Risk of opioid abuse in non-oncologic chronic pain outpatient clinic / Risco de abuso de opioides em ambulatório de dor crônica não oncológica

ABSTRACT BACKGROUND AND OBJECTIVES: Chronic pain has become an extremely prevalent disease and an ever more recurrent reason for seeking medical attention. It has been treated with opioids, opening the possibility for abuse. This study's objective was to analyze the risk profile for opioid abuse in chronic pain outpatients. METHODS: Cross-sectional study with 72 patients seen in an outpatient clinic of a public hospital in the period of July and August 2019. The variables analyzed were age, gender, comorbidities, drugs in use, and aspects related to pain such as intensity, anatomical location, etiology, and need to be absent from work. In addition, a questionnaire was applied to assess the risk of opioid abuse. RESULTS: The study analyzed 72 patients with chronic pain, most of whom were women (84.7%). The mean age was 52.8 years. Patients were classified into three groups according to the risk of opioid abuse: high (21%), moderate (29%) and low (50%). There was an association of increased risk with opioid use (p=0.004) and presence of depression (p=0.003). CONCLUSION: Half of the patients presented low risk for opioid abuse. Increased risk for opioid abuse is related to the presence of depression or depressive symptoms. No relationship was observed between benzodiazepines use and increased risk for opioid abuse. Patients considered at high risk for opioid abuse are more likely to develop aberrant behaviors. Knowing the patient's risk profile is necessary to increase the safety and effectiveness of chronic pain treatment.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor crônica tem se tornado uma doença extremamente prevalente e um motivo cada vez mais recorrente para procura de atendimento médico. Tem sido tratada com opioides possibilitando o abuso de seu uso. Este estudo teve como objetivo analisar o perfil de risco para abuso de opioides em pacientes ambulatoriais com dor crônica. MÉTODOS: Estudo transversal com 72 pacientes atendidos em ambulatório de um hospital público no período de julho e agosto de 2019. As variáveis analisadas foram idade, sexo, comorbidades, fármacos em uso e aspectos relacionados à dor como intensidade, localização anatômica, etiologia e necessidade de se afastar do trabalho. Além disso, foi aplicado um questionário para avaliar o risco de abuso de opioides. RESULTADOS: Foram analisados 72 pacientes com dor crônica, sendo a maioria mulheres (84,7%). A média de idade foi de 52,8 anos. Os pacientes foram classificados em três grupos conforme o risco de abuso de opioides: alto (21%), moderado (29%) e baixo (50%). Houve associação do aumento do risco com o uso de opioides (p=0,004) e com a presença de depressão (p=0,003). CONCLUSÃO: Metade dos pacientes apresentou baixo risco para abuso de opioides. O aumento do risco de abuso de opioides está relacionado à presença de depressão ou sintomas depressivos. Não foi observada relação entre o uso de benzodiazepínico e o aumento no risco de abuso para opioides. Pacientes considerados de alto risco para abuso de opioides têm mais chances de desenvolverem comportamentos aberrantes. É preciso conhecer o perfil de risco do paciente para aumentar a segurança e eficácia do tratamento da dor crônica.

Factores asociados con la automedicación no responsable en el Perú / Factors associated with non-responsible self-medication in Peru

RESUMEN Introducción: La automedicación no responsable conduce a una baja efectividad e inseguridad en los tratamientos, daños a la salud e insatisfacción del paciente. Objetivo: Identificar los factores asociados con la automedicación no responsable en la población peruana. Material y Métodos: Se realizó un estudio analítico transversal basado en el análisis secundario de la Encuesta Nacional de Satisfacción de Usuarios en Salud 2016 realizada en Perú. Incluyó 3849 usuarios de establecimientos farmacéuticos. Se calcularon: chi-cuadrado con valor p, odds ratio crudo (ORc) y odds ratio ajustado (ORa) con su intervalos de confianza del 95% (IC 95%). Resultados: El riesgo de automedicación no responsable fue muy alto cuando el dispensador del medicamento no solicitó la receta del usuario (ORa = 29,057). Además, acudir al establecimiento farmacéutico para pedir consejo (ORa= 1,884), el consumo eventual del medicamento comprado (ORa= 1,925), menos de cinco minutos de demora en la compra del medicamento (ORa= 1,587) y ser hombre (ORa= 1,321) también fueron factores de riesgo. La proximidad del establecimiento farmacéutico a los establecimientos de salud del primer y segundo nivel de atención también actuó como un factor de riesgo (ORa= 1,340 y 1,652, respectivamente). Conclusión: La falta de solicitud de prescripción en el establecimiento farmacéutico fue el principal factor de riesgo para la automedicación no responsable.

