ABSTRACT
Introduction: Pediatric oncology patients have a limited number of venous access routes and need a large number of drugs during hospitalization. This study evaluates potential medication incompatibilities (MI) in pediatric oncology prescriptions and identifies possible factors associated with the risk of their occurrence. Methods: This cross-sectional study evaluated prescriptions from a tertiary universitary hospital from December 2014 to December 2015. The association between variables and the risk of potential incompatibilities between drugs was determined by Student's t-test and Pearson's chi-square, considering p < 0.05 significant. The odds ratio was calculated considering a 95% confidence interval for each drug. Results: 385 prescriptions were evaluated. The mean age of 124 patients was 9.22 years old (SD = ± 5.10), and 50.65% were male. The most frequent diagnosis and reason for hospitalization were leukemia (27.30%) and chemotherapy (36.10%). The totally implantable catheter was the most commonly used venous access (61.30%). In 87.5% of prescriptions, there was the possibility of MI, and 2108 incompatibilities were found, considering 300 different combinations between two drugs. Age, diagnosis, reason for hospitalization, and type of venous access were risk factors for potential incompatibilities (p < 0.05). The following drugs present higher risk of potential incompatibilities: leucovorin, sodium bicarbonate, cefepime, diphenhydramine, dimenhydrinate, hydrocortisone, and ondansetron, with a significant odds ratio. Conclusion: The possibility of MI in prescriptions for pediatric oncology patients is frequent. Thus, the identification of risk factors may contribute to patient safety and to the rational use of drugs.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Pediatrics , Drug Utilization/statistics & numerical data , Inappropriate Prescribing , Administration, Intravenous , Neoplasms/drug therapy , Cross-Sectional Studies , Drug-Related Side Effects and Adverse Reactions/epidemiologyABSTRACT
ABSTRACT Introduction: To assess the frequency of allergic reactions to asparaginase (ASP) and possible risk factors for reactions in a cohort of pediatric patients. Method: The study was performed based on retrospective data from patients under acute lymphoid leukemia treatment in a general university hospital located in southern Brazil. Information on patients who used ASP from 2010 to 2017 was collected. Allergic reactions were identified in electronic medical records. Results: Among the 98 patients included in the study, 16 (16.3 %) experienced an allergic reaction to native l-asparaginase (L-ASP). Of the 22 patients (22.4 %) that received only intravenous (IV) administration of l-ASP, 10 (62.5 %) had allergic reactions, while 48 patients (49 %) received intramuscular (IM) administration and 28 (28.6 %) received IV and IM administrations. The occurrence of allergic reactions differed between the groups (p < 0.001), and IV administration was associated with allergic reactions. Association was also observed between the severity of the reaction and the route of administration, with the IM route associated with grade 2 and IV route associated with grade 3. Occurrence of allergic reactions was higher when the commercial formulation of l-ASP, Leuginase®, was used (p = 0.0009 in the analysis per patient and p = 0.0003 in the analysis per administration). Conclusions: The IV administration and commercial Leuginase® presentation were associated with more allergic reactions in the study population, which corroborates the findings in the literature. The IV route was also associated with higher severity of reactions in the present study.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Asparaginase/toxicity , Child , Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , HypersensitivityABSTRACT
Introduction: Care bundles help healthcare professionals provide the best care possible in a structured and reliable way. The purpose of this study was to develop and apply an instrument for inpatient follow-up by clinical pharmacists, and evaluate its results. Methods: The care bundle was based on previously validated instruments. Population consisted of patients monitored by clinical pharmacists at a general hospital. The study was conducted in two phases: the first involved the development and implementation of the bundle, and the evaluation of pharmaceutical interventions; the second involved analyzing data from patients treated with the bundle over one year. Results: The bundle included fourteen pharmaceutical follow-up criteria used in different patterns by each area of care. In the first phase of the study, 3263 patients were monitored and 536 pharmaceutical interventions were performed, with an 85.3% compliance rate. In the second phase of the study, follow-up data was collected from 21,214 patients. The bundle criteria were used in a similar way in clinical, surgical and cancer patients. Pharmacotherapy review was the most prevalent intervention in all cases (60.1%). Hospital discharge planning and medication reconciliation were performed with a similar frequency in clinical, surgical, pediatric and general patients. Conclusions: The development and validation of a bundle aimed at guiding the clinical activities of pharmacists helped standardize procedures and interventions. Pharmacotherapy review was the bundle criterion with the highest rate of application and interventions due to the hospital's complexity and the need to consider individual patient needs and follow institutional policies. (AU)
