Compounded medications for cardiovascular use in neonatology: an integrative review / Medicamentos manipulados de uso cardiovascular em neonatologia: uma revisão integrativa

ABSTRACT Objective: To analyze the profile of the compounded cardiovascular medicines prescribed in neonatology in Brazil. Data source: An integrative bibliographic review was carried out, including studies published in the last 20 years. The used descriptors were: Intensive Care Neonatal, Off-Label Use, Pharmaceutical Preparations, in the databases Virtual Health Library (VHL), PubMed, and Scientific Electronic Library Online (SciELO). Review articles and guidelines were excluded. The quality of the evidence was analyzed, and 10 articles were selected to integrate the study. Data synthesis: The profile of routine prescrption in the neonatal unit was evaluated. The main cardiovascular medications prescribed as compounding formulation were: Spironolactone, Captopril, Furosemide, Hydrochlorothiazide, Propranolol, Amiodarone, Nifedipine, Carvedilol, Digoxin, Enalapril, Epinephrine, and Hydralazine. The drugs were obtained from adaptations of dosage forms, through the transformation of capsules or tablets into liquid formulations, as a solution, suspension, or syrup, as well as in the form of solutions prepared from active pharmaceutical ingredients. The compounding of medications made drug therapy possible in neonatology, considering that such medications do not have registration of the oral liquid dosage form in the country, despite being part of the List of Essential Medicines for Children of the Word Health Organization. Conclusions: It was possible to analyze the profile of compounded cardiovascular medicines prescribed in neonatology in Brazil. The results showed the need for the development of medications suitable for the neonatal population, and the standardization of operational procedures for preparing extemporaneous formulations in neonatology to increase drug safety.

RESUMO Objetivo: Analisar o perfil dos medicamentos cardiovasculares manipulados prescritos em neonatologia no Brasil. Fontes de dados: Foi realizada uma revisão bibliográfica integrativa, incluindo estudos publicados nos últimos 20 anos. As palavras-chave utilizadas foram: intensive care neonatal, off-label use, pharmaceutical preparations, nos bancos de dados da Biblioteca Virtual em Saúde (BVS), PubMed e Biblioteca Eletrônica Científica Online (SciELO). Os artigos de revisão e diretrizes foram excluídos. A qualidade da evidência foi analisada, e foram selecionados 10 artigos para integrar o estudo. Síntese dos dados: Todos os estudos possibilitaram a avaliação do perfil de prescrição na rotina da unidade. Os principais fármacos cardiovasculares, prescritos em formulação extemporânea, foram espironolactona, captopril, furosemida, hidroclorotiazida, propranolol, amiodarona, nifedipina, carvedilol, digoxina, enalapril, epinefrina e hidralazina. Os medicamentos foram obtidos mediante adaptações de formas farmacêuticas, por meio da transformação de cápsulas ou comprimidos em formulações líquidas, como solução, suspensão ou xarope, assim como também na forma de soluções preparadas com base nos insumos farmacêuticos ativos. A manipulação de medicamentos tornou possível o tratamento medicamentoso em neonatologia, uma vez que tais medicamentos não possuem registro da forma farmacêutica líquida oral no país, apesar de integrarem a lista de medicamentos essenciais em pediatria da Organização Mundial da Saúde. Conclusões: Foi possível analisar o perfil dos medicamentos cardiovasculares manipulados prescritos na neonatologia no Brasil. Os resultados evidenciaram a necessidade do desenvolvimento de medicamentos adequados à população neonatal e à padronização dos procedimentos operacionais do preparo de formulações extemporâneas na neonatologia, para aumentar a segurança dos medicamentos.

Tendencias en el uso de fármacos para la COVID-19 durante la primera ola de la pandemia en un hospital de Lima, Perú / Trends in drugs usage for COVID-19 during the first wave of the pandemic in a hospital in Lima, Peru

Resumen Con el objetivo de evaluar las tendencias en el uso de fármacos en pacientes con la COVID-19 de un hospital del Perú durante la primera ola de la pandemia se realizó un estudio retrospectivo entre abril y septiembre del 2020. Se revisaron las historias clínicas de pacientes hospitalizados por neumonía por COVID-19 en el Hospital Nacional Dos de Mayo (Lima, Perú). De un total de 3103 pacientes, se incluyeron 381 historias clínica (77,4% varones y mediana de edad de 44 años). Se observó un incremento del uso de cuatro fármacos prehospitalarios (azitromicina, ivermectina, corticoides y ceftriaxona), y una disminución del uso de seis fármacos intrahospitalarios (ceftriaxona, azitromicina, hidroxicloroquina, ivermectina, pulso de corticoides y anticoagulación profiláctica); además, el uso de anticoagulación intrahospitalaria aumentó. Estos hallazgos sugieren que el manejo de la COVID-19 varió durante la primera ola de la pandemia, aumentando el uso de fármacos prehospitalarios y disminuyendo el uso de fármacos intrahospitalarios.

