RESUMEN

Los antiinflamatorios no esteroideos son ampliamente recetados en niños. Constituyen la segunda causa de reacciones a medicamentos en pediatría después de los antibióticos betalactámicos; sin embargo, solo una parte de estas son reacciones de hipersensibilidad. La prevalencia de dichas reacciones a antiinflamatorios no esteroideos en niños es del 0,3 % y aumenta al 5 % en asmáticos.Los mecanismos fisiopatológicos involucrados (inhibición de la ciclooxigenasa, hipersensibilidad mediada por inmunoglobulina E, linfocitos T reactivos y/o afectación de la inmunidad innata) darán lugar a diferentes entidades clínicas con sintomatología dispar.La confusión con síntomas propios de procesos virales y la variabilidad clínica hacen del diagnóstico de certeza un verdadero desafío. Una historia clínica detallada, análisis de laboratorio, pruebas cutáneas y de provocación controlada permitirán definir estrategias para cada paciente en particular sin etiquetar como alérgico a un niño que no lo es ni exponer a riesgos innecesarios a quien está sensibilizado.

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Nonsteroidal anti-inflammatory drugs are widely prescribed in children. They are the second cause of drug ́s reactions in pediatrics after beta-lactam antibiotics, however only a part of them are hypersensitivity reactions. The prevalence of these reactions to nonsteroidal anti-inflammatory drugs in children is 0.3 %, increasing to 5 % in asthmatics.The different physiopathological mechanisms involved (inhibition of cyclooxygenase, immunoglobulin E-mediated hypersensitivity, reactive T lymphocytes and/or disturbance of innate immunity) will cause different clinical entities with diverse symptoms.The confusion between the common symptoms of a viral infection and a hypersensitivity reaction, and the variability of the clinical presentations make diagnosis a real challenge.A detailed clinical history, laboratory, skin and controlled provocation tests will provide strategies for each patient, without labeling a child who is not an allergic one, or taking unnecessary risks with those who are sensitized.

Asunto(s)

Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Antiinflamatorios no Esteroideos , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/tratamiento farmacológico , Pruebas Cutáneas , Reacciones Cruzadas , Hipersensibilidad a las Drogas/prevención & control

RESUMEN

OBJECTIVE: To characterize current practice patterns of urologists in the management of intravenous (IV) contrast allergy in the setting of endourologic procedures. METHODS: A survey was administered to all members of the Endourological Society to assess management of IV contrast allergy prior to ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL). Treatment regimens, reports of adverse outcomes, and demographics of respondents were also collected. Data were analyzed using chi-square tests. RESULTS: The response rate was 15% (325/2100). A total of 21% and 28% of respondents reported giving prophylaxis prior to URS and PCNL, respectively. Nearly 3% of respondents reported having observed a severe adverse reaction to intraluminal contrast in the past. Approximately half reported giving prophylaxis only 1 hour prior to the procedure. Most respondents (77%) completed a fellowship, the most common being endourology. Chi-square analysis revealed a significant difference between giving prophylaxis for URS or PCNL and the respective case volumes (for URS, X2 = 8.3, P= .004; for PCNL, X2 = 8.5, P= .003) where urologists with the lowest and highest case volumes were more likely to give prophylaxis (Fig. 1). There was no significant difference between giving prophylaxis for URS or PCNL and recency of residency, fellowship training, practice setting, or practice type. CONCLUSION: Most urologists do not give prophylaxis for patients with IV contrast allergy prior to URS and PCNL. Further studies are needed to evaluate the necessity of prophylaxis as well as to establish clear guidelines.

Asunto(s)

Medios de Contraste/efectos adversos , Hipersensibilidad a las Drogas/etiología , Hipersensibilidad a las Drogas/prevención & control , Nefrolitotomía Percutánea/métodos , Pautas de la Práctica en Medicina/tendencias , Ureteroscopía/métodos , Urología , Medios de Contraste/administración & dosificación , Encuestas de Atención de la Salud , Humanos , Inyecciones Intravenosas

RESUMEN

O diagnóstico das reações de hipersensibilidade a medicamentos é baseado na história clínica, seguida pela realização de testes in vivo, que podem ser cutâneos ou de provocação. Os testes de provocação são considerados o padrão-ouro no diagnóstico, sendo importantes tanto para a confirmação diagnóstica como para o encontro de opções terapêuticas seguras. Recentemente, assim como os testes cutâneos, as provocações com medicamentos foram aprovadas pela Câmara Técnica da Associação Médica Brasileira para uso no diagnóstico das reações a drogas. Nesta revisão, nosso foco serão as indicações, contraindicações e método dos testes de provocação com medicamentos.

