Health education can save the environment from medicine residues

Abstract The incorrect disposal of medicines and their environmental impact has been related to the health medicalization and the improper use of medication by society. In this sense, it is very important to know the profile of drug disposal for foster health policies. The aim was to identify the profile of disposal of medicines by the population, including the cost perspective. This is an inquiry descriptive study that began in September 2019. Medicine disposal health education program was carried out over six months in two University pharmacies. A questionnaire for sociodemographic and discarded medicines data collection was applied. Logistic regression analysis for variables association of correct disposal and the chi-square and t-student analysis for comparison between disposal programs were performed for a level of 5% and test power of 80%. Medicines weighed 23.3 kg and 28.5 kg, with the cost variation from US$ 13.5 to US$ 16.1 until the final treatment. The correct disposal was strongly associated with the disposal reason (p=0.013), source of information (p=0.006), prescription (p=0.03), form of use (p=0.01), acquisition source (p=0.001), cost with medication (p=0.0001), education (p=0.028) and age (p=0.05). The correct medicine disposal was associated with important features of the community related to education health.

Intervention model for detection, prevention and control of COVID-19 in community pharmacy

Abstract The announcement by the WHO of the characterization of the new Coronavirus 2019 disease (COVID-19) as a pandemic, entails an adaptation by the community pharmacy in carrying out its care activity in general, with particular emphasis on "Minor Ailments Service" in particular. The measures taken by the different health administrations in which patient telephone care by primary care offices is prioritized have left more consultations on symptoms in the community pharmacist health-related problems as pharmacies are the closest health facilities to the patient. The similarity between the symptomatology caused by the new Coronavirus with that of some Enteroviruses that cause mild respiratory and gastrointestinal tables (dry cough, fever, sore throat, vomiting, diarrhoea, etc.) makes community pharmacies highly capable places for contagion detection and prevention. A model of protocolized intervention is needed to facilitate the pharmacist's work in discriminating during the indication between minor symptoms and symptoms of referral for possible cases of COVID-19 so that in conjunction with the rest of the staff we help control the disease and make better use of primary care consultations.

Psychoactive drugs in the Brazilian public health system: Use profile and associated factors

Abstract The purpose of this study is to estimate the prevalence of and characterize the use of psychoactive drugs among drug users in a Brazilian municipality, relating the findings to factors associated with the consumption of these substances. Through a cross-sectional design, 1,355 drug users from the public health systems community pharmacies were interviewed. Sociodemographic and health-related data were collected, as well as any other prescribed drugs. The prevalence of psychoactive drug use within the last month was 31.0%, with antidepressants and benzodiazepines being the most prescribed (53.5% and 24.6% respectively). Most psychoactive drug users were female (81.9%), lived with a partner (52.6%), had private health insurance (69.2%) and a monthly per-capita income up to one minimum wage (54.0%). The adjusted Odds Ratio (OR) confirmed the following factors to be positively associated with the use of psychoactive drugs: female gender (OR=2.06; 95% CI 1.44; 2.95), age ≥60 years old (OR=1.77; 95% CI 1.26; 2.48), follow-up with a psychologist (OR=4.12; 95% CI 1.84; 5.25), absence of regular physical activity (OR=1.59; 95% CI 1.13; 2.23), and smokers (OR=1.94; 95% CI 1.26; 2.97). Approximately one out of three individuals used at least one psychoactive drug. Health managers should focus the planning and actions aimed at their rational use for these groups, leading to increased overall treatment success

Profile of pharmaceutical interventions of a pharmacotherapeutic follow-up model for diabetic patients in a community pharmacy

Abstract The insertion of Pharmaceutical Care in Primary Health Care (PHC) improves patients' clinical outcomes and quality of life. Pharmacotherapeutic follow-up can contribute to the management of chronic diseases such as diabetes, promoting better glycemic control and adherence to therapy. This study aimed to assess the Drug-therapy Problems (DTPs) and Pharmacist Interventions (PIs) on the pharmacotherapeutic management in patients with type 2 diabetes mellitus (T2DM) in a community pharmacy. A quantitative, retrospective, and cross-sectional study was conducted in a Pharmaceutical Care Program within the PHC in Juiz de Fora (Minas Gerais, Brazil). Inclusion criteria were patients with T2DM above 18, who attended at least three pharmaceutical consultations between July 2016 and October 2018 and presented two or more glycated hemoglobin tests. The study group (n = 17) was largely composed of women (65%), elderly (76%), sedentary (72%), and obese people (52%). The resolution was achieved in 79% of the DTPs identified (n = 115). Most of DTPs were related to administration and adherence to pharmacotherapy (46%). 60% of the 437 PIs involved the provision of information and counseling. In other words, accessible interventions lead to high resolvability. Therefore, clinical actuation of pharmacists could improve the prognosis in diabetes treatment

Point-of-sale Naloxone: Novel Community-based Research to Identify Naloxone Availability.

