Thermolabile drug storage in an ambulatory setting.

More thermolabile drugs are becoming available, and in most cases, these medications are dispensed to ambulatory patients. However, there is no regulation once medications are dispensed to patients and little is known with regard to what happens during transport and home storage. Previous studies suggest that these drugs are improperly stored. The present study was designed to determine the storage conditions of thermolabile drugs once they are dispensed to the patient in the Hospital Pharmacy Department. This is a prospective observational study to assess the temperature profile of 7 thermolabile drugs once they are dispensed to ambulatory patients at a tertiary care hospital. A data logger was added to the medication packaging. Temperature was considered inappropriate if one of the following circumstances were met: any temperature record less than or equal to 0 °C or over 25 °C; temperatures between 0-2 or 8-25 °C for a continuous period over 30 min. The time series of temperature measurements obtained from each data logger were analyzed as statistically independent variables. The data shown did not undergo any statistical treatment and must be considered directly related to thermal measurements. One hundred and fourteen patients were included and 107 patients were available for the analysis. On the whole, a mean of 50.6 days (SD 18.3) were measured and the mean temperature was 6.88 °C (SD 2.93). Three data loggers (2.8%) maintained all the measurements between 2 and 8 °C with less than 3 continuous data (< 30 min) out of this range but no data over 25 °C or below or equal to 0 °C. 28 (26.2%) data loggers had at least one measurement below zero, 1 data logger had a measurement greater than 25 °C and 75 (70.1%) were between 0 and 2 °C and/or between 8 and 25 °C for more than 30 min. In conclusion, once dispensed to patients, most thermolabile drugs are improperly stored. Future studies should focus on clinical consequences and possible solutions.

[Pharmaceutical intervention to reduce the iatrogenic risk associated with the triple whammy combination]. / Intervención farmacéutica para reducir el riesgo de iatrogenia asociada a la combinación triple whammy.

OBJECTIVE: To analyze the effect of an intervention to reduce the iatrogenic risk associated with concomitant treatment with angiotensin converting enzyme inhibitors (ACEi) and/or angiotensin-II receptor blockers (ARB) with diuretics and nonsteroidal anti-inflamatory drugs (NSAID), combination known as triple whammy (TW). DESIGN: Uncontrolled before-after intervention study. LOCATION: 15 health centers from a health area (reference population of 292.746 habitants). PARTICIPANTS: 260 patients ≥18 years old with chronic and concomitant prescriptions of drugs from the therapeutic groups (ATC code): diuretics (C03), ACEi/ARBs (C09) and NSAID (M01) during the month of January 2015 INTERVENTIONS: A double intervention was conducted during February and March 2015: an educational part, which consisted of an informative session, and an individualized part, in which recommendations to general practitioner were assessed after reviewing medical records. MAIN MEASUREMENTS: The number of patients in whom at least one intervention was accepted and the number of patients who continued on TW combination in June 2015, were analyzed. Results were analyzed using descriptive statistics and the prevalence of TW was compared with the one in June 2015 using the Newcombe-Wilson's hybrid method. RESULTS: 260 patients were included in the study. Recommendations were made in 165 patients (63.5%) and at least one was accepted in 97 (58.8%) patients. In June 2015, 184 patients continued with the TW combination. The TW prevalence decreased by 0.19/1,000 patients (IC 95%: 0.04/1,000 to 0.34/1,000; P=0.017) after the intervention. CONCLUSIONS: The intervention improved the prescription and reduced the number of patients on TW combination.

Desensitization to rituximab in a multidisciplinary setting.

