Preventable adverse drug events in critically ill HIV patients: Is the detection of potential drug-drug interactions a useful tool?

OBJECTIVES: The aim of this study was to develop a strategy to identify adverse drug events associated with drug-drug interactions by analyzing the prescriptions of critically ill patients. METHODS: This retrospective study included HIV/AIDS patients who were admitted to an intensive care unit between November 2006 and September 2008. Data were collected in two stages. In the first stage, three prescriptions administered throughout the entire duration of these patients' hospitalization were reviewed, with the Micromedex database used to search for potential drug-drug interactions. In the second stage, a search for adverse drug events in all available medical, nursing and laboratory records was performed. The probability that a drug-drug interaction caused each adverse drug events was assessed using the Naranjo algorithm. RESULTS: A total of 186 drug prescriptions of 62 HIV/AIDS patients were analyzed. There were 331 potential drug-drug interactions, and 9% of these potential interactions resulted in adverse drug events in 16 patients; these adverse drug events included treatment failure (16.7%) and adverse reactions (83.3%). Most of the adverse drug reactions were classified as possible based on the Naranjo algorithm. CONCLUSIONS: The approach used in this study allowed for the detection of adverse drug events related to 9% of the potential drug-drug interactions that were identified; these adverse drug events affected 26% of the study population. With the monitoring of adverse drug events based on prescriptions, a combination of the evaluation of potential drug-drug interactions by clinical pharmacy services and the monitoring of critically ill patients is an effective strategy that can be used as a complementary tool for safety assessments and the prevention of adverse drug events.

Estudio comparativo de los efectos antivirales de agentes antioxidantes: N-acetilcisteína y ácido ascórbico e inmunosupresores: Ciclosporina A y tacrolimus en células crónicamente infectadas con el virus de la inmunodeficiencias felina / Comparative study of the antiviral effects of antioxidants, N-acetylcysteine and ascorbic acid and two immunosuppressive agents, cyclosporin A and tracrolimus in a feline cell line chronically infected with feline immunodeficiency virus

En el presente trabajo, se examinan y comparan los efectos a largo plazo de dos antioxidantes: N-acetilcisteína (NAC) y ácido ascórbico (AA), con dos agentes inmunosupresores: Ciclosporina A (CsA) y tacrolimus (también conocido como FK506) sobre la replicación viral y la apoptosis en cultivos de una línea celular de fibroblastos felinos crónicamente infectada con el virus de la inmunodeficiencia felina (VIF). En las células tratadas con NAC o AA se detectó una inhibición significativa de la replicación viral y la apoptosis, luego del agregado del factor de necrosis tumoral-alfa (TNF-a ). Cuando las células fueron tratadas con los agentes inmunosupresores CsA y FK506, la replicación viral y la apoptosis descendieron en forma similar a lo hallado con el uso de los antioxidantes. La inhibición del virus VIF en los cultivos tratados con cualquiera de los fármacos utilizados, persistió durante el tiempo que duró la suplementación de las mismas. Sobre la base de estos resultados in vitro, que muestran la eficacia de cada componente sobre la replicación viral y la apoptosis, podría sugerirse que el mejor camino para retrasar la aparición del síndrome de inmunodeficiencia adquirida es a través del uso inteligente de una combinación de terapias.