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1.
PLoS One ; 14(9): e0222972, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31557201

RESUMEN

Oral nutritional supplements (ONS) are multi-nutrient products used to increase the energy and nutrient intakes of patients. The aim of this study was to examine whether or not the adherence of patients varies according to their receiving prescription or over-the-counter ONS. Data were obtained from an online cross-sectional survey conducted with patients in Japan. A total of 107 patients who matched the inclusion criteria for the prescription ONS group and 148 who matched the criteria for the over-the-counter ONS group were further analyzed. In the prescription and over-the-counter ONS groups, the main medical reason for ONS consumption were "malnutrition" (48 patients [44.9%] vs. 63 patients [42.6%] p = 0.798], "frailty" (29 patients [27.1%] vs. 36 patients [24.3%] p = 0.663) and "aging" (25 patients [23.4%] vs. 30 patients [20.3%] p = 0.644). The proportion of "No particular disease" for prescription ONS consumption was significantly lower than that for over-the-counter ONS (6 patients [5.6%] vs. 24 patients [16.2%] p = 0.001). The body mass index of the prescription ONS group was significantly higher than that of the over-the-counter ONS group (21.1±4.38 kg/m2 vs. 19.9±3.75 kg/m2, p = 0.0161). In the prescription ONS group, all patients were given medical advice by doctors or registered dietitians. In contrast, in the over-the-counter ONS group, only 46 patients (31.1%) were given advice by doctors or registered dietitians (p<0.001). In the prescription ONS group, ONS was taken significantly more times and for a longer duration than in the over-the-counter ONS group (p<0.0001). However, among patients given advice by doctors or registered dietitians, there were no significant differences between the groups. Greater support by the medical team is still needed in order to maximize adherence to supplementation, especially concerning the calories, timing and period, so that benefits can be achieved and sustained.


Asunto(s)
Suplementos Dietéticos/estadística & datos numéricos , Desnutrición/tratamiento farmacológico , Pacientes Ambulatorios/estadística & datos numéricos , Cooperación del Paciente/estadística & datos numéricos , Administración Oral , Anciano , Estudios Transversales , Prescripciones de Medicamentos/estadística & datos numéricos , Femenino , Humanos , Japón , Masculino , Persona de Mediana Edad , Medicamentos sin Prescripción/administración & dosificación , Medicamentos bajo Prescripción/administración & dosificación , Encuestas y Cuestionarios/estadística & datos numéricos
2.
Int J Clin Pharm ; 41(6): 1462-1470, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31529269

RESUMEN

Background Increasing role of community pharmacists sometimes demands the diagnoses of minor ailments using appropriate questioning skills and recommendation of over-the-counter medications to patients seeking self-care. Objective To evaluate community pharmacists' questioning and diagnostic skills of minor ailment complaints, and the appropriateness of medication(s) recommendations made. Setting One hundred and thirty-one community pharmacies in Ibadan, Nigeria. Method A cross-sectional survey employing pseudo-patient study method. The pseudo-patient visited 131 community pharmacies from June 2017 to January 2018 and complained of stomach ache. The conversation between the pharmacists and pseudo-patient were audio-taped and transcribed verbatim. Two criteria were used to evaluate the questioning skill of the community pharmacists. One of the criteria was developed by a six-membered panel and had 13 questions while the other contained five questions:-Who is it for? What are the symptoms? How long have the symptoms been present? Action taken? and Medication used.? Questioning skill of the community pharmacists was classified based on the median scores of these two criteria as: poor, moderate and optimal. The diagnoses made by the community pharmacists from the pseudo-patients complaints were compared with the expected diagnosis of uncomplicated gastric ulcer caused by the use of ibuprofen. Recommendations for the pseudo-patients minor ailment were also compared with the Nigeria standard treatment guideline. Main outcome measure Pharmacists' questioning skill, types of diagnosis made and appropriateness of medications recommended. Results The median scores for the questioning skill criterion containing 5 and 13 questions were 2 and 4, respectively; showing poor questioning skill. Differential diagnoses of gastric ulcer, dyspepsia, gastroesophageal reflux, and hyperacidity were made by 92 (67.4%) pharmacists but 3 (2.3%) correctly diagnosed the pseudo-patients' minor ailment as uncomplicated gastric ulcer caused by short-term use of ibuprofen. Antacids were recommended in line with the standard treatment guideline by 46 (35.7%) pharmacists while proton pump inhibitors were recommended by 6 (4.7%) pharmacists. None advised the withdrawal of the provocative factor according to the treatment guideline. Conclusion The questioning skill of the community pharmacists in this setting was poor. Few community pharmacists diagnosed the pseudo-patients' minor ailment correctly. Also, recommendations were mostly inappropriate compared with the standard treatment guideline.


