Drug prevalence and comparison interaction between numbers of patients admitted at two teaching hospitals; Quetta, Pakistan

DDIs are an issue of distress for patients and health care professionals, as restorative treatment formed into more broad in the administration of diverse sicknesses or Comorbidities and the penalty can shift from negative impacts for medication related mortality and morbidity [5]. The health experts to choose the DDIs is vital to diminish their potential dangers and antagonistic result [6]. Estimation of DDIs in patients is clinically critical and evaluation will be helpful to diminish issues identifi ed with treatment and recouping pharmaceutical concern [7]. The potential advantages of medications joined must adjust the criticalness of the DDI, in perspective of Introduction


Introduction
The impact of a drug on another drug is known as drugdrug interaction DDI this might be pharmacokinetic or pharmacodynamic in nature, which can bring about undesirable impacts and adequacy decreased and viability or expanded poisonous quality [1]. DDIs can prompt to undesirable impacts of drugs that can be ruthless as much as important to require hospitalization. Past studies demonstrated that a large portion https://www.peertechz.com/journals/archives-of-nursing-practice-and-care Citation: Qadeer  presence of fl ighty. On the off chance that the upside of the administration is of signifi cance like that it repays the plausible dangers, and none of the more secure substitutes are evident, then the dangers of a DDIs can be acknowledged and administration proceeds [8]. As per an as of late distributed study, 1% of all hospitalizations are contemplated by DDIs, comparing to 16% of all patients hospitalized because of adverse drug reaction (ADR) [9]. In a late study, the creators recommend that around 0.05% of hospitalization, 0.1% of rehospitalization and 0.6% of the hospitalization are brought about by ADRs because of DDIs [10]. The potential DDI are regularly obscure, and epidemiological information managing this issue are rare. Be that as it may, it was called attention to by Hamilton et al. that pDDIs introduction is connected with an altogether expanded danger of hospitalization [11].

Methodology
The study was conducted on 183 both males and females at two teaching hospitals, Bolan Medical Complex Hospital and Sandeman Provincial Hospital of Quetta, Pakistan. The four medical wards (male unit-3 and female unit-3, male unit-4and female unit-4) of Sandeman provincial hospital and two medical wards (male unit-1 and female unit-1) of Bolan medical complex hospital Quetta, Pakistan. These six wards were selected out of eight medical wards due to unit-2 limitation.
Patients with drug prescribed in treatment chart of patients admitted at least 2 day in ward and treatment charts containing multiple drugs prescription were included in the study while those outdoor, discharged, patients on single drug treatment, surgical department patients and patients with length of stay less than 2 days were excluded from the study.

Ethical consideration
The proposal of the study was approved by the supervisor, chairman of department of pharmacy practice, faculty of Pharmacy University of Balochistan Quetta. Offi ce orders were provided by the Medical superintendent and the chief drug analysts of both teaching hospitals .Allowing in medical wards for duration of two months in each.

Results
Demographic characteristics of patients are displayed in In majority of prescriptions 39(21.3%) one pair of drugs were found having interaction.
According to Table 3. DDIs were on the basis of pharmacokinetics; in 108(59.0%) patients pharmacokinetic   The prevalence of Drug-drug interaction on the basis of severity is shown in Table 5. Using the severity scale; serious, major, moderate, minor, signifi cant and contraindicated, majority of patients 18(9.8%) had at least 1 pair of drug having serious interaction present in out of 23(12.6%). No major and moderate interactions of drugs were found. In majority of the patients 41(22.4%), 1 pair of minor drug-drug interaction was found out of 91(49.7%) patients presenting minor drugdrug interaction. Signifi cant severity of DDIs were analyzed in 18(9.8%) of the prescriptions in which majority contained one pair of drug having interaction 36(19.7%). 19(10.4%) prescriptions of hospitalized patients showed contraindicated drug-drug interaction in which more prescriptions included 1 pair of drug having DDIs 17(9.3%).
In Table 6, mean comparison of the individual demographs were taken and is calculated and determining of p-value have been done which shows that all p-values are not exceeding than 0.05 except Gender which has no signifi cance over the DDIs, and is more than 0.05 i.e. 0.237. Other than there, Age group (p=0.000), Hospital (p=0.000), Medical unit (p=0.001) and Length of stay in hospital (p=0.000) these all have signifi cance over Drug-drug interaction, hence all Demographs have signifi cant effect on DDIs except Gender.

Discussion
This study revealed that overall the prevalence of DDIs in two teaching hospitals of Quetta was 68.3%. In my study result   shows among the 125 drug-drug interactions, 59.0% DDIs were pharmacokinetic and 37.7% were on pharmacodynamic basis. These results were different from another study reported where the release prescriptions of the admitted patients were of unease and pharmacodynamic based drug-drug interactions were predominant [12]. On the basis of severity of interactions between drugs in my study, results showed that majority of the interactions were minor (49.7%) followed by serous (12.6%) and signifi cant (9.8%) interactions. This pattern is unique in relation to another study done in south Indian showing teaching hospital where the vast majority of drugdrug interactions were moderate (70%) trailed by minor (28%) and major (2%) interactions [13]. My study found that due to increase of number of drugs (majority=24%) per prescription increases the number of drug-drug interactions per patient (68.3%). This discovery was simi lar to another distributed report where the drug-drug interaction increased from 13% to 82% because the amount of medications increased from 2 to 7 or additional [14]. My conclusion also revealed that the prevalence of Drug-drug interaction was not signifi cant with sex, but it was positively correlated with the age of the patient. This corresponds to other reported studies [11,15]. Another study of correlation showed a positive association between total DDI and the age of the patient, size of the prescription and the number drugs prescribed [13]. According to prescription data recovered, it was not possible to estimate the duration of drug treatment. However, in my study, it is demonstrated that the duration of the stay of the patient is signifi cant over Drug-drug interaction during the hospitalization of the patient, this study is analogous to another result of the study reported. [13]. The importance of the use of electronic software has been reported in the previous studies [16]. I used a software Mediscape for my study, Similarly, other software has been used in a study by Sepehri and his colleagues who used the software recognition advance and noted the presence of DDIs in 20% of patients [17].