Our results indicate that FcGR polymorphisms could be a determinant of adalimumab efficacy in RA patients. Original submitted 28 July 2014; Revision submitted 19 December 2014.

Background The use of intracameral cefuroxime is becoming more widely accepted for endophthalmitis prophylaxis (EP) after cataract surgery. Recently, the European Medicines Agency approved a single, sterile, unit dose of intracameral cefuroxime in a few countries of Europe. Purpose To evaluate the cost saving resulting from the implementation of an optimisation protocol for the preparation of ready-to-use (RTU) intracameral cefuroxime syringes from 1500 mg vials of cefuroxime. Materials and methods A review of the literature was conducted when we planned to change the protocol. To evaluate the cost savings, the cost generated by the use of cefuroxime 1500 mg vials in the preparation of RTU syringes since the implementation of the protocol was compared to the costs if the marketed unit dose of intracameral cefuroxime had been used. Results A total of 200 RTU syringes are prepared from a single vial of cefuroxime 1500 mg in each batch at the Pharmacy. 40 syringes are sent weekly to the OR, the rest are stored frozen in Pharmacy (stability three months). Between January and July 2013 five vials of cefuroxime 1500 mg were used to prepare 1000 RTU cefuroxime syringes, with a cost of 14.56 € (PVP: 145.6 €/50 vials). If we had used the marketed unit dose, for the same treatment the cost would have been 12164 € (PVP: 121.64 €/10 vials); meaning a 99.8% reduction in costs. Conclusions The implementation of the optimisation protocol for the preparation of RTU intracameral cefuroxime syringes has led to a significant cost saving without compromising patient health. No conflict of interest.

Background Potentially inappropriate medicines (PIM) use in older adults has been associated with increased medicines-related problems and morbidity. Investigating the prevalence of this problem is important for the initiation of intervention programmes in order to prevent its occurrence. Purpose To estimate the prevalence of PIM use in older adults and determine the drugs involved. Materials and methods Prospective study carried out in a third level hospital over 8 months (from January to August 2013). All patients older than 65 years were included who were taking ≥5 medicines and were admitted to the hospital’s internal medicine service. Each patient’s home medicines profile was revised after admission. The frequency of PIM use was analysed according to the Beers criteria 2012. The criteria reviewed covered 2 types of statements: medicines that should generally be avoided in persons 65 years or older and medicines that should not be used in older persons known to have specific medical conditions (drug-disease interaction). Results A total of 216 patients were evaluated in this study. The average age was 78.8 ± 8.8. A total of 193 PIM were detected in 79(36.6%) patients. Frequency of PIM was: long acting benzodiazepines 35(16.2%), digoxin > 0.125 mg/d 38(17.6%), amiodarone 4(1.8%), amitriptyline 6(2.7%), first-generation antihistamines 12(5.5%), doxazosin 11(5.1%), nifedipine immediate release 2(0.9%), aspirin > 325 mg/d 2(0.9%), non–COX-selective NSAIDs 16(7.4%). Frequency of drug-disease interaction was: heart failure-diltiazem 12(5.5%), dementia and cognitive impairment-benzodiazepines 28(13.0%), Parkinson’s disease- metoclopramide 5(2.3%), history of gastric or duodenal ulcers- NSAIDs 8(3.7%), serotonin-norepinephrine reuptake inhibitors-hyponatraemia 4(1.8%), stress or mixed urinary incontinence-doxazosin 10(4.6%). Conclusions The results of this study showed a high prevalence of PIM use in older adults. Inappropriate chronic use of potentially unsafe medicines must be a key issue in medical and pharmaceutical care. Interventions for decreasing drug-related problems should be planned in order to minimise drug-related costs. No conflict of interest.

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Background Calciphylaxis (calcific uremic arteriolopathy) is the ischemic ulceration of the skin caused by the disseminated calcification of the subcutaneous tissue and small arteries as a consequence of hyperparathyroidism in uremic patients. Purpose To describe the method of preparation and checking of an injectable solution of 25% sodium thiosulfate for the treatment of intradialytic calciphylaxis in renal patients. Materials and MethodsSodium thiosulfate is an antioxidant, vasodilator and calcium chelator. The preparation process for the solution of 25% sodium thiosulfate is: Ingredients: Sodium thiosulfate pentahydrate: 25 g, water for injection (WFI): qs 100 ml. Preparation: Weigh the amount of sodium thiosulfate in a sterile beaker. Then, working in a horizontal laminar flow hood, boil WFI to eliminate CO2. Dissolve the thiosulfate in about 80 ml of boiled water. Check that the pH of the solution is between 6 and 9.5, if it is not, adjust with HCl or NaOH. Flush into a 100 ml volumetric flask and make up to volume. Filter with a double 0.22 micron philtre. Finally pack with 50 ml syringe into a sterile glass bottle and label. Results The result is a solution of 100 ml of 25% sodium thiosulfate, transparent, sterile and stable for 30 days in refrigerator. For QC a visual particulate sterility cheque is performed by sowing in aerobic and anaerobic cultures and a bubble point test to verify the integrity of the philtres. Conclusions Proper preparation and checking of the 25% solution of sodium thiosulfate has guaranteed its parenteral administration is safe. The treatment is effective and well tolerated, helping patients and improving their quality of life. No conflict of interest.