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1.
S Afr Fam Pract (2004) ; 63(1): e1-e3, 2021 06 28.
Artigo em Inglês | MEDLINE | ID: mdl-34212752

RESUMO

The use of hand sanitisers is common practice to prevent the spread of coronavirus disease 2019 (COVID-19). However, the safety thereof requires consideration as this may be hazardous in children. Recent studies have shown that the misuse and increased unsupervised availability of alcohol-based hand sanitisers may result in adverse events in children such as skin irritation, dryness, cracking and peeling. Unintentional or intentional ingestion of hand sanitisers in children under the age of 12 years may occur because of the colour, smell and flavour added to it. Consumption of alcohol in children may result in hypoglycaemia, apnoea and acidosis. This allows the invasion of other bacterial and viral infections. Children may also rub their eyes with sanitised hands and cause ocular injury. Therefore, the use of hand sanitisers in general needs to be revised in both children and adults. Other interventions on lowering the risk of adverse events because of misuse of hand sanitiser should be practised more often. These include promoting washing of hands over sanitisers where possible, training children on how to use hand sanitisers and creating awareness of the dangers if ingested or in contact with the eyes.


Assuntos
COVID-19 , Transmissão de Doença Infecciosa/prevenção & controle , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Higienizadores de Mão , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/transmissão , Criança , Saúde da Criança , Controle de Doenças Transmissíveis/métodos , Uso Indevido de Medicamentos/efeitos adversos , Uso Indevido de Medicamentos/prevenção & controle , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Oftalmopatias/induzido quimicamente , Oftalmopatias/prevenção & controle , Desinfecção das Mãos/métodos , Higienizadores de Mão/farmacologia , Higienizadores de Mão/toxicidade , Humanos , Risco Ajustado/métodos , SARS-CoV-2/efeitos dos fármacos , Dermatopatias/induzido quimicamente , Dermatopatias/prevenção & controle
2.
Int J Mol Sci ; 22(11)2021 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-34204029

RESUMO

Acute kidney injury (AKI) is a global health challenge of vast proportions, as approx. 13.3% of people worldwide are affected annually. The pathophysiology of AKI is very complex, but its main causes are sepsis, ischemia, and nephrotoxicity. Nephrotoxicity is mainly associated with the use of drugs. Drug-induced AKI accounts for 19-26% of all hospitalized cases. Drug-induced nephrotoxicity develops according to one of the three mechanisms: (1) proximal tubular injury and acute tubular necrosis (ATN) (a dose-dependent mechanism), where the cause is related to apical contact with drugs or their metabolites, the transport of drugs and their metabolites from the apical surface, and the secretion of drugs from the basolateral surface into the tubular lumen; (2) tubular obstruction by crystals or casts containing drugs and their metabolites (a dose-dependent mechanism); (3) interstitial nephritis induced by drugs and their metabolites (a dose-independent mechanism). In this article, the mechanisms of the individual types of injury will be described. Specific groups of drugs will be linked to specific injuries. Additionally, the risk factors for the development of AKI and the methods for preventing and/or treating the condition will be discussed.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Nefropatias/prevenção & controle , Rim/patologia , Animais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/tratamento farmacológico , Humanos , Inibidores de Checkpoint Imunológico/farmacologia , Inibidores de Checkpoint Imunológico/uso terapêutico , Nefropatias/tratamento farmacológico , Túbulos Renais/efeitos dos fármacos , Túbulos Renais/patologia , Metaboloma
3.
Medicine (Baltimore) ; 100(26): e26478, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190172

RESUMO

ABSTRACT: This study aims to evaluate the effect of dose titration for different oral antiepileptic medications among children with epilepsy in Riyadh, Saudi Arabia.A single-center prospective pilot, cohort study was undertaken at a tertiary hospital in Riyadh, Saudi Arabia. All medical records of pediatric patients below the age of 14 years of age who has been newly diagnosed with epilepsy by attending a medical specialist or on a new epileptic treatment plans were enrolled in the study.A total of 76 epileptic patients were screened for 3 months' period and 48 patients were included in this study. Out of the 48 patients, 31 patients followed the regular practice in the titration processes and 17 patients were in the British national formulary (BNF) guideline. Fifteen children who were on monotherapy of levetiracetam were in regular practice guideline experienced poor seizure control with a recorded number of seizure incidence (n = 10). The patient in regular practice guidelines using a combination therapy of phenytoin and levetiracetam were experiencing some behavioral disturbance and sedation effect. Seventeen patients followed in the BNF guideline who were on levetiracetam were experienced less adverse effect (n = 2) with no behavioral changes.The group who followed the regular practice found having a greater incidence of documented adverse effects compared to the patients following the BNF guideline. The titrating antiepileptic medication has a detrimental effect on the pediatric population as observed in this study.


