Current Reviews in Clinical and Experimental Pharmacology - Volume 16, Issue 1, 2021

Background: Medication reconciliation is a major part of clinical care transitions that can promote patient safety and satisfaction. The main administrators of this process are pharmacy practitioners. Currently, many medical centers all over the world implement the procedures of medication reconciliation with varying styles and inconsistent success. Some other centers are going to build protocols in the near future. By now, there is no consensus for an optimal method of running medication reconciliation and each center has its own approach. This fact can cause a huge amount of resource wastages. In this narrative review, we searched scientific literature in this field in order to extract, underline and formalize the specific features which help a medical center to reach an optimized medication reconciliation plan. Methods: We explored the PubMed database with keywords of “medication reconciliation” and “pharmacy service” to obtain a relevant reference pool for our topic. Then we checked the affiliations of authors to be assured of the international diversity of our perspective. Results: Our search method yielded 184 journal articles from different continents. The frequency of published articles from America was higher and then, Europe, Australia, Asia and Africa were placed, respectively. Conclusion: According to the results, inclusion of factors like establishing phases for implementation, proper education, developing academic coordination, providing suitable facilities, specialization of the services, periodical evaluations and promoting pharmacy practice in the development of medication reconciliation will potentially lead to an optimized plan.

Background: The aim of the review was to comprehensively characterize the antimicrobial efficacy of bacteriophages in eliminating pathogens occurring in companion animals, as an alternative to antibiotics for controlling infections that pose potential threats to the health and life of people and to the environment. Methods: The review contains detailed information on the characteristics and classification of bacteriophages and an analysis of their life cycle. The dominant element is a detailed analysis of the experimental use of bacteriophages in combating infections caused by various microorganisms in companion animals with regard to their potential use in therapy. Results: It seems that in the near future, phage therapies will provide an alternative to antibiotics in the treatment of diseases caused by multi-drug resistant bacteria in people and animals. Conclusions: The effectiveness of phage therapies depends on many factors and the properties of the bacteriophages themselves, which requires comprehensive knowledge of them.

Background: Cancer is not just one disease; it is a group of diseases either genetic or metabolic due to the malfunction of mitochondria. Thus, metabolic pathways are reprogrammed to satisfy tumor cell proliferation and survival requirements. Methods: We undertook a structured search of bibliographic databases for peer-reviewed research literature dealing with these metabolic pathways. Results: It was found that cancer cells prefer fermentation as a source of energy even in the presence of oxygen, this altered metabolism of cancer cells may confer a selective advantage for survival and proliferation according to the Warburg effect. Furthermore, some molecules like HIF, PKM2, NADPH and others are essential to the survival of cancer cells in the hypoxic abnormal environment which has limited glucose sources. Conclusion: As cancer cells use glucose for aerobic glycolysis as a preferred substrate for energyyielding metabolism, we discuss in this review the Warburg effect and a strategy of starving cancer cells from glucose to prevent cancer cell survival and induce apoptosis in various types of cancer which could be the key to future treatment.

Background: Biopharmaceuticals such as biological, medicinal products have been in clinical use over the past three decades and have benefited the therapy of degenerative and critical metabolic diseases. It is forecasted that the market of biologics will be going to increase at a rate of > 20% per year, and by 2025, more than 50% of new drug approvals might be biological products. The increasing utilization of the biologics necessitates cost control, especially for innovator products that have a lengthy period of exclusive usage. As the first wave of biopharmaceuticals is expired or set to expire, it has led to various opportunities for the expansion of bio-similars i.e. copied versions of original biologics with same the biological activity. Development of biosimilars is expected to promote market competition, meet worldwide demand, sustain the healthcare systems and maintain the incentives for innovation. Methods: Appraisal of published articles from peer-reviewed journals, PubMed literature, latest news and guidelines from European Medicine Agency, US Food Drug Administration (FDA) and India were used to identify data for review. Results: Main insights into the quality requirements concerning biologics, the current status of regulation of bio-similars and upcoming challenges lying for the upgrading of the marketing authorization of biosimilars have been incorporated. Compiled literature on the therapeutic status, regulatory guidelines and the emerging trends and opportunities of biosimilars has been thoroughly stated. Conclusion: Updates on biosimilars will support to investigate the possible impact of bio-similars on the healthcare market.

