Clinical Pharmacy & Administration

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    Utility of information in package inserts by pharmacists and pharmacy clients in a metropolitan city in Southwest Nigeria
    (Oxford University Press, 2021) Showande S.J; Babalola O.V
    Objective Package inserts provide relevant information to patients and health care professionals on the safety and rational use of drugs. This study evaluated the utility of package inserts by pharmacy clients for information, and by pharmacists during consultation and counselling with patients. Methods This cross-sectional self-administered questionnaire-based study was conducted in Ibadan, Nigeria among 705 pharmacy clients and 344 community and hospital pharmacists. The questionnaire had a 12-item and a 14-item package insert utility scale for pharmacists and pharmacy clients, respectively. The level of utility and association between demographic variables and package insert utility scores were determined with Mann–Whitney U and Kruskal–Wallis tests at P < 0.05. Key findings The response rate was 88.2% for pharmacy clients and 67.2% for pharmacists. Most of the pharmacy clients, 459 (73.8%), check for package inserts in drug packs. The most assessed information in package inserts was dose 432 (69.5%). Some of the pharmacy clients, 276 (44.4%), considered information from health professionals more reliable than that in package inserts. The pharmacy clients’ level of education was associated with package insert utility score (P = 0.001). Most of the pharmacists, 137 (59.3%), read package inserts but only 36 (15.6%) consulted package inserts during counselling with patients. The pharmacists’ age and the number of years spent in practice were significantly associated with package insert utility scores (P < 0.05). The level of utility of the information in package inserts by the pharmacy clients and the pharmacists was moderate – 66.8 and 60.0%, respectively. Conclusion Both pharmacists and pharmacy clients use package insert content moderately. Pharmacy clients rely more on information provided by health professionals than the information in package inserts but pharmacists seldom consult package inserts during counselling process.
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    Use of antibiotics among non-medical students in a nigerian university
    (2013) Sanya T.E; Titilayo O.F; Adisa R; Showande J.S
    Background: Antibiotic misuse is a major contributory factor to treatment failure, antibiotic resistance and high healthcare costs. Objectives: To evaluate level of self-reported antibiotic misuse among non-medical undergraduate students of a Nigerian university. Methods: Respondents’ knowledge of antibiotics and disposal system for left-over antibiotics were explored using a structured questionnaire. Data were summarized with descriptive statistics. Chi square was used to evaluate relationship between specific categorical variables and respondents’ opinions with p<0.05. Results: More than half the respondents obtained their antibiotics through doctor’s prescriptions (273; 68.3%). The study revealed gross antibiotic misuse with majority, (298;74.5%) either by keeping left-over antibiotics for future use or throwing it away with refuse. Respondents (289; 72.3%) sometimes forgot to take the antibiotics. Financial constraints (73; 18.3%), long duration of treatment (70; 17.5%), side effects experienced (60;15.0%), polypharmacy (56;14.0%), tablet size (45;11.3%), and perceived low level of confidence in the prescriber (11; 2.8%) were major reasons for non-adherence. Course of study of respondents had no significant effect on respondents’ knowledge or adherence (p>0.05). Conclusion: Misuse of antibiotics among non-medical undergraduate students in a Nigerian university setting is pervasive suggesting an urgent need for enlightenment on rational use and disposal of antibiotics.
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    Remedies for glucose intolerance – are traditional herbal concoctions for diabetes effective?
