Medical cannabis has recently been legalized in many countries, and it is currently prescribed with increasing frequency, particularly for treatment of chronic pain resistant to conventional therapy. The psychoactive substance delta-9-tetrahydro-cannabinol (THC) contained in cannabis may affect driving abilities. Therefore, the aims of this study (open-label, monocentric, nonrandomized) were to evaluate blood and saliva concentrations of THC after oral administration of medical cannabis and to assess the time needed for THC levels to decline below a value ensuring legal driving. The study involved 20 patients with documented chronic pain using long-term medical cannabis therapy. They were divided into two groups and treated with two different doses of cannabis in the form of gelatin capsules (62.5 mg or 125 mg). In all patients, the amount of THC was assessed in saliva and in blood at pre-defined time intervals before and after administration. THC levels in saliva were detected at zero in all subjects following administration of both doses at all-time intervals after administration. Assessment of THC levels in blood, however, showed positive findings in one subject 9 h after administration of the lower dose and in one patient who had been given a higher dose 7 h after administration. Our finding suggested that for an unaffected ability to drive, at least 9-10 h should elapse from the last cannabis use.
- MeSH
- agonisté kanabinoidních receptorů MeSH
- aplikace orální MeSH
- Cannabis * MeSH
- chronická bolest * MeSH
- lidé MeSH
- marihuana pro léčebné účely * MeSH
- sliny MeSH
- tetrahydrokanabinol MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- Názvy látek
- agonisté kanabinoidních receptorů MeSH
- marihuana pro léčebné účely * MeSH
- tetrahydrokanabinol MeSH
This pilot prospective study verified the hypothesis that use of computer-assisted therapeutic drug monitoring of aminoglycosides by pharmacists leads to better safety therapeutic outcomes and cost avoidance than only concentration measurement and dose adjustments based on a physician's experience. Two groups of patients were enrolled according to the technique of monitoring. Patients (Group 1, n=52) underwent monitoring by a pharmacist using pharmacokinetic software. In a control group (Group 2, n=11), plasma levels were measured but not interpreted by the pharmacist, only by physicians. No statistically significant differences were found between the groups in factors influenced by therapy. However, the results are not statistically significant but a comparison of the groups showed a clear trend towards safety and cost avoidance, thus supporting therapeutic drug monitoring. Safety limits were achieved in 76 % and 63 % of cases in Groups 1 and 2, respectively. More patients achieved both concentrations (peak and trough) with falling eGFR in Group 1. In present pilot study, the pharmacist improved the care of patients on aminoglycoside therapy. A larger study is needed to demonstrate statistically significantly improved safety and cost avoidance of aminoglycoside therapy monitoring by the pharmacist using pharmacokinetic software.
- MeSH
- amikacin aplikace a dávkování MeSH
- aminoglykosidy aplikace a dávkování škodlivé účinky farmakokinetika MeSH
- antibakteriální látky aplikace a dávkování MeSH
- bezpečnost MeSH
- farmaceuti * MeSH
- gentamiciny aplikace a dávkování MeSH
- lidé středního věku MeSH
- lidé MeSH
- monitorování léčiv ekonomika metody MeSH
- náklady a analýza nákladů MeSH
- nemoci ledvin chemicky indukované MeSH
- pilotní projekty MeSH
- počítačová farmakoterapie metody MeSH
- prospektivní studie MeSH
- senioři MeSH
- výpočet dávky léku * MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- amikacin MeSH
- aminoglykosidy MeSH
- antibakteriální látky MeSH
- gentamiciny MeSH
BACKGROUND: Proton pump inhibitors (PPIs) are often a part of drug regimens for many patients, including cancer patients. These drugs are very effective suppressors of gastric acid secretion; a significant increase in the gastric pH is seen with chronic use. This affects absorption of drugs, vitamins, and minerals. PURPOSE: PPIs are associated with many adverse drug reactions; nevertheless, these adverse effects are often neglected in clinical practice. The main aim of this article is to emphasize some of the adverse effects and theoretical mechanisms underlying these adverse reactions, the expected length of therapy before their clinical manifestation, and potential ways of dealing with these adverse reactions. We will focus on hypergastrinemia and rebound hyper-acidity, which occur in patients on long-term therapy with high dose PPIs. Next, we will focus on osteoporosis and hypomagnesemia, adverse effects for which the assumed mechanism is decreased absorption of particular ions from the gastrointestinal tract. Furthermore, clinically significant pharmacokinetic drug interactions at the level of absorption will be analyzed. Tyrosine kinase inhibitors (TKIs) are drugs with limited solubility; this solubility is pH-dependent. Some recommendations seek to ensure optimal absorption with minimal inter-day variability. Tables sum-marizing the optimal relationship between food and TKIs, and (sometimes) the optimal regimen of concomitant PPIs, are included. Key words: proton pump inhibitors - drug-related side effects and adverse reactions- drug interactions - tyrosine kinase inhibitors - hypochlorhydria The author declares she has no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 24. 8. 2018 Accepted: 17. 10. 2018.
- Klíčová slova
- or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 24. 8. 2018 Accepted: 17. 10. 2018, products, proton pump inhibitors - drug-related side effects and adverse reactions- drug interactions - tyrosine kinase inhibitors - hypochlorhydria The author declares she has no potential conflicts of interest concerning drugs,
- MeSH
- inhibitory proteinkinas terapeutické užití MeSH
- inhibitory protonové pumpy škodlivé účinky MeSH
- koncentrace vodíkových iontů MeSH
- lékové interakce MeSH
- lidé MeSH
- nádory farmakoterapie MeSH
- žaludeční kyselina chemie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- inhibitory proteinkinas MeSH
- inhibitory protonové pumpy MeSH
Carbapenems, beta-lactam antibiotics, are ideal candidates for the treatment of serious nosocomial infections including sepsis for their exceptionally broad antibacterial spectrum and high efficiency. They are administered parenterally by intravenous infusion. Carbapenems penetrate well and rapidly into many different tissue compartments and the interstitial fluid. They are metabolized by renal dihydropeptidase-1. Therefore, imipenem must be co-administered with an inhibitor of dihydropeptidase-1. Other carbapenems registered in the Czech Republic (meropenem, ertapenem and doripenem) are more stable to this enzyme. Carbapenems are mainly eliminated via the kidneys and dose adjustment in patients with renal impairment is necessary. The elimination half-life of most carbapenems is around 1 hour with the exception of ertapenem, with 3.8-hour half-life, which allows its once-daily use. Carbapenems are a group of antibiotics with time-dependent effect. Their typical pharmaceutical property is a limited stability in solution after dilution. Administration in the prolonged infusion appears to be a convenient strategy to achieve higher efficiency. Pharmacokinetic parameters of carbapenems may vary individually, especially in critically ill patients and those treated by renal replacement therapy. Therefore, individualization of dosing regimens based on knowledge of pharmacokinetic parameters of individual patients may be useful.
- MeSH
- karbapenemy aplikace a dávkování chemie farmakokinetika MeSH
- lékové interakce MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- karbapenemy MeSH