ABSTRACT Introduction: Non-responsible self-medication leads to low effectiveness and insecurity in treatments, damage of health and patient dissatisfaction. Objective: To identify factors associated with non-responsible self-medication in the Peruvian population. Material and Methods: An analytical cross-sectional study was conducted based on the secondary analysis of the National Survey of Users Satisfaction in Health performed in Peru in 2016. It included 3849 users of pharmaceutical establishments. Chi-square statistic with p-value, crude odds ratio (cOR) and adjusted odds ratio (aOR) with its 95% confidence interval (95% CI) were calculated. Results: When the dispenser of the medicine did not request the prescription from the user, the risk of non-responsible self-medication was very high (aOR=29.057). Additionally, going to the pharmaceutical establishment to ask for advice (aOR=1.884), eventual consumption of the purchased medicine (aOR=1.925), less than five minutes delay in purchasing medicine (aOR=1.587) and being male (aOR=1.321) were also risk factors. The proximity of the pharmaceutical store to health services from the first and second level of health care also acted as a risk factor (cOR=1.340 and 1.652, respectively). Conclusion: The lack of request for prescription in the pharmaceutical establishment was the main risk factor for non-responsible self-medication.

Prevalência de intoxicação por medicamentos no estado da Bahia entre 2007 e 2017 / Prevalence of drug poisoning in the state of Bahia between 2007 and 2017 / Prevalencia de intoxicación por medicamentos en el estado de Bahía entre 2007 y 2017

Justificativa e Objetivos: As intoxicações por medicamentos estão se tornando um problema de saúde pública. Nesse contexto, a atenção farmacêutica, bem como os cuidados dos profissionais de saúde que trabalham diretamente com medicamentos, tornam-se fundamentais na reparação da saúde do paciente e na prevenção de problemas relacionados ao uso desses produtos. Objetivou-se determinar a prevalência de intoxicação por medicamentos no estado da Bahia, Brasil, entre 2007 e 2017. Métodos: Foi realizado um estudo quantitativo, do tipo descritivo e exploratório, que avaliou as notificações relacionadas à intoxicação por medicamentos no estado da Bahia registradas no DATASUS entre 2007 e 2017, tendo como variáveis de interesse: faixa etária, raça/cor e sexo, circunstância, classificação final, critério de confirmação e evolução, ano e município de notificação. Resultados: Foram registrados 28.412 casos de intoxicação exógena no período, sendo 29,7% causados por medicamentos. A faixa etária de maior prevalência foi de 20 a 39 anos (38,5%), com maior número de casos entre pessoas do sexo feminino (66,7%), tendo a tentativa de suicídio como a principal causa, correspondendo a 38,5% das notificações. A maior concentração de casos notificados ocorreu na capital do estado. Conclusão: No período estudado, os medicamentos foram os maiores responsáveis pelos casos de intoxicação exógena, sendo a tentativa de suicídio o maior motivo. Sem dúvidas, a facilidade de acesso a esses produtos predispõe à automedicação, sendo um fator de risco para esses casos de intoxicação. Nesse cenário, é necessária a implementação de campanhas de uso racional de medicamentos no estado da Bahia, bem como de prevenção ao suicídio, direcionadas, principalmente, aos adultos jovens, faixa etária com maior prevalência de casos.(AU)

Background and Objectives: Drug poisoning is becoming a public health problem. In this context, pharmaceutical care and the care of health professionals who work directly with medications are fundamental in the repair of patients' health and in the prevention of problems related to the use of these products. This study aimed to determine the prevalence of drug poisoning in the state of Bahia, Brazil, between 2007 and 2017. Methods: This is a quantitative, descriptive and exploratory study, which evaluated the drug poisoning notifications in the state of Bahia, recorded in DATASUS between 2007 and 2017, considering as variables of interest: age group, race, sex, circumstance, final classification, confirmation criterion and evolution, year and city of notification. Results: In the period, 28,412 cases of exogenous intoxication were recorded, 29.7% of which were caused by medications. The age group with the highest prevalence was 20 to 39 years old (38.5%), females presented the highest number of cases (66.7%); suicide attempt was the main cause, corresponding to 38.5% of the notifications. The highest concentration of reported cases occurred in the state capital. Conclusion: In the studied period, the drugs were the most responsible for cases of exogenous intoxication, and suicide attempt was the main reason. Undoubtedly, the easy access to these products predisposes self-medication­a risk factor for these cases of intoxication. In this scenario, it is necessary to implement campaigns for the rational use of medicines in the state of Bahia, as well as suicide prevention, directed mainly to young adults­the age group with the highest prevalence of cases.(AU)

Justificación y Objetivos: La intoxicación por medicamentos se está convirtiendo en un problema de salud pública. En este contexto, la atención farmacéutica, así como los cuidados de los profesionales de la salud que trabajan directamente con medicamentos, se vuelven fundamentales en la reparación de la salud del paciente y la prevención de problemas relacionados con este uso. El objetivo de este estudio fue determinar la prevalencia de intoxicación por medicamentos en el estado de Bahía entre 2007 y 2017. Métodos: Se realizó un estudio exploratorio cuantitativo, descriptivo, que evaluó las notificaciones relacionadas con la intoxicación por medicamentos en el estado de Bahía registradas en DATASUS entre 2007 y 2017, teniendo como variables de interés: grupo de edad, raza/color y sexo, circunstancia, clasificación final, criterios de confirmación y evolución, año y ciudades de notificación. Resultados: Hubo 28.412 casos de intoxicación exógena en el período; de los cuales el 29,7% fueron causados por medicamentos. El grupo de edad más prevalente fue el de 20-39 años (38,5%), con un mayor número de casos entre mujeres (66,7%), con intento de suicidio como la causa principal que corresponde al 38,5% de las notificaciones. La mayor concentración de casos reportados ocurrió en la capital del estado. Conclusión: Se observó que en el período estudiado la mayoría de los casos de intoxicaciones exógenas se dieron por el uso de medicamentos, con el intento de suicidio como la principal razón. El fácil acceso a los medicamentos predispone a la automedicación, un factor de riesgo para casos de intoxicación. En este sentido, se hace necesario implementar campañas para el uso racional de medicamentos en el estado de Bahía, así como para la prevención del suicidio, sobre todo en los adultos jóvenes, grupo de edad con una mayor prevalencia de casos.(AU)

