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BACKGROUND: To determine the patterns of irrational use of medications among a sample of adult patients with insomnia. METHODS: We included 89 adult patients diagnosed with chronic insomnia who had consumed medications for this disorder during the 12 months prior to admission to a specialized Sleep Disorders Clinic (SDC) in Mexico City. With a 13-item survey, information was gathered on patterns of medication use and irrational use, considering therapeutic indications, dose, route of administration, and duration of treatment. RESULTS: The participants had taken hypnotics (65%), antidepressants (21%), anticonvulsants (8%), and antipsychotics (6%), and 92% had irrational use of their medication. Irrational use was greatest with benzodiazepines and antipsychotics. There were two main types of irrational use: (1) 47% of participants had consumed a drug unsuitable for their condition, although it was almost always prescribed by a doctor, and (2) 43% had consumed a drug for longer than the maximum time recommended. CONCLUSION: It is worrisome to find that the irrational use of medications to treat insomnia, especially benzodiazepines and antipsychotics is widespread. Although most participants had acquired their medication by prescription, for many the drug was inappropriate to treat their condition. It should be mandatory that patients with insomnia receive specialized medical attention in primary clinical care.
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BACKGROUND: Dexmedetomidine (DEX) is an α2-adrenergic receptor agonist used for its sedative, analgesic, and anxiolytic effects. Non-Operating Room Anesthesia (NORA) is a modality of anesthesia that can be done under general anesthesia or procedural sedation or/and analgesia. In this particular setting, a level-2 sedation, such as the one provided by DEX, is beneficial. We aimed to study the effects and safety of DEX in the different NORA settings in the adult population. METHODS: A systematic review with meta-analysis of randomized controlled trials was conducted. Interventions using DEX only or DEX associated with other sedative agents, in adults (18 years old or more), were included. Procedures outside the NORA setting and/or without a control group without DEX were excluded. MEDLINE, ClinicalTrials.gov, Scopus, LILACS, and SciELO were searched. The primary outcome was time until full recovery. Secondary outcomes included hemodynamic and respiratory complications and other adverse events, among others. RESULTS: A total of 97 studies were included with a total of 6,706 participants. The meta-analysis demonstrated that DEX had a higher time until full recovery (95% CI = [0.34, 3.13] minutes, a higher incidence of hypotension (OR = 1.95 [1.25, 3.05], p = 0.003, I2 = 39%) and bradycardia (OR = 3.60 [2.29, 5.67], p < 0.00001, I2 = 0%), and a lower incidence of desaturation (OR = 0.40 [0.25, 0.66], p = 0.0003, I² = 60%). CONCLUSION: DEX in NORA procedures in adults was associated with a lower incidence of amnesia and respiratory effects but had a long time to recovery and more hemodynamic complications.
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OBJECTIVE: To investigate the use of sedatives by older adults attending a private outpatient geriatric clinic in Belo Horizonte (MG), Brazil, and its association with falls and hip fractures. METHODS: Using a longitudinal design, the prevalence of benzodiazepine and nonbenzodiazepine ("z-drugs") intake by older adults was described and their association with the incidence of falls and fractures (30 days after the initial visit) was evaluated through logistic regression. RESULTS: A total of 7821 older adults were included in the study, most of them women (72.50%), with a mean age of 77.5 years and a mean Clinical-Functional Vulnerability Index (IVCF-20) score of 16.5. The overall prevalence of sedative use (any sedative) was 6.19%, with 4.48% benzodiazepines and 1.98% z-drugs. The most widely used sedatives were clonazepam (29.04%), zolpidem (28.65%), and alprazolam (23.44%). Falls were reported for 182 patients (2.33%), with a higher incidence among users of any sedatives (4.34; p = 0.002; OR = 1.94, adjusted for sex, age, and IVCF-20) and benzodiazepines (5.14%; p < 0.001; OR = 2.28) than among non-users (2.19%). Hip fractures occurred in 33 patients (0.42%), and again were more frequent among users of sedatives (1.03%; p = 0.032; OR = 2.57) and benzodiazepines (1.43%; p = 0.003; OR = 3.45) than among non-users (0.38%). CONCLUSIONS: The use of sedatives, especially benzodiazepines, is associated with an increased incidence of falls and hip fractures in older adults
OBJETIVO: Investigar a utilização de sedativos entre idosos atendidos em ambulatório privado de geriatria em Belo Horizonte (MG), bem como sua associação com quedas e fraturas de fêmur. METODOLOGIA: Trata-se de estudo longitudinal, no qual foi descrita a prevalência de uso de benzodiazepínicos e drogas Z entre idosos (60 anos ou mais) e avaliada sua associação com a incidência de queda e fratura (30 dias após consulta inicial) por meio de regressão logística. RESULTADOS: Foram incluídos no estudo 7821 idosos, com maioria feminina (72,50%), idade média de 77,5 anos e Índice de Vulnerabilidade Clínico Funcional (IVCF-20) médio de 16,5 pontos. A prevalência de uso de sedativos em geral foi de 6,19%, sendo 4,48% de benzodiazepínicos e 1,98% de drogas Z. Os medicamentos sedativos mais utilizados foram clonazepam (29,04%), zolpidem (28,65%) e alprazolam (23,44%). Relatou-se queda para 182 idosos (2,33%), com incidência maior entre usuários de sedativos (4,34; p = 0,002; OR = 1,94 ajustada por sexo, idade e IVCF-20) e de benzodiazepínicos (5,14%; p < 0,001; OR = 2,28) do que entre não usuários (2,19%). Identificou-se fratura de fêmur em 33 idosos (0,42%), sendo mais frequente entre usuários de sedativos (1,03%; p = 0,032; OR = 2,57) e de benzodiazepínicos (1,43%; p = 0,003; OR = 3,45) do que entre não usuários (0,38%). CONCLUSÃO: Concluiu-se que a incidência de quedas e fraturas de fêmur em idosos possui associação com o uso de medicamentos sedativos, em especial os benzodiazepínicos
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Benzodiazepinas/administração & dosagem , Acidentes por Quedas , Fraturas do Fêmur/tratamento farmacológico , Serviços de Saúde para Idosos , Hipnóticos e Sedativos/administração & dosagem , Estudos LongitudinaisRESUMO
Introducción: los adultos mayores son una población de riesgo para el desarrollo de reacciones adversas a los medicamentos. Los medicamentos potencialmente inapropiados son aquellos que representan mayores riesgos que beneficios en este grupo etario. Se cuenta con herramientas de apoyo a la prescripción en geriatría que permiten identificar a estos medicamentos y mediante la aplicación de estudios de utilización de medicamentos, podemos describir o analizar el uso de los mismos en una población. Objetivos: reconocer disponibilidad de medicamentos potencialmente inapropiados para adultos mayores en la RAP metropolitana de ASSE durante 2019 y establecer un diagnóstico de situación de consumo de los mismos durante ese año. Método: se realizó un análisis del vademécum institucional mediante la aplicación de los Criterios de Beers 2019 y dos escalas de riesgo anticolinérgico para identificar medicamentos potencialmente inapropiados. Posteriormente se realizó un estudio de utilización de los medicamentos identificados, mediante datos de dispensación de farmacia entre el 1 de enero y 31 de diciembre de 2019. El consumo se expresó en Dosis Diarias Definidas por cada 1000 adultos mayores-año (DHD). Resultados: se identificaron 16 medicamentos potencialmente inapropiados, de los cuales los más usados fueron clonazepam (DHD 69), quetiapina (65,6), alprazolam (DHD 43,7), flunitrazepam (DHD 42,7) y zolpidem (DHD 36,4). Conclusiones: la aplicación de herramientas explícitas facilita la identificación de medicamentos potencialmente inapropiados para adultos mayores y se evidenció un consumo elevado de los mismos durante el año 2019 a expensas de derivados benzodiazepínicos y quetiapina.
