Consequências da Polifarmacoterapia em Idosa Vestibulopata

2016 ◽  
Vol 7 (2) ◽  
pp. 31
Author(s):  
Célia Aparecida Paulino ◽  
Fabiane Maria Costa ◽  
Maria Rita Aprile
Keyword(s):  
Drug Interactions ◽  
Anatomical Therapeutic Chemical ◽  
Medical Letter ◽  
Insuficiencia Cardiaca

<p>A polifarmacoterapia para tratamento de múltiplas doenças é uma realidade na população idosa. O objetivo deste trabalho foi avaliar as consequências do uso de múltiplos fármacos em idosa com vestibulopatia. O estudo foi previamente aprovado pelo Comitê de Ética em Pesquisa (Protocolo 475.835/2013) e realizado com base em informações de idosa de 64 anos, com labirintopatia vascular e queixas de tontura, zumbido e desequilíbrio, além de relato de queda. A idosa é hipertensa, apresenta insuficiência arterial e venosa crônica, aterosclerose de artérias coronárias e hérnia discal lombar. Passou por cateterismo e angioplastia. Faz uso contínuo e concomitante de nove medicamentos, cada um contendo apenas um fármaco, a saber: Captopril, Propranolol, Hidroclorotiazida, Ácido acetilsalicílico, Pravastatina, Bezafibrato, Meloxicam, Omeprazol e Hidróxido de alumínio. Os fármacos foram classificados pela Anatomical Therapeutic Chemical (ATC) e as interações analisadas pelo The Medical Letter Drug Interactions Program. Todos os fármacos fizeram algum tipo de interação, com exceção do Bezafibrato, que não pôde ser analisado. As principais consequências das diferentes interações foram: diminuição do efeito anti-hipertensivo e diurético (em diferentes interações); redução do efeito hipotensor (em diferentes interações); bloqueio do efeito terapêutico do Ácido acetilsalicílico sobre a mortalidade após infarto do miocárdio; piora da insuficiência cardíaca congestiva; arritmias cardíacas; aumento do risco de insuficiência renal; indução e agravamento da insuficiência renal (provável efeito aditivo); hiponatremia; hipotensão; maior risco de toxicidade gastrintestinal; possível toxicidade do Ácido acetilsalicílico; aumento do efeito hiperglicêmico da Hidroclorotiazida; redução da absorção e do efeito do Captopril, Propranolol e Ácido acetilsalicílico. A polifarmacoterapia utilizada resultou em diferentes interações medicamentosas, cujas consequências farmacológicas podem ter repercussões clínicas importantes para a saúde desta idosa e de outros idosos que utilizam as mesmas medicações, sobretudo os que apresentam vestibulopatias.</p>

scholarly journals Characterization of Schizophrenia Adverse Drug Interactions through a Network Approach and Drug Classification

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Jingchun Sun ◽  
Min Zhao ◽  
Ayman H. Fanous ◽  
Zhongming Zhao
Keyword(s):  
Nervous System ◽  
Drug Interactions ◽  
Antipsychotic Drugs ◽  
Alimentary Tract ◽  
Anatomical Therapeutic Chemical ◽  
Interaction Network ◽  
Network Approach ◽  
Adverse Drug Interaction ◽  
Drug Classification

Antipsychotic drugs are medications commonly for schizophrenia (SCZ) treatment, which include two groups: typical and atypical. SCZ patients have multiple comorbidities, and the coadministration of drugs is quite common. This may result in adverse drug-drug interactions, which are events that occur when the effect of a drug is altered by the coadministration of another drug. Therefore, it is important to provide a comprehensive view of these interactions for further coadministration improvement. Here, we extracted SCZ drugs and their adverse drug interactions from the DrugBank and compiled a SCZ-specific adverse drug interaction network. This network included 28 SCZ drugs, 241 non-SCZs, and 991 interactions. By integrating the Anatomical Therapeutic Chemical (ATC) classification with the network analysis, we characterized those interactions. Our results indicated that SCZ drugs tended to have more adverse drug interactions than other drugs. Furthermore, SCZ typical drugs had significant interactions with drugs of the “alimentary tract and metabolism” category while SCZ atypical drugs had significant interactions with drugs of the categories “nervous system” and “antiinfectives for systemic uses.” This study is the first to characterize the adverse drug interactions in the course of SCZ treatment and might provide useful information for the future SCZ treatment.

scholarly journals POSSIBLE TOXIC EFFECTS OF BENZODIAZEPINES;

2013 ◽  
Vol 20 (02) ◽  
pp. 284-289
Author(s):  
SYED TALAT IQBAL ◽  
ZAINAB BATOOL ◽  
SAJID MEHMOOD
Keyword(s):  
Drug Interactions ◽  
Seizure Control ◽  
Toxic Effects ◽  
Potential Ddis ◽  
Aged Patients ◽  
Ensure Patient Safety ◽  
Medical Letter ◽  
Related Drug ◽  
Detection Software ◽  
Therapeutic Doses