Vitamin, micronutrients and supplement prescribing patterns in a group of ambulatory colombian patients, 2016 / Patrones de prescripción de vitaminas y suplementos nutricionales en un grupo de pacientes de Colombia

Abstract Introduction: Vitamins and micronutrients are essential organic substances in the metabolic processes of living things, and supplementation is only recommended in conditions of nutritional deficits. Objective: To determine the prescription patterns of vitamins and supplements in a group of patients enrolled in the Colombian Health System in 2016. Methodology: This was a cross-sectional study based on a population database. Vitamin-prescribed patients of both sexes and all ages were selected for 3 consecutive months. A database was designed using the dispensing records. SPSS 23.0 was used for the univariate, bivariate and multivariate analyses. A p-value <0.05 was considered statistically significant. Results: In total, 9998 patients receiving vitamin supplementation were identified. A female predominance was observed (n=8341, 83.4%). The mean age was 57.7±18.7 years. The most commonly formulated vitamins and micronutrients were vitamin D (58.0%), calcium (55.0%) and folic acid (25.0%). Overall, 60.8% of patients were prescribed more than one vitamin. The most frequent multiple-nutrient association was between calcium and vitamin D (n=5505); 77.3% received concurrent treatment with other medications to manage comorbidities. The probability of comedication in the multivariate analysis was higher for folic acid (OR:3.10, 95%CI 2.69-3.59), thiamine (OR:2.75, 95%CI:2.15-3.5) and calcium + vitamin D (OR:1.61, 95%CI: 1.42-1.82) and for those individuals older than 65 years (OR:1.24, 95%CI:1.02-1.51). Conclusions: Vitamins are widely used in the Colombian population. The results of this study elucidate the patterns of use of these supplements and offer proposed strategies to the future and to evaluate and minimize prescriptions that are potentially inappropriate or of little therapeutic value. MÉD.UIS. 2020;33(2):41-8.

Resumen Introducción: Las vitaminas y micronutrientes son sustancias orgánicas esenciales en los procesos metabólicos de los seres vivos y solo se recomienda suplementación en condiciones con déficits nutricionales. Objetivo: Determinar los patrones de prescripción de vitaminas y suplementos en un grupo de pacientes afiliados al Sistema de Salud en Colombia, en el año 2016. Métodos: Estudio de corte transversal a partir de una base de datos poblacional. Se seleccionaron pacientes con prescripción de vitaminas por 3 meses consecutivos de ambos sexos y todas las edades. Se diseñó una base de datos con los registros de dispensación. Se usó SPSS 23.0 para análisis univariados, bivariados y multivariados. Se consideró estadísticamente significativo un valor de p<0,05. Resultados: Se hallaron 9998 pacientes con prescripción de suplementos vitamínicos. Se halló un predominio femenino (n=8341; 83,4%). La edad media fue de 57,7±18,7 años, las vitaminas y micronutrientes más formulados fueron: vitamina D (58,0%), calcio (55,0%) y ácido fólico (25,0%). El 60,8% de pacientes tenía más de un suplemento prescrito. La asociación más frecuente fue calcio y vitamina D (n=5505), y el 77,3% recibía tratamiento simultáneo con otros medicamentos para el control de comorbilidades. La probabilidad de comedicacion en el análisis multivariado fue mayor en formulados con ácido fólico (OR:3,10; IC95%:2,69-3,59), tiamina (OR:2,75; IC95%:2,15-3,50), calcio+vitamina D (OR:1,61; IC95%:1,42-1,82) y los mayores de 65 años (OR:1,24; IC95%:1,02-1,51). Conclusiones: Las vitaminas son ampliamente usadas en la población colombiana, los hallazgos de este estudio permiten conocer un estado de los patrones de uso de estos suplementos, así como plantear estrategias para racionalizar las prescripciones potencialmente inapropiadas o de poco valor terapéutico. MÉD.UIS. 2020;33(2):41-8.