Background: Despite the developments of single or dual antiplatelet therapy consisting of aspirin and/or clopidogrel, prasugrel or ticagrelor, post-acute coronary syndrome a room for potential improvement towards optimal prevention persist. The addition of a direct oral anticoagulant to the antiplatelet treatment of patients with the acute coronary syndrome is clinically practiced in cases where anticoagulation is indicated by high thromboembolic risk. Objective: The main objective of this review was to explore the role of supplementation with a direct oral anticoagulant to antiplatelet (aspirin or P2Y12 inhibitor) in patients with the acute coronary syndrome. Methods: We have searched the Medline for studies involving direct oral anticoagulant use in acute coronary syndrome. We have reviewed specific relevant 9 meta-analyses between the years 2012 to 2019. Results: Our review of nine meta-analyses has revealed that the addition of direct oral anticoagulant to antiplatelet therapy compared with antiplatelet alone was beneficial about the composite endpoints of major ischemic events in patients with the acute coronary syndrome. Furthermore, the combined regimen of single antiplatelet plus direct oral anticoagulant is as effective as the triple regimen of dual antiplatelet plus direct oral anticoagulant and results in less bleeding. Conclusion: Cardiologists should balance the efficacy with a higher risk of bleeding with more intensified DOAC therapy. Better risk characterization and timely adaptation of the regime to the patient's need should be tested. Recurrent ischemic events and bleeding event risk scoring should guide individualized treatment.

Background: Rocuronium is a muscle relaxant with increased use due to its binding relation with the reversal agent sugammadex. The purpose of this review entails the investigation of its use for the maintenance of Deep Neuromuscular Block (NMB) via continuous infusion. Methods: Based on PRISMA systematic search guidelines, databases included PubMed, ISI Web of Science, Cochrane Library and Google Scholar. This comprehensive search addresses surgical patients under deep muscle relaxation via continuous rocuronium infusion. The main indicators were the rocuronium administration, NMB monitoring approaches and effects in order to maintain the deep level of relaxation, as well as reversal time after a standard dose of sugammadex. Results: Despite the variance in approaches found in the literature, findings show the overall maintenance of deep NMB requires approximately 0.758 mg.kg^-1h^-1 of rocuronium (according to the PTC target of 0-10, 0-5 and 1-2, mean estimates are 0.445, 0.65 and 0.833 mg.kg^-1h^-1 respectively), suggesting that a lower range and a smaller maximum of PTC response require higher amount of rocuronium for its maintenance. The standard dose of sugammadex (4 mg/kg), administered at the end of the surgery takes longer [2.85 (1.17) min] than when they are administered after moderate NMB recovery [1.68 (0.47) min]. Conclusion: Continuous infusion for deep NMB presents inherent advantages in terms of maintenance and stability of muscle relaxation. Monitoring and rocuronium administration approaches are fundamental and intrinsically connected to provide a stable and improved maintenance of deep NMB.

Background: Anti-hypertensive medications may reduce the incidence of cognitive disorders. This may be due to reasons beyond their pure hypotensive effect. This study aimed to systematically review the association between the use of Angiotensin-Receptor Blockers (ARBs) and the incidence of Alzheimer’s disease (AD). Methods: We systematically searched studies reporting the association between ARB use and the incidence of AD. Results: Ten studies (1 RCT, 2 case-control and 7 cohort studies) met the inclusion criteria. When all observational studies (9) were analyzed, ARB use was associated with a reduced risk of incident AD (HR 0.72, 95% CI: 0.58-0.88, p<0.001). In the only RCT, decrease in the incidence of AD was also significant (HR= 0.31, 95% CI: 0.14-0.68). Conclusion: ARB use may reduce the risk of incident AD. This association does not imply causation and further research is required to clarify potential mechanisms.

