Salmon D.,University Claude Bernard Lyon 1 |
Pont E.,Service Pharmaceutique |
Chevallard H.,Service Pharmaceutique |
Diouf E.,Service Pharmaceutique |
And 3 more authors.
International Journal of Pharmaceutics | Year: 2013
Medication in patients undergoing enteral intubation addresses various challenging issues considering safety and treatment efficiency. Ideally, other routes of administration (i.e. intravenous or intramuscular routes) or especially dedicated formulations should be used. However, in absence of liquid dosage form, tablets or pills must be crushed and suspended in a vehicle before administration. The administration of oral dosage forms by enteral tube is usually performed by the nursing staff facing (i) pharmaceutical relevance of crushing, (ii) loss and concomitant aero-contamination of drug substance, (iii) drug-nutriment interactions and (iv) enteral feeding tube clogging. In the present study, different combinations of either open or confined crushing and suspending protocols were compared by taking into account the crushing yield, the stability and granulometry of the solid oral form suspension and finally the extend of aerosol contamination during crushing and suspending. All protocols exhibited comparable crushing efficiency and suspending properties, but significantly higher aerosolisation of tablet particles was observed in both open crushing and suspending protocol. Therefore, both confined crushing and suspending protocol constitutes an efficient, time saving and safe alternative to the absence of available liquid dosage form for intubated patients. © 2013 Elsevier B.V.
Moch C.,Service Pharmaceutique |
Moch C.,University Claude Bernard Lyon 1 |
Salmon D.,Service Pharmaceutique |
Salmon D.,University Claude Bernard Lyon 1 |
And 6 more authors.
International Journal of Pharmaceutics | Year: 2014
The aims of this study were to assess the tissue permeability of the bladder and to characterize the transport of four drugs displaying different physico-chemical properties and commonly used in intravesical delivery, through porcine bladder. The transport of aluminium through porcine bladder was assessed by using a vertical static diffusion cell. Lidocaine hydrochloride, methylprednisolone hemisuccinate and mitomycin C were tested by using three different experimental setups, including vertical static diffusion cell, microdialyseur and lab-patented device. Penetration results on different experimental setups were homogenous suggesting dependency on physico-chemical characteristics of drug and subsequent interaction with bladder wall structure. Oppositely, permeation varied consistently with experimental setup characteristics (i.e., permeation surface, receptor fluid volume and hydrodynamic). Mathematical modelling of drug transport through bladder wall is proposed considering scarce literature on this route of administration. Practical outcome of this study could drive compounding optimization towards improvement of safety and efficacy in patient undergoing intravesical administration. © 2014 Elsevier B.V.
Goutelle S.,Groupement Hospitalier Of Geriatrie |
Goutelle S.,University of Lyon |
Goutelle S.,CNRS Biometry and Evolutionary Biology Laboratory |
Bourguignon L.,Groupement Hospitalier Of Geriatrie |
And 6 more authors.
AAPS Journal | Year: 2013
We present a unified quantitative approach to predict the in vivo alteration in drug exposure caused by either cytochrome P450 (CYP) gene polymorphisms or CYP-mediated drug-drug interactions (DDI). An application to drugs metabolized by CYP2C19 is presented. The metrics used is the ratio of altered drug area under the curve (AUC) to the AUC in extensive metabolizers with no mutation or no interaction. Data from 42 pharmacokinetic studies performed in CYP2C19 genetic subgroups and 18 DDI studies were used to estimate model parameters and predicted AUC ratios by using Bayesian approach. Pharmacogenetic information was used to estimate a parameter of the model which was then used to predict DDI. The method adequately predicted the AUC ratios published in the literature, with mean errors of -0.15 and -0.62 and mean absolute errors of 0.62 and 1.05 for genotype and DDI data, respectively. The approach provides quantitative prediction of the effect of five genotype variants and 10 inhibitors on the exposure to 25 CYP2C19 substrates, including a number of unobserved cases. A quantitative approach for predicting the effect of gene polymorphisms and drug interactions on drug exposure has been successfully applied for CYP2C19 substrates. This study shows that pharmacogenetic information can be used to predict DDI. This may have important implications for the development of personalized medicine and drug development. © 2013 American Association of Pharmaceutical Scientists.
Chamouard V.,Service Pharmaceutique |
Chevallier Brilloit C.,Grenoble University Hospital Center |
Pelus E.,Service Pharmaceutique |
Cahoreau V.,Bordeaux University Hospital Center |
And 4 more authors.
