Farmacia Hospitalaria (English Edition)最新文献

Objective

Evaluation of an analytic method for determining linezolid concentrations in biological fluids including plasma, vitreous humour and cerebrospinal fluid using high-efficiency liquid chromatography and subsequent ultraviolet detection.

Method

The method was validated by studying the following parameters: accuracy, precision, sensitivity, linearity and recovery. The drug was extracted from the biological matrix by means of a protein precipitation with perchloric acid. Chromatographic separation was performed by eluting linezolid with a mobile phase consisting of 80% K₂HPO₄ buffer solution (15 mM; pH = 5) and 20% acetonitrile, and a stationary phase, NOVAPAK C18 150 × 3.9 mm with precolumn. The wavelength reading was 254 nm and the working flow rate was 1 ml/min.

Results

We obtained values with accuracies between 94.4% and 106.1%, and precisions between 0.88%–6% and 3.7%–5.6% for intra-and inter-day variability, respectively. Recovery obtained after analysing the plasma samples was at 93%. The method showed itself to be linear for the concentration levels under study.

Discussion

The method's behaviour can be described as linear, precise and accurate. Furthermore, the method is fast, sensitive, and inexpensive. It is useful for determining linezolid concentrations in multiple biological matrices. It can also be used as a basis for further clinical pharmacokinetic studies.

Objectives

To offer a rationale for assigning a minimum score for risk of malnutrition for total proteins lower than 5 g/dl and a scoring scale for our filter (FILNUT-scale); and to analyse results of the MUST screening test performed on positive scores in the FILNUT nutritional filter and assess usefulness of said test in this population.

Methods

We searched the laboratory database for laboratory test orders (dated between 2004 and 2007) for which total proteins and albumin or cholesterol levels were determined, and we identified those with results for the above three parameters plus lymphocyte count. A limit (less than 5 g/dl) was placed on the total protein level and the results for other parameters were not limited. Distribution curves for albumin and cholesterol were analysed. The same protocol was followed after establishing the CONUT score for each sample with the necessary parameters.

From September 2007 to January 2008, the MUST test was performed on all FILNUT positives and we analysed how the degrees of risk corresponded.

Results

In 95% of the cases in which total proteins are lower than 5 g/dl (n = 1,176), albumin values are between 0.98 and 2.94 g/dl, resulting in CONUT scores of 4 or 6 for albumin. Regarding total cholesterol, (n = 761) 89.1% of the samples are lower than 180 mg/dl, which accounts for one or two points in the score.

In 98.79% of the cases (n = 490) that presented all four parameters, CONUT score was ≥5, which could be classified as medium or high risk.

During the study period, 100% of the patients identified as medium or high risk by the FILNUTscale (n = 568) tested as at-risk by MUST: of these, 421 (74.1%) were at high risk and 147 (25.9%) were at medium risk.

Objective

To update information on drug interactions in patients with HIV/AIDS.

Method

PubMed was used to review English and Spanish articles published between 1 July 2007 and 30 April 2009 on antiretroviral drug interactions in humans. The search included a review of interactions between commonly-used medications in patients with HIV/AIDS and references from articles considered to be relevant.

Results

Fifty two new interactions were identified having to do with CYP3A4 metabolism and competition for intestinal absorption. New pharmacokinetic interactions were identified for medications that were already on the market, and we report interactions for drugs that were recently introduced: Tipranavir, Fosamprenavir, Darunavir, Raltegravir, Maraviroc and Etravirine.

Conclusions

There is evidence of 52 new interactions between medications using metabolic routes in the CYP450 enzymatic system, and an explanation is given for others in the intestinal absorption process.

Introduction

Ongoing training by means of clinical sessions constitutes an essential activity for a pharmacy department, being joint analysis useful to adapt the clinical sessions’ characteristics to the preferences of the professionals involved. By means of this study we hope to optimize clinical sessions for their better use and efficiency.

Methods

A least squares model was used to assess the usefulness of different clinical session profiles. Data was collected from 14 individual interviews (7 specialists and 7 residents); these interviews consisted in ordering the clinical session profiles by order of preference.

Results

The most valued attributes were duration of sessions (29.9%) and the structure of teaching content (27.8%) in both groups studied; although the duration of the sessions was assigned greater value by the group of residents (31.1% vs. 27.2%). The availability of bibliographical references was the third attribute most valued (17.9%), and the two last attributes by order of importance were availability of a copy in files for storage (13.8%) and multimedia content (10.5%).

Discussion

The adaptation of clinical sessions as an integral part of ongoing training leads us to see that we can modify the duration, content structure and availability of bibliographical references so as to adapt them to the preferences of the professionals involved. However, according to the population surveyed, other attributes are of little importance

Objective

To assess the effectiveness and safety of using 5-azacitidine to treat myelodysplastic syndromes.

Methods

Review of medical records of patients who received 5-azacitidine 75 mg/m² subcutaneously for during 7 days every 28 days in twelve cycles as compassionate use. We evaluated the objective response, clinical improvement and time to disease progression. We recorded adverse reactions described in the medical history.

Results

Six patients were candidates for treatment with 5-azacitidine. Three cases were evaluated over the study period. Most remained in partial response or better after the study, and no longer needed transfusions. In one patient, the treatment appeared to delay progression to leukaemia.

Conclusions

5-Azacitidine might be considered an effective and relatively safe drug, and may have contributed to controlling peripheral cytopenias, improving the quality of life and delaying progression to leukaemia. Additional studies with more patients are needed to support these results.

Introduction

The objective is to assess a pharmaceutical care programme for heart transplant patients upon patient admission and discharge.

