The words you are searching are inside this book. To get more targeted content, please make full-text search by clicking here.

Volume 8, Issue 46, Jan-Feb 2017
[ISSN 2230−8741]

Discover the best professional documents and content resources in AnyFlip Document Base.
Search
Published by moley4u, 2017-03-05 02:20:40

RIPER PDIC BULLETIN

Volume 8, Issue 46, Jan-Feb 2017
[ISSN 2230−8741]

ISPOR India – Andhra Pradesh Chapter
Newsletter

Indexed in ISPOR India- Andhra Pradesh Chapter, Pharmainfo.net
New Jour, Open J-Gate, Ulrichsweb Global Serials Directory and

HINARI, WHO

RIPER-PDIC
Bulletin

Volume 8, Issue 46, Jan-Feb 2017
[ISSN 2230−8741]

Official publication of

Department of Pharmacy Practice
Raghavendra Institute of Pharmaceutical Education & Research

RIPER

&

Poison and Drug Information Center - PDIC
Rural Development Trust (RDT) Hospital, Bathalapalli

Head Quarters: ISPOR India Andhra Pradesh Regional Chapter
Raghavendra Institute of Pharmaceutical Education & Research (RIPER)

Saigram, Krishnamreddypalli Cross, Chiyyedu (Po)
Anantapuramu, Andhra Pradesh., India - 515721
Ph: 08554 – 255646, 255548 (O), 08559 – 242307 (PDIC), Fax: 08554 – 255646
Email: [email protected], [email protected]

www.riper.ac.in

ISPOR India Andhra Pradesh Regional Chapter
Executive Committee 2017

Dr. Y. Padmanabha Reddy. M. Pharm., PhD, F.I.C
President - ISPOR India Andhra Pradesh Regional Chapter
Professor & Principal
Raghavendra Institute of Pharmaceutical Education & Research RIPER, Anantapuramu,
Andhra Pradesh, India – 515721
E-Mail: [email protected]

Dr. Mohanraj Rathinavelu. Pharm. D
Elect President - ISPOR India Andhra Pradesh Regional Chapter
Assistant Professor, Division of Pharmacy Practice
Raghavendra Institute of Pharmaceutical Education & Research RIPER, Anantapuramu,
Andhra Pradesh, India – 515721
E-Mail: [email protected]

Mr. G. Narayana. M. Pharm., (PhD)
Secretary - ISPOR India Andhra Pradesh Regional Chapter
Associate Professor, Division of Pharmacy Practice
Raghavendra Institute of Pharmaceutical Education & Research RIPER, Anantapuramu,
Andhra Pradesh, India – 515721
E-Mail: [email protected]

Dr. Y. Samhitha Reddy. Pharm. D
Treasurer - ISPOR India Andhra Pradesh Regional Chapter
Assistant Professor, Division of Pharmacy Practice
Raghavendra Institute of Pharmaceutical Education & Research RIPER, Anantapuramu,
Andhra Pradesh, India – 515721
E-Mail: [email protected]

Prof. Dr. David Banji. M. Pharm., PhD
Director - ISPOR India Andhra Pradesh Regional Chapter
Professor & Director (Research and Development Cell)
Raghavendra Institute of Pharmaceutical Education & Research RIPER, Anantapuramu, Andhra
Pradesh, India – 515721
E-Mail: [email protected]

Dr. S.M.G. Ishrar. Pharm. D
Director - ISPOR India Andhra Pradesh Regional Chapter
Assistant Professor, Division of Pharmacy Practice
Raghavendra Institute of Pharmaceutical Education & Research RIPER, Anantapuramu,
Andhra Pradesh, India – 515721
E-Mail: [email protected]

Dr. Harish Handyal
Director - ISPOR India Andhra Pradesh Regional Chapter
Head, Department of Intensive Care Unit (ICU)
Rural Development Trust (RDT) Hospital,
Bathalapalli, Anantapuramu, Andhra Pradesh, India
E-Mail: [email protected]

Dr. CH. V. Suneel Babu
Director - ISPOR India Andhra Pradesh Regional Chapter
Head, Department of General Medicine
Rural Development Trust (RDT) Hospital,
Bathalapalli, Anantapuramu, Andhra Pradesh, India
E-Mail: [email protected]

Dr. Dasaratha Ramaiah.
Director - ISPOR India Andhra Pradesh Regional Chapter
Head, Department of Pediatrics
Rural Development Trust (RDT) Hospital,
Bathalapalli, Anantapuramu, Andhra Pradesh, India
E-Mail: [email protected]

2nd INTERNATIONAL CONFERENCE ON
PHARMACOECONOMICS AND OUTCOMES RESEARCH

21st & 22nd April 2017

Theme

Integrating Pharmacists in Healthcare Decision Making
A Resonate Patient Centric Therapy Initiative
Venue and Date

Prof. K. Chinnaswamy A C Auditorium, Seven Hills College of Pharmacy,
Tirupati, Andhra Pradesh
21st & 22nd April 2017

Supporting Organizations

Media Partners

International Society for Pharmacoeconomics and Outcomes Research (ISPOR):

ISPOR is the leading global professional society in Pharmacoeconomics and Outcomes Research
Founded in 1995 as an international multidisciplinary professional membership society, the
International Society for Pharmacoeconomics and Outcomes Research (ISPOR) advances the
policy, science, and practice of pharmacoeconomics (health economics) and outcomes research
(the scientific discipline that evaluates the effect of health care interventions on patient well-
being including clinical, economic, and patient-centered outcomes) www.ispor.org. With a 20-
year commitment to education, collaboration, and leadership, ISPOR meetings, published
resources, and facilitated discussions have evolved as the leading resources for health economics
and outcomes research. Moreover, as an unbiased organization of 9,500 individual and student
members from 114 countries, and over 8,700 affiliate members from our Regional Chapters
www.ispor.org/RegionalChapters, ISPOR members represent the entire field including research,
academia, decision and policy makers, consultants, payers, patient representative groups, and
others. ISPOR is a non-profit 501(c) (3) public organization for educational and scientific
purposes, as defined by the US IRS.
International Society for Pharmacoeconomics and Outcomes Research (ISPOR) - India
Andhra Pradesh Regional Chapter:

The ISPOR India - Andhra Pradesh Chapter was approved and established on June 14, 2012,
with head quarters at Raghavendra Institute of Pharmaceutical Education and Research (RIPER)
comprising of 300 members. The Chapter focuses on developing a new approach of Pharmacy
practice education from a regular curriculum wise teaching to an actual healthcare orientation /
health outcome based training to maintain and improve patient’s quality of life and adhere to
rational use of medications. The branch adages constant and novel contribution towards the
evidence based learning, teaching, practice and research in pharmacy profession with global
standards
About the International Conference on PE & OR:

The 2nd International Conference on Pharmacoeconomics and Outcomes Research (PE & OR) will
provide a case by case best practices and guidelines to advance optimal pharmacist integration in
healthcare decision making and also for collaborative practices with recognized members of
healthcare team and generate a good understanding of pharmacy researchers, practitioners,
graduates, students and academicians in healthcare decision and policy making for the
improvement, maintenance and achievement of an overall success of clinical outcomes.
Call for Abstracts:

The 2nd International Conference on Pharmacoeconomics and Outcomes Research (PE &OR)
takes immense pleasure in inviting abstracts of original research studies for poster/oral
presentation in related disciplines of Clinical pharmacy and practice, Pharmacovigilance,
Pharmacoeconomics and Pharmacoepidemiology, Outcomes research, Health policy & systems,
and Population health. Best presentations will be awarded.
Guidelines for abstract preparation (both oral and poster presentation):

*Prospective authors should submit the abstracts by 10 April 2017. The abstracts of the paper
should be limited to 250 words including keywords with line spacing 1.5. Abstracts for
poster/oral presentation competition shall be mailed to [email protected].
Corresponding author is to be marked with asterisk in superscript and complete address
including Email ID should be provided. Title should be in upper case, bold Times New Roman.
Accepted abstracts will be published in ISPOR RIPER-PDIC Bulletin (April Issue), for which a
two page summary, as a separate attachment is compulsory and should be prepared in the
following sequence: Introduction, Objectives, Experimental Methods, Results & Discussion,
Conclusion and important references, Tables, figures and graphs may be included.
Poster size is 0.95m X 1.2 m. Abstracts of good research work will be considered for Oral
presentation, guidelines of oral presentations will be mailed to corresponding author after
selection process.

2nd International Conference on Pharmacoeconomics and Outcomes Research

Integrating Pharmacists in Healthcare Decision Making - A Resonate Patient Centric

Therapy Initiative

21st & 22nd April 2017

Day 1 21st April 2017 (Friday) Time
Registration 09.00 hrs-09.30 hrs
Invocation 09.30 hrs-10.00 hrs

Lecture I Pharmacists Role in Improving Health Care Outcomes 10.00 hrs-11.15 hrs
Lecture II Dr. Shalini Sivadasan, M.Pharm, PhD
Lecture III 11.15 hrs-12.30 hrs
Senior Lecturer, Clinical Pharmacy & Pharmacy Practice 12.30 hrs-13.30 hrs
Unit, Faculty of Pharmacy, 13.30 hrs-14.45 hrs

AIMST University, Kedah, Malaysia. 14.45 hrs-15.00 hrs

Integrating Knowledge and Practice for Better Patient Care
Dr. Sriram Shanmugam. M.Pharm., PhD

Professor & Head, Department of Pharmacy Practice
College of Pharmacy, S R I P M S, Coimbatore, Tamil Nadu

LUNCH

Advances in expanding roles of pharmacist-delivered patient
care and shift toward health system implementation
Dr. Mohanraj Rathinavelu. Pharm. D
Assistant Professor, Department of Pharmacy Practice

Raghavendra Institute of Pharmaceutical Education and
Research (RIPER), Anantapuramu, Andhra Pradesh

Tea Break

Day 2 Presentations (Oral / Poster) 15.00 hrs-16.30 hrs
Lecture IV 22nd April 2017 (Saturday) Time
Lecture V
The Great New Challenging Role of Indian Pharmacist in the 09.30 hrs-11.00 hrs
Lecture VI New Millennium
Lecture VII 11.00 hrs-12.15 hrs
Mr. Prasad R. Tirunagaru. M.Pharm, M.Sc, RPh
Lt Colonel US Army, U S A 12.15 hrs-13.00 hrs
13.00 hrs-14.15 hrs
Integrating Pharmacogenomics in Pharmacy Practice for
better Patient Care - Challenges and Opportunities for 14.15 hrs-15.30 hrs
Clinical Pharmacists
Prof. Dr. David Banji. M.Pharm., PhD 15.30 hrs-16.30 hrs
Director - Research and Development Cell 16.30 hrs-17.00 hrs
Center for Pharmaceutical Research
Raghavendra Institute of Pharmaceutical Education and
Research (RIPER), Anantapuramu, Andhra Pradesh