Pharmacien Hospitalier et Clinicien | Year: 2013
SummaryIntroduction Hospital pharmacies in France have increasingly been organising the sale and delivery of medicines to the patient's home. It is an exceptional procedure and it is currently carried out at the initiative of either home healthcare providers or pharmaceutical companies selling particularly costly medication. In the first case, the company takes at its expense the transportation of medicines to the place of residence of the patients. In the second case, the pharmaceutical company finances the delivery service through a third-party carrier. These services, offered to the doctor and the patient, are implemented only after approval of the hospital pharmacist, who accepts responsibility. Objective The aim of this study is to explain the conditions under which home delivery is carried out. Discussion After the presentation of the statutory context and the illustration of the comment with some examples, the authors will discuss the interest of this service for the various actors, its limits and possible consequences on the organization of the care, and finally perspectives of evolution. Conclusion A reflection must be led, on one hand on the conditions of implementation of the home delivery, on the other hand on its possible alternatives for the improvement of the accessibility to the medication sold by hospital pharmacy. © 2013 Elsevier Masson SAS. All rights reserved.
Charhon N.,Service pharmaceutique |
Bernard C.,Service de medecine interne |
Richard J.C.,Service de reanimation medicale et dassistance respiratoire |
Cordel N.,Unite de dermatologie medecine interne |
And 4 more authors.
Revue de Medecine Interne | Year: 2016
Introduction: Several case reports have reported the benefit of intravenous immunoglobulin therapy in many autoimmune diseases, including systemic lupus erythematosus. Case reports: Here, we report on two cases of lupus myocarditis treated with high dose of intravenous immunoglobulin. The first patient was a 42-year-old woman who presented with lupus myocarditis that was resistant to corticosteroids and cyclophosphamide, and who was finally successfully treated with a single dose of 2 g/kg of intravenous immunoglobulin. The patient displayed clinical improvement a few days later. The second case - a 43-year-old woman was diagnosed with lupus myocarditis and immunosuppressive drugs were contraindicated because of the context of a recent infective endocarditis. She was treated with repeated dose of 2 g/kg of intravenous immunoglobulin. Clinical improvement was observed and the left ventricular ejection fraction increased from 20 % to 60 % within a few days. We also report 9 similar observations identified from a literature review. Conclusion: The use of intravenous immunoglobulin in lupus myocarditis is not officially recognized but could be considered as an alternative when conventional therapies have failed or are contraindicated. © 2016 Société nationale française de médecine interne (SNFMI).
PubMed | Service de reanimation medicale et dassistance respiratoire, Service de medecine interne, Service pharmaceutique and Unite de dermatologie medecine interne
Type: | Journal: La Revue de medecine interne | Year: 2016
Several case reports have reported the benefit of intravenous immunoglobulin therapy in many autoimmune diseases, including systemic lupus erythematosus.Here, we report on two cases of lupus myocarditis treated with high dose of intravenous immunoglobulin. The first patient was a 42-year-old woman who presented with lupus myocarditis that was resistant to corticosteroids and cyclophosphamide, and who was finally successfully treated with a single dose of 2g/kg of intravenous immunoglobulin. The patient displayed clinical improvement a few days later. The second case-a 43-year-old woman was diagnosed with lupus myocarditis and immunosuppressive drugs were contraindicated because of the context of a recent infective endocarditis. She was treated with repeated dose of 2g/kg of intravenous immunoglobulin. Clinical improvement was observed and the left ventricular ejection fraction increased from 20% to 60% within a few days. We also report 9similar observations identified from a literature review.The use of intravenous immunoglobulin in lupus myocarditis is not officially recognized but could be considered as an alternative when conventional therapies have failed or are contraindicated.
Beny K.,Groupement hospitalier Est |
Piriou V.,University Claude Bernard Lyon 1 |
Dussart C.,Service pharmaceutique |
Henaine R.,Groupement hospitalier Est |
And 4 more authors.
Annales Francaises d'Anesthesie et de Reanimation | Year: 2013
Introduction: Seven Neuromuscular Blocking Agents (NMBA) are commercialized in France. Four of them have an intermediate duration of action. Sugammadex required the use of NMBA slightly employed in clinical practice in France. Its introduction in routine practice could have an impact on NMBA use in clinical practice. This study was then conducted to assess and compare NMBA use before and after the commercialization of sugammadex. Materials and methods: A longitudinal, retrospective, observational study was conducted between 2008and 2011in French university hospitals and military hospitals. The consumption data for sugammadex and NMBA were collected using a collection grid which was filled by pharmacists or anesthesiologists. Drug use was measured by the number of vials used divided by the annual number of hospitalizations in surgery and obstetrics (HSO). An overall analysis of the annual frequency of NMBA use was firstly performed, then individual data of each hospital were analyzed. Descriptive statistical analysis including mean, standard deviation, median, minimum and maximum was achieved. Results: Thirty-four out of 39hospitals participated in the study (87%) and analysis was performed on 26of them (7%). The data of eight institutions were exluded due to missing values or because of the non-admission of sugammadex in their formulary. The NMBA mostly used were non-steroidal NMBA (75% of market share) with an increased use between 2008and 2011concerning atracurium (from 41to 51vials of 50. mg atracurium used per 100HSO). The overall analysis revealed an increase of the occurrence of rocuronium (between 2008and 2011: from 1to 4.8vials of 50. mg rocuronium used per 100HSO). Individual analyses on each hospital showed a possible effect of sugammadex introduction on NMBA use in nine hospitals. Discussion and conclusions: The commercialization of sugammadex seems to have induced a discrete increase of steroidal NMBA but non-steroidal NMBA remain the leading agent in France. A long-term follow-up is deserved. © 2013 Société française d'anesthésie et de réanimation (Sfar).
