Sobre-anticoagulación por warfarina ocasionada por múltiples errores de medicación

La warfarina es el anticoagulante más empleado en el mundo por su conveniencia y bajo costo. Sin embargo, su efectividad y seguridad están determinadas por el monitoreo paraclínico del INR, el control de la ingesta de vitamina K, las interacciones medicamentosas y el perfil farmacogenético entre otros factores, que podrían condicionar la ocurrencia de complicaciones trombóticas o hemorrágicas. Se presenta el caso de una paciente con hemorragia en el muslo secundaria a warfarina, en quien la falta de adherencia al esquema posológico prescrito, la falta de seguimiento y una posible interacción con el omeprazol fueron identificados por el servicio de Farmacia Clínica del hospital como factores determinantes de la reacción adversa a medicamento. La intervención farmacéutica consistió en sugerir la sustitución de warfarina por apixabán, medicamento de una costo-efectividad similar, que no requiere monitoreo paraclínico y carece de interacciones medicamentosas en la paciente

Sobre-anticoagulación por warfarina ocasionada por múltiples errores de medicación

La warfarina es el anticoagulante más empleado en el mundo por su conveniencia y bajo costo. Sin embargo, su efectividad y seguridad están determinadas por el monitoreo paraclínico del INR, el control de la ingesta de vitamina K, las interacciones medicamentosas y el perfil farmacogenético entre otros factores, que podrían condicionar la ocurrencia de complicaciones trombóticas o hemorrágicas. Se presenta el caso de una paciente con hemorragia en el muslo secundaria a warfarina, en quien la falta de adherencia al esquema posológico prescrito, la falta de seguimiento y una posible interacción con el omeprazol fueron identificados por el servicio de Farmacia Clínica del hospital como factores determinantes de la reacción adversa a medicamento. La intervención farmacéutica consistió en sugerir la sustitución de warfarina por apixabán, medicamento de una costo-efectividad similar, que no requiere monitoreo paraclínico y carece de interacciones medicamentosas en la paciente

Variability in the international normalised ratio (INR) in patients with antiphospholipid syndrome and positive lupus anticoagulant: should the INR targets be higher?

El síndrome antifosfolípido es un desorden autoinmune caracterizado por hipercoagulabilidad que requiere terapia anticoagulante como pilar fundamental, siendo la warfarina el tratamiento de elección en los casos que requieren manejo por largos periodos. Sin embargo, los pacientes con anticoagulante lúpico positivo representan un reto porque tienen mayor riesgo de presentar eventos trombóticos, sumado a que el seguimiento con el International Normalized Ratio (INR) no es confiable, ya que estos anticuerpos generan interferencia con las pruebas de laboratorio basadas en fosfolípidos, como es el caso del tiempo de protrombina (PT) con INR basal prolongado, incluso antes del inicio de la terapia anticoagulante. Por tal razón, se ilustra el caso de una paciente con síndrome antifosfolípido primario y anticoagulante lúpico positivo quien ha presentado múltiples episodios trombóticos, a pesar de recibir terapia anticoagulante. Además se hace una revisión de la literatura disponible y se postulan nuevas metas de INR en estos pacientes diferentes de las que se plantean actualmente.Antiphospholipid syndrome (APS) is an autoimmune disorder characterised by hypercoagulability requiring anticoagulant therapy as the basis, with warfarin as the treatment of choice in cases requiring long-term management. However, patients with positive lupus anticoagulant (LA) present a challenge because they have an increased risk of thrombotic events, in addition to the fact that the monitoring of the international normalised ratio (INR) is unreliable because these antibodies generate interference with the laboratory tests based on phospholipids, as is the case for prothrombin time (PT) with prolonged baseline INR, even before the start of anticoagulant therapy. For this reason, we present the case of a patient with primary APS and positive LA who had multiple thrombotic events despite receiving anticoagulant therapy

Toxicidad neurológica asociada a la fenitoína en un paciente metabolizador intermedio para la enzima CYP2C9

