Polypragmasy: A clinical pharmacologist’s view

2016 ◽  
Vol 88 (12) ◽  
pp. 94-102 ◽  
Author(s):  
D A Sychev ◽  
V A Otdelеnov ◽  
N M Krasnova ◽  
E S Ilyina
Keyword(s):  
Adverse Drug Reactions ◽  
Public Health Problem ◽  
Modern World ◽  
Drug Reactions ◽  
Treatment Standards ◽  
Level Of Evidence ◽  
Medical Associations ◽  
Start Criteria ◽  
High Level ◽  
Multiple Drugs

In the modern world, there is a rapid advance in the design and clinical introduction of a huge number of drugs that are able to cure a patient or to improve his/her health status on the one hand and to cause significant harm to his/her health on the other. Polypragmasy is the desire to enhance the efficiency of treatment and to help the patient recover from all developed diseases inevitably leads to the use of a large number of medications. At the present time, polypragmasy as a result of iatrogenia is a serious public health problem, as it is clinically manifested by a reduction in the effectiveness of pharmacotherapy, by the development of severe adverse drug reactions, and by a considerable increase in healthcare expenditures. The reason for the simultaneous prescription of multiple drugs may be comorbidity (multimorbidity), the availability of drugs, as well as clinical guidelines, manuals of professional medical associations, treatment standards that contain recommendations for using combination therapy with more than 5 drugs for only one disease in some cases, the efficiency of which corresponds to a high level of evidence. Currently, the fight against polypragmasy is one of the important tasks in rendering medical care to elderly and senile patients since it is a major risk factor of adverse drug reactions in this category of people. To minimize polypragmasy in elderly patients, it is necessary to use current methods for analyzing each prescription of a drug (the index of rational drug prescribing; an anticholinergic burden scale) and those for optimizing pharmacotherapy with the use of restrictive lists (Beers criteria, STOPP/START criteria) that will be able to reduce the number of errors in the administration of drugs and to maximize the efficiency and safety of pharmacotherapy.

scholarly journals The severity of adverse drug reactions and their influencing factors based on the ADR monitoring center of Henan Province

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ziqi Yan ◽  
Zhanchun Feng ◽  
Zhiming Jiao ◽  
Chaoyi Chen ◽  
Ganyi Wang ◽  
...  
Keyword(s):  
Adverse Drug Reactions ◽  
Adverse Reactions ◽  
Public Health Problem ◽  
Drug Reactions ◽  
Factors Affecting ◽  
Medical Institutions ◽  
History Of ◽  
Monitoring Center ◽  
Multiple Drugs ◽  
Different Levels

AbstractAdverse drug reactions (ADRs) may be a serious public health problem and have received widespread attention in recent years. This study has analyzed the factors leading to the occurrence of serious ADRs (SADRs), determined the factors affecting the prognosis of patients with severe adverse reactions at different levels of medical institutions, and finally made corresponding recommendations for the monitoring, prevention, and treatment of SADRs. We used descriptive analysis and chi-square test to analyze the year, age, gender, proportion of SADRs, and the results of the ADRs in the report. Use the logistic regression to analyze the factors affecting the prognosis of SADRs in different levels of medical institutions. A total of 387 642 people’s 394 037 ADRs were collected from the Henan Provincial Adverse Drug Reaction Monitoring Center from 2016 to 2020. Among them 35 742 cases of serious ADRs (9.1%), 96.1% were eventually relieved or cured, but 39 cases of SADRs caused death. The main causes of death included hemorrhages, organ failure, and allergies. Age, number of medication and illnesses, level of medical institution, history of adverse reactions, and type and method of medication were all factors that affected the severity of ADR. The prognosis of SADRs is worse than normal ADRs. The ADRs in autumn and winter and new adverse reactions are unique risk factors found in this study. The elderly and patients with multiple diseases or taking multiple drugs should pay attention to their adverse reactions. They should be closely observed within a week after taking the medicine. The supervision of patients with a history of allergies and new adverse reactions should be strengthened by primary medical institutions, and in nonprimary medical institutions should paid attention with past medical histories, and use imported drugs and biological agents with caution to ensure the safety and health of patients.

scholarly journals A prospective observational pharmacovigilance study of adverse drug reaction monitoring in patients of MDR-TB at tertiary care hospital

