EVALUATION OF BETA BLOCKERS USE AT A TERTIARY CARE HOSPITAL

Transcription

1 Page2587 Indo American Journal of Pharmaceutical Research, 2015 ISSN NO: EVALUATION OF BETA BLOCKERS USE AT A TERTIARY CARE HOSPITAL Sukesh Krishna Chaitanya Loka *, Vinuthna Yashki, Alekhya Vissampally, Divya Jose Malla Reddy Institute of Pharmaceutical Sciences, Hyderabad. ARTICLE INFO Article history Received 21/04/2015 Available online 01/08/2015 Keywords DUE, Beta Blockers, Hypertension, Drug Interaction. ABSTRACT Drug Utilization Evaluation (DUE) is an ongoing, authorized and systematic quality improvement process designed to review drug use and promote appropriate drug use through interventions. Beta blockers, one of the prescribed classes of cardio vascular medications reduce morbidity and mortality in patients with cardiac disease. The present study aimed to evaluate the prescribing pattern of beta blockers use. A prospective, observational study w a s carried out in inpatients of general medicine, and surgical departments of tertiary care hospital. Structurally designed proforma was used to collect patient data such as demographics, medical history, and treatment. The data was then analyzed using Microsoft Excel and evaluated. A total of 135 patients have been identified who were prescribed with beta blockers among which females accounted for 51.1% while males for 48.8%. Average length of hospital stay was 6 days. The most common diagnoses were Hypertension (62.2%), and Diabetes mellitus (34.8%). Beta blockers were mostly prescribed among the age group years (50.3%) and the widely prescribed was metoprolol (39.2%). The other anti hypertensive drugs concurrently prescribed with beta blockers included diuretics (51.1%). Major drug interactions were found in 9.83% only. Beta blockers most commonly prescribed include Metoprolol followed by atenolol. It is highly necessary for the clinical pharmacist to review and clinically check all prescriptions presented at the wards (check for appropriate dose, frequency, drug interactions etc.). Corresponding author Sukesh Krishna Chaitanya Loka Plot No: 2-1/28, Opp KVR towers B block Widia Colony, Cine town lane Miyapur, Hyderabad Telangana, India. Please cite this article in press as Sukesh Krishna Chaitanya Loka et al. Evaluation of Beta blockers use at a tertiary care hospital. Indo American Journal of Pharm Research.2015:5(07). Copy right 2015 This is an Open Access article distributed under the terms of the Indo American journal of Pharmaceutical Research, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

2 Page2588 INTRODUCTION DUE is an ongoing, systematic process designed to maintain the appropriate use and effective use of drugs. It involves a comprehensive review of patient s prescription and medication data before, during and after dispensing in order to assure appropriate therapeutic decision making and positive patient outcomes [1]. DUE is a performance improvement method that focuses on evaluating and improving drug use processes to achieve optimal patient outcomes. DUE may be applied to a drug or therapeutic class, or diagnosis [2]. Pharmacists routinely perform prospective reviews by assessing a prescription medication's dosage and its directions and reviewing patient information for possible drug interactions or duplicate therapy. Concurrent review is performed during the course of treatment and involves the ongoing monitoring of drug therapy to ensure positive patient outcomes. In retrospective DUE, patient medical charts or computerized records are screened to determine whether the drug therapy met approved criteria and aids prescribers in improving care for their patients, individually and within groups of patients, such as those with diabetes, asthma, or high blood pressure [3]. Beta b l o c k e r (-blockers, beta-adrenergic blocking agents, beta antagonists, beta adrenergic antagonists, beta-adrenoreceptor antagonists, or beta adrenergic receptor antagonists) are a class of drugs that target the beta receptor. These drugs inhibit adrenergic responses mediated through the receptor and are the most prescribed classes of cardiovascular medications. Beta blockers are registered for a wide range of indications including hypertension, angina pectoris, arrhythmias, heart failure, and as secondary prevention after MI. Long-term beta-adrenergic receptor blockade is a promising approach to the treatment of heart failure [4]. Beta blockers are effective only when they are rationally prescribed and used. These are most effective when given in combination with other anti-hypertensive medications particularly thiazide d i u r e t i c s [5]. Beta-blockers were the next class of drugs shown to save lives in CHF, when given on top of standard therapy with diuretics, ACE inhibitors, and optional digitalis glycosides. They reduce mortality in patients with cardiovascular disease, most notably after MI in the presence of CHF [6]. The present study aims to evaluate the prescribing patterns of beta blockers in a tertiary care hospital and the main objective is to control the misuse of beta blockers and promote rational drug therapy. Methodology: A prospective observational study had been conducted in the General Medicine and surgical departments of a tertiary care hospital in Hyderabad. The study had been conducted for a period of six months. All patients who were prescribed with beta blockers had been included in the study excluding pregnant and lactating women. A structurally designed data collection form was used to collect information such as demographics, medical history, lab investigations, and treatment and progress notes. The collected data was then evaluated and analyzed using Microsoft-Excel. RESULTS: A total of 135 patients have been evaluated with the use of beta blockers. GENDER DISTRIBUTION In the study population, out of 135 patients 66 were Male patients and 69 Female patients. It indicates this study is female dominated. Table 1: Gender Distribution in Study Population. GENDER NO.OF PATIENTS PERCENTAGE (%) Male Female Age distribution Out of 135 patients, 5 were below 30 years which are less whereas patients belonging to age group of were 42. In case of middle age and young old age group, number of patients was found to be 68 who are more, whereas the patients in the age group years were 20. Table 2: Age Distribution in Study Population. AGE NO.OF PATIENTS PERCENTAGE (%) < DURATION OF HOSPITAL STAY: The duration of hospital stay of 2 days for 8.1%, 3 days for 8.8%, 4 days for 14%, 5 days for 18.5%, 6 days for 12.5%, followed by 37.7% were admitted in the hospital for >7 days.

