ABSTRACT
El uso prudente de antibióticos requiere un abordaje interdisciplinar en el que la farmacia, tanto hospitalaria como comunitaria, desempeña un papel importante. Las actividades que se realizan en la farmacia hospitalaria se pueden dividir en 3 fases: a) antes de la prescripción: mediante la selección de antimicrobianos, la elaboración de guías de profilaxis y tratamiento empírico, y la incorporación de las decisiones en programas informáticos que permitan una prescripción electrónica informada; b) durante la prescripción: evaluación de la prescripción, adecuación de la dosis y pauta a los datos del paciente y de la infección, preparación de las dosis listas para su uso, ajustes farmacocinéticos y monitorización de la duración de los tratamientos, y c) después del tratamiento: realizando auditorías clínicas y medidas de la utilización de antibióticos. Desde la farmacia comunitaria las actividades a realizar son fomentar la adherencia al tratamiento, el seguimiento farmacoterapéutico del paciente para prevenir y detectar problemas relacionados con la medicación, y evitar la dispensación sin prescripción médica. Como propuestas de mejora se considera principalmente la formación en el control del uso de antimicrobianos, la integración en equipos interdisciplinares y la no venta de medicamentos sin prescripción médica
Appropriate use of antibiotics requires an interdisciplinary approach in which hospital and community pharmacies play a key role. The activities carried out in hospital pharmacy can be divided into 3 stages: a) before prescription: through the selection of antimicrobial agents, the creation of guides on prophylaxis and empirical treatments, and incorporation of the decisions into computer programmes that provide detailed electronic prescriptions; b) during prescription: prescription assessment, dose adjustment, patient information and infection data, preparation of doses to be used, pharmacokinetic adjustments and monitoring of treatment duration, and c) after treatment: clinical audits and measurements of the use of antibiotics. In community pharmacy, activities include promoting patient compliance, pharmacotherapeutic follow-up of patients to prevent and detect drug-related problems and avoidance of over-the-counter drug dispensation. Suggestions for improvement include mainly training in monitoring the use of antimicrobials, integration in interdisciplinary teams and avoiding the sale of over-the-counter antibiotics
Subject(s)
Humans , Anti-Bacterial Agents/therapeutic use , Community Pharmacy Services/standards , Pharmacy Service, Hospital/standards , Drug Resistance, Bacterial , Drug Utilization/standardsABSTRACT
Appropriate use of antibiotics requires an interdisciplinary approach in which hospital and community pharmacies play a key role. The activities carried out in hospital pharmacy can be divided into 3 stages: a) before prescription: through the selection of antimicrobial agents, the creation of guides on prophylaxis and empirical treatments, and incorporation of the decisions into computer programmes that provide detailed electronic prescriptions; b) during prescription: prescription assessment, dose adjustment, patient information and infection data, preparation of doses to be used, pharmacokinetic adjustments and monitoring of treatment duration, and c) after treatment: clinical audits and measurements of the use of antibiotics. In community pharmacy, activities include promoting patient compliance, pharmacotherapeutic follow-up of patients to prevent and detect drug-related problems and avoidance of over-the-counter drug dispensation. Suggestions for improvement include mainly training in monitoring the use of antimicrobials, integration in interdisciplinary teams and avoiding the sale of over-the-counter antibiotics.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Community Pharmacy Services/standards , Pharmacy Service, Hospital/standards , Drug Resistance, Bacterial , Drug Utilization/standards , HumansABSTRACT
RATIONALE: Prepulse inhibition (PPI) of the acoustic startle response is an operational measure of sensorimotor gating that can be assessed in both humans and animals. The noradrenergic system appears to play a role in PPI as the alpha1 agonist cirazoline disrupts PPI and the alpha1 antagonist prazosin blocks the disruptions in PPI produced by phencyclidine. OBJECTIVES: To better understand the role of adrenergic receptors in the modulation of PPI, we assessed the effects of the alpha2 adrenergic antagonist yohimbine (2.5, 5.0, and 7.5 mg/kg) on PPI. RESULTS: Yohimbine reduced PPI at the 5.0 and 7.5 mg/kg doses, without significantly affecting startle magnitude. In separate experiments, we examined whether adrenergic or serotonergic compounds blocked this disruption in PPI produced by yohimbine. There was a trend for the alpha2 agonist clonidine (0.01, 0.02 mg/kg) to attenuate the PPI disruption produced by yohimbine. However, other alpha2 agonists (guanfacine, medetomidine) and an alpha1 antagonist (prazosin) failed to prevent the disruption. The alpha2 antagonist atipamezole weakly decreased PPI in a narrow dose range (0.3-1.0 mg/kg). The 5-HT1A antagonist WAY100,635 (0.1, 0.3 mg/kg) significantly prevented the yohimbine-induced disruption of PPI. CONCLUSIONS: These findings indicate that (1) yohimbine disrupts PPI in rats and (2) the yohimbine-induced disruption of PPI is largely due to the 5-HT1A partial agonist properties of yohimbine.