Effect and associated factors of a clinical pharmacy model in the incidence of medication errors (EACPharModel) in the Hospital Pablo Tobón Uribe: study protocol for a stepped wedge randomized controlled trial (NCT03338725).

BACKGROUND: According to WHO, medication error (ME) is a subject that requires attention at all levels of care to reduce severe and preventable damage related to medication use. Clinical pharmacy practice standards have been proposed around the world so that the pharmacist, as part of a multidisciplinary health team, can help improve patient safety; however, further evidence derived from adequate studies is needed to demonstrate this. This study aims to assess the effect of a clinical pharmacy practice model (CPPM) in preventing MEs associated with the medication use process. METHODS: A prospective, stepped-wedge, cluster-randomized, controlled trial with a duration of 14 months will be performed to compare the effect of a CPPM along with the usual care process of patients in the Pablo Tobón Uribe Hospital (Medellin, Colombia). The study is designed as a cluster-randomized controlled trial, involving five hospital wards (clusters) and 720 patients. Medical wards are allocated to interventions using a stepped-wedge design. Clusters are initially assigned to the control group. After a 2-month observation period, hospital clusters were randomly allocated to the intervention group. Study outcomes will be assessed at baseline and at 2, 4, 6, 8, 10, and 12 months after randomization. The primary outcome will be to assess the effect of a CPPM on the incidence of medication errors associated with the medication use process. Drug-related problems and factors that contribute to the occurrence of MEs will be assessed as secondary outcomes. Statistical analyses will be performed using a mixed model, with the treatment group and time as fixed effects and the clustering structure as a random effect. Statistical analysis will be performed using Pearson chi-square tests and Student's t-tests, and a P value < 0.05 will be considered statistically significant. DISCUSSION: As far as we know, this is the first stepped-wedge, cluster-randomized, controlled trial designed to assess the change of a CPPM on the incidence of medication errors in a hospital in Colombia, and it could generate valuable information about a standardized and patient-centered clinical pharmacy model to improve the safety of inpatient care. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03338725. Registered on 9 November 2017. The first patient was randomized on 2 February 2018. PROTOCOL VERSION: 0010112018JG.

Incidencia de resultados clínicos negativos asociados a la utilización de medicamentos trazadores/señaladores en pacientes hospitalizados, Medellín-Colombia / Incidence of negative clinical results associated with the use of tracing/signaling drugs in hospitalized patients, Medellín-Colombia

Objetivo: Determinar la incidencia de resultados clínicos negativos-RNM en pacientes hospitalizados con prescripción de medicamentos trazadores/señaladores durante su estancia hospitalaria. Método: Diseño: Estudio de cohorte abierta. Ámbito: Institución de Salud de alta complejidad -Medellín. Periodo: noviembre 2013-noviembre 2015. Muestra: Grupos (expuestos y no expuestos) se clasificaron como pacientes con uno o más medicamentos trazadores y sin ellos, en una relación 1 (expuestos): 2 (no expuestos); ambos grupos se parearon por variables socio-demográficas y clínicas; edad con una diferencia no mayor a +/-5 años, sexo, diagnóstico principal y comorbilidades principalmente. Variables: número de medicamentos trazadores; mediante seguimiento farmacoterapéutico - SFT se identificaron problemas de necesidad, efectividad y seguridad asociados a los medicamentos. Resultados: Se incluyeron 324 pacientes, 108 (33,3%) expuestos y 216 (66,7%) no expuestos. La edad media fue 52 años (DE 25,7), 198 (61%) hombres. El 31,2% (101) de los pacientes presentó algún tipo de RNM. En los expuestos, la incidencia de RNM fue 43,5% (47 pacientes) y en los no expuestos la frecuencia de RNM fue 25% (54 pacientes). Se observó mayor incidencia de RNM en pacientes con 2 a 3 medicamentos (49,1%). El riesgo asociado a la exposición al factor de riesgo (RR) fue 1,74 (IC95%:1,27-2,39) (P=0,001). Conclusiones: El riesgo relativo (RR) obtenido fue 1,74 (IC95%:1,27-2,39) (P=0,001), indicando que la utilización de medicamentos trazadores/señaladores se asocia a la presentación de RNM. Por tanto, esta estrategia se podría utilizar para la identificación, priorización y selección de pacientes en los programas de farmacoseguridad