Subject(s)
Humans , Pharmaceutical Services , Continuity of Patient Care , Patient Care Bundles , Medication AdherenceABSTRACT
O crescimento da população idosa no Brasil acarreta aumento de problemas relacionados a medicamentos nessa população. O objetivo deste trabalho foi avaliar a prevalência de prescrições de medicamentos potencialmente inapropriados para idosos, por meio dos critérios de Beers e STOPP/START, em uma Unidade de Saúde da Família (USF) do município de Porto Alegre. Foi realizado um estudo transversal retrospectivo com dados coletados a partir de banco de dados, correspondente ao ano de 2010, do prontuário de família da Unidade de Saúde. O estudo selecionou pacientes com 60 anos ou mais, com prescrição de psicofármacos e estes foram classificados conforme os Critérios de Beers e STOPP/START. Foram incluídos no estudo 126 pacientes que apresentavam prescrições com psicofármacos, havendo maior prevalência do sexo feminino (74,60% da amostra), média de idade de 71,25 (DP 9,46), com idade mínima de 60 anos e máxima de 101 anos. A prevalência de pacientes com prescrição de algum psicofármaco potencialmente inapropriado foi de 95,24%, considerando os dois critérios. Entre esses pacientes, 115 (91,27%) apresentavam prescrições com psicofármacos inapropriados pela classificação STOPP/ START e 112 (88,89%), pelos critérios de Beers. A maior prevalência de classe de psicofármacos inapropriados foi de antidepressivos (50,54%), ansiolíticos (20,43%), antiepiléticos (16,13%) e antipsicóticos (21,37%). A Fluoxetina foi o psicofármaco com maior prevalência de prescrição (29,37%), seguido pela Amitriptilina (24,60%), Diazepam (11,11%) e Clonazepam (10,32%). No estudo, foi observada uma grande prevalência do uso de psicofármacos pelos idosos da Unidade de Saúde da Família pesquisada, principalmente dos antidepressivos, o que sugere a necessidade de trabalhar a prescrição de medicamentos para idosos com a equipe de saúde na Atenção Primária em Saúde.
The growth of the elderly population in Brazil leads to increased drug-related problems in this population. The objective of this study was to evaluate the prevalence of potentially inappropriate drug prescriptions for the elderly, through the Beers Criteria and STOPP / START in a Family Health Unit (USF) in the city of Porto Alegre. A retrospective cross-sectional study with data collected from the database, corresponding to the year 2010 and the family records of the Health Unit was conducted. The study selected patients 60 years or older, with psychotropic prescription and these were classified as inappropriate by Beers Criteria and STOPP / START. The study included 126 patients who had prescriptions with psychotropic drugs, with higher prevalence of females (74.60% of the sample), average age of 71.25 (SD 9.46), minimum age 60 and maximum of 101 years. The prevalence of patients with prescription of any potentially inappropriate psychotropic drug was 95.24%, considering the two criteria. Among these patients, 115 (91.27%) had prescriptions with psychotropic drugs inappropriate for classification STOPP / START and 112 (88.89%) by Beers criteria. The highest prevalence of inappropriate psychotropics class was Antidepressants (50.54%), anxiolytics (20.43%), antiepileptics (16.13%) and antipsychotics (21,37%). Fluoxetine was the most prevalent psychotropic drug prescription (29.37%), followed by Amitriptyline (24.60%), Diazepam (11.11%), and clonazepam (10.32%). In the study, we observed a high prevalence of the use of psychotropic drugs by the elderly in the Family Health Unit researched, especially antidepressants, suggesting the need to work to prescription drugs for the elderly with health staff in primary health care.
Subject(s)
Pharmaceutical Services , Drug Prescriptions , Primary Health Care , Psychotropic Drugs , Aged , National Health Strategies , Inappropriate PrescribingABSTRACT
Introdução: Os inibidores da bomba de prótons (IBPs) são uma das classes terapêuticas mais prescritas no mundo, sendo omeprazol o representante nas listas de medicamentos essenciais. Estudos indicam que o uso a curto prazo dos IBPs pode ser seguro, apesar de estar relacionado efeitos adversos a longo prazo. Objetivo: Avaliar o perfil dos usuários com prescrição de omeprazol em uma Unidade Básica de Saúde (UBS), relacionando com tempo de uso, dose e indicação. Métodos: Estudo transversal no qual foram avaliados os prontuários de usuários com prescrições de omeprazol atendidas no mês de maio de 2014 pela farmácia de uma UBS. Resultados: Foram incluídos no estudo 349 pacientes, sendo 75,4% do sexo feminino. A média de medicamentos prescritos por pacientes foi de 4,5 e a idade média de 64,6 anos. A dose de 20mg foi encontrada em 69,8% dos usuários, 84,3% tem prescrição mais de seis meses, e a doença do refluxo e a úlcera gástrica foram as indicações mais citadas; 29,5% dos pacientes não tinham registro de motivo de uso do omeprazol. Conclusão: O maior tempo de uso do omeprazol está associado com maior idade e número de medicamentos prescritos, podendo estes fatores estarem relacionados com o uso irracional de omeprazol, por vezes sem justificativa em prontuário e com tempo prolongado de uso.
