Purpose. Pharmacist interventions to enhance blood pressure (BP) control and adherence to antihypertensive therapy in adults with essential hypertension were reviewed. Methods. A literature search was conducted to identify relevant articles describing pharmacist interventions intended to improve adherence to antihypertensive medications. Studies were included if they described a pharmacist intervention to improve medication adherence and analyzed adherence to therapy and BP control as outcomes. A fixed-effects model was used to combine data from randomized controlled trials. Results. A total of 15 studies were identified, testing 16 different interventions and containing data on 3280 enrolled patients. Although 87.5% of the interventions resulted in significant improvements in treatment outcomes, only 43.8% of the interventions were associated with significant increases in medication adherence. All interventions that increased antihypertensive medication adherence also significantly reduced BP. Almost all the interventions that were effective in increasing adherence to medication were complex, including combinations of different strategies. Metaanalysis of 2619 patients in 8 studies found that pharmacist interventions significantly reduced systolic blood pressure (SBP) (p < 0.001) and diastolic blood pressure (DBP) (p = 0.002) and that the meta-analytic differences in SBP and DBP changes from baseline to endpoint in intervention and control groups were -4.9 ± 0.9 mm Hg (p < 0.001) and -2.6 ± 0.9 mm Hg (p < 0.001), respectively. Conclusion. A literature review and metaanalysis showed that pharmacist interventions can significantly improve medication adherence, SBP, DBP, and BP control in patients with essential hypertension. Interventions were complex and multifaceted and included medication management in all analyzed studies.

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By increasing the activity of the immune system, immune checkpoint inhibitors (ICPI) can have adverse inflammatory effects, which are referred to as immune-related adverse effects (irAEs). In this review, we present the recommendations for the appropriate identification and treatment of irAEs associated with ICPI to increase the safety and effectiveness of therapy with these immuno-oncological drugs. Several guidelines to manage irAEs adopted by different American and European societies in the field of oncology were identified. A narrative review of the several strategies adopted to manage irAEs was performed. With close clinical surveillance, ICPI can be used even in patients who have mild irAEs. Moderate to severe events require early detection and appropriate treatment, particularly in patients with a history of transplantation or pre-existing autoimmune disease. In most cases, adverse reactions can be treated with the interruption of treatment and/or supportive therapy, which includes, in serious adverse reactions, the administration of immunosuppressants. The identification and treatment of irAEs in the early stages may allow patients to resume therapy with ICPI. This review is an instrument to support healthcare professionals involved in the treatment and monitoring of patients who are administered ICPI, contributing to the timely identification and management of irAEs.

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Background Extravasation of non-cytotoxic intravenous drugs (NCID) is a complication of intravenous administration through central and peripheral venous catheters. Although rare, it can result in serious consequences, both physical and psychological; it may impair the quality of life and patient survival as well as prolonging hospitalisation and increasing costs. The hospital pharmacist should contribute to the prevention and resolution of adverse effects associated with extravasation of NCID. Purpose To undertake a survey of NCID available in Portugal and analyse four key elements related to extravasation: prevention, recognition, management and documentation. Materials and methods A literature review was performed, researching guidelines related to extravasation of NCID and articles obtained from PubMed from 2003 to September 2013, intersecting the terms ‘drug extravasation’ and ‘extravasation treatment’. The summaries of product characteristics of all of intravenous cytotoxics available in Portugal were also reviewed. Some holders of market authorisation were also contacted whenever additional information was considered necessary. Results A total of 32 NCID available in Portugal were identified, some of them widely used in hospitals (e.g., calcium gluconate 10%, potassium chloride 7.45%, epinephrine, dopamine, phenytoin, cefotaxime and vancomycin). The lack of information and documentation about extravasation of NCID are barriers for the proper extravasation management, which requires detailed information about the drug’s properties, what measures need to be taken if it occurs and which antidotes should be administered (e.g., hyaluronidase, phentolamine, topical nitroglycerin, terbutaline). Most of the available information refers to cytotoxic drugs. The procedures to decrease morbidity resulting from extravasation of NCID are not clearly defined and they are not applied uniformly. However, whenever extravasation occurs or it is suspected, administration of NCID should be stopped immediately and the proper non-pharmacologic and pharmacologic measures must be taken speedily. We also designed an extravasation kit and a model document for the appropriate recording of extravasation and clinical monitoring of the patient. Conclusions The lack of standardised information about the procedures to be undertaken if NCID extravasation occurs, justifies the need to develop a manual which includes guidelines for what to do and which antidote to use. A kit should also be assembled to use in these situations. No conflict of interest.

