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Antipsihotici su lijekovi koji se koriste za liječenje psihijatrijskih poremećaja. Njihovo otkriće 1950-ih godina dovelo je do masovnog otpuštanja bolesnika iz psihijatrijskih ustanova te njihovog povratka u društvo. Pokazalo se međutim da često uzrokuju i nuspojave koje pacijentima smanjuju kvalitetu života, povećavaju mortalitet i morbiditet, te istodobno uzrokuju značajan financijski teret za zdravstvene sustave. Ovo istraživanje objašnjava metaboličku skupinu nuspojava koje se javljaju, a to su povećanje tjelesne težine, inzulinska rezistencija, dislipidemija, kardiovaskularne nuspojave i metabolički sindrom. Daje pregled patofiziologije, epidemiologije i kliničkih obilježja metaboličkih nuspojava antipsihotika. Idealan antipsihotik je onaj koji ima najveći učinak uz najmanji rizik nuspojava. Međutim mehanizam djelovanja antipsihotika je jedan od najsloženijih u medicini općenito. Prije svega zato što djeluju na mozak koji je složene strukture, zatim, zato što djeluju na brojne neurotransmitorske sustave u mozgu, najviše direktnim učinkom na dopaminski, ali i na serotoninski, histaminski, noradrenergički i kolinergički sustav, a indirektnim učinkom na GABA i glutamatni sustav, te složenim mehanizmom na ekspresiju brojnih gena. Istraživanja povezanosti psihotičnih poremećaja i antipsihotika s povećanjem tjelesne težine, metaboličkim sindromom, dijabetesom, dislipidemijom i povišenjem krvnog tlaka zaključuju da postoji potreba za aktivnim, rutinskim pregledom zdravlja pacijenata koji su na toj terapiji. Prvi prioritet trebao bi biti racionalan izbor kada i što propisati. Od drugog je značaja intervencija u smislu promjene životnog stila radi sprječavanja povećanja tjelesne težine. Danas postoje različite upute i smjernice za praćenje metaboličkih poremećaja koje poboljšavaju kvalitetu skrbi o pacijentima i dodatno informiraju u kojem smjeru strategiju intervencije provoditi. Antipsihotici bi se trebali propisivati samo ako je jasna njihova prednost i nema sigurnije alternative. Odabir antipsihotika se treba temeljiti na kliničkoj situaciji pacijenta te se treba koristiti najmanja učinkovita doza koja je kod svakog pacijenta drugačija. Za one lijekove za koje se pokažu neželjene reakcije trebalo bi prvo sniziti dozu, zatim zamijeniti za lijek sa manje izraženim nuspojavama, predložiti nefarmakološke mjere kao što su dijeta i tjelovježba, ili konkomitantnom terapijom liječiti nuspojave koje su se pojavile. Uloga ljekarnika je bitna u prepoznavanju i sprječavanju nuspojava. Glavne ljekarničke intervencije kod tih osoba su njihovo rano prepoznavanje, pravilno savjetovanje pacijenata o promjenama životnih navika i praćenje stanja bolesnika. Edukacija pacijenata i uska suradnja sa zdravstvenim djelatnicima mogu smanjiti smrtnost i poboljšati njihovu kvalitetu života. Zaključno, metaboličke nuspojave antipsihotika su značajan klinički problem, ali mogle bi se spriječiti u mnogim slučajevima edukacijom, redovitim pregledima i odgovarajućim intervencijama. Antipsychotics are drugs used to treat psychiatric disorders. Their discovery in the 1950's led to the mass discharge of patients from psychiatric institutions and their return to society. However, they have also been shown to often cause side effects that reduce patients' quality of life, increase mortality and morbidity, and at the same time cause a significant financial burden for health organisations. This study explains the metabolic group of side effects that are known to occur: weight gain, insulin resistance, dyslipidemia, cardiovascular side effects and metabolic syndrome. The study provides an overview of the pathophysiology, epidemiology, and clinical features of the metabolic side effects of antipsychotics. The ideal antipsychotic is the one that is most effective with the lowest risk of side effects. However, the mechanism of action of antipsychotics is one of the most complex mechanisms in medicine in general. First of all, because their therapeutic place of action is the brain which is a complex structure. Secondly, because they act on many neurotransmitter systems in the brain, mostly by direct effect on the dopamine system, but also on the serotonin, histamine, noradrenergic and cholinergic systems, indirectly on the GABA and glutamate systems, and by using a complex mechanism they also affect the expression of numerous genes. Studies of the association of psychotic disorders and antipsychotics with weight gain, metabolic syndrome, diabetes, dyslipidemia, and elevated blood pressure conclude that there is a need for an active, routine health review of patients on that therapy. The priority should be a rational choice of when and what to prescribe. Of second importance is intervention in terms of lifestyle changes to prevent weight gain. Today, there are various guidelines for monitoring metabolic disorders that improve the quality of patient care and further inform in which direction to implement the intervention strategy. Antipsychotics should only be prescribed if their benefits are clear and there is no safer alternative. The choice of antipsychotics should be based on the patient's clinical situation and the lowest effective dose should be used, which is different for each patient. For those drugs that show side effects, the dose should first be reduced, then replaced with a drug with less severe side effects. Non-pharmacological measures should be suggested such as diet and exercise and lastly, side effects should be treated with concomitant therapy. The role of the pharmacist is essential for recognising and preventing side effects. The main pharmacist's interventions are early recognition, proper counseling of patients about changes in life habits and monitoring of the patient's condition. Patient education and close collaboration with healthcare professionals can reduce mortality and improve patients’ quality of life. In conclusion, metabolic side effects of antipsychotics are a significant clinical problem, but in many cases they could be prevented by education, regular checkups, and appropriate interventions.

Pospartalna depresija jedan je od najčešćih psihijatrijskih poremećaja koji se javlja unutar prvih par tjedana do prvih 12 mjeseci nakon poroda. Klinička slika jednaka je onoj velike depresivne epizode, a prilikom dijagnoze važno je razlikovati od postpartalne tuge i psihoze. Etiologija je multifaktorijalna, pri čemu se smatra da, za sada, najveći utjecaj imaju fluktuacija hormona u kombinaciji sa stresom ili anamnezom mentalnih bolesti u obitelji. Za probir se koristi Edinburška ocjenska ljestvica za postnatalnu depresiju koja je dovoljno osjetljiva i specifična, a predlaže se njeno korištenje barem jednom tijekom trudnoće i barem jednom u postpartalnom razdoblju. Liječenje postporođajne depresije ovisi o čimbenicima rizika koji su doveli do njezinog razvoja, težini simptoma i preferencijama bolesnika. Kod blage postpartalne depresije preporučaju se psihosocijalne intervencije, od kojih se „peer support“ pokazala najučinkovitijom. Kod umjerene postporođajne depresije kod koje ne pomažu psihosocijalne metode, koristi se psihoterapija u obliku kognitivno-bihevioralne (i online oblik), interpersonalne i psihodinamske terapije. Kod teških oblika postpartalne depresije indicirana je farmakološka terapija, unutar koje su prvi izbor selektivni inhibitori ponovne pohrane serotonina. Danas je na tržištu dostupan i breksanolon, specifičan lijek za postpartalnu depresiju koji se sastoji od endogenog neurosteroida alopregnanolona i sulfobutileter-β-ciklodekstrina. Glavni su mu nedostatak način i vrijeme primjene te REMS protokol kojeg se treba pridržavati zbog ozbiljnih nuspojava. Zbog toga, u fazama istraživanja nalaze se novi potencijalni lijekovi čija je najveća prednost pred breksanolonom, barem za sada, oralna primjena. Za posebno teške slučajeve postporođajne depresije može se razmotriti primjena elektrokonvulzivne terapije. Na kraju, u učinkovitom liječenju postporođajne depresije važnu ulogu imaju probir, profilaksa, dijagnostika i odabir prave terapije te proces destigmatizacije u kojem ljekarnici imaju značajan doprinos. Postpartum depression is one of the most common psychiatric disorders occurring within the first few weeks to the first 12 months after delivery. The clinical picture is the same as that of a major depressive episode, and when stating a diagnosis it is important to distinguish between baby blues and psychosis. The etiology is multifactorial, and it is believed that hormone fluctuations in combination with stress or a history of mental illness in the family have the greatest impact. The screening uses the Edinburgh Rating Scale for Postnatal Depression, which is sufficiently sensitive and specific, and its use is suggested at least once during pregnancy and at least once in the postpartum period. Treatment of postpartum depression depends on the risk factors that led to its development, the severity of symptoms and patient preferences. In mild postpartum depression, psychosocial interventions are recommended, of which "peer support" has proven to be the most effective. In case of moderate postpartum depression when psychosocial methods do not work, psychotherapy in the form of cognitive-behavioral (online as well), interpersonal and psychodynamic therapy is used. In severe forms of postpartum depression, pharmacological therapy is indicated, within which selective serotonin reuptake inhibitors are the first choice. Brexanolone, a specific drug for postpartum depression consisting of the endogenous neurosteroid allopregnanolone and sulfobutylether-β-cyclodextrin, is also available on the market today. Its main disadvantages are the method and time of application and the REMS protocol that should be followed due to serious side effects. Therefore, new potential drugs are emerging in the research phases whose greatest advantage over brexanolone, at least for now, is oral administration. For particularly severe cases of postpartum depression, electroconvulsive therapy may be considered. Finally, screening, prophylaxis, diagnosis and selection of the right therapy as well as the destigmatization process, in which pharmacists make a significant contribution, play an important role in the effective treatment of postpartum depression.

