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Siauro terapinio indekso vaistų vartojimas ir farmakokinetikos tyrimų interpretavimas reikalauja specialių farmakokinetikos žinių. Mokslinės literatūros šaltiniuose teigiama, jog gydymo procese dalyvaujant klinikiniams vaistininkams vaistų vartojimas yra optimizuojamas. Lietuvoje panašios vaistininkų veiklos nėra, todėl tyrimo tikslas buvo įvertinti siauro terapinio indekso vaistų vartojimo racionalumą ir nustatyti klinikinės farmacijos paslaugos poreikį stacionarinio gydymo įstaigoje. Darbo uždaviniai: nustatyti ir įvertinti farmakoterapinių problemų, siejamų su siauro terapinio indekso vaistų (vankomicino, ciklosporino, digoksino, gentamicino) vartojimu, paplitimą tretinio lygio ligoninėje; kiekybiškai ir kokybiškai įvertinti nustatytų farmakoterapinių problemų rizikos veiksnius; įvertinti vankomicino farmakokinetikos stebėsenos praktiką ligoninės skyriuose; įvertinti farmacininko konsultacijos įtaką vankomicino farmakokinetikos stebėsenai. Tyrimui pasirinktų siauro terapinio indekso vaistų farmakokinetikos tyrimų analizė atskleidė klinikinės farmacijos paslaugos poreikį optimizuojant tokių vaistų vartojimą Lietuvos ligoninėse. Nustatytų farmakoterapinių problemų rizikos veiksnių analizė identifikavo praktikoje dar visuotinai nepripažintą padidintą inkstų klirensą ir jo reikšmingą įtaką vaistų veiksmingumui. The prescription of narrow therapeutic index drugs (NTID) and interpretation of pharmacokinetic measurements require special pharmacokinetic knowledge. Scientific publications report that active participation of clinical pharmacists in the treatment process results in optimization of the drugs use. In Lithuania, there are no similar services provided by pharmacists up till now. Aim of the study: to evaluate the rationality of the use of NTIDs and to determine the demand for clinical pharmacy services in hospitals. Objectives of the study: to identify and evaluate the prevalence of drug-related problems associated with the use of NTIDs (vancomycin, cyclosporine, digoxin, and gentamicin) in the tertiary-level hospital; to perform quantitative and qualitative analysis of risk factors for the identified drug-related problems; to evaluate the practice of pharmacokinetic vancomycin monitoring in hospital departments; to evaluate the influence of pharmacist intervention on pharma¬cokinetic vancomycin monitoring. The analysis of pharmacokinetic measurements of NTIDs selected for this study revealed the demand for clinical pharmacy services while optimizing NTIDs use in the Lithuanian hospitals. The analysis of risk factors associated with the identified drug-related problems identified augmented renal clearance, which is not widely acknowledged in practice, and its significant impact on the effectiveness of drugs.

Aim of the work: to determine the peculiarities of the use of drugs prescribed for the reduction of cholesterol in patients visiting the pharmacy and the recommended dietary supplements for prevention. Tasks of the work: 1) To find out the most commonly used medication/food supplements that reduce cholesterol levels. 2) To disclose the opinion of patients taking medication / food supplements regulating cholesterol in the importance of treatment. 3) Identify potential drug use problems and provide appropriate solutions. 4) To clarify the changes in the lifestyle of the respondents by adjusting blood cholesterol levels. Object and methods of the research: the respondents of the research were chosen purposefully. A total of 300 patients agreed to complete the anonymous questionnaire. LSMU Bioethics Center Permission Nr. BEC-FF-12. The study was conducted in one public pharmacy in Alytus city. The analysis of the data was performed using the SPSS 25.0 version of the statistical program. Chi square (χ2) criterion was used to check for signs of independence: signs are statistically significant when the value p

Aim: To determine the use frequency and type of calcium supplements chosen by older patients. Objectives: 1. To conduct an analysis of calcium supplement assortment available at pharmacies; 2. To evaluate patients’ knowledge about the benefits of calcium use at an older age; 3. To analyze patients’ choice of calcium supplements and frequency of use; 4. To determine which recommendations patients use to choose a calcium supplement. Methods: During the study the questionnaire was completed by 300 respondents older than 50 years (61 % of them were women). Descriptive and comparative analysis has been performed to analyse the data, the results are presented in figures and percentages. Statistical significance of the data was checked using the Chi square criterion, statistically significant results when p

