Construção e validação de ferramenta preventiva sobre incompatibilidade medicamentosa em via Y / Construction and validation of a preventive tool on drug incompatibility in the Y-route / Construcción y validación de una herramienta preventiva de incompatibilidad de medicamentos en la ruta Y

Introdução: A terapia com medicamentos endovenosos é muito utilizada nas unidades hospitalares, porém, possui uma elevada chance de incidentes, principalmente quando os medicamentos são administrados simultaneamente em via Y. Essa prática pode resultar em incompatibilidades medicamentosas classificadas em reações físicas e químicas. Objetivo: Construir e validar uma ferramenta preventiva de incompatibilidade medicamentosa em via Y. Método: Estudo metodológico com abordagem quantitativa. Foi desenvolvido em três etapas: Levantamento bibliográfico, construção e diagramação do material e por fim, a validação da ferramenta preventiva. Para validação, a ferramenta preventiva foi submetida ao processo de validação de face e conteúdo por juízes com expertise na temática. Resultados: Construiu-se e validou-se uma ferramenta preventiva através da busca de dados na literatura com a participação de sete juízes especialistas na temática. Os itens avaliativos referentes a tabela de incompatibilidade medicamentosa quanto aos objetivos, estrutura, apresentação e relevância da ferramenta preventiva foi considerada válida, pois foram julgados como adequado pelos especialistas. Conclusão: A validação de conteúdo, foi considerada válida pelos juízes, portanto, espera-se que o material alcance o seu objetivo ao ser aplicado durante a prática clínica. Dessa forma, será disponibilizado à instituição para que seja utilizado, favorecendo a prevenção de danos e contribuindo para a segurança dos pacientes, bem como melhorando a qualidade da assistência e educação em saúde.

Introduction: Intravenous drug therapy is widely used in hospital units, however, it has a high chance of incidents, especially when drugs are administered simultaneously in a Y route. This practice can result in drug incompatibilities classified into physical and chemical reactions. Objective: To build and validate a preventive tool for drug incompatibility in the Y pathway. Method: Methodological study with a quantitative approach. It was developed in three stages: bibliographic survey, construction and layout of the material and finally, the validation of the preventive tool. For validation, the preventive tool was submitted to the face and content validation process by judges with expertise in the subject. Results: A preventive tool was built and validated through the search for data in the literature with the participation of seven expert judges on the subject. The evaluative items referring to the medication incompatibility table regarding the objectives, structure, presentation and relevance of the preventive tool were considered valid, as they were judged as adequate by the specialists. Conclusion: The content validation was considered valid by the judges, therefore, it is expected that the material reaches its objective when applied during clinical practice. In this way, it will be made available to the institution for use, favoring the prevention of damage and contributing to patient safety, as well as improving the quality of health care and education.

Introducción: La farmacoterapia intravenosa es ampliamente utilizada en las unidades hospitalarias, sin embargo, tiene una alta probabilidad de incidencias, especialmente cuando los fármacos se administran simultáneamente en una vía Y. Esta práctica puede dar lugar a incompatibilidades medicamentosas clasificadas en reacciones físicas y químicas. Objetivo: Construir y validar una herramienta preventiva de incompatibilidad de medicamentos en la vía Y. Método: Estudio metodológico con enfoque cuantitativo. Se desarrolló en tres etapas: relevamiento bibliográfico, construcción y diagramación del material y finalmente, la validación de la herramienta preventiva. Para la validación, la herramienta preventiva fue sometida al proceso de validación facial y de contenido por jueces expertos en el tema. Resultados: Se construyó y validó una herramienta preventiva a través de la búsqueda de datos en la literatura con la participación de siete jueces expertos en el tema. Los ítems evaluativos referentes a la tabla de incompatibilidad de medicamentos en relación a los objetivos, estructura, presentación y relevancia de la herramienta preventiva fueron considerados válidos, pues fueron juzgados como adecuados por los especialistas. Conclusiones: La validación del contenido fue considerada válida por los jueces, por lo tanto, se espera que el material alcance su objetivo al ser aplicado durante la práctica clínica. De esta forma, se pondrá a disposición de la institución para su uso, favoreciendo la prevención de daños y contribuyendo a la seguridad del paciente, además de mejorar la calidad de la atención y educación en salud.

Drug interactions and adverse events in a cohort of Warfarin users attending Public Health Clinics / Interações medicamentosas e eventos adversos em uma coorte de usuários de varfarina que freqüentam clínicas de saúde pública

Background: Warfarin is an oral anticoagulant involved in important interactions with foods and other drugs. Objectives: To evaluate the occurrence of adverse events reported by warfarin users and their relationship with drug interactions. Methods: This was an open cohort, prospective study conducted in an 18-month period with warfarin users attending public health clinics of the city of Ijuí, Brazil. Data were collected by means of interviews administered at patients' home every month. Patients' responses were confirmed by review of medical records when patients sought medical care. Data were analyzed by descriptive statistics. Potential drug interactions were evaluated in a database and vitamin K consumption was quantified using a validated method. Results: A total of 68 patients were followed-up; 63 completed the study and 5 died in the study period. Mean number of medications taken by the patients was 9.6 ± 4.5, and mean number of interactions involving warfarin was 2.91 ± 1.52. Most potential interactions increased the risk of bleeding, 61 of them severe interactions and 116 moderate interactions. Eighty-seven episodes of bleeding and 4 episodes of thrombosis were reported by a total of 37 and 4 patients, respectively. At the occurrence of these events, 56.5% of warfarin users were also taking omeprazole, 35.9% were taking simvastatin and 25.0% paracetamol. Most patients had a low vitamin K intake. Conclusions: A high frequency of potential interactions between warfarin and other drugs was detected, but a low intake of foods that could possibly affect the effects of warfarin was observed. Based on our results, it seems prudent to follow patients on warfarin therapy for drug-drug interactions, aiming to control adverse effects and to promote a safe and effective therapy

Morbidité sévère et décès après erreurs médicamenteuses en rachianesthésie

Introduction : Les erreurs médicamenteuses, compte tenu de leur gravité potentielle, constituent un problème des systèmes de santé. Nous rapportons la morbidité sévère et la mortalité liées à l'erreur médicamenteuse lors de rachianesthésies. Méthode : Cette étude rétrospective a été menée au Service d'Aide Médicale d'Urgence (SAMU) du Bénin. Nous rapportons une série de neuf cas de patients ayant présenté une complication d'anesthésie par erreur médicamenteuse au cours d'une rachianesthésie, pendant la période de 2012 à 2017. Les données ont été collectées à partir des registres du SAMU, des rapports d'anesthésie et des dossiers médicaux. Nous avons étudié les caractéristiques sociodémographiques, les circonstances de l'acci-dent, les médicaments en cause, la symptomatologie clinique et paraclinique, les soins administrés et l'évolution des patients.Résultats : Les patients étaient classés en ASA1 ou ASA2. Nous avons noté trois circonstances d'er-reurs médicamenteuses en rachianesthésie : erreurs par confusion d'ampoules et de spécialités, l'er-reur par confusion de seringues avec un mauvais médicament, l'erreur par confusion de seringues avec le bon médicament à une mauvaise concentration. Quatre médicaments ont été en cause : l'acide tra-nexamique, l'atropine, la noradrénaline et la morphine. Pour l'injection accidentelle d'acide tranexa-mique, cette erreur a concerné quatre patientes âgées de 25, 35, 41, 46 ans avec 3 décès. Les injections accidentelles d'atropine et de la noradrénaline ont concerné quatre patientes âgées de 29, 40, 41 ans pour l'atropine et de 26 ans pour la noradrénaline. Le surdosage de morphine a concerné un patient de 83 ans, qui a présenté une dépression respiratoire profonde. Conclusion : Dans cette série d'erreurs médicamenteuses en rachianesthésie, quatre médicaments ont été impliqués. Une morbidité grave et une mortalité lourde ont été observées avec l'acide tranexa-mique en injection intrathécale