Intoxicaciones agudas por medicamentos consumidos con fines de abuso / Acute poisoning due to medications used for abuse purposes

Introducción: El consumo de sustancias con fines de abuso y entre ellas los medicamentos, se ha incrementado a nivel mundial. Objetivo: Caracterizar a los pacientes atendidos por intoxicaciones agudas debido a medicamentos consumidos con fines de abuso. Métodos: El universo estuvo constituido por consultas de 961 pacientes, realizadas al servicio de información toxicológica de urgencia del Centro Nacional de Toxicología, durante el período 2010 al 2014. Fueron todas las intoxicaciones agudas por consumo de sustancias con fines de abuso. La serie incluyó 578 pacientes con intoxicaciones agudas con fines de abuso, donde el agente causal fueron los medicamentos. Se recopilaron los datos sociales y biológicos, formas de consumo, grupos farmacológicos, manifestaciones clínicas, aspectos de la toxicocinética y la toxicodinamia. Resultados: Los consumidores de medicamentos con fines de abuso, representaron el 60,14 por ciento de las consultas por consumo de sustancias con fines de abuso. El grupo etario de hasta 20 años fue el de mayor consumo (360 consultas; 62,28 por ciento) y el sexo masculino el más frecuente (447 pacientes; 77,3 por ciento). La combinación de medicamentos más alcohol fue la forma de consumo más empleada (292 consultas; 50,5 por ciento). La carbamazepina fue el medicamento más consumido (305 consultas; 52,7 por ciento). Conclusiones: Predominó la intoxicación aguda en el grupo etario de 10-20 años y del sexo masculino. La ingestión de medicamentos más alcohol, fue la forma de consumo más empleada. El grupo farmacológico más utilizado con fines no médicos, fue el de los anticonvulsivantes (carbamazepina), seguido de las benzodiacepinas y los opiáceos. Las manifestaciones clínicas que predominaron fueron del sistema neurológico, seguido del cardiovascular y el digestivo(AU)

ABSTRACT Introduction: The consumption of substances for the purpose of abuse, including drugs, has increased worldwide. Objective: To characterize patients treated for acute intoxications due to drugs consumed for abuse purposes. Methods: The universe was constituted by consultations of 961 patients, made to the emergency toxicology information service of the National Center of Toxicology, during the period from 2010 to 2014. They were all acute intoxications due to the consumption of substances for the purpose of abuse. The series included 578 patients with acute intoxications for abuse, where the causative agent was medication. We collected social and biological data, forms of consumption, pharmacological groups, clinical manifestations, aspects of toxicokinetics and toxicodynamics. Results: Consumers of medications for the purpose of abuse accounted for 60.14 percent of consultations for the consumption of substances for the purpose of abuse. The age group of up to 20 years consumed the most (360 consultations, 62.28 percent) and the most frequent was the male sex (447 patients, 77.3 percent). The combination of drugs plus alcohol was the most used form of consumption (292 consultations, 50.5 percent). Carbamazepine was the most commonly used medication (305 consultations, 52.7 percent). Conclusions: Acute intoxication predominated in the age group of 10-20 years and of the male sex. The ingestion of drugs plus alcohol was the most used form of consumption. The most used pharmacological group for non-medical purposes was the anticonvulsant group (carbamazepine), followed by benzodiazepines and opiates. The clinical manifestations that predominated were of the neurological system, followed by cardiovascular and digestive(AU)

Consumo do benzodiazepínico clonazepam (Rivotril®) no estado do Rio de Janeiro, Brasil, 2009-2013: estudo ecológico / Consumption of the benzodiazepine clonazepam (Rivotril®) in Rio de Janeiro State, Brazil, 2009-2013: an ecological study

Resumo O objetivo do estudo é estimar a prevalência do uso de clonazepam no Estado do Rio de Janeiro (RJ). Estudo ecológico e descritivo do consumo de clonazepam (2009-2013), com dados do Sistema Nacional de Gerenciamento de Produtos Controlados da Anvisa. O consumo foi medido pela Dose Diária Definida, com indicadores por população total e com 18 anos e mais utilizando a DDD padronizada de 8mg (anticonvulsivante) e a de 1mg (hipnosedativo). Os Municípios da Região Metropolitana foram agrupados segundo os Índices de Desenvolvimento Humano (IDH) e de GINI, submetidos à análise de conglomerados e apresentados segundo o consumo de clonazepam. No Estado do RJ, o consumo entre 2009 e 2013 aumentou de 0,35 para 1,97 DDD/1000 habitantes. Os valores são maiores para os indivíduos acima de 18 anos. Empregando-se 1mg ao invés de 8mg, chega-se a 21 DDD/1000 habitantes acima de 18 anos, em 2013. Rio de Janeiro e Niterói, com os maiores IDH, apresentaram em 2013 os maiores consumos, 3,38 e 4,52 DDD, respectivamente. Os dados sugerem que até 2% da população adulta é usuária de clonazepam, possivelmente como hipnosedativo. Deve-se atentar para o uso ampliado e fora de indicações terapêuticas, dados o potencial de abuso e as reações adversas ao clonazepam.

Abstract This descriptive, ecological study of clonazepam consumption in Rio de Janeiro State (RJ) estimated use prevalence from 2009 to 2013 using data from the National Controlled Product Management System operated by Brazil's health surveillance agency, Anvisa. Consumption was measured by total population and by population over 18 years old, using the standardised Daily Defined Doses of 8 mg (anticonvulsant) and 1 mg (sedative-hypnotic). The municipalities of the Rio de Janeiro Metropolitan Region were grouped by Human Development Index (HDI) and GINI index, subjected to cluster analysis and ranked by clonazepam consumption. From 2009 to 2013, consumption in the state rose from 0.35 to 1.97 DDD/1000 population, but the figures are higher for individuals over 18 years of age. A DDD of 1 mg instead of 8mg returns consumption in 2013 of 21 DDD/1000 population over 18 years of age. Consumption in 2013 was highest - 3.38 and 4.52 DDD, respectively - in Rio de Janeiro and Niterói, which have the highest HDIs. This suggests that up to 2% of the adult population uses clonazepam, possibly as a sedative-hypnotic. This broad use and use outside therapeutic indications deserves attention, given clonazepam's potential for abuse and adverse reactions.

Renovação de Prescrição Médica na atenção primária: uma análise crítica / Prescription refill in primary health care: a critical analysis

A renovação de receita é uma prática comum nos serviços de atenção básica no Brasil, ainda que pouco discutida. Embora exista um número expressivo de artigos em língua inglesa sobre o assunto, pouco se encontra a respeito na literatura brasileira. A renovação de medicamentos de uso contínuo traz consigo riscos e potenciais danos à saúde do usuário quando praticada sem protocolos bem definidos e sem a correta avaliação clínica das pessoas acompanhadas. Dessa forma, a renovação de receita pode perpetuar o uso de medicações com indicação duvidosa, efeitos colaterais significativos, interações medicamentosas importantes, medicamentos contraindicados e/ou que não são mais necessários. Além disso, pode transmitir a sensação de que a população está sendo bem assistida apenas pelo fato de as pessoas conseguirem receber medicamentos, ainda que sem uma avaliação periódica. Por outro lado, caso realizada de forma ideal, poderia favorecer aumento da adesão ao tratamento, bem como a avaliação de interações medicamentosas, o cumprimento da terapêutica e a necessidade de exames complementares. O presente artigo realizará uma discussão crítica sobre os riscos e benefícios da renovação de receita da maneira como é feita no Brasil, incluindo seus aspectos legais e pontos passíveis de melhorias segundo a literatura internacional. (AU)

Repeat prescribing is a common practice at primary health care in Brazil which is poorly discussed. Despite the large number of articles in English, the Brazilian literature barely discuss this subject. The renewal of continuous-use medication may lead to risks and potential harms to patient health when used without defined protocols or adequate clinical evaluation. This practice may perpetuate the use of medication with arguable indication, significant side effects, significant drug interactions, contraindicated drugs or that are no longer needed. It also may leads to a misperception of being well attended, although it is a mere transcription of medical receipts. However, if performed in an adequate way, it might be associated with increased adherence to treatment. It also might allow assessment of drug interactions, compliance with therapy and checking out the need for complementary tests. This article will critically discuss the risks and benefits of prescription renewal in the way it is done in Brazil, including its legal aspects and possible points for improvement according to the international literature. (AU)

Uso de substâncias psicoativas em idosos: uma revisão integrativa / Elderly substance abuse: an integrative review / El abuso de sustancias en los ancianos: una revisión integradora

Trata-se de uma revisão integrativa da literatura, que teve por objetivo analisar a produção científica sobre o uso de substâncias psicoativas em idosos, focalizando suas condições sociodemográficas e clínicas. Foi realizada uma busca sistemática utilizando-se as bases Scopus, Web of Knowledge, Academic Search Premier, PubMed e ScienceDirect. Considerando os critérios de inclusão e exclusão, foram selecionados 13 estudos, sem restrição de período de tempo. Os idosos usuários de substâncias psicoativas caracterizam-se, predominantemente, por serem homens, com baixos níveis de escolaridade e renda, desocupação laboral, não casados e a habitar isoladamente, além de apresentarem comorbilidades orgânicas e psíquicas. O álcool é a droga mais comum nessa faixa etária, seguido do abuso de medicamentos; no entanto, o uso de substâncias ilícitas tem aumentado progressivamente. Ainda que as evidências sejam limitadas, estudos indicam menores taxas de comportamentos de alto risco para saúde em idosos. A literatura é consensual sobre a necessidade de mais estudos, de modo a preencher as lacunas do conhecimento e facilitar a identificação precoce desses utentes.

This paper is an integrative literature review that analyzes the scientific production of psychoactive substances use, as well as the demographic and clinical characteristics of elderly that use psychoactive substances. The systematic research was performed in Scopus, Web of Knowledge, Academic Search Premier, PubMed, and ScienceDirect databases. Considering the criteria for inclusion and exclusion, 13 studies were selected without restriction to a period The elderly are mainly characterized for being men with low levels of education and income, unemployed, single and living alone. The elderly present organic and psychological comorbidities. Alcohol is the most common drug used by people this age, followed by the abuse of medication, however, the use of illicit substances is increasing. Although evidence is limited, studies indicate lower rates of high-risk behaviors to elderly's health. Literature is consensual about the need for more studies in order to fill the knowledge gaps and to facilitate the identification of these users.

