Isavuconazole-tacrolimus drug-drug interactions in HSCT patients.

OBJECTIVES: Because tacrolimus has a narrow therapeutic window and exhibits both intraindividual and interindividual variability, we attempted to establish the percentage of calcineurin inhibitor (CNI) dose reduction to prevent toxicity and ensure stem cell engraftment when using this immunosuppressant with the antifungal isavuconazole (ISA). By calculating the tacrolimus concentration/dose (C/D) ratio, we expected to demonstrate the magnitude of change in the C/D ratio from baseline after ISA administration. METHODS: We evaluated the interaction between ISA, a new triazole antifungal used in prophylaxis for invasive fungal infections, and the CNI class of immunosuppressive drugs, specifically tacrolimus, in 11 blood samples from HSCT recipients. RESULTS: The mean tacrolimus C/D ratio increased 1.44-fold from baseline 48 h after ISA administration (P = 0.001). CONCLUSIONS: Although further investigation is needed, the results of this study suggest that a reduction of 18% in tacrolimus may be recommended.

[Review of the stabitlity of photosensitive medications]. / Revisión de la estabilidad de los medicamentos fotosensibles.

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 was comprised of 139 photosensitive medicines, of the 1,954 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 photo-sensitivity 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.

[Effectiveness of an intervention to improve medical prescription quality in specialized care]. / Efectividad de una intervención en la mejora de la calidad de prescripción con receta médica en atención especializada.

OBJECTIVE: The study was designed to research whether providing doctors with customized reports on prescription indicators,plus a presentation of the project to clinical departments and hospital boards, would improve prescription quality in specialized care. MATERIAL AND METHODS: Quasi experimental intervention study. During three periods of time we observed whether any differences between physicians receiving said reports (intervention group) and physicians not receiving said reports (control group)occurred in three overall quality markers (94 physicians)--generic drugs, low therapeutic value drugs, and irrelevant novel drugs-and two specific indicators--angiotensin converting enzyme inhibitors (109 physicians) and omeprazole (169 physicians). Indicators were assessed using mean values (95% Cl) and differences between groups with the z test. RESULTS: Prior to the intervention, indicators had no significant differences. At 4-6 months after delivering the report, generic drug prescription improved in the intervention group - 3.13%(1.79-4.47) versus 1.81% (1.08-2.54) in the control group,p = 0.041. After 10-12 months the intervention group had significantly improved versus the control group regarding: generic drugs, 4.01% (2.28-5.73) versus 2.22% (1.56-2.87), p = 0.025;ACE inhibitors, 58.89% (47.56-70.21) versus 45.91% (36.03-55.79), p = 0.042; and low therapeutic utility drugs, 8.57%(5.56-11.6) versus 12.35% (8.96-15.74), p = 0.047. Improvement regarding omeprazole did not reach statistical significance,and novel medications remained virtually unchanged. CONCLUSION: The intervention proved effective for the improvement of qualitative prescription indicators in specialized care.

[Cystic fibrosis: nutritional aspects and recommendations]. / Fibrosis quística: aspectos y recomendaciones nutricionales.

Given the high numbers of nutritional supplements and enteral diets which are supplied for patients suffering from cystic fibrosis, by the departments of hospital pharmacy, the present study aims to review which are the characteristics of this disease which determine the appearance of malnutrition in these patients. Also, their nutritional treatment has been reviewed. On one hand, considering the general dietary measures, keeping in mind the composition of the diets, their characteristics according to age, and the supplementation with vitamins and with pancreatic enzymes. On the other hand, there is a review of the special dietary measures which should be applied in case of failure to thrive of the child, which goes from the modification of the oral diet, to the administration of parenteral nutrition.

[Alternatives to solid pharmacutical forms usually given by enteral nutrition tubes]. / Alternativas a las formas farmacéuticas sólidas administradas habitualmente por sondas de nutrición enteral.

We analyze which drugs of those administered through an enteral nutrition tube, present problems which are inherent to the pharmaceutical forms. The study is conducted with a sample of 40 patients who have a feeding tube, who received a total of 48 different medications. 38 (78.3%) were in a solid pharmaceutical form, and 10 (21.7%) were liquid. Among the most used medications, ranitidine stands out in 12 patients, paracetamol in 8, and phenytoin in 7. We note the use of the solid forms of phenytoin, nifedipine, and controlled release morphine, as having the greatest interest due to their contraindication. For all the studied cases, we propose alternatives and we note those drugs for which we did not find any. The hospitalary pharmaceutical guides should include liquid pharmaceutical forms of those drugs which should not be ground up. There is little information on the wards about the administration of drugs through feeding tubes.

[Literature review on the stability of diluted mixtures of cytostatic agents]. / Revisión bibliográfica de la estabilidad de las mezclas diluidas de citostáticos.