Assuntos
Anticonvulsivantes , Relação Dose-Resposta a Droga , Monitoramento de Medicamentos/métodos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Epilepsia , Conduta do Tratamento Medicamentoso , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/classificação , Criança , Saúde da Criança , Estudos de Coortes , Epilepsia/tratamento farmacológico , Epilepsia/epidemiologia , Epilepsia/fisiopatologia , Feminino , Humanos , Masculino , Conduta do Tratamento Medicamentoso/organização & administração , Conduta do Tratamento Medicamentoso/normas , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Estudos Prospectivos , Arábia Saudita/epidemiologia
4.
Nat Med ; 27(6): 1071-1078, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34007070

RESUMO

Several severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines are being deployed, but the global need greatly exceeds the supply, and different formulations might be required for specific populations. Here we report Day 42 interim safety and immunogenicity data from an observer-blinded, dose escalation, randomized controlled study of a virus-like particle vaccine candidate produced in plants that displays the SARS-CoV-2 spike glycoprotein (CoVLP: NCT04450004 ). The co-primary outcomes were the short-term tolerability/safety and immunogenicity of CoVLP formulations assessed by neutralizing antibody (NAb) and cellular responses. Secondary outcomes in this ongoing study include safety and immunogenicity assessments up to 12 months after vaccination. Adults (18-55 years, n = 180) were randomized at two sites in Quebec, Canada, to receive two intramuscular doses of CoVLP (3.75 µg, 7.5 µg, and 15 µg) 21 d apart, alone or adjuvanted with AS03 or CpG1018. All formulations were well tolerated, and adverse events after vaccination were generally mild to moderate, transient and highest in the adjuvanted groups. There was no CoVLP dose effect on serum NAbs, but titers increased significantly with both adjuvants. After the second dose, NAbs in the CoVLP + AS03 groups were more than tenfold higher than titers in Coronavirus 2019 convalescent sera. Both spike protein-specific interferon-γ and interleukin-4 cellular responses were also induced. This pre-specified interim analysis supports further evaluation of the CoVLP vaccine candidate.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/prevenção & controle , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Vacinas de Partículas Semelhantes a Vírus/administração & dosagem , Adolescente , Adulto , Anticorpos Neutralizantes/sangue , Anticorpos Antivirais/sangue , COVID-19/genética , COVID-19/imunologia , COVID-19/terapia , COVID-19/virologia , Vacinas contra COVID-19/efeitos adversos , Canadá , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/imunologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/virologia , Feminino , Humanos , Imunização Passiva , Imunogenicidade da Vacina , Masculino , Pessoa de Meia-Idade , SARS-CoV-2/efeitos dos fármacos , SARS-CoV-2/patogenicidade , Glicoproteína da Espícula de Coronavírus , Vacinas de Partículas Semelhantes a Vírus/efeitos adversos , Adulto Jovem
5.
Methods Mol Biol ; 2296: 411-421, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33977462

RESUMO

The aim of this chapter is to describe and give an overview of the steps from the conception of an idea in the lab to reaching the market. Starting from the early discovery in the lab environment (including reverse and classical pharmacology), and briefly going over the different phases of clinical trials: Phase I, first tests in humans; Phase II, safety and efficacy; Phase III, efficacy confirmation; and Phase IV, post-authorization, in which the investigation would focus on long-term effects, completion of technical and safety sheet. Finally, a short conclusion in regard to the continuous overview and revision of drugs in the market.


Assuntos
Ensaios Clínicos como Assunto , Descoberta de Drogas/métodos , Preparações Farmacêuticas/administração & dosagem , Animais , Aprovação de Drogas/métodos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Humanos , Marketing/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
Zhonghua Yu Fang Yi Xue Za Zhi ; 55(5): 574-582, 2021 May 06.
Artigo em Chinês | MEDLINE | ID: mdl-34034396

RESUMO

Adverse drug reactions are often encountered in the process of medication and are quite troublesome for clinicians. Skin is one of the most frequently affected organs by adverse drug reactions. Adverse drug reactions involving skin are called "drug-induced dermatitis" or "drug eruption". In some rare instances, drug eruption can be severe and life-threatening which is known as severe cutaneous adverse drug reaction. However, due to the mixed use of drugs, it is difficult to identify the culprit drug, which makes multiple drugs needed to be avoided. Recently, many studies have found that HLA alleles are closely related to the certain culprit drug. HLA genotyping before administration can significantly reduce the incidence of severe cutaneous adverse drug reaction related to certain drugs. Since limited HLA alleles are found, HLA genotyping can only prevent adverse drug reaction to a limited extent. At present, drug provocation tests are regarded as the "gold standard" to identify the culprit drug. However, this diagnostic program has not been widely developed because of the high risk. In addition, a variety of in vivo and in vitro diagnostic methods (including drug patch test, drug skin test, drug specific IgE test, basophil activation test, lymphocyte transformation test, et al) also provide evidences to identify the culprit drug.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Pele , Alelos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Humanos
7.
J Chromatogr A ; 1647: 462147, 2021 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-33957347

