Nederlands Platform voor Farmaceutisch Onderzoek

Het Nederlands Platform voor Farmaceutisch Onderzoek (NPFO) presenteert onderzoek in de farmaceutische wetenschappen, zoals medicatieveiligheid, patiëntenzorg, formulering, (bio)analyse, (klinische) farmacologie en casuïstiek.

Risicofactoren voor medicatiefouten na eerdere medicatieverificatie bij electieve opnames

M.M. Ebbens abc*, K.B. Gombert-Handoko b, M. Al-Dulaimy d, P.M.L.A. van den Bemt c en E.J. Wesselink a

Lees abstract

Risk factors for medication erros at admission in preoperatively screened patients

BACKGROUND

Preoperative screening (POS) may help to reduce medication errors at admission (MEA). However, due to the time window between POS and hospital admission, unintentional medication discrepancies may still occur and thus a second medication reconciliation at hospital admission is necessary. Insight into potential risk factors associated with these discrepancies would be helpful to focus the second medication reconciliation on high risk patients.

OBJECTIVE

To determine the occurrence of MEA and to identify risk factors for MEA in preoperatively screened patients.

METHODS

This single-centre observational cross-sectional study included elective surgical patients between 26 October and 18 December 2015. Main inclusion criteria were age ≥18 years and elective non-day care admissions. Medication reconciliation took place at the preoperative screening and was repeated within 30 hours of admission. Unintended discrepancies between the first and second medication reconciliation were defined as MEA. The primary outcome was the occurrence of MEA in preoperatively screened patients. The association of this outcome with potential risk factors was analysed using multivariate logistic regression analysis.

RESULTS

Of the 183 included patients 60 (33%) patients had at least one MEA. In a multivariate model the number of medications at POS (adjusted odds ratio 1.16, 95%-confidence interval [95%-CI] 1.04-1.30), and respiratory disease (odds ratio 4.25, 95%-CI 1.52-11.83) were significantly associated with MEA.

CONCLUSION

In our study MEA occurred in 33% of preoperatively screened patients. Polypharmacy and respiratory comorbidities are risk factors for MEA in preoperatively screened patients.

Rubriek: Korte bijdrage
Identificatie: 2018;3:a1661
Datum: 9 januari 2018

Keuzes van patiënten en apothekers bij medicatiebewaking

Marcel Kooij

Rubriek: Referaat
Identificatie: 2018;3:e1654
Datum: 9 januari 2018

Patiëntgericht communiceren voor apothekers

Marcel Kooij

Rubriek: Referaat
Identificatie: 2018;3:e1653
Datum: 9 januari 2018

Vaccinsurveillance in lage- en middeninkomenslanden

Rogier Klok

Rubriek: Referaat
Identificatie: 2017;2:e1652
Datum: 29 december 2017

Kosteneffectiviteit van farmacogenetica; een voorbeeld van een vroege analyse

Rogier Klok

Rubriek: Referaat
Identificatie: 2017;2:e1651
Datum: 28 december 2017

Het gebruik van thiazidediuretica bij een zeer lage glomerulaire filtratiesnelheid

Harm Geers ab*

Lees abstract

Using thiazide diuretics with a very low glomerular filtration rate

BACKGROUND

Diuretic therapy with thiazides is usually not recommended in chronic kidney disease (CKD, i.e. glomerular filtration rate [GFR] <30 ml/min), because of the supposed low or absent diuretic effect due to lower tubular concentrations of the thiazide. The antihypertensive volume status and sodium excretion effects of thiazide diuretics in patients with CKD and low GFR are investigated in this literature review.

METHODS

PubMed and EMBASE were searched using “thiazides” and “chronic kidney disease” as key search terms to identify studies on thiazide use in patients with an estimated GFR (eGFR) < 40 ml/min. Extracted from the included studies were effects on: blood pressure, volume status, fractional sodium excretion and side effects. Case reports were excluded. Ten studies were included.

RESULTS

Overall, thiazide diuretics lowered blood pressure, increased fractional sodium excretion and decreased extracellular volume in patients. The mean eGFR ranged from 4 to 40 ml/min. Side effects were usually mild and thiazides were well tolerated.

CONCLUSION

Thiazides are effective in patients with low GFR and can be used more often in these patients. The advice to be restrictive on using thiazides in patients with an eGFR < 30 ml/min needs to be differentiated based on the results of this review. The effectiveness of thiazide diuretics may be caused by adaptive responses of intact nephrons, which leads to increased filtration and increased distal sodium delivery, which increases the effect on sodium excretion of thiazides. In addition the concentration of thiazides at postglomerular capillaries may increase, because more fluid is filtered and upregulation of organic anion transporters may increase active secretion of thiazides into the tubules.

