Clin Pharm SSCP: April 2019

Saturday, April 27, 2019

First Edition of Newsletter

Seasonal Greetings -2019

Sree Siddaganga College of Pharmacy was established in the year 1983-84 by Sree Siddaganga Education Society ® for providing an outstanding professional education in pharmacy. Sree Siddaganga College of Pharmacy has well planned; decorative and magnanimous building and well educated highly experienced teachers to teach D.Pharma, B.Pharma, M.Pharm, PharmD and Ph.D, courses, are approved by AICTE & Pharmacy Council of India, New Dehli. and affiliated to Rajiv Gandhi University of Health Sciences, Karnataka.

With the divine blessing of His Holiness Dr. Sree Sree Shivakumara Mahaswamiji and His Holiness Sree Sree Siddalinga Mahaswamiji, we have established our new Department of Pharmacy Practice at Siddaganga Hospital & Research Center under the guidance of Dr. Shivanna Paramesh, Managing Director, Siddaganga Hospital & Research Center and Dr. Suresh V. Kulkarni, Principal, Sree Siddaganga College of Pharmacy, Tumakuru.

We are more delighted to write this editorial for the first issue of “Siddaganga Clinical Pharmacy News letter”. This will be published once in every four months. In every issue of our newsletter, we are incorporating articles from industry, academician, students and health care professionals etc. Your valuable feedbacks will be highly appreciable for improving the quality of our newsletter.

Anti-Cholinergics and Risk of Dementia

Anti-cholinergic drugs are one of the commonly used drugs in Medicine. They are used for variety of conditions like Depression, Parkinson's disease, Epilepsy, Gastrointestinal diseases and number of urologic conditions. Anti-cholinergic drugs block the neurotransmitter acetylcholine in the central or peripheral nervous system, and have diverse actions. Examples of commonly used drugs include Diphenhydramine, Trihexyphenidyl, Benztropine, Biperiden, Clomipramine, Chlorpromazine, Clozapine Fluphenazine, Loxapine, Olanzapine, Perphenazine, Pimozide, Quetiapine, Thioridazine, Thiothixene, Trifluoperazine, Dicyclomine, Hyoscyamine, Flavoxate, Glycopyrrolate, Oxybutynin, Propantheline, Scopolamine, Tiotropium, Tolterodine etc.,

Dementia is the term denoted for a decline in mental ability severe enough to interfere with daily life. Common forms of dementia include Alzheimer's disease and Vascular dementia (which occur post stroke). Other causes for Dementia include Thyroid diseases and vitamin deficiencies. Dementia is one of the leading causes of disability and death, and its prevention is a global public health priority.

Several Research studies have studied the association between Anti-cholinergic drugs and cognitive dysfunction. Over the past decade, prolonged exposure to anti-cholinergic drugs has been linked to long term cognitive decline or dementia incidence among community living cohorts and nursing home residents. Large group of elderly patients have been studied at United Kingdom with a varying history of Anti-cholinergic drug use. Study concluded that Mechanistic evidence for a link between anticholinergic drugs and dementia incidence is limited, but neuropathological studies in humans and mice do support a role of anticholinergics affecting neurodegenerative pathology. Many people use anticholinergic drugs at some point in their lives, and many are prescribed to manage chronic conditions leading to potentially long exposures. There are strong associations between levels of anticholinergic antidepressants, antiparkinsons, and urologicals and the risk of a diagnosis of dementia up to 20 years after exposure.

Reference:
1. Richardson K, Fox C, Maidment I, Steel N, Loke YK, Arthur A, Myint PK, Grossi CM, Mattishent K, Bennett K, Campbell NL, Boustani M, Robinson L, Brayne C, Matthews FE1, Savva GM. Anticholinergic drugs and risk of dementia: case-control study. BMJ. 2018 Apr 25;361:k1315.
2.Savva GM, Wharton SB, Ince PG, Forster G, Matthews FE, Brayne C, Medical Research Council Cognitive Function and Ageing Study. Age, neuropathology, and dementia. N Engl J Med2009;360:2302-9.
3.Matthews FE, Arthur A, Barnes LE, et al., Medical Research Council Cognitive Function and Ageing Collaboration. A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II. Lancet2013;382:1405-12.
4.Fox C, Richardson K, Maidment ID, et al. Anticholinergic medication use and cognitive impairment in the older population: the medical research council cognitive function and ageing study. J Am Geriatr Soc2011;59:1477-83.
5.Chatterjee S, Bali V, Carnahan RM, Johnson ML, Chen H, Aparasu RR. Anticholinergic Medication Use and Risk of Dementia Among Elderly Nursing Home Residents with Depression. Am J Geriatr Psychiatry2016;24:485-95.
6.Boustani M, Campbell N, Munger S, et al. Impact of anticholinergics on the aging brain: a review and practical application. Aging Health2008;4:311-20.

