PRIMERA REUNION INTERNACIONAL DE CIENCIAS FARMACEUTICAS Córdoba, Argentina 24 ...

394 Pages·2010·3.46 MB·English

Primera Reunión Internacional de Ciencias Farmacéuticas – RICiFa 2010

PRIMERA REUNION INTERNACIONAL DE CIENCIAS
FARMACEUTICAS
Córdoba, Argentina
24 Y 25 DE JUNIO DE 2010

Los siguientes resúmenes han sido presentados durante el
evento y serán publicados oportunamente con formato
proceeding por la revista AAPS Pharm Sci Tech

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Primera Reunión Internacional de Ciencias Farmacéuticas – RICiFa 2010

PRACTICAL UTILITY OF DIFFERE(cid:15)T SYSTEMS FOR CLASSIFYI(cid:15)G DRUG-
RELATED PROBLEMS (DRPs): ASSESSME(cid:15)T BY HOSPITAL PHARMACISTS.

Armando P1a, Fontana Db, Uema Sb, Vega EMb
aDepartament of Pharmacology, bDepartament of Pharmacy. School of Chemical Sciences, National
University of Córdoba.
Haya de la Torre y Medina Allende s/n, Ciudad Universitaria, Córdoba (Argentina) CP: 5000

Introduction
There are different classifications of DRPs with different focus (1). Both documenting and classifying
DRPs are essential to improve the process of medication’s use. In practice, professionals need a patient-
oriented base to implement pharmaceutical interventions (1-6).
Hospital Pharmacy Specialization (HPS) is a postgraduate career at the School of Chemical Sciences,
National University of Córdoba (FCQ-UNC). Most of the HPS students are working in health-system
pharmacies. One of the modules included the concept of DRPs and different classification systems.
The objectives of this work are:
• To assess the different DRPs classification systems through 4 clinical cases/examples resolved/classified
by pharmacists taking the HPS (FCQ-UNC).
• To analyze the opinions of participating pharmacists in relation to the focus and relevance of the
different DRPs classification systems.

Materials and methods
In the frame of module “Pharmaceutical Care I” (HPS), a workshop intended to identify and classify
DRPs was planned. Four clinical cases with one DRP each (or DRP risk) were presented to six working
groups of four pharmacists each. As few classifications have an official name, brief titles have been
assigned, usually referring to the originating organization or researcher(s).
The groups resolved the cases by consensus using 4 classification systems: ASHP (7), 2nd Granada
Consensus (8), PCNE V 5.01 (9) and Cipolle/Morley/Strand (10). Ideally, one type of DRP was expected
by case according to each system (1,2). An average number of categories assigned by case was obtained.
In addition, the groups were requested to assess the focus and practical utility of the DRPs classification
systems (1,2). A 5 points Likert scale was used from “totally agree” to “completely disagree”. For focus
assessment “completely disagree” was related to technical aspects while “totally agree” was associated to
a patient-oriented process.
For statistical analysis SPSS 15.0 software was used.

Results
Twenty four pharmacists discussed the DRPs classification systems during the workshop. Main outcomes
are shown in Table 1.

Conclusions
A comparison among different DRPs classification systems was carried out (1,2,3). Whereas an ideal
classification system should identify uniquely a given DRP (1), Cipolle/Morley/Strand and 2nd Granada
Consensus seem to be better than the other systems (11). Moreover, both of them obtain high scores in the
focus and practical utility assessments.

Acknowledgements
To Dr. María Eugenia Olivera (HPS director) and to all pharmacists from working groups.

References
1. van Mil JW, Westerlund LO, Hersberger KE, Schaefer MA. Drug-Related Problem Classification
Systems. Ann Pharmacother. 2004;38(5):859-67.
2. Björkman IK, Sanner MA, Bernsten CB. Comparing 4 classification systems for drug-related
problems: processes and functions. Res Social Adm Pharm 2008;4(4):320-31.
3. Björkman IK, Bernsten CB, Sanner MA. Care ideologies reflected in 4 conceptions of pharmaceutical
care. Res Social Adm Pharm 2008;4(4):332-42.

