Mild to moderate renal failure is a frequent complication during treatment with TDF although severe renal impairment is scarce. Risk factors include age, duration of treatment with TDF, elevated baseline creatinine levels, and treatment with protease inhibitor boosted with ritonavir combinations.

BackgroundPharmacist review of drug prescriptions in the intensive care unit (ICU) has been shown to prevent errors and improve patient outcomes. However, it is necessary to evaluate the efficacy of interventions performed by pharmacists.PurposeTo classify and measure the type of interventions performed by pharmacists on ICU prescriptions and to measure the physician’s acceptance of the recommendations.Material and methodsRetrospective observational study of pharmaceutical intervention on ICU prescribing, from 1st September 2013 to 31st August 2014.All the information about interventions was obtained from the computerised physician order entry system.Drug related problems (DRPs) detected were classified as follows:Indication:DRP1: the patient was not using the medicines that he needed.DRP2: the patient was using medicines that he did not need.Effectiveness:DRP3: the patient was using an erroneous medicine.DRP4: the patient was using a lower dose and/or a different dose schedule than required and/or did not continue treatment for the full course indicated.Safety:DRP5: the patient was using a higher dose or a different dose schedule than required and/or exceeding the full course of treatment indicated.DRP6: the patient was using a medicine that causes an adverse drug reaction.Overall percentage of interventions accepted and the percentage of interventions accepted in each subgroup were calculated.ResultsDuring the study, 105 interventions were recorded, of which 62 (59.1%) were accepted.Types of DRP were: DRP1 8 (7.6%); DRP2 17 (16.2%); DRP3 3 (2.9%); DRP4 19 (18.1%); DRP5 32 (30.5%); DRP6 26 (24.8%).Acceptance rates in each subgroup were: DRP1 5 (62.5%); DRP2 13 (76.5%); DRP3 1 (33.3%); DRP4 10 (52.6%); DRP5 20 (62.5%); DRP6 13 (50.0%).ConclusionThe most common types of pharmacist interventions over ICU prescriptions were in connexion with DRP5 and DRP6.However, the best rates of acceptance by physicians were achieved by interventions regarding with DRP1, DRP2 and DRP5.ReferenceHasan SS, et al. Impact of pharmacists’ intervention on identification and management of drug-drug interactions in an intensive care setting. Singapore Med J 2012;53(8):526–31No conflict of interest.

No abstract

Background Tyrosine Kinase Inhibitors (TKI) are the standard treatment for Philadelphia chromosome positive chronic myeloid leukaemia (Ph + CML). Imatinib is also indicated for Kit- (CD117) positive metastatic malignant gastrointestinal stromal tumours. The high rates of survival obtained in recent years have turned these diseases into chronic conditions. Thus, adherence to treatment is hugely important. Many studies have shown that low adherence to treatment with imatinib (<85–90%) is related to a loss of cytogenetic response in Ph + CML. There is less evidence about adherence to the second line drugs dasatinib and nilotinib. Purpose To determine the degree of adherence to treatment with all TKI. Materials and methods One year prospective/retrospective study. All patients on treatment with TKI for at least a month coming to the Pharmacy to collect the medicine were included. The study was approved by a research ethics committee and all patients were required to give written informed consent. Adherence was assessed through two indirect methods: Structured interview: adherence was evaluated in a standardised way using the Morisky Medication Adherence Scale. Dispensing records: Patients taking less than 90% of the prescribed dose were considered non-adherent. Results Nineteen patients were prescribed these drugs and 15 agreed to enter the study (8 imatinib, 6 dasatinib and 1 nilotinib). Mean duration of treatment was 1,191 days. Mean Morisky score was 11.86 and only three patients were classified as non-adherent. According to the dispensing records, adherence was 96.82 (85.08–100%) and only one patient was non-adherent (85.08%). Only one patient showed non adherence with both methods. Conclusions Patients showed a high level of adherence similar to what has been reported with imatinib. High adherence was also seen with new TKI. This study allowed us to identify patients with suboptimal adherence and attempt to educate them. No conflict of interest.