Asunto(s)
Servicios Comunitarios de Farmacia/organización & administración , Simulación de Paciente , Farmacéuticos/organización & administración , Úlcera Gástrica/diagnóstico , Competencia Clínica , Estudios Transversales , Diagnóstico Diferencial , Femenino , Humanos , Ibuprofeno/efectos adversos , Masculino , Nigeria , Medicamentos sin Prescripción/administración & dosificación , Farmacéuticos/normas , Rol Profesional , Úlcera Gástrica/etiología , Úlcera Gástrica/terapia , Encuestas y Cuestionarios
4.
JAMA Netw Open ; 2(6): e195388, 2019 06 05.
Artículo en Inglés | MEDLINE | ID: mdl-31173125

RESUMEN

Importance: Despite the increasingly important role of pharmacies in the implementation of naloxone access laws, there is limited information on the impact of such laws at the local level. Objective: To evaluate the availability (with or without a prescription) and cost of naloxone nasal spray at pharmacies in Philadelphia, Pennsylvania, following a statewide standing order enacted in Pennsylvania in August 2015 to allow pharmacies to dispense naloxone without a prescription. Design, Setting, and Participants: A survey study was conducted by telephone of all pharmacies in Philadelphia between February and August 2017. Pharmacies were geocoded and linked with the American Community Survey (2011-2015) to obtain information on the demographic characteristics of census tracts and the Medical Examiner's Office of the Philadelphia Department of Public Health to derive information on the number of opioid overdose deaths per 100 000 people for each planning district. Data were analyzed from March 2018 to February 2019. Main Outcomes and Measures: Availability and out-of-pocket cost of naloxone nasal spray (with or without a prescription) at Philadelphia pharmacies overall and by pharmacy and neighborhood characteristics. Results: Of 454 eligible pharmacies, 418 were surveyed (92.1% response rate). One in 3 pharmacies (34.2%) had naloxone nasal spray in stock; of these, 61.5% indicated it was available without a prescription. There were significant differences in the availability of naloxone by pharmacy type and neighborhood characteristics. Naloxone was both more likely to be in stock (45.9% vs 27.8%; difference, 18.0%; 95% CI, 8.3%-27.8%; P < .001) and available without a prescription (80.6% vs 42.2%; difference, 38.4%; 95% CI, 23.0%-53.8%; P < .001) in chain stores than in independent stores. Naloxone was also less likely to be available in planning districts with very elevated rates of opioid overdose death (≥50 per 100 000 people) compared with those with lower rates (31.1% vs 38.5%). The median (interquartile range) out-of-pocket cost among pharmacies offering naloxone without a prescription was $145 ($119-$150); costs were greatest in independent pharmacies and planning districts with elevated rates of opioid overdose death. Conclusions and Relevance: Despite the implementation of a statewide standing order in Pennsylvania more than 3 years prior to this study, only one-third of Philadelphia pharmacies carried naloxone nasal spray and many also required a physician's prescription. Efforts to strengthen the implementation of naloxone access laws and better ensure naloxone supply at local pharmacies are warranted, especially in localities with the highest rates of overdose death.


Asunto(s)
Naloxona/administración & dosificación , Antagonistas de Narcóticos/administración & dosificación , Farmacias/estadística & datos numéricos , Administración por Inhalación , Honorarios Farmacéuticos , Gastos en Salud/estadística & datos numéricos , Humanos , Naloxona/economía , Naloxona/provisión & distribución , Antagonistas de Narcóticos/economía , Antagonistas de Narcóticos/provisión & distribución , Rociadores Nasales , Medicamentos sin Prescripción/administración & dosificación , Medicamentos sin Prescripción/economía , Medicamentos sin Prescripción/provisión & distribución , Trastornos Relacionados con Opioides/economía , Trastornos Relacionados con Opioides/rehabilitación , Farmacias/economía , Philadelphia , Medicamentos bajo Prescripción/administración & dosificación , Medicamentos bajo Prescripción/economía , Medicamentos bajo Prescripción/provisión & distribución
5.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(5): 554-558, 2019 May 10.
Artículo en Chino | MEDLINE | ID: mdl-31177737