INTRODUCTION: Expanding naloxone availability is important to reduce opioid-related deaths. Recent data suggest low, variable urban naloxone availability. No reports describe naloxone availability at the point of sale (POSN). We characterize POSN without prescription across a Midwestern metropolitan area, via a unique poison center-based study. METHODS: Pharmacies were randomly sampled within a seven-county metropolitan area, geospatially mapped, and distributed among seven investigators, who visited pharmacies and asked, "May I purchase naloxone here without a prescription from my doctor?" Following "No," investigators asked, "Are you aware of the state statute that allows you to dispense naloxone to the public under a standing order?" Materials describing statutory support for POSN were provided. Responses were uploaded to REDCap in real time. We excluded specialty (veterinary, mail order, or infusion) pharmacies a priori. POSN availability is presented as descriptive statistics; characteristics of individual sites associated with POSN availability are reported. RESULTS: In total, 150 pharmacies were prospectively randomized, with 52 subsequently excluded or unavailable for survey. Thus, 98 were included in the final analysis. POSN was available at 71 (72.5%) of 98 pharmacies. POSN availability was more likely at chain than independent pharmacies (84.7% vs 38.5%, p<0.001); rural areas were more commonly served by independent than chain pharmacies (47.4% vs 21.5%, p = 0.022). Five chain and five independent pharmacies (18.5% each) were unaware of state statutory support for collaborative POSN agreements. Statutory awareness was similar between independent and chain pharmacies (68.8% vs 54.6%, p = 0.453). Rationale for no POSN varied. CONCLUSION: POSN is widely available in this metropolitan area. Variability exists between chain and independent pharmacies, and among pharmacies of the same chain; awareness of statutory guidance does not. Poison centers can act to define local POSN availability via direct inquiry in their communities.

Determinants of Generic Drug Substitution in the United States.

BACKGROUND: Some classes of drugs have lower than optimal uptake of generic products. We aimed to understand the determinants of generic drug substitution across classes. METHODS: We conducted a cross-sectional analysis of data from the 2013 MarketScan Commercial Claims and Encounters Database from Truven Health Analytics. We quantified generic substitution rates (GSR) for 26 drug classes, choosing one representative week in November 2013. We used mixed-effects logistic regression to estimate the independent relationship between the determinants of interest and generic substitution for 8 classes with low generic utilization. RESULTS: The GSRs for most classes exceeded 90%, although some were much lower including thyroid hormones (64%), androgens (74%), estrogens (71%), and hydantoin-type anticonvulsants (72%). The determinants of generic substitution varied across classes, albeit with important patterns. Patients using a mail order pharmacy had significantly less generic substitution than patients filling at retail pharmacies for 5 of the 8 studied classes; two additional classes showed no relationship between pharmacy type and generic use. Men relative to women and patients taking more medications were more likely to use generics for most classes. State substitution laws and patient consent laws were largely inconsequential regarding generic substitution. CONCLUSIONS: Policies are needed to support the use of safe, effective and often lower cost generic drugs, when available. Mail order pharmacies, as often required by pharmacy benefits managers, lessen generic use for many classes. These pharmacies may require additional regulatory oversight if this adversely impacts patients.

Profile of activities developed by community pharmacists: do they corroborate the precepts of the pharmaceutical profession?

Studies that addressed the profile of pharmaceutical activities and behaviors in community pharmacies in the last decades pointed to a gap between community pharmacy practice and the precepts of the profession. Facing the need to analyze whether the new legislation has impacted this scenario, the objective of this study was to describe the general profile and academic profile of community pharmacists, and the profile of the activities they develop, as well as to know their place of work. This is a descriptive study, to which all pharmacists in charge of community pharmacies in the metropolitan area of ​​Belo Horizonte-MG (n = 1624) were invited. Data collection was performed through a questionnaire validated online, from October to December 2017, via Google Docs®. Responses were obtained from 109 pharmacists, most of them female, aged 31-40 years, being general graduates, and in private institutions. Pharmacotherapeutic follow-up, an activity linked to clinical management, is performed by only 37.60% of pharmacists, evidencing that there is still a lag in relation to the provision of clinical services by community pharmacists. Thus, we emphasize the importance of implementing the precepts established by Brazilian curricular guidelines for undergraduate pharmacy courses which focus on the development of clinical skills, since the insertion of the pharmacist into the health team and the provision of clinical services to the community can add new value to the use of medications, and contribute effectively to their rational use in Brazil.