Background: Psoriasis is one of the most common skin diseases in humans and affects a major population worldwide. The aim of the present study is to evaluate the efficacy of selected polyherbal formulations against psoriasis-induced secondary infections. Aim: Psoriasis is one of the most common skin diseases in humans and affects a major population worldwide. The aim of the present study is to evaluate the efficacy of selected polyherbal formulations against psoriasis-induced secondary infections. Methods: Samples were collected from the scalp, behind the ears, chest and back of the patients. The microscopic examination of fungal and bacterial growth was carried out with lactophenol cotton blue stain and gram stain, respectively. Volatile constituents of essential oils were identified by GC-MS analysis, in order to investigate the relation between chemical composition and biological activity. Nutrient agar media was used for antibacterial activity whereas Sabourauds dextrose agar media was used for antifungal activity. Results: A total of 24 isolates were obtained from 2 patients of scalp psoriasis. Anti-oxidant activity of the samples was determined using DPPH radical scavenging method. In the present study, EOs showed a good antifungal action against Malassezia pachydermatis and other microbial strains. The GC-MS analysis revealed the presence of eugenol, linalool, citral, neral, limonene, terpenes, eucalyptol and thymol in the essential oils. The formulated retention lotion 1 (L4), 2 (L5), 3 (L6) and Cream 1 (C1) showed DPPH radical scavenging activity by 23.52%, 24.48%, 28% and 5.08%, respectively. Conclusion: The present study concluded that most of the formulated lotions and creams showed good antimicrobial activity and may be applied topically against scalp psoriasis.

Background: Stroke is the leading cause of long-term disability worldwide. Stroke recurrence is a major health problem with devastating consequences. Adherence to secondary prevention guidelines reduced stroke recurrence. Data regarding prescriptions adherence to secondary prevention guidelines in the Middle East and North Africa is lacking. Objectives: The aim of this study is to assess the degree of physician adherence to ASA guidelines and the patient specific factors that affect their prescribing patterns in a major teaching hospital in Jordan. Methods: Ischemic stroke patients referring to King Abdullah University Hospital were approached and offered a description of the study to obtain their informed consent. After getting the informed consent, their prescription at the time of discharge was evaluated for adherence to secondary prevention guidelines and classified into adherent and non-adherent based on a composite score that included each of the guidelines which indicated therapeutic classes. Odds ratio for adherence and their 95%confidence intervals were calculated and adherence to specific therapeutics classes was evaluated. Results: Two hundred and seventy-five patients were included in this evaluation. Less than 50% of the patients received guideline’s adherent prescriptions. Patients with hypertension and hyperlipidemia were associated with a lower probability were prescribed a guidelines adherent regimen (OR 0.485, 0.0.225, respectively). ACEI/ARBs combination with thiazides was prescribed to about 11.52% of the patients. Conclusion: Adherence to stroke secondary prevention guidelines was suboptimal especially in the antihypertensive prescription component. Further assessments and evaluations are required to improve guidelines adherence.

