American Pharmacists Association

About: American Pharmacists Association is a other organization based out in Washington D.C., District of Columbia, United States. It is known for research contribution in the topics: Pharmacist & Pharmacy. The organization has 2413 authors who have published 1969 publications receiving 30470 citations. The organization is also known as: APhA & American Pharmaceutical Association.

Voriconazole in Fungal Keratitis Caused by Scedosporium apiospermum

Abstract: OBJECTIVETo describe the first case, to the best of our knowledge, of posttraumatic Scedosporium apiospermum (ScA) keratitis successfully treated with systemic and topical voriconazole.CASE SUMMARYA 19-year-old man was admitted to the hospital with an incisive wound of his left eye and the cornea totally sectioned after trauma with a cutter used in gardening. Initial empirical treatment was followed by systemic and topical voriconazole, and the eye did not have to be enucleated. Five months after the trauma, a penetrating keratoplasty and chamber intraocular lens implantation was performed with a favorable visual outcome.DISCUSSIONScA keratitis is rare, but it must be suspected if a history of ocular injury with contaminated objects exists. Among the antifungals available to treat ScA keratitis, voriconazole has shown advantages such as the lowest minimum inhibitory concentration and the availability of an oral formulation.CONCLUSIONVoriconazole shows promise as an effective alternative to conventional an...

New Trends in the Therapeutic Approach to Metastatic Colorectal Cancer.

Abstract: Important developments in chemotherapy for metastatic colorectal cancer over the last years are reviewed, with an emphasis on the most recently published data from clinical trials. The systematic review of current literature was conducted involving Pubmed Central® research and full articles were obtained and analyzed when appropriate. Fluorouracil still constitutes the backbone of metastatic colorectal cancer treatment; fluorouracil combination plus either irinotecan (FOLFIRI), oxaliplatin (FOLFOX) or capecitabine (CAPOX or XELOX) are chemotherapy protocols established as treatments producing similar outcomes. Actual treatment involves these chemotherapy protocols in combination with new molecular targeted drugs: bevacizumab and aflibercept (anti-vascular endothelial growth factor monoclonal antibody) and cetuximab and panitumumab (anti-epidermal growth factor receptor monoclonal antibody for patients with wild type KRAS) which confer significant survival benefits in select patients as first- or second-line therapies. The factors affecting the decisions for one treatment over other are related to the patient and toxicity drug. Finally, metastatic colorectal cancer patients progressing after all standard therapies (maintaining a good ECOG performance status) could be candidates for further therapies such as regorafenib and TAS-102. Regarding the future, promising therapies are under development for the metastatic colorectal cancer treatment and several agents are currently being evaluated in different clinical trials.

