RESUMO
Pharmaceutical services in the treatment of hemophiliac patients in Sweden are described. To prevent arthropathy and improve quality of life, patients with severe hemophilia receive prophylactic treatment. Hemophiliac patients are referred for diagnosis, treatment, and follow-up to one of three hemophilia treatment centers. Patients are seen once or twice yearly for routine checkups. A new system for the distribution of antihemophilic factor and factor IX has been implemented to improve availability and reduce risks and costs. Patients registered at a center receive antihemophilic factor or factor IX from the corresponding hospital pharmacy. The number of different manufactured batches to which a patient can be exposed is restricted, and complete distribution data are recorded for each patient, enabling follow-up studies and facilitating withdrawals of faulty batches. Distribution of emergency kits to patients who do not receive supervised home therapy ensures the availability of treatment for bleeding episodes. Two studies performed to explore ways to reduce drug waste led to improvements in patient information, product guidelines, and equipment and a better understanding of the problems associated with product changes. Specialized pharmaceutical services in Sweden contributed to successful hemophilia treatment and reduced its cost.
Assuntos
Hemofilia A/terapia , Serviço de Farmácia Hospitalar , Fator IX/administração & dosagem , Fator VIII/administração & dosagem , Hemofilia A/economia , Hospitais Gerais , Humanos , Infusões Intravenosas , Artropatias/prevenção & controle , Cooperação do Paciente , Serviço de Farmácia Hospitalar/economia , Serviço de Farmácia Hospitalar/organização & administração , Fatores de Risco , SuéciaRESUMO
The case of a granulocytopenic patient with acute undifferentiated leukaemia and hepatosplenic candidiasis who was refractory to conventional deoxycholate amphotericin B (AmpB) and 5-flucytosine therapy is reported. He experienced severe AmpB-related side-effects, and was subsequently successfully treated with a pharmaceutical preparation of AmpB (5.7 g) entrapped in sonicated liposomes, composed of lecithin, cholesterol and stearylamine in a molar ratio of 4:3:1. Three months later, during maintenance chemotherapy, liposomal AmpB (5.1 g) was reinstituted due to the finding of biopsies positive for Candida albicans at bronchoscopy. After healing of the patient's fungal infection a left upper lobe resection was performed, which showed advanced fibrosis with signs of inflammation, but no evidence of fungal disease. Since no acute side-effects and only moderate hypokalaemia were observed, it appears that liposomal AmpB is superior to conventional AmpB treatment in granulocytopenic patients with hepatosplenic candidiasis and unbearable therapy-related side-effects.
