GEDEFO-SEFH management of antineoplastic extravasations survey results

INTRODUCTION

Extravasation is a potentially severe complication of intravenous administration of antineoplastic drugs. The limited data makes it difficult to develop an optimal management scheme. The objective of this study is to describe the clinical practice in the extravasation management of antineoplastic agents in Spanish centers.

METHODS

An online survey was distributed to oncology pharmacists using the email distribution list of the Spanish Society of Hospital Pharmacists. Respondents were surveyed on the standard operational protocol (SOP) of extravasation, tissue damage risk classification, and specific measures of extravasation management.

RESULTS

A total of 68 surveys were completed. A specific extravasation SOP was available in 82.4% centers. The pharmacist participates in the authorship (100%) and actively collaborates in extravasation management (76.5%). A tissue damage risk classification based on the three categories was mostly adopted (48.2%) and 73.2% applied specific criteria based on concentration and/or extravasated volume. Extravasation management was mainly performed with the application of physical measures and/or antidotes (91.2%). High variability in the choices of pharmacological and/or physical measures recommended is outstanding.

CONCLUSION

The results of this study highlight the involvement of Spanish pharmacists in extravasation management, the application of physical measures and/or pharmacological measures as the method of choice in extravasation management, as well as the existing discrepancies in tissue damage risk classification and management recommendations.

Classification of antineoplastic drug-induced tissue damage: a Consensus of the Spanish Oncology Pharmacy Group

OBJECTIVE

To reach at an expert consensus, using the Delphi method, for classifying the tissue-damaging potential of antineoplastic drugs, in  order to facilitate the decision-making process in the event of  extravasations.

METHOD

The panel of expert evaluators was made up of seven  pharmacists belonging to the working group on extravasations. Other  member served as coordinator. The likelihood of tissue damage was  reviewed on the basis of eight reference documents. Four categories of  drugs were established: vesicant (V); high risk irritant (HRI); low risk  irritant (LRI) and non-irritant (NI). Two rounds of surveys were performed. The drugs with an agreement of less than 70% after the two rounds were  discussed non-anonymously by the group. For each of the rounds the  following was analysed: median of the degree of consensus and the  interquartile range (IQR25-75), degree of agreement by tissue damage  category, and percentage of antineoplastics reaching a degree of  consensus of over 85% and of 100%. Drugs whose classification differed in the various reference documents were assessed separately. SPSS v23.0  statistical software was used.

RESULTS

Seventy-one antineoplastics were evaluated. In the first round, the median for degree of consensus was 100.0% (IQR25-75: 71.4- 100.0%). In the second round, the median was 100.0% (IQR25-75: 85.7- 100.0%). The percentage of antineoplastics with a consensus of 85.7% or  above increased from 66.7% to 85.9% in the second round. For the 30  antineoplastics whose values differed in the reference documents, the  degree of agreement increased from 71.4% (IQR25-75: 57.1-87.7%) to  100.0% (IQR25-75: 85.7-100.0%) in the second round. The percentage of antineoplastics with a consensus of 85.7% or above increased from 40.0%  to 76.7%. Four antineoplastics had a degree of agreement of less  than 70.0%. The final classification of drugs per category, was: 17  vesicants; 15 HRI; 13 LRI; and 26 NI. The final degree of consensus was  85.7% or above for 90.1% of antineoplastics, and 100.0% for 74.6% of  the same.

CONCLUSIONS

In this area of scarce evidence and high variability, the Delphi method allows for consensus in classifying tissue damage risk,  thus making it easier to reach clinical decisions. In approximately 90% of  the antineoplastics, the degree of consensus reached by the expert panel  was 85% or above. In 74% of the antineoplastics, it was 100%. This  provides solid ground for management decisions.

Chemical stability of ondansetron hydrochloride with other drugs in admixtures via parenteral; a review

OBJECTIVE

This review was prepared to offer the most complete information about the use of ondansetron in parenteral admixtures with other drugs.

METHOD

The search was done from September 2016 to April 2017 by using electronic databases Stabilis® and Micromedex® solutions, Medline/PubMed and Scholar Google searching publications about ondansetron stability in parenteral infusion when is administered by itself or with other medication.

RESULTS

49 studies are included with a total of 53 drugs. 15 drugs were found compatible administered with ondansetron in a clinical routine concentration range in intravenous administration. Also, four ternary blends were found compatible and another one was incompatible. Otherwise, 38 drugs were found incompatible.

DISCUSSION

Compatibility of ondansetron offers a broad number of options to be used to avoid nausea and vomiting symptoms in patients with other concomitant medication.

[Tobacco dependency and adolescents: a good time to give up smoking? Relation to social and family factors]

OBJECTIVES

To find the prevalence and dependency of adolescents on tobacco, its relation with family and social factors and the motivation for giving up smoking.

DESIGN

Cross-sectional, descriptive study using questionnaires.

SETTING

Secondary school, Jaén, Spain.

PARTICIPANTS AND MEASUREMENTS

A total of 232 students: the questionnaire included questions on age, sex, tobacco consumption, smoking habits of family and friends, and family structure. The following tests were given: the Apgar family (AFT), Fagerström (FT), and Richmond (RT) tests.

RESULTS

Mean age 14.1 years old (95% CI, 13.9-14.3; range, 5 years); 57% boys. A 22% (17.1%-24.5%) were smokers, most of whom were boys (65.2%-86.7%; P<.001, *2) and were older than non-smokers (0.7-1.5; P<.001, Student's t). Mean consumption was 9.2 cigarettes a day (7.4-11.0) over 32 months (14.6-49.5). Friends who smoked were more frequent among adolescents who smoked (80.9%-99%) than among non-smokers (57.3%-70.6%; P<.001, *2). Smoking every day increased consumption by 6 cigarettes a day (3.6-9.2; P<.001, Student's t). In 71% (65.3%-76.6%) of families, there were smokers, principally the parents (63.3%-74.6%), who, in 85% (74.2%-95.8%) of cases, disapproved of their son/daughter smoking. Family dysfunction was more frequent in smokers (30% mild [16.1%-43.9%] and 17% severe [5.4%-28.6%]; P<.001, *2). The FT was positive for 12% (2%-22%) and was associated with the consumption of cigarettes per day (r=0.78; P<.05, Pearson). The RT was positive for 22% (15.1%-28.9%): 70% in the contemplation stage (55.6%-84.3%); 17% in preparation (5.4%-28.6%); 13% in action (3%-23%).

CONCLUSIONS

The consumption of tobacco among adolescents is related to family function and having friends who smoke. The low dependency and the motivation to change make this stage of life a good moment to concentrate on anti-smoking counselling.