In-line Filtration in Parenteral Nutrition

Metabolic abnormalities and catheter-related infections are common complications of parenteral nutrition (PN). Particulate contamination is a catheter-related complication can occur when administering PN: mixing the electrolytes, trace elements, vitamins into the PN, or puncturing a rubber stopper at the PN formulation. In addition, the aggregation of the components of the PN solution by a drug incompatibility reaction could be related to particulate contamination. PN contaminated with precipitates, insoluble particles, and bacteria was reported as the cause of the death of a patient. The Food and Drug Administration recommended that the filters be used during PN administration. In-line filters can retain the bacteria and insoluble particles in PN solutions, and prevent their infusion into the patient. Therefore, in-line filters are recommended to prevent catheter-related complications that can occur during PN infusion. A 0.2µ filter for lipid-free PN and a 1.2µ filter for lipid-containing PN solutions can be used. On the other hand, when a filter is applied, the infusion rate can decrease and the economic burden will increase for patients requiring long-term PN. In addition, small particles, such as viruses, polymers, and proteins cannot be filtered out completely. In conclusion, in-line filers are recommended to prevent catheter-related complications that can occur during PN administration, but there are no international standardized guidelines. Therefore, standardized guidelines will be needed based on evidence accompanied by clinical trials. In addition, in-line filter applications should be considered in the clinical field depending on the patient's condition.

Incompatibilidade medicamentosa em terapia intensiva: revisão sobre as implicações para a prática de enfermagem / Drug incompatibility in the ICU: review of implications in nursing practice

Revisão integrativa de literatura realizada em sete bases de dados, com objetivo de analisar a produção científica sobre as potenciais incompatibilidades medicamentosas em terapia intensiva e mapear os medicamentos incompatíveis de maior prevalência descritos na literatura. Os filtros aplicados foram: artigos disponíveis na íntegra, publicações do período de 2009 a 2016 nos idiomas português, inglês e/ou espanhol, totalizando 11 artigos ao término da seleção. A partir da revisão, observou-se que os medicamentos fenitoína e pantoprazol são os principais responsáveis pelas incompatibilidades medicamentosas nas unidades de terapia intensiva. O bloqueio das incompatibilidades pode ser realizado por meio de medidas simples implementadas rotineiramente pela enfermagem, tais como o aprazamento de medicamentos otimizado, a administração em vias venosas separadas de medicamentos sabidamente incompatíveis, a padronização da forma de diluição e administração de medicamentos, focando, principalmente, nos medicamentos incompatíveis de maior prevalência encontrados no estudo.

This is an integrative review of the literature performed in seven databases, with the aim of analyzing the scientific production on potential drug incompatibilities in ICUs, and mapping the most prevalent incompatible drugs described in the literature. The filters applied were: articles available in full, and publications from 2009 to 2016 in Portuguese, English, and/or Spanish, totaling 11 articles at the end of the selection. From the review, it was observed that the medicines phenytoin and pantoprazole are the main drugs responsible for drug incompatibilities in intensive care units. Blocking of incompatibilities can be achieved through simple measures routinely implemented by the nursing team, such as optimization of drug scheduling, administration of drugs known to be incompatible in separate venous routes, and standardization of drug dilution and administration, focusing mainly on the most prevalent incompatible drugs found in the study.

Incompatibilidades medicamentosas em centro de tratamento intensivo adulto de um hospital universitário / Drug incompatibilities in the adult intensive care unit of a university hospital

RESUMO Objetivos: Identificar as incompatibilidades físico-químicas entre medicamentos administrados por via intravenosa em pacientes internados em um centro de tratamento intensivo adulto, bem como realizar orientações farmacêuticas para a administração de medicamentos incompatíveis. Métodos: Estudo transversal, prospectivo, de caráter quantitativo, realizado no período de julho a setembro de 2015. As incompatibilidades foram identificadas a partir da análise das prescrições dos pacientes disponíveis no sistema on-line do hospital. Foi realizada uma intervenção farmacêutica por meio de orientações quanto à preparação e à administração dos medicamentos incompatíveis. Após, verificou-se a adesão dessas orientações por parte da equipe da enfermagem. Resultados: Foram analisadas 100 prescrições; destas, 68 apresentaram incompatibilidade entre os medicamentos intravenosos prescritos. Foram encontradas 271 incompatibilidades, com média de 4,0 ± 3,3 incompatibilidades por prescrição. As incompatibilidades mais frequentes foram entre midazolam e hidrocortisona (8,9%), cefepime e midazolam (5,2%) e hidrocortisona e vancomicina (5,2%). Os medicamentos mais envolvidos em incompatibilidades foram o midazolam, a hidrocortisona e a vancomicina. As incompatibilidades foram mais frequentes entre um medicamento administrado por infusão contínua com outro de forma intermitente (50%). Das 68 prescrições que geraram orientação farmacêutica, 45 (66,2%) foram totalmente realizadas pela equipe de enfermagem. Conclusão: Os pacientes em cuidados intensivos estiveram sujeitos a uma elevada ocorrência de incompatibilidades. As incompatibilidades medicamentosas podem ser identificadas e evitadas com a presença do farmacêutico na equipe multidisciplinar, diminuindo a ocorrência de efeitos indesejáveis ao paciente.

ABSTRACT Objectives: This study sought to identify the physical and chemical incompatibilities among the drugs administered intravenously to patients admitted to an adult intensive care unit. We also aimed to establish pharmaceutical guidelines for administering incompatible drugs. Methods: This cross-sectional, prospective, and quantitative study was conducted from July to September 2015. Drug incompatibilities were identified based on an analysis of the patient prescriptions available in the hospital online management system. A pharmaceutical intervention was performed using the guidelines on the preparation and administration of incompatible drugs. Adherence to those guidelines was subsequently assessed among the nursing staff. Results: A total of 100 prescriptions were analyzed; 68 were incompatible with the intravenous drugs prescribed. A total of 271 drug incompatibilities were found, averaging 4.0 ± 3.3 incompatibilities per prescription. The most commonly found drug incompatibilities were between midazolam and hydrocortisone (8.9%), between cefepime and midazolam (5.2%), and between hydrocortisone and vancomycin (5.2%). The drugs most commonly involved in incompatibilities were midazolam, hydrocortisone, and vancomycin. The most common incompatibilities occurred when a drug was administered via continuous infusion and another was administered intermittently (50%). Of the 68 prescriptions that led to pharmaceutical guidelines, 45 (66.2%) were fully adhered to by the nursing staff. Conclusion: Patients under intensive care were subjected to a high rate of incompatibilities. Drug incompatibilities can be identified and eliminated by the pharmacist on the multidisciplinary team, thereby reducing undesirable effects among patients.

