Pharmacy Office Research Articles

Drug-related problems among breastfeeding patients treated for depressive spectrum disorders.

Depressive spectrum disorders are common and can hinder breastfeeding success. While medications typically pose minimal risk, the concerns persist. This is the first study that investigates the prevalence and characteristics of drug-related problems among breastfeeding mothers with depressive spectrum disorders. We analyzed those problems to understand their nature, severity, and contributing factors. Additionally, we evaluated the outcomes of pharmacist-led interventions in reducing them. Understanding drug-related problems is crucial for informing evidence-based practices to optimize both maternal mental health and breastfeeding success. This prospective observational study was conducted at a specialized pharmacy office in Poznan, Poland, which focuses on lactation support and medication consultations. 47 breastfeeding patients were enrolled. Pharmaceutical consultations were conducted according to Joint Commission of Pharmacy Practitioners Pharmacists' Patient Care Process standards. Novel MILC Questionnaire was used for efficient and optimal pharmaceutical interview. Drug-related problems were assessed basing on PCNE Classification System version 9.1. For adverse events in lactation, MedDRA v27 nomenclature was used; for causality, Naranjo Scale and LCAT were utilized. CTCAE was used for grading. Among the 47 patients, pharmacist identified 49 medication-related problems, with inadequate treatment effect due to underdosing or not taking the medication at all being the most common (57.1%). Pharmacist interventions focused on medication safety information and counseling. Overall, 78.7% of patients accepted these interventions, resulting in problem resolution for 71.4%. Twelve mothers (25.5%) reported adverse events in their infants, but after causality evaluation, only four (8.5%) might have been linked to maternal medication. None required medical intervention beyond one hospitalization for a serious adverse event possibly connected to maternal medication. The study identified high rates of drug-related problems among breastfeeding mothers with depression, primarily due to non-adherence. Pharmacist interventions significantly improved DRP outcomes. Adverse events were reported, but most were mild and did not require intervention. Our findings suggest that lactating mothers with depressive spectrum disorders may benefit from pharmacist-led support to optimize treatment adherence and address medication safety concern.

Longitudinal Exploration of Strategies Advancing Continuing Professional Pharmacy Education in a Major University: an in- Depth Study on Impact

Background: In the dynamic healthcare landscape, pharmacists contend with the challenge of staying current with evolving knowledge. Continuing Pharmacy Education (CPE) programs, play a pivotal role in addressing this need. This study focuses on a six-year evaluation of CPE programs at a College of Pharmacy, aiming to assess the impact of a multifaceted approach on various educational outcomes. Materials and Methods: The University College of Pharmacy Office of Continuing Professional Education implemented a multifaceted approach from 2017 to 2022. Changes included hiring a full-time coordinator, offering on-site and online programs, establishing partnerships, identifying knowledge gap through surveying participants, and enhancing digital presence beyond others. Data from this period were compared with the preceding six years (2010 2016). Evaluation metrics covered attendee the number and diversity, program growth, and professional impact. Results: The study showcased significant improvements in various aspects of CPE programs. Pharmacist attendees increased by 816.67%, with a notable rise in non-pharmacy participants. Geographical distribution saw a surge in out-of-state and international participants. Program content witnesseda shift towardsinfectious diseases and pain management. The number of CPE programsand awarded hours experienced a fivefold increase, reflecting a commitment to a diverse curriculum. Participant feedback consistently indicated high satisfaction with knowledge enhancement, applicability, and program usefulness. Conclusion: Over the six-year period,the evaluation revealedsubstantial advancements in our CPE programs. Increased pharmacist attendance, diversified participant engagement, and expandedgeographical reach underscored the program's success.The exponential growth in program offerings reflected a commitment to diverse and extensive education. Positive participant feedback, indicating sustained impact on drug therapy management, patient safety, and public health outcomes, affirmedthe enduring effectiveness of the CPE programs. While acknowledging study limitations, this comprehensive analysis highlights the success and ongoing efforts to enhance CPE programs at major university. Future research should address these constraints for a more nuanced understanding of CPE program impact.