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Diagnosis of hypersensitivity drug reactions is based on clinical history, followed by in vivo tests, such as skin tests and drug provocation tests. Drug provocation tests are considered the gold standard for diagnosis. They are important both for confirming diagnosis and for finding safe therapeutic options. As for skin tests, provocation tests were recently approved by the Brazilian Medical Association Technical Board to be used in hypersensitivity drug diagnosis. In this review paper, we will focus on indications, contraindications and method of drug provocation tests.

Asunto(s)

Humanos , Pruebas Cutáneas , Hipersensibilidad a las Drogas , Hipersensibilidad a las Drogas/prevención & control , Sociedades Médicas , Terapéutica , Preparaciones Farmacéuticas , Registros Médicos , Diagnóstico , Habilidades para Tomar Exámenes , Hipersensibilidad , Métodos

RESUMEN

OBJECTIVES: Patients with breast cancer who receive weekly paclitaxel therapy may experience deleterious effects associated with prophylactic dexamethasone use for 12 consecutive weeks. Approximately 90% of paclitaxel hypersensitivity reactions (HSRs) occur within the first 10 to 15 min of the first two infusions. We investigated the feasibility of dexamethasone withdrawal between weeks 3 and 12 (W3 and W12) in early stage breast cancer patients treated with weekly paclitaxel at the standard dose (80 mg/m2). METHODS: All patients received intravenous prophylaxis of dexamethasone 20 mg, ranitidine 50 mg, and diphenhydramine 50 mg in the first 2 weeks (W1 and W2) of treatment. Provided that no serious (G3/G4) HSRs events occurred, dexamethasone was omitted between W3 and W12, while ranitidine and diphenhydramine were continued. The primary end point was the incidence of any grade HSRs during the treatment period, and the secondary end points were quality of life and weight changes. RESULTS: Twenty-five patients were included in the study, and 300 infusion cycles of paclitaxel were evaluated for HSRs. The overall incidence of HSRs was 0.6% (2 events), and both of these events occurred in the first week. There were no incidents of serious HSRs or anaphylaxis and no G3 or G4 toxicities. Scores from the EORTC QLQ-C30 questionnaire did not change significantly for the global health status/quality of life scale or for the symptoms scales, although changes in scores differed significantly for the functional scales. There were no clinically relevant weight changes during the treatment period. CONCLUSIONS: Dexamethasone withdrawal from W3 to W12 in early stage breast cancer patients treated with weekly paclitaxel is feasible. The incidence of all grades of HSRs was comparable to that reported in trials with dexamethasone for 12 consecutive weeks, and no serious events (G3/G4) occurred. Studies with larger sample sizes are needed to confirm our results which are important, especially for patients for whom corticosteroids are contraindicated.

Asunto(s)

Antineoplásicos Hormonales/administración & dosificación , Antineoplásicos Fitogénicos/efectos adversos , Neoplasias de la Mama/tratamiento farmacológico , Dexametasona/administración & dosificación , Hipersensibilidad a las Drogas/prevención & control , Paclitaxel/efectos adversos , Adulto , Anciano , Antineoplásicos Fitogénicos/administración & dosificación , Difenhidramina/administración & dosificación , Esquema de Medicación , Sustitución de Medicamentos , Estudios de Factibilidad , Femenino , Humanos , Incidencia , Infusiones Intravenosas , Persona de Mediana Edad , Paclitaxel/administración & dosificación , Premedicación/métodos , Estudios Prospectivos , Calidad de Vida

RESUMEN

As reações de hipersensibilidade a medicamentos são frequentes na prática clínica e são consideradas problema de saúde pública. O diagnóstico inclui, após detalhada história clínica, a realização de testes in vivo: cutâneos ou de provocação. Recentemente, estes testes foram aprovados pela Câmara Técnica da Associação Médica Brasileira para inclusão tanto no SUS, como na Saúde Suplementar, o que facilitará o acesso dos pacientes a estas ferramentas. Nesta revisão, abordaremos com mais detalhes as indicações, técnica e impacto da utilização dos testes cutâneos com fármacos na prática clínica.

