¿Por qué los pacientes no retiran todos los medicamentos y productos sanitarios que les son prescritos por el médico? / Why do patients not withdraw all the medicines and health products prescribed to them by the doctor?

Introducción: la e-receta finalizó su implantación en la Comunidad Valenciana (CV) en septiembre de 2013, observándose que el paciente no retiraba parte de los medicamentos que tenía prescritos, por lo que se diseña un estudio para estudiar las diversas incidencias que pudieran ser la causa. Objetivos: analizar y cuantificar las incidencias detectadas en la dispensación de las e-receta prescritas a los pacientes en farmacia comunitaria de la CV. Métodos: estudio observacional, transversal, prospectivo multicéntrico de base poblacional de las incidencias detectadas en las dispensaciones de las e-receta. Población diana: pacientes mayores de 18 años o cuidadores. Resultados: se registraron 22.983 solicitudes de medicamentos o productos sanitarios (MPS) correspondientes a 6.621 pacientes. De los MPS disponibles para ser dispensados se rechazaron un 12,0 %. Las discrepancias entre lo que el médico prescribió y el paciente entendió supusieron el 19,0 % de los rechazos. Las distintas razones relacionadas con el inccumplimiento fueron el 32,3 % de los medicamentos rechazados (MR). En aquellos medicamentos en los que el paciente debía pagar una aportación el rechazo fue ligeramente mayor (12,2 %) que en el caso de los que no. Conclusiones: La dispensación de MPS prescritos a través de la e-receta permite identificar problemas relacionados con medicamentos (PRM) que inciden sobre la falta de adherencia y las discrepancias con lo prescrito en la receta electrónica

Introduction: The e-receipt finished its implantation in the Valencian Community (CV) in September 2013, observing that the patient did not withdraw part of the medicines prescribed, so a study is designed to find out the various incidents that could be the cause. Objectives: To analyze and quantify the incidences detected in the dispensation of the e-recipes prescribed to patients in community pharmacy (FC) de la CV. Methods: Observational, cross-sectional, prospective multicenter population-based study of the incidences detected in the dispensations of the e-recipes. The target population: patients over 18 years of age, or caregivers. Results: 22,983 requests for medicines or health products (HP) were recorded for 6,621 patients. Of the medicines or HP available for dispensing, 12.0% were rejected. • Discrepancies between what the doctor prescribed and what the patient understood accounted for 19.0% of refusals. • The different reasons related to non-compliance were 32.3% of medicines or health products (HP). In those medicines where the patient had to pay a contribution, the rejection was slightly higher (12.2%) than in the case of those who did not. Conclusions: The dispensing of prescribed medicines/HP through the e-prescription makes it possible to identify drug related problem DRPs that affect the lack of adherence and discrepancies with what is prescribed in the electronic prescription

How drug companies manipulate prescribing behavior / Cómo las empresas farmacéuticas manipulan la conducta para formular los medicamentos

Abstract Pharmaceutical companies affect prescribing behavior through various means, including pharmaceutical salespeople (drug reps), drug samples, influential peers, and educational events. Information on drugs provided by industry representatives has been shown to be inaccurate. Drug samples are among the most effective marketing tools that companies have. "Thought leaders" or "key opinion leaders" are used to persuade peers to use drugs for unapproved uses, raise awareness of targeted diseases, and to shape perceptions of a drug's benefits and harms, as well as perceptions about competing drugs. Although grants provided for talks, seminars, and meetings are described as "unrestricted," it is understood that the company gets to select some speakers, and that speakers with views that undermine marketing messages will not be invited. Promotion has been shown to increase physicians' prescription of targeted drugs, and increases prescription costs.

Resumen Las empresas farmacéuticas influyen sobre la conducta para formular los medicamentos de diversas formas, incluyendo a los vendedores de las empresas farmacéuticas (representantes de medicamentos), las muestras de medicamentos, pares influyentes y eventos educativos. La información sobre los medicamentos suministrada por los representantes de la industria ha demostrado ser inexacta. Las muestras de medicamentos son una de las herramientas de mercadeo más efectivas con que cuentan las empresas. Se recurre a "Los líderes de pensamiento" o a los "principales líderes de opinión" (KOLs por sus siglas en inglés) para convencer a sus pares de que utilicen medicamentos para usos no aprobados, sensibilizar sobre patologías objetivo, y conformar percepciones sobre los beneficios y perjuicios de un medicamento, además de crear impresiones sobre medicamentos en competencia. A pesar de que se dice que las asignaciones monetarias para dictar charlas, celebrar seminarios y reuniones no deben tener restricciones, es claro que la empresa selecciona determinados conferencistas y que aquellos cuyas opiniones socaven los mensajes de mercadeo no serán invitados. Se ha demostrado que la promoción aumenta la prescripción de medicamentos específicos y aumenta los costos de esta.

