[Health promotion and prevention : what role for community pharmacists ?] / Prévention et promotion de la santé : quels rôles pour le pharmacien d'officine ?

Belgian community pharmacists play a pivotal role in both primary and tertiary preventive health activities. Their involvement extends beyond the pharmaceutical care associated with dispensing to include innovative services such as medication review. Additionally, they offer therapeutic education sessions to patients as part of the «Good Use of Medicines¼ programme. The recent pandemic has precipitated significant changes in pharmacists' responsibilities: they have been temporarily granted authority to prescribe and administer vaccines for COVID-19 and influenza, as well as to perform nasopharyngeal screenings for SARS-CoV-2. As frontline healthcare providers, pharmacists have the potential to expand their role in secondary prevention, particularly in screening and providing diagnostic guidance using in vitro diagnostic medical assays. The skills developed in the vaccination domain could be leveraged to enhance vaccination coverage for other diseases, emulating models used in other countries. Furthermore, the challenges posed by climate change present opportunities for pharmacists to contribute meaningfully to public health.

Le pharmacien d'officine belge participe activement aux activités de prévention primaire et tertiaire, non seulement par le biais des soins pharmaceutiques accompagnant la délivrance de médicaments ou dispositifs médicaux, mais aussi via les nouveaux services, comme la revue de la médication. Il réalise aussi des séances d'éducation thérapeutique des patients dans le cadre des entretiens d'accompagnement de Bon Usage des Médicaments (BUM). La récente pandémie a mené à une évolution rapide des missions confiées au pharmacien : il est maintenant (temporairement) autorisé à prescrire et à administrer les vaccins contre la COVID-19 et la grippe et à effectuer le dépistage nasopharyngé du SARS-CoV-2. Professionnel de santé de première ligne, le pharmacien pourrait remplir davantage de missions de prévention secondaire, notamment en matière de dépistage et d'orientation diagnostique au moyen de dispositifs médicaux de diagnostic in vitro. Les nouvelles compétences acquises en matière de vaccination pourraient être mises à profit pour contribuer à étendre la couverture vaccinale vis-à-vis d'autres pathologies, à l'instar des missions exercées par les pharmaciens d'officine à l'étranger. Enfin, les enjeux climatiques offrent de nouvelles perspectives.

Detection and management of clinically relevant drug-drug interactions with direct oral anticoagulants: an intervention study in community pharmacies.

INTRODUCTION: Direct oral anticoagulants (DOACs) are increasingly used and can be involved in clinically relevant drug-drug interactions (DDIs) that increase the risk of major bleeding or thromboembolism. Skilled drug interaction management is essential to ensure safe and effective use of DOACs. In this study, we aimed to investigate the impact of the detection and management of DDIs with DOACs in a real-life community pharmacy setting on the pharmacotherapy of DOAC users. METHODS: We conducted an intervention study in 201 community pharmacies in Belgium. On random days, patients purchasing DOACs or drugs known to interact with them were screened. When a DDI with the DOAC was detected, the pharmacist contacted the prescribing physician to discuss the management of the interaction. A previously developed practice-oriented DDI list accompanied by management plans for ambulatory care was used for both screening and management of the DDIs. RESULTS: In total, 751 patients were included, among whom 875 DDIs were identified, primarily pharmacodynamic DDIs (95.7 %). Predominant interacting drug classes included selective serotonin or serotonin and norepinephrine reuptake inhibitors (32.9 %), antiplatelets (30.9 %), and non-steroidal anti-inflammatory drugs (28.9 %). In 43.0 % of DDIs, an intervention was decided upon. At three-month follow-up, proposed pharmacotherapy changes had been implemented in 79.1 % of these DDIs. CONCLUSIONS: This study demonstrates that active screening and management of DDIs with DOACs in community pharmacies, in close collaboration with prescribing physicians, resulted in changes in pharmacotherapy in a substantial number of patients. This may contribute significantly to the safer utilisation of DOACs in high-risk populations.

Interpretative phenomenological analysis of the collaboration among healthcare professionals in the nursing home setting.

