Emergency Drug Kits at the Danish Hospital Pharmacies: A Study of the Management and Challenges
Authors
Christensen, Maria ; Knudsen, Stine Abildgaard
Term
4. term
Publication year
2018
Submitted on
2018-06-14
Pages
59
Abstract
This thesis examines how Danish hospital pharmacies manage emergency drug kits and the challenges encountered in practice, conducted in collaboration with the Hospital Pharmacy in the North Denmark Region. To frame the topic, it includes two theory chapters: a synthesis of recent evidence (2009–2018) on vasopressors and antiarrhythmics in cardiac arrest based on guidelines (AHA, ERC), randomized trials, systematic reviews, and meta-analyses, and an overview of hospital pharmacy roles and procurement processes through Amgros. The review emphasizes that CPR and defibrillation are first-line, while drugs have limited and partly conflicting evidence: standard-dose adrenaline can increase return of spontaneous circulation and hospital admission versus placebo, but higher doses are linked to worse neurological outcomes; vasopressin is not clearly superior to adrenaline overall, with possible advantages in asystole, and combinations do not improve long-term survival. For antiarrhythmics, amiodarone is recommended for shock-resistant VF/pVT, but overall evidence for improved discharge and neurological outcomes is uncertain, and lidocaine may be comparable or favorable for some endpoints; larger randomized studies are needed. This theoretical synthesis informs decisions about the composition and prioritization of emergency drug kits and situates the topic within the logistical and regulatory context of hospital pharmacy practice. The main article focuses on the management and challenges of these kits, but specific methods and findings are not available in this excerpt.
Dette speciale undersøger, hvordan danske sygehusapoteker forvalter nødmedicinkasser (emergency drug kits) og hvilke udfordringer, der opstår i praksis, i samarbejde med Sygehusapoteket i Region Nordjylland. Som faglig ramme rummer specialet to teorikapitler: en syntese af den nyeste evidens (2009–2018) for vasopressorer og antiarytmika ved hjertestop baseret på retningslinjer (AHA, ERC), randomiserede forsøg, systematiske reviews og meta-analyser, samt en beskrivelse af sygehusapotekernes funktioner og indkøbsprocesser via Amgros. Teorigennemgangen peger på, at HLR og defibrillering er førstelinjebehandling, mens lægemidler har begrænset og delvist modstridende dokumentation: standarddoser adrenalin kan øge genoprettelse af kredsløb og indlæggelse sammenlignet med placebo, men højere doser er forbundet med flere neurologiske bivirkninger; vasopressin er samlet set ikke klart bedre end adrenalin, om end der kan være fordele ved asystoli, og kombinationsbehandling forbedrer ikke langtidsoverlevelse. For antiarytmika anbefales amiodaron ved stødresistent VF/pVT, men den samlede evidens for forbedret udskrivelse og neurologisk outcome er usikker, og lidocain kan i nogle analyser være på niveau eller bedre for enkelte mål; yderligere, større randomiserede studier efterlyses. Denne teoretiske afsøgning understøtter beslutninger om indhold og prioritering i nødmedicinkasser og sætter emnet ind i de logistiske og regulatoriske rammer for sygehusapoteker. Det konkrete studie af forvaltning og udfordringer ved nødmedicinkasser beskrives i hovedartiklen, men metoder og resultater herfra fremgår ikke af det foreliggende uddrag.
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Other projects by the authors
Christensen, Maria:
- Emergency Drug Kits at the Danish Hospital Pharmacies: A Study of the Management and Challenges (2018)
Knudsen, Stine Abildgaard: