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1.
Nat Commun ; 11(1): 4575, 2020 09 11.
Artigo em Inglês | MEDLINE | ID: mdl-32917868

RESUMO

A central issue in drug risk-benefit assessment is identifying frequencies of side effects in humans. Currently, frequencies are experimentally determined in randomised controlled clinical trials. We present a machine learning framework for computationally predicting frequencies of drug side effects. Our matrix decomposition algorithm learns latent signatures of drugs and side effects that are both reproducible and biologically interpretable. We show the usefulness of our approach on 759 structurally and therapeutically diverse drugs and 994 side effects from all human physiological systems. Our approach can be applied to any drug for which a small number of side effect frequencies have been identified, in order to predict the frequencies of further, yet unidentified, side effects. We show that our model is informative of the biology underlying drug activity: individual components of the drug signatures are related to the distinct anatomical categories of the drugs and to the specific drug routes of administration.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Aprendizado de Máquina , Algoritmos , Biologia Computacional/métodos , Bases de Dados de Produtos Farmacêuticos , Humanos , Preparações Farmacêuticas/administração & dosagem , Probabilidade
2.
Eur J Med Chem ; 201: 112559, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32563814

RESUMO

The ongoing novel coronavirus disease (COVID-19) pandemic makes us painfully perceive that our bullet shells are blank so far for fighting against severe human coronavirus (HCoV). In spite of vast research work, it is crystal clear that the evident does not warrant the commercial blossoming of anti-HCoV drugs. In this circumstance, drug repurposing and/or screening of databases are the only fastest option. This study is an initiative to recapitulate the medicinal chemistry of severe acute respiratory syndrome (SARS)-CoV-2 (SARS-CoV-2). The aim is to present an exquisite delineation of the current research from the perspective of a medicinal chemist to allow the rapid development of anti-SARS-CoV-2 agents.


Assuntos
Antivirais/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Infecções por Coronavirus/tratamento farmacológico , Descoberta de Drogas , Reposicionamento de Medicamentos , Preparações Farmacêuticas/administração & dosagem , Pneumonia Viral/tratamento farmacológico , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Humanos , Pandemias , Pneumonia Viral/transmissão , Pneumonia Viral/virologia
3.
Farm. hosp ; 44(3): 114-121, mayo-jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-192344

RESUMO

INTRODUCCIÓN: La tecnología sanitaria se ha convertido en la solución más aceptada para reducir los eventos adversos provocados por los medicamentos, minimizando los posibles errores humanos. La introducción de la tecnología puede mejorar la seguridad y permitir una mayor eficiencia en la clínica. Sin embargo, no elimina todos los tipos de error y puede crear otros nuevos. La administración de medicamentos con código de barras y la utilización de bombas de infusión inteligentes son dos estrategias que pueden emplearse durante la administración de medicamentos para evitar errores antes de que estos lleguen al paciente. OBJETIVO: En este artículo se han revisado diferentes tipos de errores relativos a la administración de medicamentos con código de barras y las bombas de infusión inteligentes, y se ha examinado la forma en la que se producían dichos errores al emplear la tecnología. También se exponen las recomendaciones encaminadas a evitar este tipo de errores. CONCLUSIÓN: Los hospitales deben comprender la tecnología, su funcionamiento y los errores que pretende evitar, así como analizar de qué manera cambiará los procesos clínicos. Es esencial que la dirección del hospital establezca las métricas necesarias y las monitorice regularmente para garantizar el uso óptimo de estas tecnologías. También es importante identificar y evitar desviaciones en los procesos que puedan eliminar o disminuir los beneficios de seguridad para los que fue diseñada. De igual forma, es necesario recopilar periódicamente las opiniones del profesional que la utiliza para detectar los posibles problemas que pudieran surgir. Sin embargo, la dirección debe ser consciente de que incluso con la implementación completa de la tecnología pueden surgir errores a la hora de administrar la medicación


