈው ዓመት በቫይረሱ ምክንያት የሞቱት ሰዎች በግማሽ ቀንሶ ወደ 1 ሚሊዮን ማለፋቸውን ጠቅሷል፡፡

የኤች አይ ቪ ኢንፌክሽን ሙሉ በሙሉ ማዳን ባይቻልም ቫይረሱ ባለበት እንዲቆይ በፀረ- ኤች አይ ቪ መድኃኒቶች ማድረግ ይቻላል፡፡ ይህንን ማድረግ ደግሞ የቫይረሱን ስርጭት ከመቆጣጠርና አዳዲስ በቫይረሱ የሚጠቁ ሰዎች እንዳይኖሩ ከማድረግ አንጻር ከፍተኛ ፋይዳ አለው፡፡ ይህ እንዲታወቅ በ10 ዓመት የእድሜ ጣራ ባለፉት አሥር ዓመት ጨምሯል፡፡

ማይከል ሲዲቤ የ(UNAids) ኤክስኪዩቲቭ  ዳይሬክተር እንደገለጹትም ‹‹በ2015 እ.ኤ.አ. ለ15 ሚሊዮን በቫይረሱ ለተጠቁ ሰዎች የፀረ-ኤች አይ ቪ መድኃኒቶች የማድረስ እቅዳችን ያሳካን ሲሆን በ2020 እ.ኤ.አ. ይህንን አሀዝ ወደ 30 ሚሊዮን በማድረስ እጥፍ ማድረግ መሆኑን›› ገልጸዋል፡፡ ‹‹አሁን ያለንን ተደራሽነት በመጨመር ፀረ- ኤች አይ ቪ መድኃኒት ፍላጎት ያለበት ቦታ ለመድረስና ማንም ወደ ኋላ እንዳይቀር የሚለውን መርሕ እንቀጥልበታለን›› በማለት ገልጸዋል፡፡

ከዚህም በተጨማሪ የፀረ- ኤች አይ ቪ መድኃኒቶች በአሁኑ ሰዓት ተደራሽነት 53 በመቶ ሲሆን ይህን ቁጥር ወደ 90 በመቶ በ2020 እ.ኤ.አ. ማድረግ እንደሆነ ኤጀንሲው ገልጸዋል፡፡

Download UNAIDS_FactSheet_Report.

ምንጭ፡

http://www.unaids.org/en/resources/fact-sheet 

http://www.bbc.com/news/health-40582836

2 questions to consider before using Proton pump inhibitors


By Hailemariam Shimelis REDP case team leader @ TASH


Heartburn medications  such as proton pump inhibitors taken by millions of people are under scrutiny following studies that reveal a risk for side effects, including kidney damage.

“The risk is pretty low, (<1 in 1000) but it’s not zero,” says Mayo Clinic gastroenterologist Dr. Ken DeVault. “So it’s worth talking to your physician.”

Kenneth R. DeVault, M.D.

The medications are called proton pump inhibitors, sold under brand names such as Prilosec, Nexium and Prevacid, and the generic forms, such as omeprazole, esomeprazole and lansoprazole.

Dr. DeVault says, despite the risks, proton pump inhibitors are the best option for some patients with heartburn. However, he thinks the medications are over used by many people who could find alternatives especially life style modification.

Below is a one minute Mayo Clinic video where Dr. DeVault asks two important questions about proton pump inhibitors and offers other ideas for beating heartburn. Jeff Olsen reports.

 Lifestyle changes can help ease heartburn:

  • Maintain a healthy weight. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus.
  • Avoid tightfitting clothing, which puts pressure on your abdomen and the lower esophageal sphincter.
  • Avoid foods that trigger your heartburn.
  • Avoid lying down after a meal. Wait at least three hours.
  • Avoid late meals.
  • Elevate the head of your bed if you regularly experience heartburn at night or while trying to sleep. If that’s not possible, insert a wedge between your mattress and box spring to elevate your body from the waist up. Raising your head with additional pillows usually isn’t effective.
  • Avoid smoking. Smoking decreases the lower esophageal sphincter’s ability to function properly.
References:

Jeff Olsen: Mayo Clinic Minute: 2 questions for people who use heartburn medications

Lifestyle and home remedies from Mayo Clinic