Barriers and enablers to deprescribing benzodiazepines in older adults: elaborating an instrument and validating its content / Facilitadores e dificultadores do processo de desprescrição de benzodiazepínicos em idosos: elaboração de um instrumento e validação de seu conteúdo

OBJECTIVE: To elaborate and validate an instrument on barriers and enablers to deprescribing benzodiazepines in the patient's perspective. METHODS: This study was conducted in 3 stages: (1) a methodological stage, (2) a semi-structured pilot interview with 25 older adults undergoing clonazepam deprescribing, and (3) content validation with the Delphi technique. Content validation was performed by 50 specialists with degrees and/or experience with primary health care and/or health care of older adults, such as physicians, pharmacists, and nurses. For evaluating the obtained results, we analyzed the concordance of evaluations with the coefficient of content validity (CCV). We considered values equal to or higher than 0.8 as acceptable levels of concordance. RESULTS: The instrument was considered validated in the first round of evaluation, where all items obtained a CCV of more than 0.8 in the specialists' assessment. Nevertheless, they proposed improvements that were incorporated to the final version of the questionnaire. CONCLUSION: The instrument represents an important tool to be used by health care professionals for optimizing benzodiazepine deprescribing, with suitable levels of clarity and validity.

OBJETIVO: Elaborar e validar um instrumento sobre facilitadores e dificultadores do processo de desprescrição de benzodiazepínicos na perspectiva do paciente. METODOLOGIA: Estudo desenvolvido em três etapas, quais sejam: (1) metodológica, (2) entrevista piloto semiestruturada com 25 idosos em desprescrição de clonazepam e (3) validação de conteúdo por meio da técnica de Delphi. A validação deu-se por 50 especialistas com formação e/ou experiência na área da Atenção Primária à Saúde e/ou Saúde do Idoso, entre eles médicos, farmacêuticos e enfermeiros. Como medidas para avaliar os resultados obtidos, foi analisada a concordância da avaliação por meio do coeficiente de validade de conteúdo (CVC). Considerou-se como nível aceitável de concordância o valor maior ou igual a 0,8. RESULTADOS: O instrumento foi considerado validado na primeira rodada de avaliação, em que todos os itens avaliados obtiveram CVC superior a 0,8 na avaliação dos especialistas. Entretanto, estes propuseram sugestões de melhorias que foram incorporadas na versão final do questionário. CONCLUSÃO: O instrumento apresenta-se como uma importante ferramenta a ser utilizada pelos profissionais de saúde para a otimização do processo de desprescrição de benzodiazepínicos, possuindo índice de clareza e de validade adequados.

Deprescribing benzodiazepines: Do Brazilian package inserts address this issue? / Desprescrição de benzodiazepínicos: As bulas brasileiras abordam essa temática?

OBJECTIVE: To analyze the presence and quality of content on drug deprescribing in Brazilian package inserts for benzodiazepine drugs. METHODS: Documentary study where we analyzed data on deprescribing extracted from electronic package inserts of drugs containing benzodiazepines; these documents were available at the Brazilian Health Surveillance Agency website. Our search was performed independently by 2 researchers who used the following keywords: "deprescription," "withdrawal," and "tapering." The deprescribing plan, when presented by the package insert, was compared to deprescribing protocols for benzodiazepines found in the literature. Moreover, we assessed the presence of guidance on the maximum length of treatment and risks of long-term use. RESULTS: We found 12 package inserts for benzodiazepines and 100% of them suggested gradual withdrawal; only 1 (8.33%) suggested a systematized deprescribing plan. One document (8.33%) did not offer guidance on maximum treatment duration. Eleven (91.67%) had the information on long-term use possibly causing dependence or tolerance, and 1 (8.33%) did not describe the risks of continuous use. CONCLUSIONS: It is known that benzodiazepines should be withdrawn in a gradual and schematized manner, but package inserts do not currently bring this information in detail. It is of utmost importance that health professionals be educated on their conduct, hence the necessity for updating medication package inserts.

OBJETIVO: Analisar a presença e a qualidade do conteúdo sobre desprescrição em bulas brasileiras de benzodiazepínicos. METODOLOGIA:Estudo do tipo documental, em que foram analisados dados sobre a desprescrição extraídos de bulas eletrônicas de medicamentos que contêm benzodiazepínicos disponibilizadas na página eletrônica da Agência Nacional de Vigilância Sanitária. A busca foi realizada de forma independente por dois pesquisadores que utilizaram as palavras-chave "desprescrição", "retirada" e "redução". Para fins de comparação, quando a bula apresentou esquema de desprescrição, este foi comparado com protocolos de desprescrição de benzodiazepínicos encontrados na literatura. Além disso, foi analisada nas bulas a existência de orientações quanto ao tempo máximo de uso e os riscos do uso prolongado. RESULTADOS: Foram encontradas 12 bulas de benzodiazepínicos e 100% delas sugeriram a redução gradual do medicamento; apenas uma (8,33%) sugeria o esquema sistematizado de desprescrição. Uma (8,33%) não apresentou orientações quanto ao tempo máximo de uso. Onze (91,67%) continham a informação de que o uso prolongado pode causar dependência ou tolerância e uma (8,33%) não descrevia os riscos do uso contínuo. CONCLUSÕES: Sabe-se que os benzodiazepínicos devem ser retirados de forma gradual e esquematizada, porém, atualmente, as bulas não trazem essas informações de forma detalhada. É de suma importância que os profissionais de saúde sejam orientados quanto a sua conduta e, por isso, há grande necessidade de atualização das bulas.

