Background: Amikacin remains a key agent in the treatment of severe and complicated infections due to its bactericidal activity and low risk of Clostridioides difficile infection. It retains activity against most aerobic Gram-negative bacteria, including multidrug-resistant Enterobacterales and Pseudomonas. However, its use is limited by nephrotoxicity and ototoxicity. Methods: This narrative review evaluates clinical indications, pharmacokinetic and pharmacodynamic properties, dosing strategies, therapeutic drug monitoring (TDM), and safety profile of amikacin in adult patients based on 56 selected publications. A total of 24 articles were identified through database searches (PubMed and Embase), complemented by 32 additional sources to provide clinical and pharmacological context. Results: Available evidence demonstrates considerable uncertainty regarding the comparative effectiveness of different monitoring strategies. Lower trough concentrations are generally associated with reduced nephrotoxicity; however, an optimal safety threshold has not been clearly established. Guideline-recommended targets vary substantially and are supported by low-quality evidence. Amikacin pharmacokinetics, tissue penetration and toxicity are influenced by patient-specific factors, including critical illness, renal function variability, and concomitant nephrotoxic therapy, particularly vancomycin. Ototoxicity remains an additional clinically relevant concern. Conclusions: Current evidence suggests that uniform dosing and monitoring paradigms are insufficient. Patient-tailored strategies integrating TDM and mitigation of modifiable risk factors are required. Prospective studies comparing monitoring regimens are needed to optimize the safe clinical use of amikacin and inform future guideline development.

The aging of the population and the increasing prevalence of multimorbidity contribute to the widespread use of polypharmacotherapy, which in turn elevates the risk of adverse drug reactions and clinically significant drug-drug interactions. One of the key yet frequently underestimated issues in clinical practice is the prescribing cascade, which occurs when an adverse drug reaction is misinterpreted as a new medical condition, leading to the initiation of an additional medication. This phenomenon is particularly relevant in the older population, in whom altered pharmacokinetics and pharmacodynamics, together with reduced organ reserve, increase susceptibility to adverse drug events, including nephrotoxicity (renal impairment is used throughout the review as a clinically relevant example of organ-specific harm resulting from prescribing cascades, rather than as the sole focus of the analysis). This article discusses the mechanisms and clinical consequences of the prescribing cascade-with particular emphasis on renal function deterioration-as well as strategies for its prevention in the geriatric population. Analysis of the literature indicates that prescribing cascades remain insufficiently recognized in clinical practice, despite the availability of pharmacotherapy assessment tools such as The American Geriatrics Society (AGS) Beers Criteria and the STOPP/START criteria. Documented prescribing cascades have been shown to contribute to deterioration in health status and quality of life, an increased frequency of hospitalizations, and a greater burden on healthcare systems. Particularly concerning are cascades involving cardiovascular, neurological, and analgesic medications, which may induce or exacerbate renal injury, ultimately leading to chronic kidney disease and organ failure. Prescribing cascades represent a significant yet frequently underestimated threat to the efficacy and safety of pharmacotherapy in older adults. Their consequences may extend beyond reduced quality of life and increased treatment costs to include serious complications such as the development of renal failure. Enhancing clinicians' awareness, conducting systematic medication reviews, and employing validated assessment tools are essential for the identification and prevention of prescribing cascades, thereby reducing the risk of renal injury and improving clinical outcomes.

The NaV1.8 sodium channel plays a key role in the transmission of pain signals in peripheral sensory neurons. Suzetrigine is a selective NaV1.8 inhibitor developed as a non-opioid analgesic. Its action is limited to sensory neurons, reducing the risk of adverse effects associated with non-selective sodium channel blockers. Phase II and III clinical trials have demonstrated the high efficacy of suzetrigine in managing postoperative pain, along with good tolerability. Adverse events, such as dizziness or drowsiness, were rare and generally mild to moderate in intensity. The drug did not cause respiratory depression or addiction, which distinguishes it from opioids. Ongoing pharmacokinetic studies and long-term observations aim to further define the drug's safety profile and its potential use in patients with comorbid conditions. Suzetrigine may offer an effective and safe alternative to opioids in pain treatment.