La fenitoína es uno de los antiepilépticos más empleados por su gran utilidad para diferentes tipos de crisis y bajo costo. Sin embargo, su uso se ve limitado por los efectos adversos, en particular los que afectan al sistema nervioso central. Este caso ilustra una intervención farmacéutica exitosa basada en la farmacogenética, para optimizar la farmacoterapia con fenitoína en un paciente metabolizador intermedio, con signos francos de neurotoxicidad por este medicamento

Toxicidad neurológica asociada a la fenitoína en un paciente metabolizador intermedio para la enzima CYP2C9

La fenitoína es uno de los antiepilépticos más empleados por su gran utilidad para diferentes tipos de crisis y bajo costo. Sin embargo, su uso se ve limitado por los efectos adversos, en particular los que afectan al sistema nervioso central. Este caso ilustra una intervención farmacéutica exitosa basada en la farmacogenética, para optimizar la farmacoterapia con fenitoína en un paciente metabolizador intermedio, con signos francos de neurotoxicidad por este medicamento

Prescription for COVID-19 by non-medical professionals during the pandemic in Colombia: a cross-sectional study

Antecedentes: La pandemia de COVID-19 ha llevado a un aumento en el comportamiento de la automedicación (SM). Dada la liberación masiva de información engañosa durante la pandemia, algunas farmacias recomiendan medicamentos como la ivermectina, la azitromicina, la hidroxicloroquina, entre otros, que no son útiles para prevenir o tratar la COVID-19 y podrían exponer a los pacientes a efectos secundarios innecesarios e interacciones con otros medicamentos. La gente debe estar al tanto de los usos aprobados y no aprobados, y de los posibles efectos secundarios de estos medicamentos. Justificación: El objetivo de este estudio era conocer los medicamentos, incluidos los productos naturales y los medicamentos homeopáticos, ofrecidos por los establecimientos farmacéuticos colombianos para la prevención y el tratamiento de la COVID-19, así como la información proporcionada sobre el uso seguro del producto. Métodos: El estudio se realizó utilizando el método de compras misteriosas, recopilando datos a través de llamadas telefónicas a cada uno de los establecimientos por parte de una persona capacitada que fingía ser un paciente con síntomas de COVID-19. El estudio incluyó 482 establecimientos farmacéuticos de 16 departamentos colombianos. Resultados: De los 59 medicamentos sugeridos por las farmacias, los más recomendados fueron azitromicina, ivermectina, acetaminofén, ibuprofeno y aspirina. La dosis recomendada se indicó en el 85,5% (236) de los establecimientos farmacéuticos, y el 14,5% (40) de ellos reportó los efectos adversos más comunes del producto recomendado. Alrededor del 9,4 % (26) de los establecimientos informaron de posibles interacciones de los medicamentos y sustancias recomendados con alimentos, bebidas o suplementos. Conclusión: La mayoría de los establecimientos farmacéuticos incluidos en el estudio promovieron una automedicación inadecuada para la COVID-19 en Colombia durante la pandemia.Background: The COVID-19 pandemic has led to an increase in the behavior of self-medication (SM). Given the massive release of misleading information during the pandemic, some pharmacies recommend drugs such as ivermectin, azithromycin, hydroxychloroquine among others, which are not useful for preventing or treating COVID-19 and could expose patients to unnecessary side effects and interactions with other medications. People should be aware of the approved and non-approved uses, and potential side effects of these drugs. Rationale: The aim of this study was to know the drugs, including natural products and homeopathic drugs, offered by Colombian pharmaceutical establishments for the prevention and treatment of COVID-19, as well as the information provided on the safe use of the product. Methods: The study was done using the mystery shopping method, collecting data through telephone calls to each of the establishments by a trained individual pretending to be a patient with COVID-19 symptoms. The study included 482 pharmaceutical establishments from 16 Colombian departments. Results: Of 59 drugs suggested by pharmacies, the most recommended were azithromycin, ivermectin, acetaminophen, ibuprofen, and aspirin. The recommended dose was indicated in 85.5% (236) of the pharmaceutical establishments, and 14.5% (40) of them reported the most common adverse effects of the recommended product. About 9.4% (26) of the establishments reported possible interactions of the recommended drugs and substances with food, beverages, or supplements. Conclusion: The majority of the pharmaceutical establishments included in the study promoted inadequate self-medication for COVID-19 in Colombia during the pandemic.https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001402116https://scholar.google.com/citations?hl=es&user=OW0mejcAAAAJ&view_op=list_works&sortby=pubdatehttps://scienti.minciencias.gov.co/gruplac/jsp/visualiza/visualizagr.jsp?nro=00000000004151https://orcid.org/0000-0002-4835-9739Introducción, Materiales y Métodos, Resultados, Conclusiones, Bibliografía