Cilj istraživanja: Cilj ovog rada je utvrditi učinkovitost, prednosti i nedostatke korištenja antipsihotika u politerapiji u odnosu na monoterapiju te se osvrnuti na važnost uloge koju ljekarnici, kao najdostupniji zdravstveni djelatnici, mogu imati u liječenju shizofrenije i primjeni antipsihotika. Ispitanici i metode: U tu svrhu napravljen je sustavni i retrospektivni pregled znanstvene i stručne literature, pretražene su trenutno važeće terapijske smjernice, publikacije stručnih udruga i institucija, baza lijekova Agencije za lijekove i medicinske proizvode te drugi raspoloživi izvori. Rezultati: Identificirane su najčešće kombinacije antipsihotika i podijeljene su na one koje uključuju klozapin i one bez njega. Istaknute su prednosti i nedostatci svake pojedine kombinacije. Naglašena je važnost uključivanja javnih ljekarnika Zaključak: Politerapija je jedino ispravno rješenje uslijed više neadekvatnih terapijskih pokušaja monoterapijom, ali se u kliničkoj praksi ipak ona uključuje puno prije, usprkos preporukama svih važećih smjernica. Zbog premalo kvalitetnih, randomiziranih studija prednost ipak treba dati monoterapiji, a uslijed kombiniranja antipsihotika treba pažljivo pratiti pacijenta kako bi prednosti kombinacije nadmašili rizik dodatnih nuspojava i povećanog troška liječenja. Javni ljekarnici mogu imati veliku ulogu u poboljšanju adherencije, a upravo neadherencija predstavlja jedan od najčešćih problema u liječenju shizofrenije. Uloga javnih ljekarnika u tome je trenutno premalo iskorištena te su nužne dodatne edukacije i angažman struke kako bi se to promijenilo na koristi preopterećenog zdravstvenog sustava. Aim: The aim of this paper is to determine the efficacy, advantages, and disadvantages of using antipsychotics in polytherapy in relation to monotherapy and to look at the importance of the role pharmacists, as the most accessible healthcare professionals, can play in treating schizophrenia and antipsychotics. Subjects and method: For the purposes of this research, a systematic and retrospective review of scientific and professional literature was made. Currently valid therapeutic guidelines, publications of professional associations and institutions, the drug database of the Agency for Medicinal Products and Medical Devices and other available sources were researched. Results: The most common combinations of antipsychotics were identified and separated into those that include clozapine and those that do not. The advantages and disadvantages of each combination were highlighted. The importance of involving public pharmacists was emphasized. Conclusion: Polytherapy is the only viable solution if all other therapy attempts have consistently proven inadequate, however, in clinical practice polytherapy is still introduced much earlier despite the recommendations of all leading guidelines. Due to insufficient quality of randomized studies, preference should be given to monotherapy treatment. If preference is in fact given to polytherapy, the patient should be closely monitored so that the benefits of the combination outweigh the risk of additional side effects and increased treatment costs. Public pharmacists can play a major role in improving adherence, and it is exactly non-adherence that is one of the most common problems in the treatment of schizophrenia. Currently, the role of public pharmacists is underutilized and additional training and engagement of the profession is needed to make changes that will benefit an overburdened health system.

Cilj istraživanja: Cilj ovog rada je utvrditi podnošljivost i sigurnost lijekova za liječenje Alzheimerove demencije, posebice iz razloga što je ova terapija uglavnom rezervirana za stariju populaciju, odnosno rizičnu skupinu pacijenata često povezanu s mutimorbiditetima i polifarmacijom, te se osvrnuti na važnost uloge koju ljekarnici, kao najdostupniji zdravstveni djelatnici, mogu imati u liječenju Alzheimerove demencije i primjeni antidementiva. Ispitanici i metode: U tu svrhu napravljen je sustavni i retrospektivni pregled znanstvene i stručne literature te su pretražene trenutno važeće terapijske smjernice, publikacije stručnih udruga i institucija, baza lijekova Agencije za lijekove i medicinske proizvode te drugi raspoloživi izvori. Rezultati: Najčešće nuspojave inhibitora acetilkolinesteraze su gastrointestinalne prirode te uključuju mučninu, povraćanje, gubitak težine i proljev. Rivastigmin je pokazao najveću učestalost nuspojava među njima, dok je donepezil povezan s najnižom stopom nuspojava. Uglavnom se javljaju na početku terapije te su blage i često prolazne. Intenzivnije nuspojave javljaju se primjenom većih doza te su često povezane s neispravnom inicijalnom titracijom lijekova. Nuspojave memantina su relativno rijetke te se dosta dobro podnose, a najčešće uključuju konstipaciju, vrtoglavicu, glavobolju i zbunjenost. Pokazalo se da su i one blagog i prolaznog karaktera. Zaključak: Identifikacijom najčešćih nuspojava svakog od odobrenih lijekova za liječenje Alzheimerove demencije, uključujući donepezil, rivastigmin i memantin, pokazalo se da su nuspojave ovih lijekova relativno rijetke te blagog i prolaznog karaktera pa možemo zaključiti da se antidementivi općenito dobro podnose. Poboljšanje kvalitete života bolesnika oboljelih od Alzheimerove demencije i njihovih njegovatelja je od iznimne važnosti, stoga ljekarnici, kao najdostupniji zdravstveni djelatnici koji su često u kontaktu s ovim pacijentima i/ili njihovim njegovateljima, moraju imati adekvatna znanja da mogu prepoznati postojeće i potencijalne terapijske probleme, uključujući i nuspojave antidementiva, te svojom intervencijom omogućiti sigurnu i učinkovitu farmakoterapiju. Aim: The aim of this paper is to determine the tolerability and safety of treatment for Alzheimer's dementia, especially because this therapy is mainly reserved for the elderly population, ie the risk group of patients often associated with multimorbidities and polypharmacy, and to look at the importance of the role that pharmacists, as the most accessible health professionals, can play in the treatment of Alzheimer’s dementia and the use of antidementia drugs. Subjects and method: For the purposes of this research, a systematic and retrospective review of scientific and professional literature was made and the currently valid therapeutic guidelines, publications of professional associations and institutions, the drug database of the Agency for Medicinal Products and Medical Devices and other available sources were searched. Results: The most common side effects of acetylcholinesterase inhibitors are gastrointestinal in nature and include nausea, vomiting, weight loss and diarrhea. Rivastigmine showed the highest frequency of side effects among them, while donepezil was associated with the lowest rate of side effects. They usually occur at the beginning of therapy and are mild and often transient. More intense side effects occur at higher doses and are often associated with incorrect initial drug titration. Side effects of memantine are relatively rare and well tolerated, and most commonly include constipation, dizziness, headache, and confusion. It turns out that they are also mild and transient. Conclusion: The identification of the most common side effects of each of the approved drugs for the treatment of Alzheimer's dementia, including donepezil, rivastigmine and memantine, showed that the side effects of these drugs are relatively rare and mild and transient, so we can conclude that antidementia drugs are generally well tolerated. Improving the quality of life of patients with Alzheimer's dementia and their carers is extremely important, so pharmacists, as the most accessible health professionals who are often in contact with these patients and / or their carers, must have adequate knowledge to identify existing and potential therapeutic problems, including side effects of antidementia drugs, and make interventions to provide safe and effective pharmacotherapy.