Introduction: Benzodiazepines and its derivatives are used widely as anxiolytics, hypnotics, seizure control and as musclerelaxants. Design: The prescriptions of 270 patients were evaluated for moderate to severe drug interactions using drug interactiondetection software. Setting: Teaching hospital in Gujrat, Pakistan. Objective: This study is used to evaluate the possible toxic effects ofbenzodiazepine related drug-drug interactions in prescriptions of indoor patients. Material & Methods: The prescriptions wereprocessed through a software program named, The Medical Letter Adverse Drug Interaction program. The randomly collected patientchart profiles included both male and female patients ranging from age of few months old children to old aged patients. Result: Out of 270patients medication charts 210 medication charts were having at least one or more drug interactions ranging from moderate to severe.Out of 80 interacting drug combinations found, 15 were benzodiazepine related drug interactions. So, percentage of benzodiazepinesrelated drug interactions was 18.75%.Moreover, the data also showed that the percentage of DDIs increases as the prescription sizeincreases. Our results indicate that hospitalized patients in Pakistan are at risk of ADRs caused by potential DDIs. Moreover, there arechances that the safe therapeutic doses of benzodiazepines may become toxic or ineffective due to drug-drug interactions andpolypharmacy. Conclusions: So, the use of DDIs detection software programs in hospitals and pharmacies should be promoted in orderto minimize drugs especially benzodiazepines related injuries and to ensure patient safety.

The Medical Letter Handbook of Drug Interactions

1984 ◽  
Vol 3 (1) ◽  
pp. 90 ◽  
Author(s):  
Martin A. Rizack ◽  
Carol D. M. Hillman
Keyword(s):  
Drug Interactions ◽  
Medical Letter

Drug Interactions in Palliative Care

2000 ◽  
Vol 18 (8) ◽  
pp. 1780-1799 ◽  
Author(s):  
Stephen A. Bernard ◽  
Eduardo Bruera
Keyword(s):  
Palliative Care ◽  
Drug Interactions ◽  
Selective Serotonin Reuptake Inhibitors ◽  
English Literature ◽  
Relevant Literature ◽  
Medical Subject Headings ◽  
Time Period ◽  
Palliative Care Setting ◽  
Medical Letter ◽  
Cyp 2D6

PURPOSE: This review of drug interactions in palliative care examines the relevant literature in this area and summarizes the information on interactions of drugs, nutrients, and natural products that are used in the palliative care setting. Particular emphasis is placed on describing the newer information on the cytochrome P450 (CYP) system and the interactions of opioids, antidepressants, and the antitussive, dextromethorphan. METHODS: We performed a search of the MEDLINE database of the time period from 1966 until April 1998, using medical subject headings such as the names of selective serotonin reuptake inhibitors and other relevant medications in palliative care. Literature reviewed included both human and animal articles as well as non-English literature. Bibliographies of these articles and the personal libraries of several palliative care specialists were reviewed. Software developed by The Medical Letter—The Drug Interaction Program was also used. RESULTS: Drug interactions can be categorized in several ways. Drug-drug interactions are the most well known and can be kinetic, dynamic, or pharmaceutical. Pharmacokinetic interactions can involve CYP 2D6, which acts on drugs such as codeine and is responsible for its conversion to morphine. Poor metabolizers, either genotypic or due to phenocopying, are at risk for undertreatment if not recognized. Pharmacodynamic interactions with dextromethorphan may produce serotonin syndrome. CONCLUSION: Drug interactions are important in palliative care as in other aspects of medicine. These interactions are similar to those seen in other areas of medical care but have significant consequences in pain management. Failure to recognize these interactions can lead to either overdosing or undertreatment.

scholarly journals Evaluation of Potentially Inappropriate Prescription and Drug-Drug Interactions in the Critically Sick Elderly Patients in China

2021 ◽  
Author(s):  
Xiaohu Yang ◽  
Orgah John Owoicho ◽  
Fengjia Zhu ◽  
Wei Liu ◽  
Yihua Yu
Keyword(s):  
Intensive Care ◽  
Elderly Patients ◽  
Drug Interactions ◽  
Anatomical Therapeutic Chemical ◽  
Clinical Importance ◽  
World Health ◽  
Potentially Inappropriate Medications ◽  
Potentially Inappropriate Prescription ◽  
Baseline Information ◽  
Health Organization

