Sistemas personalizados de dosificación en el seguimiento del paciente diabético: problemas relacionados con medicamentos originados por excipientes / Monitored Dosage Systems in Diabetic Patients Follow-Up: Drug Related Problems Due to Excipients

C. es una paciente polimedicada frágil de 83 años incluida en nuestro servicio de sistemas personali-zados de dosificación (SPD). Su control glucémico no es adecuado, por lo que su endocrino modifica el tratamiento antidiabético oral e inicia insulinote-rapia. Se consigue mejorar el control de su gluce-mia gracias al nuevo tratamiento. Días después, a causa de una infección respiratoria, su médico de atención primaria (MAP) le prescribe Dextrome-torfano (Romilar®) 3 mg/ml jarabe y Cefuroxima (Zinnat®) 500 mg granulado para suspensión oral. Debido al reciente problema del control glucémico decidimos revisar el contenido en azúcares simples de ambas presentaciones en el momento de la dis-pensación. Según la posología prescrita, la paciente podría llegar a ingerir 50 g de sacarosa al día con este tratamiento. Se opta por intervenir proponien-do un cambio en la forma farmacéutica del anti-biótico prescrito. En el caso del antitusivo, que no precisa prescripción médica, se aplica el protocolo de indicación farmacéutica: dispensamos en su lugar Dextrometorfano (Normotus®) 2mg/ml jarabe (cuya formulación no incluye sacarosa) y realiza-mos el correspondiente ajuste en la posología. El servicio SPD no solo mejora la adherencia terapéu-tica, sino que nos aporta conocimientos relevantes de la situación clínica del paciente y constituye una valiosa herramienta para la detección y el abordaje de problemas relacionados con los medicamentos (PRM).(AU)

C. is a 83-year-old fragile patient included in our monitored dosage system (MDS) service. Due to an inappropriate glycemic control, her oral antidia-betic medication was recently modified and insulin therapy was started. Two weeks later, glycemic control showed a notorious improvement. Today, she has been prescribed new medication for treat-ing a respiratory infection: an antitussive solution and an antibiotic powder for oral suspension. Since we are aware of the recent hyperglycemic issue, we decided to check the simple sugars content of the new prescriptions before dispensation. According to technical information, C. would take 50 g of sac-charose per day with both medicines. We conduct-ed an intervention proposing her doctor a pharma-ceutical dosage form change, recommending the prescription of coated tablets instead of powder. As far as the antitussive is concerned, we selected a sugar free dextromethorphan solution following our standard indication service algorithms. MDS service provides important information regarding patient therapy and it is a valuable tool to detect drugs related problems (DRP).(AU)

Riesgos del tratamiento crónico con ácido acetilsalicílico: comparación entre las prescripciones en prevención primaria y secundaria de enfermedades cardiovasculares / Risks of chronic acetylsalicylic acid use: a comparison between primary vs. secondary prevention of cardiovascular disease prescriptions

INTRODUCCIÓN: El ácido acetilsalicílico (AAS) es el antiagregante de elección en el tratamiento de la enfermedad cardiovascular. Sus beneficios en prevención secundaria (PS) han sido claramente demostrados, pero existe controversia en su uso en prevención primaria (PP): los riesgos de sufrir eventos adversos, principalmente hemorragias, pueden superar a los beneficios potenciales del tratamiento. El farmacéutico dispone de las herramientas apropiadas para la detección de problemas relacionados con los medicamentos (PRMs) tanto en PP como en PS. OBJETIVOS: Estimar la proporción de PP vs. PS en tratamientos con AAS. Evaluar el riesgo hemorrágico y otros PRMs en ambos casos. MÉTODOS: Estudio observacional y prospectivo en dos farmacias comunitarias. Se registraron las prescripciones de AAS, variables demográficas y farmacoterapéuticas del paciente. Cada prescripción se asignó a PP o PS según la existencia de enfermedad cardiovascular (ECV) previa. Los PRMs se evaluaron con BOT Plus Web(R). RESULTADOS: 82 dispensaciones de AAS válidas, 47 (57%) correspondían a PP y 35 (43%) a PS. Se encontró asociación estadística entre las variables PP y diabetes. Se detectaron 67 PRMs de los que el 80% (53) suponían un aumento del riesgo hemorrágico. No se apreciaron diferencias significativas para el aumento de riesgo hemorrágico entre PP o PS. CONCLUSIONES: Encontramos mayor prevalencia de prescripción para el tratamiento crónico con AAS en PP que en PS. Observamos asociación entre PP y diabetes y entre PS y total de PRMs. No se encuentra asociación entre el aumento de riesgo hemorrágico y PP o PS