Potential intravenous drug incompatibilities in a pediatric unit / Potencial de incompatibilidade de medicamentos intravenosos em uma unidade pediátrica

ABSTRACT Objective To investigate potential intravenous drug incompatibilities and related risk factors in a pediatric unit. Methods A cross-sectional analytical study conducted in the pediatric unit of a university hospital in Brazil. Data on prescriptions given to children aged 0-15 years from June to October 2014 were collected. Prescriptions that did not include intravenous drugs and prescriptions with incomplete dosage regimen or written in poor handwriting were excluded. Associations between variables and the risk of potential incompatibility were investigated using the Student’s t test and ANOVA; the level of significance was set at 5% (p<0.05). Relative risks were calculated for each drug involved in potential incompatibility with 95% confidence interval. Results A total of 222 children participated in the study; 132 (59.5%) children were male and 118 (53.2%) were aged between 0 and 2 years. The mean length of stay was 7.7±2.3 days. Dipyrone, penicillin G and ceftriaxona were the most commonly prescribed drugs. At least one potential incompatibility was detected in about 85% of children (1.2 incompatibility/patient ratio). Most incompatibilities detected fell into the non-tested (93.4%), precipitation (5.5%), turbidity (0.7%) or chemical decomposition (0.4%) categories. The number of drugs and prescription of diazepam, phenytoin, phenobarbital or metronidazole were risk factors for potential incompatibility. Conclusion Most pediatric prescriptions involved potential incompatibilities, with higher prevalence of non-tested incompatibilities. The number of drugs and prescription of diazepam, phenobarbital, phenytoin or metronidazole were risk factors for potential incompatibilities.

RESUMO Objetivo Avaliar o potencial de incompatibilidade dos medicamentos intravenosos, identificando possíveis fatores de risco em uma unidade pediátrica. Métodos Trata-se de um estudo observacional analítico do tipo transversal realizado na unidade de pediatria de um hospital de ensino no Brasil. Os dados foram coletados de junho a outubro de 2014 a partir da análise das prescrições de crianças (0 a 15 anos) hospitalizadas. Foram excluídas prescrições sem medicamento intravenoso e com posologia incompletas ou grafia inadequada. A associação entre as variáveis e o risco de potenciais incompatibilidades foi determinada pelo teste t de Student e ANOVA, considerando significativo para p<0,05. Calculou-se o risco relativo com intervalo de confiança de 95% de cada medicamento envolvido. Resultados Duzentos e vinte e duas crianças participaram do estudo, 132 (59,5%) eram do gênero masculino, 118 (53,2%) tinham idade entre 0 a 2 anos e estiveram internados em média 7,7±2,3 dias. Os medicamentos mais prescritos foram dipirona, penicilina G e ceftriaxona. Quase 85% das crianças apresentaram ao menos uma potencial incompatibilidade, razão de 1,2 incompatibilidades/paciente. Os tipos de incompatibilidades mais comuns foram: não testada (93,4%), precipitação (5,5%), turbidez (0,7%) e decomposição química (0,4%). Os fatores associados a potenciais incompatibilidades foram: número de medicamentos e a prescrição dos medicamentos diazepam, fenitoína, fenobarbital e metronidazol. Conclusão A maioria das prescrições pediátricas apresentou potenciais incompatibilidades e a incompatibilidade não testada foi o tipo mais comum. O número de medicamentos e a prescrição dos medicamentos diazepam, fenobarbital, fenitoína e metronidazol foram fatores de risco para potenciais incompatibilidades.

Compatibility: drugs and parenteral nutrition / Compatibilidade: medicamentos e nutrição parenteral

ABSTRACT Objective Standardization and systematization of data to provide quick access to compatibility of leading injectable drugs used in hospitals for parenteral nutrition. Methods We selected 55 injectable drugs analyzed individually with two types of parenteral nutrition: 2-in-1 and 3-in-1. The following variables were considered: active ingredient, compatibility of drugs with the parenteral nutrition with or without lipids, and maximum drug concentration after dilution for the drugs compatible with parenteral nutrition. Drugs were classified as compatible, incompatible and untested. Results After analysis, relevant information to the product’s compatibility with parental nutrition was summarized in a table. Conclusion Systematization of compatibility data provided quick and easy access, and enabled standardizing pharmacists work.

RESUMO Objetivo Padronizar e sistematizar informações, proporcionando um acesso rápido à compatibilidade dos principais medicamentos injetáveis utilizados no âmbito hospitalar para a nutrição parenteral. Métodos Foram selecionados 55 medicamentos injetáveis, os quais foram analisados individualmente com dois tipos de nutrição parenteral: dois em um, e três em um. Foram consideradas as seguintes variáveis: princípio ativo, compatibilidade dos medicamentos com a nutrição parenteral com e sem lipídios, e respectiva concentração máxima do medicamento após diluição, para os medicamentos compatíveis com a nutrição parenteral. Os fármacos foram classificados como compatível, incompatíveis e não testado. Resultados Após a análise, as informações pertinentes à compatibilidade do medicamento com a nutrição parenteral foram sintetizadas uma tabela. Conclusão A sistematização das informações de compatibilidade proporcionou um acesso rápido e fácil, viabilizando e padronizando o trabalho do farmacêutico.

Incompatibilidade medicamentosa por via intravenosa: recomendações para a prática de enfermagem / Intravenous drug incompatibility: recommendations for nursing practice

