Impact of Pharmacophobia and Pharmacophilia on Perception of Medication Use and Self-Medication Behaviors in Saudi Arabia.

Objectives: Pharmacophilia and pharmacophobia have positive and negative effects on treatment outcomes. There exist lacune of information on these phenomena in middle east countries. Therefore the current study aimed to determine the pattern and predictors of Pharmacophilia and pharmacophobia in Saudi Arabia. The study further explored the impact of these phenomena on the perception of medication use and self-medication behaviours. Experimental design: An online questionnaire-based cross-sectional study was conducted during March-May 2021. Saudi residents aged 15 years or older were eligible for this study. Individuals' attitude towards medication was assessed using the Drug attitude inventory classification questionnaire, and the general belief of medication was assessed using the Beliefs about Medicine Questionnaire. Observation: One-fifth (n = 101; 20%) and two-third (n = 338; 65%) participants were categorized as pharmacophobic and pharmacophilic, respectively. The mean BMQ score was not statistically significant between the pharmacophobic and pharmacophilic groups (mean difference = 0.314; p-value = 0.176). Males were more likely pharmacophilic than females [AOR: 0.34 (95% CI 0.17-0.69)]. Both groups showed nearly a similar pattern of self-medication behaviours. Conclusion: There exist a good number of pharmacophobic and pharmacophilic among the Saudi population. A detailed understanding of the attitudes towards treatment among these groups is essential for enhancing treatment outcomes.

Patient satisfaction with pharmaceutical care services for chronic diseases and their medication adherence during COVID-19 in Saudi Arabia.

OBJECTIVES: During the ongoing coronavirus 2019 (COVID-19) pandemic, chronic disease management and medication adherence have become challenging; thus, health-related quality of life may have been compromised. As highly trusted healthcare providers, pharmacies in Saudi Arabia have undergone restructuring or redesign to cope with the current demands during the pandemic. The study assessed satisfaction levels of patients with chronic diseases concerning pharmaceutical care services provided during COVID-19 in addition to medication adherence and quality of life during the pandemic. METHODS: An online questionnaire-based cross-sectional study was administered. Saudi residents suffering from chronic diseases and receiving pharmaceutical care from a hospital or community pharmacy during the COVID-19 pandemic were eligible. The survey was created using Google Forms and distributed through online channels. The survey targeted 385 participants. KEY FINDINGS: A sample of 317 patients was included. More than half had missed a follow-up visit for their chronic conditions since the beginning of the pandemic. The overall mean score ± standard deviation for the satisfaction level with pharmaceutical care services was 22.0 ± 10.3 on a scale of 0-36 with different satisfaction levels for different services. In addition to a good level of medication adherence, a high percentage of these patients reported no problem in most of the dimensions of the EQ-5D scale. CONCLUSIONS: Pharmacists should take a more proactive and consultive role to deliver healthcare needs of patients with a chronic condition and be aware of patient expectations from a pharmacist in situations, such as the current pandemic.

A Comprehensive Monitoring of Clozapine and Related Components in Clinical Practices. Saudi Arabian Scenario.

Objectives: Clozapine is considered as effective medication for treatment resistant schizophrenia. Due to its potential severe adverse effects' clozapine is underused in the clinical settings. Information's on clinical use and monitoring of clozapine is lacking in middle east. This research analysis clozapine prescription and monitoring patterns a in a university teaching hospital in Saudi Arabia. Experimental design: A retrospective observational study was conducted in the psychiatric department of a university hospital in Saudi Arabia. Patients on treatment with clozapine for minimum one year were reviewed and assessed for clozapine mandatory and non-mandatory requirements and its correlated factors. Observation: Majority of patients were male [(n = 36) 63%] and the average age of was 36.8 ± 12.3. TRS schizophrenia[(n = 49),85%] was the common indications. Prior to initiation of clozapine all recommended guidelines was followed for all patients (100%). In addition to the blood monitoring and vitals LFT (80.75%) and weight (87.77%) were frequently measured. Hematological work up performed routinely throughout initial 18 weeks (71.9 %) and every month (59.6%). Weight gain (29.8%) was the most documented adverse effects. Conclusion: The current study explored experiences with clozapine prescribing practices in a university hospital KSA and suggest that clozapine prescription is completely adhered with already existing guidelines in terms of dosing and monitoring. There exist a careful balance of benefit and risk in term of adverse reaction of clozapine in the local population.

The immediate psychological response of the general population in Saudi Arabia during COVID-19 pandemic: A cross-sectional study.