Facilitators and Barriers: Clients' Perspective on the Virginia AIDS Drug Assistance Program's Affordable Care Act Implementation.

Many AIDS drug assistance programs (ADAPs) purchased Affordable Care Act (ACA) qualified health plans (QHPs) for low-income people living with HIV. To date, little has been written about this from the client perspective. The study's objective was to gain information about the experience of Virginia ADAP-funded QHP enrollment and the impact of this change. English-speaking clients who were eligible for ADAP-funded QHPs were recruited at three HIV clinics in Virginia. The goal was to enroll ≥5% of those who were eligible for ADAP-funded QHPs in two Virginia Department of Health planning districts. Participants were surveyed about demographic characteristics, and semi-structured interviews were performed. Descriptive analyses were performed for cohort characteristics. Using an open coding strategy, codebooks were generated for the interviews and themes were identified. The cohort (n = 53) met our recruitment goal. Two-thirds gained their ACA knowledge at HIV clinics from case managers and social workers. Many barriers to enrollment were identified, including internet access/literacy. Almost 9 out of 10 participants had concerns about privacy, which centered on QHP's mandated use of mail-order pharmacies. Except for medication concerns, most participants had positive perceptions of the impact of QHP enrollment on their health care. HIV clinic case managers and social workers are often the primary source of knowledge for patients about insurance options and their assistance is crucial for QHP enrollment. Our findings indicate that reducing identified barriers and addressing privacy concerns by allowing people to opt out of mail order pharmacies may encourage QHP enrollment.

Current Status of Disaster Preparedness of Pharmacies and Differences in Disaster Awareness Based on Pharmacy Size.

OBJECTIVE: The prevention of deaths caused indirectly by disasters is important, especially for evacuees requiring medication. Pharmacies play a major role in providing medication to disaster victims. Therefore, this study evaluated the current status of disaster preparedness among pharmacies, the extent of disaster awareness and knowledge of disaster mitigation measures, and any associations of these with the characteristics of pharmacies. METHODS: Questionnaires about disaster preparedness were sent to 337 pharmacies in Japan, in a region at high risk of major earthquakes. Tabulation analyses were carried out to examine the characteristics of pharmacies and then a logistic regression analysis was performed to examine the relationship between disaster awareness and the level of preparedness of pharmacies. Furthermore, to examine in detail any differences associated with pharmacy size, subgroup analyses were performed. RESULTS: High disaster awareness was significantly correlated with adequate disaster preparedness. However, in the subgroup analyses, no significant differences were observed among large pharmacies. In contrast, disaster awareness was significantly related to the disaster preparedness of small pharmacies. CONCLUSION: The findings suggest that the disaster preparedness of pharmacies is related to the level of disaster awareness, highlighting the importance of disaster awareness activities in ordinary times before a disaster. (Disaster Med Public Health Preparedness. 2019;13:753-757).

Availability and Accessibility of Emergency Contraception to Adolescent Callers in Pharmacies in Four Southwestern States.

PURPOSE: To evaluate the availability and accessibility of emergency contraception (EC) to adolescents in U.S. pharmacies across four Southwestern states, 3 years after the federal Food and Drug Administration (FDA) removed age restrictions for over-the-counter sales of levonorgestrel-only pills. METHODS: Using a mystery-caller approach, we trained male and female data collectors to phone pharmacies posing as 16-year-olds who wanted to prevent a pregnancy after recent unprotected sex. From April to May 2016, they called 1,475 randomly selected retail pharmacies in Arizona, California, New Mexico, and Utah and completed an online survey about their experience. Caller data were analyzed by state and pharmacy type (i.e., national chains, regional outlets, and individually owned outlets). RESULTS: Of pharmacies contacted, 80.6% had EC available at the time of the call. Availability of EC varied by state (p < .01) and pharmacy type (p < .01), but not by rural/urban location. Even where EC was available, pharmacy personnel often hindered youths' access to EC by mentioning incorrect point-of-sale restrictions, keeping EC in restrictive store locations, or asking personal questions. Individually owned outlets presented significantly more barriers than larger chains. Overall, EC was completely accessible to an adolescent caller in only 28% of pharmacies. Lower EC accessibility was found in states with higher teen pregnancy rates. CONCLUSIONS: This study found that EC is still not sufficiently available or accessible to adolescents in Southwestern states. Differences in accessibility vary significantly by state and pharmacy type and may be a contributor to teen pregnancy rates.

