Thank you
Doing the final graduation thesis is an opportunity for students to systematize and consolidate their knowledge, apply what they have learned into practice, and especially to get acquainted with and practice scientific research skills, as a stepping stone for carrying out larger projects in the future.
I would like to express my sincere thanks to the Board of Directors of the Faculty of Pharmacy and the teachers who have devotedly taught me, provided me with the necessary knowledge and created conditions for me to complete my final graduation thesis.
I would like to express my sincere thanks to the Faculty of Pharmacy - Hue University of Medicine and Pharmacy Hospital for supporting me throughout the process of collecting data for my thesis.
In particular, I would like to express my sincere and deep gratitude to Master Vo Thi Hong Phuong - lecturer of the Department of Clinical Pharmacy, Hue University of Medicine and Pharmacy, who has directly guided, enthusiastically instructed and imparted valuable experiences to me throughout the process of implementing and completing my thesis.
And finally, I would like to send my sincere thanks to my family and friends for always being there to help me through the most difficult times, always being a solid support for me in my studies and life.
Due to time constraints, this project is inevitably flawed. Therefore, we look forward to receiving comments from teachers and students.
Hue, May 2018 Nguyen Thi Hien
COMMITMENT
I hereby certify that the research data in this thesis is entirely my own work and does not overlap with any previous thesis.
Student practice
Nguyen Thi Hien
LIST OF ABBREVIATIONS
ACC
American College of Cardiology (American College of Cardiology) | |
ADR | Adverse Drug Reaction (Adverse drug reactions) |
AHA | American Heart Association (American Heart Association) |
B | Board |
BNF | British National Formulary (British National Formulary) |
CCĐ | Contraindications |
CDC | Centers for Disease Control and Prevention (US Centers for Disease Control and Prevention) |
Database | Database |
CYP2C19 | Cytochrome P450 2C19 |
CYP450 | Cytochrome P450 |
University | Pharmacokinetics |
DLH | Pharmacodynamics |
DRUG | Online drug interaction lookup software accessed locally www.drugs.com only |
EMA | European Medicines Agency (European Medicines Agency) |
FDA | Food and Drug Administration (US Food and Drug Administration) |
ICD - 10 | International Classification of Disease, Tenth Edition (International statistical classification of diseases and related health problems 10th edition) |
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MED
Online drug interaction lookup software accessed locally only www.medscape.com | |
MM | Drug interactions - Micromedex® Solutions (Micromedex online drug interaction lookup software) |
NSAID | Nonsteroidal Anti-inflammatory Drug (Non-steroidal anti-inflammatory drugs) |
NT | Serious |
OTC | Over-the-counter (Non-prescription drugs) |
PPI | Proton Pump Inhibitor (Proton pump inhibitors) |
SD | Standard deviation |
SDI | Stockley's Drug Interactions Pocket Companion (Stockley's Drug Interactions Reference Book) |
STT | Numerical order |
TB | Medium |
TTT | Drug interactions |
YNLS | Clinical significance |
INDEX
Page
PROBLEM STATEMENT 1
CHAPTER 1. OVERVIEW 3
1.1. Overview of drug interactions 3
1.1.1. Concept of drug interactions 3
1.1.2. Classification of drug interactions 3
1.1.3. Risk factors for drug interactions 7
1.1.4. Consequences of drug interactions 8
1.1.5. Clinically significant drug interactions 9
1.1.6. Drug interaction studies 9
1.2. Measures to manage drug interactions in clinical practice 11
1.2.1. Drug interaction lookup databases 11
1.2.2. Building a list of drug interactions used in clinical practice 17
CHAPTER 2. RESEARCH SUBJECTS AND METHODS 18
2.1. Research subjects 18
2.2. Research method 18
2.3. Research content 21
2.4. Data processing 23
CHAPTER 3. RESEARCH RESULTS 24
3.1. Patient characteristics and drug use in the study sample 24
3.1.1. Characteristics of patients in the study sample 24
3.1.2. Characteristics of drug use in study sample 25
3.2. Identify clinically significant drug interactions occurring in outpatient prescriptions at Hue University of Medicine and Pharmacy Hospital 26
3.2.1. List of clinically significant drug interactions occurring in outpatient prescriptions 26
3.2.2. Characteristics of clinically significant drug interactions occurring in outpatient prescriptions 30
3.2.3. Mechanisms and consequences of clinically significant drug interactions occurring in outpatient prescriptions 32
