PRESCRIPTION AUDIT PRESCRIPTION AUDIT AND ADR PROFILE IN AND ADR PROFILE IN PATIENTS WITH LUNG PATIENTS WITH LUNG

CARCINOMACARCINOMAJitendra SJitendra S, Aruna Bhaskar, Shoba Guido, , Aruna Bhaskar, Shoba Guido,

RadheyshyamRadheyshyamDept.of Pharmacology,Dept.of Pharmacology,

St.Johns Medical College,St.Johns Medical College,BangaloreBangalore

Lung carcinoma accounts for Lung carcinoma accounts for the total of 30% of the cancers the total of 30% of the cancers and 28% of the cancer deaths.and 28% of the cancer deaths.

Chemotherapy is a part of Chemotherapy is a part of multi-modality treatment in multi-modality treatment in these patients.these patients.

ADRs happen to be a common ADRs happen to be a common occurrence in patients on occurrence in patients on chemotherapy.chemotherapy.

INTRODUCTIONINTRODUCTION

OBJECTIVES -OBJECTIVES -

To see for the prescription To see for the prescription pattern of anti-cancer drugs with pattern of anti-cancer drugs with lung carcinoma.lung carcinoma.

To look for associated ADRs and To look for associated ADRs and to define them in accordance to define them in accordance with causality assessment.with causality assessment.

MATERIALS AND MATERIALS AND METHODSMETHODS It is a retrospective study It is a retrospective study

carried out from Aug 2001-carried out from Aug 2001-Sep 2006.Sep 2006.

Data was collected and Data was collected and subjected to Simple subjected to Simple descriptive analysis.descriptive analysis.

RESULTS…..RESULTS…..

Total no. of cases treated on Total no. of cases treated on out-patient basis in five years out-patient basis in five years was 68.was 68.

Male : female ratio was 2.5:1.Male : female ratio was 2.5:1. Age range was from 34-70 Age range was from 34-70

yrs, average being 55 years.yrs, average being 55 years. 80% were smokers.80% were smokers.

Outcome on Outcome on consultation.consultation.

0 10 20 30 40 50

RECEIVEDT/ X

DAMA

REFERRED

EXPIRED

Average no. of drugs per Average no. of drugs per prescription was 3.55.prescription was 3.55.

The maximum drugs prescribed The maximum drugs prescribed in a given prescription was 11.in a given prescription was 11.

Generic prescription accounted Generic prescription accounted for 30% of prescribed drugs.for 30% of prescribed drugs.

HISTOPATHOLOGICALLY HISTOPATHOLOGICALLY DIAGNOSED CASESDIAGNOSED CASES

Adeno65%

Squamous22%

Bronchial10%

Large3%

Modality of treatmentsModality of treatments

20

11

84

CT CT+RT PALLV SUR+CT

ASSO. OF T/T WITH ASSO. OF T/T WITH DIAGNOSISDIAGNOSIS

0

5

10

15

20

25

30

35

TR

EAT

ME

NT

CT RT CT+RT SU+RT+CTADEN SQU BRO LAR

PRESCRIPTION PATTERN PRESCRIPTION PATTERN OF DRUGSOF DRUGS

26%

18%

16%

8% 8% 2%

AN-CAN AN-EMETIC STEROIDAN-ULCER HYPNOTIC BNP

PRESCRIPTION IN PRESCRIPTION IN DIFFERENT GROUP OF DIFFERENT GROUP OF

DRUGSDRUGS

50% 43%57%

37%33%

5%

43%

13%24%

95%

0%

20%

40%

60%

80%

100%

120%

AN-CANCER AN-ULCER AN-EMETIC STEROID

PATTERN OF ANTI-PATTERN OF ANTI-CANCER DRUGS CANCER DRUGS

PRESCRIBEDPRESCRIBED57

78

32

108

3

GEM CAR+ETO CARCAR+DOC DOC GEM+CAR

ADR PROFILE….ADR PROFILE….

ADRs were reported in 40% of ADRs were reported in 40% of treated patients.treated patients.

Type A was the most common type.Type A was the most common type.