Cilj istraživanja: Pretraživanjem dostupne literature moguće je pronaći stotine djelatnih tvari koje su pokazale učinkovitost u in vitro uvjetima, ali samo mali broj se pokazao djelotvornim u kliničkim in vivo ispitivanjima i u kliničkoj praksi. Cilj ovog istraživanja je pregledno opisati liječenje hiperpigmentacija, raspraviti prednosti i nedostatke djelatnih tvari koje se najčešće propisuju, s posebnim naglaskom na mogućnost izrade magistralnog pripravka i pružanje individualne terapije pacijentu. Odabir ispravnog lijeka u odgovarajućoj formulaciji i koncentraciji te edukacija pacijenta su ključni za osiguravanje djelotvornosti terapije i za adherenciju pacijenta. Metode istraživanja: Pretražena je literatura vezana za hiperpigmentacije i njihovo liječenje koristeći baze podataka PubMed, Wiley, Medscape, Cochrane library, Europsku farmakopeju i udžbenike iz područja dermatologije Fitzpatrick´s dermatology i European Handbook of Dermatological Treatments. Ključni pojmovi za pretraživanje literature su uključivali individualna imena lijekova i sljedeće pojmove na engleskom jeziku: hyperpigmentation, treatment, pharmacist, compounding, formulation . Izdvojeni su najvažniji rezultati i zaključci koji su prikazani u ovom radu. Rezultati: Topikalnu terapiju ograničuje njezina učinkovitost i ispravna aplikacija lijeka, kao i visok stupanj recidiva nakon prekida terapije. Hidrokinon i kombinirana terapija su učinkoviti, ali nose rizik od egzogene okronoze i hipopigmentacije. Prirodne djelatne tvari imaju niži rizik od nuspojava, ali nedostaje još istraživanja koja bi dokazala njihovu učinkovitost i definirala optimalne formulacije i primjerene koncentracije tih novih spojeva. Fizikalno-kemijski postupci su povezani s potencijalnim komplikacijama i sami mogu dovesti do postupalnih hiperpigmentacija. Svakodnevna fotozaštita, kao i edukacija pacijenata, su ključ uspješne terapije. Zaključak: Za optimalne rezultate treba istovremeno koristiti više lijekova koji djeluju u različitim fazama melanogeneze. Pacijente treba savjetovati o njihovoj terapiji i važnosti dugoročne ustrajnosti u terapiji hiperpigmentacija. Ljekarnici mogu dati značajni doprinos liječenju pacijenata s hiperpigmentacijama kroz edukaciju i savjetovanje pacijenata i izradu magistralnih pripravaka. Objectives: A cursory review of available literature will reveal hundreds of active substances that work on various aspects of melanogenesis in in vitro conditions, but only a small number of them has shown efficacy in in vivo experiments and clinical practice. The purpose of this research is to provide a comprehensive overview of hyperpigmentation treatments, discuss advantages and disadvantages of commonly prescribed drugs, with a special emphasis on compounding and on adjusting therapy to an individual’s needs. Choosing the correct medicine in the appropriate formulation and concentration, as well as patient education are key to ensuring effective treatment and patient adherence. Methods: A review of the literature surrounding hyperpigmentation management was completed using PubMed, Wiley, Medscape, Cochrane library, European pharmacopeia as well as Fitzpatrick’s dermatology and European Handbook of Dermatological Treatments. Scientific literature was searched using key words including hyperpigmentation treatment, pharmacist, compounding, formulation and individual drug names. Relevant findings were outlined and presented in this paper. Results: Topical treatments are limited by their efficacy and proper application, as well as high rates of recurrence after therapy discontinuation. Hydroquinone and triple combination therapy are effective but carry risks for ochronosis and hypopigmentation. Natural compounds are associated with low risk for adverse events, but more research is needed to determine the efficacy, optimal formulations, and appropriate concentrations of novel treatments. Procedural interventions are associated with potential complications and may cause postinflammatory hyperpigmentation themselves. Daily photoprotection and patient education is key to ensuring a successful therapy. Conclusion: Drugs that work at different steps of melanogenesis should be used for achieving optimal results. Patients need to be counseled about their therapy and the importance of long term adherence to the treatment. Pharmacists can make a valuable contribution to the care of patients with hyperpigmentations through patient education, counseling and compounding.

Antimikrobna rezistencija sve je veći problem kojim se trebaju baviti svi uključeni u zdravstveni sustav pa tako i ljekarnici. Zadnjih se godina objavljuje sve više radova na temu antimikrobne rezistencije i programa upravljanja antimikrobnom terapijom. Cilj istraživanja: pregled postojećih dostupnih programa upravljanja antimikrobnom terapijom, ocjenjivanje uloge ljekarnika te ukazivanje na mogućnosti koje oni pružaju ili bi mogli pružati u unaprjeđenju zdravstvene zaštite u smislu optimiziranja uporabe antibiotika. Materijal i metode: pri izradi je napravljen pregled znanstvene i stručne literature, publikacija stručnih udruga i institucija te drugih raspoloživih izvora za ključne riječi: antimikrobna rezistencija, rezistencija na antibiotike, smjernice, uloga ljekarnika, antimicrobial stewardship, antimicrobial resistance, guidelines, pharmacist role. Rezultati: Ljekarnik može sudjelovati u programima upravljanja antimikrobnom terapijom na svim razinama zdravstvene zaštite i važan je član tima u brojnim intervencijama. Tako u bolničkoj sredini, osim što brine o pravovremenoj nabavi antibiotika, može sudjelovati u izradi smjernica i praćenju pridržavanja istih, praćenju interakcija, određivanju doza te sudjelovati u izradi računalnih intervencija i njihovu praćenju. U javnoj ljekarni savjetuje bolesnika o pravilnom uzimanju propisanih antimikrobnih lijekova kao i o samoliječenju virusnih infekcija. Ljekarnik može i sudjelovati u javnozdravstvenim kampanjama usmjerenima na racionalnu uporabu antibiotika. Zaključak: Uloga ljekarnika nije jednaka u svim zemljama. Ona ovisi o obrazovnom sustavu, ovlastima koje ljekarnik ima te o mjestu rada ljekarnika. Značajnija uloga ljekarnika u programima upravljanja antimikrobnom terapijom velikim se dijelom veže uz visokorazvijene zemlje. Ljekarnici kao najdostupniji zdravstveni djelatnici imaju potencijal preuzimanja mnogo veće i značajnije uloge u programima upravljanja antimikrobnom terapijom, a u Hrvatskoj i na svim razinama zdravstvenoga sustava. Aktivnosti ljekarnika u programima upravljanja antimikrobnom terapijom u Republici Hrvatskoj predviđene su i Nacionalnim programom za kontrolu otpornosti bakterija, što je važan preduvjet za aktivnije sudjelovanje ljekarnika u programima upravljanja antimikrobnom terapijom. Zato je važno dobro i kontinuirano obrazovanje koje bi se u tom području trebalo provoditi kroz preddiplomsku, diplomsku i poslijediplomsku nastavu, u programima specijalizacija te u programima trajnog usavršavanja ljekarnika. Antimicrobial resistance is a growing problem that needs to be addressed by everyone involved in the health care system, including pharmacists. In recent years, more and more papers have been published on antimicrobial resistance and antimicrobial stewardship (AS) programs. The aim of the research: Reviewing the existing available AS programs, assessing the role of pharmacists and determining the opportunities they provide or could provide in improving health care in terms of optimizing the use of antibiotics. Material and methods: During the course of this research, a review of scientific and professional literature, texts published by professional associations and institutions, as well as other available resources has been performed for the following keywords: antimikrobna rezistencija, rezistencija na antibiotike, smjernice, uloga ljekarnika, antimicrobial stewardship, antimicrobial resistance, guidelines, pharmacist role. Results: Pharmacists can participate in antimicrobial stewardship programs at all levels of health care and are important team members in numerous interventions. For example, in the hospital environment, in addition to taking care of the timely procurement of antibiotics, they can participate in the development of guidelines and monitoring the compliance therewith, monitoring the interactions, determining the doses, developing computer interventions, their monitoring, etc. In public pharmacies, they advise patients on the proper use of prescribed antimicrobial drugs as well as on the self-treatment of viral infections. Pharmacists can also participate in public health campaigns aimed at the rational use of antibiotics. Conclusion: The role of pharmacists is not the same in every country. It depends on the education system, and the powers that the pharmacists have, as well as on the pharmacist’s place of work. A more significant role of pharmacists in AS programs is largely related to highly developed countries. Pharmacists, as the most accessible health care professionals, have the potential for a much greater and more significant role in antimicrobial stewardship in Croatia at all levels of the health care system. The activities of pharmacists in AS programs in the Republic of Croatia are also defined by the National Program for the Control of Bacterial Resistance, which is an important precondition for a more active participation of pharmacists in antimicrobial stewardship programs. This is why quality and continuous education in this field should be organised through undergraduate and postgraduate teaching, in specialization programs as well as in continuing education programs for pharmacists.

