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Background Medicines with anticholinergic activity have been linked to a variety of adverse drug reactions in the elderly. Purpose To determine the anticholinergic burden in revised profiles, and the level of risk. Materials and MethodsThe Prescription Quality Unit (PQU), which is staffed by a doctor, two pharmacists, a nurse and other technical-administrative staff, is integrated into the geriatric care team. The Unit provides care to 6800 residents in 163 centres.The PQU provides training and support to different care teams by reviewing procedures and holding conciliation meetings. The process of rationalisation consists of systematically reviewing medicines plans according to the criteria of efficacy, safety and efficiency. The team suggests modifications in medicines plans and reports to the health care professionals involved. Anticholinergic drugs were selected from the review. These medicines were classified into four groups, according to the anticholinergic potency. Results A prospective study was undertaken during the period June 2011-June 2012: 7,347 patients were reviewed (some in duplicate). 959 patients were identified, and those patients were prescribed 1,984 drugs with anticholinergic activity (mean age 85 years (52-111 years)).In 162 patients, strong anticholinergic activity drugs were found: 62% oral antimuscarinics for urinary incontinence, 33% tricyclic antidepressants, 4% antispasmodics with anticholinergic properties and 1% systemic H 1 antihistamines (dexchlorpheniramine); 252 patients with moderate anticholinergic activity drugs (70% paroxetine); 500 patients with mild anticholinergic drugs and 45 patients had drugs whose activity was concentration-dependent.Sixty-eight patients were simultaneously being prescribed more than one medicine with anticholinergic activity (17 patients on strong anticholinergic activity drugs simultaneously). Conclusions Due to the comorbidities and frailty of this population, medicines must be selected individually for each patient, selecting drugs with the lowest level of anticholinergic activity. We observed a group of patients at special risk who were being treated for pathologies related to the urinary tract.No conflict of interest. Background Dronedarone is a drug related to amiodarone, marketed in 2010. Soon after, there were several safety alerts that forced Health Authorities to reduce their use, and require hepatic and renal function cheques. The alert (reference SGMUH (FV), 16/2011) requires initial and then at least 6-monthly hepatic and renal function tests. Purpose To assess the degree of compliance with the analytical tests required by the Competent Authority in patients taking dronedarone (creatinine and liver enzymes) in a health area of 200,000 inhabitants. Monitoring Materials and MethodsWe selected patients who were prescribed dronedarone during the last half of 2011. These patients were identified by querying the electronic prescription billing system. The prescriptions were analysed in three groups of patients: those who started treatment af...

BackgroundClinical practice guidelines recommend the use of the new oral anticoagulants (NOACs) in patients with non-valvular atrial fibrillation (AF) as a strategy before and after cardioversion, which is very common in the Emergency Department. A dispensing procedure from the pharmacy service was established in such cases.PurposeTo analyse compliance of the established procedure in the prescription and dispensation of NACOs, as well as to follow-up on safety.Material and methodsRetrospective study conducted from July to September 2015. We evaluated all of the prescriptions and dispensations of NACOs within the procedure. In all cases an appointment with cardiology had to be programmed to value the continuity of treatment and/or cardioversion. We collected the cause and appropriateness of prescription, NOAC prescribed, dispensation and citation with cardiology, and continuity of the treatment by the cardiologist. Mistakes and improvement areas were identified.ResultsThe procedure was applied in 15 patients (80% women, average age 72.6 ± 9.8 years). Patients distribution was: 26.7% AF of <48 h and high thrombosis risk (cardioversion in emergency department and dispensation for 4 weeks), 53.3% AF of >48 h and low risk (cardioversion programmed in cardiology and dispensation pre and post-cardioversión) and 20% AF >48 h and high risk (dispensing for 4 weeks until review by the cardiologist).The most prescribed NOAC was rivaroxaban (73.3%) followed by apixaban (20%) and dabigatran (6.7%). In all cases the prescription was well indicated according to the procedure. However, dispensation adequacy was 73.3%. In four cases (26%) the cardiology consultation was programmed exceeding the time covered by the dispensation. A prescription error due to underdosing was identified. Only in one case was scheduled cardioversion performed according to the procedure provided for (the rest reverted to sinus rhythm spontaneously). NOAC prescription was maintained by the cardiologist in 5 cases andmodified to acenocumarol in 3 cases.ConclusionAlthough the procedure was followed by the emergency physician, this study reveals the need to improve the coordination between emergency and cardiology services to avoid delays, with the resultingrisk of under treatment, as well as to ensure the correct cardioversion programming.The availability of medication by pharmacy must also be improved. As the most prescribed anticoagulant was rivaroxaban, it seems advisable to restrict the procedure to this NACO to facilitate its knowledge and management, avoiding errors of prescription.No conflict of interest.