Analysis of drug-related problems in ischemic stroke in-patients in one Indonesian district hospital
DOI:
https://doi.org/10.46542/pe.2024.242.134139Keywords:
Drug-related problem, Ischemic stroke, PCNEAbstract
Background: Ischemic stroke is one of the leading causes of death in Indonesia. Appropriate management, including the identification of drug-related problems (DRPs), is needed to prevent disability and death.
Objective: This study aimed to analyse DRPs as defined by the Pharmaceutical Care Network Europe (PCNE).
Method: This was a cross-sectional research using the medical records of in-patients with ischemic stroke aged >18 years.
Result: Out of the 115 patients examined, 51.3% were male, and the mean age was 57.85 + 10.539 years. Exactly 204 cases of DRPs and 175 causes appeared in 101 patients. A total of 58 patients experienced one-to-two problems, and 43 patients experienced more than two problems. The problems domain consists of therapeutic effectiveness (P1, 133(65.2%)), adverse effects (P2, 67(32, 84%)), and medical expenses (P3, 4(1, 96%)). The DRPs mostly involved antihypertension and antiplatelet. The most common cause was a new indication for treatment (C1.9, 51(29.14%)) and drug interactions (C8.1, 48(27.43%)). Multivariate analysis of patient characteristics showed that patients taking more than eight medications were more likely to experience more than two DRPs than those on one-to-four medications (OR 5.593; 95%, CI 1.015-30.812).
Conclusion: Most patients experienced one-to-two DRPs with the highest being a potentially suboptimal treatment. Clinical pharmacists are expected to monitor therapy, especially in polypharmacy patients.
References
Aleksic, D. Z., Jankovic, S. M., Mlosavljevic, M. N., Toncev, G. L., Miletic Drakulic, S. D., & Stefanovic, S. M. (2019). Potential drug-drug interactions in acute ischemic stroke patients at the neurological intensive care unit. Open Medicine (Warsaw, Poland), 14, 813–826. https://doi.org/10.1515/med-2019-0093
Bouman, H. J., Parlak, E., van Werkum, J. W., Breet, N. J., ten Cate, H., Hackeng, C. M., ten Berg, J. M., & Taubert, D. (2010). Which platelet function test is suitable to monitor clopidogrel responsiveness? A pharmacokinetic analysis on the active metabolite of clopidogrel. Journal of thrombosis and haemostasis: JTH, 8(3), 482–488. https://doi.org/10.1111/j.1538-7836.2009.03733.x
Brown, D. L., Levine, D. A., Albright, K., Kapral, M. K., Leung, L. Y., Reeves, M. J., Sico, J., Strong, B., Whiteley, W. N., & American Heart Association Stroke Council (2021). Benefits and risks of dual versus single antiplatelet therapy for secondary stroke prevention: A systematic review for the 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke, 52(7), e468–e479. https://doi.org/10.1161/STR.0000000000000377
Bulsara, K. G., & Cassagnol, M. (2023). Amlodipine. StatPearls Publishing.
Bultas, J. (2013). Antiplatelet therapy—A pharmacologist’s perspective. Cor et Vasa, 55(2), e86–e94. https://doi.org/10.1016/j.crvasa.2013.03.003
Gallacher, K. I., Batty, G. D., McLean, G., Mercer, S. W., Guthrie, B., May, C. R., Langhorne, P., & Mair, F. S. (2014). Stroke, multimorbidity and polypharmacy in a national representative sample of 1,424,378 patients in Scotland: implications for treatment burden. BMC medicine, 12(151). https://doi.org/10.1186/s12916-014-0151-0
GBD 2019 Stroke Collaborators (2021). Global, regional, and national burden of stroke and its risk factors, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019. The Lancet. Neurology, 20(10), 795–820. https://doi.org/10.1016/S1474-4422(21)00252-0
Gremmel, T., Steiner, S., Seidinger, D., Koppensteiner, R., Panzer, S., & Kopp, C. W. (2010). Calcium-channel blockers decrease clopidogrel-mediated platelet inhibition. Heart (British Cardiac Society), 96(3), 186–189. https://doi.org/10.1136/hrt.2009.171488
Hui, C., Tadi, P., & Patti, L. (2023). Ischemic stroke. StatPearls Publishing.