Material and methods

Observational study of heart transplant patients, performed during the first quarter of 2007. Upon admission, the patient was interviewed regarding home treatments, adherence, allergies, and adverse effects, his/her prescriptions were compared with the last discharge report (drug reconciliation). At time of discharge, treatment was checked against the last hospital prescription (reconciliation) and an informative report was drawn up and personally delivered to the patient. Subsequently, a satisfaction questionnaire was carried out by telephone. Drug-related problems were recorded using Atefarm® software.

Results

The programme was applied to 24 patients upon admission and 23 upon discharge. No drug interactions were detected. Treatment adherence was higher than 90%. 37.5% of patients informed of an adverse reaction. Medication-related problems were identified in 16 patients (45.7%) for 6.6% of medications, most of which (38%) were for infection prophylaxis; medication omission was the most frequently-detected error. Positive evaluation of the information that was received was higher than 90%.

Conclusions

Pharmacotherapeutic follow-up upon admission and discharge resolves and prevents problems while improving patienti nformedness and satisfaction. Limitations on personnel prevent the population's requests from being met.

Introduction

Multiple studies have shown that epoetin alpha (r-HuEpo) and darbepoetin alpha (NESP) are similarly effective and safe for maintaining haemoglobin levels in patients with chronic kidney disease (CKD). Nevertheless, there is some debate over their cost-effectiveness. The purpose of this study is to carry out a cost-minimisation analysis including a comparison of the costs to the hospital arising from treatment with r-HuEpo vs NESP.

Methods

Prospective observational study. We included CKD patients on haemodialysis with no iron, vitamin B12 or folate deficiencies, treated with stable doses of IV r-HuEpo. Follow-up was performed over three periods: the first during six months, maintaining prior treatment with r-HuEpo; the second for eight months, after changing to NESP, and the third, during the final eight months, following resuming r-HuEpo treatment. For converting both treatments, the conversion factor established on technical sheet 1:200 was used.

Results

Fifty five patients completed the study and were valid for analysis. Their mean age was 68.3 years, and 18 were women (35.3%). The mean weekly doses at the end of each period were 8,058.8 (SD 3,911.1) IU for the EPO 1 period, 39.4 (SD 21.6) mg for NESP and 7,882.4 (SD 4,594.1) IU for EPO 2. The weekly costs for each treatment showed significant differences between NESP and r-HuEpo: the cost of NESP was higher.

Conclusion

In our study, we found that r-HuEpo and NESP were similarly effective in patients with CKD on haemodialysis, but that there was a significant cost increase associated with NESP treatment.

Objective

The purpose of this study was to optimise the HPLC-UV bio-analytical method currently used by the Salamanca University Clinical Hospital for determining lamotrigine plasma levels.

Material and methods

The developed HPLC-UV analytic technique currently in use was shown to be linear, exact and precise, and suitable for use in routine monitoring of lamotrigine levels. The drawback of this method has always been the time required for analysing samples, so our aim was to improve on that elapsed time.

That improvement involved using a different chromatographic column from the one used up until now. We replaced the column that was normally used (Kromasil−100C18−5 μm−15^*0.4 cm with a LiChroCART-RP18e−3 μm−5.5^*0.4 cm); in both cases, a liquid-liquid extraction was performed and the same sample extraction protocol was followed.

Results

Both validation methods showed that the two column types are valid for routine lamotrigine monitoring.

Conclusion

The decrease in retention time, in addition to a lower quantification limit and better precision and accuracy parameters obtained with the LiChorCART column, suggest that this unit is ideal for use in clinical practice because it enables a large number of determinations to be performed in less time and the greater precision of LTG measurements.

Objective

To determine the duration of and reasons behind changing the various combinations of drugs used for the initiation of antiretroviral treatment in naïıve patients.

Methods

A retrospective observational study that included all patients with HIV infection who started antiretroviral therapy in a high-tech university reference hospital during the period from 1 January 2003 and 31 December 2005. Patients were followed until 31 December 2008. To estimate the cumulative probability of discontinuation the Kaplan- Meier method was used.

Results

A total of 441 patients were included. The average duration of the first treatment was 384 (interquartile interval 84–1290) days. The regimen based on non-nucleoside reverse transcriptase inhibitors and those that included as nucleosides abacavir or tenofovir in combination with lamivudine or emtricitabine showed a significantly longer duration than the rest. The main reasons for termination were the side effects, although in a lesser percentage than that obtained in previous studies. No associations were found between the rest of the characteristics of the patients or of the treatment and the risk of termination.

Discussion

Although the duration of the first antiretroviral treatment remains short, currently fewer changes are made due to side effects and due to loss to follow-up. The reasons may be better tolerance and less complexity. However, more studies are needed to determine the benefits of one regimen or another, and to be able to generalise the results.

Introduction

Administration of biphosphonates in patients with renal failure requires a dosage adjustment.

Objectives

Analyse renal function evolution in multiple myeloma patients after reducing infusion time for 90 mg pamidronate by 2 h.

Methods

In 2007, a retrospective study was carried out on all patients who presented multiple myeloma and bone metastasis treated with pamidronate administered every 4 h. Following a review of the literature, a protocol for administering pamidronate every 2 h was created in partnership with Haematology, and a specific dose reduction framework was established for patients with baseline renal failure. Additionally, a prospective follow-up study of those patients’ renal function was completed to analyse its evolution after the change in infusion time.

Results

A total of six patients received 90 mg pamidronate every 4 h. 33.32% of the patients (2/6) presented baseline renal insufficiency, and therefore needed to have the pamidronate dose adjusted according to the new protocol. Subsequently, all of them received the treatment every 2 h, and one patient (16.6%) experienced altered renal function after two treatment cycles.

Discussion

Reducing administration time for pamidronate from four to 2 h did not lead to significant variations in patients’ renal function. This therapeutic practice can improve patients’ quality of life by shortening their hospital stay without aggravating their renal function.