Hypersensitivity Related to Abacavir in Two Members of a Family

Abstract: TO THE EDITOR: The principal adverse effect of abacavir, a potent reverse transcriptase inhibitor, is a hypersensitivity reaction, which is seen in approximately 5% of patients, usually within the first six weeks of therapy.1 This is characterized by fever, nausea/vomiting, malaise, and/or rash, and respiratory symptoms.2,3 We report cases occurring in a father and his daughter. Case Reports. A 39-year-old white HIV-infected man with no known drug allergy received zidovudine, lamivudine, saquinavir, and cotrimoxazole for several years. His CD4+ count was 180/mm3 and plasma HIV-1-RNA 16 000 copies/mL. Fifteen days after abacavir 300 mg twice daily was added to the preexisting treatment regimen, the patient developed nausea, vomiting, and fever. Three days later, he was admitted to the hospital with high fever and a circulatory collapse (BP 70/40 mm Hg). Other complications included headache, diarrhea, generalized erythema, neutropenia (441 cells/mm3), cytolytic hepatitis, and increase in serum creatinine concentration (169 μmol/L) and C-reactive protein (18.8 mg/L). All treatments were stopped. The duration of abacavir therapy was 17 days. Within seven days, the clinical and biological status of the patient improved. The eosinophil count had always been normal. When the patient was discharged, co-trimoxazole, saquinavir, nelfinavir, zidovudine, and lamivudine were resumed with no adverse event. For years, the patient had complained of chronic rhinitis: in this context, total immunoglobulin (Ig) was within the normal range. The daughter of this patient, a nine-year-old girl (140 cm/35 kg), without known atopy or drug allergy, had been treated for mother-to-child HIV transmission since she was 18 months old. She had been treated with lamivudine and efavirenz for several months. Nine days after the start of abacavir 300 mg twice daily, she developed headache, fatigue, and fever (39 ̊C). In the following days, the fever increased, and erythema of the face, trunk, and limbs appeared. Abacavir was discontinued, and all symptoms resolved within one day without treatment. Biological tests were not performed. Her new treatment regimen comprises efavirenz, stavudine, and lamivudine. Use of the Naranjo ADR probability scale4 indicated a possible relationship between adverse effects reported and abacavir in these patients. Discussion. Abacavir-related hypersensitivity reaction may limit the use of this drug in a small number of patients. The management of this adverse effect is now well documented, and rechallenge with abacavir is unnecessary.5 This is the first report of a familial hypersensitivity reaction to abacavir. The genetic predisposition of drug allergy is known with antibiotics: children of parents who are allergic to an antibiotic have been reported6 to have a 15-fold greater relative risk for allergic reactions to antibiotics than children without such family histories. Hypersensitivity reactions to drugs can be explained by immunologic and/or metabolic pathways involving cytochrome P450. Abacavir is not metabolized by cytochrome P450, and the reactivity of the formed metabolites is unknown. Immunologic factors may also be involved. In cases previously reported,2,3 the rapid onset of hypotension after rechallenge with abacavir may point to an IgE-mediated reaction, although there is no direct evidence of this type of reaction. A recent study7 suggests that epidermal cytokines and activated CD8+ lymphocytes are involved in abacavir-induced hypersensitivity. All infiltrating lymphocytes expressed HLA-DR, with no evidence of B cells, eosinophils, or CD23 expression (suggesting the absence of type 2 cytokines such as interleukin 4). The conclusions of this study suggest that the immune response in the skin does not involve antibody responses and type 2 cytokines, but may be primarily a type 1 cytokine response. The absence of CD4+ cells in the epidermis distinguishes this rash from more severe cutaneous adverse events, such as Stevens–Johnson syndrome. At this time, the pathogenesis (metabolic, immunologic, or genetic) of this reaction is undefined. Thus, our cases suggest that the genetic predisposition may play a role in abacavir hypersensitivity. The research of the precise mechanisms underlying this hypersensitivity reaction should allow to propose predictive factors to this reaction and to improve the risk/benefit ratio of this essential drug. Although confirmation is needed, abacavir should be administered with caution in children of parents who have developed a hypersensitivity reaction.

Contribution of Multivitamins, Air, and Light in the Generation of Peroxides in Adult and Neonatal Parenteral Nutrition Solutions

Abstract: OBJECTIVE:To compare the concentrations of peroxides between adult and neonatal total parenteral nutrition (TPN) solutions in response to protection against inducers of peroxidation such as multivitamins and exposure to light or air.METHODS:Peroxide concentrations were measured in freshly prepared adult and neonatal solutions of fat-free TPN in four settings: with or without an air inlet, and protected or unprotected from ambient light. An oxygen washout was performed by exposing a fat-free neonatal TPN solution to a continuous flow of nitrogen.RESULTS:Globally, light was the main inducer of peroxides in adult and neonatal solutions. However, in adult solutions the concentration of peroxides remained <15 μmol/L, while in neonatal solutions the peroxide concentration was as high as 300 μmol/L in ambient light. Although the oxygen washout did prevent the generation of peroxides, avoiding air inlet was not as effective as was photoprotection in decreasing the important peroxide load in the neonatal TPN solut...

Comparison of Drug-Related Problems in Different Patient Groups

Abstract: BACKGROUND:There is a lack of knowledge concerning how drug-related problems (DRPs) vary in different patient groups. Possible dissimilarities need to be taken into consideration when guidelines for detecting and preventing DRPs are compiled.OBJECTIVE:To characterize and compare the frequency and categories of DRPs in different groups of hospitalized patients.METHODS:Patients admitted to 4 different types of departments at 5 hospitals in Norway were included consecutively. Medical records and information acquired at multidisciplinary morning meetings were sources for assessing the patients' DRPs.RESULTS:A total of 827 patients were included. Mean age was 70.8 years, 58.6% were female, and 81% had at least one DRP. An average of 1.9, 2.0, 2.1, and 2.3 DRPs per patient were found in the departments of cardiology, geriatrics, respiratory medicine, and rheumatology, respectively. Significant differences in the type of DRPs between the patient groups were found. The most frequent DRPs and the patient group in ...