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Drug dosing of cytotoxic intravenous drugs, such as anticancer drugs or certain antivirals, has historically been based on the body surface area (BSA) or the weight of the patient being treated. This entails the individual preparation of each treatment and, consequently, it results in increased demand on pharmacy compounding area, often causing delays for patients awaiting treatment. 1 Elaboration by dose banding is one of the strategies proposed in order to optimize the processing at compounding units without reducing safety. 2 According to the definition by the NECN (North of England Cancer Network), dose banding is a system whereby, through

Background Chronic kidney disease (CKD) is a highly prevalent disease worldwide. A basic pillar for the management of a patient with CKD is the safe use of drugs. Inadequate dosing of medication or contraindicated drugs in renal impairment can lead to negative outcomes. The primary objective was to analyse the drug prescriptions of patients with CKD from two primary care centres to see if they were optimally adapted to the patient's estimated glomerular filtration rate (eGFR). Methods A retrospective observational study was conducted in two urban primary care centres. The study period was between September–October 2019. Patients over 18 years of age, with established CKD and with an eGFR less than 60 mL/min/1.73m2 for at least three months were included. Their demographic data (age and sex) and clinical variables such as associated comorbidities, eGFR value were retrospectively registered. Finally, their medication plans were reviewed in order to detect: inappropriate prescribing (IP), defined as an incorrect dose/frequency or contraindicated drug according to the renal function of the patient; nephrotoxic drugs and drugs with a high sodium content. Results A total of 273 patients were included. The most common patient profile was an elderly woman, polymedicated, with other concomitant diseases and with mild CKD. Two hundred and one IPs were detected, 13.9% of which were contraindicated drugs. Of all patients, 49.1% had been prescribed at least one IP on their medication plan, 93.8% had some potentially nephrotoxic drug and 8.4% had drugs with a high sodium content prescribed. Conclusions Patients with CKD are at increased risk of medication-related problems. It is necessary to implement measures to improve the safety in the prescription of drugs in patients with CKD.

Mitomycin C as a treatment for superficial bladder carcinomas and upper urinary tract tumours has been linked to local adverse events. Systemic toxicity has been documented for just a very few cases. This report presents a case of interstitial pneumonitis accompanied by myelosuppression in a 74-year-old patient after receiving the fifth administration of mitomycin C through a ureteral catheter as a treatment for left kidney pyelocaliceal urothelial carcinoma. Therefore, suspecting mitomycin C toxicity, urinary tract instillations were discontinued, and intravenous filgrastim and methylprednisolone were initiated. Currently, after five months since the last mitomycin C urinary tract instillation, the patient is still receiving filgrastim and corticosteroids. A moderate effort dyspnoea persists despite interstitial pulmonary infiltrates have presented a very important reduction. Pancytopenia has also persisted. Blood count and lung function monitoring would be appropriate in patients undergoing mitomycin C instillations, especially in those with established prior lung disease.

BackgroundChemotherapy extravasation is an accidental complication of antineoplastic administration. Due to its low incidence but serious consequences, further studies are needed to achieve a better management.PurposeTo analyse the context in which extravasation occurs, the degree of compliance with the extravasation protocol and the impact of electronic records on extravasation notification.Material and methodsThis was a retrospective study set in a tertiary-level hospital between 2013 and 2017. Data were obtained from 54 extravasation notifications received either on paper or electronically. Collected variables were: patient demographics, antineoplastic drug extravasated, potential factors for extravasation, description of resulting damage, degree of information given in the form, observance of extravasation protocol and follow-up of patients.ResultsExtravasation incidence was 54 of 1 47 837 doses of chemotherapy administered (0.04%): 48.15% were males and 51.85% females, mean age was 63.9±12.2 years. 48.15% (n=26) of the drugs involved were vesicant and 38.89% (n=21) irritant. The most frequent extravasated drugs were carboplatin (10, 18.5%) and paclitaxel (eight, 14.8%). 36.54% (n=19) of extravasated veins were weak, 36.54% (n=19) were small-diameter and 11.54% (n=6) were trough. In 51 cases (94.4%) the medical device access was a peripheral catheter and in 51.9% (n=28) the point of puncture was in the plexus arm or in the hand. Infusion pumps with occlusion sensor were used in 40.74% (n=22) of extravasations. In the majority of the cases, the patient (31, 57.4%) was the one who detected the incident. Most common symptoms described were qedema (35, 64.8%), pain (31, 57.4%) and redness (18, 33.3%). Protocol adherence was 83.3% (n=45). In 21 extravasations (38.9%) a control photograph was not taken. First follow-up occurred during the first 24 hours after the extravasation in 19 patients (35.19%) but in 58% of them, it was telephonically. Notifications received electronically were completed worse than paper notifications, 25.3% of unanswered questions (n=373) and 10.1% (n=102) respectively.ConclusionAlthough the incidence of extravasation is low, patient education and nursing staff training are essential for an early detection, a correct actuation, an adequate record of the incident and a proper follow-up. If the patient’s venous assessment indicates a potential issue with access, a peripheral catheter should be avoided, especially if the drug is vesicant and it is infused over more than 30 min (such as paclitaxel).No conflict of interest