Impact of a drug dispensing model at a Community Pharmacy in Goiânia, Goiás, Brazil

Although dispensing of medication has been addressed by theoretical models, studies that confirm the impact of this service are still needed. The objective was to evaluate the impact of a new model of medicine dispensing system on patients' medication knowledge, adherence to treatment and satisfaction. One hundred and four patients attending the dispensing service of a community pharmacy between 21 January 2013 and 20 April 2013 were included in this intervention study. The impact of the service on patients' medication knowledge, adherence to treatment and satisfaction was assessed by using validated questionnaires at two time points: at the moment of medication dispensing and 30 days thereafter by telephone contact. Statistical analysis was performed by McNemar's test, and a p<0.05 was set as statistically significant. The number of patients showing insufficient knowledge about medications decreased by 50% (p < 0.05), and the number of those showing sufficient knowledge was three times greater (p < 0.05) after medicine dispensing. A high level of satisfaction was observed. Improvement of medication adherence, however, was not observed. The proposed system model for drug dispensing improved patients' knowledge about medication and satisfaction

Percepción de efectividad y seguridad de los fármacos de acción lenta para osteoartritis (SYSADOA) en el tratamiento de la artrosis desde la farmacia comunitaria / Perceived effectiveness and safety of symptomatic slow action drugs for osteoarthritis (SYSADOA) for treating osteoarthrosis from community pharmacy

Introducción: La osteoartrosis es un proceso degenerativo articular que genera un dolor profundo, crónico y mal localizado. Los SYSADOA son fármacos de acción lenta que previenen el deterioro del cartílago, reducen el dolor y mejoran la función articular. Objetivos: Estudiar la percepción de efectividad y seguridad de los SYSADOA como tratamiento farmacológico de la artrosis. Material y métodos: Estudio observacional transversal en ocho farmacias comunitarias de Madrid entre los meses de diciembre de 2015 y enero de 2016 mediante la realización de una encuesta estructurada. Resultados: Se realizaron 103 dispensaciones, principalmente a mujeres (70,9%) mayores de 60 a.os (47,9%). Un 31% de los encuestados seguía hábitos de vida saludables. El 52,4% de los pacientes padecía otras enfermedades: hipertensión arterial (34,0%), hipercolesterolemia (28,2%), diabetes (15,5%). El SYSADOA dispensado con mayor frecuencia fue el condroitón sulfato. Del análisis de las encuestas obtuvimos que un 53,4% de los pacientes percibía una mejoría en la movilidad, un 50,5% mejora su calidad de vida y un 49,5% su estado anémico. El 61,2% de los pacientes refería que los SYSADOA son efectivos. De los pacientes que habían tomado analgésicos en combinación con SYSADOA con anterioridad, el 2,9% apuntaba que les iba mejor con SYSADOA. La adherencia al tratamiento fue de un 73,8% en los encuestados. Se detectaron 14 PRM (13,5%) y 13 RNM (12,6%), de los cuales 2 fueron de inseguridad (1,8%). Conclusiones: Los pacientes que padecen osteoartrosis son muy adherentes a sus tratamientos y perciben los SYSADOA como fármacos efectivos y seguros, así como refieren mejoría en la movilidad articular, calidad de vida y estado anémico (AU)

Background: Osteoarthritis is a degenerative joint process a deep, chronic and poorly localized pain. The SYSADOA are slow-acting drugs that prevent the deterioration of cartilage, reduce pain and improve joint function. Objectives: To study the perception of effectiveness and safety of SYSADOA for the treatment of osteoarthritis in the community pharmacy. Method: Cross-sectional study in eight community pharmacies in Madrid between the months of December 2015 and January 2016 by conducting surveys. Results: A sample of 103 patients was included, where the mean age was over 60 years (47.9%) and 70.9% female. 32 interviewees (31%) mentioned healthy lifestyles. 54 patients (52.4%) suffer from other diseases: hypertension (34.0%), hypercholesterolemia (28.2%), diabetes (15.5%). The SYSADOA most frequently dispensed was chondroitin sulphate. Data analysis reveals that 53.4% of patients saw an improvement in mobility, 50.5% improved their quality of life and 49.5% improved their mood. Sixty-three patients (61.2%) reported that SYSADOA were effective. 2.9% of patients who had taken analgesics in combination with SYSADOA previously reported they were doing better with SYSADOA. Medication adherence was found in 76 (73.8%) patients. Fourteen (13.5%) Drug-Related Problems (DRPs) were found and thirteen (12.6%) Negative Outcomes Related to Medicines (NOM) were detected, two of them (1.8%) safety risk. Conclusions: Patients suffering from osteoarthritis are very adherents and SYSADOA drugs are perceived as effective and safe. They refer improvement in joint mobility, quality of life and mood (AU)

