BackgroundIbrutinib is a tyrosine kinase inhibitor indicated for treatment of chronic lymphocytic leukaemia (CLL) among other pathologies. In the literature its considered a safe drug, however, one of the adverse reactions described in the data sheet as frequent is non-melanoma skin cancer.PurposeTo describe two cases of basal cell epithelioma (BCE) in patients with CLL treated with ibrutinib and to establish the causality of the adverse reaction.Material and methodsThere were descriptive and retrospective clinical cases. Data were obtained by review of the electronic medical records (EMR). A literature search was conducted on the adverse effects of ibrutinib. The causality of the adverse reaction was established using the Karch–Lasagna algorithm.ResultsCase 1: Seventy-year-old female diagnosed with CLL, with no skin history recorded in the EMR who started fourth-line treatment with ibrutinib 420 mg daily in 1 February 2016. In February 2017, the patient was referred to the Dermatology Service due to a crustal lesion on the nose, defined as BCE.Case 2: Sixty seven-year-old male diagnosed with CLL with BCE previous in cheek, temporal region, earlobe and shoulder. He started third-line treatment with ibrutinib 420 mg daily on 31 October 2016 and in January 2017, he was referred to the Dermatology Service for a nose and cheek injury compatible with a BCE.Mohs surgery was indicated in both patients, with complete wound healing. Given the good response to the treatment, the haematology service maintained ibrutinib under close follow-up of the patients. Previously, both patients received conventional chemotherapy.To apply the Karch–Lasagne algorithm in both cases we established a possible causal relationship between ibrutinib and the occurrence of BCE.ConclusionThe new oral antineoplastic drugs have demonstrated efficacy and a good safety profile in clinical trials. However, possible adverse effects due to its use can be observed with some evidence described in the literature. It is important that the health professionals know the drug’s adverse effects, how to handle them and to carry out a close follow-up of the patient. In the event of any suspicion, it is important to notify the official organisations.These possible adverse reactions were reported to the National Pharmacovigilance System.References and/or AcknowledgementsHaematology Department.No conflict of interest

BackgroundPiperacillin/tazobactam (PT) is a combination of broad-spectrum antibiotics. PT is frequently used as an empirical treatment in moderate and severe infections of different origin. PT is mainly used to cover polymicrobial flora with the participation of pseudomonas aeuroginosa and other resistant Gram – bacilli. Recently, PT’s shortage has required different actions by the Program for Optimising the use of Antibiotics (PROA).PurposeTo describe the actions carried out by the PROA and to analyse the impact they have had on the PT shortage.Material and methodsA retrospective descriptive study was carried out between July and August 2017 in a hospital. Several emails were sent with the recommendations of the Spanish Agency of Medicines and Sanitary Products to the doctors who prescribe antibiotics reporting on shortage of PT. PROA made recommendations on the current prescriptions. The data collected was: type of infection, empirical/directed prescription, recommendation, acceptance of interventions and cost of treatment.ResultsWe reviewed 361 prescriptions, of which 44 were PT. Twenty-six interventions were carried out. PT’s indication was 38.5% (n=10) of the cases of intra-abdominal infection treatment, in 23.1% (n=6) urinary tract infection, in 19.2% (n=5) respiratory infection, in 15.4% (n=4) bacteremia and 3.8% (n=1) skin infection and soft tissue. There were 84% (n=21) of empirical prescriptions. Proposed recommendations were 57.7% (n=15) of the cases switching to another antibiotic (carbapenems, fourth-generation cephalosporins), in 34.6% (n=9) it was recommended to scale to a lower spectrum antibiotic (ertapenem, third-generation cephalosporins, penicillins or quinolones) and in the remaining 7.7% (n=2) to suspend it. Acceptance of the recommendations was 84.6% (n=22), although in 96.2% (n=25) of the cases PT ceased to be used. During this period, the cost per patient/day increased from €9.99 to €18.74 at the expense of a patient who was prescribed ceftolozano/tazobactam.ConclusionAcceptance of the PROA’s recommendations was elevated. PT’s shortage involved an increase in cost per patient/day. PROA allowed improvement actions in the use of antibiotics, becoming more relevant in periods of shortage.References and/or AcknowledgementsTo everyone in the Pharmacy and Internal Medicine Departments who have collaborated in the collection of data and analysisNo conflict of interest

BackgroundThere are different factors to be considered before administering a drug through a feeding tube in order to prevent medication errors, tube obstruction, reduction of drug effectiveness and an increased risk of toxicity.PurposeThis article describes the process developed by the pharmacy service for safe administration of drugs through enteral feeding in hospitalised patients and analyses the clinical impact of the interventions.Material and methodsA prospective study in a tertiary care teaching hospital from September 2014 to May 2015. Adult patients hospitalised with enteral feeding who received medication by nasogastric tube, nasojejunal, gastrostomy or jejunostomy were included. The pharmacy department analyses patient prescriptions and completes an individual administration form which is given to nurses during hospitalisation and to patients or caregivers before hospital discharge. The baseline data collected were sex, age, type of enteral tube and medication list. The variables analysed were drug-nutrition incompatibility, complications related to wrong administration, number of interventions following an increasing relevance classification (grade 1 (G1) precautions, grade 2 (G2) sequence of administration, grade 3 (G3) change in pharmaceutical form, change of active substance, diluting high osmolar medication and incompatibility). All data were obtained from the electronic patient files, and direct interview with nurses, patients or caregivers.Results65 patients (40 men) were included with a mean age of 74.9 years (95% CI 71.5 to 78.3). The analysis of over 330 medications (5.08 drugs/patient) revealed interventions in 107 (32.4%). Therapeutic groups were antibiotics (5.5%), CNS (27.6%), cardiovascular (27.3%), gastrointestinal (GI) (19.7%), antidiabetics and thyroxine (11.2%) and other (8.8%). 82 medicines were incompatible with the nutrition. Most of the interventions (98 (71.5%)) were G3, which includes drug-nutrient incompatibility (60.7%) (ie, captopril, tyrosine, ciprofloxacin, levodopa/carbidopa), change in the pharmaceutical form to an available liquid form (15.9%) (ie, digoxin, phenytoin), change to analogue drug on discharge (esomeprazol) followed by 30 G2 interventions (21.9%). The possible complications avoided were reduction in drug absorption (40.2%) of CNS and antibiotics followed by GI disorders (27.1%) and slowed down nutrition rate (16.8%).ConclusionThe results of our study reflect the fact that safe enteral administration of medication requires individualised analysis and intervention in order to avoid possible complications of high impact in relevant therapeutic groups, such as antibiotics and GI disorders.References and/or AcknowledgementsThe pharmacy service.No conflict of interest.