Aim: to determine the prevalence of acetylsalicylic acid use as an antiplatelet drug and patient knowledge about the safe and effective use of the drug. Objectives: 1. To determine the prevalence of acetylsalicylic acid use as an antiplatelet drug and indications in the town of Rokiskis. 2. To evaluate patient knowledge about safe drug use and appropriate dosage. 3. To determine cases of the drug’s use for self-medication and provided pharmacist consultation. 4. To analyze concurrently used medication and possible drug-to-drug interactions. Methods: object of study – the knowledge of older patients who visit pharmacies about the use of acetylsalicylic acid as an antiplatelet drug. A survey was used as the instrument for the quantitative study. The study was conducted in the town of Rokiskis by surveying a total of 350 older patients. The data was analyzed using SPSS software and MS Excel. Statistical significance of the data was analyzed using the Chi square test, number of degrees of freedom and statistical significance. Hypotheses were tested using the factor mean difference statistical significance testing method (Student t-test) and multivariate logistic analysis method. Results: a total of 45.4% of respondents who participated in the study use acetylsalicylic acid. Respondents use acetylsalicylic acid for thrombosis prevention (34.2%), myocardial infarction prevention (33.2%) and stroke prevention (32.7%). It was found that 23.2% of individuals do not know the strengths of the drug they are using, 0.6% of individuals use a 500mg dose of acetylsalicylic acid, even though this dose is not meant for the suppression of platelet aggregation. A number of respondents using the analyzed drug engage in self-medication, 16.4% started using the drug because of their older age. For 9.3% of respondents the drug was recommended by friends. Pharmacists inform 63.9% of all surveyed individuals about possible adverse side-effects and 65.8% about possible drug-to-drug interactions. 92.9% of respondents use at least one additional drug for treating concurrent conditions. Conclusion: in Rokiskis almost half of respondents use acetylsalicylic acid as an antiplatelet drug, however, not everyone is aware of the dose they are using or know about proper usage. Some individuals practice self-medication. The most commonly used drugs for concurrent conditions are drugs for treating hypertension and diabetes, as well as for regulating elevated cholesterol levels in blood.

The Aim of this thesis: To evaluate the impact of a validated Assessment Risk Tool had on clinical pharmacists at Midland Regional Hospital, Tullamore, Ireland. Objectives of this research: (1) To evaluate the impact of the ART by performing a comparative analysis between the before- after study since implementation. (2) To assess the communication between prescriber and pharmacist. (3) To conduct a survey that evaluates the pharmacist’s preference on the implementation of the ART. Methodology: The before – after study was carried out focusing on specific measures from July 2017 to March 2018. A quantitative review was conducted with a selected number of drug charts to evaluate the full impact of the Assessment Risk Tool. For the before study 149 drug charts was assessed and for the after study 140. Prescribers actions were followed in response to pharmacists interventions. A total of 15 pharmacists, after implementation of the ART, were surveyed to evaluate the impact the tool had on daily work as clinical pharmacists. Data were analysed using Excel and SPSS software program. Descriptive statistics were generated in the form of numbers and percentage. To evaluate statistical significance of relation between variables chi-square (χ2) test was applied. Results: Comparative analysis between before- and after - study showed an increase in endorsement of drug charts for P1 (19 % vs 36.8%) and P2 (39.5% vs 54.0%) and a decrease in P3 drug charts (40.7% vs 9.2%). Evidence from the study shows a low response rate from prescribers to pharmacist’s interventions: 43% no response rate of drug charts with a recommendation from a pharmacist – 29% was P1 and 34.1% P2 patient drug charts. Surveyed pharmacists were overall satisfied (87.6%) with the ART and a positive preference when working with the ART. 66.7% have followed by agreeing to the ART has assisted in identifying patients who are more medically complicated and the tool has made them notice certain aspects of patient care management pre-implementation. Conclusion: Pharmacists response to survey mirrors the positive impact the tool has done overall. Assessment Risk Tool put in place was found to be useful in prioritising patients for pharmacists interventions such as medication reviews

The most commonly used non-steroidal anti-inflammatory drugs are diclofenac, ibuprofen and nimesulide. As the respondents were older people, they mostly used NSAIDs to relieve pain in the joints, and a small proportion of them were used to treat headaches, toothache or after trauma. About 75% of the respondents read the information leaflet and focus on the unpredictable effect of the medicine. 84% of the respondents consult with a pharmacist, so only a small percentage of patients feel unwanted NSAIDs. The most commonly reported undesirable effects of NSAIDs were gastric pain, half of respondents use H2 receptors or PPIs. Most respondents suffer from cardiovascular disease and most antihypertensive drugs are NSAID-specific, especially in patients with heart failure. More than half of the respondents believe that NSAIDs are safe to use at an older age and can be used at their discretion.