Objective: To determine the incidence of negative clinical results - MNR in hospitalized patients with prescription of tracer/marker drugs during their hospital stay. Method: Design: open cohort study. Scope: high complexity Health Institution - Medellin. Period: November 2013 - November 2015. Sample: groups (exposed and unexposed) were classified as patients with one or more tracer drugs and without them, in a ratio 1 (exposed): 2 (not exposed); both groups were matched by socio-demographic and clinical variables. The main ones were: age with a difference no greater than +/- 5 years, sex, main diagnosis and comorbidities. Variables: number of tracer drugs; Pharmacotherapeutic follow-up - SFT identified problems of need, effectiveness and safety associated with drugs. Results: We included 324 patients, 108 exposed (33.3%) and 216 unexposed (66.7%). The average age was 52 years (SD: 25.7), 198 (61%) patients were male. 31.2% (101) of patients had some type of Medication Negative Results. In those exposed, the incidence of MNR was 43.5% (47 patients) and in the no exposed the frequency of MNR was 25% (54 patients). A higher incidence of MNR was observe in patients with 2 or 3 medications (49.1%). The risk associated with the risk factor (RR) was 1.74 (CI 95% 1.27 - 2.39) (P = 0.001). Conclusions: The relative risk (RR) obtained was 1.74 (95% CI, 1.27-2.39) (P = 0.001), which indicates that the use of tracer / marker drugs is associated with the presentation of MNR. Therefore, this strategy could be used to identify and prioritize the selection of patients who must enter the pharmacy safety programs

Free software to analyse the clinical relevance of drug interactions with antiretroviral agents (SIMARV®) in patients with HIV/AIDS.

BACKGROUND: Highly active antiretroviral therapy has extended the expected lifespan of patients with HIV/AIDS. However, the therapeutic benefits of some drugs used simultaneously with highly active antiretroviral therapy may be adversely affected by drug interactions. OBJECTIVE: The goal was to design and develop a free software to facilitate analysis, assessment, and clinical decision making according to the clinical relevance of drug interactions in patients with HIV/AIDS. METHODS: A comprehensive Medline/PubMed database search of drug interactions was performed. Articles that recognized any drug interactions in HIV disease were selected. The publications accessed were limited to human studies in English or Spanish, with full texts retrieved. Drug interactions were analyzed, assessed, and grouped into four levels of clinical relevance according to gravity and probability. Software to systematize the information regarding drug interactions and their clinical relevance was designed and developed. RESULTS: Overall, 952 different references were retrieved and 446 selected; in addition, 67 articles were selected from the citation lists of identified articles. A total of 2119 pairs of drug interactions were identified; of this group, 2006 (94.7%) were drug-drug interactions, 1982 (93.5%) had an identified pharmacokinetic mechanism, and 1409 (66.5%) were mediated by enzyme inhibition. In terms of clinical relevance, 1285 (60.6%) drug interactions were clinically significant in patients with HIV (levels 1 and 2). With this information, a software program that facilitates identification and assessment of the clinical relevance of antiretroviral drug interactions (SIMARV®) was developed. CONCLUSIONS: A free software package with information on 2119 pairs of antiretroviral drug interactions was designed and developed that could facilitate analysis, assessment, and clinical decision making according to the clinical relevance of drug interactions in patients with HIV/AIDS.

Propuesta de un procedimiento para la construcción y validación de un instrumento psicométrico con base en un cuestionario de conocimientos sobre enfermedad cardiovascular en farmacias comunitarias de España / Proposed procedure for the construction and validation of a psychometric instrument based on a knowledge quiz about cardiovascular disease in patients attending in Spanish community pharmacies

