Sensibilidade e especificidade de sistemas open access para detecção de interações medicamentosas potenciais / Sensitivity and specificity of open access systems to detect potential drug-drug interactions

Patient safety.Estudo transversal. Objetivo: avaliar a sensibilidade e especificidade de sistemas de rastreamento de acesso aberto para interações medicamentosas potenciais (IMp) em comparação com o DRUG-REAX® system e analisar o impacto clínico potencial das IMp de gravidades "Contraindicada" e "Maior" não detectadas. Métodos: amostra composta por 140 pacientes em acompanhamento em um ambulatório especializado no atendimento a pessoas com doenças crônicas não transmissíveis (DCNT) de um hospital universitário. As IMp foram identificadas e classificadas no DRUG-REAX® System e em oito sistemas de rastreamento de acesso aberto. As IMp de gravidade "Contraindicada" e "Maior" foram analisadas segundo o impacto clínico. Utilizou-se estatística descritiva e calculou-se sensibilidade e especificidade dos sistemas de rastreamento na identificação das IMp. Resultados: Os sistemas de acesso aberto pertencentes as bases Drugs.com, UCLA School of Health e CVC Caremark apresentaram sensibilidade e especificidade > 70%. A totalidade dos sistemas de acesso aberto não detectou os pares ciprofibrato + estatinas e metformina + sitagliptina, cujos impactos clínicos incluíram risco de miopatia e rabdomiólise e hipoglicemia, respectivamente. Cerca de um terço (37,5%) dos sistemas de acesso aberto não detectou a IMp ácido acetilsalicílico + hidroclorotiazida, capaz de ocasionar nefrotoxicidade. Conclusão: A maioria dos pares de IMp integra o rol terapêutico de pacientes com DCNT e cujos impactos clínicos são tempo-dependentes. A combinação de julgamento clínico, revisão periódica do plano terapêutico e os atributos de precisão (sensibilidade e especificidade) são fundamentais para garantir a segurança do paciente, sobretudo no contexto ambulatorial. (AU)

This study aims to evaluate the sensitivity and specificity of open-access screening systems in detecting potential drug-drug interactions (PDDIs) compared to the DRUG-REAX® system and analyze the potential clinical impact of PDDIs of "Contraindicated" and "Major" severities not detected. A cross-sectional study was conducted in an outpatient clinic specialized in caring for patients with noncommunicable diseases (NCDs) of a university hospital. PDDIs were identified and classified in the DRUG-REAX® System and eight open-access screening systems. The "Contraindicated" and "Major" severity PDDIs were analyzed according to clinical impact. Descriptive statistics were used and the sensitivity and specificity of the screening systems were calculated to identify the PDDIs. Results: The open-access systems Drugs.com, UCLA School of Health and CVC Caremark showed sensitivity and specificity > 70%. All open access systems did not detect the pairs ciprofibrate + statins and metformin + sitagliptin, whose clinical impacts included the risk of myopathy/ rhabdomyolysis and hypoglycemia, respectively. About a third (37.5%) of open-access systems did not detect PDDI acetylsalicylic acid + hydrochlorothiazide, which is capable of causing nephrotoxicity. Conclusion: Most pairs of PDDIs are part of the therapeutic role of patients with NCDs and whose clinical impacts are time-dependent. The combination of clinical judgment, periodic review of the therapeutic plan and the attributes of precision (sensitivity and specificity) are essential to ensure patient safety, especially in the outpatient setting. (AU)

Developmental toxicity of lithium treatment at prophylactic levels

Lithium (Li+) salts are frequently used in psychiatry and may be administered to women in theirreproductive years. We have investigated the influence of chronic Li+ administration on rat offspring. Pregnant Wistar rats drank either tap water ad libitum or 10 mM LiCl, or were water restricted (paired to rats receiving LiCl) until pup weaning. Following birth, pups were fostered to form five experimetnal groups (N = numbers of litters): a) Control-S, stressed by water restriction (N = 21), b) Li+ during the prenatal and lactating periods (N=18),c) Li+ during the prenatal period only (N=22), d) Li+ during the lactating period only (N = 15), and e) Control-NS no treatment (N = 13). Prenatal water restriction of Li+ treatment impaired the performance of the righting reflex, altered the number of males born and delayed the final date of eye opening. Postnatal water restriction or Li+ treatment of the dams reduced body growth and the date of eye opening of pups. No difference was found in the time to pup earflap opening, or in the motor coordination test. The specific effect of lithium on pups included impairment of the righting reflex, an increase in the number of males born, a reduction in body weight at weaning and a delay in the eye opening date. The serum Li+ levels of the dams were maintained at approximately 0.5 mEq/l. Ther was an increase in serum potassium, but not sodium, concentrations. We conclude that chronic treatment of dams with Li+ in amounts similar to those used in the prophylaxis of bipolar disorders aggravated the delay in physical and behavioral development of pups produced by stress associated with limited water intake and handling