2018 ◽  
Vol 7 (7) ◽  
pp. 1291
Author(s):  
Mirza Shiraz Baig ◽  
Monali Raghunath Kale ◽  
Avinash Lamb
Keyword(s):  
Adverse Drug Reactions ◽  
Health Care Professionals ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Public Health Problem ◽  
Treatment Withdrawal ◽  
Care Hospital ◽  
Drug Reactions ◽  
Medical College ◽  
Mdr Tb

Background: The emergence of drug resistant mycobacteria has become a significant public health problem world over creating an obstacle to effective TB control. ADRs are common in patients of MDR-TB on DOTs-Plus drug regimen. Present study was carried out in tertiary care hospital. Identification of types and frequency of adverse drug reactions in Intensive and continuation phase of MDR-TB Patients.Methods: It was a prospective observational study conducted in Department of TB- Chest and Medicine, Govt. Medical College, Aurangabad, Maharashtra, India. All the MDR-TB patients admitted at the directly observed treatment, short course plus (DOTS plus) Center at Medical College Hospital were enrolled and were monitored for ADRs. The causality and severity of the reactions were determined using Naranjo algorithm and Hartwig questionnaire, respectively.Results: A total of 121 tuberculosis patients of MDR-TB on DOTS therapy were enrolled for the study. Out of 121 patients, 13 were dropouts, 6 died, 7 defaulted so 108 patients assessed for ADRs, 48 patients developed 61 (56.48%) adverse drug reactions. The higher numbers of ADRs were observed in age group 31-40yrs followed by 21-30yrs which were more common in men. Majority of adverse drug reactions were Gastrointestinal (GI) problems 32 (52.45%), followed by Ototoxicity 7 (11.48%) and Psychiatric Manifestations 6 (9.84%) and skin problems 3 (4.92%). On evaluation of the causality of ADRs, majority were found to be Possible (59.02%). The severity assessment showed that most of the patients ADRs were of moderate level (50.82%).Some patients required treatment withdrawal and replacement with other drug and most of the patients were managed with supportive medication without removing anti-tubercular drug from their treatment regimen.Conclusions: ADRs are major factor limiting completion of drug therapy under RNTCP and occurrence of drug resistance which requires attention of all health care professionals.

scholarly journals P330 Inflammatory Bowel Disease (IBD) patients frequently report adverse drug reactions during biologic therapy: A multicentre, prospective, patient-reported pharmacovigilance monitoring system

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S319-S319 ◽  
Author(s):  
P THOMAS ◽  
R West ◽  
M Russel ◽  
J Jansen ◽  
J van Lint ◽  
...  
Keyword(s):  
Healthcare Provider ◽  
Monitoring System ◽  
Adverse Drug Reactions ◽  
Daily Practice ◽  
Drug Reactions ◽  
Therapeutic Consequences ◽  
Treatment Optimisation ◽  
Patient Reported ◽  
High Level ◽  
System Organ

Abstract Background The use of biologicals has improved the treatment of IBD but the understanding of adverse drug reactions (ADRs) and the knowledge of patients’ perception on ADRs is poor. Patient-reporting may provide more insight in the extent and burden of ADRs in daily practice which in turn can lead to treatment optimisation. This study aimed to assess systematic patient-reported ADRs during biological therapy in IBD patients. Methods This multicentre, prospective, event monitoring study enrolled adult Crohn’s disease (CD) and ulcerative colitis (UC) patients treated with a biological between 1 January 2017 and 31 December 2018. Patients completed bimonthly comprehensive web-based questionnaires regarding indication and use of, description of biological induced ADRs, follow-up of previous ADRs, experienced burden of the ADR using a 5-point Likert scale, contact with a healthcare provider and therapeutic consequences due to the ADR. Patient-reported ADRs were MedDRA coded by trained pharmacovigilance assessors. MedDRA is a multi-hierarchical dictionary used to code reported ADRs into specific unambiguous terms (preferred terms). Preferred terms are subsequently grouped into high-level terms, high-level group terms and system organ classes. In total there are 26 system organ classes. Results In total, 182 patients in 4 centres (female 51%, mean (standard deviation) age 42.2 (14.2) years, CD 77%) were included and completed 750 questionnaires. At baseline, 49% used an immunomodulator (43% thiopurines, 6% methotrexate), while biologicals were documented as follows: 59% infliximab, 30% adalimumab, 9% vedolizumab, 1% ustekinumab. At least one ADR was reported by 50% of the participants, and 233 ADRs were reported in total with a median reported ADRs per participant of 2 (interquartile range, 1–3). Fatigue (n = 26), headache (n = 20), injection site reactions (n = 16) and arthralgia (n = 12) were most commonly reported, with a mean burden of 3.31, 1.63, 2.55 and 3.33, and a correlation in time with the administration of the biologic was described in 58%, 85%, 81% and 8% in these ADRs, respectively. Participants contacted a healthcare provider in 62% of all ADRs. In two out of 90 patients who reported an ADR, the biological was discontinued. Conclusion We established a patient-reported pharmacovigilance monitoring system and participants in this study frequently reported ADRs due to biologicals. Fatigue and arthralgia resulted in the highest burden. This reporting system may provide more understanding of patient-experienced ADRs which may ultimately lead to increased adherence of therapy and improved quality of life.