RESUMEN

Objective: To understand the relationship between medication during pregnancy and single live preterm birth of infant in women of childbearing age in Shaanxi province. Methods: A cross-sectional design was used in this study and stratified multistage random sampling method was used. A questionnaire survey was conducted in the childbearing-aged women selected through multi stage stratified random sampling in Shaanxi during 2010 to 2013. Qualitative datum was described by percentage and measurement datum was described by mean±standard deviation. Logistic regression analysis was done to evaluate the relationship between medication during pregnancy and preterm birth of infant. Results: The overall incidence rate of premature birth was 2.7% in Shaanxi. Among the 28 841 mothers participating in this study, the proportion of medication use at any time during pregnancy was 15.8%, and the most commonly used drug was cold medicine (5.9%). After adjusting all confounding factors, the multivariable logistic regression analysis results showed that taking hormone medicine (OR=2.23, 95%CI: 1.19-4.18), antihypertensive medicine (OR=7.74, 95%CI: 4.28-13.95) and other medicines (OR=2.15, 95%CI: 1.60-2.89) during early pregnancy were the risk factors for preterm delivery, the risk was 2.23 times, 7.74 times and 2.15 times higher compared with those taking no these medicines. Conclusion: Using hormone medicine, antihypertensive medicine and other medicines during pregnancy increased the risk for preterm delivery in women of childbearing age in Shaanxi.


Asunto(s)
Medicamentos sin Prescripción/administración & dosificación , Complicaciones del Embarazo/epidemiología , Nacimiento Prematuro/epidemiología , Medicamentos bajo Prescripción/administración & dosificación , Antihipertensivos/administración & dosificación , Antihipertensivos/efectos adversos , China/epidemiología , Estudios Transversales , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Madres , Medicamentos sin Prescripción/efectos adversos , Embarazo , Medicamentos bajo Prescripción/efectos adversos , Factores de Riesgo
6.
Int J Pharm Pract ; 27(6): 501-509, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31140669

RESUMEN

OBJECTIVES: To identify factors influencing Australian consumer decision-making and attitudes towards non-prescription medicine (NPM) purchases, pharmacy's role in providing these medications and views around sources of evidence for effectiveness of these products. METHODS: Cross-sectional survey of a general population sample of 1731 adults using an Australian online consumer panel stratified by gender, age and location (State/Territory). Beliefs about NPM purchases and evidence of their efficacy were assessed using a 5-point Likert scale (strongly disagree-strongly agree). Non-parametric measures (Ridit analysis and Mann-Whitney U-test) were used to explore associations between responses and previous experience with medicines. KEY FINDINGS: The most important factors when purchasing NPMs were effectiveness and safety. However, personal experience was the most common method of determining effectiveness. Most respondents believed buying NPMs in pharmacies gave access to advice, but were less likely to agree that pharmacies were associated with safe and effective treatments. Around half the respondents agreed that it is wrong to sell treatments lacking scientific evidence; many also agreed that it is up to consumers to decide what they want even without scientific evidence. Individuals experiencing an ineffective NPM were less likely to trust scientific evidence of efficacy as the sole source of effectiveness information; regular prescription medicine users often agreed that scientific evidence is needed to support effectiveness. CONCLUSIONS: Consumers have conflicting views regarding the need for scientific evidence and the desire for patient autonomy in NPM purchases. This presents a challenge for pharmacists wishing to maintain professional obligations to provide evidence-based treatments to consumers.


Asunto(s)
Conducta de Elección , Comportamiento del Consumidor/estadística & datos numéricos , Medicamentos sin Prescripción/administración & dosificación , Farmacéuticos/organización & administración , Adulto , Australia , Estudios Transversales , Toma de Decisiones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Servicios Farmacéuticos/organización & administración , Encuestas y Cuestionarios , Adulto Joven
7.
Medicine (Baltimore) ; 98(22): e15732, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31145288