8th ABM/EABM European Regional Conference May 11–13, 2023 Split, Croatia

8^th ABM/EABM European Regional Conference May 11–13, 2023 Split, Croatia

Remdesivir and Breastfeeding—A Case Report

Objective:The article presents a lactating patient who contacted the pharmacy office to inquire about the safety of coronavirus disease 2019 (COVID-19) therapy. She was given remdesivir, dexamethasone, and ceftriaxone during the 5-day hospital stay.Main Issue:The patient was worried about maintaining her milk supply during her hospital stay and the safety of the medication she received. At the hospital, she was given no information on when she could resume breastfeeding after discharge.Management:The pharmacist conducted an interview, determined the patient’s needs, assessed the safety of the drugs administered during the hospital stay in lactation, provided information to the patient, and stayed in touch with her during the hospital stay. As a result of the consultation, the patient decided to resume breastfeeding her baby 3 hours after discharge (or as soon as possible). The treatment did not impact the milk supply or affect the breastfed baby during a 6-day observation period. Follow-up focused on the mother’s health, potential adverse events in the baby, and the overall impact of COVID-19 infection and hospitalization on breastfeeding in this dyad.Conclusion:COVID-19 treatment with remdesivir, a low dose of dexamethasone, and ceftriaxone might be considered in lactating individuals without breastfeeding cessation or any other intervention apart from close observation of the infant. A change in the color of the milk might be concerning, but it is not a contraindication for breastfeeding. The effect of the maternal therapy, in this case, caused no apparent adverse reactions in the baby and did not impact the milk supply. The situation did not affect the mother’s ability to breastfeed.

Remdesivir and Breastfeeding—A Case Report

Objective:The article presents a lactating patient who contacted the pharmacy office to inquire about the safety of coronavirus disease 2019 (COVID-19) therapy. She was given remdesivir, dexamethasone, and ceftriaxone during the 5-day hospital stay.Main Issue:The patient was worried about maintaining her milk supply during her hospital stay and the safety of the medication she received. At the hospital, she was given no information on when she could resume breastfeeding after discharge.Management:The pharmacist conducted an interview, determined the patient’s needs, assessed the safety of the drugs administered during the hospital stay in lactation, provided information to the patient, and stayed in touch with her during the hospital stay. As a result of the consultation, the patient decided to resume breastfeeding her baby 3 hours after discharge (or as soon as possible). The treatment did not impact the milk supply or affect the breastfed baby during a 6-day observation period. Follow-up focused on the mother’s health, potential adverse events in the baby, and the overall impact of COVID-19 infection and hospitalization on breastfeeding in this dyad.Conclusion:COVID-19 treatment with remdesivir, a low dose of dexamethasone, and ceftriaxone might be considered in lactating individuals without breastfeeding cessation or any other intervention apart from close observation of the infant. A change in the color of the milk might be concerning, but it is not a contraindication for breastfeeding. The effect of the maternal therapy, in this case, caused no apparent adverse reactions in the baby and did not impact the milk supply. The situation did not affect the mother’s ability to breastfeed.

The implementation of the eight-hour working day in Spanish pharmacies, 1904-1936

This is a study about the implementation of the eight-hour day (1919) in Spanish pharmacy offices and the legislative antecedents that led to it: the Sunday rest law and the law regulating commercial dependency. These health establishments were contemplated in some of the exceptional situations that marked these provisions, which were different depending on whether the worker was "external" or was part of the "internship" system. The article also collects and analyzes the points of view of pharmacists and auxiliaries, that is, employers and workers, through the most prominent professional press, which represented the conflicting interests of these professionals.

Study of the Drivers of Inappropriate Use of Antibiotics in Community Pharmacy: Request for Antibiotics Without a Prescription, Degree of Adherence to Treatment and Correct Recycling of Leftover Treatment.

The WHO considered antibiotic resistance as 1 of the 10 greatest threats to global health in 2019. The inappropriate and indiscriminate use of antibiotics, together with the lack of new therapeutic alternatives, may eradicate their effectiveness in the closest future. The general objective is to analyze the different causes attributable to patients, providers and pharmacists that could be drivers of irrational use of antibiotics, and responsible for the appearance of bacterial resistance, in community pharmacies. To this end, the different processes or indicators were studied: patients' requests of antibiotics at the pharmacy, their degree of adherence, satisfaction with the prescribed treatment and antibiotics' surplus recycling. This study was observational, descriptive, and cross-sectional, carried out in 2 pharmacy offices, including 333 participants. At the time of dispensing, first phase, surveys to collect patients', providers' and pharmacists' data were carried out over the counter. The second phase, with the aim of checking adherence, degree of satisfaction and recycling. There were 333 requests for antibiotic regardless prescription availability, 17% of the patients requested an antibiotic without having one. 38% of patients did not have full adherence to antibiotics. Exploring non-adherence reasons, 24% forgot to take the treatment, 2% experienced adverse effects; 8% improved infection symptoms and 21% had problems to follow schedule. Regarding the recycling habits, 57% of patients had leftover treatments at home, but only 11% recycled it. 10% of medical prescriptions were forced by the patient, and significant gender differences were observed in adherence and knowledge of treatment. The results of this study suggested that there may be a significant level of antibiotic inappropriate use locally, potentially related to patients' sex, finding significant deficiencies in prescription by doctors, in the dispensing act carried out in community pharmacies, and finally in patient compliance with treatment.