Uso da microextração por sorbente empacotado (MEPS) para preparo de amostras em análises toxicológicas envolvendo fármacos benzodiazepí­nico / Microextraction by packed sorbent (MEPS) for sample preparation in toxicological analyses involving benzodiazepines

A microextração por sorbente empacotado (MEPS) é uma técnica de preparo de amostras ainda pouco utilizada no âmbito da toxicologia, em que os mesmos princípios da extração em fase sólida convencional são adaptados para uma escala miniaturizada. As principais vantagens da técnica estão associadas ao pequeno volume de amostra e de solventes utilizados, à possibilidade de realizar múltiplas extrações com um mesmo cartucho e à facilidade de automação. Os benzodiazepínicos possuem grande relevância na toxicologia dada sua ampla utilização e seus efeitos que podem, por exemplo, comprometer a capacidade de dirigir, além do uso abusivo, e como drogas facilitadoras de crimes. Neste trabalho, um método de MEPS foi desenvolvido e otimizado para a determinação de sete benzodiazepínicos e seus produtos de biotransformação (diazepam, clonazepam, flunitrazepam, alprazolam, bromazepam, 7-aminoflunitrazepam e nordiazepam) utilizando 100 µL de amostra de sangue total post mortem. Após a extração, os eluatos foram analisados por cromatografia líquida em fase reversa acoplada a espectrometria de massas. O método foi validado de acordo com as recomendações do Scientific Working Group for Forensic Toxicology, apresentando linearidade adequada de 5 a 500 ng.mL-1 . Os valores de exatidão (90,4 a 109,5%), precisão intra-dia (2,5 a 10,7 %CV) e inter-dia (1,1 a 8,0 %CV) também foram satisfatórios. MEPS foi realizada mais de 60 vezes com a mesma fase extratora sem evidências de contaminação cruzada. Dez amostras reais fornecidas pelo Instituto Médico Legal de São Paulo foram analisadas. Foram quantificados diazepam, nordiazepam, clonazepam e bromazepam. Os resultados encontrados em cada uma das amostras foram comparados com dados da literatura

Microextraction by packed sorbent (MEPS) is a sample preparation technique still little used in toxicology, where the same principles of conventional solid phase extraction are adapted to a miniaturized scale. The main advantages of the technique are associated with the small volume of sample and solvents required, the possibility of performing multiple extractions with the same cartridge and ease process automation. Benzodiazepine drugs are relevant in toxicology because of their widespread use, and effects (which may, for example, compromise the ability to drive vehicles), abuse and records as crime-facilitating drugs. In this work, a MEPS method was developed and optimized for a determination of seven benzodiazepines and their metabolites (diazepam, nordiazepam, clonazepam, flunitrazepam, 7-aminoflunitrazepam, alprazolam, and bromazepam) using 100 µL of post mortem whole blood. After extraction, the eluates were analyzed by reversed-phase liquid chromatography coupled to mass spectrometry. The method was validated according to the recommendations of the Scientific Working Group for Forensic Toxicology, presenting adequate linearity from 5 to 500 ng.mL-1 . The values of accuracy (90.4 to 109.5%), intra-day precision (2.5 to 10.7 %CV) and inter-day (1.1 to 8.0 %CV) also presented satisfactory results. MEPS was performed more than 60 times with the same extractive phase without compromising the results with the evidence of carryover. Institute of Legal Medicine were submitted to analysis by MEPS-LC-MS/MS. In these samples, the following analytes were quantified: diazepam, nordiazepam, clonazepam and bromazepam. The results found in each of the samples were compared with data from the literature

Estandarización y validación en Colombia de una metodología basada en HPLC para la determinación de la concentración sérica de posaconazol / Standardisation and validation of an HPLC method for determining serum posaconazole levels in Colombia

Antecedentes. Hasta la fecha, Colombia no cuenta con un servicio especializado de medición de concentraciones séricas de antifúngicos, procedimiento esencial para el adecuado manejo del tratamiento de las infecciones invasivas por hongos. Objetivos. Estandarizar y validar un protocolo simple, sensible y específico, basado en la cromotografía líquida de alta eficiencia, que, cumpliendo con los parámetros recomendados por la Food and Drug Administration, permita detectar y cuantificar concentraciones séricas de posaconazol. Métodos. Se usó un equipo de cromotografía líquida de alta eficiencia Agilent, serie 1200, con detector ultravioleta de matriz de diodos y columna analítica Eclipse-XDB-C18. Como estándar primario se utilizó posaconazol SCH56592 (lote IRQ-PAZ-10-X-103), y como control interno, itraconazol (lote ZR051211PUC921). La validación se hizo teniendo en cuenta los parámetros recomendados por la Food and Drug Administration (selectividad, curvas de calibración, recuperación, exactitud, precisión, sensibilidad, reproducibilidad y estabilidad de la muestra) para este tipo de métodos. Resultados. Los parámetros cromatográficos más adecuados fueron los siguientes: temperatura de la columna, 25°C; detección ultravioleta, 261nm; volumen de inyección, 50μl; flujo, 0,8ml/min; tiempo de migración, 10min; fase móvil, acetonitrilo:agua (70:30). Los tiempos de retención finales fueron de 3,4 y 7,2min para posaconazol e itraconazol, respectivamente, con un rango de cuantificación amplio y confiable, desde 0,125 hasta 16μg/ml. Bajo estas condiciones el método fue selectivo, el R2 de las curvas de calibración fue≥0,99 y el porcentaje de recuperación fue del 98,7%, con un porcentaje del coeficiente de variación inferior al 10%. El porcentaje de error relativo en la exactitud, así como el porcentaje del coeficiente de variación en la precisión, fueron inferiores al 15%, cumpliendo así con los criterios de aceptación recomendados por la Food and Drug Administration. Conclusiones. La selectividad y pureza de la señal cromatográfica obtenida, así como los límites de detección y cuantificación estandarizados, hacen de esta metodología una excelente herramienta para el seguimiento terapéutico de los pacientes bajo tratamiento con posaconazol (AU)