Rubriek: Correspondentie
Identificatie: 2017;2:a1664
Datum: 28 december 2017

Heruitgifte van ongebruikte geneesmiddelen: een kwalitatief onderzoek onder stakeholders

Charlotte L. Bekker ab*, Helga Gardarsdottir bc, Toine C.G. Egberts bc, Marcel L. Bouvy c en Bart J.F. van den Bemt ad

Lees abstract

Redispensing of medicines unused by patients: a qualitative study among stakeholders

BACKGROUND

Medication waste has undesirable economic and environmental consequences. This waste is partly unavoidable but might be reduced by redispensing medicines unused by patients. However, there is little knowledge of stakeholders’ views on the redispensing.

OBJECTIVE

To identify the stakeholders’ views on the redispensing of medicines unused by patients.

DESIGN AND METHODS

Qualitative study in which semi-structured interviews were conducted with 19 Dutch stakeholders from September 2014 until April 2015. The interview guide included two themes: medication waste and redispensing of unused medicines. The latter included qualitative, legal and financial aspects and stakeholder involvement with specific attention for the patient. Interview transcripts were subjected to thematic content analysis.

RESULTS

All stakeholders considered the redispensing of medicines desirable if the implementation is feasible and the requirements for the safe redispensing are met. All of them pointed out that the product quality of redispensed medicines should be guaranteed and that it should be clear who is responsible for the quality of redispensed medicines. The stakeholders stated that transparent communication to patients is essential to guarantee trust in the redispensing system and that patients should be willing to use redispensed medicines. Moreover, the redispensing system’s benefits should outweigh the costs and a minimal economic value of medicines suitable for redispensing should be determined.

CONCLUSION

Redispensing unused medicines could decrease medication waste if several requirements are met. For successful implementation of a redispensing system, all relevant stakeholders should be involved and cooperate as a joint-force.

Rubriek: Korte bijdrage
Identificatie: 2017;2:a1653
Datum: 28 december 2017

Ziekenhuisfarmaciedagen, 9 en 10 november 2017

Lees abstract

De hier opgenomen abstracts vormen de mondelinge presentaties tijdens de Ziekenhuisfarmaciedagen op 9 en 10 november 2017 te Bunnik.

Rubriek: Congresabstracts
Identificatie: 2017;2:a1666
Datum: 15 december 2017

Sederende medicatie bij de geriatrische intensivecarepatiënt

Bart G.J. Dekkers ab, Bert Loef c, Marijn Boer c en Ithamar Brinkman a*

Lees abstract

Sedative drugs in the geriatric intensive care patient

BACKGROUND

The number of elderly patients admitted to Intensive Care Units (ICUs) has increased significantly in recent years. It has been demonstrated that the elderly are more prone to inadequate drug treatment and adverse drug effects.

OBJECTIVE

To perform a literature review on the effects of aging on pharmacokinetic and pharmacodynamic properties of commonly used sedative drugs in Dutch ICUs.

DESIGN AND METHODS

Literature review using PubMed.

RESULTS

Literature on the effects of aging on the pharmacology of commonly used sedative drugs in the ICU is scarce. For the general population, we found that for midazolam, propofol, fentanyl and remifentanil aging is associated with an increased susceptibility of the patients for the pharmacodynamic properties of these agents. This effect is confirmed for some of these drugs in ICU patients. In addition, a reduction in drug clearance was observed for propofol and remifentanil.

CONCLUSION

Based on these findings, we suggest to start with lower dosages for midazolam, propofol, fentanyl and remifentanil in elderly ICU patients and to re-evaluate frequently and adjust the therapy by clinical effect if necessary.

Rubriek: Overzichtsartikel
Identificatie: 2017;2:a1659
Datum: 15 december 2017

Afbouw TNF-alfaremmers in de dagelijkse klinische praktijk bij reumatologie

C. Lau ab, N. van Rein a, C.F. Allaart c en J. Zwaveling a*

Lees abstract

Dose tapering of TNF-alpha inhibitors in clinical daily practice based on pharmacy dispensing data

OBJECTIVE

To analyse the clinical daily practice of dose tapering of subcutaneous TNF-alpha inhibitors in patients of the Department of Rheumatology of the Leiden University Medical Centre (LUMC).

DESIGN AND METHODS

Dispensing data of the outpatient pharmacy of the LUMC from 2012-2015 were extracted. Patients of the Department of Rheumatology receiving a subcutaneous TNF-alpha inhibitor at stable dose (range 80-120%) during at least six months were included. Dose tapering was defined as receiving a dose reduction of at least 30% compared to the last stable dose after two subsequent prescriptions or as dispensing only one prescription of the TNF-alpha inhibitor over minimally 200 days.

RESULTS

Dispensing data of 235 patients were available: 66% were diagnosed with rheumatoid arthritis, and 59% of the patients were treated with etanercept. No data were available about previous or current disease activity or concomitant treatment. Of 235 patients, 46 (20%) matched the definition of receiving a dose reduction in TNF-alpha inhibitor based on dispensing data. Remarkably, 53% of all attempts to taper a TNF-alpha inhibitor seemed not successfully continued. Compared to patients who used etanercept, patients who used adalimumab were 1.4 times more likely (95% confidence interval [95% CI] = 0.8-2.4) to receive a dose reduction and 3.4 times more likely (95% CI = 1.7-6.8) to receive a dose increment. The type of rheumatic diagnosis was not associated with the frequency of dose reduction.