RESUMEN

BACKGROUND: There are currently no FDA-approved biological or chemical drugs for the treatment of HBV-related liver fibrosis or cirrhosis. Some Chinese patent medicines have proven to be effective in this area. OBJECTIVE: The network meta-analysis (NMA) is to evaluate whether entecavir combined with Chinese patent medicine, such as "fuzhenghuayu capsules," "anluohuaxian pills," "fufangbiejiaruangan tablets," shows superior efficiency compared with entecavir alone for the treatment of chronic HBV-related liver fibrosis or cirrhosis. To evaluate which Chinese patent medicine is the most effective at improving liver fibrosis or cirrhosis in chronic hepatitis B-infected patients? METHODS: Registration of protocol: the protocol was published in the PROSPERO database (identification number: CRD42018112547). We will search PubMed, EMbase, Medline, Cochrane, China Network Knowledge Infrastructure (CNKI), and Wanfang for randomized controlled trials (RCTs) or "prospective cohort studies" of "fuzhenghuayu capsules," "anluohuaxian pills," "fufangbiejiaruangan tablets" respectively combined with entecavir in the treatment of chronic HBV-related liver fibrosis or cirrhosis from their inception to September 30, 2018. R 3.3.3 and GeMTC 0.14.3 software will be used for data analysis.


Asunto(s)
Antivirales/administración & dosificación , Medicamentos Herbarios Chinos/administración & dosificación , Guanina/análogos & derivados , Virus de la Hepatitis B , Hepatitis B Crónica/tratamiento farmacológico , Cirrosis Hepática/tratamiento farmacológico , Medicamentos sin Prescripción/administración & dosificación , Quimioterapia Combinada , Femenino , Guanina/administración & dosificación , Hepatitis B Crónica/complicaciones , Hepatitis B Crónica/virología , Humanos , Cirrosis Hepática/virología , Masculino , Metaanálisis como Asunto , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
9.
Basic Clin Pharmacol Toxicol ; 125(4): 405-413, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30983117

RESUMEN

Considering the concerns about topical corticosteroid (TC) phobia that prevents necessary use of patients from using the necessary TCs, estimating the incidence and characteristics of adverse drug events (ADEs) related to TCs in the real world is warranted. However, limited study investigated them. This prospective observational study aimed to assess the utility patterns and safety data related to TC use and predisposing factors among community-dwelling population. We included and prospectively observed the TC users through nationwide multi-centre observational cohort based on community pharmacies and dermatologic clinic. Among the enrolled 1175 over-the-counter and prescription TC users, a total of 1103 participants were included for the analysis. Inappropriate TC use was observed in 6.3%. The cumulative incidence and prevalence of overall ADE for 6 months were 3.5% and 7.2%, respectively, and the incidence rate was 0.3 cases per 1000 person-days of TC use. Most ADEs were local reactions, mainly skin atrophy and hyperpigmentation. Exposure to TCs for >12 weeks (adjusted odds ratio [aOR] 4.38, 95% confidence interval [CI] 2.23-8.63) and past experience of ADE (aOR 36.70, 95% CI 16.74-80.44) were identified as significant predictors of TC-related ADEs. The ADE incidence related to TCs was relatively low, and the real-world safety of using TCs in the general population might not be greatly concerning. However, some populations who are highly at a risk of ADEs should be closely monitored and made aware regarding the risk.


Asunto(s)
Glucocorticoides/efectos adversos , Hiperpigmentación/epidemiología , Piel/patología , Administración Cutánea , Adulto , Atrofia/inducido químicamente , Atrofia/epidemiología , Servicios Comunitarios de Farmacia/estadística & datos numéricos , Utilización de Medicamentos/estadística & datos numéricos , Femenino , Glucocorticoides/administración & dosificación , Humanos , Hiperpigmentación/inducido químicamente , Incidencia , Masculino , Persona de Mediana Edad , Medicamentos sin Prescripción/administración & dosificación , Medicamentos sin Prescripción/efectos adversos , Medicamentos bajo Prescripción/administración & dosificación , Medicamentos bajo Prescripción/efectos adversos , Estudios Prospectivos , República de Corea/epidemiología , Piel/efectos de los fármacos
10.
Med Oncol ; 36(5): 45, 2019 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-30993543

RESUMEN

Cancer is becoming more prevalent in elderly patient. Due to polypharmacy, older adults with cancer are predisposed to drug-drug interactions. There is also an increasing interest in the use of complementary and alternative medicine (CAM). Thirty to seventy percent of patients with cancer have used CAM. Through pharmaceutical counseling sessions, we can provide advices on herb-drug interactions (HDI). All the patients seen in pharmaceutical counseling sessions were prospectively included. Information was collected during these sessions: prescribed medication (oral anticancer agents (OAA) and other drugs), CAM (phytotherapy especially), and use of over-the-counter (OTC) drugs. If pharmacist considered an interaction or an intervention clinically relevant, the oncologist was notified. Then, a literature review was realized to identify the potential HDI (no interactions, precautions for use, contraindication). Among 201 pharmacist counseling sessions, it resulted in 104 interventions related to 46 HDI, 28 drug-drug interactions and 30 others (wrong dosage, omission…). To determine HDI, we review 73 medicinal plants which are used by our patients with cancer and 31 OAA. A total of 1829 recommendations were formulated about 59 (75%) medical plants and their interaction with an OAA. Herb-drug interactions should not be ignored by healthcare providers in their management of cancer patients in daily practice.