Abstract This study aimed to evaluate the pharmacological trends in patients with COVID-19 from a hospital in Peru during the first wave of the pandemic. Retrospective study conducted between April and September 2020. The medical records of patients hospitalized for COVID-19 pneumonia at the Dos de Mayo National Hospital (Lima, Peru) were reviewed. Of a total of 3103 patients, 381 medical records were included (77.4% male, median age: 44 years). The use of four prehospital drugs increased (azithromycin, ivermectin, corticosteroids, and ceftriaxone), while the in-hospital use of six drugs (ceftriaxone, azithromycin, hydroxychloroquine, ivermectin, corticosteroid pulse, and prophylactic anticoagulation) decreased and in-hospital anticoagulation use decreased. These findings suggest that the management of COVID-19 has varied during the first wave of the pandemic, typically increasing prehospital drug use and decreasing inpatient use.

Drug utilization study in schizophrenia patients in outpatient department of psychiatry: an observational prospective study

Background: A mental disorder or psychiatry disorder is a behavioural or mental pattern that causes significant distress or impairment of personal functioning. Schizophrenia is one of the most common psychiatric disorders. Aim of the study is to study drug utilization pattern in schizophrenia patients in outpatient department of psychiatry.Methods: A prospective and observational study was conducted in psychiatry outpatient department between May 2018 to October 2018 at Government Medical College and Hospital Aurangabad. Approval from ethics committee was taken. Data collected was of age, sex, final diagnosis, drugs prescribed to patients from case report form. The data obtained was then analyzed in Microsoft excel.Results: Total prescriptions of 129 patients were analyzed. Out of 129 patients 99 (76.74%) were male, while 30 (23.26%) were female. The mean age of the patients admitted in Psychiatry OPD was 36.71±11.76 years. Number of drugs prescribed per patient being 3.40±1.12 (mean±SD). The most common drugs used were olanzapine (66.6%), trihexyphenidyl (51.9%), lorazepam (44.9%), risperidone (39.5%), trifluoperazine (27.9%).Conclusions: Our study shows that atypical antipsychotics were the most common drugs prescribed in patients. Olanzapine was the most common medication used followed by risperidone. Our prospective study is carried out to get a more comprehensive data so that we can improve the drug utilization in our hospital.

Increase of binucleated cells in the oral mucosa: a study on the use of psychotropics by students of a Brazilian institution

SUMMARY This study aimed to assess the prevalence of medical and nonmedical use of psychiatric medication among undergraduate students of health sciences from a public university in Brasil. Another objective was to determine the frequency of nuclear morphological abnormalities in the buccal mucosa of students using psychiatric drugs. A cross-sectional study based on a Web survey was carried out with 375 health sciences undergraduate students from schools of Pharmacy, Physical Education, Nutrition, and Medicine. Additionally, spontaneous genetic damages in exfoliated cells of the buccal mucosa of 41 individuals by counting micronucleus (MN) and binucleated (BN) cells frequencies were evaluated. The results showed 76 (20.3%) of students reported the use of psychotropic drugs after enrolling in university. The majority of these students were from Pharmacy and Medicine programs, females, aged between 18-25 years old, nonsmokers, alcohol addicts, and with a family history of mental illness. In addition, Medical students, individuals with high-income, who live alone and are in the last period of the program are more likely to use psychotropic drugs. Moreover, exposure to psychiatric medication was able to increase the number of binucleated cells. These results provide evidence that the use of psychoactive drugs is increased in the academic context and may be related to the failure of the cell cycle.