    (2015) Showande S.J.; Bello J.J
    Background:Preventing or delaying the onset of diabetes in prediabetes has the potential to reduce the disease prevalence. Objective:The effectiveness of traditional herbal concoctions for diabetes in ameliorating glucose intolerance was investigated. Material and Methods:Oral glucose tolerance test (OGTT) was carried out by giving 500 mg/kg and 1000 mg/kg of individual plant extract and their aqueous herbal concoctions made from Musa sapientum + Allium sativum + Tetracarpidium conophorum; Gongronema latifolia + Bauhinia monandra; and Alstonia boonei + Mangifera indica to groups of rats, 30 and 60 minutes respectively prior to 3 g/kg of glucose load. Blood glucose levels were determined at 0, 10, 20, 30, 45, 60, 90, and 120 minutes post administration. Area under the curve (AUC) for OGTT and glycemic index were calculated and compared with the vehicle control and metformin (100 mg/kg). Level of significance was set at P<0.05. Results:Oral glucose tolerance test AUCs of individual plants were significantly lower than that of the vehicle control (P<0.05) but comparable with that of metformin (P>0.05) when given 30 minutes prior to glucose load. The OGTT curve AUCs of the three herbal concoctions were significantly higher than the two controls (P>0.05). Glycemic index of the concoctions were significantly higher than that of metformin (P>0.05) Conclusion:The herbal concoctions were not effective in ameliorating glucose intolerance. Individual plants were more effective when administered 30 minutes prior to glucose load. The individual herbs showed potentials to delay the onset of diabetes. Further investigations should be conducted on the numerous herbal concoctions used for diabetes.
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    Readability of medication package inserts accompanying prescription drugs and conformity of the package inserts information with regulatory requirements
    (2022) Showande S.J; Babalola V.O.
    Background: Medication package inserts (MPIs) provides patients with appropriate information on the rational use of drugs. This study evaluated the level of conformity of MPIs with the regulatory drug labelling requirements and determined the readability of selected prescription MPIs. Methods: One hundred and fifty-six MPIs of commonly used and prescribed antilipidemics, anticonvulsants, anti-diabetes, antiarthritis and antihypertensives in Nigeria were retrieved from four pharmacies. The MPIs were evaluated on the availability of 20 items drug labelling requirements for prescription drugs by the National Agency for Food and Drug Administration and Control (NAFDAC). The readability of 31 randomly selected MPIs was assessed with seven readability measures. Primary outcomes were percentage conformity with the labelling requirements and reading grade level of the MPIs. Secondary outcomes were the MPIs sentence characteristics. Results: The percentage conformity with NAFDAC drug requirements of the MPIs ranged from 82.9% to 89.6%. All the MPIs included information on active ingredient(s), adverse drug reactions, and indications. Few MPIs, 46.8% had section on product net content and 53 (34.0%) omitted information on overdose. The reading grade level for the MPIs was 14.55 ± 1.71 (undergraduate level). Most of the MPIs, 25 (80.6%), were very difficult to read. Conclusion: The percentage conformity of the MPIs with NAFDAC drug labelling requirements was high though few vital information were missing in some MPIs. Majority of the MPIs were very difficult to read. The regulatory authority may need to optimize MPIs readability and conformity of content with drug labelling requirements prior to marketing.
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    Prevalence and clusters of modifiable cardiovascular disease risk factors among intra-city commercial motor vehicle drivers in a Nigerian metropolitan city
    (2020) Showande S.J.; Odukoya O.I.
    Background: Commercial motor vehicle drivers (CMVDs) have worst health profiles among different occupations, yet the presence of clusters of cardiovascular disease (CVD) risk factors in this group have not been described in a resource-limited setting. Objectives: The prevalence of CVD risk factors and the clusters among CMVDs was evaluated. Design: A cross-sectional descriptive study. Setting: Four motor parks in three local government areas of Ibadan city, Nigeria. Participants: Consented and conveniently sampled 152 intra-city CMVDs aged ≥ 18 years. Main outcome measures: Prevalence of CVD risk factors (hypertension, diabetes, high triglyceride, low HDLc, high waist-hip ratio, central obesity, physical inactivity, smoking, alcohol, and overweight/obesity) and their clusters were determined. Results: All participants were male from 20 – 77 years old. Most of the CMVDs were physically inactive (80, 52.6%), take alcohol (78, 51.3%), and few smokes (35, 12.4%). The prevalence of hypertension, diabetes, hypertriglyceridemia, obesity, and central obesity were 36.2%, 5.9%, 23.7%, 4.6%, and 5.3%, respectively. Four clusters of CVD risk factors in the CMVDs with the prevalence of 36.2%. 33.5%, 17.1% and 13.2% were identified with significant differences (p<0.05) in the risk factors. Conclusion: The prevalence of diabetes, obesity, central obesity, and smoking was low while the prevalence of hypertension and hypertriglyceridemia was moderate among the CMVDs, but the prevalence of alcohol intake and physical inactivity were high. Four distinct clusters of CVD risk factors were observed among the drivers.
