International School of Advanced Studies

Isoflavones and coumestranes are the most important classes of compounds among phytoestrogens; by binding to estrogen receptors, they mimic or modulate the effect on the endogenous receptors. Little information can be found in literature about the presence of isoflavones and coumestrol in the environment, even if it is known that this may have significance, being these substances classified as endocrine disrupting compounds. In this research, we aim to explore the capabilities of the LTQ Orbitrap Discovery hybrid MS in full-scan acquisition mode, with high resolution, to validate an analytical method for the quantification of nine isoflavones (genistein, genistin, glycitein, daidzein, daidzin, (R,S)-equol, biochanin A, formononetin and coumestrol) in wastewater samples. The correlation coefficients of calibration curves of the nine analyzed compounds were in a range of 0.996-0.999; recoveries at two different levels of concentration (0.05 and 0.5 μg/l) were in the range 73-98%, and the limits of detection ranged between 0.0014 and 0.017 μg/l, proving that this method is sensitive enough in comparison with other methods available in literature. This method has been applied for the analysis of 20 wastewater treatment plants in County Cork, Ireland.

The correct administration of oral drugs to patients receiving enteral tube feeding presents a special challenge, as many errors are made at the administering stage (e.g. crushing of dosage forms that should not be crushed). This study was undertaken to evaluate the medication administration errors in patients with enteral nutrition discharged from a geriatric unit of the Italian National Research Centers on Aging (INRCA). Materials and Methods: Five hundred and eighty discharge letters were screened, and 50 (8.6%) related to patients on enteral nutrition were studied with a focus on medication delivery, in order to highlight all medication errors. Results: Eighty-six medication errors were detected. The most common error was "prescription of the wrong formulation" (69.8%) when a formulation suitable for administration by enteral feeding tube was commercially available. Conclusions: Given the large number of errors detected, we consider a multidisciplinary program, including the intervention of a pharmacist, necessary to promote the correct administration of drugs through an enteral feeding tube. This program may consist of training nurses, detection of drug-nutrient interactions, daily ward visits, meetings with the patient and family to provide detailed instructions about drug administration through a feeding tube as reported in the discharge letter, and preparation by the pharmacy of liquid formulations, if not commercially available, suitable for administration through enteral feeding tubes.

Demographic indicators forecast that by 2050, the elderly will account for about one-third of the global population. Geriatric patients require a large number of medicines, and in most cases, these products are administered as solid oral solid dosage forms, as they are by far the most common formulations on the market. However, this population tends to suffer difficulties with swallowing. Caregivers in hospital geriatric units routinely compound in solid oral dosage forms for dysphagic patients by crushing the tablets or opening the capsules to facilitate administration. The manipulation of a tablet or a capsule, if not clearly indicated in the product labeling, is an off-label use of the medicine, and must be supported by documented scientific evidence and requires the patient's informed consent. Compounding of marketed products has been recognized as being responsible for an increased number of adverse events and medical errors. Since extemporaneous compounding is the rule and not the exception in geriatrics departments, the seriousness and scope of issues caused by this daily practice are probably underestimated. In this article, the potential problems associated with the manipulation of authorized solid oral dosage forms are discussed.

Abstract
Background Swallowing difficulties are arising
in an increasing number of patients, especially in
elderly people. When deglutition ability is completely
compromised, enteral administration of a drug via
feeding tubes is used. Licensed pharmacists have to
compound the original solid forms to enable this drug
therapy.
Objectives To evaluate the possibility of compounding
original commercial tablets to produce a liquid
formulation suitable for administering via a feeding tube.
Methods Two liquid formulations containing potassium
canrenoate 5 mg/mL were prepared: a standard
solution obtained by solubilising raw material and an
extemporaneous preparation obtained by dissolving
film-coated 100 mg tablets. Spectrophotometric
determinations (UV range) of the drug established
chemical stability of the analyte up to 60 days.
Samples were tested for microbial growth. Gravimetric
quantifications of liquid formulations were used to check
any weight loss during the different steps before enteral
administration.
Results UV data confirmed the chemical stability of
potassium canrenoate up to 60 days. Samples showed
no microbial growth. A higher weight loss was recorded
in extemporaneous preparations than in the standard
solution (10.7% vs 7.6%) according to the gravimetric
quantification.
Conclusion It is possible to compound the
original tablets into a liquid formulation suitable for
administration via a feeding tube.