NARROW THERAPEUTIC INDEX DRUGS;

PERCEPTION, PRACTICE, FACTS AND KNOWLEDGE OF HEALTHCARE PROFESSIONALS IN IDENTIFICATION AND MANAGEMENT OF INTERACTIONS

Abstract

Introduction: There are several clinically significant outcomes of drug-drug
interactions (DDIs) which have been classified as one of the serious forms of adverse drug
reactions that may lead to prolongation of hospital stays along with severe cases of mortality and
morbidities. It may cause due to the selection of two or more interacting drugs to be prescribed
to patient. Objectives: Therefore it is indispensable to attain a collective level of therapeutic
decision making so that any potential DDIs can be minimized that ultimately turn out to be safe
and beneficial to patient. Study Design: The current study is based upon surveys to evaluate
utilization of medications that have a narrow therapeutic range with high incidence to develop
DDIs and to access the knowledge, attitude as well as practice of using such drug products
in relation to these facts, though very few such studies have been identified, yet the relevant
data is insufficient locally. The study design was selected to be qualitative and cross sectional.
Period: January 2016 till August 2016 in Karachi, Pakistan. Settings: The questionnaire was
well constructed for physicians, pharmacists as well as nurses who were selected as the
participant of the study and a former consent from the respondents was obtained. Method:
Coefficient of spearman correlation & Cronbach’s α values were calculated in order to validate
the questionnaire (α = 0.927 and p = 0.918). The information based on practice along with
demographics of study participant was included as first segment of questionnaire while their
knowledge regarding drug interactions was included as second part. Mean scores were
calculated and responses were analysed by ANOVA in relation to the knowledge of members
relating to drug interactions of vancomycin, warfarin and valproic acid. Results: Mean scores of
perception were found in order of 1.590.16, 1.549.02 and 2.020.83 for physicians, pharmacists
and nurses. No significant differences were observed between physicians and pharmacists
cohorts in identifying the drug interactions whereas noteworthy variations were observed in
the group of nurses (p < 0.05). Conclusion: Such investigations are vital in their prospect to
highlight the importance for the design, implementation and monitoring of an effectual tool
for the guidance of various healthcare members involved in identification and management of
DDIs. Furthermore, results also signify the need of sophisticated support systems for valuable
clinical judgments.