Farmacia Hospitalaria (English Edition)最新文献

Objectives

The objective is to describe the resistance mutation rate in protease and reverse transcriptase genes and sensitivity to different antiretrovirals in our environment.

Methods

We performed an observational descriptive study in which we examined the samples provided at the Clinical Immunology Laboratory between April 2004 and April 2009. We analysed both the resistance tests and the sensitivity to different drugs in patients with therapeutic failure using Trugene HIV-1 Genotyping Kits^®.

Results

We registered samples from 242 patients, 61 of which had no detectable resistance. The most prevalent mutations according to drug families were: for nucleoside analog reverse transcriptase inhibitors T215A/C/D/F/L/N/S/Y (24.10%), M184G/I/V/W (14.66%), M41J/L/R/T/W (11.24%) and K219E/G/H/N/R/T/W (10.24%). The highest levels of resistance corresponded to stavudine and lamivudine/emtricitabine, and tenofovir produced the least resistance in our environment. The non-analogues were K103N/R (23.98%), V179D/E/I/M/T (10.82%), A98E/G/S (10.53%) and K101E/P/Q/R (9.06%). Nevirapine presented greater resistance than efavirenz.

Protease inhibitors were L10F/I/V (15.95%), M36I/L (13.81%), A71I/T/V (13.10%) and 154L/S/V (7.38%). The darunavir/ritonavir combination was that which presented the least resistance, and tipranavir/ritonavir and lopinavir/ritonavir the most resistance.

Conclusions

Antiretroviral resistance and sensitivity to retroviral treatment in our environment was similar to results from other studies in Spain, but differed in the high level of resistance to lamivudine/emtricitabine and lopinavir/ritonavir.

Objectives

Identify the photosensitive drugs included in the hospital pharmacotherapeutic guide and search for stability data on the storage, reconstitution, and dilution of these compounds.

Methods

The data were obtained by referencing technical specifications, information provided by drug laboratories, and in some cases, we performed a more extensive bibliographic search (tertiary sources and conference lectures) for each particular medication. We also performed a data search on the PubMed information database (from 2004 to 2009).

The drugs were placed in alphabetical order by brand since the stability of each drug when exposed to light does not depend exclusively on the primary active ingredient. Eight columns describe the principal characteristics of the drugs: brand name, active ingredient, laboratory, storage, reconstitution and dilution conditions, observations, and references.

Results

The listing comprised of 139 of the 1954 photosensitive medicines included in the pharmacotherapeutical guide (Table 1).

Conclusions

The lack of studies published on the stability of photosensitive medications provided the need for an internal review at our hospital.

It is important for drug-producing laboratories to perform photosensitivity tests on their products, with the results presented in the technical specifications in order to provide more accessible and reliable information. We believe that this should be required by law.

Objective

To detect, quantify, and compare the medication error produced with manual versus electronically assisted prescription systems.

Methods

A descriptive, observational, prospective study in two traumatology hospitalisation units; one with manual prescriptions and the other with electronically assisted prescriptions. Prescription errors were determined.

Results

We analysed 1536 lines of treatment (393 treatment forms) from 164 patients. With manual prescriptions, we detected errors in 19.54% of cases, compared to 9.4% in electronically assisted prescriptions. Omission errors were significantly lower with electronically assisted prescriptions, especially with drugs that act upon the central nervous system.

Conclusions

Prescription error has decreased by 53% since computerising the prescription process. This is particularly useful for omission errors, as prescription is more complete. The decrease in error regarding drugs that act on the central nervous system stands out.

Objective

To evaluate the utility of a post-discharge pharmaceutical care programme.

Method

Three-month prospective study where patients were randomised into two groups according to whether or not they received verbal and written information about their treatment at hospital discharge. Treatment compliance was assessed by the Morisky–Green test at discharge and at 30–50 days via a telephone interview, also collecting information on patient medication.

Results

A total of 59 patients were included, 30 in the control group and 29 in the experimental group. 42.1 ± 9.6 days had elapsed between discharge and the telephone interview. While a higher percentage of patients were adherent to treatment at discharge in the control group (83.3 versus 62.1%, OR = 0.33, 95% CI: 0.1–1.1, P=.07), in the telephone interview the percentage in the experimental group was greater (62.5 versus 88.5%, OR = 4.6, 95% CI: 1.1–19.8, P=.03). The differences between the two groups for the rest of the variables (deaths, visits to emergency department and hospital readmissions) were not statistically significant. In the telephone interview, 70% of patients’ treatment was changed in some way since hospital discharge.

Conclusion

A post-discharge pharmaceutical care programme is a tool to improve treatment compliance, which needs continuity due to the large number of treatment changes suffered by these patients.

Objective

To evaluate the impact and type of side-effects in patients treated with cetuximab and provide a description of the general measures and treatment.

Methods

Retrospective safety study. We included all patients that received cetuximab from January to December 2009. All information was obtained from the Pharmacy and Oncology Department's Access databases and reviewed the patient's medical history. All data was registered in an Excel workbook. Skin toxicity was graded by the current National Cancer Institute-Common Toxicity Criteria (NCI-CTC).

Results

During the study period 43 patients received treatment with cetuximab. Acneiform eruption was present in 30 of the cases (69.8%): 14 patients with grade 1 (48.3%), 13 with grade 2 (44.8%) and 3 with grade 3 (10.3%). These adverse effects appeared in a median of seven (4–28) days. In a median of 40 (20–56) days, ten patients (23.3%) presented xerosis, and three (7%) suffered painful fissures in hands and feet after a median of 28 (21–35) days. Paronychia was present in two patients after a median of 42 (35–49) days. Finally, an alteration in hair growth was observed in two patients with overgrowth of facial hair and one patient with overgrowth of the eyelashes. Five patients presented important conjunctivitis. Three infusion reactions occurred.