Identifying adverse drug reactions and drug-induced diseases using network-based drug mapping

2015 ◽  
Vol 13 (01) ◽  
pp. 1540007 ◽  
Author(s):  
Alban Shoshi ◽  
Venus Ogultarhan ◽  
Tobias Hoppe ◽  
Benjamin Kormeier ◽  
Ulrich Müller ◽  
...  
Keyword(s):  
Adverse Drug Reactions ◽  
Prescription Drugs ◽  
Medical Doctor ◽  
Drug Reactions ◽  
Quality Of Information ◽  
Drug Induced ◽  
Starting Point ◽  
Molecular Information ◽  
Multiple Drugs

Drugs are essential for the prevention and treatment of diseases. However, co-administration of multiple drugs may cause serious adverse drug reactions, which are usually known but sometimes unknown. Package inserts of prescription drugs are supposed to contain risks and side effects, but such information is not necessarily complete. At the core of efforts to improve prescription quality, there is reliance on the extent and quality of information used for decision of a medical doctor. To address this on-going need, GraphSAW provides users a comprehensive view on drug-related pharmacological and molecular information. The features of GraphSAW allow users to analyze drug cocktails for adverse drug reactions and drug-induced diseases. Network visualization by drug mapping enables exploring associative networks of drugs, pathways, and diseases to fully understand effects of drugs in an intuitive way. GraphSAW is meant to be a platform and starting point for health professionals and researchers for educational and scientific research in order to achieve substantial improvements in patient safety.

scholarly journals A Multi-Agent System for Reporting Suspected Adverse Drug Reactions

2014 ◽  
Vol 6 (3) ◽  
Author(s):  
Yanqing Ji ◽  
Fangyang Shen ◽  
See-Yan Lau ◽  
John Tran
Keyword(s):  
Adverse Drug Reactions ◽  
Healthcare Professionals ◽  
Public Health Problem ◽  
Reporting Rate ◽  
Drug Reactions ◽  
Data Mining Approach ◽  
Spontaneous Reports ◽  
Post Marketing ◽  
Multi Agent ◽  
Suspected Adverse Drug Reactions

Adverse drug reactions (ADRs) represent a serious worldwide public health problem. Current post-marketing ADR detection approaches largely rely on spontaneous reports filed by various healthcare professionals such as physicians, pharmacists et.al.. Underreporting is a serious deficiency of these methods - the actually reported adverse events represent less than 10% of all cases. Studies show that two important reasons that cause the underreporting are: 1) healthcare professionals are unaware of encountered ADRs, especially for those unusual ADRs; 2) they are too busy to voluntarily report ADRs since it takes a lot of time to fill out the reporting forms. This paper addresses these two issues by developing a multi-agent ADR reporting system. The system 1) helps healthcare professionals detect the potential causal relationship between a drug and an ADR by analyzing patients’ electronic records via both case-based analysis and statistical data mining approach; 2) allows healthcare professionals to add new rules to signal potential ADRs based on their medical expertise; 3) makes the reporting much easier by automatically linking the patients’ electronic data with the reporting form. A functioning prototype of the system has been developed. The proposed data analysis approaches as well as the performance of the system have been tested. The results indicate that this system has a great potential to improve the spontaneous reporting rate of suspected adverse drug reactions.