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Hypersensitivity drug reactions are frequent in clinical practice and are considered an important public health issue. Diagnosis includes a detailed clinical history, followed by in vivo tests, such as skin tests and drug provocation tests. Those tests were recently approved by the Brazilian Medical Association Technical Board to be included in both public and private practice, which will facilitate investigation with those tools. In this review paper, we will address in more detail the indications, technique, and impact of the use of skin tests to drugs in clinical practice.

Asunto(s)

Humanos , Pruebas Cutáneas , Hipersensibilidad a las Drogas , Hipersensibilidad a las Drogas/prevención & control , Sociedades Médicas , Sistema Único de Salud , Preparaciones Farmacéuticas , Registros Médicos , Diagnóstico , Habilidades para Tomar Exámenes , Hipersensibilidad , Métodos

RESUMEN

We report a 39-year-old female who underwent a total thyroidectomy as treatment for a thyroid papillary cancer. She suffered several episodes of mild angioedema in lips and tongue, after using different commercial Levothyroxine formulations, with and without excipients. Given the need to use this drug, the patient was admitted in our hospital and we proceeded to desensitize her with oral Levothyroxine. The patient fasted throughout the whole procedure, was properly monitored and had an adequate peripheral venous access. On the first day of the procedure, a 15-step protocol was performed, first administering placebo and then, compounded formulations of Levothyroxine starting from 0.01 ug, followed by doubling doses every 15 minutes until the cumulative dose of 111.95 ug was completed, corresponding to the daily dose of Levothyroxine her endocrinologist prescribed (112 ug). The patient was monitored at baseline, between each dose and up to 3 hours after the procedure was completed. There were no incidents such as urticaria, angioedema, or others. On the second day, the patient received a single-full dose of 112 ug on an empty stomach. The medication was successfully tolerated and she was discharged. Thereafter, she tolerates daily Levothyroxine.

Asunto(s)

Desensibilización Inmunológica/métodos , Hipersensibilidad a las Drogas/prevención & control , Tiroxina/efectos adversos , Tiroxina/inmunología , Adulto , Hipersensibilidad a las Drogas/etiología , Hipersensibilidad a las Drogas/inmunología , Femenino , Humanos , Pruebas Cutáneas , Tiroidectomía

RESUMEN

We report a 39-year-old female who underwent a total thyroidectomy as treatment for a thyroid papillary cancer. She suffered several episodes of mild angioedema in lips and tongue, after using different commercial Levothyroxine formulations, with and without excipients. Given the need to use this drug, the patient was admitted in our hospital and we proceeded to desensitize her with oral Levothyroxine. The patient fasted throughout the whole procedure, was properly monitored and had an adequate peripheral venous access. On the first day of the procedure, a 15-step protocol was performed, first administering placebo and then, compounded formulations of Levothyroxine starting from 0.01 ug, followed by doubling doses every 15 minutes until the cumulative dose of 111.95 ug was completed, corresponding to the daily dose of Levothyroxine her endocrinologist prescribed (112 ug). The patient was monitored at baseline, between each dose and up to 3 hours after the procedure was completed. There were no incidents such as urticaria, angioedema, or others. On the second day, the patient received a single-full dose of 112 ug on an empty stomach. The medication was successfully tolerated and she was discharged. Thereafter, she tolerates daily Levothyroxine.

Asunto(s)

Humanos , Femenino , Adulto , Tiroxina/efectos adversos , Tiroxina/inmunología , Desensibilización Inmunológica/métodos , Hipersensibilidad a las Drogas/prevención & control , Tiroidectomía , Pruebas Cutáneas , Hipersensibilidad a las Drogas/etiología , Hipersensibilidad a las Drogas/inmunología

RESUMEN

The present document is a position statement of the Mexican College of Rheumatology on the use of biosimilars in rheumatic diseases. This position considers that biosimilars should be considered as interchangeable, that automatic substitution without previous notice in stable patients during follow-up is not ethical, that the approval of a biosimilar should only be given after exhaustive review of preclinical and clinical data marked by Mexican regulations, that it should be clearly stated in the nomenclature of biologic drugs which is the innovator and which is the biosimilar, that it is not correct to choose a biosimilar as treatment based only on economic reasons or extrapolate indications based only on the approval of the innovator and in the absence of safety and efficacy data for the biosimilar.