Introduction: older adults are at higher risk for developing adverse drug reactions. Potentially inappropriate medications are drugs that have more risks than benefits in this age group. There are a number of tools to support the prescription of medication in geriatrics that allow the identification of these medications, and by applying studies developed on the use of medications we may describe or analyze their impact on a given population. Objectives: to recognize availability of potentially inappropriate medications in older adults in ASSE's Metropolitan RAP during 2019 and to draw conclusions about the current situation in terms of the consumption of this kind of medications. Method: an institutional analysis of medications available in each healthcare provided was conducted through the application of Beers Criteria 2019, and two anticholinergic risk scales were used to identify potentially inappropriate medications. Subsequently, the use of the medications identified was studied by applying pharmacy dispensing data between January 1 and December 31, 2019. Consumption was expressed in defined daily doses every 1000 adults per year (DHD). Results: 16 potentially inappropriate medications were identified, the most widely used of which were clonazepam (DHD 69), quetiapine (65.6), alprazolam (DHD 43.7), flunitrazepam (DHD 42.7) and zolpidem (DHD 36.4). Conclusions: Applying explicit tools makes it easier to identify potentially inappropriate medications for older adults. An increased consumption of these kinds of drugs was noticed during 2019, as a result of benzodiazepine derivatives and quetiapine.
Introdução: os idosos são uma população de risco para o desenvolvimento de reações adversas a medicamentos. Medicamentos potencialmente inapropriados são aqueles que apresentam maiores riscos do que benefícios nessa faixa etária. Existem ferramentas de apoio à prescrição em geriatria que permitem identificar esses medicamentos e, por meio da aplicação de estudos de utilização de medicamentos, descrever ou analisar seu uso em uma população. Objetivos: reconhecer a disponibilidade de medicamentos potencialmente inapropriados para idosos na RAP metropolitana da ASSE durante o ano de 2019 e estabelecer um diagnóstico de consumo durante esse ano. Método: o formulário institucional foi analisado utilizando os Critérios de Beers 2019 e duas escalas de risco anticolinérgico para identificar medicamentos potencialmente inapropriados. Posteriormente, foi realizado um estudo de consumo dos medicamentos identificados, através dos dados de dispensação da farmácia entre 1 de janeiro e 31 de dezembro de 2019. O consumo foi expresso em Doses Diárias Definidas por 1000 idosos-ano (DHD). Resultados: foram identificados 16 medicamentos potencialmente inapropriados, sendo clonazepam (DHD 69), quetiapina (65,6), alprazolam (DHD 43,7), flunitrazepam (DHD 42,7) e zolpidem (DHD 36,4) os mais utilizados Conclusões: a aplicação de ferramentas explícitas facilita a identificação de medicamentos potencialmente inapropriados para idosos; foi observado um alto consumo dos mesmos em detrimento dos derivados benzodiazepínicos e da quetiapina durante o período do estudo.
Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Uso de Medicamentos , Uso Indevido de Medicamentos sob Prescrição/prevenção & controle , Idoso , Prescrição Inadequada/efeitos adversosRESUMO
Abstract Background: Dexmedetomidine (DEX) is an α2-adrenergic receptor agonist used for its sedative, analgesic, and anxiolytic effects. Non-Operating Room Anesthesia (NORA) is a modality of anesthesia that can be done under general anesthesia or procedural sedation or/and analgesia. In this particular setting, a level-2 sedation, such as the one provided by DEX, is beneficial. We aimed to study the effects and safety of DEX in the different NORA settings in the adult population. Methods: A systematic review with meta-analysis of randomized controlled trials was conducted. Interventions using DEX only or DEX associated with other sedative agents, in adults (18 years old or more), were included. Procedures outside the NORA setting and/or without a control group without DEX were excluded. MEDLINE, ClinicalTrials.gov, Scopus, LILACS, and SciELO were searched. The primary outcome was time until full recovery. Secondary outcomes included hemodynamic and respiratory complications and other adverse events, among others. Results: A total of 97 studies were included with a total of 6,706 participants. The meta-analysis demonstrated that DEX had a higher time until full recovery (95% CI = [0.34, 3.13] minutes, a higher incidence of hypotension (OR = 1.95 [1.25, 3.05], p = 0.003, I2 = 39%) and bradycardia (OR = 3.60 [2.29, 5.67], p < 0.00001, I2 = 0%), and a lower incidence of desaturation (OR = 0.40 [0.25, 0.66], p = 0.0003, I2 = 60%). Conclusion: DEX in NORA procedures in adults was associated with a lower incidence of amnesia and respiratory effects but had a long time to recovery and more hemodynamic complications..
