Coronavirus disease (COVID-19) pandemic is one of the dire issues currently worldwide. With increasing death tolls every day and with new information regarding disease every minute, it is very important to disseminate the updated and reliable information to the public. Along with other health care professionals, the pharmacists' role is crucial in preventing the spread and management of the disease. The involvement of pharmacists from clinical trials, drug evaluation to providing pharmaceutical care and other basic pharmacy services in the frontline in this health emergency is undeniable. This commentary focuses on the role of pharmacists in different settings of the health care system and the degree of recognition of the work in Nepal.

Pharmacy patronage: Identifying the roles of nepalese pharmacists in tacking COVID-19

Coronavirus disease (COVID-19) is one of the greatest pandemics of modern times. More than one hundred eleven million global deaths have already been associated with COVID-19. The incidence of COVID-19 and morbidity and mortality due to COVID-19 has increased in lowincome countries (LICs). COVID-19 has further weakened health systems in LICs, that is already distressed by inadequate funding, lack of human resource and poor infrastructure and service delivery. Despite the resources crunch, hospitals in LICs have been instrumental in treating COVID-19 patients. Pharmacists working in hospitals have an indispensable role in providing pharmaceutical services for infection prevention and control. The present study aims to discuss the contribution of hospital pharmacists and the challenges faced by them in the treatment of COVID-19 patients in LICs prior to the COVID-19 vaccine rollout.

Challenges Faced by Hospital Pharmacists in Low-income Countries Before COVID-19 Vaccine Roll Out: Handling Approaches and Implications for Future Pandemic Roles

Background: Poor adherence (compliance) is common with antihypertensive medications among elderly patients. As the elderly people are prone to multiple comorbidities, they are at higher risk of polypharmacy and therefore may present with a higher risk of non-adherence to medications compared to the younger population. The study was conducted to investigate the impact of pharmacist counseling on medication adherence among elderly hypertensive patients.
Methods: The elderly hypertensive patients who visited the out-patient department at Chitwan Medical College (CMC) between August to November 2018. The face-to-face interview was conducted among 332 elderly hypertensive patients, selected with the purposive sampling technique. A paired t-test was used to show the difference between pre-test and post-test medication adherence.
Results: It was found that 13.85% of patients were poor adherent and 86.14% low adherent in the intervention and the control group. The major reason for non-adherence was found to be carelessness about taking medicine (97%). The adherence score for intervention group changed from 1.60±0.83 to 3.95±0.56 (p-value < 0.001) while in the control group the average score before and after follow up was 1.48±0.77 and 1.51±0.80 (p=0.373) respectively. Blood pressure status improved in the intervention group than the control group (p<0.001). Polypharmacy was 27.71%, 15.66% of whom experienced adverse drug reactions.
Conclusion: The patient medication counseling had a good impact on hypertensive patients. All factors of the Morisky Green Levine adherence scale improved after counseling and motivation. Pharmacist-led counseling improved medication adherence among elderly hypertensive patients.

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Impact of Pharmacist Counselling on Medication Adherence among Elderly Patients on Antihypertensive Therapy in a Tertiary Care Hospital of Nepal

Good knowledge, awareness and preparedness regarding coronavirus disease 2019, among community pharmacy practitioners (CPPs), will enable them to provide correct information and support to patients...

https://journals.sagepub.com/doi/pdf/10.1177/2050312120974513

Knowledge, awareness and preparedness regarding coronavirus disease 2019 pandemic among community pharmacy practitioners working in Kathmandu, Nepal: A pilot study.

Pharmaceutical products are used to treat, prevent, and save lives of millions of people globally. However, pharmaceutical products known as substandard and falsified that do not meet regulatory standards and quality threaten the health of the population of today and future leading to socio-economic hardship, drug resistances and put life of patients in danger. We analyzed the recall notice from 2010 to 2020 issued by the department of drug administration (DDA), government of Nepal to understand the overview of substandard and falsified pharmaceutical products in Nepal. The number of recalled pharmaceutical products has significantly increased over the past decade in Nepal (p-value< 0.05). The most recalled drugs were antimicrobials followed by gastrointestinal medicines, vitamins and supplements, pain and palliative medicines among others. Number of recalled drugs manufactured by domestic pharmaceutical producers and imported ones were not significantly different. Majority of imported recalled drugs originated from India. Sixty-two percentage of recalled drugs were substandard, 11% were falsified and remaining 27% were not registered at the DDA. Similarly, sixty percentage of recalled drugs were modern and 35% were traditional ones. The hand sanitizers used to minimize the COVID-19 transmission contributed significantly to the list of recalled pharmaceutical products in 2020. Most of these sanitizers contained significant amount of methanol instead of ethyl alcohol or isopropyl alcohol. We also reviewed peer-reviewed research papers that reported data of substandard and falsified drugs. Only four such papers were found in literature. These papers reported issues with labeling, unregistered drugs and drugs failed in a number of laboratory testing. Since the recall data did not include number of samples tested and location of sample collected, a systematic study to understand the prevalence of substandard and falsified drugs in Nepal is recommended. Key questionsO_ST_ABSWhat is already known?C_ST_ABSO_LIPrevalence of substandard and falsified pharmaceutical products is a global threat to public health and socio-economy. C_LI What are the new findings?O_LIWe analyzed drug recall data from department of drug administration in Nepal and report that the substandard and falsified pharmaceutical products are increasing significantly. C_LIO_LIAntimicrobial drugs were the most frequently recalled drugs. Drugs manufactured by domestic producers and imported ones were equally recalled. Allopathic drugs were recalled more than ayurvedic products. C_LI What do the new findings imply?O_LIThis study suggested the problem of substandard and falsified pharmaceutical products is serious in Nepal. Integrated efforts from regulating agencies, manufacturers and pharmacies are recommended to minimize the circulation of such products in the country. C_LI