INTRODUCTION: Acetyl salicylic acid (AAS) is the antiplatelet drug of choice for long-term treatment of cardiovascular disease. The benefits in secondary prevention (SP) have been thoroughly demonstrated, although it remains unclear whether these benefits may be offset by bleeding complications in primary prevention (PP). Community pharmacist can detect and solve drug related problems (DRPs) involving both SP and PP treatments. OBJECTIVES: To assess PP vs. SP prescription ratio for AAS. To evaluate and analyze DRPs, specially bleeding risk, in both cases. METHODS: It was carried out an observational and cross-sectional study in two community pharmacies. Demographic and therapeutical variables were recorded for each AAS treatment. Prescriptions were assigned to PP or PS group on the basis of previous cardiovascular disease record. DRPs were evaluated using BOT Plus web(R). RESULTS: 82 AAS treatments were recorded. 47 (57%) were PP and 35 (43%) PS. Statistically significant association between PP and diabetes was found. 67 DRPs were recorded, 53 (80%) being related with a higher bleeding risk. As far as bleeding risk is concerned, there was no statistically significant difference between PP and SP in our data. CONCLUSIONS: Long-term treatments with AAS were mainly PP. We found statistically significant association between PP and diabetes and between SP and total DRPs. Nevertheless, no statistically significant differences for bleeding risk between PP and SP were found

Riesgo de resultados negativos asociados a inhibidores de la bomba de protones: revisión de las prescripciones electrónicas en pacientes polimedicados / Risk of negative results associated with proton pump inhibitors: review of electronic prescription in polymedicated patients

Introducción: El elevado consumo de inhibidores de la bomba de protones (IBP) puede incrementar la probabilidad de aparición de interacciones clínicamente relevantes. Pacientes mayores, polimedicados y pluripatológicos representan un grupo de alto riesgo. Se espera que la revisión sistemática de las prescripciones electrónicas (PE) permita detectar potenciales interacciones farmacológicas. Material y métodos: Estudio retrospectivo, transversal y observacional: revisión de las PE de IBP dispensadas entre enero y diciembre de 2015 en una farmacia comunitaria rural. Resultados: 1.186 PE, 164 pacientes (edad 65,7±17,2). Mayor número de pacientes en rango de edad 71-80 (n=52). Medicamentos por paciente: 11,0±5,6. PE IBP sin indicación aprobada: 27%. Indicación mayoritaria: protección frente a gastrolesión (77%). 29 pacientes (30%) con riesgo de resultados negativos asociados a la medicación (RNM) por omeprazol, 15 de ellos sin indicación. Patologías concomitantes más prevalentes: hipertensión arterial (n=81), dislipemia (n=61) y diabetes (n=36). Principios activos implicados: acenocumarol, hierro, cianocobalamina, escitalopram, benzodiazepinas y clopidogrel. Discusión: El 80% de las PE de omeprazol corresponde a pacientes entre 61 y 90 años, la mayoría con comorbilidad y polifarmacia, y supera el tiempo de tratamiento recomendado. Relacionamos la cronificación y el aumento del riesgo de RNM con la ausencia de un seguimiento adecuado. Muchos fármacos corresponsables del riesgo tratan los problemas de salud (PS) más prevalentes de nuestra población: la probabilidad de interacción resulta independiente de la correcta indicación del IBP. Conclusiones: La revisión de las PE permite valorar el riesgo de RNM y evaluar la información básica relativa al riesgo de interacción. Se detectaron RNM de no necesidad y de inseguridad en proporciones comparables. Un número elevado de PE de omeprazol tienden a cronificarse. Las interacciones más relevantes registradas ocurren a nivel metabólico (AU)

Introduction: Extensive use of proton pump inhibitors (PPI) can result in an increased risk of drug interactions. Aged polypharmacy patients are a source of particular concern. A systematic electronic prescription (EP) review allows detection of potential drug - drug interactions. Material and methods: Retrospective, transversal, observational study: review of e-prescription orders received during 2015 in our community pharmacy. Results: 1186 EP dispensed to 164 patients (age 65.7±17.2), 52 patients in 71-80 range. 11.0±5.6 medicines per patient. 27% IBP EP with no approved indication. 77% EP used as gastroprotective agent. As far as omeprazole is concerned, risk of negative outcomes associated with medication (NOM) detected in 29 patients (30%), 15 of them taking the drug without approved indication. Most prevalent comorbidities: hypertension (n=81), dyslipidemia (n=61) and diabetes (n=36). Drugs responsible for potential interaction: acenocoumarol, iron, cyanocobalamin, escitalopram, benzodiazepines and clopidogrel. Discussion: 80% of omeprazole EP were dispensed to patients aged 61-90. Coupled with multimorbidity and polypharmacy, the duration of the treatment exceeded directions for use in most of the cases. Chronification and increase of NOM may be due to lack of an appropriate patient follow-up procedure. Many of the drugs responsible for omeprazole interactions were prescribed to treat most prevalent health problems. Thus, risk of NOM does not appear to depend on PPI appropriate indication. Conclusions: EP review let us to assess the risk of suffering from a NOM. Reviewing pharmacokinetic PPI interaction profile allows to depict the basics for a later intervention. During EP review, safety and necessity NOMs were recorded in similar percentages. Most relevant interactions found for omeprazole occur during metabolism of the drugs (AU)

Efecto sobre la salud de un grupo de pacientes crónicos polimedicados en una farmacia comunitaria / Effects of the pharmacotherapeutical follow-up in a community pharmacy on aged patients with multiple medications

