Abstract

A STUDY ON PRESCRIPTION PATTERNS OF DRUGS IN HEPATIC IMPAIRMENT PATIENTS AT TERTIARY CARE TEACHING HOSPITAL

Akshatha, Siddi Shoaib Akthar, B. K. Ahilarani, H. P. Sahana, Lincy Wilson George and Dr. Nagarjuna D.*

ABSTRACT

Background: Liver is the second largest complex organ in the human body. Liver is the core of metabolic activity in the body. Liver gets impaired by various factors like infection, autoimmune conditions, toxins and drugs. Liver dysfunction reduces the blood or plasma clearance of drugs eliminated by hepatic metabolism or biliary excretion and affects the plasma protein binding. Around 50% of the classes of drugs are known to be hepatotoxic. Thus, prescribing medications in patients with liver disease is indeed a challenging task. Objective: The main objective of our study is to assess prescription patterns of drugs in hepatic impairment patients at a tertiary care teaching hospital. Methodology: A prospective observational study was carried out for 6 months among inpatients of the general medicine department of VIMS, Ballari. Patients were enrolled on the basis of inclusion criteria. A total of 150 case records of patients with hepatic disease were reviewed and recorded. Data was collected using data collection forms and results were analysed using MS Excel. Results: A total of 150 patients were enrolled, out of these 126 (84%) males and 24 (16%) were females. The majority of the patients were in the age group of 31-40 years. Most of the patients were seen in child pugh class C 87 patients (58%) and 101 patients (67%) with MDF >32. The most predominant hepatic disease was found to be DCLD 89 (59.33%) patients associated with systemic hypertension as comorbidity and portal hypertension as most common complication and abdominal distension was the most prevalent clinical manifestation. Out of 1431 drugs, 574 were hepato-specific  drugs, highly prescribed hepato-specific drugs were laxatives followed by Diuretics and non-hepato-specific drugs accounts for 857. Among them antibiotics followed by nutritional supplements were the most frequently prescribed. Conclusion: DCLD was found to be more prevalent in our study. This study suggests that there is a considerable scope for improving prescribing patterns among the health care system by minimizing the use of antibiotics in order to reduce the risk of antibiotic resistance of microbes. This study recommended that development and implementations of guidelines and software based screening of drug-drug interactions in order to identify prevent and manage them. Hence rational use of drugs should be strictly followed.

Keywords: Liver Dysfunction, Hepatotoxic, Prescription pattern, Hepatic Impairment, Child pugh, Decompensated Chronic Liver Disease (DCLD), Hepato-specific, Non Hepato-specific, Drug-drug Interactions (DDI’s), Rational use.