Background The use of intracameral cefuroxime is becoming more widely accepted for endophthalmitis prophylaxis (EP) after cataract surgery. Recently, the European Medicines Agency approved a single, sterile, unit dose of intracameral cefuroxime in a few countries of Europe. Purpose To evaluate the cost saving resulting from the implementation of an optimisation protocol for the preparation of ready-to-use (RTU) intracameral cefuroxime syringes from 1500 mg vials of cefuroxime. Materials and methods A review of the literature was conducted when we planned to change the protocol. To evaluate the cost savings, the cost generated by the use of cefuroxime 1500 mg vials in the preparation of RTU syringes since the implementation of the protocol was compared to the costs if the marketed unit dose of intracameral cefuroxime had been used. Results A total of 200 RTU syringes are prepared from a single vial of cefuroxime 1500 mg in each batch at the Pharmacy. 40 syringes are sent weekly to the OR, the rest are stored frozen in Pharmacy (stability three months). Between January and July 2013 five vials of cefuroxime 1500 mg were used to prepare 1000 RTU cefuroxime syringes, with a cost of 14.56 € (PVP: 145.6 €/50 vials). If we had used the marketed unit dose, for the same treatment the cost would have been 12164 € (PVP: 121.64 €/10 vials); meaning a 99.8% reduction in costs. Conclusions The implementation of the optimisation protocol for the preparation of RTU intracameral cefuroxime syringes has led to a significant cost saving without compromising patient health. No conflict of interest.
Background Potentially inappropriate medicines (PIM) use in older adults has been associated with increased medicines-related problems and morbidity. Investigating the prevalence of this problem is important for the initiation of intervention programmes in order to prevent its occurrence. Purpose To estimate the prevalence of PIM use in older adults and determine the drugs involved. Materials and methods Prospective study carried out in a third level hospital over 8 months (from January to August 2013). All patients older than 65 years were included who were taking ≥5 medicines and were admitted to the hospital’s internal medicine service. Each patient’s home medicines profile was revised after admission. The frequency of PIM use was analysed according to the Beers criteria 2012. The criteria reviewed covered 2 types of statements: medicines that should generally be avoided in persons 65 years or older and medicines that should not be used in older persons known to have specific medical conditions (drug-disease interaction). Results A total of 216 patients were evaluated in this study. The average age was 78.8 ± 8.8. A total of 193 PIM were detected in 79(36.6%) patients. Frequency of PIM was: long acting benzodiazepines 35(16.2%), digoxin > 0.125 mg/d 38(17.6%), amiodarone 4(1.8%), amitriptyline 6(2.7%), first-generation antihistamines 12(5.5%), doxazosin 11(5.1%), nifedipine immediate release 2(0.9%), aspirin > 325 mg/d 2(0.9%), non–COX-selective NSAIDs 16(7.4%). Frequency of drug-disease interaction was: heart failure-diltiazem 12(5.5%), dementia and cognitive impairment-benzodiazepines 28(13.0%), Parkinson’s disease- metoclopramide 5(2.3%), history of gastric or duodenal ulcers- NSAIDs 8(3.7%), serotonin-norepinephrine reuptake inhibitors-hyponatraemia 4(1.8%), stress or mixed urinary incontinence-doxazosin 10(4.6%). Conclusions The results of this study showed a high prevalence of PIM use in older adults. Inappropriate chronic use of potentially unsafe medicines must be a key issue in medical and pharmaceutical care. Interventions for decreasing drug-related problems should be planned in order to minimise drug-related costs. No conflict of interest.
BackgroundSome of the most common adverse effects of protease inhibitors in treatment of HIV are dislypidaemia, diabetes and other metabolic disorders. These adverse effects should be recognised by health professionals so that they can perform an intervention to minimise the cardiovascular risk of the patient.PurposeTo analyse the impact of the metabolic adverse effects in HIV patients on darunavir/cobicistat monotherapy treatment.Material and methodsThis work is a descriptive observational study which took place in the outpatient consultation of a Hospital Pharmacy in a third-level hospital. We made a search of clinical variables as well as results of analytical tests. The variables included in this study were age, smoking habit, systolic blood pressure, presence of antihypertensive treatment, presence of diabetes mellitus, and HDL and total cholesterol serum concentrations at the beginning of treatment and at 6 and 12 months after. With these data, we calculated the Framingham Risk Score (FRS) at these months and we performed a statistical analysis.ResultsPatients (n=30) had a mean age of 50.2±11.6 years and 66.6% were males. They were all on treatment with a daily tablet of darunavir/cobicistat (800 mg/150 mg) as a single drug for HIV treatment. The median of FRS at the beginning of the treatment was 9.3 (3.9–22.7). At month 6 of treatment the median of FRS was 8.9 (4.2–20.8) and after 12 months was 8.9 (3.4–21.7). None of the patients had an increase of more than 4 points. A small group of patients (n=7) from this sample, who had an initial FRS over 25 were separately studied. Their mean FRS were 38.2 (28.4–39.4) at the beginning, 32.1 (28.9–36.4) at month 6 and 30.5 (25.2–37) at month 12. Five of these seven patients had a decrease in FRS of more than 4 points. Only one of them had an increase (2 points).ConclusionBased on these findings, we can affirm that there was no increase in the cardiovascular risk of the patients on treatment with darunavir/cobicistat, but there was also an improvement. Even patients at greater risk reduced their Framingham Risk Score. We want to show the importance of knowing the drugs deeply to prevent their adverse effects.No conflict of interest