INTRODUCTION: Healthcare-related technology has been widely accepted as a key patient safety solution to reduce adverse drug events by decreasing the risk of human error. The introduction of technology can enhance safety and support workflow; however, it does not eliminate all error types and may create new ones. Barcode medication adminis-tration and smart infusion pumps are two technologies utilized during medication administration to prevent medication errors before they reach the patient. OBJECTIVE: This article reviewed different error types with barcode medi-cation administration and smart infusion pumps and examined how these errors were able to occur while using the technology. Recommendations for preventing these types of errors were also discussed. CONCLUSION: Hospitals must understand the technology, how it is desig-ned to work, which errors it is intended to prevent, as well as understand how it will change staff workflow. It is essential that metrics are set by hospital leadership and regularly monitored to ensure optimal use of these technologies. It is also important to identify and avoid workarounds which eliminate or diminish the safety benefits that the technology was designed to achieve. Front line staff feedback should be gathered on a periodic basis to understand any struggles with utilizing the technology. Leaders must also understand that even with full implementation of technology, medication errors may still occur


Assuntos
Humanos , Erros de Medicação/prevenção & controle , Preparações Farmacêuticas/administração & dosagem , Processamento Eletrônico de Dados/métodos , Bombas de Infusão , Gestão da Segurança/métodos , Acesso a Medicamentos Essenciais e Tecnologias em Saúde , Quimioterapia Assistida por Computador/métodos
4.
AAPS PharmSciTech ; 21(5): 177, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32592045

RESUMO

Food and drinks are commonly used to facilitate administration of paediatric medicines to improve palatability and enhance patient compliance. However, the impact of this practice on drug solubility and on oral drug bioavailability is not usually studied. Based on recommended strategies for oral administration of paediatric medicines with food and drink vehicles, the aims of this study were (i) to measure the physicochemical properties of (soft) food and drink vehicles, commonly mixed with paediatric medicines prior to administration, and (ii) to assess the impact of the co-administered vehicles on the solubility of two poorly soluble paediatric drugs. Montelukast (sodium) and mesalazine were selected as the model compounds. Distinct differences were observed between the physicochemical properties (i.e. pH, surface tension, osmolality, viscosity and buffer capacity) and macronutrient composition (i.e. fat, sugar and protein content) of the different soft foods and drinks, not only among vehicle type but also within vehicles of the same subtype. Solubility studies of the two model compounds in selected drinks and soft foods resulted in considerably different drug solubility values in each vehicle. The solubility of the drugs was significantly affected by the vehicle physicochemical properties and macronutrient composition, with the solubility of montelukast being driven by the pH, fat and protein content of the vehicles and the solubility of mesalazine by vehicle osmolality, viscosity and sugar content. This vehicle-dependent impact on drug solubility could compromise its bioavailability, and ultimately affect the safety and/or efficacy of the drug and should be taken into consideration during paediatric product development.


Assuntos
Bebidas , Composição de Medicamentos , Alimentos , Preparações Farmacêuticas/administração & dosagem , Administração Oral , Disponibilidade Biológica , Criança , Excipientes , Humanos , Solubilidade , Tensão Superficial , Viscosidade
5.
PLoS One ; 15(6): e0235087, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584864

RESUMO

BACKGROUND: In nursing practice, flushing the catheters pre and post-drug administration is considered an important clinical procedure to prevent complications, and requires the use of several syringes to comply with international standards of care. We envisioned an innovative double-chamber syringe that enables the filling and administration of both solutions. Following current international recommendations, the development of new medical devices should integrate Health Technology Assessment. The Human-centred design is usually used for that assessment purposes, as a method that actively include end-users in the devices development process. METHOD: Application of the Human-Centred Design through the involvement of nurses in the initial stages of the device development in order to accomplish the initial stages of Technology Readiness Level. A multi-method approach was used, including literature/guidelines review, focus groups with end-users and expert panels. RESULTS: The involvement of nurses enabled the definition of user requirements and contexts of use, as well as the evaluation of design solutions and prototypes in order to accomplish with usability and ergonomic features of the medical device. CONCLUSIONS: Significant contributions were made regarding the final design solution of this innovative double-chamber syringe.


