Clinical pharmacy

Kayode and Olabisi / JPBMS, 2012, 22 (04)

Available online at www.jpbms.info

Research article

ISSN NO- 2230 – 7885 CODEN JPBSCT NLM Title: J Pharm Biomed Sci.

JPBMS JOURNAL OF PHARMACEUTICAL AND BIOMEDICAL SCIENCES

Assessment Of Rational Use Of Drugs Among Patients With Chronic Heart Failure (Chf) Using Case Notes Of Patients At The Tertiary Health Care Institution In South West Nigeria OMOLE, Moses Kayode (1) Pharm. D., Malik Elizabeth Olabisi (1) B. Pharm. 1*,2 Department

of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan.

Abstract: Rational use of drugs requires that patients receive drugs appropriate to their clinical needs in doses that meet their individual requirements. The case studies were carried out to assess the various factors that influenced the rational use of drugs in the treatment of chronic heart failure (CHF) among those admitted as in-patients in the University College Hospital (U. C. H) Ibadan. Four patients consisting of two male adults and two female adults were randomly selected and monitored with their case notes thoroughly studied. Angiotensin converting enzyme inhibitors (ACEIs), were prescribed for the four patients. Beta blockers were prescribed for three patients while only two patients were prescribed calcium channel blockers. Digoxin tablets were prescribed for two patients while Isosorbide dinitrate was prescribed for only one of the patients. Other drugs prescribed were antihypertensives which include modurectic (Amiloride + Hydrochlorthiazide (HTZ)), hypoglycemic agents which include insulin and metformin (Glucophage), analgesic which include tramadol and paracetamol, antibiotics which include augmentin, ciprofloxacin and ceftriazone. Side effects documented were hypotension, cough, and chest pain. The result from these studies showed that utilization of variety of health professionals are required to reinforce rational treatment for heart failure.

Keywords: Chronic heart failure, Rational, Patients, Treatment. Introduction: Rational use of drugs requires that the right drug be used with the right dose at the right interval and at the right duration. Drug of choice is rational when patients receive medications appropriate to their clinical needs, in doses that meet their individual requirements, for an adequate period of time and at the lowest cost to them. Thus, rational use of drugs includes correct prescribing, dispensing and patient compliance [1]. When the use of drugs is not in accordance with the above definition, there are often undesirable health and/or economic problems, such as insufficient therapeutic effect, adverse drug reactions, preventable side effects, interactions of drugs and increasing resistance of bacteria to antimicrobial medicines resulting in increased, prolonged or expensive hospital admission [1, 2]. Irrational use of drugs can be due to increase in the cost of drugs resulting in inability to procure sufficient drugs to meet patient demand, inadequate training of health staff, lack of continuing education by health professional, lack of updated reliable and unbiased drug information for the healthcare proffessionals. Particular areas that precipitate the irrational drug use include poor selection of medicines without consideration for relative efficacy, cost effectiveness or local availability, prescription not in 1

accordance with standard treatment protocols, patients’ lack of knowledge about dosing schedules, patients not adhering to dosing schedules and treatment advice. Chronic heart failure (CHF) occurs when the heart is incapable of maintaining sufficient blood flow to accommodate tissue perfusion and metabolic requirements. It is characterized by dyspnoea, fatigue and fluid retention[3]. However, patient will not always have symptoms of congestion. Therefore, the term “congestive heart failure” is falling out of favor and chronic heart failure is rather used to describe this population[4]. Almost any condition that overworks or damages the heart muscle can eventually result in CHF [5, 6]. The most common cause of CHF is coronary heart disease (CAD) [7]. CHF may develop when the death of heart muscle in a heart attack leaves the heart with less strength to pump blood or simply as a result of long term oxygen deprivation due to narrowed coronary arteries[4]. Hypertension or malfunctioning valves that force the heart to work harder over extended periods of time may also lead to CHF[8]. Viral or bacterial infections, alcohol abuse, and certain chemicals, can all damage the heart muscle and result in CHF [9, 10]. The assessments of these factors form the rationale behind the choice of drugs used in the treatment of CHF. The

Journal of Pharmaceutical and Biomedical Sciences © (JPBMS), Vol. 22, Issue 22

Clinical pharmacy

Kayode and Olabisi / JPBMS, 2012, 22 (04)

principal aims of drug therapy are to reduce mortality, control symptoms, prevent hospital admission and delay disease progression [7, 11]. This study was to assess the rational pharmacotherapeutic approach to the management of chronic heart failure (CHF) in four patients at the University College Hospital (UCH), Ibadan with the goal of providing and promoting pharmaceutical care.

Patients and Methods: This study was based on the random selection of four inpatients admitted for congestive heart failure at the cardiology unit of the university college hospital (UCH), Ibadan. There was a direct contact with the patients during their admission in the hospital with their case notes thoroughly studied. The study population included randomly selected two male adults and two female adults. The patients were monitored to assure the highest degree of adherence to drug management. The patients’ medication histories, factors that influenced rational drug use such as the dosage regimen, side effects, drug-drug interactions, date of admission, chief complaints, co-morbidities, physical examinations and laboratory findings as related to the chief complaints were extracted from the case notes and thoroughly studied. The permission to carry out this study was granted by UI/UCH ethical committee.

Results: CASE A Case History A.G, a 60 year old female, widow of 5 children and a trader was in her usual state of health until three weeks before presented with progressive difficulty in breathing worsened by exercise and pedal swelling. There was associated fatigability. There was no fever, chest pain, night sweat, or unexplained weight loss. There was no paroxysmal nocturnal dyspnoea (PND), no headache, dizziness or fainting episode. About one week before presentation, she developed pedal swelling and abdominal distension. There was no abdominal pain, no associated nausea, vomiting, diarrhoea or constipation. There was a history of polydipsia, polyuria and nocturia but no dysuria, hematuria, pyuria or loin pain. Patient initially presented at a private hospital about one week before presenting at UCH, where she was placed on some oral drugs and daily injection (names not documented) which she claimed she was on for seven days. On the seventh day, patient noticed the pedal swelling. She then re-presented at the private hospital that morning from where she was then referred to UCH. Patient was a known hypertensive diagnosed about a year before presentation but poorly adherent to treatment. She was not a known asthmatic and had not been transfused or undergone surgery before. Patient took local herbal remedies consisting of alcohol and tree bark during this illness but not before. There was no known drug allergy. On Examination: Middle aged woman, not pale, anicteric, afebrile, not dehydrated, bilateral pitting pedal oedema up to the knees. 2

CVS: Pulse Rate: 176 beats per min.*BP: 170/130mmHg* HS: S1, S2 only, no murmur, no thickened arterial wall Chest: Dyspnoeic, tachypnoeic *RR – 32 cycles per min, fine bibasal crepitation *BS – vesicular Abdomen: Obese, move with respiration, no area of tenderness, Ascites+ CNS: Conscious, alert, oriented in TPP Neck is supple Assessment: Congestive Heart Failure precipitated by supraventricular tachycardia. LABORATORY RESULTS (reference values in brackets): PCV: 30% (36-48) RBG: 135mg/dL (