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Sedação Consciente , Dexmedetomidina , Anestesia , Segurança do Paciente , Hipnóticos e Sedativos , AnestesiologiaRESUMO
RESUMO Objetivo: Verificar as estratégias de prevenção e tratamento da síndrome de abstinência em unidade de terapia intensiva pediátrica. Métodos: Trata-se de revisão sistemática nas bases de dados PubMed®, Lilacs, Embase, Web of Science, Cochrane, Cinahl, Cochrane Database Systematic Review e CENTRAL. Uma estratégia de busca em três etapas foi utilizada para esta revisão. O protocolo da revisão foi aprovado no PROSPERO (CRD42021274670). Resultados: Foram incluídos na análise 12 artigos. Observou-se grande heterogeneidade entre os estudos incluídos, principalmente em se tratando de esquemas terapêuticos utilizados na sedação e na analgesia. As doses de midazolam variaram de 0,05mg/kg/hora a 0,3mg/kg/hora. A morfina também variou consideravelmente, de 10mcg/kg/hora a 30mcg/kg/hora entre os estudos. A escala mais utilizada para identificação da síndrome de abstinência, entre os 12 estudos selecionados, foi a Sophia Observational Widrawal Symptoms Scale. Em três estudos, houve diferença estatística relevante na prevenção e no manejo da síndrome de abstinência com a implantação de protocolos (p < 0,01 e p < 0,001). Conclusão: Observou-se grande variação entre o regime de sedoanalgesia utilizado entre os estudos e o método de desmame e avaliação de síndrome de abstinência. São necessários mais estudos para fornecer evidências mais robustas acerca do tratamento mais indicado para prevenção e redução dos sinais e sintomas de abstinência em crianças criticamente doentes. Registro PROSPERO:CRD 42021274670
ABSTRACT Objective: To verify strategies for the prevention and treatment of abstinence syndrome in a pediatric intensive care unit. Methods: This is a systematic review in the PubMed database®, Lilacs, Embase, Web of Science, Cochrane, Cinahl, Cochrane Database Systematic Review and CENTRAL. A three-step search strategy was used for this review, and the protocol was approved in PROSPERO (CRD42021274670). Results: Twelve articles were included in the analysis. There was great heterogeneity among the studies included, especially regarding the therapeutic regimens used for sedation and analgesia. Midazolam doses ranged from 0.05mg/kg/hour to 0.3mg/kg/hour. Morphine also varied considerably, from 10mcg/kg/hour to 30mcg/kg/hour, between studies. Among the 12 selected studies, the most commonly used scale for the identification of withdrawal symptoms was the Sophia Observational Withdrawal Symptoms Scale. In three studies, there was a statistically significant difference in the prevention and management of the withdrawal syndrome due to the implementation of different protocols (p < 0.01 and p < 0.001). Conclusion: There was great variation in the sedoanalgesia regimen used by the studies and the method of weaning and evaluation of withdrawal syndrome. More studies are needed to provide more robust evidence about the most appropriate treatment for the prevention and reduction of withdrawal signs and symptoms in critically ill children. PROSPERO register: CRD 42021274670
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Introdução: A população idosa está crescendo cada vez mais, e esse aumento da longevidade traz consigo a percepção sobre os prejuízos no acúmulo de carga tabágica e alcoólica. O idoso acumula também comorbidades que requerem medicações prescritas. Destaca-se o uso de hipnóticos/sedativos nesta população. Métodos: Estudo observacional com delineamento transversal prospectivo em indivíduos com 60 anos ou mais atendidos em três unidades de Estratégias de Saúde da Família. Resultados: Foram avaliados 350 idosos sendo a maioria da amostra composta por mulheres (61,1%), com a mediana de idade de 69,0, maioria era de casadas (53,7%), ensino fundamental incompleto (57,1%), aposentadas (68%) e com renda menor que 3 salários mínimos (56%). Dos entrevistados, 21,4% apresentavam transtorno depressivo maior, 16,9% transtorno de ansiedade generalizada e 48,0% insônia. 38,6% dos idosos, faziam uso de hipnóticos/sedativos, com prevalência de benzodiazepínicos (28%), 34% das pessoas fizeram uso de bebidas alcoólicas e 14,3%, de cigarros. Conclusão: Foi possível concluir que a população com maior prevalência sobre o uso de álcool, tabaco e hipnóticos/sedativos foi de mulheres, casadas, aposentadas, de baixa renda e baixa escolaridade. Tanto no álcool quanto no tabaco, o homem necessita mais de intervenção. Quando são analisadas ambas as substâncias, percebe-se que 54% dos que fumaram nos últimos 3 meses também ingeriram bebidas alcoólicas. Existe uma relação íntima entre as comorbidades estudadas e o uso de hipnóticos/sedativos, visto que estes são utilizados na maioria dos tratamentos dessas doenças. Tal relação já não foi possível ser feita com álcool e tabaco.
Introduction: The elderly population is growing progressively, and this increase in longevity brings with it the perception of the damages of accumulating a tobacco and alcohol load. The elderly also develop comorbidities that require prescribed medications. The use of hypnotics/sedatives in this population stands out. Method: observational study with prospective cross-sectional design in individuals aged 60 years or older seen at three Family Health Strategy units. Results: After evaluating 350 elderly, most of the sample was composed of women (61.1%), with a median age of 69.0, most were married (53.7%), had incomplete elementary school education (57.1%), were retired (68%) and had an income of less than three minimum wages (56%). Of the interviewed, 21.4% had major depressive disorder, 16.9% had generalized anxiety disorder, and 48.0% had insomnia. Also, 38.6% of the elderly used hypnotics/sedatives, with a prevalence of benzodiazepines (28%), 34% used alcoholic beverages, and 14.3% used cigarettes. Conclusion: It was possible to conclude that the population with the highest prevalence of the use of alcohol, tobacco, and hypnotics/sedatives were women, married, retired, with low income and low education. Both in alcohol and tobacco, men need more intervention. After analyzing both substances, it was clear that 54% of those who smoked in the last three months also drank alcoholic beverages. There is an intimate relationship between the comorbidities studied and the use of hypnotics/sedatives. Since these are predominant treatments for these diseases, such a relationship could not be made with alcohol and tobacco.
