Introduction During the COVID-19 pandemic, measures have been put in place to adapt to patients' needs during home quarantine, such as "telehealthcare". With this service, hospital pharmacists develop a distinct role via the implementation of pharmacovigilance services and pharmaceutical care plans for patients with comorbidities, and for special populations as immunosuppressed patients. Methods Cross-sectional study involving hospital and community pharmacists actively practising during the COVID-19 pandemic. Patients who could not come to the hospital pharmacy department were provided with a delivery service to the community pharmacy of their choice. Results A total of 1186 patients requested this service. Erythropoiesis-stimulating agents were the most indemand medication, followed by rheumatoid arthritis and antiretroviral drugs. 125 patients responded to the telephone survey, most of whom stated that they would use the delivery service again, and expressed their desire to continue doing so. Discussion Without a doubt, telepharmacy and medication delivery services have provided multiple benefits during home quarantine. The delivery service enabled us to provide drugs to patients in their immediate environment through a service that was free for both the patient and the hospital pharmacy service. However, at present, the available evidence of the impact of telepharmacy models is sparse. Conclusions This medication delivery service has provided multiple benefits to patients during home quarantine. Although the users of this service seem to be satisfied with the current model, in the future, we should consider which patients would benefit most from this service and shape it to individual needs.
Introduction Pembrolizumab is a monoclonal antibody approved for adult patients with advanced non–small-cell lung cancer (NSCLC). Although immune related adverse events are considered to be well tolerated, complications may occur and discontinuation of the treatment could be required. Case report A 62-year old patient diagnosed with advanced non-small cell lung cancer experienced a decline in the renal function after seven cycles with pembrolizumab. Management & outcome: After ruling out other common causes of interstitial nephritis, pembrolizumab was attributed as a cause of interstitial nephritis. At first, toxicity was managed with corticosteroids and closely monitoring the patient, but finally pembrolizumab had to be discontinued due to the kidney function did not recover. Discussion Renal and urinary disorders were reported in <3% of patients treated with pembrolizumab, being interstitial nephritis the most reported toxicity. The kidney damage can be a complication to consider in patients receiving pembrolizumab. Early identification of an increase in serum creatinine levels may help with prevention by establishing an effective treatment, although it may not mean a total recovery of kidney function.
not affect the activity of CTX. In the case of Toxoplasma gondii, the folate of choice is folinic acid because the microorganism can intake exogenous folate through the BT1 family transmembrane proteins which also have no affinity for folic acid. Conclusion and relevanceIn general, theoretically folic acid supplementation can be used to prevent myelotoxicity as it does not interfere with the action of the antibiotic in the case of bacteria. However, in infections caused by more complex eukaryotic organisms such as other fungi or parasites with lipophilic cell walls or specifical transmembrane proteins, each case must be evaluated on its own merits.
and the results are expressed as means± SD for continuous variables and as percentages (%) for categorical variables. Results 71 patients (53.3% women, mean age 82.7±6.7 (58-94) years) were treated with an AChEI. 74.6% (53 patients) were simultaneously treated with a DAP. Mean concomitant prescribed drugs (DAP and non-DAP) was 11.6±4.7 drugs (2-26). Prescribed AChEI were rivastigmine 56.3%, donepezil 38% and galantamine 5.6%. According to the classification of the systematic review of Durán et al, 71 patients were treated with a total of 95 DAP. The seven most frequently prescribed anticholinergic drugs were: quetiapine 39.4%, haloperidol 22.5%, ipratropium 21.1%, trazodone 14.1%, risperidone 12.7%, mirtazapine 7% and tramadol 5.6%. 57.7% of patients had dementia symptoms: confusional syndrome 31%, cognitive impairment 28.2%, mood disturbances 12.9% and somnolence 9.9%. The main destination was hospitalisation 85.9%, followed by hospital discharge 11.3% and death 2.8%. Conclusion and relevance A high percentage of elderly patients with dementia treated with AChEI were taking concomitant DAP, that present accumulated risk. The combined use of these drugs can increase cognitive impairment and also antagonise the effects of AChEI. The results of the study suggest the need for considering other treatment options or a decrease in the prescriptions for DAPs to reduce the pharmacological interactions and the related adverse effects of concomitant use.
Results 13 patients were included, 76.9% men, mean age 60.4 ±8.8 years. Among the four patients with tumour samples that were evaluated for PD-L1 expression, 75% had a score !1. Three patients were treated with at least one previous line. Previous treatments were: sunitinib (n=3) cabozantinib (n=1) or nivolumab (n=1). IMDC risk classification: 7.7% favourable, 53.8% intermediate and 38.5% poor risk. Presence of metastases: lung (7/13), bone (5/13), liver (3/13), ganglionar (2/13), cerebral (1/13) and unknown (2/13). All patients were treated with pembrolizumab 200 mg every 3 weeks and axitinib 5 mg twice daily until progression, unacceptable toxicity or death. Mean duration of treatment was 28.7 weeks. 46% are continuing with active treatment. Discontinuation causes included: death (n=3), adverse effects (n=3) and progression (n=1). Toxicities included: asthenia grade (G)1-3 (n=11), anorexia G1-2 (n=6), diarrhoea G1-4 (n=5), liver profile alterations G1-3 (n=3), hyperthyroidism G1-3 (n=3), abdominal pain G1-2 (n=3), palmar-plantar erythrodysesthesia G2-3 (n=2), pruritus G1 (n=1), dizziness and paraesthesia G1 (n=1), vomiting G1 (n=1), thrombopenia G2 (n=1) and arthralgias G1 (n=1). Best TAC responses obtained were: 50% stable disease, 25% partial response and 12.5% progressive disease. In five patients the response rate was not evaluated. Conclusion and relevance Effectiveness in our patients resulted in a higher objective response rate than that in the KEYNOTE -426 trial. The combination treatment was well tolerated. To rationalise the use of novel medicines and optimise efficiency, measuring health results is crucial.
might affect teduglutide's security, efficacy and quality. Therefore, it is highly recommended to protect the drug from light during in-use manipulation. For temperature exposition (40°C and 60°C) and agitation, the PTMs profile was not modified, thus no specific recommendations need be noted in this regard.
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