BACKGROUND: The outbreak of COVID-19 may differentially exacerbate anxiety and stress in people subjected to the real or perceived threat of the virus. METHOD: An online cross-sectional survey was carried out to assess the general population's psychological response during the initial state of the outbreak in Saudi Arabia. The study used brief screening tools PHQ-4 for anxiety-depression symptoms and IES-6 for posttraumatic stress disorder symptoms. RESULTS: Among the 584 respondents, 19.8% and 22.0% reported moderate to severe anxiety and depression symptoms respectively. According to the combined PHQ-4 score, 14.5% of participants showed moderate to severe anxiety or depression disorder. Overall, 64.8% met the level of clinical concern for posttraumatic stress disorder and 51.3% met the level of probable posttraumatic stress disorder diagnosis. Multivariate analyses showed that females, non-Saudi nationalities, and those who had a history of mental illness were more vulnerable to anxiety and depression disorders than their counterparts, whereas a higher prevalence of distress symptoms was reported among those who prefer Arabic over English for communication. It was found that people whose colleagues or family infected with the disease were more likely to report moderate to severe symptoms of anxiety or depression and distress. The study further showed that the higher the perceived threat, the higher the chances of exhibiting anxiety-depressive disorder symptoms and distress symptoms. CONCLUSION: The findings might be a matter for serious concern, and considerable attention is required from authorities and policymakers regarding early detection and treatment of these illnesses in order to reduce the burden of the pandemic related mental illness.

A retrospective study on therapeutic drug monitoring of mood stabilizers in real-life clinical scenario.

BACKGROUND: Therapeutic drug monitoring (TDM) is the widely used tool in neuropsychiatric disorders. It is a valuable tool for tailoring the dose, preventing adverse drug reactions, and testing the drug adherence, therapeutic nonresponse, pharmacokinetic, and drug-drug interactions. TDM is most useful for individualized pharmacotherapy in bipolar disorders. But there exists a death of information on TDM of mood stabilizers in real-life scenario. Hence, this study aimed to assess the use and indication of TDM for mood stabilizers in a university hospital. MATERIALS AND METHODS: A descriptive, retrospective, study was carried in a university teaching hospital in Dammam metropolitan region of Saudi Arabia. Patients were included in the study if they had a mood stabilizer with serum level drawn between January 2017 to December 2018. The patient list was collected from "QuadraMed" health information system. TDM details such as values of each TDM, reason for the TDM, and number of TDM for 1 year have been documented. RESULT: A total of 200 patients received 242 mood stabilizers during the study period. Gender distribution was almost equal in the study population male (52%) versus female (48%). Average age of the patients was 40 years (range = 17-87 years). A total of 41.5% (n = 83) patients were diagnosed with bipolar type 1. Valproic acid (n = 139 [57.9%]) and lithium (n = 54 [22.3%]) were the most commonly used mood stabilizers. Majority (80%) of the bipolar patients were managed with single mood stabilizers. A total of 613 TDM was ordered for the 200 patients during the study period. The average number of TDM per patient during the study period was 3 (range = 1-39). Validation of the therapeutic level (n = 140), lack of clinical response (n = 51), and change in the dose (n = 34) are the documented reasons for TDM. CONCLUSION: This study highlights the common and specific reasons for TDM of mood stabilizers in routine clinical practice. More extensive study on a larger sample size in the prospective basis is required to find out the rationality of TDM orders and its outcome for the development of the polices.

An observational study on adverse reactions of cosmetics: The need of practice the Cosmetovigilance system.

INTRODUCTION: Cosmetovigilance is public health surveillance on cosmetic products with a public health objective. Since the radical development in beautifying products in Saudi Arabia, the Saudi Food and Drug Authority takes the responsibility of regulating cosmetic products and issuing guidelines to ensure its safety. Despite this, there exists a lacuna of Re published reports on cosmetics-related adverse reactions in the Saudi population. We aimed to assess self-reported adverse reactions in the general public of the Eastern Province, Saudi Arabia. MATERIALS AND METHOD: A cross-sectional study was conducted for three months. The questionnaire for data collection was adopted and modified from previous studies for the cosmetic utilization behaviors and adverse reactions. RESULTS: Among the 425 participants, 50.6% reported that they had at least one adverse reaction in the past two years. Redness of the skin (19%), pimples (15%), and itching (13%) were the commonly reported adverse reactions. The majority of the adverse reactions were reported with hair care (29%) and skincare products (25%). The majority [n = 181 (84.2%)] of the participants with managed the ARs by the cessation of the product use. The univariate analysis found that gender, age, allergic to medications and food, family history of allergy, mixing cosmetics, and frequent switching of cosmetic brands were associated with adverse events. However, the adjusted analysis found that allergic to medication (adjusted OR: 3.9), family history of allergy (adjusted OR: 1.91), and mixing cosmetics (adjusted OR: 1.70) were significantly associated with cosmetics-related adverse reactions. CONCLUSION: Cosmetovigilance is a model of safety monitoring of cosmetics. It can be considered as a one of the element in public health activities. Pharmacists should be more vigil on this issue in the near future. To strengthen the findings further, a national wide prevalence study can be conducted prospectively and analyses causality and report to the pharmacovigilanvce system of the country.