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    Potential inappropriate prescribing among ambulatory elderly patients in a geriatric centre in southwestern nigeria: beers criteria versus stopp/start criteria
    (2020) Akande W.S; Ajilore O.C.; Segun J Showande S.J.; Adebusoye L.A.
    Purpose: To identify potentially inappropriate prescribing in ambulatory elderly patients and compare the appropriateness of guidelines; Beers' and Screening Tool of Older Person’s Prescription (STOPP)/ Screening Tool to Alert Right Treatment (START) criteria to detect potentially inappropriate prescribing among the elderly. Methods: A retrospective study was conducted using case files of 335 elderly patients aged ≥ 60 years between 1st January and 31st December 2016, using a data extraction sheet. The 2015 American Geriatrics Society (AGS)-Beers Criteria, and version 2 of the STOPP and START were subsequently used to identify the Potentially Inappropriate Prescribing (PIP) and Potential Prescribing Omissions (PPOs). Results: Mean age of patients was 69 ± 0.4 years (range 60 - 85 years) and 219 (65.4 %) were females. An average of 4.2 medications per patient prescription was found. The Beers criteria identified 26.5 % PIP, while STOPP criteria identified 57.1 % PIP. START detected 29 PPOs in 15 (4.4 %) of the patient’s prescription. The most prevalent disease conditions were hypertension 235 (70.1 %) and osteoarthritis 64 (19.3 %). Polypharmacy was significantly associated with PIP in both Beers (p = 0.002) and STOPP (p = 0.001) criteria. Conclusion: The prevalence of PIP is high among elderly patients. The STOPP/START criteria identified a higher proportion of PIP among elderly patients compared with Beers criteria. The frequency of PIP should stimulate efforts to curtail potentially inappropriate prescribing and may require the need for advocating for a national criterion to be adopted by health care professionals in Nigeria.
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    Potential inhibition of major human cytochrome p450 isoenzymes by selected tropical medicinal herbs—implication for herb–drug interactions
    (2018) Showande S.J.; Fakeye T.O.; Kajula M.; Hokkanen J.; Tolonen A.
    Background: Increasing use of medicinal herbs as nutritional supplements and traditional medicines for the treatment of diabetes, hypertension, hyperlipidemia, and malaria fever with conventional drugs poses possibilities of herb–drug interactions (HDIs). The potential of nine selected widely used tropical medicinal herbs in inhibiting human cytochrome P450 (CYP) isoenzymes was investigated. Materials and methods: In vitro inhibition of eight major CYP isoenzymes by aqueous extracts of Allium sativum, Gongronema latifolium, Moringa oleifera, Musa sapientum, Mangifera indica, Tetracarpidium conophorum, Alstonia boonei, Bauhinia monandra, and Picralima nitida was estimated in human liver microsomes by monitoring twelve probe metabolites of nine probe substrates with UPLC/MS- MS using validated N- in- one assay method. Results: Mangifera indica moderately inhibited CYP2C8, CYP2B6, CYP2D6, CYP1A2, and CYP2C9 with IC50 values of 37.93, 57.83, 67.39, 54.83, and 107.48 μg/ml, respectively, and Alstonia boonei inhibited CYP2D6 (IC50 = 77.19 μg/ml). Picralima nitida inhibited CYP3A4 (IC50 = 45.58 μg/ml) and CYP2C19 (IC50 = 73.06 μg/ml) moderately but strongly inhibited CYP2D6 (IC50 = 1.19 μg/ml). Other aqueous extracts of Gongronema latifolium, Bauhinia monandra, and Moringa oleifera showed weak inhibitory activities against CYP1A2. Musa sapientum, Allium sativum, and Tetracarpidium conophorum did not inhibit the CYP isoenzymes investigated. Conclusion: Potential for clinically important CYP- metabolism- mediated HDIs is possible for Alstonia boonei, Mangifera indica, and Picralima nitida with drugs metabolized by CYP 2C8, 2B6, 2D6, 1A2, 2C9, 2C19, and 3A4. Inhibition of CYP2D6 by Picralima nitida is of particular concern and needs immediate in vivo investigations.