Asunto(s)

Antirreumáticos/uso terapéutico , Biosimilares Farmacéuticos/uso terapéutico , Enfermedades Reumáticas/tratamiento farmacológico , Antirreumáticos/efectos adversos , Antirreumáticos/economía , Biosimilares Farmacéuticos/efectos adversos , Biosimilares Farmacéuticos/economía , Ensayos Clínicos como Asunto , Aprobación de Drogas , Costos de los Medicamentos , Evaluación de Medicamentos , Hipersensibilidad a las Drogas/prevención & control , Sustitución de Medicamentos , Humanos , Legislación de Medicamentos , México , Estudios Multicéntricos como Asunto , Patentes como Asunto , Terminología como Asunto , Equivalencia Terapéutica , Revelación de la Verdad

RESUMEN

WHAT IS KNOWN AND OBJECTIVE: Use of cisplatin can induce type I hypersensitivity reactions that may also be linked to the quality of the drug utilized. We observed cases of hypersensitivity that appeared to be associated with the brand of cisplatin used. The aim of this study was to compare two different brands of cisplatin in relation to type I hypersensitivity reactions. METHODS: Brand A was used in a tertiary care teaching hospital until 2012, and use of brand B started from January 2013, when the first hypersensitivity cases were observed. Patients were categorized based on symptom. Cisplatin of both brands was analysed by high-performance liquid chromatography (HPLC) and high-resolution electrospray ionization mass spectrometry (ESI-(+)-MS) and characterized according to US Pharmacopeia. RESULTS AND DISCUSSION: There were no cases of hypersensitivity associated with the use of cisplatin brand A, whereas four of 127 outpatients that used cisplatin brand B were affected. The two brands were in accordance with the US Pharmacopeia parameters, and there was no significant difference in the total platinum levels between the two brands when analysed by HPLC. However, high-resolution ESI-(+)-MS analyses show that brand B contains approximately 2.7 times more hydrolysed cisplatin than brand A. WHAT IS NEW AND CONCLUSION: The increase in the hydrolysed form of cisplatin found in brand B may be the cause of the hypersensitivity reaction observed in a subset of patients. We present the first study of the quality of drugs by high-resolution ESI-(+)-MS. Drug regulatory agencies and manufacturers should consider including measurement of hydrolysed cisplatin as a quality criterion for cisplatin formulations.

Asunto(s)

Cisplatino/efectos adversos , Cisplatino/química , Composición de Medicamentos/métodos , Hipersensibilidad a las Drogas/etiología , Platino (Metal)/química , Antineoplásicos/efectos adversos , Antineoplásicos/química , Química Farmacéutica/métodos , Cromatografía Líquida de Alta Presión/métodos , Hipersensibilidad a las Drogas/prevención & control , Femenino , Humanos , Masculino , Persona de Mediana Edad , Espectrometría de Masa por Ionización de Electrospray/métodos

RESUMEN

HLA-B(∗)57:01 is a well-known and cost-effective pharmacogenetic marker for abacavir hypersensitivity. As with other HLA alleles, there is widespread variation in its frequency across populations. The Costa Rica Central Valley Population (CCVP) is the major population in this country. The frequency of HLA-B(∗)57:01 in this population has not been described yet. Thus, our aim was to determine the frequency of this allele in the CCVP. 200 unrelated healthy volunteer donors born in the CCVP were typed. HLA-B(∗)57-positive samples identified by HLA intermediate resolution typing methods were further typed by SBT to high resolution. An HLA-B(∗)57:01 carrier frequency of 5.00% was determined in this sample. This frequency is relatively high in comparison to reports from other populations in Latin America. These results suggest that there is a considerable frequency of HLA-B(∗)57:01 in the CCVP and that pharmacogenetic testing for HIV+ patients who are going to receive abacavir-based treatment should be considered in this country.