Background. Colombia currently does not have a specialised service for measuring antifungal levels in serum, which is of prime importance for the proper treatment and correct management of invasive fungal infections. Aims. To standardise and validate a simple, sensitive, and specific protocol, based on high performance liquid chromatography, complying with the parameters recommended by the Food and Drug Administration, to detect, identify, and quantify serum concentrations of posaconazole. Methods. A high performance liquid chromatography Agilent series-1 200 equipment was used with ultraviolet diode array detector and analytical column-Eclipse XDB-C18. Posaconazole-SCH56592 (batch IRQ-PAZ-10-X-103) was used as the primary control and itraconazole (batch ZR051211PUC921) was used as an internal control. The validation was performed taking into account all criteria recommended by the Food and Drug Administration (selectivity, calibration curves, recovery, accuracy, precision, sensitivity, reproducibility, and stability of the sample). Results. The most suitable chromatographic conditions were the following: column temperature 25°C, ultraviolet detection at 261nm, 50μl injection volume, flow volume 0.8ml/min, 10min running time, mobile phase of acetonitrile:water (70:30), and final retention times of 3.4 and 7.2min for posaconazole and itraconazole, respectively, with a wide and reliable quantification range (0.125μg/ml to 16μg/ml). Using these parameters, the method was selective, R2 in the calibration curves was≥0.99, and the percentage recovery was 98.7%, with a coefficient of variation less than 10%. The relative error for accuracy and the coefficient of variation for precision were less than 15%, all meeting the acceptance criteria recommended by the Food and Drug Administration. Conclusions. The selectivity and chromatographic purity of the obtained signal, as well as the standardised limits of detection and quantification, make this method an excellent tool for therapeutic monitoring of patients treated with posaconazole (AU)

Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges

Background: Suboptimal utilisation of pharmacotherapy, non-adherence to prescribed treatment, and a lack of monitoring all contribute to poor blood (BP) pressure control in patients with hypertension. Objective: The objective of this study was to evaluate the implementation of a pharmacist-led hypertension management service in terms of processes, outcomes, and methodological challenges. Method: A prospective, controlled study was undertaken within the Australian primary care setting. Community pharmacists were recruited to one of three study groups: Group A (Control - usual care), Group B (Intervention), or Group C (Short Intervention). Pharmacists in Groups B and C delivered a service comprising screening and monitoring of BP, as well as addressing poor BP control through therapeutic adjustment and adherence strategies. Pharmacists in Group C delivered the shortened version of the service. Results: Significant changes to key outcome measures were observed in Group C: reduction in systolic and diastolic BPs at the 3-month visit (P<0.01 and P<0.01, respectively), improvement in medication adherence scores (P=0.01), and a slight improvement in quality of life (EQ-5D-3L Index) scores (P=0.91). There were no significant changes in Group B (the full intervention), and no differences in comparison to Group A (usual care). Pharmacists fed-back that patient recruitment was a key barrier to service implementation, highlighting the methodological implications of screening. Conclusion: A collaborative, pharmacist-led hypertension management service can help monitor BP, improve medication adherence, and optimise therapy in a step-wise approach. However, blood pressure screening can effect behaviour change in patients, presenting methodological challenges in the evaluation of services in this context (AU)

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Chitosán más clorhexidina (Bexident®Post) en el control del dolor y la inflamación posoperatoria en implantología oral. Estudio piloto / Chitosan and chlorhexidine (Bexident®Post) in controlling postoperative pain and inflammation in oral implantology. Pilot study

OBJETIVOS: Evaluación de la eficacia del chitosán más la clorhexidina en el control del dolor y la inflamación posoperatoria en cirugía implantológica oral. MATERIAL Y MÉTODOS: Es un estudio clínico piloto prospectivo en pacientes a los que se les colocan implantes. A todos los pacientes se les pauta después de la cirugía Bexident(R)Post en gel, tres veces al día durante siete días. Se valora la inflamación, la apertura bucal, el nivel de dolor, el grado de cicatrización y la opinión sobre el producto. RESULTADOS: Se han colocado 138 implantes en 54 pacientes. El 64% eran varones y la media de tiempo quirúrgico fue de 76 minutos. La inflamación y apertura bucal pre y postoperatoria no es significativa con una p= 0,000. Se han consumido 11 unidades analgésicas de media en los 7 días del posoperatorio. El EVA ha sido de 3,0 (DS= 2,0) a las 6 horas, 2,0 (DS= 2,0) a las 24 horas, 2,02 (DS= 1,0) el segundo día, 1,0 (DS= 1,0) el tercer y cuarto día y 0,0 el quinto, sexto y séptimo día. El grado de cicatrización es bueno en el 88,9% (48 pacientes); regular, en el 7,4% (4 pacientes) y malo, en el 3,7% (2 pacientes). 45 pacientes (83,3%) responden positivamente a todas las preguntas referentes al producto. CONCLUSIONES: El producto se muestra fácil de usar, el sabor es adecuado y en este estudio la inflamación, el dolor y el consumo de medicamentos han sido mínimos. OBJECTIVES: Evaluation of the effectiveness of chitosán and chlorhexidine in controlling postoperative pain and inflammation in oral implant surgery. MATERIAL AND METHODS: A prospective pilot clinical study in patients with implants. Bexident(R)Post gel are prescribed three times a day during 7 days to all patients. Inflammation, bucal opening, level of pain, degree of healing and opinion about the product are valued