Este trabajo es una revisión integradora de la literatura, con el objetivo de analizar la producción científica sobre el uso de sustancias psicoactivas, así como las características demográficas y clínicas de los ancianos que utilizan estas sustancias. Se ha realizado una búsqueda sistemática utilizando las bases Scopus, Web of Knowledge, Academic Search Premier, PubMed y ScienceDirect, sin restricción de tiempo. Teniendo en cuenta los criterios de inclusión y exclusión, se seleccionaron 13 estudios, sin restricción del periodo de tiempo. Las personas mayores que utilizan sustancias psicoactivas se caracterizan por ser predominantemente hombres, con bajos niveles de educación e ingresos, desempleo laboral, no casados y viviendo solos. Muestran comorbilidades orgánicas y psicológicas. El alcohol es la droga más común a esta edad, seguido por el abuso de medicamentos, sin embargo, el uso de sustancias ilícitas ha aumentado incrementalmente. Aunque las evidencias sean limitadas, los estudios indican menores porcentajes de conductas de alto riesgo para la salud en las personas mayores. La literatura es consensual sobre la necesidad de más estudios a fin de colmar las lagunas de conocimiento y facilitar la identificación de dichos usuarios.

Factors associated with the contraindicated use of oral contraceptives in Brazil / Fatores associados ao uso contraindicado de contraceptivos orais no Brasil

ABSTRACT OBJECTIVE To estimate the prevalence of the contraindicated use of oral contraceptives and the associated factors in Brazilian women. METHODS 20,454 women who answered the VIGITEL survey in 2008 also participated in this study, of which 3,985 reported using oral contraceptives. We defined the following conditions for the contraindicated use of contraceptives: hypertension; cardiovascular diseases such as heart attack, stroke/cerebrovascular accident; diabetes mellitus; being smoker and 35 years old or older. We estimated the prevalence and 95% confidence intervals of contraindicated use in users of oral contraceptives and the factors associated with contraindication by prevalence ratio and 95% confidence intervals. RESULTS In the total population, 21% (95%CI 19.7–21.9) of women showed some contraindication to the use of oral contraceptives, of which 11.7% (95%CI 10.6–13.7) belonged to the group of users of oral contraceptives. The most frequent contraindication in users of oral contraceptives was hypertension (9.1%). The largest proportion of women with at least one contraindication was aged between 45 and 49 years (45.8%) and with education level between zero and eight years (23.8%). The prevalence of contraindication to oral contraceptives was higher in women less educated (zero to eight years of study) (PR = 2.46; 95%CI 1.57–3.86; p < 0.05) and with age between 35-44 years (PR = 4.00; 95%CI 2.34–6.83) and 45-49 years (PR = 5.59; 95%CI 2.90–10.75). CONCLUSIONS Age greater than or equal to 35 and low education level were demographic and iniquity factors, respectively, in the contraindicated use of oral contraceptives.

RESUMO OBJETIVO Estimar a prevalência de contraindicação ao uso de anticoncepcionais orais e os fatores associados em mulheres brasileiras. MÉTODOS Participaram 20.454 mulheres que responderam ao inquérito Vigitel em 2008, das quais 3.985 reportaram uso de contraceptivos orais. Definiu-se como uso contraindicado de anticoncepcionais quando presente pelo menos uma condição: hipertensão; doenças cardiovasculares como infarto, derrame/acidente vascular encefálico; diabetes mellitus; ser tabagista e ter idade igual ou maior de 35 anos. Foram estimadas as prevalências e intervalos de 95% de confiança de uso contraindicado em usuárias de anticoncepcionais orais e fatores associados à contraindicação por meio de razões de prevalência e intervalos de 95% de confiança. RESULTADOS Na população total, 21,0% (IC95% 19,7–21,9) das mulheres apresentaram alguma contraindicação ao uso de anticoncepcionais orais, das quais 11,7% (IC95% 10,6–13,7) pertenciam ao grupo de usuárias de anticoncepcionais orais. A contraindicação mais freqüente entre as usuárias de anticoncepcionais orais foi hipertensão (9,1%). A maior proporção de mulheres com pelo menos uma contraindicação tinha entre 45 a 49 anos (45,8%) e escolaridade entre zero e oito (23,8%). A prevalência de contraindicação de anticoncepcionais orais foi maior nas mulheres menos escolarizadas (zero a oito anos de estudos) (RP = 2,46; IC95% 1,57–3,86; p < 0,05) e idade entre 35-44 anos (RP = 4,00; IC95% 2,34–6,83) e 45-49 anos (RP = 5,59; IC95% 2,90–10,75). CONCLUSÕES Idade maior ou igual a 35 e escolaridade baixa foram fatores demográficos e de iniquidade, respectivamente, no uso contraindicado de contraceptivos orais.

Codeine Precipitating Serotonin Syndrome in a Patient in Therapy with Antidepressant and Triptan

The serotonin syndrome is a serioius medical condition due due to an intensive stimulation of setonin receptors. It is a rare, but severe, consequence of interaction between serotomimetic agents. This is a report of a 70-year-old woman steadily in therapy with venlafaxine and rizatriptan for migraine and major depressive syndrome. She was admitted to neurology unit for decreased light reflex with miotic pupils, global hyperreflexia, tremor, anxiety, ataxia and incoordination. The patient was diagnosed as a probable case of serotonin syndrome due to a pharmacological interaction between venlafaxine and rizatriptan trigged by opioid intake. In this paper, the development of syntomatology, the clinical examination and the possible pharmacokinetics explanation were carefully discussed and analysed.