Asunto(s)

Hipersensibilidad a las Drogas/prevención & control , Frecuencia de los Genes , Antígenos HLA-B/genética , Heterocigoto , Alelos , Fármacos Anti-VIH/efectos adversos , Costa Rica , Didesoxinucleósidos/efectos adversos , Hipersensibilidad a las Drogas/genética , Hipersensibilidad a las Drogas/inmunología , Femenino , Expresión Génica , Marcadores Genéticos/inmunología , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/genética , Infecciones por VIH/inmunología , Antígenos HLA-B/inmunología , Humanos , Masculino , Factores de Riesgo

Asunto(s)

Humanos , Adolescente , Niño , Anestesia Dental/métodos , Anestesia Local/normas , Atención Dental para Niños/normas , Administración Tópica , Anestésicos Locales/farmacología , Bloqueo Nervioso/métodos , Hipersensibilidad a las Drogas/prevención & control , Sociedades Odontológicas/normas , Vasoconstrictores/farmacología

Asunto(s)

Humanos , Adolescente , Niño , Anestesia Dental/métodos , Anestesia Local/normas , Atención Dental para Niños/normas , Vasoconstrictores/farmacología , Anestésicos Locales/farmacología , Sociedades Odontológicas/normas , Administración Tópica , Bloqueo Nervioso/métodos , Hipersensibilidad a las Drogas/prevención & control

RESUMEN

Aspirin use is necessary after a coronary angioplasty. It should not be used in patients with a history of hypersensitivity. However, rapid desensitization protocols have been reported to allow its use in such patients. One of these protocols consists in the administration of progressive doses of aspirin, from 1 to 100 mg in a period of 5.5 hours, in a controlled environment. We report four male patients aged 45,49, 59 and 73 years with a history of aspirin hypersensitivity, who were subjected to a coronary angioplasty. In all, the rapid aspirin desensitization protocol was successfully applied, allowing the use of the drug after the intervention without problems.

Asunto(s)

Angioplastia Coronaria con Balón/métodos , Aspirina/administración & dosificación , Desensibilización Inmunológica/métodos , Hipersensibilidad a las Drogas/prevención & control , Inhibidores de Agregación Plaquetaria/administración & dosificación , Anciano , Aspirina/efectos adversos , Clopidogrel , Humanos , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/efectos adversos , Ticlopidina/administración & dosificación , Ticlopidina/análogos & derivados , Resultado del Tratamiento

RESUMEN

Background: Aspirin use is necessary after a coronary angioplasty. It should not be used in patients with a history of hypersensitivity. However, rapid desensitization protocols have been reported to allow its use in such patients. One of these protocols consists in the administration of progressive doses of aspirin, from 1 to 100 mg in a period of 5.5 hours, in a controlled environment. We report four male patients aged 45,49, 59 and 73 years with a history of aspirin hypersensitivity, who were subjected to a coronary angioplasty. In all, the rapid aspirin desensitization protocol was successfully applied, allowing the use of the drug after the intervention without problems.

Asunto(s)

Anciano , Humanos , Masculino , Persona de Mediana Edad , Angioplastia Coronaria con Balón/métodos , Aspirina/administración & dosificación , Desensibilización Inmunológica/métodos , Hipersensibilidad a las Drogas/prevención & control , Inhibidores de Agregación Plaquetaria/administración & dosificación , Aspirina/efectos adversos , Inhibidores de Agregación Plaquetaria/efectos adversos , Ticlopidina/administración & dosificación , Ticlopidina/análogos & derivados , Resultado del Tratamiento

RESUMEN

INTRODUCTION: Hypersensitivity reaction (HSR) to antineoplastic drugs can force doctors to stop treatment and seek other alternatives. These alternatives may be less effective, not as well tolerated and/or more expensive. Another option is to use desensitization protocols that induce a temporary state of tolerance by gradually administering small quantities of the antineoplastic drug until the therapeutic dosage is reached. The aim of this study is to assess the effectiveness of oxaliplatin desensitization protocols. MATERIALS AND METHODS: A retrospective observational study was carried out between January 2006 and May 2011. The inclusion criteria were patients undergoing chemotherapy treatment with oxaliplatin who had developed an HSR to the drug and who were candidates for continuing the treatment using a desensitization protocol. The patients' clinical records were reviewed and variables were gathered relating to the patient, the treatment, the HSR, and the desensitization protocol administered. The data were analysed using version 18.0 of the statistics program SPSS. RESULTS: A total of 53 desensitization protocols were administered to 21 patients. In 89 % of these cases, no new reactions occurred while the drug was being administered. New reactions of mild severity only occurred in 11 % of cases, and none of these reactions were severe enough for treatment to be stopped. All patients were able to complete the desensitization protocol. CONCLUSION: This study confirms that oxaliplatin desensitization protocols are safe and effective and allow patients to continue with the treatment that initially caused an HSR.