Assuntos
Enfermeiras e Enfermeiros , Seringas , Administração Intravenosa , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Preparações Farmacêuticas/administração & dosagem
6.
Yakugaku Zasshi ; 140(5): 599-608, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32378658

RESUMO

Although oral drugs account for 80% of the world drug market, many difficulties arise in their development. The drug absorption profile after oral administration may be influenced by multiple factors, including dosing conditions and physiological state of the gastrointestinal (GI) tract. Variability in GI fluid volume may influence the absorption characteristics. Indeed, the contributions of passive diffusion, transporters, and metabolic enzymes depend on GI drug concentration, which is influenced by changes in GI fluid volume. However, this important variable has been neglected in many prediction methods for oral drug absorption and drug interactions, and for convenience it is often assumed that the GI water volume is fixed at a constant value. Major global regulatory agencies such as the U.S. Food and Drug Administration (FDA), European Medicines Agency (EMA), and Japanese Pharmaceuticals and Medical Devices Agency (PMDA) recommend using a constant fluid volume of 250 mL (the fluid volume of a glass of water) to estimate the theoretical GI concentration of drugs after oral administration. However, the actual volume of water in the GI tract is both time- and site-dependent as a result of water intake, absorption, secretion, and GI transit. This review article summarizes our data showing that luminal water volume is influenced by the osmolality of the applied solution, and illustrates how this effect may contribute to changes in GI drug concentration, resulting in altered drug absorption.


Assuntos
Interações Medicamentosas , Trato Gastrointestinal/metabolismo , Absorção Intestinal , Preparações Farmacêuticas/administração & dosagem , Preparações Farmacêuticas/metabolismo , Membro 1 da Subfamília B de Cassetes de Ligação de ATP , Administração Oral , Água Corporal/metabolismo , Humanos , Modelos Biológicos , Concentração Osmolar , Valor Preditivo dos Testes
7.
Cochrane Database Syst Rev ; 5: CD012419, 2020 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-32383493

