Association between anticholinergic activity and xerostomia and/ or xerophthalmia in the elderly: systematic review.

PURPOSE: The aim of this work was to investigate the association between anticholinergic burden or anticholinergic drug use and xerostomia and/or xerophtalmia in elderly through a systematic review of the published literature. METHODS: A search was carried out in 3 databases (CINAHL, Embase and Pubmed). Studies conducted in people ≥65 years of age, who took anticholinergic medications, and measured the association between the anticholinergic burden or the use of these medications with the prevalence of xerostomia and / or xerophthalmia, published up to August 2022, were selected. Studies published in languages other than Spanish and/or English were excluded. RESULTS: One thousand two hundred eleven articles were identified, 10 were selected for this review: six cross-sectional studies, two cohorts, one case-control and one randomized controlled clinical trial. A total of 3535 patients included in the different studies were studied. The most used scales were the Anticholinergic Drug Scale (ADS) and the Anticholinergic Risk Scale (ARS). Four articles studied the relationship between the use of anticholinergic medication and the prevalence of xerostomia and / or xerophthalmia, finding a positive relationship with xerostomia in all of them. Another 6 measured the relationship between anticholinergic burden and xerostomia and / or xerophthalmia. Four found a positive relationship between anticholinergic burden and xerostomia and/or xerophthalmia. CONCLUSIONS: Our findings suggest a clear relationship between the use of anticholinergic drugs or anticholinergic burden and the presence of xerostomia. This relationship was less conclusive in the case of xerophthalmia.

[Failure mode effect analysis for safety improvement in the automatic drug dispensing systems]. / Aplicación de un análisis modal de fallos y efectos para la mejora de la seguridad en la utilización de los sistemas automatizados de dispensación de medicamentos.

OBJECTIVE: To identify the risks in automated dispensing cabinet use in order to improve routine procedure safety. METHODS: We used the Failure Mode Effect Analysis (FMEA) methodology. A multidisciplinary team identified potential failure modes of the procedure through a brainstorming session. We assessed the impact associated with each failure mode with the Risk Priority Number (RPN), which involves three variables: occurrence, severity, and detectability. Improvement measures were established for failure modes with RPN>100 considered critical. The final RPN (theoretical) that would result from the proposed measures was also calculated. RESULTS: The process was divided into five sub-processes: automatic delivery of order replacement, to prepare order in a pyramidal cart, transport of the pyramidal cart from the pharmacy service to the automated dispensing cabinet, replacement of the automated dispensing cabinet by the pharmacy technician and dispensing/returning by nursing staff. Twenty-two failure modes, with 25 cases and with varying effects (severity 2-8) were evaluated. The sub-process with more failure modes with NPR>100 was dispensing/returning by nursing staff. CONCLUSIONS: The FMEA methodology was a useful tool when applied to automated dispensing cabinet system use. The implementation of improvement actions significantly reduced the risk.

Utilización y efectividad de cinacalcet en pacientes con hiperparatiroidismo secundario sometidos a hemodiálisis / Use and effectiveness of cinacalcet in hemodialysis patients with secondary hyperparatiroidism

Objetivo: describir la efectividad y seguridad de cinacalcet en situaciones reales así como la identificación de factores que puedan interferir en la eficacia del tratamiento con cinacalcet. Método: estudio retrospectivo que evaluó el perfil de uso de cinacalcet durante 12 meses, en pacientes con hiperparatiroidismo secundario a insuficiencia renal crónica, durante el periodo de tiempo noviembre 2014 - marzo 2016. Se evaluó la eficacia de cinacalcet en un contexto real. Se valoró la incidencia de hipocalcemias como principal reacción adversa. Resultados: se estudiaron un total de 38 pacientes con hiperparatiroidismo secundario sometidos a hemodiálisis. A los 12 meses cinacalcet logró controlar la paratohormona intacta (PTHi) del 58% de los pacientes. Se observó que los pacientes con niveles de PTHi al inicio del tratamiento > 800 pg/dl tenían mayor dificultad en alcanzar niveles inferiores a 250 pg/dl. Los niveles de calcio, fósforo y producto fosfocálcico se normalizaron en la totalidad de los pacientes estudiados a partir del 3 mes de tratamiento. En cuanto al perfil de uso de cinacalcet, al tercer mes de tratamiento el 50% de los pacientes estaban infradosificados. Conclusiones: a pesar de que cinacalcet ha demostrado ser efectivo en la práctica real, el aumento de dosis según los niveles de PTHi no se realiza según las recomendaciones establecidas en la ficha técnica del medicamento. El seguimiento farmacoterapéutico de estos pacientes mejoraría los resultados de control de la PTHi y la efectividad del tratamiento (AU)

