Basic & Clinical Pharmacology & Toxicology最新文献

To address challenges in deprescribing, we investigated the feasibility of an intervention consisting of a clinical medication review (CMR) focused on deprescribing, supported by a training programme for healthcare providers (HCPs) among older patients with hyperpolypharmacy (≥ 10 chronic medications) in primary care. A mixed-methods feasibility study was conducted in six Dutch community pharmacies using Bowen's framework. The intervention comprised HCP training and a five-step deprescribing-focused CMR. Within 6 Bowen domains, 18 outcomes were assessed through (patient) questionnaires, interviews (patients, HCPs), process parameters, and medication dispensing data. Five pharmacists conducted CMRs with 24 patients (median age: 84.5 years). The intervention was well accepted by patients and HCPs. However, barriers emerged regarding implementation and practicality. Consultations lacked complete discussion of patient concerns, and pharmacists reported varying levels of confidence in making deprescribing decisions. Time constraints limited the incorporation of deprescribing into CMRs. On average, 1.3 medications per patient were deprescribed. Within a setting of motivated and CMR-experienced HCPs, adding a focus on deprescribing to CMRs for older patients with hyperpolypharmacy was feasible and well received. Feasibility was supported by high acceptability and deprescribing potential, though barriers in implementation and practicality indicate the need for further evaluation in broader primary care settings.

Many patients report being allergic to opioids and/or have allergy warnings documented in their medical records. However, the reasoning behind these warnings is often unclear and frequently lacks clinical validation. Reported reactions may include skin rashes, itching, severe vomiting, fainting or respiratory arrest occurring during postoperative recovery where opioids were administered. In many cases, there is also uncertainty about which specific opioid was used. An allergy warning to one opioid further raises the question of whether the patient can tolerate other opioids. In this review, we address the exceedingly rare IgE-mediated opioid allergy and cross-reactivity between opioids, along with non–immune-mediated histamine release and other adverse effects of opioids that patients or clinicians may mistake for allergic reactions. We propose a simple risk stratification algorithm for the clinical management of patients labelled as opioid allergic—helping to distinguish who should be referred for allergy evaluation and who can safely be treated with opioids with or without antihistamine pre-treatment.

Colorectal cancer is a growing global health concern with complex pharmacotherapy, especially as oral anticancer drugs shift responsibility for adherence to patients. This study explores the experiences of colorectal cancer patients in medication counselling in hospitals and community pharmacies. A qualitative study was conducted through semistructured individual interviews with patients with colorectal cancer (N = 21) from a university hospital. Inductive content analysis was performed using ATLAS.ti software, identifying key categories and subcategories. The following five main themes emerged: sufficiency of counselling; medication reconciliation; management of anticancer medication-related problems; instructions for contacting healthcare; and instructions for medication use. Patients reported varied experiences. Some felt well-informed and confident, while others found counselling insufficient and needed more support. Discrepancies in medication reconciliation were raised, particularly regarding nutritional and herbal products. The pharmacy's role in medication risk management was highlighted, with some patients' medications adjusted based on pharmacy consultation. While side effect management was generally addressed, some patients wanted more detailed information. Challenges in accessing counselling were highlighted, especially during weekends. Medication counselling for colorectal cancer patients should be more consistent across healthcare settings. Strengthening the role of pharmacies and enhancing collaboration and information flow between hospitals and pharmacies is crucial for achieving better patient outcomes.

The accelerating integration of rare earth elements (REEs) in advanced technologies has generated rising concern over human exposure and the attendant toxicological risks. This review presents an up-to-date synthesis of current evidence on REE toxicity across multiple exposure pathways, including inhalation, ingestion and occupational contact, providing an integrative perspective from human clinical data, animal models and in vitro systems. Distinct from traditional reviews, it critically appraises how REE-specific mechanisms, such as oxidative stress, mitochondrial dysfunction and metal ion substitution, produce multiorgan effects with clinical manifestations distinct from those of conventional heavy metals. A key novel finding is the pronounced therapeutic gap. Although chelation is well established for many toxic metals, effective chelation therapy for REE remains largely undeveloped, with current agents like DTPA showing limited efficacy, particularly for gadolinium and cerium, underscoring a major gap in clinical practice. The review highlights vital implications for clinicians, stressing the importance of early exposure recognition, tailored supportive care and the urgent development and validation of REE-specific chelators. Priorities for future research include creating novel chelation strategies and harmonizing international guidance to protect exposed populations. This synthesis aims to equip health professionals, toxicologists and policy-makers with actionable insight, emphasizing the clinical and regulatory urgency of increasing REE exposure and toxicity.