Tratamiento de la eritrodisestesia palmoplantar con una fórmula magistral de urea 20% + triamcinolona acetónido 0, 2% + lidocaína 2% / Treatment of palmoplantar erythrodysesthesia with a compounding of urea 20% + triamcinolone acetonide 0.2% + lidocaine 2%

La eritrodisestesia palmoplantar es una reacción adversa cútanea secundaria al tratamiento quimioterápico y relativamente frecuente. Cursa con enrojecimiento, hinchazón, ardor y sensibilidad; en los casos más graves produce descamación de la piel, ampollas y dolor intenso afectando a la deambulación y calidad de vida de los pacientes.Se presenta el caso de una mujer a tratamiento con capecitabina que en el tercer ciclo de tratamiento presenta eritrodisestesia palmoplantar con empeoramiento en el octavo ciclo. El Servicio de Dermatología solicita al Servicio de Farmacia la elaboración de una crema de alantoína 6%. Desde el Servicio de Farmacia se propone la adición de un corticoide por sus propiedades inflamatorias y un anestésico para alivio del dolor. A los 7 días de inicio de tratamiento la paciente describe una leve mejoría, pero continúa con descamación en los pies; por lo que el Servicio de Farmacia propone cambio de alantoína por urea e incorporar un corticoide más potente. Se mantiene la lidocaína y se cambia la base de O/W a W/O para favorecer la penetración de los fármacos en la zona palmar y plantar.La composición final de la fórmula magistral es (100 g): urea 20 g, lidocaína 2 g, acetónido de triamcinolona 0,2 g, glicerina 3 g, alantoína 1 g, aceite de argán 5 g, vaselina filante 9 g, agua conservante 35 ml y base de absorción PR W/O 25 g.Tras 45 días de tratamiento con la fórmula propuesta, la paciente presenta muy buena evolución y mejoría desde el punto de vista sintomático. Además, ha mejorado notablemente la deambulación haciendo vida normal. (AU)

Palmoplantar erythrodysesthesia is a relatively frequent adverse cutaneous reaction secondary to chemotherapy treatment. It produces redness, swelling, burning and sensitivity. In the most severe cases it produces skin desquamation, blisters and intense pain affecting patients’ ambulation and quality of life.We present the case of a woman on a capecitabine treatment who during the third cycle of treatment presents palmoplantar erythrodysesthesia, worsening during the eighth cycle. The Dermatology Department requested the Pharmacy Department the elaboration of a 6% allantoin cream. The Pharmacy Department proposes the addition of a corticosteroid, due to its anti-inflammatory properties, and the addition of an anesthetic for pain relief. 7 days after having started the treatment, the patient describes a slight improvement, but she still presents feet desquamation. Therefore, the Pharmacy Department proposed changing allantoin for urea and introducing a stronger corticosteroid. Lidocaine is maintained and the base is changed from O/W to W/O to favor the penetration of the drugs in the palmar and plantar areas.The final composition of the compounding is (100 g): urea 20 g, lidocaine 2 g, triamcinolone acetonide 0.2 g, glycerin 3 g, allantoin 1 g, argan oil 5 g, stringy vaseline 9 g, preservative water 35 mL and PR W/O absorption base 25 g.Afer 45 days of treatment with the proposed compounding, the patient shows a very good evolution and improvement from the symptomatic point of view. Moreover, she has significantly improved the ambulation and can return to normal life. (AU)

Efectividad y seguridad de un jarabe de isoniazida 50 mg/mL para uso pediátrico / Effectiveness and safety of a 50 mg/mL isoniazid syrup for pediatric use

Introducción: La tuberculosis pediátrica ha sido una epidemia mundial oculta durante décadas con dificultades para su control, entre las que se encuentra el difícil cumplimiento terapéutico debido a la correcta administración del tratamiento en niños que no pueden deglutir presentaciones farmacéuticas sólidas. El tratamiento de la tuberculosis es una terapia combinada, por lo que en su diseño se tiene que tener en cuenta el volumen final a administrar de todas las formulaciones así como su palatabilidad para favorecer la adherencia terapéutica.Objetivo: Evaluación de la efectividad y seguridad de una fórmula magistral de isoniazida 50 mg/mL.Material y métodos: Estudio observacional retrospectivo de 5 años de duración, incluyendo a todos los pacientes que recibieron dicha fórmula.Se registraron las siguientes variables: edad, sexo, indicación, reacciones adversas y evolución. Bases de datos: Silicon® (soporte informático de dispensación) y IANUS® (historia clínica electrónica). La efectividad se valoró mediante criterios clínicos, radiológicos y/o analíticos. Para la detección de reacciones adversas se realizaron analíticas de sangre y se evaluó la aparición de síntomas asociados a la ingesta de sorbitol que contiene la fórmula.Resultados: Composición de la fórmula (100 mL): isoniazida 5 g, agua conservans 50 mL (contiene Nipagin® 0,08% y Nipasol® 0,02%) y sorbitol 70% 50 mL. El periodo de caducidad establecido fue de 30 días coincidiendo con el referenciado en la bibliografía. El pH de la fórmula orale líquida (FOL) elaborada fue de 6,45±0,05 que corresponde con el de máxima estabilidad del principio activo. (AU)