1 Corresponding author. Tel [phone], fax [phone]; e-mail: [email protected]
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Primera Reunión Internacional de Ciencias Farmacéuticas – RICiFa 2010

4. Lampert M, Kraehenbuehl S, Hug B. Drug-related problems: evaluation of a classification system in
the daily practice of a Swiss University Hospital. Pharm World Sci 2008;30:768-76.
5. Hämmerlein A, Griese N, Schulz M. Survey of drug-related problems identified by community
pharmacies. Ann Pharmacother. 2007;41(11):1825-32.
6. Krähenbühl JM, Kremer B, Guignard B, Bugnon O. Practical evaluation of the drug-related problem
management process in Swiss community pharmacies. Pharm World Sci. 2008;30(6):777-86.
7. American Society of Health-System Pharmacists. ASHP guidelines on a standardized method for
pharmaceutical care. Am J Health-Syst Pharm.1996; 53:1713-6.
8. Grupo de Investigación en Atención Farmacéutica. Segundo Consenso de Granada sobre Problemas
Relacionados con Medicamentos [The second Granada consensus on drug-related problems] Ars
Pharmaceutica 2002; 43:175-84. Spanish.
9. Pharmaceutical Care Network Europe. DRP-classification V5.01 [Internet]. [cited 2009 Oct 23].
Available from: http://www.pcne.org/Documents/DRP
10. Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice. New York: McGraw-Hill, 1998:78-
9.
11. Costa S, Santos C, Madeira A, Santos MR, Santos R. Using two different Classifications of Drug
Related Problems in community pharmacies - the Portuguese experience. Seguim Farmacoter 2004; 2(4):
267-85.

Table 1: Practical comparison among different DRPs classification systems
DRPs classification Average number of
Focus* Practical utility*
system categories assigned
ASHP 2,0 2,3 ± 0,5 2,0 ± 0,8
Cipolle/Morley/Strand 1,1 4,3 ± 0,5 4,3 ± 0,5
2nd Granada Consensus 1,0 4,3 ± 0,5 4,0 ± 0,0
PCNE V 5.01 1,6 1,8 ± 0,5 2,0 ± 0,8
* 5 points Likert scale ± SD

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CO(cid:15)SUMPTIO(cid:15) OF TRA(cid:15)QUILIZERS A(cid:15)D STIMULA(cid:15)TS AMO(cid:15)G COLLEGE
STUDE(cid:15)TS ATTE(cid:15)DI(cid:15)G THE SCHOOL OF CHEMICAL SCIE(cid:15)CES AT CORDOBA
(ARGE(cid:15)TI(cid:15)A).

Armando P1####, Virgolini M1,2, Cancela L1,2.
1Departament of Pharmacology. 2IFEC-CONICET. School of Chemical Sciences, National University of
Córdoba.
Haya de la Torre y Medina Allende s/n, Ciudad Universitaria, Córdoba (Argentina) CP: 5000.

Introduction
Both licit and illicit drug intake is a public health problem worldwide that affects the entire population,
with an early onset, usually at the adolescence and young adulthood (1,2). College students do not escape
to this problem, which transcends from the individual to the collective space, affecting both, the society
and its structures (3-7). Therefore, the epidemiological study of the student population is a first step to
design or improve future prevention and/or intervention programs about drug use (8). The aim of this
study is to estimate the magnitude of the consumption of tranquillizers and stimulants in the student
population attending the School of Chemical Sciences (UNC) during 2009.

Materials and methods
A descriptive cross-sectional study, using a self-administered questionnaire. A random sample of 400
students was obtained, stratified by sex and college grades. An online standardized and previously
evaluated questionnaire, designed by the Inter-American Observatory on Drugs (OID) for university
students was applied (8). It included several modules, one of them aimed to the drugs under study. In
accordance to the test, drug intake was measured as the lifetime prevalence (the number consumption
across the lifetime), and the annual and monthly prevalence (amount and frequency of consumption
within the month). Data analysis was performed using SPSS 15.0.