Uso de inhaladores: detección de errores e intervención por el farmacéutico comunitario / Use of inhalers: Error detection and intervention by the community pharmacist

Introducción: Los inhaladores son medicamentos que requieren un adiestramiento especial para su correcto uso. Conocer a los usuarios de inhaladores y evaluar cuáles son los errores que cometen puede ser el punto de partida para su abordaje y solución. El farmacéutico comunitario es clave para asegurar el uso correcto de inhaladores. Objetivos: Conocer variables sociodemográficas de los usuarios de inhaladores. Analizar los errores que se comenten en el uso de inhaladores e intervenir sobre ellos. Conocer si perciben controlado su problema de salud y evaluar qué opinan sobre la actitud activa del farmacéutico. Material y método: Estudio observacional multicéntrico en seis farmacias de la provincia de Badajoz con hoja de recogida de datos con cuestionario y hojas de evaluación de los sistemas de inhalación. Resultados: Participan 152 pacientes y 26 cuidadores. Se evalúan 202 inhaladores y se detectan e intervienen 876 errores. El error clínicamente significativo más frecuente en la técnica de inhalación es no contener la respiración 10 segundos o lo máximo posible tras la inhalación (57,2% de los casos). En el 60,9% de los casos no conocen correctamente cómo limpiar el inhalador, en el 43,9% no saben cuándo el inhalador está vacío y en el 36,1% no saben que deben enjuagarse la boca tras su uso. El 61,8% de los usuarios cree que el problema de salud para el que usan los inhaladores no está bien controlado y el 99,4% cree que la actitud activa del farmacéutico ayuda a mejorar el uso de los inhaladores (AU)

Introduction: Inhalers are drugs that require special training for proper use. Define users of inhalers and assess what mistakes are made can be the starting point for tackle them and get a solution. The community pharmacist is key to ensuring the correct use of inhalers. Objectives: To find out social and demographic variables of users inhalers. To analyze the mistake made in the use of inhalers and act on them. To find out if users perceive their health problem controlled and to assess what they think about the active role of the pharmacist. Material and methods: Multicenter observational study whose data collection was performed in sixcommunity pharmacies located in the province of Badajoz using a questionnaire and evaluation sheets of the inhalers. Results: Participants included 152 patients and 26 careers. 202 inhalers are evaluated and 876 errors are detected and intervened. The most frequent inhalation technique clinically significant error is not contain the respiration for 10 seconds or as long as possible after inhalation (57.2% of cases). In 60.9% of cases users do not know how to clean the inhaler correctly, in 43.9% users do not know when the inhaler is empty and the 36.1% do not know they should rinse their mouth after use. The 61.8% of users believe that the health problem for using inhalers is not well controlled and 99.4% believe that the active role of the pharmacist helps improve the use of inhalers (AU)

Turn back crime: medicamentos ilegales y papel del farmacéutico comunitario / Turn back crime: illicit products and the role of the community pharmacist

El objetivo del presente trabajo fue describir y analizar la situación en España de los productos de venta ilícita, tanto medicamentos como complementos alimenticios, poniendo en conocimiento las principales acciones realizadas en los últimos meses y su contextualización a nivel mundial. Asimismo, servir de alerta sobre la magnitud del problema y la importancia del papel del farmacéutico comunitario. Se realizó una búsqueda de información tanto a nivel nacional como internacional y se realizó un análisis descriptivo de las Notas Informativas de la Agencia Española de Medicamentos y Productos Sanitarios (AEMPS) (medicamentos ilegales, uso humano, 2015). Los productos de venta ilícita representan un problema grave para la salud pública que no ha parado de aumentar. En España, en 2015 se publicaron 20 notas donde se prohibió y retiró un total de 35 productos. Dichos productos estaban comercializados como complemento alimenticio y presentaban un principio activo en cantidad suficiente para conferirle legalmente la condición de medicamento. El 86% se dirigía a la disfunción eréctil. Para minimizar este problema, es imprescindible la colaboración internacional, siendo la última y más importante operación PANGEA VIII, en junio del 2015, implicando a 115 países. En enero del 2016 entró en vigor la Convención Medicrime, tratado internacional sobre la falsificación de productos médicos y delitos similares. Por otro lado, también es necesario concienciar a la ciudadanía y dotarla de mecanismos para identificar el riesgo potencial. Los productos adquiridos fuera de los canales legales de distribución no aseguran el cumplimiento de las normas de correcta fabricación, distribución, ni posterior conservación y carecen de la información adecuada (AU)