Objective: To describe the effectiveness and safety of cinacalcet in real situations and to identify factors that may interfere with the effectiveness of cinacalcet treatment. Method: It was carried out a retrospective study evaluating the usage profile of cinacalcet during 12 months in patients with secondary hyperparathyroidism to chronic renal failure during the time period November 2014 to March 2016. The efficacy of cinacalcet was evaluated in a real context. It was evaluated the incidence of hypocalcemias as the main adverse reaction. Results: A total of 38 hemodialysis patients with secondary hyperparathyroidism were studied. Over 12 months, cinacalcet was able to control PTHi in 58% of patients. Patients with PTH levels at baseline > 800 pg / dl had greater difficulty to reach levels below 250 pg / dl. The levels of calcium, phosphorus and phosphocalcic products were normalized in all studied patients after 3 months of treatment. Regarding the profile of cinacalcet use, at the third month of treatment 50% of the patients were under-treated. Conclusions: Although cinacalcet has shown to be effective in the management of hyperparathyroidism, the increase of doses according to the levels of PTHi is not carried out according to the recommendations established in the summary of product characteristics. The pharmacotherapeutic follow-up of these patients would improve the results of PTHi and the effectiveness of the treatment (AU)

Análisis del proceso de selección de nuevos medicamentos en un hospital terciario. Años 2004–07 / Analysis of the selection process for new drugs in a tertiary hospital 2004–2007

Objetivo Describir la estructura de la Comisión de Farmacia y Terapéutica y el proceso de selección de nuevos medicamentos de un hospital terciario. Material y métodos Se revisan todas las actas de la Comisión de Farmacia y Terapéutica y las Guías para la Incorporación de Nuevos Fármacos recibidas en el periodo 2004–2007 en el Hospital Universitario Virgen del Rocío. Se realiza un estudio descriptivo que recoge variables relacionadas con el fármaco (grupo terapéutico, vía de registro, vía de administración y categoría legal), con el solicitante (servicio al que pertenece, categoría profesional y tipo de petición) y con el resultado de la evaluación (decisión final adoptada y tiempo de retraso entre la petición y la decisión).Resultados De los 72 medicamentos solicitados, se aprobaron 45 (62,5%), 6 como equivalentes terapéuticos, 36 (80%) con recomendaciones específicas y 3 (4,2%) sin ninguna restricción. De los fármacos no incluidos, en 12 (81,1%) fue por insuficiente evidencia de su eficacia comparada con el tratamiento actual. El grupo terapéutico solicitado con más frecuencia fue el de los antineoplásicos, destacando Oncología y Hematología entre los peticionarios. Destaca el alto porcentaje de solicitantes que aportaron ensayos clínicos (97,2%) y datos referentes al coste (84,7%).Conclusiones Existe un alto grado cumplimentación de la Guía para la Incorporación de Nuevos Fármacos en nuestro centro que garantiza una decisión final por parte de la Comisión de Farmacia y Terapéutica basada en la evidencia científica (AU)

Material and methods All annals of the P&TC and the New Drug Incorporation Guides (GINF) to incorporate new drugs received at Hospital Virgen del Rocío between 2004 and 2007 were reviewed. We carried out a descriptive study which collected variables having to do with the drug (drug type, type of register, route of administration and legal category), the petitioner (responsible division, professional category and request type) and the result of the evaluation (final decision, elapsed time between the request and the decision). Results Of the 72 requested drugs, 45 (62.5%) were approved: six as equivalent treatments, 36 (80%) with specific recommendations, and three (4.2%) with no restrictions. Twelve drugs (81.1%) were not included due to insufficient evidence of their effectiveness compared with the current treatment. The most frequently-requested drug type was the antineoplastics, most commonly requested by Oncology and Haematology divisions. We highlight the fact that many of the petitioners included clinical trials (97.2%) and data referring to costs (84.7%) (AU)

[Analysis of the selection process for new drugs in a tertiary hospital 2004-2007]. / Análisis del proceso de selección de nuevos medicamentos en un hospital terciario. Años 2004-07.

OBJECTIVE: The purpose of this study is to describe the structure of the CFyT, the Pharmacy and Therapeutics Committee, and a tertiary hospital's selection process for new drugs. MATERIAL AND METHODS: All annals of the P&TC and the New Drug Incorporation Guides (GINF) to incorporate new drugs received at Hospital Virgen del Rocío between 2004 and 2007 were reviewed. We carried out a descriptive study which collected variables having to do with the drug (drug type, type of register, route of administration and legal category), the petitioner (responsible division, professional category and request type) and the result of the evaluation (final decision, elapsed time between the request and the decision). RESULTS: Of the 72 requested drugs, 45 (62.5%) were approved: six as equivalent treatments, 36 (80%) with specific recommendations, and three (4.2%) with no restrictions. Twelve drugs (81.1%) were not included due to insufficient evidence of their effectiveness compared with the current treatment. The most frequently-requested drug type was the antineoplastics, most commonly requested by Oncology and Haematology divisions. We highlight the fact that many of the petitioners included clinical trials (97.2%) and data referring to costs (84.7%). CONCLUSIONS: There is a high level of compliance with the GINF guide in our centre, which guarantees that the P&TC's final decision is based on scientific evidence.