RESUMO
Methotrexate is an essential drug in the treatment of childhood cancer that is not exempt from toxicities. Glucarpidase is a drug used to reduce the toxic concentration of plasma methotrexate in patients with delayed elimination or at risk of toxicity. We describe the characteristics of a cohort of pediatric patients that received glucarpidase and analyze its role in the treatment of toxicity induced by high doses of methotrexate (HDMTX). Retrospective observational study of all pediatric cancer patients who received glucarpidase between 2012 and 2022 at a single center. Fifteen patients were treated with a single dose of glucarpidase, eleven of them presented with acute lymphoblastic leukemia and received HDMTX at 5 g/m2 in 24-hour infusion. In eight patients, glucarpidase was administered during the first cycle of HDMTX. The indication in thirteen cases was acute renal failure with delayed elimination of plasma methotrexate. The median maximum creatinine was 1.22 mg/dl (0.68 2.01 mg/dl), with a median increase over its baseline level of 313%. All patients normalized renal function after glucarpidase administration, with a median methotrexate excretion time of 193 hours (42-312 hours). No grade ≥2 adverse events derived from carboxypeptidase administration. Eleven patients received new doses of HDMTX in subsequent cycles, without new episodes of serious toxicity. The use of glucarpidase is effective and safe in the treatment of acute renal failure and methotrexate elimination delay in pediatric cancer patients. Further HDMTX doses may be prescribed without additional toxicities.
RESUMO
Objetivos: Evaluar el resultado de la implantación de un programa de atención farmacéutica en un servicio de urgencias (SU) mediante el análisis de las intervenciones farmacéuticas realizadas, y la identificación de los problemas relacionados con los medicamentos (PRM) en el servicio. Método: Incorporación de un farmacéutico a tiempo parcial en el SU durante un periodo de 7 semanas desde febrero 2009. Se incluyeron pacientes de las áreas de boxes, observación y/o críticos del SU que cumplían algún factor de riesgo relacionado con el paciente o con su medicación y/o que tuvieran una alta probabilidad de ingreso. Las variables registradas fueron: datos demográficos, datos clínicos de interés, antecedentes patológicos, medicación habitual, motivo de consulta y medicación prescrita en el SU. Se registraron y clasificaron las intervenciones farmacéuticas asociadas a un PRM, las recomendaciones de terapia secuencial, así como las reacciones adversas a medicamentos(RAM) como motivo de consulta al SU. Resultados: Se incluyeron 90 pacientes (63,7% mujeres), con edad media de 79,3(± 10,6) años. Se registraron 131 intervenciones en 62 (68,9%) pacientes: 120 (91,6%) asociadas a un PRM, de las cuales la intervención mayoritaria 54 (45%) fue iniciar un tratamiento, seguido de la suspensión de un medicamento en 28 (23,3%) casos. Según la clasificación de los PRM, el 53,3% se consideraron de necesidad, en un 15% de efectividad y en un 31,7% de seguridad. Destaca la presencia de polimedicación ( 5 fármacos) como factor de riesgo que requiere intervención farmacéutica en los pacientes incluidos (p = 0,008). La presencia de 2 o más factores de riesgo se mostró como una variable asociada a la aparición de un PRM (p = 0,003). Respecto a la valoración de los medicamentos agrupados por actividad farmacológica, la mayoría de la (..) (AU)
Objective: To assess the implementation of a pharmacist intervention program with in an emergency department, including the analysis of interventions by the pharmacist and identification of medication problems in the department. Methods: A pharmacist was employed part-time in the emergency department for 7 weeks starting in February 2009.Patients with a patient-related or drug-related risk factor or who were likely to be admitted to hospital were included from the areas of the emergency departments cubicles, observation unit, and/or critical case section. The variables recorded were demographic characteristics, clinical data of interest, medical history, medications currently used, reasons for seeking care, and drugs prescribed in the emergency department. Pharmacist interventions related to a medication problem were recorded and classified. Other information gathered included the sequence of therapeutic recommendations and adverse drug interactions as a reason for seeking emergency care. Results: Ninety patients (63.7% women) with a mean (SD) age of 79.3 (10.6) years were studied. One hundred thirty one interventions were recorded for 62 (68.9%) patients. One hundred twenty of these (91.6%) involved a medication problem. Initiating a treatment was the most frequent decision (in 54 [45%] patients); in 28 cases (23.3%) a medication was with drawn. Regarding types of medication problems detected, 53% were (..) (AU)
