1. Drug Interaction Related Queries Received By The Drug Information Center Of A Tertiary Care Teaching Hospital Beena Jimmy Lecturer Department of Pharmacy Practice Manipal College Of Pharmaceutical Sciences

2. Contents Background Objectives Methodology Results and discussion Conclusion

3. Background Drug -drug interactions have great significance and are well documented 1 Important contributor to number of emergency visits and hospital admissions Drug interactions (DI) represent 3-5% of preventable in- hospital adverse drug reactions 2 Accurate and timely information on DIs is useful to ensure safe use of medications Drug information centers can contribute in preventing and managing DIs by providing unbiased information It is important to understand the pattern of DI related queries 1. Anastasio GD, et.al. Drug interactions: keeping it straight.Clinical Pharmacology 1997: 56: 883-94. 2. Raschetti R, et al. Suspected adverse drug events requiring emergency department visits or hospital admissions. Eur J Clin Pharmacol 1999;54(12):959–963.

4. Objectives To assess the nature of queries related to drug interactions received by a drug information center of a tertiary care teaching hospital

5. Methodology Retrospective study Study site: DI center of Kasturba Hospital (1,400 bedded) tertiary care teaching hospital in South India Data evaluated: Queries on drug interaction were selected for evaluation over a period of 18 months (Aug 04- Jan 06)

6. Methodology ….continued Evaluation parameters *Department of practice *Mode of receipt *Purpose of enquiry *Urgency of answer needed *References used *Severity, Documentation and Onset of Drug interaction *Drugs and Drug class commonly inquired

7. Results and discussion No of drug information queries= 980 DI queries related to drug interaction= 128 (13%) Comparable with the results of Nibu et al 3, Rao PGM et al 4 Department of practice Medicine (75.7%) Psychiatry (6.2%) Purpose of enquiry Better patient care (74.2%) Update knowledge (25.7%) Number of references consulted Two references (46.8%) One reference (31.2%) 3. Nibu P, et.al. Review of a drug information sevice in an Indian teaching hospital. The Aust J Hosp 2001; 31: 144-5 4. Rao PGM, Gore S. Survey and evaluation of the Drug Information Services in Kasturba Hospital, Manipal. Indian J Pharm Educ 2004; 38: 150-3.

8. Mode of receipt of queries and urgency of answer needed Mode of receipt No. of queries %Urgency of answer needed No. of queries % Ward Rounds 9372.6Immediately11589.8 Telephone3325.7Within 2-4hrs86.2 Direct Access 21.5Within a day43.1 Intranet10.7Within 1-2 days 10.7

9. References used for answering queries References Reference No. of % queries MICROMEDEX, Drug interaction tool 102 41.8 Stockleys drug interaction 74 30.3 Lexicomps Drug information Handbook 32 13.1 Drug interaction facts and comparison 28 11.4 American hospital formulary system 8 3.2

10. Results and discussion contd… Number of drugs involved Two drugs (57%) Three drugs (16.4%) Interaction was observed in 46%

11. Description of nature of drug interactions. SeverityNo. of queries% Major2542.3 Moderate3152.5 Minor35.0 OnsetNo. of queries % Delayed5186.4 Rapid813.5 Documentation No. of queries % Fair1525.4 Good3661.0 Poor46.7 Excellent 35.0

12. Drug and drug class commonly involved aDrug class Total Drug No. of % queries queries 1.Antibacterial for systemic use(J01) 52 Levofloxacin 815.3 2.Antimycobacterials (J04) 51Rifampicin 17 33.3 Ethambutol1121.5 Isoniazid 1121.5 Pyrazinamide 1121.5 3.Antiviral for systemic use (J05) 35Lamivudine 822.8 4.Antiepileptics (N03) 30Phenytoin 14 46.6 Carbamazepine 8 26.6 5.Antithrombotic agents (B01) 30 Warfarin 19 63.3 aDrug class (According to second level of WHO-ATC classification ) with greater than 8 queries are represented

13. Conclusion Health care professionals utilize the service for better patient care Accurate and timely information on drug interactions very essential to ensure safe use of drugs Updated resources enhance utility by the health care professionals

14. Thank you