Uso de antiinflamatorios no esteroideos y monitorización de la función renal. Estudio piloto en un centro de salud de Atención Primaria / Renal function assessment in non-steroidal anti-inflammatory drug prescriptions. A pilot study in a primary care centre

Objetivos: Conocer el estado actual del seguimiento de la función renal realizada a los pacientes tratados con antiinflamatorios no esteroideos (AINE). Material y métodos: Se seleccionaron los pacientes adultos atendidos en un centro de Atención Primaria de la Comunidad de Madrid que recibieron algún AINE por primera vez. Se analizó si durante los 2 meses previos y los 6 posteriores a la prescripción del AINE se conocía la función renal. Resultados: Durante el período de estudio se registraron 42.822 prescripciones. Un total de 8611 figuran como nuevas prescripciones, 482 de las cuales (5,6 %) fueron prescripción de AINE y se realizaron en pacientes mayores de 14 años. Recibieron algún AINE 450 pacientes (64 % mujeres). Ibuprofeno (66,0 %) fue el más frecuentemente prescrito. El grupo de edad con más prescripciones de AINE fue el de 14-45 años. Solo 168 (37,1 %) cuentan con alguna analítica solicitada durante el estudio (68 % mujeres). Antes de recibir AINE, solo en el 14 % (63 pacientes) se conocía el valor de creatinina sérica. Dos pacientes recibieron AINE pese a tener cifras elevadas de creatinina. Tras la prescripción se solicitó creatinina sérica en 129 pacientes (28,7 %). Conclusiones: Se prescribe un número importante de AINE. El más utilizado es el ibuprofeno. Las prescripciones son más frecuentes en mujeres y en personas de entre 14-45 años de edad. El dolor musculoesquelético es la causa principal de esta indicación. Solo en el 14 % de los pacientes a los que se les trató con AINE se conocía el valor de creatinina, que no siempre se tuvo en cuenta a la hora de la prescripción. El control de la función renal tras prescribir AINE fue porcentualmente bajo (AU)

Objectives: To determine the current state of renal function monitoring carried out on patients treated with NSAIDs. Material and Method: We selected patients from a Primary Care Centre who had received NSAIDs for the first time. We checked if renal function was measured and/or controlled 2 months pre/6 months post-NSAID administration in order to assess if patient renal function was known at the time of prescription and afterwards. Results: During the study period, there were 42 822 prescriptions made. Of these, 8611 were new drug prescriptions, of which 482 (5.6%) were NSAIDs in patients older than 14 years of age. A total of 450 patients (64% female) were treated with NSAIDs. Ibuprofen (66.0%) was the most commonly prescribed. NSAIDs were more frequently used in patients between 14-45 years of age. Only 168 (37.1%) patients underwent any analytical tests over the course of the study (68% female). Before prescription, renal function was measured in only 14% of cases (63 patients). Two patients received NSAIDs despite having high serum creatinine levels. During the follow-up, serum creatinine was measured in 129 patients (28.7%). Conclusions: In primary care, NSAIDs represent a substantial percentage of the drugs prescribed (5.6%). Ibuprofen is the most commonly prescribed. NSAIDs are more frequently used in women between 14-45 years. Musculo-skeletal pain is the main indication for prescription. Only 14% of patients receiving these drugs had previously measured levels of serum creatinine. These values are rarely taken into account when prescribing NSAIDs. Control of renal function after NSAID prescription was unusual (AU)

Renal function assessment in non-steroidal anti-inflammatory drug prescriptions. A pilot study in a primary care centre.

OBJECTIVES: To determine the current state of renal function monitoring carried out on patients treated with NSAIDs. MATERIAL AND METHOD: We selected patients from a Primary Care Centre who had received NSAIDs for the first time. We checked if renal function was measured and/or controlled 2 months pre/6 months post-NSAID administration in order to assess if patient renal function was known at the time of prescription and afterwards. RESULTS: During the study period, there were 42 822 prescriptions made. Of these, 8611 were new drug prescriptions, of which 482 (5.6%) were NSAIDs in patients older than 14 years of age. A total of 450 patients (64% female) were treated with NSAIDs. Ibuprofen (66.0%) was the most commonly prescribed. NSAIDs were more frequently used in patients between 14-45 years of age. Only 168 (37.1%) patients underwent any analytical tests over the course of the study (68% female). Before prescription, renal function was measured in only 14% of cases (63 patients). Two patients received NSAIDs despite having high serum creatinine levels. During the follow-up, serum creatinine was measured in 129 patients (28.7%). CONCLUSIONS: In primary care, NSAIDs represent a substantial percentage of the drugs prescribed (5.6%). Ibuprofen is the most commonly prescribed. NSAIDs are more frequently used in women between 14-45 years. Musculo-skeletal pain is the main indication for prescription. Only 14% of patients receiving these drugs had previously measured levels of serum creatinine. These values are rarely taken into account when prescribing NSAIDs. Control of renal function after NSAID prescription was unusual.

Pharmacokinetics and pharmacodynamics of a single bolus of propofol 2% in healthy volunteers.

This study was undertaken to assess the bioequivalence between a new formulation of propofol 2% and the commercially available product Diprivan. Secondary objectives were to compare the times to onset of and emergence from hypnosis, the hemodynamic effects, and the safety profiles. Twelve healthy male volunteers were included in a randomized crossover study. Subjects were administered a 2-mg/kg single bolus injection of each formulation separated by a 7- to 10-day washout period. Plasma propofol was determined by reversed-phase liquid chromatography with fluorescence detection. Eleven subjects completed the study, and both formulations were considered bioequivalent. There were no serious or severe adverse events. The concentration-time profiles of all the subjects could adequately be described using a three-compartment model. The mean times to cessation of counting out loud (17 vs. 18 s) and to eye opening (245 vs. 244 s) were not statistically different between treatment groups. Moreover, they seem to show some degree of pharmacodynamic bioequivalence, although a higher number of subjects are necessary to unequivocally demonstrate it.

Survey of oral hydrocortisone utilization in Madrid (Spain).

A progressive 69% increase in sales of hydrocortisone tablets was observed in Spain from 1988 to 1995. But there were no data suggesting an increase in the number of adrenal insufficiency cases. We aimed to assess the hydrocortisone prescription habits of physicians in 1996 in Madrid (Spain). An anonymous mail questionnaire was sent to 6130 randomly selected physicians (3345 generalists and 2785 specialists) of Madrid. Five hundred and forty-six questionnaires (8.8%) were returned. Three hundred and eighteen physicians (58.2%) sometimes prescribed oral hydrocortisone. 70.8% of these physicians prescribed hydrocortisone for chronic adrenal insufficiency, 17.3% for acute adrenal insufficiency, 7.9% for congenital adrenal hyperplasia, and 30.2% for inflammatory diseases (asthma, allergic diseases, urticaria, rheumatic diseases, ulcerative colitis). Prescription for inflammatory diseases was more frequent in male physicians, physicians older than 40 years, and general practitioners. We can conclude that the main indication for hydrocortisone prescription was chronic adrenal insufficiency but there was a significant number of physicians that used the drug in inflammatory diseases. As a drastic increase in prevalence of adrenal insufficiency seems unlikely, the augmentation in sales of hydrocortisone could be explained by its prescription for other pathologies.