Revista Brasileira de Farmácia Hospitalar e Serviços de Saúde

3D printing of medicines: benefits of personalization, regulatory challenges, and perspectives for healthcare optimization

2024-06-04T10:32:38-03:00

Analysis of the activities of the clinical pharmacy service in the use of vancomycin in a public hospital in Belo Horizonte

2024-05-07T13:15:54-03:00

Objective: To characterize the population in vancomycin use, and analyze the parameters of indication, effectiveness and safety used by clinical pharmacists in the drug utilization review. Method: This is a cross-sectional study with retrospective collection of medical records of patients who used intravenous vancomycin from March 2022 to March 2023. The results of therapeutic monitoring of vancomycin and pharmaceutical interventions related to this antibacterial were evaluated. Results: The study included 919 patients with 1026 hospital admissions. The mean age of the population was 56.8±17.9 years and 50.9% were older than 60 years. In the period evaluated, 9379 vancomycin prescriptions were identified. The most prevalent reason for vancomycin prescription was “others: cite in observation” (15.1%), followed by “respiratory infection - nosocomial pneumonia” (14.8%). The care line responsible for most of the vancomycin prescriptions (42.9%) were the intensive care. Only 23.5% of the serum vancomycin trough concentrations results were in the range considered ideal, i.e. 15-20mg/L. Among the results that were outside the reference range, 38.2% were supratherapeutic (≥20.1mg/L) and 18.7% were subtherapeutic (≤9.9mg/L). In the drug utilization review led by pharmacists, 190 interventions were performed with the medical team. The therapeutic monitoring of vancomycin was the most prevalent intervention (44.7%) of which 87.1% were accepted. Conclusion: The study showed a high rate of serum vancomycin trough concentrations results outside the therapeutic range (76.5%) indicating the need to strengthen the institutional protocol and clinical staff training. The clinical pharmacist had an important role in identifying this risk by performing drug utilization review and therapeutic monitoring of vancomycin.

Neutrophil/lymphocyte and platelet/lymphocyte ratio and outcome after first chemotherapy of patients with breast cancer in a city of Minas Gerais

2024-05-05T20:08:50-03:00

Aim. To evaluate the factors associated with the pre and post-first chemotherapy inflammatory response in cancer patients, by determining the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) in the breast cancer population in Barbacena, and to verify their contribution to the observed outcome. Methods. Retrospective study, including 152 breast cancer patients in a reference hospital in Barbacena, MG, between 2016 and 2021. The results of complete peripheral blood counts before any therapeutic procedure (baseline blood count - surgery, radiotherapy, or chemotherapy) were collected, as well as follow-up exams. Additionally, data regarding the outcome of the first treatment and/or date of disease progression or death were also collected. The NLR was obtained by the ratio of the absolute neutrophil count to the absolute lymphocyte count. The PLR was calculated by dividing the absolute number of platelets by the absolute number of lymphocytes. The median NLR and PLR were calculated, and the data were processed using JASP statistical software v. 16.4.0. Results. It was observed that both alterations in NLR and PLR were predictors of outcome, with patients showing higher NLR (p = 0.034) and PLR (p = 0.043) in the post-first cycle of treatment blood count for disease progression or death. The effect size for both relationships was 0.218. Conclusion. NLR and PLR are useful as predictors of post-first treatment outcome in breast cancer patients.

Pharmacovigilance Program impact on notifications of adverse reactions to antineoplastic drug in a university hospital

2024-03-25T19:43:33-03:00

Objective: To evaluate the Pharmacovigilance Program impact on notifications of adverse reactions to antineoplastic drugs (ADR) in a university hospital. Methods: Cross-sectional, descriptive and retrospective study, carried out by surveying spontaneous notifications of suspected antineoplastic ADR arising from hospitalization and chemotherapy outpatient clinics and sent to the Pharmacovigilance Program of the Clinical Pharmacy section, of the Pharmacy Service of a university hospital in Porto Alegre. This work was approved by the Research Ethics Committee of that institution under number 2019-0408. Results: In 2020, the Pharmacovigilance Program received 71 notifications involving antineoplastic ADR, representing 59.7% of the total notifications received. In 2021, ADR notifications involving antineoplastics represented 47% (n=49) of notifications received. In 2022, the notifications received had an even greater reduction, with 24, representing 37% of the total notifications received in the year. In the year 2023, however, it was possible to observe an increase both in the number of spontaneous reports suspected of total ADR (n=95), as well as in the number of antineoplastics (n=45) and, consequently, in the percentage of spontaneous reports suspected of ADRs. antineoplastic ADR (47%). Conclusion: The notifications monitoring involving antineoplastics by Pharmacovigilance demonstrated the need to formulate a strategy to return to the notifier with educational objectives in conjunction with professionals from the chemotherapy outpatient clinic and the care area involved in the notifications.