Assuntos
Nicotiana , Bebidas AlcoólicasRESUMO
Resumen El uso clínico de las benzodiazepinas (BZD) y fármacos relacionados es un tema controversial, especialmente la prescripción prolongada en adultos mayores, que es contraria a las recomendaciones generales. Nuestro objetivo fue describir el uso de BZD y de los hipnóticos denominados fármacos Z (zolpidem, zopiclona y eszopiclona) en los adultos mayores beneficiarios del Instituto Nacional de Servicios Sociales para Jubilados y Pensionados (INSSJP-PAMI) de Argentina. Se realizó un estudio de utilización de medicamentos observacional, descriptivo, de corte transversal, a partir de la base de datos de dispensa de medicamentos del Instituto. Se incluyeron los beneficiarios de ambos sexos de 65 años y más. Se calculó para cada fármaco la prevalencia de uso en 2018 y las dosis diarias definidas (DDD) por cada 1000 habitantes/día (DHD). Se inclu yeron 3 864 949 beneficiarios (77.6 % de la población argentina de esa edad, 61.2 % mujeres), con 184 000 nonagenarios y más de 5000 centenarios. El 30.3 % recibió al me nos una dispensa de BZD o fármacos Z durante 2018, con mayor prevalencia de uso en mujeres (35.6%) que en varones (22.0%) y con aumento progresivo hasta los 85-89 años, y descenso posterior. Las BZD más recetadas fueron alprazolam (41.6%) y clonazepam (41.1%), seguidas por lorazepam (9.9%). La dispensa alcanzó 252.7 DHD, representado un promedio de 0.8 DDD por usuario y por día, valor que disminuyó con la edad. La prevalencia de uso encontrada está entre las más elevadas a nivel internacional, justificando la implementación de intervenciones clínicas y de salud pública para mejorar esta situación.
Abstract The clinical use of benzodiazepines (BZD) and related drugs is a controversial issue, especially prolonged prescription in older adults, which is contrary to general recommendations. Our objective was to describe the use of BZD and the hypnotics called Z drugs (zolpidem, zopiclone and eszopiclone) in elderly beneficiaries of the National Institute of Social Services for Retirees and Pensioners (INSSJP-PAMI) of Argentina. An observational, descriptive, cross-sectional drug use study was conducted based on the Institute's drug dispensing database. Beneficiaries of both sexes aged 65 years and over were included. The prevalence of use in 2018 and the defined daily doses (DDD) per 1000 inhabitants / day (DHD) were calculated for each drug. A total of 3 864 949 benefi ciaries were included (77.6% of the Argentine population of that age, 61.2% women), with 184 000 nonagenar ians and more than 5000 centenarians; 30.3% of whom received at least one dispensation of BZD or "Z drugs" during 2018, with a higher prevalence of use in women (35.6%) than in men (22.0%) and with a progressive increase until 85-89 years, with a subsequent decrease. The most prescribed BZDs were alprazolam (41.6%) and clonazepam (41.1%), followed by lorazepam (9.9%). The dispense drugs reached 252.7 DHD, representing an average of 0.8 DDD per user and per day, a value that decreased with age. The prevalence of use found is among the highest at international level, justifying the implementation of clinical and public health interventions to improve this situation.
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Objective: To evaluate dependence among chronic benzodiazepine and Z-drug users in Brazil. Methods: Chronic users of benzodiazepines (n=94), Z-drugs (n=74), or both (n=11) were recruited from the community, underwent a psychiatric evaluation and completed self-report instruments on hypnotic dependence, insomnia, anxiety, and depression. Users of benzodiazepines and Z-drugs were compared using t-tests, and logistic regression models were employed to explore significant predictors of a dependence diagnosis. Results: There was no difference in the prevalence of dependence among benzodiazepine (77.2%) and Z-drug (69.4%) users. Benzodiazepine users reported increased psychosocial aspects of dependence, anxiety, and depression. Preoccupation with the availability of medication (prevalence ratio [PR] = 2.39 [1.15-5.20]) and insomnia (PR = 1.10 [1.02-1.19]) were associated with a diagnosis of dependence (n=175). Conclusion: The prevalence of dependence was similar among both drug classes. The increased self-reported dependence, anxiety, and depression among benzodiazepine users may be due to behavioral rather than pharmacological aspects of medication use. Behaviors related to hypnotic use were important predictors of dependence.
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The clinical use of benzodiazepines (BZD) and related drugs is a controversial issue, especially prolonged prescription in older adults, which is contrary to general recommendations. Our objective was to describe the use of BZD and the hypnotics called Z drugs (zolpidem, zopiclone and eszopiclone) in elderly beneficiaries of the National Institute of Social Services for Retirees and Pensioners (INSSJP-PAMI) of Argentina. An observational, descriptive, cross-sectional drug use study was conducted based on the Institute's drug dispensing database. Beneficiaries of both sexes aged 65 years and over were included. The prevalence of use in 2018 and the defined daily doses (DDD) per 1000 inhabitants / day (DHD) were calculated for each drug. A total of 3 864 949 beneficiaries were included (77.6% of the Argentine population of that age, 61.2% women), with 184 000 nonagenarians and more than 5000 centenarians; 30.3% of whom received at least one dispensation of BZD or "Z drugs" during 2018, with a higher prevalence of use in women (35.6%) than in men (22.0%) and with a progressive increase until 85-89 years, with a subsequent decrease. The most prescribed BZDs were alprazolam (41.6%) and clonazepam (41.1%), followed by lorazepam (9.9%). The dispense drugs reached 252.7 DHD, representing an average of 0.8 DDD per user and per day, a value that decreased with age. The prevalence of use found is among the highest at international level, justifying the implementation of clinical and public health interventions to improve this situation.