A grade-based treatment algorithm was used for all patients that presented cutaneous toxicity.

Conclusions

A considerable number of patients treated with cetuximab develop dermatological side-effects which left untreated could represent a threat to the efficacy of the therapy. Therefore effective management is mandatory, patient education and immediate treatment based on a grade-based algorithm to alleviate symptoms is necessary, so that patient compliance is guaranteed.

Background

The administration of vitamin K immediately after birth has shown a significant decrease in the incidence of newborn bleeding, but there is not enough evidence to determine the most appropriate method of administration. The objective of this review is to determine the effectiveness of orally administered vitamin K compared to the intramuscular route in the prevention of haemorrhagic disease of newborn (HDN).

Methods

We conducted a systematic review of the main databases (Medline, Embase and Cochrane, among others) without limitation by date, language or type of study. Selected studies evaluated the efficacy and safety of vitamin K. Excluded were studies in pregnant women in preterm infants or patients with pathology. The validity of these studies was assessed by CASPe tools for systematic reviews and clinical trials.

Results

Only two studies evaluated clinical aspects. They showed a reduction in the incidence of bleeding in the newborn after intramuscular prophylaxis with vitamin K. With regard to the oral route, different studies examined the effectiveness of vitamin K by determining biochemical parameters (factor X, prothrombin time and index, vitamin K₁ in plasma and prothrombin antigen, among others) with inconclusive results regarding the route of administration and the number of doses.

Conclusions

There is sufficient evidence to support the effectiveness of a single intramuscular dose of vitamin K to prevent the classic form of HDN. With regard to late HDN and oral route, the results are inconclusive because the studies used biochemical indicators of effectiveness, which cannot be correlated with the actual coagulation status of the newborn due to lack of scientific evidence.

Introduction

It is well-known that there is a lack of continuity in care received from the emergency department, as patients have to visit their physician in order to receive official prescriptions. A programme has been designed that aims to provide these patients with a therapeutic protocol to ensure that they are treated, thus improving coordination between the Hospital Emergency Department and Primary Care.

Methods

Creating a multidisciplinary team. Choosing the diagnoses that are most common in the emergency department and which are likely to be standardised. Developing treatment protocols, adapting them to the diagnoses selected. Creating a database, collecting, processing and analysing data. Designing satisfaction surveys, for patients given a therapeutic protocol, and for practitioners involved in the programme.

Results

Treatment protocols were assigned to the nine most common diagnoses in the emergency department, with three-day treatment. The selected diagnoses covered 19.5% of the population attending the Emergency Department. A treatment protocol was dispensed to 17.3% of patients with the selected diagnoses. Patient satisfaction was excellent. Physicians approved of the programme, but the treatment protocol prescription did not agree with the degree of approval.

Conclusions

The results show that the programme was excellently accepted by both patients and physicians, although the coverage given to the needs identified was lower than required.

Objective

To describe the indications for use, in medical practice, of next-generation antiretroviral drugs (NGA): darunavir, raltegravir, maraviroc and etravirine.

Method

An observational, transversal and descriptive study conducted in adult patients who have started to receive a NGA between May 2008 and April 2009. The variables associated with the use of NGA were defined as follows: a) Variables related to efficacy: resistance confirmed by geno/phenotype tests or potencial resistance as a result of extensive exposure to antiretroviral agents, and/or severe immunological deterioration (CD4 less than 200 cells/mcl). b) Variables related to safety: prior toxicity to classic antiretroviral drugs and/or comorbidity which compromises their use. c) Combined efficacy and safety variable (main variable): prioritizing the variables which were detected, the patients were classified into three groups: multiresistant geno/phenotype (multi-G/P), multiresistant as a result of treatment history and other situations. Data was obtained from electronic medical records, laboratory tests, and records of interviews and drugs dispensed by the Pharmacy Service.

Results

Seventy three patients, 40% of whom had an undetectable viral load and 38.4% who showed severe immunological deterioration, were included in the study. Multi-G/P occurred in 45% and multiresistance as a result of treatment history was found in 33% of patients. Patients classified as belonging to the “other situations”ategory were characterized by having a greater viral load and a poorer immunological status. In 90% of the patients without multi-G/P two or more variables associated with the use of NGA were detected.

Discussion

The medical reality of using NGA shows that they play a role in clinical situations which are very different, specific and difficult to manage.

Objective

To describe interventions carried out by nurses in the Pharmaceutical Care Unit upon discharge and in Outpatient Consultation (FACE) with the aim of promoting effective, safe and efficient pharmacotherapy for hospitalised patients.

Method

A descriptive study of nursing activity carried out in the Outpatient Consultation Unit between April 2008 and March 2009. The nurse performs five specific, formalised activities: clarifying differences in the medical records related to drugs allergies or intolerances, identifying pharmacotherapy discrepancies between acute and chronic treatment, identifying opportunities for improving pharmacotherapy, contributing to patient education about his/her treatment upon admission and dispensing limited duration drugs (less than 30 days) upon discharge to avoid accumulation of medication at home.

Results

During the study period the nurse took part in the pharmacotherapy administered to 1360 patients (57.6% of total patients treated by the integral pharmaceutical care team), for a total of 1709 individual interventions. These interventions were performed in order to clarify differences in medical records regarding drug allergies or intolerances (n = 111), to identify pharmacotherapy discrepancies between acute and chronic treatment (n = 118), to identify opportunities for improving pharmacotherapy (n = 263), and upon discharge in order to educate the patient about his/her treatment (n = 31) and to dispense limited duration drugs (n = 1186).

Conclusions

The nurse's contribution to the integral pharmaceutical care team helps to improve the quality of pharmacotherapy in terms of effectiveness, safety and efficiency pharmacotherapy.