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Background: To investigate the prevalence of potentially inappropriate medications (PIMs) using updated Beers criteria 2012 and drug utilization study among the elderly patients attending the various outpatient departments (OPDs) of a tertiary care hospital at Pondicherry in India. Methods: This prospective, observational study involving patients aged 65 years and above, was planned and conducted over a period of six months, who attended the various OPDs were included in the study. Prescriptions were collected from the consulting rooms and pharmacy. Results: A total of 600 patients aged 65 years and above were involved in our study. Majority (61.83%) were in the age group of 65-70 years. There was a male preponderance (61.83%). Total of 1769 drugs were prescribed, giving an average of 2.98 drugs per person (range 1 to 9). Polypharmacy (≥ 5drugs) were observed in 99 patients. Of the total 748 disease conditions, cardiovascular diseases were the most prevalent (29.33%) among the elderly patients. Almost 114 patients had comorbid conditions. General medicine department was the highest (28.83%) visited patients. Frequently prescribed drugs belong to the category of analgesic and anti-inflammatory agents (16.50%). Fixed Dose Combination (FDC) was 31%. Almost 110 patients received PIMs from Beers list; majority were belonging to category 1. NSAIDs (30.66%) were the highest PIMs prescribed to musculoskeletal disorders. With regard to WHO indicator, 377(21.31%) drugs were prescribed by generic name. Utilization from Indian national list of essential medicine was 76.82%. Percentage of encounters in which an antibiotic and injections was prescribed to 23.5% and 26.33% respectively. Conclusions: Study has shown the prevalence of disease pattern, comorbidity, drug usage in elderly. PIMs, polypharmacy and FDC were high among the elderly. Prescribers need to be educated about Beers criteria and encouraged for rational prescription.

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The study shows poor pre-therapeutic risk assessment, absence of instructions regarding preventive measures, inappropriate investigation for presence of osteoporosis, and unacceptable absence of bone protective agents.

SUMMARYHypothyroidism is a commonly diagnosed endocrine disorder in medicine. Hyponatraemia is reported in up to 10% of hypothyroid patients, although it is usually mild and rarely causes symptoms. Myxoedema coma is a rare manifestation of hypothyroidism and it can be lethal if it goes undiagnosed and untreated. Our patient presented with an acute manifestation of probable long-standing, but undiagnosed, hypothyroidism. She was asymptomatic but when subjected to surgery (identifiable stress factor) it precipitated as myxoedema coma. Stressful situations such as surgery or infection are the usual precipitating factors for myxoedema coma. The patient responded well to treatment with levothyroxin, 0.9% saline infusion and other general supportive measures. Judicious use of intravenous saline to correct hyponatraemia is important. Correction with 3% normal saline should be carried out with great caution, as rapid correction with 3% normal saline can lead to central pontine demyelination. BACKGROUND