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BackgroundA potential complication of chemotherapy is vesicant cytotoxic extravasation, such as anthracyclines, which may affect the quality of life of patients. Therefore, fast acting and active treatment is essential.PurposeThe aim of this study was to develop an algorithm for management of anthracycline extravasation, which contains management measures, antidote and treatments that should be supplied.Material and methodsA literature review was performed, by research and analysis of guidelines and articles obtained from PubMed from January 2000 to September/2015, using the terms ‘cytotoxic extravasation’ and ‘extravasation treatment’.ResultsThe first action is to stop anthracycline infusion immediately, not remove the cannula, disconnect the infusion, and with a new syringe aspirate as much of the infusate as possible. The medical staff on service are then notified and the extravasated drug is identified. Thereafter, the extravasation area is marked and photographed and the cannula is removed. Ice packs, to promote local cooling of the extravasation site, should be applied to the affected area for 20 min with minimal pressure. Pharmacological measures involve intravenous infusion of dexrazoxane, for 1–2 h, into a large vein of an area other than the one affected by the extravasation. Cooling procedures should have been removed from the area at least 15 min before dexrazoxane administration in order to allow sufficient blood flow. Treatment should be given once daily for 3 consecutive days. The first infusion should be initiated as soon as possible, within the first 6 h after the accident. Treatment day 2 and day 3 should start at the same time (±3 h) as day 1. Analgesia should be provided if required. The follow-up and long term management is central. According to the clinical trials and case studies available, correct administration of dexrazoxane prevented skin necrosis and ulceration in up to 98% of patients.ConclusionThe development of algorithms for management of chemotherapy extravasation, which allow a quick and effective intervention, is essential. The developed algorithm is a valuable tool for all hospital services that prepare and administer anthracyclines, contributing to a quick and effective response to episodes of extravasation.References and/or AcknowledgementsInt J Clin Pract 2013;67:244–9No conflict of interest.

Background Consultation about travel abroad addresses preventive attitudes before, during and after the trip, which may include immunisations, the prescription of prophylactic medicines and advice on food safety. Advice to travellers is determined by the destination and characteristics of the trip, as well as by the profile and health status of the person who wishes to travel abroad. At the initial consultation about travel abroad recommendations may be made and a travel medicine kit may be prescribed in accordance with the individual needs of the traveller. Purpose To design travel medicine kits including over-the-counter and ethical drugs prescribed during a consultation about travel abroad. Materials and methods A literature review was performed by searching for scientific articles in the PubMed electronic database, intersecting the terms “travellers’ health” and “travelling internationally.” National and international tropical medicine official websites were also consulted. Results Analysis of the collected data originated 21 different ethical kits according to destination and immunisation status of the traveller. All kits included leaflets with necessary recommendations/preventive measures, bandages, gauze, adhesive bandages, an antiseptic, an antidiarrhoeal, an analgesic and antipyretic, an antihistamine, a sunscreen with UVA and UVB protection as well as an insect repellent. In addition to those products which were common to all the kits, some ethical medicines and leaflets were specific to certain kits. Conclusions The pre-manufactured ethical kits will facilitate better support for those people who travel abroad and will allow for standardisation of information to the user. We believe that this information will prove useful, helping to provide quick and effective solutions to health issues related to travel abroad. No conflict of interest.