Asunto(s)

Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias Colorrectales/tratamiento farmacológico , Desensibilización Inmunológica , Hipersensibilidad a las Drogas/etiología , Hipersensibilidad a las Drogas/prevención & control , Anticuerpos Monoclonales Humanizados/administración & dosificación , Bevacizumab , Capecitabina , Neoplasias Colorrectales/inmunología , Neoplasias Colorrectales/patología , Desoxicitidina/administración & dosificación , Desoxicitidina/análogos & derivados , Femenino , Fluorouracilo/administración & dosificación , Fluorouracilo/análogos & derivados , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Compuestos Organoplatinos/administración & dosificación , Oxaliplatino , Pronóstico , Estudios Retrospectivos , Pruebas Cutáneas

RESUMEN

OBJECTIVE: To demonstrate the role and importance of the clinical pharmacist in the Emergency Department by means of identification, classification, and assessment of the number of interventions performed by this professional. METHODS: This was a retrospective study conducted during the period of January 1st, 2010 to December 31st, 2010, at the Morumbi Emergency Department of Hospital Israelita Albert Einstein. The interventions were performed by the clinical pharmacists by means of his/her role along with the interdisciplinary team and active search in clinical charts, with daily analysis of medical prescriptions during the period of eight hours (10:00 to 19:00) from Monday to Friday. RESULTS: A total of 3,542 medical prescriptions were written and there were 1,238 interventions. Classifications and quantities of interventions were as follows: administration route: 105 (8.48%); frequency: 73 (5.89%); dosage: 431 (35%); renal function: 14 (1.13%); compatibility: 50 (4%); dilution: 121 (9.77%); legibility: 39 (3.15%); pharmacovigilance: 7 (0.56%); adverse reaction to medications: 7 (0.56%); allergy: 35 (2.82%); infusion time: 76 (6.13%); indication: 52 (4.20%); medication reconciliation: 2 (0.16%); enteral medication administration: 38 (3%); scheduling: 7 (0.56%); specific anticoagulant protocol: 44 (3.55%); specific hypoglycemic agent protocol: 42 (3.99%). CONCLUSION: The study allowed the demonstration of the importance of the clinical pharmacist active in the Emergency Department. By the classification and by the number of interventions carried out, it was possible to observe that the Clinical Pharmacy Service had a great impact on the increased safety for the patient and prevention of adverse events.

Asunto(s)

Servicio de Urgencia en Hospital , Farmacéuticos , Vías de Administración de Medicamentos , Esquema de Medicación , Hipersensibilidad a las Drogas/prevención & control , Interacciones Farmacológicas , Prescripciones de Medicamentos , Sustitución de Medicamentos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/prevención & control , Humanos , Prescripción Inadecuada , Conciliación de Medicamentos , Grupo de Atención al Paciente , Servicio de Farmacia en Hospital , Rol Profesional , Estudios Retrospectivos

RESUMEN

Objective: To demonstrate the role and importance of the clinical pharmacist in the Emergency Department by means of identification, classification, and assessment of the number of interventions performed by this professional. Methods: This was a retrospective study conducted during the period of January 1st, 2010 to December 31st, 2010, at the Morumbi Emergency Department of Hospital Israelita Albert Einstein. The interventions were performed by the clinical pharmacists by means of his/her role along with the interdisciplinary team and active search in clinical charts, with daily analysis of medical prescriptions during the period of eight hours (10:00 to 19:00) from Monday to Friday. Results: A total of 3,542 medical prescriptions were written and there were 1,238 interventions. Classifications and quantities of interventions were as follows: administration route: 105 (8.48%); frequency: 73 (5.89%); dosage: 431 (35%); renal function: 14 (1.13%); compatibility: 50 (4%); dilution: 121 (9.77%); legibility: 39 (3.15%); pharmacovigilance: 7 (0.56%); adverse reaction to medications: 7 (0.56%); allergy: 35 (2.82%); infusion time: 76 (6.13%); indication: 52 (4.20%); medication reconciliation: 2 (0.16%); enteral medication administration: 38 (3%); scheduling: 7 (0.56%); specific anticoagulant protocol: 44 (3.55%); specific hypoglycemic agent protocol: 42 (3.99%). Conclusion: The study allowed the demonstration of the importance of the clinical pharmacist active in the Emergency Department. By the classification and by the number of interventions carried out, it was possible to observe that the Clinical Pharmacy Service had a great impact on the increased safety for the patient and prevention of adverse events.

