Continuous Incisional Lidocaine in Pediatric Patients following Open Heart Surgery

Continuous incisional lidocaine infusion has been proposed as an adjunctive therapy in the management of postoperative pain in adult patients. The aim of this study was to determine the efficacy and safety of a continuous subcutaneous lidocaine infusion in pediatric patients following open heart surgery. All patients receiving a subcutaneous lidocaine infusion in median sternotomy incisions after open heart surgery during 2 consecutive years were included in the study. A historical cohort of patients was used as a control group. Demographic variables (age, size, and surgical procedure), variables related to sedation and analgesia (COMFORT and analgesia scales, drug doses, and duration), and complications were registered. 106 patients in the lidocaine infusion group and 79 patients in the control group were included. Incisional analgesia was effective for the treatment of pain as it reduced the dose and duration of intravenous fentanyl (odds ratio (OR) 6.26, confidence interval (CI) 95%: 2.48-15.97, p = 0.001 ; OR 4.30, CI 95%: 2.09-8.84, p = 0.001 , respectively). The reduction in fentanyl use was more important in children over two years of age. Adverse effects were seen in three children (2.8%): they all had decreased level of consciousness, and one of them presented seizures as well. Two of these three patients had lidocaine levels over 2 mcg/ml. A continuous lidocaine incisional infusion is effective for the treatment of pain after open heart surgery. This procedure reduced intravenous analgesic drug requirements in pediatric patients undergoing a median sternotomy incision. Although the incidence of secondary effects is low, monitoring of neurologic status and lidocaine blood levels are recommended in all patients.

Effects of Recovery-Orientation on the Use of Forced Medication and Maximum Daily Drug Dose: The “Weddinger Modell”

Objective: The aim of the present study was to analyze the effects of the implementation of the Recovery-orientated psychiatric care concept “Weddinger Modell” on the incidence of forced medication, the total number of forced medication incidents per affected case, the maximum dose of a singular forced medication and the maximum voluntary daily drug dose of different psychotropic drugs administered during an inpatient stay.Methods: This retrospective case-control study included 234 patients. A pre/post-comparison of patients on two acute psychiatric wards before (control group, n = 112) and after (intervention group, n = 122) the implementation of the Weddinger Modell in 2010 was performed. Patient data was selected at two reporting periods before and at two reporting periods after 2010.Results: No significant differences were found in the incidence of forced medication and the total number of forced medications. A significant reduction of the maximum forced medication dose of haloperidol in the intervention group was seen. Furthermore, the analysis of the intervention group showed a significant reduction of the maximum voluntary daily drug doses of clozapine, haloperidol and risperidone.Discussion: The results indicate that the implementation of the Weddinger Modell had no effect on the incidence of forced medication, but it can help to improve the approach to psychotropic drugs. Despite the reduction of mechanical coercive measures by the model, as shown in a previous study, there is no increase in forced medications or administered drug doses. Focus on Recovery helps in reducing coercion in acute psychiatric care.

Handling Fever In Toddlers At Homes In The Village Of Manarap Lama

Background: The prevalence of fever at the age of 0-4 years was 33.4%, cough was 28.7% and diarrhea was 11.4%. Central Agency Statistics in Indonesia (2012), children with fever as many as 90,245 children, in 2013 as many as 112,511 children. From field observations and interviews with some communities, the main problem was that the community had not been able to calculate drug doses for children under five and did not understand how to handle fever in children under five. The purpose is increase the level of knowledge and skill about fever handling of parents who have children under five in Manarap Village. Methods: Pre-test and Post-test, Educational counseling, training to measure temperature with a thermometer, training to calculate the dose of fever medicine for children under five, training in handling fever in children under five. The number of respondents are 14 people, total implementation of activities is 1 month, but educational activities and interviews are carried out for 1 day but at different times, then a follow-up plan is made after the activity. Results: Increased knowledge can be seen from the post-test value which is higher than the pre-test value, participants can measure body temperature with a thermometer correctly, participants can calculate the dose of paracetamol fever medicine for children under five, participants understand the handling of fever in children under five. Conclusion: Community service activities to treat fever in children under five through education have increased the knowledge and understanding of participants from the results of the pretest and post-test with a significant increase in scores. The hands-on practice of using a thermometer, compressing and calculating the right dose helped participants understand.

Nanotherapeutics for Nose-to-Brain Drug Delivery: An Approach to Bypass the Blood Brain Barrier

Treatment of neurodegenerative diseases or other central nervous system (CNS) disorders has always been a significant challenge. The nature of the blood-brain barrier (BBB) limits the penetration of therapeutic molecules to the brain after oral or parenteral administration, which, in combination with hepatic metabolism and drug elimination and inactivation during its journey in the systemic circulation, decreases the efficacy of the treatment, requires high drug doses and often induces adverse side effects. Nose-to-brain drug delivery allows the direct transport of therapeutic molecules by bypassing the BBB and increases drug concentration in the brain. The present review describes mechanisms of nose-to-brain drug delivery and discusses recent advances in this area with especial emphasis on nanotechnology-based approaches.

