Lenvatinib är en läkemedelssubstans som ingår i läkemedlen Lenvima och Kisplyx. Lenvatinib är ett cytostatikum och tillhör gruppen proteinkinashämmare. Indikationerna som läkemedelssubstansen lenvatinib har är: Differentierad sköldkörtelcancer, hepatocellulär cancer och endometriecancer. Dosering bör övervakas och initieras av sjukvård- och hälsopersonal med erfarenhet av cancerläkemedel. Hypertoni och proteinuri är två av de vanligaste biverkningarna som uppkommer under behandling med lenvatinib. Incidensen för sköldkörtelcancer i Sverige var för 10 år sedan konstant runt 350–400 fall varje år, men under det senaste decenniet har denna siffra ökat och är nu 550–600 fall. Årligen diagnostiseras ungefär 500 fall hepatocellulär cancer. Den vanligaste gynekologiska tumörformen i Sverige är endometriecancer och drabbar framför allt äldre kvinnor.    Syftet med detta examensarbete som är en litteraturstudie, var att undersöka läkemedlet Lenvima samt dess toxicitet och biverkningar. Denna substans har ett flertal indikationer för cancer, men har också en brist då läkemedlet bidrar till biverkningar och toxicitet. I detta arbete användes fem vetenskapliga artiklar vilka valdes med hjälp av databasen PubMed. Sökorden som användes var ”lenvatinib”, ”lenvatinib thyroid cancer”, ”lenvatinib hepatocellular carcinoma”, ”lenvatinib molecular” och ”lenvatinib endometrial cancer”. Alla de vetenskapliga artiklarna som har studerats under detta examensarbete påvisar resultat som bevisar att lenvatinib är en potentiell läkemedelssubstans vid indikationerna differentierad sköldkörtelcancer, hepatocellulär cancer och endometriecancer trots biverkningar och toxicitet. En av studierna påvisar att en lägre startdos bör rekommenderas för att minska toxiciteten. Lenvatinib har påvisats sig ha terapeutiska effekter för olika solida tumörer. Lenvatinib i kombination med pembrolizumab gav resultat i studier som gjorde att läkemedelssubstanserna godkändes för behandling vid avancerat endometriecancer.  Om en tidig identifiering av behandlingsrelaterade biverkningar tillämpas under studier leder det till att dosavbrott samt dosminskning och biverkningar kan minska. Food and Drug Administration godkände lenvatinib som förstahandsbehandling för patienter med icke-operabelt hepatocellulär cancer och lenvatinib i kombination med pembrolizumab är en godkänd indikation för avancerad endometriecancer. I samtliga fall skall behandlingen fortsätta så länge det observeras en klinisk nytta eller tills en oacceptabel toxicitet uppstår. / Lenvatinib is the active medical substance in the pharmaceutical drugs Lenvima and Kisplyx. Lenvatinib is an anti-cancer drug belonging to the protein kinase inhibitor group. Indications for the usage of Lenvatinib include differentiated thyroid cancer, hepatic cell carcinoma, and endometrial cancer. Dosage should be monitored and initiated by health care and health professionals with experience in cancer treatment. Hypertension and proteinuria are the most common adverse events from the treatment with lenvatinib. The goal is that >90% of the patients with thyroid cancer should be treated, investigated, and followed up according to the recommendations of the healthcare program. The incidence of thyroid cancer in Sweden was constant at around 350-400 cases each year ten years ago, but the disease has increased to 550-600 cases/year during the last decade. Each year about 500 patients are diagnosed with hepatic cellular carcinoma. In Sweden, the most common form of gynecological tumor is endometrial cancer, which primarily affects older women.   This literature study aimed to investigate the pharmaceutical drug Lenvima, containing the active drug substance lenvantinib. This substance has several indications for cancer treatment but can also contribute to adverse events and toxicity. In this study, five scientific articles from the database PubMed were selected. The keywords used for the search were “Lenvatinib,” “lenvatinib thyroid cancer,” “lenvatinib hepatocellular carcinoma,” “lenvatinib molecular,” and “lenvatinib endometrial cancer.”  All the scientific articles used for this thesis prove that lenvatinib is a potential substance as cytostatic for several indications, despite adverse effects and toxicity. One of the studies shows that a lower starting dose should be recommended to lower the toxicity. Lenvatinib has been shown to have therapeutic effects on different solid tumors. Lenvatinib, in combination with pembrolizumab, showed results in studies that approved them for treatment for advanced endometrial carcinoma.   If an early identification of treatment-related adverse events is applied during the studies, this leads to an interruption and decreased dosage in time to reduce the serious adverse events. Food and Drug Administration approved Lenvatinib as the firsthand treatment for patients with non-operable hepatocellular carcinoma, and lenvatinib, in combination with pembrolizumab, is an approved indication for advanced endometrial cancer. The treatment should continue as long as there is a clinical benefit or until non-acceptable toxicity occurs.