Scope.To determine gastric protective medicines need using nonsteroidal anti-inflammatory drugs. Tasks. 1. To perform a literature review and describe most common stomach related adverse effects caused by nonsteroidal anti-inflammatory drugs. 2. To find out the links and usage demand betweenmost common nonsteroidal anti-inflammatory drugs and gastric protective medicine agents. 3. To determine the frequency of gastric protective medicines usage and patients knowledge about them. 4. To present the practical recommendations for pharmacists when consulting a patient who is dealingwith stomach problems caused by nonsteroidal anti-inflammatory drugs. Methods. The inquiry respondents were chosen purposefully. The inquiry was anonymous. 218 nonsteroidal anti-inflammatory drug users accepted to fill in the questionnaire. Investigation was conducted in the community pharmacy in Alytus. Software as Microsoft Excel 2010 and IMB SPSS 20.0 were used for statistical analysis. Results are shown both in numbers and percentage. To evaluate statistical significance of relation between certain features chi-square (χ2) test was applied. Results. The inquiry showed ibuprofen, 48.6%, was the most often used drug of all nonsteroidal anti-inflammatory drugs. 39.9% of all respondents used gastric protective substances, 32.2% of them used ranitidine. Rest of these patients, 67.8%, used different proton pump inhibitors. Most of the protective agents users, 71.3 %, used them because of nonsteroidal anti-inflammatory drug induced adverse effect. Most common effects appeared as pain in stomach (21.2%), dyspepsia (26.9%) or both of the symptoms combined (30.8%). These side effects mostly occur to patients ranging from 18 to 65 years old (93.6%, p

The aim of the thesis: to determine possible causes and prevalence of allergies and medication use peculiarities. The goals of the thesis: 1) To determine the prevalence of allergies, possible causes and common treatments. 2) To evaluate patient’s knowledge of allergies and to determine the involvement of a patient in allergy control. 3) To determine potential pharmacotherapy problems in allergy treatment. The methods of work: a survey of 240 patients who agreed to answer the survey questions was carried out. The data analysis was performed using SPSS 20.0 software package by means of application nonparametric statistical analysis methods and the results of features for verification of the association of statistic connection using χ2 criterion. The results: 55 patients (22.9%) suffered from allergies. Most sick persons belong to the age group of 18-45 years (61.8%). Family members with allergies among persons who suffer from allergies are up to 61.8%, and 38.2% among healthy persons. The most common are two allergy-causing allergens comprising 25.5% and three allergens comprising 17.6% One third of respondents have symptoms in skin area (30.9%), 41.2% of patients aged 18-45 years and 33.3% of patients aged 46-75 years experience seasonal allergies. Patients’ interest in allergies: 60% of patients have doctor consultation, 49.1% of patients consult pharmacists, older patients more often (66.7%). Doctors usually prescribe medication for treatment of allergies in 60% of cases, 45,5% of respondents do not follow the prescriptions. Conclusions: persons in a test group were allergic to more than one allergen, mostly pollen. The reason for the emergence of allergies may be environmental factors and allergic family members. H1- receptor antagonists are usually first-line treatment for allergies, however almost one fifth of patients do not follow the prescriptions and a part of respondents do not take any medications to reduce allergy symptoms.

The Aim of the Study. To establish potential causes of constipation and medicinal products most widely used. The Objectives of the Study: 1) To create a questionnaire, using which it would be possible to establish causes of constipation among different gender and age people; 2) to identify what medicinal products are used by different gender and age people for treatment of constipation; 3) to find out what influence a pharmacist has on decisions made regarding selection of a medicinal product for treatment of constipation; 4) to conduct analysis of data obtained during this survey and compare the results obtained with the results from other researchers; 5) submit recommendations on solutions to constipation problem. The Methods. During the present survey, 304 respondents were interviewed, 250 of them were randomly selected pharmacy clients and 54 pharmacists. On the basis of data obtained during the interviewing, the constipation frequency, causes and products used for treatment have been assessed. Statistical analysis of the data obtained was conducted using the SPSS software package, version 20.0. To evaluate statistical significance of relation between attributes of the subjects, 2 was applied The Results. 55.6% of respondents in the group of subjects are suffering from constipation. Women experience constipation more frequently (65.6% permanent constipation and 60.7% - occasional constipation), as well as respondents aged over 65 years. It was established that 41% of respondents think that non-rational nutrition has influence on constipation, as well as insufficient consumption of water, life style and medicine taking (59.4% of respondents suffering from permanent constipation are among those who take β blockers). It has been established that selection of laxatives depends on gender and age (p