Up-to-date, evidence-based consensus protocols are an increasingly incorporated tool in health care. These protocols, clinical pathways, etc., represent a major support of health-care quality, namely scientific-technical quality. Compliance with these protocols by all team members guarantees that all patients be provided with an adequate level of health-care quality in the light of current knowledge and using available means. This principle of uniformity and quality in health care is essential for all, no matter the level of health care delivered or the activity being developed. In the Pharmacy Department and, more specifically, in the Unit of Cytostatic Agent Reconstitution and Dosing, knowledge and consensus on stability conditions and timing for diluted mixtures are essential to reach area-related quality standards. From literature references that are most relevant to or most widely used by in-hospital pharmacy departments, we designed a documented stabilities protocol to be used as a tool to: Augment preparation quality by including a documented expiry date within labels, optimize management on the basis of scientific criteria for mixtures not administered to patients and returned to the Pharmacy Department and design alternatives to hospitalization and outpatient delivery programs to improve end-user satisfaction and, therefore, health-care quality.

[Assessment of prescription in discharge reports at a university hospital]. / Evaluación de la prescripción de medicamentos en los informes de alta en un hospital universitario.

OBJECTIVE: To determine and analyze drug prescription at hospital discharge, mainly regarding generic drug use, use of novel but irrelevant therapeutic agents and use of low therapeutic value drugs (LTVD). MATERIAL AND METHODS: In a retrospective study 195 discharge reports from 11 different departments in a 450-bed general hospital were analyzed for a monthly period. An Access database allowed us to record the number of prescriptions, each drugs therapeutic group according to the Anatomical Therapeutic Chemical (ATC) Classification System, prescribed drugs for which generics are available, prescribed C-group drugs, LTVD drugs, etc. RESULTS: Following an analysis of results, only 6.17% of all drugs were prescribed according to their generic name, when this would have been possible in 22.8%. If only the most efficient agents had been prescribed, savings would have amounted to 589.3 Euros. In all, 1.28% of prescribed drugs were LTVD, and 1.15% had irrelevant therapeutic value. CONCLUSION: Although specialized medical prescription represents a minimum of total prescriptions in a healthcare area, measures intended to improve quality will have a positive impact on primary care prescriptions. These measures include information to physicians on more efficient preparations, plus the design of a Pharmacotherapeutic Guide to unify pharmacologic criteria in the Area.

[Improvement of the knowledge on allergic cross-reactions between two drug groups: beta-lactams and NSAIDS]. / Mejora del conocimiento sobre reacciones alérgicas cruzadas en dos grupos de medicamentos: ß-lactámicos y AINEs.

OBJECTIVES: To identify opportunities for improving the available knowledge of health care professionals (particularly, physicians, pharmacists, and nurses) on crossed allergic reactions (CAR) to penicillins and NSAIDs. METHOD: Quasi-experimental prospective pre-exposure study at a 412-beds hospital. An assessment of the knowledge on CAR to penicillins and NSAIDs was performed by means of anonymous questionnaires before (1st questionnaire) and after (2d questionnaire) the implementation of a series of improvement measures: protocol of "patient allergic to drugs", pocket card, poster with summarized information, and informative talks. The questionnaires served as the CRF and the statistical analysis was done with the SPSS v18.0 software. RESULTS: The mean number of errors in the first questionnaire on CARs of penicillin allergic patient and on CARs of NSAIDs allergic patients was 20.53 and 27.62, respectively. The mean number of errors in the second questionnaire on CARs of penicillin allergic patient and on CARs of NSAIDs allergic patients was 2.27 and 7.26, respectively. All the results were significant for a p level < 0.005. CONCLUSIONS: - There is insufficient knowledge on CARs to penicillins and NSAIDS, which justifies improvement measures. - After the implementation of improvement measures, there is an increased knowledge on CARs to penicillins and NSAIDs in the study groups.

Objetivos: Identificar oportunidades de mejora, sobre el conocimiento disponible del personal sanitario (en concreto a personal médico, farmacéutico y de enfermería), sobre reacciones alérgicas cruzadas (RAC) de penicilinas y AINEs. Método: Estudio prospectivo cuasiexperimental pre-exposición en un hospital de 412 camas. Se realizó una valoración del conocimiento sobre RAC de penicilinas y AINEs, a través de encuestas anónimas, antes (1a encuesta) y después (2a encuesta) de la implantación de una serie de medidas de mejora: protocolo "paciente alérgico a medicamentos", tarjeta de bolsillo, póster resumen de información y charlas divulgativas. Las propias encuestas sirvieron de hoja de recogida de datos y el análisis estadístico se llevó a cabo con el programa SPSS v18.0. Resultados: La media de errores en las 1as encuestas sobre "RAC en paciente alérgico a penicilinas" y sobre "RAC en paciente alérgico a AINEs", fue de 20,53 y 27,62, respectivamente. La media de errores en las 2as encuestas sobre "RAC en paciente alérgico a penicilinas" y sobre "RAC en paciente alérgico a AINEs", fue de 2,27 y 7,26, respectivamente. Todos los resultados se consideraron significativos para un nivel 945;< 0,05. Conclusiones: - No se dispone de un nivel adecuado de conocimiento sobre RAC de penicilinas y AINEs, lo que justifica la realización de un ciclo de mejora. - Tras la implantación de las medidas de mejora se aprecia un aumento en el nivel de conocimiento sobre RAC en penicilinas y AINEs, en los grupos de estudio.