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Incidences of poor-quality pharmaceutical products in Nepal

Reflecting on the role of a pharmacist during the two major earthquakes of 2015: Are we prepared for similar future disasters?

Traditional herbal medicine is widely used globally. Despite its extensive use, there are no proper regulations on standardization and use of herbal medicinal products. Nepal has a rich biodiversity and demography comprising of different socio-ethnic groups. Herbal medicines are utilized prominently in Nepalese communities. These herbal products may cause side effects and adverse effects, such as nephrotoxicity, neurotoxicity with the heavy metal toxicity associated with their powdered dosage forms. The side effects of using herbal products have been documented, such as bleeding with use of Ginkgo biloba and increase in blood pressure with use of Ephedra. Regulation of herbal products is essential to promote their optimal and rational use. Standard tools are available for assessing adverse effects of herbal products from health authorities, like the World Health Organization. In Nepal, self-medication practice using traditional herbal medicines is common and includes the concomitant use of allopathic. There is no focal point to address the regulatory issues on herbal products currently in Nepal. The Department of Drug Administration in Nepal is nominated as a national pharmacovigilance center and there are no reports on adverse events from the use of herbal medicines so far. However, not having any reports does not ensure the absolute safety and effectiveness of herbal products, so vigilance is warranted. Herbal pharmacovigilance is needed for Nepal to ensure safe and effective use of herbal medicines as the current pharmacovigilance ecosystem does not capture those cases. In the Nepalese context, the absence of reporting mechanisms may have underreported adverse cases of herbal products. The present opinion article aims to discuss the use of herbal products in Nepal, the challenges associated with the adverse reaction due to herbal medicines, and recommendations to overcome these challenges

Herbal pharmacovigilance in Nepal: challenges and recommendations

Previous qualitative studies exploring the experiences of community pharmacists (CP) in implementing weight management services (WMS) often lack a theoretical underpinning. This study applied the capability, opportunity, motivation, behaviour (COM-B) model to factors associated with WMS implementation among CPs to develop and recommend better intervention strategies.A qualitative study design was used by conducting in-depth, semi-structured interviews with CPs. All the interviews were audio-recorded and duly transcribed. The thematic analysis approach was used to analyse the data, and the themes generated were mapped onto COM-B model components.The themes that emerged were (1) motivation of pharmacists and (2) knowledge and skills, which were identified as both barriers and facilitators, and (3) the barriers to implementation in aspects of social norms and resources. Factors were subsequently categorised into the subcomponents of the model: physical capability (e.g., training), psychological capability (e.g., lack of knowledge), physical opportunity (e.g., product range), social opportunity (e.g., stigma), automatic motivation (e.g., remuneration) and reflective motivation (e.g., CPs extended roles).In conclusion, programs or training For Cps should develop their psychological capability to change their behaviour by being more proactive in promoting and providing weight management services, with a vital educational component. This behavioural change will improve the promotion of this service and will help many customers who were unaware of this service. Learning opportunities will leave CPs to feel more empowered and overcome barriers to implementing and maintaining WMS in primary care. The study findings provided essential insights into the factors that affect this provided service in Malaysia. The results will help to encourage the embedding of nutrition counselling in academic curricula. 

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Using COM-B model in identifying facilitators, barriers and needs of community pharmacists in implementing weight management services in Malaysia: a qualitative study

K.C. Bhuvan

Papers

Reflecting on the role of a pharmacist during the two major earthquakes of 2015: Are we prepared for similar future disasters?

Herbal pharmacovigilance in Nepal: challenges and recommendations

Using COM-B model in identifying facilitators, barriers and needs of community pharmacists in implementing weight management services in Malaysia: a qualitative study

Remote extemporaneous compounding lab practical for pharmacy students during the COVID-19 pandemic

Helping older adults with their medication use problems: A qualitative study on perspectives and challenges of primary health care providers.