Introducción: En la práctica clínica se requiere de herramientas para valorar el conocimiento de los pacientes, siendo los cuestionarios uno de los instrumentos más comunes. En general, los cuestionarios o instrumentos que se utilizan son traducidos o, bien, realizados ad hoc, limitando así su fiabilidad y validez. Objetivo: Desarrollar una propuesta global con el procedimiento para diseñar y validar un cuestionario. Métodos: Se realizaron revisiones bibliográficas en Pubmed/Medline y en Google Scholar de artículos con los siguientes términos: validation questionnaire and desing, developing a questionnaire y validación, diseño y cuestionario, que permitan identificar los pasos y la metodología adecuada para el diseño y la validación de un cuestionario. Resultados: Mediante la revisión se identificaron 78 artículos y se accedió al texto completo de 75 artículos. Con la información obtenida se elaboró una propuesta para diseñar y validar cuestionarios de conocimiento por pacientes. Conclusiones: Se presenta una propuesta de diseño y validación de cuestionario para orientar trabajos con este fin, la cual debe ser validada en futuros estudios

Introduction: In clinical practice, instruments that allow to quantify patients’ knowledge are frequently needed. Questionnaires are one of the most common instruments used. In general, the questionnaires or instruments used are translated or made ad hoc, which limits their reliability and validity. Objective: To develop a global proposal with the procedure to design and validate a questionnaire. Methods: We completed a bibliographic review in Pubmed / Medline and Google Scholar of articles with the terms: validation questionnaire and design, developing a questionnaire and validation, design and questionnaire, to identify the steps and the appropriate methodology to design and validate a questionnaire. Results: Through the review, 78 articles were identified and the full text of 75 articles was accessed. With the information obtained, it was developed a proposal to design and validate questionnaires of patients’ knowledge. Conclusions: It is presented a proposal to design and validate a questionnaire to guide works that have this purpose. Our proposal should be validated in future studies

Resultados negativos asociados a la medicación en pacientes medicoquirúrgicos de una institución hospitalaria / Negative outcomes associated with medication on medical-surgical patients of a hospital institution

Introducción: El seguimiento farmacoterapéutico (SFT) es la actividad en la que el farmacéutico se responsabiliza de la farmacoterapia del paciente. Diferentes estudios han mostrado un efecto positivo del SFT sobre el paciente y el uso adecuado de los medicamentos. Objetivo: Determinar la incidencia de resultados negativos asociados a la medicación (RNM) en los pacientes de las especialidades medicoquirúrgicas de la Clínica San Juan de Dios-Orden Hospitalaria San Juan de Dios (Colombia). Metodología: Estudio descriptivo, que utiliza el método Dáder adaptado al contexto hospitalario. En el estudio se incluyó aleatoriamente a 52 pacientes ingresados en la unidad medico quirúrgica entre noviembre y diciembre de 2011. Los RNM detectados se clasifi caron según el Tercer Consenso de Granada. Resultados: El promedio de edad (desviación estándar) de los pacientes fue de 46,4 (20,3) años. Del total de 52 pacientes, 43 (82,7%) fueron tratados por cirugía general. Se caracterizó a los pacientes según la estancia prolongada (65,4%) y el uso de antibióticos (63,5%). Se encontraron en total 53 RNM: 30 problemas de necesidad, 8 de efectividad y 15 de seguridad. Se realizó como promedio una intervención farmacéutica por paciente, con una aceptación global del 87% (un 98,1% de ellas realizadas al médico tratante). Conclusiones: En los pacientes medico quirúrgicos se identificó un RNM por paciente, y éstos eran susceptibles de intervención farmacéutica por parte del farmacéutico

Introduction: Pharmacotherapy monitoring (PM) is the activity in which the pharmacist is responsible for the patient’s drug therapy. Different studies have found positive impact on the patient PM and appropriate use of medicines. Objective: Determine the incidence of associated negative outcomes associated with medication (NOM) in patients in medical-surgical specialties Clínica San Juan de Dios-Orden Hospitalaria San Juan de Dios (Colombia). Methodology: Descriptive study using the method adapted to the context Dáder hospital. Randomly included 52 patients admitted to the medical-surgical unit between November and December 2011. The NOM detected were classified according to the Third Consensus of Granada. Results: Mean age of patients was 46.4 ± 20.3 years. A 43 (82.7%) of them were treated by general surgery. Patients were characterized as: extended stay (65.4% of patients), and antibiotic use (63.5% of patients). Found that 30 are related to the necessity, 8 are related to the effectiveness and 15 problems are related to the safety. Was performed on average per patient pharmaceutical intervention, with an overall acceptance of 87% (98.1% of them made the treating physician). Conclusions: We found 1 NOM per patient, being these susceptible of intervention by pharmacist