RESUMO

Drug-induced phospholipidosis (DIPLD) represents a big concern for both regulatory authorities and pharmaceutical companies in drug discovery. Many researches pointed out that the negatively charged intralysosomal lipids play an important role in the formation of DIPLD. To better mimic this negatively charged lipid surface, a novel immobilized artificial membrane (IAM) column was prepared via in situ copolymerization of 12-methacryloyl n-dodecylphosphocholine (MDPC) and 12-methacryloyl n-dodecylphosphoric acid (MDPA). By introducing MDPA, the surface of the resulting monolithic column can be maintained negatively charged over a broad pH range. Scanning electron microscopy, elemental analysis and nano-HPLC experiments were carried out to characterize the physicochemical properties and chromatographic performance of the obtained monolithic IAM column. The results of ζ-potential and retention mechanism studies indicate that both hydrophobic and electrostatic interactions contribute greatly to the retention of cation analytes owing to the existence of the negatively charged MDPA under acidic conditions. To better assess the DIPLD potency of drug, the molar ratio between MDPC and MDPA in the monolithic column was carefully optimized. The results show that the poly(MDPC70PA30-co-EDMA) column has the best predictability with only two false-positives (donepezil, flecainide) in qualitative analysis of 61 drugs.


Assuntos
Doenças por Armazenamento dos Lisossomos/induzido quimicamente , Membranas Artificiais , Preparações Farmacêuticas , Fosfolipídeos , Química Farmacêutica , Cromatografia Líquida de Alta Pressão , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Humanos , Interações Hidrofóbicas e Hidrofílicas , Microscopia Eletrônica de Varredura , Preparações Farmacêuticas/análise , Preparações Farmacêuticas/química , Preparações Farmacêuticas/metabolismo , Ácidos Fosfatídicos , Fosfolipídeos/química , Fosfolipídeos/metabolismo , Eletricidade Estática
8.
Pharm. pract. (Granada, Internet) ; 19(1): 0-0, ene.-mar. 2021. graf
Artigo em Inglês | IBECS | ID: ibc-201724

RESUMO

Finland's community pharmacy system provides an example of a privately-owned regulated system being proactively developed by the profession and its stakeholders. Community pharmacists have a legal duty to promote safe and rational medicine use in outpatient care. The development of professionally oriented practice has been nationally coordinated since the 1990s with the support of a national steering group consisting of professional bodies, authorities, pharmacy schools and continuing education centers. The primary focus has been in patient counseling services and public health programs. The services have extended towards prospective medication risk management applying evidence-based tools, databases and digitalization. Research has been essential in informing progress by indicating high-risk patients, medications, practices and processes needing improvement. Despite the commitment of the profession and pharmacy owners, large-scale implementation of services has been challenging because of lack of remuneration, the pharmacy income still consisting primarily of sale of prescription and nonprescription medicines. Policy documents by the Ministry of Social Affairs and Health have supported the extension of the community pharmacists' role beyond traditional dispensing to promote rational pharmacotherapy. The current roadmap by the Ministry of Social Affairs and Health emphasizes ensuring adequate regional availability and accessibility of medicines, regardless of the future pharmacy system. It also emphasizes the importance of strong regulation on pharmacy business operations and sale of medicines to ensure medication safety. At the same time, the roadmap requires that the regulation must enable implementation of new patient-oriented services and procedures, and further promote digitalization in service provision. Competition and balance of funding should be enhanced, e.g., through price competition, but the risk of pharmaceutical market concentration should be managed. The regulation should also consider influence of the new social and health care system on drug delivery. Year 2021 will be crucial for making long-term political decisions on the future direction of tasks and finances of Finnish community pharmacies in this framework. Government-funded studies are underway to guide decision making. Ongoing Covid-19 crisis has demonstrated the readiness of Finnish community pharmacies to adapt fast to meet the changing societal needs


No disponible


Assuntos
Humanos , Serviços Comunitários de Farmácia/organização & administração , Atenção Primária à Saúde/organização & administração , Assistência Integral à Saúde/organização & administração , Atenção à Saúde/organização & administração , 50207 , Finlândia/epidemiologia , Reforma dos Serviços de Saúde/tendências , Políticas de eSaúde , Planejamento em Saúde Comunitária/organização & administração , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle
9.
Psychiatriki ; 32(2): 165-166, 2021 Jul 10.
Artigo em Grego Moderno, Inglês | MEDLINE | ID: mdl-33759812

