[Prospective assessment of drug interactions in hospitalized patients using a computer programme]. / Evaluación prospectiva de interacciones entre medicamentos en pacientes ingresados mediante una aplicación informática.

OBJECTIVE: To describe the implementation, functioning and results of a prospective automated system monitoring clinically relevant interactions in hospitalised patients in a 400-bed hospital for the period between 1 January 2005 and 31 March 2006. METHOD: We created a computer programme in Access(R) 97 that checks, twice daily, the drug treatments of all of the patients admitted to the hospital in order to search for the 198 pairs of drugs previously selected from: a validated tertiary source (Hansten PD, Horn JR. Hansten and Horn's Drug Interactions Analysis and Management. St. Louis, MO: Facts and Comparisons; 2001 and updates), most relevant primary sources, expert opinions and alerts from the Spanish Agency of Medicines and Health Products. The clinical pharmacist will assess the drug-drug interaction (DDI) taking into account the timeline sequence, dose, administration route, management opportunities, patient diagnosis, clinical relevance, etc. If necessary, the doctor is contacted by phone and/or letter to inform him/her of the type of interaction, the mechanism and possible management. The programme files the following variables every day: interaction, sex, age, service, number of drugs, pharmaceutical intervention and doctor response. RESULTS: Clinically relevant drug interactions were detected in 3% of patients during their stay in hospital. These patients were an average of 10 years older and received an average of four drugs more than other patients. A total of 538 interactions were detected in 15 months. Forty-three of 198 possible DDls appeared at some time. The pharmacist intervened on 126 (23%) occasions. The doctor accepted the recommendation on at least 66 (52%) occasions. Fourteen drugs were responsible for 91% of the interactions reported. CONCLUSIONS: The patients with interactions are older and receive more drugs. The prior intervention of the pharmacist eliminated 77% of unnecessary alerts.

Evaluación prospectiva de interacciones entre medicamentos en pacientes ingresados mediante una aplicación informática / No disponible

Objetivo: Describir la puesta en marcha, el funcionamiento ylos resultados de un sistema automatizado de monitorización prospectivade interacciones de relevancia clínica en pacientes ingresadosen un hospital de 400 camas en el periodo comprendidoentre el 1 de enero de 2005 y el 31 de marzo de 2006.Método: Una aplicación informática en Access® 97 realizada adhoc, chequea, dos veces al día, los tratamientos farmacológicos detodos los pacientes ingresados en busca de las 198 parejas de fármacospreviamente seleccionadas desde: una fuente terciaria contrastada(Hansten PD, Horn JR. Hansten and Horn’s Drug InteractionsAnalysis and Management. St. Louis, MO: Facts andComparisons; 2001 and updates), fuentes primarias más relevantes,opinión de expertos y alertas de la Agencia Española de Medicamentosy Productos Sanitarios. El farmacéutico clínico valora lainteracción fármaco-fármaco (IFF) teniendo en cuenta la secuenciatemporal, dosis, vía de administración, posibilidad de manejo, diagnósticosdel paciente, relevancia clínica, etc. Si es necesario, contactacon el médico por teléfono y/o carta para informarle del tipo deinteracción, el mecanismo y su posible manejo. El programa archivadiariamente las variables: interacción, sexo, edad, servicio, númerode fármacos, intervención farmacéutica y respuesta del médico.Resultados: En un 3% de los pacientes se detectaron interaccionesde potencial relevancia clínica durante el ingreso. Estospacientes eran 10 años mayores y recibían 4 fármacos más demedia que el resto de los pacientes. Se detectaron un total de 538interacciones en 15 meses. Cuarenta y tres de 198 IFF posiblesaparecieron alguna vez. El farmacéutico intervino en 126 (23%)ocasiones. El médico aceptó la recomendación en al menos 66(52%) ocasiones. Catorce fármacos fueron responsables del 81%de las interacciones informadas.Conclusiones: Los pacientes con interacciones son mayoresy reciben más fármacos. La intervención previa del farmacéuticoeliminó un 77% de alertas innecesarias

