Kaolin in pharmaceutical preparations: a review

Background: Kaolin is a clay mineral with Al2Si2O5(OH)4 structure which can be found in sedimentary rocks also known as clay stones. Kaolin consists of clay materials such as quartz, illite, smectite, and hematite, with the largest constituent component being kaolinite. Kaolin is one of the most common minerals with an abundant presence in the earth's crust compared to other minerals, especially in Indonesia. In the pharmaceutical sector, this clay mineral is widely used in Indonesia. Kaolin is known to be a good adsorbent and has good physical, chemical, and surface physicochemical properties. Objective: This review article aims to provide information about the uses of kaolin in the pharmaceutical industry. Methods: This review article was written by conducting a literature search study method in the PubMed, ScienceDirect, and Google Scholar databases. Results: In the pharmaceutical field, kaolin is used as an excipient in various types of medicinal preparations, one of which is as a suspension agent because of its ability to stabilize suspensions in a deflocculated state as an emulsifying agent, crushing agent, filling agent, and drug carrier. As an active substance, kaolin is widely used because it has a therapeutic activity. In the cosmetic industry, kaolin can be administered in a variety of topical dosage forms which act as skin protective agents or sunscreens. Conclusion: Based on the results of the review, it was found that kaolin, with its abundant presence on earth and its great potential in the pharmaceutical field, is used as an active medicinal substance, excipient ingredient, and in the cosmetic field as a sunscreen. Keywords: Kaolin, excipient, active pharmaceutical ingredient, cosmetics

The use of anti-hyperlipidemia in a private hospital in Yogyakarta during 2013-2019

Background: Lipid modifying agents have an important role in the primary and secondary prevention of cardiovascular diseases such as coronary heart disease and stroke. The use of lipid-modifying agents tends to increase along with the increasing prevalence of these diseases. Objectives: To determine the utilization of lipid modifying agents for hospitalized patients in a private hospital in Yogyakarta during the period of 2013 - 2019 in regard to the agents used and their quantity. Methods: The main data for this study were aggregate data on the use of lipid modifying agents for hospitalized patients during 2013-2019 obtained from the hospital pharmacy department. After identification of the names of lipid modifying agents, the quantities of these drugs were then calculated in units of defined daily dose (DDD) and the final quantity was expressed in DDD/100 bed days (BD). The R2 value from linear regression was used to determine the trend of use of individual agents over the period. Results: There were two pharmacological subgroups of lipid modifying agents used during the period of 2013 – 2019 with an average of total quantity of 14.81 DDD/100 BD. Utilization of statins was approximately 90% of the total use, and utilization of fibrates tended to decrease over the period. Individually, simvastatin use decreased significantly over the period (R2 = 0.885), but atorvastatin use continued to increase (R2 = 0.908) with 10-fold increase from 2013 to 2019. Conclusion: The lipid modifying agents used during the period 2013 - 2019 were predominantly statins, and the utilization of atorvastatin increased significantly during this period. Keywords: lipid modifying agents, ATC/DDD, fibrates, statins

The identification of drug related problems (DRPs) using profilaxis antibiotics in orthopedic surgical patients at a Government Hospital in Yogyakarta