Cytotoxic drugs (antineoplastic drugs) are highly active drugs used in the chemotherapy of malignant diseases that cause numerous and serious side effects during treatment. As the incidence of tumor disease increases, the use of these drugs increases, especially in developed countries. Croatia belongs to the countries with a medium incidence, but high mortality from cancer, and it records a trend of increasing consumption of these drugs. Although cytotoxic/antineoplastic drugs ·are used at lower doses compared to other drugs, due to their nonselective action; they can cause various mutagenic, genotoxic and reproductive damages. Studies have shown a risk of diseases developing due to occupational exposure to cytotoxic/antineoplastic drugs and during the research, especially under conditions of inadequate protection, but also with the presence of cytotoxic drugs in various environmental systems, with concentrations varying up to 2.12 x 10-4 mg/L in different types of water. The toxic effect has been reported for aquatic organisms, and the question of the harmful effect on the entire ecosystem and ultimately on humans is being raised. The major sources of cytotoxic/antineoplastic drugs in the environment come from healthcare institutions, hospitals, industry, houshold, but also research. The patient who is the center of health professionals' care is also the holder of environmental responsibility since he/she contributes to the waste that ends up in the environment, either through excretion or through the improper disposal of such waste. Pharmacists are important health care stakeholders who can make a significant contribution in improving this problem because, based on their education and activities, they can participate in public health campaigns, change the public's awareness, educate the general population and the way they relate to the problem in each of these environmental cytotoxic/antineoplastic drugs sources. They can also foster green and sustainable pharmacy, innovation and the application of in silico methods, all together to preserve health and the environment.

Bol predstavlja sveobuhvatno, multidimenzionalno i cjelovito pacijentovo iskustvo prilikom čega se individualni doživljaj boli može značajno razlikovati u pojedinaca. Prilikom svakog savjetovanja o boli s pacijentima potrebno je imati na umu utjecaj ne samo direktnih bioloških čimbenika, već i kulturoloških i društvenih čimbenika koji mogu oblikovati pacijentov doživljaj boli. U svrhu razlučivanja pojedinih razloga traženja analgezije od strane pacijenta, ljekarnik bi trebao posjedovati određene komunikacijske vještine koje uključuju otvorenost, aktivno slušanje i jasno izražavanje. Svaki pojedini slučaj savjetovanja o boli potrebno je vrednovati je individualno prilikom čega je potrebno izbjegavati bilo kakve etničke, društvene ili religiozne stereotipe koji bi mogli utjecati na vrstu savjeta koje ljekarnik pruža pacijentu. Pain represents a comprehensive, multidimensional and holistic experience in which the pain intensity can vary among different individuals. During every patient consultation regarding pain it is necessary to take into account not just the direct biological factors, but also culturological and social factors which can all shape the patient's experience of pain. In purpose of discerning the potential motivations behind analgesia requests made by patients, the pharmacist should possess and be able to use certain communication skills which include openness, active listening and speaking plainly. Each individual case should be evaluated separately during which the pharmacist should avoid any ethnical, social or religious stereotypes which could influence the type of medical advice given to the patient.