3 Page2589 Table 3: Duration of Hospital Stay in Study Population. DURATION NO.OF PATIENTS PERCENTAGE (%) 2 Days Days Days Days 6 Days >7 Days REASON FOR ADMISSION: In our study, the major complaints reported include breathlessness for 42.9% of patients. Swelling of 29.6% and fever, headache, chest pain was reported in 17.7% of patients. Also other complaints reported include generalized weakness, involuntary movements and pain which comprise 29.61%. Table 4: Reason for Admission of Study Population. REASON FOR ADMISSION NO. OF PATIENTS PERCENTAGE (%) Swelling Breathlessness Fever, Headache Chest pain Generalized Weakness Involuntary movements Others DIAGNOSIS OF STUDY POPULATION In the study population hypertensive patients were more prominent, found in 84 patients (62.2%). It is followed by diabetes (34.8%) and CHF (14.8%), whereas other diagnoses comprised 15.5%. Table 5: Diagnosis of study population. DIAGNOSIS NO.OF PATIENTS PERCENTAGE (%) HTN DM IHD LVF CHF STROKE CKD Portal HTN, Tachycardia Others BETA BLOCKERS PRESCRIBED: In our study the main beta-blockers prescribed where metoprolol (39.2%), atenolol (28.1%), carvedilol (18.5%), propranolol (13.3%) and labetolol (0.7%). Table 6: Beta Blockers Prescribed in Study Population. BETA BLOCKERS PRESCRIBED NO. OF PATIENTS PERCENTAGE (%) Metoprolol Atenolol Carvedilol Propranolol Labetolol

4 Page2590 CONCURRENT ANTI HYPERTENSIVE DRUGS PRESCRIBED The major anti-hypertensive drugs prescribed along with beta blockers were diuretics (51.11%), calcium channel blockers (38.5%) followed by angiotensin receptor blockers (22.2%) and angiotensin converting enzyme inhibitors (19.2%). Table 7: Concurrent anti-hypertensive Drugs Prescribed in the Study Population. ANTI HYPERTENSIVE DRUG NO. OF PATIENTS PERCENTAGE (%) Diuretics Calcium channel blockers Angiotensin receptor blockers Angiotensin converting enzyme inhibitors (ACEI s) Doses of Individual beta blockers Atenolol: Out of 135 patients, atenolol 50mg was prescribed for 21.4% of study population and 25mg was prescribed for 6.6% of study population. Table 8: Prescribed doses of Atenolol in the study population. Dose prescribed No. of patients Percentage (%) 25mg mg Metoprolol: Out of 135 patients, Metoprolol 25mg was prescribed for 22.9% of study population, 8.1% of patients were prescribed. with 12.5mg and 50mg. Table 9: Prescribed doses of Metoprolol in the study population. Dose prescribed No. of patients Percentage (%) 12.5mg mg mg Carvedilol: Out of 135 patients, carvedilol 3.125mg was prescribed for 16.2% of study population, 10mg was prescribed for 7.4% and 0.7% of patients were prescribed with 6.25mg. Table 10: Prescribed doses of Carvedilol in the study population. Dose prescribed No. of Patients Percentage (%) 3.125mg mg mg Propranolol: Propranolol 40mg Out of 135 patients propranolol 10mg was prescribed for 5.9% of study population, 20mg for 4.4% and 2.9% were prescribed with 40mg. Table 11: Prescribed doses of Propranolol in the study population. Dose prescribed No. of patients Percentage (%) 10mg mg mg 4 2.9

