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Got18-0038. Compounding of 2% Anphotericin B Ointment for Topical Treatment of Long Evolution Localized Cutaneous Leishmaniasis

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Got18-0038. Compounding of 2% Anphotericin B Ointment for Topical Treatment of Long Evolution Localized Cutaneous Leishmaniasis Page 1 of 21 GOT18-0038. COMPOUNDING OF 2% ANPHOTERICIN B OINTMENT FOR TOPICAL TREATMENT OF LONG EVOLUTION LOCALIZED CUTANEOUS LEISHMANIASIS. Background Cutaneous leishmaniasis is a common problem in our Hospital. Despite the fact that our region is not endemic, we recieve lots of inmigrants from the north of Africa. In this case, Pediatric Service of our hospital requested a topical preparation of amphotericin B to treat a one year of evolution case of cutaneous leishmaniasis localized in the cheeks of a two years old infant. Purpose Describe the process of compounding a 2% amphotericin B ointment, answering the request of a Pediatric Service to treat a case of localized cutaneous leishmaniasis of long evolution. Material and methods Pediatric Service of our hospital requested a topical preparation of amphotericin B to treat a case of cutaneous leishmaniasis localized in the cheeks, with a year of evolution, in a two years old infant. We performed a search to seek for physicochemical stability of an ointment based in amphotericin B(powder), paraffin wax and liquid paraffin. Results A preparation of amphotericin B ointment was designed based on amphotericin B powder, liquid paraffin and paraffin wax. To preparate 10 g of the ointment, the following steps were followed: 0.2 g of amphotericin B powder were first weighed in a precision balance inside a powder extraction cabinet, then a mortar was tared, the weighed active ingredient was added and 1 ml of liquid petrolatum was added, mixing until an homogeneous paste was obtained, to which paraffin wax was added q.s 10 g. Finally it was packaged in a 10 ml opaque syringe and labeled indicating the need for preservation between 2 ° and 8 ° and protected from light. The expiration date was established in 30 days in the refrigerator. Conclusion The preparation of amphotericin B 2% ointment was well tolerated by the patient, with improvement of the cutaneous injuries in subsequent reviews with the specialist. We consider the ointment an alternative for treatment of these injuries while waiting for more results. References and/or Acknowledgements . Conflict of Interest No conflict of interest file:///C:/Users/henadzi.sobal/Documents/cmOffice/Temp/TempF105072491.html 7/11/2017 Page 2 of 21 GOT18-0040. COMPOUNDING OF BEVACIZUMAB 5 MG/ML EYE DROPS FOR CORNEAL NEOVASCULARIZATION. Background From the Ophthalmology Service we are requested a formulation of bevacizumab as antiangiogenic agent in two cases of corneal neovascularization. Purpose Describe the process of compounding of a bevacizumab eye drops at a concentration of 5 mg/ml in an Hospital Pharmacy Service for two patients with corneal neovascularization. Material and methods We performed a search to seek for physicochemical stability and we determined the risks of the preparation and the expiracy date. Results A bevacizumab 5 mg/ml eye drops formulation was designed from Bevacizumab 25 mg / ml injectable 4 ml and 0.9% sodium chloride ampoules 10 ml. Working in a Laminar Flow Cabinet in a cleanroom and performing aseptic technique, 2 ml of Bevacizumab 25 mg/ml was loaded into a 10 ml Luer Lock® syringe. Then, the volume was diluted with 0.9% sodium chloride q.s. 10 ml, resulting in a bevacizumab concentration of 5 mg / ml. We homogenized and packaged it in an opaque plastic dropper bottle. Finally, we labeled it indicating that it should be stored between 2 ° and 8 ° C. Given the aqueous nature of the preparation and the absence of preservative, the expiration that was assigned to the eye drops was 14 days in a refrigerator. Conclusion Eye drops were well tolerated by patients, requiring a longer duration of treatment to determine its effectiveness. We considered the inclusion of an ophthalmic preservative such as benzalkonium chloride in the preparation to prolong the expiration to 30 days in the refrigerator. References and/or Acknowledgements . Conflict of Interest No conflict of interest GOT18-0046. AUTOMATION OF PARENTERAL NUTRITION ELABORATION IN A HOSPITAL PHARMACY SERVICE Background As the parenteral nutrition (PN) is a high-risk medication, the quality control must be guarantied. This should be considered in the automation process of its production. Purpose file:///C:/Users/henadzi.sobal/Documents/cmOffice/Temp/TempF105072491.html 7/11/2017 Page 3 of 21 To evaluate the impact of implementing an automated system (Exacta-Mix 2400® Baxa) on the quality of the elaboration of PN (parenteral nutrition). Material and methods The gravimetric control is a strategy used for the quality control in the elaboration of PN. It consists of comparing the actual weight with that calculated according to the volume and density of each of its components (theoretical weight). Regulatory agencies establish an acceptable margin of error of 5%, and it is advisable to reduce this to 3%, especially in pediatric nutrition. Once the equipment was