Risks with drug labels used in preparation of medicines in pediatric hospitals Background: Dosing and preparation of medicines can be challenging and risky. Therefore, drug labels are often used by healthcare personnel when preparing medicines for hospitalized patients. There is a lack of information on how the labels should be designed and how much information they should contain. However, the National Board of Health and Welfare has required that all labels need to contain seven attributes. Aim: The purpose of this study was to analyse risks associated with labels used in pediatric care, and to investigate which attributes a standardized drug label should contain to increase patient safety. Methods: A survey was answered by pharmacist from different hospitals in Sweden. In addition, the pharmacists were asked to send pictures of labels. A risk analysis was performed to calculate the risk-level of identified label attributes.  Results: Different systems are in use for labeling when preparing medicines in Swedish hospitals, including commercial and self-developed systems. The study showed that none of the 54 collected labels complied with the National requirements. However, many labels contained additional attributes. This study identified 18 different label attributes that had different impact on patient safety as valued by pharmacists working in pediatric wards, for example barcodes to quickly look up important information. Conclusion: It is important to optimize labels used in hospitals when preparing medicines, particularly in pediatric care where the usage of off-label drugs and medication errors are common. Further studies are needed to understand the best design of labels and to increase patient safety in pediatric care.

Background and objectiveFollowing signs of lacking drug related information for inpatients in the orthopedic care unit of Mälarsjukhuset, Eskilstuna, a clinical pharmacist intervention comprised of bedside reconciliation for newly prescribed drugs prior to discharge combined with information leaflets for home use was enacted by the care unit. The aim of this study was to evauluate this intervention from the patients perspective to identify areas in need of improvement DesignA mixed method approach consisting of a questionnaire based on ”Nationella patientenkäten” and telephone interviews was used. Patients that were included in the intervention and accepted participation in this study were either sent questionnaires through the digital tool Webropol or recieved telephone interviews between w. 4-17 2022. Results from the questionnaire were compiled and analyzed for statistical dispersion while inductive content analysis based in grounded theory was used to analyze the results from the interviews. SettingOrthopedic care ward, Mälarsjukhuset Eskilstuna Main outcome measuresIdentification of key areas in need of improvement or further analysis to optimize the current intervention procedure at the care unit from the patients standpoint. ResultsOut of 40 people who recieved the intervention, 25 participated in the questionnaire and 9 in the interviews. Key themes and categories from the interview analysis combined with the quantitative questionaire data, while generelly positive, pointed toward optimization of the information content and stremlining of the process at the care unit as the two main areas in need of improvement ConclusionsWhile mostly appreciated by the study group, the current intervention procedure requires further optimization to become an effective and fully integrated part of the routines at the orthopedic care unit Note on conflict of interest: The study was financed in whole by Läkemedelscentrum Sörmland which also employs the clinical pharmacists working in the orthopedic care unit.

The aim of this project is to assess the versatility of the Sloppymerase by performing stable transfection in NIH/3T3 cells and decide whether this cell line can be a candidate for further research on the Sloppymerase as a cancer model. The American cancer society predicts 1,806,590 new cancer cases in the US in 2020. To understand and by extension prevent the disease progress of cancer, proper cancer modeling is essential. The Sloppymerase is a 2-subunit fusion polymerase that has been designed by Ola Söderberg group. The Sloppymerase gene is carried by an inducible expression vector and consists of the 5’ to 3’ exonuclease subunit from Polymerase 1 and the translesion synthesis polymerase (TLS) Polymerase η. The Sloppymerase has a low fidelity and can insert mismatching nucleotides which can lead to mutations that eventually can lead to cancer. NIH/3T3 cells were grown on cell culture plates and an antibiotic kill curve was established to determine the optimal concentration of the selection antibiotics. Transfected cells were selected with Geneticin to create a stable cell line and the gene expression of the Sloppymerase was induced with Doxycycline. The RNA was extracted from cell lysate from the induced cells and was thereafter purified followed by RT-q-PCR. The protein expression was examined with Western blotting. Transcription of the Sloppymerase gene was confirmed with RT-q-PCR and stable transfection was thereby verified. No bands were seen in the Western blot and therefore protein expression has not yet been validated. Further studies are needed to examine the theoretical cancerous effects of the Sloppymerase.

No description available.

Background: It is well known that patients' adherence to chronic drug treatment is low and in developed countries it is estimated to be 50 percent. In other European countries, pharmaceutical services are already offered but this is not done in Sweden yet. The pharmaceutical services are aimed at specific patient groups to improve drug utilization and adherence in patients with chronic drug treatment.  Aim: The aim of this study was to investigate whether it was feasible to develop and conduct pharmaceutical counselling through a videoconference call since pharmaceutical services have not been offered through videoconference calls before.Method: Material for the intervention was developed by the researcher. The study was conducted during October and November 2021, customers were recruited from two pharmacies in Uppsala. The intervention was evaluated based on how the pharmacist and customers used the material developed for the pharmaceutical service. Additionally, semi-structured interviews were conducted to evaluate customers experience of the pharmaceutical service  Results: The five customers who participated in the study were satisfied with the experience of the pharmaceutical service and thought the technology worked well. However, customers had different experiences of how useful the material developed for the service was. Conclusion: It was feasible to offer pharmaceutical counselling as a videoconference call. However, the study population was small and had little diversity. Further studies are needed to evaluate the effectiveness of the pharmaceutical service in terms of improved adherence and drug utilization.

