Study of Drug Utilization Pattern of Glucocorticosteroid Drugs with ...

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Ankit P - Study of Drug Utilization Pattern of Glucocorticosteroid Drugs with Special Emphasis on their Immediate Adverse Effects in a Tertiary Care Teaching Rural Hospitaldiseases and therapy was collected as per case recordform. All these patients were followed up till theirhospital stay. During visits, patients were asked aboutany adverse drug reactions they had developed. Theircase record files were also seen to detect any adversedrug reaction if recorded. For information regardingadverse drug reactions, a check-list was used. Causalityanalysis as per WHO criteria was performed.The data gathered were tabulated in different parameterslike age, sex, diagnosis, no. of drugs/formulationsprescribed, and Adverse Drug reactions due toglucocorticoid drugs observed.The data was entered in to SPSS-16 software forstatistical analysis, Percentage Calculation.RESULTSDemographic parameterAge wise classificationHighest number of patients (68 out of 100) werebelonging to 15 - 60 year age group. While 31 patientswere belonging to age group of more than 60. Onepatient was from 6-14 year age group (Table 1).Sex wise classificationAmongst one hundred patients, 58 were males and 42were females (Table 2).Classification based on diagnosis (system involved) ofpatientsThere were 130 conditions observed in 100 patients. Onedisease condition was observed in 78 patients, where astwo disease conditions (co-morbidity) were observed in 14patients. Eight patients were diagnosed with threeTable1: Age wise classification of patients.Age (in Years) Frequency Percent0-5 0 0.06-14 1 1.015-60 68 68.060+ 31 31.0Total 100 100.0Table 2: Sex wise classification of patients.Sex Frequency PercentMale 58 58.0Female 42 42.0Total 100 100.0different disease condition. The maximum no. of (62 outof 130) (47.69%) conditions were related to therespiratory system (Table 3).Other conditions related to the cardiovascular system,skin, ophthalmology, endocrine system, and joints andbones, were diagnosed as 16 (12.30%), 15 (11.54%),11 (8.46%), 8 (6.15%) and 4 (3.08%) patients respectively.Conditions related to the hepato-biliary, allergy, diseaserelated to the central nervous system, and sclerosis wereseen less frequently (Table 3).Total no. of formulations prescribed to patients indifferent departmentThe total number of drugs prescribed to 100 patientswere 1081 (971 formulations), amongst which 868 drugswere prescribed as single molecule, while 192 drugs wereprescribed as FDCs of two drugs (96x2) and 21 drugswere prescribed as FDCs of three drugs (7x3)[ (868x1)+(96x2)+(7x3) = 1081]It is found that amongst single molecule drugs (868),glucocorticoids were 211 and other drugs were 657 innumber.While amongst fixed dose combinations, 96 fixed dosecombinations with two drugs which did not contain anyglucocorticoid drug and 7 fixed dose combination withTable 3: Classification based on diagnosis / system involved of patientsDiagnosis Frequency PercentRespiratory System 62 47.69Dermatology 15 11.54Joints & Bones 4 3.08Cvs 16 12.31Endocrine 8 6.15Ophtholmology 11 8.46Miscellaneous Hepato- Biliary 2 1.54Cancer 1 0.77Renal 1 0.77Cns 2 1.54Bee Bite 1 0.77Infection 1 0.77Blood 1 0.77Sclerosis 2 1.54Fever(dengue Or Viral) 1 0.77Allergy 2 1.54Total 130 100.00Indian Journal of Pharmacy Practice Volume 3 Issue 4 Oct - Dec, 2010 19
Ankit P - Study of Drug Utilization Pattern of Glucocorticosteroid Drugs with Special Emphasis on their Immediate Adverse Effects in a Tertiary Care Teaching Rural Hospitalthree drugs which contain one drug as glucocorticoiddrugs (Table 4).Type ofpatientsglucocorticoids drugs prescribed to theIt was found that there were about 13 different types ofglucocorticoid drugs were prescribed.The most frequent type was dexamethasone sodiumphosphate ( 66 out of 218 glucocorticoid drugs) (30.28%),administered via intravenous route.Other widely used glucocorticoid drugs were Budesonide49 (22.48%), Prednisolone 46 (21.10%), and Hydrocortisonesodium succinate 27 (12.39%) in frequency (Table 5).In most prescription, information about strength, durationof treatment, , frequency, route and area of application ( iftopical ) were adequately mentioned, while information onquantity to be used or purchased was inadequate.Adverse Drug Reactions (ADRs) of glucocorticoiddrugs observed in patientsChecklist of common drug reactions with glucocorticoiddrug use was prepared, which contain thirty one differentsymptoms/signs associated with use of these drugs.Out of 31 Adverse drug reactions likely to develop withglucocorticoid drug use, 13 adverse drug reactions wereobserved in our study.Amongst 13 different adverse drug reactions, muscularweakness and insomnia were observed in 45 & 25patients respectively.While the adverse drug reaction like fragile skin andpurple striae, osteoporosis, peptic ulcer, psychosis,hypomania or depression were observed in one patienteach.And adverse drug reaction like hyperglycemia, Cushingsyndrome, heart failure and posterior subcapsular cataractand fever were observed in 3, 4, 2, 2, 5 patientsrespectively (Table 6).DISCUSSIONAge wise distribution of patients shows that maximumnumber of patients were in 15-60 years age group.Amongst them, maximum number of patients weresuffering from condition related to respiratory system.There was no patient in 0-5 years age group, while onlyone patient in 5-14 years age group. It suggest thatpaediatric patients may require less use of glucocorticoiddrugs.Glucocorticoid drugs were maximally utilized in diseaserelated to the respiratory system. Respiratory conditionsare usually allergic and inflammatory, whereglucocorticoid drugs have major role to play. People inthe area are addicted to smoking or tobacco chewing andare therefore more prone to develop respiratoryproblems.Second seat for allergens on our body is skin. In 15 patientssuffering from dermatological conditions, glucocorticoidswere prescribed.In the study by Adrianne C. Feldstein et al, it is reportedthat the most frequent diagnoses associated withglucocorticoid use were chronic obstructive pulmonarydisease, 25.8%; asthma, 21.4%; rheumatoid arthritis,(2)17.2%.Amongst the 100 prescription collected, the total numberof drug prescribed were 1081, i.e. a mean of 10.81 drugsper patient. It is obviously overprescribing.It may be due to patients were suffering from more thanone condition as well as they were having very longhistory of concomitant condition.To counteract common adverse reactions associated withglucocorticoids drug use, anti histaminic drugs andantiemetic drugs were prescribed to these patients, addingtotal number of drugs.Out of 1081 drugs prescribed, two hundred and eighteenwere from glucocorticoid group of drugs. It was foundthat use of the glucocorticoid drugs was rational(according to guidelines), they were used withinappropriate strength and gradually tapered off, switchedfrom parenteral to oral medication.Dexamethasone sodium phosphate by intravenous route washighly prescribed amongst all glucocorticoid drugs. It is dueto its potency and longer duration of action, which playseffective role in acute settings.In spite of large number of prescribed drugs, lowincidence of adverse drug reactions were found in ourstudy.Low incidence is certainly due to rational use ofglucocorticoid drugs. In addition, Patients were followedup to their hospital stay that was maximum 8 days formajority of patients.Indian Journal of Pharmacy Practice Volume 3 Issue 4 Oct - Dec, 2010 20
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