Perception of risk of adverse drug reactions with non-opioid analgesics by medical students

Abstract

Introduction Educationaboutadversedrugreactions(ADRs) for public, healthcareprofessionalsand medical studentsis the mostimpoftantfor reducingof druginducedpatientharm. Somestudieshavealreadyinvestigatedpatient's knowledgeaboutprescribedmedicines(Cullenet al., 2006). Bongard et al. (2002) have shown major differencesin the perception of risk of ADRs betweenhealthandnon-healthprofessionals. In this particular study, non-health professionals and pharmacistsdid not rank high non-steroidalantiinflammatorydrugs(NSAIDs) for perceivedrisk of ADRs compared to general practitioners and pharmacovigilanceprofessional.Montastrucet al. (2003)founddifferencesin theperceptionofrisks of gastrointestinalADRs with NSAIDs, including coxibsamongphysiciansaccordingto their medical specialization. Rheumatologists systematically consideredNSAIDs as less harmful than general practitionersandgastroenterologists. Thisresultmay indicate that these physiciansare involved more frequently in NSAID-induced ADRs than rheumatologists. Dift-erencesin ADR risk perceptionhasbeen illustratedin a study of French medical students (Dunieuet al.,2007).The studyassessed the effecr of educationon students'perceptionof ADR risks factors.Before taking a pharmacologycoursethe studentsrankedNSAIDs in eightposition,aspirinin twelfth position.After the coursethe order of risk perceptionschangedto NSAIDs to fifth positionand aspirin to fourth position. These results indicate significanceof educationon improving medication prescribing. The aim of the studywas to evaluateperceived risk of ADRs with non-opioidanalgesics in young medical studentsand to investigatethe impact of medicaleducationontheirperceptionof risk. Materials and methods A cross-sectional, questionnaire-based studywas conductedamongmedicalstudentsof first andsixth yearof studyon Facultyof Medicine,Universityof Pri5tina- KosovskaMitrovica. The approvalfrom Ethics Committeeeof the institution was obtained beforethestartofthe study. The study was conductedfor the period of 2 monthsfrom April throughMay,2019. The total number of respondentswas 205, of whom45 wereexcludedbecauseof incompletedata. The paper-basedquestionnairewas designedsothat * zorica.stanoj evic@med.pr. ac.rs88 the respondentscould selectmorethan oneanswer, or entertheappropriatedata. The questionnairewas divided into 3 sections. The first section included demographic informationabout students. The second section investigatedthe respondents'perceptionof risk of ADRsnext classes o[ non-opioid analgesics: paracetamol, aspirin, indomethacin for indolic derivatesNSAIDs, piroxicam for oxicam derivates NSAIDs, diclofenac for arylcarboxylic derivates NSAIDs androfecocibfor coxibs.The third section investigated the risk of ulcerogenic actrvity. gastroiniestinal bleeding,liver and kidney damage, bronchospasmandthromboembolismassociated with theuseof eachclassof non-opioidanalgesics. A visual-analoguescale (VAS) was used to definea scorefor the perceivedrisk of ADRs, The scoreswerecomparedusingMann-WhitneyU test. Differenceswereconsideredto besignificantif thep valuewaslessthan0.05. Resultsand discussion A totalof 78 medicalstudentsof thefirst (MSl) and81 medicalstudentsof the sixth (MS6) yearof study completed the questionnaire giving the responserate of 78Vo.63Voof respondentswere femaleand37% weremale.Therewasa significant agedifferencebetweenthe groups(19.6 vs. 23.6, p<0.001). Both groupof studentsrankedindolic derivates of NSAIDsandcoxibsasthemostdangerousclasses of non-opioid analgesicswith high potentialsfor ADRs. Also, they consideredthat paracetamol was the least dangerousnon-opioid analgesic.When NSAIDs and coxibs were consideredtogether,the globalmedianscoreof perceivedrisk of ADRs was 4.5vs.4.7(MSl vs.MS6),whichwasa statistically very significantdifference(p<0.001).Clearly,at the end of their study,medical studentsbecomemore cautiousin the perceptionof risk of ADRs.Earlier studies have shown that NSAIDs were the pharmacological classmost frequentlyinvolved in hospital admissionsdue to anadverseeffect of a prescribeddrug(Pouyanneet al.,2000). For NSAIDs, MS6 gave significantly higher median scores of perceived "digestive risk" than MSi (6.1 vs. 5.1, p=0.020). But unexpected,the perceived "thromboembolism risk" associated with the use of NSAIDs (including coxibs) was higher in MSI thanMS6 (5.8vs.4.8, p=0.007). Conclusion These results indicate that medical education gives young medical studentsa better understanding of the risks of potential ADRs.However, their perception of risk indicates the need for further education. Besides the influence of medical educations, other important factors, like information in the various media, have to be considered to explain the difference in the perception of risks related to drugs. References Bongard,V., M6nard-Tach6, S., Bagheri,H., Kabiri, K., Lapeyre-Mestre, M., Montastruc, J.L., 2002. Perceptionof the risk of adversedrug reactions: differencesbetween health professionalsand nonhealthprofessionals. Br. J. Clin.Pharmacol. 54,433- 436. Cullen, G., Kelly, 8., Murray, F.E., 2006. Patients knowledge of adverse reactions to current medications. Br. J.Clin.Pharmacol. 62,232-236. Durrieu,G., Hurault,C., Bongard,V., Damase-Michel, C., Montastruc,J.L., 2007. Perceptionof risk of adversedrugreactionsby medicalstudents: influence of a l-year pharmacologicalcourse.Br. J. Clin. Pharmacol. 64.233-236. Montastruc, J.L.,Bongard, V., Lapeyre-Mestre, M., 2003. Perceptionof therisk of gastrointestinal adversedrug reactionswith non-steroidalanti-inflammatorydrugs (includingcoxibs): differences among general practitioners, gastroenterologists and rheumatologists. Eur. J. Clin. Pharmacol.59, 685- 688. Pouyanne, P., Haramburu,F., Imbs, J.L., B6gaud,8., 2000. Admissions to hospital causedby adverse reactions: crosssectional incidencestudv.Br. Med.J. 320,1036