[Unsuspected danger of a medicinal preparation]. / Danger inattendu d'une préparation magistrale.

INTRODUCTION: Inhaled foreign bodies are commonly reported in childhood but less so among adults. We report the case of a patient who inhaled a medicinal preparation containing meprobamate and quinine sulfate. The consequence of this was caustic damage to the airways. CASE REPORT: A 64-year-old woman came to the emergency room because of dyspnea, oropharyngeal pain and sialorrhea. She reported that she had inhaled a capsule containing meprobamate and quinine sulfate the previous day. Flexible bronchoscopy showed evidence of caustic damage to the larynx and lower airways. The patient was treated by fasting, corticoids and intravenous broad-spectrum antibiotics. All the lesions recovered and she was discharged from the hospital 15 days after the event. CONCLUSIONS: Inhalation of drugs mostly leads to airway obstruction. Risk of harm is influenced by neurological status, the motility of the digestive system and the properties of the drug. To the best of our knowledge, this is the first time that caustic airway disease has been described following inhalation of a medicinal preparation containing meprobamate and quinine. It highlights the need to be familiar with the chemical properties of medications when prescribing them to patients who are at risk of aspiration.

Added value of pharmacist-acquired drug histories in an orthopaedic ward.

In Belgian hospitals, drug histories of patients taken on admission are generally collected by medical trainees, physicians and nurses. As errors in drug histories may lead to medication errors and adverse drug events, we aimed at comparing the data obtained by a clinical pharmacist with those obtained by the nurses in a surgical orthopaedic ward. In this four months study, 50 patients, with a mean age of 66 years, were included. Out of these 50 drug histories, 107 differences were found when comparing the data gathered by the nurses with the data of the pharmacist. On average, there were 2.1 discrepancies per patient. Omission of a drug and incorrect or unknown dose accounted for 80.3% of the discrepancies, while allergy and/or intolerance, incorrect frequency and addition of a drug accounted for respectively 11.2%, 4.8% and 3.7%. Interestingly, six drug categories represented almost 55% of the drug-related discrepancies.These were, in order of importance: anxiolytic and neuroleptics, antacids and proton pump inhibitors (PPI's), painkillers, antidepressants, aspirin and eye drops. Finally, 27% of the discrepancies concerned "over the counter" drugs. From this study we were able to conclude that the clinical pharmacist performed more complete and more accurate drug histories than nurses in the surgical orthopaedic care unit, especially in patients taking multiple drugs. These results suggest that drug histories taken by a pharmacist may lead to a reduction of potential adverse drug events during hospitalisation.