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Age-related neurological disorders (ANDs), including neurodegenerative diseases, are complex illnesses with an increasing risk with advancing years. The central nervous system's neuropathological conditions, including oxidative stress, neuroinflammation, and protein misfolding, are what define ANDs. Due to the rise in age-dependent prevalence, efforts have been made to combat ANDs. Vitis viniferahas a long history of usageto treat a variety of illness symptoms. Because multiple ligand sites may be targeted, Vitis viniferacomponents can be employed to treat ANDs. This is demonstrated by the link between the structure and action of these compounds. This review demonstrates that Vitis viniferaand its constituents, including flavonoids, phenolic compounds, stilbenoidsandaromatic acids, are effective at reducing the neurological symptoms and pathological conditions of ANDs. This is done by acting as an antioxidant and anti-inflammatory. The active Vitis vinifera ingredients have therapeutic effects on ANDs, as this review explains.
Las enfermedades neurológicas asociadas a la edad (AND, por su sigla en inglés) incluyendo las enfermedades neurodegenerativas, son enfermedades complejas con un riesgo creciente con la edad. Las condiciones neuropatológicas del sistema nervioso central, que incluyen el estrés oxidativo, la neuro inflamación, y el plegado erróneo de proteínas, son lo que define las AND. Debido al aumento en la prevalencia dependiente de la edad, se han hecho esfuerzos para combatir las AND. Vitis vinifera tiene una larga historia de uso para el tratamiento de síntomas. Puesto que puede hacer objetivo a muchos sitios ligando, los componentes de Vitis viniferase pueden utilizar para tratar AND. Esto se demuestra por el vínculo entre la estructura y la acción de estos compuestos. Esta revisión demuestra que la Vitis viniferay sus constituyentes, incluídos los flavonoides, componentes fenólicos, estilbenoides, y ácidos aromáticos, son efectivos para reducir los síntomas neurológicos y las condiciones patológicas de AND. Esto se produce por su acción como antioxidante y antiinflamatorio. Los ingredientes activos de Vitis vinifera tienen efectos terapéuticos en AND, y esta revisión lo explica.
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Humanos , Envelhecimento , Extratos Vegetais/uso terapêutico , Vitis/química , Doenças do Sistema Nervoso/tratamento farmacológico , Anti-Inflamatórios/uso terapêutico , Antioxidantes/uso terapêuticoRESUMO
Type 2 diabetes mellitus (T2D) is a chronic metabolic disorder characterized by an increase in oxidative stress, which is itself related to development of T2D's main chronic complications. Oxidative stress caused by elevated production of reactive species of oxygen and decrease of antioxidant defense system level, leads to activation of lipid peroxidation (LPO) and oxidative lipoprotein modification with increasing atherogenicity. Therefore, the aim of this study was to evaluate whether pharmacotherapeutic follow-up in patients with T2D, users and non-users of insulin, interferes with the levels of oxidative stress, measuring lipid peroxidation and protein oxidation, nitric oxide and superoxide dismutase levels. After the follow-up, there was a decrease in nitric oxide levels and an increase in superoxide dismutase concentration for the group with insulin therapy. Accordingly, these results show that the proposed pharmaceutical care program reduced the oxidative stress levels, mainly in patients in insulin therapy, as a consequence, can impact in the surging of the main chronic complications in T2D.
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Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/complicações , Óxido Nítrico/metabolismo , Estresse Oxidativo/fisiologia , Antioxidantes/metabolismo , Superóxido Dismutase/metabolismo , Peroxidação de Lipídeos , Insulina/metabolismoRESUMO
OBJECTIVE: In Ecuador, studies on clinical daily practice problems focused on parenteral nutrition in neonates are scarce. Therefore, this research aimed to identify negative results associated with medications (NRAM) in neonates with parenteral nutrition (PN) in a third-level hospital in Ecuador. MATERIAL AND METHODS: An observational, prospective, descriptive study was designed in the neonatology area of a tertiary-level public hospital, where, for over four months, the medical records, PN prescriptions, and pharmacy-managed databases of 78 patients were analyzed. Drug-related problems (DRPs) as possible causes of NRAM were classified through administrative, physicochemical, and clinical validation. RESULTS: DRPs classified as follows were found: 78.81% by physicochemical, 17.62% by clinical, and 3.57% by administrative validation. The NRAM were 72% quantitatively uncertain, 16% needed, and 11% quantitatively ineffective. CONCLUSION: The NRAM associated with DRPs were statistically related to prematurity condition, APGAR score, PN time, and the number of medications administered, which suggests the need to create a nutritional therapy committee at the health facility.
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BACKGROUND: The diagnosis of Type 2 Diabetes Mellitus (T2DM) is made by demonstrating the hypoglycemic condition, which involves the determination of plasma glucose, and the follow-up of hypoglycemic treatment is performed by assessing the glycated hemoglobin (HbA1c) concentration. AIM: The aim of this study was to evaluate the saliva as an alternative sample in assessing the adherence to treatment with oral hypoglycemic agents in patients with Type 2 Diabetes. METHODS: We selected 68 patients with T2DM, who were subjected to venous blood and saliva collection, in addition to answering a standardized questionnaire on adherence to hypoglycemic treatment. Laboratory tests performed on saliva, whole blood, serum or plasma included assessment of glycemia, urea, creatinine, uric acid, total cholesterol, HDL-cholesterol, LDL-cholesterol, VLDL-cholesterol, and glycated hemoglobin. RESULTS: It was concluded that 82% of the patients adhered to hypoglycemic treatment based on glycated hemoglobin concentration (cut-off value of 7.0%). Comparing the groups that adhered to hypoglycemic treatment and those that did not adhere, statistical differences (P<0.05) were observed in the glucose, HDL-cholesterol, triglycerides, and insulin use (insulin therapy) parameters. Plasma glucose and urea serum concentration showed positive correlations when compared to saliva samples. Regarding the questionnaire, it was found that 35% of the patients presented positive screening for belief barriers and 83% positive score for recall barriers, and the positive screening correlated with glycated hemoglobin. CONCLUSION: Data have shown that it is possible to use saliva as an alternative sample to the laboratory assessment of hypoglycemic treatment adherence in T2DM patients.