LUNCH

Pharmacy Practice Research and Health Outcomes
Dr. Mahendra Kumar B.J. M. Pharm., PhD

Professor & Head, Division of Pharmacy Practice,
Vikas Institute of Pharmaceutical Sciences (VIPS)

Rajahmundry, Andhra Pradesh

Clinical Practice Improvement and Redesign: Shaping
Pharmacy for the Future

Dr. P. Seenivasan. M. Pharm., PhD
Professor & Head, Division of Pharmacy Practice
Faculty of Pharmacy, Sri Ramachandra University,

Chennai, Tamil Nadu

Presentations (Oral / Poster)

Valedictory and Prize Distribution

REGISTRATION FORM

2nd International Conference on Pharmacoeconomics and Outcomes Research

Integrating Pharmacists in Healthcare Decision Making - A Resonate Patient Centric Therapy Initiative

21st & 22nd April 2017

Name :

Name & Address of Institution :

Mobile :

Email ID :

DD No: Bank: Attestation of Head of Institute

Date: Place:

Registration fee should be paid through Demand Draft drawn in favour of “The President
ISPOR AP Chapter”. Soft copy of Filled registration form along with DD can be mailed to
[email protected]

Category A REGISTRATION FEES Rs 600
Category B ISPOR India Andhra Pradesh Regional Chapter Members Rs 800
Category C Non ISPOR India Andhra Pradesh Regional Chapter Members Rs 1000
(spot registration) For both Members and Non members of ISPOR India Andhra
Accommodations Pradesh Regional Chapter Members Rs 200
Per individual per day (first come first serve basis)

Important Dates Organizing Committee
Abstract submission (Last Date) Chief Patron
10 April 2017 Dr. Y. Padmanabha Reddy. M. Pharm., PhD, F.I.C
Information on Selected Abstracts
15 April 2017 President: ISPOR India AP Regional Chapter
Early Bird Registration Professor & Principal - RIPER
15 April 2017 Patron
Dr. M. Niranjan Babu. M. Pharm., PhD
Kindly contact
Registration Committee Professor & Principal
Dr. Y. Samhitha Reddy. Pharm. D Seven Hills College of Pharmacy
Treasurer - ISPOR India AP Chapter Convenor
+91 9966090999 Dr. Mohanraj Rathinavelu. Pharm. D
Scientific Committee
Dr. S.M.G. Ishrar. Pharm. D Elect – President: ISPOR India AP Regional Chapter
Director - ISPOR India AP Chapter Co-convenor
For Oral/Poster presentations Dr. Subhashis Debnath. M. Pharm., PhD
+91 9000035936
Accommodations Professor & Vice Principal
Dr. B. Narasimhulu. Pharm. D
Assistant Professor, Seven Hills College of Pharmacy
Seven Hills College of Pharmacy Organizing Secretary
+91 9949912096 Mr. G. Narayana. M.Pharm., (Ph.D)
For Complete information about
Conference Secretary: ISPOR India AP Regional Chapter
Kindly contact
Dr. Mohanraj Rathinavelu. Pharm. D Coordinators
+91 8121934940 Dr. P.T. Priyanka. Pharm. D
Dr. B. Manoj Kumar. Pharm. D
Dr. B. Sahithi. Pharm. D

Local Organizing Committee

Seven Hills College of Pharmacy
Dr. B. Narasimhulu. Pharm. D
Mrs. P. Rihana Begum. M. Pharm
Mr. R. Venkatesan. M. Pharm

ISPOR India Andhra Pradesh Regional Chapter
Application Form

First Name Graduation Last Name
Degrees Post graduation

Others
(please specify)
Designation /
Position

Mailing Address

Organization

Address Line 1

Address Line 2

City State Country

E mail ID Mobile

ISPOR India Andhra Pradesh Regional Chapter Office use only

Membership ID no Application no:

Life Membership (Valid for 10 Years) 600 INR Amount received:

Approved by Executive Committee of Cheque / DD:
ISPOR India AP Regional Chapter Received on:
Registration no:

Date of approval

Statement of Intent: What contributions will you provide to ISPOR India AP Regional Chapter?

I agree to the ISPOR India Andhra Pradesh Chapter Code of Ethics:

Date: Signature of Applicant:

RIPER PDIC BULLETIN

Official Publication of

Department of Pharmacy Practice,
Raghavendra Institute of Pharmaceutical Education & Research (RIPER)

&
Poison and Drug Information Center (PDIC)
Rural Development Trust (RDT) Hospital, Bathalapalli

Volume 8, Issue 46, Jan-Feb, 2017

INDEX

S no Articles Page no

1 Editorial Facilitating and Supporting Program Outcomes 1-2

(POs) of Pharm. D Program in India

- Dr. Mohanraj Rathinavelu.

2 Review SWOT Analysis of Indian Pharmaceutical Industry 3-6

- Mr. G. Narayana

3 Review-Image Timeline History of Chemotherapy Development 7

- Dr. S. M. Kannan

4 Case Report Postpartum CVT with DVT with 8 - 12

Hyperhomocysteniemia from Rural Secondary

Referral Healthcare Setting of India

- Dr. CH. V. Suneel Babu

5 Case Report Prednisolone Induced Cushing Syndrome 13 – 15

and its Management

- Mrs. P. Rihana Begum

6 Case Report Methotrexate Induced Pancytopenia 16 – 17

- Mr. T.S. Durga Prasad

7 Drug Profile Clomiphene Citrate 18 – 20

- Dr. M. Jyothi Suchitra

8 Review Pharmacy Practice Activity Chart 21 – 22

- Mr. Shaik Arshad Ali

9 Review Computerized Physician Order Entry (CPOE) 23 – 24

- Ms. Syed Ruksar Parveen

10 Review Immunization Schedule as per 25 – 26

Indian Association of Pediatrics (IAP)

- Mr. K. Giridhar Yadav

11 Drug Updates Deflazacort- FDA Approved Drug for the Management 27

of Duchenne Muscular Dystrophy

- Ms. Umapathi Sowjanya

12 Drug Indications of Phenylephrine in Pediatrics 28 – 29

Information (Dose and Dosage forms available in Indian Market)

- Ms. Sake Naga Mani

13 Gallery One Day National Seminar on 30

Epidemiology in Pharmaceutical Sciences and Ethics in

Biomedical Research

- Dr. Raghuveer Varma Pemmadi

14 Gallery IPA Outstanding Local Branch Award at IPA Award 31 – 32

functions on 17th December 2016 at Visakhapatnam.

- Dr. Mohanraj Rathinavelu

Editorial

Facilitating and Supporting Program Outcomes (POs) of Pharm. D Program in India

Mohanraj Rathinavelu Mudhaliar

Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research
(RIPER), Anantapuramu, Andhra Pradesh., India - 515721

Doctor of Pharmacy curriculum prepares the graduates to demonstrate competence in following areas:

Individual Patient and population based pharmaceutical care services (which involves)
 Ward round participation
 Drug therapy review
 Interpretation of laboratory data’s
 Information’s on medication use (Drug information’s)
 Drug and disease monitoring
 Drug therapy management.
 Patient counseling
 Designing of dosage regimen/assistance
 Maintaining and improving quality of life in individual patients
 Achieving optimum delivery of health outcome
 Assisting healthcare providers in rational use of medications (safe, effective, economic,

appropriate)
 Therapeutic interventions
 Identification and resolving medication related problems.

Systematic and clinical fundamentals
 Evidence based practice of teaching and learning process
 Pathophysiology of disease
 Pharmacotherapy of disease
 Clinical pharmacology
 Applied therapeutics (decision on selection drugs/appropriateness)
 Posology
 Individualization of drug and dosage regimen in targeted population
 Clinical pharmacokinetics
 Toxicokinetics and toxicology

1 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Editorial

Improving healthoutcomes through advanced pharmacy practice
Research studies on

 Drug utilization and prescribing patterns
 Pharmacoeconomics
 Pharmacoepidemiology
 QALY, DALY, QoL, HRQoL,
 Inventory control management
 Outcome research
 Comparison of safety and efficacy between drugs
 Healthcare education and research.

Inter professional collaboration of Health System
 Professionalism, Communication, presentations (drug and journal club, case presentations),

drug information’s and other updates in modern medical sciences.
 System-based practice
 Developing a standard system of practicing all these activities through a structured framework

for global practice and delivery of healthcare.
 CME / CNE / CPE programmes
 Public health, health awareness programmes, vaccinations and blood donation campaign.

Address for Correspondence
Dr. Mohanraj Rathinavelu Mudhaliar. Pharm. D
Assistant Professor
Department of Pharmacy Practice
Raghavendra Institute of Pharmaceutical Education & Research (RIPER)
Anantapuramu, Andhra Pradesh., India
E mail: [email protected]

2 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Review Article

SWOT Analysis of Indian Pharmaceutical Industry

Narayana. G

Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research
(RIPER), Anantapuramu, Andhra Pradesh., India - 515721

Introduction

The Indian pharmaceutical industry comprises approximately 8000 small scale units and 250 large

scale units are present to meet the domestic and global medicine needs. In 2013 the Indian

pharmaceutical market is in fifth position of global market. Domestic market was grown from 13-14%

with increase in scale of generic medicines chronic treatments. In this year there is a drastic rise in

new drug launches, drug filings to regulatory authority and phase II clinical trial.

The Indian pharmaceutical industry grow about 8-9% annually with a worth of 4.5$ billion. The

pharmaceutical industry in India meets 70% of the domestic demands of tablets, capsules, orals, and

injectable, Pharmaceuticals, drug intermediates and bulk drugs. In India manufacture is range from

simple head ache pills to sophisticated vaccines and chemotherapeutic agents almost every type of

drug is now available in Indian pharmaceutical market.

Pharmaceutical industry was not limited to the manufacture and marketing; it also extends it focus on

new drug discovery research. For example, in 2010 some of the companies like sunpharma, pharma

life sciences and cadila health care had applied for conducting clinical trials. As an open fact that

patent protected products are dominated by generic versions, Indian pharmaceutical industry was

catch the pulse of generic marketing and getting topper in the global market. For example Dr. Reddys

Lab announced a generic version of fenesteride in US market which will be used for treatment of

Male pattern alopecia.