Results
A total of 203 students answered the questionnaire (50.1% of the total), 70.9% were female, with and
average age of 23.1 ± 4.6 year-old (range 18-46), and 92.1% of the students were single.
Regarding the use of tranquilizers, 21.7% reported having consumed them at some time in their lives.
From this percentage, 54.5% answered they consumed only by prescription, while 38.6% did so on their
own. In addition, a 1.5% reported recent use (sometime during the past year), while current use was
reported of 0.5%, in both cases without a medical prescription.
In relation to stimulants, 3.0% answered having consumed them sometime in their life. Also, while 66.7%
said the consumption was on their own, a 33.3% did so under medical prescription. In this case, both the
recent and the current use was zero (0.0%).

Conclusions
The results of this study provide interesting data about the problem of tranquilizers and stimulant drugs
consumption in an undergraduate student population. Given the lack of studies of this nature, and
although this research has limitations, the results obtained in terms of prevalence are lower than those of
other countries in the region (8,9). This could be the result of a greater awareness of the harm and risk
associated to the consumption of these drugs among students, which would act as a persuasive element,
explaining in part the low intake (3,5,6). However, it is crucial to implement prevention strategies, as well
as to provide information related to use of psychoactive substances, strengthening the formal education
about the risks given that risk perception is one of the most important protective factors to prevent drug
abuse (6).

Acknowledgments
To the School of Chemical Sciences authorities who provide the resources to carry out this study and to
Dr Ruth A Fernández for her collaboration in the development of this project.

# Corresponding author. Tel [phone], fax [phone]; e-mail: [email protected]

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References.
1. McCabe SE, Boyd CJ, Teter CJ. Subtypes of nonmedical prescription drug misuse. Drug Alcohol
Depend. 2009;102(1-3):63-70.
2. Horowitz A, Galanter M, Dermatis H, Franklin J. Use of and attitudes toward club drugs by medical
students. J Addict Dis. 2008;27(4):35-42.
3. Magaldi L, Rocafull J. Farmacovigilancia y hábitos de consumo de medicamentos en los estudiantes de
la escuela de enfermería de la Universidad Central de Venezuela. Rev. Facultad de Medicina, Caracas
2004; 27 (1): 100-107. Spanish.
4. Gómez A, Herde J, Laffee A, Lobo S, Martín E. Consumo de drogas lícitas e ilícitas por estudiantes
universitarios. Facultad de Ingeniería. Universidad de Carabobo, 2006. [Consumption of licit and illicit
drugs by college students. School of Engineering. University of Carabobo, 2006]. Salus 2007;1(3):41-5.
Spanish.
5. Martínez G, Martínez M, Rodríguez M, Mesa P, Muñoz J. Bedoya J. Características del consumo de
fármacos psicotrópicos en estudiantes de ciencias de la salud. [Characteristics of psychotropic
comsumption among health sciences students]. VITAE 2008; 15(2):244-50. Spanish.
6. Romero MI, Santander J, Hitschfeld M, Labbé M, Zamora V. Consumo de sustancias ilícitas y
psicotrópicos entre los estudiantes de medicina de la Pontificia Universidad Católica de Chile. [Illicit and
psychotropic drug use among medical students at the Pontificia Universidad Católica of Chile]. Rev Méd
Chile 2009; 137: 459-465. Spanish.
7. Cabrita J, Ferreira H, Iglésias P, Baptista T, Rocha E, Lopes da Silva A et al. Patterns and determinants
of psychoactive drug use in Lisbon University students--a population-based study. Pharm World Sci.
2004;26(2):79-82.
8. Estudio Epidemiológico Andino sobre consumo de drogas sintéticas en la población universitaria.
Informe comparativo: Bolivia, Colombia, Ecuador y Perú, 2009. [Epidemiological Study in the Andes
area about synthetic drug use in college population. Comparative Report: Bolivia, Colombia, Ecuador and
Peru, 2009]. Secretaría General de la Comunidad Andina. Lima (Perú); 2009.
9. Pelloni, C; Pronsky, L. Consumo de sustancias psicoactivas en estudiantes universitarios [Psychoactive
substance use among college students]. Sedronar [Internet]. [cited 2010 apr 23] Available from:
http://www.sedronar.gov.ar/images/novedades/biblioteca/encuesta%20consumo%20universitarios.pdf
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POTE(cid:15)TIAL DRUG TO DRUG I(cid:15)TERACTIO(cid:15)S DETECTED I(cid:15) PRESCRIPTIO(cid:15)S
DISPE(cid:15)SED AT A COMMU(cid:15)ITY PHARMACY I(cid:15) CÓRDOBA, ARGE(cid:15)TI(cid:15)A.