Interacciones medicamentosas de agentes hipolipemiantes: aproximación para establecer y valorar su relevancia clínica. Revisión estructurada / Hypolipidemic agents drug interactions: approach to establish and assess its clinical significance. Structured review

OBJETIVO: Realizar una revisión estructurada sobre interacciones medicamentosas de los hipolipemiantes y valorar su relevancia clínica. MÉTODO: Revisión estructurada de interacciones medicamentosas con hipolipemiantes en humanos, en PubMed/Medline de artículos publicados sin restricción de idioma, con acceso a texto completo hasta junio 30 de 2012. La búsqueda se realizó con los siguientes terminos Mesh: Drug Interactions, Lipid Regulating Agents, Herb-Drug Interactions, Food-Drug Interactions y Hypolipidemic Agents (Pharmacological Action). La información se complementó con artículos considerados importantes. Por último, se utilizó un método para evaluar la relevancia clínica de la interacción, basado en la probabilidad de ocurrencia y en la gravedad del efecto de la interacción. RESULTADOS: Se obtuvieron 849 publicaciones, de las cuales se seleccionaron 243 referencias, en las los que se identificaron 189 interacciones. De ellas 33 fueron valoradas como de riesgo muy alto (nivel 1) y 42 de riesgo alto (nivel 2), asociadas fundamentalmente al aumento del riesgo de rabdomiólisis. La inhibición enzimática de la CYP450 fue el mecanismo más común de las interacciones. CONCLUSIONES: En los pacientes en tratamiento con hipolipemiantes, de las interacciones identificadas 60,3% (128/189) son clínicamente relevantes (riesgo muy alto o alto), asociadas principalmente a la aparición de rabdomiólisis. La mayoría de dichas interacciones son atribuidas al uso simultáneo de reconocidos inhibidores de la CYP3A4. Por ello, las estatinas metabolizadas por la CYP3A4 (simvastatina, lovastatina y atorvastatina) son las que más interacciones de relevancia clínica presentan

OBJECTIVE: To carry out a structures review of drug interactions of hypolipidemic drugs and to assess their clinical relevance. METHOD: Structured review of drug interactions of hypolipidemic drugs in humans through PubMed/Medline of published articles, without language restrictions and with full text access until June 30th of 2012. The following Mesh terms were used: Drug Interactions, Lipid Regulating Agents, Herb-Drug Interactions, Food-Drug Interactions y Hypolipidemic Agents (Pharmacological Action). The information was completed with those articles considered to be relevant. Finally, a method was used to assess the clinical relevance of the interaction, based on the likelihood of occurrence and the severity of the effect of the interaction. RESULTS: 849 publications were gathered, of which 243 references were selected, among which 189 interactions were identified. Thirty-three of them were considered of very high risk (level 1) and 42 of high risk (level 2), basically associated to increased risk for rhabdomyolisis. Enzymatic inhibition of CYP450 was the most common mechanism for these interactions. CONCLUSIONS: Of the interactions identified in patients on hypolipidemic drugs, 60.3% (128/189) are clinically relevant (very high or high risk), mainly associated to the occurrence of rhabdomyolisis. Most of these interactions are attributed to simultaneous use of CYP3A4 inhibitors. Therefore, statins metabolized through CYP3A4 (simvastatin, lovastatin and atorvastatin) are the ones with the highest number of clinically relevant interactions

[Hypolipidemic agents drug interactions: approach to establish and assess its clinical significance. Structured review]. / Interacciones medicamentosas de agentes hipolipemiantes: aproximación para establecer y valorar su relevancia clínica. Revisión estructurada.