Insani, W. N., Whittlesea, C., Alwafi, H., Man, K. K. C., Chapman, S., & Wei, L. (2021). Prevalence of adverse drug reactions in the primary care: A systematic review and meta-analysis. PloS one, 16(5), e0252161. https://doi.org/10.1371/journal.pone.0252161
Kurniawati, F., Kristin, E., Pinzon, R. T., & Febriana, S. A. (2023). Predicting factor analysis of gastrointestinal bleeding complication among hospitalised ischemic stroke patients. Pharmacy Education, 23(2), 2. https://doi.org/10.46542/pe.2023.232.139143
Lazarus, B., Wu, A., Shin, J. I., Sang, Y., Alexander, G. C., Secora, A., Inker, L. A., Coresh, J., Chang, A. R., & Grams, M. E. (2018). Association of Metformin Use with Risk of Lactic Acidosis across the Range of Kidney Function: A Community-Based Cohort Study. JAMA Internal Medicine, 178(7), 903–910. https://doi.org/10.1001/jamainternmed.2018.0292
Micromedex (2023). Micromedex. http://www.micromedexsolutions.com/
Ministry of Health (2019). Decree of the Minister of Health of the Republic of Indonesia Number HK.01.07/MENKES/394/2019 about National Guidelines for Stroke Management. Retrieved December 7, 2019, from https://yankes.kemkes.go.id/unduhan/fileunduhan_1610420235_482259.pdf
Patel, P. S., Rana, D. A., Suthar, J. V., Malhotra, S. D., & Patel, V. J. (2014). A study of potential adverse drug-drug interactions among prescribed drugs in medicine outpatient department of a tertiary care teaching hospital. Journal of basic and clinical pharmacy, 5(2), 44–48. https://doi.org/10.4103/0976-0105.134983
Safitri, N., Alaina, M. F., Pitaloka, D. A. E., & Abdulah, R. (2021). A Narrative Review of Statin-Induced Rhabdomyolysis: Molecular Mechanism, Risk Factors, and Management. Drug, healthcare and patient safety, 13, 211–219. https://doi.org/10.2147/DHPS.S333738
Stanley M., Chippa V., Aeddula N. R., Rodriguez, B. S. Q., & Adigun R. (2023). Rhabdomyolysis. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK448168/
Stasi, S. L., MacLeod, T. D., Winters, J. D., & Binder-Macleod, S. A. (2010). Effects of statins on skeletal muscle: A perspective for physical therapists. Physical therapy, 90(10), 1530–1542. https://doi.org/10.2522/ptj.20090251
Tian, L., Wu, J., Qi, Z., Qian, S., Zhang, S., Song, D., Chen, B., & Zhu, D. (2023). Drug-related problems among community-dwelling elderly with ischemic stroke in China. Advances in clinical and experimental medicine: official organ Wroclaw Medical University, 32(4), 423–432. https://doi.org/10.17219/acem/155372
Vaduganathan, M., & Bhatt, D. L. (2015). Revisiting the Clopidogrel-Proton Pump Inhibitor Interaction: From Bench to Bedside. Circulation. Cardiovascular interventions, 8(10), e003208. https://doi.org/10.1161/CIRCINTERVENTIONS.115.003208
Wiggins, B. S., Saseen, J. J., Page, R. L., 2nd, Reed, B. N., Sneed, K., Kostis, J. B., Lanfear, D., Virani, S., Morris, P. B., & American Heart Association Clinical Pharmacology Committee of the Council on Clinical Cardiology, Council on Hypertension, Council on Quality of Care and Outcomes Research, & Council on Functional Genomics and Translational Biology. (2016). Recommendations for management of clinically significant drug-Drug interactions with statins and select agents used in patients with cardiovascular disease: A Scientific Statement from the American Heart Association. Circulation, 134(21), e468–e495. https://doi.org/10.1161/CIR.0000000000000456