Prevalencia de compra sin receta y recomendación de antibióticos para niños menores de 5 años en farmacias privadas de zonas periurbanas en Lima, Perú / Prevalence of purchase of antibiotics without prescription and antibiotic recommendation practices for children under five years of age in private pharmacies in peri-urban areas of Lima, Peru

RESUMEN Objetivos . Determinar la prevalencia de compra sin receta médica y recomendación de antibióticos para su uso en niños menores de 5 años en farmacias privadas de zonas periurbanas de Lima. Materiales y métodos. Se aplicó una encuesta anónima poblacional en adultos que compraron un antibiótico para un niño menor de cinco años en una farmacia privada. En un subgrupo de farmacias se aplicaron casos ficticios para evaluar prácticas de recomendación de antibióticos. Resultados. La prevalencia de compra sin receta fue de 13%; 1,7% por automedicación y 11,3% por indicación del farmacéutico. El 66,7% de los medicamentos para tratar resfrío fueron antibióticos de los cuales 56,9% tenían receta. El 64,4% de los medicamentos comprados para tratar broncoespasmo fueron antibióticos; el 96,4% de los medicamentos para tratar diarreas acuosas y el 90,9% de los medicamentos para tratar faringitis. Amoxicilina (51,5%) y trimetoprim-sulfametoxazol (20,6%) fueron los más comprados. En el 60% de los casos ficticios de resfrío común, en el 76% de los de broncoespasmo, en el 44% de los de diarrea acuosa y en el 76% de los casos de disentería, el farmacéutico indicó un antibiótico. Conclusiones . La compra de antibióticos para niños menores de cinco años en farmacias privadas es principalmente con receta médica. La recomendación de antibióticos por parte de la farmacia es alta cuando no hay receta médica. Urgen medidas para disminuir el uso inadecuado de antibióticos tanto a nivel médico como en las farmacias.

ABSTRACT Objectives. To determine the prevalence of purchase of antibiotics without prescription and antibiotic recommendation for its use in children <5 years of age in private pharmacies in peri-urban areas of Lima. Materials and methods. An anonymous population survey was conducted among adults who bought an antibiotic for a child <5 years of age from a private pharmacy. Fictitious cases were applied in a subgroup of pharmacies to evaluate antibiotic recommendation practices. Results. The prevalence of purchase of antibiotics without a prescription was 13%, including 1.7% that were chosen by consumers and 11.3% that were recommended by pharmacists. A total of 66.7% of the medications purchased to treat colds were antibiotics, 56.9% of which were prescribed. 64.4% of medications purchased to treat bronchospasm, 96.4% of the medications to treat watery diarrhea and 90.9% of the medications to treat pharyngitis were antibiotics. Amoxicillin (51.5%) and trimethoprim-sulfamethoxazole (20.6%) were the most commonly purchased antibiotics. A pharmacist suggested an antibiotic in 60% of the fictitious common cold cases, 76% of the bronchospasm cases, 44% of the watery diarrhea cases, and 76% of the dysentery cases. Conclusions. The purchase of antibiotics for children <5 years of age in private pharmacies primarily occurs with a medical prescription. The pharmacist commonly recommended an antibiotic in cases lacking a prescription. Measures are needed to reduce the inappropriate use of antibiotics at medical facilities and in pharmacies.

Panorama dos aspectos regulatórios que norteiam a partição de comprimidos / Overview of regulatory aspects guiding tablet scoring

RESUMO A partição de comprimidos é uma prática controversa no meio da saúde. Mesmo assim, é amplamente difundida, principalmente em tratamentos envolvendo crianças e idosos, para ajustar doses, facilitar a ingestão do medicamento ou baratear o custo do tratamento medicamentoso. Os riscos dessa prática estão relacionados principalmente à imprecisão na dosagem das frações e a problemas de estabilidade no medicamento partido. O objetivo deste trabalho foi traçar um panorama das bases sanitárias que norteiam esse tema no mundo. Constatamos que as agências regulatórias de saúde dos países que integram o Mercosul, além de outros países sul-americanos, não possuem normas publicadas que tratem de partição de comprimidos. Entre as agências sanitárias pesquisadas, a Food and Drug Administration (FDA), nos Estados Unidos, é a única a apresentar normas que abrangem desde instruções para orientar o fracionamento até a regulação do processo de fabricação. O conceito de sulco funcional implementado pela FDA estabelece algumas garantias quanto à capacidade do comprimido de ser fracionado. Pode-se concluir que ainda faltam bases técnicas e científicas para direcionar as normas sanitárias acerca desse tema, tornando a decisão sobre a partição de comprimidos, em determinadas situações, aleatória e de alto risco para a saúde pública. A necessidade de regulação mais pormenorizada é vital para garantir a segurança dos usuários de medicamentos.