El uso clínico de las benzodiazepinas (BZD) y fármacos relacionados es un tema controversial, especialmente la prescripción prolongada en adultos mayores, que es contraria a las recomendaciones generales. Nuestro objetivo fue describir el uso de BZD y de los hipnóticos denominados fármacos Z (zolpidem, zopiclona y eszopiclona) en los adultos mayores beneficiarios del Instituto Nacional de Servicios Sociales para Jubilados y Pensionados (INSSJP-PAMI) de Argentina. Se realizó un estudio de utilización de medicamentos observacional, descriptivo, de corte transversal, a partir de la base de datos de dispensa de medicamentos del Instituto. Se incluyeron los beneficiarios de ambos sexos de 65 años y más. Se calculó para cada fármaco la prevalencia de uso en 2018 y las dosis diarias definidas (DDD) por cada 1000 habitantes/día (DHD). Se incluyeron 3 864 949 beneficiarios (77.6 % de la población argentina de esa edad, 61.2 % mujeres), con 184 000 nonagenarios y más de 5000 centenarios. El 30.3 % recibió al me nos una dispensa de BZD o fármacos Z durante 2018, con mayor prevalencia de uso en mujeres (35.6%) que en varones (22.0%) y con aumento progresivo hasta los 85-89 años, y descenso posterior. Las BZD más recetadas fueron alprazolam (41.6%) y clonazepam (41.1%), seguidas por lorazepam (9.9%). La dispensa alcanzó 252.7 DHD, representado un promedio de 0.8 DDD por usuario y por día, valor que disminuyó con la edad. La prevalencia de uso encontrada está entre las más elevadas a nivel internacional, justificando la implementación de intervenciones clínicas y de salud pública para mejorar esta situación.
Assuntos
Benzodiazepinas , Previdência Social , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Benzodiazepinas/uso terapêutico , Estudos Transversais , Feminino , Humanos , Hipnóticos e Sedativos , Masculino , Pessoa de Meia-IdadeRESUMO
ABSTRACT Although, insomnia is one of the most common diseases that health professionals face in their practice, it receives little attention in medical training. Diagnosis is based on a careful history taking, and physicians must be aware of the diagnostic criteria. Insomnia should not be considered a symptom, but a comorbid condition. Although cognitive behavioral therapy (CBT) has been the mainstay treatment for insomnia for many years, it is usually regarded as a novel therapeutic strategy, both because of scarcity of qualified psychologists and of limited knowledge about insomnia among physicians. GABA receptor acting drugs are being abandoned in the treatment of insomnia because of abuse and dependence potential and accident risk. Two main current therapeutic options with the best scientific evidence are the tricyclic antidepressant, doxepin, and a new melatoninergic receptor agonist, ramelteon. Newer drugs to treat insomnia are in the pipeline. Hypocretine blocking agents will be marketed in the near future.
RESUMO Embora a insônia seja uma das doenças mais comuns encontrada por profissionais de saúde em sua prática quotidiana, está ainda é negligenciada nos currículos médicos. O diagnóstico baseia-se em anamnese cuidadosa e os médicos devem conhecer os critérios diagnósticos. A insônia não deve ser considerada apenas um sintoma, mas uma comorbidade. Apesar de a terapia cognitivo comportamental (TCC) para insônia ser a principal opção terapêutica há muito anos, esta modalidade terpêutica ainda é considerada uma nova estratégia pela escassez de psicólogos qualificados e pelo desconhecimento médico acerca da insônia. Os fármacos que atuam nos receptores GABA vêm sendo abandonados no tratamento da insônia devido ao potencial de abuso e dependência e pelo risco de acidentes. As duas principais opções terapêutica para insônia com melhor evidência científica são um antigo antidepressivo tricíclico, a doxepina, e um novo agonista do receptor melatoninérgico, a ramelteona. Novas drogas para insônia estão em processo de aprovação regulatória e comercialização. As mais próximas de serem liberadas para o mercado são as drogas bloqueadoras do sistema da hipocretina.
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Objetivo: investigar a associação entre fatores sociodemográficos e consumo de álcool, tabaco e hipnóticos em mulheres rurais. Método: estudo transversal realizado com 259 mulheres rurais. Para a coleta dos dados, utilizou-se formulário estruturado e o Alcohol, Smoking and Substance Involvement Screening Test. Para a análise empregou-se o Teste qui-quadrado e/ou Exato de Fisher com intervalo de confiança de 95%. Resultados: observou-se associação entre o uso do tabaco e a cor (p=0,041), a crença religiosa (p=0,001) e benefício governamental (p=0,006). Houve associação entre o consumo de álcool e a crença religiosa (p≤0,001). Quanto a necessidade de intervenção, observou-se associação entre tabaco e cor (p=0,009), renda (p=0,001) e benefício governamental (p=0,006), assim como álcool e idade (p=0,035), crença religiosa (p=0,006) e renda (p=0,002). Conclusão: fatores como religião, cor, renda, idade e benefício governamental estão associados ao uso de álcool e tabaco em mulheres rurais.
Objetivo: investigar la asociación entre factores sociodemográficos y consumo de alcohol, tabaco e hipnótico en mujeres rurales. Método: estudio transversal realizado con 259 mujeres rurales. Para la recolección de datos, se utilizó un formulario estructurado y se utilizó la Prueba de Detección de Alcohol, Smoking and Substance Involvement Screening Test. Para el análisis se utilizó el Chi-Cuadrado y/o la Prueba Exacta de Fisher con un intervalo de confianza del 95%. Resultados: hubo asociación entre el consumo de tabaco y el color (p=0,041), la creencia religiosa (p=0,001) y el beneficio gubernamental (p=0,006). Hubo una asociación entre el consumo de alcohol y las creencias religiosas (p≤0,001). En cuanto a la necesidad de intervención, hubo una asociación entre el tabaco y el color (p=0,009), los ingresos (p=0,001) y el beneficio del gobierno (p=0,006), así como el alcohol y la edad (p=0,035), las creencias religiosas (p=0,006) y los ingresos (p=0,002). Conclusión: factores como la religión, el color, los ingresos, la edad y el beneficio del gobierno están asociados con el consumo de alcohol y tabaco en las mujeres rurales.