Background: Pharmaceuticals are a big part of healthcare expenditures. Advancements such as the sequencing of the human genome and technical methods has led to the development of more advanced drugs. Aim: The aim of this study was to explore the trends in new drug development areas and the costs of drugs in different therapy areas. Method: To do this, data from the Swedish Medical Products Agency, e-Hälsomyndigheten and the 20 biggest pharmaceutical companies regarding new approved drugs during a 20-year period, costs and new chemical entities in late development stage has been analyzed. Results: Each year, between 20 and 60 new drugs are approved. New chemical entities are most prevalent in the ATC-group L, which includes oncology and immunomodulating drugs. Innovation is also seen in group J, antiinfectives. The cost of drugs has increased during the study period, especially for oncology drugs. In the coming years, we can expect the introduction of even more oncology drugs, as mostdrugs in later development phases are expected to be classified in this group. Conclusion: Over the studied period, the most innovative therapeutic group has not changed but rather grown. The cost of drugs has also grown, possibly because of more new drugs introduced but also due to expanded indications and larger patient groups. It is hard to see a future where oncology drugs are not the biggest cost since in the coming years, many of the expected new drugs will fall into the same category.

No description available.

Background: Multi-dose drug dispensing (MDD) is an alternative to assist patients with difficulties in administering and handling their medications. In 2019 the primary care units at Region Gotland reported a high number of discrepancies, regarding patients with MDD discharged from the Hospital of Visby. Due to the high proportion of discrepancies between the patient's medication list in TakeCare and the prescription list of MDD the clinical pharmacists at the hospital began to check all patients marked for discharge in order to discover and prevent eventual discrepancies. Aim: To identify discrepancies between the patient’s medication list and the prescription for MDD when discharged from the Hospital of Visby and investigate whether there has been a decrease since 2019. Method: A quantitative cross-sectional study was performed. Medication lists from each patient’s journal and their prescribing record from the prescription system for MDD were reviewed to identify discrepancies, which then were noted and discussed with the physician in charge. Identified discrepancies were rated into pre-defined categories and compared with data from previous years. A chi-square test was performed to investigate the significant difference of discrepancies between the units. The results from the intervention were summarized into figures and tables. Results: Medication lists from 144 patients with a mean age of 83 years were included. Discrepancies were identified in 34% of the patients and a total of 98 discrepancies were noted, which proves a significant decrease since 2019 when the number of discrepancies was 70%. Totally 79% of the discrepancies were estimated to have occurred during the patient's hospital stay. The highest number of discrepancies were found in the medical department and the difference between all inpatient care departments was significant (p <0.0001). Conclusion: The results indicate a decrease in discrepancies since 2019. Further research is necessary to clarify the reason behind the discrepancies.

Bakgrund: Paracetamol är ett av de mest kända och använda läkemedlet över hela världen för analgetisk och antipyretisk effekt. Paracetamol är ett receptbelagt läkemedel men säljs även receptfritt. Läkemedlet anses vara säkert under graviditet och därför kan den användas så länge den rekommenderade dosen inte överskrids. Hur paracetamol verkar är det inte klarlagt än idag däremot finns det en del hypoteser och teorier Syfte: Syftet med litteraturstudien är att, med hjälp av djurstudier, undersöka hur en tidig exponering av paracetamol ger neurologiska negativa effekter under hjärnutvecklingen.  Metod: Artikelsökning till litteraturstudien gjordes i databasen Pubmed genom sex sökningar där 12 artiklar kunde besvara studiens frågeställning. Sökningen följde exkluktions kriterierna: humana studier, paracetamol har antingen en positiv eller ingen påverkan på hjärnutvecklingen, paracetamols påverkande på framtida sexuella samt reproduktionsbeteende som ses i vuxen ålder. Artiklarna som inkluderades var från och med år 2016–2022, ett undantag gjordes dock vid sökning 5 och 6 där artiklar inkluderades från 2014–2022. Resultat: Paracetamol exponering under tidig hjärnutveckling har visat minskade koncentrationsnivåer av monoaminer, dess metaboliter och aminosyror i olika hjärnregioner. Dessa förändringar har kopplats till neurofysiologisk och kognitiv försämring som försämrad minne och inlärningsförmåga. Även oxidativ stressindex har ökat efter paracetamol exponeringen vilket associerades med inducerad oxidativ stress. Antioxidanterna superoxiddistumas och glutation minskade också vilket ökade de skadliga radikalerna i kroppen vilket ökade den oxidativa stressen. Slutsats: Slutligen kan en slutsats dras om en tidig paracetamol exponering. Läkemedlet har visat neurotoxiska effekter under tidig hjärnutveckling vilket har i in vivo studier visat ökad oxidativ stress, abnormitet i kognitiva funktioner och risk för neuropsykiatriska dysfunktioner. Därmed bör försiktighetsåtgärder och rekommendationerna kring paracetamol användningen under graviditet iakttas och nödvändigt utvärderas av läkare som farmaceuter och läkemedelsverket.