The objective of this article was to describe and analyze the situation of illicit products in Spain, both medicines and dietary supplements, notifying main actions taken in recent months and their worldwide contextualization. Also serve as a warning about the magnitude of the problem and the importance of the role of the community pharmacist. Searches of information were looked at a national and international level. A descriptive analysis of the Information Notes published by the Spanish Agency of Medicines and Medical Devices (AEMPS, Illegal Drugs, Human Use, 2015) was also conducted. Illicit sale products constitute a major problem for public health that has not stopped increasing. Specifically, in Spain, 20 Notes were published in 2015. These included the prohibition and withdrawal of a total of 35 products. Marketed as dietary supplement, they contained an active ingredient enough to be legally considered as a medicine. 86% were aimed at treating erectile dysfunction. It is essential international collaboration to minimize this issue. The last and most important operation was PANGEA VIII in June 2015, which involved 115 countries. In January 2016, the «Medicrime Convention» entered into force, an international agreement on counterfeiting of medical products and similar crimes. In addition, it is necessary to raise awareness and provide the citizens with mechanisms to identify potential risks inherent to the illicit sale products. Products purchased outside the permitted distribution channels do not ensure compliance with good manufacturing practice, distribution or subsequent storage, and they lack of adequate information (AU)

Indicación farmacéutica para el dolor lumbar en pacientes con diabetes y/o hipertensión arterial que acuden a la farmacia comunitaria / Pharmaceutical counselling for back pain in patients with diabetes or hypertension in community pharmacy

El dolor lumbar constituye un motivo muy frecuente de consulta en la farmacia, por lo que la indicación farmacéutica debe estar basada en criterios científicos que contribuyan a resolverlo, sin que el control de las cifras de presión arterial o de glucemia pueda verse alterado en el caso de pacientes con hipertensión arterial o diabetes. Mediante una revisión sistemática de Guías de Práctica Clínica (GPC) dirigidas al abordaje del dolor lumbar, así como de otras fuentes bibliográficas, se han elaborado recomendaciones sobre indicación farmacéutica a pacientes con diabetes y/o hipertensión arterial que acuden a la oficina de farmacia solicitando tratamiento farmacológico para dicho síntoma. Tras diseñar una estrategia de búsqueda, se realizó la selección de las fuentes bibliográficas y se llevó a cabo la recogida de información. La búsqueda bibliográfica se realizó en los siguientes recursos web de almacenamiento o búsqueda de GPC: Medline, GuíaSalud, National Guideline Clearinghouse, CMA Infobase, Scottish Intercollegiate Guidelines Network, Australia’s Clinical Practice Guidelines Portal, Trip Database y National Health Service Evidence. Como fuentes complementarias, se consultó UpToDate, Base de Datos BOT plus 2.0 y un tratado de Farmacología Humana. Las recomendaciones específicas sobre tratamiento farmacológico fueron formuladas teniendo en cuenta su nivel de evidencia y se revisaron las posibles interacciones y/o contraindicaciones de los fármacos en los pacientes con hipertensión arterial y/o diabetes mellitus. Así mismo, se construyó un algoritmo de actuación, siguiendo las Buenas Prácticas en Farmacia Comunitaria en España elaboradas por el Consejo General de Colegios Oficiales de Farmacéuticos. Las recomendaciones se refieren al manejo del dolor lumbar inespecífico e incluyen por lo general, como tratamiento de primera línea por su mejor perfil riesgo/beneficio, el uso de paracetamol en el dolor lumbar agudo o subagudo de forma aislada y de origen musculoesquelético, sin sobrepasar 3 ó 4 g/día (AU)