RESUMO

The current coronavirus pandemic (COVID-19) has led mental health systems to uncertainty regarding safe continuation of clozapine monitoring protocols. Clozapine is without doubt the only antipsychotic available with repeatedly proven efficacy in treatment resistant schizophrenia.1 Replacing clozapine with an alternative antipsychotic in patients stabilized with clozapine can potentially lead to higher risk of relapse or exacerbation of severity of illness.1 Clozapine, as already known, has a number of side effects, some of which can be serious, thus patients receiving clozapine require ongoing scheduled monitoring. Side effects of clozapine include neutropenia or agranulocytosis, myocarditis, fever, hypersalivation, weight gain and constipation. These side effects can be detected and treated when recognized on time decreasing the possibility of serious consequences making the implementation of an ongoing treatment monitoring protocol for patients on clozapine mandatory.2 Since it was advised for all mental health providers in most countries worldwide to limit non-urgent hospital visits and procedures to reduce the risk of contamination a challenge arose for patients' ability to access health care facilities for their routine clozapine monitoring. Nevertheless, the majority of Mental Health Care Authorities decided to ensure access for all patients on clozapine to their routine monitoring protocol.3,4 To date, no data exist on any potential relationship between antipsychotic use and the risk of contamination with SARS-CoV-2 or the development of severe symptoms of the infection. The literature suggests that patients receiving antipsychotics, especially clozapine, have an increased risk of developing pneumonia, leading to the assumption that patients receiving clozapine are at higher risk to develop COVID-19. 1 Balancing the importance of monitoring continuation against the increased risk for COVID-19, an International Consensus Statement was recently published addressing a monitoring protocol with reduced visits. The Consensus suggested reduced hematologic monitoring frequency of every 3 months with a prescription of 90 days clozapine supply (if safe). The above applies to patients receiving clozapine for at least one year without neutropenia. Τhe risk of neutropenia after 12 months of clozapine treatment falls significantly.4 Based on the above it is suggested to all clozapine clinics to implement a guidance monitoring protocol for all patients on clozapine to ensure safety during the pandemic. Besides hematological monitoring that requires physical contact with healthcare workers it is significant to implement a telemedicine appointment in frequent intervals to monitor symptoms of infection, symptoms of cardiovascular diseases and constipation. Patient should also be advised to regularly monitor one's blood pressure and pulses and ideally be educated on how by a member of the staff. If a patient is detected with any symptoms related to the above an emergency appointment for evaluation should be planned. Overall, since both the consequences and the duration of the pandemic are unknown, mental health services must work jointly to implement a clozapine monitoring plan to ensure safe continuation in such a vulnerable population.


Assuntos
COVID-19 , Clozapina , Monitoramento de Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Serviços de Saúde Mental , Gestão de Riscos/tendências , Esquizofrenia/tratamento farmacológico , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Clozapina/administração & dosagem , Clozapina/efeitos adversos , Monitoramento de Medicamentos/métodos , Monitoramento de Medicamentos/normas , Acesso aos Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde , Humanos , Controle de Infecções/métodos , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Mental/normas , Inovação Organizacional , SARS-CoV-2 , Esquizofrenia/epidemiologia
10.
Int Forum Allergy Rhinol ; 11(7): 1041-1046, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33728824

RESUMO

The frequent association between coronavirus disease 2019 (COVID-19) and olfactory dysfunction is creating an unprecedented demand for a treatment of the olfactory loss. Systemic corticosteroids have been considered as a therapeutic option. However, based on current literature, we call for caution using these treatments in early COVID-19-related olfactory dysfunction because: (1) evidence supporting their usefulness is weak; (2) the rate of spontaneous recovery of COVID-19-related olfactory dysfunction is high; and (3) corticosteroids have well-known potential adverse effects. We encourage randomized placebo-controlled trials investigating the efficacy of systemic steroids in this indication and strongly emphasize to initially consider smell training, which is supported by a robust evidence base and has no known side effects.


Assuntos
Corticosteroides/farmacologia , COVID-19 , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Transtornos do Olfato , COVID-19/complicações , COVID-19/fisiopatologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Saúde Global , Humanos , Conduta do Tratamento Medicamentoso/normas , Determinação de Necessidades de Cuidados de Saúde , Transtornos do Olfato/tratamento farmacológico , Transtornos do Olfato/epidemiologia , Transtornos do Olfato/etiologia , Mucosa Olfatória/efeitos dos fármacos , Mucosa Olfatória/virologia , Remissão Espontânea , Projetos de Pesquisa , SARS-CoV-2/patogenicidade
11.
Clin Pharmacol Ther ; 110(1): 108-122, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33759449