Wstęp Według danych Narodowego Programu Ochrony Antybiotyków około 50% zleceń antybiotyków jest niewłaściwa, a co dziesiąty hospitalizowany pacjent otrzymuje antybiotyki z nieuzasadnionych powodów. Nadużywanie leków doprowadziło do pojawienia się oporności, która w opinii Europejskiego Centrum Profilaktyki i Kontroli Chorób (ang. European Centre for Disease Prevention and Control, ECDC) stanowi obecnie w Polsce istotny problem kliniczny. Wydłużenie czasu hospitalizacji z powodu infekcji oraz koszty związane z antybiotykoterapią stanowią coraz większy problem finansowy. Raport Najwyższej Izby Kontroli (NIK) oszacował je w 2019 roku na 800 milionów złotych w ciągu roku. Cel pracy Celem pracy była ocena wpływu wprowadzonych konsultacji farmaceutycznych oraz innych elementów racjonalnej polityki antybiotykowej na zużycie leków przeciwdrobnoustrojowych w Szpitalu Specjalistycznym im. Ludwika Rydygiera w Krakowie. Metodologia Ordynowane leki II i III rzutu były weryfikowane przez farmaceutę z Zespołu ds. Antybiotykoterapii podczas wydawania tych leków z Apteki Szpitalnej. Po weryfikacji zasadności antybiotykoterapii zatwierdzał wydanie leku lub dokonywał konsultacji. Wyniki Efektem działań prowadzonych przez zespół ds. antybiotykoterapii jest zmniejszenie ilości wydawanych leków przeciwdrobnoustrojowych II i III rzutu o 35% w ciągu 2 lat. Zmniejszenie zużycia karbapenemów w tym okresie wyniosło 51%, a zużycie dożylnych postaci fluorochinolonów obniżono o 79%. Wnioski Wprowadzenie prospektywnej kontroli farmaceuty nad stosowaną w Szpitalu im. Ludwika Rydygiera w Krakowie antybiotykoterapią związane było ze zmianami w strukturze i ilości wydawanych leków przeciwdrobnoustrojowych. Nie jest jasne, jaki rodzaj aktywności farmaceuty (konsultacje w zakresie antybiotykoterapii empirycznej, kontrola deeskalacji, konsultacje z zakresu terapii monitorowanej stężeniem leku) w największym stopniu przyczynił się do ograniczenia ilości wydawanych leków. Zagadnienie to wymaga dalszych badań i jest szczególnie istotne w związku z wprowadzaniem w Polsce usług farmacji klinicznej, ich oceną i standaryzacją.

Background To verify the validity of the proposed pain treatment approach, which is based on concomitant blocking of the Transient Receptor Potential Ankyrin 1 (TRPA1) channel and phosphodiesterases (PDEs) 4B/7A activity, we continued our pharmacological studies on 8-alkoxypurine-2,6-diones selected based on previous in vitro screening. Methods Derivatives 17 , 31 , and 36 were pharmacologically evaluated in vivo using the formalin test and oxaliplatin-induced neuropathic pain: the von Frey and the cold plate tests, and in the carrageenan-induced edema model. Compound 36 , which turned out to be the most promising, was further evaluated in the collagen-induced arthritis model. The pharmacokinetic parameters of this compound were also estimated. Results All the tested compounds exhibited significant analgesic and anti-inflammatory activities. Compound 36 was additionally characterized by an antiarthritic effect and showed a favorable pharmacokinetic profile in rats. Conclusion The compounds evaluated in this study represent a new class of derivatives with analgesic and anti-inflammatory activities that involve TRPA1 antagonism and PDE4/7 inhibition. Graphical abstract

Fluid treatment is one of the basic medical procedures used in every hospital. To be properly conducted, it requires making complex decisions regarding the optimal volume, infusion rate, and type of fluids. Fluid therapy should only be used in patients with an insufficient oral or enteral route of fluid administration, and for the shortest possible time. Planning fluid therapy, the total and enteral fluid intake should be taken into account. There are many fluids that can be used and their choice should be reflected in the patient's condition. There are two types of substances whose solutions are used in parenteral fluid therapy: crystalloids and colloids. Crystalloids are the fluids of the first choice for intravenous fluid therapy: crystalloids remain for a relatively short time in the vascular tract, causing the extravascular water space to expand rapidly. Colloids are suspensions of macromolecules in solvents, whose task is to stabilize the intravascular water space. Pharmacovigilance is one of the most important elements of inpatient care. It is the pharmacist's task (as a specialist in the field of medicine and pharmacotherapy) to monitor the safety of the therapy. Scientific research shows that the participation of pharmacists in this process is necessary because they provide additional information that is not included in reports prepared by representatives of other medical professions. The task of the clinical pharmacist in the hospital ward is to analyze the ordered fluid therapy, a possible proposal for its correction, and above all, to analyze the prescribed solutions in terms of interactions with other medications used by the patient. Effective and safe pharmacotherapy depends on the rational selection of the appropriate medicinal product (taking into account not only active substances, but also auxiliary substances or buffers, which also affect the final therapeutic effect), proper selection of the optimal dosing schedule, and aseptic administration of the medicinal product. All this is aimed at eliminating the greatest possible number of side effects that may occur in the course of the patient's therapy