Asunto(s)
Antineoplásicos/efectos adversos , Interacciones de Hierba-Droga , Neoplasias/tratamiento farmacológico , Fitoterapia/efectos adversos , Polifarmacia , Anciano , Antineoplásicos/administración & dosificación , Humanos , Persona de Mediana Edad , Medicamentos sin Prescripción/administración & dosificación , Medicamentos sin Prescripción/efectos adversos , Farmacéuticos , Preparaciones de Plantas/administración & dosificación , Preparaciones de Plantas/efectos adversos , Estudios Prospectivos
12.
Br J Clin Pharmacol ; 85(5): 1028-1034, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30740763

RESUMEN

Temporal patterns of acetaminophen use exceeding the recommended daily maximum dosage of 4 g over a 5-year period (4/1/2011-3/31/2016) were evaluated in an online 1-week diary study of 14 434 adult acetaminophen users who also reported acetaminophen use in the previous month. Specific medications taken were identified by list-based prompting; respondents were not required to know their medications contained acetaminophen. Details of use were recorded daily; total daily dosage was determined programmatically. Prevalence of >4 g use over time was modelled and tested for linear changes. The overall prevalence of >4 g use (6.3% of users and 3.7% of usage days) did not change over the 5 years: odds ratio (OR) persons, 1.02 (95% CI, 0.98-1.09); OR days, 0.98 (0.92-1.05). Deviations from label directions were largely unchanged, though concomitant use increased slightly. Thus, over a recent 5-year period, there was no evidence of change in how often acetaminophen use exceeded the labelled maximum daily dose.


Asunto(s)
Acetaminofén/administración & dosificación , Analgésicos no Narcóticos/administración & dosificación , Sobredosis de Droga/epidemiología , Medicamentos sin Prescripción/administración & dosificación , Datos de Salud Generados por el Paciente/tendencias , Adulto , Diarios como Asunto , Etiquetado de Medicamentos , Monitoreo Epidemiológico , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Intervención basada en la Internet/estadística & datos numéricos , Intervención basada en la Internet/tendencias , Masculino , Persona de Mediana Edad , Datos de Salud Generados por el Paciente/estadística & datos numéricos , Prevalencia , Autoinforme/estadística & datos numéricos , Estados Unidos/epidemiología
13.
Drugs Aging ; 36(2): 179-188, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30607798

RESUMEN

BACKGROUND: Lower urinary tract symptoms (LUTS) attributed to benign prostatic hyperplasia (BPH) are common in men, considerably affecting quality of life. AIMS: The self-directed use of over-the-counter (OTC) tamsulosin (0.4 mg) and potential safety risks were evaluated in an open-label, uncontrolled, exploratory, 8-week OTC-simulated study. METHODS: Men (≥ 18 years) were recruited via mass advertising about bothersome LUTS. In a working retail environment, respondents reviewed the product and decided whether it was appropriate for them to use (self-selection phase). After purchasing the product, participants' ability to use it as directed by the proposed drug facts label (DFL) was assessed (home-use phase). RESULTS: Of 1446 eligible men, 679 completed the self-selection phase, and 73.9% (502/679) self-selected to use tamsulosin correctly according to the DFL. Of 369 participants who purchased tamsulosin and entered the home-use phase, 321 took one or more doses of tamsulosin and participated in at least one telephone interview. In total, 85.4% (274/321) of participants adhered to the 'Stop Use' and 'Directions' instructions in the DFL. Overall, 139 (39.6%) participants experienced one or more adverse events (AEs); 65 (18.5%) were deemed drug-related, including dizziness (11 [3.1%]), ejaculation disorder (6 [1.7%]), and semen volume decrease (6 [1.7%]). No unexpected AEs were reported. CONCLUSIONS: Of the men interested in self-managing their LUTS, a majority had moderate-to-severe LUTS of long duration. Most men were able to appropriately self-select and use tamsulosin in concordance with DFL instructions and directions. No unexpected AEs were reported during self-directed use. With further label refinement, an over-the-counter tamsulosin option might be feasible. TRIAL REGISTRATION: ClinicalTrials.gov NCT01726270.


