practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs liu...
TRANSCRIPT
![Page 1: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/1.jpg)
1
Practice on pregnancy prevention for reproductive toxic drugs
Liu Fang, Zhang TingDepartment of pharmacy,
Peking University third hospital2011.11.8
Corresponding to :
Zhang Xiao-le, 010-82265743, [email protected]
![Page 2: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/2.jpg)
2
Outline
• Background
• Methods
• Results
• Discussion
• Conclusion
![Page 3: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/3.jpg)
3
Background
Thalidomide
Pregnancy vomiting
Thalidomide
Years later
Multiple myelomaOther indications
?Pregnancy Prevention Program
![Page 4: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/4.jpg)
4
BackgroundDrug IndicationsLeflunomide Rheumatoid arthritis
Thalidomide Multiple myeloma
Acitretin Severe Psoriasis; other keratinizing skin
Acutance Severe acne
Tretinoin Ointment
Severe Psoriasis; other keratinizing skin
Danger:
NO PPP
![Page 5: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/5.jpg)
5
Background
Drug Length of time for pregnancy prevention after treatment
Leflunomide 3 monthsThalidomide 1 monthAcitretin 2 yearsAcutance 3 months
![Page 6: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/6.jpg)
6
Case
• Patient: When can I bear child after using the drugs.
• Pharmacist: Uh…Acitretin…I’m worried that you have to wait at least two years.
• Patient: Two years! It’s too long. I’ll go back to the physician to delete the medicine from my prescription.
What will happen if the patient didn’t ask the question and is
pregnant soon after stopping using the medicine?
![Page 7: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/7.jpg)
7
Objective• Through baseline survey, learn the knowledge and practice of physicians and pharmacists in prescribing or dispensing reproductive toxic (RT) drugs .
• According to the problems we learned from the baseline survey, intervention will be taken to improve the knowledge and practice of physicians and pharmacists.
![Page 8: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/8.jpg)
8
Methods
• Participating hospital
• Baseline survey
• Methods of intervention
• Evaluation of the improvement
• Statistics
![Page 9: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/9.jpg)
9
• Initiated and organized by Department of Pharmacy,
Peking University Third Hospital.
• Sponsored by Beijing Pharmaceutical association.
![Page 10: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/10.jpg)
10
Participating hospitals
• 301 Hospital
• 466 Hospital
• Peking University First Hospital
• Peking University Third Hospital,
• Chuiyangliu Hospital
• United Family Hospital
• Ji Shui Tan Hospital,
• People's Hospital
• Millennium Monument Hospital
• Shougang Hospital
• Union Hospital
• Xuanwu Hospital
• Friendship Hospital
• China‐Japan Friendship Hospital
![Page 11: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/11.jpg)
11
Calendar Time Actions
Apr,2010-Jun,2010
Training investigatorsBaseline survey in patients,
pharmacists and physicians
Jul,2010-Sep,2010 Preparing the materials for intervention
Oct,2010-Mar,2011 Carrying out intervention
Apr-Jun,2011Survey after intervention in
patients, pharmacists and physicians
Jun-Jul,2011 Data processing and statistics
![Page 12: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/12.jpg)
12
Questionnaire
• For physicians• For pharmacists• For patients
![Page 13: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/13.jpg)
13
• Reference– Martindale– Drugdex– Package insert
• outline– Primary principle for safe use of RT drugs in
reproductive population– Review of the 5 kinds of RT drugs – Appendix: a list of medication with FDA
pregnancy catagory D or X
Handbook for safe use of RT drugs
![Page 14: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/14.jpg)
14
What is RT drug?
Before using RT drug
After treatment with RT drug
During treatment with RT drug
For what kind of medication, you must tell the patients to take measures to prevent pregnancy?
![Page 15: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/15.jpg)
15
Handouts for patients
Tips to stick on the package of the drugs
During and after using the drug, you must avoid pregnancy. Please find details in package insert.
