Journal de pharmacie de Belgique最新文献

Due to the increasing complexity of medication regimens it is not always easy for the pharmacist to quickly and effectively screen the drug use of a particular patient for interactions. By means of a survey and a comparison, the advantages and disadvantages of the most common software packages available in Flanders were analysed. Major stumbling blocks of the currently available software are the high number of false positive signals, the absence of a history regarding the management of interactions, the lack of timely updates of the database and the absence of clear guidelines for the management of an interaction. Based on this research, we make the following recommendations: (1) signal fatigue should be reduced by interaction screening based on the duration of therapy in addition to the ability to suppress signals, (2) a log, coupled with the prescription-register, should be implemented, (3) software companies should help pharmacists more in configuring software preferences and provide them with better information bout the available options, (4) the underlying databases must be updated more quickly. (5) OTC medications, especially in the context of polypharmacy, should be registered in the patient record by the pharmacist, (6) note that food supplements are not included in the interaction screening software, unlike registered medication. (7) the knowledge of pharmacists regarding interactions should be maintained and improved.

Almost half of the women do not follow the guidelines around folate suppletion before and during pregnancy, despite the proven benefit in the prevention of neural tube defects, miscarriages and premature births. The Belgian Superior Health Council recommends a minimum of 400 micrograms of folic acid or folate suppletion per day from 4 weeks before conception to 8 weeks thereafter. Many studies point to the importance of a wider intake period, more particularly at least 3 months before conception and throughout pregnancy and lactation. In high-risk women 4 mg is recommended until after the first 3 months of pregnancy. Afterwards the usual dose of 400 micrograms is sufficient. About half of the European population appears to have a gene mutation on the gene coding for the production of methylenetetrahydrofolate reductase, the enzyme that is involved in the formation of 5-methyltetrahydrofolate, which is, in his turn, responsible for the conversion of the toxic homocysteine in methionine. Women with such a gene polymorphism have a significantly higher risk to have a miscarriage or a baby with neural tube defects. For this reason, a search for an alternative form of synthetic folic acid supplement "pteroylmonoglutamic acid (PMG)" was conducted, particularly the calcium salt of 5-methyltetrahydrofolate (Metafolin). This offers the possibility to deliver the reduced folate immediately, which no longer needs to be converted by the reductase enzyme. Furthermore, this avoids free PMG in the circulation, lowers the risk for drug interactions and a vitamin B2 deficiency will not be masked. Despite clear guidelines regarding dietary supplements before and during pregnancy, their implementation is poor. Not only gynecologists but also GPs and pharmacists, should make more efforts to provide women of childbearing age with personal information. Especially risk groups such as adolescents, low-skilled or less well-off women and immigrants deserve special attention.

Cough is a common symptom, often experienced as troublesome. The cough reflex is a physiological defense of the respiratory tract, most often triggered by irritation or obstruction of the airways. Productive cough can expel bronchial secretions. This cough is certainly useful. An irritating, dry cough however, has no purpose and can justify the temporary use of a cough suppressant to relieve symptoms. The pharmacist is often the first person to whom the patient turns. Persistent cough generally indicates an underlying condition that requires a causal treatment. In this case, the pharmacist should refer the patient to the doctor. This article aims to provide guidelines for dealing with dry cough in the pharmacy.

Every day, pharmacists are confronted with risks of interactions. If some interactions are well known by the pharmacist and easily detectable the considerable number of possible interactions makes necessary the use of IT technology to highlight them. However, once the risk of interaction identified, we need to analyze it to respond appropriately taking into account various factors that may influence the occurrence of adverse consequences for the patient. The computer is invaluable at this level, but it does not replace the knowledge and thinking of the pharmacist essential for meaningful and practical interpretation of interaction alerts and rational and safe use of medicines. In addition, pharmacists must remain vigilant because, in some situations, interactions whose consequences can be serious, will not be identified by computer systems. To illustrate this, some significant interactions of anti-inflammatory drugs (NSAIDs) are discussed in this article.

Medication management in home care is an error prone process. In a small pilot project in Flanders, community pharmacists collaborated with physicians and home care nurses through a shared electronic care plan, to optimize the medication management of their home care patients. The pilot project shows that GPs and nurses are positive about the possible contribution of the pharmacist in medication management of home care patients. A larger follow up study is necessary to further identify possible roles of pharmacists in home care and to show related health benefits.

The Substitution Treatment National Registry provided from mid 2006 till mid 2009 an exhaustive documentation on all patients being prescribed methadone or buprenorphine in Belgium. This endeavour was possible through cooperation of all community pharmacies and their representative organizations was supported at the time by the former Health federal minister. The Liberal belgian opiate medical substitution process authorizes untill now de facto any doctor to prescribe methadone and pharmacists are supported to dispense it. Results show the regional, provincial and county numbers of professionals and patients prevalence in the population. Nationwide, n = 16974 patients (prevalence for population aged 20-64: 26/10000) have been offered substitution from mid 2008 till mid 2009, n = 3390 pharmacies 164,4% of all pharmacies) and n = 2937 MDs (16,75% of all MDs) have been involved. Subutex or Suboxone have been dispensed to 11,1% of substitution patients with 7,4% receiving only buprenorphine on a yearly basis. Number of substitution patients by MD and prevalence by gender, age group and region are presented. Important variations are observed locally, possibly mirroring heroin addiction due to widespread access to substitution treatment. Younger patients are more prevalent in semi rural or border areas. The exhaustivity of available data enables also to observe patients quitting substitution altogether and a strong difference of maintenance rate is observed favoring methadone over buprenorphine.

This article attempts to provide a guideline for the different modalities of taking oral antibiotics. On the one hand, it focuses on the time interval between two administrations, and on the other hand on the time of optimal absorption. Antibiotics can be classified into 2 groups--either time dependent or concentration dependent--based on their antibacterial mechanism of action. By understanding the underlying reason for the different administration schedules (for example, why antibiotic A is taken three times daily with a meal and antibiotic B only once and sober), pharmacists and technicians are far better prepared for their task to inform the patient who is dispensed a first prescription.

Aim: This observational community pharmacy-based study aimed to investigate headache characteristics and medication use of persons with regular headache presenting for self-medication.

Methods: Participants (n=1205) completed ii) a questionnaire to assess current headache medication and previous physician diagnosis, (ii) the ID Migraine Screener [ID-M] and (iii) the MIDAS questionnaire.

Results: Forty-four % of the study population (n=528) did not have a physician diagnosis of their headache, and 225 of them (225/528, 42.6%) were found to be ID-M positive. The most commonly used acute headache drugs were paracetamol (used by 62% of the study population), NSAIDs (39%) and combination analgesics (36%). Only 12% of patients physician-diagnosed with migraine used prophylactic migraine medication, and 25% used triptans. About 24% of our sample (n=292) chronically overused acute medication, which was combination analgesic overuse (n=166), simple analgesic overuse (n=130), triptan overuse (n=19), ergot overuse (n=6) and opioid overuse (n=51). Only 14.5% was ever advised to limit intake frequency of acute headache treatments.

Conclusions: This study identified underdiagnosis of migraine, low use of migraine prophylaxis and triptans, and high prevalence of medication overuse among subjects seeking self-medication for regular headache. Community pharmacists have a strategic position in education and referral of these self-medicating headache patients.