RESUMO

BACKGROUND: Older people taking multiple medications represent a large and growing proportion of the population. Managing multiple medications can be challenging, and this is especially the case for older people, who have higher rates of comorbidity and physical and cognitive impairment than younger adults. Good medication-taking ability and medication adherence are necessary to ensure safe and effective use of medications. OBJECTIVES: To evaluate the effectiveness of interventions designed to improve medication-taking ability and/or medication adherence in older community-dwelling adults prescribed multiple long-term medications. SEARCH METHODS: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, CINAHL Plus, and International Pharmaceutical Abstracts from inception until June 2019. We also searched grey literature, online trial registries, and reference lists of included studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs. Eligible studies tested interventions aimed at improving medication-taking ability and/or medication adherence among people aged ≥ 65 years (or of mean/median age > 65 years), living in the community or being discharged from hospital back into the community, and taking four or more regular prescription medications (or with group mean/median of more than four medications). Interventions targeting carers of older people who met these criteria were also included. DATA COLLECTION AND ANALYSIS: Two review authors independently reviewed abstracts and full texts of eligible studies, extracted data, and assessed risk of bias of included studies. We conducted meta-analyses when possible and used a random-effects model to yield summary estimates of effect, risk ratios (RRs) for dichotomous outcomes, and mean differences (MDs) or standardised mean differences (SMDs) for continuous outcomes, along with 95% confidence intervals (CIs). Narrative synthesis was performed when meta-analysis was not possible. We assessed overall certainty of evidence for each outcome using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Primary outcomes were medication-taking ability and medication adherence. Secondary outcomes included health-related quality of life (HRQoL), emergency department (ED)/hospital admissions, and mortality. MAIN RESULTS: We identified 50 studies (14,269 participants) comprising 40 RCTs, six cluster-RCTs, and four quasi-RCTs. All included studies evaluated interventions versus usual care; six studies also reported a comparison between two interventions as part of a three-arm RCT design. Interventions were grouped on the basis of their educational and/or behavioural components: 14 involved educational components only, 7 used behavioural strategies only, and 29 provided mixed educational and behavioural interventions. Overall, our confidence in results regarding the effectiveness of interventions was low to very low due to a high degree of heterogeneity of included studies and high or unclear risk of bias across multiple domains in most studies. Five studies evaluated interventions for improving medication-taking ability, and 48 evaluated interventions for improving medication adherence (three studies evaluated both outcomes). No studies involved educational or behavioural interventions alone for improving medication-taking ability. Low-quality evidence from five studies, each using a different measure of medication-taking ability, meant that we were unable to determine the effects of mixed interventions on medication-taking ability. Low-quality evidence suggests that behavioural only interventions (RR 1.22, 95% CI 1.07 to 1.38; 4 studies) and mixed interventions (RR 1.22, 95% CI 1.08 to 1.37; 12 studies) may increase the proportions of people who are adherent compared with usual care. We could not include in the meta-analysis results from two studies involving mixed interventions: one had a positive effect on adherence, and the other had little or no effect. Very low-quality evidence means that we are uncertain of the effects of educational only interventions (5 studies) on the proportions of people who are adherent. Low-quality evidence suggests that educational only interventions (SMD 0.16, 95% CI -0.12 to 0.43; 5 studies) and mixed interventions (SMD 0.47, 95% CI -0.08 to 1.02; 7 studies) may have little or no impact on medication adherence assessed through continuous measures of adherence. We excluded 10 studies (4 educational only and 6 mixed interventions) from the meta-analysis including four studies with unclear or no available results. Very low-quality evidence means that we are uncertain of the effects of behavioural only interventions (3 studies) on medication adherence when assessed through continuous outcomes. Low-quality evidence suggests that mixed interventions may reduce the number of ED/hospital admissions (RR 0.67, 95% CI 0.50 to 0.90; 11 studies) compared with usual care, although results from six further studies that we were unable to include in meta-analyses indicate that the intervention may have a smaller, or even no, effect on these outcomes. Similarly, low-quality evidence suggests that mixed interventions may lead to little or no change in HRQoL (7 studies), and very low-quality evidence means that we are uncertain of the effects on mortality (RR 0.93, 95% CI 0.67 to 1.30; 7 studies). Moderate-quality evidence shows that educational interventions alone probably have little or no effect on HRQoL (6 studies) or on ED/hospital admissions (4 studies) when compared with usual care. Very low-quality evidence means that we are uncertain of the effects of behavioural interventions on HRQoL (1 study) or on ED/hospital admissions (2 studies). We identified no studies evaluating effects of educational or behavioural interventions alone on mortality. Six studies reported a comparison between two interventions; however due to the limited number of studies assessing the same types of interventions and comparisons, we are unable to draw firm conclusions for any outcomes. AUTHORS' CONCLUSIONS: Behavioural only or mixed educational and behavioural interventions may improve the proportion of people who satisfactorily adhere to their prescribed medications, but we are uncertain of the effects of educational only interventions. No type of intervention was found to improve adherence when it was measured as a continuous variable, with educational only and mixed interventions having little or no impact and evidence of insufficient quality to determine the effects of behavioural only interventions. We were unable to determine the impact of interventions on medication-taking ability. The quality of evidence for these findings is low due to heterogeneity and methodological limitations of studies included in the review. Further well-designed RCTs are needed to investigate the effects of interventions for improving medication-taking ability and medication adherence in older adults prescribed multiple medications.


Assuntos
Adesão à Medicação , Preparações Farmacêuticas/administração & dosagem , Polimedicação , Idoso , Idoso de 80 Anos ou mais , Viés , Feminino , Humanos , Vida Independente , Masculino , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
Pharm Res ; 37(6): 100, 2020 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-32436083

RESUMO

PURPOSE: We investigated the potential correlations between skin barrier integrity and hydrophilic drugs distribution in skin in the presence of different types of penetration enhancers (PEs) and their combinations. METHODS: We measured skin conductivity to evaluate skin barrier integrity before and after the topical application of different chemical PEs, physical PE, peptide PE and their combinations in vitro. We also investigated their effect on the skin distribution profiles of two hydrophilic model drugs, Fluorescein sodium (376 Da) and Fluorescein isothiocyanate-dextrans 10 (10 KDa). RESULTS: The physical PE significantly increased the skin conductivity compared to all other PEs, while the peptide PE had no effect on it. The drug deposition in different skin layers was not only dependent on PE applied but also its own molecular weight. We further found two excellent correlations: one (R2 = 0.9388) between skin barrier integrity and total skin absorption of FNa and another one(R2 = 0.9212) between skin barrier integrity and the deposition of FNa in dermis and receptor in presence of chemical or physical PEs and their combinations. CONCLUSIONS: The total skin absorption or the deposition in dermis and receptor of small hydrophilic drug in the presence of chemical and physical PEs and their combinations show a good correlation with skin barrier integrity. However, such correlations hold true neither for large hydrophilic drug nor for peptide PE. All good relationships found in this work will allow screening suitable PEs or combinations by measuring the skin conductivity induced by corresponding PEs. Graphical Abstract The total skin absorption of small hydrophilic drug shows a good correlation with skin barrier integrity in the presence of chemical and physical penetration enhancers and their combinations. However, such a correlation hold true neither for large hydrophilic drug nor for peptide penetration enhancer.


