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Medication adherence: a review of policy and education in South Africa

- Nyoni, Cynthia Nomagugu

Authors: Nyoni, Cynthia Nomagugu
Date: 2023-10-31
Subjects: Patient compliance South Africa , Drugs Administration Study and teaching (Higher) , Pharmacist and patient South Africa , Pharmaceutical policy South Africa , Patient education South Africa , Medication adherence
Language: English
Type: Academic theses , Master's theses , text
Identifier: http://hdl.handle.net/10962/419548 , vital:71653
Description: Medication adherence is a patient's active and voluntary participation in following all the recommendations and instructions agreed upon with a health care provider such as a pharmacist. Adherence is a multidimensional phenomenon determined by the interplay of five factors: patient-related factors, socioeconomic factors, condition-related factors, health system-related factors, and therapy-related factors. Medication non-adherence is a problem in many countries, especially low to middle-income countries, including South Africa (SA). In low to middle-income countries, non-adherence is often worse due to insufficient health resources and inequities in access to health care. Medication adherence is a global problem and has raised the need for research and review. Many healthcare professionals, especially pharmacists, have an essential role in promoting medication adherence. This study described, explained and evaluated the policies in SA relating to the pharmacist's role in promoting medication adherence. Furthermore, it described medication adherence-related education at four universities in South Africa. The study was qualitative, and a two-phased approach was employed. In the first phase, a document analysis of the pharmacist’s role in supporting medication adherence was conducted as described in national policies and guidelines in SA. A total of 38 documents were analysed, including critical documents such as the South African Pharmacy Council Good Pharmacy Practice Manual and Associated SAPC rules (GPP) manual, National Drug Policy (NDP), Standard treatment guidelines (STGS) and Integrated Adherence Guidelines. The READ approach was used in conducting the document analysis and involved (1) preparing materials, (2) extracting data, (3) analysing data, and (4) distilling findings. The critical roles of pharmacists in medication adherence that were identified were in drug use, supply and management, dispensing, therapeutic drug monitoring, pharmacovigilance, pharmaceutical care, and special programmes like antimicrobial stewardship (AMS), multi-drug resistant tuberculosis (MDR-TB) care and antiretroviral treatment (ARV) and chronic conditions. In the second phase, in-depth interviews were conducted with lecturers to investigate and report on the inclusion of medication adherence and the teaching thereof in the curriculum of the Bachelor of Pharmacy Degree (BPharm) in pharmacy institutions in SA. Purposive sampling was used, and seven lecturers from four different institutions participated in the interviews. The interviews were conducted via Zoom® and were transcribed and analysed using thematic analysis. The teaching of medication adherence in the BPharm curriculum of the respective interviewed pharmacy institutions was explored. It was found that the topic of medication adherence was integrated into all subjects throughout the curriculum and not taught as a formal course. Although medication adherence is taught in many disciplines, it is predominantly in pharmacy practice in all institutions. The teaching methods identified included lectures, case studies, workshops, tutorials, practicals, readings, tasks, assignments and videos. The perceived effectiveness of the teaching methods was explored; also the time spent teaching medication adherence and the time efficiency. Student understanding, interest and engagement with the topic were explored and determined through their assessment performance and class attendance. In conclusion, from policies, the pharmacist's role concerning adherence is indirectly integrated into many other roles. It is often not distinguishable from that of other healthcare professionals and is often implied as part of a more generic role. Pharmacy students are educated on medication adherence and the skills and knowledge required to identify, monitor and support patient adherence to therapy. However, there is scope to increase the course content on medication adherence. There is a need to identify effective strategies for preparing pharmacists to assist patients in medication adherence. , Thesis (MPharm) -- Faculty of Pharmacy, 2023
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Date Issued: 2023-10-31

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An in vitro investigation of novel quinolone derivatives on selected pharmacological targets for diabetes mellitus and associated complications