O objeto da pesquisa ora apresentada são as potenciais incompatibilidades medicamentosas intravenosas e suas implicações para a prática de Enfermagem. Com vistas a atender tal propósito, foram formulados os seguintes objetivos: mapear a prevalência das potenciais incompatibilidades medicamentosas intravenosas encontradas nas prescrições; e formular estratégias para minimização das potenciais incompatibilidades medicamentosas encontradas. Foi um estudo quantitativo, transversal, de tipologia descritiva, realizado em um centro de terapia intensiva pós-operatório de cirurgia cardíaca, de um hospital de esfera estadual. As prescrições medicamentosas do primeiro dia de internação foram analisadas quanto ao grau em que incompatibilidades medicamentosas foram geradas. O resultado evidenciou que, das 103 prescrições estudadas, 59 apresentaram incompatibilidades. Identificaram-se 23 duplas de medicamentos que geram incompatibilidades, sendo 211 o número de exposições dos pacientes. Dentre as de reações variáveis mais evidentes, destacam-se as duplas cefazolina + solução polarizante; nitroglicerina + furosemida; cefazolina + vancomicina; azitromicina + furosemida; e amiodarona + cefazolina. Dentre as incompatibilidades propriamente ditas, podem-se destacar os pares omeprazol + vancomicina e dobutamina + cefazolina. Ainda, há de se ter uma atenção especial para com medicamentos classificados como de infusão contínua, pois a presença das incompatibilidades pode ocorrer durante as 24 horas de infusão, aumentando substancialmente a exposição do paciente, cabendo enfatizar as seguintes duplas: noradrenalina + bicarbonato de sódio; midazolan + bicarbonato de sódio; e nitroglicerina + furosemida. Observou-se que o risco de incompatibilidade medicamentosa aumenta de acordo com a quantidade de medicamentos prescritos e que pacientes com polifarmácia possuem até quatro vezes mais chance de ter incompatibilidades dos que os que não a recebem. Diante disso, algumas recomendações foram formuladas, sendo subdivididas em dois segmentos: estratégias para a melhor administração medicamentosa, no CTI PO CC, e estratégias de mitigação das incompatibilidades entre medicamentos aplicadas ao cenário da pesquisa. Salienta-se a necessidade da avaliação da incompatibilidade, classificando sua tipologia, e da observação do pH e da osmolaridade dos medicamentos, para indicação mais adequada do dispositivo de infusão intravenosa. As incompatibilidades medicamentosas propriamente ditas devem ser consideradas preferencialmente para melhor distribuição nas vias venosas, em detrimento das de reações variáveis, uma vez que somente a administração separada irá bloquear tal evento.

The research addresses the potential intravenous drug incompatibilities and their implications for nursing practice. In order to meet this purpose, the following objectives were formulated: to chart the prevalence of potential intravenous drug incompatibilities found in prescriptions; and to formulate strategies to minimize potential drug incongruities. A quantitative cross- sectional study of a descriptive typology was performed at a post-operative intensive care unit of cardiac surgery at a state hospital. The drug prescriptions of the first day of hospitalization were analyzed for the degree to which drug incompatibilities were generated. The result showed that from the 103 medicinal prescriptions studied 59 presented drug incompatibilities. 22 pairs of drugs that generate incompatibilities were identified, 211 being the number of patients' exposures. Among the most obvious variable reactions are the pairs: cefazolin + polarizing solution; nitroglycerin + furosemide; cefazolin + vancomycin; azithromycin + furosemide; and amiodarone + cefazolin. Amid the incompatibilities proper we can highlight the duos omeprazole + vancomycin, and dobutamine + cefazolin. In addition, special attention should be paid to medicinal products classified as continuous infusion because the presence of incompatibilities may occur during the 24-hour infusion, substantially increasing the patient's exposure, emphasis being given to the following pairs: noradrenaline + sodium bicarbonate; midazolan + sodium bicarbonate; and nitroglycerin + furosemide. It was observed that the risk for drug incompatibility increases according to the quantity of drugs prescribed, and that patients submitted to polypharmacy have up to four times more chances of having incompatibilities than those who are not. In this way, some recommendations were formulated, being subdivided into two segments: strategies to better drug administration in the CTI PO CC, and strategies applied to the research locus in order to mitigate drug incompatibilities. It is necessary to evaluate the incompatibility, by classifying its typology, as well as to observe both the pH and the osmolarity of the drugs, to indicate the most adequate intravenous infusion device. Drug incompatibilities proper should be preferably considered for better distribution in the venous pathways in detriment of variable reactions, since only the separate administration will block such an event.

La investigación se ocupa de posibles incompatibilidades de drogas por vía intravenosa y sus implicaciones para la práctica de enfermería. Con el fin de cumplir con este propósito, se formularon los siguientes objetivos: mapear la prevalencia de posibles incompatibilidades de drogas intravenosas que se encuentran en las prescripciones; y formular estrategias para minimizar las posibles incompatibilidades entre las drogas encontradas. Se ha desarollado un estudio cuantitativo, transversal, de tipo descriptivo, realizado en un centro para el post- operatorio de cuidados intensivos la cirugía cardíaca de un hospital de nivel estatal. Se analisaron recetas de medicamentos del primer día del ingreso para determinar el grado en lo cual incompatibilidades de drogas son generadas. Los resultados mostraron que de las 103 recetas de medicamentos estudiados, 59 tenían incompatibilidades de drogas. Se identificó 23 pares de drogas que generan incompatibilidad, y 211 el número de las exposiciones de los pacientes. Entre las reacciones variables más evidentes, hay los pares siguientes: cefazolina + solución polarizante; nitroglicerina + furosemida; cefazolina + vancomicina; azitromicina + furosemida; y amiodarona + cefazolina. Entre las incompatibilidades reales se pueden destacar: omeprazol + vancomicina, y cefazolina + dobutamina. Aún, se debe prestar especial atención a las drogas clasificadas como de infusión continua, debido a que la presencia de incompatibilidades puede ocurrir durante la infusión de 24 horas, lo que aumenta sustancialmente la exposición del paciente, enfatizándose los seguientes pares: noradrenalina + bicarbonato de sodio; midazolam + nitroglicerina; y bicarbonato de sodio + furosemida. Se observó que el riesgo de incompatibilidad farmacológica aumenta con la cantidad de medicamentos con receta bien como los pacientes sometidos a polifarmacia tienen hasta cuatro veces más probabilidades de tener incompatibilidades que los que no lo son. Por lo tanto, se formularon algunas recomendaciones, que se dividen en dos segmentos: estrategias para la mejor administración de fármacos en CTI PO CC y estrategias aplicadas a la scena de la investigación para mitigación de incompatibilidades de drogas. Subraya la necesidad tanto de evaluarselas, por medio de la clasificación de su tipo, como la observación de pH y osmolaridad de la droga, con vistas a la mejor indicación del dispositivo de infusión intravenosa. Las incompatibilidades reales de medicamentos deben considerarse preferentemente para una mejor distribución de las vías venosas, em detrimento de las de reacciónes variables, ya que sólo la administración por separado bloqueará tal evento.

Incompatibilidade de medicamentos intravenosos e fatores de risco em pacientes críticos: coorte histórica / Incompatibility of intravenous medications and risk factors in critically ill patients: historical cohort

