BackgroundAnticholinergic scales (AS) are defined as medication lists that classify drugs according to their anticholinergic potential. They use different criteria for defining the anticholinergic properties of drugs. The sum of the score of each drug included in the scale is the anticholinergic burden (AB). AB can detect patients with a high risk of cognitive and functional adverse events.PurposeTo estimate the anticholinergic risk (AR) in elderly patients based on different AS.Material and methodsA cross-sectional study that included all elderly patients residing in a nursing home in September 2017. Age, sex and pharmacotherapy were collected for each patient. AB was calculated using 10 different AS described in a systematic review.1. They are as follows: Anticholinergic Cognitive Burden Scale (ACB), Anticholinergic Risk Scale (ARS), Chew’s scale (CS), Anticholinergic Drug Scale (ADS), Anticholinergic Activity Scale (AAS), Anticholinergic Load Scale (ALS), Clinician-Rated Anticholinergic Scale (CRAs), Duran’s scale (DS), Anticholinergic Burden Classification (ABC) and Drug Burden Index (DBI). The scales offer final AR scores classified in three groups: low, medium and high, according to the risk categorisation made by the authors of each scale. Higher scores are associated with increased AR.ResultsWe analysed 248 patients; mean age: 82.5±10 years, 72.6% females. Mean prescribed drugs: 8.2±3.4. All AS identified patients with AR (Table). We identified 68 drugs, with anticholinergic potency being the most common: furosemide (27%), lorazepam (20.6%), metformin (14.7%), quetiapine (12.5%).Abstract 4CPS-180 Table 1 Low n (%) Medium n (%) High n (%) ACB 79 (27.8) 38 (15.3) 46 (18.5) ARS 73 (29.4) 24 (9.7) 7 (2.5) CS 36 (14.5) 24 (9.7) 18 (7.3) ADS 55 (22.2) 32 (12.9) 44 (17.7) AAS 37 (14.9) 13 (5.2) 13 (5.2) ALS 65 (26.2) 37 (14.9) 16 (6.5) CRAs 50 (20.2) 40 (16.1) 28 (11.3) DS 80 (32.3) 28 (11.3) 9 (3.6) ABC 0 0 95 (38.3) DBI 0 90 (36.3) 81 (32.7) ConclusionA high proportion of elderly patients are at risk of anticholinergic adverse events because of treatment. Due to varying identification and scoring criteria for anticholinergic drugs, the AS used revealed extensive differences in calculating AB. However, detection of AR can be an important strategy for optimising treatment in those patients.Reference and/or Acknowledgements1. Villalba-Moreno AM, Alfaro-Lara ER, Pérez-Guerrero MC, et al. Systematic review on the use of anticholinergic scales in polypathological patients. Arch Gerontol Geriatr2016;62:1–8.No conflict of interest

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Background Hepatitis C virus (HCV) infection is a major health problem in the western world. Current treatment with interferon (IFN) and ribavirin (RBV) is able to produce a sustained virological response in approximately 50% of patients with genotype-1. Telaprevir (TPV) represents a change in the treatment of HCV. Purpose To describe the proportion of patients who had undetectable plasma HCV-RNA at week 4 and 12 of treatment, the haemoglobin and platelets level during treatment and the most frequently reported adverse events. Materials and Methods We conducted a retrospective study of all patients who started triple therapy in 2012. We collected demographics (age and sex), genotype, pre-treatment response, haemoglobin, platelets, plasma HCV-RNA at weeks 0, 4 and 12 and reported adverse events. Results Since January 2012, 9 patients began treatment with RBV+IFN+TPV with a mean of age of 49 (SD:6.2). 89% were male. Genotype-1a was predominant (95%). Five patients were previous non-responders, three were relapsers and one was missing. The mean haemoglobin at weeks 0, 4 and 12 was 15.5 (SD:1.2), 13.0 (SD:1.7), and 11.3.(SD:1.9) mg/dl respectively and the mean platelets at week 0, 4 and 12 were 217 (SD:142.4), 132 (SD:46.2) and 121 (SD:33.9) respectively. The mean of plasma HCV-RNA at the beginning was log 6.55 (SD:0.39). At week 4, 8 patients (88.9%) had undetectable plasma HCV-RNA and 1 had to discontinue treatment (HCV-RNA: log5.63). At week 12, 7 patients had undetectable plasma HCV-RNA. One patient had to discontinue treatment due to severe anaemia. The most frequent adverse event was anaemia (89%); in two cases it was even necessary to administer erythropoietin. Other adverse events were rash, fatigue and haemorrhoids. Conclusions Our rate of undetectable plasma HCV-RNA at week 4 is high (89%) which allowed TPV to be suspended at week 12 and RBV+IFN treatment to be shortened to 24 weeks. Anaemia was the major serious adverse event reported. No conflict of interest.

Background A growing body of evidence suggests that proton pump inhibitors (PPIs) may adversely interact with clopidogrel, diminishing the antiplatelet effect. The potential for increased risk of thrombotic complications warrants cautious use of this drug combination. When concomitant clopidogrel and PPI treatment is considered necessary, pantoprazole or ranitidine may offer a safe choice. Purpose To analyse the prescription profile and financial impact of an alert that was added to the assisted electronic prescription program (EPP) and is triggered by a prescription for concomitant clopidogrel and omeprazole treatment. A safer choice that is pantoprazole or ranitidine is suggested to assist health professionals. Materials and methods Retrospective cohort study. Period A (before this alert was added) April–June 2010: pantoprazole was the only PPI included in the hospital's formulary and Period B (after this alert was introduced) April–June 2011: omeprazole and pantoprazole as the low cost and the alternative options respectively for prescribing PPIs. The authors looked at all the clopidogrel prescriptions in both periods of study. Patient code, age (years), gastric protector drug (none, omeprazole, pantoprazole, ranitidine), dose (mg/day) and treatment cost/day data were collected from the EPP. Main outcome and measures: number of patient with PPIs as the treatment for gastric protection and average treatment cost/day. Statistical analysis: OR with its 95% CI and t-test were used to compare the two periods. Results A total of 360 patients were included in Period A (70% men) with a mean age of 72.2 (IC 95% 70.8 to 73.5) and 327 in Period B (68.9% men) with a mean age of 72.5 (IC 95% 71.2 to 73.8). The change from Period A to Period B was: the percentage of patients treated with a PPI fell from 68.9% to 24.7% (OR=0.15; IC 95% 0.11 to 0.21; p<0.05); the percentage of these patients treated with ranitidine rose from (26.1% to 65.7% OR=5.43; IC 95% 3.91 to 7.54; p<0.05). In Period B physicians ignored the alert in 11.6% of patients. Average cost/day per patient was higher in Period A: 0.21 (IC 95% 0.20 to 0.22) versus 0.05 (IC 95% 0.04 to 0.07; p<0.05) Conclusions The prescription profile for PPIs was modified by the introduction of the alert. Fewer patients taking clopidogrel are now being prescribed a PPI and a safer drug is used more often. The cost per patient is now lower.

patients with DPD mutation and 41.9% without DPD mutation presented AE. The most common AE in this population were gastrointestinal such as nausea (25.7%), constipation (14.3%), diarrhoea (11.4%) and vomiting (11.4%). No withdrawal treatments were registered. Conclusion and relevancePatients with DPD polymorphisms in our population completed treatment with 50% of the dose. AE were more prevalent in DPD mutation group. Determination of variants of DPD can help avoid serious or fatal EA.