Background: The theory of planned behavior (TPB) postulates that behavioral performance is guided by the intention to perform that behavior, influenced by attitudes, subjective norms, and perceived behavioral control. This framework can be applied to studying interprofessional collaboration among healthcare professionals to enhance patient safety and public health within nursing homes. Objectives: This study aimed to explore the roles of physicians, pharmacists, and nurses in the interprofessional collaboration process while identifying facilitators and barriers to effective collaboration among healthcare professionals. Methods: A qualitative interpretative phenomenological analysis (IPA) was carried out. Individual semi-structured interviews were conducted with 19 healthcare professionals. Qualitative data were then integrated and analyzed through the lens of the TPB. Findings: The IPA revealed the ten following themes, considered as both facilitators and barriers to interprofessional collaboration among healthcare professionals in the nursing home setting: communication, roles and responsibilities, willingness and recognition of collaboration's importance, mutual knowledge, trust, confidence, support from decision-makers, protocols, and technology were considered as facilitators while distance was considered as a barrier. Conclusion: Enhancing pharmacist-physician collaboration and refining pharmacist-nurse collaboration were essential goals. Intention for collaboration was influenced by attitudes (such as communication and mutual understanding), subjective norms (including support from decision-makers), and perceived behavioral control (such as confidence and adherence to protocols and technology). Addressing these factors could improve collaboration, enhancing residents' quality of life and professionals' sense of achievement.

In vivo antimalarial activity of isosungucine, an indolomonoterpenic alkaloid from Strychnos icaja.

Isosungucine (1) is a quasi-symmetric bisindolomonoterpenoid alkaloid isolated from the roots of Strychnos icaja. The in vivo antimalarial activity against the P. vinckei petteri murine strain was determined. In the Peters 4-day suppressive test, 1 suppressed the parasitemia by almost 50 percent on day 4 at the dose of 30 mg/kg by intraperitoneal route.

Study of the interaction of antiplasmodial strychnine derivatives with the glycine receptor.

Strychnos icaja Baill. (Loganiaceae) is a liana found in Central Africa known to be an arrow and ordeal poison but also used by traditional medicine to treat malaria. Recently, many dimeric or trimeric indolomonoterpenic alkaloids with antiplasmodial properties have been isolated from its rootbark. Since these alkaloids are derivatives of strychnine, it was important, in view of their potential use as antimalarial drugs, to assess their possible convulsant strychnine-like properties. In that regard, their interaction with the strychnine-sensitive glycine receptor was investigated by whole-cell patch-clamp recordings on glycine-gated currents in mouse spinal cord neurons in culture and by [(3)H]strychnine competition assays on membranes from adult rat spinal cord. These experiments were carried out on sungucine (leading compound of the chemical class) and on the antiplasmodial strychnogucine B (dimeric) and strychnohexamine (trimeric). In comparison with strychnine, all compounds interact with a very poor efficacy and only at concentrations >1 microM with both [(3)H]strychnine binding and glycine-gated currents. Furthermore, the effects of strychnine and protostrychnine, a monomeric alkaloid (without antiplasmodial activity) also isolated from S. icaja and differing from strychnine only by a cycle opening, were compared in the same way. The weak interaction of protostrychnine confirms the importance of the G cycle ring structure in strychnine for its binding to the glycine receptor and its antagonist properties.

Recent developments in the field of arrow and dart poisons.

Arrow and dart poisons, considered as conventional natural sources for future drug discovery, have already provided numerous biologically active molecules used as drugs in therapeutic applications or in pharmacological research. Plants containing alkaloids or cardiotonic glycosides have generally been the main ingredients responsible for the efficacy of these poisons, although some animals, such as frogs, have also been employed. This paper, without being exhaustive, reports the greater strides made during the past 15 years in the understanding of the chemical nature and biological properties of arrow and dart poison constituents. Examples both of promising biological properties shown by these molecules and of crucial discoveries achieved by their use as pharmacological tools are given. Further studies of these toxic principles are likely to enable scientists to find new valuable lead compounds, useful in many fields of research, like oncology, inflammation and infectious diseases.

In vitro screening of some Strychnos species for antiplasmodial activity.

The antiplasmodial activity of crude extracts of 19 species of Strychnos (Loganiaceae) was assessed in vitro against a chloroquine-susceptible strain of Plasmodium falciparum. For each species, ethyl acetate (EtOAc) extracts were analysed and, for the most active species, methanolic (MeOH) extracts were also tested. Among them, Strychnos variabilis De Wild. seemed to be very promising (inhibitory concentration 50% (IC50) < 5 microg/ml) whereas two other species, Strychnos gossweileri Exell and Strychnos mellodora S. Moore, could be interesting (IC50 < 15 microg/ml) in further antimalarial studies.

