Pioglitazona. Revisión de sus efectos metabólicos y sistémicos / Pioglitazone. Review of its metabolic and systemic effects

La diabetes mellitus tipo 2 se ha convertido en una verdadera epidemia y se espera un crecimiento importante en las próximas décadas. Se podría esperar, por tanto, que el impacto que ello puede tener sobre la incidencia y prevalencia de morbimortalidad cardiovascular sea de magnitudes considerables. El control metabólico (glucémico y lipídico) adecuado de los pacientes que la padecen, comenzando con programas de dieta y ejercicio y posteriormente con medidas farmacológicas, ha demostrado disminuir el riesgo de complicaciones. No obstante, diversos estudios han evidenciado que, independientemente del tratamiento utilizado, el control metabólico empeora con el tiempo. En los últimos años se ha incorporado una nueva familia de fármacos al arsenal terapéutico para tratar la diabetes mellitus tipo 2, las tiazolidinodionas o glitazonas, que aportan aspectos diferenciales respecto a otros fármacos. En este artículo se revisan los efectos metabólicos y sistémicos de pioglitazona, que recientemente ha demostrado en el estudio PROactive un efecto positivo en la prevención secundaria de episodios cardiovasculares

Type 2 diabetes mellitus has become a true epidemic and significant growth is expected in the next decades. Thus it could be expected that the impact it may have on the incidence and prevalence of cardiovascular morbidity-mortality will have considerable magnitudes. It has been demonstrated that adequate metabolic control (glycemic and lipid) of these patients, beginning with diet and exercise programs and then with drug measures, decreases the risk of complications. However, several studies have shown that metabolic control deteriorates over time regardless of the treatment used. In recent years, a new drug family has been incorporated into the therapeutic armamentarium to treat type 2 diabetes mellitus. These are thiazolidinediones or glitazones, which have differential aspects regarding other drugs. In this article, the metabolic and systemic effects of pioglitazone, that have recently demonstrated a positive effect in the secondary prevention of cardiovascular episodes in the PROactive study have been reviewed

[Pioglitazone. Review of its metabolic and systemic effects]. / Pioglitazona. Revisión de sus efectos metabólicos y sistémicos.

Type 2 diabetes mellitus has become a true epidemic and significant growth is expected in the next decades. Thus it could be expected that the impact it may have on the incidence and prevalence of cardiovascular morbidity-mortality will have considerable magnitudes. It has been demonstrated that adequate metabolic control (glycemic and lipid) of these patients, beginning with diet and exercise programs and then with drug measures, decreases the risk of complications. However, several studies have shown that metabolic control deteriorates over time regardless of the treatment used. In recent years, a new drug family has been incorporated into the therapeutic armamentarium to treat type 2 diabetes mellitus. These are thiazolidinediones or glitazones, which have differential aspects regarding other drugs. In this article, the metabolic and systemic effects of pioglitazone, that have recently demonstrated a positive effect in the secondary prevention of cardiovascular episodes in the PROactive study have been reviewed.

[Changes in the pattern of use of non-conventional amphotericin B after the implementation of a training intervention at the San Carlos Clinical Hospital of Madrid]. / Modificación en el patrón de uso de Anfotericina B no convencional tras la puesta en marcha de una intervención Formativa en el Hospital Clínico San Carlos de Madrid.

BACKGROUND: Amphotericin B is the treatment of choice for systemic fungal infections. Among the different AB formulations available, the lipid forms appear to have a better profile of reliability, however, their cost is noticeably higher. In 1999 (pre-initiative period) an evaluation of the quality of the prescription of these preparations was made in our hospital, which revealed that they were not being used to best advantage and were responsible for generating a significant unnecessary expenditure. As a result of this, an information initiative was implemented with respect to the prescribing physicians for the purpose of reducing the inappropriate use of AB. METHOD: The quality of 100 prescriptions was evaluated prospectively, according to the standards of use of Amphotericin B established in the hospital. Following each evaluation, a pharmacologist personally handed over to each prescribing physician a set of rules governing the use of the Amphotericin B, discussing the indication and recommending the best alternative in each case. In order to measure the impact of this initiative, the appropriateness of the prescriptions during this period was compared with the pre-initiative period. RESULTS: The percentage of inappropriate prescriptions dropped from 58% to 21% following the implementation of the initiative. Likewise, a 33-million-peseta reduction in the total expenditure was achieved in 15 months as well as a savings of 24 million in inappropriate prescriptions. CONCLUSIONS: The information initiative improved the quality of the prescribing of preparations of Amphotericin B associated with lipids and considerably reduced the unnecessary expense associated with Amphotericin B misuse in our hospital.