Introdução: A incompatibilidade de medicamento resulta de um fenômeno físico-químico causado pela combinação de dois ou mais medicamentos na mesma solução ou misturados em um mesmo recipiente. Pode ser considerado um erro de medicação pelo potencial de comprometer negativamente o tratamento. Objetivo: Estimar a incidência de incompatibilidades potenciais de medicamentos administrados por via intravenosa e fatores associados em pacientes críticos. Método: Coorte retrospectiva conduzida com pacientes internados nas Unidades de Terapia Intensiva e Semi-intensiva do Hospital Universitário da Universidade de São Paulo. A amostra foi composta por 110 indivíduos adultos hospitalizados, por pelo menos 72 horas, nessas unidades e submetidos à terapia intravenosa. A incompatibilidade potencial de medicamento foi analisada em duplas de medicamentos, utilizando-se a ferramenta Trissel´s TM 2 Compatibility IV, através da base de dados Micromedex 2.0®. A variável dependente foi a ocorrência de incompatibilidade. As variáveis independentes foram idade, sexo, procedência, tipo de internação, tempo de permanência, SAPSII, índice de Charlson, carga de trabalho de enfermagem, condição de alta, modo de infusão, número de medicamentos prescritos e de prescritores. Na análise dos dados utilizaram-se os testes qui-quadrado de Pearson, Exato de Fisher, Kruskal-Wallis, modelo de análise de variância ANOVA e regressão logística, com significância de p 0,05. Resultados: A incidência de incompatibilidade potencial de medicamentos foi de 2,7%.Foram prescritos 72 tipos diferentes de medicamentos que formaram 565 duplas, destas, 44,9%, foram compatíveis e 8,8%, incompatíveis. O aparecimento de precipitação (50,0%) foi a alteração físico-química mais identificada, após as combinações via dispositivo em Y. Na frequência de aparecimento, as duplas de medicamentos incompatíveis formadas por fenitoína (32,0%), diazepam (14,0%), midazolam (10,0%) e dobutamina (8,0%) foram as mais identificadas. Cerca de 70% dos pacientes receberam medicamentos prescritos a critério médico, principalmente durante o período noturno. Os fatores de riscos associados à incompatibilidade foram procedência (RC: 1,506; IC: 0,327 - 6,934); tempo de permanência prolongado nas unidades (RC: 1,175; IC: 1,058 - 1,306); maior número de medicamentos prescritos (RC: 1,395; IC: 1,091 -1,784) e carga elevada de trabalho de enfermagem (RC: 1,060; IC: 1,010 -1,113). Conclusão: O número de medicamentos prescritos aos pacientes críticos, em decorrência da gravidade clínica, aumenta exponencialmente a ocorrência de incompatibilidade e, os expõe a graves consequências. Embora haja outros estudos que identifiquem as incompatibilidades potenciais, observa-se, no cotidiano das unidades críticas, a repetição de rotinas que comprometem a segurança do paciente. A incompatibilidade poderá ser teoricamente diminuída, quando houver ênfase nas medidas preventivas e na contínua educação da equipe multidisciplinar.

Introduction: Drug incompatibility results from a physicochemical phenomenon caused by the combination of two or more drugs in the same solution or mixed in a single container. It can be considered a medication error due to its potential to compromise the treatment. Objective: To estimate the incidence of potential incompatibilities of drugs administered intravenously and associated factors in critically ill patients. Methods: Retrospective cohort study conducted with patients in Intensive and Semi-intensive Care Units at the University Hospital of the University of São Paulo. The sample consisted of 110 adults hospitalized for, at least 72 hours, in these units and submitted to intravenous therapy. The potential drug incompatibility was analyzed in pairs of drugs, using the TM Trissel\'s 2 Compatibility IV tool through Micromedex 2.0® database. The dependent variable was the occurrence of incompatibility. The independent variables were age, gender, origin, type of admission, length of stay, SAPSII, Charlson index, nursing workload (NAS), discharge condition, infusion mode, number of prescription drugs and prescribers. To analyze the data we used the chi-squared Pearson tests, Fisher Exact test, Kruskal-Wallis, ANOVA model and logistic regression, with significance p 0.05. Results: The incidence of potential incompatibility of drugs was 2.7%. Seventy-two 72 different types of drugs were prescribed forming 565 pairs of which 44.9% were compatible and 8.8%, incompatible. The precipitation onset (50.0%) was most identified physical-chemical change after the combinations via device Y.In frequency of appearance, the pairs of drugs formed by phenytoin (32.0%), diazepam (14.0%), midazolam (10.0%) and dobutamine (8.0%) were the most identified. About 70% of the patients received prescription drugs to medical criteria, especially during the night. Risk factors associated with the incompatibility were origin (OR: 1.506; CI: 0.327 to 6.934); prolonged length of stay in the units (OR: 1.175; CI: 1.058 to 1.306); greater number of prescribed medications (OR: 1.395; CI: 1.091 -1.784) and high nursing workload (OR: 1.060; CI: 1.010 -1.113). Conclusion: The number of prescription drugs to critically ill patients, due to the clinical severity, exponentially increases the occurrence of incompatibility and exposes them to serious consequences. Although there are other studies that identify the potential incompatibilities, we observe, in the daily life of critical units, repeating routines that compromise patient safety. Incompatibility can be theoretically reduced when there is emphasis on preventive measures and continuous education of the multidisciplinary team.

Study on incompatibility of traditional Chinese medicines / 中国中药杂志

The incompatibility of traditional Chinese medicines is related to the clinical medication safety, so has attracted wide attentions from the public. With the deepening of studies on the incompatibility of traditional Chinese medicines represented by 18 incompatible herbs, the incompatibility of theory traditional Chinese medicines has raised to new heights. From the origin of incompatibility theory of traditional Chinese medicines, relationship of herbs, harms of incompatible herbs and principle of prevention to toxic effects of specific incompatible medicines, the innovation and development of the traditional Chinese medicine incompatibility theory was explored. Structurally, the incompatibility of traditional Chinese medicines refers to the opposition of two herbs based on seven emotions and clinical experience. The combination of incompatible herbs may lead to human harms, especially latent harm and inefficacy of intervention medicines. The avoidance of the combination of incompatible herbs and the consideration of both symptoms and drug efficacy are the basic method to prevent adverse reactions. The recent studies have revealed five characteristics of incompatible herbs. Toxicity potentiation, toxication, efficacy reduction and inefficacy are the four manifestations of the incompatible relations. The material changes can reflect the effects of toxicity potentiation and toxication of opposite herbs. The accumulation of toxicity and metabolic changes are the basis for latent harms. The antagonistic effect of main efficacies and the coexistence of positive and negative effects are the distinctive part of the incompatibility. The connotation of incompatible herbs plays an important role in the innovation of the traditional Chinese medicine incompatibility theory.

Clinical study on aconite prescriptions with incompatible herbs in different areas based on association rules and analysis on compatibility features / 中国中药杂志