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Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hemoglobinas Glicadas , Glicemia , Saliva , Hipoglicemiantes , Insulina , LDL-Colesterol , UreiaRESUMO
Pharmacokinetics and pharmacodynamics are areas in pharmacology related to different themes in the pharmaceutical sciences, including therapeutic drug monitoring and different stages of drug development. Although the knowledge of these disciplines is essential, they have historically been treated separately. While pharmacokinetics was limited to describing the time course of plasma concentrations after administering a drug-dose, pharmacodynamics describes the intensity of the response to these concentrations. In the last decades, the concept of pharmacokinetic/pharmacodynamic modeling (PK/PD) emerged, which seeks to establish mathematical models to describe the complete time course of the dose-response relationship. The integration of these two fields has had applications in optimizing dose regimens in treating antibacterial and antifungals. The anti-infective PK/PD models predict the relationship between different dosing regimens and their pharmacological activity. The reviewed studies show that PK/PD modeling is an essential and efficient tool for a better understanding of the pharmacological activity of antibacterial and antifungal agents.
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Objective: Give pharmacotherapeutic following and study the variability and suitability of medical prescriptions given to patients during their hospitalization, through optimal and individualized pharmaceutical attention, that allows the best treatment stablished for each patient. Method: Data was captured prospectively, descriptively, and longitudinally with the purpose of analyzing the treatment's suitability in patients with heart disease, through their pharmacotherapeutic following. Results: The pharmacotherapeutic evaluation of a population of 1,228 subjects proved that elderly male patients with multiple comorbidities and in polypharmacy are more susceptible of presenting severe drug interactions (65%) and prescription errors (14.4%). Conclusions: It is essential to have a specialized pharmacist within a multi-disciplinary medical team who manages the validation of each prescription's suitability, making pharmaceutical interventions which allows the early detection of drug interactions and prescription errors, minimizing the probability of presenting real side effects and ensuring the effectiveness and security of the medical treatment.
Objetivo: Dar seguimiento farmacoterapéutico (SFT) y estudiar la variabilidad e idoneidad de la prescripción farmacológica de los pacientes durante su estancia hospitalaria, por medio de una atención farmacéutica individualizada que permita obtener mejores resultados en el tratamiento farmacológico. Método: Los datos fueron capturados de manera prospectiva, descriptiva y longitudinal para analizar la idoneidad del tratamiento, a pacientes cardiópatas, mediante el SFT. Resultados: La evaluación del SFT de población de 1,228 pacientes demostró que los pacientes cuentan con múltiples comorbilidades, polifarmacia, predominio del sexo masculino y de edad avanzada, por lo que son más propensos a presentar interacciones farmacológicas (IF) graves (65%) y errores en la medicación (14.4%). Conclusiones: Es indispensable la integración de un farmacéutico facultado en el equipo multidisciplinario de salud, que lleve a cabo la validación de la idoneidad en la prescripción médica, con una intervención farmacéutica que permita identificar oportunamente IF y errores en la medicación, disminuyendo así la probabilidad de presentar efectos reales ante la presencia de estas, asegurando la efectividad, seguridad y eficacia de los medicamentos.
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Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Cardiopatias , Idoso , Hospitalização , Humanos , Masculino , Polimedicação , PrescriçõesRESUMO
RESUMO Este trabalho é um estudo observacional descritivo retrospectivo, com análise de dados quantitativos de abril a julho de 2019 no Hospital Universitário de Canoas. Foram avaliados 419 prescrições e dados de pacientes quanto a sexo, idade, patologias prévias, vias de administração e medicamentos mais prescritos no CTI. Para análise, foi elaborado um Instrumento de Coleta de Dados, no qual foram transferidos para uma planilha do software Microsoft Excel para análise de frequência. Os resultados encontrados foram que a maioria dos pacientes era do sexo masculino (59%), com idade entre 40 e 69 anos (47%). As patologias mais frequentes foram Hipertensão Arterial (31%), Diabetes Mellitus (18%) e outras como infecções bacterianas, fraturas ou cirurgia cardíaca (46%). A via de administração mais utilizada foi a parenteral (63%). Os medicamentos mais prescritos foram analgésicos / antipiréticos (n = 175), analgésicos narcóticos (n = 126) e antieméticos (n = 126). A caracterização do perfil farmacoterapêutico permitiu definir estratégias de avaliação da prescrição e propor o serviço de farmácia clínica para contribuir com o conhecimento de outros profissionais relacionados aos medicamentos.