RESUMO O objetivo deste estudo foi avaliar a prevalência de uso médico e não médico de medicação psiquiátrica entre estudantes de graduação em Ciências da Saúde de uma universidade pública do Brasil. Outro objetivo foi determinar a frequência de anormalidades nucleares morfológicas na mucosa bucal desses estudantes. Realizou-se um estudo transversal baseado na Web com 375 estudantes de graduação em Ciências da Saúde das escolas de Farmácia, Educação Física, Nutrição e Medicina. Adicionalmente, danos genéticos espontâneos em células esfoliadas da mucosa bucal de 41 indivíduos foram analisados para estudo da frequência de micronúcleos e células binucleadas. Os resultados mostraram que 76 (20,8%) dos estudantes relataram que usaram drogas psicotrópicas após se matricularem na universidade. O uso desses medicamentos foi maior entre estudantes de cursos de Farmácia e Medicina, sexo feminino, idade entre 18 e 25 anos, não tabagistas, alcoolistas e histórico familiar de doença mental. Além disso, estudantes de Medicina, indivíduos com alta renda, que moram sozinhos e estão no último período do curso são mais propensos a usar drogas psicotrópicas. Ademais, a exposição à medicação psiquiátrica foi capaz de aumentar o número de células binucleadas. Esses resultados fornecem evidências de que o uso de drogas psicotrópicas aumenta no contexto acadêmico e pode estar relacionado à falha do ciclo celular.

The Patented Drugs Utilization: A Study At Nguyen Dinh Chieu Hospital In Ben Tre Province From 2011 To 2017

Objective: With their new and efficacious active ingredients, patented drugs have important roles in offering high-quality healthcare. However, huge cost-related barriers in accessing patented drugs along with the availability of low-cost bioequivalent generics have great impact on drugs policy in Vietnam. To understand situation of patented drugs utilization at hospitals for a certain period, this pilot study was conducted at Nguyen-Dinh-Chieu Hospital in Ben-Tre Province. Methods: The cross-sectional descriptive study was conducted on the retrospective data of all patented drugs used at Nguyen-Dinh-Chieu Hospital in Ben-Tre Province from 2011-2017. Characteristics of drugs utilization were described by frequency and percentage of drugs quantities and costs. Criteria for the description were as follows: active ingredient, route of administration, therapeutic class and manufacturing country. Data were extracted from the hospital information system and were processed by R software. Results: From 2011 to 2017, there were 212 patented drugs used which related to 145 active ingredients and 20 therapeutic classes. 88% were single active ingredient drugs and 49% were oral drugs. Antimicrobial and cardiovascular drugs represented the largest number of drugs and the highest cost. 79% of patented drugs were manufactured by companies in Europe and the majority came from France and Germany. Conclusion: This study provided initial information about the utilization of patented drugs during a long period of time at a Vietnamese hospital. The understanding gained will aid medical managers in assessment and adjustment of the drugs list, thus, optimizing the hospital budget and the equity in access to drugs within communities.

Armazenamento e descarte de medicamentos por acadêmicos da área da saúde de uma universidade pública paranaense / Storage and disposal of medicines by academics from health area from a public university of Paraná

Os medicamentos são ferramentas imprescindíveis para o estabelecimento da saúde e requerem cuidados quanto ao seu armazenamento e descarte. Este estudo teve como objetivo verificar a forma de armazenamento e descarte de medicamentos por estudantes da área da saúde de uma universidade pública paranaense. Realizou-se um estudo transversal com os estudantes dos cursos de Enfermagem,Farmácia e Medicina da Universidade Estadual de Londrina, por meio da aplicação de um questionário auto respondível. A coleta de dados foi executada nas salas de aula da própria universidade entre os meses de maio a junho de 2014, resultando em 564 estudantes entrevistados. Considerou-se descarte correto quando o estudante referisse destinar os medicamentos vencidos ou inapropriados ao uso em locais que fazem o recolhimento destes produtos. Os estudantes apresentaram idade média de 21,0 anos (desvio padrão: 3,3); sendo 74,1% do sexo feminino. O quarto foi o principal local citado para o armazenamento dos medicamentos (47,8%), sendo que a maioria os mantém fora do alcance das crianças (82,6%). Quanto à verificação do prazo de validade, 60,1% dos estudantes realizam esta prática. A maioria (64,5%) guarda as sobras de tratamentos para futura utilização, sendo o lixo doméstico (63,0%) o principal local citado para o descarte dos que estão vencidos. Apenas 20,7% descartavam os medicamentos corretamente. A população em estudo realiza um correto armazenamento dos medicamentos, no entanto, grande parte desconhece a existência de locais de recolhimento e promove o descarte inadequado dos mesmos, assim,faz-se necessário a criação de medidas para conscientização e orientação dos futuros profissionais.