Evolution of the consumption of lorazepam in a rural environment in the Region of Murcia (2012-2018)

Objective: To evaluate the consumption of lorazepam in the Region of Murcia, specifically in the district of Mula, during the period 2012-2018, considering age and sex variables. Method: Cross-sectional descriptive study, where the use of benzodiazepines in a specific population during the period 2012 - 2018 is investigated. The variables collected were sex, age and the prescribed Defined Daily Dose. The data correspond to the dispensations of Lorazepam in the pharmacy offices of the disctrict of Mula, provided by the Health Assistance General Directorate. Daily dose per inhabitant and per 1000 inhabitants were calculated and the groups median and interquartile ranges were established p25 and p75 for later comparisons. Results: Overall consumption over the period increased by 0.42%. In men it increased by 21.4%, while in women it decreased by 7.5%. However, in women, consumption was at higher doses, betwand significant differences were found in lorazepam consumption een groups when analyzed by sex. The analysis by age showed a significant increase in consumption as the age of the patients increased. Conclusion: The consumption of benzodiazepines is high with increasing age, more so in women, and this may have an impact on the adverse effects associated with this group of drugs and present an important public health problem.

Creation and Implementation of a New Sentinel Surveillance Model in Pharmacy Offices in Southern Europe.

Traditionally, health sentinel networks have focused on the reporting of data by primary care physicians and hospitals, ignoring the role of the community pharmacist as an expert in drugs. The objective of this study was to describe a method for creating a network of sentinel pharmacies in a region of Southern Europe in order to have a pharmaceutical surveillance system that is representative of the territory to be monitored and that can respond to any events or incidents that can be followed up by the community pharmacy. The creation process was carried out in three phases: a first phase of selection through a cluster and population analysis and a final adjustment, a second phase of voluntariness and random selection, and a third phase of training and implementation of the network. A sentinel network of 75 community pharmacies has been established in Catalonia. The network monitors 2.47% of the total population with a homogeneous proportion of urban (42), rural (30), and mountain-area (3) pharmacies based on the particular characteristics of the territory. This model allows increased surveillance in the territory, objectively and representatively detects problems arising from the use of medicines, and establishes improvement strategies of public health.

Marco legal comparado de la dispensación de medicamentos en las oficinas de farmacia de los distintos Estados miembros de la Unión Europea

Dispensing is the act carried out by a pharmacist or under his supervision, aimed at ensuring that patients receive the medicines in the precise doses according to their individual requirements, for the appropriate period, with the information for their correct use, and in accordance with current regulations. To understand this act, the concept of medicine, the studies that a pharmacist must take, the regulation of the concepts of pharmaceutical management, as well as the pharmacy offices in the European Union have been previously analyzed. Finally, compare the act of dispensing in each of the countries of the European Union. To make that comparison, each of the rules directly affecting the act of dispensing medicinal products in each Member State has been translated, analysed and interpreted. The aspects that have been investigated have been: the obligatory presence of a pharmacist in the pharmacy office; the sale of medicinal products in establishments other than pharmacies; the ability to replace those medicinal products subject to medical prescription by the pharmacist; and, the regulation of the online sale of medicines subject to medical prescription. Although it is true that it has been concluded that the presence of the pharmacist is mandatory in 99% of the countries, no total harmony has been found in the regulations of the rest of the parameters subject to comparison in this research work.

Liberalization and Governance in the Geographical Distribution of Pharmacies in Spain.

The Health system in Spain is considered one of the most valued public services by the population. In fact, during the first decade of the 21st century, Spain became a health tourism destination for people from central and northern European countries. In addition to the health infrastructure, the quality of medical and nursing care stands out. Something similar also happens with the Spanish pharmaceutical system. However, there are some characteristics that should be addressed from a Geography perspective. The pharmacies’ legal system does not consider them to be of public interest. One is when some of the main activities are the sale and distribution of medicines that are partially paid for by the Administration, that is, Social Security. In the same activity, the public function is combined with the private interests of the pharmacy owners to provide a balanced territorial service. One of the conclusions demonstrates how the borders that are sometimes created by the Administration are not always the most efficient in relation to the characteristics of the territory, nor do they provide the best service to the population and, therefore, create territorial imbalances within a country. To reach our conclusions, we carried out an exhaustive study of the pharmacy legislation in the EU and in Spain, as well as Geography of Health and theories of territorial location. We combined this information with statistics on the territorial characteristics of Spain. This allowed us to confirm the peculiarities that exist within the governance of the distribution of pharmacy offices in Spain.