Abstract Background There is ongoing debate about the incidence and relationships of potentially inappropriate prescriptions and drug-drug interactions (DDIs) in elderly patients in China. Objective This study aims to evaluate the prevalence of potentially inappropriate medications (PIMs) and DDIs in elderly patients in an intensive care unit (ICU). Methods A total of 547 patients aged ≥65 years from the 30-bed ICU in a 3A (Class Three/Grade A) hospital in China over a 1-year period were included. The participant statistics and drugs prescribed were collected by the Hospital Information System (HIS). The study was limited to drugs ordered at and during ICU hospitalization. The drug list of every patient was reviewed to identify PIMs based on the 2012 Beers criteria, and the drugs implicated in PIMs were classified at five levels according to World Health Organization Anatomical Therapeutic Chemical classification. Results In total, 94.3% of the patients had prescriptions for ≥10 drugs, and 61.4% of the patients were prescribed at least one PIM. DDIs were identified in 95.6% of the medication profiles evaluated. Conclusions The results of this study conducted in an ICU setting that assessed the incidence and relationships of PIMs and pDDIs in elderly patients in China, providing baseline information and quantifying drug-related problems among critically ill elderly patients receiving PIMs. It is of clinical importance that better information must be provided to physicians and intensive care specialists regarding the risks and benefits of drug therapy, and patient compliance and inappropriate and unnecessary prescriptions must be addressed.

scholarly journals DRUG-DRUG INTERACTIONS;

2014 ◽  
Vol 21 (03) ◽  
pp. 441-444
Author(s):  
Syed Talat Iqbal ◽  
Zainab Batool ◽  
Haseeba Amir ◽  
Tamkenat Mansoor
Keyword(s):  
Drug Interaction ◽  
Drug Interactions ◽  
Study Design ◽  
Teaching Hospital ◽  
Research Paper ◽  
Adverse Drug Interaction ◽  
Medical Letter ◽  
Ware Program

Introduction: This research paper is based on a study conducted on the in-doorpatients at a teaching hospital in Gujrat, Pakistan, in order to check for the frequency with whichPenicillins, Quinolones and Cephalosporins are being used together and in combinations withother drugs and the drug-drug interactions that occur due to these combinations and theirimpacts on the patients. Objectives: (1) To check the frequency with which Penicillins,Quinolone and Cephalosporins are being used in different combinations in patients. (2) Todetermine their drug-drug interactions. (3) Impact on patients due to these interactions. (4)Reasons for prescription of mismatched combinations by clinicians. Study Design: 270 randomprescriptions were collected from different wards of DHQ hospital, Gujrat. These prescriptionswere then analyzed for drug interactions among the above mentioned group of drugs, with thehelp of soft ware program named The Medical Letter Adverse Drug Interaction Program. Setting:Aziz Bhatti Shaheed Hospital (DHQ), Gujrat , Pakistan. Period: Prescriptions were collected overthe period of 3 months. Conclusions: Prescribing antibiotics for different indications in indoorpatients is unavoidable. However, it is the duty of the clinician to monitor the patient when he isusing two or more drugs together. This study recommends the use of drug-drug interactiondetecting software in hospitals, so that, the level of patients’ safety may be enhanced.

scholarly journals CORTICOSTERIOD;

2013 ◽  
Vol 20 (05) ◽  
pp. 694-698
Author(s):  
SYED TALAT IQBAL ◽  
ZAINAB BATOOL
Keyword(s):  
Drug Interaction ◽  
Drug Interactions ◽  
Study Design ◽  
Adverse Drug Interaction ◽  
Frequent Use ◽  
Frequency Of Use ◽  
Medical Letter

Introduction: Indoor patients in hospitals frequently use corticosteriods for different indications. As the number of drugs inprescriptions increases, the risk of drug-drug interactions increases. This study deals with the frequent use and drug-drug ofcorticosteriods. Objective: The present study was designed to determine the frequency of use of corticosteriods in indoor patients andthe resulting drug-drug interactions. Study design: 270 Prescriptions of indoor patients from different wards of Aziz Bhatti Shahidteaching hospital Gujrat were collected randomly over the period of three months. These prescriptions were subjected to a drug-druginteraction software based analysis. The results were collected analysed and presented in the form of tables. Period: The patient chartscontaining prescriptions included in this study were collected over the period of three months. Material and Method: The software namedTHE MEDICAL LETTER ADVERSE DRUG INTERACTION PROGRAM was selected for finding the drug-drug interactions in randomlyselected indoor patient charts. Moreover, the frequency of use of corticosteriods was determined by simply counting the prescriptionscontaining corticosteriods out of total prescriptions and its percentage was found. Results: 29.25% patient charts were includingcorticosteriods in their prescriptions. Percentage of corticosteriod drug interactions found was 25.55%. Conclusions: Frequent use ofcorticosteriods in indoor patients can increase the risk of drug-drug interactions that should be monitored regularly.

scholarly journals Review of Questions Concerning Clinical Drug Interactions in ADHD Treatment From Physicians in Norway

