Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Side effects of drugs annual(Elsevier, 2000) de Silva, H.J.This chapter provides an overview of gastrointestinal drugs. Some of the drug classes discussed include antacids, antiemetics, ulcer healing drugs, and cholelitholytic agents—bile acids. The chapter describes the clinical use of cisapride and its risk:benefit ratio in children. The most common adverse effects are diarrhea, abdominal cramps, borborygmi, and colic. Serious adverse events are rare and include isolated cases of extrapyramidal reactions, seizures in epileptic patients, cholestasis, and ventricular dysrhythmias, anorexia, and enuresis. Coadministration of anticholinergic drugs may compromise the beneficial effects of cisapride. Several treatments are available for promoting the healing of gastric and duodenal ulcers associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs). They include histamine receptor antagonists, proton pump inhibitors, and prostaglandin analogues. Proton pump inhibitors can interact with other drugs by increasing gastric pH, inhibiting hepatic cytochrome P450, or inducing specific isoforms of this enzyme system. However, drug interactions involving these isoenzymes and omeprazole or lansoprazole are uncommon and generally appear to be clinically unimportant.Item Ward-based clinical pharmacists and hospital readmission: a non-randomized controlled trial in Sri Lanka(2018) Shanika, L.G.T.; Jayamanne, S.; Wijekoon, C.N.; Coombes, J.; Perera, D.; Mohamed, F.; Coombes, I.; de Silva, H.A.; Dawson, A.H.OBJECTIVE: To assess if a ward-based clinical pharmacy service resolving drug-related problems improved medication appropriateness at discharge and prevented drug-related hospital readmissions. METHOD: Between March and September 2013, we recruited patients with noncommunicable diseases in a Sri Lankan tertiary-care hospital, for a non-randomized controlled clinical trial. The intervention group received usual care and clinical pharmacy service. The intervention pharmacist made prospective medication reviews, identified drug-related problems and discussed recommendations with the health-care team and patients. At discharge, the patients received oral and written medication information. The control group received usual care. We used the medication appropriateness index to assess appropriateness of prescribing at discharge. During a six-month follow-up period, a pharmacist interviewed patients to identify drug-related hospital readmissions. RESULTS: Data from 361 patients in the intervention group and 354 patients in the control group were available for analysis. Resolutions of drug-related problems were higher in the intervention group than in the control group (57.6%; 592/1027, versus 13.2%; 161/1217; P < 0.001) and the medication was more appropriate in the intervention group. Mean score of medication appropriateness index per patient was 1.25 versus 4.3 in the control group (P < 0.001). Patients in the intervention group were less likely to be readmitted due to drug-related problems (44 patients of 311 versus 93 of 311 in the control group; P < 0.001). CONCLUSION: A ward-based clinical pharmacy service improved appropriate prescribing, reduced drug-related problems and readmissions for patients with noncommunicable diseases. Implementation of such a service could improve health care in Sri Lanka and similar settings.