BACKGROUND: The need to offer first-line therapy to the increasing number of patients who have suffered an hypersensitivity reaction has stimulated the use of rapid desensitization protocols. OBJECTIVE: To present our experience working as a multidisciplinary team using a rituximab rapid desensitization scheme. METHOD: Patient demographics, allergic reaction, skin tests to rituximab, number of desensitizations, reactions during the desensitization protocol and actions taken, number of administered and completed cycles, were retrospectively collected in patients who received at least one desensitization to rituximab. MAIN OUTCOMES: Number of desensitizations successfully managed. RESULTS: Between 2012 and June 2013 five patients received a total of 19 desensitizations to rituximab using a 12 step rapid desensitization protocol. All patients received the scheduled chemotherapeutic cycles as inpatients, with no delay in administration dates. Three patients presented a hypersensitivity reaction during the first desensitization and in one patient the event occurred again during the second treatment cycle. All reactions occurred in the last step, when the infusion rate reached the maximum speed. CONCLUSION: The developed protocol for rapid desensitization was successful in five patients receiving rituximab. Patients could receive the full intended dose.

Dosing of chemotherapy in obese and cachectic patients: results of a national survey.

BACKGROUND: It is not unusual to find obese and cachectic patients in the hematology oncology setting. However, information on dosage in these groups is scarce. OBJECTIVE: The objectives of our study were to explore the dosing strategies applied in the treatment of obese and cachectic cancer patients and to determine whether these strategies are applied in clinical trials. SETTING: Members of the Spanish Group for the Development of Hematology-Oncology Pharmacy (GEDEFO). METHODS: We invited all cancer hospital pharmacists to participate in a survey. MAIN OUTCOME MEASURE: Descriptive statistics of the dosing strategies approaches. RESULTS: We invited 159 eligible hospitals to participate, and 38 responded to the survey. A total of 50 surveys were received: different strategies were applied by different physicians from the same hospital and by hematology and oncology departments. Body mass index was used to define obesity and cachexia in 40 and 30 % of the cases, respectively. Capping the body surface area (BSA) was the approach most commonly followed (64.1 %) in obese patients, whereas no specific approach was adopted in cachectic patients. In hematology patients, the BSA calculation was based on ideal body weight or adjusted body weight in 16.0 % of cases (n = 2) and 50.0 % of cases (n = 6), respectively; in oncology patients, use of adjusted or ideal body weight was negligible. Actual body weight was the main approach in obese patients (35 surveys) and cachectic patients (48 surveys). Creatinine clearance was assessed mainly using the Cockcroft and Gault equation (around 76.0 % of responses). As for clinical trials, 64.1 % of the respondents (n = 25 hospitals) considered the criteria from each clinical trial individually. CONCLUSIONS: Dose adjustments are more frequent in obese patients than in cachectic patients. In cancer oncology patients, dose is adjusted mainly by hematology and hematopoietic cell transplant teams. Capping BSA is the most frequent strategy, followed by calculating actual body weight.

Prescribing of zoledronic acid in a tertiary outpatient hospital setting.

BACKGROUND: Zoledronic acid (ZA) is an intravenous bisphosphonate approved for the prevention and treatment of cancer skeletal-related events. OBJECTIVE: Our aim was to analyze the prescription patterns of ZA in the cancer outpatient clinic. METHOD: We performed a retrospective chart review of all patients who received at least 1 dose of ZA from January 2009 until December 2010 in our institution. The patients' follow-up period was defined from the administration of the first dose until February 2011. RESULTS: The sample comprised 345 patients: 31.9 % had breast cancer, 14.5 % prostate cancer, 29.0 % multiple myeloma, and 24.6 % other solid tumors. A total of 4,546 doses were administered; 2,749 (60.5 %) without intravenous chemotherapy. 71.1 % of patients with breast cancer, 86 % with prostate cancer, 60 % with multiple myeloma and 44.6 % with other solid tumors, received ZA without intravenous chemotherapy throughout bisphosphonate treatment. Doses were adjusted in one-third of cases. Administration every 4-weeks was the most frequent schedule. Median duration of treatment varied between 15.0 months for breast cancer and 4.2 months for other solid tumors. CONCLUSION: Most of ZA prescriptions in cancer outpatients followed the labeled indications. The percentage of ZA doses administered without intravenous chemotherapy was 60.5 %.