Background: Antibiotic prophylaxis in orthopedic surgery cases aims to prevent surgery site infections (SSI). For antibiotic prophylaxis, it is recommended to use the first generation of cephalosporin, namely cefazolin which can kill the bacteria commonly found in orthopedic surgery infection. The prophylactic administration of cefotaxime is not the first line but is definitive for surgical prophylaxis. Objective: The aim of this study was to determine the rationale for the use of antibiotic prophylaxis for orthopedic surgery, the drug problems (DRPs) that occurred and their potential interactions. Method: This study was conducted using a cross sectional design with a total sampling technique of medical record samples from January to February 2019 at the Government Hospital in Yogyakarta. Observational analytical descriptive data processing by ensuring the appropriate of indications, route of administration, timing of administration and an appropriate of prophylactic doses as well as how to compare DPRs to the literature and analysis of potential co drug interaction with Drug Information Handbook (DIH), AHFS Clinical Drug Information, Drug Interaction Facts, and Interactions Stockley’s Drug Interaction. Results: All patients received appropriate therapy for indication, type of drug, routes of administration for pre and postoperative. All patients received an under dose of ranitidine and 1 patient (1,69%) received an over dose of piracetam. Potential interactions that occur include ketorolac-ranitidine, NSAIDs with other NSAIDs, NSAIDs-ranitidine, NSAIDs-ACEi, NSAIDs-bisoprolol, bisoprolol-calcium, calcium-vitamin C, and paracetamol-ranitidine. Conclusion: Pre and postoperative prophylactic antibiotics are rational. The accompanying drug, ranitidine and piracetam were not properly doses. Drug interactions in this study are potential. Keywords: prophylaxis antibiotic, orthopedic surgery, cefotaxim, DRPs

Cost consequences analysis of hypertensive outpatients: a study in a private hospital in Yogyakarta special province

Background: Hypertension is a chronic disease that requires long-term treatment and has an impact on the cost of treatment. The costs will be greater given the loss of productivity, family burden, and social life impacted by hypertension based on patient’s perspective. Objective: The purpose of the study was to determine the costs and clinical outcome of antihypertensive therapy from the patient's perspective and to identify the discrepancies between the costs and the INA-CBGs (Indonesia Case Based Groups) tariff. Methods: The research was an observational study with a cross-sectional design. The targeted population was outpatients who had received antihypertensive therapy for at least 1 month at a private hospital in Yogyakarta. The costs included direct medical costs, direct non-medical costs, and indirect costs, while the clinical outcomes were patient’s blood pressure. The descriptive analysis was carried out to describe the characteristics of the research subjects, the clinical outcome, and the cost. Analysis of the discrepancies between the costs and the INA-CBGs tariff used the Mann-Whitney test and One-Sample t-test. Results: The results showed that the average direct medical costs, direct non-medical costs, and indirect costs from the patient’s perspective were IDR359,408.00, IDR24,617.00, and IDR 40,583.00, respectively. There was a significant difference between the real costs and the rate of INA-CBGs based on the results of statistical tests, while the cost discrepancy was IDR5,287,045.00. Conclusion: The direct non-medical costs and indirect costs of hypertensive outpatients were less than the direct medical costs. A significant difference occurred between the real costs and INA CBG’s tariff. Keywords: hypertension, cost consequences, pharmacoeconomics, patient’s perspective

Correlation between potassium administration and resolution in patients with diabetic ketoacidosis

Background: Diabetic ketoacidosis (DKA) is a life-threatening complication of acute diabetes mellitus (DM). Insulin is one of the therapies for DKA, which can reduce potassium levels by shifting potassium from extracellular to intracellular. Consequently, early administration of potassium is important in the resolution of DKA. Objective: To determine the correlation between potassium administration and resolution in patients with DKA and the factors affecting such resolution. Methods: An observational study was employed with a retrospective cohort design for inpatients with a diagnosis of DKA during the period of January 2015-August 2020 at Dr. Sardjito Hospital Yogyakarta. Appraisal of the resolution of DKA variable was based on the achievement of blood glucose targets, followed by 2 criteria of serum bicarbonate, pH, and anion gap during 24 hours of therapy. This study involved 55 patients divided into groups with potassium administration and without potassium administration. Data were analyzed using the chi-square test and multivariate logistic regression. Results: The resolution of DKA achieved in less than equal to 24 hours in the group with potassium was 48.5% (16 patients) while it was 18.2% (4 patients) without potassium. Based on the chi-square analysis, there was a relationship between potassium administration and the resolution of DKA (p=0.045; RR=2.667; 95%CI=1.028-6.920). The multivariate analysis showed that the severity and history of DM were positively related to the resolution of DKA (p=0.025; OR: 8.901; 95%CI=1.318-60.123 and p=0.017; OR: 0.090; 95%CI=0.012-0.652). Conclusion: Potassium administration resulted in 48.5% of the DKA patients achieving a resolution in less than equal to 24 hours from the commencement of DKA therapy. The severity and history of DM became the factors that affected the resolution of DKA. Keywords: diabetic ketoacidosis, potassium, resolution

