BackgroundAbiraterone acetate (AA) and enzalutamide are authorised oral therapies in the treatment of metastatic castration-resistant prostate cancer (mCRPC), which act by inhibiting androgen synthesis.PurposeTo compare the effectiveness of AA and enzalutamide in patients with mCRPC.Material and methodsRetrospective observational study between January 2015 and July 2017 in patients who had been treated with AA and enzalutamide for at least 1 month.Patients’ medical records were reviewed and the following data were collected: sex, age, Eastern Cooperative Oncology Group (ECOG) scale, degree of tumour aggressiveness (GLEASON scale) and pretreatment with docetaxel. The clinical variables were reduction in prostate-specific antigen (PSA) during the first trimester of treatment (≥50% and≥90%) and progression-free survival (PFS), defined as the duration of pharmacological treatment until suspension by progression of the illness.The statistical tests used, through the IBM SPSS®Statistics 23 program, were: student’s t-test to assess the SLP and the Chi-square and Fisher’s exact test to assess the PSA response.ResultsTwenty-six patients with AA and 22 with enzalutamide were treated. The median age for AA was 76 (58–92) vs 75.5 years (56–91) enzalutamide. ECOG ≤1 was found in 80.8% AA vs 90.9% enzalutamide. The GLEASON value ≥8 at the beginning of the treatment was 53.8% AA vs 77.3% enzalutamide. A 65.4% AA had not received pretreatment with docetaxel vs 72.7% enzalutamide. During the study period, 46.2% of patients treated with AA discontinued treatment, with an SLP in 228 days (45–528) vs 50% in the enzalutamide group with an SLP of 216 (83–446), with no statistically significant differences in both groups (p=0.848). The reduction of PSA was ≥50% in 53.85% AA vs 58.85% enzalutamide, with no statistically significant differences (p=0.579). The reduction in PSA ≥90% occurred in 19.23% AA vs 18.18% enzalutamide, with no statistically significant difference (p=1.).ConclusionAccording to the analysed data we can conclude that abiraterone acetate and enzalutamide have the same effectiveness measured as PFS and PSA reduction. Even so, it is necessary to take into account the low number of patients treated, so more studies are necessary to confirm this comparison.No conflict of interest
Background The intraocular inoculation of alteplase helps to dissolve blood clots. Purpose To evaluate the effectiveness and safety of the use of alteplase in a patient with massive SCH who had to undergo vitrectomy drainage. Materials and methods A 50-year-old woman, diagnosed with glaucoma resistant to drug treatment, was admitted with an intraocular pressure of 50 mmHg. Her medical history included risk factors such as degenerative myopia, hypertension and eye inflammation. She has undergone trabeculectomy with mitomycin and after the surgery she developed an expulsive SCH. To manage the SCH, the ophthalmological unit decided to do a vitrectomy and drain the eye; to assist with this they wanted to inject intraocular alteplase 50 mcg/0.1 mL. A literature search was conducted in PubMed (keywords: tissue plasminogen activator, suprachoroidal haemorrhage, vitrectomy) to explain the clinical use and the pharmaceutical product was made according to the standard operating procedure (SOP) established in the Pharmacy Service. In the vertical laminar flow hood we reconstituted 20 mg of alteplase with 20 ml of sterile water for injection. 1 ml of this solution was added to 1 ml of 0.9% sodium chloride. The final concentration was 500 mcg/ml. 0.1 mL of this solution was transferred to a 0.5 ml sterile insulin syringe and sealed with a sterile cap and labelled recommending its immediate use to obtain a final concentration of 500 mcg/ml. Results 16 days after the SCH occurred, drainage surgery was performed after a 50 mcg intraocular inoculation of alteplase in the operating theatre to remove the blood clot. During the subsequent follow-up, there was evidence of a satisfactory clinical evolution, although a retinal detachment in the right eye was detected and the patient needed a second operation. She was prescribed brinzolamide and timolol ophthalmic drops and five months later she had normal intraocular pressure and a good quality of vision. Conclusions The intraocular alteplase inoculation helped to dissolve the blood clot and it permitted the massive haemorrhage to drain better, improving the patient’s vision and making the second operation for retinal detachment easier. There were no adverse reactions referable to the intraocular inoculation of alteplase. No conflict of interest.
