0000000000096544
AUTHOR
Mónica Climente-martí
Supplemental material for Quantitative and qualitative control of antineoplastic preparations: Gravimetry versus HPLC
Supplemental Material for Quantitative and qualitative control of antineoplastic preparations: Gravimetry versus HPLC by Ana Sendra-García, M Amparo Martínez-Gómez, Asunción Albert-Marí, N Victor Jiménez-Torres and Mónica Climente-Martí in Journal of Oncology Pharmacy Practice
Validation of a Reinforcement Learning Policy for Dosage Optimization of Erythropoietin
This paper deals with the validation of a Reinforcement Learning (RL) policy for dosage optimization of Erythropoietin (EPO). This policy was obtained using data from patients in a haemodialysis program during the year 2005. The goal of this policy was to maintain patients' Haemoglobin (Hb) level between 11.5 g/dl and 12.5 g/dl. An individual management was needed, as each patient usually presents a different response to the treatment. RL provides an attractive and satisfactory solution, showing that a policy based on RL would be much more successful in achieving the goal of maintaining patients within the desired target of Hb than the policy followed by the hospital so far. In this work, t…
Relationship Between Glucocerebrosidase Activity and Clinical Response to Enzyme Replacement Therapy in Patients With Gaucher Disease Type I
The quantification of enzyme activity in the patient treated with enzyme replacement therapy (ERT) has been suggested as a tool for dosage individualization, so we conducted a study to evaluate the relationship between glucocerebrosidase activity and clinical response in patients with Gaucher disease type I (GD1) to ERT. The study included patients diagnosed with GD1, who were being treated with ERT, and healthy individuals. Markers based on glucocerebrosidase activity measurement in patients' leucocytes were studied: enzyme activity at 15 min. post-infusion (Act75 ) reflects the amount of enzyme that is distributed in the body post-ERT infusion, and accumulated glucocerebrosidase activity …
A Bayesian Method for Predicting 5‐Fluorouracil Pharmacokinetic Parameters Following Short‐Term Infusion in Patients With Colorectal Cancer
Abstract The objective of this study was to develop a population pharmacokinetic model and validate it using a Bayesian approach for predicting, a priori and a posteriori , the individual volume of distribution ( V d ) and clearance ( Cl ) of 5‐fluorouracil (5‐FU) given as short‐term intravenous infusion in weekly and multiple doses. Forty‐four patients were divided in group A (5‐FU weekly doses) including 27 patients with nonmetastatic colorectal adenocarcinoma treated with 450 mg/m 2 of 5‐FU, 1 day per week for 48 doses, plus oral levamisol (50 mg/8 h) for 3 days, every 15 days and group B (5‐FU multiple doses) including 17 patients with metastatic colorectal adenocarcinoma, receiving 5‐F…
Quantitative and qualitative control of antineoplastic preparations: Gravimetry versus HPLC.
This article compares gravimetry vs. high-performance liquid chromatography (HPLC) as quality control (QC) methods for paclitaxel, docetaxel and oxaliplatin preparations. We aimed at assessing the preparation method reliability in our hospital, evaluating compounding accuracy and estimating the influence of personnel training and standardized homogenization on compounding accuracy. Agreement, correlation, concordance, accuracy and precision between methods were evaluated for each drug. Conforming preparation percentages (CPs) at different tolerance limits (TLs) and compounding accuracy were calculated for each method and drug. Compounding accuracy was compared before and after personnel tra…
Physico-Chemical Stability of Admixtures of Vinflunine Used in Clinical Practice.
Procedure of administration of vinflunine is complex and consists of an Y-site injection with fluid at different speeds. Dose is diluted with 100 mL of 0.9% sodium chloride or 5% glucose and infused with half of the 500 mL bag of the fluid over 20 min; after that, the remaining fluid is administered at 300 mL/h. In this study, chemical stability and physical compatibility of vinflunine diluted with in 500 mL of both fluids were evaluated to simplify the administration procedure (infusion of mixture on 20 min followed by 250 mL of fluid at 300 mL/h). Physical compatibility and chemical stability were evaluated at two temperatures and protected from and exposed to light. Physical compatibilit…
Evaluation of ABC gene polymorphisms on the pharmacokinetics and pharmacodynamics of capecitabine in colorectal patients: Implications for dosing recommendations.
Aims The aims are to develop a population pharmacokinetic model of capecitabine (CAP) and its main metabolites after the oral administration of CAP in colorectal cancer patients with different polymorphisms of the ATP-binding cassette (ABC) gene and a population pharmacokinetic/pharmacodynamic model capable of accounting for the neutropenic effects, and to optimize the dosing strategy based on the polymorphisms of the ABC gene and/or the administration regimen as a single agent or in combination. Methods Forty-eight patients diagnosed with colorectal cancer were included, with 432 plasma levels of CAP, 5'-desoxi-5-fluorouridine (5'-DFUR) and 5-fluorouracil (5-FU), and 370 neutrophil observa…
A reinforcement learning approach for individualizing erythropoietin dosages in hemodialysis patients
This paper presents a reinforcement learning (RL) approach for anemia management in patients undergoing chronic renal failure. Erythropoietin (EPO) is the treatment of choice for this kind of anemia but it is an expensive drug and with some dangerous side-effects that should be considered especially for patients who do not respond to the treatment. Therefore, an individualized treatment appears to be necessary. RL is a suitable approach to tackle this problem. Moreover, resulting policies are similar to medical protocols, and hence, they can easily be transferred to daily practice. A cohort of 64 patients are included in the study. An implementation of the Q-learning algorithm based on a st…
Potential Risk of Medication Discrepancies and Reconciliation Errors at Admission and Discharge from an Inpatient Medical Service
Background: Medication discrepancies, defined as unexplained variations among drug regimens at care transitions, are common. Some are unintended and cause reconciliation errors that are potentially detrimental for patients. Objective: To determine the prevalence of medication discrepancies and reconciliation errors at admission and discharge in hospitalized patients and explore risk factors for reconciliation errors and their potential clinical impact. Methods: An observational prospective study was conducted at a general teaching hospital. Patients who were admitted to the internal medicine service and were receiving chronic preadmission treatment were included in the study. Preadmission t…
Population pharmacokinetics of 5-fluorouracil in colorectal cancer patients
Aims. The pharmacokinetics of 5-fluorouracil (5-FU) after intravenous administration in color- ectal cancer patients were examined using population analysis. The relevant covariates and the extent of inter- and intraindividual variability were evaluated. Methods. Data from 27 patients with diagnosis of nonmetastatic colorectal adenocarcinoma receiving weekly 5-FU (450 mg/m2), plus levamisol 50 mg/8 hours by oral route for 3 days every 15 days, were pooled with data from 17 patients with diagnosis of metastatic colorectal adenocarcinoma, receiving daily 5-FU (425 mg/m2) and intravenous folinic acid (20 mg/m2) over five consecutive days (daily times five), every four weeks. In both groups 5-…