- Ayodele, Omobolanle Opeyemi

Authors: Ayodele, Omobolanle Opeyemi
Date: 2023-03-29
Subjects: Diabetes , Hyperglycemia , Quinolone antibacterial agents , Cardiovascular system Diseases , Diabetes Alternative treatment , In vitro experiment
Language: English
Type: Academic theses , Master's theses , text
Identifier: http://hdl.handle.net/10962/409813 , vital:70632
Description: Diabetes mellitus (DM) is a group of endocrine and metabolic disorders characterised and identified by the presence of hyperglycaemia over a long period and, to an extent, accompanied by hyperlipidaemia. CVD has been reported to be the leading cause of mortality in patients with DM. Several antidiabetic agents are available for managing DM, but these agents are not for curative therapy and present with undesirable side effects. In addition, these agents become less effective as the patient's condition progresses to complete beta-cell failure. Therefore, developing newer antidiabetic agents with minimal undesirable side effects, prolonged efficacy and protection against the development of DM complications are necessary. This study was conducted to identify potential novel antidiabetic agents with cardiovascular-protective activity. The compounds of interest for the study were quinolone derivatives since quinolones have been reported to have an antihyperglycaemic effect. , Thesis (MSc) -- Faculty of Pharmacy, 2023
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Date Issued: 2023-03-29

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Development and assessment of gastroretentive sustained release captopril tablets

- Mukozhiwa, Samantha Yolanda

Authors: Mukozhiwa, Samantha Yolanda
Date: 2014-04-11
Subjects: Uncatalogued
Language: English
Type: Academic theses , Master's theses , text
Identifier: http://hdl.handle.net/10962/480301 , vital:78427
Description: Cardiovascular diseases (CVD) are the leading cause of death worldwide and global projections predict that the number of deaths due to CVD will continue to increase over the next 17 years [1]. With the growing burden of CVD the design and development of formulations that optimise the delivery of existing therapeutic molecules may be an approach to improving the management of patients with CVD. Captopril (CPT) is an angiotensin converting enzyme (ACE) inhibitor used for the routine management of hypertension, cardiac failure and diabetic nephropathy [2-4]. However it has a relatively short half-life and typical therapeutic dosing regimens require multiple dosing [2]. CPT is a potential candidate for sustained oral drug delivery, however its poor stability profile and high water solubility present significant formulation challenges. CPT exhibits optimal stability at pH < 4 and is unstable in the alkaline environment of intestinal fluids [5]. A sustained release gastroretentive formulation is therefore proposed as an approach that may improve the in vivo stability of CPT in addition to slowly releasing the molecule at a desired rate that may also minimize the occurrence of drug-related adverse effects. A Capillary Zone Electrophoresis (CZE) method for the quantitation of CPT in pharmaceutical dosage forms was developed and optimised using a Central Composite Design (CCD) approach. The CZE method was found to have the necessary linearity, accuracy, precision, sensitivity and specificity for the analysis of CPT in pharmaceutical formulations. Preformulation studies were conducted as part of the preparative work required to manufacture high quality, stable gastroretentive sustained release CPT tablets. The experiments conducted were tailored for the development of CPT sustained release tablets using direct compression manufacture and included an analysis of particle size and shape, powder flow properties and CPT-excipient compatibility studies. The results revealed that there was no definite evidence of interactions between CPT and the excipients to be used to manufacture CPT tablets, and CPT formulations were developed using these excipients. A direct compression procedure was selected for tablet manufacture due to apparent simplicity and to avoid unnecessary exposure of CPT to the heat and moisture that would be encountered if a wet granulation manufacturing process was used. A numerical optimisation approach was used to predict a formulation composition that would produce minimal CPT release initially, a short floating lag time (FLT) and maximum CPT release after 12 hours of dissolution testing. The effect of increasing the agitation speed of USP Apparatus 2 on the release of CPT from the optimised formulation was also investigated. The results revealed that changing the speed of the paddle had only a relatively small impact on the in vitro release behaviour of CPT from the tablets. The optimised formulation was subjected to additional testing in an attempt to investigate the effects of pH and osmolarity on the swelling and erosion characteristics of the dosage form. It was important to evaluate the effects of pH and osmolarity from the perspective of the solubility and stability of CPT. The results generated from swelling studies revealed that the swelling characteristics of the proposed formulation were not significantly altered by a change in pH and osmolarity of the test medium and this is probably due to the non-ionic nature of HPMC. In addition, the results revealed that the solubility and/or stability of CPT in different dissolution media did not affect the water uptake and swelling of the tablet matrices. The results revealed the erosion rate constants were low and suggest that although polymer erosion does occur, the role of this phenomenon in the release of CPT may not be as significant as that of diffusion. The release kinetics of CPT from the tablets was established by fitting in vitro release data to several mathematical models. The in vitro release data were best described using the Korsmeyer-Peppas model and values of release exponent (n) suggest that the majority of the tablets exhibited an anomalous CPT transport mechanism. The short-term stability of the optimised formulation was established by undertaking stability studies at 25°/60% RH and 40°/75% RH. The results revealed that there was no significant change in appearance and physicochemical properties of the tablets over 60 days. In conclusion, gastroretentive sustained release CPT tablets with the potential for further development and optimisation have been successfully developed and assessed in these studies. A basis is thus provided for further development of this technology. , Thesis (MSc (Pharm)) -- Faculty of Pharmacy, 2014
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Date Issued: 2014-04-11