CONCLUSION

This study shows that dispensing data can be a useful source to analyse dose tapering of TNF-alpha inhibitors in daily clinical practice. However, factors that contribute to dose reduction or dose tapering could not be directly analysed.

Rubriek: Oorspronkelijk artikel
Identificatie: 2017;2:a1660
Datum: 15 december 2017

Evaluatie van doseerrichtlijnen en populatiefarmacokinetiek van vancomycine bij kinderen met kanker

P.S. van Egmond a*, N.K.A. van Eijkelenburg b, C.M. Zwaan cd en R.A.A. Mathôt a

Lees abstract

Evaluation of dosing guidelines and population pharmacokinetics of vancomycin in children with cancer

BACKGROUND

Vancomycin is standard therapy in pediatric oncology patients with neutropenic fever. In a previous study we showed that with a starting dose of 60 mg/kg/day in four doses 58% of patients had inadequate trough levels. As a result the starting dose was increased to 90 mg/kg/day.

OBJECTIVE

To determine whether a starting dose of 90 mg/kg/day in four doses leads to a higher percentage therapeutic trough levels compared to 60 mg/kg/day in four doses. Furthermore, population pharmacokinetics were described in pediatric oncology patients.

DESIGN AND METHODS

Prospective data from the VANCOPOP study were combined with retrospective data from the Academisch Medisch Centrum, Amsterdam. The percentage therapeutic trough levels (10-15 mg/L) in the first three days of therapy was the primary endpoint. As a secondary endpoint, renal toxicity was evaluated. Population pharmacokinetics were described using nonlinear mixed-effects modelling.

RESULTS

Data was available from 53 and 22 patients receiving 60 and 90 mg/kg/day, respectively. The percentages therapeutic trough concentrations were comparable in both groups (21% and 23%, respectively). The percentages sub- (68% and 41%, respectively) and supratherapeutic concentrations (12% and 36%, respectively) were different between dosing groups (p < 0.05). The population pharmacokinetics of vancomycin were described by a two-compartment model with creatinine clearance significantly affecting clearance. Based on Monte Carlo simulations the following doses were proposed: younger than two years 90 mg/kg/day, two till six years 80 mg/kg/day, six till twelve years 70 mg/kg/day and twelve till eighteen years 60 mg/kg/day, all in four doses.

CONCLUSION

Vancomycin clearance is age-dependent and highly variable in pediatric oncology patients. A prospective study is necessary to evaluate the proposed dosing guidelines for different age groups.

Rubriek: Korte bijdrage
Identificatie: 2017;2:a1658
Datum: 10 november 2017

Minder accidentele overdoseringen en intoxicaties met Thyrax bij kleine kinderen door wijziging van flacon naar blisterverpakking

T.E. van Riemsdijk *, A.J.H.P. van Riel, C.C. Hunault en I. de Vries

Lees abstract

Less accidental overdoses and intoxications with Thyrax in little children because of change from bottle to blister packaging

OBJECTIVE

In December 2013, the largest manufacturer of levothyroxine for the Dutch market (brand Thyrax) started packaging their product from glass bottles into blisters to protect it from environmental influences. We investigated whether this change in the primary packaging influenced the frequency and severity of accidental levothyroxine overdose in young children.

DESIGN AND METHODS

Telephone inquiries to our Dutch Poisons Information Center concerning children under seven years of age exposed to Thyrax were registered between January 2010 and December 2015. The ingested amount of levothyroxine in mg/kg body weight was recorded and the severity of the overdoses was estimated. An unknown dose or an ingested dose of more than 0.05 mg/kg of levothyroxine was defined as a toxic dose. Information about the actual manner of packaging was collected in 2014 and 2015. The number of telephone inquiries before and after the change in the primary packaging were compared using interrupted time series analyses. The decrease in proportions of cases exposed to a toxic dose were compared using a Z-test.

RESULTS

The monthly average number of Thyrax overdose cases decreased from 12.1 per month before the change in the primary packaging to 6.4 after (P = 0.04). Furthermore, this decrease was proportionally larger among children exposed to a toxic dose than among children exposed to a non-toxic dose: –66% versus –38%, respectively (P = 0.002). However, in 2015 still 21% of the children with an overdose took these Thyrax tablets out of a bottle.

CONCLUSION

Blister packaging has significantly reduced the number and severity of accidental intake of Thyrax by young children. However, this preventive effect is hampered by parents removing the medication from the blister well before use.

Rubriek: Oorspronkelijk artikel
Identificatie: 2017;2:a1656
Datum: 10 november 2017

Contact

Redacteur / secretaris
Arjan Polderman

(070) 373 73 14 npfo@npfo.nl