RESUMO

Numerous drugs are currently under accelerated clinical investigation for the treatment of coronavirus disease 2019 (COVID-19); however, well-established safety and efficacy data for these drugs are limited. The goal of this study was to predict the potential of 25 small molecule drugs in clinical trials for COVID-19 to cause clinically relevant drug-drug interactions (DDIs), which could lead to potential adverse drug reactions (ADRs) with the use of concomitant medications. We focused on 11 transporters, which are targets for DDIs. In vitro potency studies in membrane vesicles or HEK293 cells expressing the transporters coupled with DDI risk assessment methods revealed that 20 of the 25 drugs met the criteria from regulatory authorities to trigger consideration of a DDI clinical trial. Analyses of real-world data from electronic health records, including a database representing nearly 120,000 patients with COVID-19, were consistent with several of the drugs causing transporter-mediated DDIs (e.g., sildenafil, chloroquine, and hydroxychloroquine). This study suggests that patients with COVID-19, who are often older and on various concomitant medications, should be carefully monitored for ADRs. Future clinical studies are needed to determine whether the drugs that are predicted to inhibit transporters at clinically relevant concentrations, actually result in DDIs.


Assuntos
Antivirais , COVID-19 , Interações Medicamentosas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Proteínas de Membrana Transportadoras/metabolismo , Internalização do Vírus/efeitos dos fármacos , Replicação Viral/efeitos dos fármacos , Antivirais/farmacocinética , COVID-19/tratamento farmacológico , COVID-19/virologia , Ensaios Clínicos como Assunto , Monitoramento de Medicamentos/métodos , Monitoramento de Medicamentos/normas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/metabolismo , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Registros Eletrônicos de Saúde/estatística & dados numéricos , Células HEK293 , Humanos , Hidroxicloroquina/farmacocinética , Medição de Risco/métodos , SARS-CoV-2/efeitos dos fármacos , SARS-CoV-2/fisiologia
12.
Yakugaku Zasshi ; 141(3): 381-385, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-33642508

RESUMO

When taking a drug one must keep in mind certain risks and benefits based on the safety and efficacy information. One of the most reliable sources of information that enables patients to use drugs properly is package inserts, which are regulated under the law and therefore should include valid and accurate contents. With the recent revision of the Pharmaceutical and Medical Device Act, the information contained in the package insert, which was provided together with the drug, will now also be provided electronically and separately from the drug itself. In addition, a digital code will be displayed on the product packaging so that the latest information of the drug can be obtained from outside the package by scanning the code. The more drug information gets shared among healthcare professionals, patients and the public, the less the asymmetry in drug information among them will exist. It is necessary now more than ever to establish a framework and a system to ensure that sufficient information is provided to patients and the public to encourage their proper use of drugs. I believe that it is important for patients and the public to strive for a better understanding of drug information. It is also crucial for all relevant parties involved in drug information to work together on how best to utilize the information. In this way they would keep trying so that therapeutic effects could be maximized and the risks of side effects are minimized.


Assuntos
Serviços de Informação sobre Medicamentos/legislação & jurisprudência , Serviços de Informação sobre Medicamentos/tendências , Rotulagem de Medicamentos/legislação & jurisprudência , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Pessoal de Saúde , Humanos , Disseminação de Informação , Pacientes , Segurança
13.
Sr Care Pharm ; 36(3): 136-141, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33662236

RESUMO

OBJECTIVE: To provide clinicians with information about avoiding adverse drug withdrawal events (ADWEs) when discontinuing unnecessary medications as per the STOPPFrail criteria. DATA SOURCES: Searches of MEDLINE (1970-June 2020), the Cochrane Database of Systematic Reviews (through June 2020), Google Scholar (through June 2020). STUDY SELECTION: Reviews and original studies of ADWEs. DATA EXTRACTION: Tapering protocols for specific drugs/ classes from randomized controlled deprescribing trials. DATA SYNTHESIS: Six drug classes were identified as being high risk for physiological ADWEs. CONCLUSION: The occurrence of ADWEs is rare in comparison to adverse drug reactions in older adults. Few drugs/classes have been reported to have physiological ADWEs with abrupt discontinuation. For these we provide information about tapering protocols and symptom monitoring to avoid ADWEs.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Preparações Farmacêuticas , Idoso , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Humanos
14.
Sr Care Pharm ; 36(4): 208-216, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33766193

RESUMO

OBJECTIVE: To evaluate deprescribing of select high-risk medications (HRMs) in an Acute Care for the Elderly (ACE) unit with pharmacist involvement compared with usual care in older people. DESIGN: Retrospective, single-center case-control study. SETTING: Medical-surgical units at an urban academic medical center. PARTICIPANTS: Patients 65 years of age and older admitted April-June 2019, with 1 or more of the following target HRMs prior to admission were included in the study: acid suppressants, antipsychotics, or insulin. Patients admitted to the ACE unit were included in the case group; all other patients were randomly matched by HRMs in a 2:1 ratio into the control group. INTERVENTIONS: The Acute Care for the Elderly pharmacist reviewed patients' medications to identify and deprescribe select HRMs. Deprescribing was defined as discontinuation, dose or frequency reduction. RESULTS: A total of 47 patients with 56 HRMs and 89 patients with 126 HRMs were included in the case and control groups, respectively. The primary outcome of HRMs deprescribed were similar between the case and control groups (21.4% and 25.4%; P = 0.56). Among the HRMs deprescribed (discontinued, dose or frequency reduced), 83.2% were complete discontinuations in case patients and 34.4% were complete discontinuations in control patients.