OBJECTIVES: Evaluation of the effectiveness of chitosán and chlorhexidine in controlling postoperative pain and inflammation in oral implant surgery. MATERIAL AND METHODS: A prospective pilot clinical study in patients with implants. Bexident(R)Post gel are prescribed three times a day during 7 days to all patients. Inflammation, bucal opening, level of pain, degree of healing and opinion about the product are valued. RESULTS: 138 implants were placed in 54 patients. 64% were males and the mean operative time was 76 minutes. The inflammation, pre and post-operative mouth opening are not significant at p= 0.000. 11 analgesic units have been consumed on average during 7 days of post-operative. The EVA was 3.0 (SD= 2.0) at 6 hours, 2.0 (SD= 2.0) at 24 hours, 2.02 (SD= 1.0) the second day, 1.0 (SD= 1.0) the third and fourth day and 0.0 the fifth, sixth and seventh day. The degree of healing is good in 88.9% (48 patients), fair in 7.4% (4 patients) and bad in 3.7% (2 patients). 45 patients (83%) respond positively to al questions regarding the product. CONCLUSIONS: The product is shown as easy to use, the taste is right and in this study, inflammation, pain and medicine use have been minimal. Double-blind study is needed in order to evaluate its effectiveness

Estudio piloto sobre la utilidad de la determinación de paracetamol urinario en la sospecha de intoxicación del paciente pediátrico / Usefulness of testing for paracetamol concentration in urine when poisoning is suspected in children

Objetivo: Analizar el rendimiento de un punto de corte de 3 μg/mL en la determinación de paracetamol urinario (PCTo) como método de cribado para detectar paracetamol en posibles sobreingestas en población pediátrica. Método: Estudio de caso-control, observacional, analítico y prospectivo realizado en una unidad de cuidados intensivos pediátricos (UCIP). Se seleccionó una muestra compuesta por aquellos pacientes ingresados en UCIP, considerando el grupo de casos aquellos con administración pautada de una dosis terapéutica endovenosa de paracetamol y un grupo control sin administración del fármaco. Se recogió una muestra de orina dentro de la primera hora y una segunda muestra pasadas 4 horas de la dosis del fármaco. En todos se determinó PCTo cuantitativamente. Se comparó la proporción de pacientes con PCTo _ 3 μg/mL. Se calcularon sensibilidad, especificidad y valores predictivos. Resultados: Se incluyeron 40 niños de edades entre 1 mes y 19 años (20 en cada grupo). No se obtuvo ningún paciente de control con PCTo positiva. La sensibilidad de la prueba en la primera orina recogida fue del 95% (IC 95%: 85,5-100%) y su especificidad del 100%. El valor predictivo positivo fue 100%, y el negativo del 95,2% (IC 95%: 86,1-100%). En las segundas orinas recogidas todos los valores de rendimiento del test fueron del 100%. Conclusión: La detección de PCTo antes de las 4 horas es útil para descartar la ingesta de paracetamol en población pediátrica. Se requieren estudios que permitan validar el nuevo punto de corte de 3 μg/mL para su posible inclusión en el algoritmo de sospecha de intoxicación aguda (AU)

Objective: To analyze the diagnostic yield of a cut-point of 3 μg/mL for paracetamol in urine to screen for poisoning in children. Methods: Prospective case–control observational study in a pediatric intensive care unit (PICU). All enrolled patients had been admitted to the PICU. Cases were children receiving a therapeutic dose of intravenous paracetamol. Controls were not receiving paracetamol. Urine samples were collected early in the morning and 4 hours after a dose of paracetamol was received by case patients. Paracetamol concentration was measured in all samples. We compared the percentages of cases and controls who had a concentration of 3 μg/mL or more. The sensitivity, specificity, and predictive values of the cut-point were calculated. Results: Forty children aged between 1 month and 19 years (20 per matched group) were enrolled. Paracetamol was not detected in any of the control samples. The sensitivity of the test in early morning urine was 95% (95% CI, 85.5%–100%); specificity was 100%. The positive predictive value was 100%; the negative predictive value was 95.2% (95% CI, 86.1%–100%). Paracetamol was detected in all of the second samples collected from cases. Conclusions: Measuring the paracetamol concentration in urine within 4 hours of dosing is useful to rule out prior intake of paracetamol and overdosing in PICU patients. Studies to validate the new cut-point of 3 μg/mL for paracetamol in urine are required with a view to possibly including it in a diagnostic protocol for suspected acute poisoning (AU)

Revisión sistemática de los estudios españoles sobre atención farmacéutica comunitaria en hipertensión arterial / Systematic review of the spanish studies about community pharmaceutical care in hypertension