Cilj ovog rada je utvrditi stavove ljekarnika o sigurnosti i učinkovitosti biljnih pripravaka i izglede za njihovo racionalno izdavanje i uporabu. Među općom populacijom prevladava stav o biljnim pripravcima kao prirodnima i potpuno sigurnima, što za posljedicu ima povećan rast nekontroliranog samoliječenja koje nije popraćeno prijavljivanjem uporabe biljnih pripravaka ni liječniku ni ljekarniku. Ljekarnici imaju ključnu ulogu u sprječavanju navedenih događaja provođenjem ljekarničke skrbi i savjetovanja te racionalne fitoterapije. S ciljem utvrđivanja ljekarnikovih stavova o sigurnosti, učinkovitosti i racionalnoj uporabi biljnih pripravaka, provedeno je anketno istraživanje koje se sastojalo od 4 opće i 19 specifičnih tvrdnji koje odražavaju mišljenja ljekarnika o navedenoj temi. Anketirano je 50 ljekarnica na području grada Zagreba tijekom ožujka 2019. godine. Istraživanjem je utvrđeno da ispitanice imaju pozitivan stav o biljnim pripravcima, točnije o njihovoj sigurnosti, učinkovitosti i zdravstvenom potencijalu te da većina njih upotrebljava pripravke i u vlastite svrhe. Također, ljekarnice su pokazale i očekivanu razinu svijesti o mogućim nuspojavama biljnih pripravaka, ali i mogućim interakcijama u koje oni mogu stupiti prilikom istovremene uporabe s drugim biljnim pripravkom ili lijekom. Osim toga, izrazile su i određenu bojazan po pitanju kvalitete biljnih pripravaka, pogotovo u usporedbi s kvalitetom sintetskih lijekova. U skladu s navedenim, ispitanice smatraju kako bi biljni pripravci trebali prolaziti više ispitivanja prije stavljanja na tržište. Ohrabrujući su podaci koji pokazuju da gotovo sve ispitanice redovito savjetuju pacijente o pravilnoj i sigurnoj uporabi biljnih pripravaka i prikupljaju medikacijsku povijest koja uključuje i lijekove i biljne pripravke. Isto tako, gotovo sve ispitanice izjavile su da redovito upozoravaju pacijente koje pripravke i/ili lijekove ne smiju koristiti istovremeno s određenim biljnim pripravkom zbog mogućih interakcija. Važan je podatak da je velika većina ispitanica zainteresirana za dodatno obrazovanje koje pokriva temu biljnih pripravaka. Dakle, ispitane ljekarnice izrazile su želju za proširenjem znanja i kompetencija vezanih uz ovu temu kako bi pružile što kvalitetniju skrb pacijentima. Naime, ljekarnikova uloga od presudne je važnosti da bi biljni pripravak bio pravilno indiciran, siguran i učinkovit, u pravilnoj dozi i odgovarajućem periodu uporabe. Iz svega navedenog može se zaključiti kako je tema biljnih pripravaka, čija popularnost kontinuirano raste, sastavni i neizostavni dio korpusa znanja ljekarnika. The aim of this paper is to determine the pharmacists' views on the safety and efficacy of herbal preparations and the prospects for their rational issuance and use. Among the general population prevails the attitude of herbal preparations as natural and completely safe, resulting in increased growth of uncontrollable selftreatment which is not accompanied by reporting the use of herbal preparations to either a doctor or a pharmacist. Pharmacists play a key role in preventing these events through pharmacy care and counseling and rational phytotherapy. In order to determine the pharmacist's views on the safety, efficacy and rational use of herbal preparations, a survey was conducted that included 4 general and 19 specific claims that reflect the opinions of the pharmacist on the subject. There were 50 pharmacists surveyed in the city of Zagreb during March 2019. The study found that respondents had a positive attitude on herbal preparations, more specifically their safety, efficacy and health potential, and that most of them use the preparations for their own purposes. Also, pharmacists have shown an expected level of awareness of possible side effects of herbal preparations, but also the possible interactions they may have with simultaneous use with other herbal preparations or medicines. In addition, they expressed a certain perplexity regarding the quality of herbal preparations, especially in comparison with the quality of synthetic drugs. In accordance with the above, respondents believe that herbal preparations should undergo multiple tests before being placed on the market. It is encouraging to show that almost all pharmacists regularly advise patients on the correct and safe use of herbal preparations and collect a medical history that includes both medicines and herbal preparations. Similarly, almost all respondents stated that they regularly warn patients that preparations and / or medicines should not be used at the same time with certain herbal preparations due to possible interactions. It is important to note that the vast majority of respondents are interested in additional education covering the theme of herbal preparations. So, investigated pharmacists have expressed the desire to expand knowledge and competences related to this topic in order to provide quality care to patients. Namely, the pharmacist's role is of crucial importance for the herbal preparation to be properly indicated, safe and effective, at a proper dose and for an appropriate period of use. From all of the above it can be concluded that the theme of herbal preparations, whose popularity is constantly growing, is an integral and indispensable part of the corpus of knowledge of a pharmacist.

Primjena lijekova u trudnoći podrazumijeva procjenu rizika i koristi za majku i dijete. Izbjegavanje lijekova može ugroziti oboje. S druge strane, nepotrebna primjena lijekova tijekom trudnoće predstavlja mogući rizik kod embrionalnog odnosno fetalnog razvoja. Neprimjereno korištenje lijekova bez nadzora zdravstvenog stručnjaka može povisiti rizik od nepovoljnog ishoda trudnoće. Prikladan savjet zdravstvenog djelatnika kod korištenja bezreceptnih lijekova i dodataka prehrani, u ovom slučaju ljekarnika, može značajno utjecati na pozitivan ishod liječenja i sprečavanje mogućih zdravstvenih rizika za majku i dijete. Cilj ovog rada je ispitati prevalenciju korištenja bezreceptnih lijekova i dodataka prehrani u trudnoći te procijeniti stavove, znanja i informiranost trudnica o korištenju istih. Ispitivanje je provedeno pomoću anonimnog anketnog upitnika na uzorku od 80 trudnica. Rezultati ovog istraživanja pokazuju da se prije trudnoće samoliječilo 31,3 % ispitanica, a tijekom trudnoće došlo je do porasta na 36,3 %. Bezreceptni lijekovi koji su najčešće bili korišteni su paracetamol (kod 40 % ispitanica), topikalno klotrimazol (12,5 %), ibuprofen (7,5 %) i antacidi (5 %). Trudnice su ih koristile najviše protiv glavobolje, gljivičnih infekcija i žgaravice. Preporuke i savjete najčešće su tražile od ginekologa i ljekarnika, a vrlo rijetko na društvenim mrežama i internetskim forumima. Prenatalne formule u obliku dodatka prehrani koristio je velik broj trudnica, njih 77,5 %. Ostale dodatke prehrani, najviše magnezij, željezo i vitamin C, koristilo je 35 % ispitanica. Biljne pripravke koristio je mali broj ispitanica, njih 12,5 % budući da o sigurnosti njihove primjene imaju najmanje informacija. Istraživanje može potvrditi da se percepcija rizika od korištenja lijekova tijekom trudnoće mijenja. 42,5 % ispitanica ne slaže se s tvrdnjom da lijekove tijekom trudnoće treba potpuno izbjegavati, a njih 69 % smatra da je bolje za plod da koriste lijekove i ozdrave nego ne liječe bolest. 92 % ispitanica tvrdi da se valja prije korištenja biljnih pripravaka posavjetovati s liječnikom ili ljekarnikom. S obzirom na ukazano povjerenje te volju trudnica za dodatnim edukacijama, ljekarnici trebaju savjetovanju o samoliječenju tijekom trudnoće pristupiti s više samopouzdanja i sigurnosti. The use od medication during pregnancy implies risk and benefit assessment for both baby and the mother. Avoidance of medication use can put both to risk. On the other hand, unnecessary overuse of medication during pregnancy poses a potential embrio/fetal development risk. Inappropriate use of medication without supervision of a health care professional may increase the risk of an adverse pregnancy outcome. Suitable counseling with the health care professional (a pharamacist) about the OTC (Over The Counter, nonprescription drug) and deitary supplements's use may increase the chances of positive outcomes of medical treatments and prevent potential maternal and fetal risks. The aim of this study is to evaluate the prevalence of nonprescription drug and dietery supplements use during pregnancy, aswell as to evaluate women's beliefs and knowledge about it. Data for this study was collected using an anonymous questionnaire with 80 pregnant women. The results of this study show that 31.3 % of the subjects used self-medication before pregnancy, and during pregnancy the number increased to 36.3 %. The most commonly used OTC drugs were paracetamol (40 % of subjects), topical clotrimazole (12.5 %), ibuprofen (7.5 %) and antacids (5 %). Pregnant women used them mostly against headaches, fungal infections and heartburn. Recommendations and advice are often given by gynecologists and pharmacists, and very rarely on social networks and online forums. Prenatal formulas in the form of dietary supplements were used by a large number of pregnant women, 77.5 % of them. Other dietary supplements, mostly magnesium, iron and vitamin C, were used by 35 % of respondents. Herbal preparations were used by a small number of respondents, 12.5 %, since they have the least information on the safety of their use. The study could confirm that risk perception of drug use during pregnancy is changing. 42.5 % of respondents disagree with the claim that drugs during pregnancy should be completely avoided, and 69 % think it is better for the unborn child to use drugs and get well than not to treat the illness. 92 % of respondents claim that it is advisable to consult a physician or pharmacist before using herbal preparations. With regard to the trust shown and given, and the willingness of pregnant women to be educated on selfmedication, pharmacists need to approach counseling during pregnancy with more confidence.