<p><b>OBJECTIVE</b>To explore the current application and features of Aconite prescriptions with incompatible herbs in grade A class three hospitals in east China and central China through a clinical study and comparative analysis.</p><p><b>METHOD</b>Clinical prescriptions containing Aconite with incompatible herbs were collected. Association rules were utilized to analyze the compatible features of these herbs.</p><p><b>RESULT</b>This analysis found that the frequently used incompatible herba; pairs are Aconiti Lateralis Radix Praeparata-Pinelliae Rhizoma, with the support rate of 44.45%, occupying nearly half of the surveyed prescriptions; Pinelliae Rhizoma is the most frequently used herb in the two areas, with support rate up to 76.24%. Among the top 10 herbal pairs in the support rate, except for Aconiti Lateralis Radix Praeparata and Pinelliae Rhizoma, the top 10 herbs in Central China were mostly for warming the middle jiao and tonifying qi, such as Zingiberis Rhizoma, Atractylodis Macrocephalae Rhizoma and Codonopsis Radix; Whereas those in east China were mostly for activating and nourishing blood, such as Angelicae Sinensis Radix, Chuanxiong Rhizoma, and Salviae Miltiorrhizae Radix et Rhizoma. Among the top 10 herbal pairs in the support rate, except for Aconiti Lateralis Radix Praeparata-Pinelliae Rhizoma, the core herbal pairs applied in central China were mainly for resolving phlegm and warming the middle jiao, such as Pinelliae Rhizoma-Glycyrrhizae Radix et Rhizoma, Pinelliae Rhizoma-Zingiberis Rhizoma; Whereas those in east China were principally for activating blood and tonifying qi, like Atractylodis Macrocephalae Rhizoma and Pinelliae Rhizoma, Angelicae Sinensis Radix and Pinelliae Rhizoma. Among the core herbal groups in the two areas, the most frequently used herbal groups in the two areas are Aconiti Lateralis Radix Praeparata, Glycyrrhizae Radix et Rhizoma and Pinelliae Rhizoma with the support rate of 59.73%, accounting for the highest proportion among all of herbal groups.</p><p><b>CONCLUSION</b>There are the combined clinical application of Aconite with incompatible herbs, mostly with Aconiti Lateralis Radix Praeparata-Pinelliae Rhizoma, but with differences in the combined application in east China and central China.</p>

Compatibility and stability of polygeline [Haemaccel] with different drug products

Compatibility and stability of the polygeline-based blood plasma expander/plasma substitute Haemaccel with different drug products i.e., Profenid, Stemetil, and Lasix were examined in the context of its potential use in surgical, spinal, septic shock and in circulatory insufficiency, because treatment, safety, acceptability and efficacy of drug product may be affected by drug instability or incompatibility. Therefore, drug stability and compatibility are critical elements in accurate and appropriate delivery of drug therapy to patients. This study was initiated to specifically and critically assess the compatibility of Haemaccel with different drug products with the aim of delivering safe, suitable, acceptable and efficacious administration of two different drug products simultaneously in emergency conditions. All of these different brands of drug products were physically and chemically compatible with Haemaccel and all of the test results were almost similar before and after mixing different drugs in Haemaccel. This study revealed that Lasix, Profenid and Stemetil can be administered/co-administered with Haemaccel safely. Different drug product must be studies in detail before it's co-administration with Haemaccel

Regularity of drugs compatibility of anti-hepatoma traditional Chinese medicine ancient prescriptions and risk evaluation of anti-hepatoma new drug research and development / 中国中药杂志

Traditional Chinese ancient prescriptions have been used for treatment of liver cancer for a long history and the scientific and rational compatibility is a great wealth for modern research and development (R&D) of new drugs. The research and development of new drugs are often accompanied with a large investment, a long cycle and a high risk, especially for the anti-tumor drugs R&D which are facing more risks and lower successful rate. In this research, the regularity of compatibility of drugs was analyzed from 124 anti-hepatoma ancient prescriptions by computer program. The results can offer help to the R&D of anti-hepatoma new drugs and reduce the risk of drug screening. In addition, we surveyed 22 companies in this field from six provinces such as Beijing, Shanghai, Tianjin and so on and obtained 240 risk assessment questionaires. Then we used qualitative analysis method to interpret the greatest impacts for the risks in the process of R&D, production and sales of anti-hepatoma new drugs. The study provides a basis for anti-liver cancer drugs R&D researchers, who can take effective measures to reduce the R&D risks and improve successful rate.

Effect of different compatibility of zhizi dahuang decoction on pharmacokinetics of naringenin and hesperetin / 中国中药杂志

An HPLC-UV method was developed for the determination of total naringenin and total hesperetin in rat plasma after oral administration of Citrus aurantium Immaturus extracts and Zhizi Dahuang decoction. Plasma samples were pretreated with liquid-liquid extraction procedure and acid hydrolysis method was used for converting conjugated naringenin and hesperetin to their respective free forms. Plasma samples were separated on a C18 column (4.6 mm x 150 mm, 5 microm), using 0.1% phosphoric acid and methanol as mobile phase at a flow rate of 1.0 mL x min(-1) with gradient elution. DAS 2.0 software was applied to calculate the pharmacokinetic parameters while the SPSS 16.0 software was used for statistical analysis. Significant differences were observed, the C(max) AUC(0-t) of total naringenin in ZS group was 73.5% and 65.9% higher than those in ZZDHD group, respectively; the C(max), AUC(0-t) of total hesperetin in ZS group was 63.5% and 119.1% higher than those in ZZDHD group, respectively. There is a obvious decrease in C(max) and AUC(0-t) of total naringenin and total hesperetin after compatibility and their pharmacokinetic characteristics changed greatly due to the combination of other herbs. The established method was rapid, sensitive, selective and accurate, and it could be applied in the determination of total naringenin and total hesperetin in rat plasma.

Applications of mathematical statistics methods on compatibility researches of traditional Chinese medicines formulae / 中国中药杂志

The compatibility of traditional Chinese medicines (TCMs) formulae containing enormous information, is a complex component system. Applications of mathematical statistics methods on the compatibility researches of traditional Chinese medicines formulae have great significance for promoting the modernization of traditional Chinese medicines and improving clinical efficacies and optimizations of formulae. As a tool for quantitative analysis, data inference and exploring inherent rules of substances, the mathematical statistics method can be used to reveal the working mechanisms of the compatibility of traditional Chinese medicines formulae in qualitatively and quantitatively. By reviewing studies based on the applications of mathematical statistics methods, this paper were summarized from perspective of dosages optimization, efficacies and changes of chemical components as well as the rules of incompatibility and contraindication of formulae, will provide the references for further studying and revealing the working mechanisms and the connotations of traditional Chinese medicines.

Compatibilidad química del piracetam determinada por calorimetría diferencial de barrido / Chemical compatibility of piracetam determined by differential scanning calorimetry

Introducción: en la primera etapa de preformulación de un medicamento se seleccionan los excipientes y es importante la realización de los estudios de compatibilidad química entre el ingrediente activo farmacéutico (IFA) y excipientes. Una de las técnicas más rápidas para realizar dichos estudios es la Calorimetría diferencial de barrido (DSC), y como técnica complementaria la Termogravimetría (TG). Objetivo: empleando DSC y TG, se realiza un estudio de compatibilidad química entre IFA y excipientes preseleccionados, para comprobar la existencia o no de interacción química. Métodos: el equipo empleado fue el TA3000Mettler, aco­plado a la celda DSC20 y al horno TG50. El IFA utilizado fue Piracetam, y los excipientes: Kollidon VA 64, Estearato de magnesio, Celulosa microcristalina, Polietilenglicol 20 000 y Aerosil. Dichos excipientes se caracterizaron por DSC al igual que el IFA, al cual se le detectó la transición física de fusión. Para el estudio de compatibilidad se prepararon mezclas físicas binarias en una relación de concentración 1:1 Resultados: la figura 1 muestra la detección del punto de fusión por DSC del IFA. Se obtuvieron dos transiciones endotérmicas, comprobándose por TG cuál era la de fusión. La figura 2 muestra los termogramas de las mezclas formadas entre IFA y excipientes. Conclusiones: no se detectó aparición de nuevos picos, por lo que se infiere que no hay incompatibilidad química entre las sustancias estudiadas y se recomienda el uso de los excipientes para el desarrollo de la formulación farmacéutica