OBJECTIVE: To carry out a structures review of drug interactions of hypolipidemic drugs and to assess their clinical relevance. METHOD: Structured review of drug interactions of hypolipidemic drugs in humans through PubMed/Medline of published articles, without language restrictions and with full text access until June 30th of 2012. The following Mesh terms were used: Drug Interactions, Lipid Regulating Agents, Herb-Drug Interactions, Food-Drug Interactions y Hypolipidemic Agents (Pharmacological Action). The information was completed with those articles considered to be relevant. Finally, a method was used to assess the clinical relevance of the interaction, based on the likelihood of occurrence and the severity of the effect of the interaction. RESULTS: 849 publications were gathered, of which 243 references were selected, among which 189 interactions were identified. Thirty-three of them were considered of very high risk (level 1) and 42 of high risk (level 2), basically associated to increased risk for rhabdomyolisis. Enzymatic inhibition of CYP450 was the most common mechanism for these interactions. CONCLUSIONS: Of the interactions identified in patients on hypolipidemic drugs, 60.3% (128/189) are clinically relevant (very high or high risk), mainly associated to the occurrence of rhabdomyolisis. Most of these interactions are attributed to simultaneous use of CYP3A4 inhibitors. Therefore, statins metabolized through CYP3A4 (simvastatin, lovastatin and atorvastatin) are the ones with the highest number of clinically relevant interactions.

Objetivo: Realizar una revisión estructurada sobre interacciones medicamentosas de los hipolipemiantes y valorar su relevancia clínica. Método: Revisión estructurada de interacciones medicamentosas con hipolipemiantes en humanos, en PubMed/Medline de artículos publicados sin restricción de idioma, con acceso a texto completo hasta junio 30 de 2012. La búsqueda se realizó con los siguientes terminos Mesh: Drug Interactions, Lipid Regulating Agents, Herb-Drug Interactions, Food-Drug Interactions y Hypolipidemic Agents (Pharmacological Action). La información se complementó con artículos considerados importantes. Por último, se utilizó un método para evaluar la relevancia clínica de la interacción, basado en la probabilidad de ocurrencia y en la gravedad del efecto de la interacción. Resultados: Se obtuvieron 849 publicaciones, de las cuales se seleccionaron 243 referencias, en las los que se identificaron 189 interacciones. De ellas 33 fueron valoradas como de riesgo muy alto (nivel 1) y 42 de riesgo alto (nivel 2), asociadas fundamentalmente al aumento del riesgo de rabdomiólisis. La inhibición enzimática de la CYP450 fue el mecanismo más común de las interacciones. Conclusiones. En los pacientes en tratamiento con hipolipemiantes, de las interacciones identificadas 60,3% (128/189) son clínicamente relevantes (riesgo muy alto o alto), asociadas principalmente a la aparición de rabdomiólisis. La mayoría de dichas interacciones son atribuidas al uso simultáneo de reconocidos inhibidores de la CYP3A4. Por ello, las estatinas metabolizadas por la CYP3A4 (simvastatina, lovastatina y atorvastatina) son las que más interacciones de relevancia clínica presentan.

Actuaciones profesionales realizadas en la farmacia comunitaria / Professional services carried out in the community pharmacy

Objetivo: Describir todas las actuaciones profesionales (AP) que se llevan a cabo como respuesta a las demandas realizadas por los usuarios en la farmacia comunitaria (FC). Material y métodos: Estudio observacional, descriptivo y transversal, realizado durante 6 meses en dos farmacias comunitarias de Denia (Alicante). La población de estudio fueron todas las demandas de servicio que realizaron los usuarios de ambas farmacias. La variable de estudio fue la AP, es decir, cada uno de los servicios demandados por el usuario en la FC: dispensación, indicación, automedicación, consultas y ventas, clasificándose cada uno en sus resoluciones e incidencias. Resultados: En el estudio se realizaron 30.617 AP, correspondiendo un 42% a la dispensación con receta, y se registró casi un 23% de incidencias. Las indicaciones farmacéuticas supusieron un 9% del total, resolviéndose en la mayoría de casos con la recomendación de un medicamento. Un 33% fueron demandas de automedicación, cursando con casi un 20% de incidencias. Un 7% fueron consultas y un 10% ventas de productos sanitarios. Conclusiones: Del total de AP realizadas, el 90% se consideran farmacéuticas. El 83% fueron dispensaciones de medicamentos, más de la mitad de éstas sin prescripción médica, lo que revela la importancia del asesoramiento farmacéutico en las dispensaciones sin receta. El hecho de que 9 de cada 10 incidencias que se producen en la dispensación con receta y en la automedica ción sean por la falta de información del paciente nos pone en alerta sobre la necesidad de implementar medidas que mejoren esta carencia(AU)