Administration of liquid medications for oral use in babies: development and validation of educational material for caregivers

2024-06-04T12:09:03-03:00

Objective: To develop an educational material with guidelines for caregivers on the administration of oral liquid medications in infants. Methods: the study comprised three stages: (i) development of the educational material based on a literature review, (ii) evaluation by a committee of eight specialists, and (iii) subsequent evaluation by the target population. The validation of the material was based on a minimum Content Validity Index (CVI) of 0.80 and an agreement rate of 75% among participants. Results: the educational material, titled “Administering Liquid Medications to Infants: A Guide for Caregivers and Guardians,” was completed with 32 pages, featuring logical organization, simple language, examples, and images. After evaluation by the committee of specialists, the material achieved a CVI of 0.98 and incorporated seven suggestions. The evaluation by the target population resulted in an agreement rate of 97.5%, with all suggestions being considered. Conclusions: the educational material was validated, standing out for its alignment with objectives, cohesive structure, and relevance. This safe and informative tool can benefit both caregivers and healthcare professionals, being essential to prevent errors in the administration of liquid medications in infants, thereby reducing the risks of intoxication and other health impacts.

Characterization and evaluation of dermatological immune-mediated reactions associated with checkpoint inhibitors: an observational, longitudinal and retrospective study in an oncology service in Salvador/BA

2024-05-07T11:07:51-03:00

Objective: To evaluate dermatological immune-mediated reactions in patients treated with checkpoint inhibitors at an oncology center in Salvador-BA. Method: An observational, longitudinal, retrospective, descriptive, and uncontrolled study was carried out in patients undergoing treatment with checkpoint inhibitors, during the period from Jan/2021 to Dec/2021. After applying the exclusion criteria, the study’s sample size resulted in 69 patients. Electronic spreadsheets from the Excel tool (Microsoft®) were used for data processing and statistical analysis. The identification and measurement of the severity of toxicities followed the Common Toxicity Criteria, as defined by the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. Results: The investigation found 84 immunemediated dermatological reactions occurring in 44 patients (63.77%), with the most frequent being dry skin (37%), maculopapular rash (26%), and itching (20%).The regimen with the highest incidence of reactions was the one that included pembrolizumab, with 47 occurrences. The severity of dermatological immune-mediated toxicities ranged from grade 1 to grade 2, indicating a good safety profile for these medications. Key management strategies included the use of emollients, increased fluid intake, and administration of antihistamines and corticosteroids. Conclusion: The findings of this study are aligned with the evidence from the clinical literature and highlight the importance of in-depth understanding of factors related to immunotherapy toxicity, in order to detect these reactions prematurely, optimizing management and preventing more serious complications.

Analysis of the effectiveness of different schemes of supportive therapy in the prophylaxis of cisplatin-induced nephrotoxicity

2024-04-19T07:50:20-03:00

Objective: To evaluate, in the scenario of rapid infusion, the effectiveness of the different regimens of supportive therapy employed in the prevention of nephrotoxicity and electrolyte depletion induced by cisplatin (CDDP). Methods: Data from patients who used CDDP weekly (30 to 40mg/m2) with an infusion time of 60-120 minutes were analyzed. The regimens evaluated were: saline solution (A), saline solution and mannitol (B), saline solution and magnesium (C) and saline solution with mannitol and magnesium (D). The following laboratory parameters were evaluated: creatinine (Cr), magnesium (Mg) sodium (Na) and potassium (K), and glomerular filtration rate (GFR). They were subsequently compiled in Microsoft Office Excel® and analyzed in Software R, using with analysis by means of descriptive statistics, developed in accordance with the recommendations of Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement. Results: The study population evaluated were 46 patients, who received 218 infusions of CDDP. It was observed that schemes A and B had a progressive decrease in Mg. Scheme B had decreased levels of K, Cr and increased Na. In the individual analysis of each cycle, the different schemes of supportive therapy in rapid infusion were equally effective in preventing nephrotoxicity and electrolyte depletion. The schemes used were evaluated for throughout CDDP administrations, the regimen C and D demonstrated efficacy in maintaining renal function throughout multiple administration of CDDP. Conclusion: In the analysis of cumulative doses, regimen C proved to be effective in preserving renal function throughout CDDP administrations. In the individual analysis of each cycle, regardless of the number of times CDDP was administered, protocols C and D, which contained Mg supplementation associated or not with mannitol, were equally effective in preventing nephrotoxicity.

Pharmaceutical guidance and the impact on medication adherence in patients with amyloidosis

2024-02-28T15:23:01-03:00

Objectives: To identify medication adherence in patients with Cardiac Amyloidosis (CA) before and after pharmaceutical guidance and investigate its association with quality of life. Methods: This is a before-and-after, single-arm, non-randomized study. The selection was among patients with transthyretin (TTR) cardiac amyloidosis included in research protocols of the Instituto do Coração do Complexo do Hospital das Clínicas da Universidade de São Paulo (InCor HCFMUSP). Five pharmaceutical visits were performed, the first in person and the others by telehealth. The Kansas City Cardiomyopathy Questionnaire (KCCQ) and Brief Medication Questionnaire (BMQ) quality of life questionnaires were used. Medication adherence was identified and classified into four categories: adherent, probable adherent, probable low adherent, and low adherent. To estimate the association between medication adherence and quality of life, analysis was performed using ANOVA and unpaired t-test. Results: 11 participants agreed to participate in all study visits. Mean age was 74.2 years (SD= 8.4), 95.2% were male, and 47.6% had completed college education. The mean number of medications in use was 8 (dp= 2.9). 54.5% of participants were classified as adherent. The association between medication adherence and quality of life was significant for the Total Symptom Score and Clinical Summary domains. There was no significance in the correlations between the number of medications and KCCQ. Conclusions: Pharmacotherapy follow-up mediated by telehealth for patients with Cardiac Amyloidosis can improve in at least one domain of KCCQ.