Background Calciphylaxis (calcific uremic arteriolopathy) is the ischemic ulceration of the skin caused by the disseminated calcification of the subcutaneous tissue and small arteries as a consequence of hyperparathyroidism in uremic patients. Purpose To describe the method of preparation and checking of an injectable solution of 25% sodium thiosulfate for the treatment of intradialytic calciphylaxis in renal patients. Materials and MethodsSodium thiosulfate is an antioxidant, vasodilator and calcium chelator. The preparation process for the solution of 25% sodium thiosulfate is: Ingredients: Sodium thiosulfate pentahydrate: 25 g, water for injection (WFI): qs 100 ml. Preparation: Weigh the amount of sodium thiosulfate in a sterile beaker. Then, working in a horizontal laminar flow hood, boil WFI to eliminate CO2. Dissolve the thiosulfate in about 80 ml of boiled water. Check that the pH of the solution is between 6 and 9.5, if it is not, adjust with HCl or NaOH. Flush into a 100 ml volumetric flask and make up to volume. Filter with a double 0.22 micron philtre. Finally pack with 50 ml syringe into a sterile glass bottle and label. Results The result is a solution of 100 ml of 25% sodium thiosulfate, transparent, sterile and stable for 30 days in refrigerator. For QC a visual particulate sterility cheque is performed by sowing in aerobic and anaerobic cultures and a bubble point test to verify the integrity of the philtres. Conclusions Proper preparation and checking of the 25% solution of sodium thiosulfate has guaranteed its parenteral administration is safe. The treatment is effective and well tolerated, helping patients and improving their quality of life. No conflict of interest.
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 An estimate of the risk of suffering a cardiovascular event guides the development of preventive strategies and treatment optimization. In HIV and co-infected HIV/HCV patients the state of chronic inflammation, altered endothelial function, a higher prevalence of smoking and antiretroviral treatment toxicity tend to increase the risk compared to the non-infected population. Purpose To estimate the cardiovascular risk of HIV infected patients, HCV/HIV patients, and those treated with lopinavir/ritonavir or abacavir in a hospital. To describe the population and their main risk factors. Materials and Methods This was a 6-month retrospective and observational study. Demographic and clinical data, such as lipid profile, immunological state or current treatments, were collected. Three different tools were used to estimate the 10-year cardiovascular risk: Framingham, SCORE and Regicor, in order to minimise the possible under-estimation for the infected Spanish population. Results 56 patients matched the inclusion criteria. The average age was 48 (78.6% men). All patients had a good immunological state. The first modifiable risk factor was smoking (66.1%) dyslipidaemia the second (50%) and hypertension the third (37.5%). The co-infected population presented the main risk factors in higher percentages than the mono-infected group (81.3% smoked and 90% had dyslipidaemia). The number of patients identified as having a high cardiovascular risk with the estimation methods used was low. Framingham was the tool that classified more patients into this group (18.5% versus 12.73% SCORE and 1.85% Regicor). Conclusions The results of this study, which accorded with previous publications, show the high prevalence of cardiovascular risk factors in this population, especially smoking and dyslipidaemia, showing the importance of identifying high-risk patients in order to prevent cardiovascular events. It also evidences the lack of a specific way of identifying these patients, which would help direct preventative efforts. No conflict of interest.
BackgroundIn different clinical studies, the use of botulinum toxin has shown a reduction in health spending, reducing the number of drugs used for patients and decreasing the number of doctor visits and the frequency of episodes.PurposeTo analyse the demographic characteristics of the population diagnosed with chronic migraine and treated with botulinum toxin, to make a database for a future study.Material and methodsThis was a retrospective observational study. The neurology department reported on all patients who had been administered botulinum toxin for chronic migraine. We created a database, where the mid-point was the first administration of toxin; we registered data 1 year before and 1 year after the first administration of toxin. The variables studied were patient age, sex, obesity, toxic habits, hypertension, primary physician visits, specialist visits, emergency visits and frequency of migraine attacks.Results26 patients were included in the study. Mean age of the patients was 49 years, 3 men and 23 women. 2 patients were obese, 2 had toxic habits and 7 patients had hypertension. In the year previous to the first administration, average family doctor visits was 1.69, average visits to the neurologist was 2.46 with 1.15 emergency visits for migraine headaches. The average number of drugs prescribed per patient was 10, 3 from the family of triptans. The average expenditure on healthcare was €386 and on medicines was €602. The frequency of migraine episodes that year was daily.ConclusionThe demographic characteristics of the patients in our study were similar to other published studies: 88% were women compared with 12% of men. With reference to the risk factors studied, 7% were obese, 7% had toxic habits and 26% had high blood pressure. Once the results from the previous year are analysed, we will use the same protocol for the year after the first administration of toxin, with the goal of comparing the data and checking the reduction in expenditure that botulinum toxin has shown in published studies.References and/or acknowledgementsLainez-Andres JM. Onabotulinumtoxin en el tratamiento de la migrana crónica. Rev Neurol2012;54(Suppl 2): S39–50.Patricia Pozo-Rosic.Migraña crónica: Epidemiología e Impacto. Rev Neurol 2012;54(Suppl 2):S3–11.No conflict of interest
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