Objective: to investigate the association between sociodemographic factors and alcohol, tobacco and hypnotic consumption in rural women. Method: cross-sectional study conducted with 259 rural women. For data collection, a structured form was used and the Alcohol, Smoking and Substance Involvement Screening Test was used. For the analysis, the Chi-Square and/or Fisher's Exact Test with a 95% confidence interval was used. Results: there was an association between tobacco use and color (p=0.041), religious belief (p=0.001) and governmental benefit (p=0.006). There was an association between alcohol consumption and religious belief (p≤0.001). Regarding the need for intervention, there was an association between tobacco and color (p=0.009), income (p=0.001) and government benefit (p=0.006), as well as alcohol and age (p=0.035), religious belief (p=0.006) and income (p=0.002). Conclusion: factors such as religion, color, income, age and government benefit are associated with alcohol and tobacco use in rural women.
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Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas , Saúde da População Rural , Saúde da Mulher , Produtos do Tabaco , Hipnóticos e Sedativos , Estudos Transversais , Fatores SociodemográficosRESUMO
This study aimed to elucidate the sedative effect and physiological changes associated with the intramuscular injection of detomidine combined with morphine in horses. Six healthy crossbred horses, aged 2 to 10 years, were included. A crossover experimental design was used to compare the effects of intramuscular injection of 30 µg/kg of detomidine alone (IMD) and intramuscular administration of 30 µg/kg of detomidine and 0.1 mg/kg of morphine (IMDM). The degree of sedation, height of head above ground, were assessed at the time points before and 5, 10, 20, 30, 40, 50, 60, 75, 90, 105, and 120 minutes after drug administration, and heart rate, respiratory rate, systolic blood pressure, rectum temperature and intestinal motility were assessed at the time points before and 10, 20, 30, 40, 50, 60, 75, 90, 105, and 120 minutes after drug administration. The physiological parameters were analyzed using the Kruskal-Wallis test with Dunn's post-hoc test and analysis of variance with t-test for independent samples and the sedation scores using the Friedman test and Mann Whitney U-test. P-values <0.05 indicated a statistically significant difference. IMDM promoted a higher sedative effect as compared to IMD, but the sedation occurred inconsistently. Additionally, a reduction in intestinal motility was observed with IMDM at 60, 75, 90, and 105 minutes after administration. IMDM promoted more variable sedation and prolonged reduction in the intestinal motility in the horses as compared to IMD.
Este trabalho teve por objetivo elucidar o efeito sedativo e alterações fisiológicas em cavalos associados à injeção intramuscular de detomidina combinada com morfina. Seis cavalos saudáveis e sem raça definida, com idade de dois a 10 anos, foram incluídos. Delineamento experimental cruzado foi usado para comparar os efeitos da administração intramuscular de 30 µg/kg detomidina isolada (IMD) e da administração intramuscular de 30 µg/kg de detomidina associada à morfina a 0,1 mg/kg (IMDM). Avaliou-se o grau de sedação, a altura da cabeça acima do solo nos momentos antes (M0) e 5, 10, 20, 30, 40, 50, 60, 75, 90, 105 e 120 minutos após administração dos fármacos, e frequência cardíaca, frequência respiratória, pressão arterial sistólica, temperatura retal e motilidade intestinal foram avaliados nos momentos antes (M0) e 10, 20, 30, 40, 50, 60, 75, 90, 105 e 120 minutos após administração dos fármacos. Para análise estatística foram utilizados: teste de Kruskal-Wallis, com pós-teste de Dunn, e ANOVA associada ao teste t para amostras independentes para os parâmetros fisiológicos; e teste de Friedman e teste de Mann Whitney para os escores de sedação. Valores de P < 0.05 indicaram diferença significativa. A administração de detomidina associada à morfina pela via intramuscular (IM) promoveu maior efeito sedativo, quando comparada à administração isolada de detomidina IM. Contudo, a sedação ocorreu de forma inconsistente. Também foi observado, no IMDM, redução da motilidade intestinal aos 60, 75, 90 e 105 minutos de avaliação. A associação de morfina e detomidina pela via intramuscular promove sedação de forma variável em cavalos, e resulta em redução da motilidade intestinal, mais prolongada quando comparada a administração isolada de detomidina intramuscular.
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Animais , Sedação Consciente/veterinária , Cavalos/fisiologia , Hipnóticos e Sedativos/administração & dosagem , MorfinaRESUMO
Background: The appropriate use of analgesia, sedation, neuromuscular blockade and the diagnosis and prevention of delirium (ASBD) are associated with better outcomes in critically ill patients at Intensive Care Unit (ICUs). Aim: To know the practices about analgesia, sedation, delirium, and neuromuscular blockade use among healthcare professionals working in adult ICUs in Chile. Material and Methods: An electronic survey was sent to 812 professionals working in ICUs using a previously published instrument, which was adapted and authorized by the author. Results: We received 278 surveys. Fifty two percent of respondents were physicians, 34% nurses and 11% physical therapists. Their age ranged between 30 and 39 years in 43% and was over 50 years in 9%. Eighty four percent evaluated pain routinely, but only 26% use a validated scale. Sedation was routinely evaluated with a validated scale and 73% referred to have a protocol. Neuromuscular block is seldom used, and little monitoring occurs (43%). Delirium is routinely evaluated by 48% of respondents, usually using the CAM-ICU scale. Conclusions: There is a heterogeneous adherence to the ASBD recommended practices. The main gaps are in the assessment of pain, monitoring of neuromuscular blockade and diagnosis of delirium through validated instruments.
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Humanos , Adulto , Bloqueio Neuromuscular/efeitos adversos , Delírio/diagnóstico , Delírio/prevenção & controle , Analgesia , Dor , Chile , Cuidados Críticos , Hipnóticos e Sedativos , Unidades de Terapia IntensivaRESUMO
Abstract Objective To assess psychometric properties of the Benzodiazepine Dependence Self-Report Questionnaire - Portuguese Version (BENDEP-SRQ-PV) in a sample of Brazilian chronic hypnotic users. Methods One hundred and seventy-nine chronic hypnotic users (benzodiazepines and Z-drugs) were recruited, attended a psychiatric evaluation, and answered the BENDEP-SRQ-PV. Factor structure, reliability, and influence of covariates (dependence diagnosis and type of drug consumed) were assessed in a structural equation modelling environment. Discrimination was assessed with receiver operating characteristic (ROC) plots and stability with the test-retest method. Results Participants, mostly women (91.6%), aged 51 to 64 years old, had been using hypnotics for an average of 34.8 months, with a mean defined daily dose of 0.72. Psychometric analysis demonstrated construct and criterion validity, reliability, and response stability. The factor structure was maintained as originally proposed: problematic use (ω = 0.73), preoccupation (ω = 0.74), lack of compliance (ω = 0.74), and withdrawal (ω = 0.93). Conclusion The BENDEP-SRQ-PV is an adequate measure of hypnotic dependence in the Brazilian population of chronic users. Our results support using the scale for follow-up in clinical and research applications and in correlational studies.