Introducción: La hipertensión arterial es un problema de salud pública mundial de gran prevalencia, y responsable de una morbimortalidad muy elevada. A pesar de los grandes esfuerzos sanitarios y económicos realizados, el grado de control es muy escaso, situándose alrededor del 20% los hipertensos bien controlados entre los tratados, tanto en España como en los países de nuestro entorno. Objetivo: Revisar sistemáticamente la evidencia que aportan los estudios españoles sobre el impacto de la atención farmacéutica en hipertensión arterial, realizados en el ámbito comunitario. Métodos: Se realizó una búsqueda bibliográfica en MEDLINE, COCHRANE, DIALNET, y en revistas y webs especializadas en atención farmacéutica. Se incluyeron estudios de intervención farmacéutica en hipertensión arterial multicéntricos, realizados en España en el ámbito de la farmacia comunitaria. Se excluyeron estudios piloto, muestras inferiores a 10 pacientes y estudios descriptivos o cribados. Resultados: De los 18 estudios encontrados, 9 cumplían los criterios de inclusión. 6 eran ensayos controlados, y 3 no controlados. La descripción de cada estudio incluye el número y tipo de pacientes, tiempo de seguimiento, intervención farmacéutica y resultados obtenidos. Conclusiones: Los estudios españoles sobre el impacto de la atención farmacéutica comunitaria en el control de la presión arterial muestran mejoras en resultados clínicos (disminución de presión arterial media o de la proporción de pacientes mal controlados), en línea con los estudios realizados a nivel internacional. Por otro lado, se necesitan estudios de calidad adicionales que exploren el impacto de la intervención farmacéutica en resultados económicos y humanísticos

Background: Hypertension is an important public health problem around the world, with a high prevalence, and responsible for a very high morbidity and mortality. In spite of the big sanitary and economic efforts that have been made until now, the degree of control of this disease is very limited. Only around 20% of the treated hypertensive patients are well controlled, both in Spain and in the countries around us. Objective: To review systematically the evidence from Spanish studies about the impact of pharmaceutical care in hypertension, conducted in the community pharmacy setting. Methods: A comprehensive literature search was performed using MEDLINE, COCHRANE, DIALNET, and journals and web pages specialized in pharmaceutical care. Multicenter studies of pharmaceutical interventions in hypertension, conducted in Spain in the community pharmacy setting were included. Pilot studies, screenings, descriptive studies, or samples with less than 10 patients were excluded. Results: 18 studies were found. 9 out of them met the inclusion criteria. 6 were controlled trials, and 3 were uncontrolled trials. The description of each study includes the number and type of patients, monitoring length, pharmaceutical interventions, and outcomes achieved. Conclusions: The Spanish studies about the impact of community pharmaceutical care on blood pressure control show improvements in clinical outcomes (decrease of either mean blood pressure or percentage of uncontrolled patients). The results are similar to those carried out internationally. On the other hand, further quality studies exploring the economic and humanistic outcomes of the pharmaceutical intervention are required

Avanços e desafios em normatização de amostras grátis de medicamentos no Brasil / Advances and challenges in standardization of free samples of drugs in Brazil

Este trabalho analisou criticamente a legislação sobre amostras grátis de medicamentos no Brasil, pontuando alguns aspectos importantes relacionados à saúde da população. Foi realizado um levantamento das leis, decretos, normas e regulamentações que norteiam o assunto. A amostra grátis é uma das estratégias de publicidade e marketing usadas pela indústria farmacêutica. Em alguns casos, a indicação de certos medicamentos é baseada em dados técnicos apresentados pelos propagandistas. Por outro lado, os médicos que buscam informações técnicas em fontes com menor influência da indústria farmacêutica indicam menos os medicamentos novos, que na maioria das vezes são mais caros. Embora tenha sido observado um avanço na normatização em relação às amostras grátis, ela ainda é incipiente. Tópicos como o prazo mínimo para sua distribuição, quantidade máxima a ser entregue a cada prescritor, seu transporte, armazenamento e cuidados com o prazo de validade deveriam ser incluídas na legislação pertinente, como ocorre em outros países. Estas discussões deveriam ser retomadas com a menor influência possível dos laboratórios farmacêuticos, seguindo critérios técnico-científicos. Portanto, é necessário que este assunto seja contextualizado nas resoluções sobre amostras grátis de medicamentos, seguindo as normas das boas práticas de fabricação...

This paper critically analyzed the legislation on free samples of medicines in Brazil, scoring some important health-related aspects of the population. A survey of laws, decrees, rules and regulations that guide the subject was conducted. The free sample is one of the advertising and marketing strategies used by the pharmaceutical industry. In some cases, the designation of certain drugs is based on technical data provided by the propagandists. On the other hand, physicians seeking technical information on sources with less influence of the pharmaceutical industry indicate fewer new drugs, which most often are more expensive. Although an improvement in standardization has been seen for free samples, it is still incipient. Topics such as the time limit for its distribution, maximum to be delivered to each prescriber, transport, storage and care of the expiration date amount should be included in the relevant legislation, as in other countries. These discussions should be resumed with the least possible influence of pharmaceutical companies, following technical and scientific criteria. Therefore, it is necessary that this matter be contextualized in resolutions on free samples of medicines, following the standards of good manufacturing practices...

