Rol van de klinisch apotheker op een kinderoncologische afdeling. Le rôle du pharmacien-clinicien dans un département d hémato-oncologie pédiatrique

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1 Rol van de klinisch apotheker op een kinderoncologische afdeling Le rôle du pharmacien-clinicien dans un département d hémato-oncologie pédiatrique Tiene Bauters, UZ Gent Katrien Cosaert, UZ Leuven BOPP, Blankenberge, februari INTRODUCTION Clinical Pharmacy Professional exploitation from drug-perspective with focus on patient Promotion of correct and appropriate use of drugs Ensuring optimal patient outcome most effective treatment for each patient Minimising risk of treatment-induced adverse events cost of pharmacological treatments 2 2 1

2 2. CLINICAL PHARMACY ACTIVITIES IN PEDIATRIC ONCOLOGY 1. INDIVIDUAL PATIENT Step 1 : Gathering relevant information on patient Medication history Medical records and results of initial investigations (laboratory, ) - Patient / caregiver - General practitioner - Community pharmacist Construction of abstracted chart with clinical and pharmaceutical data Step 2 : 2a : Systematic analysis of medicines prescribed during hospital stay - Indication - Dose - Choice of drug - Duration of therapy - Cost of drug therapy - Drug-drug interactions - Drug-disease interactions (allergy, contra-indications) - Modalities of administration (correct and practical) - Adverse drug reaction Source - Summary of Product Characteristics - Hospital formulary - PubMed - Are drug related problems identified? Step 2b : Interventions to optimize prescribing 1. Discuss Drug related problems 2. Propose a solution. Ensure the followup - Prescriber - Other Health Care Professional - Patient - Caregiver Advice in electronic patient file 4 4 2

3 2. WARD LEVEL ACTIVITIES (multidisciplinary) Development and implementation of guidelines Oral care (~ mucositis) Treatment of cancer pain Prevention and treatment of chemotherapy-induced nausea and vomiting. Quality projects Implementation of Oral Liquid Dispensers (O.L.D.) Support in electronic prescribing programs Drug Use Evaluation Pain medication Anti-emetics 5 5 Example: Algorithm for treatment of cancer pain in pediatrics (UZ Gent) 6 6

4 National Kankerplan (2009) (L. Onkelinx) Program for oncological care for children Financing of halftime pharmacist for pediatric oncology in all pediatric oncological centres 7 7 Pharmacists group (BSPHO) Bauters Tiene Cosaert Katrien Deuss Sarah Gerday Elise/Limbort Véronique Janssen Aurélie Van Schandevyl Guy Wertz Aline / Duveiller Véronique Laureys Geneviève Hospital UZ Gent UZ Leuven UZ Brussel CHC CHR Citadelle HUDERF UCL UZ Gent 8 8 4

5 Pharmacist group (BSPHO) To establish institutional independent guidelines Table: interactions between drugs and food (enteral feeding) Collaboration Expertise, pharmacological data, Forum communication Projects Output: workshops,

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7 Case: allogenic bone marrow transplantation Mary, 8 years, 26 kg, BSA 0.96 m 2 Allogenic HPCT, sickle cell anemia Conditioning: Busulfan IV + cyclophosphamide IV + ATG Co-medication ofloxacin: SDD fluconazol: SDD heparin continuous IV infusion: VOD profylaxe mesna cyclosporin Post-transplant: MTX + levolic acid Check doses 2

8 Preparation of chemotherapy Incompatibilities In the absence of compatibility studies, this medicinal product must not be mixed with other medicinal products. Calculation of the quantity of Busilvex to be diluted and of the diluent Busilvex (6 mg/ml) must be diluted prior to use with either sodium chloride 9 mg/ml (0.9%) solution for injection or glucose solution for injection 5%. The quantity of the diluent must be 10 times the volume of Busilvex ensuring the final concentration of busulfan remains at approximately 0.5 mg/ml. 4 Do not use polycarbonate syringes with Busilvex. Preparation of chemotherapy BUSILVEX. UZ LEUVEN apotheek SYNONIEMEN Busulfan Myleran PRODUCTOMSCHRIJVING -vloeistof voor injectie: 60 mg/10 ml -toevoegstoffen: N,N-dimethylacetamide %, macrogol % -kostprijs: 05,- DOSIS - TOEDIENING -richthoeveelheid per dosis: afhankelijk van het lichaamsgewicht van de patiënt (0,8-2 mg/kg) -IV over 2 uur, 4x per dag (om de 6 uur) gedurende 4 dagen BEREIDING -oplosmiddel: NaCl 0,9% -oplosbaarheid: slecht -Trek eerst een volume NaCl 0,9% gelijk aan 10x het nodige volume Busilvex op in een spuit. Spuit hierbij nadien de dosis Busilvex met behulp van een 2 e spuit. -uren van toediening: 10h-16h-22h-04h. Bereid de spuiten per 2, maximum 12 uur voor de 2 e toediening (ber. om 9h00 en 16h0) BEWARING -15 uur: 12 uur in de koelkast en uur op kamertemperatuur VOORZORGEN 4 -bij extravasatie: geen specifieke maatregelen -bij kontakt met de huid: overvloedig wassen met water en zeep

9 Preparation of chemotherapy tekst Cost of drug therapy Busilvex: 60 mg: 02 euro Phaseal system: combination of vials Combination of Busilvex + cyclophosphamide for HSCT in children 18 years is reimursed! 4

10 Quality of care: electronic prescribing programme tekst Quality of care: oral liquid dispensers 5

11 IV Compatibility of drugs heparin, tpn, cyclosporin: continuous IV infusion parecetamol IV fluconazole IV ondansetron IV Compatibility? Compatibility of drugs IV PO switch: fluconazol, ondansetron, paracetamol use the lumina of the catheter 6

12 Specific questions Seizure profylaxis with busulfan? midazolam, clonazepam, lorazepam: drowsiness phenytoin: interactions levetiracetam Levolic acid folic acid? ATG Fresenius Thymoglobuline Conclusion + + = 7