ObjectiveParenterally fed preterm newborn infants require large amounts of calcium and phosphate in a low volume of solution. The lower the volume of solution, the higher is the possibility of precipitation of calcium hydrogen phosphate (CaHPO4). Precipitation could cause respiratory distress and pulmonary embolism, and the use of organic salts of calcium and phosphorus may reduce the likelihood of this problem. To date, no previous work on the stability of solutions with organic salts has been published in the literature. This study aims to evaluate the visible precipitation of calcium and phosphorus in total parenteral nutrition solutions.Methods20 parenteral nutrition solutions were aseptically prepared in a laminar airflow hood in a clean room. The solutions are intended to facilitate precipitation, with the amino acid ratio below the standard concentration and other parameters also modulated to promote the precipitation of CaHPO4. The solutions contained dextrose, amino acids, calcium gluconate and fructose 1,6-bisphosphate. We did not use lipid emulsion so that we could see all precipitations.ResultsNo visible precipitation was observed during 4 weeks of observation at 25°C. The only observed event was the change in colour of the solution, which became yellow, maybe because of a Maillard reaction.ConclusionsThis study evaluated the compatibility of organic calcium and phosphorus in order to prevent the precipitation of CaHPO4 when preparing total parenteral nutrition solutions. The fact that no precipitation was observed is very significant as it indicates the compatibility of the ions, even though no instrumental analysis was performed.
BackgroundThe elderly are a high risk population, especially because they are often receiving polytherapy. The use of two or more drugs increases the risk of drug-drug interactions that can easily cause an adverse drug reaction. Pharmacokinetic interactions concern absorption, distribution, metabolism and elimination of drugs: the most common site of interaction is hepatic metabolism and the various subtypes of cytochrome P450.PurposeTo analyse the number of prescriptions containing possible pharmacokinetic interactions. The prescriptions were verified for both hepatic metabolism and P-glycoprotein (PgP, or MDR1) interactions.Material and methodsWe evaluated discharge prescriptions from the medical area (cardiology, rehabilitation, neurology and medicine) from 1 January 2014 to 30 June 2014. We used two websites to check the cytochrome P450 isozymes responsible for drug metabolism and its possible induction/inhibition. The same websites gave us information about possible interactions mediated by the PgP.ResultsWe analysed 833 discharge prescriptions, 176 of which contained theoretical drug-drug interactions (21.13%). 55.68% of these prescriptions came from the cardiology unit (98 of 176). This unit prescribed 45 times (15.05% of 299 cardiology prescriptions) clopidogrel with pantoprazole: this proton pump inhibitor reduces the concentration of the active metabolite of clopidogrel by 20% through inhibition of CYP2C19. Digoxin and warfarin are drugs with a low therapeutic index. Physicians showed good prescribing behaviour: 11.93% (21) of 176 prescriptions contained possible interactions, respectively, 14 and 7. A risky interaction occurred between warfarin and prednisone that enhanced CYP3A4 action, reducing warfarin blood levels. 29 prescriptions (3.48%) included possible interactions at the PgP level with various active principles, such as spironolactone, atorvastatin, prednisone and amiodarone. 19 (65.52%, 19 of 29) interactions concerned atorvastatin. Analysing the prescriptions of the medicine unit (20), 11 (55%) contained quinolones and glucocorticosteroids:co-administration of these two drugs may increase the risk of tendon rupture.ConclusionThis study focused on the pharmacokinetic interactions evaluable at discharge of patients. It intended to check if physicians are aware of the pharmacokinetic interactions by analysing their discharge prescriptions, and by evaluating the most common interactions.References and/or Acknowledgements No conflict of interest.
Acute myeloid leukemia with myelodysplastic changes and monosomy 7 is a rare form of pediatric leukemia associated with very poor disease-free survival. The refractoriness of the disease is due to the protection offered by the bone marrow niche, making leukemic stem cells impervious to whatever chemotherapy or myeloablative regimen is chosen. Using a mobilizing agent for haematopoietic stem cells, Plerixafor, could sensitise leukemic cells to the myeloablative therapy. This approach was not previously used in a pediatric population, and in adult populations, was used in combination with busulphan with no difference in overall survival. We describe the case of a 4-year-old boy affected by refractory acute myeloid leukemia with myelodysplastic changes and monosomy 7. The child had never achieved a remission. We proposed a combined time-scheduled scheme of therapy with plerixafor and melphalan. Combining pharmacokinetics of plerixafor with pharmacokinetics and rapid and elevated myeloablative potential of melphalan in high dosage (200 mg/m2), we succeeded in mobilizing more than 85% of stem blasts immediately before infusion of Melphalan. The count of residual blasts after 8 h from melphalan infusion was only 1.3 cells/μL. The child achieved an engraftment at day +32 with full donor chimerism. Sixteen months after haematopoietic stem cell transplantation (HSCT), he is well and in complete remission. Our case suggests that the use of plerixafor before a conditioning therapy with melphalan could induce remission in acute myeloid leukemia refractory to the usual conditioning therapy in pediatric patients. This work adds strength to the body of knowledge regarding the “personalized” conditioning regimen for high-risk leukemic patients.