Job satisfaction among chain community pharmacists: results from a pilot study / Satisfacción con el trabajo entre farmacéuticos comunitarios de cadenas: resultados de un estudio piloto

Objectives: The objectives of this study were to obtain pilot data concerning the job satisfaction of Tucson area retail chain setting and to identify the facets of community practice that have the greatest contribution to job satisfaction. Methods: This was a cross-sectional study of chain pharmacists in the Tucson area. The Warr-Cook- Wall questionnaire of job satisfaction was used to evaluate community pharmacists’ satisfaction with their current position. This study used Rasch analysis to assess the validity and reliability of the questionnaire. The Rasch scores obtained for each respondent were used as a dependent variable in univariate and bivariate analyses to evaluate differences in job satisfaction. Results: A total of 32 pharmacists responded from 129 chain community pharmacies in the cities of Tucson, Marana and Oro Valley, Arizona. The mean (SD) Rasch score for job satisfaction was 0.93 (2.1). Results from bivariate analysis indicate that pharmacists in the Tucson area with practice experience outside community pharmacy were less satisfied with their job compared to those without experience outside community pharmacy (p<0.01). Conclusions: This pilot evaluation suggests that having pharmacy experience outside community practice affects pharmacist job satisfaction. Additionally, findings from this study indicate that there is reliability and validity evidence to support the use of the use of the Warr-Cook-Wall questionnaire for assessing overall job satisfaction in chain community pharmacy practice (AU)

Objetivos: Los objetivos de este estudio fueron obtener datos piloto sobre la satisfacción en el trabajo de establecimientos de cadena en el área de Tucson e identificar las facetas de la práctica comunitaria que tienen mayor contribución a la satisfacción con el trabajo. Métodos: Este fue un estudio transversal en farmacias de cadena del área de Tucson. Se utilizó el cuestionario de Warr-Cook-Wall de satisfacción con el trabajo para evaluar la satisfacción de los farmacéuticos comunitarios con su puesto actual. Este estudio usó el análisis de Rasch para evaluar la validez y la fiabilidad del cuestionario. Las puntuaciones de Rasch obtenidas de cada respondente fueron usadas como variable dependiente en los análisis univariado y bivariado para evaluar las diferencias en la satisfacción con el trabajo. Resultados: Un total de 32 farmacéuticos respondieron de las 129 farmacias comunitarias de cadena en las ciudades de Tucson, Marana and Oro Valley, Arizona. La media (DE) de la puntuación de satisfacción con el trabajo fue de 0,93 (2,1). Los resultados del análisis bivariado indican que los farmacéuticos del área de Tucson con práctica fuera de la farmacia comunitaria estaban menos satisfechos que los que no la tenían (p<0,01). Conclusiones: Este estudio piloto sugiere que tener experiencia fuera de la farmacia comunitaria afecta a la satisfacción con el trabajo. Además, los hallazgos de este estudio indican que existe evidencia fiable y válida para apoyar el uso del cuestionario Warr-Cook-Wall para evaluar la satisfacción general con el trabajo en la práctica de la farmacia comunitaria en cadenas (AU)

Implicación del farmacéutico comunitario en la dispensación a pacientes con trastorno por déficit de atención e hiperactividad. Un estudio piloto / Involvement of community pharmacists on attention-defi cit/hyperactivity disorder patients. A pilot study

Introducción: Los tratamientos farmacológicos para el trastorno por déficit de atención e hiperactividad (TDAH) mejoran la sintomatología, aunque cuentan con numerosos efectos secundarios. Los farmacéuticos no forman parte del equipo multidisciplinario que atiende este trastorno. Objetivo: Contribuir desde la farmacia comunitaria al proceso asistencial de estos pacientes. Material y métodos: Estudio descriptivo, transversal y observacional, realizado en farmacias comunitarias de Andalucía. La muestra estuvo formada por pacientes, familiares o cuidadores con prescripciones de metilfenidato y/o de atomoxetina. Durante marzo-junio de 2009, mediante un cuestionario estructurado, se obtuvo información sobre el paciente, el diagnóstico médico, los medicamentos prescritos, las reacciones adversas medicamentosas (RAM), las alertas, el conocimiento sobre el tratamiento y las intervenciones farmacéuticas. Resultados: Participaron 59 farmacias y se cumplimentaron 136 cuestionarios. El 83% de la muestra fueron varones, la mayoría niños de entre 8 y 14 años de edad. El 93% tenía diagnosticado un TDAH. Metilfenidato fue el tratamiento más prescrito (90,6%), frente a atomoxetina (9,4%). La pérdida de apetito (68,10%), la dificultad para conciliar el sueño (31,03%), el dolor de cabeza (28,44%), los cambios de humor (23,27%) y la aparición de tics nerviosos (13,79%) fueron las RAM más prevalentes. A excepción de los tics, las formas retardadas de metilfenidato indujeron estos efectos en un porcentaje superior a las formas de liberación inmediata. Se detectaron 2,2 RAM/paciente tratados con metilfenidato y 4,3 RAM/paciente con atomoxetina. Se dispensó el tratamiento en el 98% de los casos, con información sobre el medicamento (29%) y educación sanitaria (26%), y se realizaron un 12% de derivaciones al médico. Conclusión: La intervención del farmacéutico comunitario en pacientes con TDAH puede contribuir a mejorar la efectividad y la seguridad de los tratamientos(AU)