2020 ◽  
Vol 11 ◽  
Author(s):  
Jan Schjøtt ◽  
Kristine Heitmann ◽  
Tina Bakkebø ◽  
Jan Anker Jahnsen
Keyword(s):  
Drug Interactions ◽  
Drug Information ◽  
Anatomical Therapeutic Chemical ◽  
Drug Combinations ◽  
Manual Inspection ◽  
Real World Problem ◽  
Adhd Treatment ◽  
Information Center ◽  
Future Drug ◽  
Theoretical Evidence

Pharmacological treatment of attention deficit hyperactivity disorder (ADHD) is challenging due to a wide age span among patients, risk of reduced adherence, and comorbidities like psychiatric disorders and drug addiction. Drugs used for ADHD are associated with risk of interactions and adverse drug reactions due to their potent pharmacological effect. In this brief report we aimed to describe real-world problem areas concerning interactions in pharmacotherapy of ADHD. We reviewed questions to a Norwegian drug information center from physicians concerning drug-drug interactions involving ADHD drugs in the last 10-year period. Questions were retrieved by a combination of indexed and Boolean database searches, in addition to manual inspection. ADHD drugs and interacting drugs were defined according to the Anatomical Therapeutic Chemical (ATC) classification system. Interactions were classified by use of Stockley’s Interactions Checker (SIC). Answers were examined with regard to whether the advice from the drug information center was more restrictive, similar or more liberal than SIC when assessing drug combinations. We retrieved 61 questions that included assessment of 96 drug combinations, and found 33 potential interactions according to SIC. Methylphenidate was involved in more than 50% of the interactions, and interacting drugs were in nearly 70% of the cases from ATC-group N (Nervous system) with antidepressants most frequently involved. Seventy percent of the interactions were pharmacodynamic, and interactions were frequently described as potentially severe although they were based on theoretical evidence. All the 33 interactions could be handled with monitoring or adjusting dose or with informative measures, and none was contraindicated according to SIC. More than 90% of the questions came from physicians in hospitals or outpatient specialist practice, and questions mainly concerned adults. In 75% of the drug combinations that involved ADHD drugs, we found similar advice from SIC and the drug information center. Our results suggest that future drug information efforts in ADHD treatment to clinicians, including specialists in the field, should focus on psychotropic interactions.

scholarly journals Drug–drug interactions between treatment specific pharmacotherapy and concomitant medication in patients with COVID-19 in the first wave in Spain

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
M. D. Cantudo-Cuenca ◽  
Antonio Gutiérrez-Pizarraya ◽  
Ana Pinilla-Fernández ◽  
Enrique Contreras-Macías ◽  
M. Fernández‑Fuertes ◽  
...  
Keyword(s):  
Drug Interactions ◽  
Concomitant Medication ◽  
Anatomical Therapeutic Chemical ◽  
Tertiary Hospital ◽  
Anatomical Therapeutic Chemical Classification ◽  
Factors Associated ◽  
Mechanism Of Interaction ◽  
Concomitant Medications ◽  
The University ◽  
Potential Interactions

AbstractPrimary aim was to assess prevalence and severity of potential and real drug–drug interactions (DDIs) among therapies for COVID-19 and concomitant medications in hospitalized patients with confirmed SARS-CoV-2 infection. The secondary aim was to analyze factors associated with rDDIs. An observational single center cohort study conducted at a tertiary hospital in Spain from March 1st to April 30th. rDDIs refer to interaction with concomitant drugs prescribed during hospital stay whereas potential DDIs (pDDIs) refer to those with domiciliary medication. DDIs checked with The University of Liverpool resource. Concomitant medications were categorized according to the Anatomical Therapeutic Chemical classification system. Binomial logistic regression was carried out to identify factors associated with rDDIs. A total of 174 patients were analyzed. DDIs were detected in 152 patients (87.4%) with a total of 417 rDDIs between COVID19-related drugs and involved hospital concomitant medication (60 different drugs) while pDDIs were detected in 105 patients (72.9%) with a total of 553 pDDIs. From all 417 rDDIs, 43.2% (n = 180) were associated with lopinavir/ritonavir and 52.9% (n = 221) with hydroxychloroquine, both of them the most prescribed (106 and 165 patients, respectively). The main mechanism of interaction observed was QTc prolongation. Clinically relevant rDDIs were identified among 81.1% (n = 338) (‘potential interactions’) and 14.6% (n = 61) (contraindicated) of the patients. Charlson index (OR 1.34, 95% IC 1.02–1.76) and number of drugs prescribed during admission (OR 1.42, 95% IC 1.12–1.81) were independently associated with rDDIs. Prevalence of patients with real and pDDIs was high, especially those clinically relevant. Both comorbidities and polypharmacy were found as risk factors independently associated with DDIs development.

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