ABSTRACT This work is a retrospective descriptive observational study, with an analysis of quantitative data from April to July 2019 at the University Hospital of Canoas. 419 prescriptions and patient data were evaluated regarding sex, age, previous pathologies, routes of administration, and most prescribed drugs in the ICU. For analysis, a Data Collection Instrument was elaborated, in which they were transferred to a Microsoft Excel software spreadsheet for frequency analysis. The results found were that most of the patients were male (59%), aged 40 to 69 years (47%). The most frequent pathologies were Arterial Hypertension (31%), Diabetes Mellitus (18%), and others such as bacterial infections, fractures, or cardiac surgery (46%). The most widely used route of administration was the parenteral route (63%). The most prescribed drugs were analgesics/antipyretics (n = 175), narcotic analgesics (n = 126) and antiemetics (n = 126). Characterizing the pharmacotherapeutic profile allowed to determine prescription evaluation strategies and propose the clinical pharmacy service to contribute to the knowledge of other professionals related to medicines.
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Introducción: Revisar la prescripción representa una oportunidad para corregir errores y optimizar la farmacoterapia en grupos vulnerables. Objetivos: Analizar la complejidad farmacoterapéutica que se presenta en el paciente polimedicado del medio residencial. Material y Métodos: Estudio descriptivo, retrospectivo y transversal; de esquema terapéutico con elementos de indicación-prescripción. Universo: 117 historias clínicas de pacientes polimedicados con 60 años y más que residen en los hogares de ancianos. Período: junio-julio del 2020. Escenario: todos los hogares de ancianos en Cienfuegos, Cuba. Variable dependiente: complejidad farmacoterapéutica definida por la presencia de tres o más de los indicadores de calidad de vida medidos por la evaluación geriátrica exhaustiva, Escala de Puntuación Acumulativa de Enfermedad en Geriatría y criterios STOPP/START. Variables independientes: edad, sexo, enfermedad relacionada al mayor consumo de medicamentos, validismo, comorbilidad, tipo de prescripción, medicamentos inadecuados. Fuente: historia clínica individual. Resultados: La complejidad farmacoterapéutica en los polimedicados se detectó en el 76,9 por ciento de los prescritos inadecuadamente, con multimorbilidad (OR=17,3; IC95 por ciento:16-18,6), dependientes funcionales (OR=9,9; IC95 por ciento:6,8-13) y ancianos ≥75 años (OR=5,1; IC95 por ciento:4-6,2). Las benzodiacepinas fue el grupo más prescrito inadecuadamente. Los antiagregantes plaquetarios y las estatinas son los medicamentos indicados no prescritos. Conclusiones: Los ancianos polimedicados del medio residencial tienen prescripciones de grupos/fármacos de uso frecuente que se relacionan con errores de prescripción, que expone polifarmacia inadecuada y complejidad farmacoterapéutica con posible amenaza a la calidad de vida del geronte institucionalizado(AU)
Introduction: Reviewing the prescription represents an opportunity to correct errors and to optimize pharmacotherapy in vulnerable groups. Objectives: To analyze the pharmacotherapeutic complexity that occurs in the polymedicated patients living in the residential environment. Material and Methods: Descriptive, retrospective and cross-sectional study of therapeutic scheme with indication-prescription elements. Universe: 117 medical records of polymedicated patients aged 60 years and over who reside in nursing homes. Period: June-July 2020. Scenario: all nursing homes in Cienfuegos, Cuba. Dependent variable: pharmacotherapeutic complexity defined by the presence of three or more indicators of the quality of life measured by the exhaustive geriatric assessment, the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and the STOPP/START criteria. Independent variables: age, sex, disease related to increased drug use, validity, comorbidity, type of prescription, inappropriate medications. Source: individual medical history. Results: Pharmacotherapeutic complexity in polymedicated elderly was identified in 76.9 percent of those inappropriately prescribed, multimorbid (OR = 17.3; 95 percent CI: 16-18.6), functionally dependent (OR = 9.9; 95 percent: 6.8 -13) and elderly people ≥75 years (OR = 5.1; 95 percent CI: 4-6.2). Benzodiazepines were the most inappropriately prescribed group. Antiplatelet agents and statins are the indicated non-prescription drugs. Conclusions: Polymedicated elderly patients living in the residential environment follow prescriptions of frequently used groups/drugs which are related to prescription errors with exposure to inadequate polypharmacy and pharmacotherapeutic complexity with a possible threat to the quality of life of the institutionalized elderly people(AU)
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Humanos , Avaliação Geriátrica , Polimedicação , Medicamentos sem Prescrição , Lista de Medicamentos Potencialmente Inapropriados , Epidemiologia Descritiva , Estudos Transversais , Prescrição InadequadaRESUMO
Pharmaceutical care in sports is a new field of work to clinical pharmacists, focused on promoting pharmacotherapeutic follow up and clinical services to athletes, physical activity practitioners and enthusiasts of any sports modality. A broad range of pharmaceuticals, dietary supplements and herbal drugs have been used historically as performance promoters, doping or ergogenic aids. In this context, the role of pharmacists in prevent adverse events, drug interactions or any drug related problems, as doping issues, was described. Its actions can be important to contribute with a multi professional clinical health team, leading athletes to use these resources in a rational way, promoting and optimizing the therapeutic when its necessary.
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The aim of the study is to increase the effectiveness of diseases treatment in elderly patients. The work is based on the study of the nature and the role of compliance disorders, optimizing the effectiveness with the use of therapeutic complex of pharmacotherapy associated with psychotherapeutic component. As a result of the analysis of morbidity in elderly age and the nature of compliance in elderly patients, an optimal therapeutic complex was proposed, which consists of rational pharmacological load and psychotherapeutic intervention, aimed at informing a patient about the disease, methods of its treatment, as well as at creating an effective therapeutic alliance which provides proper medical care and prevents self-treatment in such patients.