Purpose: Available pharmacological treatments of attention-defi cit/hyperactivity disorder (ADHD) are focus on reducing symptoms, however they have numerous side effects. Pharmacists are not included within the interdisciplinary team treating this disorder. Objective: This study wants to contribute from community pharmacies to the assistential process of ADHD patients. Method: A descriptive, transversal and observational study was carried out. The setting was community pharmacies from Andalusia, Spain. Subjects were patients, parents or guardians with prescriptions of methylphenidate and/or atomoxetine. During March-June 2009, the subjects fi lled in a questionnaire with information about the patient, medical diagnosis, prescribed medication, adverse drug reactions (ADR), alerts, the degree of knowledge of treatment and the role of the pharmacist. Results: 59 community pharmacies were recruited, and 136 questionnaires were completed; 83% of the sample were male, mainly children between 8-14 years old. Extended release methylphenidate, was the most prescribed treatment (90.6%) against atomoxetine (9.4%). Loss of appetite (68.10%), diffi culty sleeping (31.03%), headache (28.44%), mood swings (23.27%) and tics (13.79%), were the most prevalent ADR. Except the tics, OROS methylphenidate induced these effects in higher percentage than immediate release forms. 2.2 ADR/patient was found using methylphenidate and 4.3 ADR/patient with atomoxetine. Treatments were dispensed in 98% of the cases, giving information about the drug (29%), health education (26%) and the patients were sent back to the doctor when necessary (12%). Conclusion: The intervention of community pharmacists on ADHD patients could be an important contribution in order to improve the effectiveness and safety of treatments(AU)

Implementación de un programa piloto de servicios farmacéuticos en una población rural de Veracruz (México) con alta prevalencia de enfermedades crónico-degenerativas / Implementation of a pilot program of pharmaceutical services in a rural population of Veracruz (Mexico) with high prevalence in chronic-degenerative diseases

Objetivo: Implementar un programa piloto de servicios farmacéuticos de carácter comunitario en una población rural de la zona centro de Veracruz (México) con una alta prevalencia de enfermedades crónico-degenerativas. Material y métodos: Consistió en dos fases: 1) identificación y caracterización de la población, y 2) implementación del programa piloto de los servicios farmacéuticos. El análisis estadístico se realizó con paquete estadístico STATA (versión 9.0). Resultados: Se le ofreció el servicio a una población de 904 personas, de las que 897 participaron; de estas últimas, 436 presentaron valores alterados de las patologías incluidas en el estudio. Para evaluar el efecto de la intervención farmacéutica sobre la efectividad de los tratamientos farmacológicos, se observó que en el grupo con hipertrigliceridemia, hipercolesterolemia y diabetes mellitus tipo 2 se produjo una disminución estadísticamente significativa de las concentraciones séricas de triglicéridos, colesterol y glucosa (p <0,001), respectivamente. De igual manera, se observó una reducción de la presión arterial diastólica y sistólica (p <0,001) después de la intervención. La evaluación clínica de los pacientes al final del tratamiento que incluyó servicios farmacéuticos fue en sentido favorable, ya que el 82,56% de la población de estudio refirió valores controlados dentro de las patologías de estudio y valores estadísticamente significativos (p <0,001). Los resultados negativos asociados a la medicación identificados fueron del tipo inefectividad cuantitativa, y se detectaron 14 reacciones adversas a medicamentos tipo A. Conclusiones: La atención farmacéutica es una estrategia idónea para actuar en el complejo proceso de generación y protección de la salud en comunidades vulnerables, como son las rurales con poblaciones con enfermedades crónico-degenerativas (AU)

Objective: Implement a pilot program of pharmaceutical services of communitarian character in a rural population of the central region of Veracruz (México) with high prevalence in chronic degenerative diseases. Methods: It consisted of two phases: 1) identification and characterization of the population, and 2) implementation of the pilot program of pharmaceutical services. Statistical analyses were done using STATA software (version 9.0). Results: The study population was of 904 people, of which 897 signed the informed consent. Fortunately, only 436 participants presented altered values related to the pathologies of study. To evaluate the effect of pharmaceutical intervention on the effectiveness of drug treatments was observed for the group with hypertriglyceridemia, hypercholesterolemia and diabetes mellitus type 2 had a statistically significant decrease in serum triglyceride, cholesterol and glucose concentrations (p <0.001). Similarly there was a reduction of systolic and diastolic blood pressure (p <0.001) after intervention. The clinical evaluation of patients at the end of treatment that included pharmaceutical services was in a positive in favorable way for the participants, since the 82.56% of the study population referred controlled values among the study pathologies and statistically significant values (p <0.001). The identifi ed negative outcomes associated with medication were of quantitative ineffectiveness type and 14 adverse drug reactions type A were detected. Conclusions: Pharmaceutical attention is a suitable strategy to act in the complex process of generation and protection of health in vulnerable communities such as the rural ones with chronic degenerative diseases (AU)

In vitro antimicrobial resistance of Pseudomonas aeruginosa isolated from canine otitis externa in Rio de Janeiro, Brazil

Isolates of Pseudomonas aeruginosa (167) were obtained from 528 samples of canine otitis externa, identified by biochemical reactions and tested for susceptibility to 10 antimicrobials. The most effective drug was ciprofloxacin. The study reports alarming resistance among P. aeruginosa isolated from canine otitis externa samples in Rio de Janeiro, Brazil.