A Case Report of Isotretinoin-induced Manic Psychosis.

Isotretinoin, an oral vitamin A derivative, used to treat severe treatment-resistant acne. Psychiatric side effects of isotretinoin particularly depression and suicidal thoughts have been well documented. We report a case of isotretinoin-induced manic psychosis in a young female without a family history and history of mental illness.

An adverse drug interaction of haloperidol with levodopa.

Drug interactions are known to play a significant role in the incidence of adverse drug reactions (ADRs) both in the community and in hospitals. Both the newer atypical antipsychotics and their more traditional counterparts are subject to drug - drug interactions amongst themselves, with other psychotropics, and with the agents used in the treatment of various physical ailments. The most common interactions encountered in clinical practice are pharmacodynamic in nature. It is well established that antipsychotic drugs reduce the efficacy of levodopa in parkinson's disease by blockade of dopamine receptors in the corpus striatum. The case reported here illustrates a common pharmacodynamic drug interaction of haloperidol with levodopa in a 60-year-old female patient.

A prospective observational study to evaluate safety reporting of antidepressants at a tertiary care hospital in India.

OBJECTIVE: This prospective observational study was carried out to identify the prevalence and Severity of ADRs of antidepressant in a tertiary care teaching hospital. MATERIALS AND METHODS: Patients prescribed with at least one antidepressant were randomly selected and monitored for adverse drug reactions (ADRs), irrespective of their age and gender. RESULTS: Of the 401 patients who received antidepressants, 170 patients (42.39%) experienced 204 ADRs. Selective serotonin receptor inhibitors (SSRIs) [110 (53.92)] was the most common therapeutic class of drugs associated with ADRs. Gastrointestinal system [54 (26.47)] was most commonly affected system organ class. Dry mouth (n = 30) and diaphoresis (n = 21) were the most frequently reported ADRs. As assessed by the World Health organization (WHO) probability scale, 61% of the ADRs were 'probable' causality. Among all the ADRs, 22.54% (46) were preventable. Majority of the ADRs [(n = 184) 90.17%] were 'mild' in their severity. CONCLUSION: In this study, incidence of adverse reaction to antidepressants was 42.3% were the most common SSRI inplicated drug group for the ADRs.

Lorazepam-induced diplopia.

Diplopia - seeing double - is a symptom with many potential causes, both neurological and ophthalmological. Benzodiazepine induced ocular side-effects are rarely reported. Lorazepam is one of the commonly used benzodiazepine in psychiatric practice. Visual problems associated with administration of lorazepam are rarely reported and the frequency of occurrence is not established. We report a rare case of lorazepam-induced diplopia in a newly diagnosed case of obsessive compulsive disorder.

Impact of clinical pharmacist interventions on the cost of drug therapy in intensive care units of a tertiary care teaching hospital.

OBJECTIVE: To analyze clinical pharmacist interventions in the intensive care units (ICUs) setting of a tertiary care Indian hospital and to assess the pharmacoeconomic impact on drug-related problems (DRPs). MATERIALS AND METHODS: A postgraduate clinical pharmacist reviewed drug prescriptions over a period of 7 months. Whenever a DRP is identified, it was discussed with a physician and appropriate suggestions were provided, later it was documented on a preprepared form. Clinical significance of each intervention was graded based on the predicted clinical outcome. Acceptance of the interventions is entirely at the discretion of the medical staff. Each intervention was analyzed with respect to potential cost saving and/or additional cost incurred to existing drug therapy. An independent clinical panel was convened, and all the interventions made by the intervening pharmacist were critically reviewed for potential cost savings. RESULTS: The intervening pharmacist made 117 recommendations, of which 94% was accepted by the medical professionals. The most frequent DRP identified was overdose (24%). The total net cost savings made was Rs. 77260.13 (USD 1796.73). This corresponds with Rs. 965.75 per patient and an annualized savings of Rs. 135205.22. CONCLUSION: Clinical pharmacist interventions had a significant impact on the cost of drug therapy and the patient outcome in intensive care settings of our hospital.