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Humanos , Idoso , Idoso de 80 Anos ou mais , Pacientes , Terapêutica , Saúde do Idoso , Inquéritos de Morbidade , Resultado do Tratamento , Tratamento Farmacológico , Múltiplas Afecções Crônicas/tratamento farmacológico , GeriatriaRESUMO
Resumen Introducción: desde hace varios años existe preocupación por el incremento específico en el consumo de antimicrobianos por los problemas que estos generan. Por tal motivo se decidió diseñar un programa de atención farmacéutica en pacientes hospitalizados en servicios abiertos para evitar el desarrollo de problemas relacionados con medicamentos asociados con antimicrobianos. Materiales y métodos: se realizó un estudio retrospectivo de utilización de medicamentos, del tipo prescripción-indicación en una muestra de estudio de 25 pacientes que recibieron antimicrobianos de amplio espectro en el área de medicina interna del hospital José María Velasco Ibarra desde abril hasta julio del 2016. Resultados: el 76 % de los pacientes fueron mujeres. La patología más frecuente que requirió la utilización de antimicrobianos fue la infección de vías urinarias complicada (48 %): el 24 % de los pacientes recibió más de un antibiótico de amplio espectro y el más utilizado fue el imipenem/cilastatina (34.4 %), seguido de la piperacilina/tazobactam y el cefepime, ambas con un 28.1 % y la vancomicina (9.4 %). El 48 % de las prescripciones fueron inadecuadas, se detectó la presencia de PRM en el 84 % de los pacientes. Conclusión: el diseño de un programa de atención farmacéutica en pacientes hospitalizados garantiza la identificación, prevención y/o solución de los problemas relacionados con medicamentos, su uso adecuado y la calidad de la atención.
Abstract Introduction: For several years there has been concern about the specific increase in the consumption of antimicrobials due to the problems they generate. For this reason it was decided design a pharmaceutical care program for hospitalized patients in open services to avoid the development of problems related to antimicrobial-associated drugs. Materials and methods: A retrospective study was conducted on the use of medications, of the prescription-indication type in a study sample of 25 patients who received broad-spectrum antimicrobials in the internal medicine area of the José María Velasco Ibarra Hospital from April to July. 2016. Results: 76 % of the patients were women; The most frequent pathology that required the use of antimicrobials was complicated urinary tract infection (48 %>); 24 % of patients received more than one broad spectrum antibiotic and the most widely used was imipenem/cilastatin (34.4 %), followed by piperacillin / tazobactam and cefepime, both with 28.1 % and vancomycin (9.4 %); 48 % of the prescriptions were inadequate, the presence of PRM was detected in 84 % of the patients. Conclusion: The design of a pharmaceutical care program in hospitalized patients guarantees the identification, prevention and / or solution of the problems related to medicines, their proper use and the quality of care.
Resumo Introdução: desde há vários anos existe preocupação pelo incremento específico no consumo de antimicrobianos pelos problemas que estes geram. Por tal motivo decidiu-se desenhar um programa de atenção farmacêutica em pacientes hospitalizados em serviços abertos para evitar o desenvolvimento de problemas relacionados com medicamentos associados a antimicrobianos. Materiais e métodos: realizou-se um estudo retrospectivo de utilização de medicamentos, do tipo prescrição-indicação em uma amostra de estudo de 25 pacientes que receberam antimicrobianos de amplo espectro na área de medicina interna do Hospital José María Velasco Ibarra desde abril até julho de 2016. Resultados: o 76 % dos pacientes foram mulheres; a patologia mais frequente que requereu a utilização de antimicrobianos foi a infeção de vias urinárias complicada (48 %); o 24 % dos pacientes recebeu mais de um antibiótico de amplo espectro e o mais utilizado foi o imipeném/cilastatina (34.4 %), seguido da piperacilina/tazobactam e o cefepima, ambas as duas com um 28.1 % e a vancomicina (9.4 %>); o 48 % das prescrições foram inadequadas, detectou-se a presença de PRM no 84 % dos pacientes. Conclusão: o desenho de um programa de atenção farmacêutica em pacientes hospitalizados garante a identificação, prevenção e/ou solução dos problemas relacionados com medicamentos, o uso adequado dos mesmos, e a qualidade da atenção.
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Humanos , Anti-Infecciosos , Assistência Farmacêutica , Impactos da Poluição na Saúde , Uso Indevido de MedicamentosRESUMO
AIMS: To develop an intervention and evaluate its effectiveness in pharmacotherapeutic empowerment of patients with type 2 diabetes mellitus (T2DM). METHOD: This is an intervention study with before and after evaluation. The intervention was conducted between 2015 and 2016 with users of the Unified Health System (SUS) in Brazil. The study was divided into six stages: initial evaluation, three individual patient-pharmacist meetings every 15 days over 6 weeks, clinical discussion between pharmacists, and final evaluation. At each meeting with the patient, specific themes for empowerment were addressed using educational booklets and pharmaceutical care. Clinical and laboratory evaluations and questionnaires on self-efficacy (IMDSES), self-care (QAD) and distress (PAID-5) were conducted before and three months after the intervention. RESULTS: 47 patients completed the intervention. Glycated hemoglobin of patients had a median reduced from 7.0% to 6.6% after the intervention (pâ¯=â¯0.02). There was a significant difference (pâ¯<â¯0.01) in the reduction in total cholesterol, fasting glycemia, creatinine and blood pressure. Participants showed significant improvements (pâ¯<â¯0.01) in scores related to self-efficacy and self-care and less distress related to T2DM. CONCLUSION: The results of the study suggest that the strategy developed is effective in promoting the empowerment of T2DM patients, improved glycemic control and self-care.