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    Pharmacy students’ proclivity towards entrepreneurship – a sign of future innovation in pharmaceutical care service delivery
    (2019) Showande S.J.; Durowaiye M. A.
    Background:Entrepreneurial inclination is linked with improved pharmaceutical care service innovations and improvements. Objective: This study examined the propensity of pharmacy students towards entrepreneurship and factors influencing this. Material and Methods:Two hundred and eighty-one pharmacy students at the University of Ibadan participated in a two-year prospective study using a self–administered validated Pharmacy Students Entrepreneurial Orientation summated scale questionnaire with five subscales in seven-points Likert scale type graded responses. Mean and percentage mean scores were determined with a high mean score indicative of entrepreneurial tendency. Results:Percentage mean score for PSEO were 88.5% and 88.8% for the first and second year of the survey, respectively. Post-graduation business ownership intentions were high (83.0%) in both years. These intentions had significantly higher mean scores on PSEO scale (p<0.001), empathic super salesperson subscale (p=0.007), innovativeness subscale (p<0.001), and risk taking subscale (p=0.024), in the first year of survey. Pharmacy students who had taken business courses had higher PSEO mean scores than those who had not taken business courses (p=0.003). Male pharmacy students were more likely to take risks more than their female counterparts in the first year of the study (p=0.035). Conclusion:Pharmacy students maintained a high level of entrepreneurial tendency in both years of the study with most students aspiring to become business owners. Male pharmacy students were more inclined to take risk and hope to be innovative in pharmaceutical care services. To further strengthen entrepreneurial inclination, pharmacy schools curricula should include entrepreneurial courses. Keywords
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    Patient medication counselling in community pharmacy: evaluation of the quality and content
    (2022) Showande S.J.; Laniyan M.W.
    Background: Patient medication counseling (PMC) is a pharmaceutical care service targeted at optimizing patient drug use, safety and improving treatment outcomes. This study assessed the content and quality of PMC from the community pharmacists’ (CPs) and pharmacy customers’ (PCs) perspectives. Methods: A cross-sectional questionnaire-guided survey was conducted in Ibadan, Nigeria, among 125 CPs and 612 PCs. The 35-counselling items validated United States Pharmacopeia Medication Counseling Behavior Guideline scale with 10-point graded responses (1 = poor to 10 = excellent) was used. Self-reported medication counseling information content provided by CPs and received by PCs was assessed and expressed in median and interquartile ranges. The quality of PMC was evaluated and graded as poor (1–29.9%), unsatisfactory (30–59.9%), satisfactory (60–79.9%) and excellent (80–100%). Associations between demographic variables and overall quality of counseling were determined with Mann–Whitney U and Kruskal–Wallis tests at p < 0.05. Results: The response rate was 92.5% and 97.6% for PCs and CPs, respectively. The PCs’ opinions on the individual content of the PMC provided by the CPs were significantly different from the pharmacists’ self-report (p < 0.05). Some of the PMC content included how to take the medicine PC = 6.00 (2.00) vs CP = 8.00 (2.00), information on possible side effects PC = 6.00 (2.00) vs CP = 8.00 (2.00), taking history of allergies and other medications PC = 6.00 (6.00) vs CP = 7.00 (1.00), and how to incorporate drug regimen into daily routine PC = 5.00 (6.00) vs CP = 8.00 (3.00). The quality of PMC purportedly provided by CPs and received by the PCs was satisfactory (75%) and unsatisfactory (55%), respectively. The quality of communication counseling offered by CPs trained in Nigeria (Mean rank = 62.49) was higher than those trained outside Nigeria (Mean rank = 26.40), U = 228.00, p = 0.024. The PC’s age, marital status, and highest educational qualification were significantly associated with their opinion on the quality of counseling received. Conclusions: Both the community pharmacists and pharmacy customers reported the provision of patient medication counseling on side effects, drug usage, medication history and allergies among others. However, the quality of counseling provided by the pharmacists was satisfactory, but the quality of counseling received by the pharmacy customers was unsatisfactory. Pharmacists may need to engage pharmacy customers more during medication counseling
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    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 counseling