About the toxicity of some Strychnos species and their alkaloids.

Poisons are widespread in plants and animals and humankind has often tried to turn them to its own advantage. Owing to their poisonous properties, some species of Strychnos genus have been employed mainly in hunting and fishing, as an adjunct to weapons used not only in the search of food and clothes, but also for preventing depredation by wild animals. They have been employed for martial and criminal purposes and also as a means of determining guilt or innocence. By their nature, poisons such as strychnine and curare affect the functioning of the victim's body; this also means that they have been, and are, an important source of pharmacological tools and medicines all over the world. With such potentially dangerous substances, care in medication is essential to avoid complications by overdose. All these points are approached in the present review.

In vitro and in vivo antimalarial properties of isostrychnopentamine, an indolomonoterpenic alkaloid from Strychnos usambarensis.

Isostrychnopentamine (ISP) is an asymmetric indolomonoterpenic alkaloid isolated from the leaves of Strychnos usambarensis. The in vitro antiplasmodial activities against five Plasmodium falciparum cell lines were evaluated: ISP possessed an in vitro IC (50) near 0.1 microM against all P. falciparum cell lines tested (chloroquine-resistant and chloroquine-sensitive lines) and showed antiplasmodial selectivity compared to cytotoxicity on human cell lines. The stage-dependent susceptibility to a short exposure of ISP was then investigated. The ring stage was shown to be the most sensitive one, but all stages were affected by ISP treatment. By means of fluorescence microscopy, it was shown that ISP was not accumulated inside the food vacuole of the parasite. Finally, the in vivo antimalarial activities against the P. berghei NK173 and P. vinckei petteri murine strains were determined. The ED (50) in vivo was about 30 mg/kg/day by the intraperitoneal route (after 4 days treatment).

Indolomonoterpenic alkaloids from Strychnos icaja roots.

In the course of our search for new antiplasmodial alkaloids from Strychnos icaja, we have isolated five alkaloids: three monomers, protostrychnine and genostrychnine, previously described in Strychnos nux-vomica, pseudostrychnine, already found in the leaves of the plant, a new bisindolic alkaloid, named strychnogucine C, and the first naturally occurring trimeric indolomonoterpenic alkaloid: strychnohexamine. This latter trimeric alkaloid presented an antiplasmodial activity against the FCA Plasmodium falciparum line near 1 microM.

Antiplasmodial activity of alkaloids from various strychnos species.

The in vitro antiplasmodial activities of 69 alkaloids from various Strychnos species were evaluated against chloroquine-resistant and chloroquine-sensitive lines of Plasmodium falciparum. The compounds, comprising mainly indolomonoterpenoid alkaloids, exhibited a wide range of biological potencies in the antiplasmodial assays. The most active alkaloids were also tested for cytotoxicity against HCT-116 colon cancer cells to determine their antiplasmodial selectivity. As a result of these studies, structure-activity relationships for these alkaloids have begun to emerge. Alkaloids presenting four types of bisindole skeleton exhibited potent and selective activities against Plasmodium. They were sungucine-type (IC(50) values ranging from 80 nM to 10 microM), longicaudatine-type (IC(50) values ranging from 0.5 to 10 microM), matopensine-type (IC(50) values ranging from 150 nM to 10 microM), and usambarine-type alkaloids. Within the last structural type, isostrychnopentamine (49) and ochrolifuanine A (46) were found to be active against chloroquine-sensitive and -resistant strains (IC(50) values of 100-150 and 100-500 nM, respectively), and dihydrousambarensine (51) exhibited a 30-fold higher activity against the chloroquine-resistant strain (IC(50) = 32 nM) than against the chloroquine-sensitive one.

In vitro antiplasmodial activity of Tithonia diversifolia and identification of its main active constituent: tagitinin C.

The antimalarial properties of Tithonia diversifolia, an Asteraceae traditionally used to treat malaria, were investigated in vitro against three strains of Plasmodium falciparum. The ether extract from aerial parts of the plant collected in São Tomé e Príncipe, demonstrated good antiplasmodial activity (IC 50 on FCA strain: 0.75 microg/ml). A bioassay guided fractionation of this extract led to the isolation of the known sesquiterpene lactone tagitinin C as an active component against Plasmodium (IC 50 on FCA strain: 0.33 microg/ml), but also possessing cytotoxic properties (IC 50 on HTC-116 cells: 0.706 microg/ml).