![Page 16: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/16.jpg)
16
![Page 17: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/17.jpg)
17
![Page 18: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/18.jpg)
18
![Page 19: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/19.jpg)
19
![Page 20: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/20.jpg)
20
Results
• Characteristics
(physicians, pharmacists and patients)
• The knowledge of the physicians and pharmacists
• The practice of the physicians and pharmacists
• The knowledge of the patients
• Case report20
![Page 21: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/21.jpg)
21
Characteristics
21
Before(N)
After(N)
Total(N)
physicians 222 166 388
pharmacists 373 389 762
Patients 503 286 789
![Page 22: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/22.jpg)
22
Characteristics
22
Personal characteristics
physicians Age, education, title ,department……
pharmacists Age, education, title……
Patients Age, gender……
![Page 23: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/23.jpg)
23
knowledge
• Physicians
• Pharmacists
23
![Page 24: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/24.jpg)
24
Physicians
24
Question ScoreDo you know the FDA pregnancy category clearly? 2Do you know which medicine is classified as X ? 2Do you know the cautions of leflunomide? 3
![Page 25: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/25.jpg)
25
Physicians
25
3.36±1.58
3.49±1.78
(p<0.05)
Before After
![Page 26: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/26.jpg)
26
Pharmacists
26
Question ScoreDo you know the FDA pregnancy category clearly? 2Do you know which medicine is classified as X ? 2Do you know the cautions of leflunomide? 3Do you know how to deal with the remaining medicines? 1
![Page 27: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/27.jpg)
27
Pharmacists
27
3.55±2.47
5.65±2.48
Before After
(p<0.05)
![Page 28: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/28.jpg)
28
Practice
• Physicians
• Pharmacists
28
![Page 29: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/29.jpg)
29
Physicians
29
Question ScoreDo you tell the patients the potential riskwhen priscribing these drugs?
2
Do you ask the patient to do the pregnacytest before prescription ?
2
Do you ask the patient to show her testresult through further consultation ?
2
Do you tell the patients when taking thesemedicines they should take method of birth‐control?
2
Do you tell the patients how to deal with theremaining medicine?
2
![Page 30: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/30.jpg)
30
Physicians
30
department of rheumatology
department of dermatology
average SD N average SD N
Before 5.61 2.8 171 6.92 3.07 76
After 6.03 2.87 70 7.03 2.81 65
![Page 31: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/31.jpg)
31
Pharmacists
31
Question ScoreDo you tell the patients the risk before dispensing?
2
How do you do the patient education? 2Do you tell the patients how to deal with the remaining medicine?
3
![Page 32: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/32.jpg)
32
Pharmacists
32
4.32±1.443.39±1.75
Before After
![Page 33: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/33.jpg)
33
Patients
• Do you know the risk of the medicine which you will use?
• How do you know about this information?
33
41.55% 78.67%
![Page 34: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/34.jpg)
34
The ways of awareness
34
Before After
physicianpharmacist
introductionOthers
![Page 35: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/35.jpg)
3535
Case report
• Female 23 y
• Visited the department of dermatology
• Diagnose: Flat wart
• Prescription :
Tretinoin Cream twice a day for external use
![Page 36: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/36.jpg)
36
Case report
• The physician didn’t mention the risk about reproductive toxicity
• The patient was planning for pregnancy
• The pharmacist carried out patient education
36
![Page 37: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/37.jpg)
37
Discussion
• The practice maybe still not good enough, but we have already made some changes
• The continuous or periodic intervention will make sense to the patient safety
• Our objective is to discuss and try to establish a flexible mode of the pharmacovigilance
37
![Page 38: Practice on pregnancy prevention for reproductive toxic drugs · for reproductive toxic drugs Liu Fang, Zhang Ting Department of pharmacy, ... • Friendship Hospital ... Do you tell](https://reader033.vdocuments.us/reader033/viewer/2022051914/600622ecc398f87231766e9a/html5/thumbnails/38.jpg)
3838