The aim of the thesis. To determine the type of drug – related problems and their most common reasons for patients who suffer from arterial hypertension. Objectives of the research. 1) To determine the drug - related problems in the investigative patients’ groups. 2) To analyze the identified problems and compare with the results from other studies. 3) To identify risk factors which affect DRP in hypertensive patients. 4) To make recommendations for the patient to prevent possible problems. Methodology. This study was questionnaire – based which was conducted between July to August 2016 in Kaliningrad, Russia and from January to February 2017 in Kaunas, Lithuania. A convenient sampling method was used and a total of 100 hypertensive patients were included in the study. DRPs were identified based on strand classification system and trustable literature. Data were analyzed using Excel and SPSS software program. Descriptive statistics were generated in the form of numbers and percentage. To summarize the quantitative variables, mean and standard deviation (SD) were calculated, and for the qualitative variables, frequencies and percentages were used. Results. The frequency of DRPs was identified 92% vs. 100% in the investigative group in Kaunas and Kaliningrad, respectively. One hundred and fourteen DRPs were identified in each city, an average of 2.3 DRP for each participant. Identified DRPs were unnecessary drug therapy (7.9% vs. 3.5%), needs an additional drug therapy (14.1% vs. 31.6%), ineffective therapy (25.4% vs. 15.8%), adverse drug reaction (27.2% vs. 17.5%), and non – adherence (25.4% vs. 31.6%) in Kaliningrad and Kaunas, respectively. Prevalence of risk factors for BP in the evaluated population was minimal: 82% vs. 72% respondents don’t smoke, 62% vs. 88% don’t consume alcohol; however, only 32% vs. 20% are doing sports and 90% vs. 84% has comorbid diseases in Kaliningrad and Kaunas, consequently. Conclusion. A number of drugs and number of comorbidities significantly affect drug – related problems. The study showed that almost all the patients in the study have drug therapy problems. For that reason, patients with multiple diagnosis and patients using multiple drugs should be closely monitored for drug – related problems, to avoid clinically significant harmful consequences. The monitoring of medicines use is an effective way to decrease the number of DRPs and to ensure safety and efficacy.

Aim of the thesis. To evaluate pharmacist role in determining possible or existing drug related problems. Objectives. 1) to determine possible drug usage problems after purchase; 2) to find out what kind of consulting is provided by pharmacist to patient during drug purchase; 3) to evaluate pharmacists role in adjusting drug usage. Results. Most participants in the study were constant drug users (68.9 %, p

Aim of the thesis - to study and to assess the approach of the patients with arterial hypertension to their disease and evaluate their participation in the disease control. Conclusions - the patients did not participate enough in their blood pressure control, despite that they used prescribed medicine, did not miss the medicine doses, had blood pressure measurement device at home and were aware of their diseases.

Objective: to determine drug related problems in patients with chronic cardiovascular diseases and their prevalence cause. Methods: a survey was conducted of patients about the medicines using a predefined and validated questionnaire for 4 months. Drug consumption efficiency estimated from the patient felt symptoms and objective results. The results are compared by indication and sex. All data were processed using the SPSS 20.0 program nonparametric methods of statistical analysis and comparison with 2 criteria. Results: the study included 66 patients (22 men, 44 women), were analysed a total of 233 used products in 158 indications. 65.5 percent. of cardiovascular diseases are hypertension, 14.9 percent. – heart rhythm disorders, 12.6 percent. – angina/ coronary heart disease, 7 percent. – heart failure. A strong potential synergies amounted to 11.5 percent. the number of interactions. ADRs occurred in 5.6 percent. used drugs. 2.3 percent. cardiovascular indications had not appointed agent. 62.7 percent. all cardiovascular cases requires treatment adjustment. On average, 83 percent of non-compliance with instructions all cardiovascular cases. Reasons of non-compliance is forgetfulness (23.7 percent.), inappropriate use (18.8 percent.), dose modification (17.8 percent.), others (17.8 percent.), consumption stability (15.1 percent.) and drug discontinuation (6.8 percent.). Conclusion: identified problems are divided into 5 five drug related problems groups. The biggest reasons for the treatment of non-compliance are forgetfulness, dose modification, inappropriate use (p < 0.05). Possible reasons for drug related problems are using more than 2 drugs, auto-observation absence. Recommended solution for drug related problems is clinical pharmacist’s intervention in the treatment process.

Aim of the thesis. To find out how elderly patients who visit pharmacies use particular medicinal products and according to the collected data to determine drug related problems the group of elderly people. Objectives. 1) to determine the drug related problems in the study group (in the elderly); 2) to analyse the drug related problems; 3) to determine reasons of identified drug related problems; 4) to propose recommendations in order to prevent possible drug related problems. Methodology. 69 elderly patients who got prescription and non-prescription medicines in the pharmacies and agreed to participate in the study signing the patient information and informed consent form were interviewed. Use of each drug/food supplement was evaluated according to the data obtained from the survey and drug related problems were identified. Categorical data were expressed as numbers (%) and were compared using the χ2 test. Statistical analysis of collected data was performed using SPSS software, version 20.0. Results. It was found that in 15.0 percent of cases the required preparations have not been assigned. Most often medications have not been allocated for gastroenterological (26.3 percent) and vascular disease symptoms (25.0 percent), p