Jul-Sep, 2012 - Indian Journal of Pharmacy Practice

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Dilip .C - Prescription Monitoring Study of Antipsychotic Drugs in Geriatric Population at Tertiary Level Referral Hospital in Rural India.Instrumental Activities of daily living scale'. According to thescale, ability of the patients to use telephone was found to be58(89.23%), shopping-19(29.23%), food preparation3(4.61%), housekeeping 32(49.23%), laundry 22(33.84%),mode of transportation 32(49.23%), responsibility formedication 16(24.61%), ability to handle finance36(55.38%).Inappropriate use of antipsychotics in geriatricsmay result in decreased patient's ability to perform dailyactivities.Majority of patients receiving anxiolytic drugs werefound to be 10(15.3846%), followed by antidepressant drugs5(7.692%) and antipsychotics 4(6.1538%).Most of thepatients enrolled in this study had diabetes (19) andhypertension (31). Patients with co-morbidities like epilepsy,cirrhosis, UTI, Parkinsonism were 2 each and patients withCOPD and CAD were 6 each respectively. The other comorbiditieswere dementia, MI, TB, anaemia,hypothyroidism, osteoarthritis.Rational prescribing was followed as per the principles ofprescription writing. There was no polypharmacy, becausethere was no prescription that does not match the diagnosis.No fixed combinations or injections were given to thepatients. Most of the prescription had one or twoantipsychotic drugs. The problem we found that cliniciansdrug of choice was not always affordable by the patientsFig.3: Socioeconomic Factors of total patients in maleand female30252015105041Low class Middle class High classFig. 4: Department wise distribution of total patientsUrologyNephrologyGeneral SurgeryGastroetrologyPulonologyGeneral MedcineCardiologyNeurologyOthers1122424817MaleFemale0 5 10 15 20101515917Fig.1: Sex wise distribution of total patientsFig.5: Lawton Brody Instrumental Activities of DailyLiving ScaleAbility to handle finance36Responsibility for own16Male 58%Female 42%Mode of TransportationLaundry2232House keeping32No. of PatientsFood paration3Shopping19Ability to use telephone5820 40 60 80Fig. 2: Education wise distribution of the total patients inmale and female2019Male Female18Fig. 6: Number of patients taking Anti-Psychotic drugs fromtotal number of drugs16141210864206107871052Patients takingantipsychoticdrugs 29%Patients not takingantipsychoticdrugs 71%LP UP HS Professional UneducatedIndian Journal of Pharmacy Practice Volume 5 Issue 3 Jul - Sep, 2012 51
Dilip .C - Prescription Monitoring Study of Antipsychotic Drugs in Geriatric Population at Tertiary Level Referral Hospital in Rural India.Table 1: Co- morbidities present in total patientDiseasesNo. of patientDiabetes 19CAD 6Hypertension 31UTI2Anaemia 1Hypothyroidism 1Renal failure 3Osteoarthritis 1Asthma 3Parkinsonism 2COPD 6Dementia 1Epilepsy 2Tb 1Cirrhosis 2MI 3Psychosis 3because the cheapest drug was not always prescribed. Thepercentage of drugs prescribed which are approved by WHOessential drug list are low.CONCLUSIONThe assessment of prescription pattern of anti-psychoticdrugs in geriatric patients at tertiary level referral hospital andtheir ability to perform daily activities was done using“Lawton Brody Instrumental Activities of daily living scale”.In-appropriate or long term use of antipsychotics in geriatricsresults in decreased patients' ability to perform dailyactivities. In geriatrics, who have multiple Co-morbidities,complex chronic condition and are usually receiving polypharmacy, are at increased risk for adverse drug events. Theindicator-driven analysis of antipsychotic prescribing qualityrevealed a need for improvement, with the main prescribingproblems relating to duration and combination of therapies.The clinicians can improve the prescription pattern byawareness about the choice of drug from the WHO essentialdrug list and thereby reduce the prescribing of sedative andhypnotics in geriatric patients which makes them more weakto do their daily activities.REFERENCES1. Gary. A. Ford et.al, Anti-Psychotic Drug Use in Older Patients,British Geriatric society. 2002: 225-6.2. Valiyeva et al. Effect of regulatory warnings on antipsychoticprescription rates among elderly patients with dementia: apopulation-based time-series analysis. Canadian MedicalAssociation Journal, 2008; 179 (5): 438 DOI: 10.1503/cmaj.0715403. Knol W. et. al. Antipsychotic drug use and risk of pneumonia inelderly people. J Am Geriatr Soc. 2008 April; 56(4):661-6. E pub2008 Feb 7.4. Charles D. Motsinger, Use of atypical antipsychotic drugs inpatients with dementia. am fam physician. 2003 jun1;67(11):2335-41.5. Elmiria Valiyeva PhD et.al. Effect of regulatory warnings onantipsychotic prescription rates among elderly patients withdementia: a population-based time-series analysis, CMAJ.August 26, 2008 ;179 ;5Indian Journal of Pharmacy Practice Volume 5 Issue 3 Jul - Sep, 2012 52
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