Pulsatile Bi-Directional Aerosol Flow Affects Aerosol Delivery to the Intranasal Olfactory Region: A Patient-Specific Computational Study

The nasal olfactory region is a potential route for non-invasive delivery of drugs directly from the nasal epithelium to the brain, bypassing the often impermeable blood-brain barrier. However, efficient aerosol delivery to the olfactory region is challenging due to its location in the nose. Here we explore aerosol delivery with bi-directional pulsatile flow conditions for targeted drug delivery to the olfactory region using a computational fluid dynamics (CFD) model on the patient-specific nasal geometry. Aerosols with aerodynamic diameter of 1 µm, which is large enough for delivery of large enough drug doses and yet potentially small enough for non-inertial aerosol deposition due to, e.g., particle diffusion and flow oscillations, is inhaled for 1.98 s through one nostril and exhaled through the other one. The bi-directional aerosol delivery with steady flow rate of 4 L/min results in deposition efficiencies (DEs) of 50.9 and 0.48% in the nasal cavity and olfactory region, respectively. Pulsatile flow with average flow rate of 4 L/min (frequency: 45 Hz) reduces these values to 34.4 and 0.12%, respectively, and it mitigates the non-uniformity of right-left deposition in both the cavity (from 1.77- to 1.33-fold) and the olfactory region (from 624- to 53.2-fold). The average drug dose deposited in the nasal cavity and the olfactory epithelium region is very similar in the right nasal cavity independent of pulsation conditions (inhalation side). In contrast, the local aerosol dose in the olfactory region of the left side is at least 100-fold lower than that in the nasal cavity independent of pulsation condition. Hence, while pulsatile flow reduces the right-left (inhalation-exhalation) imbalance, it is not able to overcome it. However, the inhalation side (even with pulsation) allows for relatively high olfactory epithelium drug doses per area reaching the same level as in the total nasal cavity. Due to the relatively low drug deposition in olfactory region on the exhalation side, this allows either very efficient targeting of the inhalation side, or uniform drug delivery by performing bidirectional flow first from the one and then from the other side of the nose.

Data-Enriched Edible Pharmaceuticals (DEEP) with Bespoke Design, Dose and Drug Release

Data-enriched edible pharmaceuticals (DEEP) is an approach to obtain personalized medicine, in terms of flexible and precise drug doses, while at the same time containing data, embedded in quick response (QR) codes at a single dosage unit level. The aim of this study was to fabricate DEEP with a patient-tailored dose, modify drug release and design to meet patients’ preferences. It also aimed to investigate physical stability in terms of the readability of QR code patterns of DEEP during storage. Cannabinoids, namely, cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC), were used as the model active pharmaceutical ingredients (APIs). Three different substrates and two colorants for the ink were tested for their suitability to fabricate DEEP by desktop inkjet printing. Flexible doses and customizable designs of DEEP were obtained by manipulating the digital design of the QR code, particularly, by exploring different pattern types, embedded images and the physical size of the QR code pattern. Modification of the release of both APIs from DEEP was achieved by applying a hydroxypropyl cellulose (HPC) polymer coating. The appearance and readability of uncoated and polymer-coated DEEP did not change on storage in cold and dry conditions; however, the HPC polymer layer was insufficient in preserving the readability of the QR code pattern in the extreme storage condition (40 °C and 75% relative humidity). To sum up, the DEEP concept provides opportunities for the personalization of medicines, considering also patients’ preferences.

Estimated Manipulation of Tablets and Capsules to Meet Dose Requirements for Chinese Children: A Cross-Sectional Study

Objectives: To estimate the frequency of manipulations of all tablets and capsules prescribed for children in a teaching and tertiary children's hospital in China over the course of 1 month. Moreover, hypothetical reduction of manipulation according to the availability of low-strength tablets/capsules licensed by the Chinese National Medical Products Administration (CNMPA) was evaluated.Methods: Information on all tablets and capsules prescribed in the hospital from March 17 to April 16, 2019 was collected. It was assumed that tablets or capsules were manipulated if the prescribed dose would have required only a proportion of the intact dose form. Manipulation typically includes splitting or crushing tablets, opening capsules and dispersing in water, or combinations of these method. Moreover, we defined an “avoidable manipulation,” when the dose could be rounded and/or when alternative products with a reduced strength or in liquid formulation were available in the hospital, and a “inappropriate manipulation,” which involved manipulated medications with a direct contraindication for any manipulation, such as those with a narrow therapeutic index or hazardous ingredients, or modified release dosage-forms. The frequencies of total, avoidable, and inappropriate manipulation were estimated, along with the hypothetical reduction of manipulation according to the availability of CNMPA-approved drug doses.Results: A total of 17,123 prescriptions for 142 medications were identified to have required a manipulation among 78,366 prescriptions administered during the study period, with 43 different proportions of subdivisions, ranging from a 19/20 to 1/180 product strength reduction. Half, quarter, and trisection were the most common subdivisions administered. Overall, 19% of the manipulated prescriptions were determined to be avoidable, and 19% of the manipulations involved medications with a clear recommendation to not manipulate. In addition, 21% of the manipulated prescriptions could have been potentially avoided if all of the approved preparations with the lowest strength would have been available at the hospital. Any manipulations undertaken were carried out by pharmacists and family care givers.Conclusions: More than 20% of tablets and capsules prescriptions need manipulated, included a high incidence of avoidable and inappropriate manipulation.