Introduction: the first phase of the drug preformulation comprises the selection of excipients and the conduction of studies on chemical compatibility between pharmacologically active ingredient and the excipients. One of the quickest techniques is the differential scanning calorimetry and the supplementary technique called thermogravimetic analysis. Objective: to conduct a chemical compatibility study of the pharmacologically active ingredient and of the preselected excipients by using differential scanning calorimentry (DSC) and thermogravimetric analysis (TG), in order to confirm the chemical interaction between them. Methods: this study used the thermal analysis equipment TA 3000 Mettler, coupled with the DSC 20 cell and the TG50 oven. The pharmacologically active ingredient was Piracetam and the excipients were Aerosil Kollidon VA64, magnesium stearate, microcrystalline cellulose, Polyethylene glycol 20 000. The differential scanning calorimetry characterized the excipients and the pharmacologically active ingredient as well, whose physical fusion transition was determined. Some binary physical mixtures with a concentration ratio of 1:1 were prepared to study compatibility. Results: figure 1 showed the pharmacologically active ingredient´s fusion point detection. Two endothermal transitions were determined as well as the fusion transition by the TG equipment. Figure 2 showed the thermograms of mixtures between pharmacologically active ingredient and excipients. Conclusions: the occurrence of new peaks was bit detected, so it was inferred from this study that there was no chemical incompatibility between the studied substances, and the excipients are recommended for the development of the final pharmaceutical formulation

Research on the incompatibility of Radix adenophora, Radix glehniae combined with Veratrum nigrum L. by uniform designed toxicity assay / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To study the toxicity changes of different proportions of Radix Adenophora, Radix Glehniae combined with Veratrum nigrum L., thus providing acute toxicity data and investigating whether decoction factors were correlated with toxicity.</p><p><b>METHODS</b>The uniform design method was used by two factors and seven levels to investigate the toxicity changes in different proportions of Radix Adenophora, Radix Glehniae combined with Veratrum nigrum L. The decoction factors were also investigated.</p><p><b>RESULTS</b>The compatibility toxicity was affected mainly by Veratrum nigrum L. and the toxicity increased along with increased doses of Veratrum nigrum L. The toxicity of co-decoction was higher than mixed decoction in the same dosage of Radix Glehniae and Veratrum nigrum L. The promotion of the dissolution of the toxic component of Veratrum nigrum L. in co-decoction may be the cause of the higher toxicity.</p><p><b>CONCLUSION</b>Radix Adenophora and Radix Glehniae combined with Veratrum nigrum L. resulted in higher toxicity, which indicated that the incompatibility between Radix Adenophora, Radix Glehniae, and Veratrum nigrum L. In clinic practice, a prescription contained these drugs should be avoided.</p>

Study on the law of compatibility in three categorized formulas for tonifying Shen Yang: Shenqi pill, Yougui pill, and Yougui drink based on rough set / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of three categorized formulas for tonifying Shen yang, i.e. Shenqi Pill (SP), Yougui Pill (YP), and Yougui Drink (YD) based on rough set, thus exploring the law of compatibility between the core herbs and the edge herbs as well as the law of compatibility between the yang-tonifying herbs and the yin-tonifying herbs in the core herbs.</p><p><b>METHODS</b>The rats were divided into the normal group, the Shen-yang deficiency model group, and the original prescription group, the core herbs group, and the edge herbs group of this three categorized formulas for tonifying Shen yang, 11 groups altogether. Thyroxine (T4), cortisol (CORT), and testosterone (T) were detected respectively. The decision rules model based on rough set was set up, the interactions between various herbs were analyzed according to the decision rules.</p><p><b>RESULTS</b>There were synergies between yam and cinnamon, yam and aconite, as well as yam and wolfberry. Poria alisma, Cortex Moutan, and oriental waterplantain tuber had no effect themselves, but they had synergistic effects with the core herbs in SP. Angelica had a certain effect itself, but its functions were different to different core herbs in YP. Licorice had no effect itself, and it was antagonistic with the core herbs in YD.</p><p><b>CONCLUSIONS</b>The compatibility of core herbs of categorized formula for tonifying Shen yang should focus on benefiting both yin and yang, as well as mutual rooting of yin-yang. Appropriate edge herbs should be chosen for compatibility according to different core herbs. The decision rules model based on rough set has a good prospect in exploring the law of compatibility of the categorized formulas.</p>

Gerenciando a segurança da clientela pediátrica nas incompatibilidades medicamentosas em uso do metotrexato endovenoso / Managing Safety in Pediatric Clients Incompatibilities in Drug Use Intravenous Methotrexate

A terapia com vários fármacos é a regra na quimioterapia antineoplásica e no tratamento de determinadas doenças infecciosas. Nesses casos os objetivos consistem na melhora da eficácia terapêutica e no retardo da emergência de células malignas ou de microrganismos resistentes aos efeitos dos fármacos disponíveis. Nas prescrições, das crianças internadas com patologias oncológicas, identificou-se como principal quimioterápico o Metotrexato (MTX), perfazendo um total de 3 a 4 doses por prescrição no tratamento de linfomas não Hodgkin e leucemias linfoides agudas. A interação farmacológica ocorre, quando um fármaco interfere com outros, alterando o efeito esperado, podendo ser prejudicial, á medida que causa aumento de riscos ao paciente. As interações farmacêuticas, também chamadas incompatibilidades medicamentosas, caracterizam-se por ocorrerem in vitro, isso é antes da administração no organismo, quando misturado dois ou mais fármacos em uma mesma seringa, equipo de soro ou outros recipientes. Objeto de estudo: As incompatibilidades físico-químicas dos medicamentos durante o ciclo de infusão do MTX endovenoso na clientela pediátrica com LLA e Linfoma não Hodgkin. Hipotese: O aprazamento de medicamentos concomitante a infusão do Metotrexato (MTX), realizado pelo enfermeiro, podem causar incompatibilidades que diminuem ou potencializam o efeito terapêutico deste quimioterápico. Objetivos: Traçar o perfil do tratamento farmacológico das crianças com LLA e LNH, durante o ciclo do MTX internadas na unidade pediátrica; verificar a prevalência das incompatibilidades físico-químicas entre os medicamentos administrados via endovenosa nas crianças com LLA e LNH, internadas na UP; estabelecer diretrizes para a Gerência do Cuidado de Enfermagem à crianças com LLA e LNH em uso de MTX endovenoso com a criação de um protocolo de aprazamento e administração. Foi um estudo observacional transversal, com abordagem quantitativa dos dados. A mostra foi composta por 13 pacientes com LLA e LNH, que atenderam os critérios de inclusão deste estudo, dos quais emergiram 86 prescrições. Os dados foram coletados no período de janeiro de 2008 à dezembro de 2011 e sofreram estatística descritiva e foi calculado a prevalência das incompatibilidades medicamentosas. O sexo masculino apresentou 61,5% da amostra, enquanto o feminino 38,5%; LLA com 85,6% e LNH com 15,2%; 100% de acessos centrais monolumen. Os eletrólitos apresentaram o maior numero de doses administradas, seguido do antiemético, e dos quimioterápicos. A interação medicamentosa do tipo farmacêutica, de maior prevalência foi a entre o cloridrato de ondansetrona e o bicarbonato de sódio a 8,4%, seguida da entre o cloridrato de midazolan e o bicarbonato de sódio. A pesquisa contribui para que o enfermeiro, se aproprie ainda mais dos conhecimentos relacionados a farmacocinética, farmacodinâmica e farmacêutica, assim como sobre as reações adversas medicamentosas, para que possam realizar a gerência do cuidado, no que tange toda a dinâmica da terapia medicamentosas, ou seja, uma assistência de enfermagem segura, livre de danos, sejam eles temporários ou permanentes, assegurando que os pacientes permaneçam o mínimo possível no ambiente hospitalar, assim como ter uma terapêutica medicamentosa com o resultado final que é a prevenção ou cura de doenças, e também eficácia nos tratamentos paliativo