Objective: To describe the implementation, functioning andresults of a prospective automated system monitoring clinicallyrelevant interactions in hospitalised patients in a 400-bed hospitalfor the period between 1 January 2005 and 31 March 2006.Method: We created a computer programme in Access® 97that checks, twice daily, the drug treatments of all of the patientsadmitted to the hospital in order to search for the 198 pairs ofdrugs previously selected from: a validated tertiary source (HanstenPD, Horn JR. Hansten and Horn’s Drug Interactions Analysisand Management. St. Louis, MO: Facts and Comparisons;2001 and updates), most relevant primary sources, expert opinionsand alerts from the Spanish Agency of Medicines andHealth Products. The clinical pharmacist will assess the drugdruginteraction (DDI) taking into account the timeline sequence,dose, administration route, management opportunities, patientdiagnosis, clinical relevance, etc. If necessary, the doctor is contactedby phone and/or letter to inform him/her of the type ofinteraction, the mechanism and possible management. The programmefiles the following variables every day: interaction, sex,age, service, number of drugs, pharmaceutical intervention anddoctor response.Results: Clinically relevant drug interactions were detected in3% of patients during their stay in hospital. These patients werean average of 10 years older and received an average of fourdrugs more than other patients. A total of 538 interactions weredetected in 15 months. Forty-three of 198 possible DDls appearedat some time. The pharmacist intervened on 126 (23%) occasions. The doctor accepted the recommendation on at least 66(52%) occasions. Fourteen drugs were responsible for 91% of theinteractions reported.Conclusions: The patients with interactions are older andreceive more drugs. The prior intervention of the pharmacist eliminated77% of unnecessary alerts

[Treatment of pulmonary hypertension]. / Tratamiento de la hipertensión pulmonar.

Pulmonary hypertension is a difficult-to-diagnose, poor-prognosis disease that may be primary or secondary to other conditions. It is characterized by pulmonary vasoconstriction, in situ thrombosis, and altered endothelial function, which clinically manifests with dyspnea and other disabling symptoms for the patient. Conventional treatment includes oral anticoagulants together with oxygen supplementation, diuretics, and digoxin --according to concurrent conditions-- as well as vasodilators, traditionally calcium antagonists. In recent years novel vasodilators have been developed for use in the treatment of pulmonary hypertension-prostaglandins (epoprostenol, iloprost), endothelin-1 receptor antagonists (bosentan), nitric oxide, and sildenafil, among other drugs under study. However, question marks remain on the management of this disease, and further studies are needed to find a truly effective therapeutic option.

[Simplification to lamivudine, zidovudine, and abacavir therapy: impact on adherence, clinical outcome, and economic issues]. / Simplificación con lamivudina, zidovudina y abacavir: repercusión sobre la adhrencia, resultados clínicos e impacto económico.

OBJECTIVES: To analyze the influence on adherence and clinical outcome of the replacement of a previous antiretroviral therapy to a simplified approach using zidovudine, lamivudine, and abacavir (Trizivir) and to assess its economic impact. METHODS: A retrospective study of 75 pretreated, HIV-infected adult patients who received Trizivir from May 2001 to December 2002. Adherence was assessed by dispensation records or medication counting, CD4 lymphocyte counts, and viral load before and six months after medication change was analyzed; finally, the cost of each therapy was assessed in order to calculate the economic impact of medication change. RESULTS: Mean adherence significantly increased a 2.5% after medication change; 16 more patients reached optimal adherence, with an NNT (number of patients requiring therapy change in order to obtain one more adherent) of 4.7. The number of patients with undetectable viral load remained almost similar, and mean CD4 cell counts stayed above 500 cells/mm3 in both periods of time. A great variability in incremental costs was seen, due to the varying costs of the previous treatments, and the influence of five intensification therapies using Trizivir. However, when only simplification regimens were analyzed such variability was reduced, and even became favorable in selected cases. CONCLUSIONS: Changing to a simplification therapy using Trizivir resulted in improved adherence, similar clinical outcomes, and a varying economic impact depending on previous antiretroviral therapy costs.