Risky calculations

Drug doses and other forms of patient treatment require detailed calculations. Calculation errors are one of the most common types of error and they could be reduced in many ways. Calculators ignore errors, and should be fixed if they are going to be used in healthcare.

UGT1A1 regulatory variant with potential effect on efficacy of HIV and cancer drugs commonly prescribed in South Africa

Aim: Despite the high disease burden of human immunodeficiency virus (HIV) infection and colorectal cancer (CRC) in South Africa (SA), treatment-relevant pharmacogenetic variants are understudied. Materials & methods: Using publicly available genotype and gene expression data, a bioinformatic pipeline was developed to identify liver expression quantitative trait loci (eQTLs). Results: A novel cis-eQTL, rs28967009, was identified for UGT1A1, which is predicted to upregulate UGT1A1 expression thereby potentially affecting the metabolism of dolutegravir and irinotecan, which are extensively prescribed in SA for HIV and colorectal cancer treatment, respectively. Conclusion: As increased UGT1A1 expression could affect the clinical outcome of dolutegravir and irinotecan treatment by increasing drug clearance, patients with the rs28967009A variant may require increased drug doses to reach therapeutic levels or should be prescribed alternative drugs.

ANALISIS PELAYANAN INFORMASI OBAT (PIO) PADA PASIEN DI APOTEK X PERIODE MEI 2021

Drug Information Service is an activity of providing and providing information, drug recommendations that are independent, accurate, unbiased, current and comprehensive carried out. The purpose of this study was to analyze the description of drug information services received by patients. This research method is descriptive with accidental sampling technique based on a survey with a sample of 62 respondents. The results of the questionnaire given to patients regarding drug information services were obtained regarding the provision of drug information through leaflets or brochures as much as 22.58% were always carried out; information related to drug names as much as 80.65% is always carried out; drug dosage forms (tabelts, capsules, syrups, creams, ointments, etc.) as much as 82.26% are always carried out; drug doses as much as 77.42% are always carried out; how to use drugs as much as 85.48% are always done; the method of storing drugs as much as 80.65% is always carried out; drug indications as much as 72.58% are always carried out; drug interactions as much as 75.81% are always carried out; prevention of drug interactions as much as 74.19% is always done; drug side effects as much as 79.03% are always carried out; the method of destroying drugs (throwing, burning, or burying) 9.68% is always done. It's just that in drug information services regarding the provision of leaflets or brochures the results are 22.58% and the method of destroying drugs is 9.68%, which means that pharmacists rarely provide information and education to patients at the pharmacy about giving leaflets or brochures and how to destroy drugs. ABSTRAKPelayanan Informasi Obat merupakan kegiatan penyediaan dan pemberian informasi, rekomendasi obat yang independen, akurat, tidak bias, terkini dan komprehensif. Tujuan penelitian ini menganalisis mengidentifikasi gambaran pelayanan informasi obat yang di terima oleh pasien di Apotek X. Metode penelitian ini yaitu deskriptif dengan teknik accidental sampling berdasarkan survei dengan sampel yang didapat yaitu 62 responden. Hasil penelitian dari kuisioner yang diberikan pada pasien mengenai pelayanan informasi obat didapatkan mengenai pemberian informasi obat melalui leaflet atau brosur sebanyak 22,58% selalu dilakukan; informasi terkait nama obat sebanyak 80,65% selalu dilakukan; bentuk sediaan obat (tabelt, kapsul, sirup, cream, salep, dll) sebanyak 82,26% selalu dilakukan; dosis obat sebanyak 77,42% selalu dilakukan; cara pemakaian obat sebanyak 85,48% selalu dilakukan; cara penyimpanan obat sebanyak 80,65% selalu dilakukan; indikasi obat sebanyak 72,58% selalu dilakukan; interaksi obat sebanyak 75,81% selalu dilakukan; pencegahan terhadap interaksi obat sebanyak 74,19% selalu dilakukan; efek samping obat sebanyak 79,03% selalu dilakukan; cara pemusnahan obat (dibuang, dibakar, atau dikubur) sebanyak 9,68% selalu dilakukan. Hanya saja pada pelayanan informasi obat mengenai pemberian leaflet atau brosur hasilnya 22,58% dan cara pemusnahan obat hasilnya 9,68% yang artinya masih jarang dilakukannya pemberian informasi dan edukasi oleh Apoteker kepada pasien di Apotek tersebut tentang pemberian leaflet atau brosur dan cara pemusnahan obat.