Peculiarities of administration of medications to patients with circulatory system diseases within the framework of the federal program of preferential provision of medicines

Objective: to analyse of medicines prescriptions for federal beneficiaries with circulatory system diseases and to identify the main trends in the implementation of the federal program for the provision of necessary medicines in the Samara Region in 2014–2017.Material and methods. The authors reviewed the nomenclature of medicines used to treat circulatory system diseases (CSDs) and distributed to the population of the Samara Region as part of the federal program for the provision of necessary medicines for the period from 2014 to 2017. The methods of comparative, retrospective, logical, graphical and content analysis, the method of data grouping according to Anatomical Therapeutic Chemical classification and methods of descriptive statistics were used.Results. In 2014–2017 the share of financial costs for the purchase of medicines in the total budget of the federal program for the provision of necessary medicines in the Samara Region did not exceed 6%. Still, in physical terms (in terms of the number of packages) the share of medicines of this pharmacotherapeutic group in the federal program for the provision of necessary medicines averaged about 25%. Nomenclature of medicines of the analyzed group prescribed to federal beneficiaries in 2014–2017 ranged from 90 to 107 nomenclature items. The number of international nonproprietary names (INN) decreased from 51 in 2014 to 36 in 2017. During the period under review, there was a decrease in the acquisition cost of medicines for the treatment of circulatory system diseases and the weighted average cost of one package (by 63% and 53%, respectively).Conclusion. Perindopril-containing medicines occupied the maximum consumption volumes in monetary terms. There was a decrease in the average cost of one package in 2017, which may be associated with the replacement of original medicines with generics and a concomitant reduction in the number of INN within the subgroup.

Analysis of the Consumption of Non-Oncological Medicines: A Methodological Study on Patients of the Ada Cohort

Cancer patients are identified as fragile patients who are often immunodepressed and subject to secondary diseases. The Ada cohort comprises cancer survivors aged 15–39 years at diagnosis included in 34 Italian cancer registries. This study aimed to analyze the possible excess of non-cancer medicines use on the basis of the medicine database of the Ada cohort. Records of medicines present in the pharmaceutical flows collected by eight Lombardy cancer registries and used by patients with any type of cancer were extracted for the year 2012. Medicine consumption data were processed to assign a defined daily dose value and to evaluate the consumption of medicines belonging to different groups of the ATC (Anatomical Therapeutic Chemical) classification. The values were compared with values in the Lombardy population. Medicine consumption related to 8150 patients was analyzed, for a total of 632,675 records. ATC groups A and C for females and group N for both sexes showed significant increases. Group J for males and group M for females showed intermediate increases, and group H for both sexes showed smaller increases. This method allowed the identification of excess medicine use to reduce cancer therapy side effects and primary disease sequelae in this group of patients.

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

Primary 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.

MEDICAMENTOS PRESCRITOS A GESTANTES EM AMBIENTE HOSPITALAR DE DOURADOS (MS)

O estudo do uso correto e seguro de medicamentos é sempre importante, especialmente durante a gestação. O objetivo desta pesquisa foi conhecer os medicamentos prescritos para gestantes em ambiente hospitalar da cidade de Dourados (MS). Analisou-se 33 prontuários de gestantes entre a faixa etária de 18 a 29 anos. Os medicamentos foram divididos por classe terapêutica (Anatomical Therapeutic Chemical Classification System - ATC) e quanto aos critérios de risco da Food and Drug Administration (FDA). O total de medicamentos utilizados foram 89, com média de 2,7 drogas por gestante. As classes terapêuticas mais utilizadas foram os para distúrbios gastrointestinais – A03 (24,7%), analgésicos – N02 (14,6%), anti-histamínicos de uso sistêmico– R06 (10,1%) e vitaminas – A11 (8,9%) e antiemético/antinauseante – A04 (5,6%). Pela classificação da FDA, 6,7% estão na categoria de risco A, 40% na B, 45% na C, 2% na D e nenhum na X. Os dados pertinentes à posologia estavam completos nos prontuários analisados. Os medicamentos mais prescritos entre 33 gestantes atendidas em uma unidade hospitalar de Dourados foram para distúrbios gastrointestinais, analgésicos, anti-histamínicos de uso sistêmico e antiemético/antinauseante. O dado mais preocupante foi relacionado aos medicamentos classificados com o risco C. Desta forma, existe a necessidade de uma prescrição criteriosa para evitar riscos fetais ocasionados por fármacos por se tratarem de medicações sem informações para um uso seguro em gestantes.

TD 2634 - Indutores do Gasto Direto do Ministério da Saúde em Medicamentos (2010-2019)

O objetivo deste texto é analisar a contribuição dos principais indutores do gasto direto do Ministério da Saúde (MS) em medicamentos que integram a lista dos componentes da assistência farmacêutica (AF) no período de 2010 a 2019. Foram utilizados dados de aquisições constantes do Sistema Integrado de Administração de Serviços Gerais (Siasg). Os medicamentos foram categorizados segundo o sistema de classificação ATC/DDD (Anatomical Therapeutic Chemical Classification System/defined daily doses) da Organização Mundial da Saúde (OMS). As unidades físicas de compra dos produtos foram transformadas em número de doses diárias definidas (DDD) para cada fármaco e o preço unitário foi convertido para preço por DDD. Com o suporte do software RStudio versão 1.3.1056 e do pacote estatístico IndexNumR, mensurou-se a contribuição dos principais indutores do gasto em medicamentos: preço, quantidade e resíduo (escolhas terapêuticas). Os resultados mostram grande variação do gasto do MS em medicamentos da lista dos componentes da AF no período de 2010 a 2019, com maior ou menor contribuição de cada indutor principal na oscilação observada. Contudo, chama a atenção a redução do gasto em alguns anos, induzida principalmente pela diminuição da quantidade de medicamentos adquirida em dois anos consecutivos, o que pode resultar em queda da disponibilidade desses produtos no Sistema Único de Saúde (SUS).