Armando P####1, Cappelli G2, Dondo V2, Rodríguez Sánchez L2, Velázquez MV2
1Pharmacy Department. Educators' Union of the Province of Córdoba. Salta 138. Córdoba (Argentina).
CP 5000. 2Student of pharmacy undergraduate professional practice course (School of Chemical
Sciences, National University of Córdoba).

Introduction
Drug to drug interactions (DDIs) are defined as the modifications in the action of one or more
concurrently administered medications (1-5). DDIs may result in either increased or decreased efficacy, in
treatment failure, or in an increased toxicity of medications (1-5). Pharmacists play an important role in
protecting the patients from potential DDIs, especially in the case of drugs with a narrow therapeutic
index (1-3,6).
While there is a lack of an effective screening system for detecting DDIs at dispensing in community
pharmacies in Argentina, potential DDIs causing serious risks to patients’ health has not been studied
extensively.
Consequently, the objectives of this study were to evaluate the nature, type and frequency of potential
DDIs in prescriptions dispensed at a community pharmacy in Córdoba (Argentina), over a 3-month
period.

Materials and methods
A database was developed with all the dispensations covered by the State Administration of Health
Insurance (APROSS) between October and December 2009, yielding to a random population of 400
patients, excluding those who only used a medication at the time of the study. The information collected
included date of the prescription, age, gender, prescribing physician’s ID, and the medications dispensed
(name, quantity and composition). Potential DDIs were detected using the Drug Interaction Checker
within www.medscape.com database and classified as severe, moderate or minor, depending on their
severity of clinical significance, and according to their production mechanism in pharmacodynamic or
pharmacokinetic. Data analysis was performed using SPSS 15.0.

Results
A total of 36.441 medications were dispensed to 7.798 patients during the study. From a total of 400
patients, 93 DDIs (23.3%) were detected in 67 different patients, 15 were severe (16,1% of all
interactions) and the remaining 78 DDIs (83,9%) were moderate while a 59,6% of cases involved
pharmacokinetic interaction.
Finally, 48.4% of the total DDIs detected involved different prescribers.

Conclusions
The present study revealed that the overall rate of potential DDIs in prescriptions dispensed was 23,3%, a
number that should raise some concern and awareness in both, the medical and pharmaceutical
community (1,7). A putative limitation of this study may be related to a certain degree of underreporting
of potential DDIs, given that data was analyzed considering only the APROSS prescription, which did not
include neither over-the-counter medications nor herbal preparations (1,2,5). A larger study including
other community or hospital pharmacies may give more reliable results (1,3,5,7).
These results provide a panoramic view of the DDIs problem, and demonstrate the need of the
implementation of a reliable screening system for DDIs at the time of dispensing (1,4,7-9). Identifying
and preventing potentially harmful DDIs is a critical component of a pharmacist’s mission, shifting the
pharmacist’s role from drug-oriented to patient-oriented (1,7).

# Corresponding author. Tel [phone], fax [phone]; e-mail: [email protected]

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Acknowledgments
To the pharmacists of the Pharmacy Department (UEPC). To the Drug Information Center (CIME),
School of Chemical Sciences, National University of Córdoba, for their cooperation in the realization of
this study. To Dr. Miriam Virgolini for the revision of this abstract.