Assuntos
Desprescrições , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Polimedicação , Medicamentos sob Prescrição/efeitos adversos , Centros Médicos Acadêmicos , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/psicologia , Humanos , Masculino , Estudos Retrospectivos
16.
Farm. hosp ; 45(1): 10-15, ene.-feb. 2021. tab
Artigo em Espanhol | IBECS | ID: ibc-202355

RESUMO

OBJETIVO: Evaluar el impacto general a nivel asistencial de una comisión de terapias biológicas, en enfermedades inflamatorias inmunomediadas, mediante los hábitos de prescripción, los estudios prebiológicos y la inmunización. MÉTODO: Se realizó un estudio cuasiexperimental sobre todos los pacientes naïve mayores de edad que iniciaron tratamiento con un medicamento biológico por enfermedad inflamatoria inmunomediada el año anterior y el año posterior a la creación de la comisión de terapias biológicas. RESULTADOS: Se incluyeron un total de 31 pacientes estudiados en 2016 y 40 pacientes estudiados en 2018. La prescripción de medicamentos inhibidores del factor de necrosis tumoral α se redujo en 2018 (80,6% versus 45,0%; p < 0,05), mientras que la prescripción de inhibidores de la interleucina 12/23 aumentó (12,9% versus 35,0%; p < 0,05). El cribaje tuberculoso fue estadísticamente diferente entre los periodos pre y postcomisión de terapias biológicas: la realización del interferon gamma release assay fue superior en 2018 (9,7% versus 80,0%, p < 0,01) y la proporción de pacientes que realizaron correctamente la quimioprofilaxis fue superior en 2018 (36,4% versus 81,8 % , p < 0,05). La proporción de pruebas solicitadas para estudio de patologías víricas, así como la administración de vacunas, fueron superiores en 2018. CONCLUSIONES: El desarrollo de una comisión específica de terapias biológicas aporta mejoras asistenciales en enfermedades inflamatorias inmunomediadas, al contribuir a un mayor conocimiento relacionado con los medicamentos y con la prevención de los efectos adversos de carácter infeccioso, por lo que sería conveniente que se impulsara el desarrollo de comisiones especializadas como la comisión de terapias biológicas


OBJECTIVE: To assess the general healthcare impact of a Biological Therapies Commitee (immune-mediated inflammatory diseases) through prescription habits, pre-biological studies and immunization. METHOD: A quasi-experimental study was conducted on all naïve patients of legal age who started treatment with a biological agent for an immune-mediated inflammatory disease the year before and the year after the creation of the Biological Therapies Committee. RESULTS: A total of 31 patients treated in 2016 and 40 patients treated in 2018 were included. Prescriptions of tumor necrosis factor alpha inhibitor drugs decreased in 2018 (from 80.6% to 45.0%, p < 0.05), while prescriptions of interleukin 12/23 inhibitors increased (from 12.9% to 35.0%, p < 0.05). Tuberculosis screening was statistically different between the two periods: the number of interferon gamma release assays performed was higher in 2018 (from 9.7% to 80.0%, p < 0.01) and the proportion of patients who successfully underwent chemoprophylaxis was higher in 2018 (from 36.4% to 81.8%, p < 0.05). The proportion of tests requested for the study of viral pathologies and the number of vaccines administered were also higher in 2018. CONCLUSIONS: The development of a specific Biological Therapies Committee allows healthcare improvements, contributing to a deeper understanding of the medications and to preventing the infection-related adverse events. It would therefore seem advisable to develop specialized committees akin to the Biological Therapies Committee in other domains


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Terapia Biológica/classificação , Doenças Autoimunes/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Inflamação/tratamento farmacológico , Comissão para Avaliação de Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Assistência Farmacêutica/organização & administração , Estudos de Casos e Controles , Prescrições de Medicamentos/classificação , Avaliação de Eficácia-Efetividade de Intervenções
17.
Farm. hosp ; 45(1): 32-40, ene.-feb. 2021. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-202359

