Safe use of NSAIDs and RAS-inhibitors at Agogo Presbyterian Hospital, Ghana.
BACKGROUND
Preventable adverse events of medication are an important cause of hospital admissions in the developed world, in which non-steroidal anti-inflammatory drugs (NSAIDs) and renin-angiotensin system (RAS-) inhibitors are frequently involved. NSAIDs and RAS-inhibitors are also often used in Ghana. The purpose of this study is to assess whether biochemical monitoring in patients on RAS-inhibitors, and co-administration of gastro protective agents (GPAs) in patients on NSAIDs, is done properly in Ghana.


METHODS
Two retrospective cross-sectional studies were carried out at the Agogo Presbyterian Hospital, Ghana, in 2013. In 114 out-and inpatients who are on NSAIDs, the risk for gastrointestinal side effects and the frequency of co-administration of GPAs were determined. In 301 outpatients who are on RAS-inhibitors, the risk for renal dysfunction and the frequency of biochemical monitoring were determined. Fisher's exact test was used to determine the statistical strength.


RESULTS
Co-administration of GPAs was done in 1.8% of patients on NSAIDs. Serum creatinine and potassium monitoring within one month after initiation of treatment with RAS-inhibitors were performed in 6.3% and 3.7%, respectively. Risk factors were neither associated with prescription of a GPA in patients on NSAIDs (p=0.134), nor in performing biochemical monitoring in patients on RAS-inhibitors (p=0.219 for creatinine, p=0.062 for potassium).


CONCLUSIONS
Biochemical monitoring in patients on RAS-inhibitors and use of GPAs in patients on NSAIDs is poorly performed at the Agogo Presbyterian Hospital in Ghana. Improving the already existing Ghanaian guidelines, especially those for RAS-inhibitors, and encouraging their widespread use among prescribers should be pursued.
Department of Pharmacology-Toxicology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
Lieke G
LG
Meulendijks
Department of Medicine, Agogo Presbyterian Hospital, Agogo Asante-Akyem, Ghana.
Emmanuel A
EA
Adomako
Pharmacy Department, Agogo Presbyterian Hospital, Agogo Asante-Akyem, Ghana.
Emmanuel B
EB
Appiah
Department of Pharmacology-Toxicology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands; Department of Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands; Department of Clinical Pharmacy, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands.
Cornelis
C
Kramers
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000009:adverse effects*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000897:Anti-Ulcer Agents / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D016903:Drug Monitoring / Q000706:statistics & numerical data*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D005869:Ghana; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D003404:Creatinine
Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Anti-Ulcer Agents; Drug monitoring; Ghana; Non-Steroidal Anti-Inflammatory Agents