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Objetivo: Demonstrar a atuação e a importância do farmacêutico clínico na Unidade de Primeiro Atendimento por meio da identificação, classificação e do levantamento do número de intervenções realizadas pelo farmacêutico clínico. Métodos: Foi realizado um estudo retrospectivo no período de 1o de janeiro de 2010 a 31 de dezembro de 2010, na Unidade de Primeiro Atendimento Morumbi do Hospital Israelita Albert Einstein. As intervenções foram realizadas pelo farmacêutico clínico por meio da atuação junto à equipe interdisciplinar e busca ativa nos prontuários, com a análise diária da prescrição médica no período de oito horas (10h00 e 19h00) de segunda à sexta-feira. Resultados: Foi avaliado o total de 3.542 prescrições médicas e ocorreram 1.238 intervenções. As classificações e as quantidades das intervenções foram: via de administração: 105 (8,48%); frequência: 73 (5,89%); dose: 431 (35%); função renal: 14 (1,13%); compatibilidade: 50 (4%); diluição: 121 (9,77%); legibilidade: 39 (3,15%); farmacovigilância: 7 (0,56%); reação adversa a medicamentos: 7 (0,56%); alergia: 35 (2,82%); tempo de infusão: 76 (6,13%); indicação: 52 (4,20%); reconciliação medicamentosa: 2 (0,16%); medicamentos via sonda: 38 (3%); aprazamento: 7 (0,56%); protocolo específico de anticoagulantes: 44 (3,55%); protocolo específico de hipoglicemiantes: 42 (3,99%). Conclusão: O estudo permitiu demonstrar a importância do farmacêutico clínico atuando na Unidade de Primeiro Atendimento. Pela classificação e pelo número das intervenções realizadas, foi possível observar que o Serviço de Farmácia Clínica teve grande impacto no aumento da segurança ao paciente e prevenção de eventos adversos.

Asunto(s)

Humanos , Servicio de Urgencia en Hospital , Farmacéuticos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/prevención & control , Vías de Administración de Medicamentos , Esquema de Medicación , Hipersensibilidad a las Drogas/prevención & control , Interacciones Farmacológicas , Prescripciones de Medicamentos , Sustitución de Medicamentos , Prescripción Inadecuada , Conciliación de Medicamentos , Grupo de Atención al Paciente , Servicio de Farmacia en Hospital , Rol Profesional , Estudios Retrospectivos

RESUMEN

AIM This study was a retrospective analysis of our experience with severe cross-hypersensitivity reactions (HSR) to the taxanes paclitaxel (P) and docetaxel (D) in patients with breast cancer. PATIENTS AND METHODS We evaluated patients with breast cancer treated with P or D who experienced severe HSR to one of the two taxanes. Severe HSR was defined as any reaction severe enough to warrant discontinuation of the drug. Initial intravenous premedication for paclitaxel was dexamethasone (20 mg), ranitidine (50 mg) and dexchlorpheniramine (10 mg). For docetaxel, dexamethasone (4 mg) orally every 12 hours was administered the day before infusion and dexamethasone (20 mg) was administered intravenously prior to infusion. After severe HSR to the taxane and 30 minutes before infusion of another taxane, we administered dexamethasone (20 mg), ranitidine (50 mg) and dexchlorpheniramine (10 mg) iv as a premedication, and we also increased the time of the infusion. RESULTS Between March 2009 and April 2010, 23 patients experienced an initial severe HSR to taxane (12 P, 11 D). Substitution of another taxane was conducted in 17 patients in the two weeks following the initial HSR. Eight patients had an initial HSR with P, and three had a cross-HSR to D. Nine patients had an initial HSR to D, and four of these patients had a cross-HSR to P. Among the 17 patients who received both taxanes, 7 (41%) had a cross-HSR. All cross- HSRs were sufficiently severe (grade 3-4) to suspend taxane treatment permanently. In the remaining 6 patients, a desensitisation protocol to taxanes was performed by increasing the dose of the diluted drug (4 P, 2 D), which resulted in administration of the drug without complications in all cases. There were no treatment-related deaths. CONCLUSION Severe cross-HSR between P and D occurred in a significant proportion of our patients with breast cancer, so care must be taken when substituting taxanes (paclitaxel and docetaxel). A desensitisation protocol can be an effective alternative to decrease the risk of a new HSR.

