Background Multiple myeloma (MM) is a malignant monoclonal gammapathy that occurs mainly in patients over 65 years. Lenalidomide is indicated in combination with dexamethasone for the treatment of MM in patients who have received at least one prior treatment regimen. All this makes it likely the patient will require Pharmaceutical Care (PC). PC consists of collaboration with other health professionals and with the patient to design a safe and effective treatment plan, as well as to identify Drug Related Problems (DRPs) and to resolve and prevent negative outcomes associated with medication (RNMs). Purpose To evaluate the impact of pharmaceutical intervention in patients diagnosed with MM treated with lenalidomide in a pharmacists-led haematological consultation within the Pharmacy Service. Materials and MethodsQuasi-experimental study of 4 months duration on patients diagnosed with MM treated with lenalidomide. Clinical practise follow-up procedures used the Dader method adapted to the study situation. Data were obtained from interviews with patients, electronic medical records and Outpatient Service Pharmacy records. Results During this period, 29 patients were diagnosed with MM and treated with lenalidomide, 21 joined the study (4 didn’t gave consent and 2 weren’t able to visit the pharmacy), 11 women and 10 men. Average age: 70.3 years (52–89). During study a total of 17 DRPs were detected: 4 related to the indication, 1 to the effectiveness and 8 to the safety, and a total of 35 RNMs: 4 related to the need, 5 to the effectiveness and 26 to the safety. Of these 35, 45.7% could have been avoided. A total of 25 pharmaceutical interventions were made: 10 related to the amount of drug, 9 to the pharmacological strategy and 6 to patient education. Conclusions A variety of goals were achieved through pharmaceutical interventions: medicines reconciliation, resolution of health problems by detecting RNMs and avoidance of RNMs by detecting DRPs. No conflict of interest.
Background Etanercept is a soluble tumour necrosis factor receptor fusion protein used in a variety of arthropathies. A new administration device (pen) has recently been marketed. Purpose To evaluate pain differences and preference between the etanercept syringe and pen as well as the relation between pain and demographic and anthropometric factors. Materials and Methods All patients with the etanercept pen from 1 January 2012 to 31 March 2012 who had previously used the syringe were chosen. Gender, age, Body Mass Index (BMI), diagnosis, self-administration, pain perception (0 = no pain; 10 = maximum pain) and device preference were recorded. Statistical analysis: Student’s t-test and variance analysis were used for comparisons of means, chi-square and Fisher’s test for proportions, and non-parametric tests for pain. Results109 patients (43% men; 57% women) met inclusion criteria. Mean age was 54 ± 13.5 years and mean BMI 26.5 ± 4.8 kg/m². 58.7% had Rheumatoid Arthritis, 19.3% Ankylosing Spondylitis, 1.8% Juvenile Idiopathic Arthritis, 16.5% Psoriatic Arthritis and 3.7% Psoriasis. 82% self-administrated the pen, and 71% the syringe. The median pain with the syringe was 3 [interquartile range (IQR): 2–6] and with the pen was 4 [IQR: 2–5] (P = 0.008). 65% reported the same pain with both devices. 35% reported differences in pain and most of them (71%) had much pain (>5) with the pen and little pain (<5) with the syringe. There was a statistically significant association of pain with gender: women had more pain with the pen (P = 0.03), but less with the syringe (p > 0.05). There was no association with BMI, age or diagnosis. 59% preferred the pen, 25% the syringe, and 16% did not mind. Conclusions An association of pain with pen device and female gender was found. However there was no association with BMI, age or diagnosis. Acceptance of the pen and self-administration were higher even though pain was greater, so it is necessary to maintain both devices to assure adherence. No conflict of interest.
Background Inhaled antibiotics are increasingly used in patients with non-cystic fibrosis bronchiectasis as off-label treatment, without quantifiable effectiveness. Patients’perspective is an important part of healthcare quality. Due to internal procedures the pharmacy service supervises off-label treatments. Purpose To explore in a group of patients suffering from bronchiectasis, their perception of their last year and their current health status. Materials and methods Prospective study based on a survey given to patients treated with inhaled colistimethate for last year at least. Surveys were delivered between October 2012 and June 2013 containing 10 items about their current health status and the perceived changes in their physical and mental health during last year. A four-point scale was used for all questions (1 = never/poor health; 2 = sometimes/regular health; 3 = usually/good health; 4 = always/very good health). Colistimethate was dispensed once a month at the pharmacy service and the procedure for completing the survey was explained by a clinical pharmacist. The questionnaire could be completed by the patient himself or by a caregiver. Results 97 questionnaires were delivered, 67 (69%) were returned: 40 (41%) were useful and 27 weren’t completely filled in. Mean age was 72 years (32–93). 82.5% of patients referred to having bad or moderate health, however 52% believed their health was better than the previous year. During the last year 48% of patients had to reduce the working time (always) and 78% had less activity than desired (always) while 43% never or sometimes had difficulty performing certain activities. 72% had a perception of bad or very bad health, and almost all (95%) believed that their health was going to get worse. Relating to mental health 93% felt calm and quiet and only 40% never had moments of discouragement or depression. Conclusions It’s difficult to measure health benefits in chronic degenerative diseases. Despite their situation half of our patients believed their health had improved during last year. No conflict of interest.