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Sorption and emulsion liquid membranes in the remediation of metal processing waste water effluents using rhodium, trioctylamine and trihexylamine as a model

- Moyo, Francis

Authors: Moyo, Francis
Date: 2014-04-11
Subjects: Uncatalogued
Language: English
Type: Academic theses , Master's theses , text
Identifier: http://hdl.handle.net/10962/480289 , vital:78426
Description: Two optimised ELMs were prepared with the diluent always being 30 % solution of toluene in kerosene. The first ELM contained 30.000 g/L (w/v) polyisobutylene, 10.870 g/L (m/v) of trioctyl amine and 51.001 g/L (m/v) of SPAN 80. The other optimised ELM was composed of 20.000 g/l of polyisobutylene, 10.268 g/l trioctyl amine and 50.024 g/l of SPAN 80. The stripping phase was always 2 M HNO3 and the mixing ratios of organic phase to stripping phase were 1:1 and 2:1. The t-test was used to test for the difference between the mean micro-droplet sizes had a p-value of 0.3018 at 5 % level of significance, i.e. there was no statistically the mean micro-droplet size of the optimised ELMs. Demulsification was performed with polyethylene glycol with molecular weight of 400 g/mol at 50 ± 1 °C for 24 hours. The volumetric ratio of treated side-stream and the ELM was 5:1 and 98.7 to 108 % of the initial Rh amount was recovered in the stripping phase after chemical demulsification. Major carryover of the diluent components into the stripping phase observed was from trioctyl amine, toluene and polyethylene glycol was observed. The final spent side-stream should not be discharged into the environment based on the acute Daphnia pulex toxicity test. For sorption studies, the specific surface area of kaolin was 18.21 0.8 m2 g-1 and loss on ignition was 0.0086 0.004 %. Removal efficiencies of trioctyl amine for 10 g of kaolin and particle size 65-100 μm and 101-400 μm were 18.1 % and 17.5 % respectively while sorption capacities were 0.92 g/g and 0.88 g/g respectively. The removal efficiency of 20 g of kaolin was 35.8 % and 33.3 % and sorption capacities were 0.93 g/g and 0.87 g/g respectively. For particle sizes 101-400 μm, the R2 values obtained for Freundlich and Langmuir were 0.9757 and 0.9819 respectively. The n and Kf for Freundlich isotherm were 1.086 and 2.622. Removal efficiency for trihexyl amine for particle size 101-400 μm and 65-100 μm was 28.5 % and 29.3 % respectively while sorption capacities were 0.73 g/g and 0.75 g/g respectively. The R2 values obtained for Freundlich and Langmuir for particle sizes 101-400 μm were 0.957 and 0.989 respectively. The n and Kf for Freundlich isotherm were 1.307 and 2.151 respectively. These results suggest that kaolinite could potentially be used in remediation of metal wastewaters containing hydrophobic extractants. , Thesis (MSc (Pharm)) -- Faculty of Pharmacy, 2014
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Date Issued: 2014-04-11

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