administration, for example, must be the oil-in-water type. However, a good stability is required. The aim of the present study is the formulation of emulsion based on paraffin oil and to evaluate the influence of gum arabic content and mixing rate on the stability of emulsions. Material and methods Distilled water was used as a dispersant phase (75%) and paraffin oil as a dispersed phase (20%). Tween 80 and Span 80 served as mix surfactants (60/40). The formulation was performed according to the Lipophilic Balance-Hydrophilic (HLB) method. Gum arabic concentrations ranging from 2.5%-10% w/w were used. The stability of the emulsions was evaluated by centrifugation at 4000 rpm for 15 min. The creamer index (IC) was used for the interpretation of the results. The emulsions thus prepared are mixed at 4000, 8000 and16000 rpm for 10 min. Results The IC of emulsions ranged from 29%-30% with a HLB of 10.72. High levels of gum arabic (10, 7.5 and 5% (w/w)) increased the creaming, therefore the stability was decreased. After addition of 2.5% (w/w) of gum arabic, 1.6% creaming was observed. In 3% (w/w) gum arabic-containing emulsion, no creaming was observed. Microscopic images of emulsions mixed at 4000, 8000 and 16000 rpm, showed that emulsion prepared at 16000 rpm had homogeneously distributed individual small droplets with no sign of flocculation compared to the others. Conclusion The present experiment has shown that a concentration of 3% w/w gum arabic, and a mixing rate of 16000 rpm provided the optimum stability of oil-paraffin emulsion.
BackgroundWhile verifying the dosage and pharmaceutical form, the pharmacist also has to check the correct compilation of the prescription. Dispensing the first cycle of therapy at discharge, the hospital pharmacist should always verify whether the physician has correctly completed all fields of the prescription. Agenzia Italiana FArmaco (AIFA) developed a tool to simplify this process: a set of’ ‘notes’, initially conceived as an instrument for government expenditure on pharmaceuticals that is now a means of ensuring the pertinent use of drugs.PurposeTo evaluate both the characteristics of the population to whom the prescription is addressed and the respective prescription, paying attention to errors/gap in AIFA notes. We also evaluated the number of prescriptions containing drugs out of the hospital formulary (FN) and drugs not reimbursed by the National Health Service (C drugs).Material and methodsThis retrospective study was performed to evaluate discharge prescriptions from 1 January 2014 to 30 June 2014 to obtain data about the patient (sex, age) and the use of AIFA note methodology. The evaluated units were cardiology, rehabilitation, neurology and medicine.ResultsOur pharmacists dispensed about 90 active principles and the drugs distributed most frequently were enoxaparine (15%), pantoprazole (11%) and ramipril (7%). We analysed 833 prescriptions, 471 for men and 362 for women. The average age obtained from the prescription was 72.50 years (70.65 for men, 74.35 for women). 349 prescriptions (41.90%) contained active ingredients that do not need AIFA notes and 373 contained the right notes. The prescriptions with incorrect or incomplete notes were 110, respectively, 11.64% (97) and 1.56% (13). The most frequently incorrect notes concerned proton pump inhibitors (note 1 and 48, 53.61%) and cholesterol lowering drugs (note 13, 11.34%). 130 prescriptions contained FN drugs (15.61%), of which 53 (40.77%) were C drugs.ConclusionThis analysis shows how physicians’ prescribing could be improved; 13.20% of prescriptions had wrong or incomplete notes. The study also underlines an increase in the number of prescriptions containing C drugs, highlighting the need for better information about the formulary to physicians.References and/or AcknowledgementsLegge 16 November 2001, p. 405 No conflict of interest.
We report the first two paediatric cases of sofosbuvir treatment during high-intensity myeloablative conditioning and engraftment phases of haematopoietic stem cell transplantation. These reports highlight the safety of sofosbuvir during all phases of transplantation and the lack of interaction between sofosbuvir and alkylating or immunosuppressive agents.
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