Background Drug compliance is a cause for concern in every medical speciality. Particularly in Psychiatry, the adherence rate to pharmacological treatment seems to be lower than in other areas. This may be due to the length and complexity of treatments and the adverse reactions they may trigger. Modified-Release Oral Psychotropic Drugs (MROPD) are helpful tools as they allow both treatment simplification and reduction in the incidence and severity of adverse drug reactions, hence easing drug compliance. Purpose The aim of this study is to analyse the prescription of MROPD and compare their posologies with the approved ones on the Summaries of Product Characteristics (SPC). Materials and methods 1 month observational, retrospective study on the prescription of MROPD used on the acute Psychiatric ward in a third level hospital. Results 411 prescriptions for MROPD were included. The distribution was as follows: 38% (155) venlafaxine, 19% (78) valproate, 17% (71) alprazolam, 10% (41) quetiapine, 9% (37) lithium and 7% (29) biperiden. 33% (134) prescriptions were not correct according to the SPCs. Long-acting venlafaxine accounted for 68% (105) of these prescriptions, just in one case the posology was corrected from 75 mg 1-0-1 to 150 mg 1-0-0. Retard alprazolam was prescribed incorrectly in 25% (18) of the occasions, quetiapine in 15% (8) and lithium in the 35% (13) of the instances. Valproate and biperiden posologies were correct 100% of the times these drugs were prescribed. Conclusions Discrepancies between SPC recommendations and real use of MROPD commonly occur, which means added risk for the patients. Pharmacists may make interventions such as suggesting simplification of treatments to improve compliance and educating clinicians on different prolonged-release preparations to promote the safer use of psychotropic drugs. No conflict of interest.

Background Pancreatic cancer is one of the most deadly forms of cancer. Standard treatment in metastatic disease is the quemotherapy with gemcitabine, but there is not a standard therapy for gemcitabine-refractory patients. Purpose Assess the off-label efficacy of nab-paclitaxel, in patients who progressed on gemcitabine-based therapy, in our hospital. Materials and Methods Observational retrospective study of pancreatic cancer patients treated with nab-paclitaxel who progressed on gemcitabine-based therapy from June 2011 to April 2012. Data were collected from clinical history, Oncofarm® and Omega3MIL® programmes. We determined: Progression free survival (PFS) and Overall Survival (OS). 12 patients (100% male) were treated with nab-paclitaxel. Eleven of them presented metastatic desease. The patients were treated with two therapies: nab-paclitaxel 100 mg/m2 (1.8,15/28d). 5 patients received this treatment. Median age was 79.4 years (sd = 4.2 years) Gemcitabine 1000 mg/m2 plus nab-paclitaxel 100 mg/m2 (1.8,15/28d): 7 patients received this treatment; Median age was 65.5 years (sd = 6.9 years). Results Median PFS was 2,8 months (95% CI, 1.5 to 4.1 months) with single agent, and 5.3 months (95% CI, 4.0 to 6.5 months) with gemcitabine plus nab-paclitaxel. The PFS in the study was 20% and 83% respectively. The OS couldn’t be determine in the nab-paclitaxel group, because there wasn’t any event during the study period. The OS with gemcitabine plus nab-paclitaxel was 66.7%. Conclusions It showed better clinical outcomes in the gemcitabine plus nab-paclitaxel group in PFS. The nab-paclitaxel can be an effective second-line chemotherapy in gemcitabine resistant patients. No conflict of interest.

Background Glutamine is the most abundant amino acid (AA) in the human body. It is classified as a non-essential AA, however in some situations may become essential and it is needed an exogenous supplementation. Glutamine plasma levels decrease in stress situations which is associated with alterations in protein turnover, intestinal barrier and immune function. Glutamine may be beneficial to critical ill patients due to it is associated with a decrease in infectious complications, decrease in hospital length of stay, and possibly a decrease in mortality. Dose recommended glutamine supplementation in PN is 0.35 g/Kg/d, no longer than nine consecutive days. Purpose Assesment of the use of glutamine-supplemented parenteral nutrition (PN) according to last ESPEN and ASPEN recommendations. Materials and methods Retrospective, observational study of patients with PN support from January to March 2011. Data were collected from the PN software Multicomp 2006®: age, gender, ward, milligrams of glutamine and duration of PN support. Results 192 patients received PN support (117 males, 75 females), 43 were prescribed glutamine-supplemented. The average age was 65 years. The allocation of patients by services was: ICU (34), surgery (7), Oncology (1), Gastroenterology (1). The prescription of the PN in this cases was: 23 postsurgical, 11 intestine diseases, 6 sepsis, 1 head injury, 1 posttraumatic and 1 pneumonia influenza A. Doses of glutamine were on average 13.2 total grams (range: 10-30g). Only 8 of the 43 patients received glutamine supplemented with an appropriate amount to fulfil the guidelines recommendations. Glutamine supplementation was 9.8 days (range 2-42). Conclusions The diagnoses included in our study 97% met the guidelines recommendations. Only 18% of patients received a correct dose of glutamine (0.35g/kg/day). Glutamine supplementation was longer than the recommendation in a 23% of patients. Glutamine supplementation to critically ill patients has been attempted to improve patient outcome, but data remain inconclusive.

