Huma Ali, Farya Zafar, Ahmed Shaukat, Shazia Alam, Umer Ali, Huma Shareef, Neelam Mallick, Yusra Shafiq, Hina Hasnain, Safila Naveed, Ghazala Raza Naqvi.
Narrow therapeutic index drugs; perception, practice, facts and knowledge of healthcare professionals in identification and management of interactions.
Professional Med J Jan ;24(4):596-606.

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.

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