Adherencija prema propisanoj terapiji čimbenik je koji bitno utječe na ishod terapije, odnosno zdravstveno stanje pacijenta. U razvijenim zemljama samo oko 50% bolesnika pridrţava se dugotrajne terapije. Loša adherencija raširen je problem koji značajno kompromitira uspješnost terapije, što za posljedice ima pogoršanje bolesti, smrt i rastuće zdravstvene troškove. Percepcije koje pacijenti imaju o lijeku, odnosno njihova vjerovanja i stavovi o nuţnosti terapije i zabrinutostima oko neţeljenih učinaka, vaţan su čimbenik adherencije budući da utječu na pacijentovu motivaciju da slijedi terapijske upute. U radu je provedeno primarno istraţivanje ispitanika o utjecaju percepcije lijekova na adherenciju. Istraţivanje je provedeno s ciljem ispitivanja percepcije pacijenata o lijekovima, njihovih vjerovanja u potrebu za lijekom i zabrinutosti oko neţeljenih učinaka lijekova, s posebnim naglaskom na utvrĎivanja stajališta pacijenata o biljnim lijekovima i njihove sklonosti korištenju biljnih lijekova, stavova pacijenata o liječnicima i ulozi ljekarnika, ispitivanja adherencije pacijenata te utvrĎivanja povezanosti percepcije o lijekovima i adherencije. Istraţivanje je pokazalo da pacijenti lijekove percipiraju nuţnima, no zabrinuti su oko njihovih neţeljenih učinaka. S druge strane, biljne lijekove percipiraju prirodnima i sigurnima te su skloni njihovom korištenju bez konzultacije s liječnikom/ljekarnikom. Trećina pacijenata prekida uzimanje terapije kada simptomi nestanu, a 66% prekida terapiju ukoliko primijete nuspojave. Poboljšanje adherencije intervencija je koja zahtijeva suradnju svih zdravstvenih profesionalaca te je ključna komponenta za poboljšanje terapijskih ishoda. U kreiranju i provoĎenju ovih intervencija vaţnu ulogu imaju ljekarnici kao pacijentu najdostupniji zdravstveni profesionalci koji imaju najveći korpus znanja o lijekovima. Adherence to the prescribed therapy is a factor that significantly affects the outcome of the therapy, ie the health of the patient. In developed countries only about 50% of patients are adherent to long-term therapy. Poor adherence is a widespread problem that significantly compromises the success of therapy and results in worsening of disease, death and increased health costs. Patients` perceptions of medicines, their beliefs and attitudes about the necessity of therapy and concerns about unwanted effects are an important adherence factor as they affect patient's motivation to follow therapy instructions. Primary research was conducted in this paper, on the influence of patients`s perceptions of medicines on adherence. The study was conducted to investigate patients` perceptions of medicines, their necessity beliefs and concerns about potential adverse effects, with a special emphasis on determining patients` views about herbal remedies and their preferences in using herbal remedies, to determine patients` attitudes about physicians and the role of pharmacists, to investigate patients` adherence and determine connection between perceptions of medicines and adherence. The research showed that patients perceive medicines as necessary but are concerned about their unwanted effects. On the other side, herbal remedies are perceived as natural and safe and patients often use them without consultation with a physician/pharmacist. One third of patients stops taking prescribed medicines when symptoms disappear and 66% if they notice side effects. Improving adherence is an intervention that requires cooperation of all healthcare professionals and it is a key component for improving therapy outcomes. Pharmacists play an important role in creating and conducting these interventions as they are most accesible healthcare professionals and have the largest corpus of knowledge about medicines.

Pozadina. Nuspojave predstavljaju jedan od najvećih izazova suvremenoj zdravstvenoj skrbi, kako u strogo medicinskom, tako i u socioekonomskom smislu. Njihovo je spontano prijavljivanje u sklopu farmakovigilancije dijelom odgovora navedenom izazovu, u čemu javni ljekarnici zbog svog specifičnog znanja i poloţaja imaju jedinstvenu ulogu. Na kvantitetu i kvalitetu ljekarničkih prijava utječu njihova znanja i stavovi, koji uključuju uvjerenja, osjećaje i ponašanja. Metode. Od 7. do 22. 8. 2018. provedeno je transverzalno opservacijsko istraţivanje meĎu javnim ljekarnicima na području Grada Zagreba, pri čemu je iz 92 ljekarne konvencionalno uzorkovano 188 ljekarnika. U ispitivanju je korišten upitnik sastavljen od 60 čestica o sociodemografskim podacima, znanjima i stavovima povezanim s nuspojavama. U analizi je korištena deskriptivna statistika te neparametrijski χ2-test i parametrijski t-test. Rezultati. Stopa odaziva bila je 71,8%, a istraţivanje je uključilo 106 ljekarnika. Ispitanici pokazuju ukupnu razinu znanja od 88,2%, pri čemu bolje vladaju formalnim znanjima o proceduri nego materijalnim znanjima o sadrţaju prijavljivanja. Unatoč općim pozitivnim trendovima, meĎu ispitanicima su prisutna i negativna uvjerenja poput preuzetnosti (64,2%), osjećaji poput zabrinutosti zbog mišljenja kolega (17,0%) te ponašanja poput kolebljivosti (40,6%). 31,1% ispitanika u posljednjih godinu dana nije prijavilo nijednu nuspojavu, dok ih 51,9% nije sudjelovalo u edukaciji o prijavljivanu nuspojava. Od sociodemografskih čimbenika značajan utjecaj imaju spol, stečena razina obrazovanja i vrsta ljekarne. Zaključak. Javni ljekarnici imaju dobra znanja o prijavljivanju nuspojava, a pokazuju i pozitivna uvjerenja i ponašanja te izostanak negativnih osjećaja. Za jačanje uloge njihove uloge u farmakovigilanciji potrebno je preciznije definiranje forme i materije prijavljivanja te kontinuirana edukacija. Background. Adverse drug reactions (ADR) are one of the major challenges for modern hcare, both from the strictly medical and from the socioeconomic aspect. Spontaneous ADR reporting is part of the answer to this challenge within pharmacovigilance, in which community pharmacists have a unique role due to their specific knowledge and position. The quantity and quality of pharmacists' reporting is influenced by their knowledge and attitudes, which include beliefs, emotions and behaviour. Methods. A cross-sectional observational study was conducted among community pharmacists in the City of Zagreb area from August 7 until August 22, where 188 pharmacists were sampled from 92 pharmacies. A questionnaire cointaining 60 items concerning sociodemographic data, knowledge and attitude towards ADRs was used. Dana analysis was done using descriptive statistics, the non-parametric χ2-test and the parametric t-test. Results. The overall response rate was 71,8%, while the study included 106 pharmacists. Participants displayed an overall knowledge level of 88,2%, having better formal knowledge of the reporting procedure in comparison with the material knowledge of the reporting matter. Despite generally positive trends, several negative beliefs, such as complacency (64,2%), emotions, such as worry about the opinion of colleagues (17,0%), and behaviours, such as reluctance (40,6%), were present among the participants as well. 31,1% of the participants did not report an ADR in the previous year, while 51,9% never participated in education about ADR reporting. Gender, education level and pharmacy type had a significant impact on the results. Conclusion. Community pharmacists have fair knowledge about ADR reporting, while also demonstrating positive beliefs and behaviour and a lack of negative emotions. Better defining of the reporting matter and form, as well as continuous education, is crucial to strengthen their role in pharmacovigilance.

