Neumonitis intersticial como reacción adversa a inhibidores de mTOR / Interstitial pneumonitis as an adverse reaction to mTOR inhibitors

Introducción: Los inhibidores de mTOR (del inglés mammalian target of rapamycin), sirolimus y everolimus, utilizados como tratamiento inmunosupresor en el trasplante de órganos sólidos, pueden producir efectos adversos graves, como la neumonitis intersticial. Incidencia y presentación clínica: La incidencia de neumonitis intersticial se ha estimado entre el 4 % y el 11 %, aunque podría ser mayor. La mayoría de los casos publicados se ha producido en pacientes trasplantados renales en tratamiento con sirolimus. La presentación clínica es heterogénea, lo que dificulta el diagnóstico. Se acostumbra a observar alteraciones en la tomografía axial computarizada torácica, como opacidades en vidrio deslustrado. La fisiopatología es poco conocida. Sin embargo, se ha observado una mayor incidencia en pacientes con función renal alterada y en pacientes que habían recibido inhibidores de calcineurina previamente. La relación entre aparición de neumonitis y concentraciones plasmáticas de inhibidores de mTOR no está bien definida. Tratamiento: La suspensión del fármaco y la administración de dosis altas de corticoides parecen ser efectivos. Otras alternativas terapéuticas, aunque más discutidas, son la reducción de la dosis del inhibidor de mTOR y el cambio de sirolimus a everolimus. Conclusión: Se debe sospechar de neumonitis iatrogénica en pacientes trasplantados en tratamiento con inhibidores de mTOR y con síntomas respiratorios. Faltan datos concluyentes en cuanto a estrategias de tratamiento. Parece que everolimus podría ser mejor tolerado que sirolimus (AU)

Introduction: mTOR (mammalian target of rapamycin) inhibitors sirolimus and everolimus, used as immunosuppressants in solid organ transplantation, may cause severe adverse effects, such as interstitial pneumonitis. Incidence and clinical presentation: The estimated incidence of interstitial pneumonitis is 4-11% although it may be higher. Most reported cases have occurred in renal transplant recipients treated with sirolimus. Clinical presentation is heterogeneous, which makes diagnosis difficult. Abnormalities, such as ground glass opacities, are often found in computerised axial tomography scans of the chest. Physiopathology is not well-known. However, patients with abnormal renal function and those with previous calcineurin inhibitor treatment display a higher incidence. The relationship between pneumonitis and mTOR inhibitor plasma concentrations is not well defined. Treatment: Drug discontinuation and administration of high doses of corticosteroids seems to be an effective treatment. mTOR inhibitor dose reduction and replacing sirolimus with everolimus are other alternatives, but they are still under discussion. Conclusion: Iatrogenic pneumonitis must be suspected when a transplant recipient being treated with mTOR inhibitors presents respiratory symptoms. There is lack of conclusive data on treatment strategies. It appears that everolimus may be tolerated better than sirolimus (AU)

Interstitial pneumonitis as an adverse reaction to mTOR inhibitors.

INTRODUCTION: mTOR (mammalian target of rapamycin) inhibitors sirolimus and everolimus, used as immunosuppressants in solid organ transplantation, may cause severe adverse effects, such as interstitial pneumonitis. INCIDENCE AND CLINICAL PRESENTATION: The estimated incidence of interstitial pneumonitis is 4-11% although it may be higher. Most reported cases have occurred in renal transplant recipients treated with sirolimus. Clinical presentation is heterogeneous, which makes diagnosis difficult. Abnormalities, such as ground glass opacities, are often found in computerised axial tomography scans of the chest. Physiopathology is not well-known. However, patients with abnormal renal function and those with previous calcineurin inhibitor treatment display a higher incidence. The relationship between pneumonitis and mTOR inhibitor plasma concentrations is not well defined. TREATMENT: Drug discontinuation and administration of high doses of corticosteroids seems to be an effective treatment. mTOR inhibitor dose reduction and replacing sirolimus with everolimus are other alternatives, but they are still under discussion. CONCLUSION: Iatrogenic pneumonitis must be suspected when a transplant recipient being treated with mTOR inhibitors presents respiratory symptoms. There is lack of conclusive data on treatment strategies. It appears that everolimus may be tolerated better than sirolimus.

Prescribing of zoledronic acid in a tertiary outpatient hospital setting.

BACKGROUND: Zoledronic acid (ZA) is an intravenous bisphosphonate approved for the prevention and treatment of cancer skeletal-related events. OBJECTIVE: Our aim was to analyze the prescription patterns of ZA in the cancer outpatient clinic. METHOD: We performed a retrospective chart review of all patients who received at least 1 dose of ZA from January 2009 until December 2010 in our institution. The patients' follow-up period was defined from the administration of the first dose until February 2011. RESULTS: The sample comprised 345 patients: 31.9 % had breast cancer, 14.5 % prostate cancer, 29.0 % multiple myeloma, and 24.6 % other solid tumors. A total of 4,546 doses were administered; 2,749 (60.5 %) without intravenous chemotherapy. 71.1 % of patients with breast cancer, 86 % with prostate cancer, 60 % with multiple myeloma and 44.6 % with other solid tumors, received ZA without intravenous chemotherapy throughout bisphosphonate treatment. Doses were adjusted in one-third of cases. Administration every 4-weeks was the most frequent schedule. Median duration of treatment varied between 15.0 months for breast cancer and 4.2 months for other solid tumors. CONCLUSION: Most of ZA prescriptions in cancer outpatients followed the labeled indications. The percentage of ZA doses administered without intravenous chemotherapy was 60.5 %.

