Clinical pharmaceutical screening in critical situations in a radioiodine therapy management service

2021 ◽  
pp. 107815522110453
Author(s):  
Lídia Freitas Fontes ◽  
Mariana Martins Gonzaga do Nascimento ◽  
Djenane Ramalho-de-Oliveira ◽  
Cristiane de Paula Rezende ◽  
Célia Helena Fernandes da Costa ◽  
...  

Radioiodine therapy can be used in differentiated thyroid carcinoma and requires extensive evaluation to ensure effectiveness and safety. Therefore, it is necessary to evaluate all health problems and medications used in the pre-radioiodine therapy period and comprehensive medication managementservices can serve as a screening tool in this context. The present study aims to describe critical clinical situations identified during the initial assessments of a comprehensive medication management service offered to differentiated thyroid carcinoma patients pre-radioiodine therapy, and the pharmaceutical interventions performed to solve them. A descriptive study with regard to the initial ten months of a comprehensive medication management service was carried out in a large oncology hospital (Rio de Janeiro, Brazil). Descriptive analysis was used to describe the critical clinical situations identified, as well as the correspondent drug therapy problems and the type, acceptability, and outcomes of the pharmaceutical interventions performed to solve them. Thirty patients with an average of 45.8 years and 5.1 medications were evaluated. Five critical clinical situations were identified; corresponding to drug therapy problems two(needs additional drug therapy – n = 4) and drug therapy problems four (dosage too low – n = 1). All pharmaceutical interventions were accepted. The comprehensive medication management service provision pre-radioiodine therapy is feasible and represents an important screening strategy.

Author(s):  
Igor G. SOUZA ◽  
Mariana G. NASCIMENTO ◽  
Djenane RAMALHO DE OLIVEIRA ◽  
Marcia E. ARCHONDO

Objective: To describe the results of a Comprehensive Medication Management (CMM) service offered to patients of an adult intensive care unit. Methods: A descriptive cross-sectional study of the results of the CMM service (April 2017 to November 2018). All the patients followed up in the CMM service were included in the sample of this study. The service was integrally based on the Pharmaceutical Care Practice and, therefore, used the Pharmacotherapy Workup (PW) method. the drug therapy Problems (DTP) were quantified and classified according to the PW method. The main medications involved in the DTP were also described, as well as the acceptance of the interventions by the multidisciplinary care team members and patients. Results: 146 patients were followed up during the study period, and 512 DTP were identified. Of these DTP, most were related to medication safety (37.7%) and to indication (37.5%). The main causes were high dose (23.0%, with emphasis on dose adjustments in cases of kidney injury), need for additional medication (18.9%, inclusion of medication for electrolytic, glycemic, and prophylactic control), and unnecessary medication (18.6%, emphasis on de-prescription of antibiotics that were not indicated). Most of the problems (23.6%) were related to the therapeutic class of systemic anti-infective agent. Of the total DTP detected, 81.6% were resolved. A total of 451 interventions were implemented, of which 92.9% (n=419) were with physicians. The majority of the interventions with physicians were accepted (n=344, 82.1%). Conclusion: A high number of drug therapy problems have been detected and resolved by the CMM pharmacist, with emphasis on safety problems. The high acceptability of the interventions reinforces the need for the service applied to the critical patient.


2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092879
Author(s):  
Katarina Fehir Šola ◽  
Iva Mucalo ◽  
Andrea Brajković ◽  
Ivona Jukić ◽  
Donatella Verbanac ◽  
...  

Objective The aim of this study was to determine the frequency and type of drug therapy problems (DTPs) in older institutionalized adults. Method We conducted a cross-sectional observational study from February to June 2016 at a 150-bed public nursing home in Croatia, where comprehensive medication management (CMM) services were provided. A rational decision-making process, referred to as the Pharmacotherapy Workup method, was used to classify DTPs. Results Data were prospectively collected from 73 residents, among which 71% were age 75 years or older. The median number of prescribed medications per patient was 7 (2–16) and polypharmacy (> 4) was recorded for 54 (74.0%) patients. A total 313 DTPs were identified, with an average of 4.3 ± 2 DTPs per patient. The most frequent DTP was needing additional drug therapy (n = 118; 37.7%), followed by adverse drug reaction (n = 55; 17.6%). Lactulose (14.4%), tramadol (6.7%), and potassium (6.4%) were the medications most frequently related to DTPs. Conclusion The high prevalence of DTPs identified among older institutionalized adults strongly suggests the need to incorporate new pharmacist-led CMM services within existing institutional care facilities, to improve the care provided to nursing home residents.


2002 ◽  
Vol 57 (1) ◽  
pp. 117-124 ◽  
Author(s):  
Jeroen Schaap ◽  
Carmen F. A. Eustatia-Rutten ◽  
Marcel Stokkel ◽  
Thera P. Links ◽  
Michaela Diamant ◽  
...  

2020 ◽  
Vol 39 (9) ◽  
pp. 1811-1818
Author(s):  
Graziele Aparecida Simões Lima ◽  
Rossana Verónica Mendoza López ◽  
Ricardo Miguel Costa Freitas ◽  
Jose Willegaignon ◽  
Marcelo Tatit Sapienza ◽  
...  

2012 ◽  
Vol 2012 ◽  
pp. 1-11 ◽  
Author(s):  
Ivana Zagar ◽  
Andreja A. Schwarzbartl-Pevec ◽  
Barbara Vidergar-Kralj ◽  
Rika Horvat ◽  
Nikola Besic

Our aim was to test the efficacy of 131-I therapy (RIT) using recombinant human TSH (rhTSH) in patients with differentiated thyroid carcinoma (DTC) in whom endogenous TSH stimulation was not an option due to the poor patient's physical condition or due to the disease progression during L-thyroxin withdrawal. The study comprised 18 patients, who already have undergone total or near-total thyroidectomy and radioiodine ablation and 0–12 (median 5) RITs after L-thyroxin withdrawal. Our patients received altogether 44 RITs using rhTSH while on L-thyroxin. Six to 12 months after the first rhTSH-aided RIT, PR and SD was achieved in 3/18 (17%) and 4/18 patients (22%), respectively. In most patients (n= 12; 61%) disease progressed despite rhTSH-aided RITs. As a conclusion, rhTSH-aided RIT proved to add some therapeutic benefit in 39% our patients with metastatic DTC, who otherwise could not be efficiently treated with RIT.


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