Asunto(s)
Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , Tamsulosina/administración & dosificación , Adulto , Conductas Relacionadas con la Salud , Humanos , Síntomas del Sistema Urinario Inferior/etiología , Masculino , Persona de Mediana Edad , Medicamentos sin Prescripción/administración & dosificación , Medicamentos sin Prescripción/efectos adversos , Hiperplasia Prostática/complicaciones , Calidad de Vida , Tamsulosina/efectos adversos , Resultado del Tratamiento , Agentes Urológicos/administración & dosificación , Agentes Urológicos/efectos adversos
14.
Int J Pharm Pract ; 27(1): 105-107, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30019790

RESUMEN

OBJECTIVE: To explore amateur endurance athletes' use and views about non-steroidal anti-inflammatory drugs (NSAIDs). METHODS: An online cross-sectional survey of amateur athletes at four athletic clubs. KEY FINDINGS: Of a sample of 129 of amateur athletes, 68% (n = 88) reported using NSAIDs in the previous 12 months (84.4% in triathletes, 70.9% in runners and 52.5% in cyclists). Overall, ibuprofen was the most popular drug (n = 48). There was a lack of knowledge of adverse drug reactions, with only 26% of use advised by a doctor or pharmacist. CONCLUSIONS: There is high usage of NSAIDs in amateur athletes, including before and during events, largely without professional health advice. Informational needs of amateur athletes are not being met.


Asunto(s)
Antiinflamatorios no Esteroideos/administración & dosificación , Atletas/estadística & datos numéricos , Entrenamiento Aeróbico/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Automedicación/estadística & datos numéricos , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medicamentos sin Prescripción/administración & dosificación , Encuestas y Cuestionarios/estadística & datos numéricos , Reino Unido , Adulto Joven
15.
J Pharm Pharmacol ; 71(4): 643-673, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30062750

RESUMEN

OBJECTIVES: Drugs used to treat gastrointestinal diseases (GI drugs) are widely used either as prescription or over-the-counter (OTC) medications and belong to both the 10 most prescribed and 10 most sold OTC medications worldwide. The objective of this review article is to discuss the most frequent interactions between GI and other drugs, including identification of the mechanisms behind these interactions, where possible. KEY FINDINGS: Current clinical practice shows that in many cases, these drugs are administered concomitantly with other drug products. Due to their metabolic properties and mechanisms of action, the drugs used to treat gastrointestinal diseases can change the pharmacokinetics of some coadministered drugs. In certain cases, these interactions can lead to failure of treatment or to the occurrence of serious adverse events. The mechanism of interaction depends highly on drug properties and differs among therapeutic categories. Understanding these interactions is essential to providing recommendations for optimal drug therapy. SUMMARY: Interactions with GI drugs are numerous and can be highly significant clinically in some cases. While alterations in bioavailability due to changes in solubility, dissolution rate, GI transit and metabolic interactions can be (for the most part) easily identified, interactions that are mediated through other mechanisms, such as permeability or microbiota, are less well-understood. Future work should focus on characterising these aspects.


Asunto(s)
Interacciones Farmacológicas , Fármacos Gastrointestinales/administración & dosificación , Enfermedades Gastrointestinales/tratamiento farmacológico , Animales , Disponibilidad Biológica , Fármacos Gastrointestinales/química , Fármacos Gastrointestinales/farmacocinética , Humanos , Medicamentos sin Prescripción/administración & dosificación , Medicamentos sin Prescripción/química , Medicamentos sin Prescripción/farmacocinética , Medicamentos bajo Prescripción/administración & dosificación , Medicamentos bajo Prescripción/química , Medicamentos bajo Prescripción/farmacocinética , Solubilidad
16.
Therapie ; 74(2): 199-207, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30470476