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Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica/normas , Psicometria/normas , Benzodiazepinas , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Hipnóticos e Sedativos , Brasil , Estudos Transversais , Reprodutibilidade dos Testes , AutorrelatoRESUMO
BACKGROUND: Palliative sedation has been used to refer to the practice of providing symptom control through the administration of sedative drugs. The objective of this article was to characterise palliative sedation use in inpatients at a medium-stay palliative care unit. MATERIAL AND METHODS: A cross-sectional study was conducted on 125 randomly selected patients (aged 15 or older) who had died in 2014. The Palliative Performance Scale was used to evaluate the functional status. RESULTS: Palliative sedation was documented in 34.4% of the patients and midazolam was the most commonly used sedative agent (86.0%). More than half (53.5%) of those who recieved sedation presented with delirium. Liver dysfunction was more frequent in the sedated patients (p=0.033) and patients with heart disease were less likely (p=0.026) to be sedated. CONCLUSION: Palliative sedation is an ethically accepted practice. It was commonly midazolam-induced, and differences were documented, among sedated and non-sedated patients, in terms of liver dysfunction and heart disease.
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Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Hipnóticos e Sedativos , Cuidados Paliativos , Estudos Transversais , Humanos , Hipnóticos e Sedativos/uso terapêutico , Pacientes Internados , Midazolam/uso terapêuticoRESUMO
RESUMO Objetivo: Descrever o uso do bloqueio neuromuscular e de outras práticas entre os médicos brasileiros atuantes em unidades de terapia intensiva para pacientes adultos. Métodos: Um levantamento nacional on-line foi aplicado a intensivistas brasileiros. As questões foram selecionadas utilizando o método Delphi e avaliavam os dados demográficos dos médicos, as características da unidade de terapia intensiva, as práticas relativas ao manuseio das vias aéreas e o uso de bloqueio neuromuscular e sedação durante a intubação endotraqueal na unidade de terapia intensiva. Como desfecho secundário, aplicamos uma análise multivariada para avaliar fatores associados com o uso do bloqueio neuromuscular. Resultados: Responderam ao questionário 565 intensivistas de todas as regiões do país. A maioria dos que responderam era homens (65%), com média de idade de 38 ± 8,4 anos, e 58,5% dos participantes tinham título de especialista em terapia intensiva. Apenas 40,7% dos intensivistas relataram o uso de bloqueio neuromuscular durante todas ou em mais de 75% das intubações endotraqueais. Na análise multivariada, o número de intubações realizadas por mês e a especialização do médico em anestesiologia se associaram diretamente com o uso frequente de bloqueio neuromuscular. Etomidato e cetamina foram utilizados mais comumente na situação clínica de hipotensão e choque, enquanto propofol e midazolam foram mais comumente prescritos em situações de estabilidade hemodinâmica. Conclusão: O relato de uso de bloqueio neuromuscular foi baixo entre intensivistas, e os fármacos sedativos foram escolhidos segundo a estabilidade hemodinâmica do paciente. Estes resultados podem ajudar no delineamento de futuros estudos relativos ao manuseio das vias aéreas no Brasil.
Abstract Objective: To describe the use of neuromuscular blockade as well as other practices among Brazilian physicians in adult intensive care units. Methods: An online national survey was designed and administered to Brazilian intensivists. Questions were selected using the Delphi method and assessed physicians' demographic data, intensive care unit characteristics, practices regarding airway management, use of neuromuscular blockade and sedation during endotracheal intubation in the intensive care unit. As a secondary outcome, we applied a multivariate analysis to evaluate factors associated with the use of neuromuscular blockade. Results: Five hundred sixty-five intensivists from all Brazilian regions responded to the questionnaire. The majority of respondents were male (65%), with a mean age of 38 ( 8.4 years, and 58.5% had a board certification in critical care. Only 40.7% of the intensivists reported the use of neuromuscular blockade during all or in more than 75% of endotracheal intubations. In the multivariate analysis, the number of intubations performed monthly and physician specialization in anesthesiology were directly associated with frequent use of neuromuscular blockade. Etomidate and ketamine were more commonly used in the clinical situation of hypotension and shock, while propofol and midazolam were more commonly prescribed in the situation of clinical stability. Conclusion: The reported use of neuromuscular blockade was low among intensivists, and sedative drugs were chosen in accordance with patient hemodynamic stability. These results may help the design of future studies regarding airway management in Brazil.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Bloqueio Neuromuscular/métodos , Manuseio das Vias Aéreas/métodos , Hipnóticos e Sedativos/administração & dosagem , Intubação Intratraqueal/métodos , Brasil , Inquéritos e Questionários , Cuidados Críticos/métodos , Unidades de Terapia IntensivaRESUMO
BACKGROUND: Benzodiazepines have low abuse potential, but patients often develop physical dependence and neurological impairments. The objective of this study was to investigate treatment cessation and use of high doses in long-term benzodiazepine users in Colombia. METHODS: Retrospective study. Patients who used benzodiazepines for at least six months (long-term) were selected from a prescription database and followed from initiation of benzodiazepine treatment for up to 30 months. We investigated treatment duration and compared patients who received normal and high (≥2 mean prescribed daily dose) doses. RESULTS: Only 1255 (6.1 %) out of 20,567 patientsprescribed benzodiazepines became long-term users; their mean age was 60.6 years (SD=20.0) and 61.7 % were women. Mean high doses were used by 42.5 % (n=534) of the sample. Age under 20 years was a protector, whereas the long half-life benzodiazepines and use of other neurological medications were predictors of high dosage. Overall, 44.8 % (n=563) of the sample was still using benzodiazepines at the end of the study period. The use of antidepressants, antipsychotics, and anticonvulsants were negatively associated with cessation of benzodiazepine treatment. CONCLUSIONS: A low proportion of patients starting benzodiazepines became long-term users. Nearly half of them used high doses and continued the medication for up to 30 months. Use of concomitant neurological drugs was associated with higher doses and less cessation.