Export and import
 From 2007 – 11 import of medicinal and pharmaceutical products was greatly declined as per

Directorate of commercial Intelligence and Statistics (D.G.C.I.S). It indicates domestic

requirements are satisfied by our own market independent on foreign import
 Similarly export of pharmaceutical product had risen over 12% comparing past years. Which

indicates Indian pharmaceutical industry was increases the foreign export.

Indian pharmaceutical trade

Indian market CAGR of 15.9% between 2010-2015 which has twice within five years with

rupees of 119677.

Retail trade % contribution in 2010 % contribution in2015 % CAGR 2010-2015
Hospital trade 74 72 14.0
Dispensing 9 12 23.2
Un audited 4 4 15.6
11 15 17.9

3 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Review Article

Indian pharmaceutical investment and production

Production value 18000 crores INR

No of units 20000U

Capital 2760 crores INR

Bulk drug production 4200 crores INR

Exports 7330 crores INR

Direct employment 460000 INR

Indirect employment 2400000 INR

SWOT Analysis
Strengths

 Low cost and capital investment to meet GMP compliance facilities.
 A good track record in formulation and bulk drug potent.
 Transparency in regulatory structure to get approvals and marketing.
 Extending pharmaceutical sector from manufacturing, marketing to contract research, clinical

research, Clinical data management and Pharmacovigilance.
 Good man power in our country.
 India had competent work force with high managerial, technical, professional and English

knowledge.
 Good information technology with sophisticated companies.
 In India due to high population and great biodiversity will favors testing of drug safety in

different environment
 In Indian pharmaceutical market MNC share was 75% in 1971 now it is 35% it indicates at

great change in investment and auto production of pharmaceuticals
 For Indian pharmaceutical firms it is very easy to win generic market in overseas especially in

US and Europe.
 In US use of generic drugs has been raised due to cost pressure by payer and introduction of

Medicare part D prescription benefit
 In USA NDA four at least one is from India
 India is also having an opportunity to manufacture biogenerics
Weakness
 Inadequate resources: in Indian pharmaceutical sector there is a great lack of resources
 Inadequate regulatory and clinical framework
 There will be high competition which may prone to loss profits
 Poor research and development efforts which leads to lack of investigation of new drugs
 Unavailability of data related to capital, product portfolios, market pressure and growth

strategies

4 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Review Article

 Poor health insurance may affect the Indian pharmaceutical market
 Strict regulations for pricing of the drugs will affect the profit of the pharmaceutical industry
 Poor infrastructure is also major weakness for Indian pharmaceutical industry where it

depends on other countries
Opportunities

 Raised Indian economy: Indian share in the world GDP is expected to reach 6.28% in 2015
from 5.0% in 2012.which indicates good economy growth. This is good opportunity for
Indian pharmaceutical industry to make a hut for pharmaceutical sector.

 Increased demand: Rise in income, literacy, change in lifestyle will increase the demand for
advanced medical treatment. In India people does not have access to modern medicines, still
they are going through traditional medicines.

 Outsourcing: in India skilled manpower, technology, IT growth will attract the projects of
neighbor countries. This is reason for a drastic raise in outsourcing projects in last decade.

 Introduction of policies like Health insurance policy, life Insurance policy and cash less
claims will increases the spending over health care, which will further increases growth of
pharma industry

 Lot of patent protected products are going to lose their patent in the coming years where
Indian pharmaceutical industry is going to put check for those products due to prior
experience of generic manufacturing.

 Rapid growth in generic and OTC drug manufacture and utilization
 A great demand for accurate diagnostic services
 Infrastructure had strengthened in between public and private sector
 A drastic raise in non-metro market
 A great investments from MNCs
 Improvements in API
Government initiatives for growth of pharmaceutical industry in India are
 Exemption from excise duty/CVD for drugs or vaccines used for management of HIV-AIDS,

renal cancer
 For probiotics tax was reduced from 10% to 5%
 Tax on soya bean products were reduced to address the deficiency in children and women's
 These are all great opportunities to enlarge the sales and to improve the profits
Jan Aushadi project

This project was government owned project where to improve health care government is
likely to procure generic drugs from private sector. Present – 117 Jan Aushadi stores are there With in
2 year – 600 stores and 2016- 3000 stores Coming soon Cipla, Ranbaxy, DRL and Lupin are
becoming part of this project

5 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Review Article

Threats
 Drug price control order was the major threat for pharmaceutical market
 Competition with other countries like china and Israel will affect the out sourcing demand of
India
 A well equipped technology based foreign traders will enter into the Indian market
 Wage inflation is also major threat for Indian pharmaceutical industry

Conclusion
Global pharmaceutical is undergoing a fast change. Indian pharmaceutical industry was

pursing the global requirements with high standards. Insurance coverage, raised incomes of the Indian
population, Government investments were having a positive impact on Indian pharmaceutical
industry. “I hope that in upcoming years India will in 1st position of global pharmaceutical market”
References

1. IMS Health. (Moving Annual Total), September.
2. International Monetary Fund. World Economic Outlook. October 2010.
3. IDFC Institutional Securities. “Indian Pharma - The Great Indian Sale is On!”. June 2011.
4. P.B. Jayakumar. “Indian Pharma on sterod-like growth”. Business Standard. (6 October

2011).
5. IBEF. Pharmaceuticals. [Online] [Cited: 21 October 2010.]
6. http://www.ibef.org/artdispview.aspx?in=52&art_id=26514&cat_id=116&page=2.

Address for Correspondence
Mr. G. Narayana. M. Pharm., (PhD)
Associate Professor
Department of Pharmacy Practice
Raghavendra Institute of Pharmaceutical Education & Research (RIPER)
Anantapuramu, Andhra Pradesh., India
E mail: [email protected]

6 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Image

Timeline History of Chemotherapy Development

S. M. Kannan

Department of Pain and Palliative Care, Rural Development Trust (RDT) Hospital, Bathapalli,
Anantapur, Andhra Pradesh., India

Address for Correspondence

Dr. S. M. Kannan.
Anesthesiologist and Head,
Department of Pain & Palliative Care,
Rural Development Trust (RDT) Hospital, Bathalapalli,
Anantapuramu, Andhra Pradesh., India
E mail: [email protected]

7 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Case Report

Postpartum CVT with DVT with Hyperhomocysteniemia from Rural Secondary Referral
Healthcare Setting of India

CH. V. Suneel Babu.

Department of General Medicine, Rural Development Trust (RDT) Hospital, Bathapalli, Anantapur,
Andhra Pradesh., India

Abstract
Cerebral venous thrombosis (CVT) presenting as status epilepticus is infrequent. We present the case
of a woman with CVT of the superior sagittal sinus who presented with a status epilepticus in this
case, we describe a hyper-homocysteinemia as a causative factor for CVT and DVT. Our report
highlights the value of an early diagnosis of CVT and DVT, the importance of identifying possible
causes that could be reversed with an appropriate treatment
Introduction
Cerebral venous thrombosis (CVT) is a disease seen in increasing frequency in daily practice and has
a variety of nonspecific clinical symptoms that are shared with other disorders.
Strokes in the young account for nearly 30% of all cases of stroke in India and cerebral venous
thrombosis (CVT) accounts for 10-20% of these cases. Two-thirds of them develop the same in the
postpartum period.
There has been a drastic reduction of infection as a causative agent for CVST in recent years. Primary
or idiopathic CVST are mainly caused by hypercoagulable state commonly from puerperium or from
dehydration.
CVST can be caused by a number of prothrombotic states and disorders of clotting system such as
inherited cause is Protein C resistance secondary to Factor V Leiden polymorphism, Protein C and S
resistance, and antithrombin III deficiency.
Other vasculitis such as Systemic lupus erythematosus (SLE) and polyarteritis nodosa (PAN) are also
relevant in young adults.
Dehydration is still most common cause puerperal CVST in our country.
CVST represents 0.5%-1% of all strokes. Multiple factors have been associated with CVST, but only
some of them are reversible. [1,2]
Hyperhomocysteniemia is a risk factor for deep vein thrombosis (DVT) and stroke but has not been
clearly associated with an increased risk of CVST.
Case Report
A woman, aged 23 years P4L4, delivered 2 months back, after 20 days of delivery developed 6
convulsive episodes (semiology s/o gtcs type 6 episodes no regaining consciousness in between
episodes), unable to raise left upper limb, swelling of right upper and lower limb since 20 days with
generalized body pains, tightness stretching all over body with burning sensation in both lower limbs
was admitted to our ward. The rest of her past medical history was unremarkable. On admission, her
pulse rate was 110 per minute, and blood pressure was 104/70mm Hg. She was afebrile, and did not

8 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Case Report

have icterus, cyanosis, clubbing, lymphadenopathy, or edema. Physical and neurological examinations
power 2/5 in left upper limb with no evidence of meningism or any focal neurological deficit.
Abdominal, respiratory, cardiovascular, and was normal.
On investigation, his hemoglobin was 7.9g/dL, with hypochromic, microcytic anemia. PT, aPTT, BT
and CT were within normal limits. LFT and RFT were normal.ECG and X-ray chest were normal.
A MRI brain, MR venogram scan was performed showing subacute hemorrhagic infarct in right
frontal lobe, superior sagittal sinus thrombosis. The angiography revealed no aneurysm. The patient
underwent a complete hemocoagulative study comprehensive of protein C, protein S, antithrombin III,
homocysteine, antiphospholipid antibodies and lupus anticoagulant, resistance to activated protein C,
factors VIII and VII, and factor V Leiden. All results were in the normal range except for total
homocysteine that was 26 μmol/L (normal value < 15 μmol/L). The levels of folic acid and
cobalamine were normal at 5.9 ng/mL (normal range 3–17 ng/mL) and 169 pg/mL (normal range
211–911 pg/mL), respectively.
During hospital stay on day5 developed pedal edema of left leg, homan’sign positive. Venous
Doppler of left lower limb showed deep venous thrombosis of common femoral vein
She responded to treatment with, enoxaparin acitrom, eptoin discharged with folic acid, pyridoxine,
vitamin b12 for lifelong she was asymptomatic at the time of discharge, and advised regular follow-
up.
Discussion
CVST is reported to be more common in developing countries, and has been linked to pregnancy,
multiparity, dehydration, and infection. Developments in imaging, diagnostic laboratory
investigations, and genetics have provided valuable information about risk factors and clinical
spectrum of CVST.
CVST represents 0.5%-1% of all strokes, According to the largest cohort study, 78% cases occurred
in patients younger than 50 years.
Hyperhomocysteniemia is a risk factor for DVT and stroke but has not been clearly associated with an
increased risk of CVT. [1]
Azin et al. [6] studied 61 patients with CVST where male-to-female ratio was 1/3.1. The mean age of
patients was 35.6 ± 12.1 years. Headache was seen in 91.8% of the patients. The most frequent risk
factor was oral contraceptive consumption (62.2%). Involvement of superior sagittal sinus and lateral
sinus was 80.3% and 41%, respectively.
Khealani et al. [7] stated that the obstetric CSVT has a different course and carries favorable prognosis
as compared with CVT unrelated to pregnancy.
There is evidence that mortality can be altered favorably by anticoagulation. Favorable outcome has
been reported from 60% to 76% of cases. Favorable outcome in obstetric CVT has been attributed to
the assumption that the occlusion is limited and transient with rapid recanalization or by development
of collaterals.