RESUMO

OBJETIVO: Dar a conocer los resultados referentes a la cartera de servicios y actividad asistencial, docente e investigación de la encuesta nacional de la Sociedad de Farmacia Hospitalaria (SEFH) 2019 en los Servicios de Farmacia Hospitalaria españoles. MÉTODO: En marzo de 2019 se elaboró y envió un cuestionario con 77 preguntas agrupadas en ocho dimensiones a los 368 Servicios de Farmacia Hospitalaria registrados en la SEFH, con un bloque adicional sobre actividad desarrollada en 2017 y 2018. RESULTADOS: La tasa global de respuesta fue 54,3%. El 69% de los hospitales eran públicos y el 75% generales. El 88,6% de los Servicios de Farmacia Hospitalaria realizaban atención farmacéutica en pacientes ingresados, y el 77,5% y el 65% en pacientes externos y ambulantes, respectivamente. Se elaboraban preparados estériles en el 70,6% de los Servicios de Farmacia Hospitalaria. Se determinaban niveles de medicamentos en el 12% y se efectuaban informes farmacocinéticos en el 76,9% de los hospitales con ≥ 1.000 camas. Los Servicios de Farmacia Hospitalaria atendieron en 2018 a una media de 929 pacientes al mes y 2.680 al año. El número de elaboraciones estériles y no estériles fue de 10.394.492, representando las estériles el 62,6%. La media de ensayos clínicos gestionados en los hospitales con más de 500 y 1.000 camas fue de 186,2 y 421,8, respectivamente. La mediana de convenios docentes de pregrado entre universidades y Servicios de Farmacia Hospitalaria era de 1 (rango intercuartílico: 0-2). El 21,5% de los Servicios de Farmacia Hospitalaria no tenía ningún convenio. La media de alumnos de grado de farmacia en los Servicios de Farmacia Hospitalaria fue 4,12 (desviación estándar: 8,26). Un total de 290 farmacéuticos eran profesores asociados en la universidad. El 15% de los farmacéuticos disponía de una certificación Board of Pharmacy Specialities, siendo el 55,3% de oncología. Los Servicios de Farmacia Hospitalaria contaban con una media de 1,31 (desviación estándar: 2,23) doctores. De los Servicios de Farmacia Hospitalaria que refirieron el factor de impacto acumulado de sus publicaciones, en un 60% era cero, y en el 19,6% ≥ 10. CONCLUSIONES: La atención a pacientes no ingresados y la elaboración de medicamentos continúan avanzando en los Servicios de Farmacia Hospitalaria españoles, mientras que existe un importante margen de mejora en farmacocinética clínica. Se refleja un compromiso con la docencia, mientras que la producción científica es todavía limitada, a pesar del incremento de doctores en los servicios


OBJECTIVE: To report on the results obtained from the 2019 SEFH National Survey regarding the service portfolio, care activities, training programs and research work of Spanish hospital pharmacy departments. METHOD: In March 2019, SEFH designed and distributed a questionnaire containing 77 questions grouped into 8 domains to its 368 affiliated hospital pharmacy departments. The questionnaire included an additional section on the activities carried out in 2017 and 2018. RESULTS: The overall response rate was 54.3%. Sixty-nine percent of hospitals were public and 75% were general hospitals. A total of 88.6% of hospital pharmacy departments provided pharmaceutical care to inpatients, whereas 77.5% and 65% treated outpatients and ambulatory patients, respectively. Sterile formulations were prepared by 70.6% of pharmacy departments, while 12% measured drug levels in bodily fluids; 76.9% of hospitals with more than 1,000 beds prepared pharmacokinetic reports. In 2018, hospital pharmacies provided for a mean of 929 patients a month and 2,680 a year. The amount of formulations (sterile and non-sterile) prepared was 10,394,492, sterile formulations accounting for 62.6%. The average amount of clinical trials managed in hospitals with ≥ 500 and ≥ 1000 beds was of 186.2 and 421.8, respectively. The median of number of undergraduate tuition agreements between pharmacy departments and universities was 1 (IQR: 0-2); 21.5% of pharmacy departments had no agreements with any university. The mean number of undergraduate pharmacy students per hospital pharmacy was 4.12 (SD: 8,26). A total of 290 pharmacists were associate professors at some university. Fifteen percent of pharmacists held a certification from the Board of Pharmacy Specialties, 55.3% of them in the specialty of oncology. Hospital pharmacy departments employed a mean of 1.31(SD: 2,23) PhD holders. From those which reported the impact factor of their publications, 60% had an impact factor of zero while in 19.6% the impact factor was ≥ 10. CONCLUSIONS: Care of out-patients and medication compounding are increasingly the main activities performed in Spanish hospital pharmacies, while there is still considerable room for improvement in the area of clinical pharmacokinetics. Pharmacy departments are generally committed to training as a key activity, while scientific output is still limited despite the increase in the number of PhD pharmacist


Assuntos
Humanos , Serviço de Farmácia Hospitalar/organização & administração , Educação em Farmácia/tendências , Pesquisa Farmacêutica/tendências , Composição de Medicamentos/métodos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Segurança do Paciente , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Relatório de Pesquisa/tendências , Conduta do Tratamento Medicamentoso/tendências
18.
Iran J Allergy Asthma Immunol ; 20(1): 11-23, 2021 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-33639626