Hematological adverse events were Hematological adverse events were seen in 70%, GIT 20%,Skin in 10%.seen in 70%, GIT 20%,Skin in 10%.

SYSTEMIC ADRSSYSTEMIC ADRS

0%

10%

20%

30%

40%

50%

60%

70%

BLOOD SKIN CNS

HAEHAE GEMGEM CAR+CAR+

ETOETOCARCAR PAC+PAC+

CARCARDOCDOC DOC+DOC+

CARCARGEMGEM+CAR+CAR

HBHB%%

2(8.2(8.1)1)

2(62(6))

1(8)1(8) 1(8)1(8)

WBWBCC

2(1.2(1.7)7)

1(1.21(1.2))

1(2)1(2)

MYMYEE

22 66 11 33 22

PLAPLA 2(542(54))

1(30)1(30) 1(8)1(8)

HAEMATOLOGY HAEMATOLOGY MANIFESTATIONSMANIFESTATIONS

NON HAEMATOLOGICAL NON HAEMATOLOGICAL MANIFESTATIONSMANIFESTATIONS

GEMGEM ETO+ETO+CARCAR

CARCAR PAC+PAC+

CARCARDOCDOC DOC+DOC+

CARCARCAR+CAR+GEMGEM

DIADIA 88 11

VOVOMM

33 44 22 55 1313 44 22

SKISKINN

44 11 11

CNSCNS 22 22

CVS CVS 11 11 11

CAUSALITY CAUSALITY ASSESSMENTASSESSMENT

4%12%

84%

CER PRO POS

DISCUSSIONDISCUSSION

THERE IS A PREDOMINANCE OF THERE IS A PREDOMINANCE OF LUNG CARCINOMA AMONG LUNG CARCINOMA AMONG ELDERLY MALE.ELDERLY MALE.

POLYPHARMACY IS LARGELY POLYPHARMACY IS LARGELY PRACTISED IN PRESCRIPTIONS.PRACTISED IN PRESCRIPTIONS.

CHEMOTHEARPY IS THE CHEMOTHEARPY IS THE COMMON MODALITY OF COMMON MODALITY OF TREATMENT AND PREFERABLY TREATMENT AND PREFERABLY USED IN ADENOCARCINOMA.USED IN ADENOCARCINOMA.

GEMCITABINE IS PREFFERED GEMCITABINE IS PREFFERED NOW. NOW.

PANTAPRAZOLE IS PREFFERED PANTAPRAZOLE IS PREFFERED OVER ESMOPRAZOLE.OVER ESMOPRAZOLE.

HAEMATOLOGICAL HAEMATOLOGICAL MANIFESTATIONS ARE COMMON MANIFESTATIONS ARE COMMON WITH GEMCITABINE.WITH GEMCITABINE.

VOMITING AND CARDIAC VOMITING AND CARDIAC MANIFESTATIONS ARE SEEN MANIFESTATIONS ARE SEEN WITH DOCETAXEL.WITH DOCETAXEL.

POSSIBLE ADVERSE REACTIONS POSSIBLE ADVERSE REACTIONS WERE MOST COMMON IN WERE MOST COMMON IN ACCORDANCE WITH CAUSALITY ACCORDANCE WITH CAUSALITY ASSESSMENT.ASSESSMENT.

CONCLUSIONCONCLUSION

SMOKING IS A RISK FACTOR SMOKING IS A RISK FACTOR FOR LUNG CARCINOMA.FOR LUNG CARCINOMA.

POLYPHARMACY IS PRACTISED TO POLYPHARMACY IS PRACTISED TO REDUCE THE ADVERSE DRUG REDUCE THE ADVERSE DRUG REACTIONS.REACTIONS.

GEMCITABINE AND GEMCITABINE AND PANTAPRAZOLE ARE THE NEWLY PANTAPRAZOLE ARE THE NEWLY PREFFERED DRUGS IN PREFFERED DRUGS IN REGIMENS BECAUSE OF BETTER REGIMENS BECAUSE OF BETTER EFFICACY AND TOLERABILITY.EFFICACY AND TOLERABILITY.

THANK YOU……..THANK YOU……..