BackgroundThe unit dose drugs dispensing system (UDDDS) is established in the following way: first, the physician prescribes the treatment for the patient, the pharmacist then validates the prescription and finally the medication is dispensed from the pharmacy department. One function on the UDDDS is review the inpatient’s pharmacotherapeutic profile and recommend therapeutic drug monitoring, such as vancomycin plasma levels. Vancomycin is an antimicrobial glycopeptide with high toxicity whose most important adverse reactions are the red man syndrome, ototoxicity and nephrotoxicity.PurposeTo evaluate the clinical impact of pharmaceutical interventions from the UDDDS in the recommendation of vancomycin plasma levels in hospitalised patients and subsequent dosage adjustment from the pharmacokinetic unit.Material and methodsDescriptive and prospective study, conducted between January and August 2015 in a teaching care hospital of 412 beds. We reviewed all of the monitoring recommendations carried out in adult inpatients with a vancomycin prescription order. Critically ill patients were excluded.From the UDDDS of the pharmacy service, the recommendations had been made taking into account if the patient did not have vancomycin plasma levels measured or ordered. We analysed physician agreement with these recommendations, and patients who had adequate concentrations (appropriate range considering both 10–15 µg/mL and 15–20 µg/mL as severe infections) or doses adjusted by the pharmacist.ResultsDuring the study period, the recommendation for vancomycin monitoring was performed in 112 patients after reviewing their pharmacotherapeutic profile, of which 64 were accepted (57.14%). 143 patients treated with vancomycin were monitored from the pharmacokinetic unit, so that 44.75% were performed following the recommendation from the UDDDS. Of these, 22 (34.38%) were within the therapeutic range and in 42 (65.62%) the pharmacist recommended a new dosing regimen tailored to the patient’s clinical condition.ConclusionThe pharmaceutical intervention from the UDDDS in the recommendation of vancomycin plasma levels in inpatients allowed correct dosage in more than half of the patients.No conflict of interest.
PurposeThe objective of this study was to evaluate a standard starting dose of vancomycin and a possible relationship between body mass index (BMI) and plasma levels (therapeutic range 10–15 µg/mL).Material and methodsRetrospective study of samples collected in a tertiary hospital of 413 beds, over a period of 3 years (2012–2014), in patients who were prescribed a standard initial dose of vancomycin 1 g/12 h.Data collected were: weight, height, gender, age, creatinine plasma levels and vancomycin plasma levels. The collected data were grouped according to BMI (18.5–25=normal weight, 25–30=overweight and >30=obesity) and plasma concentrations of vancomycin. Exclusion criteria were: samples from patients with renal insufficiency (creatinine >1.2 mg/dL) and patients with an initial dose of vancomycin different from the standard dose.The relationship between plasma levels of vancomycin and BMI was assessed by ANOVA statistical analysis.Results114 determinations of plasma levels of vancomycin from different patients were reviewed; 51 normal weight patients, 45 overweight patients and 18 obese patients, with a mean age of 61.27 ± 18.49, 68.46 ± 13.07 and 66.27 ± 13.47 years, respectively.In the normal weight group, 74.5% were men and 25.5% were women; in overweight group, 73.3% were men and 26.7% were women; and in obesity group, 66.6% were men and 33.3% were women.Mean (SD) plasma levels of vancomycin in the normal weight group were 13.98 ± 10.61 µg/mL, in the overweight group 13.77 ± 8.32 µg/mL and in the obese group 10.7 ± 4.67 µg/mL.In the statistical study, we obtained a value distribution F of 1.1669, less than 3.09, a value that should be overcome to have statistical significance (95%).ConclusionThe standard starting dose of 1 g/12 h reaches the therapeutic range in most patients. There was no statistically significant relationship between BMI and mean plasma levels of vancomycin in our study, possibly because of the small sample size.No conflict of interest.
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