Assuntos
Melhoramento Biomédico/métodos , Portadores de Fármacos/química , Peptídeos/química , Preparações Farmacêuticas/química , Absorção Cutânea/efeitos dos fármacos , Pele/metabolismo , Administração Cutânea , Animais , Dextranos/administração & dosagem , Dextranos/química , Composição de Medicamentos/métodos , Liberação Controlada de Fármacos , Excipientes/química , Fluoresceína/administração & dosagem , Fluoresceína/química , Fluoresceína-5-Isotiocianato/administração & dosagem , Fluoresceína-5-Isotiocianato/análogos & derivados , Fluoresceína-5-Isotiocianato/química , Cobaias , Humanos , Interações Hidrofóbicas e Hidrofílicas , Técnicas In Vitro , Conformação Molecular , Estrutura Molecular , Peso Molecular , Permeabilidade , Preparações Farmacêuticas/administração & dosagem , Solubilidade , Relação Estrutura-Atividade , Distribuição Tecidual
11.
Dement. neuropsychol ; 14(1): 24-27, Jan.-Mar. 2020. tab
Artigo em Inglês | LILACS | ID: biblio-1089820

RESUMO

ABSTRACT Dementia is a chronic neurodegenerative disease and Alzheimer's disease (AD) is the most prevalent type. Objective: To describe the drug monitoring of patients enrolled in a Clinical Protocol and Therapeutic Guidelines of Alzheimer's Disease (PCDTDA) in Brazil. Methods: A descriptive study based on interviews conducted in 2017 was performed. Patients diagnosed with Alzheimer's disease (AD) enrolled on the PCDTDA were included. The variables assessed were age, sex, time since diagnosis, clinical parameters of Mini-Mental State Exam (MMSE) and Clinical Dementia Rating (CDR), drug therapy used and AD drug collection. Results: The drug monitoring of 143 patients was evaluated. Observing the requirements of the screening tests for patient enrolment on the PCDTDA, all patients had scores for at least one MMSE and CDR assessment at protocol admission. None of the patients underwent the first reassessment of the effectiveness of AD drug therapy or the semiannual reassessment. Conclusion: Although PCDTDA provides the best evidence of AD treatment, the data showed failures in the monitoring of the effectiveness of AD drug therapy at dispensing.


RESUMO A demência é uma doença crônica e neurodegenerativa, e a doença de Alzheimer (DA) é a mais prevalente. Objetivo: Descrever o monitoramento da farmacoterapia de pacientes inseridos no Protocolo Clínico e Diretrizes Terapêuticas da Doença de Alzheimer (PCDTDA), Brasil. Métodos: Estudo descritivo, conduzido por meio de entrevistas em 2017. Foram incluídos pacientes com diagnóstico da doença de Alzheimer (DA) inseridos no PCDTDA. As variáveis foram idade; sexo; tempo de diagnóstico e farmacoterapia da DA; os parâmetros clínicos Mini-exame do estado mental (MEEM) e Clinical Dementia Rating (CDR); e farmacoterapia em uso. Resultados: O monitoramento de 143 pacientes foi avaliado. Considerando a exigência dos testes de rastreio para a inserção do paciente no PCDTDA, observou-se que todos os pacientes tinham pelo menos um escore no MEEM e no CDR na admissão no protocolo. Nenhum paciente foi submetido à primeira reavaliação da efetividade da farmacoterapia da DA e nem à reavaliação semestral. Conclusão: Apesar do PCDTDA ser a maior evidência do tratamento da DA, dados evidenciam falhas no monitoramento da efetividade da farmacoterapia da DA na dispensação.