Introduction: Pediatric tuberculosis has been a global epidemic hidden for decades with difficulties in its control, among which is difficult compliance with treatment due to the correct administration of treatment in children who cannot swallow solid pharmaceutical presentations. The treatment of tuberculosis is a combined therapy, so its design must take into account the final volume to be administered of all the formulations as well as its palatability to promote therapeutic adherence.Objective: Evaluation of the effectiveness and safety of a magisterial formula of isoniazid 50 mg/mL.Material and methods: A 5-year retrospective observational study, including all patients who received this formula.The following variables were recorded: age, sex, indication, adverse reactions and evolution. Databases: Silicon® (dispensing computer support) and IANUS® (electronic medical record). The effectiveness was assessed using clinical, radiological and/or analytical criteria. To detect adverse reactions, blood tests were performed and the appearance of symptoms associated with the intake of sorbitol containing the formula was evaluated.Results: Composition of the formula (100 mL): isoniazid 5 g, preservative water 50 mL (contains Nipagin® 0.08% and Nipasol® 0.02%) and sorbitol 70% 50 mL.The established expiration period was 30 days, coinciding with that referenced in the bibliography. The pH of the elaborated liquid oral formula (LOF) was 6.45±0.05, which corresponds to the maximum stability of the active principle. (AU)

Physicochemical and microbiological stability of two news oral liquid formulations of clonidine hydrochloride for pediatric patients.

Pediatric patients present changing physiological features. Because of the lack of land suitable for commercial management, pediatric specialties very often need to prepare extemporaneous formulations to improve the dosage and administration of drugs for children. Oral liquid formulations are the most suitable for pediatric patients. Clonidine is widely used in the pediatric population for opioid withdrawal, hypertensive crisis, attention deficit disorders and hyperactivity syndrome, and as an analgesic in neuropathic cancer pain. The objective was to study the physicochemical and microbiological stability and determine the shelf life of an oral solution containing 20 µg/mL clonidine hydrochloride in different storage conditions (5 ± 3 °C, 25 ± 3 °C, and 40 ± 2 °C). Using raw material with excipients safe for all pediatric age groups, two oral liquid formulations of clonidine hydrochloride were designed (with and without preservatives). Solutions stored at 5 ± 3 °C (with and without preservatives) were physically and microbiologically stable for at least 90 days in closed containers and for 42 days after opening. Two oral solutions of clonidine hydrochloride 20 µg/mL were developed for pediatric use from raw materials that are readily available and easy to process, containing safe excipients that are stable over a long period of time.

[Acute paraplegia secondary to painless aortic dissection]. / Paraplejía aguda secundaria a la disección indolora de la aorta.

INTRODUCTION: Acute aortic dissection (AAD) is a serious and uncommon event. The clinical presentation generally includes thoracic or back pain. Painless aortic dissection is an extremely rare occurrence. Acute paraplegia is one of the neurological complications secondary to AAD. Although painful paraplegia is seen in 2% to 3% of AAD cases, painless paraplegia is a very rare event. CASE REPORT: A 51-year-old man with a long term history of hypertension, presented with acute paralysis of the lower extremities, with no chest or back pain. CONCLUSION: In presence of acute neurologic events, must always be investigated a vascular cause and, in these group of disease, the aortic dissection may be researched, although the pain wasn't present on occasion of the diagnosis.

Paraplejía aguda secundaria a la disección indolora de la aorta / Acute paraplegia secondary to painless aortic dissection

La disección aguda de aorta (DAA) es una patología grave y poco común, y su presentación clínicaincluye dolor torácico y dorsal. La disección indolora de la aorta es una enfermedad muy rara y la paraplejía aguda constituye una de las complicaciones secundarias a la DAA. Aunque la paraplejía dolorosa se observa entre un 2 y un 3% de todos los casos de DAA, la paraplejía indolora es extremadamente rara. Caso clínico. Varón de 51 años, con un largo historial de hipertensión,que presentaba paraplejía aguda, sin dolor torácico o dorsal. Conclusión. Ante la presencia de episodios neurológicos agudos, siempre debe investigarse una causa vascular, y dentro de ese grupo de enfermedades hay que tener en cuenta la disección de la aorta, aunque no haya dolor en el momento de realizar el diagnóstico

Acute aortic dissection (AAD) is a serious and uncommon event. The clinical presentation generallyincludes thoracic or back pain. Painless aortic dissection is an extremely rare occurrence. Acute paraplegia is one of the neurological complications secondary to AAD. Although painful paraplegia is seen in 2% to 3% of AAD cases, painless paraplegia is a very rare event. Case report. A 51-year-old man with a long term history of hypertension, presented with acuteparalysis of the lower extremities, with no chest or back pain. Conclusion. In presence of acute neurologic events, must always be investigated a vascular cause and, in these group of disease, the aortic dissection may be researched, although the pain wasn’t present on occasion of the diagnosis

Púrpura de Schönlein-Henoch en paciente con fibrosis quística / No disponible

No disponible