9 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Case Report

Haghighi et al.[12] studied 465 patients in the age group 29.5-43.8 years with ratio of female to male
being 2.79. Headache (80%-97%), sensory/motor deficits (39%-64%), and seizure (20%-62%) were
the most common clinical presentations with mortality rate of 11.4%.
Martinelli et al.[17] in their case–control study found that the hyperhomocysteniemia is associated with
a 4-fold increased risk of CVT. Ahmad et al.[18] stated that inherited thrombophilias with concomitant
acquired risk factors such as surgery, trauma, prolonged immobilization, pregnancy and puerperium,
oral contraceptives, antiphospholipid antibodies, and hyperhomocysteniemia increase the risk of
CSVT.
Aaron et al. [19] in their study of 41 patients reported that 34% had hyperhomocysteniemia with a17%
mortality.
Akhtar et al. [22] stated that hyperhomocysteniemia is responsible for both arterial and venous
thrombosis and it should be considered as an important risk factor for atherosclerotic vascular and
venous thromboembolic diseases. Nagaraja et al. [3] stated that hyperhomocysteniemia is a known risk
factor for venous thrombosis. Hyperhomocysteniemia is associated with an increased risk of puerperal
CVST occurring in Indian women and low folate levels contribute significantly to
hyperhomocysteniemia.
Nutritional folate and vitamin B12 deficiency can cause hyperhomocysteniemia and pregnancy may
contribute to this deficiency.
Rajput et al. [23] in their case report of CVST found that acquired hyperhomocysteniemia, presumably
due to nutritional deficiencies, and was treated with LMWH, followed by warfarin, vitamin B12,
vitamin B6, and folic acid, and recovered successfully.
Fernández-Moreno et al., [24] in their case report, stated that a persistent high homocysteine level was
found in patients with CVST. Seventy percent of the patients with thrombosis of the cerebral venous
sinuses present hypercoagulable states, including moderate hyperhomocysteniemia.
Hassan et al. [26] reported that methylcobalamin, pyridoxine, and folic acid supplementation resulted
in fall in homocysteine to 16.50 μmol/L (5.46-16.2 μmol/L).
Acknowledgement
We wish to thank Dr. Sudheer Kumar K, Medical Director, Rural Development Trust (RDT) Hospital,
Bathalapalli, for encouraging us to publish this case report.
References
1. Saposnik G, Barinagarrementeria F, Brown RD, Jr, Bushnell CD, Cucchiara B, Cushman M, et al.
American Heart Association Stroke Council and the Council on Epidemiology and Prevention.
Diagnosis and management of cerebral venous thrombosis: A statement for healthcare professionals
from the American Heart Association/American Stroke Association. Stroke. 2011;42:1158–92.
2. Prakash C, Bansal BC. Cerebral venous thrombosis. J Indian Acad Clin Med. 2000;5:55–61.

10 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Case Report

3. Nagaraja D, Kruthika-Vinod TP, Christopher R. The prothrombin gene G20210A variant and
puerperal cerebral venous and sinus thrombosis in South Indian women. J Clin
Neurosci. 2007;14:635–8.
4. Pfefferkorn T, Crassard I, Linn J, Dichgans M, Boukobza M, Bousser MG. Clinical features, course
and outcome in deep cerebral venous system thrombosis: An analysis of 32 cases. J
Neurol. 2009;256:1839–45.
5. Lath R, Kumar S, Reddy R, Boola GR, Ray A, Prabhakar S, et al. Decompressive surgery for
severe cerebral venous sinus thrombosis. Neurol India. 2010;58:392–7.
6. Azin H, Ashjazadeh N. Cerebral venous sinus thrombosis—Clinical features, predisposing and
prognostic factors. Acta Neurol Taiwan. 2008;17:82–7.
7. Khealani BA, Mapari UU, Sikandar R. Obstetric cerebral venous thrombosis. J Pak Med
Assoc.2006;56:490–3.
8. Nagaraja D, Sarma GR. Treatment of cerebral sinus/venous thrombosis. Neurol
India. 2002;50:114–6.
9. Nagarajan E, Shankar V. Characteristics of cerebral venous thrombosis in a South Indian Rural
Hospital. Int J Med Health Sci. 2013;2:298–304.
10. Appenzeller S, Zeller CB, Annichino-Bizzachi JM, Costallat LT, Deus-Silva L, Voetsch B, et al.
Cerebral venous thrombosis: Influence of risk factors and imaging findings on prognosis. Clin Neurol
Neurosurg.2005;107:371–8.
11. Pai N, Ghosh K, Shetty S. Hereditary thrombophilia in cerebral venous thrombosis: A study from
India. Blood Coagul Fibrinolysis. 2013;24:540–3.
12. Borhani Haghighi A, Ashjazadeh A, Safari A, Cruz-Flores S. Cerebral venous sinus thrombosis in
Iran: Cumulative data, shortcomings and future directions. Iran Red Crescent Med J. 2012;14:805–10.
13. Mehndiratta MM, Garg S, Gurnani M. Cerebral venous thrombosis--clinical presentations. J Pak
Med Assoc.2006;56:513–6.
14. Kalita J, Bansal V, Misra UK, Phadke RV. Cerebral venous sinus thrombosis in a tertiary care
setting in India.QJM. 2006;99:491–2.
15. Koopman K, Uyttenboogaart M, Vroomen PC, van der Meer J, De Keyser J, Luijckx GJ. Risk
factors for cerebral venous thrombosis and deep venous thrombosis in patients aged between 15 and
50 years. Thromb Haemost. 2009;102:620–2.
16. Coutinho JM, Ferro JM, Canhão P, Barinagarrementeria F, Cantú C, Bousser MG, et al. Cerebral
venous and sinus thrombosis in women. Stroke. 2009;40:2356–61.
17. Martinelli I, Battaglioli T, Pedotti P, Cattaneo M, Mannucci PM. Hyperhomocysteinemia in
cerebral vein thrombosis. Blood. 2003;15:1363–6.
18. Ahmad A. Genetics of cerebral venous thrombosis. J Pak Med Assoc. 2006;56:488–90.
19. Aaron S, Alexander M, Maya T, Mathew V, Goel M, Nair SC, et al. Underlying prothrombotic
states in pregnancy associated cerebral venous thrombosis. Neurol India. 2010;58:555–9.

11 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Case Report

20. Shen HC, Lo YK, Li JY, Lai PH. Familial hyperhomocysteinemia-related cerebral venous sinus
thrombosis and pulmonary embolism: A case report. Acta Neurol Taiwan. 2007;16:98–101.
21. Pillai LV, Ambike DP, Nirhale S, Husainy SM, Pataskar S. Cerebral venous thrombosis: An
experience with anticoagulation with low molecular weight heparin. Indian J Crit Care
Med. 2005;9:14–8.
22. Akhtar N, Deleu D, Kamran S. Haematologic disorders and cerebral venous thrombosis. J Pak
Med Assoc.2006;56:498–501.
23. Rajput R, Dhuan J, Agarwal S, Gahlaut PS. Central venous sinus thrombosis in a young woman
taking norethindrone acetate for dysfunctional uterine bleeding: Case report and review of literature. J
Obstet Gynaecol Can. 2008;30:680–3.
24. Fernández-Moreno MC, Castilla-Guerra L, Castella-Murillo A, Cueli-Rincón B, Fernández-
Bolaños R, Gutiérrez-Tous R, et al. Hyperhomocysteinemia-related cerebral venous thrombosis. Rev
Neurol. 2003;37:1040–3.
25. Cantu C, Alonso E, Jara A, Martínez L, Ríos C, Fernández Mde L, et al. Hyperhomocysteinemia,
low folate and vitamin B12 concentrations, and methylene tetrahydrofolate reductase mutation in
cerebral venous thrombosis.Stroke. 2004;35:1790–4.
26. Hassan KM, Kumar D. Reversible diencephalic dysfunction as presentation of deep cerebral
venous thrombosis due to hyperhomocysteinemia and protein S deficiency: Documentation of a
case. J Neurosci Rural Pract. 2013;4:193–6.

Address for Correspondence
Dr. CH. V. Suneel Babu. MD (Gen Medicine)
Consultant Physician,
Department of General Medicine,
Rural Development Trust (RDT) Hospital, Bathalapalli,
Anantapuramu, Andhra Pradesh., India
E mail: [email protected]

12 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Case Report

Prednisolone induced Cushing syndrome and its management

P. Rihana Begum, S. Thazammul Ferdous, Y. Mounika, N.L. Likitha Reddy.

Department of Pharmacy Practice, Seven Hills College of Pharmacy, Tirupati, Andhra Pradesh., India

Abstract
Glucocorticoids are extensively used for various inflammatory and autoimmune disorders, but long
term use of these agents is not without complications .Chronic use of glucocorticoids has lot of side
effects like Cushing syndrome. Cushing syndrome occurs due to higher than normal levels of a
hormone cortisol in our body (hypercortisolism). This type of Cushing syndrome is often referred as
Iatrogenic Cushing syndrome and is reversible form of disorder. The majority of cases diagnosed
today are the result of administrating supra-physiologic doses of corticosteroids prescribed such as
prednisone, prednisolone, and methylprednisolone. Prednisolone has the same effect in the body as
does cortisol produced by your body. . The objectives of this study are to discuss monitoring of
patients on glucocorticoids and management of the complications of glucocorticoids. Here is the case
of 19 yrs old male patient who is suffering from Cushing syndrome caused by chronic usage of
prednisolone. He has complaints of moon shaped face, weakness of muscles, abdominal distension,
swelling of limbs. . It can range from minor side effects (e.g. weight gain) to life-threatening effects
(e.g. adrenal suppression, sepsis, etc.), which may require immediate intervention. Therefore, the
decision to institute steroid therapy always requires careful consideration of the relative risk and
benefit in each patient. Our reports suggested the possibility of developing Cushing Syndrome which
was possible ADR of prednisolone. Therefore further studies are required to confirm the mechanism
and risk factors associated with Prednisolone.
Introduction
Cushing syndrome is the condition caused when the body is exposed to high levels of the hormone
cortisol for a long time. Prednisolone induced Cushing syndrome is of exogenous type of cushing
syndrome. The most common systemic side effects of prolonged use glucocorticoids includes
Cushing’s syndrome, cataract, hypertension, dyslipidemia and a pre-disposition to life threatening
infections.
Case report
This is a case of 19yrs male patient who was admitted in the neurological department of a tertiary care
hospital in Tirupati, Andhra Pradesh. With the chief complaints of facial puffiness, abdominal
distension, muscle weakness, a buffalo hump, inability to walk since 1 month. He was with regular
treatment with Prednisolone (4mg) since 1yr for eye inflammation. Later, the patient continued
steroids for about 11/2 yrs and gained weight, blurred vision and loss of appetite .The patient is a
known alcoholic. His vitals were as follows Patient –conscious,PR-70bpm,BP-140/110mm/hg,CVS-
S1 S2 +,RS-BAE +.The other lab investigations showed that the patient had elevated fasting blood
sugar-155mg/dl (70-110mg/dl), elevated triglycerides-200mg/dl(mg/dl),Potassium-2.5mEq/L(3.5-