Medicines are indispensable tools for the health establishment and care is required in their storage and disposal. This study aimed to verify the form of storage and disposal of medicines by students from the Health Sciences Department of a public university in Paraná. A cross-sectional study was conducted with students of Nursing, Pharmacy and Medicine courses from Universidade Estadual de Londrina, Paraná, Brazil, through the application of a self-report study. The data collection was performed in the University’s classrooms during the months of May to June of 2014, resulting in 564 students surveyed. It was considered proper disposal when the student referred to disposing the expired or inappropriate for use products inlocations that make the collection of these products. The students interviewed had a mean age of 21.0 years (Standart Deviation: 3.3); 74.1% of the total were female. The bedroom was the main location quoted forstorage of medicines (47.8%) most of them keep the medicines out of reach of children (82.6%). Regarding the verification of the expiration date 60.1% of the students do this practice. Most of (64.5%) keeps there mains of treatments for future use, and household waste (63.0%) was the main mentioned location for the disposal of those who are expired. Only 20.7% discarded the medicines correctly. The study population stores the products correctly, however, most are largely unaware of the disposal locations. There fore, it isnecessary to promote awareness and guidance for the future professionals.

Avaliação da utilização de medicamentos na prática clínica em um hospital público / Assessment of drugs prescribed to medical in-patients in a public hospital

Através desta pesquisa, objetivou-se estudar o consumo dos medicamentos em pacientes hospitalizados na clínica médica de um hospital público na cidade de Campina Grande (PB). O estudo caracterizou-se como descritivo e exploratório, de caráter transversal, com abordagens quali-quantitativas, e foi constituído por uma amostra de 107 pacientes que iniciaram internação na clínica médica no período de agosto de 2007 a julho de 2008. Os 107 pacientes apresentavam 270 diagnósticos ativos, sendo as doenças do aparelho circulatório as de maior ocorrência. Dos pacientes, 65,4% eram idosos e 3,33% dos medicamentos prescritos foram considerados impróprios para eles. Os pacientes que apresentaram possíveis 107 RAMs totalizaram 43%, com média de 2,32 por paciente; as que afetaram o sistema gastrintestinal dos pacientes foram as identificadas com maior frequência. Houve 42 interações distintas, envolvendo 26 tipos de fármacos. Dessa forma, os resultados podem ser úteis no estímulo ao desenvolvimento de mecanismos de avaliação de processos que visem reduzir esses riscos, aumentando a chance de resultados terapêuticos positivos e benefícios para os pacientes.

We studied the consumption of drugs by in-patients in the medical ward of a public hospital in the city of Campina Grande, PB, Brazil. This paper describes a descriptive / exploratory cross-sectional quali-quantitative study of a sample of 107 patients who were admitted to the general medical ward, from August 2007 to July 2008. The 107 patients were diagnosed with 270 active complaints, mainly diseases of the circulatory system. Most of the patients (65.4%) were elderly and 3.33% of drugs prescribed for them are considered unfit for use in the elderly. Many patients (43%) presented 107 possible Adverse Drug Reactions, with an average of 2.32 per patient, those affecting the gastrointestinal system of the patients being identified most frequently. There were 42 different drug interactions, involving 26 types of drug. We hope these results may be useful in stimulating the development of means to assess drug treatment in hospital, so as to reduce these risks and increase the chance of positive outcomes and therapeutic benefits for the patients.

Intervención educativa sobre prescripción de AINES en un hospital de baja complejidad / Educational program on prescription of nsaids in a low-complexity hospital

Se analizó el efecto de dos intervenciones educativas en intervalos de seis meses sobre el uso de aines (grupo M01 según ATC de 2008), medido en términos de costos totales y dosis diarias definidas (ddd)/consultas de urgencias y ambulatorias, entre enero de 2007 y junio de 2008 en el hospital San Antonio del municipio de Marmato (Caldas) en el centro de Colombia. El costo total del grupo M01 disminuyó el 69,3% a diciembre de 2007 y 65,1% en junio de 2008. En ddd/consultas de urgencias y ambulatorias, el descenso fue en el primer semestre del 40,7% y en el segundo semestre del 48,5%. Naproxeno 250 mg e ibuprofeno 400 mg tabletas y diclofenaco 75 mg ampolla disminuyeron en consumos el 74,1%, 38,9% y 78,7%, respectivamente; mientras que diclofenaco 50 mg tableta incrementó el 280,0%. La sustitución en el perfil de uso de diclofenaco oral en lugar de naproxeno oral, y la disminución del uso de diclofenaco inyectable, contribuyó a la disminución del costo total. Los resultados positivos se obtuvieron por la participación y actitud favorable de todos los médicos generales del hospital hacia las reuniones de educación basadas en evidencias.

