Background The problem of overprescribing and failure to provide appropriate medicines in elderly people has been associated with hospitalisation. Purpose To analyse Inappropriate Prescribing (IP) and Prescribing Omissions (PO) in elderly patients in an attempt to find a link with said patients’ hospitalisation. Materials and methods Retrospective observational study from June to August 2013 with patients admitted to the Internal Medicine Unit in a tertiary hospital. We included patients ≥65 with at least four medicines in their home treatment. We used the STOPP/START criteria to detect IP/PO and compared them to the hospital’s diagnosis. We analysed IP/PO resolved after the hospitalisation process (treatment prescribed at discharge). Exclusion criteria: patients transferred to other units and patients who died. Data collected: sex, age, high comorbidity (Charlson Index ≥2), home treatment, diagnosis, hospitalisation duration, STOPP/START criteria. Results 93 patients were included: 52% male, 48% female; Average age was 79 (range = 66–92), 100% high comorbidity; average of 9 medicines (range = 3–17) prescribed per patient; average of 7 days’ (range = 1–27) hospitalisation. We identified 34 IP and 72 PO in 62% of patients (1.8 criteria/ patient). 71% of criteria related to the diagnosis and 21% of criteria unrelated to the diagnosis were solved after the hospitalisation process. Table 1 lists the IP or OP related to the diagnosis, found in 21 patients (26%). Abstract PS-017 Table 1Patient’s diagnosis related to the IP and PO. Diagnosis Number of Patients Number of IP Number of PO Ischaemic Heart Disease 4 0 4 Ischaemic Stroke 5 0 5 Heart Failure 6 3 6 COPD 2 0 2 Respiratory Failure 2 0 2 Gastrointestinal Bleeding 1 0 1 Diabetic Complication 1 0 1 Conclusions Most under- or overprescribing related to the reason for admission was detected and solved, but the rest is often unnoticed and continues unresolved in the treatment prescribed at discharge. STOPP/START criteria should be incorporated into primary care practice to improve prescription accuracy in older people and prevent morbidities. No conflict of interest.
Background Phenytoin can trigger hypersensitivity syndrome (HS), a rare but potentially fatal complication (incidence of 1:10 000 in new patients). Purpose To describe a case report of phenytoin HS. Materials and methods Medical record review and literature search about phenytoin. Results A 38-year-old man, splenectomised, with a history of seizures after traumatic brain injury. Community treatment was valproic acid (VA): 400–200–500 mg. He was admitted to the intensive care unit presenting with status epilepticus, with normal renal biochemistry and hepatic function. VA level was therapeutic (50.6 mg/l). On admission, he was initially prescribed VA, levetiracetam, propofol and clorazepate, with limited efficacy. Intravenous phenytoin was introduced to treat generalised seizure status. As seizures were controlled and electroencephalography improved significantly, phenytoin was continued orally (100–100–100 mg). Lacosamide treatment (100 mg/day for 2 days then 150 mg/day) was also started. Six days later, he reported generalised rash, fever, liver involvement, and lymphocytosis with normal renal biochemistry. Hepatic function was abnormal, with raised levels of transaminase. Phenytoin level was therapeutic (12.5 mg/l). Physicians requested collaboration from a hospital pharmacist (HP) to identify the cause of the condition. Because phenytoin HS was identified, it was discontinued and high-dose intravenous methylprednisolone and dexchlorpheniramine were initiated. The symptoms of HS responded rapidly to this treatment, with fever reducing, skin rash gradually resolving, transaminase levels becoming normalised and lymphocyte counts within normal ranges. Two days later, the patient was discharged. He has continued with lacosamide treatment (400 mg/day) and the disease is controlled at the moment. This case was reported to Regional Pharmacovigilance Centre. Conclusions The involvement of a HP can provide all the relevant information for the physician regarding the adverse effects of drugs. In order to prevent future incidents a weekly check is recommended in patients who start treatment with phenytoin.
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