13 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Case Report

5.5mEq/L),ultrasound scan fatty liver. From the above investigations the patient is provisionally
diagnosed as Exogenous Cushing syndrome due to chronic usage of prednisolone. The treatment
given to the patient was antiulcer drugs, alternate anti-inflammatory drug, oral hypoglycemic agent,
mannitol, antibiotics.
Discussion
Prednisolone is a corticosteroid used to treat short-term inflammatory conditions. Prednisolone will
provide relief from inflamed areas of the body (swelling), severe allergies, eye or vision problems,
arthritis, asthma and multiple sclerosis. Patients are susceptible to poor wound healing, increased
incidence of infection, atherosclerotic heart disease, depression and even psychosis.
Mechanism of action
Prednisolone is a glucocorticoid receptor agonist. It can inhibit leukocyte infiltration at the site of
inflammation; interfere with mediators of inflammatory response. Glucocorticoid bioavailability is
between 60%-100%.more than 90% of circulating glucocorticoid bind to corticosteroid binding
globulin (CBG).The unbound free hormone in the circulation binds to the glucocorticoid receptor
(GR). Prednisolone has high affinity to the CBG than the cortisol. Binding of glucocorticoids to GR
results in the intracellular processes of gene transcription and translation that ultimately leads to the
several actions of glucocorticoids on tissues.
Diagnosis of Cushing syndrome include low level ACTH level, low cortisol level ,higher than normal
fasting blood sugar, high cholesterol particularly triglycerides, low potassium levels.
Intervention-by pharmacist
The role of Clinical pharmacist is to suggest Doctors and nursing staff should be aware of the
following Prednisolone and all corticosteroids may cause the Cushing syndrome. Treatment is to
slowly decrease and eventually stop taking any corticosteroids. Do not stop any medication without
talking to your provider. Suddenly stopping corticosteroids after taking them for a long time can result
in life-threatening conditions called adrenal crisis. If you cannot stop the medicine because of disease,
follow your provider’s instructions on how to reduce the possibility of developing of complications,
treating high blood sugar with diet, oral medicines, or insulin, treating high cholesterol with diet or
medicines, taking medicines to prevent bone loss.
Conclusion
Our report suggest that the possibility of developing
Cushing Syndrome which was possible ADR of
prednisolone. Therefore further studies are required
to confirm the mechanism and risk factors associated
with Prednisolone. Patient /care taker should be
thoroughly informed about the risk associated with
its long term use and symptoms of steroid induced
side effects.

14 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Case Report

Bibliography
1. Romanholi DJ., Salqadol LR.Arq Bras Endocrinol metabol, 2007; 51(8):1280-92.Alder .Dipp SL.

Cushing syndrome (2013).
2. Endocrine and metabolic disorders information service NIH publications NO.02-3007.Date

assessed June (2015).
3. Nikkanen HE, Shannon MW. Endocrine toxicology. In: Shannon MW, Borron SW, Burns MJ,

eds. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose. 4th ed.
Philadelphia, PA: Elsevier Saunders; (2016).
Address for Correspondence
Mrs. P. Rihana Begum. M. Pharm
Department of Pharmacy Practice,
Seven Hills College of Pharmacy,
Tirupati, Andhra Pradesh., India
E mail: [email protected]

15 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Case Report

Methotrexate Induced Pancytopenia

T.S. Durga Prasad, K. Chandrasekhar, D. Meghana.

Department of Pharmacy Practice, Sri Padmavathi School of Pharmacy, Tiruchanoor, Tirupati,
Andhra Pradesh., India
Department of General Medicine, SV Medical College, Tirupati, Andhra Pradesh., India

Case Report
A 55 year male patient was admitted to the general medicine male department with the

complaints of chest pain and breathlessness. He was a known case of type II diabetes mellitus, B/L pleural
effusion with pulmonary tuberculosis and completed antitubercular therapy category I, Systemic lupus
erythematosus, and hypothyroidism. The patient had a positive antinuclear antibody profile with 148 IU/L
and raised C-reactive protein associated with negative rheumatoid antibodies. Based on these laboratory
assessments the patient was initiated with methotrexate 10mg once weekly and prednisolone 2.5mg twice
daily prior to two months. At the initiation of therapy patient had a hemoglobin count of 7.8 g/dL and a total
count of 6,700 cells/mm3 and peripheral smear revealed a microcytic hypochromic anemia with relative
lymphocytosis.

The patients has a total count of 2,300 cells/mm3, elevated lymphocyte percentage of 90.6%, with
an associated decline in red blood cell count (RBC) to 3.02 lakh cells/mm3 and hemoglobin count 5.7mg/dl
during this hospital stay. Apart from these alterations, the patient also experienced a decline in haematocrit,
mean cell volume, mean cell hemoglobin, mean corpuscular hemoglobin concentration. The peripheral smear
revealed microcytic RBC with mild anisocytosis and reticulocytes of 0.7%, leucopenia, and mild
thrombocytopenia presenting as pancytopenia.

Systemic lupus erythematosus (SLE) is an autoimmune disorder associated with damage to the
cells and tissues due to pathogenic auto-antibodies and immune complexes. Hematological manifestations of
SLE include leucopenia, lymphocytopenia and thrombocytopenia (Indian Guidelines). But in this case,
though the patient was experiencing anemia at the time of diagnosis with SLE, the total counts and platelets
were decline after the therapy with methotrexate for 2 months. So, the alterations in the hematological
parameters can be attributed to methotrexate.

In 1985, methotrexate was identified as an effective therapy for rheumatoid arthritis due to its
safety, efficacy and low cost profile. Methotrexate can be used in SLE when it is associated with
focal/diffuse proliferative glomerulonephritis with or without azotaemia/hypertension, lupus cerebritis with
recurrent seizures, acute confusional state, coma; systemic necrotizing Vasculitis as recommended by Indian
guidelines on the management of SLE where as steroids such as PRENISOLONE are indicated in initial
stages without life threatening complications. Methotrexate was found to be equally efficacious when
compared to chloroquine in managing cutaneous and articular manifestations in patients with SLE. But
Methotrexate therapy was not associated with a reduction in ESR similar to that of Chloroquine based
regimen as reported by Nazrul Islam et.al.,.

16 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Case Report

Many reports were published reporting Methotrexate induced pancytopenia by kim et.al, The
probable mechanism associated with this was inhibition of dihydrofolate reductase, reduced tetrahydrofolate
levels, and altered DNA, protein, lipid methylation and inhibition of thymidine synthase interference with
DNA leading to bone marrow suppression and liver toxicity. Increased was also found to be the major
contributing factor for myelosuppression.

Monitoring the elderly patients for hematologic toxicities on long run and monitoring serum
Methotrexate levels in settings with available therapeutic drug monitoring (TDM) can aid in predicting the
adverse drug reactions associated with Methotrexate therapy. A serum concentration of 0.7µmol/L of
Methotrexate was found to be reliable in assessing associated toxicities as reported by Tanveer et.al.

Apart from TDM a prophylactic co-administration of 1-5mg/day of folic acid as a supplement
was found to effective to prevent Methotrexate related toxicities. Concomitant administration of folic was
not linked to alteration in the efficacy of Methotrexate.
References

1. Henghe Tian, M.D., and Bruce N. Cronstein, M.D. Understanding the Mechanisms of Action of
Methotrexate Implications for the Treatment of Rheumatoid Arthritis. Bulletin of the NYU Hospital
for Joint Diseases 2007; 65(3):168-73.

2. Md. Nazrul ISLAM, Mohsin Hossain, Syed A. HAQ,1 Mohammad N. Alam, Peter M. Ten Klooster
And Johannes J. Rasker. Efficacy and safety of methotrexate in articular and cutaneous
manifestations of systemic lupus erythematosus. International Journal of Rheumatic Diseases 2012;
15: 62–68.

3. Syed Tanveer Abbas Gilani, Dilshad Ahmed Khan, Farooq Ahmad Khan and Mushtaq Ahmed.
Adverse Effects of Low Dose Methotrexate in Rheumatoid Arthritis Patients. Journal of the College
of Physicians and Surgeons Pakistan 2012, Vol. 22 (2): 101-104.

4. Kumar A. Indian guidelines on the management of SLE. J Indian Rheumatol Assoc 2002: 10: 80 –
96.

5. Y. N. Lim, K. Gaffney and D. G. I. Scott. Methotrexate-induced pancytopenia: serious and under-
reported? Our experience of 25 cases in 5 years. Rheumatology 2005; 44:1051–1055.

Address for Correspondence
Mr. T.S. Durga Prasad. M. Pharm
Department of Pharmacy Practice,
Sri Padmavathi School of Pharmacy,
Tiruchanoor, Tirupati, Andhra Pradesh., India
E mail: [email protected]

17 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Drug Profile

Clomiphene Citrate

M. Jyothi Suchitra.

Department of Obstetrics and Gynecology, Rural Development Trust (RDT) Hospital, Bathapalli,
Anantapur, Andhra Pradesh., India

Background
Clomiphene is a non-steroidal fertility medicine. It causes the pituitary gland to release hormones
needed to stimulate ovulation (the release of an egg from the ovary). Clomiphene is used to cause
ovulation in women with certain medical conditions (such as polycystic ovary syndrome) that prevent
naturally occurring ovulation.
Uses
Clomiphene is used to treat infertility in women. It works by stimulating an increase in the amount of
hormones that support the growth and release of a mature egg (ovulation). This medication is not
recommended for women whose ovaries no longer make eggs properly (primary pituitary or ovarian
failure).
Precautions

 Before taking clomiphene, tell your doctor or pharmacist if you are allergic to it; or if you
have any other allergies. This product may contain inactive ingredients, which can cause
allergic reactions or other problems. Talk to your pharmacist for more details.