One of our study direction is research in the group of compounds affecting the TRPA1 ion channel (Transient receptor potential cation channel, subfamily A, member 1) which can perform an important function in pain (including neuropathic pain) and inflammation for example in asthma and other chronic respiratory diseases. The aim of this study was to evaluate the analgesic and anti-inflammatory activity of two analogs of HC-030031 analogs belonging to nitrogen derivatives of the heterocyclic system: xanthine (compound 1) and benzimidazole (compound 2) with hydrazide and amide moieties respectively. In this paper, for two derivatives (compound 1 and compound 2) potential analgesic and anti-inflammatory/anti-edematous activities were evaluated in animal models of pain in mice (writhing response test, formalin test) and inflammation in rats (carrageenan-induced paw edema test). Both the tested compounds 1 and 2 showed significant analgesic and anti-inflammatory activities.

The functioning of health care centers is highly dependent on the quality of cooperation between medical staff - doctors, nurses, but also pharmacists. Pharmaceutical knowledge about medicines, combined with daily practice and supervision of the pharmacotherapy used, can bring a number of benefits, primarily increasing effectiveness and safety of treatment, as well as reducing the cost of treatment. Despite numerous difficulties, in some hospitals in Poland pharmacists undertake various types of clinical activities by directly joining the work of a hospital ward or remote monitoring of patient's pharmacotherapy using electronic systems. It should be emphasized that these are often tasks carried out outside the basic dimension of working time. The initiative taken in 2017 by the Director of the Provincial Specialist Hospital in Wroclaw, Research and Development Center, deserves a mention. Pharmacist (during the specialization in clinical pharmacy) was fully engaged in the work of hospital wards focusing first in the Department of Vascular Surgery, and then also General Surgery. Her daily duties include participation in medical celebrations, conducting medical history with newly admitted patients, optimization of pharmacotherapy, consultation with the medical and nursing team, control of orders and results of laboratory tests, giving advice to staff and educating patients in correct use of medicines. This kind of multidisciplinary cooperation has become a standard of care, which has been approved by the accreditation committee of the Center for Quality Monitoring in Health Care. In Poland, clinical pharmacy is constantly developing and gaining importance every year, but as of today, there are still no clear law regulations. Will the draft Act On The Pharmacy Profession adopted by the Council of Ministers introduce regulations and clearly define the place of a clinical pharmacist in the healthcare system? Undoubtedly, it would be a basic step to the further development of clinical pharmacy services.

A library of 34 novel compounds based on a xanthine scaffold was explored in biological studies for interaction with adenosine receptors (ARs). Structural modifications of the xanthine core were introduced in the 8-position (benzylamino and benzyloxy substitution) as well as at N1, N3, and N7 (small alkyl residues), thereby improving affinity and selectivity for the A(2A) AR. The compounds were characterized by radioligand binding assays, and our study resulted in the development of the potent A(2A) AR ligands including 8-((6-chloro-2-fluoro-3-methox-ybenzyl)amino)-1-ethyl-3,7-dimethyl-3,7-dihydro-1H-purine-2,6-dione (12d; K-i human A(2A)AR: 68.5 nM) and 8-((2-chlorobenzyl)amino)-1-ethyl-3,7-dimethyl-3,7-dihydro-1H-purine-2,6-dione (12h; Ki human A2AAR: 71.1 nM). Moreover, dual A(1)/A(2A)AR ligands were identified in the group of 1,3-diethyl-7-methylxanthine de-rivatives. Compound 14b displayed K-i values of 52.2 nM for the A1AR and 167 nM for the A2AAR. Selected A2AAR ligands were further evaluated as inactive for inhibition of monoamine oxidase A, B and isoforms of phosphodiesterase-4B1,-10A, which represent classical targets for xanthine derivatives. Therefore, the devel-oped 8-benzylaminoxanthine scaffold seems to be highly selective for AR activity and relevant for potent and selective A2A ligands. Compound 12d with high selectivity for ARs, especially for the A2AAR subtype, evaluated in animal models of inflammation has shown anti-inflammatory activity. Investigated compounds were found to display high selectivity and may therefore be of high interest for further development as drugs for treating cancer or neurodegenerative diseases.