Objective: To describe all the professional actions (PA) carried out by the community pharmacy in response to the requests made by pharmacy users. Methods: Observational, cross-sectional, descriptive study in two pharmacies in Spain, over a 6 month-period. Population: all service requests made by pharmacy users. Study variable: Professional action, each of the services requested by pharmacy users: prescription-drug-dispensing, patient-counseling in minor ailments, self-medication, pharmacist-consultations, and sales-services. Classifying each of them in their decisions and incidents. Results: The study involved 30,617 PA, of which 42% were requests for prescription-drug-dispensing. Incidences were also recorded (23%). Nine percent of requests were for patient-counseling in minor ailments, and these were solved in 99% of cases with recommending of a drug, herbal or homeopathy product. Of the total PA, 33% were self-medication cases, with 20% of incidences. Seven percent were inquiries to the pharmacist and 10% of total requests were sales-services. In one out of four prescription-drug-dispensing event an incidence was detected, and in self-medication cases, in one out of every five. Conclusions: Of all the PA performed in the pharmacies under study, 90% were pharmaceutical activities. Most of these (83%) are directly associated with drug delivery (with/without prescription). The fact that more than a half of the total PA requested were without medical prescription should be further analyzed. The fact that nine out of ten incidents that occur in prescription-drug-dispensing and self-medication are the lack of patient information, it alerts us to implement measures to improve this shortcoming(AU)

Influencia de las características sociodemográficas y clínicas en la adherencia al tratamiento farmacológico de pacientes con riesgo cardiovascular / Influence of sociodemographics and clinical characteristics in the adherence of pharmacological treatment of patients with cardiovascular risk

Introducción: Algunos autores han señalado más de 200 factores y variables relacionados con el incumplimiento, que se deben tener en cuenta si se pretende modificarlo. Objetivo: Identificar las características sociodemográficas y clínicas asociadas a la adherencia al tratamiento farmacológico en pacientes ambulatorios con riesgo cardiovascular (RCV). Metodología: A los pacientes que cumplieron los criterios de inclusión se les hizo una entrevista inicial, que incluyó la recogida de las características sociodemográficas y clínicas y el test de adherencia. Se tomaron y registraron los valores de colesterol total y presión arterial, y se determinó el RCV del paciente. Si el RCV era moderado o alto, el paciente se incluía en el estudio. Resultados: La adherencia está favorecida por la percepción por parte del paciente del estado de salud como regular, malo o muy malo, por el sexo femenino y por la presencia de algún factor de RCV, como la dislipemia. Conclusiones: Es necesario considerar las diferentes variables que pueden influir en la adherencia y establecer estrategias individualizadas para luchar contra el incumplimiento del tratamiento farmacológico (AU)

Introduction: Some authors have pointed out more than 200 factors and variables related to the breach, to be taken into account if it is to change it. Objective: To identify sociodemographic and clinical characteristics associated with pharmacological treatment adherence in outpatients with cardiovascular risk. Methodology: Patients who met the inclusion criteria were asked an initial interview, which included collection of demographic and clinical characteristics and the adherence test. Were collected and recorded the values of total cholesterol and blood pressure, and determined the patient’s cardiovascular risk. If the cardiovascular risk was moderate or high, the patient was included in the study. Results: Adherence is favored by the patient’s perception of health status as fair, poor or very poor, for the female gender and the presence of any cardiovascular risk factor such as dyslipidemia. Conclusioins: It is therefore necessary to consider the different variables that may infl uence adherence and set individualized strategies for combating non-compliance with pharmacological treatment (AU)

Aproximación para establecer y evaluar la relevancia clínica de las interacciones medicamentosas en pacientes infectados con virus de la inmunodeficiencia humana: actualización 2009 / Approach to establishing and evaluating clinical relevance of drugs interactions in HIV patients: 2009 update

