Pharmacotherapeutic Challenges in Parkinson’s Disease Inpatients

During the natural history of Parkinson’s disease (PD), many patients require hospital admission for medical or surgical problems other than the motor features of PD. Therefore, they are often admitted to non-neurological wards where the staff is unfamiliar with PD management. Among the issues related to hospitalization in patients with PD, drug-related problems such as inappropriate levodopa timing of administration, the use of contraindicated, centrally acting antidopaminergic drugs and anticholinergic burden remain among the most troublesome

Farmakokutsadura eta Garapen Iraunkorrerako 6. Helburua: ur garbia eta saneamendua

The environmental impact of drugs or pharmaceuticals is a topic of growing concern. Drugs have been found in all environmental compartments, especially in water. Although the main route of access to the environment for drugs is related to consumption and resulting excretion, emissions can occur in any of the complex life cycle of pharmaceuticals. Apart from their ecotoxicological effects, pharmaceuticals in the environment can also affect human health (e.g: antibiotic resistance). In this article, we will focus on the potential influence of drug pollution on the 6th Sustainable Development Goal (SDG), describing possible solutions. SDGs have a special relevance in developing countries, where water is more polluted with drugs. The “One-Health” approach, which considers the relationship between humans, animals, and the shared environment, is needed to understand drug pollution. Collaboration of all the stakeholders involved in the life cycle of drugs is mandatory. Considering the cost-effectiveness and sustainability of the measures will be necessary to prevent drug pollution from becoming an obstacle to obtaining the 6th SDG.; Medikamentuek naturan duten inpaktua geroz eta interes handiagoa pizten duen gaia da. Ezaguna da medikamentuak eta haien hondakinak ingurumen-konpartimentu guztietan aurkitu direla, batez ere uretan. Medikamentuak ingurumenera iristeko bide nagusia kontsumoarekin eta haren ondoriozko iraizpenarekin dago erlazionatuta. Nolanahi ere, medikamentuen bizi-zikloaren beste faseetan ere gerta daitezke ingurumenerako igorpenak. Farmako-kutsadurak eragina du ingurumenean dauden izaki bizidunetan, eta baita giza osasunean ere. Antibiotikoekiko erresistentzien gorakada da horren adibideetako bat. Bestalde, uraren erabilgarritasuna, saneamendua eta higienea giza eskubideak badira ere, mundu osoko biztanle guztiek ez dauzkate bermatuta. Artikulu honetan, Garapen Iraunkorrerako 6. Helburua (GIH) -hots, ur garbia eta saneamendua- eta haren erronkak aztertuko ditugu, farmakokutsaduraren ikuspuntutik, konponbideak aztertuz. GIHek garrantzi berezia dute garapen-bidean dauden herrialdeetan; hain zuzen ere, uretako farmakokutsadura gehien dutenetan. Farmakokutsadura ulertu eta aztertzeko, "One-Health" ikuspuntua bultzatu beharra dago, hau da, osasun bakarrean bateratzea gizakion osasuna, animaliena eta partekatzen dugun ingurumenarena, eta, arazoari aurre egiteko, nahitaezkoa da medikamentuen bizi-zikloan parte hartzen duten eragile guztien elkarlana. Farmakokutsadura 6. GIHa lortzeko oztopo bihur ez dadin, beharrezkoa da lekuan lekuko osasun publikoaren beharrez gain neurrien kostu-eraginkortasuna ere kontuan hartzea, neurrien eraginkortasuna ziurtatzeko

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Famakokutsadura. Medikamentuen ingurumen-inpaktua osasun profesionalen ikuspuntik

293 p.El impacto ambiental de los medicamentos es un problema de gran magnitud, que afecta tanto a la salud humana como a los ecosistemas. Debido a que el consumo de medicamentos, tanto de uso humano como de uso veterinario, está aumentando a nivel mundial, se espera que el volumen de residuos medicamentosos también se incremente. La farmacontaminación es un problema complejo que debe ser abordado de forma interdisciplinar, incluyendo a todos los agentes que participan en el ciclo de vida del medicamento. Son muchos los desafíos pendientes en el manejo de la farmacontaminación, y por ello es necesario abordar algunos de estos retos de forma experimental, teniendo en cuenta el punto de vista de los profesionales de la salud. En esta tesis, en primer lugar, se ha estudiado la presencia ambiental (en aguas residuales) de los fármacos utilizados en Vitoria-Gasteiz durante la primera ola de la pandemia del SARS-CoV-2 (abril-julio 2020) para el tratamiento de la COVID-19, evaluándose también su potencial riesgo ecotoxicológico. Se midió, por primera vez, a nivel mundial, hidroxicloroquina en el medio ambiente. y por segunda vez, lopinavir. Teniendo en cuenta las concentraciones ambientales medidas en el estudio, se estimó un riesgo ecotoxicológico moderado para azitromicina y bajo para hidroxicloroquina y lopinavir-ritonavir.Por otro lado, se ha revisado la presencia en el medio ambiente de los fármacos peligrosos en entornos sanitarios (según la lista NIOSH, grupo 1: carcinogénicos) y se ha evaluado su potencial riesgo ecotoxicológico, basándose en los datos disponibles en la literatura. En base a los resultados, se puede afirmar que la mayoría de los fármacos peligroso del grupo 1 de la lista NIOSH no se ha intentado medir en el medio ambiente y que no se pudo establecer una evaluación del riesgo ecotoxicológico para la mayoría de ellos. Por lo que se puede concluir que el impacto ambiental de los fármacos peligrosos del grupo 1 de la lista NIOSH no está suficientemente estudiado.Por último, se ha estudiado el impacto de la farmacontaminación en los Objetivos de Desarrollo Sostenible (ODS), ya que, si bien la evaluación del impacto ambiental de los medicamentos se considera una línea de investigación prioritaria para determinadas instituciones relacionadas con la salud y el medio ambiente, la relación de la farmacontaminación con los ODS no ha sido propiamente determinada. La farmacontaminación podría afectar al menos a 12 de los 17 ODS. Por ello, la lucha contra la farmacontaminación podría ser esencial para alcanzar los ODS

Antipsychotics and seizures: Higher risk with atypicals?