Asunto(s)

Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias de la Mama/tratamiento farmacológico , Hipersensibilidad a las Drogas/etiología , Adulto , Anciano , Antiinflamatorios/uso terapéutico , Dexametasona/uso terapéutico , Docetaxel , Hipersensibilidad a las Drogas/prevención & control , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Paclitaxel/administración & dosificación , Premedicación , Estudios Retrospectivos , Taxoides/administración & dosificación , Resultado del Tratamiento

RESUMEN

BACKGROUND: 5HT-3 antagonists and corticosteroids control less than 50% of delayed chemotherapy induced nausea and vomiting (CINV) episodes. MATERIALS AND METHODS: Two pilot phase II studies were conducted at our institution in which all patients received ondansetron 16 mg and dexamethasone 20 mg before highly and moderately emetogenic chemotherapy on day 1. Patients on study 1 received metoclopramide 10 mg PO q8 h, granisetron 0.5 mg PO QD and dexamethasone 8 mg QD on days 2 and 3, whereas only metoclopramide was continued on the same schedule on day 4. On study 2, patients received the same medications, but no drugs were given on day 2, and the same treatment schedule was given to them but from days 3 to 5 instead. Patients were interviewed on days 1 and 6. RESULTS: Twenty-one patients participated on each study. There were no significant clinical differences between these two studied populations. Complete CINV control occurred from days 2 to 5 in 23.1% (95% CI: 8 to 47%) on study 1 vs 61.9% (95% CI: 38 to 81%) of the patients on study 2. By logistic regression, complete CINV control was correlated significantly with antiemetic treatment group (p=0.011) even when we considered only patients who achieved complete CINV control during the first 24 h (p=0.031). CONCLUSIONS: Skipping day 2 antiemetic medications does not seem to worsen delayed CINV control and may even improve it, perhaps by avoiding tachyphylaxis to these medications. A randomized controlled study is in progress to confirm these results.

Asunto(s)

Antieméticos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Hipersensibilidad Tardía/inducido químicamente , Náusea/inducido químicamente , Náusea/prevención & control , Vómitos/inducido químicamente , Vómitos/prevención & control , Adolescente , Adulto , Anciano , Análisis de Varianza , Brasil , Dexametasona/administración & dosificación , Hipersensibilidad a las Drogas/etiología , Hipersensibilidad a las Drogas/prevención & control , Femenino , Granisetrón/administración & dosificación , Humanos , Hipersensibilidad Tardía/prevención & control , Modelos Logísticos , Masculino , Metoclopramida/administración & dosificación , Persona de Mediana Edad , Ondansetrón/administración & dosificación , Proyectos Piloto , Calidad de Vida , Proyectos de Investigación , Antagonistas de la Serotonina/administración & dosificación , Resultado del Tratamiento

RESUMEN

Objetivo: Evaluar retrospectivamente las características de nuestra población, sus patologías prevalentes y las drogas recibidas; evaluar la naturaleza de las reacciones agudas de hipersensibilidad (RAH) producidas por la infusión de agentes antineoplásicos; evaluar las maniobras médicas instauradas y la necesidad de que estos tratamientos sean realizados en el ámbito hospitalario. Material y métodos: Se consideraron los pacientes (ptes.) que concurrieron a hospital de día para recibir tratamiento ambulatorio; se categorizaron las reacciones agudas en severas (requieren maniobras médicas activas para reestablecer la estabilidad clínica y se debe suspender la infusión) y moderadas (requieren maniobras médicas activas pero se puede reiniciar la infusión) sin considerarse las reacciones leves (por ej.: acatisia, eritema facial) ni las extravasaciones, se categorizaron las maniobras médicas en complejas (inotrópicos, internación) y no complejas (corticoides, antihistamínicos, alta institucional)...(AU)

Asunto(s)

Humanos , Masculino , Adulto , Femenino , Persona de Mediana Edad , Anciano , Hipersensibilidad a las Drogas/clasificación , Antineoplásicos/efectos adversos , Neoplasias/tratamiento farmacológico , Hipersensibilidad a las Drogas/prevención & control , Hipersensibilidad a las Drogas/tratamiento farmacológico , Estudios Retrospectivos , Antineoplásicos/uso terapéutico , Carboplatino/efectos adversos , Leucovorina/efectos adversos , Paclitaxel/efectos adversos , Cisplatino/efectos adversos , Enfermedad Aguda