Gastritis kao bolest modernoga doba i širokom rasprostranjenošću diljem svijeta svakako zaslužuje pažnju. On predstavlja veliki javno zdravstveni problem ne samo zbog posljedične hospitalizacije i povećanja troškova liječenja, već i zbog smanjene kvalitete života pacijenta. Velik je napredak postignut u definiciji i terapiji gastritisa od otkrića bakterije H. pylori 1982. godine do danas. Liječenje infekcije H. pylori provodi se kombinacijom IPP-a, makrolida i beta laktamskog antibiotika. Neuspjeh je najčešće povezan s rezistencijom, a ne s reinfekcijom. IPP su visoko efektivni lijekovi čije nuspojave dugoročne primjene moramo temeljito istražiti. Potreban je individualan pristup za svakoga pacijenta te pažljiv i svrsishodan izbor terapije. Uz farmakološke mjere ne smijemo zaboraviti i ne farmakološke mjere koje su jednako važne i služe kao nadopuna. Ulaganjem u znanost i nova istraživanja povećavamo razumijevanje bolesti i problema koje ona nosi. Iskrena znatiželja, potraga za istinom i dobrobit pacijenta neka budu naši glavni motivatori. Gastritis, being a widespread illness of the modern era, certainly deserves our attention. It represents a serious public healthcare problem, because of not only the consequent hospitalization and increased healthcare expenses, but also because it reduces the life quality of those afflicted. Since the initial discovery of the H. pylori bacteria in 1982, there has been significant progress in the definition and treatment of Gastritis. The infection caused by the H. pylori bacteria is treated with a combination of Proton pump inhibitors (PPIs), macrolides and β-lactam antibiotic, unsuccessful treatment usually being a result of patient resistance, rather than reinfection. PPIs are highly effective drugs whose side effects are yet to be thoroughly examined, keeping in mind the necessity of an individual approach for each patient, as well as a mindful choice of appropriate therapy. In addition to pharmacological measures, we should not neglect equally important non-pharmacological measures, which can be additionally helpful. By investing in new scientific research, we can help raise awareness about this illness and its resulting problems. Honest curiosity, the search for truth, as well as the well-being of our patients, should be our main motivators moving forward.

Rosacea je kronična upalna bolest kože koja zahvaća obraze, nos, bradu i čelo. Najčešće se javlja između 30. i 50. godine života kod osoba svjetlije puti. Glavna klinička obilježa na temelju kojih se donosi dijagnoza su prolazno ili trajno crvenilo lica, teleangiektazije, papule i pustule, fimatozne promjene i okularne manifestacije. To je bolest multifaktorijalne i nerazjašnjene patofiziologije koja je vjerojatno splet genetskih čimbenika, promjena u urođenom imunosnom odgovoru, neurovaskularne disregulacije i utjecaja vanjskih čimbenika, zbog čega klinička prezentacija varira od pacijenta do pacijenta. Iz tog razloga, odabir terapije ovisi o kliničkoj prezentaciji rosacee kod pojedinog pacijenta. Najveću razinu dokaza o učinkovitosti terapije imaju topikalno primijenjeni brimonidin, metronidazol, ivermektin i azelatna kiselina te sistemski primijenjeni doksiciklin i izotretinoin, ali se često propisuju lijekovi čija učinkovitost kod rosacee nije dokazana. Ljekarnici mogu znatno doprinjeti poboljšanju kvalitete života pacijenata savjetovanjem o pravilnoj njezi kože, primjeni lijekova i izbjegavanju okidača. Rosacea is a chronic inflammatory skin disease that affects the cheeks, nose, chin and forhead. It usually starts between 30 and 50 years of age, commonly in fair-skinned individuals. Main clinical characteristics, which are the foundation of a diagnosis, are transient or permanent erythema, telangiectasia, presence of papules and pustules, sebaceous gland hypertrophy and ocular manifestations. The patophysiology of the disease is unclear and multifactorial, probably a combination of genetic factors, native immune response alterations, neurovascular disregulation and environmental factors. Therefore, the selection of therapy depends on clinical presentation of rosacea in each individual patient. Medicines with high-quality evidence of efficacy are locally administred brimonidine, metronidazole, ivermectin and azelaic acid, and orally administred doxycycline and isotretinoin. Still, medicines without proven efficacy in rosacea are often prescribed. Pharmacists can greatly improve patients quality of life by giving the right advice about general skin care measures, administration of the medicines and avoiding triggers.

Osim brojnih zahtjeva koje oftalmički lijekovi moraju zadovoljiti u svrhu postizanja očekivanih ishoda liječenja, bitna je i tehnika primjene kapi za oko. Za razliku od „jednostavne“ oralne primjene lijekova, primjena kapi u oko zahtijeva vještinu, a što je pacijentima često problematično i predstavlja poteškoće pri primjeni. Tehnika primjene kapi za oko jedan je od vodećih uzroka loše adherencije. Studije koje su procijenjivale tehnike primjene kapi za oko ukazale su na brojne greške kojih pacijenti često nisu svjesni. Najčešće uočene greške su neprecizna primjena (mimo oka) i/ili primjena prevelikog broja kapi za oko te kontaminacija kapaljke/nastavka za iskapavanje uslijed kontakta pri primjeni. Neprimjerena tehnika primjene kapi za oko rezultira lošim ishodima liječenja, nepotrebnim uključivanjem dodatnih lijekova u terapijski protokol i problemom infekcija. Slično liječenju drugih bolesti, problemi adherencije prisutni su pri kroničnoj primjeni kapi za oko (primjerice, terapija glaukoma). Primjerice, studije pokazuju da je samo oko 50% pacijenata koji primjenjuju kapi za oko u liječenju glaukoma adherentno, a čak je i manji postotak onih koji pravilno primjenjuju kapi u oko. Više od 60% pacijenata ističe jednu ili više prepreka pri korištenju kapi za oko, a među njima značajan je broj onih koji naglašavaju probleme s primjenom kapi kao što su ciljanje oka, odmjeravanje samo jedne kapi ili držanje i stiskanje bočice. Problemi pri rukovanju bočicom, različita snaga koja je potrebna pri ististiskivanju kapi, oslabljeni vid ili nelagoda pri ukapavanju dodatno čini probleme adherencije složenim, a posebno u slučaju starijih pacijenata. Dok je na mnoge čimbenike loše adherencije teško utjecati, edukacija pacijenata o pravilnoj primjeni kapi za oko jednostavan je i ekonomski prihvatljiv način kojim se može utjecati na jedan od glavnih uzroka neprimjerenih ishoda liječenja oboljenja prednjeg segmenta oka.