References
1. Chatsisvili A, Sapounidis I, Pavlidou G, Zoumpouridou E, Karakousis VA, Spanakis M, Teperikidis L,
Niopas I. Potential drug-drug interactions in prescriptions dispensed in community pharmacies in Greece.
Pharm World Sci. 2010;32(2):187-93.
2. Malone DC, Abarca J, Skrepnek GH, Murphy JE, Armstrong EP, Grizzle AJ, Rehfeld RA, Woosley
RL. Pharmacist workload and pharmacy characteristics associated with the dispensing of potentially
clinically important drug-drug interactions. Med Care. 2007;45(5):456-62.
3. Becker ML, Kallewaard M, Caspers PW, Schalekamp T, Stricker BH. Potential determinants of drug–
drug interaction associated dispensing in community pharmacies. Drug Saf. 2005;28: 371-8.
4. Vonbach P, Dubied A, Krahenbuhl S, Beer JH. Evaluation of frequently used drug interaction
screening programs. Pharm World Sci. 2008;30:367-74.
5. Barris Blundell D, Rodríguez Zarzuelo C, Sabio Sánchez B, Garrido Jiménez B. Interacciones
farmacológicas detectadas en una farmacia comunitaria [Drug interactions detected in a community
pharmacy]. Pharm Care Esp 2003;5:261-7. Spanish
6. Becker ML, Caspers PW, Kallewaard M, Bruinink RJ, Kylstra NB, Heisterkamp S, et al. Determinants
of potential drug–drug interaction associated dispensing in community pharmacies in the Netherlands.
Pharm World Sci. 2007;29:51-7.
7. Astrand B, Astrand E, Antonov K, Petersson G. Detection of potential drug interactions - a model for a
national pharmacy register. Eur J Clin Pharmacol. 2006; 62(9):749-56.
8. Murphy JE, Malone DC, Olson BM, Grizzle AJ, Armstrong EP, Skrepnek GH. Development of
computerized alerts with management strategies for 25 serious drug-drug interactions. Am J Health Syst
Pharm. 2009;66:38-44.
9. Heikkila T, Lekander T, Raunio H. Use of an online surveillance system for screening drug interactions
in prescriptions in community pharmacies. Eur J Clin Pharmacol. 2006;62:661-5.

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CALCULATI(cid:15)G OF I(cid:15)DICATORS OF PHARMACEUTICAL I(cid:15)TERVE(cid:15)TIO(cid:15)S
MEA(cid:15)S OF Unit Dose Drug Distribution System (UDDDS)

Bessone L2, Lopez M
Pharmacy Service - Hospital Arturo Illia
Av. of the Liberator 1450 - Alta Gracia C.P:5186 – Córdoba (Argentina)
Hospital Pharmacy specialization student

Introduction
The Pharmacy Service is responsible for the accurate safe effective utilization of the medicines in the
hospital. This implies assuming the responsibility of drug selection, acquisition, conservation, preparation
for administering, distribution and dispensing to patients when they are correctly prescribed.(1,2)
The European model is based on the self evaluation as key process for the constant services improvement
(2) . To carry out this process, measuring with adequate specific quality indicators is required from time
to time.
Within the Pharmacy Service functions, the Resolution 641/2000 MS (3) defines establishing an effective
safe drug distribution system. Among them, the UDDDS is the only one that allows obtaining the aims
previously exposed, and it is the most suitable recognized.

Objetive
To evaluate Pharmacist interventions (PI) done with specific indicators developed from UDDDS’s
pharmacotherapeutic patient charts at Internal Medicine Service, in a public hospital of the province of
Córdoba with posterity to value the acceptance the PI for health team members.

Material and method
UDDDS’s pharmacotherapeutic patient charts completed for Internal Medicine Service in the Hospital
Arturo Illia (Alta Gracia City, Córdoba) were analyzed during October and November in 2009.
Analysis criterion: PI required by prescription, dosing and other errors detected in patient charts at
Internal Medicine Service. Indicator: percentage of PI divided by total of analyzed charts. Standard: less
than 5 % and numbers the PI total accept for realized PI.

Results
The total of analyzed charts in the study period was 66. The number of PI was 16 (24.2 %).
The types of PI for detecting errors were classified (4) according to: lack of generic name 8 (12 %), dose
problems 5 (7.6 %), and lack of medication or therapeutic substitution requirement 3 (4.5 %).
In addition, with these results, the degree of PI acceptance by the health team of Internal Medicine was
assessed, obtaining 87.5 %. Indicator (5): number of accepted PI divided by number of PI done during
the study period multiplied by 100. Standard: higher than 90 %.

Discussion and conclusions
Evidently, procedures’ documentation is required for evaluating the quality of care. Pharmacy Service has
a key position in the drug distribution and dispensing processes.
With the PI, accurate administration of medicines is guaranteed for inpatients as well as prescription
compliance and cost containment. Furthermore, the drug related problems are diminished, drug
distribution and dispensing are rational based, relationships with nurses and other health team members
are improved by PI in UDDDS, and they allow the obtainance of results in quality assessment to inform.
Against who the degree lower of standar, bright the repercussion of prescriptors doctors, after the IF,
there were obvious changes that will meet reflected in later works.., The pharmacist’s responsibility in
rational use of medicines and drug dispensing are the principal legitimization source of the pharmacy
profession.

