Introduction Drug utilization research (DUR) is "the marketing, distribution, prescription, and use of drugs in a society, with special emphasis on the resulting medical, social, and economic consequences" as per the definition of the World Health Organization (WHO). The ultimate goal of DUR is to evaluate whether the drug treatment is rational or not. Various gastroprotective agents are available today, such as proton pump inhibitors, antacids, and histamine 2A receptor antagonists (H2RAs). Proton pump inhibitors block the gastric H+/K+-adenosine triphosphatase (ATPase) via covalent binding to cysteine residues of the proton pump to inhibit gastric acid secretion. Antacids are compounds containing different combinations, such as calcium carbonate, sodium bicarbonate, aluminum, and magnesium hydroxide. Histamine 2A receptor antagonists (H2RAs) decrease gastric acid secretion by reversibly binding to histamine H2 receptors located on gastric parietal cells, thereby inhibiting the binding and action of the endogenous ligand histamine. A recent literature review has shown that inappropriate use of gastroprotective agents has increased the risk for adverse drug reactions (ADRs) and drug interactions. Methods A total of 200 inpatient prescriptions were analyzed. The extent of prescribing, dosing information given, and cost incurred on the use of gastroprotective agents in both surgery and medicine inpatient departments was assessed. Prescriptions were also analyzed using WHO core indicators and for drug-drug interactions. Results Proton pump inhibitors were prescribed to 112 male patients and 88 female patients. The most common diagnosis was diseases of the digestive system with 54 (27.5%) cases, followed by diseases of the respiratory tract with 48 (24%) cases. Out of 200 patients, 51 comorbidities were reported from 40 patients. Among all prescriptions, injection of pantoprazole was the most common route of administration (181 (90.5%)), followed by tablets of pantoprazole (19 (9.5%)). The most common dose prescribed of pantoprazole was 40 mg in 191 (95.5%) patients in both departments. The frequency of therapy was also most commonly prescribed twice daily (BD) in 146 (73%) patients. Potential drug interaction was most commonly found with aspirin in 32 (16%) patients. The total cost incurred on proton pump inhibitor therapy of the medicine and surgery departments was 20,637.4 Indian Rupees (INR). Of this, the cost for patients admitted in the medicine ward was 11,656.12 INR and in the surgery department was 8,981.28 INR. Conclusion Gastroprotective agents are a group of drugs that are used to protect the stomach and the gastrointestinal tract (GIT) from acid-related injury. Our study found that proton pump inhibitors were the most commonly prescribed gastroprotective agents among inpatient prescriptions, with pantoprazole being the most frequently used. The most common diagnosis among patients was diseases of the digestive system, and most of the prescriptions were for injection administration at a dose of 40 mg twice daily. These findings suggest that there may be opportunities for improvement in the rational use of gastroprotective agents to reduce the risk of adverse drug reactions and interactions and lower healthcare costs. Overall, the study highlights the need for healthcare providers to be aware of the appropriate use of gastroprotective agents to minimize irrational prescriptions and reduce polypharmacy.

2022-10-01·Giornale italiano di cardiologia (2006)

[Aspirin in primary cardiovascular prevention - a 2022 update].

Article

作者: Negro, Francesco ; Morganti, Riccardo ; De Caterina, Raffaele ; Michelotti, Erica

In the context of secondary prevention, the efficacy of aspirin in reducing cardiovascular events is widely acknowledged. However, its use for primary prevention is still debated because of uncertain data regarding the risk-benefit ratio. Despite the reduction in atherothrombotic events, almost all randomized clinical trials and meta-analyses have failed to demonstrate a net clinical benefit, as cardiovascular outcome improvement was counterbalanced by increased bleeding. We have, however, to acknowledge that, within the population eligible for primary prevention, cardiovascular risk distribution is extremely heterogeneous. Using data obtained from the most recent trials, we performed a meta-regression of benefits and risks associated with aspirin related to 10-year risk of major adverse cardiovascular events (MACEs). We are thus proposing a tailored approach to find the proper patient category to treat with aspirin in primary prevention. In patients <70 years old with an optimal control of cardiovascular risk factors, physicians should carefully evaluate individual MACE risk and make a therapeutic decision accordingly, also considering bleeding risk and patient preference. The results of net clinical benefit analysis of aspirin therapy suggest that patients with intermediate-high cardiovascular risk (10-year MACE risk >10%) without a prohibitive bleeding risk may represent the target population, since in these patients the reduction in atherothrombotic events overcomes the induced excess of bleeding. Antiplatelet therapy benefits also appear to be amplified by the simultaneous administration of gastroprotective agents and treatment of other cardiovascular risk factors, such as dyslipidemia and hypertension.

2022-05-01·Current Neuropharmacology2区 · 医学

Influence of Drugs on Mild Cognitive Impairment in Parkinson’s Disease: Evidence from the PACOS Study

2区 · 医学

Article

作者: Terravecchia, Claudio ; Caccamo, Maria ; Luca, Antonina ; Giuliano, Loretta ; Mostile, Giovanni ; Donzuso, Giulia ; Nicoletti, Alessandra ; Cicero, Calogero Edoardo ; Baschi, Roberta ; Zappia, Mario ; Monastero, Roberto

Background::

Polytherapy and the anticholinergic activity of several drugs negatively influence cognition in the elderly. However, little is known on the effect on Mild Cognitive Impairment (MCI) in Parkinson’s Disease (PD).

Methods::

Patients with PD belonging to the baseline PACOS cohort with full pharmacological data, have been included in this study. MCI diagnosis was made according to the MDS level II criteria. Polytherapy was defined as patients assuming ≥6 drugs. Anticholinergic burden has been calculated using the Anticholinergic Drug Scale (ADS). Molecules have been classified according to the ATC classification. Association with MCI has been assessed with a multivariate logistic regression analysis with MCI as the dependent variable.

Results::

Pharmacological data was available for 238 patients (mean age 64.7±9.7). One hundred (42.0%) were diagnosed as MCI. In the full multivariate model (correcting for age, sex, disease duration, education, UPDRS-ME, LEDD-DAs) no association was found with either polytherapy or the ADS. Concerning drug classes, anti-hypertensive medications increased the risk of PD-MCI (OR 2.02;95%CI 1.04-3.89; p=0.035) while gastroprotective agents had a protective effect (OR 0.51; 95%CI 0.27-0.99; p=0.047).

Conclusion::

The magnitude of polytherapy and anticholinergic drugs burden does not appear to modulate MCI risk in PD, probably due to cautious prescription patterns. The effect of anti-hypertensive and gastroprotective agents on PD-MCI risk, while needing further confirmations, could be relevant for clinical practice.

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