RESUMO

The Coronavirus disease 2019 (COVID-19) virus spread from Wuhan, China, in 2019 and is spreading rapidly around the world. COVID-19 victims are almost associated with cardiovascular disease, high blood pressure, diabetes, and other underlying diseases. Concerning the high prevalence of these disorders, widespread mortality threatens global society, and its fatality rate may increase with increasing COVID-19 prevalence in countries with older populations. Therefore, evaluating patients' clinical status with severe COVID-19 infection and their medical history can help manage treatment. Currently, one of the considered treatments is angiotensin-converting enzyme 2 (ACE2) inhibition. This study investigated virus entry mechanisms through membrane receptors, their role in the pathogenesis of COVID-19 and underlying diseases, and treatment methods based on the viral entrance inhibition. According to existing studies, inhibition of ACE2 can increase oxidative stress, inflammation, fibrosis and ultimately exacerbate underlying diseases such as cardiovascular disease, kidney disease, diabetes, and hypertension in individuals with COVID-19. The ACE2 inhibition is not suitable for patients with COVID-19 with underlying diseases, but it seems that the recombinant ACE2 solution is more appropriate for inhibiting the virus in these patients if hypotension would be monitored.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Antivirais/uso terapêutico , COVID-19/tratamento farmacológico , COVID-19/virologia , SARS-CoV-2/fisiologia , Internalização do Vírus/efeitos dos fármacos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Humanos , Hipotensão/etiologia , Hipotensão/prevenção & controle , Monitorização Fisiológica , Peptidil Dipeptidase A/metabolismo
19.
J Adv Nurs ; 77(7): 3168-3175, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33624324

RESUMO

AIMS: To identify and prioritize the root causes of adverse drug events (ADEs) in hospitals and to assess the ability of artificial intelligence (AI) capabilities to prevent ADEs. DESIGN: A mixed method design was used. METHODS: A cross-sectional study for hospitals in Spain was carried out between February and April 2019 to identify and prioritize the root causes of ADEs. A nominal group technique was also used to assess the ability of AI capabilities to prevent ADEs. RESULTS: The main root cause of ADEs was a lack of adherence to safety protocols (64.8%), followed by identification errors (57.4%), and fragile and polymedicated patients (44.4%). An analysis of the AI capabilities to prevent the root causes of ADEs showed that identification and reading are two potentially useful capabilities. CONCLUSION: Identification error is one of the main root causes of drug adverse events and AI capabilities could potentially prevent drug adverse events. IMPACT: This study highlights the role of AI capabilities in safely identifying both patients and drugs, which is a crucial part of the medication administration process, and how this can prevent ADEs in hospitals.


Assuntos
Inteligência Artificial , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Estudos Transversais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Hospitais , Humanos , Erros de Medicação/prevenção & controle , Espanha
20.
Trials ; 22(1): 119, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33546752

RESUMO

BACKGROUND: Repeat exposures to culprit medications are a common cause of preventable adverse drug events. Health information technologies have the potential to reduce repeat adverse drug events by improving information continuity. However, they rarely interoperate to ensure providers can view adverse drug events documented in other systems. We designed ActionADE to enable rapid documentation of adverse drug events and communication of standardized information across health sectors by integrating with legacy systems. We will leverage ActionADE's implementation to conduct two parallel, randomized trials: patients with adverse drug reactions in the main trial and those diagnosed with non-adherence in a secondary trial. Primary objective of the main trial is to evaluate the effects of providing information continuity about adverse drug reactions on culprit medication re-dispensations over 12 months. Primary objective of the secondary trial is to evaluate the effect of providing information continuity on adherence over 12 months. METHODS: We will conduct two parallel group, triple-blind randomized controlled trials in participating hospitals in British Columbia, Canada. We will enroll adults presenting to hospital with an adverse drug event to prescribed outpatient medication. Clinicians will document the adverse drug event in ActionADE. The software will use an algorithm to determine patient eligibility and allocate eligible patients to experimental or control. In the experimental arm, ActionADE will transmit information to PharmaNet, where adverse drug event information will be displayed in community pharmacies when re-dispensations are attempted. In the control arm, ActionADE will retain information in the local record. We will enroll 3600 adults with an adverse drug reaction into the main trial. The main trial's primary outcome is re-dispensation of a culprit or same-class medication within 12 months; the secondary trial's primary outcome will be adherence to culprit medication. Secondary outcomes include health services utilization and mortality. DISCUSSION: These studies have the potential to guide policy decisions and investments needed to drive health information technology integrations to prevent repeat adverse drug events. We present an example of how a health information technology implementation can be leveraged to conduct pragmatic randomized controlled trials. TRIAL REGISTRATION: ClinicalTrials.gov NCT04568668 , NCT04574648 . Registered on 1 October 2020.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Informática Médica , Adulto , Colúmbia Britânica , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
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