Management and prevention of problems related to oncology drugs are particularly important due to the excessive cost, high toxicity, and narrow therapeutic index of the antineoplastic drugs, in addition to the patients' state of health. Therefore, the presence of the pharmacist as a member of the multidisciplinary team is essential to contribute to patient safety. In this work, the interventions performed were identified, quantified, and classified to characterize the work of the clinical oncology pharmacist. This is a prospective and quantitative study, conducted over a period of six months in the outpatient oncology and chemotherapy clinic of the University Hospital of the University of Campinas, Brazil. A total of 3526 medical prescriptions were evaluated for the 780 patients seen and, among these prescriptions, 220 (6.24%) contained errors, representing 6.24% of the total number. The most common error was dose-related with 79 (22.83%) cases of overdosing. Wrong-patient medication error was the least reported (0.29%). Thirty drugs were involved in the pharmaceutical interventions, Carboplatin and Ondansetron being the most frequent. Thirteen types of potential errors were evaluated according to the method proposed by Cardinal and Fernandes. Two (15.38%) included interventions of indication, contraindication, and therapeutic efficacy of a drug. Five of them (38.46%) are related to the treatment regimen, and two (15.38%) were related to prevention of potential adverse events. Four interventions (30.77%) concerned technical interventions in injectable drugs such as dilution, compatibility, and administration time. Of the 346 interventions performed, 1 (0.29%) was classified as potentially lethal, 114 as serious (32.95%), 140 as significant (40.46%), and 91 as minor (26.30%).

Clinical oncology pharmacist: Effective contribution to patient safety

BackgroundSome studies in the literature describe drug-related problems in patients with cancer, although few studies focused on patients receiving targeted chemotherapy and/or immunotherapy. To id...

Drug-related problems with targeted/immunotherapies at an oncology outpatient clinic:

Exploring troublesome symptom and problems experienced by cancer patients undergoing chemotherapy.

Background: Drug Related Problems (DRPs) in cancer chemotherapy can have severe consequences originating from the high toxicity and narrow therapeutic range of anticancer drugs. 
Objective: This study was conducted to investigate drug-related problems and factors associated with it in hospitalized cancer patients at Tikur Anbessa Specialized Hospital.
Method: A cross-sectional study was conducted at Tikur Anbessa Specialized Hospital from January to June 2013. A total of 367 study participants were recruited by simple random sampling technique and data were collected by medical chart review using data abstraction format.
Results: Four hundred seventy four drug-related problems were identified in 274 patients among the 367 patients, which gave rise to a prevalence of 74.7%. The most prevalent drug-related problems was adverse drug reaction (45.5%) followed by dosing problem (37.9%). The risk factors for DRPs were number of medications, comorbidity and length of hospital stay.
Conclusion: Drug related problems were common among cancer patients in our set up indicating a need for intervention like involvement of a pharmacist for better therapeutic outcome.

/pdf/drug-related-problems-in-chemotherapy-of-cancer-patients-1iplvpe5dw.pdf

Drug Related Problems in Chemotherapy of Cancer Patients

Background Morbidity and mortality associated with the use of medicines is a great problem of public health. The pharmacist has a key role in detection, preventing and resolving drug-related problems (DRP). This is even more important in the case of cancer patients, where the high number of treatment protocols and the extensive supportive therapy increases the number of drugs used. This particular setting is a challenge to the clinical pharmacist. Purpose Analysis and characterisation of pharmacotherapeutic follow-up and pharmacist interventions in oncology patients. Materials and methods Retrospective study of pharmacotherapeutic follow-up from January to September of 2011, in a central hospital. Results Between January to September of 2011 the team of oncology pharmacists monitored 56 patients (29 males and 26 females) with mean age of 69 years (min.: 33; max.: 93). Colorectal cancer was the most prevalent cancer in the study population, followed by breast and pulmonary cancers. The team monitored 316 drugs (a mean of 5.64 drugs per patient). The follow-up detected 43 DRPs, resulted in 43 pharmaceutical interventions (0.77/patient). The majority of interventions were related to the need to adjust dosages (53.5%), followed by the need to substitute one or more medicines (11.6%) and those related to adverse effects (11.6%), such as emesis protocol optimisation and other supportive treatment. The physicians accepted approximately 79% of pharmacist interventions. Conclusions The results show that cancer patients are one of the groups most at risk of DRPs. The analysis, characterisation and quantification of pharmaceutical interventions performed on the oncology unit are an important step in documenting the activities of hospital pharmacists in this area, enabling them to be measured. The pharmacist interventions stand out as individual contributions throughout the patient9s cancer treatment, highlighting the role of the pharmacist as part of the multidisciplinary team.

Pharmacotherapeutic follow-up in oncology

Introduction PTSD is a chronic, debilitating condition with limited treatment efficacy. Accessing traumatic memories often leads to overwhelming distress, impacting treatment process. Current approved pharmacological treatments have exhibited small to moderate effects when compared with placebo. Evidence suggests 3,4,-methylene-dioxymethamphetamine(MDMA)-assisted psychotherapy as a viable option for refractory PTSD. Objectives Comprehensive review of early clinical research, proposed mechanisms, safety and emerging therapeutic models. Methods Eligible studies will be identified through strategic search of MEDLINE. Results Pre-clinical and imaging studies suggest memory reconsolidation and fear extinction as candidate psychological and neurological mechanisms, involving MDMA’s combined effects of increasing serotonergic activity, as well the release of oxytocin and brain-derived neurotrophic factor in key memory and emotional circuits. Resulting reduction in amygdala and insula activation and increasing connectivity between the amygdala and hippocampus may create a “tolerance window” of neuroplasticity for emotional engagement and reprocessing of traumatic memories during psychotherapy. Early clinical trials report impressive and durable reduction in PTSD symptoms, with a safety profile comparable to that of SSRIs. A recently completed randomized, double-blind, placebo-controlled phase 3 trial reported full remission of PTSD symptoms in 67% of patients at 2 months, with no increase in suicidality, cardiovascular events or abuse behavior. Emerging treatment models underline the importance of unmedicated therapeutic sessions for preparation for the experience and subsequent integration as essential for full benefit and safety of the clinical context. Conclusions The psychological impact associated with the COVID-19 pandemic is an reminder of the emotional and economic burden associated with PTSD. MDMA-assisted therapy may be a breakthrough approach meriting further multidisciplinary investment and clinical research. Disclosure No significant relationships.

MDMA-Assisted Therapy for Treatment-Resistant Posttraumatic Stress Disorder (PTSD) – One step further toward a patient-centered treatment pathway

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Pharmacotherapeutic follow-up in oncology

MDMA-Assisted Therapy for Treatment-Resistant Posttraumatic Stress Disorder (PTSD) – One step further toward a patient-centered treatment pathway