Enhancing self-medication practices in the era of infodemic: the role of pharmacovigilance

The COVID-19 pandemic has represented one of the most important public health events of the last century, with more than 6.9 million deaths attributable to the disease. Fortunately, the advent of vaccines for this disease, almost a year after the appearance of the pandemic, drastically changed the global panorama, preventing at least 14 million additional deaths just in the first year of vaccination. The combination of knowledge from many areas of expertise has allowed humanity to overcome the pandemic in an incredibly short period of time. Apart from the fundamental problem of finding preventive and therapeutic strategies to control the disease – something practically solved thanks to the vaccines – the pandemic has been characterized by an avalanche of information, often incorrect and lacking in scientific evidence, about potential new therapies that did not provide any benefit, but did have an associated risk of adverse effects, sometimes serious or even fatal. Likewise, the appearance of vaccines in record time compared to the usual times of clinical research generated mistrust in some sectors of the population, who viewed with concern the appearance of some serious but at the same time very infrequent adverse events (e.g. cavernous sinus thrombosis). This excessive concern was largely due to not having a clear idea of the risk-benefit ratio of vaccines for COVID-19, based on ignorance of the extreme rarity of this type of event, as well as a lack of awareness of the high effectiveness of these vaccines in preventing serious or fatal forms of the disease – even though it doesn’t have a significant effect to diminish the contagion risk. This clearly favorable risk-benefit ratio has made it possible to offer the vaccination (and application of booster doses) to practically all population groups, from 6 months onwards

The DoTS classification is a useful way to classify adverse drug reactions: A preliminary study in hospitalized patients

Objective The aim was to determine the prevalence of adverse drug reactions (ADRs) in hospitalized patients in a university hospital. Methods ADRs were identified by two evaluators, who reviewed the clinical histories of all patients admitted between 24 April and 24 May 2006. Patients with suspected ADRs were contacted. Three different investigators evaluated causality, the degree of preventability, and the mechanism producing the ADR. Causality was assessed using the scale proposed by the World Health Organization (WHO), and preventability was assessed using the modified Schumock and Thornton criteria. Key findings There were 32 ADRs in 104 hospitalized patients. Effects on the autonomic nervous system were the most common (13%) and the drugs most frequently implicated were systemic antimicrobial drugs (19%). Fifty-four per cent of the ADRs were classified as possible. Using the Dose, Time and Susceptibility (DoTS) classification, 77% of the ADRs were classified as being of collateral dose-responsiveness (i.e. they occurred within the range of therapeutic doses), and 65% were classified as intermediate reactions. The susceptibility factors associated most frequently with ADRs were comorbidities (i.e. the presence of diseases that were considered as risk factors to developing an ADR; 36%), age (26%) and exogenous factors (i.e. the presence of drug interactions that were involved in the occurrence of ADRs; 17%). Fifty per cent of the ADRs could have been prevented. Conclusions ADRs are very frequent in hospitalized patients and a significant proportion of them is preventable. The DoTS classification allowed complete evaluation of the types of ADR encountered. We are currently carrying out a much larger prospective study. © 2010 Royal Pharmaceutical Society of Great Britain

El ibuprofeno aumenta las infecciones de tejidos blandos en niños

Because ibuprofen is more effective as monotherapy than paracetamol in controlling fever in children Hay and colleagues conclude that ibuprofen should be administered first to feverish children in discomfort.1 Paracetamol should be added after 24 hours if recovery is n