RESUMEN

The systematic case-referent method is a special case-referent design originally developed for pharmacoepidemiologic research purposes. It consists in the systematic collection of series of incident cases of various disorders and the assembling of a general reference pool, from which "controls" are secondarily selected to be matched to specific cases. Both series are collected independently from each other and with no a priori hypothesis to be investigated. The reference pool can be either general or limited to a subpopulation, representative of the source population of the cases. Based on clinical recruitment of cases and referents, the design allows a very high specificity of diagnosis and documentation of clinical variables. All cases and referents are systematically documented on all treatments received before the incidence of the cases or before identification of referents. This documentation is done preferentially using objective sources assembled independently (linkage to claims data, medical records, pharmacy records, prescription records, hospital discharge letters). It can be completed with patients' interviews using standardised research tools, in particular for over-the-counter drug use and self-medication, and for the documentation of adherence to treatment and specific time-windows of exposure. Likewise, all cases and all referents are systematically documented on a series of risk factors, which are common to most epidemiological studies and are not hypothesis-dependent. Whenever the documentation of a confounding factor specific to the disease at hand is necessary, additional questionnaires can be applied to all or a sample of patients. The method has been successfully implemented for the pharmacoepidemiologic study of myocardial infarction, stroke, lupus, multiple sclerosis, rheumatoid arthritis, Guillain Barré syndrome, idiopathic thrombocytopenic purpura, type 1 diabetes mellitus, suicide attempts, breast cancer, and other disorders, for the analysis of the risk or preventing action of NSAIDs, statins, antiplatelet agents, anticoagulants, insulins, vaccines and other drugs.


Asunto(s)
Factores de Confusión Epidemiológicos , Farmacoepidemiología/métodos , Proyectos de Investigación , Estudios de Casos y Controles , Humanos , Incidencia , Medicamentos sin Prescripción/administración & dosificación , Medicamentos sin Prescripción/efectos adversos , Factores de Riesgo , Automedicación/efectos adversos , Automedicación/métodos , Encuestas y Cuestionarios
17.
J Pharm Pract ; 32(1): 62-67, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29108459

RESUMEN

PURPOSE:: To evaluate the differences in medication history errors made by pharmacy technicians, students, and pharmacists compared to nurses at a community hospital. METHODS:: One hundred medication histories completed by either pharmacy or nursing staff were repeated and evaluated for errors by a fourth-year pharmacy student. The histories were analyzed for differences in the rate of errors per medication. Errors were categorized by their clinical significance, which was determined by a panel of pharmacists, pharmacy students, and nurses. Errors were further categorized by their origin as either prescription (Rx) or over the counter (OTC). The primary outcome was the difference in the rate of clinically significant errors per medication. Secondary outcomes included the differences in the rate of clinically insignificant errors, Rx errors, and OTC errors. Differences in the types of errors for Rx and OTC medications were also analyzed. Additionally, the number of patients with no errors was compared between both groups. RESULTS:: The pharmacy group had a lower clinically significant error rate per medication (0.03 vs 0.09; relative risk [RR] = 0.66; 95% confidence interval [CI]: 0.020-0.093; P = .003). For secondary outcomes, the pharmacy group had a lower total error rate (0.21 vs 0.36, RR = 0.58; 95% CI: 0.041-0.255; P = .007), Rx error rate (0.09 vs 0.27, RR = 0.44; 95% CI: 0.071-0.292; P = .002), and OTC error rate (0.24 vs 0.46; RR = 0.52; 95% CI: 0.057-0.382; P = .009) per medication. The pharmacy group completed 20% more medication histories without Rx errors ( P = .045) and 25% more histories without OTC errors ( P = .041). CONCLUSION:: This study demonstrated that expanded use of pharmacy technicians and students improves the accuracy of medication histories in a community hospital.


Asunto(s)
Anamnesis/normas , Enfermeras y Enfermeros/normas , Farmacéuticos/normas , Técnicos de Farmacia/normas , Estudiantes de Farmacia/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Errores de Medicación/estadística & datos numéricos , Persona de Mediana Edad , Medicamentos sin Prescripción/administración & dosificación , Enfermeras y Enfermeros/estadística & datos numéricos , Farmacéuticos/estadística & datos numéricos , Servicio de Farmacia en Hospital/normas , Técnicos de Farmacia/estadística & datos numéricos , Medicamentos bajo Prescripción/administración & dosificación , Estudios Prospectivos
18.
Clin Pharmacol Ther ; 105(1): 161-167, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30094825

RESUMEN

Sunscreens are regulated as over-the-counter drugs in the United States. Some sunscreen ingredients are absorbed into the systemic circulation, which raises concerns about the safety of these drugs. There is limited information on the systemic exposure for most sunscreen ingredients. This report estimates the systemic absorption of two sunscreen active ingredients, oxybenzone and enzacamene, by developing a pharmacokinetic model from published sunscreen absorption data and compares the results with safety thresholds proposed by the US Food and Drug Administration and in the literature. Our analysis indicates that systemic absorption can be substantial, and evaluation of the systemic exposure of sunscreen ingredients is warranted to better assess any long-term risks of use.


