A study of pharmacist intervention in patient care at institutional and community pharmacies [abstract]

The objectives of the study are: (1) To demonstrate the various types of pharmacist therapuetic interventions encountered in institutional and community pharmacies in Trinidad. (2) To identify the prevalent drug-related problems in therapeutic interventions. (3) To investigate the use of a more detailed form to document intervention in the provision of pharmaceutical care. The study used a detailed form to record the therapeutic interventions. It was conducted over a three-month period. The collected data were transcribed to a Patient Care Intervention (PCI) form with relevant categories for drug-related problems. It was analyzed and presented as frequencies on graphs and tables. From a total of 289 interventions, 174 interventions were collected from an institutional pharmacy and 115 from community pharmacies. Nineteen percent of the interventions were due to unclear instructions or no instructions to the patients, of which 92 percent were from the community pharmacies; 17 percent accounted for dosing problems where excessive was 9 percent and sub-therapeutic 8 percent; 6.9 percent were due to wrong choice of drug or dosage form. Others accounted for 55 percent of the interventions of which 92 percent were due to out-of-stock medications. The study showed that there is a variety of significant drug-related problems on prescribing. It highlighted the need for pharmacist intervention, thorough documentation of the interventions, effective pharmacist-physician communication and improved inventory management in order to achieve positive outcomes of patient medication therapy. Due to the limitations of the study, it is recommended that a further study should be done and it should include the pharmacoeconomic aspect of the interventions. (AU)

The use and misuse of antihypertensive medications [abstract]

The primary aim of the study was to evaluate the use and misuse of antihypertensive medications. "Use" is defined as the stringent adherence to prescribed therapy and to the instructions of the healthcare provider. "Misuse" is the alteration of prescribed therapy by the patient, who fails to comply with/adhere to the prescribers instructions. "Non-adherence" is a form of misuse, in which the patient fails to conform to the prescribed drug regime. The methodology of this study entailed a review of primary literature, interviews with colleagues and the clinical experience of the researchers. Use, misuse, and non-adherence to antihypertensive medications are global issues. In the United States of America, 25 percent of hospital admissions are due to patients' misuse or non-adherence to medication therapy. Unfortunately, local statistics are unavailable for comparison. The study did conclude that, locally, problems do exist with the use and misuse of hypertensive medications. Management of medication therapy in the hypertensive patient can be achieved by a health-care team approach and patient education. (AU)

Evaluation of Trinidad and Tobago traditional medicine I: effects of traditional folk remedy on diarrhoea

Hot aqueous extract of bark of Anacardium occidentale (Cashew), commonly used in Trinidadian folk medicine for the treatment of diarrhoea was evaluated for antidiarrhoeal activity. The extract inhibited castor oil-induced diarrhoea in rats as judged by a decrease in the number of wet faeces in the extract-treated rats. The extract was also inhibited the propulsive movement of intestinal contents in mice. The extract showed no direct effect on the isolated guinea-pig ileum, however, it inhibited in a dose-related manner the contractile effects of acetylcholine, histamine, and 5-hydroxytryptamine. The inhibitary effects on these agonists were non competitive in nature. Phytochemical tests revealed the main constituents as tannin, steroids, triterpenoid and carbohydrates. The results indicates that action of A. occidentale bark extract could be through a combination of inhibition of elevated transmitter released and reduced propulsive movement of the small intestine. There is merit in the folk medicinal use of the extract (AU)