2 Corresponding author.Tel: [phone]. e-mail: [email protected]
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Primera Reunión Internacional de Ciencias Farmacéuticas – RICiFa 2010

References
1-International Pharmaceutical Federation (FIP). Normas para la calidad de los servicios farmacéuticos.
La Haya: FIP; Septiembre 1997.
2-Sociedad Española de Farmacia Hospitalaria. Farmacia Hospitalaria. 3ª Edición. Fundación Española
de Farmacia Hospitalaria-Glaxo Smith Kline; 2002.
3-Normas de Organización y Funcionamiento de Farmacia en Establecimientos Asistenciales, Resolución
641/2000 Ministerio de Salud de la Nación, PEN, República Argentina (Ago 22, 2000).
4-Promoción de la utilización de medicamentos por su nombre genérico, Ley 25.649, Congreso de la
Nación Argentina, República Argentina (Sept 19, 2002).
5-Management Sciences for Health. La gestión del suministro de medicamentos. 2ª Edición. Boston:
MSH, Inc; 2002.

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RISKS ASSOCIATED WITH THE USE OF DRUGS I(cid:15) THE ELDERLY:
APPLICATIO(cid:15) OF BEER´S CRITERIA.

Ascar, G. I3.; Bertoldo, P.; Hernandez, M. M.; Huespe, C. B.; Welter, A. B.
Faculty of Chemical Sciences, Catholic University of Cordoba
Km 7 ½, Camino Alta Gracia. Córdoba, Capital.Argentina.

Introduction
Older Adults are characterized by multiple chronic diseases. An important part of them, are under
complex treatment plans. In some cases, prescriptions include high risk for older persons and a safer
alternative is available, reason why they are included in the criteria established by Beer 1. It is believed
that the medication is inappropriate when the risk outweighs the benefit, making this more often in the
third age, because of changes in the pharmacokinetics and pharmacodynamics related to aging process
2,3,4
The objectives of this study are to determinate the rate of drug consumption on the population
studied,identify potentially unsafe prescription for elderly patients, according to Beer´s criteria and to
identify misuse drugs most commonly used in drug treatments.

Materials and methods
Observational longitudinal multicenter study, 104 outpatients and housed in nursing homes were
included, being all over 65 years old, randomly selected, under pharmacological treatments and regular
asisten to the care and dispense centers between January and March this year. Information on the
therapeutic-drug plan was recorded when the patients took contact with the pharmacist.
Gathered data consisted on:
-Age,
-Sex
-Drugs used by patients,
-Dose/regimen used in each case
Treatment plans were evaluated using Explicit Criteria of inappropiate medication in older adults by
Beer.

Results
Of the 104 patients, 67 were women and 37 were men with an average age of 74,80 years. To determine
the rate of drug consumption in this population, ranges of drugs prescribed were established. These data
can be seen on Table 1.
It should be considered that in those patients who have being prescribed lorazepam in a daily dose of
2.5mg (under Beer´s criteria > 3mg) reported open doses according to anxiety, for this reason they are
considered of inappropriate use.
Making use of Beer´s criteria, it was determinated that 35.6 % of the patients have potentially unsafe
prescriptions, accounting for 8.92 % of total drugs prescribed. Misuse drugs most commonly used in drug
treatments were for occasional use (Hyoscine and Ergotamine). Table 2, show the frequency of use of
drugs clustred according to if they are considerated inappropriate, independently of dose or diagnosis,
according to the condition of limitation

Discussion
From the results obtained, and to sharpen the research of drugs responsible for adverse reactions in
elderly patients, it is suggested to take into account the use of other tools to synergize this search
(STOPP-START).

Conclusions
Studied population is similar to other author’s ones in potentially risky prescriptions 4,5. The most
consumed drugs were the occasional-use ones.

3 Corresponding autor: Ascar Graciela Tel [phone] [email protected]

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