 This medication should not be used if you have certain medical conditions. Before using this
medicine, consult your doctor or pharmacist if you have: ovarian cysts or enlarged ovaries
(not due to polycystic ovary syndrome), abnormal vaginal bleeding, liver disease,
uncontrolled thyroid or adrenal gland problems, tumor in the brain (pituitary tumor).

 Before using this medication, tell your doctor or pharmacist your medical history, especially
of: polycystic ovary syndrome, uterus problems (e.g., uterine fibroids, endometriosis).

 Use of clomiphene may result in multiple births (e.g., twins, triplets). Consult your doctor for
more details.

 This drug may make you dizzy or cause vision changes. Do not drive, use machinery, or do
any activity that requires alertness or clear vision until you are sure you can perform such
activities safely. Limit alcoholic beverages.

 Stop using this medication when you become pregnant. This medication must not be used
during pregnancy. If you think you may be pregnant, tell your doctor right away.

 It is not known whether this drug passes into breast milk. This drug may reduce milk
production. Consult your doctor before breast-feeding.

18 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Drug Profile

Side Effects
 Stomach upset, bloating, abdominal/pelvic fullness, flushing ("hot flashes"), breast
tenderness, headache, or dizziness may occur. If any of these effects persist or worsen, notify
your doctor or pharmacist promptly.
 Remember that your doctor has prescribed this medication because he or she has judged that
the benefit to you is greater than the risk of side effects. Many people using this medication
do not have serious side effects.
 Tell your doctor right away if any of these unlikely but serious side effects occur: abnormal
vaginal bleeding, mental/mood changes.
 Vision changes (e.g., blurred vision, seeing spots or flashes) may sometimes occur during
clomiphene treatment, especially if you are exposed to bright light. These side effects usually
go away a few days or weeks after treatment is stopped. However, in rare cases, vision
changes may be permanent. Get medical help right away if any of the following occur: vision
problems/changes, eye pain.
 This medication may cause a condition known as ovarian hyperstimulation syndrome
(OHSS). Rarely, serious OHSS causes fluid to suddenly build up in the stomach, chest, and
heart area. This may occur during therapy or after treatment has been stopped. Get medical
help right away if you develop any of the following side effects: severe pain/swelling in the
lower abdomen (pelvic) area, sudden/rapid weight gain, nausea/vomiting, diarrhea, shortness
of breath, decreased urination, pain/redness/swelling of the legs, chest pain, fast/irregular
heartbeat.
 A very serious allergic reaction to this drug is unlikely, but seeks immediate medical attention
if it occurs. Symptoms of a serious allergic reaction may include: rash, itching/swelling
(especially of the face/tongue/throat), severe dizziness, trouble breathing.
 This is not a complete list of possible side effects. If you notice other effects not listed above,
contact your doctor or pharmacist.

Dosage
Usual Adult Dose for Ovulation Induction

 50 mg orally once a day for 5 days. Therapy should be initiated on or near the 5th day of the
menstrual cycle, but may be started at any time in patients without recent uterine bleeding.

 If ovulation occurs and pregnancy is not achieved, up to 2 additional courses of clomiphene
50 mg orally once a day for 5 days may be administered. Each subsequent course may be
started as early as 30 days after the previous course and after pregnancy has been excluded.

 Most patients ovulate following the first course of therapy. However, if the patient fails to
ovulate, a second course of 100 mg/day for 5 days may be given as early as 30 days following
the initial course. A third course of 100 mg/day for 5 days may be given after 30 days, if
necessary.

19 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Drug Profile

 Treatments beyond three cycles of clomiphene, dosages greater than 100 mg once a day,
and/or course durations beyond 5 days are not recommended by the manufacturer. However,
successful pregnancies and term deliveries have been reported in women receiving up to 200
mg/day for 5 days, or extended 10-day course of therapy, or consecutive cycles of treatment
beyond the 3 recommended by the manufacturer.

Usual Adult Dose for Lactation Suppression
 50 to 100 mg orally once a day for 5 days. Generally, one course of therapy is sufficient.

Usual Adult Dose for Oligospermia
 25 to 100 mg orally once a day. Therapy is generally given over a period of several months.

Renal Dose Adjustments
 Dosage reductions are not recommended for patients with renal dysfunction during short term
clomiphene therapy.
 Dosage reductions are also not recommended for patients with renal dysfunction during long
term clomiphene therapy.
 However, the half-life of clomiphene may be prolonged with chronic therapy and patients
with renal dysfunction should be monitored for patient response and tolerance.

Liver Dose Adjustments
 Clomiphene is contraindicated in patients with liver disease or a history of liver dysfunction.

References
1. https://www.drugs.com/dosage/clomiphene.html
2. http://www.webmd.com/drugs/2/drug-13979/clomiphene-citrate-oral/details#uses

Address for Correspondence
Dr. M. Jyothi Suchitra. DGO, DNB
Head, Department of Obstetrics and Gynecology
Rural Development Trust (RDT) Hospital, Bathalapalli,
Anantapuramu, Andhra Pradesh., India
E mail: [email protected]

20 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Review Article

Pharmacy Practice Activity Chart

Shaik Arshad Ali, Kenchugundu Jagadeesh

Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research
(RIPER), Anantapuramu, Andhra Pradesh., India - 515721

As pharmacists increasingly focus their practices on the provision of pharmaceutical care and expect
to be compensated for pharmaceuticals care services, the need for a consistent and broadly accepted
classification of pharmacy practice activities becomes evident. Although many systems exist to record
pharmacists activities, until now the profession has lacked a widely accepted way to describe or
document these activities in a common language.
The pharmacy practice activity classification (PPAC) initiated by the American Pharmacists
Association (APhA) provides a common language that, if used consistently, will yield comparable
data among studies. This in turn can contribute to building databases for statistically sound
determinations about pharmacist’s patient - centered activities and whether they improve patient
outcomes and the use of resources. Such systems are already used by other health professions (e.g.;
Medicine, nursing). An important purpose of the PPAC is to provide a solid foundation to support
system for remuneration that can be used for billing.
The PPAC is focused primarily on activities of licensed, practicing pharmacists across the continuum
of health care settings. The classification captures a range of activities from traditional dispensing to
direct patient care services. It is recognized that pharmacists occupy other roles in the industry,
administration, regulatory agencies, professional associations, public health, academia – that are not
directly related to patient care. The benefits of consensus on a uniform classification system include,
advancing the recognition of pharmaceutical care as a key component of pharmacy practice, leading
to an understanding of the valve of and need for compensation for the delivery of pharmaceutical care
services.

The Pharmacy Practice Activity Classification
1. Ensuring appropriate therapy and outcomes.

1.1 Ensuring appropriate pharmacotherapy
1.2 Ensuring patients understanding / adherence to his or her treatment plan
1.3 Monitoring and reporting outcomes
2. Dispensing medication and devices
2.1 Processing the prescription or medicine order
2.2 Preparing the pharmaceutical product
2.3 Delivering the medication or device

21 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Review Article

3. Health promotion and disease prevention
3.1 Delivering clinical preventive services
3.2 Surveillance and reporting of public issues
3.3 Promoting safe medication use in society

4. Health system management
4.1 Managing the practice
4.2 Managing medication throughout the health system
4.3 Managing the use of medication within the health system
4.4 Participating in research activities
4.5 Engaging in interdisciplinary collaboration

 Increasing interdisciplinary links and encouraging collaboration with other healthcare
professionals, by defining common goals and patients interventions.

 Facilitating and standardizing research directed towards establishing the valve of services in
optimizing patient care.

 Assisting in developing quality assurance systems and quality of care guidelines for practices.
 Facilitating documentations of pharmaceutical care activities in computer based patient record

system.

Address for Correspondence
Mr. Shaik Arshad Ali.
Intern – Doctor of Pharmacy Program
Department of Pharmacy Practice
Raghavendra Institute of Pharmaceutical Education & Research (RIPER)
Anantapuramu, Andhra Pradesh., India
E mail: [email protected]

22 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Review Article

Computerized Physician Order Entry (CPOE)

Syed Ruksar Parveen, Sravani Jollireddy

Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research
(RIPER), Anantapuramu, Andhra Pradesh., India - 515721

Computerized physician order entry (CPOE) is the process of a medical professional entering
medication order or other physician Instructions electronically instead of paper charts
Benefits

 It promotes or warns against the possibility of drug interaction Allergy or over dose.
 Accurate current information that helps physicians keeps up with new drugs or they are

introduced in to the market.
 Drug specific information that eliminates confusion among drug names that sound alike.
 Improved communication between physician and pharmacist.
 Reduced health care costs due to improved efficiencies.
 Reduced nursing manual steps (paper requisition, transcription).
 Reduced laboratory manual steps
CPOE Consists
 Quality improvement
 Process improvement
 Error reductions
 Cost reductions

Error Prone Step

Providers Processing
Analysis

CPOE Laboratory Label
Onformation Prints
Paper System (LIS)
Requesition
and Label LIS used Specimen
terminal Relabelled
23
RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Review Article

Quality improvement Process improvement Error reduction Cost reductions
Elimination of orders Order sets (frequency, Appropriate dosing Elimination of
duration) recommendations duplication orders
Elimination of illegible Protocol management Elimination of dosage Reduced order
handwriting errors (e.g. strength, verification time
routes of
Improved or consistent Expedited ordering administration Reduced order
Interaction processing time
documentation process checking(e.g. drug-
drug, drug allergy, Improved charge
Considerations for Reduced (from drug laboratory) capture
patients clinical data prescription)to Interactive alerts
dispensing Reduced length of stay
Coded data for Online knowledge
outcome analysis Automated sources Improved malpractice
documentation Medication exposure
administration
Virtual system verification Reduced data entry
access(anytime Improved legibility needs
anywhere) Alternative medication
Diagnostics indication guidelines
Lower cost for
diagnostic and
treatment interventions

Sources:
1. American Society of Health System Pharmacist 2004
2. J Path Information

Address for Correspondence
Ms. Syed Ruksar Parveen.
Intern – Doctor of Pharmacy Program
Department of Pharmacy Practice
Raghavendra Institute of Pharmaceutical Education & Research (RIPER)
Anantapuramu, Andhra Pradesh., India
E mail: [email protected]

24 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Review Article

Immunization Schedule as per Indian Association of Pediatrics (IAP)