AbstractPurposeAlmost all antipsychotics have been associated with a risk of epileptic seizure provocation. Among the first-generation antipsychotics (FGA) chlorpromazine appears to be associated with the greatest risk of seizures among the second-generation antipsychotics (SGA) clozapine is thought to be most likely to cause convulsions. This information is largely based on studies that are not sufficiently controlled. Besides, information about the seizure risk associated with newer antipsychotics is scarce.MethodThe Pharmacovigilance Unit of the Basque Country (network of centers of the Spanish Pharmacovigilance System, SEFV) provided reporting data for adverse reactions (AR) from the whole SEFV to estimate the reporting odds ratio (ROR) for antipsychotics and seizures (“convulsions” as Single MedDra Query). Data was obtained from SEFV database from 1984 to the June 2011.ResultsThe total number of convulsions reported for SGA was 169 (total reported AR 3.204). The number of convulsions reported for FGA was 35 (total reported AR 2.051). 94 convulsions were reported in association with clozapine (total AR 1.052). The ROR for SGA versus FGA was 3.2 (CI 95%: 2.21–4.63). The ROR for SGA excluding clozapine versus FGA was 2.08 (CI 95%: 1.39–3.12).ConclusionOur results show that SGA may pose a higher risk of seizures than FGA, mainly, but not only due to clozapine. This is line with recent studies suggesting that some SGA carried a higher average risk of electroencephalographic abnormalities than many FGA. Nonetheless, It is well known that spontaneous reports do not allow strong inferences about adverse drug effects, because differences in reporting fractions by time, drug or type of event are difficult or even impossible to distinguish from differences in the occurrence rates of adverse events. Still, we consider that the possibility of SGA carrying a higher risk of seizure induction than FGA warrants further research

Pharmaceutical residues in stranded dolphins in the Bay of Biscay

There is a growing concern about the presence of pharmaceuticals on all trophic levels of the 3 aquatic environment. The presence of pharmaceuticals in the marine environment, which is the 4 final receiver of the continental water including treated wastewater, has been much less 5 investigated than in freshwater. Marine mammals are very suitable sentinel species of the 6 marine environment because they often feed at high trophic levels, have unique fat stores and 7 long lifespan. Small delphinids in particular serve as excellent sentinel species for contamination 8 in the marine environment worldwide. To the best of our knowledge, no pharmaceuticals have 9 been detected or reported in dolphins so far. 10 In the present study, muscle, liver and blubbler samples from four common dolphins (Delphinus 11 delphis) and six striped dolphins (Stenella coeruleoalba) stranded along the Basque Coast were 12 collected. A total of 95 pharmaceuticals based on detectability and predicted ability to 13 bioaccumulate in fish were included in the analysis. 14 At least one pharmaceutical was found in 70% of the individuals. Only three of the 95 monitored 15 pharmaceuticals (orphenadrine, pizotifen, and promethazine) were detected in dolphin ́s tissues 16 (liver or blubber) at very low concentrations (<1ng/g). 17 In this study we also highlight the gap in the knowledge regarding the study organisms and 18 marine environments with respect to pharmaceutical pollution, which demands further 19 research to understand the threat pharmaceuticals might pose for these apex predators.Funding support from Fundación Vital & Ayuntamiento de Vitoria-Gasteiz to GO and the Swedish Research Council Formas 2020-01052 to D.C. and the Basque Government through Consolidated Research Group GIC IT1743-22 to X.L

Multidisciplinary Collaboration for the Optimization of Antibiotic Prescription: Analysis of Clinical Cases of Pneumonia between Emergency, Internal Medicine, and Pharmacy Services

Background: Pneumonia is a lung parenchyma acute infection usually treated with antibiotics. Increasing bacterial resistances force the review and control of antibiotic use criteria in different health departments. Objective: Evaluate the adequacy of antibiotic treatment in community-acquired pneumonia in patients initially attended at the emergency department and then admitted to the internal medicine service of the Alto Deba Hospital—Osakidetza Basque Country Health Service (Spain). Methods: Observational, retrospective study, based on the review of medical records of patients with community-acquired pneumonia attended at the hospital between January and May 2021. The review was made considering the following items: antimicrobial treatment indication, choice of antibiotic, time of administration of the first dose, adequacy of the de-escalation-sequential therapy, duration of treatment, monitoring of efficacy and adverse effects, and registry in the medical records. The review was made by the research team (professionals from the emergency department, internal medicine, and pharmacy services). Results: Fifty-five medical records were reviewed. The adequacy of the treatments showed that antibiotic indication, time of administration of the first dose, and monitoring of efficacy and adverse effects were the items with the greatest agreement between the three departments. This was not the case with the choice of antibiotic, de-escalation/sequential therapy, duration of treatment, and registration in the medical record, which have been widely discussed. The choice of antibiotic was optimal in 63.64% and might have been better in 25.45%. De-escalation/oral sequencing might have been better in 50.91%. The treatment duration was optimal in 45.45% of the patients and excessive in 45.45%. Discussion: The team agreed to disseminate these data among the hospital professionals and to propose audits and feedback through an antibiotic stewardship program. Besides this, implementing the local guideline and defining stability criteria to apply sequential therapy/de-escalation was considered essential

Is the Environmental Risk of Metformin Underestimated?

2024-05-31S