Mr. Vishwas H N
Lecturer
Department of Pharmacy Practice,
JSS College of Pharmacy,
Ooty, Tamilnadu

Death by Misadventure

A death by misadventure, as recorded by coroners and on death certificates and associated documents, is one that is principally endorsed to an accident that occurred due to a risk that was taken voluntarily. In contrast, when a cause of death is scheduled as an accident rather than a misadventure, this implies no unreasonable willful risk. Misadventure is a legally-defined manner of death: a way by which an actual cause of death (trauma, exposure, etc.) was allowed to occur. For example, a death caused by an illicit drug overdose may be ruled a death by misadventure as the user ignored the risks of the drugs. Misadventure is a form of unnatural death, a category that also includes accident, suicide, and homicide. Therapeutic misadventure can be defined as an injury or an adverse event caused by medical management rather than by an underlying disease. Unfortunately one of the maximum contributors to iatrogenic injury is human error. The impending types of misadventure are infinite. Medication errors are a major part of this, being responsible for over 70% of cases that cause serious harm. However, many medication errors caused by slips, lapses, technical errors and mistakes are preventable; intentional violations of safe operating procedures are not. Despite the endeavour of health-care professions to stick to the rule of 'first, do no harm', in reality this is difficult to achieve all of the time. Identifying and correcting system (latent) errors will, in the end, provide a safer health-care system.

Key words: Death, Health-care system, Misadventure, Therapeutic misadventure.

Address for Correspondence:

Dr. L. Reddenna, Pharm.D, Ph.D
Associate Professor
Department of Pharmacy Practice
Balaji College of Pharmacy, Rudrampeta,
Ananthapuramu-515001.
Andra Pradesh.

Role of Calcium in Local Anaesthesia

Local anaesthetics (LAs) block nerve conduction of sensory impulses (mainly pain, temperature, touch and deep pressure). The most commonly used ones are Lidocaine, Bupivacaine, Tetracaine, Procaine and Ropivacaine. At physiologic pH, they are cationic and interacts with the protein receptor of the voltage gated Na+ channel to inhibit its function and achieve local anaesthesia. Moreover, exposure to higher concentration of Ca2+ reduces inactivation of Na+ channels and lessens the degree of block. The bound Ca2+within the cell membrane are presumed to exert a regulatory role on the movement of Na+across the nerve membrane. The proposed mechanism includes: The displacement of the Ca2+from the sodium receptor site, which allows the binding of local anaesthetics, blockade of sodium channels, decrease in sodium conductance, and decrease in rate of depolarisation and finally conduction blockade. The aforementioned process includes the rise in the level of intracellular Calcium levels from the Endoplasmic reticulum. LAs indirectly inhibit the Calcium channels, thereby decreasing its influx. These released Ca2+ intracellular and the non-entered extracellular ions can exert various actions. The local anaesthetics form a more stable bond at the site from where calcium ions are displaced and exert their local anaesthetic action.

For example : In the myocardium, There is LA mediated slow release of Calcium from the sarcoplasmic reticulum, with an increased reduction in the amount of calcium required for myocardial contractility. The decreased entry and reduced intracellular calcium storage results in decreased myocardial contractility.

Prepared by:

Janice Jacson M
Pharm D
Nirmala College of Pharmacy,
Muvathupuzha,
Kerala.

Probiotics

Probiotics are live bacteria and yeast is also known as “good” or “helpful” bacteria which is good for our health when introduced into the body, especially for our digestive system. Yogurt, kimchi, tempeh, pickles contains probiotics.

probiotic concept was introduced in early 20th century and “Nobel Laureate Elie Metchnikoff” is known as the Father of Probiotics . Most common bacteria which is used as probiotics are lactobacillus and bifidobacterium. When good bacteria of our body lose, probiotics helps to replaces those bacteria, also maintains balance between good and bad bacteria for body to function effectively. (1) It treats and prevents acute diarrhoea. (2) Prevent food allergy in infants and children caused by cow milk. (3) Treat allergic reactions such as eczema. (4) Prevent respiratory infections and dental caries in childrens. Meta-analysis performed to assess effect of probiotics supplements on Chronic Kidney Disease (CKD) progression. Until 2018 a research was conducted by Pubmed, Embase and Cochrane. Randomized controlled trials (RCTs) with control receiving placebo, evaluating the effects of probiotics on CKD. A total of ten RCTs in 8 countries were selected and shows in non-dialysis population urea level was significantly reduced, while in dialysis population found as no significant changes of uric acid, C-reactive protein, creatinine and GFR.

Dr. Kavya H.B.
Assistant Professor

Submitted by: Ms. Soumya Sangawara, IV Pharm D

Prebiotics

Prebiotics are non-viable or non-digestable ingredients of food that improve the health by enhancing the growth of essential micro flora. The beneficial bacteria's include Bifidobacteria and Lactobacilli. The positive impacts of prebiotics are on prevention of inflammatory bowel diseases, treatment of eczema, cancer and urinary tract infection. Clinical trials had proven that a particular food product that acts as prebiotics improves the well- being of the patient with such conditions. The main sources of prebiotics are dietary fibres. Some of the fruits and vegetables like banana, garlic, onion, asparagus, leeks acts as major prebiotics. Human milk also contains huge quanity of prebiotics. In infants these are very essential as they produced microflora which balance the consistency, ph, and frequency of the stool and also enhances the activity of immune system. Plethora of research studies and clinical trials have been conducted regarding the effect of prebiotics which includes, effectiveness of prebiotics (1) to reduce the duration of acute diarrhoea and gastritis in children, (2) children who are overweight or with obesity (3) infectious diseases caused by bacteria viruses and fungi . Apart from the mammalian study chickens have also been used to study about the role of prebiotics in the enhancement of their lifespan.

Dr.Mohammed Mustafa.G.
Assistant Professor

Submitted by: Ms. Hitha kommeri, IV Pharm D