Introducción: El seguimiento farmacoterapéutico (SFT) puede suponer importantes beneficios para la salud de los pacientes mayores polimedicados. Objetivos: Valorar la influencia de la implantación del SFT en la salud de nuestros pacientes. Evaluar la efectividad de las intervenciones farmacéuticas (IF). Analizar los resultados negativos asociados a la medicación (RNM) en función del principio activo y problema de salud. Método: Estudio longitudinal, descriptivo y no aleatorizado en mayores de 65 años polimedicados, siguiendo la metodología delprograma ConSIGUE. Los datos, correspondientes a diez pacientes, se recopilaron de estados de situación (ES), cuestionarios de utilización de recursos sanitarios, encuestas de calidad de vida y registros de RNM e IF. Resultados: Hubo reducción apreciable en número de principios activos, problemas de salud (PS), RNM y visitas a urgencias. Se registró un incremento de la percepción subjetiva de la calidad de vida. En la revisión, se retiró algún medicamento al 80% de los pacientes. Registramos 69 IF, siendo aceptadas 61 (~90%). Detectamos 28 RNM: 20 fueron resueltos (70%) y 2 son todavía objeto de seguimiento. Omeprazol, ácido acetilsalicílico y acenocumarol, estuvieron implicados en el 30% de los RNM. La prevención de gastrolesión, junto con patologías como diabetes y anticoagulación, se asociaron con el 60% de los RNM. Conclusiones: La inclusión en el SFT ha supuesto importantes beneficios en salud para nuestros pacientes. El uso extensivo de fármacos considerados seguros puede contribuir a la aparición de RNM en pacientes crónicos y polimedicados

Introduction: The implementation of a pharmacotherapeutical follow-up program can suppose many health benefits for aged patients with multiple medications. Objectives: The main objectives are to evaluate the impact of this program on patients’ health and the effectiveness of the pharmaceutical interventions. On the other hand, to analyze the negative results associated with the medication according to the active ingredient or the health problem involved. Methods: It was carried out a longitudinal, descriptive and non randomized study in aged patients with multiple medications, following ConSIGUE methodology. Data, concerning ten patients, were collected from assessment forms, use questionnaires of healthcare resources, quality of life surveys and negative results associated with medication and pharmaceutical interventions records. Results: There was a reduction in the number of active ingredients, health problems and hospitalization and emergency room visits. In contrast, an increase in the patients’ quality of life was found. At least, one medicine (outdated medicines or non active prescriptions) was withdrawn in 80% of the patients during the medication review. We recorded 69 pharmaceutical interventions from which 61 were accepted. 20 out of 28 negative results associated with medication were solved while 2 are still under study. Omeprazole, acetylsalicylic acid and acenocumarol were found to be responsible for 30% of negative results associated with medication. 60% of the negative outcomes recorded were associated to the prevention of ulcers and pathologies such as diabetes and anticoagulation. Conclusions: The inclusion in a pharmacotherapeutical follow-up program resulted in improved health outcomes of our patients. The extensive use of safe drugs may contribute to negative phamacotherapeutical results in aged patients with multiple medications

Dynamics of the chili pepper transcriptome during fruit development.

BACKGROUND: The set of all mRNA molecules present in a cell constitute the transcriptome. The transcriptome varies depending on cell type as well as in response to internal and external stimuli during development. Here we present a study of the changes that occur in the transcriptome of chili pepper fruit during development and ripening. RESULTS: RNA-Seq was used to obtain transcriptomes of whole Serrano-type chili pepper fruits (Capsicum annuum L.; 'Tampiqueño 74') collected at 10, 20, 40 and 60 days after anthesis (DAA). 15,550,468 Illumina MiSeq reads were assembled de novo into 34,066 chili genes. We classified the expression patterns of individual genes as well as genes grouped into Biological Process ontologies and Metabolic Pathway categories using statistical criteria. For the analyses of gene groups we added the weighted expression of individual genes. This method was effective in interpreting general patterns of expression changes and increased the statistical power of the analyses. We also estimated the variation in diversity and specialization of the transcriptome during chili pepper development. Approximately 17% of genes exhibited a significant change of expression in at least one of the intervals sampled. In contrast, significant differences in approximately 63% of the Biological Processes and 80% of the Metabolic Pathways studied were detected in at least one interval. Confirming previous reports, genes related to capsaicinoid and ascorbic acid biosynthesis were significantly upregulated at 20 DAA while those related to carotenoid biosynthesis were highly expressed in the last period of fruit maturation (40-60 DAA). Our RNA-Seq data was validated by examining the expression of nine genes involved in carotenoid biosynthesis by qRT-PCR. CONCLUSIONS: In general, more profound changes in the chili fruit transcriptome were observed in the intervals between 10 to 20 and 40 to 60 DAA. The last interval, between 40 to 60 DAA, included 49% of all significant changes detected, and was characterized predominantly by a global decrease in gene expression. This period signals the end of maturation and the beginning of senescence of chili pepper fruit. The transcriptome at 60 DAA was the most specialized and least diverse of the four states sampled.