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      Revisión de la administración por sonda nasogástrica o gastrostomía de fármacos para patologías víricas: VIH, VHB y VHC Translated title: Review of enteral drugs administration for viral diseases: HIV, HBV and HCV

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          Abstract

          Introducción: Las características demográficas de los pacientes infectados por VIH han cambiado en los últimos años y las co-infecciones por virus de la hepatitis B y C son muy comunes en estos pacientes. Debido al aumento de supervivencia, a menudo estos pacientes presentan patologías o tienen que ser sometidos a intervenciones quirúrgicas que imposibilitan o dificultan la ingesta siendo necesaria la utilización de la vía enteral para la administración de fármacos. De entre los factores que influyen en el fracaso terapéutico destacan falta de adherencia, la falta de concentraciones adecuadas en sangre por malabsorción o interacciones y los errores de dosificación. Por ello se pretende elaborar una guía con recomendaciones de administración por vía enteral de los medicamentos antivirales. Material y métodos: Se revisaron las fichas técnicas de los medicamentos utilizados en VIH, VHB o VHC. Se llevó a cabo una búsqueda en las bases de datos Pubmed® y Micromedex®, se contactó con los fabricantes y se revisó otra literatura al respecto. Resultados: Los resultados se detallan en la Tabla 1. Discusión: A veces, la mera suspensión del comprimido triturado en agua no basta y esta práctica hace que muchos fármacos vean alterada su biodisponibilidad con la consiguiente modificación del efecto terapéutico. Actualmente no existe suficiente evidencia que apoye las prácticas de triturado y suspensión de los fármacos expuestos en este estudio, y consideramos que deberían llevarse a cabo más estudios para determinar la biodisponibilidad de formulaciones diferentes a las convencionales, especialmente de los medicamentos de reciente comercialización.

          Translated abstract

          Introduction: Patients infected with HIV demographic have changed in recent years and sometimes, co-infections with hepatitis virus B and C are common. Due to their longer survival, these patients often present diseases or undergo surgical procedures that preclude the intake of drugs, requiring the use of the enteral administration. This practice, however, may fail due to the lack of adherence, unsuitable drug blood concentrations caused by malabsorption or interactions, and dosage errors. We aim to develop management guidelines for antiviral drugs enteral administration. Material and methods: We reviewed the technical specifications of drugs used in HIV, HBV or HCV. A search was conducted in Pubmed® database and Micromedex®, manufacturers were contacted for futher information and other related literature was reviewed. Results: The results are shown in table 1. Discussion: Although in pharmaceutical practice crushing tablets is common, sometimes suspension of crushed drugs in water is not completely appropriate for enteral administration, because this practice may alter the bioavailability of drugs, which may modify the therapeutic effect. There is currently not enough evidence that supports the practice of crushed and suspension of drugs exposed in this study. Therefore, the bioavailability of different formulations should be studied more carefully, especially of recent marketing drugs.

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            Antiretroviral medication errors among hospitalized patients with HIV infection.

            Highly active antiretroviral therapy (HAART) has improved survival for persons living with human immunodeficiency virus (HIV) infection. However, effective therapy requires high levels of adherence over extended periods of time. Previous studies suggest that patients receiving long-term medication are at risk for unintended medication discrepancies at the time of hospital admission. We retrospectively identified every HIV-infected patient admitted to our hospital over a 1-year period who received an antiretroviral agent. We collected information on medications and renal function from the hospital computerized provider order entry system. We reviewed the medical records for those admissions for which a potential error was identified. We defined errors using Department of Health and Human Services guidelines and included only those errors that were not corrected within 24 h after initial entry. There were a total of 209 admissions during a 1-year period in which an HIV-infected patient received antiretroviral therapy. After review of the medical records for 77 admissions with a potential error, 61 uncorrected errors from 54 admissions were identified (percentage of total admissions, 25.8%; 95% confidence interval, 20.1%-32.3%). The most common type of error was an error with respect to the amount or frequency of dosage, which occurred in 34 (16.3%) of the admissions; 18 of these errors were attributable to failure to appropriately adjust dosage for renal insufficiency. The next most common error was combining antiretroviral drugs with a contraindicated medication; this occurred in 12 (5.2%) of the admissions. Patients erroneously received
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              Coinfection with HIV and hepatitis C virus in injection drug users and minority populations.

              Coinfection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) is common. In the United States, it has been estimated that 25% of persons infected with HIV are also infected with HCV. The prevalence of coinfection with HIV and HCV is highest among those infected via percutaneous routes. In fact, in urban areas in the United States, 50%-90% of persons infected with HIV via injection drug use are coinfected with HCV. In addition, limited data from drug treatment centers in these urban areas suggest that the prevalence of coinfection with HIV and HCV may be highest among African Americans and Hispanics. Little information is available with regard to the epidemiology of coinfection with HIV and HCV among injection drug users (IDUs) or minority populations. Likewise, although there is a growing body of data on the potential complexities of treating HCV among IDUs and the poor response to current anti-HCV treatment among African Americans, few data address the therapy of coinfection with HIV and HCV among IDUs and minority populations.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                fh
                Farmacia Hospitalaria
                Farm Hosp.
                Aula Médica Ediciones (Grupo Aula Médica S.L.) (Madrid )
                1130-6343
                October 2013
                : 37
                : 5
                : 412-418
                Affiliations
                [1 ] Hospital Costa del Sol Spain
                Article
                S1130-63432013000500012
                10.7399/FH.2013.37.5.815
                60e8f798-1e76-420b-8b93-a85a026c11f5

                http://creativecommons.org/licenses/by/4.0/

                History
                Categories
                PHARMACOLOGY & PHARMACY

                Pharmacology & Pharmaceutical medicine
                Antiretroviral treatment,antiviral therapy,hepatits B,hepatitis C,nasogastric gastrostomy tube,HIV,swallowing problems,Tratamiento antirretroviral,tratamiento antiviral,hepatitis B,hepatitis c,sonda nasogástrica,gastrostomía,VIH,problemas de deglución

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