Asunto(s)
Benzofenonas/metabolismo , Alcanfor/análogos & derivados , Modelos Biológicos , Absorción Cutánea/fisiología , Protectores Solares/metabolismo , United States Food and Drug Administration/legislación & jurisprudencia , Administración Tópica , Benzofenonas/administración & dosificación , Benzofenonas/efectos adversos , Alcanfor/administración & dosificación , Alcanfor/efectos adversos , Alcanfor/metabolismo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medicamentos sin Prescripción/administración & dosificación , Medicamentos sin Prescripción/efectos adversos , Medicamentos sin Prescripción/metabolismo , Absorción Cutánea/efectos de los fármacos , Protectores Solares/administración & dosificación , Protectores Solares/efectos adversos , Estados Unidos , Adulto Joven
19.
J Drugs Dermatol ; 17(12): 1317-1321, 2018 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-30586264

RESUMEN

Introduction: A limited number of treatments have been approved for androgenetic alopecia, however, myriad over-the-counter products for hair loss are available and readily purchased by consumers. This study aims to provide an overview of popular over-the-counter hair loss products and to review the available evidence regarding their use. Methods: Top-selling hair loss products were identified using sales data from the online retailer Amazon.com. The active ingredients, consumer ratings, quantity, and price were collected for each product. A search of the literature was conducted for ingredients that frequently appeared on the top-seller list. Results: Forty-two of the top 50 products met inclusion criteria, including orals (21.4%), topicals (35.7%), or shampoos/conditioners (42.9%). Common active ingredients included minoxidil, nutrients (ie, vitamins, minerals, proteins), and plant-based botanicals. 23.8% of products were FDA-approved treatments for androgenetic alopecia. Evidence for non-approved treatments is limited to small studies without generalizability. Discussion: While some over-the-counter treatments may be efficacious, more rigorous study is required. Dermatologists should be equipped to discuss the efficacy of these therapies as well as the risks and benefits associated with their use with patients. J Drugs Dermatol. 2018;17(12):1317-1321.


Asunto(s)
Alopecia/tratamiento farmacológico , Comportamiento del Consumidor , Humanos , Minoxidil/administración & dosificación , Minoxidil/uso terapéutico , Medicamentos sin Prescripción/administración & dosificación , Medicamentos sin Prescripción/uso terapéutico , Fitoterapia , Estados Unidos , Vitaminas/administración & dosificación , Vitaminas/uso terapéutico
20.
Expert Opin Drug Saf ; 17(12): 1211-1224, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30372367

RESUMEN

INTRODUCTION: Ambroxol is a widely used secretolytic and mucoactive over-the-counter agent primarily used to treat respiratory diseases associated with viscid mucus. Following post-marketing reports of hypersensitivity reactions and severe cutaneous adverse reactions (SCARs) possibly linked to ambroxol, the European Union's Pharmacovigilance Risk Assessment Committee (PRAC) initiated in April 2014 a review of the safety of ambroxol in all its registered indications, which was finalized in 2016. Areas covered: Here, we evaluate the clinical safety of ambroxol and provide an expert opinion on the benefit-risk balance of ambroxol in the treatment of adult patients with bronchopulmonary diseases. The evidence for this review is derived from clinical trials of ambroxol that were provided to the PRAC by the marketing authorization holders of ambroxol-containing medicines. Expert opinion: Clinical experience accumulated from randomized clinical trials and observational studies suggests that ambroxol is a safe and well-tolerated treatment of bronchopulmonary diseases, with a well-balanced and favorable benefit-risk profile. All reported adverse events were mild and self-limiting, and the risk of SCARs with ambroxol is low. Further investigations could address the safety and efficacy of ambroxol in pediatric lung diseases and in additional therapeutic indications, such as biofilm-dependent airway disease and lysosomal storage disorders.


Asunto(s)
Ambroxol/administración & dosificación , Expectorantes/administración & dosificación , Enfermedades Respiratorias/tratamiento farmacológico , Adulto , Ambroxol/efectos adversos , Animales , Expectorantes/efectos adversos , Humanos , Medicamentos sin Prescripción/administración & dosificación , Medicamentos sin Prescripción/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto
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