Drug interactions with oral antineoplastic drugs: The role of the pharmacist

The main objective of the study is to determine the pharmacist detection of drug-drug and drug-food interactions in patients receiving oral antineoplastic drugs (OADs). Descriptive, prospective study in a tertiary-care teaching hospital. The study population included patients who received OADs from the Outpatient Pharmacy of the hospital. The study population was attended by a pharmacist who checked potential interactions. The severity of interactions was evaluated using the summary of product characteristics of each drug and three different databases. We included 219 patients with a total of 736 concomitant medications. A total of 34 drug-drug or food-drug interactions were recorded. The most common interaction detected was between erlotinib and ranitidine (major interaction). In 19 of the 34 interactions detected in the experimental group, the pharmacist prevented them from reaching the patient. Interactions were resolved by drug suspensions, drug changes, or changes in schedules always according to the attending physician or the patient. In the remaining 15 interactions, the doctor was not contacted because the interactions were considered to be of little relevance or because they only required surveillance. Hospital pharmacist can improve the patient's safety and the efficiency of oral cytostatic treatment by detecting and preventing drug-drug and drug-food interactions.

Recomendaciones GESIDA/SEFH/PNS para mejorar la adherencia al tratamiento antirretroviral en el año 2004

Since the early days of antiretroviral therapy, adherence has emerged as the milestone of success; in fact, it is the most potent predictor of effectiveness. The main factors related to adherence include the complexity of the therapeutic regimen, adverse effects, psychological problems, alcoholism and active addiction to drugs, lack of social and family support and the patient's beliefs and attitudes about the treatment. Adherence monitoring should be part of the HIV patient's regular care, and should be done with feasible, easily applied methods adapted to the different clinical settings. The minimally acceptable measures should include use of a validated questionnaire, together with data from the Pharmacy Department's drug dispensation registry. All patients that begin HAART or undergo a change of treatment should participate in a treatment education program imparted by health professionals with knowledge and experience in the management of patients with HIV infection. The health team (doctors, pharmacists and nursing professionals) should offer maximum availability to solve the doubts and problems that may occur during treatment. When sub-optimal adherence is detected, intervention strategies based on psychological therapy, educational efforts and personal advice should be attempted, in order to adapt the treatment scheme to the patient's habits and provide solutions to the problem of non-compliance. In certain situations, co-morbid conditions will also require attention. Treatment adherence, being a multidimensional problem, needs a multidisciplinary team approach. The choice of therapy, only one aspect of the multidimensional problem of adherence, must be a careful and individualized decision; however, simpler regimens with regard to the number of pills and daily dose are desirable.

Características de los fármacos antivirales

This article summarizes the principal characteristics of the drugs used to treat viral infections, with the exception of human immunodeficiency virus infection. It includes antiviral agents active against herpes virus, cytomegalovirus, hepatitis B and C virus, and respiratory viruses, such as influenza and respiratory syncytial virus. Dosage according to the indication, dose adjustment in the case of renal or hepatic insufficiency, significant pharmacokinetic characteristics, and the main adverse effects and interactions are described.