No abstract

Our results indicate similarities related to the labeling of drugs with potential for errors, especially in dispensing, storage, and administration if preventive measures are not adopted.

What is known and objective: Immunosuppression is the main goal in the treatment of autoimmune diseases, chronic inflammatory diseases, and solid organ and tissue transplantation. However, due to a lack of liquid-form medications, it is challenging to achieve adequate immunosuppression when the patient is using enteral feeding tubes. It is necessary to transform solid oral medications into other forms for administration. Besides that, the occupational risk should be considered, and safetyhandling measures should be taken. This review aimed to investigate the available evidence regarding the use of immunosuppressive drugs through enteral feeding tubes, focusing on the administration technique, efficacy and treatment safety. Methods:We performed an integrative review using the databases PubMed, LILACS, SciELO, Cochrane and Google Scholar, including papers published between 1997 and 2017 in Portuguese, English and Spanish. We excluded editorials, theoretical reflections, abstracts presented at events, dissertations, theses, monographs and studies with extemporaneous formulations administered only by the oral route. In addition, we investigated the references of the included papers, as well as pharmaceutical guides, books and package inserts of selected drugs for additional evidence.Information and recommendations found were analysed and classified according to the GRADE system. Results and discussion:Fifty papers were identified, and 14 met the selection criteria. Among the assessed immunosuppressive drugs, we observed that tacrolimus, mycophenolic acid derivatives and azathioprine were the most studied, and they have more guided recommendations regarding their use through enteral feeding tubes.We noted the need for personal protective equipment for the conversion of the solid oral dosage forms, along with special caution during administration, due to occupational hazard. Other important factors identified were the position of the tube and interactions with the enteral nutrition, because they may compromise absorption, bioavailability and serum blood levels of immunosuppressive agents. However, the studies found have methodological limitations and poor quality, and this was taken into consideration during the classification of the evidence. | 409 e SILVA et AL.

Introduction: The transplanted patient has a complex pharmacotherapy, with the pharmacist having an important role in the multidisciplinary team. Objective: To analyze the pharmaceutical recommendations made during the hospitalization of the patients in kidney and liver transplant units. Methods: This was a cross-sectional study in which pharmaceutical recommendations from May 2017 to April 2018 were collected from the records contained in the database of the Clinical Pharmacy Unit of a University Hospital in Fortaleza, Brazil. The recommendations were categorized and analyzed based on the classification used in the institution. Results: There were 1241 pharmaceutical recommendations involving 325 patients and 1466 medications. The recommendations were more frequent during liver transplantation (54.2%, n = 672), with dose adjustments (18.2%, n = 122) and dilution / reconstitution (9.8%, n = 66) being the most predominant types. In kidney transplantation, recommendations for education about medication use (17.6%, n = 100) and treatment adherence strategies (17.6%, n = 100) were the most predominant. The most frequent therapeutic classes were systemic antibacterials (31.2%, n = 458) and immunosuppressants (25.1%, n = 368). The acceptance rate of recommendations for kidney and liver transplantation were 95.1% (n = 541) and 95.4% (n = 641), respectively. Conclusions: The present study showed a high frequency of pharmaceutical recommendations and these results demonstrate that the detection of drug-related problems generates pharmaceutical recommendations that can contribute to the reduction of negative drug-associated results and increase patient safety.