Potential drug interactions analysis of COVID-19 patients at a hospital in West Java

Background: Treatment guidelines of COVID-19 are changing continuously by involving many off-label and various symptomatic or supportive drugs. The use of these various drugs might increase the patient’s risk of developing drug interactions. Objective: The study aimed to analyze potential drug-drug interactions in COVID-19 inpatients and the correlated factors. Method: A cross-sectional study was conducted in a hospital by using inpatients admitted from August-December 2020. Potential drug-drug interaction was analyzed by using Lex-Interact® software. Results: From 107 patients, the majority of them are in moderate severity-degree (98.1%), having comorbidities (93.5%), and polypharmacy (98.1%). The average of potential drug interactions was 8.47±8,04, with most of the interaction in risk rating C-monitor therapy. Major potential drug interactions found were prolongation of QT interval and disturbance of drug absorption in the gastrointestinal tract. A positive correlation occurred between drug interactions found and comorbidity (r=0.436), number of drugs per prescription (r=0.674), and length of stay (r=0.222) Conclusions: COVID-19 patient is at risk for developing potential drug interactions that can affect the patient's physiological condition and reduce drug effect. It is necessary to manage the medication schedule, therapy modification, administration route changing, dosage adjustment, and monitoring of effects that might occur because of the drug interactions. Keywords: drug interaction, COVID-19, inpatient, correlated factor

Review: Neuroprotective effect of herbal plant extracts against Parkinson's disease

Background: Parkinson's disease (PD) is a progressive neurodegenerative disorder caused by the loss of dopaminergic neurons and the exist of alpha-synuclein aggregates in the substantia nigra pars compacta (SNpc). Among the various types of neuroprotective therapy, natural products are potential therapeutic agents for PD. Objective: The aim of this study is to describe the neuroprotective effect of herbal plant extracts against Parkinson's Disease (PD). Method: The search strategy was carried out on electronic databases, namely Google Scholar, ScienceDirect, and PubMed. There are 111 scientific journals that have been filtered into 20 scientific journals which are international journals published in the last 5 years (2015-2020). The keywords used include Parkinson's Disease, Neuroprotective Effects, Neuroprotection, Plant Extracts, Natural Products and Parkinson's Disease Model. Results: Several experimental studies have shown the neuroprotective ability of various plant extracts to protect against neurotoxicity, through several neuroprotective pathways including antioxidant activity, anti-inflammatory activity, and antiapoptotic activity. Conclusion: Herbal plant extracts have been shown to have strong neuroprotective effects, making them as potential drug candidates for prevention or treatment of Parkinson's Disease (PD). There are Mucuna pruriens, Centella asiatica, Camellia sinensis, Ginkgo biloba, and Uncaria rhynchophylla. Keywords: Parkinson's Disease (PD), neuroprotective, extract.