A pharmacist is an educated specialist working to provide patients’ with the highest level of care for who business goals should be a secondary aim. Due to an ethical attitude which is in line with the pharmacist code of ethics, a set of most important guidelines, regulating the pharmacist's profession, are them main stream of pharmaceutical care regulation implemented in daily practice. Pharmaceutical care by deploying variety of different pharmacy services, is an important element of the process of optimizing the use of medicines. To start providing pharmaceutical care by implementing a wide catalog of pharmaceutical services, a Polish pharmacist must change their attitude from the typical role of the “seller” or “shop assistant” to the role of a professional adviser to the patient who is using skills and references to provide the best possible advice. The term: "pharmaceutical care" used to refer to the understanding of the responsible action of a pharmacist, whose professional goal is to ensure the safety of pharmacotherapy and improve the patient's quality of life. The process of implementing this type of care is very difficult and this is due to the fact that most Polish pharmacies since the 90s of the twentith century operate mainly as business entities (discounts, loyalty programs, marketing campaigns). Due to the fact that the pharmacy market in Poland is constantly evolving, it seems reasonable to reflect on how to make contemporary Polish pharmacies unique medical facility, in which the patient will receive not only the prescription, but above all - substantive support from pharmacists, being specialist consultancy in the field of health and safety in taking medicines. The pharmacist, which is specialist advice on health and safety in admission drugs could start to build an authority and respect by step by step transferring the pharmacy from price only focused pharmacy to advance advice focused center of patient well being . It is a very simple process which can be start even from tomorrow. It only a matter of will, and eagerness to make a chance.

Pharmaceutical care of patients with cancer • A comprehensive approach to the needs of an oncological patient requires the involvement of specialists of various fields.Regardless of the type of therapy or medical problem effective communication, the transmission of informations, the subjective treatment of the patient (as a member of therapy) is important.This procedure is called "adherence".Understanding the legitimacy of diagnostic activities, assumptions and course of treatment by the patient is the way to its acceptance and increase of effectiveness of therapy.Cooperation between medical staff and the patient and their caregivers should be continuous and dynamic, adepted to changing needs (depending on the stage of treatment, type and severity of the disease).

A new prescription formula for the Polish healthcare system in the context of pharmaceutical care • The current prescription formulaalbeit adapted to the applicable rules -does not seem to be the optimal solution in medical practice and in the pharmaceutical field.Each part of the prescription can induce many problems and create numerous inaccuracies, such as: incorrect determination of the level of payment for the drug, incorrectly prescribed dosage of the drug or the lack of a medical stamp with the doctor's corrections.Such frequent errors can often cause communication problems between the doctor, the patient and the pharmacist, and affect the perception of the doctor and pharmacist's professional prestige by patients.From this point of view, it seems justified to be necessary to modify the existing prescription pattern and introduce to it the kind of changes that would enable complete pharmaceutical care and self-treatment of patients.

Intensive studies on the role of adenosine A2A receptors in Parkinson’s disease have been carried out for many years,. These studies have indicated that the antagonists of these receptors not only alleviate motor deficits but also exhibit neuroprotective effects in various animal models. Little is known about the role of these receptors in ailments accompanying Parkinson’s disease, such as depression and anxiety. This paper provides a summary of existing research on the role of A2A receptors in comorbid depression in Parkinson’s disease.

A new series of 1,3-substituted pyrrolidine-2,5-dione derivatives as potential anticonvulsant agents are described. Initial pharmacological screening of these compounds was performed by using acute models of seizures (MES and scPTZ tests) in mice after intraperitoneal administration. Quantitative pharmacological research revealed that the most promising compounds were N-[{4-(3-trifluoromethylphenyl)piperazin-1-yl}propyl]-3-benzhydrylpyrrolidine-2,5-dione monohydrochloride (11) with a ED50 value of 75.9 mg kg-1 (MES test) and N-[{4-(3,4-dichlorophenyl)piperazin-1-yl}ethyl]-3-methylpyrrolidine-2,5-dione monohydrochloride (18) with ED50 =88.2 mg kg-1 (MES test) and ED50 =65.7 kg mg-1 (scPTZ test). These compounds displayed a more beneficial protective index than well-known antiepileptic drugs. A plausible mechanism of action of compounds 11 and 18 [molecule 11 blocked the sodium channel (site 2) and 18 blocked both the sodium (site 2) and L-type calcium channels] and their preliminary safety in vitro were evaluated. Besides, the lipophilicity of all synthesized compounds was determined by using UPLC-MS.