Charpiat B.,Service Pharmaceutique |
Bornet C.,Service Pharmaceutique |
Bourdon O.,Service Pharmaceutique |
Grassin J.,Service Pharmaceutique |
And 2 more authors.
Pharmacien Hospitalier et Clinicien | Year: 2012
Objectives: To examine the documentation tools used by hospital pharmacists for detection and management of drug-drug interactions (DDI) and to estimate their feelings to handle easily this issue in the context of the drug prescriptions analysis. Material and method: A questionnaire was sent to members of the Société Française de Pharmacie Clinique and hospital pharmacists included on the mailing list of the professional website of Association pour le Développement d'Internet en Pharmacie Hospitalière. Results: Two hundred and ninety-one pharmacists responded with an average of 16 years of professional experience. The Theriaque database and the Vidal dictionary appear as the most common and widely used as first line tool. More than three quarters of the participants feel comfortable or very comfortable to name the drugs involved in DDI and describe the effect. Respectively 76%, 75%, 59%, 72% and 57% of respondents expressed little or no ease to describe its time to onset, its intensity, to rate the potential severity, to specify the level of evidence supported by literature, and to propose the measures to be implemented. 68%, 56%, 30% and 21% of participants thought they might be more comfortable in the field of drug interactions through continuing education, by performing a more regular reading work, by the acquisition of software that automatically analyzes drug interactions and by acquiring an additional documentary tool respectively. Conclusion: The establishment of a continuing education program on management of drug-drug interactions in clinical routine is necessary. © 2012 Elsevier Masson SAS. All rights reserved.
Gabriel L.,Service Pharmaceutique |
Tod M.,University of Lyon |
Goutelle S.,Service Pharmaceutique |
Goutelle S.,University of Lyon |
Goutelle S.,CNRS Biometry and Evolutionary Biology Laboratory
Clinical Pharmacokinetics | Year: 2016
Background: A simple method to predict drug–drug interactions mediated by cytochrome P450 enzymes (CYPs) on the basis of in vivo data has been previously applied for several CYP isoforms but not for CYP1A2. The objective of this study was to extend this method to drug interactions caused by CYP1A2 inhibitors and inducers. Methods: First, initial estimates of the model parameters were obtained using data from the literature. Then, an external validation of these initial estimates was performed by comparing model-based predicted area under the concentration–time curve (AUC) ratios with observations not used in the initial estimation. Third, refined estimates of the model parameters were obtained by Bayesian orthogonal regression using Winbugs software, and predicted AUC ratios were compared with all available observations. Finally, predicted AUC ratios for all possible substrates–inhibitors and substrates–inducers were computed. Results: A total of 100 AUC ratios were retrieved from the literature. Model parameters were estimated for 19 CYP1A2 substrate drugs, 26 inhibitors and seven inducers, including tobacco smoking. In the external validation, the mean prediction error of the AUC ratios was −0.22, while the mean absolute error was 0.97 (37 %). After the Bayesian estimation step, the mean prediction error was 0.11, while the mean absolute error was 0.43 (22 %). The AUC ratios for 625 possible interactions were computed. Conclusion: This analysis provides insights into the interaction profiles of drugs poorly studied so far and can help to identify and manage significant interactions in clinical practice. Those results are now available to the community via a web tool (http://www.ddi-predictor.org). © 2016 Springer International Publishing Switzerland
David P.-M.,succursale Center Ville |
Maire P.,Service Pharmaceutique
Pharmacien Hospitalier | Year: 2011
Recurrent ideological discourses on hospital are significative of what is expected from it and even further than its therapeutical fonction: its very symbolic fonctions for society. Nominative registered delivery of drugs in the care units by pharmaceutical assistants is a specific organisation of hospital work. The aim of this paper is to assess within a sociological perspective the consequences of this organization on the pharmaceutical assistants and on the hospital more broadly. Based on a qualitative inquiry, this work is constructed on semi-structured interviews and daily observations registered during our six-months presence in the units. One first result is that this organization of the pharmaceutical work helps the pharmaceutical assistants to integrate in the hospital and strengthens their focus on the work. Another result, less expected, is the way this work helped spread new discourses about hospital ressources management. In the end, this work points out the interest of a "bottum-up" changing practice model compared to the regular "top down" mangement. © 2011 Elsevier Masson SAS. All rights reserved.