Background Nanoparticle albumin-bound paclitaxel (nab-paclitaxel) is a protein-bound derivative of paclitaxel with improved solubility over conventional paclitaxel. This allows a shorter infusion time, reduces the risk of hypersensitivity reactions and eliminates the need for premedication with dexamethasone, dexchlorpheniramine and ranitidine. Purpose The aim was to determine the off-label use and evaluate the toxicity of, and tolerance towards, nab-paclitaxel in patients with metastatic pancreatic adenocarcinoma. Materials and methods Retrospective observational study of two patients with metastatic pancreatic adenocarcinoma treated with nab-paclitaxel. Data were collected from the cytostatics software Oncofarm, patient histories and record of tests performed with Omega3MIL software. Results Patient 1: A seventy-six year-old woman, diagnosed with pancreatic adenocarcinoma cT3cN0M1 (hepatic cells) in February 2011, started first-line treatment with gemcitabine-oxaliplatin x 5 cycles. In April 2011, biochemical and hepatic progression, second-line treatment with capecitabine-erlotinib x 3 cycles. In July 2011, biochemical and clinical progression, third-line treatment with nab-paclitaxel 100 mg/m2 and gemcitabine 800 mg/m2 days 1, 8 and 15 every 4 weeks. Received 3 cycles in total until progression of the disease in October 2011. The patient developed second-degree lymphopenia and anaemia. Patient 2: A fifty-eight year-old man, diagnosed with pancreatic adenocarcinoma pT3pN1(7/19)M1 (lung, retroperitoneal ganglion and hepatic cells). Head-pancreaticoduodenectomy was performed. In December 2009, first-line treatment with gemcitabine-oxaliplatin x12 cycles followed by gemcitabine monotherapy x11 cycles. In December 2010, progression in lungs and liver. Started second-line treatment with capecitabine-erlotinib x5 cycles. In May 2011, pulmonary and hepatic progression. Started third-line treatment with nab-paclitaxel 100 mg/m2 days 1, 8 and 15 every 4 weeks. The patient had received 5 cycles and was continuing treatment at the time of writing. First-degree anaemia was observed. Conclusions The patients tolerated the treatment well. They did not develop any severe adverse reactions associated with nab-paclitaxel. Peripheral neuropathy, neutropenia and hypersensitivity reactions were not observed. No doses of the drug needed to be omitted or postponed.

BackgroundInvasive fungal infection (IFI) is a serious problem due to its high incidence, morbidity, mortality and budget impact. Therefore strategies are needed for antifungal use optimisation. Posaconazole has the approval of our Hospital Pharmacy and Therapeutics Committee (PTC) for its use in IFI prophylaxis in patients diagnosed with acute myeloid leukaemia (AML), myelodysplastic syndrome, oropharyngeal candidiasis, and in treatment of refractory cases of IFI.PurposeTo analyse posaconazole use, assessing the compliance with the criteria established by our PTC, and also its efficacy, safety and budget impact.Material and methodsWe have carried out a retrospective study of patients under posaconazole treatment in our hospital between September 2013 and September 2014. We gathered data from patients’ clinical history and the Farmatools unit dose records module about age, gender, diagnosis, indication, posology, treatment length, previous treatment lines, clinical analytics and microbiology, outcomes, adverse events, drug interactions and laboratory selling price.ResultsWe found data from eleven patients (81% male, average age 52 years, 18 minimum and 86 maximum). Average posaconazole dose was 600 mg/day, and average treatment length was 12.8 days. The most frequent diagnosis was AML (4), followed by myelodysplastic syndrome (3), current IFI (2), iatrogenic agranulocytosis (1) and aplastic anaemia (1). In most cases (90.9%) posaconazole use met PTC criteria; the remaining indications weren’t approved (first line treatment for current IFI). The outcome was positive for 81.8% of patients, the remaining two switched to another antifungal because of symptoms suggestive of IFI. All experienced increases in transaminases and direct bilirubin, improving after treatment ended. Main drug interactions involved ranitidine and ciclosporin. Total cost was € 33,899.47 (average per patient €3000).ConclusionPTC criteria were met in most of the cases, but posaconazole use for non-approved indications represented an additional cost of €18,155.4, which emphasises the need for tight control of criteria compliance.References and/or AcknowledgementsNo conflict of interest.