Nutritional Status of Non-Institutionalized Adults Aged over 65. Study of Weight and Health in Older Adults (PYSMA).

Background. A significant increase in the prevalence of malnourishment, obesity, and sarcopenic obesity has been observed in developed countries over the last few decades. In Spain, this especially happens in populations over 65 who are not institutionalized. Differences in lifestyle, medication, and economic capacity partially explain this increase. Objective. To study the nutritional status of a population of 65 year-olds and subjects who are not institutionalized, in the Cádiz region (Spain). Methods. Observational, transversal study carried out on 2621 subjects who are 65 years old and over, with a direct weight and height measurement, in 150 pharmacy offices from 44 locations. A mobile application was designed for homogeneous data collection in all the pharmacy offices. The data required from all subjects was gender, age, postal code, social security contribution regime, if the patient lives alone, type of food consumed as the main meals, level of physical activity, polypharmacy, weight, and height. Results. The prevalence of overweight and obesity amounts to 82.2% of the population (43.2% overweight and 39% obese). We found an inverse relationship between the prevalence of overweight and obesity with carrying out physical activity and having full dinners. Conclusion. We identify the need to reinforce the messages to the elderly aimed at maintaining adequate physical activity and assessing the quality and quantity of dinners, as well as reducing, as much as possible, the treatments that may lead to weight gain.

Medication preparation program in Liencres Hospital

IntroductionThe need to implement a program of autonomy in the handling of oral medication has been observed at the time of discharge from the hospital.Objectives- That the patient is able to know his medication, differentiating between active ingredient and commercial brand. - That the patient is able to interpret the guideline in the electronic prescription. - That the patient is able to prepare his weekly medication autonomously.Methods- The doctor in charge indicates the Program in those patients susceptible to benefit of the same and after consensus with the multidisciplinary team. He validates and prints the electronic prescription well in advance. Preferably the patient himself (alone or accompanied by family members or Educators) get their medication and a weekly “polydosis” at a pharmacy office bringing him with him to the Unit. - Occupational Therapy helps the patient interpret the electronic prescription guideline and place the weekly medication in the “polydosis” and works with the patient in forecasting execution tasks of medication needs for outpatient follow-up.ResultsThe program is well accepted by patients. None of the patients included so far have had an early relapse.ConclusionsThe program has helped patients interpret the medical indications given mnesical and executive difficulties of patients with severe mental disorder.DisclosureNo significant relationships.

Healthcare risk management during the SARS-CoV-2 virus pandemic in the European Union: The guaranteed access to medicines.

The disease caused by the novel coronavirus SARS-CoV-2 has rapidly spread escalating the situation to an international pandemic. The absence of a vaccine or an efficient treatment with enough scientific evidence against the virus has generated a healthcare crisis of great magnitude. The precautionary principle justifies the selection of the recommended medicines, whose demand has increased dramatically. we carried out an analysis of the healthcare risk management and the main measures taken by the state healthcare authorities to a possible shortage of medicines in the most affected countries of the European Union: Spain, France, Italy and Germany. the healthcare risk management in the European Union countries is carried out based on the precautionary principle, as we do not have enough scientific evidence to recommend a specific treatment against the new virus. Some measures aimed to guarantee the access to medicines for the population has been adopted in the most affected countries by the novel coronavirus. in Spain, Italy and Germany, some rules based on the precautionary principle were pronounced in order to guarantee the supply of medicines, while in France, besides that, the competences of pharmacists in pharmacy offices have been extended to guarantee the access to medicines for the population.

OFICINA DE FARMACIA. ATENCIÓN FARMACÉUTICA. SERVICIO PERSONALIZADO DE DOSIFICACIÓN

I try to bring the pharmacy office closer from its legislation to its professional practice, focusing on less known points such as pharmaceutical care and quality of life, the psychiatric profile that accompanies non-adherence to medical therapy. I would like to draw the conclusion that I have managed to interest so that the mission of the pharmacists and pharmacy technicians who are part of them is known.