5 Page2591 DRUG COMBINATIONS: Out of 135 study population 18 patients were prescribed with beta blocker (atenolol) in combination with calcium channel blocker (amlodipine). In 18 patients 7.4% were prescribed with Amlo-AT and 5.69% were prescribed with Stamlo beta. Table 12: Drug combinations prescribed in the study population. Brand prescribed No. of patients Percentage (%) Stamlo beta Amlo AT DRUG INTERACTIONS In the study population total 122 drug interaction were reported out of these 12 (9.83%) were major drug interactions whereas 110 (90.16%) were moderate. Table 13: Type of drug interactions noted in the study population. TYPE OF NO. OF PERCENTAGE (%) INTERACTION INTERACTIONS Major % Moderate % DISCUSSION: In our study, a total of 135 prescriptions were recorded from General medicine, General surgery, and ICU departments. Out of them, male patients were 66 (48.88%) and female were 69 (51.11%) as shown in Tab: 1. these findings are similar to study of Queen Mary Utilization of Antihypertensive Drugs Study (QUADS) conducted in 2004 observed 48% male and 52% female in the study [7]. Most common age group involved in our study was years (50.3%), followed by years (31.9%) and 70-90years (14.8%). In the present study prescribing pattern is extended for the duration of hospital stay and days of treatment. The duration of hospital stay is 37.7% for more than 7days (Shown in Table: 3). Prolonging the duration of hospital stay does not provide for an additional therapeutic benefit, and it may result in costly remedial care and adverse effect simultaneously. The chief complaints of admission include breathlessness (42.9%), swelling (29.6%), followed by generalized weakness and chest pain (17.7%) as shown in Table: 4. Major diagnosis in the study population included Hypertension (62.2%) followed by Diabetes mellitus (34.81%) and chronic heart failure (14.8%) as shown in Table: 6. Monitoring of blood pressure and daily weight records were obtained during hospitalization. In the present study it was observed that most commonly prescribed beta-blockers were Metoprolol (22.2%), Atenolol(21.4%), followed by vasodilator Carvedilol (16.2%) and propranolol (13.3%) in different dosages. Most of the beta blockers were prescribed in single formulation rather than two formulations like amlodipine plus atenolol (13.33%). Concomitant antihypertensive drugs prescribed other than beta blockers include diuretics (51.11%), calcium channel blockers (38.5%), angiotensin receptor blockers (22.2%) followed by angiotensin converting enzyme inhibitors (19.2%). Two d r u g r e g i m e n of diuretics and monotherapy of remaining anti hypertensives were prescribed. In the two drug combination, a beta blocker (atenolol) with calcium channel blocker (amlodipine) was often prescribed which was comparable with other study by H Tiwari et al [8]. In this form of combination beta blockers trend to blunt the troublesome reflex tachycardia induced by dihydropyridine class of CCB s. Earlier studies suggested that an ideal combination therapy must include anti-hypertensive drugs possessing complementary modes of action (synergistic effect) without any adverse effect with low dose. In majority of the patients the use of polypharmacy was reported to control or manage medical conditions. Therefore before prescribing a medication it is important to determine if the patient s condition is caused by a current medication. In the study population drug interactions were reported with major DI (9.83%) and moderate (90.16%). The most common interactions included among beta blockers with other anti hypertensives, also with anti-diabetics. CONCLUSION From this female dominated study it was concluded that beta blockers most commonly prescribed include Metoprolol followed by atenolol. It is highly necessary for the clinical pharmacist to review and clinically check all prescriptions presented at the wards (check for appropriate dose, frequency, drug interactions etc.). She/he should compulsory monitor the patient regarding medication adherence, so that the best choice of drug can be prescribed. A therapeutic audit provides regular feedback associated with the drug use with continuous education and training program. From the study it was concluded that most of the prescription were rational, but further improvement is needed. A therapeutic audit provides regular feedback associated with the drug use with continuous education and training programs among the health care team helps to improve the quality of patient care, in achieving National goal of pharmacoeconomics. In the future perspective, it is essential to identify if the usage is as per the guidelines and report to the health care authorities in promoting the rational use of beta blockers based on standard therapeutic guidelines.

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