Identification of Drug-Related Problems (DRPS) of drugs with special dosage forms in geriatric patients (study at the outpatient pharmacy unit, Airlangga University Hospital, Surabaya)

Main Article Content

Yulistiani Yulistiani https://orcid.org/0000-0002-4942-8978
Febriansyah Nur Utomo https://orcid.org/0000-0002-3819-4993
Cahyo Wibisono Nugroho https://orcid.org/0000-0001-8477-8140
Muga Wiji Rahayu https://orcid.org/0000-0002-0320-1487

Keywords

Drugs with special dosage forms, Geriatrics, Drug-related problems, Prospective studies, Statistical analysis

Abstract

Background: Geriatric syndrome is a condition of decreased organ function that causes DRPs, especially drugs with special dosage forms, such as an inhaler, insulin pens, and modified release drugs. Objective: To identify DRPs of drugs with special dosage forms in geriatric patients at the Outpatient Pharmacy Unit of RSUA Surabaya. Methods: It was an observational and prospective study with the interview method. Each problem identified was given a score to be analyzed descriptively and statistically. Data collection was carried out from April to June 2022. Results: The sample is 82 special dosage forms, there are drug delivery devices including inhaler (26%) and insulin pen (29%), and drug delivery systems including OROS (33%), retard (6%), and sustained-release (6%). DRPs were found in 40% of them. In inhaler form, the DRPs of DPI are failure to load the dose, shaking after the dose was loaded, and not checking the remaining dose after using the device. While in MDI, no DRPs were found. The DRPs of insulin pens are errors in device storage (25%), injection position (8%), and repeated use of blunt/broken needles (38%). While in modified release drugs is an error in drug storage (5%). The percentages of nonadherence are Turbuhaler 33%, Breezhaler 60%, Diskus 25%, MDI 0%, insulin pen 29%, and modified release drugs 24%. The solution is given by using verbal education such as leaflets. Statistical analysis showed a significant difference in the insulin pen and the modified release drug, while there was no significant difference in the inhaler. Conclusion: Each type of drug with a special dosage form has its problems and problem-solving in the form of interventions has not given maximum results. 