Estudo sobre a utilização racional de medicamentos em idosos

Este estudo teve como objetivo analisar as Interações Medicamentosas Potenciais e os Medicamentos Potencialmente Inapropriados para Idosos usuários das farmácias da atenção primária. Estudo descritivo com desenho transversal com amostra de 384 idosos/cuidadores, distribuídos entre todas as seis farmácias da cidade de Uberaba, MG no ano de 2015. Todas as prescrições apresentadas foram analisadas e os medicamentos classificados segundo a Anatomical Therapeutic Chemical Classification; e, na base de dados MICROMEDEX® e pelo Critério de Beers-Fick (2015). Foram analisadas 580 prescrições e verificadas 570 Interações, estando 47,4% dos participantes sujeitos a pelo menos uma interação; 54,7% utilizavam medicamentos inapropriados. Os medicamentos mais envolvidos nas interações foram: omeprazol (19,5%), AAS (14,2%) e losartana (13,2%). Verificou-se a necessidade de adoção de medidas gerenciais e educativas que visem mais segurança e eficácia terapêutica para os idosos.

Implementation of pharmacogenomics in product information

Aim: The aim of our study was to analyse the level of implementation of pharmacogenomics (PGx) in product information (PI) of medicinal products approved through national procedures in the EU. Materials & methods: In the analysis, we included nationally approved medicinal products in Croatia if guidelines for relevant substances were published. Results: Overall, 265 marketing authorizations were analyzed. The majority of data included in PI was only informative, while the most frequent PGx biomarkers were genes which code CYP P450. Analysis according to the Anatomical Therapeutic Chemical classification revealed that most substances belonged to the nervous system. Conclusion: Although hindrances in implementation are anticipated, PI should be more specific in terms of when the testing is indicated and should include actionable recommendations according to the results of PGx testing.

Perfil de tratamento com psicofármacos de usuários de um centro de atenção psicossocial infanto-juvenil

A presente pesquisa objetiva analisar o perfil de tratamento com psicofármacos de usuários de um Centro de Atenção Psicossocial Infanto-juvenil (CAPSi). Delineamento transversal, documental, quantitativo e analítico, realizado em um CAPSi do Noroeste do Rio Grande do Sul. Foram coletadas informações sobre idade, sexo, tratamento medicamentoso, diagnóstico e tempo de atendimento de 208 prontuários de usuários, com idade menor ou igual a 18 anos, ambos os sexos e cadastro ativo no período da pesquisa. Medicamentos classificados Anatomical Therapeutic Chemical Classification System e interações medicamentosas a partir da base de dados Micromedex® Solutions. Análise de dados com Qui-quadrado de Pearson, Odds ratio (OR) e Mann-Whitney. Identificou-se idade média dos usuários de 12,34±3,59 anos, 63,9% do sexo masculino, 82,2% em tratamento medicamentoso, desses 95,5% com ação sobre o sistema nervoso central. Os antidepressivos e antiepiléticos foram utilizados com maior frequência, 31,5% e 29,6% respectivamente. O sexo feminino apresentou quase três vezes mais chance de usar medicação e pacientes previamente hospitalizados de ambos os sexos quase quatro vezes mais. Entre os usuários, 71,6% estão expostos a pelo menos uma interação medicamentosa potencial, destas 54,9% graves. Verificou-se elevado consumo de psicofármacos e potenciais interações medicamentosas entre os usuários estudados. Evidencia-se a necessidade de novos estudos que orientem a prática clínica nessa população a fim de garantir qualidade de vida, reabilitação psicossocial e reintegração à comunidade.

Comparative analysis of the use of lipid modifying agents in the Republic of Serbia and Nordic countries in the period 2015-2017

Introduction: Cardiovascular diseases are the leading cause of death both in Serbia and in the rest of the world. It has been shown that as many as 80% of them are preventable. Control of serum lipid levels is one of the most important tasks of cardiovascular diseases prevention. Aim: The aim of the study was to analyze the use of serum lipid-modifying drugs in Serbia, Norway and Finland in the period 2015-2017. Methods: Data on drugs use during 2015, 2016 and 2017 were taken from the official websites of national drug regulatory authorities: the Serbian Medicines and Medical Devices Agency, the Norwegian Institute of Public Health and the Finnish Medicines Agency. Use was expressed as DDD/1000 inhabitants/day according to the Anatomical Therapeutic Chemical classification. Results: The share of drugs used for treatment of cardiovascular diseases in total drugs use was the largest in all three countries during the observed period. The use of lipidmodifying agents was 3-4 times lower in Serbia than in Norway or Finland. Of all lipidmodifying drugs, statins are most commonly prescribed in all three countries. Atorvastatin and rosuvastatin are the most widely used in Serbia, and simvastatin and atorvastatin in Norway and Finland. Conclusions: Use of lipid-modifying drugs in Serbia is lower than in Norway and Finland, but it is constantly increasing. This use in Serbia still represents the smallest share of all drugs for the treatment of cardiovascular diseases.