Introduction: Proton pump inhibitors (PPIs) are one of the most prescribed therapeutic classes worldwide. Omeprazole, a PPI, is included in the essential medicines list. Studies indicate that short-term use of PPIs can be safe, but that their long-term use is associated with adverse effects. Objective: To evaluate the profile of patients prescribed omeprazole at a Basic Health Unit (BHU) and to evaluate the duration of use, prescribed dose, and indication for use. Methods: This was a cross-sectional study. The medical records of patients prescribed omeprazole in May 2014 were identified by the pharmacy of the BHU, and were reviewed. Results: Of the 349 patients included, 75.4% were female patients and the average age was 64.6 years. The average number of drugs prescribed was 4.5 per patient. A dose of 20 mg was prescribed most frequently (69.8%), and 84.3% of patients had been prescribed omeprazole for more than six months. Gastro-esophageal reflux disease and gastric ulcers were the most cited indications for use. However, in 29.5% of the patients in the medical records examined, no indication for the use of omeprazole could be found. Conclusion: Older age and the number of prescription drugs were associated with increased omeprazole use. These factors can also be associated with irrational, and sometimes unjustified, use of omeprazole, and with its prolonged use.
Introdución: Los inhibidores de la bomba de protones (IBP) son una de las clases terapéuticas más recetados en el mundo, y omeprazol es el representante frente a las listas de medicamentos esenciales. Los estudios indican que el uso em poco tiempo de los IBP puede ser seguro, aunque está relacionado con efectos adversos a largo plazo. Objectivo: Evaluar el perfil de los usuarios con las recetas de omeprazol en una Unidad Básica de Salud (UBS), evaluando la duración del uso, dosis e indicación. Métodos: Diseño transversal donde se evaluaron las historias clínicas de los usuarios con las recetas de omeprazol atendidas en mayo 2014 en la farmacia de UBS. Resultados: El estudio incluyó a 349 pacientes, el 75,4% eran mujeres. El número medio de fármacos prescritos para los pacientes fue de 4,5 y la edad promedio de 64,6 años. La dosis de 20 mg se encontró en el 69,8% de los usuarios, el 84,3% tiene receta para más de seis meses, y la enfermedad de reflujo y úlceras gástricas fueron las indicaciones más citadas; 29,5% de los pacientes no tenían registro de la razón para el uso de omeprazol. Conclusión: El tiempo de mayor uso de omeprazol se asocia con la edad avanzada y el número de medicamentos recetados, y estos factores están relacionados con el uso irracional de omeprazol, a veces sin justificación en los registros médicos y el uso a largo plazo.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Drug Prescriptions , Health Centers , OmeprazoleABSTRACT
O uso de psicofármacos está aumentando e no Brasil há poucos estudos investigando seu emprego pela população e na Atenção Primária à Saúde (APS). Este estudo buscou verificar a prevalência e o padrão de consumo por usuários de uma Unidade de Saúde da Família de Porto Alegre através de um delinemeanto observacional, descritivo, retrospectivo e de corte transversal. A amostra foi composta por usuários que retiraram receitas de medicamentos controlados e os dados coletados a partir do prontuário. Foram incluídos 329 usuários, com prevalência de utilização de psicofármacos de 7,30%, média de idade de 53,14 (DP = 18,58) anos e 72% de indivíduos do sexo feminino. A média de medicamentos e psicofármacos prescritos por usuário foi de 3,56 (DP = 2,36) e 1,66 (DP = 0,90), respectivamente. A classe mais utilizada foi a de antidepressivos, seguida de antiepiléticos, ansiolíticos e antipsicóticos. Faz-se necessário elaborar estratégias para melhorar o acesso, tratamento dos usuários e uso racional de psicofármacos, incluindo a revisão das listas de medicamentos essenciais e a capacitação dos profissionais da APS.
The use of psychotropic drugs is on the increase, and there are few studies in Brazil investigating their use in the population and in Primary Health Care (PHC). This study aimed to determine the prevalence and patterns of psychotropic drug use by patients of a Family Health Unit in Porto Alegre, through an observational, descriptive, retrospective and cross-sectional study. The sample consisted of patients who received prescriptions for controlled psychotropic drugs and the data collected from medical records. The study included 329 patients, with prevalence of the use of psychotropic drugs of 7.30%, mean age of 53.14 (SD = 18.58) years and 72% female. The average number of prescribed drugs and psychotropic drugs per user was 3.56 (SD = 2.36) and 1.66 (SD = 0.90), respectively. The most widely used class was antidepressants, followed by antiepileptics, anxiolytics and antipsychotics. It is necessary to develop strategies to improve access, treatment of patients and rational use of psychotropic drugs, including the revision of lists of essential drugs and training of professionals in PHC.