Giridhar Yadav. K

Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research
(RIPER), Anantapuramu, Andhra Pradesh., India - 515721

Age Vaccines Comment
Birth BCG Administer these vaccines to all newborns before hospital discharge
6 weeks OPV 0
DTP
10 weeks Hep-B 1  DTaP vaccine/combinations should preferably be avoided for the
14 weeks DTwP 1 primary series
6 months  DTaP vaccine/combinations should be preferred in certain
9 months IPV 1 specific circumstances/conditions only
Hep-B 2  No need of repeating/giving additional doses of whole cell
pertussis (wP) vaccine to a child who has earlier completed their
Hib 1 primary schedule with A cellular pertussis (aP) vaccine-
Rotavirus 1 containing products

PCV 1 Polio
 All doses of IPV may be replaced with OPV if administration of
DTwP 2 the former is unfeasible
IPV 2  Additional doses of OPV on all supplementary immunization
Hib 2 activities (SIAs)
 Two doses of IPV instead of 3 for primary series if started at 8
Rotavirus 2 weeks, and 8 weeks interval between the doses
PCV 2  No child should leave the facility without polio immunization
DTwP 3 (IPV or OPV), if indicated by the schedule
PV 3  See footnotes under figure titled IAP recommended
Hib 3 immunization schedule (with range) for
 recommendations on intradermal IPV
Rotavirus 3
PCV 3 Rotavirus
OPV 1  2 doses of RV1 and 3 doses of RV5 & RV 116E
Hep-B 3  RV1 should be employed in 10 & 14 week schedule, 10 & 14
week schedule of RV1 is found to be more immunogenic than 6
OPV 2 & 10 week schedule
MMR-1
Rotavirus
If RV1 is chosen, the first dose should be given at 10 weeks

Rotavirus
Only 2 doses of RV1 are recommended.
If RV1 is chosen, the 2nd dose should be given at 14 weeks

Hepatitis-B
The final (3rd or 4th) dose in the Hep B vaccine series should be
administered no earlier than age 24 weeks and at least 16 weeks after the
first dose.
MMR
Measles-containing vaccine ideally should not be administered before
completing 270 days or 9 months of life;
The 2nd dose must follow in 2nd year of life.

25 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Review Article

Age Vaccines Comment
9 - 12 Typhoid Currently, two typhoid conjugate vaccines, Typbar-TCV® and
months Conjugate PedaTyph® available in Indian market; either can be used
Vaccine An interval of at least 4 weeks with the MMR vaccine should be
12 maintained while administering this vaccine
months Hep-A 1 Hepatitis A
Single dose for live attenuated H2-strain Hep-A vaccine
15 MMR 2 Two doses for all inactivated Hep-A vaccines are recommended
months Varicella 1 MMR
PCV booster The 2nd dose must follow in 2nd year of life
16-18 However, it can be given at anytime 4-8 weeks after the 1st dose
months DTwP Varicella
B1/DTaP B1 The risk of breakthrough varicella is lower if given 15 months onwards
18 The first booster (4thth dose) may be administered as early as age 12
months IPV B1 months, provided at least 6 months have elapsed since the third dose.
2 years Hib B1 DTP
1st & 2nd boosters should preferably be of DTwP
4-6 years Hep-A 2 Considering a higher teratogenicity of DTwP, DTaP can be considered
for the boosters
10-12 Booster of Hepatitis A
years Typhoid 2nd dose for inactivated vaccines only
Conjugate A booster dose of Typhoid conjugate vaccine (TCV), if primary dose is
Vaccine given at 9-12 months
A dose of Typhoid Vi-polysaccharide (Vi-PS) vaccine can be given if
DTwP conjugate vaccine is not available or feasible;
B2/DTaP B2 Revaccination every 3 years with Vi-polysaccharide vaccine
Typhoid conjugate vaccine should be preferred over Vi- PS vaccine
OPV 3 Varicella
Varicella 2 The 2nd dose can be given at anytime 3 months after the 1st dose.
MMR
MMR 3 The 3rd dose is recommended at 4-6 years of age.
Tdap/Td
Tdap is preferred to Td followed by Td every 10 years
HPV HPV
Only 2 doses of either of the two HPV vaccines for
adolescent/preadolescent girls aged 9-14 years;
For girls 15 years and older, and immunocompromised individuals 3
doses are recommended
For two-dose schedule, the minimum interval between doses should be 6
months.
For 3 dose schedule, the doses can be administered at 0, 1-2 (depending
on brand) and 6 months

Address for Correspondence
Mr. Giridhar Yadav. K
Intern – Doctor of Pharmacy Program
Department of Pharmacy Practice
Raghavendra Institute of Pharmaceutical Education & Research (RIPER)
Anantapuramu, Andhra Pradesh., India
E mail: [email protected]

26 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Drug Updates

Deflazacort- FDA Approved Drug for the Management of Duchenne Muscular Dystrophy

Umapathi Sowjanya

Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research
(RIPER), Anantapuramu, Andhra Pradesh., India - 515721

The US Food and Drug Administration (FDA) approved the first corticosteroid to be made available
in the United States for the treatment of patients of Duchenne muscular dystrophy.
Date of Approval 21 February 2017
The medicine safety regulator has first tracked a license of Deflazacort, marketed as emflaza by
marathon pharmaceuticals, to treat patients aged 5 years and older with a rare genetic disorder
Duchenne muscular dystrophy, the most common type of muscular dystrophy and is caused by an
absence of dystrophin, a protein that helps keep muscle cells intact.
The first symptoms are usually noticed between the ages of 3 and 5 years with the disease becoming
progressively worse over time.
People with Duchenne muscular dystrophy progressively lose the ability to perform activities
independently and often require use of a wheel chair by their early teens. As the disease progresses
life threatening heart and respiratory conditions can occur. Disease severity and life expectancy vary.
Deflazacort works by decreasing inflammation and reduces immune system activity. Side effects of
deflazacort which has been given orphan drug status by the FDA, are similar to those experienced
with other corticosteroids.
The FDA decision follows the results of two clinical trials. The first involved 196 male patients aged
5-15 years who had evidence of the new dated dystrophim gene and onset of weakness before the age
of 5.
Improvements in muscle strength- which lasted 104 weeks –were also shown in another trial
involving 29 male patients.

Address for Correspondence
Ms. Umapathi Sowjanya
Intern – Doctor of Pharmacy Program
Department of Pharmacy Practice
Raghavendra Institute of Pharmaceutical Education & Research (RIPER)
Anantapuramu, Andhra Pradesh., India
E mail: [email protected]

27 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Drug Information

Indications of Phenylephrine in Pediatrics
(Dose and Dosage forms available in Indian Market)

Sake Naga Mani

Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research
(RIPER), Anantapuramu, Andhra Pradesh., India - 515721

Phenylephrine
 Selective α1-adrenergic receptor agonist
 Phenethylamine class
 Primarily used as a decongestant, as an agent to dilate the pupil, and to increase blood
pressure.
 Phenylephrine is marketed as an alternative for the decongestant pseudoephedrine,
although clinical trials show phenylephrine, taken orally at the recommended dose, to be no
more effective than placebo for allergy relief.
 Phenylephrine can also cause a decrease in heart rate through reflex bradycardia.
 Oral phenylephrine is extensively metabolized by monoamine oxidase, an enzyme that is
present on the outside of cells, throughout the body.
 Compared to intravenous pseudoephedrine, phenylephrine has a reduced and variable
bioavailability; only up to 38%.
 Phenylephrine is a sympathomimetic drug, which means that it mimics the actions of
epinephrine (commonly known as adrenaline) or norepinephrine.
 Phenylephrine selectively binds to alpha receptors which cause blood vessels to constrict.
 Phenylephrine may cause side effects such as headache, reflex bradycardia, excitability,
restlessness and cardiac arrhythmias. Phenylephrine is not suggested for use in patients with
hypertension.
 Phenylephrine is used as a decongestant sold as an oral medicine or as a nasal spray. It is a
common ingredient in over-the-counter decongestants in America.
 International preparations: Deconsal CT, Histinex HC, Neo-Synephrine.
 10 Brands of generics of Phenylephrine listed in medindia are the following: The information
provided includes the cost of the drug and the type of drug - tablet, capsule, syrup, cream, gel,
ointment, liquid or injection.

28 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Drug Information

Sno Brand Name Manufacturers Type Unit
1 Drosyn (10%w/v) FDC (Proxima) Eye Drops 10%w/v
2 Frenin Wyeth (I) Limited Injection
3 Nefrin Eye Klar Sehen Pvt. Limited 10mg
4 Nefrisol SG Pharma Pvt. Ltd. Drop 10%
5 Paripher Biomedica International Injection 10mg
6 Phenpres Neon Laboratories Ltd 10%
7 Phenylephrine Eye Klar Sehen Pvt. Limited Drop 10mg
8 Sunepherine -Eye Sunways India Pvt. Ltd. Injection 10%
9 Sunepherine -Eye (10%) Sunways India Pvt. Ltd. 2.50%
10 Sunepherine -Eye (5%) Sunways India Pvt. Ltd. Drop 10%
Drop 5%
Drop
Drop

Address for Correspondence
Ms. Sake Naga Mani
Intern – Doctor of Pharmacy Program
Department of Pharmacy Practice
Raghavendra Institute of Pharmaceutical Education & Research (RIPER)
Anantapuramu, Andhra Pradesh., India
E mail: [email protected]

29 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Gallery

One Day National Seminar on
Epidemiology in Pharmaceutical Sciences and Ethics in Biomedical Research

Raghuveer Varma Pemmadi

Research and Development Cell, Center for Pharmaceutical Research, Raghavendra Institute of
Pharmaceutical Education and Research (RIPER), Anantapuramu, Andhra Pradesh., India - 515721
The Research and Development Cell, Center for Pharmaceutical Research (CPR) of Raghavendra
Institute of Pharmaceutical Education & Research (RIPER) in association with Indian Pharmaceutical
Association (IPA) Anantapuramu Local Branch organized One Day National Seminar on
“Epidemiology in Pharmaceutical Sciences and Ethics in Biomedical Research” chaired by Dr. Y.
Padmanabha Reddy (Professor and Principal - RIPER) and Prof. Dr. David Banji (Director – R & D
Division - RIPER) coordinated by Dr. Raghuveer Varma Pemmadi (Research Coordinator – R &D
Cell - RIPER). Chief Guest of the National Seminar was Dr. H. N. Sarma (Medical Superintendent
and Head Dept. of. Pathology, RDT Hospital Bathalapalli, Anantapur). Dr. Bontha Veerraju Babu was
the Resource Person, currently working as Scientist-F & Head for Health Systems Research & Social
Behavioral Research division, ICMR; headquarters, New Delhi. Other resource persons of the seminar
were Prof. Dr. David Banji and Dr. Peraman Ramalingam (PG Director - RIPER).

