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Item Impact of pharmacists’ training on oral anticoagulant counseling: a randomized controlled trial(2019) Showande S.J; Edidiong N.O.Objective: The study evaluated the impact of oral anticoagulant counseling training on the quality of counseling provided by pharmacists. Methods: A prospective RCT was conducted among 33 pharmacists from 23 pharmacies in Ibadan, Nigeria. Six mystery patients (MPs) who were either warfarin-naïve, experienced adverse drug reaction (ADR), or drug interaction (DI) to warfarin were used to assess pharmacists’ oral anticoagulant counseling quality at pre- and post-intervention. A 2-week online oral anticoagulant counseling training was given to the intervention group pharmacists. Quality of counseling was categorized as poor (0–20 %), fair (21–50 %), moderate (51–80 %), and optimal (81–100 %). Results: At pre-intervention, the quality of oral anticoagulant counseling provided to the MPs was poor. Post-intervention, the quality improved among pharmacists in the intervention group, from poor to fair for both warfarin-naïve MP and MP who experienced DI, and from fair to moderate for MP with ADR. Conclusion: Short-term online oral anticoagulant counseling training improved the quality of counseling provided by community pharmacists to mystery patients on warfarin. Practice implication: Online oral anticoagulant counseling training may be employed by pharmacists’ professional bodies intermittently to improve oral anticoagulant counselingItem Management of uncomplicated gastric ulcer in community pharmacy: a pseudo‑patient study(2019) Showande S.J; Adenike R.A.Background Increasing role of community pharmacists sometimes demands the diagnoses of minor ailments using appropriate questioning skills and recommendation of over-the-counter medications to patients seeking self-care. Objective To evaluate community pharmacists’ questioning and diagnostic skills of minor ailment complaints, and the appropriateness of medication(s) recommendations made. Setting One hundred and thirty-one community pharmacies in Ibadan, Nigeria. Method A cross-sectional survey employing pseudo-patient study method. The pseudo-patient visited 131 community pharmacies from June 2017 to January 2018 and complained of stomach ache. The conversation between the pharmacists and pseudopatient were audio-taped and transcribed verbatim. Two criteria were used to evaluate the questioning skill of the community pharmacists. One of the criteria was developed by a six-membered panel and had 13 questions while the other contained five questions:—Who is it for? What are the symptoms? How long have the symptoms been present? Action taken? and Medication used.? Questioning skill of the community pharmacists was classified based on the median scores of these two criteria as: poor, moderate and optimal. The diagnoses made by the community pharmacists from the pseudo-patients complaints were compared with the expected diagnosis of uncomplicated gastric ulcer caused by the use of ibuprofen. Recommendations for the pseudo-patients minor ailment were also compared with the Nigeria standard treatment guideline. Main outcome measure Pharmacists’ questioning skill, types of diagnosis made and appropriateness of medications recommended. Results The median scores for the questioning skill criterion containing 5 and 13 questions were 2 and 4, respectively; showing poor questioning skill. Differential diagnoses of gastric ulcer, dyspepsia, gastroesophageal reflux, and hyperacidity were made by 92 (67.4%) pharmacists but 3 (2.3%) correctly diagnosed the pseudo-patients’ minor ailment as uncomplicated gastric ulcer caused by short-term use of ibuprofen. Antacids were recommended in line with the standard treatment guideline by 46 (35.7%) pharmacists while proton pump inhibitors were recommended by 6 (4.7%) pharmacists. None advised the withdrawal of the provocative factor according to the treatment guideline. Conclusion The questioning skill of the community pharmacists in this setting was poor. Few community pharmacists diagnosed the pseudo-patients’ minor ailment correctly. Also, recommendations were mostly inappropriate compared with the standard treatment guideline.Item In Vitro Modulation Of Cytochrome P450 Isozymes And Pharmacokinetics Of Caffeine By Extracts Of Hibiscus Sabdariffa Linn Calyx(2019) Showande S.J; Igbinoba S.I.; Kajula M.; Hokkanen J.; Tolonen A.; |Adegbolagun O.M.; Fakeye T.O.Background: Hibiscus sabdariffa beverage (HSB) is widely consumed as a medicinal herb and sometimes used concomitantly with drugs. This study evaluated the in vitro inhibitory potential of the aqueous extract of H. sabdariffa calyces (AEHS) on selected cytochrome P450 (CYP) isozymes and the effect of HSB on the pharmacokineticsofcaffeineinvivo. Methods:InvitroinhibitionsofeightmajorCYPisozymesbyAEHSwereestimatedbymonitoringCYP-specific modelreactionsof10CYPprobesubstratesusingN-in-oneassaymethod.Subsequently,anopen,randomized, two-periodcrossoverdesignwasusedtoevaluatetheeffectofHSBonthepharmacokineticsofsingle-dose200 mg caffeine in six healthy human volunteers. Blood samples were obtained at specific times over a 24 h period. Probe drugs and metabolites were analyzed in their respective matrices with ultra-performance liquid chromatography/mass spectrometer/mass spectrometer and reversed-phase high-performance liquid chromatography/ultravioletdetection. Results:TheH.sabdariffaaqueousextractweaklyinhibitedtheselectedCYPisozymesinvitro,withIC50of >100 μgmL-1 intheorderofCYP1A2>CYP2C8>CYP2B6»CYP2D6>CYP2C19>CYP3A4>CYP2A6>CYP2C9. HSBdecreasedterminalt1/2andTmaxofcaffeineby13.6%and13.0%,respectively,andincreasedCmaxby10.3%. Pointestimatesofprimarypharmacokineticendpoints,Cmax=1.142(90%confidenceinterval(CI)=0.882,1.480) andAUC0–∞=0.992(90%CI=0.745,1.320),wereoutsidethe90%CIof0.8–1.25bioequivalencelimits. Conclusion:TheaqueousextractofH.sabdariffaweaklyinhibitedeightCYPisozymesinvitro,butHSBmodified theexposuretocaffeineinhuman.CautionshouldbeexercisedinadministeringHSBwithcaffeineorsimilar substratesofCYP1A2untilmoreclinicaldataareavailable.Item Evaluation of the extent and pattern of use of herbal(2014) Showande S.J; Amokeodo O.S.Purpose: To evaluate the extent and pattern of use of herbal bitters among students. Methods: This was a cross-sectional study where pre-tested structured questionnaires were administered to 1000 students. The questionnaire elicited information on the extent and pattern of use, self-reported indications, side effects experienced and possible drugs that were concomitantly coadministered with herbal bitters. Pearson Chi square, Fisher exact test and Relative risk ratio were used to detect association between gender and self-reported indications and side effects experienced with herbal bitters at a level of significance of p < 0.05. Results: The response rate and extent of use were 96 % and 40.9 % respectively. Herbal bitters were used for claims such as cleansers 88 (40.2 %), anti-infectives 48 (21.1 %), for rejuvenation 32 (14.0 %), and for weight loss 14 (6.1 %). Self-reported side effects included dizziness 49 (22.0 %), loss of taste 46 (20.6 %) and nausea and vomiting 22 (9.7 %). Herbal bitters were also co-administered with antimalarials 22 (6.3 %); analgesics 16 (4.5 %) and herbal supplements 13 (3.7 %). Reports of students using two different types of herbal bitter concurrently 15 (3.9 %) were also garnered. Male students experienced more side effects than females (p < 0.05). Conclusion: The co-administration of herbal bitters with allopathic medicines and the use of more than one herbal bitter at a time reported in this study can be addressed by the appropriate health authorities through proper educational programme.