Effects of Rehmannia and Storesin on Peripheral-type Benzodiazepine Receptors in Early Hepatic Encephalopathy Rats / 中国康复理论与实践

@#Objective To assess the effects of Rehmannia and Storesin (RS) on peripheral-type benzodiazepine receptors (PBRs) in early hepatic encephalopathy (HE) rats. Methods CCl4 was used to induce the HE model. The benzodiazepine binding sites of PBRs in rats cortex were studied using the specific ligands [3] PK11195. Lactulose was used in the positive medicine group, and the treatment groups received different dosages of RS. Results The specific binding and the Bmax value of [3] PK11195 both significantly increased in the model group than in the control group (P<0.01). The specific binding decreased in the medium dosage group and the high dosage group than in the model group (P<0.05), and the Bmax value of [3] PK11195RS-H decreased in the high dosage group than in the model group (P<0.01). Conclusion Rehmannia and Storesin is effective on early HE rats by decreasing the specific binding of PBRs, which could reduce the neural injury.

Change of Peripheral-type Benzodiazepine Receptors in Brain Mitochodria and Platelet Membrane in Aging Rat / 中国康复理论与实践

@#ObjectiveTo evaluate the quantitative and qualitative changes of peripheral-type benzodiazepine recepors (PBRs) in brain mitochodria and in platelet membrane in aging rats. MethodsMale Sprague-Dawley rats were divided into 3- and 24-month groups. All animals were sacrificed by decapitation and the brains were immediately removed. Mitochondrial components from dissected cerebral cortex were isolated. The membrane of platelets from venous blood was prepared by the method of hypotonic hemolysis. The specific binding assay of the radioactive PBRs antagonist ［3H］PK11195 to membrane was performed. Scatchard analysis was performed to estimate the equilibrium dissociation constant (Kd) and the maximal binding site density (Bmax). ResultsA significant increase in ［3H］PK11195 binding activity in the mitochodria from cerebral cortex in 24-month rats was observed compared to that in 3-month rats(P<0-001). Meanwhile, the Scatchard analysis revealed that there was an increase in Bmax, with a significant increase in Kd in 24-month rats. The same change of ［3H］PK11195 binding activity was noted for platelet membrane in 24-month rats(P<0-001).ConclusionThe density of PBRs increases in cortex mitochondria in aging rats, but the binding affinity of PBRs decreases which may be attributable to the progressive pathogenesis of aging in rats. ［3H］ PK11195 binding activity of platelet membrane might reflect the change of PBRs in the brain tissue.

Correlations between peripheral benzodiazepine receptors in mitochondria,synaptosomes in brain cells and platelet membrane and biological significance / 吉林大学学报(医学版)

Objective To investigate correlations between peripheral benzodiazepine receptors(PBRs) in mitochondria and synaptosomes in the brain and platelet membrane of rats during aging and to explore the significance of the relationships.Methods Sprague-Dawley rats of both sexes were divided into 3-,12-and(24-month) groups.All animals were sacrificed by decapitation and the brains were immediately removed.Mitochondrial components from dissected cerebral cortex and synaptosomal fractions from dissected hippocampus were isolated by gradient centrifugation.The membrane of platelets from venous blood was prepared by the method of hypotonic haemolysis.The specific binding assay of the radioactive PBRs antagonist PK11195 to membrane was performed.(Results A significant) difference about PK11195 binding activity of mitochondria was observed among three groups(F=194.6,P

Study on PBR expression in telencephalon of schistosomiasis mice with liver fibrosis / 中国血吸虫病防治杂志

Objective To explore the change of peripheral benzodiazepine receptors (PBR) expression in the telencephalon of mice with schistosomiasis. Methods The changes of PBR mRNA in the telencephalon of schistosomiasis mice were observed by the real-time FQ-PCR method. The results were judged with circle number of times (C_T) when the level of amplification exponent achieved detecting liminal value. Results Comparing the experiment group (n=10) with the healthy control (n=10) at the 8th、12th、20th week, the changes of C_T were significant(P