Two educational interventions were analyzed at intervals of six months on the use of nsaids (group M01 as atc, 2008) measured in terms of total costs and Defined Daily Dose (ddd)/Ambulatory and emergency visits between January 2007 and June 2008 at the San Antonio hospital of Marmato (Caldas) in the center of Colombia. The total cost of the M01 group decreased 69.3% in December 2007 and 65.1% in June 2008. The decline of ddd/emergency and ambulatory consultations was of 40.7% in the first semester, and 48.5% in the second semester. Consumptions of naproxen 250 mg and ibuprofen 400 mg tablets, and diclofenac 75 mg ampoules decreased 74.1%, 38.9%, and 78.7% respectively, while diclofenac 50 mg tablet increased 280.0%. Oral diclofenac substitution instead of oral naproxen, and decreased use of diclofenac injectable, contributed to low total cost. Positive results were obtained by the participation and positive attitude of hospital general physicians to the educational evidence-based meetings.

Adesão ao tratamento medicamentoso de pacientes com doenças inflamatórias intestinais acompanhados no ambulatório de um hospital universitário / Compliance to drug therapy in inflammatory bowel diseases outpatients from an university hospital

RACIONAL: A adesão ao tratamento medicamentoso nas doenças inflamatórias intestinais apresenta grande importância clínica e social. Porém, são escassos os estudos sobre este tema em nosso meio. OBJETIVO: Investigou-se a adesão ao tratamento medicamentoso prescrito, bem como a influência de alguns fatores sobre a adesão, de pacientes com doenças inflamatórias intestinais em acompanhamento em ambulatório de Gastroenterologia de um hospital universitário ligado ao Sistema Único de Saúde (SUS). MÉTODO: Realizou-se estudo transversal, com métodos indiretos, para avaliar a adesão ao tratamento de 26 casos da doença de Crohn, 26 pacientes com retocolite ulcerativa e 4 com colite indeterminada, que faziam uso contínuo de medicamentos, dos quais 89,3 por cento eram fornecidos pelo SUS. Os pacientes foram classificados como tendo alto ou baixo grau de adesão, com base em dois diferentes instrumentos. RESULTADOS: A análise dos medicamentos utilizados revelou baixa adesão em 15,4 por cento de pacientes com doença de Crohn e 13,3 por cento com retocolite ulcerativa. Porém, o teste de Morisky, que avalia hábitos de uso dos medicamentos, mostrou 50 por cento de baixa adesão na doença de Crohn e 63,3 por cento na retocolite ulcerativa. Análise univariada evidenciou na doença de Crohn relação entre baixa adesão e maior duração da doença, estado marital instável, residência próxima ao hospital e envolvimento do cólon. Na retocolite ulcerativa observou-se relação entre baixa adesão e atividade da doença e maior número de medicamentos em uso. Porém, a análise multivariada não evidenciou relação estatisticamente significativa que indicasse influência de qualquer fator sobre a adesão ao tratamento. CONCLUSÕES: Proporções elevadas de pacientes com doenças inflamatórias intestinais apresentam hábitos de uso de medicamentos indicativos de baixa adesão, difíceis de prever a partir de dados demográficos e clínicos, o que aponta para a necessidade de maior atenção...

BACKGROUND: Compliance to drug therapy is important for a successful treatment. Although many studies have assessed compliance to treatment in patients with chronic diseases, few investigations have been carried out in inflammatory bowel diseases. AIM: To assess compliance to drug therapy in patients with inflammatory bowel diseases - Crohn's disease and ulcerative colitis -, followed at a university hospital, who had prescribed medication supplied by the Brazilian National Health System. METHODS: In a cross sectional study, a structured interview was applied to assess the compliance of 26 Crohn's disease patients, 26 ulcerative colitis patients and 4 cases with undetermined colitis. Patients were characterized as presenting higher or lower degree of compliance, based on the comparison of the information provided by the patient in the interview and data in the medical records. The Morisky test was also used to assess the behavioral pattern of the patient regarding the daily use of the medication. RESULTS: The interview showed that 15.4 percent of patients with Crohn's disease and 13.3 percent of those with ulcerative colitis could be regarded as less compliant. However, the Morisky test revealed lower compliance in 50 percent of patients with Crohn's disease and 63.3 percent of those with ulcerative colitis. Univariate analysis showed an association between low compliance and long disease duration, married status and colon involvement in Crohn's disease, and between low compliance and increased disease activity and greater number of medications in ulcerative colitis. However, multivariate analysis did not confirm any association between low compliance and any demographic or clinical factor. CONCLUSIONS: A high degree of noncompliance to treatment, linked to habitual behavior and hard to predict from demographic or clinical factor, was detected in inflammatory bowel disease patients, which suggests the need for investment in patient education...