[Drug related problems and hospital admissions]. / Problemas relacionados con la medicación que causan ingresos hospitalarios.

OBJECTIVE: Drug related problems (DRP) are health problems associated with the pharmacological treatment of patients and interfere or can interfere with the expected results on their health. The aim of this study is to determine the prevalence of DRP in patients from an urban health centre that lead to hospitalisation, and its prevention. DESIGN: It is a retrospective, observational and descriptive study. SETTING: Les Corts Health Centre (HC), which is an urban health and teaching centre with a reference population of 32,318 inhabitants. PARTICIPANTS: Users of the les Corts HC admitted to the Barcelona Hospital Clinic from August 2005 to January 2006. RESULTS AND MAIN OUTCOME MEASUREMENTS: A pharmacist and a family doctor analysed the clinical histories and determined whether or not there was a DRP. A DRP was present in 13.4% of all hospital discharges, and 12% were implicated in the hospital admission. It was considered that 57.3% of all the discharges with a DRP as the causing factor in the hospital admission were avoidable. Admissions due to DRP were mainly in internal medicine, cardiology and pneumology. The health problems that lead to hospital admission due to DRP are mainly circulatory (38.5%) and respiratory (11.5%). CONCLUSIONS: The number of hospital admissions due to drug related problems is avoidably high.

Problemas relacionados con la medicación que causan ingresos hospitalarios / Drug related problems and hospital admissions

ObjetivoLos problemas relacionados con los medicamentos (PRM) están vinculados al tratamiento farmacológico del paciente e interfieren o pueden interferir con los resultados esperados en su salud. El presente estudio tiene como objetivo determinar la prevalencia de los PRM en los pacientes de un centro de salud urbano que son causa de ingreso en su hospital de referencia, y su evitabilidad.DiseñoEs un estudio observacional de tipo descriptivo y retrospectivo.EmplazamientoCENTRO de Salud Les Corts, que es un centro de salud urbano y docente con una población asignada de 32.318 habitantes.ParticipantesUsuarios del CS Les Corts ingresados en el Hospital Clínico de Barcelona desde agosto de 2005 a enero de 2006.Resultados y mediciones principalesUna pareja de un farmacéutico y un médico de familia analizan las historias clínicas y determinan la presencia o no de PRM. El 13,4% de todas las altas presentan PRM, que en su mayoría están implicados en el ingreso hospitalario (12%). Un 57,3% del total de altas con un PRM como causa del ingreso hospitalario se ha considerado evitable. Los ingresos por PRM se concentran en los servicios de medicina interna, cardiología y neumología. Los problemas de salud motivo de ingreso hospitalario por PRM son mayoritariamente circulatorios (38,5%) y respiratorios (11,5%).ConclusionesEl número de ingresos debidos a problemas relacionados con la medicación es elevado y evitable(AU)

ObjectiveDrug related problems (DRP) are health problems associated with the pharmacological treatment of patients and interfere or can interfere with the expected results on their health. The aim of this study is to determine the prevalence of DRP in patients from an urban health centre that lead to hospitalisation, and its prevention.DesignIt is a retrospective, observational and descriptive study.SettingLes Corts Health Centre (HC), which is an urban health and teaching centre with a reference population of 32,318 inhabitants.ParticipantsUsers of the les Corts HC admitted to the Barcelona Hospital Clinic from August 2005 to January 2006.Results and main outcome measurementsA pharmacist and a family doctor analysed the clinical histories and determined whether or not there was a DRP. A DRP was present in 13.4% of all hospital discharges, and 12% were implicated in the hospital admission. It was considered that 57.3% of all the discharges with a DRP as the causing factor in the hospital admission were avoidable. Admissions due to DRP were mainly in internal medicine, cardiology and pneumology. The health problems that lead to hospital admission due to DRP are mainly circulatory (38.5%) and respiratory (11.5%).ConclusionsThe number of hospital admissions due to drug related problems is avoidably high(AU)

Gestión de un servicio de farmacia hospitalaria / No disponible

Al igual que la sanidad en general, la farmacia, hospitalaria ha experimentado una evolución importante en estos últimos años. El sector sanitario se está enfrentando a nuevos retos, como son los cambios demográficos y tecnológicos, lo que hace que económicamente tengan efectos muy marcados sobre la asistencia sanitaria y la salud. Los hospitales se ven afectados por todos estos cambios, tanto por lo que se refiere a organización, como a las funciones que se están desarrollando. En un futuro muy próximo los profesionales sanitarios tendremos que asumir mayores responsabilidades en la gestión de utilización de los recursos (AU)

No disponible