Objetivo Actualizar información sobre interacciones medicamentosas en pacientes con VIH/sida. Método Se realizó una revisión en PubMed de artículos publicados en inglés y español entre el 1 de julio de 2007 y el 30 de abril de 2009 sobre interacciones de antirretrovirales en humanos. La búsqueda fue complementada con la revisión de interacciones de medicamentos utilizados frecuentemente en pacientes con VIH/sida y de referencias de artículos considerados relevantes. Resultados Se encontraron 52 nuevas interacciones relacionadas con el metabolismo por el CYP3A4 y la competencia por la absorción intestinal, también se encontraron nuevas interacciones de tipo farmacocinético para medicamentos que ya estaban en el mercado, y se reportaron interacciones para medicamentos recientemente comercializados: tipranavir, fosamprenavir, darunavir, raltegravir, maraviroc y etravirina. Conclusiones Hay evidencia de 52 nuevas interacciones, encontrándose medicamentos que utilizan vías metabólicas en el sistema enzimático CYP450, y se aclaran otras del proceso de absorción intestinal (AU)

Objective To update information on drug interactions in patients with HIV/AIDS. Method PubMed was used to review English and Spanish articles published between 1 July 2007 and 30 April 2009 on antiretroviral drug interactions in humans. The search included a review of interactions between commonly-used medications in patients with HIV/AIDS and references from articles considered to be relevant.Results52 new interactions were identified having to do with CYP3A4 metabolism and competition for intestinal absorption. New pharmacokinetic interactions were identified for medications that were already on the market, and we report interactions for drugs that were recently introduced: Tipranavir, Fosamprenavir, Darunavir, Raltegravir, Maraviroc and Etravirine. Conclusions There is evidence of 52 new interactions between medications using metabolic routes in the CYP450 enzymatic system, and an explanation is given for others in the intestinal absorption process (AU)

[Approach to establishing and evaluating clinical relevance of drug interactions in HIV patients: 2009 update]. / Aproximación para establecer y evaluar la relevancia clínica de las interacciones medicamentosas en pacientes infectados con virus de la inmunodeficiencia humana: actualización 2009.

OBJECTIVE: To update information on drug interactions in patients with HIV/AIDS. METHOD: PubMed was used to review English and Spanish articles published between 1 July 2007 and 30 April 2009 on antiretroviral drug interactions in humans. The search included a review of interactions between commonly-used medications in patients with HIV/AIDS and references from articles considered to be relevant. RESULTS: 52 new interactions were identified having to do with CYP3A4 metabolism and competition for intestinal absorption. New pharmacokinetic interactions were identified for medications that were already on the market, and we report interactions for drugs that were recently introduced: Tipranavir, Fosamprenavir, Darunavir, Raltegravir, Maraviroc and Etravirine. CONCLUSIONS: There is evidence of 52 new interactions between medications using metabolic routes in the CYP450 enzymatic system, and an explanation is given for others in the intestinal absorption process.

Application of the SCORE and Wilson-Grundy methods for the assessment of cardiovascular risk in community pharmacies.

BACKGROUND: The assessment and follow-up of patients with risk factors, or with cardiovascular disease (CVD), involves estimating and monitoring their CVD risk (CVDR). There are different opinions about the most appropriate method for this. OBJECTIVE: To compare the SCORE system and the Wilson-Grundy system (based on Framingham's study). METHODS: A descriptive, observational study over 15 days in six pharmacies, with patients aged between 25 and 74 years, and with a prescription for medications related to hypertension, dyslipidaemia, CVD prevention or type-2 diabetes. Results of patients' absolute CVDR were assessed and compared using the SCORE system and the Wilson-Grundy method, adapted for Spain. The Chi-square test was used to compare proportions, and the Student t-test was used to compare mean values, including odds ratios (OR) and 95% confidence intervals (95%CI). RESULT: A total of 257 patients [165 women, 92 men; mean (SD) age, 60.9 (10.8) years; percentage of previous medical history of hypertension (70.0%), dyslipidaemia (42.4%), type-2 diabetes (19.5%) and CVD (22.6%)] participated. With the CVDR assessed with SCORE, the distribution was as follows: low 35.8%, intermediate 21.0% and high 43.2%. The corresponding values using the Wilson-Grundy system was low 60.7%, intermediate 8.2% and high 31.1%. CONCLUSION: The cardiovascular risk of patients that attend community pharmacies with prescriptions for cardiovascular medications is significantly higher when assessed using the SCORE system than with the Wilson-Grundy method.

Hipertensión de bata blanca (HABB) / White coat hypertension

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Perfil de presiones arteriales como indicador de la efectividad del tratamiento / Blood pressure profile as a treatment effectiveness indicator

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