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.
Background In patients with infection related to catheter (IRC) is needed to consider several aspects that will lead both the managing and treatment of them. When the retention of the catheter is advisable it is necessary to apply technologies of sealed antibiotic. With that aim, the mixture daptomicine/heparine prepared in ringer lactate solution has been proposed to be used. Purpose The purpose of this research has been to study the mixture daptomicine/heparine sodium prepared in ringer lactate solution since no information upon its chemical and physical compatibility has been found in the consulted bibliography. A high performance liquid chromatography method (HPLC) has been developed following the International Conference on Harmonisation guidelines (ICHs) for this purpose. Materials and methods The chromatographic separation was performed in a C-18 column. Due to the complexity of the mixture, it was necessary to apply a gradient in the mobile phase to achieve complete separation of the compounds, also to get separation from the degradation products of daptomicine. The started mobile phase composition was water /acetonitrile containing 0.1% of trifluoroacetic (60%:40%). The entire compounds were separated in 10 min. The detection was performed using a Diode Array Detector. Results The linearity, accuracy, reproducibility, robustness and specificity of this HPLC method have been validated following the ICH guidelines. In fact, the HPLC method considered the degradation products that were detected when the mixture was submitted to accelerated stress conditions. The method was optimised to ensure that degradation products will not interference in the determination of daptomicine/heparine when analysing the mixture. Recoveries higher than 90.0% of the initial concentration were found when analysing the mixture daptomicine/heparine in ringer sodium lactate in preloaded syringes in a long term stability study (15 days). Conclusions The method here propose has been validated following the ICH guidelines to be used as indicating-stability one. Thus, it has been used in the stability study of the mixture daptomicine/heparine in ringer sodium lactate in preloaded syringes since no information has been previously published about its chemical and physical compatibility. This study has demonstrated the stability of the mixture during the time tested (15 days).
BackgroundHormone treatment based on analogues of gonadotropin releasing hormone (GnRH) with antiandrogens is the first-line treatment for prostate cancer. This treatment produces a PSA reduction, improvement of symptoms and tumour regression. When PSA increases again it is considered to have developed resistance and other treatment lines such as abiraterone are used.Abiraterone is an androgen synthesis inhibitor in the testes, adrenals and prostate tumour tissue.PurposeTo analyse the response to, and safety of, abiraterone in the population of a tertiary level hospital.Material and methodsA retrospective observational study was carried out including all patients who started on abiraterone from 2011 to present. Demographical, diagnostic, therapeutic and clinical variables were gathered.The response was assessed by a 50% PSA reduction or more as compared to baseline values. To assess the safety, abiraterone-related adverse events were recorded.Outpatient dispensing application Farmatools and electronic medical records were used for patient identification and data collection.Results18 patients were included, 89% diagnosed with metastatic prostate cancer. 50% had poor tumour differentiation with high aggressiveness (Gleason 7–10).As a first-line of treatment, 83% received GnRH analogues plus an antiandrogen, 11% GnRH analogues alone and 6% ketoconazole. No patients orchiectomized. As a second-line treatment, 28% received docetaxel, 44% estramustine, 22% abiraterone and 6% ketoconazole. Abiraterone was started as third-line or later treatment and after tumour progression, except in 3 patients who received it as second-line treatment.44% were considered responders and 56% non-responders because of an increase or non-reduction of PSA.The median duration of treatment was 5 months (1–25). In all cases, the reason for suspension was disease progression.17% had fatigue as the only adverse effect.ConclusionAbiraterone is a well-tolerated drug that has shown low activity in previously-treated prostate cancer patients who had responded poorly to ketoconazole, docetaxel and estramustine.Best responding patients were those who received only GnRH analogues as pre-treatment.References and/or AcknowledgementsNo conflict of interest.
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