Assuntos
Humanos , Segurança , Preparações Farmacêuticas/administração & dosagem , Protocolos Clínicos , Monitoramento de Medicamentos , Demência , Doença de Alzheimer , Segurança do Paciente
12.
Rev Bras Epidemiol ; 23: e200016, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32159627

RESUMO

INTRODUCTION: In Brazil, drugs are the main causative agents of poisonings, and children under age five are the group with the highest number of cases. The objective of the present study was to describe hospitalizations due to drug poisoning in this population regarding demographics, deaths and worsening indicators in hospitalizations. METHODS: The frequency of hospitalizations for drug poisoning between 2003 and 2012 was verified using data from the Hospital Information System. The study variables were year, gender, age, place of residence and hospitalization, patient follow-up, main diagnosis, secondary diagnosis, nature of the health establishment and amount related to Intensive Care Unit expenses. RESULTS: There were 17,725 hospitalizations due to drug poisoning in children under five, predominantly two-year-old male children. The hospitalizations outside the city of residence occurred in 25% of the cases, with predominance in the Northeastern region. The proportion of deaths in hospitalizations was 0.4%, with a higher number of deaths in the Southeastern region. CONCLUSION: Despite the decrease in the number of hospitalizations in the period, regional disparities remained, which could be attenuated with the provision of specialized attention to drug poisonings in municipalities, expanding the access to a more complex care.


Assuntos
Tratamento Farmacológico/mortalidade , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/mortalidade , Hospitalização/estatística & dados numéricos , Preparações Farmacêuticas/administração & dosagem , Envenenamento/mortalidade , Distribuição por Idade , Brasil/epidemiologia , Pré-Escolar , Feminino , Sistemas de Informação Hospitalar/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Envenenamento/etiologia , Distribuição por Sexo
13.
Curr Pharm Biotechnol ; 21(11): 1016-1027, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32188383

RESUMO

Graphene Derivatives (GDs) have captured the interest and imagination of pharmaceutical scientists. This review exclusively provides pharmacokinetics and pharmacodynamics information with a particular focus on biopharmaceuticals. GDs can be used as multipurpose pharmaceutical delivery systems due to their ultra-high surface area, flexibility, and fast mobility of charge carriers. Improved effects, targeted delivery to tissues, controlled release profiles, visualization of biodistribution and clearance, and overcoming drug resistance are examples of the benefits of GDs. This review focuses on the application of GDs for the delivery of biopharmaceuticals. Also, the pharmacokinetic properties and the advantage of using GDs in pharmaceutics will be reviewed to achieve a comprehensive understanding about the GDs in pharmaceutical sciences.


Assuntos
Portadores de Fármacos/farmacologia , Grafite/farmacologia , Preparações Farmacêuticas/administração & dosagem , Portadores de Fármacos/química , Portadores de Fármacos/farmacocinética , Sistemas de Liberação de Medicamentos/métodos , Sistemas de Liberação de Medicamentos/tendências , Liberação Controlada de Fármacos , Grafite/química , Grafite/farmacocinética , Humanos , Cinética , Nanomedicina Teranóstica , Distribuição Tecidual
14.
Med. intensiva (Madr., Ed. impr.) ; 44(2): 80-87, mar. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-188656

RESUMO

Objetivos: Recopilar la información publicada sobre estabilidad de los fármacos usados en el paciente crítico, evaluar la calidad de los datos publicados y generar una tabla de compatibilidad con información actualizada. Diseño: 1) Se realizó una búsqueda sistemática en las bases de datos Medline, Stabilis, Handbook on Injectable Drugs y Micromedex, para completar y actualizar la información disponible. Se incluyeron los estudios publicados entre 1990 y 2017 redactados en inglés, español y francés; 2) se analizó la calidad de los artículos según los criterios indicados en las guías de práctica para estudios de estabilidad; 3) se construyó una tabla de compatibilidades con los datos hallados para las combinaciones binarias de 44 fármacos de uso frecuente en unidades de cuidados intensivos (UCI). Ámbito: UCI de hospitales españoles e internacionales. Resultados: La revisión sistemática incluyó 29 artículos (27 originales y 2 revisiones). Ningún estudio cumplió todos los criterios de calidad establecidos, aunque el 93% garantizaba una correcta reproducibilidad. La tabla final aporta datos de compatibilidad fisicoquímica de 475 de las 945 combinaciones posibles (50,3%), de las cuales 366 (77,1%) son compatibles y 80 (16,8%) son incompatibles. Conclusiones: Se proporciona una actualización de las compatibilidades entre los fármacos habitualmente empleados en las UCI, con la intención de contribuir a la administración segura de medicamentos en pacientes críticos