Background: Opioid-sparing strategies are recommended, and Opioid-Free Anaesthesia (OFA) is proposed in the literature. But few data exist about the feasibility of OFA in the routine practice. From a larger series of 21,463 patients receiving OFA, this work investigates the postoperative pain and related outcomes in patients undergoing laparoscopic hysterectomy. Materials and Methods: This matched retrospective study concerned 521 patients scheduled for a laparoscopic hysterectomy between 2010 and 2015 (118 receiving OFA and 403 receiving anaesthesia with opioids, AO). Primary outcome was pain in the Post-Anaesthetic Care Unit (PACU). Results: Among the 521 included patients, 403 received sufentanil (mean±SD: 0.1±0.05 mcg/kg), the only synthetic opioid used to balance anaesthesia. Concerning the 118 patients receiving OFA, most of them received an association of clonidine (97%) and ketamine (95%). Most of the patients in both groups received non-steroidal anti-inflammatory drugs. No difference in pain scores was observed between AO and OFA (median [IQR], respectively: 4 [0-5] vs. 4.5 [0-6], P=0.74). A difference in the perioperative morphine equivalent use was observed (mean±SD: 0.18±0.06 mg/kg vs. 0.09±0.06 mg/kg, P<0.001). No difference was observed regarding the nausea/vomiting incidences, use of anti-emetics, sedation scores, or time spent at the PACU. Conclusion: Coming from an extensive daily practice, these data show that OFA is feasible and not associated with higher pain scores or longer PACU stay, suggesting the absence of specific immediate complications.

Background: Persistence and adherence to treatment are considered efficacy outcomes in psychiatric disorders. One of the best ways to improve these values in patients with psychiatric disorders is to prefer Long-Acting Injectable (LAI) drugs to oral AP. Objective: The objective of this study is to evaluate adherence, persistence and switching of antipsychotics and compare in real life long-acting with oral formulations. Materials and Methods: This pharmacological, observational, retrospective and non-interventional study involved all patients of the ASL of Pescara treated in the front-line with AP in the period between January 2011 and February 2019. Adherence was measured using the ratio between the received daily dose and prescribed daily dose. Persistence to treatment with antipsychotics was calculated as the daily difference between the beginning and end of treatment. Results: We examined 840 patients treated with aripiprazole, 130 patients treated with paliperidone and 925 patients treated with risperidone. Adherence was significantly better in long-acting formulations with values of 0.89 (aripiprazole) and 0.82 (paliperidone and risperidone) than in oral formulations with values of 0.78, 0.70 and 0.58, respectively (p> 0.999, p= 0.0091, p=< 0.0001). Threeyear persistence curves relating to three study drugs did not show a statistically significant difference (p = 0.3314). Persistence curves based on formulation have not shown a statistically significant difference (p= 0, 4658, p=0, 4794, p=0, 2199 for ariprazolo, paliperidone and risperidone, respectively). 7% of patients were treated with aripiprazole, 12% of patients were treated with risperidone and 28% of patients were treated with paliperidone switched therapy. Conclusion: In all the drugs of present study, adherence values were better in LAI than in OA, whereas no statistically significant difference was found in persistence values.

Background: Postoperative Nausea and Vomiting (PONV) is a common complication associated with the use of anesthesia. Several antiemetics are used to reduce the incidence and severity of PONV. The aim of this study was to investigate the role of dexamethasone and ondansetron to treat PONV in patients undergoing cesarean section (c-section) under spinal anesthesia. Methods: This double-blind clinical trial study was performed on patients who were referred to Haji Karim Asali Hospital of Khorramabad for elective cesarean section in 2016-17. Upon meeting the inclusion criteria, patients were allotted into two groups (n=60). Group A received 8mg of dexamethasone and group B received 4mg of ondansetron after spinal anesthesia. The Visual Analog Scale (VAS) questionnaire and Depression-Anxiety-Stress Scale (DASS) questionnaire were used for the analysis. Patients with mild to moderate stress, anxiety, and depression were included in the study. Data were analyzed using SPSS 16 software. Results: There was no difference in the demographic data of the two groups. The mean severity of nausea in group A was significantly higher than in group B. The odd ration of PONV was 20.67, which was found to be statistically significant, p = 0.018. Concerning the type of delivery with the frequency of nausea, the results showed that the frequency of nausea in group A was 3.24 times higher than group B, however, this difference was not statistically significant, p = 0.106. Conclusion: Based on the results of this study, ondansetron had a significant effect on the alleviation of postoperative nausea and vomiting, as compared to dexamethasone in C-section surgical candidates.