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Diabetes Mellitus/tratamento farmacológico , Hiperglicemia/prevenção & controle , Hipoglicemia/prevenção & controle , Hipoglicemiantes/uso terapêutico , Assistência Farmacêutica , Poder Psicológico , Autocuidado , Adulto , Biomarcadores/análise , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , PrognósticoRESUMO
Resumen: Introducción: El error de medicación es toda desviación en el proceso del uso de medicamentos que son administrados al paciente. Los errores de medicación son una causa frecuente de eventos adversos en el paciente. Objetivo: Identificar la relación del seguimiento farmacoterapéutico en la detección de errores de medicación con el incremento del número de intervenciones para la prevención de eventos adversos en pacientes de la unidad de terapia intensiva (UTI). Material y método: Se determinó la tasa de errores de medicación con el fin de obtener el valor basal (periodo 1), posteriormente se evaluó un segundo periodo (periodo 2), en el cual el seguimiento farmacoterapéutico se incrementó con la búsqueda intencionada de los errores de medicación. La identificación, clasificación y registro se llevó a cabo de acuerdo con la taxonomía de NCC MERP con ayuda del seguimiento farmacoterapéutico en cada uno de los pacientes. Resultados: En el periodo 1 se identificó un total de 107 errores de medicación, mismos que representaron una tasa de errores de 514.42 por 1,000 días/paciente, con una tasa de intervenciones de 52.88 por 1,000 días/paciente. En el periodo 2 se observó una tasa de 950.76 por 1,000 días/paciente, con una tasa de intervenciones de 132.58 por 1,000 días/paciente. En ninguno de los dos periodos se identificaron errores que produjeran daño en los pacientes. Conclusiones: La búsqueda intencionada de errores de medicación e intervenciones farmacéuticas favorecen la seguridad del uso de medicamentos, lo que ayuda a prevenir los eventos adversos asociados en pacientes de la unidad de terapia intensiva.
Abstract: Introduction: Medication error is all deviation in the process of using medications that are administered to the patient; the medication errors are a frequent cause of adverse events in the patient. Objective: To identify the relationship of pharmacotherapeutic monitoring in the detection of medication errors with the increase in the number of interventions for the prevention of adverse events in patients of the Intensive Care Unit. Material and method: The medication error rate was determined in order to obtain the baseline value (period 1), then a second period (period 2) was evaluated in which the pharmacotherapeutic follow-up was increased with the intentional search for medication errors. The identification, classification and registration were carried out according to the NCC MERP taxonomy with the help of the pharmacotherapeutic follow-up to each of the patients. Results: In period 1, a total of 107 medication errors were identified, representing an error rate of 514.42 per 1,000 days/patient, with a rate of interventions of 52.88 per 1,000 days/patient. For period 2 a rate of 950.76 per 1,000 days/patient was found, with a rate of interventions of 132.58 per 1,000 days/patient. In either period, an error was identified that caused damage in the patients. Conclusions: The intentional search for medication errors and pharmaceutical interventions favor the safety in the use of the drugs helping to prevent the adverse events associated with its use in patients of the intensive care unit.
Resumo: Introdução: O erro de medicação é qualquer desvio no processo de utilização de medicamentos que são administrados aos pacientes, os erros de medicação são uma causa comum de eventos adversos no paciente. Objetivo: Identificar a relação do seguimento farmacoterapêutico na detecção de erros de medicação com o aumento do número de intervenções para a prevenção de eventos adversos em pacientes na unidade de terapia intensiva. Material e método: Determinou-se a taxa de erros de medicação a fim de obter a linha de base (período 1), avaliou-se posteriormente um segundo período (período 2) em que o acompanhamento farmacoterapêutico aumentou com a busca deliberada de erros de medicação. A identificação, classificação e registo foram realizados de acordo com a taxonomia do NCC MERP com ajuda do seguimento farmacoterapêutico para cada um dos pacientes. Resultados: No período 1, identificamos um total de 107 erros de medicação, o que representou uma taxa de 514.42 erros por 1,000 dias/paciente, com uma taxa intervenção de 52.88 por 1,000 dias/paciente. Para o período 2 foi encontrada 950.76 para 1,000 dias/paciente, com uma taxa de intervenção de 132.58 por 1,000 dias/pacientes. Não identificamos em nenhum dos dois períodos um erro que produzisse danos aos pacientes. Conclusões: A busca intencional por erros de medicação e intervenções farmacêuticas favorecem a segurança no uso de medicamentos, ajudando a prevenir os eventos adversos associados ao seu uso em pacientes na unidade de terapia intensiva.