3.2.4. Analysis of the influence of some factors on the possibility of clinically significant drug interactions 34
3.3. Developing guidelines for managing clinically significant drug interactions at Hue University of Medicine and Pharmacy Hospital 35
CHAPTER 4. DISCUSSION 36
4.1. Patient characteristics and drug use in the study sample 36
4.2. Identify clinically significant drug interactions occurring in outpatient prescriptions at Hue University of Medicine and Pharmacy Hospital 37
4.2.1. List of clinically significant drug interactions occurring in outpatient prescriptions 37
4.2.2. Characteristics of clinically significant drug interactions occurring in outpatient prescriptions 39
4.2.3. Mechanisms and consequences of clinically significant drug interactions occurring in outpatient prescriptions 43
4.2.4. Analysis of the influence of some factors on the possibility of clinically significant drug interactions 45
4.3. Developing guidelines for managing clinically significant drug interactions at Hue University of Medicine and Pharmacy Hospital 46
CONCLUSION 47
PROPOSAL 50
REFERENCES APPENDIX
LIST OF TABLES
Page
Table 1.1. List of drugs with narrow therapeutic index 7
Table 1.2. Some drug interaction lookup databases in the world and in Vietnam11 Table 1.3. Classification of severity of interactions in MM 12
Table 1.4. Classification of severity of interactions in BNF 74 13
Table 1.5. Severity classification of interactions in SDI 14
Table 1.6. Severity classification of interactions in DRUG 15
Table 1.7. Severity classification of interactions in MED 15
Table 2.1. Conventional table of levels of assessment of clinically significant drug interactions in 19 databases
Table 3.1. Distribution of patient age groups in the study sample 24
Table 3.2. Gender distribution of patients in the study sample 24
Table 3.3. Distribution of disease groups in the study sample 25
Table 3.4. Characteristics of the number of drugs prescribed in the prescription 25
Table 3.5. Distribution of drug groups in the study sample 26
Table 3.6. List of clinically significant drug interactions agreed upon by 27 databases
Table 3.7. List of 20 clinically significant drug interaction pairs occurring in outpatient prescriptions 29
Table 3.8. Clinically significant drug interaction characteristics 30
Table 3.9. Frequency of clinically significant drug interactions 31
Table 3.10. Mechanisms and consequences of clinically significant interactions 32
Table 3.11. Classification of clinically significant interactions according to interaction mechanism 33
Table 3.12. Influence of some factors on the possibility of clinically significant drug interactions 34
PROBLEM STATEMENT
Drug combinations are inevitable, especially in multi-pathological and multi-symptom conditions. That is the reason why adverse drug interactions are likely to occur. The rate of interactions increases exponentially with the number of drugs combined and drug interactions are one of the important causes of adverse drug reactions [2].
The consequences of drug interactions affect the quality of treatment and the health of patients, and can even lead to death. Clinically, in addition to some beneficial interactions, drug interactions can lead to the consequence of "reduced activity" which means reduced treatment effectiveness or "excessive activity" leading to abnormal drug effects. In a systematic analysis of adverse drug reactions, drug interactions accounted for 3 - 5% of drug-related errors occurring in hospitals, and the consequences caused by drug interactions contributed to the causes of hospitalization and emergency care [38]. Drug interactions affect the health of patients and at the same time increase treatment costs, increasing the burden on the health system [33].
However, drug interactions are a problem that can be avoided by using drugs carefully and closely monitoring patients during treatment or taking interventions to minimize the risk of drug interactions. Along with the development of science and medicine, many drug interaction lookup databases have been created to help medical staff and workers easily identify drug interactions before prescribing drugs to patients. However, there is no similarity between drug interaction lookup databases in the way of recording drug interactions and assessing the severity [4], [10], [47]. Therefore, evaluating drug interactions based on consensus from many databases will help us be more certain about the possibility of drug interactions, thereby paying more attention to these interactions in clinical practice to ensure the rational use of drugs for patients.