Karcinomi kože su u današnje vrijeme jedna od najzastupljenijih vrsta karcinoma u većini zemalja svijeta te njihov broj neprestano raste. Uzrok tome je ponajprije povećana izloženost suncu (UV zrakama), duži životni vijek (rak kože se češće javlja u starijoj životnoj dobi), kao i sve tanji ozonski omotač. Cilj ovog rada jest upoznavanje s najčešćim prekancerozama i tumorima kože, koji se posljednjih godina javljaju sve češće i kod sve mlađe populacije, prvenstveno kako bi ljekarnik, kao jedan od najdostupnijih zdravstvenih djelatnika, mogao prepoznati navedena stanja i pravovremeno uputiti pacijenta liječniku. Obrađena je aktinička keratoza kao jedna od najčešćih prekanceroza, planocelularni karcinom, bazocelularni karcinom i melanom kao najčešći zloćudni tumori kože koji se javljaju kao posljedica izloženosti UV zrakama. Također, rad obrađuje preventivne mjere kojih bi se trebalo držati kako do navedenih stanja ne bi došlo, gdje je bitna uloga ljekarnika u edukaciji stanovništva kao i u odabiru odgovarajuće zaštite za svakog pojedinog pacijenta. Prema dostupnoj literaturi, analizirane su vrste zaštitnih sredstava prisutne trenutno na tržištu, njihove karakteristike, prednosti i nedostaci, trenutno važeća regulativa koja se odnosi na takvu vrstu preparata. Nadalje, bilo je riječi i o antioksidansima za koje se smatra da mogu apsorbirati neke od slobodnih radikala koji nastaju u koži kao posljedica prekomjernog izlaganja UV zračenju. Antioksidansi mogu biti osobito korisni kod promjena na koži uvjetovanih UVA zračenjem koje su velikim dijelom određene oksidativnim procesom. Dugoročna ispitivanja na ljudima su potrebna kako bi se odredila učinkovitost tih proizvoda, međutim oni nisu opasni i mogu biti učinkoviti zbog čega su spomenuti u radu. Pojam sekundarna prevencija označava rano otkrivanje i dijagnostiku zloćudnih tumora kože čime se povećava stopa izliječenja i smanjuje smrtnost. Potrebno je redovito provoditi samopregled lica, tijela i vlasišta kako bi se na vrijeme uočile promjene na koži. Uz to, potrebno je povremeno kontrolirati kožu i kod dermatologa, a osobe s povećanim rizikom za nastanak tumora kože bi trebale obaviti dermatoskopski pregled svakih 6 mjeseci ili češće. I za primarnu i za sekundarnu prevenciju zloćudnih tumora kože važna je edukacija stanovništva te provedba odgovarajućih mjera za ranu dijagnostiku i ranu terapiju od strane svih zdravstvenih djelatnika, uključujući i ljekarnika. Skin cancer is nowadays one of the most common types of cancer in most countries of the world and its number is constantly increasing. The reason for this primarily lies in increased exposure to the sun (UV rays), longer lifetime (skin cancer is more common in old age) and thinner ozone layer. The objective of this paper is to introduce the most common precancerous lesions and skin tumours, which in recent years appear more frequently and with increasingly younger population, primarily in order to enable the pharmacist, as one of the most accessible health care professionals, to recognize the listed conditions and promptly refer the patient to the doctor. The paper deals with actinic keratosis as one of the most common precancerous lesions, and squamous cell carcinoma, basal cell carcinoma and melanoma, the most common malignant skin tumours that occur as a result of UV exposure. Furthermore, the paper discusses the preventive measures to be followed in order to avoid the stated conditions, where again the pharmacist has the key role in educating the population as well as in selecting adequate protection for each individual patient. According to available literature, this paper analyses types of sunscreens present on the market, their characteristics, advantages and disadvantages and the applicable regulations relating to such preparations. In addition, there was discussion about antioxidants that are thought to be able to absorb some of the resulting free radicals that occur in the skin as a result of excessive exposure to UV radiation. Antioxidants may be particularly useful for skin changes caused by UVA radiation, which are largely determined by oxidative process. Long-term clinical trials are needed to determine the effectiveness of these products, however they are not dangerous and can be effective, which is why they are mentioned in the paper. The notion of secondary prevention refers to early detection and diagnosis of malignant skin tumours which enables higher cure rate and reduces mortality. It is necessary to regularly conduct self-examination of face and body in order to timely detect skin changes. It is also necessary to periodically have the skin examined by a dermatologist, and persons with an increased risk of skin tumour should undergo a dermoscopic examination every 6 months or more often. Both for primary and secondary prevention of malignant skin tumours it is important to educate the public and to implement appropriate measures for the early diagnosis and early treatment by all health care professionals, including pharmacists.

In recent years, in most developed countries, the use of dietary supplements in general, and especially those intended for children is increasing. Despite the fact that most dietary supplements, especially those intended for children, can have side effects, legislation puts them in a group of foods, not drugs. Therefore there are not subject to such strict requirements of safety, quality and efficiency as medicines are. Because of higher availability, but also because of many other reasons, such as growing increase of self-care in general and growing concern of modern man for their own health, the opinion is prevailing that dietary supplements are safe. It is undisputed that the majority of food supplements for children can have very beneficial effects on their overall health. However, not enough attention is given to the fact that dietary supplements may have a positive effect only if these products are used for the right reason at the right time, in the right dose and in the right way. Do to the fact that children are a special group that are particularly vulnerable, one must keep in mind the issue of production and distribution practice, and the use of food supplements should be approached with caution. In order to avoid a number of potential risks that the use of dietary supplements in general especially those intended for children brings, dietary supplements should be subject to continuous scientific research, pharmaceutical expert supervision and appropriate legal controls. It is extremely important that the parents themselves acquire more knowledge about dietary supplements used by their children. Only if all above mentioned criteria are met, dietary supplements can achieve their optimum performance. The aim of this survey was to determine how much parents are familiar with dietary supplements intended for their children. In addition to evaluating the level of their knowledge on the composition, purpose and method of use of dietary supplements, in the present study we investigated the attitudes and opinions that parents generally have about dietary supplements. Based on the data of the survey conducted on a sample of parents (N = 415) it was found that parents perceive dietary supplements as safe. The research results unequivocally confirm the disturbingly low level of awareness of parents about dietary supplements for children. Such insight is ultimately a claim for an important advisory role of a pharmacist. In fact, the pharmacist should play a key role in advising parents to make an informed decision on the selection and manner of use of the food supplement for their child. Based on their knowledge, experience and expert assessment, pharmacists will decide whether there is a need for a certain dietary supplement, depending on the intended use and indications. If necessary they will recommend a different dietary supplement, explain in what cases to use it, and for how long, as well as how to use it. The pharmacist must raise parents’ awareness that dietary supplements contain active substance and that they should not be taken lightly and that the recommended daily dose should not be exceed. It is also necessary to point out that dietary supplements for children, especially those that contain plant extracts, may contain alcohol. The pharmacist, when dispensing medicines, should make a recommendation what dietary supplement may contribute to faster recovery, prevent or mitigate side effects and complications of pharmacotherapy. It is also important that the pharmacist emphasizes that certain dietary supplements should not be used with a certain drug because of possible interactions. In the end, it is necessary to point out that the pharmacist should play a key role in advising parents to make an informed decision on the selection of the dietary supplement for their child as well as the correct way of using it.

Dodaci prehrani namijenjeni djeci - znanje, navike i stavovi roditelja u primjeni ovih proizvoda te uloga ljekarnika

Prema podacima Svjetske zdravstvene organizacije (SZO) pretilost je poprimila razmjere epidemije u cijelom svijetu, podjednako u razvijenim zemljama i zemljama u razvoju. Hrvatska je na 5. mjestu po učestalosti debljine u Europi ; oko 58% žena i 68% muškaraca ima prekomjernu težinu, a 20% žena i 22% muškaraca je pretilo. Različite “čudotvorne dijete” za brzo mršavljenje nisu medicinski niti zdravstveno preporučljive niti se mogu smatrati liječenjem debljine, a rezultati su redovno poražavajući uz narušavanje zdravlja. Prema preporuci SZO, ljekarnici su među najodgovornijim zdravstvenim radnicima koji mogu upozoravati na štetne posljedice prekomjerne tjelesne težine, pružati savjetovanje iz pravilne prehrane i pomoć u gubitku prekomjerne tjelesne težine. Cjelovit pristup liječenju debljine temelji se na multidisciplinarnom pristupu koji podrazumijeva suradnju liječnika obiteljske medicine, endokrinologa (internist ili pedijatar), nutricionista, ljekarnika, fizioterapeuta, psihologa i medicinske sestre. U Kliničkoj bolnici Dubrava tijekom 2008. godine uveden je prvi takav multidisciplinarni program liječenja pretilosti, te će njegovi rezultati s naglaskom na ulogu ljekarnika biti prikazani u okviru interaktivnog predavanja. Na slučajevima pojedinih pacijenata prikazat će se primjeri ljekarničkih intervencija.

Prema podacima Svjetske zdravstvene organizacije Republika Hrvatska je na 5. mjestu po učestalosti debljine u Europi. Različite “čudotvorne dijete” za brzo mršavljenje nisu medicinski niti zdravstveno preporučljive niti se mogu smatrati liječenjem debljine, a rezultati su redovno poražavajući uz narušavanje zdravlja. Cjelovit pristup liječenju debljine temelji se na multidisciplinarnom pristupu koji podrazumijeva suradnju liječnika obiteljske medicine, endokrinologa (internist ili pedijatar), nutricionista, ljekarnika, fizioterapeuta, psihologa i medicinske sestre. U Kliničkoj bolnici Dubrava tijekom 2008. godine uveden je prvi takav multidisciplinarni program liječenja pretilosti, te će njegovi rezultati s naglaskom na ulogu ljekarnika biti prikazani u okviru interaktivnog predavanja. Posebno će se pokazati na primjeru pojedinih pacijenata način praćenja i ljekarničke intervencije.

Pregled najčešćih i najznačajnijih nuspojava prijavljenih Agenciji u Republici Hrvatskoj, te uloga ljekarnika u sprečavanju istih.