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Benzodiazepinas/administração & dosagem , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/psicologia , Suspensão de Tratamento/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Benzodiazepinas/efeitos adversos , Criança , Pré-Escolar , Colômbia/epidemiologia , Bases de Dados Factuais/tendências , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto JovemRESUMO
Objetivo: el Basuco es una sustancia psicoactiva derivada de la hoja de coca; hasta ahora no se ha descrito la sintomatología que genera su consumo ni su síndrome de abstinencia, por lo que suele incluirse en el mismo grupo sindromático de la cocaína. En este estudio se pretende determinar si existen signos y síntomas característicos del Basuco. Materiales y métodos: etudio piloto de carácter descriptivo y transversal, empleando una encuesta heteroaplicada a pacientes que consumieran exclusivamente Basuco, donde se les preguntaba si habían presentado determinados signos y síntomas durante su consumo o durante el síndrome de abstinencia por Basuco. Resultados: en el consumo se encontró predominio del insomnio, hiporexia, disminución de la sensación del cansancio, delirios y aislamiento social, mientras que durante la abstinencia predominó la depresión, irritabilidad, hipersominia e hiperfagia, asociado a sensación de deterioro y deseo de abandonar el consumo. Conclusiones: la sintomatología tanto del consumo como del síndrome de abstinencia por Basuco parece tener diferencias respecto a la generada por la cocaína..(AU)
Objetive: the Basuco is a psychoactive substance derived from the coca leaf, which has not been described the symptoms that generate the consumption or withdrawal syndrome, so they are included in the same syndromic group of cocaine. This study aims to identify if there are signs and symptoms characteristic of Basuco to improve diagnostic accuracy and facilitate syndromic management. Materials and methods: bservational and cross-sectional study, using a hetero-applied survey of patients who exclusively consumed Basuco, in which they were asked if they had presented certain signs and symptoms during the intoxication or during the withdrawal syndrome by Basuco. Results: during the consumption, the insomnia, hyporexia, decreased sensation of tiredness, delusions and social isolation were predominant, while during depression abstinence, irritability, hypersomnia and hyperphagia, associated with a sense of deterioration and desire to abandon the consume were more representative. Conclutions: the symptomatology of both intoxication and withdrawal syndrome by Basuco has important differences with respect to those generated by cocaine..(AU)
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Dependência de HeroínaRESUMO
ABSTRACT Objective: To establish the prevalence of delirium and its subsyndrome in intensive care and to associate it with the use of sedative and analgesia, severity and mortality. Method: Carried out in two intensive care units of adult patients, this is a quantitative and transversal study, with 157 patients, using the Richmond Agitation-Sedation Scale to assess the level of sedation and the Intensive Care Delirium Screening Checklist for delirium. The T test and Chi-square test were applied for statistical analysis. Results: The prevalence of delirium was 22.3%, and 49.7% of the subsyndrome. Associations of the use of midazolam with the presence of delirium (p=0.05) and subsyndromal delirium (p<0.01), use of clonidine with the appearance of delirium (p<0.01) and of fentanyl with subsyndromal delirium (p=0.09). There were no significant differences between the mortality of patients with delirium (p=0.40) and subsyndromal delirium (p=0.86), as well as association with the mortality score. Conclusion: The use of sedoanalgesia is associated with the presence of delirium and subsyndromal delirium. No significant statistical associations were found between the severity and mortality scores.
RESUMEN Objetivo: Establecer la prevalencia del delirio y su subsíndrome en pacientes de cuidados intensivos y asociarlos con el uso de la sedoanalgesia, con la gravedad y con la mortalidad. Método: Realizado en dos unidades de cuidados intensivos de pacientes adultos, se trata de un estudio cuantitativo y transversal, con 157 pacientes, utilizando las escalas Richmond Agitation-Sedation Scale (Escala de agitación-sedación de Richmond) para evaluar el nivel de sedación y la de la Intensive Care Delirium Screening Checklist (Lista de verificación para la detección del delirio en cuidados intensivos) para el delirio. Se aplicaron las pruebas de T y Chi-cuadrado para el análisis estadístico. Resultados: La prevalencia del delirio fue del 22,3%, y la del subsíndrome fue del 49,7%. Se han encontrado asociaciones del uso de midazolan con la presencia de delirio (p = 0,05) y del deilirio subsindromático (p < 0,01), del uso de clonidina con la aparición de delirio (p < 0,01) y de fentanil con el delirio subsindromático (p = 0,09). No se registraron diferencias significativas entre la mortalidad de los pacientes con delirio (p = 0,40) y el delirio. Conclusión: El uso de sedoanalgesia se asocia con la presencia de delirio y delirio subsindromático. No se encontraron asociaciones estadísticas significativas entre la gravedad y las puntuaciones de mortalidad.
RESUMO Objetivo: Estabelecer a prevalência do delirium e sua subsíndrome em pacientes de terapia intensiva e associar com uso de sedoanalgesia, gravidade e mortalidade. Método: Realizado em duas Unidades de Terapia Intensiva de pacientes adultos, trata-se de estudo quantitativo e transversal, com 157 pacientes, utilizando as escalas Richmond Agitation-Sedation Scale para avaliação do nível de sedação e Intensive Care Delirium Screening Checklist para delirium. Foi aplicado o teste t e qui-quadrado para análise estatística. Resultados: A prevalência de delirium foi 22,3% e da subsíndrome 49,7%. Foram encontradas associações do uso de midazolan com a presença de delirium (p=0,05) e delirium subsindromático (p<0,01), uso de clonidina com o aparecimento de delirium (p<0,01) e de fentanil com o delirium subsindromático (p=0,09). Não houve diferenças significativas entre mortalidade de paciente com delirium (p=0,40) e delirium subsindromático (p= 0,86), bem como associação com o escore de mortalidade. Conclusão: O uso de sedoanalgesia está associado à presenta de delirium e delirium subsindromático. Não foram encontradas associações estatísticas significativas entre os escores de gravidade e mortalidade.