Objectives: To gather all published information about the stability of drugs commonly used in Intensive Care Units (ICU); evaluate the methodology of published data; and generate a compatibility table. Design: i) A systematic review was conducted searching the following databases: Medline, Stabilis, Handbook of Injectable Drugs and Micromedex. Articles published from 1990 to 2017 in English, Spanish and French were included. ii) Article quality was analyzed according to the stability studies practice guidelines. iii) A compatibility table was produced with data for 44 binary combinations of drugs frequently used in the ICU. Scope: Spanish and international hospital ICU. Results: The systematic review included 29 studies (27 originals, 2 reviews). None of the included studies followed all the methodological requirements. However, 93% guaranteed correct reproducibility. Accordingly, drug stability knowledge was available for 50.3% of the studied admixtures, in which 77.1% of the binary combinations proved compatible and 16.8% proved incompatible. Conclusions: This review provides new reliable evidence about the physicochemical stability of drugs commonly used in the critical care setting. The study contributes to the safe administration of intravenous drugs in critical patients with a view to avoiding adverse events in this frail population


Assuntos
Humanos , Unidades de Terapia Intensiva , Estabilidade de Medicamentos , Preparações Farmacêuticas/química , Combinação de Medicamentos , Incompatibilidade de Medicamentos , Infusões Intravenosas/métodos , Preparações Farmacêuticas/administração & dosagem
16.
PLoS One ; 15(2): e0229235, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32069318

RESUMO

Life Cycle Assessment typically focuses on the footprint of products and services, expressed on three Areas of Protection (AoP): Human Health, Ecosystems and Resources. While the handprint is often expressed qualitatively, quantified handprints have recently been compared directly to the footprint concerning one AoP: Human Health. We propose to take this one step further by simultaneously comparing the quantified handprint and footprint on all AoPs through normalization and weighting of the results towards a single score. We discuss two example cases of a pharmaceutical treatment: mebendazole to treat soil-transmitted helminthiases and paliperidone palmitate to treat schizophrenia. Each time, treatment is compared to 'no treatment'. The footprint of health care is compared to the handprint of improved patient health. The handprint and footprint were normalized separately. To include sensitivity in the normalization step we applied four sets of external normalization factors for both handprint (Global Burden of Disease) and footprint (ReCiPe and PROSUITE). At the weighting step we applied 26 sets of panel weighting factors from three sources. We propose the Relative Sustainability Benefit Rate (RSBR) as a new metric to quantify the relative difference in combined handprint and footprint single score between two alternatives. When only considering the footprint, the first case study is associated with an increased single score burden of treatment compared to 'no treatment', while in the second case study treatment reduces the single score burden by 41.1% compared to 'no treatment'. Also including the handprint provided new insights for the first case study, now showing a decrease of 56.4% in single score burden for treatment compared to 'no treatment'. For the second case study the reduction of single score burden was confirmed as the handprint burden was also decreased because of treatment by 9.9%, reinforcing the findings.


Assuntos
Assistência à Saúde/normas , Setor de Assistência à Saúde/normas , Necessidades e Demandas de Serviços de Saúde/normas , Helmintíase/tratamento farmacológico , Modelos Estatísticos , Preparações Farmacêuticas/administração & dosagem , Esquizofrenia/tratamento farmacológico , Nível de Saúde , Helmintíase/epidemiologia , Humanos , Esquizofrenia/epidemiologia
17.
Guatemala; MSPAS; 06 feb 2020. 2 p.
Não convencional em Espanhol | LILACS, LIGCSA | ID: biblio-1096853

RESUMO

Menciona el proceso de selección, adquisición, mantenimiento y distribución de medicamentos con el objetivo de que los servicios de Salud se encuentren abastecidos de los insumos correctos, en la cantidad óptima y con buenas prácticas de almacenamiento, para atender a la población frente al coronavirus, principalmente los Hospitales que cuenten con Área de aislamiento.