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ABSTRACT Pharmaceutical care is a professional practice seeking the responsible provision of drug therapy by identifying, resolving, and preventing Drug-Related Problems (DRP). The study aims to describe and evaluate the impact of pharmaceutical care given to patients being treated for tuberculosis (TB). Study concurrent, longitudinal, prospective conducted during pharmaceutical care in the TB outpatient clinic, Clinical Hospital, Federal University of Minas Gerais during the period August 2009 to July 2012. The Pharmacotherapy Workup proposed by Cipolle et al. (2004) was used. Statistical analyses were performed by X2 or Fisher exact test, as appropriate. A total of 62 patients were followed up, and 128 drug-related problems (DRP) were identified: 69.5% related to safety, 13.3% to effectiveness, 12.5% to indication, and 4.7% to treatment adherence, and 62.1% of the DRP were resolved. A total of 115 pharmaceutical interventions were performed. The impact of pharmaceutical care was satisfactory for 73.9% of patients with a resolution rate of 77%. There was a greater impact on pharmaceutical care (index ≥ 0.50) for those patients who were not smokers (p <0.05). The impact of pharmaceutical care was important, so the pharmacist should work alongside the multidisciplinary team to monitor treatment and perform interventions.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Assistência Farmacêutica/estatística & dados numéricos , Tuberculose Pulmonar/tratamento farmacológico , Atitude do Pessoal de Saúde , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Antituberculosos/uso terapêutico , Equipe de Assistência ao Paciente , Fatores Socioeconômicos , Brasil , Estudos Prospectivos , Estudos Longitudinais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controleRESUMO
OBJETIVOS: Avaliar a farmacoterapia de pacientes com reação hansênica tipo 2 em tratamento com talidomida em um centro filantrópico de atendimento especializado. MÉTODOS: O estudo foi realizado no Centro Maria Imaculada de reabilitação de pacientes com hanseníase na cidade de Teresina, Piauí. Foram incluídos na pesquisa pacientes de ambos os sexos atendidos entre setembro e novembro de 2016. O Seguimento Farmacoterapêutico foi fundamentado no Método Dáder, na base eletrônica Drugdex System Thomson Micromedex® Interactions para análise de interações medicamentosas; na classificação de reações adversas a medicamentos de Rawlins e Thompson; e no teste de Morisky-Green para avaliar o nível de adesão terapêutica. RESULTADOS: Foram acompanhados 11 pacientes, dos quais oito eram homens. Foram identificadas três interações medicamentosas, sendo duas classificadas em risco moderado e uma em menor risco. Foram identificados 23 resultados negativos associados ao medicamento, destacando-se insegurança não quantitativa e problemas de saúde não tratados. Além disso, 22 problemas relacionados com medicamentos foram identificados, sendo o mais frequente a ocorrência de reações adversas a medicamentos. Todas as reações adversas associadas a medicamentos foram classificadas como tipo A ou previsíveis. Quanto à adesão, seis entre os nove pacientes que responderam ao teste de Morisky-Green obtiveram alto grau de adesão. A educação em saúde correspondeu à intervenção farmacêutica preponderante, sendo aplicada a todos os pacientes. CONCLUSÕES: Foram evidenciadas interações medicamentosas relevantes, resultados negativos associados ao medicamento e problemas associados a medicamentos. O grau de adesão ao tratamento com talidomida foi considerado alto. Foram necessárias intervenções farmacêuticas, sobretudo voltadas para ações de educação em saúde, o que ratifica a necessidade de acompanhamento constante desse grupo de pacientes.
AIMS: Evaluate the pharmacotherapy of patients with type 2 leprosy reaction in treatment with thalidomide in a philanthropic center of specialized care at Teresina. METHODS: The study was conducted at the Centro Maria Imaculada, for rehabilitation of patients with leprosy, in the city of Teresina, Piauí, Brazil. Patients of both sexes attended between september and november 2016 were included in the study. Pharmacotherapeutic follow-up was based on the Dáder Method, in the electronic base Drugdex System Thomson Micromedex® Interactions for analysis of drug interactions; in the classification of adverse drug reactions of Rawlins and Thompson; and the Morisky-Green test to evaluate the level of therapeutic adherence. RESULTS: Eleven patients were followed, of whom eight were male. Three drug interactions were identified, two of which were classified as moderate risk and one in lower risk. There were 23 negative results associated with medicines, mainly quantitative insecurity and untreated health problems. In addition, 22 drug-related problems were identified, with adverse drug reactions being the most frequent occurrence. All adverse drug reactions were classified as type A or predictable. Regarding adhesion, six patients among nine who responded to the Morisky-Green test obtained a high degree of adhesion. Health education corresponded to the preponderant pharmaceutical intervention, being applied to all patients. CONCLUSIONS: Relevant drug interactions, negative results associated with medicines, and drug-related problems were identified. Degree of adherence to thalidomide treatment was considered high. Pharmaceutical interventions were necessary, mainly focused on health education actions, which ratifies the need for constant monitoring of this group of patients.
Assuntos
Tratamento Farmacológico , Hanseníase , Talidomida , Efeitos Colaterais e Reações Adversas Relacionados a MedicamentosRESUMO
Resumen Introducción: los resultados negativos asociados a la medicación (RNM), incluyendo las reacciones adversas a medicamentos (RAM) o problemas de seguridad, son un problema clínico relevante, debido a su alta incidencia y a efectos nocivos en la salud. Un medicamento podría ser considerado como trazador/señalador, debido a: 1) una mayor probabilidad de causar RAM o problemas de seguridad; o 2) su utilización para tratar y por tanto identificar pacientes con RAM. Los listados de medicamentos trazadores podrían ser útiles en los programas de farmacoseguridad o seguimiento farmacoterapéutico (SFT). Objetivo: el objetivo de este trabajo fue estructurar un listado de medicamentos trazadores/ señaladores de los pacientes con mayor riesgo de presentar RNM, el cual podría ser útil para seleccionar pacientes para programas de SFT o farmacoseguridad. Obtención de datos: inicialmente, se realizó una revisión estructurada en PubMed/Medline para identificar medicamentos asociados a la presentación de RAM clasificadas como graves o moderadas y con una prevalencia igual o superior a 10%. Posteriormente, el listado de medicamentos identificados, fue comparado y complementado con medicamentos de alta alerta del Institute for Safe Medication Practices (ISMP) y con medicamentos utilizados para el tratamiento de RAM o antídotos. Resultados: se generó un listado general de 139 medicamentos trazadores/señaladores. Conclusiones: este listado podría ser una herramienta para detectar y seleccionar los pacientes que más se podrían beneficiar de los programas de SFT o farmacoseguridad. Se requiere de la realización de estudios diseñados para evaluar la utilidad práctica de dicho listado.
