[Interlevel incident management: The experience of a primary care district]. / Gestión de incidencias interniveles. La experiencia de un distrito de atención primaria.

AIM: Determine the prevalence and define the profile of interlevel incidences (ININ) between primary care (PC) and hospital (HC). DESIGN: Multicenter cross-sectional descriptive study. SITE: Primary care. PARTICIPANTS: Professionals from a Health District and its reference hospitals. INTERVENTIONS: ININ are errors in communication between PC and HC professionals derived from administrative, pharmaceutical or clinical procedures not resolved during the formal interlevel communication processes, which requires a coordinated and validated response from the health care directions to not overload the family physician. MAIN MEASUREMENTS: ININ by category, hospital services and health centers, total and validated, relative to the total number of referrals, and the reason for the ININ. RESULTS: We detected 2011 ININs (3.36%) among the 59.859 referrals, although only 1684 were validated (83.7%). Most were administrative (59.5%), followed by pharmaceutical (24.2%), clinical (10.2%) and reverse (6.1%). 41.3% of the clinical ININs were grouped around 5 hospital specialties, and 45.9% in 5 health centers. The main reasons for clinical ININ were non-prescription of the recommended pharmacological treatment in outpatient clinics or on hospital discharge (27.3%), request for referral to another hospital specialist (27.9%), or request to referral in person to patients who had already been referred by teleconsultation (17.8%). CONCLUSIONS: 3.36% of interlevel referrals are accompanied by incidents and 83.7% are validated and processed. It is necessary to develop ININ management tools to guarantee safe healthcare and debureaucratize PC.

[Review of pharmacological interactions of oral anticancer drugs provided at pharmacy department]. / Revisión de las interacciones farmacológicas de los fármacos antineoplásicos orales dispensados en un Servicio de Farmacia.

OBJECTIVE: To identify the pharmacologic interactions of oral anti-cancer drugs provided at an outpatient clinic. MATERIAL AND METHODS: Anti-cancer drugs included in the Phamacotherapeutic Guideline of the Hospital were identified. A literature search was carried out on the pharmacologic interactions in MEDLINE® and EMBASE® (with the filer language English or Spanish, and the descriptors: "name of the anti-cancer drug" AND ("drug interactions" OR "pharmacokinetic")), Up-to-date®, MICROMEDEX® and the drug information sheet for the EMA and the FDA. Information was also gathered from the abstract presented to European and Spanish scientific meetings for the last 4 years. When an interaction was analyzed and had clinical relevance, the best pharmacotherapeutic interaction-free alternative was sought. RESULTS: Twenty-three drugs were identified, of which Chlorambucil, Fludarabine, Lenalidomide, Melphalan, and Thalidomide were the active compounds with the lowest likelihood of producing a pharmacologic interaction. Tyrosine kinase inhibitors (particularly Erlotinib, Imatinib, Lapatinib, and Pazopanib) are the drugs with highest number of pharmacologic interactions described, many of them with severe clinical consequences, with increases and decreases of the plasma levels of anti-cancer drugs. The active compounds identified that may have pharmacologic interactions with anticancer drugs were mainly: Allopurinol, Amiodarone, Carbamazepine, Dabigatran, Digoxin, Spironolactone, Phenytoin, Itraconazol, Repaglinide, Silodosin, Tamoxifen, Verapamil, and Warfarin. Pharmacologic interactions through the cytochrome P450 1A2, 2D6, 2C8, 2C9, 3A4 were the most important for tyrosine kinase inhibitors. Other non-pharmacologic compounds, with an important potential of producing relevant pharmacologic interaction were immunomodulators (Echinacea extracts) and Hypericum perforatum. CONCLUSIONS: Oral anticancer drugs have numerous pharmacologic interactions that should be monitored during pharmacotherapy. Given its position, the hospital pharmacist is the key professional for identifying and assessing the pharmacologic interactions or oral anticancer drugs that may have clinical consequences.

OBJETIVO: Identificar las interacciones farmacológicas de los fármacos antineoplásicos orales dispensados desde una consulta de pacientes externos. MATERIAL Y MÉTODOS: Se identificaron los fármacos antineoplásicos incluidos en la Guía farmacoterapéutica del Complejo Hospitalario. Se realizó una búsqueda bibliográfica sobre sus interacciones farmacológicas en MEDLINE® y EMBASE® (tomando como límites los idiomas español e inglés, los descriptores: «nombre del fármaco antineoplásico¼ AND («drug interactions¼ OR «pharmacokinetic ¼)), Up-to-date®, MICROMEDEX® y ficha técnica del medicamento de la EMA y FDA. También se buscó información en los resúmenes de los congresos europeos y nacionales de los últimos 4 años. Cuando una interacción analizada resultó ser de relevancia clínica, se buscó la mejor alternativa farmacoterapéutica no interaccionante. RESULTADOS: Se identificaron veintitrés fármacos, de ellos, clorambucilo, fludarabina, lenalidomida, melfalan y talidomida son principios activos con menor probabilidad de ocasionar una interacción farmacológica. Los inhibidores de la tirosin kinasa (especialmente ertininib, imatinib, lapatinib y pazopanib) son los fármacos con más interacciones farmacológicas descritas, muchas de ellas con consecuencias clínicas severas, con aumentos y descensos de los niveles plasmáticos de los agentes antineoplásicos. Los principios activos identificados que pueden tener interacciones farmacológicas con antineoplásicos fueron principalmente: alopurinol, amiodarona, carbamazepina, dabigatran, digoxina, espironolactona, fenitoina, itraconazol, repaglinida, silodosina, tamoxifeno, verapamilo y warfarina. Las interacciones farmacológicas a través del citocromo P450 1A2, 2D6, 2C8, 2C9, 3A4 fueron las más importantes para los inhibidores de la tirosin kinasa. Otras sustancias no medicamentosas, con importante potencial de poder causar una interacción farmacológica de relevancia fueron los inmunomoduladores (extractos de equinacea) y el Hypericum perforatum. CONCLUSIONES: Los fármacos antineoplásicos orales poseen numerosas interacciones farmacológicas de interés que deben ser monitorizadas en farmacéutico de hospital, por el privilegiado papel que ocupa, es el profesional clave para identificar y valorar las interacciones farmacológicas de antineoplásicos orales que pudieran tener consecuencias clínicas.