Lumbar pain is a frequent reason for consultation in the pharmacy, so the pharmaceutical indication must be based on scientific criteria that contribute to solve it, without the control of the blood pressure or blood sugar figures can be altered in the case of patients with hypertension or diabetes. Through a systematic review of Clinical Practice Guidelines (CPG) aimed at addressing back pain, as well as other literature sources, recommendations have been made on minor ailment scheme for patients with diabetes and/or hypertension who come to the office of Pharmacy requesting pharmacological treatment for said symptom. After designing a search strategy, the selection of the bibliographic sources was carried out and the collection of information was carried out. The literature search was conducted in the following web storage resources or GPC search: Medline, GuíaSalud, National Guideline Clearinghouse, CMA Infobase, Scottish Intercollegiate Guidelines Network, Australia’s Clinical Practice Guidelines Portal, Trip Database and National Health Service Evidence. As additional sources, were consulted of UpToDate, Database BOT plus 2.0 and a treaty of Human Pharmacology. Specific recommendations on drug treatment were formulated taking into account their level of evidence and possible interactions and contraindications of drugs in patients with hypertension and/or diabetes mellitus. Likewise, performance algorithm were built, following Good Practices in Community Pharmacy in Spain of General Council of Official Colleges of Pharmacists. The recommendations refer to the management of non-specific low-back pain and generally include, as a first-line treatment due to its better risk / benefit profile, the use of paracetamol in acute or subacute low back pain in isolation and of musculoskeletal origin, without exceeding 3 or 4 g / day (AU)

Protocolo de actuación ante la rosácea en la farmacia comunitaria / Course of action for rosacea in community pharmacy

La rosácea es una dermatosis facial inflamatoria, recidivante y crónica, que con frecuencia demanda consulta en la farmacia comunitaria. Orientado hacia la práctica clínica del farmacéutico comunitario, este artículo revisa y sintetiza los conceptos clásicos y los avances más recientes en la comprensión y el tratamiento de esta enfermedad cutánea. Finalmente, propone un protocolo para la asistencia de pacientes con rosácea en la farmacia comunitaria (AU)

Rosacea is a chronic relapsing inflammatory facial dermatosis that demands often attention in the Community Pharmacy. Keeping in mind what could be useful in the clinical practice for the community pharmaceutist, this paper reviews and synthesizes clasical concepts and the most recent advances in the understanding and management of this skin disease. Finally, a protocol for the assistence of patients with rosacea in the Community Pharmacy is proposed (AU)

Vacunación en neumococo. Actuación en la farmacia comunitaria / Pneumococcal vaccination. Community pharmacy procedure

En la elaboración del documento han participado SEFAC, semFYC, SEMERGEN y SEPAR. El objetivo principal era definir los perfiles de paciente susceptibles prioritariamente de la vacunación frente al neumococo considerando los grupos de riesgo, las patologías concomitantes, las posibles consecuencias de una infección neumocócica y la elaboración, a su vez, de un algoritmo de vacunación en el adulto. Se han definido igualmente las indicaciones de la vacuna así como la propuesta de entrevista por parte de la farmacia comunitaria. El documento, avalado por las principales sociedades científicas médico-farmacéuticas, será de gran utilidad para el farmacéutico comunitario de cara a abordar a pacientes con mayor factor de riesgo de contraer enfermedad neumocócica. Será también una manera muy gráfica para conseguir detectar, asesorar y, llegado el caso, derivar al facultativo médico a todo este tipo de paciente (AU)

SEFAC, semFYC, SEMERGEN and SEPAR were involved in the production of the document. The primary objective was to define the patient profiles most susceptible to be vaccinated against pneumococcus, considering the risk groups, the associated pathologies and the possible consequences of a pneumococcal infection and in turn, to develop a vaccination program in adults. The vaccine indications were also defined, as well as the proposed consultation by the community pharmacy. The document, backed by the main medico-pharmaceutical science companies, will be very useful to community pharmacies with regards to handling patients with a greater degree of risk of contracting pneumococcal disease. This will also be a very explicit way of detecting, assessing and, as necessary, diverting medical staff to this type of patients (AU)

Especificaciones del servicio de medición y control de la presión arterial mediante MAFC, AMPA y MAPA / Specifications of the arterial pressure measurement and testing service using one-off measurement in community pharmacies, arterial pressure self-measurement and outpatient arterial pressure monitoring