Therapy with multiple drugs is the rule in cancer chemotherapy and in the treatment of certain infectious diseases. In such cases the objectives consist in improving the therapeutic efficacy and delay the emergence of malignant cells or microorganisms resistant to the effects of available drugs. In the prescriptions of children with oncological diseases, was identified as the main chemotherapeutic methotrexate (MTX), making a total of 3 to 4 doses per prescription in the treatment of non-Hodgkin lymphomas and acute lymphoid leukemias. The pharmacological interaction occurs, when a drug interferes with other, changing the desired effect and may be harmful, as will cause the patient to increased risks. The drug interactions, also called drug incompatibilities, characterized by occur in vitro that is prior to administration in the body, when two or more components mixed in one syringe, serum catheter or other containers. Object of study: The physicochemical incompatibilities of drugs during the course of intravenous infusion of MTX in pediatric clients with ALL and non-Hodgkin's lymphoma. Hypothesis: The scheduling of drugs concomitant infusion of methotrexate (MTX), performed by the nurse, can cause incompatibilities that reduce or enhance the therapeutic effect of chemotherapy. Objectives: To describe the pharmacological treatment of children with ALL and NHL, during the cycle of MTX admitted to the pediatric unit and verify the prevalence of physical and chemical incompatibilities between drugs administered intravenously in children with ALL and NHL, admitted in UP; establish guidelines for the Management of Nursing Care for children with ALL and NHL in MTX intravenously with the creation of a protocol for scheduling and administration. It was an observational cross-sectional quantitative data approach. The show was comprised of 13 patients with ALL and NHL, who met the study inclusion criteria, 86 of which emerged prescriptions. Data were collected from January 2008 to December 2011 and suffered descriptive statistics and calculated the prevalence of drug incompatibilities. The male group showed 61.5% of the sample, while females 38.5%, 85.6% with ALL and NHL with 15.2%, 100% hits central monolumen. Electrolytes showed the highest number of doses administered, followed by an anti-emetic, and chemotherapy. The type of pharmaceutical drug interaction, was the most prevalent of the ondansetron hydrochloride and sodium bicarbonate to 8.4%, followed by between midazolam hydrochloride and sodium bicarbonate. The research contributes to the nurse, to appropriate further knowledge related to pharmacokinetics, pharmacodynamics, and pharmaceutical, as well as on adverse drug reactions so that they can carry out care management, regarding the dynamics of drug therapy, or is a safe nursing care, free of damage, whether temporary or permanent, ensuring that patients remain as little as possible in the hospital environment, as well as having a drug therapy with the end result is the prevention or cure of diseases, and also effective in the palliative treatment

El tratamiento con múltiples fármacos es la regla en la quimioterapia del cáncer y en el tratamiento de ciertas enfermedades infecciosas. En tales casos, los objetivos consisten en la mejora de la eficacia terapéutica y retrasar la aparición de células malignas o microorganismos resistentes a los efectos de los fármacos disponibles. En las prescripciones de los niños con enfermedades oncológicas, fue identificado como el principal de la quimioterapia con metotrexato (MTX), haciendo un total de 3 a 4 dosis por receta en el tratamiento de los linfomas no Hodgkin y leucemias linfoides agudas. La interacción farmacológica ocurre cuando un medicamento interfiere con la otra, cambiando el efecto deseado y puede ser perjudicial, ya que hará que el paciente a un mayor riesgo. Las interacciones de medicamentos, también llamados incompatibilidades de drogas, caracterizado por producirse in vitro que es antes de la administración en el cuerpo, cuando dos o más componentes mezclados en una jeringa, catéter suero u otros recipientes. objeto de estudio: Las incompatibilidades físico-químicas de las drogas durante el curso de la infusión intravenosa de MTX en clientes pediátricos con LLA y no-Hodgkin. Hipótesis: La programación de las drogas de infusión concomitante de metotrexato (MTX), realizado por la enfermera, puede provocar incompatibilidades que reducen o aumentan el efecto terapéutico de la quimioterapia. Objetivos: Describir el tratamiento farmacológico de los niños con LLA y linfoma no Hodgkin, durante el ciclo de MTX ingresados en la unidad pediátrica y verificar la prevalencia de incompatibilidades físicas y químicas entre los fármacos administrados por vía intravenosa en niños con LLA y la NHL, admitió en la UP; establecer directrices para la Gestión de Cuidados de Enfermería para los niños con LLA y linfoma no Hodgkin en el MTX por vía intravenosa con la creación de un protocolo para la programación y administración. Fue un estudio observacional transversal enfoque cuantitativo de los datos. La muestra estaba compuesta por 13 pacientes con LLA y la NHL, que cumplieron con los criterios de inclusión del estudio, el 86 de los cuales surgieron las recetas. Los datos fueron recogidos entre enero de 2008 diciembre de 2011 y sufrió la estadística descriptiva y se calculó la prevalencia de las incompatibilidades de la droga. El grupo masculino mostró un 61,5% de la muestra, mientras que las mujeres 38,5%, 85,6% con todos y la NHL, con un 15,2%, 100% llega a monolumen centrales. Los electrolitos mostró el mayor número de dosis administradas, seguida de un antiemético, y la quimioterapia. El tipo de interacción fármaco, fue la más frecuente de la clorhidrato de ondansetrón y bicarbonato de sodio al 8,4%, seguido por entre el clorhidrato de midazolam y bicarbonato de sodio. La investigación contribuye a la enfermera, a un conocimiento adecuado adicional relacionada con la farmacocinética, la farmacodinamia y farmacéutica, así como sobre las reacciones adversas a los medicamentos para que puedan llevar a cabo la gestión de la atención, en cuanto a la dinámica de la terapia con medicamentos, o es un cuidado de enfermería seguro, libre de daño, ya sea temporal o permanente, asegurando que los pacientes permanecen tan poco como sea posible en el ambiente hospitalario, así como tener una terapia con medicamentos con el resultado final es la prevención o curación de enfermedades, y también eficaz en el tratamiento paliativo