Assuntos
Humanos , Pneumonia Viral/tratamento farmacológico , Preparações Farmacêuticas/administração & dosagem , Infecções por Coronavirus/tratamento farmacológico , Betacoronavirus , Guatemala , Hospitais Públicos/provisão & distribução
18.
J Med Chem ; 63(5): 1908-1928, 2020 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-32023055

RESUMO

After the first seed concept introduced in the 18th century, different disciplines have attributed different names to dual-functional molecules depending on their application, including bioconjugates, bifunctional compounds, multitargeting molecules, chimeras, hybrids, engineered compounds. However, these engineered constructs share a general structure: a first component that targets a specific cell and a second component that exerts the pharmacological activity. A stable or cleavable linker connects the two modules of a chimera. Herein, we discuss the recent advances in the rapidly expanding field of chimeric molecules leveraging chemical biology concepts. This Perspective is focused on bifunctional compounds in which one component is a lead compound or a drug. In detail, we discuss chemical features of chimeric molecules and their use for targeted delivery and for target engagement studies.


Assuntos
Produtos Biológicos/química , Produtos Biológicos/metabolismo , Sistemas de Liberação de Medicamentos/tendências , Descoberta de Drogas/tendências , Animais , Produtos Biológicos/administração & dosagem , Sistemas de Liberação de Medicamentos/métodos , Descoberta de Drogas/métodos , Humanos , Preparações Farmacêuticas/administração & dosagem , Preparações Farmacêuticas/química , Preparações Farmacêuticas/metabolismo , Estrutura Secundária de Proteína
19.
Proc Natl Acad Sci U S A ; 117(7): 3502-3508, 2020 02 18.
Artigo em Inglês | MEDLINE | ID: mdl-32015123

RESUMO

Accurate analysis of blood concentration and circulation half-life is an important consideration for any intravenously administered agent in preclinical development or for therapeutic application. However, the currently available tools to measure these parameters are laborious, expensive, and inefficient for handling multiple samples from complex multivariable experiments. Here we describe a robust high-throughput quantitative microscopy-based method to measure the blood concentration and circulation half-life of any fluorescently labeled agent using only a small (2 µL) amount of blood volume, enabling additional end-point measurements to be assessed in the same subject. To validate this method, we demonstrate its use to measure the circulation half-life in mice of two types of fluorescently labeled polymeric nanoparticles of different sizes and surface chemistries and of a much smaller fluorescently labeled monoclonal antibody. Furthermore, we demonstrate the improved accuracy of this method compared to previously described methods.


Assuntos
Monitoramento de Medicamentos/métodos , Ensaios de Triagem em Larga Escala/métodos , Microscopia/métodos , Preparações Farmacêuticas/administração & dosagem , Preparações Farmacêuticas/química , Animais , Feminino , Meia-Vida , Humanos , Injeções Intravenosas , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Nanopartículas/química
20.
Crit Care Nurs Q ; 43(2): 205-215, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32084063

RESUMO

Patients with Parkinson's disease (PD) face unique challenges when admitted to the hospital. The nature of the disease, complexity of the pharmacotherapeutic home regimens, and the medication-related policies of institutionalized care all contribute to the challenges patients and providers face. In addition, medication errors are common in this population. Incorrectly ordered or omitted home medications or delayed administration can have significant negative consequences including worsening of PD symptoms, dopamine agonist withdrawal syndrome, or malignant or hyperpyrexia syndrome. Also, this patient population may commonly encounter contraindicated medications ordered during their hospitalizations. These medication misadventures negatively affect patient care, which may lead to increased length of stay and significant adverse sequalae. Nurses, pharmacists, and other health care providers can help ease the anxiety of patients and their families by taking detailed medication histories, restarting home medication regimens, customizing medication administration to fit patients' needs, and screening patient profiles for drug-drug and drug-disease interactions. Education of hospital staff regarding the unique needs of this patient population and seeking the advice of specialists in PD can also promote improved patient care.


Assuntos
Unidades de Terapia Intensiva , Anamnese , Erros de Medicação/efeitos adversos , Doença de Parkinson/tratamento farmacológico , Preparações Farmacêuticas/administração & dosagem , Pessoal de Saúde/educação , Hospitalização , Humanos , Erros de Medicação/prevenção & controle , Farmacêuticos
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