Abstract Introduction: negative outcomes associated with medication (NOM), including adverse drug reactions (ADRs) or safety problems, are a relevant clinical problem due to their high incidence and harmful effects on health. A drug could be considered a tracer / marker because of: 1) an increased likelihood of causing ADR or safety problems; or 2) its use to treat and therefore identify patients with ADR. Tracer drug listings could be useful in pharmacological safety or pharmacotherapeutic monitoring programs. Objective: the objective of this study was to structure a list of drug tracer / markers of the patients with the highest risk of presenting NOM, which could be useful to select patients for FFT or pharmacological safety programs. Data collection: initially, a structured review was performed in PubMed / Medline to identify drugs associated with the presentation of ADRs classified as severe or moderate and with a prevalence of 10% or greater. Subsequently, the list of identified medications was compared and complemented with high alert medications of the Institute for Safe Medication Practices (ISMP) and medications used to treat ADRs or antidotes. Results: a general listing of 139 drug tracers / markers was generated. Conclusions: this listing could be a tool to detect and select the patients who could most benefit from the FTS or pharmacological safety programs. Studies designed to evaluate the practical usefulness of this listing are required.
Assuntos
Preparações Farmacêuticas , Segurança , Coleta de Dados , Farmacovigilância , Erros de MedicaçãoRESUMO
INTRODUCCIÓN: la atención farmacéutica se define como la provisión responsable e individualizada del tratamiento farmacológico, con el propósito de mejorar la calidad de vida del paciente, lo que se puede lograr mediante la correcta utilización de los medicamentos, realizando un seguimiento farmacoterapéutico para prevenir o resolver problemas relacionados con medicamentos (PRM). se ha comprobado que la inclusión del químico farmacéutico dentro de los programas de cuidados paliativos y alivio del dolor han mejorado los resultados obtenidos con la farmacoterapia y la calidad de vida de los pacientes. OBJETIVOS: Implementar y evaluar un servicio de atención farmacéutica para pacientes de la uidad de cuidados paliativos y alivio del dolor en el Hospital Clínico Félix Bulnes Cerda. MATERIALES Y MÉTODOS: se realizó en 3 etapas: la primera de forma retrospectiva, se revisaron recetas de mayo a julio de 2015, provenientes de la unidad para obtener un estado situacional. en una segunda etapa se implementó el servicio de atención farmacéutica, basado en el método DADER. en una tercera etapa, se tipificaron las intervenciones totales realizadas y se evaluó tanto la adherencia al tratamiento como la satisfacción del servicio ofrecido a los pacientes y/o cuidadores. RESULTADOS: etapa I de 500 recetas se seleccionaron 244, detectando 165 (67,5%) con posibles PRMs, los cuales se resolvieron en un 35% con 58 intervenciones al equipo médico.etapa II se enrolaron 39 pacientes a quienes se les realizaron entrevistas sucesivas, se detectaron 53 PRMs, los que se resolvieron con 39 intervenciones.finalmente, se evaluó el servicio ofrecido: se tipificaron 111 intervenciones (84 a médico y 27 a paciente), se evaluó adherencia terapéutica mediante test SMAQ, mejorando en un 61,5% entre la evaluación inicial y una posterior (a los 3 meses) y la satisfacción usuaria del servicio con una encuesta obteniendo un 100% de satisfacción.CONCLUSIÓN: la complejidad del dolor y los tratamientos actuales para aliviarlo representan un gran desafío en los actuales equipos de cuidados paliativos. la integración y participación activa del Farmacéutico clínico en el proceso clínico-asistencial permitió garantizar la calidad y seguridad tanto del proceso de dispensación, interviniendo en la selección de la fármaco terapia de acuerdo a parámetros farmacocinéticos y farmacodinámicos que apunten a la optimización e individualización de la terapia; como además interviniendo al paciente o cuidador, entregando herramientas que logren un uso racional de los medicamento. como resultado de esto, se mejoró la adherencia al tratamiento, se entregó información sobre su correcta administración y también se realizó seguimiento farmacoterapéutico, que permitió prevenir problemas relacionados con los medicamentos (PRM). estos resultados mostraron un alto grado de aceptación, tanto por parte del equipo médico como del paciente, avalando la importancia del farmacéutico.