ABSTRACT Tablet scoring is a controversial but common practice used to adjust doses, facilitate drug intake, or lower the cost of drug treatment, especially in children and the elderly. The risks of tablet scoring are mainly related to inaccuracies in the resulting dose and stability problems. The aim of this article is to provide an overview of worldwide guidelines regarding tablet scoring. We found that regulatory health agencies in Mercosur countries as well as other South American countries do not have published standards addressing tablet splitting. Among the surveyed health agencies, the Food and Drug Administration (FDA) in the United States is the only one to present standards, ranging from splitting instructions to regulation of the manufacturing process. The concept of functional scoring implemented by the FDA has introduced some level of guarantee as to the ability of tablets to be split. In conclusion, technical and scientific bases are still insufficient to guide health rules on this subject, making the decision on scoring, in certain situations, random and highly risky to public health. The need for more detailed regulation is vital to ensure the safety of tablet medications.

A Prediction Model of Drug Misuse Behaviors in Community-Dwelling Older Adults

PURPOSE: This study was designed to construct a model which explains drug misuse behaviors in community-dwelling older adults. METHODS: The design of this research is a cross-sectional study using structure equation modeling. The hypothetical model consisted of two types of variables: the exogenous variables of health status, cognitive ability, and negative emotion, and the endogenous variables of number of drugs, and drug misuse behaviors. The data collection was conducted from September 2 to September 21, 2013 through self-report questionnaires. Participants were 320 community-dwelling adults over the age of 65 living in J city. Data were analyzed with SPSS 21.0 program and Amos 18.0 program. RESULTS: The results of the model fitness analysis were satisfied. The predictor variables for the hypothetical model explained 62.3% of variance regarding drug misuse behaviors. Drug misuse behaviors were directly affected by health status, cognitive ability, negative emotion and number of drugs and indirectly affected by health status, and negative emotion through number of drugs. CONCLUSION: These findings indicate factors that should be used in developing effective nursing interventions for safe and proper drug use and the prevention of drug misuse behaviors in community-dwelling older adults.

Non-Medical Use of Prescription Drugs in Bangalore, India.

Background: Non-medical prescription drug use is an ongoing problem in India; however, there is paucity of literature in the Indian population. Objective: The objective of the present study is to explore the non-medical use of prescription medicines in urban Bangalore, South India (N = 717). Materials and Methods: Participants were recruited using a mall-intercept approach, wherein they were intercepted in 5 randomly selected shopping malls, and interviewed on their use of prescription medicines. Results: The mean age of the participants was 28 years (S.D. 5). The nonmedical use of different prescription medicine classes over the past 12 months was as follows: anti-infl ammatories and analgesics (26%), opioids (17%), antibiotics (13%), and sedatives (12%). The majority reported “use without prescription,” while “use in ways other than as prescribed” was also reported. In all cases, chemist shops were the main source of obtaining the drugs non-medically. In multivariate logistic regression analyses, non-medical use was found to be signifi cantly associated with participants’ baseline characteristics like gender, education, current employment status, and marital status. Sixty-fi ve percent stated that although “doctor’s prescription is not required for common complaints, we can decide ourselves,” while 60% stated, “it’s okay to deviate from a prescription as needed.” One hundred percent said that “using prescription medicines is more socially acceptable, and safer, compared to alcohol or illicit drugs.” Conclusion: These fi ndings underscore the need for considering various contextual factors in tailoring preventive interventions for reducing non-medical use of prescription drugs.

A survey of the use of veterinary anesthetics in Korea / 대한수의학회지

This study was conducted to investigate actual conditions associated with veterinary anesthetic drug use in Korea, and to obtain responses from Korean veterinarians and researchers pertaining to the use of anesthetic drugs. To accomplish this, a nationwide survey was issued to veterinarians working at animal hospitals and to researchers in the Korean Association for Laboratory Animal Science (KALAS). A self-administered questionnaire-based survey was then conducted in which respondents were asked questions about actual conditions associated with the use of animal anesthetic drugs. The survey revealed that the distribution and management of animal medicines in Korea was quite vulnerable to misuse or abuse due to a variety of factors. Therefore, a relevant regulatory system should be strictly enforced to protect vulnerable individuals from abuse or misuse.

Medication Status and the Effects of a Medication Management Education Program for the Elderly in a Community

PURPOSE: This study investigated medication status by examining the effects of a medication management education program on the knowledge of medications and medication misuse behaviors in the elderly in a local community. METHODS: This study used a non-equivalent control group quasi-experimental design. For the study, 116 subjects were assigned to the control group and another 116 subjects were assigned to the experimental group. The medication management education program consisted of 1:1 education, practice in medication management, consultation, and discussion. Data were analyzed using the SPSS 21.0 program. RESULTS: Statistically significant differences were found between the experimental and control groups in terms of their knowledge of medications and medication misuse behaviors. CONCLUSION: The results indicate that the medical management education program is effective in improving the knowledge of medications and decreasing medication misuse behaviors. Therefore, this education program can be used as an intervention to improve the medication behaviors of the elderly in local communities.