The design of bioactive marine peptides as a HIV-1 protease inhibitor

Background: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV or AIDS) is a disease related to the human immune system. Given its important role in viral replication, HIV1 protease (HIV1 PR) becomes the major therapeutic target in the treatment of AIDS. In this case, we need a dynamic aspect of molecular interactions that can demonstrate the important role of conformational variability in the design of HIV1 PR inhibitors. There are several inhibitor candidates from marine organisms, such as the LLEYSL and LLEYSI bioactive peptides produced by oysters (Crassostrea gigas). Objective: Proteinpeptide docking method was used in silico to identify, evaluate, and explore the molecular interactions between bioactive peptide molecules and HIV-1 protease macromolecules. Methods: The sequencing of bioactive peptide molecules was modeled into 3D conformation using the PEPFOLD software. The best conformation was chosen for the study of molecular interactions against HIV1 protease macromolecules using the PatchDock software. The molecular interactions formed were further observed using the BIOVIA Discovery Studio 2020 software. Results: The results of this study indicated that the LLEYSL bioactive peptide had the best affinity with an ACE score of minus 1284.70 kJ per mol. Conclusion: Bioactive peptide molecule is predicted to be a candidate for HIV1 protease inhibitor. Keywords: AIDS, HIV1 protease, bioactive peptides, protein-peptide docking, in silico

Anti-inflammatory activity of the topical formulation of Drymoglossum piloselloides (L) Presl. extract on mice

Background: Chronic inflammation of the joints that occur in the condition of gout or osteoarthritis and rheumatoid arthritis often causes repeated inflammation which requires patients to take a long-term pain medication, leading to serious side effects. Alternative treatment especially from herbal ingredients in a topical form is needed. Objective: This study aims to evaluate the anti-inflammatory activity of the leaves extract of Drymoglossum piloselloides (L) Presl. in mice to prove their potential as an anti-inflammatory agent. Methods: Mice were divided into four groups (n=7), namely positive control (sodium diclofenac emulgel), negative control (placebo), P1 (emulgel extract 2.5%), and P2 (emulgel extract 5%). The anti-inflammatory activity test was carried out on mice with carrageenan-induced paw edema by measuring the relative changes in the volume of inflammation at 0 and 3 hours after treatment. Data were analyzed using the Kruskal-Wallis and Mann-Whitney tests with a confidence level of 95%. Results: The emulgel contained flavonoids, triterpenoids, steroids, tannins, and quinones. The anti-inflammatory test showed a significant inhibition of inflammation (p <0.05) at concentrations of 2.5% and 5%. This anti-inflammatory activity could be influenced by the phytochemical compounds contained in the emulgel. Conclusion:Drymoglossum piloselloides (L) Presl. emulgel at concentrations of 2.5% and 5% had an anti-inflammatory activity on mice with carrageenan-induced paw edema. Keywords: inflammation, Drymoglossum piloselloides (L) Presl., emulgel

Identification of waste: DOWNTIME in the outpatient prescription services at the pharmacy installation of Rumah Sakit Islam Siti Hajar Mataram

Background: The hospital pharmacy installation is a health service unit that is required to provide professional services and improve quality which is oriented towards achieving patient satisfaction. Waste identification in pharmaceutical services is important because it has an impact on stakeholder satisfaction. Objective: Identifying waste using the DOWNTIME method for the outpatient prescription services at the pharmacy installation of Rumah Sakit Islam Siti Hajar Mataram. Methods: The study used the cross-sectional design, with the population being all outpatients who were provided with pharmaceutical services during February – April 2019 as well as all staff. Data were tabulated and analyzed descriptively. Critical waste was obtained through questionnaires and the root causes of critical waste were obtained through in-depth interviews with 5-why methods. Results: Waste waiting had the highest rate compared to other wastes, reaching 44% or 53 out of 121 respondents, followed by inventory (26%), extra processing (19%), transportation (14%), defects (14%), motion (13%), over production (8%), and non-utilized skills (7%). Meanwhile, from the staff respondents, waiting was also the highest waste (18%), followed by inventory (16%), motion (13%), over production (12%), transportation (12%), non-utilized skills (10%), extra processing (10%), and defects (9%). The root cause of waste waiting was the frequent drug unavailability due to delays in payment of services from the cooperating party to the hospital as well as the narrow service areas. Conclusion:Waste waiting became the critical waste with the highest percentage of dissatisfaction in the patient respondents (44%) and staff respondents (18%). Keywords: Waste, DOWNTIME, outpatient prescription services, pharmacy installation of RSI Siti Hajar Mataram