implanted, a comparison was made between the manual procedure and the new one. A comparative gravimetric control was performed between the PNs made the first week of December 2015 (manual procedure) and the same week one year later (automated system), excluding the tricameral ones. The deviations from the theoretical weight and the percentage of preparations that exceeded 3% were analyzed. For the comparison of means of deviation, a K-W test was performed using software R. Results A total of 144 PNs (77 manuals and 77 automated) were analyzed. The mean variation of the actual weight with respect to the theoretical weight was 3.37% and 0.73%, respectively (significant decrease (p <0.05)). The reduction in the percentage of preparations above the 3% limit was also significant. None of the PNs made with Exacta-Mix 2400® Baxa exceeded the variation limit of 3%, with a maximum variability of 1.95%. Conclusion Automation means an increase in accuracy control and a decrease in the risk of exceeding acceptable limits. Despite the difficulties of implementing a new technological process, robotization tends to become an essential in Hospital Pharmacy Services and allows an improvement in the integral quality of care. References and/or Acknowledgements Llop Talavera JM et al. Automation of parenteral nutrition elaboration: adaptation to in force legislation.Nutr Hosp. 2006 Mar-Apr;21(2):184-8. Conflict of Interest No conflict of interest GOT18-0066. EVALUATION OF THE EFFICIENCY AND SATISFACTION OF ORAL LIQUID MAGISTRAL PREPARATION FOR MUCOSITIS ELABORATED IN A TERTIARY HOSPITAL Background Mucositis is a complication arising from chemotherapy which reduces the quality of life of a cancer patient. Its prevention and treatment is important. Purpose file:///C:/Users/henadzi.sobal/Documents/cmOffice/Temp/TempF105072491.html 7/11/2017 Page 4 of 21 To evaluate efficiency and satisfaction of the suspension for mucositis elaborated in the Pharmacy Service, destined for patients with mucositis as a consequence of cytostatic treatment, in order to identify where improvement is needed. Material and methods Observational descriptive study for one month. Oncohematological day hospital patients who attended for treatment and to pick up the suspension for mucositis were included. A form was designed that was an anonymous questionnaire. It included information about demographics data, pathology, degree of mucositis (according to the World Health Organisation), tolerability, effectiveness and patient satisfaction. The replies referred to qualitative dichotomous or polytomous variables, with nominal or ordinal gradations. The replies were analysed via an Excel® 2010. Results 69 questionnaires were collected. 26 belonged to men. 4 were excluded from the study for lack of information. The average age of the patients was 63±10,83 years old. The patients were classified based on the degree of mucositis: 21 patients grade 0, 19 grade 1, 23 grade 2, 1 grade 3 and 1 grade 4. In no patient was it necessary to suspend the chemotherapy treatment as a consequence of the mucositis which presented. 56 patients (86.15%) indicated a considerable improvement in symptoms after the use of the magistral preparation after 2-4 days of use. In 5(7.69%) patients there was no improvement. As for the taste, the valuation of the majority (64.68%) was that it was disagreeable. In general the valuation of the magistral preparation was: 1 (3.07%), 2 (9.23%), 3 (40%), 4 (36.92%), and 5 (10.77%), 1 being nothing, 2 being a little, 3 being quite a bit, 4 being a lot and 5 being totally satisfactory. Conclusion The magistral preparation for mucositis elaborated in the Pharmacy Service is efficient in the control of the symptoms of mucositis at all levels. The patients showed a high degree of satisfaction globally, palatability being the factor that needed improvement. As an opportunity to improve we found the study of flavourings compatible with the preparation and that they did not interfere with the therapeutic effect. References and/or Acknowledgements . Conflict of Interest No conflict of interest file:///C:/Users/henadzi.sobal/Documents/cmOffice/Temp/TempF105072491.html 7/11/2017 Page 5 of 21 GOT18-0087. EXTEMPORANEOUS PREPARATION OF ORAL VANCOMYCIN SUSPENSION FOR PEDIATRIC PATIENTS Background Solutions of vancomycin for oral administration are not available commercially in Bosnia and Herzegovina but are needed for pediatric patients who cannot swallow capsules. Child 40 days old diagnosed with Megacolon congenitum, St.post Ileus meconialis, Peritonitis diff., Sepsis, Hepatitis toxica, Convulsiones, Insuff. cardiorespiratoria, ARDS was admitted in Pediatric Clinic. Child was also diagnosed with Clostridium difficile and should receive 25mg/ml of vancomycin suspension as the first-line therapy. The recommended dose was not available on the market and the only solution was that pharmacists prepare the suspension extemporaneously from the injectable form. Purpose The aim was to describe the preparation procedure of vancomycin suspension dedicated to child and the standard technology process. Material and methods Pediatric Clinic send request for preparation of 25 mg/ml vancomycin oral suspension.
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