En abril de 2013, la Sociedad Española de Farmacia Familiar y Comunitaria (SEFAC) presentó su propuesta sobre servicios profesionales farmacéuticos (SPF) cuyo fin es cubrir las necesidades relacionadas tanto con la atención de los pacientes que utilizan medicamentos, como con la salud pública. Esta propuesta ofrece un planteamiento sobre la implantación y desarrollo de los SPF con el objetivo de impulsar su prestación por las farmacias comunitarias en los próximos años. De acuerdo con dicha propuesta todos los SPF que constituyen el catálogo de servicios contarán con un documento de especificaciones. El objeto de este documento de especificaciones es definir y caracterizar el servicio de medición y control de la presión arterial con un doble objeto: • Ayudar al farmacéutico comunitario y a sus representantes en el ofrecimiento, prestación, difusión, financiación y concertación de este servicio. • Servir de guía a los farmacéuticos comunitarios que desean implantar este servicio en la farmacia o elaborar un procedimiento normalizado de trabajo para su realización. Este documento se complementa con la Guía de actuación para el farmacéutico comunitario en pacientes con HTA y riesgo cardiovascular (RCV). Documento de consenso GIAF-UGR, SEFAC y SEH-LELHA y con el programa impacHta: formación de SEFAC y SEH-LELHA en hipertensión y riesgo vascular (AU)

In April 2013, the Spanish Family and Community Pharmacy Society (Sociedad Española de Farmacia Familiar y Comunitaria - SEFAC) issued a proposal for professional pharmacy services, with an aim to cover both the needs relating to care for patients on medication and to public health. This proposal put forward an approach for the implementation and development of professional pharmacy services with an aim to roll out this service in community pharmacies in the next few years. In accordance with this proposal, all professional pharmacy services that offer these services will be supported by a specifications document. The purpose of this specifications document is to define and characterize the arterial pressure measurement and testing service with two aims: • To help community pharmacists and their representatives in the offer, provision, promotion, financing and arrangement of this service. • To serve as a guide for community pharmacists who want to implement this service in the pharmacy or to provide a standardized working procedure to do so. This document is accompanied by the procedural guide for community pharmacists for patients with arterial hypertension and cardiovascular risk (Guía de actuación para el farmacéutico comunitario en pacientes con HTA y riesgo cardiovascular (RCV)). Consensus document of GIAF-UGR, SEFAC and SEH-LELHA and the impacHta program: SEFAC and SEH-LELHA training in hypertension and vascular risk (AU)

Cross-sectional study of the dispensation of synthetic anorectic drugs in community pharmacies in the city of Cruz Alta - State of Rio Grande do Sul

Obesity is defined as the excess adipose tissue in the body. Drugs responsible for inhibiting the appetite are called anorectics or appetite suppressants. Sibutramine, fenproporex and amfepramone belongs to this class, and are capable of causing physical or psychological dependence. The aim of this study was to evaluate the frequency of prescriptions for appetite suppressants in community pharmacies at Cruz Alta, State of Rio Grande do Sul, Brazil. The sales of fenproporex, amfepramone and sibutramine in the months of September, October and November 2010 and April, May and June 2011 were compared. It was observed that the most commonly dispensed anorectic in the three community pharmacies analyzed was sibutramine. In the months of September, October and November 2010, consumption was higher, with sibutramine achieving 40.3% of overall sales, amfepramone 21% and, finally, fenproporex, 7.9%. The consumption of appetite suppressants was more prevalent in females, who represented 82% of total. The results suggested the existence of high consumption of anorectics, possibly related to the current concern with aesthetic standards, which emphasizes the importance of strict control over the marketing of these substances.

Obesidade define-se como excesso de tecido adiposo no organismo. Os fármacos responsáveis por inibir o apetite são denominados anorexígenos ou supressores de apetite. Sibutramina, femproporex e anfepramona, pertencentes a essa classe, são capazes de provocar dependência física ou psíquica. O objetivo deste estudo foi avaliar a prevalência da prescrição de anorexígenos em farmácias comerciais de Cruz Alta - RS. Foi comparada a venda dos fármacos femproporex, anfepramona e sibutramina, nos meses de setembro, outubro e novembro de 2010 e abril, maio e junho de 2011. Observou-se que o anorexígeno mais prescrito nas três farmácias analisadas foi a sibutramina. Nos meses de setembro, outubro e novembro de 2010, o consumo foi maior, quando a sibutramina alcançou um percentual de 40,3%, a anfepramona 21% e, por fim, o femproporex, 7,9%. O consumo de inibidores de apetite foi mais prevalente no sexo feminino, o qual representou 82% do total. Os resultados sugeriram a existência de elevado consumo de anorexígenos, possivelmente relacionada à preocupação com padrões estéticos atuais, o que ressalta a importância de um controle rigoroso sobre a comercialização destas substâncias.