Certificados de qualidade para matrizes homeopáticas / Certificate of quality for homeopathic matrixes

Os medicamentos homeopáticos são manipulados em farmácias, que precisam de matérias primas, tinturas-mãe ou dinamizações mais baixas, chamadas de matrizes, compradas de laboratórios de insumos farmacêuticos homeopáticos, pequenas empresas que não contam com uma legislação específica. Matérias primas para a manipulação alopática são sempre acompanhadas de Laudos de Análises. Como as matrizes dinamizadas não podem ser analisadas, um termo diferente deve ser proposto, que traga o máximo de informações sobre o produto comprado. Através da análise de documentos fornecidos por laboratórios nacionais e estrangeiros, este texto propõe um Certificado de Qualidade, que deve conter informações básicas para garantir a rastreabilidade e a qualidade das matrizes adquiridas por uma farmácia para atender às prescrições homeopáticas.(AU)

Homeopathic medicines are manipulated in pharmacies, which need raw materials, mother-tinctures or low potencies called matrixes, which are bought from homeopatic pharmaceutical laboratories, namely small companies for which there is no specific legislation. The raw materials for conventional manipulation are given Analysis Certificates. Since potentiated matrixes may not be analyzed, a different term must be developed indicating the maximum of information on the acquired product. After analyzing the document supplied by national and European laboratories, this article suggests a Certificate of Quality containing the essential information to warrant the sourcing and quality of the matrixes a pharmacy acquires to fill homeopathic prescriptions.(AU)

Determination of the melting temperature, heat of fusion, and purity analysis of different samples of zidovudine (AZT) using DSC / Determinação da temperatura de fusão, calor de fusão e pureza análise de diferentes amostras de zidovudina (AZT) por DSC

The determination of chemical purity, melting range, and variation of enthalpy in the process of characterizing medicines is one of the principal requirements evaluated in quality control of the pharmaceutical industry. In this study, the method of purity determination using DSC was outlined, as well as the application of this technique for the evaluation of commercial samples of zidovudine (AZT) (raw material) supplied by different laboratories. To this end, samples from six different laboratories (A, B, C, D, E, and F) and the standard reference (R) from the United States Pharmacopeia (USP) were analyzed. The DSC curves were obtained in the temperature range of 25 to 200 ºC under the dynamic atmosphere of N2 (50 mL min-1), heating rate of β=2 ºC min-1, using an Al capsule containing approximately 2 mg of sample material. The results demonstrated that the standard reference presented a proportion of 99.83 percent whereas the AZT samples presented a variation ranging from 97.59 to 99.54 percent. In addition, the standard reference was found to present a temperature of onset of melting point of 122.80 ºC. Regarding the samples of active agents provided by the different laboratories, a variation ranging from 118.70 to 122.87 ºC was measured. In terms of ΔHm, the samples presented an average value of 31.12 kJ mol-1.

A determinação da pureza química, a faixa de fusão e a variação de entalpia envolvida no processo de caracterização de fármacos é um dos principais requisitos avaliados no controle de qualidade em indústrias farmacêuticas. Neste trabalho é feita uma breve abordagem sobre o método de determinação de pureza utilizando DSC, assim como a aplicação desta técnica para avaliação de amostras comerciais de zidovudina (AZT) (matéria-prima) fornecida por diferentes laboratórios. Para tal, foram analisadas amostras de seis diferentes laboratórios (A,B,C,D,E e F) e a substância química de referência (R) da United States Pharmacopeia (USP). As curvas DSC foram obtidas na faixa de temperatura entre 25 a 200 ºC, sob atmosfera dinâmica de N2 (50 mL min-1), β=2 ºC min-1, utilizando cápsula de Al contendo aproximadamente 2 mg de amostra. De acordo com os resultados, pode-se observar que a substância química de referência apresentou teor igual a 99,83 por cento e que as amostras de AZT apresentaram uma faixa de variação entre 97,59 e 99,54 por cento. Pode-se verificar, ainda, que a substância química de referência apresentou uma temperatura onset de fusão igual a 122,80 ºC. Para as amostras dos princípios ativos fornecidos pelos diferentes laboratórios, pode-se verificar uma faixa de variação entre 118,70 e 122,87 ºC. No que se refere ao ΔHm, as amostras apresentaram valor médio de 31,12 kJ.mol-1.

Mutants with heteroresistance to amphotericin B and fluconazole in Candida

Several studies have reported the occurrence of infections caused by Candida yeasts as well as the increasing prevalence of non albicans species. The aim of the present work is focused on the obtaining of heteroresistance to amphotericin B and fluconazole in Candida species using two distinct methodologies: selection and induction. Resistant samples were obtained by selective pressure using a medium with fluconazole for growth, followed by growth in a medium with amphotericin B. The selective pressure was also created beginning with growth in amphotericin B medium followed by growth in fluconazole medium. Concomitantly, samples were submitted to the induction of resistance through cultivation in increasing concentrations of fluconazole, followed by cultivation in increasing concentrations of amphotericin B. Subsequently, the induction began with amphotericin B followed by fluconazole. Three samples resistant to fluconazole and amphotericin B were obtained, two by induction (C. glabrata and C. tropicalis) and one by selection (C. tropicalis). Both C. tropicalis originated from the same wild sample. After successive transfers for drug free medium, only the sample obtained by selection was able to maintain the resistance phenotype. These results suggest that the phenotype of heteroresitance to fluconazole and amphotericin B can be produced by two methodologies: selection and induction.