Background It is necessary to monitor the effect of erythropoietin (EPO) on haemoglobin (Hb) levels to check the efficacy and safety of the medicine. The desirable therapeutic range of Hb according to the product information is from 10 to 12 g/dl and higher or lower levels can damage health. The tolerance, clinical need and urgency required in the resolution of the anaemia varies among patients, however, Hb ≥13 g/dl is associated with cardiovascular events such as thromboembolism, requiring urgent care. Purpose To determine the proportion of patients with anaemia linked to chronic renal failure in predialysis treated with EPO, with a value of Hb within or outside (lower or higher than) the therapeutic range. Materials and methods A retrospective study was performed of 155 nephrology patients who collect erythropoietin at the outpatient unit of the hospital pharmacy; duration 1 month. All of them had anaemia associated with chronic renal failure in predialysis and were treated with subcutaneous erythropoietin for at least 4 weeks. The outpatient dispensing program compiles items dispensed per patient, with dates, age, sex, medical record number, diagnosis, amount collected, dosage, department/ward and prescribing physician The last Hb value was obtained for the computerised medical history records and the proportion of patients below and above the therapeutic range was estimated. Results 139 patients, 61 women (43.9%) and 78 men (56.1%), between 21 and 101 years (mean 68.6). 48.9% (68) of the patients had an Hb within the therapeutic range (mean 11). 22.3% (31) had Hb less than 10 g/dl (mean 9.2 and minimum 6) while in 28.8% (40) it was greater than 12 (mean 13.2 and maximum 15.4). Conclusions 71 patients (51%) had Hb outside the therapeutic range. It is necessary to monitor the haemoglobin levels to check the safety and efficacy of erythropoietin. It is essential to include all episodes and data in the computerised medical history.
Background When an unrelated donor is used for an allogeneic hematopoietic stem cell transplant (AlloHSCT) highly immunosuppressive treatment is needed during the early post-transplant period as prophylaxis against acute graft versus host disease (aGVHD). Tacrolimus is one the drugs used with a target level of 5–15 ng/mL. Purpose To compare the accuracy of real plasma tacrolimus levels with target levels in the immediate post-transplant period. Materials and methods A retrospective review was made between 2008/01/01 and 2013/09/30 of all aGVHD prophylaxis that included tacrolimus. Data were obtained from the electronic medical history records and the Pharmacy Unit intravenous database. Results Tacrolimus was used in 46 patients (17 women) with a median of 51 years old (17–69). First dose of tacrolimus was administered on day -1 at 0.03 mg/kg/day by continuous intravenous infusion. Only half of patients, 23 (50%), were within the therapeutic range when the first measure was made. Supratherapeutic levels were found in 15 patients and infratherapeutic in 8 patients. This first tacrolimus plasma level was obtained between day + 2 and + 11. Conditioning was done with myeloablative regimens (fludarabine-busulfan: 13 patients; total body irradiation and cyclophosphamide: 5 patients) and non myeloablative regimens (fludarabine-melphalan: 7 patients; fludarabine-busulfan: 17 patients; fludarabine-cyclophosphamide: 4 patients). Antibiotic prophylaxis was administered in all cases with ciprofloxacin and antifungal prophylaxis was fluconazole, voriconazole and caspofungin for 42, 3 and 1 patient, respectively. A direct relationship has not been found between the day of measurement, conditioning regimen, antibiotic or antifungal prophylaxis and the tacrolimus plasma level obtained. Conclusions There is great discordance between theoretical tacrolimus plasma levels and real levels. Renal function doesn’t affect tacrolimus pharmacokinetics, although it is potentially nephrotoxic, which might require dose adjustment. After this review a pharmacokinetic drug interaction among drugs used during conditioning or antibiotic or antifungal prophylaxis was excluded. A thorough investigation of how tacrolimus samples are obtained and handled is mandatory. No conflict of interest.
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