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References

1. Halter JB. Hazzard’s Geriatric Medicine and Gerontology. 7th ed. China: McGraw-Hill Education. 2017.
2. Carlson C, Merel SE, Yukawa M. Geriatric Syndromes and Geriatric Assessment for the Generalist. Medical Clinics of North America. 2015;99(2):263-279. https://doi.org/10.1016/j.mcna.2014.11.003
3. Allen LV, Ansel HC. Ansel’s Pharmaceutical Dosage Forms and Drug Delivery Systems. 10th ed. Philadelphia: Lippincott Williams & Wilkins. 2014.
4. Etse J. Novel Dosage Form Analysis. 2 ed., Separation Science and Technology. 2nd ed. New Jersey, USA: Elsevier Inc. 2011. https://doi.org/10.1016 /B978-0-12-375680-0.00006-1
5. Atkin S, Javed Z, Fulcher G. Insulin degludec and insulin aspart: Novel insulins for the management of diabetes mellitus. Therapeutic Advances in Chronic Disease. 2015;6(6):375-388. https://doi.org/10.1177/2040622315608646
6. Dolovich MB, Dhand R. Aerosol drug delivery: Developments in device design and clinical use. The Lancet. 2011;377(9770):1032-1045. https://doi.org/10.1016/S0140-6736(10)60926-9
7. Clark AR, Weers JG, Dhand R. The Confusing World of Dry Powder Inhalers: It Is All about Inspiratory Pressures, Not Inspiratory Flow Rates. Journal of Aerosol Medicine and Pulmonary Drug Delivery. 2020;33(1):1-11. https://doi.org/10.1089/
jamp.2019.1556
8. Haughney J. Choosing inhaler devices for people with asthma: Current knowledge and outstanding research needs. Respiratory Medicine. 2010;104(9):1237-1245. https://doi.org/10.1016/ j.rmed.2010.04.012 
9. Ibrahim M, Verma R, Garcia-Contreras L. Inhalation drug delivery devices: Technology update. Medical Devices: Evidence and Research. 2015;8(1):131-139. https://doi.org/10.2147/MDER.S48888
10. Chrystyn H. Device errors in asthma and COPD: Systematic literature review and meta-analysis. Primary Care Respiratory Medicine. 2017;27(1):1-9. https://doi.org/10.1038/s41533-017-0016-z
11. Wright BM, Bellone JM, McCoy EK. A review of insulin pen devices and use in the elderly diabetic population. Clinical Medicine Insights: Endocrinology and Diabetes. 2010;3:53-63. https://doi.org/10.4137/CMED. S5534
12. Mira JJ. Oversights, confusions and misinterpretations related to self-care and medication in diabetic and renal patients. Medical Principles and Practice. 2014;23(3):246-252. https://doi.org/10.1159/000358225
13. Hambridge K. The management of lipohypertrophy in diabetes care. British journal of nursing (Mark Allen Publishing). 2007;16(9):520-524. https://doi.org/10.12968/bjon.2007.16.9.23428
14. Murugesan S. Oral Modified Drug Release Solid Dosage Form with Special Reference to Design; An Overview. Current Drug Research Reviews. 2020;12(1):1-10. https://doi.org/10.2174/2589977511666191121094520
15. Mira JJ. A systematic review of patient medication errors on self-administering medication at home. Expert Opinion on Drug Safety. 2015;14(6):815-838. https://doi.org/10.1517/1474 0338.2015.1026326
16. Tramunt B. Sex differences in metabolic regulation and diabetes susceptibility. Diabetologia. 2019. https://doi.org/10.1007/s00125-019-05040-3
17. Reitsma MB. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and initiation among young people in 204 countries and territories, 1990–2019. The Lancet Public Health. 2021;6(7):e472-e481. https://doi.org/10.1016/
S2468-2667(21)00102-X
18. Spollett G. Improvement of Insulin Injection Technique: Examination of Current Issues and Recommendations. Diabetes Educator. 2016. https://doi.org/10.1177/0145721716648017
19. Gorska. Improved insulin injection technique, treatment satisfaction and glycemic control: Results from a large cohort education study. Journal of Clinical and Translational Endocrinology. 2020. https://doi.org/10.1016/j.jcte.2020.100217
20. Beers E. Practical problems with medication use that older people experience: A qualitative study. Journal of the American Geriatrics Society. 2014;62(12):2339-2344. https://doi.org/10.1111/jgs.13126
21. PCNE. Classification for Drug Related Problems. Pharmaceutical Care Network Europe Association, 2017;8(2):1-10. Available at: https://www.pcne.org/upload /files/318_PCNE_classification_V8-03.pdf
22. Barrons R, Pegram A, Borries A. Inhaler device selection: Special considerations in elderly patients with chronic obstructive pulmonary disease. American Journal of Health-System Pharmacy. 2011;68(13):1221-1232. https://doi.org/10.2146/
ajhp100452
23. Price DB. Inhaler Errors in the CRITICAL Study: Type, Frequency, and Association with Asthma Outcomes. Journal of Allergy and Clinical Immunology: In Practice. 2017;5(4):1071-1081.e9. https://doi.org/10.1016/j.jaip.2017.01.004
24. NPS MedicineWise. Inhaler technique: Device-specific checklists, NPS Medicine Wise. 2020. https://doi.org/10.7748/ns.26.29.55.s49
25. Kramer. Storage Of Insulin – IDF Europe Awareness Paper. 2020.
26. Gibney MA. Skin and subcutaneous adipose layer thickness in adults with diabetes at sites used for insulin injections: Implications for needle length recommendations. Current Medical Research and Opinion. 2010;26(6):1519-1530. https://doi.
org/10.185/03007995.2010.481203
27. Sarbacker GB, Urteaga EM. Adherence to insulin therapy. Diabetes Spectrum. 2016. https://doi.org/10.2337/diaspect.29.3.166
28. Yap. Medication adherence in the elderly. Journal of Clinical Gerontology and Geriatrics. 2016. https://doi.org/10.1016/j.
jcgg.2015.05.001
29. Aldila F, Walpola RL. Medicine self-administration errors in the older adult population: A systematic review. Research in Social and Administrative Pharmacy. 2021;17(11):1877-1886. https://doi.org/10.1016/j.sapharm.2021.03.008
30. Al-Showair RAM. Can all patients with COPD use the correct inhalation flow with all inhalers and does training help? Respiratory Medicine. 2017;101(11):2395-2401. https://doi.org/10.1016/j.rmed.2007.06.00
31. Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice: The Patient Centered Approach to Medication Management Services. Pharmaceutical Care Practice: The Patient-Centered Approach to Medication Management Services. 2012;3e(Part 
D):1-30.