Desarrollo, elaboración y control de un preparado cosmético antiestrías

Las estrías son cicatrices atróficas formadas por la rotura y pérdida de fibras de colágeno, elastina y fibrina. Actualmente, se han convertido en un problema estético más que médico, que cursan con un gran componente emocional, y que pueden ocasionar síntomas físicos como picazón, sensibilidad y dolor. Se pueden desarrollar a cualquier edad, pero son más frecuentes en el inicio de la pubertad; son más frecuentes en las mujeres y se desarrollan en zonas de crecimiento corporal. Las estrías están condicionadas por múltiples factores endocrinos y exocrinos.
 A día de hoy, no existe un tratamiento que elimine por completo a la estría, por lo que se emplean tratamientos orientados a la prevención y atenuacion de la misma. El objetivo de esta memoria es el desarrollo de productos cosméticos con una composición eficaz, combinables con otros tratamientos y de fácil elaboración desde la oficina de farmacia.

E-HoA: A Distributed Layered Architecture for Context-aware Autonomous Vehicles

Abstract The Embedded Higher-order Agent (E-HoA) architecture presented in this paper addresses the growing need for context-aware ambient systems, such as autonomous vehicles. This multi-process architecture, to be embedded into the control loop of these vehicles, includes a Belief-Desire-Intention agent that can consistently assist the symbolic execution of intentions. It also performs the appropriate conversion of these intentions into real physical vehicle maneuvers based on ROS. The proposed architecture offers gradually 4 levels of reactivity, from arch-reflex to the deep modification of the previously built symbolic execution plan. The presented use-case, the daily delivery of a network of pharmacy offices by an autonomous vehicle taking into account contextual (spatio-temporal) traffic features, shows the efficiency and the modularity of the architecture, as well as the scalability of the reaction levels.

Before We Talk About Student Debt Cancelation, Can We Talk About Interest Rates?

Recently, several presidential candidates in the Democratic primary have created media buzz with policy proposals to eliminate debt (either partially, or completely) for millions of Americans.1 Given the rise in tuition prices and growing debt for pharmacy graduates over the past decade, these proposals may offer hope for those still drowning in debt and potentially resentment for others who sacrificed making other investments to pay down student loans.2-4 While bold policy proposals help make great sound bites and campaign ads, they may also divert attention from more pragmatic solutions where a larger majority of people with different political biases could come to consensus. This commentary focuses less on flashy political rhetoric and more on a boring aspect of student loans: the mathematical components of debt. Using the Class of 2017 exiting survey data published by the American Association of Colleges of Pharmacy (AACP) Office of Institutional Research & Effectiveness,5 this article aims to demonstrate how more moderate steps to reduce interest rates may offer relief for pharmacy graduates while avoiding potential resentment and other unintended consequences.4.

Review of Alzheimer’s Disease: Treatments and New Pharmacological Strategies

Alzheimer's disease belongs to a group of pathologies called dementias, being this one the most common type. It is a neurodegenerative disease that causes a progressive and disabling impairment of cognitive functions, including memory, comprehension, language, attention, reasoning and judgment. Until now there is no cure, although there are treatments available that can improve the symptoms. In this paper we describe the disease, its classification and prognosis, as well as its physio pathological mechanism and the different diagnostic techniques currently being used. In addition, we perform an analysis of different therapies both pharmacological and non-pharmacological, focusing on conventional drugs marketed so far, making a comparison between them, as well as those strategies or therapeutic targets that are being researched, different phases of clinical trials which project different perspectives towards the future. For this, we carry out a bibliographic review of the most updated scientific literature, analyzing the most relevant information about this disease. Unfortunately, in the last years there have not been relevant bibliography or studies done. Finally, as a practical contribution to complement and conclude this study, we collect the dispensing data of several pharmacy offices, in order to approximate the data obtained through the bibliographic analysis with the treatments that are currently used in the Spanish population. The data found coincide with the daily practice at the pharmacy: the population gets older and the most used drug is Donepezil.

A exclusión territorial como unha forma de manifestación dos procesos de exclusión social

A accesibilidade aos servizos básicos é esencial para asegurar a calidade de vida da poboación. Unha distribución equilibrada destes servizos (escolas, centros de saúde, oficinas de farmacia, centros sociais, servizos deportivos, servizos financeiros, supermercados etc.) permite á poboación identificarse co seu espazo máis próximo, aumentando a cohesión social e a interrelación entre o núcleo de poboación e os seus habitantes. De feito, un dos factores que poden provocar ou agravar a exclusión social dos individuos radica na vulnerabilidade, afastamento ou estigma social dos territorios que habitan. Neste traballo reflexionase sobre o concepto de exclusión territorial e a súa relación coa exclusión social, preséntase un método de cuantificación e análise da exclusión territorial e móstranse os resultados da súa aplicación a un servizo público básico, a prestación farmacéutica. Os resultados obtidos mostran que a regulación actual non permite resolver os problemas de acceso ao medicamento de numerosos núcleos de poboación do interior de Lugo e Ourense.