Revisión de las interacciones farmacológicas de los fármacos antineoplásicos orales dispensados en un servicio de farmacia / Review of pharmacological interactions of oral anticancer drugs provided at pharmacy department

Objetivo: Identificar las interacciones farmacológicas de los fármacos antineoplásicos orales dispensados desde una consulta de pacientes externos. Material y métodos: Se identificaron los fármacos antineoplásicos incluidos en la Guía farmacoterapéutica del Complejo Hospitalario. Se realizó una búsqueda bibliográfica sobre sus interacciones farmacológicas en MEDLINE® y EMBASE® (tomando como límites los idiomas español e inglés, los descriptores: "nombre del fármaco antineoplásico" AND ("drug interactions" OR "pharmacokinetic")), Up-to-date®, MICROMEDEX® y ficha técnica del medicamento de la EMA y FDA. También se buscó información en los resúmenes de los congresos europeos y nacionales de los últimos 4 años. Cuando una interacción analizada resultó ser de relevancia clínica, se buscó la mejor alternativa farmacoterapéutica no interaccionante. Resultados: Se identificaron veintitrés fármacos, de ellos, clorambucilo, fludarabina, lenalidomida, melfalan y talidomida son principios activos con menor probabilidad de ocasionar una interacción farmacológica. Los inhibidores de la tirosin kinasa (especialmente ertininib, imatinib, lapatinib y pazopanib) son los fármacos con más interacciones farmacológicas descritas, muchas de ellas con consecuencias clínicas severas, con aumentos y descensos de los niveles plasmáticos de los agentes antineoplásicos. Los principios activos identificados que pueden tener interacciones farmacológicas con antineoplásicos fueron principalmente: alopurinol, amiodarona, carbamazepina, dabigatran, digoxina, espironolactona, fenitoina, itraconazol, repaglinida, silodosina, tamoxifeno, verapamilo y warfarina. Las interacciones farmacológicas a través del citocromo P450 1A2, 2D6, 2C8, 2C9, 3A4 fueron las más importantes para los inhibidores de la tirosin kinasa. Otras sustancias no medicamentosas, con importante potencial de poder causar una interacción farmacológica de relevancia fueron los inmunomoduladores (extractos de equinacea) y el Hypericum perforatum. Conclusiones: Los fármacos antineoplásicos orales poseen numerosas interacciones farmacológicas de interés que deben ser monitorizadas en farmacéutico de hospital, por el privilegiado papel que ocupa, es el profesional clave para identificar y valorar las interacciones farmacológicas de antineoplásicos orales que pudieran tener consecuencias clínicas

Objective: To identify the pharmacologic interactions of oral anti-cancer drugs provided at an outpatient clinic. Material and methods: Anti-cancer drugs included in the Phamacotherapeutic Guideline of the Hospital were identified. A literature search was carried out on the pharmacologic interactions in MEDLINE® and EMBASE® (with the filer language English or Spanish, and the descriptors: "name of the anti-cancer drug" AND ("drug interactions" OR "pharmacokinetic")), Up-to-date®, MICROMEDEX® and the drug information sheet for the EMA and the FDA. Information was also gathered from the abstract presented to European and Spanish scientific meetings for the last 4 years. When an interaction was analyzed and had clinical relevance, the best pharmacotherapeutic interaction-free alternative was sought. Results: Twenty-three drugs were identified, of which Chlorambucil, Fludarabine, Lenalidomide, Melphalan, and Thalidomide were the active compounds with the lowest likelihood of producing a pharmacologic interaction. Tyrosine kinase inhibitors (particularly Erlotinib, Imatinib, Lapatinib, and Pazopanib) are the drugs with highest number of pharmacologic interactions described, many of them with severe clinical consequences, with increases and decreases of the plasma levels of anti-cancer drugs. The active compounds identified that may have pharmacologic interactions with anticancer drugs were mainly: Allopurinol, Amiodarone, Carbamazepine, Dabigatran, Digoxin, Spironolactone, Phenytoin, Itraconazol, Repaglinide, Silodosin, Tamoxifen, Verapamil, and Warfarin. Pharmacologic interactions through the cytochrome P450 1A2, 2D6, 2C8, 2C9, 3A4 were the most important for tyrosine kinase inhibitors. Other non-pharmacologic compounds, with an important potential of producing relevant pharmacologic interaction were immunomodulators (Echinacea extracts) and Hypericum perforatum. Conclusions: Oral anticancer drugs have numerous pharmacologic interactions that should be monitored during pharmacotherapy. Given its position, the hospital pharmacist is the key professional for identifying and assessing the pharmacologic interactions or oral anticancer drugs that may have clinical consequences