(From Left: Prof. Dr. David Banji, Dr. Y. Padmanabha Reddy, Dr. Dr. Bontha Veerraju Babu, Dr.
H.N. Sarma and Dr. P. Ramalingam)

Address for Correspondence
Dr. Raghuveer Varma Pemmadi
Research Coordinator
Center for Pharmaceutical Research (CPR)
Raghavendra Institute of Pharmaceutical Education & Research (RIPER)
Anantapuramu, Andhra Pradesh., India
E mail: [email protected]

30 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Gallery

Indian Pharmaceutical Association (IPA) Anantapuramu Local Branch conferred
The Outstanding Local Branch Award at IPA Award functions at Visakhapatnam

on 17th December 2016

Mohanraj Rathinavelu, Sanjeeva Kumar. A, Nagarjuna. S

Indian Pharmaceutical Association (IPA) Anantapuramu Local Branch, Raghavendra Institute of
Pharmaceutical Education and Research (RIPER), Anantapuramu, Andhra Pradesh., India - 515721

Indian Pharmaceutical Association (IPA) Anantapuramu Local Branch

It’s another milestone of achievement and merit for Raghavendra Institute of Pharmaceutical

Education & Research (RIPER), in getting associated with the Indian Pharmaceutical Association

(IPA) and establishing the Indian Pharmaceutical Association - Anantapuramu Local Branch with 34

Professional Life Members and 48 Student Life Members, the inauguration of which was held at

RIPER Auditorium on 05.03.2015 (Thursday) Chaired by Dr. Y. Padmanabha Reddy Professor &

Principal, RIPER; Chief Guest: Dr. Neeraja Myreddy (Dean/Principal, Govt Medical College &

Hospital, Anantapuramu, A.P), Guest of Honors: Dr. Rao V.S.V. Vadlamudi President – Indian

Pharmaceutical Association (IPA) and Dr. T.V. Narayana Vice President & Chairman Indian

Pharmaceutical Association (IPA) Education Division and Special Guest: Dr. E. Shankar Goud

President – Indian Medical Association (IMA) Anantapuramu Branch.

Objective IPA Anantapuramu Local Branch ensure a constant and novel contribution towards the

evidence based learning, teaching, research and practice of pharmacy profession and patient care with

global standards.

RIPER in association with IPA Anantapuramu Local Branch (2015-16) organized

Workshops and Conferences (National) 07

Workshops and Conferences (International) 01

Pharmacists Day celebrations 01

National Pharmacy Week celebrations 01

Public health awareness and promotion 25

environment, literacy programmes

Indian Pharmaceutical Association (IPA) Anantapuramu Local Branch Constitution

President Dr. Y. Padmanabha Reddy

Vice President Mr. Katta Anand

Honorable Secretary Dr. Mohanraj Rathinavelu Mudhaliar

Joint Secretary Mr. S. Nagarjuna

Treasurer Mr. A. Sanjeeva Kumar

L E C Members Dr. H. Abdul Ahad

Mr. D. Hari Hara Theja

Mrs. K. Vara Lakshmi Devi

31 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

Gallery

The Outstanding Local Branch Award at IPA Award functions at Visakhapatnam
on 17th December 2016

(From Left: Mrs. K. Varalakshmi Devi, Dr. Mohanraj Rathinavelu Mudhaliar, Dr. Ramalingam. P,
Dr. Rao V.S.V. Vadlamudi, Prof. T.B. Nair and Mr. Kaushik Desai)

Address for Correspondence
Dr. Mohanraj Rathinavelu
Honorable Secretary – IPA Anantapuramu Local Branch
Raghavendra Institute of Pharmaceutical Education & Research (RIPER)
Anantapuramu, Andhra Pradesh., India
E mail: [email protected]

32 RIPER PDIC Bulletin, Vol 8, Issue 46, Jan-Feb, 2017

EDITOR -IN-CHIEF

Dr. Y. Padmanabha Reddy. M. Pharm., PhD, F.I.C
President ISPOR India – Andhra Pradesh Regional Chapter

Professor & Principal
Raghavendra Institute of Pharmaceutical Education & Research (RIPER)

EDITOR

Dr. Mohanraj Rathinavelu. Pharm. D
President Elect ISPOR India – A P Regional Chapter

Assistant Professor, Division of Pharmacy Practice
Raghavendra Institute of Pharmaceutical Education & Research (RIPER)

ASSOCIATE EDITORS

Prof. Dr. David Banji. M. Pharm., PhD Mr. G. Narayana. M. Pharm., (PhD)
Director ISPOR India – A P Regional Chapter Secretary ISPOR India – A P Regional Chapter

Director Research & Development, Associate Professor, Division of Pharmacy Practice

Center for Pharmaceutical Research (CPR) Raghavendra Institute of Pharmaceutical

Raghavendra Institute of Pharmaceutical Education Education & Research (RIPER)

& Research (RIPER)

EXECUTIVE EDITORS

Dr. Y. Samhitha Reddy. Pharm. D Dr. S.M.G. Ishrar. Pharm. D
Treasurer ISPOR India – A P Regional Chapter Director ISPOR India – A P Regional Chapter

Assistant Professor, Division of Pharmacy Practice Assistant Professor, Division of Pharmacy Practice

Raghavendra Institute of Pharmaceutical Education Raghavendra Institute of Pharmaceutical

& Research (RIPER) Education & Research (RIPER)

ASSISTANT EDITORS

Dr. B. Manoj Kumar. Pharm. D Dr. K. Somasekhar Reddy. M.Pharm., PhD
Dr. P. T. Priyanka. Pharm. D Mr. B. Pradeep Kumar
Dr. B. Sahithi. Pharm. D
EDITORIAL ADVISORY BOARD

Dr. K. Sudheer Kumar. Director, RDT Hospital, Bathalapalli
Dr. Hari Hara Nadha Sarma. Medical Superintendent, RDT Hospital, Bathalapalli
Dr. Shanmugham M. Kannan. Head – Pain & Palliative Care, RDT Hospital, Bathalapalli
Dr. Harish Handyal. Head – Dept. of Intensive Care Unit, RDT Hospital, Bathalapalli
Dr. CH. V. Suneel Babu. Head – Dept. of General Medicine, RDT Hospital, Bathalapalli
Dr. J. D. Paul. Head – Dept of Surgery, RDT Hospital, Bathalapalli
Dr. M. Jyothi Suchitra. Head – Dept of Obstetrics & Gynaecology, RDT Hospital, Bathalapalli
Dr. J. Dasaratha Ramaiah. Head – Dept of Paediatrics, RDT Hospital, Bathalapalli
Dr. G.P. Mohanta, Professor, Annamalai University, Tamil Nadu
Dr. Shoba Rani. H. R. Professor & Principal, Al Ameen College of Pharmacy, Bengaluru
Dr. Pramil Tiwari. Head - Dept. of Pharmacy Practice, NIPER, Mohali
Dr. Sriram Shanmugam. Head-Dept. of Pharmacy Practice, COP SRIPMS, Coimbatore
Dr. P. Seenivasan. Head-Dept. of Pharmacy Practice, Faculty of Pharmacy, SRMU, Chennai
Dr. V. Shankar. Head-Dept. of Pharmacy Practice, PSG College of Pharmacy, Coimbatore
Mrs. R. Rajeswari. Assoc. Professor, Dept. of Pharmacy Practice, Krupanidhi COP, Bengaluru
Mrs. Asawari Raut. Associate Professor, Poona College of Pharmacy, Mumbai
Dr. Mahendra Kumar. BJ. Head-Dept. of Pharmacy Practice, VIPS, Rajahmundry
Dr. Allen LAI Yu-Hung. President ISPOR Singapore Chapter
Dr. Shalini. Sivadasan. AIMST, Malaysia
Dr. Dixon Thomas. Gulf Medical University, Ajman
Dr. Subish Palaian. Gulf Medical University, Ajman
Dr. M.K. Unnikrishnan, Professor, Manipal University, Karnataka
Mr. Emmanuel James. Assoc. Professor, Pharmacy Practice, Amrita, School of Pharmacy, Kochi
Dr. Ramalingam Peraman. PG Director, RIPER

About RIPER PDIC Bulletin

RIPER PDIC Bulletin is an official publication of Department of Pharmacy Practice, Raghavendra
Institute of Pharmaceutical Education & Research (RIPER) and ISPOR India Andhra Pradesh
Regional Chapter.

RIPER PDIC Bulletin publishes original articles, reviews, case reports & images, medical education,
from India and worldwide.

The bulletin systematically covers the following areas of health: medical sciences (including surgical
fields), pharmaceutical sciences (clinical pharmacy & practice), allied health sciences, nursing,
rehabilitation and public health.

Authors Instructions

1. The type of manuscript (original article, case report, review article, Images, etc.) title of the
manuscript, running title, names of all authors/ contributors and their affiliation and full
contact information of corresponding author.

2. Entire manuscript to be type written on with Times New Roman font, font size 11, 1.5
spacing, 1” margin on all sides.

3. All type of manuscript should hold an abstract of not more than 250 words.

4. References should be numbered consecutively in the order in which they are first mentioned
in the text (not in alphabetic order). Identify references in text, tables, and legends by Arabic
numerals in superscript with square bracket after the punctuation marks.

5. Follow Vancouver style in reference list.

6. Kindly forward the manuscript to [email protected].

7. If any queries kindly contact [email protected].

RIPER (PDIC) Poison and Drug Information Center

RIPER PDIC was established on 2009, by Raghavendra Institute of Pharmaceutical Education and
Research (RIPER) in association with Rural Development Trust (RDT) Hospital. The first release of
RIPER PDIC bulletin was on August 2009. For the 8 successive years, we are providing a unbiased,
well-referred information’s on medication use, drug and disease monitoring, drug and disease
management, poison information’s, pharmacoeconomics and Pharmacoepidemiology, medication
therapy management services, and all population based pharmaceutical care services with global
standards. RIPER PDIC operates with Micromedex and Clinical pharmacology databases; online
access to primary resources through virtual library and more than 1000 tertiary resources on medicine
and pharmaceutical sciences; nursing and allied healthcare sciences.

Dear healthcare professionals, graduates and practitioners; and public, feel free to contact......

RIPER (PDIC) Poison and Drug Information Center
Email ID: [email protected], [email protected]
Phone (O): 08559 – 242307


Click to View FlipBook Version