INTRODUCTION: the pharmaceutical care is defined as responsible pharmacological treatment in order to improve the life quality of a patient. may be achieved using the right drug, and monitoring the side effect to prevent problem with the medical prescription. It has been proved that pharmacist inclusion in the therapy improve the health and welfare of these patients.OBJECTIVES: carry out and evaluate a pharmaceutical care in patient that need to be relieved at Félix Bulnes Hospital.method and equipment: it was realize in three steps, in the first one the prescriptions were audited in a retrospective way from march to july in the year 2015 in this unit to evaluate this period.In the second step: a pharmacological attention service using DADER method in the third step: OBJECTIVES AND METHOD were evaluated and tipified .the treatment progress and the patient satisfaction were also evaluated. RESULTS: from 500 prescription in the step one 244 were selected finding on 165 (67.5%) possibles PRMs .from that number (500) only 35% were solved with the help of medical auditory.In the second step, 39 patient were selected and interviewed finding 53 PRMs, these were solved with 39 interventions. finally, the service were evaluated: 111 intervention were tipified (84 to medical attention and 27 to the patient), therapeutical adherence were evaluated using SMAQ test improving 61,5 comparing the inicial evaluation with a posterior one (three month later). the satisfaction in the attention service using a survey were 100%. CONCLUSION: the pain and nowadays treatments complexity to relieve it are such a big challenge for current palliative care teams. the active integration and participation of clinical pharmacist in the clinical assistance process guarantees quality and security, not only on the dispensation process by intervening the pharmacotherapy selection according to pharmacokinetic and pharmacodynamic parameters that work on optimization and individualization therapy, but also by intervening the patient and assistant, by giving them necessary tools to get a rational drug use. as a result, the adherence to treatment was improved, information about the correct drug use was given and there was also a pharmacotherapy tracing that allowed to avoid any problems related to the drugs themselves. these results showed a higher acceptance degree either for patiens and professionals.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Avaliação de Processos e Resultados em Cuidados de Saúde , Cuidados Paliativos/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Prescrições de Medicamentos/estatística & dados numéricos , Inquéritos e Questionários , Estudos Retrospectivos , Desenvolvimento de Programas , Satisfação do Paciente , Cooperação e Adesão ao Tratamento/estatística & dados numéricosRESUMO
BACKGROUND: Non-adherence to prescribed treatment is a principle cause of treatment failure in patients with chronic diseases, such as type 2 diabetes mellitus (T2DM) and hypertension. Improved patient monitoring and education have been shown to improve adherence and clinical outcomes. OBJECTIVE: This study evaluates the impact of a pharmacotherapy optimization plan centered on patient education that was implemented at a hospital in Arauco, Chile. METHODS: A prospective study was conducted using 50 randomly selected patients diagnosed with both T2DM and hypertension. Each patient participated in three successive interview sessions over 6 months. At each session, the following variables were evaluated by a pharmacist: blood pressure, HbA1c, adherence to prescribed medication, and patient knowledge of disease. RESULTS: Significant decreases were observed for HbA1c (<0.001), and SBP (<0.001), with stronger and more significant decreases observed for females. Patient adherence to prescribed medication also improved, but not significantly. The number of patients with full knowledge of their diseases increased significantly (p < 0.001) from 10 to 66%. CONCLUSION: This study suggests that the incorporation of a pharmacotherapeutic optimization plan for patients with chronic diseases can have a positive impact on the control of chronic diseases, such as T2DM and hypertension.
Assuntos
Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Adesão à Medicação , Educação de Pacientes como Assunto/métodos , Farmacêuticos , Papel Profissional , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Chile , Doença Crônica , Diabetes Mellitus Tipo 2/psicologia , Feminino , Hemoglobinas Glicadas/efeitos dos fármacos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Hipertensão/psicologia , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Background: Pharmaceutical follow-up consists on the detection, prevention, and resolution of drug-related problems (DRP) in a continuous, systematized, and documented way. DRP is a health problem connected to pharmacotherapy, which can interfere with the expected health outcomes in the patient. Aim: To make a pharmacotherapeutic surveillance in HIV/AIDS inpatients attended at "Hospital San Juan de Dios" throughout a year prospective study (January to December 2012). Results: 88.6% (93/105) of patients were in stage AIDS with a median of CD4+ lymphocytes of 29 cells/mm³ and a viral load of 107,000 RNA copies/mL. The 16.2% were admitted to a intensive care unit ICU. 296 DRP (DRP 2.8 per patient) were detected, 72% of DRP (n; 213) were associated with treatment safety, 94 were adverse reactions, 19 required dose adjustments, and 6 interactions had a negative clinical impact; 23.3% (n: 69) experimented the necessity to add or remove a drug and 4.7% (n: 14) presented problems associated with effectiveness. A statistically significant relation was observed when associating the number of DRP with admittance to the ICU and the use of more than six drugs. Conclusion: The results allow the conclusion that inpatients present drug-related problems mainly related to toxicity, becoming risk factors for the development of them admittance to ICU, and concomitant use of more than 6 drugs.
Introducción: El seguimiento farmacoterapéutico, consiste en la detección, prevención y resolución de los problemas relacionados con los medicamentos (PRM), en forma continua, sistematizada y documentada. Un PRM es un problema de salud vinculado con la farmacoterapia, que interfiere o puede interferir con los resultados de salud esperados en el paciente. Objetivo y Métodos: Realizar un seguimiento farmacoterapéutico a pacientes hospitalizados con infección por VIH/SIDA del Hospital San Juan de Dios, a través de un estudio prospectivo de un año (enero a diciembre 2012). Resultados: El 88,6% (93/105) de los pacientes se encontraba en etapa SIDA, con una mediana de linfocitos TCD4+ de 29 céls/mm³ y una carga viral de 107.000 copias ARN/mL. El 16,2% de los pacientes ingresó a una unidad de paciente crítico. Se detectaron 296 PRM (2,8 PRM por paciente); el 72% de los PRM (n: 213) estuvieron asociados a seguridad del tratamiento, objetivándose 94 reacciones adversas, 19 eventos con necesidad de ajustes de dosis y seis interacciones con repercusión clínica negativa; 23,3% (n: 69) a la necesidad de incorporar o eliminar algún fármaco y 4,7 % (n: 14) a problemas asociados a efectividad. Se observó una relación estadísticamente significativa al asociar el N° de PRM con la unidad de pacientes críticos y uso de más de seis fármacos. Conclusión: Los resultados permiten concluir que los pacientes hospitalizados presentan problemas relacionados al uso de medicamentos, principalmente asociado a toxicidad, encontrándose como factores de riesgo para el desarrollo de éstos la permanencia en una unidad de paciente crítico y el uso concomitante de más de seis fármacos.