FRAILTY AND DRUG USE

2016 ◽  
pp. 1-4
Author(s):  
K. PALMER ◽  
A. MARENGONI ◽  
P. RUSSO ◽  
F. MAMMARELLA ◽  
G. ONDER
Keyword(s):  
Older Adults ◽  
Drug Use ◽  
Adverse Drug Reactions ◽  
Poor Adherence ◽  
Drug Reactions ◽  
Adherence To Treatment ◽  
Older Population ◽  
Development Management ◽  
Increased Risk ◽  
Multiple Drugs

Older adults often have co-occurring multiple chronic and acute diseases, which progressively and steadily increase in prevalence with age (1, 2). The treatment of these diseases usually requires multiple drugs (polypharmacy); it has been estimated that more than 50% of persons aged 65 years or older receive five or more drugs concomitantly (3, 4). Drug use in the older population might raise several concerns related to an increased risk of drug-drug and drug-disease interactions, poor adherence to treatment, and increased risk of adverse drug reactions (5-7). In this chapter we will discuss what role drugs and polypharmacy play in the development, management and treatment of frailty.

scholarly journals The pattern of reported adverse drug reactions with reference to specific drug class and organ system

2020 ◽  
Vol 9 (12) ◽  
pp. 1824
Author(s):  
Margaret Viola Jillapegu ◽  
Dhishan Sai Kumboju Srinivasulu ◽  
Umamaheswara Raju Sarikonda ◽  
Raghunatha Rao Ponnaluri ◽  
Jahnavi Tiruveedhula
Keyword(s):  
Adverse Drug Reactions ◽  
Antimicrobial Agents ◽  
Drug Class ◽  
Tertiary Care ◽  
Public Health Problem ◽  
Organ System ◽  
Major Public Health Problem ◽  
Specific Drug ◽  
Drug Reactions ◽  
Cross Sectional

Background: Adverse drug reactions (ADRs) represent a major public health problem. The overall ADR rate is estimated to be 6.5 and 28% of these are preventable.ADR incidence in Indian population ranges between 1.8-25% with 8% resulting in hospitalization. Hence, the present study was undertaken to study the pattern of reported adverse drug reactions with reference to specific drug class and organ system in a tertiary care hospital.Methods: A cross-sectional retrospective study was carried to analyse the ADRs reported over a period of one year (January-December 2019). Individual case safety reports (ICSRs) of all patients of suspected adverse drug reactions seen in various out-patient departments and admitted in the wards of the hospital were included in the study. The ICSRs were analysed for patient demography, causality, severity and with reference to specific drug class and organ system.Results: Among 382 reported ADRs, 27.2% of the ADRs were reported as serious. The most common therapeutic class of drugs causing ADRs where Antimicrobial agents (36.07%). The skin is the most common affected organ system (25.39%).Conclusions: A coordinated system of identifying the ADRs early in the course of treatment and recognizing the preventable ADRs is required by the health care system. The coordination of prescribing physicians and pharmacovigilance personnel can produce better trend of reporting the ADRs.

scholarly journals Pharmacogenomic Profile and Adverse Drug Reactions in a Prospective Therapeutic Cohort of Chagas Disease Patients Treated with Benznidazole

2021 ◽  
Vol 22 (4) ◽  
pp. 1960
Author(s):  
Lucas A. M. Franco ◽  
Carlos H. V. Moreira ◽  
Lewis F. Buss ◽  
Lea C. Oliveira ◽  
Roberta C. R. Martins ◽  
...  
Keyword(s):  
Signaling Pathways ◽  
Chagas Disease ◽  
Adverse Drug Reactions ◽  
Public Health Problem ◽  
Nucleotide Polymorphisms ◽  
Drug Reactions ◽  
Single Nucleotide ◽  
Genomic Analyses ◽  
Before And After ◽  
Genetically Determined

Chagas disease remains a major social and public health problem in Latin America. Benznidazole (BZN) is the main drug with activity against Trypanosoma cruzi. Due to the high number of adverse drug reactions (ADRs), BZN is underprescribed. The goal of this study was to evaluate the genetic and transcriptional basis of BZN adverse reactions. Methods: A prospective cohort with 102 Chagas disease patients who underwent BZN treatment was established to identify ADRs and understand their genetic basis. The patients were classified into two groups: those with at least one ADR (n = 73), and those without ADRs (n = 29). Genomic analyses were performed comparing single nucleotide polymorphisms between groups. Transcriptome data were obtained comparing groups before and after treatment, and signaling pathways related to the main ADRs were evaluated. Results: A total of 73 subjects (71.5%) experienced ADRs. Dermatological symptoms were most frequent (45.1%). One region of chromosome 16, at the gene LOC102724084 (rs1518601, rs11861761, and rs34091595), was associated with ADRs (p = 5.652 × 10−8). Transcriptomic data revealed three significantly enriched signaling pathways related to BZN ADRs. Conclusions: These data suggest that part of adverse BZN reactions might be genetically determined and may facilitate patient risk stratification prior to starting BZN treatment.

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